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A Review of Rapid Prompting Method and Prompt Therapy for Autism Treatments

A Review of Rapid Prompting Method and Prompt Therapy for Autism Treatments. Casi M. Healey, MA, BCBA Caldwell College. Rapid Prompting Method. Search Criteria. Psych Info ,ERIC, and Google Search Terms: Rapid Prompting Method RPM Rapid Prompting Halo Soma Mukhopadhyay Soma and Tito

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A Review of Rapid Prompting Method and Prompt Therapy for Autism Treatments

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  1. A Review of Rapid Prompting Method and Prompt Therapy for Autism Treatments Casi M. Healey, MA, BCBA Caldwell College

  2. Rapid Prompting Method

  3. Search Criteria • Psych Info ,ERIC, and Google Search Terms: • Rapid Prompting Method • RPM • Rapid Prompting • Halo • Soma Mukhopadhyay • Soma and Tito • Dominant Learning Channel • Autism • Autism Interventions • Alternative Autism Interventions

  4. Outline • What is Rapid Prompting Method (RPM) • History • Basic Components of RPM • RPM Materials • Video Examples of RPM • What does Rapid Prompting Method Claim To Do? • Does Research Support the Use of RPM? • Conclusions

  5. What is Rapid Prompting Method (RPM)?History • Developed by Soma Mukhopadhyay when her three-year-old son, Tito, was diagnosed with autism. • Also known as Soma® RPM • She taught him herself through the use textbooks and classics by having him point to letter and numbers. • According to Soma, when Tito was six-years-old he was able to write independently. • By age eleven he was diagnosed as gifted by the National Autistic Society in the UK. • Came to US by foundation of Cure Autism Now (CAN). Retrieved from: www.halo-soma.org

  6. What is Rapid Prompting Method (RPM)?History • Media attention began in 2000 by the BBC did a story called “Tito’s Story”. • Tito’s first book was published in 2001 titled “Beyond the Silence”. • 2003 television program Sixty Minutes II provided national attention for RPM. Retrieved from: www.halo-soma.org

  7. What is Rapid Prompting Method (RPM)?History • Soma started HALO (Helping Autism through Learning and Outreach). • Started in January 2004 in Burbank, CA. • Moved clinic in January 2005 to Austin, TX. • 1:1 sessions are conducted with Soma. • Must be a member of HALO before the child can be seen by Soma. • Annual membership fee is $25.00 Retrieved from: www.halo-soma.org

  8. What is Rapid Prompting Method (RPM)?The Basic Components • “RPM is an empirical and rational teaching method, based upon how the brain works” • 1. Teaching Choice: • First step: teaching the student to make choices from a field of two. • Second step: The student is taught to spell words by pointing to letters in one row of 3-6 choices. Then to two rows and so on. • Third step: The student uses a letter board with 26 choices. • What are some questions we can derive from this? Retrieved from: www.halo-soma.org

  9. What is Rapid Prompting Method (RPM)?The Basic Components • 2. Build Self-Esteem, Interest and Success • Individualized instruction opens “learning channels” • The location of the “dominant learning channel” is based on the students primary “stim”. • “Soma observes the students reactions to his environment as well as the student's primary stim, which can be the best indicator. Example: How does the student respond to a book?.... Does he flip the pages? (kinesthetic/visual) Does he focus on a specific part? (visual) Does he bang the book against something? (auditory) Does he tear the pages? (auditory/tactile) Any of these behaviors would help point to open learning channels.” • Questions? Concerns? Retrieved from: www.halo-soma.org

  10. What is Rapid Prompting Method (RPM)? • Email question: “Hi, I have a few questions.  How does Soma know which is the primary “stim” to locate the dominant learning channel?  Are data collected to make the decision because some learners with autism have different types of stereotypic behavior that all appear to occur at high rates?” Email correspondence with Halo school

  11. What is Rapid Prompting Method (RPM)? • Email Response: • Hello, In the FAQ's section of our website (Under Learning RPM) This question is addressed: “Soma observes the students reactions to his environment as well as the student's primary stim, which can be the best indicator. Example: How does the student respond to a book?.... Does he flip the pages? (kinesthetic/visual) Does he focus on a specific part? (visual) Does he bang the book against something? (auditory) Does he tear the pages? (auditory/tactile) Any of these behaviors would help point to open learning channels.” The determination is found by observing the student from the moment they walk in and sit down to do a session. Will they sit or do they need to move around alot (kinesthetic) are they tactile defensive about sitting in a chair or how do or will they hold a pencil (tactile defensive) . Email correspondence with HALO School

