OpenLB
Open Library of Bioscience
Advanced Search
Journal of autism and developmental disorders
Jun, 2024;54 (6): 2081-2093.

Using Pivotal Response Treatment to Improve Language Functions of Autistic Children in Special Schools: A Randomized Controlled Trial.

Leilei Wang, Shuting Li, Chongying Wang
Author Information
  1. Leilei Wang: Department of Social Psychology, Zhou Enlai School of Government, Nankai University, 38 Tongyan Road, Tianjin, China.
  2. Shuting Li: Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.
  3. Chongying Wang: Department of Social Psychology, Zhou Enlai School of Government, Nankai University, 38 Tongyan Road, Tianjin, China. chongyingwang@nankai.edu.cn. ORCID
PMID: 37101061 DOI: 10.1007/s10803-023-05988-7

Abstract

Language difficulties exert profound negative effects on the cognitive and social development of autistic children. Pivotal Response Treatment (PRT) is a promising intervention for improving social communication in autistic children, but there is a lack of a comprehensive examination of language functions. This study aimed to investigate the effectiveness of PRT in promoting the primary language functions (requesting, labeling, repeating, responding) defined by (Skinner, B. F. (1957). Verbal behavior. Martino Publishing.) theory of verbal behavior in autistic children. Thirty autistic children were randomly divided into the PRT group (M = 6.20, SD = 1.21) and control group (M = 6.07, SD = 1.49). The PRT group were provided with an 8-week training of the PRT motivation component in addition to treatment as usual (TAU) in their schools, whereas the control group only received TAU. Parents of the PRT group were also trained to practice the PRT motivation procedures at home. The PRT group demonstrated greater improvements in all four measured language functions compared to the control group. The improvement in language functions in the PRT group was generalized and maintained at the follow-up assessment. In addition, the PRT intervention enhanced untargeted social and communicative functioning, cognition, motor skills, imitation, and adaptive behaviors in the autistic children. In conclusion, language intervention using the motivation component of PRT is effective in promoting language functions as well as widespread untargeted cognitive and social functions in autistic children.

Keywords

Autism spectrum disorder Language functions Motivation procedure Pivotal response treatment

