Books by Drs. Robert and Lynn Koegel & ColleagueS

Note that Koegal and Lovass did much of the original research using the ABA technique of Discrete Trial Learning (DTL). They subsequently criticised the shortcomings of that approach for not promoting motivation and generalisation. This was addresses by further research in Natural Language Paradigm, now Known as Pivotal Response Treatment (PRT). PRT research was spearheaded by Drs.Koegel and Colleagues at the University of California at Santa Barbara, and replicated in other settings.

Pivotal Response Treatment: Recent Publications

2007

Vismara, L.A., & Lyons, G.L. (2007). Using perseverative interests to elicit joint attention behaviors in young children with autism: Theoretical and clinical implications to understanding motivation. Journal of Positive Behavior Interventions, 9, 214-228.

Various explanations have been offered in the literature on the underlying cause of joint attention deficits in autism. One possible explanation is that children with autism are capable of producing joint attention but are lacking the social motivation to share their interests with others. The current study used a single-subjects reversal design with alternating treatments to examine whether joint attention initiations for social sharing would occur as a collateral effect of utilizing the motivational techniques of Pivotal Response Treatment in conjunction with perseverative interest stimuli for three young non-verbal children with autism. Results indicated an immediate increase in joint attention initiations when perseverative, or highly-preferred, interests were incorporated within the motivational techniques of Pivotal Response Treatment. Additional findings included collateral increases in joint attention initiations toward less preferred interests, as well as improvements in the quality of interaction between the children and caregivers. Findings are discussed in terms of theoretical and clinical implications for understanding the role of motivation in facilitating the development of joint attention in autism.

Bryson, S.E., Koegel, L. K., Koegel, R.L., Openden, D., Smith, I.M., & Nefdt, N. (2007). Large Scale Dissemination and Community Implementation of Pivotal Response Treatment: Program Description and Preliminary Data. Research and Practice for Persons with Severe Disabilities. Vol. 32, No 2. 142-153.

This paper describes a collaborative effort aimed at province-wide dissemination and implementation of pivotal response treatment (PRT) for young children with autism spectrum disorder (ASD) in Nova Scotia, Canada. Three critical components of the associated training model are described: (1) direct training of treatment teams (parents, one-to-one interventionists, and clinical supervisors/ leaders); (2) training of trainers; and (3) follow-up and monitoring of treatment fidelity and child progress. A major goal of the Dalhousie University/ IWK Health Centre - University of California at Santa Barbara partnership was to optimize effectiveness when translating PRT from the "lab" for dissemination in large geographical areas with community service providers. Finally, we provide data on stakeholder satisfaction with the training workshops and end by identifying features that may have contributed to our success thus far.

Koegel, R.L. (2007). Social Development in Individuals with High Functioning Autism and Asperger Disorder. Research and Practice for Persons with Severe Disabilities. Vol. 32, No 2. 140-141.

Commentary

Cosden, M., Koegel, L. K., Koegel, R. L., Greenwell, A., & Klein, E. (2006). Strength-based assessment for children with autism spectrum disorders. Research and Practice for Persons with Severe Disabilities. Research and Practice for Persons with Severe Disabilities. Vol. 31, No. 2, 134-143.

Despite improvements in interventions for children with autism, assessments tend to focus on their social, cognitive, and behavioral deficits, without similar systematic examination of their strengths. Strength-based assessment (SBA), which has been used in work with children with milder behavioral disorders, may also have value for individuals who have autism. Although not supplanting usual assessment procedures, SBA provides a method for identifying personal, familial, and broader contextual strengths. Research outside the area of autism has found that SBA can be a useful addition to assessment protocols because it provides specific information on assets that can be incorporated into interventions. Further, SBA has the potential to affect the attitudes and beliefs of parents and educators involved in the assessment, creating greater hope about the ability of the child to function well and contributing to a stronger bond between the assessor, the child, and their family. This article describes ways in which SBA can be added to typical assessment protocols for children with autism. Examples are provided on how to identify and utilize strengths that can be used for planning interventions and for building more effective working relationships between clinicians and children with autism and their families. Areas for future research are also discussed.

2006

Openden, D., Symon, J. B., Koegel, L. K., Koegel, R. L. (2006) Developing a student respite provider system for children with autism. Journal of Positive Behavior Interventions. Vol 8, pp. 119-123

Many parents of children with autism and other severe disabilities report heightened levels of stress. The approach delineated here contributes to the wraparound process, one of three interrelated aspects of positive behavior support (PBS) that drive the implementation of a values-based perspective. To recruit potential respite providers, a simple form was developed. The purpose of the respite list was to develop a requested tool for families. Parents also reported collateral effects on their personal, social, and family lives by having access to respite care. Aside from benefiting the family members, the opportunity to provide respite appeared to be advantageous to the respite providers. Further, it appeared that some of the students who provided respite for the families decided to pursue careers in the field on the basis of their respite experience.

Koegel, R. L., & Koegel, L. K. (2006). Pivotal Response Treatments for Autism. Baltimore, MD: Paul H. Brookes.

An innovative, state-of-the-art treatment for autism, Pivotal Response Treatment (PRT) uses natural learning opportunities to target and modify key behaviors in young children with autism, leading to widespread positive effects on communication, behavior, and social skills. The product of 20 years of research from Robert L. and Lynn Kern Koegel--co-founders of the renowned research and training center on autism at the University of California, Santa Barbara--this proven approach is clearly presented in this single accessible volume. Keeping parents involved in every aspect of intervention, educators and therapists can use these research-supported PRT strategies to (a) improve children's academic performance; (b) advance children's communication and language skills; (c) foster social interactions and friendships with typically developing peers; (d) reduce disruptive behaviors; (e) aid early identification and intervention; and (f) reduce ritualistic behaviors and broaden children's interests. Because PRT works with each child's natural motivations and stresses functional communication over rote learning, this comprehensive model helps children develop skills they can really use. With this timely resource, educators, therapists, and parents can support children with autism as they enjoy more positive interactions, more effective communication, and higher academic achievement in natural, inclusive settings.

Koegel, L. K., Koegel, R. L., Nefdt, N., Fredeen, R. M., Klein, E., & Bruinsma, Y. (2006). First S.T.E.P.: A model for the early identification of children with autism spectrum disorders. Journal of Positive Behavior Interventions, 7, 247-252.

Abstract: This forum article outlines an innovative model, Project First Screening, Training, Education, Project, (First S.T.E.P.), for helping families build the skills to establish and sustain communication gains for young children with autism. The project is designed to address the apparent delays in identification of children at risk for Autism Spectrum Disorders. The emphasis is on a "whole family" intervention approach, and the changes that occur are not just with specific child skills but with the ability of the whole family to be more successful.

2005

Schreibman, L. and Koegel, R. L. (2005). Training for parents of children with autism: Pivotal responses, generalization, and individualization of interventions. In P. S. Jensen & E. D. Hibbs (Eds.), Psychosocial Treatments for Child and Adolescent Disorders. Washington, D.C.: American Psychological Association.

This chapter describes a systematic line of clinical research focusing on the involvement of parents as intervention providers for their children with autism. The authors begin with a brief description of autism and the impact of such children on their parents. The next section of the chapter describes the advantage of parent training over a program in which the child is treated exclusively by clinicians in a clinic setting. Next, the authors discuss the evolution of an optimal form of parent training. The core of this research begins with a comparison of a parent training program that treats only individual target behaviors with a parent training program that focuses on pivotal behaviors in autism (i.e., motivation and responsivity to multiple cues). Because of limitations in the generalization of this approach and continued reported high stress in parents, a third pivotal behavior, self-management, was added. Although it improved overall general intervention success, remaining heterogeneity in intervention outcome suggests the need to develop individualized intervention protocols tailored to individual children and families.

