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Updated: 8 hours 47 min ago

Parent training may benefit children with severe autism

Wed, 2016-10-26 09:30

"A new form of therapy has for the first time been shown to improve the symptoms and behaviour of autistic children," The Guardian reports.

A new trial looked at the impact of early intervention in children with severe autism. This programme of treatment aimed to mainly focus on the parents, who were trained to pick up on communication cues from their child, which are usually much more subtle than in other children.

For example, a small shift in head movement could be a sign that the child wanted to communicate.

The hope is that once parents receive sufficient training they can then provide "around the clock" therapy to their child rather than one-off sessions provided by external therapy.

The programme, Parent-mediated social communication therapy for young children with autism (known as PACT), showed early promise. The children of parents who took the course showed improvements in symptoms such as communication and repetitive behaviour after one year. This study tested the children again, five to six years after the end of treatment, to see if the effects had lasted.

The children in the PACT group had on average lower symptoms scores for autism when compared to those who had normal care. But the difference was small enough that it could have been down to chance (it wasn't statistically significant). That doesn't mean the treatment didn't work, but arguably suggests the PACT programme should be now tested in larger groups of families affected by autism. 

Where did the story come from?

The study was carried out by researchers from Kings College London, Newcastle University, the University of Manchester and Guys and St Thomas University NHS Trust and was funded by the Medical Research Council, Department of Health and National Institute of Health Research.

The study was published in the peer-reviewed journal The Lancet on an open-access basis, so it's free to read online.

Most of the UK media reports were enthusiastic. The Daily Telegraph called it "the first successful treatment for autism" while The Guardian reported a "potential breakthrough".

But at the risk of sounding like a kill-joy, none of the media sources mentioned that the main finding of the study was not statistically significant.

Many made the effort to include some useful feedback and commentary from independent experts. For example, Dr James Cusack, the director of science at the charity Autistica, was quoted widely, saying: "Too often, parents fall victim to the false claims of charlatans who prey on desperate families.

"These results look promising for the many thousands of parents who want to find early interventions for their children based on solid science,"


What kind of research was this?

This was a long-term follow up of a randomised controlled trial. These types of studies are usually good ways to assess the effects of treatments.


What did the research involve?

Researchers randomly divided parents of pre-school children with autism into two groups.

One group of 75 had normal care, while in the other group, 77 parents were coached in how to communicate better with their children, using videos of play sessions to spot opportunities for communication.

The programme, called PACT, lasted for a year.

Five to six years later, researchers contacted the families again and asked them to have follow-up tests of autism symptoms.

They compared the results from the group who'd had normal care with those who'd had PACT.

In the PACT training, parents were coached to recognise what might be very subtle clues that their children wanted to engage with them and then respond appropriately, in a way that was intended to help children learn social interaction and language.

They had 12 two-hour coaching sessions over six months, then a further six support sessions over six months.

Unlike many treatments for autism, therapists worked with the parents rather than directly with the children. The aim was to produce long-lasting improvements, by changing the children's home environment.

Children were aged between two and four years 11 months when they started in the study. The average age at follow-up was 10 and a half.

Follow up assessments for the main results were done by researchers who didn't know which treatment group the children had been in.

The researchers also asked parents about their children's symptoms and behaviour.

They analysed the data in different ways, but the main result was a change in autism symptom score severity.

They looked at children's scores at the start of the study, after the 12 month treatment period, and at follow up.


What were the basic results?

The original study showed that children in the PACT group had a bigger improvement in symptom scores after treatment, compared to those who'd had usual care.

At follow-up, both groups of children had worse scores than immediately after the study.

There was still a difference between the groups, but it was no longer statistically significant.

That means we cannot be sure that, five years on from treatment, PACT improved average symptom scores more than normal care.

Average scores (1 to 10, higher being more severe) were:

  • 8.0 for PACT and 7.9 for usual care at the start of the study
  • 6.7 for PACT and 7.3 for usual care immediately after the study
  • 7.3 for PACT and 7.8 for usual care at follow-up

Fewer children in the PACT group had severe symptom scores at follow up (46%) than those who'd had usual care (63%).

The difference between the groups was too small to be sure this was not simply a chance finding (group difference 17.2%, 95% confidence interval [CI] -2.9 to 37.3).

However, looking at the combined mean symptoms scores from immediately after the study and at follow-up compared to baseline (before treatment), the results show a statistically-significant moderate effect in favour of PACT treatment (effect size 0.55, 95% CI 0.14 to 0.91).


How did the researchers interpret the results?

The researchers say their results "are encouraging and provide evidence that sustained changes in autism symptoms can be possible after early intervention," in a way that has not been shown before.

They go on to say that "on the basis of these results, we are now able to support the use of the PACT intervention for reducing symptoms of autism in young children".

