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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Study: Popular Autism Treatment Lacks Scientific Evidence

Researchers from the University of Texas at Austin claimed that sensory integration therapy, a popular autism treatment, does not have a strong scientific basis showing that it is effective.

One of the most popular intervention therapies for children with autism spectrum disorders (ASD) lacks scientific support according to a literature review published by University of Texas at Austin professor Mark O’Reilly and an international team of scientists.

The researchers reviewed 25 major studies on sensory integration therapy (SIT) to see if the current evidence base supports use of this therapy in the education and rehabilitation of children on the autism spectrum. Their conclusion that research does not support the use of SIT means providers who work with children with ASD will need to reassess their education and treatment strategies.

Many agencies serving children on the autism spectrum are mandated to use research-based, scientifically valid interventions, but several previous surveys indicate SIT remains one of the most common intervention choices. In one study, 99 percent of interviewed occupational therapists reported using it.

“According to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, a person has to have severe communication and social deficits as well as restrictive and repetitive behaviors to be diagnosed with ASD,” said O’Reilly, interim chair of the College of Education’s Department of Special Education. “SIT was proposed as a way to help with these symptoms. Rigorous, methodologically sound studies do not indicate that it helps and, in fact, the majority of studies that were reviewed reported no benefits for children with ASD.”

Because many children on the autism spectrum have abnormal responses to auditory, visual, tactile and oral stimuli, sensory integration therapy is designed to offer specific forms of sensory stimuli in the appropriate amounts, with the aim of improving how the nervous system processes sensory stimuli. Therapists who use SIT may have a child with ASD wear a weighted vest, swing, sit on a bouncy ball, or be compressed between pillows, said Dr. Russell Lang, lead investigator in the SIT literature review.

"Many researchers have pointed out that SIT may actually lead to an increase in undesirable behavior because it gives children who exhibit unwanted behavior access to fun activities, more attention from therapists and breaks from less desirable tasks like schoolwork,” said Lang, executive director of Texas State University’s Clinic for Autism Research, Evaluation and Support. “It also can undermine the effectiveness of research-based behavioral interventions that the therapist is administering at the same time.”

According to experts, the only scientifically valid treatment and intervention for individuals on the autism spectrum is applied behavior analysis. The University of Texas at Austin’s Department of Special Education, of which Lang is an alumni, is one of only a few in the nation that trains graduate students in this therapy. With applied behavior analysis, the therapist teaches children age-appropriate skills and offers systematic, repetitious positive reinforcement for desired behaviors.

“The American Academy of Pediatrics, the premier professional organization for pediatrics, recently issued a policy statement which offers similar cautions regarding a lack of research support for SIT with this population,” said O’Reilly.

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New Treatment for Irritability in Autism

ScienceDaily (May 31, 2012) — Autism is a developmental disorder that affects social and communication skills. Irritability is a symptom of autism that can complicate adjustment at home and other settings, and can manifest itself in aggression, tantrums, and self-injurious behavior. These disruptive behaviors are frequently observed in children with autism, which may considerably affect their ability to function at home or in school.

N-acetylcysteine (NAC) is approved by the US Food and Drug Administration for the treatment of acetaminophen (Tylenol) overdoses, but it may have other applications related to its effects in the brain. NAC helps maintain and restore glutathione, which play a key role in the antioxidant defense system. Additionally, cysteine as supplied by NAC treatment, stimulates a protein, the cystine-glutamate antiporter, resulting in the decrease of glutamatergic neurotransmission.

NAC has two resulting effects:


1) it may protect brain cells by raising the level of a protective antioxidant metabolite called glutathione, and


2) it may reduce the excitability of the glutamate system by stimulating inhibitory receptors.

These drug actions are important because, although the causes of autism are unknown, it is clear that there are many influencing factors and scientists are pursuing multiple hypotheses. Two in particular relate to NAC: one theory is that autism may be caused by an imbalance between oxidants and antioxidants in the body; the other is that the glutamate system may be dysfunctional in individuals with autism.

These hypotheses led researchers at Stanford University and the Cleveland Clinic to conduct a pilot trial of NAC in children with autistic disorder. Children were randomized to receive either NAC or placebo daily for 12 weeks and their symptoms were evaluated four times during that period.
They found that irritability was significantly decreased in the children who received NAC. In addition, NAC was well-tolerated and caused minimal side effects....

Pilot Study Finds Promise for Autism in Antioxidant Therapy

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on May 30, 2012

A new pilot study suggests a specific antioxidant supplement may be an effective therapy for some features ofautism.

Researchers from the Stanford University School of Medicine and Lucile Packard Children’s Hospital studied 31 children with the disorder.

The antioxidant, called N-Acetylcysteine, or NAC, effectively reduced irritability in children with autism and moderated repetitive behaviors. The researchers emphasized that the findings must be confirmed in a larger trial before NAC can be recommended for children with autism.

Irritability affects 60 to 70 percent of children with autism. “We’re not talking about mild things: This is throwing, kicking, hitting, the child needing to be restrained,” said Antonio Hardan, M.D., the primary author of the new study.

“It can affect learning, vocational activities and the child’s ability to participate in autism therapies.”

The study will appear in a forthcoming issue of the journal Biological Psychiatry.

Stanford University is filing a patent for the use of NAC in autism, and one of the study authors has a financial stake in a company that makes and sells the NAC used in the trial.

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