title: Age-related differences in prevalence of autism spectrum disorder symptoms in children and adolescents with Costello syndrome.
abstract: Dysregulation of the mitogen activated protein kinase (MAPK) pathway in Costello syndrome (CS) may contribute to increased risk for autism-spectrum disorder (ASD). We examined prevalence of ASD symptoms in 14 individuals (six females) age 1-18 years with molecularly confirmed CS. Caregivers completed the Modified Checklist for Autism in Toddlers (M-CHAT) for ages 0-4 years (n = 7), and the Social Communication Questionnaire (SCQ) for ages 4 and older (n = 7). Age was associated with meeting ASD criteria: 5/7 (71.4%) younger children met the ASD cut-off on the MCHAT, compared to 0/7 older children on the SCQ. The following medical and developmental factors were strongly associated with ASD criteria on the M-CHAT: having a gastrostomy tube at time of assessment, not eating solid food, not walking, and not being toilet trained. Two children who met stricter ASD criteria had significantly lower adaptive functioning and were physically much more impaired. Among older participants, SCQ subscale scores in communication, socialization, and repetitive behavior domains were comparable to the typically-developing normative sample. ASD symptoms were highly elevated in younger CS individuals. Older children did not differ from typically developing samples in prevalence of ASD symptoms. CS individuals may appear to fall on the autism spectrum in early childhood due to severe feeding and orthopedic problems that improve by age four, suggesting many of these children may eventually emerge out of an ASD presentation.
authors.affiliation: Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
authors.forename: David D
authors.initials: DD
authors.lastname: Schwartz
authors.affiliation: Department of Psychology, Johns Hopkins Medicine, All Children's Hospital, St. Petersburg, Florida.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Katzenstein
authors.affiliation: Pediatric Neurobehavioral Group, Indianapolis, Indiana.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Highley
authors.affiliation: Biomedical Research, A. I. DuPont Hospital for Children, Wilmington, Delaware.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Stabley
authors.affiliation: Biomedical Research, A. I. DuPont Hospital for Children, Wilmington, Delaware.
authors.forename: Katia
authors.initials: K
authors.lastname: Sol-Church
authors.affiliation: Medical Genetics, A. I. DuPont Hospital for Children, Wilmington, Delaware.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Gripp
authors.affiliation: Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
authors.forename: Marni E
authors.identifier: http://orcid.org/0000-0002-8865-971X
authors.initials: ME
authors.lastname: Axelrad
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000067877:Autism Spectrum Disorder / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D056685:Costello Syndrome / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012919:Social Behavior; D011795:Surveys and Questionnaires
keywords: Costello syndrome; autism spectrum disorder; genetics