Potential neural mechanisms underlying the effectiveness of early intervention for children with autism spectrum disorder

Abstract

Although evidence supports the efficacy of early intervention for improving outcomes for children with autism spectrum disorder (ASD), the mechanisms underlying their effectiveness remain poorly understood. This paper reviews the research literature on the neural bases of the early core deficits in ASD and proposes three key features of early intervention related to the neural mechanisms that may contribute to its effectiveness in improving deficit areas. These features include (1) the early onset of intensive intervention which capitalizes on the experience-expectant plasticity of the immature brain, (2) the use of treatment strategies that address core deficits in social motivation through an emphasis on positive social engagement and arousal modulation, and (3) promotion of complex neural networks and connectivity through thematic, multi-sensory and multi-domain teaching approaches. Understanding the mechanisms of effective early intervention will enable us to identify common or foundational active ingredients for promoting optimal outcomes in children with ASD.

Oxytocin Treatment, Circuitry, and Autism: A Critical Review of the Literature Placing Oxytocin Into the Autism Context

“…Some argue that early social-training interventions shape the brain's receptiveness to the social world to mitigate the severity of autism symptoms (94,95) and reduce the compounding negative influence of social impairment (96). There seems a very strong 12 rationale to combine oxytocin with social-learning interventions to improve outcomes in early development.…”

“…Older children who then perform poorly on related emotion-recognition tasks also perform poorly on measures of social skills (100) and have a worse long-term prognosis (101). Theoretical models (38,94,98,102) propose that initial deficits in engaging with social stimuli from an early age (through mechanisms such as eye-gaze and joint attention) compound existing social deficits across development, as the social responses that are required become more complex. Individuals may then increase their withdrawal from sociallearning opportunities.…”

Oxytocin modulation of neural circuits for social behavior

“…In parallel with predetermined genetic factors, maternal obesity has also been shown to increase the risk of autism spectrum disorder in children (Krakowiak et al, ; Sullivan et al, ; Connolly et al, ). Subsets of patients who present cognitive and developmental disorders may also present irregularities with the gut microbiota flora (Parracho et al, ; Mayer et al, ; Bresnahan et al, ).…”

To Screen or Not to Screen Universally for Autism is not the Question: Why the Task Force Got It Wrong

“…Implementing ASD screening as standard-of-care is particularly important for children from low SES and minority backgrounds who are consistently overlooked and under-detected and as a result have a later age of first diagnosis and delayed access to services relative to other children 15 . Early detection importantly allows for intervention to begin earlier, which is considered essential to achieving the best outcomes 16–18 . Research suggests that individuals with positive outcomes, including gains in IQ, adaptive skills, and reduction in ASD core symptoms, as well as those with optimal outcomes who no longer meet criteria for ASD over time, are more likely to have been identified and treated before age 3 years 19 .…”