A parent-led early intervention for autism has become the first ever to show a reduction in symptom severity through to the ages of seven and 11, according to UK researchers.
The intervention, aimed at helping parents communicate with a child, was shown to reduce the severity of some autism symptoms, which continued for six years after the end of treatment.
“Our findings suggest that sustained changes in autism symptoms are possible”
Tony Charman and Andrew Pickles
The study – led by the University of Manchester, King’s College London and Newcastle University – is the first to identify a long-term effect of an early intervention for autism.
The researchers found children who had received the intervention between the ages of two and four had less severe overall symptoms six years later, with improved social communication and reduced repetitive behaviours.
However, no changes were seen in other areas such as language or anxiety, and the researchers cautioned that additional ongoing support would usually be needed as the children got older.
The type of early intervention used in the new study focused specifically on working with parents.
Through watching videos of themselves interacting with their child and receiving feedback from therapists, parents were able to enhance their awareness and response to their child’s unusual patterns of communication, said the researchers.
As a result, they became better able to understand their child and communicate back appropriately in a focused way, said the study authors.
“Our findings are encouraging, as they represent an improvement in the core symptoms of autism”
Parents took part in 12 therapy sessions over six months, followed by monthly support sessions for the next six months. In addition, parents agreed to do 20-30 minutes per day of planned communication and play activities with the child.
The study, published today in The Lancet, is a follow-up analysis of children around six years after the end of treatment.
In the original Preschool Autism Communication Trial (PACT), 152 children, aged two to four, with autism were randomised to receive the 12-month early intervention or treatment as usual.
The follow-up study involved 121 of the original trial participants, of which 59 had previously received the PACT intervention and 62 had received treatment as usual.
Autism severity was measured using the international standard measure of autism symptoms (ADOS CSS), which combines social communication and restricted and repetitive behaviour symptoms into an overall measure of severity scored 1-10, with 10 being the most severe.
At the start of the trial, the researchers said both groups had similar ADOS CSS scores – 8.0 in the intervention group, 7.9 in the treatment as usual group.
At follow-up, children in the intervention group scored an average of 7.3 on the ADOS CSS score, with 46% of the group in the severe range. By comparison, children in the control group scored an average of 7.8, with 63% in the severe range.
The study authors said the finding corresponded to a reduction of 17% in the proportion of children with severe symptoms in the intervention group, compared to treatment as usual.
Parent communication boost ‘cuts autism symptoms’
Improvements in children’s communication with their parents were also observed among the intervention group, but there were no apparent differences in the language scores of children.
Additionally, parents in the intervention group reported improvements in peer relationships, social communication and repetitive behaviours.
However, there was no significant difference between the two groups on measures of child anxiety, challenging behaviours or depression.
Study author Ann Le Couteur, professor of child and adolescent psychiatry at Newcastle University and Northumberland, Tyne and Wear NHS Foundation Trust, described the research as a “landmark”.
“It is one of the first studies to identify a relatively long-term benefit – the follow-up period is just under six years – of an early intervention for autism,” she said.
“Our findings suggest that helping parents to focus on early social communication skills with their child through play can lead to improvements in autism symptoms,” she added.
Meanwhile, Professor Tony Charman led the London arm of the trial and Professor Andrew Pickles was the study methodology expert.
They said: “Our findings suggest that sustained changes in autism symptoms are possible after early intervention, something that has previously been regarded as difficult to achieve.
“However, we found no evidence of any effect on child mental health, such as anxiety or challenging behaviours, suggesting that additional interventions may be needed to address these difficulties at later ages,” they said.
“As these children grow up, they will continue to need support in many aspects of their lives. We are currently working to further enhance our intervention,” said the researchers, both from King’s College London.
Parent communication boost ‘cuts autism symptoms’
Lead author Professor Jonathan Green, from the University of Manchester and Royal Manchester Children’s Hospital, added: “This type of early intervention is distinctive in being designed to work with parents to help improve parent-child communication at home.
“The advantage of this approach over a direct therapist-child intervention is that it has potential to affect the everyday life of the child,” he said. “Our findings are encouraging, as they represent an improvement in the core symptoms of autism previously thought very resistant to change.
“This is not a ‘cure’, in the sense that the children who demonstrated improvements will still show remaining symptoms to a variable extent, but it does suggest that working with parents to interact with their children in this way can lead to improvements in symptoms over the long-term,” he said.
The study authors noted that the trial included children with core autism symptoms, rather than wider autism spectrum disorder.
Case study: Practice nurse and mother backs impact of intervention
The Sawyer-Copus family were one of 48 families in the North East to take part in the study. Aaron, now 13, and Alex, 18, both have autism.
Their mother, Tracey, works as a practice nurse. She said: “Aaron was non-verbal and had very limited speech. He wasn’t interested in people or toys or playing. He was in his own little world.
‘Landmark’ study finds autism symptoms can be reduced
“The play therapy was really good. It taught him to play – that was the biggest thing. He didn’t play with toys, but by the end he was playing by himself. It was just wonderful,” she said.
“We noticed a big difference. In that year he went from being non-verbal to being able to talk. He doesn’t always, but at least now he has the choice,” said Ms Sawyer-Copus.
“It’s just the best thing in the world,” she said. “As a parent you just want your child to be happy and safe and have friends. Now, if he does want to be sociable, he can be.”
She added: “If they know that this form of intervention works then they can use it – get it in schools and in the home. They can show parents how to do this.”