A particular type of behavioral therapy that can help autistic children develop social skills also appears to change and improve the way their brains function, new research has found.
The study, by researchers with Yale University and the University of California-Santa Barbara, indicates a form of therapy known as Pivotal Response Treatment (PRT) leads to significant improvements in lower- and higher-functioning children with autism.
The findings, published in the Journal of Autism and Developmental Disorders, also indicate PRT leads to noticeable changes in brain structure, as measured by functional magnetic resonance imaging (fMRI), that closely resemble features seen in the brains of normal children.
"The cool thing that we found was that these kids showed increased activation in regions of the brain utilized by [normally] developing kids," said Avery C. Voos, a researcher with the UCSB-based Koegel Autism Center, who helped lead the study. "After four months of treatment, they're starting to use brain regions that typically developing kids are using to process social stimuli.
"We can say that we have shifted the way these children are processing low-level social stimuli, and that's what we want. There's a social deficit in autism, so any improvement toward social interaction really helps with development. That's what makes this very exciting, and it speaks to the promise and success of PRT."
The study, which was completed at Yale University's Child Study Center, was designed to measure the impacts of PRT — a behavioral therapy pioneered at UCSB by Lynn Koegel, clinical director of the Koegel Autism Center. The technique aims to improve social engagement among children with autism spectrum disorders by concentrating on "pivotal areas," such as motivation, in hopes of boosting social interaction. The approach contrasts with other therapies that emphasize specific skills, like block-building.
"For instance … say a child wants to draw, and asks for a red crayon while she has her back to me," Voos explained. "I say, 'I can't understand what you're asking if you're not looking at me.' Once she [turns] toward me, we provide a contingent response –– in this case, giving her the red crayon –– and ideally she begins to understand, 'Hey, me looking at you and asking for what I want gets me what I want.'
“Ultimately, the social interaction becomes the reward on its own, which is the ultimate goal."
For the study, researchers monitored fMRI scans to see what areas of the brain were active while two 5-year-old children with autism processed certain information.
Comparing pre- and post-therapy data from the fMRI scans, the researchers reported “marked and remarkable” changes in how the children’s brains were processing the information.
Voos said researchers now plan to test the technique on more children with autism to confirm their findings that PRT does impact processing, and is not simply inspiring learned behavioral changes.
"The logical next step is to assess a larger group of children that are the same age as these two, to see whether these improvements were unique to these kids," Voos said. "We also want to know if the changes we saw remain after treatment. Long-term, it would be amazing to do this with hundreds of kids, in different age groups, to see what differences there may be.
“I would postulate that the younger we start these kids in treatment, the more improvement we will see in the way that they process social stimuli. Early intervention is wonderful. It can make serious improvements not only in overt behavior, but potentially in the way children are processing the world around them and the way they're processing your interaction with them on a daily basis.”
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