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RESEARCH: In the broadest sense of the word, research is the formal gathering of data, information and facts for the advancement of knowledge.

Autism—What is the latest research telling us?… Failure to orient to social stimuli represents one of the earliest and most basic impairments in autism. Early intervention that address the basic social impairments is the most effective tool we have to provide optimum outcomes in children with autism.

Autism

Autism…The Research

What is Autism?

Statistical information from the Centers for Disease Control (CDC) indicates that the rate of autism is 1 in 59 children. More children will be diagnosed with autism spectrum disorder (ASD) this year than with AIDS, diabetes, and cancer combined. ASD is a group of heterogeneous neurodevelopmental disorders that severely compromise the development of social relatedness, reciprocity, social communication, joint attention, and learning. 

In recent years, more and more autism research has focused on infants and toddlers. We now understand that autism begins at birth with altered social engagement—a difference in the way a child “tunes in” and interacts with the people around him. This altered social engagement goes on to manifest as deficits in social communication and restricted interests and behaviors. These core characteristics of autism cause a cascading and pervasive effect. Dr. Ami Klin, director of the Marcus Autism Center and one of the nation’s leading researchers, describes this process by saying, Autism creates autism.”

Failure to orient to social stimuli represents one of the earliest and most basic social impairments in autism. From birth, typical babies are naturally drawn to people. They would rather look at people than things; they would rather hear human voices than environmental sounds. But it is different for our babies with autism. Brain studies have found that while typical infants and young children show increased brain activity when viewing people rather than objects, children with autism show the opposite pattern—they preferred objects. Children with autism do not seem to experience as much natural reward in social interactions as other children.

Early Diagnosis

Research has established that autism begins well before birth. Several studies have shown that early signs of ASD can sometimes be detected as early as 12 to 18 months of age, however according to the latest CDC report, the average age of diagnosis is generally around 4 years of age. Before that age, when the brain is developing at an accelerated pace, is when the opportunity to make lasting change is the greatest. When children are diagnosed later, they miss this window of opportunity. 

Until now people were hesitant about the stability of early diagnosis. A recent study, which made national news, should change that. The large-scale study, conducted at the University of California, San Diego, found evidence that an ASD diagnosis becomes stable starting at 14 months of age and overall is more stable than other diagnostic categories, including language or developmental delay.

It is important to understand how autism might affect a child’s development and how it differs from that of a typically developing child. For example:

Attention… Instead of seeking out interaction with others and actively paying attention to the people in the environment, the child may seem to prefer to play alone and may not even notice some of the people in his world. The child may seem to pay more attention to objects or other unusual things like lights or patterns. Instead of consistently responding or turning when his name is called, the child may seldom or never respond. You may even wonder if the child has a hearing problem.

Babbling… Instead of making a lot of different speech-like sounds and some words while looking at someone as if in conversation , the child may be very quiet or make a lot of noise but with a limited variety of sounds. Instead of saying words like “Mama” and “Daddy”, the child may label or repeat random words that seem to have no meaning or are not functional.

Gestures… Instead of pointing, reaching to be picked up, waving bye-bye and shaking the head to say “no”, the child may be using few, if any, gestures to communicate. The child may not respond to gestures either—like looking when you point at something. Instead of showing and sharing things that are interesting or fun, the child may play with things alone or perform a similar routine with them over and over.

Imitation… Instead of imitating the sounds and actions of others in back and forth social games that seem to bring joy and fun, the child may not copy the actions and sounds of others and may not smile or laugh when you attempt this type of play.

Eye Contact… Instead of using eye contact to start a social exchange and looking at the communication partner during social interaction, the child may rarely make eye contact and may even avoid eye contact. Instead of using eye contact to request by looking back and forth between the communication partner and the desired object, the child may cry or tantrum without you even knowing what it is he wants.

Early Intervention
Early intervention that is designed to enhance social attention and engagement can change brain function in toddlers with autism. Research shows that this type of early intervention can make a significant difference in a child’s level of function by school age.

 Autism-specific early interventions, like the Pathways Parent Training Program, address the core deficits of autism which will change the way a child tunes in and interacts with the social environment. This change can alter the child’s brain development toward a more typical learning and developmental trajectory and diminish autism symptoms. Because early intervention may activate typical processing mechanisms due to the plasticity of a child’s brain before age three, the capacity for learning and change is great. Autism specific early intervention has been shown to significantly increase social attention and engagement, thereby enhancing the development of cognitive and language skills of children with autism. Early intervention is the most effective tool we have to change the way these children learn—improving both brain and behavioral development.

Research on Our Program!

While all components of the Pathways Parent Training Program are based on current research, the program itself has also been independently studied. Four articles have been published in peer reviewed journals. Three studies have been completed and a fourth large scale study is now being conductedresults are very promising.

The first study was supported by a grant from the Texas Department of Aging and Disability Services, in conjunction with the Texas Council on Autism & PDD, and the Texas Autism Research and Resource Center. It was published in Autism—International Journal of Research and Practice. The study found Pathways Parent Training Program model to be effective for developing the early foundational social communication skills of eye contact, social engagement, and verbal reciprocity in toddlers enrolled in an IDEA part C program. Social validity showed a high level of satisfaction as parents perceived the intervention as beneficial, easy to learn, and easy to incorporate into daily life.

A case study on the Pathways Parent Training Program authored by Dr. Pamela Rollins from the School of Behavioral and Brain Sciences, University of Texas at Dallas, was published in Topics in Language Disorders. In the study, Dr. Rollins describes the early development of shared attention and intention that typical children develop before words—the very skills our babies with autism lack. Without these early social skills many children with autism may go on to develop words, but not true social understanding and communication. These children may be able to name and request but not be able to effectively engage and interact with the people in their world. Rather than focusing on the development of words, the Pathways Parent Training Program targets the precursor social cognitive skills of face-to-face reciprocal social interaction and socially modulated eye contact. Results of this case study showed a marked increase in social engagement and vocal/verbal reciprocity—words within social interactions and social games significantly increased. In addition, eye-tracking data revealed that eye contact increased dramatically. 

A large scale two year randomized study was recently completed. Two papers have been published on the preliminary results. One published in Revista de Logopedia, Foneatría y Audiología, and the other, a mini review, in the Journal of Mental Health and Clinical Psychology. Results indicated “large and significant effects of the Pathways PTP  on the early social pragmatic milestones that comprise the phase of shared emotions. Parents perceived that the intervention made positive changes in their children and their families. Pathways provides the intensity of services necessary for change in toddlers with ASD while simultaneously utilizing a U.S. state and federally funded compatible service delivery model for children under 3 years of age. Effective early ASD community-based programs, such as Pathways, are crucial to help states to offer cost-effective models, build capacity for their early evidence-based interventions, and break down barriers to timely intervention.”

Because of these positive results, the University of Texas at Dallas recently received funding for a second two-year large scale study to continue this promising research. While the first large-scale study included children from 18-months to 3-years of age, the second study includes children from 12-months through 5-years of age. The study will be completed in the fall of 2020. 

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