Randomized Controlled Trial of Group Parent Education in Pivotal Response Treatment (PRT): Focus on Child Language Outcomes

Background: The need for effective and efficient service delivery models to treat autism spectrum disorders continues to expand, as rates of this disorder have increased significantly in recent years. In previous studies of Pivotal Response Training (PRT), research has supported 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 conducted to date.

Objectives: The current investigation is a randomized controlled 12-week trial, in its final year of data collection, which examines the effectiveness 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 targeted PRT skills and that their children will show significant benefits in language abilities, relative to those in the PEG.

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

Results: This study is in its final year of data collection. To date, more than 42 participants have been randomized and 26 have completed the trial. Preliminary findings support that group parent education is an effective method for teaching parents to implement PRT with their children. Preliminary findings from subjects who have finished the trial (PRTG N=13; PEG N=13) reveal that children whose parents participated in the PRTG exhibited a significant increase in the number of utterances (29.7 ± 24.2) compared to those whose parents participated in the PEG (0.5 ± 19.9; t= -3.352; df 24; p= 0.003). 

Repeated measures analyses (ANOVA) also revealed significant benefits from PRTG when compared with PEG on the Expressive Communication raw score of the Vineland-II (PEG: Baseline= 34.2 ± 18.4, Week 12= 34.8 ± 22.6;  PRTG: Baseline= 37.0 ± 13.2, Week 12= 50 ± 10.6; F: 8.607; df 1,22; p= 0.008) and the Communication Scale standard score (PEG: Baseline= 75.91 ± 16.31, Week 12= 75.92 ± 18.9;  PRTG: Baseline= 78.23 ± 9.9, Week 12= 87.1 ± 12.8; F: 4.761; df 1,22; p= 0.04).

Conclusions: Data will continue to be added until the trial is complete; however, these preliminary 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 support conducting parent training in a group format and will be discussed in relation to the growing need for efficient dissemination of evidence-based parent education models.