Parent Support University: Week 15

July 8, 2020

AnswersNow Chief Science Officer, Adam Dreyfus, speaks about Prompting as a part of the Parent Support University series.

Transcript:

Speaker 1 (00:01):

Hello AnswersNow, friends and family. I am Adam Dreyfus. I'm the chief science officer of AnswersNow, and also one of the co-founders, what is AnswersNow? AnswersNow is a mobile platform that connects you directly to your own clinician board certified behavior analyst. A hundred percent of our clinicians are board certified behavior behavior analyst, there's master's level. So you're talking, you'll be talking to communicating with FaceTiming someone with an enormous amount of experience that can help you and your family helped navigate this crazy thing that we call autism. So what we're doing now with this series of videos during the pandemic is we're trying to demystify a little of the terms. So ABA, we talked about that earlier on applied behavior analysis is the large umbrella of all of the interventions ideas that a clinician will bring to the table.

Speaker 1 (00:59):

And there's roughly 25, 26, what they call evidence based practices. And this is where the jargon stuff comes in. This is where you see these kinds of terms in your IEP, in your the assessments that you get. And that can just make it confusing to understand exactly how to make decisions that are in your child's best interest because you need a translator to get through a lot of it. So we've gone through, I think about 17 of them. So far, this has been a weekly thing today. We're going to be talking about prompting. Prompting sounds very simple. And when you see somebody doing like, Oh, I, I can totally understand how to do that. But it is also one of the most misused intervention strategies and results in one of the most challenging behaviors for us to tackle whether we're a clinician or a parent, which has prompted dependency children and adults who become dependent upon prompts to do the things that they want to do in their lives. So we'll talk about that in a little bit.

Speaker 2 (02:00):

How did we decide

Speaker 1 (02:02):

Which topics to cover? We really didn't. About 10 years ago, a wonderful group came together called the national professional development center. And they created a sort of a clearing house of all of the things that we know work. That's the best way to describe it. They call them evidence based practices but things that we know work cause if you're a parent or a grandparent or anybody, a teacher associated with children diagnosed with autism, you know, that almost every year, there's some new book and new set of videos and new ideas about what's causes autism new ideas. And, and especially as technology kind of come into this space, you've got autism robots and autism wearables, and all kinds of, and it's just overwhelming. So what they did is like, what do we just know works? And so what we're doing is we're just working through their list.

Speaker 1 (02:52):

You can go check them out. The National Professional Development center they have created like a series of trainings called the afirm one F, A F I R M modules, and they're free and they take about two and a half hours. So if you were going to go through all of them, obviously be a little bit of a heavy lift. But I would highly recommend going through them with somebody who's got some clinical expertise. Cause even though like, to my estimation, they're one of the best places that a parent can go and learn more about the various tools to implement, to help them out with it, your kids it's still pretty complicated. And they do a great job, but that's what that's really why AnswersNow is here. It's to help you navigate this give you tips and tricks.

Speaker 1 (03:39):

We have several offerings now at AnswersNow go to getanswersnow.com and check out more about it. We've got direct service. We're taking insurance now in the state of Virginia. So we'll be doing direct service providing direct services through the telehealth model. We also have what we kind of call the one-off videos where you can sign up and like, just talk to a clinician for half an hour. Maybe you get an IEP coming up. Maybe there's a specific issue toileting, putting on your shoes, playing with your siblings. And you just want to kind of brainstorm it for a little bit. So you're gonna sign up and talk to a clinician for a little bit, but our main product is definitely the subscription service and the insurance based services where you have an ongoing relationship with your very own clinician.

Speaker 1 (04:26):

So we're going to talk a little bit more today about prompting. What exactly is that now prompting is one of those words where most people have an idea they're like, well, I know what a prompt is, right? Like it's a, you know, your, your watch reminds you that you've got a meeting coming up. That's exactly right. You look at your calendar to see what's coming up next. That's exactly right. Almost your whole world is kind of designed through signs. And when you go into a store to prompt you, right. Like to let you know what's going on. So in, in this context, we mean, it's generally used to mean that the child is struggling to learn what we call independently. Right. Cause you're just, you're just teaching him. You're like, Hey, what's the capital of California. And they say, San Francisco, you say no Sacramento.

