A Comparison of Two Treatments for Teaching Language, Play, and Imitation Skills to Young Children with Autism

Background: Given the heterogeneity of treatment response in autism, research should focus on identifying the variables that influence the effectiveness of specific interventions in different learning domains and at different times in development. Two interventions for teaching language, play, and imitation to children with autism are discrete trial training (DTT) and pivotal response training (PRT). Both are grounded in applied behavior analysis, accepted as best practice, and used widely in community settings. Data suggest that although rates of acquisition may be similar for both DTT and PRT, PRT facilitates greater spontaneity, generalization, and maintenance of skills, and decreased disruptive behaviors in comparison to DTT. Importantly, most studies have been conducted with children over 3 and comparison studies have focused on teaching expressive language, although these interventions are commonly used to teach receptive language, play, imitation, and other social skills. It is unknown whether the same strengths and limitations extend to these other domains and to younger children. Finally, although many have emphasized the importance of treatment individualization, little is known about how to determine a priori what combination of methods is most likely to benefit individual children.

Objectives: To evaluate the relative effectiveness of DTT and PRT for teaching children with autism under the age of 3 years receptive and expressive language, play skills, and imitation skills, and to identify variables influencing whether specific children are more likely to benefit from DTT or PRT in these domains.

Methods: Preliminary data are presented for three children who participated in a single-subject alternating treatments design. Expressive and receptive language, play, and imitation targets were matched on developmental appropriateness and difficulty level and then randomly assigned to treatment conditions. Children received three 45-minute sessions of in-home treatment per week in each intervention for 12 weeks. Order of teaching procedures was randomly determined on the first day of the study and counterbalanced across subjects. Data are reported on session rate of learning, skill acquisition and generalization during weekly probes, and maintenance of gains at 3-month follow-up. Potential predictor variables were also collected at pre-treatment.

Results: Participants made gains in the acquisition and generalization of the target items taught via DTT and PRT. Children demonstrated distinct patterns of responding to DTT and PRT. Word acquisition and generalization, as well as rates of learning and disruptive behaviors during treatment sessions, varied depending on the treatment method used and domain of focus. Potential predictor variables useful in deciding treatment appropriateness a priori will be discussed.

Conclusions: These data corroborate with other studies emphasizing the importance of treatment individualization and begin to suggest specific methods for tailoring treatment programs to individual child needs. The strengths and weakness of DTT and PRT are not as explicit as previous research may suggest. Effectiveness may vary depending on child variables and curriculum area focus. Follow-up research aimed at improving methods for combining interventions into comprehensive treatment programs is important.