Behavioral effects of fever and other illnesses on young children with autism

The purpose of this study is to determine the effects of fever on the behavior of young children (aged 2 to 7 years) with autism spectrum disorder (ASD), compared with a typically developing control group. Although clinical case reports have described behavioral changes in response to fever in children with ASD, few empirical investigations of this phenomenon have been conducted.

Cathy Lord and Somer Bishop and their teams will employ momentary sampling to record specific behavioral effects in response to febrile illness in children with ASD and typically developing children. In addition to measuring fever, other life events, including minor injuries, stomach upsets, respiratory infections and out-of-town trips, will be used as ‘comparison’ events to help distract families from reporting placebo effects in response to febrile events. Data collection will occur daily over three- to four-month periods from late fall through winter (when the rate of illness is higher) for three years. A total of 120 children, 80 with ASD and 40 controls, who have a history of fevers will be recruited each year across two sites: the Center for Autism and the Developing Brain of NewYork-Presbyterian Hospital and the STAR (Service, Training, Advocacy & Research) Center at the University of California, San Francisco. Given estimates from the Simons Simplex Collection data that about 19 percent of families report behavioral changes in response to fevers, the proposed sample size (240 children with autism and 120 typical controls) is sufficiently large to allow analysis of individual differences in how fever, and other illnesses and events, affect everyday behavior.

An iPhone app will be provided to families. This app will transmit temperatures, as well as parent/caregiver reports of activity level, negative mood and irritability, repetitive behaviors and social communication. Questions within the app will be developed based on information that Lord and her colleagues gained as part of an earlier SFARI-funded study in which they tested the feasibility and usefulness of various app-based methods of collecting behavioral data. Baseline data about child behavior problems, adaptive skills, level of language and severity of autism symptoms will be examined as moderating variables of changes in response associated with fever or other events, thus allowing the researchers to assess whether particular children respond to fever (and other life events) in different ways.

Information gained from the proposed research will significantly advance our understanding of whether and how behaviors of children with ASD are affected by fever, and how this differs in children with different phenotypic profiles.