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Pivotal Response Treatments for Autism
Communication, Social, and Academic Development
Discover how to use natural learning opportunities to target and modify key behaviors in children with autism—leading to widespread positive effects on communication, behavior, and social skills. It’s all possible with the innovative, widely used Pivotal Response Treatment (PRT), an empirically supported treatment for autism recognized by the National Professional Development Center on Autism Spectrum Disorders and the National Standards Project.
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The product of 20 years of research from Robert and Lynn Koegel—co–founders of the renowned Autism Research Center at the University of California, Santa Barbara—this proven approach is now clearly presented in one accessible book. Keeping parents involved in every aspect of behavioral intervention, therapists and educators of children from preschool to elementary school will use the research-supported PRT strategies to
- advance children's communication and language skills, even in extremely challenging cases
- foster social interactions and friendships with typically developing peers
- reduce disruptive behaviors by combining functional assessment with self-management strategies
- aid early identification and intervention
reduce ritualistic behaviors and broaden children's interests
- improve children's performance in school activities and on homework assignments
Because PRT works with each child's natural motivations and stresses functional communication over rote learning, this comprehensive model helps children develop skills they can really use. With this timely resource, educators and therapists will support children with autism as they enjoy more positive interactions, more effective communication, and higher academic achievement in natural, inclusive settings.
Review by: Robert Naseef, Psychologist and author of Special Children, Challenged Parents: The Struggles and Rewards of Raising a Child with a Disability
"A landmark contribution . . . [gives] the reader . . . an in-depth understanding about the pivotal responses in the child's developmental trajectory in relationships with teachers, therapists and, most importantly the family."
Review by: Michael Alessandri, University of Miami
"This important new book of evidence-based practices comes as a breath of fresh air . . . [and] will help to ensure that best practices become common practices."
Review by: Ilene Schwartz, University of Washington
"One of the few validated strategies that draws from both a developmental approach and applied behavior analysis. This book will be extremely helpful for teachers, parents, and other people who care about students with autism."
Review by: John Neisworth, Professor Emeritus, Penn State University
"Of pivotal importance to professional preparation and practice . . . target[s] behaviors that are catalysts to rapid and sweeping enhancement of the child's social, communication, and academic development."
Review by: Robert Horner, Professor, Special Education, University of Oregon
"Provides an eloquent braiding of current science, practical intervention design, and informed advocacy for children with autism."
Review by: Teresa Cardon, Clinical Services Officer, Southwest Autism Research & Resource Center, author of Let’s Talk Emotions: Helping Children with Social Cognitive Deficits, Including AS, HFA, and NVLD, Learn to Understand and Express Empathy and Emotions
"Will motivate and inspire everyone who participates in a child's day . . . a true demonstration of Pivotal Response Treatments as an effective and adaptable intervention!"
Review by: Lauri Bell, parent
"A true godsend! Learning the PRT approach gave us the tools to work with our son throughout our day, so in effect he was receiving treatment during his every waking hour. He has gone from being completely non-verbal and difficult, to gregarious and well behaved!"
Section I. Overview of Pivotal Response Treatment
Section II. Development of Communication
- The Basics of Pivotal Response Treatment
Robert L. Koegel, Daniel Openden, Rosy Matos Fredeen, and Lynn Kern Koegel
- A Screening, Training, and Education Program (First S.T.E.P.)
Lynn Kern Koegel, Nicolette Nefdt, Robert L. Koegel, Yvonne Bruinsma, and Rosy Matos Fredeen
- Interventions in General Education Classrooms: One Boy's Story as Seen by His Mother
- Incorporating Motivational Procedures to Improve Homework Performance
Robert L. Koegel, Quy H. Tran, Amanda Mossman, and Lynn Kern Koegel
- Parent Perspectives of Parent Education Programs
Jennifer B. Symon, Robert L. Koegel, and George H.S. Singer
- Ecocultural Theory and Cultural Diversity in Intervention Programs
Karen M. Sze and Robert L. Koegel
Section III: Social Development
- Developmental Trajectories with Early Intervention
Robert L. Koegel, Yvonne E.M. Bruinsma, and Lynn Kern Koegel
- First Words: Getting Verbal Communication Started
Robert L. Koegel, Karen M. Sze, Amanda Mossman, Lynn Kern Koegel, and Lauren Brookman-Frazee
- he Pivotal Role of Initiations in Habilitation
Rosy Matos Fredeen and Robert L. Koegel
Section IV: Reducing Disruptive Behavior and Broadening Children's Interests
- Working with Paraprofessionals to Improve Socialization in Inclusive Settings
Robert L. Koegel, Eileen F. Klein, Lynn Kern Koegel, Mendy A. Boettcher, Lauren Brookman-Frazee, and Daniel Openden
- Play Dates, Social Interactions, and Friendships
Grace A. Werner, Laurie A. Vismara, Robert L. Koegel, and Lynn Kern Koegel
- Reducing Ritualistic Behaviors and Broadening Children's Interests
Robert L. Koegel, Jane Lacy Talebi, and Lynn Kern Koegel
- Improving Social-Communication, Empathy, and Pragmatics in Individuals with Asperger Syndrome
Lynn Kern Koegel, Jane Lacy Talebi, Robert L. Koegel, and Cynthia Carter
- Combining Functional Assessment and Self-Management Procedures to Rapidly Reduce Disruptive Behaviors
Lynn Kern Koegel, Robert L. Koegel, Mendy A. Boettcher, Joshua Harrower, and Daniel Openden
Excerpted from Chapter 5 of Pivotal Response Treatments for Autism: Communication, Social, and Academic Development,
by Robert L. Koegel, Ph.D., & Lynn Kern Koegel, Ph.D., with invited contributors.
