Utilizing this least-to-most prompting hierarchy (see photo below) helps give children the scaffolded support they need to become more independent and autonomous communicators.  Often times I find communication partners jump halfway down this hierarchy by giving directives (e.g. "Say 'train' on your talker") or asking specific questions (e.g."What do you want to play?"). There's magic that happens when you tempt a child with a fun activity or desired item and you simply pause to see what they come up with completely on their own. Remember: if we are constantly prompting our communicators, then we are teaching them to only communicate when someone tells them to. To check out our AAC Vocabulary Bundle (prompt hierarchy included), click here.

STEP 1: Choose a word or phrase and provide direct instruction 

Before we can expect children to independently communicate with us, we need to provide lots of opportunities where children see words being used on their device. EXAMPLE: If a child is highly motivated to be pushed on the swing we can set up the activity and provide numerous opportunities where the child sees us model the words "STOP" and  "GO" on their device. Practice lots of different exciting activities where you can target "STOP" and "GO" and include lots of modeling on the child's device. Once you have provided lots of different experiences where you use the target words, you're ready to utilize a least-to-most prompting hierarchy to elicit more independent communication of those words. 

STEP 2: Find something a child is jazzed about 

Children who are really motivated will surprise you with how creative they can get with their communication. Without a high level of engagement, we are forced to rely heavily on modeling and explicit teaching. Having a child answer questions like "What color is it?" likely won't get us very far when we're teaching children to become independent communicators. Often times, motivation is inversely correlated with how much support a child requires. EXAMPLE: If a child has a low level of motivation, they require more support from communication partners. Conversely, if a child is highly motivated, they are typically more inclined to communicate with more independence.

STEP 3: Tempt + Pause 

When we tempt children with an activity or highly desired item, children are often eager and determined to communicate with us. The goal here is to have a child spontaneously initiate communication using their device.  The level of accuracy (i.e. which word they selected) is less important in the initial stages of learning how to use a new word; we want to teach children that all of their words have power. Not getting any response? Move one level down on the hierarchy.

STEP 4: Use Body Language 

After waiting 10-15 seconds (yes, that long!) you can try to tempt again by presenting an item or activity. You then use some type of gestural cue  (e.g. shrugging your shoulders or giving a quizzical facial expression) to indicate to a child that a response is expected. Still no response? Keep movin' on down! 

STEP 5: Open-Ended Question 

If there's still no response, tempt the child again with the super fun and exciting activity or item and pair it with a vague question like "now what?" or "what should we do?". You can even make a general comment like "Hmm".  Still nothing? Move (with caution) to the yellow zone of the hierarchy. 

STEP 6: Ask for a Response 

This area of the hierarchy is where many communication partners accidentally spend most of their time. They jump directly to giving directives (e.g. "Tell me what you want") or asking a specific question (e.g "What do you want?"). These types of demands for communication should only be used as an absolute last resort. Still not getting a response? We can provide some visual supports in the next level of the hierarchy. 

STEP 7: Point to Device or Symbol 

You can start by simply looking at the device or gesturing to the device to encourage a child to communicate with you. If that's not working, you can try pointing to a general area of the child's device or even to a specific symbol to get a child to communicate. This level of prompting should be used with extreme caution. The more children are spoon-fed what to say, the more likely they will be to rely too heavily on these types of supports. We want children formulating novel thoughts and communicating them with us, not going on auto-pilot while we point to the words we think they might want to say.  Are you STILL not getting any communication?! You might want to reassess the child's motivation. If you feel confident that the child is highly motivated you can jump down to the next level of the hierarchy. 

STEP 8: Model 

We know the importance of modeling a variety of words for children so they are able to learn how to use them on their own. This portion of the hierarchy is in the red zone because there is a difference between modeling generally to expose children to language vs. modeling a specific word or target with the expectation that a child says the word after us. If a child continuously requires direct models, it's possible they haven't received enough modeling exposure to that specific word in a way that is motivating and solidifies meaning for them. 

STEP 9: Physical Touch 

We're officially in the red zone, and this zone is red for a reason. We don't have the capacity to force a verbal child to talk, so why would it be acceptable to take a child's hand and force them to activate words on their device? I like to use the phrase "Inspire, don't Require" when thinking about working with children who have complex communication needs. As the adults who are responsible for teaching children how to communicate, it's our responsibility to create language opportunities that are so exciting and fun that children can't wait to communicate with us.  Spoiler Alert: physical prompting rarely translates into communication that is independent. Be patient, and try finding something that is so motivating to the child that they are inspired to communicate!  

Need a more in-depth training on least-to-most prompting? One of my favorite AAC experts Rachael Langley has a presentation on this topic that's completely free! You can also find amazing AAC resources on her website. 

Citation

Finke, E. H., Davis, J. M., Benedict, M., Goga, L., Kelly, J., Palumbo, L., . . . Waters, S. (2017). Effects of a Least-to-Most Prompting Procedure on Multisymbol Message Production in Children With Autism Spectrum Disorder Who Use Augmentative and Alternative Communication. American Journal of Speech-Language Pathology, 26(1), 81-98. doi:10.1044/2016_ajslp-14-0187