# Empirical Support for Pivotal Response Treatment

| Study | Design | Treatment | Dependent Variables | Treatment Outcome |
| --- | --- | --- | --- | --- |
| INITIAL RESEARCH ON MOTIVATION AS A KEY FOR AUTISM INTERVENTION |  |  |  |  |
| CORE PIVOTAL AREA OF MOTIVATION |  |  |  |  |
| Koegel, R.L. & Egel, A.L.(1979). Motivating autistic children. Journal of Abnormal Psychology, 88, 4118-4126. | Multiple baseline design across subjects | Influence of correct versus incorrect task completion on children's motivation to respond to such tasks. Treatment procedures designed to prompt children to keep responding until they completed the tasks correctly. | ·Proportion of time child attempted to complete tasks without engaging in non-related behavior ·Enthusiasm level | Effective treatments were those that increased exposure to a response-reinforcement contingency for completing the tasks. |
| INITIAL RESEARCH USED IN THE DEVELOPMENT OF PRT A. CHILD CHOICE/USE OF RITUALISTIC THEMES |  |  |  |  |
| Koegel, R.L., Dyer, K., & Bell, L.K.(1987). The influence of child-preferred activities on autistic children's social behavior. J Appl Behav Anal, 20, 243-252. | 3 studies: correlational analysis, repeated reversals design with 3 children, community setting | Manipulation of child-preferred and arbitrary activities | ·Number of social avoidance behaviors(gaze aversion, closed eyes, etc.) ·Subjective measures of social responsiveness | Child-preferred activities and social avoidance behaviors were significantly negatively correlated in terms of both objectively scored behavior and subjective ratings of social responsiveness in unmanipulated settings. |
| B. REINFORCING ATTEMPTS |  |  |  |
| Koegel, R.L., O’Dell, M.C., & Dunlap, G.(1988). Producing speech use in non-verbal autistic children by reinforcing attempts. J Autism Dev Disord, 18(4), 525-538. | Within-subject repeated reversals design | Compared 2 different reinforcement conditions: ·Successive more approximates of speech sounds reinforced ·"Motivation" condition in which attempts to produce speech sounds were reinforced; no shaping of speech |
| C.TASK VARIATION |  |  |  |
| Dunlap, G. & Koegel, R.L.(1980). Motivating autistic children through stimulus variation. J Appl Behav Anal, 13, 619-627. | Within subject design, multiple baseline across participants | Varied task condition vs. constant task condition | ·Ratings of affect ·Measures of improvement in speech production | While each condition produced some improvement in the children's speech, the data indicate that considerably more rapid and consistent progress occurred when the children were reinforced within the framework of a speech attempts contingency rather than when they were reinforced solely on the basis of their correct speech production |
|  |  |  | ·Number of correct unprompted responses to questions ·Enthusiasm, happiness and interest | Declining trends in correct responding during the constant task condition, with substantially improved and stable responding during varied task condition. Children more enthusiastic, interested, and better behaved during the varied task sessions. |
| D. NATURAL REINFORCERS |  |  |  |
| Williams, J.A., Koegel, R.L., and Egel, A.L.(1981). Response-reinforcer relationships and improved learning in autistic children. J Appl Behav Anal, 14, 53-60. | Multiple baseline design across participants | Changing arbitrary response-reinforcer relationships (while holding target behaviors and reinforcers constant) to make target behaviors functional | Percentage of correct unprompted responses | Arranging functional response-reinforcer relationships produced immediate improvement in learning, and resulted in rapid acquisition of criterion level responding. |
| Koegel, R.L., and Williams, J.(1980). Direct vs. indirect response-reinforcer relationships in teaching autistic children. Journal of Abnormal Psychology, 4, 537-547. | Multiple baseline design across participants | 2 different response-reinforcer relationships: (1) target behaviors were a direct part of the response chain required to procure a reinforcer and (2) where target behavior was an indirect part of chain leading to reinforcer | Percentage of correct responses | Results showed rapid acquisition only when the target behavior was a direct part of the chain leading to the reinforcer |
