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What is the title of your thesis?

DAN-PACT: Development, implementation, and early insights from a Danish parent-mediated autism intervention trial.

At which department and/or research unit did you complete your PhD?

Research Unit for Child and Adolescent Psychiatry (Southern Denmark), Department of Clinical Research, University of Southern Denmark.

Who was your principal supervisor?

Professor and consultant Niels Bilenberg.

What question did you aim to answer with your thesis?

The aim of this PhD project was to develop, implement and gain early insights from a Danish parent-mediated autism intervention study.

What did you find?

The systematic literature review found no benefits of parent-mediated interventions on the severity of autism characteristics, adaptive functioning, language or parental stress. Benefits were identified in terms of reductions in children’s behavioural problems and increased parental sensitivity to and synchrony with the child. However, the evidence remains uncertain. There is a need for more high-quality trials that also include outcomes on adverse effects and quality of life.

The DAN-PACT RCT protocol aimed to minimise the risk of bias, anchor the trial in a naturalistic clinical setting, and broaden the range of outcome measures used in previous PACT studies.

The cross-sectional study provided evidence that the use of Naturalistic Developmental Behavioural Intervention (NDBI) strategies is inherent among parents in Denmark, although it varies considerably between families at the time of their child’s autism diagnosis. These differences are largely related to the child’s developmental characteristics at that time. The pattern of strategy use cannot be linked to parental demographics or the overall severity of the child’s autism characteristics, highlighting the complexity of parent–child interactions and development.

The findings emphasise parents’ use of key NDBI mechanisms—particularly following the child’s lead in interactions, modelling, prompting and reinforcement—which appear central to the early development of social communication and engagement. Finally, this sub-study indicates that children’s language can be assessed independently using the Measure of Naturalistic Developmental Behavioural Intervention Strategy Implementation – Caregiver Change (MONSI-CC). However, this needs to be replicated in future studies to further establish its validity.

Overall, the results suggest that the use of parent strategies is closely associated with children’s functional developmental level and the quality of interaction, but only weakly related to the severity of autism characteristics. This underlines the importance of tailoring parent-mediated interventions to the child’s developmental profile rather than relying solely on symptom severity.

How did you do it?

This PhD project comprises a systematic review with meta-analysis evaluating the benefits and harms of parent-mediated interventions for children diagnosed with autism spectrum disorder; a study protocol for a national, multicentre RCT, DAN-PACT, which aimed to assess the advantages and disadvantages of the PACT intervention in children aged 2.0–6.9 years with a recent autism diagnosis; and a cross-sectional study examining Danish parents’ inherent use of supportive strategies and how these relate to the developmental characteristics of their recently diagnosed child with autism.

How can your research be applied (in the clinic, society, etc.)?

Integrating MONSI-CC into a child’s comprehensive diagnostic assessment may support the identification of both the child’s and the family’s resources and needs, thereby enabling more individually tailored interventions and optimising the use of resources.

Furthermore, the findings may help identify families most likely to benefit from participation in an intervention, as well as those who may benefit equally from alternative forms of support, such as psychoeducation, thereby further optimising the allocation of treatment resources.