Behavior Therapy Normalizes Brains of Autistic Children

Autism likely has deep genetic roots, but the latest research provides hope that some learning techniques can lessen symptoms of the developmental disorder.

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Autism likely has deep genetic roots, but the latest research provides hope that some learning techniques can lessen symptoms of the developmental disorder.

In children with the mildest cases of autism, these techniques resulted in changes in their brains that made them “indistinguishable” from those of unaffected children of the same age — essentially normalizing them, according to Geraldine Dawson in the department of psychiatry at the University of North Carolina at Chapel Hill.

(MORE: Autism Rises: More Children Than Ever Have Autism, but Is the Rise Real?)

The results, published in the Journal of the American Academy of Child & Adolescent Psychiatry, are validation for the Early Start Denver Model (ESDM), a behavioral-intervention program that involves intensive engagement with children diagnosed with autism spectrum disorders (ASD). Specially trained counselors work with children twice a day in two-hour sessions, five days a week. In 2009, Dawson’s group reported on related work that showed that children with autism who received this intervention beginning at 18 months for about two years showed an average improvement in IQ scores of 17.6 points and dramatic gains in adapting so-called normal developmental behaviors, such as brushing their teeth and engaging with family members during meals.

Dawson and her colleagues were curious about what was driving the change. Could alterations in the brains of the Denver Model toddlers be responsible? After all, in the first six years of life, the brain is remarkably plastic, meaning it can be molded and shaped depending on the growing child’s experiences and exposures. To find out, she enrolled a group of 48 toddlers ages 18 months to nearly 3 years who had been diagnosed with ASD. Half were randomly assigned to receive the Denver intervention, while the other half were assigned to traditional community-intervention programs that included some special-education programs at schools. After about two years, Dawson’s group took electroencephalography (EEG) readings of the electrical activity of all the children ‘s brains while they were looking at pictures of human faces or toys, and compared these readings with those of similarly aged children without autism. In most of the affected children, previous studies showed the brain is more highly activated when the child looks at an inanimate object like a toy, and less activated when looking at a human face. In the current study, however, the children participating in the Denver program showed the opposite effect: their brains lit up more when looking at a woman’s face than when viewing a toy.

(MORE: Can Autism Really Be Diagnosed In Minutes?)

“We essentially reversed the pattern so kids with autism are now showing greater normal brain activity when they saw a woman’s face and less activity when looking at objects,” says Dawson. “In fact, the brain-activity patterns of kids with autism who received ESDM were no different than a typical 4-year-old’s [pattern] when viewing a woman’s face. They were indistinguishable.”

Dawson says the intervention is not a cure, but that the brain changes hint that some early drivers of ASD may be manipulated and even redirected toward more normal development. The findings may also reveal where in the brain and which systems are responsible for the problems associated with autism. “By providing intervention early on, we can mitigate the severity of autism symptoms and perhaps really alter the trajectory of the disease at both the level of behavior and the brain,” she says.

(MORE: Brain Imaging Could Detect Autism in Infants as Young as 6 Months)

That’s what has the autism-research community excited. If it’s possible to change the course of the disease, and possibly reduce the severity of symptoms, it could mean the difference between a child who isn’t able to communicate and engage with family or friends and one who may be able to participate in a normal classroom.

The key, however, is the ESDM program, and those who provide the therapy need to be certified by a program Dawson and her co-developer, Sally Rogers, have created at University of California, Davis. About 1,000 people have been trained in the technique so far, with 15 specifically trained to teach the model to others. So far, ESDM is available in the U.S., Australia, Japan, India and Sweden, and while the researchers are hoping to expand the program, they are wary about losing the intimate and specialized techniques required to conduct the behavior interventions properly. While most of the sessions look like play, they are carefully designed to engage and reinforce children’s social skills by asking them about how characters in a book might be feeling, for example, or by helping children to read the body-language cues that most of them miss.

(MORE: Ending the Autism Epidemic. If the Definition Changes, Will Some Kids Lose Services?)

And given the latest understanding of how plastic the brain remains, even after childhood, Dawson says the results are encouraging for not just newly diagnosed toddlers with autism but those who have been living with the disorder for years. “Although it’s optimal to start as early as possible,” she says, “I don’t believe there is any point where the door is shut and the intervention is not helpful.”

