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Cited by 377Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesFamily and Disability Support Research

Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study

Open access
Ozonoff, Sally, Young, Gregory S., Landa, Rebecca J., Brian, Jessica, Bryson, Susan, Charman, Tony, Chawarska, Katarzyna, Macari, Suzanne L. +4 more·2015·Journal of Child Psychology and Psychiatry
DOI 10.1111/jcpp.12421PMC PMC4532646
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Abstract

Background: The diagnosis of autism spectrum disorder ( ASD ) made before age 3 has been found to be remarkably stable in clinic‐ and community‐ascertained samples. The stability of an ASD diagnosis in prospectively ascertained samples of infants at risk for ASD due to familial factors has not yet been studied, however. The American Academy of Pediatrics recommends intensive surveillance and screening for this high‐risk group, which may afford earlier identification. Therefore, it is critical to understand the stability of an ASD diagnosis made before age 3 in young children at familial risk. Methods: Data were pooled across seven sites of the Baby Siblings Research Consortium. Evaluations of 418 later‐born siblings of children with ASD were conducted at 18, 24, and 36 months of age and a clinical diagnosis of ASD or Not ASD was made at each age. Results: The stability of an ASD diagnosis at 18 months was 93% and at 24 months was 82%. There were relatively few children diagnosed with ASD at 18 or 24 months whose diagnosis was not confirmed at 36 months. There were, however, many children with ASD outcomes at 36 months who had not yet been diagnosed at 18 months (63%) or 24 months (41%). Conclusions: The stability of an ASD diagnosis in this familial‐risk sample was high at both 18 and 24 months of age and comparable with previous data from clinic‐ and community‐ascertained samples. However, almost half of the children with ASD outcomes were not identified as being on the spectrum at 24 months and did not receive an ASD diagnosis until 36 months. Thus, longitudinal follow‐up is critical for children with early signs of social‐communication difficulties, even if they do not meet diagnostic criteria at initial assessment. A public health implication of these data is that screening for ASD may need to be repeated multiple times in the first years of life. These data also suggest that there is a period of early development in which ASD features unfold and emerge but have not yet reached levels supportive of a diagnosis.

Integrity signals

Registry

Crossref · 10.1111/jcpp.12421

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 45 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among children with ASD outcomes at 36 months, 63% had not been diagnosed at 18 months.

    “There were, however, many children with ASD outcomes at 36 months who had not yet been diagnosed at 18 months (63%) or 24 months (41%).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
  • Findingown data

    Few children diagnosed with ASD at 18 or 24 months had their diagnosis unconfirmed at 36 months.

    “There were relatively few children diagnosed with ASD at 18 or 24 months whose diagnosis was not confirmed at 36 months.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
  • Findingown data

    In children at familial risk for ASD, the stability of an ASD diagnosis made at 24 months was 82%.

    “The stability of an ASD diagnosis at 18 months was 93% and at 24 months was 82%.”
    • Also stated in: § Results · plain
      “There is also a small but statistically significant decrease (p = 0.02) in positive predictive value from 18 months (93%) to 24 months (82%).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
  • Findingown data

    In children at familial risk for ASD, the stability of an ASD diagnosis made at 18 months was 93%.

    “The stability of an ASD diagnosis at 18 months was 93% and at 24 months was 82%.”
    • Also stated in: § Results · plain
      “There is also a small but statistically significant decrease (p = 0.02) in positive predictive value from 18 months (93%) to 24 months (82%).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
  • Findingown data

    Among children with ASD outcomes at 36 months, 41% had not been diagnosed at 24 months.

    “There were, however, many children with ASD outcomes at 36 months who had not yet been diagnosed at 18 months (63%) or 24 months (41%).”
    • Also stated in: § Conclusions · plain
      “However, almost half of children with ASD outcomes were not identified as being on the spectrum at 24 months and did not receive an ASD diagnosis until 36 months.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
  • May combine two claims. 32
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Findingown data

    The false negative group had lower Mullen and higher ADOS scores than the true negative group at 18 and 24 months.

    “They had higher Mullen and lower ADOS scores than the TP group, but lower Mullen and higher ADOS scores than the TN group”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
    • Rests on an assumption: The Mullen Scales of Early Learning have excellent internal consistency and test-retest reliability.

