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Team detects signs of early autism in at-risk infants 

Dr. Lonnie Zwaigenbaum conducts a study with a young participant Charlotte Hurst

By Ian Popple 

Autism is often perceived on a linear scale, or spectrum. Those touched by the condition know this is an over-simplification. A multi-dimensional structure influenced by differences in language, motor skills, executive functioning and sensory perceptions would perhaps be a better way to describe this complex condition, which affects nearly one million people in Canada. 

Researchers describe being humbled by the heterogeneity of autism and how that translates into the wide range of features, with varied intensities, early in life. One thing that is relatively clear in all the complexity, however, is that early detection and intervention significantly improves outcomes thanks to the brain’s neuroplasticity at young ages. 

While some of the social and communication indicators of autism, such as reduced eye contact and repetitive behaviours, can be detected by around two years of age, diagnosis only occurs on average at 4 to 5 years of age, according to the Public Health Agency of Canada. 

The research 

Parents are remarkably observant and attuned to their children and often recognize differences in sensory interests and motor skills, which can be signs of autism, when they are just infants, even prior to the first birthday. Not only are parents adept at recognizing the early signs, but they can also play an essential role in intervention strategies

Dr. Lonnie Zwaigenbaum, Stollery Children’s Hospital Foundation Chair in Autism, Associate Director of the Women’s and Children’s Health Research Institute, and one of Canada’s leading authorities on autism.

Dr. Zwaigenbaum and his research team aimed to improve the development and wellbeing of autistic children by investigating novel detection and intervention strategies in high-risk toddlers as young as six months. According to Heath Canada, 1 in 50 children are diagnosed with Autism Spectrum Disorder (ASD), an umbrella term that includes a range of related developmental disorders, such as Asperger’s Syndrome. But because ASD runs in families, the rate of occurrence is 1 in 5 for children with an older sibling previously diagnosed with the condition.  

“Studying a group with elevated rates of autism provides a unique opportunity to observe the signs early in life, as they are first emerging,” explains Dr. Zwaigenbaum, who is also a professor in the Faculty of Medicine & Dentistry at the University of Alberta.  

The team developed two complementary studies, both funded through a Brain Canada-Azrieli Foundation Neurodevelopment Research Program grant, and support from the Canadian Institutes of Health Research (CIHR) and the Kids Brain Health Network.  

What they found: Detection 

The first study leveraged autistic toddlers’ tendency to hyperfocus on objects.  

“We know that autistic children struggle to focus on things that don’t capture their interest yet are capable of intense concentration on things that do interest them,” says Dr. Zwaigenbaum. Autistic children also tend to exhibit more extreme reactions to day-to-day emotion-evoking experiences, such as the removal of a toy. “We wanted to look at both observable behaviours and physiological responses, such as heart rate and heart rate variability, to see whether their responses could be used as an early indicator of autism,” says Dr. Zwaigenbaum. 

The results showed that autistic toddlers exhibited more intense reactions to frustration, which may support earlier detection, especially when there is already an autistic child in the family. The relationship between the behavioural and physiological responses was not strong, implying that the frustration responses vary considerably and are less obvious in some autistic children.  

“The great variety present in ASD highlights the value of flexible monitoring approaches over an extended period of time, including listening carefully to family concerns, which supports the current Canadian approach to identifying autism,” says Dr. Zwaigenbaum. 

What they found: Intervention 

In the second study, researchers attempted to enhance the effects of autism interventions, specifically in a parent-mediated program called the Social ABC. This program, developed by co-lead Investigators Dr. Jessica Brian and Dr. Susan Bryson, involves coaching parents in techniques aimed at improving communication and emotion sharing in toddlers with early features of autism. However, the team wondered if the effects could be improved by helping these toddlers become more flexible in the attention they give various objects.  

“We suspected that getting over-focused might make it more difficult for these children to participate in the Social ABCs because they’re not necessarily responding to their parents in the same way,” explains Dr. Zwaigenbaum.  

The researchers were able to improve attention skills and flexibility in toddlers using dynamic computer games, with visual characters that respond to the eye movements of those playing the game. However, the results of the study suggest that these differences did not produce a large enough difference in the success of the Social ABCs to warrant becoming standard practice.  

Interestingly, this highlights that intervention programs like the Social ABCs, which coach parents with strategies that help their children communicate and interact socially, can yield significant benefits on their own. 

It also reinforces how essential parents are in this process and how we can better support families, and enhance the skills and functioning of autistic children, long before diagnosis occurs.

Dr. Lonnie Zwaigenbaum

The impact 

“Our hope is always that clinical research will improve the lives of those touched by conditions like ASD,” says Dr. Viviane Poupon, President and Chief Executive Officer of Brain Canada. “These studies bring us closer to that goal because they progress our understanding and provide clearer insight into where valuable resources should be focused to provide the best results.”  

Since this research, the Social ABCs, under Dr. Brian’s leadership, have been adopted in several locations across Canada and are also being trialed internationally in both India and Israel. 

Dr. Zwaigenbaum, Dr. Brian, co-investigator Dr. Isabel Smith, and colleagues went on to publish three national practice guidelines on early ASD detection, assessment, and management as part of the Canadian Paediatric Society Autism Spectrum Disorder Guidelines Task Force.  

Dr. Lonnie Zwaigenbaum and team members were awarded a $2.09 million Azrieli Neurodevelopment Research Program team grant in 2016 to support the project: Novel approaches to early detection and treatment of ASD. The grant was made possible with the financial support of Health Canada (through the Canada Brain Research Fund, an innovative partnership between the Government of Canada (through Health Canada) and Brain Canada) and the Azrieli Foundation.  

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Autism | Brain Canada | Team Grant