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The PRT Pocket GuidePivotal Response Treatment
for Autism Spectrum Disorders
Baltimore • London • Sydney
by
Robert L. Koegel, Ph.D.
and
Lynn Kern Koegel, Ph.D.
Koegel Autism CenterUniversity of California, Santa Barbara
with invited contributor
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
v
Contents
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
For the Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
I What Is the P in PRT?
1 Treatment of Pivotal Areas . . . . . . . . . . . . . . . . . . . . . . . . . 13
2 How to Teach the Pivotal Area of Motivation . . . . . . . . . 39
3 How to Get Rid of Disruptive Behavior . . . . . . . . . . . . . . 65
4 How to Teach the Pivotal Area of Self-Initiation . . . . . . . 73
II How and When to Implement Treatment
5 Maximizing Family Involvement . . . . . . . . . . . . . . . . . . . 105
6 How to Minimize Parent Stress . . . . . . . . . . . . . . . . . . . . 123
7 Treatment and Assessment in Natural Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
8 Making Data Collection Easy in PRT . . . . . . . . . . . . . . . . 163 8 with Sarah Kuriakose
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
v
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
vii
About the Authors
Robert L. Koegel, Ph.D., has focused his career in the area of autism, special-izing in language interven-tion, family support, and school inclusion. Dr. Robert L. Koegel is Director of the Koegel Autism Center at the University of California, Santa Barbara. He has pub-
lished more than 200 articles and papers relating to the treat-ment of autism, has published six books on the treatment of autism and positive behavioral support, and is Editor of the Journal of Positive Behavior Interventions. Models of his proce-dures have been used in public schools and in parent edu-cation programs throughout the United States and in other countries. He has trained many health care and special edu-cation leaders in the United States and abroad.
Lynn Kern Koegel, Ph.D., is Director of Clinical Services at the Koegel Autism Center and Director of the Eli and Edythe L. Broad Center for Asperger’s Research. She has been active in the development of programs to improve communication in children with autism, including the development of first words, grammatical structures, pragmatics, and social con-versation. In addition to her published books and articles in the area of communication and language development, Dr. Lynn Kern Koegel has developed and published procedures and field manuals in the area of self-management and func-tional analysis that are used in school districts and by par-ents throughout the United States and have been translated into other major languages. Dr. Lynn Kern Koegel is the
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
viii � About the Authors
author of Overcoming Autism: Finding the Answers, Strategies, and Hope that Can Transform a Child’s Life (Viking/Penguin, 2004) and Growing Up on the Spectrum (Viking/Penguin, 2009) with Claire LaZebnik.
The Koegels are the developers of Pivotal Response Treatment, which focuses on motivation. They were the re-cipients of the first annual Children’s Television Workshop Sesame Street Award for brightening the lives of children and the first annual Autism Speaks award for science and research. In addition, Dr. Lynn Kern Koegel appeared on ABC’s hit show Supernanny, working with a child with au-tism. The University of California, Santa Barbara, received a $2.35 million gift to expand the physical space of the Autism Research and Training Center, which was renamed the Koegel Autism Center in recognition of the Koegels’ work on behalf of children with autism, and a large gift from the Eli and Edythe L. Broad Foundation to start a center for Asperger syndrome research, which is now part of the Koegel Autism Center.
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
1
Introduction
Pivotal Response Treatment (PRT) is one of the few evi-dence-based approaches for the treatment of autism. That is, the approach is supported by research that meets the stan-dards set by many professional agencies and organizations, such as the American Psychological Association. That’s im-portant because supporting children and families affected by autism is a race against time. Families can’t afford to repeatedly go up blind alleys with treatment procedures that sound good but have no evidence to support their ef-fectiveness in helping children with autism. Each day more children are diagnosed with autism, and they need instruc-tion and intervention in many different areas. Furthermore, early intervention is effective—partly because it keeps bad habits from getting started (habits that would be hard to break), but also because without intervention kids on the autism spectrum get worse, whereas with intervention they get better. Although it’s never too late, the earlier any com-munication delays and social challenges are addressed, the sooner parents, teachers, and therapists can start helping the kids learn what they’ll need to survive and thrive. PRT focuses on core underlying areas that are critical for children with autism. Functionally, the major core area—which affects all other areas—is motivation to engage in social communication. That core area is linked both to un-derlying neurological bases and to thousands of individual behaviors that are affected by the motivational problem as the children develop. The figure on the next page shows the many interrelationships addressed by PRT.
