Easy Ways to Use Prompts & Cues in Speech Therapy

A while back I was charged to do an in-service for the paraprofessionals at my school. I talked to them about using prompts and cues in speech therapy and in the classroom. Fortunately, the paras did great and were immediately able to start implementing some of the strategies we discussed!

All that to say, I hope that this blog post can do the same for you and be something you can refer back to over again. Let’s dive deep into how to use prompts and cues in our speech therapy sessions.

What is prompting anyway?

Prompting and cueing are strategies that help the student but still increases learning.  A lot of educators will just do this naturally.  We ask questions and try to help students come up with the answer or learn a task in any way we know how. But it helps to define what we are doing and be more purposeful with our interactions. 

So what’s the difference between prompting and cuing? From my research prompting is said to be a little more invasive and leads the student to the correct answer more directly.  Cuing is more like a hint or clue that typically doesn’t give them the answer directly.  So prompting is a little more direct and cuing is said to be more indirect.  Today, I’m just going to use the term “prompting” as the broader term to refer any type of assistance with getting the right answer.

So if we are purposeful in the way we help students, prompting when necessary and fading the prompts as soon as we can, it can really help.  That’s why I wanted to teach the paras at my school about the different ways to prompt as well as the importance of fading it.

Why should we use prompts at all?

Vygotsky said, “What a child can do today with assistance, she’ll be able to do by herself tomorrow.”

We use prompts ourselves whether we realize it or not.  When we’re in Target, we look up at the aisle signs to help point us to what we’re looking for.  If we still can’t find the item, we ask someone who works there.  We may even need the worker to point the item out to us, if we need further assistance.  The next time we go into Target, we probably won’t need any prompts to find the item.  We’d go straight there and find it independently.

Prompts are really beneficial for our kiddos when learning a new skill.  However, if you want the student to become fully independent in that skill, you have to be able to decrease the prompts.  Fading prompts are almost as important as giving the prompts.  Things you can do to prevent dependency is to reward or reinforce with the prompts at first.  Then as they progress, only reward when they respond correctly without the prompts.  This could help the student learn the skills more quickly as well as deter them from depending on those prompts.

What are the different types of prompts?

OK, so let me preface this by saying that this is a huge topic and there are a lot of ways to support our kiddos.  I use the Prompting Hierarchy from The Autism Helper with my staff.  Though there are lots out there, especially related to ABA, this one seemed to lend itself best to a variety of disorders, not just autism.

Here are the different types of prompts, starting from the least invasive (or most independent level):

1. Visual prompts – support in the form of pictures or text, photos, or even videos 

This is a great way to give support in a way that’s natural or easy to fade. Examples can be anything from a sign on the door to a visual schedule.  In speech, I use this one like nobody’s business.  Visuals for everything. 

Sentence strips for expanding utterances and using correct grammar, pictures for WH questions, making inferences, pretty much any language skill.  It’s my go-to way that I level the support I give.  And it’s super easy to fade because you can just take away the visual.

2. Verbal prompt – spoken instructions or questions that provide the student with direction on completing the task

This one can look a lot of different ways and it’s probably the most commonly used.  I feel like there is even a mini hierarchy within verbal prompting. 

There’s a direct verbal prompt – which is when you plainly give them the correct response or answer. (What is this? -book) Sometimes I use this one when I’m trying to teach WH questions and the student is very echolalic. 

There’s also indirect prompts – which is just giving more of a subtle hint but not the exact answer.  This can look more like asking questions, using CLOZE (or fill in the blank), giving choices, and so on.  So for example, if we’re working on sequencing I could ask, “What did the boy do next?” Or if we’re looking at a picture and I want them to label, I could say “She’s putting on her ___.” And they would say shoes.  There are really lots of different ways that we verbally prompt students, and the possibilities for this one are as endless as language is.

3. Gesture prompt – when you gesture, point, nod or move to indicate the correct response as you’re giving the instruction.

You can even look at the student expectantly or look in the direction of the correct answer as a gesture.  Of course as SLPs, we will look at students expectantly a lot, especially with our minimally verbal friends, to give them a hint that we are waiting for them to respond. 

Another way I gesture is by pointing, especially when I’m teaching WH questions.  For example, if there’s a picture of a mouse driving a car, I might ask “who’s driving the car?” while pointing to the mouse over and over again.  Or gesturing can even be as simple as if it’s a student’s turn to participate, you might make eye contact and nod in his direction for them to take their turn.

4. Modeling – showing the student what they are supposed to do before they do it.

This is one that we use a TON as SLPs, right?  It’s when we just show them what to do.  So, if you tell a student to touch their nose, you would touch your nose.  Or maybe you are teaching the student a new skill, like a specific sequencing task.  They watch you do it first, then they would try it. 

