Early Intervention

We all saw *that article*… But what does the research ACTUALLY say?

Full research paper: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2784066

Link to article:
Newsbreak: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2784066
Telegraph (paywall): https://www.telegraph.co.uk/news/2021/09/20/two-thirds-autism-cases-could-prevented-baby-video-intervention/

Autism can be prevented by teaching parents how to interact with their babies, study finds

By Sarah Knapton

Telegraph 14 days ago

Two thirds of autism cases could be prevented by treating babies with a simple video intervention, new research shows. In a landmark study, scientists from the University of Manchester and the University of Western Australia found that they could reduce the number of children being diagnosed with autism at the age of three, from 20.5 per cent per cent to 6.7 per cent.

Nothing about us without us
Who: Whitehouse and colleagues
Journal: JAMA Pediatrics
Published: 2021
Title: Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism

Early Autism Intervention

Headline reads: Autism can be prevented by teaching parents how to interact with their babies, study finds.
An arrow points to the headline, and reads “NOPE!”

Many of us saw this Telegraph article…

But what does the research actually say?

[Screenshot from research]
Key Points

Question: Does preemptive intervention compared with usual care reduce the severity of autism symptoms and the likelihood of an autism spectrum disorder (ASD) diagnosis in infants showing
early signs of ASD?

Findings: In this randomized clinical trial of 103 infants showing early behavioral signs of ASD, preemptive intervention led to a statistically significant reduction in the severity of ASD behaviors across early childhood. Infants who received the preemptive intervention had lower odds of meeting diagnostic criteria for ASD (7%) than those who received usual care (21%) at age 3 years, with a number needed to treat of 7 participants.

Meaning: This study found that a preemptive intervention
reduced ASD diagnostic behaviors when used at the time atypical development first emerges during infancy.
[Screenshot end]

But autism isn’t something that goes away or which can be prevented… If you are autistic, you are always autistic! Not meeting the diagnostic criteria means that you may be barred from beneficial support later in life…

So, let’s look at this study.

Study background:

Autistic people are not typically diagnosed until 3 years old, however, intervention around the age of 2 can have a lot of impact on their development.

They used an intervention called “The iBASIS–Video Interaction to Promote Positive Parenting (iBASIS-VIPP)”. Previous research suggested that the use of this intervention led to a reduction in the “severity” of autistic characteristics up to 3 years old.

What they did:

They wanted to see how this intervention impacted children’s development. Children were referred to the study between the ages of 9 and 15 months if they showed atypical development in at least 3 of the following:
– spontaneous eye contact
– protodeclarative pointing (pointing to show another person an object of interest)
– social gestures
– imitation
– response to name

They got data from 89 children in the study.
45 received the intervention and 44 didn’t.

[edit: I’m sorry about the wonky text box on this slide. It doesn’t look like this in the design, only when uploaded to FB. It annoys me too, I’ll try and fix it later]

The intervention:

The primary caregiver had 10 sessions with a therapist in their own home over 5 months. Their interactions with their child were recorded and they were given feedback.

The therapist supported the caregiver to communicate with their child, and they were taught targeted skills to interact with & respond to their child effectively.

Over the next 2 years, they assessed how many autistic characteristics the children displayed, and whether or not they were diagnosed.

[edit: it’s wonky on this slide too, whyyy]

The results:

The children who received this intervention had a reduction in severity of autistic characteristics, and they were less likely to be diagnosed in early childhood.

However, this effect was small and it’s unclear whether there is any clinical significance.

Thinking critically:

Is a “severe” autistic characteristic any non-neurotypical trait, or a trait which is distressing to the child? (in this study, it appeared to be any non-neurotypical trait.)

Is a reduction in autistic traits actually a positive & desirable outcome?

Is there any actual reduction in autistic traits, or increased masking? What impact does this have on mental wellbeing later in life, especially when research shows that a positive autistic identity is protective against mental illness?

Do we want autistic children to be less likely to receive a diagnosis in early childhood, when a diagnosis opens the path to beneficial support later in life and increased understanding of oneself and ones needs?

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