  • May combine two claims.

    Findingown data

    The effect sizes of differences between false positive and false negative groups were in the small range, with largest d=0.3 at 18 months and 0.2 at 24 months.

    “and the effect sizes of the differences were in the small range (with the largest d across all scales = 0.3 at 18 months and 0.2 at 24 months).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.

  • May combine two claims.

    Findingown data

    The false negative group had higher Mullen and lower ADOS scores than the true positive group at 18 and 24 months.

    “They had higher Mullen and lower ADOS scores than the TP group, but lower Mullen and higher ADOS scores than the TN group”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
    • Rests on an assumption: The Mullen Scales of Early Learning have excellent internal consistency and test-retest reliability.

  • May combine two claims.

    Findingown data

    By 36 months, the false negative and true positive groups had similar ADOS scores, but the false negative group's Mullen scores remained higher than the true positive group's.

    “By 36 months, the FN and TP groups had similar ADOS scores, but the FN group's Mullen remained higher than that of the TP group.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
    • Rests on an assumption: The Mullen Scales of Early Learning have excellent internal consistency and test-retest reliability.

  • May combine two claims.

    Findingown data

    At 36 months, there were no differences between false positive and false negative groups on the Mullen scales, but the false negative group had a significantly higher ADOS score than the false positive group.

    “At 36 months, there continued to be no differences on the Mullen scales, but the FN group now had a significantly higher ADOS score than the FP group.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
    • Rests on an assumption: The Mullen Scales of Early Learning have excellent internal consistency and test-retest reliability.

  • May combine two claims.

    Findingown data

    At 36 months, the false positive group's Mullen scores remained lower and mean ADOS score was still higher than the true negative group, indicating continued atypical development.

    “At 36 months, the Mullen scores of the FP group remained lower and their mean ADOS score was still higher than the TN group, so they demonstrated continued atypical development.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.
    • Rests on an assumption: The Mullen Scales of Early Learning have excellent internal consistency and test-retest reliability.

  • May combine two claims.

    Findingreasoning

    The pattern of ADOS scores over time clearly falls in the FP group and rises in the FN group.

    “The pattern of ADOS scores over time clearly falls in the FP group and rises in the FN group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premiseown data

    Across those 8 clinically ascertained studies, negative predictive value ranged from 67% to 100%, with half over 89%.

    “and the negative predictive value ranged from 67% to 100% (half the studies over 89%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Using clinic-ascertained samples likely increases the base rate of ASD, which biases rates of false positives and negatives and increases stability estimates.

    “Using samples ascertained from clinics, where there has already been a degree of concern raised that was sufficient to bring the child to clinical attention, is likely to increase the base rate of ASD, in turn biasing rates of false positives and negatives, and increasing stability estimates.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premiseown data

    Across 8 clinically ascertained studies including children with and without ASD at Time 1, positive predictive value ranged from 72% to 100%, with half over 93%.

    “Across 8 studies with clinically ascertained samples, the positive predictive value ranged from 72% to 100% (with half of the studies over 93%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    In community-based studies using pre-screening, base rates of ASD and stability estimates may have been overestimated by the screening process and sampling frame.

    “Thus, even in these community-based studies, the base rates of ASD, and thus the stability estimates, may have been overestimated by the screening process and sampling frame.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Familial-risk participants are generally enrolled in longitudinal studies in early infancy, before initial behavioral signs are usually evident and before parents begin to report concerns.

    “participants at familial risk for ASD by virtue of having an older affected sibling are generally enrolled in longitudinal studies in early infancy, before the initial behavioral signs are usually evident (Ozonoff et al., 2010) and prior to when parents begin to report concerns (Hess & Landa, 2012; Ozonoff et al., 2009).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Ozonoff et al., 2010

      Not checked in the free run.

    • cites Hess & Landa, 2012

      Not checked in the free run.

    • cites Ozonoff et al., 2009

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In four community-ascertained studies, positive predictive value ranged from 83% to 100%, comparable to clinically ascertained samples.

    “Four such studies are summarized last in Table S1. The positive predictive value ranged from 83% to 100%, comparable to the estimates for clinically ascertained samples.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Community-ascertained samples have the potential to provide less biased psychometric indices of classification accuracy.

