the prt pocket guide - brookes publishing co....overcoming autism: finding the answers, strategies,...

The PRT Pocket GuidePivotal Response Treatment

for Autism Spectrum Disorders

Baltimore • London • Sydney

by

Robert L. Koegel, Ph.D.

and

Lynn Kern Koegel, Ph.D.

Koegel Autism CenterUniversity of California, Santa Barbara

with invited contributor

Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.

Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved

FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide

v

Contents

About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

For the Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

I What Is the P in PRT?

1 Treatment of Pivotal Areas . . . . . . . . . . . . . . . . . . . . . . . . . 13

2 How to Teach the Pivotal Area of Motivation . . . . . . . . . 39

3 How to Get Rid of Disruptive Behavior . . . . . . . . . . . . . . 65

4 How to Teach the Pivotal Area of Self-Initiation . . . . . . . 73

II How and When to Implement Treatment

5 Maximizing Family Involvement . . . . . . . . . . . . . . . . . . . 105

6 How to Minimize Parent Stress . . . . . . . . . . . . . . . . . . . . 123

7 Treatment and Assessment in Natural Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

8 Making Data Collection Easy in PRT . . . . . . . . . . . . . . . . 163 8 with Sarah Kuriakose

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

v




vii

About the Authors

Robert L. Koegel, Ph.D., has focused his career in the area of autism, special-izing in language interven-tion, family support, and school inclusion. Dr. Robert L. Koegel is Director of the Koegel Autism Center at the University of California, Santa Barbara. He has pub-

lished more than 200 articles and papers relating to the treat-ment of autism, has published six books on the treatment of autism and positive behavioral support, and is Editor of the Journal of Positive Behavior Interventions. Models of his proce-dures have been used in public schools and in parent edu-cation programs throughout the United States and in other countries. He has trained many health care and special edu-cation leaders in the United States and abroad.

Lynn Kern Koegel, Ph.D., is Director of Clinical Services at the Koegel Autism Center and Director of the Eli and Edythe L. Broad Center for Asperger’s Research. She has been active in the development of programs to improve communication in children with autism, including the development of first words, grammatical structures, pragmatics, and social con-versation. In addition to her published books and articles in the area of communication and language development, Dr. Lynn Kern Koegel has developed and published procedures and field manuals in the area of self-management and func-tional analysis that are used in school districts and by par-ents throughout the United States and have been translated into other major languages. Dr. Lynn Kern Koegel is the




viii � About the Authors

author of Overcoming Autism: Finding the Answers, Strategies, and Hope that Can Transform a Child’s Life (Viking/Penguin, 2004) and Growing Up on the Spectrum (Viking/Penguin, 2009) with Claire LaZebnik.

The Koegels are the developers of Pivotal Response Treatment, which focuses on motivation. They were the re-cipients of the first annual Children’s Television Workshop Sesame Street Award for brightening the lives of children and the first annual Autism Speaks award for science and research. In addition, Dr. Lynn Kern Koegel appeared on ABC’s hit show Supernanny, working with a child with au-tism. The University of California, Santa Barbara, received a $2.35 million gift to expand the physical space of the Autism Research and Training Center, which was renamed the Koegel Autism Center in recognition of the Koegels’ work on behalf of children with autism, and a large gift from the Eli and Edythe L. Broad Foundation to start a center for Asperger syndrome research, which is now part of the Koegel Autism Center.




1

Introduction

Pivotal Response Treatment (PRT) is one of the few evi-dence-based approaches for the treatment of autism. That is, the approach is supported by research that meets the stan-dards set by many professional agencies and organizations, such as the American Psychological Association. That’s im-portant because supporting children and families affected by autism is a race against time. Families can’t afford to repeatedly go up blind alleys with treatment procedures that sound good but have no evidence to support their ef-fectiveness in helping children with autism. Each day more children are diagnosed with autism, and they need instruc-tion and intervention in many different areas. Furthermore, early intervention is effective—partly because it keeps bad habits from getting started (habits that would be hard to break), but also because without intervention kids on the autism spectrum get worse, whereas with intervention they get better. Although it’s never too late, the earlier any com-munication delays and social challenges are addressed, the sooner parents, teachers, and therapists can start helping the kids learn what they’ll need to survive and thrive. PRT focuses on core underlying areas that are critical for children with autism. Functionally, the major core area—which affects all other areas—is motivation to engage in social communication. That core area is linked both to un-derlying neurological bases and to thousands of individual behaviors that are affected by the motivational problem as the children develop. The figure on the next page shows the many interrelationships addressed by PRT.




