Controlling for the Influence of Education Level on Fidelity of Implementation of Pivotal Response Treatment for Children with Autism

Background: Pivotal Response Training (PRT) combines the research on task interspersal, direct reinforcement, and role of choice in a treatment for autism spectrum disorders. PRT, through its training of parents of children with ASD, has repeatedly demonstrated widespread effects on many behaviors associated with language and social interaction (Koegel & Koegel, 2006; Koegel, Bimbela, & Schreibman, 2004). Little is known about parental characteristics associated with successful outcomes, despite literature on parent training that indicates the influence of variables other than child characteristics, such as income and parent level of education, on training and the resulting child outcomes (Reyno & McGrath, 2005). Objectives: The primary aim of this research was to control for the influence of education level on caregiver implementation of PRT for 3 caregiver-child dyads. The specific research question was: Does limited caregiver education affect level of fidelity of implementation?. Secondary research aims included: 1) Does the caregivers' level of fidelity impact the child's social-communication and play behaviors?, and 2) Are there potential wider affects on adaptive behaviors that can be captured with the Vineland Adaptive Behavior Scale (VABS)? Methods: A concurrent multiple baseline design across participants for baseline, training, and follow-up phases was utilized. All three children (ages 3-7) had a medical diagnosis of autism spectrum disorder (ASD) or pervasive developmental disorder (PDD) confirmed on the ADI-R or ADOS. In the first dyad, the caregiver was the child's grandmother. She provided primary care for the child, and had a high school diploma with no additional college education. In the second dyad, the caregiver was the child's biological father. He had a high school diploma with no additional college education. In the third dyad, the caregiver was hired by the child's parents as a home care provider. She had a high school diploma and two years of college education. Results: Two of the three caregiver-child dyads benefited from the intervention. The caregivers were trained to implement PRT with fidelity, and maintained fidelity of implementation in follow-up sessions. The children in these dyads increased responsiveness and appropriate play engagement as determined through direct observation procedures. One of the three dyads, however, received limited benefit from the intervention. The caregiver was unable to meet the level of fidelity required for mastery of implementation during the training sessions, and instead demonstrated inconsistent implementation. Likewise, the child's responsiveness was inconsistent, however the child's amount of time engaged in appropriate play increased during training. During the intervention for this dyad, a family emergency resulted in a three-week break from training, during which time the child was placed back in the care of her biological mother. No significant difference was found between the pre and post intervention scores on the Vineland Adaptive Behavior Scales for any of the participants. Conclusions: Level of education may not be as critical a variable in training success for PRT, as other variables, such as consistency of training sessions, or other family dynamics.