Autism Therapy in 6-Month-Old Babies Eliminates Symptoms in Limited Study

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By the time the children turned four, almost none of them required any form of autism services. Ali Jarekji/Reuters

Autism research is in a race against time. For years, researchers have sought to screen for symptoms of autism spectrum disorder (ASD) at younger ages, and enroll children in behavioral therapy earlier and earlier. A new study published Tuesday pushed the age limits of the research with a small number of extremely young infants, some as young as six months old. By the time the children turned four, having received therapy administered entirely by their parents, almost none of them required any form of autism services.

Because the infants were so young—6 to 15 months—they were not able to be diagnosed with autism. Rather, researchers at the University of California Davis MIND institute identified them according to the number and severity of their symptoms, which indicated they were at a high risk of developing autism later in childhood.

"We know that autism affects children very differently from one child to another, and we know that no one intervention will affect all children the same," said Sally J. Rogers, a professor of psychiatry at UC Davis and a co-author of the study. "But we do believe, and the infant literature tells us, that learning happens the most rapidly early in life," giving less time for the behaviors associated with autism to develop.

A previous study looked at an older group, 18 to 30 month-olds. They received 20 hours a week of social and behavioral therapy with a clinician, plus another 5 hours of therapy with their parents. After two years, the group who received the therapy had greater improvements than the control group, who had received only whatever forms of intervention were available in their community.

The hope embedded in that and other studies have prompted some parents to pay thousands of dollars for many hours a week of intensive behavioral therapy for their children. Some, including children profiled in a New York Times Magazine story earlier this year, beat the odds and no longer have signs of autism. Others did not.

By contrast, the UC Davis study's behavioral therapy was very low-intensity, and relatively low-cost, in addition to beginning the therapy much younger. Parents met with a therapist once a week to learn to "administer" the therapy to their babies, which amounted to a more intentional form of playtime, mealtime, and other everyday activities rather than a clinical regimen.

The key was to get the parents into the habit of approaching interactions with their child from a new, altered perspective. "We're capitalizing on the teaching that most parents do effortlessly with infants and toddlers," Rogers said.

If babies had difficulties with repetitive hand behaviors, for example, the parents were taught to give their child a toy whenever he or she began the repetitive motion, to occupy that hand with an activity Rogers described as "more stimulating than watching their fingers move."

Similarly, if the child performed a repetitive action with a particular object, like a toy or a book, the parents were taught to pick up a similar object and show their child a different way to interact with it.

In time, "the babies were building a flexible repertoire of more ways to play," Rogers said.

Difficulty maintaining face-to-face interaction with other people, like their parents, is another sign that a young child may develop autism. The infants in the study rarely or never sought eye contact, and rarely made noise to get attention. Therapists taught their parents to find every opportunity to put their own faces and bodies in what Rogers called "the spotlight"; front and center of their babies' field of vision.

"Many of these babies didn't have very clear signals to the parent about what they wanted. They would have a more subtle repertoire. They might lean forward a little, or they might raise their eyebrows if they enjoyed something, but that wouldn't include the smile that one would expect," Rogers said. The parents were coached to better read these subtle cues, and to coax their children towards making clearer cues. They followed up any sounds their children made with clear reactions, so the babies knew "that their voices were very powerful, that their sounds were a powerful cue to get attention and get their needs met."

Many of the parents worked full-time, and in the cases where children went to daycare, the daycare teachers also learned the techniques. The study set no hour requirements for working with the children. Rather, by establishing habits, the parents and teachers were administering the therapy whenever they and the children interacted.

Remarkably, by age two, some of the children in the study were doing so well that they didn't need or qualify for any other behavioral therapy. Many of them attended standard preschool. Now, at age four, one child still has significant autism-like symptoms and difficulty learning, Rogers said. None of the other children are getting autism services any longer.

The outcome is exciting, but a study with only seven subjects and no formal control group cannot result in a clear statement of cause and effect. That would require a much larger, randomized clinical trial. "We don't know to what extent this particular treatment caused this particular outcome," Rogers said. But infants who had initially shown enough symptoms to qualify for participation in the study, but who were not included in the study sample (and thus did not receive this particular intervention), had more impairments than the study group by the time they turned three, Rogers said.

If more research elicits similar results, infant screening could be regarded as not only possible, but potentially beneficial. "That's the hope among everyone who is doing earlier intervention and earlier screening. It would allow for more effective from less intensive interventions," Rogers said. For now, her new study can only prompt further inquiry. "I consider this promise, but not proof."

Autism Therapy in 6-Month-Old Babies Eliminates Symptoms in Limited Study | Tech & Science