Limits...
Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial

View Article: PubMed Central - PubMed

ABSTRACT

Background: It is not known whether early intervention can improve long-term autism symptom outcomes. We aimed to follow-up the Preschool Autism Communication Trial (PACT), to investigate whether the PACT intervention had a long-term effect on autism symptoms and continued effects on parent and child social interaction.

Methods: PACT was a randomised controlled trial of a parent-mediated social communication intervention for children aged 2–4 years with core autism. Follow-up ascertainment was done at three specialised clinical services centres in the UK (London, Manchester, and Newcastle) at a median of 5·75 years (IQR 5·42–5·92) from the original trial endpoint. The main blinded outcomes were the comparative severity score (CSS) from the Autism Diagnostic Observation Schedule (ADOS), the Dyadic Communication Assessment Measure (DCMA) of the proportion of child initiatiations when interacting with the parent, and an expressive-receptive language composite. All analyses followed the intention-to-treat principle. PACT is registered with the ISRCTN registry, number ISRCTN58133827.

Findings: 121 (80%) of the 152 trial participants (59 [77%] of 77 assigned to PACT intervention vs 62 [83%] of 75 assigned to treatment as usual) were traced and consented to be assessed between July, 2013, and September, 2014. Mean age at follow-up was 10·5 years (SD 0·8). Group difference in favour of the PACT intervention based on ADOS CSS of log-odds effect size (ES) was 0·64 (95% CI 0·07 to 1·20) at treatment endpoint and ES 0·70 (95% CI −0·05 to 1·47) at follow-up, giving an overall reduction in symptom severity over the course of the whole trial and follow-up period (ES 0·55, 95% CI 0·14 to 0·91, p=0·004). Group difference in DCMA child initiations at follow-up showed a Cohen's d ES of 0·29 (95% CI −0.02 to 0.57) and was significant over the course of the study (ES 0·33, 95% CI 0·11 to 0·57, p=0·004). There were no group differences in the language composite at follow-up (ES 0·15, 95% CI −0·23 to 0·53).

Interpretation: The results are the first to show long-term symptom reduction after a randomised controlled trial of early intervention in autism spectrum disorder. They support the clinical value of the PACT intervention and have implications for developmental theory.

Funding: Medical Research Council.

No MeSH data available.


Related in: MedlinePlus

Profile of PACT trial plus follow-up study
© Copyright Policy - CC BY
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5121131&req=5

fig1: Profile of PACT trial plus follow-up study

Mentions: 152 participants were initially recruited into PACT between September, 2006, and February, 2008. 77 participants were assigned to the PACT intervention and 75 were assigned to treatment as usual. Figure 1 shows the flow of participants through the trial and follow-up. We were able to trace 144 (95%) of 152 participants, 126 (88%) of whom consented to participate in the current study. Of those randomly assigned, the follow-up ADOS assessment was completed for 59 (77%) of 77 participants assigned to the PACT intervention group and 62 (83%) of 75 participants in the treatment as usual group. At follow-up, 43 participants were assessed with module 1 of ADOS, 22 were assessed with module 2, and 56 were assessed with module 3. The median length of follow-up (baseline to follow-up) was 82 months (IQR 78–85), with median time from treatment endpoint to follow-up of 69 months (65–71). The mean age of participants at follow-up was 10·5 years (SD 0·8). Table 1 shows descriptive statistics by intervention group at baseline (all complete) and follow-up. The 31 participants lost to follow-up (six during the trial and 25 during follow-up) had no significant associations with treatment group, centre, autism severity, level of adaptive functioning, or any of the demographic measures shown in table 1. In individuals with follow-up data, participants in the PACT intervention group were more likely to be boys (p=0·05), from two-parent households (p=0·02), and to have parents with higher education (p=0·001) at baseline.


Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial
Profile of PACT trial plus follow-up study
© Copyright Policy - CC BY
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121131&req=5

fig1: Profile of PACT trial plus follow-up study
Mentions: 152 participants were initially recruited into PACT between September, 2006, and February, 2008. 77 participants were assigned to the PACT intervention and 75 were assigned to treatment as usual. Figure 1 shows the flow of participants through the trial and follow-up. We were able to trace 144 (95%) of 152 participants, 126 (88%) of whom consented to participate in the current study. Of those randomly assigned, the follow-up ADOS assessment was completed for 59 (77%) of 77 participants assigned to the PACT intervention group and 62 (83%) of 75 participants in the treatment as usual group. At follow-up, 43 participants were assessed with module 1 of ADOS, 22 were assessed with module 2, and 56 were assessed with module 3. The median length of follow-up (baseline to follow-up) was 82 months (IQR 78–85), with median time from treatment endpoint to follow-up of 69 months (65–71). The mean age of participants at follow-up was 10·5 years (SD 0·8). Table 1 shows descriptive statistics by intervention group at baseline (all complete) and follow-up. The 31 participants lost to follow-up (six during the trial and 25 during follow-up) had no significant associations with treatment group, centre, autism severity, level of adaptive functioning, or any of the demographic measures shown in table 1. In individuals with follow-up data, participants in the PACT intervention group were more likely to be boys (p=0·05), from two-parent households (p=0·02), and to have parents with higher education (p=0·001) at baseline.

View Article: PubMed Central - PubMed

ABSTRACT

Background: It is not known whether early intervention can improve long-term autism symptom outcomes. We aimed to follow-up the Preschool Autism Communication Trial (PACT), to investigate whether the PACT intervention had a long-term effect on autism symptoms and continued effects on parent and child social interaction.

Methods: PACT was a randomised controlled trial of a parent-mediated social communication intervention for children aged 2–4 years with core autism. Follow-up ascertainment was done at three specialised clinical services centres in the UK (London, Manchester, and Newcastle) at a median of 5·75 years (IQR 5·42–5·92) from the original trial endpoint. The main blinded outcomes were the comparative severity score (CSS) from the Autism Diagnostic Observation Schedule (ADOS), the Dyadic Communication Assessment Measure (DCMA) of the proportion of child initiatiations when interacting with the parent, and an expressive-receptive language composite. All analyses followed the intention-to-treat principle. PACT is registered with the ISRCTN registry, number ISRCTN58133827.

Findings: 121 (80%) of the 152 trial participants (59 [77%] of 77 assigned to PACT intervention vs 62 [83%] of 75 assigned to treatment as usual) were traced and consented to be assessed between July, 2013, and September, 2014. Mean age at follow-up was 10·5 years (SD 0·8). Group difference in favour of the PACT intervention based on ADOS CSS of log-odds effect size (ES) was 0·64 (95% CI 0·07 to 1·20) at treatment endpoint and ES 0·70 (95% CI −0·05 to 1·47) at follow-up, giving an overall reduction in symptom severity over the course of the whole trial and follow-up period (ES 0·55, 95% CI 0·14 to 0·91, p=0·004). Group difference in DCMA child initiations at follow-up showed a Cohen's d ES of 0·29 (95% CI −0.02 to 0.57) and was significant over the course of the study (ES 0·33, 95% CI 0·11 to 0·57, p=0·004). There were no group differences in the language composite at follow-up (ES 0·15, 95% CI −0·23 to 0·53).

Interpretation: The results are the first to show long-term symptom reduction after a randomised controlled trial of early intervention in autism spectrum disorder. They support the clinical value of the PACT intervention and have implications for developmental theory.

Funding: Medical Research Council.

No MeSH data available.


Related in: MedlinePlus