Variability in Autism Symptom Trajectories Using Repeated Observations From 14 to 36 Months of Age
Open accessAbstract
Objective This study examined variability in autism symptom trajectories in toddlers referred for possible autism spectrum disorder (ASD) who had frequent observations from 14 to 36 months of age. Method In total, 912 observations of the Autism Diagnostic Observation Schedule (ADOS) were obtained from 149 children (103 with ASD) followed from 14 to 36 months of age. As a follow-up to a previous analysis of ADOS algorithm scores, a different analytic approach (Proc Traj) was implemented to identify several courses of symptom trajectories using ADOS Calibrated Severity Scores in a larger sample. Proc Traj is a statistical method that clusters individuals into separate groups based on different growth trajectories. Changes in symptom severity based on individual ADOS items also were examined. Results Trajectory analysis of overall symptom severity identified 4 clusters (non-spectrum ~25%; worsening ~27%; moderately-improving ~25%; severe-persistent ~23%). Trajectory clusters varied significantly in the proportions of confirmatory ASD diagnosis, level of baseline and final verbal and nonverbal abilities, and symptom severity. For the moderately-improving group, social communication improved, whereas restricted and repetitive behaviors were stable over time. Language and verbal and nonverbal communication improved for many children, but several social affect and restricted and repetitive behavior symptoms remained stable or worsened. Conclusion Significant variability in symptom trajectories was observed among toddlers referred for possible ASD. Changes in social and restricted and repetitive behavior domain scores did not always co-occur. Similarly, item-level trajectories did not always align with trajectories of overall severity scores. These findings highlight the importance of monitoring individual symptoms within broader symptom domains when conducting repeated assessments for young children with suspected ASD.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
ADOS-2 calibrated severity scores and SRS-2 T-scores have been useful tools for measuring the degree of social communication impairments and repetitive behavior patterns.
“The ADOS-2’s calibrated severity scores (CSS) and the SRS-2’s T-scores have been useful tools for measuring the degree of social communication impairments and repetitive behavior patterns (Kim et al. 2018; Wiggins et al. 2019).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Kim et al. 2018
The Measures section (page not provided) says ADOS calibrated severity scores quantify overall symptom severity and the Social Affect and Restricted and Repetitive Behaviors domains. That supports the ADOS portion of the claim, but our copy does not mention SRS-2 or its T-scores (searched: “SRS-2” and “Social Responsiveness Scale T score”). (LLM, conf=0.88)
Experimental — accuracy not yet measuredDimensional measures can provide information about phenotypic profiles in autism, both related to autism symptoms and non-autism related symptoms, that can contribute to improved treatment planning and better symptom tracking over time.
“Dimensional measures such as these can provide information about the phenotypic profiles in autism, both related to autism symptoms as well as non-autism related symptoms, that can contribute to improved treatment planning and better symptom tracking over time (Gotham et al. 2009; Kim et al. 2018).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Kim et al. 2018
The Discussion (page unavailable) says that tracking individual autism symptoms alongside developmental and communication skills can inform monitoring and assessment of treatment response. It also notes diagnostic and treatment implications. The paper does not establish the broader claim that dimensional profiles of non-autism-related symptoms improve treatment planning. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSeveral studies have evaluated the performance of parent-report instruments between 14 and 24 months of age, such as the Modified Checklist for Autism in Toddlers (M-CHAT) and the Early Screening of Autistic Traits (ESAT).
“The potential for early testing to prospectively identify children with ASD at a young age has considerable interest, and several studies have evaluated the performance of parent-report instruments between 14 and 24 months of age, such as the”
From Autism spectrum disorder (2020) · cites this paper as [143]
The Measures section describes clinician-administered ADOS assessments and parent-reported information used in diagnosis, but does not discuss studies evaluating the performance of parent-report screening instruments. Searches for M-CHAT, ESAT, and parent-report screening between 14 and 24 months found no passage addressing the attributed claim. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
ggplot2: Elegant Graphics for Data Analysis
Ginestet, C. E. (2011) · Journal of the Royal Statistical Society Series A (Statistics in Society) · doi:10.1111/j.1467-985x.2010.00676_9.x · Cited by 14,484 · see citing works
