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Pivotal Response Treatment Improves Brain Function and Social Response

Brain scan and gaze test reflect how strongly children respond to PRT; may offer future way to tailor therapy to increase benefit
November 17, 2014

Early findings from an ongoing study suggest that Pivotal Response Training (PRT) doesn’t just teach children social-communication skills. It also improves activity in brain regions associated with social behavior. The researchers foresee a day when brain scans may help identify which children will respond most strongly to particular therapies.

The study, funded in part by Autism Speaks, is among those being discussed this week at Neuroscience 2014, the world’s largest gathering of brain researchers.

“This type of information is important for providing parents and practitioners more-objective evidence for deciding which interventions are best for which children,” comments Lucia Murillo Autism Speaks assistant director for education research. Currently there is no way to predict how much a given autism therapy will help a child. Costly and time-intensive interventions produce great strides for some children but not others.

Study assesses autism symptoms, brain activity and visual attention
The Yale University researchers conducting the study are enrolling and testing 20 children with autism, ages 4 to 6. Each receives seven hours a week of PRT for four months. PRT is based on Applied Behavioral Analysis (ABA) and emphasizes playful, child-initiated interactions that promote enjoyable communication during daily activities.

Before and after the therapy, researchers assess the severity of the children’s autism symptoms. They also perform before and after brain scans to measure changes in the children’s brain responses to social images such as faces. In addition, the researchers are using gaze-tracking technology to measure the amount of attention the children pay to key aspects of facial expressions (eye and mouth area).

For comparison, half the children are tested before and after a four-month waiting period. (They, then receive the same therapy.) A second comparison group consists of 20 typically developing children of the same age, IQ and gender.

In her presentation at Neuroscience 2014, lead researcher Gabriela Rosenblau described preliminary results from the first nine children to complete the study.

“Before treatment started, we saw clear differences in the brain regions related to social functioning,” Rosenblau says. “The kids with autism had less activation than did the typically developing kids in response to happy or fearful faces.”

After four months of PRT, all the children with autism showed improved social behavior and less-severe autism symptoms. What’s more, the magnitude of their improvement reflected the degree of increased brain activity in response to facial images.

“Their brains became more similar to those of the typically developing children compared to the kids with autism who were on our wait list,” Rosenblau says.

Similarly, gaze tracking showed increased attention to areas of the face associated with emotion – particularly the mouth.

“The ultimate goal is to better understand why an intensive treatment such as PRT works for particular children,” says senior researcher Pamela Ventola, also at Yale. “The hope is to tailor autism treatments more specifically to individuals based in part on brain patterns.” Conversely, she adds, “if we can identify which children will respond best to which treatment, we can save precious time and money. That would be really meaningful.”

Read more coverage of autism research at Neuroscience 2014 here.

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