The symptoms of autism spectrum disorder are conceptualized to alter the quality of parent-children interactions, exposure to social learning exchanges, and ultimately the course of child development. There is evidence that modifying the procedures of Pivotal Response Treatment (PRT) to explicitly target social motivation enhances child engagement and parent-child synchrony in moment-by-moment exchanges. However, it is unclear if these within session improvements ultimately yield favorable developmental outcomes over time. The current investigation presents feasibility, utility, and preliminary efficacy data of a pilot randomized clinical trial (RCT) of a Pivotal Response Intervention for Social Motivation (PRISM) model. Data on participant factors, treatment protocol acceptability, and outcome variance and effect size are highly favorable and support the pursuit of a future, large scale RCT.

There is a pressing need for objective, quantifiable outcome measures in intervention trials for children with autism spectrum disorder (ASD). The current study investigated the use of eye tracking as a biomarker of treatment response in the context of a pilot randomized clinical trial of treatment for young children with ASD. Participants included 28 children with ASD, aged 18-48 months, who were randomized to one of two conditions: Pivotal Response Intervention for Social Motivation (PRISM) or community treatment as usual (TAU). Eye-tracking and behavioral assessment of developmental functioning were administered at Time 1 (prior to randomization) and at Time 2 (after 6 months of intervention). Two well-established eye-tracking paradigms were used to measure social attention: social preference and face scanning. As a context for understanding relationships between social attention and developmental ability, we first examined how scanning patterns at Time 1 were associated with concurrent developmental functioning and compared to those of 23 agematched typically developing (TD) children. Changes in scanning patterns from Time 1 to Time 2 were then compared between PRISM and TAU groups and associated with behavioral change over time. Results showed that the social preference paradigm differentiated children with ASD from TD children. In addition, attention during face scanning was associated with language and adaptive communication skills at Time 1 and change in language skills from Time 1 to Time 2. These findings highlight the importance of examining targeted biomarkers that measure unique aspects of child functioning and that are well-matched to proposed mechanisms of change. Autism Res 2019, 12: 779-793.Lay Summary: Biomarkers have the potential to provide important information about how and why early interventions effect positive change for young children with ASD. The current study suggests that eye-tracking measures of social attention can be used to track change in specific areas of development, such as language, and points to the need for targeted eye-tracking paradigms designed to measure specific behavioral changes. Such biomarkers could inform the development of optimal, individualized, and adaptive interventions for young children with ASD.

Background: Vulnerabilities in social motivation among children with ASD constrain attention and responsiveness to parents and other social partners. When this limited social responsiveness remains uncorrected, it is hypothesized to restrict the quality and quantity of social learning opportunities and ultimately yield negative long-term effects on development. Early intervention efforts that target social motivation may hold promise for correcting this detrimental chain of events. Method: The current pilot RCT examined changes in participant social responsiveness and language use in a trial of 21 young children with ASD who were randomly assigned to treatment or waitlist control groups. Treatment participants received a mean of 6.81 h/week of an enhanced Pivotal Response Intervention for Social Motivation (PRISM) treatment model for six months. Data on social responsiveness to parent bids and expressive language (number of total words, number of different words, mean length of utterance in words) were obtained from behaviorally coding and analyzing video-recorded parent-child play sessions. Results: Results indicated that young children who participated in the PRISM treatment model demonstrated significant pre-post improvements in social responsiveness and mean length of utterances. Participants in the waitlist condition experienced negligible improvements. Participants who are minimally verbal appear to experience greater gains as a result of the PRISM model. Additionally, initial levels of social responsiveness with parents appear to be predictive of subsequent language use at post-intervention among minimally verbal participants. Conclusion: This study provides preliminary evidence for the importance of using early intervention paradigms that explicitly target social motivation and responsiveness in young children with ASD. Results also suggest that initial social responsiveness to parents may serve as an important predictor of treatment response.