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Carruthers S, Charman T, Leadbitter K, Ellis C, Taylor L, Moore H, Taylor C, James K, Balabanovska M, Langhorne S, Aldred C, Slonims V, Grahame V, Howlin P, McConachie H, Parr J, Emsley R, Le Couteur A, Green J, Pickles A. Generalisation of Social Communication Skills by Autistic Children During Play-Based Assessments Across Home, School and an Unfamiliar Research Setting. J Autism Dev Disord 2024:10.1007/s10803-024-06370-x. [PMID: 38743153 DOI: 10.1007/s10803-024-06370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
We investigated autistic children's generalisation of social communication over time across three settings during a play-based assessment with different adults and explore the potential moderating effects on generalisation of age, nonverbal IQ and level of restricted and repetitive behaviours. The social communication abilities of 248 autistic children (2-11 years, 21% female, 22% single parent, 60% white) from three UK sites were assessed from 1984 video interactions in three contexts with three different interaction partners (parent/home, teaching assistant/school, researcher/clinic) at baseline, midpoint (+ 7m) and endpoint (+ 12m) within the Paediatric Autism Communication Trial-Generalised (PACT-G), a parent-mediated social communication intervention. Children's midpoint social communication at home generalised to school at midpoint and to clinic at endpoint. Generalisation was stronger from home to school and clinic than school to home and clinic. Generalisation was not moderated by age, nonverbal IQ or restricted and repetitive behaviour. Broader child development did not explain the pattern of results. The current study is the largest study to date to explore generalisation with autistic children and provides novel insight into their generalisation of social communication skills. Further research is needed to gain a more comprehensive understanding of facilitators of generalisation across settings and interaction partners in order to develop targeted strategies for interventions to enhance outcomes for young autistic children.
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Affiliation(s)
- Sophie Carruthers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Kathy Leadbitter
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ceri Ellis
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lauren Taylor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Heather Moore
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Carol Taylor
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Kirsty James
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matea Balabanovska
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Sophie Langhorne
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Catherine Aldred
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Vicky Slonims
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundations Trust, London, UK
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vicki Grahame
- Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, London, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
- Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, London, UK
- Great North Children's Hospital, Newcastle Upon Tyne NHS Foundation Trust, London, UK
| | - Richard Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester Royal Children's Hospital, University of Manchester, Manchester, UK
| | - Andrew Pickles
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Williams P, Slonims V, Weinman J. 'Turning up and tuning in'. Factors associated with parental non-attendance and non-adherence in intervention for young children with speech, language communication needs. Int J Lang Commun Disord 2024; 59:762-778. [PMID: 37824327 DOI: 10.1111/1460-6984.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non-attendance or non-adherence that are multifactorial and variable dependent on, for example, population and intervention. AIMS To identify rates of non-attendance and non-adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. METHODS Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self-efficacy), personal circumstances (socio-demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non-attendance rates were identified via local health records and non-adherence ascertained using a specific parent-reported measure within the treatment experience domain. RESULTS Participants (N = 199) were predominantly mothers, and were ethnically and socio-economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non-attendance was 25% and the main predictors of non-attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non-adherence in this cohort was 26% with parental rating of the importance of a recommendation and self-efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. CONCLUSIONS & IMPLICATIONS Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS What is already known on the subject It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge This study identified rates of parental non-attendance and non-adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non-attendance. What are the potential or actual clinical implications of this work? This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN.
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Affiliation(s)
- Penny Williams
- Children's neurosciences, Evelina London Children's Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vicky Slonims
- Children's neurosciences, Evelina London Children's Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
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Carruthers S, Pickles A, Charman T, McConachie H, Le Couteur A, Slonims V, Howlin P, Collum R, Salomone E, Tobin H, Gammer I, Maxwell J, Aldred C, Parr J, Leadbitter K, Green J. Mediation of 6-year mid-childhood follow-up outcomes after pre-school social communication (PACT) therapy for autistic children: randomised controlled trial. J Child Psychol Psychiatry 2024; 65:233-244. [PMID: 37095645 PMCID: PMC10953331 DOI: 10.1111/jcpp.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND There are very few mechanistic studies of the long-term impact of psychosocial interventions in childhood. The parent-mediated Paediatric Autism Communication Therapy (PACT) RCT showed sustained effects on autistic child outcomes from pre-school to mid-childhood. We investigated the mechanism by which the PACT intervention achieved these effects. METHODS Of 152 children randomised to receive PACT or treatment as usual between 2 and 5 years of age, 121 (79.6%) were followed 5-6 years after the endpoint at a mean age of 10.5 years. Assessors, blind to the intervention group, measured Autism Diagnostic Observation Scale Calibrated Severity Score (ADOS CSS) for child autistic behaviours and Teacher Vineland (TVABS) for adaptive behaviour in school. Hypothesised mediators were child communication initiations with caregivers in a standard play observation (Dyadic Communication Measure for Autism, DCMA). Hypothesised moderators of mediation were baseline child non-verbal age equivalent scores (AE), communication and symbolic development (CSBS) and 'insistence on sameness' (IS). Structural equation modelling was used in a repeated measures mediation design. RESULTS Good model fits were obtained. The treatment effect on child dyadic initiation with the caregiver was sustained through the follow-up period. Increased child initiation at treatment midpoint mediated the majority (73%) of the treatment effect on follow-up ADOS CSS. A combination of partial mediation from midpoint child initiations and the direct effect of treatment also contributed to a near-significant total effect on follow-up TVABS. No moderation of this mediation was found for AE, CSBS or IS. CONCLUSIONS Early sustained increase in an autistic child's communication initiation with their caregiver is largely responsible for the long-term effects from PACT therapy on autistic and adaptive behaviour outcomes. This supports the theoretical logic model of PACT therapy but also illuminates fundamental causal processes of social and adaptive development in autism over time: early social engagement in autism can be improved and this can have long-term generalised outcome effects.
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Affiliation(s)
- Sophie Carruthers
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Tony Charman
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Helen McConachie
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Ann Le Couteur
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Vicky Slonims
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
| | - Patricia Howlin
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Rachel Collum
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Erica Salomone
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Department of PsychologyUniversity of Milano‐BicoccaMilanItaly
| | | | - Isobel Gammer
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Jessica Maxwell
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jeremy Parr
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jonathan Green
- Manchester Academic Health Sciences Centre, Royal Manchester Children's HospitalUniversity of ManchesterManchesterUK
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Ondruskova T, Royston R, Absoud M, Ambler G, Qu C, Barnes J, Hunter R, Panca M, Kyriakopoulos M, Oulton K, Paliokosta E, Sharma AN, Slonims V, Summerson U, Sutcliffe A, Thomas M, Dhandapani B, Leonard H, Hassiotis A. Clinical and cost-effectiveness of an adapted intervention for preschoolers with moderate to severe intellectual disabilities displaying behaviours that challenge: the EPICC-ID RCT. Health Technol Assess 2024; 28:1-94. [PMID: 38329108 PMCID: PMC11017145 DOI: 10.3310/jkty6144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Background Stepping Stones Triple P is an adapted intervention for parents of young children with developmental disabilities who display behaviours that challenge, aiming at teaching positive parenting techniques and promoting a positive parent-child relationship. Objective To evaluate the clinical and cost-effectiveness of level 4 Stepping Stones Triple P in reducing behaviours that challenge in children with moderate to severe intellectual disabilities. Design, setting, participants A parallel two-arm pragmatic multisite single-blind randomised controlled trial recruited a total of 261 dyads (parent and child). The children were aged 30-59 months and had moderate to severe intellectual disabilities. Participants were randomised, using a 3 : 2 allocation ratio, into the intervention arm (Stepping Stones Triple P; n = 155) or treatment as usual arm (n = 106). Participants were recruited from four study sites in Blackpool, North and South London and Newcastle. Intervention Level 4 Stepping Stones Triple P consists of six group sessions and three individual phone or face-to-face contacts over 9 weeks. These were changed to remote sessions after 16 March 2020 due to the coronavirus disease 2019 pandemic. Main outcome measure The primary outcome measure was the parent-reported Child Behaviour Checklist, which assesses the severity of behaviours that challenge. Results We found a small non-significant difference in the mean Child Behaviour Checklist scores (-4.23, 95% CI -9.98 to 1.52, p = 0.146) in the intervention arm compared to treatment as usual at 12 months. Per protocol and complier average causal effect sensitivity analyses, which took into consideration the number of sessions attended, showed the Child Behaviour Checklist mean score difference at 12 months was lower in the intervention arm by -10.77 (95% CI -19.12 to -2.42, p = 0.014) and -11.53 (95% CI -26.97 to 3.91, p = 0.143), respectively. The Child Behaviour Checklist mean score difference between participants who were recruited before and after the coronavirus disease 2019 pandemic was estimated as -7.12 (95% CI -13.44 to -0.81) and 7.61 (95% CI -5.43 to 20.64), respectively (p = 0.046), suggesting that any effect pre-pandemic may have reversed during the pandemic. There were no differences in all secondary measures. Stepping Stones Triple P is probably value for money to deliver (-£1057.88; 95% CI -£3218.6 to -£46.67), but decisions to roll this out as an alternative to existing parenting interventions or treatment as usual may be dependent on policymaker willingness to invest in early interventions to reduce behaviours that challenge. Parents reported the intervention boosted their confidence and skills, and the group format enabled them to learn from others and benefit from peer support. There were 20 serious adverse events reported during the study, but none were associated with the intervention. Limitations There were low attendance rates in the Stepping Stones Triple P arm, as well as the coronavirus disease 2019-related challenges with recruitment and delivery of the intervention. Conclusions Level 4 Stepping Stones Triple P did not reduce early onset behaviours that challenge in very young children with moderate to severe intellectual disabilities. However, there was an effect on child behaviours for those who received a sufficient dose of the intervention. There is a high probability of Stepping Stones Triple P being at least cost neutral and therefore worth considering as an early therapeutic option given the long-term consequences of behaviours that challenge on people and their social networks. Future work Further research should investigate the implementation of parenting groups for behaviours that challenge in this population, as well as the optimal mode of delivery to maximise engagement and subsequent outcomes. Study registration This study is registered as NCT03086876 (https://www.clinicaltrials.gov/ct2/show/NCT03086876?term=Hassiotis±Angela&draw=1&rank=1). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: HTA 15/162/02) and is published in full in Health Technology Assessment; Vol. 28, No. 6. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Rachel Royston
- Division of Psychiatry, University College London, London, UK
| | - Michael Absoud
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck University, University of London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Monica Panca
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, UK
- National and Kapodistrian University of Athens, Vyronas-Kessariani Community Mental Health Centre, Athens, Greece
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Eleni Paliokosta
- The Tavistock and Portman NHS Foundation Trust, Kentish Town Health Centre, London, UK
| | - Aditya Narain Sharma
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Walkergate Park Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
| | - Vicky Slonims
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | | | | | - Megan Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Helen Leonard
- Great North Children's Hospital, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Palmer M, Chandler S, Carter Leno V, Mgaieth F, Yorke I, Hollocks M, Pickles A, Slonims V, Scott S, Charman T, Simonoff E. Factors associated with mental health symptoms among UK autistic children and young people and their parents during the COVID-19 pandemic. Autism 2023; 27:2098-2111. [PMID: 36847345 PMCID: PMC9974376 DOI: 10.1177/13623613231153694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
LAY ABSTRACT What is already known about the topic: The COVID-19 pandemic and the associated restrictions impacted all of society. There is emerging evidence showing a range of impacts on autistic children and young people and their families. Further research that looks at how individuals coped during the pandemic while considering how they were doing before the pandemic is needed.What this paper adds: This article explores whether how well autistic youth were doing before the pandemic influenced how they coped during the pandemic. It also looked at how well their parents were doing during the pandemic and whether any pre-pandemic factors influenced how they coped. Samples of both primary-school-aged autistic children and autistic teenagers and their parents were surveyed to answer these questions. More engagement and enjoyment in education provision during the pandemic and getting outside more were linked with better child and parental mental health during the pandemic. More attention deficit hyperactivity disorder before the pandemic was linked with more attention deficit hyperactivity disorder and behavioural problems during the pandemic in primary-school-aged autistic children, and more emotional problems during the pandemic in autistic teenagers. Parents with more mental health problems during the pandemic had more mental health problems before the pandemic.Implications for practice, research or policy: Encouraging engagement and enjoyment in education and promoting physical exercise are key intervention targets. Ensuring access to attention deficit hyperactivity disorder medication and support is important, especially if this is managed jointly across school and home.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tony Charman
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
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6
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Loncarevic A, Maybery MT, Barbaro J, Dissanayake C, Green J, Hudry K, Iacono T, Slonims V, Varcin KJ, Wan MW, Wray J, Whitehouse AJO. Parent-Child Interactions May Help to Explain Relations Between Parent Characteristics and Clinically Observed Child Autistic Behaviours. J Autism Dev Disord 2023:10.1007/s10803-023-05914-x. [PMID: 37209200 DOI: 10.1007/s10803-023-05914-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 05/22/2023]
Abstract
The importance of supporting parent-child interactions has been noted in the context of prodromal autism, but little consideration has been given to the possible contributing role of parental characteristics, such as psychological distress. This cross-sectional study tested models in which parent-child interaction variables mediated relations between parent characteristics and child autistic behaviour in a sample of families whose infant demonstrated early signs of autism (N = 103). The findings suggest that associations between parent characteristics (psychological distress; aloofness) and child autistic behaviours may be mediated by the child's inattentiveness or negative affect during interactions. These findings have important implications in developing and implementing interventions in infancy which target the synchrony of parent-child interaction with the goal to support children's social communication development.
