January 22, 2015

expert reaction to video-based therapy for autism

In a paper published in the Lancet Psychiatry, a group of researchers have studied the effects of using a video-based intervention for infants with familial risk of autism. The research team report that the intervention produced positive outcomes in terms of behaviour, developmental, and brain function.

Dr Judith Brown, Head of Autism Knowledge and Expertise at the National Autistic Society (NAS), said:

“This is a robust piece of research combining the knowledge of very experienced research teams.

“The study reinforces current evidence which suggests that very young children with autism do not engage with their parents in the same way as their non-autistic peers. The reason for this is still unknown, but we hope that further studies will help us to understand more about the infant brain, the importance of parent-infant communication and how professionals can better support parents and improve the outcomes for their children.

“However, it is important to reassure families that the aim of this study is to improve and support early development and the paper’s findings in no way suggest that poor communication between a parent and child ‘causes’ the social difficulties which are a feature of autism.”

Prof. Dorothy Bishop, Professor of Developmental Neuropsychology, Department of Experimental Psychology, University of Oxford, said:

“It is widely thought that intervention for autism is most likely to be effective if it starts early. The problem is we can’t know in advance which children will develop autism. We do know, though, that children are at risk if they have an older sibling with autism: around 20% of these ‘high risk’ children develop autism.

“These researchers did a well-designed study of an intervention with infant siblings of children with autism, in which parents were trained to communicate with their infant. The training started around 9 months of age and children were followed up at 14 months of age. A control group was seen over the same period but had no training. The training was effective in changing the behaviour of parents but findings for the children were suggestive rather than conclusive, with some measures showing a trend for improvement, but others going in the opposite direction.

“None of the child measures achieved conventional levels of statistical significance. The real test of the treatment will come in a year or two when it will be possible to identify how many of these children do develop autism.”

Dr Melissa Allen, Senior Lecturer in Psychology (specialising in autism), University of Lancaster, said:

“There is no doubt that early intervention can change the course of autism.  This paper presents a rigorous and impressive approach to intervention study, but as the authors note, some of the effects are limited, and in the case of language acquisition where a decline in skills was noted, downright puzzling.

“A crucial factor this paper targets is the importance of parent based intervention: there is no one better placed to guide early socio-communicative behaviour than the individuals who interact with young infants the most and have the highest stake in their development.  Teaching parents techniques to understand and scaffold their child’s earliest communicative actions is a fantastic way to change the course of development, as evidenced here by an increase in the infant’s attentiveness to his or her parent.  Such a seemingly small change in behaviour can have an enormous impact on subsequent learning.

“This research exhibits a meticulous approach to data collection by combining traditional behavioural assessment with brain functioning measures, while also offering flexibility tailored to each family’s individual needs during the intervention protocol.  Although the findings bear further replication, they offer promise in terms of a relatively low-cost, family inclusive, method to increase social attention in children who are at risk of developing autism and broader social difficulties.

“It will be important to document whether any such changes observed in the children’s behaviour persist in the absence of continued intervention.  Whether these changes are long lasting and can prevent an autism diagnosis remains an open and essential question.”

‘Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial’ by Green et al. will be published in The Lancet Psychiatry at 00:01 UK time on Thursday 22^nd January 2015, which is also when the embargo will lift. 

Declared interests

None declared