Koegel, R. L., Bimbela, A., & Schreibman, L. (1996). Collateral effects of parent training on family interactions. Journal of Autism and Developmental Disorders, 26(3), 347–359. https://doi.org/10.1007/BF02172479

Type of Study: Randomized controlled trial
Number of Participants: 17

Population:

• Age — 3–9 years
• Race/Ethnicity — Not specified
• Gender — 10 Male and 7 Female
• Status — Participants were children with autism and their families.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess collateral effects of two parent training paradigms, teaching individual target behaviors (ITB) serially and Pivotal Response Training (PRT) [now called Pivotal Response Treatment (PRT)]. Participant families were randomly assigned to either ITB or PRT. Measures utilized include the Vineland Social Maturity and Adaptive Behavior Scales. Results indicate that the families in both conditions initially scored in the neutral range, and the ITB training paradigm produced no significant influence on the interactions from pretraining to posttraining. In contrast, however the PRT parent training paradigm resulted in the families showing positive interactions on all four scales, with the parent-child interactions rated as happier, the parents more interested in the interaction, the interaction less stressful, and the communication style as more positive. Limitations include the small sample size and lack of follow-up.

Length of controlled postintervention follow-up: None.

Stahmer, A. C., & Gist, K. (2001). The effects of an accelerated parent education program on technique mastery and child outcome. Journal of Positive Behavior Interventions, 3(2), 75–82. https://doi.org/10.1177/109830070100300203

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 22 families

Population:

• Age — 19–50 months (Mean=35–35.6 months)
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were families with a child with a diagnosis of autistic disorder or pervasive developmental disorder–not otherwise specified (PDD-NOS).

Location/Institution: Children's Hospital and Health Center, San Diego, California

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the addition of a parent education support group to an accelerated parent education program, Pivotal Response Treatment (PRT). All participants received PRT, while half the families also received the parent education support group. Measures utilized include the Bayley Scales of Infant Development and the MacArthur Communicative Development Index. Results indicate that inclusion of a parent education support group in a parent education program may increase parent mastery of teaching techniques and success of accelerated programming and, in turn, increase children's language success. Limitations include the lack of a no treatment control group, the lack of randomization, and the small sample size.

Length of controlled postintervention follow-up: None.

Nefdt, N., Koegel, R. L., Singer, G., & Gerber, M. (2010). The use of a self-directed learning program to provide introductory training in Pivotal Response Treatment to parents of children with autism. Journal of Positive Behavior Interventions, 12(1), 23–32. https://doi.org/10.1177/1098300709334796

Type of Study: Randomized controlled trial
Number of Participants: 27 families

Population:

• Age — Parents: Mean=36.21–36.31 years; Children: Mean=38.43–38.92 months
• Race/Ethnicity — Parents: Not specified; Children: 81% Caucasian
• Gender — Parents: Not specified; Children: 93% Male
• Status — Participants were primary caretakers and their children with autism.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate whether the use of a self-directed learning program, Pivotal Response Training (PRT) [now called Pivotal Response Treatment (PRT®)], could result in changes in behavior for parents and their children with autism. Participants were randomly assigned to either PRT or to a wait list control group. Measures utilized include the coding of videotaped sessions for fidelity, language opportunities, verbal utterances, and parent confidence. Results indicate that there were significant differences between the PRT and control groups at posttest on all of the dependent measures. Furthermore, all of the parents who completed the self-directed learning program reported high ratings of satisfaction. Limitations include concerns about generalizability and maintenance of skills as this was not addressed in this study, small sample size, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Mohammadzaheri, F., Koegel, L. K., Rezaee, M., & Rafiee, S. M. (2014). A randomized clinical trial comparison between Pivotal Response Treatment (PRT) and structured applied behavior analysis (ABA) intervention for children with autism. Journal of Autism and Developmental Disorders, 44(11), 2769–2777. https://doi.org/10.1007/s10803-014-2137-3

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

• Age — 6–11 years
• Race/Ethnicity — 100% Iranian
• Gender — 60% Male
• Status — Participants were verbal children with a clinical diagnosis of autism spectrum disorder (ASD) who were identified by their teacher as meeting study criteria.

Location/Institution: Hamedan University of Medical Sciences and Health Services, Iran

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the effectiveness of two interventions, Pivotal Response Treatment (PRT) and structured ABA (Treatment as Usual), in a school setting. Participants were matched according to age, sex, and mean length of utterance and then randomized to one of the two interventions. Measures utilized include the Children's Communication Checklist (CCC). Results indicate that the PRT approach was significantly more effective in improving Mean Length of Utterance (MLU) and CCC scores. Limitations include the small sample size, the relatively few hours of intervention received, and the focus on improving only one target behavior (improving MLU).

Length of controlled postintervention follow-up: None.

