Pivotal Response Pivotal Response TreamentTreament

A Brief Overview of an Autism Therapy A Brief Overview of an Autism Therapy ApproachApproach

By-Catherine Livingston and Earlene DarlingBy-Catherine Livingston and Earlene DarlingBrandman University EDUU 676, January 22, Brandman University EDUU 676, January 22,

20112011

A Snapshot of Pivotal Response A Snapshot of Pivotal Response TreatmentTreatment

Pivotal Response Treatment (PRT) is a behavioral Pivotal Response Treatment (PRT) is a behavioral intervention therapy for intervention therapy for autism.

A treatment for Autism based on Applied Behavior A treatment for Autism based on Applied Behavior Analysis (ABA) principles. It is one of four research-Analysis (ABA) principles. It is one of four research-based ABA therapies.based ABA therapies.

was created by Dr Lynn and Robert Koeglewas created by Dr Lynn and Robert Koegle

Is also based on Natural Language Training.Is also based on Natural Language Training.

Focuses on increasing communication, motivation and Focuses on increasing communication, motivation and appropriate responses to cues in children diagnosed appropriate responses to cues in children diagnosed with Autism.with Autism.

Targets areas of development rather than specific Targets areas of development rather than specific behaviors (i.e. motivation, responses to cues) behaviors (i.e. motivation, responses to cues) 

Main goal is to increase “normal” behaviorsMain goal is to increase “normal” behaviors

A Description of The Pivotal Response TreatmentA Description of The Pivotal Response Treatment

PRT aims to increase a child’s motivation to learn, monitoring PRT aims to increase a child’s motivation to learn, monitoring

of his/her own behavior, and initiations of communication of his/her own behavior, and initiations of communication

with others.with others.

PRT targets PIVOTAL AREAS of a child's development, such as PRT targets PIVOTAL AREAS of a child's development, such as

motivation, responses to multiple cues, self-management, motivation, responses to multiple cues, self-management,

and appropriate self-initiationand appropriate self-initiation

These changes are described as pivotal because they are These changes are described as pivotal because they are

viewed as helping the child learn a wide range of other skills. viewed as helping the child learn a wide range of other skills.

Pivotal Response Treatment™ Description Pivotal Response Treatment™ Description Cont.Cont.

Pivotal Response Treatment™ is a highly Pivotal Response Treatment™ is a highly acclaimed research-based intervention for acclaimed research-based intervention for individuals with Autism Spectrum Disorders. individuals with Autism Spectrum Disorders.

PRT is a naturalistic intervention model PRT is a naturalistic intervention model derived from Applied Behavior Analysis derived from Applied Behavior Analysis Methods. Methods.

PRT is different than some other ABA PRT is different than some other ABA methods because the focus is on improving methods because the focus is on improving developmental deficits rather than developmental deficits rather than targeting specific behaviors.targeting specific behaviors.

Parents are taught to provide the therapy in Parents are taught to provide the therapy in the child’s natural environment. Natural the child’s natural environment. Natural and targeted reward systems are taught to and targeted reward systems are taught to parents so they can implement them with parents so they can implement them with their child.their child.

Target Population for Target Population for PRTPRTYoung children with Autism are the most appropriate Young children with Autism are the most appropriate

recipients of PRT. This therapy is targeted toward recipients of PRT. This therapy is targeted toward children who are elementary school aged or younger.children who are elementary school aged or younger.

Some children with other developmental disabilities Some children with other developmental disabilities can benefit from PRT methods.can benefit from PRT methods.

The PRT intervention program is geared specifically The PRT intervention program is geared specifically to the individual child so it is appropriate for severe to the individual child so it is appropriate for severe to mildly autistic individuals.to mildly autistic individuals.

Research supports the use of PRT with both very Research supports the use of PRT with both very young and older subjects can yield improved young and older subjects can yield improved communication and responses to cues. (Hupp & communication and responses to cues. (Hupp & Reitman, 2000; Koegel & Frea, 1993; Koegel, Koegel, Reitman, 2000; Koegel & Frea, 1993; Koegel, Koegel, Harrower et al., 1999; Pierce & Schreibman, 1997).?Harrower et al., 1999; Pierce & Schreibman, 1997).?

