methods - eliciting communicative behaviors

How should prompts/cues be faded?

Fade by producing less and less of the prompt/cue: Reduce loudness Simply mouth the prompt Exhibit the mouth posture only Make the gesture smaller Point instead of touch Have a single letter/mnemonic instead of the entire written prompt Move from the big red rubber band to a small rubber band to fingers only to a mental image...

Giving Instructions and Definitions

One way we elicit responses is to describe/show what we want the client to do (how the behavior looks, feels, sounds), when to do it and how often to do it. Sometimes beginning clinicians may want to write down their instructions, including the points where demonstrations will occur... This is a little detail of preparation that can make beginners feel better about what they're doing. It sometimes helps to rehearse instructions and/or demonstrations until the delivery is natural, smooth, informal, and conversational

What are prompting/cuing hierarchies?

Prompting/cueing hierarchies are commonly used in intervention for word-finding (naming) disorders in adults. Here is an example of a cueing hierarchy for word finding, with cues arranged from least to most powerful: Confrontation Naming Direction by clinician to have the patient state the function and then try to name Direction by clinician to have the patient demonstrate the function and then try to name Statement of function by clinician Statement and demonstration of function by clinician Sentence completion task provided by clinician Sentence completion plus silent posturing of target word's first sound provided by clinician Sentence completion plus audible vocalization of the target word's first and second sound by clinician Imitation

Fading of prompts & cues

Prompts/cues should be faded - systematic withdrawal - when a few correct responses to prompts/cues are observed, stop prompting/cueing to see if response will be maintained...if not, reinstate prompts/cues.

The clinician should be sure not to...

"talk down to the client"; modify your presentation based on your perception of the client's sophistication

How to Model Effectively

1. Decide whether YOU will model the target response or whether a taped or otherwise mechanically-represented model will be used. It is possible that as clinical instrumentation becomes more sophisticated, mechanical models will be used more often. 2. If a client's own correct response can serve as a model, USE IT!! 3. Model OFTEN during the early stages of intervention - it is needed to establish the targeted skills. 4. Model consistently and continuously until imitated responses are produced reliably...this doesn't necessarily mean perfectly. At first, reinforce approximations of the model - later, reinforce progressively better approximations until the response matches the model. 5. Use an objective criterion such as "5 consecutively correct imitated responses before terminating modeling" - Do not terminate modeling prematurely...this will increase the error rate.

How to Use Successive Approximation

1. Select the final target skill 2. Make an analysis of the skill so you'll know how to simplify it 3. Experiment with the client to find out which (if any) parts of the skill the client can imitate 4. Simplify a skill only to the extent needed, NOT to the extent possible (the more complex the initial level, the faster the treatment progress) 5. Teach progressively more complex responses, but always make sure the client is moving in the direction of the final target skill 6. Use instructions, modeling, prompting/cueing all along the way 7. Stabilize only the final target sound

How is a CUE sometimes defined?

A CUE is sometimes defined as a signal (verbal or nonverbal) that tells the client when to produce the response.

What is one valuable type of modeling?

Recasting! repeating the client's response back to them, but doing it correctly

What should we do if the client forgets the instructions?

Repeat all or part of your instructions whenever the client makes mistakes that suggest that he/she has forgotten the instructions.

What are some common mistakes in giving instructions?

Using unclear/unfamiliar/ambiguous terms Using too many words Using verbal instructions when visuals would be clearer Stating instructions in terms of favors or begging Conflicting or inconsistent instructions

Remember the "art of the half step"

When a client can do Step 1 very well, but can't do Step 2 at all, a good clinician can devise a half-step between the two. This requires thinking on your feet!

creating new skills

When it is not possible to simply model a target response and have the client imitate it...that response is NONEXISTENT in the client's repertoire...it is necessary to create new skills, basically from scratch.

Prompts & Cues

a minimal clue sufficient to evoke a response [Note: Sometimes it's not so minimal!] Is often a partial stimulus (vs. modeling, which is a full-fledged copy of the desired target) Is often an indirect stimulus - only suggest the target instead of displaying it May contain parts of the target or may contain no part of it

Some prompts/cues are....

nonverbal Gesture Touch Physical Guidance Expectant Gaze Object/Picture Written message

How can we tell whether the client understands our instructions?

Ask him/her to repeat, and see if he/she can do as you ask. If not, use repair strategies to clarify your instructions and/or demos.

What are successive approximations?

Successive Approximation can be viewed as an intervention principle - its efficacy is highly researched, and it is pervasive in our intervention. The idea is to shape a new, complex response from simpler responses that DO currently exist in the client's repertoire.