Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial


Rahman, Atif ORCID: 0000-0002-2066-4467, Divan, Gauri, Hamdani, Syed Usman, Vajaratkar, Vivek, Taylor, Carol, Leadbitter, Kathy, Aldred, Catherine, Minhas, Ayesha, Cardozo, Percy, Emsley, Richard et al (show 2 more authors) (2016) Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial. The Lancet Psychiatry, 3 (2). pp. 128-136.

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Abstract

<h4>Background</h4>Autism spectrum disorder affects more than 5 million children in south Asia. Although early interventions have been used for the treatment of children in high-income countries, no substantive trials have been done of the interventions adapted for use in low-income and middle-income countries (LMICs). We therefore assessed the feasibility and acceptability of the parent-mediated intervention for autism spectrum disorder in south Asia (PASS) in India and Pakistan.<h4>Methods</h4>A single-blind randomised trial of the comparison of 12 sessions of PASS (plus treatment as usual) with treatment as usual alone delivered by non-specialist health workers was done at two centres in Goa, India, and Rawalpindi, Pakistan. Children aged 2-9 years with autism spectrum disorder were randomly assigned (1:1) by use of probabilistic minimisation, controlling for treatment centre (Goa or Rawalpindi), age (<6 years or ≥6 years), and functional impairment (Vineland Adaptive Behaviour Scale Composite score <65 or ≥65). The primary outcome was quality of parent-child interaction on the Dyadic Communication Measure for Autism at 8 months. Analysis was by intention to treat. The study is registered with ISRCTN, number ISRCTN79675498.<h4>Findings</h4>From Jan 1 to July 30, 2013, 65 children were randomly allocated, 32 to the PASS group (15 in Goa and 17 in Rawalpindi) and 33 to the treatment-as-usual group (15 in Goa and 18 in Rawalpindi). 26 (81%) of 32 participants completed the intervention. After adjustment for minimisation factors and baseline outcome, the primary outcome showed a treatment effect in favour of PASS in parental synchrony (adjusted mean difference 0·25 [95% CI 0·14 to 0·36]; effect size 1·61 [95% CI 0·90 to 2·32]) and initiation of communication by the child with the parent (0·15 [0·04 to 0·26]; effect size 0·99 [0·29 to 1·68]), but time in mutual shared attention was reduced (-0·16 [-0·26 to -0·05]; effect size -0·70 [-1·16 to -0·23]).<h4>Interpretation</h4>Our results show the feasibility of adapting and task-shifting an intervention used in a high-income context to LMICs. The findings also replicate the positive primary outcome treatment effects of a parent-mediated communication-focused intervention in the original UK Preschool Autism Communication Trial, with one negative effect not reported previously.<h4>Funding</h4>Autism Speaks, USA.

Item Type: Article
Uncontrolled Keywords: Humans, Treatment Outcome, Feasibility Studies, Single-Blind Method, Communication, Parent-Child Relations, Parents, Child, Child, Preschool, India, Pakistan, Female, Male, Autism Spectrum Disorder
Depositing User: Symplectic Admin
Date Deposited: 04 Aug 2016 09:50
Last Modified: 19 Jan 2023 07:32
DOI: 10.1016/S2215-0366(15)00388-0
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3002630
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