What is Pivotal Response Training (PRT)?

Applied Behavior Analysis (ABA) offers an abundance of treatment options based on the principles of behavior including formal, structured teaching and more naturalistic approaches. Pivotal Response Training (PRT) is just one of these options. Through a variety of assessments, professionals must determine which treatment option meets the needs of their learners.

ABA teaching methods occur in a variety of treatment settings falling along a continuum between natural and highly analog environments. Pivotal Response Training is a teaching methodology from the more natural end of this continuum. It focuses on improving skills in 4 pivotal areas that, once learned, help the child acquire other skills more rapidly.

For more information about the various teaching methodology available within ABA, read these posts: Should I Use Natural Environment Teaching (NET) or Discrete Trial Training (DTT)? and Generalization: How teaching strategies and environment affect generalization.

Contents

4 Pivotal Areas
Skills Taught Using Pivotal Response Training
Benefits of Pivotal Response Training
If Pivotal Response Training is so Great, Why isn’t Everyone Using it?
Ethical Considerations When Implementing PRT
Research Related to PRT
References and Related Reading

4 Pivotal Areas

Pivotal Response Training is based on the assumption that there are key skills that have significant impact on other areas of development. PRT seeks to target these skills as a method of improving efficiency of intervention. Essentially, by focusing on these key skills, interventionists expect collateral impacts on other skill areas outside of those receiving immediate intervention.

Koegel, Koegel, Harrower and Carter (1999) published Pivotal Response Intervention I: Overview of Approach where they describe three pivotal areas (motivation to initiate, response to multiple cues, and self-management). More recently (2013), one of the authors, Dr. Lynn Koegel expanded on this when she specified 4 pivotal areas:

• Motivation
• Initiation
• Multiple cues
• Self-management

She explains more in this video:

Pivotal Area: Motivation

Dictionary.com defines motivation as “having a strong reason to act or accomplish something.” Pivotal Response Training seeks to improve the motivation of learners. As motivation increases, the learner becomes more driven to complete tasks. PRT targets motivation through the following interventions:

• Child choice
• Task variation
• Natural reinforcement
• Interspersal of easy and hard tasks
• Reinforcing attempts
• Motivational package

Child Choice

Offering choice has been long identified as connected to motivation in a variety of contexts. Studies in psychology have linked choice with intrinsic motivation (Iyengar & Lepper, 1999) and the field of ABA refers to offering choice as shared control. During PRT, learners control much of the teaching session. The learner communicates their choice, thereby strengthening language (Koegel, 1988).

Task Variation

A study by Stahmer (1995) demonstrated much lower rates of maladaptive and self-stimulatory behavior when programming included variety in tasks. Variety builds motivation and as motivation for task participation increases, the child’s motivation to engage in maladaptive and self-stimulation decreases.

Natural Reinforcement

During PRT, emphasis is placed on reinforcement occurring immediately after a correct response to ensure the correct behavior is reinforced. The relationship between the child’s response and the reinforcement must be clear. PRT focuses on using reinforcement that is the natural result of the behavior. There should be a direct relationship between the behavior and the reinforcer provided. If the learner mands for a ball, the reinforcer is access to the ball, not some arbitrary reinforcer. With this natural reinforcement, the learner understands the relationship between his behavior and access to those items and activities he values.

Initially, every response made by the learner receives reinforcement. Only once the behavior is well established does the interventionist begin to fade the schedule of reinforcement.

Interspersal of Easy and Hard Tasks

Motivation is highest when learners experience success. When easy tasks are interspersed with hard tasks, the learner build momentum with correct responding and then is more likely to attempt hard tasks. The ratio of easy:hard tasks will vary depending on the learner. Some learners quickly become bored with too many easy tasks and others become frustrated with too many hard tasks. Watch the motivation of your learner to guide your decision making.

Reinforcing Attempts

Although it’s critical that the interventionist never reinforce an incorrect response, they often reinforce attempts the child makes at a correct response. Any “reasonable attempt” made by the learner to respond correctly, receives reinforcement, especially when introducing new instructional targets. This reduces frustration on the part of the learner and builds the learner’s motivation to respond.

