April 2nd is World Autism Awareness Day. For more information and resources, visit Autism Ontario’s website.
CAMH clinician-scientist Dr. Stephanie Ameis investigates promising treatment for youth with autism spectrum disorder.
Connor is a young man with what’s known as high-functioning autism spectrum disorder (HF-ASD). His language skills are good – in fact he will talk your ear off about his train-spotting hobby. And his intelligence is in the average range. Connor finished high school recently and has been working part-time at a recreational facility. He’s proud of his job and takes transit to get there on his own. But often he’s had difficulties focusing on getting ready for his day and work shifts. His parents help him keep on track. He’s currently living with them but eventually wants his own place.
A critical moment
“Young people with autism like Connor are at a really important crossroads for their independence,” says Dr. Stephanie Ameis. Dr. Ameis, a child and youth psychiatrist and clinician-scientist, is the O'Brien Scholar with the Child and Youth Mental Health Collaborative at CAMH, the Hospital for Sick Children and U of T. In fact, recent studies suggest that only about one in four will reach social and financial independence, she says. After high school ends, there is often a real gap in resources and support for this group to help them make the transition to adulthood successfully.
It’s estimated there are 60,000 people in Ontario diagnosed with HF-ASD.
Dr. Stephanie Ameis
One of the key challenges when it comes to being independent is thinking problems related to the “executive function” of the brain, Dr. Ameis notes. “This group may have difficulty getting organized to get up and out the door, to prioritize tasks, plan, stay focused, or manage their responses at work and school.” To date, no treatment has been shown to help with long-term outcomes for young people with autism, she notes.
Testing a proven concept
Dr. Ameis has launched a two-year pilot study to investigate a potential treatment involving brain stimulation for young people like Connor. The therapy is called rTMS – or Repetitive Transcranial Magnetic Stimulation. It stimulates nerve cells in the brain through a series of short magnetic pulses limited to a small area in the frontal lobe. The client stays awake during the 45-minute procedure and can resume normal activities right away. The therapy is being conducted at CAMH’s Temerty Centre for Therapeutic Brain Intervention.
Approved by Health Canada for depression, the treatment has already shown promise for improving executive functioning in people with schizophrenia and youth with depression. A recent study from the Temerty Centre showed that a program of intense stimulation – rTMS five days a week for four weeks – led to a significant improvement in executive functions including short-term memory for people with schizophrenia, Dr. Ameis notes (Barr et al; Biol Psychiatry March 2013).
“We are taking this exciting finding in schizophrenia and assessing its potential to help young people aged 16 to 35 with high-functioning autism.” Twenty participants will receive the active intense rTMS therapy and a control group of 20 more will receive an inactive version (similar to a placebo), in a randomized study. Participants’ cognitive functions will be tested three times -- at the start and end of rTMS treatment, and at one month afterwards.
“In this study, we will also try to learn more about how rTMS treatment may bring about improvement in thinking through positive changes in the brain,” says Dr. Ameis. That includes the effects on both the brain’s hardware (structure) and software (functioning). Magnetic Resonance Imaging (MRI) Brain scans will be completed at the start and end of participants’ rTMS treatment during the study.
Dr. Ameis’ research team is based out of CAMH and includes child and adult psychiatrists, psychometrists, research assistants/analysts and students.
The road ahead
The pilot study will be completed in late 2016. “We’re excited about this opportunity,” says Dr. Ameis. “If we see promising results from this small-scale study, we hope to expand our work in this area.” That may include studying a larger group, and assessing how rTMS may complement other therapies, such as cognitive training, that may also help with thinking problems in this population.
Dr. Ameis is leading the research study, teaming with two senior co-investigators:
- Dr. Jeff Daskalakis is a world expert in brain stimulation research and Director of the Temerty Centre for Therapeutic Brain Intervention at CAMH
- Dr. Peter Szatmari is Chief of the Child and Youth Mental Health Collaborative at CAMH, the Hospital for Sick Children and the University of Toronto, and a leader in ASD research.
During her career, Dr. Ameis trained extensively in the evidence-based assessment and treatment of children and youth with autism spectrum disorder. Her special focus is on neuro-imaging to assess how brain structure may affect susceptibility to childhood mental health conditions. Her current research work focuses on examining the impact of novel and existing treatments on the brain over time.
“This is an exciting chapter as we try to assist young people with high-functioning autism at a critical time in their lives,” she says.
Learn more about this research project and brain imaging at CAMH. Meet Dr. Ameis, Research Assistant Katharine Coons, and one of their clients, Raphael.
If you or a family member are: 16-35 years old, have a diagnosis of autism spectrum disorder, are verbal and fluent, have average intelligence, struggle with organization, task completion, planning or shifting focus, and are interested in participating, please contact: Katharine.Coons@camh.ca (416) 535-8501 ext. 30217