Pivotal Response Intervention I: Overview of Approach
01 Sep 1999-The Journal of The Association for Persons With Severe Handicaps (SAGE Publications)-Vol. 24, Iss: 3, pp 174-185
TL;DR: In this article, the authors present an overview of pivotal response interventions, focusing on identifying pivotal areas that, when changed, result in concomitant positive changes in other areas, including self-management and self-initiations.
Abstract: The purpose of this article is to present an overview of several pivotal response interventions. Our research at the University of California, Santa Barbara, has been focused on attempting to identify pivotal areas that, when changed, result in concomitant positive changes in other areas. Pivotal areas that are discussed include responsivity to multiple cues, motivation to initiate and respond appropriately to social and environmental stimuli, and self-regulation of behavior, including self-management and self-initiations. The trend to streamline intervention by targeting behaviors that will have widespread effects on development, rather than targeting individual behaviors one at a time, is discussed.
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1,483 citations
Cites background from "Pivotal Response Intervention I: Ov..."
...Teaching of pivotal skills, such as increasing motivation or self-management, can produce improvement in wide areas of functioning that might otherwise require hundreds or even thousands of discrete trials for the child to master individually (Koegel et al., 1999)....
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...As for other aspects of development, programs have been implemented to maximize generalization of learning (Koegel et al., 1999), but this process cannot be assumed to occur naturally....
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...Two important findings have been reported (Koegel et al., 1999)....
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...Other behaviors, or often classes of behaviors, have been described as “pivotal behaviors” in the sense that their acquisition allows a child to learn many other skills more efficiently (Koegel et al., 1999; Pierce and Schreibman, 1997)....
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...In pivotal response training (Koegel et al., 1999), certain behaviors are seen as central to wide areas of functioning....
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01 Apr 2007TL;DR: The quantity and quality of research into autism and related conditions have increased dramatically in recent years as mentioned in this paper, and there has been significant advances in the molecular genetics of autism and understanding of the underlying neurobiological processes.
Abstract: The quantity and quality of research into autism and related conditions have increased dramatically in recent years. Consequently we selectively review key accomplishments and highlight directions for future research. More consistent approaches to diagnosis and more rigorous assessment methods have significantly advanced research, although the boundaries of the 'broader phenotype' remain to be defined and the validity of Asperger's disorder as a discrete syndrome remains controversial. Recent epidemiological studies have shown that Autism Spectrum Disorders are common, but there continues to be debate about the causes of the increase in the frequency with which autism is diagnosed. Psychological research has helped to develop new developmental models for the disorder and there have also been significant advances in the molecular genetics of autism and understanding of the underlying neurobiological processes. Areas important for future research include the study of autism as it first develops, i.e., in infants and very young children, and of specific processes (psychological and neurobiological) which underlie the disorder. Significant challenges lie ahead in evaluating the growing number of treatments for autism and in integrating the results of research into treatment and educational settings.
1,029 citations
TL;DR: The empirical studies of comprehensive treatments for young children with autism published since 1998 were reviewed and found that most studies were either Type 2 or 3 in terms of their methodological rigor based on Nathan and Gorman's (2002) criteria.
Abstract: Early intervention for children with autism is currently a politically and scientifically complex topic. Randomized controlled trials have demonstrated positive effects in both short-term and longer term studies. The evidence suggests that early intervention programs are indeed beneficial for children with autism, often improving developmental functioning and decreasing maladaptive behaviors and symptom severity at the level of group analysis. Whether such changes lead to significant improvements in terms of greater independence and vocational and social functioning in adulthood is also unknown. Given the few randomized controlled treatment trials that have been carried out, the few models that have been tested, and the large differences in interventions that are being published, it is clear that the field is still very early in the process of determining (a) what kinds of interventions are most efficacious in early autism, (b) what variables moderate and mediate treatment gains and improved outcomes foll...
909 citations
Cites background from "Pivotal Response Intervention I: Ov..."
...commenting), play skills, and joint attention behaviors (Koegel, Camarata, Valdez-Menchaca, & Koegel, 1998; Koegel et al., 1999; Koegel et al., 2003; Stahmer, 1995; Thorp, Stahmer, & Schreibman, 1995; Vismara & Lyons, in press; Whalen & Schreibman, 2003)....
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...L. K. Koegel et al. (1999) 10 children with autism participated in phase 1 (N ¼ 6; M CA 42 months, M language age 27 months) and phase 2 (N ¼ 4; M CA 37 months, M language age 23 months)....
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TL;DR: It cannot be assumed that even significant improvements in the diagnosed child will ameliorate the parent and family distress already present, especially as the time and expense of intervention can add further family disruption.
