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| Applications of Pivotal Response Treatment (PRT) for Treating Social Communication Delays in Young Children With Autism Spectrum Disorder |
| Saturday, May 27, 2023 |
| 10:00 AM–11:50 AM |
| Convention Center Mile High Ballroom 4C/D |
| Area: AUT/CBM; Domain: Translational |
| Chair: Devon White (Division of Child & Adolescent Psychiatry, Stanford Children’s Health, Stanford, CA) |
| Discussant: Grace Werner Gengoux (Stanford School of Medicine, Child and Adolescent Psychiatry) |
| Abstract: A growing body of literature supports the efficacy of Naturalistic Developmental Behavioral Interventions (NDBIs) for treating young children with autism. Pivotal Response Treatment (PRT) is one such intervention which places specific emphasis on child motivation and has demonstrated effectiveness in improving functional and social communication skills (Koegel and Koegel 2019). The current symposium illustrates recent research evaluating factors that may impact treatment responses in populations of young children with Autism Spectrum Disorder, including parent involvement, treatment setting, intensity, duration and modalities of treatment delivery. The first study describes outcomes of a parent-training and clinician delivered PRT treatment package. The second study describes delivery of a similar PRT parent-training model via telehealth. The third study presents data from a randomized control trial of PRT parent training delivered via telehealth. Finally, the fourth study evaluates outcomes for a group of children in an intensive center-based PRT program. Findings from these studies have potential impact on understanding factors to optimize the delivery of PRT and improve access to evidence-based treatment. |
| Instruction Level: Advanced |
| Keyword(s): Early Intervention, NDBI, Parent training, PRT |
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| Randomized Controlled Trial of a Pivotal Response Treatment Package for Children With Autism Spectrum Disorder |
| (Applied Research) |
| GRACE WERNER GENGOUX (Stanford School of Medicine, Child and Adolescent Psychiatry), Daniel Abrams ( Department of Psychiatry and Behavioral Sciences at Stanford University), Maria Millan (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Christina Ardel (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Jennifer Phillips (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Melanie Fox (PGSP - Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California), Antonio Hardan (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California) |
| Abstract: Combining clinician-delivered and parent-delivered treatment is routine in clinical practice of Pivotal Response Treatment (PRT). This presentation reviews data from the first 24-week randomized controlled trial comparing delayed treatment with this treatment package (PRT-P; parent training and clinician-delivered treatment). Forty-eight children with autism spectrum disorder and significant language delay between 2 and 5 years were randomly assigned to PRT-P (n = 24) or the delayed treatment group (DTG; n = 24) for 24 weeks. The effect of treatment on child communication skills was assessed via behavioral coding of parent-child interactions, standardized parent-report measures, and blinded clinician ratings. Compared with DTG, children in PRT-P demonstrated greater improvement in frequency of functional utterances (F1,41 = 6.07; p = .026; d = 0.61; see Figure). The majority of parents in the PRT-P group (91%) were able to implement PRT with fidelity within 24 weeks. Children receiving PRT-P also demonstrated greater improvement on the Brief Observation of Social Communication Change, on the Clinical Global Impressions Improvement subscale, and in number of words used on a parent-report questionnaire. Additional research is warranted to understand the optimal combination of treatment settings, intensity, and duration, and to identify child and parent characteristics associated with treatment response. |
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| Telehealth Pivotal Response Treatment Parent Training: A Pilot Study |
| (Service Delivery) |
| ALICIA GENG (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Christina Ardel (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Elizabeth Karp (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Kari Berquist (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Grace Werner Gengoux (Stanford School of Medicine, Child and Adolescent Psychiatry), Antonio Hardan (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California) |