Many studies conducted by Rober and Lynn Koegel look at reinforcing attempts to shape verbal communication. This aligns with research by others in the field of verbal behavior including Mark Sundberg’s work with the VB-MAPP. When reinforcing attempts, it’s important to keep in mind the need to move forward as the various attempts are mastered. For example, “b” cannot forever be reinforced as a mand for ball. Eventually, the next step (i.e. “ba”) must be encouraged and ultimately required to receive reinforcement.

Motivational Package

Often a “package” addresses many of the above interventions to ensure that programming is effective. Not every learner requires every learner requires that programming include every component. Choose just those interventions that are appropriate given your learner’s specific needs.

Pivotal Area: Initiation

During Pivotal Response Training, learners are taught to initiate interactions. Initiating refers to the ability to independently begin interactions, activities, and communication with others. In PRT, initiating is considered a pivotal behavior because it serves as a foundation for social interaction, communication, and overall development. Here’s a list of a few of the different components and benefits of teaching initiation:

1. Social Engagement: Initiating allows individuals with ASD to actively engage with others, initiate conversations, and establish social connections. By teaching and reinforcing initiating behaviors, PRT helps individuals develop social skills and promotes meaningful interactions with peers, family members, and educators.
2. Communication Development: Initiating is closely linked to communication skills. When individuals with ASD initiate interactions, they have opportunities to practice and refine their communication abilities, such as using verbal or nonverbal gestures, making requests, or expressing their needs and interests.
3. Independence and Autonomy: The ability to initiate empowers individuals with ASD to take control of their environment and engage in activities that interest them. By fostering initiating behaviors, PRT supports the development of independence, autonomy, and self-advocacy skills, enabling individuals to actively participate in their daily lives.
4. Generalization of Skills: Through practicing initiating behaviors in various settings and with different individuals, PRT promotes generalization. Individuals with ASD learn to initiate not only with therapists or educators but also with peers, family members, and community members, allowing them to apply their skills in a wide range of social contexts.
5. Motivation and Engagement: Initiating is often driven by an individual’s motivation and interests. In PRT, therapists capitalize on the child’s natural motivations to increase engagement and active participation in learning. By incorporating the child’s interests into therapy sessions and promoting initiating behaviors, PRT enhances motivation, making the learning process more enjoyable and rewarding.

Initiating serves as a critical building block for overall development and fosters meaningful connections with others. Through the implementation of PRT, autistic learners can acquire and enhance their initiating skills, leading to improved social interactions and increased opportunities for growth and success.

Pivotal Area: Multiple Cues

Responding to multiple cues refers to the learners ability to respond to SDs with 2 or more components, for example, blue car. The learner demonstrates understanding that this is not the same as the red car or the blue dump truck (Koegel, 1988). Learners who respond to multiple cues to items within their environment show greater generality and become less rigid in their learning styles. They learn to adapt and respond to the wide variety of cues available within the natural environment. Interventionists use multiple cues throughout as many interactions as possible, expanding the number of learning opportunities available to the learner.

The list below highlights some of the important benefits of teaching learners to respond to multiple cues.

1. Flexible Learning: Developing the skill to respond to multiple cues allows individuals with ASD to adapt to different situations and stimuli. PRT focuses on teaching individuals to respond to a variety of cues, such as verbal instructions, visual cues, and gestures, ensuring that they can generalize their skills and apply them in various contexts.
2. Generalization of Skills: By targeting Multiple Cues as a pivotal behavior, PRT helps individuals with ASD generalize their learned skills. Teaching individuals to respond to different cues enhances their ability to transfer acquired skills from therapy settings to real-life situations, promoting meaningful and functional application of skills.
3. Discrimination Skills: The ability to discriminate between multiple cues is crucial for effective learning and understanding. PRT aims to improve individuals’ discrimination skills by systematically teaching them to differentiate between various cues, which leads to more accurate and appropriate responses.
4. Reduction of Prompt Dependency: Individuals with ASD may become dependent on specific prompts or cues. By training them to respond to Multiple Cues, PRT helps reduce prompt dependency and encourages independent responding. This leads to increased confidence, autonomy, and self-initiation of appropriate behaviors.
5. Generalization to Natural Communication: Responding to Multiple Cues is closely related to natural communication and social interaction. PRT helps individuals with ASD transfer their skills to real-life communication scenarios, such as understanding social cues, interpreting nonverbal gestures, and comprehending contextual cues, which are essential for successful social interactions.
6. Improved Social Engagement: The ability to respond to Multiple Cues facilitates social engagement and interaction. PRT targets this pivotal behavior to enhance individuals’ social skills, allowing them to better understand and respond to the cues given by others, fostering more meaningful and reciprocal social connections.