Abstract: Raising a child with an autism spectrum disorder (ASD) can be an overwhelming experience for parents and families. The pervasive and severe deficits often present in children with ASD are associated with a plethora of difficulties in caregivers, including decreased parenting efficacy, increased parenting stress, and an increase in mental and physical health problems compared with parents of both typically developing children and children with other developmental disorders. In addition to significant financial strain and time pressures, high rates of divorce and lower overall family well-being highlight the burden that having a child with an ASD can place on families. These parent and family effects reciprocally and negatively impact the diagnosed child and can even serve to diminish the positive effects of intervention. However, most interventions for ASD are evaluated only in terms of child outcomes, ignoring parent and family factors that may have an influence on both the immediate and long-term effects of therapy. It cannot be assumed that even significant improvements in the diagnosed child will ameliorate the parent and family distress already present, especially as the time and expense of intervention can add further family disruption. Thus, a new model of intervention evaluation is proposed, which incorporates these factors and better captures the transactional nature of these relationships.
675 citations
TL;DR: A developmental link between parental sensitivity and the child's subsequent development of communication skills in children with autism is suggested.
Abstract: The present study focused on behaviors that caregivers of children with autism show during play interactions, particularly the extent to which the caregiver's behavior is synchronized with the child's focus of attention and ongoing activity. The study had two major findings. First, caregivers of children with autism synchronized their behaviors to their children's attention and activities as much as did caregivers of children with developmental delay and caregivers of typically developing children, matched on language capacities. Second, caregivers of children with autism who showed higher levels of synchronization during initial play interactions had children who developed superior joint attention and language over a period of 1, 10, and 16 years than did children of caregivers who showed lower levels of synchronization initially. These findings suggest a developmental link between parental sensitivity and the child's subsequent development of communication skills in children with autism. Implications for parent training interventions are discussed.
620 citations
Cites background from "Pivotal Response Intervention I: Ov..."
...In addition, a variety of recent interventions that specifically target communication skills in children with autism consider the child’s motivation and the sharing of control over material and tasks as basic parameters of intervention: Pivotal Response Intervention ( Koegel, Koegel, Harrower, & Carter, 1999; Koegel, Koegel, Shoshan, & McNerney, 1999), Natural Language Learning Paradigm (Koegel, O’Dell, & Koegel, 1987), ......
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...In addition, a variety of recent interventions that specifically target communication skills in children with autism consider the child’s motivation and the sharing of control over material and tasks as basic parameters of intervention: Pivotal Response Intervention (Koegel, Koegel, Harrower, & Carter, 1999; Koegel, Koegel, Shoshan, & McNerney, 1999 ), Natural Language Learning Paradigm (Koegel, O’Dell, & Koegel, 1987), ......
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References
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TL;DR: The results of behavior modification treatment for two groups of similarly constituted, young autistic children showed that 47% achieved normal intellectual and educational functioning, with normal-range IQ scores and successful first grade performance in public schools.
Abstract: Autism is a serious psychological disorder with onset in early childhood. Autistic children show minimal emotional attachment, absent or abnormal speech, retarded IQ, ritualistic behaviors, aggression, and self-injury. The prognosis is very poor, and medical therapies have not proven effective. This article reports the results of behavior modification treatment for two groups of similarly constituted, young autistic children. Follow-up data from an intensive, long-term experimental treatment group (n = 19) showed that 47% achieved normal intellectual and educational functioning, with normal-range IQ scores and successful first grade performance in public schools. Another 40% were mildly retarded and assigned to special classes for the language delayed, and only 10% were profoundly retarded and assigned to classes for the autistic/retarded. In contrast, only 2% of the controlgroup children (n = 40) achieved normal educational and intellectual functioning; 45% were mildly retarded and placed in language-delayed classes, and 53% were severely retarded and placed in autistic/retarded classes. Kanner (1943) defined autistic children as children who exhibit (a) serious failure to develop relationships with other people before 30 months of age, (b) problems in development of normal language, (c) ritualistic and obsessional behaviors ("insistence on sameness"), and (d) potential for normal intelligence. A more complete behavioral definition has been provided elsewhere (Lovaas, Koegel, Simmons, & Long, 1973). The etiology of autism is not known, and the outcome is very poor. In a follow-up study on young autistic children, Rutter (1970) reported that only 1.5% of his group (n = 63) had achieved normat functioning. About 35% showed fair or good adjustment, usually required some degree of supervision, experienced some diffaculties with people, had no personal friends, and showed minor oddities of behavior. The majority (more than 60%) remained severely handicapped and were living in hospitals for mentally retarded or psychotic individuals or in other protective settings. Initial IQ scores appeared stable over time. Other studies (Brown, 1969; DeMyer et al., 1973; Eisenberg, 1956; Free
2,919 citations
"Pivotal Response Intervention I: Ov..." refers background in this paper
...Although the children appear to need intensive intervention throughout the day (Lovaas, 1987; R. L. Koegel & Koegel, 1995), we believe that the quality of the intervention and the specific target behaviors that they are taught may be as important as the number of hours of direct contact from a…...
