Autism Q and A: Using Prompts to Promote Skill Acquisition

by Katherine J. Inge, Dawn Hendricks, and Susan Palko

Prompts are used every day by friends, coworkers, parents, teachers, or anyone who is teaching or showing another person a new skill. For example, a supervisor explains to a new employee how to access documents on the office computer network. A sales person explains to a customer how to use a cell phone while demonstrating the phone’s features. A teacher taps a student on the back and points in the direction of the coat closet to prompt him to hang up his coat. In these examples, verbal, model, gestural and/or physical prompts are being used to assist each person in performing a specific skill. How and when different prompts are used depends on the person’s skill level, the activity to be completed, and the amount of assistance needed for successful completion of the activity.

Question: What are prompts and why are they important?

Answer: A critical component of any instruction is the application of prompting procedures. A prompt is a cue or instruction that is given before or during the person’s action or response. A prompt increases the likelihood that the person will emit a correct response and reduces the possibility of errors being made. Learning new tasks requires effective use of prompts to ensure the person knows how to perform the skill without becoming frustrated and without wasting precious instructional time.

Question: What types of prompts can be used to teach students new skills?

Answer: Prompts are provided by a parent, teacher, paraprofessional or even a peer and can include verbal, gesture, model, and physical prompts. Some students with Autism Spectrum Disorder (ASD) may learn a new skill very quickly with minimal prompts provided. Others may require more frequent and systematic prompting to learn new tasks. Prompts range from minimal to intrusive. For instance, verbal prompts usually are considered to be the least intrusive type of prompt and a physical prompt the most intrusive. The following table depicts the hierarchy of prompts from the least to most intrusive.

Hierarchy of Prompts


Independence

No guidance is needed.

Indirect Verbal

A verbal instruction is provided that gives a hint about the next step or reminds the student to move on to the next step.

Direct Verbal

A verbal instruction is provided that tells the student exactly what to do.

Model

Instructor shows the student what to do by demonstrating part or all of the action.

Gesturing

Instructor uses gestures, e.g. pointing, tapping, or head nod, to motion towards an item or location.

Partial Physical Guidance

Gentle guidance is provided to help the student complete a portion of the step or activity.

Full Physical Guidance

Gentle guidance is provided to help the student complete the entire step or activity.

Considered to be the least intrusive prompt, a verbal prompt provides verbal instructions on what the student is to do. An indirect verbal prompt provides a cue that something is expected of the student, but very little information is given. "What do you do next?" "Where are you supposed to go?" are examples of indirect verbal prompts. A direct verbal prompt is more specific and tells the student what is expected. "Put the books on your desk." "Go to the cafeteria." Indirect verbal prompts are typically used for instruction after the student has shown some skill acquisition on a task but is not performing independently. When teaching persons with ASD, be cautious of using verbal prompts. Many individuals do not demonstrate strong auditory processing making verbal prompts less effective while others may become dependent on verbal prompting. Use verbal prompting purposefully and always carefully plan their use.

When providing a model prompt, the entire action may be modeled or only a relevant portion of it. For example, a teacher may demonstrate how a student should get out and place a book on his desk. A more intrusive model prompt would be for the teacher to model putting a book on the desk and opening to the correct page. Gesture prompts can include such things as pointing, looking at, motioning toward, or moving closer to the correct response. For instance, the teacher points to the books and then to the student's desk gesturing what is expected. Or, the teacher looks at the student and then looks at the desk.

Physical prompts include partial and full physical prompts. A partial physical prompt might be for the teacher to gently tap the student's elbow as a prompt to place the book on the desk or the teacher may guide the student's elbow to support placing the book on the desk. The most intrusive type of full physical assistance would be to take the student's hands and physically guide him or her to place the book on the desk to complete the skill.

Question: How are prompts used to teach new skills?

Answer: Any student with ASD can benefit from prompting during instruction regardless of age, communication skills, or cognitive ability. Prompts can be used alone or simultaneously to assist the student in successfully completing an activity. One important point to remember is that the teacher should not repeat prompts if the student is not performing successfully. For instance, repeating a verbal prompt for a student to begin the math assignment more than one time with no success usually means that a more intrusive type of prompt is needed for instruction.

