Pivotal response treatment for autism spectrum disorder: current perspectives

Abstract

Pivotal response treatment (PRT) is an evidence-based behavioral intervention based on applied behavior analysis principles aimed to improve social communication skills in individuals with autism spectrum disorder (ASD). PRT adopts a more naturalistic approach and focuses on using a number of strategies to help increase children’s motivation during intervention. Since its conceptualization, PRT has received much empirical support for eliciting therapeutic gains in greater use of functional social communication skills in individuals with ASD. Building upon the empirical evidence supporting PRT, recent advancements have increasingly turned to using interdisciplinary research integrating neuroimaging techniques and behavioral measures to help identify objective biomarkers of treatment, which have two primary purposes. First, neuroimaging results can help characterize how PRT may elicit change, and facilitate partitioning of the heterogeneous profiles of neural mechanisms underlying similar profile of behavioral changes observed over PRT. Second, neuroimaging provides an objective means to both map and track how biomarkers may serve as reliable and sensitive predictors of responder profiles to PRT, assisting clinicians to identify who will most likely benefit from PRT. Together, a better understanding of both mechanisms of change and predictors of responder profile will help PRT to serve as a more precise and targeted intervention for individuals with ASD, thus moving towards the goal of precision medicine and improving quality of care. This review focuses on the recent emerging neuroimaging evidences supporting PRT, offering current perspectives on the importance of interdisciplinary research to help clinicians better understand how PRT works and predict who will respond to PRT.

Using rational-emotive language education to improve communication and social skills of adolescents with autism spectrum disorders in Nigeria

“…The major focus of the RELE program was to help the participants to improve communication and social skills by disputing harmful thoughts and beliefs they were holding as reasons for their inability to communicate and socialize with others. [42] The RELE identified pivotal areas such as motivation, self-initiation, and self-management, which have been proven to be critical in eliciting broader treatment gains. [42] The RELE focuses on using a number of strategies to help increase participants’ motivation during intervention, such as using a variety of adolescent-chosen activities that are intrinsically motivating to each adolescent, and interspersing maintenance and acquisition tasks to strengthen adolescents’ exposure to well-established response-reinforcer contingency.…”

Back-translating behavioral intervention for autism spectrum disorders to mice with blunted reward restores social abilities

“…Directly derived from ABA-based EIBI, novel interventions have recently emerged (such as the Early Start Denver Model, enhanced Milieu teaching, Pivotal Response Treatment, parent-implemented programs), often play-based, in which the intervention is more child-directed and occurs in “naturalistic” environments, to facilitate generalization to the child’s everyday life 35 – 40 . A common feature of all these interventions remains the use of direct positive reinforcers to promote behavioral improvements, whereas punishment is mostly discarded 29 , 36 , 41 . Reinforcers are often edible or tangible items, such as palatable food, preferred by patients with ASD over more social reinforcement, like praise 42 , 43 .…”

Early processing (N170) of infant faces in mothers of children with autism spectrum disorder and its association with maternal sensitivity

“…Future investigations could explore whether the association between maternal neural specialization and MS predict ASD severity in children because ASD severity could reflect a greater load on parenting abilities or greater need for adaptation on the part of the mother. As well, given the emphasis on parent–child interactive skills in interventions for ASD such as pivotal response therapy [Cadogan & McCrimmon, ; Duifhuis et al, ; Koegel, Koegel, & Brookman, ; Lei & Ventola, ], our findings could be relevant in unpacking treatment mechanisms and in predicting treatment outcome for young children with ASD.…”