Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial
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DOI：
10.1016/s0140-6736(10)60587-9
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发表时间：
2010-06-19
期刊：
影响因子：
168.9
通讯作者：
Pickles, Andrew
中科院分区：
文献类型：
--
作者：
Green, Jonathan;Charman, Tony;Pickles, Andrew
背景：小型试验的结果表明，社会沟通的早期干预对儿童自闭症的治疗是有效的。因此，我们在一个更大的试验中调查了这种干预的有效性。方法将核心自闭症儿童（2岁至4岁零11个月）按一对一的比例随机分配到英国三家专业中心进行以父母为中心的以沟通为重点的学龄前自闭症交流试验（PACT）干预或常规治疗。那些被分配到PACT组的患者也照常接受治疗。随机化采用治疗中心、年龄（42个月）和自闭症严重程度（自闭症诊断观察表-通用[ADOS-G]算法评分12-17或18-24）边缘分布概率最小化的方法。主要结局是13个月时自闭症症状的严重程度（来自ADOS-G的社会沟通算法项目的总分，得分越高表示严重程度越高）。辅助的次要结果是亲子互动、儿童语言和学校适应功能的测量。分析的目的是治疗。本研究已注册为国际标准随机对照试验，注册号为ISRCTN58133827。结果共招募了152名儿童。77例被分配到PACT（伦敦[n=26]，曼彻斯特[n=26]，纽卡斯尔[n=25]）；75人接受正常治疗（伦敦[n=26]，曼彻斯特[n=26]，纽卡斯尔[n=23]）。在13个月的终点，根据ADOS-G算法，PACT组的症状严重程度降低了3.9分（SD 4.7），常规治疗组的症状严重程度降低了2.9分（3.9），在调整中心、性别、社会经济地位、年龄、语言和非语言能力后，组间效应大小为0.24 （95% CI 0.59至0.11）。父母对孩子的同步反应（1.22,0.85 ~ 1.59）、孩子与父母的启蒙（0.41,0.08 ~ 0.74）和亲子共同关注（0.33,0.02 ~ 0.68）的治疗效果均为阳性。对学校直接评估的语言和适应功能的影响很小。根据我们的研究结果，我们不能建议在常规治疗的基础上增加PACT干预来减轻自闭症症状；然而，在亲子二元社会交流中有明显的好处。
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), 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 nonverbal 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.