ggplot2: Elegant Graphics for Data Analysis
Wickham, H. (2009) · doi:10.1007/978-0-387-98141-3 · Cited by 14,447 · see citing works
Group-Based Modeling of Development
NAGIN, D. (2005) · doi:10.4159/9780674041318 · Cited by 4,164 · see citing works
A SAS Procedure Based on Mixture Models for Estimating Developmental Trajectories
Jones, B. L., Nagin, D. S., & Roeder, K. (2001) · Sociological Methods & Research · doi:10.1177/0049124101029003005 · Cited by 2,374 · see citing works
Mullen Scales of Early Learning
Bradley‐Johnson, S. (1997) · Psychology in the Schools · doi:10.1002/(sici)1520-6807(199710)34:4 · Cited by 2,329 · see citing works
Standardizing ADOS Scores for a Measure of Severity in Autism Spectrum Disorders
Gotham, K., Pickles, A., & Lord, C. (2009) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-008-0674-3 · Cited by 1,605 · see citing works
Self-citationBehavioral manifestations of autism in the first year of life
Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts, W., Brian, J., & Szatmari, P. (2005) · International Journal of Developmental Neuroscience · doi:10.1016/j.ijdevneu.2004.05.001 · Cited by 1,602 · see citing works
Advances in Group-Based Trajectory Modeling and an SAS Procedure for Estimating Them
Jones, B. L., & Nagin, D. S. (2007) · Sociological Methods & Research · doi:10.1177/0049124106292364 · Cited by 1,206 · see citing works
The Autism Diagnostic Observation Schedule: Revised Algorithms for Improved Diagnostic Validity
Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0280-1 · Cited by 1,161 · see citing works
Self-citationNagin, D. S., & Land, K. C. (1993) · Criminology · doi:10.1111/j.1745-9125.1993.tb01133.x · Cited by 1,136 · see citing works
Vineland Adaptive Behavior Scales
Burger-Caplan, R., Saulnier, C. A., & Sparrow, S. S. (2017) · Springer eBooks · doi:10.1007/978-3-319-56782-2_1602-4 · Cited by 598 · see citing works
Hus, V., Gotham, K., & Lord, C. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-012-1719-1 · Cited by 568 · see citing works
Self-citationCognitive profiles and social‐communicative functioning in children with autism spectrum disorder
Joseph, R. M., Tager‐Flusberg, H., & Lord, C. (2002) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00092 · Cited by 503 · see citing works
Self-citationA prospective case series of high-risk infants who developed autism
Bryson, S. E., Zwaigenbaum, L., Brian, J., Roberts, W., Szatmari, P., Rombough, V., & McDermott, C. (2007) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0328-2 · Cited by 455 · see citing works
Autism spectrum disorder in the second year: stability and change in syndrome expression
Chawarska, K., Klin, A., Paul, R., & Volkmar, F. (2007) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01685.x · Cited by 384 · see citing works
Ozonoff, S., Young, G. S., Landa, R. J., Brian, J., Bryson, S., Charman, T., Chawarska, K., Macari, S. L., Messinger, D., Stone, W. L., et al. (2015) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12421 · Cited by 377 · see citing works
Guthrie, W., Swineford, L. B., Nottke, C., & Wetherby, A. M. (2013) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12008 · Cited by 366 · see citing works
Self-citationSzatmari, P., Georgiades, S., Duku, E., Bennett, T. A., Bryson, S., Fombonne, E., Mirenda, P., Roberts, W., Smith, I. M., Vaillancourt, T., et al. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.2463 · Cited by 322 · see citing works
Developmental Trajectories in Children With and Without Autism Spectrum Disorders: The First 3 Years
Landa, R. J., Gross, A. L., Stuart, E. A., & Faherty, A. (2013) · Child Development · doi:10.1111/j.1467-8624.2012.01870.x · Cited by 316 · see citing works
The onset of autism: patterns of symptom emergence in the first years of life
Ozonoff, S., Heung, K., Byrd, R., Hansen, R., & Hertz‐Picciotto, I. (2008) · Autism Research · doi:10.1002/aur.53 · Cited by 293 · see citing works
de Bildt, A., Sytema, S., Ketelaars, C., Kraijer, D., Mulder, E., Volkmar, F., & Minderaa, R. (2004) · Journal of Autism and Developmental Disorders · doi:10.1023/b:jadd.0000022604.22374.5f · Cited by 278 · see citing works
Trajectories of Autism Severity in Children Using Standardized ADOS Scores
Gotham, K., Pickles, A., & Lord, C. (2012) · Pediatrics · doi:10.1542/peds.2011-3668 · Cited by 271 · see citing works
Self-citationThe Autism Diagnostic Observation Schedule, Toddler Module: Standardized Severity Scores
Esler, A., Bal, V. H., Guthrie, W., Wetherby, A. M., Weismer, S. E., & Lord, C. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2432-7 · Cited by 269 · see citing works
Self-citationA prospective study of toddlers with ASD: short‐term diagnostic and cognitive outcomes
Chawarska, K., Klin, A., Paul, R., Macari, S. L., & Volkmar, F. R. (2009) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2009.02101.x · Cited by 233 · see citing works
Grzadzinski, R., Carr, T., Colombi, C., McGuire, K., Dufek, S., Pickles, A. R., & Lord, C. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2782-9 · Cited by 230 · see citing works
