Heterogeneity of treatment response is common in children with autism spectrum disorder. Thus, many providers vary the intervention used based on child characteristics and learning domain. An improved understanding of how to match treatments to different children and domain areas may enhance efforts to individualize treatment and improve treatment response. This study evaluated the relative efficacy of discrete trial training and pivotal response training for teaching young children at risk for autism spectrum disorder receptive and expressive language, play, and imitation skills. Using a single-subject adapted alternating treatments design, children received both the treatments for 12 weeks. Data were collected during treatment and at 3-month follow-up. All participants acquired target skills in both treatments and demonstrated some generalization, maintenance, and spontaneous skill use. Pivotal response training and discrete trial training were each more effective for some children and domains. The results suggest that early rates of learning may be predictive of longer-term treatment response and useful in informing treatment decisions.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR) (4th ed., Text Rev.). Washington, DC: Author.
2.
ArickJ. R.LoosL. M.FalcoR. A.KrugD. A. (2004). Strategies for teaching based on autism research. Austin, TX: PRO-ED.
3.
ArickJ. R.YoungH. E.FalcoR. A.LoosL. M.KrugD. A.JohnsonS. B. (2003). Designing an outcome study to monitor the progress of students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18, 75–87.
4.
BaconE. C.DufekS.SchreibmanL.StahmerA. C.PierceK.CourchesneE. (2014). Measuring outcome in an early intervention program for toddlers with autism spectrum disorder: Use of a curriculum-based assessment. Autism Research and Treatment, 2014, 1–9.
5.
BarlowD. H.HayesS. C. (1979). Alternating treatments design: One strategy for comparing the effect of two treatments in a single subject. Journal of Applied Behavior Analysis, 12, 199–210.
6.
DawsonG. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20, 775–803.
7.
DawsonG.RogersS.MunsonJ.SmithM.WinterJ.GreensonJ.VarleyJ. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The early start Denver Model. Pediatrics, 125, e17–e23.
8.
DelmolinoL.HarrisS. L. (2012). Matching children on the autism spectrum to classrooms: A guide for parents and professionals. Journal of Autism and Developmental Disorders, 42, 1197–1204.
9.
DelpratoD. J. (2001). Comparisons of discrete-trial and normalized behavioral language intervention for young children with autism. Journal of Autism and Developmental Disorders, 31, 315–325.
10.
EstesA.MunsonJ.RogersS. J.GreensonJ.WinterJ. (2015). Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 580–587.
FossumK.WilliamsL.GaronN.BrysonS. E.SmithI. M. (2018). Pivotal response treatment for preschoolers with autism spectrum disorder: defining a predictor profile. Autism Research, 11, 153–165.
13.
HumphreyN.ParkinsonG. (2006). Research on interventions for children and young people on the autistic spectrum : A critical perspective. Journal of Research in Special Educational Needs, 6, 76–86.
14.
HumphriesT. L. (2003). Effectiveness of pivotal response training as a behavioral intervention for young children with autism spectrum disorders. Bridges: Practice-based Research Syntheses, 2, 1–10.
15.
IngersollB.DvortcsakA. (2010). Teaching social-communication: A practitioner’s guide to parent training for children with autism. New York, NY: Guilford Press.
16.
IngersollB.SchreibmanL. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36, 487–505.
17.
IngersollB.SchreibmanL.StahmerA. (2001). Brief report: Differential treatment outcomes for children with autistic spectrum disorder based on level of peer social avoidance. Journal of Autism and Developmental Disorders, 31, 343–349.
18.
IovannoneR.DunlapG.HuberH.KincaidD. (2003). Effective educational practices for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18, 150–165.
19.
KoegelR. L.CamarataS.KoegelL. K.Ben-TallA.SmithA. E. (1998). Increasing speech intelligibility in children with autism. Journal of Autism and Developmental Disorders, 28, 241–251.
20.
KoegelR. L.KoegelL. K. (2006). Pivotal response treatments for autism. Baltimore, MD: Paul H Brookes Publishing.
21.
KoegelR. L.KoegelL. K.SurrattA. (1992). Language intervention and disruptive behavior in preschool children with autism. Journal of Autism and Developmental Disorders, 22, 141–153.
22.
KoegelR. L.O’DellM.DunlapG. (1988). Producing speech use in nonverbal autistic children by reinforcing attempts. Journal of Autism and Developmental Disorders, 18, 525–538.
