Step 2.1 Select target behaviors

Select your targets from the toddler’s individualized goals and objectives.

a. Determine the specific responses to prompt

Vary tasks. While following the toddler’s lead, parents and practitioners should vary tasks, materials, and activities to maintain their toddler’s interest and engagement. Mix up the activities and the tasks within activities. You should be alert to a toddler’s behavioral cues (e.g., lack of attention, attempts to change activities) that signal that they are becoming bored and that it is time to change to a new item or activity, or change the tasks and demands within an activity. It is best to vary the task before the toddler disengages, so that motivation can be sustained.

Target response variation. If appropriate, mix up the skills. Varying the target responses helps maintain a toddler’s level of responding and initiating during learning interactions. Varying targeted responses also helps avoid “drilling” the toddler. If attempting to improve a toddler’s motivation to engage socially and learn, avoid drilling by varying the target responses. Again, be alert to a toddler’s behavioral cues that signal that they are becoming frustrated or bored and that it is time to vary the targeted responses.

Mix up the instructional cues, prompts, and contexts. Increasing the variation in cues and prompts for a task, and other environmental conditions, also helps to link desired responses to a variety of antecedents and contexts that could be present in a toddler’s everyday environments. An example would be: teaching colors on a variety of child preferred stimuli during a variety of games in different rooms of the house. This increase in variation allows for the possibility of greater spontaneity and generalization beyond the initial learning situations and fosters the toddler’s responsiveness to a range of stimuli.

b. Intersperse maintenance and acquisition tasks

You can maximize a toddler’s motivation during learning and interaction by mixing maintenance opportunities with acquisition opportunities. The acquisition trials involve tasks that are new or currently being learned and are often times more difficult trials than previously mastered items in maintenance trials.

By attending to a toddler’s behavioral cues that signal that adding maintenance tasks prior to the next acquisition task might help optimize the toddler’s motivation to learn and socially engage, the ratio of maintenance and acquisition tasks can be varied.

The toddler's behavioral cues might include: lack of attention, avoidance responding, escape-driven challenging behavior, lack of trying, and indications of frustration.

Step 2.2 Identify learning activities and stimuli

a. Follow the child's lead

Following the toddler’s lead in order to identify child-preferred teaching materials or activities and natural reinforcers is an important component of establishing motivation in PRT. This step allows toddlers to choose play materials, toys, and activities that will be used in the PRT learning opportunity.

• Begin following the child's lead by observing when the toddler has free access to materials and activities to identify their preferences for items, activities, and toys. Entice the toddler with toys and activities and observe how they toddler responds in order to assess if, in that moment, they are interested in playing with the materials or engaging in the activity.
• If the toddler indicates interest in the moment, then the item or activity can be used within the PRT learning opportunity.

A toddler might indicate interest by reaching for the materials, begining and playing with the materials, or by smiling and giviing eye contact during the social activity.

Beginning learners, or younger toddlers, working on developing communicative intent could be prompted to vocalize “dino” or point to the “dino” in order to take a turn playing with the dinosaur. A more advanced learner, or older toddler, working on play skills such as block building could be prompted to build a tower together prior to letting a dinosaur knock over the tower.

b. Embed social interests and preferences

Identifying individualized, socially oriented reinforcers and embedding preferred social interaction within the delivery of natural reinforcement has been shown to improve social engagement and joint attention (Jones, Carr, & Feeley, 2006; Koegel, Vernon, & Koegel, 2009; Vernon, Koegel, Dauterman, & Stolen, 2012).

Why embed social activity interests and preferences?

These strategies may help increase social behaviors such as reciprocal social smiling, eye contact, social orientation toward a parent instead of toward an object, and joint attention. Some researchers suspect that early challenges in social motivation are core to the development of ASD (Dawson, Webb, & McPartland, 2005).

PRT can be used to increase social motivation early in an infant or toddler’s development before secondary symptoms arise (Dawson, 2009; Voos et al., 2013).

Preferred social activities:

• incorporate as activities more frequently in the child’s day.
• embed within natural reinforcers.
• use as an idiosyncratic social reinforcer as a consequence for joint attention.

It is important, especially for infants and young toddlers, that rewarding social activities comprise many of their PRT learning interactions. A rewarding social activity is an activity where another person, such as a parent, is a crucial component of the reward value associated with the activity. In other words, the reinforcer does not exist without the social engagement of the parent or practitioner with the toddler or infant.

