Use of Objective Behavioral Observation Measures to Evaluate Outcomes of Pivotal Response Treatment

Background: Behavioral interventions are robustly supported in autism spectrum disorder (ASD) treatment, including those that are parent-administered. There remains a need, however, for objective outcome measures that capture child response to treatment, as well as parent implementation of intervention strategies. Although research in Pivotal Response Treatment (PRT) does often include measures of parent treatment fidelity, detailed information about scoring procedures is sparse in the literature. Other parent training models often do not include information about whether the parents gained the targeted skills and child outcome data are often the sole focus.

Objectives: The goal of this presentation is to review outcomes from an objective behavioral observation measure from two trials of PRT, one randomized controlled trial of the group model of PRT, and one pilot study of a brief model of individual PRT. As there is little description of behavioral observation measures in the literature, especially with regard to parent fidelity of implementation, detailed information will be provided about operational definitions of targeted behaviors, as well as scoring and data analysis procedures.

Methods: In both trials, participants included children, ages 2-6 years, with diagnosis of ASD and significant language delay. In the RCT, 53 participants were randomly assigned to either PRT group or parent psychoeducation control group. In the study of brief individual PRT, child and parent outcomes were evaluated pre- and post-treatment for 13 children. Active treatment included parent training in PRT to target language development across 12 weeks for both studies. Dependent measures included standardized measures and structured lab observation (SLO), which will be the focus of this presentation. The SLO includes several standardized conditions (i.e., standard toys and parent instructions for interaction), designed to evaluate different aspects of parent-child interaction and child language skills. It is video taped and scored by blind raters for several target behaviors, including child language and parent treatment fidelity. This presentation will review administration and scoring procedures in detail, including novel approaches used to score total number as well as types of child utterance and trial-by-trial parent fidelity of implementation.

Results: Outcomes from these studies demonstrate that parent training in PRT was associated with child language improvements, as scored during the SLO, with a significant increase in functional utterances from baseline (34.2 ± 31) to post-treatment (55.9 ± 34; t = -2.922; df =8; p= 0.019) for the brief individual PRT, as well as the RCT of PRT group (F(2, 43) = 3.53, p = .038). Parents also effectively learned PRT in the RCT, as 84% met fidelity criteria. Fidelity data analyses for the brief PRT trial are ongoing.

Conclusions: Findings from these studies support that parent training programs are effective in teaching parents PRT and children show correlated gains in language. Together with previous studies of PRT, these findings also support the use of SLO procedures to measure parent and child outcomes. Findings will be discussed in light of the structured lab observation’s relationship to other standardized measures and its utility as an end point in the study of ASD interventions.