‘The Brain, early development, and autism’ – In Conversation with Professor Emily Jones

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Professor Emily Jones of the Centre for Brain and Cognitive Development at Birkbeck University of London talks neurodevelopment, attention training and intervention.

Emily talks about her research around understanding cognitive and neural mechanisms that drive variability in the early development of core skills, why early development is highly important and translating findings into clinical practice.

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Professor Emily Jones

My research interests centre on understanding the cognitive and neural mechanisms that drive variability in the developmental trajectories of young children (BOND lab). Taking a multimodal approach, I use behavioural, electrophysiological and psychophysiological techniques to investigate the development of core skills such as memory and attention in early development.

I am particularly interested in the early development of basic skills in children with Autism. Understanding how early emerging symptoms contribute to later strengths and difficulties both illuminates the aetiology of the condition and may highlight appropriate targets for intervention. My work in this area has focused on both toddlers with autism and infants with older siblings with autism, and is associated with the Early Connections Study at the University of Washington, the British Autism Study of Infant Siblings (BASIS) and the Study of Autism and ADHD Risk in Siblings (STAARS) at CBCD. I also collaborate with the Autism Research Group at City University. Bio via Birkbeck University of London.

Transcript

Interviewer: Hello, welcome to the In-Conversation podcast series for the Association for Child and Adolescent Mental Health or ACAMH for short. I’m Jo Carlow, a freelance journalist with a specialist in psychology. Today I’m interviewing Professor Emily Jones of the Centre for Brain and Cognitive Development at Birkbeck University of London. Emily is particularly interested in the early development of basic skills in children with autism.

If you’re a fan about In-Conversation series please subscribe on iTunes or your preferred streaming platform. Let us know how we do it with a rating or overview and do share with friends and colleagues. Emily, welcome. Thank you for joining me. Can you start with a brief introduction?

Professor Emily Jones: Yes, it’s great to be here. I’m Emily Jones. I’m a Professor of Translational Neuro Development at the Centre for Brain and Cognitive Development in London.

Interviewer: Emily, your research centre is on understanding the cognitive and neural mechanisms that drive variability in the early development of core skills. What prompted your interest in this particular area?

Professor Emily Jones: I’ve always been interested in individual differences and how different children take different developmental paths. During my PhD I focused on the development of learning and memory. So, you know two very important mechanisms through which information is selected from the environment and it affects the child’s development, and during that time I did a lot of volunteering with kids with autism, and it was interesting to think about at that time how some of the processes I was studying in typical development might be different for kids with neurodevelopmental conditions.

So I then went on to do a postdoc in the area of autism in Seattle and that’s kind of really what kicked it off.

Interviewer: Your research into autism spectrum disorders and also attention deficit hyperactivity disorder suggests that symptoms of both likely emerge from a complex interaction of emerging neurodevelopmental vulnerabilities and aspects of a child’s prenatal and postnatal environment. Why is it important to untangle these factors?

Professor Emily Jones: So I think there’s, sort of, both a basic science reason for it and I’m also the clinical translational application. So from the basic science side a lot of research on kids with autism or with ADHD looks at kids with a diagnosis. Obviously what we’re often trying to do is understand how the symptoms that contribute to that diagnosis came about, but when we’re looking at kids who have been identified already in the clinic it’s quite hard to understand where that came from because you’re looking at the end point of a series of developmental interactions and we know that, you know, a lot of the factors that pre-disposes to autism or ADHD act either at conception or prenatally substantially.

So both genetic, environmental factors. So what’s actually happening is that the brain is being built a little bit differently. The brain is processing information a little bit differently from very early on. So that’s going to impact what the child is learning from the environment. It impacts how they behave. What information they then seek. You know, how they interact with their social partners and that over time creates this cascade that ultimately leads to these behavioural symptoms that we then identify and label.

If we’re interested in where autism and ADHD come from then we need to unpack those kind of processes, but from the clinical translational side, you know, if we’re thinking about helping kids with some of the challenges that they experience, understanding the mechanisms by which those challenges emerge is one of the ways we can do that, and particularly when we’re thinking about both autism and ADHD they both come with challenges, but also strengths.

