There is strong research evidence to suggest that pivotal response treatment provides a positive approach to targeting key developmental skills, such as language in some children on the autism spectrum.
Reports have suggested that parents and non-autistic peers can be trained to implement this approach, and that the focus on naturalistic reinforcement may make it more accessible than more traditionally structured behavioural interventions such as discrete trial training.
However, there are few large-scale randomised control trials of pivotal response treatment in real world settings or which compared pivotal response training to other, similar interventions.
There are few studies which examined whether pivotal response treatment was being implemented correctly or which looked at effectiveness at least one year post intervention.
None of the studies appeared to involve people on the autism spectrum in reviewing the efficacy and ethical basis of the intervention.
We agree with Cadogan and McCrimmon (2013) who made the following recommendations for future research on pivotal response treatment,
“This review indicates recommendations that may enhance PRT research efforts. First, translucency in methodology through clear description of research methodology, interventionist training methods and the use of objective and/or naive behavioural raters may strengthen research designs. It is fundamental that PRT research studies conduct treatment fidelity measures in order to ascertain whether it is being implemented correctly. It would also be beneficial to state the treatment fidelity standards that interventionists were required to meet and maintain, and what steps were taken when these standards are not met. Furthermore, it is recommended that researchers continue to incorporate appropriate baseline and follow-up designs to objectively measure treatment effectiveness. Similar to recommendation by Skokut et al. recommendation regarding the viability of follow-up studies, it would be especially valuable to ascertain treatment effectiveness at least one year post intervention. Finally, comparison of intervention approaches is highly recommended in determining which children with ASD respond best to particular interventions. This is especially important given the increased diversity of interventions for ASD as such comparisons may build upon knowledge pertaining to intervention (in-)effectiveness.”
In addition, we believe that future research should also involve people on the autism spectrum to review the efficacy and ethical basis of pivotal response treatment including individuals who may be non-verbal.