Using Engaging Social Interactions within a Pivotal Response Treatment Framework to Improve Adaptive Communication Skills and Autism Symptom Severity in Toddlers with ASD: Evidence from a Randomized Controlled Trial

Background:

Extensive research has examined the use of motivating stimuli to facilitate interventions for young children with autism spectrum disorder (ASD). Rewarding a child’s communicative attempts via access to a preferred item has been demonstrated to foster expressive and receptive language development and reduce autism symptomatology (Koegel et al., 1987; Koegel et al., 2010). Considering these promising results, recent studies have evaluated if these benefits may be enhanced through the use of engaging social interactions in lieu of items (Vernon, 2014; Vernon et al., 2012; Koegel et al., 2009). Rather than foster developmental efforts through delivery of motivating stimulus items, this intervention encourages social engagement by capitalizing on social activities informed by child sensory preferences. Research suggests that this approach is particularly effective, leading to widespread gains in eye contact, directed positive affect, verbal initiations, and parent-child engagement (Vernon et al., 2012). The present investigation examines preliminary results of an ongoing RCT examining the impact of this social engagement intervention on language development and amelioration of autism symptoms.

Objectives: This study’s objective was to investigate the impact of using embedded social interactions within a Pivotal Response Treatment intervention framework to improve the language skills and autism symptom severity of young children with ASD.

Methods: 19 toddlers with ASD, ages 18-48 months, participated in an ongoing randomized controlled trial. Participants in the immediate treatment condition received 6 months of a social engagement intervention in which language was reinforced with access to a motivating social exchange derived from each child’s existing, but non-social preferred activities. A comprehensive battery of assessments was administered to participants at pre- and post-intervention, including measures of adaptive functioning (the Vineland Adaptive Behavior Scales, Second Edition) and autism symptom severity (the Autism Diagnostic Observation Schedule, Second Edition). A multivariate analysis of variance (MANOVA) was conducted to identify changes in language abilities and autism symptoms across groups.

Results: With the use of Wilk’s criterion, multivariate analysis of Vineland scores revealed that the treatment group exhibited significantly greater gains in overall communication abilities in comparison to the control group: F(1, 15) = 6.42, p=.023. More specifically, the intervention was associated with significant improvement in participants’ receptive language skills when compared to the control group: F(1, 15)= 5.65, p=.031. While expressive language scores exhibited a positive trend within the intervention group that was not present in the control group, this result was not yet statistically significant given the preliminary nature of the data and small n: F(1, 15)= 2.92, p=.108. Multivariate analysis of ADOS total scores revealed that participants in the treatment group exhibited a significantly greater improvement in autism symptoms than the control group: F(1, 17)= 5.27, p=.035.

Conclusions: These results support the benefits of using an embedded social interaction modification to established PRT procedures to improve the communication skills and autism symptoms of toddlers with ASD. The positive growth trend seen in the data suggest that the adaptive language skills of children with ASD move within the proximity of typically-developing peers following participation in this project.