These empirical articles are a sampling of those that specifically evaluate PRT/NLP.
Please email autism@education.ucsb.edu for a copy of any of these articles.

To see a summary table of these articles, click here.

2008

Harper, C.B., Symon, J.B.G., Frea, W.D. (2008). Recess is time-in: Using peers to improve social skills of children with autism. Journal of Autism and Developmental Disorders, Vol. 38, 815-826.

Children with autism face enormous struggles when attempting to interact with their typically developing peers. More children are educated in integrated settings; however, play skills usually need to be explicitly taught, and play environments must be carefully prepared to support effective social interactions. This study incorporated the motivational techniques of Pivotal Response Training through peer-mediated practice to improve social interactions for children with autism during recess activities. A multiple baseline design across subjects was used to assess social skills gains in two elementary school children. The results demonstrated an increase in important social skills, namely social initiations and turn taking, during recess.

Bryson, S.E., Koegel, L. K., Koegel, R.L., Openden, D., Smith, I.M., & Nefdt, N. (2007). Large scale dissemination and community implementation of Pivotal Response Treatment: Program description and preliminary data. Research and Practice for Persons with Severe Disabilities. Vol. 32 (2). 142-153.

This paper describes a collaborative effort aimed at province-wide dissemination and implementation of pivotal response treatment (PRT) for young children with autism spectrum disorder (ASD) in Nova Scotia, Canada. Three critical components of the associated training model are described: (1) direct training of treatment teams (parents, one-to-one interventionists, and clinical supervisors/ leaders); (2) training of trainers; and (3) follow-up and monitoring of treatment fidelity and child progress. A major goal of the Dalhousie University/IWK Health CentreY University of California at Santa Barbara partnership was to optimize effectiveness when translating PRT from the ‘‘lab’’ for dissemination in large geographical areas with community service providers. Finally, we provide data on stakeholder satisfaction with the training workshops and end by identifying features that may have contributed to our success thus far.

Baker-Ericzen, M.J., Stahmer, A.C., & Burns, A. (2007). Child demographics associated with outcomes in a community-based Pivotal Response Training program. Journal of Positive Behavior Interventions, Vol. 9 (1), 52-60.

Although knowledge about the efficacy of treatments such as pivotal response training (PRT) for children with autism is increasing, studies of large-scale effectiveness for and transportability to diverse community populations are needed. The current study provides a large-scale preliminary assessment of (a) the effectiveness of a community-based parent education PRT intervention and (b) whether specific child variables are associated with outcomes. One hundred fifty-eight families with children having an autism spectrum diagnosis participated. Children were heterogeneous with regards to age, gender, and race/ethnicity. Results indicate that all of the children showed significant improvements in adaptive functioning on the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984). However, younger children (3 years old or younger) showed the least impairment at intake and the most improvement postintervention. This is one of the first large-scale community studies of PRT that included a diverse sample.

LeBlanc, L.A., Geiger, K.B., Sautter, R.A., & Sidener, T.M. (2007) Using the natural language paradigm (NLP) to increase vocalizations of older adults with cognitive impairments. Research in Developmental Disabilities, Vol. 28, 437-444.

The Natural Language Paradigm (NLP) has proven effective in increasing spontaneous verbalizations for children with autism. This study investigated the use of NLP with older adults with cognitive impairments served at a leisure-based adult day program for seniors. Three individuals with limited spontaneous use of functional language participated in a multiple baseline design across participants. Data were collected on appropriate and inappropriate vocalizations with appropriate vocalizations coded as prompted or unprompted during baseline and treatment sessions. All participants experienced increases in appropriate speech during NLP with variable response patterns. Additionally, the two participants with substantial inappropriate vocalizations showed decreases in inappropriate speech. Implications for intervention in day programs are discussed.

Vismara, L.A., & Lyons, G.L. (2007). Using perseverative interests to elicit joint attention behaviors in young children with autism: Theoretical and clinical implications to understanding motivation. Journal of Positive Behavior Interventions, 9, 214-228.

Various explanations have been offered in the literature on the underlying cause of joint attention deficits in autism. One possible explanation is that children with autism are capable of producing joint attention but are lacking the social motivation to share their interests with others. The current study used a single-subjects reversal design with alternating treatments to examine whether joint attention initiations for social sharing would occur as a collateral effect of utilizing the motivational techniques of Pivotal Response Treatment in conjunction with perseverative interest stimuli for three young non-verbal children with autism. Results indicated an immediate increase in joint attention initiations when perseverative, or highly-preferred, interests were incorporated within the motivational techniques of Pivotal Response Treatment. Additional findings included collateral increases in joint attention initiations toward less preferred interests, as well as improvements in the quality of interaction between the children and caregivers. Findings are discussed in terms of theoretical and clinical implications for understanding the role of motivation in facilitating the development of joint attention in autism.

