Topic:
How does Pivotal Response Training affect young children with autism?

Research tells us:Available research offers convincing evidence that young children with autism can learn skills that are central (or pivotal) to good communication and social behavior through Pivotal Response Training provided by trained adults or peers.

Acting on the evidence:During play times in natural settings, with a variety of different play activity options, use these strategies to help young children with autism learn and practice important communication and social skills:

1. Use activities that the child prefers and allow the child to make choices about the play activities and objects used.
2. Vary the communication/social tasks during the play in order to maintain the child's interest.
3. Include tasks the child has already mastered among new tasks as a way to maintain the child's sense of capability.
4. Show or model a desired behavior, like how to take turns, plenty of times during interactions.
5. Use natural reinforcers to reward the child's performance of a desired behavior. For example, push the child on a swing when he says "swing," rather than giving a token for having spoken.
6. Reward all the child's attempts to respond correctly instead of only the successful attempts.

Parents of young children with autism, as well as early childhood practitioners who teach and care for them, will welcome a method to help their children build core communication and social-emotional skills that is both highly beneficial and so easy to understand and learn to do that even other children can take on the role of "peer trainer" with notable success.

An analysis of existing research confirms that Pivotal Response Training (PRT)-a set of positive, child-centered, teaching strategies and guidelines-is a valuable and effective approach for helping young children with autism learn important communication and social-behavior skills.

Tracy L. Humphries, Ph.D., of the Orelena Hawks Puckett Institute, in cooperation with the Research and Training Center on Early Childhood Development, evaluated 13 studies of PRT conducted with a total of 51 children with autism, most of whom were age six years or younger when the studies began.

Seven of the studies Dr. Humphries examined described improvements in communication and behavior as a result of PRT. These included such benefits as more understandable speech, the ability to stay with a targeted activity for longer periods of time, fewer disruptive behaviors, less repetitive play, and increased word use. Nine of the studies included information about improvements in child social-emotional behavior following PRT. These kinds of improvements included such things as increased play with play partners (as opposed to solo play), more asking questions or starting conversations, better ability to maintain social interactions, and increased child social competence.

Dr. Humphries found the study designs and procedures to be of generally high quality, with adequate procedures in place to correct for potential problems. Taken together, they offer convincing evidence supporting the effectiveness of PRT. As a result, the Research and Training Center recommends with confidence the use of Pivotal Response Training to improve communication and social-emotional functioning of young children with autism.

Instead of teaching very specific skills or pieces of information one item at a time, Pivotal Response Training focuses on promoting large areas of child functioning that are considered to be central or "pivotal" to a child's ability to benefit from everyday learning opportunities and interactions. Examples of such areas would be increasing children's motivation to learn new skills and learning to begin and respond to spoken interactions.

According to the evidence, PRT includes the following characteristics applied during teaching opportunities in everyday settings in the home, school, or community:

1. Using the child's preferred activities, and allowing the child to make choices during activities.
2. Sustaining interest by varying the learning tasks.
3. Mixing tasks that the child has mastered among new tasks to help maintain the child's sense of ability, accomplishment, and willingness to continue performing a task.
4. Demonstrating or modeling the target behavior.
5. Using logical, related, natural rewards to reinforce the child's performance of a desired behavior.
6. Rewarding all the child's attempts to perform a new behavior, not only the successful ones.

In addition, adults or other children conducting PRT sessions with a young child with autism use very clear, simple instructions when speaking to the child, first making sure that the child is paying attention to them or to the task. They also give plenty of time for the child to attempt to respond to their directions.

Now, let's take a look at Pivotal Response Training in action:

Stephen and Daniel, brothers aged 5 and 6, enjoy playing in the small city park across the street from their house most afternoons while their mom relaxes with a book on one of the well-shaded benches near an inviting sandbox, swing set, and climbing structure. Today the park’s fenced play area is a busy place, with a half dozen other neighborhood children scurrying exuberantly from one activity to another.

Daniel has learned to spend the first few minutes of these play sessions on what he and his mom have come to call "Stevie Time." Hand-in-hand, the two boys enter the play area.

"Stevie," Daniel says, positioning himself directly in front of his brother's face. "Stevie, do you want to dig in the sand or swing? What do you want to do first? Dig in the sand or swing?

"Swing today," replies Stephen, moving straight toward a just-abandoned swing.

"Great, Stevie! We'll swing. Do you want to go first or second?"

"First turn!"

"OK, this time you get the first turn. Do you want me to push you?"

"High, high, high, high," chants Stephen, grasping the swing chains.

"Should I push you?" repeats Daniel.

"Push, yes! Yes, push!"

"Okay, here goes!" exclaims Daniel, pushing his little brother. "This is fun! You are going really high!"

After a while, Daniel begins to tire, but he knows Stephen "can go on forever." He stops pushing

"More!"

"Wait. My turn now, Stevie. My turn second. Remember?"

"Danny now," Stephen says, standing aside.

"Thanks! Great sharing! I get to swing and then you get another turn!"

After several more change-overs, Daniel speaks up. "Stevie, do you want to dig in the sand with Lucy? See? Lucy's over there." Daniel waits until Stephen shifts his gaze to the sand box.Stephen nods. "OK! Let's say 'Hi' to Lucy."

Daniel greets his young next-door neighbor, and prompts his brother to follow suit.

"Lucy," Stephen murmurs as he busies himself collecting a shovel and pail in the sand play area.

"Good try!" notes Daniel. "You can play in the sand with the blue truck, too, Stevie. You play here. Lucy's here, too."

With a quick nod of approval from his mom, Daniel races off to join a group of friends on the jungle gym.

Take another look:
Visit www.researchtopractice.info to read or download the complete practice-based research synthesis by T. L. Humphries (2003). Effectiveness of pivotal response training as an intervention for young children with autism spectrum disorders. Bridges, 1 (10). Copies of the research synthesis, this Bottomlines research summary, and a variety of print and multimedia practice guides based on this topic are available from Winterberry Press, online at www.wbpress.com, or by mail at P. O. Box 2277, Morganton, NC 28680. 828-432-0150 or 800-824-1174.