Neurology Practice Changers 2014

Bret S. Stetka, MD; Andrew N. Wilner, MD

Disclosures

December 08, 2014

In This Article

Early Intervention in Autism

Autism spectrum disorder (ASD) is characterized by communication difficulties; restricted, repetitive, and stereotyped patterns of behavior; and social impairments. Approximately 1% of children aged 8 years have ASD. The cause of ASD is unknown, but there is evidence of a genetic predisposition with presumed, as yet unidentified environmental contributing factors. Behavioral interventions can improve social and language skills, and medications are used to treat related problems, such as anxiety, depression, attention-deficit disorder, and obsessive-compulsive disorder.

Screening can identify infants with autistic features by the age of 12 months or even earlier, opening the door for therapeutic intervention. A pilot study suggests that very early intervention may be beneficial to long-term outcome.[30] In this study, seven infants ranging in age from 6 to 15 months who had scores of 7 or higher on the Autism Observation Scale for Infants (AOSI); scores on the Infant-Toddler Checklist in the risk range; and two or more target symptoms, defined as ratings of 2 or higher on related AOSI items and other criteria, participated in the Infant Start treatment program. This program consisted of 12 consecutive, weekly, 1-hour clinic sessions that focused on parent training to address six target symptoms.

When assessed at 36 months, only two of the seven infants who participated in Infant Start received a diagnosis of ASD. In contrast, among a control group of four children who would have been included in the therapeutic group but whose parents declined to participate, three children (75%) met criteria for ASD at the final visit.

Although the number of patients in this pilot study is very small, it is exciting to see such a positive impact on childhood development associated with early intervention in this devastating disorder. Larger, randomized controlled trials are needed to determine whether this type of intervention should be routinely applied to children with ASD.

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