Skip to main content
SpringerLink
Log in

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

  • Brief Report
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale (2nd ed.). Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Elliott, C. D. (2007). Differential ability scales: Introductory and technical handbook (2nd ed.). San Antonio, TX: Psycholoogical Corporation/A Harcourt Assessment Company.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). ADOS: Autism diagnostic observation schedule. Manual. Los Angeles: WPS.

    Google Scholar 

  • 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.

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R Autism diagnostic interview revised manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • Wiig, E. H., Secord, W. A., & Semel, E. (2006). Clinical evaluation of language fundamentals-preschool (2nd ed.). Marrickville: Harcourt Assessment.

    Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, PO Box 207900, New Haven, CT, 06520-7900, USA

    Pamela E. Ventola, Daniel Yang, Sebiha M. Abdullahi, Courtney A. Paisley, Megan L. Braconnier & Denis G. Sukhodolsky

Authors
  1. Pamela E. Ventola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sebiha M. Abdullahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Courtney A. Paisley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Megan L. Braconnier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Denis G. Sukhodolsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pamela E. Ventola.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ventola, P.E., Yang, D., Abdullahi, S.M. et al. Brief Report: Reduced Restricted and Repetitive Behaviors after Pivotal Response Treatment. J Autism Dev Disord 46, 2813–2820 (2016). https://doi.org/10.1007/s10803-016-2813-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-016-2813-6

Keywords

Search

Navigation