Abstract: This study examined the effectiveness of delivering Pivotal Response Treatment (PRT) in the natural environmental activity of horseback riding on social communication of children with autism spectrum disorder. We hypothesized that children provided with PRT in a natural setting (n= 8) would exhibit improvement in social communication compared to children who did not get the treatment (n= 8) following an 8- consecutive weeks of Pivotal Response Treatment delivered during horseback riding activity. The results of this study revealed that children participants demonstrated improvement in social communication as measured by Social Communication Questioner (SCQ) across three main domains: reciprocal social skills, social communication, and restricted ridged behaviors.
Keywords: Children with Autism. Pivotal Response Treatment (PRT). Horseback riding. Social Communication.
Autism is a multifaceted developmental disability that negatively impacts the verbal and non-verbal communication and social interaction such as play or leisure activities among children. The unique characteristics of children who are diagnosed with Autism Spectrum Disorder (ASD) pose special challenges for those teachers and educators who serve them in the schools and for the caregivers who deal with them in a daily base (Howlin, 2006).
Social communication is the core deficit of ASD in which is defined broadly as an individuals ability to respond to social bids and initiates and maintain interactional discourse (Adamson, McArthur, Markov, et al., 2001; Bruinsma, Koegel, & Koegel, 2004; Jones & Schwartz, 2009). These impairments are typically manifested by difficulty in responding to verbal initiation exhibited by others, inappropriate facial expressions, lack of eye contacts during social interactions, and lack of joint attention skill; additional symptoms may include echolalia or an absence of verbalization (Koegel et al., 1993; Pierce & Schreibman, 1995).
The delay in initial social communication skills affects the development of social language for children. With autism across the lifespan (Dawson, 2008; Mundy & Stella, 2000). Thus, providing children with autism with early intensive behavioral interventions has become a research priority.
Research literature has accentuated the importance of improving social behavior at an early age in order to provide these children with the prerequisite communication skills needed for distinctive child development (Koegel, Vernin, & Koegel, 2009; Charman, Baron-Cohen, Swettenman et al., 2003; Mundy, Sigman, & Kasaire, 1999). Several intervention strategies have been supported by empirical research to increase the communication skills of children with autism. Other strategies incorporate procedures that are especially effective in encouraging social communication that are characterized by delivering the intervention in a natural environment, using natural reinforcements, and emphasizing the importance of direct and immediate reinforcements (Lovass, 1987; Yoder & Stone, 2006; Koegel and Koegel, 2006, and Prizant, Wetherby, & Rubin).
Pivotal Response Treatment (PRT) intervention is an example of an empirically, valid, behavioral intervention that is derived from a naturalistic language paradigm in which the intervention is implemented in natural environments. It is characterized by enhancing functional communication skills through utilizing each childs natural motivations. The emphasis of PRT approach is on delivering instructions in a natural context (Coolican, Smith, & Bryson, 2010).
PRT approach is targeted to address the severity of autistic characteristics in several core areas. It aims to teach responses that resemble behavior that is more typical.
Underlying PRT is motivational strategies that are used to teach language skills, reduce disruptive or self-stimulatory behaviors, increase social communication skills, and increase academic skills (Koegel et al., 2006). Researchers identified several pivotal behavioral areas that when treated, produce large gains in desired outcomes due to the intervention: motivation in which the child is willing to engage interactively in social communication activities; social initiation in which child initiates participation in enjoyable activities; and self-regulation in that child can manage and monitor personal behaviors.
Motivation and self-initiation are the primary pivotal areas of PRT intervention. Initiating social motivation for children with autism is an essential value regarding the importance of being engaged in meaningful social interaction. Specific PRT motivational techniques include following the childs preferred items, varying task difficulties, rewarding and reinforcing immediately and continually, and delivering natural reinforcement that is related to the childs response. (Koegel, Camarate, & Valdez-Menchaca, 1998). Other pivotal areas include self-management and the ability to respond to multiple cues or prompts. By targeting the pivotal essential areas, individuals with autism can positively progress in other areas that are not targeted in the intervention (Koegel et al., 2006).
