Pivotal Response Treatment

By: Family Linkages  09-12-2011
Keywords: Autism Services

The Centre of Autism Services Alberta is committed to providing the most effective, evidence-based intervention for autism, which is why Pivotal Response Treatment (PRT) is our primary intervention. PRT is a behavioral intervention model that has resulted in positive growth for many children with autism. Developed by Drs. Robert L. Koegel and Lynn Kern Koegel at the University of California, Santa Barbara, the Centre is one of the few service providers in Canada to offer PRT.

The Centre’s primary intervention is PRT since it has proven to be highly successful for many children, however each child who receives services from the Centre will have an individualized program designed specifically to best meet his or her needs. After an assessment, parents will meet with the team to discuss whether PRT, as a primary intervention, offers the most benefits for your child. The Centre has a multi-disciplinary, integrated team that utilizes a variety of strategies and interventions that target autism. While PRT works for many children, your son or daughter may have better success with a service plan that blends elements of PRT with other strategies and interventions. If your child’s team feels he’s a prime candidate for PRT during the assessment then you will be asked to participate in parent education to maximize the success of the intervention. All members of your child’s team will be fully trained in PRT.

What is PRT?

Based on the principles of Applied Behavioral Analysis, PRT works on improving language, increasing social, communication and academic skills and strives to decrease disruptive or self-stimulatory behaviors. These goals are achieved by targeting pivotal or crucial behaviors that often result in improvement in a wide variety of behaviors. PRT focuses on motivation and child self-initiation.

PRT’s overall aim is to see positive growth in pivotal behaviors that will lead to improvement in communication, play, socialization and a child’s capacity to manage/monitor his actions.

One advantage of PRT is that it is child led, which increases an individual’s motivation, thus resulting in a more engaged child and potentially better learning opportunities. For example: a child gets to choose between activities and pick the one he most wants to do. This will result in more active play and increased communication during play time, which over time will extend to other areas of life.

“Children think of PRT as play rather than work and look forward to therapy. Children often detest "drill practices" used in other forms of autism therapy leading to therapy resistance, frustration, and tantrum throwing. This causes parents a great deal of stress. PRT is different. Parents love it because their children do and this leads to a decrease in their stress level. PRT is effective in all of the child’s environments and versatile enough to use at home, in clinical settings, in an inclusive classroom, and in the community, and parents can easily start folding PRT strategies into the child's established routine right away” (Robert Koegel, co-developer of PRT)

Evidence shows that PRT can result in the following:

• Increase in correct imitative utterances
• Increase in correct spontaneous language
• Increase in generalized spontaneous utterances
• Increase in generalization and maintenance of intervention gains
• Increase in positive child affect
• Lower percentages of disruptive behaviors
• Collateral gains in other often, untargeted behaviors

 PRT at Home

The Centre has a mandate to deliver evidenced-based practices, but equally important is that the type of intervention should be easily manageable for parents. PRT meets both of these goals. Compared to other interventions it is easy for parents to learn and use. PRT can be adapted to any family’s lifestyle, routines and values. This means that PRT can be fun and motivating for both children and parents.

PRT doesn’t require special materials, workspace, or session length and uses reinforcers consistent with those received in natural environment for similar behaviors. Parents are not only included as an important part of the decision making process for goals and objectives but following parent education also become valued members of the team. Parent education ensures that a child has consistent application of the intervention, which increases success.

PRT is done through:

  • Shared control and child choice
  • Reinforcement of good attempts
  • Mixing hard and easy tasks
  • Natural environments and activities

“There is definitely a lot of family involvement with PRT. PRT becomes more of a lifestyle than just a form of treatment and is versatile enough to use at home, in clinical settings, in an inclusive classroom, and in the community. It works best if everyone involved in the child's life is "on board" with PRT, consistency with treatment is the key to seeing results in the child’s behavior. Parents often have to unlearn a lot of what they have been doing to help their child. A mother's natural instinct is to give her child what he wants so he stops throwing tantrums or listens, but with PRT, success involves patience and having the ability to let go of appeasing the child as well as sticking to consistently using PRT methods in every part of the child's life. As soon as this happens, changes occur and the parents will begin to see results that become more and more frequent as more behaviors become modified. Parents can easily start implementing PRT strategies into the child’s established routine right away. Since PRT is a lifestyle that families practice every day and not a treatment administered only in a therapist’s office, families will start seeing positive results in a very short amount of time.” Dr. Robert Koegel

The Centre

For the past four years The Centre has been working in collaboration with the University of California to train our staff in PRT. While numerous team members are certified in the implementation of PRT, the Centre aims to have all its clinical staff (SLP, OT and Program Coordinators) certified in the implementation of PRT. Over the past two years, 25 families from the Centre have been involved in accessing PRT as an intervention for their children and working towards their own training in PRT by participating in the parent education sessions. These families are at various stages of training however all of them have seen improvements in their children. More specifics on PRT can be found on the Koegel autism website www.koegelprt.com .

“A child’s motivation to communicate about colors will increase if they are offered specific colored candies, to be given once they attempt to ask for the candies verbally. Once they understand the connection between using their own words and getting something they want, they will start to use words spontaneously to communicate their needs. Mastering this one pivotal behavior, motivating the child to understand the connection between their own efforts to communicate with the outcomes of their efforts, will have an enormous ripple effect on other skills. This sparks improvements in many other areas like speech and overall language development, cognitive development and social connection.” Robert Koegel


Keywords: Autism Services

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