Target: Treating Pre-symptomatic ASD in the First and Second Years of Life

November 01, 2021

New Review Defines the Research Agenda to Make this Goal a Reality

The current average age for autism diagnosis in the United States is four years and four months, which is an improvement from twenty years ago when the average age of diagnosis was closer to 5 years.  Early intervention for children with autism spectrum disorder (ASD) has always been the goal and gives the chance to achieve the best outcomes. But what if it were possible to treat children extremely early, in their first or second year, prior to becoming symptomatic and months or years before they received an autism diagnosis? This idea isn’t science fiction, it is an important new hypothesis and the topic of a recent review published in the Journal of Neurodevelopmental Disorders. The paper focuses on the pre-symptomatic period, which is generally considered to be the time before and during the emergence of core symptoms of autism, typically exhibited in the latter part of the first and second years of life. The paper’s authors suggest that treating very high-likelihood ASD (VHL-ASD) toddlers, defined as having dual risk factors of neuroimaging markers of ASD and a positive family history of ASD, may be possible. Treatment at this early developmental time would provide an excellent opportunity to examine the efficacy of intervention before full symptom onset. This is the stage when the brain is extremely malleable, treatment at this point could provide robust improvements in functional outcomes. The design of a pre-symptomatic intervention would entail a non-deterministic or plastic developmental trajectory that could be altered through environmental modifications with the aim that its cascading effects would result in better, more adaptive outcomes. These better outcomes could possibly lead to decreased service needs and a higher quality of life. The researchers involved in this paper identified key intervention targets for VHL-ASD toddlers that parents, caregivers and clinicians could receive training for. These targets include sensory regulation, attentional biases and flexibility, early motor skills, social communication, directing communication, joint attention, and joint engagement. The paper’s authors acknowledge that pre-symptomatic intervention is still a long way off. However, they feel that they have taken the important first steps towards developing a conceptual framework to intervene during the pre-symptomatic period.  These interventions could alter the trajectories of VHL-ASD toddlers, steering them towards a better quality of life. In the future, if this pre-symptomatic framework was successful and adopted as a public health measure, the course of ASD would markedly improve.

Original Study

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