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. [DOI: 10.1176/appi.books.9780890425596]
  2. Baker-Ericzén, M. J., Stahmer, A. C., & Burns, A. (2007). Child demographics associated with outcomes in a community-based pivotal response training program. Journal of Positive Behavior Interventions, 9(1), 52–60. https://doi.org/10.1177/10983007070090010601 [DOI: 10.1177/10983007070090010601]
  3. Chen, F., Cheung, C. C. H., & Peng, G. (2022). Linguistic tone and non-linguistic pitch imitation in children with autism spectrum disorders: A cross-linguistic investigation. Journal of Autism and Developmental Disorders, 52(5), 2325–2343. https://doi.org/10.1007/s10803-021-05123-4 [DOI: 10.1007/s10803-021-05123-4]
  4. Chen, J., Liang, C., Wei, Z., Cui, Z., Kong, X., Dong, C., Lai, Y., Peng, Z., & Wan, G. (2019). Atypical longitudinal development of speech-evoked auditory brainstem response in preschool children with autism spectrum disorders. Autism Research, 12(7), 1022–1031. https://doi.org/10.1002/aur.2110 [DOI: 10.1002/aur.2110]
  5. de Korte, M. W. P., van den Berk-Smeekens, I., Buitelaar, J. K., Staal, W. G., & van Dongen-Boomsma, M. (2021). Pivotal response treatment for school-aged children and adolescents with autism spectrum disorder: A randomized controlled trial. Journal of Autism and Developmental Disorders, 51(12), 4506–4519. https://doi.org/10.1007/s10803-021-04886-0 [DOI: 10.1007/s10803-021-04886-0]
  6. Dunlap, G. (1984). The influence of task variation and maintenance tasks on the learning and affect of autistic children. Journal of Experimental Child Psychology, 37(1), 41–64. https://doi.org/10.1016/0022-0965(84)90057-2 [DOI: 10.1016/0022-0965(84)90057-2]
  7. Dunn, L. M., & Dunn, L. M. (1981). Peabody picture vocabulary test-revised. American Guidance Service, Inc.
  8. Dyer, K., Dunlap, G., & Winterling, V. (1990). Effects of choice making on the serious problem behaviors of students with severe handicaps. Journal of Applied Behavior Analysis, 23(4), 515–524. https://doi.org/10.1901/jaba.1990.23-515 [DOI: 10.1901/jaba.1990.23-515]
  9. Feldman, E. K., & Matos, R. (2013). Training paraprofessionals to facilitate social interactions between children with autism and their typically developing peers. Journal of Positive Behavior Interventions, 15(3), 169–179. https://doi.org/10.1177/1098300712457421 [DOI: 10.1177/1098300712457421]
  10. Forbes, H. J., Travers, J. C., & Vickers Johnson, J. (2020). A systematic review of linguistic and verbal behavior outcomes of pivotal response treatment. Journal of Autism and Developmental Disorders, 50(3), 766–778. https://doi.org/10.1007/s10803-019-04307-3 [DOI: 10.1007/s10803-019-04307-3]
  11. Fossum, K. L., Williams, L., Garon, N., Bryson, S. E., & Smith, I. M. (2018). Pivotal response treatment for preschoolers with autism spectrum disorder: Defining a predictor profile. Autism Research, 11(1), 153–165. https://doi.org/10.1002/aur.1859 [DOI: 10.1002/aur.1859]
  12. Franchini, M., Duku, E., Armstrong, V., Brian, J., Bryson, S. E., Garon, N., Roberts, W., Roncadin, C., Zwaigenbaum, L., & Smith, I. M. (2018). Variability in verbal and nonverbal communication in infants at risk for autism spectrum disorder: predictors and outcomes. Journal of Autism and Developmental Disorders, 48(10), 3417–3431. https://doi.org/10.1007/s10803-018-3607-9 [DOI: 10.1007/s10803-018-3607-9]
  13. Gau, S. S. F., Lee, C. M., Lai, M. C., Chiu, Y. N., Huang, Y. F., Kao, J. D., & Wu, Y. Y. (2011). Psychometric properties of the Chinese version of the social communication questionnaire. Research in Autism Spectrum Disorders, 5(2), 809–818. https://doi.org/10.1016/j.rasd.2010.09.010 [DOI: 10.1016/j.rasd.2010.09.010]
  14. Gengoux, G. W., Berquist, K. L., Salzman, E., Schapp, S., Phillips, J. M., Frazier, T. W., Minjarez, M. B., & Hardan, A. Y. (2015). Pivotal response treatment parent training for autism: Findings from a 3-month follow-up evaluation. Journal of Autism and Developmental Disorders, 45(9), 2889–2898. https://doi.org/10.1007/s10803-015-2452-3 [DOI: 10.1007/s10803-015-2452-3]
  15. Huang, W. H., & Li, D. (2017). Yu yan xing wei li cheng bei ping gu yu an zhi cheng xu [Tran: The verbal behavior milestones assessment and placement program: The VB-MAPP]. Peking University Medical Press.
  16. Issarraras, A., Matson, J. L., Matheis, M., & Burns, C. O. (2019). Differences in developmental concerns of young children with autism spectrum disorder across racial/ethnic groups. Developmental Neurorehabilitation, 22(3), 174–179. https://doi.org/10.1080/17518423.2018.1504828 [DOI: 10.1080/17518423.2018.1504828]
  17. Johnson, G., Kohler, K., & Ross, D. (2017). Contributions of Skinner’s theory of verbal behaviour to language interventions for children with autism spectrum disorders. Early Child Development and Care, 187(3–4), 436–446. https://doi.org/10.1080/03004430.2016.1236255 [DOI: 10.1080/03004430.2016.1236255]
  18. Kim, S., Koegel, R. L., & Koegel, L. K. (2017). Training paraprofessionals to target socialization in students with ASD: Fidelity of implementation and social validity. Journal of Positive Behavior Interventions, 19(2), 102–114. https://doi.org/10.1177/1098300716669813 [DOI: 10.1177/1098300716669813]
