Studies show that PACT significantly improves social communication by autistic children as well as the well-being of their families, with positive effects that persist after six years (photo: Freepik*)

Published on 02/28/2025

By Gabriel Alves  |  Agência FAPESP – One of the most important aspects of caring for and treating children with autism spectrum disorder (ASD) is ensuring that they develop autonomy and communication skills. In the public health context, access to therapies that assist this process is often limited owing to regional disparities and/or a shortage of qualified professionals.

To contribute to an improvement in this situation, psychologist and researcher Elizabeth Shephard with collaborators is studying and promoting a novel approach known as pediatric autism communication therapy, or PACT. Mediated by the child’s parents and supported by a specialist, the process focuses on communication and interaction centering on the child’s interests.

Shephard is conducting her project at the Institute of Psychiatry (IPq) attached to the University of São Paulo’s Medical School (FM-USP) in Brazil, with funding from FAPESP. 

The therapy offered by the various health services is applied behavior analysis (ABA), a more structured approach led by a therapist and focusing on incentives to change specific behaviors.  One of the limitations of ABA, Shephard explained, is a scarcity of scientific evidence on which to base its deployment, especially in the long term and in public health services.

PACT was first proposed in 2004 by Jonathan Green, Professor of Child and Adolescent Psychiatry at the University of Manchester in the United Kingdom, as a form of intervention with a sounder scientific foundation. Studies have shown that PACT significantly improves social communication by autistic children as well as the well-being of their families, with positive effects that persist after six years.

But how does PACT work in practice? The process begins with the analysis of a video of the child playing freely with a primary caregiver, such as a parent. An accredited PACT therapist uses the video to explain the positive aspects of the interaction, reinforcing beneficial behaviors for the development of communication. A behavior that is typically encouraged, for example, is making comments instead of asking questions.

“Asking many questions makes demands of the autistic child’s language processing. This is very stressful for the child, and may even be overwhelming. We therefore helped the adults ask fewer questions and make more comments. It’s important to use simple language relating to the child’s interests and reinforce what the child wants to communicate,” Shephard said.

In the UK, the National Health Service (NHS) provides social communication therapies like PACT as the first line of treatment for people with ASD. The challenge now is showing that this is worthwhile in the Brazilian context.

Cost effectiveness will be the focus of research in 2025 and beyond. With regard to acceptance and efficacy, studies are under way, and some have already produced results. In an article published in the journal Autism, Shephard and her PhD student Priscilla Godoy note that Brazilian parents reported better understanding of their children’s needs and improved social communication by the children after the provision of PACT. Mediation by parents enabled interactions to occur in the family home, promoting a more natural and less structured approach than standard therapies such as ABA.

The qualitative study also showed that stronger initial engagement with caregivers would enable therapists to explain the approach more successfully and hence produce even better results.

Meanwhile, a project called Floreah (a portmanteau comprising elements of the Portuguese equivalents of “flourish” [florescer], “ASD” [TEA] and “ADHD” [TDAH]), which recruited babies aged 6 months, seeks to understand the possible benefit of iBASIS, a PACT-like type of early intervention, for babies with a propensity to develop autism and/or ADHD (attention deficit/hyperactivity disorder). The recruitment stage is over, and publication of the results should begin this year.

In order to conduct research on PACT and its deployment nationwide, it was necessary to create a training environment for therapists, Shephard explained.

“Priscilla and I opened the training center [PACT Brazil], so that people can train in Portuguese in Brazil for an affordable cost – less than half of what they’d spend at the center in the UK. We translated the entire manual into Brazilian Portuguese and adapted it extensively to make sure the meaning was preserved despite the cultural and sociodemographic differences. Sixteen professionals have completed their training so far. Our goal is to train a significantly larger number in the next few years,” she said.

The article “Acceptability and feasibility of a parent-mediated social-communication therapy for young autistic children in Brazil: A qualitative implementation study of Paediatric Autism Communication Therapy” is at: journals.sagepub.com/doi/full/10.1177/13623613221144501. 

Information on the PACT training course (in Portuguese) can be found at: https://www.pactbrasil.com.br. 

* Image by Racool_studio from Freepik

 

Source: https://agencia.fapesp.br/54108