What is Pivotal Response Treatment?
Pivotal Response Treatment, or PRT, is a behavioral treatment for autism. This therapy is play-based and initiated by the child. PRT is based on the principles of Applied Behavior Analysis (ABA).
Goals of this approach include:
- Development of communication and language skills
- Increasing positive social behaviors
- Relief from disruptive self-stimulatory behaviors
The PRT therapist targets “pivotal” areas of a child’s development instead of working on one specific behavior. By focusing on pivotal areas, PRT produces improvements across other areas of social skills, communication, behavior and learning.
Pivotal areas include:
- Motivation
- Response to multiple cues
- Self-management
- Initiation of social interactions
Motivation strategies are an important part of the PRT approach. These emphasize natural reinforcement.
For example, if a child makes a meaningful attempt to request a stuffed animal, the reward is the stuffed animal – not a candy or other unrelated reward. Children are rewarded for making a good attempt, even if it is not perfect.
PRT was developed by Dr. Robert L. Koegel and Dr. Lynn Kern Koegel of Stanford University. It was previously called the Natural Language Paradigm (NLP). This approach has been used since the 1970s.
Who provides PRT?
A variety of providers seek training in PRT methods, including:
- Psychologists
- Special education teachers
- Speech therapists
What is a typical PRT therapy program like?
Each program is tailored to meet the goals and needs of the individual person and his or her everyday routines.
A session typically involves six segments. Language, play and social skills are targeted with both structured and unstructured interactions.
The focus of each session changes as the person makes progress, to accommodate more advanced goals and needs.
PRT programs usually involve 25 or more hours per week.
Everyone involved in the child’s life is encouraged to use PRT methods consistently in every part of his or her life. PRT has been described as a lifestyle adopted by the whole family.
What is Pivotal Response Treatment?
One of the most proven behavioral approaches for treating children with autism spectrum disorders is pivotal response treatment, or PRT. Drawn from applied behavior analysis, PRT is a play-based method that targets improving “pivotal” development areas instead of individual behaviors. It’s based on the idea that changes in pivotal responses would spark widespread progress in other developmental areas. PRT was initially established in the 1970s by Dr. Robert Koegel and Dr. Lynn Kern Koegel at the University of California- Santa Barbara. First called pivotal response teaching, PRT combined several research-based interventions to improve autistic children’s social and communicative growth. A study published in Behavior Modification journal showed that pivotal response treatment is highly effective for preschool, elementary, and middle school students with ASD.
Four Main Pivotal Areas Targeted
Pivotal response treatment strives to thwart negative, self-stimulatory behaviors associated with autism by addressing four main “pivotal” areas. The central area is motivation. PRT therapy works to increase children’s desire to learn and perform skills associated with good consequences. Rather than force tasks, PRT uses the child’s interests to reinforce pro-social behaviors and trigger enthusiasm. The second “pivotal” area is initiations. PRT encourages the child to initiate social interaction by asking questions or obtaining attention. Next comes self-regulation. This “pivotal” area teaches children to self-evaluate and discriminate their behaviors for greater independent. Finally, PRT trains autistic youth to respond to multiple cues rather than focus on specific details or stimuli.
What’s Involved in PRT Sessions
PRT therapy sessions involve using positive reinforcement to address the above “pivotal” areas, which will result in broad progress for sociability. Pivotal response treatment is customized to meet the unique needs of individual children and their routines. Most school-based PRT programs will consist of 25 or more hours weekly. Parents or guardians should also adopt PRT methods in the home environment for consistency. Pivotal response treatment uses play therapy to target social skill development, so unstructured interactions are common. Lessons could include taking turns, imitation, joint attention, or peer interaction. For example, if the child verbally expresses a desire for a doll, they’ll be rewarded with the toy.
Qualifications to Provide PRT Therapy
Practitioners of pivotal response treatment typically need special certification beyond their training and licensing. PRT is most often provided by school psychologists, special education teachers, speech-language pathologists, and occupational therapists. Some applied behavior analysts may dabble in PRT therapy since it’s derived from ABA. Most PRT providers attain at least a master’s degree in counseling, psychology, education, or therapy. Accredited master’s programs will require clinical practicum to satisfy the contact hours for licensing, which varies greatly by state and title. After licensing, providers should pursue certification from the UCSB Koegel Autism Center. Three levels of PRT certification can be obtained with workshops. Level I Certification requires attending the two-day Pivotal Response Treatment Conference.
Overall, pivotal response treatment was recognized by the National Research Council as one of the top 10 model programs for autism. Motivation strategies utilized in PRT therapy helped 85% of toddlers with autism develop verbal language as their primary communication. PRT is an evidence-based behavioral approach targeting critical behaviors in natural environments for better social skills. As the diagnosis of children with ASD grows more prevalent, pivotal response treatment is expected to become a leading form of early intervention.
Pivotal Response Training (PRT) is a variation of Applied Behavioral Analysis (ABA) type therapy. It focuses on more comprehensive “pivotal” areas such as increasing a child’s motivation to learn, initiate communication, and monitor their own behaviors. This focus on motivation is crucial: a child who is motivated to change their behavior will experience more success. By focusing on critical over-arching areas, the effects of treatment can carry over into many aspects of a child’s behavior and skills including social, communicative, and academic.
In order to motivate children, PRT is typically play-based and the therapist lets the child initiate activities such as what game to play, what to talk about, or what to learn. Tasks are varied and children are given natural reinforcers that relate to the current situation: such as asking appropriately for a toy and then being handed that toy.
Pivotal Response Training (PRT) is a naturalistic intervention model based in Applied Behavior Analysis. Rather than target individual behaviors one at a time, PRT targets pivotal areas of a child’s development, such as motivation, responsivity to multiple cues, self-management, and social initiations. By targeting these critical areas, PRT results in widespread, collateral improvements in other social, communicative, and behavioral areas that are not specifically targeted. Underlying motivational strategies are incorporated throughout intervention including: choices, task variation, interspersing maintenance tasks, rewarding attempts, and the use of direct and natural reinforcers. The child plays a crucial role in determining the activities and objects that will be used in the PRT exchange. Intentful attempts at the target behavior are rewarded with a natural reinforcers (e.g. if a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or unrelated reinforcer). PRT is used to teach language, decrease disruptive/self- stimulatory behaviors and increase social, communication, and academic skills.