The Effectiveness of Brief Community-Based Parent Coaching in Pivotal Response Treatment

Background: Parent coaching is a cost effective and important element of early autism intervention. We examined the effectiveness of brief parent coaching in Pivotal Response Treatment (PRT) for 4-5 year-old early communicators. Coaching was provided by community clinicians at the beginning of a publicly funded intervention program in Nova Scotia, Canada. Parents received four, two-hour coaching sessions within the same week. Trainers reviewed a handout with parents that described PRT principles and provided 10-minute blocks of individualized coaching using strategies such as suggestive prompting, reinforcing parent initiations, and providing frequent, specific, positive feedback.

Objectives: 1) Our primary objective was to determine if training led to increases in parents’ skills providing clear, developmentally appropriate language opportunities. This was defined as gaining shared control of preferred objects or activities and providing either model prompts (e.g., “spin”), leading prompts (“e.g., ready, set…”), choice questions (e.g., “milk or juice?”), or time delays (e.g., holding onto a bubble wand and giving an expectant look). 2) We also examined changes in parents’ fidelity using the following PRT techniques: following child lead, ensuring child attention, and being contingent on reasonable attempts at correct responding.

Methods: Parents of 27 children were included in analyses. Children were 4 to 5 years old (M = 4.78, SD = 0.14) and were included if they were non-verbal (48%), used single words (22%) or used 2-word combinations (30%). If more than one caregiver from a family participated in training, a single caregiver was randomly selected. Participants were 17 mothers, 8 fathers, 1 aunt and 1 grandfather. Ten-minute videos of parent-child interaction were obtained pre- and post- training (at each, parents were asked to encourage communication through play). Inter-rater reliability of video coding was moderate to strong (ICC = .90 for objective 1; ĸ = .59-.77 for objective 2).

Results: 1) Prior to coaching, parents presented a mean of 4.3 clear, developmentally appropriate language opportunities in 10 minutes (40% presented none, 19% presented one). A large increase in frequency was seen after coaching, to a mean of 15.2 clear opportunities (all but one parent presented at least two). 2) Parent fidelity improved for attaining child attention, demonstrated in 15% of intervals prior to coaching and 59% of intervals four days later, t(26) = 5.47, p<.001. Fidelity for contingency also improved, from 11% to 66%, t(26) = 7.61, p<.001. Following child lead was high at baseline and did not change (85% to 91%; t(26) = 1.00, p=.327).

Conclusions: Brief parent coaching in PRT by trained community clinicians led to substantial changes in parents’ interactions with their children with ASD. In four days, parents learned to present frequent, clear, developmentally appropriate language opportunities. Parents also demonstrated the PRT techniques of attaining child attention and contingency much more frequently following coaching. These findings support PRT as an intervention model readily implemented by parents. They add to a growing body of research supporting parent coaching in natural developmental behavioral interventions as a cost-effective approach to improving outcomes for children with ASD.