Step 1 Planning

The planning process for PRT involves identifying objectives for the toddler, collecting baseline data, and preparing materials and activities.

Step 1.1 Develop meaningful objectives

The first step is to develop goal areas and specific objectives. In developing goals and objectives, take into account the toddler’s needs, strengths or interests, and family preferences, values, and context.

a) Identify the toddler's needs through direct observation, interviews, and

assessment

In PRT, the identification of child needs is based on the integration of observational data in everyday environments, interviews and collaboration with parents, and assessments. Generally, goals should address core areas of autism and developmentally meaningful behaviors through improving a toddler’s motivation to acquire and engage in the target behaviors.

There are no prescribed assessments, and it is not necessary to have formal assessments and testing complete in order to start PRT. Assessments might include, but are not limited to:

ADOS

Vineland Adaptive Behavior Scale,
Peabody Picture Vocabulary Test (one word expressive and receptive)
Child Development Inventory.

More intensive assessments, such as the Autism Diagnostic Observation Scale (ADOS), could also provide important information on specific target behaviors. Behavioral assessments, such as functional behavior assessments (FBA), provide valuable information regarding the child’s functional communication and challenging behavior. Further, assessments should be strength-based (Cosden, Koegel, Koegel, Greenwell, & Klein, 2006). PRT researchers and clinicians suggest that standardized assessments might reflect performance issues related to motivation, rather than ability levels.

Strength-based Planning for Infants and Toddlers provides some examples of the potential for strength-based, naturalistic assessment for toddlers with autism.

Always directly observe the infant or toddler and collect baseline data within natural, everyday environments and during child interactions with both parents and practitioners.

Semi-structured language and play samples (examples provided below), which collect a variety of information on the child’s communication, language, and behavior during play and daily routines, provide important information necessary to develop the toddler’s PRT program related to communication, socialization, and language. Direct observation and collection of baseline data on meaningful target areas, such as social interaction, joint attention, imitation, play, and interfering behaviors should inform your target goals and objectives.

What target skills might be pivotal or which learning areas will have the widest and most immediate impact on the toddler or infant’s overall development?

In order to establish pre-intervention levels of a toddler’s motivation to learn and engage in developmentally appropriate behavior, initial and ongoing data collection should be collected by the interventionist to evaluate how responsive the toddler is to the social environment, how often the toddler initiates interactions (and the function of the initiations), and the toddler’s overall affect across contexts.

A Likert Scale can be used to monitor the toddler's affect. Included also are examples of possible meaningful goal areas that can be used when developing a PRT program for a toddler or an infant.

pdf icon Monitoring Toddler Affect Using a Likert Scale

pdf icon Possible Meaningful Goal Areas for Infants and Toddlers

b) Develop meaningful communication and language objectives

Language or communication samples can help parents and practitioners assess communication in a toddler. The data gathered from language samples are individualized. This type of data would likely have to be scored from a video, or by another person than the person interacting with the toddler. For each opportunity to communicate or each initiated communicative act (numbered 1, 2,3...):

an antecedent is noted (i.e., what happens before the communicative behavior?),
what the verbal communication sounded like (and whether it was a new acquisition word, or an easy maintenance word?),
what the function or purpose of the communication was, and
where and with whom the communicative act occurred?

Nonverbal (prelinguistic) communicative behavior can be assessed in conjunction with verbal behavior, or by itself if that is an appropriate mode of communication for the infant or toddler. It is also important to note the duration of your sample.

Review an example oortion of an language sample

Consider the suggested questions to ask about an infant or toddler's social-communicative behaviors. What data can be collected from the language sample?

data that can be collected from a language sample

The rate of initiations.
The percentage of responding to social-communicative stimuli (i.e., responsivity).
The percent of the time a toddler attempts to imitate verbal models and various sounds.
The percent of spontaneous versus prompted utterances.
The overall vocabulary and word diversity (e.g., number of different words used in 20 minutes).
The accuracy of choice making, amount of echolalia, and the accuracy of word label-object/action correspondence (i.e., word discrimination).
The functions of the verbalizations used (e.g., percent of spontaneous utterances used to comment on events versus to request items).
The types of questions the toddler uses. The parent or practitioner can add specific evocations for various question types within the language sample (e.g., hide a needed toy piece in order to evoke a “where?” question).
The differences in communication/language used between settings, activities, and communicative partners (e.g., familiar vs. unfamiliar people).
The use of communicative nonverbal behaviors in conjunction with verbal behaviors (e.g., percent of utterances used in combination with joint attention behaviors such as pointing and gaze shifting).
The length of the utterances (i.e., mean length utterance by words or morphemes).
The developmentally appropriate use of various linguistic skills and syntax (e.g., use of verbs, [-ing] endings, plurals).
The percent of multiple-word utterances that were spontaneously generated.
The ratio of maintenance and acquisition interspersed by a parent or practitioner.
The ratio of various antecedents (i.e., cues, discriminative stimuli, prompts, and task variation) used by the parent or practitioner (e.g., percent of time delays used versus model prompts).
The sounds (phonemes) being produced by the child (e.g., articulation) and vocal attempts being made (e.g., percent correct terminal [-d] sounds) and the overall intelligibility.