  12. What is Rapid Prompting Method (RPM)?The Basic Components • 2. Build Self-Esteem, Interest and Success • “But when treated with confidence, ASD students (just like typical students) are more hopeful and sure about themselves and their potential” • Exposure to varied academic topics such as science, social studies, and math. • Questions? Concerns? Retrieved from: www.halo-soma.org

  13. What is Rapid Prompting Method (RPM)? The Basic Components • 3. Patience and Practice for Development of Motor Skills: • Teaching the student to point BUT understand that it involves a lot of muscles and joints as well as motor planning which children with autism have difficulty with. • Requires patience and caring to teach pointing skills. • Once they have mastered this skill they increase to pointing to 3 to 4 letters on a line and so on until they are able to use a QWERTY chart. • Questions? Concerns? Retrieved from: www.halo-soma.org

  14. RPM Materials Retrieved from: www.halo-soma.org

  15. Some Video Examples of RPM • Beginning session: http://www.halo-soma.org/learning_videos.php?sess_id=20fb8fc6b6c0eecc35d245f786d2f167 Session using QWERTY board: http://www.youtube.com/watch?v=m1OAqtAR_-E Retrieved from: www.halo-soma.org & www.youtube.com

  16. Some Video Examples of RPM • High school student: http://www.mtv.com/videos/true-life-i-have-autism/1554937/playlist.jhtml Comments about these videos? Retrieved from: www.mtv.com

  17. What Does RPM Claim To Do? • RPM “activates” the brain by using the “Open Learning Channels” • Uses a “Teach/Ask” Paradigm to teach individuals with autism academics and learn to communicate in the process. • Use of visual, auditory, verbal, and tactile prompts. • The use of these prompts “compete” with the students stereotypic behaviors. • Soma paces her instruction based on the rate of the student’s stereotypy. • This claims to keep student “on-task”. Retrieved from: www.halo-soma.org

  18. What Does RPM Claim To Do? • Teaching begins with focus on a particular subject area that is age appropriate. • Soma adjusts teaching matter to stimulate the desired side of the brain. • Use of the “open learning channel” facilitates maximum learning and output by the student with autism. • As a student’s motor and cognitive skills improve, so does the sophistication of their responses. • Manual prompting helps the student to make independent responses. • Prompt dependency is preferred to no response. • Manual prompts are faded if and when an student no longer needs them. Retrieved from: www.halo-soma.org

  19. What Does RPM Claim To Do? • What if a student engages in a tantrum and/or aggressive behaviors? • “Soma converts students' right-brain emotional state by teaching specific subject matter (for example: math and spelling) to activate left-brain reasoning.” • Converts right-brain tantrum to left-brain reasoning Retrieved from: www.halo-soma.org

  20. Does Research Support the Use of RPM? • According to Soma, “RPM is the most direct and unlimited path to teaching learning and communicating.” • HOWEVER, RPM has no scientific research to back-up its claims that is successful to teach academics and communication. • Research was allegedly conducted in 2003 at the Carousel School but was never published. • They claim research is currently being conducted at Cornell University. • In addition, there are no references to support this interventions methodology regarding how the “brain works”. Retrieved from: www.halo-soma.org

  21. Does Research Support the Use of RPM? • RPM only provides testimonials and case studies as any evidence to its effectiveness. • http://www.halo-soma.org/about_testimonials.php?sess_id=20fb8fc6b6c0eecc35d245f786d2f167 • http://www.halo-soma.org/learning_case_studies.php?sess_id=20fb8fc6b6c0eecc35d245f786d2f167 • Why is this not considered scientific evidence? Retrieved from: www.halo-soma.org

  22. Does Research Support the Use of RPM? • Email question: • “I understand that research is being conducted at Cornell University. Could you tell me the specific areas that they are researching and an anticipated time frame when the research will be completed and available to the public? Is there a contact person at Cornell that can share some information? Thank you in advance.” Email correspondence with HALO