2 � Introduction

It’s also important to understand that the PRT proce-dures were developed over many, many years and that there are now hundreds of studies showing their effectiveness. PRT is based on behavioral intervention, a method devel-oped in earlier work in the field of applied behavior analysis that is also supported by plenty of research that documents its effectiveness as an approach for autism. In general, for all behavioral interventions, the standards for documenting treatment effectiveness require multiple research studies

NEUROBIOLOGICAL BASE

CORE PROBLEM

AREALack of

motivation to engage in social

communication

PRIMARY DIAGNOSTIC

CRITERIACommunication

disabilitySocial disability

Restricted interests

PIVOTAL RESPONSE

TREATMENT (PRT)

Motivation to initiate and respond to

complex social, linguistic, and

academic interventions

THOUSANDS OF

PERIPHERAL FEATURES

Language (i.e., vocabulary,

syntax, semantics, phonology)

Pragmatics (e.g., eye contact, mannerisms,

prosody)Self-helpAcademic

Many more

Environmental feedback

Self-regulation

A model of pivotal response intervention.




Introduction � 3

conducted by several independent researchers using either randomized, controlled experimental designs or rigorous single-case experimental designs, or both. (See Chambless & Ollendick, 2001, for a general description of these stan-dards.) In short, this means that not only have we succeeded with research conducted in our own clinics, but that other researchers, working in other clinics and using a variety of different experimental designs, have also found the same positive results. This duplication shows that there isn’t bias on our part. It really works. Another important point is that not only has the PRT “package” been shown to make real and significant changes, but every component of PRT has also been tested individually and found to be valuable in intervention (see R.L. Koegel, Koegel, & Camarata, 2010; R.L. Koegel, Koegel, Vernon, & Brookman-Frazee, 2010; National Autism Center, 2009; National Research Council, 2001; Odom, Boyd, Hall, & Hume, 2010a, 2010b; Simpson, 2005). As we’ll repeat many times in this book, there are a lot of packaged autism inter-ventions out there—some we’ve all heard of—for which the proponents haven’t shown that the individual components work. Using those interventions may be wasting valuable time teaching behaviors that just aren’t helpful for the child. It’s important to note that because PRT is scientifically based, it continues to evolve, with new components being added as they are discovered. This point is critical, because all the answers aren’t in yet, and there are always improve-ments that can be made. As new ways to teach or to teach more effectively are found—so the kids will learn faster and have more fun—the methods will continue to change. As an example, as the PRT approach has been developed and re-fined over the years, it has gone by several different names. When it was first applied specifically to communication, as in the original studies focused on teaching first words, it was called the “Natural Language Paradigm,” or NLP for




4 � Introduction

short. It got that name because the motivational compo-nents incorporated into the treatment for communication resembled natural interactions with children, as opposed to the more structured, drill-type interventions that were com-monly used at that time. Through further research, it became clear that the ap-proach was surprisingly effective in many areas beyond communication. Thus, the approach began to go by the name “Pivotal Response Treatment” to reflect its impact on thousands of behaviors within the overall condition of autism. The table summarizes the evidence supporting the comprehensive PRT package. There are four primary reasons why empirical evidence is important when choosing which treatment approach to use.

1. Empirical evidence separates approaches that really work from approaches that are mere fantasy and hype or are simply less effective. Don’t be fooled by fancy brochures and treatment providers claiming to have the “latest and greatest” interventions for autism. That’s unlikely. Because nonscientific approaches may sound good on paper or in dramatic speeches by celebrities, one can be easily deceived by rhetoric and fancy sales pitches.

2. Certifying agencies, as well as credentialing and licensing bodies, are increasingly requiring profession-als to use approaches that are backed by sound scientific evidence, making those who use non–evidence-based approaches increasingly vulnerable to lawsuits. Don’t get caught in that situation, as you’ll look extremely ill informed in court.

3. Insurance companies and other third-party funding agencies are refusing to pay for treatments that do not have scientific evidence to back their effectiveness. It may sound superficial, but someone has to pay for the treatment, and no one wants to pay for something that doesn’t work!




5

Sum

mar

ized

em

piri

cal s

upp

ort

for

Pivo

tal R

esp

onse

Tre

atm

ent

(PRT

)

Stud

yTi

tleN

otab

le t

reat

men

t ou

tcom

e(s)

Ori

gin

al P

RT s

tud

ies

R.L.

