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Classic sign of autism appears in early infancy, study says

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Virginia Hughes
6 November 2013

Baby talk: Unlike typically developing infants (blue), infants later diagnosed with autism (red) tend not to look at the eyes of actresses making cooing noises or playing pat-a-cake.

Baby boys who will later be diagnosed with autism show a loss of interest in other people's eyes between 2 and 6 months of age, according to a study published today in Nature1. This is the earliest behavioral marker of autism found to date.

The researchers found that the steeper the decline in eye fixation over the first two years of life, the greater the level of social and communication impairment at 2 years old.

"Now we know that it is possible to develop a quantitative assay in early infancy that is predictive of both autism and level of social disability," says lead investigator Ami Klin, director of the Marcus Autism Center in Atlanta, Georgia.

The study is the latest in a surge of research on the younger siblings of children with autism, dubbed 'baby sibs,' who have a one in five chance of developing the disorder.

Researchers have found that some baby sibs have distinctive brain-wave patterns and a loss of interest in faces beginning as early as 6 months of age. The new study uncovers changes in brain development even earlier.

"We’re most excited about the fact that these are some of the earliest signs of autism we’ve ever observed," says co-investigator Warren Jones, director of research at the Marcus Autism Center. "We’re measuring what babies see, but more importantly, what they don't see."

Altered trajectory:

Klin and Jones recruited 59 baby sibs and 51 controls at ten different time points between 2 and 24 months of age.

They used eye-tracking equipment to track the infants' gaze as they watched videos of a woman addressing the camera as if it were a child, cooing and playing pat-a-cake. "We really wanted to do videos that were as close to natural, real life as possible," Jones says.

The researchers calculated the proportion of time that each infant looked at the woman's eyes, mouth, body and other objects in the surroundings.

Over the course of the study, 12 of the babies went on to be diagnosed with autism by age 3. Only 2 of the 12 are girls, so the researchers restricted their analyses to boys. They compared 11 boys diagnosed with autism (10 from the baby sibs group and 1 from the controls) with 25 typically developing controls.

The children with autism showed a steady loss of interest in eyes beginning in early infancy, looking instead at other parts of the face or body, the study found. In contrast, babies who were not later diagnosed with the disorder become more interested in eyes over the same period.

By 24 months, the gaze time of the autism group was about half that of the controls, the study found. Their attention to objects also declined in the first year, but then increased in the second, rising to about double that of controls by 24 months.

The study offers a developmental perspective on autism. That is, it found significant differences in how the children’s gaze changes over time, but not when comparing the children at a single age in infancy.

"At any single time point from 2 until 6 months, infant looking is highly variable," Jones says. "When viewed developmentally, however, as month-to-month rate of change in looking, the differences are quite clear."

This is a bit like watching someone age, he adds. "On a daily basis, you hardly notice any changes. But if you see two photographs, taken years apart, the differences are obvious."

Subtle signs:

Growing pains: Between 2 and 24 months, babies later diagnosed with autism (red) steadily lose interest in eyes, whereas typically developing babies (blue) gain interest. Enlarge image »

It's not yet clear whether these early changes in social gaze are markers of autism per se, notes Mayada Elsabbagh, assistant professor of psychiatry at McGill University in Montreal, who was not involved in the work. Two studies have found, for example, that babies who show more attention to the mouth region relative to the eyes have superior language skills as toddlers2. "The literature suggests that this increased looking to different areas [of the face and body] is not unique to autism," Elsabbagh says.

The new study found that children whose gaze declines most rapidly until 2 years of age have the most severe scores on the ‘social affect’ domain of the Autism Diagnostic Observation Schedule at age 2.

"It's hard to say what that means," notes Helen Tager-Flusberg, professor of psychology at Boston University, who has studied baby sibs but was not involved in the new study. "The sample size is very small and correlations are notoriously susceptible to small sample sizes."

Tager-Flusberg also points out that studies of typically developing babies have shown "striking sex differences" in the developmental trajectory of social gaze. "So I think that needs to be looked at in autism."

Warren and Jones agree, and are planning to study a larger sample of girl baby sibs.

The researchers say their study has an optimistic message: that at 2 months old, the gaze patterns of babies with autism aren't all that different from those of their peers, pointing to a window of opportunity for early intervention.

"Our ultimate goal is to translate this discovery into community-viable tools for early identification," Klin says.

