An early intervention that focuses on helping parents communicate with their child with autism yields long-term reductions in symptoms, a new study shows.
Published in The Lancet, the study was conducted by researchers at the University of Manchester, King's College London, and Newcastle University - all of which are in the United Kingdom.
Autism spectrum disorder (ASD) is a developmental disorder causing social, communication, and behavioral problems.
People with ASD can have learning, thinking, and problem-solving abilities that range from gifted to extremely challenged. They might repeat specific behaviors and may not welcome change in their daily routines.
Additionally, people with ASD typically have different ways of learning, paying attention, or reacting to situations. The condition can sometimes be detected before the age of 18 months, but by the age of 2 years, a diagnosis from a healthcare professional is typically considered accurate.
Still, many children do not receive an initial diagnosis until they are older, which means they may not get the early help that they need.
ASD typically endures throughout a person's life; there is no cure at present, and the condition affects about 1 in 100 people. As such, managing symptoms through early interventions is key in trying to alter the long-term course of the disorder.
However, until now, it has been difficult to demonstrate lasting outcomes for people with ASD that have come from effective early treatment.
Intervention teaches parents how to effectively communicate with child
This is where the Preschool Autism Communication Trial (PACT) comes in. As part of this trial, investigators randomized 152 children with autism between the ages of 2-4 to receive either a 12-month early intervention or treatment as usual.
- ASD presents itself in all racial, ethnic, and socioeconomic groups
- It is 4.5 times more common in boys than girls
- In 2006-2008, 1 in 6 children in the United States had a developmental disability, including intellectual disabilities, cerebral palsy, and autism.
This new study reports the follow-up analysis of these same children about 6 years after the end of their treatment.
Interestingly, the early intervention used in the trial focuses on the parent. By watching videos of themselves communicating and engaging with their child - and then receiving feedback from therapists - the parents are typically able to become more aware and responsive to their child's unique patterns of communication.
In short, the parents learn how to better understand their child and communicate back to them in a direct way.
In the intervention group, the parents take part in 12 therapy sessions over 6 months, in addition to monthly support sessions for the following 6 months.
The parents also do 20-30 minutes of daily planned communication and play activities with their child.
In this follow-up study, 80 percent of the original 152 trial participants were included. Of these, 59 children had received the PACT intervention, while 62 had treatment as usual.
The researchers measured autism severity with the international standard measure of autism symptoms (ADOS CSS), which combines social communication and restricted and repetitive behavior symptoms into one measure of severity. This is scored from 1-10, and 10 is the most severe.
Both groups had similar scores at the start of the trial. Those in the intervention group had ADOS CSS scores of 8.0, and those in the treatment-as-usual group had a score of 7.9.
At follow-up, the children in the treatment-as-usual group scored an average of 7.8, with 63 percent in the severe range, while the children in the intervention group scored an average of 7.3, with 46 percent in the severe range.
The researchers explain that this equates to a reduction of 17 percent in the proportion of children with severe symptoms in the intervention, compared with the children in the treatment-as-usual group.
'Sustained changes in autism symptoms possible after early intervention'
Results also reveal that there were improvements in children's communication with their parents in the intervention group. However, there were no differences in language scores for the children.
While parents from the intervention group reported improvements in peer relationships, social communication, and repetitive behaviors, there was no major difference between the two groups on indicators of child anxiety, challenging behaviors, or depression.
Lead author Prof. Jonathan Green, from the University of Manchester, says that their findings are promising, but he adds that it "is not a 'cure,' in the sense that the children who demonstrated improvements will still show remaining symptoms to a variable extent."
However, he adds that their findings suggest "that working with parents to interact with their children in this way can lead to improvements in symptoms over the long-term."
Profs. Tony Charman and Andrew Pickles - both study authors from King's College London - say:
"Our findings suggest that sustained changes in autism symptoms are possible after early intervention, something that has previously been regarded as difficult to achieve.
However, we found no evidence of any effect on child mental health, such as anxiety or challenging behaviors, suggesting that additional interventions may be needed to address these difficulties at later ages. As these children grow up, they will continue to need support in many aspects of their lives. We are currently working to further enhance our intervention."
The researchers add that their study included children with core autism symptoms, as opposed to wider ASD symptoms, so they are unable to conclude that their results would apply to children with less severe symptoms.
Additionally, the follow-up study was conducted when the children were 7-11 years of age, so it does not provide information on how their symptoms will be when they are adults.
Still, the team adds that their study is the first to identify a long-term symptom reduction after a trial of early intervention in ASD. They say their results "support the clinical value of the PACT intervention and have implications for developmental theory."