Observation of Social Communication Red Flags in Young Children with Autism Spectrum Disorder, Developmental Delay, and Typical Development Using Two Observation Methods

A discrepancy exists between the age at which children are currently identified with autism spectrum disorder (ASD) in the community and the age at which they can be reliably identified in research. Observational measures are needed to improve screening and early detection of toddlers with ASD as recommended by the American Academy of Pediatrics. The purpose of this study was to examine social communication in three groups of toddlers with ASD, developmental delay (DD), or typical development (TD) using two concurrent methods of observation: a systematic semi-structured clinic observation and a naturalistic home observation of everyday activities. Participants between 16 and 26 months of age with ASD (n = 114), DD (n = 32), or TD (n = 34) were selected from the archival database of the FIRST WORDS® Project, a longitudinal, prospective sample of children identified from the general population. The standard scores of the Communication and Symbolic Behavior Scales (CSBS) Behavior Sample were used to measure social communication skills in the clinic observation. A subset of four social communication items of the Systematic Observation of Red Flags for ASD (SORF-SC) was also rated during the clinic and home observations. The four SORF-SC items selected for this study included lack of sharing enjoyment and interest, lack of coordination of nonverbal communication, lack of vocalizations with consonants, and lack of pointing or showing gestures. Results revealed significant differences among the ASD, DD, and TD groups with both measures (CSBS and SORF-SC) in the clinic observation and in both observations (clinic and home) with the SORF-SC. Medium to large concurrent and predictive correlations were observed among the SORF-SC items across the clinic and home observations and between the SORF-SC and the CSBS. The home observation SORF-SC accounted for 15−36% of the unique variance for predictions of developmental level and autism symptoms and the CSBS standard scores in the clinical observation added significant unique variance of 11−25%. The results of this study suggest that ratings of social communication deficits in prospective home observations of children late in the second year of life can meaningfully add screening information as an initial step towards identifying children with ASD. These findings have important clinical implications for improving early screening tools and reducing the age of identification of children with ASD.