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Prompting Hierarchy: Part 2

In our early intervention program at CSLOT, therapists aim to give each child enough opportunities to communicate on their own. However, some children may need assistance to successfully communicate their specific wants and needs. This is when we use prompting to support their efforts. The amount of prompting depends on the level of development of the child in the task at hand.

The prompts below are listed from the least directive to the most directive. Providing the least amount of prompting needed will lead to the highest level of success for your child. All these prompting techniques can be incorporated into your home routine. We encourage you to involve family members to engage your child in communication by using the appropriate level of prompting. You may speak with your therapist to help determine what level of help your child currently needs.

Expectant Delay (Expectantly Waiting)

This is the least directive kind of prompting, allowing your child the most independence. When your child is presented with a desired object, pause for approximately five seconds to allow time for him to initiate an attempt to communicate independently.

Examples

  • Ask your child to “give the car” and pause to see if he attempts the task.
  • Present two objects without saying anything. Wait five seconds to see if he initiates a request.
  • When using picture icons with a child who isn’t yet speaking, put your hand close to the child’s hand to receive the icon. Icons will not replace speaking; they will just help facilitate communication and decrease frustration until the child is ready to use words. Once he is familiar with using one icon, we up the ante by giving a choice of two icons. Again, we use the expectant delay, pausing and waiting for the child to make his choice by handing us the icon.

Open-Ended Questions

If your child does not respond when given an expectant delay, ask a “Wh” question. “Wh” questions begin with words such as what, where, and who.

Examples

  • If your child doesn’t initiate a request when silently presented with a choice of two objects, re-present the objects while asking, “What do you want?” Then pause again to see if she initiates a request.
  • When your child is getting dressed, pause and wait for her to initiate the next step in the sequence. If she does not respond after a five second pause, ask, “Where are your shoes?” to remind her of what’s next and to continue the communicative interaction.

Request for Response

If your child does respond to a pause or an open-ended question, but his response is inappropriate or insufficient, give a direct request for a more complete response.

Examples

  • If your child points to a desired object rather than labeling it, you could say:
    • “Tell me what you want.”
    • “Use your word.s”
    • “Put in my hand.”

Partial Prompt

If your child does not respond appropriately to a request for response, provide part of the answer.

Examples

  • Ask a question that contains a choice: “Do you want red or green?”
  • Model the first few words of the answer: “My name is …”

Direct Model for Imitation

If your child has never said a response verbally and/or is not responsive to a partial prompt, then provide a full model and pause for her to imitate you.

Examples

  • Hold up a closed box of crackers and give your child a chance to say, “Open!” If she doesn’t respond, model the sound “o” for her to imitate. As an alternative, model the sign for open and pause for her to repeat.
  • If your child is already using whole words (e.g. “more”), prompt her to put two words together (e.g. “more milk”).

Physical Prompt

If your child does not respond to a direct model for imitation, provide hand-over-hand assistance. This is exactly how it sounds – put your hands over your child’s and help him complete the sign or finish the task at hand. This level of prompting provides the maximal support. Once we know the child can sign more on his own, we may remind him by showing the sign visually only. Eventually, he will use the sign on his own, and we can pair it with the spoken word more. In this way, we are moving from greater to lesser support and increasing his independence.

Examples

  • If you see your child is looking at an object and desiring it, but he is not following your model to ask for it, put your hands over his to show him the sign for more.
  • If your child is not clapping to the song as you have shown him to do, put your hands over his and clap together.
  • If you have shown him how to throw a ball, but he does not release the ball from his hands, stand behind him with your hand over his and say, “Ready, set, throw!” as you help him do so.

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The key to effective treatment is an early response.
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