Dear Kids with Autism, Prompt Dependency is Not Your Fault

I can't even count how many times I've heard teachers say, "This child is so prompt-dependent!"  They say it as if to imply it is the child's fault, and it is a nuisance to have to deal with a child who is purposefully waiting for prompts (cues, assistance, help) in order to respond to directions, to begin tasks, or to make initiations.  Well, here's the news flash: Kids with autism can only become prompt-dependent if that is what we teach them.  When kids receive excessive amounts of prompting, it is inevitable that they will begin to rely on prompts.  Generally, kids with autism want to please adults.  In situations in which heavy amounts of prompting is used, the kids quickly learn that it is best to wait for the prompt to make sure they know exactly what the adult wants so they can "get it right." ABA interventions are very effective and can change the lives of many kids with autism; however, we have to be very careful with how we use certain behavioral techniques to prevent prompt dependency.  In classical discrete trial training programs, kids are presented with an antecedent (request, direction, question, etc.), and if they don't respond, prompting/fading procedures are used to elicit the desired behavioral response followed by a consequence (positive reinforcement).  While this is almost a fool-proof way of teaching new skills, we do have to be cautious about how we use prompting/fading procedures to prevent prompt-dependency.  Many behaviorists use what is called, most-to-least prompts (beginning with the most intrusive prompts and gradually fading out the prompts used until the child responds independently).  While this is necessary to use when teaching skills that are brand new to the child, we shouldn't use this approach in every interaction with the child or prompt dependency can be the result.  Here ten ways to decrease the likelihood that kids with autism will become prompt dependent (please share some additional ideas):

1.  When prompts are needed use least-to-most prompts whenever possible: This entails using the least intrusive prompt you think the child needs in order to respond.  If the child does not respond, you increase the level of prompting until the child can respond independently.  With each new learning opportunity you attempt to decrease the level of prompting used until the child can respond independently.

2. Make sure you don't leave out the FADING piece: I think it's safe to say that all caregivers and teachers prompt kids with autism.  However, it is not anywhere near safe to say that all caregivers and teachers systematically fade out their prompts until the child responds independently.  There is a "science" to fading prompts, and fading should be systematically planned.

3.  Use modeling/request imitation before prompting: When a child doesn't respond to a request, direction, questions, etc., caregivers and teachers often jump right into prompting using either verbal prompts, gestural prompts, or physical prompts.  Instead, before making a request, use modeling/request imitation by first showing the child exactly what you expect then providing an opportunity for the child to imitate your model with immediate feedback provided.  Many times, children can respond to this modeling/request imitation strategy without the need for additional prompts. 

4.  Use time-delay: There are a few different ways to use the time-delay strategy with some being more technical than others.  I like to keep it simple: after you make a request, give a direction, ask a question, make a comment etc. provide a brief period of wait time paired with an expectant look/body language to encourage the child to respond (recently in a teacher training, a teacher rephrased this strategy as "waiting happily" :)

5.  Avoid using hand-over-hand assistance: Hand-over-hand assistance is just what it sounds like: you literally put your hands over the child's hands and perform the desired response.  When you do this, in most cases, the child is like a marionette puppet and just lets you do what you need to do without really taking part in performing the behavior.  Instead of using hand-over-hand, I recommend using "gentle physical assistance" when physical prompts are necessary.  This means you gently touch or guide the child to get the child started and gradually reduce your physical assistance as the child is able to perform independently. 

6. Use visual supports: We know that most children with autism are visual learners.  To prevent the overuse of verbal, gestural, and physical prompts, use more visual prompts by using picture cues or written words to serve as reminders for the children.  This creates much less dependency on adults.

7.  Use self-monitoring: This entails having children record the occurrence of the desired behavior.  If the children are responsible for recording when they display a certain behavior, they may be more likely to perform the behavior without the need for prompts.

8.  Use Literacy-Based Behavioral Interventions:  Many times kids with autism "need" prompts because they do not know what the desired expectations are.  Therefore, if you use literacy-based behavioral interventions such as social stories, modified social stories, comic strip conversations, etc. the child can learn exactly what is expected without the need for as much prompting.

9. Accept all attempts and use shaping: If a child has been taught that there is always only one specific correct response, it is likely that the child will wait for a prompt to make sure he/she gets the answer right.  Instead, positively reinforce children for all attempts they make to encourage independent responses.  Then you can use shaping to get the child's response closer and closer to what you have set in your mind as the end goal.

10.  Vary the antecedents: If you make requests, give directions, or ask questions using the exact same language and the exact same tone of voice every time, the child may begin to see a pattern that they find enjoyable to "play out." For example, the teacher says, "What do you want?" The child doesn't respond, so the teacher prompts by saying, "I want ______." The child responds.  If this is the same exact pattern every time, the child may think the expectation is to wait for the "I want ____" prompt before responding.  Instead, vary how you present requests, directions, and questions and be sure to fade any prompts you use.