Dr. ?ine Roddy:

On the evidence for early intervention, I can only comment on a certain amount because the work is not published and there is stuff in progress. A study has been done called the Pre-school Autism Communication Trial or PACT, which is a parent mediated intervention programme that was set up in the UK. The programme involved speech and language therapists working with parents and helping them to interact more with their child, which, in turn, led to an improvement in outcomes. Further research on the cost effectiveness of that is being finalised and the results are promising. However, I am uncomfortable with that language and fully agree with the Deputy that this should not be described like a transaction in a bank. There is no solid foundation whereby if you spend "X" amount, you will get "Y" in return. I believe that there is a huge lack of evidence in this area.

On the naturalistic types of supports or interventions, international research and practices have moved more towards, say, play therapy where it is more about the parent or parents understanding the child's communication pattern, maybe in a different perspective, and understanding more about it if the children are struggling. It is trying to interact at child level and where the children are at but help with their communication. That is what is being analysed internationally. There are pros and cons to this. I am mindful of the fact that the State has only a certain amount to spend. If you look for intensive resources then you must know what is an appropriate level of care. There is a lot of uncomfortable conversations needed. There is no best practice guideline to always look to and know what is the appropriate level of services that need to be provided in certain scenarios.

First, there is a huge lack of guidance for health professionals in what should be best practice for autism care, to a certain extent. Second, they are moving more towards a parent-type of training programmes to help parents understand when their child is distressed or, through play, that they are able to improve social skills and communicate more clearly. That is what it is moving towards more internationally and different pilot programmes, and programmes have looked at that.