Babies at risk for autism: Why, how, and what (do we know)?

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Babies at risk for autism Why, how, and what (do
we know)?

• Mark Johnson

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Superior Temporal Sulcus/Gyrus
Left Frontal Operculum
Fusiform Gyrus (blue)
Orbitofrontal Cortex (red)
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How does the social brain develop?
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Superior Temporal Sulcus/Gyrus
Left Frontal Operculum
Fusiform Gyrus (blue)
Orbitofrontal Cortex (red)
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Infants at-risk for autism
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Why?

• Research into early onset can get at causal
  factors
• Symptoms may be compounded during development
• Possibility of early intervention

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Cause The triad of impairment
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Compounding Symptoms

• In developmental disorders, initial symptoms can
  be compounded by atypical interactions with
  others and the environment
• Important to start early e.g. over 1,000 hours
  of face-to-face social interaction in the first
  year.

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Early intervention

• Medical research moving to prevention rather than
  cure
• Intervention programmes exist for young children
  already diagnosed
• Can we devise interventions for babies at highest
  risk, or that show early signs?

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How?

• How can study the mind/brain of young babies?
• What at-risk groups are best for these studies
• What design of studies should we use?

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How (can we study the mind of babies)?
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Behavioral Testing
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Looking measures in babies

• Preferential looking
• Habituation
• Eye-tracking

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Eye-tracking in babies
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EEG/Event-related potentials
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ERP Results
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Optical imaging (NIRS)
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Optical Imaging (NIRS)
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Infants at-risk

• Children with known genetic conditions (e.g.
  fragile-X 30 have ASD)
• Children with other known medical conditions
  (e.g. tuberous sclerosis 24 have ASD).
• Baby brothers and sisters of older children with
  autism (10).

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Design of studies

• Longitudinal design with infant measures and
  assessment at 3 years
• Involves a 5 year-cycle and hundreds of babies
• Currently very few studies have reached this stage

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So far

• Why? Cause, compounding, intervention
• How? New methods, study design
• What? - do we know so far?

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Canadian study (Zwaigenbaum, Bryson and
colleagues)

• siblings low-risk controls
• Assessed at 6, 12, 18 and 24 months, with
  diagnostic assessment at 3 years
• AOSI Autism Observation Scale for Infants

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AOSI (Bryson et al. In press)

• Interactive, play-based measure of early signs of
  autism
• Attention tracking
• Communication (e.g. social babbling)
• Social responses (e.g. peek-a-boo)
• Play (e.g. imitation)
• Motor control

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AOSI (examples)

• Disengagement of visual attention Anticipation
• Social babbling Imitation

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Results so far

• No big differences at 6 months - most show
  typical social behaviours
• At 12 months differences appear in several
  measures (e.g. visual tracking, decreased eye
  contact, lack of imitation).
• By 18 months these differences are much clearer,
  but still only a 80-90 match with diagnosis at
  age 3 years

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VERY preliminary conclusions

• Indicators are present in most children with ASD
  by 18 months
• Key features early language, social
  communication, atypical attention and orienting
• Developmental trajectories vary some show
  regression, others do not
• A need for more sensitive measures and methods

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Infant Sibs in UK

• Collaboration with Tony Charman (ICH), Simon
  Baron-Cohen (Cambridge), Patrick Bolton (IOP) and
  others.
• Phase 0 (pilot), 31 baby siblings seen at 10
  months. Currently seeing them at 3-4 years old.
• Phase 1, planned for 100 babies seen at 6, 12, 24
  and 36 months

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Pilot (Phase 0) study

• Parent questionnaires about temperament, medical
  history etc
• Standardised tests (Mullen, Vineland)
• Physical growth measurements
• Lab measures of attention and perception

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Preliminary findings

• Baby sibs differ as a group from low-risk
  controls in subtle measures of attention and
  social perception
• One possible reason - this is due to a few
  individuals (who may go on to be diagnosed)
• Another possibility - sibs do differ as a group,
  but the vast majority recover from risk to
  develop typically

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National Infant Sibs Network

• Funded by Autism Speaks (UK) with other charities
  to start in 2008
• Provides a platform for supporting and
  encouraging infant sibs work
• Central database with shared measures
• Meetings, workshops, and training
• Mark.johnson_at_bbk.ac.uk

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Centre for Brain Cognitive Development BabySibs
team
Holly Garwood Agnes Volein Leslie Tucker
Gergely Csibra Mayada Elsabbagh
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• Thanks to
• Collaborators Tony Charman, Patrick Bolton, Simon
  Baron-Cohen
• All the babies and their families
• - Our funders MRC and Autism Speaks