Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
Center for Autism, Cleveland Clinic, Cleveland, OH, USA.
J Child Psychol Psychiatry. 2015 Aug;56(8):884-92. doi: 10.1111/jcpp.12354. Epub 2014 Oct 27.
With rates of autism diagnosis continuing to rise, there is an urgent need for effective and efficient service delivery models. Pivotal Response Treatment (PRT) is considered an established treatment for autism spectrum disorder (ASD); however, there have been few well-controlled studies with adequate sample size. The aim of this study was to conduct a randomized controlled trial to evaluate PRT parent training group (PRTG) for targeting language deficits in young children with ASD.
Fifty-three children with autism and significant language delay between 2 and 6 years old were randomized to PRTG (N = 27) or psychoeducation group (PEG; N = 26) for 12 weeks. The PRTG taught parents behavioral techniques to facilitate language development. The PEG taught general information about ASD (clinical trial NCT01881750; http://www.clinicaltrials.gov).
Analysis of child utterances during the structured laboratory observation (primary outcome) indicated that, compared with children in the PEG, children in the PRTG demonstrated greater improvement in frequency of utterances (F(2, 43) = 3.53, p = .038, d = 0.42). Results indicated that parents were able to learn PRT in a group format, as the majority of parents in the PRTG (84%) met fidelity of implementation criteria after 12 weeks. Children also demonstrated greater improvement in adaptive communication skills (Vineland-II) following PRTG and baseline Mullen visual reception scores predicted treatment response to PRTG.
This is the first randomized controlled trial of group-delivered PRT and one of the largest experimental investigations of the PRT model to date. The findings suggest that specific instruction in PRT results in greater skill acquisition for both parents and children, especially in functional and adaptive communication skills. Further research in PRT is warranted to replicate the observed results and address other core ASD symptoms.
随着自闭症诊断率的持续上升，我们迫切需要有效的服务提供模式。关键反应治疗（PRT）被认为是自闭症谱系障碍（ASD）的一种既定治疗方法；然而，很少有足够大样本量的精心控制研究。本研究的目的是进行一项随机对照试验，以评估 PRT 家长培训组（PRTG）治疗自闭症儿童语言缺陷的效果。
53 名 2 至 6 岁有自闭症且语言发育迟缓的儿童被随机分为 PRTG（N=27）或心理教育组（PEG；N=26），进行为期 12 周的治疗。PRTG 教父母行为技巧来促进语言发展。PEG 教授有关 ASD 的一般信息（临床试验 NCT01881750；http://www.clinicaltrials.gov）。
对结构化实验室观察期间儿童言语的分析（主要结果）表明，与 PEG 组相比，PRTG 组儿童的言语频率改善更大（F（2,43）=3.53，p=0.038，d=0.42）。结果表明，父母能够以小组形式学习 PRT，因为 PRTG 中的大多数父母（84%）在 12 周后达到了实施标准的实施保真度。在 PRTG 治疗后，儿童的适应性沟通技能（Vineland-II）也得到了更大的改善，而基线 Mullen 视觉接受分数预测了 PRTG 的治疗反应。
这是群组提供的 PRT 的首个随机对照试验，也是迄今为止对 PRT 模型的最大实验研究之一。研究结果表明，PRT 的具体指导会使父母和孩子都获得更多的技能，特别是在功能性和适应性沟通技能方面。需要进一步研究 PRT，以复制观察到的结果，并解决其他核心 ASD 症状。
