1. Pivotal Response Treatment: An Overview & Case Study
Items to print and post for workshop:
PRT screener
Fidelity form
Feedback form
Summary of steps
Jena K. Randolph, PhD
Kathleen Larocco, MEd
Elizabeth Mrozowicz, PhD, BCBA, LBA

2. Overview
Why PRT?
What is PRT?
Practical Impact

3. Children must be MOTIVATED to learn to communicate

4. Children Learn Through Play… & Play should be FUN!!!

5. Following the Child’s Lead
Typical Adult-child interactions
Adult-directed
Child-control
Adult-monitored
Following a child’s lead = sharing control
See what they are interested in
An engaging environment will assist in keeping the child interested
If the child appears disinterested or requests a change in activities- do so!
This teaches valuable language

6. Pivotal Response Treatment
Evidence Based Practice for Autism
Highly effective for children with ASD ages 3-9 years
Shown to improve:
Social skills
Communication skills
Play skills

7. Pivotal Response Treatment
Understanding Child Characteristics
Profile of “Responders”:
Have some established social initiation skills
Have some established toy play skills
Have low rates of social avoidance
Have low levels of self- stimulatory behavior
Responders: Have increases in language abilities and social interactions
·      participated in moderate levels of object manipulation and verbal self stim
·      Minimal rates of avoidance and minimal non-verbal self-stimulatory behavior
·      Participate in some basic toy play
·      Moderate to high rates of object manipulation, approach and verbal self- stim behaviors with low avoidance- responders (Sherer & Shreibman, 2005)
·      Meeting the cutoffs of percentage of intervals of occurrence of “responders” at least 4/5 of the screened behaviors (using partial interval)
o   Appropriate toy play: 61% of intervals
o   Approach – 15%
o   Verbal self stim 17%
o   No more than the maximum percentage of avoidance 13%
o   No more than maximum for non-verbal self stim 34%

8. Pivotal Response Treatment
Method of instruction which systematically applies the principles of Applied Behavior Analysis
Direct caregivers (parents/teachers) have a critical role
Majority of research on parent implementation
More support is needed for classroom use
Focus on developing language, play and social behaviors through child motivation
Considered a naturalistic intervention
Naturalistic: Providing instruction in the child’s everyday environments with common items/activities
Promotes generalization and maintenance of skills
Intervention can be implemented more seamlessly and therefore more likely to be implemented
Child lead:
Using the child’s interests and preferences to guide activities
Changing focus or activity when the child is not engaging
This does not mean the child is in control of the environment and can engage in inappropriate behavior

9. Pivotal Behaviors
PRT targets pivotal behaviors, meaning they are thought to have larger impact and change across other domains:
Motivation
Responding to Multiple Cues
Self-Management
Self-Initiations
Today we are focusing on the first two, Motivation and Responding to Multiple Cues- as these are the core PRT procedures that are utilized in the evidence base to target social, communication and play skills.

10. General Strategy Communication elicited by adult or environment
Embedded into natural social/play routines
The adult creates a situation to elicit communication
Communication elicited by adult or environment
Child responds
Adult provides natural consequence
Antecedent
Behavior
Consequence

11. Beginning to Implement
Arrange the environment:
Make it interesting to the child
Keep preferred materials in sight but out of reach
Make it easy for the adult to regain control if needed
Plan for strategies to get the student to communicate with you
“Gatekeeper” of materials
Portions of materials
Sabotaging the routine

12. Beginning to Implement
Identify preferred activities/toys that the child is interested in
The adult SHARES CONTROL of preferred toys
Create opportunities with materials:
Multiple activities and toys planned for and ready to use
Items that can be used in several ways
Variety of shapes/colors/sizes
Break toys into multiple parts

13. Components of PRT Gain Attention Shared Control
Responsivity to Multiple Cues
Intersperse Maintenance Tasks
Contingent Response to Behavior
Reinforce Attempts
Direct Response-Reinforcer Relationship

14. Gain Attention

15. Gain Attention We want to do this in the least intrusive way possible:
Pause activity
Position object or self in line of sight
Make an expectant noise
Tap shoulder
Physically interrupt line of sight
Say “look”
Call name
Regain control of object prior to statement
Least Intrusive
Most Intrusive

