TY - JOUR T1 - Associations between autistic traits and early ear and upper respiratory signs: a prospective observational study of the Avon Longitudinal Study of Parents and Children (ALSPAC) geographically defined childhood population JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2022-067682 VL - 13 IS - 3 SP - e067682 AU - Amanda Hall AU - Richard Maw AU - Yasmin Iles-Caven AU - Steven Gregory AU - Dheeraj Rai AU - Jean Golding Y1 - 2023/03/01 UR - http://bmjopen.bmj.com/content/13/3/e067682.abstract N2 - Objective To determine whether early ear and upper respiratory signs are associated with the development of high levels of autistic traits or diagnosed autism.Design Longitudinal birth cohort: Avon Longitudinal Study of Parents and Children (ALSPAC).Setting Area centred on the city of Bristol in Southwest England. Eligible pregnant women resident in the area with expected date of delivery between April 1991 and December 1992 inclusive.Participants 10 000+ young children followed throughout their first 4 years. Their mothers completed three questionnaires between 18–42 months recording the frequency of nine different signs and symptoms relating to the upper respiratory system, as well as ear and hearing problems.Outcome measures Primary—high levels of autism traits (social communication, coherent speech, sociability, and repetitive behaviour); secondary—diagnosed autism.Results Early evidence of mouth breathing, snoring, pulling/poking ears, ears going red, hearing worse during a cold, and rarely listening were associated with high scores on each autism trait and with a diagnosis of autism. There was also evidence of associations of pus or sticky mucus discharge from ears, especially with autism and with poor coherent speech. Adjustment for 10 environmental characteristics made little difference to the results, and substantially more adjusted associations were at p<0.001 than expected by chance (41 observed; 0.01 expected). For example, for discharge of pus or sticky mucus from ears the adjusted odds ratio (aOR) for autism at 30 months was 3.29 (95% CI 1.85 to 5.86, p<0.001), and for impaired hearing during a cold the aOR was 2.18 (95% CI 1.43 to 3.31, p<0.001).Conclusions Very young children exhibiting common ear and upper respiratory signs appear to have an increased risk of a subsequent diagnosis of autism or demonstrated high levels of autism traits. Results suggest the need for identification and management of ear, nose and throat conditions in autistic children and may provide possible indicators of causal mechanisms.Data may be obtained from a third party and are not publicly available. ALSPAC data are available to researchers for particular projects, provided no attempt is made to reveal the identities of the subjects. Guidelines for access are found on the ALSPAC website: www.bristol.ac.uk/alspac/researchers. ER -