Autism: first research to predict responses to treatment models

Posted on November 9, 2012

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Gains in four cognitive areas after one year of therapy

Gains in four cognitive areas after one year of therapy

Scientists at La Trobe University’s Olga Tennison Autism Research Centre (OTARC) have successfully profiled children with autism to predict how they will respond to a particular form of developmental therapy.

OTARC Director, Dr Cheryl Dissanayake, says research led by Dr Giacomo Vivanti, published this week in the Journal of Autism and Developmental Disorders, is the first of its kind to profile children in order to predict treatment responses.

This research is important,’ she says, ‘because it is the first step towards being able to identify which intervention programs are best suited to specific children.’  The intervention model studied by Research Fellow Dr Vivanti and his team is the ‘Early Start Denver Model’ (ESDM).

About the same time a new US study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, has provided further evidence in support of the ESDM. (More details, below.)

Dr Dissanayake says ESDM therapy has been used at the Victorian Autism Specific Early Learning and Care Centre (The Margot Prior Wing of the La Trobe Community Children’s Centre) since 2010.

Naturalistic play-based approach

Dr Vivanti: researching what works for whom, and why?

A developmentally-based behavioural intervention for children between 12 and 60 months of age, it is a naturalistic play-based approach involving specially trained therapists working in collaboration with parents or guardians.

The therapy is based on strict adherence to a manual that guides treatment. In its original form the model relies on one-on-one delivery, but La Trobe autism research has adapted it for use in groups.

‘There is little doubt,’ says Dr Dissanayake, ‘that all children in the Margot Prior Wing benefit from the ESDM, but what we’re trying to understand is why some children make more gains than others.

‘Children are making gains across four cognitive areas after one year of therapy. And some children in our sample are moving from a severe autism diagnosis to a less severe diagnosis.’

Programs best suited for specific needs

However, not all children improve to the same degree. Dr Vivanti says the challenge is to better understand how to match children to the programs best suited to their specific needs.

‘We are working on what works for whom and why?’ says Dr Vivanti.

The paper published by his team details the initial results of the OTARC research, and uses the profiling model developed by Dr Vivanti to predict the responses of children to the ESDM therapy.

It shows Dr Vivanti’s profiling model has been highly successful in predicting treatment outcomes for children undergoing the ESDM intervention, although the sample size of 21 was relatively small.

The next step in the research, says Dr Dissanayake, is to assess whether the predictors of treatment success used by Dr Vivanti work equally well when used in other types of early intervention programs.

‘We really want to get to the stage where we can say, “this group of children will do better in program A, whereas these other children will do better in program B, so that we can prospectively match treatments to individual children”,’ says Dr Dissanayake.

New US findings that ESDM normalises brain signals

Dr Dissanayake: strong evidence

 The latest American study published in the Journal of the American Academy of Child and Adolescent Psychiatry, says Dr Dissanayake, provides strong evidence for the effectiveness of the Early Start Denver Model used at the Margot Prior Wing of La Trobe University’s Children’s Centre.

‘It’s been known for some time that ESDM leads to significant positive changes in the development of children with autism.

‘The American research builds on this by demonstrating that ESDM may actually normalise brain signals of young children receiving the therapy in terms of the way that they respond to faces and objects.

‘What this means is that children receiving ESDM showed the same pattern of response to faces and objects as typically developing kids. They are still autistic, but the ESDM seems to be changing the way their brain responds to other people.

‘Ultimately, this means that they will relate to other people in a more normal manner,’ says Dr Dissanayake. The new American research, she adds, provides further evidence in support of the ESDM

The La Trobe University autism centre is one of six Autism Specific Early Learning and Care Centres funded by the Federal Government, and one of just two centres that deliver a group-based ESDM.

See also:

‘Honorary Gran’ fights for better child autism services

Look here! Research toward earlier autism diagnosis