Heading off autism diagnoses early

Australian researchers have shown for the first time that early intervention with parent-led therapy can help to reduce autism diagnoses in children that exhibit early signs of the condition. The study, published in JAMA Pediatrics, found that a specific type of video-feedback-based therapy has the potential to reduce the clinical diagnosis of autism in children by two-thirds at age three.

Autism Spectrum Disorder is a lifelong neurodevelopmental condition that affects children’s social skills, communication and behaviour.

Around 2% of Australians have been diagnosed with autism, but more than half of all kids receiving support under the National Disability Insurance Scheme (NDIS) have an autism diagnosis. The average age of diagnosis is around 3 or 4.

In an AusSMC briefing on the JAMA research, lead researcher Professor Andrew Whitehouse, from the Telethon Kids Institute, said that the first two years of development are too important to be missed.

“Anyone who’s seen a child develop language knows just how extraordinary that brain is in the first two years of life,” Whitehouse says. “And because we’re waiting and seeing during that period our therapies are currently missing that really critical period of brain development to support. Rather than providing starting support at age three, we’re saying let’s identify parental concerns, and then verify that with clinical observation in the first year of life.”

The team identified that babies under a year old who begin to develop the behaviours associated with autism, such as differences in the way that they interact with the people around them, can fall “out of sync” with the interactions required for their brains to continue to develop.

“So this can lead to what we call a developmental cascade, where disability becomes more entrenched over time,” says Whitehouse. “The children have an early vulnerability, which we know is genetic in origin, but because they are actually interacting with their caregivers in a different way, that disability becomes further and further entrenched.”

This is where the therapy, called iBASIS-VIPP, is able to help. It involves a therapist filming the parent or caregiver interacting with the child who is suspected of developing autism. The therapist is then able to work with the parents, and highlight ways for them to alter their behaviour to support and enrich their child’s interactions using subtle changes to their everyday routines.

Co-author of the research, Associate Professor Kristelle Hudry from La Trobe University, says this parental behaviour change at such an early stage of development can provide significant improvements in child communication skills and more generally for their development.

“The hope then is that this changed parent behaviour will lead to increased child skills through the parent implementing these subtle changes in their everyday routines, all day every day, at home in everything that they’re doing, Hudry says. “And then ultimately that this will bring improvements in child social communication skills… and impact their skills to such an extent that the likelihood of autism is changed.”

The Australian trial provided 10 fortnightly sessions of the therapy over five months for babies exhibiting early signs of autism between nine and 15 months of age.

After following up with those families over three years, the trial found that only 6.7% of children receiving the therapy met the criteria for autism, compared to around 21% of children who did not receive the therapy.

“That’s a significant reduction, and that’s the first time that has ever been shown that a pre-emptive support can be so effective in supporting development, that it actually reduces the likelihood that children go on to receive a diagnosis of autism,” says Whitehouse.

The critical point here is that although those children have a lower likelihood of subsequently receiving a diagnosis of autism, they still require support services. Whitehouse says that the current system is flawed as it uses a diagnosis as the trigger or entry point to receive support. He says a needs-based service rather than a diagnosis-based service should be provided.

Whitehouse also emphasises that they aren’t ‘curing’ autism and that the aims of the study are not about seeking a cure, but rather to “reduce the level of autism behaviours to the point that we can actually remove barriers in their life so children can reach their full potential”.

Hudry and Whitehouse both make it clear that parents are not the cause of autism, but that parents are able to provide a key way to support their child’s development to reduce the barriers that autism can create.

“This therapy is about working with each child’s unique differences,” says Whitehouse. “It’s not about trying to make kids more typical; it’s about actually identifying and nurturing and celebrating those differences and using them as a foundation for further development.”