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How to Use Prompts to Teach a Child with Autism


I’m sure you’ve been there before. You overhear your in-home ABA (Applied Behavior Analysis) therapist discuss prompt levels with their supervisor or your child’s teacher talks about using a partial-physical prompt to teach writing letters during their IEP meeting. You may feel confused about what these terms mean or unsure about how to exactly use them with your child. What exactly are “prompt levels?” How are they used to teach a child with Autism a new skill? How can they be used to reteach an old skill they may have forgotten? 

Prompts are simply instructions, gestures, touches or indicators of what you want your child to do and when. They are especially useful in teaching a child with autism a new skill or when correcting a mistake to ensure they respond correctly. For example, you may tell your child, “Brush your teeth” while pointing to the toothbrush. You may also start brushing your own teeth as an example of what you want your child to do. Giving the instruction, “Brush your teeth,” pointing to the toothbrush and modeling “brushing teeth” are all examples of prompts. You are giving multiple prompts to indicate to your child exactly what you want them to do and when. Most likely, you are giving your child prompts all the time! In fact, we all respond to prompts in our daily interactions. The siren from the ambulance tells us to pull the car over. The cashier saying “Next!,” tells us to move forward in line. Your child pointing to their favorite food tells you to retrieve it for a snack. Prompts are constantly being used, but how can they be used in an effective manner that will help a child with autism feel less stressed and more successful?

What is the Prompt Hierarchy?

There are several types of prompts and they are arranged in what ABA professionals call a “Prompt Hierarchy." They are organized from the most invasive or intruding prompt to the least invasive or intruding prompt. You can also think of them arranged by how much or how little independence they require. The most intrusive prompt is typically used when teaching a brand new skill or behavior to ensure that the child responds correctly. The least intrusive prompt is usually used when the child makes a mistake with a skill they had previously learned. Let’s look at what the prompt hierarchy looks like and the different types of prompts. We will use the example of “picking up toys” as the task the child is expected to complete.

  • Natural: This is when the child responds or completes a task independently or in a natural way. An example of a “Natural” response to picking up toys would be if your child sees their toys sprawled out all across the living room causing family members to weave their way around them and your child begins to clean up their toys on their own. A child responding to a natural prompt means they are independently completing the task or skill. This is always the end goal! 

  • Gesture: A gesture or gestural prompt is when a finger point or other gesture is given to the child to indicate the correct answer or response. When the toys are scattered across the room, you may simply point to the toys and then point to the toy box to indicate that you want your child to pick them up and put them in the basket. If your child responds to this by cleaning up their toys, then you have only used a gestural prompt to help them complete the task. This is the least intrusive prompt on the Prompt Hierarchy.

  • Verbal: A verbal prompt is anything that is said out loud to tell the child what needs to be done. You might say, “toys” or “pickup” or “put your toys away” to your child to let them know what he or she needs to do. These are all different ways of using a verbal prompt.

  • Visual/Picture: A visual or picture prompt is when a picture or other type of visual is used to show the child what needs to be done. You may show your child a picture of their toy box or reference their visual schedule that shows a picture of toys being cleaned up. Both of these are examples of visual prompts that let your child know it’s time to clean up. 

  • Model: Modeling or a model prompt is a demonstration of the desired behavior. You may actually pick up some of the toys in the living room and place them in the toy box to model to your child that you want them to pick them up.

  • Partial Physical: There are two types of physical prompts. The first is a partial physical prompt which means a light touch may be used to help the child complete the task. You can place your child’s hand on the first toy to indicate you want them to pick it up. You could also help them stand up from the floor to let them know it’s time to clean up. 

  • Full Physical: The second type of physical prompt is the most intrusive and thus allows the least independence. A full physical prompt may require “hand-over-hand” assistance to ensure the child reacts correctly. Your child might need you to place your hand on top of their hand to pick up their toys. You may need to help walk your child over to the toy box to place the items in the box and close the lid. 

The autism helper prompt hierarchy

How to Begin Using Prompts

Practice makes perfect!
When you first begin using prompts with your child, you may find yourself using several types of prompts simultaneously. That is okay when you are first starting out using them with your child but as you begin to feel comfortable with how each prompt differs, try to focus on using one at a time and slowly moving up the Prompt Hierarchy to get closer to independence. Keep practicing and don’t give up! There are a lot of terms to learn and it can be challenging to analyze your own behavior by identifying which prompt you used!

New skills require most to least prompting.
When helping your child learn a new skill, start at the bottom of the Prompt Hierarchy. For example, if you’re teaching them learn to tie their shoes, you should start with a hand-over-hand prompt, or full physical prompt. This will ensure that they learn this new skill with the least amount of error.

Mastered skills require least to most prompting.
For a skill or behavior that your child has mastered or typically does independently, you should steer clear of using prompts as much as possible. However, if you’re noticing they’re not completing the skill correctly, start with at the top of the Prompt Hierarchy with the least intrusive prompt. If your child has correctly been making their bed but suddenly forgets to place their pillows at the top, you may try just pointing to the top of the bed to remind them what to do next.

Prompt teaching with autistic child

Allow time to respond!
It is important to allow your child to respond to a natural cue or instruction before giving a prompt. Some children, especially those on the Autism Spectrum, need a few extra seconds to process the cue or instruction before they respond. If you give a prompt too soon, you’ve just taken away a great opportunity for them to complete the task independently!

Fade prompts as soon as possible!
Once your child begins consistently responding to a single type of prompt, it is important to begin moving up the prompt hierarchy to a less intrusive type of prompt! This is called prompt fading and is one of the most critical steps in ensuring your child responds more independently. If your child has cleared their dinner plate when you've ask them to do so for three days in a row, try pointing or gesturing towards their plate on the fourth day. This will ensure they don’t become prompt dependent on any single prompt for too long.

Prompts are a great tool to use when teaching your child with Autism how to respond correctly or to indicate what you want them to do. They allow your child to learn more efficiently and can decrease the frustration they experience when learning something new. They also give plenty of opportunities for success during the learning process. Less frustration and more success can create positive and joyful experiences between you and your child!

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Mallory Giacopuzzi is a Board Certified Behavior Analyst who has over 10 years of experience serving children, adolescents, and adults with disabilities and their families in a classroom, clinic, and home setting. She is the Program Administrator for an Adult Day Program for adults with autism and other disabilities and a Case Manager for in-home ABA services.

 

Editor's note: This information is not meant to diagnose or treat and should not take the place of personal consultation, as needed, with a qualified healthcare provider and/or BCBA.