Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial

Jonathan Green, Tony Charman, Helen McConachie, Catherine Aldred, Vicky Slonims, Pat Howlin, Ann Le Couteur, Kathy Leadbitter, Kristelle Hudry, Sarah Byford, Barbara Barrett, Kathryn Temple, Wendy Macdonald, Andrew Pickles, PACT Consortium, Lydia White, Clare Holt, Dharmi Kapadia, Katy Bourne, Laura Blazey, Tori Houghton, Carol Taylor, Anna Cutress, Sue Leach, Sam Barron, Ruth Colmer, Sarah Randles, Karen Beggs, Julia Collino, Jonathan Green, Tony Charman, Helen McConachie, Catherine Aldred, Vicky Slonims, Pat Howlin, Ann Le Couteur, Kathy Leadbitter, Kristelle Hudry, Sarah Byford, Barbara Barrett, Kathryn Temple, Wendy Macdonald, Andrew Pickles, PACT Consortium, Lydia White, Clare Holt, Dharmi Kapadia, Katy Bourne, Laura Blazey, Tori Houghton, Carol Taylor, Anna Cutress, Sue Leach, Sam Barron, Ruth Colmer, Sarah Randles, Karen Beggs, Julia Collino

Abstract

Background: Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children. We therefore investigated the efficacy of such an intervention in a larger trial.

Methods: Children with core autism (aged 2 years to 4 years and 11 months) were randomly assigned in a one-to-one ratio to a parent-mediated communication-focused (Preschool Autism Communication Trial [PACT]) intervention or treatment as usual at three specialist centres in the UK. Those assigned to PACT were also given treatment as usual. Randomisation was by use of minimisation of probability in the marginal distribution of treatment centre, age (</=42 months or >42 months), and autism severity (Autism Diagnostic Observation Schedule-Generic [ADOS-G] algorithm score 12-17 or 18-24). Primary outcome was severity of autism symptoms (a total score of social communication algorithm items from ADOS-G, higher score indicating greater severity) at 13 months. Complementary secondary outcomes were measures of parent-child interaction, child language, and adaptive functioning in school. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN58133827.

Results: 152 children were recruited. 77 were assigned to PACT (London [n=26], Manchester [n=26], and Newcastle [n=25]); and 75 to treatment as usual (London [n=26], Manchester [n=26], and Newcastle [n=23]). At the 13-month endpoint, the severity of symptoms was reduced by 3.9 points (SD 4.7) on the ADOS-G algorithm in the group assigned to PACT, and 2.9 (3.9) in the group assigned to treatment as usual, representing a between-group effect size of -0.24 (95% CI -0.59 to 0.11), after adjustment for centre, sex, socioeconomic status, age, and verbal and non-verbal abilities. Treatment effect was positive for parental synchronous response to child (1.22, 0.85 to 1.59), child initiations with parent (0.41, 0.08 to 0.74), and for parent-child shared attention (0.33, -0.02 to 0.68). Effects on directly assessed language and adaptive functioning in school were small.

Interpretation: On the basis of our findings, we cannot recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms; however, a clear benefit was noted for parent-child dyadic social communication.

Funding: UK Medical Research Council, and UK Department for Children, Schools and Families.

Copyright 2010 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Trial profile PACT=Preschool Autism Communication Trial.
Figure 2
Figure 2
Context and assessment of Preschool Autism Communication Trial (PACT) intervention Data are effect size (95% CI). *Negative value indicates lower abnormality in PACT group.

