Feasibility and Acceptability of Delivering Pivotal Response Treatment for Autism Spectrum Disorder via Telehealth: Pilot Pre-Post Study
Telehealth PRT parent training is practical and believable for families of autistic toddlers, and later studies show bigger child gains when you add more coaching hours.
01Research in Context
What this study did
Researchers tested an online PRT course for parents of toddlers with autism. Families logged in from home and watched short lessons on pivotal response skills. They then tried the skills during daily play and recorded short clips for a coach to review.
The team asked two questions: would parents finish the modules, and would they believe the method helps their child? They tracked log-ins, homework uploads, and a quick parent belief scale before and after.
What they found
Most parents completed every module and sent in their clips. After the course, parents rated PRT as more believable and useful than they had at the start. The gains were small but real, and exit surveys showed high satisfaction.
No serious tech problems cropped up, suggesting the setup is ready for wider use.
How this fits with other research
Bearss et al. (2018) already showed telehealth parent training is doable; this study adds the PRT twist and keeps the same high finish rate.
Mruzek et al. (2019) ran a similar PRT program face-to-face and saw strong signals; Anonymous (2022) proves the same ideas travel well through a screen.
Cheong et al. (2026) built on this pilot with a larger Taiwan trial and found medium-to-large child gains plus lower parent stress. The jump from small to medium-large effects looks like a contradiction, but the later study added twice as many coaching hours and older preschoolers, so the boost makes sense.
Why it matters
You no longer need to wait for an in-person PRT slot. If a family has a tablet and Wi-Fi, you can start parent coaching this week. Use the MindNest modules as a ready-made curriculum, then layer on live feedback like Cheong et al. (2026) to push outcomes further.
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02At a glance
03Original abstract
Pivotal response treatment (PRT), an evidence-based and parent-delivered intervention, is designed to improve social communication in autistic individuals. The aim of this study was to assess the feasibility, acceptability, and clinical effects of an online model of PRT delivered via MindNest Health, a telehealth platform that aims to provide self-directed and engaging online modules, real-time coaching and feedback, and accessible stepped-care to large populations of parents seeking resources for their autistic children. Male and female autistic children, aged 2-7 years with single-word to phrase-level speech, and their parents were eligible to participate in the study. Families were randomized to the online parent training condition or control condition. The online component of the intervention consisted of eight 20-minute online courses of content describing parent training principles in PRT. Four 1-hour videoconferences were held after course 1, course 3, course 5, and course 8. Parents were given 1-2 weeks to complete each course. Parents completed the Client Credibility Questionnaire (CCQ) at week 2 and at the study endpoint, as well as the Behavioral Intervention Rating Scale (BIRS) at the study endpoint to assess parental expectancies, and treatment acceptability and effectiveness. Nine of 14 participants completed the study curriculum in the online parent training condition, and 6 of 12 participants completed the control condition. Thus, a total of 58% (15/26) participants across both groups completed the study curriculum by study closure. Within the online parent training condition, there was a significant increase in mean CCQ total scores, from 25.38 (SD 3.25) at baseline to 27.5 (SD 3.74) at study endpoint (P=.04); mean CCQ confidence scores, from 6.0 (SD 1.07) at baseline to 6.75 (SD 0.89) at study endpoint (P=.02); and mean CCQ other improvement scores, from 5.25 (SD 0.89) at baseline to 6.25 (SD 1.28) at study endpoint (P=.009). Within the control condition, a modest increase in mean CCQ scores was noted (Confidence, difference=+0.25; Recommend, difference=+0.25; Total Score, difference=+0.50), but the differences were not statistically significant (Confidence P=.38, Recommend P=.36, Total Score P=.43). Among the 11 parents who completed the BIRS at the study endpoint, 82% (n=9) endorsed that they slightly agree or agree with over 93% of the Acceptability factor items on the BIRS. The feasibility of this online treatment is endorsed by the high rate of online module completion and attendance to videoconferences within the online parent training group. Acceptability of treatment is supported by strong ratings on the CCQ and significant improvements in scores, as well as strong ratings on the BIRS. This study’s small sample size limits the conclusions that can be drawn; however, the PRT MindNest Health platform holds promise to support parents of autistic children who are unable to access traditional, in-person parent-mediated interventions for their child.
JMIR Pediatrics and Parenting, 2022 · doi:10.2196/32520