Notes on Prompts, Prompt Fading, and Error Correction

Prompts and Prompt Fading

Objectives:
- Identify different types of prompts.
- Demonstrate ability to use and fade prompts in therapy.
Definition:
- Prompts are signals given to the learner to increase the rate of acquisition for a new behavior.
- They are antecedent stimuli that occur after the discriminative stimulus (SD) or instruction.
- Can occur before or after the learner has produced a response.
Purpose:
- Help learners succeed in acquiring new behaviors.
- Assist the learner to respond correctly, enabling reinforcement.
- Always temporary.
- Correct errors in learner responses.

Categories of Prompts

Stimulus Prompts:
- Involve adding or removing a stimulus to elicit a correct response.
- Often involves changing an aspect of the SD (size, shape, position, color, texture).
- Examples:
  - Making a target larger than other stimuli.
  - Positioning a target closer to the patient.
  - Including a picture with a word.
  - Placing a pink sticker on the washing machine and a yellow sticker on the dryer.
Response Prompts:
- Occur after the SD but before the response.
- Elicit the correct response from the learner.
- Usually involves a behavior from the Registered Behavior Technician (RBT).
- Examples:
  - Pointing to the correct answer.
  - Modeling the correct response.
  - Hand-over-hand brushing teeth.

Types of Response Prompts

Verbal: Altering loudness of voice/sounds or saying the correct response.
Full Physical: Hand-over-hand assistance.
Partial Physical: Guiding with a light touch.
Gestural: Pointing, nodding, gesturing.
Model: Demonstrating the skill.

Types of Stimulus Prompts

Visual: Written words or pictures.
Positional: Situating the correct selection closer to the child.

Transfer Procedures

Transferring control from the prompt to the SD.
When the SD alone does not lead to the desired behavior, a prompt is used.
The goal is for the learner to respond without a prompt (independent responding).
Learner can become prompt dependent if stimulus control does not occur with the SD alone.

Stimulus Control Transfer:

Involves fading prompts.
Occurs when behavior originally evoked by an SD comes under control of another SD.
The end goal is to transfer control to the SD without prompts.
Analogy: Prompts are like training wheels, eventually needing removal for independent performance.

Prompt Hierarchy

Consult supervising Board Certified Behavior Analyst (BCBA) for the specific prompt hierarchy for each patient.

Stimulus Fading

Gradually adjusting the SD back to its normal appearance.
Example: Reducing the size of a stimulus that was initially enlarged.

Prompt Fading

Gradual process of eliminating the response prompt.
Determine the level of intrusiveness of the initial prompt, then gradually reduce it.
Reduction signaled based on learner response; do not move to a less intrusive prompt if the learner has not emitted the desired response with the most intrusive prompt.

Prompting Methods

Most-to-Least Prompting:
- Begins with the most intrusive prompt and ends with the least intrusive prompt.
- Often called "errorless teaching" because it minimizes errors.
- Hierarchy:
  - Full physical prompt (most assistance).
  - Fade to partial physical, then model, gestural, and eventually independence.
- When teaching new skills, prompt immediately after the SD to prevent errors.
- Example:
  - Teaching a learner to tact "ball".
  - RBT says, "What is it?" while holding up the ball and immediately prompts the answer "ball".
  - The learner responds with "ball" and is reinforced.
Least-to-Most Prompting:
- Provides the least intrusive prompt first and gradually increases intrusiveness if there is not a correct response.
- Used when a learner has prerequisite skills but does not demonstrate the behavior.
- Example: Maintenance targets (skills already taught and mastered).
- Prompts are only used if an error is made.
- Progression:
  - Independent response (no prompt).
  - If error, use a gestural prompt.
  - If error continues, move to model, then partial physical, and finally full physical.
- Do not jump from an independent response to a full physical prompt without trying all prompts in between.
- Use the prompt that is successful.

Transfer Trials

Used to transfer a response occurring in one operant to another.
Example: Child imitates clapping hands when the RBT models it, but the goal is for the child to clap hands when given the verbal SD "clap hands".
Transfer trials can be used as a prompt in errorless teaching.
Each operant is under control of its specific SD.
Transferring across operants involves transferring control from one SD to another.
Example: Transfer from motor imitation to listener responding (LR).

Example Transfer Trial

Student can clap hands when therapist models clapping hands.
Goal: Student claps hands when given the LR command "clap your hands".
Procedure:
- Therapist says "Do this" while clapping their own hands.
- Student claps hands (imitation) and is reinforced.
- Therapist says "Clap your hands" (new SD).
- Student either claps hands or receives a prompt to do so, then is reinforced.

