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J Dev Phys Disabil

https://doi.org/10.1007/s10882-017-9575-8
R E V I E W A RT I C L E

A Review of Prompt-Fading Procedures: Implications


for Effective and Efficient Skill Acquisition

Mirela Cengher 1,2 & Anna Budd 1 & Nicole Farrell 1 &
Daniel M. Fienup 1,3

# Springer Science+Business Media, LLC 2017

Abstract This paper reports a systematic review of prompt-fading research, with a


focus on experiments comparing two or more prompt-fading procedures. Forty-five
articles with 46 experiments met the operationally-defined inclusion criteria. For the
selected articles, data on several variables were extracted and analyzed. Research
demonstrated that all prompt-fading procedures were generally effective in promoting
acquisition of behavior. Stimulus prompting was more effective and efficient when
compared to response-prompting procedures. Comparisons of response-prompting
procedures yielded variable efficiency results. These outcomes are discussed in terms
of the behavioral principles that facilitate transfer of stimulus control from the prompt
to the discriminative stimulus, such as blocking and overshadowing. Basic investiga-
tions of the role of these behavioral principles might help develop prompt-fading
procedures that are consistently effective across participants. Implications for research
include suggestions for the development of individualized assessments of stimulus
control, similar to the functional analysis methodology.

Keywords Prompt . Prompt fading . Response . Stimulus . Transfer of stimulus control

Interventionists regularly incorporate prompts to promote correct responding during skill


acquisition for individuals with developmental disabilities. A prompt is defined as a

* Mirela Cengher
mirela.cengher@yahoo.com

1
Queens College and the Graduate Center, City University of New York, Department of
Psychology, 6530 Kissena Blvd, Flushing, New York, NY 11367, USA
2
Present address: John Hopkins School of Medicine, Kennedy Krieger Institute, 9730 Patuxent
Woods Dr, Columbia, MD 21046, USA
3
Columbia University, Department of Health and Behavior Studies, 525 W. 120th Street, Box 223,
New York, NY 10027, USA
J Dev Phys Disabil

supplemental stimulus that evokes correct responding, but is not a critical part of the three-
term-contingency unit (discriminative stimulus or SD, response, and reinforcer; Deitz and
Malone 1985). An example of the three-term-contingency is asking a student to clap (SD),
the student claps (response), and the student receives praise as a consequence (reinforcer);
in this example, if the student cannot reliably and independently respond to the instruction
to clap, a prompt (e.g., modeling a clap response) can be used to evoke correct responding.
Prompts have or can quickly develop stimulus control that needs to then be
transferred to the natural SD (in the example above, from the model to the instruction
to clap). Transfer of stimulus control occurs when prompts are gradually faded until
correct responding occurs consistently under the appropriate stimulus control
conditions (Deitz and Malone 1985). For example, in teaching a student to discriminate
letters, the experimenter might place three cards, each depicting a different letter, on the
table, ask BPoint to d!^ (SD), and prompt by pointing to the letter d (modeling
response). As the student responds correctly and reliably to the prompt, the
experimenter can start fading the prompt until the student can point to d when
verbally instructed to do so, in the absence of any prompts.
For the purpose of this paper, prompt-fading procedures were divided into two
categories: stimulus- and response-prompting (Cooper et al. 2007). Stimulus prompting
involves the manipulation of the configuration of the SD across learning trials. The
experimenter presents the SD and the prompt simultaneously, as the prompt is included
in the configuration of the SD. Transfer of stimulus control is programmed using
stimulus fading and stimulus shaping. With stimulus fading, only one dimension of
the SD is manipulated, whereas in stimulus shaping the overall configuration of the SD
is manipulated (Deitz and Malone 1985). For example, in teaching a student to
receptively discriminate letters b and p, one could use stimulus fading to emphasize
the feature that is critical to the discrimination by extending and highlighting the arm of
the letters up and down, respectively, and then gradually reducing the exaggerated
length of the letters arms until the letters are of a normal size. In contrast, with stimulus
shaping one could superimpose a ball on the letter b, and a dog on letter d, then
gradually fade the images until the letters alone control responding.
Another category of prompt-fading procedures is response prompting, where addi-
tional stimuli are added to the configuration of the SD in order to evoke correct
responding. With these procedures, the prompt and the SD can be presented at
different times (e.g., presented right after the SD or with a 2-s delay), or different
prompt topographies are used in succession. Response-prompting procedures are:
most-to-least prompting, graduated guidance, no-no prompting, least-to-most
prompting, progressive/gradual time delay, constant time delay, and simultaneous
prompting (Cooper et al. 2007). An example of most-to-least prompting is fading the
prompts from full physical to partial physical, gestural, and no prompt in teaching a
student to jump when instructed to do so (in this example, the verbal instruction should
eventually function as the SD). With graduated guidance, the same skill would be taught
using prompts within the physical continuum only (e.g., full, partial physical, no
prompt). An example of no-no prompting is asking the student to jump and, upon
two consecutive incorrect responses, presenting a single topography of prompt (e.g., a
physical prompt) to evoke correct responding. An example of least-to-most prompting
is asking the student to jump and, upon incorrect responding, providing prompts in
succession from least intrusive (e.g., pointing) to most intrusive (e.g., full physical)
J Dev Phys Disabil