  23. Does Research Support the Use of RPM? • Email response: “The Cornell study is on the effectiveness of RPM as an educational method. When complete it will be made available to the public.” Let’s read Soma’s recent response to the lack of scientific research. http://counteringageofautism.blogspot.com/2010/04/why-rapid-prompting-method-doesnt-pass.html Retrieved from email correspondence with HALO & www.counteringageof autsm.blogspot.com

  24. Does Research Support the Use of RPM? • There is one “study” about RPM: • Titled “The Rapid Prompting Method of Communicating with Severely Autistic Children: a Language Socialization Study” By Olga Soloman Ph.D., University of Southern California. • The study looked at the use of RPM as it was being trained across users (Socialization) • Soma trained parents & teachers (1st generation) to use RPM • Then 1st generation trained RPM to other parent & teachers (2nd generation) • 200 hours of video footage were reviewed involving 16 children diagnosed with autism across to different cities (Los Angeles and Chicago). • According to the authors, the study showed that as parents and experts socialized RPM they constructed an empirically-based theoretical framework of autism. • Interestingly, the parents differed with Soma (via parent interviews) in that they used RPM as a conversational practice rather then educational. • Is this a scientific study? Why? Solomon, O (2006 ). The Rapid Prompting Method of Communicating with Severely Autistic Children: a Language Socialization Study

  25. Does Research Support the Use of RPM? • There is mention of RPM in a case study titled: • Language is more than speech: A case study. By Morton Ann Gernbacher, Ph.D. in 2004. • Article follows a child with autism and his parents search for an appropriate intervention. • RPM is mentioned as the mother brought her son to meet with Soma. • Parent’s perspective was that she was unwilling to go the extreme measures that Soma used for her son, Tito, but wanted to possibly use some aspects of RPM to teach a “gross” style of handwriting. • Is this a scientific study? Why? Gersbacher, M. A. (2004). Language is more than speech: A case study. Journal of Developmental and Learning Disorder, 8, 81-98.

  26. Conclusions • Based on the research provided the Rapid Prompting Method is not an empirically validated intervention for children with autism. • It lacks any evidence-based research to prove its effectiveness since its inception 10 years ago. • Only testimonials and case studies are provided for parents to make a decision of its efficacy • Only the rigor of scientific study will provide answers if RPM does what it says it does!

  27. Conclusions • What are some of the warning signs of RPM as a pseudoscientific therapy? • Claim of high success ratesSoma has helped hundreds of individuals with autism • Many different disorders and symptoms can be helped with this therapy It claims to be effective with AngelmanSyndrome, Williams Syndrome, Prader-Willi Syndrome, and students with other Chromosomal abnormalities.Also students who are blind, deaf, Fragile X, Isodicentric 15, Down Syndrome. • Very little training is required and is easy to administer : Claims to be a “low-tech” intervention that only requires a teacher, student, paper and pencil. (adapted from the American Arthritis Foundation)*originally printed in Science in Autism Treatment, Spring 1999http://www.asatonline.org/resources/articles/evaluate.htm

  28. Conclusions • The therapy’s theory contradicts objective knowledge (and common sense):How does Soma “convert” learning from the right brain hemisphere to the left? What are open learning channels? • Therapy effectiveness is in the form of testimonials, anecdotes, or personal accounts, no objective evidence is provided.: Only case studies and testimonials are available in lei of scientific research. Although there are claims that research is being conducted yet nothing has been published. adapted from the American Arthritis Foundation)*originally printed in Science in Autism Treatment, Spring 1999http://www.asatonline.org/resources/articles/evaluate.htm

  29. Conclusions • Objective evaluation and scrutiny of the therapy by others is resisted by its promoters: According to Soma, she was waiting for the right opportunity to conduct research. She also had to prove results before research interest could be stimulated. • Promoters accuse critics and scientific investigators of persecuting them, being "close-minded," or having some ulterior motive for "debunking" the therapy:www.counteringageofautism.blogspot.com adapted from the American Arthritis Foundation)*originally printed in Science in Autism Treatment, Spring 1999http://www.asatonline.org/resources/articles/evaluate.htm

  30. Questions? Comments?

  31. References • Gersbacher, M. A. (2004). Language is more than speech: A case study. Journal of Developmental and Learning Disorder, 8, 81-98. • Solomon, O (2006 ). The Rapid Prompting Method of Communicating with Severely Autistic Children: A Language Socialization Study. Submitted to National Academy of Education. • Wombles, K.(2010, April 12) http://counteringageofautism.blogspot.com /2010/04/why-rapid- prompting-method-doesnt-pass.html • www.halo-soma.org • http://www.asatonline.org/resources/articles/evaluate.htm • (adapted from the American Arthritis Foundation)*originally printed in Science in Autism Treatment, Spring 1999 • www.youtube.com • www.mtv.com