Interviewer: So if we’re thinking about intervention or support, if we can understand better, you know, what kinds of mechanisms lead to strengthen, what kinds of mechanisms lead to challenges the we can target them more effectively such that we’re not removing some of the things that kids find really valuable, but we’re helping them with the things they struggle with.

Can you say something more then about how you go about translating findings into clinical practice?

Professor Emily Jones: So I think I mean, I would say we’re at a fairly early stage with that, but we have a number of different avenues. So one is if we’re thinking about the concepts of autism, we know that one of the things that’s affected fairly early on is the child’s interactions with other people. So they start to become less interested in other people. They start to engage less, initiate less. So one of the things that we’ve tried to do and other research groups is to work with parents to try to help them, you know, respond to even the very subtle keys that their child might be giving.

You know, respond more than you normally would to the child’s initiations to try to boost the social input the kids getting when they do initiate or when they do want to pay attention to you.

So that’s one set of work that is still at a very early stage, I think, but there’s been some promising early findings to suggest that we can boost children’s social communication functioning or at least a little bit with some of those early stage interventions. Then a second set of work that we’re doing is looking at, I guess, what is more inspired by some of these basic learning mechanisms early on. So, you know, one system that we think is quite important is the attention system, because that’s of course what kids use to gaze what they take in about the world.

So we’ve been working with some colleagues to develop attention training interventions for babies. Whereby we have this set of gaze contingent computer games that they play with their eyes effectively. So it’s using an eye tracker that records what babies look at. Where they look at on a screen, and what we do is set it up so that as the kids look at, say, a butterfly that’s flying along the screen the longer they look at it, the more it flies.

There are interesting landscapes. If they get distracted and look away then it stops. So over time they learn that the more they pay attention the more interesting things happen. We’re looking at whether or not using that with babies between eight and 14 months. In babies who have got older siblings with ADHD. So have a greater likelihood of developing ADHD themselves. Whether that might help to boost their early attention skills and therefore have sort of cascading benefits that lead to development.

Interviewer: You give them an example then of the kind of techniques that you use to investigate the development of core skills, such as attention in early development. How do you go about tracing emerging symptoms back to their etiology then?

Professor Emily Jones: Yes, so we have a number of different ways of doing it, but probably the primary way is what we call our prospective studies of infants who are more likely to develop particular conditions. So, for example, we work with infants who have older siblings with autism or with ADHD because they have about 20% chance of going on to develop autism and probably ADHD themselves. Then a number of infants who have that family history will also develop other developmental difficulties.

We run these perspective longitudinal studies whereby we bring the babies in very early on, and more recently we’ve started to work with a group where we’re looking prenatally as well.

So even in the womb, and then we measure the baby’s brain development. Their cognitive development, behavioural development through the first three years of life. Then when they get to three then we can assess them for symptoms of autism. You know, traits associated with ADHD, their language skills, cognitive skills and then we look back at what was present early in development in the kids who go on to a diagnosis of autism or go on to experience high levels of ADHD symptomatology.

So that way we’re starting to look at what is changing earlier on in the brain and kids who go on to those outcomes. Then the other thing we’re starting to do now is to bring in genetics to that. So we can take DNA samples from kids and look at the profile of different common variants that they have that we know are associated with a slightly higher likelihood of developing autism and again, we can look at how does that level of genetic liability in the kid relate to some of their early trajectories of brain development.

So we can start to understand how some of these etiological genetic factors, say, linked to early trajectories.

Interviewer: It’s really interesting, isn’t it, because you initially said when a child first presents it’s at a kind of end-point developmentally and you have to work backwards almost.

Professor Emily Jones: Exactly. So the idea with these kinds of studies is that actually what we need to be doing is going forward from infancy. You’ve got these, an elevated likelihood of developing autism later and measure them until the point at which they get that diagnosis, and that’s a really important window to study.

Interviewer: Emily, I want to turn to some of your current research projects. You coordinated a large cross European study of infants at high familial risk of autism. This is the AIMS 2 project. What does that involve and can you share some of the interim findings?

