Early Red Flags for Autism Spectrum Disorders in Toddlers in the Home Environment

Early detection of autism spectrum disorders (ASD) is crucial to optimizing child and family outcomes. Most research on the early diagnostic features of ASD has been done in the clinic environment; therefore there is a need for research on diagnostic features displayed in a natural environment. Observation of behaviors of young children in their home environment is a possible way to assist in earlier diagnosis in a less time consuming, less stressful, and more cost-effective manner for families. The primary purpose of this study was to explore and quantify red flags for ASD in the behaviors of young children between 17 and 36 months of age (N = 60) demonstrated in the home environment. Measures on the Systematic Observation of Red Flags for Autism Spectrum Disorders in Young Children at Home (SORF-Home; Wetherby & Woods, 2009) were coded from video recorded home observation samples of the child interacting with a parent or caregiver during everyday activities. Overall, the results of this study demonstrated that early red flags of ASD were evident in the home environment. Seven of the red flags identified by previous researchers to be evident in the clinic environment (lack of warm, joyful expression with directed gaze, lack of coordination of gaze, facial expression, gestures and sounds, lack of response to name, lack of communicative vocalizations with consonants, inappropriate eye gaze, lack of response to contextual cues, and lack of sharing interest or enjoyment) were also found to be demonstrated by a majority of children during the home observations. Examination of the relationship between the early red flags and developmental level revealed no significant correlations between the red flags and nonverbal cognitive developmental level and medium to large negative significant correlations between some red flags and verbal developmental level. Significant correlations were observed between many of the early red flags and ASD symptom severity on the Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 2002). No significant correlations were observed between measures of parent report of red flags and the early red flags measured in the home environment. The results of this exploratory study extend knowledge on the nature of red flags for ASD in young children to the home environment which adds valuable information for both practicing clinicians and families. The findings also provide promising information on the utility of the SORF-Home as an interactive screening measure for ASD and offer important implications for early identification of ASD.