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Prompts and Cues: Little Words with a Big Impact

So quickly let’s review…

Prompt : Prompt is defined as: “Instructions, gestures, demonstrations, touches, and/or things that we do to increase the likelihood that children will make correct responses.” By Lynn McClannahan and Patricia Krantz of Princeton Child Development Institute. Prompts are designed to lead the student to the correct answer or response.

Cue: A cue is just a hint and does not lead the student to the correct answer. Now, many use these words interchangeably, but it is not a good idea when you are writing goals or reports. The main reason is clarity.  You may know that when you are writing a goal and say a student is allowed ‘2 prompts’ before the trial is marked incorrect, you are referring to prompting ( giving hint and support to get the correct answer ) as well as cueing ( giving extra hints but not directing to the correct response ), but someone else may not.  If your student moves and the new SLP is reading that they can only prompt them, it can mess with the data that will be collected and that isn’t good for anyone!

Then there is the side that no one likes to think about …the legal side! DUN DUN DUN!!! 

So, If your IEP and data are brought into court for some reason, they are going to look at how the data is collected which means analyzing the parameters for the goals, which includes prompts and cues.  If you aren’t taking data the way the goal states because you are using prompts and cues interchangeably then it could be a problem.

Now let’s look at some examples of each:

Prompt Examples: 

Gestural Prompt – The SLP models the action of placing a ball under a basket to show the concept of under.

Verbal Prompt – ” Pick up the ball and put it under the basket ”

Cue Examples

Gestural Cue – The SLP taps the ball/basket to indicate that the student needs to perform an action with the objects.

Verbal Cue ( Indirect ) – “Where should the ball go?”

Similar but different. I Think of them as siblings; they are in the same family but two different entities… and the last thing either wants to hear is why can’t you be more like your brother!  So, what can we do about this whole ‘ prompt and cue are the same thing ‘ because now we know they are different.  When writing your goals include that both can be used and what kind. Something like this, ” …with no more than 2 visual and/or verbal prompts/cues…”.  This allows for 2 prompts, 2 cues, or a combination to be used to help the student.

What do you use more, prompts or cues?

If you still aren’t sure about prompts and cues in your goal writing I would like you to check out this video tutorial I just did. Click HERE to watch the preview.

For information about the Prompting Hierarchy and a free reference card, check out this post !

Hierarchy of Cueing and Prompting

Clarification fo Cueing and Prompting Terms

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Hey there! I’m Maureen Wilson, a school-base SLP who is data driven and caffeine powered. My passion is supporting other pediatric SLPs by teaching them how to harness the power of literacy and data to help their students achieve their goals…without sacrificing time they don’t have.

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Hello! Is there any way to get the hierarchy of cueing and prompting? When I click on it it doesn’t work. Thanks so much!

There is a free reference card in my TpT store 🙂

Hi! How would you explain the difference between prompting and cueing in the area of articulation?

Hi! When you say will…. With no more than 1 verbal prompt with 80% accuracy. Does that mean 1 prompt each question or they can get 2 wrong and they can get 1 prompt for the 10 questions? Thanks!

I always do trials of 10! Makes it easier to grade and more consistent for review/ assessing progress.

10 or multiples of 10.*

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A Guide to the Prompting Hierarchy in Speech Therapy

• allisonfors
• December 16, 2020
• Speech Therapy Education , Therapy Ideas

The prompting hierarchy is a structured, systematic method of assisting a person in learning new skills. It outlines the different ways we motivate our students to get the correct answer or achieve their goals. Prompt hierarchies provide many opportunities for communication. There are two different types of hierarchies: Most-To-Least and Least-To-Most.

Most-To-Least is used before a new skill is mastered. It provides a high level of support. This begins at the base of the hierarchy (physical assistance.)

Least-To-Most is used after a new skill is learned, and the person is working on mastery. This begins with the top of the hierarchy (pause.)

Choose the response latency time appropriate for your student (i.e. 30 seconds while you wait for a response) and if you don’t get the desired result, move onto the next prompt level in the hierarchy.

A Note about the Prompting Hierarchy

There are many different prompt hierarchies, and the one you choose and use is based on preference and your purpose. Most hierarchies are created for Augmentative and Alternative Communication (AAC). I highly recommend downloading and reading about Kate Ahern hierarchy. The big difference is physical assistance is not included. The reasoning for this is taking a child’s hand and moving it for them to communicate is not advisable. We want AAC users to know their voice is their own. Research has shown that modeling language on an AAC device is more effective than hand over hand or physical prompting. Kate Ahern says: “What does a hand-on, full physical “cue” tell the child? It tells them that: A) we have the right to manipulate their bodies or make them touch or do things whether they want to or not and B) that we have the right to force them to say things just because we want them to say it.”

