Pivotal Response Treatment (PRT)

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What is Pivotal Response Treatment?

Pivotal Response Treatment, or PRT, is a behavioral treatment for autism. This therapy is play-based and initiated by the child. PRT is based on the principles of Applied Behavior Analysis (ABA).

Goals of this approach include:

  • Development of communication and language skills
  • Increasing positive social behaviors
  • Relief from disruptive self-stimulatory behaviors

The PRT therapist targets “pivotal” areas of a child’s development instead of working on one specific behavior. By focusing on pivotal areas, PRT produces improvements across other areas of social skills, communication, behavior and learning.

Pivotal areas include:

  • Motivation
  • Response to multiple cues
  • Self-management
  • Initiation of social interactions

Motivation strategies are an important part of the PRT approach. These emphasize natural reinforcement.

For example, if a child makes a meaningful attempt to request a stuffed animal, the reward is the stuffed animal – not a candy or other unrelated reward. Children are rewarded for making a good attempt, even if it is not perfect. 

PRT was developed by Dr. Robert L. Koegel and Dr. Lynn Kern Koegel of Stanford University. It was previously called the Natural Language Paradigm (NLP). This approach has been used since the 1970s.

Who provides PRT?

A variety of providers seek training in PRT methods, including:

  • Psychologists
  • Special education teachers
  • Speech therapists

What is a typical PRT therapy program like?

Each program is tailored to meet the goals and needs of the individual person and his or her everyday routines.

A session typically involves six segments. Language, play and social skills are targeted with both structured and unstructured interactions.

The focus of each session changes as the person makes progress, to accommodate more advanced goals and needs.

PRT programs usually involve 25 or more hours per week.

Everyone involved in the child’s life is encouraged to use PRT methods consistently in every part of his or her life. PRT has been described as a lifestyle adopted by the whole family.

What is the evidence that PRT is effective?

PRT is one of the best studied and validated behavioral treatments for autism.

More than 20 studies suggest that PRT improves communication skills in many (though not all) children who have autism. Most of these studies looked at PRT delivered by trained therapists in one-on-one therapy sessions. Others looked at PRT delivered in group settings by school teachers and by trained parents in their homes. A 2017 review of brain imaging studies showed evidence that PRT improves brain activity associated with sociability and communication.

Is PRT covered by insurance?

Sometimes. Many types of private health insurance are required to cover behavioral services such as PRT. This depends on what kind of insurance you have, and what state you live in.

All Medicaid plans must cover treatments that are medically necessary for children under the age of 21. If a doctor prescribes PRT and says it is medically necessary for your child, Medicaid must cover the cost.

Please see our insurance resources for more information about insurance and coverage for autism services

You can also contact the Autism Response Team if you have difficulty obtaining coverage, or need additional help.

Where do I find PRT services? 

Use the Autism Speaks Directory to search for providers near you. 

Visit the Koegel Autism Center website for a list of professionals certified in PRT methods

For more information