Background: Pivotal response treatment (PRT) is suggested to be an effective treatment for children with autism spectrum disorder (ASD). Objectives: We aimed to compile evidence examining the effectiveness of PRT on social communication, social interaction, and repetitive behavior for children with ASD. Methods: We performed a systematic and comprehensive search for relevant trials about PRT. The results are summarized quantitatively and qualitatively. Results: We included five randomized controlled trials suggesting that PRT may have positive effects on expressive language (SMD = 0.48; 95% CI 0.04 to 0.93), social interaction (SMD = 1.12; 95% CI 0.50 to 1.74), and repetitive behavior (SMD = 15.97; 95% CI 11.57 to 20.36). The effect on other outcomes, receptive language, and early learning skills is more uncertain. The quality of the evidence was found to be low. Author's Conclusions: PRT may be associated with advantageous effects, but more high-quality research is needed before we can draw firm conclusions.