Preemptive Intervention Reduces Autism Symptoms, Diagnosis in Early Childhood

Video-based, early interventions for autism spectrum disorder (ASD) beginning as early as 9 months of age, is associated with reduced ASD symptom severity and diagnosis risk at 3 years of age. These findings were published in JAMA Pediatrics.

ASD isn’t usually diagnosed until 3 years of age with current guidelines suggesting the implementation of therapeutic interventions following diagnosis. However, preemptive interventions starting at 2 years of age, when signs of atypical development are observed and the brain is quickly developing, could have a greater effect on developmental outcomes in early childhood, according to the study authors. The objective of the current study was to determine whether the use of video-based interventions in infants showing early signs of ASD could reduce symptom severity and the odds of an ASD diagnosis later in life.

Patients (N=103) who exhibited ³3 early signs of ASD were recruited at Telethon Kids Institute and Perth Children’s Hospital in Australia between 2016 and 2018. The children were randomized in a 1:1 ratio to receive preemptive care plus usual care (n=50) or usual care alone (n=53) for 5 months. Preemptive care was a Video Interaction for Promoting Positive Parenting approach that comprised of 10 home sessions conducted by trained therapists in which interactions between the caregiver and infant were videotaped. The interaction was watched and discussed between therapist and caregiver. ASD symptom severity and diagnosis rates through age 3 years were assessed.

The infants in the intervention and control cohorts were 76.0% and 60.4% boys, mean age 12.40 and 12.38 months, and 20.0% and 18.9% had an older sibling with ASD.

Across time points, ASD symptom severity was more effectively reduced by the intervention (area between curves [ABC], -5.53; 95% CI, -¥ to -0.28; P =.04).

At the age of 3 years, 12 had been diagnosed with clinical ASD, 64 with atypical development, and 13 with typical development. Infants who received the video intervention had a decreased risk for meeting the ASD diagnostic criteria deficits in social-emotional reciprocity (odds ratio [OR], 0.35; 95% CI, 0-0.82; P =.02), stereotyped or repetitive movements (OR, 0.29; 95% CI, 0-0.73; P =.02), and unusual sensory interests (OR, 0.13; 95% CI, 0-0.53; P =.02).

In addition, children who received the intervention were less likely to be diagnosed with ASD on a binary ASD or no ASD scale (OR, 0.18; 95% CI, 0-0.68; P =.02).

Study limitations include relying on ASD diagnosis at 3 years of age when neurodevelopmental conditions may not be as apparent as later in life.

These data indicated that a videotaped, trained therapist-driven behavioral intervention for families with infants who were displaying early signs of ASD decreased symptom severity and odds of being diagnosed with ASD later in life.

“A cost-effectiveness analysis of the entire treatment pathway (incorporating screening and service delivery) and modeling of longer-term childhood and adulthood outcomes is an important next step to determine the feasibility and value of this clinical model,” the researchers concluded.

Disclosure: Some of the study authors declared receiving personal fees from institutions and organizations both during and outside the submitted work. Please see the original reference for a full list of authors’ disclosures and funding sources.

Reference

Whitehouse AJO, Varcin KJ, Pillar S, et al. Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis. JAMA Pediatr. Published online September 20, 2021. doi:10.1001/jamapediatrics.2021.3298