Symptoms of autism spectrum disorders may appear as early as 6 months, but parent concern, which can precipitate evaluation, often lags significantly. The presence of typical or atypical older siblings can change parents’ sensitivity to departures from typical development. This study investigated type and age of parent's first concerns in toddlers with autism spectrum disorder, prior to diagnosis. Participants had (1) at least one older sibling with ASD (Sibs-ASD); (2) only typically-developing older siblings (Sibs-TD), or (3) were only/oldest (No-Sibs). Specific autism spectrum disorder diagnoses and symptom severity were similar among groups. Developmentally, No-Sibs showed the largest delays, followed by Sibs-TD, followed by Sibs-ASD. Mean age of first concern was 16 months for No-Sibs, 14 months for Sibs-TD, and 10 months for Sibs-ASD. Age of first concern differed significantly by group, even after controlling for mother's age and education. Concern about language was prevalent in all groups. Thus, the presence of an older child with typical or, especially, atypical development was associated with earlier concerns for the affected child, despite milder developmental delays. These findings underscore the importance of encouraging parents to report concerns to pediatricians, routine standardized screening for autism spectrum disorder, and the need for pediatrician vigilance, especially for only or oldest children.

Restricted and Repetitive Behaviors (RRBs) are core features of Autism Spectrum Disorders (ASDs). Efforts to understand the purpose of RRBs have raised questions about the significance of the presence of RRBs in the long-term outcome of children with ASDs. Some studies have reported that the presence of RRBs during preschool years is a negative prognostic indicator for later childhood (e.g., Charman et al., 2005), while others have failed to replicate this finding (e.g., Bopp et al., 2009). This study examined the effect of RRBs on later functioning in 40 children with ASDs. RRBs were examined at ages 1-2 and 3-5 years using direct observation and parent report. These scores were used to predict cognitive functioning, adaptive abilities, and ASD symptomatology at age 8-10 years. The results suggest that RRBs observed early in the preschool period do not predict later functioning. However, when RRBs are observed at age 3-5 years, they appear to be useful prognostic indicators. Specifically, more severe preoccupations with parts of objects, sensory interests and stereotyped motor movements observed between 3-5 years of age predicted less developed cognitive and adaptive skills, as well as greater ASD symptom severity at age 8-10 years. The relationship between RRBs in the late preschool period and school age outcome is not as strong as the relationship between cognitive functioning in the late preschool period and school age outcome. However, overall, these findings indicate that exhibiting RRBs in the late preschool period does appear to be a negative prognostic indicator for school-age outcome.

Objective Characterization of academic functioning in children with autism spectrum disorder (ASD), particularly predictors of achievement, may have important implications for intervention. The current study aimed to characterize achievement profiles, confirm associations between academic ability and concurrent intellectual and social skills, and explore preschool predictors of school-age academic achievement in a sample of children with ASD. Method Children with ASD (N = 26) were evaluated at the approximate ages of two, four, and ten years. Multiple regression was used to predict school-age academic achievement in reading and mathematics from both concurrent (i.e., school-age) and preschool variables. Results Children with ASD demonstrated a weakness in reading comprehension relative to word reading. There was a smaller difference between mathematics skills; math reasoning was lower than numerical operations, but this did not quite reach trend level significance. Concurrent IQ and social skills were associated with school-age academic achievement across domains. Preschool verbal abilities significantly predicted school-age reading comprehension, above and beyond concurrent IQ, and early motor functioning predicted later math skills. Conclusions Specific developmental features of early ASD predict specific aspects of school-age achievement. Early intervention targeting language and motor skills may improve later achievement in this population.