Pivotal Response Treatment: autism therapy

What is Pivotal Response Treatment (PRT)?

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

PRT 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.

PRT 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 PRT include Pivotal Response Intervention and the Natural Language Paradigm.

Who is Pivotal Response Treatment (PRT) for?

Pivotal Response Treatment (PRT) 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 (PRT) used for?

Pivotal Response Treatment (PRT) techniques are used to improve autistic children’s social interactions, communication skills, play skills and behaviour. The techniques aim to promote independence and reduce the need for ongoing therapy and support.

Where does Pivotal Response Treatment (PRT) come from?

Pivotal Response Treatment (PRT) was developed in the 1980s, mainly by a team of psychologists in the United States. PRT 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 PRT 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 (PRT)?

The theory behind Pivotal Response Treatment (PRT) 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 they 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 and encouraging 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 PRT believe that improvements in more complex skills (like behaviour, social, communication and play skills) follow if autistic children can first learn and develop in these foundation areas.

What does Pivotal Response Treatment (PRT) involve?

Pivotal Response Treatment (PRT) always takes place in autistic children’s natural or everyday environments – that is, preschool, home or school. It also uses everyday activities to help children learn.

PRT involves the following steps:

Set goals that are specific to an individual child – for example, saying a 2-word sentence or phrase.
Use the child’s interest in something as an opportunity to help the child learn and reach their goals.
Praise or reward every time the child tries to reach a goal. It doesn’t matter whether the child is successful. Base rewards on what the child likes.

PRT can take a lot of time. It can involve many hours a day and go on for several years, depending on children’s goals.

Does Pivotal Response Treatment (PRT) help autistic children?

High-quality research shows that this technique has positive effects on autistic children’s skills.

Who practises Pivotal Response Treatment (PRT)?

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

ABA specialists are usually familiar with PRT. Psychologists, speech pathologists, special education teachers and occupational therapists are often ABA specialists.

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 practitioner?

Pivotal Response Treatment (PRT) 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 PRT practitioners, but you can find professionals by going to:

If you’re interested in PRT, 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.

Parent education, training, support and involvement

If your child is in a program that uses Pivotal Response Treatment (PRT), you’ll be actively involved. You can get training and support materials through the Koegel Autism Center in the United States.

Cost considerations

The cost of Pivotal Response Treatment (PRT) depends on the type of behaviour program in which it’s used 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.

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.