The Autism Blog

Pivotal Response Training (PRT)

August 3, 2011

PRT. Yet Another Acronym. What is Pivotal Response Training and How Does it Differ from Other Behavioral Interventions?

If you have been following our blog recently you know that we are in full swing with our series on autism treatments. We featured two posts that reviewed Applied Behavioral Analysis (ABA) therapy so it only makes sense that we now move on to covering Pivotal Response Training (PRT). PRT is yet another type of ABA therapy. Remember, we learned that ABA therapy is not a synonym for discrete trial training, which is often how people use the term. ABA therapy is the science of altering human behavior through learning principles. And PRT uses those very same principles, but in a different way. So, your next question is logically…then what is PRT?

PRT is considered a naturalistic behavioral intervention

This means that it utilizes the principles of ABA (e.g., reinforcement), but also incorporates developmental principles, such as following the child’s lead in intervention. Rather than applying ABA principles in a highly structured way, as in discrete trial training, in PRT parents are taught to embed ABA teaching principles into interactions with their child to enhance learning. In PRT, parents are taught to provide clear prompts to the child and reinforce targeted skills during natural parent-child interactions. While this might seem pretty simple (and many parents do it all the time without training), what sets PRT apart from other behavioral interventions is its focus on “pivotal areas”, such as motivation.

Pivotal areas are thought of as areas one can target in intervention that result in widespread gains in other untargeted areas. For example, when motivation is targeted in intervention, studies have shown that eye contact and joint attention improve as a result even if those skills are not directly taught. In contrast to discrete trial training, where the focus is on teaching each individual or “discrete” skill, the focus in PRT is on addressing pivotal areas so one does not have to teach each individual skill.

To get down to the nuts and bolts, PRT includes seven simple principles that parents are taught to use. Some of the principles are derived from ABA and some are more developmentally based, with similarities to treatment models such as Floortime (see our future blog on this topic).

The PRT principles include

Gaining the child’s attention and providing clear prompts to the child to cue the behavior you are trying to teach (clear prompts)
Following the child’s lead in the teaching interaction to insure the context or activity is motivating (child choice)
Obtaining shared control in the environment in order to provide natural reinforcers in a contingent manner (shared control)
Providing reinforcement contingent on the child producing the prompted behavior (contingent reinforcement)
Providing reinforcement that is natural to and embedded within the teaching interaction (natural reinforcement)
Reinforcing the child for trying to produce the prompted behavior if they are not yet fully capable of doing so (reinforcing attempts, aka shaping)
Interspersing tasks that have already been mastered (maintenance) with tasks that are still being learned (acquisition) to enhance motivation (task variation)

Examples of PRT teaching interactions

Let’s look at some examples of PRT teaching interactions for targeting language and play skill goals.

Teaching Expressive Language

Clear Prompt: “Do you want the ball?”

Child Choice: Occurs in context where child wants the ball

Shared Control: Parent is holding the ball

Contingent/ Natural Reinforcement: Child receives the ball contingent on saying the word or another appropriate word or phrase

Reinforcing Attempts: Child could receive the ball continent on trying to say the word, depending on current language level

Task Variation: If this task was easy the parent might present a more difficult task next or vice versa

Teaching Symbolic Play

Clear Prompt: “Drive the truck!” While demonstrating the action.

Child Choice: Occurs in context where the child wants the truck

Shared Control: Parent is holding the truck

Contingent/ Natural Reinforcement: Child receives full access to the truck contingent on imitating the parent’s action first

Reinforcing Attempts: Child could receive the truck contingent on partially completing the behavior depending on current play skill level

Task Variation: If this task was difficult the parent might present an easier task next or vice versa

Now a lot of ABA folks look at these principles and say, “well that’s just good ABA!” Which is true! It is just delivered in a naturalistic format, where parents are the primary intervention agents. It also places the focus equally between putting demands on the child and targeting motivation.

PRT Pros and Cons

Like anything, there are pros and cons to this model.

Pros

teaching parents is an efficient way to create intensity of intervention without needing hours and hours with a clinician
skills that are taught in natural environments often generalize better, which is particularly important in autism
focusing on motivation in therapy can be extremely important for children with autism, especially because they often do not have the same social motivation to learn as typically developing children
parents and families often find naturalistic interventions more acceptable and desirable (social validity) than structured behavioral interventions

Cons

some children learn better in highly structured environments and therefore, struggle with naturalistic models
some skills can be difficult to teach in a child-driven, naturally reinforcing manner (e.g., higher level academics)
some parents find it challenging to learn and/or incorporate behavioral intervention strategies into parent-child interactions
because PRT involves more parent participation than other intervention programs, some parents may find it is not feasible, given competing demands related or unrelated to parenting a child with autism

Whichever intervention model is best for your child and family, PRT is certainly among your choices! It has strong empirical evidence, which is the result of years of research supporting this model. Have you tried PRT and/or other ABA-based interventions? What worked for your child and why? Share your stories with us and the other families who may have questions about how to choose an intervention for their child.