Prompts and Cues
Prompts and Cues: We use these words all the time and probably correspondently, but it is crucial to understand the difference, and yes, there is a difference.
Prompt: "Instructions, gestures, demonstrations, touches, or other things that we arrange or do to increase the likelihood that children will make correct responses." - Lynn McClannahan and Patricia Krantz.
Prompts are designed to lead the student to the correct answer.
Cue: Many people use these words correspondently, but it's not a good idea to write goals or reports.
A cue is a hint and does not lead the student to the correct answer.
"Pick up the ball and put it under the basket."
"Where should the ball go?"
Similar, but different! Think of them like siblings: they are in the same family, but two different substances.
15-30 seconds with expectant/encouraging facial expression
Indirect (ore less direct) Verbal
"Maybe you have something to say."
Gesture and Direct Verbal
Point to the device, or "your talker might help me understand."
Show 2-3 options that may meet the need (imitation is not required).
How and when to use prompts and cues?
Don't use prompts and cues until there has been a significant period of aided language input (modeling).
How long is a considerable period? Hard to say precisely, but there needs to be an extended period of modeling without expectation of use by the learner.
When we use prompts and cues, we do it in response to initiation from the AAC learner. By this, I mean they have done something that makes me think they have something to say. Maybe they vocalized, gestured, or moved their body.
If they have communicated clearly through these methods, we don't prompt! We don't want to make it work by making them repeat it! Instead, we use their system to reflect on what they have expressed.
Prompts can teach a new skill like washing your hands, eating with a fork, doing laundry, and more elementary abilities. These are supports joined to help the person learn, but the supports don't relate to the skill. Here are some examples of prompt types:
Gesture - simple gestures like pointing to the light switch or tapping it
Model - showing how to complete the task for the learner to imitate (e.g. you turn the light on and then back off for the learner to imitate)
Physical - guiding the learner to do the task through touch (e.g. hand-over-hand to flip on the light switch)
Visual - picture or written instructions (e.g. a picture of a person flipping the light switch)
Verbal - saying the instructions (e.g. "turn on the light")
These prompts are used initially to teach a skill and then disappeared. This way, the learners can do the task by themselves without prompts.
Cues are the end goal when fading prompts, so when the learner naturally sees the cue, they will complete the skill they've already learned. Think about things you do in everyday life. Cues will also modify depending on the person and situation.
Commenting is for everyone! Even if they are beginning communicators, commenting is really necessary. Let's suppose you are teaching commenting to a learner who doesn't yet have this communication function. In this case, there has to be 'buy-in' or interest through another communication function that is already known. For a learner who can ask for things they want or say 'no' to things they don't like, you may need to form routines to ask for something and comment.
Strategies you can use to support commenting
Improve how frequently your AAC user gets to see other people comment. Pick engaging activities and focus on demonstrating commenting while you model.
• Verbal Referencing:
Build on the non-symbolic expression of preferences (gestures, facial expressions, vocalizations, body language). Describe the communication behaviors you see and model comments that might match. For example, "You made a funny face when you tasted that. Maybe it's yuck or gross" or "You're jumping up and down. So exciting!"
• Co-Authored or Scaffolded Writing:
Increase your AAC user's opportunities to comment through a shared writing task. It might include writing a letter, journaling about an event, writing movie reviews, or writing a poem. These activities are great because they give a shared context to comment for a real purpose. Invite the AAC user to contribute. Accept any communication modality as contributing. The goal is for your AAC user to observe and experience commenting and not demonstrate the skill independently.
More ways to teach commenting
Repetition with variety
Do lots of commenting in similar situations but also in different situations with the same materials. Use any unexpected opportunities to relate comments from one situation or one set of materials to other ones.
Aided Language Input (ALI)
Use ALI as much as possible.
Use all Language Modalities
Use commenting in reading, writing, listening, & communicating/talking.
Use Core & Fringe Words
Core words will help the commenting easily go between situations and materials. Add fringe vocabulary commenting when appropriate.
