Pivotal Response Therapy

Pivotal Response Therapy (PRT) is a behavioral treatment intervention based on the principles of applied behavior analysis (ABA) and derived from the work of Koegel, Schreibman, Dunlap, Horner, and other researchers. With PRT, play environments are used to teach pivotal skills, such as turn-taking, communication, engagement and language. Rather than target individual behaviors one at a time, PRT targets pivotal areas of a child's development, such as the role of choice, motivation, responsiveness to multiple cues, and social initiations. By targeting these critical areas, PRT results in widespread improvements in other social, communicative, and behavioral areas that are not specifically targeted.

The main components of PRT:

• Child chooses the object for instruction (or "play"). This shared control increases motivation.
• Therapist provides clear and uninterrupted instructions or opportunities.
• Therapist positively reinforces approximations/attempts
• Reinforcement is "natural" and has a specific relationship to the desired behavior. (For example, a request for "ball" gets the ball, not praise. This is done to increase motivation, and increase the likelihood that the child will use this skill in natural situations.)
• Therapist presents multiple examples or multiple components. For example, the therapist might use the same verb in relation to two different objects, e.g., "roll car" and then "roll ball". The therapist may then say "throw ball." This is done to increase responsiveness to multiple cues.

Discrete Trial Teaching

A discrete trial is a behaviorally-based instruction routine, derived from the work of Dr. Ivar Lovaas, which takes a task or process a child needs to learn and breaks it down into short, simple steps. DTT takes place one-on-one with the therapist or parent prompting the child to perform a specific behavior and rewarding success with positive reinforcement. This is based on the ABC model:

A - Antecedent

A directive or request for the child to perform an action.

B - Behavior

The child's behavior in response to the request; either successful performance, noncompliance, or no response.

C - Consequence

The consequence or the reaction from the therapist or parent, which can range from positive reinforcement (ie. a special treat, verbal praise) to a negative response.

Discrete Trial Teaching procedures are highly structured, with the choice of stimuli, the criteria for the target response, and the type of reinforcement all clearly defined before each trial commences. Only the child's correct responses are reinforced whereas incorrect or off-task behaviors are ignored. More

Discrete trials can be used to advance cognitive development, verbal communication, play, social and self-help skills. These trials can also be used to increase attention, motivation and confidence. At the start of a program, interactions may only be a few seconds in length. As the child's attention span increases, the length of the interactions increases accordingly. A particular trial may be repeated several times in succession, several times a day, over several days (or even longer) until the skill is mastered.

A basic example might be for Suzie to brush her hair. The first step may be simply to pick up the brush. The therapist says "Suzie, pick up the brush".

The therapist then takes Suzie's hand and wraps it around the brush. After a short interval, the therapist repeats, "Suzie, pick up the brush." Suzie does not respond, so the therapist wraps Suzie's hand around the brush again. On the third time, Suzie makes a tentative move for the brush but the therapist still needs to wrap her hand around it. The therapist says, "That's a good try, Suzie." On the fourth time, Suzie grabs the brush. The therapist rewards her by saying "That's really good, Suzie" and giving her a granola bar. Pairing external reinforcement with social praise is done with the idea that eventually praise will become as reinforcing as the treats.

Positive Behavioral Support

Positive Behavioral Supports begin with a functional behavioral assessment to help better understand the nature of the individual's challenging behavior. This information is used to develop a comprehensive behavioral support plan. Once implemented, this plan helps to reduce the likelihood that challenging behavior will occur, teaches desirable alternative behaviors that give the individual a more adaptive way to get their needs met, and often makes challenging behaviors irrelevant and ineffective. PBS services are most effective when they include family members and others who support the individual across their day (e.g., teachers, friends, other caregivers), so that the strategies can produce their intended benefit in every environment. Outcomes of PBS services include enhanced quality of life, effective communication of basic wants and needs, and increased opportunities to engage in meaningful activities with others. More

Shaping
The gradual modification of a child's existing behavior. For example, if a child is just learning to say words, he may just be asked to touch an item before receiving it. Later, we may require the beginning sound, a syllable and eventually the word.

Prompting
Action taken by the teacher to promote the correct response. For example, when initially teaching a child to "touch" a given object, such as a ball, the teacher may need to actually move his hand to the object at the beginning.

Fading
The gradual removal of prompts. This is a critical part of teaching children to NOT become dependent on the teacher's actions to succeed. Any prompts used are slowly removed until the child can respond correctly with no prompts. To use the above example, if we wanted to teach a child to touch a ball we may start by physically moving his hand to the ball, and then provide less physical guidance by just touching his elbow, then pointing at the ball, etc. until the child is able to successfully touch the ball when asked. (Many children would not require this many prompts to learn to "touch" an object.)

Chaining
The process of breaking down skills into their smallest units and then "chaining" these units together. Forward or backward chaining are both techniques that are frequently used in teaching a new skill. An example of forward chaining may be to teach a child to say a sentence, one word at a time. ("Say, 'I,'" "Say, 'I love,'" "Say, 'I love you!'") If we taught the same sentence using backward chaining we would teach it from the end first! ("Say, 'You,'" "Say, 'love you,'" "Say, 'I love you.'")

Differential Reinforcement
Perhaps the most important part of teaching, Differential Reinforcement involves providing a response to a child's behavior that will most likely increase that behavior. The term "differential" refers to the varying levels of reinforcement based on the child's response. "Hard" tasks may be reinforced heavily whereas "easy" tasks may be reinforced more lightly. We must systematically change our reinforcement so that the child eventually responds appropriately under all circumstances.

Verbal Behavior

The Verbal Behavior (VB) approach encourages very basic to very complex communication skills. VB breaks down language into its basic function for example repeating, labeling, commenting and responding.

Summary of Verbal Operants

The following table summarizes the new verbal operants in the analysis of Verbal Behavior.

One must keep in mind, however, that almost all verbal behavior does not consist of these 'pure' operants, but of a mixture of them.

Natural Environment Teaching

The natural environment refers to your child's day-to-day surroundings. It may include places like school, home, grandma's house, church, day care, extracurricular activities, etc. This is the environment where your child's learning and communication skills should be "put to work." The ultimate goal is for your child to have the ability to interact independently with others in their environment. Training in the natural environment should be consistent and ongoing. Since these surroundings don't always provide multiple opportunities for your child to use their skills, we often "set up" the environment to create learning opportunities. However, just because these are contrived situations, it does not make the environment "unnatural." Training in these surroundings simply provides a context for your child to use their skills they have been taught.