By incorporating and reinforcing multiple cues, PRT helps individuals develop a broader repertoire of responses and enables them to navigate various environments with greater ease and confidence.

Pivotal Area: Self-Management

Self-management refers to teaching the learner to become aware of his or her own behavior, emotions and actions; and to intervene to either increase or decrease that behavior. When individuals feel a sense of ownership, control and responsibility for their own behavior, the results can be significant.

Teaching a learner to engage in self-management requires 2 distinct steps:

1. Teaching the learner to discriminate between when the behavior occurs and when it does not occur.
2. Teaching the learner to access a reinforcer for exhibiting the behavior.

Learners at a variety of developmental levels can be taught to use self-management interventions. For example, if the learner understands how to follow a schedule, that learner can utilize self-management strategies to obtain reinforcement for completing tasks on that schedule. It is often best to begin with clear, distinct behaviors and build to include other behaviors.

The list below presents many of the benefits of teaching self-management skills to learners.

1. Independence and Autonomy: Self-management empowers individuals with ASD to take control of their own behaviors and actions. By teaching self-management strategies, PRT fosters independence and autonomy, enabling individuals to make choices, set goals, and regulate their behavior in various contexts.
2. Executive Functioning: Self-management is closely tied to executive functioning skills, such as planning, organizing, problem-solving, and self-monitoring. PRT focuses on developing these skills, which are vital for academic success, social interactions, and everyday tasks.
3. Generalization of Skills: Through self-management, individuals with ASD learn to apply their skills across different situations and environments. PRT emphasizes the generalization of self-management strategies, enabling individuals to transfer their abilities from therapy sessions to home, school, and community settings.
4. Emotional Regulation: Self-management includes the ability to regulate emotions and cope with stress or frustration effectively. PRT teaches individuals with ASD strategies for recognizing and managing their emotions, leading to improved emotional regulation and self-control.
5. Self-Advocacy: Self-management skills empower individuals to advocate for their own needs and preferences. PRT helps individuals with ASD develop self-advocacy skills, enabling them to express their opinions, make choices, and communicate their desires to others.
6. Long-Term Success: Self-management is a pivotal behavior that promotes long-term success and independence. By acquiring self-management skills through PRT, individuals with ASD gain the tools they need to navigate challenges, make informed decisions, and thrive in various aspects of life.

By teaching self-management strategies, PRT empowers them to take control of their own behaviors, make informed choices, and navigate daily challenges. Through the development of self-management skills, your learners can enhance their overall functioning and achieve greater autonomy and success.

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Skills Taught Using Pivotal Response Training

Pivotal Response Training (PRT) is an evidence-based intervention that has proven to be highly effective in promoting the development of a wide variety of skills.. By targeting pivotal areas of development, PRT focuses on improving pivotal behaviors that have a broad impact on a wide range of skills. Below is a list of skills that are easily suited for using Pivotal Response Training.

1. Communication Skills: PRT places a strong emphasis on enhancing communication abilities. It helps individuals with ASD develop language skills, such as requesting, labeling objects, and engaging in meaningful conversations. PRT also encourages the use of alternative communication systems, such as augmentative and alternative communication (AAC) devices, sign language, or picture exchange communication systems (PECS).
2. Social Skills: PRT aims to enhance social interactions by teaching individuals with ASD important social skills. This includes turn-taking, initiating and maintaining conversations, sharing, joint attention, and recognizing and responding to social cues. PRT creates opportunities for individuals to practice these skills in a structured and supportive environment.
3. Play and Leisure Skills: PRT incorporates play-based activities to teach individuals with ASD appropriate play skills. This includes engaging in imaginative play, playing with peers, taking turns, following rules, and participating in age-appropriate activities. PRT helps individuals develop leisure skills that enable them to independently engage in enjoyable and meaningful activities.
4. Academic Skills: PRT also supports the development of academic skills. It focuses on teaching foundational skills, such as attending to tasks, following instructions, completing assignments, and problem-solving. PRT uses motivating materials and incorporates individualized teaching strategies to promote active learning and generalization of skills across different settings.
5. Self-Care and Independence Skills: PRT assists individuals with ASD in acquiring essential self-care skills, such as dressing, grooming, toileting, and feeding themselves. It also fosters independence by teaching skills related to organization, time management, and self-regulation, enabling individuals to become more self-sufficient in their daily routines.

