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Psychiatry Newsletter - Pulling out the stops for autism

Hopkins BrainWise - Summer 2011

Pulling out the stops for autism

Date: July 15, 2011

Dr. Rebecca Landa
For two decades Rebecca Landa has worked to pry open autism’s black box. Her early research helped map ASD’s first signs in young, at-risk children. All of her studies shout out the need for early, aggressive therapy that’s affordable.

A toddler sits at a table at home, a red, shiny ball the size of his fist in front of him. As he repeatedly hears touch ball, a parent’s or health worker’s hands move his finger to the ball. At some point—not right away, since the child has an autism spectrum disorder (ASD)—touch ball connects. A small hand, on its own, reaches out at the prompt. 

Since one in 110 children has some degree of ASD—the umbrella term for autism, Asperger syndrome and a more general type of developmental disability—the odds are high that a similar scene plays out daily worldwide.

But as helpful as this common approach to therapy is, the focused, one-on-one in a home setting might benefit kids even more as part of a program that features social interaction, according to new research. Work reported by Rebecca Landa and Hopkins colleagues in a recent issue of Journal of Child Psychology and Psychiatry suggests that as early as possible, children with ASD are helped by training them to ease the skills they learn into everyday social life. The idea is to appear natural and spontaneous in dealings with others.

Landa’s “integrated development” approach heavily targets the abnormal social behavior that, along with communicating, is a key problem in autism. Social inabilities, she says, possibly sidestep hardwired brain programs that cement the ability to communicate or carry out abstract social thought—brain activity that relies on interactions with people.         

But how to improve those interactions? Landa’s recent study pulled out the stops. The researchers offered a group of 25 young toddlers with ASD an established curriculum—Landa laughingly calls it “gorgeous”—in a nursery school setting. For six months, four times a week, 2.5 hours a day, each child had direct face time, literally, with a mentor, plus encouragement to interact with four other tots. Through play—toys weren’t in short supply—children were taught to notice and understand meaning in others’ faces and actions. They learned the behavioral signs of sharing an interest with someone and how to imitate those signs. The results were what she’d hoped, Landa says. Children improved significantly, especially in developing language.

But the study revealed more.

A second, matched group of toddlers received an extra helping of social practice. The benefits there, in becoming more socially engaged, were dramatic. “Extra gains,” says Landa, “at no extra expense.” When a teacher uses a toy car to coach a child to share attention and feelings, that’s one thing. To see that child, on his own, offer the car to another? That’s the happiest sort of ending.

For information: 443-923-7632.

Dr. Landa directs the Center for Autism and Related Disorders at the Kennedy Krieger Institute.

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