Parents’ first concerns about toddlers with autism spectrum disorder: Effect of sibling status

Abstract

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.

Diary Reports of Concerns in Mothers of Infant Siblings of Children with Autism Across the First Year of Life

“…Retrospective reports of the age at which parents first became concerned indicate there may be some benefit of prior experience with an older diagnosed child in detecting early symptoms in later-born children, but the evidence is mixed. Herlihy et al (2013) found that while parents of firstborn children with ASD reported first becoming concerned around 16 months of age, parents of an older child with ASD reported first becoming concerned about the second child with ASD around 10 months of age. Conversely, Chawarska et al (2007) found no significant differences in the proportion of infants with diagnosed older siblings whose parents who reported first becoming concerned sometime in the first year of life, between 12 and 18 months, or later than 18 months.…”

“…Despite these early symptoms, parents typically do not report concerns until the second year of life (Chawarska et al, 2007; De Giacomo & Fombonne, 1998; Herlihy et al, 2013; Hess & Landa, 2012; Veness et al, 2012). Retrospective reports of the age at which parents first became concerned indicate there may be some benefit of prior experience with an older diagnosed child in detecting early symptoms in later-born children, but the evidence is mixed.…”

“…In general, parents of children with ASD report elevated levels of concern beginning in the second year of life (De Giacomo & Fombonne, 1998; Veness et al, 2012). Several studies have investigated the possibility that parents of children with ASD may be particularly sensitive to the early emergence of behavioral symptoms in later-born children (Herlihy, Knoch, Vibert, & Fein, 2013; Hess & Landa, 2012; Ozonoff et al, 2009). These studies have demonstrated that while parents of children with ASD report concerns regarding subsequent children's development as early as 6 months of age, these concerns do not begin to predict long-term diagnostic outcomes until the end of the first year of life (Ozonoff et al, 2009).…”

Early detection of autism spectrum disorders: From retrospective home video studies to prospective ‘high risk’ sibling studies

“…In particular, it was found that parents' accuracy in reporting their child's difficulties increases when they already have an older son-daughter, not necessarily affected (Herlihy et al, 2015). This evidence underlines the utility of these tools when used free from recalling biases to complete information acquired during well-child visits or during lab visits (i.e.…”

Language disorder from infancy to adulthood: predictors and outcomes

“…Expressive language is often the first reported parental concern for children later diagnosed with ASD (De Giacomo & Fombonne, 1998;Herlihy, Knoch, Vibert, & Fein, 2015), and thus previous work has comprehensively explored the possible link between language and ASD (see Boucher, 2012 for a review). This previous work highlights that a range of language ability exists in the ASD population, in that there is a subset of children who present with intact structural language abilities (Grzadzinski, Huerta, & Lord, 2013); however, there is also a substantial number of individuals with ASD who also present with concomitant language difficulties (Buschmann et al, 2008;Luyster, Qiu, Lopez, & Lord, 2007;Rescorla, 2011;Rescorla & Safyer, 2013).…”