The investigators also used the Autism Diagnostic Observation Schedule (ADOS), although it was not designed for children younger than 18 months. It includes semistructured, play-based assessment of social interaction, communication, play, and repetitive behaviors or interests.

ADOS scores were used with clinical judgment to classify children with autism spectrum disorder. Diagnosis as a study outcome was determined at 30 or 36 months "because diagnosis at that age is reliable," Dr. Landa and colleagues said.

In the high-risk group, 30 children were classified as having autism spectrum disorder.

Among them, 16 had a diagnostic impression of autism recorded at 14 months, and all but one of those who had a later diagnosis had been noted to have at least mild developmental impairment by 14 months.

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