It may be possible to predict whether an infant will go on to develop autism, researchers

say.

Overgrowth in brain volume during the first year of life forecasts whether a child at
high risk of developing autism spectrum disorder is likely to receive a diagnosis at
age 2, according to a small study published Wednesday in the journal Nature.
This new diagnostic method requires MRI brain scans to look for the features of
autism, a developmental disability with behavioral symptoms that usually become
obvious between ages 2 and 4.
Common symptoms of autism include difficulty with communication and repetitive
behaviors. In the United States, about one in 68 children has been identified with
autism spectrum disorder, according to the Centers forgene Disease Control and
Prevention. Yet, for infants who have an autistic sibling, the risk of developing the
disorder may be as high as one in five. The risk is only one in 100 for infants without
an affected sibling.
Measuring the brain
Hazlett and her colleagues studied two groups of infants: a high-risk group of 106 infants
who had an older sibling with autism and a low-risk group of 42 infants with no immediate
family history of autism.
The research team used MRI technology to measure brain development for each infant
at set time points between 6 months and 24 months of age. Specifically, the research
team measured overall volume, surface area and thickness of the cerebral cortex in
particular regions.
According to Dr. Joseph Piven, senior author of the study and a professor of psychiatry
at the University of North Carolina at Chapel Hill, evidence from previous studies has
showed that, compared with typically developing children, the brain volume of autistic
children increased around age 2. These findings suggest "that brain overgrowth was
happening before 2," Piven said.
At 24 months, the kids who developed autism had significantly bigger brains, according
to Piven, "which means that sometime between 12 and 24 months, they were
overgrowing the normal size of the brain."
"What we found was that cortical thickness didn't differ between the groups (of infants),
but surface area increased at a higher rate than normal between 6 and 12 months of
age" in the infants later diagnosed with autism, Piven said, referring to this as "hyper-
expansion of cortical surface area."
Piven explained that even in typically developing babies, surface area is increasing
rapidly at this stage of life, "but in the kids that had autism, it was even more
accentuated."

"The expansion of cortical surface area is thought to be due to increased proliferation of

something called neural progenitor cells. Those are immature pre-neurons," Piven said.
Another piece of this puzzle relates to behavior. Looking at the emergence of autistic
behaviors, only the social symptoms of autism -- not the ritualistic repetitive behaviors -
- related to increased brain growth rate, according to Piven.
Summing up the findings, Piven said a cascade of brain changes across the first two
years of life "result in the emergence of autism at the end of the second year."

Early clues to other conditions

According to Mathew T. Pletcher, vice president and head of genomic discovery at the
advocacy group Autism Speaks, the new study made great use of modern technology
as well as a recognized phenomenon of autism: Children with a sibling diagnosed with
autism are at much greater risk of developing the disorder.
Despite the important findings, the study "is still relatively small," Pletcher said. "The
total study involved 148 infants. Out of that, only 15 of them ended up eventually being
diagnosed with autism. At this point, it's hard to extrapolate whether these findings are
going to apply to a much larger population."
"One of the things that has been shown over and over again is, the earlier you can begin
an intervention," such as behavioral therapy for children with autism, "the greater the
chance of limiting some of the characteristics of autism," Pletcher said. "That's why
there's a lot of excitement around this study."
ASD: Early intervention may erase signs of autism
If it's possible to detect changes in brain development as early as 6 months to 12 months
of age, you could conceivably begin working with an infant very early on and "try to help
nurture their development in a way that's going to be most beneficial."
"Right now, we're at the point where generally, the age of diagnosis is 4, there's
indications that say we should be able to diagnose kids at age 2, and now this is saying
it could be even earlier than that," Pletcher said.
However, he noted that using expensive MRI technology to screen every baby for autism
would probably be unrealistic. But the method might benefit at-risk populations, such as
the younger siblings of those diagnosed with autism.
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