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.cite journal |journal= Focus Autism Other Dev Disabl |date=2005 |volume=20 |issue=3 |pages= 140–9 |title= Evidence-based practices and students with autism spectrum disorders |author= Simpson RL |doi=10.1177/10883576050200030201]

History

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 Paradigmcite journal| journal=Journal of Autism and Developmental Disorders|year=1987|title=A natural language teaching paradigm for nonverbal autistic children|author=Koegel RL, O'Dell MC, Koegel LK|doi=10.1007/BF01495055|volume=17|pages=187–200|pmid=3610995 ] 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

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,cite journal |journal=Journal of Abnormal Psychology |date=1979 |volume=88 |issue=4 |pages= 418–426 |title= Motivating autistic Children |author= Koegel RL, Egel AL|pmid=479464] responsivity to multiple cues,cite journal |journal=Journal of Experimental Child Psychology |date=1982 |volume=33 |issue=3 |pages= 475–491 |title= Teaching autistic children to use extra stimulus prompts |author= Schreibman L, Charlop MH, Koegel RL|pmid=7097156] self-management, and social initiations.cite journal |journal=American Journal on Mental Retardation |date=1998 |volume=102 |issue=4 |pages= 346–357 |title= Generalization of question asking in children with autism |author= Koegel LK, Camarata S, Valdez-Menchaca M, Koegel RL|pmid=9475943|url=http://vnweb.hwwilsonweb.com/hww/results/results_common.jhtml;hwwilsonid=GMWXQQDTBPF35QA3DILSFGGADUNGIIV0|accessdate=2008-07-18 ] 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,cite journal |journal=Journal of Applied Behavior Analysis |date=1987 |volume=20 |issue=3 |pages= 243–252 |title= The influence of child-preferred activities on autistic children's social behavior |author= Koegel RL, Dyer K, Bell LK|pmid=3667475|url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=3667475|accessdate=2008-07-17 ] task variation,cite journal |journal=Journal of Applied Behavior Analysis |date=1980 |volume=13 |issue=4 |pages= 619–627 |title= Motivating autistic children through stimulus variation |author= Dunlap G, Koegel RL|pmid=7204282|url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=7204282|accessdate=2008-07-18 ] interspersing maintenance tasks, rewarding attempts,cite journal |journal=Journal of Autism and Developmental Disorders |date=1988 |volume=18 |issue=4 |pages= 525–538 |title= Producing speech use in nonverbal autistic children by reinforcing attempts |author= Koegel RL, O'Dell MC, Dunlap G|pmid=3215880|url=http://www.springerlink.com/content/u150538212m11836/|accessdate=2008-07-18 ] and the use of direct and natural reinforcers.cite journal |journal=Journal of Applied Behavior Analysis |date=1981 |volume=14 |issue=1 |pages= 53–60 |title= Response-reinforcer relationships and improved learning in autistic children |author= Williams JA, Koegel RL, Egel AL|pmid=7216932|url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=7216932|accessdate=2008-07-18] 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,cite journal |journal=Journal of Applied Behavior Analysis |date=1990 |volume=23 |issue=1 |pages= 119–127 |title= Extended reductions in stereotypic behavior of students with autism through a self-management treatment package |author= Koegel RL, Koegel LK|pmid=2335483|url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=2335483|accessdate=2008-07-18] 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.

Footnotes

Further reading

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External links

* [http://kady.education.ucsb.edu/autism/ UCSB Koegel Autism Center]