Pivotal Response Treatment Parent Training Group: Effects on Parent Factors and Child Outcomes from a Randomized Controlled Trial

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 and that their children show associated benefits in language. Recent research has also provided preliminary evidence that group parent training in PRT may reduce parenting stress and improve parent empowerment. However, this hypothesis has not yet been evaluated in a controlled trial.

Objectives:  This presentation will review research on the effects of parent training on levels of parenting stress and family empowerment, as well as children’s language outcomes. Evidence will be presented from a recently completed randomized controlled trial of group parent training in PRT (PRTG) compared to a parent psychoeducational group (PEG).

 Methods: Participants included 53 children (2-6.11 years) with autism and significant language delay. Children were randomized into either the PRTG (N=27) or PEG (N=26). The PRTG taught parents PRT to facilitate language development. The PEG addressed general topics related to the assessment and treatment of autism. Measures of parental empowerment and stress and children’s language outcomes were obtained at baseline and at the end of the 12-week trial.

Results:  Results suggest that group parent education is an effective method for teaching parents to implement PRT with their children and that a majority of parents (84%) in the PRTG met PRT fidelity of implementation criteria after 12 weeks of treatment. Analysis of parents who participated in PRTG and PEG indicated that they endorsed strong empowerment on the Family and Service System subscales of the Family Empowerment Scale (FES).  Results also showed that parents who participated in the PEG showed a trend toward greater improvement on the Community/Political subscale (t=3.942; df 43; p=0.054). Consistent with the literature reporting high levels of parenting stress in this population, 75% of parents across groups showed clinically significant levels of stress on the Parenting Stress Index, Short Form (PSI-SF). Furthermore, 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 compared to those whose parents participated in the PEG (F= 3.53; df 44; p= 0.038; d=0.42).  Changes on a standardized measure of adaptive communication were also observed following PRTG: Receptive Communication V-Scale score (F= 4.27; df 40; p= 0.028; d=0.23) and overall Communication Standard Score (F=3.80; df 40; p=0.041; d=0.34). 

Conclusions:  These findings suggest that specific instruction in PRT results in strong skill acquisition for both parents and children and may also have a positive impact on feelings of empowerment related to direct teaching interactions. Parents participating in a general psychoeducation group benefited more in terms of their empowerment related to community and political advocacy. These findings will be discussed in the context of programs which combine parent education in specific intervention strategies with education related to community advocacy, and recommendations for future research in this area will be reviewed.