A Randomized Controlled Trial of the Effectiveness of Pivotal Response Treatment with and without Use of a NAO Robot in Young Children with ASD
Objectives: The present study aims to examine the effectiveness of using a humanoid (NAO) robot within parent-mediated PRT for diminishing ASD-related symptoms and improving general clinical functioning in young children with ASD compared with PRT (without robot) and treatment-as-usual (TAU).
Methods: A randomized controlled trial (RCT) design was used to compare 1) parent-mediated PRT with using the NAO robot (PRT+robot), 2) parent-mediated PRT, and 3) TAU in 74 young children (3-8 years) with ASD. PRT consisted of 20 weekly therapy sessions, including 14 parent-child sessions and 6 parent sessions. In both PRT conditions, parents were trained in use of the PRT techniques and in the PRT+robot condition, the robot was added in all parent-child sessions to train the child with programmed scenarios incorporating PRT techniques. At baseline, week 10, 20 and 3-month follow-up, the child's ASD-related symptoms were assessed with the Social Responsiveness Scale (SRS, Roeyers, Thys, Druart, De Schryver, & Schittekatte, 2011) completed by parents and teachers. Clinically significant improvement was examined using the Clinical Global Impression-Improvement Scale (CGI-I, Guy, 1976) completed by a blinded child psychiatrist.
Results: Repeated measures analysis using the GLM approach indicated a significant main effect of time (F(3,147) = 14.53, p < .001) and a time x group interaction effect (F(6,147) = 2.78, p = .018) on the SRS completed by parents, reflecting steeper decrease of ASD-related symptoms over time in the PRT+robot condition (see Figure 1). Furthermore, the percentage clinical responders (much and very much improved on the CGI-I) was significantly higher in the PRT+robot condition (66.7%) compared with both the PRT (36.4%) and TAU condition (36.4%) (χ²(1) = 4.22, p = .040) at week 20, but not at follow-up (PRT+robot (63.2%) vs PRT (50.0%): χ²(1) = 0.67, p = .408; PRT+robot (63.2%) vs TAU (40.0%): χ²(1) = 2.09, p = .148).
Conclusions: Results of this study provide a first indication that the use of robotics in PRT may be an effective treatment component in diminishing ASD-related symptoms and improving general clinical functioning in young children with ASD. Implications for clinical use of robotics in PRT and future research will be discussed.