Big gains when autism therapy starts early
UC DAVIS (US) — An early intervention for autism improves social skills and normalizes brain activity in young children, a new study shows.
“We know that infant brains are quite malleable and previously demonstrated that this therapy capitalizes on the potential of learning that an infant brain has in order to limit autism’s deleterious effects,” says study author Sally Rogers, professor of psychiatry and behavioral sciences at the University of California, Davis, and a researcher with the UC Davis MIND Institute.
“The findings on improved behavioral outcomes and the ability to normalize brain activity associated with social activities signify that there is tremendous potential for the brains of children with autism to develop and grow more normally,” she says.
Published in the Journal of the American Academy of Child & Adolescent Psychiatry, the randomized, case-controlled, multi-centered study found that the children who received intervention exhibited greater brain activation when viewing faces rather than objects, a response that was typical of the normal children in the study, and the opposite of the children with autism who received other intervention.
The US Centers for Disease Control and Prevention estimates that 1 in 88 children born today will be diagnosed with autism spectrum disorder. Hallmarks of the neurodevelopmental condition include persistent deficits in social communication and relatedness, and repetitive or restrictive patterns of interest that appear in early childhood and impair everyday functioning.
Named the Early Start Denver Model (ESDM), the intervention method fuses a play-based, developmental, relationship-based approach and the teaching methods of applied behavioral analysis. It was developed by Rogers and Geraldine Dawson, chief science officer of the research and advocacy organization Autism Speaks.
New target identified
“This may be the first demonstration that a behavioral intervention for autism is associated with changes in brain function as well as positive changes in behavior,” says Thomas R. Insel, director of the National Institute of Mental Health, which funded the study. “By studying changes in the neural response to faces, Dawson and her colleagues have identified a new target and a potential biomarker that can guide treatment development.”
For the study, researchers recruited 48 diverse boys and girls diagnosed with autism between 18 and 30 months in Sacramento, Calif., and in Seattle, as well as typically developing case controls. The ratio of boy-to-girl participants was more than 3-to-1. Autism is five times more common among boys than girls.
Approximately half of the children with autism were randomly assigned to receive the ESDM intervention for more than two years. The participants received ESDM therapy for 20 hours each week, and their parents also were trained to deliver the treatment, a core feature of the intervention. The other participants with autism received similar amounts of various community-based interventions as well as evaluations, referrals, resource manuals, and other reading materials.
At the study’s conclusion, the participants’ brain activity was assessed using electroencephalograms (EEGs) that measured brain activation while viewing social stimuli—faces—and non-social stimuli—toys. Earlier studies have found that typical infants and young children show increased brain activity when viewing social stimuli rather than objects, while children with autism show the opposite pattern.
Twice as many of the children who received the ESDM intervention showed greater brain activation when viewing faces rather than when viewing objects—a demonstration of normalized brain activity. Eleven of the 15 children who received the intervention, 73 percent, showed more brain activation when viewing faces than toys. Similarly, 12 of the 17 typically developing children, or 71 percent, showed the same pattern.
But the majority—64 percent—of the recipients of the community intervention showed the opposite, “autistic” pattern, i.e., greater response to toys than faces. Only 5 percent showed the brain activation of typical children.
Further, the children receiving ESDM who had greater brain activity while viewing faces also had fewer social-pragmatic problems and improved social communication, including the ability to initiate interactions, make eye contact. and imitate others, Rogers says.
Use of the intervention has been shown to improve cognition, language, and daily living skills. A study published in 2009 found that recipients showed more than three times as much gain in IQ and language than the recipients of community interventions.
“This is the first case-controlled study of an intensive early intervention that demonstrates both improvement of social skills and normalized brain activity resulting from intensive early intervention therapy,” says Dawson, the study’s lead author and professor of psychiatry at the University of North Carolina, Chapel Hill.
“Given that the American Academy of Pediatrics recommends that all 18- and 24-month-old children be screened for autism, it is vital that we have effective therapies available for young children as soon as they are diagnosed.
“For the first time,” she says, “parents and practitioners have evidence that early intervention can alter the course of brain and behavioral development in young children. It is crucial that all children with autism have access to early intervention which can promote the most positive long-term outcomes.”
Researchers from the University of Washington and Vanderbilt University were also co-authors on the study that was funded by the National Institute of Mental Health and by a postdoctoral fellowship to Jones from Autism Speaks.
Source: UC Davis