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What Pediatric Traumatic Brain Injury Can Teach Us About Autism


Nearly three million Americans suffer a traumatic brain injury (TBI) each year, one quarter of them children. Most of these are mild, resulting in concussion, but 50,000 deaths result from TBI annually.

At the same time, one in 59 children is diagnosed with autism spectrum disorder each year. Three and a half million Americans live with autism spectrum disorder (ASD).

These two conditions share more than a surprisingly large impact on our children: they share many biologic mechanisms and symptoms. Researchers have begun inquiring into how diagnosis and treatment of ASD and TBI might inform each other and lead to breakthroughs in one or both.

Children with traumatic brain injuries exhibit many of the same challenges as children with autism. These include deficits in intelligence, memory, attention, learning and social judgment. Anatomical changes to the brain resulting from TBI can impair emotional decision-making, self-regulatory behavior, emotional perception and the ability to recognize non-verbal cues. These are also classic characteristics of autism.

Children with ASD often present with decreased diversity of microflora in their intestines, which can hinder brain development. For children suffering TBI, reduced metabolism can also lead to a lack of microflora diversity. Whether the nature of this reduced diversity is similar in the two groups will require more study, but administration of probiotics has had success in both.

Brain plasticity – the ability of one region of the brain to rewire itself to execute functions normally performed by a damaged region – offers a ray of hope to TBI patients and autistic individuals. With intense therapy, brain stimulation and intervention, children with these two conditions can learn new skills by “training” their brains to process information in new ways.

Applied behavior analysis (ABA) is considered the gold standard in autism treatment given the extensive research conducted on its efficacy. It is employed to redirect behavior from harmful and counterproductive to useful and beneficial, and to teach critical skills for independence. Begun early in a child’s life, the progressive learning process of ABA therapy has demonstrated success in addressing multiple deficits – e.g., verbal, attentional, and learning – associated with ASD. ABA is now being used to readapt pediatric TBI patients to their home environment. As with ASD, this therapy yields optimum results when begun early and maintained over time.

ABA requires children to verbalize (or express using assistive communication devices) the instructions they have been given in an iterative approach that builds beneficial habits. This progressive learning process is applied to multiple behaviors characteristic of ASD and TBI. Additional strategies such as Pivotal response treatment (PRT), based on the principles of ABA, targets “pivotal” areas of a child’s development instead of working on one specific behavior. By focusing on pivotal areas, PRT produces improvements across other domains of skill development.

Verbal behavior therapy is a comprehensive language program that focuses on understanding the purpose of words and how they are used to communicate specific ideas. Also built on an ABA foundation, verbal behavior positively reinforces correct use of verbal and non-verbal communication that connects the speaker and the listener.

Although ASD and TBI present similar symptoms, there is no evidence that ASD is caused by trauma or injury to the brain. Its causes appear to be multifaceted and complex, including genetics, fetal conditions and various maternal and paternal factors. Like TBI, skill development and expansion can be optimized with behavioral treatment that begins as soon as possible.

How AI Can Transform the Autism Services Industry


Imagine providing parents with an app that enables them to upload videos of their children, analyzed by computers applying algorithms to diagnose autism earlier in their development than currently possible.

Imagine equipping autistic individuals with smart glasses that whisper instructions for navigating social situations in the user’s ear.

Imagine two-foot-tall humanoid robots that could serve as therapists for use in treating children with autism.

Artificial intelligence (AI) has made all this possible today. AI, equipped with machine learning, is improving constantly, and is positioned to become a critical adjunct to the human element in the diagnosis and treatment of autism. The operational and clinical advantages these advances convey are creating added value propositions for those enterprises that embrace it.

AI Disruptors in Other Industries

The ground for these paradigm-shifting advances has been well-trod in other industries. Consider how Waze disrupted the navigation business less than a decade ago. When other mapping apps stumbled to diagnose traffic jams and redirect travelers, Waze crowd-sourced traffic reports and provided real-time data about traffic incidents, speed limits, speed traps, and other valuable trip information to navigate the fastest possible route. As a result, the navigation app captured market share from Google, Mapquest, and other providers, with 25.6 million monthly users by 2018.

Waze has exploited that unique value add by establishing a ride share component that allows users to find, connect and ride together at a fraction of the cost of Uber and Lyft, themselves industry disruptors. Waze is also being accessed by governments and researchers seeking real-time data collected by its users. In Israel, researchers are asking Waze users to report roadkill, so they can track animal collisions and reroute animal movements to avoid them. The city of Hampton Roads, VA is mining Waze traffic data to determine where flooding is most acute as they develop their flood maps.

The Story of AI in Autism Services

The frame-breaking opportunities are similarly ripe in the autism services industry.  The platform created by Cognoa, a Palo Alto-based pediatric behavioral health program, uses machine learning and predictive analytics to analyze parent input of behavioral information to diagnose autism earlier. This allows intervention and customized education to begin in the critical early years of a child’s brain development.

Another AI solution developed by Brain Power, helps autistic individuals manage their emotions with a wearable digital coach that recognizes social situations and guides the user towards appropriate responses. This facilitates increased functional independence, also enabling some to interact more effectively in a standard workplace setting.

Monitors and wearable devices can also deliver a plethora of health, activity, and geographic information about clients in real time. With some analysis, staff could correlate patient meltdowns with changes in physiological ratios such as a spike in blood sugar levels, increased heart rate and sweating.

As an example, for individuals whose sugar intake is correlated with aggression, making dietary changes and collaborating with parents to monitor sugar and carbohydrate intake could reduce the frequency of outbursts and the required interventions, and would improve client outcomes and quality of life.

AI’s Impact Is Clinical and Operational

The business imperative for artificial intelligence covers the operational aspects of the autism services business as well. Employing this new business intelligence would enable service providers to tackle issues such as scheduling in a more targeted manner. If traffic on Friday afternoons in one location is causing sessions to start late, for example, modifications can be made to maximize session time.

This avoids the current practice of implementing policy and process changes across the board that may have negative impacts on service delivery in a different location where Friday afternoon traffic is not an issue. It is an ongoing process: continuing use of these tools could help determine which modifications were working and whether they were creating cancellation bulges elsewhere in the schedule.

The artificial intelligence that drives these revelations is the business imperative of the future of autism services, if not the present. It will eventually be a normal part of every autism service enterprise, as it already is in many industries. The early adopters will exploit a market inefficiency to deliver services that their competitors lack.