ERIC EJ1025644: The Use of Prompting as an Evidence-Based Strategy to Support Children with ASD in School Settings in New Zealand

2013·0.28 MB·English

by  ERIC

The Use of Prompting as an Evidence-based Strategy to
Support Children with ASD in School Settings in
New Zealand
dervla Hayes
Speech Language Therapist, Manurewa
AbstrAct schools. This is done by working collaboratively
with families, wha¯nau and educational teams to
This article examines the use of prompting as an
identify opportunities for developing specific and
evidence-based strategy to support children with
appropriate language, communication and social
autism to develop their language, communication
interaction goals for children. This collaboration
and social interactions skills. The literature is
most often takes place as part of the individual
reviewed using a three-ringed, evidence-based
education planning (IEP) process. As a support,
practice model to support evaluation of the use
teams draw on the New Zealand Autism Spectrum
of prompting. The article outlines considerations
Disorder Guideline (Ministries of Health and
about the effective use of prompting, and some
Education, 2008). These are a set of evidence-
practical tools to support implementation of the
based practice guidelines based on research
effective prompting practice.
evidence. The guidelines came about following a
1988 government review of autism services which
research paper identified gaps and which formulated several
recommendations to improve the quality of ASD
Keywords: Autism, communication, evidence- services.
based strategies, language, prompting
We know that about three percent of the
mainstream student population have significant
IntroductIon
physical, sensory, neurological, psychiatric,
The purpose of this article is to consider if the use behavioural or intellectual impairment (Education
of prompting as a teaching strategy for children Review Office, 2010). We also know that, as
with Autism Spectrum Disorder (ASD) in learning stipulated in the Education Act (1989), all children
language, communication and social interaction from age five can attend their local school full
skills is an effective support strategy and teaching time and families and wha¯nau have the right to

methodology in New Zealand. Prompting is where choose which school their child attends. The New
an adult or peer assists a learner to acquire a Zealand Autism Spectrum Disorder Guideline
new skill. Prompts can be gestural, verbal, visual, supports this by stating that “each child should
or physical. Evidence-based practice is defined be accommodated in the least restrictive setting
in Enhancing Effective Practice: Springboards required (i.e. as close to a regular school setting
to Practice (Ministry of Education, 2005) as a as possible)” (Ministries of Health and Education,
procedure that is supported by research from the 2008, p. 129). Whilst the approach, attitude and
literature (tika); aligned with the personal skills skills of the adults supporting the learner with
and knowledge of the person implementing the autism is more important than the setting, some
practice (pono); and considered appropriate by research suggests that children educated in regular
family and wha¯nau (aroha). schools make better connections (Ministries of

Health and Education, 2008).
This article addresses each of these components
in an effort to establish whether prompting can be In selecting appropriate communication goals for
suggested as an appropriate procedure to be used children with autism we can refer again to the
for children with autism in New Zealand schools. New Zealand Autism Spectrum Disorder Guideline
It also addresses some important considerations in (Ministries of Health and Education, 2008) which
ensuring that children do not become over-reliant outlines that communication, socialisation and
on adult prompting. play should be given a high priority in establishing
focus learning areas (3.1.6), and that interventions
The writers’ work as a speech language therapist focusing on the development of communication
(SLT) with the Ministry of Education is to skills “should take place in natural settings, using
support children with autism and other special natural routines and natural consequences”
educational needs in attending mainstream (3.2.1.4) (p. 95). Other recommendations support
52 KAIRARANGA – VOLUME 14, ISSUE 2: 2013
the use of the child’s usual carers, peers and used the ‘What’s that?’ question prior to the
teachers as instructors (3.1.4) and the focus model from the adult this was scored as a correct
on spontaneity, initiation, motivation and self- response. Success criteria was reached when the
management as pivotal skills (3.1.7). child asked the question within 10 seconds of
being presented with an unknown picture during
This article explores the use of prompting as a eight of ten trials over three teaching sessions. The
support mechanism within naturally-occurring three children in this study successfully learned to
settings. ask ‘What’s that?’ when seeing novel items both
in structured sessions and they also generalised
this to other settings (generalisation was part of the
rEsEArcH contEXt for ProMPtInG (tIKA)
teaching strategy).
