MedicalResearch.com Interview with:
Prof. Tony Charman
Chair in Clinical Child Psychology
King’s College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN)
Department of Psychology
PO77, Henry Wellcome Building
De Crespigny Park
Denmark Hill London
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The study is a follow-up of a treatment trial on which we have previous reported. In the original Preschool Autism Communication Trial (PACT), 152 children aged 2-4 with autism were randomised to receive the 12 month early intervention or treatment as usual. The type of early intervention used in this study focuses specifically on working with parents. Through watching videos of themselves interacting with their child and receiving feedback from therapists, parents are able to enhance their awareness and response to their child’s unusual patterns of communication; they become better able to understand their child and communicate back appropriately in a focused way. Parents take part in 12 therapy sessions over 6 months, followed by monthly support sessions for the next 6 months. In addition, parents agree to do 20-30 minutes per day of planned communication and play activities with the child.
The study published today is the follow-up analysis of the same children approximately 6 years after the end of treatment. The main findings are that children who had received the PACT intervention aged 2-4 had less severe overall symptoms six years later, compared to children who only received ’treatment as usual’ (TAU) with improved social communication and reduced repetitive behaviours, although no changes were seen in other areas such as language or anxiety. These findings on an international recognised and blind rated observational measure of autism symptoms were accompanied by improvements in children’s communication with their parents for the intervention group, but no differences in the language scores of children. Additionally, parents in the intervention group reported improvements in peer relationships, social communication and repetitive behaviours. However, there was no significant difference between the two groups on measures of child anxiety, challenging behaviours (eg, conduct/oppositional disorder) or depression.
MedicalResearch.com: What should readers take away from your report?
Response: Our study is the first to show a reduction in autism symptom severity through to age 7 to 11 years following early intervention. The findings suggest that sustained changes in autism symptoms are possible after early intervention, something that has previously been regarded as difficult to achieve. This type of early intervention is distinctive in being designed to work with parents to help improve parent-child communication at home. The advantage of this approach over a direct therapist-child intervention is that it has potential to affect the everyday life of the child. Our findings are encouraging, as they represent an improvement in the core symptoms of autism previously thought very resistant to change. This is not a ‘cure’, in the sense that the children who demonstrated improvements will still show remaining symptoms to a variable extent, but it does suggests that working with parents to interact with their children in this way can lead to improvements in symptoms over the long-term. However, we found no evidence of any effect on child mental health, such as anxiety or challenging behaviours, suggesting that additional interventions may be needed to address these difficulties at later ages. As these children grow up, they will continue to need support in many aspects of their lives
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We are currently working to further enhance our intervention. We are about to begin a new trial – PACT–Paediatric Autism Communication Trial – Generalised. This will be working in schools with learning support or teaching assistants who spend part of the day with young children with autism – teaching them the same skills with taught to parents. The hope is that in combination working at the same time with the parent in the home and also in the school will provide more benefit (and so help the gains to ‘generalise’ across contexts and communication partners. The study will commence early in 2017.
The other key priority is to see the children and families again as they enter adolescence to see if the gains are maintained further into development.
MedicalResearch.com: Is there anything else you would like to add?
Response: We think that our findings also contribute something new to developmental science. One of the key elements that makes the programme successful is working with parents who are able to practice the skills and techniques that they are learning (and in turn internalising in their interactions with their child) in the child’s everyday environment in the home. This is both efficient in terms of professional time but empowering for parents, boosting their confidence. This both creates a ’24/7’ therapeutic effects and holds the possibility the effects will extend beyond the end of treatment – which borne out by the remarkable effect that we have found of a treatment effect on both reducing autism symptoms and improving child communication initiations some 6 year following the end of treatment in our new follow-up study. We have explored in some of our previous work the mechanisms that we think are at play – based theory and evidence about dyadic communication between parents and children who are typically developing – that there is a casual chain of effect between the changes we see in parenting behaviour (what we have measured in our study as ‘parental synchrony’) and the changes this produces in their child’s communication style (increasing child communicative initiations when interacting with their parents) and then the reductions we see in core autism symptoms measured in our study in an interaction with an unfamiliar adult researcher.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial
Pickles, Andrew et al.
The Lancet , Volume 0 , Issue 0 , October 2016
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