Examining relationships between child skills and potential key components of an evidence-based practice in ASD

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Abstract

Background

Research in autism spectrum disorders (ASD) has identified a need to understand key components of complex evidence-based practices (EBP). One approach involves examining the relationship between component use and child behavior.

Aims

This study provides initial evidence for identifying key components in a specific EBP, Pivotal Response Training (PRT). We examined which components were related to child response and evaluated relationships between provider characteristics, child characteristics and component intensity.

Methods

Trained coders reviewed archival videos (n = 278) for PRT fidelity and child behavior. We completed multi-level regression and latent profile analysis to examine relationships between intensity of individual or combinations of PRT components and child behavior, and moderators of component use.

Results

Analyses indicated differential relationships between specific components and child behaviors which may support methods of altering intensity of components to individualize intervention. Profile analysis suggested relatively intensive use of most PRT components, especially antecedent strategies, may maximize child responsivity. Providers with postgraduate education trended toward higher intensity component use. Child characteristics did not moderate use.

Implications

Careful examination of key components of ASD interventions may helps clarify the mechanisms of action. Recommendations specific to PRT implementation and use of the methodology for other interventions are discussed.

Section snippets

What this paper adds

These analyses represent a first step to inform strategies for associating key components of evidence-based practice (EBP) for children with autism spectrum disorder (ASD) with child responsivity to intervention. This paper targets one naturalistic developmental behavioral intervention, Pivotal Response Training (PRT) to demonstrate methodological process and potential outcomes; however, we envision these analytical methods as applicable to interventions more broadly. Specific to PRT, analyses

Design

This study employed a descriptive design using archival video data from three intervention studies involving providers using PRT with children with ASD. To address the research aims, we completed: (A) detailed coding of archival video data of providers using PRT with children with ASD for (i) quality and intensity of use of each PRT component, and (ii) child behavior and responsivity; (B) multi-level regression analyses to examine the association between use of PRT components and child behavior

Description of PRT component use and coding reliability

Table 3 shows the mean and standard deviation for PRT components and child behavior using average rate of use per minute. Descriptively, providers tended to use antecedent strategies more often than consequence strategies. Providers presented acquisition tasks over twice as often as maintenance tasks. The children tended to be responsive and participate in the sessions with good attention. Children exhibited few inappropriate responses but often failed to respond. ICCs ranged from .10 to .44,

Discussion

This project demonstrates a novel method for identifying key components of a multi-component EBP associated with child behavior. This is a first step toward systematic identification of key components of ASD intervention. Clear associations between provider use of individual components and within-session child behavior provide direction for understanding the mechanism of action of interventions like PRT. Additionally, examining combinations of strategies and how they relate to child behavior

Acknowledgements

Drs. Stahmer, Suhrheinrich and Zeedyk, Ms. Chan, Mr. Chan and Ms. Lee were affiliated with the University of California, San Diego, Department of Psychiatry, and Dr. Roesch with San Diego State University, Department of Psychology when this work was completed. All authors were also affiliated with the Child and Adolescent Services Research Center.

Dr. Stahmer is now at the Davis MIND Institute and Department of Psychiatry at the University of California, Dr. Suhrheinrich is now at the Special

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