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
2 � Introduction
It’s also important to understand that the PRT proce-dures were developed over many, many years and that there are now hundreds of studies showing their effectiveness. PRT is based on behavioral intervention, a method devel-oped in earlier work in the field of applied behavior analysis that is also supported by plenty of research that documents its effectiveness as an approach for autism. In general, for all behavioral interventions, the standards for documenting treatment effectiveness require multiple research studies
NEUROBIOLOGICAL BASE
CORE PROBLEM
AREALack of
motivation to engage in social
communication
PRIMARY DIAGNOSTIC
CRITERIACommunication
disabilitySocial disability
Restricted interests
PIVOTAL RESPONSE
TREATMENT (PRT)
Motivation to initiate and respond to
complex social, linguistic, and
academic interventions
THOUSANDS OF
PERIPHERAL FEATURES
Language (i.e., vocabulary,
syntax, semantics, phonology)
Pragmatics (e.g., eye contact, mannerisms,
prosody)Self-helpAcademic
Many more
Environmental feedback
Self-regulation
A model of pivotal response intervention.
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
Introduction � 3
conducted by several independent researchers using either randomized, controlled experimental designs or rigorous single-case experimental designs, or both. (See Chambless & Ollendick, 2001, for a general description of these stan-dards.) In short, this means that not only have we succeeded with research conducted in our own clinics, but that other researchers, working in other clinics and using a variety of different experimental designs, have also found the same positive results. This duplication shows that there isn’t bias on our part. It really works. Another important point is that not only has the PRT “package” been shown to make real and significant changes, but every component of PRT has also been tested individually and found to be valuable in intervention (see R.L. Koegel, Koegel, & Camarata, 2010; R.L. Koegel, Koegel, Vernon, & Brookman-Frazee, 2010; National Autism Center, 2009; National Research Council, 2001; Odom, Boyd, Hall, & Hume, 2010a, 2010b; Simpson, 2005). As we’ll repeat many times in this book, there are a lot of packaged autism inter-ventions out there—some we’ve all heard of—for which the proponents haven’t shown that the individual components work. Using those interventions may be wasting valuable time teaching behaviors that just aren’t helpful for the child. It’s important to note that because PRT is scientifically based, it continues to evolve, with new components being added as they are discovered. This point is critical, because all the answers aren’t in yet, and there are always improve-ments that can be made. As new ways to teach or to teach more effectively are found—so the kids will learn faster and have more fun—the methods will continue to change. As an example, as the PRT approach has been developed and re-fined over the years, it has gone by several different names. When it was first applied specifically to communication, as in the original studies focused on teaching first words, it was called the “Natural Language Paradigm,” or NLP for
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
4 � Introduction
short. It got that name because the motivational compo-nents incorporated into the treatment for communication resembled natural interactions with children, as opposed to the more structured, drill-type interventions that were com-monly used at that time. Through further research, it became clear that the ap-proach was surprisingly effective in many areas beyond communication. Thus, the approach began to go by the name “Pivotal Response Treatment” to reflect its impact on thousands of behaviors within the overall condition of autism. The table summarizes the evidence supporting the comprehensive PRT package. There are four primary reasons why empirical evidence is important when choosing which treatment approach to use.
1. Empirical evidence separates approaches that really work from approaches that are mere fantasy and hype or are simply less effective. Don’t be fooled by fancy brochures and treatment providers claiming to have the “latest and greatest” interventions for autism. That’s unlikely. Because nonscientific approaches may sound good on paper or in dramatic speeches by celebrities, one can be easily deceived by rhetoric and fancy sales pitches.
2. Certifying agencies, as well as credentialing and licensing bodies, are increasingly requiring profession-als to use approaches that are backed by sound scientific evidence, making those who use non–evidence-based approaches increasingly vulnerable to lawsuits. Don’t get caught in that situation, as you’ll look extremely ill informed in court.
3. Insurance companies and other third-party funding agencies are refusing to pay for treatments that do not have scientific evidence to back their effectiveness. It may sound superficial, but someone has to pay for the treatment, and no one wants to pay for something that doesn’t work!
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
5
Sum
mar
ized
em
piri
cal s
upp
ort
for
Pivo
tal R
esp
onse
Tre
atm
ent
(PRT
)
Stud
yTi
tleN
otab
le t
reat
men
t ou
tcom
e(s)
Ori
gin
al P
RT s
tud
ies
R.L.
