Is the PROMPT Technique a Good Fit for Your Child with Motor Speech Challenges?
If your child struggles with a significant speech disorder, you want to find an approach that will make a noticeable difference in the least amount of time. It is so frustrating for your child when they cannot successfully express themselves verbally! Difficulty producing understandable speech can be due to problems executing specific sounds, as is the case with articulation and phonological disorders. Other speech disorders can impact all sounds and are due to muscle weakness or difficulty coordinating muscle movements. These motor speech disorders can be challenging to remediate using traditional articulation therapy; a reliable method specific to your child’s diagnosis and unique needs should be used. One Method, PROMPT, is effective in treating many children with motor speech disorders, including childhood apraxia of speech (CAS) and dysarthria. This method has also been used with acquired brain injuries and autism.
The acronym, PROMPT, stands for Prompts for Restructuring Oral Muscular Phonetic Targets. This acronym helps describe the basic method. PROMPT is an approach to remediating speech disorders which focuses on specific tactile-kinesthetic cues. The use of “touch cues” makes PROMPT unique from other approaches that focus on visual and verbal cues. The speech therapist uses the pads of her fingers to provide dynamic tactile prompts to the individual’s face, jaw, and mylohyoid muscles under the chin. The prompts are complicated, which is why special training is required in order to use this method. But, in general, the mandibular prompts address jaw height; facial prompts aid lip rounding/retraction, nose prompts cue nasality; and prompts to the mylohyoid stimulate the tongue muscles lying above. Prompts vary not only in terms of placement but also in pressure and timing to provide specific information on how to produce a sound. The PROMPT technique uses these “touch cues” to shape more accurate speech productions at the targeted sound, word, phrase or sentence level. PROMPT focuses on teaching motor control for correct speech production while at the same time eliminating interfering or inadequate muscle movements.
Why are tactile-kinesthetic cues such as those used in the PROMPT method necessary when treating some speech disorders? Why won’t visual and verbal cues suffice? To answer this question, we must consider that speech production is a very complicated process involving more than 100 muscles. The smallest unit of sound in speech is a phoneme. For instance, the word”cat” has three phonemes, the “c” sound, “a” sound, and “t” sound. If you stop and produce each sound you will realize that you use different movements of your jaw, lips, and tongue during production of each phoneme in “cat”. Not only does each phoneme have a specific manner and placement of production, but the phoneme must also be timed and sequenced based on surrounding phonemes. Syllable structure and prosody also mandate subtle changes in the way a phoneme is produced. You can see how speech is very complicated even at the word level. Now imagine coordinating all those muscles to produce a phrase…a sentence…a conversation. This is why treatment of motor speech disorders is complicated and requires thorough training.
If the PROMPT method is being used in speech therapy, it is important that the assessment and treatment be performed by a speech therapist who has completed the PROMPT technique workshop. This intensive training teaches a therapist how to break down each subsystem involved in speech production so that specific areas of deficits are identified. It also teaches the therapist how to execute the tactile-kinesthetic cues to the articulators to help the child produce the targeted phoneme or word. Therapists are trained in three kinds of prompts: Parameter, Surface, and Syllable Prompts. Many sounds and words can be cued using multiple types of prompts; the type of prompt used is determined based on the level of support needed. For example, the word “mom” can be cued with Parameter Prompts if the focus is developing jaw control or Surface Prompts if the focus is developing a more refined production of each phoneme.
A PROMPT assessment includes a System Analysis Observation (SAO), which is a non-standardized observational measure of how a child’s motor subsystems function during speech production. The SAO is used in conjunction with the Motor Speech Hierarchy (MSH) which assesses a child’s motor speech development along 7 interrelated stages which correspond with the stages on the SAO. These stages are:
Foundations of speech
Stage I: Tone
Stage II: Phonation Control
Articulators moving across just the vertical plane of movement or just the horizontal plane of movement
Stage III: Mandibular Control
Stage IV: Labial-Facial Control
Stage V: Lingual Control
Integration across all stages and across both vertical and horizontal planes of movement:
Stage VI: Sequenced Movements
Stage VII: Prosody
After identifying the needs of the child in each of these stages through assessment, a hierarchal treatment plan is developed to target specific goals and objectives for the child. Treatment will focus on supporting the child through tactile-kinesthetic cues to shape speech at increasingly more complex levels. The speech therapist also must determine which kind of prompts to use.
Research supports that PROMPT, as well as other methods for treating childhood apraxia of speech or other significant motor speech disorders, should incorporate Principles of Motor Learning. Some of these principles are:
Pre-practice – involves phonetic placement training before beginning the practice/drill phase.
Repetitive Drill – multiple trials within a practice session for motor learning to take place and become habitual.
Distributed Practice – involves the same duration of practice, distributed across more sessions. It takes longer, but achieves better motor learning. 3-5 weekly sessions have been recommended for CAS.
Block and Random Practice -. Many approaches begin with block practice and then moves to random practice. In random practice the order of presentation of all stimuli is random throughout the session. This typically leads to better retention, thus better motor learning.
Rate of Production Trials – A slower rate can, to an extent, increase accuracy. A varied rate of production can be an effective strategy with repetitive “motor drill” practice of targeted utterances
Just consider, when you are trying to change the way a muscle works and strengthen that response; directed, frequent practice is very important! Just like physical exercise of any kind, frequency and correct practice is critical for good outcomes.
Jacqueline Floras, MS, CCC/SLP, a speech pathologist practicing in our Frisco Clinic is PROMPT trained and has utilized this technique with a variety of diagnoses. She would be happy to talk with you regarding this technique and whether it might be an appropriate treatment for your child. Please call us at 972-424-0148 to get more information about our services or to request information about PROMPT at Speech & Occupational Therapy of North Texas. We are network providers for many insurance plans.
PROMPT has been found to meet fidelity measures for Evidence Based Practices. “The underlying assumption (for evidence based practices) is that the best possible outcomes for a client can only be achieved when the empirically supported treatment is delivered in a systematic manner with high fidelity (Kaderavek and Justice, 2010)”. For more information on research regarding PROMPT or apraxia visit: