Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation

Abstract

In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed. Lay abstract Pivotal response treatment is a naturalistic behavioral intervention that teaches pivotal skills to children with autism spectrum disorder to produce widespread gains in other skills. Although most children with autism spectrum disorder benefit from pivotal response treatment, intervention outcomes vary considerably among children. Fidelity of intervention implementation (i.e. the extent to which an intervention is implemented as intended) may affect intervention outcomes. In this study, we studied the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether a child’s age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 pivotal response treatment therapists who videotaped three pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. This study found that therapists’ openness to innovation and their experience with pivotal response treatment predicted fidelity of implementation. Therapist personality, therapist–child relationship, and child characteristics were not related to pivotal response treatment fidelity. The results of this study emphasize that it is important (1) to target therapists’ attitudes toward innovation prior to or during training in pivotal response treatment and (2) to provide therapists with ongoing supervision and feedback after training to increase fidelity of implementation and thus to improve intervention outcomes for children with autism spectrum disorder.

Self-initiations in young children with autism during Pivotal Response Treatment with and without robot assistance

“…In the larger RCT from which the data for this study were drawn, additional blinded measurements were included (van den Berk-Smeekens et al, 2020). Parental fidelity of PRT implementation was low in our study, due to (1) the high emphasis of daily implementation of PRT techniques at home (not recorded on video for scoring), rather than intensively during a video-recorded 10-min parent–child interaction and (2) the use of a different (and more stringent) fidelity coding system, in which a correct sequence of PRT skills are highly emphasized (Verschuur et al, 2020). Although in both groups parental fidelity of PRT implementation did not reach 80%, the fidelity rate in the robot-assisted PRT group was significant lower than in the PRT group.…”

“…Fidelity of PRT Implementation of parents at the end of the intervention was measured using the partial interval recording procedure as described in the study of Verschuur et al (2020), in which fidelity criteria are based on a sequence of correctly implemented PRT components, instead of coding each PRT component separately. Video probes of 10 minutes of the last two recorded parent–child sessions were coded by a trained research assistant, blinded to group assignment.…”

Pivotal Response Treatment with and without robot-assistance for children with autism: a randomized controlled trial

“…Parental Fidelity of PRT Implementation at the end of the intervention was assessed using the partial interval recording procedure as described by Verschuur et al [ 34 ]. In this procedure, the fidelity is based on a sequence of correctly implemented PRT components that constitute a three-term contingency, instead of scoring each PRT component separately.…”

Psychotherapists' personality traits and their influence on treatment processes and outcomes: A scoping review

“…Peters-Scheffer et al ( 2013) found a negative relationship between therapists' openness to experience and procedural fidelity when delivering applied behavior analysis with autistic children. Although Verschuur et al (2020) expected to find a similar result, their research did not find any significant associations. They attributed this null finding to a small sample size, which meant findings were vulnerable to Type II error.…”