In 1997, NAAR awarded a $29,700 grant to Rebecca Landa, Ph.D., of the Kennedy Kreiger Institute & Johns Hopkins School of Medicine in Baltimore, MD to fund the pilot study, Core Deficits of Autism: Evidence from Infant Siblings of Autistic Probands, a case control project that employed innovative procedures to produce the first prospective study of siblings of autistic children ever undertaken.
NAAR funded Dr. Landa's Baby Sibs work for three consecutive years before she
NAAR-funded pilot study into a much larger award from the National Institutes of Health
More information on Dr. Landa's
work is featured in the story below, which was published in the April 15, 2003 edition of the Washington Post
:Seeking the First Signs of Autism Researchers Hope Early Diagnosis, Intervention Can Improve Outcomes
Behind the room's two-way mirror sits Rebecca Landa, director of the Center for Autism and Related Disorders at Baltimore's Kennedy Krieger Institute and associate professor of psychiatry at the Johns Hopkins School of Medicine.
hidden perch, Landa
scrutinizes the little one's reactions, gathering data for the first study funded by the National Institutes of Health
(NIH) to detect autism in children aged 14 months and younger.
has also found that autistic babies aren't able to communicate by expression about a topic like the penguin, or even react to a simple game of peekaboo on a consistent basis.
Unfortunately, says Landa
, these are subtle signs a parent may not notice, simply thinking their child is distracted or obstinate.
And a hurried pediatrician may miss the signals, too, saying that boys -- who are four times as likely to have autism as girls -- are just slower to develop.
But the earliest signs of autism should become much better known once Landa
is soon to publish data showing that many children who will later be diagnosed with autism are showing subtle signs of the disorder as early as 6 months, an age previous researchers had believed was too early to tell.
By 14 months, her
work shows, a constellation of signs has emerged in most autistic children, making a definitive diagnosis possible.
"Such clear evidence of developmental disruption before babies can be formally diagnosed," Landa
said, "will be tremendously helpful to doctors, therapists, teachers and parents."
Current tests for diagnosing autism can't be used for babies, as the tests measure whether a child is making friends, whether he
has conversations in which there is reciprocation and whether he
engages in imaginary play.Anatomy of a Disease
"What's important about Rebecca Landa's
work is that she's saying you can do it a lot earlier than that," said Shestack.
After that age, said Landa
, critical time frames for effective intervention may be quickly closing.Acting Early
According to Landa
, there are certain "sensitive periods" of a baby's life when the child becomes hyper-focused on understanding specific elements in their environment.
For instance, from birth to about 12 weeks, a normally developing baby will be compelled to focus on the faces of people around her
, trying to understand what faces are, what they convey.
Between 6 and 12 months, babies concentrate on language and speech perception, trying to understand the subtle difference between similar sounds in an effort to get ready to speak themselves, said Landa
theory is if you get to autistic kids early in these sensitive periods, you may be able to reroute confused brain signals so that these sensitive periods are not squandered.
Otherwise, says Landa
, bad signals from the disorganized portions of an autistic child's brain are sent to otherwise strong brain tissue, where they fall flat.
The result is that the child may never come to understand what faces convey or what words mean.
But, says Landa
, earlier intervention can help.
"You have to go after a kid when he's
doing things like processing faces and breaking the speech stream down," said Landa
"If you give them consistent input at those times, they start to get it.
If you wait until they're 3, you might miss out on shaping the outcome most effectively."Digging In
Landa, a speech pathologist who has done autism research for 16 years, is wrapping up her early detection study this spring.
Because up to 10 percent of families who have an autistic child give birth to another child with autism, Landa
asked the parents of autistic kids to enroll new babies.
has a control group of 50 kids and another 50 in her
at-risk group, constituting the largest sample group of babies to be studied for autism since birth, said Landa
research team start by observing newborns in maternity wards, checking to see if they prefer to stare at a picture of a solid black stripe over a simple drawing of a face. (The theory is that autistic babies will prefer the stripe).
When babies turn 3 months old, Landa or an assistant go to their homes and present them with more stripe-or-face choices, this time with the face drawings being more complex.
At 6 months the parents are asked to bring the babies in for several hours of observed play.
This is repeated at 14, 18, 24 and 36 months.
At 3 years old, when the children can be diagnosed with autism through traditional means, the study period ends.
Besides identifying developmental abnormalities in very young autistic babies, the early detection study has allowed Landa
to show that some autistic kids will develop seemingly normally until about 14 months, at which point they regress.
The National Institute of Child Health and Human Development
(NICHD) reports that about 20 percent of autistic kids may develop normally then regress dramatically, but says its information on this phenomenon has been based on anecdotal reports from parents.
And, says NICHD
, there is little information about when this regression occurs.
research is likely to change that.
With the early detection study nearly done, Landa
is beginning to recruit 50 toddlers diagnosed with autism spectrum disorder for an NIH-funded early intervention study.
Kids will start the study early, at 24 months, while most other autism intervention trials begin at 36 months.
The study will focus on communication and social interaction, blending multiple instruction methods like structured teaching and following the child's lead, reinforcing positive behavior as they go.
The study will last five years, with researchers focusing on 10 kids per year.
research team is looking for participants.
"What we're hoping to show is that if you intervene early enough, you can help [autistic children] understand that they can do things to make others understand them without having to cry," said Landa
"They can use symbols, acquire a language and learn to engage with you."
Part of the trial will involve examining the toddlers' blood.
This section of the study -- done by Karin Nelson (no relation to Daniel Nelson, pictured above) and colleagues at the National Institute of Neurological Diseases and Stroke
-- could lead to insights about possible pharmaceutical intervention for autism, said Landa
Meantime, trials like Landa's
are giving parents of autistic kids hope.
Nobody's talking about a cure, but with a condition as devastating as autism, even the hint of an effective treatment is exciting.
For information about the upcoming early-intervention trial for toddlers with autism, call 877-850-3372 or e-mail Rebecca Landa
According to Johns Hopkins researcher Rebecca Landa, some early infant behaviors can clue parents in to potential problems before a formal test or a pediatrician visit might.
Landa stresses that seeing any or several of these does not necessarily indicate autism, but she
urges parents who detect a pattern of the behaviors below to consult a developmental specialist.
• Not smiling when parents smile (parents shouldn't have to touch the baby to elicit a smile, says Landa)
• Not participating in vocal turn-taking (where the baby makes a sound, you imitate him, he
then makes the sound again, and so on.)