Applied behavioral analysis (ABA) therapy is often thought of as the gold standard for treating individuals with autism spectrum disorders. It’s therapeutic approaches and treatments have proven successful at every level for helping people with ASD to achieve greater personal milestones.

One of the most successful, and commonly used approaches in ABA therapy is known as pivotal response therapy (PRT). This is a naturalistic intervention model that uses ABA’s data-driven principles in a play-based methodology designed to improve “Pivotal” moments in common child development. At its core is the concept that changes in pivotal responses would spark widespread progress in other developmental areas.

History of Pivotal Response Therapy

PRT can trace its roots all the way back to the 1970s when it was originally pioneered by Dr. Robert Koegel and Dr. Lynn Kern Koegel at the University of California-Santa Barbara. At the time it was called Natural Language Paradigm (NLP). Though it gradually evolved to include pivotal response teaching, and the combined methodology was renamed PRT.

Pivotal Response Therapy Skills

PRT is agile as well as versatile, which makes it a great method for helping individuals with ASD to improve a wide range of skills including:

  • Social skills
  • Communication skills
  • Unlearning negative behaviors
  • Adopting positive behaviors
  • Improving academics

A growing body of research has found PRT to be highly effective at improving pivotal areas of a child’s development throughout preschool, elementary, and middle school levels. It is especially effective for helping the academics of children with autism spectrum disorders.

Pivotal Response Therapy Primary Targets

Pivotal response therapy is designed to target negative behaviors and modify or replace them with positive ones by addressing four main “pivotal” areas of a child’s development. This involves targeting four specific areas.

  • Motivation
  • Response to Multiple Cues
  • Self-Management

Encouraging Initiation in Social Interaction

PRT strives to increase a child’s desire to learn and perform new skills that are directly associated with positive consequences. Instead of forcing tasks, PRT engages a child’s interests to reinforce positive social behaviors that are triggered enthusiastically.
The ABA therapist might use a variety of possible motivational procedures including task variation, interspersing maintenance, and acquisition tasks.

The second pivotal area of focus is initiation. PRT directly encourages a child to initiate social interaction through the asking of key questions or by techniques designed to obtain and retain attention. At that point, the skill development exercise adds self-regulation, with the focus being on teaching the child to self-evaluate and discriminate their behaviors in a way that opens the door for increasing independence. The final stage of the PRT process then trains the child to respond to multiple cues rather than focus on specific details or stimuli.

What Does A PRT Session Look Like?

Pivotal Response Therapy sessions typically evoke positive reinforcement to address targeted areas, to help the child progress toward increased sociability. These sessions use a customized approach to meet the unique needs of each child and their routines.

A lot of school-based pivotal response programs have up to 25 hours of weekly sessions, which can decrease over time based on how well the child responds to them.

PRT Practice At Home

For maximum reinforcement value parents and caregivers should also adopt PRT methods in their home environment. This unilateral level of consistency helps the child adopt the changes as their “New Normal.”

Many PRT approaches use some form of play therapy to target social skill development. This often leads to unstructured interactions that include things like:

  • Practicing taking turns
  • Use of playful imitation
  • Joint attention to detail
  • Direct peer interaction
  • Transitioning from one activity to another
  • Taking care of daily chores
  • Helping with mealtimes & food prep

A basic introductory PRT session might look like this:

The important aspects of these at-home sessions are that the child is motivated to participate and that they are rewarded with a natural reward for a correct response. Of course, this also makes parent/caregiver training critically important. Especially since the bulb of PRT as an autism intervention needs to take place in a natural setting.

Who Offers PRT Therapy?

PRT isn’t just offered by clinical ABA therapists. PRT can be administered in a wide range of settings including schools, clinical settings, at home, and more.

PRT administrators can be:

  • School psychologists
  • Special education teachers
  • Speech-language pathologists
  • Occupational therapists

A lot of applied behavior analysts will use PRT concepts in the customized treatment plans they create for their patients.

Pivotal Response Therapy Qualifications

To be able to treat children with autism spectrum disorder PRT providers must attain at least a master’s degree in either:

  • Counseling
  • Psychology
  • Education
  • Therapy

Once certified PRT practitioners will still need special certification beyond their training and licensing. This includes 3 levels of PRT certification that can be obtained via workshops.

Does Insurance Cover Pivotal Response Therapy?

Most private and employer-sponsored health insurance policies will cover therapies like PRT and many common types of ABA therapy. This is thanks in large part to PRT being a data-driven, evidence-based approach to helping children with autism spectrum disorder in a way that is truly measurable.

Since Pivotal Response Training is a form of applied behavior analysis, the majority of health insurance companies will cover all or part of the treatment. However, you will need to reach out to your insurance company to check your specific policy coverage. Often they will need to coordinate with the provider, or the PRT provider might need to submit pre-approval documents to ensure compliance with the insurance company’s standards for coverage.

If your child is actively enrolled in a Medicaid plan, pivotal response therapy will likely be covered so long as it is prescribed by a physician. There also needs to be documentation demonstrating that it is deemed to be “Medically Necessary” for PRT to be fully covered by Medicaid.