It may be the case that an infant or toddler’s involvement in social activities is restricted, minimal, and fleeting. Combining this step with Interspersing Maintenance and Acquisition, as well as the other motivational components, can help increase the duration and quality of engagement in social activities. Researchers and clinicians at the UCSB Koegel Autism Center have developed Five Steps for Building Early Developing Engagement in Social Activities. These are described below:

See Natural Reinforcers, for more on embedding social activities in natural reinforcers and using individualized social reinforcers.

c. Incorporate interests and preferences

You may also incorporate a toddler’s interests into established or new activities, tasks, and routines. For instance, if the toddler has a perseverative or strong interest in dinosaurs, during the play dough center, the dinosaur cookie cutters could be used to motivate the toddler to play functionally with the play dough. A toddler working on receptive language skills and functional play could be told to either roll the play dough or pat down the play dough. Making dinosaurs with the dinosaur cookie cutters naturally reinforces the toddler’s attempts. During book time, books with dinosaurs could be read together and PRT opportunities could be interspersed during the engagement (e.g., asking the toddler, “What do you see?” and then naturally reinforcing them by turning the page to see more dinosaurs).

Arrange the toddler’s environment with child-preferred, developmentally appropriate objects and activities. During free time a parent could lay out an array of art materials for a toddler who enjoys arts and crafts.

d. Provide choices

Incorporate choice-making opportunities into naturally occurring routines, activities, and task demands or instructions throughout the day. Choices enhance engagement, increase rates of learning, and decrease challenging behavior. Choices also provide outstanding communication and language development opportunities.

Choices are also provided within adult-directed instructions, providing a level of shared control (see Shared Control) that improves a toddler’s response to adult direction. A variety of choices can be offered in terms of: what / which (what to do, which one to play), where  (to do the task), with whom (to play), how (the action should be done), and when (to do the activity).

Allow toddlers to select materials, topics, and toys during teaching activities. This may be particularly important when introducing new skills and tasks. Using toys, items, and activities that individual toddlers prefer may increase their motivation to participate and thus may increase the likelihood that they will rapidly acquire target skills and use them spontaneously. For example, when a toddler chooses to use colored Legos instead of wooden blocks, he may be more motivated to complete a tower building task during fine motor center.

Examples of Incorporating Perseverative Interests to Increase Joint Attention
Perseverative Interest	Puzzle	Pretend Figurines	Books
Numbers	Number puzzle	Draw numbers or put number stickers on existing figurines	Counting and number books
Opening and closing various doors	Wooden board with different doors and latches to open	A doll house or barnyard set with various doors	An interactive book that has flaps hiding pictures and text (flaps that can be open and closed)
Animals	Zoo animal puzzle	Barnyard play set, animal figurines	Zoo books
Vehicles	Vehicle puzzle	Miniature vehicles with ramps/garage	Car books

More information about Individualization see Restricted Interests and Perseverations

Restricted interests. Many children with ASD have restricted interests. Although expanding interests should be an important component of intervention, many skill areas targeted for toddlers with autism, such as communication, language, and socialization, will capitalize on the child’s current interests and preferences. This is particularly the case for toddlers just beginning to learn communicative intent and develop first words. If a toddler has a restricted interest in turning lights on and off, in the PRT model the toddler’s first word may be an approximation of the word “light” or “on” in order to gain access to turning on or off a light. However, as the toddler progresses, and in certain circumstances, a practitioner might work on expanding preferred play and functional activities and interests via PRT and related evidence-based strategies.

Perseverative interests. Incorporating perseverative interests into PRT opportunities has been shown to increase initiated joint attention acts where children share their interests socially with the adult (Vismara & Lyons, 2007). For this reason, parents and practitioners incorporate perseverative interests in play and daily routines in which PRT is implemented. A toddler’s increased engagement in joint attention may be an important collateral effect – or indirect effect – of using this PRT strategy. In this study, incorporating perseverative interests specifically into PRT evoked initiated joint attention acts with clear social functions, such as to share affect and their interest with an adult (versus communicating with the adult via joint attention in order to obtain the item).

For instance, if a two-year-old perseverates on numbers, then number puzzles and number books could be used when playing with the child. See the table provided above for ways to incorporate perseverative interests in order to improve social motivation and increase initiated joint attention.

Step 2.3 Establish motivation through shared control and turn taking

Creating shared control is an important step in establishing the toddler’s motivation to respond. Shared control also assists in obtaining the toddler’s attention. The concept of shared control generally has to do with both the adult and child playing important roles in the learning interaction. Shared control also helps to set up, or establish, a situation where natural reinforcers can be provided contingent on attempts at target behaviors (see Natural Reinforcers). Sometimes this is called briefly “restricting access” to a child chosen item or activity.

Ways of creating shared control in order to increase a toddler’s attending and establish a toddler’s motivation to interact and try during the learning opportunity:

Step 2.4 Get the toddler's attention

Parents and practitioners should establish the toddler’s attention before providing cues, prompts, questions, instructions, and/or choices (see Prompting Strategies). Strategies for gaining attention include: saying the toddler’s name, tapping on their shoulder, making an enthusiastic sound or phrase, giving a quick tickle, making eye contact, and/or arranging the environment to support shared control (see Shared Control). Strategies for gaining a toddler’s attention should also be varied over time.

