Abstract
Pivotal Response Treatment (PRT) is a popular intervention for improving targeted and untargeted communication skills for learners with autism. We systematically reviewed communication outcomes reported in experimental research to determine linguistic forms and verbal behavior functions associated with PRT. We found most researchers aggregated results or did not report sufficient detail to determine linguistic forms and/or verbal behavior functions. Generalization of communication skills to untargeted people, settings, materials, and/or activities was evident. However, only one study clearly indicated untargeted linguistic forms emerged following PRT, and no researchers described results that indicated improved generalized and collateral verbal behavior functions. We suggest PRT researchers more clearly define and report primary, generalized, and collateral communication-specific outcomes in order to advance research and practice.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
*References marked with an asterisk indicate studies included in the systematic review
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Bail, C. A. (2016). Combining natural language processing and network analysis to examine how advocacy organizations stimulate conversation on social media. Proceedings of the National academy of Sciences of the United States of America,113, 11823–11828. https://doi.org/10.1073/pnas.1607151113.
*Baker-Ericzén, 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,9, 52–60. https://doi.org/10.1177/10983007070090010601.
Barbu, E., Martín-Valdivia, M. T., Martínez-Cámara, E., & Ureña-López, L. A. (2015). Language technologies applied to document simplification for helping autistic people. Expert Systems with Applications,42, 5076–5086. https://doi.org/10.1016/j.eswa.2015.02.044.
Barokova, M., & Tager-Flusberg, H. (2018). Commentary: Measuring language change through natural language samples. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-018-3628-4.
*Berman, S., Ventola, P., & Gordon, I. (2018). Improvements in micro level indices of social communication following Pivotal Response Treatment (PRT). Research in Autism Spectrum Disorders,51, 56–65. https://doi.org/10.1016/j.rasd.2018.04.003.
Bloom, L., & Lahey, M. (1978). Language development and language disorders. New York, NY: John Wiley and Sons.
Bloomfield, L. (1933). Language. London: Compton Printing, Ltd.
Boudreau, A. M., Corkum, P., Meko, K., & Smith, I. M. (2015). Peer-mediated pivotal response treatment for young children with autism spectrum disorders: A systematic review. Canadian Journal of School Psychology,30, 218–235. https://doi.org/10.1177/0829573515581156.
Bozkus-Genc, G., & Yucesoy-Ozkan, S. (2016). Meta-analysis of pivotal response training for children with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities,51, 13–26.
*Brookman-Frazee, L., & Koegel, R. L. (2004). Using parent/clinician partnerships in parent education programs for children with autism. Journal of Positive Behavior Interventions,6, 195–213. https://doi.org/10.1177/10983007040060040201.
Buckley, S. D., & Newchok, D. K. (2005). Differential impact of response effort within a response chain on use of mands in a student with autism. Research in Developmental Disabilities,26, 77–85. https://doi.org/10.1016/j.ridd.2004.07.004.
Cadogan, S., & McCrimmon, A. W. (2015). Pivotal response treatment for children with autism spectrum disorder: A systematic review of research quality. Developmental Neurorehabilitation,18, 137–144. https://doi.org/10.3109/17518423.2013.845615.
*Carter, C. M. (2001). Using choice with game play to increase language skills and interactive behaviors in children with autism. Journal of Positive Behavior Interventions,3, 131–151. https://doi.org/10.1177/109830070100300302.
*Coolican, J., Smith, I. M., & Bryson, S. E. (2010). Brief parent training in pivotal response treatment for preschoolers with autism. Journal of Child Psychology and Psychiatry,51, 1321–1330. https://doi.org/10.1111/j.1469-7610.2010.02326.x.
Eigsti, I.-M., de Marchena, A. B., Schuh, J. M., & Kelley, E. (2011). Language acquisition in autism spectrum disorders: A developmental review. Research in Autism Spectrum Disorders,5, 681–691. https://doi.org/10.1016/j.rasd.2010.09.001.
*Elliott, R. O., Hall, K., & Soper, H. V. (1991). Analog language teaching versus natural language teaching: Generalization and retention of language learning for adults with autism and mental retardation. Journal of Autism and Developmental Disorders,21, 433–447. https://doi.org/10.1007/bf02206869.
