A Pivotal Response Treatment Package for Children With Autism Spectrum Disorder: An RCT
A Pivotal Response Treatment Package for Children With Autism Spectrum Disorder: An RCT
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DOI：
10.1542/peds.2019-0178
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发表时间：
2019-09-01
期刊：
影响因子：
8
通讯作者：
Hardan, Antonio Y.
中科院分区：
文献类型：
--
作者：
Gengoux, Grace W.;Abrams, Daniel A.;Hardan, Antonio Y.
目的：我们的目的是进行一项随机对照试验，以评估关键反应治疗方案（PRT-P），包括父母培训和临床医生提供的家庭干预对自闭症谱系障碍儿童沟通技巧的影响。方法：48例2 ~ 5岁的自闭症谱系障碍伴显著语言迟缓儿童随机分为PRT-P组（n = 24）和延迟治疗组（n = 24），治疗时间为24周。治疗对儿童沟通技巧的影响通过亲子互动的行为编码、标准化的父母报告测量和盲法临床医生评分来评估。结果：结构化实验室观察期间的儿童话语分析显示，与延迟治疗组相比，PRT-P组儿童功能性话语频率改善更大（F-1,F-41 = 6.07; P = 0.026; d = 0.61）。PRT- p组的大多数家长（91%）能够在24周内忠实地实施关键缓解治疗（PRT）。接受PRT-P的儿童在社会沟通变化的简短观察、临床整体印象改善子量表和父母报告问卷中使用的单词数量上也表现出更大的改善。结论：这是第一个将社区治疗与家长培训和临床提供PRT相结合进行比较的24周随机对照试验。PRT- p对提高儿童社会沟通能力和教育家长实施PRT是有效的。需要进一步的研究来了解治疗环境、强度和持续时间的最佳组合，并确定与治疗反应相关的儿童和家长特征。
OBJECTIVES:Our aim was to conduct a randomized controlled trial to evaluate a pivotal response treatment package (PRT-P) consisting of parent training and clinician-delivered in-home intervention on the communication skills of children with autism spectrum disorder.METHODS:Forty-eight children with autism spectrum disorder and significant language delay between 2 and 5 years old were randomly assigned to PRT-P (n = 24) or the delayed treatment group (n = 24) for 24 weeks. The effect of treatment on child communication skills was assessed via behavioral coding of parent-child interactions, standardized parent-report measures, and blinded clinician ratings.RESULTS:Analysis of child utterances during the structured laboratory observation revealed that, compared with the delayed treatment group, children in PRT-P demonstrated greater improvement in frequency of functional utterances (F-1,F-41 = 6.07; P = .026; d = 0.61). The majority of parents in the PRT-P group (91%) were able to implement pivotal response treatment (PRT) with fidelity within 24 weeks. Children receiving PRT-P also demonstrated greater improvement on the Brief Observation of Social Communication Change, on the Clinical Global Impressions Improvement subscale, and in number of words used on a parent-report questionnaire.CONCLUSIONS:This is the first 24-week randomized controlled trial in which community treatment is compared with the combination of parent training and clinician-delivered PRT. PRT-P was effective for improving child social communication skills and for teaching parents to implement PRT. Additional research will be needed to understand the optimal combination of treatment settings, intensity, and duration, and to identify child and parent characteristics associated with treatment response.