Lasting Effects of a 12-Week Group Parent Education Model for Pivotal Response Treatment

Background: Preliminary studies of Pivotal Response Treatment (PRT) have shown that parents can successfully learn and implement PRT with high fidelity, indicating that parent-delivered treatment could be an efficacious treatment modality. While a recent randomized controlled trial of a 12-week parent education group treatment showed an increase in children’s functional utterances and adaptive communication skills (Hardan et al., 2014), the lasting effects of a short-term parent-delivered PRT group intervention have not yet been sufficiently researched.  

Objectives: The objective of this study was to assess maintenance of treatment effects, following a 12-week PRT parent education intervention at the follow-up assessment at 24-week. The primary goal was to measure improvement in children’s language development between baseline, week 12 (treatment end), and week 24 (follow-up assessment), as well as changes in developmental functioning over this 6-month period.

Methods: Families who were randomized to the active treatment group and participated in the full 12-week PRT parent education group training (n=23; mean age=3.9 years, SD= 1.04) were followed over the course of 6 months with parent questionnaires and structured laboratory observations. At follow-up, participants were re-assessed for changes in communication, cognitive, adaptive, and social skills. 

Results: Preliminary results from baseline, week 12 and week 24 measures suggest that a 12-week group-delivered parent education treatment model has enduring effects on language. Mean total number of child functional utterances during a 10-minute structured laboratory observation suggests a significant improvement from pre to post-treatment, with maintenance at 24 week follow-up  (Baseline: 45.7 ± 23.1; Week 12: 64.5 ± 28.9; Week 24: 55.1 ± 23.2; F: 5.9, p=.009). Children also made significant gains on the Vineland Communication Domain Standard Score that continued to improve over time (Baseline: 69.9 ± 16.3; Week 12: 78.9 ± 18.9; Week 24: 83.1 ± 17.8; F:11.74, p=.001). In order to assess the effects of parent-implemented PRT on early developmental/cognitive skills, standard scores from week 24 on the Mullen Scales of Early Learning (MSEL) were compared with baseline levels. The MSEL early learning composite score was calculated and showed significant improvements beyond expected developmental gains (F= 5.43, p=.03). 

Conclusions: Children randomized to PRT showed evidence that treatment gains were maintained 12 weeks after the active treatment ended. Overall improvements were noted on child communication measures, at post-treatment, as well as 12 weeks after that (24-week follow-up), indicating maintenance of treatment effects. Interestingly, gains in total number of child utterances appeared to decline after active treatment. Nevertheless, at 6 months, the children were still using significantly more functional utterances than at baseline. The preliminary results of this study suggest that a brief PRT parent group intervention can facilitate improvements in language skills and cognitive functioning that are maintained 12 weeks post treatment.  These findings will be discussed in terms of the need for effective and efficient treatments that can be easily disseminated. Future research should continue to address questions about the maintenance of developmental gains from short-term parent education interventions.