Klin and Jones' study is a good example of the novel discoveries that can come from the baby sibs approach, notes Daniel Messinger, professor of psychology at the University of Miami, who was not involved in the study. "This is a big step, looking at kids before 6 months."

Autism is generally diagnosed in the clinic around 3 or 4 years of age. Researchers began following baby sibs' development around ten years ago, looking for early signs of the disorder, as well as to track its developmental trajectory.

The first studies found that these high-risk babies show subtle behavioral differences from controls in their first year of life. This research also clarified the disorder's recurrence in families, estimating that about 19 percent of baby sibs develop autism, compared with 1 percent of the general population.

Subsequent work has uncovered more nuanced patterns. For example, a study published 21 September in the Journal of Autism and Developmental Disorders showed that 15-month-old baby sibs — whether they go on to be diagnosed with autism or not — tend to do less 'social smiling' while looking at someone’s eyes than controls do. Intriguingly, though, the baby sibs who don’t have autism show typical levels of eye contact and non-social smiling3.

Another study, published in August, found that 6-month-old baby sibs later diagnosed with autism pay less attention to faces compared with baby sibs who develop typically.

"I think baby sibs [research] is reaching its golden age — just reaching it," Messinger says.

News and Opinion articles on SFARI.org are editorially independent of the Simons Foundation.

References:

1. Jones W. and A. Klin Nature Epub ahead of print (2013) Abstract

2. Elsabbagh M. et al. Soc. Cogn. Affect. Neurosci. Epub ahead of print (2013) Pubmed

3. Nichols C.M. et al. J. Autism Dev. Disord. Epub ahead of print (2013) PubMed

Comments

Name: usethebrainsgodgiveyou
6 November 2013 - 8:13PM

I took my son to the pediatrician at 4 months and told her he was not bonding to me because he never looked at me. She said "I've seen failure to thrive, and he's is bonded to you!Look at how he clings to you! "

Perhaps we should see another way of bonding, rather than with the eyes. We were stupid enough at 6 months to try "holding therapy", or "child abuse" as my husband termed it, and made me stop after one hour stint of trying to make him look into my eyes. It is a source of shame for me to bring this up. I later read that some societies, boys do not look mothers in the eyes until age 1 year, so I just forgot about it.

You've got to be very careful. The worst thing in the world is not autism, but abusing a child by forcing him to be something he isn't hard wired for. PLEASE take that into consideration.

Name: Happyaboutthis
8 November 2013 - 9:40AM

Thanks for sharing, eye contact is only important to bonding if the brain is wired for it. It seems like there can be advantages to not being drawn to eye contact. I'm on the spectrum and I can almost always spot when a magician palms something or forces a card for example.

(And no I don't call them out if I see it)

Name: Jane
6 November 2013 - 8:29PM

I wonder whether the babies in this study, later identified as having Autism, have been directing their visual attention toward the most movement, ie the lips and hands, rather than the eyes, because they had developmental vision problems and could attend longest to the place in their visual field that had the most movement?

Name: usethebrainsgodgiveyou
6 November 2013 - 10:25PM

Jane: I concur. Look at the kids who watch fans, trees blowing in the wind, flicker patterns on television. Very interesting. My son's pscho-ed testing at age 17 showed a strange (to me) anomaly.His ability to process "simple or routine visual material without making errors (Symbol search in the WAIS-IV was in the bottom 5%.

Eye contact is not the most meaningful human activity in the world, and is over-emphasized in the United States. Instead of looking for behavioral signs in infants (the easy way out), why not look for reason's ~why~ it might be so.

Name: usethebrainsgodgiveyou
6 November 2013 - 10:31PM

I am not ashamed of my son. I think he is a miracle to have come so far with such profound learning differences. He does things, through sheer grit and perserverance, that he should not be able to do. I hate to see "behavioral science" enter the nursery and take all the joy out of it. God help me.

Name: Amanda
7 November 2013 - 4:57AM

I am sorry but isn't this old news? There are 100s of studies on eye tracking and autism. Hundreds. In 2013 if a pediatrician does not recognize poor eye contact is a possible sign of autism, they are living or practicing medicine under a rock. There are so many huge gaps in autism research it is such a shame to see so many millions poured into the same eye tracking research year after year.
We need to study the brain inflammation and encephalitis that is so common parallel to the onset of ASD signs. We need to study the environmental factors triggering the onset of autism. Continually describing the obvious is not helpful at this point. We need more options for treatment, not more eye gazing studies.

