#VisualAbstract: A Pivotal Response Treatment Package for Children With Autism Spectrum Disorder

1. Pivotal response treatment (PRT) is an intervention designed to increase motivation to interact by rewarding effort with natural reinforcement. Children with autism spectrum disorder (ASD) randomized to receive 24 weeks of PRT showed improved frequency of functional utterances compared to children randomized to the control group.

2. Parents of children in the PRT group also reported significant improvement in number of words used after 24 weeks.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Pivotal response training is a naturalistic behavioral intervention designed to increase motivation to interact through modeling appropriate language during play and rewarding attempts at communication. While there is growing support for this intervention in ASD, there has not previously been rigorous empirical testing in this population. In this randomized controlled trial, researchers assigned children and parents to 24 weeks of PRT or delayed treatment. Frequency of functional utterances and other measures of social communication were measured at baseline, 12 weeks, and 24 weeks using a 10-minute structured laboratory observation, parent-report questionnaire, and other scales. At 24 weeks, children receiving PRT demonstrated significantly improved number of functional utterances between baseline and week 24, compared to children in the delayed treatment group. They also had significant improvement in number of words used, based on a parent-report questionnaire.

These findings are limited by the small sample size, and the study was underpowered to evaluate predictors of treatment response. Furthermore, researchers were unable to determine the individual effects of parent-training and clinical-delivered PRT, as these components were combined in the treatment group. Nonetheless, the study is strengthened by its randomized, controlled design examining the efficacy of a novel treatment. For physicians, these findings suggest that PRT is effective for improving social communication behaviors among children with ASD.

Click to read the study in Pediatrics