Clinical study of Early Start Denver Model intervention shows that it improves not only social skills, but also brain responses to social cues
Decades of research have shown that behavioral therapies for autism can improve cognitive and language skills. Still, it remained unclear whether behavioral interventions simply reduced autism’s symptoms or actually “treated” the developmental disorder. In other words, could an effective behavioral intervention change the brain biology that underlies autism spectrum disorder?
This year, researchers delivered compelling evidence that the Early Start Denver Model (ESDM), an intensive early intervention program for toddlers with autism, improves brain activity related to social responsiveness. The Journal of the American Academy of Child & Adolescent Psychiatry published the findings in its November issue.
“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,” commented Tom Insel, M.D., director of the National Institute of Mental Health.
Psychologists Sally Rogers, Ph.D., and Geraldine Dawson, Ph.D., developed the ESDM therapy program in the 1990s. It adapts key techniques from Applied Behavioral Analysis (ABA) for toddlers, with an emphasis on interactive play between children and their therapists and parents. Dr. Rogers is a professor and researcher at the University of California, Davis, MIND Institute. Dr. Dawson was a professor and researcher at the University of Washington, Seattle, when she and Dr. Rogers developed the program. She is now the chief science officer of Autism Speaks and a professor at the University of North Carolina, Chapel Hill.
Three years ago, Drs. Dawson and Rogers published the first results of a clinical trial comparing ESDM with conventional autism therapy services. They randomly assigned 48 toddlers (ages 18 to 30 months) to receive either ESDM therapy or the early intervention services routinely available in their communities (Seattle). Both groups received roughly 20 hours of weekly therapy for two years. Overall, those in the ESDM group showed greater increases in IQ, language and adaptive behavior than children in the community-intervention group.
In this year’s report, the research team published their analysis of brain activity monitoring performed on both groups of children at the end of their two years of therapy. For comparison, they also performed the brain activity tests on a group of age-matched children without autism.
Noninvasive electroencephalography (EEG) showed that the children in the ESDM group showed greater brain responses to social information compared to children in the community group. When they viewed women’s faces, their brain activity patterns were virtually identical to those of the children without autism. This more-typical pattern of brain activity was associated with improved social behavior including improved eye contact and social communication.
By contrast, children in the community intervention group showed greater brain activity when viewing objects than faces. Previous research has shown that many children with autism have this unusual pattern of brain activity.
“By studying changes in the neural response to faces, Dr. Dawson and her colleagues have identified a new target and a potential biomarker that can guide treatment development,” Dr. Insel said.
“So much of a toddler’s learning involves social interaction,” Dr. Dawson added. “As a result, an early intervention program that promotes attention to people and social cues may pay dividends in promoting the normal development of brain and behavior.”
The American Academy of Pediatrics recommends autism screening for all children twice before 24 months. “When families receive a diagnosis, it’s vitally important that we have effective therapies available for their young children,” Dr. Dawson urged. Currently ESDM is the only early intervention evaluated in clinical trials.
As methods for earlier detection become available, infants flagged at risk for ASD may likewise benefit from early intervention, many experts agree. Research suggests that adults with autism can benefit from interventions that promote social engagement as well.
Dawson G, Jones EJ, Merkle K, et al. Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adolesc Psychiatry. 2012; 51(11):1150-9.