2005

Sherer, M.R. & Schreibman, L. (2005) Individual behavioral profiles and predictors of treatment effectiveness for children with autism. Journal of Consulting and Clinical Psychology, Vol. 73 (3), 525-538.

Differential responsiveness to intervention programs suggests the inadequacy of a single treatment approach for all children with autism. One method for reducing outcome variability is to identify participant characteristics associated with different outcomes for a specific intervention. In this investigation, an analysis of archival data yielded 2 distinct behavioral profiles for responders and nonresponders to a widely used behavioral intervention, pivotal response training (PRT). In a prospective study, these profiles were used to select 6 children (3 predicted responders and 3 predicted nonresponders) who received PRT. Children with pretreatment responder profiles evidenced positive changes on a range of outcome variables. Children with pretreatment nonresponder profiles did not exhibit improvements. These results offer promise for the development of individualized treatment protocols for children with autism.

2003

The purpose of this study was to assess whether children with autism could be taught a child-initiated query as a pivotal response to facilitate the use of grammatical morphemes. Data were collected within the context of a multiple baseline design across two children who lacked the use of temporal morphemes. Results of the study indicated that both children learned the self-initiated strategy and both acquired and generalized the targeted morpheme. Additionally, generalized use of the self-initiation into other question forms and concomitant increases in mean length of utterance, verb acquisition, and diversity of verb use occurred for both children. These generalized effects and the applications of this procedure across linguistic targets are discussed.

1999

Koegel, L. K., Koegel, R. L., Harrower, J. K., Carter, C. M. (1999). Pivotal response intervention I: Overview of approach. Journal of the Association for Persons with Severe Handicaps, 24, 174-185.

Presents an overview of several pivotal response interventions for autistic children. Teaching in pivotal areas constitutes an efficient and effective mode of intervention in overcoming the number of difficulties that exist for children with severe disabilities. Key pivotal areas include responsivity to multiple cues, observable motivation to initiate and respond appropriately to social and environmental stimuli, and self-regulation of behavior. Approaches to teaching multiple cues include within-stimulus prompting and conditional discrimination. Motivation techniques include child choice, natural reinforcers, interspersed maintenance trials, and reinforcing attempts. The goal of the model is to provide autistic individuals with the social and functional proficiency to participate in enriched and meaningful lives in inclusive settings.

Koegel, L. K., Koegel, R. L., Shoshan, Y., McNerney, E. (1999). Pivotal response intervention II: Preliminary long-term outcomes data. Journal of the Association for Persons with Severe Handicaps, 24 (3): p. 186-198.

Examined the degree to which self-initiation was associated with highly favorable postintervention outcome in treating autism. In phase 1 of the Exp, 3 children achieving a highly favorable outcome to a treatment intervention and 3 who responded unfavorably (aged 3 yrs at program entry) were retrospectively examined concerning self-initiating behaviors. Results show that those with favorable outcomes exhibited more spontaneous self-initiations at preintervention. Results of phase 2 of the Exp,comprising 10 autistic children (aged 2-3 yrs at program entry) show that Subjects could be taught self-initiating behavior, thereby leading to highly favorable treatment outcomes, based on data collected several years subsequent to intervention. It is concluded that social communicative initiation is a pivotal behavior in autism treatment.

1998

Koegel, L. K., Camarata, S. M., Valdez-Menchaca, M. C., & Koegel, R. L. (1998). Teaching children with autism to use self-initiated strategy to learn expressive vocabulary. American Journal of Mental Retardation, 102, 346-357.

Examined whether motivational procedures incorporated into teaching question-asking to 3 children (aged 3.75-5.42 yrs) with autism, who lack verbal initiations, would result in generalization without additional teaching, prompting, or reinforcement in other settings. Specifically, the authors assessed whether such children could learn to use questions and whether the spontaneous use of question-asking would generalize across stimuli, settings, and people. All children learned to use questions in relation to items they had previously been unable to label and demonstrated generalization of spontaneous question-asking to new items and to their home environments with their mothers, with concomitant gains in expressive vocabulary. Results are discussed in terms of teaching response strategies, such as question-asking, to promote spontaneous child-initiated social interactions and expressive language development.