until the student responds correctly. An example of gradual time delay is asking the
student to jump and providing the prompt with 0-s time delay, then gradually increasing
the time interval between the SD and the prompt in 2-s increments until the student
responds before the prompt. With constant time delay, the prompt would initially be
presented with 0-s time delay, but thereafter the time interval between the SD and the
prompt would remain constant (e.g., at 5 s). Finally, an example of simultaneous
prompting is asking the student to jump and immediately providing a prompt; probes
(i.e., presenting the SD, no prompts or programmed reinforcement) are conducted every
few training sessions to assess transfer of stimulus control from the prompt to the SD.
Comparisons of these different prompt-fading procedures can inform which one is
optimal for a particular student or for a particular dependent variable. Such information
is crucial for the development of effective and efficient intervention, which can enhance
the quality of services provided to children with developmental disabilities.
In order to evaluate and measure the effects of prompt-fading procedures, two
dimensions of the behavior need to be considered: effectiveness and efficiency (for an
example, see Tekin and Kircaali-Iftar 2002). For the purpose of this paper, effectiveness
refers to the extent to which the prompting procedure was successful in producing the
predetermined behavior change (e.g., the learner claps hands when verbally instructed to
do so, in the absence of prompts). Effectiveness can be measured in terms of meeting a
predetermined mastery criterion, such as performing a skill independently with 90%
accuracy across 10 trials or across two consecutive sessions. Efficiency refers to the
amount of resources (e.g., time, number of trials or sessions, errors) required for the
participant to reach a mastery criterion (Cengher et al. 2016). High levels of effective-
ness and efficiency are important because prompt-fading procedures should promote the
highest level of independent correct responding with the least amount of resources in
order to meet the best standard practices in education (Spooner et al. 2011).
There is empirical evidence that prompt-fading procedures are effective (Deitz and
Malone 1985), but less is known about which prompt-fading procedures are most
efficient and under which conditions. One way to assess these variables is to examine
the literature on specific prompt-fading procedures. Several literature reviews have
reviewed the relevant literature to identify whether a specific prompt-fading procedure
is effective (e.g., simultaneous prompting; Waugh et al. 2011). While the information
provided in these reviews is useful in determining the optimal parameters and compo-
nents for a specific procedure, it does not allow for comparative analyses of different
prompt-fading strategies. Four other identified literature reviews targeted a more
extensive analysis and comparison of several prompt-fading strategies (Ault et al.
1989; Demchak 1990; Schoen 1986; Wolery and Gast 1984). In these reviews, it was
noted that (a) there is limited research to support the selection of a prompt-fading
procedure over another (Demchak 1990; Schoen 1986; Wolery and Gast 1984), (b)
treatments that incorporate multiple components or multiple prompt-fading procedures
are generally more efficient than procedures that employ only one prompt-fading
procedure (Ault et al. 1989), (c) component analyses of treatment packages that
integrate multiple prompt-fading procedures are warranted (Schoen 1986), and (d)
stimulus-prompting procedures are more efficient than response-prompting procedures
(Ault et al. 1989). An updated systematic review of prompt-fading procedures is needed
to assess whether the literature has changed during the last 25 to 30 years. Thus, the
purpose of this paper was to conduct a systematic review and analysis of articles that
J Dev Phys Disabil

have compared the effectiveness and efficiency of prompt-fading procedures. Such


knowledge could inform the selection of effective and efficient prompt-fading proce-
dures for particular students, or for particular skills. This is especially important in
educational settings, where instructional resources are limited.

Method

Data Search

Stage one An initial search was conducted through the PsycINFO database using the
following terms: prompt, prompting, autism, developmental disabilities, ASD,
Asperger’s syndrome, Asperger’s, intellectual disability, intellectual disorder, retarded,
and autistic. The author selected the aforementioned words from the PsycINFO list of
potential keywords, denoting that they are commonly used by the users of the respec-
tive search database. The authors used Boolean operators to ease the search process.
Searches were conducted for the keyword prompt and each diagnostic label, as well as
for the keyword prompting and each diagnostic label. This resulted in 18 combinations
of keywords. The following limiters were used: (a) publication year up to 2015, (b)
peer reviewed journals, (c) articles in English, and (d) document type research article
(i.e., excluding book chapters, literature reviews, etc.). These searches yielded a total of
2314 articles. Because multiple searches were performed with different keyword
combinations, some of the articles were duplicates.
In the initial search, the abstracts of 2314 articles were analyzed based on the
following criteria: (a) the authors used the term prompt(s) to describe antecedent
stimuli, (b) the population consisted of individuals with developmental disabilities,
and (c) the articles employed comparative analyses of two or more levels of the
independent variable. Two hundred forty-two articles met the aforementioned inclusion
criteria, and were thus selected for the second stage.

