Professor Emily Jones Hi, I’m Professor Emily Jones, from the Centre for Brain and Cognitive Development at Birkbeck, University of London. And today, I’m going to be talking about some of the work that we and others have been doing to understand developmental pathways in early autism. And just before I begin, the work that I’ll talk about is the work of a whole team of people, so I just want to acknowledge that these kinds of studies take a huge amount of effort, and lots of people have been engaged with us, and the work that we do is also highly collaborative. So, we work with networks of different universities and different organisations to try to understand developmental trajectories in children who have autism. And so, what I’m going to do is start by talking a little bit about what neurodevelopmental conditions like autism are, for anybody who’s unfamiliar, and then, I’ll talk a bit about the approach that we take to understanding autism, which is what we call a neuroconstructivist approach. And I’ll talk a bit about what that means, and I’ll talk about how that intersects with neurodiversity, which is a really important concept, that again, I’ll explain in more detail, but that recognises that we all differ from each other in a number of different ways. And rather than see differences as deficits, or as things that are wrong with children, we should be embracing the value that the individual children can bring to the world. So, I’ll talk a bit about how that interfaces with our understanding of autism and other neurodevelopmental conditions. And I’ll talk a little bit about what we have been trying to do, and others, to understand developmental trajectories in autism, both over the longer term, so what might differ from infancy through to childhood, but also in the short-term, so the moment to moment changes in what a child’s doing, what they’re paying attention to, and what their brain’s doing, that might contribute to those longer term outcomes. And then at the end, I’ll talk a bit about the implications for this kind of research, for children and for their families. So, just to start, most of what I’ll talk about focuses on autism, but we also do work on co-occurring conditions, like ADHD. And we know that autism is relatively common, so, you know, affects up to one to 2% of people across the world, ADHD a little bit more common. And both of these conditions come with a whole range of other associated difficulties for some people. So, some autistic people have sleep/wake problems, may have depression or anxiety, may have things like impulse control or conduct differences. So, there’s a whole range of differences that can be associated with neurodevelopmental conditions like autism and ADHD. So, when we’re thinking about what might happen in early development that underpins trajectories, we need to think now just about the definitions of autism and ADHD themselves, but also, what they might come with. And when we’re thinking about autism, often, the way it’s diagnosed is by the presence of difficulties with social interaction and communication, but also, increasingly, sensory differences. So, differences in the way a child might perceive the world around them and how they might react to common sensations or sights or sounds. And ADHD is diagnosed by children who may struggle to pay attention, who may have higher activity levels than normal, who might struggle to concentrate in school. And we know if we look at the genetics of both autism and ADHD, that a whole range of different genes are involved in both of those conditions. So, we know that both of them run in families. So, if you have a older sibling with autism, we know you’re more likely to develop autism yourself, or if you have a parent with autism, and the same is true for ADHD, and that tells us that there is some degree of genetic involvement. So, some of the genes that children inherit from their parents can contribute to the development of autistic traits and also, ADHD. But we know when we look at the genes associated with autism that they’re involved in a whole range of different processes in the brain. So, there’s no-one specific gene connected to autism. There’s a whole number of genes that, together, might influence whether a child develops some of those traits. And those genes might be involved in how neuronal cells communicate with each other, how the brain grows, how genes change their expression over time. So, a whole range of different processes connected to early brain development. The traditional way of understanding, you know, how those genetic changes might lead to changes in the way that a child behaves or interacts, is to look at kids or adults who have a diagnosis of autism. And the assumption is that these genetic changes change something in the brain, and they relate, at the same time, to differences in the way the child might behave or experience the environment. We actually know, of course, that genes are there right from the beginning. So, genes are present from conception and are shaping how the baby’s brain is growing and developing right from pregnancy. So, we know that, actually, in infants who are developing autism, we’re going to have genetic differences very early on, they’re going to influence how the brain is grown from the beginning, and how different areas of the brain connect with each other. And right from the beginning, that might be influencing the child’s behaviour, but also, the way they experience the world. For example, if there are sensory differences in autism, they might emerge very early, that might influence what a child enjoys doing, or what they pay attention to. And we know, in turn, those differences in behaviour and experience can influence how the brain is developing. So, a child who pays a lot of attention to particular sensory stimuli, their brain might develop in a certain way that’s different from a child who doesn’t like