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. 2014 Oct;53(10):1063-73.e5.
doi: 10.1016/j.jaac.2014.07.008. Epub 2014 Aug 13.

Early generalized overgrowth in autism spectrum disorder: prevalence rates, gender effects, and clinical outcomes

Daniel J Campbell  1 , Joseph Chang  2 , Katarzyna Chawarska  3
Affiliations

Early generalized overgrowth in autism spectrum disorder: prevalence rates, gender effects, and clinical outcomes

Daniel J Campbell et al. J Am Acad Child Adolesc Psychiatry. 2014 Oct.

Abstract

Objective: Although early head and body overgrowth have been well documented in autism spectrum disorder (ASD), their prevalence and significance remain unclear. It is also unclear whether overgrowth affects males and females differentially, and whether it is associated with clinical outcomes later in life.

Method: To evaluate prevalence of somatic overgrowth, gender effects, and associations with clinical outcomes, head circumference, height, and weight measurements were collected retrospectively between birth and 2 years of age in toddlers with ASD (n = 200) and typically developing (TD; n = 147) community controls. Symptom severity, verbal, and nonverbal functioning were assessed at 4 years.

Results: Abnormalities in somatic growth in infants with ASD were consistent with early generalized overgrowth (EGO). Boys but not girls with ASD were larger and exhibited an increased rate of extreme EGO compared to community controls (18.0% versus 3.4%). Presence of a larger body at birth and postnatal overgrowth were associated independently with poorer social, verbal, and nonverbal skills at 4 years.

Conclusion: Although early growth abnormalities in ASD are less common than previously thought, their presence is predictive of lower social, verbal, and nonverbal skills at 4 years, suggesting that they may constitute a biomarker for identifying toddlers with ASD at risk for less-optimal outcomes. The results highlight that the search for mechanisms underlying atypical brain development in ASD should consider factors responsible for both neural and nonneural tissue development during prenatal and early postnatal periods, and can be informed by the finding that early overgrowth may be more readily observed in males than in females with ASD.

Keywords: autism; gender; head circumference; infancy; overgrowth.

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Conflict of interest statement

Disclosure: Drs. Campbell, Chang, and Chawarska report no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1
Figure 1
A–C: Group differences in morphological measures: comparisons among groups with autism spectrum disorder (ASD) and typically developing (TD) groups in (A) head circumference, (B) height, and (C) weight, from birth to 24 months. Note: graphs display mean difference curves and 95% credible bands for ASD-TD differences in boys (left) and in girls (right). Separation of the 95% credible bands from 0 represents a statistically significant difference between means at the 0.05 level (two-sided).
Figure 2
Figure 2
A–B: Group differences in overall body size and relative head size: comparisons between groups with autism spectrum disorder (ASD) and typically developing groups (TD) in (A) overall body size (PC1) and (B) relative head size (PC2), from birth to 24 months. Note: graphs display mean difference curves and 95% credible bands for ASD-TD differences in boys (left) and in girls (right). Separation of the 95% credible bands from 0 represents a statistically significant difference between means at the 0.05 level (two-sided).
Figure 3
Figure 3
Group difference effect sizes. Note: Cohen’s d effect sizes for group differences as a function of time for overall body size (PC1); ASD = autism spectrum disorder; TD = typically developing.
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