Classroom Pivotal Response Teaching, or CPRT, is a naturalistic behavioral intervention designed for classrooms serving students with autism spectrum disorder (ASD). CPRT was created by modifying an evidence-based practice called Pivotal Response Training (PRT), which strives to improve learning in children with ASD through increasing their motivation. PRT is naturalistic in that it is intended to be used in natural learning environments (places and activities that are part of a child’s daily routine), and behavioral in that it is based on the principles of applied behavior analysis (ABA). ABA involves modifying antecedents (what occurs before a behavior, such as an instruction) and consequences (the result of behavior, such as feedback from the teacher or access to an item or activity) to produce changes in behavior. Naturalistic behavioral strategies such as PRT have strong research support and are recommended for improving learning in children with ASD (National Standards Project, 2009; Odom, Collet-Klingenberg, Rogers, & Hatton, 2010). However, due to their complexity, often the use of these strategies in community settings can be challenging.
Research conducted in Southern California indicates that over 70% of teachers use PRT strategies in their classrooms, but they also report modifying the procedures to work better for their individual settings (Stahmer, 2007). As researchers, we felt it important to better understand the modifications teachers were making to the procedure to ensure the intervention remained effective after alteration. We also wished to create a protocol for use of the strategies in the classroom to provide guidance for teachers on how to use PRT in a way that fit with their environment. To meet these goals, a team of researchers, teachers, and school administrators collaborated to: (1) gain a clear picture of the adaptations necessary to make PRT meet the demands facing special education teachers; (2) test the effectiveness of the adaptations; and (3) develop a manualized program to help teachers use the intervention (Stahmer, Collings, & Palinkas, 2005). Based on teacher feedback, the original procedures of PRT were systematically adapted to give more information on how to use PRT with groups of children, target specific IEP goals using PRT strategies, and train classroom assistants to use PRT. Teachers also requested adaptation of some components they found difficult to use in groups, and adaptations were tested in a research setting (Reed, Stahmer, Schreibman, & Suhrheinrich, in press; Reed, Stahmer, Suhrheinrich, & Schreibman, 2013; Rieth et al., 2013). These modifications were made by teachers and for teachers to form a novel classroom intervention known as CPRT (Stahmer, Suhrheinrich, Reed, Bolduc, & Schreibman, 2011).
CPRT is supported by years of research conducted on the components of PRT. CPRT involves eight critical components, each of which is also part of PRT and adapted for classroom use. The components are:
- Gain Student Attention: The teacher gains the student’s attention before asking him to say or do something.
- Make Instructions Clear and Appropriate: The teacher provides clear and developmentally appropriate instructions that are easy for the student to understand and are at, or just above, her developmental level.
- Provide a Mixture of Easy and Difficult Tasks: Rather than consistently increasing task difficulty, the teacher provides a balance of easy and difficult tasks to maintain previously mastered skills, and to keep motivation high and frustration low.
- Share Control with the Student: The teacher follows the student’s lead to her choice of activities and materials, takes turns with the student, and incorporates preferred materials into activities.
- Use Multiple Exemplars: The teacher presents opportunities to respond that require the student to attend to multiple aspects of the learning materials to give a correct response, and the teacher varies the form and content of cues given to students.
- Provide Direct Reinforcement: The teacher should provide reinforcement that is naturally or directly related to the activity or behavior.
- Present Contingent Consequences Immediately: The teacher should present consequences immediately, and based on the student’s response.
- Reinforce Appropriate Behaviors: By rewarding not only correct responses, but also goal-directed attempts toward correct responses.
When all eight components are used within one teaching interaction, CPRT is being implemented effectively.
The effectiveness of the complete CPRT program is being tested in our current research study, which includes 108 teachers randomly assigned to receive training and coaching in CPRT. As part of the training, CPRT coaches rate how well and how consistently teachers use the components of CPRT in their classrooms. In order to meet implementation criteria, teachers must skillfully perform each component for 80% or more of the teaching interaction. Of the 58 teachers trained thus far, coaches report that 75% of teachers have met criteria for correct use of CPRT. This is an improvement from previous studies in which teachers demonstrated difficulty implementing PRT strategies consistently (Suhrheinrich et al., 2013). In addition to the ratings from the coaches, expert independent observers watch video samples of teachers working with their students to provide unbiased ratings of teachers’ CPRT use. In the project’s first year, we found that teachers consistently implement antecedent components such as gaining student attention and providing clear instructions. Furthermore, teachers typically did well with session preparation and providing consequences contingently. This suggests that teachers may find training that targets the CPRT components that focus on maximizing student motivation, such as shared control strategies and providing appropriate tangible consequences (reinforcement), most useful because these are the areas that appear most challenging. By way of example, difficulties that teachers have reported with the shared control and reinforcement strategies and possible solutions to these difficulties that could be the focus of additional training are discussed below.