Koegel, L. K.,. Koegel, R. L. & Brookman L. I. (2005). Child-initiated interactions that are pivotal in intervention for children with autism. Jensen & Hibbs (Eds.) Psychosocial Treatments for Child and Adolescent Disorders.

The authors review empirically supported interventions for children with communication difficulties and present their work, which focuses on a reciprocal parent-child dyad communication approach. They present in detail their model of interactive communication accentuating the child's role as an active communicative partner to enhance language procedures. They also outline the techniques used for teaching children to be active communicators. Preliminary results indicate the promising nature of this procedure, with some evidence of generalization to home settings. The treatment was successful in improving communication with widespread concomitant decreases in disruptive and inappropriate behaviors. The authors recommend that future techniques be designed to promote self-learning and independence to develop more efficient treatments for children with autism, more significant generalization and maintenance treatment gains, and greater reduction of parental stress.

Koegel, L. K., Koegel, R. L., Boettcher, M., & Brookman-Frazee, L. (2005). Extending behavior support in home and community settings. In L. M. Bambara & L. Kern (eds), Individualized Supports for Students with Problem Behaviors. New York: Guilford Press. Book chapter.

Koegel, R. L., Werner, G. A., Vismara, L. A., & Koegel, L. K. (2005). The effectiveness of contextually supported play date interactions between children with autism and typically developing peers. Research and Practice for Persons with Severe Disabilities, 30, 93-102.

Abstract: Difficulties with social interaction are characteristic of autism. This study presents data illustrating the use of motivational strategies in play dates to improve the quality of social interactions between children with autism and their typically developing peers. Specifically, a multiple baseline design across participants shows how a contextual support package implemented during play dates can promote reciprocal interactions and improve affect. These results support the use of intervention strategies that target the pivotal area of motivation and provide evidence for using play dates as a context for intervention. The findings are discussed in terms of promoting quality interactions and encouraging friendship development.

Horner, R.H., Dunlap, G., Koegel, R.L., Carr, E.G., Sailor, W., Anderson, J., Albin, R.W., & O'Neill, R.E. (2005). Toward a technology of "nonaversive" behavioral support. Research and Practice for Persons with Severe Disabilities, 30 (1), 3-10.

Abstract: Nonaversive behavior management is an approach to supporting people with undesirable behaviors that integrates technology and values. Although this approach has attracted numerous proponents, more adequate definition and empirical documentation are still needed. This article presents an introduction to the nonaversive approach. Important definitions are suggested, and three fundamental elements are presented: (a) an emerging set of procedures for supporting people with severe challenging behavior; (b) social validation criteria emphasizing personal dignity; and (c) a recommendation for prohibition or restriction of certain strategies. These elements are defined in hopes of stimulating further discussion and empirical analyses of positive behavioral support.

2004

Koegel, R. L., Openden, D., & Koegel, L. K. (2004). A systematic desensitization paradigm to treat hypersensitivity to auditory stimuli in children with autism in family contexts. Research & Practice for Person with Severe Disabilities, 29, 122-134.

Abstract: Many children with autism display reactions to auditory stimuli that seem as if the stimuli were painful or otherwise extremely aversive. This article describes, within the contexts of three experimental designs, how procedures of systematic desensitization can be used to treat hypersensitivity to auditory stimuli in three young children with autism. Stimuli included the sounds from a vacuum cleaner, blender, hand-mixer, toilet flushing, and specific animal sounds from musical toys. A changing criterion design was used and data were collected on (a) the number of hierarchical steps completed as comfortable with the stimulus per week and (b) the mean level of anxiety per probe. A clinical replication was implemented using a replication of the desensitization procedures for three children. In addition, a systematic replication across three different stimuli is presented for one child in a multiple baseline. The data show that the children's responses could be modified to the point where they were comfortable with these noises. Furthermore, this level of comfort was maintained at follow-up. The discussion suggests that the extreme reactions to auditory stimuli many children with autism exhibit may be decreased with procedures that have been shown to be effective with reducing phobias, and the possibility that the reactions may be symptomatic of a phobia rather than actual pain.

Bruinsma, Y., Koegel, R.L., & Koegel, L.K. (2004). Joint attention and children with autism: A review of the literature. Mental Retardation and Developmental Disabilities Research Reviews, 10(3), 169-175.

Abstract: Preverbal communication and joint attention have long been of interest to researchers and practitioners. Both attending to social partners and sharing attentional focus between objects or events and others precede the onset of a child's first lexicon. In addition, these prelinguistic acts also appear to have important implications with regard to learning to socialize. The construct of joint attention has been noted as an early developing area prior to the transition to symbolic communication. Thus, the importance of joint attention in typically developing children, and the lack thereof in children with autism, has interested researchers for use in diagnosis and intervention for autism. That is, joint attention has been gaining momentum as an area that not only helps characterize children with autism, but also as a prognostic indicator and a potential intervention goal. In this paper, the status of the literature about initiation of joint attention by young typically developing children and young children with autism was examined. Empirical studies regarding joint attention behaviors, including eye gaze alternation, the use of protodeclaratives and protoimperatives, and studies that investigated joint attention as a predictor of language acquisition were reviewed. Possible areas for future research for children with autism are discussed.

2003

Boettcher, M., Koegel, R. L., McNerney, E.K., & Koegel, L.K. (2003). A family-centered prevention approach to PBS in a time of crisis. Journal of Positive Behavior Interventions, 5, 55-59.

Abstract: This article describes a family-wide prevention approach to positive behavior support (PBS) interventions during a period of potential crisis for a family with a child with autism. Specifically, the mother in this family was to have major invasive surgery that would require extensive time for recovery. Past functional assessment data and anecdotal evidence indicated that lack of predictability, structure, supervision, and systematic behavior supports all contributed to problem behaviors in this family. As a result, a multicomponent intervention plan was implemented to prevent such problems. The procedures included the following elements: (a) priming intervention, (b) stakeholder meeting, (c) coordination of services and schedules, (d) family-wide PBS plan, and (e) ongoing support. The outcome of this intervention was that the child with autism and her siblings showed decreases in their disruptive behaviors (as opposed to the expected increases), and the family experienced other family-wide collateral positive effects from this proactive intervention approach.

Brookman, L., Boettcher, M., Klein, E., Openden, D., Koegel R. L., Koegel, L. K. (2003). Facilitating social interactions in a community summer camp setting for children with autism. Journal of Positive Behavior Intervention, 5, 249-252.

Abstract: This article describes a program developed to support the participation of children with autism in a full-inclusion summer day camp program with their typically developing peers. The goal of the program was to support the children in inclusive summer recreational settings and specifically target their social development with typically developing peers. The program contained the following elements: recruiting appropriate aides, providing the aides with ongoing training and support, creating individualized social and behavioral goals for the campers, developing interventions that were contextually appropriate to the camp settings, and communicating with the families during their participation in the program. This article discusses the relevant child, family, agency, and community issues relevant to the implementation of this program.

Ingersoll, B., Schreibman, L., & Tran, Q. (2003). Effect of Sensory Feedback on Immediate Object Imitation in Children with Autism. Journal of Autism and Developmental Disorders, 33, 673-683.

