On 21st September, over 100 researchers, along with parents taking part in the British Autism Study of Infant Siblings (BASIS), attended the BASIS annual scientific conference, kindly sponsored by The Waterloo Foundation. This year, our special topic was motor development in neurodevelopmental disorders. There were eleven excellent presentations, including two keynotes from Prof. Jana Iverson and Prof. Angela Roberts, along with enthusiastic audience participation during time for questions!
You may not immediately think of motor issues when you think of autism or ADHD, but research increasingly suggests differences in motor development might have cascading effects contributing to the key areas of difficulty found in these conditions. One such area is language, and in one talk, Sinead Rocha described the BabyRhythm project. The BabyRhythm team have found not only that typically-developing infants improve with age in how they keep time with a beat, but, perhaps most intriguingly, that their performance is associated with vocabulary scores. If infants later diagnosed with autism have poorer motor control could this also explain differences in language development? This might be possible, as from Clare Press we learnt that using motion sensors, she and her team have found autistic adults move more jerkily. Further work has suggested individuals use their own movement to assess others’ emotions, and this appears to lead to autistic individuals experiencing more difficulty in assessing the emotions of both neurotypical and other autistic individuals. However, in early development, contrary to expectation, more jerky movement at 10 months was related to less social atypicality at 14 months. Clare and her team are currently hypothesising that high jerkiness in infancy, with its higher variability in movement, may promote greater learning and hence a feedback loop to smoother actions later. Differences in motor development are also of interest in understanding ADHD, since motor delays are now being investigated as a possible first sign of this condition. From home videos, Argyro Athanasiadou confirmed previous work suggesting delays in gross motor function very early in development (0-5 months) are more common in infants who later develop ADHD. A language delay between 9-14 months was also found in the ADHD group; perhaps another link between early motor development and later language?
Threads were brought together in Prof. Jana Iverson’s keynote which closed the morning session. She outlined the extensive work done at her lab with the younger siblings of children with autism, who have a greater likelihood of being diagnosed with autism themselves. They found younger siblings experience more early motor delays, such as later sitting or walking, compared to infants without familial history of autism, with siblings later diagnosed showing the greatest delay. They also found infants’ motor abilities can impact the language to which they are exposed; when infants manipulate objects in a more active and sophisticated manner, caregivers talk less but use more labels and richer language. This phenomenon highlights a perhaps unexpected pathway to how motor development might impact an infant’s environment, with potentially cascading effects on later language.
Autism and ADHD
In the afternoon, we continued to learn about motor development in ADHD as well as ASD. There is significant co-morbidity between autism and ADHD and so investigating the early emergence and differences and similarities between these conditions has been the research target of the latest cohort study of BASIS, known as STARRS (Study of Autism and ADHD Risk in Siblings). This programme adds a new group of infant participants, those who have a first degree relative, parent or sibling, with ADHD. We heard from three contributors. Firstly, Jannath Begum Ali talked about her work suggesting that 10 months infants who have a family member with autism or ADHD show significantly fewer arm reaches across the mid-line. She is exploring whether these findings are symptomatic of delayed multi-sensory integration, possibly linked to atypical inter-hemispheric connections within the brain. So far, we had learnt about how infants act on the world whereas input, especially tactile input, has implications for how or when we move. Elena Piccardi outlined her work on tactile sensory input inspired by previous work highlighting the tactile hyper/hyposensitivity reported by children with ASD or ADHD. Elena found that although all infants responded with similar movement to repeated touching, neural signatures showed infants with familial risk for ASD or ADHD showed less ability to suppress responses to the second (expected) stimulus in the pair. Those who remained more responsive had fewer sensory seeking behaviours, as reported by parents. This may reflect an adaptive response from these infants, which could prove beneficial in the long term. Lastly, Amy Goodwin has been investigating early attention and activity, specifically for infants at risk for ADHD. However, perhaps surprisingly, at 10 months she found no differences between this group and infants without familial risk for ADHD across a range of tasks. Her focus now moves to other age groups to see if differences are present at any age. Perhaps in common with Argyro, she will find more differences at younger ages?
Worldwide research and other populations
Most research on developmental disorders takes place in high resource countries. Two of the talks in this meeting presented work which aims to develop technology that could be accessible in a variety of settings. Indu Dubey presented the START project which has developed tablet-based assessments to screen children for social, motor and attention difficulties, in low resource settings. This project is currently being trialled in India. Bosiljka Milosavljevic described the BRIGHT (Brain Imaging for Global Health) study which is comparing the development of infants in the Gambia and the UK to explore the potential impact of malnutrition. Initial findings suggest delays begin to emerge in Gambian infants by 8 months and by 12-14 months they achieve lower cognitive scores compared to infants in the UK. However, in motor skills Gambian infants are relatively advanced. Sue Fletcher-Watson talked about the Theirworld Edinburgh Birth Cohort, a study of infants born early. In this cohort, 50% have cognitive and behavioural difficulties and autism is four times more prevalent than in term born infants without familial risk. Sue and her team have linked social and economic disadvantage with increased language issues and are exploring possible links to differences in maternal communication. Like infants later diagnosed with autism, infants born early also show less preference for social over non-social scenes than those born at term. Is this difference maintained and does it predict later emergence of autism traits?
What can marmosets tell us?
After a well-earned coffee break, we returned for our second keynote talk from Prof. Angela Roberts in which she described her work with marmosets. So how does this relate to developmental disorders? Angela made a compelling case for marmosets making a good model for humans: they are highly social; their cortex size is closer to humans than many animal models; and their prefrontal cortex, key in cognition and emotion, and which may act differently in those with autism or ADHD, has a similar structure to humans. One area very relevant to autism is anxiety, and again marmosets make an excellent human model as they vary widely in social approach and anxiety, showing very individual behaviours when strangers approach their cage. Angela and her team have linked different areas of the pre-frontal cortex to distinct underlying mechanisms leading to anxiety. Understanding the varied origins and mechanisms underlying anxiety in this way has great potential to help treat it more effectively.
Finally, the day ended with a lively debate around progress on interventions, during which a trio of professors, Tony Charman, Jana Iverson and Sarah-Jane Webb fielded audience questions. It was agreed that the most promising interventions for autism rely on parental training and delivery; main carers are with the child for the longest time and have the close relationship needed to make the most impact. However, there is still much to learn about when and how interventions should be applied. Also, emphasis on parents/carers could pile further pressure into a situation which is already very stressful. So, further questions arise, how soon and how best to support parents/carers to become the ‘super-communicators’ they need to be?
Theirworld Edinburgh Birth Cohort http://www.tebc.ed.ac.uk
The Waterloo Foundation http://waterloofoundation.org.uk/
Sinead Rocha, University of Cambridge
Clare Press, Birkbeck, University of London
Argyro Athanasiadou, Radboud University
Indu Dubey, University of Reading
Jana Iverson, University of Pittsburgh
Jannath Begum Ali, Birkbeck, University of London
Elena Piccardi, Birkbeck, University of London
Amy Goodwin, King’s College, University of London
Bosiljka Milosavljevic, Birkbeck, University of London
Sue Fletcher-Watson, University of Edinburgh
Angela Roberts, University of Cambridge
Tony Charman, King's College, University of London
Sarah-Jane Webb, University of Washington