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Pivotal Response Treatment (PRT)

Other common names: Natural Language Paradigm, Pivotal Response Intervention
At a glance: Pivotal Response Treatment (PRT)
Type of therapy
Behavioural
The claim
Improves social, communication and play skills
Suitable for
People with autism spectrum disorder (ASD)
Research rating

Find out more about this rating system in our FAQs.

Research shows positive effects.
Time

Estimate of the total time for family in hours per week and duration

20+
The time needed for PRT depends on the type of program in which it’s used and the specific needs of the child.
Cost

Estimate of cost to family per session/item or week

$120+
The cost of this therapy depends on the type of behavioural intervention program in which it’s used.

What is Pivotal Response Treatment (PRT)?

Pivotal Response Treatment (PRT) is not a therapy in itself. It’s a set of teaching techniques used in children’s everyday environments.

PRT is based on the principles of Applied Behaviour Analysis (ABA). It focuses on four key or ‘pivotal’ areas of children’s development, with the aim of helping children develop more complex skills and behaviour including social and communication skills.

Some therapies for autism spectrum disorder (ASD) include PRT techniques as part of their approach, particularly ABA-based programs.

Who is Pivotal Response Treatment (PRT) for?

Pivotal Response Treatment (PRT) techniques typically target children aged 2-6 years, but they can be used with people of any age with autism spectrum disorder (ASD).

What is Pivotal Response Treatment (PRT) used for?

Pivotal Response Treatment (PRT) techniques are used to improve children’s social, communication and play skills and behaviour. The techniques aim to promote independence and reduce the need for ongoing intervention.

Where does Pivotal Response Treatment (PRT) come from?

Pivotal Response Treatment (PRT) was developed in the 1980s, mainly by a team of psychologists in the United States. PRT and other naturalistic teaching techniques grew out of concerns about more traditional behaviour approaches and how well the skills taught using these approaches could be adapted for different settings.

Naturalistic behavioural interventions like PRT are based on the work done by researchers Hart and Risley in the 1970s. Their studies focused on improving language development in preschool children with language delays.

What is the idea behind Pivotal Response Treatment (PRT)?

The theory behind Pivotal Response Treatment (PRT) is that there are four key areas of child development that are ‘pivotal’ to later development:

  • Motivation: this is encouraging learning by giving children choices, varying tasks, combining previously learned tasks with new tasks, prompting, and using rewards.
  • Self-initiation: this involves encouraging and rewarding children’s curiosity – for example, when they ask questions about something they see.
  • Self-management: this is teaching children to be more independent and take responsibility for their learning.
  • Responsiveness to multiple cues: this is teaching and encouraging children to respond to various forms of the same prompt or instruction – for example, ‘Get your jumper’, ‘Get your pullover’ or ‘Go and get your jumper now’.

Supporters of PRT believe that improvements in more complex skills (like social skills, communication and play skills, and behaviour) follow if children can first learn and develop in these foundation areas.

What does Pivotal Response Treatment (PRT) involve?

Pivotal Response Treatment (PRT) takes place in children’s natural environments (at preschool, home or school) and uses everyday activities to teach children.

For a person working with an individual child, PRT involves the following steps:

  1. Set up goals that are specific to the individual child – for example, saying a two-word sentence or phrase.
  2. Use the child’s interest in an item or activity as an opportunity to teach and help the child reach the goal.
  3. Praise and/or reward every time the child makes an effort to reach the goal. It doesn’t matter whether the attempt is successful. Rewards are based on what the child likes.

PRT can take a lot of time. It can involve many hours a day and go on for several years, depending on children’s goals. PRT always takes place in children’s natural environments and can be done by therapists, parents, teachers and even children’s peers.

Cost considerations

The cost of Pivotal Response Treatment (PRT) depends on how long children use it and who does the approach. The cost can be reduced if parents do the approach themselves. Parents might need to buy training manuals.

Does Pivotal Response Treatment (PRT) work?

High-quality research shows that this approach has positive effects on the behaviour of children with autism spectrum disorder (ASD).

Who practises Pivotal Response Treatment (PRT)?

Anyone can practise Pivotal Response Treatment (PRT), including professionals, parents, teachers and even peers.

ABA specialists are usually familiar with PRT. Psychologists, speech pathologists, special education teachers and occupational therapists are often ABA specialists.

Most official training is available through the Koegel Autism Center in the United States, which provides parent training and support materials.

Parent education, training, support and involvement

If your child is in an intervention that uses Pivotal Response Treatment (PRT), you’ll be actively involved. You can get training and support materials through the Koegel Autism Center in the US.

Where can you find a practitioner?

Pivotal Response Treatment (PRT) forms part of some other intervention programs, like the Early Start Denver Model. You might be able to access it through these programs.

There’s no register of trained PRT practitioners, but the Behavior Analyst Certification Board has a list of certified behaviour analysts.

You can find other professionals by going to:

If you’re interested in PRT, you could talk about it with your GP or one of the other professionals working with your child. You could also talk about it with your NDIA planner, NDIS early childhood partner or NDIS local area coordination partner, if you have one.

There are many treatments for autism spectrum disorder (ASD). They range from those based on behaviour and development to those based on medicine or alternative therapy. Our article on types of interventions for children with ASD takes you through the main treatments, so you can better understand your child’s options.

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Last updated or reviewed
01-08-2017

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