Abstract: This study examined the effect of sensory feedback (e.g., flashing lights and sound) on the imitation performance of children with autism and typical children group-matched for mental age. Participants were administered an immediate object-imitation task with six novel toys constructed for this study: three with a sensory effect that could be activated by imitating the modeled action and three without a sensory effect. Although overall imitation performance of the participants significantly between groups, the imitation performance of the participants with autism was significantly higher with sensory toys than with nonsensory toys. Typical participants' imitation performance did not differ between the two sets of toys. Both groups played significantly more with the sensory toys during free play, indicating that sensory toys were more reinforcing for both groups. Additional results demonstrated that typical children used significantly more social behaviors during imitation than children with autism, but they did not differ in object-oriented behaviors, replicating previous findings. It is argued that children with autism may be less motivated to imitate by social interaction, but may be motivated to imitate to receive a nonsocial reward (sensory feedback).

Koegel, L. K., Koegel, R. L., Frea, W., & Green-Hopkins, I. (2003). Priming as a method of coordinating educational services for students with autism. Language, Speech & Hearing Services in Schools, 34, 3, 228-235.

Abstract: The importance of coordination of educational services has been well documented in the literature. For students with disabilities, coordinated programs result in more rapid acquisition of targeted behaviors and the increased likelihood of long-term maintenance of gains. The purpose of this study was to assess whether "priming" or exposing students with autism and disruptive behaviors to school assignments before their presentation in class would affect academic performance and problem behaviors. Two students diagnosed with autism who attended general education classrooms, both of whom exhibited numerous disruptive behaviors and low academic performance, participated in this study. A repeated reversals design was used to monitor student progress. The results demonstrated decreases in problem behavior and increases in academic responding when priming sessions occurred. Application is discussed in terms of a mechanism for speech-language pathologists to assist classroom teachers, with a systematic educational coordination plan that can quickly produce improved school performance.

Koegel, R. L., Koegel, L. K., & Brookman, L. I. (2003). Empirically supported pivotal response interventions for children with autism. In Kazdin, Alan E. (ED). Yale University School of Medicine & Child Study Center (Eds), Evidence-based psychotherapies for children and adolescents. New York, Guilford Press.

This chapter focuses on two pivotal areas, motivation and child initiations, that appear to be especially important in producing widespread improvements for children with autism. Individual child and family characteristics determine the intervention setting and target behaviors for each child. Specifically, the target behaviors are determined based on the individual child's needs, and intervention programs are developed to be consistent with a family's goals, values, and cultural identity. Much of the focus of intervention is on communication skills and appropriate social communication interactions.

Koegel, R. L., Brookman, L., & Koegel, L. K. (2003). Autism: Pivotal response intervention and parent empowerment. Trends in Evidence-based Neuropsychiatry, 5, 61-69.

Abstract currently unavailable.

Koegel, L. K., Carter, C. M., & Koegel, R. L. (2003). Teaching children with autism self-initiations as a pivotal response. Topics in Language Disorders, 23, 134-145.

Abstract: The purpose of this study was to assess whether children with autism could be taught a child-initiated query as a pivotal response to facilitate the use of grammatical morphemes. Data were collected within the context of a multiple baseline design across two children who lacked the use of temporal morphemes. Results of the study indicated that both children learned the self-initiated strategy and both acquired and generalized the targeted morpheme. Additionally, generalized use of the self-initiation into other question forms and concomitant increases in mean length of utterance, verb acquisition, and diversity of verb use occurred for both children. These generalized effects and the applications of this procedure across linguistic targets are discussed.

2002

Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W. (2002). Positive behavior support: Evolution of an applied science. Journal of Positive Behavior Interventions, 4, 4-16.

Abstract: Positive behavior support (PBS) is an applied science that uses educational and systems change methods (environmental redesign) to enhance quality of life and minimize problem behavior. PBS initially evolved within the field of developmental disabilities and from three major sources: applied behavior analysis, the normalization/inclusion movement and person-centered values. Although elements of PBS can be found in other approaches, uniqueness lies in the fact that it integrates the following critical features into a cohesive comprehensive lifestyle change, a lifespan perspective, ecological validity, stakeholder participation, social validity, systems change and multicomponent intervention, emphasis on prevention, flexibility in scientific practices, and multiple theoretical perspectives. These characteristics are likely to produce future evolution of PBS with respect to assessment practices, intervention strategies, training, and extension to new populations. The approach reflects a more general trend in the social sciences and education away from pathology-based to a new positive model that stresses personal competence and environmental integrity.

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.

Many families who are geographically distant from a center that specializes in intervention for autism are unable to access specialized services for their children. This article describes an evaluation of an intensive, week-long, center-based parent education program that teaches procedures for improving social communication for children with autism. Five representative families who participated in this program are described. Data were collected on parent implementation of target behaviors using specific motivational teaching procedures of Pivotal Response Training. Data suggest improvements in the parents' use of the procedures, parent affect, and child expressive language during a week-long parent education session. Furthermore, follow-up measures demonstrate that these positive changes generalized to the families' home communities and maintained over time. These findings suggest the feasibility of a short-term, intensive parent education program for families who live in areas that are geographically distant from an intervention center.

2001

Koegel, L. K., Koegel, Valdez-Menchaca, M., Koegel, R. L., & Harrower, J. (2001). Autism. In M. Hersen & V. B. Van Hasselt (Eds.), Advanced Abnormal Psychology (2nd Edition) (pp 165-189). New York, NY: Kluwer Academic/Plenum Publishers.

Provides an account of the major findings that have led to the increased understanding of the behavioral manifestations of autism and the development of intervention techniques. Evidence on the etiology and intervention is reviewed within a framework that explores the possibility that neurological or physiological processes may result in an inappropriate level of social interaction which leads to disabilities in communication and other problem behaviors that characterize autism.

Koegel, L. K., Koegel, R., Frea W., & Fredeen, R. (2001) Identifying early intervention targets for children with autism in inclusive school settings. Behavior Modification, 25, 745-761.

Abstract: This study assessed play and social behavior of young children with autism in inclusive school settings to identify important targets for intervention. Data were collected for 5 children (aged 3-10 yrs old) with autism and for typically developing peers. All children with autism received intervention in one-on-one settings but did not have individual education plan goals that provided systematic intervention for developing play and social skills in their school settings. Results indicated the children with autism and their typically developing peers played with a comparable number of stimulus items (e.g., toys), but the children with autism engaged in these activities for shorter durations. Both children with autism and their typically developing peers engaged in similar levels of social interaction with adults. However, the children with autism rarely or never engaged in social interactions with their peers, whereas the typically developing peers frequently engaged in social interactions with other children. The results suggest important targets for intervention.

Santarelli, G., Koegel, R. L., Casas, J. M., & Koegel, L. K. (2001). Culturally diverse families participating in behavior therapy parent education programs for children with developmental disabilities. Journal of Positive Behavior Interventions, 3, 120-123.

Abstract: Describes a parent education program implemented for the parents of a 6-yr-old Latino boy with autism. The authors discuss cultural diversity and raises extremely important issues regarding cultural sensitivity and cultural competence.

Carter, Cynthia, 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.

Abstract: This study examined the use of providing choice to decrease disruptive behaviors, encourage interactive play, and increase language skills in children with autism. Children with autism often exhibit significant language delays. The developmental literature suggests that language skills may be increased by engaging in play interactions, but children with autism are unlikely to engage in interactive toy and game play. Children with autism also may exhibit extreme disruptive behaviors when confronted with task situations or other interactions they would rather not partake in. However, the literature suggests that providing choice opportunities will increase responding and adaptive behaviors in children with autism. Therefore, this investigation was conducted to assess the effects of choice during language intervention on disruptive behavior, social play/pragmatic behaviors, and language development.

