Parent-led early intervention for autism is the first to show reduction in symptom severity through to ages 7-11

October 26, 2016, Lancet

An early intervention for autism aimed at helping parents communicate with their child has been shown to have an effect on reducing the severity of autism symptoms, and this reduction continued for six years after the end of treatment, according to a study published in The Lancet. The study led by the University of Manchester, King's College London and Newcastle University (UK) is the first to identify a long-term effect of an early intervention for autism, and is consistent with UK guidance supporting the use of early intervention.

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 anxiety. However, they say that difficulties remain and additional ongoing support will usually be needed as the children get older.

"This type of early intervention is distinctive in being designed to work with to help improve parent-child communication at home," says Professor Jonathan Green, University of Manchester and Royal Manchester Children's Hospital, who led the study. "The advantage of this approach over a direct therapist-child intervention is that it has potential to affect the everyday life of the child. Our findings are encouraging, as they represent an improvement in the core symptoms of autism previously thought very resistant to change. This is not a 'cure', in the sense that the children who demonstrated improvements will still show remaining symptoms to a variable extent, but it does suggests that working with parents to interact with their children in this way can lead to improvements in symptoms over the long-term."

Autism spectrum disorder is a developmental disorder that affects about 1 in 100 people; it can have a profound effect on children's social development into adulthood and results in an estimated £1-1.5 million in lifetime costs for families and the community. The type of early intervention used in this study focuses specifically on working with parents. Through watching videos of themselves interacting with their child and receiving feedback from therapists, parents are able to enhance their awareness and response to their child's unusual patterns of communication; they become better able to understand their child and communicate back appropriately in a focused way. Parents take part in 12 therapy sessions over 6 months, followed by monthly support sessions for the next 6 months. In addition, parents agree to do 20-30 minutes per day of planned communication and play activities with the child.

In the original Preschool Autism Communication Trial (PACT), 152 children aged 2-4 with autism were randomised to receive the 12 month early intervention or treatment as usual. The study published today is the follow-up analysis of the same children approximately 6 years after the end of treatment. 121 (80%) of the 152 original trial participants were assessed as part of the follow-up study. Of these, 59 children had previously received the PACT intervention and 62 had received treatment as usual. Autism severity was measured using the international standard measure of autism symptoms (ADOS CSS), which combines social communication and restricted and repetitive behaviour symptoms into an overall measure of severity scored 1-10, with 10 being the most severe.

At the start of the trial, both groups had similar ADOS CSS scores (8.0 in the intervention group, 7.9 in the treatment as usual group). At follow-up, children in the intervention group scored an average of 7.3 on the ADOS CSS score and 46% (27/59) of the group were in the severe range. By comparison, children in the treatment as usual group scored an average of 7.8, with 63% (39/62) in the severe range. This corresponds to a reduction of 17% in the proportion of children with severe symptoms in the intervention group compared to treatment as usual.

At follow-up, there were also improvements in children's communication with their parents for the intervention group, but no differences in the language scores of children. Additionally, parents in the intervention group reported improvements in peer relationships, social communication and repetitive behaviours (figure 2). However, there was no significant difference between the two groups on measures of child anxiety, challenging behaviours (eg, conduct/oppositional disorder) or depression.

"Our findings suggest that sustained changes in autism symptoms are possible after early intervention, something that has previously been regarded as difficult to achieve," say Professor Tony Charman, who led the London arm of the trial and Professor Andrew Pickles, the study methodology expert, both from King's College London. "However, we found no evidence of any effect on child mental health, such as anxiety or challenging behaviours, 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 authors note that the study included children with core autism symptoms rather than wider autism spectrum disorder, and therefore cannot be sure how these results would apply to children with less severe symptoms. They also add that the study was a follow-up at age 7-11 years so does not provide information in how children's symptoms will develop in adulthood.

Writing in a linked Comment, Professor Jeff Sigafoos and Dr Hannah Waddington, School of Education, Victoria University of Wellington, Wellington, New Zealand, say that the authors of the study "have made a major contribution to autism research by providing new high-quality evidence to support the potential value of adding the PACT intervention to educational services for young with autism spectrum disorder. Future research of this type could advance science by attempting to isolate the critical treatment components and mechanisms underlying sustained treatment gains. (The authors) suggest that their positive long-term outcomes stemmed from optimisation of parent-child social communicative interactions, which then become self-sustaining. Another possibility is that early interventions of this type enable neural development and normalise brain activity. Of course these two possible mechanisms are neither mutually exclusive nor exhaustive. Still, the emerging evidence favouring the PACT intervention and similar programmes suggests that some major, yet undetermined, developmental mechanism might be involved."

Explore further: Early intervention improves long-term outcomes for children with autism

More information: The Lancet, … (16)31229-6/fulltext

Related Stories

Early intervention improves long-term outcomes for children with autism

June 9, 2015
Early intervention for toddlers with autism spectrum disorder helps improve their intellectual ability and reduces autism symptoms years after originally getting treatment, a new study shows.

Children with autism need intervention over a long period of time

March 24, 2016
9 out of 10 preschool children with autism still have major difficulties within the autism field at school age, despite having received early intervention. A majority of the parents stated that the children do not receive ...

New study aims to give children with autism the best start in life

October 20, 2016
A ground-breaking new study has been launched understand how to support families affected by autism as soon as they receive their diagnosis.

Helping children with autism transfer new communication skills from home to school

June 22, 2016
A new study is testing whether an intervention with parents and teachers can help children with autism transfer newly acquired social communication skills from home into school.

Intensive intervention by parents rather than clinicians best for autistic toddlers

November 4, 2014
For the first time, toddlers with autism have demonstrated significant improvement after intensive intervention by parents rather than clinicians, according to a new Florida State University study published online in the ...

Risk for autism increases for abandoned children placed in institutions

February 2, 2015
A recent study published in the February 2015 issue of the Journal of the American Academy of Child and Adolescent Psychiatry demonstrates that children who were abandoned to institutional care have an increased risk for ...

Recommended for you

Nearly imperceptible fluctuations in movement correspond to autism diagnoses

January 17, 2018
A new study led by researchers at Indiana University and Rutgers University provides the strongest evidence yet that nearly imperceptible changes in how people move can be used to diagnose neurodevelopmental disorders, including ...

Epigenetics study helps focus search for autism risk factors

January 16, 2018
Scientists have long tried to pin down the causes of autism spectrum disorder. Recent studies have expanded the search for genetic links from identifying genes toward epigenetics, the study of factors that control gene expression ...

Being bilingual may help autistic children

January 16, 2018
Children with Autism Spectrum Disorders (ASD) often have a hard time switching gears from one task to another. But being bilingual may actually make it a bit easier for them to do so, according to a new study which was recently ...

No rise in autism in US in past three years: study

January 2, 2018
After more than a decade of steady increases in the rate of children diagnosed with autism in the United States, the rate has plateaued in the past three years, researchers said Tuesday.

Autism therapy: Brain stimulation restores social behavior in mice

December 13, 2017
Scientists are examining the feasibility of treating autistic children with neuromodulation after a new study showed social impairments can be corrected by brain stimulation.

Social phobia linked to autism and schizophrenia

December 11, 2017
New Swinburne research shows that people who find social situations difficult tend to have similar brain responses to those with schizophrenia or autism.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.