Group Parent Education In Pivotal Response Treatment (PRT): Preliminary Outcomes of a Randomized Controlled Trial

Background: With rates of autism on the rise and children being diagnosed as young as 18 months of age, there is an increasing need for effective and efficient service delivery models. Previous studies of Pivotal Response Training (PRT) have demonstrated that parents can learn this evidence-based treatment using a family therapy model; however, few studies have looked at other models, particularly those that may increase efficiency and allow more families to be served (e.g., group treatment models).

Objectives: This investigation is a randomized controlled 12-week trial, currently underway, which examines the effectiveness of Pivotal Response Treatment Group (PRTG) in targeting language deficits in young children with autism. PRTG teaches parents PRT strategies in a group format and will be compared to parents who are participating in a psychoeducational group (PEG). The research hypothesis is that parents participating in PRTG will demonstrate evidence of targeted 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 according to age, gender, and intensity of behavioral treatment. The PRTG includes weekly group therapy sessions designed to provide systematic instruction in implementation of PRT to facilitate language development. The PEG consists of group educational sessions which discuss general topics related to the assessment and treatment of children with autism. Standardized and video-taped assessments, including 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 ongoing. Preliminary findings suggest that group parent education is an effective method for teaching parents to implement PRT with their children. The majority of parents were able to implement the procedures with fidelity following 12 weeks of training. Children whose parents participated in the PRTG also made significant gains in frequency and variety of utterances and 3 out of 4 subjects were judged to be either much improved or very much improved as assessed by the clinical global impression-improvement subscale. In contrast 1 out of 4 children whose parents participated in the PEG were judged to be much improved.  Parents report high levels of satisfaction with both types of training.

Conclusions: Since recruitment is ongoing, additional data will be available in the near future. 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 will be discussed in relation to the growing need for efficient dissemination of evidence-based parent education models for providing early interventions to children with autism.