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Affiliation(s)
- Antonina Loncarevic
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia.
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia.
| | - Murray T Maybery
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Kristelle Hudry
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, College of Science, Health, and Engineering, Victoria, Australia
| | - Vicky Slonims
- Children's Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, Evelina London Children's Hospital, Kings College London, London, UK
| | - Kandice J Varcin
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Brisbane, QLD, Australia
| | - Ming Wai Wan
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Andrew J O Whitehouse
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- University of Western Australia, Crawley, WA, Australia
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7
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Palmer M, Carter Leno V, Hallett V, Mueller JM, Breese L, Pickles A, Slonims V, Scott S, Charman T, Simonoff E. Effects of a Parenting Intervention for Emotional and Behavioral Problems in Young Autistic Children Under Conditions of Enhanced Uncertainty: Two-Year Follow-up of a Pilot Randomized Controlled Trial Cohort (ASTAR) During the United Kingdom COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2023; 62:558-567. [PMID: 36639313 PMCID: PMC9832423 DOI: 10.1016/j.jaac.2022.09.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/25/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Most young autistic children display emotional and behavioral problems (EBPs). There is evidence that behavioral parenting interventions (BPIs) reduce these. The COVID-19 pandemic and associated lockdowns can be seen as a natural experiment to test the longer-term effect of BPIs under conditions of increased uncertainty. METHOD Opportunistic follow-up (n = 49) of a pilot randomized controlled trial (RCT) cohort (n = 62 autistic children aged 6-11 years; originally randomized to a 12-week group BPI [Predictive Parenting; n = 31] or an attention control [Psychoeducation; n = 31]) was conducted during COVID-19-related lockdowns. Measures of parent-reported child irritability and parenting stress were collected at 3 time points (baseline: mean age = 6.7 years; primary endpoint: mean age = 7.1 years, ∼5 months after randomization; and COVID-19 follow-up: mean age = 8.8 years, ∼2 years after randomization). We tested the magnitude of intervention effects using point estimates of differences in child irritability and parenting stress between arms at primary endpoint and COVID-19 follow-up, covarying for baseline scores. We used area under the curve (AUC) analyses to obtain overall estimates of the average intervention effect across all 3 timepoints. Semi-structured qualitative interviews were conducted with a subsample of parents (n = 18). RESULTS A small but significant intervention effect was found from baseline to COVID-19 follow-up in favor of Predictive Parenting on parent-reported child irritability (d = -0.33, 95% CI = -0.65, -0.01) and parenting stress (d = -0.31, 95% CI = -0.59, -0.03). No overall mean intervention effect for these measures as estimated by the AUC analyses (which takes into account the nonsignificant effect at primary endpoint) was found. Interview feedback on the both interventions was positive, and parents reported using strategies from Predictive Parenting during COVID-19-related restrictions. CONCLUSION This opportunistic follow-up study at a time of stress indicates the need for careful consideration of how and when to measure the effects of BPIs in autistic child populations. Future trials should consider both the most appropriate endpoint and in what context effects may be more likely to be seen. CLINICAL TRIAL REGISTRATION INFORMATION Autism Spectrum Treatment and Resilience (ASTAR); https://www.isrctn.com; 91411078.
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Affiliation(s)
- Melanie Palmer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Virginia Carter Leno
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Victoria Hallett
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Joanne M Mueller
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Lauren Breese
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Vicky Slonims
- Newcomen Neurodevelopmental Centre, Children's Neurosciences, Evelina Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
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8
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Hudry K, Smith J, Pillar S, Varcin KJ, Bent CA, Boutrus M, Chetcuti L, Clark A, Dissanayake C, Iacono T, Kennedy L, Lant A, Robinson Lake J, Segal L, Slonims V, Taylor C, Wan MW, Green J, Whitehouse AJO. The Utility of Natural Language Samples for Assessing Communication and Language in Infants Referred with Early Signs of Autism. Res Child Adolesc Psychopathol 2023; 51:529-539. [PMID: 36602626 DOI: 10.1007/s10802-022-01010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Abstract
Natural Language Sampling (NLS) offers clear potential for communication and language assessment, where other data might be difficult to interpret. We leveraged existing primary data for 18-month-olds showing early signs of autism, to examine the reliability and concurrent construct validity of NLS-derived measures coded from video-of child language, parent linguistic input, and dyadic balance of communicative interaction-against standardised assessment scores. Using Systematic Analysis of Language Transcripts (SALT) software and coding conventions, masked coders achieved good-to-excellent inter-rater agreement across all measures. Associations across concurrent measures of analogous constructs suggested strong validity of NLS applied to 6-min video clips. NLS offers benefits of feasibility and adaptability for validly quantifying emerging skills, and potential for standardisation for clinical use and rigorous research design.
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Affiliation(s)
- Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Jodie Smith
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sarah Pillar
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Kandice J Varcin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
| | - Alena Clark
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Bendigo, VIC, 3550, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Alicia Lant
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Jemima Robinson Lake
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Leonie Segal
- Australian Centre for Precision Health Sciences, School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, SE5 8AF, UK
| | - Carol Taylor
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, M13 PL9, UK
| | - Ming Wai Wan
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, M13 PL9, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, M13 PL9, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Andrew J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
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9
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Palmer M, Tarver J, Carter Leno V, Paris Perez J, Frayne M, Slonims V, Pickles A, Scott S, Charman T, Simonoff E. Parent, Teacher and Observational Reports of Emotional and Behavioral Problems in Young Autistic Children. J Autism Dev Disord 2023; 53:296-309. [PMID: 35028809 PMCID: PMC9889526 DOI: 10.1007/s10803-021-05421-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
Emotional and behavioral problems (EBPs) frequently occur in young autistic children. Discrepancies between parents and other informants are common but can lead to uncertainty in formulation, diagnosis and care planning. This study aimed to explore child and informant characteristics are associated with reported child EBPs across settings. Participants were 83 4-8-year-old autistic children and their parents and teachers in the Autism Spectrum Treatment and Resilience (ASTAR) study. Questionnaires of child EBPs were completed by parents and teachers, and self-reported parenting stress and wellbeing measures were obtained. An observation of parent-child/researcher-child interaction was also completed. Parents reported more EBPs than teachers and parent-teacher agreement was low, particularly for emotional problems. Greater parenting stress and being verbal was associated with more parent- but not teacher-reported EBPs. More observed behaviors that challenge were displayed by minimally verbal children. More parenting stress could be associated with the presence of more EBPs in the home; alternatively, parenting stress may confound reports. It is essential for assessments of EBPs in autistic children to take a multi-informant approach. Better understanding of the associations between informant characteristics and informant discrepancies of EBPs is needed.
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Affiliation(s)
- Melanie Palmer
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Joanne Tarver
- grid.7273.10000 0004 0376 4727Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Virginia Carter Leno
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Juan Paris Perez
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Margot Frayne
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Vicky Slonims
- grid.420545.20000 0004 0489 3985Newcomen Neurodevelopmental Centre, Evelina Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Andrew Pickles
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Stephen Scott
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Tony Charman
- grid.37640.360000 0000 9439 0839Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Psychology, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Emily Simonoff
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK ,grid.37640.360000 0000 9439 0839Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
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10
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Smith J, Chetcuti L, Kennedy L, Varcin KJ, Slonims V, Bent CA, Green J, Iacono T, Pillar S, Taylor C, Wan MW, Whitehouse AJO, Hudry K. Caregiver sensitivity predicts infant language use, and infant language complexity predicts caregiver language complexity, in the context of possible emerging autism. Autism Res 2022; 16:745-756. [PMID: 36563289 DOI: 10.1002/aur.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
While theory supports bidirectional effects between caregiver sensitivity and language use, and infant language acquisition-both caregiver-to-infant and also infant-to-caregiver effects-empirical research has chiefly explored the former unidirectional path. In the context of infants showing early signs of autism, we investigated prospective bidirectional associations with 6-min free-play interaction samples collected for 103 caregivers and their infants (mean age 12-months; and followed up 6-months later). We anticipated that measures of caregiver sensitivity/language input and infant language would show within-domain temporal stability/continuity, but also that there would be predictive associations from earlier caregiver input to subsequent child language, and vice versa. Caregiver sensitive responsiveness (from the Manchester Assessment of Caregiver-Infant interaction [MACI]) predicted subsequent infant word tokens (i.e., amount of language, coded following the Systematic Analysis of Language Transcripts [SALT]). Further, earlier infant Mean Length of Utterance (MLU; reflecting language complexity, also derived from SALT coding) predicted later caregiver MLU, even when controlling for variability in infant ages and clear within-domain temporal stability/continuity in key measures (i.e., caregiver sensitive responsiveness and infant word tokens; and infant and caregiver MLU). These data add empirical support to theorization on how caregiver input can be both supportive of, and potentially influenced by, infant capacities, when infants have social-communication differences and/or communication/language delays suggestive of possible emerging autism.
