The first rigorous trial of a pre-emptive behavioural intervention for babies showing early signs of autism has found that the therapy can improve early language development.
In a study published in The Lancet Child & Adolescent Health, a research team headed-up locally by Dr Kristelle Hudry from La Trobe University and led by Professor Andrew Whitehouse of the Telethon Kids Institute and The University of Western Australia, found that babies who received the intervention – which helps parents better identify and respond to their baby’s communication cues – were able to say and understand significantly more words than a control group when followed up six months later.
“This study represents an important shift in research efforts in the early autism intervention space; to test interventions that can be implemented very early in life – when parents might have their first concerns about their child’s development – rather than waiting until a definite diagnosis has been made,” La Trobe University’s Dr Hudry said.
Trial lead, Professor Whitehouse, said that although the intervention – known as iBASIS-VIPP – did not reduce early autism behaviours after the six month period, the language progress was an exciting finding that reinforced the importance of early intervention.
“Although there was no difference on some autism measures, the measures we did find, in language and communication, were quite clear,” Professor Whitehouse said. “Parents who received the intervention reported that their toddlers improved in understanding an average of 37 more words and saying an average of 15 more words than the control group.
“This is an important milestone in our research as it’s the closest we’ve come yet to proving the long-held theory that early intervention for babies on a suspected pathway to autism will be more beneficial than waiting until after diagnosis, which typically doesn’t happen until around three years of age,” Professor Whitehouse said.
“Rather than waiting to the point of diagnosis, this study indicates that we should identify children as early as we can and provide intervention at that point.”
Dr Whitehouse and Dr Hudry’s teams enrolled more than 100 babies aged 9-14 months in a randomised controlled trial to investigate the impacts of the video-based intervention across a range of autism measures. All 103 babies had shown early behavioural signs of autism spectrum disorder. Half received the intervention, while a control group received current best practice treatment.
Parents were filmed interacting with their babies, with researchers later providing feedback to help them recognise communication cues from their baby which might be otherwise difficult to interpret. Parents were then guided on how to respond in ways that would increase infant interaction.
“As parents, we respond to babies in a certain way,” Professor Whitehouse said. “When a baby doesn’t respond in a typical way, then we change our interaction patterns accordingly: we tend to either become very ‘hands off’, or we try to tell or show the baby what to do. These are very normal human responses.”
“Using this structured therapy program, we teach parents to sit back and watch their babies – to be a detective of their babies – so they can understand the way they’re interacting and then respond accordingly.
“We are striving to help parents to get more in sync with how their baby is communicating with them. When parents understand how their baby is communicating, and then respond accordingly, it creates a very rich social environment around them. This is gold in terms of helping boost language development.”
The team followed up with both groups six months later, finding no significant difference in most early autism behaviours between the intervention group and the control group, but a significant improvement in language abilities.
“This progress alone is significant for families with children who may be developing atypically, and who previously had not been able to access therapies,” Professor Whitehouse said.
“I often think that the most magic words families can ever hear are ‘Mum’ and ‘Dad’ – and if you can help improve a child’s language development after receiving an intervention, then that can be genuinely life-changing,” he said.
The team will follow up the children at age three to find out whether the boost in language and communication has endured, and whether the intervention has any longer-term impact on autism behaviours over a longer period.
The study was funded by the WA Children’s Research Fund, the Autism Cooperative Research Centre (Autism CRC), La Trobe University’s Understanding Disease Research Focus Area, and the Angela Wright Bennett Foundation. Collaborating local institutions included the Autism CRC, La Trobe University, The University of Western Australia, and the Western Australian Child and Adolescent Health Service, and the University of Manchester and Kings College London, UK.
The full paper, A randomised-controlled trial of a pre-emptive intervention for infants showing early behavioural risk signs of autism spectrum disorder, can be read here: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(19)30184-1/fulltext
