Randomized Controlled Trial of Pivotal Response Treatment (PRT) Parent Training Group

Background: As rates of autism spectrum disorder have increased in recent years, the need for effective and efficient service delivery models continues to expand. In previous studies of Pivotal Response Treatment (PRT), research has documented that parents can learn this evidence-based treatment using a family therapy model; however, few studies have looked at more efficient service delivery models, such as group treatment. Previous pilot studies have supported the use of a group therapy model, but no randomized controlled trials have been completed to date.

Objectives: The current investigation is a randomized controlled 12-week trial, examining the efficacy of Pivotal Response Treatment Group (PRTG) in targeting language deficits in young children with autism. This condition is compared to parents participating in a psychoeducational group (PEG). The research hypothesis is that parents participating in PRTG will demonstrate evidence of more targeted PRT skills and that their children will show significant benefits in language abilities, relative to those in the PEG.

Methods: Participants included children (age range: 2-6.11 years) with autism and significant language delay. Children were randomized into either the PRTG or PEG. The PRTG taught parents PRT to facilitate language development. The PEG addressed general topics related to the assessment and treatment of autism. Video-taped assessments (structured lab observation of parent-child interactions) and standardized measures (e.g., Vineland-II) were conducted at baseline, week 6, post-treatment, and three month follow-up and were rated by a blind investigator.

Results: Fifty-three participants were randomized to either PRTG (N=27) or PEG (N=26). Preliminary analyses suggest that group parent education is an effective method for teaching parents to implement PRT with their children and that a majority of parents (approximately 83%) in the PRTG met PRT fidelity of implementation criteria after 12 weeks of treatment. Analysis of changes in child communication for families who completed the trial (PRTG N=26; PEG N=20) revealed that children whose parents participated in the PRTG exhibited a significant increase in the number of utterances (23.08 ± 22.97) compared to those whose parents participated in the PEG (8.65 ± 22.20; t= -2.14; df 44; p= 0.038).  Changes on a standardized measure of adaptive communication were also observed following PRTG.  Specifically, children whose parents participated in the PRTG showed greater improvement on the Vineland-II compared to children whose parents participated in the PEG on the Receptive Communication V-Scale score (PRTG: 1.29 ± 2.03; PEG: 0.06 ± 1.77; t= -2.062; df 40; p= 0.046) and the overall Communication Standard Score (PRTG: 6.13 ± 7.94; PEG: 0.83 ±8.54; t= -2.069; df 40; p=0.045).  Changes on the Expressive Communication V-Scale score approached significance (PRTG: 0.71 ± 1.20; PEG: -0.32 ± 2.187; t= -1.957; df 41; 0.057).

Conclusions: These findings suggest that, compared with general parent psychoeducation sessions, specific instruction in PRT results in greater skill acquisition for both parents and children. These findings provide preliminary evidence supporting the usefulness of PRT in targeting language deficits in children with autism and warrant larger trials to attempt to replicated these findings and potentially identify predictors and mediators of response.