References

    1. Bailey A, Le Couteur A, Gottesman I. Autism as a strongly genetic disorder: evidence from a British twin study. Psychol Med. 1995;25:63–77.
    1. Baird G, Simonoff E, Pickles A. Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP) Lancet. 2006;368:210–215.
    1. Howlin P, Goode S, Hutton J, Rutter M. Adult outcome for children with autism. J Child Psychol Psychiatry. 2004;45:212–229.
    1. Knapp M, Romeo R, Beecham J. Economic cost of autism in the UK. Autism. 2009;13:317–336.
    1. Le Couteur A, Baird G, Mills R. The National Autism Plan for Children (NAPC) National Autistic Society; London: 2003.
    1. Chakrabarti S, Fombonne E. Pervasive developmental disorders in preschool children. JAMA. 2001;285:3141–3142.
    1. Lord C, Wagner A, Rogers S. Challenges of evaluating psychosocial interventions for autistic spectrum disorders. J Autism Dev Disord. 2005;35:695–708.
    1. Rogers SJ, Vismara LA. Evidence-based comprehensive treatments for early autism. J Clin Child Psychol. 2008;37:8–38.
    1. Diggle T, McConachie HR, Randle VRL. Parent mediated early intervention for young children with autistic spectrum disorder (Cochrane review) John Wiley and Sons; Chichester: 2003.
    1. McConachie H, Diggle T. Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. J Eval Clin Pract. 2007;13:120–129.
    1. Lord C, Risi S, Lambrecht L, Cook EH., Jr The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord. 2000;30:205–223.
    1. Aldred C, Green J, Adams C. A new social communication intervention for children with autism: a pilot randomised controlled treatment study suggesting effectiveness. J Child Psychol Psychiatry. 2004;45:1420–1430.
    1. Kasari C, Freeman S, Paparella T. Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. J Child Psychol Psychiatry. 2006;47:611–620.
    1. Kasari C, Paparella T, Freeman S, Jahromi L. Language outcome in autism: randomized comparison of joint attention and play interventions. J Consult Clin Psychol. 2008;76:125–137.
    1. Yoder P, Stone WL. Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. J Consult Clin Psychol. 2006;74:426–435.
    1. Dawson G, Rogers S, Munson J. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics. 2010;125:17–23.
    1. Howlin P, Magiati I, Charman T. A systematic review of early intensive behavioural interventions (EIBI) for children with autism. Am J Intellect Dev Disabil. 2009;114:23–41.
    1. Spreckley M, Boyd R. Efficacy of Applied Behavioral Intervention in preschool children with autism for improving cognitive, language, and adaptive behavior: a systematic review and meta-analysis. J Pediatr. 2009;154:338–344.
    1. Lord C, Rutter M, Le Couteur A. Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive development disorders. J Autism Dev Disord. 1994;24:659–685.
    1. Mullen EM. Mullen Scales of Early Learning. American Guidance Service; Circle Pines, MN: 1995.
    1. Zimmer IL, Steiner VG, Pond RE. The Preschool Language Scales. British Psychological Corporation; London: 1992.
    1. Fenson L, Dale P, Reznick S. The MacArthur communicative development inventories: user's guide and technical manual. Singular Publishing Group; San Diego, CA: 1993.
    1. Wetherby AM, Prizant BM. Communication and Symbolic Behaviour Scales Developmental Profile. Paul H Brookes Publishing; Baltimore, MD: 2002.
    1. Sparrow SS, Cicchetti DV, Balla DA. Vineland adaptive behavior scales: second edition, Teacher Rating Form. Pearson Assessments; Livonia, MN: 2006.
    1. Royston P. Multiple imputation of missing values. Stata J. 2004;4:227–241.
    1. Rubin DB. Multiple imputation for nonresponse in surveys. Wiley; New York: 1987.
    1. Taylor A, Pickering K, Lord C, Pickles A. Mixed and multilevel models for longitudinal data: growth curve analysis of language development. In: Everitt B, Dunn G, editors. Recent advances in the statistical analysis of medical data. Arnold; London: 1998. pp. 127–144.
    1. Cohen DJ. Statistical power analysis for the behavioural sciences. Academic Press; New York: 1977.
    1. Siller M, Sigman M. The behaviors of parents of children with autism predict the subsequent development of their children's communication. J Autism Dev Disord. 2002;32:77–89.
    1. Siller M, Sigman M. Modeling longitudinal change in the language abilities of children with autism: parent behaviors and child characteristics as predictors of change. Dev Psychol. 2008;44:1691–1704.
    1. McMahon B, Holly L, Harrington R, Roberts C, Green J. Do larger studies find smaller effects? The example of studies for the prevention of conduct disorder. Eur Child Adolesc Psychiatry. 2008;17:432–437.
    1. Goldstein H. Communication intervention for children with autism: a review of treatment efficacy. J Autism Dev Disord. 2002;32:373–396.

Source: PubMed

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