Purpose: As rates of Autism Spectrum Disorders (ASD) increase, there is growing strain on public schools to provide high quality, specialized programming for meeting the needs of students with ASD. Very little research has examined the efficacy of any specific techniques for intervening with children with ASD in school settings. The translation of interventions that have been demonstrated to be effective in controlled settings to school settings is needed.

To address this need, researchers at Rady Children's Hospital Research Center are modifying an evidence-based intervention, Pivotal Response Training, for use in classroom settings and evaluating its effectiveness for improving outcomes for children with ASD. For the Classroom Pivotal Response Training intervention, the researchers will adapt the current Pivotal Response Training procedures, manual, and training process for classroom implementation while preserving the integrity of the program. The purpose of this study is to develop, refine, and conduct an initial evaluation to determine whether exposure to the intervention is associated with improvements in the communication, play, academic and social skills of children with ASD.

Project Activities: The researchers will use an iterative process to adapt and develop the intervention. In Phase 1, the researchers will conduct focus groups with teachers to determine how different teachers use, modify, and apply Pivotal Response Training in the classroom and identify which specific components need adaptation. In Phase 2, information from Phase 1 will be used to adapt Pivotal Response Training procedures and develop a manualized program for classroom use (Classroom-Pivotal Response Training). Alterations to the core elements of the program will be experimentally validated with children, ages 3-8, with ASD using single subject methodology. In the final phase, a pilot study of the efficacy of Classroom-Pivotal Response Training in classrooms will be conducted. A multiple baseline design will be used to examine fidelity of implementation, teacher satisfaction, and improvements in child outcomes including communication, play, academic and social skills.

Products: The expected outcomes from this study include reports on the effectiveness of the developed intervention for improving the communication, academic, play and social skills of children with autism. The research team will also produce an intervention manual that will include curriculum goals.

Structured Abstract

Purpose: As rates of Autism Spectrum Disorders (ASD) increase, there is growing strain on public schools to provide high quality, specialized programming for meeting the needs of students with ASD. Very little research to date has examined the efficacy of any specific techniques for intervening with children with ASD in school settings. The translation of interventions that have been demonstrated to be effective in controlled settings to school settings is needed.

To address this need, researchers at Rady Children's Hospital Research Center are modifying an evidence-based intervention, Pivotal Response Training, for use in classroom settings and evaluating its effectiveness for improving outcomes for children with ASD. For the Classroom Pivotal Response Training intervention, the researchers will adapt the current Pivotal Response Training procedures, manual and training process for classroom implementation while preserving the integrity of the program. The purpose of this study is to develop, refine, and conduct an initial evaluation to determine whether exposure to the intervention is associated with improvements in the communication, play, academic and social skills of children with ASD.

Setting: Participating students will be from California school districts.

Population: In Phase 1, 10 teachers who currently report using Pivotal Response Training in their classrooms, and 10 who do not will be asked to participate in one of two focus groups. In Phase 2, an as-yet undetermined number children ages 3-8 with an educational diagnosis of ASD will participate. The number of children participating will be dependent on the number of modifications necessary to the Pivotal Response Training. In Phase 3, a minimum of 15 teachers with at least two students with a primary diagnosis of ASD will participate.

Intervention: A manualized Pivotal Response Training program for classroom use (Classroom Pivotal Response Training) will be developed. Alterations to the core elements (e.g., prompts, child choice, turn-taking, interspersal of maintenance tasks) of the program will be adapted and modified and experimentally validated using single subject methodology. For example, an element that may require adaptation is child choice, including reducing the number of choices and delineating procedures for providing types of choice. An initial evaluation of Classroom Pivotal Response Training in classrooms will be conducted. A multiple baseline design across schools will be used to examine fidelity of implementation of the techniques, teacher satisfaction and ease of use of the protocol, and improvements in child communication, play, academic and social skills using both observational and standardized assessments.