28 comments
workingwithautism
workingwithautism

Dont forget:Working with Autism, located in Los Angeles, has helped hundreds of children with an Autism Spectrum Disorder to achieve their maximum potential for independence. www.workingwithautism.com

Yankeegirl2012
Yankeegirl2012

"Deep genetic roots" my eye.. there is likely a sensitive population of children that exists but that senstivity does not equal autism or mean a child will develop autism.  In fact we likely all carry genetic mutations due to years of evolution and exposure to viruses. Children should not be defined or labeled based on their genetic makeup because that is a very slippery slope toward eugenics and the potential for future discrimination based on one's DNA.  Environmental factors factor strongly in the autism increase. According to the CDC reports released last April, autism now effects 1 in 88 children and 1 in 54 American boys.  There's been a 78% increase in autism in the US since 2002. It's been said before, you cannot have a genetic epidemic- this has all the features of toxic enviromental exposure (poisoning) on a mass scale. Genetic variation exists in all of us but variation in DNA are only a risk factor for disease not the cause. More likely toxins in our environment to which children are exposed early in life are what is triggering the exploding number of autism in the US and around the globe. Honest dialogue and recognition that autism as an environmental health crisis is what is needed. Steering the conversation and the public mind set toward genetics is not the answer and definitely not the whole story.

Art2
Art2

People used to have living rooms with couches that faced each other.  Then as houses grew larger, there was space for a living room with couches that faced each other, and a family room with couches that faced a TV.  Now most every room that people spend much time in includes a TV, a Computer, any number of devices that create music and other forms of electronic generated entertainment, and most recently a smart phone that people can sleep with to always stay connected.  So as the ability to connect is stronger than ever before how did those people with only couches connect?  It takes a natural disaster wiping out electricity, roads, bridges, cell phone towers, radio towers, to come close to living that connection that once existed with couches facing each other and time spent on front porches when the humidity and heat was a bit too much too handle in the Summer.  It took a Hurricane for me to meet my neighbors.  The full spectrum of cultural factors associated with this "milder section" of "the spectrum" appears to be much more complex than a refrigerator mother.  However, considering that human empathy is not a static quality and is affected by what one feeds one's mind, at least some of the "human world", appears to be growing gradually cooler. 

hcipro
hcipro

'While most of the sessions look like play, they are carefully designed to engage and reinforce children’s social skills by asking them about how characters in a book might be feeling, for example...' These 'interventions' sound very much like normal parenting. Could the rise in autism be caused by more parents who don't know to interact with their kids? The 'refrigerator mom' hypothesis was supposedly debunked, but maybe it's time to revisit it.

Art2
Art2

Anne, also in regard and response to your comments that the diagnoses exploded from 1995 to the year 2000.  There appears to be at least one potential answer for that and why PDD NOS cases were the majority of diagnoses provided during that period of time that diagnoses exploded.  In 1994 there was an editorial mistake in the DSMIV, that theoretically allowed any person to be diagnosed with PDD NOS, with only a mandatory requirement of one of the triad of impairments, per social interaction/ social communication/Restrictive Repetitive Behaviors(RRB's),  to be met.  So in effect a person during that period of time could have been diagnosed with RRB's only and met the mandatory requirements for a diagnosis.  A voice of reason, Dr. Fred Volkmar, provided a study that indicated this editorial mistake could be a force for increased diagnoses of PDD NOS, and the DSMIV revised edition produced in the year 2000 corrected that mistake to put the mandatory requirements back at 2 out 3 of the triad of impairments per the DSMIII criteria for PDD NOS.  Dr. Volkmar still appears to be a champion of reason per his constructive criticism of the limitations of the most recent study suggested by some to support the efficacy of the new DSM5 criteria for ASD.

