Pivotal Response Treatment for Autism

1. Pivotal Response Treatment
By: James Rinka & Liza Sandy

2. Definition
Pivotal 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 child’s 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

3. Overview
• PRT targets four pivotal areas of students
development
 Motivation
 Response to multiple cues
 Self-management
 Initiation to social interaction
• Focusing 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

4. Goal of PRT
The 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

5. PRT session
• Typically 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.

6. Motivation
1. Establishing Students Attention
2. Using Shared Control
3. Using Learners Choice
4. Varying Tasks and Response
5. Interspersing Acquisition and Maintenance
Task
6. Reinforcing Response attempts
7. Using Natural and Direct Response

7. Response to Multiple Cues
1. Varying Stimuli and Increasing Cues
1. Properties or attributes
2. Scheduling the Reinforcement
1. Give rewards for good behavior.

8. Self Management – Why it is Important
• Once behaviors start
to get under control,
it is important to
gradually turn over
the monitoring of the
behaviors to the
learner

9. Self-Management – How To
1. Define the Behavior – know the function of the behavior for the
learner
2. Preparing the Self-Management System
a. Look at replacement behaviors and find one that will work for the
student
b. When to use the behavior
c. How the behavior will be measured
d. Identify rewards
e. Develop overall goal and share with learner
f. Provide opportunities for success
3. Teaching Self-Management
a. Teach the difference between desirable and undesirable behaviors
b. Teach learners to record success across intervals
c. Provide reward for success
4. Creating Independence
a. Gradually increase the time that learners self-manage by increasing
time between intervals
b. Gradually fade intensity and frequency of prompts
5. Generalize to Other Settings – teaching in a variety of settings and
with other people

10. Initiation to Social Interaction – Why it
is Important
• Found to have made a great difference in overall
functioning
• Study 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 children
▫ 1 group was successful – in college or has a job
▫ 1 group was not successful – institutionalized or just
staying home
▫ Looking back at video-taped sessions, the successful
group initiated conversations – asked questions

11. Initiation to Social Interaction - Steps
• Basic Question-Asking:
▫ “Dat?” “What’s That?”
▫ “What’s happening?” and “What’s happened?”
• Communication and Social Skills
▫ Imitate learner’s actions
▫ Provide item to learner only when requested
▫ Wait for response before providing a prompt
• Social Initiations
▫ “Can I play with you?”
▫ Sharing objects
▫ Taking turns choosing activities

12. Initiation to Social Interaction – How
to
• Most basic = question asking
• Young children, have started using words for
either a request or protest
▫ Place favorite objects in an opaque bag
▫ Begin by prompting them to say “What’s that?”
and then give them an object from the bag
▫ Eventually, they will ask on their own
▫ Keep this as a maintenance task and work on
“What’s happening?” as an acquisition task.

13. Initiation – How To
• Older children, focus is more on give and take
▫ Practice prompts with them such as:
 I say “I had a great weekend”
 They say “What did you do?”
 I say “I’m so full from lunch”
 They say “What did you eat?”
▫ Practice initiating interaction
 “Can I play with you?”
 “Can I sit here?”

14. Example with Lynn Koegel
• In the following videos, we see one of the
founders of PRT, Lynn Koegel, on the show
SuperNanny.
• Tristin is a three year old with Autism
• The videos demonstrate:
▫ Using a child’s interests to increase motivation
▫ Involving the parents
▫ Using a naturalistic setting
▫ Using imitation to improve social skills

15. Lynn Koegel on SuperNanny:
Communication

16. Lynn Koegel on SuperNanny: Setting
the Table

17. Example of Actual PRT Session – Saying
“open” and “block”

18. Questions to Ask? (Teacher)
• Are the target behaviors I’m 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 child’s
goals?

19. 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 child’s goals?
• Has my child been accurately assessed?

20. Additional Resources
• Autism Speaks – also check out their Video
Glossary for more example videos
• AIM on PRT – this is under Autism at Home. It
also has videos and case studies
• Koegel’s Field Testing Manual
• The PRT Site
• Video with more advanced session – child is
making sentences and asking questions
• Video about teaching infants using PRT

21. 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.