About

Annette Estes, PhD, is a Research Professor and the Director of the UW Autism Center at the University of Washington. She holds the Susan and Richard Fade Endowed Chair and is a licensed psychologist in the state of Washington. Her academic expertise includes autism spectrum disorders, child development, clinical psychology, and early intervention. Dr. Estes's research is focused on supporting autistic individuals and their families through clinical services, research, and education. She has served as the principal investigator on clinical trials aimed at supporting young autistic children and collaborates with institutions such as UC Davis, Vanderbilt University, and the University of Michigan. She is also part of the Infant Brain Imaging Study (IBIS) Network, where she serves as co-principal investigator and directs the behavioral core, with the goal of improving early recognition of infants at high familial likelihood of autism and identifying brain mechanisms to develop new strategies for improving outcomes. Her work emphasizes the role of family support in fostering positive developmental outcomes for children with developmental disabilities.

Research topics

• Psychology
• Developmental psychology
• Audiology
• Medicine
• Clinical psychology

Selected publications

• Predicting Cognitive Outcomes by Mapping White Matter Tracts to Surface

  Lecture notes in computer science · 2026-01-01

  book-chapter
  PublisherDOI

• Early White Matter Microstructure Alterations in Infants with Down Syndrome

  Open MIND · 2026-02-05

  articleOpen access
  OA PDFDOI

• Enlarged Perivascular Spaces in Infancy and Autism Diagnosis, Cerebrospinal Fluid Volume, and Later Sleep Problems

  Open MIND · 2026-02-05

  articleOpen access

  Importance: Perivascular spaces (PVS) and cerebrospinal fluid (CSF) are essential components of the glymphatic system, regulating brain homeostasis and clearing neural waste throughout the lifespan. Enlarged PVS have been implicated in neurological disorders and sleep problems in adults, and excessive CSF volume has been reported in infants who develop autism. Enlarged PVS have not been sufficiently studied longitudinally in infancy or in relation to autism outcomes or CSF volume. Objective: To examine whether enlarged PVS are more prevalent in infants who develop autism compared with controls and whether they are associated with trajectories of extra-axial CSF volume (EA-CSF) and sleep problems in later childhood. Design, Setting, and Participants: This prospective, longitudinal cohort study used data from the Infant Brain Imaging Study. Magnetic resonance images were acquired at ages 6, 12, and 24 months (2007-2017), with sleep questionnaires performed between ages 7 and 12 years (starting in 2018). Data were collected at 4 sites in North Carolina, Missouri, Pennsylvania, and Washington. Data were analyzed from March 2021 through August 2022. Exposure: PVS (ie, fluid-filled channels that surround blood vessels in the brain) that are enlarged (ie, visible on magnetic resonance imaging). Main Outcomes and Measures: Outcomes of interest were enlarged PVS and EA-CSF volume from 6 to 24 months, autism diagnosis at 24 months, sleep problems between ages 7 and 12 years. Results: A total of 311 infants (197 [63.3%] male) were included: 47 infants at high familial likelihood for autism (ie, having an older sibling with autism) who were diagnosed with autism at age 24 months, 180 high likelihood infants not diagnosed with autism, and 84 low likelihood control infants not diagnosed with autism. Sleep measures at school-age were available for 109 participants. Of infants who developed autism, 21 (44.7%) had enlarged PVS at 24 months compared with 48 infants (26.7%) in the high likelihood but no autism diagnosis group (P = .02) and 22 infants in the control group (26.2%) (P = .03). Across all groups, enlarged PVS at 24 months was associated with greater EA-CSF volume from ages 6 to 24 months (β = 4.64; 95% CI, 0.58-8.72; P = .002) and more frequent night wakings at school-age (F = 7.76; η2 = 0.08; P = .006). Conclusions and Relevance: These findings suggest that enlarged PVS emerged between ages 12 and 24 months in infants who developed autism. These results add to a growing body of evidence that, along with excessive CSF volume and sleep dysfunction, the glymphatic system could be dysregulated in infants who develop autism.

