International Meeting for Autism Research: Training in Evidence-Based Pivotal Response Treatments: Exploring Different Models of Parent-Training and Direct Implementation

Training in Evidence-Based Pivotal Response Treatments: Exploring Different Models of Parent-Training and Direct Implementation

Friday, May 21, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
2:00 PM
S. A. Northington , Chicago Children's Clinic, Chicago, IL
R. E. Daniels , Chicago Children's Clinic, Chicago, IL
Background: There is substantial evidence that early, intensive behavioral interventions (EIBI) for children with autism are effective.  Historically, providing effective treatment to children with autism required substantial time and resources. Traditional, direct service models of treatment require at least 25 hours a week of treatment, 12 months a year, for several years to produce published outcomes. Pivotal Response Treatment (PRT), with its emphasis on family and school involvement, targeting “Pivotal” areas for treatment in natural environments, has demonstrated outcomes that are unmatched in the autism literature (Koegel, Koegel, Shoshan & McNerney, 1999; Koegel, 2000; Koegel, Koegel & Brookman, 2003).  Because parents spend more time with their children during the days, evenings, and weekends, they can provide more consistent and time intensive intervention for their children (R.L. Koegel, Koegel, Frea & Smith, 1995).  Thus, it seems natural to incorporate parents into the treatment team for their child.  Research shows that parents of children with autism can be trained as effective implementers of programs for their children (R.L. Koegel et al., 1996; R.L. Keogel et al., 1991; Laski et al., 1988; McClannahan et al., 1982; Sanders & Glynn, 1981; Stiebel, 1999; Vaughn, Clarke & Dunlap, 1997).  By providing parents with training in PRT implementation, children demonstrated improved functional communication skills, mean length of utterance, reciprocal play skills, and a decrease in disruptive behaviors.
Objectives: To determine the efficacy of parent training in PRT in bringing about improvement in their child’s functioning. Three families were followed, utilizing the models described below; one model per family.
Methods: Three different models of parent-training were provided: 1) a three-day intensive (4-hour per day; 12 hours in total) parent training, with minimal direct implementation with the child; 2) a 25-hour (approximately 5 hours per week) parent-training model over a 5-week period, with minimal direct implementation with the child; or 3) a 25-hour parent-training model over a 5-week period, followed by direct implementation with the child for approximately 10 hours per week, and parent training sessions weekly, as needed.  Three different families were trained in PRT.  Data were collected for the following treatment goals: 1) increase functional verbal utterances (decrease scripting) of the child, 2) increase mean length of verbal utterances of the child, 3) increase the number of spontaneous verbal utterances and initiations of the child, and 4) parents demonstrate fidelity of implementation of the PRT procedures 80% of the time within a 10-minute video sample.
Results: Regardless of parent training method employed, all parents eventually demonstrated fidelity of implementation.  All children demonstrated marked improvements in their goal areas.
Conclusions: Different models of parent-training were found to be effective at improving child outcomes with substantially less than 25 hours a week of direct intervention from clinicians.  Future research is needed to determine child and parent factors that influence the amount of parent training and direct intervention with PRT needed to achieve treatment goals. Training parents in PRT is an efficient, economical, and effective method to bring about significant improvement in the functioning of children with autism.
See more of: Treatment
See more of: Mandell
See more of: Clinical & Genetic Studies