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The results of this study may aid in the design of interventions that will support parents when managing their child's postoperative pain at home and thus improve children's experiences.

Research on the expression of positive affect in young children with Autism Spectrum Disorder (ASD) suggests that differences in this domain emerge late in the first year or early in the second year. However, many previous studies in this area employed retrospective research methods and global rating schemes. In the current study, the expression of positive affect was examined prospectively at ages 6, 12, and 18 months in three groups: infant siblings with ASD, infant siblings without ASD, and low-risk comparison infants. Infant siblings were the younger brothers or sisters of children diagnosed with ASD and, therefore, had a higher familial risk of ASD. The frequency and duration of smiles were coded from video excerpts from the Autism Observation Scale for Infants (Bryson, Zwaigenbaum, McDermott, Rombough, and Brian 2008), a standardized, play-based assessment of early signs of ASD. Results indicated that at 12 months, infant siblings with ASD had a lower rate of smiling than the other two groups. At 18 months, infant siblings with ASD continued to display a lower rate of smiling than infant siblings without ASD, but not comparison infants. Overall, these results indicate that infant siblings with ASD demonstrate less positive affect than infant siblings without ASD and low-risk comparison infants at 12 months. This suggests that reduced smiling may be an informative behavioural risk marker for ASD by children's first birthdays and may have implications for our understanding of atypical social development in children with ASD.

Background & aims In response to limited research on early language development in infants at high risk for Autism Spectrum Disorder (ASD), the current prospective study examined early expressive and receptive language trajectories in familial high-risk (HR) infants who were and were not later diagnosed with ASD (HR-ASD and HR-N, respectively), and low-risk (LR) controls with no family history of ASD. Methods Participants were 523 children (371 HR siblings, 56% boys; 152 LR controls, 52% boys) followed from age 6 or 12 months to 36 months. Based on independent, best-estimate clinical diagnoses at 36 months, HR participants were classified as HR-ASD (n = 94; 69% boys), or HR-N (n = 277; 52% boys); the sample also included 152 LR controls (52% boys). Expressive and receptive language trajectories were examined based on corresponding domain standard scores on the Mullen Scales of Early Learning (MSEL) at 6, 12, 24, and 36 months. In the combined sample of HR and LR infants, semi-parametric group-based modeling was used to identify distinct trajectories in MSEL standard scores. Results A 3-group solution provided optimal fit to variation in both expressive and receptive language, with the following patterns of scores: (1) inclining from average to above average, (2) stable-average, and (3) declining from average to well below average. For both expressive and receptive language, membership in these trajectories was related to 3-year diagnostic outcomes. Conclusions Although HR-ASD, HR-N, and LR control infants were in each trajectory group, membership in the declining trajectory (expressive and/or receptive) was associated with an ASD diagnosis. Implications Evidence of declining trajectories in either expressive or receptive language may be a risk marker for ASD in a high-risk sample.

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