FLIPPING THE SWITCH

In 2000 the rate of autism spectrum disorder in the U.S. was estimated to be about 1 in 150. By 2014, that rate had jumped to an estimate of 1 in 68. No clear cause has been identified for the alarming escalation but, in light of these statistics, parents of young children are kept on their toes with questionnaires at well-child doctor visits.

The forms, some of which Fein helped develop, ask questions like “Have you ever suspected your child is deaf?” or “Does your child make eye contact with you?” Though cumbersome to complete with a squirming baby in tow, they are pivotal for noticing signs of ASD early on.

A mother of one of Fein and Eigsti’s study participants described her child’s subtle spiral into autism by saying it was as if her child was on “a dimmer switch,” slowly retreating into himself. If the questionnaires do their work and a diagnosis is made early, children with ASD seem to have a better chance of switching the light back on and leaving their diagnosis behind them.

For most individuals who achieve “optimal outcome,” or OO, the path seems to be one of diligent observation and early diagnosis followed by extensive behavioral treatment, such as applied behavioral analysis, or ABA. With ABA small tasks or behaviors often taken for granted, such as making eye contact, are practiced repeatedly with plenty of positive feedback and celebration as reward for task completion. This repetition may be key in forging compensation pathways seen in OO individuals’ brains, the pathways that help flip the switch.

But not always. Fein recalls two early patients. “It was a very poignant example,” she says. “Two mothers of autistic children became friends. They went through the same treatments, and one child recovered whereas the outcome for the other was quite different; he is still seriously disabled. The parents were highly supportive of one another, very close. The mother of the child who did recover felt terrible. Why did her child respond to the treatment and recover when the other child did not, even though both kids underwent the same treatment?”

The hope, of course, is that these fMRI images that illuminate compensation measures in the OO brain will not only confirm recovery but help figure out the whys and hows behind it.

Reflecting on the amazing plasticity of the brain and on some of the factors that may come into play for answering this question, Eigsti explains, “It was always thought you can’t teach old dogs new tricks and that you had to be young and flexible to learn new things. Now we know that, though difficult, it is certainly possible.”

In this case, we are referring to children, and among this cohort the “old dogs” may be toddlers or preschool kids, which demonstrates how key earlier intervention may be.

WHAT NEXT?

The next stage of the team’s research will focus on monitoring the OO group’s progression into adulthood.

Follow-ups are likely to involve bringing back some of the OO kids to see how they are doing as they transition into young adulthood — how they’re doing with things like finding housing and living independently, for instance.

“We want to follow them into their twenties and see how life goes,” says Fein. “We also want to study other aspects, such as are they more prone to anxiety or depression?”

Of course they don’t want to lose track of success stories either. One early study participant, Jake Exkorn, and his mom still check in at significant milestones. “He is now a busy, active college student,” notes Fein. She also is quick to say that this may not be the best path for everyone. “OO is one kind of good outcome, not the only good outcome.”