This infographic is available for free download.

The least invasive instructional support. Provide the person sufficient time to process the request and initiate communication with their own motivation. It is recommended to wait a minimum of ten seconds.

Indirect Nonverbal Prompt

Use your body language to show a form of communication is expected. Some examples include facial expressions, questions, hand motion, or eye contact. 

Indirect Verbal Prompt

An indirect verbal prompt starts the student in the right direction without providing the answer. Often this is in the form of asking open-ended questions, which pushes them towards action, such as asking, “What happens next?” as they recount a story or, “Where does this piece go?” as they solve a jigsaw puzzle.

Request a Response

If there is still no response, try asking a specific question, such as “You need to ask me.” or “Tell me what you want.”

Gestural Cue

Use a gesture, such as pointing, reaching, or showing to let the person know what they are expected to do. 

Partial Verbal Cue

Provide part of the verbal expected response, such as “You want the…”

Direct Model

If there is still not a response, model a potential response. Then pause and wait for the person to imitate or respond.

Physical Assistance

The most invasive instructional support. Provide hand-over-hand assistance.

You may be interested in the Speech-Language Development Handouts which includes a section on prompting!

Do you have any favorite strategies for using the prompting hierarchy?

2 Responses

Hi Allison, great post! I am an SLP as well beginning to gain experience working with AAC devices. Would you mind sharing the research article stating that modeling language on a device is better than providing physical prompts?

Thanks so much!

Hi! Biederman, G., Fairhall, J. L., Raven, K. A., & Davey, V. (1998). Teaching basic skills to children with Down Syndrome and developmental delays: The relative efficacy of interactive modeling with social rewards for benchmark achievements and passive observation. Down Syndrome Research and Practice, 5(1), 26-33. doi:10.3104/reports.72

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What is PROMPT Therapy?

PROMPT therapy is a unique holistic tactile/kinesthetic approach to speech therapy. Therapists use touch cues on the lips, jaws, tongue, and vocal cords. They use this technique to help shape and support proper movement and placement of the vocal organs, known as articulators, and include the lips, tongue, hard palate, and teeth.

PROMPT therapy was first developed in the 1970s by a speech therapist named Deborah Hayden. Dr. Hayden set out to create a form of speech therapy to help those who were not benefiting or responding to traditional forms of speech therapy. The name comes from an acronym: Prompts for Restructuring Oral Muscular Phonetic Targets. It’s both a treatment method and philosophy and this holistic program is designed to promote and facilitate the development of motor skills and the production of phonemes, which are the smallest units of sound. 

Speech sound production is a very complicated process, involving the use and co-operation of over a hundred different muscles. The treatment of motor speech disorders can be complicated, and in many cases, PROMPT therapy can be an incredibly effective treatment option. PROMPT therapy focuses on teaching motor control and approaches communication as a combination of cognitive-linguistic, physical-sensory, and social-emotional capabilities. 

For the most part, PROMPT therapy is used to improve functional speech, meaning the clarity of speech. Using this method, therapists are able to clearly communicate and demonstrate the proper placement and movement of the lips, tongue, teeth, and jaw to create specific sounds and sound combinations. 

Do you need help with articulation and overall speech clarity? Here at Great Speech, our biggest goal is matching the right client with the right specialized online speech therapist on our team, so you can start seeing some real progress towards your speech therapy goals. Schedule a free introductory call with us to discuss the challenges you are facing, as well as the best online program available to help you.

Who does PROMPT Therapy help?

Research has shown that PROMPT speech therapy can be highly effective in treating a vast array of speech delays and disorders. The most common disorders to be treated through PROMPT therapy are those related to speech-sound production such as motor speech difficulties, articulation delays, autism spectrum disorder, and apraxia in speech. Apraxia is a neurogenic speech disorder that directly affects speech sound production, rate or speed of speech, and disrupted prosody. PROMPT therapy has also been shown to help adults who are struggling with aphasia or apraxia as a result of a stroke or other traumatic brain injury. 

Prompt therapy may be used, in a variety of ways and intensities, from the age of 6 months onward. You can also schedule a free introductory call to get matched with an online speech language therapist on our team to get help with speech sound production. 

How does PROMPT Therapy work? 

 In order to be certified in this approach, a speech-language pathologist must attend PROMPT training courses and meet a number of certification requirements that have been established by the PROMPT Institute. 

Once the PROMPT method has been selected as an appropriate form of treatment, an initial standardized assessment will be conducted by a speech therapist that is educated, intensively trained, and qualified in this unique approach. This assessment (which may include multiple portions or evaluations) will allow the therapist to observe and assess motor speech development. The assessment will progress following seven interrelated stages, beginning with the Foundations of Speech and continuing until all challenges and/or delays are identified. Through the use of this unique conceptual framework, speech therapists are able to identify, prioritize and target areas that pose the most difficulty. 

