Study: Early Autism Intervention Improves Brain Responses to Social Cues

A study shows promising signs that behavioral intervention can positively change brain function in toddlers with autism.

An autism intervention program that emphasizes social interactions and is designed for children as young as 12 months has been found to improve cognitive skills and brain responses to faces, considered a building block for social skills. The researchers say that the study, which was completed at the University of Washington, is the first to demonstrate that an intensive behavioral intervention can change brain function in toddlers with autism spectrum disorders.

"So much of a toddler's learning involves social interaction, and early intervention that promotes attention to people and social cues may pay dividends in promoting the normal development of the brain and behavior," said Geraldine Dawson, lead author and chief science officer for the advocacy group Autism Speaks.

"For the first time, parents and practitioners have evidence that early intervention can result in an improved course of both brain and behavioral development in young children," she said.

Dawson began the study while she was the director of the UW Autism Center. The study was published online Oct. 26 in the Journal of the American Academy of Child & Adolescent Psychiatry.

Forty-eight children, aged 18 to 30 months and diagnosed with autism, either participated in routine community-based interventions or the Early Start Denver Model, which emphasizes interpersonal exchanges and shared participation in activities. The model was developed by Dawson and co-author Sally Rogers, a professor at the UC Davis MIND Institute.

Participants received one of the interventions for about 20 hours each week over a period of two years. For the children randomly assigned to the ESDM group, treatment took place two hours, twice a day, five days a week, by trained interventionists who came to the child's home. The children got an extra boost from their parents, who were trained to use ESDM strategies during routine exchanges with their child.

A previous study found that the ESDM intervention improved IQ, language, and adaptive skills and the researchers wanted to know if the approach also led to brain changes.

After two years of treatment, the brain function of the participants -- now about four to five years old -- was measured with electroencephalography while the youngsters viewed social stimuli, such as faces, and nonsocial stimuli, such as toys.

"Humans are experts at processing faces, but the brains of children with autism have delays in the ability respond to faces," said co-author Sara Webb, a UW research associate professor. If the brain can quickly identify a face, she said, then it can build on this to also quickly decide whether the face is of a man or a woman, happy or sad, and familiar or not.

Children in both intervention groups showed similar brain responses to faces as did children in a control group who did not have autism, suggesting that "the high level of intervention in both groups allowed the children with autism to catch up to the children in the control group," Webb said. "That's fantastic news."

Looking at a higher level of brain processing, the researchers studied whether the treatments changed brain measures of attention and cognitive engagement when seeing faces compared with a nonsocial stimulus. Eleven of 15 -- or 73 percent -- of children in the ESDM group showed greater attention to faces than to toys. In contrast, the EEGs of only five of the 14 recipients of the community intervention, or 36 percent, showed similar activation.

"The ESDM intervention resulted in greater attention and cognition brain activity to social stimuli, and these brain function patterns are more similar to the typical developing group of children," Webb said.

She stressed not only the importance of receiving intensive early intervention for autism, but that the intervention should focus on enhancing social attention, reciprocal interactions and engagement with a social partner.

Other study authors at UW are Emily Jones, Kaitlin Venema, Rachel Lowy, Susan Faja, Dana Kamara, Michale Murias, Jessica Greenson, Jamie Winter and Milani Smith, as well as Kristen Merkle of Vanderbilt University.

The study was funded by a grant from the National Institute of Mental Health and an Autism Speaks postdoctoral fellowship awarded to Jones.

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EEG and Video EEG Guide: Reference Sites for Information About The Test For Children, Teens and Young Adults

Electroencephalogram (EEG) and Video EEG

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Fast Facts About EEG

An EEG does not hurt. Typically, its a boring, bad hair day. 

• The EEG measures the electrical activity in the brain called brain waves.
• Your child should not drink anything with caffeine in it on the day of the test.
• Words are important when talking to an apprehnesive child.  I avoid scary medical words when talking to an apprehensive patient.  
  
  
  Small" button-shaped stickers  or golden plates" called electrodes will be placed on your child’s scalp to measure the brain activity.  The electrodes are connecte to "rainbow strings" 
  or wires.  "Dr Rotenberg's friend " or the technician will clean little areas on your head with "hair gel" or shampoo.
• All testing takes place on the outside of your child’s body and will not hurt.
• An EEG takes about 1-2 hours to complete.

Fast Facts About Video EEG

• During the video EEG, your child will be video recorded while the EEG is done.
• Like an EEG, this test does not hurt. But, its SUPER boring.
• This test is usually done at the hospital.
• This test takes from 12 hours to several days, depending on the information that is needed.

What Is An Electroencephalogram (EEG)?

An electroencephalogram (ee-leck-tro-en-SEFF-a-lo-gram) or EEG uses small button-shaped electrodes on the outside of the scalp to record the brain’s electrical activity or brain waves.  These brain waves are the way brain cells talk to one another and get information from the brain to the rest of the body. An EEG gives doctors a record of that activity by recording it onto a computer or printing it out on a piece of paper.

