Gordon Ramsay, PhD

Gordon Ramsay, PhD, has dedicated the last 12 years to working with kids with autism and learning about speech and language. Dr. Ramsay is the Director of the Spoken Communication Laboratory at the Marcus Autism Center and conducts research on early vocal development in children at risk for autism. His studies focus on infants and toddlers from birth to three-years-old and he’s interested in learning about early detection and intervention, and why kids have trouble with talking at an early age.

Autism is a neurodevelopmental disorder defined by core deficits in social communication and restricted interests and repetitive behaviors. Studies show the rate continues to increase, mainly due to progress in assessment and diagnosis: the current estimate from the Centers for Disease Control and Prevention is that 1 in 44 children will develop autism. Although autism is no longer defined by speech and language difficulties, up to half of individuals with autism will have trouble learning to speak early on in life. Kids with autism who can talk by the time they’re five-years-old will do much better when they’re adults than kids who don’t, whereas kids with autism who struggle with talking often end up in severe behavior programs and have trouble gaining independence as adults. Making sure that every child learns to talk is important for all children, but is especially important in ensuring the best outcomes for children with autism.

Dr. Ramsay and his team want to understand why autism creates difficulties in speech even though this is not a core defining feature of the syndrome. They want to know how they can detect early on which kids are at risk of developing autism, which of these kids will have trouble with spoken communication, and whether they can find biomarkers to detect the unfolding of autism before it can be diagnosed.

There are currently six different research studies in speech and language underway at the Spoken Communication Lab. All of these studies are designed to test how kids learn to talk, how speech is different in kids with autism, and how these differences can be measured using a variety of technologies to develop new methods of early detection in autism. In one NIH-funded study, Dr. Ramsay has babies wear a recording device in specially designed clothing, one day every month from birth, to make whole-day audio recordings of their natural language environment in the home. These recordings provide a much better sample of infant vocal behavior and infant-caregiver vocal interaction than short recordings in the lab or clinic. When the parents mail back the recorder each month, Dr. Ramsay can listen to what the infants are saying and what they hear around them. Using specialized software he developed, he can also automatically analyze the sounds each child makes, and the sounds caregivers make when talking to their children, to map out trajectories of vocal development.

Autism isn’t a subtle condition once it’s diagnosed, but the earliest precursors of autism in infancy can only be detected if you look at behavior for long periods of time, and developmental disorders can only be understood by monitoring change over time. The recordings from these studies help researchers measure behaviors over months and years, as well as from moment to moment. They also provide the data needed to identify subtle signs of autism in patterns of vocal signaling and response, not only in the infant but also in the caregiver. Precursors of autism that predict later diagnosis and outcome can be found in the timing of infant-caregiver interactions, and in the onset of key milestones in speech and language development such as babbling and first words, all of which are different in autism. Differences in prosody – the intonation and rhythm of the voice typically used to signal emotion – that are atypical in adults with autism can also be found in the higher-pitched cries of babies within the first months of life. By mapping out individual developmental trajectories in all of these domains of vocal behavior, children who go on to develop autism can be differentiated from typically developing peers before their first birthday.

While autism can’t be cured, researchers can help alter trajectories of development to lead to better outcomes. The earliest biomarkers of risk for autism are deficits in early social interaction, so interventions that can promote early interaction at home are likely to be effective in shaping better outcomes for kids. Results from research studies like those at the Marcus Center can teach caregivers how to stimulate social interactions early in life, when a baby’s brain is still malleable and easier to shape through experience, instead of waiting until later in life, when intervention becomes more difficult and may not be effective as neuroplasticity declines.

Dr. Ramsay says Ami Klin convinced him to get into this work up at Yale and says, “When we came down to Atlanta, the motivation of seeing the Marcus family was inspiring. There’s no doubt everyone at Emory and Children’s Healthcare of Atlanta is deeply committed to helping children. We all want to help kids by doing worthwhile research. This kind of work teaches us we can take basic research, implement it on a large scale, and translate it out into the community. Our Center shows you can combine basic research on early childhood development with clinical practice to make a difference and shape the lives of kids. I never thought I’d work with children or communication disorders, but I think we can all be a good model of how to combine engineering and medicine to promote early detection and intervention.”