What is Prompting?

In this blog, we are covering what prompting means and types of prompting that is used to support goal achievement. If you’ve seen therapy goals in the past, you may have seen the words “prompts”, but what is prompting and what does this look like in therapy? Let’s discuss prompting in therapy.

Therapists use prompting with their learners continually. We do it without really thinking about it. Things like a helpful verbal prompt and visual schedules that list out the tasks to complete in therapy are part of every therapy session. Parents and caregivers use prompts also. 

Have you ever stopped to critically assess prompting, its meaning, how to use them, grading of prompts, and documentation methods? In this post we will dig deep into prompting to be sure we are using them effectively, in the least restrictive way to elicit a successful response. As we break down prompting you will learn how to best instruct caregivers in the use of prompts.

What is prompting?

Prompting is a cue or signal provided to guide and assist a child with performing a specific skill or behavior. One way to think about this assist is thinking of it as a “clue” or a “hint” to help the student or patient achieve a task. This hint can come in the form of a verbal cue, a visual cue, or a physical cue.

The dictionary definition of prompting is: to request input from, the act of persuading somebody to do something, to cause or bring about an action or feeling, and to cause someone to take a course of action. 

Prompts are a type of modification to the curriculum. When it comes to accommodations vs modifications, prompts are considered a modification because modifying a task includes using instructional strategies to breakdown a specific assignment, task, or curriculum. For example, modifications might include providing the student with a simplified version of a task, reducing the assignment, reducing the number of trials (math problems for example), and/or providing the student with prompts. Prompts might be used in addition to accommodations in the school environment.

That’s not to say that using prompts means that modifications are in place. This is just one way that a task might be modified.

Does this align with your perception of prompting?

In the context of working with children, prompting serves as a supportive tool used by teachers or therapists to enhance behavior shaping and skill acquisition. When a typical trigger fails to evoke the desired response to complete a specific task, prompting steps in to provide assistance, aiming to boost the likelihood of the targeted behavior.

Think of a prompt as a guiding cue or support system employed to encourage a behavior that might not naturally manifest. This approach is particularly crucial in educational and therapeutic settings, where tailoring support to individual needs is essential for effective learning and development

Successful performance of a desired behavior elicits positive reinforcement, therefore reinforcing learning. This means that the “Desired Behavior” or a specific action, response, or skill that is encouraged or expected.

The positive reinforcement component means that when someone does something well or as desired, they receive a positive consequence. The positive reinforcement serves as a consequence that strengthens or reinforces the likelihood of the individual repeating the behavior in the future.

For example, if a student successfully completes a challenging assignment (desired behavior), and the teacher praises them or provides some form of positive feedback (positive reinforcement), the student is more likely to repeat the behavior in the future. This cycle of behavior, followed by positive reinforcement, contributes to the learning and retention of the desired behavior.

A prompt is like a cue or support to encourage a desired behavior that otherwise does not occur. 

Prompts are always antecedents, which means they are given before the behavior starts. In other words, if the client is already completing the skill or task, a prompt is not needed; though positive reinforcement might be appropriate to encourage the behavior in the future.

The goal is to always use the least intrusive prompt possible that produces results. The frequency and types of prompts you use will depend on several factors, including the environment, and will always involve considering what prompts work best for an individual client.

A few things to remember about prompts:

• Prompts in interventions vary from most to least intrusive.
• Prompting in interventions should be faded to avoid prompt dependency.
• A prompt can be anything the practitioner finds effective and that the client responds to.
• Prompts are a modification to a task or an assignment, and they might be used in addition to an accommodation in the school setting.

six different types of prompts

There are three general different types of prompts that can be used as graded support for those working on goals. These types can be broken down into different supports (like positional or gestural prompts which are a version of visual prompting).

There are different types of prompts that we use in therapy:

• Visual prompts- this can include modeling and gestures. This can also include positional prompts, like placing items in a different place or more prominent place that offers a visual clue.
• Verbal prompts- this can include words or sounds like a bell to change classes at school
• Physical prompts- this can include hand-over hand support, slight nudges, or light touch.

We have listed these types of prompts from most restrictive to least restrictive:

1. Full physical prompting– Hands-on assistance given to a child to successfully perform a skill or behavior. The practitioner places their hand over the hand of the client, guides it to the object, and wraps the client’s fingers around the object.
2. Partial Physical Prompt- The caregiver moves the client’s hand toward the object.
3. Visual Modeling– Showing the child the correct way to perform a skill/behavior (for example, demonstrating how to put toys away in the basket to show the child how-to pick-up toys).
4. Visual gesturing- A movement that provides the child with information about how to perform the target skill/behavior (for example, pointing to the top of the paper to remind the child to write their name.
5. Positional Prompting- The practitioner places the object next to the learner
6. Verbal Prompting- Any words said to the child to help them perform a skill correctly
7. Visual Prompting- A picture, icon, or object used to give the child information about how to perform a skill or behavior. This could also include a visual schedule or a list of tasks to complete, like a checklist.

Visual Prompts

One type of prompt that comes up a lot in therapy sessions, either in documentation or in goals, is the visual prompt.

A visual prompt is like a picture-based visual helper. This might include pictures, visual schedules, lists, icons, drawings, or symbols to symbolize a task. This could include highlighting the baseline of writing paper, or creating a bold line when cutting out a shape.