Participants were 3 children who exhibited problem behaviors, a lack of engagement in interactive play, and delayed acquisition of grammatical morphemes. Within a reversal (ABAB) design, a choice and no-choice condition were compared in a naturalistic language intervention procedure using play. In the choice condition, the participant was allowed to choose desired interactive toys and games to be used during the language intervention session and the order of which these games were played. In the no-choice condition, the interventionist selected the interactive games and toys to be used during the language intervention session based on previously selected (i.e., preferred) games by the child. Results indicate that when choice is permitted during language intervention within a play context, disruptive behaviors are considerably reduced, and levels of appropriate social play/pragmatic skills increase, thereby reducing interventionist redirection. Moreover, the children participating in the study only showed generalization of the targeted language structures to their home environments following intervention in the choice condition. Findings are discussed with regard to the importance of providing choice for children with autism, increasing desirable language and social behaviors in these children, and directions for future research.

Koegel, R.L., Koegel, L.K., & McNerney, E. (2001). Pivotal areas in intervention for autism. Journal of Clinical Child Psychology, 30(1), 19-32.

Abstract: This article discusses several core pivotal areas that appear to be influential in intervention for autism. Literature and outcome data are reviewed with respect to several core areas that appear to be particularly helpful in intervention for autism, including improving motivation, responsivity to multiple cues, self management, and self-initiation of social interactions. A conceptual framework is described, and outcome data are reviewed suggesting that when children with autism are motivated to initiate complex social interactions, it may reverse a cycle of impairment, resulting in exceptionally favorable intervention outcomes for many children. Because the peripheral features of autism can be numerous and extensive, the concept of intervention for pivotal areas of functioning may be critical if children are to be habilitated in a time and cost efficient manner.

2000

Baker, Mary J. Incorporating the thematic ritualistic behaviors of children with autism into games: Increasing social play interactions with siblings. (2000). Journal of Positive Behavior Interventions, 2, 66-84.

Abstract: Investigated an intervention increasing sibling social play interactions by incorporating the thematic ritualistic activities of children with autism into typical games. Subjects were 3 children with autism (aged 5.4-6.8 yrs) and their siblings (aged 7.6-8.6 yrs). Data collected revealed very low levels of sibling play, joint attention, and affect during the baseline condition and high levels of thematic ritualistic behaviors. In contrast, when the children with autism were taught a play interaction based on their thematic ritualistic behavior (e.g., for a child who perseverated on movies, incorporating that theme into a Bingo(R)-style game), the percentage of social interactions and joint attention increased and maintained in 1- and 3-mo follow-up measures. All of the children's affect improved, and the rate of thematic ritualistic behaviors decreased to a minimum or no occurrence. The children's social interactions also generalized to other games and settings. These results imply that children with autism can learn social skills through play and natural interactions in their environment.

Koegel, L.K. (2000). Interventions to facilitate communication in autism. Journal of Autism and Developmental Disorders, 30, 383-392.

Abstract: The purpose of this article is to discuss research opportunities arising from the current literature in the area of communication. Six general themes were discussed, including (a) increasing spontaneity, initiations, and the variety of functions of language verbal and nonverbal children with autism exhibit; (b) assessing and teaching precursors relating to positive outcome; (c) the importance of family involvement in intervention programs; (d) best practices for implementation of communicative interventions; (e) the interrelationship between language and other behavioral symptoms of autism; and (f) the social and pragmatic use of language. These areas are discussed in terms of improving assessment and intervention practices to produce greater long-term communicative outcomes for individuals with autism.

1999

Koegel, L. K., Koegel, R. L., Harrower, J. K., Carter, C. M. (1999). Pivotal response intervention I: Overview of approach. Journal of the Association for Persons with Severe Handicaps, 24, 174-185.

Abstract: Presents an overview of several pivotal response interventions for autistic children. Teaching in pivotal areas constitutes an efficient and effective mode of intervention in overcoming the number of difficulties that exist for children with severe disabilities. Key pivotal areas include responsivity to multiple cues, observable motivation to initiate and respond appropriately to social and environmental stimuli, and self-regulation of behavior. Approaches to teaching multiple cues include within-stimulus prompting and conditional discrimination. Motivation techniques include child choice, natural reinforcers, interspersed maintenance trials, and reinforcing attempts. The goal of the model is to provide autistic individuals with the social and functional proficiency to participate in enriched and meaningful lives in inclusive settings.

Koegel, L. K., Koegel, R. L., Shoshan, Y., McNerney, E. (1999). Pivotal response intervention II: Preliminary long-term outcomes data. Journal of the Association for Persons with Severe Handicaps, 24 (3): p. 186-198.

Abstract: Examined the degree to which self-initiation was associated with highly favorable postintervention outcome in treating autism. In phase 1 of the Exp, 3 children achieving a highly favorable outcome to a treatment intervention and 3 who responded unfavorably (aged 3 yrs at program entry) were retrospectively examined concerning self-initiating behaviors. Results show that those with favorable outcomes exhibited more spontaneous self-initiations at preintervention. Results of phase 2 of the Exp,comprising 10 autistic children (aged 2-3 yrs at program entry) show that Subjects could be taught self-initiating behavior, thereby leading to highly favorable treatment outcomes, based on data collected several years subsequent to intervention. It is concluded that social communicative initiation is a pivotal behavior in autism treatment.

Koegel, R. L., Koegel, L. K., Carter, C. M. (1999). Pivotal teaching interactions for children with autism. School Psychology Review, 28, 576-594.

Abstract: Discusses effective teaching interactions in the treatment of autism in children with a focus on pivotal target behaviors. Specifically, in behaviorally oriented intervention approaches, it is suggested that several areas appear to be especially important. First, progress may be enhanced by defining "pivotal" target behaviors that affect wide areas of functioning so that school psychologists, teachers, and other practitioners may be able to have widespread impacts on children's overall functioning. Second, psychologists are now able to develop interventions that simultaneously lead to independence on the part of the child, are correlated with decreases in untreated problem behaviors, are maintained with the passage of time, and therefore result in a long-term improved prognosis. It is concluded that accumulating research has identified a variety of specific procedures that, when implemented in the school setting, can greatly improve academic and social performance of children with autism.

Koegel, L. K., Harrower, J. K., Koegel, R. L. (1999). Support for children with developmental disabilities in full inclusion classrooms through self-management. Journal of Positive Behavior Interventions, 1, 26-34.

Abstract: The literature has suggested that without the implementation of support procedures, placements of children with severe disabilities in full-inclusion classrooms are often unsuccessful. This study assessed whether a support person who taught young elementary school students (aged 5 and 6 yrs) to use self-management procedures and then faded involvement with them would be effective in increasing these students' appropriate performance on schoolwork tasks and reducing disruptive behavior in full inclusion classrooms. The percentage of time the children engaged in appropriate performance of schoolwork tasks and disruptive behavior was recorded during in-class periods. Data were collected over a 9-month period in a multiple baseline design during the academic year. The results showed that implementation of self-management resulted in high levels of appropriate performance of schoolwork activities, negligible levels of disruptive behavior, and complete elimination of time spent in time-out. Following the intervention, both appropriate schoolwork performance and disruptive behavior exhibited by the children with severe disabilities were within the range of the typical children in the classroom.

Singer, G.H.S., Gert, B., & Koegel, R.L. (1999) A moral framework for analyzing the controversy over aversive behavioral interventions for people with severe mental retardation. Journal of Positive Behavior Interventions, 1(2), 88-100.

Abstract: This article applies a systematic analysis of everyday moral decision making to the controversy surrounding the use of aversive treatments for people with severe mental retardation. The authors' aim is to provide a framework for analyzing the issue, and they take a position against the use of aversive procedures. The analysis adds some new ideas to the debate. It provides a definition of aversive procedures based upon common moral rules. The concept of protection by the moral rules is discussed and the case made that people with severe mental retardation deserve the protection of the moral rules and that this right is historically new and tenuous. The importance of symbols of dehumanization is discussed in light of this tenuous condition. The idea of moral agency is applied in order to clarify the kinds of societal sanctions that are and are not appropriate when a person with severe mental retardation violates a moral rule. The authors argue that data are always relevant to moral decision making and that a mounting body of evidence indicates that nonaversive alternatives are available and can replace aversive procedures in all but a very small number of highly unusual cases.

