Infant motor skill predicts later expressive language and autism spectrum disorder diagnosis

Motor difficulties may be an early Autism Spectrum Disorder (ASD) risk indicator and may predict subsequent expressive language skills. Further understanding of motor functioning in the first year of life in children with ASD is needed. We examined motor skills in 6-month-olds (n = 140) at high and low familial risk for ASD using the Peabody Developmental Motor Scales (Grasping, Visual-Motor Integration, and Stationary subscales). In Study 1, motor skill at 6 months predicted ASD status at 24–36 months; ASD was associated with poorer infant motor skills. In Study 2, motor skill at 6 months predicted expressive language at 30 and 36 months. Findings provide evidence that vulnerability in motor function early in development is present in ASD. Findings highlight the importance of developmental monitoring in high-risk infants and possible cascading effects of early disruption in motor development.     

Word comprehension mediates the link between gesture and word production: Examining language development in infant siblings of children with autism spectrum disorder

Children's gesture production precedes and predicts language development, but the pathways linking these domains are unclear. It is possible that gesture production assists in children's developing word comprehension, which in turn supports expressive vocabulary acquisition. The present study examines this mediation pathway in a population with variability in early communicative abilities—the younger siblings of children with autism spectrum disorder (ASD; high‐risk infants, HR). Participants included 92 HR infants and 28 infants at low risk (LR) for ASD. A primary caregiver completed the MacArthur‐Bates Communicative Development Inventory (Fenson, et al., 1993) at 12, 14, and 18 months, and HR infants received a diagnostic evaluation for ASD at 36 months. Word comprehension at 14 months mediated the relationship between 12‐month gesture and 18‐month word production in LR and HR infants (ab = 0.263; p < 0.01). For LR infants and HR infants with no diagnosis or language delay, gesture was strongly associated with word comprehension (as = 0.666; 0.646; 0.561; ps < 0.01). However, this relationship did not hold for infants later diagnosed with ASD (a = 0.073; p = 0.840). This finding adds to a growing literature suggesting that children with ASD learn language differently. Furthermore, this study provides an initial step toward testing the developmental pathways by which infants transition from early actions and gestures to expressive language.     

Altered lateralization of dorsal language tracts in 6‐week‐old infants at risk for autism

Altered structural connectivity has been identified as a possible biomarker of autism spectrum disorder (ASD) risk in the developing brain. Core features of ASD include impaired social communication and early language delay. Thus, examining white matter tracts associated with language may lend further insight into early signs of ASD risk and the mechanisms that underlie language impairments associated with the disorder. Evidence of altered structural connectivity has previously been detected in 6‐month‐old infants at high familial risk for developing ASD. However, as language processing begins in utero, differences in structural connectivity between language regions may be present in the early infant brain shortly after birth. Here we investigated key white matter pathways of the dorsal language network in 6‐week‐old infants at high (HR) and low (LR) risk for ASD to identify atypicalities in structural connectivity that may predict altered developmental trajectories prior to overt language delays and the onset of ASD symptomatology. Compared to HR infants, LR infants showed higher fractional anisotropy (FA) in the left superior longitudinal fasciculus (SLF); in contrast, in the right SLF, HR infants showed higher FA than LR infants. Additionally, HR infants showed more rightward lateralization of the SLF. Across both groups, measures of FA and lateralization of these pathways at 6 weeks of age were related to later language development at 18 months of age as well as ASD symptomatology at 36 months of age. These findings indicate that early differences in the structure of language pathways may provide an early predictor of future language development and ASD risk.     

Imitation from 12 to 24 months in autism and typical development: a longitudinal Rasch analysis

The development of imitation during the second year of life plays an important role in domains of sociocognitive development such as language and social learning. Deficits in imitation ability in persons with autism spectrum disorder (ASD) from toddlerhood into adulthood have also been repeatedly documented, raising the possibility that early disruptions in imitation contribute to the onset of ASD and the deficits in language and social interaction that define the disorder. This study prospectively examined the development of imitation between 12 and 24 months of age in 154 infants at familial risk for ASD and 78 typically developing infants who were all later assessed at 36 months for ASD or other developmental delays. The study established a developmental measure of imitation ability and examined group differences over time, using an analytic Rasch measurement model. Results revealed a unidimensional latent construct of imitation and verified a reliable sequence of imitation skills that was invariant over time for all outcome groups. Results also showed that all groups displayed similar significant linear increases in imitation ability between 12 and 24 months and that these increases were related to individual growth in both expressive language and ratings of social engagement but not in fine motor development. The group of children who developed ASD by age 3 years exhibited delayed imitation development compared with the low-risk typical outcome group across all time-points, but were indistinguishable from other high-risk infants who showed other cognitive delays not related to ASD.     