  OA PDFDOI

• Adaptive Functioning Development in Infants With Agenesis of the Corpus Callosum

  PEDIATRICS · 2025-04-02 · 2 citations

  articleOpen access

  BACKGROUND AND OBJECTIVES: Agenesis of the corpus callosum (ACC) is a common congenital brain malformation. Early development in ACC remains unexamined, despite the increased likelihood for developmental delays and autistic behaviors. This study compares adaptive functioning in infants/toddlers with isolated ACC to children with other neurodevelopmental conditions and typical development. METHODS: Parents of children with ACC completed the Vineland Adaptive Behavior Scale Interview at 6, 12, 18, and 24 months as part of a prospective longitudinal study. Comparison groups included children with fragile X, Down syndrome, high familial likelihood of autism spectrum disorder (both with and without autism spectrum diagnosis), and typical development (total n = 957; total assessments = 2676). RESULTS: By 24 months, 29% of children with ACC were delayed in at least 1 domain. Linear mixed effect models showed significant group × time point interactions in all domains. Post-hoc comparisons revealed the ACC group had poorer performance in communication by 6, motor by 12, and daily living by 18 months but equivalent socialization compared with typically developing children; stronger skills across most domains and time points compared with genetic groups; and equivalent communication, stronger socialization, and weaker motor skills compared with the autism group. CONCLUSIONS: Although there is significant variability, on average, ACC compromises communication skills by 6 months, with reduced motor and daily living skills by 12 and 18 months, respectively. Multipronged intervention programs are needed for ACC beginning early in the first year of life, possibly leveraging early strengths in social skills.

  PublisherOA PDFDOI

• Brain Morphometry in Infants Later Diagnosed With Autism is Related to Later Language Skills

  Human Brain Mapping · 2025-05-01 · 1 citations

  articleOpen access

  Autism spectrum disorder (ASD) presents early in life with distinct social and language differences. This study explores the association between infant brain morphometry and language abilities using an infant-sibling design. Participants included infants who had an older sibling with autism (high likelihood, HL) who were later diagnosed with autism (HL-ASD; n = 31) and two non-autistic control groups: HL-Neg (HL infants not diagnosed with autism; n = 126) and LL-Neg (typically developing infants who did not have an older sibling with autism; n = 77). Using a whole-brain approach, we measured cortical thickness and surface area at 6 and 12 months and expressive and receptive language abilities at 24 months. Partial least squares correlation analyses were computed separately for each of the three groups. Results from the HL-ASD group indicated negative associations between surface area in the left inferior frontal gyrus and 24-month language abilities. Notably, regions outside the standard adult language network were also associated with language in the HL-ASD group. Results in the HL-ASD group highlight the distinct processing guiding development of surface area and cortical thickness; associations were mostly negative for surface area at 6 months but mostly positive for cortical thickness at the same time point. Results from this data-driven study align with the theory of interactive specialization-a theory highlighting the dynamic nature of the infant brain-and advocate for a whole-brain approach in investigating early brain-behavior neurodevelopment in ASD.

  PublisherOA PDFDOI

• Brain functional connectivity correlates of autism diagnosis and familial liability in 24-month-olds

  Journal of Neurodevelopmental Disorders · 2025-07-18 · 2 citations

  articleOpen access

  BACKGROUND: fcMRI correlates of autism spectrum disorder (ASD) diagnosis and familial liability were studied in 24-month-olds at high (older affected sibling) and low familial likelihood for ASD. METHODS: fcMRI comparisons of high-familial-likelihood (HL) ASD-positive (HLP, N = 23) and ASD-negative (HLN, N = 91), and low-likelihood ASD-negative (LLN, N = 27) 24-month-olds from the Infant Brain Imaging Study (IBIS) Network were conducted, employing object oriented data analysis (OODA), support vector machine (SVM) classification, and network-level fcMRI enrichment analyses. RESULTS: OODA (alpha = 0.0167, 3 comparisons) revealed differences in HLP and LLN fcMRI matrices (p = 0.012), but none for HLP versus HLN (p = 0.047) nor HLN versus LLN (p = 0.225). SVM distinguished HLP from HLN (accuracy = 99%, PPV = 96%, NPV = 100%), based on connectivity involving many networks. SVM accurately classified (non-training) LLN subjects with 100% accuracy. Enrichment analyses identified a cross-group fcMRI difference in the posterior cingulate default mode network 1 (pcDMN1)- temporal default mode network (tDMN) pair (p = 0.0070). Functional connectivity for implicated connections in these networks was consistently lower in HLP and HLN than in LLN (p = 0.0461 and 0.0004). HLP did not differ from HLN (p = 0.2254). Secondary testing showed HL children with low ASD behaviors still differed from LLN (p = 0.0036). CONCLUSIONS: 24-month-old high-familial-likelihood infants show reduced intra-DMN connectivity, a potential neural finding related to familial liability, while widely distributed functional connections correlate with ASD diagnosis.

  PublisherOA PDFDOI

• Anticipation of a therapeutic odyssey following predictive testing for autism.

