In the loop: Jonathan Green says cycles of social feedback falter when interacting with a child who has autism.
Green’s study is that experiment.
By changing the dynamic between parents and children at high risk of autism, Green says, his team is trying to change the trajectory of the children’s development.
When Bethany was between 9 and 14 months old, a therapist visited Laura’s home once every two weeks and recorded them engaging in ordinary activities such as mealtime or play. The therapist then analyzed each video, picking out segments to replay for Laura during the next visit.
The goal was to help Laura better recognize and interpret Bethany’s attempts to communicate, whether through gestures, glances, grunts or other sounds. The therapist pointed out moments when Laura did particularly well at noticing and responding to her daughter’s cues.
For instance, when Bethany turned to look at the bus, she was communicating the focus of her attention; by translating this gesture into words, Laura gave her daughter an opportunity to expand her vocabulary.
The therapist also helped Laura spot small signs she had missed — for example, that Bethany had lost interest in a particular toy or game, or that she had not yet finished playing with something Laura was bored with. “Parents don’t always notice these subtle things,” Laura says.
Laura also learned strategies she could use to respond to Bethany’s bids for attention, practicing them for at least 30 minutes a day to help Laura’s behaviors become habit. “It was loads of fun,” Laura says. “None of this study has been hard work.”
The intervention starts in infancy in the hopes of changing the feedback loops before they become fixed, says Teodora Gliga, a neuroscientist at Birkbeck College, University of London, who helps to assess the infants’ behaviors. “Once they become the usual way in which the parent and child interact, it becomes more difficult to modify them.”
Half of the families in the study are getting this intensive hands-on coaching, and the other half make up a control group. To make sure that they’re seeing an effect of change in the parent’s behavior, the researchers are careful to interact only with the parents.
In Green’s study, “Any effect on the baby comes through a change in the parental behavior,” he says. “There’s no other route through which the baby could be affected.”
The study is still underway, but early results, reported 21 January in Lancet Psychiatry, indicate that the intervention makes a difference for both parents and children. Parents who received the training became less controlling in their interactions, instead waiting for their child to make the first move. What’s more, the children in those families became more attentive to and engaged with their parents. They also showed fewer autism-like behaviors when they were 14 months old, compared with children whose parents did not receive training.
It is not yet possible to determine whether the intervention in Green’s study prevents autism or lessens its symptoms because most of the children are still too young to be accurately diagnosed. Bethany turned 3 in January, and her mother says she showed no signs of autism at her last checkup at Green’s lab in February. “She’s incredibly bright,” Laura says. “She’s the most sociable, most interactive child.”
At the very least, the study’s results suggest that therapists can teach parents strategies to boost the social attention of a child who is biologically predisposed to autism.
“That is pretty exciting,” says Aubyn Stahmer, associate professor of psychiatry at the University of California, San Diego, who was not involved in the study. “What that means for them long-term, I don’t think we know yet, but certainly it suggests that very early intervention with kids who might be at risk is a good idea.”
An added benefit is that the treatment is easy for parents to do and doesn’t require a diagnosis. “The more that we work towards some type of intervention that’s non-stigmatizing, that becomes more normalized, then parents will be able to do it in the privacy of their own homes and maybe make a difference for their babies,” says Connie Kasari, professor of human development and psychology at the University of California, Los Angeles. Kasari was not involved in the study, but has led interventions in preschoolers with autism.
The study’s final evaluations will take place later this year. But already, Green sees these preliminary findings as support of his theory that parent-child interactions play a role in autism’s trajectory.
“I don’t want to say that one can ‘cure’ autism like this, that’s not true,” Green says. “But I hope we’ll be able to make a difference.”
This article was republished on TheGuardian.com.