Purpose of PRTPurpose of PRTTeach language skillsTeach language skills

Decrease disruptive/self-Decrease disruptive/self-stimulatory behaviors,stimulatory behaviors,

Increase social, Increase social, communication, and communication, and academic skills.”academic skills.”

The focus on reducing The focus on reducing problematic/atypical problematic/atypical behaviorsbehaviors

in children with Autisin children with Autismm

Key ResearchersKey ResearchersDrs. Lynn and Robert Koegel Drs. Lynn and Robert Koegel

Drs. Robert and Lynn Koegel from Drs. Robert and Lynn Koegel from the University of California, Santa the University of California, Santa Barbara are the developers of Barbara are the developers of Pivotal Response Treatment.Pivotal Response Treatment.

Over the past 30 years, the Over the past 30 years, the Koegels, their graduate students, Koegels, their graduate students, and their colleagues have and their colleagues have published over 200 research published over 200 research articles in peer-reviewed journals articles in peer-reviewed journals that support the effectiveness of that support the effectiveness of PRT, and have written over 30 PRT, and have written over 30 books and manuals.books and manuals.

PRT is listed by the National PRT is listed by the National Research Council as one of the ten Research Council as one of the ten model programs for autism, and is model programs for autism, and is one of four scientifically based one of four scientifically based practices for autism intervention in practices for autism intervention in the U.S. (Simpson, 2005).the U.S. (Simpson, 2005).

Some Research Some Research States-States-

Children with autism have difficulties making Children with autism have difficulties making initiations. Previous research has found that initiations initiations. Previous research has found that initiations are associated with more positive long-term outcomes are associated with more positive long-term outcomes and that children with autism can be taught initiations and that children with autism can be taught initiations using Pivotal Response Treatment.using Pivotal Response Treatment.

Initiations tend to be among the first words of Initiations tend to be among the first words of typically developing children. This project aims to typically developing children. This project aims to teach young children with autism initiations (What's teach young children with autism initiations (What's That?) at a language age approximating that of typical That?) at a language age approximating that of typical development. We anticipate that this will positively development. We anticipate that this will positively affect developmental trajectory and lead to collateral affect developmental trajectory and lead to collateral gains in vocabulary acquisition and generalized gains in vocabulary acquisition and generalized initiations. initiations.

•From University of Santa Barbara Pivotal Response Treatment Research CenterFrom University of Santa Barbara Pivotal Response Treatment Research Center

  

Some Current Research Supports Pivotal Some Current Research Supports Pivotal Response TreatmentResponse Treatment

Nefdt, N., Koegel, R.L., Singer, G., & Gerber, M. Nefdt, N., Koegel, R.L., Singer, G., & Gerber, M. (2010).(2010).Journal of Positive Behavior Intervention. Vol. 12, No.1. Journal of Positive Behavior Intervention. Vol. 12, No.1.

23-32. 23-32.

There is increasing demand for access to effective There is increasing demand for access to effective interventions for families who have children with autisminterventions for families who have children with autism

The purpose of this study was to evaluate, through a The purpose of this study was to evaluate, through a randomized clinical trial, whether the use of a self-randomized clinical trial, whether the use of a self-directed learning program could result in changes in directed learning program could result in changes in behavior for parents and their children with autism. behavior for parents and their children with autism.

Results indicated significant differences between Results indicated significant differences between treatment and control groups at posttest on all of the treatment and control groups at posttest on all of the dependent measures.dependent measures.

Furthermore, all of the parents who completed the self-Furthermore, all of the parents who completed the self-directed learning program reported high ratings of directed learning program reported high ratings of satisfaction. satisfaction.

The data suggest the efficacy and effectiveness of a self-The data suggest the efficacy and effectiveness of a self-directed learning program to serve as an initial step directed learning program to serve as an initial step toward providing intervention for parents with children toward providing intervention for parents with children with autism.with autism.