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.

Abstract: Examined the feasibility of an intervention using naturalistic language teaching procedures for communication problems of 3 children (aged 4-6 yrs) with autism conducted by the child's general education teacher in collaboration with the child's language clinician. The results of a multiple baseline study across children indicate successful implementation of naturalistic language teaching procedures in the school settings by all general education teachers and improved intelligibility of the language skills of all the children with autism in generalized spontaneous language use. These results are discussed in terms of previous research demonstrating the effectiveness and benefits of naturalistic teaching procedures and in terms of the implications for educational practices involving children with autism.

Stiebel, D. (1999) Promoting augmentative communication during daily routines: A parent problem-solving intervention. Journal of Positive Behavior Interventions, 1, 159-169.

Abstract: The field of augmentative and alternative communication (AAC) continues to struggle with issues relating to generalization and maintenance. Current methods of modifying instructional practices and teaching skills directly to the communication partner have contributed to developing successful treatment outcomes. However, few studies have examined AAC in the home setting during daily routines with parents. This study examined whether teaching parents of 3 children (aged 4 and 6 yrs) with autism a problem-solving intervention that considered the family's lifestyle would promote child spontaneous picture card use and parent-provided communication opportunities during daily routines. Data were collected in the context of a multiple baseline design across child and parent behavior. Results show increases in the child's use of cards and in the parent's use of communication opportunities across multiple routines, parent and child behavior maintenance over time, and increases in the parent's perception of their child's communication skill and of their own ability to promote communication. The findings support the use of a problem-solving intervention that incorporates the family's lifestyle as a method to promote augmentative communication during daily routines.

1998

Moes, D. R. Integrating choice-making opportunities within teacher-assigned academic tasks to facilitate the performance of children with autism. (1998). Journal of the Association for Persons with Severe Handicaps, 23, 319-328.

Abstract: Investigated how providing choice opportunities to children with autism impacted their performance during teacher-assigned homework activities. An ABAB design was utilized to evaluate the effects of choice making (student vs tutor) on the academic performance of four children with autism (aged 5-9 yrs). Results showed that providing students with opportunities to make choices regarding the order of task completion and use of stimulus materials improved participants' accuracy, productivity, affect, and reduced their disruptive behaviors. These findings support the use of child choice as a teaching strategy to improve the academic performance of children with autism during curricular activities. The functional properties of choice making and considerations for its use as a curricular-based antecedent intervention are discussed.

Koegel, L. K., Camarata, S. M., Valdez-Menchaca, M. C., & Koegel, R. L. (1998). Teaching children with autism to use self-initiated strategy to learn expressive vocabulary. American Journal of Mental Retardation, 102, 346-357.

Abstract: Examined whether motivational procedures incorporated into teaching question-asking to 3 children (aged 3.75-5.42 yrs) with autism, who lack verbal initiations, would result in generalization without additional teaching, prompting, or reinforcement in other settings. Specifically, the authors assessed whether such children could learn to use questions and whether the spontaneous use of question-asking would generalize across stimuli, settings, and people. All children learned to use questions in relation to items they had previously been unable to label and demonstrated generalization of spontaneous question-asking to new items and to their home environments with their mothers, with concomitant gains in expressive vocabulary. Results are discussed in terms of teaching response strategies, such as question-asking, to promote spontaneous child-initiated social interactions and expressive language development.

Koegel, L. K., Koegel, R. L., & Steibel, D. (1998). Reducing aggression in children with autism toward infant or toddler siblings. Journal of The Association for Persons with Severe Handicaps, 23, 111-118

Abstract: Children with autism often lack appropriate means to communicate and may rely on aggression and other disruptive behaviors to express their needs. This may be a particularly serious problem when aggression occurs toward an infant or toddler, who could be severely injured by an older sibling. This study examined the use of functional assessment and individualized parent-implemented intervention plans in the home setting, including functional communication training with relevant ecological manipulations. Data were collected in the context of a multiple baseline design across 3 sibling dyads, who lived at home with their parents. Within each dyad the older sibling was diagnosed as having autism or a related developmental disability, and the infant or toddler sibling was not diagnosed as having a disability. The results showed that after the intervention there were (1) large reductions in the children's aggression toward their infant or toddler sibling, (2) increases in parent and child happiness level, and (3) increases in strangers' level of comfort with respect to interacting with the family. Findings are discussed in terms of improving the overall quality of life for families of children with autism.

Baker, M., Koegel, R. L., & Koegel, L. K. (1998). Increasing the social behavior of young children with autism using their obsessive behaviors. Journal of The Association for Persons with Severe Handicaps, 23, 300-308.

Abstract: This study systematically asked whether individual topics or themes on which children with autism perseverated across a variety of settings (often called obsessions) could be used to create the theme for a socially appropriate game. Three children with autism (aged 5-7 yrs) participated. Data collected within the context of a multiple baseline design revealed very low levels of social interaction during play periods in the baseline condition. In contrast, when the children with autism were taught a socially appropriate game (e.g., one child who perseverated on maps was taught a tag game played on a giant outline of a US map), the percent of social interactions increased dramatically and continued to be high during follow-up measures. Generalization measures indicated that following intervention, the children also demonstrated increases in social interaction during other play activities. The results are discussed in terms of incorporating obsession themes into common games to create intrinsically reinforcing appropriate activities for increasing social interactions, and in relation to developing activities that capitalize on the child with autism's interests, so that the child is a valued member of the peer group.

Koegel, R. L., Camarata, S., Koegel, L. K., Ben-Tall, A., & Smith, A. E. (1998). Increasing speech intelligibility in children with autism. Journal of Autism and Developmental Disorders, 28, 241-251.

Abstract: Systematically compared 2 intervention conditions, a Naturalistic approach (which incorporated motivation variables) vs an Analog (more traditional, structured) approach. Subjects were 4 male and 1 female 3.7-7.5 yr olds with autism. Developmentally similar speech sounds were equated within and across conditions for each child. Data indicate that although both methods effectively increased correct production of the target sounds under some conditions, functional use of the target sound in conversation occurred only when the naturalistic procedures were used during intervention. Results are discussed in terms of pivotal variables that may produce improvements in speech sounds during conversational speech.

Koegel, L.K., Camarata, S.M., Valdez-Menchaca, M., & Koegel, R.L.(1998). Setting generalization of question-asking by children with autism. American Journal on Mental Retardation, 102(4) , 346-357.

1997

Koegel, L.K., Koegel, R.L., & Smith, A. (1997). Variables related to differences in standardized test outcomes for children with autism. Journal of Autism and Developmental Disorders , 27(3), 233-243.

Abstract: Assessed whether manipulation of variables related to motivation and attention in children with autism would influence performance on standardized tests. Two different testing conditions were compared: one consisted of the usual standardized testing procedures; during the other, specific variables that were hypothesized to relate to each child's responsiveness to task stimuli were manipulated. Data were collected in the context of a repeated reversals experimental design with condition order varied within and across children. Six autistic children (aged 3-9 yrs) participated in a total of 44 separate testing sessions, controlled for order of conditions, number of sessions, and type of test. Results show consistent differences between the 2 conditions, suggesting that improving motivation and attention in children with autism may considerably influence test performance and interpretation. Findings are discussed in relation to the difficulty in administering and interpreting changes in performance on standardized tests with this population.

