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PROMPT Speech Therapy, Looking at the WHOLE Child

PROMPT therapy stands for PROMPTS for Restructuring Oral Muscular Phonetic Targets. During PROMPT therapy, the speech therapist will touch and move the patient’s tongue, lips, jaw, and cheeks to help elicit and correct certain sounds. All the PROMPTS are done on the outside of the face.

When most people think of PROMPT they think of the physical part of a therapist touching and cueing the patient’s face. However, PROMPT actually takes a look at the whole child’s physical-sensory, social-emotional, and cognitive-linguistic domains. It addresses the whole child and just not their physical deficits. For example, a child may have a difficult time taking turns with peers at school (social-emotional). PROMPT will focus on physical prompts making intercommunication (turn-taking words) more clear, such as: my turn, I go, you go, me, and you. Once the child is able to play with a peer successfully with their new intelligible words, their confidence in their speech should increase. This new gained confidence in their social-emotional domain will motivate them to work harder in the physical-sensory domain. All the domains work together!

The Physical-Sensory domain includes speech articulators (i.e. tongue, lips, jaw), sensory processing ability, overall physical ability, sensation, and skeletal structure. Speech therapists can assess the speech articulators but often need to consult with neurologists, physical therapists, and occupational therapists to get a clearer picture of where the child is at. I have learned so much about my patients from these other professionals! After talking to an occupational therapist, I learned that one of my patients had very poor core strength. He was always slouched and mumbled most of his words. I presumed he was unmotivated to work on his speech and defiant, when in reality, he just couldn’t sit up long enough to work on speech. He was referred to OT where he got core work, and the OT gave me suggestions to help his core strength in speech. When he was able to sit up, he gave better eye contact, and others were able to understand him better. His attitude and confidence improved!

The cognitive-linguistic domain is the child’s ability to process information, both cognitively and through their senses. A speech and language pathologist will assess their expressive and receptive language skills. Psychological testing may be requested as well. With most all of my PROMPT patients, they are unable to do cognitive or language testing because of their delays in the physical-sensory domain. If a language test is assessing their ability to enunciate plural -s for “dogs” but the patients cannot make an /s/ sound they are not going to do well in this area. A child is not going to perform well on a cognitive assessment if they are not being understood.

The social-emotional domain takes into consideration interpersonal reaction and trust. Being social is hard for our speech delayed kids. Not being able to be understood by their peers may cause them to become withdrawn. They may even appear antisocial, when in reality they just need the tools to express themselves! Many of the children with severe speech delays come to me after several unsuccessful therapies. They are frustrated and don’t want anything to do with a speech therapist. Not only do they need to trust that I am going to try to help them, they need to trust me enough to touch their face. Using reward systems and positive reinforcement lets the patient know that they are getting better and getting rewarded for trying! This is where we would determine a vocabulary of words to work on to encourage them to be more confident and social.

We know that all of these 3 domains affect overall communication. If one is lacking, it’s going to affect the other. This is why it is important to do a full assessment of your child so support every part of their communication system.

Nicole Yates
About the author

I have been working in the speech-language field since 2007. I received my undergraduate degree from the University of Florida in 2006, and my masters from University of South Florida in 2009. I have worked in the school system, hospital, independent clinic, and home health settings. I decided to leave the hospital to work for myself, because I was frustrated with the amount of children required for me to see daily. Starting my own company has allowed me time to adequately prepare for each of my patients so that I can serve them and their families in the best way possible. Every child is so different, and I can now give them the time they need. I myself was in speech therapy as a child and know what it feels like not to be understood. It is my passion to help every child reach their fullest potential in the area of communication. There is nothing more fulfilling than hearing a child tell their parents they love them for the first time! I would be grateful to be a part of your child’s journey.