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M.I.N.D. Institute researcher receives funding to treat toddlers with autism

Photo of toddler playing with puzzle The M.I.N.D. Institute has launched a new study to determine if intervention earlier than 24 months of age is effective for children in reducing — or circumventing altogether — the language impairments and social deficits associated with autism.

UC Davis M.I.N.D. Institute researcher Sally J. Rogers has received $15.3 million to test the effects of an intensive intervention for toddlers with autism that combines play- and relationship-based approaches with applied behavior analysis. This five-year study is the first multisite, randomized trial funded by the National Institutes of Health to determine if intervention earlier than 24 months of age is effective for children in reducing — or circumventing altogether — the language impairments and social deficits associated with the serious developmental disorder. Researchers will also determine the behavioral factors that help predict whether or not a child will respond well to this early treatment.

Rogers, one of the world's leading researchers on autism treatment, will be joined in the investigation by Annette Estes, research assistant professor of psychiatry and behavioral sciences and associate director of the University of Washington Autism Center; and Catherine Lord, professor of psychology and psychiatry and director of the University of Michigan Autism and Communication Disorders Center.

"There is very little published about the effectiveness of any intervention model for children in treatment earlier than age 2. However there are some very promising results from a feasibility study that is being conducted at the University of Washington," said Rogers, professor of psychiatry and behavioral sciences with the UC Davis M.I.N.D. Institute and the study's principal investigator. "With this new funding, we can broaden that study and truly provide an 'acid test' of the effectiveness of this type of interventional approach for very young children with autism."

The intervention to be tested — the Early Start Denver Model — was developed by Rogers, Geraldine Dawson, a study consultant and professor emeritus of psychology at the University of Washington, and their collaborators at the University of Washington, the M.I.N.D. Institute and University of Colorado Health Sciences Center. The approach fuses developmental and relationship-based intervention techniques with applied behavior analysis teaching strategies. It focuses on using play and positive reciprocal interactions to teach a developmental curriculum designed for each child based on current abilities and interests. The individualized approach is what makes the model easy to adapt for younger children. A combination of the developmental curriculum, teaching techniques based on applied behavior analysis, and warm, engaging social exchanges between an adult and the child is used to achieve measurable treatment goals targeting affective connection, social relatedness and communication skills.

Together, the three study sites will recruit a total of 108 children aged 18-to-30 months who have symptoms of autism. Typical "red flags" in social communication skill development between the ages of 1 and 2 indicating that a child may have an autism spectrum disorder include:

  • Lack or loss of typical behaviors, such as pointing, playing with a variety of toys, responses to contextual cues, vocalizations with consonants
  • The presence of atypical behaviors, such as repetitive movements with objects and/or repetitive movements or posturing of the body
  • Unusual prosody (intonation and rhythm in speech)
  • Lack of pointing, showing and sharing objects with others
  • Lack of appropriate gaze
  • Lack of sharing interest or enjoyment
  • Lack of response to name
  • Lack of coordinating gestures, eye contact and vocalizations to communicate

"Development changes over time, and missing a particular marker or having one or more of the 'red flags' does not necessarily mean that a child has autism," explained Rogers. "However, it is beneficial to any child — whether or not he or she has autism — to receive help in catching up with any missed or delayed developmental milestones."

Photo of Sally Rogers"There are reports that this type of intensive treatment early in life significantly improves the development of useful speech and decreases the severity of cognitive impairments in children with autism. However, most interventions are designed for older preschoolers. It's time to find out if they work or need to be adjusted for the very young."
— Sally Rogers, study principal investigator
Children enrolled in the study will receive intensive, one-on-one intervention in their homes for more than 25 hours per week over the course of two years, and caregivers will be instructed on how to deliver the intervention themselves. Results will be compared to children of the same age receiving standard community interventions — such as occupational therapy, speech therapy, special preschools or applied behavioral analysis — to determine the efficacy of the Early Start Denver Model at measurably reducing some or much of the disability associated with autism.

"There are reports that this type of intensive treatment early in life significantly improves the development of useful speech and decreases the severity of cognitive impairments in children with autism," Rogers said. "However, most interventions are designed for older preschoolers. It's time to find out if they work or need to be adjusted for the very young. This is especially important as we are able to diagnose autism earlier and earlier. It is essential to have treatment options with proven results to recommend to children of any age once the diagnosis of autism is given."

One of the biggest issues in autism science involves the varying range of outcomes for different children who are receiving the same behavioral intervention. Researchers in this study will help resolve that issue by identifying predictors of response to both the Early Start Denver Model and community interventions. The children will undergo complete diagnostic and developmental assessments at the onset of their enrollment in the study and annually after that, giving researchers the chance to carefully track overall developmental progress as well as changes in symptoms. These thorough assessments will be used to identify specific changes in real time throughout the intervention process.

"We know that intervention works, but we are still perplexed about why it works so very well for some and less for others," said Rogers. "We'll help determine the reasons for those varying responses so those differences can be better accounted for up front in the curriculum design."

Laura Henderson's youngest son, Logan, received the Early Start Denver Model intervention from Rogers beginning at 16 months old. Logan's two older brothers have autism, and Logan was beginning to show signs of the disorder as well.

"Sally worked really hard with him, playing with him wherever he went and following his lead in using what he liked to do to expand his skill levels. She also worked with me, showing me how to read the subtle clues of his behavior and use that to encourage language use and help him get what he wants in a positive way instead of throwing a fit," said Henderson. "During the sessions, we got the news that Logan does have autism. But today, two years later, we hardly notice it, and we truly believe it is because of Sally's intervention."

Rogers theorizes that reports of the effectiveness of this approach so far are based in the "cascade effect" of autism. Once the disorder begins its onset, symptoms continue to unfold unless treatment alters that course.

"If you can interrupt that chain of developmental effects of autism, the better the outcomes for the child. We assume that the earlier that interruption occurs, the better. This study will also help us know if that theory is really true," Rogers said.

"Now that we are able to recognize autism in infants and toddlers, it is critical that we offer effective early intervention for very young children with autism," said Dawson. "This multisite project will test a treatment approach that can help children very early in life. This offers hope for a much better future for infants and toddlers at risk for autism."

"We are very pleased that the University of Michigan is part of the study and that we can offer families of toddlers with autism spectrum disorders the opportunity to participate in the innovative intervention developed by Rogers and Dawson," said Lord. "We very much need to better understand how early intervention works and what interventions work best. Participating in the study allows us to provide high-quality service to families free-of-charge and to learn more about how to carry out the most effective treatments of autism in young children."

Any child 18-to-30 months old who is showing signs of autism, who has a sibling with an autism spectrum disorder or who has any developmental concerns can be considered for the new M.I.N.D. Institute study by calling Stacy Goldring, clinical research coordinator, at (916) 703-0397. She will conduct a brief phone interview for autism-related symptoms. Families who enroll need to be willing to participate in the intervention on a daily basis over the course of two years, beginning in February 2008. Goldring can also advise families about other M.I.N.D. Institute research programs currently underway that are enrolling toddlers who are at risk for autism.

The UC Davis M.I.N.D. (Medical Investigation of Neurodevelopmental Disorders) Institute is a unique collaborative center for research into causes, treatments and cures for neurodevelopmental disorders, including autism, fragile X syndrome, Tourette's syndrome, ADHD and learning disorders. For more information, visit www.mindinstitute.org.