Once the needs of the client are identified, the therapist will then design a custom treatment plan with a focus on targeting the specific objectives and goals that are unique to that person. Tactile cues are used to shape speech and aid sound production at increasing complexities. Often therapists will use repetition of these cues and encourage the client to repeat the same sound or phoneme multiple times, in order to solidify the correct placement and movement of the articulators and build muscle memory. This approach is so effective because it allows the therapist to visually demonstrate how a sound is made, how it should sound, and exactly how it can be made with their own articulators.

Most of the therapy will be focused on targeting specific sounds, and over time incorporating these sounds into syllables, words, and eventually full and clear sentences. Each therapist will design a program based on socially appropriate and meaningful contexts which can help to provide motivation for the client to learn and master the use of their skills. 

What is the difference between Prompt and Cue Therapy?

PROMPT therapy is a literal hands-on approach to speech therapy. A therapist using the PROMPT method uses physical tactile touch or prompts to help guide and demonstrate proper movement and placement of the vocal organs.

The use of cues in speech therapy is one of the fundamental and most important aspects of a therapy program. These can include verbal, gestural, or visual cues. 

The main difference between PROMPT therapy and the use of cues in speech therapy is that prompts are direct instructions with a demonstration, whereas cues are simply clues or hints that are aimed to help guide towards the correct response or action. As therapy progresses, and skills become more solidified, prompts may be replaced with cues. 

Is PROMPT Therapy effective? Is PROMPT therapy evidence-based? 

There have been many studies that have illustrated and highlighted the effectiveness of PROMPT therapy, especially in the treatment of Speech Motor Delays. PROMPT intervention has been directly associated with improved speech motor control, word-level speech intelligibility, and speech articulation. This approach to speech therapy integrates the communication of information across visual, auditory, and tactile/kinesthetic systems and as a result, helps to establish improved accuracy and stability of speech. PROMPT therapy is constantly changing and evolving as new research and empirical evidence are established.

PROMPT therapy is a highly unique and specialized approach to speech therapy and has been proven to be highly effective in the improvement of speech motor control, speech articulation, and speech intelligibility. 

If you are worried about your child’s speech development, have concerns about the clarity of their speech, or want to learn more about PROMPT speech therapy, the next step is to connect with one of our highly trained and specialized speech therapists by beginning your online speech therapy program. Get started and schedule your free introductory call today! 

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Prompting in Speech Therapy: Quick Tips for How to Use Gestural Prompts

January 26, 2023

As SLPs, we all use prompting in our speech therapy sessions. It helps us build upon what a child already knows by scaffolding the skills that we target.  There are many forms of prompts and scaffolds.  We’ve spent time talking about the importance of verbal prompts and visual prompts in the past.

Today, let’s chat about ways to use gestural prompting in speech therapy.

WHAT IS IT?

Gestural prompts are supports in the form of a gesture or action that the learner can observe the instructor doing.  This could include pointing, nodding, reaching, etc.

Gestures give clues and information about the correct response in a non-verbal way.  They are like a mix between physical prompts and visual prompts.  For more information about prompts and cues in general, including when to use which type, check out this blog post .

TYPES OF GESTURAL PROMPTS

Here are a few of the most common types of gestures that you might use with your students.

1. Modeling

Modeling involves the therapist demonstrating a gesture while saying a word or phrase , in order to encourage the client to imitate it.  For example, an SLP might tell a student to clap their hands while modeling clapping hands.

2. Pointing

This involves the therapist pointing in the direction of the correct response .  For example, an SLP may point to an object or picture while saying the word for it, in order to help the child make the connection between the word and the object.

3. Hand gestures

Many use hand gestures as a slightly less direct cue than pointing.  It involves moving your hand to indicate a specific object or area .  For example, the SLP says, “Put the toy on the shelf.” while gesturing toward the shelf.

4. Looking/nodding

This involves looking or nodding in the direction of the correct response .  You may use this to encourage a child to follow directions.  For example, after giving a direction (“sit in the chair”), the SLP looks at the student and then looks at the chair. 

This could also include looking at a child expectantly .  I use this one all the time with my minimally verbal kids to give them a clue that I’m waiting for them to respond.

5. Iconic gestures

This reminds me of miming . It involves using gestures that resemble the action or object being described, such as holding an imaginary steering wheel to indicate “driving” or making a rocking motion to indicate “rocking.”

