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Pivotal Response Treatment (PRT)

What is Pivotal Response Treatment?

Pivotal Response Treatment (PRT) is one of the best studied and validated behavioral treatments for autism. Derived from applied behavioral analysis (ABA), it is play based and child initiated. Its goals include the development of communication, language and positive social behaviors and relief from disruptive self-stimulatory behaviors.

Rather than target individual behaviors, the PRT therapist targets “pivotal” areas of a child's development. These include motivation, response to multiple cues, self-management and the initiation of social interactions. The philosophy is that, by targeting these critical areas, PRT will produce broad improvements across other areas of sociability, communication, behavior and academic skill building.

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, say, a stuffed animal, the reward is the stuffed animal – not a candy or other unrelated reward. 

Though used primarily with preschool and elementary school learners, studies show that PRT can also help adolescents and young adults. Indeed, autism-affected persons of all ages may benefit from its techniques. In all age groups, the learner plays a crucial role in determining the activities and objects that will be used in a PRT exchange.

What is the History of PRT?

Pivotal response treatment was developed in the 1970s by educational psychologists Robert Koegel, Ph.D., and Lynn Kern Koegel, Ph.D., at the University of California, Santa Barbara. The Koegels are now director and clinical director, respectively, of the UCSB Koegel Autism Research Center.

Since its inception, Pivotal Response Treatment has been called Pivotal Response Training, Pivotal Response Teaching, Pivotal Response Therapy, Pivotal Response Intervention and the Natural Language Paradigm. These terms all refer to the same treatment delivery system.

Who provides PRT?

Many psychologists, special education teachers, speech therapists and other providers pursue training in PRT. The Koegel Autism Research Centers offers training and certification. (More information here.)

What is a typical PRT therapy session like?

Each program is tailored to meet the goals and needs of the individual learner and his or her school and home routines. A session typically involves six segments during which language, play and social skills are targeted with both structured and unstructured interactions. As the learner progresses, the focus of each session changes to accommodate more advanced goals and needs.

What is the time commitment involved?

PRT programs usually involve 25 or more hours per week for the learner as well as instruction for parents and other caregivers. Indeed, everyone involved in the learner’s life is encouraged to use PRT methods consistently. PRT has been described as a “lifestyle” adopted by the affected family.

Where can I find more information on PRT?

Autism Speaks is currently funding several studies on PRT, including a study on enhancing the benefits of parent-led PRT. More information on PRT can be found at the website of the UCSB Koegel Autism Center and the UCSD Autism Research Program.

Click here to read about a new randomized control trial study validating PRT.

For more information and resources related to autism, please see our Treatment overview, Video Glossary, FAQs and special sections on Symptoms, Diagnosis, Learn the Signs, Your Child’s Rights, Asperger Syndrome and PDD-NOS. We also offer a number of resource-packed tool kits for free download (here and here). They include our 100 Day Kit for families who have a child recently diagnosed with autism. These resources are made possible through the generous support of our families, volunteers and other donors.