Pivotal Response Treatment (PRT)
An ABA approach?
Lynn & Bob Koegel, 1987

What is PRT?     
Pivotal Response Treatment®, http://www.autismprthelp.com/, is a research-based intervention for individuals with Autism Spectrum Disorder (ASD). PRT® is a naturalistic intervention model derived from Applied Behavior Analysis (ABA). This is a Discrete Trial Training (DTT) method focusing on teaching easily generalizable and impactful, “pivotal” skills that are known to affect broad aspects of general functioning. Rather than target individual behaviors one at a time, PRT® targets four main pivotal areas of a child’s development resulting in widespread, collateral improvements in other social, communicative, and behavioral areas that are not specifically targeted. Lynn and Bob Koegel’s PRT is one of several Lovaas “classic DDT” adaptations generated after they worked with Dr. O. Ivar Lovaas at UCLA, home of the Lovaas Institute www.lovaas.com, in the 1970’s. Drs. Robert and Lynn Koegel departed from Lovaas and developed PRT® at the Koegel Autism Center at the University of California, Santa Barbara, http://education.ucsb.edu/autism. Their website reports, PRT® is one of the few intervention methods for autism that is both comprehensive (as listed by the National Research Council; of the National Academy of Sciences) and empirically supported. It is recognized by the National Professional Development Center on Autism Spectrum Disorders and the National Standards Project. Watch the Project ACCESS informational video on You Tube: https://www.youtube.com/watch?v=MejrblUOiro

What is Applied Behavior Analysis (ABA)?
Applied = Principles applied to socially significant behaviors

Behavior = Based on scientific principles of behavior

Analysis = Progress is continually measured and intervention adapted

In 1960 Dr. Lovaas was one of the first researchers to use applied behavior analysis as a treatment for autism developing his DTT technique including a specific skills curriculum. This is the basis for the ABA programming that is commonly referred to today, but is NOT the only way to incorporate Applied Behavior Analysis to student learning experiences. Many, actually most, specific treatment interventions follow the general theory of applied behavior analysis: Apply or try a strategy to target a specified developmentally appropriate Behavior and Analyze results (collect data) to determine its effectiveness. Other specific models of ABA intervention derived from the Lovaas “classic DDT” method include Drs. Ronald Leaf and John McEachin’s Approach available through the Autism Partnership established in 1994 near Long Beach, CA as well as M. L. Sundberg and J.W. Partington’s Applied Verbal Behavior Approach and subsequent Assessment of Basic Language and Learning Skills (ABLLS) published in 1998.

PRT developers, Lynn and Bob Koegel worked with Lovaas at UCLA. They eventually decided that it is “an insurmountable task to teach children every skill” (a prominent aspect of the Lovaas DTT method), so they choose to work the pivotal skills that are likely to affect a wide area of functioning.

PRT® targets four main pivotal areas of a child’s development

1. Motivation
2. Responsivity to multiple cues
3. Self-initiations
4. Self-management

PRT guiding principles:

1. Family involvement is essential in the treatment process
2. Treatment should be provided in natural environments
3. Treatment must target key behaviors, i.e. pivotal behaviors
4. Treatment must be implemented in the home AND school environment.

* Underlying feature = training should involve intensive engagement in natural settings throughout the day.

How it Works!
The first of the skills that the Koegels thought was pivotal is motivation; to increase motivation they reinforced attempts and used child choice of materials, again keeping data on outcomes for completion of the ABA format. The Koegels also did research on what made some of their children more successful than others, finding that the ability to initiate is another pivotal skill that makes a difference. One activity they used to increase initiation was to put a desirable item in a bag. The adult would ask, “What is this?” and then pull the item out of the bag and say, “This is a ….” After doing this a number of times. Bring out the bag, and pause (time delay). If the child does not say anything, start the prompt, “What….?” “What is….?” “What is this?” Keep repeating until the student is able to initiate “What is this?” When this initiation is solid. Use this game without the bag? Teacher touch something and say, “What is this?” Then teacher touches an object and wait (time delay) for the student to say, “What is this?” Keep this going until the student can independently say, “What is this?” in multiple situations and environments. The acquisition of the ability to ask what things are is huge!

• In the example of teaching motivation, the guiding principles of PRT are realized by using intrinsic reinforcers rather than unrelated rewards, during activities that are meaningful and relevant to their natural environment. This example of reinforced choice-making could be easily transferred to home activities as well.  
• In the example of teaching initiation (bag activity to ask what things are), the clearly outlined scaffold of steps is a structured way to reinforce attempts and gradually broaden the task to be more generalizable. Again, procedures like this could be implemented across a range of activities throughout the student’s day.
• See more detail from Dr. Lynn Koegel on YouTube at https://www.youtube.com/watch?v=5n9vlBtbji8

Who can use it?
Everyone! No special training required to implement the theoretical premise of PRT, just an understanding of the guiding principles and ABA intervention to facilitate learning of pivotal skills. A five level certification training program is available through the Koegel Autism Consultants at the website listed below.

Find more information @ http://www.autismprthelp.com/

• For a comprehensive and free training module on using PRT visit autisminternetmodules.org , for a list of free trainings developed by (OCALI). You will be required to register, but the online training modules are free. Find the PRT module under the “Autism at Home” tab including instruction on using PRT in the classroom.

Contact Project ACCESS (866-481-3841; projectaccess@missouristate.edu) for additional research articles and references.

©Project ACCESS – 2017 – Shannon Locke, M.S., CCC-SLP
#Behavior
This fact sheet and other #AutismResources, #AutismTraining and #AutismSupportServices information may be found on our website:  http://education.missouristate.edu/access/