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Autism is diagnosed based on social and communication difficulties, restricted and repetitive behaviours and sensory anomalies. Existing evidence indicates that anxiety and atypical sensory features are associated with restricted and repetitive behaviours, but cannot clarify the order of emergence of these traits. This study uses data from a prospective longitudinal study of infants with and without a family history of autism (N = 247; Elevated Likelihood N = 170 and Typical Likelihood N = 77). Longitudinal cross-lag models tested bidirectional pathways between parent-rated infant fear/shyness and perceptual sensitivity at 8, 14 and 24 months, and associations between these domains and parent-rated restricted and repetitive behaviours and social communication scores at 36 months. In addition to within-domain continuity, higher levels of fear/shyness at 14 months were associated with higher levels of perceptual sensitivity at 24 months. Higher levels of both fear/shyness and perceptual sensitivity at 24 months were associated with greater restricted and repetitive behaviours and social communication scores at 36 months. Results demonstrate the directionality of developmental pathways between fear/shyness and perceptual sensitivity in infancy and toddlerhood, but question theories that argue that these domains specifically underlie restricted and repetitive behaviours rather than autism. Identifying how early emerging anxiety and sensory behaviours relate to later autism is important for understanding pathways and developing targeted support for autistic children. [This article was co-authored by the BASIS Team.]

Shared difficulties with cognitive control may play a role in co-occurring mental health problems frequently observed in autistic children. We investigated how different cognitive control processes (inhibitory control, conflict resolution, cognitive flexibility) associated with traits of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and anxiety in 7-year-old children at elevated (n = 44) and typical (n = 37) familial likelihood for ASD. Poor inhibitory control was associated with higher ADHD traits. Better inhibitory control and poorer cognitive flexibility predicted higher anxiety traits. Cognitive control processes were not associated dimensionally with autistic traits, though better conflict resolution predicted greater likelihood of meeting diagnostic criteria for ASD in categorical analysis. These findings suggest that different cognitive control alterations are associated with ASD, ADHD and anxiety. [This article was co-written with the BASIS Team.]

The aim of this study was to explore the associations between temperamental reactivity and regulation and the emergence of anxiety traits in a longitudinal sample of infants enriched for later ASD. Parents of 143 infants who were at high- and low-risk for ASD rated their child's temperament traits when they were 9, 15 and 24 months old; they rated anxiety and ASD traits when they were 36 months old. The findings suggest that behavioural inhibition may be an early predictor of later anxiety in children with and without ASD and that lower levels of effortful control in children who later develop ASD may contribute to the higher expression of anxiety within this population. [The BASIS Team co-authored this article.]

Parents participating in a prospective longitudinal study of infants with older siblings with autism completed an autism screening questionnaire and were asked about any concerns relating to their child's development, and children were administered an interactive assessment conducted by a researcher at 14 months. Scores on the parent questionnaire were highest for children later diagnosed with autism. Parental concerns and scores from the examiner-led assessment distinguished children with later developmental difficulties (both autism and other developmental atypicalities) from those who were developing typically. Children about whom parents expressed concern scored higher on both the questionnaire and the interactive assessment than those without concerns. There were no significant associations between total or individual item scores from the questionnaire and interactive assessment. [The BASIS Team co-authored this article.]

We investigated infant's manual motor behaviour; specifically behaviours crossing the body midline. Infants at elevated likelihood of Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD) produced fewer manual behaviours that cross the midline compared to infants with a typical likelihood of developing these disorders; however this effect was limited to 10-month-olds and not apparent at age 5 and 14 months. Although, midline crossing did not predict ASD traits, it was related to ADHD traits at 2 years of age. We rule out motor ability and hand dominance as possible explanations for this pattern of behaviour, positing that these results may be a consequence of multisensory integration abilities, and the neurobehavioural shift period, in the first year of life. [This article was co-written by the BASIS/STAARS Team.]

