1. Early developmental markers may predict the future diagnosis of an autism spectrum disorder.
2. Video therapy sessions under the guidance of a therapist may improve behavioral outcomes in infants with developmental markers of autism spectrum disorder (ASD).
Evidence Rating Level: 2 (Good)
Study Rundown: In most cases, the diagnosis of autism is not made until the child has reached at least 2 years of age. Developmental markers of autism spectrum disorders, however, may manifest earlier. These markers include reduced attention to social scenes, reduced social eye contact, decreased neural response to eye gaze, and abnormal temperament. In this study, the investigators further explored those behavioral markers, as well as roles parental interaction may play in modifying or perpetuating those behaviors. They hypothesized that targeted adjustments in parent-child interaction, especially in early childhood when neural plasticity remains a factor, may positively alter the behavioral patterns of children determined to be high-risk for developing ASDs. These targeted adjustments were made using the “Video Interaction for Promoting Positive Parenting (VIPP)” program. In this program, parent-child interactions were recorded and then later reviewed with a trained therapist. The therapist then suggested modifications to improve communication with their child. The primary behavioral outcome was infant attentiveness to parents. Other behaviors, including caregiver non-directiveness, atypical infant behavior, attention disengagement, adaptive function, and language development, were also studied. Both the primary and secondary outcomes showed a positive intervention effect (expect in language development which was unaffected), suggesting that video training may indeed alter the development of children with early markers of ASD. The study was limited by its relatively small sample size, which moderately limited statistical powers resulting in wide confidence intervals.
In-Depth [randomized controlled trial]: This study investigated the effect of video training sessions on the behavior of infants at risk for the development of ASD. 28 families were assigned to the intervention group, while 26 received no video training. The early developmental markers were identified and assessed by the Autism Observation Scale for Infants. Attention disengagement was measured using the gap-overlap task. These initial assessments took place in a research setting. Only assessors were blind to the intervention assignments; families and therapists were not.
In the intervention group, at least 6 video sessions were recorded and reviewed with a therapist. Depending on the needs of the family, up to 12 sessions could be scheduled. The results showed an increase in the primary outcome of attentiveness to parent (ITT estimate of β 0.31, 95% confidence interval [CI], –0.30 to 0.93), with point estimate effect size of 0.29 (95% CI, -0.24 to 0.86). Improvements in the secondary outcomes were also observed. The intervention was associated with improved AOSI total store for behavioral atypicality (2.51 points, effect size 0.50, 95% CI -0.15 to 1.08), and increased parental non-directiveness (0.81, 95% CI 0.28 to 1.52). There was also improved attention disengagement in the Gap-overlap task (effect size 0.48, 95% CI -0.01 to 1.02), and improved parent-rated infant adaptive function (χ²=15.39, p=0.0005). Language development (i.e. language and responsivity to vowel change) did not appear to be affected by the intervention, with p>0.05 for auditory ERPs, directly assessed Mullen language scales, and parent-reported MCDI vocabulary scores (p=0.33, 0.30 and 0.75, respectively).
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