Pre-school Autism Communication Trial (PACT)
We are pleased to be able to let you know that the first results from the PACT trial have now been published in The Lancet one of the world’s leading medical journals.
The PACT trial was a great success scientifically. It is bigger than any previous early intervention research study, having recruited by far the largest group of families with a child with autism, and we have been able to keep in touch with almost all of you over the trial period. This is a real achievement and we could not have done it without your involvement and support of this work. We are very grateful to you all.
Findings
The study assessed 152 preschool children across three UK sites (Manchester, Newcastle, South London) with roughly half receiving the PACT intervention plus local services and half just local services. The PACT intervention consisted of fortnightly then monthly sessions where speech therapists coached parents, using techniques such as video play-back, in ways of interacting and communicating with their child. Local provision consisted of various general and specialist autism services provided by local health, education and social care services.
Improvement in behaviours characteristic of autism was assessed by using a play-based observational assessment. After one year the severity of the autism behaviours was reduced slightly in both groups, but the difference between the two groups was not clinically significant. However, the PACT intervention did lead to improvements in the timing and responsiveness of parents’ communication with their child, and the amount that children communicated using speech and gestures when playing with their parents. Parents also reported greater improvements in their child’s language abilities.
In reporting to the media we concluded that, on the basis of our findings, we cannot recommend the addition of this PACT intervention to treatment as usual for the purpose of reduction in autism symptoms. The PACT intervention does, however, significantly alter parent-child two-way social communication in ways that are associated with subsequent positive child outcomes in longitudinal studies, and are likely to be positive for parents themselves. Ways to help children to improve their communication skills with other people and in wider contexts need to be developed.
What are the consequences of the trial?
It is particularly clear from our study that the intervention can greatly improve parents’ morale and their ability to interact with their children, which in turn improves children’s communication with their parents. This is why we are keen to understand more about the nature of the benefit of this over time.
What are the next steps for the PACT trial team?
The first step for us is to apply for funds to undertake a follow up of families involved in PACT to look at children’s further progress and at the possibilities of further interventions in the school years. We have already contacted you about undertaking a telephone interview with our researchers. We are now applying for funding for a followup visit to all of the children and parents.
Our second plan is to look at adapting the PACT treatment to build on what was very successful and to try different techniques in areas that did not prove so successful. We will be exploring how we can modify the PACT treatment to help children with autism be able to generalise the improvements they have made into other situations such as at school. This is always a challenging task in autism. Then we will be planning to conduct a new trial to test whether these improvements give even better results. This new research trial would be undertaken with a new group of pre-school children who have just received a diagnosis of autism.
Thank you again for taking part in the PACT trial. We hope it has been a good experience for you all. Without the support of the families who have taken part, we would not know what we now do about the strengths and weaknesses of PACT. This knowledge helps us understand more about how to help children with autism and their families.
Contact Us
If you have any questions, or comments that you would like to make please do not hesitate to write to Helen McConachie or any of the other research team at the PACT office. Our contact details are as follows:
University of Newcastle
Institute of Health and Society
Sir James Spence Institute, 3rd Floor
Royal Victoria Infirmary
Newcastle upon Tyne NE1 4LP
Email: h.r.mcconachie@ncl.ac.uk or A.s.le-couteur@ncl.ac.uk or daslne@ncl.ac.uk.
PACT website: www.medicine.manchester.ac.uk/pact/
Published papers: