Authors Andrew Pickles, Ann Le Couteur, Kathy Leadbitter, Erica Salomone, Rachel Cole-Fletcher, Hannah Tobin, Isobel Gammer, Jessica Lowry, George Vamvakas, Sarah Byford, Catherine Aldred, Vicky Slonims, Helen McConachie, Patricia Howlin, Jeremy Parr, Tony Charman, Jonathan Green
Published by The Lancet, October 2016
SUMMARY
There has been relatively little research into the long-term effects of autism treatment. Researchers from the University of Manchester, King's College London and Newcastle University set out to investigate whether an intervention to support parents to communicate with their child helped reduce symptoms of autism. Between 2006 and 2009, 152 children with autism aged between two and four took part in the Preschool Autism Communication Trial (Pact) in London, Manchester and Newcastle. Children either received the early intervention programme for 12 months or continued to receive their usual treatment.
Pact focused on working with parents, who watched videos of themselves interacting with their child and received feedback from therapists. This helped parents build awareness of how they were responding to their child's unusual patterns of communication, and learn to communicate with them more appropriately. Parents took part in 12 therapy sessions over six months, followed by monthly support sessions for the next six months. They also agreed to carry out 20 to 30 minutes of communication and play activities with their child every day.
In all, 80 per cent of the original sample - 121 children - were assessed six years after the trial concluded. Of these, 59 children had received the intervention and 62 had received treatment as usual. The severity of the children's autism was measured using the international standard measure of autism symptoms - the ADOS calibrated severity score. This combines symptoms around social communication and behaviour into an overall measure of severity scored between one and 10, with 10 being the most severe.
The researchers found children who had received the intervention had less severe overall symptoms six years later. At the start of the trial, both groups of children had similar scores. Those in the intervention group had an average score of 8.0 while those in the treatment as usual group had an average score of 7.9. At the follow-up assessment six years later, children in the intervention group scored an average of 7.3, with 46 per cent of the group classed as being in the severe range. Children who had received treatment as usual scored an average of 7.8, with 63 per cent in the severe range. This equates to a 17 percentage point gap in the proportion of children with severe symptoms in the intervention group, compared with those who had undergone treatment as usual.
IMPLICATIONS FOR PRACTICE
The researchers say the findings are encouraging, as they indicate an improvement in core symptoms of autism previously thought very resistant to change. Rather than a therapist working directly with a child, this type of programme is designed to work with parents to help improve parent-child communication at home so has the potential to affect children's everyday lives.
FURTHER READING
Parent-Mediated Communication-focused Treatment in Children with Autism (Pact): A Randomised Controlled Trial, Jonathan Green and others, The Lancet, June 2010. The original results of the Pact trial, followed up in the current paper.
Longitudinal Follow-up of Children with Autism Receiving Targeted Interventions on Joint Attention and Play, Connie Kasari and others, Journal of the American Academy of Child & Adolescent Psychiatry, May 2012. This study examines cognitive and language outcomes for children with an autism spectrum disorder who have received targeted early interventions.
Parent-Mediated Early Intervention for Young Children with Autism Spectrum Disorders (ASD), Inalegwu Oono, Emma Honey, Helen McConachie, The Cochrane Database of Systematic Reviews, April 2013. A review of approaches that help parents of children with autism develop strategies for interaction and behaviour management.
