A pilot randomised control trial of a parent training intervention for pre-school children with autism

Abstract

Few attempts have been made to conduct randomised control trials (RCTs) of interventions for pre-school children with autism. We report findings of a pilot RCT for a parent training intervention with a focus on the development of joint attention skills and joint action routines. Twenty-four children meeting ICD-10 criteria for childhood autism (mean age = 23 months) were identified using the CHAT screen and randomised to the parent training group or to local services only. A follow-up was conducted 12 months later (mean age = 35 months). There was some evidence that the parent training group made more progress in language development than the local services group. However, the present pilot study was compromised by several factors: a reliance on parental report to measure language, non-matching of the groups on initial IQ, and a lack of systematic checking regarding the implementation of the parent training intervention. Furthermore, three parents in the local services group commenced intensive, home-based behavioural intervention during the course of the study. The difficulties encountered in the conduct of RCTs for pre-school children with autism are discussed. Methodological challenges and strategies for future well-designed RCTs for autism interventions are highlighted.

Evolução da criança autista a partir da resposta materna ao Autism Behavior Checklist

“…The ABC was proposed by Krug et al and translated into Portuguese by Marteleto. (17,18) It contains a list of 57 different behaviors that allows a detailed description of the non-adaptive characteristics in the following areas: Sensory (9); Body and Object Use (12); Language (13); Social Self Help (11); and Relating (12). It incorporates balanced scores from 1 to 4 points that vary according to the occurrence of each behavior.…”

“…(3)(4)(5)(6)(7)(8)(9)(10) A number of authors have described intervention programs in which the active participation of parents is assessed. (11)(12)(13)(14) Active care on the part of parents provides them with precise information on the development of the child, clarifying questions and understanding requests, and invites them to participant as agents in the language process, which is fundamental to the language and speech therapy of the child.…”

Challenges in Evaluating Psychosocial Interventions for Autistic Spectrum Disorders

“…They demonstrate the important effects of study enrollment and the perception of receiving a potentially effective treatment. Yet there are only three published studies that have used a randomized control design to determine intervention outcome in response to psychosocial treatments (Drew et al, 2002;Jocelyn, Casiro, Beattie, Bow, & Kneisz, 1998;Smith et al, 2000a, b). In the Smith and colleagues' study of a comprehensive program of the Lovaas treatment model, at follow-up, the intensive treatment group had a statistically significant advantage over a parent-training group in IQ and visual-spatial skills, but not adaptive behavior or language.…”

“…Outcome measures can be grouped according to whether they are measured close in time to the intervention or in longer-term follow-up, whether they are near or distant to the treatment in terms of the conceptualization, and to what degree, inferences about specific effects of a treatment can be drawn (Charman & Howlin, 2003;Drew et al, 2002). A distinction can be made between skills directly taught by the treatment and general measures of development likely to be affected by these skills.…”

“…A working group in the UK also produced a report about the design of autism treatment studies. The earlier discussion in this paper on ''levels of inference'' was based on this document (Charman & Howlin, 2003;Drew et al, 2002).…”