asd…intervene early, see positive changes.

In Autism Spectrum Disorders, Psychiatry, School Psychology, Special Education on Friday, 2 November 2012 at 06:04

Early Autism Intervention Normalizes Brain Activity

Pam Harrison

Early behavioral intervention is associated with normalized patterns of brain activity along with improvements in social behavior in young children with autism spectrum disorder (ASD), a new nationwide study shows.

The multicentre study conducted by investigators at the University of North Carolina, Chapel Hill, showed that 73% of children who received the Early Start Denver Model (ESDM) intervention showed greater brain activation when viewing faces than when viewing objects.

This was very similar to typically developing children, 71% of whom showed the same brain activation pattern when viewing faces rather than objects.

In contrast, 64% of ASD children who received the control community intervention showed a greater response to objects than to faces, the opposite response from that seen in ESDM recipients.

Previous research has shown that ASD children typically respond more to nonsocial than to social stimuli.

“Those of us in the intervention field always assumed that improving children’s learning had to change brain function — that is how we learn,” Sally Rogers, PhD, University of California, Davis, MIND Institute, told Medscape Medical News.

“This evidence confirms how we understand learning — it’s not a surface change [but rather] a change in brain activation and patterns of brain connection.

“So I think behavioral intervention can be seen as a biological intervention because it changes the biology of brain activity.”

The study is published in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Intensive Therapy

A previous report from a randomized trial indicated that ESDM, a developmental behavioral intervention, resulted in gains in IQ, language, and adaptive behavior in children with ASD (Pediatrics 2010;125:e17-e23).

The current report describes electroencephalographic (EEG) activity, a secondary outcome measurement from the same study.

A total of 48 children aged 18 to 30 months who had been diagnosed with ASD were randomly assigned to receive ESDM or referral to community intervention for 2 years.

Children randomly assigned to ESDM received the intervention for 2 hours, twice a day, 5 days a week for 2 years.

The community intervention group received comprehensive diagnostic evaluations, interventional recommendations, and community referrals.

The children enrolled in the study represented the full range of severity of ASD in early childhood, and as Dr. Rogers emphasized, they were not picked because they had mild symptoms.

Two types of brain activity measurements were collected in response to social (faces) and nonsocial (toys) stimuli.

“The first reflected early-stage perceptual processing of faces versus objects,” the authors state, “[and] the second set of measurements reflected the degree of attention engagement…and active cognitive processing of the stimulus.”

Children randomly assigned to either intervention arm did not differ from typical children in early-stage perceptual face processing, the researchers point out.

In contrast, EEG measurements reflecting patterns of attention engagement and active cognitive processing of social stimuli showed that children who received the ESDM intervention exhibited brain activity that was comparable to age-matched typical children in that both allotted greater attentional and cognitive resources during viewing of social stimuli than to nonsocial stimuli.

These patterns were different from patterns observed in children who received the community intervention, who allotted greater attentional and cognitive resources to viewing of nonsocial stimuli than to social stimuli.

Powerful Intervention

“This is a very powerful intervention,” Dr. Rogers emphasized. For example, almost none of the children had speech prior to the ESDM intervention.

The average IQ prior to the intervention was only 65, she added.

Following the intervention, the average IQ was in the 80s.

“This means that these children no longer had intellectual disability as a group, so it was a huge change, and almost all of the children were able to use language effectively and functionally as well,” Dr. Rogers said.

Children with good EEG data who received the ESDM intervention also differed significantly on behavioral outcomes in autism symptoms, IQ, language, and adaptive and social behavior.

“Many public services provide interventions for young ASD children, but too many children are getting a hodgepodge of interventions,” Dr. Rogers observed.

“But national standards require we use evidence-based intervention, and what this study demonstrated is the importance of using evidence-based interventions and delivering them with enough intensity so they can have maximal effect.”

New Target, Potential Biomarker

Thomas Insel, MD, National Institute of Mental Health, noted in a press release on the study that this may be the first demonstration that a behavioral intervention for autism is associated with changes in brain function as well as positive changes in behavior.

“By studying changes in the neural response to faces, Dawson and her colleagues have identified a new target and a potential biomarker that can guide treatment development,” Dr. Insel added.

The study was funded by the National Institute of Mental Health. Dr. Dawson and Dr. Rogers are authors of the book Early Start Denver Model for Young Children with Autism, from which they receive royalties. Dr. Insel has disclosed no relevant financial relationships.

J Am Acad Child Adolesc Psychiatry. 2012:51:1150-1160. Abstract

Retrieved from: http://www.medscape.com/viewarticle/773641

Early Behavioral Intervention Is Associated With Normalized Brain Activity in Young Children With Autism 






A previously published randomized clinical trial indicated that a developmental behavioral intervention, the Early Start Denver Model (ESDM), resulted in gains in IQ, language, and adaptive behavior of children with autism spectrum disorder. This report describes a secondary outcome measurement from this trial, EEG activity.


Forty-eight 18- to 30-month-old children with autism spectrum disorder were randomized to receive the ESDM or referral to community intervention for 2 years. After the intervention (age 48 to 77 months), EEG activity (event-related potentials and spectral power) was measured during the presentation of faces versus objects. Age-matched typical children were also assessed.

ResultsThe ESDM group exhibited greater improvements in autism symptoms, IQ, language, and adaptive and social behaviors than the community intervention group. The ESDM group and typical children showed a shorter Nc latency and increased cortical activation (decreased α power and increased θ power) when viewing faces, whereas the community intervention group showed the opposite pattern (shorter latency event-related potential [ERP] and greater cortical activation when viewing objects). Greater cortical activation while viewing faces was associated with improved social behavior.


This was the first trial to demonstrate that early behavioral intervention is associated with normalized patterns of brain activity, which is associated with improvements in social behavior, in young children with autism spectrum disorder.

Retrieved from: http://www.jaacap.com/article/S0890-8567(12)00643-0/abstract


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