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 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.. Results Participant Characteristics at School Age Goal 1: (continued) B. What Therapies Did Children of Three Different Later Functioning Levels Receive? B. Do Early Adaptive Scores Predict Autism Scores at School age? ASD with Mod-Severe Disability ASD with Mild Disability No ASD Dx; N % N % 13 62% 5 24% 3 14% Speech 13 100 100 3 100 ABA 12 92 3 60 1 33 Spec Ed (non-ABA) 2 67 OT 92 80 PT 7 54 20 2 67 Family Training 3 39 40 Feeding 2 15 0 0 M SD Total Therapies 4.85 1.3 4.2 1.6 4.3 2.1 Total Hours 2901 1575 802 370 1884 2266 Correlations between Time 1 Vineland (early adaptive skills) and Time 2 Autism Scores) 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. GARS Tot GARS Com GARS Soc GARS RRB VABS T1 Comm -.128 .346 56 .044 .753 54 -0.60 .662 -.178 .185 57 VABS T1 DLS -.130 .332 58 .062 .650 -.176 .186 -.157 .234 59 VABS T1 Soc -.339** .009 -.159 .239 -.264* .043 -.346** .007 60 VABS T1 Mot -.008 .957 52 -.034 .819 49 -.108 .450 51 -.073 .608 VAB T1 ABC -.138 .320 -.046 .744 -.118 .396 -.158 .250 55 Distribution of Time 2 Diagnoses at School Age and Autism and Adaptive Scores for Each Level Study Goals What early childhood characteristics predict autism and disability level at school age? What early intervention characteristics predict autism and disability at school age? ASD with Mod-Severe Disability ASD with Mild Disability No ASD Dx; N % N % 36 51.4 22 31.4 12 17.1 VABS T2 ABC M N 61.83 23 80.85 13 104.60 10 GARS 94.61 36 70.85 20 54.60 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. 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. Half the children were in the most severe category, one-third was milder, and about 20% did not retain an ASD diagnosis. Adaptive behavior (VABS) and autism severity scores (GARS) supported the categorization. Only the Socialization subscale of the early Vineland had predictive power for later autism severity. Age of Participants Mean Range SD Age at Time 1 25 mos 13 – 36 mos 5.5 mos Age at Time 2 10.5 yrs 7 – 18 yrs 2 yrs 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. Goal 1: Child Characteristics from Time 1 to Time 2 Goal 2: Early Intervention Experiences and Time 2 Diagnostic Status A. Do Early Autism Scores Predict Autism Scores at School Age? A. Does Age of Diagnosis (Starting Early Intervention) Predict Later Dx Level? Discussion   Correlations between Time 1 CARS (early autism symptom severity), and Time 2 GARS (later autism symptom severity 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. ASD with Mod-Severe Disability ASD with Mild Disability No ASD Dx; N=36 N=22 N=12 Age of Dx M, SD 24.4 6.3 25.6 3.4 27.0 5.6 GARS tot GARS Comm Social RRB CARS Tot R Sig N 384** .016 39 .267 .116 36 .311 .054 465** .002 40 There was no significant difference in age at diagnosis for children of different severity levels at school age. CARS scores before age 3 significantly correlated to autism severity scores at school age.