  19. Koegel, L. K., Bryan, K. M., Su, P., Vaidya, M., & Camarata, S. (2019). Intervention for non-verbal and minimally verbal individuals with autism: A systematic review. International Journal of Pediatric Research. https://doi.org/10.23937/2469-5769/1510056 [DOI: 10.23937/2469-5769/1510056]
  20. Koegel, L. K., Camarata, S. M., Valdez-Menchaca, M., & Koegel, R. L. (1998a). Setting generalization of question-asking by children with autism. American Journal on Mental Retardation, 102(4), 346–357. https://doi.org/10.1352/0895-8017(1998)102%3c0346:SGOQBC%3e2.0.CO;2 [DOI: 10.1352/0895-8017(1998)102<0346]
  21. Koegel, L. K., Koegel, R. L., & Carter, C. M. (1998b). Pivotal responses and the natural language teaching paradigm. Seminars in Speech and Language, 19(04), 355–372. [DOI: 10.1055/s-2008-1064054]
  22. Koegel, L. K., Koegel, R. L., Green-Hopkins, I., & Barnes, C. C. (2010). Brief report: Question-Asking and collateral language acquisition in children with autism. Journal of Autism and Developmental Disorders, 40(4), 509–515. https://doi.org/10.1007/s10803-009-0896-z [DOI: 10.1007/s10803-009-0896-z]
  23. Koegel, R. L., Bradshaw, J. L., Ashbaugh, K., & Koegel, L. K. (2014). Improving question-asking initiations in young children with autism using pivotal response treatment. Journal of Autism and Developmental Disorders, 44(4), 816–827. https://doi.org/10.1007/s10803-013-1932-6 [DOI: 10.1007/s10803-013-1932-6]
  24. Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social, & academic development. Brookes Publishing Co.
  25. Koegel, R. L., & Koegel, L. K. (2012). The PRT pocket guide: Pivotal response treatment for autism spectrum disorders. Brookes Publishing Co.
  26. Koegel, R. L., & Koegel, L. K. (2016). Pivotal response treatments for autism: Communication, social, and academic development. Brookes Publishing Co.
  27. Koegel, R. L., & Koegel, L. K. (2019). Pivotal response treatment for autism spectrum disorder (ASD) (2nd ed.). Brookes Publishing Company.
  28. Koegel, R. L., Koegel, L. K., & McNerney, E. K. (2001). Pivotal areas in intervention for autism. Journal of Clinical Child and Adolescent Psychology, 30(1), 19–32. https://doi.org/10.1207/S15374424JCCP3001_4 [DOI: 10.1207/S15374424JCCP3001_4]
  29. Koegel, R. L., Koegel, L. K., & Surratt, A. (1992). Language intervention and disruptive behavior in preschool children with autism. Journal of Autism and Developmental Disorders, 22(2), 141–153. [DOI: 10.1007/BF01058147]
  30. Koegel, R. L., O’Dell, M. C., & Koegel, L. K. (1987). A natural language teaching paradigm for nonverbal autistic children. Journal of Autism and Developmental Disorders, 17(2), 187–200. https://doi.org/10.1007/BF01495055 [DOI: 10.1007/BF01495055]
  31. Kwok, E. Y. L., Brown, H. M., Smyth, R. E., & Oram Cardy, J. (2015). Meta-analysis of receptive and expressive language skills in autism spectrum disorder. Research in Autism Spectrum Disorders, 9, 202–222. https://doi.org/10.1016/j.rasd.2014.10.008 [DOI: 10.1016/j.rasd.2014.10.008]
  32. Levinson, S., Eisenhower, A., Bush, H. H., Carter, A. S., & Blacher, J. (2020). Brief report: Predicting social skills from semantic, syntactic, and pragmatic language among young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(11), 4165–4175. https://doi.org/10.1007/s10803-020-04445-z [DOI: 10.1007/s10803-020-04445-z]
  33. Lovaas, O. I., Schreibman, L., & Koegel, R. L. (1974). A behavior modification approach to the treatment of autistic children. Journal of Autism and Childhood Schizophrenia, 4(2), 111–129. [DOI: 10.1007/BF02105365]
  34. Marini, A., Ozbič, M., Magni, R., & Valeri, G. (2020). Toward a definition of the linguistic profile of children with autism spectrum disorder. Frontiers in Psychology, 11, 1–13. https://doi.org/10.3389/fpsyg.2020.00808 [DOI: 10.3389/fpsyg.2020.00808]
  35. Marrus, N., Hall, L. P., Paterson, S. J., Elison, J. T., Wolff, J. J., Swanson, M. R., Parish-Morris, J., Eggebrecht, A. T., Pruett, J. R., Hazlett, H. C., Zwaigenbaum, L., Dager, S., Estes, A. M., Schultz, R. T., Botteron, K. N., Piven, J., Constantino, J. N., Piven, J., Hazlett, H. C., & Gu, H. (2018). Language delay aggregates in toddler siblings of children with autism spectrum disorder. Journal of Neurodevelopmental Disorders, 10(1), 1–16. https://doi.org/10.1186/s11689-018-9247-8 [DOI: 10.1186/s11689-018-9247-8]
  36. Moes, D. R. (1998). Integrating choice-making opportunities within teacher-assigned academic tasks to facilitate the performance of children with autism. Journal of the Association for Persons with Severe Handicaps, 23(4), 319–328. [DOI: 10.2511/rpsd.23.4.319]
  37. Mohammadzaheri, F., Koegel, L. K., Bakhshi, E., Khosrowabadi, R., & Soleymani, Z. (2021). The effect of teaching initiations on the communication of children with autism spectrum disorder: A randomized clinical trial. Journal of Autism and Developmental Disorders, 52(6), 2598–2609. https://doi.org/10.1007/s10803-021-05153-y [DOI: 10.1007/s10803-021-05153-y]
  38. Mohammadzaheri, F., Koegel, L. K., Rezaee, M., & Rafiee, S. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavior analysis (ABA) intervention for children with autism. Journal of Autism and Developmental Disorders, 44(11), 2769–2777. https://doi.org/10.1007/s10803-014-2137-3 [DOI: 10.1007/s10803-014-2137-3]
