Pivotal Response Training (PRT)

Pivotal Response Training (PRT) is a method of systematically applying the scientific principles of applied
behavior analysis (ABA) to teach learners with autism spectrum disorders (ASD). PRT builds on learner
initiative and interests, and it is particularly effective for developing communication, language, play, and
social behaviors. PRT was developed to create a more efficient and effective intervention by enhancing four
pivotal learning variables: motivation, responsivity to multiple cues, self-management, and social
initiations. According to theory, these skills are pivotal because they are the foundational skills upon which
learners with ASD can make widespread and generalized improvements in many other areas. The PRT
model has gained a strong foundation in empirically supported research over the past 25 years or more. The
ultimate goal of PRT is ensure that individuals with autism have access to a high quality of life in home,
school, and community (Koegel et al., 1999; Nfedt et al., 2010).

PRT is an intervention or treatment approach derived from the principles of applied behavior analysis
(ABA; R. L. Koegel, Openden, Fredeen, & Koegel, 2006). PRT focuses on building a set of four "pivotal"
skills or behaviors, including (a) motivation to respond to natural environmental and social cues, (b)
responding to multiple (rather than single) cues in the environment, (c) management of own behavior, and
(d) self-initiation of behavior in appropriate contexts. These are called pivotal behaviors because they are
likely to have a positive effect on the learner's acquisition and use of a wider range of developmental or
behavior skills than those specifically targeted for the PRT intervention (Coolican, Smith & Bryson, 2010;
Smith, Koegel, Koegel, Openden, Fossum, & Bryson, 2010).

The core goals of PRT are to:

 Teach learners to respond to the many learning opportunities and social interactions that occur in
the natural environment
 Decrease learners' needs for constant supervision and support from adults
 Promote family involvement and improve the quality of life for all family members
 Decrease the number of services delivered in separate settings that remove learners from the
natural environment
 Improve learners' academic performance
 Advance learners' communication and language skills
 Foster learners' social interactions and friendships with typically developing peers
 Reduce learners' interfering behaviors (e.g., disruptive, repetitive, stereotypical)
 Move learners toward a typical developmental trajectory by teaching a diverse number of behaviors
 Broaden learners' interests

The first behavioral interventions for children and youth with ASD successfully used the basic behavioral
principles of reinforcement, punishment, and shaping to teach target behaviors such as speech,
imitation, following instructions, and reduction of unwanted behaviors (Ferster, 1961; Ferster & DeMyer,
1962). This basic teaching approach was developed further by Lovaas, Koegel, Simmons, and Long (1973),
who demonstrated success at teaching functional behaviors such as toy play, simple social responses, and
self-help skills.

Children in these studies were taught in a discrete trial format. That is, interventions were implemented in
highly structured, tightly controlled environments in which opportunities to demonstrate skills were
determined by the researcher. These studies demonstrated that many of the participants receiving discrete
trial training showed significant gains, including gains in standardized test scores.

However, there were also some weaknesses to this approach. First, it was extremely costly and time-
consuming to implement, and it required children to spend most of their waking hours in one-to-one
instruction (Lovaas et al., 1973). Second, gains were limited to the specific behaviors that were taught, and
they often were performed only in the teaching setting. Finally, skills were not easily maintained without
continuous ongoing rehearsal and reinforcement, perhaps because the use of extrinsic reinforcers and
punishers may have led children to respond only to the stimulus that was reinforced (R. L. Koegel et al.,
2001).

PRT was developed by Robert Koegel and Laura Schreibman, who arranged teaching settings in which
children were allowed to choose materials and activities while adults interspersed teaching opportunities
within learning and play activities. Children in these settings learned new skills and maintained those skills
over time (Schreibman, 2006). PRT, like all other behavioral teaching approaches (and probably non-
behavioral teaching approaches as well), uses the fundamental teaching tools of reinforcement, antecedent
control, prompting, fading, shaping, and chaining. PRT uses both motivational and learning principles
and applies them systematically in natural settings to optimize the development of fundamental skills that
are pivotal to the development of a wide range of other skills. With PRT, the practitioner provides play and
learning opportunities, follows the learner's interests and initiations, and uses the learner's choices as the
reward for attempting to perform a desired behavior. This approach gives the learner opportunities to make
choices and share control of the interactions with adults. The teaching that follows these interactions
enhances learners' motivation to engage with objects and activities that maximize the reward strength (i.e.,
the intrinsic motivating power of the activity or object) and minimize the need for extrinsic reinforcers (e.g.,
stickers, tokens, edibles). The use of natural reinforcers (i.e., rewards that are directly associated with the
behavior being reinforced within the activity) allows learners to gain the rewards present in natural
environments, fosters skill maintenance and generalization across environments, and prepares learners to
develop skills through interactions within natural settings. Additional critical components of PRT that
significantly increase maintenance and generalization include (a) using varied materials and stimuli to build
responses to multiple cues, (b) using PRT techniques in multiple environments, and (c) interacting with
multiple social partners (Smith et al., 2010).

PRT was developed by behavioral psychologists and was first used in their individual therapy sessions.
However, an important objective of PRT has been to provide a successful intervention approach for "a
range of individuals who interact with children with autism and other severe handicaps, and to provide
treatment that is easy to implement and readily usable in community settings" (R. L. Koegel et al., 1989, p.
6). As the effectiveness of PRT became evident, parents were taught how to use PRT to foster their
children's learning throughout the day and across environments (Coolican et al., 2010).

Parents' ability to successfully implement PRT in the home and in the community has been demonstrated in
a number of studies (Baker-Ericzen, Stahmer, & Burns, 2007; Schreibman & Koegel, 2005; Stahmer & Gist,
2001). Peers and siblings also can use PRT strategies to increase communication and social interaction
during activities (Pierce & Schreibman, 1997). Thus, PRT is a technique that a wide range of individuals can
use, including family members and school staff, as well as individual therapists and consultants (e.g.,
speech-language pathologists, occupational therapists).

The focus of PRT is to teach children and youth with ASD certain pivotal behaviors through a set of
specific training procedures, which, when learned, will lead to the development of new behaviors (Baker-
Ericzen, Stahmer, & Burns, 2007). For example, learners who are motivated to participate in a social skills
activity are more likely to acquire target behaviors. The most important targets for PRT are to first develop
and increase social-communication skills and then to focus on specific play/leisure skills and adaptive
functioning (Bryson et al., 2007). These pivotal behaviors are targeted through two key aspects of the
intervention:

 Families are viewed as experts on their children and are essential in setting goals for their children
and implementing the intervention. The outcomes of intervention are greatly increased when families
are able to continue therapeutic interventions at home in addition to school or through outside
services (Lovaas et al., 1973).

