Advertisement

Journal of Autism and Developmental Disorders

, Volume 46, Issue 8, pp 2813–2820 | Cite as

Brief Report: Reduced Restricted and Repetitive Behaviors after Pivotal Response Treatment

  • Pamela E. Ventola
  • Daniel Yang
  • Sebiha M. Abdullahi
  • Courtney A. Paisley
  • Megan L. Braconnier
  • Denis G. Sukhodolsky
Brief Report

Abstract

Children with ASD show high frequency of restricted and repetitive behaviors (RRBs); however, higher-order RRBs, such as restricted interests, have remained largely resistant to treatment. This study evaluated change in severity of RRBs following a 16-weeks open trial of Pivotal Response Treatment (PRT). Participants included 15 children with ASD ages 4–7 years. RRBs, as measured by the repetitive behavioral scales-revised (RBS-R) and aberrant behaviors checklist, decreased significantly after treatment. These reductions remained significant after controlling for change in social communication skills. PRT shows promise in reducing RRBs; although PRT explicitly addresses pivotal social communication skills, there is a secondary and less direct effect on RRBs.

Keywords

Restricted and repetitive behaviors Pivotal Response Treatment (PRT) Behavior therapy Repetitive Behavior Scale-Revised (RBS-R) 

Notes

Acknowledgments

Funding for this study came from Autism Science Foundation, Simons Foundation, Women’s Health Research at Yale, Deitz Family, Esme Usdan & Family, and Dwek Family. We wish to thank the families of the children included in this study for their time and participation.

Author Contributions

PV conceived of the study, participated in its design and coordination, and drafted the manuscript. DY participated in the design of the study and performed the statistical analysis. SA participated in the coordination of the study, helped to draft the manuscript, and delivered the treatment. CP participated in the coordination of the study and delivered the treatment. MB participated in the coordination of the study and delivered the treatment. DS conceived of the study and helped to draft the manuscript. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

This work was approved by Yale University Institutional Review Board (IRB). All participants provided informed consent for participation.