a particular sensation, for example, because their experiences are different. So, if we want to understand autism, and where autism comes from and how to best support autistic children to grow and flourish, we need to understand these, sort of, cascades that happen over developmental time, through infancy and early childhood. And one way to think about it is this, kind of, almost a surface where you’ve got a lot of different genetics, you’ve got a lot of different environmental factors, and they set up this, kind of, landscape down which development progresses. And for some children, their particular constellation of genetic background, their environment, is going to mean their development progresses in one road – one route. Another child might progress down a different developmental route, and our job is to try to figure out how we can support children in whatever path they’re going down. And in some of the research that we’re doing, we’re trying to understand what are the markers of those different paths, what is it that might mean a child is starting to go down a different route, and what can we do to support them? And so, the study designs that we and lots of others work with to try to ask this question are called “prospective studies.” And so, if we want to understand what happens before autism emerges, or before autism is diagnosed, we have to identify children before they have an autism diagnosis. So, we can’t go to work with children in a clinic. We need to find children before they get to that point. And so, we can leverage the fact that autism runs in families, so that we know that infants who have a older sibling or a parent with autism are more likely to develop autism themselves. And so, we can follow groups of those children from pregnancy or from birth, through developmental time, until they get to two or three or seven, where we can determine, you know, which children meet criteria for autism, how are they doing at school? What are their ADHD or anxiety traits? And then we can look back at the data we collected earlier in development, and look at what might precede those later developmental differences. And this kind of design can help us identify what’s different or what’s changing in the early brain development of infants with a later diagnosis of autism. And so, the kinds of studies that we do, we collect a lot of different measures to try to understand that. So, we collect some measures of behaviour, where we observe babies playing with their parents, or on their own. We can use what’s called eye tracking, where we shine a weak light into baby’s eye, to see what they’re interested in looking at, ‘cause that controls what they take in. We can measure their brain development with EEG, which is a network of sensors that measures the co-ordinated activity of groups of neurons, or with NIRS here, which uses very weak rays of light to measure patterns of blood flow in the cortex, which can tell us about which regions are active, and we can measure genetics and other things like that. And by putting all that information together, we’re trying to understand those early developmental trajectories. So, to turn to neurodiversity, and how that might interface with the research that we do, we try to take a neurodiversity affirmative approach to understanding early autism. And the core of the neurodiversity concept is that there’s actually a spectrum of human neurocognitive functioning. So, different people’s brains work in different ways, and that’s part of the natural variation that we have in our species, that helps us be really successful in adapting to different environments. So, the idea here is that we don’t see autism as a disease or as a deficit, we see it as a difference, and some people find it helpful to think about that as a difference in the way that autistic people’s brains are wired, for example. So, as I was saying before, you know, if we’re thinking about these cascading effects of – on brain development, where some children’s brains are just developing slightly differently, in some children that’s going to lead to them being autistic. And we know that all forms of diversity enrich society, they bring collective advantages, and so, seeing autism through this lens can be really powerful. And it’s important to recognise that this doesn’t mean that autistic people don’t have challenges, or that we should not be paying attention to autistic people where they have significant needs and significant medical or support needs, and so we can think about this through what’s called the “social relational model.” So, that’s both that, you know, people will have difficulties that can be a barrier to thriving, but nonetheless, sometimes those difficulties or those disabilities can be coming from society more broadly. So, things like stigma that affect autistic people can create this ability in themselves, and so, if you can remove the stigma, you can support someone’s ability to live and to thrive. And so, when we’re thinking about our studies of early autism, we really try to make sure that we’re not thinking about it in a way that’s contributing to societal stigma. You know, in fact, we’re thinking more about how these differences emerge over time, rather than trying to think about, you know, where deficits are coming from, or what’s wrong in children with later autism. We’re just looking at what’s different. When we’re thinking about these cascading patterns, kind of, under that approach, what we’re really interested, then, is what is adaptive for the child? So, what kinds of changes in behaviour might actually be changes that the child’s making that suit their particular brain, that are going to help them thrive in the long-term? And what changes might be maladaptive? So, it might be things that the child’s doing, perhaps to cope with a really challenging environment, that aren’t necessarily good for them in the long-term, but that we