Name: David
12 November 2013 - 1:21AM

Amanda,
there are two things that are different about this than any other study. First no reliable behaviors have ever been isolated that are predictive for ASD before 1 year. Most recent studies show that at 6 months social engagement of baby sibs that go on to develop ASD is equal to or even higher than typically developing ones. Second, what is important here (and not well spelled out in this piece) is that it is NOT the level of eye contact, it is the DECREASE in the level of eye contact. Note that at 2 months ASD sibs look at the eyes MORE, and by 6 months the same amount as typical sibs (see the graphic). Also note this is consistent with the first point-at 6 months as a static snapshot there is no difference. Only by looking at the time course from 2 to 6 months are these differences clear. ASD sibs have a decrease while typical in this period have a slight increase.

Name: Jon Brock
7 December 2013 - 1:46AM

David, I noticed the same thing. Unfortunately, hardly any of the babies were actually tested at 2 months, which in turn casts doubt on the reliability of the difference at 2 months and therefore the claim of decreasing eye gaze between 2 and 6 months.

More here: http://crackingtheenigma.blogspot.com.au/2013/12/does-babys-eye-gaze-really-predict.html

Name: Chrissy Young
30 November 2013 - 7:20AM

Hi I love your honesty and straightforwardness. The info that is out there on ASD as far as I am concerned is not hitting the key points either. The eyes all of the symptoms are symptoms and they are horrible are symptoms of a underlying cause. I believe in SCIENCE 100%. I am a nurse and have been in the field of nursing since I was a candy striper at 13 years old. ENDOCRINE DISRUPTORS are to blame. I think this is where the insurgence of learning disabilities couple with many overt diagnoses i.e. diabetes, fibromyalgias, fertility problems, memory problems, vascular problems. Issues with depression, chromosomal disorders yes I believe due to the crap in our foods shampoos paint on kids toys (pulled off Market were the toys from china a few years back. Plastic bottle with BPA. HORMONES given to cows to increase milk production. HORMONES that were given all too liberally in the 50's 60's and yes the 70's and are still being given today marketed with different names but they all bring about similar diagnoses aforementioned, and all to often to cancers. I work at one of the biggest hospitals in Boston and the MDs Nurses etc etc all buy into the BIG PHARMACO's which are still making these treacherous drugs. I was given huge doses of estrogen and progestins in utero in Boston in 1969 and was born with heart defects had bad PMS polcyctic ovaries hives (secondary to cortisol levels off the charts) miscarriages one being a baby with Turners Syndrome a missing X chromosomal disorder that if my lil girl was born would have had major mental/cognitive disturbances, short stature, webbed toes, short in stature, and MISSING HER OVARIES. Everything to do with what i got while forming in utero and which ultimately is now in our genes as my dtr has been dx with learning disabilities and looks as if she may be headed in my horrible medical direction. I was thrown into perimenopause with ovarian failure secondary to a huge cyst affecting my ovary that had to be removed. Suffered depression, anxiety and huge weight gain craving carbs, eyesight diminishing rapidly and memory SHOT! Yeah NO HORMONES< STEROIDS, GO ORGANIC unfortunately we have to pay more for something that we took for granted as kids natural untainted foods. NO BPAs. thats my story & I'm sticking to it!

Name: brian
8 November 2013 - 10:01PM

Behavioral signs have been associated with ASD earlier than two months of age. Children who developed ASD were, by one month of age, already different from their typically developing peers who had graduated from the same neonatal intensive care. "At 1 month, children with ASD but not control children had persistent neurobehavioral abnormalities and higher incidences of asymmetric visual tracking and arm tone deficits." [Pediatrics. 2010 September; 126(3): 457–467.]

Name: usethebrainsgodgiveyou
13 November 2013 - 4:39PM

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC25000/ It always takes me so long to find this study, which knocked my socks off because I saw the pictures (a picture is worth a thousand words...) It always reminds me of the "startle response" that I learned was missing in some handicapped children, and an indicator of atypical development. To me, it shows that autism is a part of the very core of the child. To think that "eye exercises" are going to change that, is ludicrous...my word of the day. It might be nice to celebrate how far our children come despite their handicaps.

Name: Mary Dombrowski
14 November 2013 - 5:04PM

Amanda, David has the right explanation as to why this particular study is significant. Although there are many anecdotal instances of these eye contact issues in infancy, this is the first double-blind study that documents a statistically different behavior in the kids who later become diagnosed with ASD. While it may try your patience, this is the way science is done. BTW, in my opinion, there isn't a sufficient body of strong science that supports Sally Ozonoff's theory about brain inflammation and/or encephalitis. We have to be patient to get the real deal that is scientifically proven.

