The Development of Social, Attention, and Perception Abilities in Typical and At-risk Infants

Diagnosis of developmental disorders such as autism and attention deficit hyperactivity disorder (ADHD) rarely occurs prior to 3 years. Thus, there is very little known about the emergence of these disorders during infancy. It is important to identify the earliest symptoms of these conditions for three reasons: (1) as it allows us to see symptoms in their original "pure" form before a child's difficulties becomes compounded by years of atypical development, (2) it enables us to discover early risk signs suggesting the infant's development needs close monitoring, and (3) it allows us to potentially intervene in the course of development before the onset of the full syndrome - a strategy that some believe may be more effective than waiting until a disorder is fully established. This grant addresses these issues in three parts.

In the first Part (A) we will expand on our current studies of infants at-risk for a later diagnosis of autism to also include infants at-risk for ADHD (by virtue of being the younger brother or sister of an older child already diagnosed with ADHD). We will compare the development of brain and cognitive functions in typical (low-risk) infants, and those at-risk for autism and ADHD, using a variety of baby-friendly methods such as MRI (Magnetic Resonance Imaging) while in natural sleep, EEG (electroencephalography), eye-tracking, and parent-infant interaction. We have chosen to compare autism and ADHD risk for several reasons. One of these is to determine how specific the early warning signs are for particular later outcomes. Another reason is that we know that there is some shared genetic risk between these disorders, and that they quite commonly co-occur in the same children. Part A is embedded within national and international collaborative networks in order to increase the number of babies studied on some key measures, and correspondingly increase our ability to detect effects.

While in Part A we search for the earliest appearing markers and symptoms, in Part B we will initiate work on potential early interventions. Specifically, we will build on our recent study on improving attention skills in typical (low-risk) infants by engaging them in eye-tracker controlled "games" in which they track moving objects on a screen. We will extend this work in several ways to make the training programme more suitable as a potential intervention for infants at-risk for ADHD, e.g. by greatly extending the period of training, and by taking advantage of new technology to allow for some training sessions to take place in the infant's home.

In Part C we plan a new line of basic research that can also be extended to infants at-risk in the future. While we know much about the early development of vision and auditory processing, very little research has been done on the sense of touch. Touch is important to study for many reasons, including that it is a primary mode of sensory interaction with parents. We will use several imaging methods to learn about the development of brain regions important for basic aspects of touch, social touch, and the infants emerging multi-sensory perception of its own body.

Diagnosis of developmental disorders such as ASD and ADHD rarely occurs prior to 3 years, resulting in little being known about the emergence of these disorders during infancy. In Part A of the grant we will expand our existing study of infant siblings at familial risk for ASD to also include infants at familial risk for ADHD/attention difficulties. We will compare the development of social and attention abilities using several baby-friendly neuroimaging methods (sMRI, fMRI, NIRS, EEG, ERP), eye-tracking and touch screen tasks, parent-infant interaction, and questionnaire and clinical assessments. By studying infants at-risk for ASD and ADHD on the same measures at 4, 8-10, 14-16, 24 and 36 months we can determine how specific early markers are for particular later outcomes, and address issues about the early development of co-morbidity. Part A is embedded within collaborative national and international networks that will increase sample size and power for key measures. In Part B we will initiate work on potential early interventions by building on our recent study demonstrating improved attention skills in low-risk infants following training on gaze-contingent attention "games". We will extend this training study in several ways to make it more applicable to groups of infants at-risk, including increasing the training period and following up the effects of training more frequently. While we know much about the early development of vision and auditory processing, comparatively little research has been done on tactile perception. This is important to study, as it is a primary mode of interaction with parents. In Part C we will use several imaging methods to develop new paradigms for tracking the neurodevelopment of basic tactile perception, social touch, and the emerging multi-sensory perception of the infant's own body.

We envisage several groups of non-academic beneficiaries for our research; (i) the families of children at-risk for developmental disorders, (ii) parents with a general interest in child development, (iii) policy-makers within government interested in investment in early child development and intervention, (iv) professionals, managers and commissioners in NHS, responsible for the care of individuals with autism/ADHD and their families, and (v) commercial enterprises interested in new software and hardware development to aid attention and learning early in life, and in the development of treatments for autism and ADHD.

Autism and ADHD are lifelong neurodevelopmental disorders that in many cases bring considerable burden and cost to the individual, their family and society. About 1% of children are on the autism spectrum and the prevalence for ADHD is estimated at 5%. Recent estimates of the UK annual societal cost of ASD exceed £27 billion. Total ADHD annual cost in the US has been put at between $143 and $266 billion. Recent financial analyses show that even high cost early intervention has the potential for large lifetime cost savings. The study of at-risk infant siblings remains an important and powerful approach in uncovering the early signs of autism and ADHD through identifying neuropsychological and neurophysiological hallmarks in infancy. This knowledge is important for early detection, improving diagnostic strategies, and providing the basis for early interventions aimed at improving the quality of life of those who are affected.

In Part B of the grant we will develop work on infant-directed early intervention through the use of gaze-contingent eye-tracking. Although the appeal of brain enhancement entertainment products is widespread (e.g. US consumers are reported to have spent $1.6 billion on technology based learning products) the market is currently served by very few (if any) initiatives that are scientifically tested. Furthermore there is a gap in the market for entertaining interactive computerised products that are aimed solely at cognitive enhancement of babies. According to the national statistics for live births, in the UK the total potential market is ~765,000 per year in England, Wales and Scotland. The first year of life is a critical period of rapid neural and cognitive development which lays the foundation for cognitive abilities and educational performance in later life. Targeted cognitive training during infancy has the potential to capitalise on neural plasticity and have the maximum impact on cognitive function such as attentional control.

We will continue to seek opportunities to influence government policy in the area of child development. These opportunities include (1) invitations to attend formal and informal events at the Houses of Parliament, some through our charity collaborators (project partner, Autistica), (2) invitations to contribute to specific policy groups (e.g. Johnson was consultant on the Byron Report), and (3) opportunities for secondments for team members (e.g. research fellow Gliga had a 3-month secondment to the Houses of Parliament).