Failure to respond to name is indicator of possible autism spectrum disorder

Article Outline

• Nadig AS, Ozonoff S, Young GS, Rozga A, Sigman M, Rogers SJ. A prospective study of response to name in infants at risk for autism. Arch Pediatr Adolesc Med 2007;161:378-83
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Nadig AS, Ozonoff S, Young GS, Rozga A, Sigman M, Rogers SJ. A prospective study of response to name in infants at risk for autism. Arch Pediatr Adolesc Med 2007;161:378-83 

Question Among children at high risk for autism, does failure to respond to name accurately predict a subsequent diagnosis of autism spectrum disorder (ASD)?

Design Prospective longitudinal study of infants at risk for autism.

Setting University medical center.

Participants Infants at risk for autism (55 age 6 months and 101 age 12 months) and a control group at no known risk (43 age 6 months and 46 age 12 months). To date, 46 at-risk infants and 25 control infants have been followed up to 24 months.

Intervention Experimental task eliciting response-to-name behavior.

Outcome Autism Diagnostic Observation Schedule, Mullen Scales of Early Learning.

Main Results At age 6 months, there was a nonsignificant trend for control infants to require a fewer number of calls to respond to name compared with the infants at risk for autism. At age 12 months, 100% of infants in the control group “passed,” responding on the first or second name call, compared with 86% in the at-risk group. Three-fourths of the children who failed the task were identified with developmental problems at age 24 months. Specificity of failure to respond to name was 0.89 for ASD and 0.94 for any developmental delay; sensitivity was 0.50 for ASD and 0.39 for any developmental delay. For a diagnosis of ASD, the likelihood ratios are 4.55 for a positive test and 0.56 for a negative test.

Conclusions Failure to respond to name by age 12 months is highly suggestive of developmental abnormality but does not identify all children at risk for developmental problems. Lack of response to name is not universal among infants later diagnosed with ASD and/or other developmental delays. Poor response to name may be a trait of the broader autism phenotype in infancy.

Commentary Developmental pediatricians have advocated for earlier diagnosis of autism because of growing evidence that early intervention may improve long-term outcomes. However, no single diagnostic test has been found to be reliable and valid. Retrospective studies using videotapes of children subsequently diagnosed with autism have suggested a consistently decreased response to name. This also has been seen in some prospective studies. The current study compared a group of high-risk children (infant siblings of a child diagnosed with autism) with a control group representative of the general population. By age 12 months, children who did not respond to their name were much more likely to be diagnosed with developmental delay or an ASD. Although the sensitivity was low, the specificity was decent, giving a positive likelihood ratio of 4.55 for the diagnosis of ASD. This was a small study, and the authors are still planning to follow all of the children to age 36 months. Larger numbers of children also will produce more stable estimates of sensitivity and specificity. In addition, this test was applied in a group of high-risk children, resulting in spectrum bias, and care needs to be taken when applying this to the general population of patients seen in practice. Nonetheless, response-to-name behavior is an easy and inexpensive test. A high-risk child who fails to respond to his or her name at 12 months should be referred for further testing.