Art2
Art2

Anne, it appears from the most recent research that ASD's have genetic roots and are influenced by potentially thousands of different complex environmental factors, resulting in the behavioral impairments described in the current revision of the DSMIV.   It is interesting that the current methodology used for the 1 in 88 statistic is most reliant on 8-year-old children receiving support in education tailored for individuals with developmental disabilities.  A slightly lower prevalence in South Korea is reported with similar statistical methodology, however a community wide scan of school children resulted in a total of three times as many cases, at a 1 in 38 prevalence, that where two-thirds were measured in previously undiagnosed in the mainstream school environment.  There was a community wide door to door scan done in Amish counties, ages 3 to 21, resulting in a prevalence of 1 in 271.  Before that scan was done in Amish counties, the understood cases diagnosed and identified were somewhere close to 1 to 3 in 15,000.  While the vaccine controversy issues have often been brought up in this conversation in the past specific to regressive autism symptoms, these additional cases in South Korea and Amish counties, were not likely of the regressive autism variety, as those type of symptoms do not usually go amiss in a child in the school environment. The research discussed in the topic article is interesting as it suggests that social interaction skills, at the neurological level can be improved through structured socialization in young childhood.  That shouldn't be a surprise, as the motivation and opportunities for actual face to face interaction in culture have been dropping fast where ever there are electronic media devices.  South Korea and the US are leaders in the world in this area, while people in Amish counties are still living in a place where face-to-face social interaction is the focus of daily life, similar to what it was centuries ago.  The issue may not as much associated young children engaged with electronic devices, as it may be with the family engaged with electronic media devices, with young children close by, but outside of face-to-face interaction. The causal factors and potential remediation of symptoms associated with the identified "milder autism" subgroups of ASD's, is not likely the same for those described in a subgroup like regressive autism.  A healthy dose of social-communication interaction in young childhood, instead of a life spent interacting with inanimate objects mostly in a receptive way, seems to be a healthy path toward social-communication development for any child.  The Denver model appears to put a concerted effort in that area, from the description in the article, that is effective.  The effect neurologically observed, apparently at least in part, results from the natural plasticity of the brain, however the observed effect of plasticity is impacted by the cultural environment the mind is fed, whether it is inanimate electronic media devices or full flesh and blood, face to face, complex human social communication interaction.

MaurineMeleck
MaurineMeleck

I don't think anyone in the autism community is going to be excited about this.   It;s old news and has been for years.  Both my grandchildren were on the autism spectrum-. The oldest, now 15, had ABA and wonderful therapists in 2000 when he just turned 3..  He had 40 hours a week for 3 years.   His brother, diagnosed at age 14 months, had 2 full years of 40 hours a week with great therapists well trained.  In 4 years or a little less, the younger child was FULLY recovered from autism.  The oldest is still fully on the spectrum and I am trying everything for him.  Know what the difference was? Bro #1 was fully vaccinated until age 2.  Bro #2 had his vaccines  halted at the tender age of 5 months.    When will that fully vaccinated  vs fully unvaccinated study of children be done?

There is no such thing as a genetic epidemic.  The children who get sick have a predisposition to not being able to excrete toxins  like a NT child and thus it crosses the blood/brain barrier.  Predisposition the revolver--vaccines the trigger.

Maurine Meleck SC

cathstuff
cathstuff

Some of this is offensive and insensitive to people on the spectrum. We're not "diseased" for starters. And why are people so keen to "normalize" others. Go "normalize" yourself.

annedachel
annedachel

“Autism likely has deep genetic roots.”That amazing statement is the first thing we read in this piece. How could something that has continued to increase exponentially possibly be a genetic disorder? Why do countless families report that they’ve never had anyone anywhere in their family with autism?In the 1970s, the autism rate was one in every 10,000 kids and almost no one knew anyone with autism. That changed when the definition was broadened in 1994 to include other behaviors doctors were seeing in children. At that point the numbers exploded.1995 1:5002001 1:2502004 1:1662007 1:1502009 1:1102012 1:88Some people claim that all the autism is the result of better diagnosing of a disorder that’s always been around. If that were true, the rate would have leveled out between 1995 and 2000, after the definition was changed in 1994. That hasn’t happened.In truth, autism is an epidemic and there has never been a purely genetic epidemic in history.The autism rate is based on studies of eight year olds, not eighty year olds. No one has ever been able to show us a comparable rate among adults. And that simple fact should be scaring us all.Anne Dachel, Media editor: Age of Autism

annedachel
annedachel

“That’s what has the autism research community excited.”I don’t think that the autism community is really all that excited about this latest study.This research looked at children “with the mildest forms of autism” and many parents are dealing with kids on the other end of the spectrum and they’re getting no help. They have autistic children who don’t speak and are a danger to themselves and to others. Many are still in diapers as teenagersThe disorder that has no known cause or cure continues to be an objective of research, but there’s nothing a mainstream doctor can tell a new mother so that her child who was born healthy and is developing normally doesn’t also end up on the autism spectrum.Anne Dachel, Media editor: Age o Autism

annedachel
annedachel

And when these healthy kids suddenly lose learned skills and regress into autism, many losing their ability to speak, all doctors can do is tell them it’s a mystery. The symbol for autism is a puzzle piece because so much is unknown.I wonder if parents whose children were born with normal vision would just accept it if they suddenly lost their sight around age two. Would they be satisfied that it was a medical mystery doctors just can’t figure out? That’s what autism parents are expected to believe. Autism happens; there’s nothing that can be done to stop it.Anne Dachel, Media editor: Age o Autism