Stage two For the second stage, the author reviewed the abstract and body of text of
each article that met the inclusion criteria for Stage One (N = 242). The inclusion
criteria for Stage Two were: (a) the use of prompts as antecedent stimuli, (b) the
population consisted of individuals with developmental disabilities, (c) at least two
independent variables which included empirically-supported prompting strategies (i.e.,
stimulus prompting, response prompting, most-to-least prompting, least-to-most
prompting, stimulus fading, stimulus shaping, progressive/gradual time delay, constant
time delay, simultaneous prompting, no-no prompting) had been used, and (d) the
dependent variable involved transfer of stimulus control from the prompt to the SD (i.e.,
skill acquisition). Thirty-eight articles met the criteria. The inclusion criteria for the first
and second stages were also applied to the articles retrieved from the citation and
reference search (described below).

Citation Search A citation search was conducted for the articles retrieved from Stage
Two (N = 38), using the ERIC database. The citation search yielded 540 hits and 56
articles met Stage-One inclusion criteria. Out of these, three articles met Stage-Two
inclusion criteria.
J Dev Phys Disabil

Reference Search A reference search was conducted for the articles included in data
analysis (N = 38). The reference search yielded 1603 hits, out of which 37 articles met
Stage-One inclusion criteria, and four of these articles met Stage-Two inclusion criteria.

Data Search Interrater Reliability

The first author searched for and analyzed all articles included in this review. Interrater
reliability data were collected for a larger data set, of which only a subset is reported in
the current paper. For this larger data set, a second reviewer (i.e., the second and third
authors) searched for and analyzed 52% of the articles that met Stage-One and Stage-
Two inclusion criteria. The articles coded by the second reviewer were chosen randomly,
using a research-randomizer software. In order to calculate interrater reliability for the
articles that met the inclusion criteria for Stage One, the smaller number was divided by
the larger number and multiplied by 100. For the articles retrieved from PsycINFO,
overall interrater reliability was 96%. For the articles retrieved from the citation search,
overall interrater reliability was 97%. For the articles retrieved from the reference search,
overall interrater reliability was 96%. In order to calculate interrater reliability for the
articles that met the inclusion criteria for Stage Two, trial-by-trial (study-by-study) was
used, where the number of items with agreement were divided by the number of items
with disagreement and multiplied by 100. For articles that met the inclusion criteria for
Stage Two, overall interrater reliability was 89%. The articles that were subjected to data
analysis (described below) are the ones selected by the first author.

Data Analysis

A total of 45 articles were identified: 38 articles from the original search, three articles
from the citation search, and four articles from the reference search. One of the 45
identified articles contained two experiments relevant for this review, thus, a total of 46
experiments were analyzed. For each article, data on the following categories were
extracted: (a) authors, (b) name of paper, (c) year of publication, (d) journal, (e)
dependent variable, (f) independent variable(s), (g) participants, (h) mastery criterion,
(i) results effectiveness, (j) results efficiency, (k) measurements of efficiency, (l)
generalization, and (m) maintenance.

Journal The journal name, issue number, and page number of the articles were
collected under the journal category.

Dependent Variable(s) Dependent variables were broadly categorized as academic,


leisure or vocational, and play. Academic skills included all responses that focused on
preacademic skills (e.g., discrimination of shapes), language acquisition, reading, writing,
and science. Most academic skills were discrete responses. Examples of academic skills
included are receptively identifying prepositions, defining words, or other simple or condi-
tional discriminations (discrimination of shapes, numbers, prepositions, etc.). Sixty-seven
percent (N = 31%) of the dependent variables included in this review fit into the academic
category. Leisure and vocational skills included all responses that could be performed as part
of a job or activities of daily living. Most of these responses constituted behavior chains.
J Dev Phys Disabil

Examples of leisure and vocational skills include folding towels, manipulating CD players,
or making popcorn. Twenty-eight percent (N = 13) of the dependent variables included in
this review were leisure or vocational skills. Play skills included all responses that involved
toy manipulation, such as making a Lego® structure, or pretend play; these responses
constituted behavior chains. Four percent (N = 2) of the studies included in this literature
review included play skills.

Independent Variable(s) For each independent variable, the first author extracted data
for the specific prompting procedure used (e.g., most-to-least prompting). Each of these
procedures was then categorized as a stimulus or as a response prompt.

Participants Data were extracted for diagnoses and age range. The diagnostic labels
were the ones retrieved from the research articles included in this analysis.

Mastery Criterion The articles were reviewed in order to identify whether there was a
specified mastery criterion. The mastery criterion had to be described in the body of the
text, specifically in the Method section, in order to be considered for analysis.

Effectiveness Results Effectiveness refers to the measure of the effects of the indepen-
dent variable on the dependent variable (e.g., the learner claps hands when verbally
instructed to do so, in the absence of prompts; Cengher et al. 2016). Effectiveness can be
measured in terms of meeting a predetermined mastery criterion, such as performing a
skill with 90% accuracy (i.e., in the absence of prompts) across 10 trials, across two
consecutive sessions, or other criteria. For the purpose of data collection, effectiveness
was defined as a dichotomous variable: a procedure could either be effective or not. There
were only two exceptions to this rule: (a) when more participants met a mastery criterion
with one of the procedure, but not with the other one, and (b) when a mastery criterion was
met with more stimuli in one procedure versus another (e.g., participant learned more
colors with most-to-least as compared to least-to-most). If a procedure met one or both
criteria, it was considered to be more or less effective than another procedure.

