Early autism treatment changes social behavior, brain

Researchers at the Yale School of Medicine have begun to research methods for early intervention treatments for autistic children.
Researchers at the Yale School of Medicine have begun to research methods for early intervention treatments for autistic children. Photo by Monica Disare.

Researchers at the School of Medicine’s Child Study Center have demonstrated the effectiveness of early intervention treatments for children with autism spectrum disorders.

In a study published in the online issue of the Journal of Autism and Developmental Disorders on Oct. 27, Child Study Center researchers Fred Volkmar, Kevin A. Pelphrey and their colleagues showed that an early intervention treatment called pivotal response training caused improvements in social behavior in young children. In pivotal response training, therapists interact with children in a play environment and try to encourage social behavior in this “naturalistic” setting, researchers said. The therapy does not seek to teach specific responses in children through rote instruction, but rather is structured around their natural interactions with people. This study is the first to prove that pivotal response training directly induces beneficial changes in areas of the brain associated with social interaction, researchers said.

“We’ve known for about 10 or 15 years that early intervention in autism can and often does make a tremendous difference in terms of outcome,” Volkmar said. “If you lack the social frame to motivate yourself, you have a lot of trouble making sense of the world. This is where early intervention helps.”

Over the course of summer 2011, the researchers conducted pivotal response training with two young children diagnosed with autism. The training, developed in 1979 by Robert and Lynn Koegel at the University of California, Santa Barbara, can be used for children across a variety of ages and functioning levels and can be conducted by parents at home, said co-author Pamela Ventola, associate research scientist at the Child Study Center.

Before and after the training, the team evaluated the children’s various communication skills, such as speaking and eye contact. After four months of pivotal response training, they observed improvements in all of these areas. Researchers also tested the subjects using functional magnetic resonance imaging and found increased activity in areas of the brain associated with face recognition, social decision-making, social responsiveness and biological motion, Ventola said.

The Child Study Research team demonstrated the effectiveness of pivotal response training in teaching autistic children communicative skills and in changing their neurology.

“We may be able to change how their brains are functioning,” Ventola said.

The study was significant because most of the research on pivotal response training has been conducted by its developers at UC Santa Barbara and because its effects have never been studied through neuroimaging, she said.

Volkmar said the use of fMRI to evaluate the treatment was a natural extension of the neuroimaging research that the Child Study Center has conducted for years. The Center has been at the forefront of research regarding the neurology of face recognition and social behavior, and has pioneered the use of eye tracking to measure social competence, he said.

“We’ve been involved in this for a very long time,” Volkmar said.

The study is the first step in a more thorough investigation of the effects of pivotal response training. Volkmar’s team is currently conducting a full-scale study with 60 children.

The study was also unique in that it paired autism research with autism treatment.

“There’s often a disconnect between what’s going on in the research environment and what therapists are doing at home,” said research assistant Jonathan Tirrell, one of the therapists who worked on the study. The study was an attempt to bridge this gap between therapy and research, he added.

Volkmar said that understanding the markers for successful treatment response may help tailor more specialized treatments for autistic children. Integrating fMRI data into this approach will help researchers understand which treatments are working, and why and how they are working, he said. Volkmar added that this study is important because within the field of autism research, studies focusing on treatment programs are rare.

Volkmar and Pelphrey’s team also included the paper’s first author Avery C. Voos, Danielle Bolling, Brent Vander Wyk, Martha D. Kaiser and James C. McPartland of the Child Study Center.

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