Early developmental milestone clusters of autistic children based on electronic health records

Abstract

ASD children vary in symptoms, co-morbidities and response to interventions. This study aimed to identify clusters of ASD children with a distinct pattern of attaining early developmental milestones. Clustering of 5,836 ASD children was based on attainment of 43 gross motor, fine motor, language and social developmental milestones in the first three years of life as recorded in baby wellness visits. K-means cluster analysis detected 4 Early Developmental Milestone (EDM) clusters: typical (n=1,686); mild (n=1,691); moderate (n=2,265); and severe (n=194). Most prominent cluster differences were in the language domain. The severe cluster showed earlier and greater developmental delay across domains, unique early gross motor delays, and more were born preterm via cesarian section. Moderate cluster had poor language development prominently in the second year of life, later fine motor delays. Mild cluster had language delays in the third year of life. The typical cluster mostly passed milestones. EDM clusters differed demographically, with higher socioeconomic status in typical cluster and lowest in severe cluster. Moderate cluster had more immigrant and non-Jewish mothers followed by the mild cluster. The rates of parental concerns and provider developmental referrals were significantly higher in the severe, followed by the moderate, mild, and typical EDM clusters. ASD children's language and motor delay in the first three years can be grouped by common magnitude and onset profiles as distinct groups that may link to specific etiologies (like prematurity or genetics) and to specific intervention programs. Early ASD screening should be tailored to these different developmental profiles.