Help for the Chıld with Autism

Help for the Chıld with Autism

Waiting another decade for approval of a new drug is an agonizing prospect for the parents of a recently diagnosed child. Initial despair, however, can be tempered by the knowledge that a few good treatment options already exist. The latest research has shown that the brain of a toddler with autism can learn and change in response to behavioral therapies that enhance the child's social or language skills or that address another common problem: difficulties in engaging in play and other typical toddler activities. The flexibility demonstrated by the young child's brain opens new possibilities for intensive one-on-one therapy with trained professionals and parents to alleviate the difficulties with speech and social interactions that are a hallmark of the disorder.

One early intervention method derived from developmental psychology and applied behavior analysis (a technique for improving cognitive, language and social skills) is known as the Early Start Denver Model (ESDM). An ESDM therapist tries to deal with the difficulty a child with autism has in heeding social cues—facial expressions, gestures and spoken words. ESDM and other programs—such as Joint Attention, Symbolic Play, Engagement and Regulation—draw the attention of children to faces and voices. Healthy young children react more to a face than to a block, yet the pattern reverses for the child with autism, who typically responds more to an object than to a parent's gaze.

An ESDM therapist tries to encourage the child to focus attention. The professional will present a toy, perhaps name the toy in an inviting way and, when the child looks, will share it and start to play. The therapist tries to keep a child engaged in rounds of play intended to cultivate a nascent liking for social activities, all the while teaching social and communication skills.

ESDM has now begun to receive validation from formal scientific studies. With funding from the National Institutes of Health, Geraldine Dawson of Duke University and Sally J. Rogers of the University of California, Davis, have evaluated the technique and have recently reported the strongest evidence to date of the effectiveness of an early intervention for autism.

After two years of intensive training beginning anywhere from 18 to 30 months of age, children paid attention more to faces than did youngsters with autism in non-ESDM behavioral programs. The children who received ESDM scored higher on cognitive tests: their developmental quotient (an IQ test for very young children) rose in the study by 10.6 points more on average than did that of children in non-ESDM behavioral programs. The severity of social deficits and repetitive behaviors diminished, although some symptoms not directly related to autism lingered.

Imaging shows that the brain undergoes desirable changes as well. Brain areas activated when a child looks at faces lit up more in children with autism who received ESDM relative to those in in non-ESDM programs. In fact, the brain response of the ESDM-trained youngsters was identical to that of typical four-year olds. When charting electrical brain activity with electroencephalography (EEG), the researchers noted an increase in power (the amount of energy in the signal) for certain types of brain waves known as theta oscillations in an area below the brain's surface called the hippocampus, so named from the Greek hippokamposbecause it resembles the shape of a seahorse. Increases in theta power correlate with more focused attention and short-term memory function.

Researchers also found a reduction in the power of alpha oscillations—which generate EEG recordings that cycle up and down more quickly than theta waves—in several regions, including the hippocampus. A lower level of alpha power hints that the brain was becoming more attuned to people's faces. Increased theta and decreased alpha together reflect higher levels of electrical activity at the surface of the brain, or cerebral cortex, and specifically in the prefrontal and anterior cingulate cortices that are involved in the perception of faces. Observing these changes, the researchers conjecture that ESDM may spur brain changes in the treated children that may explain their higher scores on cognitive tests.

ESDM brought about these changes after more than 2,000 hours of intensive therapy over the course of two years, a labor of two hours twice daily for five days a week. A drug that could replace or hasten this process would make a world of difference to children and their families. The latest research has started to target a range of medications that address symptoms, including impaired social communication, hyperactivity and inattention, as well as repetitive, ritualistic behaviors and sleep disturbances.

A leading prospect for a drug that could mimic the benefits of ESDM is the brain hormone oxytocin, which has made headlines in the popular science press variously as the “cuddle” chemical, the “moral molecule” and the “trust hormone.” Known in the medical textbooks for its role in pregnancy, oxytocin readies a woman's body for childbirth. As levels rise, breasts swell and fill with milk, and later the hormone triggers labor. In the past 25 years researchers have learned that oxytocin, present in men as well, appears to play a role in promoting the bonding of infant to mother and cementing trust between friends. The hormone may even induce a sense of attachment to the baby in fathers-to-be.

Hope that oxytocin might help youngsters with autism comes from the observation that when the compound is administered in single doses either intravenously or within the nasal passages, the child with autism who normally fails to distinguish whether a new acquaintance is being “mean” or “nice” can suddenly detect the difference. Genetic studies add further evidence of oxytocin's role as a chemical that acts as a general social sensitizer and one that does so particularly in individuals with autism. Mice genetically tweaked to shut off the gene CD38, involved in making oxytocin, display less trust and recognition of other animals. Also, patients with autism have fewer oxytocin “receptors”—proteins that bind to oxytocin and convey its messages into specific nerve cells—and therefore lower levels of oxytocin.

These findings pave the way for larger studies. The nih is now providing $12.6 million for five institutions to conduct a trial of intranasal oxytocin in which patients are randomly assigned to a treatment or control group. The Study of Oxytocin in Autism to Improve Reciprocal Social Behaviors (SOARS-B) should determine within a few years whether oxytocin becomes a routine part of treatment. Ascertaining whether the hormone is an effective drug is especially important because a large number of parents already administer oxytocin to their children with autism, using prescriptions from physicians allied with the DAN! (Defeat Autism Now!) faction. Yet the evidence so far is not conclusive enough to justify the practice. If oxytocin receives validation through this study, it might be recommended to facilitate ESDM by readying a child to respond to the ministrations of a therapist.

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