Name: Sam
17 November 2013 - 1:38AM

Well said Mary

Name: kathy
28 January 2014 - 7:36AM

well i knew my son had something different when he didnt sleep at night more than a few hours, screamed more than usual and had difficulty with eye contact and didnt talk until 6... he is now 26 i canada they diagnosed him at 25.... what a great system....

Name: Kathy
28 January 2014 - 7:41AM

i was told oh well he eventually talk and now ive lost my house, almost m job because i missed so much work taking him to the child psych. place...its a sin that the govt wouild leave these kids with us.... he got no approp services until 26 fight for ur young ones

Name: grammie
9 February 2014 - 5:32PM

I am a great grand to a darling little boy who will soon be four months old. I have noticed for the last month or so that he has symptoms........of what exactly I don't know.....he has a stiff body when picked up, stares at faces with no response or emotion until repeated efforts to 'latch on' by someone gazing at him...........he also detests being laid on his stomach..............he doesn't grab for toys or any other distractions.........his stomach area is large in comparison with the rest of him...........I hesitate to say anything to anyone ...........how crucial is it for early diagnosis? ......or am I just a nervous Nelly?

Name: Kay
17 February 2014 - 6:26PM

No you aren't a nervous Nelly at all! If you think that there may be an issue I would address it as soon as possible with his parents. A lot of people go into denial though and push out doing something for years. The negative aspects of autism can be overcome to a degree but it takes very hard work from the parents and the child. Many kids with autism have allergies and need special diets and sometimes supplements. Say something so that if he continues to exhibit characteristics of autism by around age 2 the family can begin to work hard with him on a series of therapies and behavior and diet modifications that can help him. Hopefully you are wrong, but it doesn't hurt to look out for your grand baby.

Name: Natalie Lawson
24 February 2014 - 4:48PM

I have a beautiful grandson with the same characteristics, exception size of his belly. But the stiffness, his continued efforts to look up? Arch his back, seem to be very abnormal to me. His mama said that he despises belly time. He has delayed responses to seeing a person attempting to get his attention. I dont feel like any of this is normal. I've been around babies my entire life the neighborhood favorite go to babysitter. This must be an indication of something. (?)

Name: Fiona
21 February 2014 - 9:35PM

My son has ASD and is "high functioning". I am trained in child development and own my own chain of day nurseries for children aged 0-5 years, so whilst I am not clinically trained, I understand a great deal about children's "normal" development.

The biggest problem that we have is the barrier to awareness of conditions like ASD, particularly with parents and that health care professionals have the training and awareness to spot these conditions or symptoms before a child reaches pre-school or school age.

My son's development was unremarkable and normal up to the age of 18 months, including eye contact. He had fantastic routines, would sleep and eat normally and was just a really lovely baby. The difference we noticed wasn't eye contact but his apparent ability to focus on playing with toys and items for over 45 minutes at a time without the need to adult input and stimulation. Although we were in the room, he was very own agenda and self contained from the age of 5 months. As he got older into 14 months plus, he would only go to an adult if he had a use for you - i.e., needing a drink or something to eat or to get a toy. He would be happy and content for long periods entertaining himself and was and remains to be the happiest child I have known. At the age of 18 months, we saw a regression in eating and diet and verbal communication skills were delayed. He struggled with sensory issues and being around other children in the initial stages. He was diagnosed at an early point of around 3 years of age. Perhaps because he is high functioning and therefore he is not affected in the same way as children who may be further down the spectrum.

We have worked and continue to work with him to develop socially and with language, to the point where most people do not know he is autistic. He has a great imagination and loves role play and acting out his own imagination. He is the dearest and sweetest little boy. Please please please do not write children off with a label of ASD as their ability to learn from the age of 0-5 is vast. The biggest barrier to children with conditions like ASD is the people around them and their environment. If we make people aware, and provide early help and support then the outcomes for these children during critical brain development ages could be significantly different than perhaps otherwise. I wouldn't wish my son didn't have ASD as it is a small part of his psych but not an overriding one that prevents him from being capable of a normal life.

Name: Catie
8 March 2014 - 11:59PM

I can't look at someone's eyes, if they are very animated. The movement of the hands and the mouth draws my vision.
Some Web pages have video or continuously rotating images. I cannot read the article. Other people do not understand. I choose to read the article, but can not do it. My eyes do not obey me.

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