Pivotal Response Treatment

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.

EXAMPLE

When a toddler indicates he wants to turn the water on at the sink, a parent or practitioner can teach the toddler to request to turn it on (when the toddler has not yet acquired the word “water”) by prompting the toddler simply with the verbal model, “water.” There is no need to prompt with, “Say water.” Likewise, saying a long phrase, such as, “Okay, Logan, just say water!” is not an appropriate instructional antecedent for teaching first words with PRT.

The most commonly used PRT prompting strategies, or instructional antecedents, from most assistance to least assistance, and from least independent to most independent, are:

model prompts
chioces
open-ended questions or statements and
time delays.

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.

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