Consistency between parent report and direct assessment of development in toddlers with autism spectrum disorder and other delays: Does sex assigned at birth matter?
Parent report mostly matches direct testing, yet toddler girls with ASD get higher parent language scores and boys get lower receptive-motor scores.
01Research in Context
What this study did
James et al. (2023) compared what parents said about their toddlers with what trained testers saw.
All toddlers had autism or other delays. The team looked at every skill area and asked: do parents and testers give the same score?
They also asked: does the child’s sex assigned at birth change the answer?
What they found
Parents and testers mostly agreed. Yet parents rated their toddlers lower on two skills: understanding words and fine-motor play.
Sex mattered for talking. Parents of boys matched tester scores closely. Parents of girls slightly over-rated their child’s talking.
How this fits with other research
Nevill et al. (2019) already showed that one language test is never enough. Their data said, “Use two tools.” Stephen’s team adds, “And check the child’s sex, because parent words shift with girls.”
Fyfe et al. (2007) first mapped toddler sex differences: girls led in visual skills, boys in motor. Stephen’s work links those old profiles to parent-observer gaps today.
Clawson et al. (2020) found that autistic boys and their parents disagreed on puberty signs. Stephen shows the same rift can start at age two, but only for language.
Why it matters
When you screen a toddler, collect both parent report and direct test. If the child is a girl with ASD, double-check expressive-language scores; parents may paint a rosier picture. If the child is a boy with ASD, probe receptive and fine-motor items more, because parents may undersell them. One score is not the story—sex and source shape the plot.
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02At a glance
03Original abstract
The current study examined differences between parent report and diagnostician direct assessment of receptive language, expressive language, and fine motor abilities in toddlers with autism spectrum disorder (ASD) and other delays. Additionally, this study examined whether parent-diagnostician consistency varied by child diagnosis and sex assigned at birth (SAB). Initial mixed analysis of variances (ANOVAs) were conducted using data from a sample of 646 toddlers to examine whether parent-diagnostician consistency differed by child diagnosis. Matched samples (using child age, SAB, and nonverbal IQ) were then created within each diagnostic group and mixed ANOVAs were conducted to examine if consistency was similar in matched diagnostic subsamples and whether it differed by SAB. Findings from the full sample mostly replicated previous research that has documented consistency between parent report and direct observation regardless of child diagnosis. However, when examined in matched diagnostic subgroups, more nuanced patterns were observed. Parent report of receptive language was lower in ASD and ASD features subgroups and parent report of fine motor skills was lower than direct observation in the ASD, ASD features, and developmental delay groups. When examining the moderating effect of SAB, only expressive language was impacted for children in the ASD group. Results indicate the importance of considering child demographic characteristics and that child SAB may impact parent report and/or diagnostician perception of expressive language.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1097/DBP.0000000000001130