Megan Brooks

June 06, 2012

June 6, 2012 (Toronto, Canada) — Weak head and neck control may be a red flag for autism spectrum disorder (ASD) and language and/or social developmental delays in high-risk infants, new research shows.

Results of a prospective study suggest that adding a simple "pull-to-sit" task to existing developmental screenings at pediatric well-child visits might improve early detection of developmental delays.

Poor postural control, defined as poor head control while being pulled up from a supine position during pull-to-sit maneuver, has been documented to be an early predictor of developmental problems in other populations, including children with cerebral palsy and preterm infants. This study, the authors report, is the first to investigate postural control in infants at risk for autism.

Led by Rebecca J. Landa, PhD, director of the Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, the study was presented here at the 11th Annual International Meeting for Autism Research (IMFAR).

Tip-off to Problems

Typically developing infants achieve postural control by 4 months of age. Dr. Landa's group examined the association between poor postural control (head lag) at 6 months of age in high-risk infants and diagnosis of autism at 36 months.

They tested the infants' ability to maintain head alignment when being carefully, yet firmly, pulled by the arms from lying flat on their back to a sitting position.

The infants were scored according to whether their head maintained alignment with the spine or was in front of the spine during the task. Lack of this head control indicated head lag.

They found that head lag at 6 months of age was significantly associated with ASD at 36 months (P = .02). According to the researchers, 90% of infants diagnosed with ASD and 54% of those meeting criteria for social/communication delay exhibited head lag as infants. In comparison, 35% of children not meeting the criteria for social or communication delay or ASD exhibited head lag at 6 months.

The researchers also compared the prevalence of head lag in 20 infants at high risk for ASD and 21 at low risk for ASD. They found that head lag was present significantly more often in the high-risk infants (P = .018). Fifteen (75%) of 20 high-risk infants had head lag compared with 7 (33%) of 21 low-risk infants.

Clinical Implications

"Our findings show that the evaluation of motor skills should be incorporated with other behavioral assessments to yield insights into the very earliest signs of autism," Dr. Landa said in a prepared statement.

"While more research is needed to examine why not all children with ASD experience motor delay, the results of our studies examining motor development add to the body of research demonstrating that early detection and intervention for infants later diagnosed with autism is possible and remains crucial to minimize delays and improve outcomes," Dr. Landa added.

The study was supported by the National Institutes of Mental Health, Autism Speaks and the Karma Foundation. The authors have disclosed no relevant financial relationships.

11th Annual International Meeting for Autism Research (IMFAR). Abstract 9882. Presented May 18, 2012.

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