    “Community-ascertained samples have the potential to provide less biased psychometric indices of classification accuracy.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Data from 7 BSRC sites whose procedures and common measures permitted data pooling were used.

    “The present analyses were carried out using data contributed from 7 sites (University of Alberta, Dalhousie University, Kennedy Krieger Institute, McMaster University, University of California – Davis, University of Toronto, Yale University) whose procedures and common measures permitted data pooling.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the prior data-mining study, a decision-tree algorithm correctly identified over half of ASD cases at 18 months but missed those with less pronounced developmental delays and fewer ASD symptoms.

    “In that study, a decision-tree learning algorithm identified correctly over half of the ASD cases at 18 months, but missed those who had less pronounced developmental delays and fewer symptoms of ASD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chawarska et al., 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The ADOS is a standardized protocol that measures ASD symptoms and provides an empirically derived cutoff with high inter-rater reliability and construct validity.

    “The ADOS is a standardized protocol that measures symptoms of ASD and provides an empirically derived cutoff for ASD that has high inter-rater reliability and construct validity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lord et al., 2002

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The familial-risk design had strengths including three longitudinal visits at ages corresponding to AAP-recommended screening ages.

    “Improving upon previous studies, three longitudinal visits were conducted, the ages of which corresponded with screening ages recommended by the American Academy of Pediatrics (AAP; Johnson et al., 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Johnson et al., 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Residual analyses and graphical diagnostics were used to determine that model assumptions were adequately met.

    “Residual analyses and graphical diagnostics were used to determine that model assumptions were adequately met.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    The familial-risk cohort was not biased by clinical ascertainment or by pre-screening selection methods often applied to community-based samples.

    “In addition, the familial-risk cohort was not biased by clinical ascertainment or by the pre-screening selection methods often applied to community-based samples.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The low sensitivity of an ASD diagnosis at 18 months and the decrease in stability from 18 to 24 months suggest age-dependent differences in clinical calibration in this familial-risk sample.

    “The low sensitivity of an ASD diagnosis at 18 months and the decrease in stability from 18 to 24 months suggest that there may have been age-dependent differences in clinical calibration operating in this familial-risk sample.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mixed-effects linear models allow for unequally spaced and missing observations.

    “These models are flexible and allow for unequally spaced and missing observations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Laird & Ware, 1982

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The 18- and 24-month stability rates in this familial-risk sample fall within the range of and are consistent with stability rates for children under age 3 in clinic- and community-ascertained samples reviewed in Table S1.

    “The 18- and 24-month stability rates in this familial-risk sample fall within the range of, and are consistent with, the stability rates for children under age 3 in clinic- and community-ascertained samples reviewed in Table S1.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.

  • May combine two claims.

    Interpretationown data

    Clinicians' ratings were conservative and biased toward committing as few positive identification errors as possible.

    “suggesting that clinicians’ ratings were conservative and biased towards committing as few positive identification errors as possible.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    At each site, 36-month outcome assessments were performed by examiners unaware of risk group and previous diagnostic decisions.

    “36-month outcome assessments performed by examiners unaware of risk group and previous diagnostic decisions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Familial-risk samples have not been pre-screened based on symptoms before the initial evaluation, potentially reducing sampling biases that may influence stability.

    “They have not been ‘pre-screened’ based on symptoms before the initial evaluation, potentially reducing such sampling biases that may influence stability.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    When clinicians were confident in identifying the phenotype at early ages and made a diagnosis, they were generally correct and it was verified at subsequent visits.

    “But when clinicians were confident in identifying the phenotype, even at early ages (e.g., 18 months) and did make a diagnosis, they were generally correct and it was verified at subsequent visits.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.

  • May combine two claims.

    Interpretationown data

    The FN group may have been composed of higher-functioning children with ASD who had later symptom onset or subtle symptoms masked by age-appropriate language and cognitive abilities.

    “One interpretation of these data is that the FN group was composed of higher-functioning children with ASD who had a later onset of symptoms or whose symptoms were subtle at first and masked by age-appropriate language and cognitive abilities.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent study identified poor eye contact, lack of communicative gestures, and repetitive behaviors at 18 months as especially predictive of an ASD diagnosis.