Professor Emily Jones: So AIMS 2 is actually a very large European study that involves lots of different components with the overall goal of developing new interventions or new support strategies to improve the lives of autistic people. So as part of that there’s a set of different studies, some with adults, some with kids. So some of the work that we do in the context of AIMS 2 is looking at brain activity not just in babies, but also in kids and adults with autism, linking that to genetic factors.

There’s a set of trials as part of AIMS 2. So trying to understand, you know, new ways of developing treatments, but then as part of it, yeah, we also have our baby study. So that’s similar to what I was just describing. So we are working prospectively with infants, with older siblings, with autism but this time we’re working together with a network of sites across Europe. So researchers in Belgium and Sweden and the Netherlands. By bringing our groups together we can build larger sample sizes.

Then that’s going to give us much more power to answer some of the questions about differences in developmental trajectories. What’s different about the early development of kids with different types of autism later on or different levels of strengths and weaknesses, and that’s very much still ongoing. You know, these studies take a long time because we have to wait for the kids to grow. We’re starting in pregnancy for AIMS 2. So with our colleagues at King’s we’re doing prenatal and neonatal scanning to look at very early brain development.

So it’s still in progress, but we have some early emerging results from both that study and some of the early work we’ve done. We are starting to see some clear differences in infancy go into autism. So some of those are behavioural that we see in the second year of life that children are initially interested in people, but then gradually withdraw over time, but then we can look at what might underlie that in the brain.

So some of the things we see in the first year of life is less engagement of key brain regions when infancy, pictures of people. So one technique we use is called near-infrared spectroscopy, which is essentially using weak rays of light to shine into the brain, and just like if you shine a light on your finger it comes up red. You can see the oxygenation in the blood. NIS picks up the extent to which the blood is oxygenated or deoxygenated and as a brain region becomes active initially, it sort of uses up all the oxygen in the blood and then there’s a big influx of blood flow to bring more oxygen to that region.

This is a bit like FMRI for people. You know about that, but we can use that to measure specialisation in the different brain regions that normally would be specialising to be very interested in people, and what we see is that at five months in our infants with autism, the temporal region of the brain that normally would be very active in response to people we see much less activation, and we see similar things in the EEG that brain responses that we think reflects engagement of attention, which is important for kids to then learn about a social situation are also diminished in the infants, even at that age where they’re still behaviourally looking at people and interacting with people.

So we think there are some very subtle early differences that mean that even though kids might be looking at a person, they’re not taking in the same amount of information. Their brain is not specialised in the same way.

Interviewer: Emily, that sounds really important and that’s from five months you can start seeing those.

Professor Emily Jones: Yeah, that’s five to six months. I mean, one thing to say is that these findings are still very much at a group level. So, you know, in terms of individual babies it’s still almost impossible to predict which baby will develop autism, but if we look at a group of infants with later autism we do see these changes. So they’re subtle, but they’re detectable when you can look at enough kids.

You mentioned before that some of this research involves siblings and you’re looking at siblings and autism. Can you say something more about this important aspect of your work?

We started off, you know, predominantly looking at infants with older siblings with ASD, but we’ve now extended that because we recognise that actually in families with kids with autism there’s a lot of other conditions that often overlap with that too. So things like ADHD, but also anxiety disorders, language problems. So more recently we’ve been looking at longitudinal studies of babies who’ve both got older siblings with autism and are ADHD and looking at what might be different in the early brain and behaviour that might map onto differently later neurodevelopmental conditions.

So, you know what might we see that relates to just general neurodevelopmental risk and what might be specific to autism or specific to ADHD? So we do find some indicators. For example, we can use EEG to look at communication between different brain regions and how closely different brain regions are synchronised with each other, and we’ve now found in a couple of different cohorts that at 12 months infants who show a greater level of synchronisation between brain regions are more likely to go onto having higher levels of restricted and repetitive behaviours which is a sort of specific set of symptoms within the autism spectrum in general.

