Intervention in 6-month-olds with autism eliminates symptoms, developmental delay

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'Infant Start' therapy removes disabling delay before most children are diagnosed "Treatment at the earliest age when symptoms of autism spectrum disorder (ASD) appear – sometimes in infants as young as 6 months old – significantly reduces symptoms so that, by age 3, most who received the therapy had neither ASD nor developmental delay, a UC Davis MIND Institute research study has found. The treatment, known as Infant Start, was administered over a six-month period to 6- to 15-month-old infants who exhibited marked autism symptoms, such as decreased eye contact, social interest or engagement, repetitive movement patterns, and a lack of intentional communication. It was delivered by the people who were most in tune with and spent the most time with the babies: their parents. “Autism treatment in the first year of life: A pilot study of Infant Start, a parent-implemented intervention for symptomatic infants,” is co-authored by UC Davis professors of Psychiatry and Behavioral Sciences Sally J. Rogers and Sally Ozonoff. It is published online today in the Journal of Autism and Developmental Disorders. "Most of the children in the study, six out of seven, caught up in all of their learning skills and their language by the time they were 2 to 3," said Rogers, the study's lead author and the developer of the Infant Start therapy. "Most children with ASD are barely even getting diagnosed by then." "For the children who are achieving typical developmental rates, we are essentially ameliorating their developmental delays," Rogers said. "We have speeded up their developmental rates and profiles, not for every child in our sample, but for six of the seven." Rogers credited the parents in the small, pilot study with making the difference. "It was the parents – not therapists – who did that," she said. "Parents are there every day with their babies. It's the little moments of diapering, feeding, playing on the floor, going for a walk, being on a swing, that are the critical learning moments for babies. Those moments are what parents can capitalize on in a way that nobody else really can." Early identification crucial Children diagnosed with autism typically receive early intervention beginning at 3 to 4 years, six to eight times later than the children who participated in the study. But the earliest symptoms of autism may be present before the child’s first birthday. Infancy is the time when children first learn social interaction and communication, so autism researchers and parents of children with the condition have been working to identify autism and begin intervention sooner. Effective autism treatment relies on early detection so that a child can begin therapy as soon as possible, to prevent or mitigate the full onset of symptoms and sometimes severe and lifelong disability. "We were very fortunate to have this treatment available for the affected infants identified through our study," said Ozonoff, who directs the MIND Institute's Infant Sibling Study, an early detection project that follows babies at risk for autism or ADHD from birth through age 3. "We want to make referrals for early intervention as soon as there are signs that a baby might be developing autism," Ozonoff said. "In most parts of the country and the world, services that address autism-specific developmental skills are just not available for infants this young." Of the seven babies in the study, four were part of the Infant Sibling Study. In addition to these four, the other three children were referred by community parents. The treatment group was compared with four other groups of children that included: High-risk children with older siblings with autism who did not develop autism Low-risk children who were the younger siblings of typically developing children Infants who developed autism by the age of 3 Children who also had early autism symptoms but chose to receive treatment at an older age Treatment based on Early Start Denver Model The treatment was based on the highly successful Early Start Denver Model (ESDM) intervention developed by Rogers and her colleague, Geraldine Dawson, professor of psychiatry, psychology and pediatrics at Duke University in North Carolina. ESDM is usually provided in the home by trained therapists and parents during natural play and daily routines. Parents were coached to concentrate their interactions on supporting their infants’ individualized developmental needs and interests, and embedded these practices into all of their play and caretaking, focusing on creating pleasurable social routines to increase their children’s opportunities for learning. Parents were encouraged to follow their infants’ interests and subtle cues and gauge activities in ways that optimized their child's attention and engagement. The intervention focused on increasing: Infant attention to parent faces and voices Parent-child interactions that attract infants' attention, bringing smiles and delight to both Parent imitation of infant sounds and intentional actions Parent use of toys to support, rather than compete with, the child's social attention The treatment sessions included: Greeting and parent progress sharing A warm-up period of parent play, followed by discussion of the activity and intervention goals Discussion of a new topic, using a parent manual Parents interacting in a typical daily routine with their child while fostering social engagement, communication and appropriate play, with coaching from therapists Parents practicing the approach with their child across one or two additional home routines with toys or caregiving activities Autism scores lowered by 18 to 36 months All of the participants who received treatment were between 6 and 15 months old, lived within a one-hour drive of the MIND Institute, and came from families where English was the primary language. They had normal vision and hearing and no significant medical conditions. All received assessments prior to their participation and at multiple points throughout the study. The treatment group of seven children received scores on the Autism Observation Scale for Infants (AOSI) and the Infant-Toddler Checklist that indicated they were highly symptomatic and at risk of developing ASD. Their symptoms also elicited clinical concern from professors Rogers and Ozonoff. The study measured the children’s and parents’ responses to the intervention. Treatment began immediately after enrollment and consisted of 12 one-hour sessions with infant and parent. It was followed by a six-week maintenance period with biweekly visits, and follow-up assessments at 24 and 36 months. The treatment sessions focused on parent–child interactions during typical daily life and provided parent coaching as needed to increase infant attention, communication, early language development, play and social engagement. The children who received the intervention had significantly more autism symptoms at 9 months, but significantly lower autism severity scores at 18- to 36-months of age, when compared with a small group of similarly symptomatic infants who did not receive the therapy. Overall, the children who received the intervention had less impairment in terms of autism diagnosis, and language and development delays than either of the other affected groups. Treating severe disability Given the preliminary nature of the findings, the study only suggests that treating these symptoms so early may lessen problems later. Larger, well controlled studies are needed to test the treatment for general use. However, the researchers said that this initial study is significant because of the very young ages of the infants, the number of symptoms and delays they exhibited early in life, the number of comparison groups involved, and because the intervention was low intensity and could be carried out by the parents in everyday routines. “I am not trying to change the strengths that people with ASD bring to this world," Rogers said when asked whether she is seeking to "cure" autism. "People with ASD contribute greatly to our culture," she said. "The diversity of human nature is what makes us a powerful and strong species. We are trying to reduce the disability associated with ASD." “My goal is for children and adults with autism symptoms to be able to participate successfully in everyday life and in all aspects of the community in which they want to participate: to have satisfying work, recreation, and relationships, education that meets their needs and goals, a circle of people they love, and to be generally happy with their lives.” ### Other study authors are Laurie Vismara of UC Davis and York University, Toronto; and A.L. Wagner, C. McCormick and Gregory Young, all of UC Davis. The study was funded by grants from the National Institute of Child Health and Human Development R21 HD 065275 to Sally Rogers and National Institute of Mental Health grant MH068398 to Ozonoff. At the UC Davis MIND Institute, world-renowned scientists engage in collaborative, interdisciplinary research to find the causes of and develop treatments and cures for autism, attention-deficit/hyperactivity disorder (ADHD), fragile X syndrome, 22q11.2 deletion syndrome, Down syndrome and other neurodevelopmental disorders. For more information, visit mindinstitute.ucdavis.edu." For more informationon this topic and other related subjects, please visit Counselor CEUs

