Abstract | Summary | Original Article

A pilot randomized control trial of a parent training intervention for pre-school children with autism. Preliminary findings and methodological challenges.

Drew A, Baird G, Baron-Cohen S, Cox A, Slonims V, Wheelwright S, Swettenham J, Berry B, Charman T.

European Child & Adolescent Psychiatry 11:266-272 (2002)

Question: Does parent training improve joint attention and joint action in pre-school children with autism?

Background: Children with autism have varying degrees of difficulty in engaging in social interactions with other people. One of the hallmark symptoms of autism is a problem with sharing interest in objects with other people; that is, shared attention. Some researchers believe that improvement of this basic skill will enhance language and non-verbal communication development. As with any other intervention for children with autism, an early start is crucial, so this study was done with preschoolers.

Design: This was a pilot randomized controlled trial (RCT) of a training intervention for parents of preschool children with autism. Using a random numbers table, the families of twenty-four children were assigned to either standard community care or to a parent training program. Analysis was by intention to treat, that is, every child who entered the study was accounted for and their outcomes were included in the analysis whether or not they stayed in the study.

Setting: Health visitors screened children in a British community, using a shortened version of the Checklist for Autism in Toddlers (CHAT). If a child met the study’s criteria, they were referred for full assessment.

Patients: The patients were the parents of twenty-four children with a mean age of 23 months who had been diagnosed with autism after a full clinical assessment. The diagnosis was based on ICD-10 criteria, as well as all clinical, historical, and psychometric data. The diagnosis was based on consensus between two experienced clinicians.

Intervention: Parent-training intervention using a psycholinguistic and social-pragmatic approach, emphasized development of joint attention and provided advice about behaviour management, especially around the promotion of compliance. The control group received standard community care.

Main outcome measures: Language comprehension and production was assessed with the MacArthur Communictive Development Inventory (CDI). The intelligence of non-verbal children was assessed using the Griffiths Scale of Infant Development. The symptom severity was measured with the ADI-R. Parental stress was measured with the Parental Stress Inventory.

Main results: After the intervention there was no difference in non-verbal I.Q. between the two groups. The parent training group showed higher language comprehension but the difference between the groups did not meet statistical significance. More children in the parent training group became verbal, that is, they went from no speech to using single words or phrases and the acquisition of speech in this group did meet statistical significance.

There was no difference between groups in symptom severity

There was no difference between groups in the parents’ self report of stress.

Conclusion: The authors concluded that the study demonstrated that the parent training program focusing on joint attention and joint engagement would improve communication skills.It is possible that the improvement in language seen in the training group was due to differences in the characteristics of the two groups. Many of the outcomes relied on parent report, rather than on objective measures.

The problems associated with running RCTs with children with autism were described in the report and suggestions were made as to how to overcome them.