Pivotal Response Treatment (PRT) from Pre-K through Transition Robert E. Daniels, Ph.D. Licensed Clinical Psychologist Executive Director RDaniels@chicagochildrensclinic.com www.chicagochildrensclinic.com
Goals What is PRT? What are Pivotal Skills? What are the components of PRT? How Effective is PRT?
What is PRT? Developed using the principles of Applied Behavior Analysis (ABA) and Typical child development Implemented in the natural environment Improvements in untargeted areas Coordinated effort by all stakeholders
Pivotal Skills: Lead to Gains in Untargeted Areas Motivation Responsivity to Multiple Cues Self-initiations Self-management Social Facilitation
Why is PRT Effective? Research Variables that increase motivation to respond Stimulus variation (Dunlap & Koegel, 1980) Natural reinforcers (Koegel & Williams, 1980) Child-preferred activities (Koegel, Dyer, & Bell, 1987) Reinforcing attempts (Koegel, O Dell, & Dunlap, 1988) Point 1: Child Attention Point 2: Maintenance Tasks Point 3: Shared Control Point 4: Responsivity to Multiple Cues Point 5: Contingent Reinforcement Point 6: Reinforce Attempts Point 7: Direct and Natural Reinforcers
The A-B-C s of PRT Antecedent: Provide an opportunity to respond. Behavior: The child responds. Consequence: Provide a reinforcer contingent upon the child s response
Clear Opportunity
A B C Opportunity What color do you want? Child responds Yellow Response Reinforced: Child given yellow marker
Child Attention
Shared Control Adult does not have control of object Adult DOES have control of object/action
Responsivity to Multiple Cues
Contingent Reinforcement
Reinforce Attempts
Natural Reinforcers
How Quickly It Can Work! Reinforce INTENT and ATTEMPTS FIRST WORDS!!!!
Opportunities for Language Definition: Any question/offer/instruction that the parent provides to the child where the child is expected to respond verbally Examples of Opportunities Model-Prompt Open-ended Time-delay
Putting It All Together
Initiations Independent, spontaneous use of functional communication What? Questions Start with model-prompt Quickly introduce openended & time delay Be sure to reinforce intent and attempts
Social Conversation in ASD Limited quantity Limited quality/variety Marked by select, perseverative topics Limited complexity
What Needs To Be Taught? 1) On-topic question-asking* 2) On-topic commenting* 3) Transitions 4) Checking-in
Self-Management 1. Identify self-management strategy a. Materials b. Length c. Reinforcement 2. Identify skill a. On-topic question-asking b. On-topic commenting 3. Teach what skill is and is not 4. Teach how to self-manage
Sample Self-Management Sheet =Reward
On-Topic Commenting: Procedure Parent/adult/peer provides leading statement I saw Shrek 2 last night. I got a ticket for speeding. Child with autism or asperger prompted to make ontopic comment I ve seen that before You probably weren t too happy. Fade prompting for independence **
12-Month Outcome June 2009 July 2010
Motivational Academics PRT Principle Child Choice Task Variation/Maintenance Tasks Examples Order of assignments Writing instrument Color of paper Book to be read Writing topic Intersperse preferred tasks and breaks using First/Then framework Intersperse a learned task (i.e., counting), with new task (i.e., money).
Motivational Academics-Continued PRT Principle Reinforce Attempts Natural Reinforcers Examples Provide verbal and written praise for effort vs. outcome Change prompts, pace, and task difficulty to ensure sustained effort and motivation Meaningful activities Tell time relevant to student s schedule Earn money to purchase desired activities Write about personal experiences Read about upcoming events
Motivational Academics-Conclusion PRT Principle Multiple Cues Initiations Self-Management Example Furnish multiple writing utensils and surfaces Vary questions Apply concepts to multiple examples Teach question-asking Provide checklists for specific desirable behaviors
Analogue PRT STIMULI PROMPTS INTERACTIONS CHILD RESPONSE CONSEQUENCES -Chosen by clinician -Repeated until criterion met say with a manual prompt (clinician touches child s mouth) Clinician holds up item while child sits passively Only correct responses reinforced Edible paired with social -Chosen by child -Varied Clinician labels item Clinician and child are playing together Appropriate attempts reinforced Natural reinforcer & social
Koegel, O Dell & Koegel (1987)
Koegel, Koegel, & Surratt (1992)