Speaker 1 (05:14):

And then they, you do that a couple of times. And now they know that Sacramento is the capital of California. It's the technical sort of term for it is called general case teaching. I'm also known as kind of trial and error, right? Like you're introduced to material. You begin working with it. You either get correct answers and Hey, that's great. You get a 75 on that. Or you get a bunch of incorrect answers. And you learn through your incorrect answers. That is how most learning takes place. We call that the independent condition, right, where there's no prompting, you're just presenting a question or a challenge or something and the kids reacting and they're either getting it right, getting it wrong. So when prompting comes in is where the child generally struggles with that.

Speaker 1 (06:02):

Like, they're just, they're not learning at the rate that you would expect them to. And so you implement a prompt now we all do it all the time. I'm a dad, I've got two kids. I prompt them constantly, right? Like there's verbal prompts put on your shoes. You can make a little schedule for them. Like you see that with toothbrushing and kind of, some parents are very clever like that. There's modeling, we do that a lot where I show you how to do it, right? Like this is how you pour a cup of water and then you put it down. And that's exactly how that works. There's physical prompting, which is usually reserved for the, the kids that are most impacted that really struggled to learn things. So a physical prompt is exactly what it sounds like, like a partial physical might mean.

Speaker 1 (06:49):

I sorta touch your elbow where I give you a little sort of push in the right direction. And then full physical is the most invasive, right? Like that's where you're kinda like if I say point at the phone and you pointed the duck, I pick up your hand and I put it on the phone and I'd say point at the phone. You, most people try to avoid full on hand, over hand prompting. So if you think about it, there's, you can either go like the most invasive to the least invasive or intrusive, whatever word you want. So there's kind of different schools of thought. Do you start with the least intrusive level of prompting and sort of work your way up to kind of get to like, Oh, that didn't work. That didn't work. That didn't work, that didn't work.

Speaker 1 (07:35):

You don't have to go in the exact sequence. This is where a good clinician or a parent who's been doing this for a while. You know, you want to find out what works best for your kid. Some kids do great with visual prompts. Important note here, there should be a little stop sign that comes up. You don't want to prompt, right? Like you want to have the child learn under the independent condition as much as possible. What happens if you prompt too much prompt dependency and really you see in the, in the autism community, lots and lots of examples of really tough prompt dependency, like kids who won't get up to go out to play, unless somebody prompts them. So here it is, it it's something they really like to do. But they become so dependent on the visual, the verbal, the maybe the schedule prompt.

Speaker 1 (08:27):

And if it's not there and it doesn't tell them, it's like, I'm sitting at a stoplight and the light never goes green, right. And you're just waiting and waiting and waiting and waiting until you get some kind of signal that you get to go that is what you want to avoid. And it happens a lot when I run as many of, you know, a very large school for children diagnosed with autism. And that's one of the main problems that we address is prompt dependencies, kids who and some adults, right? Like I work with kids or up to 22 years old. Some of them are adults and they've spent so much time in therapy and around folks prompting them that they're, they're a hundred percent dependent or not a hundred percent pretty close to that. And at first the parents are pretty happy that they can see, you know, more progress with their kids.

Speaker 1 (09:19):

Their kids look like they're engaging more. But definitely as the kids age up and the prompt dependency is not addressed. It can become really frustrating for parents because they see the kids unable to do things independently. So, you know, like for you, probably your alarm goes off in the morning and that's the signal to wake up and it sets in motion, all of your behaviors up through the whole day, and you've, you're independent, right? Like you've got your own kind of prompts built in, but somebody doesn't have to be there and tell you, like put on your shoes and then help you put on your shoes and do all of those things. And so it's crucial to be, if you're prompting, you want to have a strategy and a plan for fading the prompting, I think of it like a scaffolding on a house, right?

Speaker 1 (10:06):

The scaffolding goes up on the house only for as long as it's needed. And as soon as you don't need it, you take it away. And what happens is because prompting really helps you know, like get the kids to do what you want them to do, whether that's moving around from one place to another, or doing certain activities, you use it, right. Like, it's your go to? Cause it, it works right. And you don't have a strategy for like, how do I get, how do I stop doing this? How do I stop having to prompt everything? So these are great, great, great questions to ask your clinician. We've got an incredible set of clinicians at AnswersNow you go to getanswersnow.com. You can look at some of the clinicians, see what they're all about.

