The Pull-to-Sit Task: Examining Infant Postural Development in Autism Spectrum Disorder

J Pediatr. 2023 Feb:253:225-231.e2. doi: 10.1016/j.jpeds.2022.09.047. Epub 2022 Oct 3.


Objective: To evaluate the predictive relationship between early trajectories of postural and head control during a pull-to-sit task and later autism diagnostic and developmental outcomes.

Study design: Using a prospective longitudinal design, postural skills of 100 infants at elevated and low familial likelihood of autism spectrum disorder (ASD) were evaluated using a pull-to-sit task monthly from age 1 month to 6 months. At age 24 months, infants were seen for a developmental and diagnostic evaluation completed by examiners masked to participant group. Latent growth curve models were used to compare early trajectories of pull-to-sit performance in infants later diagnosed with ASD and typically developing infants and to predict developmental outcomes.

Results: Pull-to-sit trajectories did not differ in infants with an elevated likelihood of ASD or infants with ASD compared with low-likelihood and typically developing infants, but infants with ASD were more likely to exhibit a head lag by age 4 months. In addition, pull-to-sit trajectories were predictive of social and speech skills 2 years later.

Conclusions: These findings highlight the link between very early pull-to-sit skills and later social and language outcomes. Atypical postural development and persistent presence of head lag may be important early indicators of social and language vulnerabilities, including ASD.

Keywords: NICU Network Neurobehavioral Scale; infant development; motor assessment; posture; sitting; social communication.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Autism Spectrum Disorder* / diagnosis
  • Autistic Disorder*
  • Child Development
  • Child, Preschool
  • Humans
  • Infant
  • Language
  • Prospective Studies