6. Phonemic supports

I use gestures for articulation and phonetic cuing all the time. You might do it too, like touching your nose for a nasal sound.  I’m actually trained in Visual Phonics , which is a system of hand cues that represent the 46 phonemic sounds of spoken English.  There are a few different systems for using hand gestures to cue articulation sounds out there.  Visual Phonics is just one we use district-wide for both literacy and articulation, so my students are familiar with it.

IMPORTANT THINGS TO CONSIDER WHEN USING GESTURES

It is important to note that gestural prompts should be used in conjunction with verbal prompts , not as a replacement for verbal language. Additionally, gestural prompts should be tailored to the individual client’s needs and abilities.

When using gestural prompting in speech therapy, it is important to have a plan to fade the prompt .  Even within gestures, you can give a more direct to less direct cue.  For example, if you are giving a direct model, you might decrease to a small hand gesture, then to a look or head nod.  You could also decrease the number of prompts given.

DOWNLOAD A FREE GUIDE!

You might be thinking that all the different kinds of prompts, cues, scaffolds, and when to use them are starting to get jumbled in your head.  If you want a concise, easy-to-read reference for scaffolding, be sure to download this FREE Scaffolding Guide !

It includes all my best tips and checklists to give you a clear understanding of prompting!  With this guide you’ll get: 

• My favorite tips for using prompts
• Helpful strategies and examples for visual, verbal, and gestural prompt
• List of printable resources and my favorite scaffolding and prompting blog posts
• Lists of the types of supports and examples for how to use each one!

Head over HERE to feel better about scaffolding and get your guide sent straight to your inbox!

January 28, 2023 at 9:12 am

wonderful, bravo, love your free forms! this is so helpful for my families! slp, dee dee

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Prompt Speech Therapy for Kids

Erin Vollmer MS, CCC-SLP

• February 3, 2023

What is the PROMPT method?

PROMPT stands for P rompts for R estructuring O ral M uscular P honetic T argets.

PROMPT is a successful, evidence-based  treatment method for children with motor speech disorders such as apraxia , dysarthria or phonological disorders . 

The PROMPT method focuses on the physical aspects of speech production (i.e.,  movements of the lips, jaw, tongue, and larynx). A PROMPT trained speech language pathologist uses tactile cues, such as gentle pressure on the face and neck, to guide children to the correct movements for producing speech sounds. 

PROMPT is a multidimensional and holistic approach that combines physical and cognitive techniques to improve speech and language skills. Children learn to to use their new speech movements in context. The therapist will work on building vocabulary, grammar, and sentence structure, as well as conversation and social skills .

In a typical PROMPT therapy session, a speech-language pathologist will manually guide the child’s jaw, lips, vocal folds, and tongue by targeting certain words, phrases, or sentences. They use touch cues to shape and support movements. In doing so, the therapist helps the child produce   phonemes ( the smallest units of sound that distinguish one word from another).

Together, the therapist and child progress through the hierarchy of sounds at a steady pace, moving to more sounds only when the child is ready. Children learn (through assistance and repetition) to plan, organize, and create increasingly more advanced speech sounds.

PROMPT is literally a hands-on method of improving speech . At the beginning, the therapist relies heavily on touch cues to guide patients. As speech skills improve, the touch cues like training wheels are gradually removed.

To be certified in the PROMPT method, a speech-language pathologist attends PROMPT training courses and meets a number of certification requirements established by the PROMPT Institute . Many TherapyWorks therapists are PROMPT certified.

How to help a child with apraxia or other motor speech disorders

If you have a child with motor-speech difficulties, you may already know that conventional articulation therapy can be frustrating and may not always produce the best results for your child. The PROMPT method provides children with mass practice and repeated tactile, aural, and visual cues. They will see how a sound is made, hear what it should sound like, and feel exactly how to produce it.

If you think your child may benefit from a PROMPT-based treatment approach, please do not hesitate to reach out to us.  We’d be happy to match your child to one of our PROMPT-certified speech-language pathologists.

Click the  Get Started button  on our homepage.  Simply answer a few questions about your child and their specific needs, and the TherapyWorks team will follow up with scheduling and PROMPT trained therapist options.

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43 Conversation Starters for Speech Therapy Practice

As promised here are the words for your unlimited use .

If you know others who can use our lists ...

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Conversation starters.