There are four parts to the shared control aspect of CPRT: providing choices, taking turns, following student interest, and using preferred materials and activities in the teaching interaction. Data from independent observers indicates that in one-on-one settings, shared control is crucial to cultivating student engagement. Specifically, teachers’ use of turns and a greater number of choices is correlated with higher student engagement (Vejnoska, Rieth, Suhrheinrich, Wang, & Stahmer, 2015). Teachers, however, have expressed to their coaches that it is difficult to implement certain shared control strategies, such as incorporating preferred materials when students in a group had highly individualized preferences. For example, a common academic skill taught in a group setting is counting. When using CPRT, we may encourage teachers to provide pictures of students’ favorite cartoon characters to count, instead of counting blocks or plastic bears. Teachers found it difficult, however, to provide character pictures catered to every student’s individual preferences. One solution is to provide a choice between a limited set of popular characters such that student preference is involved in the activity but is also balanced with feasibility. Similarly, many teachers incorrectly believed that using preferred materials required the creation of novel materials rather than incorporation of existing materials and activities that are popular with students. For instance, when working on reading comprehension skills, instead of reading The Polar Express and utilizing materials that most students generally prefer, such as shaving cream as pretend snow, some teachers felt the need to create individualized reading comprehension activities with teacher-made stories and worksheets based on their students’ favorite characters. Because of this, fewer teachers have met fidelity criteria on preferred materials in comparison to the other shared control strategies. Thus, it is worthwhile to continue to collaborate with teachers to identify which strategies are the most beneficial and what is feasible, and adjust training accordingly.
Another example of how training can be adjusted relates to providing feedback. Recognition of appropriate student behaviors can come in the form of contingent consequences (such as verbal praise) and/or reinforcement that is tangible and directly related to the activity or behavior. Teacher struggles with implementing these consequence strategies is an area of concern. Independent observers found that though teachers excelled at providing contingent consequences (usually praise), they did not often provide tangible reinforcement in either one-on-one or group settings. This is in keeping with coaches’ reports that many teachers had difficulty with determining appropriate consequence strategies for students, particularly for those who seemed intrinsically motivated to complete typical classroom activities. This implies that future training should focus on identification of which students require tangible reinforcement and maintaining teachers’ implementation of tangible consequences for those students. Further analyses will explore the student characteristics that necessitate a high frequency of tangible reinforcement delivery.
Overall effectiveness of and satisfaction with the CPRT training program has been very positive. Teachers enjoy the strategies and see them working with students. The fact that teachers have difficulty implementing certain components of CPRT indicates that adapting evidence-based practices for use in the classroom is an ongoing process. The implementation issues surrounding group activities and student characteristics illustrate the need for continued partnerships between researchers and teachers to help make CPRT more useful for teachers. Additionally, further research should investigate the influence that adaptations to shared control and consequence strategies have on student engagement. Despite these growing pains, 100% of teachers who completed training reported being satisfied with the quality of training they received. Furthermore, 97% of teachers said they were satisfied with their ability to use CPRT with their students. To put it in the words of one of the teachers who completed CPRT training, “This program provides a fresh perspective on ABA as it simplifies the most effective evidence-based strategies for teaching children with autism in individual and group settings and gives that to the teacher in a nice, easy to use package. CPRT would benefit teachers in all areas, including those teaching only neurotypical children!”
Sarah Vejnoska, BA, is Research Assistant, Janice Chan, MA, BCBA, is Research Associate, and Jessica Suhrheinrich, PhD, is Assistant Adjunct Professor at the Child and Adolescent Services Research Center of University of California, San Diego. Sarah Rieth, PhD, BCBA-D, is Assistant Professor at the Child and Adolescent Services Research Center, Department of Child and Family Development, San Diego State University. Aubyn Stahmer, PhD, BCBA-D, is Associate Professor, Department of Psychiatry at the MIND Institute, University of California, Davis.
National Standards Project (2009). National Standards Report. Randolph, MA: National Autism Center.
Odom, S. L., Collet-Klingenberg, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing school failure: Alternative education for children and youth 54(4), 275-282.
Reed, S., Stahmer, A., Schreibman, L., & Suhrheinrich, J. (in press). Examining the use of multiple cues as a necessary component of pivotal response training. Journal of Applied Behavior Analysis.
Reed, S., Stahmer, A., Suhrheinrich, J., & Schreibman, L. (2013). Stimulus overselectivity in typical development: Implications for teaching children with autism. Journal of Autism and Developmental Disorders.
Rieth, S. R., Schreibman, L., Stahmer, A. C., Suhrheinrich, J., Kennedy, J., & Ross, B. (2013). Identifying critical elements of treatment: Examining the use of turn taking in autism intervention. Focus on Autism and Other Developmental Disabilities, OnLineFirst.
Stahmer, A., Collings, N. M., & Palinkas, L. A. (2005). Early intervention practices for children with autism: Descriptions from community providers. Focus on Autism & Other Developmental Disabilities, 20(2), 66-79.
Stahmer, A., Suhrheinrich, J., Reed, S., Bolduc, C., & Schreibman, L. (2011). Classroom Pivotal Response Teaching: A Guide to Effective Implementation. Guilford Press.
Suhrheinrich, J., Stahmer, A., Reed, S., Schreibman, L., Reisinger, & Mandell. (2013). Implementation challenges in translating pivotal response training into community settings. Journal of Autism and Developmental Disorders.
Vejnoska, S., Rieth, S., Suhrheinrich, J., Wang, T., & Stahmer, A. (Submitted). CPRT Fidelity of Implementation: An Examination of Antecedent and Consequence Strategies in Relation to Student Active Engagement. Poster submitted to the International Meeting for Autism Research (IMFAR), Salt Lake City, UT.