Koe
gel
, O’D
ell,
and
Koe
gel (
1987
)A
Nat
ural
Lan
gua
ge
Para
dig
m
for
Teac
hing
Non
verb
al A
utis
tic
Chi
ldre
n
Chi
ldre
n p
rod
uced
mor
e im
itativ
e an
d s
pon
tane
ous
utte
ranc
es in
PRT
co
nditi
on t
han
in t
rad
ition
al d
iscr
ete
tria
l tra
inin
g. G
ener
aliz
atio
n of
tr
eatm
ent
gai
ns o
ccur
red
onl
y in
PRT
con
diti
on.
R.L.
Koe
gel,
Koe
gel,
and
Surr
att
(199
2)La
ngua
ge
Inte
rven
tion
and
D
isru
ptiv
e B
ehav
ior
in P
resc
hool
C
hild
ren
with
Aut
ism
Incr
ease
d la
ngua
ge
resp
ond
ing
and
few
er d
isru
ptiv
e b
ehav
iors
oc
curr
ed d
urin
g t
he P
RT c
ond
ition
com
par
ed t
o tr
aditi
onal
dis
cret
e tr
ial t
rain
ing
.
L.K
. Koe
gel,
Koe
gel,
Shos
han,
and
M
cNer
ney
(1
999)
, Pha
se 1
Pivo
tal R
esp
onse
Inte
rven
tion
II:
Prel
imin
ary
Long
-Ter
m O
utco
me
Dat
a
Look
ing
thr
oug
h re
tros
pec
tive
anal
ysis
, chi
ldre
n w
ith p
oor
and
favo
rab
le
outc
omes
had
com
par
able
lang
uag
e ag
es a
nd a
dap
tive
beh
avio
r sc
ale
scor
es a
t p
rein
terv
entio
n, b
ut c
hild
ren
who
exh
ibite
d h
igh
leve
ls
of s
pon
tane
ous
initi
atio
ns a
t p
rein
terv
entio
n ha
d m
ore
favo
rab
le
outc
omes
.
L.K
. Koe
gel,
Koe
gel,
Shos
han,
and
M
cNer
ney
(1
999)
, Pha
se 2
Pivo
tal R
esp
onse
Inte
rven
tion
II:
Prel
imin
ary
Long
-Ter
m O
utco
me
Dat
a
Follo
win
g P
RT in
itiat
ion
trai
ning
, chi
ldre
n in
crea
sed
the
ir ad
aptiv
e an
d
pra
gm
atic
sco
res
to n
ear
chro
nolo
gic
al a
ge
leve
l. Th
ey d
id n
ot re
tain
th
eir
dia
gno
sis
of a
utis
m o
r th
eir
spec
ial e
duc
atio
n p
lace
men
ts.
Soci
al/a
cad
emic
func
tioni
ng w
as c
omp
arab
le t
o th
at o
f typ
ical
ly
dev
elop
ing
pee
rs.
L.K
. Koe
gel
, Car
ter,
and
Koe
gel (
2003
)Te
achi
ng C
hild
ren
with
Aut
ism
Sel
f-In
itiat
ions
as
a Pi
vota
l Res
pon
seTh
roug
h PR
T, c
hild
ren
wer
e su
cces
sful
ly t
aug
ht t
o us
e th
e q
uerie
s “W
hat
hap
pen
ed?”
or
“Wha
t’s h
app
enin
g?”
dur
ing
inte
rven
tion.
C
hild
ren
gen
eral
ized
the
use
of -
ing
and
-ed
to
othe
r ve
rbs
and
in
crea
sed
the
ir m
ean
leng
th o
f utt
eran
ce a
nd v
erb
div
ersi
ty.
R.L.
Koe
gel
, Sh
iroto
va, a
nd
Koe
gel
(200
9b)
Brie
f Rep
ort:
Usi
ng In
div
idua
lized
O
rient
ing
Cue
s to
Fac
ilita
te
Firs
t-W
ord
Acq
uisi
tion
in N
on-
resp
ond
ers
with
Aut
ism
PRT
with
ind
ivid
ualiz
ed o
rient
ing
cue
s p
rod
uced
ver
bal
com
mun
icat
ion
gai
ns in
cor
rect
resp
ond
ing
, cor
rect
pho
nem
es, a
nd in
dep
end
ent
wor
d p
rod
uctio
n th
at P
RT w
ithou
t su
ch c
ues
did
not
.
(con
tinue
d)
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
Stud
yTi
tleN
otab
le t
reat
men
t ou
tcom
e(s)
R.L.
