In a new study, researchers found pivotal response treatment (PRT) involving parents can work better than other therapies at motivating children with autism and language delays to talk.
PRT gives parents a way to breach this barrier.
The research was conducted by a team from the Stanford University School of Medicine.
Because children with autism are less socially motivated than typically developing children, parents’ instincts about how to engage them often don’t succeed.
The six-month study enrolled 48 children who were 2 to 5 years old and had autism and significant language delays.
Half the children received PRT treatment from therapists and their parents, while the remaining children continued to receive the autism treatments they had been getting before the study began.
For the first 12 weeks of the study, children in the PRT group underwent 10 hours per week of PRT from a trained therapist, and their parents received training for one hour per week in how to use the treatment’s techniques during everyday interactions with their children.
For the second 12 weeks of the study, children in the PRT group received five hours per week of therapist treatment, and their parents had monthly instruction sessions.
In PRT, the therapist or parent notes what the child is interested in, and uses the object to encourage speech.
At the end of the study, the children in the PRT group spoke more than those in the comparison group and were using common words that could be recognized by others.
The children also showed greater improvement in a measure of their overall social communication, which is critical for an optimal long-term outcome.
The team also found that children who began with lower developmental abilities benefited more from the intervention.
The researchers say that children in the PRT group improved not just in their communication skills, but also in their broader social abilities.
For example, Heidi Pim of Palo Alto, California, participated in the study with her son, James, who was diagnosed as a toddler with autism and speech delays.
In PRT, if James wanted a toy car, Pim, his mother, learned to pick up the car, hold it where he could see it and encourage him to say “car.” When he tried to say the word, he was rewarded with the toy.
At first, James learned single words. He then progressed to phrases such as “green car” and “ready, set, go.” Pim also used PRT to help James learn to express his needs, such as by saying “bottle” if he was thirsty.
“He used to not be able to point to something or ask,” Pim said. “PRT really improved his vocabulary skills and communication back and forth. It helped us understand what he needs and wants.”
As the trial progressed, Pim also saw James’ frustration levels decrease. “Before, he didn’t know how to express his feelings,” she said. “When I would leave for the day and come back, he didn’t know how to say ‘Mommy, I missed you,’ so instead he would hit me or cry. That has lessened.”
Today, James, now 8, is a happy kid who attends school in a mainstream classroom and enjoys playing with his twin sister, Jessica. Pim still uses PRT techniques to engage James in conversation on his favorite topics, such as elevators.
The Stanford researchers believe that findings are promising but that they need to be replicated in larger research.
They are also currently recruiting young children with autism for a new study of how the brain changes in PRT. Interested parents can call (650) 736-1235 or e-mail firstname.lastname@example.org for more information.
Parents and teachers who want to learn PRT techniques can attend a one-day conference being held at Stanford in September.
More information about the conference is available at http://med.stanford.edu/autismcenter.html.
The lead author of the study is Grace Gengoux, Ph.D., clinical associate professor of psychiatry and behavioral science.
The study is published in Pediatrics.
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