New research suggests that the Early Start Denver Model (ESDM) behavioral program for autism improves not only social skills, but also brain activity in response to social cues such as facial expressions. The report appears today in the Journal of the American Academy of Child & Adolescent Psychiatry.
“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,” says Tom Insel, M.D., director of the National Institute of Mental Health.
The study looked at brain activity in a group of 48 preschoolers after two years of early intervention. The intervention started when the children were 18 to 30 months old. Roughly half the children participated in therapy program. The other half received their community’s usual autism intervention services. Both groups received roughly 18 to 20 hours of therapy per week for two years. For comparison, the researchers also tested brain activity in a group of age-matched children without autism.
Noninvasive electroencephalography (EEG) showed that the children in the ESDM group responded to images of women’s faces in an active and engaged manner. When they viewed the faces, their brain activity patterns matched those of the children without autism. Their more-normal patterns of brain activity were associated with improved social behavior including improved eye contact and social communication.
This was not true of the children with autism who received routine intervention services. Their brain activity showed a relative lack of engagement and attention to facial images. Instead they showed greater brain activity when viewing objects. Previous research has shown that many children with autism have this unusual pattern of brain activity.
Autism Speaks Chief Science Officer Geraldine Dawson, Ph.D., led the randomized, controlled trial. Dr. Dawson is a professor of psychiatry at the University of North Carolina, Chapel Hill. Co-investigators included Sally Rogers, Ph.D., of the University of California-Davis, and Sara Webb, Ph.D., of the University of Washington.
“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 says.
In an earlier report on the same clinical trial, the team found that the children receiving ESDM achieved significantly greater gains in cognitive, language and daily living skills than did the children receiving routine intervention services.
What aspects of the Early Start Denver Model could have normalized brain activity and improved social skills? It may be the program’s strong focus on social cues and enjoyable shared activities, the researchers suggest.
“So much of a toddler’s learning involves social interaction,” Dr. Dawson explains. “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 between 18 and 24 months. “When families receive a diagnosis, it’s vitally important that we have effective therapies available for their young children,” Dr. Dawson urges.
As methods for earlier detection become available, infants flagged at risk for ASD may likewise benefit from such programs, the investigators note. Though early intervention is the ideal, research suggests that adults with autism can likewise benefit from interventions that promote social engagement.