Pivotal response treatment (PRT)
Pivotal response treatment (PRT) is an intervention designed to support individuals on the autism spectrum by focusing on pivotal areas of development that can lead to broader improvements in behavior and skills. Developed in the 1970s by Robert and Lynn Kern Koegel, PRT emphasizes a learner-led approach, allowing children to guide their own learning experiences based on their interests. The therapy targets four key areas: self-management, social initiation, responding to multiple cues, and motivation. By integrating natural reinforcement—where desired behaviors are encouraged through engaging activities—PRT helps enhance communication and social skills while reducing disruptive behaviors.
Training for caregivers and parents is integral to the PRT approach, as it empowers them to apply these techniques consistently in various settings, making it adaptable and effective outside of formal therapy sessions. Research suggests that with adequate training, many caregivers can successfully implement PRT, fostering a collaborative environment that supports the child’s growth. Typically, it requires substantial commitment, with around twenty-five hours of weekly practice recommended. Overall, PRT is viewed as a comprehensive method that not only addresses specific behavioral challenges but also promotes a more fulfilling interaction between autistic individuals and their communities.
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Pivotal response treatment (PRT)
Pivotal response treatment (PRT) is an intervention used with people on the autism spectrum. It is a learner-led treatment that uses specific areas of a child's development to help improve behaviors. PRT can also address more than one behavior area at a time. The technique uses multiple techniques that parents and other caregivers can readily learn and use on a daily basis. Some of the areas that it can address include decreasing disruptive behaviors and increasing social skills and language development. It is considered an important method of addressing the needs of individuals with autism.
Background
Autism spectrum disorder, also known as ASD, refers to a group of developmental disorders that affect behavior, language development, and social skills. It is characterized by repetitive behaviors, difficulty with communication and interaction with others, and sometimes limited or very intense interests. Individuals with ASD are often reluctant to make eye contact or develop close contact with people, are not interested in activities that others are interested in, may not respond to or listen to others, have limited communication abilities or repeat words and phrases, are easily upset by changes in routine or new circumstances, and have other difficulties functioning in a way seen as appropriate for the situation. Autism is usually identified in childhood, but because of the wide range in how the condition presents, some people are not diagnosed until adolescence or adulthood.
Despite these challenges, autistic individuals are often above average intelligence. Even those with more severe symptoms can have strong abilities to learn and may even excel in music, art, math, or science. These wide ranges of ways in which the disorders manifest make it challenging to find ways to help autistic individuals reach their full potential.
Pivotal response treatment (PRT) was developed in the 1970s by educational psychologists Robert Koegel and Lynn Kern Koegel while they were working at the University of California at Santa Barbara. Originally referred to as the natural language paradigm, PRT has been known by a variety of names, including pivotal response training, pivotal response teaching, pivotal response therapy, and pivotal response intervention. The Koegels derived their treatment plan from another model, known as applied behavior analysis (ABA).
Overview
Pivotal response treatment gets its name from the fact that it addresses four key, or pivotal, areas of a child's development. These are self-management, social initiating, responding to multiple cues, and motivation. The treatment is based on the belief that by working with these pivotal areas, improvements will result in other areas of the individual's life.
The treatment is most commonly used with preschool and school-aged children, but PRT can be adapted to use with all ages. In PRT, the person working with the autistic learner will follow the learner's lead. For instance, if a child with autism has shown an interest in toy cars, the cars will be incorporated into efforts to engage the child in learning various skills. The child might be encouraged to learn colors by using various colors of cars, for instance, and to count by driving various numbers of cars along on a table.
Experts believe that using PRT to help individuals with autism will help them improve in other areas. For example, a child who uses developing language skills to ask for a toy by name will be allowed to play with the toy. This serves as a natural reinforcement of the behavior and will encourage the child to repeat the behavior. The resulting improvements in communication skills and social interactions will help limit disruptive behaviors, which are often, at least partly, the result of frustration at being unable to have or communicate what the individual wants.
This type of natural reinforcement is a key technique in PRT. The person working with the individual finds an opening to direct the person's behavior and builds on repeated opportunities to repeat that behavior to gradually reinforce the desired result. For example, to teach a child to put belongings away, the therapist, parent, or other adult using the technique might get the appropriate container out and begin putting toys in the container. The caregiver might then hand one to the child and guide the child to putting it in the container, then put a few more in reach for the child to put away. The next time, the process might include getting the container and putting a few toys near the child and the container, with ample positive reinforcement when the child cooperates. As the child gains competence, more tasks are left for the child to complete until the child does the task alone. By allowing the child some choice and ownership of the tasks, experts believe the child develops motivation to take part in the activity.
PRT is initially administered by psychologists, therapists, and special education teachers. However, parents are usually taught how to use the techniques. Some limited studies have shown that about 84 percent of caregivers can successfully apply the techniques after twelve weeks of training. These trainings have been successfully implemented in group class situations, making PRT relatively cost-effective to teach to those who care for autistic individuals.
Many of the techniques used as part of PRT are easy to implement in a variety of settings. Learning is not limited to a therapist's office or home setting and can occur in nearly any setting, which benefits both the individual and family members. Autistic individuals learning through PRT usually need at least twenty-five hours of work with the techniques each week, and experts recommend that all those who interact with the individual use the techniques; therefore, PRT is sometimes described as a lifestyle treatment.
The technique has been shown to lead to improvements in communication and language usage, which are often key areas for those with autism. Improved communication enables the individual to feel more in control. This can lead to fewer instances of disruptive behaviors and increased interaction with others.
Bibliography
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Oaklander, Mandy. "Autistic Kids May Benefit from This Kind of Parent-Led Therapy." Time, 27 Oct. 2014, time.com/3541149/autism-language-therapy/. Accessed 24 Feb. 2018.
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"Pivotal Response Treatment (PRT)." Autism Speaks, www.autismspeaks.org/what-autism/treatment/pivotal-response-therapy-prt. Accessed 24 Feb. 2018.