  32. PROMPT Therapy

  33. Search Criteria • Psych Info, ERIC, and Google Search Terms: • Prompt Therapy • Prompts for Restructuring Oral Muscular Phonetic Targets • Autism and Prompt Therapy • Research on the Use of Prompt for Children with Autism • Speech/Language Interventions for Children with Autism

  34. Outline • What is Prompt Therapy? • History • Video examples of PROMPT Therapy • What Does PROMPT Therapy Claim To Do? • How is PROMPT different from traditional manual prompting techniques. • How to become certified in PROMPT. • Does Research Support the Use of PROMPT? • Example of PROMPT Recommendations from SLP • Conclusions

  35. What is PROMPT Therapy?History • Deborah Hayden, MA, CCC-SLP developed PROMPT in the 1970’s. • PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets • First used with children who presented with severe motor impairment. • In 1984, the first manual was published describing the PROMPT technique. • In the 1990’s PROMPT was refined as standardized assessment protocols were developed. Retrieved from www.promptinstitute .com

  36. What is PROMPT Therapy?History • They looked at how the interaction of all motor systems directly affect speech-motor systems control. • Also looked at the influence on speech-motor development if motor systems were damaged or pathways disrupted. • The PROMPT Institute has clinics in Santé Fe and Espanola, New Mexico. Retrieved from www.promptinstitute.com

  37. What is PROMPT Therapy? • PROMPT method applies external tactile-sensory information in order to create new and more intact motor pathways. • The PROMPT instructor places his/her hand on the student’s face around the mouth area in order to facilitate correct articulation of words. Retrieved from www.promptinstitute.com

  38. Videos of PROMPT Therapy • Deborah Hayden speaking about PROMPT: • http://www.youtube.com/watch?v=oa9KOMtY-N0&NR=1 • Demonstration of PROMPT with a student: • http://www.youtube.com/watch?v=Pbul2YP8pL4 • Demonstration of PROMPT technique: • http://www.youtube.com/watch?v=osSBtHV0JZY&feature=related • http://www.youtube.com/watch?v=WOIizoHp43Q&feature=related • Questions? Comments? Retrieved from www.youtube.com

  39. What Does PROMPT Claim To Do? • Described as a multidimensional. • Physical-sensory aspects of motor planning. • Social-emotional aspects. • Cognitive-linguistic aspects. • Uses “touch” as prime sensory modality. • Touch helps to provide “sensory input” regarding placement of mouth, jaw, head, torso, lips etc… Hayden, D.A. (2004). PROMPT: A tactually grounded treatment approach to speech production disorders. In I. Stockman (Ed.), Movement and action in learning and development: Clinical implications for pervasive developmental disorders (pp. 255–297). San Diego, CA: Elsevier–Academic Press.

  40. What Does PROMPT Claim To Do? • The surface tactile prompts provide: • The student with input about place of articulation. • The amount and type of muscular contraction. • Movement transition. • Timing needed to produce speech sounds. • Enhances social-emotional interactions with child and therapist. • Helps to re-establish or develop motor control of speech production. Hayden, D.A. (2004). PROMPT: A tactually grounded treatment approach to speech production disorders. In I. Stockman (Ed.), Movement and action in learning and development: Clinical implications for pervasive developmental disorders (pp. 255–297). San Diego, CA: Elsevier–Academic Press.