Self-citationChawarska, K., Shic, F., Macari, S. L., Campbell, D. J., Brian, J. A., Landa, R. J., Hutman, T., Nelson, C. A., Ozonoff, S. J., Tager-Flusberg, H. B., et al. (2014) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.09.015 · Cited by 229 · see citing works
Mullen Scales of Early Learning
(2012) · Springer eBooks · doi:10.1007/springerreference_184265 · Cited by 212 · see citing works
Developmental trajectories as autism phenotypes
Lord, C., Bishop, S. L., & Anderson, D. K. (2015) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.31440 · Cited by 196 · see citing works
Self-citationBaird, G., Charman, T., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., Carcani-Rathwell, I., Serkana, D., & Simonoff, E. (2008) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-008-0571-9 · Cited by 182 · see citing works
Kim, S. H., Macari, S., Koller, J., & Chawarska, K. (2016) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12448 · Cited by 160 · see citing works
Self-citationOnset Patterns in Autism: Correspondence Between Home Video and Parent Report
Ozonoff, S., Iosif, A.-M., Young, G. S., Hepburn, S., Thompson, M., Colombi, C., Cook, I. C., Werner, E., Goldring, S., Baguio, F., et al. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.03.012 · Cited by 151 · see citing works
Self-citationPatterns of developmental trajectories in toddlers with autism spectrum disorder
Lord, C., Luyster, R., Guthrie, W., & Pickles, A. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0027214 · Cited by 142 · see citing works
Self-citationNiyonkuru, C., Wagner, A. K., Ozawa, H., Amin, K. B., Goyal, A., & Fabio, A. (2013) · Journal of Neurotrauma · doi:10.1089/neu.2012.2578 · Cited by 119 · see citing works
Macari, S. L., Campbell, D., Gengoux, G. W., Saulnier, C. A., Klin, A. J., & Chawarska, K. (2012) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-012-1521-0 · Cited by 116 · see citing works
Group-based modeling of development
(2005) · Choice Reviews Online · doi:10.5860/choice.43-1258 · Cited by 112 · see citing works
Editorial Perspective: Longitudinal research in autism – introducing the concept of ‘chronogeneity’
Georgiades, S., Bishop, S. L., & Frazier, T. (2017) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12690 · Cited by 100 · see citing works
Brian, J. A., Bryson, S. E., Smith, I. M., Roberts, W., Roncadin, C., Szatmári, P., & Zwaigenbaum, L. (2015) · Autism · doi:10.1177/1362361315614979 · Cited by 77 · see citing works
Visser, J. C., Rommelse, N. N. J., Lappenschaar, M. G. A., Servatius-Oosterling, I. J., Greven, C. U., & Buitelaar, J. K. (2017) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2017.05.022 · Cited by 64 · see citing works
Soke, G. N., Philofsky, A., DiGuiseppi, C. G., Lezotte, D. C., Rogers, S. J., & Hepburn, S. (2011) · Autism · doi:10.1177/1362361309358332 · Cited by 50 · see citing works
Bedford, R., Gliga, T., Shephard, E., Elsabbagh, M., Pickles, A. R., Charman, T., & Johnson, M. H. (2017) · Molecular Autism · doi:10.1186/s13229-017-0167-3 · Cited by 34 · see citing works
Why It’s Important to Continue Universal Autism Screening While Research Fully Examines Its Impact
Dawson, G. (2016) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2016.0163 · Cited by 28 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E. J. H., Jones, R. M., Pickles, A., State, M. W., et al. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0138-4 · Cited by 1,859 · see citing works
Self-citationThe Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond
Rosen, N. E., Lord, C., & Volkmar, F. R. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-04904-1 · Cited by 302 · see citing works
Self-citationThe longitudinal heterogeneity of autistic traits: A systematic review
Pender, R., Fearon, P., Heron, J., & Mandy, W. (2020) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2020.101671 · Cited by 55 · see citing works
- Authors
- Kim, S. H., Bal, V. H., Benrey, N., Choi, Y. B., Guthrie, W., Colombi, C., & Lord, C.
- Affiliations
- Weill Cornell Medicine (US)
- University of California, San Francisco (US)
- Children's Hospital of Philadelphia (US)
- University of Michigan (US)
- Corresponding author
- Kim, So Hyun
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 57
- Issue
- 11
- Pages
- 837-848.e2
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6636833
- OpenAlex
- W2892185794
- Semantic Scholar
- 50faa1ece17a1a6e6306af4ce6a6b75e714b408a
- Cited by
- 70
- References
- 42
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 2 · 2023: 8 · 2022: 8 · 2021: 18 · 2020: 13 · 2019: 4 · 2018: 1
- FWCI
- 5.35
- Type
- journal article
- Language
- en
- Update notices
- erratum (2019-05-01)
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH066496)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- autism spectrum disorder, symptom trajectories, toddlers, autism severity, restricted and repetitive behaviors, social communication, language development, nonverbal communication, social affect, ASD diagnosis
- MeSH terms
- Autistic Disorder, Child, Preschool, Female, Humans, Infant, Male, Severity of Illness Index
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