*Feldman, E. K., & Matos, R. (2013). Training paraprofessionals to facilitate social interactions between children with autism and their typically developing peers. Journal of Positive Behavior Interventions,15, 169–179. https://doi.org/10.1177/1098300712457421.
*Fossum, K.-L., Williams, L., Garon, N., Bryson, S. E., & Smith, I. M. (2018). Pivotal response treatment for preschoolers with autism spectrum disorder: Defining a predictor profile. Autism Research,11, 153–165. https://doi.org/10.1002/aur.1859.
*Gengoux, G. W., Berquist, K. L., Salzman, E., Schapp, S., Phillips, J. M., Frazier, T. W., et al. (2015). Pivotal response treatment parent training for autism: Findings from a 3-month follow-up evaluation. Journal of Autism and Developmental Disorders,45, 2889–2898. https://doi.org/10.1007/s10803-015-2452-3.
*Gianoumis, S., Seiverling, L., & Sturmey, P. (2012). The effects of behavior skills training on correct teacher implementation of natural language paradigm teaching skills and child behavior. Behavioral Interventions,27, 57–74. https://doi.org/10.1002/bin.1334.
*Gillett, J. N., & LeBlanc, L. A. (2007). Parent-implemented natural language paradigm to increase language and play in children with autism. Research in Autism Spectrum Disorders,1, 247–255. https://doi.org/10.1016/j.rasd.2006.09.003.
Grow, L. L., & Kodak, T. (2010). Recent research on emergent verbal behavior: Clinical applications and future directions. Journal of Applied Behavior Analysis,43, 775–778.
Hale, C. M., & Tager-Flusberg, H. (2005). Brief report: The relationship between discourse deficits and autism symptomatology. Journal of Autism and Developmental Disorders,35, 519–524. https://doi.org/10.1007/s10803-005-5065-4.
*Hardan, A. Y., Gengoux, G. W., Berquist, K. L., Libove, R. A., Ardel, C. M., Phillips, J., et al. (2015). A randomized controlled trial of Pivotal Response Treatment Group for parents of children with autism. Journal of Child Psychology and Psychiatry,56, 884–892. https://doi.org/10.1111/jcpp.12354.
*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,38, 815–826. https://doi.org/10.1007/s10803-007-0449-2.
*Huskens, B., Reijers, H., & Didden, R. (2012). Staff training effective in increasing learning opportunities for school-aged children with autism spectrum disorders. Developmental Neurorehabilitation,15, 435–447. https://doi.org/10.3109/17518423.2012.705910.
Iacono, T., Trembath, D., & Erickson, S. (2016). The role of augmentative and alternative communication for children with autism: Current status and future trends. Neuropsychiatric Disease and Treatment,12, 2349–2361. https://doi.org/10.2147/NDT.S95967.
Jurgens, A., Anderson, A., & Moore, D. W. (2009). The effect of teaching PECS to a child with autism on verbal behaviour, play, and social functioning. Behaviour Change,26, 66–81.
Kelley, M. E., Shillingsburg, M. A., Castro, M. J., Addison, L. R., & LaRue, R. H. (2007). Further evaluation of emerging speech in children with developmental disabilities: Training verbal behavior. Journal of Applied Behavior Analysis,40, 431–445.
*Kim, S., Koegel, R. L., & Koegel, L. K. (2017). Training paraprofessionals to target socialization in students with ASD: Fidelity of implementation and social validity. Journal of Positive Behavior Interventions,19, 102–114.
Koegel, L. K. (2000). Interventions to facilitate communication in autism. Journal of Autism and Developmental Disorders,30, 383–391. https://doi.org/10.1023/A:1005539220932.
*Koegel, R. L., Bradshaw, J. L., Ashbaugh, K., & Koegel, L. K. (2014). Improving question-asking initiations in young children with autism using Pivotal Response Treatment. Journal of Autism and Developmental Disorders,44, 816–827.
Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social, & academic development. Baltimore, MD: Paul H. Brookes Publishing Co.
Koegel, R. L., & Koegel, L. K. (2019). Pivotal response treatment for autism spectrum disorders (2nd ed.). Baltimore, MD: Paul H. Brookes Publishing Co.
