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When it comes to intervention, earlier is better

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This week, we talk to Whitney Guthrie from Children’s Hospital of Philadelphia who spent the last 6 years conducting the gold-standard randomized control trial that demonstrates intervention for social communication skills at 18 months shows greater effects than intervention starting at 27 months. If you wanted evidence that earlier is better, here it is! Interventions and supports are important at any age, but the critical window of development between 18-27 months is particularly important for long term development.

https://pubmed.ncbi.nlm.nih.gov/36922406/

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Here’s what you won’t hear about that new JAMA study on Twitter

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A couple of weeks ago, a group in Australia published a study that investigated the efficacy of a “preemptive” intervention. That is, what happens if you provide support to parents to improve social communication, interaction and skills in infants before a diagnosis can be made? The results have a lot of meaningful implications of what interventions are possible at this age, how they can be delivered, and what it means to NOT receive an autism diagnosis but still show challenges. But the Twitter hive didn’t perceive it that way. This week I explain what the study did and didn’t do, and how it can help people across the spectrum.

Open access here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453361/

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ABA studies in ASD are not perfect

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ABA and ABA – inspired behavioral therapies like Naturalistic Developmental Behavioral Interventions are the most commonly used in autism. They have become more sophisticated in design, using control groups and implementing other ways to minimize bias. But when you put all of the data together around ABA-type interventions in a pile, are they effective? Do they work? It turns out, just like everything, these studies are not perfect. But even using the strictest of criteria, the results are positive for the support of social communication skills. Of course, there are nuances and details, you can hear about them in this podcast.

https://pubmed.ncbi.nlm.nih.gov/31763860/

https://pubmed.ncbi.nlm.nih.gov/33482692/

THE FACTS BEHIND APPLIED BEHAVIOR ANALYSIS
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If you can make it there, you can make it anywhere: preparing early interventions for the community

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This week two groups of heroes of autism research published studies that may not be the type of major breakthrough that the media reports on, but they are more important to families:  These studies help translate what works in the research clinic into the community.  Specifically, is it even possible, how, and what do families need to know when they receive an intervention that has yet to be “field tested”.  This is a whole field of research called implementation science, and it deals with how scientists and community services implement what is learned in research settings into real world settings.

https://www.ncbi.nlm.nih.gov/pubmed/31206690 

https://www.ncbi.nlm.nih.gov/pubmed/31241851

 

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Tristram Smith, 1961-2018

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Two weeks ago, the autism research community lost a pioneer, mentor and advocate for the autism community.  This podcast only highlights a portion of the enormous contribution he made to autism research and the impact his research had on families with ASD.  Also, two people that know him best, one of his current mentees, Suzannah Iadarola and his wife, Jennifer Katz, reflect on his dedication and commitment to families of all ages.  He will be missed.

 

Some of his more recent papers are here, although just a recent sampling of everything he contributed:

https://www.ncbi.nlm.nih.gov/pubmed/30101320

https://www.ncbi.nlm.nih.gov/pubmed/30009626

https://www.ncbi.nlm.nih.gov/pubmed/29458258

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From Early Detection to Early Intervention

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This month, two new important research findings were published from scientists that study the very earliest signs and symptoms of autism.  First, Dr. Suzanne Macari at Yale showed that a type of temperament in toddlers was associated with autism at about 3 years of age.  This may be used in the future to develop specialized interventions very very early on.  Meanwhile, Dr. Jessica Brian’s group in Canada used the very early signs of autism – social orienting – to develop a new intervention called the Social ABC’s which they piloted last year.  Last week, a randomized clinical trial of this intervention showed improvements in social smiling, reactions to parents, and social orienting, suggesting it is a feasible and valid intervention option.  There is now a list of these interventions that have been rigorously tested.  This demonstrates that the early detection of features of autism, like temperament, can be turned into interventions to improve the outcome of toddlers with ASD.

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Hip hip hooray for toddler interventions for autism

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As always, good news and bad news in autism this week.  First the good news:  an intervention given between 9-14 months of age in children with a high probability of having an autism diagnosis improved autism symptoms at 3 years of age.  Now the bad:  mothers who experience severe childhood abuse are more likely to have a child with an autism diagnosis.  Why?  A new study explains it might have a lot to do with autism traits in the parents.  We would love to hear your thoughts on the results, please provide them in the comment section.

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The infant brain on early behavioral intervention

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The brain is developing even after birth.  So interventions that are given very early have the best chance of remolding and rewiring a brain with autism to prevent autism related disabilities.  This week, a group from the University of London, Duke University and University of Washington measured brain activity during tasks that required social attention following 2 months of very very very early intervention.  They found that the way the brain responded to social stimuli was more like those without an autism diagnosis.  This study shows a biological marker of brain function is altered after behavioral interventions that are intended to do just that – change the way the brain functions.

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A scary halloween story about the media misrepresenting science

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How long do you have to study an intervention to see if it works?  Many scientists agree that it isn’t just about what happens in the short run, but if those interventions can be sustained for long periods of time.  In the case of very early interventions, it is now clear that treatment for about a year can change the trajectory of symptoms so those improvements are sustained, maintained or lead to even further improvements for 6 years after the initial intervention has stopped.  This important finding was hidden by the BBC getting the headline wrong and hiding the true value of the research at the end of the story.  This week’s podcast outlines the contribution of parent-implemented intervention and research studying autism even before symptoms emerge in improving trajectories rather than just immediate outcomes.  Happy Halloween!

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The importance if IQ in an autism outcome.

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Cognitive ability, measured by intellectual quotient or IQ, has been thought to predict response to intervention, social abilities, adaptive behavior and long term outcome.  Numerous studies have shown that it can influence what is labeled as a good outcome.  However, two studies this week point out how those across the spectrum in cognitive ability still benefit from early intervention and make friends on the playground.  In both studies, there were factors that were more important for outcome than IQ.  So it may be an important factor in outcome, but not the only factor.