Updated: Jun 6
Prompting is used to facilitate a new skill (Neitzel & Wolery, 2009). When teaching a new communication skill, it's common to provide prompting to support the AAC user. However! It's important to consider the type of prompting, the level of prompting, and who is providing the prompts as we want to avoid any prompt dependency.
What is prompt dependency?
This occurs when an AAC user relies on communication partners to prompt or cue them before they ever initiate communication.
The AAC user becomes dependent on prompts, which prevents them from becoming independent, autonomous communicators.
There are different types of prompting, as described below.
Simply giving the AAC user an expectant look without any verbal prompts or cues can be all it takes!
Give an expectant look and wait several seconds. Be a patient communication partner.
This can be as simple as pointing to a symbol on an AAC system or a hand gesture towards the speech generating device (SGD).
Be careful with verbal prompting! It can be overwhelming to an AAC user to have a bombardment of verbal cues.
Use verbal prompting with intent. Think about what you are going to say and why you are going to say it. The verbal cue should be intentional in how it will help facilitate use of an AAC system for communication.
Giving an AAC user a tactile cue, such as a touch to the elbow, may be enough of a prompt for them to then initiate accessing their AAC system to communicate a message.
The use of physical prompting, such as hand-over-hand assistance, isn't an effective intervention strategy.
Using a strategy such as modeling is an evidence-based intervention strategy that has been show to be significantly more effective than hand-over-hand modeling.
Unsure of where to start? Carole Zangari (2013) recommends the following:
Most to least prompting hierarchy for a new skill, device, or pageset
Least-to-most prompting hierarchy for an emerging skill that is inconsistent
Least-to-most prompting hierarchy
The least-to-most prompting (LTM) approach has been found to increase multi-symbol message production (Finke et al., 2014).
It guides communication partners in adjusting the level of prompting being provided to an AAC user to facilitate their acquisition of language abilities, which in turn allows the AAC user to become independent communicators!
How to use the LTM approach?
Identify the target word, phrase, or communication function being taught
Create a motivating activity or environment that incorporates the target word or phrase
Model the use of the targeted word or phrase
Teach in a natural setting
Provide prompts in a sequence from the LEAST amount of support to the most amount of support
It's important to fade the type and frequency of prompting being provided during AAC intervention and training as this will better facilitate an AAC user's independent communication (ASHA, n.d.).
Want to learn more about prompting? Check out these great posts!
American Speech-Language-Hearing Association (n.d.). Augmentative and Alternative Communication (Practice Portal). www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/
Beukelman, D. R., & Light, J. C. (2020). Augmentative & alternative communication: Supporting children and adults with complex communication needs (5th ed.). Brookes.
Finke, E. H., Davis, J. M., Benedict, M., Goga, L., Kelly, J., Palumbo, L., Peart, T., & Waters, S. (2017). Effects of a least-to-most prompting procedure on multisymbol message production in children with autism spectrum disorder who use augmentative and alternative communication. American Journal of Speech-Language Pathology, 26(1), 81–98. https://doi.org/10.1044/2016_AJSLP-14-0187
Mirenda, P., & Santogrossi, J. (1985). A prompt-free strategy to teach pictorial communication system use. Augmentative and Alternative Communication, 1,143–150. https://doi.org/10.1080/07434618512331273641
Neitzel, J., & Wolery, M. (2009). Steps for implementation: Least-to-most prompts. Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorders, Frank Porter Graham Child Development Institute, University of North Carolina.
Zangari, C. (2013, September 16). 5 Things to Consider About Prompts in Teaching AAC. PrAACtical AAC. https://praacticalaac.org/praactical/5-things-to-consider-about-prompts-in-teaching-aac/
Katie Threlkeld, M.S., CCC-SLP is a licensed, ASHA-certified speech-language pathologist and the Educational Program Developer at Forbes AAC. She has over eight years of experience in AT and AAC assessment and treatment with both the pediatric and adult populations. Katie has presented at the state and national level on AAC topics and she has University teaching experience at the undergraduate and graduate level.