They caution that the treatment has not yet been tested in older children, or in children with autism spectrum disorder, rather than "core" autism.



This study seems to provide some much-needed good news for parents of children with autism, and has been welcomed by experts and campaigners. However, the lack of statistical significance of some of the results mean we can't be sure the findings are reliable.

Statistical significance is a way of including a margin of error in calculations and allowing for chance. So the "true result" for PACT could be between 6.3 and 8.3, and the true results for usual care could be between 6.9 and 9.6. As these results overlap, we can't be sure that PACT treatment led to better scores.

One expert said that the main outcome measure of the autism symptom scale is "insensitive to change" meaning that it may not be the best way to show improvements. Another said the effects of PACT in the study were "not dramatic" and "very variable" across the group of children.

However, most seem to think that the results are promising, especially for an intervention that does not require the intensive time and commitment of some other autism treatments.

The National Institute for Health and Care Excellence says "social communication interventions" should be considered for children with autism, although it doesn't mention PACT specifically.

Hopefully further trials of PACT in larger groups of parents will point to a significant improvement in autism symptoms.

Links To The Headlines

Study offers potential breakthrough in care of children with autism. The Guardian, October 25 2016

'Super-parenting' improves children's autism. BBC News, October 26 2016

Parents can be taught to help treat autism: Children show 'extraordinary' improvement in communicating when technique is used. Daily Mail, October 26 2016

First ever treatment for autism leads to improved social communication and reduced repetitive behaviours. Daily Mirror, October 26 2016

Scientists hail first successful treatment for children with autism. The Daily Telegraph, October 26 2016

Communication and play therapy reduces autism symptoms, study finds. ITV News, October 26 2016

‘Super-parenting’ is the first therapy ‘that actually helps BEAT autism’. The Sun, October 26 2016

Links To Science

Pickles A, Le Couteur A, Leadbitter K, et al. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. The Lancet. Published online October 25 2016

Categories: News

Women now drinking 'almost as much alcohol as men'

Tue, 2016-10-25 09:00

"Women have caught up with men in the amount of alcohol they drink," The Guardian reports.

A survey of data from around the world suggests the gap between men and women is closing rapidly when it comes to alcohol use and subsequent alcohol-related harms.

Researchers looked at 68 studies from across the world studying people born from 1891 to 2000 to examine changing trends in alcohol use in men and women.

In the early 1900s, men were twice as likely as women to drink alcohol and three times more likely to experience alcohol-related problems. Now, there is far less of a difference, so the genders have very nearly equalised.

Despite the many suggestions mooted in the media – such as the influence of "90s ladette culture" – the study did not investigate the reasons behind the rise.

The authors suggest the findings indicate the need to particularly focus on young women to reduce the impact of alcohol use and related harms.

Women are more vulnerable to the harmful effects of alcohol because of a number of factors, such as the fact it takes longer for their bodies to break down alcohol.

To keep health risks to a low level, both men and women are advised to drink no more than 14 units a week.

If you're concerned about your drinking, find out more about alcohol support services in your area

Where did the story come from?

The study was carried out by researchers from the Australian NHMRC Centre of Research Excellence in Mental Health and Substance Use at the University of New South Wales, Australia, and Columbia University Mailman School of Public Health in the US.

It was funded by the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund and a National Health and Medical Research Council Centre of Research Excellence Grant. The authors declare no competing interests.

The study was published in the peer-reviewed journal, BMJ Open. As the name suggests, this is an open access journal, so the study is free to read online.

The media generally reported the story accurately. However, despite many suggestions provided by the media and independent experts, the study did not investigate why these trends have changed.

One hypothesis put forward by the researchers is that more women are now working than 50 years ago, so they have an independent income. This may mean they are free to socialise as they wish without having to rely on their partner.

What kind of research was this?

This systematic review and meta-analysis aimed to summarise published literature on changes across time of male-to-female ratios in key indicators of alcohol use and related harm.

While meta-analyses are a useful way of pooling research in an area, they are only as good as the individual studies included.

In this case, 68 studies were included in total:

  • 48 repeated cross-sectional studies
  • 19 single cross-sectional studies
  • 1 longitudinal study

These study designs can provide observational information from a single point in time or show how things have changed over time, but they can't provide answers to explain the trends.

There may also be some inaccuracies in terms of how representative the populations were or the information on frequencies of alcohol use. 

What did the research involve?

The review used accepted quality standards for performing a systematic review. Studies including regional or nationally representative populations were identified.

Separate data for males and females was given on at least one of the following key indicators of alcohol use and harms:

  • lifetime or current alcohol use disorder – for example, dependence
  • alcohol-related problems – for example, drunkenness or other negative consequences
  • alcohol-related treatment
  • seeking stages in the alcohol use and related problems cycle – for example, onset of use or transition from use to disorder
  • heavy episodic or binge drinking

Researchers pooled the data from 68 relevant international studies published between 1980 and 2014, including a comparison of male and female drinking patterns.