This is not an exhaustive list of all skills that can be taught using PRT, but if you’re considering incorporating PRT into your practice, these skills are a good place to start. As you become comfortable implementing this technique, you can explore teaching other skills with PRT.

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Benefits of Pivotal Response Training

Pivotal Response Training (PRT) is a widely recognized and effective intervention approach used to support autistic learners. It is a child-centered, and evidence-based therapy. PRT has gained popularity among parents, educators, and therapists due to its numerous benefits and positive outcomes. Here are some key advantages of implementing Pivotal Response Training:

1. Enhanced Motivation: PRT utilizes the child’s natural interests and preferences to increase motivation and engagement in learning. By incorporating activities and materials that capture the child’s attention, PRT fosters intrinsic motivation, making learning enjoyable and rewarding.
2. Collateral Gains: PRT often leads to collateral gains, where improvements in targeted skills have a positive impact on other areas of development. For example, improvements in communication skills may also lead to better social interactions and academic performance.
3. Improved Communication Skills: PRT places a strong emphasis on communication development. Through the use of naturalistic and functional communication strategies, such as requesting, commenting, and initiating conversations, PRT helps individuals with ASD improve their language and social communication skills.
4. Lower Levels of Challenging Behavior: PRT has been found to result in decreased levels of challenging behavior. By addressing underlying communication and social difficulties, individuals with ASD may experience a reduction in challenging behaviors that were previously used as a means of communication or frustration expression.
5. Generalization of Skills: PRT promotes generalization, which means that the skills learned in one setting can be applied to other contexts. This is achieved by systematically teaching and reinforcing target skills in various environments, ensuring that individuals with ASD can apply their learned skills in different situations.
6. Increased Independence: PRT aims to enhance individuals’ independent functioning and reduce reliance on prompts and cues. By gradually fading prompts and providing opportunities for self-initiation, PRT supports the development of independent skills, such as self-care, organization, and problem-solving.
7. Family Involvement: PRT encourages active participation from family members and caregivers, promoting a collaborative and supportive environment. By involving families in the therapy process, PRT helps generalize skills beyond therapy sessions and supports consistent implementation of strategies in daily life.
8. Positive Behavior Changes: PRT focuses on reinforcing positive behaviors rather than solely targeting challenging behaviors. By providing individuals with ASD opportunities to engage in appropriate and desired behaviors, PRT helps reduce problem behaviors and increase adaptive behaviors.

Pivotal Response Training offers a range of benefits for autistic learners. Its family-centered nature and emphasis on positive behavior changes make it a valuable intervention for individuals with ASD and their families.

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If Pivotal Response Training is so Great, Why isn’t Everyone Using it?

Many well-known and respected ABA programs and experts use programming that is heavy in Discrete Trial Training (DTT). Dr. Vincent Carbone and many others model the use of highly structured teaching in their work with autistic learners. If the research shows the benefits of PRT, why aren’t these experts using a more natural approach?

The answer may lie, in part, in the difference in learners these researchers are working with. In comparing some of the research, it appears that learners with more profound disabilities may learn better in more contrived or analog situations, although this is hard to confirm. Working with learners with severe disabilities and behavior challenges in a more natural, less controlled environment can be difficult on the interventionist.

Another reason might be related to the ease of data collection and the desire to demonstrate experimental control. The more contrived the setting, the more control the researcher has over the variables that might influence skill acquisition and behavior. Although better data does not mean a better intervention, the field of ABA prides itself on ensuring the use of interventions that work. Without high quality data, it can be difficult to justify the use of an intervention.

While Discrete Trial Training (DTT) often comes to mind first when planning your ABA programming, you must consider every option to decide what is best for the individual learner. To learn more about DTT, read this article: Should I Use Natural Environment Teaching (NET) or Discrete Trial Training (DTT)?