References

  1. Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985). The aberrant behavior checklist: A behavior rating scale for the assessment of treatment effects. American Journalon Mental Deficiency, 89, 485–491.Google Scholar
  2. Bishop, S. L., Richler, J., & Lord, C. (2006). Association between restricted and repetitive behaviors and nonverbal IQ in children with autism spectrum disorders. Child Neuropsychology, 12(4–5), 247–267. doi: 10.1080/09297040600630288.CrossRefPubMedGoogle Scholar
  3. Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: Comparisons to mental retardation. Journal of Autism and Developmental Disorders, 30(3), 237–243. doi: 10.1023/A:1005596502855.CrossRefPubMedGoogle Scholar
  4. Boyd, B. A., McDonough, S. G., & Bodfish, J. W. (2012). Evidence-based behavioral interventions for repetitive behaviors in autism. Journal of Autism and Developmental Disorders, 42(6), 1236–1248. doi: 10.1007/s10803-011-1284-z.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Carrasco, M., Volkmar, F. R., & Bloch, M. H. (2012). Pharmacologic treatment of repetitive behaviors in autism spectrum disorders: Evidence of publication bias. Pediatrics, 129(5), E1301–E1310. doi: 10.1542/peds.2011-3285.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale (2nd ed.). Los Angeles, CA: Western Psychological Services.Google Scholar
  7. Cuccaro, M. L., Shao, Y., Grubber, J., Slifer, M., Wolpert, C. M., Donnelly, S. L., et al. (2003). Factor analysis of restricted and repetitive behaviors in autism using the Autism Diagnostic Interview-R. Child Psychiatry and Human Development, 34(1), 3–17.CrossRefPubMedGoogle Scholar
  8. Elliott, C. D. (2007). Differential ability scales: Introductory and technical handbook (2nd ed.). San Antonio, TX: Psycholoogical Corporation/A Harcourt Assessment Company.Google Scholar
  9. Esbensen, A. J., Seltzer, M. M., Lam, K. S., & Bodfish, J. W. (2009). Age-related differences in restricted repetitive behaviors in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 57–66. doi: 10.1007/s10803-008-0599-x.CrossRefPubMedGoogle Scholar
  10. Gabriels, R. L., Agnew, J. A., Miller, L. J., Gralla, J., Pan, Z., Goldson, E., et al. (2008). Is there a relationship between restricted, repetitive, stereotyped behaviors and interests and abnormal sensory response in children with autism spectrum disorders? Research in Autism Spectrum Disorders, 2(4), 660–670. doi: 10.1016/j.rasd.2008.02.002.CrossRefGoogle Scholar
  11. Gabriels, R. L., Cuccaro, M. L., Hill, D. E., Ivers, B. J., & Goldson, E. (2005). Repetitive behaviors in autism: Relationships with associated clinical features. Research in Developmental Disabilities, 26(2), 169–181. doi: 10.1016/j.ridd.2004.05.003.CrossRefPubMedGoogle Scholar
  12. Goldman, S. E., Surdyka, K., Cuevas, R., Adkins, K., Wang, L., & Malow, B. A. (2009). Defining the sleep phenotype in children with autism. Developmental Neuropsychology, 34(5), 560–573. doi: 10.1080/87565640903133509.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Hardan, A. Y., Gengoux, G. W., Berquist, K. L., Libove, R. A., Ardel, C. M., Phillips, J., et al. (2014). A randomized controlled trial of Pivotal Response Treatment Group for parents of children with autism. Journal of Child Psychology and Psychiatry,. doi: 10.1111/jcpp.12354.Google Scholar
  14. Harrop, C., Gulsrud, A., Shih, W., Hovsepyan, L., & Kasari, C. (2015). Characterizing caregiver responses to restricted and repetitive behaviors in toddlers with autism spectrum disorder. Autism,. doi: 10.1177/1362361315580443.Google Scholar
  15. Harrop, C., McConachie, H., Emsley, R., Leadbitter, K., Green, J., & Consortium, P. (2014). Restricted and repetitive behaviors in autism spectrum disorders and typical development: Cross-sectional and longitudinal comparisons. Journal of Autism and Developmental Disorders, 44(5), 1207–1219. doi: 10.1007/s10803-013-1986-5.CrossRefPubMedGoogle Scholar
  16. Hattori, J., Ogino, T., Abiru, K., Nakano, K., Oka, M., & Ohtsuka, Y. (2006). Are pervasive developmental disorders and attention-deficit/hyperactivity disorder distinct disorders? Brain Development, 28(6), 371–374. doi: 10.1016/j.braindev.2005.11.009.CrossRefPubMedGoogle Scholar
  17. Honey, E., McConachie, H., Turner, M., & Rodgers, J. (2012). Validation of the repetitive behaviour questionnaire for use with children with autism spectrum disorder. Research in Autism Spectrum Disorders, 6(1), 355–364. doi: 10.1016/j.rasd.2011.06.009.CrossRefGoogle Scholar
  18. Kanne, S. M., & Mazurek, M. O. (2011). Aggression in children and adolescents with ASD: Prevalence and risk factors. Journal of Autism and Developmental Disorders, 41(7), 926–937. doi: 10.1007/s10803-010-1118-4.CrossRefPubMedGoogle Scholar
  19. Kim, S. H., & Lord, C. (2012). New autism diagnostic interview-revised algorithms for toddlers and young preschoolers from 12 to 47 months of age. Journal of Autism and Developmental Disorders, 42(1), 82–93. doi: 10.1007/s10803-011-1213-1.CrossRefPubMedGoogle Scholar
  20. King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill, L., Bregman, J. D., et al. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior citalopram ineffective in children with autism. Archives of General Psychiatry, 66(6), 583–590.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Koegel, R. L., & Koegel, L. K. (2012). The PRT pocket guide: Pivotal response treatment for autism spectrum disorders. Baltimore, MD: Paul H Brookes Publishing.Google Scholar
  22. Koegel, R. L., Schreibman, L., Good, A. B., Cerniglia, L., Murphy, C., & Koegel, L. K. (1989). How to teach pivotal behaviors to autistic children. Santa Barbara: University of California.Google Scholar
  23. Kuhn, D. E., Hardesty, S. L., & Sweeney, N. M. (2009). Assessment and treatment of excessive straightening and destructive behavior in an adolescent diagnosed with autism. Journal of Applied Behavior Analysis, 42(2), 355–360. doi: 10.1901/jaba.2009.42-355.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Lam, K. S., & Aman, M. G. (2007). The Repetitive Behavior Scale-Revised: Independent validation in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(5), 855–866. doi: 10.1007/s10803-006-0213-z.CrossRefPubMedGoogle Scholar
