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Cited by 322Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesGenetics and Neurodevelopmental Disorders

Developmental Trajectories of Symptom Severity and Adaptive Functioning in an Inception Cohort of Preschool Children With Autism Spectrum Disorder

Szatmari, Peter, Georgiades, Stelios, Duku, Eric, Bennett, Teresa A., Bryson, Susan, Fombonne, Eric, Mirenda, Pat, Roberts, Wendy +7 more·2015·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.2463
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Abstract

IMPORTANCE: Symptom severity and adaptive functioning are fundamental domains of the autism spectrum disorder (ASD) phenotype. To date, the longitudinal association between these 2 domains has not been examined. OBJECTIVE: To describe the developmental trajectories of autistic symptom severity and adaptive functioning in a large inception cohort of preschool children with ASD. DESIGN, SETTING, AND PARTICIPANTS: The sample consisted of 421 newly diagnosed preschool children with ASD 2 to 4 years old (355 boys; mean age at study enrollment, 39.87 months) participating in a large Canadian multisite longitudinal study (Pathways in ASD Study). Prospective data collected at 4 points from time of diagnosis to age 6 years were used to track the developmental trajectories of children. MAIN OUTCOMES AND MEASURES: Autistic symptom severity was indexed using the Autism Diagnostic Observation Schedule. Adaptive functioning was indexed using the Vineland Adaptive Behavior Scales, Second Edition. RESULTS: Two distinct trajectory groups provided the best fit to the autistic symptom severity data. Group 1 (11.4% of the sample) had less severe symptoms and an improving trajectory (P < .05), whereas group 2 (88.6% of the sample) had more severe symptoms and a stable trajectory. Three distinct trajectory groups provided the best fit to the adaptive functioning data. Group 1 (29.2% of the sample) showed lower functioning and a worsening trajectory, group 2 (49.9% of the sample) had moderate functioning and a stable trajectory, and group 3 (20.9% of the sample) had higher functioning and an improving trajectory (P < .05). Cross-trajectory overlap between the autistic symptom severity and adaptive functioning groups was low (φ = 0.13, P < .05). Sex was a significant predictor of autistic symptom severity group membership and age at diagnosis, and language and cognitive scores at baseline predicted membership in adaptive functioning trajectories. Trajectories of both symptom severity and adaptive functioning predicted several different outcomes at age 6 years. CONCLUSIONS AND RELEVANCE: Findings confirm the heterogeneous nature of developmental trajectories in ASD. Change in adaptive functioning suggests that improvement is possible in roughly 20% of the sample. Autistic symptom severity appears to be more stable, with roughly 11% of the sample showing a marked decrease in symptom severity. During the preschool years, there appears to be only a small amount of "yoking" of developmental trajectories in autistic symptom severity and adaptive functioning. It is imperative that a flexible suite of interventions that target both autistic symptom severity and adaptive functioning should be implemented and tailored to each child's strengths and difficulties.

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  • ASD shows wide phenotypic variability and follows heterogeneous developmental trajectories.

    “ASD manifests with broad phenotypic variability and evolves along heterogeneous developmental trajectories (1).”

    From Genetics and genomics of autism spectrum disorder: embracing complexity (2015) · cites this paper as [1]

  • The subgroup connectivity differences overlapped substantially with ASD-control differences, suggesting that normal variation in mechanisms also affected by ASD may cause variation in how ASD manifests.

    “These differences overlapped substantially with the differences observed between ASD and controls (Figure 5A), suggesting that normal variation in mechanisms that are also affected by ASD may cause variation in how ASD may manifest 1,91.”

    From Subtyping cognitive profiles in Autism Spectrum Disorder using a Functional Random Forest algorithm (2018) · cites this paper as [91]

  • Variation within the ASD subgroups may be nested within the normal variation found in brain networks across typical children.

    “it is possible that variation within the ASD subgroups identified here may actually be “nested” within the normal variation found in brain networks across typical children 1,71,91”

    From Subtyping cognitive profiles in Autism Spectrum Disorder using a Functional Random Forest algorithm (2018) · cites this paper as [91]

  • Because the authors are confident in the ASD diagnosis, they suspect that variation among the three subgroups reflects typical variation in cognitive mechanisms that may be independent of autism symptom severity but influence ASD presentation.

    “Because we are confident in the ASD diagnosis, we suspect that the variation between these three subgroups reflects typical variation in cognitive mechanisms, which may be independent of autism symptom severity but influence ASD presentation14,91.”

    From Subtyping cognitive profiles in Autism Spectrum Disorder using a Functional Random Forest algorithm (2018) · cites this paper as [91]

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Authors
Szatmari, P., Georgiades, S., Duku, E., Bennett, T. A., Bryson, S., Fombonne, E., Mirenda, P., Roberts, W., Smith, I. M., Vaillancourt, T., Volden, J., Waddell, C., Zwaigenbaum, L., Elsabbagh, M., & Thompson, A.
Affiliations
  • Centre for Addiction and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  • McMaster University (CA)
  • Dalhousie University (CA)
  • Oregon Health & Science University (US)
  • University of British Columbia (CA)
  • University of Toronto (CA)
  • University of Ottawa (CA)
  • University of Alberta (CA)
  • Simon Fraser University (CA)
  • McGill University (CA)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2015-03-01
Volume
72
Issue
3
Pages
276
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.2463
OpenAlex
W2120646369
Cited by
322
References
39
Citations by year
2026: 26 · 2025: 23 · 2024: 26 · 2023: 33 · 2022: 29 · 2021: 36 · 2020: 38 · 2019: 36 · 2018: 26 · 2017: 27 · 2016: 11 · 2015: 10
FWCI
14.82
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Autism Speaks
  • Sinneave Family Foundation
  • Alberta Innovates
  • Canadian Institutes of Health Research
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
Keywords
autism spectrum disorder, preschool children, symptom severity, adaptive behavior, developmental trajectories, trajectory heterogeneity, autism phenotype, sex differences, developmental outcomes
MeSH terms
Adaptation, Psychological, Canada, Child, Child Development, Child Development Disorders, Pervasive, Child, Preschool, Female, Humans, Longitudinal Studies, Male, Severity of Illness Index

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