Next Journal of the American Academy of Child & Adolescent Psychiatry

Volume 49, Issue 3 , Pages 256-266.e2, March 2010

A Prospective Study of the Emergence of Early Behavioral

Signs of Autism
Sally Ozonoff, Ph.D.
,
Ana-Maria Iosif, Ph.D.
,
Fam Baguio, B.S.
,
Ian C. Cook, Ph.D.
,
Monique Moore Hill, M.S.
,
Ted Hutman, Ph.D.
,
Sally J. Rogers, Ph.D.
,
Agata Rozga, Ph.D.
,
Sarabjit Sangha, B.S.
,
Marian Sigman, Ph.D.
,
Mary Beth Steinfeld, M.D.
,
Gregory S. Young, Ph.D.
Accepted 30 November 2009. published online 08 February 2010.

Abstract
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Objective
To examine prospectively the emergence of behavioral signs of autism in the first years of life in infants at low and
high risk for autism.

Method
A prospective longitudinal design was used to compare 25 infants later diagnosed with an autism spectrum disorder
(ASD) with 25 gender-matched low-risk children later determined to have typical development. Participants were
evaluated at 6, 12, 18, 24, and 36 months of age. Frequencies of gaze to faces, social smiles, and directed
vocalizations were coded from video and rated by examiners.

Results
The frequency of gaze to faces, shared smiles, and vocalizations to others were highly comparable between groups
at 6 months of age, but significantly declining trajectories over time were apparent in the group later diagnosed with
ASD. Group differences were significant by 12 months of age on most variables. Although repeated evaluation
 documented loss of skills in most infants with ASD, most parents did not report a regression in their child's
development.

Conclusions
These results suggest that behavioral signs of autism are not present at birth, as once suggested by Kanner, but
emerge over time through a process of diminishment of key social communication behaviors. More children may
present with a regressive course than previously thought, but parent report methods do not capture this phenomenon
well. Implications for onset classification systems and clinical screening are also discussed.

Key Words: Autism, Onset, Infancy, Regression

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This article is discussed in an editorial by Dr. Tony Charman on p. 208.

Supplemental material cited in this article is available online.

This study was supported by grants from the National Institute of Mental Health: R01 MH068398 (Ozonoff) and U54
MH068172 (Sigman).
Editorial support for the preparation of this article was provided by Diane Larzelere, UC Davis.

Disclosure: Drs. Ozonoff, Iosif, Cook, Hutman, Rogers, Rozga, Sigman, Steinfeld, and Young, and Mr. Baguio, Ms. Hill, and
Ms. Sangha report no biomedical financial interests or potential conflicts of interest.

PII: S0890-8567(09)00031-8

doi:10.1016/j.jaac.2009.11.009

2010 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Refers to article:
Autism Research Comes of (a Young) Age

Tony Charman
Journal of the American Academy of Child & Adolescent Psychiatry March 2010 (Vol. 49, Issue 3, Pages 208-209)
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 PreviousNext Journal of the American Academy of Child & Adolescent Psychiatry
Volume 49, Issue 3 , Pages 256-266.e2, March 2010

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