Early joint attention abilities measured by the ADOS-2 predict subsequent expressive language development in minimally verbal autistic children

BackgroundMost preschool autistic children exhibit substantial language delays, yet only [~]25% remain minimally verbal (MV) throughout life. Previous studies have demonstrated that development of expressive language abilities is crucial for improving long-term outcomes. This study aimed to identify early predictors of later expressive language development specifically in MV preschool autistic children. MethodsWe analyzed prospective data collected from 99 MV autistic children, who were 27.7 months old at diagnosis, on average. All children completed an ADOS-2 assessment at diagnosis and again 12-24 months later. We classified children into three expressive language groups at follow up: MV, one-word phase, and phrases phase. Logistic regression analyses were used to identify significant predictors of expressive language abilities at follow up. Predictors included ADOS-2 social affect (SA) calibrated severity scores (CSS), ADOS-2 restricted and repetitive behavior (RRB) CSS, cognitive scores, and joint attention (JA) scores, derived from a summation of six ADOS-2 items. ResultsChildren who successfully developed expressive language abilities at follow-up (i.e., were in the one-word or phrases groups) had significantly lower ADOS-2 SA CSS and JA scores at diagnosis. Logistic regression analyses demonstrated that both ADOS-2 SA CSS and JA scores at diagnosis predicted expressive language outcomes while cognitive scores and ADOS-2 RRB CSS did not. Moreover, concurrent improvements in JA were significantly larger in children who developed expressive language. ConclusionsPreschool MV autistic children with better social abilities, and specifically JA abilities, at diagnosis were more likely to develop expressive language within 1-2 years. JA scores derived from the ADOS-2 offer an easily accessible and widely available measure with important prognostic value for these children.