Last week, findings from a small but notable University of California–Davis study showed that intervening earlier than usual with infants who show signs of autism spectrum disorder (ASD) can help prevent them from developing the disorder by the time they reach age 
Last week, findings from a small but notable University of California–Davis study showed that intervening earlier than usual with infants who show signs of autism spectrum disorder (ASD) can help prevent them from developing the disorder by the time they reach age 3 or 4. For perspective, we spoke with Einstein’s Dr. Lisa Shulman, a neurodevelopmental pediatrician and featured contributor to this blog. She explains how the study’s findings mirror what she sees in clinical practice at Einstein’s Children’s Evaluation and Rehabilitation Center and offers takeaways for clinicians and parents.
What are the most important findings of this study?
A small group of seven infants, 7 to 15 months of age, who were already showing early signs of autism spectrum disorder received a behavioral intervention. The intervention involved a parent-coaching model in which parents were trained by experienced clinicians in 12 weekly hour-long sessions with a curriculum derived from an evidence-based intervention program called the Early Start Denver Model, developed for older toddlers with ASD by the first author of the U.C. Davis study.
At age 3, six of the seven children did not meet the criteria for ASD and did not demonstrate the developmental delays often associated with ASD. The majority of these infants were being observed at this young age because an older sibling has ASD and they are at increased risk.
If this small pilot study is replicated, the implication is that if ASD symptoms are identified and intervention is undertaken extremely early by parents who have been taught various skills designed to increase infant engagement, an ASD diagnosis can possibly be avoided in some cases.
You’ve been diagnosing ASD for more than 20 years; how do the findings in this study correspond to what you see clinically?
Every year, we see a number of infants ages 6 to 15 months referred because of concerns about autism or other developmental delays. While some children have clear biological abnormalities or risk factors presumed to cause their patterns of delayed development, or highly atypical patterns of development, there is always a group of young infants and toddlers who have signs that provoke concern but whose social engagement can be worked on through various techniques. We talk about their having the building blocks of social capability, but they lack social motivation or contend with sensory sensitivities that get in the way of their social engagement.
This latter group can be wooed into social interaction in a variety of ways. Parents can be taught to read their children’s cues and develop their infants’ nascent social interest. We speak to parents about their children “hanging in the balance,” with the potential to go one way, toward ASD, or to be “lassoed back” into a pattern of social engagement.
Young children learn through their social interests and “nosiness” and their tendency to imitate. If an intervention can increase a baby’s social interest and nosiness, it can alter the entire course of how he or she learns in the important toddler years and beyond. The capabilities targeted in the Infant Start program of intervention get at the core weaknesses of young children with ASD. The strategies the program teaches parents allow them to woo these infants into engaging, and shift the balance toward social engagement. Based on my experience, the program feels clinically very much on the money.
What are some of the earliest signs that an infant may have ASD?
The symptoms that give rise to concern about ASD in infants (6 months or older) include:
- Unusual visual fixation (e.g., looking at a ceiling fan for long periods of time as a preferred activity)
- Unusual, repetitive patterns of object exploration (e.g., spending long periods of time spinning, tapping, or opening and closing things)
- Lack of communicative acts such as gestures (e.g., no hands being raised to be picked up by 9 months, no pointing by 12 months)
- Lack of sound and consonant production
- Lack of coordinated eye contact, smiling and reciprocal interaction during play with a parent
- Decreased eye contact and interest in social interaction
- Lack of response to name
- Reluctance to smile
- Lack of a tendency to imitate sounds or actio