Early developmental milestone clusters of autistic children based on electronic health records

ASD children vary in symptoms, co-morbidities and response to interventions. This study aimed to identify clusters of ASD children with a distinct pattern of attaining early developmental milestones. Clustering of 5,836 ASD children was based on attainment of 43 gross motor, fine motor, language and social developmental milestones in the first three years of life as recorded in baby wellness visits. K-means cluster analysis detected 4 Early Developmental Milestone (EDM) clusters: typical (n=1,686); mild (n=1,691); moderate (n=2,265); and severe (n=194). Most prominent cluster differences were in the language domain. The severe cluster showed earlier and greater developmental delay across domains, unique early gross motor delays, and more were born preterm via cesarian section. Moderate cluster had poor language development prominently in the second year of life, later fine motor delays. Mild cluster had language delays in the third year of life. The typical cluster mostly passed milestones. EDM clusters differed demographically, with higher socioeconomic status in typical cluster and lowest in severe cluster. Moderate cluster had more immigrant and non-Jewish mothers followed by the mild cluster. The rates of parental concerns and provider developmental referrals were significantly higher in the severe, followed by the moderate, mild, and typical EDM clusters. ASD children's language and motor delay in the first three years can be grouped by common magnitude and onset profiles as distinct groups that may link to specific etiologies (like prematurity or genetics) and to specific intervention programs. Early ASD screening should be tailored to these different developmental profiles. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement All phases of this study were supported by The Gertner Institute of Health Policy and Epidemiology, 2020.351. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of Israeli Ministry of Health gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data studied is confidential and belongs to the Israeli Ministry of Health.