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Affiliation(s)
- Jodie Smith
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jonathan Green
- School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Pillar
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Carol Taylor
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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11
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Carruthers S, Mleczko N, Page S, Ahuja S, Ellis C, Howlin P, Leadbitter K, Taylor L, Slonims V, Charman T. Using implementation science frameworks to explore barriers and facilitators for parents' use of therapeutic strategies following a parent-mediated autism intervention. Autism 2022; 27:1011-1025. [PMID: 36314780 PMCID: PMC10115939 DOI: 10.1177/13623613221125630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Many early autism interventions teach parents therapeutic strategies to help them adjust their communication style with their children. Research has shown that this behaviour change in parents leads to improvements in child communication. It is, therefore, important to learn what factors support or hinder parents in their use of therapeutic strategies learned in such interventions. This study set out to interview parents who had participated in a research trial of the Paediatric Autism Communication Therapy-Generalised intervention. We interviewed 27 caregivers and explored their use of the strategies up to 2 years after the end of the research trial. Qualitative frameworks were used to inform interview questions and data analysis. These frameworks focused on a range of contextual factors, including parents' characteristics, their context and features of the intervention. Parents reported barriers and facilitators to using Paediatric Autism Communication Therapy-Generalised strategies across three themes: Motivating Factors; Opportunity and Support; Parent Characteristics. One of these themes, Motivating Factors, was further divided into the subthemes Compatibility and Buy-In and Alignment of Goals and Outcomes. Almost all parents reported continued use of the Paediatric Autism Communication Therapy-Generalised strategies. Facilitators included parental confidence in using the strategies and barriers included child's behaviour. Consideration of these factors can inform ways to better support parents in future autism interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Vicky Slonims
- King's College London, UK
- Guy's and St Thomas' NHS Foundation Trust, UK
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12
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Green J, Leadbitter K, Ellis C, Taylor L, Moore HL, Carruthers S, James K, Taylor C, Balabanovska M, Langhorne S, Aldred C, Slonims V, Grahame V, Parr J, Humphrey N, Howlin P, McConachie H, Couteur AL, Charman T, Emsley R, Pickles A. Combined social communication therapy at home and in education for young autistic children in England (PACT-G): a parallel, single-blind, randomised controlled trial. Lancet Psychiatry 2022; 9:307-320. [PMID: 35305746 PMCID: PMC9630149 DOI: 10.1016/s2215-0366(22)00029-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autistic children can have difficulty generalising treatment effects beyond the immediate treatment context. Paediatric Autism Communication Therapy (PACT) has been successful when delivered in the clinic. Here we tested the Paediatric Autism Communication Therapy-Generalised (PACT-G) intervention combined between home and education settings for its overall effect and mechanistic transmission of effect across contexts. METHODS In this parallel, single-blind, randomised, controlled trial, we recruited autistic children aged 2-11 years in urban or semi-urban areas in Manchester, Newcastle, and London, England. Children needed to meet core autism criteria on Autism Diagnostic Observation Schedule-second edition (ADOS-2) and parent-rated Social Communication Questionnaire (SCQ-lifetime), and children older than 5 years were included if they had intentional communication but expressive language equivalent of age 4 years or younger. Eligible children were randomly assigned (1:1), using block randomisation (random block sizes of 2 and 4) and stratified for site, age (2-4 years vs 5-11 years), and gender, to either PACT-G plus treatment as usual or treatment as usual alone. Research assessors were masked to treatment allocation. The PACT-G intervention was delivered by a therapist in parallel to the child's parents at home and to learning-support assistants (LSA) at their place of education, using both in-person and remote sessions over a 6 month period, to optimise adult-child social interaction. Treatment as usual included any health support or intervention from education or local community services. The primary outcome was autism symptom severity using the ADOS-2, as measured by researchers, at 12 months versus baseline. Secondary outcomes were Brief Observation of Social Communication Change (BOSCC) and dyadic social interaction between child and adult across contexts, both at 12 months. Other secondary outcome measures were assessed using the following composites: language, anxiety, repetitive behaviour, adaptive behaviour, parental wellbeing, child health-related quality of life, and disruptive behaviour. Assessments were done at baseline, 7 months, and 12 months. We used an intention-to-treat (ITT) analysis of covariance for the efficacy outcome measures. Adverse events were assessed by researchers for all trial families at each contact and by therapists in the PACT-G group at each visit. This study is registered with the ISRCTN Registry, ISRCTN 25378536. FINDINGS Between Jan 18, 2017, and April 19, 2018, 555 children were referred and 249 were eligible, agreed to participate, and were randomly assigned to either PACT-G (n=122) or treatment as usual (n=127). One child in the PACT-G group withdrew and requested their data be removed from the study, giving an ITT population of 248 children. 51 (21%) of 248 children were female, 197 (79%) were male, 149 (60%) were White, and the mean age was 4·0 years (SD 0·6). The groups were well balanced for demographic and clinical characteristics. In the PACT-G group, parents of children received a median of 10 (IQR 8-12) home sessions and LSAs received a median of 8 (IQR 5-10) education sessions over 6 months. We found no treatment effect on the ADOS-2 primary outcome compared with treatment as usual (effect size 0·04 [95% CI -0·19 to 0·26]; p=0·74), or researcher-assessed BOSCC (0·03 [-0·25 to 0·31]), language composite (-0·03 [-0·15 to 0·10]), repetitive behaviour composite (0·00 [-0·35 to 0·35]), adaptive behaviour composite (0·01 [-0·15 to 0·18]), or child wellbeing (0·09 [-0·15 to 0·34]). PACT-G treatment improved synchronous response in both parent (0·50 [0·36 to 0·65]) and LSA (0·33 [0·16 to 0·50]), mediating increased child communication with parent (0·26 [0·12 to 0·40]) and LSA (0·20 [0·06 to 0·34]). Child dyadic communication change mediated outcome symptom alteration on BOSCC at home (indirect effect -0·78 [SE 0·34; 95% CI -1·44 to -0·11]; p=0·022) although not in education (indirect effect -0·67 [SE 0·37; 95% CI -1·40 to 0·06]; p=0·073); such an effect was not seen on ADOS-2. Treatment with PACT-G also improved the parental wellbeing composite (0·44 [0·08 to 0·79]) and the child disruptive behaviour composite in home and education (0·29 [0·01 to 0·57]). Adverse events on child behaviour and wellbeing were recorded in 13 (10%) of 127 children in the treatment as usual group (of whom four [31%] were girls) and 11 (9%) of 122 in the PACT-G group (of whom three [33%] were girls). One serious adverse event on parental mental health was recorded in the PACT-G group and was possibly study related. INTERPRETATION Although we found no effect on the primary outcome compared with treatment as usual, adaptation of the 12-month PACT intervention into briefer multicomponent delivery across home and education preserved the positive proximal outcomes, although smaller in effect size, and the original pattern of treatment mediation seen in clinic-delivered therapy, as well as improving parental wellbeing and child disruptive behaviours across home and school. Reasons for this reduced efficacy might be the reduced dose of each component, the effect of remote delivery, and the challenges of the delivery contexts. Caution is needed in assuming that changing delivery methods and context will preserve an original intervention efficacy for autistic children. FUNDING National Institute for Health Research and Medical Research Council Efficacy and Mechanism Evaluation Award.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK; Manchester Royal Children's Hospital, Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Ceri Ellis
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Lauren Taylor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Heather L Moore
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Sophie Carruthers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Matea Balabanovska
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Sophie Langhorne
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Vicky Slonims
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Victoria Grahame
- Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; Great North Children's Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil Humphrey
- Institute of Education, University of Manchester, Manchester, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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13
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 227] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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14
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Whitehouse AJO, Varcin KJ, Pillar S, Billingham W, Alvares GA, Barbaro J, Bent CA, Blenkley D, Boutrus M, Chee A, Chetcuti L, Clark A, Davidson E, Dimov S, Dissanayake C, Doyle J, Grant M, Green CC, Harrap M, Iacono T, Matys L, Maybery M, Pope DF, Renton M, Rowbottam C, Sadka N, Segal L, Slonims V, Smith J, Taylor C, Wakeling S, Wan MW, Wray J, Cooper MN, Green J, Hudry K. Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis. JAMA Pediatr 2021; 175:e213298. [PMID: 34542577 PMCID: PMC8453361 DOI: 10.1001/jamapediatrics.2021.3298] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Intervention for individuals with autism spectrum disorder (ASD) typically commences after diagnosis. No trial of an intervention administered to infants before diagnosis has shown an effect on diagnostic outcomes to date. OBJECTIVE To determine the efficacy of a preemptive intervention for ASD beginning during the prodromal period. DESIGN, SETTING, AND PARTICIPANTS This 2-site, single rater-blinded randomized clinical trial of a preemptive intervention vs usual care was conducted at 2 Australian research centers (Perth, Melbourne). Community sampling was used to recruit 104 infants aged 9 to 14 months showing early behaviors associated with later ASD, as measured by the Social Attention and Communication Surveillance-Revised. Recruitment occurred from June 9, 2016, to March 30, 2018. Final follow-up data were collected on April 15, 2020. INTERVENTIONS Infants were randomized on a 1:1 ratio to receive either a preemptive intervention plus usual care or usual care only over a 5-month period. The preemptive intervention group received a 10-session social communication intervention, iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP). Usual care comprised services delivered by community clinicians. MAIN OUTCOMES AND MEASURES Infants were assessed at baseline (approximate age, 12 months), treatment end point (approximate age, 18 months), age 2 years, and age 3 years. Primary outcome was the combined blinded measure of ASD behavior severity (the Autism Observation Scale for Infants and the Autism Diagnostic Observation Schedule, second edition) across the 4 assessment points. Secondary outcomes were an independent blinded clinical ASD diagnosis at age 3 years and measures of child development. Analyses were preregistered and comprised 1-tailed tests with an α level of .05. RESULTS Of 171 infants assessed for eligibility, 104 were randomized; 50 infants (mean [SD] chronological age, 12.40 [1.93] months; 38 boys [76.0%]) received the iBASIS-VIPP preemptive intervention plus usual care (1 infant was excluded after randomization), and 53 infants (mean [SD] age, 12.38 [2.02] months; 32 boys [60.4%]) received usual care only. A total of 89 participants (45 in the iBASIS-VIPP group and 44 in the usual care group) were reassessed at age 3 years. The iBASIS-VIPP intervention led to a reduction in ASD symptom severity (area between curves, -5.53; 95% CI, -∞ to -0.28; P = .04). Reduced odds of ASD classification at age 3 years was found in the iBASIS-VIPP group (3 of 45 participants [6.7%]) vs the usual care group (9 of 44 participants [20.5%]; odds ratio, 0.18; 95% CI, 0-0.68; P = .02). Number needed to treat to reduce ASD classification was 7.2 participants. Improvements in caregiver responsiveness and language outcomes were also observed in the iBASIS-VIPP group. CONCLUSIONS AND RELEVANCE Receipt of a preemptive intervention for ASD from age 9 months among a sample of infants showing early signs of ASD led to reduced ASD symptom severity across early childhood and reduced the odds of an ASD diagnosis at age 3 years. TRIAL REGISTRATION http://anzctr.org.au identifier: ACTRN12616000819426.
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Affiliation(s)
- Andrew J. O. Whitehouse
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,University of Western Australia, Crawley, Western Australia, Australia,Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia
| | - Kandice J. Varcin
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Sarah Pillar
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Gail A. Alvares
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Catherine A. Bent
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Daniel Blenkley
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Maryam Boutrus
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Abby Chee
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Lacey Chetcuti
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Alena Clark
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Emma Davidson
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Stefanie Dimov
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Jane Doyle
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Megan Grant
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cherie C. Green
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Megan Harrap
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, College of Science, Health, and Engineering, Victoria, Australia
| | - Lisa Matys
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Murray Maybery
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel F. Pope
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Michelle Renton
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Catherine Rowbottam
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, Allied Health and Human Movement, University of South Australia, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia
| | - Vicky Slonims
- Children’s Neurosciences, Evelina London Children’s Hospital/Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Jodie Smith
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Scott Wakeling
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Ming Wai Wan
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Matthew N. Cooper
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
| | - Kristelle Hudry
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
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15
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Charman T, Palmer M, Stringer D, Hallett V, Mueller J, Romeo R, Tarver J, Paris Perez J, Breese L, Hollett M, Cawthorne T, Boadu J, Salazar F, O'Leary M, Beresford B, Knapp M, Slonims V, Pickles A, Scott S, Simonoff E. A Novel Group Parenting Intervention for Emotional and Behavioral Difficulties in Young Autistic Children: Autism Spectrum Treatment and Resilience (ASTAR): A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2021; 60:1404-1418. [PMID: 33965518 DOI: 10.1016/j.jaac.2021.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/08/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the feasibility and preliminary efficacy of a group behavioral parenting intervention for emotional and behavioral problems (EBPs) in young autistic children. METHOD This was a feasibility pilot randomized controlled trial comparing a 12-week group behavioral parenting intervention (Predictive Parenting) to an attention control (Psychoeducation). Parents of 62 autistic children 4 to 8 years of age were randomized to Predictive Parenting (n = 31) or Psychoeducation (n = 31). The primary outcome was a blinded observational measure of child behaviors that challenge. Secondary outcomes were observed child compliance and parenting behaviors; parent- and teacher-reported child EBPs; self-reported parenting practices, stress, self-efficacy, and well-being. Cost-effectiveness was also explored. RESULTS Recruitment, retention, completion of measures, treatment fidelity, and parental satisfaction were high for both interventions. There was no group difference in primary outcome: mean log of rate 0.18 lower (d, 90% CI = -0.44 to 0.08) in Predictive Parenting. Differences in rates of child compliance (0.44, 90% CI = 0.11 to 0.77), facilitative parenting (0.63, 90% CI = 0.33 to 0.92) and parent-defined target symptom change (-0.59, 90% CI -0.17 to -1.00) favored Predictive Parenting. There were no differences on other measures. Predictive Parenting was more expensive than Psychoeducation, with a low probability of being more cost-effective. CONCLUSION Feasibility was demonstrated. There was no evidence from this pilot trial that Predictive Parenting resulted in reductions in child EBPs beyond those seen following Psychoeducation; in addition, the effect size was small, and it was more expensive. However, it showed superiority for child compliance and facilitative parenting with moderate effect sizes. Future, definitive studies should evaluate whether augmented or extended intervention would lead to larger improvements. CLINICAL TRIAL REGISTRATION INFORMATION Autism Spectrum Treatment and Resilience (ASTAR); https://www.isrctn.com/; 91411078.