The most important aspect of PRT approach is that a child-directed approach that the child determines the direction of the therapy by making choices. The child determines the activities and objects that will be utilized during the intervention (Koegel et al., 2006). Children with autism often demonstrate a lack of verbal initiation required to prompt language acquisition. Therefore, enhancing their motivation with specific PRT techniques help them to initiate meaningful verbal communication and ensure the generalization of verbal initiation across different settings, stimuli, or people (Koegel, Camarate, & Koegel, 1998). The outcome of research studies gathering longitudinal data about children with autism suggests that the presence of verbal initiation could be a predictive indicator for more positive long-term social-behavioral outcomes. The results indicated the need for more board application systematic teaching interventions such as PRT intervention to foster child initiations (Koegel, Koegel, & Shoshan et al., 1999).
In a recent study by Voos, Pelphrey, & Tirrel et al., (2013), researchers investigated the effect of PRT technique on social brain activity. By using functional Magnetic Resonance Imaging, they measured the social brain activities while delivering the PRT technique to two young children with autism. Results showed a positive impact on the neural mechanisms that support the social perception skills for both cases. Furthermore, there were more activities in the regions that are typically recruited by typical children during social perception process. These results support the conclusion that PRT is an effective procedure by verifying that permanent positive changes have occurred in the brains of children receiving PRT.
Moreover, Generalization and maintenance have been at the heart of the intervention core for children with autism. Therefore, implementing the intervention in a natural environment has given significant attention to responses provided by controlling the stimuli in the natural environment (National Research Council 2001). Also, motivational components in the PRT intervention package can be better promoted in the natural environment where children have their preferred activities and reinforcements (Koegel et al., 2006). Researchers observed that the natural environment paradigm leads to collateral intervention gains in targeted and non-targeted areas such academic, behavior, and social developments in addition to the generalized effect across individuals and settings (Baker, Koegel, & Koegel, 1998; Baker, 2000; Koegel, Koegel & Surratt, 1992; Koegel, ODell & Dunlap, 1988).
Within a context of single-subject design, researchers conducted a study to examine the effect of incorporating motivational techniques with natural language paradigm on responses spontaneity and generalization for two nonverbal children with autism (Koegel, ODell, & Koegel, 1978). The setting of this study included a clinic room directed by a clinician, and the generalization probes were monitored in a clinical room decorated as a living room. In both settings, the children were exposed to traditional learning procedures (i.e., directed by a clinician, structured activities, edible reinforcement) and natural language paradigm condition (i.e., directed by the child, attempts reinforcement, and natural reinforcement). The result of this study indicated that the children exhibited broad generalization gains within the natural language paradigm condition compared to traditional learning procedures
One of the critical features of the natural language paradigm is that generalization and maintenance are integrated within the intervention, making them habitually applicable in natural settings and with varied individuals (Camarate, 1995). The natural language paradigm supports more inclusion for children with disabilities. By implementing the intervention in a natural setting, these children have better chances of being included with typical individuals in community settings (Camarate, 1995).
Therapeutic horseback riding is one of the therapy approaches that emphasized the role of the natural environment is. It is an example of animal-assisted therapy that has been drastically increased during the last forty years (Prothmann & Fine 2011). Recent developmental research demonstrated that both typically developing children and children with autism show a natural interests towards animals and other nonhuman aspects in their environments (Melson, 2003). Therapeutic horseback riding has extended the effect of animal research on the social functioning of children with autism regarding using horseback riding as a treatment to enhance posture, balance, and mobility and laterally developing the therapeutic bond between the horse and the child with autism (Martin& Farnum, 2002). Riding a horse involved many skills such as self-control, attention and focus, sensory integration, and verbal/ non-verbal communication. It also consists of multisensory integration, contact with the horse, psychological stimulations, and social responses. Consequently, this type of therapy can benefit children with autism who exhibited deficits in join-attention, social communication, and sensory integration and management (Prothmann & Fine 2011).
Ward et al., (2013) conducted a study in 21 children with autism, they utilized single group quasi- experimental interrupted time series design to examine the associations between therapeutic horseback riding and social communication and sensory processing in children with autism. All children attended therapeutic horseback riding for ten consecutive weeks followed by a six weeks break to investigate whether or not children were able to maintain the therapeutic effect following the withdrawal of therapeutic riding effects. The teachers of this study conducted pre and post of two measures: Gilliam Autism Rating Scale: Second Edition (GARS-2) that was used to assess autism characteristics and Sensory Profile School Companion (SPSC) to measure childrens sensory processing abilities. The results indicated that all children showed improvement in their social communication, tolerance, and sensory input reaction in which was also reflected on their learning in the classroom.
Since both interventions, Pivotal Response Treatment (PRT) and therapeutic horseback riding treatment are lined up with the latest research regarding the importance of natural environment in eliciting children with autism social communicat...
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