Efficacy of a brief intervention targeting a low responder profile in preschoolers with autism spectrum disorder
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Background: Autism spectrum disorder (ASD) is characterized by impaired social communication, and repetitive behavior and restricted interests. The need for effective service delivery models is urgent, as rates of ASD diagnosis continue to be high (Ofner et al., 2018). However, heterogeneity of symptom severity and functional impact makes effective treatment for all preschoolers difficult. Individual-level data from Nova Scotia’s early intervention program based on Pivotal Response Treatment (PRT; Bryson et al., 2007) show that some children make minimal treatment gains (Smith, Flanagan, Garon, & Bryson, 2015). These “low responders” have a distinct behavioral profile that includes low levels of toy contact and positive affect (Fossum, Williams, Garon, Bryson, & Smith, 2018)—potentially modifiable variables. Objective: The study aim was to generate efficacy data for a brief therapist- and parent-implemented intervention targeting these skills that low responders lack, the Pivotal Response Intervention-Minimal Responder (PRIMeR) Intervention. Methods: Four preschoolers with ASD (aged 3.5–4.5 years) participated in this single case experimental design study. The 12-week intervention, using Reciprocal Imitation Training (Ingersoll, 2010) to target toy play, and responsiveness training (Landry, Smith, & Swank, 2006) to boost shared positive affect, was delivered in each child’s natural environment, at 2–3 hours per week, plus a one-month follow-up. Parents were coached in responsiveness intervention strategies. Results: An intervention effect was obtained for shared positive affect, variety of functional play actions, and variety of functional play objects, but not frequency of functional play. This study provides initial support for the efficacy of this partially parent-mediated naturalistic and developmental treatment package in shifting preschoolers’ low responder profiles by boosting skills in areas that are theoretically important for optimal response to PRT-based programs such as NS EIBI. Conclusions/Importance: The current intervention remediates behavioral deficits associated with poor progress in treatment. Individualization of children’s programming within PRT, by including PRIMeR, may optimize children’s progress and thereby produce positive outcomes for a wider range of children.