Individualization: Orienting cues and nonverbal toddlers

Some toddlers who are nonverbal may have difficulty orienting and attending to the relevant cues in the learning interaction, such as, a verbal model of a word. In this case, effective and individualized strategies for gaining child attention/orienting should be tried (Koegel, Shirotova, & Koegel, 2009).

Using individualized orienting cues just prior to providing the verbal model prompt could improve the beginning learner’s response to the verbal model prompt, that is, imitation of the verbal model.

Step 2.5 Use clear, natural, and varied prompts

Once the toddler is attending, parents and practitioners use brief and clear instructions. These instructional antecedents should mirror naturally occurring cues and prompts as much as possible.

Model Prompts

The full model is used to prompt the child to respond with an imitation of the model. In order to increase rapid independence, partial prompts can be used to fade full models.

Choices

Providing choices is another motivational procedure (see Step 2.2 for more on choices) and is an important prompting strategy. Choices contain two models for the toddler to choose between and can prompt the toddler to imitate one of them (and not the other) and/or engage in one of the response choices (and not the other). Careful and systematic teaching of choices is also useful for reducing immediate echolalia and indiscriminate choice making (e.g., the toddler simply repeats the last part of the choice). See Koegel and Lazebnik (2004, pp. 56 - 59) for simple solutions for reducing immediate echolalia and increasing accurate choice making in verbal children with autism.

Open-ended questions or statements

Open-ended questions, such as Wh- questions can be immediately faded into prompting strategies as the toddler acquires various words or communicative acts. If a toddler already asks to go outside by approximating the word “outside,” a model prompt is not necessary. A choice, question, or time delay will help a toddler become more spontaneous with their communication. Example questions could be, “What do you want?” or “Where should we go?” or “What would you like to do?”

Be careful providing too many close-ended questions that result in yes or no answers, unless this is a specific objective. These yes or no questions limit the toddler’s chances of practicing more meaningful and varied verbal skills. You can also make open-ended statements that would prompt a different but similar statement or a question from the child. For instance, upon taking the letter puzzle piece “A” from a container, you say, “I got A!,” which provides a verbal cue for the toddler to say, “I got [ the letter the toddler picked ]!” when they take a letter on their turn. Similarly, you can take a letter and hide it in their hands, and say, “I got a letter!” as an opportunity for the child to ask, “What letter?”

Time delays

Time delay prompts involve minimal immediate actions on the part of the parent or practitioner. Time delays involve waiting for a brief period (e.g., 3-5 seconds) prior to providing more assistance. For instance, if the toddler wants his father to roll the ball back to her, and the father has been providing the model “ball” to prompt the request, the father might instead pause and wait expectantly for a few seconds. If his toddler says “ball” independently during that pause, the father should roll the ball back as he recasts, “roll ball!” If his toddler does not respond, then the father can provide more assistance by: modeling the word, asking if he should “roll ball or roll car,” (while showing each option) or simply asking her what he should roll, “What should I roll?”

 

information on Progressing and individualization

Balancing prompts. Prompts that provide more assistance are tools for successfully teaching new responses. Prompts should be faded into prompts that provide less assistance in order to increase a toddler’s spontaneity, initiations, and independence. Prompting should be fairly balanced in terms of providing assistance to teach new responses while maintaining opportunities for the toddler to be spontaneous and use mastered responses independently.

Carrier phrases. Toddlers, who are first learning to talk, may also benefit from “carrier phrases.” Common carrier phrases include, “ready, set… go!” or “one, two… three!” where after the third listed word a natural reinforcer follows. Once the toddler becomes familiar with the carrier phrase routine, a time delay can be inserted after the second word in the phrase in order to evoke a communicative attempt by the toddler (e.g., “go!”). This strategy is an example of a high probability behavioral momentum sequence.
Capitalizing on existing sounds a toddler makes. Some nonverbal toddlers, who are having difficulty with word attempts, may benefit from a strategy that pairs their existing nonfunctional sounds or utterances with a natural reinforcer. For instance, a practitioner provides a preferred movie each time the toddler makes a stereotypic “mm” sound. Each time, the parent models and recasts the word “movie” clearly. This has the potential for transforming nonfunctional speech into functional speech where the toddler learns to request “movie” by saying, “mmm.”

Building complexity. Parents and practitioner provide increasingly lengthy and varied instructions, questions, models, and choices to toddlers with more advanced language skills, or who are in the process of developing more complexity. An appropriate level of clarity, however, should be maintained based on the toddler’s language level.

For more information on effective prompting strategies, see the NPDC website and the ASD Toddler Prompting Learning Module.

Step 2.6 Immediately reinforce the toddler's attempts

a) Reinforce the toddler's attempts at responding that are clear, unambiguous, and goal-directed.

