Self-Initiations in Young Children with Autism during Pivotal Response Treatment with and without Robot Assistance

The aim of this study was to investigate the effect of Pivotal Response Treatment versus robot-assisted Pivotal Response Treatment on self-initiations of children with autism spectrum disorder and to explore the relation between self-initiations and collateral gains in general social-communicative skills. Forty-four participants with autism spectrum disorder aged 3-8 years (Pivotal Response Treatment: n=20, Pivotal Response Treatment + robot: n=24), who were recruited as part of a larger randomized controlled trial (number NL4487/NTR4712, https://www.trialregister.nl/trial/4487), were included. Self-initiations were blindly coded, assessing video probes of all parent-child sessions using an event-recording system. General social-communicative skills were assessed with the parent- and teacher-rated Social Responsiveness Scale during intervention and at 3-month follow-up. Results using linear mixed-effects models showed overall gains in self-initiations during both Pivotal Response Treatment intervention groups (estimate = 0.43(0.15), 95% confidence interval (CI): 0.13-0.73), with larger gains in functional self-initiations in children receiving robot-assisted Pivotal Response Treatment (estimate = -0.27(0.12), 95% confidence interval: -0.50 to -0.04). Growth in self-initiations was related to higher parent-rated social awareness at follow-up compared with baseline in the total sample (r=-0.44, p=0.011). The clinical implications of these findings, as well as directions for future research in the utility of Pivotal Response Treatment and robot assistance in autism spectrum disorder intervention, are discussed.