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Pivotal Response Treatment (PRT)
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PRT Description
Strengths and Weaknesses
Evidence Based Approach
PRT Providers
Pivotal Response Treatment
Christena Parent and Bianca Prevost
Description of Pivotal Response Treatment
Pivotal Response Treatment (PRT) is
- a naturalistic, behavioral approach
-play-based
-initiated by the child
-also known as Pivotal Response Training
Pivotal Response Treatment was developed
-by Dr. Robert Koegel, Dr. Lynn Kern-Koegel, and Dr. Laura Shreibman
- at the University of California, Santa Barbara
-around since 1970's
-Previously termed the “Natural Language Paradigm” (NLP)
Authors and Date
Theoretical Principles behind PRT
Pivotal Response Treatment focuses on 5 "pivotal" areas
Theoretical Principles
Motivation
Motivation
Underlying motivational strategies:
-child choice
-reinforcing attempts
-use of direct and natural reinforcers
-interspersing maintenance tasks
-task variation
Child Choice
child choice
-Child-preferred materials, activities, topics and toys
-Either ask or observe the child's preferences.
-incorporate into treatment to stimulate and prompt child responses.
-A child’s preference can vary over time
-sometimes within a single intervention session.
-re-access regularly and adjust when necessary
reinforcing attempts
reinforcing attempts
A study by Koegel (1988) on nonverbal children with ASD
-Reinforce speech sound attempts even when mispronounced
- improves speech production, interest, enthusiasm and general behavior
Don't reinforce when
- child doesn't make an attempt
-looking away
-engaging in repetitive ritualistic behavior
interspersing maintenance tasks
Interspersing tasks
incorporate mastered skills with ones just outside the child's zone of proximal development.
-when practicing articulation
- incorporate some sounds child can easily produce
-incorporate some difficult sounds
This results in improved motivation, increased confidence, and more exposure to successful response-reinforcers
Task Variation
Task variation study by Dunlap and Koegel (1980)
-constant task condition vs. varied task condition with children with ASD.
The constant task condition
-single task repeated throughout the session
-children’s correct responding declined
The varied task condition
-target task was interspersed with a variety of relative tasks
-improved and more stable responding
An example of task variation
-allowing the child select his or her favorite toys
-identify sizes, colors, shapes within one session
task Variation
use of direct and natural reinforcers
direct and natural reinforcers
Use child's verbal request as reinforcer
-Child requests ball, give child the ball
In opposition of
-the child labeling the ball and given praise or candy
Learning the relationship between responding and reinforcement is a key point in remediating learned helplessness
Initiation of social Situations
Initiation
Initiation is prompted by motivation
Koegel study (1998)
- variety of child preferred items in an opaque bag
-prompted the children to ask, “What’s that?”
-before giving the desired items to the child, researchers had them repeat the label.
-the clinician should gradually replace child preferred items with neutral items that the child was first unable to label. E
A following prompts would be “Where is it” “Help” and “Look” Koegel -arrange situations such as
-hiding their favorite toys
-closing a jar too tight
Responses to Multiple Cues
During coloring:
-Offer the child a variety of markers and sizes
Getting dressed
“Put on your blue short sleeved shirt and your jean shorts”
During cooking
"Can you hand me the long wooden spoon?”
Response to Multiple Signals
Empathy
- ask questions such as
-"How do you feel when..?"
-"What helps when you feel that way?"
-"How do you think they feel when..?"
use leading statements to prompt responses
Empathy
Self-Management
Self-management
-Clinician measures appropriate behavior via timer or counter
-make child aware of expected appropriate behavior
-demonstrate and model behavior to encourage child
-eventually child may self-monitor
-self soothing tools may also be helpful
Pivotal Response Treatment is evidence based
PRT is one of the highest studied and validated behavioral treatments for ASD
-studies were done by Koegel Research at UCSB
- over 20 additional subsequent studies
Studies have observed PRT delivered
-by trained therapists in one-on-one sessions
-in group settings by teachers at school
- by trained parents in the home
Population of Approach
Pivotal Response Treatment is designed for
Autism Spectrum Disorder (ASD)
Children with Autism Spectrum Disorder (ASD)
PRT accounts for behavioral deficits such as:
-Motivational
-Communicative
-Social
-Attentional Perceptual
-Expectational
Learned Helplessness
- First proposed by Seligman 1967
- Followed by a study conducted by Hiroto (1974)
-Study titled uncontrollable noise
-3 separate groups of college students
- group 1 received no noise
-group 2 received controllable noise
-group 3 received uncontrollable noise
When all three groups were re-tested with controllable noise, the first and second group terminated the noise while the third group passively listened.
Learned Helplessness
A variety of providers seek training in PRT methods:
- Psychologists
-Teachers of students with Intellectual Disabilities
-Speech Language Pathologists
The UCSB Koegel Autism Research Center offers a PRT certification program
*Everyone involved in the child’s life is encouraged to use to PRT methods consistently during daily routines.
Pivotal
Response
Treatment
Strengths
Strengths
Naturalistic Approach
-child directed
-use of typical and motivational child objects
Evidence based and efficient
-study showed 40% increase in verbalization of children with ASD (Prizant).
-evidence showed that PRT improves brain activity associated with sociability and communication (Neuropsychiatry Dis. Treat, 2017).
Weaknesses
Weaknesses
Further research
-likely additional pivotal areas yet to be considered
Fidelity of Implementation
-procedures need to be correctly implemented at 80%
Implementation
-procedures should be done throughout daily tasks