Background: Existing evidence indicates that atypical sensory reactivity is a core characteristic of autism, and has been linked to both anxiety (and its putative infant precursor of fearfulness) and repetitive behaviours. However, most work has used cross‐sectional designs and not considered the differential roles of hyperreactivity and hyporeactivity to sensory inputs, and is thus limited in specificity. Methods: 161 infants with and without an elevated likelihood of developing autism and attention‐deficit hyperactivity disorder (ADHD) were followed from 10 to 36 months of age. Parents rated an infant precursor of later anxiety (fearfulness) using the Infant Behaviour Questionnaire at 10 and 14 months, and the Early Childhood Behavioural Questionnaire at 24 months, and sensory hyperreactivity and hyporeactivity at 10, 14 and 24 months using the Infant Toddler Sensory Profile. Domains of autistic traits (restrictive and repetitive behaviours; RRB, and social communication interaction, SCI) were assessed using the parent‐rated Social Responsiveness Scale at 36 months. Cross‐lagged models tested (a) paths between fearfulness and hyperreactivity at 10–24 months, and from fearfulness and hyperreactivity to later autism traits, (b) the specificity of hyperreactivity effects by including hyporeactivity as a correlated predictor. Results: Hyperreactivity at 14 months was positively associated with fearfulness at 24 months, and hyperreactivity at 24 months was positively associated with SCI and RRB at 36 months. When hyporeactivity was included in the model, paths between hyperreactivity and fearfulness remained, but paths between hyperreactivity and autistic traits became nonsignificant. Conclusions: Our findings indicate that alterations in early sensory reactivity may increase the likelihood of showing fearfulness in infancy, and relate to later social interactions and repetitive behaviours, particularly in individuals with a family history of autism or ADHD. [ABSTRACT FROM AUTHOR]

Autism sibling recurrence in prospective infant family history studies is ~20% at 3 years but systematic follow‐up to mid‐childhood is rare. In population and clinical cohorts autism is not recognized in some children until school‐age or later. One hundred and fifty‐nine infants with an older sibling with autism underwent research diagnostic assessments at 3 years and mid‐childhood (6 to 12 years (mean 9)). We report the autism sibling recurrence rate in mid‐childhood and compare developmental and behavioral profiles at mid‐childhood and 3 years in those with earlier versus later recognized autism, and those who had, or had not, received a community autism diagnosis. The autism recurrence rate in this sample in mid‐childhood was 37.1%, 95% CI [29.9%, 44.9%] and higher in boys than girls. Around half of those diagnosed with autism in mid‐childhood had not received a diagnosis at 3 years. Later, diagnosis was more common in girls than boys. While some had sub‐threshold symptoms at 3, in others late diagnosis followed a largely typical early presentation. Sibling recurrence based on community clinical diagnosis was 24.5%, 95% CI [18.4%, 31.9%]. Those who also had a community diagnosis tended to be older, have lower adaptive function and higher autism and inattention symptoms. Notwithstanding limitations of a single site study, modest sample size and limits to generalisability, autism sibling recurrence in family history infants may be higher in mid‐childhood than in studies reporting diagnostic outcome at 3 years. Findings have implications for families and clinical services, and for prospective family history studies. Lay Summary: Autism sibling recurrence in prospective infant family history studies is ~20% at 3 years but follow‐up to mid‐childhood is rare although in some children autism is not recognized until school‐age or later. We assessed 159 infants with an older sibling with autism at 3 years and in mid‐childhood (9 years). The autism sibling recurrence rate in mid‐childhood was 37.1%, 95% CI [29.9%, 44.9%] and higher in boys than girls. Only half of those diagnosed with autism in mid‐childhood had received a diagnosis at 3 years and later diagnosis was more common in girls than boys. Clinicians need provide ongoing monitoring of younger siblings of autism probands to be able to offer support to families when they express concern and seek services. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the associations between temperamental reactivity and regulation and the emergence of anxiety traits in a longitudinal sample of infants enriched for later ASD. Parents of 143 infants who were at high- and low-risk for ASD rated their child's temperament traits when they were 9, 15 and 24 months old; they rated anxiety and ASD traits when they were 36 months old. The findings suggest that behavioural inhibition may be an early predictor of later anxiety in children with and without ASD and that lower levels of effortful control in children who later develop ASD may contribute to the higher expression of anxiety within this population., Author(s): Mutluhan Ersoy [sup.1] , Tony Charman [sup.1] , Greg Pasco [sup.1] , Ewan Carr [sup.2] , Mark H. Johnson [sup.3] [sup.4] , Emily J. H. Jones [sup.3] , Anna [...]

Shared difficulties with cognitive control may play a role in co-occurring mental health problems frequently observed in autistic children. We investigated how different cognitive control processes (inhibitory control, conflict resolution, cognitive flexibility) associated with traits of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and anxiety in 7-year-old children at elevated (n = 44) and typical (n = 37) familial likelihood for ASD. Poor inhibitory control was associated with higher ADHD traits. Better inhibitory control and poorer cognitive flexibility predicted higher anxiety traits. Cognitive control processes were not associated dimensionally with autistic traits, though better conflict resolution predicted greater likelihood of meeting diagnostic criteria for ASD in categorical analysis. These findings suggest that different cognitive control alterations are associated with ASD, ADHD and anxiety., Author(s): Priscilla B. G. Godoy [sup.1] , Elizabeth Shephard [sup.1] [sup.2] [sup.5] , Bosiljka Milosavljevic [sup.2] [sup.3] [sup.6] , Mark H. Johnson [sup.3] [sup.4] , Tony Charman [sup.2] , Simon [...]