Rober and Lynn Koegel’s book Pivotal Response Treatment for Autism Spectrum Disorders is THE guide to help you implement PRT.

Go give PRT a try and see how it impacts your learner.

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Ethical Considerations When Implementing PRT

The table below presents some important ethical considerations when implementing PRT. The table includes specific action steps to help you ensure you practice in an ethical way.

Ethical Concerns	Description	Action Steps to Ensure Ethical Practice
Failure to adequately assess the learner’s needs	PRT should only be used after a comprehensive assessment of the learner’s individual needs, including functional analysis and assessment of strengths and weaknesses.	Conduct thorough assessments before implementing PRT interventions. Regularly review and update assessments as needed.
Inadequate training of PRT practitioners	PRT practitioners must receive proper training in the principles and procedures of PRT, including didactic instruction and supervised practice.	Ensure PRT practitioners receive appropriate training and certification. Provide ongoing professional development opportunities.
Use of PRT in settings that are not conducive to naturalistic learning	PRT is most effective in naturalistic settings, but if used in more structured environments, ensure the environment resembles a naturalistic setting as much as possible.	Create environments that simulate naturalistic settings. Incorporate real-life situations and natural cues into the learning environment.
Inappropriate use of reinforcement	Reinforcement should be used ethically and tailored to the individual learner, avoiding coercion or negative side effects.	Develop reinforcement protocols that prioritize the learner’s well-being and respect their preferences. Continuously monitor and evaluate the effects of reinforcement.
Failure to monitor the learner’s progress	Regular monitoring of the learner’s progress is crucial in PRT interventions, using objective and subjective measures.	Establish data collection systems to track progress objectively. Solicit feedback from multiple stakeholders to assess subjective measures of progress.
Failure to adapt PRT to the individual learner	PRT should be flexible and adapted to the unique needs of the learner while maintaining its effectiveness.	Continuously assess the learner’s progress and make appropriate adjustments to the PRT program. Individualize strategies and goals based on the learner’s strengths and challenges.
Failure to involve the learner’s family in PRT	The learner’s family should be actively involved in the PRT intervention process, providing support and participating in training.	Collaborate with the learner’s family to develop a partnership and involve them in all aspects of the intervention. Offer training and support to the family to enhance their understanding and implementation of PRT strategies.
Failure to respect the learner’s rights	Children with ASD have the same rights as all learners, including privacy, freedom from harm, and participation in treatment decisions.	Ensure informed consent is obtained and respect the learner’s autonomy and preferences. Safeguard the learner’s privacy and confidentiality. Involve the learner in decision-making to the extent possible.
Use of PRT to suppress challenging behaviors	If PRT is used to address challenging behaviors, it must be done in an ethical and humane manner, avoiding punishment or coercion.	Utilize positive behavior support strategies to address challenging behaviors, focusing on teaching appropriate alternative behaviors rather than suppression. Emphasize proactive strategies to prevent challenging behaviors.
Use of PRT to promote compliance	PRT should promote compliance in an ethical and respectful manner, avoiding threats or undue pressure.	Focus on building motivation and engagement through reinforcement strategies. Foster collaboration and shared decision-making to increase intrinsic motivation. Respect the learner’s autonomy in decision-making when appropriate.
Failure to consider the learner’s long-term needs	PRT should consider the learner’s long-term needs, helping them develop skills for success in various domains of life.	Align PRT goals and strategies with the learner’s long-term developmental, educational, and social needs. Regularly assess progress toward long-term goals and adjust interventions as needed.
Failure to document PRT intervention	Documentation is essential to track progress, ensure correct implementation, and provide a comprehensive record of the intervention.	Develop a systematic documentation process for PRT interventions, including goals, strategies, progress notes, and assessment results. Regularly review and update documentation. Ensure compliance with relevant legal and ethical guidelines for record-keeping and data privacy.

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Research Related to PRT

Below is a table summarizing research articles related to Pivotal Response Training. The table includes important action steps to help you put these ideas into practice.

