Pivotal Responses in the Treatment of Autism
Robert L. Koegel, Ph.D. and Lynn Kern Koegel, Ph.D., University of California at Santa Barbara
Pivotal responses are responses that affect very widespread areas of functioning (Koegel & Koegel, 2006). The Pivotal Response approach to the treatment of autism was developed as a response to children demonstrating extremely slow gains during intervention (Koegel, O’Dell, & Koegel, 1987). Not only did the children not make the gains necessary to lead independent lives, but very few service providers had the time and patience necessary to implement the multitude of trials necessary to make even small gains (Koegel, Koegel, Shoshan, & McNerney, 1999). Moreover the cost of intervention and the strain on the children was prohibitive for most families when individual target behaviors had to be treated one at a time (Koegel & LaZebnik, 2004).
Initially, we began this line of research into the identification of keystone, or pivotal responses, because nonverbal children frequently did not learn to acquire speech, and those who did acquire some speech could require as many as 90,000 trials to learn a single word (Lovaas, 1977). The first pivotal behavior delineated focused on motivation as a pivotal behavior to produce speech use in nonverbal children with autism. This early work (Koegel, O’Dell, & Koegel, 1987; Koegel, O’Dell, & Dunlap, 1988), focusing entirely on speech use, was called the Natural Language Paradigm. Later, as researchers began to realize that these motivational procedures could be applied to a variety of areas of functioning beyond just speech and language, the approach began to be referred to as the “Pivotal Response” approach to treatment, because motivation appeared to be pivotal in affecting wide areas of functioning (Koegel & Koegel, 1988; Koegel, Schreibman, Good, Cerniglia, Murphy, & Koegel, 1989). Further, in addition to helping the children, certain pivotal responses such as motivation have proven to decrease disruptive behaviors (Koegel, Koegel, & Surratt, 1992) and to decrease parental stress (Koegel, Bimbela, & Schreibman, 1996), commonly evidenced in families who have a child with a disability (Bristol & Schopler , 1983; 1984; Moes, Koegel, Schreibman & Loos, 1992). Thus, incorporating pivotal behaviors into parent education programs can create an ideal learning environment for the child, in which the parents become active intervention agents in their child’s habilitation process (Koegel, Koegel, & Carter, 1998).
Since the initial work on pivotal responses, some other pivotal behaviors that have been discussed in the literature as very likely to be critical in the children’s development, include joint attention (Mundy & Crowson, 1997) child-initiations (L. Koegel, 1995; Koegel & LaZebnik, 2004), empathy (Koegel & LaZebnik, in press), self-management (Koegel & Koegel, 1995) and attention to multiple cues (Schreibman & Koegel, 1996). If intervention research is to result in the necessary gains the children need to overcome the symptoms of autism, it appears critical that the identification of pivotal behaviors continues to occur, such that socially significant widespread and rapid gains in functioning can take place.
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