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Published on: July 31, 2017
Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
Jonathan Green1, Tony Charman, Helen McConachie
1Psychiatry Research Group, University of Manchester, Manchester, UK. jonathan.green@manchester.ac.uk
Insights
The Preschool Autism Communication Trial (PACT) did not significantly reduce autism symptom severity in young children. However, PACT showed benefits in improving parent-child social communication, suggesting a targeted advantage for early autism interventions.
Area of Science:
- Developmental Psychology
- Clinical Psychology
- Pediatrics
Background:
- Small trials indicate early social communication interventions are effective for childhood autism.
- This larger trial investigated the efficacy of a parent-mediated intervention for autism in children.
Purpose of the Study:
- To evaluate the effectiveness of the Preschool Autism Communication Trial (PACT) intervention compared to treatment as usual.
- To assess the impact of PACT on autism symptom severity, parent-child interaction, child language, and adaptive functioning.
Main Methods:
- Randomized controlled trial involving 152 children aged 2 to 4 years and 11 months with core autism.
- Children were assigned to either PACT intervention plus treatment as usual, or treatment as usual alone.
- Primary outcome was autism symptom severity measured by the Autism Diagnostic Observation Schedule-Generic (ADOS-G) at 13 months.
Main Results:
- No significant difference in autism symptom severity (ADOS-G score) was found between the PACT group and the treatment as usual group.
- The PACT intervention demonstrated positive effects on parent-child interaction, including parental synchronous response and child initiations.
- Improvements were noted in parent-child shared attention, while effects on language and adaptive functioning were minimal.
Conclusions:
- Adding the PACT intervention to standard treatment did not lead to a significant reduction in overall autism symptoms.
- A notable benefit of PACT was observed in enhancing dyadic parent-child social communication skills.
- Findings suggest PACT may be beneficial for specific aspects of social communication in young children with autism.
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), 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.
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