16. Shared Control

17. Sharing Control What activity to play Where to play the activity
Consider two strategies:
Providing choice (between and within activities)
Taking turns with items/activities
By doing this you:
Enhance child motivation in participation
Expand play scheme and flexibility in activities
Big choices:
What activity to play
Where to play the activity
Smaller choices
How to engage with the objects (e.g., throw or roll the ball)
Color of materials
Be aware, at times it is not appropriate or not possible to follow the child’s lead-redirect to an appropriate activity
Under no circumstances should the child be allowed to engage in an activity that is hazardous (aggression, self-injury) or unacceptable because it is inappropriate (self-stimulation, compulsive rituals).
In these circumstances the implementer must assume control until the child is able to assume appropriate control

18. Shared Control Shared control primarily includes: Taking turns
Short turn with resistant turn-takers
Discontinue if unable to build in short turn (highly preferred items)
Providing choice
Using shared control
Enhances student motivation in participation
Expands play scheme and flexibility within play

19. Response to Multiple Cues

20. Response to Multiple Cues
Multiple components, draws awareness to and work towards response to more units within the environment
Examples:
Colors red pen, v. red crayon or blue pen
Size big bubble v. little bubble
Speed fast car v. slow car
Embed into play activities
Steps:
Adult labeling in environment
Work towards receptively responding (first without distractors then with distractors)
Encourage child expressive use of cues
Color
Shape
Size
Texture
Quantity
Quality
Specific position/ location (e.g., sticker on bottom)- not “here or there”
Speed (fast/slow)
Children are more likely to learn to respond to these cues when they are used

21. Reinforcement:
Contingent
Direct
Reinforce Attempts

22. Contingent to Behavior
Reinforcement MUST be contingent upon the correct behavior or attempt
The response must be:
As immediate as possible after the child’s response
Appropriate to the response
Dependent upon the response
Reinforce immediately for correct responses or attempts

23. Reinforce Attempts
Honor attempts to initiate and to respond to questions or instructions
Must be a “reasonable attempt”
Child’s attention is directed to the task
The attempt is related to the task
Used a reasonable amount of effort (at the child’s level of ability)

24. TO SUMMARIZE PRT COMPONENTS…
The question/ instruction/ opportunity to respond should be… 1. Clear, uninterrupted, and appropriate to the task 2. Interspersed with maintenance tasks 3. Chosen by the child 4. Include multiple components And the reinforcer should be…. 5. Contingent upon behavior 6. Administered following any attempts to respond 7. Related to the desired behavior

25. Putting It All Together
Embedded into natural social/play routines
-Set-up environment
-Gain attention
-Share control with
choices and turns
-Use multiple cues
Child is motivated to play and communicate
Actively engaging with you
-Reinforce what
they ask for
-Reinforce attempts
and expand
Antecedent
Behavior
Consequence

26. Practical
Implications

27. Training Process

28. Training Process Training and Feedback
2 hour overview training (in person)
Weekly session:
Observe 10-minute independent PRT session
10 minutes of feedback and modeling with student
Fidelity:
3 consecutive sessions at 80% or higher
or 3/4 consecutive sessions at 80% (no session below 70%)
One monthly 10 minute follow up session

29. Feedback Process
Coding sessions based on specific definitions (all staff trained and reliable)
Educators given feedback on each of the targeted components and general session structure
Percentage of fidelity reported to educator

30. Training Model
Graph here showing after
Change Average to 4.8 sessions

31. Outcomes

32. Child Benefits See child progress Social-communication Engagement
Increase in their use of descriptive language
Social attention
Engagement
Increased engagement
Decreased behavior
Willingness to engage AND sustain engagement

33. Case Example #1

34. Case Example #2

35. More Child Benefits Reduction in restrictiveness of programming
Amount of cues/redirections needed decreases
Independence increases
Child is continuously provided a language model
Increase in child’s self-esteem / excitement

36. Team Benefits Foundational Naturalistic Intervention
ESDM
Forms stronger relationship with child
More reinforcing for staff
child gives more back
Confidence in their skills
Teachers share strategies/successes together
Everyone is using the same language

37. More Team Benefits Training both teachers & paraprofessionals
Teachers have tools to train paraprofessionals when turnover occurs
Makes classroom “downtime” meaningful
Cost
Easily generalizable
Across activities
Small group/large group

38. Challenges When teacher doesn’t specify to the team WHEN to use PRT
Challenging for staff who have foundation in DTT (at first)
Coaching can be uncomfortable
Not having ENTIRE team trained
SLP, OT
Child characteristics can make it challenging to get to fidelity
Decreases staff motivation

40. Contact Information
For questions or more information, please contact the Thompson Center TEAM Program:
Louis Nevins, Staff Specialist
(573)

41. Thank you!
Questions?