Autism spectrum disorder (ASD) is associated with brain overgrowth, but it has been unclear how this relates to behavioural symptoms. In a longitudinal neuroimaging study of young children at high familial risk of autism, Heather Hazlett and colleagues now show that high-risk children who receive a diagnosis of ASD at 24 months of age had an increased cortical growth rate at 6–12 months. Early overgrowth in high-risk children is associated with social impairments at 24 months, and imaging data obtained at 6 and 12 months can predict an ASD diagnosis at 24 months in high-risk children. These findings indicate that differences in the developmental trajectory towards ASD emerge as early as the first year of life.
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