Pivotal response treatment (previously known as pivotal response training or the natural language paradigm) is a form of teaching in which the teacher concentrates on changing certain 'pivotal' behaviours, such as motivation and self-management.
Pivotal response treatment is based on the idea that certain aspects of a child's development are considered to be 'pivotal', that is crucial for the behaviours which depend on them. The pivotal areas are motivation, self-management, self-initiation, and the ability to respond to multiple cues.
In pivotal response treatment the trainer concentrates on changing these pivotal areas in order to change the behaviours which depend on them, such as speech and language, social behaviour, and challenging behaviour.
There are several multi-component programmes (such as the Early Start Denver Model and the Nova Scotia early intensive behaviour intervention) which include pivotal response treatment as a key element.
There is strong research evidence to suggest that pivotal response treatment provides a positive approach to targeting key developmental skills, such as language in some autistic children.
Reports have suggested that parents and non-autistic peers can be trained to implement this approach, and that the focus on naturalistic reinforcement may make it more accessible than more traditionally structured behavioural interventions such as discrete trial training.
However, there is a need for more large-scale randomised control trials of pivotal response treatment in real world settings and which compare pivotal response training to other, similar interventions.
There is a need for studies which examine whether pivotal response treatment is being implemented correctly and which look at effectiveness at least one year after the intervention.
There is also a need for research which involves autistic people to review the efficacy and ethical basis of pivotal response treatment including individuals who may be non-verbal.
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