Efficiency Results The results were also interpreted in terms of efficiency. Efficiency
refers to the amount of resources required for the participant to reach the mastery
criterion. Efficiency can be measured in trials to criterion, sessions to criterion, total
instructional time, or number of errors to criterion (Cengher et al. 2016). A procedure
can be more efficient than another in one or more measurements of efficiency (e.g.,
number of errors, duration of training).

Generalization and Maintenance Data were collected on the number of articles


with generalization and maintenance assessments. Data were analyzed per time
periods (decades).

Data Analysis Interrater Reliability

The first author analyzed all articles included in this review. A second reviewer (i.e., the
second and third author) searched for and analyzed 40% of the articles. The articles
J Dev Phys Disabil

coded by the second reviewer were chosen randomly, using a research-randomizer


software. Trial-by-trial analyses were used to calculate IOA for each of the following:
(a) independent variable(s), (b) participants, (c) mastery criterion, (d) results for
effectiveness, (e) results for efficiency, (f) measurements of efficiency, (g) generaliza-
tion, and (h) maintenance. Overall interrater reliability was 94%.

Results

General Characteristics of the Literature

Data that inform the general characteristics of the literature are: journal, year of
publication, participants, measurements of efficiency, independent variable(s), and
generalization and maintenance. More articles were published in the first two
decades (1973–1990, N = 28), as compared to the last two decades (1991–2014,
N = 17). The number of publications per year has remained relatively stable
throughout the years, with two exceptions: an increased number of publications
between 1987 and 1990 and another spike from 2011 to 2014. As per the inclusion
criteria of this review, all articles contained dependent variables focused on
response acquisition with individuals who had a diagnosis that fell within the
developmental disabilities umbrella (age range, 2 to 55 years old).
One article had two experiments that were relevant to the current review rather than
one; therefore, the remaining calculations were based on the 46 experiments that were
identified. Most experiments evaluated efficiency across multiple measures (N = 25,
54%), and some found contradicting outcomes across different measures of efficiency
(e.g., Demchak 1989; further discussed in the discussion section). Ten experiments
(22%) did not report efficiency data, and the remaining 11 experiments (24%) reported
data on a single measurement of efficiency (e.g., trials to criterion).
The independent variables were categorized as stimulus- and response-
prompting. One experiment employed comparisons between different stimulus-
prompting procedures, 32 experiments compared response-prompting procedures,
and 15 experiments compared stimulus- and response-prompting procedures.
Some experiments compared more than two prompting procedures, which is
why the number of comparisons (N = 48) exceeds the actual number of experi-
ments (N = 46) reported. The focus on response-prompting might be explained by
the fact that there are seven variations of these procedures as compared to the two
stimulus-prompting procedures. In addition, the response effort of using response-
prompting on the part of the practitioner is generally lower than for stimulus-
prompting procedures, because response-prompting may not require additional
time to prepare materials, as is the case with stimulus fading or shaping proce-
dures. 1 For example, when teaching a discrimination of shapes using stimulus
fading one has to make materials for each step of the fading process, while most-
to-least prompting requires only the terminal set of instructional materials (Green

1
However, some forms of stimulus prompting might not require a high response effort. For example, a
positioning prompt, such as placing the discriminative stimulus closer to the participant as compared to the
delta stimuli, is a low response effort prompting procedure.
J Dev Phys Disabil

2001). Thus, response-prompting procedures might not only benefit from more
empirical research, but also be more commonly used by practitioners in applied
settings.
Twenty-one experiments (46%) reported maintenance data and 15 experiments
(33%) reported generalization data. Overall, there was a greater number of experiments
that did not report maintenance (54%) and generalization data (67%) as compared to
experiments that reported such data. Prior to the publication of Stokes and Baer’s paper
on generalization (1977), no identified experiments reported generalization or mainte-
nance data. Thereafter, the percentage of experiments reporting generalization data
increased progressively throughout the decades. A similar pattern was found with
maintenance data. Overall, there is an increasing trend in the number of experiments
reporting generalization and maintenance data, which is important considering that the
optimal prompt-fading procedure is not only the most effective and efficient, but the
one that results in lasting and generalized behavior change as well.
There were 46 experiments comparing two different prompting procedures. The
outcomes of each study can be found in Table 1, while the sections below focus on a
summary of findings across and within studies, and on clinical implications.

Stimulus-Prompting Procedures

Smeets et al. (1984) conducted the only experiment comparing the two stimulus
prompting procedures: stimulus fading and stimulus shaping (see Table 1). While both
procedures were effective, stimulus shaping was slightly more efficient in terms of
trials to criterion. Because these two procedures have only been compared in one
article, more research is needed to extend the external validity of these findings.