Koegel, L. K., Koegel, R. L., Green-Hopkins, I., & Barnes, C. C. (2010). Brief report: Question-asking and collateral language acquisition in children with autism. Journal of Autism and Developmental Disorders,40, 509–515. https://doi.org/10.1007/s10803-009-0896-z.
*Koegel, R. L., Koegel, L. K., & Surratt, A. (1992). Language intervention and disruptive behavior in preschool children with autism. Journal of Autism and Developmental Disorders,22, 141–153. https://doi.org/10.1007/BF01058147.
*Koegel, L. K., Kuriakose, S., Singh, A. K., & Koegel, R. L. (2012a). Improving generalization of peer socialization gains in inclusive school settings using initiations training. Behavior Modification,36, 361–377. https://doi.org/10.1177/0145445512445609.
Koegel, L., Matos-Freden, R., Lang, R., & Koegel, R. (2012b). Interventions for children with autism spectrum disorders in inclusive school settings. Cognitive and Behavioral Practice,19, 401–412. https://doi.org/10.1016/j.cbpra.2010.11.003.
*Koegel, R. L., O’Dell, M. C., & Koegel, L. K. (1987). A natural language teaching paradigm for nonverbal autistic children. Journal of Autism and Developmental Disorders,17, 187–200. https://doi.org/10.1007/bf01495055.
*Koegel, R. L., Shirotova, L., & Koegel, L. K. (2009a). Brief report: Using individualized orienting cues to facilitate first-word acquisition in non-responders with autism. Journal of Autism and Developmental Disorders,39, 1587–1592.
*Koegel, R. L., Symon, J. B., & Koegel, L. K. (2002). Parent education for families of children with autism living in geographically distant areas. Journal of Positive Behavior Interventions,4, 88–103. https://doi.org/10.1177/109830070200400204.
*Koegel, R. L., Vernon, T. W., & Koegel, L. K. (2009b). Improving social initiations in young children with autism using reinforcers with embedded social interactions. Journal of Autism and Developmental Disorders,39, 1240–1251. https://doi.org/10.1007/s10803-009-0732-5.
*Kuhn, L. R., Bodkin, A. E., Devlin, S. D., & Doggett, R. A. (2008). Using pivotal response training with peers in special education to facilitate play in two children with autism. Education and Training in Developmental Disabilities,43, 37–45.
*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,21, 391–400. https://doi.org/10.1901/jaba.1988.21-391.
*Lydon, H., Healy, O., & Leader, G. (2011). A comparison of Video Modeling and Pivotal Response Training to teach pretend play skills to children with autism spectrum disorder. Research in Autism Spectrum Disorders,5, 872–884. https://doi.org/10.1016/j.rasd.2010.10.002.
*Minjarez, M. B., Williams, S. E., Mercier, E. M., & Hardan, A. Y. (2011). Pivotal response group treatment program for parents of children with autism. Journal of Autism and Developmental Disorders,41, 92–101. https://doi.org/10.1007/s10803-010-1027-6.
*Mohammadzaheri, F., Koegel, L. K., Rezaee, M., & Rafiee, S. 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. https://doi.org/10.1007/s10803-014-2137-3.
National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Randolph, MA: Author.
National Professional Development Center on Autism Spectrum Disorders. (2010). Module: Pivotal response training. Retrieved March 13, 2019 from https://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/imce/documents/PRT-Complete-10-2010.pdf.
*Nefdt, N., Koegel, R., Singer, G., & Gerber, M. (2010). The use of a self-directed learning program to provide introductory training in pivotal response treatment to parents of children with autism. Journal of Positive Behavior Interventions,12, 23–32.
Newman, B., Reinecke, D., & Ramos, M. (2009). Is a reasonable attempt reasonable? Shaping versus reinforcing verbal attempts of preschoolers with autism. The Analysis of Verbal Behavior,25, 67–72. https://doi.org/10.1007/BF03393070.
Paul, R. (2008). Interventions to improve communication in autism. Child and Adolescent Psychiatric Clinics of North America,17, 835–856. https://doi.org/10.1016/j.chc.2008.06.011.