Koe
gel
, Ve
rnon
, and
K
oeg
el (2
009)
Imp
rovi
ng S
ocia
l Ini
tiatio
ns in
Yo
ung
Chi
ldre
n w
ith A
utis
m U
sing
Re
info
rcer
s w
ith E
mb
edd
ed S
ocia
l In
tera
ctio
ns
PRT
with
em
bed
ded
soc
ial i
nter
actio
ns re
sulte
d in
incr
ease
d le
vels
of
child
-initi
ated
soc
ial e
ngag
emen
t d
urin
g c
omm
unic
atio
n, im
pro
ved
no
nver
bal
dya
dic
orie
ntin
g, a
nd h
ighe
r ra
ting
s of
ove
rall
child
affe
ct
com
par
ed t
o th
e no
nem
bed
ded
con
diti
ons.
Ind
epen
den
t re
plic
atio
ns o
f PR
T ef
fect
iven
ess
wit
h or
igin
al la
b c
olla
bor
atio
n
Schr
eib
man
, K
anek
o, a
nd
Koe
gel
(199
1)
Posi
tive
Affe
ct o
f Par
ents
of A
utis
tic
Chi
ldre
n: A
Com
par
ison
Acr
oss
Two
Teac
hing
Tec
hniq
ues
Pare
nts
trai
ned
in P
RT w
ere
obse
rved
dis
pla
ying
sig
nific
antly
mor
e p
ositi
ve a
ffect
tha
n p
aren
ts t
rain
ed in
dis
cret
e tr
ial t
rain
ing
.
R.L.
Koe
gel
, B
imb
ela,
and
Sc
hrei
bm
an
(199
6)
Col
late
ral E
ffect
s of
Par
ent
Trai
ning
on
Fam
ily In
tera
ctio
nsD
iscr
ete
tria
l con
diti
on re
sulte
d in
no
sig
nific
ant
influ
ence
on
inte
ract
ions
, whi
le P
RT re
sulte
d in
pos
itive
par
ent–
child
inte
ract
ions
no
ted
on
ratin
gs
of h
app
ines
s, in
tere
st, s
tres
s, a
nd c
omm
unic
atio
n st
yle
dur
ing
din
nert
ime
pro
bes
.
R.L.
Koe
gel
, C
amar
ata,
K
oeg
el, B
en-T
all,
and
Sm
ith (1
998)
Incr
easi
ng S
pee
ch In
telli
gib
ility
in
Chi
ldre
n w
ith A
utis
mSi
gni
fican
t g
ains
ob
serv
ed in
cor
rect
pro
duc
tion
of t
arg
et s
ound
s an
d
spee
ch in
telli
gib
ility
dur
ing
the
PRT
inte
rven
tion.
L.K
. Koe
gel
, C
amar
ata,
Val
dez
-M
ench
aca,
and
K
oeg
el (1
998)
Sett
ing
Gen
eral
izat
ion
of Q
uest
ion-
Ask
ing
by
Chi
ldre
n w
ith A
utis
mC
hild
ren
lear
ned
in P
RT t
o co
nsis
tent
ly a
nd s
pon
tane
ousl
y in
itiat
e “W
hat’s
tha
t?”
acro
ss t
reat
men
t an
d g
ener
aliz
atio
n se
ttin
gs.
Si
gni
fican
t in
crea
se in
voc
abul
ary
achi
eved
due
to
item
lab
el
acq
uisi
tion.
Bry
son
et a
l. (2
007)
Larg
e Sc
ale
Dis
sem
inat
ion
and
C
omm
unity
Imp
lem
enta
tion
of
Pivo
tal R
esp
onse
Tre
atm
ent:
Pr
ogra
m D
escr
iptio
n an
d
Prel
imin
ary
Dat
a
Prel
imin
ary
dat
a sh
ow t
hat
PRT
pro
vid
ers
who
par
ticip
ated
in la
rge-
scal
e, c
omm
unity
tra
inin
g m
aint
aine
d fi
del
ity o
f im
ple
men
tatio
n ac
ross
tim
e an
d in
crea
sed
the
func
tiona
l ver
bal
utt
eran
ces
of t
he
par
ticip
ant
child
ren.