| Abstract: This study aims to evaluate a telehealth model of PRT Parent Training. Twenty-one autistic children (2-6 years) with significant language delays and their parents participated. Parents attended 12 weekly telehealth parent education sessions and submitted 10-minute home videos of PRT practice before and after the study. Parent-reported communication scores on the Vineland Adaptive Behavior Scale significantly increased post-intervention (t(15) = 2.80, p = 0.014). On the MacArthur-Bates Communicative Development Inventory (CDI), parents reported their children were able to express more words after intervention (t(19) = 2.39, p = 0.028). Children made significantly more utterances per minute in response to parents’ non-verbal prompts in post-intervention videos, (t(20) = 2.72, p = .013). Though all other types of utterances (e.g., unintelligible, imitative, verbally-prompted) increased, the changes were not statistically significant. Analysis of videos also showed that 20 of 21 parents achieved at least 80% fidelity of overall PRT implementation and most parents (16/21) implemented all six PRT principles with fidelity. Parents reported feeling greater family empowerment after intervention (t(17) = 2.19, p = .043). Future controlled trials will be an important next step to better understand the impact of telehealth PRT parent training as a tool for overcoming intervention accessibility barriers. |
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| Telehealth Pivotal Response Treatment Parent Training: A Randomized Controlled Pilot Trial |
| (Applied Research) |
| KATHERINE PASZEK (Stanford University ), Maria Millan (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Tatyana Lark (PGSP - Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California), Jane Shkel (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Antonio Hardan (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Grace Werner Gengoux (Stanford School of Medicine, Child and Adolescent Psychiatry) |
| Abstract: Determining the efficacy of telehealth methods is critical in improving access to care. The aim of this randomized controlled pilot trial was to examine the effects of training parents in PRT via telehealth (PRT-T) compared to children in a waitlist group (WL). Twenty-eight children with ASD, aged 2-5:11 years (M=4.09 ± 1.08 years) with significant language delay were randomly assigned to WL (N=13) or PRT-T (N=15), which involved 12 parent education sessions via secure video conference. Parents completed the MacArthur-Bates Communicative Development Inventory (CDI) at baseline and week 12 and an expert clinician naïve to treatment assignment completed the Clinical Global Impression Improvement rating (CGI-I). Children in PRT-T showed greater improvement on the CDI – Words Produced between baseline (M = 129.7 ± 92.1) and week 12 (M = 192.4 ± 111.7), compared to the WL (BL: M = 45.08 ± 55.693; Wk 12: M = 48.08 ± 66.274; F = 4.306; p = 0.048). Furthermore, on the CGI-I the PRT-T group showed more communication improvement (X2 (3, N=28) = 11.44; p = 0.010). These preliminary data suggest that delivery of PRT parent training via telehealth is a promising method for increasing access to evidence-based treatment for young children with ASD. |
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Randomized Controlled Trial of Center-Based Pivotal Response Treatment: Preliminary Language Outcomes From an Early Intervention Classroom |
| (Applied Research) |
| DEVON WHITE (Division of Child & Adolescent Psychiatry, Stanford Children’s Health, Stanford, CA; Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Jane Shkel (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), morgan steele (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Maria Victoria Dalusong Bundang (Stanford Children's Health), Tanya Rego (Division of Child & Adolescent Psychiatry, Stanford Children’s Health, Stanford, CA), Antonio Hardan (Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California), Grace Werner Gengoux (Stanford School of Medicine, Child and Adolescent Psychiatry) |
| Abstract: Many children with autism struggle to acquire fluent verbal communication skills in spite of early behavioral intervention. Pivotal Response Treatment (PRT) employs maintenance tasks and reinforcement of child attempts to motivate children to initiate communication, and may have promise for rapidly increasing independent utterances. This presentation explores the short-term benefits and geralizability of clinician-delivered, center-based PRT on the acquisition of vocal communication skills. To date, twenty-six autistic children with significant language delays between 2 and 5 years have been randomly assigned to a center-based early intervention PRT program (n = 12) or the delayed treatment group (DTG; n = 14). Available pilot data from 10-minute video samples for the first three participants indicate rapid increase in number of words used during session probes over the course of treatment (Figure 1). Data analysis will continue for the remaining participants using available 10-minute video samples to assess the frequency of child-initiated utterances pre- and post-treatment. Interobserver agreement will be assessed for 30% of the videos and coders will meet an 80% reliability standard. Implications of the findings, as well as limitations, will be discussed with emphasis on the potential utility of PRT for motivating children with ASD to speak more independently. |
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