What Is Pivotal Response Treatment (PRT) for Autism?

Pivotal Response Treatment (PRT) is a play-based, child-led behavioral therapy for individuals with autism spectrum disorder (ASD). It is designed to foster development in broad areas of growth, with the idea that positive changes will naturally extend to other skills and behaviors rather than addressing them one at a time. The therapy is structured to be motivating and integrated into the child’s daily experiences.

The Core Principles of PRT

The application of Pivotal Response Treatment is guided by several foundational principles. These methods are designed to increase a child’s natural motivation to engage and participate in interactions.

• Child Choice: Therapeutic activities are guided by the child’s own interests. If a child shows interest in a set of blocks, the therapist will build learning and communication opportunities around that activity.
• Natural Reinforcement: The reward provided is a direct and logical consequence of the behavior. For example, if a child on a swing attempts to say “push,” the natural reinforcement is the act of being pushed, as opposed to an unrelated reward like a snack.
• Mixing Tasks: To maintain engagement and prevent frustration, sessions intersperse new, more challenging tasks with ones the child has already learned. This technique helps build the child’s confidence.
• Reinforcing Attempts: The therapy reinforces any valid attempt a child makes to communicate, not just perfect answers. If the goal is for a child to say “red ball,” a reward might be given for an effort like pointing or saying “ball,” which reduces the pressure to perform perfectly.

Targeting Pivotal Developmental Areas

PRT focuses on four areas of a child’s development, with the understanding that improvements in these areas will lead to widespread gains in other skills.

• Motivation: This is enhanced through the core principles of child choice and natural reinforcers to increase a child’s desire to learn and interact with others.
• Responsivity to Multiple Cues: This involves teaching a child to respond to more complex environmental and verbal signals. Instead of just responding to “get the ball,” the child learns to act on a more detailed request like “get the big red ball,” a skill needed for understanding nuanced language.
• Self-Management: This area teaches children how to recognize and regulate their own behaviors. The goal is to foster greater independence and reduce the need for constant external prompting from caregivers or therapists, allowing for more success in settings like the classroom.
• Initiation of Social Interactions: PRT encourages children to be the ones to start social engagement, rather than only responding to others. This can include asking questions or joining in a game, which helps build more reciprocal and meaningful social relationships.

Implementing PRT in Daily Life

While PRT can be delivered by trained professionals, a significant aspect of the approach involves training parents and caregivers. This allows the therapeutic techniques to be used consistently throughout the child’s daily life in natural environments like the home or school.

For instance, during mealtime, a parent might wait for their child to request a specific food, reinforcing the verbal attempt by giving them that food. Similarly, during playtime at a park, a caregiver could use a child’s interest in the slide to encourage communication by prompting them to say “up” or “go.”

This integration into daily routines helps generalize skills, meaning the child is more likely to use what they’ve learned in different contexts. By using naturally occurring activities, learning opportunities become a seamless part of the child’s day instead of a separate therapy session.

PRT’s Relationship to Applied Behavior Analysis

Pivotal Response Treatment is a specific type of Applied Behavior Analysis (ABA), but its approach differs from more traditional forms like Discrete Trial Training (DTT). Understanding this distinction is useful for parents exploring therapy options, as “ABA” encompasses a wide range of methods.

The primary difference lies in the structure and delivery. Traditional ABA is often highly structured and therapist-led, involving repetitive drills in a controlled environment. In contrast, PRT is play-based and child-led, taking place in the child’s natural settings by following their motivations.

While both PRT and DTT are based on the principles of ABA, PRT’s method is less rigid. It focuses on broad areas of development to produce widespread improvements, whereas DTT targets discrete, specific behaviors one by one.