Applied behavior analysis uses a data-driven approach to help individuals adjust their behavior away from negative outcomes to new positive behaviors. One of the most effective tools used by ABA therapists is called “Pivotal Response Training (PRT). What is Pivotal Response Therapy? This approach is designed to encourage children with autism, and others to monitor their behaviors and change them over time.

PRT therapy often uses play to help the child communicate and socialize more effectively with others. It’s an evidence-based practice that focuses on less structured playtime, that is guided just as much by the child as it is by the therapist. This gives the child a sense of agency in the process, while also helping to keep them encouraged to participate.

Many of PRT’s core techniques are involved in parent training sessions, to help children make the most out of the process when they engage their child with ASD. This helps boost treatment success rates, by letting the child reinforce the process in the comfort of their own home.

A typical PRT session often starts with the child playing with the parent or therapist. The adult gives the child the opportunity to make some choices while rewarding specific behavioral changes. This might be rewarding the child when they use a full sentence or working toward some other therapeutic milestone.

This variability and choice dynamic means that pivotal response training can be used to make changes in broad categories of behavior. This includes cognitive development, socialization, and communication. Though the underlying goal is always to encourage the child to monitor their own behavioral reactions to learn to self-regulate or find their own internal motivation.

How Does Pivotal Response Training Work?

Pivotal response training is designed to support a child with autism spectrum disorder by reducing self-stimulating behaviors, or stimming. This helps reduce disruptive behaviors that can often get in the way of parents, teachers, or peers who are trying to interact with the child.

PRT focuses on “Pivotal” points in the child’s development. These can occur over a broad range of interactions and responses without having to exclusively focus on just one skill at a time. PRT can be used to:

  • Motivate them to communicate
  • Encourage them to socialize
  • Stay focused on specific activities
  • Improve social interactions
  • Self-regulate emotions
  • Practice healthy self-management.
  • Respond to multiple cues at a time

PRT Empowers Self-Regulation

With PRT the focus is often on making a positive change through self-regulation and choosing positive behaviors over negative ones. This leads to widespread improvements. Many times rewards for positive behaviors directly correlate to what the parent or the therapist is trying to get from the interaction.

Let’s say your child has been struggling to communicate, but they attempt to ask for a specific snack. Even if they don’t perform the behavior perfectly, you should still reward the effort with that snack rather than an unrelated prize.

Who Can Use PRT?

For a lot of children with ASD parents are the primary implementors of PRT. Though PRT can be used in a variety of settings, including their home, school, and the greater community. Other people in the child’s support team and those who interact with the child, such as siblings, extended family, teachers, and other therapists can all benefit from applying PRT concepts to their interactions.

Will Insurance Cover PRT?

Many private health insurance policies provide coverage for behavioral services such as PRT and applied behavior analysis. Though the level of coverage can vary depending on the type of insurance you have, and the state you live in.

By law, Medicaid plans must cover treatments that are deemed to be “Medically Necessary” for any child under the age of 21. If a physician or ABA therapist prescribes PRT and says it is medically necessary for your child, Medicaid will cover the cost.

How Effective Is PRT?

PRT is most effective when it’s based on a pivotal moment in a child’s development. These pivotal responses need to be targeted to make the strongest change in behavioral cusps. These mindfully timed changes then spread throughout several aspects of the child’s life. These positive interactions then become reinforcing experiences that the child takes in as being part of their “New Normal.”

A growing body of research has found that the process of PRT is most effective for children with autism, between 2 to 16 years of age. PRT used to help children with autism who are 5 years old or younger, has been shown to improve verbal communication skill by 85% to 90%.

Another study published in 2014 found that children with autism spectrum disorder who participated in PRT therapy went on to improve in targeted skill areas. This included pragmatic skills, as well as self-regulation of inappropriate social initiation. They also showed improvements in the use of context, a better ability to build rapport with their peers, and improvements in language.

How Is PRT Implemented?

PRT typically has six recognized forms of implementation. This consists of:

  • Offering choices based on following the child’s lead
  • Capturing the child’s attention
  • Providing opportunities for the child to respond
  • Integrating play while learning new tasks
  • Using contingent and natural reinforcement
  • Consistently reinforcing any attempt at learning a targeted skill

Who Provides PRT

Pivotal response training starts with an ABA therapist or someone from a similar form of behavioral science instructing the parents and other key caregivers in the primary PRT techniques. Many ABA therapists will include some form of PRT instruction as part of a parenting education process.

These training sessions are an excellent opportunity for you to ask questions and explore any areas of concern. Your child’s ABA therapist might even engage in a practice session with your child with you present so you can see the process in action.

One of the great things about PRT is that its adaptability means it can be used at home or in other important settings in the child’s life. It’s an opportunity to take approaches introduced in the ABA clinical setting and move them out into the real world.
PRT is primarily performed by parents. Though teachers in prekindergarten or special education classes can also use PRT concepts to help create specific drills that practice specific behaviors as a way to support ongoing behavioral change.