Trial reportJournal of child psychology and psychiatry, and allied disciplines2024
Mediation of 6-year mid-childhood follow-up outcomes after pre-school social communication (PACT) therapy for autistic children: randomised controlled trial.
Trial report in Journal of child psychology and psychiatry, and allied disciplines, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed.
- Assess the Fidelity, Validity and Responsiveness of the Brief Observation of Social Communication Change (BOSCC) to Measure Changes in the Social Interactions of Preschool Children With Autism Spectrum Disorder.Autism : the international journal of research and practice · 2026Trial
- Mapping the landscape of early childhood development services: a global scoping review.BMJ open · 2026Article
- Mechanistic trials, therapy and developmental science-An exemplar from early autism care.JCPP advances · 2026Article
- Generalisation of Social Communication Skills by Autistic Children During Play-Based Assessments Across Home, School and an Unfamiliar Research Setting.Journal of autism and developmental disorders · 2025Article
- The process of co-design for a new anxiety intervention for autistic children.JCPP advances · 2025Article
- "It Seems Much More Enjoyable Now": Parental Perception of Relational Change from Participating in Paediatric Autism Communication Therapy (PACT).Children (Basel, Switzerland) · 2024Article
- Mediation of meaningful outcomes in early intervention: a commentary on Carruthers et al. (2023).Journal of child psychology and psychiatry, and allied disciplines · 2024Article
- Autism as emergent and transactional.Frontiers in psychiatry · 2022Review
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Authors and funding
16 authors.
Funding
Abstract
backgroundThere 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.
methodsOf 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.
resultsGood 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.
conclusionsEarly 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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