Planned, systematic delivery, and fading of prompts is essential. A variety of prompt delivery and fading methods have been successfully used with individuals with ASD. One type of prompting strategy is referred to as a “least to most” prompt procedure. With this method, prompts are presented one after another providing a gradual increase in assistance as needed. For instance, the teacher provides a verbal prompt telling the student to hang up his coat. If the student does not respond within a specified time period such as five seconds, the teacher may provide a gesture prompt such as pointing to the coat and the coat hanger. If the student does not respond to the gesture prompt within five seconds, the teacher might provide a physical prompt such as guiding his hands to place the coat on the hanger.

Other types of prompting procedures that are effective for individuals with autism spectrum disorder include graduated guidance, most to least prompts, and time delay. All of these procedures require that the teacher presents or sequences prompts in a specific and systematic manner. The procedure to be used can vary based on the skill level of the student who is receiving instruction as well as the skill being taught. Always determine a student’s preferences and take note of reactions to different prompting procedures. Some students with ASD may respond negatively to verbal instruction while doing very well if model prompts are provided. Other students may withdraw or exhibit challenging behaviors if full physical assistance is attempted. Teachers need to evaluate this carefully so that they do not trigger challenging behaviors with the type of prompt or procedure being used.

Question: What does it mean if a student is prompt dependent?

Answer: The goal for all students, including those with ASD is that they become independent. Teachers may use prompts to teach new skills and to increase the student's independence. But if the student responds only when the prompt is presented instead of to a natural cue in the environment, there is a reason the student may become prompt dependent. An example of this might be a student who waits to wash his/her hands until the teacher or paraprofessional points to the picture schedule and says "wash your hands." To avoid this, prompts should be faded as soon as possible.

Question: How are prompts faded during instruction to facilitate student independence?

Answer: The importance of fading prompts should be considered from the first day of instruction on any skill. The least to most prompting strategy is a natural way to gradually fade the teacher's assistance. The student is provided an opportunity during every trial to perform the skill with the least amount of assistance prior to moving to a more intrusive level of prompting.

Here is an example of fading prompts while teaching a student to communicate using the picture of a desired item. The teacher places the picture of the item in front of the student, and the item is placed just out of his reach in front of a communication partner. The teacher stands behind the student. When the student reaches for the desired item, the teacher redirects her to the picture hand over hand helping her pick up the picture and place it in the communication partner’s hand. The student is then reinforced by getting access to the desired item.

The teacher sets up the trial again. When the student goes for the desired item, the teacher guides her to the picture of the item and waits a few seconds before physically assisting her to place it in the communication partner’s hand. The teacher continues fading by increasing the number of seconds waited for the student to respond correctly. Fading should be done in a systematic way and decisions for when this occurs made by collecting data on the student’s skill acquisition.

Summary: The purpThe purpose of using prompts in the classroom is to assist students in making the correct response. The level of prompt that the student receives is contingent on their skill acquisition level. It is important to remember to fade the prompts as the student becomes more independent.

Please visit the VCU-ACE website for more information on using prompting procedures for instruction -- http://www.vcuautismcenter.org

For more information
Alberto, P.A., Troutman, A.C. (2005). Applied Behavior Analysis for Teachers. Upper Saddle River, New Jersey: Prentice-Hall

Contributors for this issue: Katherine Inge, Ph.D., O.T.R., Dawn Hendricks, Ph.D., & Sue Palko, M.Ed.
Editor: Becky Boswell, MBA

Information for this Frequently Asked Questions (FAQ) is from Virginia Commonwealth University's Autism Center for Excellence (VCU-ACE), which is funded by the Virginia State Department of Education (Grant # 881-61172-H027A100107).  Contributors for this issue are Katherine J. Inge, Ph.D., OTR; Dawn Hendricks, Ph.D.; and Susan Palko, M.Ed.

Information for this Frequently Asked Questions (FAQ) is from Virginia Commonwealth University's Autism Center for Excellence (VCU-ACE), which is funded by the Virginia State Department of Education (Grant # 881-61172-H027A100107). Virginia Commonwealth University is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran’s status, political affiliation, or disability. If special accommodations or language translation are needed contact Voice (804) 828-1851 | TTY (804) 828-2494. For additional information on ACE, contact: [autismcenter@vcu.edu].