Wednesday, 26 October 2016


But it is not a treatment
(Or a therapy)

From the concluding discussion of a research report on an intervention for autism, that centred upon parents rather than their children –

...optimising naturalistic parent–child social communication in the home setting. The theoretical advantage of this approach over direct therapist–child therapy is that it has potential for change in the everyday life of the child, in which much social learning takes place, and might continue to have sustained effects after the end of the therapist-delivered intervention to the parent. Evidence from the initial trial mediation analysis supported this theoretical model of action by showing that it was the treatment effects on parent interaction style that were responsible for the positive child change during the treatment period. The current follow-up analysis shows a loss of this original treatment effect on parental synchrony over time, but maintenance of the effects on child communication and symptom-change. This finding suggests that the improvement in child communication and autism symptoms during treatment could have become self-sustaining during the years following the end of treatment, independent of the initial parental behavioural change that mediated them. This finding lends support to the theoretical rationale behind a developmental approach in which targeting of pivotal precursor social communication skills can lead to improvements in developmental trajectories, further supporting the notion that a parent-mediated approach can lead to sustained effects beyond the end of treatment....

Strip away the guff and the jargon and what does this report say? Parents get help in bringing up their developmentally disordered children and things tend to get better. The help is then discontinued and the families left to fend for themselves. Nearly six years later, some relative beneficial effect is still discernible from what was done.

Er, that's it, isn't it? To put it differently, better upbringing helps bring up children better, but don't ask how long it takes to bring up a child.

Without denying the validity of this report in its own terms, stand back from it and ask what it says underneath, what has been happening in the real world, beyond the way in which it is recounted here – and what is the wider social narrative of which this is part. Wonder why it is reported in a medical journal, construed in terms of a condition and treatment (and researched accordingly), Wonder too about intervening in childhood and childrearing for a finite period.

If you are concerned with so-called autism then you may have your own specific questions to raise. But the psycho-social mechanisms that may act to disorder the course of human development can hardly differ fundamentally from child to child, from upbringing to upbringing,

If you are concerned with motor disorders and more specifically with Conductive Education, then you might wonder about the relevance of all this to what families are seeking, and what services are providing. Yes, that also relates to conductive services, or experiences, or however one states them.

More research is needed, it says. But this kind?

If you would prefer a mediated account of this study (therefore slightly more easy to read), try the one in the Guardian (written by its Health Editor!):


Boseley, S. (2016) Study offers potential breakthrough in care of children with autism, Guardian, 25 October

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

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