The Effect of Pivotal Response Treatment in Children with Autism Spectrum Disorders: A Non-randomized Study with a Blinded Outcome Measure.
E A Duifhuis, J C den Boer, A Doornbos and 3 others
PMID 27815645WHAT IT FOUND
Children receiving PRT showed lower observed autism severity after 6 months, while children receiving usual care showed higher severity.
The trial was not randomised and the PRT group started at higher severity, so this does not prove PRT caused the change.
Key findings
01The ADOS total score, the study's primary outcome, showed a significant interaction: PRT mean fell from 14.8 to 13.2, while usual-care mean rose from 7.3 to 9.0.
02Calibrated ADOS severity scores also showed a significant interaction: PRT mean fell from 7.2 to 6.6, while usual-care mean rose from 3.8 to 4.8.
03Secondary outcomes on total SRS, CBCL, and parental stress showed no treatment effects; only the SRS social communication subscale was significant.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Randomisation was not possible, and PRT therapists were available only at one location, so allocation bias is a concern. The sample was small, with 24 enrolled and 11 in the PRT group and 13 in the usual-care group. The PRT group had higher baseline ADOS and SRS scores than the usual-care group, so the groups did not start at the same severity. The ADOS social affect and restricted repetitive behaviour subscales did not show significant interactions, even though the ADOS total score did. Secondary parent-reported outcomes were mostly null, and only one subscale was significant. Parents were not blinded, so parent-reported SRS, CBCL, and parental stress scores may be influenced by knowing the treatment. The usual-care group was heterogeneous, with sessions ranging from 3 to 37. One ADOS score was missing, and three children in the PRT group and three in the usual-care group withdrew before the midpoint. There was no follow-up after 6 months. Regression to the mean was mentioned as a possible explanation for the small improvement in the PRT group.
Declared interests
The only funding statement supplied is that the study was funded by Karakterkennisbeurs 2012.
The easy way to misread this
Do not conclude that PRT caused the ADOS improvement. The study was not randomised, the PRT group started with higher autism severity than the usual-care group, and the usual-care treatment varied widely, so the result may reflect baseline imbalance or other factors.