The Impact of Pivotal Response Treatment on the Spoken Language Phase of Preschool Children

Background: Pivotal Response Treatment (PRT) is a widely used intervention for children with Autism Spectrum Disorders (ASD). Children receiving PRT experience gains on standardized measures of expressive communication that measure vocabulary and grammar skills (e.g., the Preschool Language Scale; Smith et al., 2010). Guidelines recommend exploring the impact of treatments on a wider range of expressive communication skills (e.g., phonology, pragmatics) using approaches that incorporate natural language samples (Tager-Flusberg et al., 2009).  

Objectives: To examine the impact of PRT on children’s spoken language phase (preverbal communication, first words, word combinations, sentences, or complex language) using a comprehensive approach recommended by an expert panel that combines data from standardized assessment and natural language samples. 

Methods: Participants were 16 preschool children who received a year of intensive community-based PRT (15 hours/ week for 6 months; 10 hours/week for 3 months; 5 hours/week for 3 months). Using structured guidelines based on those outlined by Tager-Flusberg et al. (2009), each child’s spoken language phase was determined pre- and post- intervention. Categorization incorporated information from video-recorded natural language samples (collected during a play-based task), and standardized measures (Preschool Language Scale, 2^nd ed. and Vineland Adaptive Behavior Scales, 2^nded.). 

Results: Many children (44%) advanced one language phase (e.g., from first words to word combinations), and 11% advanced two phases (from preverbal to word combinations). Children who were preverbal at the start of intervention were less likely to move to a higher phase (11% attained first words; 22% advanced to word combinations). Additional analyses explored gains in specific language domains (e.g., vocabulary, pragmatics). 

Conclusions: Most children receiving PRT in a community program experienced gains on a global measure of spoken language phase. Outcomes varied across language domains and initial skill levels. Determining gains in language phase may be useful across a range of clinical and research contexts.