In examining the research context for prompting
the writer selected studies which met the Bryan and Gast (2000) evaluated the use of a
evidence-based criteria set out by the American graduated-guidance prompting procedure to teach
National Professional Development Center three children with high functioning autism to use
(NPDC) on Autism Spectrum Disorders. This is picture schedules to remain on-task independently.
a multi-university centre established to promote Following a verbal request (e.g., ‘It’s time to start
the use of evidence-based practice for children literacy’) and a 10 second wait time, the teacher
and adolescents with autism spectrum disorders. would then use a physical prompt (hand on
Prompting (Neitzel & Wolery, 2010) is one of child’s shoulder) to guide the child to their picture
twenty four evidence-based practices endorsed by schedule. No verbal or gestural prompts were
the NPDC. The NPDC describe prompting as an given at any time (only physical prompts from
adult or peer assisting a learner to acquire a new behind the child). The number and frequency of
skill. prompts were gradually reduced until the student
was successful in completing the task. The authors
Prompts can be gestural (e.g., gesturing cutting found the use of the graduated-guidance procedure
when wanting the child to cut something out, supported all students in the study to effectively
or pointing to the mat when wanting the child use the picture activity schedules to independently
to come to the mat), verbal (e.g. providing an remain on task.
instruction ‘Get your coat’, or a lower intensity
verbal prompt may be ‘This says … [pause]), visual Godby, Gast and Wolery (1987) evaluated the
(e.g., checklists, photos, schedules), provision of use of either a time-delay prompting procedure
a model (e.g., when the verbal or visual prompt is or a system of least prompts in teaching object
not sufficient the adult may show the child exactly identification to three students with severe special
what to do - if it’s a motor skill) or tell the child the educational needs. In the system of least prompts
answer to allow for imitation (e.g., ‘It says duck’), (sometimes referred to least-to-most prompts) a
or physical (when a child needs full or partial hierarchy of prompts is established, with the first
physical assistance to complete the skill (e.g., an level allowing the learner to respond with no
adult puts the child’s coat on for them). prompts, and the final level ensuring success -
called the controlling prompt (Neitzel & Wolery,
Prompts should be selected based on the 2010). Godby et al., (1987) showed that while
individual needs of the learner (Bryan & Gast, both procedures were effective, the time-delay
2000). They should be minimal and faded as procedure required fewer sessions, and resulted in
quickly as possible (Neitzel & Wolery, 2010) fewer errors.
so that the child learns the target behaviour
independent of the adult prompt (Godby, Gast & Kurt and Tekin-Iftar (2008) compared simultaneous
Wolery, 1987). prompting with a time-delay prompt procedure to
teach young children with autism leisure skills (to
Four particular studies, all endorsed by the NPDC, use a digital camera and to turn on a CD player).
demonstrate various prompting methods and their They found both prompting procedures were
effectiveness in different settings. The first of these successful, with some suggestion that simultaneous
(Taylor & Harris, 1995) evaluated the effectiveness prompting procedure resulted in fewer errors
of teaching three children with autism how to ask in teaching trials, and therefore fewer lessons
the question ‘What’s that?’ using a time-delayed were needed. Simultaneous prompting includes
prompting procedure. The adults/instructors cueing the learner through a verbal direction and
initially modelled the question when looking at an simultaneously using a controlling prompt (that
unknown picture or item alongside the child. They is, one which ensures success) (Neitzel & Wolery,
gave praise if the child imitated the question (e.g., 2010). A further session is then designed where
saying ‘Good asking. It’s a _____.’). A time-delay the verbal direction is given without the prompt to
was then introduced in subsequent sessions prior determine if the skill has been successfully taught.
to modelling the question. Once the child correctly
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Weaving educational threads. Weaving educational practice. KAIRARANGA – VOLUME 14, ISSUE 2: 2013
PrActItIonEr KnoWLEdGE And sKILLs examined comparing behavioural procedures
(Pono) with normalised (or naturalistic) interventions for
teaching language to young children with autism
Evidence-based practice does not rely wholly on
showed in favour of the naturalistic settings.
research findings to validate the effectiveness of
prompting. It is necessary to see how it works in
However, it is important to understand that even
teaching practice.
in naturalistic teaching environments adults often
need to provide some extension or prompt to help
Based on personal experience, the use of
the child improve their language performance.
prompting can be an effective support for children
This rather “intricate aspect of incidental teaching”
with autism. It is a strategy which supports children
(Delprato, 2001, p. 316) is the crucial component
to make the correct choices and have successful
to successful acquisition of the target skill. While
learning experiences. Mueller, Palkovic and
in an effective incidental teaching moment it may
Maynard (2007) describe it as an errorless learning
not appear that “anything special [is] occurring;
technique: one which reduces a learner’s response
more expert analysis reveals systematic application
to incorrect choices and therefore results in fewer
of behaviour principles … ” (Delprato 2001, p.
detrimental effects such as negative emotional
315). The effective use of prompts in the teaching
responses (Weeks & Gaylord-Ross, 1982, cited
of language and communication skills for children
in Mueller et al., 2007) and problem behaviour
with autism should be supported by sound
(Ducharme, 2003, cited in Mueller et al., 2007)
background knowledge, instructor practice and
which have been seen to occur with traditional
self-reflection.
choice-making (trial-and-error) learning situations.