| Koegel, L.K., Koegel, R.L., Green-Hopkins, I., Koegel, L.K., & Barnes, C.C.(2010). Brief report: Question-asking and collateral language acquisition in children with autism. J Autism Dev Disord, 40(4), 509-515. | Multiple baseline design across participants | Taught children to use the question "Where is it?" using intrinsic reinforcers | Language acquisition # of unprompted "where" questions asked Number of prepositions/ ordinal markers correctly produced | The children could rapidly acquire and generalize the query, and that there were collateral improvements in the children's use of language structures corresponding to the answers to the questions the children asked. |
| Koegel, R.L., Vernon, T.W., & Koegel, L.K.(2009). Improving social initiations in young children with autism using reinforcers with embedded social interactions. J Autism Dev Disord, 39(9), 1240-1251. | ABAB design | Assessed whether embedding social interactions into reinforcers, delivered during language intervention, would lead to increased levels of child-initiated social behaviors |
| Koegel, L.K., Carter, C.M., Koegel, R.L.(2003). Teaching children with autism self-initiations as a pivotal response. Topics in language disorders, 23, 134-145. | Multiple baseline design across participants | Assessed whether children with autism could be taught a child-initiated question as a pivotal response to facilitate the use of grammatical morphemes. |
| Koegel, L.K., Camarata, S.M., Valdez-Menchaca, M., & Koegel, R.L.(1998). Setting generalization of question-asking by children with autism. American Journal on Mental Retardation, 102(4), 346-357. | Multiple baseline design across participants | Self-initiated question asking (“What’s that?”) using a PRT framework |  |  |
| Of Special Psismery sense | ·Reinforcer strength ·Self-initiated social engagement during communication ·Nonverbal dyadic orienting ·General child affect | Embedding social interactions into the reinforcers resulted in increases in child-initiated social engagement during communication, improved nonverbal dyadic orienting, and improvements in general child affect |
|  | ·Language ·Use of morphemes | Both children learned the self-initiated strategy and both acquired and generalized the targeted morpheme. Additionally, generalized use of the self-initiation into other question forms and concomitant increases in mean length of utterance, verb acquisition, and diversity of verb use occurred for both children. |
|  | ·Spontaneous use of target question ·Number of stimulus items labeled correctly | Children consistently and spontaneously initiated “What’s that?” across treatment and generalization settings. Significant increase in vocabulary due to item label acquisition |
| RESEARCH SUGGESTING SELF-MANAGEMENT AS A CORE PIVOTAL AREA |  |  |  |
| Koegel, L.K., Koegel, R.L., Hurley, C., & Frea, W.D.(1992). Improving social skills and disruptive behavior in children with autism through self-management. J Appl Behav Anal, 25(2), 341-353. | Multiple baseline design across participants | Self-management used to improve responsiveness to verbal initiations from others in multiple settings without the presence of a treatment provider. | Responsiveness to verbal initiations | Collateral reductions in disruptive behavior occurred when the children's responsivity improved. |
| Koegel, R.L., and Koegel, L.K.(1990). Extended reductions in stereotypic behaviors through self-management in multiple community settings. J Appl Behav Anal, 1, 119-127. | Multiple baseline design across participants | Assessed whether students with severe autistic disabilities could learn to use a self-management treatment package to reduce their stereotypic behavior | Stereotypic behavior | With the initiation of self-management procedures, rapid and substantial decreases in stereotypic behavior occurred, often to 0% for Students 1 and 2. For Students 3 and 4, percentages of intervals of stereotypic behavior were more variable, but also frequently reached 0% after the initiation of self-management. |
| EMPIRICAL VALIDATION FOR THE PRT PACKAGE |  |  |  |
| Baker-Ericzen, M.J., Stahmer, A.C., & Burns, A.(2007). Child demographics associated with outcomes in a community-based Pivotal Response Training program. J Posit Behav Interv, 9(1), 52-60. | Clinical replication | Large-scale community-based 12-week parent education PRT intervention and examined whether child variables are associated with treatment outcome |
| Gillett, J.N., & LeBlanc, L.A.(2007). Parent-implemented natural language paradigm to increase language and play in children with autism. Research in Autism Spectrum Disorders, 1(3), 247-255. | Non-concurrent multiple baseline design across participants | Parent-implemented PRT (called NL) to target language and play skills |
