Journal of Autism and Developmental Disorders

, Volume 48, Issue 8, pp 2854–2869 | Cite as

Deviations from Typical Developmental Trajectories Detectable at 9 Months of Age in Low Risk Children Later Diagnosed with Autism Spectrum Disorder

  • Michael DavidovitchEmail author
  • Nataly Stein
  • Gideon Koren
  • Bat Chen Friedman
Original Paper


This study was designed to track the developmental trajectory, during the first 24 months of life, of 335 low-risk infants later diagnosed with Autism Spectrum Disorder and identify early deviations observed in routine Well Care checkups. We compared their achievements to typically developing children and to children later diagnosed with non-autistic developmental impairments. The results show that in the first 6 months, the children with autism showed normal acquisition of milestones, whereas by 9 months of age they began to fail the language/communication, as well as motor items when compared to typical and delayed non-autistic children. Regular check-up visits may be useful in detecting early failure in achieving milestones, leading to earlier referral for further evaluation and treatment.


Autism spectrum disorder Early development Developmental trajectories Low risk 



The authors thank Lior Ganor and Diana Kogan for editing the manuscript.

Author Contributions

MD made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data and was involved in drafting the manuscript. NS made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. GK made substantial contributions to analysis and interpretation of data, and was involved and revising it critically for important intellectual content. BCF made substantial contributions to analysis and interpretation of data and was involved in drafting the manuscript.

Compliance with Ethical Standards

Conflict of interest

All authors are employees of Maccabi Healthcare Services.

Ethical Approval

The study was approved by the Ethics Review Board of Maccabi Healthcare Services.


