Promoting parent–child interaction: what parent-mediated programmes showed

What parents learn in such programmes

In the PACT programme, parents were guided in parent–child interaction: they learned to respond sensitively to the child’s communication, to reduce unhelpful reactions and to use strategies that promote the child’s communication. This included video feedback and psychoeducation. ^{[2, Ch. C.4.2, p. 54]} Related programmes use similar building blocks, such as joint attention (both look at something together), imitation and play. ^{[2, Ch. C.4.2]} More on early intervention and shaping everyday life: Early intervention for autism, Family life with a child on the autism spectrum.

What the 2021 guideline recommended

The guideline stated: parents or legal guardians should be involved in therapeutic interventions; in the preschool years they should be systematically guided in supportive interaction with the child, without themselves becoming therapists. After the diagnosis, all parents should be offered psychoeducation, individually or in a group. Siblings should be offered support and psychoeducation. ^{[2, Rec. 106]} For therapy in toddler and preschool age, it recommended a combination of exercises with the child and guidance of the parents; in its view, parent training alone without the child was not enough, and where implementation is mainly at home, there should be regular feedback from trained therapists, ideally by video. Attention should also be paid to the strain on parents caused by the therapy. ^{[2, Rec. 10, 12]}

What studies showed

The guideline summarised studies on individual parent training (among others PACT, a programme in South Asia, a play programme, “focused playtime”). According to them, parental attunement to the child increased markedly (with PACT with a large effect size of d = 1.22), and individual programmes improved the child’s initiative to communicate (with PACT d = 0.42). By contrast, blind-tested language skills and social interaction according to the ADOS did not improve directly after therapy in most programmes. ^{[2, Ch. C.4.2, pp. 57–58]} Only for PACT was there a long-term follow-up (80 % of the children at a mean age of 10.5 years): here a medium effect on ADOS scores for social interaction and communication was seen (d = 0.55). About 70 % of the effect on the child’s initiative could, according to the analysis, be explained by the increased parental attunement. ^{[2, Ch. C.4.2, p. 58]} A meta-analysis of 16 randomised trials of programmes that practise joint attention (children from 18 months to 8 years) showed consistently medium effects on joint attention. ^{[2, Ch. C.4.2, p. 63]}

Strain and limits

Programmes that involve parents heavily mean time and effort. The guideline named as planning considerations the parental strain, the parents’ skills in implementation and a positive way of dealing with the child. ^{[2, Rec. 10]} How burdensome therapy, everyday life and dealings with authorities can be and what relief exists: Self-care for parents and relatives, Relief for families: services at a glance. If you feel overwhelmed, that is no sign that you are doing something wrong; talk to the therapist about it. Note: this is an assessment by the editorial team.

Sources and literature

1. DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
2. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021. – Guideline (in German); expired on 23 March 2026