Reinforcement of response attempts is a consequence PRT component brecause it happens after the toddler provides a response. Reinforce the toddler's attempts that are purposeful approximations of the targeted response. By reinforcing attempts, in addition to correct responses, you increase the likelihood that children will engage in future attempts as they experience more success and positive reinforcement for appropriate trying. Learning to talk, play, and socialize can be hard work, and reinforcing attempts may keep toddlers willing to engage in the “hard work.”

 

b) Provide direct reinforcement immediately after a goal-directed attempt

Provide direct reinforcement immediately after and contingent on a goal-directed attempt. Pay careful attention to providing reinforcement only after a correct response or attempt by the toddler.

Step 2.7 Use direct or natural reinforcers and then transition to the next opportunity

A natural reinforcer is defined as a reinforcer that has a direct relationship to the child’s behavior and the task. The reinforcer, a consequence, is logically related to a chain of antecedents and responses.

 

a) Identify materials and activities that can be used to address a toddler’s

objective during a teaching opportunity

This is done in conjunction with following the toddler’s lead, providing choices, and establishing motivation through shared control. The delivery of the natural reinforcer is directly tied to these PRT components.

For example, a parent or practitioner presents a child with a clear jar with a lid that contains raisins. The toddler will most likely try to open the jar and then look to the practitioner for help. After the toddler attempts to use a target phrase either independently or through clear prompting, such as “help!” or “open raisins", the practitioner immediately provides access to the natural reinforcer inside the jar.

In contrast to PRT opportunities that employ natural reinforcers, the parent could have prompted the toddler to say “open” in reference to an empty jar, then provide a raisin sitting on a plate on the table.

b) Parents and practitioners implement a learning activity that is functionally

and directly related to the toddler’s objectives

If a toddler’s target behavior is to ask for a break instead of escaping demands by screaming, when the toddler initiates a request for a break by saying, “break” or pointing to a “break card,” the practitioner immediately responds by allowing the toddler to have a minute of neutral free time while staying in the same area. However, if the teacher instructed the toddler to complete another task before reinforcing her initiated response, “break,” then this would not be an example of a directly related, functional reinforcer.

Note: Although not a natural reinforcer, this would be an appropriate strategy for thinning reinforcement in order to increase desired task engagement over time.

c) Embed social interaction into natural reinforcers

Follow the infant and toddler’s lead in order to identify reinforcing social activities that can be increasingly incorporated into routines for infants and toddlers. Research has also identified that embedding preferred social activity into the delivery of the reinforcer is effective in improving synchronous toddler and parent engagement, eye contact, and improved toddler and parent affect (Vernon et al., 2012).

Potential Ways to Embed Motivating Social Activity into Delivery of Natural Reinforcers
Activity & child response (prompted or spontaneous)	Natural reinforcers without social activity	Natural reinforcers with embedded social activity
Jumping on trampoline Toddler requests, “jump”	Toddler gets to jump on trampoline	Adult jumps with the toddler
Splashing in the bath Toddler requests, “splash”	Toddler gets to splash water	Adult splashes the toddler, toddler splashes the adult
Playing cars Toddler says, “crash cars”	Toddler is given two cars to crash into each other	Adult crashes a toy car into the toddler’s toy car
Sliding on slide Toddler says, “slide”	Toddler gets to go down the slide	Adult and the toddler go down the slide together
Music Toddler requests a song	Toddler listens to the song on the computer	Adult sings the songs to the toddler
Playing with dinosaurs Toddler communicates “dino”	Toddler is given a toy dinosaur	Adult “roars” the dinosaur and makes it “stomp” or “fly” over to the toddler

 

d) Reinforce joint attention and social comments with individualized social

reinforcers

Joint attention is a triadic social experience between a child, item or event, and an adult. Infants as young as 8-months old engage in joint attention in order to share with parents their affect (interest, happiness, enthusiasm) associated with an event or item. The natural reinforcers for joint attention acts should be distinct from the natural reinforcers associated with requesting items and events, as well as other behavior regulation functions (Jones, Carr, & Feeley, 2006). Provide the enjoyable social reinforcers right after joint attention, such as pointing at a picture or saying a comment.

These reinforcers are:

(1) individually identified (and often unique) for each toddler and

(2) they are social.

They are social because the rewarding aspect of the activity centers around interaction with the adult.

Review examples below of potential ways to use social reinforcers when directly targeting joint attention in infants and toddlers. In the examples, the toddler’s social reinforcers include tickles, exaggerated noises or voices, and jumping with an adult.

