Study Offers Best Evidence Yet That Intervening Early Helps Curb Autism
A leading doctors' group recommends that toddlers get screening for autism at 18 months old. That may not be a moment too soon — and earlier may be even better, researchers say.
A new randomized clinical trial, the gold standard for studies, backs up the recommendation from the American Academy of Pediatrics.
Intervention at 18 months for children on the autism spectrum led to better gains in language, social communication and daily living skills than when individual coaching was delayed until 27 months old, the researchers found.
“The rationale behind this was to add more robust evidence to this notion we've long had, that earlier is better when it comes to intervention for autistic kids, but because these trials can be challenging to do there hadn't been a randomized controlled trial yet,” said study co-author Whitney Guthrie. She is a child psychologist and researcher at the Children's Hospital of Philadelphia's Center for Autism Research.
These findings highlight how early intervention can capitalize on brain plasticity, Guthrie said. "Babies' brains are changing rapidly in the first three years of life. If we can intervene and provide these developmental supports for kids to learn new skills as early as possible, we can capitalize on how rapidly their brains are changing anyway,” she explained.
In the United States, about 1 in 36 children has an autism spectrum disorder, according to new data from the U.S. Centers for Disease Control and Prevention. Symptoms can range from mild to severe, with boys affected more often than girls.
“The median age of diagnosis in our country, according to a number of different reports, is between 4 and 5 years,” said study co-author Amy Wetherby, director of the Autism Institute at Florida State University (FSU). “That's outrageous to me. We need to do better.”
That's important for both the children and their parents, Wetherby said, because the symptoms of autism can make parenting very difficult when a family doesn't have specialized treatment or help.
The new study was done with a complete crossover design, said Wetherby.
At 18 months, one group of children and parents received individual coaching and interventions for nine months. They then received nine months of less-individualized resources at 27 months. The other group did the reverse.
The researchers relied on what's called the Early Social Interaction model. This is a parent-implemented intervention used to incorporate these evidence-based strategies into everyday practice in their own homes and activities.
A total of 82 toddlers and their parents participated in the study, which was done at FSU and the University of Michigan.
Alycia Halladay, chief science officer for the Autism Science Foundation in Scarsdale, N.Y., suggested that parents of infants should familiarize themselves with developmental milestones published by the CDC. She was not involved in this study.
What to look for
Toddlers of this age should respond to their name, make eye contact, smile when somebody else smiles at them, and reach out and point to things, Halladay said.
“Parents know their child best, especially at these early ages. And if something doesn't seem right and your pediatrician isn't paying attention to you or kind of dismissing you, go get another opinion,” Halladay suggested.
Halladay also said parents can benefit from free online tools offered through FSU, including babynavigator.com and autismnavigator.com.
Parents who live in very rural areas or have no insurance and thus may not have easy access to clinicians may find these resources especially helpful, Halladay said.
Baby Navigator includes a screening tool for children as young as 12 months old, along with many additional resources. It's a companion to professional development courses through Autism Navigator, Wetherby said.
Wetherby is part of a team studying interventions at even earlier ages, including 9 months old. "If we can do this earlier, because of brain plasticity we can achieve bigger outcomes faster,” she added.
Yet parents who have not had their child diagnosed with autism as an infant or young toddler should not despair. It's not too late.
“There's still strong evidence to suggest that intervention has really important impacts later in development,” Guthrie said.
At whatever age, early and continued interventions through the years are important, Halladay said.
“All of these things are not just important, they're critical, so that everyone can live their best life possible,” Halladay said.
The study findings were recently published online in the journal Autism.
The U.S. Centers for Disease Control and Prevention has more on developmental milestones.
SOURCES: Whitney Guthrie, PhD, child psychologist and researcher, Children's Hospital of Philadelphia's Center for Autism Research, Philadelphia; Amy Wetherby, PhD, director, Autism Institute, Florida State University, Tallahassee, Fla.; Alycia Halladay, PhD, chief science officer, Autism Science Foundation, Scarsdale, N.Y.; Autism, March 15, 2023, online