Tuesday, November 2, 2010

At the Age of Peekaboo, in Therapy to Fight Autism

In the three years since her son Diego was given a diagnosis of autism at age 2, Carmen Aguilar has made countless contributions to research on this perplexing disorder.
She has donated all manner of biological samples and agreed to keep journals of everything she’s eaten, inhaled or rubbed on her skin. Researchers attended the birth of her second son, Emilio, looking on as she pushed, leaving with Tupperware containers full of tissue samples, the placenta and the baby’s first stool.

Now the family is in yet another study, part of an effort by a network of scientists across North America to look for signs of autism as early as 6 months. (Now, the condition cannot be diagnosed reliably before age 2.) And here at the MIND Institute at the University of California Davis Medical Center, researchers are watching babies like Emilio in a pioneering effort to determine whether they can benefit from specific treatments.

So when Emilio did show signs of autism risk at his 6-month evaluation — not making eye contact, not smiling at people, not babbling, showing unusual interest in objects — his parents eagerly accepted an offer to enroll him in a treatment program called Infant Start.

The treatment is based on a daily therapy, the Early Start Denver Model, that is based on games and pretend play. It has been shown in randomized trials to significantly improve I.Q., language and social skills in toddlers with autism, and researchers say it has even greater potential if it can be started earlier.

“What you ultimately might be doing is preventing a certain proportion of autism from ever emerging,” said David Mandell, the associate director of the Center for Autism Research at the Children’s Hospital of Philadelphia. “I’m not saying you’re curing these kids, but you may be changing their developmental trajectory enough by intervening early enough that they never go on to meet criteria for the disorder. And you can’t do that if you keep waiting for the full disorder to emerge.”

Sally Rogers, a MIND Institute researcher who has been working with the Aguilars, said she faced several challenges in adapting the toddler therapy for infants.

Even normally developing babies cannot speak or gesture, let alone pretend. Instead, Ms. Rogers has parents focus on babbling and simple social interactions that occur in the normal routine of feeding, dressing, bathing and changing the baby.

“Patty-cake and peekaboo or tickle games, those are people games,” she explained to Carmen and Saul Aguilar during their first session with their son Emilio at 7 months old. Ms. Rogers talked about the next 12 weeks and how they would focus on getting Emilio to exchange smiles, to respond to his name, to babble with them, starting with single syllables (“ma”) and moving on to doubles (“gaga”) and more complex combinations (“maga”).

“Most babies come into the world with a built-in magnet for people,” Ms. Rogers said. “One thing we know about autism is that it weakens that magnet. It’s not that they’re not interested, they have a little less draw to people. So how do we increase our magnetic appeal for his attention?”

Lesson 1 was eye contact. Ms. Rogers had the parents take turns playing with Emilio, encouraging them to get face to face with the baby and stay in his line of vision. Mrs. Aguilar leaned down on the blue blanket and rattled a toy. “Emilio? Where’s Emilio?”

On the other side of a two-way mirror, another researcher watched the session and an assistant monitored three video cameras in the room. Sally Ozonoff, a researcher who first identified Emilio as a candidate for the study, stopped by to observe.

“He’s just staring at that object even though her face is three inches away,” she said. “He has that flat, very sober-looking face.”

Mr. Aguilar tried next. He put Emilio in a red beanbag chair and folded the sides together over the baby. “Squish, squish, squish!” he said. No response.

He picked Emilio up over his head and flew him like an airplane. Emilio stared at the ceiling.

Mr. Aguilar put the baby back in the beanbag and picked up a stuffed wolf toy. He put it on his head and let it drop into his hands. “Pschooo! Uh-oh!” Finally, Emilio was watching. READ MORE

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