Disability - Autism
Intervention in the British Study of Autism Siblings (i-BASIS)
Overview
Autism is a severe child development disorder affecting about 1 in 100 children and results in an annual UK cost of around £2.7 billion. It comes as no surprise that finding effective early interventions for autism is an international health priority. Our researchers at the BRC, including Professor Jonathan Green, Dr Janine Lamb and Professor Jill Clayton-Smith, are testing interventions as well as investigating the basic development of the disorder.
Neurofibromatosis Type 1 (NF1) is another important developmental disorder in childhood. This is partly due to both the causative gene abnormality and the pathway from the gene to the disorder being known in detail, a knowledge that suggests treatment approaches. NF1 provides insight in to the development of autism, as at least 40 per cent of NF1 cases show autism symptoms. A national service by Dr Susan Huson at our centre is working on understanding the precise cognitive and behavioural problems in NF1 and on treatment approaches that aim to further understand the pathways to the disorder.
Problem
Recent research has explored the possibility of very early intervention for infants who are at high risk of developing the disorder, by being siblings of children already diagnosed .
Theory suggests that some aspects of brain and genetic functioning may be responsive to environmental effects. This is thought to be especially true during the estimated 1000 hours of one-to-one social interaction in the first year with parents/caregivers. Our researchers are therefore looking into how intervention could be targeted to modify this aspect of the infant’s environment.
What we have achieved to date
Professor Jonathan Green who is leading this research has recently completed the largest pre-school intervention study in autism internationally, Parent-Mediated Communication-Focused Treatment for preschool children with Autism (PACT); a randomised controlled trial. Dr Janine Lamb is a leading young researcher in autism genetics, and has been working with Professor Green on the landmark international reports in to autism genetics.
Our researchers have new methods to identify behavioural and biological markers in infancy that may be associated with later emergence of autistic spectrum disorder (ASD). There is also indirect evidence that intervention at this age may be appropriate and effective.
Intervention in the British Study of Autism Siblings (i-BASIS) is only the second study internationally to mount an infancy intervention in the first year with high-risk siblings, and the first to use a RCT design with control.
Our study begins in late infancy when atypicality is more likely to have emerged. We are not only looking at the impact of behaviours that are believed to signal risk for ASD, but also at the impact on candidate biomarkers in brain functioning. The effect of intervention on these different areas will give early indication of the malleability of very early development pathways in ASD and on the prospect for alteration of later developmental course.
What we aim to achieve
The aim of the i-BASIS study is to conduct an experimental trial of a targeted early intervention to see if this will shift aspects of behaviour, brain function and eventually genetic expression towards a more typical path in at-risk infants.
The trial is based on a combination of developmental theory and the best current evidence for effective intervention for parent-child interaction in typically developing infants at high and low risk, as well as in pre-schoolers with autism. The intervention is parent mediated and video aided to help parents understand and adapt to their infant’s particular communication style to promote optimal social and communicative development.
The research will also test its effect on behaviour and biological functioning. Researchers will use this intervention study to test hypotheses about the sensitivity to environmental change of selected potential risk markers for later autism: namely, a) markers of behavioural atypicality; b) neurophysiological bio-markers.
This study will build on the successful proof of concept case series that we have recently completed, using the same intervention and measurement methods.
The study expects to provide information on the impact of intervention on parental confidence and family functioning. The study will also give information on: markers of behavioural atypicality, patterns of attention shifting, visual preference for faces and brain processing of face information.