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Affiliation(s)
- Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
| | - Melanie Palmer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Dominic Stringer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Victoria Hallett
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Joanne Mueller
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Renee Romeo
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Joanne Tarver
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Juan Paris Perez
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Lauren Breese
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Megan Hollett
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Thomas Cawthorne
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Janet Boadu
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Fernando Salazar
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mark O'Leary
- Bromley Healthcare CIC Ltd, London, United Kingdom
| | - Bryony Beresford
- Social Policy Research Unit, University of York, York, United Kingdom
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Vicky Slonims
- Newcomen Neurodevelopmental Centre, Children's Neurosciences, Evelina Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
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16
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Chetcuti L, Uljarević M, Varcin KJ, Boutrus M, Pillar S, Dimov S, Barbaro J, Dissanayake C, Green J, Wan MW, Segal L, Slonims V, Whitehouse AJO, Hudry K. Caregiver Psychological Distress Predicts Temperament and Social-Emotional Outcomes in Infants with Autism Traits. Res Child Adolesc Psychopathol 2021; 49:1669-1681. [PMID: 34216330 DOI: 10.1007/s10802-021-00838-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 01/10/2023]
Abstract
Child temperament and caregiver psychological distress have been independently associated with social-emotional difficulties among individuals with autism. However, the interrelationship among these risk factors has rarely been investigated. We explored the reciprocal interplay between child temperament (surgency, negative affectivity, and self-regulation) and caregiver psychological distress in the development of child internalizing and externalizing symptoms, in a cohort of 103 infants showing early autism traits. Caregivers completed questionnaires when children were aged around 12-months (Time 1 [T1]), 18-months (Time 2 [T2]), and 24-months (Time 3 [T3]). Cross-lagged path models revealed a significant pathway from T1 caregiver psychological distress through lower T2 child self-regulation to subsequently greater T3 child internalizing symptoms. No such caregiver-driven pathway was evident through T2 child negative affectivity or in the prediction of T3 child externalizing symptoms. Further, no support was found for temperament-driven pathways through caregiver psychological distress to child social-emotional difficulties. Child surgency was mostly unrelated to caregiver psychological distress and social-emotional difficulties. These findings implicate the need to support the mental health of caregivers with an infant with autism traits in order to enhance the emotion regulation and social-emotional development of their infants.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. .,Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.
| | - Mirko Uljarević
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, School of Medicine, Stanford University, Stanford Autism Center, Stanford, California, USA.,School of Psychological Sciences, Faculty of Medicine, The University of Melbourne, Dentistry and Health Sciences, Melbourne, Australia
| | - Kandice J Varcin
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Stefanie Dimov
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester Mental Health NHS Trust, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Leonie Segal
- Australian Centre for Precision Health, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Vicky Slonims
- Evelina Children's Hospital / Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Kristelle Hudry
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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17
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Palmer M, Paris Perez J, Tarver J, Cawthorne T, Frayne M, Webb S, Baker E, Yorke I, Hay D, Slonims V, Pickles A, Simonoff E, Scott S, Charman T. Development of the Observation Schedule for Children with Autism-Anxiety, Behaviour and Parenting (OSCA-ABP): A New Measure of Child and Parenting Behavior for Use with Young Autistic Children. J Autism Dev Disord 2021; 51:1-14. [PMID: 32350790 PMCID: PMC7810641 DOI: 10.1007/s10803-020-04506-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Co-occurring emotional and behavioral problems (EBPs) frequently exist in young autistic children. There is evidence based on parental report that parenting interventions reduce child EBPs. More objective measures of child EBPs should supplement parent reported outcomes in trials. We describe the development of a new measure of child and parenting behavior, the Observation Schedule for Children with Autism-Anxiety, Behaviour and Parenting (OSCA-ABP). Participants were 83 parents/carers and their 4-8-year-old autistic children. The measure demonstrated good variance and potential sensitivity to change. Child and parenting behavior were reliably coded among verbal and minimally verbal children. Associations between reports from other informants and observed behavior showed the measure had sufficient convergent validity. The measure has promise to contribute to research and clinical practice in autism mental health beyond objective measurement in trials.
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Affiliation(s)
- Melanie Palmer
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Juan Paris Perez
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Joanne Tarver
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Thomas Cawthorne
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Margot Frayne
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sophie Webb
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Elena Baker
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Isabel Yorke
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Dale Hay
- School of Psychology, Cardiff University, Cardiff, UK
| | - Vicky Slonims
- Newcomen Neurodevelopmental Centre, Evelina Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Tony Charman
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
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18
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Hallett V, Mueller J, Breese L, Hollett M, Beresford B, Irvine A, Pickles A, Slonims V, Scott S, Charman T, Simonoff E. Introducing ‘Predictive Parenting’: A Feasibility Study of a New Group Parenting Intervention Targeting Emotional and Behavioral Difficulties in Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 51:323-333. [DOI: 10.1007/s10803-020-04442-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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Chetcuti L, Uljarević M, Varcin KJ, Boutrus M, Wan MW, Slonims V, Green J, Segal L, Iacono T, Dissanayake C, Whitehouse AJO, Hudry K. The Role of Negative Affectivity in Concurrent Relations Between Caregiver Psychological Distress and Social-Emotional Difficulties in Infants With Early Signs of Autism. Autism Res 2020; 13:1349-1357. [PMID: 32390345 DOI: 10.1002/aur.2296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/24/2020] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
Abstract
Recent evidence suggests the link between caregiver psychological distress and offspring social-emotional difficulties may be accounted for by offspring temperament characteristics. However, existing studies have only focused on neurotypical children; thus, the current study sought to provide an initial examination of this process among children with varying levels of early autism features. Participants included 103 infants aged 9-16 months (M = 12.39, SD = 1.97; 68% male) and their primary caregiver (96% mothers) referred to a larger study by community healthcare professionals. We utilized caregiver-reported measures of psychological distress (Depression Anxiety Stress Scales), infant temperament (Infant Behavior Questionnaire-Revised) and internalizing and externalizing symptoms (Infant-Toddler Social and Emotional Assessment) and administered the Autism Observation Schedule for Infants (AOSI) at an assessment visit to quantify autism features. Infant negative affectivity was found to mediate positive concurrent relations between caregiver psychological distress and infant internalizing and externalizing symptoms, irrespective of the infants' AOSI score. While preliminary and cross-sectional, these results replicate and extend previous findings suggesting that the pathway from caregiver psychological distress to negative affectivity to social-emotional difficulties might also be apparent among infants with varying levels of autism features. More rigorous tests of causal effects await future longitudinal investigation. LAY SUMMARY: Offspring of caregivers experiencing psychological distress (i.e., symptoms of depression, anxiety, and/or stress) may themselves be at increased risk of poor mental health outcomes. Several previous studies conducted with neurotypical children suggest that this link from caregiver-to-child may be facilitated by children's temperament qualities. This study was a preliminary cross-sectional exploration of these relationships in infants with features of autism. We found that infants' elevated negative emotions were involved in the relation between caregiver heightened psychological distress and children's mental health difficulties, consistent with neurotypical development. Autism Res 2020, 13: 1349-1357. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Lacey Chetcuti
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Mirko Uljarević
- Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, School of Medicine, Stanford University, Stanford, California, USA.,Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia.,School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Leonie Segal
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, Bendigo, Victoria, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Kristelle Hudry
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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- The AICES Team in Alphabetical Order: Josephine Barbaro, Stefanie Dimov, Murray Maybery, Michelle Renton, Nancy Sadka, Scott Wakeling, and John Wray
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20
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Carruthers S, Pickles A, Slonims V, Howlin P, Charman T. Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism. Autism Res 2020; 13:506-522. [PMID: 31943828 PMCID: PMC7187421 DOI: 10.1002/aur.2264] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/09/2019] [Accepted: 12/26/2019] [Indexed: 01/07/2023]
Abstract
Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation 'difficulties' associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506-522. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: It is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed.
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Affiliation(s)
- Sophie Carruthers
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Vicky Slonims
- Guy's and St Thomas' NHS Foundation Trust (Evelina Children's Hospital)LondonUnited Kingdom
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
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Farris O, Royston R, Absoud M, Ambler G, Barnes J, Hunter R, Kyriakopoulos M, Oulton K, Paliokosta E, Panca M, Paulauskaite L, Poppe M, Ricciardi F, Sharma A, Slonims V, Summerson U, Sutcliffe A, Thomas M, Hassiotis A. Clinical and cost effectiveness of a parent mediated intervention to reduce challenging behaviour in pre-schoolers with moderate to severe intellectual disability (EPICC-ID) study protocol: a multi-centre, parallel-group randomised controlled trial. BMC Psychiatry 2020; 20:35. [PMID: 32000729 PMCID: PMC6993328 DOI: 10.1186/s12888-020-2451-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/21/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Children with intellectual disabilities are likely to present with challenging behaviour. Parent mediated interventions have shown utility in influencing child behaviour, although there is a paucity of UK research into challenging behaviour interventions in this population. NICE guidelines favour Stepping Stones Triple P (SSTP) as a challenging behaviour intervention and this trial aims to evaluate its clinical and cost effectiveness in preschool children with moderate to severe intellectual disabilities. METHODS This trial launched in 2017 at four sites across England, with the aim of recruiting 258 participants (aged 30-59 months). The Intervention Group receive nine weeks of SSTP parenting therapy (six group sessions and three individualised face to face or telephone sessions) in addition to Treatment as Usual, whilst the Treatment as Usual only group receive other available services in each location. Both study groups undergo the study measurements at baseline and at four and twelve months. Outcome measures include parent reports and structured observations of behaviour. Service use and health related quality of life data will also be collected to carry out a cost effectiveness and utility evaluation. DISCUSSION Findings from this study will inform policy regarding interventions for challenging behaviour in young children with moderate to severe intellectual disabilities. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, NCT03086876. Registered 22nd March 2017, https://clinicaltrials.gov/ct2/show/NCT03086876.
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Affiliation(s)
- Olayinka Farris
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Rachel Royston
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Michael Absoud
- Evelina London Children’s Hospital, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH and King’s College London, Strand, London, WC2R 2LS UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birbeck University of London, Malet Street, London, WC1E 7HX UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, Royal Free Medical School, NW3 2PF, London, UK
| | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, PO66 De Crespigny Park, London, SE5 8AF UK
| | - Kate Oulton
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Eleni Paliokosta
- The Effra Clinic, 4th Floor, 86-90 Paul Street, London, EC2A 4NE UK
| | - Monica Panca
- Research Department of Primary Care and Population Health, Royal Free Medical School, NW3 2PF, London, UK
| | - Laura Paulauskaite
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Michaela Poppe
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Federico Ricciardi
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Aditya Sharma
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
| | - Vicky Slonims
- Evelina London Children’s Hospital, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH and King’s College London, Strand, London, WC2R 2LS UK
| | | | | | - Megan Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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22
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Whitehouse AJO, Varcin KJ, Alvares GA, Barbaro J, Bent C, Boutrus M, Chetcuti L, Cooper MN, Clark A, Davidson E, Dimov S, Dissanayake C, Doyle J, Grant M, Iacono T, Maybery M, Pillar S, Renton M, Rowbottam C, Sadka N, Segal L, Slonims V, Taylor C, Wakeling S, Wan MW, Wray J, Green J, Hudry K. Pre-emptive intervention versus treatment as usual for infants showing early behavioural risk signs of autism spectrum disorder: a single-blind, randomised controlled trial. Lancet Child Adolesc Health 2019; 3:605-615. [PMID: 31324597 DOI: 10.1016/s2352-4642(19)30184-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Great interest exists in the potential efficacy of prediagnostic interventions within the autism spectrum disorder prodrome, but available evidence relates to children at high familial risk. We aimed to test the efficacy of a pre-emptive intervention designed for infants showing early behavioural signs of autism spectrum disorder. METHODS In this single-blind, randomised controlled trial done at two specialist centres in Australia, infants aged 9-14 months were enrolled if they were showing at least three early behavioural signs of autism spectrum disorder on the Social Attention and Communication Surveillance-Revised (SACS-R) 12-month checklist. Infants were randomly assigned (1:1) to receive a parent-mediated video-aided intervention (iBASIS-VIPP) or treatment as usual. Group allocation was done by minimisation, stratified by site, sex, age, and the number of SACS-R risk behaviours. Assessments were done at baseline (before treatment allocation) and at the 6 month endpoint. The primary outcome was Autism Observation Scale for Infants (AOSI), which measures early behavioural signs associated with autism spectrum disorder. Secondary outcomes were a range of infant and caregiver outcomes measured by Manchester Assessment of Caregiver-Infant interaction (MACI), Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd edition (VABS-2), MacArthur-Bates Communicative Development Inventory (MCDI), and Parenting Sense of Competence (PSOC) scale. This trial is registered with Australian New Zealand Clinical Trials Registry, number ANZCTR12616000819426. FINDINGS Between June 9, 2016, and March 30, 2018, 103 infants were randomly assigned, 50 to the iBASIS-VIPP group and 53 to the treatment-as-usual group. After the intervention, we observed no significant differences between groups on early autism spectrum disorder behavioural signs measured by the AOSI (difference estimate -0·74, 95% CI -2·47 to 0·98). We also observed no significant differences on secondary outcomes measuring caregiver non-directiveness (0·16, -0·33 to 0·65), caregiver sensitive responding (0·24, -0·15 to 0·63), and infant attentiveness (-0·19, -0·63 to 0·25) during parent-child interactions (MACI), as well as on researcher-administered measures of receptive (1·30, -0·48 to 3·08) and expressive language (0·54, -0·73 to 1·80), visual reception (0·31, -0·77 to 1·40), and fine motor skills (0·55, -0·32 to 1·41) using the MSEL. Compared with the treatment-as-usual group, the iBASIS-VIPP group had lower infant positive affect (-0·69, -1·27 to -0·10) on the MACI, but higher caregiver-reported receptive (37·17, 95% CI 10·59 to 63·75) and expressive vocabulary count (incidence rate ratio 2·31, 95% CI 1·22 to 4·33) on MCDI, and functional language use (difference estimate 6·43, 95% CI 1·06 to 11·81) on VABS. There were no significant group differences on caregiver-reported measures of MCDI infant gesture use (3·22, -0·60 to 7·04) and VABS social behaviour (3·28, -1·43 to 7·99). We observed no significant differences between groups on self-reported levels of parenting satisfaction (difference estimate 0·21, 95% CI -0·09 to 0·52), interest (-0·23, -0·62 to 0·16) and efficacy (-0·08, -0·38 to 0·22) on PSOC. INTERPRETATION A pre-emptive intervention for the autism spectrum disorder prodrome had no immediate treatment effect on early autism spectrum disorder symptoms, the quality of parent-child interactions, or researcher-administered measures of developmental skills. However, we found a positive effect on parent-rated infant communication skills. Ongoing follow-up of this infant cohort will assess longer-term developmental effects. FUNDING Western Australia Children's Research Fund, Autism Cooperative Research Centre, La Trobe University, and Angela Wright Bennett Foundation.