  39. Mohammadzaheri, F., Koegel, L. K., Rezaei, M., & Bakhshi, E. (2015). A Randomized clinical trial comparison between pivotal response treatment (PRT) and adult-driven applied behavior analysis (ABA) intervention on disruptive behaviors in public school children with autism. Journal of Autism and Developmental Disorders, 45(9), 2899–2907. https://doi.org/10.1007/s10803-015-2451-4 [DOI: 10.1007/s10803-015-2451-4]
  40. Padilla, K. L., & Akers, J. S. (2021). Content validity evidence for the verbal behavior milestones assessment and placement program. Journal of Autism and Developmental Disorders, 51(11), 4054–4066. https://doi.org/10.1007/s10803-020-04864-y [DOI: 10.1007/s10803-020-04864-y]
  41. Popovic, S. C., Starr, E. M., & Koegel, L. K. (2020). Teaching initiated question asking to children with autism spectrum disorder through a short-term parent-mediated program. Journal of Autism and Developmental Disorders, 50(10), 3728–3738. https://doi.org/10.1007/s10803-020-04426-2 [DOI: 10.1007/s10803-020-04426-2]
  42. Ramezani, M., Lotfi, Y., Moossavi, A., & Bakhshi, E. (2019). Auditory brainstem response to speech in children with high functional autism spectrum disorder. Neurological Sciences, 40(1), 121–125. https://doi.org/10.1007/s10072-018-3594-9 [DOI: 10.1007/s10072-018-3594-9]
  43. Reindal, L., Nærland, T., Weidle, B., Lydersen, S., Andreassen, O. A., & Sund, A. M. (2021). Structural and pragmatic language impairments in children evaluated for autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-020-04853-1 [DOI: 10.1007/s10803-020-04853-1]
  44. Richards, M., Mossey, J., & Robins, D. L. (2016). Parents’ concerns as they relate to their child’s development and later diagnosis of autism spectrum disorder. Journal of Developmental and Behavioral Pediatrics, 37(7), 532–540. https://doi.org/10.1097/DBP.0000000000000339 [DOI: 10.1097/DBP.0000000000000339]
  45. Rutter, M., Bailey, A., & Lord, C. (2003). The social communication questionnaire: Manual. Western Psychological Services.
  46. Sang, B., & Miao, X. (1990). The revision of PPVT–R trial norm in Shanghai. Psychological Science, 5, 20–25.
  47. Schopler, E., Lansing, M. D., Reichler, R. J., & Marcus, L. M. (2005). Psychoeducational Profile: TEACCH individualized assessment for children with autism spectrum disorders (3rd ed.). Austin.
  48. Shek, D. T. L., & Yu, L. (2014). Construct validity of the Chinese version of the psycho-educational profile-3rd edition (CPEP-3). Journal of Autism and Developmental Disorders, 44(11), 2832–2843. https://doi.org/10.1007/s10803-014-2143-5 [DOI: 10.1007/s10803-014-2143-5]
  49. Skinner, B. F. (1957). Verbal behavior. Martino Publishing. [DOI: 10.1037/11256-000]
  50. Stahmer, A. C., Suhrheinrich, J., Reed, S., Schreibman, L., & Bolduc, C. (2011). Classroom Pivotal Response Teaching for Children with Autism. Guilford Publications. https://books.google.com.au/books?id=fluK_xLWND0C
  51. Stock, R., Mirenda, P., & Smith, I. M. (2013). Comparison of community-based verbal behavior and pivotal response treatment programs for young children with autism spectrum disorder. Research in Autism Spectrum Disorders, 7(9), 1168–1181. https://doi.org/10.1016/j.rasd.2013.06.002 [DOI: 10.1016/j.rasd.2013.06.002]
  52. Sundberg, M. L., & Michael, J. (2001). The benefits of Skinner’s analysis of verbal behavior for children with autism. Behavior Modification, 25(5), 698–724. https://doi.org/10.1177/0145445501255003 [DOI: 10.1177/0145445501255003]
  53. Tang, X., Hua, Z., Xing, J., Yi, L., Ji, Z., Zhao, L., Su, X., Yin, T., Wei, R., Li, X., & Liu, J. (2022). Verbal fluency as a predictor of autism spectrum disorder diagnosis and co-occurring attention-deficit/hyperactivity disorder symptoms. Reading and Writing. https://doi.org/10.1007/s11145-022-10319-w [DOI: 10.1007/s11145-022-10319-w]
  54. Tillinghast, B. S., Morrow, J. E., & Uhlig, G. E. (1983). Retest and alternate-form reliabilities of the ppvt-r with fourth, fifth, and sixth grade pupils. Journal of Educational Research, 76(4), 243–244. https://doi.org/10.1080/00220671.1983.10885458 [DOI: 10.1080/00220671.1983.10885458]
  55. Verschuur, R., Didden, R., Lang, R., Sigafoos, J., & Huskens, B. (2014). Pivotal response treatment for children with autism spectrum disorders: A systematic review. Review Journal of Autism and Developmental Disorders, 1(1), 34–61. https://doi.org/10.1007/s40489-013-0008-z [DOI: 10.1007/s40489-013-0008-z]
  56. Wang, L., Pfordresher, P. Q., Jiang, C., & Liu, F. (2021). Individuals with autism spectrum disorder are impaired in absolute but not relative pitch and duration matching in speech and song imitation. Autism Research, 14(11), 2355–2372. https://doi.org/10.1002/aur.2569 [DOI: 10.1002/aur.2569]
  57. Weismer, S. E., Kaushanskaya, M., Larson, C., Mathée, J., & Bolt, D. (2018). Executive function skills in school-age children with autism spectrum disorder: Association with language abilities. Journal of Speech, Language, and Hearing Research, 61(11), 2641–2658. https://doi.org/10.1044/2018_JSLHR-L-RSAUT-18-0026 [DOI: 10.1044/2018_JSLHR-L-RSAUT-18-0026]
  58. Yu, L., Zhu, X., Shek, D. T. L., Zou, X. B., Deng, H. Z., & Au Yeung, P. W. H. (2019). Validation of the simplified Chinese psychoeducational profile third edition in mainland China. Journal of Autism and Developmental Disorders, 49(4), 1599–1612. https://doi.org/10.1007/s10803-018-3827-z [DOI: 10.1007/s10803-018-3827-z]