 Intervention should be conducted across all environments, including school, community, and home,
with coordination across settings to ensure that the intervention is comprehensive and maximizes
opportunities for teaching and learning throughout the learner's day.
One primary goal of PRT is to promote generalization and maintenance of mastered skills. A successful
strategy for addressing this goal is to focus on skill deficits in the natural environment, in as many naturally
occurring opportunities as possible, and with multiple intervention partners (National Research Council,
2001). For example, it is much more likely that learners will maintain newly acquired skills, such as
buttoning, and generalize to different types of buttons if they button pajamas at night, coats when going
outside, or a doll's dress during play-all naturally occurring opportunities that take place throughout the daily
routine.

PRT can be implemented in any setting and context where (a) the learner has consistent contact with an
individual and (b) there are activities or objects that the learner prefers. By targeting empirically identified
key pivotal behaviors instead of only focusing on individual behaviors, PRT leads to gains that are sustained
and generalized, allowing for broader, widespread effects and the development of other untargeted behavior
changes in functioning and responding (Baker-Ericzen et al., 2010; Nefdt, 2010). This not only provides
more effective intervention, but is a much more efficient way to teach.

The pivotal behaviors that have led to significant gains in skill development and in collateral functioning are
(a) motivation, (b) responding to multiple cues, (c) self-management, and (d) self-initiation (Baker-Ericzen et
al., 2010; Nefdt, 2010).

Motivation to respond to social and environmental cues is fundamental to development and a critical
area of intervention. Learners with ASD may appear poorly motivated to respond to and engage in the social
world around them (Jones, Carr, & Feeley, 2006). One possible explanation for this central deficit is that
they have great difficulty learning the response-reinforcer contingency (i.e., the relationship between the
learner's response and direct reinforcement of the response), and instead view responses and reinforcers
as unrelated (Coolicon et al., 2010).

This can lead to a vicious cycle, where low levels of correct responding lead to low levels of reinforcement,
leading to even lower levels of responding. However, pivotal response interventions that emphasize
associations between social-communicative responses and direct positive consequences lead to increased
motivation, enhanced learning, more rapid acquisition of target behaviors, and less avoidance behavior
(Smith et al., 2010).

Other theories suggest a neurobiological reason for the motivational problems often found among
individuals with ASD, such as a lack of internal motivation due to abnormalities in the brain. As the
learner's motivation increases, so does the number of responses that he or she makes in response to the
teaching attempts. This, in turn, results in decreases in response latency (i.e., the time between initial
stimulus and learner's response) and increases in positive affect. The increases in motivation likely lead to
more practice, which may be why increases in motivation lead to increases in student learning (Nfedt et al.,
2010).

Responding to Multiple Cues: Many learners with ASD demonstrate a characteristic called "stimulus
over-selectivity" (Brown & Bebco, 2012). For example, in a situation in which typically developing peers
might use three cues (e.g., visual, auditory, tactile) together to identify a stimulus, learners with ASD tend to
use only one or two cues while ignoring the others. In addition, learners with ASD are more likely than
others to respond to small, irrelevant cues, which significantly limit their ability to understand and generalize
more complex stimuli (Brown & Bebco, 2012). For instance, learners may come to recognize a familiar and
preferred adult by a very limited detail, like his or her eyeglasses, a piece of jewelry, or a specific gesture
instead of by the person's face, hairstyle, or body shape. If the detail changes, learners with ASD might fail
to recognize that person However, this characteristic appears to be malleable. Many learners with ASD can
enhance their attention to multiple cues and increase their abilities to learn and generalize if this deficit is
targeted (Brown & Bebco, 2012; Reed, 2012). These skills can be taught by building in multiple cues in
activities and instructions. For example, in a pegboard task, instead of pointing to the desired peg and
asking "May I have that one, please?" the adult might ask the learner for the "square, green peg" from a mix
of pegs, including square pegs of different colors and green pegs of different shapes. This requires the
learner to discriminate among multiple features of the pegs at once in order to correctly follow the request.
Self-Management: The ability to self-regulate and manage one's behavior is a critical developmental task
for all individuals. For learners with ASD, development of this skill usually takes time and planned teaching.
The initial stage of self-regulation includes regulating arousal and responses to sensory stimulation. Later
stages of self-regulation consist of inhibition, delay of gratification, and communication. Learners with ASD
appear to have difficulty regulating their own behavior, limiting their ability to attend to and be responsive to
their environment and the learning opportunities around them (Jahmromi et al., 2012).

Self-management is a positive behavior support strategy that decreases interfering behaviors (e.g.,
repetitive, disruptive, stereotypical) while more functional replacement behaviors are being learned.
Development of self-management techniques has been shown to improve academic performance (Palmen,
Didden, & Arts, 2008), and play skills (Barry & Singer, 2001). The benefits of teaching this skill include
increased independence, personal competence, and reduced need for constant vigilance by a treatment
provider (R. L. Koegel & Koegel, 2006).

Self-Initiation: The definition of "initiations" is complex, as there are many different types of initiations
(Fredeen & Koegel, 2006). L. K. Koegel, Koegel, Harrower et al. (1999) defined spontaneous initiations as
"the individual beginning a new verbal or nonverbal social interaction, self-initiating a task that results in a
social interaction, or changing the direction of an interaction" (p. 3). Typical examples of initiations include
spontaneous verbal requests, commenting, or asking questions. In general, learners with ASD have been
observed to have limited interest in asking questions or making comments, often using them only to request
items, and rarely using them to inquire about their environment or to obtain social information about the
individuals with which they are interacting (Palmen et al., 2008).

Studies have demonstrated that initiations are pivotal behaviors and that increasing these behaviors yields
gains in other areas of language and social development. For example, children who were taught to use the
question "What's that?" demonstrated an increase their use of expressive labels and generalize their
question-asking to the home (L. K. Koegel, Camarata, Valdez-Menchaca, & Koegel, 1998). Researchers
also have found that, when children were taught the question, "What's happening?" they exhibited other
general language gains, including an increase in the average number of words spoken per sentence (L. K.
Koegel, Carter, & Koegel, 2003).

Other important self-initiation skills that are targeted for intervention include learning how to use language to
enter into a conversation or to start an interaction, such as asking people questions (e.g., "Can I play?"
"What are you doing?" "Do you want to play hide-n-seek?" "What do you want to play?"). Once the game or
activity has started, learners with ASD also need to know how to sustain the interaction. This requires
teaching them how to listen to another person and then reflect back and make comments about what was
just said. Teaching learners with ASD how to initiate questions and comments in contexts has myriad
benefits. For example, when children and youth with ASD learn to initiate, they no longer sit alone or
respond just when spoken to. Their interactions involve turn taking, and are more complete. Thus, using
self-initiations enables learners with ASD to be more social.

