Possible new ASD screening method found

In research, it can be difficult to conduct a longitudinal study, one that repeatedly gathers data from participants over a prolonged period of time. Their continuous participation can’t be guaranteed, and a great deal of funding is needed to manage collecting data at a large scale. Still, when Yun-Ju (Claire) Chen began work on her dissertation, she joined a six-year study of infants to analyze the distinction between the sensory patterns of children with autism spectrum disorder and children with other or no diagnosis. The group’s findings present a potential new form of ASD screening, allowing for early intervention and support of children with ASD.

Chen joined the study in its third year of data collection at the University of North Carolina at Chapel Hill, as a doctoral student under the guidance of USC Chan Division Associate Dean Grace Baranek and Director of Instrument Development and Psychometric/Statistical Analysis John Sideris. The study analyzed the correlation between the developmental trajectories of sensory patterns in infants and later ASD diagnosis. The study, co-written by Baranek and Sideris, was published March 2 as an empirical article in scientific journal “Child Development.”

When Baranek moved from UNC to USC to serve as associate dean and chair of the Chan Division, Chen made the decision to follow and continue her dissertation work in Los Angeles. 

Having worked with Sideris for close to a decade in North Carolina, Baranek hired him shortly after she assumed her new role at USC to fulfill the need for another methodologist on the team. Baranek also brought the Program for Early Autism Research, Leadership and Service — a group that continues as a collaboration between UNC and USC — and created the insp!re lab.

The study followed a cohort of 1,517 infants born in 2013 to further examine the sensory patterns of developing children identified by other researchers. The researchers first identified the infants’ risk of a later ASD diagnosis, then tracked their sensory patterns at three time-points: infancy, pre-school years and school years through parent reporting. 

In her dissertation, Chen described the three major sensory patterns analyzed in this study: hyperresponsiveness, “an exaggerated or avoidant response to sensory stimuli;” hyporesponsiveness, “a lack of or delayed response to sensory stimuli” and sensory interests, repetitions and seeking behaviors, “a fascination with or craving of sensory stimulation that is intense and may be repetitive in nature.” 

The study found that the sensory patterns of children with ASD were characterized by higher hyperresponsiveness and hyporesponsiveness at infancy that increased as the children grew older, which contrasts the sensory patterns of children not diagnosed with ASD, which began with lower sensory trait scores that decreased or remained stable over time.

This difference in developmental trajectory suggests that the measuring of sensory patterns in infants could be used to detect ASD early on and provide children the support necessary from a young age.

In addition to the clinical outcome, the study recorded three demographic variables to determine if variability of sensory trajectory could be further accounted for by a child’s sex, race or their parents’ education levels. 

The greatest variability of sensory pattern trajectory between groups was by their parents’ education level. Children of parents with higher education levels tended to have more stable or improving trajectories for hyporesponsiveness and hyperresponsiveness than children of parents with lower education levels. As parents with higher education levels may be more enabled to intervene early and utilize different resources, the finding could be an indication of the effect of caregivers on children’s development and highlight the importance of parent responsiveness.

Sideris said that what he found exciting about the study was its innovative use of latent growth analysis. While there was existing literature on this aspect of child development, Baranek said that it relied on cross-sectional analysis of different children of various ages, while this study followed a cohort of infants and recorded data from the same children at different ages.

“You can’t compare one child at one year to a different child at two years,” Baranek said. “It’s apples to oranges.”

Baranek explained that the variability between individuals with the same demographics and their clinical outcome highlighted the importance of tracking long-term trajectory, rather than comparing the averages of different age groups in a cross sectional study.

“There’s so much variation within the group of autism that it actually overlaps with the variation we see in normal development,” Baranek said. “You can’t just isolate one trajectory and say, ‘That’s the definitive marker of autism.’”

To expedite implementation of the study’s findings, Baranek said the group involved the “people who [they’re] trying to impact with the work” from the beginning, including parents and clinicians. While more research is needed about the effect of intervention treatment, Baranek said the study immediately supports clinicians because “sometimes they need studies to back up why what they’re doing is important and that what they’re doing is a real phenomenon.”

Chen postulates that given more time and research to validate its findings, researchers may use the study to revise current autism diagnostic standards.

“Social communication deficits are probably still kind of the mass standard for ASD diagnosis,” Chen said, but this study shows that sensory behavior “could be another behavioral domain that needs to be paid attention to during early childhood.”

“The general consensus is that early intervention is usually associated with better outcomes. The earlier you introduce the intervention to the child, they’ll have more opportunities to acquire the skills they need,” Chen said on the importance of early intervention for children at a high risk of ASD. “We could identify their needs early on and provide timely and/or targeted interventions to them.”

Since the parent questionnaire used to evaluate the risk of later ASD diagnosis in infants, the First Year Inventory, had not yet been translated and validated in Spanish, Hispanic and Latinx families were not included in the study. The Innovations in Neurodevelopmental Sensory Processing Research lab team has since worked on translating the FYI to be “culturally and linguistically appropriate” for Spanish-speaking families. The researchers at insp!re lab are now collecting norms from families to calibrate the scores and cut-offs of the screener so that it can be used in a follow-up study focusing on Spanish-speaking families in L.A.

“We’re able to contact families and have them fill out the FYI on their infant, and we’ll be able to now do that in Spanish and English,” Baranek said.