Teaching Pivotal Skills
Jordan is a four-year-old child with autism. He has a limited vocabulary and typically communicates his needs and wants by acting out, aggressively. This behavior has become a barrier and has made it increasingly difficult for him to learn a variety of age-appropriate skills from communication to appropriate social and play skills. Jordan’s parents have placed him in a program designed to target his needs and barriers. After a couple weeks, Jordan began demonstrating noticeable growth in a number of different areas. His vocabulary was steadily growing, his play skills were improving, and his aggressive behavior had begun diminishing in frequency and intensity. He was a completely different child!
These pleasant observations led to optimistic curiosity, ultimately bringing Jordan’s parents to request an observation of their child’s treatment session. They were very impressed with these early results and wondered how exactly these professionals were able to achieve this kind of success with their child. To their surprise, for most of the session, the therapist appeared to just play with Jordan and a few other children, moving from one game or activity to the next. After the session, they were still in awe and were eager to understand exactly how the therapist had been able to bring about so much change spending all the time letting their child just ‘play’. Jordan’s therapist, familiar with this reaction, simply smiled and began explaining the “ins and outs” of Pivotal Response Training (PRT).
What is Pivotal Response Training (PRT)?
Pivotal Response Training (PRT) is an intervention developed by Lynn and Bob Koegel that integrates principles of child development with those of applied behavior analysis (ABA). PRT builds on a child’s motivation and interests, and is particularly effective for developing communication, language, imitation, play skills, joint attention, and social skills (Vismara & Bogin, 2009). Pivotal skills are foundational in that they set the stage for children to make widespread improvements in many other areas of their lives. Developing these skills will reduce inappropriate behaviors from occurring in the future as children’s frustrations diminish. PRT focuses on improving developmentally appropriate behavior in natural settings. How do we use PRT? PRT has certain basic steps, but is implemented in a flexible and creative way.
Here are the basic steps with examples of each:
1.Identify what skills will make the biggest difference in your child’s life. For example, in the story about Jordan, his emerging language was used for communication during everything from socialization and play skills to simple requests. Other pivotal skills to consider targeting are pre-requisite learning skills like paying attention or successfully imitating simple actions. Once these are achieved, doors of possibility begin opening.
2.Determine with whom, when, and where the skills can be taught. Anyone in a child’s life can teach pivotal skills. Consider natural routines that might provide the best learning opportunities. This may include morning and bedtime routines, though more success may be found at times when your child is playing and they are motivated by the activity. For Jordan, he made most of his initial progress in a controlled learning environment with trained professionals. While this may be ideal, it may not be possible and certainly is not a requirement.
3.Set up the environment for success. If the settings and the routines do not immediately prompt your child to use the skills, make some changes. Make favorite toys, books, and other interesting items available, but not readily accessible. Draw your child’s attention to these items by saying, “Wow, look what I have”. Your child will communicate if they need assistance or access to something they want. Hold off on helping them, no matter how convenient it may seem to you. Even if you know they will need help, wait for them to ask or remind them to ask for help before providing assistance.
4.Wait for your child to show interest and respond. Follow your child’s lead, providing choices, if necessary. When your child shows interest (e.g., by looking or reaching for things), prompt the correct response by modeling or guiding your child. This may come naturally during play, but your child may also be fascinated with other things you are doing. Take breaks during your daily activities periodically to see if they are watching you and draw them into activities such as cooking, chores, organization, or other tasks when appropriate. Taking turns during these activities may promote important learning.
5.Reward any and all effort. If your child responds, even if it is not perfect, reward them. This may involve simply continuing play, providing item or activity, or taking your turn. Any earnest attempts at independence deserve praise and enthusiasm. This encourages children to continue the behavior and lets them know they did something good. Any time your child fails when trying something new deserves a sincere “Great trying!”. Use your judgement to determine if your child can actually complete the task at hand and help them succeed as necessary.
6.Gradually extend learning to more pivotal skills. It’s amazing how one seemingly basic skill can be the key to unlocking a whole new set of skills. Jordan was able to use his newly acquired communication skills to ask peers to play with him and ask adults for access to toys. When there is a lot of momentum in learning a few pivotal skills, things can appear to fall together like dominos. Also, remember that your child is still learning- even after initial progress, and that success isn’t too far out of reach. Success can be just as motivating as the rewards achieved for completion.
Here are some videos demonstrating PRT to teach language and play skills:
Super Nanny Video about PRT
Build Communication through Play
Important Tips in Teaching through PRT
When teaching pivotal skills, it is important to make sure you are following the child’s lead and giving the child some time to respond. If they are unable to respond immediately (within 5 – 10 seconds) you can prompt them, but you want to provide the least amount of help necessary. Make sure you have the child’s attention before placing any type of demand. Provide reinforcement to the child both when they are completing the task we set out and/or just for the attempt so that they do not become discouraged. Reinforcers are anything that the child prefers that will help them to want to do this again, so be sure to select items that the child’s time with is normally limited so that they want it more.
Conclusion
As you can see, PRT can be a very useful strategy to incorporate with your child. The accessibility and natural approach that it uses makes it more appealing to both practitioners and parents. As mentioned in the original story about Jordan, PRT can appear to be nothing more than simply playing or interacting with another individual. Using these naturally occurring scenarios and items and activities that children would typically find motivating really drives their responding and treatment progress. Through these organic situations, we are able to really build the fundamental framework and provide structural support to the foundational and pre-requisite skills that anchor and enable future growth to occur. For more information on Pivotal Response Training (PRT), feel free to visit any of these resources:
Autism Speaks:
https://www.autismspeaks.org/pivotal-response-treatment-prt-0 [1]
Koegel Autism Center:
https://education.ucsb.edu/autism/pivotal-response-treatment [2]
Home & Community Positive Behavior Supports: https://hcpbs.org/ [3]
References
Koegel R. L., Camarata S., Koegel, L. K., Ben-Tall A., & Smith, A.E. Increasing speech intelligibility in children with autism. J Autism Dev Disorders. 1998 Jun;28(3):241-51. doi:10.1023/a:1026073522897. PMID: 9656136.
Vismara, L.A., & Bogin, J. (2009). Steps for implementation: Pivotal response training. Sacramento, CA: The National Professional Development Center on Autism Spectrum Disorders, The M.I.N.D. Institute, The University of California at Davis School of Medicine.
https://www.parentingspecialneeds.org/article/embracing-your-childs-best-ways-of-learning-12-different-ways-to-learn/
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This post originally appeared on our January/February 2021 Magazine [15]