Teaching Key Pivotal Behaviors: Procedures for Implementation: The aim of PRT is to change
learners' behaviors to allow for a more typical trajectory of development in the most inclusive settings
possible. In the sections that follow, specific procedures are provided to address each key pivotal
behavior: motivation, responses to multiple cues, self-management, and self-initiation. Ideally, these
procedures should be incorporated into general curricula instead of creating a separate curriculum for
learners with ASD (R. L. Koegel & Koegel, 2006).

Motivation Procedures: Strategies to increase motivation can be incorporated into a general education
classroom quite easily and can have positive benefits for typically developing peers as well as learners with
ASD. Several procedures have been identified to increase motivation. These include (a) establishing learner
attention, (b) using shared control, (c) using learner choice, (d) varying tasks, (e) interspersing acquisition
and maintenance tasks, (f) reinforcing response attempts, and (g) using reinforcers that are directly linked
to the learner's goals (R. L. Koegel et al., 2001). These procedures and how they can be used to increase
motivation are discussed in the following sections.
Step 1: Establishing Learner Attention

When implementing PRT, learners first must pay attention to the task before practitioners can present them
with (a) a question, (b) instruction, or (c) opportunity to respond. Once the learner attends, the practitioner
gives brief and clear instructions that are appropriate to what the learner is doing at the time. For example, a
practitioner could tap a learner on the shoulder or gain eye contact before providing instructions. Once
learner attention has been established, practitioners can work on other skills.

Step 2: Using Shared Control and Turn Taking

Shared control refers to a balanced interaction in which each partner has some control over the activity. For
example, the child may select the material, but the adult may require a communicative behavior before
handing it to the child. The child may be able to play with the material for 30 seconds, but the adult may also
take turns with the object. This is in contrast to adult control, in which the adult is making all the decisions
about what the child has to do and what rewards the child receives, and child control, in which the adult
follows the child's leads but does not place demands on the child.

Shared control is important for several reasons.

(1) Play that involves shared control gives the child experience in the typical give-and-take of social and
communicative interactions.
(2) The adult's "turn" provides the adult with an opportunity to model the desired behavior (e.g., a targeted
communication, a play skill) for the child.
(3) The adult's turn gives the adult an opportunity to capture the child's attention prior to modeling a
behavior, giving an instruction, or prompting a target behavior.

In a shared control interaction, both adults and children participate in a shared activity. In the beginning
stages of learning, adults may scaffold the bulk of the routine. But as learners become more familiar with
the routine and begin to anticipate the reward, adults can require more and more participation from the child.

Example

For a child whose current targeted objective is learning to produce and imitate the consonant-vowel
combination "ba-ba," the adult may use bubbles. At the beginning, the adult may offer the bubble container
while saying, "Bubbles ... want bubbles?" and when the child reaches for the container, the adult blows lots
of bubbles. The adult pauses, waiting for a learner response (which, at this initial stage, may simply be the
child looking toward the adult). Then the adult says, "More bubbles" and blows many more. After a few
weeks, the interaction grows more complex. The adult gives the child a choice of a bubble jar or pencils,
and the child reaches for the bubbles. The adult holds the bubbles closer to the child and says "Bubbles ...
bubbles," and waits. The child now says, "Ba-ba" and the adult blows a few bubbles. The child is delighted
and reaches for more. The adult says, "Bubbles ... more bubbles?" and waits for the child to imitate "ba" or
"ba-ba." The child says, "Ba," and the adult blows a few more at the child's shoes while saying, "Bubbles on
shoes" as the child smiles and laughs. The adult then puts the top on the bubbles container, hands it to the
child, and waits. The child tries to open the container, cannot, and hands it back to the adult. Before taking
the container, the adult asks, "More bubbles?" The child says, "Ba." The adult takes the bubbles and models
"ba-ba" slowly and clearly to the expectant child. The child says, "Ba-ba," and the adult opens and blows a
stream of bubbles. At this point, the adult is making many requests of the child, and the child is also making
requests of the adult. The two are sharing control of the interaction and the activity.

During teaching episodes, practitioners also maintain a balance between adult- and learner-selected
materials, topics, activities, and toys. By sharing control of the activity and material selection, adults
increase learners' motivation to participate and thus help them learn target behaviors and skills.
Example Shared Control: In this activity, the therapist and child are having a snack. Food routines are a
great way to work on expressive and receptive language development. The child can communicate to the
adult what he or she wants to eat or to drink, when he or she want more of the preferred item, and can also
participate with the set up and clean up of the activity (such as giving the cup to the adult, putting the
napkins and utensils on the table cup, throwing the trash away). However, accomplishing these goals are
dependent on the adult having shared control of the activity, that is dispensing the materials so the child has
some access, but also maintaining control over additional items so that the adult's involvement is needed to
complete the activity and thus target learning objectives. The snack activity demonstrates this concept the
therapist exerts control by working on specific expressive and receptive language goals and the child exerts
control by telling the therapist what he wants to eat and drink, making choices between food items, telling
the therapist where to place the items, and indicating when he doesn't want something. Having shared
control enables the child to stay connected to the therapist as a social play partner, to be aware of the
therapist's actions and to take part in a rewarding and enjoyable activity.

Step 3: Using Learner Choice

Learner choice has been defined as "using child preferred or child selected materials, topics, and toys and
following the child's lead" (R. L. Koegel et al., 2001, p. 22). With this procedure, adults set up an
environment rich in preferred, age-appropriate objects and activities for the learner (R. L. Koegel & Koegel,
2006). Objects and activities are arranged so that the learner must communicate in some way (e.g., pointing
to the object, verbally labeling it) in order to obtain them. This allows for multiple, natural opportunities to
work on target behaviors within daily routines and activities, especially those related to language
development, while maintaining the learner's interest (R. L. Koegel & Koegel, 2006).

For example, a ball, a clear box of blocks, a shape sorter, and a bottle of bubbles can all be placed on a
shelf in the playroom. When the child points to the bottle of bubbles and says "bubbles," the adult says
"Bubbles!" while taking the bottle down and starting to open it with the child. The learner has the choice of
several objects, each providing an equal opportunity to practice requesting and communication. Teachers
and other practitioners should provide a variety of activities and items for learners to choose from
throughout the day to increase their motivation to participate in numerous learning activities.

