The Weak Link: Hypotonia in Infancy and Autism Early Identification
Front. Neurol., 04 February 2021. Sec. Pediatric Neurology, Volume 12 – 2021 | https://doi.org/10.3389/fneur.2021.612674
The Weak Link: Hypotonia in Infancy and Autism Early Identification
Lidia V. Gabis1,2*, Meirav Shaham3, Odelia Leon Attia1, Shahar Shefer1, Ruth Rosenan1, Tal Gabis4 and Michal Daloya3
1Weinberg Child Development Center at Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel
2Sackler Faculty of Medicine at Tel Aviv University, Tel Aviv, Israel
3Department of Statistics, University of Haifa, Haifa, Israel
4Faculty of Medicine, Charles University, Prague, Czechia
Background: Presenting symptoms and age specific differential diagnosis of Autism Spectrum Disorder (ASD), determine the age of initial assessment and the age of a definite diagnosis. The AAP recommends screening all children for ASD at 18 and 24 months followed by a comprehensive evaluation for children with developmental concerns. More recently it has been recommended that the evaluation should be performed at a younger age, with a diagnosis being made as early as the beginning of the second year of life resulting in earlier intensive intervention.
Objective: To assess early developmental milestones in a cohort of children diagnosed with Autism Spectrum Disorder (ASD) in order to find an objective and reliable early marker. We suggest that low muscle tone- hypotonia, is a sign that meets the above criteria of consistency and reliability and may be related to early diagnosis.
Methods: We compared age distributions of ASD diagnosis in the presence of hypotonia in a dataset of 5,205 children diagnosed at Keshet Center. One thousand, one hundred eighty-two children (953 males) were diagnosed with ASD and compared to other developmental diagnoses. Within the ASD cohort we further analyzed for gender and pre-maturity differences.
Results: In the presence of hypotonia, the mean age for ASD diagnosis was significantly lower (by 1.5 years for males and females) and this effect increased in children born at term as compared to pre-maturity.
Conclusions: Hypotonia is a recognizable marker of ASD and may serve as a “red flag” to prompt earlier recognition and neurodevelopmental evaluation toward an autism diagnosis.
