The findings did not support the widely reported generalisation ' difficulties ' associated with autism .
Research ers have generally considered autistic individuals to have difficulties generalising learned skills across novel context s. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment .
We conducted a systematic review of r and omised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement .
Treatment mechanism in the MRC preschool autism communication trial: implications for study design and parent-focussed therapy for children.
BACKGROUND The PACT r and omised-controlled trial evaluated a parent-mediated communication-focused treatment  for children with autism , intended to reduce symptom severity as measured by a modified Autism Diagnostic Observation Schedule-Generic ( ADOS-G ) algorithm score . The therapy targeted parental behaviour , with no direct interaction between therapist and child . While nonsignificant group differences were found on ADOS-G score , significant group differences were found for both parent and child intermediate outcomes . This study aim ed to better underst and the mechanism by which the PACT treatment influenced changes in child behaviour though the targeted parent behaviour . METHODS Mediation analysis was used to assess the direct and indirect effects of treatment via  parent behaviour on child behaviour and via child behaviour on ADOS-G score . Alternative mediation was explored to study whether the treatment effect acted as hypothesised or via another plausible pathway . Mediation models typically assume no unobserved confounding between mediator and outcome and no measurement error in the mediator . We show how to better exploit the information often available within a trial to begin to address these issues , examining scope for instrumental variable and measurement error models . RESULTS Estimates of mediation changed substantially when account was taken of the confounder effects of the baseline value of the mediator and of measurement error . Our best estimates that accounted for both suggested that the treatment effect on the ADOS-G score was very substantially mediated by parent synchrony and child initiations . CONCLUSIONS The results highlighted the value of repeated measurement of mediators during trials . The theoretical model underlying the PACT treatment was supported . However , the substantial fall-off in treatment effect highlighted both the need for additional data and for additional target behaviours for therapy
The findings did not support the widely reported generalisation ' difficulties ' associated with autism .
Research ers have generally considered autistic individuals to have difficulties generalising learned skills across novel context s. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment .
We conducted a systematic review of r and omised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement .