What is Pivotal Response Training?

A particular method of teaching children with autism using the principles of ABA was developed by Schreibman and Koegel (Shreibman & Pierce, 1993; Koegel& Koegel, 1988) and first published in the 1980s. PRT differs greatly from discrete trial teaching (the method publicised by Lovaas, 1987), even though the same core ABA teaching principles underlie both. PRT techniques were developed to optimise children’s motivation to interact with adults and engage in repeated learning opportunities. Core motivational and teaching strategies include (1) use the reinforcers that are directly related to the child’s goal and responses, (2) incorporating child choice into the teaching episodes, (3) interspersing previously acquired tasks with acquisition tasks, (4) therapist reinforcement of child’s attempts to perform the desired behaviour at whatever level of accuracy the child can produce at the moment, (5) using activities that are highly motivating to the child, and (6) sharing control of the materials and interactions with the child. 

PRT is currently considered one of the empirically supported practices for building communications skills in children with autism, given its long history of published findings documenting enhanced child motivation, spontaneity, and social initiations; improved language, improved maintenance , and response generalisation; and for concomitant reductions in unwanted behaviours. PRT strategies are incorporated into the teaching approaches used in the ESDM; their explicit incorporation represents one are difference between the original Denver Model and the ESDM.     

For whom it can be used?

Naturalistic or loose training techniques (e.g., those that are conducted in loosely controlled contexts, that provide multiple examplars, and that incorporate the target child’s preference into the teaching interaction), such as PRT, have been traditionally used to increase the language skills of children with autism. Recently, these techniques have been adapted to increase other complex behaviours, such as symbolic play (Stahmer, 1995) and sociodramatic play (Thorp, Stahmer, & Schreibman, 1995). A similar naturalistic technique, incidental teaching, has been shown to increase the social skills of these children (McGee, Almeida, Sulzer-Azaroff, & Feldman, 1992). McGee et al. showed that young, typical peers could effectively implement incidental teaching strategies to increase reciprocal interactions with their schoolmates with autism. This finding is important because it suggests that loose training techniques are not only effective but also can be implemented by peers, a population that has great potential to produce behaviour change in their schoolmates with autism. 

More research, however, is necessary to examine the collateral effects of naturalistic strategies (e.g., areas related to social skills, such as language and attention) and to determine whether this procedure can be effectively implemented with low-functioning children with autism. Although research shows that children with autism can be taught to respond to initiations (e.g., Odom, Hoyson, Jamieson, & Strain, 1985), complex social behaviours such as initiating play and conversation typically remain low. Pilot research (Pierce, 1993) using PRT to increase the social skills of a child with autism indicated that this procedure was highly effective in increasing complex social behaviours, such as initiations.


Intervention studies evaluating pivotal response treatment (PRT) were systematically identified and analysed. Forty-three studies were summarised in terms of (a) participant characteristics, (b) dependent variables, (c) intervention procedures, (d) intervention outcomes, and (e) certainty of evidence.

The majority of the reviewed studies (56.4 %) had serious methodological limitations. However, the reviewed studies that provided conclusive or preponderant evidence (43.6 %) indicated that PRT results in increases in self-initiations and collateral improvements in communication and language, play skills, affect and reductions in maladaptive behaviour for a number of children. Furthermore, the reviewed studies suggested that the majority of caregivers and staff members were able to implement PRT techniques, but evidence for collateral improvements in caregivers’ and staff members’ behaviours remains sparse.

Conclusion remarks

Compared to discrete trial teaching, PRT techniques result in children with more motivation to perform, better generalisation of new skills, more spontaneous responding, and less problem behaviour (Ingersoll & Schreibman, 2006; Losardo & Bricker, 1994). PRT works to increase motivation by including components such as child choice, turn taking, reinforcing attempts, and interspersing maintenance tasks.

PRT builds the child’s capacity to respond to multiple cues by varying the antecedents, purposefully setting up stimuli with multiple cues, and teaching children to emit the same behaviour in response to varying related antecedents. PRT has been used successfully to target language skills, play skills, imitation, gesture, and social behaviours in children with autism (Koegel & Koegel, 1995; Schreibman & Koegel, 2005). However, PRT is an appropriate teaching method only when the skill to be taught has a direct relationship to a reinforcer. 


Ingersoll, B., & Schreibman, L. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36(4), 487-505.

Koegel, R. L., Koegel, L. K., Frea, W. D., & Smith, A. E. (1995). Emerging interventions for children with autism: Longitudinal and lifestyle implications. In R. L. Koegel & L.

Koegel (Eds.), Teaching children with autism: Strategies for initiating positive interactions and improving learning opportunities (pp. 1-15). Baltimore: Paul H. Brookes.

Losardo, A., & Bricker, D., (1994). Activity-based intervention and direct instruction: A comparison study. American Journal of Mental Retardation, 98, 744-765.

McGee, G. G., Almeida, C., Sulzer-Azaroff, B., & Feldman, R. (1992). Promoting reciprocal interactions via peer incidental teaching. Journal ofApplied Behavior Analysis, 25, 117-126.

Odom, S. L., Hoyson, M., Jamieson, B., & Strain, P. S. (1985). Increasing handicapped preschoolers’ peer social interactions: Cross-setting and component analysis. Journal ofApplied Behavior Analysis, 18, 3-16.

Pierce, K. (1993). Teaching an autistic child to respond to and instigate social initiations via pivotal response training. Unpublished data, University of California, San Diego.

Schreibman, L., & Koegel, R., L. (2005). Training for parents of children with autism: Pivotal response, generalization, and individualization of intervention. In E. D. Hibbs, & P. S. Jensen (Eds.), Psychosocial treatment for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed., pp. 605-631). Washington, DC: American Psychological Association. 

Stahmer, A. (1995). Teaching symbolic play to children with autism using pivotal response training. Journal ofAutism and Developmental Disorders, 25, 123-141.

Thorp, D., Stahmer, A., & Schreibman, L. (1995). The effects of sociodramatic play training on children with autism. Journal of Autism and Developmental Disorders, 25, 265-282.