31757
Randomized Clinical Trial of an Online Pivotal Response Treatment Training Program: Parent and Child Outcomes
Despite advances in early interventions for autism spectrum disorder (ASD), disparities in access to contemporary evidence-based treatments remain a serious concern (Thomas et al., 2007; Liptak et al., 2008). Numerous barriers, including delays in translating research to community practice, cost of services, extensive time commitments, and geographical distance to trained providers limit the ability for families to take advantage of the latest scientifically based autism interventions (Johnson & Hastings, 2002; McIntyre & Barton, 2010). To address this, recent studies have begun to explore parent-implemented interventions via an online format. These approaches improve access to training for families, can fit into busy family schedules, and lower the cost of treatment (Nelson, Bui, & Velasquez, 2011; Ritterband et al., 2003). The current project examined the feasibility, utility, and preliminary efficacy of a newly developed online course designed to help parents implement an evidence-based natural developmental behavioral intervention, Pivotal Response Treatment (PRT), with young children with ASD. This new program was examined using a randomized clinical trial design.
Objectives:
This study’s objective was to investigate the impact of an online course of PRT early intervention strategies on parent and child outcomes.
Methods:
Participants were 24 parent-child dyads with ASD, ages 12-56 months. PRT presentations consisting of informational slides, video examples, and brief quizzes were delivered through a Qualtrics-based digital platform each week. Topics focused on core intervention strategies to elicit communication and social engagement through playful interactions, motivational elements, natural environments, and behavior principles. Parents submitted weekly videos capturing their use of these treatment strategies, which were coded for PRT fidelity of implementation (FOI) and child social-communicative behaviors. FOI was defined as the parent properly demonstrating all PRT components with competency at least 80% of the time. Social validity measures were also obtained following course participation.
Results:
Preliminary data from families who have completed the course were analyzed. Analysis revealed that parent’s treatment fidelity improved significantly from baseline (M= 65.40%, SD= 19.02) to Week 5 (M= 90.18%, SD= 7.59); t (9)= -5.57, p= .01. By the end of the program, 90% of parents met fidelity of implementation (80% or higher fidelity score). These results were supported by social validity data from families indicating high satisfaction with the course. On a 0-5 scale (0= Strongly Disagree, 5= Strongly Agree), all families reported that the course was clearly written and well organized (M= 4.5, SD=0.53), that they would recommend the course to a friend (M=4.5, SD=0.53), and that the course provided them with a clear understanding of Pivotal Response Treatment (M= 4.2, SD=0.42). Coding and analysis of child social-communication outcome measures is currently underway, with preliminary data indicative of increases in social engagement, prompted language, and spontaneous language use.
Conclusions:
The data indicate that parent fidelity significantly improved following participation in the online course. These results suggest that an online intervention may be a feasible approach to disseminating PRT strategies. This innovative format has the potential to reduce disparities in access to evidence-based intervention.