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Affiliation(s)
- Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia; Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia.
| | - Kandice J Varcin
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia; Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Catherine Bent
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia; Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia; School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Lacey Chetcuti
- Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia; Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Alena Clark
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Emma Davidson
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Stefanie Dimov
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia; Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Jane Doyle
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Megan Grant
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, Bendigo, VIC, Australia
| | - Murray Maybery
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Michelle Renton
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia; Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Catherine Rowbottam
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Scott Wakeling
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Ming Wai Wan
- School of Health Sciences, University of Manchester, Manchester, UK
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
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23
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Palmer M, Tarver J, Paris Perez J, Cawthorne T, Romeo R, Stringer D, Hallett V, Mueller J, Breese L, Hollett M, Beresford B, Knapp M, Slonims V, Pickles A, Simonoff E, Scott S, Charman T. A novel group parenting intervention to reduce emotional and behavioural difficulties in young autistic children: protocol for the Autism Spectrum Treatment and Resilience pilot randomised controlled trial. BMJ Open 2019; 9:e029959. [PMID: 31248932 PMCID: PMC6597639 DOI: 10.1136/bmjopen-2019-029959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/24/2019] [Accepted: 05/16/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The majority of young autistic children display impairing emotional and behavioural difficulties that contribute to family stress. There is some evidence that behavioural parenting interventions are effective for reducing behavioural difficulties in autistic children, with less evidence assessing change in emotional difficulties. Previous trials have tended to use unblinded parent-report measures as primary outcomes and many do not employ an active control, limiting the conclusions that can be drawn. METHODS AND ANALYSIS The Autism Spectrum Treatment and Resilience study is a pilot randomised controlled trial (RCT) testing the specific effect of a 12-week group parenting intervention (Predictive Parenting) on primary and secondary outcomes, in comparison to an attention control condition consisting of psychoeducation parent groups. Following a feasibility study to test research procedures and the interventions, the pilot RCT participants include 60 parents of autistic children aged 4-8 years who are randomised to Predictive Parenting versus the attention control. Measures are administered at baseline and post intervention to assess group differences in child and parent outcomes, costs and service use and adverse events. The primary outcome is an objective measure of child behaviours that challenge during interactions with their parent and a researcher. The trial aims to provide data on recruitment, retention, completion of measures and acceptability of the intervention and research protocol, in addition to providing a preliminary indication of potential efficacy and establishing an effect size that could be used to power a larger-scale efficacy trial. We will also provide preliminary estimates of the cost-effectiveness of the interventions. ETHICS AND DISSEMINATION Ethical approval was granted from NHS Camden and Kings Cross Research Ethics Committee (ref: 16/LO/1769) along with NHS R&D approval from South London and Maudsley, Guy's and St Thomas', and Croydon Health Services NHS Trusts. The findings will be disseminated through publication in peer-reviewed journals and presentations at conferences. TRIAL REGISTRATION NUMBER ISRCTN91411078.
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Affiliation(s)
- Melanie Palmer
- Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Joanne Tarver
- Department of Psychology, Aston University, School of Life and Health Sciences, Birmingham, UK
| | - Juan Paris Perez
- Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Thomas Cawthorne
- Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Renee Romeo
- Department of Health Service and Population Research, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Victoria Hallett
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Joanne Mueller
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Lauren Breese
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Megan Hollett
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Vicky Slonims
- Evelina Children’s Hospital, Guy’s and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Adoption and Fostering Service & Conduct Problems Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tony Charman
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Palmer M, San José Cáceres A, Tarver J, Howlin P, Slonims V, Pellicano E, Charman T. Feasibility study of the National Autistic Society EarlyBird parent support programme. Autism 2019; 24:147-159. [DOI: 10.1177/1362361319851422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The EarlyBird programme is a group-based psychoeducation intervention for parents of young children with autism. Although it is widely used in the United Kingdom, the evidence base for the programme is very limited. Using a mixed method, non-randomised research design, we aimed to test (1) the acceptability of the research procedures (recruitment, retention, suitability of measures), (2) the parental acceptability of EarlyBird (attendance, views of the programme, perceived changes) and (3) the facilitator acceptability of EarlyBird (fidelity, views of the programme, perceived changes). Seventeen families with a 2- to 5-year-old autistic child and 10 EarlyBird facilitators took part. Pre- and post-intervention assessment included measures of the child’s autism characteristics, cognitive ability, adaptive behaviour, emotional and behavioural problems and parent-reported autism knowledge, parenting competence, stress and wellbeing. Semi-structured interviews were completed at post-intervention with parents and facilitators. For those involved in the study, the research procedures were generally acceptable, retention rates were high and the research protocol was administered as planned. Generally, positive views of the intervention were expressed by parents and facilitators. Although the uncontrolled, within-participant design does not allow us to test for efficacy, change in several outcome measures from pre- to post-intervention was in the expected direction. Difficulties were encountered with recruitment (opt-in to the groups was ~56% and opt-in to the research was 63%), and strategies to enhance recruitment need to be built into any future trial. These findings should be used to inform protocols for pragmatic, controlled trials of EarlyBird and other group-based interventions for parents with young autistic children.
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Salomone E, Leadbitter K, Aldred C, Barrett B, Byford S, Charman T, Howlin P, Green J, Le Couteur A, McConachie H, Parr JR, Pickles A, Slonims V. The Association Between Child and Family Characteristics and the Mental Health and Wellbeing of Caregivers of Children with Autism in Mid-Childhood. J Autism Dev Disord 2019; 48:1189-1198. [PMID: 29177606 PMCID: PMC5861164 DOI: 10.1007/s10803-017-3392-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We examined predictors of mental health difficulties and wellbeing in caregivers of children with autism in the Pre-school Autism Communication Trial cohort in middle childhood (N = 104). Child’s intellectual disability, daily living skills impairment, elevated emotional and behavioural difficulties, high educational level of caregiver and household income below the median significantly predicted caregivers’ mental health difficulties, but autism severity, child communication skills and family circumstances did not. Lower caregiver mental wellbeing was predicted by elevated child emotional and behavioural difficulties. The need to support the mental health and wellbeing of caregivers of children with autism is discussed in light of the results.
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Affiliation(s)
- Erica Salomone
- University of Turin, Via Po, 14, 10123, Turin, Italy. .,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | | | | | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan Green
- University of Manchester, Manchester, UK.,UK Royal Manchester Children's Hospital, Manchester Academic Health Sciences Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ann Le Couteur
- Newcastle University, Newcastle, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vicky Slonims
- Evelina London Children's Hospital, Guys and St Thomas University NHS Trust, London, UK
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Tarver J, Palmer M, Webb S, Scott S, Slonims V, Simonoff E, Charman T. Child and parent outcomes following parent interventions for child emotional and behavioral problems in autism spectrum disorders: A systematic review and meta-analysis. Autism 2019; 23:1630-1644. [PMID: 30818965 DOI: 10.1177/1362361319830042] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
There is growing interest in the development of behavioral parent interventions targeting emotional and behavioral problems in children with autism spectrum disorders. Such interventions have potential to improve a number of child and parental well-being outcomes beyond disruptive child behavior. This systematic review and meta-analysis assesses evidence for the efficacy of behavioral parent interventions for disruptive and hyperactive child behavior in autism spectrum disorders, as well as parenting efficacy and stress. A total of 11 articles from nine randomized controlled trials were included. Sufficient data were available to calculate standardized mean difference and show favorable effects of behavioral parent interventions on parent-reported measures of child disruptive behavior (standardized mean difference = 0.67), hyperactivity (standardized mean difference = 0.31) and parent stress (standardized mean difference = 0.37); effects on parent efficacy are less clear (standardized mean difference = 0.39, p = 0.17). There were insufficient data to explore intervention effects on internalizing behavior in autism spectrum disorders, parenting behaviors, or observational and teacher-reported outcomes, providing important avenues for future research. This review adds to growing evidence of the efficacy of behavioral parent interventions for child behavior and parental well-being in autism spectrum disorders (Prospero: CRD42016033979).
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Ebbels SH, McCartney E, Slonims V, Dockrell JE, Norbury CF. Evidence-based pathways to intervention for children with language disorders. Int J Lang Commun Disord 2019; 54:3-19. [PMID: 29696726 DOI: 10.1111/1460-6984.12387] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 02/22/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs. AIMS To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence-based model of SLT service delivery and a flowchart to aid clinical decision-making. METHODS & PROCEDURES Meta-analyses and systematic reviews, together with controlled, peer-reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted. MAIN CONTRIBUTION The service-delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non-SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT-specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored. CONCLUSIONS & IMPLICATIONS SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost-effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches.