Sum
mar
ized
em
piri
cal s
upp
ort
for
Pivo
tal R
esp
onse
Tre
atm
ent
(PRT
) (c
ontin
ued
)
6
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
7
Nef
dt,
Koe
gel
, Si
nger
, and
Ger
ber
(2
010)
The
Use
of a
Sel
f-D
irect
ed L
earn
ing
Pr
ogra
m t
o Pr
ovid
e In
tro d
ucto
ry
Trai
ning
in P
ivot
al R
esp
onse
Tr
eatm
ent
to P
aren
ts o
f Chi
ldre
n w
ith A
utis
m
The
maj
ority
of p
aren
ts p
artic
ipat
ing
in t
he P
RT S
elf-
Dire
cted
Lea
rnin
g
Prog
ram
(DV
D a
nd a
ccom
pan
ying
mat
eria
ls) c
omp
lete
d t
he p
rog
ram
, d
emon
stra
ted
lear
ning
of s
pec
ified
pro
ced
ures
, and
was
ob
serv
ed t
o ap
pea
r m
ore
confi
den
t d
urin
g p
aren
t–ch
ild in
tera
ctio
ns.
Ind
epen
den
t re
plic
atio
ns o
f ef
fect
iven
ess
of P
RT
Lask
i, C
harlo
p-
Chr
isty
, and
Sc
hrei
bm
an
(198
8)
Trai
ning
Par
ents
to
Use
the
Nat
ural
La
ngua
ge
Para
dig
m t
o In
crea
se
Thei
r A
utis
tic C
hild
ren’
s Sp
eech
Aft
er p
aren
t tr
aini
ng in
PRT
at
hom
e an
d in
a c
linic
set
ting
, p
ostt
reat
men
t in
crea
ses
in p
aren
t re
que
sts
for
voca
lizat
ions
wer
e ob
serv
ed, a
s w
ere
incr
ease
s in
chi
ldre
n’s
verb
al re
spon
sive
ness
dur
ing
in
terv
entio
n an
d g
ener
aliz
atio
n.
Pier
ce a
nd
Schr
eib
man
(1
995)
Incr
easi
ng C
omp
lex
Play
in C
hild
ren
with
Aut
ism
via
Pee
r-Im
ple
men
ted
Pi
vota
l Res
pon
se T
rain
ing
Follo
win
g p
eer-
imp
lem
ente
d P
RT, c
hild
ren
incr
ease
d in
tera
ctio
ns t
o a
hig
h le
vel o
f int
erva
ls a
nd in
crea
sed
pla
y an
d c
onve
rsat
ion
initi
atio
ns.
Chi
ldre
n ex
hib
ited
incr
ease
s in
coo
rdin
ated
and
sup
por
ted
join
t at
tent
ion
beh
avio
rs fo
llow
ing
tre
atm
ent.
Thor
p, S
tahm
er,
and
Sch
reib
man
(1
995)
Effe
cts
of S
ocio
dra
mat
ic P
lay
Trai
ning
on
Chi
ldre
n w
ith A
utis
mA
ll ch
ildre
n in
crea
sed
in a
ll p
lay
beh
avio
r m
easu
res
follo
win
g P
RT
teac
hing
of s
ocio
dra
mat
ic p
lay.
Pla
y b
ehav
ior
gai
ns m
aint
aine
d d
urin
g
gen
eral
izat
ion.
Stah
mer
(199
5)Te
achi
ng S
ymb
olic
Pla
y to
Chi
ldre
n w
ith A
utis
m U
sing
Piv
otal
Re
spon
se T
rain
ing
Mod
ified
PRT
usi
ng s
ymb
olic
pla
y as
a t
arg
et b
ehav
ior
incr
ease
d
sym
bol
ic p
lay
and
pla
y co
mp
lexi
ty. T
reat
men
t g
ains
wer
e m
aint
aine
d
dur
ing
gen
eral
izat
ions
acr
oss
toys
, set
ting
s, a
nd p
artn
ers.
Pier
ce a
nd
Schr
eib
man
(1
997)
Mul
tiple
Pee
r U
se o
f Piv
otal
Re
spon
se T
rain
ing
Soc
ial B
ehav
iors
of
Cla
ssm
ates
with
Aut
ism
: Res
ults
fr
om T
rain
ed a
nd U
ntra
ined
Pee
rs
Peer
-imp
lem
ente
d P
RT w
as s
ucce
ssfu
l in
pro
duc
ing
pos
itive
soc
ial
beh
avio
r ch
ang
e ac
ross
mul
tiple
pee
r im
ple
men
ters
. The
soc
ial
beh
avio
r ch
ang
e w
as m
aint
aine
d d
urin
g g
ener
aliz
atio
n w
ith
untr
aine
d p
eers
.
