Pivotal response treatment involving parents works better than other existing therapies at motivating children with autism and significant speech delays to talk, according to the results of a large study by researchers at the Stanford University School of Medicine.

Because children with autism are less socially motivated than typically developing children, parents’ instincts about how to engage them often don’t succeed, said Grace Gengoux, PhD, clinical associate professor of psychiatry and behavioral sciences. PRT gives parents a way to breach this barrier.

“We were teaching parents how to set up situations where their child would be motivated to communicate,” Gengoux said. “The results of our study are exciting because we found that children in the PRT group improved not just in their communication skills, but also in their broader social abilities.”

Heidi Pim of Palo Alto, California, participated in the study with her son, James, who was diagnosed as a toddler with autism and speech delays.

“I was really worried and anxious about not knowing if he would ever be able to talk,” Pim said. She was impressed by the changes she saw in James, who was 3 at the time of the study. “I feel so grateful now to see how many words and phrases he knows,” she said. “He’s able to speak clearly and socialize as well, to go up to people and ask them questions.”

A paper describing the study was published online Aug. 5 in Pediatrics. Gengoux is the lead author. The senior author is Antonio Hardan, MD, professor of psychiatry and behavioral sciences. They both treat children and adolescents at Lucile Packard Children's Hospital Stanford.

Six-month study

The six-month study enrolled 48 children who were 2 to 5 years old and had autism and significant language delays. Half the children received PRT treatment from therapists and their parents, while the remaining children continued to receive whatever autism treatments they had been getting before the study began, which included other types of applied behavior analysis and conventional speech therapy.

For the first 12 weeks of the study, children in the PRT group underwent 10 hours per week of PRT from a trained therapist, and their parents received training for one hour per week in how to use the treatment’s techniques during everyday interactions with their children. For the second 12 weeks of the study, children in the PRT group received five hours per week of therapist treatment, and their parents had monthly instruction sessions.