1996

Koegel, R.L., Bimbela, A., Schreibman, L. (1996). Collateral effects of parent training on family interactions . Journal of Autism and Developmental Disorders , 26(3), 347-359.

Abstract: Assessed the collateral effects of 2 parent training paradigms: (1) focused on teaching individual target behaviors (ITBs) serially, and (2) focused on teaching the pivotal responses (PRs) of motivation and responsivity to multiple cues. 17 Ss with autism (aged 3-9 yrs) and their families were randomly assigned to either ITB or PR training. Pretraining and post-parent-training videotapes of dinnertime interactions were scored randomly across 4 interactional scales (level of happiness, interest, stress, and style of communication). Results obtained for the 4 scales show that the families in both conditions initially scored in the neutral range, and the ITB training produced no significant influence on interactions posttraining. The PR training resulted in the families showing positive interactions on all 4 scales, suggesting high degrees of happiness and interest, low stress during the interaction, and more positive communication.

Koegel, L.K., & Koegel, R.L. (1996). The child with autism as an active communicative partner: Child-initiated strategies for improving communication and reducing behavior problems. In Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice. (pp. 553-572) Washington, DC: American Psychological Association.

Abstract: Discuss techniques that extend presently available language intervention procedures for children with autism that emphasize the adult as the initiator of language. Focus instead on interventions that teach the child to be an active communicative partner in the dyad / pilot data are presented on important linguistic structures that show improvement as a result of such language intervention, in addition to concomitant improvements in a number of other disruptive and interfering behaviors / data suggest that, for children with autism, treatment is vastly enhanced if the children are recruited as active participants in the habilitation process / discuss pilot work that suggests that teaching young children with autism to evoke language learning from their environments may be especially likely to result in rapid language growth.

Koegel, L.K., Koegel, R.L., Kellegrew, D., Mullen, K. (1996). Parent education and reduction of severe problem behaviors . In Positive Behavioral Support: Including people with difficult behavior in the community. (pp. 3-30) Baltimore, MD: Paul H Brookes Publishing.

Abstract: it is clear that specific gaps exist in the treatment of children with autism relating to the issue of heterogeneity of the symptoms exhibited in autism / research suggests that specific variables associated with outcomes relate to the complex interactions of child characteristics, family variables, and target behaviors / specifically, it appears that an individualized intervention that addresses these variables has the potential to ultimately result in a prescriptive approach to parent education, so that implementation of an intervention would result in prevention and reduction of severe problem behaviors and significant skill acquisition across all children / parents' active participation in implementing language, communication, and other goals will most likely hasten and facilitate acquisition and generalization in the habilitation process /// reviews a few programs that have been scientifically documented to promote effective change and reduce or prevent severe problem behaviors from occurring in natural environments such as home and school /// pivotal responding and motivation [skill acquisition and practice through daily routines, involving parents in home interventions, functional analysis] / independent functioning [child self-management, self-initiated queries] / home-school coordination [priming, child and family characteristics]

PRT Publications of Historical Significance

Lovaas, O.I, Koegel, R.L., Schreibman, L. (1979). Stimulus overselectivity in autism: A review of the research. Psychological Bulletin , 86(6), 1236-1254.

Abstract: Reviews a series of investigations that suggest that autistic children show "stimulus overselectivity," a response to only a limited number of cues in their environment, and discusses how such overselectivity may relate to several of the behavioral deficits in autism. These include failure to develop normal language or social behavior, failure to generalize newly acquired behavior to new stimulus situations, failure to learn from traditional teaching techniques that use prompts, and a general difficulty in learning new behaviors. Several studies that suggest possible remedial procedures are discussed, and the concept of stimulus overselectivity is related to the literature on attentional or response deficits in adult schizophrenia, mental retardation, learning disabilities, and autism.

Russo, D.C., & Koegel, R.L. (1977). A method for integrating an autistic child into a normal public-school classroom. Journal of Applied Behavior Analysis, 10(4), 579-590.

Abstract: Investigated, in 2 experiments, the feasibility of using behavioral techniques to integrate an autistic 5-year-old girl into a normal public-school class with 1 teacher and 20-30 normal children. In both experiments, initial treatment was given by a therapist who then trained the classroom teacher to continue treatment. Overall results show that (a) during treatment by a therapist in the classroom, the Ss appropriate verbal and social behaviors increased and autistic mannerisms decreased; and (b) training teachers in behavioral techniques was apparently sufficient to maintain the S's appropriate school behaviors throughout kindergarten (Exp I) and the 1st grade (Exp II).

Koegel, R.L., & Wilhelm, H. (1973). Selective responding to the components of multiple visual cues by autistic children. Journal of Experimental Child Psychology, 15(3), 442-453.

Abstract: Trained 15 normal and 15 profoundly retarded, autistic children (mean ages 9 and 6 yrs, respectively) to respond to a card containing 2 visual cues. After this training discrimination was established, Ss were tested on the single cues in order to assess whether 1 or both stimuli had acquired control over their responding. 12 autistic Ss gave evidence for stimulus overselectivity in that they responded correctly to only 1 of the 2 component cues. On the other hand, 12 normals showed clear evidence of control by both component cues of the training card. Results are consistent with previous studies, where autistics showed overselectivity when presented with multiple sensory input in several modalities. However, autistic Ss appeared to have difficulty responding to multiple cues even when both cues were in the same modality. Results are discussed in relation to the experimental literature on selective attention in normally functioning organisms.

Lovaas, O.I., Koegel, R., Simmons, J.Q., & Long (1973). Some generalization and follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis, 6(1), 131-166.

Abstract: Details the treatment of 20 autistic children. At intake, most of the Ss were severely disturbed, having symptoms indicating an extremely poor prognosis. They were treated in separate groups, and some were treated more than once, allowing for within- and between-S replications of treatment effects. Reliable measures of generalization were employed across situations and behaviors as well as across time (follow-up). Findings can be summarized as follows: (a) Inappropriate behaviors (self-stimulation and echolalia) decreased during treatment, and appropriate behaviors (appropriate speech, appropriate play, and social nonverbal behaviors) increased. (b) Spontaneous social interactions and the spontaneous use of language occurred about 8 mo. into treatment for some of the Ss. (c) IQs and social quotients reflected improvement during treatment. (d) There were no exceptions to the improvement; however, some of the Ss improved more than others. (e) Follow-up measures recorded 1-4 yr. after treatment showed that large differences between groups of Ss depended upon the posttreatment environment (those groups whose parents were trained to carry out behavior therapy continued to improve, while Ss who were institutionalized regressed). (f) A brief reinstatement of behavior therapy could temporarily reestablish some of the original therapeutic gains made by the Ss who were subsequently institutionalized.

Lovaas, O.I., Schreibman, L., Koegel, R., Rehm, R. (1971). Selective responding by autistic children to multiple sensory input. Journal of Abnormal Psychology, 77(3), 211-222.

Abstract: Reinforced 6 autistic, 5 retarded, and 5 normal children for responding to a complex stimulus involving the simultaneous presentation of auditory, visual, and tactile cues. After discrimination was established, elements of the complex were presented separately to assess which aspects of the complex stimulus had acquired control over the S's behavior. It was found that (a) the autistics responded primarily to only 1 of the cues, normals to all 3 cues, and retardates to 2 cues; and (b) conditions could be arranged such that a cue which had remained nonfunctional when presented in association with other cues could be established as functional when trained separately. Data fail to support theories that any 1 sense modality is impaired in autistic children. When presented with a stimulus complex, autistic Ss' attention was overselective. Findings are related to the literature on selective attention. Since much learning involves contiguous or near-contiguous pairing of 2 or more stimuli, failure to respond to 1 of the stimuli may be an important factor in the development of autism.