Schreibman, L., & Stahmer, A. C. (2014). A randomized trial comparison of the effects of verbal and pictorial naturalistic communication strategies on spoken language for young children with autism. Journal of Autism and Developmental Disorders, 44(5), 1244–1251. https://doi.org/10.1007/s10803-013-1972-y

Type of Study: Randomized controlled trial
Number of Participants: 39

Population:

• Age — Mean=29.2 months
• Race/Ethnicity — Not specified
• Gender — 87% Male
• Status — Participants were young, nonverbal or minimally verbal (≤9 words) children with autism.

Location/Institution: Two university-based autism research programs

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the effectiveness of a verbally-based intervention, Pivotal Response Training (PRT) [now called Pivotal Response Treatment (PRT)] to a pictorially-based behavioral intervention, the Picture Exchange Communication System (PECS) on the acquisition of spoken language by young children with autism. Participants were randomly assigned to either the PRT or PECS condition. Measures utilized include the Mullen Scales of Early Learning, the Expressive One-Word Picture Vocabulary Test-Revised (EOWPVT, and Vineland Adaptive Behavior Scales, 2nd Ed. Results indicate that children in both intervention groups demonstrated increases in spoken language skills, with no significant difference between the two conditions. Parents were very satisfied with both programs but indicated PECS was more difficult to implement. Limitations include the lack of a no treatment control group, concerns about generalizability to children who are verbal, possible bias by coders who were aware of the treatment conditions, and the small sample size.

Length of controlled postintervention follow-up: 3 months.

Mohammadzaheri, F., Koegel, L. K., Rezaei, M., & Bakhshi, E. (2015). A randomized clinical trial comparison between Pivotal Response Treatment (PRT) and adult-driven applied behavior analysis (ABA) intervention on disruptive behaviors in public school children with autism. Journal of Autism and Developmental Disorders, 45(9), 2899–2907. https://doi.org/10.1007/s10803-015-2451-4

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

• Age — 6–11 years
• Race/Ethnicity — 100% Iranian
• Gender — 60% Male
• Status — Participants were verbal children with a clinical diagnosis of autism spectrum disorder (ASD) who were identified by their teacher as meeting study criteria.

Location/Institution: Hamedan University of Medical Sciences and Health Services, Iran

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Mohammadzaheri et al. (2014). The purpose of the study was to compare the effectiveness of two interventions, Pivotal Response Treatment (PRT) and structured ABA (Treatment as Usual), in lowering levels of disruptive behavior during the intervention. Participants were matched according to age, sex and mean length of utterance and then randomized to one of the two interventions. Measures utilized include the coding of videotaped sessions for disruptive behaviors. Results indicate that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition, as compared to the ABA condition. Limitations include the small sample size, the short intervention length, and the lack of parent involvement in the intervention.

Length of controlled postintervention follow-up: None.

Duifhuis, E. A., Den Boer, J. C., Doornbos, A., Buitelaar, J. K., Oosterling, I. J., & Klip, H. (2017). The effect of Pivotal Response Treatment in children with autism spectrum disorders: A non-randomized study with a blinded outcome measure. Journal of Autism and Developmental Disorders, 47(2), 231–242. https://doi.org/10.1007/s10803-016-2916-0

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 24

Population:

• Age — 3–8 years
• Race/Ethnicity — Not specified
• Gender — 83% Male
• Status — Participants were children with a clinical diagnosis of autism spectrum disorder (ASD) who were receiving services at a multi-site center for complex child and adolescent psychiatry.

Location/Institution: Outpatient clinics of six sites of a large Child and Adolescent Psychiatry Center (Karakter), in the Eastern part of The Netherlands

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the effect of Pivotal Response Treatment (PRT) versus treatment as usual (TAU) on autism symptoms. Participants received either PRT or TAU. Measures utilized include the Autism Diagnostic Observation Schedule (ADOS), the Social Responsiveness Scale (SRS), the Child Behavior Checklist (CBCL), and the Nijmegen Parental Stress Index—Short Version (NOSI‑K). Children in the PRT condition significantly improved on the ADOS, compared to the TAU group. Limitations include the small sample size, the lack of randomization, the lack of post-intervention follow-up, differences between the groups at baseline on the autism measures, and the variability in the services received by the TAU group.

Length of controlled postintervention follow-up: None.

de Korte, M. W., van den Berk-Smeekens, I., Buitelaar, J. K., Staal, W. G., & van Dongen-Boomsma, M. (2021). Pivotal Response Treatment for school-aged children and adolescents with autism spectrum disorder: A randomized controlled trial. Journal of Autism and Developmental Disorders, 51(12), 4506–4519. https://doi.org/10.1007/s10803-021-04886-0

Type of Study: Randomized controlled trial
Number of Participants: 44

Population:

• Age — Control: Mean=11.70 years; Intervention: Mean=11.87 years
• Race/Ethnicity — Not specified
• Gender — Control: 68% Male; Intervention: 73% Male
• Status — Participants were children with a clinical diagnosis of autism spectrum disorder (ASD) who were receiving services at a multi-site expert center for child and adolescent psychiatry.