Koe

gel

, O’D

ell,

and

Koe

gel (

1987

)A

Nat

ural

Lan

gua

ge

Para

dig

m

for

Teac

hing

Non

verb

al A

utis

tic

Chi

ldre

n

Chi

ldre

n p

rod

uced

mor

e im

itativ

e an

d s

pon

tane

ous

utte

ranc

es in

PRT

co

nditi

on t

han

in t

rad

ition

al d

iscr

ete

tria

l tra

inin

g. G

ener

aliz

atio

n of

tr

eatm

ent

gai

ns o

ccur

red

onl

y in

PRT

con

diti

on.

R.L.

Koe

gel,

Koe

gel,

and

Surr

att

(199

2)La

ngua

ge

Inte

rven

tion

and

D

isru

ptiv

e B

ehav

ior

in P

resc

hool

C

hild

ren

with

Aut

ism

Incr

ease

d la

ngua

ge

resp

ond

ing

and

few

er d

isru

ptiv

e b

ehav

iors

oc

curr

ed d

urin

g t

he P

RT c

ond

ition

com

par

ed t

o tr

aditi

onal

dis

cret

e tr

ial t

rain

ing

.

L.K

. Koe

gel,

Koe

gel,

Shos

han,

and

M

cNer

ney

(1

999)

, Pha

se 1

Pivo

tal R

esp

onse

Inte

rven

tion

II:

Prel

imin

ary

Long

-Ter

m O

utco

me

Dat

a

Look

ing

thr

oug

h re

tros

pec

tive

anal

ysis

, chi

ldre

n w

ith p

oor

and

favo

rab

le

outc

omes

had

com

par

able

lang

uag

e ag

es a

nd a

dap

tive

beh

avio

r sc

ale

scor

es a

t p

rein

terv

entio

n, b

ut c

hild

ren

who

exh

ibite

d h

igh

leve

ls

of s

pon

tane

ous

initi

atio

ns a

t p

rein

terv

entio

n ha

d m

ore

favo

rab

le

outc

omes

.

L.K

. Koe

gel,

Koe

gel,

Shos

han,

and

M

cNer

ney

(1

999)

, Pha

se 2

Pivo

tal R

esp

onse

Inte

rven

tion

II:

Prel

imin

ary

Long

-Ter

m O

utco

me

Dat

a

Follo

win

g P

RT in

itiat

ion

trai

ning

, chi

ldre

n in

crea

sed

the

ir ad

aptiv

e an

d

pra

gm

atic

sco

res

to n

ear

chro

nolo

gic

al a

ge

leve

l. Th

ey d

id n

ot re

tain

th

eir

dia

gno

sis

of a

utis

m o

r th

eir

spec

ial e

duc

atio

n p

lace

men

ts.

Soci

al/a

cad

emic

func

tioni

ng w

as c

omp

arab

le t

o th

at o

f typ

ical

ly

dev

elop

ing

pee

rs.

L.K

. Koe

gel

, Car

ter,

and

Koe

gel (

2003

)Te

achi

ng C

hild

ren

with

Aut

ism

Sel

f-In

itiat

ions

as

a Pi

vota

l Res

pon

seTh

roug

h PR

T, c

hild

ren

wer

e su

cces

sful

ly t

aug

ht t

o us

e th

e q

uerie

s “W

hat

hap

pen

ed?”

or

“Wha

t’s h

app

enin

g?”

dur

ing

inte

rven

tion.

C

hild

ren

gen

eral

ized

the

use

of -

ing

and

-ed

to

othe

r ve

rbs

and

in

crea

sed

the

ir m

ean

leng

th o

f utt

eran

ce a

nd v

erb

div

ersi

ty.

R.L.

Koe

gel

, Sh

iroto

va, a

nd

Koe

gel

(200

9b)

Brie

f Rep

ort:

Usi

ng In

div

idua

lized

O

rient

ing

Cue

s to

Fac

ilita

te

Firs

t-W

ord

Acq

uisi

tion

in N

on-

resp

ond

ers

with

Aut

ism

PRT

with

ind

ivid

ualiz

ed o

rient

ing

cue

s p

rod

uced

ver

bal

com

mun

icat

ion

gai

ns in

cor

rect

resp

ond

ing

, cor

rect

pho

nem

es, a

nd in

dep

end

ent

wor

d p

rod

uctio

n th

at P

RT w

ithou

t su

ch c

ues

did

not

.

