Autism Intervention in Infants May Change Disorder's Course

Pam Harrison

September 09, 2014

(Updated Sept. 9, 2014) An intervention aimed at helping parents more successfully engage with their infants can reverse marked symptoms of autism and the usual pattern of developmental deceleration by the time infants reach the age of 36 months, preliminary reasearch shows.

Sally Rogers, PhD, professor of psychiatry and behavioral sciences, University of California, Davis, MIND Institute, Sacramento, California, and colleagues found that 6 out of 7 infants who received a parent-implemented interactive program exhibited normal patterns of both verbal and nonverbal development by the age of 36 months.

In contrast, 4 infants who did not receive the intervention continued to show significant developmental delays during the same follow-up period.

"We are now developing screening tools for identifying autism in children as young as 12 months of age, but we don't have any validated treatments for these infants yet," Dr. Rogers told Medscape Medical News. Dr. Rogers was responsible for developing the Infant Start therapy program.

"So this study was done to test a technique for supporting infants who had many symptoms of autism before the age of 12 months.

"And we found that most of the children in the study caught up in all of their learning skills and their language by the time they were 2 to 3 years of age, and for children who are achieving typical developmental rates, we are essentially curing their developmental delays."

The study was published on September 9 in the Journal of Autism and Development Disorders.

Recruitment Challenging

About half of the infants were identified through their participation in a prospective study of younger siblings of children with autism spectrum disorder (the Infant Sibling Project); the other half were referred by parents or clinicians to the program because of early signs of autism spectrum disorder (ASD).

The Infant Start intervention is based on the successful Early Start Denver Model (ESDM) intervention developed by Dr. Rogers and Geraldine Dawson, MD, professor of psychiatry, psychology, and pediatrics at Duke University in North Carolina. ESDM is provided in the home by trained therapists as well as parents during play and daily routines.

For the Infant Start program, therapists focused on coaching parents on how to interact with their infant during day-by-day interactions ― in floor play; play on the bed; and during diaper changing times, feeding times, bath times — "just the general ongoing activities that parents do because that is where most of the child-parent interactions occur in an infant's life," said Dr. Rogers.

"These are difficult babies to read," she explained.

"They were quiet babies, they did not babble, they did not use their voices to communicate their feelings or their faces or bodies to send or receive messages from their caregivers. They may have enjoyed the physical interactions initiated by their families, but they did not put out much effort to continue them. So these babies were not giving their parents very clear cues about what they liked or didn't like or what they wanted more of or less of, and we needed to look for very subtle cues of the infants' engagement or interest in order to help them get onto the parents' wavelength."

On treatment initiation, infants were aged 9 to 15 months, and all exhibited well-described symptoms of ASD ― repetitive actions and visual fixation with objects; little use of their voices or faces to communicate their feelings; few appeals for attention; and little effort to maintain any games their caregivers might have initiated.

"We worked with the parents for an hour a week for 12 weeks," Dr. Rogers said. During these hour-long sessions, researchers coached parents on ways in which they might increase infants' attention to their parents' faces and voices as well as how parents could initiate interactions that would attract their infants' attention and that made them both smile.

Parents were also taught to imitate the sounds and actions that their infants made and to use toys to support rather than compete with social attention.

Infant development and symptoms were assessed every 3 to 6 months until the age of 3, at which point most cases of autism can be diagnosed.

Several different groups of infants were used as comparators, the most important of which consisted of infants who had the same level of symptoms at treatment onset but whose parents chose not to participate in the study. Those infants were followed to the age of 36 months.

Same Skill Level

"Within 6 to 8 weeks, we found that parents were carrying out these kinds of interactions with their infants at the same skill level as trained therapists," Dr. Rogers reported.

Moreover, parents liked working with the therapist, she added: "They enjoyed carrying out the interventions at home, and they were highly satisfied with the intervention and found it easy to use and said they felt like more successful parents with these tools in hand."

As for the treated infants, researchers first saw a pattern of development typical for autistic children. Initially, children who go on to develop autism have relatively normal skills at the age of 6 months. However, from 6 to 12 months of age, they start to fall behind, and that pattern of "deceleration" continues through the first 3 years of life, resulting in considerable developmental delays, particularly in language and social skills.

In infants who received the Infant Start intervention, researchers observed the typical pattern of developmental deceleration out to about 15 to 18 months.

"But at 18 months, these infants showed a change, and their developmental rates started to accelerate again," Dr. Rogers said.

Indeed, only 2 out of these 7 infants had any ASD symptoms ― 1 had moderate symptoms, and 1 had milder symptoms. In addition, 6 out of the 7 infants in the intervention group did not show any signs of intellectual or developmental delay at 36 months.

In contrast, among the 4 untreated infants, 3 out of the 4 children developed autism, and the fourth child was diagnosed with intellectual disability at the age of 3, as Dr. Rogers noted.

"These data do not prove that this intervention prevented autism or changed the course of the disorder, so essentially, it was a proof-of-concept study where we wanted to see if we could recruit infants before their first birthday, if parents could learn an intervention and deliver it with a high level of skill, and whether developmental patterns could be changed over the course of 3 years," Dr. Rogers cautioned.

"So whether this type of specific intervention really can change the course of ASD onset really requires a randomized controlled trial, which I hope we will be able to do, and that's the next step."

Groundbreaking, Exciting

Commenting on the study for Medscape Medical News, Lisa Shulman, MD, director of the Rehabilitation, Evaluation and Learning for Autistic Infants and Toddlers at Einstein Program, Albert Einstein College of Medicine, New York City, said the researchers worked hard to use state-of-the-art identification methods to find symptomatic infants, not only infants at high risk for ASD, which was key.

She also thought highly of the intervention researchers provided, because it was based on the ESDM used in older children.

"This model really targets the core social communicative deficits of ASD in a meaningful way," Dr. Shulman said. "And the intervention they provided was again grounded in evidence-based methodology."

"We can't completely embrace the findings and change clinical practice at this very moment because this is a pilot study, as the authors note, and the treatment group consists of only 7 children," Dr. Shulman cautioned.

"It needs to be replicated, with a larger, more diverse group who have been randomized into treatment or control. But the study pulls together everything we know from research about the earliest identification of ASD and intervention, with an intervention provided by parents after a limited period of training. So I consider the study groundbreaking and exciting."

J Autism Dev Disord. Published online September 9, 2014.

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