Earlier Help for Children at Risk for Autism, by Shirley S. Wang

This article appeared in today’s Wall Street Journal. It is very important for any parent concerned about their child’s propensity to develop autism. While it is important for all parents to optimize the social interactions they have with their baby, it is especially important for parents who have other children with autism or who suspect their child might be delayed. To read this article at the Wall Street Journal, CLICK HERE.

Earlier Help for Children at Risk for Autism
A Study Examines Six-Month-Old Babies Showing Early Signs of Developmental Delays

Parents concerned that their babies are showing signs of autism may be able to help them develop normally, according to a small but intriguing new published study.

Researchers analyzed seven babies at high risk for developing autism. Most of those whose parents received 12 weekly sessions on how to more effectively improve their babies’ social communication and play caught up developmentally to babies who were considered low-risk and displayed no symptoms.

By 3 years of age, five of the seven babies were considered to be developing normally and had no diagnosis of autism-spectrum disorder, or ASD. Four had older siblings diagnosed with the condition. Researchers believe repeated social stimulation and making engagement with other people more appealing helped the babies learn more about social information, which is critical to their learning about language and communication.

“They went from a period of being behind to catching up or accelerating” in their development, says Sally J. Rogers, a professor of psychiatry at the University of California, Davis and one of the authors on the study, which was published Tuesday in the Journal of Autism and Developmental Disorders.

Carmen Aguilar’s then-6-month-old son Emilio was identified as having developmental delays and enrolled in the study. She learned that she could optimize each opportunity for interacting with her son in a way she hadn’t fully realized before, such as during diaper changes. The Sacramento, Calif., mother, now 32, had already incorporated talking, singing and nurturing touches into her routine, but now she did more.

It’s long been known that early intervention benefits children with autism and related disorders characterized by social and communication deficits. But this study is thought to focus on intervention with the youngest children to date.

Autism can be diagnosed reliably around 2 years old. Preschool-age children who receive intensive therapy tend to do better than those with pronounced symptoms who are identified after that age. Despite experts’ push for early intervention, the average age of diagnosis for autism is around 4 in the U.S., according to the Centers for Disease Control and Prevention.

The number of children identified with autism has risen sharply since 2002, and the latest figures from a 2014 CDC report estimate 1 in 68 U.S. children are affected by autism or a related disorder. That climb could result from a combination of more children affected with the condition, plus greater awareness of it, experts say.

Some parents are more aware of the risk of autism and are tuning into their children’s social development earlier. “Parents would call us and say they were concerned,” Dr. Rogers says. “We would see the babies and be concerned, too.”

Dr. Rogers and her colleagues at UC Davis’s MIND Institute were already evaluating the babies regularly as part of a study of siblings of children previously diagnosed with autism. If the babies’ performance had been found to be below normal after tests several weeks apart, they were recommended for the intervention.

Such concerns included unusual behaviors with objects, such as fixating on them much longer than average babies their age. Parents often described these babies as neutral, undemanding, quiet and hard to read, Dr. Rogers says.

The intervention employed well-known principles used in treatment of older children with autism to increase the frequency of social interactions and maximize babies’ engagement.

Tuesday’s findings are a good first step in studying the intervention, but the tiny study can’t prove that the intervention was responsible for the children’s improvement. The babies could have simply caught up on their own.

It’s also impossible to know whether the children would have developed autism without intervention, says Rebecca Landa, director of the Center for Autism and Related Disorders at Kennedy Krieger Institute in Baltimore, who wasn’t involved in the current study but studies early intervention efforts for young children at risk for autism.

The symptoms the babies showed in the study clearly indicated the babies’ development was off and of concern, she says. And the results were encouraging because the high-risk babies didn’t get worse between 15 and 36 months. Dr. Landa calls this a “treacherous period” in development, when children with autism tend to show slowing development and an increase in symptoms.

The study was so small because it was a pilot to see if the researchers could identify babies at risk and teach parents in a limited amount of time techniques to carry out at home. The researchers would like to try a larger, randomized trial in the future.

