Autism: UC hunts for causes and treatments

Autism is a developmental disorder now recognized as a growing public health crisis in California. The Centers for Disease Control estimates that 1 in 150 U.S. children have some degree of autism spectrum disorder, a developmental disability classification that includes autism, Asperger's syndrome, Rett syndrome, childhood disintegrative disorder and nonspecified pervasive developmental disorders.

The University of California is leading the way in both autism spectrum treatment and research. Families can turn to UC medical centers for evaluation and diagnostic services as well as treatment programs. Through research centers on several campuses, doctors, psychologists and education specialists are working to discover the causes of autism and effective treatments to improve the autistic child's educational and social experiences

M.I.N.D. Institute seeks to define autism

David Amaral, professor, Department of Psychiatry and Behavioral Sciences, UC Davis, director of research, UC Davis M.I.N.D. Institute

The Autism Phenome Project at UC Davis' Medical Investigation of Neurodevelopmental Disorders Institute is the largest comprehensive autism study ever attempted. Its goal is to identify different subtypes of autism. That identification process could lead researchers closer to discovering the causes of the disorder and finding the most effective treatment for each subtype.

"One of the major stumbling blocks to understanding autism and treatment for autism is that it's very heterogeneous," says David Amaral, M.I.N.D. Institute director of research.

Autism spectrum disorders are typically characterized by varying degrees of impaired verbal and nonverbal communication skills, repetitive behaviors such as rocking or hand flapping and difficulty with social interactions. But not every person with autism will exhibit the same symptoms. About 30 percent of children with autism have seizures, Amaral says, while others don't. Some have delayed language skills, gastrointestinal conditions or enlarged heads and brains, but others show none of those signs. He believes the types of autism could range from as few as six to 20 or more. That's something the study will determine.

The ability to match an effective treatment to each type of autism would be a major breakthrough. Treatments take time to show results, and they must be employed at critical times when the brain is developing.

"If you pick the wrong treatment, you've lost a valuable window," says Amaral.

There are currently 110 families participating in the phenome project, with two new families joining each week. Amaral's goal is to enroll 1,350 children, 900 with autism and 450 typically developing children. Most of the study participants are from Northern California. Amaral would like to expand the study nationally to other university research sites.

Children enter the study when they are between the ages of 2 and 3 ½ and are tracked over a number of years. In addition to behavioral observation, the children receive a comprehensive analysis of their genetics, brain structure and functioning, environmental exposures, blood proteins and immune systems.

Amaral believes he may have identified an immune system-related type of autism. He has found a link between prenatal exposure to certain maternal antibodies and the repetitive behaviors characteristic in autism. Antibodies from a pregnant woman's blood are transferred through the placenta and affect the developing fetus's brain. Researchers are working to confirm that the presence of these antibodies is a risk factor for autism. If that's the case, Amaral says, women could be screened for the presence of the antibodies and a treatment developed to remove them and prevent one subtype of autism.

Parent training can alter autistic behaviors

Laura Schreibman, distinguished professor, Department of Psychology, UC San Diego, director of behavioral therapy, UCSD Autism Center of Excellence

The National Institutes of Health-designated Autism Center of Excellence at UC San Diego is working to uncover the causes of autism and to identify biologically based treatments for infants and toddlers.

Eric Courchesne, a professor of neurosciences at the UC San Diego School of Medicine, is directing the program with a goal of developing earlier diagnosis and interventions. Laura Schreibman, author of the book The Science and Fiction of Autism, is the center's director of behavioral therapy. Her autism research has focused on developing individualized behavior-based interventions and training parents to use the techniques at home. Working with Robert Koegel at UC Santa Barbara, Schreibman developed something called pivotal response training, or PRT.

This method teaches parents to help their autistic child learn to communicate, interact with the environment and family members and achieve some of the basic infant developmental milestones. PRT uses play and natural behaviors to enhance language and social development.

Children who are referred to the autism center by pediatricians undergo an intensive biological and genetic evaluation. As part of the family's participation in the center's five-year study, they receive free behavioral intervention from Schreibman's research group.

This summer she will begin working with babies 18 to 24 months old and their parents. Each child will receive 10 hours of work a week with trained therapists in the home. Parents will receive additional hours of training to learn how to work with their babies.

"What they do would look like playing and having fun, but regular play doesn't work with these children," says Schreibman. "There are very specific skills the parents or clinicians need to have."

One of the effective interventions involves using a child's favorite toy or something the child is motivated to want as a reward. Parents have learned to teach babies to respond to their names by withholding the object until the child reacts to hearing his name spoken.

One of the research goals is to find which specific brain development patterns respond best to specific behavior treatments. Someday in the future, Schreibman says, researchers may be able to develop early interventions that can change the way the autistic brain develops.

Simple interventions could improve school life

Connie Kasari, professor of psychological studies, UCLA Graduate School of Education and Information Sciences
UCLA Center for Autism Research and Treatment

Many children with autism have a hard time forging friendships. On school playgrounds they may be isolated from their classmates, hanging on the outskirts of a group, not really engaging in the activities. 

Connie Kasari, a researcher at the UCLA Center for Autism and Research, also a National Institutes of Health-designated Autism Center of Excellence, just completed a five-year study that tested ways to improve the autistic child's social interactions and peer relationships.

The study worked with 60 Los Angeles Unified School District first to fifth graders with high-functioning autism. The students were included in regular classrooms with nonautistic children.

First the researchers assessed, with student surveys and playground observations, the way autistic kids participated in the social interactions of their peers.

"Less than 15 percent were isolated, and that surprised us," says Kasari. "We had some kids who were even popular."

Yet the children with autism had poorer friendship quality than the nonautistic kids, and they were lonely. Researchers evaluated the quality of their friendships by asking children to respond to statements such as, "When I do a good job at something, my friend is happy for me," or "I think about my friend even when my friend is not around." It was clear that the children with autism weren't getting as much out of childhood friendships as other kids.

The study interventions explored ways to improve those social relationships. Researchers tested four approaches. In one intervention, they worked one-on-one with the autistic child on building social skills. In another intervention, they worked only with the nonautistic children on ways to improve interactions with their autistic classmates. For a third group, they used a combination of the work with autistic children and nonautistic children. The control group received no social skills intervention, which Kasari says reflects the current school district practices. The researchers visited the schools twice a week for six weeks.

The combination intervention had the greatest effect. Kasari thought the one-on-one intervention with the autistic child would come in a close second, but it didn't. The intervention with the peer-only group did, showing the valuable influence good peer interactions can have on autistic children's quality of life.

As a follow-up, Kasari's group is doing a small pilot study of the effectiveness of training classroom aides to carry out the combination interventions. They're testing an after-school activities club for both autistic and nonautistic children with classroom aides supervising fun, developmental activities. Kasari hopes to getting funding to expand this study to more school sites. If aides are trained to carry out the social interaction interventions, she believes it would be a relatively inexpensive way to make great improvements in the school experiences of autistic children.