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A therapy for infants showing early signs of autism reduces the chance of the child meeting diagnostic criteria for autism at three years of age. That’s according to our new research, published today in the journal JAMA Pediatrics.
Therapy for children with autism often begins after receiving a diagnosis, which usually doesn’t occur until after the child turns two.
Our findings suggest starting therapy during the first year of life, when the brain and mind are developing rapidly, may provide even greater benefits.
Infants who received the therapy at 12 months of age were re-assessed at age three. They had fewer behaviours of autism, such as social communication difficulties and repetitive behaviours, compared to infants who didn’t receive the therapy.
Infants who received the therapy were also less likely to meet criteria for an overall diagnosis of autism when they were three.
Like all neurodevelopmental conditions, autism is diagnosed using “deficit-focused” diagnostic criteria. In other words, children are assessed on what they can’t do.
The Diagnostics and Statistical Manual is the authoritative guide describing the behaviours we use to diagnose neurodevelopmental and psychiatric conditions. It specifies individuals must have “persistent deficits” in social communication and behavioural interaction to receive a diagnosis of autism spectrum.
Significantly more children are now recognised as having difficulties learning social communication skills than previously. This has led to an increase in the numbers of children being diagnosed with autism – now estimated to be 2% of the population.
These social and communication difficulties, restricted behavioural repertoire and sensory issues, can present significant barriers to relationships, education and employment as they mature. So reducing these challenges can be important to helping individuals thrive into adulthood.
The aim of the therapy we trialled in our study was to help support social communication skills early in life, with the aim of reducing these long-term barriers.
The therapy, called iBASIS-VIPP, was based on the Video Interaction for Positive Parenting (VIPP) program. This program was adapted by our colleagues in the United Kingdom to specifically support social communication development.
The therapy is parent-led, which means parents and caregivers, who are the most prominent and important people in their babies’ lives, are trained to deliver it.
iBASIS-VIPP uses video-feedback to help parents recognise their baby’s communication cues so they can respond in a way that builds their social communication development.
Parents are videoed interacting with their baby in everyday situations, such as feeding and playing. The trained therapist then provides guidance to the parent about how their baby is communicating with them, and they can communicate back to have back-and-forth conversations.
We know these back-and-forth conversations are crucial to support early social communication development, and are a precursor to more complex skills, such as verbal language.
Importantly, parent-infant interactions are in no way the “cause” of autism. Infants are born with developmental vulnerabilities, which other studies tell us are likely of genetic origin.
This therapy focuses on supporting parent-child interactions as a way of enriching their social environment, creating learning opportunities for the child. And this is tailored to the child’s unique abilities.
The therapy takes the approach that children who develop differently experience the world and learn skills in different ways. By understanding unique abilities and interests of each baby, we can use these strengths as a foundation for future development.
What we found
In our study, we identified 103 infants in Perth and Melbourne who were showing early behavioural signs of autism, such as reduced eye contact, imitation or social smiling.
Fifty of the infants were randomised to receive the iBASIS-VIPP therapy for five months. The other 53 infants received the usual services they would receive in their local community, such as allied health therapy, working with psychologists, speech pathologists and occupational therapists.
The babies then received developmental assessments at around 18 months of age, two years, and three years.
When the babies were aged three, independent clinicians who did not know which therapies the children had received, reviewed all of the developmental information collected. And they determined whether the children met diagnostic criteria for autism.
The iBASIS-VIPP therapy was so effective in supporting children to learn social communication skills that only 6.7% of the children met diagnostic criteria for autism at age three years, compared to 20.5% of children who did not receive the therapy. That’s a reduction of two-thirds.
While most children in the study still had some level of developmental difficulties, the therapy supported the development of social communication skills. This meant they no longer met the criteria for a diagnosis.
The iBASIS-VIPP therapy led to increased parental responsiveness to their child’s unique communication. It also improved parent-reported language development, compared to the control group.
This is the first time a “pre-emptive” therapy – that is, a therapy provided before diagnosis – has shown an effect on autism diagnostic outcomes.
What do the findings mean?
This therapy represents a new way of providing support to infants showing early developmental difficulties.
Many therapies for autism try to improve development by working with children directly to shape more “typical” behaviours.
By contrast, this therapy does not work with the child directly but with the social environment around the child. It adapts to each child’s unique differences, and helps them learn in a way that is best for them.
By doing so, this therapy was able to support social communication skills and behavioural expression to the point that infants were less likely to meet the “deficit-focused” diagnostic criteria for autism.
This finding provides strong evidence for a new model of how we provide clinical support to children with developmental differences.
Rather than waiting until a diagnosis to start therapy – typically at two years of age at the earliest – we need to identify developmental differences as early as possible. Then we need to provide developmental supports that nurture each child’s strengths.
At its most basic, this is a change of clinical support from “wait and see” to “identify and act”.
The finding also emphasises the importance of providing supports to children based on functional difficulties, rather than the presence or absence of a diagnosis. This approach is consistent with Australia’s National Disability Insurance Scheme.
