Pandemic Yields Unexpected Discovery in Autism Therapy Study
Elizabeth Morey
The COVID-19 pandemic has had many unexpected consequences, the majority of which are arguably negative. However, there have been some bright silver linings to the clouds hanging over our lives for the past couple of years, one of which being an unexpected discovery made by researchers after they were forced to take their autism therapy study virtual.
Before the start of the pandemic, Stanford Medicine researchers were working on a study in preschool students aged two to five with autism spectrum disorder and speech delays. The participants were coming into the clinic for 12 hours a week for pivotal response treatment (PRT), a type of therapy that aims to use an individual's specialized interests to motivate them to begin using more verbal communication.
In PRT, a therapist generally uses objects that interest a child as rewards for communication or other types of improvement. When the child asks for a toy out loud or performs the desired task, they are rewarded with something they love.
"We want to teach kids that when they verbally engage with other people, things get better, more fun," said behavioral analyst Devon White, who supervised the treatments.
When the pandemic caused lockdowns and canceled in-person activities, the researchers were forced to pause their study. However, they were worried about causing distress to participants and their families by canceling the program so abruptly, so they decided to offer an online version instead, with help from parents to facilitate it, and added 12 new students to their pool of participants as well.
Remarkably, the change worked and even offered some unexpected benefits that participants hadn't been reaping before the program went virtual.
"We were shocked at how effective it was," says Grace Gengoux, Ph.D., pediatric psychologist and the program's clinical director.
What researchers discovered was that making their program virtual gave their participants more choices, improving the chances that they'd find the right "thing," the thing that would best motivate the child to learn to speak. Instead of showing a child who was interested in racecars one or two racecar toys, for example, they could show him photos of the entire range of NASCAR competitors and let him choose his favorite.
"The number of toys you would have to have in a clinic to deliver this kind of variety or cater to this special interest" is not realistic," Gengoux said. "Having a practically infinite library of online images is valuable."
The virtual version of the therapy allows therapists to offer a wider range of rewards for their clients and also create entirely new "worlds" for every session to keep things interesting. They could change the background, the shape of the cursor, and much more, while the children were unable to make any changes except by speaking, after which the therapist would make changes to the screen as a reward.
"One child was really interested in the airport, and the therapist was working with him on sequencing, telling a story," White said. "She got a bunch of virtual backgrounds -- the ticket counter, bag check, security -- and put herself there. It was so motivating for him; it looked real. He was able to learn to tell stories, and that would have been difficult to facilitate in a clinic setting."
Because many children on the autism spectrum are interested in gadgets and technologies, using iPads gave therapists a little extra assistance in engaging the children's attention as well.
The children participated in the program for anywhere between 10 weeks and just over a year. And during a time when in-person socialization has been difficult, Gengoux says families have been grateful for any help they can get.
"Families were extremely grateful we could do anything to help their children, and excited and surprised at how much their kids could learn online," she said.
Since many gathering restrictions have been lifted, the children have returned to having in-person therapy. However, Gengoux and White hope to continue their research on the online version of PRT, as they believe it could increase accessibility and be a good complement to in-person sessions. They also hope to test out larger group sessions.
The study was published in the journal Social Sciences.