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Affiliation(s)
- Susan H Ebbels
- Moor House School & College, Oxted, UK; Division of Psychology and Language Sciences, University College London
| | | | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London
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Norbury CF, McCartney E, Slonims V, Dockrell JE, Ebbels SH. Public health approaches still have room for individualized services: response to commentaries on 'Evidence-based pathways to intervention for children with language disorders'. Int J Lang Commun Disord 2019; 54:28-29. [PMID: 30393985 DOI: 10.1111/1460-6984.12436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - Vicky Slonims
- Guy's and St Thomas NHS Foundation Trust, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Julie E Dockrell
- Psychology and Human Development, UCL Institute of Education, Bedford Way, London
| | - Susan H Ebbels
- Moor House Research and Training Institute, Moor House School & College and Psychology & Language Sciences, UCL, London
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Green J, Aldred C, Charman T, Le Couteur A, Emsley RA, Grahame V, Howlin P, Humphrey N, Leadbitter K, McConachie H, Parr JR, Pickles A, Slonims V, Taylor C. Paediatric Autism Communication Therapy-Generalised (PACT-G) against treatment as usual for reducing symptom severity in young children with autism spectrum disorder: study protocol for a randomised controlled trial. Trials 2018; 19:514. [PMID: 30241574 PMCID: PMC6150959 DOI: 10.1186/s13063-018-2881-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/27/2018] [Indexed: 01/17/2023] Open
Abstract
Background Prior evidence shows that behaviours closely related to the intervention delivered for autism are amenable to change, but it is more difficult to generalise treatment effects beyond the intervention context. We test an early autism intervention designed to promote generalisation of therapy-acquired skills into home and school contexts to improve adaptive function and reduce symptoms. A detailed mechanism study will address the process of such generalisation. Objective 1 will be to test if the PACT-G intervention improves autism symptom outcome in the home and school context of the intervention as well as in the primary outcome research setting. Objective 2 will use the mechanism analysis to test for evidence of acquired skills from intervention generalizing across contexts and producing additive effects on primary outcome. Methods/design This is a three-site, two-parallel-group, randomised controlled trial of the experimental treatment plus treatment as usual (TAU) versus TAU alone. Children aged 2–11 years (n = 244 (122 intervention/122 TAU; ~ 82/site) meeting criteria for core autism will be eligible. The experimental intervention builds on a clinic-based Pre-school Autism Communication Treatment model (PACT), delivered with the primary caregiver, combined with additional theory- and evidence-based strategies designed to enhance the generalisation of effects into naturalistic home and education contexts. The control intervention will be TAU. Primary outcome: autism symptom outcome, researcher-assessed using a standardised protocol. Secondary outcomes: autism symptoms, child interaction with parent or teacher, language and reported functional outcomes in home and school settings. Outcomes measured at baseline and 12-month endpoint in all settings with interim interaction measurements (7 months) to test treatment effect mechanisms. Primary analysis will estimate between-group difference in primary outcome using analysis of covariance with test of homogeneity of effect across age group. Mechanism analysis will use regression models to test for mediation on primary outcome by parent-child and teaching staff-child social interaction. Discussion This is an efficacy and mechanism trial of generalising evidence-based autism treatment into home and school settings. It will provide data on whether extending treatment across naturalistic contexts enhances overall effect and data on the mechanism in autism development of the generalisation of acquired developmental skills across contexts. Trial registration ISRCTN, ID: 25378536. Prospectively registered on 9 March 2016: Electronic supplementary material The online version of this article (10.1186/s13063-018-2881-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, PACT-G Trial Office, Room 3.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. .,Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, PACT-G Trial Office, Room 3.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.,Children's and Young People's Disability Partnership, Kingsgate House, Wellington Road North, Stockport, SK4 1LW, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Box PO77, Henry Wellcome Building, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Ann Le Couteur
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Level 3, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Richard A Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Room S 2.03, De Crespigny Park, London, SE5 8AF, UK
| | - Victoria Grahame
- Northumberland, Tyne and Wear NHS Foundation Trust, Walkergate Park, Benfield Rd, Newcastle upon Tyne, NE6 4QD, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Box PO77, Henry Wellcome Building, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Neil Humphrey
- Manchester Institute of Education, University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, University of Manchester, PACT-G Trial Office, Room 3.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Helen McConachie
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Level 3, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Framlington Place, Newcastle upon Tyne, NE1 9DU, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, Room S 2.10, De Crespigny Park, London, SE5 8AF, UK
| | - Vicky Slonims
- Guy's and St Thomas' NHS Foundation Trust (Evelina Children's Hospital), Newcomen Centre at St Thomas' 2nd Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, University of Manchester, PACT-G Trial Office, Room 3.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
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Green J, Pickles A, Pasco G, Bedford R, Wan MW, Elsabbagh M, Slonims V, Gliga T, Jones E, Cheung C, Charman T, Johnson M. Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years. J Child Psychol Psychiatry 2017; 58:1330-1340. [PMID: 28393350 PMCID: PMC5724485 DOI: 10.1111/jcpp.12728] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has been increasing interest in the potential for pre-emptive interventions in the prodrome of autism, but little investigation as to their effect. METHODS A two-site, two-arm assessor-blinded randomised controlled trial (RCT) of a 12-session parent-mediated social communication intervention delivered between 9 and 14 months of age (Intervention in the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting), against no intervention. Fifty-four infants (28 intervention, 26 nonintervention) at familial risk of autism but not otherwise selected for developmental atypicality were assessed at 9-month baseline, 15-month treatment endpoint, and 27- and 39-month follow-up. PRIMARY OUTCOME severity of autism prodromal symptoms, blind-rated on Autism Observation Schedule for Infants or Autism Diagnostic Observation Schedule 2nd Edition across the four assessment points. SECONDARY OUTCOMES blind-rated parent-child interaction and child language; nonblind parent-rated communication and socialisation. Prespecified intention-to-treat analysis combined estimates from repeated measures within correlated regressions to estimate the overall effect of the infancy intervention over time. RESULTS Effect estimates in favour of intervention on autism prodromal symptoms, maximal at 27 months, had confidence intervals (CIs) at each separate time point including the null, but showed a significant overall effect over the course of the intervention and follow-up period (effect size [ES] = 0.32; 95% CI 0.04, 0.60; p = .026). Effects on proximal intervention targets of parent nondirectiveness/synchrony (ES = 0.33; CI 0.04, 0.63; p = .013) and child attentiveness/communication initiation (ES = 0.36; 95% CI 0.04, 0.68; p = .015) showed similar results. There was no effect on categorical diagnostic outcome or formal language measures. CONCLUSIONS Follow-up to 3 years of the first RCT of a very early social communication intervention for infants at familial risk of developing autism has shown a treatment effect, extending 24 months after intervention end, to reduce the overall severity of autism prodromal symptoms and enhance parent-child dyadic social communication over this period. We highlight the value of extended follow-up and repeat assessment for early intervention trials.
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Affiliation(s)
- Jonathan Green
- Social Development Research GroupSchool of Biological SciencesUniversity of ManchesterManchesterUK,Royal Manchester Children's HospitalManchesterUK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,National Institute for Health Research Medical Health Biomedical Research CentreSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Greg Pasco
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Rachael Bedford
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Ming Wai Wan
- School of Health SciencesUniversity of ManchesterManchesterUK
| | - Mayada Elsabbagh
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK,Department of PsychiatryMcGill UniversityWest MontréalQCCanada
| | - Vicky Slonims
- Evelina London Children's Hospital and King's College London Neurosciences CentreLondonUK
| | - Teea Gliga
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Emily Jones
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Celeste Cheung
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Tony Charman
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Mark Johnson
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
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Pickles A, Le Couteur A, Leadbitter K, Salomone E, Cole-Fletcher R, Tobin H, Gammer I, Lowry J, Vamvakas G, Byford S, Aldred C, Slonims V, McConachie H, Howlin P, Parr JR, Charman T, Green J. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. Lancet 2016; 388:2501-2509. [PMID: 27793431 PMCID: PMC5121131 DOI: 10.1016/s0140-6736(16)31229-6] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is not known whether early intervention can improve long-term autism symptom outcomes. We aimed to follow-up the Preschool Autism Communication Trial (PACT), to investigate whether the PACT intervention had a long-term effect on autism symptoms and continued effects on parent and child social interaction. METHODS PACT was a randomised controlled trial of a parent-mediated social communication intervention for children aged 2-4 years with core autism. Follow-up ascertainment was done at three specialised clinical services centres in the UK (London, Manchester, and Newcastle) at a median of 5·75 years (IQR 5·42-5·92) from the original trial endpoint. The main blinded outcomes were the comparative severity score (CSS) from the Autism Diagnostic Observation Schedule (ADOS), the Dyadic Communication Assessment Measure (DCMA) of the proportion of child initiatiations when interacting with the parent, and an expressive-receptive language composite. All analyses followed the intention-to-treat principle. PACT is registered with the ISRCTN registry, number ISRCTN58133827. FINDINGS 121 (80%) of the 152 trial participants (59 [77%] of 77 assigned to PACT intervention vs 62 [83%] of 75 assigned to treatment as usual) were traced and consented to be assessed between July, 2013, and September, 2014. Mean age at follow-up was 10·5 years (SD 0·8). Group difference in favour of the PACT intervention based on ADOS CSS of log-odds effect size (ES) was 0·64 (95% CI 0·07 to 1·20) at treatment endpoint and ES 0·70 (95% CI -0·05 to 1·47) at follow-up, giving an overall reduction in symptom severity over the course of the whole trial and follow-up period (ES 0·55, 95% CI 0·14 to 0·91, p=0·004). Group difference in DCMA child initiations at follow-up showed a Cohen's d ES of 0·29 (95% CI -0.02 to 0.57) and was significant over the course of the study (ES 0·33, 95% CI 0·11 to 0·57, p=0·004). There were no group differences in the language composite at follow-up (ES 0·15, 95% CI -0·23 to 0·53). INTERPRETATION The results are the first to show long-term symptom reduction after a randomised controlled trial of early intervention in autism spectrum disorder. They support the clinical value of the PACT intervention and have implications for developmental theory. FUNDING Medical Research Council.
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Affiliation(s)
- Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Ann Le Couteur
- Newcastle University, Newcastle, UK; Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne, UK
| | | | - Erica Salomone
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | | | - Isobel Gammer
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | - George Vamvakas
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | - Vicky Slonims
- Evelina London Children's Hospital, Guys and St Thomas University NHS Trust, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | - Tony Charman
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Jonathan Green
- University of Manchester, Manchester, UK; Royal Manchester Children's Hospital and Manchester Academic Health Sciences Centre, Manchester, UK.
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Loucas T, Baird G, Simonoff E, Slonims V. Phonological processing in children with specific language impairment with and without reading difficulties. Int J Lang Commun Disord 2016; 51:581-588. [PMID: 26992032 DOI: 10.1111/1460-6984.12225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/10/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Specific language impairment (SLI) is heterogeneous and identifying subgroups within it may help explain the aetiology of the condition. Phonological processing abilities distinguish between children with SLI who do and do not have reading decoding impairments (RDIs). AIMS To probe different levels of phonological processing in children with SLI with and without RDI to investigate the cognitive basis of these differences. METHODS & PROCEDURES A total of 64 children aged 5-17 years were classified using the results of standardized language and single-word reading tests into those with no SLI and no RDI (No SLI/No RDI) (N = 18), no SLI but with RDI (No SLI/RDI) (N = 4, not included in analyses because of the small number), SLI/No RDI (N = 20), and SLI/RDI (N = 22). The groups were compared on a range of tasks engaging different levels of phonological processing (input and output processing and phonological awareness). OUTCOMES & RESULTS The SLI/RDI group was distinguished from the SLI/No RDI and No SLI/No RDI groups by more errors in the longer items in non-word repetition and by poorer phonological awareness. Non-word discrimination scores indicated a gradient of performance across groups that was not associated with a qualitatively different pattern of performance. CONCLUSIONS & IMPLICATIONS This is the first study contrasting input and output processes associated with phonological processing. The results suggest that deficits in SLI plus RDI may be associated with impairment in actively maintaining phonological representations for phonological processing, which is not present in those without RDI and which leads to reading decoding difficulties.
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Affiliation(s)
- Tom Loucas
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Gillian Baird
- Children's Neurosciences Centre, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Emily Simonoff
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Vicky Slonims
- Children's Neurosciences Centre, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
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Bauminger N, Sofronoff K, Slonims V. Book Reviews. Autism 2016. [DOI: 10.1177/1362361304040645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Byford S, Cary M, Barrett B, Aldred CR, Charman T, Howlin P, Hudry K, Leadbitter K, Le Couteur A, McConachie H, Pickles A, Slonims V, Temple KJ, Green J. Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial. BMC Psychiatry 2015; 15:316. [PMID: 26691535 PMCID: PMC4685630 DOI: 10.1186/s12888-015-0700-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/14/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Autism is associated with impairments that have life-time consequences for diagnosed individuals and a substantial impact on families. There is growing interest in early interventions for children with autism, yet despite the substantial economic burden, there is little evidence of the cost-effectiveness of such interventions with which to support resource allocation decisions. This study reports an economic evaluation of a parent-mediated, communication-focused therapy carried out within the Pre-School Autism Communication Trial (PACT). METHODS 152 pre-school children with autism were randomly assigned to treatment as usual (TAU) or PACT + TAU. Primary outcome was severity of autism symptoms at 13-month follow-up. Economic data included health, education and social services, childcare, parental productivity losses and informal care. RESULTS Clinically meaningful symptom improvement was evident for 53 % of PACT + TAU versus 41 % of TAU (odds ratio 1.91, p = 0.074). Service costs were significantly higher for PACT + TAU (mean difference £4,489, p < 0.001), but the difference in societal costs was smaller and non-significant (mean difference £1,385, p = 0.788) due to lower informal care rates for PACT + TAU. CONCLUSIONS Improvements in outcome generated by PACT come at a cost. Although this cost is lower when burden on parents is included, the cost and effectiveness results presented do not support the cost-effectiveness of PACT + TAU compared to TAU alone. TRIAL REGISTRATION Current Controlled Trials ISRCTN58133827.
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Affiliation(s)
- Sarah Byford
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Maria Cary
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Barbara Barrett
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | | | - Tony Charman
- Department of Psychology, Box P077, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Patricia Howlin
- Department of Psychology, Box P077, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kathy Leadbitter
- Institute for Brain, Behaviour and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Andrew Pickles
- Biostatistics, Box P020, King`s College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Vicky Slonims
- Evelina Children`s Hospital, King`s College London, London, SE1 7EH, UK.
| | - Kathryn J. Temple
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Jonathan Green
- Manchester Academic Health Sciences Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
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Pickles A, Harris V, Green J, Aldred C, McConachie H, Slonims V, Le Couteur A, Hudry K, Charman T. Treatment mechanism in the MRC preschool autism communication trial: implications for study design and parent-focussed therapy for children. J Child Psychol Psychiatry 2015; 56:162-70. [PMID: 25039961 DOI: 10.1111/jcpp.12291] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The PACT randomised-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 aimed to better understand 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.
