Pivotal Response Treatment (PRT)
PIVOTAL RESPONSE TREATMENT (PRT)
Pivotal Response Treatment (PRT) is an evidence-based practice targeting pivotal areas to produce collateral effects on symptoms of autism (Simpson, 2006; Koegel & Koegel, 2006). The basic components of PRT consist of providing opportunities for learning within the context of the child’s natural environment, facilitating opportunities for family involvement, and treating the pivotal areas. The five pivotal areas of PRT are motivation, responsivity to multiple cues, self-management, initiation of social interaction, and empathy (Koegel et al., 2003). PRT begins with motivation, as it underlies all other pivotal areas. Multiple cues encompass’ a child’s ability of taking in multiple modalities of sensory input (i.e. visual, auditory, etc.). Self- management teaches an individual to self-regulate their own behavior, increasing their personal independence. When targeting social initiations, beginning with items the child wants or needs will help increase social motivation. The inability to recognize that other people have a perspective other than their own is what led to empathy being added as a pivotal area (Baron-Cohen, 1985).
Rather than targeting individual behaviors one at a time, PRT targets the pivotal areas of a child’s development, resulting in widespread, collateral improvements across social, communicative, and behavioral domains. As a result, skills are proven to generalize more rapidly. There are seven core techniques when implementing PRT that are utilized throughout every session in order to increase child motivation and maintain their attention and willingness to learn. These strategies include gaining the child’s attention, interspersing maintenance tasks/ task variation, shared control, responsivity to multiple cues, contingent reinforcement, reinforce attempts, direct response- reinforce relationship (Koegel et al., 1999).
PRT strives to incorporate child choice throughout the session in order to maintain their motivation, while simultaneously maintaining partial control (such that the child needs the therapist and the therapist can continue to place demands). As a result, the tools used to teach become reinforcing within themselves, since the child typically selects them. PRT focuses on increasing socialization and motivation through play therapy, setting the stage for natural environment learning. With the use of Pivotal Response Treatment, providing intervention in social-communication and behavior domains leads to collateral gains in additional areas.