Take It A Few Prompts Back; A Short Discussion on Prompting During Daily Task Performance.
Disclaimer: Information provided in this blog post is based on concepts taught and discussed in The Learn, Play, Thrive Approach to Autism referenced below.
When your child struggles to perform activities of daily living, such as getting dressed, washing hands, brushing teeth, etc., it’s hard to find the perfect balance of just how much to help them. We don’t want to help too much to the point that they’re not using skills they have, but we also don’t want them to struggle to the point that the task becomes too challenging. What is just the right amount of help and why is this important to consider? The extent to which adults involve themselves in helping children during everyday tasks has a direct impact on how children not only complete tasks, but also perceive them. Sometimes, without even noticing, we may be helping a little bit too much. We may be using too many words, be using too many gestures, and we may be accidentally overwhelming our child and contributing to the difficulty in completing the task. We may be, unintentionally, making something more difficult than it may be for that child.
So, let’s talk about prompting. First of all, what is prompting during task performance? Prompting refers to the number of cues given to a child while they perform or complete a specific task (i.e., wash their hands). There are 3 different types of prompts: verbal, gestural, and tactile. Verbal prompts refer to any kind of verbal instruction such as “color with this marker” or “turn on the water”. Gestural prompts refer to physical body gestures that suggest the next step of a task or next object to use. For example, pointing toward a water faucet or a marker. Tactile prompts refer to using the sense of touch to cue a child such as tapping their hand as a reminder to reach for the marker or faucet. These 3 prompts can be used independent of each other or simultaneously during a task or activity. This means that there may be situations in which you only use verbal prompts, or verbal prompts paired with gestural prompts, or all three at the same time. The prompts used strongly depend on the child and how much help or prompting they may need to complete a task or activity. Usually, the more help a child needs to do something, the more prompts will be used.
Prompts are something that we as occupational therapists have been trained to use strategically during our therapy sessions to support our clients to succeed at different activities. However, prompts are also used naturally during everyday activities to help children get through the day! The issue arises when more prompts than needed are used. For example, imagine yourself washing your hands. You’ve never had any issues but for some reason, today, someone assumes you are struggling. Out of the goodness of their heart, they want to help you. They watch over you as you perform the task of hand washing, start telling you the next steps, start handing you things, start pointing at things over your shoulder… that’s a lot and probably would distract you, wouldn’t it? Most likely. And it would ultimately hold you back from performing that task independently, even if you have the skills to do so. Too many prompts can be overwhelming and stressful, so a child may not actually be performing optimally.
The prompt hierarchy refers to how prompts are introduced during activities to support participation and success, starting from least supportive to most supportive. When an occupational therapist is assessing how many prompts a child may need to perform a certain task, they will usually start with observing the child perform the task with the least amount of prompting as possible. This may look like putting the materials for a task in front of the child and seeing what they do. Then, as the child responds or does not respond, the occupational therapist will build up on that. Starting with gestural prompts, an OT may point towards the materials to bring the child’s attention to them. If that still doesn’t get the child started, then maybe they need verbal prompts in addition to the gestural prompt. And so on, all depending on how the child responds at each step.
Starting with the least number of prompts possible will tell us the exact point in the task that the child begins to struggle. This approach enables us as OTs to always assume that a child can do something and to always make sure that we are not doing more for the child than they need. The purpose of bringing up this prompt hierarchy is to offer a new perspective to helping our kids throughout day-to-day life. If you notice that your child is struggling with a certain task and the help you’ve been offering hasn’t been as successful as you’d like, maybe take it a few prompts back. See how they do without any support and then slowly add on those prompts. Taking a few prompts back will also give your child the opportunity to problem solve for themselves how to complete the task, which in itself provides children with a whole new way of learning; however, that’s a topic for another blog post. It is important to note that this approach by no means will solve everything, but rather, can be used in conjunction to other supports already in place. The overarching point is that sometimes we help too much, too fast, and maybe taking a few prompts back may be exactly what our child needs to succeed.
Below you will find an application of this concept in a hypothetical situation and chart quickly summarizing how prompts build on each other:
Application of Concept
Task: Coloring with a colored pencil
Moving through the prompt hierarchy*:
Paper and colored pencils placed in front of child.
(Adding on gesture) Pointing to colored pencil then paper.
(Adding gesture and verbal prompt) Point to colored pencil and paper and saying, “We can use these colored pencils to color on the paper.”
(Handing objects to child) Saying, “We can use these colored pencils to color on the paper”.
(Demonstrate) Show them how to color with colored pencil on the paper.
*It is important to note that the types of prompts used will vary for every child.
*The amount you move through the hierarchy depends on how the child performs with each level of prompting given. For example, if they are successful in the task with just gestures, you do not need to move to adding a verbal prompt.
References
Proctor, Meg. The Process of Autism-Specific Therapy. The Learn, Play, Thrive Approach to Autism: Module 2. https://learnplaythrive.com/ . PowerPoint Presentation.
Author: Camila Hojda, MS, OTR/L
Occupational Therapist
Tiny Transformations, LLC