Our understanding of autism has evolved a great deal since the dark days when doctors blamed it on cold, distant mothering. Scientists have identified any number of factors that are linked to an increased risk of developing autism, from more than 100 different genes to prenatal factors (such as exposure to certain medications or maternal infection during pregnancy) to a variety of other health concerns in mothers, including obesity, gestational diabetes and autoimmune diseases like lupus. We’ve also learned a lot about which types of therapy are most effective at promoting positive changes in behaviour, communication and social skills in kids with autism.
“There has been a huge paradigm shift from autism being viewed as purely genetic or purely a different hard-wired brain to autism being a complex condition that affects many body systems, including the brain, genes, gut and immune system,” notes Laurie Mawlam, executive director of Autism Canada. There is also a growing belief that there may, in fact, be more than one different type of autism. “The good news is, a lot of things are happening in research,” she adds. “There’s a lot of hope.”
Here are just a few of the fascinating developments in research that have taken place over the past year.
Make a difference with earlier-than-ever interventions In recent years, studies have found that children with autism begin to show certain differences in behaviours (such as the amount of time spent smiling and making eye contact) as early as seven months old. Now, evidence is emerging that interventions tailored to kids under two may help foster improvements in verbal and social skills, areas in which many kids with autism have difficulties. “We’re getting better and better at detecting early markers to help make the diagnosis,” says Dr. Evdokia Anagnostou, a Canada Research Chair in translational therapeutics in autism and a senior clinician scientist at the Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital in Toronto.
In one small but fascinating pilot study in the U.S., parents of seven kids aged six to 15 months with autism symptoms were coached for 12 weeks in a program called Infant Start, which targets six characteristic traits of the condition, such as a preference for looking at objects, like toys, over people and repetitive behaviours. For the program, parents learned new ways to teach their child to play with those toys, for example, with the idea being that parents could seamlessly apply these skills in everyday situations, such as mealtime and playtime. By age three, these children had fewer symptoms than similar children whose parents hadn’t completed the program. What’s more, their visual and verbal skills, which had been delayed, caught up to those of typically developing three-year-olds. This study was, of course, small, so more studies are needed to substantiate the findings.
Canadian researchers tested a similar approach in a group of kids who had either confirmed or suspected autism spectrum disorder (ASD). (Many were younger siblings of children with autism, who, as a group, are up to 20 times more likely to develop autism than those with no such family history.) Parents in 20 families received 12 weeks of coaching in a set of strategies called Social ABCs, an early-intervention program co-developed by Susan Bryson in Halifax and Jessica Brian in Toronto. “One technique might be to remember to face your child and smile when you’re playing with her so that when she looks up, she’ll see that you’re enjoying the interaction,” explains study co-author Jessica Brian, a clinician investigator and psychologist at the Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital in Toronto. When investigators checked back in on the families after the 12-week coaching sessions ended, the babies were talking more—responding more to their parents and also initiating more interaction—than when they started the program, says Brian. “We also saw some nice changes in how much time parents and babies spent smiling at each other and how much the babies were looking at their parents,” she adds. “It really enriches the interaction between parent and child in a way that our research suggests would be helpful for children who are on the path to ASD.” Also worth noting, researchers checked back in with the families at week 24 and the changes were maintained.
While more studies are needed to confirm these findings, there are several programs being developed and evaluated for this very young age group, says Brian. “Our goal is to hopefully make them available to families sooner rather than later,” she adds.
“It’s very exciting,” says Mayada Elsabbagh, an autism researcher and assistant professor of psychiatry at McGill University in Montreal. “If we can support parents to support their kids very early, even before symptoms are fully present, we might prevent unwanted consequences and help ensure that every child can reach his or her full potential.”
Mom’s antibodies may provide clues Evidence from animal studies suggests that some cases of autism occur when certain antibodies found in the blood of some expectant mothers spark changes in fetal brain development that can predispose the baby to develop autism later on. (Antibodies are “flags” that the immune system uses to mark invaders like viruses and bacteria for destruction, but they can also bind to healthy cells and trigger attacks by the immune system.) A group of researchers in California have identified these maternal antibodies, says Dr. Julio Martinez-Trujillo, the provincial endowed academic chair in autism at Western University’s Schulich School of Medicine and Dentistry, and that group would like to further their research here in Canada. “You could test mothers to see if they have the antibodies and, with current technology, potentially neutralize those antibodies,” he says. Such potential preventive treatments in humans are years—if not decades—away, but if antibody testing turns out to be reliable, it could also be used as a means of identifying babies who might benefit from very early intervention.
Parental instincts should be trusted and acted upon Canadian researchers have found that parents are pretty good at detecting differences in their kids’ development that can herald a diagnosis of autism. In work led by Lori Sacrey, scientists made a discovery after tracking the concerns of two groups of parents: one with babies who were considered at high risk for developing autism because they had an older sibling with the condition and a control group with no such family history. When all of the children were formally assessed at three years of age, it turns out that parents’ concerns as early as 12 months were a good predictor of a future diagnosis, particularly when they already had an older child on the spectrum. “The general idea is that, by 12 months, the risk signs become increasingly clear and can be observed by clinicians,” says Sacrey. “However, we find that the brain is beginning to develop differently from a young age before the behaviour risk signs become increasingly clear in the first two years.”
“One of the biggest take-home messages is the importance of taking parents’ perspectives very seriously,” says Elsabbagh. “We still have many families who have concerns that are dismissed early on, which delays diagnosis and treatment.” It’s extremely important that when parents have early concerns, they go to the physician’s office and air them because we’re getting better and better at intervening earlier and earlier, says Anagnostou.
Use technological supports Scientists have begun to develop technological supports that may be helpful for some kids, such as the estimated 40 percent of children with autism who have a co-existing anxiety disorder. “The usual interventions for anxiety often don’t work very well,” says Anagnostou, because they require that kids have a lot of language and can recognize their feelings—two things that some kids with autism struggle with. Researchers at the Bloorview Research Institute have developed an algorithm that identifies when kids are anxious by measuring their heart rate. “It gives feedback about what their level of anxiety is and, if it’s going up, they can practise deep-breathing techniques to bring it down,” says Anagnostou. The device, called the Anxiety Meter, is now being tested in a randomized controlled trial. “We want to see if the kids who have the device are more successful at achieving deep breathing and maintaining it than kids who don’t have the device,” explains Azadeh Kushki, a scientist at the Bloorview Research Institute at Holland Bloorview and an assistant professor at the Institute of Biomaterials and Biomedical Engineering at the University of Toronto.
Kushki and her colleagues are also working on Holli, a device that harnesses the technology behind Google Glass to provide prompts during social interactions, such as ordering in a restaurant. “The idea is that Google Glass would listen to the conversations that the children are having, analyze the content and prompt them as to what to say next,” says Kushki. “It could provide coaching over time as well, following the principles of behavioural intervention. The key thing is that it would be an inexpensive way to reinforce treatment concepts during everyday life.” If all goes well, after being fully developed, Holli will also go into randomized trials. “Unfortunately, despite all the potential of technology, the evidence supporting its effectiveness in this population is very limited,” says Kushki. “Well-designed studies are needed to unlock the potential of technology in this area.”