Parent-mediated social communication therapy for young children with autism (PACT):long-term follow-up of a randomised controlled trial

SummaryBackgroundIt is not known whether early intervention can improve long-term autism symptom outcomes. We aimed to follow-up the Preschool Autism Communication Trial (PACT), to investigate whether the PACT intervention had a long-term effect on autism symptoms and continued effects on parent and child social interaction.MethodsPACT was a randomised controlled trial of a parent-mediated social communication intervention for children aged 2–4 years with core autism. Follow-up ascertainment was done at three specialised clinical services centres in the UK (London, Manchester, and Newcastle) at a median of 5·75 years (IQR 5·42–5·92) from the original trial endpoint. The main blinded outcomes were the comparative severity score (CSS) from the Autism Diagnostic Observation Schedule (ADOS), the Dyadic Communication Assessment Measure (DCMA) of the proportion of child initiatiations when interacting with the parent, and an expressive-receptive language composite. All analyses followed the intention-to-treat principle. PACT is registered with the ISRCTN registry, number ISRCTN58133827.Findings121 (80%) of the 152 trial participants (59 [77%] of 77 assigned to PACT intervention vs 62 [83%] of 75 assigned to treatment as usual) were traced and consented to be assessed between July, 2013, and September, 2014. Mean age at follow-up was 10·5 years (SD 0·8). Group difference in favour of the PACT intervention based on ADOS CSS of log-odds effect size (ES) was 0·64 (95% CI 0·07 to 1·20) at treatment endpoint and ES 0·70 (95% CI −0·05 to 1·47) at follow-up, giving an overall reduction in symptom severity over the course of the whole trial and follow-up period (ES 0·55, 95% CI 0·14 to 0·91, p=0·004). Group difference in DCMA child initiations at follow-up showed a Cohen's d ES of 0·29 (95% CI −0.02 to 0.57) and was significant over the course of the study (ES 0·33, 95% CI 0·11 to 0·57, p=0·004). There were no group differences in the language composite at follow-up (ES 0·15, 95% CI −0·23 to 0·53).InterpretationThe results are the first to show long-term symptom reduction after a randomised controlled trial of early intervention in autism spectrum disorder. They support the clinical value of the PACT intervention and have implications for developmental theory.FundingMedical Research Council

Rhetoric, discourse and the surplus of meaning: innovations in First Nations' language bible translation

Although there has been a noticeable push in recent years to produce contemporary literature to ensure the Cree language remains intact for future generations, Cree Bible translations remain some of the best known and used printed resources in the Cree language. Given the influence that these translations continue to exercise in Cree and Bible translation communities this study imagines a trajectory of future Bible translations into First Nations languages. The study begins with an extensive analysis of past translations into the Cree 'Y' dialect, their production as well as their reception. Chapter 2 contains an in-depth analysis of the history of William Mason's Cree translation into the 'Y' dialect. This supports and informs the development of a new translation method into Canadian indigenous languages in Chapter 3. This method highlights the rhetorical significance of elements of style and orality in the production and reception of Cree texts. In addition to this, it envisions a significant amount of discussion and innovation between Bible translators and Cree linguists surrounding the theories and practices that have guided Bible Translation thus far.Malgré l'effort évident dans les dernières années de produire de la littérature contemporaine pour assurer que la langue Cree soit préservée pour les générations futures, les traductions de la Bible en Cree demeurent parmi les ressources imprimées les plus connues dans la langue Cree. Étant donné l'influence que ces traductions continuent d'exercer dans les communautés Cree et de traduction biblique, cette thèse imagine une trajectoire future de traductions bibliques en langues des Premières Nations. La thèse commencera avec une analyse des traductions en dialecte 'Y' Cree completées dans le passé et regardera leur production et la réception qu'elles ont connues. Une analyse en profondeur de l'histoire de la traduction Cree de William Mason en dialecte 'Y' sera entreprise dans le deuxième chapitre qui soutien et informe le développement d'une nouvelle méthode de traduction en langues indigènes Canadiennes dans le troisième chapitre. Cette méthode met en évidence le sens des élements de style et de l'oralité dans la production et la réception de textes Crees. De plus, elle envisage une quantité de discussion et d'innovation importante entre traducteurs bibliques et linguistes Crees au sujet des théories et des pratiques qui ont guidé la traduction biblique jusqu'à présent