Prompt Dependency

Occurs when too many prompts are used or prompts are not faded quickly enough.
Signs to fade prompts: When the desired skill starts to be displayed with less prompting.
If there is no clear sign, trial and error may be needed.
Monitor learner's progress to ensure prompts are being faded at an appropriate rate.

Examples of Prompting for Different Skills

Skill: Greeting Others

Independence: Danielle says "hello" upon seeing a person enter the room.
Visual Prompt: Therapist holds up a script saying "hello", and Danielle reads it.
Verbal Prompt: Therapist says "Say hello", and Danielle says "hello".
Gestural Prompt: Therapist points toward the person entering the room, and Danielle says "hello".
Model Prompt: Therapist says "hello" to a person, and Danielle repeats "hello".
Partial Physical Prompt: Therapist touches Danielle's elbow and gently guides her hand to begin waving.
Full Physical Prompt: Therapist picks up Danielle's hand and waves it.

Skill: Pulling Up Pants

Independence: Chloe pulls up her pants immediately after using the restroom.
Visual Prompt: Therapist puts up a picture schedule reminding Chloe of the steps of using the bathroom, including pulling up pants.
Verbal Prompt: Therapist says, "What comes next?" after Chloe wipes, reminding her to pull up her pants.
Gestural Prompt: Therapist points at the pants, and Chloe pulls them up.
Model Prompt: Not appropriate for this skill.
Partial Physical Prompt: Therapist nudges Chloe's wrist toward the floor in the direction of her pants.
Full Physical Prompt: Therapist places their hands over Chloe's hands to pick up her pants and pull them up.

Error Correction

Objectives:
- Identify and implement different error correction procedures.
Guidelines:
- Use error correction procedures if incorrect responding errors occur (if advised by BCBA).
- Prompting will vary depending on the learner and whether the skill is novel or mastered.
- Can be done with least-to-most or most-to-least prompting.
- Consult with BCBA before implementing error correction procedures.

Types of Error Correction

Prompt and Move On:
- Error occurs after SD is presented.
- Re-present the trial along with an immediate prompt.
- The learner responds with the prompt and receives neutral praise.
- Move on to another target but plan to return to the skill later for practice.
- Example:
  - Therapist says "Touch the ball", but the learner touches the sock (error).
  - Therapist repeats "Touch the ball" while prompting (least-to-most) the client to touch the ball.
  - After the learner touches the ball, they are neutrally reinforced.
Short Error Correction (ECT):
- Error occurs after the SD is presented.
- E = Error: Therapist immediately re-presents the trial along with an immediate prompt.
- C = Correction: The learner responds with the prompt.
- T = Transfer: The therapist then re-presents the trial again, but this time without the prompt; the learner correctly responds without the prompt and reinforcement is delivered for the correct response.
- Example:
  - Therapist says "Touch the ball", but the learner touches the sock.
  - E: Therapist repeats "Touch the ball" while prompting them to touch the ball, which they do.
  - C: Therapist again says "Touch the ball" without a prompt.
  - T: The learner touches the ball and is reinforced.
Long Error Correction (ECTE R):
- E = Error: SD is presented, and an error occurs.
- C = Correction: Therapist represents the trial with an immediate prompt, and the learner responds.
- T = Transfer: Therapist represents the trial without the prompt, and the learner correctly responds and is reinforced.
- E = Expansion: Therapist then places distractor demands that the client will respond to (mastered tasks).
- R = Return: Therapist returns to the original demand without prompting, and the learner responds correctly and is reinforced.
- Example:
  - Therapist says "Touch the ball", but the learner touches the sock.
  - E: Therapist restates "Touch the ball" while prompting them to touch the ball, which they do.
  - C: Therapist then represents the demand again, "Touch the ball" without a prompt.
  - T: The learner does so and is reinforced.
  - E: Therapist then distracts the client with a mastered task, such as "clap your hands".
  - R: Therapist then returns to the original demand, "Touch the ball".
  - The learner touches the ball and receives reinforcement.

Considerations with Error Correction

Present the SD one time before prompting (unless otherwise instructed by BCBA).
If an error occurs or if there is no response within 3-5 seconds (or as specified by BCBA), provide a prompt.
Do not give the learner the opportunity to make another error or engage in scrolling/guessing.
Prompt before an error occurs if possible.
Stay close to the learner when presenting demands to be able to prevent errors.
Fade prompts on subsequent trials.
The number of expansion trials in ECTE R can vary (typically 1-4 distractors).
BCBAs can implement error correction in different ways for different patients, so always check with your BCBA.