Comparison of Prompting Strategies on the Acquisition of Daily Living Skills

Determining the most effective prompting strategies to be used for individuals with significant intellectual disability can assist in the acquisition of skills, reduction of errors, and avoidance of prompt dependency. However, few studies have directly compared the effects of different prompting strategies to determine which are the most effective. In the present study, physical only and physical plus vocal prompting strategies were compared to determine if one led to more efficient acquisition of two folding tasks than the other. An alternating treatments design was used with two individuals with significant intellectual disability, whereby the prompting strategies were counterbalanced across folding a shirt and folding a pair of pants. Results demonstrated that both strategies were equally effective for one participant, whereas the physical only prompting strategy may have been the more effective strategy for the second participant. The results suggest that pairing vocal instructions with a physical prompting strategy neither inhibits nor assists the acquisition of daily living skills for individuals with significant intellectual disability. Determining the most effective prompting strategies to be used for individuals with significant intellectual disability has the potential to increase the efficiency of skill acquisition, reduce the number of errors (Cooper, Heron, & Heward, 2007), and avoid prompt dependency (Oppenheimer, Saunders, & Spradlin, 1993). Prompts can be delivered before or during the performance of a behavior; those that are delivered during the target behavior are called response prompts, which vary in form, and include verbal instructions (i.e., vocal and nonvocal), modeling, and physical guidance (Cooper et al., 2007). In a review of the response prompting literature, Demchak (1990) concluded the following regarding the use of response prompting procedures for the acquisition of skills: (a) using a most-to-least prompting hierarchy results in fewer errors as compared to a least-to-most prompting hierarchy; (b) time delay procedures are more efficient than least-to-most prompting, (c) most comparative research has focused on discrete responses over chained responses, and (d) more research on the comparison of prompting procedures would be beneficial. Although prompting strategies are tools that most practitioners utilize, few studies have directly compared strategies to determine which are the most effective. In one comparison study, McDonnell and Ferguson (1989) evaluated the use of a decreasing prompt hierarchy (i.e., most-to-least prompting) and a time delay procedure to teach four students with moderate disabilities to cash checks and use an automatic teller. In the most-to-least prompting procedure, prompts were faded by systematically reducing the prompt level used at each step of the task analysis. During the time delay procedure, the same prompt was utilized throughout the task analysis, but the delay to the prompt was systematically manipulated. The authors found that both strategies were effective, but that the decreasing prompt hierarchy (i.e., most-toleast prompting) was more efficient (i.e., fewer trials to mastery and less instructional time), and resulted in fewer errors. It should be emphasized that the authors evaluated the use of these prompting procedures with students with moderate disabilities. Therefore, the extent to which the findings can be generalized to students with more significant disabilities may be limited. Correspondence concerning this article should be addressed to Linsey M. Sabielny, DePaul University; College of Education; Department of Counseling and Special Education; 2247 N. Halsted St., Chicago IL, 60614. E-mail: [email protected]. Education and Training in Autism and Developmental Disabilities, 2014, 49(1), 145–152 © Division on Autism and Developmental Disabilities Acquisition of Daily Living Skills / 145 In another comparison study, Day (1987) evaluated the use of a decreasing prompt hierarchy (i.e., most-to-least prompting) and an increasing prompt hierarchy (i.e., least-tomost prompting) to teach six individuals with significant disabilities two tasks of comparable difficulty each. The tasks were chosen from each individual’s treatment plan and varied across participants (e.g., prepositions, sorting, assembly, receptive identification). The mostto-least procedure involved prompting the individual before they responded and fading prompts on subsequent trials. The least-tomost procedure involved prompting the individual after an error, and gradually fading the prompt on subsequent corrections. Results demonstrated that the most-to-least strategy was more effective, produced greater gains, and resulted in fewer errors than the least-tomost strategy. However, several of the participants did not reach or maintain mastery criterion with either strategy. In a similar comparison, Libby, Weiss, Bancroft, and Ahearn (2008) directly compared the use of most-to-least and least-to-most prompting procedures in the acquisition of solitary play skills for five children with significant disabilities. Both procedures involved the same physical prompts: (a) hand-overhand, (b) forearm, (c) upper arm, and (d) light touch. However, the most-to-least procedure began with the most restrictive prompt (i.e., hand-over-hand) and faded out to independence, whereas the least-to-most procedure began with independence and faded in to the most restrictive prompt. A third hierarchy was added in a second study that utilized the most-to-least format, but added a 2-s delay before each prompt. The authors found that participants acquired skills almost as quickly with most-to-least prompting with the delay, but with fewer errors, suggesting that it may be the best default prompting procedure. Whereas solitary play skills are important for many students with significant disabilities, students who are transition-aged could benefit from learning more functional, daily living skills. Though a few articles have compared the use of various prompting strategies for individuals with significant intellectual disability, we were able to identify only one study that directly compared the effectiveness of a physical prompting procedure to a physical prompting procedure paired with vocal instruction. Glendenning, Adams, and Sternberg (1983) evaluated the use of three prompting sequences: (a) vocal cue, gesture, model, and full physical assistance; (b) vocal cue and full physical assistance, vocal cue and light physical assistance, vocal cue and gesture, and vocal cue; and (c) full physical assistance, moderate physical assistance, light physical assistance, and gesture. Twelve students with moderate disabilities were randomly assigned to one of the three prompting sequences and were taught a 48-step stringtying task analysis. The results demonstrated that the vocal prompts paired with physical guidance were superior to the other two strategies, including physical guidance alone. However, the prompting strategies that were evaluated varied in the type of prompt across strategies. In other words, the fading procedures were not equivalent across strategies. Overall, most-to-least prompting has been found to be the most effective strategy when compared to other physical prompting strategies in the acquisition of skills by individuals with varying disabilities. In addition, one comparison article (i.e., Glendenning et al., 1983) found that a physical plus vocal prompting strategy was more effective than a physical only prompting strategy. Though this study used most-to-least prompting for two of the three strategies, it did not keep the fading procedures equivalent across strategies. Therefore, the purpose of the present study was to compare the effectiveness of both a physical prompting strategy and a physical plus vocal prompting strategy, while keeping the fading procedures consistent across strategies. The two prompting strategies were evaluated on the acquisition of daily living skills in individuals with severe to profound intellectual disability. The researchers aimed to identify the most effective strategy that resulted in fewer trials to mastery criterion.