Teens in child welfare system show higher drug abuse rate

PISCATAWAY, NJ – Teenagers in the child welfare system are at higher-than-average risk of abusing marijuana, inhalants and other drugs, according to a study in the November issue of the Journal of Studies on Alcohol and Drugs. However, the study also shows that parental involvement matters. "When youth perceive that their parents or caregivers are actively engaged in their lives, this may steer them away from drugs," according to lead researcher Danielle L. Fettes, Ph.D., of the University of California, San Diego. "Youth who feel supported by parents tend to have a better sense of self and better mental health and, in this case, are less likely to engage in high-risk behaviors—which is important for this already high-risk population." Using data from two national surveys, Fettes and colleagues found that 18 percent of teens in the welfare system admitted to ever smoking marijuana, versus 14 percent of other teens. Meanwhile, 12 percent said they'd abused inhalants, compared with 6 percent of other U.S. kids. In addition, although abuse of "hard drugs," like cocaine and heroin, was less common, teens in child welfare were still at greater risk: Six percent admitted to ever using the drugs, versus 4 percent of other teens. The findings are not necessarily surprising, according to Fettes. It's known that kids who enter the child welfare system typically have some risk factors for drug use—such as a history of domestic abuse or mental health issues. But until now, there had been little research into their actual rates of substance abuse, Fettes said. For their study, she and her colleagues culled data from two national health surveys: one covered 730 12- to 14-year-olds in the child welfare system; the other included 4,445 kids the same age from the general U.S. population. Overall, teens in the welfare system were more likely to have tried marijuana, inhalants or hard drugs—but not alcohol. Around 40 percent of kids in each survey admitted to drinking at some point in their lives LSW Continuing Education That, according to Fettes, may reflect a couple of facts. "Alcohol is readily available to teenagers," she said, "and drinking is something of a normative behavior to them." But whereas drug use was more common among teens in the welfare system, not all of those kids were at equal risk. A key risk factor—for all teens in the study—was delinquency. Teenagers who admitted to things like shoplifting, theft, running away or using a weapon were at increased risk of both drug and alcohol abuse. On the other hand, some family factors seemed to protect kids from falling into drug use. Teens from two-parent homes were generally less likely to report drug use—and so were kids who said they felt close to their parents or other guardian. For the parents and others who care for these kids, Fettes said it's important to be aware of the increased risk of substance abuse. On the wider scale, Fettes said that right now, there are typically multiple, distinct service systems working with teens in the child welfare system. They may also be receiving mental health services and alcohol and other drug counseling, as well as having contact with the criminal justice system. "Often, they don't work together," she noted. "Given the increased risk, the child welfare system may be an ideal venue to incorporate proven prevention and intervention programs for youth substance use," Fettes concluded. "Drug abuse screening and treatment, or referrals for treatment, should be a regular part of kids' case management." ### Fettes, D. L., Aarons, G. A., & Green, A. E. (November 2013). Higher rates of adolescent substance use in child welfare versus community populations in the United States. Journal of Studies on Alcohol and Drugs, 74(6), 825. To arrange an interview with Danielle L. Fettes, Ph.D., please contact Debra Kain at ddkain@ucsd.edu or 619-543-6202. The Journal of Studies on Alcohol and Drugs is published by the Center of Alcohol Studies at Rutgers, The State University of New Jersey. It is the oldest substance-abuse journal published in the United States. To learn about education and training opportunities for addiction counselors and others at the Rutgers Center of Alcohol Studies, please visit AlcoholStudiesEd.rutgers.edu.

