Background & Objectives: Children with intellectual disabilities, as a population with special needs, face numerous challenges in their daily lives. Social difficulties are among the most significant challenges experienced by these children. They often have difficulty establishing effective communication with others and may be unable to express their emotions and needs appropriately. Furthermore, inappropriate or maladaptive social behaviors may further contribute to peer rejection, which, in turn, can lead to the development of behavioral problems, including internalizing and externalizing disorders. One intervention developed in recent years to address communication difficulties in children with autism spectrum disorder is pivotal response treatment (PRT), which appears to have potential applicability for other children with special needs as well. PRT is a naturalistic, child–centered intervention characterized by a flexible structure and grounded in natural learning principles and responsive interactions. It is based on the premise that children's developmental difficulties can be improved through systematic modifications of their environment. Therefore, the present study aimed to examine the effectiveness of pivotal response treatment on social communication skills and internalizing and externalizing behavioral problems among female students with intellectual disabilities in Yazd.

Methods: The present study employed a quasi–experimental design with a pretest–posttest design, a two–month follow–up, and a control group. The study population consisted of female students with intellectual disabilities enrolled in special education schools in Yazd, Iran, during the 2024–2025 academic year. A total of 30 educable female students with intellectual disabilities, aged 7–11 years, who met the study inclusion criteria were selected through purposive sampling from special education schools in Yazd. The participants were then randomly assigned to two groups of 15 participants each: an experimental group and a control group, with 15 participants in each group. The inclusion criteria were as follows: parental informed consent to participate in the study; a diagnosis of educable intellectual disability based on the child's screening records (IQ range: 50–70); age between 7 and 11 years; no use of psychiatric medication according to parental report; and no severe physical disabilities or medical conditions based on the researcher's observations. The exclusion criteria included lack of cooperation during the study, absence from more than two intervention sessions, incomplete questionnaire responses, and withdrawal of consent to continue participation. Data were collected using the Social Skills Rating System (SSRS; Gresham & Elliott, 1990) and the Child Behavior Checklist (CBCL; Achenbach, 1991). Participants in the experimental group received pivotal response treatment (PRT) in twenty 1–hour sessions conducted twice weekly, whereas those in the control group were placed on a waiting list. Written informed consent was obtained from the participants, and written information regarding the study was provided to them. Participation in the study was voluntary, and the participants were assured that the confidentiality of their information would be maintained. Furthermore, following the completion of the study, pivotal response treatment (PRT) was also provided to the control group to ensure compliance with ethical principles. Statistical analyses were performed using SPSS version 27. Descriptive statistics included frequencies, percentages, means, and standard deviations. Inferential analyses were conducted using repeated–measures analysis of variance (repeated–measures ANOVA), followed by Bonferroni post hoc tests. Statistical significance was set at 0.05.

Results: The results showed that the main effects of time and group, as well as the time × group interaction effect, were significant for social communication skills, externalizing problems, and internalizing problems (p < 0.0001). Furthermore, significant differences were observed in these variables between the pretest and posttest mean scores (p < 0.0001) and between the pretest and follow–up mean scores (p < 0.0001). However, no significant differences were found between the posttest and follow–up mean scores (p > 0.05).

Conclusion: Based on the findings of the present study, pivotal response treatment (PRT) is effective in improving social communication skills and reducing internalizing and externalizing problems in children with intellectual disabilities. Therefore, it may be incorporated into rehabilitation programs for children with intellectual disabilities.