Koegel, R. L., Camarata, S., Koegel, L. K., Ben-Tall, A., & Smith, A. E. (1998). Increasing speech intelligibility in children with autism. Journal of Autism and Developmental Disorders, 28, 241-251.

Systematically compared 2 intervention conditions, a Naturalistic approach (which incorporated motivation variables) vs an Analog (more traditional, structured) approach. Subjects were 4 male and 1 female 3.7-7.5 yr olds with autism. Developmentally similar speech sounds were equated within and across conditions for each child. Data indicate that although both methods effectively increased correct production of the target sounds under some conditions, functional use of the target sound in conversation occurred only when the naturalistic procedures were used during intervention. Results are discussed in terms of pivotal variables that may produce improvements in speech sounds during conversational speech.

Koegel, L.K., Camarata, S.M., Valdez-Menchaca, M., & Koegel, R.L.(1998). Setting generalization of question-asking by children with autism. American Journal on Mental Retardation, 102(4) , 346-357.

Examined whether motivational procedures incorporated into teaching question-asking to 3 children (aged 3.75-5.42 yrs) with autism, who lack verbal initiations, would result in generalization without additional teaching, prompting, or reinforcement in other settings. Specifically, the authors assessed whether such children could learn to use questions and whether the spontaneous use of question-asking would generalize across stimuli, settings, and people. All children learned to use questions in relation to items they had previously been unable to label and demonstrated generalization of spontaneous question-asking to new items and to their home environments with their mothers, with concomitant gains in expressive vocabulary. Results are discussed in terms of teaching response strategies, such as question-asking, to promote spontaneous child-initiated social interactions and expressive language development.

1997

Pierce, K. & Schreibman, L. (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, Vol. 30, 157-160.

Two children with autism and 8 typical peers participated in a study designed to replicate an earlier finding of successful social-skills intervention for children with autism using peer implemented pivotal response training (PRT) and to assess the effects of using multiple peer trainers on generalization of treatment effects. During training, peers were taught PRT strategies using didactic instruction, modeling, role playing, and feedback. After treatment, children with autism engaged in increased levels of social behavior.

1996

Assessed the collateral effects of 2 parent training paradigms: (1) focused on teaching individual target behaviors (ITBs) serially, and (2) focused on teaching the pivotal responses (PRs) of motivation and responsivity to multiple cues. 17 Ss with autism (aged 3-9 yrs) and their families were randomly assigned to either ITB or PR training. Pretraining and post-parent-training videotapes of dinnertime interactions were scored randomly across 4interactional scales (level of happiness, interest, stress, and style of communication). Results obtained for the 4 scales show that the families in both conditions initially scored in the neutral range, and the ITB training produced no significant influence on interactions posttraining. The PR training resulted in the families showing positive interactions on all 4 scales, suggesting high degrees of happiness and interest, low stress during the interaction, and more positive communication.

Pierce, K. & Schreibman, L. (1995) Increasing complex social behaviors in children with autism: Effects of peer-implemented pivotal response training. Journal of Applied Behavior Analysis, Vol. 28, 285-295.

Two children with autism were taught to engage in a variety of complex social behaviors using peer-implemented pivotal response training (PRT), a set of procedures designed to increase motivation and promote generalization. Typical peers were taught to implement PRT strategies by modeling, role playing, and didactic instruction. After training, peers implemented the procedures in the absence of direct supervision in a classroom environment. After the intervention, both children with autism maintained prolonged interactions with the peer, initiated play and conversations, and increased engagement in language and joint attention behaviors. In addition, teachers reported positive changes in social behavior, with the largest increases in peer-preferred social behavior. Further, these effects showed generality and maintenance. Implications of these findings are discussed.

Stahmer, A.C. (1995) Teaching symbolic play skills to children with autism using pivotal response training. Journal of Autism and Developmental Disorders, Vol. 25 (2), 123-141.

Used Pivotal Response Training (PRT) to teach 7 children with autism to engage in symbolic play behaviors. Symbolic play, complexity of play behavior, and creativity of play were assessed. In addition, generalization measures were obtained across settings, toys, and play partners. Interaction with the play partners and comparison with typical controls were also examined. Results indicated that children with autism rarely exhibited symbolic play before training or after a control condition. After specific symbolic play training using PRT, all of the children learned to perform complex and creative symbolic play actions at levels similar to that of language-matched (typical controls. In most cases the children generalized their play to new toys, environments, and play partners and continued to engage in symbolic play behavior after a 3-month follow-up period. In addition, interaction skills improved after training. Treatment implications for these findings are discussed.