23.
KoegelR. L.O’DellM. C.KoegelL. K. (1987). A natural language teaching paradigm for nonverbal autistic children. Journal of Autism and Developmental Disorders, 17, 187–200.
24.
KoegelR. L.SchreibmanL.GoodA.CernigliaL.MurphyC.KoegelL. K. (1989). How to teach pivotal behaviors to children with autism: A training manual. Santa Barbara: University of California.
25.
KoegelR. L.WernerG. A.VismaraL. A.KoegelL. K. (2005). The effectiveness of contextually supported play date interactions between children with autism and typically developing peers. Research and Practice for Persons with Severe Disabilities, 30, 93–102.
26.
KoegelR. L.WilliamsJ. A. (1980). Direct versus indirect response-reinforcer relationships in teaching autistic children. Journal of Abnormal Child Psychology, 8, 537–547.
27.
LeBlancL. A.EschJ.SidenerT. M.FirthA. M. (2006). Behavioral language interventions for children with autism: Comparing applied verbal behavior and naturalistic teaching approaches. The Analysis of Verbal Behavior, 22, 49–60.
28.
LordC.LuysterR. J.GothamK.GuthrieW. (2012). Autism Diagnostic Observation Schedule, Second Edition-Toddler Module (2nd ed.). Torrance: Western Psychological Services.
29.
LovaasO. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.
30.
LovaasO. I. (2002). Teaching individuals with developmental delays: Basic teaching techniques. Austin, TX: PRO-ED.
31.
LoveJ. R.CarrJ. E.AlmasonS. M.PetursdottirA. I. (2009). Early and intensive behavioral intervention for autism: A survey of clinical practices. Research in Autism Spectrum Disorders, 3, 421–428.
32.
MauriceC.GreenG.LuceS. C. (1996). Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: PRO-ED.
33.
McGeeG.KrantzP. J.McLannahanL. E. (1985). The Facilitative Effects of Incidental Teaching on Preposition Use by Autistic Children. Journal of Applied Behavior Analysis, 1, 17–31.
34.
Miranda-LinnéF.MelinL. (1992). Acquisition, generalization, and spontaneous use of color adjectives: a comparison of incidental teaching and traditional discrete-trial procedures for children with autism. Research in Developmental Disabilities, 13, 191–210.
35.
MohammadzaheriF.KoegelL. K.RezaeiM.RafieeS. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavior analysis (ABA) intervention for children with autism. Journal of Autism and Developmental Disorders, 44, 2769–2777.
36.
MohammadzaheriF.KoegelL. K.RezaeiM.BakhshiE. (2015). A randomized clinical trial comparison between pivotal response treatment (PRT) and adult-driven applied behavior analysis (ABA) intervention on disruptive behaviors in public school children with autism. Journal of Autism and Developmental Disorders, 45, 2899–2907.
37.
MullenE. M. (1995). Mullen Scales of Early Learning: AGS Edition. Circle Pines, MN: American Guidance Service.
38.
National Autism Center. (2009). National standards report. Randolph, MA: Author.
39.
National Research Council. (Ed.) (2001). Educating children with autism. Washington, DC: National Academy Press.
40.
NeefN.WaltersJ. (1984). Establishing generative yes/no responses in developmentally disabled children. Journal of Applied Behavior Analysis, 4, 453–460.
41.
OdomS. L.Collet-KlingenbergL.RogersS. J.HattonD. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure: Alternative Education for Children and Youth, 54, 275–282.
42.
OdomS. L.HumeK.BoydB.StabelA. (2012). Moving beyond the intensive behavior treatment versus eclectic dichotomy: Evidence-based and individualized programs for learners with ASD. Behavior Modification, 36, 270–297.
43.
PierceK.SchreibmanL. (1995). Increasing complex social behaviors in children with autism: Effects of peer-implemented pivotal response training. Journal of Applied Behavior Analysis, 3, 285–295.
44.
PierceK.SchreibmanL. (1997). Multiple peer use of pivotal response training to increase social behaviors of classmates with autism: Results from trained and untrained peers. Journal of Applied Behavior Analysis, 1, 157–160.
45.
RochaM. L.SchreibmanL.StahmerA. C. (2007). Effectiveness of training parents to teach joint attention in children with autism. Journal of Early Intervention, 29, 2154–2172.
46.
