Pivotal Response Treatment Best For Motivating Kids With Autism To Speak, Study Shows

A type of therapy called Pivotal Response Treatment (PRT) has been shown to improve significant speech delays in children with autism, a six-month study has shown.

PRT is based on the principles of ABA (Applied Behavior Analysis). ABA aims to improve specific behaviors of children with autism that are socially significant. PRT focuses on specific, pivotal development areas instead of individual behaviors.

Parents play a key role in the success of this therapy, since they are most familiar with what motivates their child. PRT that involves parents was found to work better than other existing therapies to motivate autistic children with significant speech delays to talk.

“We were teaching parents how to set up situations where their child would be motivated to communicate. The results of our study are exciting because we found that children in the PRT group improved not just in their communication skills, but also in their broader social abilities,” said Grace Gengoux, PhD, clinical associate professor of psychiatry and behavioral sciences at Stanford and lead author of the study.

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Like ABA, PRT is is also a play-based therapy. The therapy uses items that the child is already interested in to encourage them to speak. There are four main areas of socialization that PRT targets: motivation, initiation, self-regulation, and response to multiple cues.

People with autism tend to struggle with social skills, and often lack the motivation to try to speak. Because of this lack of interest and/or ability to speak, parental instincts for encouraging speech often don’t succeed, according to lead author Gengoux.

So in PRT, therapists work with children and their parents to tap into the child’s interests and use them as incentive. Either the therapist or parent will take an object that they already know the child is interested in and use it to encourage speech. When the child attempts to say the word or communicate, he is rewarded with the object.

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The study was published in August of 2019 in the journal Pediatrics and was conducted by researchers at the Stanford University School of Medicine.

Over the course of 6 months, researchers observed children who had autism as well as significant speech delays. There were 48 children total, and they ranged in age from 2 to 5 years old.

Half of the children underwent PRT while the other half continued whatever therapy they had been using before the study began, including some types of ABA and conventional speech therapy.

For the children in the PRT group, they spent the first three months undergoing PRT for 10 hours every week with a trained therapist. Meanwhile, their parents underwent training for one hour per week to learn how to use PRT techniques during their everyday interactions with their children. Then, during the second half of the study’s run, the children underwent five hours of PRT per week with a trained therapist, while their parents dropped down to once-a-month sessions on PRT instruction. When at home, parents worked with their children on PRT techniques.

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The results showed that the children in the PRT group spoke more than the children in the non-PRT group, and could speak everyday words that others recognized — another important sign of progress. They also improved their overall social communication.

The study also has interesting news for lower-functioning children: they seemed to benefit more from PRT than the higher-functioning kids in their group. This is not typically the case with most autism therapies, which tend to benefit higher-functioning kids more.

The researchers are pleased with the results of this findings, but know that they need to mimic the results in larger studies to confirm the initial data.

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As of August of 2019, Stanford researchers are recruiting young children with autism for a new study of how the brain changes in PRT. If you’re a parent interested in enrolling your child in this study, you can call (650) 736-1235 or e-mail autismdd@stanford.edu for more information.

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