Clinical impact of the Development of Communication Skills in Autism (DHACA) on the development of social skills in children with autism.

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.

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.

Do not read the significant p-values as proof that DHACA causes social-skill gains in children with autism. There was no control group, no randomisation, and the children simultaneously received weekly parent coaching and bi-monthly parent meetings alongside the 20 therapist sessions, so the observed improvements could reflect natural maturation, the attention of any structured programme, or family involvement rather than the DHACA method specifically. The three skills that did not improve (asking questions, taking initiative, tantrum behaviour) also caution against assuming the intervention addresses all social difficulties.