Parent-child communication is just as significant as therapy!

Pivotal Response Therapy (PRT): The Benefits of Utilizing Natural Reinforcement When Engaging With Your Child

 

What is PRT?

 

Pivotal response therapy (PRT) is one type of behavior therapy that came from the principles used in Applied Behavior Analysis (ABA). A more well-known type of ABA therapy is called Discrete Trial Training (DTT). PRT and DTT differ in terms of the situations and settings in which they are used, the behaviors they focus on improving, and the different ways they reward children. DTT typically occurs in a clinic and focuses on the child completing tasks and being rewarded by a therapist; there is little parent involvement. Therapists teach correct responses by breaking down skills into very small steps. They ask the child questions and then prompt them to answer over the course of many repeated trials. In contrast, PRT typically takes place in natural environments (e.g., at home and in public places) during play. Instruction occurs naturally as circumstances arise rather than being taught in an arranged lesson which results in following the child’s lead. Parent’s continuing use of PRT techniques outside of therapy sessions is also essential.

 

DTT teaches concrete skills, and each therapy activity has very specific steps that are followed. The adult begins by modeling the correct answer and then slowly fades their support until the child can answer on their own. If a therapist was teaching color naming they may take out one red card and one blue card and ask the child to “touch red.” First, the therapist would point to the red card and see if the child imitated their correct point. Next, the therapist would ask the child to touch red again, but this time they would only gesture halfway towards the correct card. Finally, the therapist would ask the child to touch red and not provide any support. If the child was unable to answer correctly the therapist would increase their support on the next trial. This method teaches the child about correctly labeling and identifying things in their environment. Providing fading support is meant to improve motivation to respond to questions.

 

PRT, on the other hand, does not focus on specific skills; it addresses broad areas of development such as motivation and initiation of social interactions. This approach of addressing broad areas of behavior has been shown to help children apply the skills they have learned to many situations. A common way parents use PRT at home is by prompting their child to request the activity they want. For example, if a parent is playing their child’s favorite tickle game they may stop and say “tickle” several times to prompt their child to repeat the word. If the child does not say “tickle,” they would not get more tickles. If they did say it, they receive encouragement and more tickling. This tactic teaches children that they have to request what they want in order to receive it, which is a form of natural reinforcement.

 

One of the main differences between PRT and DTT is the way in which children are reinforced for positive behaviors. In DTT, children get a general reward that is not as directly related to their task. For example, a child may be rewarded with a 5-minute break or a snack for correctly matching objects on flashcards. In PRT, the object or activity the child requests becomes their reward. For example, if a child asks for their iPad, they are “rewarded” by getting the iPad. The PRT reward system has shown to be especially effective because children are less reliant on the cues of adults. In theory, this prevents solely communicating in response to questions and commands and motivates children to ask questions and make requests themselves.

 

Impact of PRT

 

A recent study examined whether PRT was an effective therapy for children with autism. The researchers compared two groups of children. One group of parents and their children received PRT training. Parents in the other group (i.e., the control group) received counseling services by a family worker. Eleven children were in the PRT group and thirteen children were in the control group. All of the children had been diagnosed with autism spectrum disorder (ASD) and were between 3–8 years old. The researchers measured improvement based on the children’s scores on the Autism Diagnostic Observation Schedule (ADOS) before and after the study. The ADOS is designed to measure characteristics of ASD. The researchers found that children who received PRT showed decreased characteristics and children who did not receive PRT showed increased characteristics. Therefore, this study suggests that PRT may lessen autism characteristics in children with ASD.

 

What does this mean for me as a parent?

 

1. Therapies differ in terms of who is involved in helping the child. If your therapist primarily works with your child, ask them how to get more involved. How you play with your child at home effects their development and is just as impactful as their interactions with their therapists. You can play a big role in helping your child!
2. Therapies also differ in terms of their goals. Think about whether your therapist is working on concrete skills (e.g., naming colors) or broad areas (e.g., initiating a social interaction). Be sure their goals match what you’d like to see your child improve on.
3. Therapies differ in terms of how they “reward” children for showing a skill. Use natural reinforcement as much as possible because it is the best model of how communication works in everyday life. In other words, teach your child that requesting something results in receiving what was requested instead of rewarding them for communicating with a treat or a break.

 

Reference:

 

Duifhuis, E.A., den Boer, J.C., Doornbos, A. et al. (2016). The Effect of Pivotal Response Treatment in Children with Autism Spectrum Disorders: A Non-randomized Study with a Blinded Outcome Measure [Electronic Version]. Journal of Autism and Developmental Disorders, 1-12. doi:10.1007/s10803-016-2916-0