Response-Prompting Procedures

Thirty-two experiments (in-text citations provided in Table 1) compared the effective-


ness and efficiency of response-prompting procedures. Twenty-nine experiments re-
ported that all procedures were effective, while two reported that effectiveness outcomes
were not consistent across participants (Demchak 1989; Fentress and Lerman 2012). For
example, Demchak (1989) reported that 24 of 25 participants met the mastery criterion
with both graduated guidance and least-to-most promoting, and one participant did not
meet the mastery criterion in either condition. Heckaman et al. (1998) did not report a
mastery criterion, therefore, effectiveness data were not reported.
Despite the overall effectiveness of response-prompting procedures, efficiency out-
comes were not replicated across experiments or across participants in the same
experiment. As an example of discrepancies between experiments, Aykut (2012) found
that most-to-least prompting was more efficient than constant time delay, whereas
McDonnell and Ferguson (1989) reported the opposite outcome. As an example of
failure to replicate within an experiment, Riesen et al. (2003) found that simultaneous
prompting was more efficient than constant time delay for two participants, but
constant time delay was more efficient for the other two participants. In addition, some
articles yielded incompatible outcomes for different measurements of efficiency. For
example, Demchak (1989) found that least-to-most prompting was more efficient in
terms of trials to criterion, whereas graduated guidance was more efficient in terms of
Table 1 Comparative analyses

Procedures compared Number Effectiveness outcomes Efficiency outcomes References


of studies
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Stimulus fading to stimulus shaping 1 Both procedures were effective Stimulus shaping was more efficient Smeets et al. 1984
Stimulus fading to 1 Stimulus fading was more effective Stimulus fading was more efficient Dorry and Zeaman 1973
simultaneous prompting (more stimuli were learned with
this procedure)
Stimulus fading to most-to-least 1 Both procedures were effective Most-to-least prompting was more efficient Strand and Morris 1986
Stimulus fading to least-to-most 3 Two studies did not report a mastery Stimulus fading was more efficient Karsh et al. 1990; Karsh
criterion. In Repp et al. (1990), and Repp 1992; Repp et al. 1990
both procedures were effective
Stimulus fading to progressive 2 Both procedures were effective In Aeschleman and Higgins (1982), stimulus Aeschleman and Higgins 1982;
time delay fading was more efficient. In McGee McGee and McCoy 1981
and McCoy (1981), both procedures
were more efficient than control
Stimulus fading (Criterion-related) 1 Both procedures were effective Stimulus fading was more efficient Strand and Morris 1988
to extra-stimulus
(Noncriterion-related)
prompting
Stimulus shaping to progressive 1 No mastery criterion was reported, N/A Graff and Green 2004
time delay but the accuracy of responding
was higher for stimulus shaping
Within-stimulus prompt to 6 Within-stimulus was effective in Within-stimulus prompting was Arick and Krug 1978; Collier and
extra-stimulus prompt all but one study; In Collier and more efficient Reid 1987; Richmond and Bell 1983;
Reid (1987), extra-stimulus Schreibman 1975; Summers et al. 1993;
prompting was more effective. Wolfe and Cuvo 1978
In three studies, extra-stimulus
prompt was not effective
Most-to-least to least-to-most 5 Both procedures were effective Most-to-least was more efficient in McDonnell Glendenning et al. 1983; Libby et al. 2008;
and Ferguson (1989). Libby et al. (2008) McConville et al. 1998; Seaver and
and Seaver and Bourret (2014) reported Bourret 2014; Walls et al. 1981
Table 1 (continued)

Procedures compared Number Effectiveness outcomes Efficiency outcomes References


of studies

inconclusive outcomes. Two studies did


not report efficiency data
Most-to-least to constant 3 Both procedures were effective Constant time delay was more efficient in Aykut 2012; McDonnell and Ferguson 1989;
time delay Aykut (2012) and Miller and Test (1989). Miller and Test 1989
Most-to-least was more efficient in McDonnell
and Ferguson (1989)
Most-to-least to progressive 2 Both procedures were effective Progressive time delay was more efficient in Berkowitz 1990; Seaver and Bourret 2014
time delay Berkowitz (1990). Efficiency data were
inconclusive in Seaver and Bourret (2014)
Most-to-least to no no 1 Both procedures were effective for No-no prompt was more efficient Fentress and Lerman 2012
prompting all but one participant, who failed
to reach mastery with no-no prompt
Least-to-most to 1 Both procedures were effective, with Efficiency outcomes were inconclusive Demchak 1989
graduated guidance the exception of one participant
Least-to-most to 6 Both procedures were effective Constant time delay was more efficient in four Ault et al. 1988b; Ault et al. 1988a;
constant time delay studies (Ault et al., 1988b; Ault et al. 1988a; Doyle et al. 1990; Gast et al. 1988;
Doyle et al. 1990; Wolery et al. 1990). Results McDonnell 1987; Wolery et al. 1990
were inconclusive in the remaining two studies
Least-to-most to 6 No mastery criterion was reported in Efficiency outcomes were inconclusive in five Bennett et al. 1986; Gast et al. 1991;
progressive time delay Heckaman et al. (1998). In the studies. Heckaman et al. (1998) did not report Godby et al. 1987; Heckaman et al. 1998;
other studies both procedures efficiency data Schoen and Sivil 1989; Seaver and
were effective Bourret 2014
No-no prompt to simultaneous 1 Both procedures were effective No-no prompting was more efficient Leaf et al. 2010
prompting
Progressive time delay to constant 1 Both procedures were effective Constant time delay was more efficient Ault et al., 1988a, b
time delay
Progressive time delay to 1 Both procedures were effective Efficiency outcomes were inconclusive across Swain et al. 2014
simultaneous prompting measurements of efficiency in Swain et al. (2014)
J Dev Phys Disabil
Table 1 (continued)

