Improvement in Reciprocal Conversation Skills and Maladaptive Behaviors in Young Adults with ASD

Background:  Many young adults with ASD are under- or unemployed and struggle with social relationships. Despite these difficulties and the significant challenges faced during the transition into adulthood, there are few evidence-based treatment options for young adults with ASD. Pivotal Response Treatment (PRT) is a naturalistic behavioral treatment that focuses on increasing skills in pivotal areas. PRT has been adapted for use in adolescents with a focus on self-monitoring (Doggett et al., 2013), but no study, to date, has used this model with young adults.

Objectives:  Using a multiple baseline design, we sought to determine if a four-month treatment based on principles of PRT could improve reciprocal conversation skills and decrease maladaptive behaviors (e.g. skin picking, odd vocalizations) in young adults with ASD.

Methods:  Three young adults between the ages of 18 and 21 years (Mean IQ = 106.67, S.D. = 11.93) participated in four months of treatment targeting reciprocal conversation skills and maladaptive behaviors. The sessions were 90 minutes, twice a week. The treatment followed principles of PRT, adapted for use with young adults (Doggett et al., 2013). Using a multiple baseline design, participants were randomized into a baseline condition (between 3 and 7 probes spanning 6 to 14 weeks). Specific targets included number of conversational turns and maladaptive behaviors. During the treatment phase, data on targeted behaviors was collected every two weeks. Additionally, to provide a measure of day-to-day functioning following treatment, the parents of the participants completed a Vineland Adaptive Behavior Scale-Second Edition (Vineland-II) before and after treatment. 

Results:  Following the start of intervention, participants rapidly increased their reciprocal conversation skills and the frequency of their maladaptive behaviors decreased. These improvements were maintained over time. Furthermore, the participants made notable gains in adaptive communication and social skills based on parent report. Specifically, participants made the equivalent of at least one year of gains in expressive and receptive communication skills and two years of gains in interpersonal relationship skills over the course of the 4-month intervention. 

Conclusions:  Young adults with ASD are a vastly underserved group with few options for evidence-based treatment and often limited access to care. Young adults can, though, dramatically benefit from behavioral treatment targeting reciprocal conversation skills and maladaptive behaviors following a short-term behavioral treatment based on principles of PRT adapted for young adults. Improvements are evidenced in the context of a clinical setting but also within their daily lives.