Scientists say they have established the first successful treatment for autism, after training parents in how best to respond to the needs of children with the condition.
The study, published in The Lancet, found “striking” and “remarkable” long-term changes after toddlers were enrolled in intensive communication programmes, which aimed to coax them out of their shell. Researchers called for the national rollout of the schemes, which were found to reduce overall severity of symptoms by 17 per cent.
The study – the largest ever randomised controlled trial for treatment of autism – tracked 152 families for six years, starting when children were aged between two and four years old. Half of the families were enrolled in communication training, which records interaction between children and parents, replaying it in slow motion, while giving insights about how best to respond to each cue.
Among those given the coaching, the percentage of children with severe symptoms fell from 55 per cent to 46 per cent over six years. The remainder of the group saw problems worsen, with the number suffering from severe symptoms rising from 50 to 63 per cent, by the end of the trial, when they were aged between 7 and 11.
Researchers said the study by the University of Manchester, King’s College London and Newcastle University showed the first ever long-term effect of an early intervention for autism. Lead author Prof Jonathan Green, Professor of Child & Adolescent Psychiatry, Division of Neuroscience and Experimental Psychology, University of Manchester described the results as “pretty remarkable”.
“Our findings are encouraging, as they represent an improvement in the core symptoms of autism previously thought very resistant to change,” he said, with scores showing significant improvements in communication skills and reduced repetitive behaviour.
The majority of children in the new study suffered from severe autism, limiting their verbal interaction with parents. Coaching involved 12 therapy sessions for parents, who were given homework to spend 30 minutes a day in planned communication with children, following detailed guidance from experts who had observed them on video. Parents were taught to develop strategies to respond to children, after watching slowed-down videos of them playing with their children, which highlighted points of communication breakthrough.
Prof Andrew Pickles, from King’s College London’s Institute of Psychiatry, Psychology & Neuroscience, said the differences between the two groups at the end of the six years were “strikingly significant” – and had surprised those involved in the study.
Researchers stressed that it was not about teaching parenting skills, but about helping parents to decode specific individual cues from children whose behaviour was difficult to interpret. Dr Catherine Aldred, Consultant Speech and Language Therapist, Stockport NHS Trust and University of Manchester, said: “This is about raising their interactions to a ‘super’ level.” The difficulties of communicating with children with severe autism were such that specialist skills were required, using training from therapists, she said. “They [children with autism] need more than ‘good enough’ they need exceptional,” she said, describing such methods as helping parents to “press just the right button at just the right time.”
Independent experts said the results were impressive. “I can see why these researchers are excited,” said Prof Dorothy Bishop, Professor of Developmental Neuropsychology at Oxford University. “These results at follow-up are pretty consistent in showing benefit of this early intervention for autism across a range of measures.
One of the most impressive findings was the improvement in repetitive behaviours among children involved in the treatment, she said.
Prof Uta Frith, Emeritus Professor of Cognitive Development at UCL, said: “I don’t know of any long term follow-up study of early intervention in autism carried out with such rigorous controls. It is a remarkably positive story, because the intervention itself was neither intensive nor invasive."
Researchers involved in the study said the programme used in the Preschool Autism Communication Trial is rarely funded by the NHS. They said the new research provided “robust evidence” that it works and should be offered far more widely.
Prof Green said: “We think this should be part of the core provision for children.”
Dr Max Davie, from the Royal College of Paediatrics and Child Health, said the findings were “hugely cheering” and ought to encourage more commissioners to invest in such services.