Talendria
Talendria

@Yankeegirl2012 The statistical increase in autism is more likely due to overdiagnosis than an actual increase in incidence.  Think about the fact that foster kids are 2-4 times more likely to be prescribed ADD drugs. Is that because being a foster kid increases one's disposition to ADD by 400%, or is it because foster parents are more prone to medicate their kids?  When discussing autism, it's important to differentiate severe autism (non-verbal, rocking behavior) from mild autism (socially awkward, physically uncoordinated).  The mild cases can be caused by many different factors, and many people have probably been misdiagnosed with autism because it's the childhood disease du jour.  Last time I checked, there was no binary test for autism; the diagnosis relies on one person's subjective assessment.

Talendria
Talendria

@Art2 We used to be dependent upon each other in many tangible ways, and now we have the illusion of self-sufficiency.  That's one reason I prefer to live in towns rather than cities or suburbs.  I like to feel integrated in a community where I know my mailman, my butcher, my public safety officers, etc.  I worry for the next generation because social media is inherently sociopathic.  When I look at my son's peers, most of them seem to be asking, "What can I get from you?" rather than "What can we experience together?"

mmortal03
mmortal03

@Art2 Based on your thoughts here, you might be interested in the book "Alone Together" by Sherry Turkle.

RanaIndignada
RanaIndignada

@hcipro  I am finding it hard to find the words to reply to your ignorant comment. The only thing I can think of is that you have no clue what you're talking about.

MissBetsy
MissBetsy

@hcipro As a Speech-Language Pathologist, I have worked everyday for the past 12 years with children diagnosed with ASD and their families - while I am sure that there are some parents out there that would fit this bill, I can assure that that they are few and far between - I have known families that move to other states so their child with ASD will get the care they need - we have families that travel close to 3 hours one way to have therapy for their child - they quit (or lose) their jobs to assist with the therapies, take out second mortgages on their home - they go above and beyond what typically is required for a parent - and the benefits are amazing - their child can communicate!  So, please do not even consider that this old school of thought is worth "revisiting!"

Yankeegirl2012
Yankeegirl2012

Seriously? Haven't autism parents been out through enough? Now you want to blame them for not interacting with their kids enough?  no more offensive garbage theories. Ove the years the medical particularly psychiatric community has consistently wrong about autism since Bruno Bettlehim coined the term "refrigerator mothers"  Autism is a neuro immune disorder and there is plenty of good science that supports that.

Talendria
Talendria

@hcipro That's exactly what I was thinking.  It's extremely self-serving that this doctor is hawking a proprietary (and no doubt expensive) program when you could probably boil down the components to ten skills/activities for parents to do at home with similar if not equivalent results.

Talendria
Talendria

@Art2 I've long suspected that mild cases of ADD, ADHD, and ASD are lifestyle diseases triggered by too much media exposure, too little social interaction, and too little exercise.  I think our society took a sharp left turn in the 1980s when both parents went to work and left "latch-key kids" at home unsupervised.  Most kids now have no concept of discipline because they're not required to do chores at home, and their schedule and diet are left to their own discretion.  Worst of all, most daycare workers have the personality of a robot.  They're brusque with the children because they're overworked and underpaid.  How is a preschool-age child supposed to learn empathy when he never receives it?

In the many years that I've worked in public schools and coached Little League programs, I've only met a handful of children who, in my opinion, had a genuine medical disorder.  The rest just needed much firmer guidance at home.  While I'm not a certified specialist, I've done a lot of research over the past decade because my son was suspected of being mildly autistic.  He had some unusual behaviors that were impeding his progress at school and in sports.  Through a combination of occupational therapy, cooperative play, and exploring the human condition through classic literature (all conducted by me at home), he's learned to control his behavior and is happy and successful.

I don't like the word "normal" because it sounds totalitarian.  There's usually more than one acceptable way to do something, but public school teachers have become extremely intolerant.  They feel that any deviation from what they consider to be the norm is an inconvenience, and they make the offending child feel unwelcome in the classroom which only exacerbates his awkward behavior.

tiredofmen
tiredofmen

@annedachel Maybe we should stop playing the blame game. There obviously isn't any doctors/scientists who know how to cure ASD. So in the meantime STOP bullying them & let them find a cure - these things take time. I would have to say ur just like me who has a child with ASD & is frustrated that u can't help him/her.

