Pivotal response treatment (PRT) is an empirically validated behavioral treatment that has widespread positive effects on communication, behavior, and social skills in young children with autism spectrum disorder (ASD). For the first time, functional magnetic resonance imaging was used to identify the neural correlates of successful response to PRT in two young children with ASD. Baseline measures of social communication, adaptive behavior, eye tracking and neural response to social stimuli were taken prior to treatment and after 4 months of PRT. Both children showed striking gains on behavioral measures and also showed increased activation to social stimuli in brain regions utilized by typically developing children. These results suggest that neural systems supporting social perception are malleable through implementation of PRT.
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Bertenthal, B., & Pinto, J. (1994). Global processing of biological motions. Psychological Science, 5, 221–224.
Blake, R., & Shiffrar, M. (2007). Perception of human motion. Annual Review of Psychology, 58, 47–73.
Castelli, F., Happe, F., Frith, U., & Frith, C. (2000). Movement and mind: A functional imaging study of perception and interpretation of complex intentional movement patterns. NeuroImage, 12, 314–325.
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: Treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9, 788–796.
Elliott, C. D. (2006). Differential ability scales—Second Edition (DAS-II). San Antonio, TX: Psychological Corporation.
Elsabbagh, M., Mercure, E., Hudry, K., Chandler, S., Pasco, G., Charman, T., et al. (2012). Infant neural sensitivity to dynamic eye gaze is associated with later emerging autism. Current Biology, 22(4), 338–342.
Grossman, E. D., & Blake, R. (2002). Brain areas active during perception of biological motion. Neuron, 35(6), 1167–1175.
Kaiser, M. D., Hudac, C. M., Shultz, S., Lee, S. M., Cheung, C., Berken, A. M., et al. (2010). Neural signatures of autism. Proceedings of the National Academy of Sciences, 107(49), 21223.
Kaiser, M. D., & Shiffrar, M. (2009). The visual perception of motion by observers with autism spectrum disorder: A review and synthesis. Psychonomic Bulletin & Review, 16(5), 761–777.
Klin, A., Lin, D. J., Gorrindo, P., Ramsay, G., & Jones, W. (2009). Two-year-olds with autism orient to non-social contingencies rather than biological motion. Nature, 459, 257–261.
Koegel, R. L., Camarata, S., Koegel, L. K., Ben-Tall, A., & Smith, A. E. (1998). Increasing speech intelligibility in children with autism. Journal of Autism and Developmental Disorders, 28(3), 241–251.
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(2), 134–145.
Koegel, R. L., & Frea, W. D. (1993). Treatment of social behavior in autism through the modification of pivotal social skills. Journal of Applied Behavior Analysis, 26(3), 369–377.
Koegel, R. L., & Koegel, L. (2006). Pivotal response treatments for autism: Communication, social, and academic development. Baltimore, MD: Brookes.
Koegel, R. L., & Koegel, L. (2012). The PRT pocket guide. Baltimore, MD: Brookes.
Koegel, R. L., O’Dell, M. C., & Koegel, L. K. (1987). A natural language paradigm for nonverbal autistic children. Journal of Autism and Developmental Disorders, 17(2), 187–200.
Koegel, R. L., Schreibman, L., Good, A., Cemiglia, 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, Santa Barbara.
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(4), 391–400.
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2002). Autism diagnostic observation schedule—WPS (ADOS-WPS). Los Angeles, CA: Western Psychological Services.
Neri, P., Morrone, M. C., & Burr, D. C. (1998). Seeing biological motion. Nature, 395(6705), 894–895.
Oram, M. W., & Perrett, D. I. (1996). Integration of form and motion in the anterior superior temporal polysensory area (STPa) of the macaque monkey. Journal of neurophysiology, 76(1), 109–129.
Pelphrey, K. A., Morris, J. P., McCarthy, G., & LaBar, K. S. (2007). Perception of dynamic changes in facial affect and identity in autism. Social Cognitive and Affective Neuroscience, 2(2), 140–149.
Perlman, S. B., Hudac, C. M., Pegors, T., Minshew, N. J., & Pelphrey, K. A. (2011). Experimental manipulation of face-evoked activity in the fusiform gyrus of individuals with autism. Social Neuroscience, 6(1), 22–30.
Pierce, K., Muller, R.-A., Ambrose, J., Allen, G., & Courchesne, E. (2001). Face processing occurs outside the fusiform ‘face area’ in autism: evidence from functional MRI. Brain, 124(10), 2059–2073.
Pinkham, A. E., Hopfinger, J. B., Pelphrey, K. A., Piven, J., & Penn, D. L. (2008). Neural bases for impaired social cognition in schizophrenia and autism spectrum disorders. Schizophrenia Research, 99(1–3), 164–175.
Rutter, M., Le Couter, A., & Lord, C. (2003). ADI-R: Autism diagnostic interview-revised. Los Angeles, CA: Western Psychological Services.
Schultz, R. T., Gauthier, I., Klin, A., Fulbright, R. K., Anderson, A. W., Volkmar, F., et al. (2000). Abnormal ventral temporal cortical activity during face discrimination among individuals with autism and Asperger syndrome. Archives of General Psychiatry, 57(4), 331–340.
Schultz, R. T., Grelotti, D. J., Klin, A., Kleinman, J., Van der Gaag, C., Marois, R., et al. (2003). The role of the fusiform face area in social cognition: Implications for the pathobiology of autism. Philosophical Transactions of the Royal Society B- Biological Science, 358, 415–427.
Semel, E., Wiig, E., & Secord, W. A. (2003). Clinical evaluation of language fundamentals 4 (CELF-4). San Antonio, TX: The Psychological Corporation.
Siegle, G. J., Carter, S. C., & Thase, M. E. (2006). Use of fMRI to predict recovery from unipolar depression with cognitive behavior therapy. The American Journal of Psychiatry, 163(4), 735–738.
Simion, F., Regolin, L., & Bulf, H. (2008). A predisposition for biological motion in the newborn baby. Proceedings of the National Academy of Sciences, 105(2), 809–813.
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales: Second edition (Vineland II), Survey interview form/caregiver rating form. Livonia, MN: Pearson Assessments.
Stahmer, A. C. (1995). Teaching symbolic play skills to children with autism using pivotal response training. Journal of Autism and Developmental Disorders, 25(2), 123–141.
Talairach, J., & Tournoux, P. (1988). Co-planar stereotaxic atlas of the human brain: 3-dimensional proportional system: An approach to cerebral imaging. New York: Thieme Medical.
Vander Wyk, B. C., Hudac, C. M., Carter, E. J., Sobel, D. M., & Pelphrey, K. A. (2009). Action understanding in the superior temporal sulcus region. Psychological Science, 20(6), 771–777.
Wiig, E. H., Secord, W. A., & Semel, E. (2004). CELF Preschool 2: Clinical evaluation of language fundamentals, Preschool (2nd ed.). San Antonio, TX, USA: Harcourt Assessment.
Funding for this study came from the Harris Professorship at the Yale Child Study Center given to Kevin Archer Pelphrey, Allied World and NIMH grant K23MH086785.
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Voos, A.C., Pelphrey, K.A., Tirrell, J. et al. Neural Mechanisms of Improvements in Social Motivation After Pivotal Response Treatment: Two Case Studies. J Autism Dev Disord 43, 1–10 (2013). https://doi.org/10.1007/s10803-012-1683-9
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