Autism Spectrum Disorder is recognized as a developmental disability that can influence social communication and behavioral growth. It is a spectrum of closely associated disorders with a shared core of symptoms. It is characterized by persistent social communication and interaction deficiencies and restricted, repetitive patterns of behavior, interests, or actions. As a neurodevelopmental disorder, ASD begins at a very young age, and the diagnosis is constant during life in most individuals. Heritability and environmental circumstances contribute to the etiology of ASD. It affects boys more frequently than girls, with a ratio of 5:1 among individuals with normal mental functioning and a rate of 2:1 among those with an intellectual disability.

History of ASD and Behavioral Treatments

Autism is from the Greek term “autos'' meaning self, was first pointed out by Kanner in his evident account of Donald T, a child who underwent significant social impairments. The child was reported to be so “self-satisfied” that to get his attention almost needs one to break down a mental wall between his inner awareness and the outside world. Today, autism spectrum disorder or ASD is still regarded as a pervasive developmental disorder described by social communication deficiency and restricted interest in objects, and repetitive behavior. There is an estimation that up to one-third of young children with ASD also encounter clinically notable levels of maladaptive habits, such as recession, distraction, and aggression. 

In the 1970s, pioneering behavioral interventions that aimed to increase social communication and diminish clinically important maladaptive behaviors gradually relied on operant conditioning systems. The most influential model was Applied Behavior Analysis (ABA). Traditional ABA proposed to obtain behavioral modifications in highly concentrated and structured experiments. It has been described as efficient in enhancing social functioning and lessening clinically vital maladaptive behaviors. The clinical process can be expensive in both time and effort, which has drawn much criticism. Individuals frequently encounter increased exposure to failed efforts on profoundly structured tests, which can considerably reduce motivation and provoke a feeling of learned inability. Also, highly structured practice sustains limited ecological efficacy, more discrediting the generalizability of any successfully obtained skills over other developmental areas and outside of clinical surroundings. Pivotal Response Treatment (PRT), developed from the Natural Language Paradigm (NLP), is defined as a complete naturalistic intervention model based on ABA. 

What is Pivotal Response Treatment (PRT)?

Pivotal Response Treatment is a set of teaching procedures practiced in children’s everyday settings. It is based on the systems of Applied Behavior Analysis (ABA) that centers on four key or ‘pivotal’ areas of autistic children’s advancement, intending to help children improve more complex skills and behavior that includes social and communication skills. PRT aims to teach children and adults to respond to the various learning opportunities and social interactions that happen in their natural environment and improve their motivation to communicate. 

PRT focuses on pivotal core areas such as motivation, multiple cues, self-initiation, and self-management, resulting in broad gains in non-targeted domains, such as lessening behavioral problems. It is also characterized by a naturalistic behavioral procedure, where interferences are primarily set in practical activities that are less structured.

What are the Advantages of PRT?

PRT has plenty of benefits compared to other approaches. These advantages involve utilizing natural reinforcements which promote generalization. It is anticipated to develop parental self-efficacy because of their specific and definite involvement, in contrast to other methods that are performed by therapists. PRT is carried out in a child's everyday environment. In contrast, the instruction's adult-directed nature and stringent stimulus control in other methods may narrow the natural application of skills. 

In PRT, parents and other individuals' clear responsibility in the child's everyday life reduces the number of services required, following in less cost concentrated treatments. Parents are instructed in using PRT techniques as much as feasible in everyday life. 

Who practices PRT, and what does it involve? 

ABA specialists are usually familiar with PRT, such as psychologists, speech therapists, special education teachers, and occupational therapists, just among the ABA experts. But almost all can practice pivotal response training, including parents, teachers, and even peers. Every program is tailored to match the person's goals and requirements from his or her regular routines. A session typically comprises six segments. Language, exercises, and social skills are targeted with both structured and unstructured synergies. Each session's focus moves as the person performs progress to provide more advanced intentions and needs. 

This training happens in autistic children's natural surroundings like preschool, home, or school. It also applies daily exercises to educate children and consumes a lot of time. It involves many hours a day and goes on for several years, depending on children's intentions. 

The Efficacy of PRT in Treating ASD

PRT is one of the best-studied and verified behavioral methods for autism. There are more than 20 studies suggesting that PRT enhances communication skills in several children who have autism concerns. Most of these studies observed at PRT performed by qualified therapists in one-on-one therapy sessions. Others viewed at PRT delivered in group environments by school teachers and by trained parents at homes. A 2017 study of brain imaging analyses presented data that PRT advances brain activity associated with sociability and communication.

Early behavioral interventions are meant to consolidate clinician-delivered treatment with parent training. In community practice, children usually get primarily clinician-delivered treatment, and providers have inadequate training in parent-mediated methods. Experiential evidence from randomized controlled trials (RCTs) has arisen concerning the efficacy of both clinician-delivered PRT and parent training to administer PRT to the child effectively. An RCT exhibited that children with ASD presented a more remarkable change in the base length of response after three months of clinician-delivered PRT than a structured ABA program. 

A new RCT reported that contrasted with a psychoeducation control group, children with ASD whose parents engaged in a 12-week PRT training group displayed advances in many responses and adaptive communication skills. Conclusively, given proof that parent constancy of treatment implementation can decrease after training ends, a guide to assist resources exceeding an initial 12-week period is assured.