Developmental change in the neuropsychological functioning of very low birth weight infants

Research on very low birth weight (VLBW) infants has not carefully evaluated developmental patterns of neurological and neuropsychological functioning across time. This study reports on a broad range of developmental outcomes for VLBW infants of low (LR, n = 116) and high (HR, n = 84) medical risk compared to full term infants (FT, n = 120) across 6, 12, and 24 months of age. While low risk infants showed initial delays in most areas, faster rates of change in motor and neurological development resulted in catch-up by 2 years of age as compared to the FT infants. The lack of acceleration in development of mental skills demonstrates a persistent lag in this area. In contrast, HR infants showed initial delays in all areas as compared to both LR and FT infants with slower rates of change in mental and expressive language skills. Although faster rates of change were evident for HR infants in motor, neurological, and receptive language skills, scores in these areas remain lower than those for the LR and FT infants. The absence of accelerated rates of development for certain VLBW infants has implications for prognosis and patient access to early intervention services.     

Infants’ intentionally communicative vocalizations elicit responses from caregivers and are the best predictors of the transition to language: A longitudinal investigation of infants’ vocalizations,gestures and word production

What aspects of infants’ prelinguistic communication are most valuable for learning to speak, and why? We test whether early vocalizations and gestures drive the transition to word use because, in addition to indicating motoric readiness, they (a) are early instances of intentional communication and (b) elicit verbal responses from caregivers. In study 1, 11 month olds (N = 134) were observed to coordinate vocalizations and gestures with gaze to their caregiver's face at above chance rates, indicating that they are plausibly intentionally communicative. Study 2 tested whether those infant communicative acts that were gaze‐coordinated best predicted later expressive vocabulary. We report a novel procedure for predicting vocabulary via multi‐model inference over a comprehensive set of infant behaviours produced at 11 and 12 months (n = 58). This makes it possible to establish the relative predictive value of different behaviours that are hierarchically organized by level of granularity. Gaze‐coordinated vocalizations were the most valuable predictors of expressive vocabulary size up to 24 months. Study 3 established that caregivers were more likely to respond to gaze‐coordinated behaviours. Moreover, the dyadic combination of infant gaze‐coordinated vocalization and caregiver response was by far the best predictor of later vocabulary size. We conclude that practice with prelinguistic intentional communication facilitates the leap to symbol use. Learning is optimized when caregivers respond to intentional vocalizations with appropriate language.     

Associations between gross motor and communicative development in at-risk infants

Infants’ advances in locomotion relate to advances in communicative development. However, little is known about these relations in infants at risk for delays in these domains and whether they may extend to earlier achievements in gross motor development in infancy. We examined whether advances in sitting and prone locomotion are related to communicative development in infants who have an older sibling with autism spectrum disorder (ASD) and are at risk for motor and communication delays (heightened-risk; HR). We conducted a longitudinal study with 37 HR infants who did not receive an ASD diagnosis at 36 months. Infants were observed monthly between the ages of 5 and 14 months. We assessed gross motor development using the Alberta Infant Motor Scales (AIMS) and recorded ages of onset of verbal and nonverbal communicative behaviors. Results indicated increased presence of early gross motor delay from 5 to 10 months. In addition, there were positive relations between sitting and gesture and babble onset and between prone development and gesture onset. Thus, links between gross motor development and communication extend to at-risk development and provide a starting point for future research on potential cascading consequences of motor advances on communication development.     

Foundational Tuning: How Infants' Attention to Speech Predicts Language Development

Orienting biases for speech may provide a foundation for language development. Although human infants show a bias for listening to speech from birth, the relation of a speech bias to later language development has not been established. Here, we examine whether infants' attention to speech directly predicts expressive vocabulary. Infants listened to speech or non‐speech in a preferential listening procedure. Results show that infants' attention to speech at 12 months significantly predicted expressive vocabulary at 18 months, while indices of general development did not. No predictive relationships were found for infants' attention to non‐speech, or overall attention to sounds, suggesting that the relationship between speech and expressive vocabulary was not a function of infants' general attentiveness. Potentially ancient evolutionary perceptual capacities such as biases for conspecific vocalizations may provide a foundation for proficiency in formal systems such language, much like the approximate number sense may provide a foundation for formal mathematics.     