    “a recent study identified several features at 18 months that were especially predictive of an ASD diagnosis, such as poor eye contact, lack of communicative gestures, and repetitive behaviors (Chawarska et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Chawarska et al., 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Study design and conductnone given

    All sites maintained high standards for initial training and ongoing reliability of ADOS administration.

    “Since all sites maintained high standards for initial training and ongoing reliability of ADOS administration”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Orinstein et al. (2014) reported no differences between outcome groups in number of hours of therapy.

    “Orinstein et al. (2014) reported that children who lost their diagnosis were more likely to have received applied behavior analysis services than children who retained a diagnosis, but there were no differences between the outcome groups in number of hours of therapy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Orinstein et al. (2014)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Orinstein et al. (2014) reported that children who lost their diagnosis were more likely to have received applied behavior analysis services than children who retained a diagnosis.

    “Orinstein et al. (2014) reported that children who lost their diagnosis were more likely to have received applied behavior analysis services than children who retained a diagnosis, but there were no differences between the outcome groups in number of hours of therapy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Orinstein et al. (2014)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Intervention history data were available from only a few sites in the current study, and the small sample size precluded formal analysis.

    “Intervention history data were available from only a few sites in the current study and the small sample size precluded formal analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    This or other unknown biases of the infant sibling methodology may have contributed to a slight elevation in recurrence rate in this sample relative to previously reported rates.

    “This, or other unknown biases of the infant sibling methodology, may have contributed to a slight (and not surprising, given the restrictive inclusion criteria) elevation in recurrence rate in this sample, relative to previously reported rates (Gronberg et al., 2013; Ozonoff et al., 2011; Sandin et al., 2014).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Gronberg et al., 2013

      Not checked in the free run.

    • cites Ozonoff et al., 2011

      Not checked in the free run.

    • cites Sandin et al., 2014

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Inclusion in the FP and FN groups may be due to later emerging phenotypes or symptom patterns that change with age.

    “In this study, however, inclusion in these groups may also be due to later emerging phenotypes or symptom patterns that change with age.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The stability of an ASD diagnosis in the present investigation and in numerous previous studies is impressive and substantially higher than the stability rate reported for developmental delay classifications.

    “Yet the stability of an ASD diagnosis, both in the present investigation and in numerous previous studies (Rondeau et al., 2011; Woolfenden et al., 2012), is impressive and is substantially higher than the stability rate reported for developmental delay classifications.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Rondeau et al., 2011

      Not checked in the free run.

    • cites Woolfenden et al., 2012

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Moura et al. (2010) studied a population-based cohort of 3,907 infants tested at 12 and 24 months with the Batelle Developmental Screening Inventory.

    “Moura et al. (2010) studied a population-based cohort of 3,907 infants, tested at 12 months and again at 24 months with the Batelle Developmental Screening Inventory.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Moura et al. (2010)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Infant sibling study designs have inherent biases that differ from clinic- and community-based investigations.

    “Infant sibling study designs have inherent biases that differ from clinic- and community-based investigations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Infancy is characterized by rapid developmental changes and significant moment-to-moment behavioral variability, which make early diagnosis challenging.

    “Infancy is characterized by rapid changes in development as well as significant behavioral variability from moment to moment, features which themselves make early diagnosis challenging.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    False negatives lead to misclassification at 24 months, potentially affecting the statistical significance of group differences.

    “Not only will the numbers of false negatives lead to misclassification at 24 months, potentially affecting the statistical significance of group differences”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Biased enrollment of infants with higher levels of parental concern cannot be ruled out in this study.

    “Biased enrollment of infants with higher levels of parental concern cannot be ruled out.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The unstable FP and FN groups were defined very conservatively, with misclassifications at either 18 or 24 months leading to inclusion.

    “Finally, it is worth reiterating that the ‘unstable’ FP and FN groups were defined very conservatively in this study, with misclassifications at either 18 or 24 months leading to inclusion in these groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Fisch (2012) cites low test-retest correlations across multiple developmental areas in infancy and points out psychometric and norming limitations of many measures of infant development.

    “Fisch (2012) cites low test-retest correlations across multiple developmental areas in infancy and points out the psychometric and norming limitations of many measures of infant development.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fisch (2012)

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    The high stability and low rate of false positive diagnoses documented in the current study support the AAP guidelines for extra surveillance for this high-risk group.

