Video Program May Prevent Autism in High-Risk Infants

Megan Brooks

January 22, 2015

Parents may be able to lower the risk for autism in at-risk infants by learning how to get more in tune with their baby's communication style, results of a novel study suggest.

Using videotaped parent and child interactions and parent feedback from therapists, parents were able to learn to more effectively interact with their child in the first year of life, which led to increased engagement and attentiveness in their infants.

"Children with autism typically receive treatment beginning at 3 to 4 years old. But our findings suggest that targeting the earliest risk markers of autism — such as lack of attention or reduced social interest or engagement — during the first year of life may lessen the development of these symptoms later on," Jonathan Green, MBBS, FRCPsych, lead author and professor of child and adolescent psychiatry at the University of Manchester, United Kingdom, said in a statement.

The study was published online January 22 in Lancet Psychiatry.

Altered Trajectory

The study involved 54 families participating in the British Autism Study of Infant Siblings (BASIS) with at least one autistic child. Studies suggest that about 20% of infants with an older sibling with an autism spectrum disorder (ASD) develop ASD themselves.

Twenty-eight families were randomly assigned to a specially adapted Video Interaction for Promoting Positive Parenting Programme (iBASIS-VIPP); 26 were randomly assigned to receive no intervention. The intervention group received at least six home-based visits from a therapist who used video feedback to help parents understand and respond to their infant's style of communication with the goal of improving infant attention, communication, early language development, and social engagement.

"This therapy has an evidence base for changing relevant aspects of parental interactive behavior in infancy contexts other than autism," the investigators write.

The high-risk infants were assessed at baseline when they were 7 to 10 months old and again 5 months after the intervention or after receiving no intervention.

"The intervention was very acceptable and easily accessed and enjoyed by parents," Dr Green said during a press briefing, and parents were "very successful in working with us" to learn to recognize how their baby communicates.

After 5 months, infants in the intervention group showed improvements in several known ASD risk markers, including engagement, attention, and social behavior.

"Although CIs [confidence intervals] sometimes include the null, point estimates suggest that the intervention increased the primary outcome of infant attentiveness to parent (effect size 0.29, 95% CI -0.26 to 0·86, thus including possibilities ranging from a small negative treatment effect to a strongly positive treatment effect)," the investigators report.

Of note, infants receiving the intervention showed increased "flexibility" in their attention, as determined on the basis of objective eye-tracking technology. "Increasingly sticky or less flexible attention" is a well-known early risk marker for later ASD, Prof Green explained, and this was improved by the intervention. "We know that flexible attention shifting is important for learning and social interaction," added Teodora Gliga, from the Centre for Brain and Cognitive Development, Birkbeck College, London, who worked on the study.

The infants also showed improved social behavior with people other than their parents.

Early Plasticity

Compared with control infants, intervention infants showed a reduction in autism-risk behaviors, as assessed by the Autism Observation Scale for Infants (effect size 0.50; 95% CI, -0.15 to 1.08), suggesting that video-based therapy may help modify the emergence of autistic behaviors during early development.

There was a suggestion of a "nil or negative effect" on language, but Prof Green said this appeared to be only a "temporary blip, as it were, as we've understood now, looking a bit later in their development."

Overall, the intervention "improved these risk markers for autism, and therefore logically we can say we potentially lowered the risk of later autism development in these infants," Prof Green said.

"Overall, we are excited by these findings. It's the first time that a study of this kind has been done, a randomized trial in the first year of life to intervene in this way, capitalizing on early plasticity, and we think we've had success in shifting the targeted areas of intervention in a positive way," Prof Green added.

"One of the great benefits of a parent-mediated intervention of this kind is that once the parent is skilled up in this way, the therapy as it were goes on 24/7," he noted. The next phase is to follow the infants to age 3 years for development of autism.

In an accompanying commentary, Catherine Lord, PhD, director of the Center for Autism and the Developing Brain, Weill Cornell Medical College/New York–Presbyterian Hospital, in White Plains, New York, said this "carefully designed and thoughtfully presented study...offers the possibility of providing a focused low-intensity intervention on the basis of risk, without the need to identify a specific condition such as Autism Spectrum Disorder."

"Although early biomarkers are, of course, still of great interest in neurobiology, a focus on identification and then treatment of behavioral deficits that restrict a child's opportunities to learn might provide an equally effective initial treatment as more specific approaches aimed at changing a diagnosis that is more cost-effective," Dr Lord added.

It is not the first time a parent-mediated intervention has shown promise. Last year, researchers at the University of California, MIND Institute, in Sacramento, reported that 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.

Funding for the current study was provided by Autistica, the Waterloo Foundation, Autism Speaks, and the UK Medical Research Council. The authors and Dr Lord have reported no relevant financial relationships.

Lancet Psychiatry. Published online January 22, 2015. Full text, Commentary

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