Least-to-most prompting

Also called Prompt hierarchy, Least-to-most prompts, Graduated prompting, System of least prompts

Give the smallest help that works, and step up only if it doesn't. The aim is a person who doesn't need you, not one who waits for you.

What it is

Least-to-most prompting is a ladder of help. You start at the bottom, with the least intrusive prompt, and only climb a rung if the person doesn't respond. Wait first. Then an expectant look. Then a spoken hint. Then a gesture towards the board. Then pointing at the symbol. Then, only if agreed and only if nothing else works, physical guidance.

The order matters because prompts are habit-forming. A person who is always shown the answer at step one learns to wait to be shown. That's called prompt dependence, and it is the commonest way well-meant help makes someone less independent.

Who it can help

Learners at the stage where they know what a symbol does but don't yet reach for it on their own: children building their first core vocabulary, adults relearning a system after brain injury, anyone with a new device. It suits classrooms and care settings where several adults support the same person, because the ladder can be written down and everyone can use the same one.

It is a teaching tool, not a conversation style. Everyday talk should mostly be modelling without expectation; the ladder is for the moments when you're deliberately teaching a specific skill.

How it works

A typical hierarchy, from least to most:

One, a pause of at least ten seconds with the system in reach (wait time). Two, an expectant look or open body language. Three, an indirect verbal cue: "I wonder what you'd like." Four, a direct verbal cue: "Tell me on your board." Five, a gesture towards the board or the right page. Six, pointing to or tapping the target symbol yourself, then waiting again. Seven, physical guidance, and most therapists now prefer hand-under-hand to hand-over-hand for this.

Whatever rung gets the response, you stop there, respond to what the person said as if it were a real message (because it is), and next time you start from the bottom again. The record you keep is which rung worked; over weeks the number should fall.

Getting started

Write the ladder on one sheet of paper and stick it where the support happens. Number the rungs. Agree that nobody skips to rung six because the bus is coming.

Pick one routine, such as asking for a drink at breakfast, and use the ladder only there for a fortnight. Note the rung each day. That's the whole data collection, and it tells you more than a term of vague impressions.

Whichever prompt gets the symbol, honour it immediately. The drink appears. Otherwise the person learns that the board is a hoop, not a voice.

Where to get help

Ask the speech and language therapist to write the hierarchy for this person, because the right rungs depend on their access method. The ACE Centre covers prompting in its AAC training for schools. Communication Matters has guidance for parents on avoiding prompt dependence. For pupils with an EHCP, the ladder can be written into the communication provision so that every adult uses the same one.