Empirical Support for Pivotal Response Treatment

2008

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, Vol. 38, 815-826.

Children with autism face enormous struggles when attempting to interact with their typically developing peers. More children are educated in integrated settings; however, play skills usually need to be explicitly taught, and play environments must be carefully prepared to support effective social interactions. This study incorporated the motivational techniques of Pivotal Response Training through peer-mediated practice to improve social interactions for children with autism during recess activities. A multiple baseline design across subjects was used to assess social skills gains in two elementary school children. The results demonstrated an increase in important social skills, namely social initiations and turn taking, during recess.

2007

Bryson, S.E., Koegel, L. K., Koegel, R.L., Openden, D., Smith, I.M., & Nefdt, N. (2007). Large scale dissemination and community implementation of Pivotal Response Treatment: Program description and preliminary data. Research and Practice for Persons with Severe Disabilities. Vol. 32 (2). 142-153.

This paper describes a collaborative effort aimed at province-wide dissemination and implementation of pivotal response treatment (PRT) for young children with autism spectrum disorder (ASD) in Nova Scotia, Canada. Three critical components of the associated training model are described: (1) direct training of treatment teams (parents, one-to-one interventionists, and clinical supervisors/ leaders); (2) training of trainers; and (3) follow-up and monitoring of treatment fidelity and child progress. A major goal of the Dalhousie University/IWK Health CentreY University of California at Santa Barbara partnership was to optimize effectiveness when translating PRT from the ‘‘lab’’ for dissemination in large geographical areas with community service providers. Finally, we provide data on stakeholder satisfaction with the training workshops and end by identifying features that may have contributed to our success thus far.

Baker-Ericzen, 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, Vol. 9 (1), 52-60.

Although knowledge about the efficacy of treatments such as pivotal response training (PRT) for children with autism is increasing, studies of large-scale effectiveness for and transportability to diverse community populations are needed. The current study provides a large-scale preliminary assessment of (a) the effectiveness of a community-based parent education PRT intervention and (b) whether specific child variables are associated with outcomes. One hundred fifty-eight families with children having an autism spectrum diagnosis participated. Children were heterogeneous with regards to age, gender, and race/ethnicity. Results indicate that all of the children showed significant improvements in adaptive functioning on the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984). However, younger children (3 years old or younger) showed the least impairment at intake and the most improvement post-intervention. This is one of the first large-scale community studies of PRT that included a diverse sample.

LeBlanc, L.A., Geiger, K.B., Sautter, R.A., & Sidener, T.M. (2007) Using the natural language paradigm (NLP) to increase vocalizations of older adults with cognitive impairments. Research in Developmental Disabilities, Vol. 28, 437-444.

The Natural Language Paradigm (NLP) has proven effective in increasing spontaneous verbalizations for children with autism. This study investigated the use of NLP with older adults with cognitive impairments served at a leisure-based adult day program for seniors. Three individuals with limited spontaneous use of functional language participated in a multiple baseline design across participants. Data were collected on appropriate and inappropriate vocalizations with appropriate vocalizations coded as prompted or unprompted during baseline and treatment sessions. All participants experienced increases in appropriate speech during NLP with variable response patterns. Additionally, the two participants with substantial inappropriate vocalizations showed decreases in inappropriate speech. Implications for intervention in day programs are discussed.

2005

Sherer, M.R. & Schreibman, L. (2005) Individual behavioral profiles and predictors of treatment effectiveness for children with autism. Journal of Consulting and Clinical Psychology, Vol. 73 (3), 525-538.

Differential responsiveness to intervention programs suggests the inadequacy of a single treatment approach for all children with autism. One method for reducing outcome variability is to identify participant characteristics associated with different outcomes for a specific intervention. In this investigation, an analysis of archival data yielded 2 distinct behavioral profiles for responders and nonresponders to a widely used behavioral intervention, pivotal response training (PRT). In a prospective study, these profiles were used to select 6 children (3 predicted responders and 3 predicted nonresponders) who received PRT. Children with pretreatment responder profiles evidenced positive changes on a range of outcome variables. Children with pretreatment nonresponder profiles did not exhibit improvements. These results offer promise for the development of individualized treatment protocols for children with autism.

2003

Koegel, L. K., Carter, C. M., & Koegel, R. L. (2003). Teaching children with autism self-initiations as a pivotal response. Topics in Language Disorders, 23, 134-145.

The purpose of this study was to assess whether children with autism could be taught a child-initiated query as a pivotal response to facilitate the use of grammatical morphemes. Data were collected within the context of a multiple baseline design across two children who lacked the use of temporal morphemes. Results of the study indicated that both children learned the self-initiated strategy and both acquired and generalized the targeted morpheme. Additionally, generalized use of the self-initiation into other question forms and concomitant increases in mean length of utterance, verb acquisition, and diversity of verb use occurred for both children. These generalized effects and the applications of this procedure across linguistic targets are discussed.

1999

Koegel, L. K., Koegel, R. L., Harrower, J. K., Carter, C. M. (1999). Pivotal response intervention I: Overview of approach. Journal of the Association for Persons with Severe Handicaps, 24, 174-185.

Presents an overview of several pivotal response interventions for autistic children. Teaching in pivotal areas constitutes an efficient and effective mode of intervention in overcoming the number of difficulties that exist for children with severe disabilities. Key pivotal areas include responsivity to multiple cues, observable motivation to initiate and respond appropriately to social and environmental stimuli, and self-regulation of behavior. Approaches to teaching multiple cues include within-stimulus prompting and conditional discrimination. Motivation techniques include child choice, natural reinforcers, interspersed maintenance trials, and reinforcing attempts. The goal of the model is to provide autistic individuals with the social and functional proficiency to participate in enriched and meaningful lives in inclusive settings.

Examined the degree to which self-initiation was associated with highly favorable postintervention outcome in treating autism. In phase 1 of the Exp, 3 children achieving a highly favorable outcome to a treatment intervention and 3 who responded unfavorably (aged 3 yrs at program entry) were retrospectively examined concerning self-initiating behaviors. Results show that those with favorable outcomes exhibited more spontaneous self-initiations at preintervention. Results of phase 2 of the Exp,comprising 10 autistic children (aged 2-3 yrs at program entry) show that Subjects could be taught self-initiating behavior, thereby leading to highly favorable treatment outcomes, based on data collected several years subsequent to intervention. It is concluded that social communicative initiation is a pivotal behavior in autism treatment.

1998

Examined whether motivational procedures incorporated into teaching question-asking to 3 children (aged 3.75-5.42 yrs) with autism, who lack verbal initiations, would result in generalization without additional teaching, prompting, or reinforcement in other settings. Specifically, the authors assessed whether such children could learn to use questions and whether the spontaneous use of question-asking would generalize across stimuli, settings, and people. All children learned to use questions in relation to items they had previously been unable to label and demonstrated generalization of spontaneous question-asking to new items and to their home environments with their mothers, with concomitant gains in expressive vocabulary. Results are discussed in terms of teaching response strategies, such as question-asking, to promote spontaneous child-initiated social interactions and expressive language development.

Koegel, R. L., Camarata, S., Koegel, L. K., Ben-Tall, A., & Smith, A. E. (1998). Increasing speech intelligibility in children with autism. Journal of Autism and Developmental Disorders, 28, 241-251.

Systematically compared 2 intervention conditions, a Naturalistic approach (which incorporated motivation variables) vs an Analog (more traditional, structured) approach. Subjects were 4 male and 1 female 3.7-7.5 yr olds with autism. Developmentally similar speech sounds were equated within and across conditions for each child. Data indicate that although both methods effectively increased correct production of the target sounds under some conditions, functional use of the target sound in conversation occurred only when the naturalistic procedures were used during intervention. Results are discussed in terms of pivotal variables that may produce improvements in speech sounds during conversational speech.

