Overview

After reviewing this overview section, you should be able to answer the following questions about this practice:

What is Prompting?
Why Use Prompting?
Where Can Prompting Be Used and by Whom?
What is the Evidenc-base for Prompting?

What is Prompting?

A prompt is a specific form of assistance given by an adult before or as the toddler attempts to use a skill. With these procedures, parents, family members, early interventionists, child care providers, or other team members can use different types of prompts systematically to help toddlers with ASD acquire target skills (Neitzel, J. & Wolery, M, 2009).

Prompts are generally given by an adult before or as a toddler attempts to use a skill. With prompting procedures, parents, family members, early interventionists, child care providers, or other team member can use different types of prompts systematically to help toddlers with ASD acquire target skills (Neitzel, J. & Wolery, M, 2009).

A prompt is a specific form of assistance given before or as the toddler attempts to use a skill.

Prompting procedures include any help given to learners that assist them in using a specific skill. Verbal, gestural, or physical assistance is given to learners to assist them in acquiring or engaging in a targeted behavior or skill. Prompting procedures provide a systematic way of providing and removing prompts so that toddlers begin to perform skills independently. These procedures rely on reinforcing correct responses - both those that are prompted and those that are not. In addition to reinforcement, prompting procedures are often used in conjunction with other evidence-based practices, such as time delay, or are part of protocols for the use of other evidence-based practices such as such pivotal response training, discrete trial teaching, and video modeling. Thus, prompting procedures are considered foundational to the use of many other evidence-based practices (Cox, A., 2014; Adapted from Neitzel, J. & Wolery, M, 2009). 

Prompting procedures provide a way of systematically providing and removing prompts so that toddlers begin to perform skills independently. These procedures rely on reinforcing correct responses, both those that are prompted and those that are not. In addition to reinforcment, prompting procedures are often used in conjunction with other evidence-based practices including time delay and are an integral part of other evidence-based practices such as Pivotal Response Training and Naturalistic Intervention.

A prompting procedure is a systematic way of giving help to toddlers with ASD to acquire skills.

 

Three Components of Prompting

There are three main components in a prompting procedure:

  1. the antecedent,
  2. the behavior (target behavior or target skill), and
  3. the consequence.

These three components are critical to implementing prompting procedures effectively. Each time a team uses these three components during an activity, it is called a trial.  

The antecedent is the target stimulus and the cue.

The antecedent includes the target stimulus and the cue. The target stimulus is the “situation” in which we want the learner to perform the target skill. The target stimulus is important because it signals to the toddler that something is expected of him with or without direction from adults, therefore, helping the toddler make this connection and minimizing prompt dependency. The cue is a naturally occurring hint or task direction that tells the toddler the skills or behaviors they should be using.

EXAMPLE
 
An EI provider might give a toddler a picture card to go wash his or her hands, saying,
"Time to wash your hands."
 
The target stimulus is the dirty hands; the cue or task direction is the picture and verbal command.

 

When using prompting procedures, the cue should be consistent so that toddlers know exactly when they are supposed to do something. Toddlers are more likely to use a skill or behavior accurately when the cue and target stimulus are clear and consistent.

The behavior is the target skill or skills the toddler is to perform.
The toddler's response is essentially the target skill or behavior EI providers want the toddler to learn.
 
Types of target skills include:
 
  • discrete skills: single skills of a short duration (e.g., requesting objects, labeling pictures, social greetings)
  • chained skills: a series of behaviors/ skills that include a number of steps put together to form a complex skill such as (e.g., dressing and undressing, washing hands, cleaning up a play area)
  • response classes: groups of  responses that have the same function.

Imitating adults or peers: a variety of behaviors could be used when imitating adults or peers, such as clapping, waving, driving a toy car, point to body parts, or imitating actions in simple social games; all of these behaviors make up the response class for the skill.

Initiating social interactions: a variety of behaviors could be used when initiating social interactions with others, such as speaking to a family member or peer, getting closer to a family member or peer, or offering a toy to a family member or peer; all of these behaviors make up the response class for this skill.

Consequence: reinforcement and / or feedback

The reinforcement and feedback provided after a toddler’s response are critical components for teaching the target skill. When toddlers use skills successfully or respond accurately, feedback should be highly positive and descriptive so that toddlers know exactly what they did that was correct.

Positive feedback (reinforcement) increases the likelihood that the target skill will be used correctly in the future. With prompting procedures, correct responding should be reinforced even when it is prompted.

Feedback for incorrect responding, or incorrect use of target skill, is delivered either by ignoring the incorrect response or by applying a correction procedure (e.g. interrupting the toddler when they begin to respond incorrectly, repeating or stopping the trial, or completing the expected response).

Continue for Types of Prompts

Types of Prompts

Type of Prompt

Description of Prompt Type

Verbal Prompt

A verbal prompt  is any verbal assistance given that helps toddlers use target skills correctly such as spoken words, signs, or statements. A verbal prompt includes hints, a clue, or a direction and range in intensity level from least to most restrictive. For example, providing a direction is more restrictive than providing a hint about how to identify the object.

Gestural Prompt

A gestural prompt gives toddlers with ASD information about the cue to use a behavior or skill through the use of gestures. Gestural prompts may include pointing or touching an object (e.g. pointing to the car on the “road”).

