What Is Pivotal Response Treatment?

Medically Reviewed by Jabeen Begum, MD on August 25, 2022

Also known as PRT, pivotal response treatment for autism focuses on pivotal, or fundamental, areas of development. These areas focus on helping children develop important social skills that are needed to perform well at home, at school, and in other areas of their life. The targeted pivotal areas are areas such as learning how to start a conversation, learning how to respond to questions, and learning how to take part in current discussions. PRT focuses on play-based therapies and uses natural reinforcements to reward a child for appropriate behavior. 

PRT’s main characteristic is that it aims to motivate children to interact. It works to increase a child’s natural desire to engage with their peers either through conversation or through play. 

To put it simply, PRT is a behavioral treatment for autism that allows autistic children to learn new, pro-social behaviors through a play-to-teach method. 

What Are the Pivotal Areas in Pivotal Response Therapy?

There are four main pivotal response areas in PRT. These areas include: 

  • Motivation: Motivation is the central principle and foundational procedure of PRT. The learning opportunities of PRT are specifically designed to improve the motivation of a child to both learn and interact. Motivation is defined in PRT by a child’s response and initiation when they are placed in social and learning environments. The goal of motivation is to increase a child’s desire to perform skills and behaviors by using specific past occurrences and consequences.
  • Initiations: Teaching children to initiate learning is pivotal, as it helps to open the door to more learning and social interactions. It’s important for children to learn to self-initiate through question asking, obtaining attention, socially commenting, and asking for help.
  • Responding to Multiple Cues: Children with autism spectrum disorder, or ASD, are sometimes good at figuring out specific details of a stimulus. However, they may not be able to pick up and respond to multiple cues in an environment. By learning how to respond to relevant cues, the child can improve their ability to learn from more complex situations.
  • Self-Regulation: Self-management is oftentimes regarded as teaching children to self-monitor, self-evaluate, discriminate their own behaviors, and to self-reinforce. Self-management is thought to help improve general skills, self-regulation, and decrease challenging behavior.

How Does Pivotal Response Treatment Work?

PRT offers children a chance to develop certain skills in a way that is unique to them, focusing on the child’s own special interests and aiming to make learning fun. As such, each treatment is individualized to the child in question. If the child has an interest in trains, dinosaurs, or sports, then the treatment plan is developed around one of those interests. With their special interest in play, PRT enables a child to initiate conversation or play with their peers. 

Additionally, PRT also requires a substantial amount of support and guidance from the parents or guardians of the child. It allows parents and guardians to learn the best ways of supporting the development of their child’s social and communication skills. While PRT cannot be involved in every interaction that a child has, parents and guardians are encouraged to use PRT as much as they can, especially since PRT works better when used consistently. 

A typical PRT therapy program session usually involves multiple segments. Structured and unstructured interactions are responsible for the skills pertaining to language, play, and socializing. The program is not only tailored to the specific interests of the child involved: It is also tailored to meet the specific needs and goals of the individual and their everyday routines. 

Each PRT session changes its focus as the individual progresses. When it changes, the focus shifts to more advanced needs and goals. 

Pivotal Response Treatment Examples

It’s important to retain the attention of the child and to use shared control methods to instill motivation in the child. To establish the attention of the child or the learner, their teachers, parents, or guardians could simply tap the child on the shoulder to get their attention or make eye contact. Instructions would then be provided to the child to motivate them. To do this, it is recommended that the adult in question uses short and concise instructions. 

Once attention has been established, it’s time to use shared control. Shared control is exactly what it sounds like: The routine is shared between the child and adult, with the adult choosing which part of the routine they will help with. When the choice is shared with the child, the child becomes more motivated to interact with the materials in question. 

As an example, a child who is learning to put on their coat before going outside to play might receive some help from the adult before completing the objective on their own. This could look like the adult retrieving the coat from the coat rack and then allowing the child to put the coat on themselves. 

Is Pivotal Response Treatment Effective?

Pivotal Response Treatment is one of the best-studied and confirmed behavioral therapies for autism. There have been over 20 studies conducted that purport the benefits of PRT for children with ASD. 

Is Pivotal Response Treatment Covered By Insurance?

Whether PRT is covered by insurance will depend on your specific health insurance plan and where you live. There are several types of private health insurance that are required to cover the costs of behavioral services, including PRT. 

In addition, Medicaid plans are required to cover all treatments that are medically necessary for those who are under the age of 21. With that being said, a doctor must prescribe PRT as being medically necessary for Medicaid to cover the cost. 

If you’re unsure whether your insurance plan covers this type of treatment, you should reach out to your health insurance provider and ask whether PRT is covered. 

Show Sources


ASD Toddler: “Pivotal Response Treatment.”

autism speaks: “Pivotal Response Treatment (PRT).”

National Professional Development Center on Autism Spectrum Disorders: “Pivotal Response Training.”

Yale Medicine: “Pivotal Response Treatment.”

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