Pivotal Response Treatment Package: Combined Parent Training with Clinician-Delivered in-Home Treatment

Background:  Pivotal Response Treatment (PRT) is an evidence-based naturalistic behavioral intervention which is traditionally delivered via a parent training model. While there is some evidence in support of brief treatment models, some children and parents may need longer duration of treatment or greater intensity in order to make clinically meaningful progress. For instance, while parents are still learning to implement the treatment themselves, clinician-delivered intervention may help boost child language development.

Objectives:  This presentation will review initial outcomes from a randomized controlled trial of a PRT package treatment (PRT-P) which combines parent training with clinician-delivered in-home treatment.

Methods:  This study is a randomized controlled trial of PRT-P compared to a Delayed Treatment Group (DTG). The active treatment involves weekly parent training and 10 hours per week of in-home therapist-delivered treatment for 3 months, followed by a less-intensive phase with 5 hours per week of in-home treatment and monthly parent training sessions. Participants include children with ASD and significant language delay, ages 2-5 years. Dependent measures include Clinical Global Impression Improvement (CGI-I) ratings by trained raters blinded to treatment condition, as well as standardized parent questionnaires and structured behavioral observations.

Results: To date, 18 subjects have been randomized. The trial is ongoing and preliminary data are currently available from 14 participants. CGI-I ratings focused specifically on communication indicate 3 children rated as very much improved (0 in DTG), 4 children rated as much improved (2 in DTG), 1 child rated as minimally improved (3 in DTG) and no children rated “no change” (1 in DTG).  Preliminary examination of changes with PRT-P revealed that children in the active group are acquiring language skills as evidenced by increased performance on the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) Expressive Language raw scores (Baseline: 28.55 ± 9.63 ; Post-treatment: 37.13 ± 14.93) and an  average gain of over 100 words between baseline (M=70.67 ± 23.46) and post treatment (M=187.67 ± 46.97) on the MacArthur-Bates Communicative Development Inventories.

Conclusions: These preliminary data suggest that the PRT package approach shows promise for addressing communication deficits associated with ASD. Potential benefits and challenges of a combined parent training and clinician-delivered intervention approach will be discussed and areas in need of future research will be explored.