PACT Paediatric Autism Communication Therapy
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Contents
Acknowledgements vii
Part 1: The PACT intervention programme
Chapter 1: Overview of PACT 2
Chapter 2: Background 3
2/1 Communication impairments in autism spectrum disorder and impact
on adult-child communication 3
2.2 Communication interventions for children with ASD . 4
Chapter 3: Development of PACT 6
Chapter 4: General principles 8
4.1 Developmental orientation 8
4.2 Focus on naturalistic interactions 8
4.3 Adult-mediated 8
4.4 Video-aided 9
4.5 Adapted to adult style 9
Chapter 5: Specific aims 10
5.1 Shared attention 10
5.2 Communication 10
5.3 Communication intention 10
5.4 Pragmatics 11
Chapter 6: Procedure 12
6.1 Initial session 12
6.2 PACT sessions 12
6.3 Selecting video clips for feedback 15
6.4 Setting the practice programme 16
6.5 Home/centre practice 17
6.6 Generalisation 17
Chapter 7: Additional clinical considerations 18
7.1 Diagnostic assessments 18
7.2 Trainingtherapists/ongoing supervision 18
7.3 Families involved in other intervention programmes 18
7.4 Demands on families 19
7.5 Feedback to adults 19
7.6 Adapting PACT for verbally fluent children 19
7.7 Adapting PACT for children who use delayed echolalia 20
7.8 Adapting PACT for older children 20
7.9 Home or clinic/centre-based training 20
7.10 Bilingualism 21
7.11 Working with both parents 21
Part 2: The PACT stages
Chapter 8: PACT stages 23
8.1 Sequence of PACT intervention stages 24
8.2 Moving through the stages of the PACT intervention 24
8.3 Maintenance sessions 25
Chapter 9: Stage 1: Establishing shared attention 26
9.1 Aims 26
9.2 Explaining this stage to the adult ' 26
9.3 Identifying video clips to watch during feedback 26
9.4 Adult strategies 27
9.5 Examples of child targets at Stage 1 30
9.6 Adult concerns that might arise at Stage 1 30
9.7 Useful analogies to use at Stage 1 31
9.8 Useful toys for Stage 1 31
9.9 Criteria for end of Stage 1 32
9.10 PACT Stage 1 notes: Establishing shared attention 33
Chapter 10: Stage 2: Synchrony and sensitivity 34
10.1 Aims 34
10.2 Explaining this stage to the adult 34
10.3 Identifying video clips to watch during feedback 35
10.4 Adult strategies 35
10.5 Examples of child targets at Stage 2 39
10.6 Adult concerns that might arise at Stage 2 39
10.7 Useful analogies to use at Stage 2 39
10.8 Criteria for end of Stage 2 40
10.9 PACT Stage 2 notes: Synchrony and sensitivity 41
Chapter 11: Stage 3: Focusing on language input 42
11.1 Aim 42
11.2 Explaining this stage to the adult 42
11.3 Identifying video clips to watch during feedback 42
11.4 Adult strategies 43
11.5 Examples of child targets at Stage 3 48
11.6 Adult concerns that might arise at Stage 3 48
11.7 Useful analogies to use at Stage 3 49
11.8 Criteria for end of Stage 3 50
11.9 PACT Stage 3 notes: Focusing on language input 51
Chapter 12: Stage 4: Establishing routines and anticipation 52
12.1 Aims .: - 52
12.2 Explaining this stage to the adult 52
12.3 Identifying video clips to watch during feedback 53
12.4 Adult strategies 53
12.5 Adult concerns that might arise at Stage 4 56
12.6 Useful analogies to use at Stage 4 56
12.7 Criteria for end of Stage 4 57
12.8 Useful toys for Stage 4 57
12.9 PACTStage 4 notes: Establishing routines and anticipation 58
Chapter 13: Stage 5: Increasing communication functions 59
13.1 Aims 59
13.2 Explaining this stage to the adult 59
13.3 Identifying video clips to watch during feedback 59
13.4 Adult strategies 60
13.5 Useful analogies to use at Stage 5 63
13.6 Examples of child targets at Stage 5 63
13.7 Adult concerns that might arise at Stage 5 64
13.8 Criteria for end of Stage 5 64
13.9 PACT Stage 5 notes: Increasing communication functions 66
Chapter 14: Stage 6: Language expansion and developing conversation 67
14.1 Aims : 67
14.2 Explaining this stage to the adult 67
14.3 Identifying video clips to watch during feedback 68
14.4 Adult strategies 68
14.5 Examples of child targets at Stage 6 73
14.6 Adult concerns that might arise at Stage 6 73
14.7 Useful analogies to use at Stage 6 74
14.8 Useful toys for Stage 6 74
14.9 Criteria for end of treatment 75
14.10 PACT Stage 6 notes: Language expansion and developing conversation 76
References 77
Appendix 1: Play, communication and English national curriculum P-levels 83
Appendix 2: PACT research evidence background 84
Appendix 3: Therapeutic alliance 92
Appendix 4: Strategies to modify adult learning styles 93
Appendix 5: PACT therapist evaluation 94
Appendix 6: Examples of probes to gain adult’s observations and support understanding 96
Appendix 7: PACT initial session. 97
Appendix 8: Toys and materials 99
Appendix 9: PACT session notes. 102
Appendix 10: PACT practice programme 104
Appendix 11: Examples of questions used at each stage of the therapy session 108
Appendix 12: Measurement criteria for moving to the next stage of the programme 109
Glossary of terms 110
