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Pivotal Response Treatment: What Is It And How Does It Work?

Pivotal Response Treatment (PRT) is an intervention for autism that is derived from Applied Behavior Analysis (ABA) principles.

PRT focuses on individual behaviors, one at a time, and uses positive reinforcement to help improve social, behavioral, and communication skills in children with autism.

Pivotal Response Treatment was developed by Dr. Robert L. Koegel, Dr. Lynn Kern Koegel, and Dr. Laura Shreibman, at the University of California, Santa Barbara.

PRT was previously called the Natural Language Paradigm, which has been in development since the 1970s. Like ABA therapy, PRT is a behavioral intervention model that uses reinforcement to modify behavior and to increase a child’s willingness to participate in learning new skills.

PRT is used to teach language skills, to decrease disruptive behaviors, and to increase academic, social, and communication skills.

PRT is child-directed (that is, the child makes choices in determining what activities and objects will be used in the therapy) and uses reinforcers to reward behavior.

PRT advocates believe that motivation and the ability to respond to multiple cues are 2 pivotal behavioral skills and that developing these 2 skills will result in a larger, overall improvement in behavior.

Motivation and the initiation of activities are the major areas that PRT focuses on.

The theory behind PRT holds that an improvement in these areas will mean improvement in other, non-targeted areas of behavior, such as self-management, communication, turn-taking, and language.

In order to develop these skills, PRT is often used in a play setting.

Therapists start with single-step play then move on to model more complex ideas.

Therapists provide clear instructions to the child, offer a choice of stimuli, and direct reinforcement (e. g. if a child decides to ask for a particular toy and attempts to request that toy, he or she receives that toy, and not a different, unrelated object, and receives it immediately).

In effective PRT sessions, previously mastered tasks should be interspersed in the therapy in order to maintain them, and rewards should be immediate and contingent upon response attempts.

Naturally occurring opportunities to teach and their consequences are used in PRT, making it a loosely-structured therapy and one that parents can implement.

Resources & References:

About PRT

PRT Help

Visit the UCSB  Koegel Autism Center’s website here.

The Parent Infant Centre: 35 Years Of Helping Infants And Children

Early autism intervention is critical to a positive outcome for children. Not only must intervention be appropriate for the child’s needs, but it must come as early as possible as many interventions do not begin until a child is at least 18 months old or older.

Many autism interventions do not begin until a child is in his or her toddler years, and the parents and siblings can feel somewhat removed from the treatment process.

Not so with the treatment offered at the Hamstead, England-based Parent-Infant Clinic.

The Infant Family Program of the Parent-Infant Clinic is an intensive and successful program of intervention designed for infants who are exhibiting pre-autistic behaviors.

Treatment there is an Infant-Family program comprised of three phases, all designed to assist parents and babies with symptoms of pre-autism find new ways to relate to each other, resulting in positive outcomes for the child.

The clinic offers different treatments based on the child’s age. For children under 5 years of age, the Infant-Family program is one intensive program lasting 2 to 4 weeks followed by a follow-up program that lasts for 1 to 2 years.

The staff works with the entire family and the child 6 hours a day, 6 days a week. One day of the treatment is performed in the family environment.

In the assessment and formulation phase of the treatment program (phase 1), the baby is observed to identify what obstacles there may be to communication.

Family relationships, a critical part of the assessment, are explored and observed, and emotional, environmental, or relational obstacles to communication are identified.

Practitioners observe and investigate the entire spectrum of child development in order to identify problems with social, communication, and behavioral and emotional development.

Phase 2 is the therapeutic intervention phase in which practitioners work with all family members.

Work with the parents and child together helps to build on sensitive ways of being together and to expand on the parent/child relationship skills.

Work with the infant in this phase helps the infant to understand his or her repetitious behaviors and to expand their communication skills. Play objects are use to stimulate sensory development.

Working with parents and siblings together teases out patterns of managing emotions that may be obstacles to helping the infant respond to them.

Finally, in keeping with the whole child / whole family approach, staff works with the couple to explore issues that may interfere with effective co-parenting.

Because having a special-needs sibling can be difficult, the staff works with siblings to help expand their ability to manage their feelings and frustrations.

The final stage (phase 3) is the integration phase in which staff helps the family to anticipate challenges that may be in their future, to support the family during transitions, and to document the progress made during treatment.

By the end of the intensive treatment period, the family is able to enjoy their infant in a new way and to utilize new patterns of relating to him or her.

Post-treatment follow-up is recommended and includes weekly support of parents and child in the home.

The Parent-Infant clinic’s website states that they “can say that 100% of the infants we treated achieved physical and emotional development.”

Clearly this innovative approach to autism treatment not only starts very early, but the nature of its family-centered intervention helps to achieve phenomenal results for the child.

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