• What is your favorite movie and what happens in it?
• Tell me about your family.
• Tell me about your pets or the pet you would like to have.
• What kind of music do you like to listen to?
• Tell me about what you watch on TV.
• What is your favorite toy to play with or what toy do you wish you had?
• Tell me about your favorite video games.
• Tell me about a funny or scary dream you had.
• What do you want to do when you grow up?
• How do you celebrate the 4th of July?
• How do you celebrate Easter?
• What do you do for Halloween? What did you dress up last time and what do you want to be this year?
• What do you do for Valentine’s Day?
• What do you do for Christmas and what is your favorite thing about it?
• What do you do for Thanksgiving?
• When is your birthday and what did you do for your last birthday? What do you want to do for your next birthday?
• What is your favorite animal and why?
• What is your favorite movie?
• Do you have any hidden talents?
• What is your favorite color and why?
• What is your favorite holiday and why?
• What is your favorite game to play?
• What is your favorite sport and why?
• What are you excited about that’s going to happen soon?
• Where have you lived and which was your favorite place?
• What does your room look like?
• Tell me about your favorite book?
• What is your favorite thing about school and why?
• What are some things you don’t like to do and why?
• What do you like to do when you’re alone?
• What do you like to do in the winter?
• What do you like to do in the summer?
• If you could meet anyone, who would it be?
• What do you like to do with other people?
• Tell me about a time you went camping or slept outside?
• What animal would you be and why?
• What would you change about yourself if you could change one thing?
• What are your favorite candies and/or treats?
• What are your favorite foods? What are some foods you don’t like?
• If you could buy anything you wanted, what would you buy?
• If you could go anywhere on vacation, where would you go?
• If you could live anywhere, where would you live and why?

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This list of functional words was professionally selected to be the most useful for a child or adult who has difficulty using conversation starters.

We encourage you to use this list of conversation starters when practicing at home.

Home practice will make progress toward meeting individual language goals for using conversation starters much faster.

Speech-Language Pathologists (SLPs) are only able to see students/clients 30-60 mins (or less) per week. This is not enough time or practice for someone to strengthen their understanding of this important language concept.

Every day that your loved one goes without practice it becomes more difficult to help them. 

SEE ALSO:   The Best Books for Speech Therapy Practice

We know life is busy , but if you're reading this you're probably someone who cares about helping their loved one as much as you can.

Practice 5-10 minutes whenever you can, but try to do it on a consistent basis (daily).

Please, please, please use this list to practice.

It will be a great benefit to you and your loved one's progress.

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05 Aug What is PROMPT?

Course Abstract:

PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT). PROMPT trained SLPs assess and treat individuals holistically by approaching communication as an interaction of the physical-sensory, cognitive-linguistic and social-emotional domain within the Conceptual Framework. PROMPT is most wildly known for treating motor speech disorders, however all aspects of the child are addressed. This webinar describes and demonstrates what PROMPT is as well as examines how children with childhood apraxia of speech (CAS) are assessed and treated from a PROMPT perspective. In addition, current and past PROMPT evidence-based research is briefly reviewed. Treatment videos and research will emphasize how PROMPT helps SLPs meet the individual needs of each client and facilitates optimal functional communication outcomes.

Presented By: Amy Clark, M.S., CCC-SLP, PI and Alice Stroutsos, M.S., CCC-SLP-PCI

This course is offered for 0.10 ASHA CEU’s ( Introductory  level,  Professional  area)

Learning Objectives

• Discuss the PROMPT Conceptual Framework.
• Describe key components of PROMPT assessment and treatment.
• Apply the PROMPT Conceptual Framework to their client or child.

Timed Agenda

Minutes 1-3:            Introduction Minutes 3-8:           Learning Objectives, PROMPT Institute Vision/Mission Minutes 8-12:         What is PROMPT? Minutes 12-22:       PROMPT Conceptual Framework Minutes 22-27:       Uses of PROMPT Minutes 27-37:       Implementing PROMPT with Children with CAS Minutes 37-50:       PROMPT Assessment & Treatment Minutes 50-55:      PROMPT Research Minutes 55-60:      Summary

PROMPT: A Parent's Guide to Hands-On Speech Therapy

This guide will provide you with an overview of the PROMPT method in speech therapy and how it can be used as effective treatment for childhood apraxia.

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The PROMPT method of  speech therapy  provides many children with the support they need to see significant improvement.

What is PROMPT speech therapy? You may have heard this term before but were unsure how it applies to your child's needs. Prompt stands for Prompts for Restructuring Oral Muscular Phonetic Targets. It is a highly successful therapy option for children with motor speed disorders. This includes children who have  childhood apraxia  or dysarthria. It may also help some adults who struggle with these needs as well. It is unique and effective as a robust type of speech therapy.

A History of This Therapy

The PROMPT style of speech therapy was first developed in the 1970s by  Deborah Hayden . It was initially used to help children displaying severe motor impairments who did not do well with other types of traditional speech therapy. To take on these more challenging cases, Dr. Hayden worked to create a tactile-kinesthetic way to improve speech therapy.

The PROMPT method in speech therapy is both a method and a philosophy in that it focuses on a holistic way of improving speed therapy. It also helps to focus communication as a blend of cognitive-linguistic and physical-sensory aspects. It also blends social and emotional factors into the method. It is also important to know that this type of therapy is continuously evolving as new research and data help strengthen its basis.