c) Develop meaningful play, social engagement, imitation, and behavior

objectives

PRT targets social communication and language in the context of play, functional engagement in daily routines, and social activities. The development of social communication within PRT relies on the continued development of other developmentally meaningful areas, including expansion of the toddler’s preferences and play skill repertoire, increased attempts at spontaneous imitation of functional actions, and increased social engagement (including joint attention).

Use questions to guide the development of play, engagement, and functional imitation objectives.

While using PRT, you will monitor challenging behaviors, such as stereotypical behavior and tantrums, but may not initially focus intervention here (unless the behaviors are particularly interfering and dangerous). Instead, the effort is placed on improving motivation during learning opportunities and interaction, and increasing functional communication, so that challenging behavior becomes less relevant to the toddler.

As a toddler’s motivation, functional communication, and functional engagement improves during the initial stages of PRT, many challenging behaviors may indirectly decrease. Still, the initial PRT plan should define the challenging behaviors and implement a functional behavior assessment in order to determine the behaviors’ functions, or the purpose they may serve for the toddler.

PRT continuously and proactively teaches communication that is functionally equivalent to challenging behavior, thereby helping to prevent further development of challenging behavior.

Step 1.2 Incorporate specific toddler and family factors in goal development

Incorporate the toddler's strengths, interests, as well as family preferences and values, into the development of goals and objectives when planning PRT. It is important to identify areas of need as well as the strengths of the toddler. PRT researchers and clinicians recommend a strength-based, naturalistic approach to assessment and intervention. Strengths should be capitalized on when developing goals, objectives, and intervention plans.

pdf icon Review examples of strength-based assessment and intervention planning for a toddler

EXAMPLE: If a non-verbal toddler sometimes shouts out labels in a favorite TV show, this is where communication or language intervention might begin.

Developing the intervention plan should also focus on the contextual fit of the intervention objectives and the family’s needs. Instead of simply requiring a family to adapt to the intervention procedures and goals, make explicit efforts to adapt the intervention to various family contexts. Families differ in many ways, and goal development should attempt to fit into differing family contexts.

For instance, if a family has a newborn on the way, the play objectives may change to increasing independent, functional play (or play with an older sibling), instead of increasing turn taking during social games with a parent.

Step 1.3 Collect baseline data

Remember to take baseline data on the selected objectives and analyze the data.

Typically, 6-10 meaningful objectives are formally targeted at a time (where data are collected), but multiple other goal areas are still addressed and maintained. PRT implementation is not limited to those specific, formal objectives. You may capitalize on incidental learning opportunities that target different behaviors than the ones established in the formal objectives.

Taking baseline data will help you verify that the objective is necessary. You also will be able to compare intervention data to the baseline data in order to answer whether the intervention was effective. This, in combination with monitoring fidelity of implementation, allows for data based decision-making.

Step 1.4 Plan when opportunities will occur and prepare materials

PRT is intended to eventually become a part of the toddler family’s lifestyle. When this occurs, provide opportunities quite naturally, with minimal formal preparation. This is also the case in home and community settings. At first, you may benefit from some explicit planning and preparation. Even as PRT becomes a more natural occurrence throughout the day, continue to engage in some level of planning and preparation, particularly as new objectives and activities are introduced.

a) Create an inventory of motivators through various reinforcer and preference

assessments

This inventory help you provide more motivating items and activities during intervention and throughout the day. Make sure to follow the toddler’s lead and provide choices between these preferences in the moment. Although you may expect the toddler to engage in the most preferred activity, in the moment they may choose a different activity. You may be surprised at how many items and activities a toddler enjoys!

Planning Considerations:

What are the toddler’s learning strengths and emerging skills?

How can the toddler’s individualized PRT program capitalize on them?

