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.
Categories: Behavior, Health, Intervention, Must Read, Parenting, Pregnancy, Red-Hot Parenting | Tags: 2012, autism, DSM 5, Early Start Denver Model, Health, Kids Health, Review
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
Categories: Behavior, Genetics, Health, Intervention, Must Read, Parenting, Red-Hot Parenting | Tags: autism, Brain, Early Intervention for Autism, Early Start Denver Model, Health, intervention, Kids Health