By understanding who a child is (their strengths and challenges) rather than what they are (a diagnostic label), we can provide individualised therapy supports that will help them towards their full potential.
Andrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, The University of Western Australia; Jonathan Green, Professor of Child/Adolescent Psychiatry, University of Manchester, and Kristelle Hudry, Associate Professor of Developmental Psychology, La Trobe University
Rates of self-harm could be rising more quickly in children and adolescents from ethnic minority groups than in those from white groups, according to a study led by University of Manchester researchers.
A parent-led intervention that supports the social development of babies displaying early signs of autism has significantly reduced the likelihood of an autism diagnosis being made in early childhood, according University of Manchester scientists, part of an international research team led by CliniKids at the Telethon Kids Institute in Australia.
Early trial of multivariant COVID-19 vaccine booster begins in Manchester
(20 September 2021)
A phase one trial of one of the world’s first multivariant COVID-19 Vaccine has been launched by US pharmaceutical company Gritstone in collaboration with The University of Manchester and Manchester University NHS Foundation Trust.
Researcher bags second global award for suicide prevention
(20 September 2021)
Professor Nav Kapur is the 2021 recipient of the Stengel Research Award, one of the International Association of Suicide Prevention’s most important honours.
Mental health patients who were discharged from or admitted to acute mental health services during the first Covid-19 lockdown experienced loneliness and social isolation, according to a new study.
Study links childhood exposure to air pollution and self-harm in later life
(16 September 2021)
A study of over 1.4 million Danes has revealed a link between higher levels of exposure to two common pollutants during childhood and an increased risk of self-harm in later life.
Potential new drug for incurable vascular dementia
(15 September 2021)
A drug already used to treat high blood pressure could be re-purposed as the first treatment to tackle a type of vascular dementia caused by damaged and ‘leaky’ small blood vessels in the brain, according to research part-funded by the British Heart Foundation and published today in the Journal of Clinical Investigation.
Several countries – including the UK – are now offering third COVID-19 shots amid reports of vaccines proving less effective over time. But do these countries really need to embark on widespread booster campaigns? Here’s what research tells us so far about how vaccines are performing.
One study suggests that after four months of the second dose, the Pfizer/BioNTech vaccine is less effective at preventing infection (classified as a positive PCR test), with protection falling from 96% to 84%. However, the research is a preprint, meaning that its results have yet to be formally reviewed by other scientists.
Similarly, real-life data from Israel suggests that over-60s who received their second dose of the Pfizer vaccine in March 2021 were 1.6 times better protected against infection than those who received their second dose two months earlier. However, the data was less clear cut when looking across other age groups. This study also hasn’t yet been peer reviewed.
Data for the Moderna vaccine shows that functional antibodies (those able to stop viruses from entering cells) persisted in most people for six months after vaccination. However, there was a gradual decrease in performance against the beta variant of the virus, and the study didn’t assess the vaccine against the now-dominant delta variant.
A separate preprint has looked at vaccine effectiveness against delta, and found both the Oxford/AstraZeneca and Pfizer vaccines were less effective at preventing infection when facing this variant. Similar findings have been reported by the US Centers for Disease Control and Prevention.
While all these studies may sound alarming, most are yet to be formally reviewed, so their results need to be treated with caution. They also measure different things. Some look at numbers of positive PCR tests rather than symptoms or disease. Others consider antibody levels or the response to different variants. Really, we need to consider what the most important goals of vaccination are when assessing performance.
Vaccines still protective
An ideal vaccine would completely prevent infection and so stop people catching and spreading the virus. However, earlier on in the pandemic, reports appeared of people being reinfected with COVID-19 as well as of antibodies waning – and high levels of antibodies are thought to be important in preventing infection from starting. So it’s been suspected for a while that creating a vaccine that completely blocks infection wouldn’t be possible.
Indeed, antibodies are just one indicator of an effective immune response. We also need T lymphocytes that kill the virus, and immune memory to enable us to quickly produce lots of these killer T cells and antibody-producing B cells. Here the news is much more positive. Studies have shown that both killer T cells and immune memory persist well.
What this could mean is that some people might not have enough antibodies to completely prevent infection, but can still fight the infection off and stop it from taking hold. If this were the case, you would expect vaccines to reduce the impact or severity of disease. And this is where we are seeing good news.
Reports in the UK and the US are showing fewer vaccinated people requiring hospitalisation or developing severe symptoms from the delta variant. For example, fully vaccinated people in the US have been shown to be five times less likely to get COVID-19 and ten times less likely to be hospitalised or die from it.
Similarly, the Israeli study mentioned above showed that in people aged 40-59, four months after vaccination, vaccines were 98% effective at preventing people from being hospitalised with COVID-19. After six months, protection remained high, at 94%.
For people over the age of 60, though, the data shows a bigger drop off in performance, with protection against hospitalisation lower after four months (91%) and six months (86%). This difference may be due to older people being less able to mount a good immune response following vaccination, as well as the challenge of the delta variant.