(con
tinue
d)
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
Stud
yTi
tleN
otab
le t
reat
men
t ou
tcom
e(s)
Sher
er a
nd
Schr
eib
man
(2
005)
Indi
vidu
al B
ehav
iora
l Pro
files
an
d Pr
edic
tors
of T
reat
men
t Ef
fect
iven
ess
for
Chi
ldre
n w
ith
Aut
ism
Chi
ldre
n p
rofil
ed a
s p
red
icte
d re
spon
der
s to
PRT
exh
ibite
d in
crea
ses
in
lang
uag
e, p
lay,
and
soc
ial b
ehav
ior
follo
win
g P
RT in
terv
entio
n.
Bak
er-E
riczé
n,
Stah
mer
, and
B
urns
(200
7)
Chi
ld D
emog
rap
hics
Ass
ocia
ted
with
O
utco
mes
in a
Com
mun
ity-B
ased
Pi
vota
l Res
pon
se T
rain
ing
Pro
gra
m
Follo
win
g a
12-
wee
k PR
T p
aren
t ed
ucat
ion
pro
gra
m, a
ll ch
ildre
n sh
owed
sig
nific
ant
imp
rove
men
t in
ad
aptiv
e b
ehav
ior
scal
e sc
ores
re
gar
dle
ss o
f gen
der
, ag
e, a
nd r
ace/
ethn
icity
of t
he c
hild
ren/
fam
ilies
.
Vis
mar
a an
d L
yons
(2
007)
Usi
ng P
erse
vera
tive
Inte
rest
s to
Elic
it Jo
int A
tten
tion
Beh
avio
rs in
You
ng
Chi
ldre
n w
ith A
utis
m: T
heo r
etic
al
and
Clin
ical
Impl
icat
ions
for
Und
erst
andi
ng M
otiv
atio
n
Usi
ng t
he c
hild
’s p
erse
vera
tive
inte
rest
s in
a P
RT m
odel
incr
ease
d jo
int
atte
ntio
n in
itiat
ions
.
Gill
ett
and
LeB
lanc
(2
007)
Pare
nt-Im
ple
men
ted
Nat
ural
La
ngua
ge
Para
dig
m t
o In
crea
se
Lang
uag
e an
d P
lay
in C
hild
ren
with
Aut
ism
Pare
nt-im
ple
men
ted
PRT
led
to
incr
ease
s in
ove
rall
rate
and
sp
onta
neity
of
utt
eran
ces
for
child
ren.
Chi
ldre
n al
so s
how
ed a
n in
crea
se in
ap
pro
pria
te p
lay.
Par
ents
rat
ed t
he in
terv
entio
n si
mp
le t
o im
ple
men
t an
d e
ndor
sed
con
tinue
d u
se o
f PRT
.
Har
per
, Sym
on, a
nd
Frea
(200
8)Re
cess
Is T
ime-
In: U
sing
Pee
rs t
o Im
pro
ve S
ocia
l Ski
lls o
f Chi
ldre
n w
ith A
utis
m
Peer
imp
lem
enta
tion
of P
RT in
crea
sed
initi
atio
ns a
nd t
urn-
taki
ng
initi
atio
ns.
8
Sum
mar
ized
em
piri
cal s
upp
ort
for
Pivo
tal R
esp
onse
Tre
atm
ent
(PRT
) (c
ontin
ued
)
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
Introduction � 9
4. Serious problems can occur when approaches that have not been properly tested are employed: In addition to wasting the children’s valuable time, untested procedures are often found to be risky or dangerous, and using them may create problems that are greater than the original symp-toms of autism. Take the casein-free diet, for example. Many parents put their children on this diet, only to find that it results in low bone density after several years—and studies now show that it doesn’t help the symptoms of autism. In short, remember that evidence-based procedures are essen-tial, valuable, and available. Beware of snake-oil salesmen!
This book presents scientifically based and practical intervention procedures that can be implemented in every-day settings; are easy and fun to implement; and produce valuable treatment gains for children with autism, as well as benefits for the entire family’s lifestyle. PRT has been used effectively for more than 25 years with hundreds of thou-sands of families. By focusing on several foundational areas of development in children, PRT results in life-changing improvements for children with an autism diagnosis. The following chapters will highlight each of the pivotal areas and provide details on effective implementation and ex-pected outcomes.
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
Excerpted from The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders by Robert L. Koegel Ph.D., Lynn Kern Koegel Ph.D.
Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved
FOR MORE, go to http://www.brookespublishing.com/prt-pocket-guide
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