Make a difference with Paediatric Autism Communication Therapy (PACT)

This week is World Autism Awareness Week and this year we wanted to focus on those who are making real change in the field and improving the lives of those with autism and their families. The Covid-19 pandemic has brought much of the world to a standstill, and yet the groundbreaking Paediatric Autism Communication Therapy (PACT) intervention continues to be rolled out internationally to great success. Read on to discover how it was developed, how it works and how you can become a PACT practitioner. 

The Guardian:

A new form of therapy [PACT] has for the first time been shown to improve the symptoms and behaviour of autistic children, offering a potential breakthrough in care for millions of families.

What is PACT and how was it developed?

Dr Catherine Aldred, a consultant speech and language therapist, and Professor Jonathan Green, Professor of Child and Adolescent Psychiatry at the University of Manchester, in collaboration with colleagues in Manchester, London and Newcastle, developed and tested a new approach over 15 years which uses video feedback techniques with parents to help them understand and respond to the particular communication style of their young child with autism. PACT aims to help autistic children to develop their early social communication skills. A not-for-profit community interest company called Interaction Methods for Paediatric Autism Communication Therapy (IMPACT), was set up to deliver PACT training to professionals, so as to help extend implementation of evidence-based interventions for children with autism in the UK and internationally.

Autism is an enduring condition affecting over 1% of people worldwide but with a lack of evidenced therapy to reduce its symptoms. PACT is an early social communication intervention working through parents and carers that is the first to have demonstrated long-term improvements in autism symptoms after therapy within a clinical trial. This relatively low intensity approach is referenced in UK national guidance for autism treatment and is being disseminated through professional training in the UK and worldwide through the IMPACT training programmme. With PACT, therapists are able to encourage and empower parents and carers, allowing them to develop the key skills shown to improve the child’s social communication outcomes.

One parent's feedback on the experience of receiving PACT therapy (obtained through independently conducted interview):

"Reflecting on the video was like looking through a magnifier, I could see so much more, now I feel I know him better, I’m more skilled in interacting and communication with him. You have changed our lives."

How does PACT work?

PACT aims to improve communication and interaction skills in children on the autism spectrum along with patterns of restrictive and repetitive behaviour. An important feature of the PACT method is the way it links the familiarity and skills of adults who know the child best – their parents or carers – with the specialist knowledge of therapists. The process involves video recording sessions between parents or carers where they are playing or interacting with their child who has autism. Skilled therapists then review and reflect with caregivers on the video recordings, with the aim of observing and creating opportunities for communication and adapted interaction with individualised goals. In this way, PACT empowers the caregivers who know the child best, allowing them to develop skills shown to improve the child’s social communication outcomes. Professional therapists are trained to identify both the child’s and the adult’s existing abilities and build on them to extend communication skills to the highest possible level, equipping key adults who can infiltrate these skills into the child’s day-to-day interactions and experiences. A key feature of PACT is the way it uses video feedback to work through parents and carers, in contrast to working directly with the child.

Professionals report that PACT enhances and aligns well with their current practice:

"PACT harmonises with my approach to communication intervention, supporting parent/carer skills in seeing imperceptible moments of interaction and communication."

Why the PACT intervention?

  • PACT is one of the leading evidence-based early interventions for autism internationally, having been trained and implemented in 22 countries and with implementation studies published, planned or underway in North and South America, Europe, South East Asia and Australia; as well as adaptations for low resource settings in Indian and Pakistan. 
  • The UK research charity Autistica’s independent evidence summary for NHS providers, commissioners and professionals (available here) recommends the national clinical implementation of PACT: “when clinically appropriate, all local areas should provide parent-led video feedback therapy as an early intervention for pre-school and school-aged children on the autism spectrum.”
  • PACT was awarded the "Outstanding Innovation Award" as the most 'innovative and potentially transformation solutions to social issues' and the "Making A Difference Award" for social responsibility (2018) for offering an 'outstanding benefit to society through research'.

How can I get trained in PACT?

PACT training can be undertaken by professionals from health and education, including SALTs, Educational Psychologists or Mental Health Support Teams in schools and CAMHS/HYMS professionals.

Those who wish to administer PACT must successfully complete five days of training:

  • Level 1: A half-day e-learning programme with Hogrefe - information here.
  • Level 2: Two days training with IMPACT (Interaction Method for Paediatric Autism Communication Therapy) with an additional two and a half days post-course work with IMPACT. Full details of the training with IMPACT can be found here.