Teaching Yes & No
Yes & No questions are a common target for speech therapy sessions because once a child can answer Yes & No questions, you will be able to get more information to find out what they are trying to communicate to you. AAC users need a reliable way to indicate yes/no before they can answer questions. Children who communicate through speech learn yes/no words or movements. Sometimes their use matches their intent, sometimes not. Adults have to give them feedback, and they adjust over time. We need to provide the same time and feedback to individuals with complex communication needs.
How to approach it?
• Explicit motor practice for head nods. Practice the movements together.
• Lots of verbal referencing when we notice the learner is moving their head.
• Lots of "failure-free" opportunities to practice head nods.
• Lots of modeling of head nods with verbal referencing: "I'm moving my head from side to side, I'm saying no".
Show your child something you know he likes, such as a favorite snack. Then, ask your child, "Do you want (something)?". If your child shows you that he wants it (by reaching for it or repeating the word), model "yes" for your child to imitate. You can do this by having him say the word yes or by nodding his head up and down. As your child gets better at this, try just nodding your head to remind him instead of saying the word "yes" for him to imitate each time.
When your child is consistently answering yes, try to offer something that you know she or he would say "no". For example, suppose you're playing with bubbles, and your child is consistently answering "yes". In that case, you can switch it up and offer something uninteresting, like a small scrap of paper: "Do you want paper?" Model "no" just like as described above with yes. Say "No, no paper" and switch back to the one you know she likes: "Do you want bubbles?" Once you've practiced helping her say "no", try to get her to answer without your help. If she still says "yes", say "yes, yes paper" and hand her the uninteresting object.
The term 'rhythmical intention' consists of two elements: rhythm and intention. Combining speech and activity into a single circle of feedback means that the goal's accomplishment is conscious and verbally directed. The verbal direction determines the action.
According to this method which integrates the child's motor, language, and intellectual skills, the child uses speech or internal language to express intent. Speech is conducted by movements, which are executed rhythmically through the use of dynamic speech.
Rhythmical Intention is a unique way of facilitation in Conductive Education that engages the student's mental readiness to complete coordinated voluntary movements. Physical tasks are verbalized rhythmically to prepare the student mentally to approach the action and break complex movements into a motor plan."
-I move my head down, down down
-I move my head up, up up
-I nod my head and I say yes
-I shake my head and I say no
-I move my head to the middle, middle middle
-I nod my head and I say yes
-I move my head to the other side, side side
This technique comes from Conductive Education. It's excellent for teaching movements for communication. Practice the exercises together. In groups, we use a call and repeat format. The speed is approximately 60 beats per minute to encourage a good pace for intentional movement. Our intonation goes down at the end of a movement.
When we practice, it's not about compliance, but about developing the internal language and ability to intend the action. Repeated practice over time is more important than performing the skill in any one practice opportunity.
Reasons to teach head nods
Why should you teach them?
• Everyone recognizes them, even unfamiliar communication partners. Head nods are universal.
• Individuals who can use head nods are often judged as being more "able". Yes, it's unfair.
• Head nods are not partner dependent. The learner doesn't need to rely on anyone to set up or offer assistance because they can do it themselves.
Steps to teach head nods
• Model an enthusiastic head nod and shake for yes and no frequently throughout the day. Have others model it as well.
• Directly teach the child what the head nod and shake mean using multi-sensory teaching methods.
• Remember that there are different levels of yes and no responses beginning with yes and no to accept and reject. Start with accepting and refuse before moving on to more complex yes and no questions.
• Provide a target for the child to aim their head movement by placing your fingers at their cheek and chin. The child touching your fingers with their chin and cheek should be accepted and rewarded as a yes or no response.
• Some children may need more feedback when they touch the target. For those children, you can use a voice output communication aid such as a talking switch. You can add picture symbols to the switch if this will help increase understanding for the child.
• In general, you should not be touching the child's face except a gentle and slight tap as a touch cue if the child is NOT tactile defensive, and the child needs such a cue to increase understanding or motor planning.
• Continue to provide informative feedback as you shape the yes and no response and continue with enthusiastic modeling of yes and no throughout this process.