Dr Giacomo Vivanti & Professor Cheryl Dissanayake
Research underway for many years at La Trobe University has been supporting the very early identification of Autism Spectrum Disorders in infancy and toddlerhood with the view of promoting optimal development by access to early intervention. Recent research by Sally Rogers and her colleagues of the MIND Institute, published in the Journal of Autism and Developmental Disorders this week describes the first controlled study documenting outcomes of infants with signs of autism who received treatment in their first year of life, well before the age at which autism is usually diagnosed.
A small group of seven infants between the ages of 6- to 15 months who showed clear signs of autism were provided a parent-mediated intervention program – Infant Start – based on the Early Start Denver Model. Their outcomes were compared to those of children who similarly showed clear symptoms, but did not receive the intervention. Six out of the seven children who received treatment had normal learning and language skills by the time they were age 2 to 3 years.
While this pilot study does not allow for definite conclusions on the efficacy of the infant intervention, the results have important implications for our understanding of the nature of autism and its treatment. First, they support the notion that the natural course of autism may be altered by “taking action” to mitigate the influence of autism on development. This notion is based on scientific research that the human brain is an “experience-expectant” device, genetically programmed to rely on everyday exposure to species-typical experiences to develop normally. For example, the developing brain “expects” exposure to light and other visual information from birth, and is genetically programmed to utilize these inputs for the normal development of vision. Cataracts or other “barriers” that prevent exposure to species-typical visual input can permanently alter brain organization – unless the barrier is detected and treated early. And the earlier, the better!
In the same way, the brain is programmed to expect and to rely on early social experience to develop “normally”, and early symptoms of autism are the barriers that interfere with this process. As the initial biological alterations in the brains of children with ASD result in a diminished ability and motivation to explore, attend to, and learn from the social world, the brain does not receive the necessary inputs needed to develop in the typical way – and this, in turn, further disorganizes brain functioning and development. The corollary of this model is that the provision of targeted intensive early intervention, by engaging the “expectant” social brain areas, may prevent this escalating deviance from typical development. The data from the Rogers and colleagues study provide strong support for this explanatory framework.
It is important to note, however, that not all children developing autism show early signs. The onset of autism is variable across the first two years of life, with some children showing signs as late as 15 – 18 months of age, and others later still. Furthermore, there is research indicating that optimal outcomes are possible in children who have begun intervention in their preschool years. Therefore parents of children with ASD should not feel bad if they did not notice early signs in the first year of life, and they should not feel like “they missed the boat” if the child did not receive treatment in infancy.
The findings from the study do, however, support the notion that more improvement is possible if autism is detected and treated early in development. They point to the need to increase our efforts to improve early detection to enable earlier access to interventions which we know can alter developmental trajectories early in life. Our work in the very early identification of ASDs has now been incorporated into the Autism CRC, and paves the way for very early behavioural treatment.