| Harper, C.B., Symon, J.B.G., Frea, W.D.(2008). Recess is time-in: Using peers to improve social skills of children with autism. J Autism Dev Disord, 38, 815-826. | Concurrent multiple baseline design across participants | Peer-implemented PRT to increase social play |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| Individual time | Communication Daily living skills Socialization Motor skills Adaptive behaviors | Following parent education in PRT, all children showed significant improvement in communication, daily living skills, socialization, motor skills, and Adaptive Behavior Composite domains of the Vineland Adaptive Behavior Scales regardless of gender, age, and race/ethnicity of the children/families. |
| Instated (separate) time | Frequency of vocalizations (spontaneous and prompted) Mean length of utterance Appropriate and inappropriate play Social validity questionnaire | Increases in overall rate and spontaneity of utterances were found for all three children. Children also showed an increase in appropriate play. Parents rated the intervention simple to implement and endorsed continued use of PRT. |
| Individual time | Attempts at: Gaining peer's attention Turn-taking Initiating play with peers | Following peer implementation of PRT, both children increased social play initiations. Turn-taking play skills also increased across phases of the study for both children. The results were maintained during the generalization phase. |
| Koegel, L.K., Carter, C.M., Koegel, R.L.(2003). Teaching children with autism self-initiations as a pivotal response. Topics in language disorders, 23, 134-145. | Multiple baseline design across participants | Assessed whether children with autism could be taught a self-initiated query as a pivotal response to facilitate the use of grammatical morphemes | Initiations morpheme acquisition and generalization Related language gains | Both children learned the self-initiated strategy and both acquired and generalized the targeted morpheme. Additionally, generalized use of the self-initiation into other question forms and concomitant increases in mean length of utterance, verb acquisition, and diversity of verb use occurred for both children. |
| Koegel, L.K., Koegel, R.L., Shoshan, Y., McNermey, E.(1999). Pivotal Response Intervention II: Preliminary Long-term Outcomes Data. Journal of the Association for Persons with Severe Handicaps, 24(3):p. 186-198. | Retrospective analysis of archival data | Examined treatment outcomes for children initiating social communication at high and low rates Assessed an intervention to teach initiations | Number of initiations Pragmatic ratings Social/community functioning Adaptive behavior scale scores | Retrospective analysis of archival data showed that children who exhibited high levels of spontaneous initiations at pre-intervention had more favorable post-intervention outcomes. In addition, children who were taught to initiate social communication (when such initiating was low) showed highly favorable post-intervention outcomes. |
| Koegel, R.L., & Frea, W.D. (1993). Treatment of social behavior in autism through the modification of pivotal social skills. J Appl Behav Anal, 26, 369-377. | Multiple baseline design across participants and behaviors | Self-manage targeting of social communicative behaviors |
| Koegel, R.L., Koegel, L.K., & Surratt. (1992) Language intervention and disruptive behavior in preschool children with autism. J Autism Dev Disord, Vol. 22(2), 141-153. | Repeated reversals design | Traditional Trial vs. P Analogue Treatment vs. NLP* |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| Agreement time or two positive | Facial expression and affect Non-verbal mannerisms Perseveration of topic Intensity of voice volume Eye gaze Subjective judgments of overall appropriateness | Social behaviors improved rapidly and generalized improvements in untreated social behaviors were found. These improvements were accompanied by increases in subjective ratings of the overall appropriateness of the children's social interactions. |
| Discrete PRT (called positive) | Expressive language Disruptive behavior | The PRT condition consistently produced lower levels of disruptive behavior both within and across children, as compared to the Analogue treatment. Children also produced more correct language target behaviors in the PRT condition. |
| Discrete PRT (called negative) | Imitative child utterances Spontaneous child utterances Generalization | Children produced more imitative and spontaneous utterances in the PRT condition. Generalization of treatment gains occurred only in the PRT condition. |
