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Tuesday, July 22, 2014
I have a 6th grade student with ASD. He has become increasingly prompt dependent. For example, if you tell him to go wash his hands because they are dirty, he will walk out of the room and stand in front of the sink with his hands under the running water and wait for you to come out and tell him to dry his hands. There is a task analysis chart in front of the sink, but he doesn`t repond to this now. In addition, when you give him a choice of snack he will not choose one. He stares at you waiting for you to tell him which one to take. We have presented the snack choices in picture form, in written form, verbally etc. Even if you give him a choice that you know he will like versus a non-preferred snack, he still won`t take one. Do you have any suggestions? This problem is affecting almost all areas and he can no longer answer simple questions or make choices.
Prompt dependency is a difficult problem to solve, but one that can be solved in most instances. Here are some ideas:
1. Create and use a prompt hierarchy. First, list all variety of possible prompts for the specific task in question, from full physical, partial physical, gesture, shadow, point, tap, visual, pictoral, verbal, partial verbal, stimulus, etc. Second, organize these prompts in a least intrusive (least helpful) to most intrusive (most helpful) format; this will differ for every child and every task.
Sometimes a physical prompt is most intrusive, while in other situations a verbal prompt would be more intrusive. Your prompt hierarchy should lead from the most help required to get the child to be successful to the least help needed to get the child to be independent with the task.
Third, teach the child to complete each step of the task with the MOST intrusive prompt necessary to get full success on that step. Then, on the following teaching trials, gradually step down your prompts, fading back your support. Sometimes it is helpful to pair a most intrusive prompt (e.g. partial physical guidance) with a less intrusive prompt (e.g. visual or verbal) for a few trials before using the less intrusive prompt alone.
Finally, observe the child's response. If he is successful after you faded on the prompt, keep fading. If he was not successful on your fade, drop back down a prompt level, and attempt your prompt fade after a few more trials at the higher level.
2. Use Progressive Time-Delay Prompts. With any of the prompts you are using, you can also gradually fade the prompt across one second intervals. Progressive time delay works like this in the following example about handwashing:
a) initially provide sufficient physical guidance at the same time as you say "turn on the water"
b) on the next step, say "turn on the water" and count silently to yourself for 1 second, then provide sufficient physical guidance
c) on the next step, say "turn on the water" and count silently to yourself for 2 seconds, then provide sufficient physical guidance
d) continue adding seconds until the child beats your physical prompt (this usually happens by 5 to 7 seconds). You can use the progressive time delay with physical prompts as described in the example above, but also with any other kind of prompt.
If these suggestions are not immediately helpful or unclear, it is best for you to consult a behavior analyst or a behaviorally oriented psychologist.
Eric Butter, PhD
Clinical Associate Professor of Pediatricsl
Adjunct Assistant Professor of Psychology
College of Medicine
The Ohio State University