A follow-up trial conducted 6 years after the conclusion of a randomized controlled trial of early intervention in autism spectrum disorder demonstrated that the intervention had a long-term effect on autism symptoms and continued effects on parent and child social interaction.
The intervention, the Preschool Autism Communication Trial (PACT), was conducted in 3 specialized clinical services centers in the United Kingdom in children aged 2 to 4 years with so-called core autism. About half of participants were assigned to the PACT intervention and the other half to usual treatment. The PACT is a developmentally targeted social communication program that focuses on optimizing parent interactive behaviors to improve child communication and more general autism symptoms. It provides 12, 2-hour therapy sessions during a 6-month period followed by monthly support and extension sessions for a further 6 months. In addition, parents spend 20 to 30 minutes a day performing planned practice activities with the child.
Evaluations of 80% of the original 152 PACT participants 6 years after the conclusion of the PACT trial, when they had a mean age of 10.5 years, found that although the proportion of participants with high severity symptoms had increased in both groups, the PACT group fared better than the usual treatment group. Specifically, 29% in the PACT intervention group had high symptom severity scores compared with 44% of the usual treatment group. In addition, parental reports also indicated that PACT had a treatment effect on symptoms as well as social communication skills (Pickles A, et al. Lancet. 2016; 388:2501-2509).
my take This study provides strong, evidence-based support for the American Academy of Pediatrics (AAP) recommendation for routine screening for autism. Routine screening leads to early diagnosis and treatment, which in turn lead to an improved prognosis. The AAP continues to recommend screening for autism at ages 18 and 24 months and whenever the family expresses concern about the diagnosis. (Pediatrics. 2007;120:1183-1215). —Michael G Burke, MD