Pivotal Response Treatment improves brain activity in children with autism

Published on February 15, 2013 at 4:21 AM · No Comments

Using functional magnetic resonance imaging (fMRI) for before-and-after analysis, a team of researchers including a UC Santa Barbara graduate student discovered positive changes in brain activity in children with autism who received a particular type of behavioral therapy.

Work completed at Yale University's Child Study Center used fMRI as the tool for measuring the impact of Pivotal Response Treatment (PRT) -- therapy pioneered at UCSB by Lynn Koegel, clinical director of the Koegel Autism Center -- on both lower- and higher-functioning children with autism receiving PRT for the first time. fMRI allows researchers to see what areas of the brain are active while processing certain stimuli -- in this case human motion. Comparing pre- and post-therapy data from the fMRI scans of their 5-year-old subjects, the researchers saw marked -- and remarkable -- changes in how the children were processing the stimuli. Findings from their study, "Neural Mechanisms of Improvements in Social Motivation After Pivotal Response Treatment," are published in a recent issue of the Journal of Autism and Developmental Disorders.

"The cool thing that we found was that these kids showed increased activation in regions of the brain utilized by typically developing kids," explained Avery C. Voos, first-year graduate student at the UCSB-based Koegel Autism Center, and one of the lead authors of the Yale study. "After four months of treatment, they're starting to use brain regions that typically developing kids are using to process social stimuli.

"We can say that we have shifted the way these children are processing low-level social stimuli, and that's what we want," she added. "There's a social deficit in autism, so any improvement toward social interaction really helps with development. That's what makes this very exciting, and it speaks to the promise and success of PRT."

A targeted technique meant to improve social engagement among children with autism spectrum disorders, PRT forgoes the focus on specific skills, like block-building, to concentrate instead on so-called "pivotal areas," such as motivation, in hopes of inducing a cascading effect with similar impact across multiple areas.

"For instance, if you're orienting to people, socially it may appear more acceptable, but you're also getting rich information from those people, which will affect the way you're interacting with people more broadly," Voos explained. "Say a child wants to draw, and asks for a red crayon while she has her back to me. I say, 'I can't understand what you're asking if you're not looking at me.' Once she orients toward me, we provide a contingent response -- in this case, giving her the red crayon -- and ideally she begins to understand, 'Hey, me looking at you and asking for what I want gets me what I want.' Ultimately, the social interaction becomes the reward on its own, which is the ultimate goal."

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