Many families and professionals are well aware of the increasing prevalence of Autism Spectrum Disorders (ASD), that include Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder-Not Other Specified, because of recent public awareness campaigns. When people think about ASD, they might imagine a 5-year-old who is “locked in his own world,” nonverbal, and engaging in self-injurious behaviors; or they might envision a school-aged child who is best described as a “little engineer” who can be socially “quirky;” still others might think of Dustin Hoffman’s 1988 portrayal of an adult with autism in the motion picture “Rainman.” Such vivid images depict the vast continuum of symptom severity of individuals who are diagnosed with an ASD.
The new vision of autism is moving toward an 18-month-old who is not socially engaged with family members or peers, not talking, and not playing with toys in typical ways. Clinical and research protocols are now moving toward early detection and treatment of young children with ASD. Therefore, professionals at UNM’s Center for Development and Disability are frequently asked if toddlers under two years of age have an ASD. Given this shift to early detection and diagnosis, the face of ASD is slowly changing.
Social relatedness and social communication are at the core of ASD, and problems in these areas are evident as early as 18 months of age. More specifically, very early characteristics of ASD include subtle deficits in response to name, variable eye contact, inconsistent joint attention skills, impaired imitation skills, and repetitive or abnormal use of objects. The early diagnosis of ASD is difficult because many of these behaviors vary among individuals and change over time. For example, very few young children with ASD display repetitive behaviors before the age of three years, and these repetitive behaviors change in type and intensity as the child ages.
Currently, the early diagnosis of ASD is solely based on observing behavioral characteristics that research suggests are evident as early as 12 to 18 months of age. In order to detect ASD as early as possible, the CDD utilizes a multidisciplinary team to identify these early symptoms and to rule out other neurodevelopmental disorders and medical conditions. Given that UNM’s CDD is the only program in New Mexico that specializes in the early diagnosis of ASD, UNM is poised to conduct cutting edge research on the early behavioral and medical markers of ASD.
Autism Research Activities
Neuroimaging: At the MIND Institute, Julia Stephen, PhD, in the Department of Radiology – in collaboration with Dina Hill, PhD and Brian Lopez, PhD – is using a novel magnetoencephalography (MEG) system designed specifically for measuring neural activity in infants and young children. The prototype MEG system, called babySQUID® , provides superior spatial resolution and sensitivity compared to the available adult MEG systems.
The goal of the proposed research using babySQUID® is to characterize the development of auditory and somatosensory integration in very young children with ASD. There are two primary reasons that motivate us to study multisensory processing in children with ASD. First, current theories of autism implicate sensory atypicalities as common symptoms of autism, and these atypicalities may have lasting effects on the individual’s development and behavioral presentation. Second, many studies have shown abnormal cortical connectivity in children diagnosed with autism, suggesting poor communication between cortical areas.
A number of investigators have proposed that sensory integration will be impaired in individuals with autism due to the requirement of cooperation between disparate brain regions; however, very few studies have directly tested this hypothesis. MIND researchers think that a multisensory integration paradigm provides an important bridge between simple sensory and complex cognitive tasks, requiring no response from the participant but invoking activation of an intricate cortical network.
Behavioral: Dr. Lopez and Dr. Hill were awarded a grant from the Organization for Autism Research to investigate the child, family, and community-based factors that predict treatment initiation following a diagnosis of ASD. Although early intervention for children with ASD has been shown to be highly effective, no studies have examined the factors that affect a family’s ability to initiate such treatment for their child. Delays in the initiation of early intervention for children with ASD can significantly impact their long-term developmental trajectory and outcomes.
This project is in collaboration with the New Mexico Department of Health’s Family Infant Toddler Program, which funds early intervention services for children 0 to 3 years of age. Families whose children receive a diagnosis of ASD for the first time are eligible for the study.
The study is following these children for six months to determine factors associated with the frequency, intensity, and duration of treatment provided to young children diagnosed with ASD. The findings from the study will provide professionals with critical information that will allow them to better target limited resources to those families who would otherwise not initiate early treatment for their children, to improve children’s long-term prognosis, to reduce parent stress, and to improve families’ quality of life.
Diagnostic: Elizabeth Provost, PhD, at the Department of Physical Therapy, and Dr. Lopez, in collaboration with others at the CDD, have demonstrated that young children with ASD have significant fine and gross motor delays as early as 18 months. The documented motor delays and differences are present at the time of a young child’s first diagnosis. Given the CDD’s involvement in early diagnosis of ASD, this is only the first of a series of studies looking at early diagnosis factors and which child-based factors affect later prognosis.
Treatment: Because ASD is a life-long disorder, behavioral-based interventions are critical in maximizing an individual’s learning potential, in teaching new skills, and in decreasing challenging behaviors. Through the Department of Psychiatry, Dr. Hill, Dr. Lopez, Marcia Moriatia, PsyD, and Nilofer Mody, PhD, completed a research project evaluating a time-limited social skills group for high functioning children with an ASD. The project included a co-occurring parent support group to facilitate skill carryover to the child’s natural activities, routines, and environments.
The research team implemented the units of a social skills curriculum in weekly sessions over a 20-week period. Intervention strategies included classroom teaching, use of visual structure, practice, homework, video modeling, and community outings. The project addressed some of the methodological issues raised in previous social skills group research, including using both quantitative and objective measures, evaluating at a three-month follow-up to assess for generalization and maintenance of skills, and administering measures at pre-treatment, mid-treatment, and post-treatment to assess the effects of short-term versus long-term treatment.
Changes in child, parent, and teacher report of social skills abilities, mood (depression ratings), and anxiety levels are currently being evaluated. However, based on qualitative parental and teacher reports, the project was a success at teaching new social skills that generalized to school settings.
In conjunction with Xinyu Zhao, PhD, and Andrea Allen, PhD, in the Department of Neurosciences, the aforementioned primary investigators are in the preliminary steps of developing a translational research group (genetic, neuroimaging, diagnostic, and treatment) that will collaborate on bringing high-quality research projects to the UNM School of Medicine. If you have any questions, please do not hesitate to contact Dr. Lopez