Pivotal Response Treatment: Insights into a Scientifically-Based Treatment for Autism Spectrum Disorders

Page content

Pivotal response treatment (PRT) is based on principles of applied behavior analysis (ABA). Drs. Lynn and Robert Koegel adapted principles from ABA and natural language training and applied them to troublesome behaviors in children on the autism spectrum. According to an article by Richard Simpson, Ed.D of the University of Washington, pivotal response is one of only four treatments for autism spectrum disorders that are scientifically based. The approach of PRT is naturalistic and targets pivotal developmental areas, rather than specific behaviors.

Pivotal Areas of Development

Pivotal response treatment seeks to improve developmental areas such as a child’s motivation, how they respond to specific cues, their ability to manage themselves and their behavior choices, as well as initiating social contacts and connections. The Koegels believed that focusing on improving developmental deficits in these areas, rather than targeting specific behaviors, would result in greater overall improvements, including eliminating problematic behaviors.

Studies by the Koegel Autism Center at the University of California, Santa Barbara have shown that using pivotal response treatment early in a child’s life produces far greater results. Researchers believe this is the time when parents, teachers, and professionals have the most cohesive approach to helping a child improve. Therefore, it is believed that such treatments are most effective when introduced during elementary school. By targeting pivotal areas of development early in a child’s life, collateral improvements are made in problematic behaviors, language skills, and social interactions.

The Key Factors and Primary Goals

While each child is different, the primary factors of PRT are child choice and parental intervention. In short, that means that how the child responds to teaching directs the activities used. Parents are taught how to assume the role of primary intervention agent. Teachers and therapists are also predominant in reinforcing what parents are attempting to teach the child and supporting the parent in goal-setting. Therapists who use PRT help not only to train the child and direct therapy, but also teach parents how to use direct and natural reinforcers.

Pivotal response therapy seeks to teach the child self-management and empathy. Improving the child’s motivation and their ability to respond to more than one cue or signal at a time, whilst also promoting self-initiated activities are also primary goals of therapy. The exact activities and intervention objectives are different for each child, based on his or her needs. However, the ultimate outcome is to bring the child closer to a typical level of developmental ability.

Examples of PRT

The goal of specific PRT activities is not necessarily clear success. Instead, the child is rewarded for making the honest effort to make the right choices. For example a child who does not communicate or initiate social communications will participate in a series of activities with both therapists and parents. Play environments in a natural setting, such as the child’s home or school are used as often as feasibly possible.

Toys may be placed out of the child’s immediate reach to foster communication and social interaction. The child must communicate their desire for a particular toy, like a board game. Provided the child makes the attempt to communicate their needs or wants, they are given the toy. Their attempt to communicate teaches motivation, communication, and social interaction. The use of direct reinforcers (getting the toy requested) rather than other unrelated rewards (such as a treat) helps the child improve targeted developmental areas in a simple, straightforward, natural environment.

Likewise, during PRT, play environments are used to teach the child how to understand social cues and respond appropriately. For example, parents and therapists may use a variety of games to teach the child to take turns, to participate in on-going communications, and to improve their language skills. While the parents, teachers, or therapists may initiate activities, the child’s choices direct the therapy. As the child’s choices improve, so do their behaviors, and treatment can move to more advanced skill development.

References and Resources

Evidence-Based Practices and Students with Autism Spectrum Disorders https://depts.washington.edu/pdacent/Publications/Simpson/Simpson2.pdf

Koegel PRT, About Pivotal Response Treatments: https://www.koegelautism.com/

University of California, Santa Barbara, The Koegel Autism Center: https://education.ucsb.edu/autism/JPBIJuly2010.htm