Location/Institution: The Netherlands

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the impact of Pivotal Response Treatment (PRT) for children with autism spectrum disorder (ASD). Participants were randomly allocated to PRT or treatment-as-usual (TAU). Measures utilized include the Social Responsiveness Scale (SRS), the Clinical Global Impression‑Improvement (CGI‑I) Scale, the Autism Diagnostic Observation Schedule‑Second Edition (ADOS‑2), the Vineland Adaptive Behavior Scales‑ Second Edition (Vineland‑II), the Brief Problem Monitor‑Parents (BPM‑P), and the Parenting Stress Questionnaire. Results indicate that PRT resulted in significantly greater improvements on parent-rated social-communicative skills after 12 weeks treatment, compared to TAU. Furthermore, larger gains in PRT compared to TAU were observed on blindly rated global functioning, and parent-rated adaptive socialization skills and attention problems. Limitations include the flexible endpoint of treatment duration in PRT and variability in kind and intensity of TAU, which led to an increase in heterogeneity in both groups, the use of multiple types of PRT treatment providers, the relatively broad age range in the study sample, and the small sample size.

Length of controlled postintervention follow-up: 2 months.

van den Berk-Smeekens, I., de Korte, M. W. P, van Dongen-Boomsma, M., Oosterling, I. J., den Boer, J. C., Barakova, E. I., Lourens, T., Glennon, J. C., Staal, W. G., & Buitelaar, J. K. (2022). Pivotal Response Treatment with and without robot-assistance for children with autism: A randomized controlled trial. European Child & Adolescent Psychiatry, 31(12), 1871–1883. https://doi.org/10.1007/s00787-021-01804-8

Type of Study: Randomized controlled trial
Number of Participants: 73

Population:

• Age — PRT: Mean=6.43 years; PRT + Robot: Mean=6.18 years; TAU: Mean=6.09 years
• Race/Ethnicity — Not specified
• Gender — PRT: 88% Male; PRT + robot: 8% Male; TAU: 83% Male
• Status — Participants were children with a clinical diagnosis of autism spectrum disorder (ASD) who were receiving services at a multi-site center for complex child and adolescent psychiatry.

Location/Institution: The Netherlands

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Pivotal Response Treatment (PRT) and robot-assisted PRT with treatment-as-usual (TAU). Participants were randomly assigned to PRT, PRT + robot, or TAU. Measures utilized include the Social Responsiveness Scale, preschool and child version (SRS), the Clinical Global Impression-Improvement (CGI-I), and the Autism Diagnostic Observation Schedule-Second edition (ADOS-2). Results indicate that there were no significant group differences on parent- and teacher-rated general social-communicative skills and blindly rated global functioning directly after treatment. However, at follow-up, the largest gains were observed in the PRT + robot group compared to other groups. Limitations include the small sample size, attrition during the study, the high rates of psychiatric comorbidities in the sample, and low rates of fidelity of implementation among parents.

Length of controlled postintervention follow-up: 3 months.

Wang, L., Li, S., & Wang, C. (2023). Using Pivotal Response Treatment to improve language functions of autistic children in special schools: A randomized controlled trial. Journal of Autism and Developmental Disorders, 1–13. https://doi.org/10.1007/s10803-023-05988-7

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

• Age — 4–8 years
• Race/Ethnicity — Not specified
• Gender — 73% Male
• Status — Participants were children with ASD who were enrolled in two special schools and two rehabilitation centers.

Location/Institution: Ningbo, Zhejiang province, China

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the effectiveness of Pivotal Response Treatment (PRT) in promoting the primary language functions (requesting, labeling, repeating, responding) in autistic children. Participants were randomly assigned to the PRT group or a control group. Measures utilized include the Chinese version of the Peabody Picture Vocabulary Test Revised Edition (PPVT-R), Chinese version of the Verbal Behavior Milestones Assessment and Placement Program, the Chinese version of the Social Communication Questionnaire, and the Chinese version of the Psychoeducational Profile—Third Edition. Results indicate that the PRT group demonstrated greater improvements in all four measured language functions compared to the control group. The improvement in language functions in the PRT group was generalized and maintained at the follow-up assessment. In addition, the PRT intervention enhanced untargeted social and communicative functioning, cognition, motor skills, imitation, and adaptive behaviors in the autistic children. Limitations include the small sample size, the short follow-up length, lack of data on treatment fidelity, and a lack of examination of parent- versus therapist-administered PRT.

Length of controlled postintervention follow-up: 3 weeks.