Overcoming Barriers to Mass Dissemination: A Pilot Online Pivotal Response Treatment Training Program for Parents of Toddlers with Autism Spectrum Disorder

Background: Despite advances in evidence-based treatment for autism spectrum disorders (ASD), disparities in service access remain a serious concern. The current delivery format of many interventions represents a critical roadblock to treatment access. Most models require parents to commute to a clinic or have a clinician visit their home many hours per week. This format may not be feasible for families who live in remote geographical regions, do not have the resources to travel or pay for weekly therapy services, and/or are headed by single parents with competing work obligations. To address this, recent studies have begun to explore parent-implemented interventions via an online or telehealth format (Nefdt et al., 2009; Vismara et al., 2012; Wainer & Ingersoll, 2013). These approaches are particularly beneficial as they improve access to training for families, can fit into busy family schedules, and lower the cost of expensive treatments (Nelson, Bui & Velasquez, 2011). The current pilot study examined a newly developed 5-week online course designed to help parents implement an evidence-based intervention, Pivotal Response Treatment (PRT), for their child with ASD.

Objectives: This study’s objective was to investigate the impact of an online course to disseminate PRT strategies for parents of young children with ASD.

Methods: Participants were 20 families of toddlers with ASD, ages 24-48 months. PRT presentations consisting of informational slides, video examples, and brief quizzes were delivered through Qualtrics each week. Topics focused on core intervention strategies to elicit communication and social engagement through playful interactions, child-selected materials, and positive behavior principles. Parents submitted weekly videos capturing their use of these treatment strategies, which were coded for PRT fidelity of implementation (FOI). FOI was defined as the parent properly demonstrating all PRT components with competency at least 80% of the time. Fidelity summary scores were obtained at multiple time points (pre-intervention and once per weekly session). Social validity measures were also obtained.

Results: Data from families who have completed the course were analyzed. A paired samples t-test was conducted to compare parent treatment fidelity pre- and post-intervention. Analysis revealed that parent’s treatment fidelity improved significantly from baseline (M= 2.5, SD= 1) to Week 5 (M= 4.5, SD= 1.29), p= .016. These results were supported by social validity data from families indicating high satisfaction with the course. On a 0-6 scale, (0= Strongly Disagree, 6= Strongly Agree) all families reported that their child’s level of social engagement had improved over the course of intervention (M= 5.00). Additionally, all families indicated that they would recommend this course to a friend in need of intervention for their child (M= 5.33).

Conclusions: The data indicate that PRT implementation fidelity significantly improved following participation in the online course. These results suggest that an online intervention may be a feasible approach to disseminating PRT strategies. This innovative format has the potential to reduce disparities in access to evidence-based intervention.