Paul, R., Orlovski, S. M., Marcinko, H. C., & Volkmar, F. (2009). Conversational behaviors in youth with high-functioning ASD and asperger syndrome. Journal of Autism and Developmental Disorders,39, 115–125. https://doi.org/10.1007/s10803-008-0607-1.
*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,28, 285–295. https://doi.org/10.1901/jaba.1995.28-285.
*Pierce, K., & Schreibman, L. (1997a). 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,30, 157–160. https://doi.org/10.1901/jaba.1997.30-157.
*Pierce, K., & Schreibman, L. (1997b). Using peer trainers to promote social behavior in autism: Are they effective at enhancing multiple social modalities? Focus on Autism and Other Developmental Disabilities,12, 207–218. https://doi.org/10.1177/108835769701200403.
*Randolph, J. K., Stichter, J. P., Schmidt, C. T., & O’Connor, K. V. (2011). Fidelity and effectiveness of PRT implemented by caregivers without college degrees. Focus on Autism and Other Developmental Disabilities,26, 230–238.
Rice, M. L., Smolik, F., Perpich, D., Thompson, T., Rytting, N., & Blossom, M. (2010). Mean length of utterance; Levels in 6-month intervals for children 3 to 9 years with and without language impairments. Journal of Speech, Language, and Hearing Research,53, 333–349. https://doi.org/10.1044/1092-4388(2009/08-0183).
Richman, D. M., Wacker, D. P., & Winborn, L. (2001). Response efficiency during functional communication training: Effects of effort on response allocation. Journal of Applied Behavior Analysis,34, 73–76. https://doi.org/10.1901/jaba.2001.34-73.
*Robinson, S. E. (2011). Teaching paraprofesionals of students with autism to implement Pivotal Response Treatment in inclusive school settings using a brief video feedback training package. Focus on Autism and Other Developmental Disabilities,26, 105–118.
Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., et al. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders,45, 2411–2428. https://doi.org/10.1007/s10803-015-2407-8.
*Schreibman, L., & Stahmer, A. C. (2014). A randomized trial comparison of the effects of verbal and pictorial naturalistic communication strategies on spoken language for young children with autism. Journal of Autism and Developmental Disorders,44, 1244–1251.
*Schreibman, L., Stahmer, A. C., Barlett, V. C., & Dufek, S. (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.
*Seiverling, L., Pantelides, M., Ruiz, H. H., & Sturmey, P. (2010). The effect of behavioral skills training with general-case training on staff chaining of child vocalizations within natural language paradigm. Behavioral Interventions,25, 53–75. https://doi.org/10.1002/bin.293.
Sham, E., & Smith, T. (2014). Publication bias in studies of an applied behavior-analytic intervention: An initial analysis. Journal of Applied Behavior Analysis,47, 663–678.
*Sherer, M. R., & Schreibman, L. (2005). Individual behavioral profiles and predictors of treatment effectiveness for children with autism. Journal of Consulting and Clinical Psychology,73, 525–538. https://doi.org/10.1037/0022-006X.73.3.525.
Skinner, B. F. (1957). Verbal behavior. Mansfield Centre, CT: Martino Publishing.
*Smith, A. E., & Camarata, S. (1999). Using teacher-implemented instruction to increase language intelligibility of children with autism. Journal of Positive Behavior Interventions,1, 141–151. https://doi.org/10.1177/109830079900100302.
*Smith, I. M., Koegel, R. L., Koegel, L. K., Openden, D. A., Fossum, K. L., & Bryson, S. E. (2010). Effectiveness of a novel community-based early intervention model for children with autistic spectrum disorder. American Journal on Intellectual and Developmental Disabilities,115, 504–523. https://doi.org/10.1352/1944-7558-115.6.504.
*Spector, V., & Charlop, M. H. (2018). A sibling-mediated intervention for children with autism spectrum disorder: Using the Natural Language Paradigm (NLP). Journal of Autism and Developmental Disorders,48, 1508–1522. https://doi.org/10.1007/s10803-017-3404-x.
*Stahmer, A. C. (1995). Teaching symbolic play skills to children with autism using Pivotal Response Training. Journal of Autism and Developmental Disorders,25, 123–141.
