Early therapy can reduce likelihood of autism diagnosis in children

A parent-led therapy that supports social development can reduce likelihood of an autism spectrum disorder (ASD) diagnosis in children showing early behavioural signs of the condition, according to a study led by CliniKids at the Telethon Kids Institute.

Researchers led by Professor Andrew Whitehouse (Angela Wright Bennett Professor of Autism Research at Telethon Kids and The University of Western Australia and Director of CliniKids) studied over 100 infants aged 9–14 months exhibiting early signs of autism.

They found that a clinician diagnosis of autism at age three was only a third as likely in children who received the pre-emptive therapy (iBASIS-VIPP) compared to those who received treatment as usual.

Many therapies for autism tried to replace developmental differences with more ‘typical’ behaviours. In contrast, iBASIS-VIPP sought to work with each child’s unique differences and create a social environment around the child that would help them learn in a way that was best for them, he said.

“The use of iBASIS-VIPP resulted in three times fewer diagnoses of autism at age three,” Professor Whitehouse said.

“The therapy uses video-feedback to help parents understand and appreciate the unique abilities of their baby, and to use these strengths as a foundation for future development,” said Professor Whitehouse. This supported their later social engagement and other autistic-related behaviours such as sensory behaviours and repetitiveness, to the point that they were less likely meet the ‘deficit-focused’ diagnostic criteria for autism.

“We also found increased parental sensitivity to their baby’s unique communication and an increase in parent-reported language development. Other general aspects of development were not affected.

“The children falling below the diagnostic threshold still had developmental difficulties, but by working with each child’s unique differences, rather than trying to counter them, the therapy has effectively supported their development through the early childhood years.”

The four-year randomised clinical trial enrolled babies aged 9–14 months to investigate the impacts of iBASIS-VIPP. All babies had shown early behavioural signs of autism. Over a period of five months, half received the video intervention, while a control group received current best practice treatment.

Eighty-nine children completed an assessment at the start of the study, at the end of the therapy period and when they were two and three years of age.

This Australian study trialled a parent-mediated therapy, iBASIS-VIPP, which was developed by the study’s UK collaborators — Professor Jonathan Green, Dr Ming Wai Wan, Dr Carol Taylor (University of Manchester) — and Dr Vicky Slonims (Evelina London Children’s Hospital, part of Guys and St Thomas’ Hospital NHS Foundation Trust).

A previous UK trial of iBASIS-VIPP, led by Professor Green, had shown similar positive benefits of intervention on social development and behaviour which were sustained after the end of therapy — but numbers were too small to show if there was an effect on clinical diagnosis.

“Autism is not typically diagnosed until three years of age; however, interventions commencing during the first two years of life, when the first signs of development difference are observed and the brain is rapidly developing, may lead to even greater impact on developmental outcomes in later childhood,” Professor Whitehouse said.

Professor Whitehouse said given the high prevalence of autism worldwide, the implications of the findings were enormous. In Australia, about 2% of all children have an autism diagnosis.

A follow-up of study participants in later childhood, when the behaviours for autism may be more apparent, would be critical to determining the longer-term significance of the video intervention, Professor Whitehouse said.

The study, published in JAMA Pediatrics, was funded by the WA Children’s Research Fund, the Cooperative Research Centre for Living with Autism (Autism CRC — established and supported under the Australian Government's Cooperative Research Centre Program), La Trobe University’s Understanding Disease Research Focus Area, and the Angela Wright Bennett Foundation.

Collaborating institutions included La Trobe University, The University of Western Australia, the Western Australian Child and Adolescent Health Service, Griffith University, the University of South Australia, the University of Manchester UK, and Evelina London Children's Hospital, part of Guys and St Thomas’ NHS Foundation Trust UK.

Image credit: ©stock.adobe.com/au/New Africa