SallowsG. O.GraupnerT. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal of Mental Retardation, 110, 417–438.
47.
SandallS. R.AshmunJ. W.SchwartzI. S.DavisC.a WilliamsP.Leon-Guerrero McBrideB. J. (2011). Differential response to a school-based program for young children with ASD. Topics in Early Childhood Special Education, 31, 166–177.
48.
SchreibmanL.DawsonG.StahmerA. C.LandaR.RogersS. J.McgeeG. G.. . . HalladayA. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 2411–2428.
49.
SchreibmanL.StahmerA. C.Cestone BartlettV.DufekS. (2009). Brief report: Toward refinement of a predictive behavioral profile for treatment outcome in children with autism. Research in Autism Spectrum Disorders, 3, 163–172.
50.
ShererM. R.SchreibmanL. (2005). Individual behavioral profiles and predictors of treatment effectiveness for children with autism. Journal of Consulting and Clinical Psychology, 73, 525–538.
51.
SigafoosJ.O’ReillyM.MaC. H.EdrisinhaC.CannellaH.LancioniG. E. (2006). Effects of embedded instruction versus discrete-trial training on self-injury, correct responding, and mood in a child with autism. Journal of Intellectual & Developmental Disability, 31, 196–203.
52.
SindelarR.RosenbergM.WilsonR. (1985). An adapted alternating treatments design for instructional research. Education and Treatment of Children, 8, 67–76.
53.
SmithT. (2001). Discrete trial training in the treatment of autism. Focus on Autism and Other Developmental Disabilities, 16, 86–92.
54.
SparrowS. S.CicchettiV.BallaD. A. (2005). Vineland Adaptive Behavior Scales, Second Edition (2nd ed.). Minneapolis, MN: Pearson Assessment.
55.
StahmerA. C. (1999). Using pivotal response training to facilitate appropriate play in children with autistic spectrum disorders. Child Language Teaching and Therapy, 15, 29–40.
56.
StahmerA. C.AkshoomoffN.CunninghamA. B. (2011). Inclusion for toddlers with autism spectrum disorders: the first ten years of a community program. Autism : The International Journal of Research and Practice, 15, 625–641.
57.
StahmerA. C.Brookman-FrazeeL.LeeE.SearcyK.ReedS. (2011). Parent and multidisciplinary provider perspectives on earliest intervention for children at risk for autism spectrum disorders. Infants & Young Children, 24, 344–363.
58.
StahmerA. C.CollingsN.PalinkasL. A. (2005). Early intervention practices for children with autism: Descriptions from community providers. Focus on Autism and Other Developmental Disabilities, 20, 66–79.
59.
StahmerA. C.IngersollB. (2004). Inclusive programming for toddlers with autism spectrum disorders: Outcomes from the children. Journal of Positive Behavior Interventions, 6, 67–82.
StahmerA. C.SchreibmanL.CunninghamA. B. (2011). Toward a technology of treatment individualization for young children with autism spectrum disorders. Brain Research, 1380, 229–239.
62.
SteegeM. W.MaceF. C.PerryL.LongeneckerH. (2007). Applied behavior analysis: Beyond discrete trial teaching. Psychology in the Schools, 44, 91–99.
63.
SundbergM. L.PartingtonJ. W. (2010). Teaching language to children wtih autism and other developmental disabilities (2nd ed.). Concord, CA: AVB Press.
64.
ThorpD. M.StahmerA. C.SchreibmanL. (1995). Effects of sociodramatic play training on children with autism. Journal of Autism and Developmental Disorders, 25, 265–282.
65.
VismaraL. A.RogersS. J. (2010). Behavioral treatments in autism spectrum disorder: What do we know?Annual Review of Clinical Psychology, 6, 447–468.
66.
WallaceK. S.RogersS. J. (2010). Intervening in infancy: Implications for autism spectrum disorders. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 51, 1300–1320.
67.
WilliamsJ.KoegelR. (1981). Response-reinforcer relationships and improved learning in autistic children. Journal of Applied Behavior Analysis, 1, 53–60.
68.
WongC.OdomS. L.HumeK. A.CoxA. W.FettigA.KucharczykS.. . . SchultzT. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45, 1951–1966.
69.
YoderP.ComptonD. (2004). Identifying predictors of treatment response. Mental Retardation and Developmental Disabilities Research Reviews, 10, 162–168.
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