Autism, PDD-NOS & Asperger's fact sheets | Introduction to Pivotal Response Therapy for children with Autism or Asperger's syndrome
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PIVOTAL RESPONSE THERAPY FOR AUTISM

Pivotal response therapy (PRT), also referred to as pivotal response treatment or pivotal response training, is a behavioral intervention therapy for autism. Pivotal response therapy advocates contend that behavior hinges on 'pivotal' behavioral skills—motivation and the ability to respond to multiple cues—and that development of these skills will result in collateral behavioral improvements. In 2005, Simpson identified Pivotal Response Treatment as one of the four scientifically based treatments for autism.[1]

 

History of Pivotal Response Therapy

Initially attempts to treat autism were mostly unsuccessful, and in the 1960s researchers began to focus on behavioral intervention therapies. Though these interventions enjoyed a degree of success, limitations included long hours needed for thousands of trials and limited generalization to new environments. Drs. Lynn and Robert Koegel incorporated ideas from the Natural Language Paradigm[2] in developing a model to develop verbal communication in children with autism. They theorized that, if effort was focused on certain pivotal responses, intervention would be more successful and efficient. As they saw it, developing these pivotal behaviors will result in widespread improvement in other areas. Pivotal Response Theory (PRT) is based on a belief that autism is a much less severe disorder than originally thought.

 

Theory of Pivotal Response Therapy

Pivotal Response Treatment is a naturalistic intervention model derived from the principals of Applied Behavior Analysis. Rather than target individual behaviors one at a time, PRT targets pivotal areas of a child's development, such as motivation,[3] responsivity to multiple cues,[4] self-management, and social initiations.[5]

 

By targeting these critical areas, PRT results in widespread, collateral improvements in other social, communicative, and behavioral areas that are not specifically targeted. The underlying motivational strategies of PRT are incorporated throughout intervention as often as possible, and they include child choice,[6] task variation,[7] interspersing maintenance tasks, rewarding attempts,[8] and the use of direct and natural reinforcers.[9] The child plays a crucial role in determining the activities and objects that will be used in the PRT exchange. Intentful attempts at the target behavior are rewarded with a natural reinforcer (e.g, If a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer).

 

Pivotal Response Treatment is used to teach language, decrease disruptive/self-stimulatory behaviors, and increase social, communication, and academic skills. The two primary pivotal areas of pivotal response therapy involve motivation and self-initiated activities. Three others are self-management,[10] empathy, and the ability to respond to multiple signals, or cues. Play environments are used to teach pivotal skills, such as turn-taking, communication, and language. This training is child-directed: the child makes choices that direct the therapy. Emphasis is also placed upon the role of parents as primary intervention agents. Simpson (2005) noted that PRT was a scientifically based practice for treating autism. The effectiveness of pivotal response therapies has been proven, but ongoing research of its effects on autistic children is being conducted.[1]

 

Footnotes

1 Simpson RL (2005). "Evidence-based practices and students with autism spectrum disorders". Focus Autism Other Dev Disabl 20 (3): 140–9. doi:10.1177/10883576050200030201.
2 Koegel RL, O'Dell MC, Koegel LK (1987). "A natural language teaching paradigm for nonverbal autistic children". Journal of Autism and Developmental Disorders 17: 187–200. doi:10.1007/BF01495055. PMID 3610995.
3 Koegel RL, Egel AL (1979). "Motivating autistic Children". Journal of Abnormal Psychology 88 (4): 418–426. PMID 479464.
4 Schreibman L, Charlop MH, Koegel RL (1982). "Teaching autistic children to use extra stimulus prompts". Journal of Experimental Child Psychology 33 (3): 475–491. PMID 7097156.
5 Koegel LK, Camarata S, Valdez-Menchaca M, Koegel RL (1998). "Generalization of question asking in children with autism". American Journal on Mental Retardation 102 (4): 346–357. PMID 9475943. Retrieved on 2008-07-18.
6 Koegel RL, Dyer K, Bell LK (1987). "The influence of child-preferred activities on autistic children's social behavior". Journal of Applied Behavior Analysis 20 (3): 243–252. PMID 3667475. Retrieved on 2008-07-17.
7 Dunlap G, Koegel RL (1980). "Motivating autistic children through stimulus variation". Journal of Applied Behavior Analysis 13 (4): 619–627. PMID 7204282. Retrieved on 2008-07-18.
8 Koegel RL, O'Dell MC, Dunlap G (1988). "Producing speech use in nonverbal autistic children by reinforcing attempts". Journal of Autism and Developmental Disorders 18 (4): 525–538. PMID 3215880. Retrieved on 2008-07-18.
9 Williams JA, Koegel RL, Egel AL (1981). "Response-reinforcer relationships and improved learning in autistic children". Journal of Applied Behavior Analysis 14 (1): 53–60. PMID 7216932. Retrieved on 2008-07-18.
10 Koegel RL, Koegel LK (1990). "Extended reductions in stereotypic behavior of students with autism through a self-management treatment package". Journal of Applied Behavior Analysis 23 (1): 119–127. PMID 2335483. Retrieved on 2008-07-18.

 

 

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Pivotal Response Therapy is a behavioral intervention based on similar foundations to that of Applied Behavior Analysis and the Lovaas program for children on the autism spectrum