Autism Prevention in Infancy: A Broad Interpretation

Carla’s bright flamboyance stood in stark contrast to her quiet 3-month-old infant, who lay on a blanket on the floor, his eyes transfixed by the light in the ceiling. ‘I think he’s autistic” had been her opening words when she called to make an appointment in my behavioral pediatrics practice.  We sat beside him on the floor. With her bright flowered dress and bangling necklaces matching her high lilting voice, she leaned into her son’s face, with increasingly urgent efforts to engage him. “Theo it’s Mommy!” Theo remained unfazed, not shifting his gaze from the spot on the ceiling. He seemed to confirm her concerns.

As I felt my anxiety rising to meet hers, I took a slow deliberate breath to calm myself. I thought, “we don’t know but let’s find out.” “Tell me about him from the beginning.” I asked. She shared the story of this “surprise” third boy, so different in every way from her loud, outgoing 5- and 7-year-old sons.

As she turned her gaze and attention to our adult conversation her voice came down in both pitch and volume. I continued to watch Theo in my peripheral vision. When I spoke in a tone a notch softer than hers, I noticed Theo’s mouth begin to move. At first, I thought I had imagined it. Once I felt certain of the shift, I called her attention to my observation. She held her face at a distance from her son, keeping her posture as she had in conversation with me but tilting her head to speak to him. She used the same conversational tone as she had in our adult exchange. We both observed a remarkable transformation. Theo’s whole face came to life as he moved his mouth in imitation of his mother’s. Her body relaxed; her face an expression of pure joy. Theo responded in kind with a broad smile.  Theo showed us through his behavior that, likely different from his older brothers at birth, he preferred a less intense, quieter type of interaction. With a busy and often chaotic household, mom felt overwhelmed. In this quiet space with room for curiosity and time to take notice, she was rewarded with an unexpected answer and a powerful moment of connection with her son.

I thought of this story when I read a recent long thread twitter by developmental psychologist Suzanne Zeedyk in response to the newly published study of an intervention for infants with early signs of autism. In one tweet she wrote: “What if we helped parents to feel more confident in responding to their baby. What if we helped them see & make sense of all the tiny behavioural cues that say “that’s too much for me” “that’s overwhelming” “can you slow down” “oh that is brilliant! so comfortable!” She suggests that these finding have broad implications beyond the question of a “diagnosis of autism,” citing as an example similar support for parents of blind babies. She concludes, “I think everyone deserves to know how powerfully attuned communication shapes babies’ brains & bodies. This autism research is telling us that 6 short months of communicative help for parents is having noticeable impacts on infant development. Attunement decreases stress.”Every baby deserves that. Every baby deserves a less-stressed world. The world we make babies grow up in is tough. No parent intends that. But it just is. Loud noises, fast pace, bodily disconnectn in car seats, parents distractd by phones. Babies’ brains notice *everything*.

In my 2016 book The Silenced Child I express a similar idea in relation to an earlier study addressing autism prevention in a section titled Listening as Prevention

“John Green and colleagues at the University of Manchester have shown how listening to parent and child together can set a child at risk for autism on a different path. His group studied infants with an older sibling with a diagnosis of autism. These infants have a twentyfold increase in risk of receiving the diagnosis. In one randomly assigned group, a therapist sat on the floor with a parent and child and supported the parent in making sense of the child’s communication. While the study is ongoing, the first round of published results at fourteen-month follow-up showed children receiving this form of intervention displaying fewer autistic-like behaviors than the group who did not receive this supportive treatment.

While this study is specifically about autism, it has relevance for any parent-infant pair that is having trouble trying to connect. This difficulty may stem from issues in the parent, as with postpartum depression, the child, as when her signals are difficult to read, or both. A person who has a relationship with the parent, who offers space and time to listen to parent and child together, makes all the difference. Given what we know about the plasticity of the brain, rather than framing the question as “Does a young child have a disorder or not?” we might ask instead, “How to we hold parents through a period of uncertainty to give a child the best opportunity to grow into her true self?”

In an article about the current study, Green, who designed the protocol these researchers also used, said,  “Many therapies for autism have tried previously to replace developmental differences with more ‘typical’ behaviours. In contrast, this works with each child’s unique differences and creates a social environment around the child that helps them learn in a way that was best for them.”

Zeedyk’s thread tackles the complex issue of guilt. Sadly, the notion of protecting space to support parents in listening to their baby’s earliest communications often gets translated into blaming parents when things go wrong. But parents naturally blame themselves. We typically call this “guilt.” A more positive spin calls it an appropriately profound sense of responsibility.

Especially during the COVID-19 pandemic parents are raising children in a highly stressful, unpredictable, and often overwhelming environments. A recent policy statement from the American Academy of Pediatrics on Early Relational Health points us in the direction of supporting all early relationships, not only those at risk for autism. Taking time to listen to parents as they listen to their baby’s earliest communications, as I was able to do with Carla and Theo. might go a long way in reducing the negative impact of these difficult and uncertain times.

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