Early therapy reduces babies’ autism diagnosis

A parent-led therapy that supports the social development of babies displaying early signs of autism has significantly reduced the likelihood of an autism diagnosis being made in early childhood, according to a world-first two-site research study based at La Trobe University and the Telethon Kids Institute.

In a study published in JAMA Pediatrics today, the research team, led in Victoria by Associate Professor Kristelle Hudry from La Trobe, found that an autism diagnosis at age three was only a third as likely in children who receive the pre-emptive therapy (iBASIS-VIPP) compared to those who received treatment as usual.

The findings were the first evidence worldwide that a pre-emptive intervention during infancy could lead to such a significant improvement in children’s social development that they then fell below the threshold for a clinical diagnosis of autism.

iBASIS-VIPP uses video-feedback as a means of helping parents to recognise their baby’s communication cues so they can respond in a way that builds their social communication development.

La Trobe’s Associate Professor Kristelle Hudry, who leads the Childhood Autism Phenotype Team (CAPTeam) within the Department of Psychology and Counselling, School of Psychology and Public Health, said the findings represented a significant breakthrough for clinicians and families.

“While having a confirmed autism diagnosis is an important step in the clinical journey for families with young children – bringing relief and understanding for parents and opening doors to services and support for the child and family – our research shows there is no need to wait until we know for sure a child has autism, to offer beneficial supports.”

“Our study shows we can have a real, positive impact on a child’s development by identifying infants who might be developing autism early, and providing support to parents at home, as part of their everyday routines. Similar naturalistic interventions begun after diagnosis show some benefits for autistic children’s skill development, but not to the extent shown here when the support was offered very early in life.”

The four-year randomised clinical trial enrolled babies aged 9-14 months to investigate the impacts of iBASIS-VIPP. All babies had shown early behavioural signs of autism. Over a period of five months, half received the video intervention, while a control group received current best practice treatment.

Eighty-nine children completed assessments at the start of the study, at the end of the therapy period, and again when they were two and three years of age.

Professor Andrew Whitehouse, the Angela Wright Bennett Professor of Autism Research at Telethon Kids and the University of Western Australia and Director of CliniKids, said given the high prevalence of autism worldwide, the implications of the findings were enormous. In Australia, about 2 per cent of all children have an autism diagnosis.

“Autism is not typically diagnosed until three years of age, however, interventions commencing during the first two years of life, when the first signs of development difference are observed and the brain is rapidly developing, may lead to even greater impact on developmental outcomes in later childhood,” Professor Whitehouse said. “This is a genuine landmark moment for child health research. Our aim is to understand each child’s strengths and challenges so that we can better support and nurture the unique abilities they bring to this world.

“This is an important step forward in what we hope is an opportunity to develop new clinical models that use very early intervention in babies showing early behavioural signs of autism.”

Professor Whitehouse said follow-up of study participants in later childhood, when the behaviours for autism may be more apparent, would be critical to determining the longer-term significance of the video intervention.

Associate Professor Kristelle Hudry added, “what is really encouraging is that the support these children received as infants – 2 years earlier – has reduced the extent to which any emerging signs of autism have become disabling. We value neurodiversity and acceptance, and also advocate for acceptable and affordable services that focus on promoting positive outcomes for children and their families.”

The study was funded by the Cooperative Research Centre for Living with Autism (Autism CRC – established and supported under the Australian Government’s Cooperative Research Centre Program), La Trobe University’s Understanding Disease Research Focus Area, the Western Australian Children’s Research Fund, and the Angela Wright Bennett Foundation.

Collaborating institutions included La Trobe University (Department of Psychology and Counselling, Olga Tennison Autism Research Centre, and Living with Disability Research Centre), The University of Western Australia, the Western Australian Child and Adolescent Health Service, Griffith University, the University of South Australia, the University of Manchester UK, and Evelina London Children’s Hospital, and Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust. We are also grateful for the support from the Victorian Maternal and Child Health Service.

The full paper, Effect of pre-emptive intervention on developmental outcomes for infants showing early signs of autism: A randomized clinical trial of outcomes to diagnosis can be accessed here.

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