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A Pilot Randomized Clinical Trial of an Enhanced Pivotal Response Treatment Approach for Young Children with Autism: The PRISM Model

  • Ty W. VernonEmail author
  • Anahita N. Holden
  • Amy C. Barrett
  • Jessica Bradshaw
  • Jordan A. Ko
  • Elizabeth S. McGarry
  • Erin J. Horowitz
  • Daina M. Tagavi
  • Tamsin C. German
Original Paper

Abstract

The symptoms of autism spectrum disorder are conceptualized to alter the quality of parent–children interactions, exposure to social learning exchanges, and ultimately the course of child development. There is evidence that modifying the procedures of Pivotal Response Treatment (PRT) to explicitly target social motivation enhances child engagement and parent–child synchrony in moment-by-moment exchanges. However, it is unclear if these within session improvements ultimately yield favorable developmental outcomes over time. The current investigation presents feasibility, utility, and preliminary efficacy data of a pilot randomized clinical trial (RCT) of a Pivotal Response Intervention for Social Motivation (PRISM) model. Data on participant factors, treatment protocol acceptability, and outcome variance and effect size are highly favorable and support the pursuit of a future, large scale RCT.

Keywords

Pivotal response treatment Pivotal response intervention for social motivation (PRISM) Early intervention Pilot study Randomized clinical trial (RCT) 

Notes

Acknowledgements

The authors would like to acknowledge all of the families who participated in this research, along with all of the undergraduate research assistants and clinicians that made this project possible.

Author Contributions

TWV served as PI for this RCT, trained and supervised the grant coordinators, and participated in the conceptualization, implementation, and data analysis of the clinical trial. ANH and ACB served as grant project coordinators and assisted with data analysis and the recruitment, training, and supervision of all research assistants. JB, EJH, and Co-PI TCG assisted with study conceptualization, design, and data analysis. ANH, ACB, JAK, and ESM were responsible for clinician recruitment, training, and supervision and also conducted parent training sessions. DMT assisted with major aspects of manuscript drafting and revision. All authors assisted with article preparation.