Parents participating in a prospective longitudinal study of infants with older siblings with autism completed an autism screening questionnaire and were asked about any concerns relating to their child's development, and children were administered an interactive assessment conducted by a researcher at 14 months. Scores on the parent questionnaire were highest for children later diagnosed with autism. Parental concerns and scores from the examiner-led assessment distinguished children with later developmental difficulties (both autism and other developmental atypicalities) from those who were developing typically. Children about whom parents expressed concern scored higher on both the questionnaire and the interactive assessment than those without concerns. There were no significant associations between total or individual item scores from the questionnaire and interactive assessment., Author(s): Greg Pasco [sup.1] , Kim Davies [sup.2] , Helena Ribeiro [sup.2] , Leslie Tucker [sup.2] , Carrie Allison [sup.3] , Simon Baron-Cohen [sup.3] , Mark H. Johnson [sup.2] [sup.4] [...]

Atypicalities in sensory perception are observed in individuals diagnosed with ASD and ADHD but have rarely beencontrasted in experimental studies. In the visual domain, superior performance on visual search tasks and hypersensitivity toflickering lights have been cited as evidence of unusual sensory profiles.To measure a reliable visual response, black-and-white checkerboards were presented under free-viewing conditions to threegroups of 10-month-olds: siblings of children with ASD (N=47), ADHD (N=21) and controls (N=18). Continuous EEG wasrecorded and VEPs time-locked to checkerboards presentation computed.Analysis of VEPs amplitude and latency revealed statistically significant group differences in the first 200ms post-stimulusonset. Early components were enhanced in amplitude (P100) and delayed in latency (P100-N100) in at-risk infants comparedto controls (p

Caregiver-infant interaction through touch was shown to have long-term effects on child’s cognitive development,but the mechanisms are poorly understood. Our aim is to investigate how affective touch (slow gentle caressing) affects arousalstates in young infants. Previous work showed that slow-touch decreases heart rate in 9-month-old infants.We tested two groups of 6-months-old (n=26) and 9-months-old infants (n=23). We measured heart rate and saccadic reactiontime while infants performed a visual orienting task, where speed of re-orienting from a central fixation to a peripheral targetwas measured. During the experiment, infants received either slow or fast-touch on their back in blocked trials. We found noeffects of touch on heart rate in either age-group, and only marginal effects of slow-touch on reaction times in 9-month-oldinfants. We are currently testing 2 months-old infants to investigate if these effects are observed earlier in life; these new resultswill be discussed.

It is known that affective touch leads to broad cortical activations including posterior STS, key region of the so-cial brain. Our goal is to discover if a similar pattern of activation can be observed in 5-months-old infants, or whether thedevelopment of this cortical specialization results from extensive postnatal experience.Over two studies we used functional-Near-InfraRed-Spectroscopy (fNIRS) to compare social touch (a human caress) tonon-social touch (a caress performed with a spoon in study1 -n=22- or with an electric toothbrush in study2 -n=17-).In study1 we found similar patterns of activation to the social and non-social stimulus. In study2 we report broad responsesto the non-social stimulus, but, to our surprise, we found no activations to the human caress.In light of these results we conclude that it is possible that at this age discrimination between social and non-social touch inthe posterior temporal lobe is still undergoing specialization.

Infants as young as 2 months can integrate audio and visual aspects of speech articulation. A shift of attention from the eyes towards the mouth of talking faces occurs around 6 months of age in monolingual infants. However, it is unknown whether this pattern of attention during audiovisual speech processing is influenced by speech and language experience in infancy. The present study investigated this question by analysing audiovisual speech processing in three groups of 4- to 8-month-old infants who differed in their language experience: monolinguals, unimodal bilinguals (infants exposed to two or more spoken languages) and bimodal bilinguals (hearing infants with Deaf mothers). Eye-tracking was used to study patterns of face scanning while infants were viewing faces articulating syllables with congruent, incongruent and silent auditory tracks. Monolinguals and unimodal bilinguals increased their attention to the mouth of talking faces between 4 and 8 months, while bimodal bilinguals did not show any age difference in their scanning patterns. Moreover, older (6.6 to 8 months), but not younger, monolinguals (4 to 6.5 months) showed increased visual attention to the mouth of faces articulating audiovisually incongruent rather than congruent faces, indicating surprise or novelty. In contrast, no audiovisual congruency effect was found in unimodal or bimodal bilinguals. Results suggest that speech and language experience influences audiovisual integration in infancy. Specifically, reduced or more variable experience of audiovisual speech from the primary caregiver may lead to less sensitivity to the integration of audio and visual cues of speech articulation.