could support by, for example, making the environment easier for them. So, if you imagine a child who has sensory sensitivities, it might be that they’re withdrawing from particular events that they just find overwhelming, and that that has negative side effects for them, and – but by making those events less overwhelming, we could help them engage, and boost their enjoyment and their engagement with the world. So, we’re always trying to think about when we see behavioural differences, you know, which of these differences are adaptive for the child, and which might be challenging, that we might want to support them to change. And the other thing that’s important to bear in mind in this whole field is what the priorities of autistic people are for our research programmes, and this was a priority setting exercise done by Autistica, who are a big UK charity, a few years ago. And the number one priority for autistic people in this survey were – was looking at interventions to improve mental health, ‘cause we know that a lot of autistic people experience co-occurring anxiety or depression. And that’s a huge priority for people in terms of trying to buffer or to reduce the impact of that. So, one of the things that’s we’ve been really interested in understanding is what kinds of things in our cohorts might predict early anxiety or early depression? And what might we be able to learn that could help us contribute to very early preventative interventions, that could prevent mental health problems, rather than prevent autism, per se? And so, a lot of the data I’ll talk about to illustrate this kind of approach comes from what we call our “STAARS Study,” and this is a study, as I said, of infants who either have a family history of autism, or don’t have a family history of autism. And we see babies from – often from pregnancy, but then often from early infancy, at five/ten/14 months, then in toddlerhood, when we can make a determination of whether they meet criteria for autism. And then, increasingly, we’re following children up to mid-childhood, where we can look in more detail at things like anxiety and depression and mental health outcomes. And the methods that we use are illustrated here, as I talked a little bit about before. So, we can use eye tracking, we can measure children’s brains, we measure their arousal, with their heart rate or skin conductance, to measure how comfortable they’re feeling in different situations. And then, importantly, we also measure their behaviour, so how are children interacting with other people? How are they playing with toys? What are their motor skills like? And so, one area that we’ve been looking at increasingly is sensory differences, ‘cause as I mentioned, a lot of autistic people talk about sensory differences, so experiencing the world differently. Sensory sensitivities have recently been introduced into the diagnostic criteria for autism. And so, we know that sensory differences might be something that are very important to look at in early development, particularly since sensory systems are something that develop very early in the brain. So, babies develop very early vision and audition, they can hear, they can see from birth, and prenatally too. So, they’re using those sensory systems to learn about the world from very early on, and differences in the way they’re working could have these cascading effects quite early, too. And if we think about those, sort of, mental health outcomes, there’s lots of discussion from autistic people about the potential connection between sensory issues and mental health. Because of course, if you’re finding the world overwhelming sensorially, that may well contribute to anxiety or to stress, and that might also, in turn, make you more sensitive to sensory problems. And this is a lovely illustration from the Institute of Education, who have a lovely booklet on this. So, we were interested in whether or not these two domains are connected right from very early on in autism, or is this something that we just see appearing later, once children have had a lot of experience with environments that they find overwhelming? And so, one thing we’ve been looking at in our prospective studies is very early sensory processing. So, this is data from babies who are ten-months-old, who either do or don’t have a family history of autism. And in this study, we have a little buzzer on their foot, we buzz their foot a couple of times, and then we have a gap, and then we do it again. And we’re just looking at how much they react to those paired buzzers. And we know that typically developing babies will react to the first buzz in each pair, but then for the second one, because they know it’s coming, they don’t react as much. So, they can do what we call “habituate” to that second buzz. And we can see that here in this EEG data. The size of these blue blobs down here show you how much the baby’s reacting to that buzz. So, you can see for the typical kids, this is the first buzz here, they react a lot, and then they react less to the second buzz. And when we look at our infants with a family history of autism, they’re showing similar reactions to both buzzes, so they’re continuing to react to this tactile stimulus, even though they, sort of, know it’s coming, and they’ve felt it before. So, that might suggest that, even at this age, babies are reacting more to environmental stimuli if they have a family history of autism. And then we’ve looked at a similar thing, but in the visual domain. So, again, these are eight to ten-month-old babies, this time with and without a diagnosis of autism later on. And here, what we look at is just how the pupil responds to changes in light levels, ‘cause we know that our pupils contract and dilate to change the amount of light they let in. So, if you’re in a bright room your pupil gets smaller, to let less light in. You go into a dim room, it’ll expand, to let more light