Speaker 1 (10:48):

You can sign up. We do text-based support. We do video support. We do direct instruction support. But it's especially if you've got a kid where you're like, Ooh, this month, it's pretty prompt dependent. I hear what he's kind of saying. You're going to want to get some assistance in some eyes on on that to help you out. You, one of the lesser known ways to go about prompting, but that can be very powerful. And if you kind of internalize it and get good at it they don't talk about it for hours, but it is you delay the prompt a little bit. So you might ask like, what time is it? And instead of giving them the answer right away, you know, Oh, it's eight thirty. You delay your correction for a couple of seconds.

Speaker 1 (11:39):

This is important because this is the best way to fade prompts, right? Like, instead of just giving them the prompt you mentally like, do a one count, we call it the one second time delay, two second time delay, three second time delay. And you begin to increase that space between what you're asking them originally. And when the prompt occurs. So you give them more opportunities to respond somehow to either give it could be the wrong answer, but then you, you know, you correct them. But hopefully they give you the right answer. There's a word that comes up a fair amount clinically, and isn't used enough. I think in helping out parents is latency. That just means how long does it take before something happens. And a lot of kids on the spectrum, it takes them a couple of seconds. It takes them a little bit longer than typically developing folks to process something and answer a question.

Speaker 1 (12:31):

I will say, like, here's a perfect example of it. I came into a school working with they introduced me to a child in one of the classrooms and they said, he's got great listening skills. He totally understands what we're saying. But he doesn't talk at all. We think he might be mute. We're not sure. But he, you know, if you tell him, like go to the office and get the yellow folder off of the green desk on the second office in the left, he'll go do it. And interestingly he knows sign language, which is not super surprising. Kids are very visual. Gestural communication is sometimes easier for them to adopt than spoken communication. So you had sign language, but he can listen. He could hear he wasn't deaf. He perfectly understood. And so I said, well, show me, show me how you work with him.

Speaker 1 (13:19):

Are you trying to get him to talk or is it just, Oh yeah, yeah. We work on it all the time. So they sat down with the kid and they said, alright say phone, what is this? What is this? This is a phone. It's a phone. I talk on the phone. It's a phone. P H O N E it's a. And I said, Oh, okay. And the kid sitting there and he's not responding. I said, okay well let's let me try something. So I sat down across from him and I said what is this seven seconds? One time? And very, very quietly said, perfect pronunciation, just very quiet. Whoa. The teachers went crazy. Oh, you taught them how to talk. You taught them how to talk. I said, no, no, I didn't teach him how to talk.

Speaker 1 (14:11):

He he doesn't have a reason to talk. He was one of the main issues because he can communicate through sign language, his, he can speak through sign language and he can understand what you're saying. So it was kind of a perfect storm there of so but once they knew that he had words that he could say outside, he just had, he had a latency at a seven second latency. It took him about seven seconds to respond to something. Now that kid, once we kinda got his program up and running away, he went and he ended up in a general education classroom within, I want to say about 18 months. And the biggest shift was the staff and the parents knew he could talk. And so the expectations radically changed and what they essentially just had to do is not pay attention to him signing, which, Oh my God, you hear that. And why would you not

Speaker 3 (15:00):

Pay attention of signing? Oh, you never do that again. Yeah.

Speaker 1 (15:03):

Kind of talk, right. He wasn't deaf. Remember this was a sort of just a fairly unique situation, but a good example. So there's lots of prompting, there's literally thousands of videos out there to show you how to do the different kinds of prompting. I'm not going to go into all of that. It's a, you do that within the context of kind of larger goals and stuff, and we're happy to do that working with you, but definitely  jump over to getanswersnow.com or go to your Apple store or your Google play store and download the app and you can get started right away. You will be chatting with a clinician in less than 24 hours. And we are definitely here for you in this crazy pandemic. We were going to provide services through this whole thing. You are not alone. So check us out, getanswersnow.com. Appreciate you listening to this and feel free to contact us. I will talk to you next week.


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