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Parent-mediated intervention helps infants at risk for autism
Parent-mediated intervention within the first year of life may reduce the severity of autism prodromal symptoms and enhance parent-child dyadic social communication over the 3 years following the intervention, according to findings published in Journal of Child Psychology and Psychiatry.
“Advances towards a developmental account of the emergence of autism ... suggest possibilities for intervention in the autism prodrome, targeting either the earliest behavioral symptoms of emerging disorder or those neurocognitive biomarkers that have predictive salience in early development,” Jonathon Green, MD, from the social development research group at the University of Manchester School of Biological Sciences, England, and colleagues wrote. “There is an appealing, but unproven, argument that very early intervention in these emergent trajectories may be especially effective, with added potential to exploit early brain system plasticity to altered environmental input.”
Researchers delivered a parent-mediated social communication intervention to infants aged 9 to 14 months at familial risk of autism. Using an adapted version of the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting Program (iBASIS-VIPP), they compared 28 infants randomly allocated to this intervention group with 26 infants in the nonintervention group. Therapists delivered a minimum of six home-based visits using video-feedback to help the parents recognize and respond to their child’s individual communication style. They assessed treatment outcomes at 15-month, 27-month and 39-month follow-up.
The results revealed that the families who received the video therapy intervention had improved prodromal symptoms associated with autism compared with those in the nonintervention group. The researchers saw similar results in the effects on proximal intervention targets of parent nondirectness/synchrony (Effect size [ES] = 0.33; 95% CI, 0.04-0.63) and child attentiveness/communication initiation (ES = 0.36; 95% CI, 0.04-0.68). Green and colleagues observed a noticeable positive impact on parent-child interactions. The intervention had no effect on categorical diagnostic outcome or formal language measures.
“We know that similar kinds of intervention later in childhood can show long term effects; here we have shown that beginning intervention of this kind in the first year of life can produce important improvements for the babies over the medium term in development, continuing after the therapy finishes,” Green said in the accompanying press release. “If this intervention continues to show improvements in such larger studies, then the method would have real potential use for families at the point of early concern, or if their child is genetically at risk of developing autism.” – by Savannah Demko
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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The clinical scientists from the British Autism Study of Infant Siblings have conducted an intervention trial of infants at high-risk for autism. The study is important in that it is the first systematic evaluation of a pre-emptive intervention for infants at risk for autism during the first year of life. This is the earliest intervention for familial autism risk ever evaluated, targeting to help babies as young as 7 months. The study is also important because it follows these babies at 39 months, well past the 5-month active intervention period. The social-communication intervention focuses on helping parents engage in positive and developmentally supportive interactions with their babies. The infants who received the intervention were compared with children who had no planned intervention.
This study provides some support for the intervention to reduce symptom severity among children showing early signs of autism. The research team also demonstrated that parents were able to change their behavior to promote development of more positive social-communication skills in their babies.
This study included a small number of children and broad generalizations or definitive conclusions about the value of this particular very early intervention cannot be made. It is also very difficult to assess autism spectrum-related symptoms in children from infancy through early childhood because we do not have one single measure of autism spectrum related symptoms that can be used across this age span.
Some observations of this research are noteworthy:
•This is the first study to demonstrate that a very early intervention for autism could be delivered to at-risk infants as young as 7 months and be shown to be related with a reduction in the severity of autism symptoms.
•The intervention is brief, targeted, and well-described in a manual. This treatment can be replicated by any qualified developmental specialist, will have minimal cost, and could be broadly disseminated. The same cannot be said about many other autism intervention programs.
•As a parent-mediated intervention, this research is important in emphasizing the central role parents have in promoting healthy development and suggests that parents could alter aberrant developmental trajectories.
•The long-term follow-up of the babies enrolled in this study shows the importance of tracking early intervention effects across years, not just at the end of the active intervention period.
•More research is needed. The clinical intervention was evaluated among children with high familial risk for autism. It is important that high-risk infants were identified and responded to treatment. However, the true relevance of this intervention would be if very early signs of autism could be identified at 6 or 7 months of age among a general population of children and these children would then be referred for this intervention. The current study does not evaluate such a referral pathway.
Perspective
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The results of this study offer promising evidence that pre-emptive intervention can reduce behaviors associated with ASD in infants at risk for this disorder. Results are particularly promising given that treatment effects continued to be evident 2 years after treatment ended. This study was among the first to test the hypothesis that disrupted social communication and parent-child interactions can be ameliorated through intervention initiated well before a clinical diagnosis of autism spectrum disorder (ASD) could be made.
This study was unique in that at-risk siblings were not selected based on developmental risk, but on familial risk alone. This is important given the limited evidence to date for our ability to reliably detect prodromal symptoms of ASD that will persist past infancy and result in a later diagnosis of ASD.
This study also provides compelling evidence for parent-mediated treatments as a method of providing intervention for children at-risk for ASD. Given the role of parent-child interactions in social communication development, parents are likely to be especially effective in delivering early treatments aimed at reducing symptoms of ASD.
Given the promising effects of pre-emptive treatment in this study, parents may wonder whether intervention is necessary for their infant if they have an older child already diagnosed with ASD. It is too soon for clinicians to recommend treatment for asymptomatic high-risk infants, as more research needs to be done in this area. However, these promising results suggest the need for additional studies with larger sample sizes in order to determine whether treatments of this type may lead to a reduction of risk for an ASD diagnosis, rather than simply a reduction in behaviors associated with ASD.