Pivotal Response Treatment: Identifying and Targeting Areas of Need in Children with ASD
Applied Behavior Analysis (ABA) continues to enjoy the most solid research base of any intervention approach for autism spectrum disorder, and Pivotal Response Treatment (PRT), an advanced type of ABA approach, also has an abundance of data to support its effectiveness. Research in PRT began when we noticed that many children didn’t seem to be enjoying the drill-practice format used in early ABA discrete-trial teaching sessions. Moreover, targeting individual behaviors was extremely time consuming, laborious and inefficient. Thus, over the past two decades, we have focused on “pivotal” areas that, when taught, have a widespread positive effect on numerous symptoms of autism.
Philosophy of PRT
Before discussing PRT in more detail, it’s important to mention the underlying philosophies of the approach. First, intervention is implemented in natural settings to maximize the likelihood of producing a normalized developmental trajectory. This may seem obvious to those who read the literature showing that intervention in more clinical, segregated or analog settings results in difficulties with generalization, slower academic gains, less socialization and a greater challenge getting the children on a typical developmental trajectory. However, many families and practitioners are faced with schools and community settings that just don’t embrace the idea of inclusion. It’s often an uphill battle to get a child into (and keep a child in) regular education settings, afterschool community activities and summer recreational programs. PRT emphasizes inclusion—that all children should be educated and involved in environments they would be in if they didn’t have a disability.
A second underlying philosophy relates to family involvement. First, families take an active role in the development of intervention goals and the implementation of procedures to achieve these goals. Intervention is coordinated across all settings, with parents learning, through practice-with-feedback, to implement the procedures. We’ve learned from our research that the procedures need to be incorporated into everyday routines and activities to decrease parental stress and to maximize the normalcy of developmental gains. Assignments that require parents to take time out of their busy schedules to sit down and drill their children actually increase stress and can produce artificial responses. We can’t overemphasize the need to reduce parental stress, which we have not dealt with adequately as a society. Stress indexes indicate that parents of individuals diagnosed with autism experience very high levels of stress, which are very difficult to reduce. This may, in part, relate to society’s lack of willingness to fully include and support children on the spectrum in schools and other community activities. Parental stress may also relate to the difficulties, and lack of proper training and support, in raising a child who is affected by the disability in many areas. And parents of older children worry about what will happen to their child after they are no longer able to care for them. Will others love them as much they have, treat them with respect and dignity, and advocate for them? Our goal is to help families reduce their stress, enjoy full and happy lives with the support of the community, create more positive long-term outcomes and help adults on the spectrum have lifestyles that their parents feel good about.
The third aspect of PRT is identifying pivotal areas of need in children, so that the intervention is more effective and efficient.
Reprinted with the permission of the Autism Society.
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