Allowing learners to choose preferred objects or activities is particularly important when teaching new skills.
Using toys, items, and activities that individual learners with ASD prefer increases their motivation to
participate, and thus the likelihood that they will acquire target skills. To assess learner choice, teachers and
other practitioners should look at the interests of individual learners as well as the items, activities, and toys
with which they engage most often when they have free access to a variety of toys and activities. For
example, a teacher may notice that a young child with ASD in her class plays with dinosaurs for most of free
play. Or a middle school teacher may observe a student with ASD in her class who is particularly interested
in race cars. When implementing learning activities, teachers and other practitioners should include these
preferred materials and activities in learning tasks and activities. Practitioners also should consider that the
interests of individual learners may change from day to day as well as hour to hour, or even minute to
minute. Therefore, it is extremely important to follow the lead of learners to capitalize on their motivation to
participate during teaching episodes. Because learners are not interested in the same activities and objects
all the time, practitioners should consider what learners are most interested in at the moment and thus what
will motivate them to participate each time a learning activity is arranged (R. L. Koegel, Sze, Mossman,
Koegel, & Brookman-Frazee, 2006).
Using Learner Choice Example 1: Incorporating during drawing activity the child-preferred or child chosen
materials and activities into learning opportunities. The therapist also provides multiple opportunities for the
child to make choices, such as choosing what to draw next on the paper, deciding whose turn it is to use the
paint markers, and what size dots to make with the markers. The therapist follows the child's lead but the
environment must remain structured such that learning objectives can still be targeted. This balance
between adhering to child choice and maintaining structure (or shared control) sustains the child's attention
and decreases the likelihood that the child will avoid the interaction and engage in disruptive behavior.

Using Learner Choice Example 2: offer choices to promote language and address different
communicative functions. The therapist asks the child what he wants to play with and offers different
materials to the child such as the pegs and markers, and when she observes that he's not interested (again
following his lead), she quickly teaches him how to protest ("no pegs", "no markers") before moving on to
the next choice. Once the child shows interest in playing with something else (a hammer), the therapist
continues to offer choices within the child chosen activity, such as asking the child whether he wants the
peg or hammer. Other choice making opportunities within this play activity may include asking the child
who's turn is it, where do you want to put the peg, or whether he wants to play more or be all done. Offering
choices such as these helps to strengthen the child's ability to request preferred items, to make comments
related to the activity, to ask for help, to protest, and to continue building vocabulary.

Step 4: Varying Tasks and Responses

Variation is essential for (a) building a wide behavioral repertoire and (b) maintaining a learner's interest and
engagement. Adults need to vary their language so that children are not just hearing one word over and
over, but are hearing a variety of ways used to mean the same thing. A child who has just learned "all done"
should be prompted to say "finished," "clean up," "no more" as well as "all done" to request the end of an
activity. When playing with cars, the adult should model several different multiword constructions - yellow
car, big car, noisy car, slow car, rather than repetitively commenting on only one aspect of the car.

This variation aids in generalization in that specific responses are not tied to specific stimuli. Rather, the
child learns that a number of responses may be associated with a particular stimulus and vice versa. In
addition, adults should be alert to learner's behavioral cues (e.g., lack of attention, attempts to change
activities) that signal that they are becoming bored and that it is time to change to a new item or activity.
Researchers have noted that increased responding occurs when stimuli (e.g., tasks, materials, activities)
are varied, rather than when a single stimulus is repeatedly presented (Pitts & Dymond, 2012).

Varying Tasks and Responses Example 1: This activity highlights the therapist and child carrying out a
play schema of giving the bear doll a haircut. As the activity unfolds, the child might initiate many comments
and offer creative ideas to elaborate the schema; however, his activity level will be high so might results in
becoming distracted at times. When the child's attention begins to wane, the therapist must vary the task
sequencing and introduce new stimuli or concepts to bring the child back to the play activity. The technique
of task variation heightens the child's motivation to respond and to continue participating in the learning
activity.

Varying Tasks and Responses Exercise 2: The child has chosen to play with airplanes and the therapist
establishes turn taking by having the child roll the train back and forth across the table. Next, the therapist
introduces a new action by showing the child how to fly the plane in the air (new play ideas). The therapist
builds this into a game of chase and tickle, and the child responds by laughing, smiling, and initiating further
rounds. Lastly, the child chooses to go back to rolling the airplane on the table but again the therapist
extends the play by having the two airplanes crash. Within a few minutes, the child has successfully
verbalized three new action words "crash, roll, fly" (all in appropriate context) as a result of elaborating or
varying the play.

Step 5: Interspersing Acquisition and Maintenance Tasks

Interspersing maintenance trials with acquisition trials also can maximize motivation. This means
making sure that acquisition trials (tasks that are new or currently being learned) are combined with
maintenance tasks (previously mastered items). When using this procedure, practitioners identify skills that
are easy for individual learners as well as skills that are more difficult. By providing a mixture of easy and
more difficult tasks, learners are able to feel successful, increasing their motivation to participate in the
activity.

Behavioral momentum is often used to facilitate learners' maintenance of newly acquired skills (Koegel,
Shirotova, & Koegel, 2012). With this strategy, three rapid, short requests that are easy for the individual
learner to follow (high-probability requests) are delivered before a request that the learner has historically
had more difficulty following (low-probability requests). An example of this strategy is to give learners
several opportunities to use a word they have mastered and that is easy for them, such as the word ball,
and then provide an opportunity to use a new, acquisition word, such as "cookie" (R. L. Koegel & Koegel,
2006).

Research suggests that learners are able to learn much more efficiently when acquisition and maintenance
tasks are variably presented than when acquisition tasks are repeatedly presented (Dunlap, 1984).
Furthermore, learners are much more likely to stay focused and engaged in tasks and activities where they
experience high rates of success and reinforcement (R. L. Koegel, Carter et al., 1998; Davis et al., 1992).

Interspersing Acquisition and Maintenance Tasks Example 1: A child regularly uses single words to
make requests or initiate comments to others. The therapist incorporates many language opportunities
throughout the play activity aimed at strengthening his use of single words. For example, when the child
initiates with "bang", the therapist hands over the hammer so that the child can hit the pegs or when the
child spontaneously verbalizes "here" and offers the hammer, the therapist takes it and immediately hits the
peg, or when the therapist holds up the hammer and the child responds with "hammer", the therapist
acknowledges the child's bid and hands it over. The therapist rewards the child for using single words so
that the child will experience a higher rate of success and have the momentum needed to tolerate and
respond to the acquisition trial when the therapist models two-word phrases, such as having the child
respond with "my turn" to take back the hammer or "put in" when the therapist asks which hole to place the
peg in. This slightly more sophisticated use of language however does not phase the child or disrupt the
activity again because the interspersal rate is tolerable to the child.

Interspersing Acquisition and Maintenance Tasks Example 2: During the game of Caribou the therapist
rewards the child's use of mastered language, such as when the child initiates "key" to request it from the
therapist, comments "there's a ball" upon opening a box, or responds with "ball in" when the therapist blocks
the hole. The therapist continues to build and expand the child's language by modeling "open box" (a new or
acquisition phrase) during her turn. The therapist then teaches this phrase during the child's turn, but not for
every single box. The child continues to feel like a competent learner, enjoying the interaction because she
intersperses this slightly harder demand at an acceptable and supportable ratio. None of us are perfect
100% of the time and we cannot expect children with autism especially beginning language learners to
perform at a difficult level 100% of the time. The child needs to feel successful and alternating between
maintenance and acquisition tasks allows the child to experience a high level of reinforcement and to stay
motivated to respond.

