{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T02:15:30Z","timestamp":1767665730815,"version":"3.41.2"},"reference-count":43,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000276","name":"UK Department of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["G0401546"],"award-info":[{"award-number":["G0401546"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003592","name":"UK Department for Children, Schools and Families","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003592","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Autism &amp; Developmental Language Impairments"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Background and aims<\/jats:title><jats:p> Despite recent gains in the amount and quality of early autism intervention research, identifying what works for whom remains an ongoing challenge. Exploiting data from the Preschool Autism Communication Trial (PACT), we undertook secondary analysis to explore prognostic indicators and predictors of response to one year of PACT therapy versus treatment as usual within this large and rigorously characterised cohort recruited across three UK trial sites. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> In this secondary analysis of variability in child gains on the primary trial outcome measure \u2013 social-communication symptom severity \u2013 we used a pragmatic and data-driven approach to identify a subgroup of children who showed reliable improvement and a subgroup showing clear lack thereof. We then tested which among several baseline child and family factors \u2013 including measures routinely collected in research trials and clinical practice \u2013 varied as a function of child outcome status and treatment group. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Greater baseline child non-verbal ability was a significant prognostic indicator of symptom reduction over time (i.e. irrespective of treatment group). By contrast, parent synchrony presented as marginal predictor, and trial recruitment site as a significant predictor, of differential outcome by treatment group. Specifically, lower parent synchrony showed some association with poorer outcomes for children from families assigned to treatment as usual (but with no such effect for those assigned to PACT). Similarly, children at one recruitment site were more likely to have poorer outcomes if assigned to treatment as usual, compared to children at the same site assigned to PACT. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> The current data contribute to an evidence base indicting that early non-verbal ability is a robust indicator of generally better prognosis for young children with autism. Lower parent synchrony and a broadly more deprived socio-geographical context may inform the appropriate targeting of PACT. That is, given that the former factors predicted poorer outcome in children from families assigned to treatment as usual, the receipt of a relatively low-dose, parent-mediated and communication-focused therapy might be developmentally protective for young children with autism. Nevertheless, results from this study also highlight the paucity of meaningful predictors of outcome among routine clinical characterisation measures such as those investigated here. <\/jats:p><\/jats:sec><jats:sec><jats:title>Implications<\/jats:title><jats:p> Understanding the factors associated with differential treatment outcomes is critical if we are to individualise treatment decisions for children with autism. Inherently tied to this objective is a need to delineate those factors which specifically predict positive response (or lack of response) to one or other treatment option, versus those that indicate generally better (or poorer) prognosis, irrespective of treatment. <\/jats:p><\/jats:sec>","DOI":"10.1177\/2396941518764760","type":"journal-article","created":{"date-parts":[[2018,4,3]],"date-time":"2018-04-03T07:18:14Z","timestamp":1522739894000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Predictors of reliable symptom change: Secondary analysis of the Preschool Autism Communication Trial"],"prefix":"10.1177","volume":"3","author":[{"given":"Kristelle","family":"Hudry","sequence":"first","affiliation":[{"name":"Victorian Autism Specific Early Learning and Care Centre, and Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne Australia"}]},{"given":"Helen","family":"McConachie","sequence":"additional","affiliation":[{"name":"Institute of Health and Society, Newcastle University, and Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK"}]},{"given":"Ann","family":"Le Couteur","sequence":"additional","affiliation":[{"name":"Institute of Health and Society, Newcastle University, and Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK"}]},{"given":"Patricia","family":"Howlin","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology & Neuroscience, Kings College London, and Brain & Mind Centre, Faculty of Health Sciences, University of Sydney, New South Wales, Australia"}]},{"given":"Barbara","family":"Barrett","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Health Services and Population Research, King\u2019s College London, UK"}]},{"given":"Vicky","family":"Slonims","sequence":"additional","affiliation":[{"name":"Children's Neurosciences Centre, Evelina Children\u2019s Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, and Child Health, Clinical Academic Group, King\u2019s College London, UK"}]},{"name":"The PACT Consortium","sequence":"additional","affiliation":[]}],"member":"179","published-online":{"date-parts":[[2018,4,3]]},"reference":[{"key":"bibr1-2396941518764760","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2004.00338.x"},{"key":"bibr2-2396941518764760","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0183160"},{"key":"bibr3-2396941518764760","doi-asserted-by":"publisher","DOI":"10.1177\/1362361315598634"},{"key":"bibr4-2396941518764760","doi-asserted-by":"publisher","DOI":"10.3310\/hta18280"},{"key":"bibr42-2396941518764760","doi-asserted-by":"crossref","unstructured":"Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125, e17\u2013e23.","DOI":"10.1542\/peds.2009-0958"},{"key":"bibr5-2396941518764760","doi-asserted-by":"publisher","DOI":"10.1177\/0145445509351961"},{"volume-title":"MacArthur communicative development inventories: User\u2019s guide and technical manual","year":"1993","author":"Fenson L.","key":"bibr6-2396941518764760"},{"key":"bibr7-2396941518764760","doi-asserted-by":"publisher","DOI":"10.1177\/0022219412468889"},{"key":"bibr8-2396941518764760","doi-asserted-by":"crossref","unstructured":"Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P. \u2026 PACT Consortium. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. 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