What is Pivotal Response Treatment?


By Todd A. Ward, PhD, BCBA-D

Founding Editor, bSci21.org

If you attended the 2015 ABAI Autism Conference in Las Vegas, you heard of Pivotal Response Treatment (PRT), a popular and effective approach commonly used with individuals with autism. If you aren’t yet familiar with PRT, AutismSpeaks.org provides a brief primer.

The key feature of PRT is the targeting of “pivotal” or critical areas of the child’s skill set that will then generalize across a wide range of behaviors not directly targeted.  Pivotal responses typically include “motivation, response to multiple cues, self-management and the initiation of social interactions.”

An additional feature of PRT is the utilization of natural reinforcers, rather than those contrived by a therapist.  In other words “if a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer.”

Lastly, PRT is noted by its emphasis on play-based teaching, child-directed interactions, and an emphasis on parents providing much of the treatment.

To read more about PRT, visit AutismSpeaks.org for more details and many other related links.

Tell us about your experience with PRT in the comments below.  Also don’t forget to subscribe to bSci21 via email to receive the latest articles directly to your inbox


Todd A. Ward, PhD, BCBA-D is President of bSci21 Media, LLC, which owns bSci21.org and BAQuarterly.com.  Todd serves as an Associate Editor of the Journal of Organizational Behavior Management and as an editorial board member for Behavior and Social Issues.  He has worked as a behavior analyst in day centers, residential providers, homes, and schools, and served as the director of Behavior Analysis Online at the University of North Texas.  Todd’s areas of expertise include writing, entrepreneurship, Acceptance & Commitment Therapy, Instructional Design, Organizational Behavior Management, and ABA therapy. Todd can be reached at [email protected].

7 Comments on "What is Pivotal Response Treatment?"

  1. The early studies that were the impetous of the PRT model focused on antecedent and reinforcer variation, procedures for reducing stimulus overselectivity and guided (or errorless) responding. All studies very much within the rhelm of traditional behavior analysis. Staring in the 1990s these procedures were package in under the label of PRT and have subsequently been marketed as such. If one were to closely analyze the management of contingencies with a PRT session one would see management of natural and contrived EOs, antecedent and consequential stimulus variation, response shaping,contingent reinforcement and hedonic contrast with non-session environments. None of these contingencies fall out side of tradition ABA practice. Not the incidental or “NET” training, not the use of discrete instructional interactions, etc. etc.
    If one were to review the PRT research literature there is not much there in terms of characterization of the program via traditional ABA and EAB vocabularly and causal mechanisms. Models that overtly recognize, package and utilize the venacular of the field contribute to its growth and demonstration of efficacy. As it stands, most discussion of ABA tend to separate PRT out as a sub-species of the field that holds some special prominence of vitality. This is not the case. PRT is behavior analysis packaged in a form that allows it to be marketed to a consumer base that accepts it as an intervention somehow separate from ABA.

  2. PRT is typically referred to by parents as PRT versus ABA. This is also true of many school district personnel. In fact, many laypeople think of Discrete Trial Training as something other than ABA, with ABA being a technology that is used to address onerous conduct problems

  3. The National Standards Project reports the following:
    The following interventions are Established Treatments:
    ◖◖ Antecedent Package
    ◖◖ Behavioral Package
    ◖◖ Comprehensive Behavioral Treatment for Young Children
    ◖◖ Joint Attention Intervention
    ◖◖ Modeling
    ◖◖ Naturalistic Teaching Strategies
    ◖◖ Peer Training Package
    ◖◖ Pivotal Response Treatment
    ◖◖ Schedules
    ◖◖ Self-management
    ◖◖ Story-based Intervention Package

    Notice that the acronym “ABA” or any reference to applied behavior analysis is absent from the discussion. This leaves the lay audiance to interprent each intervention as a stand alone program in its own orthogonal space. Notice how “Behavioral Packag” is listed separate form the other interventions. Laypeople and other behavioral health professional equate “behavior analysis” with “Behavioral Package”. This is not good for the field as it promotes the partitioning of behavior analytic technology into orthogonal disciplines (much like what has happened in psychology).

    • I see your point. However, laypeople don’t care about “the field” and they shouldn’t. They want technologies of behavior change, and that is a pretty good list of technologies if I do say so myself! It is an interesting question to ask how behavior analysts can adapt their way of speaking to market their technologies to the public.

  4. There is a great review paper that summarizes the PRT literature:

    Verschurr, R., Didden, R., Lang, R., Sigafoos, J., & Huskens, B. Pivotal response treatment for children with autism spectrum disorders: A systematic review. Journal of Autism and Developmental Disorders, 1(1), 34-61.

    PRT® asserts that four “pivotal” areas (i.e., self-initiations, motivation, self-management, and responsivity to multiple cues), when targeted, result in collateral improvements in non-targeted behaviors (Koegal Autism, n.d.). I noticed the National Standards Project included this detail in the description of PRT® in Phase 1 (2009) and later omitted it in Phase 2 (2015). While I believe this was a warranted omission, the report still directs the consumer to the PRT® website in which they will be informed that treatment results in “widespread and generalized improvements” (Koegal Autism, n.d), which if I am not mistaken is currently unfounded.

    Researchers reported that “it is unclear whether the research on PRT supports the theoretical model of PRT” in a recent systematic review of Pivotal Response Treatment (Verschurr, Didden, Lang, Sigafoos, & Huskens, 2014). Out of the 18 articles reviewed that targeted a pivotal behavior, 17 targeted self-initiations. Only one study targeted motivation. The study that targeted motivation was included in the National Standards Report article review (Koegel, 2010); however, according to the systematic review, this study only provided a suggested level of evidence.

    As a new scholar hoping to become a scientist-practitioner that relies on evidence-based treatments, I believe, it is misleading that PRT—as a whole—is considered an evidence based treatment in the National Autism Report when three quarters of its package has not been adequately studied (or not studied at all). I think lay persons will assume that all components of this treatment are evidence-based. PRT® certainly has its merits, some of which are well-established behavioral procedures (e.g., natural environment teaching; NET), but it is clear more research is warranted before we can consider the procedures or the treatment package as established.

    I understand why PRT is so popular with parents, practitioners, and educators; they market the package very well. Certainly components to learn from! My company uses PRT with many clients, but as stated above, I think more research is definitely needed.

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