Pivotal Response Treatment for autistic children

What is Pivotal Response Treatment (PRT)?

Pivotal Response Treatment is a set of teaching techniques used in children’s everyday environments. It isn’t a therapy in itself.

Pivotal Response Treatment focuses on 4 key or ‘pivotal’ areas of autistic children’s development, with the aim of helping children develop more complex skills and behaviour, including social and communication skills.

Pivotal Response Treatment is based on the principles of Applied Behaviour Analysis (ABA). But unlike traditional ABA, which is adult led, PRT is play based and child led.

Other common names for Pivotal Response Treatment include Pivotal Response Intervention and the Natural Language Paradigm.

Who is Pivotal Response Treatment for?

Pivotal Response Treatment techniques are typically used with autistic children aged 2-6 years, but they can be used with autistic people of any age.

What is Pivotal Response Treatment used for?

Pivotal Response Treatment techniques are used to improve autistic children’s social interactions, communication skills, play skills and behaviour, with overall aims of:

increasing children’s participation in everyday activities
promoting children’s independence
reducing children’s need for ongoing therapy and support
improving children’s quality of life.

ABA approaches like Pivotal Response Treatment can help autistic children develop skills and independence. But these approaches should always be used in a way that respects neurodiversity, works with children’s strengths and rewards positive behaviour change.

Where does Pivotal Response Treatment come from?

Pivotal Response Treatment was developed in the 1980s, mainly by a team of psychologists in the United States. Pivotal Response Treatment and other naturalistic teaching techniques grew out of concerns about more traditional behaviour approaches and how well the skills children learned using these approaches could be adapted for different settings.

Naturalistic techniques like Pivotal Response Treatment are based on the work done by researchers Hart and Risley in the 1970s. Their studies focused on improving language development in preschool children with language delays.

What is the idea behind Pivotal Response Treatment?

The theory behind Pivotal Response Treatment is that there are 4 key areas of child development that are ‘pivotal’ to later development:

Motivation – this is encouraging learning by giving children choices, varying tasks, giving new tasks, prompting and using rewards.
Self-initiation – this is encouraging and rewarding children’s curiosity, like when children ask questions about something they see.
Self-management – this is helping children learn to be more independent and take responsibility for their learning.
Responsiveness to multiple cues – this is teaching children to respond to various forms of the same prompt or instruction. For example, ‘Get your jumper’, ‘Get your pullover’ or ‘Go and get your jumper now’.

Supporters of Pivotal Response Treatment believe that if these foundational skills are stronger, children can more easily learn a wide range of everyday skills, like back-and-forth communication and play skills.

What does Pivotal Response Treatment involve?

Pivotal Response Treatment always takes place in autistic children’s natural or everyday environments – that is, preschool, home or school. It also uses children’s everyday activities, strengths and interests to help with learning.

Steps in Pivotal Response Treatment

Set goals that are specific to an individual child – for example, saying a 2-word sentence or phrase.
Use the child’s interests to help the child learn and reach their goals. For example, if a child is interested in trains, the therapist might pause a toy train and wait for the child to say ‘go train’ before letting the train go again.
Praise or reward the child every time they try to reach a goal. It doesn’t matter whether the child is successful. Rewards are based on what the child likes.

Pivotal Response Treatment can involve many hours a day. Because Pivotal Response Treatment is so intense, therapy sessions that use it should always include breaks when children need them.

Pivotal Response Treatment can go on for several years, depending on children’s goals.

Does Pivotal Response Treatment help autistic children?

High-quality research shows that Pivotal Response Treatment technique has positive effects on autistic children’s social communication skills.

There’s also some research showing improvement in daily living skills and other behaviour, but the evidence isn’t consistent across studies or the studies were small.

Most research so far has focused on preschool and early primary school children, so we know less about how well Pivotal Response Treatment works for older children and teenagers.

More high-quality research is needed to better understand how effective Pivotal Response Treatment is and which children benefit most from this approach.

Who can do Pivotal Response Treatment with autistic children?

Anyone can do Pivotal Response Treatment with autistic children, including professionals, parents, teachers and even peers.

ABA therapists are usually familiar with Pivotal Response Treatment. ABA therapists come from a wide range of professional backgrounds. For example, they might be occupational therapists, psychologists, special education teachers or speech pathologists.

Official training is available through the Koegel Autism Center in the United States, which provides parent training and support materials.

Where can you find a Pivotal Response Treatment program or therapist?

Pivotal Response Treatment forms part of some other programs, like the Early Start Denver Model. You might be able to get it through these programs.

There’s no register of trained Pivotal Response Treatment therapists, but you can find professionals by going to:

If you’re interested in Pivotal Response Treatment, you could talk about it with your GP or one of the other professionals working with your child. You could also talk about it with your NDIA planner, early childhood partner or local area coordinator, if you have one.

How are parents involved in Pivotal Response Treatment?

If your child is in a program that uses Pivotal Response Treatment, you’ll be actively involved. You might watch your child’s sessions, use Pivotal Response Treatment strategies during play and daily routines, and have regular check-ins with your child’s therapist to review your child’s goals and progress.

You can get training and support materials through the Koegel Autism Center in the United States.

How much does Pivotal Response Treatment cost?

The cost of Pivotal Response Treatment depends on the type of program it’s used in and how long children do it for. As a parent, you can reduce the cost by using this technique yourself, but you might still need to buy training manuals.

You might be able to include the cost of some Pivotal Response Treatment supports in your child’s NDIS plan. You can contact the NIDS to find out.

Therapies and supports for autistic children range from behavioural therapies and developmental approaches to medicines and alternative therapies. When you understand the main types of therapies and supports for autistic children, it’ll be easier to work out the approach that will best suit your child.