1. Early Communication Intervention: Principles – Communication focused – Developmental – Naturalistic – Synchrony and balance of interaction – Parent empowering Green et al 2010 Lancet

2. Intervention Took place over 1 year, each session 2+hrs (fortnightly for 6 months, then monthly for 6 months – total of 18 sessions) Clinic based sessions with speech and language therapist Testing a model deliverable in NHS Video feedback used.

3. ‘It was a revelation to me … I thought I was the only person who knew my child … and I didn’t. When I watched the video he had his back to me … he wasn’t playing with me at all … now I know him best … but I didn’t at the start of PACT.’ Quote from parent

4. Design and outcomes First large randomised controlled trial (RCT) of early psychosocial treatment 3 UK sites, N = 152 (PACT n = 77) 2 to 4,11 yrs; core autistic disorder Outcomes: – Child behaviours – Autism Diagnostic Observation Schedule (ADOS) – Parent synchrony as a proportion of parent communication acts – Proportion of child initiations

5. Parent child interaction Parental synchronyChild initiations

6. Primary outcome ADOS (modified SC algorithm)

7. Interpretation Changes in parent-child interaction – Positive consequences for child development, parental morale, family environment, parent-child relationship, child adjustment? …but lack of generalisation – Measurement sensitivity? – Intensity/duration of treatment? – Need extra input to carry over skills into school?