The Relationship of Early Intervention and Early Child Characteristics
to Autism and Disability Severity at School Age
Patricia Towle, Ph.D., Nicole Turygin, Ph.D., and Colleen O’Sullivan, Ph.D.
Leadership Education in Neurodevelopmental and related Disabilities (LEND) Program, Westchester Institute for Human Development, University Center for Excellence in Developmental Disabilities and New York Medical College
Background
Results
Longitudinal studies of Autism Spectrum Disorder (ASD)
are important to understand outcomes of children
diagnosed early. Few studies have followed children from
as early as the second year of life to school age. This study
focuses on prediction of autism and disability severity at
school age from both early childhood characteristics and
early intervention experiences..
Participant Characteristics at
School Age
Three diagnostic categories at Time 2 were developed based
on parent report of: current functioning ▪social skills ▪GARS
scores ▪ learning difficulties, and special education services.
The participants were then placed into one of three ASD and
Disability categories.
ASD with ModSevere
Disability
1. What early childhood characteristics predict
autism and disability level at school age?
2. What early intervention characteristics predict
autism and disability at school age?
N
%
36
Method
Participants
70 children who received early intervention evaluations and/or
service coordination at WIHD and, through a chart abstraction
coding system, were diagnosed with ASD before the age of 3
years old (Time 1). The same children were re-evaluated at age
7-18. years old (Time 2). Twenty were evaluated in person.
Age at Time 1
Age at Time 2
10.5 yrs
7 – 18 yrs
B. Do Early Adaptive Scores Predict Autism
Scores at School age?
Distribution of Time 2 Diagnoses at School Age and
Autism and Adaptive Scores for Each Level
Study Goals
Age of Participants
Mean
Range
25 mos
13 – 36 mos
Goal 1: (continued)
SD
5.5 mos
2 yrs
Instruments :Time 1: Demographics, Vineland Adaptive
Behavior Scales (VABS) and Childhood Autism Rating
Scale (CARS); early intervention services child received
through preschool.
Time 2: Parent Questionnaire ,Vineland Adaptive Behavior
Scales and Gilliam Autism Rating Scale (GARS)
Procedure: Parents were contacted about participation in
the study. Packets including consent form and
questionnaires were mailed out. Each child’s early
intervention hours were recorded from Department of
Health early intervention charts. All instruments were
scored and entered into the database using SPSS to
conduct planned analysis.
51.4
ASD with
Mild
Disability
N
22
%
No ASD Dx;
N
%
31.4 12
17.1
VABS T2 M
ABC N
61.83
23
80.85
13
104.60
10
M
N
94.61
36
70.85
20
54.60
10
GARS
Half the children were in the most severe category, onethird was milder, and about 20% did not retain an ASD
diagnosis. Adaptive behavior (VABS) and autism severity
scores (GARS) supported the categorization.
Goal 1: Child Characteristics from
Time 1 to Time 2
A. Do Early Autism Scores Predict Autism
Scores at School Age?
Correlations between Time 1 CARS (early autism
symptom severity), and Time 2 GARS (later autism
symptom severity
CARS
Tot
R
Sig
N
GARS
tot
GARS
Comm
GARS
Social
GARS
RRB
384**
.016
39
.267
.116
36
.311
.054
39
465**
.002
40
CARS scores before age 3 significantly correlated to
autism severity scores at school age.
B. What Therapies Did Children of Three Different Later
Functioning Levels Receive?
ASD with
Mod-Severe
Disability
Correlations between Time 1 Vineland (early adaptive
skills) and Time 2 Autism Scores)
GARS Tot GARS Com GARS Soc GARS RRB
ASD with Mild
Disability
N
%
N
%
13
62%
5
24%
No ASD Dx;
N
3
%
14%
VABS
T1
Comm
-.128
.346
56
.044
.753
54
-0.60
.662
56
-.178
.185
57
Speech
13
100
5
100
3
100
ABA
12
92
3
60
1
33
VABS
T1
DLS
-.130
.332
58
.062
.650
56
-.176
.186
58
-.157
.234
59
Spec Ed (non-ABA)
12
92
5
100
2
67
OT
12
92
4
80
3
100
VABS
T1 Soc
-.339**
.009
59
-.159
.239
57
-.264*
.043
59
-.346**
.007
60
PT
7
54
1
20
2
67
VABS
T1 Mot
-.008
.957
52
-.034
.819
49
-.108
.450
51
-.073
.608
52
Family Training
3
39
2
40
2
67
Feeding
2
15
2
0
0
0
VAB
T1
ABC
-.138
.320
54
-.046
.744
52
-.118
.396
54
-.158
.250
55
M
SD
M
M
SD
Only the Socialization subscale of the early Vineland
had predictive power for later autism severity.
Goal 2: Early Intervention Experiences and
Time 2 Diagnostic Status
A. Does Age of Diagnosis (Starting Early
Intervention) Predict Later Dx Level?
ASD with ModSevere Disability
N=36
Age of Dx
M, SD
24.4
6.3
ASD with
Mild
Disability
N=22
25.6
3.4
No ASD Dx;
N=12
27.0 5.6
There was no significant difference in age at diagnosis
for children of different severity levels at school age.
SD
Total Therapies
4.85 1.3
4.2 1.6
Total Hours
2901 1575
802 370
4.3 2.1
1884 2266
The most common therapies were Speech, ABA, Special Instruction,
and OT. Children who were more Severe at outcome tended to get more
types of therapy, and more hours. However, the No ASD group had more
hours than the Mild ASD.
Discussion
Child early autism scores (CARS) and Vineland Socialization
scores were predictive of later autism severity at follow up.
This suggests continuity between ASD severity measured
before age 3 years and when reported by parents at school
age. Age when starting EI did not differ among the three
outcome severity levels. The number of EI and Preschool
therapies received was higher for the more severe children
at outcome. More complex analyses (i.e., multiple
regression) will explore more complex relationships
between early and later variables.