Prompts and Prompt Fading

1. Prompting Definition and Use

Prompting involves giving extra help to enable the patient to perform a specific response so that it can be reinforced.

A prompt is a stimulus or “hint” presented in addition to the S^D to assist the patient in providing a correct response.

This diagram may help you understand what we mean when we say a prompt is an additional stimulus. It’s something we say or do, in addition to the S^D, to help the patient respond.

The stimulus that evokes a response through pairing (stimulus → response → reinforcement) eventually comes to have stimulus control over a response. Prompts are supplementary stimuli that will temporarily have stimulus control over a response.

EXAMPLE

In this case, Jake does not know how to respond to the instruction or S^D, “Sit down.” To teach Jake to respond to this instruction, the behavior technician physically guides the patient to respond.

The prompt differs from the S^D in that the prompt does not stand on its own. You present a prompt with an S^D to help the patient respond.

EXAMPLE

In this case, the instruction was given to get a toothbrush. To teach the patient to respond to this instruction, the behavior technician points to the toothbrush to indicate where the patient needs to look to get it.

EXAMPLE

In this case, Jacob can’t expressively label or say, “Car,” when he sees a car. To teach Jacob to respond to this S^D, the behavior technician vocally gives the patient the answer as the first step in teaching the patient to expressively label the car.

Prompts are used by all individuals to help us perform tasks and be more successful in various situations. We use prompts in ABA for several reasons:

• Prompts help make learning more effective and efficient.
• Prompts allow patients to immediately access reinforcers.
• Prompts help to avoid frustration and confusion for the patient.
• Prompts can be individualized according to the patient’s needs and the specific target behavior.

think about it

Can you think of a prompt that occurred in your day?

term to know

Prompt

A stimulus or “hint” presented in addition to the S^D to assist the patient in providing a correct response

2. Types of Prompts

Many different types of prompts exist (Cooper, Heron, & Heward, 2020). During this training, we will discuss and provide examples of eight of the most commonly used prompts for teaching patients with autism spectrum disorder (ASD).

1. Physical Prompt

A physical prompt involves manual guidance of the patient to facilitate a correct response, in one of two ways:

• Full Physical: Providing guidance for the entire time, sometimes called “Hand over Hand.” For instance, if the S^D is “Clap,” the behavior technician gently pushes the patient’s hands together.
• Partial Physical: Providing guidance for part of the performance of the skill. For instance, if the S^D is “Clap,” the behavior technician gently moves the patient’s hands towards each other, but not all the way together.

EXAMPLE

A full physical prompt might involve helping a patient write their name hand over hand, while a partial physical prompt might involve only guiding their hand to the paper.

2. Gestural Prompt

A gestural prompt refers to gesturing in some way with your body to indicate the correct response to the patient. The behavior technician points, nods their head, or gazes notably to indicate target stimulus.

EXAMPLE

The behavior technician says “Give me blue,” and points to the blue card.

EXAMPLE

The behavior technician says “Find fish,” and glances at the toy fish.

3. Model Prompt

Model prompts involve providing a physical demonstration of the desired behavior for the patient to imitate.

EXAMPLE

“I’ll show you how to first, then you do it!”

EXAMPLE

The behavior technician says “Take off sock,” and takes off their own sock.

think about it

Think of an example of a time someone modeled something for you. For example, you might see someone on a cooking show use an ingredient in a new way. This serves as a model – now you can try the new recipe, too!

4. Echoic Prompt

An echoic prompt means providing vocal demonstration of the desired behavior for the patient to imitate, in one of the following ways:

• Full Echoic: Fully vocalizing the desired behavior

EXAMPLE

“What is your name?” “Marie!”

EXAMPLE

“What color is this?” “Blue!”

• Partial Echoic: Partially vocalizing the desired behavior

EXAMPLE

“What is your name?” “Ma…”

EXAMPLE

“What color is this?” “Bl…”

5. Directive Prompt

Directive prompts involve giving verbal instructions to guide the patient’s behavior. They may include textual, visual, or other verbal cues, such as directions on how to do something, like how to make a snack, how to prepare to do homework, etc.

EXAMPLE

The behavior technician rolls a ball to the patient. The behavior technician says “Push,” and makes the pushing motion with their hand to demonstrate.

EXAMPLE

“What is your name?” “Say ‘Marie.’”

hint

Note the distinction between an echoic and directive prompt when it comes to vocal responses. The echoic is only the vocal response that should be repeated, whereas the directive includes the instruction “Say...” Your BCBA will determine which type of prompt is more appropriate for a given patient.

