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

Summary 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 a... Full description

Journal Title: The Lancet 2016, Vol.388 (10059), p.2501-2509
Main Author: Pickles, Andrew, Prof
Other Authors: Le Couteur, Ann, Prof , Leadbitter, Kathy, PhD , Salomone, Erica, PhD , Cole-Fletcher, Rachel, PhD , Tobin, Hannah, BSc , Gammer, Isobel, MSc , Lowry, Jessica, MSc , Vamvakas, George, MSc , Byford, Sarah, Prof , Aldred, Catherine, PhD , Slonims, Vicky, PhD , McConachie, Helen, Prof , Howlin, Patricia, Prof , Parr, Jeremy R, MD , Charman, Tony, Prof , Green, Jonathan, Prof
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
Link: https://www.ncbi.nlm.nih.gov/pubmed/27793431
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title: Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial
format: Article
creator:
  • Pickles, Andrew, Prof
  • Le Couteur, Ann, Prof
  • Leadbitter, Kathy, PhD
  • Salomone, Erica, PhD
  • Cole-Fletcher, Rachel, PhD
  • Tobin, Hannah, BSc
  • Gammer, Isobel, MSc
  • Lowry, Jessica, MSc
  • Vamvakas, George, MSc
  • Byford, Sarah, Prof
  • Aldred, Catherine, PhD
  • Slonims, Vicky, PhD
  • McConachie, Helen, Prof
  • Howlin, Patricia, Prof
  • Parr, Jeremy R, MD
  • Charman, Tony, Prof
  • Green, Jonathan, Prof
subjects:
  • Abridged Index Medicus
  • Analysis
  • Articles
  • asjc
  • atira
  • Autism
  • Autism Spectrum Disorder
  • Autistic Disorder - therapy
  • Care and treatment
  • Child
  • Children
  • Communication
  • Early intervention
  • Follow-Up Studies
  • Health aspects
  • Humans
  • Internal Medicine
  • Medicine(all)
  • Parents
  • Parents & parenting
  • Preschool children
  • pure
  • Social aspects
  • Social interaction
  • Studies
  • subjectarea
ispartof: The Lancet, 2016, Vol.388 (10059), p.2501-2509
description: Summary 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.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleParent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial
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creatorPickles, Andrew, Prof ; Le Couteur, Ann, Prof ; Leadbitter, Kathy, PhD ; Salomone, Erica, PhD ; Cole-Fletcher, Rachel, PhD ; Tobin, Hannah, BSc ; Gammer, Isobel, MSc ; Lowry, Jessica, MSc ; Vamvakas, George, MSc ; Byford, Sarah, Prof ; Aldred, Catherine, PhD ; Slonims, Vicky, PhD ; McConachie, Helen, Prof ; Howlin, Patricia, Prof ; Parr, Jeremy R, MD ; Charman, Tony, Prof ; Green, Jonathan, Prof
creatorcontribPickles, Andrew, Prof ; Le Couteur, Ann, Prof ; Leadbitter, Kathy, PhD ; Salomone, Erica, PhD ; Cole-Fletcher, Rachel, PhD ; Tobin, Hannah, BSc ; Gammer, Isobel, MSc ; Lowry, Jessica, MSc ; Vamvakas, George, MSc ; Byford, Sarah, Prof ; Aldred, Catherine, PhD ; Slonims, Vicky, PhD ; McConachie, Helen, Prof ; Howlin, Patricia, Prof ; Parr, Jeremy R, MD ; Charman, Tony, Prof ; Green, Jonathan, Prof
descriptionSummary 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.
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subjectAbridged Index Medicus ; Analysis ; Articles ; asjc ; atira ; Autism ; Autism Spectrum Disorder ; Autistic Disorder - therapy ; Care and treatment ; Child ; Children ; Communication ; Early intervention ; Follow-Up Studies ; Health aspects ; Humans ; Internal Medicine ; Medicine(all) ; Parents ; Parents & parenting ; Preschool children ; pure ; Social aspects ; Social interaction ; Studies ; subjectarea
ispartofThe Lancet, 2016, Vol.388 (10059), p.2501-2509
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14Parr, Jeremy R, MD
15Charman, Tony, Prof
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descriptionSummary 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.
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titleParent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial
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abstractSummary 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.
copEngland
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pmid27793431
doi10.1016/S0140-6736(16)31229-6
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