6 year follow-up supports early autism intervention

There have been few large randomised controlled trials of early intervention for children with autism spectrum disorder, even fewer with follow-up data, and none with such a lengthy follow-up period as that reported by Andrew Pickles and colleagues 1 in The Lancet. These researchers assessed long-term outcomes for children who had received a parent-mediated intervention versus treatment as usual nearly 6 years earlier. That earlier study from 2010 2 was notable for its rigorous methodology. 3 The present follow-up study is also worthy of note. To appreciate its importance, some background is needed on the 2010 study. That study was a large randomised controlled trial in which young children (aged from 2 years to 4 years and 11 months) were assigned to receive treatment as usual (n=75) or treatment as usual plus the manual-based PreSchool Autism Communication Trial (PACT) programme (n=77). The PACT intervention is grounded in developmental principles and aims to increase parent sensitivity and responsiveness to child communication through various strategies such as improving parent observation, responsiveness, and focused communication. Compared with other early intervention approaches for young children with autism, 4–6 the PACT intervention reported in 2010 was a relatively low-intensity programme. Parents received 2 h clinical sessions every 2 weeks for the fi rst 6 months, followed by monthly booster sessions during the fi nal 6 months. Parents were also asked to implement their newly acquired sensitivity and responsivity skills at home for 20–30 min each day. The treatment eff ect was initially viewed as modest, 2 but the updated analysis reported in this follow-up study 1 reveals greater improvements in the intervention group than in the treatment-as-usual group. The improvements seen from the initial PACT trial are consistent with results from other randomised controlled trials of early autism interventions. 4–6 The follow-up study 1 sought to establish the long-term durability of these initial treatment gains. Follow-up was done at 5·75 years after the trial endpoint and included nearly 80% of the original sample. The resulting data, which were analysed with repeated measures approaches, showed sustained treatment eff ects. Specifi cally, the severity of autism symptoms was signifi cantly lower for children in the intervention group than for children in the treatment-as-usual group. These diff erences were evident at the trial endpoint and at this 5·75 year follow-up. Secondary analyses showed that changes in social communication and restricted and repetitive behaviour, which are the two core …