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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.

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 group rooms. As a guideline, the max number of participants allowed in group settings is five students, per UC Santa Barbara. Pivotal Response Treatment is a subdivision of Applied Behavior Analysis or ABA and therefore uses many of the same guidelines.

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What are the main objectives for treating autism with PRT?

Some of the predominant goals for treating a child on the spectrum with PRT include:

  1. Stimulating verbal communication between all participants (i.e., the therapist and child)
  2. Learning social skills
  3. Diverting stimming, commonly known as self-stimulation via repetitive behaviors that may be considered disruptive
  4. Taking a multifaceted approach to key behavioral improvements rather than focusing on a singular goal, hence the term “pivotal response treatment”.

What are the pivotal areas being targeted, you may ask?

The treatment targets four main skills:

  • Drive and passion for learning: In other words, therapists aim to encourage the child’s level of self-motivation
  • Reactions to various prompts: Through repetition and learning through play, the child begins to understand more of the world around them and what responses are generally anticipated
  • Self-control: Earlier, we mentioned that stimming was a big concern for parents and education in children with autism. Many such stimulatory behaviors are not only disruptive, but they can also cause physical harm to children. With PRT, children learn to soothe sensory overloads by diverting one’s attention to a productive activity
  • Start or engage in conversations: PRT also emphasizes teaching children on the spectrum how to initiate conversations with others.

The end goals are to improve the children:

  • Social abilities
  • Interaction skills
  • Conduct
  • Understanding

During treatment, the therapist incorporates tested motivation tactics that promote improvements in a natural vs. clinical way.

Sample analysis of PRT

To provide more insight, let’s look at this PRT example:

In PRT, 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.

A Brief History of PRT:

PRT was established at the University of Santa Barbara, California, in the 1970s through the culmination of years of research and practice conducted by:

  • Dr. Robert L. Koegel
  • Dr. Lynn Kern Koegel
  • Dr. Laura Shreibman

PRT was labeled “Natural Language Paradigm” or NLP during the initial stages of development and initiation. Some other early program names include:

  • Pivotal response intervention
  • Pivotal response teaching
  • Pivotal response therapy
  • Pivotal response training

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 is customizable

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 one-on-one time with the child, taking mental notes and studying daily routines to improve prompts and practices. 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.

What is the average timeframe for PRT sessions?

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.

Are PRT curriculums the same for every session or week?

As time progresses and if improvements in behavioral patterns are noted, modifications are typically made. Parents and the family unit also play a key role in PRT success rates. As a result, caretakers and/or family members are generally introduced to the main strategies used in PRT, prompting an adopted routine or way of life. In short, all members of the family are encouraged to be involved.

How effective is PRT?

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 point to PRT providing behavioral improvements and advantages 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. Unequivocally, studies point to notable neurodevelopmental improvements, particularly in brain parts responsible for social and communication skills.

Do insurance carriers pay for PRT autism?

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.

What about Medicaid, you may ask?

Medicaid covers Pivotal Response Training when a licensed and approved doctor prescribes this treatment medically necessary –, and the child is a minor under 21 years old.

Where to Locate Approved PRT Providers

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. One institution nationwide offers certifications: California at the Koegel Autism Center. 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 make referrals and pinpoint established education centers offering pivotal response training in one-on-one, group settings, or a combination of both.