Grants

  1. (Grant No. 21&ZD182)/National Social Science Fund of China
  2. (220600287161903)/collaborative project of industry and academia by Ministry of Education

MeSH Term

Humans
Male
Child
Female
Autistic Disorder
Child, Preschool
Education, Special
Motivation
Schools
Language Development Disorders
Treatment Outcome
Language Therapy
Verbal Behavior
Journal Article Randomized Controlled Trial
Article has an altmetric score of 1

Word Cloud

Created with Highcharts 10.0.0PRTgroupfunctionsautisticchildrenlanguagesocialLanguagePivotalinterventioncontrolmotivationcognitiveResponseTreatmentpromotingbehaviorM = 6SD = 1componentadditiontreatmentTAUuntargeteddifficultiesexertprofoundnegativeeffectsdevelopmentpromisingimprovingcommunicationlackcomprehensiveexaminationstudyaimedinvestigateeffectivenessprimaryrequestinglabelingrepeatingrespondingdefinedSkinnerBF1957VerbalMartinoPublishingtheoryverbalThirtyrandomlydivided20210749provided8-weektrainingusualschoolswhereasreceivedParentsalsotrainedpracticeprocedureshomedemonstratedgreaterimprovementsfourmeasuredcomparedimprovementgeneralizedmaintainedfollow-upassessmentenhancedcommunicativefunctioningcognitionmotorskillsimitationadaptivebehaviorsconclusionusingeffectivewellwidespreadUsingImproveFunctionsAutisticChildrenSpecialSchools:RandomizedControlledTrialAutismspectrumdisorderMotivationprocedureresponse

Similar Articles

Cited By