'Coaching' parents found to reduce autism diagnosis by two-thirds

Two thirds of autism cases could be prevented by treating babies with a simple video intervention, new research shows.

In a landmark study, scientists from the University of Manchester and the University of Western Australia found that they could reduce the number of children being diagnosed with autism at the age of three, from 20.5 per cent per cent to 6.7 per cent.

The intervention involved videoing at-risk babies as they interacted with a parent, before a therapist showed how the child was trying to communicate, so that the parent could respond.

Scientists believe that rather than shunning social interaction, babies with autistic tendencies are often trying to communicate, but do so in a way that is difficult for a parent to understand, for example, seeking attention without holding eye contact.

When parents fail to respond to such communication, it can damage brain development, leading to long-term difficulties in social interactions.

Jonathan Green, professor of child and adolescent psychiatry at Manchester University, said: “Autism is a condition that we know is present from birth, in fact before birth. In the first couple of years you don’t see autism fully emerge, but you see signs, and we make a diagnosis around three.

“Early caregiver interactions are crucial to the brain and social development and we think in the autistic brain, parents and babies, through no fault of their own, get a bit out of sync, leaving parents highly perplexed about how to communicate with their babies.

“What is missing in autism therapy is work at the early stage before diagnosis when all the crucial developmental processes are happening.”

Helping understand communication

The four-year randomised clinical trial followed 89 babies aged 9-14 months. Over a period of five months, half received the video intervention, while a control group received current best practice treatment.

The team said the therapy did not actually involve the child at all, but rather worked with parents to help them understand how their baby was trying to communicate.

Babies initially learn how to communicate with their parents, and that ability then gets generalised to other people. But if there is little interaction early on, it prevents the skill being learned and transferred to others, making social behaviour harder in later life.

Tests showed that scores of "social emotional reciprocity" (the back and forth interaction between parents) was far higher in children who underwent the intervention, compared to children that did not.

The youngsters were even able to communicate with the researchers who they did not know.

Repetitive movements associated with autism were also reduced in the intervention group, which experts said showed the therapy was having a "cascade effect" which went beyond social benefits.

Prof Green added: “For the children who had had therapy as usual, just over 20 per cent of them went on to develop autism, which is roughly what we would expect. In the therapy intervention group it was 6.7 per cent.

“That is a really big big difference. This is the first evidence worldwide that a pre-emptive intervention can reduce autism. It shifts the focus of therapy from after diagnosis to before diagnosis. There are a lot of babies who could benefit from this.”

'Gobsmacking' clinical impact

Around 700,000 people are living with autism in Britain, and 10,000 babies are born with the condition each year.

Prof Andrew Whitehouse, of the University of Western Australia, added: “The clinical impact that could be immediate is really gobsmacking.

“We are extremely excited about these findings. It is a landmark in the field. The idea that we can provide support to kids very early in life and can change their long-term trajectory, so that they may not meet the criteria for a diagnosis, is truly groundbreaking.”

The research, which was published on Monday in the journal Jama Paediatrics, was also welcomed by autism charities.

Dr James Cussak, of Autistica, said: “We think today’s work is important. It suggests that the government and health services need to think differently about how they support children, and suggests we may not need to wait until someone receives a diagnosis.”

The team will be testing the children again at the age of six to seven to see if the intervention lasts.