What Does PROMPT Speech Therapy Do?

If a child suffers from speech delay, disorder, or another type of impairment, it is often necessary to begin therapy immediately. The PROMPT method is often one of the first options for those who fit the mold because of its effectiveness.

PROMPT is a tactile-kinesthetic approach to speech therapy. What does that mean? In this type of therapy, the pathologist will guide the patient's articulators manually. This includes the lips, jaw, tongue, and vocal folds. To do this, the therapist will target particular words and sentences. To help the child learn, the therapist will use touch cues to help to support the proper movement of each articulator during the speaking process.

By doing this, the patient can produce phonemes. These are the smallest types of sounds that allow for distinguishing one word from the next. During each speech session, the child and therapist work in this way, through touch cues, to create better physical function. This often includes moving through various sounds over time at a steady pace. The patient will move from one sound to the next, at their own pace, as they learn and accomplish the first set of sounds.

The child gains improvement in their skills in multiple ways. This includes the assistance they receive as well as repetition. They also learn to build more complex sounds over time, adding one to the next until they master the sounds fully.

Various techniques are in use that use the muscles, jaw, and face to help create improved sound. This therapy is not just to help individuals learn single speech sounds. Instead, therapists can use this method to help children learn full words, phrases, and sentences.

Who Is a Candidate for PROMPT Therapy?

Many children may benefit from the use of PROMPT. This includes individuals who are typically at least six months or older. They may have a diagnosis of a condition such as:

• Cerebral palsy
• Cleft lip and palate repair patients

Treatment for other speech disorders and impairments may also be effective using this method. It is best to use it on those with partial or completely non-verbal children. It may also be an alternative treatment for those with mild articulation delays who have not responded to other types of treatment. It is also suitable for those who have motor speech disorders as well as language disorders.

Is PROMPT Speech Therapy Effective?

Yes, in many ways, it can prove to be one of the most effective methods for improving speech in children. It can help children to accomplish a great deal of improvement in a short timeframe, which helps to create motivation and sparks a significant positive impact on the lives of children.

Choosing a speech therapist certified explicitly in this area is critical to be effective. This includes a professional who has completed training courses and has met certifications beyond just being a speech and language pathologist.

Because this technique can be molded and designed to meet the child's specific needs and for just about any given concern, it is very effective overall. With this method, many children learn new sounds and then also learn new vocabulary and how to use it within their day-to-day needs. It is a type of reprogramming of their current speech production system, and as a result, it has the opportunity to create significant improvement.

How Does PROMPT Therapy Differ from Traditional Approaches?

There are various ways that PROMPT is different from other types of speech therapy. For example, it is a much more hands-on experience designed to improve speech. To work well, the therapist has to use touch cues to help to guide the patient. As the patient learns and expands their skills, the touch cues are removed, one after the other, allowing the further building of those skills. Unlike other methods that rely on repetition, this method is far more hands-on in its functionality.

Also crucial in this type of therapy are the practice activities and the social components of the child's experience. This method is not just a single-track but a more holistic approach that helps to blend social elements, cognitive function, and physical aspects. The experience is also very customizable to meet the child's unique needs.

Learn more about PROMPT and other treatments for childhood apraxia and other speech impairments.

About the Author

Myles Nobles is a pediatric speech pathologist in Laurel, MD. With patience and a friendly demeanor, he helps children from all walks of life develop independence, greater confidence, and social well-being by improving speech and language. Treatment plans address developmental, articulation, fluency , and other crucial language skills impeded due to autism and other challenges.

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Where We Answer the 'Why' Questions of Speech Therapy

PROMPT- Useful for Childhood Apraxia of Speech (CAS)

What is prompt.

PROMPT is an acronym for:

P rompts for R estructuring  O ral  M uscular  P honetic  T argets.  This is a dynamic, hands-on program for children with apraxia of speech in which the trained clinician shapes the movement of a child’s jaw, tongue, and lips using our hands in support of sound production.  Although the use of touch and movement is an integral component, PROMPT is more than just executing tactile support.  It is a program that incorporates all aspects of a child’s processing, understanding, and interaction.

These areas of development, or domains, are known individually as: The Cognitive-Linguistic, (ability & language), Social-Emotional (socialization), and Physical-Sensory (muscle tone & senses) Domains.  Together, these domains function in unison and influence each other to the extent that challenges in one area directly impact progress in another.  This video for families on the PROMPT website visually explains the domains and PROMPT’s multifaceted treatment approach.  Some children that may benefit from PROMPT include those diagnosed with motor speech disorders like apraxia and dysarthria , cerebral palsy, and autism.  To determine if PROMPT is appropriate for your child, your clinician will begin with an observation and comprehensive evaluation.

