What is Pivotal Response Treatment?
Pivotal Response Treatment® is a highly acclaimed research-based intervention for individuals with Autism Spectrum Disorders (ASD).
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:
- Response to multiple cues
- 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.
Specific research-based motivational procedures including child choice, task variation, interspersing maintenance and acquisition tasks, rewarding attempts, and the use of direct natural reinforcers, are incorporated to make the intervention extremely powerful and efficient. The goal of PRT® is to move the child with ASD towards a more typical developmental trajectory, through individualized intervention objectives based on the child's needs.
PRT® targets each core area of development, and focuses on increasing motivation to engage and learn for children with ASD. PRT® is implemented in the natural environments of the child (e.g., home, community, and school) and emphasizes parent education to empower family members to become agents of intervention, so that learning can be embedded across daily routines.
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 a lot of 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 the evidence that PRT is effective?
PRT is one of the best studied and validated behavioral treatments for autism.
More than 20 studies suggest that PRT improves communication skills in many ( children who have autism. Most of these studies looked at PRT delivered by trained therapists in one-on-one therapy sessions. Others looked at PRT delivered in group settings by school teachers and by trained parents in their homes. A 2017 review of brain imaging studies showed evidence that PRT improves brain activity associated with sociability and communication.
According to the studies that form the evidence base for PRT®, children with Autism Spectrum Disorders (ASD) aged from 2 to 16 years have benefited from PRT® intervention. Research has shown that the use of motivational techniques within the PRT® teaching framework can lead to 85-90% of children with autism (who begin intervention before the age of 5) developing verbal communication as a primary mode of communication. Researchers have also identified specific behavioral characteristics associated with favorable responses to the teaching practices. Precursors related to positive outcomes thus far, include increased use of social initiations and more toy play as well as decreased social avoidance and stereotypic language.
Pivotal Response Treatment® was developed initially by Drs. Robert and Lynn Koegel at the University of California, Santa Barbara, and is now further being developed by the Koegels at Stanford University. Over the past 30 years, the Koegels, their graduate students, and their colleagues have published over 200 research articles in peer-reviewed journals that support the effectiveness of PRT®, and have written over 30 books and manuals. PRT® is listed by the National Research Council as one of the ten model programs for autism, and is one of four scientifically-based practices for autism intervention in the U.S.