Copyright © 2006 by Paul H. Brookes Publishing Co. All rights reserved.
Bradley, a 5-year-old boy with autism, lived with his mother, father, and 7-year-old
sister in a suburb of a Southwestern city. Bradley's mother worked part time, and his
father worked full–time in a small business. With both parents working, the family
was lucky to have support from their maternal grandmother, who provided a significant
amount of caregiving while Bradley's mother was working.
Bradley spoke in single words and short phrases to have his needs met. He also
engaged in disruptive behaviors (e.g., screaming, tantrums, grabbing) when he was
told "no" or when making the transition from a preferred activity (e.g., playing video
games) to a nonpreferred activity (e.g., getting ready for school). In the area of play,
he showed some interest in several toys, but his play often became repetitive (e.g.,
saying the same words after pushing a button, repeatedly landing on the same square
of a board game). Socially, he showed some interest in other children, but he did not
interact or play appropriately with them.
These behaviors prompted Bradley's mother to contact the Autism Research
and Training center (ARTC) at the University of California, Santa Barbara, to participate
in an individualized parent education program. She hoped to gain skills to increase
Bradley's motivation to communicate, to reduce his aggressive and noncompliant
behaviors, and to improve the family's interactions with him. Bradley's mother
and babysitter participated in the program. During the week–long, intensive program,
Bradley's mother learned techniques to address his motivation and to improve
his social communication. She mastered the use of the motivational teaching techniques
and identified teaching opportunities that could be transferred to the family's
typical routines (e.g., meals, bath time, play time) at home and in the community.
Most important, she became hopeful that her son would make progress in his communication
skills and was eager to share her new experience and skills with others
who interacted frequently with Bradley (e.g., Bradley's grandmother, teachers, and
When the family returned home, Bradley's mother successfully taught his father
how to use the Pivotal Response Treatment (PRT) strategies with Bradley during
play interactions. When the family visited with Bradley's grandparents shortly thereafter,
Bradley's grandmother commented on the improvements in his language as
well. The family has maintained a relationship with the parent educator through email
and telephone contact. Three years after the family participated in the program,
Bradley's mother still shares Bradley's progress through anecdotal stories about his
academic and social success as a student in an inclusive elementary school classroom:
Just wanted to say "Hi" and brag about my son. . . . He has a wonderful teacher and incredible
"first grade friends". . . . [Bradley] is included full time — he doesn't even leave for
special ed. He receives all his instruction in the regular class and is performing at or above
grade level in all areas. His teacher tells me there are days at recess you would never know
he has special needs. . . . [During a school game] he shouted, "I'm a winner!" and EVERY
kid in that class cheered for him. They were all truly excited for him. It was one of those moments
I just wanted to cry.
OVERVIEW OF THE PARENT EDUCATION PROGRAM
Although the majority of services at the ARTC are provided to nearby families,
ARTC's parent education program provides services to children with autism and
their families who live far from the center. With the growing number of children becoming
diagnosed with autism spectrum disorders (ASDs) and a limited number of
specialized centers, more families are searching for services for their children (Bryson,
Clark, & Smith, 1998; Burton, 2002; Fombonne, 2003b; Gillberg, Steffenburg, &
Schaufman, 1991; R.L. Koegel, Koegel, & Carter, 1999; Yeargin–Allsopp, Rice, &
Karapurkar, 2003). ARTC's parent education program provides an innovative service
delivery system that expands existing resources and gives children and families
access to specialized services. This chapter describes the program and describes a
project that provided some initial findings through qualitative outcome data. The
goal of this project was to begin to understand the types of support and experiences
that families encountered as a result of participating in a parent education program.
Although the findings are specific to ARTC's program, the experiences that participating
families have are likely similar to those of many other families who receive
parent education as part of their child's intervention plan. The purpose of this chapter
is to discuss an intensive parent education program and the effect it can have on
the families of children with autism.