| Koegel, R. L., Symon, J.B., & Koegel, L.K.(2002). Parent education for families of children with autism living in geographically distant areas. J Posit Behav Interv, 4, 88-103. | Non-concurrent multiple baseline design across participants | Intensive, very long, centered PRT parent education program |
| Laski, K.E., Charlop, M.H., & Schreibman, L.(1988). Training parents to use the Natural Language Paradigm to increase their autistic children's speech. Journal of Applied Behavior Analysis, 21, 391-400. | Multiple baseline design across participants | Parent training PRT (called to increase child's speech) |
| Pierce, K., Schreibman, L.(1995). Increasing complex social behaviors in children with autism: Effects of peer implemented pivotal response training. Journal of Applied Behavior Analysis. 1995; 28: 285-295. | Multiple baseline design across participants | Peer-implemented PRT |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| week-based program | ·Parent implementation of PRT motivational techniques ·Children's expressive verbal communication ·Parents' composite affect score during parent-child interactions | Parents increased their use of PRT motivational techniques and showed more positive affect while interacting with their child. The children's expressive verbal production also increased. Improvements generalized to the families' home communities and maintained over time. |
| ing in (NLP*) their speech | ·Parent requests for vocalizations from their child ·Child vocalizations (imitations, answers to questions, and spontaneous speech) | Following training, parents increased the frequency with which they required their children to speak (i.e., modeled words and phrases, prompted answers to questions). Correspondingly, all children increased the frequency of their verbalizations. |
| mented | ·Maintenance of social interactions ·Conversation initiations ·Play initiations ·Attention behaviors ·Number of appropriate words spoken ·Sentence length | After the intervention, both children with autism maintained prolonged interactions with the peer, initiated play and conversations, and increased engagement in language and joint attention behaviors. Teachers reported positive changes in social behavior. These effects showed generality and maintenance. |
| Pierce, K., & Schreibman, L.(1997). Multiple peer use of pivotal response training to increase social behaviors of classmates with autism: Results from trained and untrained peers. Journal of Applied Behavior Analysis, 30, 157-160. | Multiple baseline design across peer trainers and replicated across participants | Peer-implemented PRT |  |  |
| Smith, A., & Camarata, S.(1999). Using teacher-implemented instruction to increase language intelligibility of children with autism. Journal of Positive Behavior Interventions, 1(3), 141-151. | Non-concurrent multiple baseline design across participants | Naturalistic language teaching process (based on PRT called NLP*) conducted by the child's general education team collaboration the child's language clinician |
| Stahmer, A.C.(1995). Teaching symbolic play skills to children with autism using pivotal response training. Journal of Autism and Developmental Disorders, 25, 123-142. | Single subject multiple baseline design across participants | PRT to teach symbolic play |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| Instited | Maintenance of social interactions Conversation initiations Play initiations | Posttreatment, the children with autism showed increases in maintenance of social interactions and social initiations. |
| Language procedures T, the teacher in with language | Feasibility of implementation (rated by teacher) Child's language intelligibility Verbal response intervals | Result indicate that teachers found the naturalistic language teaching procedures highly feasible to implement in the school settings. All participants showed improved intelligibility of verbalizations as well as near typical levels of time intervals engaged in speaking following intervention. |
| Skills | Symbolic Play Complexity of play behavior | Following training, all children with autism showed an increase in symbolic play and play complexity to levels similar to those of language-matched typical controls. In most cases the children generalized their play to new toys, environments, and play partners and maintained these skills at follow-up. |
