Parent-Mediated Communication-Focused Treatment for Preschool Children with Autism (MRC PACT); A Randomised Controlled Trial

Background: Accumulating evidence from recent randomized trials and systematic reviews^1,2,3,4 has suggested the potential effectiveness of early social communication interventions for autism. Positive reports have also come from studies of behaviourally focused approaches although evidence from the few randomised controlled trials in that area is more equivocal.⁵ Firm inferences from all these studies to date have been somewhat limited however by size and heterogeneity of samples and sometimes aspects of methodology. The PACT trial aimed to provide a stringent test of parent-child communication-focused intervention in preschoolers with core autism, using the largest sample to date and a rigorous RCT design.

Objectives: To provide a stringent test of a parent-mediated communication-focused intervention for preschoolers with core autism, using a large sample and a rigorous RCT design (www.medicine.manchester.ac.uk/pact).

Methods: 152 children with core autism aged 2 - 4.11 were studied in a 3 site 2 arm single (assessor) blinded randomised controlled trial of a parent-mediated communication-focused intervention added to treatment as usual (TAU) against TAU alone. The primary outcome was severity of autism symptoms (total social communication algorithm items from the Autism Diagnostic Observation Schedule, ADOS). Complementary secondary outcomes were: 1) a standardised measure of parent-child interaction (PCI)²; 2) blinded research rating of child language on the Preschool Language Scales; 3) parent reported (non-blind) ratings on the McArthur Communicative Developmental Inventory (MCDI; infant form raw scores), the Communication and Symbolic Behaviour Scales – Developmental Profile (CSBS-DP), and the Vineland Adaptive Behavior Scales (Parent Form); 4) Vineland Adaptive Behavior Scales, 2^nd edition, Teacher Rating Form rated by teachers in nurseries, reception class or other appropriate out-of-family carers. Attention was paid in the study to the details of randomization and blinded ascertainment. All the analysis undertaken was pre-specified.

Results: Data analysis is complete but the results currently embargoed while undergoing review by the Lancet.  Full data from the study will be available to be presented at IMFAR.

Conclusions: The implications of our results for autism intervention practice and research will be outlined.

References

1. Diggle et al. Parent mediated early intervention for young children with autistic spectrum disorder (Cochrane review). The Cochrane Library, Issue 4. Chichester, UK: John Wiley & Sons, 2003.

2. Aldred C et al. A new social communication intervention for children with autism:  a pilot randomised controlled treatment study suggesting effectiveness. J Child Psychol Psychiatry 2004; 45: 1420-30.

3. Kasari et al.  L. Language outcome in autism: Randomized comparison of joint attention and play interventions. J Consult Clin Psychol 2008; 76: 125-37.

4. Yoder & Stone. Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. J Consult Clin Psychol 2006; 74: 426-35.

5. Spreckley & Boyd. 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: 338-44.