Pivotal Response Treatment
Pivotal Response Training (PRT) was developed as a treatment method for children with autism and is considered a state-of-the-art treatment for several childhood disorders. This method uses a detailed analysis of the child’s behavior to develop an individual and specific plan for each child.
PRT is designed to help children learn skills that are pivotal, or essential, for more effective functioning. These skills help children learn and improve a wide range of behaviors. PRT will, for example, help the child be more motivated in daily activities, have more awareness of others and the environment and respond more appropriately to them. Improvement in these areas will improve many other problems that the child has in coping with daily life and performing age-appropriate tasks. Two of the ‘pivotal’ abilities that are improved by PRT are the child’s motivation and the child’s initiative, or initiation.
Motivation
Motivation affects how a child responds to others and the environment. Some children will seem unmotivated and unresponsive to the people, objects and activities that other children approach with enthusiasm. In relationships with peers, teachers, parents and caregivers these children can seem unaware, withdrawn and lacking in motivation to interact or participate. They are not as responsive as other children are to interactions, educational materials or age-appropriate toys, games and activities. PRT can improve how quickly a child responds, how interested or enthusiastic the child is and how often the child will attempt to interact with others, make choices and participate in activities. To improve how well a child functions in these areas, PRT encourages the child through reinforcing attempts to do these behaviors and by providing natural rewards or natural reinforcers for the child’s new behavior. An example of natural rewards would be that the child receives a cookie after asking for the cookie. In this way, the child shows motivation in expressing what is wanted and receives what is ‘asked’ for. The child learns that more directly ‘asking’ for what is wanted will result in getting what is wanted. Giving such natural rewards will, over time, increase the child’s motivation to communicate more effectively. Helping the child be more motivated to interact in such a way may take time. Often the child will be rewarded for any ‘close’ expression—in this example, perhaps pointing at the cookie would be rewarded as a ‘close’ attempt to ask for the cookie. Such work with the PRT method will eventually teach children more effective communication of what is wanted and increase motivation to express themselves better as well as to interact with others more appropriately.
Initiations
It is developmentally appropriate for children to ask many questions in order to learn and interact. Language skills are built through asking questions as well. “What is that?” for example, helps the child build vocabulary and knowledge of the environment. Additionally, asking questions is a way that children get their needs met, build relationships and interact with others. One of the ways PRT helps children initiate more is by teaching questioning skills. Children in PRT will, for example, be taught to use what, when, where and why questions. They can then use these questions outside PRT to initiate interactions, build language and ask for help (Myers & Johnson, 2007). Children who learn to better initiate interactions will also develop more interest in their environments, improve their ability to pay attention, become more appropriately persistent, more cooperative and more independent. These additional benefits of improved initiation are examples of how PRT will work on one skill in order to affect many other areas of the child’s development and overall functioning. In these ways, PRT will reduce problem behaviors, improve socialization, language, responsiveness, education and participation in their families. Ultimately, greater independence is gained through building such skills.
Conditions Treated with PRT
PRT was developed originally to treat children with Autistic Disorder (autism or ‘classical autism’); however it is commonly regarded as an effective method of treatment for children with any of the Autism Spectrum Disorders. These include Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorder, Childhood Disintegrative Disorder and Rett’s Disorder. Additionally, some children who do not have one of these diagnoses may also be treated with PRT. Typically, these children will have some symptoms or features of one or more of the diagnoses mentioned here. Such symptoms can be observed in some children as young as 18 months, but usually older children are easier to diagnose and treat. Some of the symptoms helped by PRT include communication, social and behavioral patterns that are vague, ineffective and below the norm for the child’s age.
Family Participation in PRT
Families of children with the symptoms or disorders discussed here are often greatly relieved to find that PRT is so effective. Further, families will find that their children enjoy PRT because it uses techniques that children consider to be play and materials considered to be toys or games. Children involved in many other treatments often resist appointments and can be unwilling to go readily or to cooperate once there. Tantrums and other related disruptive behaviors are greatly reduced when children prepare for and participate in PRT appointments. Since children involved in PRT typically view these therapy appointments as enjoyable, they are far more likely to attend them willingly and even enthusiastically. Consequently, families who use PRT often find that this method is far less stressful and disruptive to the entire family. Also, families can expect to be taught PRT techniques to use outside sessions and will become active participants in the child’s treatment. In doing so, the child will more rapidly progress. Families can use PRT techniques in the home and in outings in the community. Siblings and caregivers can also participate in assisting with these techniques. Many therapeutic educational settings use PRT methods to help the child develop more quickly as well. With such a comprehensive approach, PRT provides a thorough and efficient treatment method for children with many developmental difficulties (Bryson, Koegel, Koegel, Openden, Smith, & Nefdt).
References:
Bryson, S., Koegel, L., Koegel, R., Openden, D., Smith, I., & Nefdt, N. (n.d.). Large scale dissemination and community implementation of Pivotal Response Treatment: Program description and preliminary data. Research and Practice for Persond with Severe Disorders, 32:2 , 142-153.
Myers, S., & Johnson, C. (2007). Management of Children With Autism Spectrum Disorders. PEDIATRICS, 120:5 , 1162-1182.
Why choose PRT?
A revolutionary intervention approach for autism, PRT combines the best of applied behaviour analysis with today’s proven best practices.
Why does PRT work?
Several studies have indicated the validity and efficacy of using Applied Behavior Analysis (ABA), cognitive-behavioral and developmental techniques for treating the symptoms of autism.
Pivotal Behaviours
Four pivotal behaviours have been identified that have led to significant gains in skill development and in collateral functioning.
Focus of PRT
The focus of PRT is to teach children and youth with ASD certain pivotal behaviours through a set of specific training procedures, which, when learned, will lead to the development of new behaviours.