Have you considered... Example ideas of motivators for toddlers:

objects, items, and toys
actions and physical activities
social activities (where other people are an important part of the activity!)
sensory activities (including stereotypy; non-functional, repetitive activities)
snacks, meals, and drinks
daily routines and actions
places to go
topics, themes, shows, characters

b) Continue to have toddler’s learning strengths and emerging skills in mind as

your prepare the materials

If the toddler is great at reciting the ABC’s, then this might indicate a strength and learning preference. If you are going to introduce some puzzles during play, ABC puzzles might be a great place to start. It might mean that the toddler learns well from repeated patterns and/or songs. If you initially select to teach functional, spontaneous verbal communication to a toddler, you might start by using carrier phrases within the alphabet or within a song. It is important to consider the toddler’s developmental level when selecting motivating activities and materials.

A practitioner might start singing, “A, B, C, ___” and then wait a few seconds for the toddler to say “D” before singing and pointing to the letter D. The practitioner could then plan to use other carrier phrases, such as “ready, set, __” and “one, two, three, __.”

c) List out the daily routines

These routines might differ by weekdays versus weekends, winter days versus summer days, etc. Remember to include the mundane!

Parents and practitioners often find that the best learning opportunities occur among the basic day-to-day events or items a toddler desires. These might include opening the door to go outside and play, buckling a seat belt to drive to the park, turning on the bath tub water before a bath, and turning a light on and off upon entering and exiting a room. Daily routines may provide excellent times to present motivating learning opportunities, as long as the toddler indicates that he or she wants these things to occur in the moment.

d) Decide what parts of the routine can be used to target the toddler’s meaningful

objectives and how the toddler’s interests and preferences can be incorporated.

After listing the various daily routines and activities, form an activity matrix of what objectives can be targeted during the different times of the day. Consider whether a particular time of the day should be dedicated to more intense intervention sessions with more frequent opportunities provided.

Prepare materials.

Once you have identified what types of interests and preferences the toddler has, and have planned where opportunities can be provided, the next step is to prepare any materials.

Consider the environmental arrangement.

Can the materials be arranged to gain shared control and establish motivation? For instance, a parent might prepare by putting the different colored ducks up on a shelf, in sight but out of reach in the shower, or put the ducks in a “locked” Tupperware container. Preparing materials is also about preparing to manage the materials.

If you are working on accurately requesting colors and the toddler enjoys playing with ducks in the bath, then prepare multiple colored ducks to have out during bath time. A toddler can even help paint them or select them at the store! In summary, you should use an activity matrix to help you plan when opportunities will occur and then prepare your materials and activities.

Practice Scenarios: Planning PRT

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We recommend that you continue with the same Scenario setting throughout the module

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Knowledge Check

Question:

Which of the below is the most complete and accurate sequence of planning PRT for toddlers?

Planning PRT Sequence 1:

Decide on the skills to target based on an established curriculum and standardized assessment protocol, write measurable and observable objectives, collect baseline data, plan when the opportunities will be provided, and prepare any materials.

Planning PRT Sequence 2:

Decide on the skills to target based on direct observation, write measurable and observable objectives, collect baseline data, plan when the opportunities will be provided, and prepare any materials.

Planning PRT Sequence 3:

Decide on the skills to target based on direct observation and collaboration with parents, any assessments that have been completed, developmentally appropriate and meaningful areas (including core ASD characteristics) that are likely to produce immediate a widespread positive changes, strengths and preferences/interests of the toddler, and family preferences/context. This is followed by writing measurable and observable objectives, planning when the opportunities will be provided, and preparing any materials.

Planning PRT Sequence 4:

Decide on the skills to target based on direct observation and collaboration with parents and other practitioners, any assessments that have been completed, developmentally appropriate and meaningful areas (including core ASD characteristics) that may produce immediate a widespread positive changes, strengths and preferences/interests of the toddler, and family preferences/context. This is followed by writing measurable and observable objectives, collecting and analyzing baseline data, planning when the opportunities will be provided (and by whom), and preparing any materials.

Check your answer

Of the given possible choices, the most complete and accurate sequence of planning PRT for toddlers is

Sequence 4:

Deciding on the skills to target based on direct observation and collaboration with parents and other practitioners, any assessments that have been completed, developmentally appropriate and meaningful areas (including core ASD characteristics) that may produce immediate a widespread positive changes, strengths and preferences or interests of the toddler, and family preferences/context.

This is followed by:

writing measurable and observable objectives,
collecting and analyzing baseline data,
planning when the opportunities will be provided (and by whom), and
preparing any materials.