An EEG helps doctors understand what is happening inside the brain. It can help doctors:

• Tell if a child’s level of alertness or consciousness is normal.
• Point out something that is not normal in one part of the brain.
• See if a child has a tendency to have seizures or convulsions.
• See if a child may have a certain kind of epilepsy.

Sometimes a child who has been having seizures may have a normal EEG. That is because the problem causing the seizures may come and go. When that is the case, the doctor may want to do another EEG, a longer EEG or a video EEG.

What Is A Video EEG?

A video EEG records  video your child while the regular EEG is being done. The video recording is done over a longer period of time than a regular EEG. 

• A video EEG can take from 6 hours to several days, depending on the information that is needed. 
• The video EEG is usually done in the hospital, where it is safe to allow your child to have some seizures. It lets doctors record the seizures with the EEG to see how your child behaves when those seizures happen.

Home Preparation

Before your child’s EEG or video EEG:

• Wash your child’s hair the night before the test, but do not use any oil, gel or hairspray. Please do not braid or pull up long hair, and do not use any hair extensions.
• If you were given special instructions about waking your child up early or changing his or her sleep schedule on the day of the EEG, please follow these instructions. Some EEGs need to be done when a child is sleep-deprived to get the right information.
• Give your child his or her medications as usual, unless your doctor tells you otherwise. 
• On the day of the test, dress your child in clothing that does not slip on and off over the head.  Shirts that zip or button up the front or back are preferred. 
• Bring a list of all the medications your child takes, including how often your child takes each medication and how much your child takes with each dose. 
• Your child’s doctor will give you specific instructions about when your child can eat before and after the test. 
• Your child should not have any drinks that have caffeine in them on the day of the test. These drinks include soda or pop with caffeine, coffee and tea. 
• You may bring along a “comfort” item—such as a stuffed animal or “blankie”—for your child to hold during the test.
  
  
  Remind teens and young adults this is going to be a "BAD HAIR DAY". Bring a hat if they are concerned about their image.

The Test

An EEG is simple and painless. Here is what to expect:

• Your child will be asked to lie down on a bed. 
• An EEG technician will be in the room and will explain the test to you and your child. 
• The technician will measure your child’s head and make small marks on the scalp with a washable marker or pen. 
• Each marked area will be rubbed gently with a gritty lotion that helps the electrodes work better.   
• A mild glue that can be removed later will be put on the electrodes and the electrodes will be placed on each of the marks made on your child’s scalp.
• The electrodes will then be connected to the EEG machine and the test will begin. 
• During the test, your child should lie as still as possible. 
• At times, your child may be asked to breathe fast, to look at flashing lights and to try to sleep.

A video EEG is done much the same way, but it takes longer and your child is videotaped for a long period of time.

• A video EEG is often done at the hospital.
• Your child will be asked to sit in a chair or lie on a bed.

A Parent’s/Guardian’s Role During the Test

We welcome your help and support during this test. One parent or guardian is invited to stay with your child in the room during the EEG.  Other adults and children must stay in the waiting area.

• The most important role of a parent or guardian during the EEG is to help your child stay calm and relaxed. 
• The best way to help your child stay calm is for you to stay calm.
• We encourage you to talk to your child for reassurance during the EEG.
• Video EEGs can be boring for children, so you may want to bring an ipad, computers, books to read, toys or quiet games to play, or a favorite DVD for your child to watch.  These things will help the time go by faster. 

After the Test

Once the test is over:

• The electrodes will be removed from your child’s scalp and the glue will be washed off with warm water and a washcloth. If all of the glue doesn’t come off at first, you may need to wash your child’s hair at home.  
• The technician or a nurse will give you further instructions and tell you when you and your child may leave. 
• A pediatric neurology doctor will look at and interpret the EEG, and a report of your child’s EEG will be sent to the doctor who ordered it. If the results are urgent, the referring doctor will be contacted immediately.
• Please contact the doctor who ordered the test for the results.

Special Needs

If your child has any special needs or health issues you feel the doctor or technician performing the test needs to know about, please call our office  before the test and ask to speak with a nurse. It is important to notify us in advance about any special needs.

printable pdf here

I found this site while searching for video eeg patient information and explanations online. While the masked tech is scarier than the ones in my office, the site explains the procedure for parents. I would not use this site for an anxious young child. JR


Welcome to Kids
Video EEG Guide Online


Some kids need to have a test called Video EEG Monitoring. This picture guide and information will help caregivers and patients see what it is like and answer some basic questions. It is designed by a Child Life Specialist. If your Video EEG Center or Epilepsy Monitoring Unit has one working there, please feel free to talk to them about how to make the experience better for both patients and caregivers.




http://www.kidsvideoeeg.com/index.html