Pivotal Response Treatment (PRT) is a naturalistic intervention based on the principles and practices of applied behavior analysis (ABA) and developmental approaches. PRT shares many instructional practices found in other well-researched, naturalistic behavior interventions, such as incidental teaching, enhanced milieu teaching, and naturalistic aspects of applied verbal behavior therapy (Allen & Cowan, 2008).
PRT focuses on improving children’s motivation during learning and socialization (Koegel et al., 2006).
PRT improves core behaviors, such as social communication, and is ideal for use with toddlers with ASD.
PRT is also a child and family-centered intervention and capitalizes on child interests and initiations in everyday environments and within daily routines. It is particularly helpful for improving communication, language, play, and social behaviors.
Motivation may be the central pivotal area. Creating motivational PRT opportunities provides the foundation for implementing the other pivotal areas, as well as improving specific meaningful goals and objectives.
Select a pivotal learning area to read more:
Motivation
Motivation as Pivotal
Improving motivation is a central principle of PRT and is the foundational procedure for the other pivotal areas (Koegel & Koegel, 2012). PRT learning opportunities are specifically designed to increase child motivation to learn and interact. In PRT, motivation can be defined as a high degree of child responding and initiating within social and learning environments, in the presence of positive child affect (i.e., happiness, interest/enthusiasm, and pro-social behavior; see Table 1 for a Likert scale). PRT may increase a toddler’s desire to perform (and try to perform) skills and behaviors by using specific antecedents (events that happen before a behavior) and consequences (events that happen after a behavior) within PRT learning interactions. For instance, PRT builds on a toddler’s interests and choices, reinforces attempts through immediate and contingent contact with natural reinforcers, and avoids “drilling” by varying tasks and interspersing maintenance and acquisition tasks.
Review Antecedent and Consequence components
Initiations
Initiations as Pivotal
Teaching toddlers to initiate learning is pivotal in that it “opens the door” to additional learning and social interaction. Teaching toddlers to self-initiate is in contrast to learning opportunities that are most often adult-initiated (e.g., the child’s response only occurs when specific discriminative stimuli – specific learned cues or instructions – are presented by an adult). Initiations have been taught in the forms and functions of: question asking (e.g., What’s that?), obtaining attention and socially commenting (e.g.,“Look!”), and asking for assistance (e.g., “Help!”). Carefully fading prompts and using time delays across teaching targets and opportunities, by waiting a few seconds for the child to initiate without prompts, enhances child-initiated behaviors.
Responding to multiple cues
Responding to Multiple Cues as Pivotal *
Children with ASD are often good at focusing on a specific detail or aspect of a stimulus, but they may not simultaneously attend to multiple cues present in the environment. This is sometimes called, over-selectivity. Further, children may attend to less relevant cues. Focusing on teaching toddlers to respond to relevant and multiple cues is suspected to produce widespread effects in the child’s ability to learn from his/her complex environment (Koegel & Koegel, 1995).
* Targeting multiple cues may only be developmentally appropriate for older toddlers and beyond.
self-regulation
Self-Regulation as Pivotal *
Self-regulation as Pivotal. Self-management* for toddlers with autism looks different than self-management for older children, adolescents, and adults. For older children, self-management is sometimes defined as teaching children to self-monitor, self-evaluate and discriminate their own behaviors, and finally self-reinforce. Self-management strategies may lead to improved generalization of skills, as well as improved self-regulation, such as increased independence (i.e., less dependent on prompts by adults) and decreased challenging behavior.
* Targeting self-regulation/self-management through typical self-management teaching procedures may not be developmentally appropriate for toddlers. Improving self-regulation of behaviors for toddlers, however, is important and certain steps can be provided to young children in order to establish a foundation for self-regulation and self-management later in development. Teaching language and communication are early developing foundations of self-management, in that language can be used as a mediator to teach and use self-management when the child is older. Further, appropriate communication can functionally replace difficult behavior.
