WA Research Scoop on AICES: the Australian Infant Communication and Engagement Study

The AICES clinical trial was the largest study of its kind and it sought to identify ways to help infants who were at risk of developing autism.

The randomised clinical trial took place in Perth and Melbourne to help improve the lives of children with an increased likelihood of developing Autism Spectrum Disorder (ASD). The project worked with ‘high-likelihood’ ASD infants between the ages of 9 and 14 months and their parents.

The main goal of the study was to identify ways to help improve the developmental outcomes of these children before they were diagnosed with ASD. Currently, there are no interventions available for infants under 14 months of age who are at increased likelihood of developing ASD.

The study was led by Prof Andrew Whitehouse, from the Telethon Kids Institute and Director of CliniKids and brought together a multi-institutional collaboration involving partners from Child and Adolescent Health Service – Community Health (Western Australia), La Trobe University and the University of Manchester.

About ASD
Autism Spectrum Disorder (ASD) is a lifelong developmental disorder that primarily affects communication and behavioural traits. It is usually diagnosed in children after their first two years of life, but the condition can affect a person throughout their childhood, adolescence, and adult life.

ASD is an umbrella term used to describe a range of early-appearing social communication problems and repetitive sensory–motor behaviours. ASD has a strong genetic component, but may also be influenced by as yet to be fully characterised environmental factors.

According to the Australian Bureau of Statistics (ABS), more than 205,000 Australians were diagnosed with autism in 2018, a 25.1% increase from 2015, with males being 3.5 times more likely than females to have this condition. Children between aged between 5 and 14 years bear the largest burden of this disease, with a prevalence of 7.1%, more than half of the overall prevalence of this condition across all age groups. Autistic individuals have also been estimated to have a two-fold higher mortality rate, and a seven-fold higher rate of suicide, compared to the general population.

Children and young adults with autism, aged between 5 to 20 years, also face multiple challenges, particularly with their education. According to data from the ABS, about 92% had some type of educational restriction, and about 41% of children in this group attended a special class or school. As adults, people with ASD face difficulties finding employment, with about 34% being unemployed, compared to 4.6% of the general population.

About the study
The clinical trial recruited 103 infants who showed early behavioural signs of ASD, such as social and/or communication difficulties, and were at increased likelihood of being diagnosed with ASD later in childhood. “Children were enrolled in the study if they showed ‘atypical’ behaviour on at least three of the following: spontaneous eye contact, pointing to show interest, social gestures, imitation of simple gestures (e.g., waving, clapping), and response to name,” Prof Whitehouse told Medical Forum.

“It is currently not possible to determine definitively which infants will go on to receive a diagnosis of autism in later childhood. Therefore, any interventions that we develop and apply at such an early age must have no side-effects, and provide benefits to all children and families,” he added.

The intervention tested in this study was iBASIS-VIPP, a parent-mediated intervention in which therapists use video-feedback to help parents adapt to their infants’ interactive styles and promote optimal social and communicative development. The intervention was delivered by child health nurses from Child and Adolescent Health Service – Community Health.

The study tested whether the use of the iBASIS-VIPP helped improve the developmental outcomes of infants. Half of the participant families received this protocol, while the other half, who served as control, used the standard treatment.

The iBASIS-VIPP protocol aimed to help parents understand the behaviour of their baby and learn how to help them improve their development. “The intervention used in the AICES study is helping parents understand the unique abilities of their babies, and teaching strategies to modify their own interaction style to enrich the social environment around the baby. That is hugely beneficial for any parent of a young child!” Prof Whitehouse said.

The AICES study is now complete, with results expected to be published soon.