Clinical impact of the Development of Communication Skills in Autism (DHACA) on the development of social skills in children with autism.
Letícia Cristiny Arcanjo da Silva, Fádja Auxiliadora Alves E Silva, Rafaela Asfora Siqueira Campos Lima and 1 others
Twenty-three young children with autism showed clear gains in eye contact, shared attention, and responding to name after 20 weekly sessions of a picture-based communication programme.
With no control group, these gains cannot be separated from natural development or the attention of therapists.
Key findings
1DHACA intervention produced statistically significant improvement in several social skills, including eye contact (p = 0.001), shared attention (p = 0.003), and responding to name (p = 0.003).
2Engaged play (p = 0.053) and responding to 'no' (p = 0.095) showed score increases that did not meet the study's 0.05 significance threshold.
3Asking questions (p = 0.371), taking initiative in activities (p = 0.350), and not throwing tantrums (p = 0.638) showed no significant change after the intervention.
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What it does not show
No control group and no randomisation: children were not assigned to a comparison condition, so gains cannot be separated from natural development, the attention of therapists, or parent involvement over the same period. Small sample of 23 children, all from a single clinic in Brazil, limiting generalisability. The intervention bundled multiple components (therapist-delivered DHACA sessions, weekly parent guidance, bi-monthly parent meetings), so the contribution of any single element cannot be isolated. Parent adherence to home practice was not monitored, and home use of the DHACA book by other family members was not controlled. DSM-5 support level was not recorded, preventing analysis across different severity profiles. Sessions were delivered by students rather than qualified clinicians, which may affect fidelity and generalisability to practice settings. The authors themselves describe the evidence as preliminary and call for larger samples and longitudinal follow-up.
Declared interests
Funded by Brazilian public research bodies: FINEP (Grant 2170/22), PROEXT-UFPE, and CAPES (n.8881.926979/2023-01). No industry sponsor, no commercial tie to the DHACA method, and no conflicts of interest declared by the authors.
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