Pivotal Response Treatments

Pivotal Response TreatmentBy: James Rinka & Liza Sandy

DefinitionPivotal Response Treatment (PRT) is a comprehensive service delivery model that uses both a development approach and applied behavior analysis procedures. PRT aims to provide opportunities for learning within the context of the childs natural environments.

Koegel, L. K. and Koegel, R. L. (2006) Pivotal Response Treatments Autism: Communication, Social and Academic Development. 1st edn. United States: Brookes, Paul H. Publishing Company

OverviewPRT targets four pivotal areas of students developmentMotivationResponse to multiple cuesSelf-managementInitiation to social interactionFocusing on these areas will produce improvement across other areas of sociability, communication, behavior and academic skill building.

https://www.autismspeaks.org/what-autism/treatment/pivotal-response-therapy-prt

Goal of PRTThe primary goal of PRT is to move individuals with autism toward a typical developmental trajectory by targeting a broad number of behaviors and providing children with autism the opportunity to lead meaningful lives in natural, inclusive setting.

Koegel, L. K. and Koegel, R. L. (2006) Pivotal Response Treatments Autism: Communication, Social and Academic Development. 1st edn. United States: Brookes, Paul H. Publishing Company

PRT sessionTypically last 25 or more hours per week.Encourage parents to use PRT at home.Session typically has 6 segments where language, play and social skills are involved.As learner progresses the focus of each session changes to accommodate more advance needs and goals.

MotivationEstablishing Students AttentionUsing Shared ControlUsing Learners ChoiceVarying Tasks and ResponseInterspersing Acquisition and Maintenance TaskReinforcing Response attemptsUsing Natural and Direct Response

Response to Multiple Cues Varying Stimuli and Increasing CuesProperties or attributesScheduling the ReinforcementGive rewards for good behavior.

Self Management Why it is ImportantOnce behaviors start to get under control, it is important to gradually turn over the monitoring of the behaviors to the learner

Self-Management How ToDefine the Behavior know the function of the behavior for the learnerPreparing the Self-Management SystemLook at replacement behaviors and find one that will work for the studentWhen to use the behaviorHow the behavior will be measuredIdentify rewardsDevelop overall goal and share with learnerProvide opportunities for successTeaching Self-ManagementTeach the difference between desirable and undesirable behaviorsTeach learners to record success across intervalsProvide reward for successCreating IndependenceGradually increase the time that learners self-manage by increasing time between intervalsGradually fade intensity and frequency of promptsGeneralize to Other Settings teaching in a variety of settings and with other people

Initiation to Social Interaction Why it is ImportantFound to have made a great difference in overall functioningStudy looking at 2 groups of adults:Both started at the same level verbal before 5, IQ above 50 and received same intervention (early PRT) as children1 group was successful in college or has a job1 group was not successful institutionalized or just staying homeLooking back at video-taped sessions, the successful group initiated conversations asked questions

Initiation to Social Interaction - StepsBasic Question-Asking:Dat? Whats That?Whats happening? and Whats happened?Communication and Social SkillsImitate learners actionsProvide item to learner only when requestedWait for response before providing a promptSocial InitiationsCan I play with you?Sharing objects Taking turns choosing activities

Initiation to Social Interaction How to Most basic = question askingYoung children, have started using words for either a request or protest Place favorite objects in an opaque bagBegin by prompting them to say Whats that? and then give them an object from the bagEventually, they will ask on their ownKeep this as a maintenance task and work on Whats happening? as an acquisition task.

Initiation How ToOlder children, focus is more on give and takePractice prompts with them such as:I say I had a great weekendThey say What did you do?I say Im so full from lunchThey say What did you eat?Practice initiating interactionCan I play with you?Can I sit here?

Example with Lynn KoegelIn the following videos, we see one of the founders of PRT, Lynn Koegel, on the show SuperNanny. Tristin is a three year old with AutismThe videos demonstrate:Using a childs interests to increase motivationInvolving the parentsUsing a naturalistic settingUsing imitation to improve social skills

Lynn Koegel on SuperNanny: Communication

Lynn Koegel on SuperNanny: Setting the Table

Example of Actual PRT Session Saying open and block

Questions to Ask? (Teacher)Are the target behaviors Im trying to teach going to lead to positive changes in other behaviors?Am I interspersing easy and difficult tasks?Is my curriculum motivating for my students so that the likelihood of disruptive behavior is low?Am I encouraging curiosity?Is my student using questions with peers?Is everyone on the team using a consistent teaching approach?Am I gathering data that relate directly to the childs goals?

Questions to Ask? (Parent)Am I giving my child choices?Am I reinforcing trying?Is my child getting what he or she wants through exhibiting disruptive behavior?Is my child using a variety of questions?Do I know all my childs goals?Has my child been accurately assessed?

Additional ResourcesAutism Speaks also check out their Video Glossary for more example videosAIM on PRT this is under Autism at Home. It also has videos and case studiesKoegels Field Testing ManualThe PRT SiteVideo with more advanced session child is making sentences and asking questionsVideo about teaching infants using PRT

Sources Koegel, L. K. and Koegel, R. L. (2006) Pivotal Response Treatments Autism: Communication, Social and Academic Development. 1st edn. United States: Brookes, Paul H. Publishing Company

Koegel, L. K. and Koegel, R. L. (2012) The PRT Pocket Guide, United States: Brookes, Paul H. Publishing Company

Koegel, L.K. (2013), Dr. Lynn Koegel Pivotal Response Treatment for Children with Autism presentation, https://www.youtube.com/watch?v=5n9vlBtbji8

Vismara, L.A., & Bogin, J. (2009). Steps for implementation: Pivotal response training. Sacramento, CA: The National Professional Development Center on Autism Spectrum Disorders, The M.I.N.D. Institute, The University of California at Davis School of Medicine.