What is Pivotal Response Treatment?

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Pivotal Response Treatment is a type of play therapy that uses puppets and dolls to teach children with autism how to learn new skills. One such skill, for example, might be recognizing faces in photos or playing the piano.

Pivotal response treatment is a type of therapy that is used to treat autism. It includes a combination of behavioral, speech and occupational therapies. The “example” will show what the therapy looks like in practice. Read more in detail here: pivotal response treatment example.

Pivotal response therapy, or PRT, is one of the most effective behavioral methods for treating kids with autism spectrum disorders. However, what is PRT? PRT is a play-based strategy that improves “pivotal” child development regions rather than specific behaviors. It is a naturalistic intervention model built from applied behavioral analysis. Its foundation is the hypothesis that modifications to critical responses would catalyze broad advancements in other developmental domains.

At the University of California-Santa Barbara, Drs. Robert Koegel and Lynn Kern Koegel developed PRT in the 1970s. PRT, formerly known as Natural Language Paradigm (NLP) or crucial response teaching, combines numerous behavioral strategies based on research to help autistic children:

  • social abilities
  • communication
  • behavior
  • learning

Pivotal response therapy is very helpful in enhancing crucial aspects of a child’s development for preschool, primary, and middle school kids with autism spectrum disorders, according to a research published in the Behavior Modification journal.

DTT ABA, or discrete trial teaching in Applied Behavior Analysis is another option.

Targeting Four Major Pivotal Areas

By focusing on four key “pivotal” aspects of a child’s development, pivotal response therapy aims to prevent the self-stimulatory, negative behaviors associated with autism. Among these four regions are:

  • Motivation
  • Adaptation to various signals 
  • Self-management
  • Promoting the start of social interactions

Motivating yourself is the main topic. PRT treatment serves to boost kids’ motivation to acquire and practice skills that have positive outcomes. PRT leverages the child’s interests to encourage pro-social behaviour and spark excitement rather than imposing chores. Therapy professionals use a variety of incentive techniques, such as task modification and alternating maintenance and acquisition activities.

Initiations is the second “pivotal” section. PRT promotes the youngster to approach others and start a conversation by getting their attention or asking questions.

Self-regulation follows. Children are taught to self-evaluate and differentiate their behaviour in this “pivotal” area in order to become more autonomous.

Finally, PRT teaches autistic children to react to a variety of signals rather than concentrating on certain information or stimuli.

What Takes Place During PRT Sessions

Positive reinforcement is used during PRT treatment sessions to target the aforementioned “pivotal” regions, which will lead to significant development for sociability. Pivotal response therapy is tailored to each child’s particular requirements and habits. The majority of PRT programs offered in schools last 25 hours or longer per week. For consistency, parents or guardians should implement PRT practices at home. Unstructured encounters are frequent in pivotal response treatment because it employs play therapy to foster the development of social skills Lessons could cover:

  • turning around
  • imitation
  • jointly focused
  • mutual interaction

Here are some examples of crucial response therapies:

  • switching between one task and another
  • everyday errands
  • everyday habits
  • mealtimes

An elementary PRT session would like this:

  • A parent removes a toy bin full of many items that their kid has previously showed interest in.
  • The youngster is asked to choose a toy to play with by the parent.
  • The youngster indicates the item they want to use.
  • “You want to play with the toy car?” the parent would inquire of the youngster.
  • The kid gets the automobile as a reward when they respond appropriately.
  • The parent may then take advantage of the chance to inquire more about the vehicle, such as “what color is the vehicle?”
  • The parent could play with their own car alongside the child, using the opportunity to demonstrate appropriate play and social abilities during the session.

The kid was encouraged to participate (they loved the toy selection), they got to choose the toy they wanted to play with, and they got a natural reward for giving the right answer. These are the key elements of the session. Since parent training must take place in a natural environment, it is an essential part of PRT as an autistic intervention.

Does Pivotal Response Training Have Any Support? 

One of the ABA therapy choices for autistic kids that has received the most research is PRT. PRT has been found to help autistic kids communicate better. The majority of these research focus on PRT provided in a one-on-one therapy environment by licensed therapists. A few others examined PRT in contexts where instructors or parents were present.

Although not all, most autistic kids react well to ABA. Parents may employ this instruction effectively at home because of its beneficial, realistic features.

Requirements for Providing PRT Therapy


Beyond their education and license, critical response therapy practitioners often need specific Certification. Providers of key response training include, for instance:

  • educational psychologists
  • instructors of special education
  • experts in speech-language pathology
  • Occupation-focused therapists

PRT treatment is developed from ABA, hence certain applied behavior analyzers may experiment with it. The majority of PRT practitioners have at least a master’s degree in

  • counseling
  • psychology
  • education
  • therapy

Clinical practicum is a requirement for accredited master’s programs in order to fulfill the license contact hours, which vary widely by state and title.


Providers should obtain certification from the UCSB Koegel Autism Center after receiving their license. With workshops, one may get certified in one of three PRT levels. Attending the two-day Pivotal Response Treatment Conference is required for Level I Certification. The meeting covers the following PRT subject areas:

  • Definition of Key Areas
  • PRT’s motivating methods for teaching social communication
  • Promoting Social Interactions with Peers Who Are Typically Developing
  • Educational Motivation
  • Assessing Functional Behavior
  • Other PRT/Emerging PRT Interventions and Research Applications
  • PRT’s Development and History
  • Autism Spectrum Disorder features (ASD)

People who have successfully completed Level I Certification are eligible for Level II Certification. Participants learn about the basic PRT motivating teaching techniques for teaching communication. This level of certification verifies that participants have adhered to the implementation standards for PRT with one autistic kid.

For those who have successfully earned Level I and Level II Certification, the Level III Credential is an advanced certificate. The capacity of the participants to adapt their PRT techniques for teaching communication across a wide variety of children with ASD is the main emphasis of this program. The Level III Certification verifies that participants satisfied the requirements for fidelity for using PRT with three separate ASD youngsters.

Will PRT Treatment Be Covered by Insurance? 

The sort of insurance you have has a significant impact on the response. PRT is covered by several private health insurance providers. PRT is regarded as an evidence-based strategy for assisting kids with autism. Pivotal Response Training is considered applied behavior analysis thus many businesses will pay the whole or partial cost of therapy. To verify coverage, get in touch with your specific insurance provider.

PRT is probably going to be covered by your child’s Medicaid coverage if it is recommended by a doctor. Medicaid will pay for required medical care.


Overall, pivotal response treatment was recognized by the National Research Council as one of the top 10 model programs for autism.  Motivation strategies utilized in PRT therapy helped 85% of toddlers with autism develop verbal language as their primary communication. PRT is an evidence-based behavioral approach targeting critical behaviors in natural environments for better social abilities. As the diagnosis of children with autism spectrum disorders grows more prevalent, pivotal-response treatment is expected to become a leading form of early intervention.

What Can Be Done To Prevent Autism? is a related resource.

Pivotal Response Treatment is a type of treatment that is used to help autistic children. It has been proven to be very effective, but it also has some disadvantages. Reference: disadvantages of pivotal response training.

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