Pivotal Response Treatment, abbreviated PRT, is a common autism behavioral therapy.
Pivotal Response Treatment, abbreviated PRT, is a common autism behavioral therapy.
It is predominantly used to treat children but can benefit all age groups.
One standout feature of this therapy is that the participant generally takes the lead instead of the therapist. Additionally, the therapy is centered around play.
Therefore, the PRT autism therapist may ask the child what he or she wants to participate in rather than dictating activities. Another noteworthy point is that therapy generally happens in the child’s natural environment, at home, in a familiar classroom, or with family and friends.
PRT may also be conducted in a one-on-one setting or in group rooms. According to UC Santa Barbara, as a basic guideline, the maximum number of participants allowed in group settings is five students. Pivotal Response Treatment is a subdivision of Applied Behavior Analysis or ABA and therefore uses many of the same guidelines.
Some of the main goals for treating a child on the spectrum with PRT include:
The treatment targets four main skills:
The end goals are to improve the children:
The therapist will use tested motivation tactics during treatment to promote natural and clinical improvement.
To provide more insight, let’s look at a PRT example:
Remember, the therapist’s goal isn’t perfection, but practice makes perfect.
Take John, for instance, a 3-year-old recently diagnosed with autism. During PRT, if John makes a reasonable effort to ask (in his way) for a piece of chalk to write with, this observation would be rewarded. The incentive wouldn’t be a piece of candy, either. The reward would be the actual request: a piece of chalk.
PRT was established at the University of Santa Barbara, California, in the 1970s through the culmination of years of research and practice conducted by:
During the initial stages of development, PRT was called the “Natural Language Paradigm” (NLP). Some other early program names include:
Like most therapies used in treating autism, refinements have been made since PRT’s inception to help accelerate improvements and outcomes. Today, numerous professionals in the health and education industry pursue certification and training in PRT to incorporate into their respective practices. These include but aren’t limited to speech therapy professionals, teachers trained to work with special needs children, and psychologists.
PRT isn’t a one-size-fits-all therapy. Using key guidelines, therapists and teachers customize activities to achieve core objectives. Teachers and therapists will, therefore, spend quality time with the child, studying daily routines to improve prompts and practices and taking mental notes. Even though the child predominantly takes the lead, both preconceived and free-form exchanges unfold during each session. Teachers and therapists compartmentalize six segments to capitalize on meeting goals.
In a weeklong period, teachers and therapists may spend as many as 25 hours or longer on PRT. However, therapy sessions must not fall below 25 hours per week.
If improvements in behavioral patterns are noted as time progresses, modifications are usually made. Parents and the family unit also play a key role in PRT success rates. As a result, guardians and/or family members are generally introduced to the main strategies of PRT, resulting in an adopted routine or way of life. In short, all members of the family are encouraged to be involved.
Is PRT even worth incorporating in your special needs practice classroom?
PRT’s efficacy is validated by several years of research and findings. According to studies conducted by the US National Library of Medicine National Institutes of Health, findings suggest PRT provides behavioral advantages and improvements to participants, not excluding neurotypical students. In another study conducted by NCBI, researchers confirm that PRT prompts a purposeful rewiring of the brain – for the better.
Let’s look at this PRT assessment, published by Semantics Scholar, to reinforce these conclusions. The neuro-report explores MRI imaging conducted in patients before and after Pivotal Response Treatments. Indisputably, studies report notable improvements in neurodevelopment, particularly in the parts of the brain responsible for communication and social skills.
Several factors affect coverage, including geographical location and the type of coverage in effect. Generally speaking, most private health insurance groups cover ABA therapies, including PRT, but this isn’t a guarantee. To confirm coverage, call or speak to your insurance provider for details.
Medicaid covers Pivotal Response Training, where a licensed doctor prescribes this treatment to be medically necessary –, and the child is a minor (under 21 years of age).
Due to the validated effectiveness of PRT, this therapy has been growing in popularity, not only in North America – but worldwide. As a result, it’s fairly easy to locate a PRT provider. It should be noted that not all PRT professionals receive formal training. Currently, certifications are provided by one institution nationwide: the Koegel Autism Center in California. Nevertheless, training (not certifications) is offered at several institutions nationwide.
The Koegel Autism Center has moreover published its training manual, which can be accessed by anyone interested.
The easiest place to start your search is a medical provider’s office. Your doctor can recommend established education centers offering pivotal response training in group or one-on-one settings or a combination of both.