AUTISM : INFANT INTERVENTION ELIMINATES SYMPTOMS
Treatment at the
earliest age when symptoms of autism spectrum disorder (ASD) appear --
sometimes in infants as young as 6 months old -- significantly reduces symptoms
so that, by age 3, most who received the therapy had neither ASD nor
developmental delay, a UC Davis MIND Institute research study has found.
The treatment, known
as Infant Start, was administered over a six-month period to 6- to 15-month-old
infants who exhibited marked autism symptoms, such as decreased eye contact,
social interest or engagement, repetitive movement patterns, and a lack of
intentional communication. It was delivered by the people who were most in tune
with and spent the most time with the babies: their parents.
"Autism
treatment in the first year of life: A pilot study of Infant Start, a
parent-implemented intervention for symptomatic infants," is co-authored
by UC Davis professors of Psychiatry and Behavioral Sciences Sally J. Rogers
and Sally Ozonoff. It is published online in the Journal of Autism and Developmental Disorders.
"Most of the
children in the study, six out of seven, caught up in all of their learning
skills and their language by the time they were 2 to 3," said Rogers, the
study's lead author and the developer of the Infant Start therapy. "Most
children with ASD are barely even getting diagnosed by then."
"For the
children who are achieving typical developmental rates, we are essentially
ameliorating their developmental delays," Rogers said. "We have
speeded up their developmental rates and profiles, not for every child in our
sample, but for six of the seven."
Rogers credited the
parents in the small, pilot study with making the difference.
"It was the
parents -- not therapists -- who did that," she said. "Parents are
there every day with their babies. It's the little moments of diapering,
feeding, playing on the floor, going for a walk, being on a swing, that are the
critical learning moments for babies. Those moments are what parents can
capitalize on in a way that nobody else really can."
Early identification
crucial
Children diagnosed
with autism typically receive early intervention beginning at 3 to 4 years, six
to eight times later than the children who participated in the study. But the
earliest symptoms of autism may be present before the child's first birthday.
Infancy is the time when children first learn social interaction and
communication, so autism researchers and parents of children with the condition
have been working to identify autism and begin intervention sooner.
Effective autism
treatment relies on early detection so that a child can begin therapy as soon
as possible, to prevent or mitigate the full onset of symptoms and sometimes
severe and lifelong disability.
"We were very
fortunate to have this treatment available for the affected infants identified
through our study," said Ozonoff, who directs the MIND Institute's Infant
Sibling Study, an early detection project that follows babies at risk for
autism or ADHD from birth through age 3.
"We want to
make referrals for early intervention as soon as there are signs that a baby
might be developing autism," Ozonoff said. "In most parts of the
country and the world, services that address autism-specific developmental
skills are just not available for infants this young."
Of the seven babies
in the study, four were part of the Infant Sibling Study. In addition to these
four, the other three children were referred by community parents. The
treatment group was compared with four other groups of children that included:
High-risk children with older siblings with autism who did not
develop autism
Low-risk children who were the younger siblings of typically
developing children
Infants who developed autism by the age of 3
Children who also had early autism symptoms but chose to receive
treatment at an older age
Treatment based on
Early Start Denver Model
The treatment was
based on the highly successful Early Start Denver Model (ESDM) intervention
developed by Rogers and her colleague, Geraldine Dawson, professor of
psychiatry, psychology and pediatrics at Duke University in North Carolina.
ESDM is usually provided in the home by trained therapists and parents during
natural play and daily routines.
Parents were coached
to concentrate their interactions on supporting their infants' individualized
developmental needs and interests, and embedded these practices into all of
their play and caretaking, focusing on creating pleasurable social routines to
increase their children's opportunities for learning. Parents were encouraged
to follow their infants' interests and subtle cues and gauge activities in ways
that optimized their child's attention and engagement. The intervention focused
on increasing:
Infant attention to parent faces and voices
Parent-child interactions that attract infants' attention,
bringing smiles and delight to both
Parent imitation of infant sounds and intentional actions
Parent use of toys to support, rather than compete with, the
child's social attention
The treatment
sessions included:
Greeting and parent progress sharing
A warm-up period of parent play, followed by discussion of the
activity and intervention goals
Discussion of a new topic, using a parent manual
Parents interacting in a typical daily routine with their child
while fostering social engagement, communication and appropriate play, with
coaching from therapists
Parents practicing the approach with their child across one or
two additional home routines with toys or caregiving activities
Autism scores
lowered by 18 to 36 months
All of the
participants who received treatment were between 6 and 15 months old, lived
within a one-hour drive of the MIND Institute, and came from families where
English was the primary language. They had normal vision and hearing and no
significant medical conditions. All received assessments prior to their
participation and at multiple points throughout the study. The treatment group
of seven children received scores on the Autism Observation Scale for Infants
(AOSI) and the Infant-Toddler Checklist that indicated they were highly symptomatic
and at risk of developing ASD. Their symptoms also elicited clinical concern
from professors Rogers and Ozonoff.
The study measured
the children's and parents' responses to the intervention. Treatment began
immediately after enrollment and consisted of 12 one-hour sessions with infant
and parent. It was followed by a six-week maintenance period with biweekly
visits, and follow-up assessments at 24 and 36 months. The treatment sessions
focused on parent-child interactions during typical daily life and provided
parent coaching as needed to increase infant attention, communication, early
language development, play and social engagement
The children who
received the intervention had significantly more autism symptoms at 9 months,
but significantly lower autism severity scores at 18- to 36-months of age, when
compared with a small group of similarly symptomatic infants who did not
receive the therapy. Overall, the children who received the intervention had
less impairment in terms of autism diagnosis, and language and development
delays than either of the other affected groups
Treating severe
disability
Given the
preliminary nature of the findings, the study only suggests that treating these
symptoms so early may lessen problems later. Larger, well controlled studies
are needed to test the treatment for general use. However, the researchers said
that this initial study is significant because of the very young ages of the
infants, the number of symptoms and delays they exhibited early in life, the
number of comparison groups involved, and because the intervention was low
intensity and could be carried out by the parents in everyday routines
"I am not
trying to change the strengths that people with ASD bring to this world,"
Rogers said when asked whether she is seeking to "cure" autism.
"People with
ASD contribute greatly to our culture," she said. "The diversity of
human nature is what makes us a powerful and strong species. We are trying to
reduce the disability associated with ASD."
"My goal is for
children and adults with autism symptoms to be able to participate successfully
in everyday life and in all aspects of the community in which they want to
participate: to have satisfying work, recreation, and relationships, education
that meets their needs and goals, a circle of people they love, and to be
generally happy with their lives."
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