A fundamental question about the development of communication behavior in early life is how infants acquire adaptive communication behavior that is well-suited to their individual social environment, and how the experience of parent-child communication affects this development. The current study investigated how infants develop communication skills when their parents are visually impaired and cannot see their infants' eye gaze. We analyzed 6-min video recordings of naturalistic interaction between 14 sighted infants of blind parents (SIBP) with (a) their blind parent, and (b) a sighted experimenter. Data coded from these interactions were compared with those from 28 age-matched sighted infants of sighted parents (controls). Each infant completed two visits, at 6-10 months and 12-16 months of age. Within each interaction sample, we coded the function (initiation or response) and form (face gaze, vocalization, or action) of each infant communication behavior. When interacting with their parents, SIBP made relatively more communicative responses than initiations, and used more face gaze and fewer actions to communicate, than did controls. When interacting with a sighted experimenter, by contrast, SIBP made slightly (but significantly) more communicative initiations than controls, but otherwise used similar forms of communication. The differential communication behavior by infants of blind versus sighted parents was already apparent by 6-10 months of age, and was specific to communication with the parent. These results highlight the flexibility in the early development of human communication behavior, which enables infants to optimize their communicative bids and methods to their unique social environment.

Executive functions (EFs) are key abilities that allow us to control our thoughts and actions. Research suggests that two EFs, inhibitory control (IC) and working memory (WM), emerge around 9 months. Little is known about IC earlier in infancy and whether basic attentional processes form the "building blocks" of emerging IC. These questions were investigated longitudinally in 104 infants tested behaviorally on two screen-based attention tasks at 4 months, and on IC tasks at 6 and 9 months. Results provided no evidence that basic attention formed precursors for IC. However, there was full support for coherence in IC at 9 months and partial support for stability in IC from 6 months. This suggests that IC emerges earlier than previously assumed.

Cognitive and adaptive behaviour abilities early in life provide important clinical prognostic information. We examined stability of such skills in children at high familial risk for ASD who either met diagnostic criteria for ASD at age 7 years (HR-ASD, n = 15) or did not (HR-non-ASD, n = 24) and low-risk control children (LR, n = 37), prospectively studied from infancy. For both HR groups, cognitive skills were consistently lower across time than those of LR children. HR-ASD children showed increasing difficulties in adaptive behaviour over time compared to LR children, while the HR-non-ASD children showed no such difficulties. This pattern of change may inform our understanding of developmental profiles of HR siblings beyond core ASD symptoms.

We investigated infant's manual motor behaviour; specifically behaviours crossing the body midline. Infants at elevated likelihood of Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD) produced fewer manual behaviours that cross the midline compared to infants with a typical likelihood of developing these disorders; however this effect was limited to 10-month-olds and not apparent at age 5 and 14 months. Although, midline crossing did not predict ASD traits, it was related to ADHD traits at 2 years of age. We rule out motor ability and hand dominance as possible explanations for this pattern of behaviour, positing that these results may be a consequence of multisensory integration abilities, and the neurobehavioural shift period, in the first year of life., Author(s): Jannath Begum Ali [sup.1] , Tony Charman [sup.2] , Mark H. Johnson [sup.1] [sup.3] , Emily J. H. Jones [sup.1] Author Affiliations: (1) grid.88379.3d, 0000 0001 2324 0507, Centre [...]