Ms. Aguilar and her husband were shocked when doctors told them Emilio was showing “delays across the board” at 6 months of age. Since they have another son, Diego, now 9, with an ASD diagnosis, they were highly attuned to Emilio’s development, but they didn’t notice his developmental delays.

When told about the study of the new, untested intervention, they didn’t hesitate to participate. Diego benefited greatly from every intervention, which at times totaled 45 hours of therapy a week, Ms. Aguilar says.

The Aguilars learned exercises to optimize their interactions with Emilio, encouraging interactive play and sounds. For instance, if he made a sound, they aimed to mimic it to encourage Emilio to participate. “There are times you feel a little bit silly, but you have to get past that,” Ms. Aguilar said.

Over time, Emilio would then say it back, realizing he was playing a game that could go back and forth.

Though the intervention was meant to be brief at 12 sessions with parents and children, the goal was to see if parents could continue the techniques at home. The babies were assessed until they were 36 months old.

Ms. Aguilar says clinicians have told her Emilio, now 4, isn’t on the autism spectrum.

Even if the intervention itself isn’t the cause of the improvement, enhanced engagement with parents would likely help all babies, regardless of whether they have autism, Dr. Rogers says.

She is careful to point out that parents aren’t to blame for their children’s delays. “The parents were not doing anything wrong or anything that wasn’t helpful or sensitive to their babies,” she says. “They parent like any other parent. The difference is in the infants.”

Betty Goldberg was concerned about her son Sammy. He didn’t seem to say as many words as other children. Well-meaning friends and acquaintances told her not to worry, that boys spoke later than girls.

But clinicians at the Kennedy Krieger Institute, who were monitoring him because he has a sister with ASD, detected around 18 months that his development lagged behind that of other children.

The Goldbergs, who live in Baltimore, began working with clinicians in January to play more effectively with him. They talked in more basic terms with him, focusing on nouns and verbs instead of words suggesting more abstract concepts like time, to improve his communication.

Sammy, now 2, is doing well and has learned an “explosion of words,” Ms. Goldberg says.

Write to Shirley S. Wang at shirley.wang@wsj.com

Early Autism Diagnosis Tool – A Baby’s Gaze

This very interesting article appeared in the NY Times earlier this month. CLICK HERE to read the article at the NY Times Website and to watch a video of the study in action. If you know a family whose child was diagnosed with autism, please check out “A Spectacular Bond.” I highly recommend this book and wrote about it in an earlier posting.

Baby’s Gaze May Signal Autism, a Study Finds

Updated, 1:11 a.m. | When and how long a baby looks at other people’s eyes offers the earliest behavioral sign to date of whether a child is likely to develop autism, scientists are reporting.

In a study published Wednesday, researchers using eye-tracking technology found that children who were found to have autism at age 3 looked less at people’s eyes when they were babies than children who did not develop autism. But contrary to what the researchers expected, the difference was not apparent at birth. It emerged in the next few months and autism experts said that might suggest a window during which the progression toward autism can be halted or slowed.

The study, published online in the journal Nature, found that infants who later developed autism began spending less time looking at people’s eyes between 2 and 6 months of age and paid less attention to eyes as they grew older. By contrast, babies who did not develop autism looked increasingly at people’s eyes until about 9 months old, and then kept their attention to eyes fairly constant into toddlerhood.

“This paper is a major leap forward,” said Dr. Lonnie Zwaigenbaum, a pediatrician and autism researcher at the University of Alberta, who was not involved in the study. “Documenting that there’s a developmental difference between 2 and 6 months is a major, major finding.”

The authors, Warren R. Jones and Ami Klin, both of the Marcus Autism Center and Emory University, also found that babies who showed the steepest decline in looking at people’s eyes over time developed the most severe autism.

“Kids whose eye fixation falls off most rapidly are the ones who later on are the most socially disabled and show the most symptoms,” said Dr. Jones, director of research at the autism center. “These are the earliest known signs of social disability, and they are associated with outcome and with symptom severity. Our ultimate goal is to translate this discovery into a tool for early identification” of children with autism.

The eye-tracking differences are not something parents and pediatricians would be able to perceive without the technology and expertise of an autism clinic, Dr. Jones said. “We don’t want to create concern in parents that if a child isn’t looking them in the eyes all the time, it’s a problem,” he said. “It’s not. Children are looking all over the place.”

