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document
Parent-mediated communication-focused treatment in children with autism ( PACT ) : a randomised controlled trial . 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 can not 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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Intervention_Educational
Parent-mediated communication-focused treatment
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Intervention_Educational
parent-mediated communication-focused ( Preschool Autism Communication Trial [ PACT ] ) intervention
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Intervention_Control
treatment as usual
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Intervention_Educational
PACT
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Intervention_Other
treatment as usual
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Intervention_Educational
PACT intervention
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Outcome_Other
efficacy
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Outcome_Mental
severity of autism symptoms ( a total score of social communication algorithm items from ADOS-G , higher score indicating greater severity ) at 13 months .
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Outcome_Mental
measures of parent-child interaction , child language , and adaptive functioning in school .
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Outcome_Mental
severity of symptoms
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Outcome_Mental
parental synchronous response
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Outcome_Mental
directly assessed language and adaptive functioning
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Outcome_Mental
parent-child dyadic social communication .
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Participant_Age
children
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Participant_Condition
autism
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Participant_Condition
autism
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Participant_Age
children
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Participant_Age
Children
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Participant_Condition
core autism
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Participant_Age
( aged 2 years to 4 years and 11 months )
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Participant_Sample-size
152
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Participant_Sample-size
77
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Participant_Sample-size
n=26
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Participant_Sample-size
n=26
45866
Participant_Sample-size
n=25
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Participant_Sample-size
75
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Participant_Sample-size
n=26
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Participant_Sample-size
n=26
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Participant_Sample-size
n=23