Procedures compared Number Effectiveness outcomes Efficiency outcomes References


of studies

Constant time delay to 5 Both procedures were effective Efficiency data were inconclusive in three studies Head et al. 2011; Kurt and Tekin-Iftar 2008;
J Dev Phys Disabil

simultaneous prompting (Kurt and Tekin-Iftar 2008; Riesen et al. 2003; Riesen et al. 2003; Schuster et al. 1992;
Tekin and Kircaali-Iftar 2002). Simultaneous Tekin and Kircaali-Iftar 2002
prompting was more efficient in terms of
errors-to-criterion in Head et al. (2011).
Simultaneous prompting was slightly more
efficient in Schuster et al. (1992)
J Dev Phys Disabil

number of errors made. In summary, response-prompting procedures were effective,


but there were no conclusive, replicated efficiency outcomes. Based on the existing
literature, there are no clear guidelines to support the selection of the most efficient
response-prompting procedure for individuals with developmental disabilities.

Stimulus- and Response-Prompting Procedures

Fifteen experiments compared stimulus- and response-prompting procedures (in-text


citations are provided in Table 1). Of these, nine experiments compared specific
stimulus- and response-prompting procedures (e.g., stimulus fading and least-to-most
prompting in Karsh et al. 1990). The remaining six experiments compared the generic
stimulus- and response-prompting procedures. For example, Schreibman (1975) com-
pared stimulus- and response-prompting (i.e., a gestural prompt) and found that
stimulus prompting was effective in 15 of 16 cases, while response prompting was
not effective at all when used as an independent teaching procedure. Eight of 15
experiments reported that all procedures were effective, one reported that response-
prompting was more effective (Collier and Reid 1987), four reported that response-
prompting procedures were not effective, or that they were less effective than stimulus-
prompting procedures (Arick and Krug 1978; Dorry and Zeaman 1973; Schreibman
1975; Strand and Morris 1988; Summers et al. 1993), and the remaining three did not
report a mastery criterion. Collectively, 14 experiments evaluated efficiency and 12 of
these experiments reported that stimulus-prompting procedures were more efficient.
The outlying experiments found most-to-least prompting to be more efficient than
stimulus prompting (Strand and Morris 1986), or that the procedures were similarly
efficient (McGee and McCoy 1981).
In summary, both stimulus- and response-prompting procedures were found to be
effective and overall, stimulus-prompting procedures produced faster acquisition of
behavior. However, only two studies that compare stimulus- and response-prompting
procedures have been published since 1990 (Graff and Green 2004; Karsh and Repp
1992). Future studies should continue to build on this line of research to increase its
external validity, considering that the findings so far have been robust. Given the status
of the literature, a special emphasis should be placed on identifying which of these
procedures is most efficient across different measurements of efficiency (e.g., trials to
criterion, errors, duration). Such analyses would be beneficial for clinical practice.

Discussion

The purpose of this systematic review was to identify general characteristics of the
literature and to analyze the efficacy and efficiency of the respective prompt-fading
procedures. Forty-eight comparisons, contained in 46 experiments across 45 articles,
were selected for analysis based on operationally-defined inclusion criteria. With few
exceptions, the prompt-fading procedures employed in these experiments led to skill
acquisition and were, thus, effective in producing independent and correct responding.
Only six of the experiments with a specified mastery criterion reported failure to
acquire skills with one procedure across participants, or to demonstrate that one
procedure was consistently effective across participants. With one exception, all of
J Dev Phys Disabil

the ineffective procedures utilized a response-prompting procedure. Overall, compari-


