Pivotal response treatment

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Pivotal response treatment (PRT), also referred to as pivotal response training, is a naturalistic form of applied behavior analysis used as an early intervention for children with autism that was pioneered by Robert and Lynn Koegel. PRT 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, Richard Simpson of the University of Kansas identified pivotal response treatment as one of the four scientifically based treatments for autism.[1]


Initial 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 procedures to develop verbal communication in children with autism.[2] 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 would result in widespread improvement in other areas. Pivotal response treatment (PRT) is based on a belief that autism is a much less severe disorder than originally thought.


Pivotal response treatment is a naturalistic intervention model derived from the principles 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] responsiveness 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] mand training, 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 to 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 are 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) described PRT as a scientifically based practice for treating autism, and the effectiveness of pivotal response therapies as having been "proven". Research of its effects on children with autism is continuing as of 2005.[1]


An article published in 2015 from Mohammadzaheri et al.[11] found that PRT can be up to eight times more effective than standard ABA practices for reducing certain behaviors.


  1. ^ a b 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 (2): 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. doi:10.1037/0021-843X.88.4.418. 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. doi:10.1016/0022-0965(82)90060-1. 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. doi:10.1352/0895-8017(1998)102<0346:SGOQBC>2.0.CO;2. ISSN 0895-8017. PMID 9475943. Retrieved 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. doi:10.1901/jaba.1987.20-243. PMC 1286014. PMID 3667475.
  7. ^ Dunlap G, Koegel RL (1980). "Motivating autistic children through stimulus variation". Journal of Applied Behavior Analysis. 13 (4): 619–627. doi:10.1901/jaba.1980.13-619. PMC 1308168. PMID 7204282.
  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. doi:10.1007/BF02211871. PMID 3215880.
  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. doi:10.1901/jaba.1981.14-53. PMC 1308185. PMID 7216932.
  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. doi:10.1901/jaba.1990.23-119. PMC 1286216. PMID 2335483.
  11. ^ Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaei, Mohammad; Bakhshi, Enayatolah (2015-09-01). "A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism". Journal of Autism and Developmental Disorders. 45 (9): 2899–2907. doi:10.1007/s10803-015-2451-4. ISSN 1573-3432. PMC 4554985. PMID 25953148.

Further reading[edit]

  • Bryson SE, Koegel LK, Koegel RL, Openden D, Smith IM, Nefdt N (2007). "Large scale dissemination and community implementation of Pivotal Response Treatment: Program description and preliminary data" (PDF). Research and Practice for Persons with Severe Disabilities. 32 (2): 142–153. doi:10.2511/rpsd.32.2.142. Archived from the original (PDF) on 2013-05-12.
  • Harper CB, Symon JB, Frea WD (2007). "Recess is time-in: using peers to improve social skills of children with autism". J Autism Dev Disord. 38 (5): 815–26. doi:10.1007/s10803-007-0449-2. PMID 17874290.
  • Koegel LK, Koegel R, Nefdt N, Fredeen R, Klein E, Bruinsma YE (2005). "First S.T.E.P.: A Model for Early Identification of Children with Autism Spectrum Disorders". Journal of Positive Behavior Interventions. 7 (4): 247–252. doi:10.1177/10983007050070040601.
  • Koegel LK (October 2000). "Interventions to facilitate communication in autism" (PDF). Journal of Autism and Developmental Disorders. 30 (5): 383–91. doi:10.1023/A:1005539220932. PMID 11098873.
  • Koegel LK, Koegel RL, Harrower JK, Carter CM (1999). "Pivotal response intervention I: Overview of approach". Journal of the Association for Persons with Severe Handicaps. 24 (3): 174–185. doi:10.2511/rpsd.24.3.174.
  • Koegel LK, Koegel RL, Shoshan Y, McNerney E (1999). "Pivotal response intervention II: Preliminary long-term outcomes data". Journal of the Association for Persons with Severe Handicaps. 24 (3): 186–198. doi:10.2511/rpsd.24.3.186.
  • Koegel, Lynn Kern & Claire LaZebnik (2005). Overcoming Autism. Penguin (Non-Classics). ISBN 978-0-14-303468-1.
  • Koegel, Lynn Kern; Robert L. Koegel & Glen Dunlap (1996). Positive Behavioral Support: Including People with Difficult Behavior in the Community. Brookes Publishing Company. ISBN 978-1-55766-228-6.
  • Koegel RL, Koegel LK, McNerney E (2001). "Pivotal behaviors in the treatment of autism". Journal of Clinical Child Psychology.
  • Koegel RL, Brookman L, Koegel LK (2003). "Autism: Pivotal response intervention and parent empowerment". Trends in Evidence-based Neuropsychiatry.
  • Koegel RL, Carter CM, Koegel LK (2003). "Teaching children with autism self-initiations as a pivotal response". Topics in Language Disorders. 23 (2): 134–145. doi:10.1097/00011363-200304000-00006.
  • Koegel, Robert L. & Lynn Kern Koegel (c. 2006). Pivotal Response Treatments for Autism : Communication, Social, and Academic Development. Baltimore, Md.: Paul H. Brookes. ISBN 978-1-55766-819-6.
  • Koegel RL, Koegel LK, Carter CM (1999). "Pivotal teaching interactions for children with autism". School Psychology Review. 28 (4): 576–594.
  • Koegel, Robert L. & Lynn Kern Koegel (1996). Teaching Children with Autism: Strategies for Initiating Positive Interactions and Improving Learning Opportunities. Brookes Publishing Company. ISBN 978-1-55766-180-7.

External links[edit]