How is Pivotal Response Treatment® (PRT) Used in ABA?

Verbal communication is perhaps one of humankind’s greatest gifts. With it we share everything from dramatic dialogs in Oscar-winning dramas, to the sweet whispers of a child’s goodnight as you tuck them into bed.

As new parents, you can’t wait to hear your child speak their first words. As the months tick by and the developmental chart offers up milestone markers, by eighteen months of age most parents hear the blissful sound of ma-ma or da-da as if on cue.

What happens then if your child missed the mark? And then continues to miss it? Such was the case of three-year-old Tristan Facente who has autism. His parents were at their wits end trying to help their toddler verbally communicate – so much so that they decided to enlist the help of the TV show Supernanny, and along with it Dr. Lynn Koegel, co-developer of the Pivotal Response Treatment ® (PRT) theory.

Most parents would not go as far as having their family’s story aired on national television, but when the opportunity presented itself, the Facente family felt it was the best thing they could do for their son. They knew they were in over their heads trying to help him on their own.

By employing the methods of PRT, Dr. Koegel was able to teach Tristan to say the word “tickle” during the airing of the show.

It had taken the Facente family three years to hear Tristan talk. They were elated with the results.

How the Methods of Pivotal Response Training Align with Applied Behavior Analysis

Pivotal Response Treatment® is a method of teaching a child to learn based on the idea that there are pivotal behaviors in children that, once changed, could influence other behaviors as well. For instance, according to Virginia Department of Education’s Training and Technical Assistance Center, if you teach a child to play Bingo they will learn a variety of skills apart from simply playing a game; skills like listening, verbalizing, interacting, taking turns and socializing. It’s easy to see how mastering all the fundamentals of a game as seemingly simple as Bingo could translate into other areas of life.

There are four methods to learning in PRT that help bring about behavioral changes: motivation, responding to multiple cues or stimuli, child initiations, and self-regulation.

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Each component is designed to encourage the child to take action. In applied behavior analysis, the theory rests on the concept of exchanging an undesirable behavior with a preferable one. From as early as the 1930s and well into the late twentieth century, applied behavioral analysis was defined by pioneering psychologists have laid the groundwork used to accomplish just that.

The ABA theory has four distinct points:

  1. Applying interventions in a systematic way
  2. Basing the interventions on principles of learning theory
  3. Having the goal to improve behaviors in meaningful ways
  4. Proving that the method was the reason behind the behavioral change

Pivotal response training claims to have the ability to encourage behavioral changes in exact accordance with what ABA prescribes.

  1. Applying interventions in a systematic wayPart of the intervention includes employing repetition when working with a child with autism. For instance, when Dr. Koegel tried to teach Tristan the word tickle, she played a tickle game with his tummy, while repeating the word tickle multiple times. Finally, when she wanted him to say the word, she stopped short of saying the last “tickle” in the sequence and waited for Tristan to fill in the blank. At this point he said tickle, and Dr. Koegel proceeded to reward his efforts by tickling him. This systematic method helped Tristan to understand what was required of him.
  1. Basing the interventions on principles of learning theoryIn ABA point two, basing PRT interventions on potential learning theories has many possibilities due to the number of theories available, however, we can see, for instance, that the concepts of self-regulation and initiation apply to the theory of experiential and self-directed learning described in the Oman Medical Journal. PRT gives children with autism the opportunity to make their own choices (self-directed) as it applies to preferences, resources, and outcomes.For example, your goal may be to help a child stay focused. You also know your child loves dogs. You’ve decided to use books as your teaching tool. When choosing material for your child, ask if they prefer the book about dogs, trains or dinosaurs. They are given the opportunity to choose the one they like best.Applauding their choice helps to reinforce their willingness to pay attention to the book. Letting them know that when reading time is over, they get to play with their favorite toy, or their favorite activity, even if that happens to be video games. This is their motivation to change behavior. The desire to obtain the reward allows the child to determine its own outcome. If they pay attention, they will have their reward; if not, than the reward is withheld. Just that simple.
  1. Having the goal to improve behaviors in meaningful waysFor ABA point three, PRT maintains the goal of changing behavior in a meaningful way. Its intentions are to correct certain key behaviors in ways that will transfer over to other areas of life, taking the behaviors out of the realm of therapy and making them very much a part of day-to-day life. So rather than teaching a child just to say the word “Bingo,” the child learns that mechanics of the game, plus all the other skills involved – listening, taking turns, verbalizing, and interacting with peers in a civil way.
  1. Proving that the method was the reason behind the behavioral changeThis method sounds very effective for a child with ASD, but is there proof, as the ABA theory requires? Is the PRT method actually instrumental in bringing about behavioral change?In a teaching module for the National Professional Development Center on Autism Spectrum Disorders it was found that nine different controlled studies have shown that PRT does satisfy the criteria for an evidence-based practice.

PRT is Not a Miracle, so Be Realistic About Where You Set Your Expectations

PRT has been shown to be an effective ABA method to help children with autism. It’s important, however to keep your expectations real. Because the effects of autism are highly varied, altering behavior is definitely not as easy as it appeared to be on the Supernanny. It’s unrealistic to expect that all children will be so responsive in such a short time. Also different methods may be required to continually help your child grow and change over time.

The series of Supernanny episodes that featured Tristan aired in 2005. Yet in 2017 on a Go-Fund-Me page we read that the Facente family is once again publicly reaching out for more help. Tristan’s mom posted the page around 2013 when he was in middle school, saying that, “He [Tristan] is somewhat verbal but abstract things like feelings and emotions are very hard for him to understand and communicate.” She indicated that he needs a different kind of ABA therapy at this time in his life.

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There is no one-size-fits-all solution for behavioral change, and one single method isn’t always the sole solution. PRT is just one method that has proven to be effective in some children’s lives.

As a parent, you have the hard job of deciding when something is working or not. Even with all the help that is available, and all the scientific evidence that shows the effectiveness of these interventions, you ultimately bear the burden of having to determine how to best help your child as they grow and change.