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American Academy of Pediatrics
Article

Trajectories of Autism Severity in Children Using Standardized ADOS Scores

Katherine Gotham, Andrew Pickles and Catherine Lord
Pediatrics November 2012, 130 (5) e1278-e1284; DOI: https://doi.org/10.1542/peds.2011-3668
Katherine Gotham
aUniversity of Michigan Autism and Communication Disorders Center, Ann Arbor, Michigan;
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Andrew Pickles
bDepartment of Biostatistics, Institute of Psychiatry, King’s College London, London, England; and
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Catherine Lord
cCenter for Autism and the Developing Brain, Weill-Cornell Medical College, White Plains, New York
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Abstract

OBJECTIVES: To plot longitudinal trajectories of autism spectrum disorder (ASD) severity from early childhood to early adolescence. In line with reported trajectories in toddlers, we hypothesize that a substantial minority of children will show marked changes in ASD severity over time, with “Improvers” demonstrating the highest mean baseline and rate of growth in verbal IQ (VIQ).

METHODS: Patients included 345 clinic referrals and research participants with best-estimate clinical diagnoses of ASD at 1 or more time points, and repeated Autism Diagnostic Observation Schedule (ADOS), VIQ, and nonverbal IQ scores. Standardized ADOS severity scores were applied to 1026 assessments collected longitudinally between the ages of 2 and 15 (VIQ at most recent assessment: mean = 58, SD = 35). Scores were fitted for latent severity trajectory classes with and without covariates. Adaptive behavior and VIQ trajectories over time were modeled within each of the best-fit latent classes.

RESULTS: A 4-class model best represented the observed data. Over 80% of participants were assigned to persistent (stable) high or moderately severe classes; 2 small classes respectively increased or decreased in severity over time. Age, gender, race, and nonverbal IQ did not predict class membership; VIQ was a significant predictor. Baseline VIQ was highest in the improving and worsening classes; it increased at the greatest rate in the improving class. Adaptive behavior declined in all but the improving class, with consistent impairment in all classes.

CONCLUSIONS: If replicated, identified trajectory classes of ADOS severity may contribute to clinical prognosis and to subtyping samples for neurobiological and genetic research.

KEY WORDS
  • autism spectrum disorders
  • severity
  • trajectory
  • Autism Diagnostic Observation Schedule Comparison Score
  • Abbreviations:
    ABA —
    applied behavior analysis
    ADI-R —
    Autism Diagnostic Interview-Revised
    ADOS —
    Autism Diagnostic Observation Schedule
    ASD —
    autism spectrum disorder
    BIC —
    Bayesian Information Criteria
    CSS —
    calibrated severity score
    MPST —
    mentored, parent-implemented structured teaching
    NVIQ —
    nonverbal IQ
    PDD-NOS —
    pervasive developmental disorder-not otherwise specified
    VIQ —
    verbal IQ
    • Accepted July 24, 2012.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 130, Issue 5
    1 Nov 2012
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    Trajectories of Autism Severity in Children Using Standardized ADOS Scores
    Katherine Gotham, Andrew Pickles, Catherine Lord
    Pediatrics Nov 2012, 130 (5) e1278-e1284; DOI: 10.1542/peds.2011-3668

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    Trajectories of Autism Severity in Children Using Standardized ADOS Scores
    Katherine Gotham, Andrew Pickles, Catherine Lord
    Pediatrics Nov 2012, 130 (5) e1278-e1284; DOI: 10.1542/peds.2011-3668
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    Subjects

    • Developmental/Behavioral Pediatrics
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      • Autism/ASD

    Keywords

    • autism spectrum disorders
    • severity
    • trajectory
    • Autism Diagnostic Observation Schedule Comparison Score
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