Using Social Reinforcers as Natural Reinforcers for Targeting Socially Motivated Joint Attention Behaviors
Activity & child response (prompted or spontaneous)	Example non-social reinforcers for: joint attention used for requesting objects	Example of Idiosyncratic natural social reinforcers for: joint attention used for socially sharing affect
Walking at the zoo Toddler points at a monkey and looks back at mom	TToddler allowed to go look at the monkey	Mom says, “Yes, a monkey!” gives the toddler “monkey tickles;” mom and child make monkey noises together
Reading a book Toddler brings the train book over to mom, gives eye contact, and says, “trains!”	Mom gives the train book and/or reads the book to the toddler	Mom exclaims, “Choo! Choo!” and pretends to be a train while making train sounds
Playing Pop Up Pirate™ Toddler points at the pirate, looks at mom, and comments, “it popped!”	Mom gives the toddler more pirate swords to continue playing the game	Mom says, “The pirate popped!” and has the toddler on her lap, and bounces him as if to make him “pop up”
Doing a letter puzzle Toddler finds the letter “V,” picks it up, holds it out to show Dad, and smiles at him.	Mom gives the puzzle board to the toddler so they may put in the letter “V”	Dad tickles the child while making a “Vvv” sound and says, “You found V!”
Playing Cariboo™ Toddler opens a door with the key, points down, looks up at the practitioner, smiles, and exclaims, “pink ball!”	Toddler may take out the pink ball and continue with the chosen game	The practitioner juggles the ball while making silly noises, and says, “the pink ball!”

 

Step 2.8 Target pivotal area of initiations

Using Child-Initiated Strategies: Teaching Question Asking

Toddlers with ASD can successfully be motivated and taught to ask a variety of Wh- questions (Koegel, Bradshaw, Ashbaugh, & Koegel, 2013). Question asking is particularly relevant to initiations because it shifts the initiation of the learning interaction from the adult to the child. Often times, adults ask all the questions and start most of the learning interactions. By asking questions independently, toddlers initiate interactions that facilitate information gathering and further learning. Teaching question asking also expands the purposes for which children might use communication.

The questions described in this section are in developmental sequence.

a) asking: "What's that?"

“What’s that?” is one the earliest developing questions and can be targeted for verbal children, with limited vocabulary, between the ages of 12 and 24 months.

1. Place highly preferred items in an opaque bag (child choice and shared control).

2. Prompt the toddler to ask, “What’s that?” or simply, “That/Dat?” for very young toddlers. Pointing at the object, in conjunction with asking the question, should be modeled as the toddler learns to ask the question. Parents and practitioners should also model proper question asking intonation and additional gestures (e.g., shrugging shoulders) during these opportunities.

3. Show the toddler what is inside the bag, provide the answer (i.e., a verbal model of the item’s label), and then give them immediate access to the item (natural reinforcer). In other words, initially the toddler does not have to make an additional request for the item. As the toddler learns to ask the question, practitioners may prompt the toddler to repeat the label prior to obtaining it. This additional step facilitates vocabulary development and teaches the difference between asking questions to obtain information and requesting to obtain an item. Obtaining information becomes a secondary reinforcer and a better approximation of the immediate natural reinforcer for asking questions.

4. Gradually fade prompts as toddlers begin to spontaneously ask the question, “What’s that?” or “That/Dat?”

5. Gradually replace preferred items in the bag with neutral and unfamiliar items (e.g., a blank notebook, one wooden block, a fork).

6. Gradually fade the use of the opaque bag when toddlers consistently and spontaneously ask the question, “What’s that?” or “That/Dat?” All prompts are also faded. Remember, it is important that the toddler ask the questions independently.

7. An index finger point toward the bag and items could also be modeled and prompted as the toddler progresses so that the toddler points in conjunction with asking the question.

8. Encourage generalization by placing items in other opaque objects or locations (e.g., boxes, in hands, behind back).

b) Asking: “Where’s _____?”

1. During a preferred activity with multiple pieces, collect the pieces and hide them nearby without the toddler seeing. If the item is desired or needed during the activity, this will establish the toddler’s motivation to ask a “Where?” question (shared control and following the toddler’s lead). This can also be done by gathering a variety of highly preferred objects and playing a “hide and seek” game in a similar fashion.

2. Once the toddler’s motivation to find the item has been established, prompt the toddler to ask “Where?” or “Where’s [item]?” (depending on the toddler’s language level).

3. Immediately tell the toddler where it is by emphasizing the preposition (e.g., “under the bridge”). If nearby, initially point or gesture to where the item is hidden (as the parent answers verbally). Or if the item is a bit further away, immediately run the toddler over to where it is and let them take the item (natural reinforcer).

4. As the toddler learns these prepositions, fade prompts and simply tell the toddler where the item is so that they may go obtain it. It is important that parents and practitioners not just go get the item and hand it to the toddler. This is because ultimately toddlers should distinguish basic requests from requests for information. Obtaining location/positional information (of desired items) is the goal and best approximation of the natural reinforcer for asking where questions.

