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Pivotal Response Treatment

What is Pivotal Response Treatment (PRT)?

Based on the principles of Applied Behavior Analysis (ABA), Pivotal Response Treatment (PRT) is a play-based and child initiated intervention that aims to develop communication, language, and positive social behaviors, while discouraging disruptive self-stimulatory behaviors.1 Pivotal Response Treatment was developed by Dr. Robert Koegel and Dr. Lynn Kern Koegel and incorporates ideas from the Natural Language Paradigm. They theorized that by focusing on the pivotal areas of a child’s development widespread improvement would occur in other areas.2 According to the UCSB Koegel Autism Center,3 the four key pivotal behaviors are:

  • Motivation
  • Responding to multiple cues
  • Self-management
  • Social initiations

Ideally, by focusing on these pivotal behaviors the individual will experience “broad improvements across other areas of sociability, communication, behavior, and academic skill building.”1

Similar to other interventions, the PRT intervention provides a program that is tailored to a child’s unique individual needs, but is also utilized throughout the day in the child’s natural environments. PRT emphasizes inclusion, not just in a school setting, but also in after school and summer community activities to “maximize the likelihood of producing a normalized developmental trajectory.”4 Unlike discrete trial training (DTT), Pivotal Response Treatment lets the child’s interests in specific activities dictate what will be learned during the treatment session. For example, a practitioner might use a child’s interest in balloons to teach them about colors or numbers. A detailed assessment for implementing PRT provided by the National Professional Development Center on Autism Spectrum Disorders can be found here.

How does Pivotal Response Treatment (PRT) Make a Difference for Individuals on the Autism Spectrum?

Research concerning Pivotal Response Treatment demonstrates that the intervention is “effective at promoting language development, increasing socialization, and decreasing disruptive behaviors in children with autism.”5 According to the principles of PRT, by focusing on building specific skills like communication, the learner may begin to show improvement by displaying less disruptive behaviors, their affect can change, and their ability to maintain eye contact may increase.6 Pivotal Response Training utilizes “natural reinforcers” that are contingent upon the child’s behavior, administered following a reasonable attempt to fulfill the desired response, and related to the desired behavior in a direct way.7

Natural reinforcement is one of the techniques used to develop motivation. Lack of motivation is a common problem seen in children with autism spectrum disorders and other developmental disorders.8 Another technique used to build motivation in the child is to share choice or control in an activity. A helpful example to illustrate this point would be teaching a child how to put on a coat. To help share control the teacher may initially get the coat off the hook, place it on the child, together they will start the zipping process, and the teacher should let the child finish zipping up their coat by his/herself. As the child gets more proficient, the teacher will let him/her complete more steps on his/her own. By “sharing control of the activity and material selection, adults increase learners’ motivation to participate and thus help them learn target behaviors.”9 Other motivational strategies include incorporating old tasks that the child has already learned and changing tasks periodically to keep things fresh and interesting for the learner.6 These motivation strategies are incorporated during the intervention as often as possible.10

What do Pivotal Response Treatment Providers do?

Practitioners of the Pivotal Response Treatment include parents, family members, teachers, psychologists, and a range of other professionals who work with individuals on the autism spectrum. Family involvement helps professionals in the “development of intervention goals and the implementation of procedures to achieve these goals. Intervention is coordinated across all settings, with parents learning, through practice-with-feedback, to implement procedures.”4 Although PRT is a technique that encourages the use of multiple natural environments and teaching partners,11 PRT therapy programs usually involve 25 hours a week or more. According to Autism Speaks, a Pivotal Response Therapy session “typically involves six segments during which language, play, and social skills are targeted in structured and unstructured formats.”12 To help with implementation, the National Professional Development Center on Autism Spectrum Disorders has developed PRT checklists and data sheets to assure that PRT is implemented with fidelity.

Where Do Pivotal Response Treatment Providers work?

Pivotal Response Treatment therapists and consultants can specialize in any number of disciplines related to the field of autism (e.g. speech-language pathologists, occupational therapists, etc.). A major principle of PRT is that the intervention is “easy to implement and readily usable in community settings.”13 PRT is implemented in normal classroom settings and in the home to help the individual learn fluently throughout the day.

Who is Qualified as a Treatment Provider?

There are six levels of PRT certification, the first of which can be obtained by attended the 2-day conference/workshop known as the Annual Pivotal Response Treatment Conference hosted by the Koegel Autism Center at UC Santa Barbara.14 The Koegel Autism Center is also offering on-site PRT training for groups interested in learning about the intervention across America.

Is There Research to Support Pivotal Response Treatment?

According to the UCSB Koegel Autism Center, Pivotal Response Treatment “is one of the few [treatment programs] that is both comprehensive (as listed by the National Research Council of the National Academy of Sciences) and empirically supported (as recognized by the National Professional Development Center on Autism Spectrum Disorders and the National Standards Project).”3 The National Standards Projecthas qualified Pivotal Response Treatment as one of their eleven established treatments for autism spectrum disorder.15 Favorable research outcomes have been achieved when the study’s focus is on parent-training of the Pivotal Response Treatment as the results “indicated significant [a] difference between treatment and control groups at post-test on all of the dependent measures.”16 The UCSB Koegel Autism Center includes numerous research abstracts detailing the empirical support for PRT conducted by the developers of the intervention and independent researchers.

How can I get find More Information about Pivotal Response Treatment?

The official website for Pivotal Response Treatment includes information on research, certification, products, and numerous summaries about the intervention itself. The UCSB Koegel Autism Center is another helpful resource for individuals interested in learning more about Pivotal Response Treatment.