Physical Prompt

A physical prompt includes physically guiding or touching the toddler to help him/her use the target behavior or skill (e.g. tapping a toddler’s hand which is already on the toy car to cue him to push the car). Physical prompts are used when the toddler does not respond to less restrictive prompts (e.g., modeling, verbal, visual). Physical prompting is useful when teaching motor behaviors (Alberto & Troutman, 1999).

Controlling Prompt

The controlling prompt is the prompt that results in the toddler performing the skill correctly.  It is the last prompt in a least to most prompt hierarchy. The controlling prompt can be any of the other types of prompts described above and is individualized for the toddler and skill. For graduated guidance, the controlling prompt is typically a physical prompt. 

Model Prompt

A model prompt includes either performing the target skill for the toddler or showing the toddler what to do (e.g., pushing the car on the “road”). When using model prompts, adults demonstrate or model, the target skill. Modeling may be used to prompt discrete or chained skills (Alberto & Troutman, 1999).

A model prompt is a component of modeling, another evidence-based practice. A description of model prompts is included here. For more information, please refer to the fact sheet on Modeling.



Visual Prompt

A visual prompt includes pictures, photographs, or objects that provide the toddler with information about how to use the target skill or behavior (e.g., a washcloth or a picture of a washcloth as the cue to pick up the washcloth to wash face).

Visual prompts are often incorporated into activities to help toddlers with ASD acquire target skills. For example, adults may show the toddler a photo or drawing with an example of a correctly completed Duplo structure. Visual prompts can be used to teach a wide variety of skills, including play activities and daily routines. When using visual prompts, it is important to identify supports that are developmentally and age appropriate for individual toddlers with ASD. For example, adults would not want to use pictures if the toddler does not yet have the ability to understand that a picture or drawing represents a real object.

A visual prompt is a component of visual supports, another evidence-based practice. A description of visual prompts is included here. For more information, please refer to fact sheet on Visual Supports.
 
A Note About Prompt Dependence

 

If prompts are not used in a systematic manner (i.e. using a clear target stimulus, waiting for a response from the toddler before prompting, using them when they are not needed or not effectively fading the use of the prompts), toddlers can become prompt dependent. In other words, the toddler does not respond until the adult gives the prompt.

Learning to use a prompting procedure as intended should reduce the chance that toddlers become dependent on receiving a prompt before using the target skill or behavior.

Why Use Prompting?

Prompting, sometimes referred to as errorless learning, includes a set of procedures designed to reduce incorrect responding as toddlers acquire new skills. It is an effective way to help toddlers with ASD by maximizing their success and minimize the negative effects toddlers may experience when target skills are not used successfully (Kurt & Tekin-Iftar, 2008; Mueller, Palkovic, & Maynard, 2007; West & Billingsley, 2005).

This is particularly important for toddlers with ASD because they often have difficulty learning new skills through imitation and understanding the most important or relevant details of a task or skill. Prompting can be used effectively with toddlers, regardless of cognitive level and/or expressive communicative abilities.

The evidence-base shows that prompting is an effective intervention for learners with ASD throughout the age span of toddler to adults.

The evidence-base for prompting is covered in this Overview section.

Where Can Prompting Be Used and by Whom?

Any parent, family member, early interventionist, child care provider, or other team member can use prompting. Prompting procedures can be adapted for use in naturalistic settings such as during ongoing routines and activities in the home or in community-based settings.

EXAMPLE

Everyday skills or behaviors that are a part of a toddler’s daily activities and routines and that could be taught using prompting procedures include:

  • requesting food during snack or meal times,
  • requesting favorite toys or objects during a play routine,
  • completing a play sequence, and
  • completing a daily routine more independently such as getting dressed, brushing teeth or washing hands.

What Is the Evidence-base for Prompting?

The National Professional Development Center on Autism Spectrum Disorders (NPDC) initially reviewed the research literature on evidence-based, focused intervention practices in 2008. A second, more comprehensive review was completed by NPDC in 2013.

  • A total of 27 EBPs are identified in the current review.
  • Of the 27 practices, 10 practices that met criteria had participants in the infant and toddler age group, thus showing effectiveness of the practice with infants and toddlers with ASD.

The practices were identified as evidence-based when at least two high quality group design studies, five single case design, or a combination of one group design and three single case designed studies showed that the practice was effective. The full report is available on the NPDC on ASD website.

Prompting meets the evidence-based practice criteria in all age groups (birth to twenty one) with 1 group design and 32 single case design studies. For the infant and toddler age group, one single-subject design study included toddlers with autism and demonstrated positive outcomes in promoting the development of pretend play behaviors (Barton, E. E. & Wolery, M., 2010). In addition, 14 studies included preschool children. Prompting procedures can be used effectively to address social, communication, behavior, joint attention, play, school-readiness, motor, adaptive, and, for older learners, academic and vocational skills. A complete list of the evidence base for children aged birth to five is included in the resource section.

Refer to the Prompting Fact Sheet from the updated EBP report for further information on the literature for prompting procedures. 

Knowledge Check

Question:

What are some key reasons to use prompting?

Question:

What are the three components of a prompting procedure?

Question:

What are some different types of prompts?

Question:

Name and describe two prompting procedures?