Step 6: Reinforcing Response Attempts

Reinforcement of response attempts is a consequence-based strategy in which all attempts that are
clear approximations of the targeted response are rewarded. This procedure is in contrast to a more rigid
shaping procedure in which only approximations that are as good as or better than previously
demonstrated approximations are rewarded (Esch, Carr, & Michael, 2005). It is particularly effective in
helping children with severe communication delays develop more language and demonstrate more positive
affect (Hupp & Reitman, 2000; R. L. Koegel et al., 1988). Reinforcing attempts not only directly reinforces
the attempted behavior but increases the probability that learners will engage in future attempts and
interactions as they experience more success and positive reinforcement. Take for example, a nonverbal
child who is starting to make goal-directed vocalizations and reaches for a book and says, "Oh." Although
this is not the targeted response (i.e., "book"), the adult immediately reinforces the attempt by saying
"Book!" while handing the book to the child. In this manner, the adult reinforces the attempted vocalization
and models the word for the child.

The above example also illustrates how teachers and other practitioners should provide reinforcement
immediately following communication attempts, even if the response is not correct. The teacher hands the
book to the child as soon as he makes a vocalization. Although this is not the target response, the child's
attempts at communication are being reinforced and he is beginning to understand that there is a direct
relationship between his vocalizations and getting something in return.

Reinforcing Response Attempts Example: In the game of Caribou, the purpose is to use the key to open
boxes in order to find balls. Once all the balls have been collected and placed in the side container, their
pressure automatically triggers the opening of the treasure chest. During this game, the therapist regularly
reinforces the child's appropriate attempts to make social and communicative responses. In the beginning of
the video, the child starts closing the boxes to begin a new round of the game and the therapist asks, "What
are you doing?" The child immediately responds with "close" and the therapist recasts with "close box" and
helps the child close the remaining boxes. Next, the therapist asks, "What do we do?" in reference to the
child holding onto the ball and the child responds with "ball". The therapist rewards this attempt by letting the
child put the ball into the slots and recasts her and the child's actions with "ball in". As the child continues to
drop balls in, he self corrects without additional prompting and says, "ball in". Later, the therapist sees that
the child is ready to open another box and asks him "Now what?" The child immediately responds with "that
one" and points to the box he wants to open. Although earlier in the example, the therapist had modeled
"open box", his response of "that one" is also suitable and appropriate to the activity. It is more important
that the child learn to use language in a flexible and natural manner rather than only communicating a
limited phrase that applies to a specific context. Reinforcing attempts helps to promote spontaneity of
language and maintain the child's motivation to continue the interaction. Subsequent acquisition tasks can
always be embedded within the play to extend the child's language or to teach other relevant responses (as
evident when the therapist prompts the child to say "open box" or "ball in"), but reinforcing attempts helps
the child practice language in a supportive and motivating learning environment.

Step 7: Using Natural and Direct Reinforcers

Providing natural, contingent reinforcement is one of the most powerful ways to teach learners that there is
a direct link between their behavior and access to rewards (R. L. Koegel et al., 2006). A natural reinforcer
is directly and functionally related to the task so that when children give the target response, they will
naturally obtain the reward" (DeLeon, Frank, Gregory, & Allman, 2009).

Research has shown that learners with ASD are much more likely to acquire skills rapidly when reinforcers
are directly related to a given task or activity (Lanovaz & Argumedes, 2010). For example, a teacher or other
practitioner could present a learner with a clear, lidded jar that contains a highly motivating object (e.g.,
bubbles or raisins). The learner will most likely try to open the jar and then look to the practitioner for help.
After the learner uses the target phrase (e.g., "Help, please."), the practitioner provides access to the
reinforcer inside the jar. This might be contrasted with an indirect reinforcer wherein the practitioner says,
"good talking" instead of providing access to the motivating object. Another example of a direct and natural
reinforcer is a learner who appears to want a break and is prompted to request it, makes the request, and
gets the break. If the learner has to do something else, such as complete something to get the break, this
would not be an example of a directly related reinforcer. As a final example, an adolescent wants to
purchase a drink from a machine, and so calculates the correct combination of coins needed to operate the
drink machine (a math objective for him), and then operates it.

The importance of successfully motivating learners cannot be overemphasized. Research has shown that
not only does motivation have a dramatic effect on increasing learners' language and social learning but it
also decreases interfering behaviors (Geurts, Luman, & Van Meel, 2008).
Using Natural and Direct Reinforcers Example 1: the therapist shows the child how to blow up and let the
air out of a whoopee cushion. This activity highlights several important points. First is the child's interest and
enthusiasm for learning how to use the cushion. Since the child does not know how to operate the cushion
by himself, the therapist is able to teach him how to ask for help. Second, once the child initiates a bid for
help, the therapist immediately responds with a positive and activity related consequence...she shows the
child how to blow up the cushion. The therapist's response is contingent or dependent on the child asking
for help and her actions of teaching him how to use the cushion are directly related to the activity. In doing
so, the therapist teach the child that responding and reinforcement are related, that his social
communicative responses are likely to result in positive consequences and will likely lead to increased
motivation, enhanced learning, and more rapid acquisition of the target behaviors.

Using Natural and Direct Reinforcers Example 2: Throughout this snack routine, the therapist supports
the child's communicative initiations by immediately providing the appropriate reinforcer. When the child
initiates "more water", the therapist hands over her cup; when the child asks for "cookie", the therapist
places a cookie while modeling a two-word phrase or acquisition label "in bowl"; when the child initiates
social bids such as imitating the therapist's drinking sounds, the therapist responds and continues the
interaction. Providing the reinforcer related to the target behavior (in this case, expressive language)
teaches the child about the relationship between the child's behavior and the positive consequence that
follows. It also allows the teaching environment to be more rewarding and enjoyable to the child, making
avoidance or escape behavior less likely to occur.

