Pivotal Response Training (PRT) is a behavioral treatment intervention based on the principles of applied behavior analysis (ABA). Applied Behavior Analysis is the design, use, and evaluation of environmental modifications and interventions to produce socially significant improvement in human behavior. ABA uses antecedent stimuli and consequences, based on the findings of descriptive and functional analysis, to produce practical change in behavior. ABA is based on the belief that an individual's behavior is determined by past and current environmental events in conjunction with organic variables such as genetics. Thus, it focuses on explaining behavior in terms of external events that can be manipulated rather than internal constructs that are beyond our control. ABA has been used to develop interventions for children with autism for over 50 years. Treatments based on ABA represent a wide range of early intervention strategies for children with autism, from highly structured programs conducted in one-on-one settings to naturalistic strategies focusing on using the child's usual activities to build skills.
Pivotal Response Training (PRT) is a naturalistic behavioral intervention developed to facilitate stimulus and response generalization, increase spontaneity, reduce prompt dependency, and increase motivation while still relying on the principles of applied behavior analysis. PRT was designed based on a series of studies identifying important "pivotal" treatment components that affect a wide range of behaviors. Pivotal behaviors are those behaviors that are central to wide areas of a child's functioning, and when promoted, they are believed to produce improvement in many non-targeted behaviors. To date, there have been four identified pivotal behaviors, including responsivity to multiple cues, motivation, self-management, and child self-initiations. According to Koegel et al. (1999), when these pivotal behaviors are enhanced, improvement in autonomy, self-learning, and generalization of new skills will follow.
PRT is a loosely structured, naturalistic intervention; in other words, it relies on naturally occurring teaching opportunities and naturally occurring consequences (Schreibman, 2000). Research has shown that naturalistic interventions are associated with more expressed positive affect on the part of the child as well as the parent implementing the treatment. PRT is child directed (as opposed to therapist or parent directed), giving children the opportunity to initiate learning events. Thus PRT is able to increase the generalization of new skills while increasing the motivation of children to perform these behaviors being taught to them. PRT works to increase motivation by including components such as child choice, turn-taking, reinforcing attempts and interspersing maintenance tasks. PRT has been used to target language skills, play skills and social behaviors in children with autism. These strategies are also used by some other naturalistic behavioral strategies such as milieu teaching and incidental teaching. An independent review of the research-base for use of PRT recommends the intervention as an efficacious evidence-based intervention for children with ASD (Humphries, 2003).
Frequently Asked Questions About PRT
What does PRT stand for?
Pivotal Response Training
What are "pivotal" behaviors?
Behaviors that are central to a wide area of functioning.
Which pivotal behaviors are central to PRT?
Motivation and child self-initiations in all children. Responsivity to multiple cues and self-management may be pivotal behaviors in children with sufficient language.
How is PRT different from Discrete Trial?
Discrete Trial Training (DTT) is also based on the principles of applied behavior (ABA). Specific components of DTT include breaking a skill into smaller parts, teaching one subskill at a time, prompt fading and shaping appropriate behaviors until mastered. PRT is a child directed naturalistic treatment; DTT is a more structured therapist directed treatment PRT uses reinforcement directly related to the task; DTT uses reinforcement not necessarily related to the task.
Is PRT appropriate for all children with autism?
Research is currently being conducted which assesses ideal child characteristics for PRT. Pilot data suggests that there are some children that are better candidates for PRT than others. However, it seems that most children can benefit from PRT as one component of a comprehensive treatment plan.
What can PRT be used for?
PRT has been used to improve language, social, behavioral, academic, and play skills in children with autism. PRT can be learned by parents and teachers and was developed specifically for parent education. We are currently working on a manual specifically for classroom teachers.
Is there any research to support the use of PRT?
Overall, research provides evidence of the success of this intervention for increasing language, social, and play skills in children with autism, as well as decreasing behavioral problems. There are numerous research articles and book chapters examining the use of PRT in children with autism.