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Autism intervention: steps in the right direction

In 2016, the results of a trial led by Professor Jonathan Green from the University of Manchester showed long-term improvement of autism symptoms in children for the first time. But what if we could reduce the severity of these symptoms by acting even earlier? In National Autism Awareness Month, Jonathan describes why the results of his new collaborative study give cause for optimism.

Jonathan with one of his study participants. Image credit: Jonathan Green

Intense scientific work to understand autism and its causes has continued ever since it was first identified over 70 years ago. But good quality research to develop effective interventions has only really accelerated since the turn of the century.

My research focuses on helping parents of children with autism communicate with their child. We work with parents, using video feedback techniques, to help them understand and respond to their child’s communication style.

Lasting improvement

Starting in 2006, I led the MRC-funded Preschool Autism Communication Trial (PACT)¹ to test these techniques. Rigorous testing of complex psychological interventions had previously been considered hard to do, so we used specific methods that we developed in a parallel MRC-NIHR funded programme.

The results of the 12-month intervention trial, and six-year follow-up, showed that parent-led early intervention successfully improved autism symptoms in children aged between two and four. And this improvement was sustained for a further six years after the treatment ended.

Parents watched videos of themselves interacting with their child and received feedback from therapists. This enhanced parents’ awareness and response to their child’s often unusual patterns of communication. The technique helped them better understand their child and respond in a focused way. And embedding the changes in family life may have helped produce the lasting effect.

Earlier action

In parallel to this trial we wondered whether we might be able to help children at a much younger age. That’s where the new trial comes in.

In the trial, called iBASIS² (Intervention in the British Autism Study of Infant Siblings), we tested a similar parent-led technique with infants in their first year of life who have a sibling with autism and are therefore at higher risk of developing the condition. We wanted to see whether it might modify their early development prior to receiving a diagnosis of autism.

Although this trial was smaller than the first, our results are surprisingly similar. They suggest that the technique could make a difference to the very early development of symptoms in children, in the period before autism is diagnosed.

Cause for optimism

This kind of intervention is by no means a ‘cure’. Autism development in most children will continue and further support will be needed. But through our work we’ve learnt something fundamental about autism development.

Despite the ways in which children with autism are different, they can respond positively to improved social interactions, just as other children do. Their uniqueness remains but their adaptation and well-being can improve. And this could in turn benefit their families, as well as the wider community.

Community involvement

As a scientist and clinician I aim to combine the best science with the views and concerns of the public and interested parties. I want to continue conversations with families and others in the autism community. The science needs to be understood and trusted by the community.

Early social communication interventions have been recommended for consideration in autism treatment since 2013. But results from the MRC PACT follow-up and the new iBASIS infancy study, provide important further evidence to support this approach.

Together with new evidence for other effective interventions for problems often associated autism – such as behavioural difficulties or anxiety – I have a sense of the beginning of real progress in establishing evidence for effective ways of responding to the autism condition and associated difficulties throughout childhood.

As is the nature of science, work will be a step at a time, building as it goes. But there is now definite momentum in the right direction – and optimism that real progress is possible.

Jonathan Green

¹The PACT was a collaboration between the University of Manchester, Newcastle University, King’s College London and Evelina London Children’s Hospital.

²Jonathan led iBASIS in collaboration with Professor Mark Johnson’s MRC-funded team at Birkbeck, University of London and teams at King’s College London’s Institute of Psychiatry, Psychology and Neuroscience and Evelina London Children’s Hospital.

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