26052
Studying Symptom Onset and Intervention for Infant Siblings of Children Diagnosed with Autism
About 20 percent of infant siblings of ASD children will be diagnosed with ASD by age three. (Brian et al., 2014; Ozonoff et al., 2011). Symptoms of ASD are present during the first two years of life, and reflect aberrant brain activation (Brian et al., 2014; Jones and Klin, 2013; Landa et al., 2012), which may be normalized by learning new responses to environmental stimulation, including human interaction (e.g., Helt, et al., 2008; Xu et al., 2009). By intervening before the full syndrome is present, at risk children may avoid being diagnosed (Rogers et al., 2008). Using ABA, ESDM or other strategies, several studies have found improvement in at risk children under two years old (MacDonald et al., 2004; Rogers et al., 2010, 2014).
Objectives:
1. Determine the earliest signs of symptomatic behavior including delays and loss of skills during the first six months of life in infant siblings.
2. Describe the response to intensive intervention with symptomatic infants and their parents.
Methods:
Parents of infant siblings gave informed consent. Infants were assessed using the AOSI (Bryson et al., 2000), Bayley III, the Mullen, the PLS-5, and the Vineland. Development was followed weekly throughout intervention. Intervention followed developmental, ABA and ESDM strategies, coupled with family counseling and training for parents. Intervention ranged from 15 to 40 hours weekly. Parents attended with their infants, which allowed us to do direct coaching. Staffing of the intervention room was 1:1.
Results:
1. Of the 75 infants, ranging in initial age from 6 days to 7.5 mos (mean 2.5 mos), 13 were identified as showing symptoms of ASD (20.3%), and 11 were typical developing (TD). Symptoms included poor eye contact, reactivity, fleeting attention and engagement with us, flat affect with no smiling, low response to physical interaction, staring off, preferring objects to human interaction, repetitive toy play, poor self-soothing, and rigidity/ fear of novelty, e.g., new toys or people.
2. TD infants showed no losses of raw score points during the first six months. By comparison, symptomatic infants showed delays beginning at 16 days to 2 mos (mean 1.2 mos), and losses of raw score points beginning at 16 days to 5 months (mean 2.6 mos). Most children with losses had 3-4 during the first 6 months, while 2 had 20 losses. The duration of losses was 1 to 2.5 weeks. Losses represented all areas: motor, language, cognitive and social skills.
3. Parents needed coaching to become more attentive, interactive, positive and sensitive to their infant’s cues (Wan et al., 2013).
Conclusions:
Early symptoms including loss of skills in all areas occurred during the first one or two months of age. In spite of showing early delays and loss of skill, all infants responded well to intervention. Progress was somewhat uneven, with periods of rapid learning followed by plateaus for a week or so, followed by resumption of gains. So far, the 13 infants who showed ASD symptoms, no longer do so. However, since only two are now 2 years old, these results are preliminary.