| Thorp, D. M., Stahmer, A.C., & Schreibman, L.(1995). Effects of sociodramatic play training on children with autism. Journal of Autism and Developmental Disorders, 25, 265-21R2. | Single subject multiple baseline probe design across participants | PRT to teach sociodramatic play to children with autism | Role playing Make believe transformations Persistence of play theme Social behavior Verbal communication | Positive changes were observed in all elements of sociodramatic play following training. These changes generalized across toys and settings. |
| Vismara, L.A., & Lyons, G.L.(2007). Using perseverative interests to elicit joint attention behaviors in young children with autism: Theoretical and clinical implications to understanding motivation. J Posit Behav Interv, 9, 214-228. | Within subject design with counterbalancing and alternating treatments in final phase | PRT involving child's perseverative interests vs. PRT not involving child's perseverative interests | Number of joint attention initiations Contingencies to joint attention initiations Child-caregiver interaction measures | Using stimuli related to children's perseverative interests as natural reinforcers within the motivational procedures of PRT led to increases in joint attention initiation for social sharing. |
| Voos, A.C., Pelphrey, K.A., Tirrell, J., Bolling, D.Z., VanderWyk, B., Kaiser, M.D., McPartland, J.C., Volkmar, F.R., & Ventola, P.(2012). Neural mechanisms of improvements in social motivation after pivotal response treatment: Two case studies. J Autism Dev Disord, 2012 Oct 27 [Epub ahead of print]. | Single case series | PRT targeting pivotal areas of development, including motivation, social initiation and responsivity in order to improve social and language functioning in both participants. | Total Fixation Duration and percent of looking time at adult faces Neural mechanisms supporting social perception Skills in communication, daily living and socialization Pragmatic skills Number of on topic comments, questions, total narrative details, and conversations | PRT resulted in increased activation in regions recruited by typically developing children during social perception. |
| A.PARENT EDUCATION |  |  |  |
| Mossman-Steiner, A.(2011). A strength-based approach to parent education for children with autism. J Posit Behav Interv, 13(3), 178-190. | Alternating treatments design | Studied the impact of a strength-based approach to parent education; compared the effects of therapist statements that highlighted the child's deficits to those that emphasized strengths | Parent affect Parent statements regarding child behavior Quality of parent-child interactions | Results indicate that parents displayed improved affect, made more positive statements about their child, and also exhibited more physical affection toward their child during the strength-based approach |
| Nefdt, N., Koegel, R.L., Singer, G., & Gerber, M. (2010). The use of a self-directed learning program to provide introductory training in pivotal response treatment to parents of children with autism. J Posit Behav Interv, 12(1), 23-32. | Randomized clinical trial | To evaluate whether the use of a self-directed learning program could result in changes in behavior for parent and their children with autism. |
| Coolican, J., Smith, I.M., Bryson, S.E.(2010). Brief parent training in pivotal response treatment for preschoolers with autism. Journal of Child Psychology and Psychiatry, 51(12), 1321-1330. | Non-concurrent multiple baseline across participants | To evaluate the efficacy of brief training in PRT for parents of preschoolers with autism, who were unable to access more comprehensive treatment |
| Gillett, J.N., & LeBlanc, L.A.(2007). Parent-implemented natural language paradigm to increase language and play in children with autism. Research in Autism Spectrum Disorders, 1(3), 247-255. | Non-concurrent multiple baseline design across participants | Parent-implement PRT (called NLP) to target language and play skills |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| User result items | ·Fidelity of implementation of PRT procedures ·Language opportunities (parent measure) ·Child's functional verbal utterances ·Observed parent confidence | Results indicated significant differences between treatment and control groups at posttest on all of the dependent measures. Furthermore, all of the parents who completed the self-directed learning program reported high ratings of satisfaction. |
| Parentive move | ·Functional utterances ·Parent's fidelity in implementing PRT techniques | Brief parent training in PRT promises to provide an immediate, cost-effective intervention that would be adopted widely |
