As our understanding of autism continues to evolve, so too does our approach to helping young autistic children and their families through early intervention.
By introducing the right kind of support within the first years of life, particularly when implemented within the child’s home environment, early intervention can significantly influence developmental pathways, fostering improved communication, social engagement, and overall emotional and mental well-being.
However, despite a strong consensus on the importance of timely support for families, providing comprehensive early intervention services remains a significant challenge. Although advances in current research offer promising new solutions, translating these into practical and accessible everyday care for autistic children is an ongoing and complex endeavour.
Recognising the Early Signs: A Case for Urgent Action
Consider Joey, a 14-month-old who exhibits some of the early signs of autism. While Joey plays quietly with a crinkly sensory book, he remains unresponsive to his mother’s repeated attempts to engage with him. She calls his name, kneels down to face him, smiles, and tries to establish eye contact with him. Instead, his gaze is drawn to the beads of her necklace and lingers on the light reflecting off the rim of her glasses—the perception of such intriguing details captivates his senses far more than her invitation for play and social interaction.
Parents, like Joey’s, often sense very early on that something is different about their child. Early signs such as a lack of eye contact, unusual passivity, or an intense focus on objects or sensory impressions can be indicators of autism, even within the first year of life.
Many families reach out to health professionals, voice their concerns, and seek help at this stage, which is precisely the right course of action. This is the ideal time to seize the window of opportunity when neuroplasticity is at its peak, and Joey’s brain pathways are just beginning to form and solidify. Intervening proactively at this critical stage of the child’s development could help synchronise dyadic communications and foster more reciprocal and mutually joyful interactions between Joey and his parents, leading to much improved outcomes.
Sadly, in the UK, families still continue to wait for many years. The average age of diagnosis remains around five years—an unfortunate delay that often leaves families without support during this crucial period. During the prolonged waiting time, the perceived lack of interest from an autistic child can deeply unsettle parents, who may feel emotionally rejected and uncertain about how to help and connect with their child.
Beyond Observable Behaviours: Embracing the Neurodiversity Paradigm
Since the 1960s, the diagnosis of autism has been predominantly based on an observable behavioural phenotype—an approach that, while providing a consistent framework for decades of clinical diagnosis, has often overlooked the internal experiences of autistic individuals.
As a consequence, behaviours such as “stimming” (repetitive actions like hand-flapping or rocking) were often targeted in therapeutic efforts to lessen the prevalence of autism.
In recent years, however, autistic advocates have emphasised that such behaviours are vital and adaptive self-regulatory mechanisms for an autistic person, essential for managing sensory overload and reducing stress. This has prompted an important shift in our understanding of what it means to be autistic. Autistic people sharing their inner experiences with the world have brought about significant changes in how autism is perceived and consequently “treated.”
Rather than viewing autism as a disorder to be “corrected,” there is now a growing appreciation for the unique traits and strengths that characterise autistic individuals—traits that thrive best, however, in an environment tailored to their specific sensory and social-emotional needs.
According to Jonathan Green, Child and Adolescent Psychiatrist for Royal Manchester Children’s Hospital and Professor of Child and Adolescent Psychiatry at The University of Manchester, it is likely that a child’s sense of “difference” is rooted more in their sensory perception than in interpersonal interaction. He asserts that autistic children are not inherently disinterested in their caregivers; rather, they are more intensely focused on processing sensory stimuli than on engaging with the social world—as we observe with Joey in the beginning.
Green (2023) takes it even one step further by suggesting that certain behaviours we observe in autistic individuals—such as lack of eye contact, repetitive actions, and reduced communication—might actually be secondary responses to environmental factors rather than core aspects of autism itself. These behaviours might develop as coping mechanisms or responses to external stressors in the child’s environment, helping to manage sensory overload or social challenges.
Considering all this, it becomes clear that our central mission—achieving shared attention with the autistic child and establishing reciprocal communication—might indeed be quite a complex endeavour that requires careful thought and deliberation. Fittingly, there are some promising studies and clinical developments taking place at The University of Manchester.
Emerging Research in Early Intervention: The PACT and iBASIS Programs
Jonathan Green’s first publication on the PACT (Pre-school Autism Communication Trial) study appeared in 2010 in The Lancet, titled “Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial.” This ground-breaking study, one of the largest randomised controlled trials for autism intervention, focused on parent-mediated communication and laid the foundation for the development of parent-led autism therapies.
Green’s research underscores the transformative potential of early intervention methods that empower parents through video-based interaction training. Programmes like PACT and the later iBASIS are at the forefront of innovation in the field.