(con

tinue

d)




Stud

yTi

tleN

otab

le t

reat

men

t ou

tcom

e(s)

R.L.

Koe

gel

, Ve

rnon

, and

K

oeg

el (2

009)

Imp

rovi

ng S

ocia

l Ini

tiatio

ns in

Yo

ung

Chi

ldre

n w

ith A

utis

m U

sing

Re

info

rcer

s w

ith E

mb

edd

ed S

ocia

l In

tera

ctio

ns

PRT

with

em

bed

ded

soc

ial i

nter

actio

ns re

sulte

d in

incr

ease

d le

vels

of

child

-initi

ated

soc

ial e

ngag

emen

t d

urin

g c

omm

unic

atio

n, im

pro

ved

no

nver

bal

dya

dic

orie

ntin

g, a

nd h

ighe

r ra

ting

s of

ove

rall

child

affe

ct

com

par

ed t

o th

e no

nem

bed

ded

con

diti

ons.

Ind

epen

den

t re

plic

atio

ns o

f PR

T ef

fect

iven

ess

wit

h or

igin

al la

b c

olla

bor

atio

n

Schr

eib

man

, K

anek

o, a

nd

Koe

gel

(199

1)

Posi

tive

Affe

ct o

f Par

ents

of A

utis

tic

Chi

ldre

n: A

Com

par

ison

Acr

oss

Two

Teac

hing

Tec

hniq

ues

Pare

nts

trai

ned

in P

RT w

ere

obse

rved

dis

pla

ying

sig

nific

antly

mor

e p

ositi

ve a

ffect

tha

n p

aren

ts t

rain

ed in

dis

cret

e tr

ial t

rain

ing

.

R.L.

Koe

gel

, B

imb

ela,

and

Sc

hrei

bm

an

(199

6)

Col

late

ral E

ffect

s of

Par

ent

Trai

ning

on

Fam

ily In

tera

ctio

nsD

iscr

ete

tria

l con

diti

on re

sulte

d in

no

sig

nific

ant

influ

ence

on

inte

ract

ions

, whi

le P

RT re

sulte

d in

pos

itive

par

ent–

child

inte

ract

ions

no

ted

on

ratin

gs

of h

app

ines

s, in

tere

st, s

tres

s, a

nd c

omm

unic

atio

n st

yle

dur

ing

din

nert

ime

pro

bes

.

R.L.

Koe

gel

, C

amar

ata,

K

oeg

el, B

en-T

all,

and

Sm

ith (1

998)

Incr

easi

ng S

pee

ch In

telli

gib

ility

in

Chi

ldre

n w

ith A

utis

mSi

gni

fican

t g

ains

ob

serv

ed in

cor

rect

pro

duc

tion

of t

arg

et s

ound

s an

d

spee

ch in

telli

gib

ility

dur

ing

the

PRT

inte

rven

tion.

L.K

. Koe

gel

, C

amar

ata,

Val

dez

-M

ench

aca,

and

K

oeg

el (1

998)

Sett

ing

Gen

eral

izat

ion

of Q

uest

ion-

Ask

ing

by

Chi

ldre

n w

ith A

utis

mC

hild

ren

lear

ned

in P

RT t

o co

nsis

tent

ly a

nd s

pon

tane

ousl

y in

itiat

e “W

hat’s

tha

t?”

acro

ss t

reat

men

t an

d g

ener

aliz

atio

n se

ttin

gs.

Si

gni

fican

t in

crea

se in

voc

abul

ary

achi

eved

due

to

item

lab

el

acq

uisi

tion.

Bry

son

et a

l. (2

007)

Larg

e Sc

ale

Dis

sem

inat

ion

and

C

omm

unity

Imp

lem

enta

tion

of

Pivo

tal R

esp

onse

Tre

atm

ent:

Pr

ogra

m D

escr

iptio

n an

d

Prel

imin

ary

Dat

a

Prel

imin

ary

dat

a sh

ow t

hat

PRT

pro

vid

ers

who

par

ticip

ated

in la

rge-

scal

e, c

omm

unity

tra

inin

g m

aint

aine

d fi

del

ity o

f im

ple

men

tatio

n ac

ross

tim

e an

d in

crea

sed

the

func

tiona

l ver

bal

utt

eran

ces

of t

he

par

ticip

ant

child

ren.