But then if we look at things like anxiety we find the things that you might imagine actually at early [inaudible 12:55], early inhibition quite strongly, predictably to anxiety in these cohorts. So we can start to try to pull out different types of patterns that might relate to different types of outcomes later on.

Interviewer: Emily, you also co-lead the Sapiens Network of Researchers studying how the social brain is shaped by early social interactions. Once again can you tell us something about this project?

Professor Emily Jones: Sure. So Sapiens is a Marie Curie early stage researcher training network. So essentially it’s a network across Europe set up to train 15 early stage researchers. Essentially, all of our students are doing PhDs at different centres within the network, but we also have a set of network training events and collaboration between different sites. Students go for secondments to different sites. So the idea is to build capacity in Europe but also, you know, collaborations across distinct centres with distinct expertise.

Interviewer: The Sapiens Project in general is focused around how it’s sort of the space between the parent and child. That’s the substrate of social brain development. So, you know, often people look at parents separately. So, you know, parent behaviour. How sensitive are you or they look at the child and they look at people and they look at objects, but really early social development is probably shaped by that interactive space between the two partners.

Professor Emily Jones: So we’re trying to use different methods to understand that. So there’s some projects using dual-eye tracking where you look at both the coordination gaze between the parent and the child. Some projects looking at what they call hyper scanning.

So measuring brain activity in both the parent and the child. We’ll look at how synchronised it is, the information, communication between them. A couple of our projects using computational models of teachers and children to try to make predictions about how information transfer might work between the dyadic partners. Then the idea that comes together into this sort of greater whole to understand social brain development.

Interviewer: You’re also working on developing new methodologies to study the developing brain through the brain tools and OM Projects. What are those?

Professor Emily Jones: Brain tools is essentially about developing toolkits for global health. So often these eye-tracking and EEG methods are predominantly used in western high income countries in the lab. You know, babies are in a very unusual situation.

But if we want to move to more clinical applicability, but also more generalisable findings that generalise beyond those, sort of, weird populations we need ways of taking these tools out into the field. So either into clinics or into home-based settings. So brain tools is about developing a combined EEGR tracking toolkit that can be used by…Ultimately the goal is to be usable by health care workers, field workers. So we had an initial project in Gambia in rural India, where our team went into kids’ homes and measured brain activity in three year olds, and we’re essentially looking at a set of social attention, visual attention, auditory processing in a way that’s semi-automated.

So the eye tracker detects when the child is looking at the screen. Then they present them with a stimuli. The data is collected and analysed. So at the moment that kit is being used in a large scale project called Stream, which is a screening study in India and Malawi where we’ll be using the kit with a very large sample of babies and kids to look at, you know, early signs of neurodevelopmental difficulties with the idea that that might complement other behavioural screening methods.

Then we’re also using it in a big study in South Africa. Again, with the idea that, you know, if we can collect some of these scalable data sets we can then understand more about how particularly the environmental risk factors might impact on early brain development, using more objective sort of culture fair methods. Then, you know, the typical sort of behavioural measures.

Interviewer: What about the BONS Project?

Professor Emily Jones: BONDS is very much at the other end of scale spectrum, I guess. So brain tool is a sort of big data and DONDs is much more about the individual child. So BONDS is a project where we’re collecting brain activity in real time. So we measure the brain signal and we analyse it and we find the brain feature we’re interested in in a second after the stimulus has been presented and we use that information to select what stimulus is presented next.

And the reason we’re doing that is that, you know, a typical way of studying kids, say, with risk factors for neurodevelopmental disorders is to show every kid the same stimulus and then look at how their brain might respond differently. But returning to our earlier conversation about intervention, when we’re thinking about intervention then you’re not really left knowing what to do about that. So you might know that the child’s brain is responding slightly differently, but you don’t know what it is that would engage that child’s brain.

So say, what is it that they would pay attention to, and that actually might give us more information in terms of how their brain is specialising, but also how might you design an intervention? So the idea with this is that you have this big space of different potential things the child could be interested in. The algorithm picks one of them, shows it to the child. We measure their brain activity in real time. So say a signature of brain activity that we think reflects attention or reward.