in, to help you see. And we can measure how quickly that happens, and what we see in infants with later autism, which is the black line here, is that their constriction is greater than infants without a family history of autism, who are typically developing. So, again, babies are reacting more to those perceptual changes, even in infancy where, you know, at this point, children don’t have any behavioural signs of autism, at all. And then, finally, we looked again at this, kind of, similar idea, but with sounds, and here, we’re playing repeated sounds to baby, while they watch someone blow bubbles, or they watch a movie. And what you can see is that these are the typically developing babies, and this is what happens when you repeat a sound, and this time the blue colour means that they’re responding less. So, the typically developing babies respond less when they hear a repeated sound. They, sort of, tune it out, ‘cause they’ve heard it before. But the infants with later autism show an increase in their response to the sound. So, if anything, as the sound’s repeated, they’re finding it more and more attention grabbing. So, across all these three tasks, across vision and tactile processing and audition, it suggests that what we’re seeing is this greater reactivity and this difference in the ability to tune out sensory stimuli over time. And so, what we’re interested in is then, how do children react to that? So, what influence might have on their trajectory? Is this something that is a strength for them? Is it something that’s a challenge? Does it contribute to later anxiety? And, if so, how can we mitigate that? So, this is a complicated figure, but it’s trying to test the simple question of whether or not these hypersensitivity to sounds and to sights and to touches relates to fearfulness in infancy. So, you know, we know, later on, if you are finding sensory stimuli overwhelming, you might become anxious, but we’re not sure in infancy whether that’s true. So, here, we were looking at infant hypersensitivity at ten, 14 and 24 months, so, you know, babies and toddlers. This is fearfulness, so in this kind of age range, that’s maybe crying if a stranger comes to the house, or being afraid of a new toy, and then we’re later on, measuring autism traits. And what we find is that these hypersensitivities by 14 months, so being more reactive to sensory stimuli, predicted more fearfulness in infancy by two. So, if you were more reactive at 14 months, later in development, you were a little bit more fearful, and this greater reactivity also related to more autism traits. So, we do think this is connected to emerging autism for some kids. So, that could suggest that, you know, having this experience of finding sensory stimuli a bit overwhelming can contribute to feeling a bit of anxiety about encountering new people and new situations. And we’ve also looked at whether or not there is anything that might buffer that. So, this is a study, again, where we looked at – this is parent report of fearfulness and shyness, again, through infancy and toddlerhood, so that’s the same thing as previously. But this time we’re looking at how it relates to other skills, what we call “effortful control.” And this is a child’s ability to control their feelings and their emotions and to regulate themselves. So, sometimes it’s measured with what we call “the marshmallow test,” where we ask children to wait, and if they wait ,they can get two of the marshmallows, but if they can’t wait they get one. So, it measures your ability to, kind of, control your behaviour, even when there’s something you really want. And what we find is that this ability actually predicts reduced anxiety at three. So, if you’re better at controlling your feelings and emotions, you’re less likely to be anxious at three, whereas, if you’re a bit shyer earlier on, you’re more likely to be anxious at three. So, it might be that if your child has good, sort of, self-control skills, you know, even if they’re a bit sensitive to the environment and they’re a little bit shy, they might be less likely to develop anxiety later on. And so, helping children to boost these self-control skills could be one thing that we can do to support reducing the risk of mental health difficulties later in development. Another interesting thing from this data was that effortful control skills, or ability to control your emotions, also predicted less shyness, too. So, it might also be that both being able to control your emotions is better for your later anxiety, but also, it can make you less shy, potentially, too, in development. And so, asking some questions about the extent to which supporting effortful control could help with some of these outcomes is an important next step. So, another thing that we thought is really important to look at in this regard is sleep, ‘cause we know that a lot of autistic people, you know, tell us that they have difficulties with sleep. A lot of autistic children have real difficulties sleeping, and sleep could interface with your – at least, you know, anecdotally, with how much you react to stimuli in your environment. ‘Cause we all know if we’ve had a bad night’s sleep, you can be much more sensitive to loud sounds, you can be much more irritable and anxious. So, we think that, you know, these differences in sleep might play into some of these domains in important ways. To – as a first step, we asked, you know, when do those sleep differences start? Is it just something that starts after children are showing behavioural signs of autism, or are we seeing this from infancy too? So, again, these are, sort of, complicated graphs, but on the left-hand side we measured day sleep, and basically, we didn’t find any differences in day sleep, depending on whether you had a family history of autism, or autism later. But we did see differences in night sleep. So, this bottom graph here measures differences in