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What is Pivotal Response Treatment?

One of the most proven behavioral approaches for treating children with autism spectrum disorders is pivotal response treatment, or PRT. Drawn from applied behavior analysis, PRT is a play-based method that targets improving “pivotal” development areas instead of individual behaviors. It’s based on the idea that changes in pivotal responses would spark widespread progress in other developmental areas. PRT was initially established in the 1970s by Dr. Robert Koegel and Dr. Lynn Kern Koegel at the University of California- Santa Barbara. First called pivotal response teaching, PRT combined several research-based interventions to improve autistic children’s social and communicative growth. A study published in Behavior Modification journal showed that pivotal response treatment is highly effective for preschool, elementary, and middle school students with ASD.

Four Main Pivotal Areas Targeted

Pivotal response treatment strives to thwart negative, self-stimulatory behaviors associated with autism by addressing four main “pivotal” areas. The central area is motivation. PRT therapy works to increase children’s desire to learn and perform skills associated with good consequences. Rather than force tasks, PRT uses the child’s interests to reinforce pro-social behaviors and trigger enthusiasm. The second “pivotal” area is initiations. PRT encourages the child to initiate social interaction by asking questions or obtaining attention. Next comes self-regulation. This “pivotal” area teaches children to self-evaluate and discriminate their behaviors for greater independent. Finally, PRT trains autistic youth to respond to multiple cues rather than focus on specific details or stimuli.

What’s Involved in PRT Sessions

PRT therapy sessions involve using positive reinforcement to address the above “pivotal” areas, which will result in broad progress for sociability. Pivotal response treatment is customized to meet the unique needs of individual children and their routines. Most school-based PRT programs will consist of 25 or more hours weekly. Parents or guardians should also adopt PRT methods in the home environment for consistency. Pivotal response treatment uses play therapy to target social skill development, so unstructured interactions are common. Lessons could include taking turns, imitation, joint attention, or peer interaction. For example, if the child verbally expresses a desire for a doll, they’ll be rewarded with the toy.

Qualifications to Provide PRT Therapy

Practitioners of pivotal response treatment typically need special certification beyond their training and licensing. PRT is most often provided by school psychologists, special education teachers, speech-language pathologists, and occupational therapists. Some applied behavior analysts may dabble in PRT therapy since it’s derived from ABA. Most PRT providers attain at least a master’s degree in counseling, psychology, education, or therapy. Accredited master’s programs will require clinical practicum to satisfy the contact hours for licensing, which varies greatly by state and title. After licensing, providers should pursue certification from the UCSB Koegel Autism Center. Three levels of PRT certification can be obtained with workshops. Level I Certification requires attending the two-day Pivotal Response Treatment Conference.

Overall, pivotal response treatment was recognized by the National Research Council as one of the top 10 model programs for autism. Motivation strategies utilized in PRT therapy helped 85% of toddlers with autism develop verbal language as their primary communication. PRT is an evidence-based behavioral approach targeting critical behaviors in natural environments for better social skills. As the diagnosis of children with ASD grows more prevalent, pivotal response treatment is expected to become a leading form of early intervention.

Related Resource: What Can Be Done To Prevent Autism?