Trajectories of adaptive functioning from early childhood to adolescence in autism: Identifying turning points and key correlates of chronogeneity

JCPP advances Pub Date : 2023-12-14 DOI:10.1002/jcv2.12212
Yun-Ju Chen, Eric Duku, Peter Szatmari, Mackenzie Salt, Isabel Smith, Annie Richard, Lonnie Zwaigenbaum, Tracy Vaillancourt, Anat Zaidman-Zait, Terry Bennett, Mayada Elsabbagh, Connor Kerns, Stelios Georgiades
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Abstract

Background

Previous research has demonstrated heterogeneous adaptive outcomes across the autism spectrum; however, the current literature remains limited in elucidating turning points and associated factors for longitudinal variability (chronogeneity). To address these empirical gaps, we aimed to provide a finer-grained characterization of trajectories of adaptive functioning from early childhood to adolescence in autism.

Methods

Our sample (N = 406) was drawn from an inception cohort of children diagnosed Autistic at ages 2–5. Adaptive functioning was assessed with Vineland Adaptive Behavior Scales (VABS, 2nd Edition) across 6 visits from the time of diagnosis by age 18. Parallel-process latent growth curve modeling were used to estimate domain-level VABS trajectories, followed by latent class growth analysis to identify trajectory subgroups. Child characteristics at diagnosis, family demographics, and participation outcomes at adolescence were compared across subgroups.

Results

Piecewise latent growth models best described VABS trajectories with two turning points identified at around ages 5-6 and 9–10, respectively reflecting transitions into school age and early adolescence. We parsed four VABS trajectory subgroups that vary by level of functioning and change rate for certain domains and periods. Around 16% of the sample exhibited overall adequate functioning (standard score >85) with notable early growth and social adaptation during adolescence. About 21% showed low adaptive functioning (standard score ≤70), with decreasing slopes by age 6 followed by improvements in communication and daily-living skills by age 10. The other two subgroups (63% in total) were characterized by adaptive functioning between low and adequate levels, with relatively stable trajectories entering school age. These subgroups differed most in their cognitive ability at diagnosis, household income, and social participation in adolescence.

Conclusions

We identified key individual and family characteristics and time windows associated with distinct adaptive functioning trajectories, which have important implications for providing timely and tailored supports to Autistic people across developmental stages.

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自闭症患者从幼儿期到青春期的适应功能轨迹:确定转折点和时序性的关键相关因素
以往的研究表明,自闭症谱系的适应性结果各不相同;然而,目前的文献在阐明转折点和纵向变异性(时序性)的相关因素方面仍然有限。为了弥补这些经验上的不足,我们旨在对自闭症儿童从幼儿期到青春期的适应功能轨迹进行更精细的描述。我们的样本(N = 406)来自于2-5岁被诊断为自闭症儿童的初始队列。我们的样本(N = 406)来自 2-5 岁被诊断为自闭症的儿童的初始队列。适应功能通过文兰适应行为量表(VABS,第 2 版)进行评估,评估时间为自诊断之时起至 18 岁止的 6 次访问。平行过程潜增长曲线模型用于估算领域级 VABS 轨迹,然后进行潜类增长分析以确定轨迹亚组。分段式潜增长模型对 VABS 的轨迹进行了最佳描述,并在 5-6 岁和 9-10 岁左右发现了两个转折点,分别反映了学龄期和青春期早期的过渡。我们分析了四个 VABS 轨迹亚组,它们在某些领域和时期的功能水平和变化率各不相同。约 16% 的样本表现出总体功能良好(标准分大于 85 分),青春期早期成长和社会适应能力显著增强。约 21% 的人表现出较低的适应功能(标准分≤70 分),6 岁时斜率下降,10 岁时沟通和日常生活技能有所改善。另外两个亚组(共占 63%)的特点是适应功能介于低水平和适当水平之间,进入学龄期后的轨迹相对稳定。这些亚组在诊断时的认知能力、家庭收入和青春期的社会参与方面差异最大。我们确定了与不同适应功能轨迹相关的关键个人和家庭特征及时间窗口,这对在自闭症患者的各个发育阶段为其提供及时和有针对性的支持具有重要意义。
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Issue Information Implementing open science and reproducible research practices in mental health research through registered reports Special educational needs provision and academic outcomes for children with teacher reported language difficulties at school entry Examining the association of neighborhood conditions on attention‐deficit/hyperactivity disorder symptoms in autistic youth using the child opportunity index 2.0 The trajectory of anxiety symptoms during the transition from childhood to young adulthood is predicted by IQ and sex, but not polygenic risk scores
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