Autism therapies have not yet been developed for young babies, but there are efforts to adapt intensive behavioral therapy for use with children as young as 12 months, Dr. Jones said.

Diagnoses of autism have increased, according to the Centers for Disease Control and Prevention, from one child in 150 in 2002 to one in 88 in 2008. The reasons are unclear, although some factors could be greater awareness of the disorder and a growing number of older fathers.

Dr. Jones and Dr. Klin, who directs the autism center, studied two groups of babies. One group was at high risk for autism, with a 20 times greater likelihood of developing it because they had siblings with the disorder. The other group was at low risk, with no relatives with autism.

The researchers assessed 110 children, from 2 months to 2 years of age, 10 times while watching videos of friendly women acting like playful caregivers. Eye-tracking technology traced when the babies looked at the women’s eyes, mouths and bodies, as well as toys or other objects in the background. At age 3, the children were evaluated for autism. Ultimately, researchers used data from 36 boys, 11 of whom developed autism. (They excluded data from girls because only two developed autism.)

While the number of children studied was small — and the researchers are now studying more children — experts not involved in the study said the results were significant because of the careful and repeated measurements that were not just snapshots, but showed change over time.

“It’s well done and very important,” said Dr. Geraldine Dawson, director of the Center for Autism Diagnosis and Treatment at Duke University. She said it was notable that “early on these babies look quite normal; this really gives us a clue to brain development.”

She said a possible explanation was that early in life, activities like looking at faces are essentially reflexes “controlled by lower cortical regions of the brain that are likely intact” in children with autism. But “as the brain develops, babies begin to use these behaviors in a more intentional way. They can look at what they want to look at. We think that these higher cortical regions are the ones that are not working the same” as in typical children.

Dr. John N. Constantino, a child psychiatrist and pediatrician at Washington University in St. Louis, said the study showed that “babies who develop autism are for the most part doing an awful lot of things right for the first few months.” Perhaps the genes that drive autism begin to derail typical development after that, so that “what you are looking at moment by moment, day by day, second by second, is completely different from what other children are looking at, and the cumulative experience is what sends you off into the trajectory of autism.”

The researchers found that children who developed autism paid somewhat more attention to mouths and sustained attention to bodies past the age when typical children became less interested. Even more noticeable was that children who developed autism looked more at objects after the first year, while typical children’s interest in objects declined.

“We’re measuring what babies see, but more importantly we’re measuring what they don’t see,” Dr. Jones said.

Dr. Dawson said that looking at people teaches babies about “facial expressions and language and gesture. If the baby who’s developing autism is paying attention to objects, they’re really losing out on those opportunities.”

Before this study, experts said, research found that potential signs of autism — including differences in temperament, eye contact and pointing out objects — could be detected late in a child’s first year. Most cases of autism in children are diagnosed between ages 3 and 5, although the American Academy of Pediatrics recommends screening children at between 18 and 24 months.

But the new study suggests the need to develop therapies that begin even earlier. “The train has long left the station if you don’t start intervention until 18 months,” Dr. Constantino said.

Dr. Jones said eye contact was “just one very important channel.”

He continued, “I think we’d see the same things if we were measuring a child’s social reciprocity via touch or auditory listening preferences, but those are harder to measure.”

He and Dr. Klin advocate the eventual use of eye tracking and other measures in social development growth charts, similar to height and weight charts. Still, the authors and other experts cautioned that the results required confirmation in many more children.

Autism is so complex and varied that eye-tracking is unlikely to be able to identify every condition on the autism spectrum, Dr. Zwaigenbaum and others said. But they said the study helped illustrate the need for therapies to increase social engagement among very young infants, “either by intensifying the experience for them or making it pleasurable in other ways,” Dr. Constantino said.

“It really does present an opportunity for seeing if we could do some preventative interventions,” said Dr. Sally Ozonoff, vice chairwoman for research in psychiatry and behavioral sciences at the MIND Institute of the University of California, Davis. “Maybe you could keep the child from heading into that decline, so it doesn’t turn into autism.”