  25. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). ADOS: Autism diagnostic observation schedule. Manual. Los Angeles: WPS.Google Scholar
  26. Lounds, J., Seltzer, M. M., Greenberg, J. S., & Shattuck, P. T. (2007). Transition and change in adolescents and young adults with autism: Longitudinal effects on maternal well-being. American Journal on Mental Retardation, 112(6), 401–417. doi: 10.1352/0895-8017(2007)112[401:TACIAA]2.0.CO;2.
  27. Militerni, R., Bravaccio, C., Falco, C., Fico, C., & Palermo, M. T. (2002). Repetitive behaviors in autistic disorder. European Child and Adolescent Psychiatry, 11(5), 210–218. doi: 10.1007/s00787-002-0279-x.CrossRefPubMedGoogle Scholar
  28. Mohammadzaheri, F., Koegel, L. K., Rezaee, M., & Rafiee, S. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavior analysis (ABA) intervention for children with autism. Journal of Autism and Developmental Disorders, 44(11), 2769–2777.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Mohammadzaheri, F., Koegel, L. K., Rezaei, M., & Bakhshi, E. (2015). A randomized clinical trial comparison between pivotal response treatment (PRT) and adult-driven applied behavior analysis (ABA) intervention on disruptive behaviors in public school children with autism. Journal of Autism and Developmental Disorders, 45(9), 2899–2907.CrossRefPubMedGoogle Scholar
  30. Mooney, E. L., Gray, K. M., Tonge, B. J., Sweeney, D. J., & Taffe, J. R. (2009). Factor analytic study of repetitive behaviours in young children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 39(5), 765–774. doi: 10.1007/s10803-008-0680-5.CrossRefPubMedGoogle Scholar
  31. Nadig, A., Lee, I., Singh, L., Bosshart, K., & Ozonoff, S. (2010). How does the topic of conversation affect verbal exchange and eye gaze? A comparison between typical development and high-functioning autism. Neuropsychologia, 48(9), 2730–2739. doi: 10.1016/j.neuropsychologia.2010.05.020.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Rapp, J. T., & Vollmer, T. R. (2005). Stereotypy I: A review of behavioral assessment and treatment. Research in Developmental Disabilities, 26(6), 527–547. doi: 10.1016/j.ridd.2004.11.005.CrossRefPubMedGoogle Scholar
  33. Ray-Subramanian, C. E., & Ellis Weismer, S. (2012). Receptive and expressive language as predictors of restricted and repetitive behaviors in young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(10), 2113–2120. doi: 10.1007/s10803-012-1463-6.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Richler, J., Bishop, S. L., Kleinke, J. R., & Lord, C. (2007). Restricted and repetitive behaviors in young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 73–85. doi: 10.1007/s10803-006-0332-6.CrossRefPubMedGoogle Scholar
  35. Richler, J., Huerta, M., Bishop, S. L., & Lord, C. (2010). Developmental trajectories of restricted and repetitive behaviors and interests in children with autism spectrum disorders. Development and Psychopathology, 22(1), 55–69. doi: 10.1017/S0954579409990265.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R Autism diagnostic interview revised manual. Los Angeles: Western Psychological Services.Google Scholar
  37. Scahill, L., Aman, M. G., Lecavalier, L., Halladay, A. K., Bishop, S. L., Bodfish, J. W., et al. (2015). Measuring repetitive behaviors as a treatment endpoint in youth with autism spectrum disorder. Autism, 19(1), 38–52. doi: 10.1177/1362361313510069.CrossRefPubMedGoogle Scholar
  38. Schultz, T. M., & Berkson, G. (1995). Definition of abnormal focused affections and exploration of their relation to abnormal stereotyped behaviors. American Journal on Mental Retardation, 99(4), 376–390.PubMedGoogle Scholar
  39. Shattuck, P. T., Seltzer, M. M., Greenberg, J. S., Orsmond, G. I., Bolt, D., Kring, S., et al. (2007). Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(9), 1735–1747. doi: 10.1007/s10803-006-0307-7.CrossRefPubMedGoogle Scholar
  40. Soorya, L., Kiarashi, J., & Hollander, E. (2008). Psychopharmacologic interventions for repetitive behaviors in autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 17(4), 753–771. doi: 10.1016/j.chc.2008.06.003.CrossRefPubMedGoogle Scholar
  41. Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36(1), 117–128. doi: 10.1007/s10802-007-9165-9.CrossRefPubMedGoogle Scholar
  42. Szatmari, P., Georgiades, S., Bryson, S., Zwaigenbaum, L., Roberts, W., Mahoney, W., et al. (2006). Investigating the structure of the restricted, repetitive behaviours and interests domain of autism. Journal of Child Psychology and Psychiatry, 47(6), 582–590. doi: 10.1111/j.1469-7610.2005.01537.x.CrossRefPubMedGoogle Scholar
  43. Ventola, P., Friedman, H. E., Anderson, L. C., Wolf, J. M., Oosting, D., Foss-Feig, J., et al. (2014). Improvements in social and adaptive functioning following short-duration PRT program: A clinical replication. Journal of Autism and Developmental Disorders, 44(11), 2862–2870. doi: 10.1007/s10803-014-2145-3.CrossRefPubMedGoogle Scholar
  44. Ventola, P., Yang, D. Y. J., Friedman, H. E., Oosting, D., Wolf, J., Sukhodolsky, D. G., et al. (2015). Heterogeneity of neural mechanisms of response to pivotal response treatment. Brain Imaging and Behavior, 9(1), 74–88. doi: 10.1007/s11682-014-9331-y.CrossRefPubMedGoogle Scholar
  45. Werner, E., & Dawson, G. (2005). Validation of the phenomenon of autistic regression using home videotapes. Archives of General Psychiatry, 62(8), 889–895. doi: 10.1001/archpsyc.62.8.889.CrossRefPubMedGoogle Scholar
  46. Wiig, E. H., Secord, W. A., & Semel, E. (2004). Clinical evaluation of language fundamentals—Preschool, second edition (CELF Preschool-2). Toronto: The Psychological Corporation/A Harcourt Assessment Company.Google Scholar
  47. Wiig, E. H., Secord, W. A., & Semel, E. (2006). Clinical evaluation of language fundamentals-preschool (2nd ed.). Marrickville: Harcourt Assessment.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Pamela E. Ventola
    • 1
  • Daniel Yang
    • 1
  • Sebiha M. Abdullahi
    • 1
  • Courtney A. Paisley
    • 1
  • Megan L. Braconnier
    • 1
  • Denis G. Sukhodolsky
    • 1
  1. 1.Yale Child Study CenterYale University School of MedicineNew HavenUSA

Personalised recommendations