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Pivotal Response Treatment: Frequently Asked Questions

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Trenna Sutcliffe

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Pivotal response treatment is one of the most highly acclaimed behavioral interventions for individuals with autism spectrum disorders (ASD). Still, it can be difficult to understand how it can apply to or aid your child. As a starting point, here are answers to eight of the most frequently asked questions about pivotal response treatment.


Pivotal response treatment, also known as PRT, is a behavior intervention model primarily designed for ASD and was developed by Drs. Lynn and Robert Koegel. It is based on applied behavior analysis (ABA) principles but focuses more on naturalistic opportunities to influence or change behavior. PRT is centered around the pivotal areas of child development, which include motivation, self-initiation, and self-management. These categories are emphasized because they allow children with ASD to unlock packages of skills in areas like communication, socialization, and behavior.

The Sutcliffe Clinic offers a variety of autism treatment services, including PRT.


PRT is rooted in motivation – by channeling natural or intrinsic motivations through toys, games, or personal interests, the model can make a child want to interact by associating communication and socialization with enjoyable activities. Because PRT connects motivation to learning and interaction, children are more likely to attempt the skills and behaviors they build in their daily lives when they observe situations similar to those in PRT.


PRT can be used for individuals from ages 1 to 18 but is most frequently used for younger children. If used as part of early intervention, PRT can be especially effective, as it helps children to develop skills for interacting and socializing with others. Additionally, using PRT at an earlier stage of development can make its focus on teaching initiation through forms like verbal queries and eye contact more achievable.


PRT sessions can differ vastly in form, as the model is child-led, and therefore changes based on whatever the child being treated is interested in and motivated by. Since motivation is the primary catalyst for behavior change, activities and strategies can change from session to session, or even within a single one. One of the pivotal areas PRT focuses on is initiation, so a session might concentrate on teaching a child to say certain words, ask questions, or cooperate with others. These goals would be achieved by engaging in one of the child’s interests and creating opportunities to practice the target skills.

For example, if a child enjoys painting but has trouble with social interaction and cooperation, they might have a session in which they’re painting with others, but everyone has to share one paintbrush. Since the child wants to paint, they’re motivated to ask for the paintbrush and work with the other people involved, therefore practicing the pivotal skill.


Pivotal response treatment is one of the best-reputed behavioral treatments for children with autism. It’s been listed by the National Research Council as one of ten model programs for autism and is one of only four scientific-based practices in the U.S. for autism. According to the Koegel Autism Center, 85-90% of children who begin PRT before the age of 5 develop verbal communication as a main mode of communication. These children also demonstrate more social initiations and play interactions, in addition to decreased social avoidance.


Progress in pivotal response treatment is tracked in a variety of ways, with one method being data-based. Data collection from trials and sessions can allow for a more tangible understanding of how a child has progressed and can help a provider better understand their evolving strengths and vulnerabilities. However, the bigger shift takes place in the child’s behavior – progress is visible in the way that their skills emerge. These progressions allow for new opportunities to learn skills, inherently encouraging growth. For example, a child who has made progress in language might be using words more often in their day-to-day life, like when interacting with their parents or classmates. This also allows their PRT sessions to move on to skills like verbal requests or queries, which build on their previous language acquisition.


Pivotal response treatment is a form of ABA therapy and shares many of its basic principles, including play-based treatment and a focus on social skills. However, PRT is a more naturalistic approach than ABA – it tries to use naturally occurring moments or situations to teach lessons or encourage certain behaviors, whereas ABA can rely more on simulated events or controlled trials. While these trials can be very helpful opportunities for a child to practice a specific skill, they don’t always mimic the real-life situations in which a child might need to apply the skills they’re working on. By finding these opportunities to practice in more natural scenarios, PRT can not only teach a variety of skills but can present them in a way that’s more easily applicable to the child being treated.


Parents have a key role in a PRT-based approach, as while sessions may be conducted by a therapist or clinician, they only occur once a week or even less frequently. Because parents are often with their children more than almost anyone else, parent involvement in PRT can significantly increase its effectiveness. If parents can model the skills their child is working on in PRT, it allows for the child to better generalize how the skill is used in everyday life, and possibly mimic it as well. In PRT, the responsibility of creating opportunities to practice key skills falls on the adult, and parents can play a huge role in doing so. While a parent can’t guarantee that a child will engage in an interaction, it’s important to keep trying to create opportunities for success so that the child is eventually able to apply what they’ve learned in the pivotal focus areas. For more parent resources regarding PRT, we recommend Stanford’s program, which can be found here.

We hope that these answers have given you a better understanding of the mission of pivotal response treatment, as well as some of its core methods and strategies.