Pivotal Response Treatment
Pivotal Response Treatment (PRT) is one of the best studied and validated behavioral treatments for autism. A High quality form of applied behavioral analysis (ABA), it is play based and child initiated. Typically involving 25 or more hours per week for the learner, as well as instruction for the parents and other caregivers, its goals include the development of communication, language, positive social behaviors, and relief from disruptive self-stimulatory behaviors.
Rather than target individual behaviors, the PRT therapist targets "pivotal" areas of a child's development. These include motivation, response to multiple cues, self-management and the initiation of social interactions. The philosophy is that, by targeting these critical areas, PRT will produce broad improvements across other areas of sociability, communication, behavior and academic skill building.
Motivation strategies are an important part of the PRT approach. These emphasize "natural" reinforcement. For example, if a child makes a meaningful attempt to request, say, a stuffed animal, the reward is the stuffed animal – not a candy or other unrelated reward.
Though used primarily with preschool and elementary school learners, studies show that PRT can also help adolescents and young adults. Indeed, autism-affected persons of all ages may benefit from its techniques. In all age groups, the learner plays a crucial role in determining the activities and objects that will be used in a PRT exchange.
Pivotal response treatment was developed in the 1970s by educational psychologists Robert Koegel, Ph.D., and Lynn Kern Koegel, Ph.D., at the University of California, Santa Barbara. The Koegels are now director and clinical director, respectively, of the UCSB Koegel Autism Research Center.
The Instruction; Question; or Opportunity to Respond MUST be
- Clear, uninterrupted, and appropriate to task
- Interspersed with maintenance tasks
- Including multiple components
- Note: Activities should be child-selected from an adult menu of options (shared control)
Reinforcers should be
- Contingent upon the behavior
- Provided following any attempts to respond
- Directly related to the desired behavior
Motivation
- https://www.youtube.com/watch?v=9VdPL8GhPfY
- Individuals with an autism diagnosis or other developmental handicaps often exhibit either deficits in or unusual motivation
- Depending on age, motivation issues are often seen in frequent temper tantrums, crying, noncompliance, inattention, fidgeting, staring, attempting to leave social and learning situations, and lethargy
- PRT is designed to be used in the natural environment in ways that build and link motivation to real everyday situations
Social Initiations
- Social Skills are often considered a hallmark deficit for individuals with an autism diagnosis, as well as for a variety of other diagnostic conditions
- Learning how to move from observation of social exchanges to initiating and maintaining social interactions is explicitly taught using developmentally sequenced play, as well as sharing, play organizing, turn taking, and for older individuals trading of information around common interests
- Individuals with an autism diagnosis or other developmental handicaps often exhibit either deficits in or unusual motivation
Self Management
- https://www.youtube.com/watch?v=DB-uwTf-sek
- Self-regulation issues resulting in extremely disruptive behavior are a commonly associated difficulty experienced by family members of those with autism or other diagnoses, as well as by the individual him or herself
- Finding Functionally Equivalent Replacement Behaviors (FERBs) is a key piece of a proper PRT based behavior intervention plan. Disruptive behaviors serve a communicative purpose. To reduce them, it is necessary to understand why the behavior is occurring and what behaviors are a more appropriate and effective means to communicate wants/needs and achieve the desired outcome
- PRT focuses on natural environment interventions and building an appropriate self-management system that can be implemented by the individual whenever and wherever appropriate
Responsivity to Multiple Cues
- Many individuals with an autism diagnosis exhibit "stimulus over selectivity" or hyper focus on some details to the exclusion of other relevant information, which interferes with learning and responding to the environment
- This difficulty is likely to source of difficulties experienced with generalization, social skills, and attention
The natural environment aspect of PRT is designed to provide frequent everyday opportunities that directly support recognizing, attending and responding to multiple cues.