Koegel, L.K., Camarata, S.M., Valdez-Menchaca, M., & Koegel, R.L.(1998). Setting generalization of question-asking by children with autism. American Journal on Mental Retardation, 102(4) , 346-357.

1997

Pierce, K. & Schreibman, L. (1997) 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, Vol. 30, 157-160.

Two children with autism and 8 typical peers participated in a study designed to replicate an earlier finding of successful social-skills intervention for children with autism using peer implemented pivotal response training (PRT) and to assess the effects of using multiple peer trainers on generalization of treatment effects. During training, peers were taught PRT strategies using didactic instruction, modeling, role playing, and feedback. After treatment, children with autism engaged in increased levels of social behavior.

1996

Koegel, R.L., Bimbela, A., Schreibman, L. (1996). Collateral effects of parent training on family interactions. Journal of Autism and Developmental Disorders , 26(3), 347-359.

Assessed the collateral effects of 2 parent training paradigms: (1) focused on teaching individual target behaviors (ITBs) serially, and (2) focused on teaching the pivotal responses (PRs) of motivation and responsivity to multiple cues. 17 Ss with autism (aged 3-9 yrs) and their families were randomly assigned to either ITB or PR training. Pretraining and post-parent-training videotapes of dinnertime interactions were scored randomly across 4interactional scales (level of happiness, interest, stress, and style of communication). Results obtained for the 4 scales show that the families in both conditions initially scored in the neutral range, and the ITB training produced no significant influence on interactions posttraining. The PR training resulted in the families showing positive interactions on all 4 scales, suggesting high degrees of happiness and interest, low stress during the interaction, and more positive communication.

1995

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, Vol. 28, 285-295.

Two children with autism were taught to engage in a variety of complex social behaviors using peer-implemented pivotal response training (PRT), a set of procedures designed to increase motivation and promote generalization. Typical peers were taught to implement PRT strategies by modeling, role playing, and didactic instruction. After training, peers implemented the procedures in the absence of direct supervision in a classroom environment. After the intervention, both children with autism maintained prolonged interactions with the peer, initiated play and conversations, and increased engagement in language and joint attention behaviors. In addition, teachers reported positive changes in social behavior, with the largest increases in peer-preferred social behavior. Further, these effects showed generality and maintenance. Implications of these findings are discussed.

Stahmer, A.C. (1995) Teaching symbolic play skills to children with autism using pivotal response training. Journal of Autism and Developmental Disorders, Vol. 25 (2), 123-141.

Used Pivotal Response Training (PRT) to teach 7 children with autism to engage in symbolic play behaviors. Symbolic play, complexity of play behavior, and creativity of play were assessed. In addition, generalization measures were obtained across settings, toys, and play partners. Interaction with the play partners and comparison with typical controls were also examined. Results indicated that children with autism rarely exhibited symbolic play before training or after a control condition. After specific symbolic play training using PRT, all of the children learned to perform complex and creative symbolic play actions at levels similar to that of language-matched (typical controls. In most cases the children generalized their play to new toys, environments, and play partners and continued to engage in symbolic play behavior after a 3-month follow-up period. In addition, interaction skills improved after training. Treatment implications for these findings are discussed.

Thorp, D.M., Stahmer, A.C. & Schreibman, L.(1995) Effects of sociodramatic play training on children with autism. Journal of Autism and Developmental Disorders, Vol. 25 (3), 265-282.

Assessed the effects of teaching sociodramatic play to 3 boys (aged 5 yrs 4 mo, 8 yrs 2 mo, and 9 yrs 9 mo) with autism. Ss' expressive language ages ranged from 3 yrs 7 mo to 5 yrs 2 mo. Training was conducted using a variation of pivotal response training, a program used to teach language to children with autism. Measures of play skills, social behavior, and language skills were obtained before and after treatment and at a 3-mo follow-up session. The correlation between language and pretend play was explored, as was the relationship between sociodramatic play and social competence. Positive changes were observed in play, language, and social skills. These changes generalized across toys and settings, although little generalization to other play partners occurred. Effects of play training with children with autism and maintenance of behavior change are discussed.

1992

Koegel, R.L., Koegel, L.K., & Surratt. (1992) Language intervention and disruptive behavior in preschool children with autism. Journal of Autism and Developmental Disorders, Vol. 22(2), 141-153.

Examined whether the incorporation of parameters of natural language interactions and motivational techniques reduces disruptive behavior during language teaching tasks. Within a repeated reversals design with order of conditions and number of sessions varied within and across 3 autistic children (aged 3 yrs 4 mo to 4 yrs 6 mo), treatment was conducted for 2 language teaching conditions. During 1 condition, trials were presented serially in a traditional analog clinical format where the therapist presented instructions, prompts, and reinforcers for correct responses. The other condition incorporated parameters of natural language interactions and natural motivational techniques, such that stimulus items were functional and varied. Communicative attempts were reinforced. Greater improvements in responding and considerably less disruptive behavior occurred during the natural language teaching conditions.

1991

Schreibman, L., Kaneko, W.M., & Koegel, R.L. (1991) Positive affect of parents of autistic children: A comparison across two teaching techniques. Behavior Therapy, Vol. 22(4), 479-490.

Compared parental affect of 19 parents of autistic children across 2 parent training techniques: individual target behavior (ITB) or pivotal response training (PRT). 120 undergraduates who served as judges were asked to rate positive affect of Ss as they worked in one-on-one training sessions with their children. Results indicate that Ss implementing the PRT procedure were rated as exhibiting significantly more positive affect than those Ss implementing the ITB procedure. Results also support the hypothesis that the interactions inherent in the PRT procedures may represent more natural parent-child interactions and are more pleasant for the parents to conduct than the highly structured interactions associated with the ITB form of treatment.

1988

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, Vol. 21, 391-400.

Parents of four nonverbal and four echolalic autistic children were trained to increase their children's speech by using the Natural Language Paradigm (NLP), a loosely structured procedure conducted in a play environment with a variety of toys. Parents were initially trained to use the NLP in a clinic setting, with subsequent parent-child speech sessions occurring at home. The results indicated that following training, parents increased the frequency with which they required their children to speak (i.e., modeled words and phrases, prompted answers to questions). Correspondingly, all children increased the frequency of their verbalizations in three nontraining settings. Thus, the NLP appears to be an efficacious program for parents to learn and use in the home to increase their children's speech.

1987

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, Vol. 17(2), 187-200.

Assessed whether 2 nonverbal autistic children (aged 4 yrs 5 mo and 5 yrs 8 mo) would increase their verbal responding in a language intervention program if specific variables were manipulated in a natural language teaching paradigm. Within a multiple baseline design, treatment was conducted in a baseline condition with trials presented serially in a traditional analog clinical format where the therapist presented instructions, prompts, and reinforcers for correct responses. Variables were manipulated in the natural language teaching condition such that (1) stimulus items were functional and varied, (2) natural reinforcers were employed, (3) communicative attempts were also reinforced, and (4) trials were conducted within a natural interchange. Treatment and generalization data demonstrate broadly generalized treatment gains

:: ABA course based on DTL & Pivotal Response Treatment

Courses to train parents, caregivers, therapists and Psychologists are run almost on a monthly basis. Courses are run on three consecutive saturdays.

Watch here for the dates of the next courses. Click on the course date for a PDF brochure

Sat Oct 21,28 and Nov 5th

FaHCSIA will pay for parents and caregivers to do the course.