Other types of visual prompts used in therapy might include:

• Checklists
• Charts
• Graphs
• Timers
• Mind maps
• Social Stories
• Visual schedules
• Lists
• Icons
• Gestures
• Modeling

Gestural Prompts

Related to the visual prompt clues is gestural prompts. This type of prompt should be described in more detail because you can create a hierarchy of support and offer different types of gestures to support learning of skills.

Gestural prompts involve using gestures or physical movements to provide support or convey information. Some of the various types of gestural prompts or gestural supports include:

• Pointing
• Demonstration
• Modeling desired actions
• Hand Signals to communicate information
• Facial Expressions
• Body Language
• Gaze or Eye Contact
• Nodding or Shaking Head
• Guiding Movements, or physically assisting someone by guiding their movements or actions.

Verbal Prompts

Another type of prompt worth highlighting is the verbal prompt. A verbal prompt can include a word, a phrase, or a complete direction that supports task completion or learning. Some examples include:

• A verbal clue
• The beginning letter sound of a word
• A hint to begin a task
• Safety prompts
• Direct Instruction with clear and explicit verbal instructions on what needs to be done.
• Brief spoken hints or clues to assist in a task or activity.
• Asking questions to stimulate thought or prompt a specific response.
• Feedback, with positive verbal reinforcement to acknowledge and encourage desired behaviors
• Modeling by describing a behavior or task verbally while demonstrating it simultaneously.
• Reminders, including verbal prompts to help someone remember steps of a task, or specific information.
• Social Scripts, or pre-written or verbally communicated scripts to navigate social situations.
• Countdowns

Different ways to offer and grade prompts

There are several different methods to offering and using prompts. There are at least three different levels of prompting usually used to teach a new skill. The practitioner first identifies the target behavior, and then identifies suitable prompts. 

• Least-to-most prompting– This is gradually providing prompts to help the child be as independent as possible is key when using least-to-most prompting. At least three different levels of prompts are used to teach new skills. At the first level (usually the independent level), the child is given the opportunity to respond without prompts. The remaining levels include prompts that proceed from least to most amounts of assistance until the child responds correctly.
• Most to least prompting- This is using more intrusive prompting and fading to least intrusive prompts. You would start teaching a task with the most assistance possible such as hand over hand guidance. Work on fading the amount of assistance until your learner is at the least intrusive they can manage.  This does not always mean independence. Some tasks may always require some prompting for success.
• Delayed prompts- Sometimes a prompt will be given after a certain amount of time has passed without a response. This is almost the “sit on your hands” method of watching and waiting.

For each of these ways to offer prompts, the teacher therapist or will only use the prompt if the client gives the wrong response. They will give the student a chance to succeed or fail before adding prompts.

Steps to use in Prompting

Prompts support goal achievement. You can use the prompts as a shaping behavior and teaching skills is a three step process.  Those steps include:

• Prompt
• Offer reinforcement
• Fade prompt

1. Prompt- Identify the least intrusive prompt that is necessary for a correct response to occur. Does a visual prompt work, or is a visual and verbal prompt needed?
2. Reinforcement- Give differential reinforcement. After a correct response, give appropriate reinforcement that is equivalent to the level of performance independency. At first reward the prompts and relevant cues, not just the prompts.  
3. Fade- Fade prompts as quickly as possible to avoid prompt dependency.  When a child is first learning a new skill, responding to prompts can be rewarded.  As the child progresses, reward or affirm the child when unprompted responses occur. Fading a prompt means to move from most-to-least prompting. After the child masters a skill, gradually move prompt away or replace with least intrusive prompt.

3 components of prompting

1. 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. This might be getting the table ready to eat, or moving toward the sink to wash hands. The cue is a naturally occurring hint or task direction that tells the toddler the skills or behaviors they should be using.  The cue might be “time to eat.”  Toddlers are more likely to use a skill or behavior accurately when the cue and target stimulus are clear and consistent.
2. The behavior (target behavior or target skill). This is what you are asking your child to do (sit down, snip with scissors, don a shirt) There are three types of target skills:
   • 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 several 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 (such as waving hello, tapping someone on the shoulder, giving a high five to greet)
3. The consequence.  What happens after the target skill is accomplished?  It might be a natural consequence, like getting to eat after washing hands, or a reinforcement such as praise, a treat, or preferable activity.  It will be important to find the right reinforcement for each child for the training to be effective

Other Words for Prompting

There are other ways to describe the concept of prompting and you might see these words in occupational therapy goals. These variations to the word “prompting” include:

1. Cue
2. Clue
3. Hint
4. Signal
5. Prompting
6. Assistance
7. Support
8. Nudge
9. Guidance
10. Stimulus

How to document prompting

Correctly and accurately documenting progress and the amount of support needed gets tricky.

Therapists have long-used the min, mod, max scale to document the amount of assistance. The problem with this type of documentation is, it is not specific.  What is minimal or 25% of assistance of cutting with scissors?  Based on the information above, you could describe whether you offered full or partial physical assist, gestural or verbal prompts, or visual cues. 

You can further define prompting by the number of prompts given.  “Child needed five verbal prompts to snip with scissors.”  This can be cumbersome to keep track of during a session, but is a great way to document progress, especially when the milestones are met very slowly.

After six months your student might not be able to snip with scissors, but they can tolerate hand over hand assist to open and close scissors.  They may not be able to wash their hands yet, but given continued verbal prompts they can go through the steps without physical assist.

What is prompting in the everyday world?

This may seem overwhelming when you see it written on paper, but you are probably already using prompts without thinking about it.  Now you have the verbiage and documentation strategies to put all the pieces together and instruct a caregiver.