  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. (2000) Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. (2013). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  3. Baio, J., et al. (2014). Prevalence of autism spectrum disorder among children aged 8 years: autism and developmental disabilities monitoring network, 11 sites, United States 2010. Surveillance Summaries, 63(SS02), 1–21.Google Scholar
  4. Baranek, G. T. (1999). Autism during infancy: A retrospective video analysis of sensory-motor and social behaviors at 9–12 months of age. Journal of Autism and Developmental Disorders, 29, 213–224.CrossRefPubMedGoogle Scholar
  5. Barbaro, J., & Dissanayake, C. (2012). Developmental profiles of infants and toddlers with autistic spectrum disorder identified prospectively in a community-based setting. Journal of Autism and Developmental Disorders, 42, 1939–1948.CrossRefPubMedGoogle Scholar
  6. Bhat, A. N., Galloway, J. C., & Landa, R. J. (2012). Relation between early motor delay and later communication delay in infants at risk for autism. Infant Behavior & Development, 35(4), 838–846.CrossRefGoogle Scholar
  7. Bolton, P. F., Golding, J., Emond, A., & Steer, C. D. (2012). Autism spectrum disorder and autistic traits in the Avon longitudinal study of parents and children: Precursors and early signs. American Academy of Child & Adolescent Psychiatry, 51(3), 249–260.e25.CrossRefGoogle Scholar
  8. Bradshaw, J., Steiner, A. M., Gengoux, G., & Koegel, L. K. (2015). Feasibility and effectiveness of very early intervention for infants at risk for autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 45, 778–794.CrossRefPubMedGoogle Scholar
  9. Brenes, J. C., Lackinger, M., Hoglinger, G. U., Schratt, G., Schwarting, R. K., & Wohr, M. (2016). Differential effects of social and physical environmental enrichment on brain plasticity, cognition, and ultrasonic communication in rats. The Journal of Comparative Neurology, 524, 1586–1607.CrossRefPubMedGoogle Scholar
  10. Brian, J., Bryson, S., Garon, N., Roberts, W., Smith, I., Szatmari, P., & Zwaigenbaum, L. (2008). Clinical assessment of autism in high-risk 18-month-olds. Autism, 12(5), 433–456.CrossRefPubMedGoogle Scholar
  11. Bryson, S., Zwaigenbaum, L., Brian, J., Roberts, W., Szatmari, P., Rombough, V., & McDermott, C. (2007). A prospective case series of high-risk infants who developed autism. Journal of Autism and Developmental Disorders, 37(1), 12–24.CrossRefPubMedGoogle Scholar
  12. Colgan, S. E., Lanter, E., McComish, C., Watson, L. R., Crais, E. R., & Baranek, G. T. (2006). Analysis of social interaction gestures in infants with autism. Child Neuropsychology, 12(4–5), 307–319.CrossRefPubMedGoogle Scholar
  13. Davidovitch, M., Glick, L., Holtzman, G., Tirosh, E., & Safir, M. P. (2000). Developmental regression in autism: Maternal perception. Journal of Autism and Developmental Disorders, 30, 113–119.CrossRefPubMedGoogle Scholar
  14. Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20, 775–803.CrossRefPubMedGoogle Scholar
  15. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 125, e17–e23.CrossRefPubMedGoogle Scholar
  16. De Giacomo, A., & Fombonne, E. (1998). Parental recognition of developmental abnormalities in autism. European Child and Adolescent Psychiatry, 7, 131–136.CrossRefPubMedGoogle Scholar
  17. Deconinck, N., Soncarrieu, M., & Dan, B. (2013). Toward better recognition of early predictors for autism spectrum disorders. Pediatric Neurology, 49(4), 225–231.CrossRefPubMedGoogle Scholar
  18. DiCicco-Bloom, E., Lord, C., Zwaigenbaum, L., Courchesne, E., Dager, S. R., Schmitz, C., et al. (2006). The developmental neurobiology of autism spectrum disorder. Journal of Neuroscience, 26, 6897–6906.CrossRefPubMedGoogle Scholar
  19. Elsabbagh, M., Fernandes, J., Jane Webb, S., Dawson, G., Charman, T., & Johnson, M. H., British Autism Study of Infant Siblings Team. (2003). Disengagement of visual attention in infancy is associated with emerging autism in toddlerhood. Biological Psychiatry 74(3), 189–194.CrossRefGoogle Scholar
  20. Estes, A., Zwaigenbaum, L., Gu, H., St. John, T., Paterson, s, Elison, J. T., et al. (2015). Behavioral, cognitive and adaptive development in infants with autism spectrum disorder in the first 2 years of life. Journal of Neurodevelopmental Disorders, 7, 24.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Fountain, C., King, M. D., & Bearman, P. S. (2011). Age of diagnosis for autism: Individual and community factors across 10 birth cohorts. Journal of Epidemiology and Community Health, 65(6), 503–510.CrossRefPubMedGoogle Scholar
  22. Gillberg, S., Ehlers, H., Schaumann, et al. (1990). Autism under age 3 years: A clinical study of 28 cases referred for autistic symptoms in infancy. Journal of Child Psychology and Psychiatry, 31, 921–934.CrossRefPubMedGoogle Scholar
  23. Herbert, M., & Shank (2011). The synapse, and autism. New England Journal of Medicine, 365, 173–175.CrossRefPubMedGoogle Scholar
  24. Israel Central Bureau of Statistics (2008). Characterization and classification of geographic units by the socio-economic level of the population. Publication No. 1530. 2013; Jerusalem, Israel.Google Scholar
  25. Iverson, J., & Wozniak, R. (2007). Variation in vocal-motor development in infant siblings of children with autism. Journal for Autism and Developmental Disorders, 37(1), 158–170.CrossRefGoogle Scholar
  26. Jones, W., & Klin, A. (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, 504(7480), 427–431.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Katz, I. C., & Shatz, C. J. (1996). Synaptic activity and the construction of cortical circuits. Science, 274, 133–138.CrossRefGoogle Scholar
  28. Klin, A., Lin, D. J., Gorrindo, P., Ramsay, G., & Jones, W. (2009). Two-year-olds with autism orient to non-social contingencies rather than biological motion. Nature, 459, 257–261.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Landa, R., & Garrett-Mayer, E. (2006). Development in infants with autism spectrum disorders: A prospective study. Journal of Child Psychology and Psychiatry, 47, 629–638.CrossRefPubMedGoogle Scholar
  30. Landa, R. J., Gross, A. L., Stuart, E. A., & Faherty, A. (2013). Developmental trajectories in children with and without autism spectrum disorders: The first 3 years. Child Development, 84(2), 429–442.CrossRefPubMedGoogle Scholar