  UNC Libraries · 2025-11-21

  articleOpen access

  Brain-based tools are being developed to identify infants at ultra-high likelihood for developing autism and enable presymptomatic intervention, though such interventions are not yet clinically available. Given persistent challenges in accessing autism services, we sought to understand how families might use early predictive results to seek support. We analyzed 55 interviews with parents of infants aged 6-13 months; one group had experience parenting an older autistic child (n = 30), the other had no prior autism parenting experience (n = 25). All parents were asked what steps they would take if told their infant was likely to develop autism. Both groups described an intent to find appropriate services; parents with prior autism experience provided more specifics based on prior knowledge. The groups diverged in their anticipated supports and information sources. Parents with autism experience anticipated seeking financial support via insurance and disability benefits; those without autism experience reported they would consult their pediatrician for information or search online. This qualitative study was conducted with a sample of parents selected for their specific life experiences, but likely does not capture the full range of potential responses to biomarker testing in infancy. Given that most services and benefits require a formal diagnosis, families receiving predictive results in infancy will likely face challenges finding appropriate services. Prior to implementing predictive testing in the first year of life, researchers should consider their obligation to support families who receive predictive results.

  PublisherDOI

• Corrigendum: Joint Attention and Brain Functional Connectivity in Infants and Toddlers

  UNC Libraries · 2025-06-26

  articleOpen access

  Corrigendum to "Joint Attention and Brain Functional Connectivity in Infants and Toddlers"

  PublisherDOI

• Human cortical organoids recapitulate inter-individual variability in infant brain-growth trajectories

  Cell stem cell · 2025-12-22 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Clarifying the developmental association between gesture and later vocabulary for autistic children

  Infant Behavior and Development · 2025-04-11 · 2 citations

  articleOpen access

  Gestures serve as both a communication and a word-learning tool, with typically developing children consistently showing that early gestures are positively associated with later vocabulary skills. However, many autistic children experience delays and challenges in both gesture and vocabulary skills, and studies also show mixed gesture-vocabulary associations; thus, it is unclear whether gestures in autistic children support emerging vocabulary skills. To address previous conflicting findings, the current conceptual replication study uses linear models with a large sample ( N = 451 ) of 12- to 24-month-old English-raised infants to investigate whether gestures are associated with expressive and receptive vocabulary. Using the infant-sibling design, gesture-vocabulary associations and group moderation were investigated in three groups: infant-siblings of autistic children who later meet the criteria for autism themselves (HL-ASD, n = 73), infant-siblings who did not meet criteria for autism (HL-Neg, n = 238), and a control group without a family history of autism (LL-Neg, n = 140). Both LL-Neg and HL-ASD groups showed positive associations between 12-month gestures and 18-month receptive vocabulary; however, only the LL-Neg group showed a positive association between 12-month gestures and 18-month expressive vocabulary. For 12-month gestures and 24-month receptive and expressive vocabulary, the LL-Neg and HL-Neg groups showed positive association, whereas the HL-ASD group did not. Similarly, the LL-Neg and HL-Neg groups showed positive associations between 18-month gestures and 24-month vocabulary, but the HL-ASD did not. Overall, the LL-Neg group showed significant gesture-vocabulary associations across all tested models, while the HL-ASD only showed one significant positive association. • Infant-sibling research designs can provide insights into the early identification of autism. • In the first two years of life, autistic children showed a weaker and less consistent gesture-vocabulary association compared to their non-autistic peers. • Gestures might not serve the same function in vocabulary development for young autistic children. • Despite a weaker relationship compared to their non-autistic peers, gesture interventions may still be effective for improving receptive vocabulary in autistic children.

  PublisherDOI

Recent grants

• NIH Grant P50HD055782

  NIH · $22.0M · 2013

Frequent coauthors

• Stephen R. Dager

  Seattle University

  413 shared

• Robert T. Schultz

  University of Pennsylvania

  405 shared

• Joseph Piven

  University of North Carolina at Chapel Hill

  335 shared

• Heather C. Hazlett

  University of North Carolina Health Care

  326 shared

• Kelly N. Botteron

  Washington University in St. Louis

  324 shared

• Sarah Paterson

  James S. McDonnell Foundation

  287 shared

• Martin Styner

  University of North Carolina at Chapel Hill

  267 shared

• Guido Gerig

  254 shared

Education

• Ph.D Clinical Child Psychology, Psychology

  University of Washington

  1998

Awards & honors

• Susan & Richard Fade Endowed Chair