The studies included collected data between 1948 and 2014, and included 4,426,673 people born as far back as 1891 and up to 2000. Of those, just over a third each were from North America and Europe.

The births were grouped into five-year cohorts from 1891 to 2000, except for the first (1891-1910) and last (1991-2000), generating 1,568 sex ratios. The study quality was assessed by two independent moderators.

The male-to-female ratios were calculated for three broad categories:

  • any alcohol use
  • problematic alcohol use
  • alcohol-related harms

The meta-analyses resulted in pooled sex ratios within these three categories for each birth cohort.

What were the basic results?

The pooled data showed that the gap between men and women consistently closed across all three categories of any alcohol use, problematic alcohol use and alcohol-related harms:

  • alcohol use – the sex ratio of men to women was 2.2 (95% confidence interval [CI] 1.9 to 2.5) in the 1891-1910 birth cohort, indicating men were two times more likely to report any alcohol use compared with their female counterparts; this decreased to a low of 1.1 (95% CI 1.1 to 1.2) for those born between 1991 and 2000
  • problematic alcohol use – the sex ratio decreased from 3.0 (95% CI 1.5 to 6.0) in the 1891-1910 cohort to 1.2 (95% CI 1.1 to 1.4) in those born between 1991 and 2000
  • alcohol-related harms – the sex ratio decreased from 3.6 (95% CI 0.4 to 30.4) in the 1911-15 birth cohort (no earlier data) to 1.3 (95% CI 1.2 to 1.3) in those born between 1991 and 2000

For all three broad categories, sex ratio declined by 3.2% every five years across birth cohorts after accounting for potential bias. However, it was steepest in cohorts born from 1966 onwards.

How did the researchers interpret the results?

The researchers concluded that, "Alcohol use and alcohol use disorders have historically been viewed as a male phenomenon.

"The present study calls this assumption into question, and suggests that young women in particular should be the target of concerted efforts to reduce the impact of substance use and related harms."

They also said: "That the birth cohort effect on sex ratios has become more pronounced in these recent birth cohorts points to the value of continuing to focus research on adolescent and young adult sex-specific trends in substance use.

"Given that this young age group are relatively early in their alcohol use careers, these findings highlight the importance of further tracking young male and female cohorts as they age into their 30s, 40s and beyond."


This review provides support that the male-female gap in indicators of alcohol use and related harms has been closing. This is more evident in young adults, and has changed quicker in more recent years.

While the study provides evidence of a continuing trend, there are some key limitations.

The review can provide observations of trends over time, but cannot tell us the reasons behind the closing of the alcohol use gap.

It did not examine, for example, whether the changes in sex ratios in alcohol use and alcohol-related harms are the result of a fall in prevalence among men or a rise in women.

The authors speculated about some of the reasons behind this narrowing sex difference.

They suggested it could be down to the female gender role changing over time – for example, the increasing participation of women in the labour force, better education, and increased age of first marriage. 

They also suggested broader social, cultural and economic changes might be involved.

Another important limitation is that these estimates may be imperfect. The studies included were all assessed for quality, though are likely to have varied widely in their inclusions, methods and follow-up.

For example, the majority of studies were from the US and Europe, but we can't say they'd be applicable to all populations.

The questions used to assess alcohol use and problems are also likely to have varied widely across studies, and across the century that the study covered.

Participants may also not have been fully reliable in their responses – which again could have differed over the years.

For example, it's possible that women in the earlier part of the 1900s may have been less willing to report excess alcohol consumption because of social perception, even if they did drink higher quantities of alcohol.

Overall, this is a good data set and likely to be the best we can get on this question, but the data still really needs to be considered to be estimates and not definite figures.  

To keep health risks from alcohol to a low level if you drink most weeks:

  • men and women are advised not to drink more than 14 units a week on a regular basis
  • spread your drinking over three or more days if you regularly drink as much as 14 units a week
  • if you want to cut down, try to have several drink-free days each week

Complications of persistent alcohol misuse include:

Read more about the risks of drinking too much.

Links To The Headlines

Women now drink as much alcohol as men, global study finds. The Guardian, October 24 2016

Women 'nearing equality with men - in alcohol consumption'. BBC News, October 25 2016

Women drink almost as much alcohol as men, global study finds. Sky News, October 25 2016

Blame wine o'clock! Women now drink nearly as much as men as the gender gap in alcohol consumption has vanished over the past century. Daily Mail, October 25 2016

Young women are BIGGER boozers than men – and 'risk drinking themselves to death'. The Sun, October 24 2016

Links To Science

Slade T, Chapman C, Swift W, et al. Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression. BMJ Open. Published online October 24 2016

Categories: News