Preemptive Interventions Led to Reduction in Autism Spectrum Symptom Severity

Andrew J.O. Whitehouse, PhD

A preemptive intervention program for autism spectrum disorder (ASD) could help avoid more severe symptoms of the disease later in life.

A team, led by Andrew J.O. Whitehouse, PhD, CliniKids, Telethon Kids Institute and the University of Western Australia, determined the efficacy of preemptive intervention for autism spectrum disorder beginning during the prodromal period.

Autism spectrum disorder is not typically diagnosed until 3 years, with current clinical guidelines calling for therapeutic interventions following diagnosis.

“Interventions beginning during the first 2 years of life, when the first signs of atypical development are observed and the brain is rapidly developing, may lead to an even greater impact on developmental outcomes in later childhood,” the authors wrote.

The Interventions

In the single rater-blinded randomized clinical trial, the investigators compared preemptive intervention with usual care at 2 Australian research centers in Perth and Melbourne. Using community sampling, the investigators identified 104 infants between 9-14 months showing early behaviors associated with autism spectrum disorder, measured by the Social Attention and Communication Surveillance-Revised.

Each participant was randomized to receive either a preemptive intervention to go along with usual care or just usual care alone over a 5-month study period. The preemptive intervention group consisted of 50 infants with a mean chronological age of 12.40 months, while 53 infants with a mean chronological age of 12.38 months were included in the usual care arm.

The preemptive intervention regimen consisted of a 10-session social communication intervention called iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP) to go along with usual care services delivered by community clinicians.

Each infant was assessed for a number of metrics at baseline of approximately 12 months, the treatment end point at approximately 18 months, age 2 years, and age 3 years. The 3 year old reassessment included 89 participants, 45 of which were in the preemptive intervention group.

The investigators sought primary outcomes of the combined blinded measure of autism spectrum disorder behavior severity, measured by the Autism Observation Scale for Infants and the Autism Diagnostic Observation Schedule, across the 4 assessment points.

They also sought various secondary outcomes, including an independent blinded clinical autism spectrum disorder diagnosis at age 3 years and the measures of child development.

Stark Outcomes

The intervention led to a reduction in autism spectrum disorder symptom severity (area between curves, −5.53; 95% CI, −∞ to −0.28; P = .04), as well as reduced odds of autism spectrum disorder in 6.7% (n = 3) compared to 20.5% (n = 9) in the usual care group (OR, 0.18; 95% CI, 0-0.68; P = .02).

The number needed to treat to reduce the autism spectrum disorder classification was 7.2 individuals. In addition, an improvement in caregiver responsiveness and language outcomes was found in the intervention group.

“Receipt of a preemptive intervention for ASD from age 9 months among a sample of infants showing early signs of ASD led to reduced ASD symptom severity across early childhood and reduced the odds of an ASD diagnosis at age 3 years,” the authors wrote.

The study, “Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism,” was published online in JAMA Pediatrics.