Intervention Response by Genetic Subtype: PRETEND-Preschool Program for Children with Prader-Willi Syndrome via Remote Parent Training.

The samples were very small, and the subtype analyses were tiny: in Study 2, 6 children with mUPD were in the intervention group and 6 on waitlist, while 4 children with DEL were in the intervention group and 2 on waitlist. Study 1 enrolled 30 children and reported 15 in each group, but the main play analysis table lists 11 intervention and 10 waitlist children, so the analysed number is unclear. Study 2 enrolled 20 children and reported 18 analysed, but the main play analysis table lists 10 intervention and 8 waitlist children. The design was quasi-randomized by child characteristics rather than fully random allocation, and the control group was a waitlist. The sample lacked diversity, making generalization to a broader preschool PWS population difficult. Only pretend play was evaluated as a pre-post outcome, so the study cannot show whether play gains are meaningful outside the play task. In Study 1, parents were advised to practice skills at home, but there was no controlled element of practice.

Do not conclude that this program improves pretend play for all preschoolers with PWS. The whole-sample analyses did not show improvement, and the positive finding was limited to a very small mUPD subgroup in the second study.