Infants' early ability to segment the conversational speech signal predicts later language development: a retrospective analysis

Two studies examined relationships between infants' early speech processing performance and later language and cognitive outcomes. Study 1 found that performance on speech segmentation tasks before 12 months of age related to expressive vocabulary at 24 months. However, performance on other tasks was not related to 2-year vocabulary. Study 2 assessed linguistic and cognitive skills at 4-6 years of age for children who had participated in segmentation studies as infants. Children who had been able to segment words from fluent speech scored higher on language measures, but not general IQ, as preschoolers. Results suggest that speech segmentation ability is an important prerequisite for successful language development, and they offer potential for developing measures to detect language impairment at an earlier age.     

The mediating role of joint attention in the relationship between motor skills and receptive and expressive language in siblings at risk for autism spectrum disorder

Language problems are highly prevalent in younger siblings of children with autism spectrum disorder (HR-sibs), yet little is known about early predictors. There is growing evidence that motor and language development are linked and this connection might be mediated by joint attention. Developmental changes in motor abilities change how children interact with objects and people (e.g., by showing), which may influence language development. This association has however not yet been studied in HR-sibs. The interrelationship between motor, joint attention and language skills was explored in younger siblings of typically developing children (LR-sibs, N = 31) and HR-sibs (N = 32). In both groups, motor skills (composite of fine and gross motor skills) at 10 months influenced receptive and expressive language at 36 months directly and indirectly through joint attention at 14 months. Group status moderated this direct and indirect effect with mainly significant effects in HR-sibs. This indicates that lower motor skills can have cascading effects on joint attention and language in HR-sibs. Consequently, assessment of early motor skills in HR-sibs might hold promise for early identification of motor difficulties but can also be indicative of language difficulties later in life, especially when difficulties with joint attention are also present.     

SES differences in language processing skill and vocabulary are evident at 18 months

This research revealed both similarities and striking differences in early language proficiency among infants from a broad range of advantaged and disadvantaged families. English‐learning infants (n = 48) were followed longitudinally from 18 to 24 months, using real‐time measures of spoken language processing. The first goal was to track developmental changes in processing efficiency in relation to vocabulary learning in this diverse sample. The second goal was to examine differences in these crucial aspects of early language development in relation to family socioeconomic status (SES). The most important findings were that significant disparities in vocabulary and language processing efficiency were already evident at 18 months between infants from higher‐ and lower‐SES families, and by 24 months there was a 6‐month gap between SES groups in processing skills critical to language development.     

Gaze behavior and affect at 6 months: predicting clinical outcomes and language development in typically developing infants and infants at risk for autism

This paper presents follow‐up longitudinal data to research that previously suggested the possibility of abnormal gaze behavior marked by decreased eye contact in a subgroup of 6‐month‐old infants at risk for autism ( Merin, Young, Ozonoff & Rogers, 2007 ). Using eye‐tracking data and behavioral data recorded during a live mother–infant interaction involving the still‐face procedure, the predictive utility of gaze behavior and affective behaviors at 6 months was examined using diagnostic outcome data obtained longitudinally over the following 18 months. Results revealed that none of the infants previously identified as showing lower rates of eye contact had any signs of autism at outcome. In contrast, three infants who were diagnosed with autism demonstrated consistent gaze to the eye region and typical affective responses at 6 months. Individual differences in face scanning and affective responsivity during the live interaction were not related to any continuous measures of symptom frequency or symptom severity. In contrast, results of growth curve models for language development revealed significant relationships between face scanning and expressive language. Greater amounts of fixation to the mother's mouth during live interaction predicted higher levels of expressive language at outcome and greater rates of growth. These findings suggest that although gaze behavior at 6 months may not provide early markers for autism as initially conceived, gaze to the mouth in particular may be useful in predicting individual differences in language development.     

Attachment security differs by later autism spectrum disorder: A prospective study

Although difficulties with social relationships are key to autism spectrum disorder (ASD), no previous study has examined infant attachment security prior to ASD diagnosis. We prospectively assessed attachment security at 15 months in high‐risk infants with later ASD (high‐risk/ASD, n = 16), high‐risk infants without later ASD (high‐risk/no‐ASD, n = 40), and low‐risk infants without later ASD (low‐risk/no‐ASD, n = 39) using the Strange Situation Procedure. High‐risk/ASD infants were disproportionately more likely to be classified as insecure (versus secure) and more likely to be classified as insecure‐resistant (versus secure or avoidant) than high‐risk/no‐ASD and low‐risk/no‐ASD infants. High‐risk infants with insecure‐resistant attachments were over nine times more likely to receive an ASD diagnosis than high‐risk infants with secure attachments. Insecure‐resistant attachment in high‐risk infants suggests a propensity toward negative affect with the parent in conditions of stress. Insecure‐resistant attachment may prove useful as a potential early index of propensity toward ASD diagnosis in high‐risk siblings, while insecure‐resistant attachment in the context of emergent autism may contribute to difficulties experienced by children with ASD and their families.     