*Stahmer, A. C., & Gist, K. (2001). The effects of an accelerated parent education program on technique mastery and child outcome. Journal of Positive Behavior Interventions,3, 75–82. https://doi.org/10.1177/109830070100300203.
Stahmer, A. C., Schreibman, L., & Cunningham, A. B. (2011). Toward a technology of treatment individualization for young children with autism spectrum disorders. Brain Research,1380, 229–239. https://doi.org/10.1016/j.brainres.2010.09.043.
*Steiner, A. M. (2011). A strength-based approach to parent education for children with autism. Journal of Positive Behavior Interventions,13, 178–190.
*Stiebel, D. (1999). Promoting augmentative communication during daily routines: A parent problem-solving intervention. Journal of Positive Behavior Interventions,1, 159–169.
*Stock, R., Mirenda, P., & Smith, I. M. (2013). Comparison of community-based verbal behavior and pivotal response treatment programs for young children with autism spectrum disorder. Research in Autism Spectrum Disorders,7, 1168–1181.
Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis,10, 349–367.
Sundberg, M. L., & Michael, J. (2001). The benefits of Skinner’s analysis of verbal behavior for children with autism. Behavior Modification, 25, 698–724. https://doi.org/10.1177/0145445501255003.
*Symon, J. B. (2005). Expanding interventions for children with autism: Parents as trainers. Journal of Positive Behavior Interventions,7, 159–173.
Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: The neglected end of the spectrum. Autism Research,6, 468–478.
*Thorp, D. M., Stahmer, A. C., & Schreibman, L. (1995). Effects of sociodramatic play training on children with autism. Journal of Autism and Developmental Disorders,25, 265–282.
Tincani, M. & Travers, J. C. (2019). Replication research, publication bias, and applied behavior analysis. Perspectives on Behavioral Science. Advance online publication.
*van Straten, C. L., Smeekens, I., Barakova, E., Glennon, J., Buitelaar, J., & Chen, A. (2018). Effects of robots’ intonation and bodily appearance on robot-mediated communicative treatment outcomes for children with autism spectrum disorder. Personal and Ubiquitous Computing,22, 379–390. https://doi.org/10.1007/s00779-017-1060-y.
*Vernon, T. W., Koegel, R. L., Dauterman, H., & Stolen, K. (2012). An early social engagement intervention for young children with autism and their parents. Journal of Autism and Developmental Disorders,42, 2702–2717. https://doi.org/10.1007/s10803-012-1535-7.
Verschuur, R., Didden, R., Lang, R., Sigafoos, J., & Huskens, B. (2014). Pivotal response treatment for children with autism spectrum disorders: A systematic review. Review Journal of Autism and Developmental Disorders,1, 34–61.
*Verschuur, R., Huskens, B., Verhoeven, L., & Didden, R. (2017). Increasing opportunities for question-asking in school-aged children with autism spectrum disorder: Effectiveness of staff training in pivotal response treatment. Journal of Autism and Developmental Disorders,47, 490–505. https://doi.org/10.1007/s10803-016-2966-3.
Weismer, S. E., Lord, C., & Esler, A. (2010). Early language patterns of toddlers on the autism spectrum compared to toddlers with developmental delay. Journal of Autism and Developmental Disorders, 40, 1259–1273. https://doi.org/10.1007/s10803-010-0983-1.
Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., et al. (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. https://doi.org/10.1007/s10803-014-2351-z.
Acknowledgments
The authors would like to thank the reviewers for their feedback and recommendations. Their feedback significantly improved our report.
Author information
Authors and Affiliations
Contributions
HJF conceptualized the study, searched and screened articles, coded included articles, and drafted the manuscript. JCT conceptualized the study and drafted the manuscript. JVJ coded included articles.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to disclose. This systematic review did not involve human or animal subjects. This systematic review did not require informed consent because there were no human participants.
Research Involving Human and Animal Participants
This systematic review did not involve human or animal subjects.
Informed Consent
This systematic review did not require informed consent because there were no human participants.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Forbes, H.J., Travers, J.C. & Vickers Johnson, J. A Systematic Review of Linguistic and Verbal Behavior Outcomes of Pivotal Response Treatment. J Autism Dev Disord 50, 766–778 (2020). https://doi.org/10.1007/s10803-019-04307-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-019-04307-3