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The Lancet Psychiatry: Video-based therapy might benefit babies at risk of autism

The Lancet

Video-based therapy for families with babies at risk of autism improves infants' engagement, attention and social behavior, and might reduce the likelihood of such children developing autism, according to new research published in The Lancet Psychiatry journal.

"Our findings indicate that using video feedback-based therapy to help parents understand and respond to their infant's individual communication style during the first year of life may be able to modify the emergence of autism-related behaviours and symptoms," [1] explains Jonathan Green, lead author and Professor of Child and Adolescent Psychiatry at the University of Manchester, UK.

"Children with autism typically receive treatment beginning at 3 to 4 years old. But our findings suggest that targeting the earliest risk markers of autism--such as lack of attention or reduced social interest or engagement--during the first year of life may lessen the development of these symptoms later on." [1]

Previous research has found that the earliest risk markers of autism--such as a lack of attention to a parent, reduced social interest or engagement, and decreased eye contact--may be present as early as a child's first year of life, but until now, no treatment trials have assessed the possibility of modifying these early markers with the aim of reducing later risk of developing autism.

In this study, a specially adapted Video Interaction for Promoting Positive Parenting Programme (iBASIS-VIPP) was delivered over 5 months to infants aged 7 to 10 months, who had a higher chance of developing autism because they had an older sibling diagnosed with the condition [2]. The aim of the Programme was to reduce the full onset of autistic symptoms prior to diagnosis, by optimising the babies' social interaction during the first year of their life.

54 families with an infant at high risk of autism were randomly assigned to either the iBASIS-VIPP programme or no intervention. The iBASIS-VIPP group received a minimum of six home-based visits from a therapist who used video-feedback to help parents understand and respond to their infant's individual communication style to improve infant attention, communication, early language development, and social engagement.

After 5 months, families who received video therapy showed improvements in infant engagement, attention and social behaviour. For example, there was a reduction in emerging autism-related behaviours in the video therapy group compared with controls (2.51 points on the Autism Observation Scale for Infants, AOSI [3]). This suggests that the therapy may be able to modify the emergence of autism-related aspects of development during infancy. There were also changes in parents' behaviour, such as being less directive in their interactions whilst increasing infants' attentiveness. However, reduced responsiveness to language sounds was noted in infants in the video therapy group.

However, the authors caution that because of the relatively limited number of participants, their treatment effect estimates have wide confidence intervals, meaning that larger studies will be needed before researchers can make definitive conclusions about the therapy's effect on preventing or reducing autism symptoms.

According to Professor Green, "Previous research has shown that parent-based interventions--similar to the one we tested here, but delivered later in the pre-school years and to children already diagnosed with autism--tend to have the greatest effects on parent-child interaction, whilst having little impact on actual autism symptoms. In contrast, the video-based intervention we tested in this study in early infancy seems to have wider impact on a number of behavioural effects and risk markers for later autism. The results suggest that the video-based therapy we tested may have a moderate effect on reducing some children's risk of autism, although larger studies will be needed to confirm this." [1]

Writing in a linked Comment, Catherine Lord, from the Center for Autism and the Developing Brain at Weill Cornell Medical College, New York, USA, says, "The study by Green and colleagues offers the possibility of providing a focused low-intensity intervention on the basis of risk, without the need to identify a specific condition such as Autism Spectrum Disorder...Because siblings of children with autism are at risk for a broader array of difficulties than only autism, this intervention allows a way to provide services that directly address their needs without having to make very early decisions about diagnosis."

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An embargoed telephone media briefing with the study authors will be held 2:00pm - 3:00pm [UK time], Wednesday 21 January. To receive dial in details, please email pressoffice@lancet.com

The funding for this project was led by Autistica, with support from ICAP plc, Autism Speaks (US) and the Waterloo Foundation. The project was also funded by the UK Medical Research Council and the Economic and Social Research Council.

The institutions involved were: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester Childrens Hospital. Manchester, UK. Centre for Brain and Cognitive Development, Birkbeck, University of London, UK. Institute of Psychiatry, Psychology and Neuroscience, King's College London, National Institute for Health Research Mental Health Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, London, UK. Evelina London Children's Hospital and Kings College London Neurosciences Centre, London, UK.

[1] Quotes direct from author and cannot be found in text of Article.

[2] Evidence suggests that around a fifth of infants who have an older sibling with autism spectrum disorder will go on to develop autism, with a further 20-30% developing broader social and communication problems.

[3] The Autism Observation Scale for Infants, AOSI, is a score-based system designed to detect and monitor the early signs of autism in infants aged 6-18 months. The score is evaluated via a systematic set of play-based activities, administered by an expert examiner who is skilled at interacting with infants and knowledgeable about autism spectrum disorder.

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