STEVEN REINBERG

NYT SYNDICATE

IN children as young as six months old, changes in the brain that can lead to autism spectrum disorder may have already begun, preliminary research suggests.

Although early signs of autism, such as problems communicating and repetitive behaviours, can often be seen as early as one year, processes in the brain linked to communication are seemingly being altered months earlier, University of North Carolina researchers report.

“We know that there is evidence that autism affects the ability of different brain regions to communicate with each other. This study confirms that this atypical brain development begins very early in life,” said study cobauthor Geri Dawson, the chief science officer at Autism Speaks.

“These findings raise the possibility of developing imaging markers that could detect risk for autism in advance of actual symptoms, and (to) begin treatment before symptoms begin,” she said.

However, whether these brain changes occur in all autistic children isn’t known, Dawson said. It is possible that the developmental problems of autism start even earlier, while in the womb, she said.

“One can imagine a day when you would use these imaging biomarkers to identify a young baby who is at risk and then provide them with early stimulation that could, hopefully, reduce or even prevent the onset of autism,” Dawson said.

The report was published recently in online edition of the American Journal of Psychiatry.

For the study, a team led by Jason Wolff, a postdoctoral fellow at the Carolina Institute for Developmental Disabilities at the University of North Carolina, used MRI brain scans to look for early brain development in 92 infants.

These babies all had older sisters or brothers who had been diagnosed with autism spectrum disorder, putting these infants at higher risk for developing the condition, the researchers noted. The children underwent a special type of MRI called diffusion tensor imaging at six months, one year and two years of age.

These repeated scans allowed the researchers to make three-dimensional pictures that show changes in “white matter.” White matter is a part of the brain particularly embedded with nerve fibres that form information pathways between different areas of the brain.

Of the 28 infants who developed autism spectrum disorder, the scans showed different white matter development in 12 of the 15 brain pathways the researchers looked at, compared with 64 infants who did not go on to develop autism spectrum disorder.

At six months, these pathways were denser than usual in the babies who developed autism spectrum disorder, but on later scans development had slowed. At two years, the pathways were less dense than those of typical toddlers, the researchers found. These differences suggest that white matter development is affected during early childhood, at the very time the brain is making and strengthening these vital connections, the investigators said. “These brain changes appear to occur in advance of many symptoms,” said Wolff.

“Autism unfolds over early development, and this process may begin with basic differences in brain connections.” These early brain changes suggest the potential for biological signs for early detection of autism, Wolff said. “This is an initial study, but (it) holds promise for the development of early detection down the road,” he added.

In addition, there is the potential for intervention that could disrupt the process that leads to autism, Wolff added.

“We may be able to intervene before autism fully manifests,” he said.

This study is part of a larger, ongoing multi-site study, Wolff said.

“This is an initial sub-sample, and we are aiming to enroll about 400 infants at high risk for autism and 150 at low risk. Eventually we will be able to report on development of both brain and behaviour in this group,” he said.

Dr Andrew Adesman, chief of developmental & behavioural pediatrics at the Steven & Alexandra Cohen Children’s Medical Centre of New York in New Hyde Park, said one drawback to this approach is the number and cost of MRIs that would have to be done to identify babies at risk for autism.

“This is not a cheap or casual procedure,” he said.

“However, this study suggests that there are roots to autism on a neurological level very early on,” Adesman said.

In the future, the new research may have a clinical application, he said, but right now “this is not a diagnostic test and parents should not be asking for it.” Another expert, Dr Robert F Lopez-Alberola, an associate professor and chief of pediatric neurology at the University of Miami School of Medicine, added that while it has been known that there are changes in the brain in autism, “this is the first time we see this over time.” “From the clinical prescriptive, we may have identified a potential marker for earlier diagnosing and then to begin interventions that could make the symptoms less significant or even to prevent them,” he said.