NEW RESEARCH
Early Behavioral Intervention Is Associated With Normalized Brain Activity in Young Children With Autism

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Objective

A previously published randomized clinical trial indicated that a developmental behavioral intervention, the Early Start Denver Model (ESDM), resulted in gains in IQ, language, and adaptive behavior of children with autism spectrum disorder. This report describes a secondary outcome measurement from this trial, EEG activity.

Method

Forty-eight 18- to 30-month-old children with autism spectrum disorder were randomized to receive the ESDM or referral to community intervention for 2 years. After the intervention (age 48 to 77 months), EEG activity (event-related potentials and spectral power) was measured during the presentation of faces versus objects. Age-matched typical children were also assessed.

Results

The ESDM group exhibited greater improvements in autism symptoms, IQ, language, and adaptive and social behaviors than the community intervention group. The ESDM group and typical children showed a shorter Nc latency and increased cortical activation (decreased α power and increased θ power) when viewing faces, whereas the community intervention group showed the opposite pattern (shorter latency event-related potential [ERP] and greater cortical activation when viewing objects). Greater cortical activation while viewing faces was associated with improved social behavior.

Conclusions

This was the first trial to demonstrate that early behavioral intervention is associated with normalized patterns of brain activity, which is associated with improvements in social behavior, in young children with autism spectrum disorder.

Section snippets

EARLY PATTERNS OF EEG ACTIVITY IN ASD

Research has documented atypical patterns of EEG activity in young children with ASD in response to face stimuli.7, 8, 9 This atypical response is characterized by delays in the development of an attention-related event-related potential (ERP) component, the Nc, and a face-specific perceptual processing component, the N290 (and later in development, the N170).8, 9 The Nc component, the source of which is the prefrontal cortex and anterior cingulate cortex, reflects attention engagement with a

Participants

The study was approved by the University of Washington institutional review board; informed consent was obtained from the participants’ parents. Forty-eight participants with ASD were 18 to 30 months of age at entry to the study and had a diagnosis of an autistic disorder or a pervasive developmental disorder (PDD) not otherwise specified. Participants with ASD were recruited through pediatric practices, Birth-to-Three centers, preschools, hospitals, and state and local autism organizations.

Event-Related Potentials

The ERP waveforms in response to faces versus objects for each group are shown in Figure 2.

P1. P1 is a posterior positive deflection, 50 to 200 ms after stimulus onset, reflecting orienting to the stimulus. For P1, the significant main effects of stimulus were a larger amplitude over the central region to faces than to objects (F2,86=3.8, p=.03) and shorter latency responses to faces than to objects across regions (F1,43=5.8, p=.02). There was no main group difference in P1 amplitude or

Discussion

Dawson et al.5 previously reported the primary behavioral outcomes of this randomized controlled trial of the ESDM intervention with young children with ASD. Children receiving the ESDM intervention demonstrated significant improvements in IQ, language, adaptive behavior, and autism diagnosis. The present article reports EEG data collected at outcome. Two types of brain activity measurements, collected in response to social (faces) versus nonsocial (toys) stimuli, were of interest. The first

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    This article can be used to obtain continuing medical education (CME) category 1 credit at www.jaacap.org.

    This study was supported by grant U54MH066399 from the National Institute of Mental Health (G.W.). This research was also supported by a postdoctoral fellowship from Autism Speaks (E.J.H.J.).

    The authors gratefully acknowledge the children and families who participated in this study. Dr. Webb served as the statistical expert for this research.

    Disclosure: Drs. Dawson and Rogers are authors of the book, Early Start Denver Model for Young Children with Autism (Guilford Press), from which they receive royalties. Dr. Murias is a minority shareholder in Electrical Geodesics, Inc. Drs. Jones, Faja, Greenson, Winter, Smith, and Webb and Ms. Merkle, Ms. Venema, Ms. Lowy, and Ms. Kamara report no biomedical financial interests or potential conflicts of interest.

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