Responsivity to Multiple Cues

Two types of approaches have been found to be particularly successful in reducing stimulus over-
selectivity (i.e., learner focuses on only one aspect of an object or environment while ignoring other
aspects) and increasing awareness of salient, multiple cues for learners with ASD (Smith et al., 2010).
Within-stimulus prompting is a more effective initial intervention than extra-stimulus prompting (e.g.,
pointing to prompt the correct response from the learner). Within-stimulus prompting involves exaggerating
or overemphasizing the feature that differentiates between two stimuli. For example, "when teaching the
difference between the letters "˜p' and 'b', the stems are elongated to twice the length. Then, as the student
learns how to distinguish between the two letters, the stems are gradually shortened to the correct
proportion" (Rosenblatt, Bloom, & Koegel, 1995, pp. 39-40). While this is teaching the learner to attend to
one specific cue, it has been shown to be successful in teaching learners with ASD to attend to more
complex stimuli with multiple cues. Children who are taught to respond to multiple cues through within-
stimulus prompting are better able to generalize and learn from extra-stimulus prompting such as pointing
(Warren et al., 2011).

Another approach that has been successful in reducing stimulus over-selectivity is multiple-cue
discrimination training, which systematically teaches learners to respond to additional cues of a single
stimulus. Burke and Cerniglia (1990) determined that a systematic training program to teach each stimulus
cue incrementally helped children with ASD increase correct responding as the number of stimulus
components increased from one to four. In this study, the authors presented a task involving verbal
instructions and requiring visual and motor responses. Four different types of cues were used, each from a
different dimension: color (red/blue), size (big/little), type of object (pencil/crayon), and location of object (in
the box/in the cup). Initial teaching began with one cue and systematically increased to two, three, and then
all four types of cues (e.g., "little blue pencil in the cup"). Not only were the children able to increase their
ability to respond to multiple cues in the experimental condition, they also were able to improve their correct
responding to more naturalized verbal instructions within more typical social settings (e.g., school, home).
More recent research has supported these findings (Stahmer, Suhrheinrich, Reed, Bolduc, & Schreibman,
2010).

Over-selective responding also has been reduced or eliminated by teaching learners to respond to
conditional discriminations-tasks in which reinforcement is available contingent upon responding to a
combination of cues and not available to the individual components. For example, in one study children with
ASD were presented with three stimuli: light alone, sound alone, and light plus sound (Stahmer et al., 2010)
A conditional discrimination was in effect when reinforcement was delivered ONLY for responses to the light
plus sound and not for either the light only or the sound only. Research has demonstrated that children who
are initially over-selective can become less over-selective if they are trained on a series of conditional
discriminations (Stahmer et al., 2010).

The schedule of reinforcement has been shown to be important for developing awareness and responding
to multiple cues. For example, children over-selected less when they moved to a variable schedule of
reinforcement (presenting a reinforcer one out of every three responses, on average) from a continuous
schedule (presenting a reinforcer after every correct response) (Lee, Sturmey, & Fields, 2007).

Self-Management Procedures

The goal of self-management is to increase the independence of learners while decreasing their
dependence on practitioners. An increase in autonomy also provides learners with more opportunities to
engage in activities independently or with others in a more age-appropriate, typical manner (L. K. Koegel et
al., 1999).

To promote self-management, learners are taught to discriminate their target behaviors and then to record
or monitor the occurrence (or absence) of them. Self-management is designed to take place in the absence
of practitioners and provide learners with a set of procedures to promote autonomy and independence. It is
an ideal strategy for teaching learners with ASD who have mild to moderate intellectual impairment and a
range of social-communicative behaviors. Prior research has shown this technique to be particularly
successful for targeting a range of communicative functions, including information seeking, bids for
attention, and conversational initiations. In addition, self-managing social-communicative behaviors has
resulted in collateral improvements in untreated social skills and generalized improvements in other
pragmatic behaviors such as prosody, on-topic comments and questions during conversation (Southall &
Gast, 2011).

The general process for teaching self-management is explained in the sections that follow (L. K. Koegel,
Koegel, & Parks, 1992). Procedures for increasing positive behaviors are described, followed by procedures
for decreasing interfering, or negative, behaviors.

Self-Management to Increase Positive Behaviors

Defining the Behavior

The first task in targeting a behavior is to operationally define it by describing it in terms that are specific,
observable, and measurable (Cooper, Heron, & Heward, 2007). Clearly defining the target behavior makes
it easier for adults to "see" the same behavior over time and for other adults to determine whether or not
they are observing the same behavior. Thus, teacher and practitioners include a specific criterion for the
learner to receive reinforcement. For example, the learner receives a break after staying quiet for two
minutes. The criterion of "staying quiet" might be defined as remaining in his desk and engaging himself with
a book. Definitions of behaviors that learners should do, as opposed to what they should not do, should be
used.

EXAMPLE: Mark will sit in his chair for five minutes during math class.

Collecting Baseline Data

Before an intervention is put into place, baseline data should be taken to determine how frequently,
intensely, and/or for how long (duration) the behavior occurs before the intervention is initiated. This step is
important because frequency, intensity, and duration data help practitioners make decisions about the
effectiveness of an intervention. Baseline recordings should include several observations of the target
behavior to accurately determine the level at which the child is performing. Baseline samples can be
collected by observing the student in the same environment in which the target behavior occurs.
Selecting Reinforcers

The next task is to choose a reward that will be motivating for individual learners. Types of rewards include
playing with favorite objects or toys, activities or special outings (e.g., going to a favorite store or restaurant),
sensory activities (e.g., tickles, hand squeezes, manipulating a squishy ball), and tangible objects (e.g.,
stickers, food items). Social reinforcement such as praise ("Yes!" or "You did it!") and actions (e.g.,
clapping or high-fives) also are very powerful and can be paired with other types of reinforcement (e.g.,
giving a sticker and verbally praising at the same time). Delayed reinforcement schedules (e.g., earning
tokens that can be exchanged for preferred reinforcers later) also can be implemented if they motivate the
learner to engage in the target behavior. When appropriate, learners should help determine reinforcers so
that they will be more motivated to engage in the target behaviors.

Data Collection

The next task is to identify the data collection system that learners and practitioners will use to record
occurrences of successful behavior. Devices such as wrist counters can be helpful when collecting data on
frequent behaviors. For example, learners can keep track of their behavior on their wrist counter and record
the number of occurrences of a given behavior every few minutes (e.g., intervals up to 5 minutes). Paper-
and-pencil systems, with clear charts for tally marks or stickers, are also successful. In addition, kitchen or
portable timers, watches, or cell phone alarms can be used to measure time intervals. Learners' behaviors
should be considered given that the goal is independent recording. If appropriate, learners can help identify
what method works best.

When teaching self-management to individual learners, the first task is to teach learners how to
discriminate between desirable and undesirable behaviors. This should be very specific and in a format that
learners understand. If learners do not understand what is and is not expected of them, they will not be able
to manage their behavior. Role-playing these behaviors may be helpful.

The next task is to teach the learner how to follow the signal from the timer (if used) and accurately evaluate
the interval. If learners behave appropriately, they should record the interval as successful. If learners did
not meet the criterion for the target behavior, they should not record the interval as successful.