night sleep between infants who have an autism diagnosis later on, in white, and infants who didn’t have an autism diagnosis. And you can see, the infants with an autism diagnosis just showed less night sleep than infants who didn’t meet criteria for autism. So, by 14 months, we’re seeing less sleep at night for infants with later autism. Then we were interested in understanding what that might associate with. So, again, we’re doing a model, looking at this night sleep over time, and some developmental outcomes. So, this is autism traits at three, this is children’s every day social skills at three, and this is their cognitive skills at three, and their sleep at 14 months associated with all three. So, kids who slept less later on had more autistic traits, had lower social – sort of, every day social skills, and had lower cognitive skills at three. So, there seems to be this, sort of, broad range of correlations. Now, of course, we can’t say that poor sleep causes those things. It might just be something that comes along with a child who’s developing on a different trajectory, but it seems to emerge in earlier development than we see these different behaviours. And we also looked at how that might inter-relate with attention, because we know that what you pay attention can influence what you learn about. And so, we can see here that differences in sleep early in infancy were also interrelating to differences in attention, in some simple eye tracker tasks. So, it could be that differences in sleep are influencing how you pay attention during the day, which is influencing your learning, but again, that, sort of, causal path is something that we need to test further in future work. And so, then we wanted to come back to that question of sensory sensitivities, and so, you know, are there relationships, that we think there might be, between sleep and your sensitivity to the world? And, of course, it might be that if you’re more sensitive to touch or to sound, that you just wake up more. So, it might be that, actually, kids are sleeping poorly because they’re sensitive to what’s happening in the environment. And so, here, we were working, again, with our ten-month-old infants, looking at that buzz task I told you about before, where we see decreases in responses to the buzz in typically developing babies, but not infants with a family history of autism. And we can see here that that response correlated with how long it took babies to fall asleep. So, babies who are better at tuning out that change in tactile information were better at falling asleep faster. So, that might suggest that, you know, babies who are, sort of, reacting to the feeling of things around them just find it harder to fall asleep. And one thing that we’re trying to study at the moment, to ask that question, is to look at some of these measures while babies are sleeping at the time. So, we’re working with one and five-month-olds to measure what’s happening in their brains while they’re asleep, and what happens when they feel sensory input. Then we can test whether, you know, babies who aren’t as good at tuning that input out are more likely to wake up during the session. So, we’re doing measuring brain activity with EEG, which measures co-ordinated activity of groups of neurons during sleep, and while they feel the buzzes and hear some sounds, and then, while they sleep peacefully again. But we were then also interested in asking how do these, sort of, sleep and sensory measures interact over developmental time? So, can we see any changes in your sleep over the first years of life, and how that relates to sensory sensitivities? And so, here again, we’ve got our sleep measure at the top, so sleep at four months, ten months and 15 months, and we can see that there’s some relative stabilities. That means if you’re a good sleeper at four months, you tend to be a good sleeper later on, too. And we see that, again, by 14 months, sleep is associating with autistic traits. So, babies with higher levels of autistic traits later were poorer sleepers earlier on. But this is our sensory sensitivity measure, and here what we can see is that sensory sensitivities at 14 months predicted sensory sensitivities at two, but also, sleep at 14 months predicted sensory sensitivities at two. So, this kind of data suggests that we both see concurrent relationships in the previous task, between babies who are more sensitive to tactile stimuli and then babies who wake up more, but then, also, that struggling to settle to sleep at 14 months might predict later increases in sensory sensitivities. So, it may also be that poor sleep could contribute in some way to finding the environment more overwhelming later in development. So, just as a summary picture to illustrate the, sort of, pattern that we’re seeing, it’s complicated, but we’re seeing these differences in sleep in early autism. We’re seeing differences in sensory functioning, or sensory responsivity, and we’re seeing that these two things may contribute, or relate, at least, to emerging fearfulness and, potentially, to later anxiety. But we’re also seeing that effortful control skills, so the ability to regulate your behaviour and your feelings and your emotions, can actually buffer, potentially, against that. And so, one thing that we’re thinking about at the moment is interventions that might both help support sleep for babies, but that might also help them with their emerging ability to regulate and sooth themselves. One thing that’s important to understand is what might be happening in the shorter term, ‘cause some of these models we’ve looked at are asking, you know, what happens at six months, and how does that relate to what happens at ten months? But we know that tonnes are things are happening in a baby’s life between those two timepoint. So, what we really want to know is, in addition to that, you know, on a day-to-day basis, how does baby’s sleep