When children with autism do not start a task it is cHILd, PArEnts, fAMILY/WHĀnAu (AroHA)
often because they don’t know what is expected
Evidence-based practice considers whether
of them. A well-timed, clear prompt to show
the strategy is compassionate, respectful and
the child what is expected, or a prompt to give
interactive to the wha¯nau, parents and the learner.
the child the words to use in a given situation,
The New Zealand ASD Guideline (Ministries
can keep the child engaged in learning and
of Health and Education, 2008) emphasises the
support the successful development of language,
importance of considering and respecting family
communication and social interaction skills.
values, preferences, and culture in decision
making around service provision (2.1.1) and in
Learning can not, however, be entirely errorless.
the selection of interventions (2.1.5 and 2.1.6). In
It is important that as learning develops, children
particular, when discussing which level of prompts
are challenged and reliance on prompts is
to use to support a child learning a skill, it is
proportionately reduced. Tasks should increase in
important that parents are consulted and included
difficulty and inevitably, in these circumstances,
in this decision. Without consistency, particularly
there will be greater opportunity for errors. Prompts
when identifying the level of support a child needs,
should be faded quickly and it is important that
there may be different perceptions about the
all adults working with a learner are aware of the
child’s level of skill, e.g., a child may be able to
level of prompt needed for set tasks.
put on his own coat at home, but is receiving full
physical prompts to do this at school.
A further advantage of prompting is that it fits well
within naturalistic teaching environments which
One of the challenges in using prompts correctly
are optimal environments for developing language
is to be mindful of the individual. It is important
and communication skills in children with autism
to consider that in naturalistic teaching situations
(Ministries of Health and Education, 2008). Parents
there are, by the nature of the situation, no pre-
of children who have autism identify that “having
determined responses and therefore a variety of
accommodations made to enable inclusion in
prompts may be used (Delprato, 2001). Instructors,
everyday … activities” (Bevan-Brown 2010, p. 17)
when prompting the child, need to be aware of
is important.
not only the personal learning style of the child,
but also as one mother points out in Bevan-Brown
Delprato (2001) describes natural teaching
(2010), the personal behaviours of the child, e.g.
settings, using the term ‘normalized interventions’
“don’t touch the child from behind” (p. 18). It is
as including aspects of ‘incidental teaching
also vital that while prompts need to be introduced
opportunities’ whereby the child initiates the
to support children with autism to learn language,
interaction and the instructor (either the teacher,
communication and social skills, the goal is to
parent, teaching assistant or peer) responds
support independent engagement and decreasing
in a way that reflects the “normal conditions
dependence on adult support as a priority life-skill
for one person to speak to another” (p. 316).
(Hall, McClannahan, & Krantz, 1995; Mechling
A review of 10 studies which Delprato (2001)
54 KAIRARANGA – VOLUME 14, ISSUE 2: 2013
& Gast, 1997, cited in Bryan & Gast, 2000). This Creating good profiles of each learner, evaluating
means there should be a balance between the successes and then modifying prompting will
level of prompting and the need to fade prompts as support our learners with autism to develop their
quickly as possible. language, communication and social skills. From
this point, with a good understanding of the
To develop appropriate policies around the use of child’s skills and strengths and a clear focus on
prompting to support learners with autism it may developing independence, adults can use a prompt
be useful to create a hierarchy of prompts, such hierarchy to support children to generalise these
as that outlined in the Functional Assessment of language, communication and social skills to a
Comprehension Skills (FACS) (Uliana & Mitchell range of educational and community settings.
1998, p. 26). Neitzel and Wolery (2010) suggest
step-by-step guidelines for implementing different
prompting procedures. In order to evaluate or rEfErEncEs
reflect on the level of support provided by teaching
Bevan-Brown, J. (2010). Message from parents
assistants, Giangrecco and Broer (2007) have of children with autism spectrum disorder.
published a useful self-reflective screening tool for Kairaranga, 11(2), 16-22.
schools.
