Abstract | Summary | Original Article

Parent-mediated communication-focused
treatment in children with autism (PACT):
A randomised controlled trial.

Green J, Charman T, McConachie H, Aldred C, Slonims V, Howlin P, et al.

Lancet. 2010; 375: 2152-2160.

Question: Did a treatment program provided by parents trained in a communication intervention improve children`s core symptoms of autism?

Background: Early intervention is important for children with ASD and other developmental disorders. There have been multiple small studies that have shown that such interventions targeting social communication problems are effective in improving the core symptoms of autism. However, large scale randomized controlled trials of these treatments that could show definitely that they work had not been done. This study sought to remedy that situation by recruiting a large number of children to a program in which their parents were taught by a trained therapist to improve communication with their child.

Design: A randomized controlled trial, comparing the treatment under study to treatment as usual.

Setting: Three specialist clinics in England.

Participants: One hundred and fifty two children between the ages of 2 and 5 and their parents took part. All of the children had a diagnosis of autistic disorder. None of the children had a twin with autism, a developmental stage of less than 12 months, epilepsy requiring medication, severe hearing or sight problems in either the parent or the children, or a parent with a severe psychiatric disorder that required treatment.

Intervention: The treatment studied was a early language and social communication skills program that was delivered in 18 sessions to each child`s parent(s) with their child present. The goals of the treatment program were to increase the parents’ sensitivity to the child`s attempts to communicate and to reduce the number of times the parents misunderstood them. These skills are needed to encourage the child to communicate with others.

Outcome Measures: The most important outcome was the severity of autism symptoms. The researchers also looked at how the child and parents interacted, the child`s language use, and their ability to learn and meet the usual demands in life, including how independent they are compared to typically developing children of their own development stage.

Main Results: The intervention did not improve the children`s core symptoms of autism. However, there were significant gains in the quality of parent-child communication and the parents` sensitivity to their child`s attempts to communicate. Improved parent-child relationships have been shown to enhance the ASD child’s learning and improve the family situation.

Conclusions: Although the desired outcome of reducing autistic symptoms in these young children was not achieved, the families benefited through greater understanding of the children`s communication attempts and improved parent-child relationships.