5. As the toddler progresses, prompt him/her to repeat the answer, or ask him/her the where question as a follow-up question, so that the toddler may acquire the prepositional phrases. In this way, the toddler is simultaneously efficiently learning to ask where questions, to answer where questions, and to understand and use prepositions.

6. As the toddler progresses, fade all prompts and focus on using time delays or indirect prompts. For instance, parents and practitioners may wait three seconds before prompting the toddler to ask the question, or say that “[name] knows where it is,” or say “it’s not in here…,” as additional ways to indirectly prompt the toddler to ask the question.

7. When the toddler begins to spontaneously initiate “Where?”, try to immediately reinforce the toddler with the information and access to the item as continuously as possible. The reinforcement schedule is thinned as the children initiate more consistently.

8. Facilitate generalization by prompting and reinforcing “Where?” questions in multiple settings, with multiple types of stimuli, and with multiple people throughout the daily routine.

C) asking: "Whose _____?"

1. Gather a variety of the toddler’s favorite items (child choice).

2. Before the toddler can take an item, prompt the toddler to ask, “Whose?” or “Whose is it?” (depending on language level).

3. Immediately answer, “Yours!” and allow the toddler to take the item (natural reinforcer).

4. As the toddler spontaneously asks, “Whose?”, target pronoun reversals by prompting the toddler to say, “Mine!” after telling her/him “Yours!” This reinforces the toddler for making the correct pronoun reversal.

5. Begin to intersperse neutral items and answer the toddler’s initiated “Whose?” question with the answer “Mine!” Because these items are neutral, the toddler will not mind if the adult takes it. Prompt the child to respond back with the pronoun reversal “Yours!” prior to bringing back out the more preferred items (natural reinforcer, turn taking).

6. Target possessive endings, such as Mom’s, Suzy’s, or Grandpa’s, in the same manner and by using items that can be associated with each person.

7. Fade prompting, use time delays, and target throughout the toddler’s day.

D) asking: "What's happening?" and "What happened?"

There are several ways to teach older toddlers and preschoolers how to ask more advanced questions.

One example is to use pop-up books as a cue for asking questions:

1. Select pop-up books that are related to the toddler’s interests (child choice).
2. Prompt older toddlers and preschoolers to either ask, “What’s happening?” or “What happened?” after they pull the tab for the pop-up pictures.
3. Once toddler ask the question, model the correct verb ending (“dog’s jumping” or “dog jumped”) and give toddlers a turn to pull the tab (natural reinforcer).
4. As toddlers progress, repeat the verb phrases, or answer these questions as a follow-up question, in order to facilitate development of these morphemes or language skills.
5. Fade prompting and use time delays.

This procedure can also be done using iPad games, computer games, and watching favorite TV shows and movies. Teaching these questions can also occur throughout the toddler’s routine whenever actions can be repeated and controlled by the parent and practitioner. Preferred physical activities (e.g., trampoline) represent another time when these questions can be targeted. Here is a similar example conducted with a favorite video:

1. Follow the toddler’s lead and select videos that are related to the older toddler’s interests.
2. Pause the video (creating shared control) and then prompt children to either ask, “What’s happening?” or “What happened?” during or after a clear action has occurred in the video while the toddler is attending.
3. Once the toddler asks the question, model the correct verb ending (“dog’s jumping” or “dog jumped”) and then press play and/or re-watch the action in the video (natural reinforcer).
4. As toddlers progress, repeat the verb phrases, or answer these questions as follow-up questions, in order to facilitate development of these morphemes or language skills.
5. Fade prompting and use time delays.

E) attention and social commenting: "Look!"

Set up motivating situations where the toddler may try to obtain adult attention non-verbally. There are at least two types of situations where a toddler may want your attention. Either of these situations can be used in order to establish a toddler's motivation to initiate, “Look!” In either case, begin the learning opportunity by clearly turning away their attention briefly.

1. The toddler may try to gain attention in order to obtain or request something. For instance, as a dad checks his email, a toddler may engage in nonverbal behaviors in order to recruit his father’s attention in order to ask him for juice from the refrigerator. A toddler might want adult attention to socially share something with an adult, as is often the case for joint attention behaviors. If a toddler has just drawn something on a sheet a paper, he/she may want to share that drawing with his father and say, “Look at what I made!”

2. Once the toddler indicates he or she wants attention, prompt the toddler to say, “Look!”

3. Immediately and enthusiastically give the toddler attention. Follow by either: assisting the child with his/her request or providing attention and praise for the item or event being socially shared by the child (natural reinforcers). For toddlers initially developing interest in social comments, adding individualized social reinforcers (e.g., tickles, silly noises) to the natural reinforcement may also be helpful. For instance, if a parent prompts her toddler to comment on a train, “Look, train,” the parent can provide attention toward the train and make a “choo choo!” sound (if the child enjoys the sound), followed by playing together with a preferred train.

