The interventions conducted by a robot and a human trainer were both effective in promoting self-initiated questions in children with ASD. No conclusion with regard to the differential effectiveness of both interventions could be drawn. Implications of the results and directions for future research are discussed.

Intervention studies evaluating pivotal response treatment (PRT) were systematically identified and analyzed. Forty-three studies were summarized in terms of (a) participant characteristics, (b) dependent variables, (c) intervention procedures, (d) intervention outcomes, and (e) certainty of evidence. The majority of the reviewed studies (56.4 %) had serious methodological limitations. However, the reviewed studies that provided conclusive or preponderant evidence (43.6 %) indicated that PRT results in increases in self-initiations and collateral improvements in communication and language, play skills, affect and reductions in maladaptive behavior for a number of children. Furthermore, the reviewed studies suggested that the majority of caregivers and staff members were able to implement PRT techniques, but evidence for collateral improvements in caregivers' and staff members' behaviors remains sparse. Implications for future research are discussed.

Deficits in question-asking are common in children with autism spectrum disorder (ASD). Furthermore, their opportunities to self-initiate questions are often hindered by directive behavior of their conversation partners. This study assessed the effectiveness of staff training in pivotal response treatment (PRT) on staff member-created opportunities and self-initiated questions of school-aged children with ASD. Generalization and maintenance were also assessed. Participants were 14 staff members and children with ASD attending an inpatient treatment facility. Data showed that PRT resulted in significant increases in both staff member-created opportunities and child-initiated questions. Generalization to group situations and collateral changes in children’s language, pragmatic, and adaptive skills, and maladaptive behaviors did not occur. Implications for clinical practice and directions for future research are discussed.

In two studies, we investigated the effectiveness of parent education in Pivotal Response Treatment (PRT) on parent-created opportunities and spontaneous child initiations in two community-based treatment facilities for children with autism spectrum disorder (ASD). Changes in parental stress and self-efficacy were explored. Participants were 26 parents and their children who participated in group (Study 1) or individual (Study 2) parent education in PRT. Results indicated that group-based parent education resulted in moderate increases in opportunities, functional initiations, and empathic social initiations. Furthermore, parental stress reduced and self-efficacy increased. Individual parent education resulted in large increases in opportunities and functional initiations, but parental stress and self-efficacy did not change. Implications for clinical practice and directions for future research are discussed. Electronic supplementary material The online version of this article (10.1007/s10803-019-04061-6) contains supplementary material, which is available to authorized users.

Results support the use of the structured interview protocol to determine the preferences of children with ASD. Practical implications and directions for future research are discussed.