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We know that for autism, the causes and changes in the brain occur long before birth. But in a groundbreaking new study, an intervention in infants with early signs of autism has reduced clinical diagnoses by two-thirds.
Autism Spectrum Disorder (ASD) describes a wide range of conditions affecting a person’s social, communication and motor skills. The diagnosis is based on criteria outlined in the American Psychiatric Association’s DSM-5 – such as persistent deficits in social interactions and reciprocal emotions, lack of interest in friends, repetitive movement or speech, and extreme or unusual reactions to stimuli.
“These results are the first evidence that a preventive intervention during early childhood could lead to such a significant improvement in children’s social development that they have then fallen below the threshold for a clinical diagnosis of autism,” says the one of the study’s authors, from the University of Jonathan Green, a child psychiatry researcher in Manchester.
“Many autism therapies have already tried to replace developmental differences with more ‘typical’ behaviors. In contrast, iBASIS-VIPP works with each child’s unique differences and creates a social environment around the child that helps him learn in a way that suits him best. them. “
This iBASIS-Video Interaction to Promote Positive Parenting (or VIPP) is what the team calls parent-mediated therapy. This is by no means intended to be a “cure” for autism, but an approach to “reduce long-term disability” for ASD.
Normally, the diagnosis can begin around the age of two, but there are also signs that can occur much earlier, such as avoiding eye contact and using fewer words than their peers. It’s these early symptoms that researchers are interested in, because making small changes early on could lead to significantly better development outcomes later.
Researchers followed 103 infants with these first signs of ASD, aged as little as nine months to three years, in a randomized, blinded experiment.
Fifty of the infants received iBASIS-VIPP – a treatment that teaches parents to change the way they interact with their babies to stimulate their social and communicative development, while the remaining 53 received normal care.
The results were astounding – among those who had received the iBASIS-VIPP treatment, only 3 of 45 participants who were retested at age three reached the clinical threshold for a diagnosis of autism, compared with 9 of the 45 who received regular care. It’s a two-thirds difference.
“It’s a bit of a holy grail in children’s health,” lead author Andrew Whitehouse, a researcher at the Telethon Kids Institute, told the Australian Broadcasting Corporation.
“What we have found is to provide a new clinical model, to identify children as early as possible in life, to provide a supportive intervention to help them be who they want to be, we can in fact reduce the clinical criteria for autism by two-thirds. “
The discovery is a remarkable first step, but there are important details in the evaluation of this approach that still need to be worked out.
First, the children in this trial were only followed up to age three, and although this is a typical cut-off age for clinical diagnosis of ASD in someone, it is always possible that the symptoms of some of these children change, change or appear later in life. .
Additionally, receiving a clinical diagnosis is currently an important step towards accessing treatment options, and although children who received this intervention no longer fit a DSM-5-based diagnosis, they may still need treatment. ‘extra help and support as they get older.
Finally, as with many diagnoses, it is critical to ensure that work in this area focuses on improving accessibility and understanding to people living with the disease, rather than to simply “eradicate” a particular diagnosis or disability.
“Autism is not a disease and is not something that should be cured or alleviated, so how this study assessed the impact of the intervention on the ‘severity of autistic behavior’ may be of concern. many people with autism and their families, “said Tim Nicholls, a spokesperson for the National Autistic Society of the United Kingdom.
“There are strong technical points in this research, but there will be questions about its general principle … It is important that any further study on very early intervention does not seek to reduce ‘severity’ – the intervention. early should aim to support people with autism with the greatest challenges they face.
“For effective research to be conducted in this area in the future, people with autism must be involved at every stage.”
The research was published in JAMA Pediatrics.
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