A UAB-led study of an intensive reading intervention among high-functioning children with autism spectrum disorders is now enrolling participants.Is it too late? That’s a concern shared by many parents of children with autism spectrum disorder. Rajesh Kana, Ph.D., has heard it again and again.
“Some parents think, if their child is 8 or 10 years old when diagnosed, that the game is lost,” said Kana, an adjunct associate professor of psychology in the UAB College of Arts and Sciences and a professor in the Department of Psychology at the University of Alabama. “What I stress constantly is the importance of intervention, and the magic of intervention, on the brain and its connections.”
Rewiring the brain to read
Three years ago, Kana’s Cognition, Brain and Autism Lab at UAB (now at the University of Alabama) was the first in the world to use brain imaging (done using the MRI scanner at the Civitan International Neuroimaging Laboratory at UAB's Civitan International Research Center) to study what happens to children with ASD when they take part in an intensive reading intervention. That study, which found that the intervention improved both reading and brain activity in a study group of 13 children, made headlines around the world. It also attracted the attention of the NIH, which funded Kana to expand his research.
Now, investigators at UAB and UA are collaborating to recruit more than 200 children ages 7–13 with ASD and their parents for a new intervention study. It’s one of two ongoing studies between the two institutions delving into the “magic” of intervention to rewire the autistic brain. The other is investigating an intensive social skills intervention that aims to help teens and young adults with ASD make friends, learn to date and succeed in the workplace. (See below.)
Training to strengths
Compared with typically developing children, children with ASD often have decreased connectivity between certain areas of the brain’s “reading network” — related regions that work together to turn words on a page into ideas in the mind. “Some children with autism can read well, but have trouble understanding what they are reading,” Kana said. However, “many people with autism are relatively better at visual/spatial processing.”
| “Some parents think, if their child is 8 or 10 years old when diagnosed, that the game is lost. What I stress constantly is the importance of intervention, and the magic of intervention, on the brain and its connections.” — Rajesh Kana, Ph.D. |
That insight lies behind the intervention Kana has studied, Visualizing and Verbalizing for Language Comprehension and Thinking, developed by the Lindamood-Bell Learning Processes. The company operates learning centers or learning camps in more than 150 locations across the United States. The company’s reading program teaches children to form conceptual images when they read and hear language, building on their strengths “to ultimately improve language comprehension,” Kana said. The intervention is certainly intense: it requires four hours a day, five days a week, for a total of 200 hours of face-to-face instruction.
That amount of personal instruction comes at a higher price. But is it worth it? Parents debate that question regularly online. Kana’s 2015 study at UAB, published in the journal Autism Research, was the first to demonstrate what was happening inside participants’ brains.
What happened?
The study recruited 13 high-functioning children with ASD — the average age was 10.9 years — who could read aloud well but had poor comprehension. The children came from Birmingham, Philadelphia, Houston, Chicago, Boston and as far away as Hawaii. They participated in Lindamood-Bell instruction in their hometowns at no cost, then came to UAB with their parents for two days of tests before and after the program. “The intervention is expensive,” Kana said. “They got it for free.”
Functional magnetic resonance imaging (fMRI) scans in Kana’s lab showed increased activation of the brain regions involved in language and visual/spatial processing in the left hemisphere. The researchers also found that the amount of increased brain activation and functional connectivity of two important language areas — the left middle temporal gyrus and the left inferior frontal gyrus — correlated with the amount of improvement in reading comprehension. The control groups of matched typically developing children and children with ASD — who did not receive any reading intervention during the study period — showed no significant changes in connectivity in their brains or in reading comprehension.
“The ASD brain processing after intervention looks richer, with visual, semantic and motor coding that is reflected by more active visual activity and involvement of the motor areas,” Kana said in describing the study findings.
How does it work?
The new study is recruiting children ages 7–13 with high-functioning ASD, children with reading comprehension difficulties and typically developing children to take part in the trial, which will take place in Birmingham at UAB. Participants must be native English speakers and right-handed; they cannot be claustrophobic or have braces. (To help the children in the original study adjust to the large, unfamiliar fMRI machine, the UAB researchers let them lie in it beforehand and hear recordings of the sounds the machine would make. On scanning days, the machine was decorated with colorful stickers to look like a toy and the child was tucked in with a Mickey Mouse blanket.)
| See more studies of autism at UAB on our clinical trials page. |
To learn more, contact Maria Martino in the Kana lab at 205-202–0616 or email mmartino@uab.edu.
Learning the rules for social intervention
One of Kana’s doctoral students is working on a dissertation related to the Program for the Education and Enrichment of Relational Skills (PEERS), which “trains individuals to improve their social functioning,” Kana said. “Young adults with ASD go through a lot of struggle in their early teen years. PEERS is a very structured program in a group setting, where participants talk about rules of conversation and other social interactions and apply those to new situations.”
The 14-week, parent-assisted program is aimed at motivated teens with ASD in middle and high school. It teaches them formal rules for a wide variety of social situations, from making friends to asking someone out on a date to dealing with co-workers at a job. UAB has a PEERS program in the Civitan-Sparks Clinics, led by Sarah O’Kelley, Ph.D., director of the Autism Spectrum Disorders Clinic. “We’re interested in whether this intervention is changing the social brain,” Kana said. (Learn more about PEERS and the study by calling 205-934-1046 or sending an email to peers@uab.edu.)
To test that question, Kana’s lab has developed a video task for use in the fMRI. Participants will watch short clips of appropriate and inappropriate social interaction during imaging before and after the PEERS intervention, he said. “We are looking to see what changes.”
