Therapy with babies significantly boosts social communication development

20 Sep 2021 Updated 14 Oct 2021 to include additional quotes from lead author of the study

A parent-led therapy that supports babies displaying early signs of autism has significantly reduced their social and communication difficulties, according to world-first research led by CliniKids at the Telethon Kids Institute and funded by the WA Children’s Research Fund, Autism CRC, La Trobe University, and the Angela Wright Bennett Foundation. 

In a study published in JAMA Pediatrics, an international research team led by Professor Andrew Whitehouse (Angela Wright Bennett Professor of Autism Research at Telethon Kids and The University of Western Australia, Director of CliniKids, and Autism CRC Research Strategy Director) presented the first evidence worldwide that pre-emptive therapy during infancy could lead to such a significant improvement in children’s social communication development that they then fell below the threshold for a 'deficit-focused' DSM-5 diagnosis of autism.

Professor Whitehouse said many therapies for autism tried to replace developmental differences with more ‘typical’ behaviours. In contrast, the pre-emptive therapy (iBASIS-VIPP) sought to work with each child’s unique differences and create a social environment around the child that would help them learn in a way that was best for them.

“The therapy uses video-feedback to help parents understand and appreciate the unique abilities and interests of their baby, and to use these strengths as a foundation for future development,” Professor Whitehouse said. 

“By doing so, this therapy was able to support their later social engagement and other autistic-related behaviours such as sensory behaviours and repetitiveness, to the point that they were less likely meet the ‘deficit-focused’ diagnostic criteria for autism," he said.

The team found that a clinician diagnosis of autism at age three was only a third as likely in children who received the pre-emptive therapy (iBASIS-VIPP) compared to those who received supports as usual. 

We also found increased parental awareness of their baby’s unique communication and an increase in parent-reported language development. Other general aspects of development were not affected.

“The children falling below the diagnostic threshold still had developmental challenges, but by working with each child’s unique differences, rather than trying to counter them, the therapy has effectively supported their development through the early childhood years.”

The four-year randomised clinical trial enrolled babies aged 9-14 months to investigate the impacts of iBASIS-VIPP. All babies had shown early behavioural signs of autism. Over a period of five months, half received the video intervention, while a control group received current best practice treatment. 

Eighty-nine children completed an assessment at the start of the study, at the end of the therapy period, and when they were two and three years of age. Identification, assessments and interventions took place in Perth as a collaboration between Telethon Kids and the Child Development Service, which is part of the Child and Adolescent Health Service, and in Melbourne at La Trobe University, led by Associate Professor Kristelle Hudry. 

Professor Whitehouse said given the high prevalence of autism worldwide, the implications of the findings were enormous. In Australia, about 2 per cent of all children have an autism diagnosis.

“Autism is not typically diagnosed until three years of age, however, therapy beginning during the first two years of life, when the first signs of development difference are observed and the brain is rapidly developing, may lead to even greater impact on developmental outcomes in later childhood,” Professor Whitehouse said.

“This is a genuine landmark moment for child health research. Our aim is to understand each child’s strengths and challenges so that we can better support and nurture the unique abilities they bring to this world.

“This is an important step forward in what we hope is an opportunity to develop new clinical models that use very early therapy to support babies showing early signs of autism.”

"Contrary to any sense of 'opposing' autism, this therapy cherishes neurodiversity by attending to and understanding it, giving these babies a social environment that is adapted and responsive to them as individuals." 

"The development improvements the babies experienced are a consequence of creating an environment that supports neurodivergence. The baby is able to benefit like any child from an adapted social environment. Our study showed that this approach is safe and effective in supporting development,"  Professor Whitehouse said.

Professor Whitehouse said follow-up of study participants in later childhood, when the behaviours for autism may be more apparent, would be critical to determining the longer-term significance of the video intervention.

This study also re-affirms the importance of disability support systems being based on needs rather than diagnosis. 

“The findings of our study provide clear evidence that we can be more effective in providing support by seeking to understand ‘who’ someone is (that is, their strengths and challenges) rather than ‘what’ a child is (that is, what diagnostic criteria they may meet),” Professor Whitehouse said. 

“System change requires evidence and advocacy. We hope that the evidence provided in this study will be a powerful catalyst for that change,” Professor Whitehouse said. 

Collaborating institutions included La Trobe University, The University of Western Australia, the Western Australian Child and Adolescent Health Service, Griffith University, the University of South Australia, the University of Manchester UK, and Evelina London Children's Hospital, Guys and St Thomas’ NHS Foundation Trust UK.

Read the full paper: Effect of pre-emptive intervention on developmental outcomes for infants showing early signs of autism: A randomized clinical trial of outcomes to diagnosis.

Read more about the study in The Conversation. Autistica UK has also published an explainer article