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Baza natječaja

Djelomična stipendija za poslijediplomski iz medicine na sveučilištu Manchester

Rok za prijavu: 31.12.2005.

Kontakt institucija: University of Manchester
Razina studija: diplomski studij
Područje studija: biomedicina i zdravstvo
Mjesto studija: Ujedinjeno Kraljevstvo


UK: Partial PhD studentship in Health studies, University of Manchester

PhD proposal linked to the PACT trial Inter-relation between Communication and Inter-Personal Domains in Pre-School Autism School of Medicine

Supervisor: Dr Jonathan Green
Funding: Part-funding
To start September 2006


There have been converging lines of evidence suggesting the somewhat counterintuitive fact that the language and inter-personal reciprocity domains of autism are independent. My study of high functioning autism/asperger syndrome (Green et al 2000, Gilchrist et al 2001) found that (considered retrospectively using ADI) language domains and reciprocity domains of autism breed true and seemingly independently. Children with early language delay pre-school continue to have relatively language delay in adolescence; children with impaired reciprocity pre-school continue to have difficulties with this in early adolescence: additionally, poor social outcomes were not predicted by early language delay and early reciprocity delay did not predict later language difficulty. Recent analysis of national twin cohort (TEDS) data on autistic siblings found a similar effect; a relative disjunction between communication domains and reciprocity domains of the triad, with behavioural rigidity more linked to language (Happe personal communication, Ronald et al 2005). This is a matter of significant current interest in the field.

Design opportunities within the RCT
PACT gives us the opportunity to use the RCT to look at this issue as it emerges pre-school. We have detailed measures of language/communication (researcher observations of parent child interaction, researcher rated assessment, parental report); and symmetrical measures of inter-personal behaviour. We have the observational items at three time points and the other items at baseline and end point. The PACT intervention is focused purely on language/communication only. The PACT trial is a large multisite RCT (n=144), using standardised measures and a focussed protocol driven intervention. there is sufficient power to undertake the proposed analysis.

Research question
Normative developmental theory would suggest that improving communication should have an effect on inter-personal behaviour - for instance attachment related behaviours. There is good evidence to the effect that improving sensitivity and communicative responsiveness enhances interpersonal attachment behaviours in normal samples. Do we see this happen in autism or is there some dysjunction? Clinical experience suggests that we should see some at least of the normative effect: observations of early interventions of this kind do seem to improve children's interpersonal responsiveness some cases. However, the overall findings from other studies as above suggest the opposite.

1. Observation of the relationship between communication and inter-personal behaviour over time (1 year) in both arms of the trial. the PhD student will conduct amplified measures of these kinds supplementing the study measures on some cases
2. Measurement of the impact on both domains of an intervention specifically aimed at shifting language development. Does this change in parent/child communication impact on the child's inter-personal behaviours? Or do the two domains run independently?

This is a good example of how a systematic intervention study can potentially illuminate developmental psychopathology research. The additional PhD analysis will allow a rigorous contribution to the research theme of the relationship between social and non social aspects of autism in development using a classic design of a developmental perturbation caused by targeted intervention. The follow up data will also allow ongoing longitudinal research on this cohort to this effect.

There will also be relevance to the translation of this intervention into practice and the design of future interventions – since the issue of generalisability into other domains is a key one for the field.

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