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A parent-led intervention is the first to have lasting benefits for children with severe autism. That鈥檚 the message from a study following up on a trial to see whether expert feedback could improve social communication in young children with autism.

The intervention is the first to show any consistent improvements in core symptoms over such a long period of time, says at the University of Manchester, UK.

Although many interventions for autism, including drug-based ones, have been trialled, none has shown any strong evidence of benefit.

The involved children between the ages of 2 and 4 years and 11 months who had been diagnosed with autism. Each child鈥檚 symptoms were measured and they were given a score of overall symptom severity.

In half of the 152 families involved, specialists in childhood autism videoed interactions between parents and their children 12 times over six months. They analysed the interplay between parent and child before advising parents on various ways in which they could tweak their communication skills to respond better to the child鈥檚 needs and hidden cues. This was then followed by six further therapy sessions over six months 鈥� a programme they called PACT. The other half carried on with their existing therapies.

At the beginning of the trial, around 53 per cent in each group were classed as having symptoms that scored in the highest category of severity. At the end of the trial, the results of which were published in 2010, 29 per cent of the children in the PACT programme were still classed as having severe symptoms of autism, compared with 44 per cent of the other group.

Six years on, Green and his colleagues tracked down and re-evaluated 121 of the families who participated in the trial. They found that 46 per cent of children who were in the PACT programme were classed as having severe symptoms of autism, compared with 63 per cent of children not in the programme.

鈥淲e鈥檝e shown that the therapy has had this effect of a sustained reduction in severity right through almost till the teenage years,鈥� says Green. 鈥淚t鈥檚 pretty remarkable for therapies of this kind, and has never been shown before in autism,鈥� he says. 鈥淚t has a consistent and effective impact on severity.鈥�

Sensitive dance

鈥淚t鈥檚 like a sensitive dance between you and your child,鈥� says Louisa Harrison, who has participated in the PACT programme outside of the trial. Her son鈥檚 favourite activity was watching street lights come on, and she learned that her son responded best and learned new words if her comments didn鈥檛 challenge him. So instead of asking 鈥淲hich lamp post will come on next?鈥�, she would say 鈥淚t鈥檚 gone on,鈥� which is unthreatening and neutral, but still provides contact and a phrase he can potentially use use himself next time.

Her son Frank, now 10, is in a mainstream school with provisions for autism. 鈥淭he videos are incredibly revealing in a very illuminating and constructive way, and the therapists were very good at asking questions,鈥� she says. 鈥淚 felt I was being 鈥榮killed up鈥� to use ways of communication, creating a space where we could be together but with no pressure on the child to communicate,鈥� she says.

Other autism researchers welcomed the findings, but cautioned that the improvements were not dramatic and varied across recipients. 鈥淚t鈥檚 a remarkably positive story, because the intervention itself was neither intensive nor invasive,鈥� says Uta Frith of University College London. 鈥淏ut we鈥檙e still a long way from individualised programmes that might produce lasting behavioural improvements in all autistic children,鈥� she says.

Green and his colleagues argue that the results are good enough to merit much wider application in healthcare systems. 鈥淲e think this could be and should be part of core provision for autism,鈥� he says. However, he acknowledges that the intervention hasn鈥檛 been tested in children with milder forms of autism, or younger infants.

The team is now exploring whether PACT can help learning support assistants who specialise in teaching children with autism. If parents and their specialist teachers both use PACT, it would provide a 鈥渄ouble dose鈥� for children, says Green.

The team is also compiling e-learning and online teaching materials so that healthcare workers and parents can potentially learn for themselves how to apply PACT.