SCIENTIFIC RATIONALE OF THE EARLY START DENVER MODEL by Dr Mary Mupa Madumadu
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1 SCIENTIFIC RATIONALE OF THE EARLY START DENVER MODEL by Dr Mary Mupa Madumadu
2 WHAT IS AUTISM 9 Autism is a neuro developmental disorder ( Language social impairments, repetitive behaviours) Different from ADHD 9 Early diagnosis is vital to early initiation of management. Imagery; future most objective diagnostic tools in autism. 12. Prolonged ABR was consistent in infants and children with ASD, suggesting it can serve as an ASD biomarker at infancy
3 IMAGERY
4 IMAGERY
5 IMAGERY FMRI, Pierce et al 2001, - fusiform gyrus (FG), inferior temporal gyrus, middle temporal gyrus and amygdala (weak or no activation in FG in ASD) - significantly reduced activation in the inferior occipital gyrus,superior temporal sulcus and amygdala.
6 IMAGERY 9. PET imaging not indicated in autism evaluation, PET e.g. 18F-fluorodeoxyglucose brain positron emission tomography (PET) as an ancillary investigation can provide corroborative information and increase the diagnostic confidence for the same. 9 Findings; diffuse bilateral temporal hypo metabolism. 10. Brain-imaging results, abnormalities in the superior temporal sulcus (STS) are highly implicated in ASD. 10. ( decreased grey matter concentration,rest hypo perfusion and abnormal activation during social tasks.)
7 THERAPY & THE BRAIN 3.individual-specific, scattered activation seen in asd vs highly consistent FG activation; normals, experiential factors play a role in the normal development of the FFA. Therapy like the ESDM can contribute to these experiential factors
8 THERAPY & THE BRAIN
9 AUTISM THERAPY Autism therapy; long and expensive affair. POOR OR NO SCIENTIFIC AUTISM SUPPORT SYSTEMS IN KENYA 15. Identifying effective, community-based specialized interventions for young children with autism spectrum disorder is an international clinical and research priority
10 ESDM THERAPY RCT A RCT published in 2009; 48 children with ASD (18-30 months); either ESDM or a community intervention for two years (Dawson et al, 2010). ESDM; improved 17.6 standard pts VS community 7.0 pts ESDM maintained rate of growth in adaptive behaviour compared with a sample of typically developing children, while the comparison group showed greater delays in this area. ESDM likely change in Dx from ASD to PDD NOS, than the comparison group (Dawson et al, 2010)
11 ESDM CONSTRUCTS Communication-receptive and expressive Social skills Imitation Cognition Play Fine Motor & Gross Motor Behaviour Activities of Daily Living
12 KEY ISSUES 20 HOURS A WEEK INVOLVE PARENTS esp IN KENYA TO GET TO THIS GOAL INITIAL RCT 15 PROFFESSIONALS AND 5 PARENTS
13 REFERENCES 1. Hadjikhani N, Joseph RM, Snyder J, Chabris CF, Clark J, Steele S, McGrath L, Vangel M, Aharon I, Feczko E, Harris GJ, Tager-Flusberg H. Activation of the fusiform gyrus when individuals with autism spectrum disorder view faces. Neuroimage Jul;22(3): PubMed PMID: Schultz RT, Gauthier I, Klin A, Fulbright RK, Anderson AW, Volkmar F,Skudlarski P, Lacadie C, Cohen DJ, Gore JC. Abnormal ventral temporal cortical activity during face discrimination among individuals with autism and Asperger syndrome. Arch Gen Psychiatry Apr;57(4): PubMed PMID: Pierce K, Müller RA, Ambrose J, Allen G, Courchesne E. Face processing occurs outside the fusiform 'face area' in autism: evidence from functional MRI. Brain Oct;124(Pt 10): PubMed PMID: Redcay E, Courchesne E. Deviant functional magnetic resonance imaging patterns of brain activity to speech in 2-3-year-old children with autism spectrum disorder. Biol Psychiatry Oct 1;64(7): doi: /j.biopsych Epub 2008 Jul 30. PubMed PMID: ; PubMedCentral PMCID: PMC