Sum

mar

ized

em

piri

cal s

upp

ort

for

Pivo

tal R

esp

onse

Tre

atm

ent

(PRT

) (c

ontin

ued

)

6




7

Nef

dt,

Koe

gel

, Si

nger

, and

Ger

ber

(2

010)

The

Use

of a

Sel

f-D

irect

ed L

earn

ing

Pr

ogra

m t

o Pr

ovid

e In

tro d

ucto

ry

Trai

ning

in P

ivot

al R

esp

onse

Tr

eatm

ent

to P

aren

ts o

f Chi

ldre

n w

ith A

utis

m

The

maj

ority

of p

aren

ts p

artic

ipat

ing

in t

he P

RT S

elf-

Dire

cted

Lea

rnin

g

Prog

ram

(DV

D a

nd a

ccom

pan

ying

mat

eria

ls) c

omp

lete

d t

he p

rog

ram

, d

emon

stra

ted

lear

ning

of s

pec

ified

pro

ced

ures

, and

was

ob

serv

ed t

o ap

pea

r m

ore

confi

den

t d

urin

g p

aren

t–ch

ild in

tera

ctio

ns.

Ind

epen

den

t re

plic

atio

ns o

f ef

fect

iven

ess

of P

RT

Lask

i, C

harlo

p-

Chr

isty

, and

Sc

hrei

bm

an

(198

8)

Trai

ning

Par

ents

to

Use

the

Nat

ural

La

ngua

ge

Para

dig

m t

o In

crea

se

Thei

r A

utis

tic C

hild

ren’

s Sp

eech

Aft

er p

aren

t tr

aini

ng in

PRT

at

hom

e an

d in

a c

linic

set

ting

, p

ostt

reat

men

t in

crea

ses

in p

aren

t re

que

sts

for

voca

lizat

ions

wer

e ob

serv

ed, a

s w

ere

incr

ease

s in

chi

ldre

n’s

verb

al re

spon

sive

ness

dur

ing

in

terv

entio

n an

d g

ener

aliz

atio

n.

Pier

ce a

nd

Schr

eib

man

(1

995)

Incr

easi

ng C

omp

lex

Play

in C

hild

ren

with

Aut

ism

via

Pee

r-Im

ple

men

ted

Pi

vota

l Res

pon

se T

rain

ing

Follo

win

g p

eer-

imp

lem

ente

d P

RT, c

hild

ren

incr

ease

d in

tera

ctio

ns t

o a

hig

h le

vel o

f int

erva

ls a

nd in

crea

sed

pla

y an

d c

onve

rsat

ion

initi

atio

ns.

Chi

ldre

n ex

hib

ited

incr

ease

s in

coo

rdin

ated

and

sup

por

ted

join

t at

tent

ion

beh

avio

rs fo

llow

ing

tre

atm

ent.

Thor

p, S

tahm

er,

and

Sch

reib

man

(1

995)

Effe

cts

of S

ocio

dra

mat

ic P

lay

Trai

ning

on

Chi

ldre

n w

ith A

utis

mA

ll ch

ildre

n in

crea

sed

in a

ll p

lay

beh

avio

r m

easu

res

follo

win

g P

RT

teac

hing

of s

ocio

dra

mat

ic p

lay.

Pla

y b

ehav

ior

gai

ns m

aint

aine

d d

urin

g

gen

eral

izat

ion.

Stah

mer

(199

5)Te

achi

ng S

ymb

olic

Pla

y to

Chi

ldre

n w

ith A

utis

m U

sing

Piv

otal

Re

spon

se T

rain

ing

Mod

ified

PRT

usi

ng s

ymb

olic

pla

y as

a t

arg

et b

ehav

ior

incr

ease

d

sym

bol

ic p

lay

and

pla

y co

mp

lexi

ty. T

reat

men

t g

ains

wer

e m

aint

aine

d

dur

ing

gen

eral

izat

ions

acr

oss

toys

, set

ting

s, a

nd p

artn

ers.

Pier

ce a

nd

Schr

eib

man

(1

997)

Mul

tiple

Pee

r U

se o

f Piv

otal

Re

spon

se T

rain

ing

Soc

ial B

ehav

iors

of

Cla

ssm

ates

with

Aut

ism

: Res

ults

fr

om T

rain

ed a

nd U

ntra

ined

Pee

rs

Peer

-imp

lem

ente

d P

RT w

as s

ucce

ssfu

l in

pro

duc

ing

pos

itive

soc

ial

beh

avio

r ch

ang

e ac

ross

mul

tiple

pee

r im

ple

men

ters

. The

soc

ial

beh

avio

r ch

ang

e w

as m

aint

aine

d d

urin

g g

ener

aliz

atio

n w

ith

untr

aine

d p

eers

.