| Intervention (used) | ·Frequency of vocalizations (spontaneous and prompted) ·Mean length of utterance ·Appropriate and inappropriate play ·Social validity Questionnaire | Increases in overall rate and spontaneity of utterances were found for all three children. Children also showed an increase in appropriate play. Parents rated the intervention simple to implement and endorsed continued use of PRT. |
| Koegel, R. L., Symon, J.B., & Koegel, L.K.(2002). Parent education for families of children with autism living in geographically distant areas. J Posit Behav Interv, 4, 88-103.* | Non-concurrent multiple baseline across participants design | Intensive, week long, center-based PRT parent education programs |
| Koegel, R.L., Bimbel, A., Schreibman, L.(1996). Collateral effects of parent training on family interactions. J Autism Dev Disord, 26(3), 347-359. | Group design with random assignment | Trial vs. PRT Individual Tactile Behaviors vs. |
| Schreibman, L., Kaneko, W.M., & Koegel, R.L.(1991). Positive affect of parents of autistic children: A comparison across two teaching techniques. Behavior Therapy, 22(4), 479-490. | Group design with random assignment | Traditional Trial vs. PRT Individual Tactile Behaviors |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| K-based program | ·Parent implementation of PRT motivational techniques ·Children's expressive verbal communication ·Parents' composite affect score during parent-child interactions | Parents increased their use of PRT motivational techniques and showed more positive affect while interacting with their child. The children's expressive verbal production also increased. Improvements generalized to the families' home communities and maintained over time. |
| (called target PRT) | Ratings of ·Happiness ·Interest ·Stress ·Communication style | The Discrete Trial condition resulted in no significant influence on interactions, while PRT resulted in positive parent-child interactions |
| Discrete (called target PRT) | Parental affect | Parents in the PRT condition displayed significantly more positive affect than parents trained in Discrete Trial. |
| B.ACADEMIC SETTINGS |  |  |  |
| Robinson, S.E.(2011). Teaching paraprofessionals of students with autism to implement pivotal response treatment in inclusive school settings using a brief video feedback training package. Focus on Autism and Other Developmental Disabilities, 26(2), 105-118. | Multiple baseline design across participants | The author investigated a training package consisting of modeling and video-based feedback as a means of enabling paraprofessionals to implement Pivotal Response Treatment (PRT) in the inclusive school setting |
| Koegel, L.K., Singh, A.K., & Koegel, R.L.(2010). Improving motivation for academics in children with autism. J Autism Dev Disord, 40(9), 1057-1066. | Multiple baseline design across participants | Specific motivation variables such as choice, interspersal of maintenance tasks, and natural reinforcers incorporated into academic tasks |
| Koegel, L.K., Koegel, R.L., Frea, W., & Green-Hopkins, I.(2003). Priming as a method of coordinating educational services for students with autism. Lang, Sp, and Hear Serv in Sch, 34, 228-235. | A repeated reversals design was used to monitor student progress in 2 children. | Priming |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
|  |  |  |
| -心理效应 | ·Paraprofessional fidelity of affect ·Paraprofessional levels of involvement ·Focal students' target social communication goals ·Student affect | The findings suggest that the training package was effective and efficient in improving paraprofessional PRT implementation and levels of involvement as well as social communication target behaviors of the students with autism. |
| 实际效果 | Academics (writing and math performance) | For all children, disruptive behavior decreased immediately following implementation of the intervention and remained low throughout the intervention and post-intervention phases. |
|  | ·Academic performance ·Problem behaviors | Decreases in problem behavior and increases in academic responding when priming sessions occurred. |
| C. INCLUSION/PEER MEDIATION |  |  |  |
| Harper, C.B., Symon, J.B.G., Frea, W.D.(2008). Using peers to improve social skills of children with autism. J Autism Dev Disord, 38, 815-826. | Multiple baseline design across participants | Peer-Implemented PRT to increase social play | Attempts at Gaining peer's attention Turn taking Interactions Play initiations | Following peer implementation of PRT, both children increased initiation and turn-taking initiations. The results maintained during generalization |