Thorp, D.M., Stahmer, A.C. & Schreibman, L.(1995) Effects of sociodramatic play training on children with autism. Journal of Autism and Developmental Disorders, Vol. 25 (3), 265-282.

Assessed the effects of teaching sociodramatic play to 3 boys (aged 5 yrs 4 mo, 8 yrs 2 mo, and 9 yrs 9 mo) with autism. Ss' expressive language ages ranged from 3 yrs 7 mo to 5 yrs 2 mo. Training was conducted using a variation of pivotal response training, a program used to teach language to children with autism. Measures of play skills, social behavior, and language skills were obtained before and after treatment and at a 3-mo follow-up session. The correlation between language and pretend play was explored, as was the relationship between sociodramatic play and social competence. Positive changes were observed in play, language, and social skills. These changes generalized across toys and settings, although little generalization to other play partners occurred. Effects of play training with children with autism and maintenance of behavior change are discussed.

1992

Koegel, R.L., Koegel, L.K., & Surratt. (1992) Language intervention and disruptive behavior in preschool children with autism. Journal of Autism and Developmental Disorders, Vol. 22(2), 141-153.

Examined whether the incorporation of parameters of natural language interactions and motivational techniques reduces disruptive behavior during language teaching tasks. Within a repeated reversals design with order of conditions and number of sessions varied within and across 3 autistic children (aged 3 yrs 4 mo to 4 yrs 6 mo), treatment was conducted for 2 language teaching conditions. During 1 condition, trials were presented serially in a traditional analog clinical format where the therapist presented instructions, prompts, and reinforcers for correct responses. The other condition incorporated parameters of natural language interactions and natural motivational techniques, such that stimulus items were functional and varied. Communicative attempts were reinforced. Greater improvements in responding and considerably less disruptive behavior occurred during the natural language teaching conditions.

1991

Schreibman, L., Kaneko, W.M., & Koegel, R.L. (1991) Positive affect of parents of autistic children: A comparison across two teaching techniques. Behavior Therapy, Vol. 22(4), 479-490.

Compared parental affect of 19 parents of autistic children across 2 parent training techniques: individual target behavior (ITB) or pivotal response training (PRT). 120 undergraduates who served as judges were asked to rate positive affect of Ss as they worked in one-on-one training sessions with their children. Results indicate that Ss implementing the PRT procedure were rated as exhibiting significantly more positive affect than those Ss implementing the ITB procedure. Results also support the hypothesis that the interactions inherent in the PRT procedures may represent more natural parent-child interactions and are more pleasant for the parents to conduct than the highly structured interactions associated with the ITB form of treatment.

1988

Laski, K.E., Charlop, M.H., & Schreibman, L. (1988) Training parents to use the natural language paradigm to increase their autistic children's speech. Journal of Applied Behavior Analysis, Vol. 21, 391-400.

Parents of four nonverbal and four echolalic autistic children were trained to increase their children's speech by using the Natural Language Paradigm (NLP), a loosely structured procedure conducted in a play environment with a variety of toys. Parents were initially trained to use the NLP in a clinic setting, with subsequent parent-child speech sessions occurring at home. The results indicated that following training, parents increased the frequency with which they required their children to speak (i.e., modeled words and phrases, prompted answers to questions). Correspondingly, all children increased the frequency of their verbalizations in three nontraining settings. Thus, the NLP appears to be an efficacious program for parents to learn and use in the home to increase their children's speech.

1987

Assessed whether 2 nonverbal autistic children (aged 4 yrs 5 mo and 5 yrs 8 mo) would increase their verbal responding in a language intervention program if specific variables were manipulated in a natural language teaching paradigm. Within a multiple baseline design, treatment was conducted in a baseline condition with trials presented serially in a traditional analog clinical format where the therapist presented instructions, prompts, and reinforcers for correct responses. Variables were manipulated in the natural language teaching condition such that (1) stimulus items were functional and varied, (2) natural reinforcers were employed, (3) communicative attempts were also reinforced, and (4) trials were conducted within a natural interchange. Treatment and generalization data demonstrate broadly generalized treatment gains.

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