Collateral Gains in Social Communication Skills

Background: Pivotal Response Training (PRT) and the Picture Exchange Communication System (PECS) are empirically-based programs for teaching communication skills to children with autism. Because PRT teaches verbal communication and PECS teaches communication via pictures, research has focused on evaluating gains in these areas. Less is known about collateral gains in early social communication skills.

Objectives: To assess change in child social and communicative behaviors.

Methods: Sixteen children with autism (age 2-4), with 10 or fewer functional words, were randomly assigned to PRT (n=8) or PECS (n=8). Children were matched on pre-treatment age, word use, and developmental level. Children received 258 hours of intervention across 23 weeks. Participants were assessed using the Early Social Communication Scales (ESCS) at pre- and post-treatment.

Results: Participants showed improvements in several behavioral domains. Participants made statistically significant gains in rate of high-level joint attention initiations, social interaction initiations, and use of language coordinated with other requesting behaviors. Participants also increased significantly in frequency of responding to the assessor's bids for joint attention and social invitations. There was no significant difference in verbal requesting between treatment conditions.

Conclusions: These findings suggest that children benefit from collateral gains in social skills and communication skills that are not directly targeted through PECS and PRT. Children in both treatment conditions made gains in use of verbal language to request, which suggests that children are equally likely to learn verbal communication skills when taught through a pictorial communication system. Differences in areas of growth in specific nonverbal social communication domains will be discussed within the context of intervention received.