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

BACKGROUND: Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children. We therefore investigated the efficacy of such an intervention in a larger trial. METHODS: Children with core autism (aged 2 years to 4 years and 11 mo...

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Autores principales: Green, Jonathan, Charman, Tony, McConachie, Helen, Aldred, Catherine, Slonims, Vicky, Howlin, Pat, Le Couteur, Ann, Leadbitter, Kathy, Hudry, Kristelle, Byford, Sarah, Barrett, Barbara, Temple, Kathryn, Macdonald, Wendy, Pickles, Andrew
Formato: Texto
Lenguaje:English
Publicado: Lancet Publishing Group 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890859/
https://www.ncbi.nlm.nih.gov/pubmed/20494434
http://dx.doi.org/10.1016/S0140-6736(10)60587-9
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author Green, Jonathan
Charman, Tony
McConachie, Helen
Aldred, Catherine
Slonims, Vicky
Howlin, Pat
Le Couteur, Ann
Leadbitter, Kathy
Hudry, Kristelle
Byford, Sarah
Barrett, Barbara
Temple, Kathryn
Macdonald, Wendy
Pickles, Andrew
author_facet Green, Jonathan
Charman, Tony
McConachie, Helen
Aldred, Catherine
Slonims, Vicky
Howlin, Pat
Le Couteur, Ann
Leadbitter, Kathy
Hudry, Kristelle
Byford, Sarah
Barrett, Barbara
Temple, Kathryn
Macdonald, Wendy
Pickles, Andrew
author_sort Green, Jonathan
collection PubMed
description BACKGROUND: Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children. We therefore investigated the efficacy of such an intervention in a larger trial. METHODS: Children with core autism (aged 2 years to 4 years and 11 months) were randomly assigned in a one-to-one ratio to a parent-mediated communication-focused (Preschool Autism Communication Trial [PACT]) intervention or treatment as usual at three specialist centres in the UK. Those assigned to PACT were also given treatment as usual. Randomisation was by use of minimisation of probability in the marginal distribution of treatment centre, age (≤42 months or >42 months), and autism severity (Autism Diagnostic Observation Schedule-Generic [ADOS-G] algorithm score 12–17 or 18–24). Primary outcome was severity of autism symptoms (a total score of social communication algorithm items from ADOS-G, higher score indicating greater severity) at 13 months. Complementary secondary outcomes were measures of parent-child interaction, child language, and adaptive functioning in school. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN58133827. RESULTS: 152 children were recruited. 77 were assigned to PACT (London [n=26], Manchester [n=26], and Newcastle [n=25]); and 75 to treatment as usual (London [n=26], Manchester [n=26], and Newcastle [n=23]). At the 13-month endpoint, the severity of symptoms was reduced by 3·9 points (SD 4·7) on the ADOS-G algorithm in the group assigned to PACT, and 2·9 (3·9) in the group assigned to treatment as usual, representing a between-group effect size of −0·24 (95% CI −0·59 to 0·11), after adjustment for centre, sex, socioeconomic status, age, and verbal and non-verbal abilities. Treatment effect was positive for parental synchronous response to child (1·22, 0·85 to 1·59), child initiations with parent (0·41, 0·08 to 0·74), and for parent-child shared attention (0·33, −0·02 to 0·68). Effects on directly assessed language and adaptive functioning in school were small. INTERPRETATION: On the basis of our findings, we cannot recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms; however, a clear benefit was noted for parent-child dyadic social communication. FUNDING: UK Medical Research Council, and UK Department for Children, Schools and Families.
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spelling pubmed-28908592010-07-15 Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial Green, Jonathan Charman, Tony McConachie, Helen Aldred, Catherine Slonims, Vicky Howlin, Pat Le Couteur, Ann Leadbitter, Kathy Hudry, Kristelle Byford, Sarah Barrett, Barbara Temple, Kathryn Macdonald, Wendy Pickles, Andrew Lancet Articles BACKGROUND: Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children. We therefore investigated the efficacy of such an intervention in a larger trial. METHODS: Children with core autism (aged 2 years to 4 years and 11 months) were randomly assigned in a one-to-one ratio to a parent-mediated communication-focused (Preschool Autism Communication Trial [PACT]) intervention or treatment as usual at three specialist centres in the UK. Those assigned to PACT were also given treatment as usual. Randomisation was by use of minimisation of probability in the marginal distribution of treatment centre, age (≤42 months or >42 months), and autism severity (Autism Diagnostic Observation Schedule-Generic [ADOS-G] algorithm score 12–17 or 18–24). Primary outcome was severity of autism symptoms (a total score of social communication algorithm items from ADOS-G, higher score indicating greater severity) at 13 months. Complementary secondary outcomes were measures of parent-child interaction, child language, and adaptive functioning in school. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN58133827. RESULTS: 152 children were recruited. 77 were assigned to PACT (London [n=26], Manchester [n=26], and Newcastle [n=25]); and 75 to treatment as usual (London [n=26], Manchester [n=26], and Newcastle [n=23]). At the 13-month endpoint, the severity of symptoms was reduced by 3·9 points (SD 4·7) on the ADOS-G algorithm in the group assigned to PACT, and 2·9 (3·9) in the group assigned to treatment as usual, representing a between-group effect size of −0·24 (95% CI −0·59 to 0·11), after adjustment for centre, sex, socioeconomic status, age, and verbal and non-verbal abilities. Treatment effect was positive for parental synchronous response to child (1·22, 0·85 to 1·59), child initiations with parent (0·41, 0·08 to 0·74), and for parent-child shared attention (0·33, −0·02 to 0·68). Effects on directly assessed language and adaptive functioning in school were small. INTERPRETATION: On the basis of our findings, we cannot recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms; however, a clear benefit was noted for parent-child dyadic social communication. FUNDING: UK Medical Research Council, and UK Department for Children, Schools and Families. Lancet Publishing Group 2010-06-19 /pmc/articles/PMC2890859/ /pubmed/20494434 http://dx.doi.org/10.1016/S0140-6736(10)60587-9 Text en © 2010 Elsevier Ltd. All rights reserved. This document may be redistributed and reused, subject to certain conditions (http://www.elsevier.com/wps/find/authorsview.authors/supplementalterms1.0) .
spellingShingle Articles
Green, Jonathan
Charman, Tony
McConachie, Helen
Aldred, Catherine
Slonims, Vicky
Howlin, Pat
Le Couteur, Ann
Leadbitter, Kathy
Hudry, Kristelle
Byford, Sarah
Barrett, Barbara
Temple, Kathryn
Macdonald, Wendy
Pickles, Andrew
Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
title Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
title_full Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
title_fullStr Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
title_full_unstemmed Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
title_short Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
title_sort parent-mediated communication-focused treatment in children with autism (pact): a randomised controlled trial
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890859/
https://www.ncbi.nlm.nih.gov/pubmed/20494434
http://dx.doi.org/10.1016/S0140-6736(10)60587-9
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