Component Analysis of Pivotal Response Training: Child Preferred-Materials and Reinforcement Strategies

Background: Pivotal response training (PRT), an evidence-based behavioral intervention for children with autism, incorporates child-preferred materials and contingent, direct reinforcement and can significantly improve children’s language when administered with high fidelity of implementation. However, community providers often struggle with implementing these components and modify PRT depending on their preferences or the characteristics of the children they work with (Stahmer, Collings, & Palinkas, 2005). Whether these modifications still yield maximum treatment benefits is unknown because most studies to date have focused on PRT as a package and little is known about its essential components. A systematic manipulation of PRT components is needed in order to identify the active ingredients and to make modifications to PRT that would facilitate ease of use in community settings. 

Objectives: The effects of teaching materials (child-preferred or standard academic) and reinforcement strategies (direct, indirect, or non-contingent) on children’s receptive language gains were evaluated by making component-specific modifications to PRT. 

Methods: An alternating treatments design was used to assess differential effects of preferred materials and direct reinforcement on skill acquisition. Five children with ASD, ages 4 to 10, are enrolled and three have completed the study. Each child’s preferred materials were determined by a preference assessment and a parent report prior to the PRT sessions. While holding other PRT components constant, therapists systematically varied teaching materials and reinforcement strategies in four conditions: (1) preferred materials and direct reinforcement, (2) preferred materials and indirect reinforcement, (3) standard academic materials and indirect reinforcement, and (4) preferred materials and non-contingent reinforcement. Conditions were alternated randomly until each condition has been presented five times. Child response was coded on a trial-by-trial basis. The mastery criterion for each target skill was defined as at least 80% correct responding in a single session. 

Results: All participants mastered the fewest skills in Condition 4, which utilized preferred materials and non-contingent reinforcement. Even though child-preferred materials were incorporated, PRT was less effective when the contingent reinforcement component was excluded. Individual differences were observed in children’s responsivity to teaching materials and direct and indirect reinforcement. Participant 1 learned the greatest number of skills in Conditions 2 and 3, both of which involved indirect reinforcement, whereas Participant 2 responded most favorably in Condition 1. Participant 3, who showed the greatest skill gains among the participants, learned more than twice as many skills in Condition 3 as in any other conditions. Additional data from remaining participants and maintenance and generalization results will be presented. 

Conclusions: Motivational use of preferred materials alone is not adequate for teaching new skills. Contingent reinforcement is necessary to maximize PRT treatment benefits, and a strict adherence to fidelity of this component by community providers may be required. Future studies should consider the use of indirect reinforcement in PRT as it may be more practical in the community settings and still produce optimal treatment outcomes.