SOCIOEMOTIONAL AND BEHAVIORAL PROBLEMS IN TODDLERS WITH LANGUAGE DELAY

Toddlers with language delay are at risk for persistent developmental and behavioral difficulties; however, the association between socioemotional/behavior problems and language in young children is not well understood. This study explored socioemotional/behavior problems in a unique sample of toddlers with language delays using a measure developed explicitly for this age group. Toddlers identified by 18 months with receptive and expressive language delay (LD; n = 30) or typical development (TD; n = 61) were evaluated at 18 and 24 months of age using the Infant‐Toddler Social and Emotional Assessment (ITSEA) and the Mullen Scales of Early Learning. Compared to toddlers who had TD, toddlers with LD had significantly more concerning scores at 18 and 24 months on all ITSEA domains. The rate of “clinical concern” on most domains was not high in either group, except that >60% of LD toddlers were in the clinical concern range on the Competence domain. Socioemotional/behavioral problems were dimensionally related to receptive and expressive language, with greater language delay associated with more concerning ITSEA scores. Socioemotional and behavioral problems are related to receptive and expressive language abilities in 18‐ and 24‐month‐olds, indicating the need for screening of both types of concerns in toddlers identified with potential language delays.     

Enhancing the language development of toddlers in foster care by promoting foster parents’ sensitivity: Results from a randomized controlled trial

Young children in foster care are at increased risk for problematic language development, making early intervention a critical tool in enhancing these children's foundational language abilities. This study examined the efficacy of an early preventative intervention, Attachment and Biobehavioral Catch‐up for Toddlers (ABC‐T), in improving the receptive vocabulary abilities of toddlers placed in foster care. All the children had been removed from their biological parents’ care and placed into foster care. When children were between 24 and 36 months old, foster parents were contacted by research staff and consented to participate. Parents were randomly assigned using a random number generator to receive either ABC‐T (n = 45), which aimed to promote sensitive parenting for children who have experienced early adversity, or a control intervention (n = 43). Foster children's receptive vocabulary skills were assessed post‐intervention using the Peabody Picture Vocabulary Test, Third Edition, when children were between 36 and 60 months old. Children whose foster parents received ABC‐T demonstrated more advanced receptive vocabulary abilities than children whose foster parents received the control intervention. The positive effect of ABC‐T on foster children's receptive vocabulary was mediated by increases in foster parents’ sensitivity during parent–child interactions. Trial registration: ClinicalTrials.gov NCT01261806.     

Stability of developmental status and risk of impairment at 24 and 36 months in late preterm infants

BackgroundFew studies investigated whether late preterm infants might have developmental delays in several domains in early life and how stable the lag in developmental status might be.AimWe aimed to examine the stability of potential delays across developmental domains at 24 and 36 months of age in late preterm (34°-36⁶ weeks) and term (≥37 weeks) children and whether the risk of delays remained high at 36 months.Study design, subjects, and outcome measureWe conducted a prospective cohort analysis of the children of pregnant women participating in the Vitamin Antenatal Asthma Reduction Trial (VDAART). 652 children who were prospectively followed up and had parent-completed Ages Stages Questionnaires (ASQ-3) questionnaires at both 24 and 36 months were analyzed to assess their domain-specific developmental status.Results6.61 % (42/635) of children had a late preterm birth. Developmental delays were stable between 24 and 36 months on all 5 domains for the children born preterm and on 4/5 domains for those born at term. The developmental domains with the status stability at 24 and 36 months in both late preterm and term children were the gross motor, communication, personal-social skills, and problem-solving. Late preterm children compared with term children remained at higher risk of delays at 36 months for gross motor, communication, and problem-solving skills (aOR = 4.54, 95 %CI: 1.81−10.79; aOR = 8.60, 95 %CI: 3.10−23.28 and aOR = 3.80, 95 %CI: 1.58−8.73, respectively).ConclusionLate preterm birth is associated with suboptimal development and stability in several domains at both 24 and 36 months and compared with term birth, requiring early monitoring and assessment of the developmental lag to avoid potential long-term implications.     