In speech, we do this ALL THE TIME with articulation, right?  We model the correct productions of the sound errors.  We even pull out a mirror so that they can copy what our mouths are doing.  We use modeling and imitation as a strategy for expanding language utterances as well.

5. Partial physical prompt – going in and physically guiding the student through the response with a partial physical gesture, like a tap or a nudge.

In this one you are touching the child, but you’re giving them minimal physical guidance.  So if you want the student to touch a certain object, you might move their elbow in the direction of that object.  You aren’t completely hand over hand helping them.  It’s more subtle. 

I use this the most when teaching simple signs.  If I’m prompting the child to sign “more” and I’ve already modeled or I know the child knows the sign, I might tap under their hands to help them initiate the sign.

6. Full physical prompt – going in and physically guiding the student through the response with a full physical gesture.

This is the one where you are hand-over-hand helping the student.  It might be doing the hand motions to a song, getting the student to sign, or helping the student do an action.  You tell the student to clap his hands, and then you take his hands and make them clap. 

This prompt is the most invasive.  So you want to fade this one as soon as you can, because you don’t want them to be dependent on that.  They are not mastering the skill at all if you are completing the task for them.

How do we know which type of prompt to use?

There are a couple of different ways you can approach this when you’re teaching a student a new skill.  A lot of it will depend on the student as well as the skill you are trying to teach.  You and your team might have to make some judgment calls and use your knowledge of the student.  But I’ll give a few general rules of thumb that you can use.

1. Go from least invasive to most invasive

The first approach would be to use the least intrusive prompt first, which according to our hierarchy would be the visuals, and go down the hierarchy adding more prompts only if needed. 

So, if you go back to our Target example from earlier.  I couldn’t find my item by using the store signs.  So I asked a store clerk to help me, and he gave me directions to find it (verbal prompt).  If I still can’t find it, he could walk me over and point to the item on the shelf (gesture).  Hopefully, I don’t need him to model taking the item from the shelf, but I might need him to physically help me if it’s out of reach or something (ha). 

This is a good approach to use if you are trying to assess how much of the skill the child can do independently.  Another benefit to this one is that the student gets repeated time to respond to the requests and more practice time with the skill, since you are asking the same thing of them over and over.

2. Go from most invasive to least invasive

The second approach would be to do the opposite.  You start with the most invasive and work your way up to the least invasive.  Depending on the skill, you might start with the full physical prompt, then continually fade the prompts as they learn the skill.   

So, if you were teaching a student to sign “more,” you might hand over hand the sign when you are first teaching it.  Then you may tap their hands to remind them to sign.  Soon you might just model the sign when you expect them to use it and they will imitate you.  After that, maybe you just need to point to their hands or look at them expectantly.  Then you might say “ need more?” or “what do you want?” and they will make the sign on their own.   This approach is good to use when a student is first learning something new. 

You just want to make sure you are fading those prompts when you can.  Another benefit to this approach is – it is said that it results in fewer errors and quicker skill acquisition…probably as long as you are fading the prompts quickly. 

3. Delay prompting by decreasing the amount of time before you offer assistance

Basically, you want to wait a bit before going to the next level of prompting.  You might give a verbal prompt then wait 3 seconds before giving the gesture prompt.  Then you might wait 5 seconds between prompts.

4. Gradually decrease the intensity of the type of prompt you are giving

Maybe you are giving the partial physical prompt. You want to fade from the wrist – to the elbow – to the shoulder – then maybe stand behind – then back away entirely.  Or in the case of verbal prompts – you could start by giving direct prompt, then on the next target try cloze or indirect prompts.

5. Know how to reinforce appropriately to prevent prompt dependence

Like I mentioned before, you want to praise the child or give rewards that will help the student become more independent.  So if they are first learning then, sure, reward them for completing the task prompted.  But after you have backed away from that type of prompt, only reward the student (star chart or whatever) for the level of prompting that they are on currently.  That will motivate them to become more independent and try harder.  We don’t want them to depend on that assistance, ya know.

6. Evaluate the effectiveness of the prompts you are using

You want to use your observations and any data to make sure that the prompts being used are effective for that student.  It will also help you determine when you can fade the prompts.  Remember that each child and each new skill is different. 

Having specific data can help you make those important decisions.  You don’t want to only rely on your previous experiences.  It might be helpful to do trial runs with the levels of prompting and create a plan of action with your team.  Take note in your data or tally sheets on what prompts you used and how invasive they were.

A few helpful resources

For more information about scaffolding, you can check out this blog post I wrote a while back.

I’ve got several resources in my TPT store that are already scaffolded based on visual prompting – my most popular ones are for making inferences, sequencing, and overall baseline data for language.

Grab a few freebies from my resource library! I’ve got a data sheet that includes a section for prompting. Plus, you can grab the prompting hierarchy visuals from this blog post!

I hope this helped! What questions do you have for me?