Earlier Help for Children at Risk for Autism A Study Examines Six-Month-Old Babies Showing Early Signs of Developmental Delays By: Shirley S. Wang 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 Aguilars 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 hadnt 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. Its 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 childrens 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 Daviss 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. Tuesdays findings are a good first step in studying the intervention, but the tiny study cant prove that the intervention was responsible for the childrens improvement. The babies could have simply caught up on their own. Its 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 wasnt 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 didnt 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 Emilios development, but they didnt notice his developmental delays. When told about the study of the new, untested intervention, they didnt 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, isnt on the autism spectrum. Even if the intervention itself isnt 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 arent to blame for their childrens delays. The parents were not doing anything wrong or anything that wasnt 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 didnt 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.
Posted on: Fri, 12 Sep 2014 14:56:47 +0000
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