Article Title	Summary	Action Steps for Applying the Information
Pivotal Response Training in Early Intervention – Center, K. A. (2021)	This article explores the effectiveness of Pivotal Response Training (PRT) in early intervention for children with autism. It highlights the importance of using PRT to target pivotal behaviors that can lead to broader improvements in social communication and adaptive skills.	Implement PRT in early intervention programs for children with autism. Identify and target pivotal behaviors that have the potential to influence other areas of development. Utilize naturalistic teaching strategies and capitalize on child-initiated interactions. Incorporate motivational strategies, such as offering choices and reinforcing attempts.
Classroom Pivotal Response Teaching – Chan, J., Suhrheinrich, J., Rieth, S., & Stahmer, A. C. (2022)	This article focuses on the implementation of Classroom Pivotal Response Teaching (CPRT) as an inclusive teaching approach for students with autism. CPRT emphasizes individualized instruction, promoting communication, social engagement, and academic success.	Integrate CPRT principles into classroom practices for students with autism. Foster a supportive and inclusive classroom environment. Design individualized educational plans based on the student’s strengths and needs. Implement strategies to increase communication, social engagement, and academic skills. Provide ongoing professional development and support for teachers.
Rethinking the Value of Choice: A Cultural Perspective on Intrinsic Motivation – Iyengar, S. S., & Lepper, M. R. (1999)	This article explores the cultural perspective on intrinsic motivation and the value of choice. It discusses the influence of cultural factors on individuals’ preferences for autonomy and decision-making.	Consider cultural perspectives when providing choices in interventions. Be aware of cultural variations in the perception and importance of autonomy. Seek input from clients and their families regarding their preferences for choices and decision-making. Adapt interventions to align with individual cultural values.
How to Teach Pivotal Behaviors to Children with Autism: A Training Manual – Koegel, R. L. (1988)	This manual provides guidance on teaching pivotal behaviors to children with autism using the Pivotal Response Training (PRT) approach. It outlines strategies for selecting and implementing pivotal behaviors, promoting motivation, and generalizing skills.	Familiarize yourself with the PRT approach described in the manual. Select appropriate pivotal behaviors to target based on individual needs and goals. Follow the step-by-step guidance for implementing PRT techniques. Monitor progress and adjust strategies as needed. Seek supervision or consultation from experienced practitioners when implementing complex aspects of PRT.
Pivotal Response Treatment for Autism Spectrum Disorders, Second Edition – Koegel, L. K., & Koegel, R. L. (2019)	This book provides an updated overview of Pivotal Response Treatment (PRT) for individuals with autism spectrum disorders. It covers the theoretical foundations, assessment, and intervention strategies of PRT.	Familiarize yourself with the content of the book to gain a comprehensive understanding of PRT. Apply the assessment and intervention strategies outlined in the book to individuals with autism spectrum disorders. Continuously evaluate and modify interventions based on individual progress. Seek additional resources and professional support for further guidance.
Pivotal Response Intervention I: Overview of Approach – Koegel, L. K., Koegel, R. L., Harrower, J. K., & Carter, C. M. (1999)	This article provides an overview of Pivotal Response Intervention (PRI) as a comprehensive treatment approach for individuals with autism. It discusses the pivotal areas targeted by PRI, such as motivation, responsivity to multiple cues, and self-management.	Incorporate PRI principles into interventions for individuals with autism. Address pivotal areas of motivation, responsivity to cues, and self-management. Utilize naturalistic teaching strategies and follow child-initiated interactions. Promote generalization of skills across various settings and individuals. Collaborate with families and other professionals to implement PRI effectively.
Motivation in Childhood Autism: Can They or Won’t They? – Koegel, R. L., & Mentis, M. (1985)	This study investigates motivation in children with autism and its impact on skill acquisition. It emphasizes the importance of individualized motivation strategies to facilitate learning and engagement in individuals with autism.	Tailor motivational strategies to the specific interests and preferences of individuals with autism. Use reinforcers that are highly preferred by the individual. Create a positive and engaging learning environment. Offer choices and opportunities for self-determination. Continuously monitor and adjust motivational strategies based on the individual’s responses.
Producing Speech Use in Nonverbal Autistic Children by Reinforcing Attempts – Koegel, R. L., O’Dell, M., & Dunlap, G. (1988)	This study explores the use of reinforcement to facilitate speech production in nonverbal children with autism. It highlights the importance of reinforcing communicative attempts to encourage language development.	Reinforce communicative attempts in nonverbal children with autism to promote speech production. Utilize strategies such as modeling, prompting, and reinforcement to shape and encourage vocalizations and speech. Provide immediate reinforcement for approximations and gradually shape towards more complex verbal responses. Include functional communication training to establish alternative forms of communication.
Teaching Symbolic Play Skills to Children with Autism Using Pivotal Response Training – Stahmer, A. C. (1995)	This study focuses on teaching symbolic play skills to children with autism using Pivotal Response Training (PRT). It emphasizes the importance of targeting pivotal behaviors related to symbolic play to enhance overall development.	Incorporate PRT strategies to teach symbolic play skills in children with autism. Select pivotal behaviors related to symbolic play and design interventions to promote their development. Utilize child-initiated interactions and naturalistic teaching techniques. Provide reinforcement and support for attempts and progress in symbolic play skills. Facilitate generalization of play skills to various contexts and play partners.
Comparison of the Effectiveness of Pivotal Response Treatment and Applied Behavioral Analysis on the Symptoms Severity and Executive Functions in Autistic Children – Tababaienavainobari, P., Soleymani, M., & Shalchi, B. (2021)	This study compares the effectiveness of Pivotal Response Treatment (PRT) and Applied Behavioral Analysis (ABA) on symptoms severity and executive functions in children with autism. It highlights the potential benefits of both approaches in improving outcomes.	Consider incorporating both PRT and ABA strategies in interventions for children with autism. Tailor the treatment plan based on individual needs, strengths, and goals. Monitor symptoms severity and executive functions to assess progress. Use a combination of evidence-based strategies from both approaches to optimize outcomes.
Using Pivotal Response Treatment to Improve Language Functions of Autistic Children in Special Schools: A Randomized Controlled Trial – Wang, L., Li, S., & Wang, C. (2023)	This randomized controlled trial examines the effectiveness of Pivotal Response Treatment (PRT) in improving language functions of autistic children in special schools. It demonstrates positive outcomes in language development using PRT.	Implement PRT techniques in special school settings to enhance language functions in autistic children. Incorporate pivotal areas such as motivation, responsivity to multiple cues, and self-management. Use naturalistic teaching strategies and capitalize on child-initiated interactions. Provide frequent reinforcement and opportunities for generalization of language skills. Continuously monitor progress and adjust interventions as needed.

