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Babies at risk for autism: Why, how, and what (do we know)?
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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
Social interaction
Communication Restricted behaviors and interests
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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
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Holly Garwood Agnes Volein Leslie Tucker Gergely Csibra Mayada Elsabbagh
Centre for Brain & Cognitive Development BabySibs team
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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