What a difference a grade makes

First-graders with attention problems lag for years afterward; second-graders, less so DURHAM, N.C. -- When it comes to children's attention problems, the difference between first and second grade is profound, says a new study from Duke University. The study, which appears online in the November issue of the Journal of Attention Disorders, says the age at which attention problems emerge makes a critical difference in a child's later academic performance. When the problems emerged in first grade, children's performance suffered for years afterward. For instance, those children scored lower than their peers on reading achievement scores after fifth grade. The poor performance occurred even if the attention problems were fleeting and improved after first grade. By contrast, children who developed attention problems starting in second grade performed as well as their peers in later years. Other studies have noted the link between early attention problems and academic achievement. But the new study is the first to identify the impact of attention problems that emerge in first grade versus those that emerge just a year later. The research was conducted by Duke psychologists David Rabiner, Madeline Carrig and Kenneth Dodge, the William McDougall Professor of Public Policy and director of Duke's Center for Child and Family Policy. It draws on data from the Fast Track Project, a longitudinal study of the development of conduct problems that has followed 891 individuals in four different locales from kindergarten into adulthood. The attention study examined academic performance among a subsample of 386 children by looking at grades as well as reading and math scores before and after first grade, and again after fifth grade. The results may reflect the critical importance of first grade as an academic building block, Rabiner said. Children who suffer from attention problems in first grade fail to acquire key academic skills, and their performance suffers in later years as a result. Not all first-graders who struggle to focus in school have ADHD, Rabiner added. But whether they have diagnosable ADHD or not, he said it's important to help them at the outset of their academic careers, when they are acquiring essential building block skills. "Even when these children overcome their attention problems, they continue to struggle in school," Rabiner said. "The earlier we can identify children who are struggling with sustaining attention in the classroom and intervene to help them, the better." Professional Counselor Continuing Education The study emphasized first and second grades, but Rabiner noted that future researchers would do well to look at kindergarten as well. Data for the study was collected beginning in the early 1990s. Since that time, kindergarten has assumed a more important academic role in many schools. ### The research was supported by National Institute of Mental Health (NIMH) Grants R18 MH48043, R18 MH50951, R18 MH50952, R18 MH50953, K05MH00797, and K05MH01027; National Institute on Drug Abuse Grants DA016903, K05DA15226, and P30DA023026; and Department of Education Grant S184U30002. The Center for Substance Abuse Prevention also provided support through a memorandum of agreement with NIMH. CITATION: "Attention Problems and Academic Achievement: Do Persistent and Earlier-Emerging Problems Have More Adverse Long-Term Effects," David L. Rabiner, Madeline M. Carrig and Kenneth A. Dodge, Journal of Attention Disorders, October 18, 2013. DOI: 10.1177/1087054713507974