By combining early diagnosis with parent-delivered therapy, a new pilot study shows that treatment for autism spectrum disorder can be successful for kids as young as 6 months of age.
At the start of the study, which was published today in the Journal of Autism and Developmental Disorders, the infants ranged from 6 to 15 months old. They all displayed symptoms of autism, such as decreased social interest and lack of eye contact and communication.
Over the course of 12 sessions, parents learned new ways to interact with their children during play and other daily routines. The goal of this training was to increase the infants' social interactions and how much attention they paid to their parents' faces and voices.
By age 3 — an age when many children with autism are just being diagnosed — most of the infants who received the therapy were developmentally back on track.
"Most of the children in the study, six out of seven, caught up in all of their learning skills and their language by the time they were 2 to 3,” said study author Sally Rogers, a professor of psychiatry and behavioral sciences at the University of California, Davis. “We are essentially curing their developmental delays.”
Study Combines Early Diagnosis and Treatment
The study brings together multiple areas of autism research, including an emphasis on early diagnosis and treatment. The brain is developing rapidly in infancy and is more plastic, or open to change. Researchers believe that because of this, targeting infants at a young age could lessen the symptoms of autism later on.
“The reason for picking such a young group of kids is that clinically there is a sense that children or babies who have autistic tendencies end up getting a set of secondary impairments because of those tendencies,” said Dr. Lisa Shulman, a developmental pediatrician at the Albert Einstein College of Medicine of Yeshiva University, “and those arise between 1 and 2.”
These additional problems stem from the way infants with autism tend to hyper-focus on certain things. This limits their natural interest in other aspects of the environment. The environment shapes the brain by presenting new opportunities for learning. Earlier treatment is meant to revitalize a baby's interest in the world through interaction with a parent.
“When you can catch them very young — as an intervention like this is doing — you can kind of lasso back their social interest and pull them in and show them how engaging is fun and reinforcing in its own right,” Shulman said.
Identifying autism in infants can be challenging. According to the Centers for Disease Control and Prevention, an autism diagnosis by an experienced professional is reliable in children as young as age 2. In the new study, researchers relied on multiple methods to diagnose the children at a younger age, when the symptoms of autism may not be as clear.
“They’re as good as we have,” said Shulman of those methods. “So I would say nothing is fool-proof in that young age group, but this is getting at the core of the difficulties.”
Parents at the Heart of the Treatment Program
Because this was a pilot study with only a small number of children, it is difficult to know whether the treatment will be effective for all infants with autism symptoms. It could be that the children who improved would have done so even without therapy, or the results may be due to the parents' high level of motivation.
The researchers also used very strict criteria to choose children to participate in the study. While this ensures that the infants are similar to one other, many groups of children were left out, such as premature infants and those with genetic risks or complicated medical histories.
Some children may not benefit from this type of therapy at all, due to the nature of their multiple problems. This is important to keep in mind, said Shulman, because parents may be tempted to blame themselves for a child's lack of progress, even with additional therapy.
“There are babies who may have been excluded from this study because they had increased biologic risk for whom no amount of excellent intervention is going to do away with the autism diagnosis,” she said. “But hopefully those children, by identifying them earlier, you can avoid some of the secondary impairments.”
More research, including a larger, randomized study, is needed to know how effective this type of early treatment is for autism. While not all parents would be able to commit the time required for this demanding type of therapy, they are still a very important part of their children's support system.
“It was the parents — not therapists — who [were successful]," said Rogers. "Parents are there all day with their babies. It's the little moments of diapering, feeding, playing, going for a walk, being on a swing, that are learning moments for babies. Those moments are what parents can capitalize on in a way that nobody else really can."