| Koegel, R.L., Werner, G.A., Vismara, L.A., & Koegel, L.K.(2005). Contextually supported interactions between children with autism and typically developing peers. Res Prac Pers with Sev Disab, 30, 93-102. | Multiple baseline design across participants | Using motivational strategies in play dates to improve the quality of social interactions between children with autism and their typically developing peers | Synchronous reciprocal interaction Child affect. | During play dates with contextual support, both children showed immediate increases in the percentage of intervals containing synchronous reciprocal interaction, ranging from 70% to 85% |
| Brookman, L., Boettcher, M., Klein, E., Openden, D., Koegel, R.L., Koegel, L.K.(2003). Facilitating social interactions in a community summer camp setting for children with autism. J Posit Behav Interv, 5, 249-252. | Participants split into groups based on age; one child with autism per group | Priming, self-management, peer involvement in a full inclusion summer camp setting | Social initiations Participation Problem behaviors | The children with autism, who had varying levels of functioning, were able to successfully participate in the camp activities with the support of their aides |
| Koegel, R.L., & Frea, W.D. (1993). Treatment of social behavior in autism through the modification of pivotal social skills. J Appl Behav Anal, 26, 369-377. | Multiple baseline design across participants | Targeting one pivotal area to improve social communicative behaviors |
| D.WIDE SCALE DISSEMINATION |  |  |  |
| Bryson, S.E., Koegel, L.K., Koegel, R.L., Openden, D., Smith, I.M., & Nefdt, N.(2007). Large scale dissemination and community implementation of Pivotal Response Treatment: Program description and preliminary data. Res Pract Pers with Sev Disab, 32(2), 142-153. | Clinical Replication | Large scale community treatment PRT for interventionist clinical supervised clinical leader parents |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| For two to three social interactions | Social communicative variables Non-verbal mannerisms Perseveration of topic Intensity of voice volume | Social behaviors improved rapidly and generalized changes in untreated social behaviors. These improvements were accompanied by increases in subjective ratings of the overall appropriateness of the children's social interactions. |
|  |  |  |
| Maintaining skills, advisors, and relationships | Fidelity of implementation Intervals with Functional Verbal Utterances | Treatment providers maintained fidelity of implementation across time and increased the functional verbal utterances of the participant children. |
| E. COMMUNITY IMPLEMENTATION |  |  |  |
| Smith, I.M., Koegel, R.L., Koegel, L.K., Openden, D.A., Fossum, K.L., & Bryson, S.E.(2010). Effectiveness of a novel community-based early intervention model for children with autistic spectrum disorder. Amer J on Intel and Dev Dis, 115(6), 504-523. | 53 preschool-age children (on the broad autism spectrum), multiple measures over time, no control group. | PRT is the primary treatment modality, with positive behavior supports as supplementary strategies. |
| Baker-Ericzen, M.J., Stahmer, A.C., & Burns, A.(2007). Child demographics associated with outcomes in a community-based Pivotal Response Training program. J Posit Behav Interv, 9(1), 52-60. | Clinical replication | 12-week PRT parent education programs |
| F. INDIVIDUALIZED TREATMENT PROTOCOLS |  |  |  |
| Koegel, R.L., Shirotova, L., & Koegel, L.K.(2009). Brief report: Using individualized | Non-concurrent multiple baseline design across participants | Whether individualized orienting cues can be identified, and |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| Parenter | ·Verbal communication ·Functional communication ·Adaptive behavior skills | Positive growth was evident not only in language and communication, the main focus of intervention, but also on measures of cognitive, adaptive behavior, problem behavior, and autism symptoms. |
| Parentism | Adaptive behavior skills | Following parent education in PRT, all children showed significant improvement in adaptive behavior scale scores regardless of gender, age, and race/ethnicity of the children/families |
| Should be did | ·Verbalizations ·Parent report of words produced | The results showed that this antecedent stimulus control procedure produced improvements in responding to the stimuli |