Research Design and Methods: In Phase 1, both qualitative and quantitative methods will explore the use of Pivotal Response Training in classroom settings. Focus groups will be used to investigate the benefits and barriers of using Pivotal Response Training methodology in classroom programs. These data will be analyzed using the constant comparative method to identify primary and secondary themes. In Phase 2, an alternating treatments design will be used to examine the effect of individual modifications to the training protocol. Each adaptation will be tested in one-on-one settings. In Phase 3, assessment of the effectiveness of the Classroom Pivotal Response Training program on student outcomes will be conducted using a multiple baseline design across school sites. Participating teachers will be randomly assigned to a 2-, 4-, or 6-week baseline condition, with five teachers in each condition.

Control Condition: Not applicable.

Key Measures: An initial communication assessment will be conducted using the Preschool Language Scales-4 for children under age 5 or the Clinical Evaluation of Language Fundamentals for children age 5 and over, to determine the appropriate level of communication to target. To assess severity of symptoms, the Pervasive Developmental Disorder Behavior Inventory, a rating scale, will be used. Data recording sheets completed by teachers will be used to determine gains in child communication, play and social skills.

Data Analytic Strategy: Both qualitative and quantitative strategies will be used throughout the project period. Focus groups will be used in the first phase to determine benefits and barriers to the use of Pivotal Response Training in the classroom. Single subject methodology will be used in the second phase to determine whether adaptations in Pivotal Response Training are effective. Visual inspection will be used to examine differences between the two conditions. In addition, a simplified time series analysis will be used and the magnitude of the change will be evaluated using a C statistic. In the final phase, a multiple baseline design across school sites will be used.

Products and Publications

Book

Stahmer, A.C., Suhrheinrich, J., Reed, S., Schreibman, L., and Buldoc, C. (2011). Classroom Pivotal Response Teaching for Children With Autism. New York: Guilford Press.

Book chapter

Schreibman, L., Suhrheinrich, J., Stahmer, A.C., and Reed, S. (2012). Translating Evidence-Based Practice From the Laboratory to the Classroom: The Development of Classroom Pivotal Response Teaching. In P. Mundy, and A. Mastergeorge (Eds.), Empirically Supported Educational Interventions for School Age Children With Autism (pp. 107–130). San Francisco: Jossey-Bass/Wiley.

Suhrheinrich, J., Hall, L., Reed, S.R., Stahmer, A.C., and Schreibman, L. (2014). Evidence-Based Interventions in the Classroom. In L.A. Wilkinson (Ed.), Autism Spectrum Disorders in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. Washington, DC: American Psychological Association.

Suhrheinrich, J., Zeedyk, S., Vejnoska, S., and Stahmer, A.C. (in press). Educator Involvement in Research and Evaluation. In R. Jordan, J. Roberts, and K. Hume (Eds.), Autism and Education: An International Handbook. New York: Sage.

Journal article, monograph, or newsletter

Reed, S., Stahmer, A.C., Suhrheinrich, J., and Schreibman, L. (2013). Stimulus Overselectivity in Typical Development: Implications for Teaching Children With Autism. Journal of Autism and Developmental Disorders, 43(6): 1249–1257. doi:10.1007/s10803–012–1658–x

Rieth, S.R., Stahmer, A.C., Suhrheinrich, J., and Schreibman, L. (2015). Examination of the Prevalence of Stimulus Overselectivity in Children With ASD. Journal of Applied Behavior Analysis, 48(1): 71–84. doi:10.1002/jaba.165

Rieth, S.R., Stahmer, A.C., Suhrheinrich, J., Schreibman, L., Kennedy, J., and Ross, B. (2014). Identifying Critical Elements of Treatment: Examining the Use of Turn Taking in Autism Intervention. Focus on Autism and Other Developmental Disabilities, 29(3): 168–179. doi:10.1177/1088357613513792

Stahmer, A.C., Suhrheinrich, J., and Rieth, S.R. (2016). A Pilot Examination of the Adapted Protocol for Classroom Pivotal Response Teaching. Journal of the American Academy of Special Education Professionals: 119–139.

Stahmer, A.C., Suhrheinrich, J., Reed, S., and Schreibman, L. (2012). What Works for You? Using Teacher Feedback to Inform Adaptations of Pivotal Response Training for Classroom Use. Autism Research and Treatment, Article ID 709861, 2012: 1–11. doi:10.1155/2012/709861 Full text