Concomitant Gains in Joint Attention Via Naturalistic Communication Intervention

Background: The Picture Exchange Communication System (PECS) and Pivotal Response Training (PRT) are empirically-based programs for teaching communication skills to children with autism. As these naturalistic interventions teach communication skills, research has primarily addressed gains in these areas. The treatment literature emphasizes the importance of targeting core autism deficits (e.g., joint attention). Little research has evaluated concomitant gains in these behaviors as a result of naturalistic verbal and augmentative communication interventions.
Objectives: To assess collateral gains in joint attention skills and other social communicative behaviors not directly targeted by the interventions.
Methods: Thirty-five children with autism (age 2-4), with 10 or fewer functional words, were randomly assigned to PRT (n=17) or PECS (n=18). 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 Scale (ESCS) at pre- and post-treatment.
Results: Participants showed improvements in behaviors targeted through PECS and PRT, such as verbal language to request. Participants also demonstrated concomitant gains in rate of high-level joint attention initiations, and frequency of responding to the assessor’s social invitations, bids for joint attention, and receptive commands (i.e. “Give it to me”).
Conclusions: While as expected, children in both treatment conditions made significant gains in use of verbal language, results also indicate that when naturalistic communication interventions are used, children may demonstrate gains in areas not specifically targeted. These data are encouraging as they suggest core deficits in autism may be improved as a function of PECS and PRT.