4. Fade prompting, use time delays, and prompt and reinforce “look!” initiations throughout the toddler’s daily routines as soon as appropriate.

5. Increase the complexity of the utterance and add point to toddler’s initiations: “Look, daddy!” or “Look, a train!” (while pointing to the train on TV) or “Look mommy, juice!” (while pointing at the refrigerator).

F) assistance seeking: "HELP!"

Set up motivating situations where their toddler may try to obtain assistance nonverbally or may need help even though they may not seek assistance. For instance, if a toddler enjoys ring stackers, but needs assistance to put them on, a practitioner follows the toddler’s lead to the ring stacker and waits until s/he needs help.

1. Once the toddler indicates s/he needs the adult’s help, the parent or practitioner prompts the toddler to say, “Help!”

2. Once the toddler says “Help!” the parent of practitioner immediately and enthusiastically helps the toddler. For example, they put the ring on the stack together (natural reinforcer).

3. As soon as appropriate, parents and practitioner fade full assistance into showing the toddler how to do it for him/herself.

4. As soon as appropriate, parents and practitioners fade prompting, use time delays, and prompt and reinforce throughout the toddler’s daily routines.

5. Increase complexity of the utterance and add pointing to the toddler’s initiations: “Help me, Greg!” or “Help with shape!” while pointing at the shapes, or “Need help!” while pointing at the refrigerator.

Step 2.9 Target the toddler's responses to multiple cues

Increase the toddler's responses to multiple cues

Using PRT motivational opportunities, teach and motivate older toddlers and preschoolers with ASD to respond to multiple cues. Cues, also called properties or attributes, are taught incrementally until toddlers respond to more complex tasks. Teaching multiple cues may not be appropriate for younger toddlers and are associated with advancing language and conceptual skills.

Identify multiple cues and gather materials with multiple cues. Parents and practitioners identify a variety of cues (properties or attributes) that are associated with the stimulus (e.g., toy) or activity and that can be used during a PRT learning opportunity.

Add another cue. As the older toddler advances, parents and practitioners provide at least two cues (e.g., overemphasizing feature of object, color, size, type of object, location of object) so that their toddler will begin to use the target skill in response to more than one cue.

Increase complexity. Parents and practitioners gradually increase the number of cues associated with a particular object, material, or toy so that the learner can respond to a variety of stimuli

Schedule reinforcement

Parents and practitioners also use different schedules of reinforcement to teach an older toddler with ASD to respond to multiple cues.

Identify natural reinforcers. Numerous natural reinforcers that can be used to increase a toddler’s motivation to use the target skill of responding to multiple cues. For example, a practitioner might notice that the toddler enjoys playing games on the iPad, including a balloon popping game.

Begin with fixed ratio, continuous schedule (i.e., FR1). Provide reinforcement for every attempt to use the target skill successfully (continuous schedule). As an example, a toddler is allowed to “pop a balloon” (natural reinforcer) on an iPad screen every time she answers what color or shape the balloon is.

Progress to variable ratio, intermittent schedule (e.g., VR2). It is important to progress to intermittent reinforcement schedules throughout an older toddler’s PRT programming. In a continuous schedule of reinforcement, you would allow the toddler to pop the balloons on the iPad game every time she responds to a question about the color or shape of the balloons she wants to pop. With a variable ratio schedule of reinforcement, VR2, the toddler responds with good attempts for an average of 2 questions prior to popping the balloons in the game.

Step 2.10 Target self-regulation

Use PRT motivational opportunities to teach and motivate children with ASD to engage in appropriate behaviors that foster early developing self-regulation skills. Implement self-management differently for older children. Refer to the National Professional Development Center on ASD for more information on Self-Management.

Below are strategies that are integral aspects of early PRT programs and designed to teach the toddler to regulate his/her behavior through appropriate communication rather than challenging behaviors.

Teaching “all done” and “break” to terminate activity and transition

1. Parents and practitioners teach the toddler to terminate an activity and transition by prompting them to communicate, “all done” prior to leaving an activity or areas. This can replace challenging behavior related to frustration and boredom that results in the toddler escaping the task. Or it may replace a toddler’s fleeting engagement as they bounce around from one activity to another.

2. When the toddler communicates “all done,” naturally reinforce the toddler by allowing them to leave the area/activity.

3. As the toddler learns to communicate “all done,” parents and practitioners add a clean up component that is brief at first and then gradually more involved. Clean-up occurs prior to allowing the toddler to leave the child-chosen activity.

4. When toddlers are happy to clean up, parents and practitioners target various skills during clean up and it may be the case that the toddler re-engages in the activity during clean up. Often this leads to increasing a toddler’s duration engaged in the same child-chosen activity.

5. As the toddler progresses, toddlers learn to terminate the activity by initiating “all done,” cleaning up, and then initiating play with a new activity with an adult (e.g., “come play…!”), prior to engaging in the new child-chosen activity.