Then the computer algorithm uses that to decide which bit of the space to move to next. What picture to show the child next, and the idea is the algorithm is trying to find where in that space maximises that brain signal. So what is it that the child is most attentive to? So initially we’re doing that with social stimuli. So, you know, what kinds of social cues engage particular children in typical development and if the sort of technique works and it’s going well, then we’ll move into kids at risk for autism.

Interviewer: What kind of age group is that?

Professor Emily Jones: So at the moment we’re doing four to eight month olds. So very young babies and then we’ll start to look at, sort of, individual differences, developmental differences, older children, but in the beginning we’re going to start very young, because that’s the age at which, you know, as otherwise very difficult to tell what it is that’s engaging them or what is it that would sort of maximise their social attention.

Whereas with older children it’s a little bit easier behaviourally.

Interviewer: And when it switched then. So if the stimuli appears to interest the child what would be an example? Would it be a picture or photos of people and then it moves on to relatives or something?

Professor Emily Jones: Exactly. So we’re starting with a space that has the baby’s mum in there and then lots of different strangers, but they’re kind of organised by how similar they are to the baby’s mum, and this is all sort of proof of principle, because we know from a standard experimental design, if you show your baby just a picture of their mum and a stranger, they’ll make a great response to their parent.

So what we’re doing initially is setting up this big space with lots and lots of different photos and we’ll look at whether the algorithm can find the baby’s mum just by using the baby’s brain activity, and that gives us proof of principle that if the algorithm can indeed find the mum’s face, we’ve got a way of saying, well, yeah, we know that is baby’s mom. So it was working. Then we’ll move on to looking at things like brief video clips of different social cues. So smiling, gaze, different levels of predictability of a social interaction.

So some ideas that, you know, typically developing kids like sort of moderately predictable social interaction. Whereas maybe infants who are going on to autism actually prefer things to be more predictable. So if you can find that sweet spot actually they would continue to be engaged in interaction. So we can start to ask these kinds of questions.

Interviewer: Do you envisage that being adapted to become some kind of tool for intervention?

Professor Emily Jones: I mean, possibly. These things are always, you know, in reality like a ten year window, but I mean, yeah idea would be that if you could use this in the clinic as a way of finding out for an individual child what it is that motivates them that could be then taken into a behavioural assessment or behavioural intervention protocol for the child or they could do them with their parent or a therapist.

So it might generate some additional input, I guess, as to what might engage that child very early on.

Interviewer: Emily, I notice that most of these projects involve collaborative networks, often across Europe and beyond. Why is this global focus so critical to answering core questions about the early development of autism?

Professor Emily Jones: So I think, you know, there’s the sort of standard reasons about sample size and power and obviously joining together we can build larger sample sizes and answer more questions, and particularly for thinking about genetics. Often the effect sizes are quite small. So you need larger cohorts to understand it, but also in terms of, you know, if our ultimate goal is to generate clinical insights or basic science insights that could be used to improve the lives of people with autism then that has to be applicable, kind of, worldwide.

So it’s very unlikely that if we just study one particular group of kids in one country that we’re going to be able to generate the kind of generalisable data that we’re going to need. So a lot of our work is about building capacity and building connections with other countries so that together we can actually generate more robust insight, but also do work that would be potentially translatable into the clinic because every country has a different clinical system. Every country has a different way of providing intervention for kids.

So unless you work together probably what your output is not necessarily something that can be easily translated into a clinic in every setting. So part of it’s about that, about the sort of ultimate clinical utility but also, you know, if we look more globally we can then start to probe the limits of some of our conclusions. So we know, for example, like heritability estimates. If everybody’s got an identical environment then something might look very heritable.

But if you’ve got a lot of environmental diversity then all of a sudden it might look less heritable because actually the environment is having more of an influence on the phenotype. So putting together data from lots of different cultural settings, environmental settings, early risk settings is important to really understanding exactly how the environment and genetics interact with each other, for example.

Interviewer: What are the research areas that are coming up for you?