  31. Landa, R. J., Holman, K. C., & Garrett-Mayer, E. (2007). Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders. Archives of General Psychiatry., 64, 853–864.CrossRefPubMedGoogle Scholar
  32. Landry, O., & Burack, J. A. (2009). Visual orienting among persons with autism spectrum disorders. McGill Journal of Medicine: MJM, 12(2), 112.PubMedGoogle Scholar
  33. Maestro, S., Casella, C., Milone, A., Muratori, F., & Palacio-Espasa, F. (1999). Study of the onset of autism through home movies. Psychopathology, 32, 292–300.CrossRefPubMedGoogle Scholar
  34. Maestro, S., Muratori, F., Cavallaro, M. C., et al. (2002). Attentional skills during the first 6 months of age in autism spectrum disorder. The Journal of the American Academy of Child & Adolescent Psychiatry, 41(10), 1239–1245.CrossRefGoogle Scholar
  35. Mazer, J. A. (2011). Spatial attention, feature-based attention and saccades: Three sides of one coin? Biological Psychiatry, 69(12), 1147–1152.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Merin, N., Young, G. S., Ozonoff, S., & Rogers, S. J. (2007). Visual fixation patterns during reciprocal social interaction distinguish a subgroup of 6-month-old infants at-risk for autism from comparison infants. Journal of Autism and Developmental Disorders, 37(1), 108–121.CrossRefPubMedGoogle Scholar
  37. Ministry of Health, State of Israel. (2013). Accessed 27 Mar 2018.
  38. Ministry of Health, State of Israel. (2017). Accessed 27 Mar 2018.
  39. Müller, R., Shih, P., Keehn, B., Deyoe, J. R., Leyden, K. M., & Shukla, D. K. (2011). Underconnected, but how? A survey of functional connectivity MRI studies in autism spectrum disorders. Cerebral Cortex, 21, 2233–2243.CrossRefPubMedGoogle Scholar
  40. Ozonoff, S., Iosif, A. M., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., et al. (2010). A prospective study of the emergence of early behavioral signs of autism. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 256–266.PubMedPubMedCentralGoogle Scholar
  41. Pardo, C. A., & Eberhart, C. G. (2007). The neurobiology of autism. Brain Pathology, 17, 434–447.CrossRefPubMedGoogle Scholar
  42. Pierce, K., Carter, C., Weinfeld, M., Desmond, J., Hazin, R., Bjork, R., et al. (2011). Detecting, studying, and treating autism early: The one-year well-baby check-up approach. The Journal of Pediatrics, 159, 458–465.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Pierce, K., Courchesene, E., & Bacon, D. (2016). To Screen or not to screen universally for autism is not the question: Why the Task Force got it wrong. The Journal of Pediatrics, 176, 182–194.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Quartz, S. R., & Sejnowski, T. J. (1997) The neural basis of cognitive development: A constructivist manifesto. Behavioral and Brain Sciences 20, 537–556 (Discussion 556–596).PubMedGoogle Scholar
  45. Robins, D. L., Adamson, L. B., Barton, M., Connell, J. E., Dumont-Mathieu, T., Dworkin, P. H., et al. (2016). Universal autism screening for toddlers: Recommendations at odds. Journal of Autism and Developmental Disorders, 46(5), 1880–1882.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Ronconi, L., Gori, S., Ruffino, M., Franceschini, S., Urbani, B., et al. (2012). Decreased coherent motion discrimination in autism spectrum disorder: The role of attentional zoom-out deficit. PLoS ONE, 7(11), e49019. Scholar
  47. Schumann, C. M., Bloss, C. S., Barnes, C. C., Wideman, G. M., Carper, R. A., Akshoomoff, N., et al. (2010). Longitudinal magnetic resonance imaging study of cortical development through early childhood in autism. Journal of Neuroscience, 30, 4419–4427.CrossRefPubMedGoogle Scholar
  48. Siu, A. L., the US Preventive Services Task Force (USPSTF). (2016). Screening for autism spectrum disorder in young children us preventive services task force recommendation statement. JAMA 315(7), 691–696.CrossRefPubMedGoogle Scholar
  49. Sullivan, K., Stone, W. L., & Dawson, G. (2014). Potential neural mechanisms underlying the effectiveness of early intervention for children with autism spectrum disorder. Research in Developmental Disabilities, 35, 2921–2932.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Sullivan, M., Finelli, J., Marvin, A., Garrett-Mayer, E., Bauman, M., & Landa, R. (2007). Response to joint attention in toddlers at risk for autism spectrum disorder: A prospective study. Journal of Autism and Developmental Disorders, 37, 37–48.CrossRefPubMedGoogle Scholar
  51. van Praag, H., Kempermann, G., & Gage, F. H. (2000). Neural consequences of environmental enrichment. Nature Reviews Neuroscience, 1, 191–198.CrossRefPubMedGoogle Scholar
  52. Werner, E., & Dawson, G. (2005). Validation of the phenomenon of autistic regression using home videotapes. Archives of General Psychiatry., 62, 889–895.CrossRefPubMedGoogle Scholar
  53. Wolff, J. J., Gu, H., Gerig, G., IBIS Network, et al. (2012). Differences in white matter fiber tract development present from 6 to 24 months in infants with autism. American Journal of Psychiatry 169(6), 589–600.CrossRefGoogle Scholar
  54. Zwaigenbaum, L., Bauman, M. L., Choueiri, R., Kasari, C., Carter, A., Granpeesheh, D., et al. (2015a). Early intervention for children with autism spectrum disorder under 3 years of age: recommendations for practice and research. Pediatrics. 136(Suppl 1), S60–S81.CrossRefPubMedGoogle Scholar
  55. Zwaigenbaum, L., Bauman, M. L., Choueiri, R., Kasari, C., Carter, A., Granpeesheh, D., et al. (2015b). Early identification of autism spectrum disorder: recommendations for practice and research. Pediatrics, 136, S10–S40.CrossRefPubMedGoogle Scholar
  56. Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts, W., Brian, J., & Szatmari, P. (2005). Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience, 23(2–3), 143–152.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Michael Davidovitch
    • 1
    Email author
  • Nataly Stein
    • 2
  • Gideon Koren
    • 3
    • 4
  • Bat Chen Friedman
    • 5
    • 6
  1. 1.Department of Child Development, Medical DivisionMaccabi Healthcare ServicesTel AvivIsrael
  2. 2.Nursing Department, Medical DivisionMaccabi Healthcare ServicesTel AvivIsrael
  3. 3.Research InstituteMaccabi Healthcare ServicesTel AvivIsrael
  4. 4.University of Western OntarioLondonCanada
  5. 5.Child Development CenterMaccabi Healthcare ServicesHaifaIsrael
  6. 6.Child Neurology DepartmentRuth Rappaport Children’s Hospital, Rambam Health Care CampusHaifaIsrael

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