Bryan, L. C., & Gast, D. L. (2000). Teaching on-task
and on-schedule behaviors to high-functioning
concLusIons children with autism via picture activity
schedules. Journal of Autism and Developmental
Prompting is an effective evidence-based strategy
Disorders, 30(6), 553-567.
in supporting the language and communication
development of children with autism. However, Delprato, D. J. (2001). Comparisons of discrete-trial
it is paramount to have a good understanding of and normalized behavioural language intervention
each individual child’s strengths and needs in for young children with autism. Journal of Autism
and Developmental Disorders, 31(3), 315-325.
order to calibrate the correct level of prompting. It
is also recommended to continually evaluate and Education Review Office. (2010). Including students
reflect on which prompts most suit the situation with high needs. Wellington: ERO. Available from
and the task, and also how these should be faded www.ero.govt.nz/National-Reports/Including-
to support independence, and to avoid creating an Students-with-High-Needs-June-2010
ethos of over-dependence. The way in which this
Giangrecco, M. F., & Broer, S. M. (2007). School-
author most effectively supports teams to embed
based screening to determine overreliance on
effective prompting is through observation and
paraprofessionals. Focus on Autism and other
then collaborative discussion to identify whether
Developmental Disabilities, 22(3), 149-158.
the level of prompting used carefully matches Full text, including screening tool, available
the child’s strengths and needs. For example, this from http://www.uvm.edu/~cdci/archives/
SLT worked with one school team to reduce the mgiangre/149-158.pdf
level of prompting provided to a child to access
Godby, S., Gast, L. D., & Wolery, M. (1987). A
the toilet. At the time of the initial observation an
comparison of time delay and system of least
adult walked with the child to the toilet block and
prompts in teaching object identification.
remained with him, as there was a fear he would
Research in Developmental Disabilities, 8, 283-
not return to class. Support staff were encouraged
306.
to slowly reduce the prompts, by initially waiting
outside the toilet block, then waiting six feet Hall, L. J., McClannahan, L. E., & Krantz, P. J. (1995).
from the toilet block and then waiting outside the Promoting independence in integrated classrooms
by teaching aides to use activity schedules and
classroom door. Adults were encouraged to use
decreased prompts. Education and Training
praise for the child when he returned to class and
in Mental Retardation and Developmental
after one week the child was going to the toilet
Disabilities. September, 208-217.
block with his peers.
Hume, K., Loftin, R., & Lantz, J. (2009). Increasing
Hume, Loftin and Lantz (2009) suggest that independence in autism spectrum disorders: A
for those children who are subjected to high review of three focused interventions. Journal
amounts of adult-directed one-on-one teaching, of Autism and Developmental Disorders, 39(9),
there is greater concern of developing prompt 1329-1338.
dependence, less success in generalisation of skills Kurt, O., & Tekin-Iftar, E. (2008). A comparison of
and participation, and more passivity and learned constant time delay and simultaneous prompting
helplessness. These authors suggest that strategies within embedded instruction on teaching leisure
which promote independence need to be inserted skills to children with autism. Topics in Early
as part of the learning experience for the child. Childhood Special Education, 28(1), 53-64.
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Weaving educational threads. Weaving educational practice. KAIRARANGA – VOLUME 14, ISSUE 2: 2013
Ministries of Health and Education. (2008). New AutHor ProfILE
Zealand autism spectrum disorder guideline.
Wellington: Ministry of Health.
dervla Hayes
Ministry of Education. (2005). Springboards to
Practice: Building capability in education
for students with moderate and high needs.
Wellington, New Zealand: Author.
Mueller, M. M., Palkovic, C. M., & Maynard, C. S.
(2007). Errorless learning: Review and practical
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dervla Hayes is a Speech Language Therapist
Schools, 44(7), 691-700.
(SLT) with the Manurewa Early and Ongoing team,
Neitzel, J., & Wolery, M. (2010). Prompting for Regional Operations - Special Education. Prior to
children and youth with autism spectrum her current position in Manurewa, Dervla worked in
disorders: Online training module. Chapel Hill: Wellington from 2009, also for Special Education.
National Professional Development Center Dervla qualified as an SLT from City University,
on Autism Spectrum Disorders, FPG Child London, in 2006. Prior to moving to New Zealand
Development Institute, UNC-Chapel Hill). In in 2009, Dervla worked at home in Dublin and in
Ohio Center for Autism and Low Incidence London. Dervla completed the Postgraduate Diploma
(OCALI), Autism Internet Modules, www. in Specialist Teaching (ASD) in 2012 and this report
autisminternetmodules.org. Columbus, OH: formed part of her final assignment.
OCALI.
Email
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[email protected]
with autism to seek information: Acquisition
of novel information and generalization of
responding. Journal of Applied Behaviour
Analysis, 28, 3-14.
Uliana, L., & Mitchell, R. (1998). Functional
assessment of comprehension skills (FACS).
Sydney: Autism Spectrum Australia.
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