Cumulative risk disparities in children's neurocognitive functioning: a developmental cascade model

The current longitudinal study examined the role of cumulative social risk on children's theory of mind (ToM) and executive functioning (EF) across early development. Further, we also tested a cascade model of development in which children's social cognition at 18 months was hypothesized to predict ToM and EF at age 4.5 through intermediary language skills at age 3. We then examined whether this developmental mechanism varied as a function of social risk status. Participants were 501 children recruited when they were newborns, at which point eight psychosocial risk factors were assessed and combined into a metric of cumulative social disadvantage. Families were followed up at 18 months, at which point four social‐cognitive skills were assessed using developmentally sensitive tasks: joint attention, empathy, cooperation, and self‐recognition. Language was measured at age 3 using a standardized measure of receptive vocabulary. At age 3 and 4.5, EF and ToM were measured using previously validated tasks. Results showed that there were notable cumulative risk disparities in overall neurocognitive skill development, and these effects became more differentiated over time. Support was also found for a developmental mechanism wherein the effect of social cognition at 18 months on ToM and EF in the preschool period operated specifically through children's receptive language ability at age 3. This pathway functioned similarly for children with both low‐ and high‐risk backgrounds. These results extend previous findings by documenting the role of cumulative social disadvantage on children's neurocognition and the pathways that link key neurocognitive abilities across early development.     

What explains the correlation between growth in vocabulary and grammar? New evidence from latent change score analyses of simultaneous bilingual development

A close relationship between children's vocabulary size and the grammatical complexity of their speech is well attested but not well understood. The present study used latent change score modeling to examine the dynamic relationships between vocabulary and grammar growth within and across languages in longitudinal data from 90 simultaneous Spanish–English bilingual children who were assessed at 6‐month intervals between 30 and 48 months. Slopes of vocabulary and grammar growth were strongly correlated within each language and showed moderate or nonsignificant relationships across languages. There was no evidence that vocabulary level predicted subsequent grammar growth or that the level of grammatical development predicted subsequent vocabulary growth. We propose that a common influence of properties of input on vocabulary and grammatical development is the source of their correlated but uncoupled growth. An unanticipated across‐language finding was a negative relationship between level of English skill and subsequent Spanish growth. We propose that the cultural context of Spanish–English bilingualism in the US is the reason that strong English skills jeopardize Spanish language growth, while Spanish skills do not affect English growth. A video abstract of this article can be viewed at: https://youtu.be/qEHSQ0yRre0     

Parents’ early book reading to children: Relation to children's later language and literacy outcomes controlling for other parent language input

It is widely believed that reading to preschool children promotes their language and literacy skills. Yet, whether early parent–child book reading is an index of generally rich linguistic input or a unique predictor of later outcomes remains unclear. To address this question, we asked whether naturally occurring parent–child book reading interactions between 1 and 2.5 years‐of‐age predict elementary school language and literacy outcomes, controlling for the quantity of other talk parents provide their children, family socioeconomic status, and children's own early language skill. We find that the quantity of parent–child book reading interactions predicts children's later receptive vocabulary, reading comprehension, and internal motivation to read (but not decoding, external motivation to read, or math skill), controlling for these other factors. Importantly, we also find that parent language that occurs during book reading interactions is more sophisticated than parent language outside book reading interactions in terms of vocabulary diversity and syntactic complexity.     

Prediction of childhood problems at three years in children experiencing disorders of regulation during infancy

The objective of this study was to determine if symptoms of regulatory disorder (RD) during infancy were related to clinical status at three years. Two age‐matched RD groups based on severity (N = 10 in mild RD group; N = 22 in moderate–severe RD group) and an age‐matched control group (N = 38) were evaluated at 7 and 30 months. A fourth group with pervasive developmental disorders (N = 18) also were tested. Problems with self‐regulation, including sleep, feeding, state control, self‐calming, sensory reactivity, mood regulation, and emotional and behavioral control, were documented during infancy. Children were retested at 36 months in their development, behavior, and play. Two child psychiatrists unfamiliar with the subjects' diagnostic classification during infancy provided diagnoses at 36 months. At 36 months, 60% of children with mild regulatory disorders did not meet criteria for any disorders, while 95% of infants with moderate regulatory disorders had diagnoses that fell into two diagnostic clusters: (1) delays in motor, language, and cognitive development and (2) parent–child relational problems. Most toddlers in the pervasive developmental disorder group were diagnosed as having PDD or autism with mental retardation or borderline intelligence at 36 months. Early symptoms are discussed as they relate to later diagnostic outcomes for the clinical samples. © 2000 Michigan Association for Infant Mental Health.