Eggebrecht AT, Elison JT, Feczko E, Todorov A, Wolff JJ, Kandala S, Adams CM,Snyder AZ, Lewis JD, Estes AM, Zwaigenbaum L, Botteron KN, McKinstry RC,Constantino JN, Evans A, Hazlett HC, Dager S, Paterson SJ, Schultz RT, Styner MA,Gerig G, Das S, Kostopoulos P; IBIS Network, Schlaggar BL, Petersen SE, Piven J,Pruett JR Jr. Joint Attention and Brain Functional Connectivity in Infants andtoddlers. Cereb Cortex Mar 1;27(3): doi: /cercor/bhw403.PubMed PMID: ; PubMed Central PMCID: PMC Hwang BJ, Mohamed MA, Brašić JR. Molecular imaging of autism spectrum disorder. Int Rev Psychiatry Dec;29(6): doi: / Epub 2017 Dec 12. PubMed PMID: Herringshaw AJ, Ammons CJ, DeRamus TP, Kana RK. Hemispheric differences inlanguage processing in autism spectrum disorders: A meta-analysis of neuroimaging studies. Autism Res Oct;9(10): doi: /aur Epub 2016 Jan 11. PubMed PMID: Patriquin MA, DeRamus T, Libero LE, Laird A, Kana RK. Neuroanatomical and neurofunctional markers of social cognition in autism spectrum disorder. HumBrain Mapp Nov;37(11): doi: /hbm PubMed PMID: ; PubMed Central PMCID: PMC Manglunia AS, Puranik AD. FDG PET/CT findings in a clinically diagnosed case of childhood autism. Indian J Nucl Med Apr-Jun;31(2): doi: / PubMed PMID: ; PubMed Central PMCID:PMC Saitovitch A, Bargiacchi A, Chabane N, Brunelle F, Samson Y, Boddaert N, Zilbovicius M. Social cognition and the superior temporal sulcus: implications in autism. Rev Neurol (Paris) Oct;168(10): doi: /j.neurol Epub 2012 Sep 13. Review. PubMed PMID: Bhat AN, Hoffman MD, Trost SL, Culotta ML, Eilbott J, Tsuzuki D, Pelphrey KA. Cortical Activation during Action Observation, Action Execution, and Interpersonal Synchrony in Adults: A functional Near-Infrared Spectroscopy (fnirs) Study. Front Hum Neurosci Sep 5;11:431. doi: /fnhum ecollection PubMed PMID: ; PubMed CentralPMCID: PMC
14 REFERENCES 12. Miron O, Beam AL, Kohane IS. Auditory brainstem response in infants and children with autism spectrum disorder: A meta-analysis of wave V. Autism Res.2017 Oct 31. doi: /aur [Epub ahead of print] PubMed PMID: Geva R, Dital A, Ramon D, Yarmolovsky J, Gidron M, Kuint J. Brainstem as a developmental gateway to social attention. J Child Psychol Psychiatry Dec;58(12): doi: /jcpp Epub 2017 May 15. PubMed PMID: Miron O, Ari-Even Roth D, Gabis LV, Henkin Y, Shefer S, Dinstein I, Geva R. Prolonged auditory brainstem responses in infants with autism. Autism Res Jun;9(6): doi: /aur Epub 2015 Oct 19. PubMed PMID: ; PubMed Central PMCID: PMC Colombi C, Narzisi A, Ruta L, Cigala V, Gagliano A, Pioggia G, Siracusano R, Rogers SJ, Muratori F; Prima Pietra Team. Implementation of the Early Start Denver Model in an Italian community. Autism Oct 1: doi: / [Epub ahead of print] PubMed PMID: Cidav Z, Munson J, Estes A, Dawson G, Rogers S, Mandell D. Cost Offset Associated With Early Start Denver Model for Children With Autism. J Am AcadChild Adolesc Psychiatry Sep;56(9): doi: /j.jaac Epub 2017 Jul 4. PubMed PMID: Ogilvie E, McCrudden MT. Evaluating the Social Validity of the Early Start Denver Model: A Convergent Mixed Methods Study. J Autism Dev Disord Sep;47(9): doi: /s PubMed PMID: Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics Jan;125(1):e doi: /peds Epub 2009 Nov 30. PubMed PMID: ; PubMed CentralPMCID: PMC Vismara LA, Young GS, Stahmer AC, Griffith EM, Rogers SJ. Dissemination of evidence-based practice: can we train therapists from a distance? J Autism Dev Disord Dec;39(12): doi: /s Epub 2009 Jul 7. PubMed PMID: ; PubMed Central PMCID: PMC Vismara LA, Colombi C, Rogers SJ. Can one hour per week of therapy lead to lasting changes in young children with autism? Autism Jan;13(1): doi: / PubMed PMID:
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