The idea of the hierarchy is to provide the least amount of prompting your child needs to be successful in communicating. If the child is reaching for a toy spider, the adult could say “spider” and give the child a chance to repeat. If he doesn’t respond, she could sign spider and give him a chance to sign it. If he still doesn’t use any communication, that’s when you as a parent (or a therapist or paraprofessional) can provide hand-over-hand assistance to help the child sign spider.
Least to most level of prompting … How to tie it all in
Once you determine what level of prompting your child needs, always be on the watch to decrease your prompting as your child becomes more independent. For example, if you are giving your child hand-over-hand assistance to perform signs, he may eventually just need a tap on the elbow to perform the sign.
A special note on open-ended questions and requests for response
As we discussed in the Prompting Hierarchy: Part 2, one way to prompt for communication is to ask a question directly, such as “What do you want?” As adults we should be careful not to ask too many questions because this puts a lot of language demand on children who already have communication difficulties. If you ask a direct question, be sure to allow enough time for the child to respond at his or her level. Repeating the same question over and over again may overwhelm your child and increase frustration.
Reading your child’s natural interest (Communicative Intent)
Follow your child’s natural lead when playing with your child and use language as a way to enhance and add meaning to your child’s experience. Therefore, it is important to be careful to not prompt for communication when the child isn’t showing interest. In other words, if the child is looking at the wall, we do not want to ask him about an item on which his attention is not directed, such as asking him which color crayon he wants. During a structured activity, we recommend first eliciting the child’s interest in the activity. Ways to redirect a child’s focus include shaking the materials, tapping the table, bringing the material in front of the eyes of the child, or changing the inflection of your voice to show enthusiasm. Once the child shows a natural interest for the activity or shows a desire for an object, we can create opportunities for communication (with an appropriate level of prompting). During an unstructured activity, such as free play time, we advise parents to follow the child’s lead. Learn to watch signals for what your child is interested in, and follow him or her to that toy. That means follow your child as he walks or crawls around the room! Play with the toy that he wants to play with, pairing language that fits with that toy (e.g. “You’re pushing the car!”).
All of these ideas can be carried over into your home routine. We encourage you to involve family members in engaging your child in communication through the appropriate level of prompting. Give your child plenty of opportunities to communicate and make choices that are part of his daily routine. Possibilities include dinner time, bath time, story time, bed time, and car time. When your child says or signs something spontaneously, encourage him/her by responding right away, and consider decreasing the amount of prompting the next time. You will empower your child! Please consult with your child’s therapist for specific methods on how to best meet your child’s unique communication needs in the natural environment.