Pivotal Response Training Group Therapy Model: Analysis of Parent and Child Outcomes

Background:  The number of children diagnosed with autism spectrum disorders has increased recently in the United States. With children being diagnosed as young as 18 months of age, the need for services is increasing.  Research has demonstrated that interventions based on operant conditioning procedures, such as Applied Behavior Analysis and Pivotal Response Training (PRT), lead to improvements in the core symptoms of autism.  This research supports that parents can become effective intervention agents.  Historically, such interventions have been delivered to families individually; however, the increase in service demand makes this model relatively inefficient.  As a result, researchers are beginning to develop strategies that investigate the effectiveness of group treatment models. 

Objectives: The aim of the present study was to demonstrate that parents can learn PRT procedures in a ten-week group therapy format and meet fidelity of implementation criteria for treatment termination typically used in individual therapy.  An additional purpose was to demonstrate that when parents learn the PRT procedures their children make correlated gains in language. 

Methods: Twelve families have participated to date in this trial and data collection is ongoing.  Data were obtained using systematic scoring of parent and child target behaviors observed during 10-minute video-taped parent-child interaction probes.  The independent variable was parent participation in a 10-week PRT parent training group.  The dependent variables were: 1) parent fidelity of implementation of PRT intervention during parent-child interaction probes, and 2) number of child utterances (number of 10-second intervals containing one or more utterances) used during parent-child interaction probes. These variables were scored by independent raters. Data were collected at baseline, week five of treatment, and post-treatment (week 10).  Paired t-tests were used to examine changes in the dependent variables from baseline to week ten of treatment.

Results: Preliminary findings suggest that parents can learn PRT in a group format and their children benefit from it.  Specifically, targeted intervention skills not used by parents during baseline parent-child interactions are used at post-treatment (10 weeks), as evidenced by changes in fidelity of implementation scores (Baseline score: 9.3 ± 4.8; Post-treatment score: 20.1 ± 5.4; paired t test: 5.782; df =11; p<0.0001).  Benefits were also observed in children, who demonstrated an increased number of utterances during a 10-minute parent-child interactions (Baseline score: 27.5 ± 15.5 utterances; Post-treatment score: 40.9 ± 5.3; paired t test: 3.287; df =11; p= 0.007).

Conclusions: Findings suggest PRT strategies can be taught to parents in a group treatment format with both parents and children demonstrating positive outcomes in targeted behaviors.  These findings are analyzed in light of the clinical need for more data driven, cost-effective, and efficient treatment models and the research need for more robust analysis of naturalistic behavioral treatment models.  Our preliminary findings suggest future controlled studies are warranted using larger samples to further examine the efficacy of this group treatment model and to identify indicators of treatment response.