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Affiliation(s)
- Andrew Pickles
- Department of Biostatistics, Institute of Psychiatry, Kings College London, London, UK
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Green J, Charman T, Pickles A, Wan MW, Elsabbagh M, Slonims V, Taylor C, McNally J, Booth R, Gliga T, Jones EJH, Harrop C, Bedford R, Johnson MH. Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial. Lancet Psychiatry 2015; 2:133-40. [PMID: 26359749 PMCID: PMC4722333 DOI: 10.1016/s2215-0366(14)00091-1] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk markers for later autism identified in the first year of life present plausible intervention targets during early development. We aimed to assess the effect of a parent-mediated intervention for infants at high risk of autism on these markers. METHODS We did a two-site, two-arm assessor-blinded randomised controlled trial of families with an infant at familial high risk of autism aged 7-10 months, testing the adapted Video Interaction to Promote Positive Parenting (iBASIS-VIPP) versus no intervention. Families were randomly assigned to intervention or no intervention groups using a permuted block approach stratified by centre. Assessors, but not families or therapists, were masked to group assignment. The primary outcome was infant attentiveness to parent. Regression analysis was done on an intention-to-treat basis. This trial is registered with ISCRTN Registry, number ISRCTN87373263. FINDINGS We randomly assigned 54 families between April 11, 2011, and Dec 4, 2012 (28 to intervention, 26 to no intervention). Although CIs sometimes include the null, point estimates suggest that the intervention increased the primary outcome of infant attentiveness to parent (effect size 0.29, 95% CI -0.26 to 0.86, thus including possibilities ranging from a small negative treatment effect to a strongly positive treatment effect). For secondary outcomes, the intervention reduced autism-risk behaviours (0.50, CI -0.15 to 1.08), increased parental non-directiveness (0.81, 0.28 to 1.52), improved attention disengagement (0.48, -0.01 to 1.02), and improved parent-rated infant adaptive function (χ(2)[2] 15.39, p=0.0005). There was a possibility of nil or negative effect in language and responsivity to vowel change (P1: ES-0.62, CI -2.42 to 0.31; P2: -0.29, -1.55 to 0.71). INTERPRETATION With the exception of the response to vowel change, our study showed positive estimates across a wide range of behavioural and brain function risk-markers and developmental outcomes that are consistent with a moderate intervention effect to reduce the risk for later autism. However, the estimates have wide CIs that include possible nil or small negative effects. The results are encouraging for development and prevention science, but need larger-scale replication to improve precision. FUNDING Autistica, Waterloo Foundation, Autism Speaks, and the UK Medical Research Council.
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Affiliation(s)
- Jonathan Green
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
| | - Tony Charman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ming W Wan
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Mayada Elsabbagh
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK; Department of Psychiatry, McGill University, West Montreal, QC, Canada
| | - Vicky Slonims
- Evelina London Children's Hospital and Kings College London Neurosciences Centre, London, UK
| | - Carol Taylor
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Janet McNally
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK; Institute of Psychological Sciences, University of Leeds, Leeds, UK
| | - Rhonda Booth
- Institute of Child Health, University College London, London, UK
| | - Teodora Gliga
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK
| | - Clare Harrop
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK; Kasari Lab, UCLA Center for Autism Research and Treatment, Semel Institute, Los Angeles, CA, USA
| | - Rachael Bedford
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK
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Green J, Wan MW, Guiraud J, Holsgrove S, McNally J, Slonims V, Elsabbagh M, Charman T, Pickles A, Johnson M. Intervention for infants at risk of developing autism: a case series. J Autism Dev Disord 2014; 43:2502-14. [PMID: 23532347 DOI: 10.1007/s10803-013-1797-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n = 8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8-10 months of age. We outline the theory and evidence base behind this model and present data on feasibility, acceptability and measures ranging from parent-infant social interaction, to infant atypical behaviors, attention and cognition. The intervention proves to be both feasible and acceptable to families. Measurement across domains was successful and on larger samples promise to be an effective test of whether such an intervention in infancy will modify emergent atypical developmental trajectories in infants at risk for autism.
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Affiliation(s)
- Jonathan Green
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 4.308, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK,
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Simpson NH, Addis L, Brandler WM, Slonims V, Clark A, Watson J, Scerri TS, Hennessy ER, Bolton PF, Conti-Ramsden G, Fairfax BP, Knight JC, Stein J, Talcott JB, O'Hare A, Baird G, Paracchini S, Fisher SE, Newbury DF, Consortium SLI. Increased prevalence of sex chromosome aneuploidies in specific language impairment and dyslexia. Dev Med Child Neurol 2014; 56:346-53. [PMID: 24117048 PMCID: PMC4293460 DOI: 10.1111/dmcn.12294] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2013] [Indexed: 12/05/2022]
Abstract
AIM Sex chromosome aneuploidies increase the risk of spoken or written language disorders but individuals with specific language impairment (SLI) or dyslexia do not routinely undergo cytogenetic analysis. We assess the frequency of sex chromosome aneuploidies in individuals with language impairment or dyslexia. METHOD Genome-wide single nucleotide polymorphism genotyping was performed in three sample sets: a clinical cohort of individuals with speech and language deficits (87 probands: 61 males, 26 females; age range 4 to 23 years), a replication cohort of individuals with SLI, from both clinical and epidemiological samples (209 probands: 139 males, 70 females; age range 4 to 17 years), and a set of individuals with dyslexia (314 probands: 224 males, 90 females; age range 7 to 18 years). RESULTS In the clinical language-impaired cohort, three abnormal karyotypic results were identified in probands (proband yield 3.4%). In the SLI replication cohort, six abnormalities were identified providing a consistent proband yield (2.9%). In the sample of individuals with dyslexia, two sex chromosome aneuploidies were found giving a lower proband yield of 0.6%. In total, two XYY, four XXY (Klinefelter syndrome), three XXX, one XO (Turner syndrome), and one unresolved karyotype were identified. INTERPRETATION The frequency of sex chromosome aneuploidies within each of the three cohorts was increased over the expected population frequency (approximately 0.25%) suggesting that genetic testing may prove worthwhile for individuals with language and literacy problems and normal non-verbal IQ. Early detection of these aneuploidies can provide information and direct the appropriate management for individuals.
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Affiliation(s)
- Nuala H Simpson
- Wellcome Trust Centre for Human Genetics, University of OxfordOxford, UK
| | - Laura Addis
- Department of Clinical Neuroscience, Institute of Psychiatry, King's College LondonLondon, UK
| | - William M Brandler
- MRC Functional Genomics Unit, Department of Physiology, Anatomy & Genetics, University of OxfordOxford, UK
| | - Vicky Slonims
- Newcomen Centre, Evelina Children's HospitalLondon, UK
| | - Ann Clark
- Speech and Hearing Sciences, Queen Margaret UniversityEdinburgh, UK
| | - Jocelynne Watson
- Speech and Hearing Sciences, Queen Margaret UniversityEdinburgh, UK
| | - Thomas S Scerri
- The Walter and Eliza Hall Institute of Medical ResearchMelbourne, Australia
| | | | - Patrick F Bolton
- Departments of Child & Adolescent Psychiatry & Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King's College LondonLondon, UK
| | - Gina Conti-Ramsden
- School of Psychological Sciences, University of ManchesterManchester, UK
| | - Benjamin P Fairfax
- Wellcome Trust Centre for Human Genetics, University of OxfordOxford, UK
| | - Julian C Knight
- Wellcome Trust Centre for Human Genetics, University of OxfordOxford, UK
| | | | | | - Anne O'Hare
- Department of Reproductive and Developmental Sciences, University of EdinburghEdinburgh, UK
| | - Gillian Baird
- Newcomen Centre, Evelina Children's HospitalLondon, UK
| | | | - Simon E Fisher
- Max Planck Institute for PsycholinguisticsNijmegen, the Netherlands,Donders Institute for Brain, Cognition and Behaviour, Radboud UniversityNijmegen, the Netherlands
| | - Dianne F Newbury
- Wellcome Trust Centre for Human Genetics, University of OxfordOxford, UK,Correspondence to Dianne F Newbury, MRC Career Development Fellow, Office 00/008, Lab 1, Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Headington, Oxford OX3 7BN, UK. E-mail:
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Pasco G, Clark B, Dragan I, Kalambayi F, Slonims V, Tarpan AK, Wittemeyer K. A training and development project to improve services and opportunities for social inclusion for children and young people with autism in Romania. Autism 2014; 18:827-31. [PMID: 24590469 DOI: 10.1177/1362361314524642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2010, the Romanian Angel Appeal Foundation launched a 3-year national training and development programme to develop and deliver a model of diagnostic and therapeutic services aimed at promoting social inclusion for children and young people with autism spectrum disorders. The project adopted a number of strategies aimed at developing knowledge and skills among professionals and increasing awareness in political and public spheres: (a) a three-stage training programme designed to increase knowledge of autism spectrum disorders and promote best practice among professionals working in services providing for children with autism spectrum disorders and their families, on a nationwide basis; (b) two online courses for general practitioners and psychiatrists, with content relating to the identification, diagnosis and treatment of autism spectrum disorders; (c) a total of 40 counselling and assistance centres for people with autism spectrum disorders were launched in partnership with local authorities; (d) a national strategy for social and professional integration of people with autism spectrum disorders developed through consultation with political, statutory and voluntary sector partners; and (e) a nationwide media campaign to raise awareness of the needs of children and young people with autism spectrum disorders that reached over eight million people. The project provides a transferable model to achieve important improvements in the quantity and quality of services on a national level within a brief time frame.
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Affiliation(s)
- Greg Pasco
- Institute of Psychiatry, King's College London, UK
| | - Bruce Clark
- South London and Maudsley NHS Foundation Trust, UK
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Abstract
AIM A deficit in non-word repetition (NWR), a measure of short-term phonological memory proposed as a marker for language impairment, is found not only in language impairment but also in reading impairment. We evaluated the strength of association between language impairment and reading impairment in children with current, past, and no language impairment and assessed any differential impairment of NWR, compared with two other tests of verbal memory in children with language impairment with and without reading impairment. METHOD Our sample comprised children aged 6-16y 11mo participating in a study of the genetics of language impairment: 78 children from 68 families (53 males, 25 females) with current language impairment (C-LI), compared with their 74 siblings: 25 children (18 males, seven females) with a past history of language impairment and 49 children (27 males, 22 females) who had never had a language impairment. The tests used were the Clinical Evaluation of Language Fundamentals (CELF III), the Children's Test of Non-word Repetition (CN-Rep), the Wide Range Assessment of Memory and Learning (WRAML) verbal memory index, the Wechsler Intelligence Scale for Children-III (WISC-III) digit span, and the Wechsler Objective Reading Dimensions (WORD(UK) ). RESULTS Reading impairment was present in two-thirds of the children with current language impairment. NWR deficits were significantly worse in children with language impairment who had reading impairment in reading decoding (p=0.007 and 0.004 - average group compared with borderline and definitely impaired groups respectively) or spelling (p=0.002 and 0.005 - average group compared with borderline and severely impaired groups respectively) (not correlated with severity of language impairment) but not comprehension impairment. In contrast, WISC digit span and WRAML verbal memory were impaired in all children with language impairment and did not differentiate those who also had reading impairment. INTERPRETATION We suggest that current NWR ability may be a marker of a process specifically underlying language impairment, co-occurring with reading impairment involving reading decoding and spelling, rather than a generic correlate of language impairment. Other verbal memory deficits appear to be pervasive in children with language impairment.
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Affiliation(s)
- Gillian Baird
- Newcomen Child Development Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
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Hudry K, Leadbitter K, Temple K, Slonims V, McConachie H, Aldred C, Howlin P, Charman T. Preschoolers with autism show greater impairment in receptive compared with expressive language abilities. Int J Lang Commun Disord 2010; 45:681-690. [PMID: 20102259 DOI: 10.3109/13682820903461493] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND In early typical language development, children understand words before they are able to use them in speech. Children with autism spectrum disorders (ASD) generally show impairments in both the comprehension and the production of language. However, the relative degree of delay or impairment in each of these sub-domains may also be atypical and remains less well-understood. AIMS Relative delay in receptive and expressive language skills was examined within a large sample of preschoolers with autism. Children's language abilities varied from pre-verbal to fluent speech. METHOD & PROCEDURES Scores on one direct clinician assessment and two parent-report measures of language were obtained for 152 preschoolers with core autism. OUTCOMES & RESULTS As expected, on average, the language ability of the children with autism was lower than typical age norms, albeit with substantial individual variability. On all three language measures, receptive ability was relatively more impaired than expressive ability. Higher non-verbal ability was associated with such an atypical language profile. CONCLUSIONS & IMPLICATIONS Recognition of the marked receptive language impairment relative to expressive language, found to affect at least one-third of preschoolers with autism in this sample, has important implications for interacting with these children and for informing appropriate targets in language and communication intervention.
