Developmental Deceleration Linked to Elevated Risk for Autism Spectrum Disorder

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Existing developmental screening tools could be used to detect autism spectrum disorder more reliably and at younger ages.

Clear developmental deceleration within the first 2 years of life is detectable through routine developmental screenings, and when this pattern is present, it is associated with elevated risk for autism spectrum disorder (ASD), according to research results presented at the International Society of Autism Research 2019 Annual Meeting, held May 1 to 4, in Montreal, Canada.

Researchers from the Children’s Hospital of Philadelphia aimed to evaluate whether developmental screenings can predict risk for ASD using the Survey of Well-Being in Children Milestones, a universal screening tool administered at age 9, 18, and 24 to 30 months. Based on data collected over a decade across 31 primary care sites, all patients with ≥1 screening and follow-up diagnostic data at ≥4 years were included in the cohort (n = 32,280). The cohort’s ASD prevalence rate was 2.4%.

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A 4-class model provided the best fit for the distinct developmental trajectories of survey scores from 9 to 30 months. Two-thirds of children with ASD were classified into Class 3 or 4, indicating a sensitivity of 74% using the developmental profiles. Participants in Class 3 (10%) showed developmental deceleration from 9 to 30 months and had an elevated rate of ASD (7.1%), and those in Class 4 (4%) had lower 9-month scores and more significant developmental deceleration, with a very elevated rate of ASD (27%).

Children in Classes 1 and 2 (86% of the cohort) had 9-month developmental scores that met age expectations and increased to 30 months. Both classes had a lower probability of a later ASD diagnosis.

“[S]creening for developmental deceleration in the first 2 years of life may improve the status quo of universal screening in primary care,” the researchers concluded.


Guthrie W, Schultz RT, and Miller JS. Leveraging developmental trajectories of broadband screening to detect autism risk in primary care. Presented at: International Society of Autism Research 2019 Annual Meeting; May 1-4, 2019; Montreal, Canada.