relate to what their brain’s doing, or, even on a moment to moment basis, how much does a particular activity you might do with baby influence different brain signals? And so, for that, we need to understand these, sort of, short-term interactions between baby’s brain and what baby’s doing and what baby’s seeing and taking in, and so, that’s another area of important research in this field. And one way that we can try to address that is by looking at what we call “attentive brain states.” So, these are configurations of brain activity that we think mean baby’s paying attention. And we have lots of different networks in our brain that support attention and support attentive brain states, and we can use measures like EEG or NIRS to see the co-ordinated activity of lots of these networks, and to try to detect when a baby is, sort of, ready to pay attention, what kinds of things support that, and when a baby isn’t. And one thing we’re interested in is how that, over time, might strengthen some of those brain networks to support children’s development. And one of the contexts this might be really important in, of course, is social interaction, ‘cause babies spend a lot of their early development interacting with other people, with adults, with their siblings, you know, as they get to preschool, with other children. And those social interactions are all really important sources of learning, both about social things, but also, about the world in general. And so, we’re interested in how baby’s brain can support those social interactions, and when is baby attentive to their caregiver, and what means that they’re not? And one way to measure that is using EEG. So, as I mentioned before, this is a technique where we have these nets of electrodes that just sit on baby’s head and pick up what baby’s brain is doing naturally, and they pick up broadly the co-ordinated activity of groups of neurons, who are all firing together, so brain networks that are firing consistently in the same way. And we can use that to detect brain activity that we know is different between when babies are watching a social video or interacting with a person versus playing with a toy. And so, one thing we look at is called the “theta rhythm.” So, that’s brain activity that’s oscillating at a certain rate, and that rhythm tends to be greater or higher in amplitude when babies are watching social videos rather than non-social videos, or even more strongly, when they’re interacting with a person versus an object. So, you can see here on the brain in red, this is the difference between as baby – this group of 12-month-old babies are watching a social versus a non-social video. So, we see lots of extra activation for the social video. So, this is a way of telling, you know, whether baby’s brain is attending to this particular set of stimuli. And one thing we were interested in is, how, then, do our sleep measures relate to changes in these brain states? So, this was a study with typically developing babies, so this was a start to map what this looks like in the general population, and this is a study run by Louisa Gossé. And she brought babies for four different visits while they – and they did an EEG paradigm. So, we measured their brain activity while they watched videos, and then, in between that, she measured their sleep over seven days, using an actigraph, which is a little monitor that measures how much baby moves around, and can tell how much they’re sleeping versus being awake. And she was interested in how those sleep measures might inter-relate with these moment-to-moment changes in brain activity, that we think are important for attention and learning. And what she found was that because both her actigraph data and her diary data, so when parent said baby was asleep or awake, there were associations between how often baby woke up and this measure of theta power. So, broadly, babies who woke up more at night didn’t show so much brain engagement with the videos that we measure during the day. And again, we don’t know what causes what, but we can at least say there’s an association between differences in sleep and brain functioning during the day. And we also know that some of these brain measures might relate to later social behavioural development. So, in our studies with infants with a family history of autism, if we look at the difference between the social and the non-social video, we find that this weakly, but significantly, associates with autism-related social traits later on. So, this is a measure of how much babies show – or three-year-olds, show differences in social interaction that might be relevant to autism, and then associating that with differences in their response to the social versus the non-social video. And you can see that babies who have, sort of, fewer social traits associated with autism showed bigger differences in theta response to a woman singing nursery rhymes versus a toy. So, there’s some suggestion that some of these brain rhythms might be sensitive to social processing differences that might relate to later social behavioural differences that are relevant to autism. And so, one other metric that we’ve been looking at is not just your, sort of, average theta power while you’re watching somebody, but the change in theta power while you’re doing it. So, we know that when we first show these videos to babies, what we often get is an increase in theta power during the video, that we think means they’re engaging and getting interested in the material, and we can measure the extent of that increase and look at whether, again, that associates with later developmental outcomes. And what we found in this study, led by Ellie Braithwaite, was that infants who showed a bigger increase in theta power during the video that they were watching went on to have better cognitive skills at age three and at age seven. So, we think it might be that the baby’s ability to