Autism therapy aimed at infants may reduce likelihood of later diagnosis

Study suggests tailored therapy could help some children develop social skills before school age

Doctors have shown for the first time that a new therapy aimed at infants can reduce autistic behaviour and the likelihood the children will go on to be diagnosed with autism before they reach school age.

Infants who received the therapy after displaying early signs of potential autism, such as avoiding eye contact and not responding to their name, were one-third as likely to have autism diagnosed at the age of three, compared with those who had standard care, the researchers found.

The findings suggest intervening in the first year of life, when autism may be suspected but far from certain, can boost social development in autistic children, with long-term beneficial knock-on effects for their broader lives.

“This is the first worldwide evidence that a pre-emptive intervention can reduce autism behaviours and the likelihood of a later diagnosis,” said Prof Jonathan Green at the University of Manchester.

“We think this is a landmark finding because it suggests intervention at this early time can have this substantial effect. It may well change the way services provide support to a large number of children worldwide.”

The international research team, led by Prof Andrew Whitehouse at the University of Western Australia in Perth, assessed 104 infants aged nine months to 14 months who had come to the attention of community healthcare services after displaying early signs of autism. While one half was randomly assigned to have routine care, the other received 10 sessions of therapy over five months. All were reassessed for autism behaviours at 18, 24 and 36 months.

In the therapy sessions, parents were videoed playing with their children. A therapist then reviewed the footage with the parent and helped them understand the different ways their child was trying to communicate, and how they might better engage the child. The aim was to strengthen the connection and improve the “back and forth” between parent and child, to help the infant develop their social communication skills.

Writing in the journal Jama Pediatrics, the researchers describe how the therapy appeared to reduce some autism symptoms, a change that largely remained until the children turned three. At that point, independent clinicians assessed each of the children. While one-fifth who received standard care received an autism diagnosis, only 6.7% of those who had therapy did.

According to the study, the children scored better on social interactions but also on other symptoms, such as repetitive movements and unusual reactions to senses such as smell and taste. Further follow-up is needed to see if the therapy merely delays diagnosis or prevents it in some children.

The researchers stress that the therapydoes not address all the challenges autistic people might face. Many of the children still had significant developmental problems when they turned three at the end of the study. But the findings suggest a tailored therapy may at least help some infants to develop their social skills before they reach school age.

“The clinical impact that could be immediate is really gobsmacking,” said Whitehouse. “To date, no therapy has shown such positive effects on development that it has influenced child’s diagnostic outcomes.

“For this reason, the therapy has the very real potential to change how we provide support to children developing differently. At its most basic, this is a change from ‘wait and see’ to ‘identify and act’ – a new clinical model that could transform support for families.”

But the study raises serious questions about how autism services should be provided. Some children who improve on the therapy may still need specialist care but no longer qualify if they are not formally diagnosed. Green said the findings “highlight the flaws in the system”, adding that services should be designed around need, not diagnosis.

Tim Nicholls, the head of policy at the National Autistic Society, said the work had some positives but criticised the researchers for the lack of community involvement.

“It’s important that any further study into very early intervention does not seek to lessen ‘severity’ – early intervention should be about supporting autistic people with the biggest challenges they face,” he said. “For effective research to be done in this area in the future, autistic people must be involved at every stage.”

• This article was amended on 1 October 2021 to remove a reference to the therapy not being “a cure” for autism, as this term is not appropriate within the context of reporting on autism.

Contributor

Ian Sample Science editor

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