New therapy targets autism signs in infancy

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Research shows interventions in infancy can reduce the effects of ASD in early childhood.

Pre-emptive therapy for infants showing early signs of austism spectrum disorder could become more widely available in Australia in the next 12 months.

The intervention has already been shown by researchers to reduce the likelihood and severity of an ASD diagnosis by early childhood.

And they have now turned their attention on training allied health professionals across the country to use the therapy that moves away from the traditional “wait and see” approach to early signs of ASD towards an “identify and act” model.

The randomised clinical trial, published in JAMA Pediatrics late last year, was the first to demonstrate that a pre-emptive intervention for infants showing early signs of ASD led to a “small but enduring reduction in ASD symptom severity and reduced odds of ASD diagnosis in early childhood”, the authors wrote.

The trial was conducted at two Australian research centres in Perth and Melbourne between 2016 and 2020. Community sampling was used to recruit 104 infants aged nine to 14 months showing early behaviours associated with later ASD

The researchers found that a clinician diagnosis of autism at age three was only a third as likely in children who received the pre-emptive therapy, which involved training parents to recognise babies’ communication cues and respond appropriately, compared to those who received treatment as usual.

Infants who received the therapy at 12 months of age were re-assessed at age three and found to have fewer behaviours of autism, such as social communication difficulties and repetitive behaviours, compared to infants who didn’t receive the therapy.

As part of the trial, infants were randomized on a 1:1 ratio to receive either a pre-emptive intervention plus usual care or usual care only over a five-month period. The pre-emptive intervention group received a 10-session social communication intervention, known as iBASIS–Video Interaction to Promote Positive Parenting (iBASIS-VIPP). Usual care comprised services delivered by community clinicians.

Lead researcher Professor Andrew Whitehouse – the Angela Wright Bennett Professor of Autism Research at Telethon Kids and the University of Western Australia – told The Medical Republic that the results had received international attention.

The next natural step was to roll out a national training program to upskill health professionals in delivery of the iBASIS-VIPP intervention, he said.

“Our goal is to get practitioners around Australia trained on this intervention as quickly as possible so families can get access it as soon as possible and that’s, that’s going to start early next year,” he told The Medical Republic.

“We are going to do a WA-wide implementation first, but at the same time also conduct training exercises in all states of Australia.”

Professor Whitehouse, who is also president of the Australasian Society for Autism Research, said the training would be relevant for allied health professionals such as speech pathologists, occupational therapists and clinical psychologists.

And he said he hoped more awareness of the intervention would flow through to GPs.

“GPs provide a really important monitoring and referral system,” he said.

“And our message to GPs is that if you suspect [ASD] don’t sit on your hands, refer. Because that’s take-home message from this trial is – prompt access to evidence-based services can actually make a large difference in people’s lives.”

The iBASIS-VIPP therapy is based on the Video Interaction for Positive Parenting (VIPP) program, which was adapted by researchers and clinicians in the UK to specifically support social communication development.

Parents and caregivers are trained to deliver the therapy and supported by video-feedback to help them recognise their baby’s communication cues so they can respond in a way that builds their social communication development.

Parents are videoed interacting with their baby in everyday situations, such as feeding and playing. The trained therapist then provides guidance to the parent about how their baby is communicating with them.

Professor Whitehouse said there was strong interest from all over the world in the therapy, and the UK has already started using the intervention.

“We’ve been contacted by people from over 40 countries to provide training, it really is a landmark moment in how we can provide support to kids who are developing differently,” he said.

“Our current model of wait and see is not up to scratch and we need to transition to an identify and act. This is a worldwide movement that has been certainly catalysed by the [JAMA Pediatrics] publication and we are going to concentrate our efforts in Australia our home country.”

The research team is now working on a well-advanced clinical trial involving families with a history of autism and a baby on the way. This project includes interventions at the antenatal stage where parents are provided education about neurodiversity.

“Then we work with their family from when the baby’s four weeks of age to eight months of age, providing very similar type of intervention just in a younger age group,” Professor Whitehouse said.

“Certainly the feedback so far from parents is how beneficial they have found the program to be and we certainly are hoping and would hypothesise that that also plays out into the development of the baby.”

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