sons of different response-prompting procedures yielded variable efficiency results.
That is, a particular procedure was found to be more efficient in some comparisons and
less efficient in other comparisons either between experiments or between participants
within a single experiment. The most reliable finding of this review was that stimulus
prompting was more effective and efficient than response prompting, which was found
in 14 of the 15 studies that examined this research question. These outcomes are in line
with the ones identified in previous reviews on the topic (Ault et al. 1989; Demchak
1990; Schoen 1986; Wolery and Gast 1984). In what follows, we will discuss the
mechanisms behind the effectiveness and efficiency of prompt-fading procedures, as
well as their application to clinical practice.
In experiments that compared response-prompting procedures, 11 combinations of
prompt-fading procedures out of 21 possible combinations were investigated. There-
fore, the experiments identified through this literature review represent half of the
possible prompt-fading comparisons. Other comparisons, not yet investigated, could be
explored in future research. For example, least-to-most prompting has been compared
to five other procedures in 18 different experiments, despite limited evidence that it is
more effective or efficient than any of the compared procedures, while no-no prompting
has only been compared to one other procedure, and it was demonstrated to be more
efficient (Fentress and Lerman 2012). In addition, the number of articles (N = 46
experiments in 45 articles) is low when compared to the number of articles on other
topics; for example, Beavers et al. (2013) identified 435 articles employing functional
analyses. Because of the limited number of articles on the topic, as well as the fact that
not all combinations have been explored, the extent to which inferential statements can
be made about the comparative effectiveness and efficiency of response-prompting
procedures is limited.
Across prompt-fading studies, the most reliable effect comes from experiments
comparing stimulus- and response-prompting procedures, which demonstrates a
robust effect for stimulus-prompting procedures across both effectiveness and
efficiency (Arick and Krug 1978; Collier and Reid 1987; Richmond and Bell
1983; Schreibman 1975; Summers et al. 1993; Wolfe and Cuvo 1978). Basic
principles, such as the blocking effect or overshadowing, may shed light on why
stimulus-prompting procedures are more efficient than response-prompting pro-
cedures. With stimulus blocking, one antecedent stimulus (A) acquires discrimi-
native properties. Then, A is presented at the same time with another antecedent
stimulus (B), which has no prior conditioning history. With repeated presentations
of the two stimuli together, A will continue to control responding, whereas B will
fail or it will be slow to acquire any associative properties (Dittlinger and Lerman
2011). The blocking effect might explain why stimulus-prompting procedures are
more efficient than response-prompting procedures (Schreibman 1975); response
prompts are stimuli that typically have a conditioning history and, as a result,
have discriminative properties. In contrast, stimulus prompts consist of empha-
sizing a feature of a stimulus with no prior conditioning history, and then the
prompt is gradually faded. It is possible that response prompts hinder the
acquisition of stimulus control of the SD. This effect should be observed to a
lesser degree with the response-prompting procedures, if the antecedent stimuli
have no prior conditioning history.
J Dev Phys Disabil

An alternative explanation for why stimulus-prompting may work better than


response-prompting is overshadowing. In overshadowing, when two stimuli are pre-
sented together, one stimulus is quicker to acquire discriminative properties as com-
pared to the other(s) (Dittlinger and Lerman 2011). Unlike the blocking effect, in
overshadowing, the two stimuli have no known prior conditioning history. Because
only one stimulus is presented during conditioning in the stimulus-prompting condi-
tion, overshadowing is less likely to occur, unless one dimension of the stimulus is
more salient than other, and is quicker to gain discriminative properties. This will only
result in overshadowing if the dimension that gains discriminating properties is not
critical to the respective discrimination (e.g., in teaching a child to sight read, the order
of the letters in a word is relevant, whereas the font or font size are redundant
dimensions of the word stimulus). Future research should examine the role of basic
principles such as blocking and overshadowing on transfer of stimulus control from
stimulus and response prompts to SDs; for example, future studies can examine the
types of stimuli that are least likely to evoke stimulus blocking or overshadowing for
each learner, with the goal of using them as prompts.

Application

There are applied implications of the findings of this literature review, in light of the literature
on stimulus blocking and stimulus overshadowing. Stimulus blocking and stimulus
overshadowing have been advanced as mechanisms behind stimulus overselectivity
(Ploog 2010). Stimulus overselectivity can be limited by (a) extinguishing responding to
the prompt (Broomfield et al. 2010), (b) teaching participants to perform an observable
observing response when presented with the SD (Doughty and Hopkins 2011), (c) teaching
the participants to engage in a conditional discrimination from the beginning of intervention,
rather than teaching a simple discrimination followed by a conditional discrimination (Green
2001), and (d) using a differential reinforcement schedule, favoring responding to the SD, if
such responses occur (Olenick and Pear 1980; Touchette and Howard 1984).
The failure to obtain consistent efficiency outcomes for response-prompting procedures
can be explained in several ways. First, the studies included in this literature review
employed different mastery criteria, populations, dependent variables, and parameters or
components of the independent variable(s), making between-studies comparisons difficult.
To illustrate, two experiments that compared the same procedure might employ different
parameters (e.g., progressive time delay increased by 2 s, versus progressive time delay
increased 4 s at a time), different components (e.g., simultaneous prompting with or without
instructive feedback), or both. For example, Ault et al. (1988b) used a progressive time delay
procedure where the time interval was gradually increased by 4 s, while McDonnell (1987)
increased the time interval by 2 s at a time. Another potential explanation is that confounding
variables might have skewed the data. For example, it has been demonstrated that instruc-
tional history affects response acquisition (Coon and Miguel 2012), in that a procedure that
had been used before is likely to result in more efficient acquisition when compared to a
never-before-experienced teaching procedure. It is possible that the participants entered the
study with different instructional history for the types of procedures being compared, which
favors procedures the participants had previously experienced. Last, different measures of
efficiency address different dimensions of the dependent variable, which are not necessarily
congruent. When that is the case, it is important to select procedures that employ
J Dev Phys Disabil

