Improving Peer Interactions and Social Skills in Preschool Children With Autism Using Pivotal Response Treatment

Pivotal Response Treatment (PRT) is a naturalistic, child-led behavioral intervention grounded in applied behavior analysis that targets motivational "pivots" to promote generalized social communication. Peer interaction is a core difficulty for many preschoolers with autism spectrum disorder (ASD), yet evidence from randomized designs in group-based settings remains limited.

In a randomized controlled trial, 30 preschool children with mild to moderate ASD were assigned to either the PRT group (n = 15) or a treatment-as-usual (TAU) group (n = 15). The PRT group received 24 sessions over 8 weeks, comprising 30 min, play-based interventions administered three times per week. Target behaviors were embedded in five structured games. Outcomes were assessed via a mixed experimental design, combining single-subject (A-B-A) and pretest-posttest group comparisons. Standardized measures included the Peer Interaction Skills Scale, Social Responsiveness Scale, Childhood Autism Rating Scale, and Autism Behavior Checklist.

Children in the PRT group were found to show significant improvements in peer interaction skills, including increased social initiation and prosocial behavior. They also appeared to demonstrate reductions in core autism symptoms and gains in adaptive functioning, with improvements largely maintained post-intervention. In contrast, the TAU group tended to exhibit minimal changes across most outcomes.

Even though the findings can be explained by causes other than the treatment, the findings are consistent with the hypothesis that PRT enhanced children's within-game target behavior and more generalized social and adaptive behavior. The findings encourage future studies that address particular flaws in the current study to test this hypothesis.