A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Introduction: With the increase in children diagnosed with autism spectrum disorders (ASD) each year comes the need for individualized interventions necessary for children with autism. Many of the treatments currently available are time consuming, costly, and rely heavily on behavioral interventionists despite the lack of qualified interventionists to provide these services. Therefore, there is a growing recognition of the need for efficient, cost-effective treatment models that involves families in the intervention. This study examined the effects of continuous parent training and feedback for 3 months in Pivotal Response Treatment (PRT) through telemedicine on responsivity to language opportunities in children with ASD versus a control group of parents receiving one week of PRT training alone. We hypothesized that with telemedicine support, the child’s verbal communication would increase. Methods: 30 child-parent dyads from Tucson, AZ were enrolled in this randomized control trial. Subjects were 24-60 months of age and met DSM-IV criteria for autism at the time of enrollment. All subjects received one week of intensive parent training at the Southwest Autism Research and Resource Center (SARRC) in PRT. The support group received telemedicine feedback three times weekly for three months. Data was analyzed using two sample t-tests and Wilcoxon rank sum tests. Results: The control group had a mean responsivity in function verbal utterances of 64.3% and the telemedicine group had a 62.7% verbal responsivity rate prior to initiation of telemedicine support. At three month follow-up, the control group had a mean responsivity rate of 58.6% and the telemedicine group had a mean responsivity of 64.3%. A two sample t-test showed a no significant difference between the two groups with a p-value of 0.51. Conclusions: This study did not find any significant difference between the telemedicine and control groups. However, there is a trend towards increased verbal communication in the telemedicine group. We therefore recommend further studies to determine the utility of telemedicine and parent training in PRT in the treatment of children with ASD.

After a review of the literature on Pivotal Response Treatment (PRT) in young children with developmental delays, less was known on its effects on challenging behavior and functional communication in preschool age children receiving services in a traditional public school. A multiple baseline design across three participants was used to evaluate the effects of PRT on the functional communication of three preschool students with developmental delays. Based on a functional analysis, we also observed the effects of PRT on challenging behavior. A visual analysis of the data revealed a functional relation between PRT and functional communication and provided promising evidence regarding the effectiveness of function aligned mands in reducing problem behavior. Brief surveys and interviews revealed that the intervention was feasible and effective based on staff and family reports. This research study adds to the evidence supporting the use of the intervention and expands on the knowledge base surrounding function aligned communication. Implications for research and practice are discussed.

abstract: Parents fulfill a pivotal role in early childhood development of social and communication skills. In children with autism, the development of these skills can be delayed. Applied behavioral analysis (ABA) techniques have been created to aid in skill acquisition. Among these, pivotal response treatment (PRT) has been empirically shown to foster improvements. Research into PRT implementation has also shown that parents can be trained to be effective interventionists for their children. The current difficulty in PRT training is how to disseminate training to parents who need it, and how to support and motivate practitioners after training. Evaluation of the parents’ fidelity to implementation is often undertaken using video probes that depict the dyadic interaction occurring between the parent and the child during PRT sessions. These videos are time consuming for clinicians to process, and often result in only minimal feedback for the parents. Current trends in technology could be utilized to alleviate the manual cost of extracting data from the videos, affording greater opportunities for providing clinician created feedback as well as automated assessments. The naturalistic context of the video probes along with the dependence on ubiquitous recording devices creates a difficult scenario for classification tasks. The domain of the PRT video probes can be expected to have high levels of both aleatory and epistemic uncertainty. Addressing these challenges requires examination of the multimodal data along with implementation and evaluation of classification algorithms. This is explored through the use of a new dataset of PRT videos. The relationship between the parent and the clinician is important. The clinician can provide support and help build self-efficacy in addition to providing knowledge and modeling of treatment procedures. Facilitating this relationship along with automated feedback not only provides the opportunity to present expert feedback to the parent, but also allows the clinician to aid in personalizing the classification models. By utilizing a human-in-the-loop framework, clinicians can aid in addressing the uncertainty in the classification models by providing additional labeled samples. This will allow the system to improve classification and provides a person-centered approach to extracting multimodal data from PRT video probes. / Dissertation/Thesis / Doctoral Dissertation Computer Science 2019