Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial.
Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial.
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DOI：
10.1016/s0140-6736(16)31229-6
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发表时间：
2016-11-19
期刊：
影响因子：
168.9
通讯作者：
Green, Jonathan
中科院分区：
文献类型：
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作者：
Pickles, Andrew;Le Couteur, Ann;Leadbitter, Kathy;Salomone, Erica;Cole-Fletcher, Rachel;Tobin, Hannah;Gammer, Isobel;Lowry, Jessica;Vamvakas, George;Byford, Sarah;Aldred, Catherine;Slonims, Vicky;McConachie, Helen;Howlin, Patricia;Parr, Jeremy R.;Charman, Tony;Green, Jonathan
目前尚不清楚早期干预是否可以改善长期自闭症症状的结果。我们的目的是随访学龄前自闭症沟通试验（PACT），以调查PACT干预是否对自闭症症状有长期影响，并对父母和孩子的社会互动产生持续影响。PACT是一项针对2 - 4岁核心自闭症儿童的父母介导的社会沟通干预的随机对照试验。在英国的三个专业临床服务中心（伦敦、曼彻斯特和纽卡斯尔）进行了随访确认，距离原始试验终点的中位时间为5·75年（IQR 5·42 - 5·92）。主要的盲法结果是自闭症诊断观察表（ADOS）的比较严重程度评分（CSS），与父母互动时儿童主动性比例的二元沟通评估量表（DCMA），以及表达-接受语言复合物。所有分析均遵循意向治疗原则。PACT在ISRCTN注册处注册，编号为ISRCTN58133827。在2013年7月至2014年9月期间，对152例试验受试者中的121例（80%）（77例分配接受PACT干预的受试者中的59例[77%] vs 75例分配接受常规治疗的受试者中的62例[83%]）进行了追踪并同意接受评估。随访时的平均年龄为10.5岁（SD 0.8）。基于ADOS CSS的对数优势效应量（ES），支持PACT干预的组间差异为0.64治疗终点时（95% CI 0.07至1.20）和ES 0.70随访时（95% CI-0.05至1.47），在整个试验过程和随访期间症状严重程度总体减轻（ES 0·55，95% CI 0·14至0·91，p = 0·004）。随访时DCMA儿童启动的组间差异显示Cohen d ES为0.29（95% CI-0.02至0.57），在研究过程中具有显著性（ES 0.33，95% CI 0.11至0.57，p = 0.004）。随访时，语言综合评分无组间差异（ES 0.15，95% CI-0.23至0.53）。在对自闭症谱系障碍进行早期干预的随机对照试验后，该结果首次显示了长期症状减轻。他们支持PACT干预的临床价值，并对发展理论产生影响。医学研究理事会。
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. 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. 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). 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. Medical Research Council.