The small number of studies included in the present study limited the ability to make inferences when comparing the three models and investigating the strengths and weaknesses of each type of intervention with respect to important outcomes .
Since the outcome of ' reciprocity of social interaction towards others ' could be a dependent variable that might be context -bound to interactions with the child 's parent , we can not conclude the interventions for pre-school children with ASD have significant effects on a generalized skill to engage in reciprocal interactions with others .
However , the outcomes of ' reciprocity of social interaction towards others ' and ' parental synchrony ' may be promising targets for interventions involving pre-school children with ASD .
BACKGROUND There has an increasing number of published trials on psychosocial intervention programmes for pre-school children with autism spectrum disorder ( ASD ) .
To achieve better quality of unbiased evidence for the effectiveness of ASD interventions , it is necessary to conduct a comprehensive review that covers studies with adequate quality st and ards , such as r and omised controlled trials ( RCTs ) , and different types of intervention In this study , we categorize interventions for ASD as behavioural , social-communication focused , and multimodal developmental based on Howlin 's classification of early interventions for children with ASD .
The aim of this study was to compare these three models and investigate the strengths and weaknesses of each type of intervention and to identify the approaches that contribute to a successful outcome for children with autism .
Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
Summary Background Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children . We therefore investigated the efficacy of such an intervention in a larger trial . Methods Children with core autism ( aged 2 years to 4 years and 11 months ) were r and omly assigned in a one-to-one ratio to a parent-mediated communication-focused ( Preschool Autism Communication Trial [ PACT ] ) intervention or treatment as usual at three specialist centres in the UK . Those assigned to PACT were also given treatment as usual . R and omisation was by use of minimisation of probability in the marginal distribution of treatment centre , age ( ≤42 months or > 42 months ) , and autism severity ( Autism Diagnostic Observation Schedule-Generic [ ADOS-G ] algorithm score 12–17 or 18–24 ) . Primary outcome was severity of autism symptoms ( a total score of social communication algorithm items from ADOS-G , higher score indicating greater severity ) at 13 months . Complementary secondary outcomes were measures of parent-child interaction , child language , and adaptive functioning in school . Analysis was by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N58133827 . Results 152 children were recruited . 77 were assigned to PACT ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=25 ] ) ; and 75 to treatment as usual ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=23 ] ) . At the 13-month endpoint , the severity of symptoms was reduced by 3·9 points ( SD 4·7 ) on the ADOS-G algorithm in the group assigned to PACT , and 2·9 ( 3·9 ) in the group assigned to treatment as usual , representing a between-group effect size of −0·24 ( 95 % CI −0·59 to 0·11 ) , after adjustment for centre , sex , socioeconomic status , age , and verbal and non-verbal abilities . Treatment effect was positive for parental synchronous response to child ( 1·22 , 0·85 to 1·59 ) , child initiations with parent ( 0·41 , 0·08 to 0·74 ) , and for parent-child shared attention ( 0·33 , −0·02 to 0·68 ) . Effects on directly assessed language and adaptive functioning in school were small . Interpretation On the basis of our findings , we can not recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms ; however , a clear benefit was noted for parent-child dyadic social communication . Funding UK Medical Research Council , and UK Department for Children , Schools and Families
The small number of studies included in the present study limited the ability to make inferences when comparing the three models and investigating the strengths and weaknesses of each type of intervention with respect to important outcomes .
Since the outcome of ' reciprocity of social interaction towards others ' could be a dependent variable that might be context -bound to interactions with the child 's parent , we can not conclude the interventions for pre-school children with ASD have significant effects on a generalized skill to engage in reciprocal interactions with others .
However , the outcomes of ' reciprocity of social interaction towards others ' and ' parental synchrony ' may be promising targets for interventions involving pre-school children with ASD .
BACKGROUND There has an increasing number of published trials on psychosocial intervention programmes for pre-school children with autism spectrum disorder ( ASD ) .
To achieve better quality of unbiased evidence for the effectiveness of ASD interventions , it is necessary to conduct a comprehensive review that covers studies with adequate quality st and ards , such as r and omised controlled trials ( RCTs ) , and different types of intervention In this study , we categorize interventions for ASD as behavioural , social-communication focused , and multimodal developmental based on Howlin 's classification of early interventions for children with ASD .
The aim of this study was to compare these three models and investigate the strengths and weaknesses of each type of intervention and to identify the approaches that contribute to a successful outcome for children with autism .