Examining Risk, Resilience, and Protection in the Study of Autism Spectrum Disorder in Infancy Open Access

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. These symptoms present with enormous heterogeneity among individuals with ASD, though the developmental pathways toward such variable presentation are not well studied. ASD is one of the most highly heritable of all psychiatric disorders, suggesting a genetic etiology for the disorder, however current means of identifying infants at risk for ASD remain limited to variables that mark the probability for ASD outcome, rather than a risk factor marking experienced insults to the typical developmental trajectory. The absence of a truly measurable risk factor is limiting both clinically and methodologically. Without a clear quantifier of risk, it is impossible to identify processes that may ameliorate or protect against such risk and contribute to the heterogeneity of clinical presentation. The current dissertation introduces a framework for clearly quantifying and characterizing processes of risk, resilience, and protection into the study of ASD, aiming to reveal the mechanisms by which some infants at risk do not develop full ASD. Infant participants were drawn from a large longitudinal study and included a sample of infant siblings of children with ASD who had a higher likelihood of developing the disorder. The first study applies a risk, resilience, and protection framework to test several variables for their usability and potency as markers of measurable, experienced risk for ASD in infancy. Results reveal four factors as usable and potent predictors of ASD, though highlight the paucity of truly measurable markers of individual experienced risk. The second study introduces social visual engagement in the first 2-6 months of life as a marker of measurable, experienced risk. The risk, resilience, and protection framework is applied to assess this measure’s usability and potency as a risk factor and to test elements of early social communicative development as mechanisms of resilience, promoting adaptive development in the presence of risk. Results indicate receptive language and communication skill developed in the first year of life as a resilience factor. Results from both studies suggest future directions toward clarifying the role of protective factors, and the impact of risk and resilience results presented here for the hypothesized protective role of female biological sex.

Table of Contents

Chapter One: Dissertation General Introduction……………………………….1

           References………………………..…………………………………….………16

Chapter Two: Examining Concepts and Quantifications of Risk in the Study of Autism Spectrum Disorder in Infancy………23

           Introduction………………………………………..…………………………25

           Methods…………………………………...……………………………………32

           Results……………………………………………………………………………34

           Discussion………………………………………………………………………36

           References………………………………………………………………………44

           Appendix A: Tables………………………………...…………………………51

           Appendix B: Figures…………………………...…………………………….56

Chapter Three: Examining Concepts and Quantifications of Resilience in the Study of Autism Spectrum Disorder in Infancy…59

           Introduction………………………….......………………………………………61

           Methods……………………………………………………………………………70

           Results………………………………………………………………………………73

           Discussion…………………………………………………………………………78

           References…………………………………………………………...……………81

           Appendix C: Tables…...……………………………………………………….91

           Appendix D: Figures………………………………………………...…………93

Chapter Four: Dissertation General Conclusion, Implications of Risk and Resilience for Clarifying Protection……97

           References………………………………………………………………………….109

Acknowledgements………………………………………………………………………113

About this Dissertation

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School	Laney Graduate School
Department	Psychology
Subfield / Discipline	Clinical Psychology
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Psychology, Clinical Psychology, Developmental
Keyword	Resilience Risk Autism Spectrum Disorder Social Communication Infancy Protection
Committee Chair / Thesis Advisor	Klin, Ami, Emory University
Committee Members	Saulnier, Celine, Emory University Goodman, Sherryl, Emory University Bachevalier, Jocelyne, Emory University Jones, Warren, Emory University

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