6. Asking for a “break” is taught in a similar fashion, however breaks are limited to a brief termination in the activity followed by re-engagement in the same activity.

Teaching "help" to request assistance

Teaching children to request help can decrease challenging behaviors associated with frustration, avoidance of tasks, and escaping tasks. It is important to be careful of reinforcing challenging behavior by helping a toddler after they just engaged in a tantrum or similar challenging behavior. Prior to providing assistance, parents and practitioners prompt the toddler to communicate, “help,” using an appropriate mode of communication. This teaches the toddler to regulate his/her behavior through appropriate communication.

Replace challenging behavior with Functional Commuication Training (FCT)

PRT can be used to teach appropriate, functionally equivalent (but more efficient) communicative replacement behaviors. During PRT interactions, proactively replace challenging behavior by prompting and differentially reinforcing appropriate communication while placing challenging behavior on extinction (i.e., withdrawing the maintaining consequences when challenging behavior is exhibited.

PRT components also serve as antecedent (preventative) procedures by maintaining a toddler’s motivation and making challenging behaviors less relevant or necessary to the toddler.

Replace challenging behaviors that serve the following functions:

1. obtain items or activities
2. obtain attention
3. avoid or escape task demands and attention

This strategy relies on the adult correctly identifying the function of the challenging behavior, and so the parent or practitioner may need to take data through a functional behavior assessment (FBA). However, clear functions can be actively replaced in the moment across multiple situations. Teaching the toddler to communicate to get his/her needs met is an important early developing self-regulation skill that can be fostered in toddlers. Differentially reinforcing functional communication at a young age could play an important role in the prevention of more serious challenging behavior from developing later in childhood. Combining FCT with the motivational components of PRT is an effective way to decrease interfering challenging behavior and keep children happy and learning during intervention and interaction.

Improve tolerance for delays to reinforcement. For functional communicative acts, it is also important to teacher older toddlers and more advanced learners to tolerate delays to reinforcement. The amount of time before receiving reinforcement for maintenance requests by the toddler can be gradually increased and the reinforcer can be provided contingent on appropriate waiting during the delay (e.g., absence of challenging behavior). Parents and practitioners introduce reinforcement schedule thinning by intermittently reinforcing maintenance behaviors.

Note: There are many positive behavior supports that should be integrated into a toddler’s intervention as needed. Other important techniques for addressing challenging behaviors in toddlers might include systematic desensitization, various antecedent manipulations, differential reinforcement of other behavior, additional applications of differential reinforcement of alternative behavior, and instructions based on the Premack principle.

Using Visual Activity Schedules and Systems

Teaching toddlers to use a visual schedule or activity system is another way to foster early developing self-regulation skills.

Practice Scenarios: Implementing PRT

Knowledge Check

 

Question:

Which of these represents a motivational opportunity for a nonverbal 17-month old toddler?

check your answer

The correct answer is c.
Dad notices his two-year old nonverbal son keeps going inside the laundry basket and is avoiding playing cars with him. Dad goes over to the basket and picks it up and puts it down with his son inside. His son smiles and nonverbally indicates he wants more. Before picking it up, Dad gets his son’s attention and models “up,” and picks it up and puts it back down a couple of times in a row. The child still indicates he wants to go up again, but this time dad models, “up” and waits for the child to attempt to vocalize “up” before he lifts him up. After 3 seconds, the child finally says, “aah,” and dad immediately and enthusiastically lifts up the laundry basket while clearly and enthusiastically recasting, “Up!”

PIVOTAL AREA: SELF-INITIATIONS

Question:

What are some potential collateral effects of self-initiations?

check your answer

Potential choices:

• increased socialization
• expanded communicative functions and linguistic skills
• improved long-term outcomes
• decreased disruptive behavior

Question:

Which intervention uses an appropriate natural reinforcer for teaching question-asking?

check your answer

The correct answer for the intervention that uses an approprate natural reinforcer for teaching question-asking is 3.

When the toddler asks where an item is, you tell the toddler the location of the item and assist/prompt to make sure they can obtain the item from the location quickly.

PIVOTAL AREA: RESPONDING TO MULTIPLE CUES

Question:

An older toddler enjoys playing with wooden puzzles. Which of these examples of learning materials provide an ideal situation for teaching multiple cues?

check your answer

The correct answer for an example of learning materials that provide an ideal situation for teaching multiple cues is 3.

A puzzle with one blue square, one red square, one blue circle, and one red circle .

Is this statement True or False?

Teaching multiple cues is a beginning level PRT intervention target for nonverbal toddlers with autism.

check your answer

The statement is FALSE.

Teaching multiple cues may not be appropriate for younger toddlers and are associated with advancing language and conceptual skills. Review Step 2.9 for more information.