NOTE: The initial target goal should be slightly lower than the current level of the target behavior in order for
the learner to initially experience success. For example, if the learner yells approximately every two minutes
in the classroom, the first target may be a minute and a half with a quiet voice.

Finally, learners must be provided with access to the reward they have chosen when they meet the criterion
for receiving a reward. To keep motivation high, make sure it is a positive, enjoyable experience. If learners
do not respond enthusiastically to the reinforcer/reward, give them the opportunity to choose another
reinforcer.

As learners become more successful at managing their behavior, teachers/practitioners increase the
amount of time that learners must self-manage the target behavior. For example, if a learner has become
very successful at sitting in his chair for five minutes during math class, the next step would be for him to sit
for a longer period of time during math class. It is important to do this incrementally and gradually to make
sure that the learner continues to experience success.

Teacher/practitioners then gradually fade any prompts provided by others by reducing prompt intensity
and frequency. Prompt intensity can be systematically faded, such as moving from a verbal prompt (e.g.,
"Time to mark your sheet.") to a gestural prompt of pointing to the sheet. Prompts should then be provided
less and less frequently. As learners become more successful at managing their behavior, the number of
responses needed to receive the reward is increased. For example, if a learner receives a reward every
time he sits in his chair in math class, the next step would be for him to receive a reward after he sits for two
minutes without getting up. Eventually, the learner would not receive the reward until after class. Again, it is
important to ensure a balance between maximizing the learner's opportunity to progress in performing the
target behavior and the learner experiencing success and staying motivated to participate.
The presence of the practitioner can be faded incrementally as necessary. First, practitioners can sit farther
away from the learner, engaging in other tasks to decrease the amount of direct attention provided. Then,
they can fade out of the environment completely for longer time periods. Learners can also be taught to
administer their own rewards (Palmen, Didden, & Lang, 2012).

Initially, other practitioners enter the new environment for a few minutes to initiate the self-management
procedures. This may only need to occur in new settings. Then, the presence of the self-management
materials alone can provide enough support for the learner to generalize the self-management procedures
to a new setting and context (Southall & Gast, 2011).

Self-Management Strategies to Reduce Interfering Behaviors and Teach Positive Replacement

Behaviors

Self-management of interfering behavior involves another important phase after teachers and other
practitioners have successfully implemented strategies that reduced and managed the interfering behavior.
To successfully reduce the interfering behavior over the long term, learners must be involved in the process
of developing a comprehensive intervention plan that is: durable; generalizable; addresses the different
maintaining functions and problem routines learners present; and involves a self-management component.
This requires (a) an assessment of the interfering behavior to determine its function and (b) the
development of appropriate behavioral intervention strategies that teach learners how to use alternative
behaviors that serve the same function as the interfering behaviors in question (i.e., replacement
behaviors). (Love, Carr, & LeBlanc, 2009).

When self-management is being implemented to reduce an interfering behavior, the reinforcer/reward is

particularly important, because for most learners it takes some time before the functionally equivalent
replacement behavior becomes as successful as (ideally more successful than) the undesirable
predecessor (e.g., appropriately requesting attention instead of having a tantrum). Rewarding the period of
time without the interfering behavior will help to quickly reduce it while the replacement behavior is being
learned (L. K. Koegel, Koegel, Boettcher, Harrower, & Openden 2006).

Step 1. Defining the behavior. The first step requires developing a behavioral definition for the
inappropriate or interfering behavior. The behavior must be defined so that practitioners know why it is
occurring. This information can be obtained by completing a functional behavior assessment (FBA).
Once the function of the interfering behavior has been identified, the replacement behavior to teach the
learner can be defined. EXAMPLE: Jonah will raise his hand during class to ask for a break.

Step 2: Preparing the Self-Management System

The next step is to prepare the self-management system by defining the behavior that will be taught to
replace the interfering behavior. After identifying the function of the interfering behavior and potential
replacement behaviors, consider the following questions:

 What behavior will the learner use to attract the teacher's attention?
 When will the learner need to use the behavior?
 Can the learner independently use the behavior?
 How will the behavior be measured?

In addition, rewards must be identified that can be used when the learner uses the replacement behavior.
Remember that the rewards have to be worth the learner's effort. For example, if learners are not motivated
by a given reward, they will not engage in the desired behavior. Learners also should have a range of
rewards, some small and some large, to choose from as the behavior develops and becomes more
consistent. Finally, an initial goal should be identified and explained to the learner. For instance, the teacher
or other practitioner would explain to the learner that he must wait until the teacher asks for questions before
raising his hand. Inappropriate behaviors also can be defined and explained through examples (or role play
if needed) for learners. When initially implementing the self-management system, the teacher also might
pause more often for student comments/questions, providing the learner with more opportunities to
experience success. As the learner becomes more proficient at using the new skill, the length of the time
between periods when learners can ask questions would increase.

Step 3: Teaching Self-Management

Once the system has been prepared, learners are taught to self-manage the new behavior. This process
involves having learners identify and record the occurrence of the behavior. Initially, they may use wrist
counters (e.g., a golf counter) or a sheet of paper with boxes for tally marks to record each response. As
they progress, time intervals may be used, especially for higher functioning children and adolescents. Once
enough checks or points have been gained, they are exchanged for one of the predetermined rewards
chosen by the learner. Remember that the learner has worked hard for the reward and initially will need to
be reinforced immediately after exhibiting the positive behavior.

Step 4: Creating Independence

The reward system be can gradually faded by increasing the amount of time that the individual self-
manages the behavior or the number of responses necessary for a reward. In the previous example, the
learner may be able to tolerate two class periods or check off 20 boxes before needing a break. Thus, his
self-management program is adjusted accordingly (based on the data). Fading learners' reliance on
prompts and the presence of practitioners are also critical steps to sustain independent responding.

The goal in this program is to teach behaviors that normalize interactions with others. Part of creating
independence may require thinking about the selection of reinforcers. Initially, learners may require an
object or item that does not necessarily improve social communicative skills. However, when learners can
self-manage their behaviors, several other positive changes occur. As learners become more comfortable
and successful, other reinforcers that promote sociability may be substituted to facilitate further
development. In the above example, as the learner earns time toward a break for raising his hand, he may
be more inclined to share this with a friend, such as playing a game at the computer or having a few
additional free minutes at recess/lunch.

Step 5: Generalizing to Other Settings

The final step is to teach the learner how to apply the self-management program in additional settings. To
ensure success, this may involve going back to prior steps in the teaching or planning phase. For example,
the learner may need a break while at recess and may raise his hand, but the physical education teacher
may not understand the behavior and thus unintentionally ignores his bid; or a learner might make
inappropriate outbursts, but the function of the behavior has changed (now he does it to attract his peers'
attention). These issues can be effectively addressed with the self-management program. With support and
teaching, learners are likely to attain independence and self-control.