Art2
Art2

@Talendria Ironic, as that illusion of self-sufficiency appears to be a symptom of at least in part, a cultural generated disability that can more easily be overlooked as long as cultural supports of technology are in place for the much larger population.  The word independence appears to be a kind of oxymoron for any social animal.  Social media provides a look into the human heart, or what some might refer to as capacity for empathy, that is reminiscent of the book the "Lord of the Flies", at times, as social norms of civility appear lost in some avenues of social networking.  Since the early nineties most all types of crime has steadily decreased and continues to do so, in the US, along with the frequency of teenage sexual activity and teenage pregnancies.  Serial killing is down 300 percent in the 2000's as compared to the three previous decades of spiked activity.  The only type of violent crime that appears to be on the rise is rampage killings that are often associated with suicide.  One might think from most of these statistics that the social norms of civility as well as empathy for others might be rising instead of falling.  However, at least one longitudinal study in young college adults reports a 40% measured drop of empathy in the last 3 decades with levels plummeting in the 2000's.  The comparison, although distant , that I see as most unusual is the spike of loss of empathy and spike in a reduction of serial killing since 2000.  Perhaps one simple answer may be that when one has their fingers and eyes attached to a an electronic device, there is no longer nearly as much time, for even the less positive face to face interactions in life, some of which can be approximated through the virtual reality avenue of electronic media devices.  The rampage killings which are often the last stand some take, associated with some type of extreme turmoil in life, may also be an increasing signal of silent distress in society, when technological accommodations through culture are no longer effective in approximating that illusion of self-sufficiency among some, along with the loss of empathy that appears to be steadily growing colder in the general population, where an almost infinite number of alternate realities can be generated in part, from the exposure to the information explosion, where social norms, in some cases, no longer apply.  There are no longer enough real life social roles to meet the diverse needs of a large complex society; a dangerous long term  prospect for any group of social animals, with apparently a continuing sufficient number of cultural accommodations to approximate social roles both positive and negative for some, in preventing substantial social anarchy, at least for now.  But if the accommodations are in part behind  the challenges for some and preventing anarchy among others, there does not appear to be any easy answer for the masses, other than individual efforts toward the good of one's family where it seems you have described a path in life, in a place where it still exists.  I think it does still exist, and I am not sure that a lower prevalence of actual diagnosed cases of ASD's,  in some rural areas of the country, as indicated by some, are due just to a lower awareness and access to diagnosis.  There can be a different type of life in smaller "close knit'' communities, that people in general, appear to be better evolved for adaptation.

Art2
Art2

@mmortal03 @Art2 Thanks.  I found a TED talk where Turkle described her ideas. While I provided an anecdotal observation that seems to be growing among the masses, she has gone through a great deal of time and effort to explore this idea further, that while still at the hypothesis stage, seems so obvious to me.  Interesting to me too, that the usual "TED" audience didn't shoot her ideas down in the comments like I thought they might in defense of electronic devices, per what Lady Greenfield, a well known scientist in the UK,  faced when she made comments of concern, generally related to this issue. The best example of potential actual consequences, in part, from this phenomenon, that I can think of, may be in Japan where young people are increasingly losing interest in actual intimate relationships with each other, and people are increasingly dying alone in apartments, with no real life connections to anyone that misses them enough after they die to check on them.  It is resulting in a new morbid specialty profession of clean-up crews for apartments, in Japan.  Humans, at least in some countries, may overall eventually lose their status as the social animal with the most complex, real life, flesh and blood social interactions, to other species like Elephants. It also reminds me of a more modern analogy with different variables, of John Calhoun's "Behavioral Sink Experiment".  A  potential  "mouse model" analogy for the overall phenomenon with some interesting spectrum like potential associations.  The link to the TED talk video is here for anyone else that might be interested in it:

http://www.ted.com/talks/sherry_turkle_alone_together.html

kywrite
kywrite

@tiredofmen @annedachel TiredOfMen, a "cure" isn't quite what is needed; autism is in many ways a different wiring of the brain, not a disease per se. What we need to do is find out what it is that has changed in the world to cause this difference (reference Art2's insights above). My gut says it's more a social change than an organic one.