Research update
Bradshaw, J., Shi, D., Hendrix, C. L., Saulnier, C., & Klaiman, C. (2022). Neonatal neurobehavior in infants with autism spectrum disorder. Developmental medicine and child neurology, 64(5), 600–607. https://doi.org/10.1111/dmcn.15096
Aim: To investigate neurobehavioral maturation for neonates who are later diagnosed with autism spectrum disorder (ASD).
Method: In a prospective longitudinal design, neonatal neurobehavior was examined monthly in 1- to 3-month-old infants at elevated and low familial likelihood of ASD (n=60). At 2 years, infants were seen for a clinical best-estimate evaluation, resulting in 18 infants with ASD and 36 typically developing infants. Repeated-measures analysis of variance models were conducted to examine the effects of age, diagnostic group, and their interactions.
Results: Neurobehavioral maturation of infants diagnosed with ASD was largely comparable to typically developing infants from 1 to 3 months, with the exception of the development of attention. Object-focused attention was significantly attenuated for infants with ASD beginning at 2 to 3 months and was predictive of social-communication skills 2 years later.
Interpretation: This is the first study to prospectively examine neonatal neurobehavior of infants at an elevated familial likelihood of ASD who later received a diagnosis. Despite relatively intact neurological and behavioral maturation in the neonatal period, attention to objects emerged as a key early indicator of ASD. This suggests a complex attentional vulnerability within the first 3 months of life that may be associated with cascading sequelae of social-communication challenges and the emergence of ASD.
More about the NNNS
https://www.issup.net/files/2020-03/NNNS%20Assessment.pdf
More about neonatal neurobehavioral
Extract from Bradshaw, J., Shi, D., Hendrix, C. L., Saulnier, C., & Klaiman, C. (2022). Neonatal neurobehavior in infants with autism spectrum disorder. Developmental medicine and child neurology, 64(5), 600–607.
"Neonatal neurobehavior describes a hierarchically organized system of neurological and behavioral functioning that includes autonomic regulation, motor organization, state regulation, and attention. The NNNS is a 15- to 30-minute semi-structured behavioral examination designed to evaluate neurobehavioral organization and functioning. Typically developing, term-born infants demonstrate symmetrical, reflexive responses when elicited (e.g. plantar and Moro reflexes), respond with moderate muscle tone when manipulated, demonstrate smooth and controlled motor movements with few tremors and startles, reach moderate levels of overall arousal and excitability, engage in effective self-regulation behavior, respond to being soothed by a caregiver, and sustain periods of alertness and attention to people and objects in the environment. The NNNS examination evaluates neonatal neurobehavior of preterm, term-born, medically fragile, and typically developing neonates through direct observation and manipulation of the infant to elicit specific behaviors. Scoring of the NNNS includes infant responses to individual items, overall ratings of infant behavior on the basis of examiner observations, and recording the presence or absence of specific stress behaviors that occur during the examination. A total of 115 items are scored and algorithms are used to generate 13 summary scores: habituation, attention, handling, quality of movement, regulation, non-optimal reflexes, asymmetric reflexes, stress, arousal, hypertonicity, hypotonicity, excitability, and lethargy. In this study, the habituation items were not administered because most infants arrived at the clinic awake. The NNNS was administered by trained and certified licensed psychologists and doctoral trainees. Examiners maintained interrater scoring reliability, defined by interrater agreement across all 115 items above 80%. Item-by-item agreement was defined by scores within one point on the examination and examiner rating items (total of 65 items) and exact agreement on the stress/abstinence scale (total of 50 items). Examiners were masked to family history of participants (i.e. familial likelihood of ASD)."
Bradshaw, J., Shi, D., Federico, A., Klaiman, C., & Saulnier, C. (2023). The Pull-to-Sit Task: Examining Infant Postural Development in Autism Spectrum Disorder. The Journal of pediatrics, 253, 225–231.e2. https://doi.org/10.1016/j.jpeds.2022.09.047
Objective: To evaluate the predictive relationship between early trajectories of postural and head control during a pull-to-sit task and later autism diagnostic and developmental outcomes.
Study design: Using a prospective longitudinal design, postural skills of 100 infants at elevated and low familial likelihood of autism spectrum disorder (ASD) were evaluated using a pull-to-sit task monthly from age 1 month to 6 months. At age 24 months, infants were seen for a developmental and diagnostic evaluation completed by examiners masked to participant group. Latent growth curve models were used to compare early trajectories of pull-to-sit performance in infants later diagnosed with ASD and typically developing infants and to predict developmental outcomes.
Results: Pull-to-sit trajectories did not differ in infants with an elevated likelihood of ASD or infants with ASD compared with low-likelihood and typically developing infants, but infants with ASD were more likely to exhibit a head lag by age 4 months. In addition, pull-to-sit trajectories were predictive of social and speech skills 2 years later.
Conclusions: These findings highlight the link between very early pull-to-sit skills and later social and language outcomes. Atypical postural development and persistent presence of head lag may be important early indicators of social and language vulnerabilities, including ASD.