The Steps of PRTThe Steps of PRTKoegel, Koegel, and Suratt (1992) suggested the Koegel, Koegel, and Suratt (1992) suggested the

following steps to teach self‐management:following steps to teach self‐management:

  Step 1: Identify the desired behavior. Step 1: Identify the desired behavior.

The teacher and the child identify a desired The teacher and the child identify a desired behavior they will work on. The desired behavior they will work on. The desired behavior has to be measurable and objective. behavior has to be measurable and objective.

  Step 2: Identify reinforcers.Step 2: Identify reinforcers.

The teacher helps the child choose rewards The teacher helps the child choose rewards that are reinforcing to him or her. that are reinforcing to him or her.

In order to improve self‐management capacity, In order to improve self‐management capacity, it is recommended that internal reinforcement it is recommended that internal reinforcement be paired with external rewards. be paired with external rewards.

The Steps of PRT The Steps of PRT Cont.Cont.

Step 3: Select a self‐monitoring deviceStep 3: Select a self‐monitoring device. .

The teacher decides on a method of collecting The teacher decides on a method of collecting data that is appropriate for the child.  data that is appropriate for the child.  

Step 4: Teach to self‐monitorStep 4: Teach to self‐monitor. .

The teacher teaches the child how to monitor The teacher teaches the child how to monitor the occurrence or absence of the desired the occurrence or absence of the desired behavior using the selected self‐monitoring behavior using the selected self‐monitoring device.  device.  

Step 5: GeneralizeStep 5: Generalize. .

The teacher collects data to see whether the The teacher collects data to see whether the child can generalize the self‐management child can generalize the self‐management procedures into real‐life situations. procedures into real‐life situations.

  

  

Some Other Information Some Other Information About PRTAbout PRT

The primary goal of PRT is to instill The primary goal of PRT is to instill motivation in the child with autism to motivation in the child with autism to respond to cues and social interactions that respond to cues and social interactions that can replace inappropriate or atypical can replace inappropriate or atypical behaviors.behaviors.

Parents and Teachers are trained to be the Parents and Teachers are trained to be the PRT therapists.PRT therapists.

Parents and teachers are trained to Parents and teachers are trained to recognize opportunities where natural recognize opportunities where natural reinforcers can be used to increase the reinforcers can be used to increase the child’s internal motivation to respond child’s internal motivation to respond appropriately to multiple cues.appropriately to multiple cues.

Some Parent ResourcesSome Parent Resources

Where to Order Pivotal Response Training Where to Order Pivotal Response Training Guides-Guides-

http://education.ucsb.edu/autism/help.html

Journal of Positive Behavior Interventions-Journal of Positive Behavior Interventions-

http://education.ucsb.edu/autism/JPBI.htm

About Pivotal Response Treatment-About Pivotal Response Treatment-

http://www.koegelautism.com/http://www.koegelautism.com/

ReferencesReferencesJohnson, Sandi, 2010, Johnson, Sandi, 2010, What is Pivotal Response What is Pivotal Response TreatmentTreatment? ? --http://www.brighthub.com/mental-http://www.brighthub.com/mental-health/autism-pdd/articles/99537.aspxhealth/autism-pdd/articles/99537.aspx

Key Components of PRI-Key Components of PRI-

http://www.autismnetwork.org/modules/behavior/pri http://www.autismnetwork.org/modules/behavior/pri lecture03.html#topic3lecture03.html#topic3

Koegle PRT Home-Koegle PRT Home-

http://www.koegelprt.com/about.htmlhttp://www.koegelprt.com/about.html

Nefdt, N., Koegel, R.L., Singer, G., & Gerber, M. Nefdt, N., Koegel, R.L., Singer, G., & Gerber, M. (2010).(2010).

http://education.ucsb.edu/autism/RecentPublicationhttp://education.ucsb.edu/autism/RecentPublications.htms.htm