PIVOTAL RESPONSE THERAPY
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.
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
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, responsivity
to multiple cues, self-management, and social initiations.
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, task variation,
interspersing maintenance tasks, rewarding attempts, and the
use of direct and natural reinforcers. 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, 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 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.
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5 Koegel LK, Camarata S, Valdez-Menchaca M, Koegel RL (1998). "Generalization
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7 Dunlap G, Koegel RL (1980). "Motivating autistic children through
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8 Koegel RL, O'Dell MC, Dunlap G (1988). "Producing speech use
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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
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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