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Affiliation(s)
- Kristelle Hudry
- Centre for Research in Autism and Education, Department of Psychology and Human Development, Institute of Education, London, UK.
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Green J, Charman T, McConachie H, Aldred C, Slonims V, Howlin P, Le Couteur A, Leadbitter K, Hudry K, Byford S, Barrett B, Temple K, Macdonald W, Pickles A. Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial. Lancet 2010; 375:2152-60. [PMID: 20494434 PMCID: PMC2890859 DOI: 10.1016/s0140-6736(10)60587-9] [Citation(s) in RCA: 430] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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 randomly 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. Randomisation 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 Standard Randomised Controlled Trial, number ISRCTN58133827. 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 cannot 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.
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Affiliation(s)
- Jonathan Green
- Psychiatry Research Group, University of Manchester, Manchester, UK.
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Abstract
AIM The aim of this study was to assess whether any memory impairment co-occurring with language impairment is global, affecting both verbal and visual domains, or domain specific. METHOD Visual and verbal memory, learning, and processing speed were assessed in children aged 6 years to 16 years 11 months (mean 9 y 9 m, SD 2 y 6 mo) with current, resolved, and no language impairment using the Wide Range Assessment of Memory and Learning (WRAML), a standardized memory and learning test for children, and the Children's Test of Non-Word Repetition (CNRep), a test of phonological short-term memory. Fifty-one children (38 males, 13 females) with current speech and language impairment from 49 families were compared with 13 siblings (11 males, 2 females) with a past history of language impairment and 26 (15 males, 11 females) who had never had language impairment. RESULTS Children with current language impairment showed impairment in all verbal memory measures compared with children who had never had language impairment, and these impairments were still evident in children with a past history of learning impairment. Visual memory and learning were not impaired compared with children who had never had language impairment. The severity of verbal memory impairment correlated with the degree of language impairment. INTERPRETATION We concluded that in language impairment there is domain specificity of memory impairment affecting verbal processing.
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Affiliation(s)
- Gillian Baird
- Guy's & St Thomas' NHS Foundation Trust, London, UK.
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Newbury DF, Winchester L, Addis L, Paracchini S, Buckingham LL, Clark A, Cohen W, Cowie H, Dworzynski K, Everitt A, Goodyer IM, Hennessy E, Kindley AD, Miller LL, Nasir J, O'Hare A, Shaw D, Simkin Z, Simonoff E, Slonims V, Watson J, Ragoussis J, Fisher SE, Seckl JR, Helms PJ, Bolton PF, Pickles A, Conti-Ramsden G, Baird G, Bishop DV, Monaco AP. CMIP and ATP2C2 modulate phonological short-term memory in language impairment. Am J Hum Genet 2009; 85:264-72. [PMID: 19646677 PMCID: PMC2725236 DOI: 10.1016/j.ajhg.2009.07.004] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 07/03/2009] [Accepted: 07/07/2009] [Indexed: 11/15/2022] Open
Abstract
Specific language impairment (SLI) is a common developmental disorder characterized by difficulties in language acquisition despite otherwise normal development and in the absence of any obvious explanatory factors. We performed a high-density screen of SLI1, a region of chromosome 16q that shows highly significant and consistent linkage to nonword repetition, a measure of phonological short-term memory that is commonly impaired in SLI. Using two independent language-impaired samples, one family-based (211 families) and another selected from a population cohort on the basis of extreme language measures (490 cases), we detected association to two genes in the SLI1 region: that encoding c-maf-inducing protein (CMIP, minP = 5.5 × 10−7 at rs6564903) and that encoding calcium-transporting ATPase, type2C, member2 (ATP2C2, minP = 2.0 × 10−5 at rs11860694). Regression modeling indicated that each of these loci exerts an independent effect upon nonword repetition ability. Despite the consistent findings in language-impaired samples, investigation in a large unselected cohort (n = 3612) did not detect association. We therefore propose that variants in CMIP and ATP2C2 act to modulate phonological short-term memory primarily in the context of language impairment. As such, this investigation supports the hypothesis that some causes of language impairment are distinct from factors that influence normal language variation. This work therefore implicates CMIP and ATP2C2 in the etiology of SLI and provides molecular evidence for the importance of phonological short-term memory in language acquisition.
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Affiliation(s)
- Dianne F. Newbury
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
- The SLI Consortium, UK
| | - Laura Winchester
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
- The SLI Consortium, UK
| | - Laura Addis
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
- The SLI Consortium, UK
| | - Silvia Paracchini
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | | | - Ann Clark
- Speech and Hearing Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK
- The SLI Consortium, UK
| | - Wendy Cohen
- Department of Educational and Professional Studies, University of Strathclyde, Glasgow G13 1PP UK
- The SLI Consortium, UK
| | - Hilary Cowie
- Department of Speech and Language Therapy, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
- The SLI Consortium, UK
| | - Katharina Dworzynski
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London SE5 8AF, UK
- The SLI Consortium, UK
| | - Andrea Everitt
- Department of Child Health, University of Aberdeen, Aberdeen AB25 2GZ, UK
- The SLI Consortium, UK
| | - Ian M. Goodyer
- Developmental Psychiatry Section, University of Cambridge, Cambridge CB2 8AH, UK
- The SLI Consortium, UK
| | - Elizabeth Hennessy
- Department of Child Health, University of Aberdeen, Aberdeen AB25 2GZ, UK
- The SLI Consortium, UK
| | - A. David Kindley
- The Raeden Centre and Grampian University Hospitals Trust, Aberdeen AB2 4PE, UK
- The SLI Consortium, UK
| | - Laura L. Miller
- Avon Longitudinal Study Parents and Children, Department of Social Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Jamal Nasir
- Division of Clinical Developmental Sciences St. George's University of London, London SW17 0RE, UK
- The SLI Consortium, UK
| | - Anne O'Hare
- Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh EH9 1UW, UK
- The SLI Consortium, UK
| | - Duncan Shaw
- Department of Child Health, University of Aberdeen, Aberdeen AB25 2GZ, UK
- The SLI Consortium, UK
| | - Zoe Simkin
- Human Communication and Deafness, School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK
- The SLI Consortium, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London SE5 8AF, UK
- The SLI Consortium, UK
| | - Vicky Slonims
- Newcomen Centre, Guy's Hospital, London SE1 9RT, UK
- The SLI Consortium, UK
| | - Jocelynne Watson
- Speech and Hearing Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK
- The SLI Consortium, UK
| | - Jiannis Ragoussis
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Simon E. Fisher
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
- The SLI Consortium, UK
| | - Jonathon R. Seckl
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
- The SLI Consortium, UK
| | - Peter J. Helms
- Department of Child Health, University of Aberdeen, Aberdeen AB25 2GZ, UK
- The SLI Consortium, UK
| | - Patrick F. Bolton
- Department of Child and Adolescent Psychiatry and Medical Research Council Centre for Social, Developmental, and Genetic Psychiatry, Institute of Psychiatry, London SE5 8AF, UK
- The SLI Consortium, UK
| | - Andrew Pickles
- Biostatistics Group, School of Epidemiology and Health Science, University of Manchester, UK
- The SLI Consortium, UK
| | - Gina Conti-Ramsden
- Human Communication and Deafness, School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK
- The SLI Consortium, UK
| | - Gillian Baird
- Newcomen Centre, Guy's Hospital, London SE1 9RT, UK
- The SLI Consortium, UK
| | - Dorothy V.M. Bishop
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
- The SLI Consortium, UK
| | - Anthony P. Monaco
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
- The SLI Consortium, UK
- Corresponding author
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Abstract
Delays in development of early social behaviors in babies with Down syndrome are likely to affect patterns of interaction with their caregivers. We videotaped 23 babies in face-to-face interaction with their mothers at 8 and 20 weeks of age and compared them to 23 typically developing infants and their mothers. Social behaviors, mothers' behaviors, and quality of interaction were rated. At 8 weeks, babies with Down syndrome were significantly less communicative and lively than the typically developing babies. Their mothers' behaviors did not differ at 8 weeks, but did at 20 weeks. Although the social behaviors of babies with Down syndrome improved over time, qualitative differences remained.
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Abstract
Parents want autism to be diagnosed as early as possible, and early intervention may improve long term outcomes. The authors of this review discuss the identification and assessment process for children with autism and autistic spectrum disorder
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Affiliation(s)
- Gillian Baird
- Newcomen Centre, Guy's and St Thomas' NHS Trust, London SE1 9RT.
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Charman T, Howlin P, Aldred C, Baird G, Degli Espinosa F, Diggle T, Kovshoff H, Law J, Le Couteur A, MacNiven J, Magiati I, Martin N, McConachie H, Peacock S, Pickles A, Randle V, Slonims V, Wolke D. Research into early intervention for children with autism and related disorders: methodological and design issues. Report on a workshop funded by the Wellcome Trust, Institute of Child Health, London, UK, November 2001. Autism 2003; 7:217-25. [PMID: 12846389 DOI: 10.1177/1362361303007002008] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cass H, Reilly S, Owen L, Wisbeach A, Weekes L, Slonims V, Wigram T, Charman T. Findings from a multidisciplinary clinical case series of females with Rett syndrome. Dev Med Child Neurol 2003; 45:325-37. [PMID: 12729147 DOI: 10.1017/s0012162203000616] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Systematic data from a multidisciplinary clinical assessment of a large series of females with Rett syndrome (RS; n=87) is presented. Participants' ages ranged from 2 years 1 month to 44 years 10 months. Areas assessed included oromotor skills, feeding problems, growth, breathing abnormalities, mobility, postural abnormalities and joint deformities, epilepsy, hand use and stereotypies, self-care, and cognitive and communication skills. Many previously reported trends in the presentation of RS over time were confirmed, notably the increasingly poor growth and near pervasiveness of fixed joint deformities and scoliosis in adulthood. In contrast, there was a slight trend towards improved autonomic function in adulthood, whereas feeding difficulties increased into middle childhood and then reached a plateau. Improvements in mobility into adolescence were followed by a decline in those skills in adulthood. Levels of dependency were high, confirming findings from previous studies. Despite the presence of repetitive hand movements, a range of hand-use skills was seen in individuals of all ages. Cognitive and communication skills were limited, but there was little evidence of deterioration of these abilities with age. These findings confirm that RS is not a degenerative condition and indicate that intervention and support to maintain and increase motor skills, daily living skills, and cognitive and communicative functioning are appropriate targets for individuals with RS.
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Affiliation(s)
- Hilary Cass
- Wolfson Centre, Great Ormond Street Children's Hospital NHS Trust, Mecklenburgh Square, London WC 1N 2AP, UK.
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Abstract
Eighteen children (13 males, five females) who had severe developmental language delay/disorder and some features of autism (although insufficient in severity and combination to meet ICD-10 diagnostic criteria for childhood autism) at preschool age (Time 1; mean age 4 years 4 months) were followed up 4 years later (Time 2; mean age 8 years 7 months). At the initial assessment the diagnostic dilemma was how much the social communication impairments and behavioural problems were secondary to the language problem and how much they constituted a genuine case of a pervasive developmental disorder. It was anticipated that at follow-up some children would continue to show social impairments but that in others social impairments would have receded as language competence improved. Follow-up assessments included the Wechsler Intelligence Scale for Children, the Clinical Evaluation of Language Fundamentals, the Children's Communication Checklist, and the Social Communication Questionnaire. At follow-up, five children had continuing language disorder and were considered to fulfil diagnostic criteria for childhood autism, four children had continuing language disorder and met criteria for atypical autism, and nine met criteria for atypical autism but had somewhat recovered language skills. Thus, even in the subgroup of children whose language ability had improved the features of autism had not dissipated. Severity of social communication impairments and repetitive behaviours at Time 1, rated retrospectively from case notes, were associated with severity of autism symptoms and pragmatic competence at Time 2. The findings are discussed in relation to the unclear boundary between autism spectrum disorders and language delay/disorder.
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Affiliation(s)
- Janine Michelotti
- Donald Winnicott Centre, City and Hackney Community Services, NHS Trust, London, UK
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