Increasing initiations towards peers in children with autism using pivotal response training and collateral gains in quality of initiations.

摘要

The ability to initiate is something typically developing children appear to do early on and with great ease (Adamson, 1995; Lord & Paul, 1998). Moreover, children with other developmental disabilities, such as Down syndrome, also engage in initiations, albeit delayed (McGee, Feldman, & Morrier, 1997; Sigman & Ruskin, 1999). However, the ability to initiate, one usually taken for granted in typically developing children, is arguably one of the greatest challenges facing children diagnosed with autism (Zanolli, Daggett, & Adams, 1996). Specifically, it is clearly documented in the literature that children with autism consistently exhibit pervasive impairments in the ability to initiate, both in terms of quantity and quality (Sigman & Ruskin, 1999; Weiss & Harris, 2001; Wetherby & Prutting, 1984; Wetherby, Yonclas, & Bryan, 1989). This is particularly important in light of recent research identifying initiations as a likely prognostic indicator. That is, children with autism who engage in initiations toward others are likely to have more favorable outcomes than children with autism who do not initiate (Koegel, Koegel, Shoshan, Mcnerney, 1999). Therefore, the purpose of this study was to empirically examine the effects of using the motivational procedures of PRT on the quantity and quality of initiations toward peers exhibited by children with autism. Specifically, a multiple baseline across participants was be employed to address the following (1) quantity of initiations toward peers; (2) collateral gains in quality of initiations toward peers (i.e., social interaction and joint attention initiations; (3) quantity of initiations typically developing children make toward other typically developing peers; and (4) quality of initiations typically developing children make toward other typically developing peers. Data suggest that overall quantity of initiations increased and that social interaction and joint attention initiations increased as a collateral effect of Pivotal Response Treatment. Furthermore, all three types of initiations (behavior regulation, social interaction, joint attention) generalized to peers who did not participate in intervention and to toys not utilized during intervention. Generalization gains were also maintained at follow-up. Results are discussed in terms of clinical implications and future directions for research.