engage and really get interested in a new thing when they’re very young associates with cognitive development over a much longer timescale. So, again, some of these brain rhythms could be really important in helping us to work out within infancy, you know, what difference, for example, does a good sleep versus a poor sleep have on the kinds of brain rhythms that we know relate to later developmental outcomes? And we also know that some of the supportive interventions that we can do in early development can, potentially, alter some of these brain rhythms. So, this was an intervention that was designed for infants who have a family history of autism. And it’s important to say that when I talk about interventions, I don’t mean things that are trying to fix a child. I mean things that we do to try to support children’s development. So, all children go to school, and that’s an intervention that all children take part in, and it might be that some children need additional supports to learn things that they wouldn’t otherwise learn, and that’s the idea of some of this work with infants with a family history of autism. So, this particular intervention is based around the idea that babies developing autism might communicate slightly differently than other children, and so, as a caregiver, you might need to learn some specific skills to recognise when your child’s trying to communicate with you, in order that you can, kind of, get into their world and support their learning and engagement. And in this study, infants either received this intervention between six and 12 months, or they received a, sort of, control condition, where they didn’t do the similar thing. And what we found was that infants who’d received the intervention showed increases in their responsiveness to these videos. So, they showed more of this theta power response to a social video, than our infants with a family history of autism who didn’t receive the intervention. So, it might be that these, sort of, supportive social engagement, kind of, interventions can alter social brain function. And in a different study, using a very similar intervention, that we did here in the UK, led by Jonathan Green, the research has showed that actually, these interventions can also reduce some of the differences seen on the AOSI and the ADOS, which are, sort of, behavioural autism trait measures, but also, importantly, that they can boost children’s initiative with a parent. So, that means the children started to show parents more what they wanted to do, or tell parents more about what they were doing, so the child was engaging more with their caregivers, which we think helps them then get their needs met. So, I think there’s some suggestion that some of these early supportive environmental interventions can boost both children’s social interactions and change some of their brain development. And this is just an example from a study where we did a similar thing but in older children, that they had a much – a more intensive intervention. But again, what we saw is changes in brain activity, so changes in these theta power signals that we think might indicate that children were becoming more engaged with social stimuli, and that might be something that we can detect in their brains. So, just to come back to that, sort of, complicated slide. We think we’re starting to see this, sort of, emerging picture whereby we see these, sort of, complicated interactions in the early development of children who are going to develop autism. So, we’re seeing, you know, sensory differences early on, sleep differences early on. Yes, we’re seeing some of these, sort of, social brain differences, but it could be that some of those differences are related to the sleep differences, or indeed, some of the sensory processing differences. And that, importantly, the things that we probably want to think about changing are the things that are contributing to anxiety or to some of these mental health difficulties. And it might be that the sensory sensitivities or the sleep are things that we can try to work with to support children to have optimal environments, to allow them to grow and develop. And it might be, also, that children’s self-control or effortful control skills can help us in that regard. And one thing that we’re trying to do now is to understand – you know, rather than just ask, “What doesn’t a baby pay attention to?” or, “Where do they show differences?” We can ask, “What does engage them?” And so, this technique is using EEG and measuring a baby’s brain response every time a person interacts with them, and then using an algorithm to try to ask, “Okay, what kind of interactions does that baby particularly like?” So, we’re trying to test whether we can identify for an individual baby what kind of social signals they might find appealing, or they might want to interact with, and we think that can help us identify what might provide a supportive social environment for different children, developing differently. And so, to summarise what we’ve talked about, you know, what we think we know is that phenotypes, what we call phenotypes, so differences in behaviour in children when they get older, come from these, sort of, cascades of interactions between children and their environments. And to understand them, we need to measure these dynamic interactions both in the short-term, so how does baby’s brain respond to what they’re seeing and doing? But also over the long-term, so how do differences in development at one stage relate to differences in development at the next stage? And we always must maintain our ultimate goal, which is to improve outcomes of autistic people, but without losing sight of how neurodiversity and taking a neurodiversity affirmative approach enriches our society in general. And just to say thank you to all the families who partas – participate in our research and to all of the organisations who have funded us.