Saturday, December 6, 2014

Group Pivotal Response Training for Parents of Children with Autism

More children than ever before are being diagnosed with autism spectrum disorder (ASD). The dramatic increase in the prevalence of children with ASD has created an urgent need for effective and efficient service delivery models. Parents and caregivers everywhere are eager for credible, research-based information on the most effective treatments for ASD. 

Utilizing a group training format, researchers have found that parents can learn to successfully incorporate an established treatment for ASD into everyday interactions with their children. According to findings published in the Journal of Child Psychology and Psychiatry, parents learned to successfully apply an evidence-based therapy method called Pivotal Response Treatment (PRT), also referred to as Pivotal Response Training, and observed meaningful improvement in their children.

PRT is one of the best studied and validated behavioral treatments for autism. It is a naturalistic behavioral intervention derived from the principles of Applied Behavior Analysis (ABA). PRT builds on learner initiative and interests, and is particularly effective for developing communication, language, play, and social behaviors. PRT was developed to create a more efficient and effective intervention by enhancing four pivotal learning variables: motivation, responding to multiple cues, self-management, and self-initiations. According to theory, these skills are pivotal because they are the foundational skills upon which learners with ASD can make widespread and generalized improvements in many other areas.

The objective of the study was to evaluate a PRT parent training group (PRTG) for targeting language deficits in young children with ASD. For the study, researchers randomly assigned parents of 53 children with autism to participate in 12 weeks of classes on PRT or a psychoeducation group (PEG). All of the children were between the ages of 2 and 6 and had language delays. The PRTG taught parents behavioral techniques to facilitate language development. The PEG taught general information about ASD. All of the children were assessed at the outset of the study, at six weeks and at 12 weeks to determine their language abilities. Parents were also videotaped at six and 12 weeks to measure how well they were applying the treatment.

The results indicated that parents were able to learn PRT in a group format, as the majority of parents in the PRTG (84%) were using it correctly by the end of the study. Children also demonstrated improvement in adaptive communication skills. Children whose parents learned the technique reported greater gains in both the number of words used and how they used them as compared to children in the psychoeducation (control) group.

This study is considered the first randomized controlled test of group-delivered PRT and one of the largest experimental investigations of the PRT model to date. The findings suggest that specific instruction in PRT results in greater skill acquisition for both parents and children, especially in functional and adaptive communication skills. Even with the improvements, researchers said that parent-implemented approaches are intended to augment, not replace, autism therapies from professionals. Likewise, further research in PRT is warranted to replicate the observed results and address other core ASD symptoms. It should also be noted that research findings are not the only factor involved when selecting an intervention. Professional judgment and the values and preferences of parents, caregivers, and the individual are also important.

Hardan, A. Y., Gengoux, G. W., Berquist, K. L., Libove, R. A., Ardel, C. M., Phillips, J., Frazier, T. W. and Minjarez, M. B. (2014), A randomized controlled trial of Pivotal Response Treatment Group for parents of children with autism. Journal of Child Psychology and Psychiatry. doi: 10.1111/jcpp.12354

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.





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