The effectiveness of Pivotal Response Treatment in children and adolescents with autism spectrum disorder: a randomized clinical trail

Autism spectrum disorder (ASD) is characterized by persistent deficits in
social communication and social interaction and restricted, repetitive patterns
of behaviour, interests, or activities (APA, 2013). Despite the large variety
of treatment methods for ASD (Seida et al., 2009), sufficient scientific
evidence for the effectiveness of the interventions in targeting the core
symptoms of ASD (i.e. social communication and social interaction) is lacking.
A promising intervention that targets the core symptoms of ASD is Pivotal
Response Treatment (PRT) (Koegel & Koegel, 2006). Earlier studies have shown
that PRT, by targeting those pivotal areas, is effective in improving a variety
of social and communicative skills in children with ASD, including joint
attention (Vismara & Lyons, 2007), turn taking (Harper, Symon, & Frea, 2008),
question asking (Koegel, Camarata, Valdez-Menchaca, & Koegel, 1998; Koegel,
Koegel, Green-Hopkins, & Barnes, 2010) and spontaneous initiations (Kuhn,
Bodkin, Devlin, & Doggett, 2008; Pierce & Schreibman, 1995). However, the
majority of studies is conducted in children under the age of 6 (Verschuur,
Didden, Lang, Sigafoos, & Huskens, 2014) and consequently, sufficient
scientific evidence that supports the use of PRT in older children and
adolescents is lacking.The current study aims to investigate the promising
treatment option, PRT in a highly needed target population (i.e. school-aged
children and adolescents with ASD). If PRT is effective in significantly
reducing the core symptoms of ASD in this age group, PRT will be further
implemented within Karakter and The Netherlands.

Primary Objective:
The main objective is to investigate the effectiveness of PRT compared to CAU
in school-aged children and adolescents with ASD.
The primary research question is:
1) Directly after treatment and at follow-up, what is the effectiveness of PRT
compared to care-as-usual in improving:
-child social and communicative skills?


Secondary Objectives:
2) Which child, parent and structural intervention factors
(predictors/moderators) have influence on effectiveness of treatment?
3) Compared to care-as-usual, what is the effectiveness of PRT in improving
child clinical global functioning?
4) Compared to care-as-usual, what is the effectiveness of PRT in improving
feelings of competence in parents?
5) Compared to care-as-usual, what is the effectiveness of PRT in improving
parent-child interaction?

A randomized controlled trail with partly blinded measures at end-point and
follow-up.

Participants are randomized to one of the following conditions:
1) PRT condition: PRT on top of psycho-education
2) CAU condition: regular treatment of ASD (e.g. guidance of parents) on top of
psycho-education

Patients and their parents/caregivers in both treatment groups (PRT and CAU)
are expected to highly benefit from their treatment. Both groups receive
psycho-education on ASD prior to treatment and medical management is continued,
when necessary. In both groups, trained clinicians focused on ASD provide
high-quality care. Within both groups, gains are expected in both child-related
factors (e.g. lower severity of symptoms) and parent-related factors (e.g.
lower parenting stress).
The study is highly therapeutic and is expected to be highly beneficial for
both subjects and their parents/caregivers. The risk of participating in the
study are considered negligible and the burden associated with participation is
estimated to be very low.