Pickles, A., Le Couteur, A., Leadbitter, K., Salomone, E., Cole-Fletcher, R., Tobin, H., … Aldred, C. (2016). Parent-mediated social communication therapy for young children with autism (PACT): Long-term follow-up of a randomized controlled trial. The Lancet, 388, 2501-2509. doi:10.1016/S0140-6736(16)31229-6
Reviewed by: Nicole A. Pantano
Caldwell University
Why research this topic?
Few studies have looked at long-term outcomes of autism spectrum disorder (ASD) treatment such as changes in symptoms associated with ASD. The purpose of the current study was to measure the long -term outcomes of the Preschool Autism Communication Trial (PACT). This trial randomly assigned children with ASD, age 2-4 years at entry into the study, to receive either the PACT intervention or services available in the community (“treatment as usual”). The PACT intervention consisted of 12, two-hour parent training sessions for six months and monthly sessions for another six months, focused on social communication skills. Parents completed specific activities with their child for about 30 minutes every day.
What did the researcher do?
Originally, 152 participants received either PACT or treatment as usual. At follow-up, 59 PACT participants and 62 treatment as usual participants were assessed at an average age of 10.5 years. The assessors watched 8-min videos of parent-child naturalistic play to examine parent-child communication and child language. Parents reported on ASD symptoms including: restricted and repetitive behaviors, insistence on sameness, peer problems, and adaptive behavior outcomes. Also, the researchers evaluated whether any children had additional diagnoses.
What did the researchers find?
Children whose parents received PACT had fewer or less severe ASD symptoms and more communication with their parents at follow-up, but they did not differ from children in treatment as usual in their receptive or expressive language.
What are the strengths and limitations of the study?
A strength of this study was that assessors were unaware of which treatment the children received. This helped ensure that their ratings were unbiased (i.e., unaffected by expectations about whether one group would do better than the other). Another strength was that the study included a large sample of children diagnosed with ASD, most of whom took part in the follow-up assessment. However, a limitation of the study is that, despite random assignment to groups, parents in PACT had more education than parents in treatment as usual. This imbalance could have contributed to the more favorable outcomes in PACT. Also, in their discussion, it would have been helpful if the authors could have done more to put their findings in the context of reports on long-term outcomes in intensive behavioral treatment, such as McEachin, Smith, Lovaas (1993).
What do the results mean?
Overall, PACT was superior to treatment as usual at a 6-year follow-up on most, but not all, measures. This indicates that a low-intensity parent training program can be effective in producing long-term improvements on core features of ASD. However, the finding of no group differences on some measures suggests either that PACT has limited effects on some aspects of functioning or shares common elements with treatment as usual. Replications are needed to confirm the findings, identify which components of PACT contributed to the favorable outcomes, and determine which children and families are most likely to benefit from the intervention.
Reference:
McEachin, J. J., Smith, T., & Ivar Lovaas, O. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 97, 359-359.
Citation for this article:
Pantano, N. (2017). Research synopses: Parent-mediated social communication therapy for young children with autism (PACT). Science in Autism Treatment, 14(4), 24-25.
