This briefing is designed to provide further insight into a recent research article on the effectiveness of an early intervention approach in families with an autistic child. The briefing also discusses the potential, wider relevance of the parent-child intervention at the heart of the research.
The first thing to note is that the introductory page to which we provided a link sets out a usefully brief summary of the research’s main conclusions. The key thing that summary, and the article itself emphasises, is that the particular intervention which was evaluated was shown to have longer-term positive effects. The research article suggests this finding is in contrast to other studies which have identified only short-term benefits from intervention.
As the research article says: “Previous evidence from trials has suggested that early intervention can result in short-term symptom reduction in young children with autism spectrum disorder. We now show that a 12 month parent-mediated preschool intervention can produce sustained improvement in child autism symptoms and social communication with parents, which remained at nearly 6 years after the end of treatment. These findings support the potential long-term effects and value of early parent-mediated interventions for autism.”
The research involved longer-term follow-up of the Preschool Autism Communication Trial (PACT). PACT was “a randomised controlled trial of a parent-mediated social communication intervention for children aged 2–4 years with core autism”. (That means the result cannot be assumed to apply to other children with less severe symptoms who are on the autism spectrum).
The intervention is a 1 year developmentally focused social communication intervention programme for young children that consists of 12 therapy sessions (each 2 hours long) over 6 months, followed by monthly support and extension sessions for a further 6 months. Additionally, parents agree to do 20–30 min per day of planned practice activities with the child.
As the King’s College introduction further clarifies, through watching videos of themselves interacting with their child and receiving feedback from therapists, parents were able to enhance their awareness and their responses to their child’s unusual patterns of communication.
The King’s College also says that the researchers found that children who had received the intervention aged 2-4 had less severe overall symptoms six years later, with improved social communication and reduced repetitive behaviours, although no changes were seen in other areas such as language or child mental health issues such as anxiety or challenging behaviours.
The successes of the intervention therefore didn’t mean that all difficulties had been overcome and the researchers recognised that additional ongoing support would usually be needed as children get older.
Nonetheless, the research findings seem very encouraging in what is still a relatively recent subject of clinical and care concern, particularly since, as the researchers point out, “the advantage of this approach over a direct therapist-child intervention is that it has potential to affect the everyday life of the child.” The research is also of increased interest because of its relatively large sample size (152 participants).
The research article itself is, of necessity, a fairly technical one, but I took the following additional points from its discussion of findings.
Alongside the identified continued improvements in directly measured symptoms, and in social communication and reduced repetitive behaviours, the study found some evidence of parent-reported improvements in symptoms. That might translate into a service user outcome measure and has the additional potential advantage of reflecting behaviour in ‘naturalistic’ settings.
The article points out that effects on targeted outcomes of the type seen in the study, and for a prolonged period after the end of treatment, are very uncommon in developmental interventions. And that perhaps opens wider questions for developmental science.
Emphasis is one again laid on the probable importance of the parent-mediated nature of the intervention in affecting long term change; and the possibility that the improvements made at the early stage become, to some extent, self-sustaining.
Finally, the article notes that the intervention’s focus on improved child social communication had the hoped-for additional effect on restricted and repetitive behaviours of the child, On the other hand, and as noted above, no positive effect on child anxiety was found.
We’re providing this briefing, partly, and as always, to draw additional attention to what is an interesting practice-related article. We also felt it was worth doing so because of the potential wider applicability of the methods used in the interventions evaluated in the study.
This was, of course, a fully-funded and extensive piece of research on a specific childhood disorder; and one which looked at the effects of a tailored intervention designed to tackle a particular set of circumstances.
But the focus on improving early social communication and improving child-parent relationships will lie at the heart of many of the situations with which practitioners will be dealing. The use of video, linked to professional feedback; and, effectively, allowing parents to be – to some extent – their own therapists in working with their children, seem key elements to the approach that should be tested more widely.
Of course, there are issues of family type, and cost that are not discussed in the article – the intervention seems unlikely to be cheap. But are there not at least a small number of children with other problems severe enough to merit at least a trial of the sort directed at relieving the symptoms of autism?
And, as a final comment in relation to autism itself, the whole approach described in the study must rely on effective early diagnosis of autism, which, in an improving field, cannot yet, or always, be relied upon.
Recent CareKnowledge links on autism
A national clinical guideline produced by the Scottish Intercollegiate Guidelines Network School Report 2016&
A report from that looks at how the new Special Educational Needs and Disability (SEND) system is meeting the needs of children and young people on the autism spectrum in England, two years on from its inception
This guide introduces the debate around autism and gender and identifies the key issues for girls with autism spectrum conditions.
For children with learning disabilities and/or autism, getting dressed can be a challenge, but there are some simple ways it can be made easier.
Learning Disabilities Elf research summary which looks at a study which focused in particular on adolescents, and considered that the severity of autism symptoms were related to the incidence of self-injurious behaviour during adolescence.