Posts Tagged ‘ Early Start Denver Model ’

Decreasing Eye Contact In Infancy: An Early Indicator Of Autism?

Thursday, November 7th, 2013

Early diagnosis of autism spectrum disorders (ASD) offers the promise of early intervention – with the premise being the earlier, the better. New research suggests that we may be on the horizon of finding signs of ASD in the first 6 months of life. Here’s the breakdown of why this study – which examined attention to eyes in infants as a predictor of a diagnosis of ASD in toddlerhood – is so important.

Why Is This Study Design Powerful?  This study – which builds on substantial prior research on eye contact in ASD – uses a powerful longitudinal design to search for the early signs of ASD in infants, including some at high risk (babies of older siblings with ASD). These design features give confidence in the results – the sampling frame goes from early infancy through the typical age of first diagnosis of ASD, and the high-risk component ensures enough cases to draw meaningful conclusions. And the construct of interest – attention to eyes – has been well-studied, is theoretically grounded, and can be measured with precision.

Why Are The Findings Provocative? Two reasons. First, while ASD (or the risk, or liability, to develop ASD) is assumed to be present at birth, early signs of ASD have been elusive. This study offers hope that by detecting a lack of attention to eyes in the first 6 months of life may offer one potentially powerful screen for risk for ASD. But there’s more. An especially novel finding is that infants later diagnosed with ASD started out in life attending to eyes – but that that ability declined over time. This may eventually be a clue in terms of underlying brain mechanisms – and it also suggests that if these fundamental mechanisms are “in tact” at birth and then decline, perhaps there is even more room for change with very early intervention. Either way, a strong signal of risk in the first 6 months of life may be translated – perhaps rapidly – into very early intervention strategies.

What’s The Take-Home Message? Parents have been encouraged to be mindful of some of the signals of risk for ASD in the early years – including 7 early signs of ASD. Although this study has not yet led to formal recommendations for parents, it does suggest how important face-to-face interaction is during infancy – and also highlights that parents should be vigilant about seeing how their baby reacts when eye contact is expected. The way a baby looks at the human face changes a lot over the first year in life – but the constant is that they spend a lot of time looking at it. The suggesting from this new research is that babies at risk for ASD show a decrease in their interest in the face during infancy. If this is happening, it is certainly worth bringing to the attention of a pediatrician, who will be positioned to look for other developmental milestones and indicators.

What’s The Future? Research studies are especially influential if they give a glimpse into the future. Here the hope is that a screening protocol can be developed to route infants into very early intervention – a developmental time that may hold promise for a lot of plasticity and response to intervention. Bear in mind that some of the most exciting findings to date about intervention – based on application of the Early Start Denver Model (ESDM) – demonstrated that one of the results of intensive intervention is changing the brain response to the human face, with normative patterns of brain activity achieved in some cases. Starting that process in infancy might lead to even more effective intervention programs for ASD.

Early Signs of Autism
Early Signs of Autism
Early Signs of Autism

Mom and Baby via Shutterstock.com

 

 

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Autism: 2012 In A Snapshot

Sunday, December 30th, 2012

There were three big themes this year in autism research from my vantage point:
DSM-5: The ongoing debate and speculation about the diagnostic changes that have now taken hold in the upcoming DSM-5 was clearly the biggest story of the year. Proponents suggest that the change to a singular diagnostic category (which eliminates Asperger’s Disorder as a separable diagnosis) will provide clearer criteria and hence more precision. Those who disagree worry that some youth will no longer receive diagnoses – and hence access to services. Another concern is that even if children meet diagnostic criteria, the new severity ratings may prove troublesome when it comes time to receiving coverage for services. The only thing for certain is that it will take some time until we see enough data – and feedback from clinicians and parents – to know how this will all play out.
Causes of Autism: There were a number of studies which demonstrated the complexity of searching for the causes of autism. Genetic research continued to focus on rare mutations that may help explain a very small number of cases. Included here were studies suggesting potential links between paternal age and risk for spontaneous mutations. While these findings continue to appear in the journals, it is not clear if there are many other genes involved – and if a vast majority of cases of autism are due to many genes acting in combination with environmental effects. To that end, environmental studies pointed to prenatal influences, including use of antidepressants and exposure to the flu virus. The studies to date are preliminary, require replication and expansion in terms of isolating mechanisms, and again account for small increases in absolute risk (typically a magnitude of 1%). Overall, the pieces of the puzzle continue to be researched, but the puzzle remains elusive.
Early Intervention: While it is known that early intervention yields positive changes in development, new studies suggest that intensive intervention that is especially tailored to promoting reactivity to the social environment may hold considerable promise. One study showing changes in brain activity in response to faces after such intervention (the Early Start Denver Model) was particularly intriguing. While autism remains a mystery, the one thing we know is that early intervention is beneficial – and we can hope that it will become even more powerful in the future.
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Behavioral Interventions For Autism: A Small Breakthrough?

Friday, November 30th, 2012

Autism is a biological disorder. That said, recent research continues to reinforce the power of behavioral interventions – and a recent study may be pointing the way to a small breakthrough. 

In October, Dr. Geraldine Dawson and colleagues published a paper showing exciting results from a relatively new intervention called the Early Start Denver Model (ESDM). Previous studies demonstrated that the ESDM leads to improvements in a number of developmental domains – including reduction of symptoms, and increases in social behavior, language and IQ performance. The latest study revealed something especially remarkable – ESDM resulted in “normalized patterns of brain activity” in kids with autism when viewing a human face as compared to other objects. Since a fundamental goal of behavioral intervention is to improve interest in the social world, these results were especially powerful – the kids who participated in ESDM not only behaved differently, but their brains were functioning differently in real time.

ESDM applies learning principles – such as those used in more traditional ABA interventions – to shape and reinforce social behaviors as they happen in the stream of daily interaction. Parents as well as therapists are trained to administer the intervention program. And it is very intensive – it takes lots of hours every week, and the recent study evaluated kids after two years of intervention. No doubt, all these features are critical reasons why it may be having such a beneficial effect.

I see this work as signaling a breakthrough in intervention in two ways. First, it reminds us that just because a developmental disorder may be biological/genetic in origin, that does not mean that interventions need to be biological to produce substantial changes in developmental patterns. Second, creative interventions that utilize learning principles within the flow of everyday interaction – and incorporate the collaboration of therapists and parents – may be particularly effective in “reprogramming” both social behavior and how the brain processes social information.

We will continue to see lots of research on the biology of autism, and this work continues to be extremely important. But I do hope that we see more and more effort (and scientific and social resources) aimed at developing and refining behavioral interventions that hold considerable promise for promoting positive developmental changes in kids with autism.

Human Brain Research and Autism via Shutterstock.com

 

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