The PACT study was specifically designed to enhance and synchronise early parent-child communication. The method helps parents adjust their communication style to better align with their autistic child’s specific needs, focusing on increasing shared attention through eye-gaze, sharing, and turn-taking. Parents in the programme are introduced to strategies that facilitate their child’s communication and participation, such as action routines, repeated verbal scripts, and the use of pauses and elaborations.
Recognising that autistic children may often respond to verbal cues with some delay, parents learn to wait for their child to initiate a response, ultimately leading to an increase in contingent and attuned communicative exchanges.
The iBASIS programme (Intervention within the British Autism Study of Infant Siblings) specifically targets infant siblings of children already diagnosed with autism. Grounded in recent research, iBASIS explores the potential of early intervention during infancy—a critical period when brain and genetic development may be particularly responsive to environmental influences. It is the first experimental trial of a targeted intervention at the end of the first year of life, aiming to positively influence early development, brain function, and even genetic expression.
By focusing exclusively on empowering parents, these innovative approaches shift the traditional paradigm of early intervention and therapy. Instead of working directly with the child, trained clinicians equip parents with the tools and understanding needed to optimally support their child’s development in everyday life, ultimately fostering a home environment continuously attuned to the child’s distinct perception and communication needs.
The research outcomes indicate that when parents learn to respond to their child’s cues and initiatives in an autism-specific, fine-tuned, and synchronised manner early on in development, the child, in turn, initiates spontaneous social interactions much more frequently. Over time, this also leads to greater engagement in social activities outside the immediate family.
Interestingly, follow-up studies by Jonathan Green have shown that repetitive and stereotypical behaviours, such as stimming, decrease naturally with this type of intervention, without the need to directly address or specifically target those behaviours. Consequently, Green emphasises that early intervention should not aim to change or ‘normalise autistic behaviour’, as was often attempted in the past. Instead, the goal is to optimise the environment around the child, allowing them to thrive optimally with their individual neurological predisposition.
A Glimpse into a Brighter Future for Autistic Children
Overall, the effectiveness of parent-mediated strategies has become increasingly evident through this specific area of clinical research. We now know with certainty that as parents fine-tune their engagement and communication patterns during the early years of their child’s life, improvements in social interaction and communication naturally follow.
Some professionals and service providers are already incorporating this knowledge and a progressive understanding of autism into their clinical practice. For example, the MIFNE Centre in Israel and the FIAS Therapy Centre at the University Psychiatric Clinics in Switzerland have been running intensive early intervention programs for young autistic children that involve the entire family and focus on implementing parent-mediated strategies for many years.
However, there is an acute need for additional early support services to ensure that children and their parents receive the help they need when it matters most. To take full advantage of the critical neurodevelopmental window in early childhood and alleviate some of the immense stress caused by prolonged uncertainty during extensive waiting times, it is essential to provide more timely interventions and immediate support.
Given this urgency, we must rethink our approach to early intervention for children showing early signs of autism. Currently, many children must wait several years for an official diagnosis, which then serves as the gateway to therapies and additional support services.
However, it would be far more beneficial to respond to parents’ initial concerns rather than waiting for behavioural issues to become more pronounced and deeply set at a later stage of development. A very recent study by Cleary et al. (2024), published in the Journal of Autism and Developmental Disorders, underscores the reliability of parental observations as early indicators of autism. The study found that parents’ concerns, even within the first year of life, are strongly linked to later autism diagnoses, irrespective of the child’s birth order or whether an older sibling has been diagnosed. This reinforces the importance of taking parents’ concerns seriously, as they are often accurate and can guide earlier, more effective interventions.
Consequently, at Transforming Autism, we are committed to adopting a forward-thinking and progressive stance on early intervention that responds to the critical needs of families who are concerned about their child’s development and seek our help. In the future, by integrating elements of video intervention therapy with remote coaching methods—such as using audio earpieces and a direct video link to the family home—we aim to provide highly specialised yet practical, accessible, and, above all, timely support to families. These exciting new developments have the potential to fill many of the existing gaps in care and provide support while avoiding the long delays that have become all too common today.
By supporting Transforming Autism, you help pioneer innovative online interventions that reach families irrespective of their geographical location and support them in establishing home environments where autistic children can thrive best and develop their diverse strengths.
As we advance with complex digital technology and telehealth solutions, our central mission and commitment remain clear and simple: to ensure every autistic child has the opportunity to lead a connected, meaningful, and fulfilling life.
With today’s knowledge, 14-month-old Joey has a strong chance of maintaining mental and emotional well-being while embracing his unique and individual developmental path together with his family, and actively contributing to an enriched society—an outcome still beyond reach for many autistic individuals today.
At Transforming Autism, we remain dedicated to ensuring this possibility eventually becomes a reality for all.
Nicolas Krueckeberg
Senior Clinical Advisor
Transforming Autism
