The Pre-School Autism Communication Therapy (PACT) and The Paediatric Autism Communication Trail-Generalised (PACT-G).
Autistic Spectrum Condition (ASC) impacts a child’s interactions with others because communication signals can be infrequent, weak or poorly timed, and adults tend to initiate more and consequently overly direct and interpret the child’s focus.
Pre-school Autism Communication Therapy or PACT, is a one year intervention designed to improve social communication skills in children with ASC. It was developed for children aged between two and seven years of age who are at either the pre-verbal stage, or early stages of language development. The Pre-school Autism Communication Trial evaluation showed changes in parent communication style, which were found to significantly lead to increases in child communication and parent-reported everyday social communication, child expressive vocabulary and language understanding.
The intervention uses video to support learning and reflection and enables collaborative work with the child’s parents or key adults.
About the PACT intervention
The intervention works through a developmental hierarchy of social and communication skills. The therapy has six stages with goals focusing on: observing child communication; adapting the timing and pace of parent responses and using adapted language input; fostering child communication initiation and pragmatics; developing child language extensions; and conversation.
In PHASE 1, parents undertake one to one therapy sessions lasting two hours, every two weeks for six months, with 30 minutes of daily practice in between sessions. In PHASE 2, further monthly maintenance sessions are available to generalise the therapy goals into daily routines and different social contexts.
The stage one aim is to enable the parent and child to experience mutual shared attention. Shared attention is a very important skill and is a stepping stone for communication. As we know, communication occurs through child and adult interaction and is the foundation for the development of language. An aim of the stage is to have the parent sharing the child’s focus for at least 50% of a 10 minute play session.
What happens in the session?
During the intervention, the parent plays with their child and the therapist films the play. The video is then watched and discussed with the parent, to notice where any shared attention occurred and how this happened. During stage one, strategies are taught to the parent to help extend mutual shared attention such as mirroring the child’s play, sharing the child’s interest, and following and positioning. For example, mirroring is where the parent copies the child’s actions, sounds and words in a sensitive way. This strategy increases the frequency with which the child looks at the parent and refers to the parent whilst playing, supporting the development of shared attention.
Professor Jonathan Green from the University of Manchester stated, “this is not a cure” because though there are improvements, other symptoms will continue to show. In addition to this, though the study found improvements in parent interaction and child communication, the intervention outcomes did not generalise to interactions with adults outside of the family such as school staff.
The Paediatric Autism Communication Trail-Generalised (PACT-G) aims to test new ways to transfer the child’s improving communication skills into the education setting and is aimed at two to 11 year olds. The pilot study ran from July to December 2016, and the main study will be run throughout 2017, to evaluate the therapy provided to the parent and also a key person (such as a learning mentor) in the education setting.
As an educational psychologist, my work mainly takes place in educational settings. I have completed PACT training and learnt about the theory, approach and strategies described in the six stages to develop children’s social communication skills. I wanted to apply the approaches for use by support staff working with children with social communication difficulties. I found that I could refer to the goals and techniques during my consultations and these provided a supportive and structured framework. It will be really interesting to see the outcome of the PACT-G study and how improvements in communication skills can be transferred into school.