Evaluation:

PROMPT is rooted in a Dynamic Systems Theory, meaning that clinicians must factor in cognitive, social, behavioral, sensory-motor, and physical influences on communication.  Let us break these down into some specific questions that we as clinicians ask ourselves during a comprehensive assessment process:

• Cognitive: What is the child’s ability to process sensory information and comprehend language?  Does the child need visual schedules and/or other modifications and cues to learn new information?  How should clinicians and parents’ scaffold, cue, and elicit language with the child?
• Social: Do we need to work on establishing trust before diving into PROMPT?  How does the child express his wants and needs (i.e., pointing, gestures, sounds?)  How is the child’s non-verbal communication?  What communicative intents does the child relay (i.e., greeting, requesting, commenting, responding to questions?)  Is the child interested in engaging in communication and interactions with others?
• Physical: What is the child’s skeletal system and muscle tone like?  Do we need to provide additional supports in the environment to support skeletal and/or musculature issues?  Does the child have difficulty with vision, hearing, tactile/touch?

System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH):

In addition to collecting information from a parent interview, a PROMPT evaluation also includes analyzing the movements necessary for speech. These yes/no questions are based on typical speech development. Next, the clinician transfers the results to a visual representation to rate the severity of the speech disorder.  The System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH) provide us with practical information to develop a treatment plan.

Well-Built House

Marcus Neal, a PROMPT instructor, describes the Motor Speech Hierarchy as a well-built house with a strong foundation (jaw) necessary for sustaining the other structures (lips, tongue.)  The jaw is the first articulator to develop, so we need to make sure that this foundation is ready to support sophisticated lip and tongue movements.  Jaw stability and the ability to open our mouths in four graded levels (minimal to wide) helps us sequence movements for speech.  In PROMPT, we incorporate vowels into a child’s practice because vowels shape jaw movements.

After completing a SAO, clinicians calculate percentages for each of these areas:  tone, phonatory, mandibular (jaw), labial-facial (lips-face), lingual (tongue), sequenced movements, and prosody (inflections/intonation.)  Next, we shade in the boxes for each of these areas on the MSH to help identify points of intervention.  Given the fluid interaction between these Stages, we need to address three areas to work on immediately.  While we cannot change a child’s tone, it is important to note limitations and consult with OTs and PTs for suggestions on improving posture.

After selecting three areas to prioritize, we develop goals and vocabulary lists to practice words/ phrases during functional activities.  This list will include a variety of vowels, consonants, and blends with emphasis on core vocabulary.  From the start, we blend words into phrases to work on prosody (intonation).  So, we model and support with PROMPTs, “ma more!” or “go ma?”  The reason for working on prosody early on is to help make speech movements fluid and vary communication intentions.

Service Delivery:

Typically, young children with apraxia of speech benefit from at least two, 30-minute sessions.  Depending on the degree of severity, services may range anywhere from a few months to several years.  Other contributing factors that can impact longevity of services are medical conditions, cognition, social/pragmatic skills, sensory/tactile defensiveness, and comprehension delays.

Typical PROMPT Therapy Session:

If a child with apraxia of speech has limited verbal skills, then sessions will initially focus on using vowel sounds.  As vocalizations increase, then PROMPT support shifts to productions of consonant sounds/words/phrases/sentences.

A typical 30-40 minute PROMPT session for apraxia of speech would proceed as follows:

• Greeting and set up (5-10 minutes)
• Motor phoneme warm-up reviewing the targeted words embedded in the session’s activities with 3-5 PROMPT supported repetitions per target. (5-10 minutes)
• Most sessions have 2-3 activities, each lasting 5-10 minutes.  These activities incorporate pertinent aspects from the Domains reviewed above factoring in picture supports, timers, movement breaks, supported seating, and any other cues the child may need for success.  Speech sound movements are worked on during play to help the child attach meaning and strengthen memory.
• Review home practice plan (5-10 minutes)

Here are some examples of activities that I have used for children with varying cognitive abilities during my PROMPT sessions:

• early childhood: Toy Vet Play Set with word targets to address needs in tongue control and jaw movements (go, goes, take, push, home, help)
• preschool: Play-Doh Kitchen Oven with words to help work on lips-face control with movements that require rounding lips (no, two, dough, do, “mo” for more)
• elementary school-aged: Pop the Pirate Game practicing words that support improving jaw control, lip contact (pop, Bob, up, “hep” for help)
• middle school-aged: Knock, knock jokes to address improving prosody (intonation) and tongue control (Who’s there? cat, kitten, bike, show)

PROMPT Supports:

There are four levels of PROMPT (Parameter, Surface, Complex, Syllable) with clinicians using at least 2-3 of these in one session.  Here is a breakdown on each level and the type of support it provides a child:

Parameter: provides the most support you can offer through stabilizing/ moving the jaw and lips.  There are 13 sounds supported at this level some of which include: h, p, b, m, sh, and vowels in words like “cat”, “father”, and “eat”.

