PhD proposal linked to the PACT trial Inter-relation between Communicationand Inter-Personal Domains in Pre-School Autism School of Medicine

Supervisor: Dr Jonathan Green
Funding: Part-funding
To start September 2006

Background
There have been converging lines of evidence suggesting the somewhatcounterintuitive fact that the language and inter-personal reciprocitydomains of autism are independent. My study of high functioningautism/asperger syndrome (Green et al 2000, Gilchrist et al 2001) found that(considered retrospectively using ADI) language domains and reciprocitydomains of autism breed true and seemingly independently. Children withearly language delay pre-school continue to have relatively language delayin adolescence; children with impaired reciprocity pre-school continue tohave difficulties with this in early adolescence: additionally, poor socialoutcomes were not predicted by early language delay and early reciprocitydelay did not predict later language difficulty. Recent analysis of nationaltwin cohort (TEDS) data on autistic siblings found a similar effect; arelative disjunction between communication domains and reciprocity domainsof the triad, with behavioural rigidity more linked to language (Happepersonal communication, Ronald et al 2005). This is a matter of significantcurrent interest in the field.

Design opportunities within the RCT
PACT gives us the opportunity to use the RCT to look at this issue as itemerges pre-school. We have detailed measures of language/communication(researcher observations of parent child interaction, researcher ratedassessment, parental report); and symmetrical measures of inter-personalbehaviour. We have the observational items at three time points and theother items at baseline and end point. The PACT intervention is focusedpurely on language/communication only. The PACT trial is a large multisiteRCT (n=144), using standardised measures and a focussed protocol drivenintervention. there is sufficient power to undertake the proposed analysis.

Research question
Normative developmental theory would suggest that improving communicationshould have an effect on inter-personal behaviour - for instance attachmentrelated behaviours. There is good evidence to the effect that improvingsensitivity and communicative responsiveness enhances interpersonalattachment behaviours in normal samples. Do we see this happen in autism oris there some dysjunction? Clinical experience suggests that we should seesome at least of the normative effect: observations of early interventionsof this kind do seem to improve children’s interpersonal responsiveness somecases. However, the overall findings from other studies as above suggest theopposite.

Design
1. Observation of the relationship between communication and inter-personal behaviour over time (1 year) in both arms of the trial. the PhD student will conduct amplified measures of these kinds supplementing the study measures on some cases
2. Measurement of the impact on both domains of an intervention specifically aimed at shifting language development. Does this change in parent/child communication impact on the child’s inter-personal behaviours? Or do the two domains run independently?

Outputs
This is a good example of how a systematic intervention study canpotentially illuminate developmental psychopathology research. Theadditional PhD analysis will allow a rigorous contribution to the researchtheme of the relationship between social and non social aspects of autism indevelopment using a classic design of a developmental perturbation caused bytargeted intervention. The follow up data will also allow ongoinglongitudinal research on this cohort to this effect.

There will also be relevance to the translation of this intervention intopractice and the design of future interventions – since the issue ofgeneralisability into other domains is a key one for the field.

An application pack can be downloaded from the following address:
http://www.medicine.manchester.ac.uk/postgraduate/research/Studentships/

For further information contact:
jonathan.green@manchester.ac.uk