On Teaching Children with Autism: Self-Initiation (from Pivotal Response Training)

I’m not enthusiastic about ABA-related approaches that appear to be trying to hijack ABA procedures for proprietary purposes – Vince Carbone once said something like, “Don’t call what I am teaching ‘The Carbone Method.’ What I am teaching is ABA.” – as appears to be the case with such programs as Positive Behavior Supports.  Although Robert and Lynn Koegel’s Pivotal Response Training (PRT) initially struck me as one of these approaches, I have found in it enough new ideas that it is worth knowing about. I am not an expert in this approach, but I have read The PRT Pocket Guide, and I highly recommend that you purchase a copy of it for yourself (particularly since it is relatively inexpensive).

Unfortunately, while I have been able to find many references to research support for the effectiveness of PRT, and several references to research studies which are under way to evaluate its effectiveness, I have not been able to locate any of the research support itself — although I admit that my resources are limited.  According to Freeman (2007):

PRT/NLP [Natural Learning Paradigm] relies upon literature which studies the lack of joint attention behaviors characteristic of children with autism and the ramifications of the lack of joint attention on the development of speech and language. Although there has not been a single study comparing children in a comprehensive Pivotal Response Training program to a well-settled behavioral treatment program (such as Lovaas and colleagues created), Pivotal Response researchers have found a positive relationship between very targeted interventions and an increase in speech. <snip>

Over the last 18 years, proponents of PRT/NLP have published data on a total of fifty-one children who were involved in very short term and/or low intensity experiments (often lasting no more than thirty minutes a week over three months and often less than that). The majority of children in these studies were over three years of age, and many between the ages of five and ten years, some of whom were very high functioning. Based on these children, results have been reported that children with autism utilizing PRT/NLP have more prosocial behavior, improvements in social skills (and play), and an improvement in speech and language. Although these results sound encouraging, the studies as a whole have several serious drawbacks. <snip>

if my child were recently diagnosed, I would not rely upon PRT/NLP to ameliorate her autism do to the lack of data reporting efficacy for young children who are not yet speaking. This is an example of a promising area of research that is leaving the laboratory too early and being incorporated prematurely by parents and educational systems prematurely. <snip>

The authors of the PRT manual claim that it is designed for any child, including those who are nonverbal. This conclusion is premature because subjects in all of the studies had baseline language abilities that were higher than those typically found in the population of young autistic children.   <snip>

The Developmental Behavioral Pediatrics on-Line (a site closely connected with the American Academy of Pediatrics) has reviewed PRT and states: “although each of the components of the Pivotal Response intervention model has been extensively tested, there are no randomized trials comparing PRT to any other intervention model. The only published follow-up study was done retrospectively. Other than that, PRT/NLP has been protected from criticism as it falls under the general rubric of ABA which is a well-established discipline.”

So I have to ask myself, “Would I choose PRT as my main approach to treating a child with autism?”  I would have to offer a resounding “Definitely not!”  On the other hand, PRT focuses on and, hence, directs our attention to motivation, responsivity to multiple cues (i.e., teaching learners to attend to the many aspects/components of complex stimuli rather than focusing on only one aspect of an object or the environment while ignoring other aspects), self-management, and child self-initiations – all of which are obviously important, and all of which can and should be targetted within any ABA-based program for children with autism. As I have said many times, if a skill does not come naturally to a child and you want him or her to learn it, you have to teach it.  In this posting, I particularly want to draw your attention to PRT’s focus on the skill of self-initiation, because I agree that it is vital to the full development of any individual and doesn’t come naturally to many of our ASD children; and PRT is the only place that I can remember having seen this particular skill targetted. 

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