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References and Related Reading

Center, K. A. (2021). Pivotal response training in early intervention. Behavior Analysis, 88.

Chan, J., Suhrheinrich, J., Rieth, S., & Stahmer, A. C. (2022). Classroom Pivotal Response Teaching. TEACHING Exceptional Children, 54(5), 380-382.

Iyengar, S. S., & Lepper, M. R. (1999). Rethinking the value of choice: a cultural perspective on intrinsic motivation. Journal of personality and social psychology, 76(3), 349.

Koegel, R. L. (1988). How to teach pivotal behaviors to children with autism: A training manual.

Koegel, L. K. & Koegel, R. L. (2019). Pivotal Response Treatment for Autism Spectrum Disorders, Second Edition. Balmore, MD: Paul H Brookes Publishing Co.

Koegel, L. K., Koegel, R. L., Harrower, J. K., & Carter, C. M. (1999). Pivotal response intervention I: Overview of approach. Journal of the Association for Persons with Severe Handicaps, 24(3), 174-185.

Koegel, R. L., & Mentis, M. (1985). Motivation in childhood autism: Can they or won’t they?. Journal of Child Psychology and Psychiatry, 26(2), 185-191.

Koegel, R. L., O’Dell, M., & Dunlap, G. (1988). Producing speech use in nonverbal autistic children by reinforcing attempts. Journal of autism and developmental disorders, 18(4), 525-538.

Stahmer, A. C. (1995). Teaching symbolic play skills to children with autism using pivotal response training. Journal of autism and developmental disorders, 25(2), 123-141.

Tababaienavainobari, P., Soleymani, M., & Shalchi, B. (2021). Comparison of the Effectiveness of Pivotal Response Treatment and Applied Behavioral Analysis on the Symptoms Severity and Executive Functions in Autistic Children. The Neuroscience Journal of Shefaye Khatam, 9(2), 22-34.

Wang, L., Li, S., & Wang, C. (2023). Using pivotal response treatment to improve language functions of autistic children in special schools: A randomized controlled trial. Journal of Autism and Developmental Disorders, 1-13.