Brief Parent Training in Pivotal Response Treatment for Preschoolers with Autism

Abstract

Evidence of improved outcomes with early behavioural intervention has placed the early treatment of autism as a health research priority. However, long waiting lists for treatment preclude timely access, despite recommendations that intervention be provided as early as possible to optimize the children's outcomes. Pivotal Response Treatment (PRT) has been shown to be effective at promoting communication in children with autism. An integral component of PRT is parent training, as parents are considered to be the primary implementers in the PRT model. To date, research on parent training in PRT has focused primarily on a 25-hour program, although there is some evidence that less intensive training may still be effective. The objective of the present study was to evaluate the efficacy of brief training in PRT for parents of preschoolers with autism, who were awaiting, or unable to access, more comprehensive treatment. Eight preschoolers with autism and their parents participated in the study, which used a non-concurrent multiple (across-participants) baseline design . Parents were seen for three 2-hour training sessions on PRT. Measures focusing on child and parent outcomes, using standardized tests, questionnaires, and behaviour coded directly from video, were obtained before, immediately after, and 2 to 4 months following training. Overall, children's communication skills, namely functional utterances, increased following training. Parents' fidelity in implementing PRT techniques also improved after training and these changes were generally maintained at follow-up, although there was some variability. Generally children presented with low levels of disruptive behaviour across all phases, although disruptive behaviour decreased for the two children who displayed higher levels prior to training. There were no changes observed in child affect. Overall, there were no significant changes in parental self-efficacy, stress, or affect, although parents reported being very satisfied with the training. A moderate to strong relationship was found between parents' increased ability to implement PRT techniques and improvement in the children's communication skills. While discussion focuses on outstanding issues to be addressed, the present findings suggest that brief parent training promises to provide an immediate cost-effective intervention that could be adopted widely.