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TL;DR: The results indicated that, even when controlling for language level, mental age, or IQ, autistic children displayed deficits in gestural joint attention skills on two testing sessions that were 13 months apart.
Abstract: This study was designed to examine the degree to which individual differences in gestural joint attention skills predicted language development among autistic children. A group of 15 autistic children (mean CA=45 months) were matched with one group of mentally retarded (MR) children on mental age and another group of MR children on language age. These groups were administered the Early Social-Communication Scales. The latter provided measures of gestural requesting, joint attention, and social behaviors. The results indicated that, even when controlling for language level, mental age, or IQ, autistic children displayed deficits in gestural joint attention skills on two testing sessions that were 13 months apart. Furthermore, the measure of gestural nonverbal joint attention was a significant predictor of language development in the autistic sample. Other variables, including initial language level and IQ were not significant predictors of language development in this sample.
1,011 citations
TL;DR: Inappropriate behaviors decreased during treatment, andappropriate behaviors increased, and appropriate behaviors (appropriate speech, appropriate play, and social non-verbal behaviors) increased in autistic children treated with behavior therapy.
Abstract: We have treated 20 autistic children with behavior therapy. At intake, most of the children were severely disturbed, having symptoms indicating an extremely poor prognosis. The children were treated in separate groups, and some were treated more than once, allowing for within- and between-subject replications of treatment effects. We have employed reliable measures of generalization across situations and behaviors as well as across time (follow-up). The findings can be summarized as follows: (1) Inappropriate behaviors (self-stimulation and echolalia) decreased during treatment, and appropriate behaviors (appropriate speech, appropriate play, and social non-verbal behaviors) increased. (2) Spontaneous social interactions and the spontaneous use of language occurred about eight months into treatment for some of the children. (3) IQs and social quotients reflected improvement during treatment. (4) There were no exceptions to the improvement, however, some of the children improved more than others. (5) Follow-up measures recorded 1 to 4 yr after treatment showed that large differences between groups of children depended upon the post-treatment environment (those groups whose parents were trained to carry out behavior therapy continued to improve, while children who were institutionalized regressed). (6) A brief reinstatement of behavior therapy could temporarily re-establish some of the original therapeutic gains made by the children who were subsequently institutionalized.
732 citations
TL;DR: The validity study indicated that teacher's ratings on the Motivation Assessment Scale predicted how their students would behave in analogue situations, and the MAS predicted the subjects' self-injurious behavior in situations with decreased adult attention, with increased academic demands, with restricted access to tangibles, and in unstructured settings.
Abstract: Reliability and validity data are reported for an instrument designed to identify variables maintaining self-injurious behavior. The Motivation Assessment Scale (MAS) is a 16-item questionnaire that addresses the situational determinants of self-injurious behavior in persons with autism and other developmental disorders. The reliability study indicated that teachers of 50 developmentally disabled persons could agree on the variables presumably maintaining their student's self-injury (interrater reliability), and that they would be in agreement again 30 days later (test-retest reliability). The validity study indicated that teacher's ratings on the MAS of 8 subjects' self-injury predicted how their students would behave in analogue situations. Specifically, the MAS predicted the subjects' self-injurious behavior in situations with decreased adult attention, with increased academic demands, with restricted access to tangibles, and in unstructured settings. The MAS is presented as an alternative or adjunct to more formal functional analyses in efforts to identify the variables controlling self-injurious behavior.
578 citations
Additional excerpts
...…analysis (Carr, Carlson, Langdon, Magito-McLaughlin, & Yarborough, 1998; Carr, Reeve, & Magito-McLaughlin, 1996; Daly, Witt, Martens, & Dool, 1997; Durand & Crimmins, 1988; Ervin, DuPaul, Kern, & Friman, 1998; Kern, Childs, Dunlap, Clarke, & Falk, 1994; L. K. Koegel, Koegel, & Dunlap, 1996)....
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TL;DR: A functional analysis of communicative behaviors indicated that, despite a wide variation in communicative means, the autistic subjects displayed a relatively homogeneous profile of communative functions that was both quantitatively and qualitatively different from the normal profile.
Abstract: The purpose of this study was to examine profiles of communicative and cognitive-social abilities in a small group of autistic children functioning in the prelinguistic and early stages of language...
497 citations
"Pivotal Response Intervention I: Ov..." refers background in this paper
...…181 Self-Initiations The language characteristics of children with autism often include low levels or the absence of question asking, apparent low levels of curiosity, and using language only to obtain desired items (Tager-Flusberg, 1996; Wetherby & Prutting, 1984), not to initiate conversation....
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