A Pivotal Response Treatment Package for Children With Autism Spectrum Disorder: An RCT

Abstract

Objectives: Our aim was to conduct a randomized controlled trial to evaluate a pivotal response treatment package (PRT-P) consisting of parent training and clinician-delivered in-home intervention on the communication skills of children with autism spectrum disorder.

Methods: Forty-eight children with autism spectrum disorder and significant language delay between 2 and 5 years old were randomly assigned to PRT-P (n = 24) or the delayed treatment group (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.

Results: Analysis of child utterances during the structured laboratory observation revealed that, compared with the delayed treatment group, children in PRT-P demonstrated greater improvement in frequency of functional utterances (F_1,41 = 6.07; P = .026; d = 0.61). The majority of parents in the PRT-P group (91%) were able to implement pivotal response treatment (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.

Conclusions: This is the first 24-week randomized controlled trial in which community treatment is compared with the combination of parent training and clinician-delivered PRT. PRT-P was effective for improving child social communication skills and for teaching parents to implement PRT. Additional research will be needed to understand the optimal combination of treatment settings, intensity, and duration, and to identify child and parent characteristics associated with treatment response.

Trial registration: ClinicalTrials.gov NCT02037022.

FIGURE 1

Consolidated Standards of Reporting Trials form flowchart.

FIGURE 2

Number of utterances by group during SLO at baseline (PRT-P group: mean ± SE = 49.9 ± 6.13; DTG: mean ± SE = 52.7 ± 5.08), week 12 (PRT-P group: mean ± SE = 75.3 ± 4.31; DTG: mean ± SE = 50.2 ± 5.45), and week 24 (PRT-P group: mean ± SE = 71.3 ± 5.66; DTG: mean ± SE = 53.4 ± 5.96). F_2,40 = 3.765; P = .032.

FIGURE 3

BOSCC total score from SLO by group at baseline (PRT-P group: mean ± SE = 34.3 ± 1.6; DTG: mean ± SE = 34.6 ± 0.93), week 12 (PRT-P group: mean ± SE = 29.9 ± 1.25; DTG: mean ± SE = 33.93 ± 1.35), and week 24 (PRT-P group: mean ± SE = 26.5 ± 1.35; DTG: mean ± SE = 34.4 ± 1.13). F_2,39 = 17.597; P < .001. Improvement was observed at week 12 (F_1,40 = 4.345; P = .044).