A body of literature discusses the challenges that many parents face if their child is
diagnosed with a disability such as autism. Parents of children with disabilities can
endure high levels of negative stress, often reported to be in the clinical range as
scored on standardized measures. This heightened stress can be due to the unknown
prognosis for the child's future and the family's challenged expectations. It can also
be related to obtaining high-quality specialized resources that the children often need.
Children with ASDs require special education resources, as well as ongoing and intensive
intervention and support. In regard to obtaining effective and appropriate
support, researchers have identified common barriers that family members face (Ruef,
Turnbull, Turnbull, & Poston, 1999; Turnbull & Ruef, 1996). Through focus group
meetings, these authors obtained feedback from individuals with disabilities, their
family members, and others who support them. They found that a lack of effective
resources was a widespread barrier to effectively supporting families. This lack of resources
was associated with a limited amount of services, lack of sufficiently trained
staff members, high staff turnover, negative staff attitudes, and use of negative practices.
Again, realizing the discrepancy between the specialized services available to
families of children with autism as compared with the growing number of identified
children, it is clear why families may struggle to find support for their children and
themselves. In order to obtain these necessary services for their children, parents may
be faced with excessive financial burdens and stress (Birenbaum & Cohen, 1993; Singer
& Powers, 1993a).
In addition to the emotional and financial stress of trying to obtain appropriate
services, parents of children with autism often deal with the stress caused from managing
their children's challenging behaviors. In children who have a diagnosis of
autism, social communication is delayed and stereotypic behaviors are common. Many
of these children rely on using early forms of communication, specifically disruptive
behaviors, to get their needs met. They also engage in repetitive and stereotypic behaviors
that also present challenges to parents who find it strenuous to successfully
interact with their children in more prosocial ways. Research has shown elevated levels
of stress for parents of children with autism due to the children's scattered skills
and engagement in repetitive and antisocial behavior (Moes, 1995; Plienis, Robbins,
& Dunlap, 1988). Parents of children with autism reported greater stress related to
caregiving responsibilities, cognitive impairment, disruption in daily activities, and
long–term care for their children as compared with parents whose children did not
have disabilities. Specifically, findings suggest that parenting a child with a disability
increases stress in the areas of everyday management of disruptive behaviors, heavy
caregiving responsibilities, and concerns about the child's future when the parents
are no longer able to care for the child (R.L. Koegel, Koegel, & Schreibman, 1991).
Heavy caregiving responsibilities and problem behaviors can affect the family's daily
living situation by limiting engagement in leisure or recreational activities. For example,
if a child has tantrums in public areas (e.g., a restaurant, the grocery store),
the family may avoid taking their child into the community.
For these reasons, families can develop feelings of social isolation and choose not
to engage in such activities. For a family that enjoys spending time in community settings,
having a child who engages in disruptive and stereotypic behaviors can be
embarrassing, stressful, and overwhelming. This lifestyle alteration can serve as a
source of stress for families. In turn, these areas of family stress can inevitably lead
to a lowered quality of life for the children and for their family members. The increased
stress for parents of children with autism was found to be consistent across
family characteristics including geographic location, child's age, and severity of impairment
(R.L. Koegel, Koegel, & Surratt, 1992).
In an effort to enhance program outcomes and to support families, many intervention
programs for children with autism include a parent education component.
Given that children with autism typically spend time engaged in self–stimulatory or
other socially avoidant behaviors, they miss many natural opportunities to learn from
their environment. Therefore, it has been suggested that they receive intensive intervention
throughout the day and during their waking hours (L.K. Koegel, Koegel, Kellegrew,
& Mullen, 1996; Lovaas, 1987). There is a large body of literature supporting
the inclusion of parents as active team members for their children with autism, and
the results of many studies have shown the benefits of this model. Unlike professionals,
teachers, and service providers, parents typically spend more time with their
children throughout the days and evenings or on weekends. Therefore, they can provide
"round–the–clock" intervention for their children (R.L. Koegel, Koegel, Frea, &
Smith, 1995). Educators and other service providers most likely provide support to
children based on a set weekday schedule, during specific and regular periods of
time, and in a particular setting such as a clinic room, classroom, or even in a room
at the child's home. Conversely, parents are natural teachers for their children throughout
the week and on the weekend. They are often with their children in numerous
settings such as homes, stores, restaurants, airports, parks, beaches, museums, and
movie theatres. In addition to the various settings in which parents are frequently
with their children, parents also provide teaching opportunities across various daily
routines such as mealtime, car rides, bath time, running errands, shopping, and bedtime.
Therefore, a benefit of parent education is the likelihood that children's skills
will more likely generalize because teaching occurs in many settings.