| Sherer, M.R. & Schreibman, L.(2005) Individual behavioral profiles and predictors of treatment effectiveness for children with autism Journal of Consulting and Clinical Psychology, 73(3), 525-538. | Clinical replication | PRT administered groups with two distinct profiles (predicted responders vs. non-responder) |
| EMPIRICALLY VALIDATED OUTCOMES RELATED TO A. LANGUAGE |  |  |  |
| Carter, Cynthia, M.(2001). Using choice with game play to increase language skills and interactive behaviors in children with autism J Posit Behav Interv, 3, 131-151. | Reversal (ABAB) design | Providing choice during naturalistic language intervention in a game-playing context |
| Koegel, R.L., Camarata, S., Koegel, L.K., Ben-Tall, A., & Smith, A.E.(1998). Increasing speech intelligibility in children with autism J Autism Dev Disord, 28, 241-251. | Within subject design-ABA with counterbalancing to control for order effects | Traditional Disc Trial vs. PRT (Analogue Treatment vs. PRT) for teaching target sounds |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| Used to rears | Language (echolalia, cued speech, spontaneous speech Play (functional, symbolic, and varied play measures) Social measures (interaction, social initiations) | Children in the responder profile exhibited increases in language, play, and social behavior following PRT intervention |
| PRT DELIVERY |  |  |  |
|  |  |  |
| Cic | Disruptive behavior Social play/pragmatic behaviors Language development | Higher levels of disruptive behaviors in the No Choice conditions without exception than in the Choice conditions. Only during a No Choice phase was it necessary to discontinue the condition due to repeated requests to leave the session and task across four continuous sessions; did not occur during the Choice condition sessions. |
| Prete called | Correct production of target sounds in language samples Intelligibility ratings | Significant gains in correct production of target sounds and speech intelligibility during the PRT intervention |
| B. JOINT ATTENTION |  |  |  |
| Vismara, L.A., & Lyons, G.L.(2007). Using perseverative interests to elicit joint attention behaviors in young children with autism: Theoretical and clinical implications to understanding motivation. J Posit Behav Interv, 9, 214-228. | Within subject design with counterbalancing and alternating treatments in final phase | PRT with child's perseverative interests vs. non-perseverative interests | Number of joint attention initiations Contingencies to joint attention initiations Child affect ratings | Using the child's perseverative interests in a PRT model increased joint attention initiations |
| C.ACADEMIC PERFORMANCE |  |  |  |
| Koegel, L.K., Koegel, R.L., & Smith, A.(1997). Variables related to differences in standardized test outcomes for children with autism. J Autism Dev Disord, 27(3), 233-243. | Repeated reversals experimental design with condition order varied within and across children | Assessed when manipulation variables related to motivation and attention influence performance standardized |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
| Child's adaptive | Test performance/scores | Results showed consistent differences between the two conditions, suggesting that improving motivation and attention in children with autism may considerably influence test performance and interpretation. |
| D. REDUCTION IN DISRUPTIVE BEHAVIORS |  |  |  |
| Koegel, L.K., Koegel, R.L., & Steibel, D.(1998). Reducing aggression in children with autism toward infant or toddler siblings. Journal of The Association for Persons with Severe Handicaps, 23, 111-118 | Multiple baseline across 3 families | Parent-implementer intervention in home setting |
| Koegel, R.L., Koegel, L.K., & Surratt.(1992). Language intervention and disruptive behavior in preschool children with autism. J Autism Dev Disord, Vol. 22(2), 141-153. | Repeated reversals design | Traditional D Trial vs. PRT Analogue Treatment vs. NLP*) |  |  |
|  | Dependent Variables | Treatment Outcome |
| --- | --- | --- |
|  |  |  |
| mented plans in | Specific number of occurrences of aggressive behavior | Large reductions in the children's aggression toward their infant or toddler sibling, increases in parent and child happiness level, increases in strangers' level of comfort with respect to interacting with the family |
| screte (called) | Expressive language Disruptive behavior | The PRT condition consistently produced lower levels of disruptive behavior both within and across children, as compared to the Analogue treatment. Children also produced more correct language target behaviors in the PRT condition.