Professor Emily Jones: So one thing we’re starting to do a lot more of is remote assessment, partly, practically at the moment, but also in terms of reaching populations that are harder to reach. So we’re starting to do a lot more work with infants with genetic syndromes, and some of those syndromes are relatively rare. So we work with kids with neurofibromatosis, for example, because we know again they have a greater likelihood of developing autism or ADHD, but in order to work with these kids it’s going to be much better for families and probably for our data collection too, if a lot of it can be done in the baby’s home.

So we’re developing more at face base methods. So parents can tell us about their children’s skills and some of those methods used, some of these adaptive algorithms that I was talking about for BONDS where, you know, parents get asked a question based on their previous response, but it’s also measuring things like anxiety or arousal at home in both the parent and child. You know, how their heart rate levels are coupled during the day. Things like sleep. So we have reports on infant sleep where families track their baby’s sleep over a certain period of time.

Then we look at what’s happening in baby’s brain. If they’re a good or a bad sleeper? So we’re trying to move to some of these more scalable in-home assessments where we can measure development also over a longer period of time.

Interviewer: Was that happening already, the remote assessment or has that been accelerated due to the pandemic?

Professor Emily Jones: It’s definitely been accelerated. So we started before, but I think, you know, because we have our labs well set up it had never been sort of necessary and I think now we’re starting to… it’s given us a reason essentially to accelerate that. So we’ve also been developing online experiments for parents that they can set it up with their baby at home and then input their responses into the computer. Those kinds of things.

So I think it’s really led us to accelerate some of that work.

Interviewer: Emily, is there anything else in the pipeline that you’d like to mention?

Professor Emily Jones: The other thing that we’re really excited about on our sensor is we’re just about to open the world’s first toddler lab. So we have this baby lab where we measure brain activity in the babies. So all the work I’ve been talking about, but we know very, very little about the toddler age range. So two, three, four year olds, because they’re really hard to test. They don’t necessarily want to sit in front of a screen.

So we were very lucky to receive funding to open this toddler lab where we’ll have naturalistic environments for kids. So preschool environment, a home based environment where the child can run around and interact with things, but at the same time we’ll measure things like arousal levels, brain activity, using wearable technologies. So that will include both EEG, the optical imaging that I was talking about before, and there will be set up with a virtual reality screen in one of the rooms. So a very big virtual reality wall essentially where we can do things like, you know, programme avatars, interact with the child and look at their brain activity at the same time.

So we’re really excited about that because it should give us ways of looking in that age range where the behavioural signs of some of these conditions are already becoming apparent, but look in the brain what’s changing in that period in a way that we haven’t been able to do before. So we should be opening fairly soon. Sort of Covid permitting but at the moment we’re just putting in all of the equipment. The building is all finished. So hopefully in the next two to three months.

Interviewer: Finally, Emily, what is your takeaway message for those listening to our conversation today?

Professor Emily Jones: I think probably just the early development is really important and it’s an area that, sort of, waxes and wanes in terms of governmental funding and the Sure Start Programme and all of the ways in which early development is sometimes supported I think are really important, and what we’re learning from some of these prospective studies is that there are early signs that we can see that might relate to later developmental outcomes. So, you know, providing support, intervention, enriched experiences in those early years is an important thing as a society, we should be thinking about. You know, I think a lot of pressure gets put on parents that’s not necessarily that helpful, because often there’s a limit to what an individual parent you can do, but a societal level we need to be thinking about this this developmental window and what we can do to support trajectories.

Interviewer: Are you optimistic?

Professor Emily Jones: I think that there’s a growing understanding of the importance of early development. There’s been a lot of public campaigns about it. It’s very funding dependent, I think and I think, you know, at the moment obviously public finances are going to be very challenged by Covid and Brexit, etc. So, yeah, I’m not hugely optimistic, but at the same time I think we understand a lot more and we’re developing a lot more ways to understand what’s happening in early development and I think that might create this kind of pressure to support kids in the early years.

Interviewer: Brilliant. Thank you ever so much. For more details on Professor Emily Jones please visit the ACAMH website, www.acamh.org and Twitter at ACAMH. ACAMH is spelt ACAMH and don’t forget to follow us on iTunes or your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review and do share with friends and colleagues.

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