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

Ayelet Ben-Sasson, Joshua Guedalia, Keren Ilan, Galit Shefer, Roe Cohen, Lidia V. Gabis

Research output: Contribution to journalArticlepeer-review


Autistic children vary in symptoms, co-morbidities, and response to interventions. This study aimed to identify clusters of autistic children with a distinct pattern of attaining early developmental milestones (EDMs). The clustering of 5836 autistic children was based on the attainment of 43 gross motor, fine motor, language, and social developmental milestones during the first 3 years of life as recorded in baby wellness visits. K-means cluster analysis detected four EDM clusters: mild (n = 1686); moderate (n = 1691); severe (n = 2265); and global (n = 194). The most prominent cluster differences were in the language domain. The global cluster showed earlier and greater developmental delay across domains, unique early gross motor delays, and more were born preterm via cesarean section. The severe cluster had poor language development prominently in the second year of life, and later fine motor delays. Moderate cluster had mainly language delays in the third year of life. The mild cluster mostly passed milestones. EDM clusters differed demographically, with higher socioeconomic status in mild cluster and lowest in global cluster. However, the severe cluster had more immigrant and non-Jewish mothers followed by the moderate cluster. The rates of parental concerns and provider developmental referrals were significantly higher in the global, followed by the severe, moderate, and mild EDM clusters. Autistic children's language and motor delay in the first 3 years can be grouped by common magnitude and onset profiles as distinct groups that may link to specific etiologies (like prematurity or genetics) and specific intervention programs. Early autism screening should be tailored to these different developmental profiles.

Original languageEnglish
JournalAutism Research
Early online date26 Jun 2024
StateE-pub ahead of print - 26 Jun 2024

Bibliographical note

Publisher Copyright:
© 2024 The Author(s). Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.


  • autism
  • children
  • clusters
  • developmental milestones
  • subgroups
  • trajectories

ASJC Scopus subject areas

  • General Neuroscience
  • Clinical Neurology
  • Genetics(clinical)


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