Babies at risk for autism: Why, how, and what (do we know)? Mark Johnson
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Superior Temporal Sulcus/Gyrus
Fusiform Gyrus (blue) Orbitofrontal Cortex (red)
Left Frontal Operculum
How does the social brain develop?
Superior Temporal Sulcus/Gyrus
Fusiform Gyrus (blue) Orbitofrontal Cortex (red)
Left Frontal Operculum
Infants at-risk for autism
Why? • Research into early onset can get at causal factors • Symptoms may be compounded during development • Possibility of early intervention
Cause: The triad of impairment Social interaction
Communication
Restricted behaviors and interests
Compounding Symptoms • In developmental disorders, initial symptoms can be compounded by atypical interactions with others and the environment • Important to start early; e.g. over 1,000 hours of face-to-face social interaction in the first year.
Early intervention • Medical research moving to prevention rather than cure • Intervention programmes exist for young children already diagnosed • Can we devise interventions for babies at highest risk, or that show early signs?
How? • How can study the mind/brain of young babies? • What at-risk groups are best for these studies • What design of studies should we use?
How (can we study the mind of babies)?
Behavioral Testing
Looking measures in babies • Preferential looking • Habituation • Eye-tracking
Eye-tracking in babies
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EEG/Event-related potentials
ERP Results
Optical imaging (NIRS)
Optical Imaging (NIRS)
Infants at-risk • Children with known genetic conditions (e.g. fragile-X; 30% have ASD) • Children with other known medical conditions (e.g. tuberous sclerosis; 24% have ASD). • Baby brothers and sisters of older children with autism (10%+).
Design of studies • Longitudinal design with infant measures and assessment at 3 years • Involves a 5 year-cycle and hundreds of babies • Currently very few studies have reached this stage
So far…… • Why? Cause, compounding, intervention • How? New methods, study design • What? - do we know so far?
Canadian study (Zwaigenbaum, Bryson and colleagues)
• siblings + low-risk controls • Assessed at 6, 12, 18 and 24 months, with diagnostic assessment at 3 years • AOSI: Autism Observation Scale for Infants
AOSI (Bryson et al. In press) • Interactive, play-based measure of early signs of autism • Attention & tracking • Communication (e.g. social babbling) • Social responses (e.g. peek-a-boo) • Play (e.g. imitation) • Motor control
AOSI (examples) Disengagement of visual attention
Anticipation
Social babbling
Imitation
Results so far • No big differences at 6 months - most show typical social behaviours • At 12 months differences appear in several measures (e.g. visual tracking, decreased eye contact, lack of imitation). • By 18 months these differences are much clearer, but still only a 80-90% match with diagnosis at age 3 years
VERY preliminary conclusions • Indicators are present in most children with ASD by 18 months • Key features: early language, social communication, atypical attention and orienting • Developmental trajectories vary: some show regression, others do not • A need for more sensitive measures and methods
Infant Sibs in UK • Collaboration with Tony Charman (ICH), Simon Baron-Cohen (Cambridge), Patrick Bolton (IOP) and others. • Phase 0 (pilot), 31 baby siblings seen at 10 months. Currently seeing them at 34 years old. • Phase 1, planned for 100 babies seen at 6, 12, 24 and 36 months
Pilot (Phase 0) study • Parent questionnaires about temperament, medical history etc • Standardised tests (Mullen, Vineland) • Physical growth measurements • Lab measures of attention and perception
Preliminary findings • Baby sibs differ as a group from low-risk controls in subtle measures of attention and social perception • One possible reason - this is due to a few individuals (who may go on to be diagnosed) • Another possibility - sibs do differ as a group, but the vast majority “recover from risk” to develop typically
National Infant Sibs Network • Funded by Autism Speaks (UK) with other charities to start in 2008 • Provides a platform for supporting and encouraging infant sibs work • Central database with shared measures • Meetings, workshops, and training •
[email protected]
Centre for Brain & Cognitive Development BabySibs team
Holly Garwood
Agnes Volein
Leslie Tucker Gergely Csibra
Mayada Elsabbagh
Thanks to: -Collaborators Tony Charman, Patrick Bolton, Simon Baron-Cohen -All the babies and their families - Our funders MRC and Autism Speaks
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