Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial

Rahman, Atıf; Divan, Gauri; Hamdani, Syed Usman; Vajaratkar, Vivek; Taylor, Carol; Leadbitter, Kathy; Aldred, Catherine; Minhas, Ayesha; Cardozo, Percy; Emsley, Richard; Patel, Vikram; Green, Jonathan

doi:10.1016/s2215-0366(15)00388-0

Cited by 161 publications

(178 citation statements)

References 31 publications

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“…The success of this strategy in iBASIS is marked by the initial increase in parental ‘nondirectiveness’ within dyadic interaction (Green et al., ; Figure B). Other early interventions using similar structured video‐aided techniques have shown improvements in the same or related parental interaction behaviours, in both autism (Green et al., ; Kasari et al., ; Poslawsky et al., ; Rahman et al., ) and nonautism (Juffer et al., ) contexts. This gives persuasive support for the efficacy of these video‐aided methods and may relate to the less predictable effect in parent interventions that do not use this approach.…”

Section: Discussionmentioning

confidence: 99%

Randomised trial of a parent‐mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years

Green

Pickles

Pasco

et al. 2017

Child Psychology Psychiatry

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BackgroundThere has been increasing interest in the potential for pre‐emptive interventions in the prodrome of autism, but little investigation as to their effect.MethodsA 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.ResultsEffect 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.ConclusionsFollow‐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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Section: Discussionmentioning

confidence: 99%

Randomised trial of a parent‐mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years

Green

Pickles

Pasco

et al. 2017

Child Psychology Psychiatry

Self Cite

267

223

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“…PACT was tested in an RCT of 152 children with core autism (age 2-5 years), which found large endpoint effect in optimising parental synchrony across three geographically varied contexts in the United Kingdom (Green et al, 2010;Pickles et al, 2016). The same effect was replicated in an RCT testing adaptation of PACT to South Asia in 64 children aged 2-9 years (Rahman et al, 2016). The FPI intervention as above, also partially video-aided, found small gains in parental synchrony confined to dyads with more language-delayed children (Siller et al, 2013).…”

Section: Targets and Mechanisms In Psychosocial Autism Interventionmentioning

confidence: 94%

“…Replicated effects from robust trials of various interventions in autism show moderate to large effect sizes, particularly to improve parental responsiveness sensitivity and synchrony , theoretically linked in development to positive child social and communication outcomes. In relation to intervention techniques, video feedback probably has the strongest evidence for producing reliable parental change in this kind in both autism (Aldred, Green, & Adams, ; Green et al., ; Kasari, Siller et al., ; Poslawsky et al., ; Rahman et al., ) and neurotypical groups (Juffer, Bakermans‐Kranenburg, & van IJzendoorn, ). Techniques primarily using group or individual coaching and modelling techniques with parents do not show such reliable results (Carter et al., ; Rogers et al., ).…”

Section: Targets and Mechanisms In Psychosocial Autism Interventionmentioning

confidence: 99%

“…Reduced intrusiveness Poslawsky et al, 2015) Parent communicative synchrony 'Child focused dyadic behaviours' (Siller et al, 2013). DCMA Improved on video-aided intervention Rahman et al, 2016;Siller et al, 2013) Improved and mediates child initiation change on video-aided intervention (Green et al, 2010;Pickles et al, 2015) Child dyadic behaviours Child dyadic communication/ attentiveness with parent MACI/DCMA Improved in PACT, sustained 6 years after treatment end . Improved in iBASIS, sustained 2 years after treatment end .…”

Section: Parent Intrusiveness/ Directivenessmentioning

confidence: 99%

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Annual Research Review: The state of autism intervention science: progress, target psychological and biological mechanisms and future prospects

Green

Garg

2018

Child Psychology Psychiatry

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103

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There has been enough progress in psychosocial intervention research now to be able to begin to identify some evidence-based practice in autism treatment. To consolidate and improve outcomes, the next phase of intervention research needs improved trial design, and an iterative approach building on success. It may also include the testing of potential synergies between promising biological and psychosocial interventions.

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“…Maternal mental health supports in ASD care and QoL. Studies conducted in both the high resource and LMIC settings have reported that parents who participated in any training interventions for their children with ASD consistently report a high degree of satisfaction and improvement in their children [Patterson & Smith, 2011;Perera et al, 2016;Rahman et al, 2016]. However, higher socioeconomic status of mothers and improvement in children after schooling were important contributory factors for the improvement of the QoL of mothers in our study, suggesting affordability of the families to offer ASD care through school services may influence QoL of mothers of children with ASD, and more representative studies will be needed to further parse such a relationship.…”

Section: New Evidence Of Asd In Relevance To Lmic and Contextualizatimentioning

confidence: 99%

Burden of major depressive disorder and quality of life among mothers of children with autism spectrum disorder in urban bangladesh

Naheed

Islam

Hossain³

et al. 2019

Autism Research

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This cross‐sectional study examined the burden of depression and quality of life (QoL) among mothers of children with autism spectrum disorder (ASD) attending six schools offering special educational services for children with ASD in urban Dhaka, Bangladesh. All consenting mothers were 18 years of age and older and met criteria for major depressive disorder (MDD) on the Structured Interview for DSM‐V‐TR Research Version‐non patient edition administered by trained raters. QoL was assessed by the EuroQol five‐dimensional standardized questionnaire. MDD was diagnosed in 45% of mothers and was proportionally higher among those who did not work outside the home, had no childcare support at home, expressed low level of satisfaction with the quality of providers when they had sought care for their children with ASD, and reported being recipient of negative attitudes from neighbors toward their children with ASD. QoL was negatively associated with MDD, mothers' illness, and low satisfaction with the health care providers for children with ASD, as well as experiencing a negative attitude by neighbors toward their children. QoL was positively associated with the reported family monthly income and improvement of the children with ASD on school attendance. The prevalence of MDD among mothers of children with ASD was high and associated with poor QoL. Integrating mental health services and supports for mothers in the ASD care of children is likely to address the high burden of depression they face, and improve their overall quality of life. Autism Res 2020, 13: 284–297. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary The levels of depression were assessed among mothers of children with autism spectrum disorder (ASD) attending six schools offering special educational services for children with ASD in urban Dhaka, Bangladesh. Almost one in two mothers was found to have major depression. The quality of life of these mothers was generally poor. Integrating mental health services for mothers with ASD care in children is likely to address the burden of depression among the mothers of children with ASD and improve overall quality of life.

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Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial

Cited by 161 publications

References 31 publications

Randomised trial of a parent‐mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years

Randomised trial of a parent‐mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years

Annual Research Review: The state of autism intervention science: progress, target psychological and biological mechanisms and future prospects

Burden of major depressive disorder and quality of life among mothers of children with autism spectrum disorder in urban bangladesh

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