- New research finds pivotal response treatment (PRT) may be the most effective way to help young children with autism improve language and communication skills.
- PRT is a behavioral treatment for autism. This therapy is play-based and initiated by the child.
- Using a child’s interests in therapy helps ensure the child remains motivated while learning and increases the likelihood they’ll spontaneously use these same communication skills outside of treatment.
- Experts say early intervention can also help improve treatment effectiveness.
Raising a child with autism can come with a lot of joys and wins, but there are also a lot of challenges. For many parents, one of the biggest of those challenges is learning how to communicate with their child.
“Between 25 and 40 percent of children with autism are nonverbal, depending on whose stats you listen to,” speech-language pathologist Susan Berkowitz told Healthline.
Beyond that, she explains, autism is largely a language disorder, always presenting with at least some communication struggles.
“Many children have some verbal skills, but not always enough to meet their communication needs. That can be difficult, discouraging, and demoralizing for parents, particularly mothers, if they are the primary caregiver,” she said.
American Academy of Pediatrics (AAP) spokesperson and neurodevelopmental pediatrician Dr. Lisa Shulman told Healthline that a “lack of reciprocal exchanges between the parent and a child with ASD can have a significant impact on bonding, especially in situations with extreme communication limitations on the child.”
She gives the example of the feeling parents describe upon witnessing their baby’s first smiles, or hearing their first words.
“Parents often say that finally, after many sleepless nights, they have tangible evidence that their baby is truly a social being, responding to them as an individual. That recognition often seems to cement the relationship, bringing it to a new, reciprocal level,” Shulman said.
When that reciprocity isn’t there, it can cause strains on the bond and stress for the parent. So, seeking out the best treatment options becomes crucial for both the parent and child.
New research points to a therapy that could be best for helping children with autism spectrum disorder (ASD) improve their language abilities.
The study, led by Grace Gengoux, PhD, the clinical associate professor of psychiatry and behavioral sciences at Stanford University, looked at 48 children between the ages of 2 and 5 years old, all of whom had an autism diagnosis and were experiencing serious language delays.
These children were split into two groups. Half received pivotal response treatment (PRT). The other half continued with whatever treatments they had been receiving before the start of the study.
By the end of the study, the children in the PRT group were speaking more than the other study participants. The words they were using were better recognized by others as well.
PRT involves relying on a child’s own motivations to get them to speak.
For example, if a child seems to be expressing interest in a toy on the ground, the therapist would pick up that toy and use the name of it to encourage the child to repeat the name. When the child does so, they’re rewarded by then being given the object.
For the purposes of this study, participants underwent 10 hours of weekly therapy for the first 12 weeks. Parents received one hour of training every week on how to utilize the therapy at home as well.
During the second 12 weeks, children received five hours of weekly therapy. The parents continued with monthly instruction sessions.
This type of child-led therapy is important, according to Gengoux, because, “When adults choose the therapy goals and direct the child’s play, the child may resist or show disruptive behavior to avoid the demands.”
Gengoux explains that using a child’s interests in therapy helps ensure the child remains motivated while learning.
“When children learn to communicate about the things they love, they are more likely to use these same communication skills spontaneously outside the treatment context,” Gengoux said.
“Pivotal response has been around for a while, though I’m not sure too many SLPs [speech-language pathologists] are adequately trained in it. But the principle of using the child’s interests is the same across a number of philosophies and strategies,” Berkowitz said.
Shulman, who specializes in diagnosing and treating children with autism, adds that in addition to the type of therapy used, intervening early is also important.
“There is strong evidence for brain plasticity in young children, giving us a critical period for effecting meaningful change. There is, as well, practical value in getting in there with adaptive strategies before maladaptive routines are entrenched,” she said.
From there, she agrees that PRT may be the best way to help young children with autism improve their communication skills.
“Motivation is key to achieving the best results in intervention,” she said.
Giving the example of a child who loves watermelon, she added, “If offered watermelon, he will bring his best effort and skill to that inherently reinforcing scenario. Likely more so than if he is offered Brussels sprouts. Make him work for it when he is motivated, and keep doing so in naturally reinforcing situations.”
For parents who are concerned about their child’s speech development, Gengoux said, “It is reasonable to consult with an experienced professional (developmental pediatrician, psychologist, speech-language pathologist) or to request formal evaluation.”
She explains that most states have early intervention programs for children with developmental delays. Many insurance plans will cover medically necessary behavioral therapies.
Also, many school districts will provide speech therapy when warranted.
But what can parents do at home?
“Encouraging a child to talk about the items and activities the child is naturally interested in across their natural environments can help the child learn language skills more quickly,” Gengoux said.
However, making that happen doesn’t have to be scary or stressful.
“When child communication during natural routines is encouraged and rewarded, their social development improves as well. Effective therapy can also be fun and involve the whole family,” Gengoux said.