ABA therapy uses a science-based, data-driven approach to help children, adolescents, and adults with autism spectrum disorder to reach the highest possible positive outcomes. ABA therapy is designed to teach new skills using behavior chaining prompts that help the patient understand what they need to do next. There are several steps to this prompting hierarchy. Each is customized by the ABA therapist to the individual’s ASD symptoms and severity.
Many common prompting hierarchies use a “Most-to-Least” or “Least-to-Most” progressing. The overarching goal of these techniques is to support the client in learning the skill so thoroughly that they do not need prompting.
What Is Prompting in ABA Therapy?
Prompting is a very common technique in ABA therapy. It is a critical component of behavior chaining, used in many highly effective treatment plans. This core approach to skill-building involves taking a specific task apart into its baseline pieces.
Prompting can be used to teach a variety of skills from how to properly brush their teeth, to dressing themselves and other personal hygiene tasks. Once the patient becomes familiar with the prompting process it can be used for ever more complex processes and life skills.
A lot of people with ASD struggle to pick up steps in behaviors or skills. When brushing their teeth, they might get all the early steps correct, but forget to put the toothpaste on the toothbrush. Behavior chaining is prompting in ABA therapy to help with this.
How Does An ABA Therapist Use Prompting Hierarchies?
Prompting hierarchies and behavior chaining helps the individual process each step of a new skill while encouraging them to act independently to each step. The ABA therapist might provide a prompt for a step, but the action and decision making is already ingrained in the patient.
Sometimes prompts are increasingly intrusive. Especially if the child needs additional help in the process of learning the skill. Yet there will be some delays between prompts. This allows the child with ASD to respond and figure out the next step on their own.
Most-to-Least prompting uses less instruction, as it typically starts with a lot of interaction between the ABA therapist and the child with ASD. Your child’s therapist might even place their hands on the child’s hands, as they carefully guide them through each step of the process. This ensures that they know what each step of the skill feels like.
In a later session, their ABA therapist will be gradually less intrusive, decreasing their involvement in prompting to let the child demonstrate their ability to complete the task for themselves. The therapist might simply move their hands like the child should move their hands, but they will not guide the child’s hands for them.
Once the child with ASD learns the behavior chain and demonstrates mastery of the skill, the ABA therapist will use less intrusive prompts until the child no longer needs any prompting.
In a lot of these cases, a child with ASD will learn a new skill faster with the MTL prompting hierarchy. This allows the therapist to add a time delay between each prompt which allows the child to study and respond on their own. A growing body of research has found that this technique seems to produce rapid skills acquisition.
However, the prompting hierarchy used by the therapist will be customized to the child’s individual needs as well as their existing skill level. Their ABA therapist might even start early sessions with MTL as part of assessing the child’s needs but can change to different prompting hierarchies for other skills later.
The More-to-Less Prompting Hierarchy
The MTL prompting hierarchy often begins with an ABA therapist guiding the child’s hands as they perform each step of a specific skill. Here again, this type of guiding prompt helps the child process and understand how it feels to perform the task. As the therapist guides each step, they may say the words for the step out loud.
Later in a follow-up session, the therapist might simply say each step out loud, without any form of hand-guiding. This allows for the prompt to remain in place, yet the child with ASD is doing all of the cognitive processing needed to accomplish the skill.
At each session, the therapist will prompt less often until the child demonstrates complete mastery of the skill.
The Less-to-More Prompting Hierarchy
ABA therapists also use the Less-to-More prompting hierarchy to help identify the target skill or behavior that they want the child to acquire. This often calls for outlining the steps necessary to complete the skill.
Once the child with ASD shows comprehension, the ABA therapist will actively identify the target stimulus. This further helps the child to continue to use the behavior outside of the clinical setting rather than associating it with the therapist themselves or the therapeutic environment.
Material or environmental manipulation is one of the best ways to apply the Less-to-More approach. It creates the stimulus that indicates the child must complete the skill, such as completely washing their hands.
This technique often uses task direction to tell the child It’s time to do something. This might be something as simple as holding up a snack at snack time or holding up a cue card with a picture of hands being washed.
Oftentimes a naturally occurring event, like the child getting their hands dirty during another ABA therapy activity, such as painting, can serve as a prompting opportunity to get them to wash their hands.
Conclusion
ABA therapy is seen by many experts as the gold standard for treating individuals with autism spectrum disorder. It uses many approaches to address specific issues that a child might be having. Yet many of these approaches will use some degree of prompting when it comes to teaching new skills.
Starting out with mechanical, and self-care skills helps the child with ASD to understand how to respond when they receive a prompt. As the child demonstrates an increasing level of mastery with one skill, a new skill can be added and they can continue progressing toward greater and greater positive outcomes.