    “The high stability and low rate of false positive diagnoses documented in the current study support the AAP guidelines for extra surveillance for this high-risk group”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The results of the present investigation may or may not generalize to the general population of young children with ASD.

    “and so the results of the present investigation may or may not generalize to the general population of young children with ASD.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: No published studies have compared the clinical phenotypes of familial and non-familial ASD cohorts.

  • Classified as probably not a substantial claim.

    Interpretationown data

    Early screening, assessment, and referral to intervention will not be wasted effort for this high-risk group.

    “and provide reassurance that early screening, assessment, and referral to intervention will not be wasted effort.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The AAP recommends performing more intensive surveillance on infants with a positive family history of ASD.

    “since the AAP recommends performing more intensive surveillance on infants with a positive family history of ASD (Johnson et al., 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Johnson et al., 2007

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The modest negative predictive value and high rate of false negatives at 18 and 24 months suggest that not all children demonstrate clear enough clinical phenotypes to be identified prior to 36 months, particularly those with higher cognitive levels.

    “However, the modest negative predictive value and high rate of false negatives found in the current study at 18 and 24 months also suggest that, even in the context of the intensified surveillance that occurs in infant sibling studies, not all children are demonstrating clear enough clinical phenotypes to be identified prior to 36 months, particularly those with higher cognitive levels.”
    Quote in the paperSubstantial claim
48 of 48

  • The authors state this as an assumption.

    The clinical diagnosis made at 36 months is a valid gold standard for ASD outcome.

    “Diagnosis at 36 months was used as the gold standard.”

  • The paper relies on this without support.

    The Mullen Scales of Early Learning have excellent internal consistency and test-retest reliability.

    “The Mullen scales have excellent internal consistency and test-retest reliability.”

  • The paper relies on this without support.

    No published studies have compared the clinical phenotypes of familial and non-familial ASD cohorts.

    “Currently, there are no published studies comparing the clinical phenotypes of familial and non-familial cohorts”
3 of 3

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?

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Lord C., 2002, Autism diagnostic observation schedule manual
  2. Mullen E.M., 1995, Mullen scales of early learning
  3. SAS Institute, Inc., SAS/STAT Version 9.4

Cited by

Sorted by citations

Authors
Ozonoff, S., Young, G. S., Landa, R. J., Brian, J., Bryson, S., Charman, T., Chawarska, K., Macari, S. L., Messinger, D., Stone, W. L., Zwaigenbaum, L., & Iosif, A.
Affiliations
  • University of California, Davis (US)
  • Kennedy Krieger Institute (US)
  • University of Toronto (CA)
  • Dalhousie University (CA)
  • King's College London (GB)
  • Yale University (US)
  • University of Miami (US)
  • University of Washington (US)
  • University of Alberta (CA)
Corresponding author
Ozonoff, Sally
ORCID
Venue
Journal of Child Psychology and Psychiatry
Publisher
Wiley
Published
2015-04-29
Volume
56
Issue
9
Pages
988-998
ISSN
  • 0021-9630 (ISSN-L)
  • 1469-7610
DOI
10.1111/jcpp.12421
PMC
PMC4532646
OpenAlex
W2139013981
Cited by
377
References
31
Citations by year
2026: 17 · 2025: 39 · 2024: 24 · 2023: 29 · 2022: 30 · 2021: 62 · 2020: 38 · 2019: 35 · 2018: 32 · 2017: 31 · 2016: 29 · 2015: 9 · 2014: 1
FWCI
20.02
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Child Psychology and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
Funders
  • National Institutes of Health Grants (RO1 MH068398, P01 HD003008, R01MH087554, R01MH059630)
  • Canadian Institutes of Health Research (62924, 102665)
  • NeuroDevNet
  • Autism Speaks Canada
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 › Clinical Psychology › Family and Disability Support Research
Keywords
autism spectrum disorder, diagnostic stability, familial risk, early diagnosis, autism screening, toddlers, longitudinal follow-up, social communication deficits
MeSH terms
Autism Spectrum Disorder, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Male, Risk, Genetic Predisposition to Disease, Siblings, Early Diagnosis

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

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 ›

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