measurements of efficiency that are most relevant for each student. For example, if a student
has limited instructional time (e.g., only 5 h of behavior analytic services per week), trials to
criterion might be a more relevant measurement of efficiency as compared to number of
errors. In contrast, a student who exhibits escape behavior during academic instruction might
benefit more from interventions that are most efficient in minimizing the number of errors.
These explanations represent limitations that can be further remedied in literature reviews by
focusing on more reliable analyses between studies, such as meta-analysis, or restricting the
scope of literature review to procedures that are consistently manipulated across studies.
The failure to obtain consistent efficiency outcomes for response-prompting proce-
dures can be ameliorated in one of two ways. First, researchers could attempt to better
control for potential confounding variables, such as instructional history (Coon and
Miguel 2012), or to try to be more consistent in the development and implementation of
treatment packages within and across experiments. An alternative approach to obtain
more reliable outcomes would be to shift the focus of investigation from experiments
that compare different prompt-fading procedures to a more individualized, function-
based analysis of antecedent variables that control behavior. The functional analysis
literature has improved the way practitioners assess and address problem behavior (for
a review, see Beavers et al. 2013). Recent advances of the functional analysis method-
ology have focused on dependent variables other than problem behavior (e.g., Plavnick
and Normand 2013). This has set the stage for further development of stimulus control
analysis and methodology, which could inform the selection of prompt-fading proce-
dures for students with developmental disabilities.
Such an analysis can be accomplished in a few steps for transfer-of-stimulus-control
research, based on the findings of this literature review. First, it should be identified
whether stimulus-prompting procedures can be used and, if so, they should be prior-
itized over response-prompting procedures (Green 2001). Analyses of the effectiveness
of stimulus fading and stimulus shaping could be conducted in order to identify the
most efficient procedure. Such an analysis could be conducted by assigning two set of
targets with the same level of difficulty to each procedure (e.g., tacting the letters a and
b in one set, c and d in another), and teaching one of these sets using stimulus fading
and the other one using stimulus shaping. Efficiency data can then be compared to
establish which one of the two procedures is optimal for each learner. Second, the
discriminative properties of stimuli to be used as prompts should be assessed in order to
verify whether these stimuli can evoke correct responding. Only stimuli that evoke
correct responding should be further used as prompts. The stimuli that do not control
responding could be targeted for acquisition separately in order to acquire discrimina-
tive properties. Last, individualized assessments should be developed, targeting the
identification of optimal prompt-fading procedures, parameters, and components for
each learner. The most effective and efficient treatment package should then be
incorporated in the students’ curriculum, to address and to test the generality of the
procedures for a variety of skills. A preliminary step in applying such a methodology
with transfer of stimulus control research has been conducted by Seaver and Bourret
(2014) and Cengher et al. (2016). The authors implemented an individualized, multi-
step process of identifying effective prompts and prompt-fading procedures. This line
of research is promising in that it provides an empirically-based alternative to the
traditional comparison of response-prompting procedure, which, as indicated by the
outcomes of this investigation, has poor external validity.
J Dev Phys Disabil

Limitations

There are some limitations to this literature review. First, studies assessing the
effects of video modeling were not included. Future literature reviews should
consider including video modeling, considering its popularity and increasing
empirical support (e.g., Bovi et al. 2017). Second, it is possible that the search
methods used in this literature review (e.g., keyword searches using two data-
bases, reference search, citation search) were not exhaustive, and did not retrieve
every single article that is relevant to the topic. Third, the articles included in this
literature review were not analyzed for quality, which poses limitations to our
analyses. Future studies should include such quality measures. Last, for data
collection purposes, effectiveness was defined as a dichotomous variable (i.e., a
procedure could either be effective or not). However, effectiveness can be a
continuous variable, and this could be better captured by conducting meta-analy-
ses. Future studies should consider conducting meta-analyses as opposed to
systematic literature reviews such as this one.

Conclusion

In conclusion, there are limited data to support the selection of efficient response-
prompting procedures. In order to address this limitation, two directions of
research are recommended. First, a translational analysis of basic behavioral
principles, such as blocking and overshadowing, can shed light on the mecha-
nisms in place behind stimulus- and response-prompting procedures. This infor-
mation, in turn, can inform the selection of efficient prompt-fading procedures.
Second, the function-based approach to behavior has established behavior analysis
as the most effective and efficient treatment for individuals with developmental
disabilities (e.g., Peters-Scheffer et al. 2011). Recent advances of the functional
analysis methodology have focused on dependent variables other than problem
behavior (e.g., Plavnick and Normand 2013). This has set the stage for further
development of stimulus control analysis and methodology, which could inform
the selection of prompt-fading procedures for students with developmental
disabilities.

Acknowledgements This systematic review was conducted by the first author in partial fulfillment of
a Ph.D. program in Psychology at The Graduate Center, City University of New York. We thank Drs.
Nancy Hemmes and Emily Jones for feedback on early revisions of this manuscript. We also thank
Eliora Habshush and Ellieana Garcia for their assistance in the data analysis process.

Compliance with Ethical Standards

Funding The authors did not receive funding for the development of this project.

Conflict of Interest The authors declare that they have no conflict of interest with respect to the develop-
ment of this literature review.
J Dev Phys Disabil

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