Scientific American Mind
Dec 19, 2013 | By Luciana Gravotta
Autism, a complex disorder of brain development, is now estimated to affect one in 88 kids.
Delivering therapy to kids with symptoms of autism at age one or two is likely to result in greater improvements in IQ, language and social skills than does starting therapy later.
Researchers have developed screening tools that can identify at-risk infants and toddlers, along with a treatment designed for children as young as a year old.
Soon after Noah turned a year old, his parents, Leslie and Paul, noticed something was not quite right with their son. At 10 months Noah had learned to say “Mama” and “Dada,” but at 14 months he no longer uttered any discernible words. Music had a powerful and strange effect on Noah: when he heard it, he would stop what he was doing and “zone out,” according to Leslie.
Four months later Noah's parents brought up their concerns about their son with his pediatrician. The doctor recommended they wait until his second birthday to see if he would catch up with his peers. The advice did little to allay Leslie and Paul's worries.
Absence of language, heightened sensitivity to sound or other sensory stimuli, and difficulty shifting focus from such stimuli, including music, raise the specter of autism in very young children. Autism, a complex disorder of brain development, is now estimated to affect one in 88 kids. It is characterized by communication deficits, impaired social interaction, repetitive motor behaviors, and, sometimes, intellectual disability or physical health problems. Because autism is defined by complex behaviors, obvious signs do not emerge until children start stringing words together and engaging in play with their parents, at about two years old. Children with autism may, for example, continue to play alone far longer than is normal.
The concept that autism is treatable is controversial and new. Newer still is the idea that if children receive therapy very early in life, they are more likely to overcome their deficits. Now, however, many experts believe that delivering therapy to children as young as age one or two—instead of four, as is more typical—can garner greater improvements in IQ, language and social skills. Officials at the American Academy of Pediatrics and the Centers for Disease Control and Prevention, among others, now recommend early detection. To identify autism (or autism risk) in younger children, researchers have had to develop novel screening tools. In addition, one new intervention designed for children as young as a year old has been shown to significantly improve social communication skills.
Noah was not pointing, was not responding consistently to his name and was not bringing his parents objects that he wanted to show them. Noah now scored “at risk.” Leslie and Paul brought him to a neuropsychologist, who watched him play and tested him for behaviors that are considered red flags. His parents completed additional rating scales. These assessments indicated that Noah indeed had autism. His was a moderate case; his cognitive abilities outpaced his social skills.
Paul scoured the Internet for other interventions and found the Early Start Denver Model (ESDM), a therapy for infants as young as a year old developed by Sally J. Rogers of the University of California, Davis, MIND Institute and Geraldine Dawson, now at Duke University Medical Center. Because no ESDM therapists lived near them—only 50 or so individuals are certified to perform it in the U.S.—Leslie and Paul used the manual as their guide. But eventually they realized they needed professional help and contacted Dawson. They began driving three hours each way to get Dawson's advice, as well as therapy for Noah.
The ESDM emphasizes interaction as the basis for learning, and instead of doling out explicit rewards, the therapist aims to make the activities themselves rewarding to the child. An adult first searches for something that engages the child—tickling, say, or driving toy cars. Then the parent or therapist coaxes social behaviors in that context. If a child likes a specific book, for example, the adult might encourage the child to point to the book as a way of requesting it. In Noah's home, toys are now in bins and on high shelves so that he has to point to get what he wants.
Collaborative play involving eye contact and sharing is taught next. For example, Noah's parents try to surprise their son by changing the tone or speed of their voice while reading, so that Noah will look up at them and make eye contact—which they reward with a huge smile. Social skills are also taught as part of everyday activities, such as during bath time or lunch. If Leslie wants Noah to choose between two types of drinks at a meal, she holds both beside her face so that he naturally looks up at her before asking for one of them.
In Noah's case, early therapy seems to have produced remarkable results. Within one month of first seeing Dawson, at 28 months old, Noah started pointing spontaneously. About three months later he looked at his parents to request something. One month after that, in April 2013, Noah gestured as a way of sharing information with others: he pointed something out to his younger sister, Elina.