  41. How is PROMPT Different From Traditional Manual Prompting? • There are two major differences that PROMPT is different. • PROMPT claims to provide a tactile prompt at the point of muscle constriction to activate the specific muscles to produce sound. • PROMPT does not require a vocal response from the student when applying the tactile prompt. They claim they are mapping the response. There are no criteria when to require a vocal response. Questions? Concerns? Interpretation by SLP-CCC,BCBA

  42. How To Become Trained in PROMPT • *Must be a certified SLP in order to take course work. • Introduction to PROMPT technique: • Three day workshop for $700.00 • On-Line Course: PROMPT Treatment Planning • One-day online course for $150.00 • PROMPT technique practicum (self-study): • 30 days to complete video recorded sessions of person using PROMPT with a child. First video should be 3 min showing pre-PROMPT intervention. Followed by a 7 min videos showing use of PROMPT during two interactive therapy activities. Videos are then sent to a PROMPT certified clinician for review and feedback. $175.00 Retrieved from: www.promptinstitute.com

  43. How To Become Trained in PROMPT • Bridging PROMPT to intervention: • A three-day workshop for $700.00 • PROMPT certification project: • Write a detailed assessment of a client’s abilities across domains and write a holistic intervention approach as well as development of parent goals. Provide plan that was developed over a four month time treatment time frame to the PROMPT Institute for review. $350.00 • ** One can also hire a PROMPT mentor to assist and review your skills for $100.00 per session. Retrieved from: www.promptinstitue.com

  44. Does Research Support the Use of PROMPT? • There are unpublished studies involving the use of PROMPT with children with autism. They are not available for review: • According to the website www.promptinstitute.com a case study conducted by Chumpelik [Hayden] & Sherman,(1980) looked at an eight-year-old girl with autism who was non-verbal and displayed cognitive impairment. PROMPT was used and she reportedly learned 30 functional words. Retrieved from: www.promptinstitute.com

  45. Does Research Support the Use of PROMPT? • Book Chapter: PROMPT: A Tactually Grounded Treatment Approach to Speech Disorders: Movement and Action in Learning and Development:Clinical Implications for Pervasive Developmental Disorder. (2004) p. 255-297. • Edited by: Ida Stockman • Provides a detailed history of PROMPT and it’s techniques • Only provides case studies for children with autism. • Reports there is a disconnect between the brain and tactile-kinesthetic senses Hayden, D.A. (2004). PROMPT: A tactually grounded treatment approach to speech production disorders. In I. Stockman (Ed.), Movement and action in learning and development: Clinical implications for pervasive developmental disorders (pp. 255–297). San Diego, CA: Elsevier Academic Press

  46. Does Research Support the Use of PROMPT? • Pilot study conducted by Rogers et al. (2006) compared the Denver Model and PROMPT to teach vocal speech to children with autism who are non-verbal. • Subjects: 10 participants age range from 20-65 months old who received an independent diagnosis of autism. • Participants were randomly selected to participant in the either the Denver Model or PROMPT Therapy. • Both groups received intervention for 1 hour per week for 12 weeks • Participants allowed to be enrolled in other interventions during study. Rogers, S. J., Hayden, D. Hepburn, S., Charlifue-Smith, R., Hall, T., & Hayes, A. (2006). Teaching young nonverbal children with autism useful speech: A pilot study of the Denver Model and PROMPT interventions. Journal of Autism and Developmental Disorders, 36(8), 1007–1024.

  47. Does Research Support the Use of PROMPT? • Design: Single subject using a reversal design (A-B-A) • Three baseline probes were conducted • During intervention sessions, parents observed either in vivo or video camera. They were asked to practice the new skills at home. • Treatment fidelity was assessed for 25% of the sessions at achieved a rate of 85% or better across those sessions. Rogers, S. J., Hayden, D. Hepburn, S., Charlifue-Smith, R., Hall, T., & Hayes, A. (2006). Teaching young nonverbal children with autism useful speech: A pilot study of the Denver Model and PROMPT interventions. Journal of Autism and Developmental Disorders, 36(8), 1007–1024

  48. Does Research Support the Use of PROMPT? • Results: • 8 out of the 10 participants learned at least five functional spontaneous words by the end of the 12 weeks. • These participants demonstrated generalization of language skills in the home setting. • Two of the participants (one in each model) did not acquire any functional language. • Discussion • Both interventions produced similar results. • Parental involvement probably played a significant role. • Another study needs to be conducted for replication. Rogers, S. J., Hayden, D. Hepburn, S., Charlifue-Smith, R., Hall, T., & Hayes, A. (2006). Teaching young nonverbal children with autism useful speech: A pilot study of the Denver Model and PROMPT interventions. Journal of Autism and Developmental Disorders, 36(8), 1007–1024.

  49. What are some SLP’s recommending for Children with Autism • The following document is an actual formal list of recommendations for a seven-year-old learner with autism from a speech-language pathologist after a one-day in-office evaluation.

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