Aim: To characterize early changes in developmental ability, language, and adaptive behaviour in infants diagnosed with tuberous sclerosis complex (TSC), and determine whether clinical features of epilepsy influence this pathway. Method: Prospective, longitudinal data were collected within the Early Development in Tuberous Sclerosis (EDiTS) Study to track development of infants with TSC (n = 32) and typically developing infants (n = 33) between 3 and 24 months of age. Questionnaire and observational measures were used at up to seven timepoints to assess infants' adaptive behaviour, developmental ability, language, and epilepsy. Results: A significant group by age interaction effect showed that infants with TSC had lower adaptive functioning at 18 to 24 months old (intercept = 88.12, slope estimate = −0.82, p < 0.001) and lower developmental ability scores from 10 months old (intercept = 83.33, slope estimate = −1.44, p < 0.001) compared to typically developing infants. Early epilepsy severity was a significant predictor of these emerging developmental (R2 = 0.35, p = 0.004, 95% confidence interval [CI] –0.08 to −0.01) and adaptive behaviour delays (R2 = 0.34, p = 0.004, 95% CI –0.05 to −0.01]). Lower vocabulary production (intercept = −1.25, slope = −0.12, p < 0.001) and comprehension scores (intercept = 2.39, slope estimate = −0.05, p < 0.001) in infants with TSC at 24 months old were not associated with epilepsy severity. Interpretation: Divergence of developmental ability and adaptive functioning skills occur in infants with TSC from 10 and 18 months, respectively. Associations between early epilepsy severity and impaired development supports the importance of early intervention to reduce seizure severity. This original article is commented on by Jóźwiak on pages 556–557 of this issue. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, expectant parents experienced changes in the availability and uptake of both National Health Service (NHS) community and hospital-based healthcare. To examine how COVID-19 and its societal related restrictions have impacted the provision of healthcare support for pregnant women during the COVID-19 pandemic. A thematic analysis using an inductive approach was undertaken using data from open-ended responses to the national COVID in Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study online survey (n = 507 families). The overarching theme identified was the way in which the changes to healthcare provision increased parents' anxiety levels, and feelings of not being supported. Five sub-themes, associated with the first wave of the pandemic, were identified: (1) rushed and/or fewer antenatal appointments, (2) lack of sympathy from healthcare workers, (3) lack of face-to-face appointments, (4) requirement to attend appointments without a partner, and (5) requirement to use PPE. A sentiment analysis, that used quantitative techniques, revealed participant responses to be predominantly negative (50.1%), with a smaller proportion of positive (21.8%) and neutral (28.1%) responses found. This study provides evidence indicating that the changes to healthcare services for pregnant women during the pandemic increased feelings of anxiety and have left women feeling inadequately supported. Our findings highlight the need for compensatory social and emotional support for new and expectant parents while COVID-19 related restrictions continue to impact on family life and society. [ABSTRACT FROM AUTHOR]

A diagnosis of autism typically depends on clinical assessments by highly trained professionals. This high resource demand poses a challenge in low-resource settings. Digital assessment of neurodevelopmental symptoms by non-specialists provides a potential avenue to address this challenge. This cross-sectional case-control field study establishes proof of principle for such a digital assessment. We developed and tested an app, START, that can be administered by non-specialists to assess autism phenotypic domains (social, sensory, motor) through child performance and parent reports. N = 131 children (2–7 years old; 48 autistic, 43 intellectually disabled and 40 non-autistic typically developing) from low-resource settings in Delhi-NCR, India were assessed using START in home settings by non-specialist health workers. The two groups of children with neurodevelopmental disorders manifested lower social preference, greater sensory interest and lower fine-motor accuracy compared to their typically developing counterparts. Parent report further distinguished autistic from non-autistic children. Machine-learning analysis combining all START-derived measures demonstrated 78% classification accuracy for the three groups. Qualitative analysis of the interviews with health workers and families of the participants demonstrated high acceptability and feasibility of the app. These results provide feasibility, acceptability and proof of principle for START, and demonstrate the potential of a scalable, mobile tool for assessing neurodevelopmental conditions in low-resource settings. Autism is diagnosed by highly trained professionals– but most autistic people live in parts of the world that harbour few or no such autism specialists and little autism awareness. So many autistic people go undiagnosed, misdiagnosed, and misunderstood. We designed an app (START) to identify autism and related conditions in such places, in an attempt to address this global gap in access to specialists. START uses computerised games and activities for children and a questionnaire for parents to measure social, sensory, and motor skills. To check whether START can flag undiagnosed children likely to have neurodevelopmental conditions, we tested START with children whose diagnoses already were known: Non-specialist health workers with just a high-school education took START to family homes in poor neighbourhoods of Delhi, India to work with 131 two-to-seven-year-olds. Differences between typically and atypically developing children were highlighted in all three types of skills that START assesses: children with neurodevelopmental conditions preferred looking at geometric patterns rather than social scenes, were fascinated by predictable, repetitive sensory stimuli, and had more trouble with precise hand movements. Parents' responses to surveys further distinguished autistic from non-autistic children. An artificial-intelligence technique combining all these measures demonstrated that START can fairly accurately flag atypically developing children. Health workers and families endorsed START as attractive to most children, understandable to health workers, and adaptable within sometimes chaotic home and family environments. This study provides a proof of principle for START in digital screening of autism and related conditions in community settings. [ABSTRACT FROM AUTHOR]