Funding

This study was funded by Autism Speaks.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Philadelphia: American Psychiatric Association Publications.Google Scholar
  2. 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. Research & Practice for Persons with Severe Disabilities, 32(2), 142–153.Google Scholar
  3. Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in Cognitive Sciences, 16(4), 231–239.Google Scholar
  4. Dunn, L. M., & Dunn, L. M. (2007). Peabody picture vocabulary test (4th ed.). New York: Pearson Clinical.Google Scholar
  5. Esler, A. N., Bal, V. H., Guthrie, W., Wetherby, A., Weismer, S. E., & Lord, C. (2015). The autism diagnostic observation schedule, toddler module: Standardized severity scores. Journal of Autism and Developmental Disorders, 45(9), 2704–2720.Google Scholar
  6. Freeman, S., & Kasari, C. (2013). Parent–child interactions in autism: characteristics of play. Autism, 17(2), 147–161.Google Scholar
  7. French, L., & Kennedy, E. M. (2018). Annual research review: Early intervention for infants and young children with, or at-risk of, autism spectrum disorder: A systematic review. Journal of Child Psychology and Psychiatry, 59(4), 444–456.Google Scholar
  8. Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.Google Scholar
  9. Jones, W., & Klin, A. (2009). Heterogeneity and homogeneity across the autism spectrum: The role of development. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 471–473.Google Scholar
  10. Julious, S. A. (2005). Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics, 4(4), 287–291.Google Scholar
  11. Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social, & academic development. Baltimore: Paul H Brookes Publishing.Google Scholar
  12. Koegel, R. L., Koegel, L. K., & McNerney, E. K. (2001). Pivotal areas in intervention for autism. Journal of Clinical Child Psychology, 30(1), 19–32.Google Scholar
  13. Koegel, R. L., Schreibman, L., Good, A., Cerniglia, L., Murphy, C., & Koegel, L. K. (1989). How to teach pivotal behaviors to children with autism: A training manual. Santa Barbara, CA: University of California.Google Scholar
  14. Koegel, R. L., Vernon, T. W., & Koegel, L. K. (2009). Improving social initiations in young children with autism using reinforcers with embedded social interactions. Journal of Autism and Developmental Disorders, 39(9), 1240–1251.Google Scholar
  15. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., … Rutter, M. (2000). The autism diagnostic observation schedule—generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.Google Scholar
  16. Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3.Google Scholar
  17. Luyster, R., Gotham, K., Guthrie, W., Coffing, M., Petrak, R., Pierce, K., … Richler, J. (2009). The autism diagnostic observation schedule—Toddler module: A new module of a standardized diagnostic measure for autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(9), 1305–1320.Google Scholar
  18. Moore, C. G., Carter, R. E., Nietert, P. J., & Stewart, P. W. (2011). Recommendations for planning pilot studies in clinical and translational research. Clinical and Translational Science, 4(5), 332–337.Google Scholar
  19. Mullen, E. M. (1995). Mullen scales of early learning. New York: Pearson Clinical.Google Scholar
  20. Muratori, F., & Maestro, S. (2007). Autism as a downstream effect of primary difficulties in intersubjectivity interacting with abnormal development of brain connectivity. International Journal for Dialogical Science, 2(1), 93–118.Google Scholar
  21. Rosenthal, T. L., & Zimmerman, B. J. (2014). Social learning and cognition. Cambridge: Academic Press.Google Scholar
  22. Sameroff, A. (2009). The transactional model. Washington, DC: American Psychological Association.Google Scholar
  23. Sameroff, A. J., & Fiese, B. H. (2000). Transactional regulation: The developmental ecology of early intervention. Handbook of Early Childhood Intervention, 2, 135–159.Google Scholar
  24. Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., … McNerney, E. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428.Google Scholar
  25. 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.Google Scholar
  26. Sparrow, S. S., Cicchetti, D. V., Balla, D. A., & Doll, E. A. (2005). Vineland adaptive behavior scales. New York: Pearson Clinical.Google Scholar
  27. Thabane, L., Ma, J., Chu, R., Cheng, J., Ismaila, A., Rios, L. P., … Goldsmith, C. H. (2010). A tutorial on pilot studies: The what, why and how. BMC Medical Research Methodology, 10(1), 1.Google Scholar
  28. van Belle, G. (2002) Statistical Rules of Thumb. Chichester: Wiley.Google Scholar
  29. Van Teijlingen, E. R., & Hundley, V. (2001). The importance of pilot studies. Social Research Update 35.Google Scholar
  30. Vernon, T. W. (2014). Fostering a social child with autism: A moment-by-moment sequential analysis of an early social engagement intervention. Journal of Autism and Developmental Disorders, 44(12), 3072–3082.Google Scholar
  31. Vernon, T. W., Koegel, R. L., Dauterman, H., & Stolen, K. (2012). An early social engagement intervention for young children with autism and their parents. Journal of Autism and Developmental Disorders, 42(12), 2702–2717.Google Scholar
  32. Verschuur, R., Didden, R., Lang, R., Sigafoos, J., & Huskens, B. (2014). Pivotal response treatment for children with autism spectrum disorders: A systematic review. Review Journal of Autism and Developmental Disorders, 1(1), 34–61.Google Scholar
  33. Williams, K. T. (2007). Expressive vocabulary test, second edition (EVT™ 2). Journal of the American Academy of Child & Adolescent Psychiatry, 42, 864–872.Google Scholar
  34. Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (2007). Preschool Language Scale, 5 Edition. San Antonio: Psychological Corporation.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ty W. Vernon
    • 1
    Email author
  • Anahita N. Holden
    • 1
  • Amy C. Barrett
    • 1
  • Jessica Bradshaw
    • 2
  • Jordan A. Ko
    • 1
  • Elizabeth S. McGarry
    • 1
  • Erin J. Horowitz
    • 1
  • Daina M. Tagavi
    • 1
  • Tamsin C. German
    • 1
  1. 1.University of California Santa BarbaraSanta BarbaraUSA
  2. 2.University of South CarolinaColumbiaUSA

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