(con

tinue

d)




Stud

yTi

tleN

otab

le t

reat

men

t ou

tcom

e(s)

Sher

er a

nd

Schr

eib

man

(2

005)

Indi

vidu

al B

ehav

iora

l Pro

files

an

d Pr

edic

tors

of T

reat

men

t Ef

fect

iven

ess

for

Chi

ldre

n w

ith

Aut

ism

Chi

ldre

n p

rofil

ed a

s p

red

icte

d re

spon

der

s to

PRT

exh

ibite

d in

crea

ses

in

lang

uag

e, p

lay,

and

soc

ial b

ehav

ior

follo

win

g P

RT in

terv

entio

n.

Bak

er-E

riczé

n,

Stah

mer

, and

B

urns

(200

7)

Chi

ld D

emog

rap

hics

Ass

ocia

ted

with

O

utco

mes

in a

Com

mun

ity-B

ased

Pi

vota

l Res

pon

se T

rain

ing

Pro

gra

m

Follo

win

g a

12-

wee

k PR

T p

aren

t ed

ucat

ion

pro

gra

m, a

ll ch

ildre

n sh

owed

sig

nific

ant

imp

rove

men

t in

ad

aptiv

e b

ehav

ior

scal

e sc

ores

re

gar

dle

ss o

f gen

der

, ag

e, a

nd r

ace/

ethn

icity

of t

he c

hild

ren/

fam

ilies

.

Vis

mar

a an

d L

yons

(2

007)

Usi

ng P

erse

vera

tive

Inte

rest

s to

Elic

it Jo

int A

tten

tion

Beh

avio

rs in

You

ng

Chi

ldre

n w

ith A

utis

m: T

heo r

etic

al

and

Clin

ical

Impl

icat

ions

for

Und

erst

andi

ng M

otiv

atio

n

Usi

ng t

he c

hild

’s p

erse

vera

tive

inte

rest

s in

a P

RT m

odel

incr

ease

d jo

int

atte

ntio

n in

itiat

ions

.

Gill

ett

and

LeB

lanc

(2

007)

Pare

nt-Im

ple

men

ted

Nat

ural

La

ngua

ge

Para

dig

m t

o In

crea

se

Lang

uag

e an

d P

lay

in C

hild

ren

with

Aut

ism

Pare

nt-im

ple

men

ted

PRT

led

to

incr

ease

s in

ove

rall

rate

and

sp

onta

neity

of

utt

eran

ces

for

child

ren.

Chi

ldre

n al

so s

how

ed a

n in

crea

se in

ap

pro

pria

te p

lay.

Par

ents

rat

ed t

he in

terv

entio

n si

mp

le t

o im

ple

men

t an

d e

ndor

sed

con

tinue

d u

se o

f PRT

.

Har

per

, Sym

on, a

nd

Frea

(200

8)Re

cess

Is T

ime-

In: U

sing

Pee

rs t

o Im

pro

ve S

ocia

l Ski

lls o

f Chi

ldre

n w

ith A

utis

m

Peer

imp

lem

enta

tion

of P

RT in

crea

sed

initi

atio

ns a

nd t

urn-

taki

ng

initi

atio

ns.

8

Sum

mar

ized

em

piri

cal s

upp

ort

for

Pivo

tal R

esp

onse

Tre

atm

ent

(PRT

) (c

ontin

ued

)




Introduction � 9

4. Serious problems can occur when approaches that have not been properly tested are employed: In addition to wasting the children’s valuable time, untested procedures are often found to be risky or dangerous, and using them may create problems that are greater than the original symp-toms of autism. Take the casein-free diet, for example. Many parents put their children on this diet, only to find that it results in low bone density after several years—and studies now show that it doesn’t help the symptoms of autism. In short, remember that evidence-based procedures are essen-tial, valuable, and available. Beware of snake-oil salesmen!

This book presents scientifically based and practical intervention procedures that can be implemented in every-day settings; are easy and fun to implement; and produce valuable treatment gains for children with autism, as well as benefits for the entire family’s lifestyle. PRT has been used effectively for more than 25 years with hundreds of thou-sands of families. By focusing on several foundational areas of development in children, PRT results in life-changing improvements for children with an autism diagnosis. The following chapters will highlight each of the pivotal areas and provide details on effective implementation and ex-pected outcomes.




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