6. Proximity Prompt

Proximity prompts refer to altering the location or placement of a stimulus to facilitate a desired response, such as placing the answer closer to your patient in a DTT program.

EXAMPLE

The behavior technician places a lemon and a banana in front of the patient. They make sure that the patient will respond correctly by placing the lemon closer to the patient than the banana. The behavior technician says “Give me lemon.”

EXAMPLE

The behavior technician places the patient’s shoes by the front door, and when standing at the door to go outside, asks the patient, “What do you need to put on before we go outside?”

7. Stimulus Manipulation Prompt

With a stimulus manipulation prompt, the behavior technician changes some aspect of the target stimulus (for example, color, size, shape), such as making the target response larger than the distracter items.

EXAMPLE

The behavior technician wants the patient to identify the word "Dog" from an array of three words: Dog, Cat, Pig. The behavior technician prints the word "Dog" in color (blue) while the other words are in black and white.

8. Visual and Textual Prompts

With a visual or textual prompt, the behavior technician shows a picture or object (visual) or a word (textual) to the patient to evoke the correct response.

EXAMPLE

The behavior technician asks “What has fur?” and shows a flash card with a picture of a dog when the target response is “Dog.”

3. Prompt Fading

The most important thing about prompting is that it has to work. It must help the patient make the correct response.

The second most important thing about prompting is that you have to get rid of it! So, as soon as a prompt starts to work, you should start removing it. The process by which prompts are removed is called prompt fading, defined as the systematic removal of a prompt across successive trials.

This two-part process consists of

• the transfer of control of the behavior from the prompt to the S^D/MO
• the gradual reduction of prompts until the patient no longer needs them to perform the skill independently

This may involve fading one specific prompt or various types of prompts. Fading is critical in order to avoid prompt dependency.

EXAMPLE

Let’s look back at a case. Jacob can’t expressively label or say, “Car,” when he sees a car. To teach Jacob to respond to this S^D, the behavior technician vocally gives the patient the answer as the first step in teaching the patient to expressively label the car.

If the behavior technician always vocally gives the patient the answer, the patient will never learn to say, “Car,” on his own when he sees a car. So, once Jacob can respond, “Car,” when the behavior technician uses this prompt, the behavior technician will need to start fading the prompt. The picture slide will show us how the behavior technician can fade the prompt.

step by step

Step 1: Initially, the prompt evokes the response.

We say the prompt evokes the response because Jacob cannot respond correctly unless the behavior technician says, “Car,” while showing him the picture. This is a full vocal prompt.

think about it

Ultimately, what do we want the thing that evokes the response, “Car,” to be? In this case, do we want the behavior technician saying, “Car,” to be what evokes the response? Or do we want the patient seeing the picture to evoke the response?

Step 2: Begin fading the prompt so the relevant S evokes the R.

At this point, Jacob can respond correctly if the behavior technician: a) shows him the picture of the car, and b) says, “Ca....” The behavior technician only has to say part of the word now for the patient to respond correctly. This is a partial vocal prompt. The response is now partially evoked by the picture and the behavior technician saying, “Ca....”

Step 3: Continue fading…we’re almost there!

Now the behavior technician just has to say, “C...” while showing Jacob the picture of the car and Jacob responds correctly. The response, “Car,” is still partially evoked by the picture and partially evoked by the behavior technician saying, “C...,” but we can see that we are effectively fading out the need for the behavior technician to say anything because they have gone from saying, “Car” to “Ca...” and now to “C....”

Step 4: Fade the prompt completely.

This is our goal. Now Jacob says, “Car,” when he sees a picture of a car!

Prompting can also be faded using delays before the prompt is delivered, called a time delay prompt. When teaching manding (requesting an item), you may hold up a preferred item and wait for the patient to say the name of the item. During initial acquisition, you will likely need to prompt the patient to say the name of the item, perhaps with a vocal model. Zero time delay would involve giving an immediate vocal model as soon as the patient makes any kind of initiation toward the item (such as pointing, reaching, or looking). The vocal model can be faded out by gradually increasing the delay between the patient’s initiation to the preferred item and your delivery of the prompt. This is called a progressive time delay, as you gradually increase the delay between the instruction and the prompt.

You might also use a constant time delay procedure, where the delay of a particular length or duration is always used, regardless of the stage of the training.

EXAMPLE

You always wait ten seconds to present the vocal model. By doing this, you are essentially providing the patient with a choice: sit and wait ten seconds, respond to the prompt, and then get the reinforcer, or they can respond immediately and get the reinforcer sooner.

term to know

Prompt Fading

The systematic removal of a prompt across successive trials