However, what’s clear is that the vaccines are highly effective at protecting against severe disease compared with those who have not had a vaccine. And this, really, is the most important goal of vaccination – to stop people getting dangerously ill and dying.
Turning on the boosters
Despite protection against severe disease remaining high many months after vaccination, a number of governments have chosen to launch vaccine booster programmes. Will the third doses being rolled out by the UK and other governments be sufficient to provide long-term and even more highly protective immunity in the most vulnerable? The truth is, we don’t yet know.
We should remember that vaccination is just one of the ways we protect ourselves from infection, and that maybe other measures, such as mask wearing and ventilation, will still be needed if we cannot achieve sufficient protection. Indeed, as well as boosters, the British government has also outlined plans for reintroducing home working and mask wearing over the winter should the virus threaten to get out of hand.
The other question we have to ask ourselves is whether we should actually be looking to help other vulnerable people across the world. It’s been estimated that the richest countries have more than enough vaccines already, even if boosters are used and children are vaccinated.
The most important goal of vaccination is to protect against severe disease and death, yet many countries haven’t given even 2% of their population a first vaccine dose, enabling the virus to thrive at a huge cost to lives. Really, can we look the other way?
New online tool developed to help prevent self-harm
(14 September 2021)
A new online tool to help reduce and prevent repeat self-harm has been designed by researchers alongside those with lived experience. The tool was tested by a national sample of 514 people who have self-harmed to find out what they thought of it and whether they believed it could help them.
Is anybody out there? Human embryos make contact with mother-to-be
(14 September 2021)
FDA-approved drugs reduced SARS-CoV-2 infection in lab
(9 September 2021)
An in vitro study of drugs already approved by the regulatory authority in the United States to treat a range of conditions, has shown eight of them are also effective in slowing SARS-CoV-2 replication in infected human cells.
Review suggests best ways to treat to reoccurring prostate cancer
(9 September 2021)
More patients who have a type of internal radiotherapy used for reoccurring prostate cancer have side effects compared to two other forms of radiation treatment, a review of 39 academic studies has shown.
Unwell COVID-19 patients may be treated just as effectively with oxygen through a mask rather than the sometimes difficult to tolerate therapy known as Continuous Positive Airway Pressure (CPAP), according to a new study.
A report released today shows northerners were more likely to die from COVID-19, spent nearly a month and-a-half more in lockdowns, suffered worse mental health and were made poorer than the rest of England during the first year of the pandemic.
Sex drug can strongly suppress abnormal heart rhythms, finds study
(2 September 2021)
The drug Viagra, used to treat sexual impotence, can strongly suppress abnormal heart rhythms known as arrythmias in sheep according to University of Manchester scientists.
A study has revealed that 232 people could have died from taking an accidental overdose of prescription opioids in England between 2000 and 2015.
A 70-year-old woman, forced to live with cough since her 40s, is ‘excited’ to be the first person in the world to receive a potential new cough treatment at the NIHR Manchester Clinical Research Facility (CRF).
A new digital platform to support remote monitoring of complex wounds has begun rolling out across Greater Manchester.
A paper examining the role of Health Innovation Manchester as an Academic Health Science System has been published in an international journal.
GP turnover increasing over past decade in England
(23 August 2021)
The majority of NHS regions experienced a steady rise in GP turnover between 2007 and 2019, according to a new study by University of Manchester academics.
Hearing loss could be cause of depression in older people
(20 August 2021)
University of Manchester researchers have discovered that hearing loss may act as a cause of depression in older people.
Lung drug hope for heart failure patients
(12 August 2021)
An early phase trial of a drug currently used to treat lung fibrosis has shown it may also help patients who suffer from a common form of heart failure.
Medicines Discovery Catapult (MDC) today announces the relaunch of radiochemistry at the Wolfson Molecular Imaging Centre (WMIC) in Manchester. The facility, which was closed in 2020, includes the multi-million pound cyclotron, one of only a handful in the UK. It will supply hard-to-make radiochemicals to drug discovery biotechs and academic innovators – increasing the UK’s potential to discover new and better therapies for patients, faster.
Student volunteers from across The University of Manchester have given up over 1,000 hours of their time to support the COVID-19 vaccination programme.
The healthcare partnership between Kenya and the UK government has been strengthened through the signing of a Memorandum of Understanding (MoU).
Expansion of MR and CT imaging at Salford Royal
(28 July 2021)
Three new, state of the art MRI (Magnetic Resonance Imaging) scanners and a new CT (Computed Tomography) scanner have been installed at Salford Royal, part of the Northern Care Alliance NHS Group (NCA).
Homelessness linked to emergency hospital admissions
(28 July 2021)
Patients experiencing homelessness use hospital services, especially emergency admissions, at much higher rates than housed patients according to new research published this week.
In the first year of the Covid-19 pandemic, deprived areas suffered more excess deaths than affluent areas , with a disproportionate impact on their younger age groups according to the early draft of a new study.
Breakthrough into leading cause of blindness
(14 July 2021)
A University of Manchester led team of scientists has discovered that the most common form of adult blindness is probably caused by a failure of at least one of five proteins to regulate the immune system.