AUTISM INTERVENTION In the FIRST YEAR of LIFE

Background: The primary purpose of early detection of autism spectrum disorders (ASD) is to prevent or mitigate the full onset of autism and its associated severe disabilities by allowing for earliest possible treatment.  Early detection science requires that early treatment science develop in parallel, so that tested treatments are available for infants and toddlers showing early signs of ASD.   To our knowledge, there are no published or tested treatment models that target autism-specific symptoms in infants. 

Objectives:  We developed and conducted a pilot study of Infant Start, a manualized, parent-delivered intervention for infants at or before 12-months of age who display risk features of ASD.  The intervention targets six specific behaviors known to occur in infants who show abnormal behaviors in the first year of life and later develop autism:  (1) visual fixations of objects; (2) abnormal repetitive behaviors; (3) lack of intentional communicative acts; (4) lack of age-appropriate, phonemic development; (5) lack of coordination of gaze, affect, and voice in reciprocal, turn-taking interactions; and (6) decreased gaze, social orientation, pleasure, and engagement (Bryson et al., 2007). Parent-coaching focuses for two weeks on fostering more typical develop in each of the six symptom areas.  

Methods:  To date, five infant-parent dyads have enrolled, in the Infant Start pilot study.  Each received twelve weeks of one-hour parent-coaching sessions and at least three follow-up visits for assessment and continued support.  Overall infant development is measured before, during, and after treatment, up until 36 months of age using the Mullen Scales of Early Learning, the Vineland Adaptive Behavior Scales II, and the MacArthur-Bates Communicative Development Inventories.  Autism-specific behaviors and symptomology are examined with the Autism Observation Scale for Infants (AOSI) and, after 24 months, the Autism Diagnostic Observation Schedule (ADOS).  Parent-child play interactions are coded both for parent fidelity to the treatment model, as well as child behavior.    

Results:  To date, four of the five infant-parent dyads have completed the entire Infant Start treatment; four of the five have older siblings with ASD.  All four infants demonstrated significant improvements in their overall developmental levels; three of the four are in the normal range by 24 months.  All were speaking by 18 months of age; none of them displaying developmental regression.  In addition, two of the four met diagnostic criteria for ASD by 12 or 18 months but no longer met any ASD criteria by 24 months. Three of the four children do not meet any ASD criteria on AOSI or ADOS scores by 24 months.    

Conclusions: Initial findings from this pilot intervention study show improvement in social, communication, and developmental scores in children who met criteria for ASD during infancy. Future randomized controlled treatment studies are needed to test efficacy of this intervention model for improving developmental trajectories for infants under 12 months showing early risk signs of ASD.