Syllable: only used for consonant-vowel (CV) productions such as “go”.

Complex: helps the child contract and/or tighten his tongue to produce consonants such as (r), blends (sh), and vowels.

Surface: these supports specifically help a child with placing articulators accurately, timing movements using rhythm and prosody, and transitioning from one sound movement to another to create words.

PROMPT and Teletherapy:

In 2020, PROMPT training for speech pathologists shifted from in person to virtual because of global shelter-in-place restrictions.  The PROMPT Institute also developed specific training for clinicians using PROMPT via teletherapy. Parameter PROMPT offers the most support for a child and can be easily administered by a caregiver following a trained speech pathologist demonstration.  Some surface PROMPTs can also be used in teletherapy with the clinician showing this support on herself, a doll, or willing assistant.

My hope in writing this post was to provide a thorough explanation of the dynamic intervention of PROMPT.  This program is unlike any other that I have been trained in over the last two decades in the field of speech pathology, as I have witnessed tremendous success when applying this methodology with clients who have motor speech disorders.  Both caregiver carryover and early intervention are crucial to these achievements, so please continue advocating for your child and seeking resources like the PROMPT website to further your knowledge and education.

If you want to find a speech pathologist in your area trained in PROMPT, then you can visit this link and conduct a search.  

Nanette Cote

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

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PromptSLP.com

PROMPT Speech Therapy for Children

• PROMPT© FOR SPEECH PRODUCTION
• What is PROMPT© Therapy
• Contact Page

Denielle DiMarzo is a PROMPT© Certified Instructor .

In addition to teaching PROMPT© courses nationally and utilizing PROMPT© in her clinical practice, Denielle is committed to supporting clinicians who are new to the PROMPT© experience. Denielle holds her Certificate of Clinical Competence from ASHA and has Connecticut and New York licensure in Speech and Language Pathology and is the owner of private practice in Fairfield County.

She has over 20 years of experience working in a variety of settings with many different populations. Her specialty is providing direct and consultative services using the PROMPT Conceptual Framework. Denielle works with various populations such as: Birth-3, pre-school and school aged children with motor speech disorders.

Denielle began teaching PROMPT in 2000. In addition to PROMPT certification, Denielle holds an Early Intervention Specialist Certification from the University of Connecticut.

Certifications and Licensure:

• Certificate of Clinical Competence, ASHA (American Speech-Language–Hearing Association) • CT Department of Public Health License • CT Professional Teaching Certification • NY Teacher of Students with Speech and Language Disabilities /State of New York (TSSLD) (accreditation from the Department of Education) • PROMPT Institute, Certified PROMPT Clinician • PROMPT Institute, PROMPT Certified Instructor

Education of Children with Special Needs pp 193–201 Cite as

Dyslexia: An Attempt to Define the Notion

• Olga E. Gribova   ORCID: orcid.org/0000-0002-6289-4703 3  
• First Online: 04 November 2022

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The paper focuses on the term “dyslexia” to refer to reading disorders as a type of speech activity. Nowadays, there is no clear definition and understanding of the structure of this speech disorder, its causes, and ways of correction. The scientific community has two main approaches to the study of dyslexia. The first approach—psychological and pedagogical—is implemented mainly in Russia and assumes a diagnosis of dyslexia based on the analysis of the phenomenology of errors and the identification of the mechanisms causing them through speech therapy and psychology. The second approach—the medical and biological or clinical-psychological approach—is based on objective instrumental studies of brain activity and the identification of genetic predisposition. It is implemented in foreign studies. However, the qualification of dyslexia varies not only depending on the traditions of countries but also on the point of view of a particular author. The author attempts to define the notion of dyslexia and designate the scope of its application considering the traditions established in Russian defectology. The search for ways to intersect the content of the concept of dyslexia available in different countries and cultures allows us to expand the understanding of the nature of this defect and its mechanisms, which, in turn, will contribute to the further development of the theory and practice of correction and prevention of dyslexia in preschool age. This will positively impact the development of comprehensive approaches to methods and technologies for dyslexia correction and will be useful for a wide range of learners, their parents, teachers, and specialists in the system of comprehensive support for children with dyslexia.

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Gribova, O.E. (2022). Dyslexia: An Attempt to Define the Notion. In: Arinushkina, A.A., Korobeynikov, I.A. (eds) Education of Children with Special Needs . Springer, Cham. https://doi.org/10.1007/978-3-031-13646-7_20

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