Early intervention with infants at risk of autism through therapy led by their parents improves the child’s social development to such an extent they are two-thirds less likely to meet the clinical criteria for an autism diagnosis, according to world-first research by the Telethon Kids Institute.
The groundbreaking study, published in JAMA Pediatrics, is the first time pre-emptive intervention with children as young as one or two has been shown to so significantly reduce autism-related behaviours.
Advocacy group Autism Awareness said the research signaled the need for a complete rethink of early childhood approaches to autism “to give our children a chance to have their best outcome in life”.
‘A bit of a holy grail’ in child health
The international research team, which included La Trobe University, the University of Western Australia, and the University of Manchester, was led by Telethon Kids Institute Professor Andrew Whitehouse, who described the findings as a true breakthrough moment.
“This is a bit of a holy grail in the area of child health,” Professor Whitehouse said.
“What we have found is providing a new clinical model, identifying children as early as possible in life, providing supportive intervention to help them be who they want to be, we can actually reduce the clinical criteria for autism by two-thirds.
“The potential for what this means for our society is quite staggering.
“When we think about 53 per cent of all children within the NDIS have a diagnosis of autism, we start to understand how significant this finding could be.”
Typically children are diagnosed with autism at about the age of three, which is when therapies usually start.
Professor Whitehouse said this meant nothing was happening in the first couple of years after a child’s birth when the brain was developing rapidly and therapies may have more effect.
Taking the opposite approach
The researchers wanted to test if they could provide therapy in those early years to better support the child’s development and reduce the likelihood or intensity of disabilities.
They worked with WA’s Child and Adolescent Health Service to identify children at risk of autism, whose siblings may have autism or who had early behavioural signs of autism.
It was a four-year clinical trial with 89 infants aged from 9-14 months. Over five months, half received the intervention and half did not.
Professor Whitehouse said most therapies or interventions for autism tried to replace or shape the developmental differences in children with more “typical” behaviours.
They took the opposite approach.
“What we wanted to do was to identify the unique behaviours of each and every baby and use those strengths as a foundation for future development,” Professor Whitehouse said.
They videotaped the parents and children playing and interacting and then gave them feedback on the unique way their child was communicating, to help the parents interact with their children.
They wanted to boost the back-and-forth communications between the parent and the child as the building blocks for brain development.
“What we’re doing is helping give the parents the secret as to how their baby’s communicating with them through their body, through their face, through their vocal expressions and how they can best communicate back to get those back and forth interactions to build the brain,” Professor Whitehouse said.
Children less likely to meet autism criteria after therapy
“What we found at three years of age is the babies who had received our therapy had significantly reduced autism behaviours compared to a control group. And the therapy was so effective that actually the children who received the therapy were less likely to meet the clinical criteria for an autism diagnosis.
“The children who received our therapy, they were two-thirds less likely to meet criteria for autism. That’s a huge reduction.
“That’s the first time that’s ever been found in the world.”
The research found providing support very early in life could alter the developmental trajectories of children and potentially change the course of their life.
‘The tiny, subtle clues’
Perth woman Alianna Celisano said that was very much the case for her and her family.
She and her 18-month-old daughter Angelina participated in the study. Ms Celisano said her daughter was in an at-risk category because her eight-year-old son, Michele, had been diagnosed with autism.
Over 10 sessions lasting about 75 minutes each, a researcher would observe and video record them as she and Angelina played with toys, read a book or had a meal.
The researcher would go through the footage with her and closely discuss the interactions between mother and daughter.
“What was really interesting was the really tiny, subtle cues that in the business of life are often missed,” Ms Celisano said.
“So because I could see that and then I was able to reflect on my own facial expressions and body language, I was able to adapt it and optimise it, so each time I was interacting with Angelina, I was thinking, ‘How am I expressing myself to her and how can I do it in a way that helps her engagement and helps her develop even further?’ “
Ms Celisano believed participating in the study had helped shape her daughter’s brain at a critical stage of her development.
“I do think she’s grown,” she said. “She loves people, she’s very, very social and she engages beautifully. And I have to say I think a lot of it comes down to what we learned in the research study.”
‘Radical change’ possible from limited amount of work
Autism Awareness chief executive Nicole Rogerson said the research demonstrated how much good could be achieved from this form of early intervention.
“What this research has shown is what a limited amount of work very early that could be done could have a radical change for these children and their ultimate outcome,” she said
“This research shows us we have to look at early childhood completely differently. We can’t wait until children are three or four years old to see where they are developmentally.
If we see some warning signs at that 12-month age it is absolutely imperative we get started. And this research shows the great outcomes for these kids.
“If we’ve helped their communication, if we helped those social skills, if we’ve made it more likely that they’re going to go on to have an independent life and be successful in school, then it’s incumbent on us, we have to do it.”
Parents not to blame
Addressing concerns that without an Autism diagnosis the children would not get funding for services, the researchers said the study’s findings highlighted the importance of needs-based services, rather than diagnosis-based services.
They noted funding through the NDIS was already based on needs and not diagnosis.
They argued by providing therapy based on the unique needs of each infant, rather than a general diagnosis, the study had demonstrated significant benefits to development.
The researchers stressed parent-child interactions were not the cause of autism and parents were not to blame in any way, rather children were born with a developmental vulnerability that was related to genetics.
“What we’re saying is parent-child interactions are a powerful tool through which we can support brain development for developmentally vulnerable kids,” Professor Whitehouse said.Internet Explorer Channel Network