Training parents to better communicate with their children with autism spectrum disorder may lead to long-lasting improvements in certain symptoms, scientists report online in the Oct. 25 Lancet.
The results are “very encouraging,” because they show long-term benefits for a relatively low-intensity treatment — one that’s delivered by parents, says clinical psychologist Geraldine Dawson, who directs the Duke Center for Autism and Brain Development.
The idea behind the approach, called PACT for preschool autism communication trial, is that children with autism can be reached by training their parents to be better conversationalists. From 2006 to 2008, the trial, led by child psychiatrist Jonathan Green of the University of Manchester in England, enrolled parents and children, ages 2 to 4, with autism. For six months, parents went to 12 therapy sessions, in which they were taught how to read and respond to their children’s signals. For six months after that, parents attended support sessions.
In the PACT trial, parents watched videos of themselves interacting with their child while experts pointed out missed opportunities for interaction that are hard to spot. These included subtle movements, facial expressions and nonspeech sounds that indicate the child wants to communicate.
Soon after the original trial ended, Green and colleagues reported that the technique didn’t improve autism symptoms. But after reanalyzing those data with a more sensitive measure of autism, the researchers saw some small signs of improvement. Some gains seem to have lasted for almost six years after the trial ended. All of the 152 children who participated in the original study began with autism scores of about 8 on a 10-point scale called the ADOS CSS, in which 10 is the most severe. Nearly six years later, 59 children whose parents had been trained scored a 7.3 on average. Sixty-two children whose parents were not trained scored 7.8.
Communication between children and parents seemed stronger in the group who received PACT training, a different measure indicated. But other symptoms, such as depression and language skills, were unchanged. “The autism doesn’t go away,” Green says, but certain symptoms seem to be reduced.
Although the gains are small and their margin of error is wide, the reported improvements are encouraging, some autism experts argue.
The results from this paper and other similar trials suggest that parent training is a potentially promising autism treatment, says education expert Jeff Sigafoos of Victoria University of Wellington in New Zealand, who wrote a commentary in Lancet accompanying the study. “I would be confident in recommending that programs of this type should be available to parents of children newly diagnosed with autism.”
Dawson says that at the Duke autism clinic, parents are offered coaching as soon as their child receives a diagnosis, and that most autism clinics offer similar services geared toward parents.
In addition to potentially better outcomes for children, the treatment had the bonus of empowering parents, Green says. As a result of the training, parents felt better equipped to interact with their child, even in the absence of obvious feedback. “To us, that’s one of the most pleasing effects of this,” Green says.