Self-Initiation Procedures

Several methods have been devised to develop question-asking and conversation initiation in learners with
ASD. Peer-mediated and learner-initiated strategies have shown the most promising results and are
discussed below and in the following sections.

Implementing Peer-Mediated Strategies

When using peer-mediated strategies, typically developing peers are taught to initiate, reinforce, and
maintain ongoing interactions with learners with ASD. The following peer-mediated intervention strategies
often are used with young children and students in elementary school; however, they can be adapted for
use with older students.

 Paying attention. Peers ensure that learners with ASD are attending to them before initiating a social
exchange.
  Providing learners with choices. Typically developing peers give choices between different activities
and materials to keep motivation high.
 Varying materials. Peers vary materials (e.g., toys, paper, writing utensils) frequently, according to
the learner's preferences.
 Modeling appropriate social behavior. Peers provide frequent and varied models for appropriate play
and social skills, including verbal statements (e.g. "this game is fun!") and complex actions within
play and leisure activities (e.g., acting out a script with dolls, playing kickball, playing a board game).
 Reinforcing attempts. Peers verbally reinforce any attempt at social interaction or functional,
appropriate play (e.g., while playing catch, peer says, "great throw!").
 Encouraging conversation. Peers withhold the desired object just until the learner says a verbal
response related to that object or activity (e.g., waiting for him or her to say "let's play ball!" before
giving the ball).
 Extending conversations. Peers ask questions or encourage conversation centered around tangible
objects, especially ones that are part of the activity (e.g., while playing with toy food, peer says, "I
like to eat ice cream. Do you like ice cream or pizza?").
 Taking turns. Peers take turns during play and other social interactions to show learners with ASD
different ways to play and interact appropriately and also to encourage sharing and increase
motivation.
 Narrating play. During play, peers describe what they are doing (e.g., while playing with the toy oven,
peer says, "I'm going to cook the pizza.").
 Teaching responsivity to multiple cues. Peers describe objects as clearly as they can and encourage
the learner with ASD to do the same. For example, peers may ask the learner with ASD whether he
wants to play with the small, green ball or the big, blue ball (Pierce & Schreibman, 1995, 1997;
Sherer & Schreibman, 2005).

Peer-mediated strategies have been found to be successful not only in helping learners with ASD maintain
increases in initiations gained during the intervention, but also in helping them generalize these skills to
other typically developing peers who have not been trained in PRT.

Learner-Initiated Strategies

Step 1: Teaching Social Initiations

Another successful approach when teaching learners with ASD how to initiate interactions with others
involves learner initiation training (Carter, 2001; L. K. Koegel et al., 1998; Oke & Schreibman, 1990). With
these types of strategies, learners with ASD acquire skills that will help them initiate and maintain
interactions with others. Research has demonstrated that learners with ASD can be taught to:

 Use two approach behaviors: sharing (e.g., "Can I play with you?" "Can I have some blocks?") and
play organizing (e.g., "How about if you build a road and I'll build a bridge?")
 Take turns choosing activities
 Keep trying, even if they are unsuccessful at first

Learners with ASD are given the opportunity to practice these skills with a practitioner before using them
with typically developing peers. It may be helpful to video record the practice sessions and provide feedback
to learners with ASD about how they can improve the use of the skills.

Step 2. Teaching Question-Asking: "What's That?"

Learner-initiated strategies also can be used to teach children and youth with ASD skills such as question
asking. One effective procedure is to place learner-preferred items in an opaque bag and prompt the
learner to ask, "What's that?" After the prompted question, the learner is shown what's inside the bag and
allowed access to the item. The prompt is then faded until spontaneous question asking occurs. The next
step is to gradually replace learner-preferred items with neutral items with which the learner is not familiar.
Finally, the opaque bag itself is faded, and the learner is able to ask the question "What's that?" when
presented with a new, unknown item (L. K. Koegel et al., 1998).
Step 3. Teaching Question-Asking: "What Happened?" and "What's Happening?"

Another effective learner-initiated strategy is to teach questions such as "What's happening?" and "What
happened?" by using pop-up books that are related to learner interests. Using this procedure, learners are
taught to use one of the questions after they pull the tabs for the pop-up pictures. Research has shown that
books of high interest are powerful resources for teaching other self-initiations, including other WH-
questions or asking for help (L. K. Koegel, Carter, & Koegel, 2003).

Step 4: Teaching Language, Communication, and Social Skills Using Naturalistic Techniques

Naturalistic techniques also have been found to be highly effective in providing opportunities for learners
with ASD to initiate interactions with others (Hwang & Hughes, 2000). The most consistent component of
each of these techniques is that practitioners' responses are simple, predictable, and contingent upon the
learner's initiations (McGee, Morrier, & Daly, 1999). Naturalistic techniques used to teach a variety of skills
such as language, communication, and social skills include the following:

 Contingent imitation: Imitating learners' actions during interactions, play, and other activities
 Naturally occurring reinforcement: Providing learners with an appropriate item after requesting it
(e.g., child gets snack after vocalization, learner is provided with help after asking appropriately)
 Time delay: Providing a task demand, allowing a time delay for the child to respond independently,
followed by a prompt if child doesn't respond
 Environmental arrangements: Placing preferred items out of reach, for example (Fredeen & Koegel,
2006).

Because one of the fundamental goals of PRT is to ensure that learners with ASD participate in natural
settings, PRT strategies ideally are implemented in inclusive classrooms and applied within a general
education curriculum. R. L. Koegel and colleagues have developed techniques for using basic PRT
strategies in schools (R. L. Koegel, Openden, Fredeen, & Koegel, 2006).

Data Collection to Monitor the Progress for Learners with ASD During PRT Sessions

Because of the ongoing and interactive nature of PRT intervention, recording learners' performance on
tasks trial-by-trial does not work well for PRT. Ongoing interactions with learners are interrupted if the adult
stops to record data. One way to monitor learner performance involves using a 15-minute interval coding
system to record the consistency of learner performance (for a high-frequency behavior) or first opportunity
performance (for a low-frequency behavior) during the rating interval.

When using this type of system, the adult interacts with the learner using PRT techniques for 15 minutes
and then allows the learner to continue to interact with the materials alone for a couple of minutes while the
adult records performance. The adult then scans over the learner's target objectives, marking a summary
score indicator for each target skill that has been performed successfully or unsuccessfully over the
previous 15 minutes. (The summary scores indicate consistent success, consistent failure, inconsistent
performance, or no opportunity to perform that objective.) At the end of the intervention period, these scores
can then be summarized into an overall code for each target skill that reflects the performance level across
the intervention period.

Codes for Acquisition of Skills: + Consistent, correct performance; - Incorrect and/or inconsistent
performance