Copyright 2005 by the American Psychological Association 0022-006X/05/$12.00 DOI: 10.1037/0022-006X.73.3.525
Individual Behavioral Profiles and Predictors of Treatment Effectiveness for Children With Autism Michelle R. Sherer and Laura Schreibman
University of California, San Diego
Differential responsiveness to intervention programs suggests the inadequacy of a single treatment approach for all children with autism. One method for reducing outcome variability is to identify participant characteristics associated with different outcomes for a specific intervention. In this investigation, an analysis of archival data yielded 2 distinct behavioral profiles for responders and nonresponders to a widely used behavioral intervention, pivotal response training (PRT). In a prospective study, these profiles were used to select 6 children (3 predicted responders and 3 predicted nonresponders) who received PRT. Children with pretreatment responder profiles evidenced positive changes on a range of outcome variables. Children with pretreatment nonresponder profiles did not exhibit improvements. These results offer promise for the development of individualized treatment protocols for children with autism. Keywords: autism, behavioral treatment, behavioral profiles, individualized treatment, pivotal response training
Initially identified by Kanner (1943), autism remains a perplexing disorder that results in significant lifelong disability for most affected individuals (e.g., Gillberg, 1990; Rogers, 1998). However, a substantial number of children who have received intensive behavioral treatment during the preschool years have shown remarkable improvement (see reviews by Erba, 2000; Smith, 1999). The early intervention research that has generated the greatest amount of interest has been Lovaas’s (1987) Early Intervention Project. In this investigation, 19 children with autism received intensive discrete trial training (DTT). The results from this study were dramatic: Of the intensive (40 hr per week) treatment group, nearly half (47%) achieved “normal intellectual and educational functioning” (Lovaas, 1987, p. 3). Partial replications of this methodology have been conducted (e.g., Eikeseth, Smith, Jahr, & Eldevik, 2002; Smith, Groen, & Wynn, 2000), and although no researchers have reported the level of recovery of Lovaas’s participants, they have reported improvement in the treatment groups compared with control groups not receiving the high-intensity intervention. These studies have produced remarkable changes in the lives of many children with autism and have raised optimism as to the prognosis for children with this disorder. They have also incited a proliferation of DTT programs in schools, clinics, and homes, with some leaders in the field promoting this approach as the interven-
Michelle R. Sherer and Laura Schreibman, Department of Psychology, University of California, San Diego. This research was supported by U.S. Public Health Service Grant MH 39434 from the National Institute of Mental Health. We thank Aubyn Stahmer for insightful comments on earlier versions of this article. Correspondence concerning this article should be addressed to Laura Schreibman, Department of Psychology, 0109, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0109. E-mail: email@example.com 525
tion to be prescribed for all children with autism (Green, 1996; Smith, 1996). This enthusiasm, however, is appropriate only for the subset of the children who achieved the most favorable response and fails to recognize the unexplained outcome variability that consistently has been documented with this approach. Of the 19 children in Lovaas’s (1987) intensive therapy group, 9 made significant progress. There is little information, however, regarding the poorest outcome participants in this and other DTT studies. There is also little insight as...