Pivotal response treatment (PRT) is an evidence-based, naturalistic intervention for autism spectrum disorder, integrating principles of applied behavior analysis with a developmental framework. Originating in the 1980s, PRT targets “pivotal” areas such as motivation, responsivity to multiple cues, self-management, self-initiation, and empathy to foster widespread improvements in developmental domains. This chapter explores the evolution, core components, and implementation strategies of PRT within the broader framework of Naturalistic Developmental Behavioral Interventions. PRT’s child-centered approach leverages natural reinforcement, child choice, and task variation to enhance engagement, generalization, and social communication. Research highlights its effectiveness across diverse settings, including home, school, and community, and its adaptability for cultural contexts. A systematic review of 95 empirical studies emphasizes PRT’s versatility, focusing on parent-mediated interventions, fidelity of implementation, and long-term outcomes such as social communication, language skills, and adaptive functioning. The chapter also underscores the necessity for cultural adaptations to extend PRT’s applicability globally. Studies from countries like Canada, Netherlands, and China demonstrate promising results, although further replication research is needed in underrepresented regions.