Social Gains Are Maintained at 4-Month Follow-up Evaluation of Pivotal Response Treatment for Children with Autism

Background: Pivotal response treatment (PRT) is a naturalistic behavioral approach to treating autism that targets core deficits in social motivation. PRT is an evidence-based treatment which has been shown to foster improvements in social interaction, language skills, and adaptive behavior in children with autism (e.g., L. K. Koegel, Koegel, Harrower, & Carter, 1999; R. L. Koegel, Koegel, & McNerney, 2001). However, there is limited research examining whether these treatment effects are maintained over time, after treatment is concluded.

Objectives: In a sample of children with autism spectrum disorder (ASD) who had participated in a 16-week PRT treatment program, we examined the maintenance of treatment effects 16 weeks following the completion of treatment.

Methods: Twenty children, nine girls, (mean IQ 97.32; SD 19.42; range 55-128) completed a 16-week trial of PRT with a follow-up visit 16 weeks post-treatment. This study was part of a larger randomized controlled trial of PRT, but only a subset of the children--those in the PRT condition--completed the follow-up assessment measures. The trial included 7 hours per week of individual work with the child and parent training. Primary clinical outcome was assessed at baseline, endpoint, and follow-up using the SRS-2, a parent report measure of social communication.

Results: Children gained social communication skills over the course of the trial (baseline to endpoint) and, importantly, gains were maintained through the 16-week follow-up period. Over the course of PRT, children demonstrated significant improvements on the SRS Total Score and the SRS Social Communication scale (SRS Total Score baseline mean=87.471, post-treatment mean=72.235, p<.01; SRS Social Communication baseline mean=32.294, post-treatment mean=25.647, p<.01). Furthermore, skills at follow-up remained significantly improved from skills at baseline (SRS Total Score baseline mean=87.471, follow-up mean=76.118, p<.05; SRS Social Communication baseline mean=32.294, follow-up mean=27.588, p<.05). Gains made from endpoint to follow-up visit were not significant (p>.05). The remaining subscales of the SRS, including Social Awareness, Social Cognition, Social Motivation, and Autistic Mannerisms followed this pattern, but results were not significant (p>.05).

Conclusions: We aimed to investigate maintenance of social communication skills following a 16-week trial of PRT. Children in the trial made significant gains over the course of the treatment, and these gains were maintained at the follow-up time-point (16 weeks after the conclusion of treatment). These results suggest that PRT can have lasting effects on children’s development. It is likely that the parent-training component allowed parents to continue to implement PRT principles after participation in the active phase of treatment concluded. There were some limitations to this study; namely, the SRS is a parent report measure of social skills and the control group did not participate in the follow-up portion of the study, as treatment was not delayed this additional period of time.