Hand-Over-Hand and the Missing Request
Andre is 9, has autism and a moderate-to-severe intellectual disability, and uses a picture exchange system. He has no vocal speech. During snack, a paraeducator holds the picture card, says 'Andre, request,' and guides his hand to pick up the card and place it in her hand; she then gives him a cracker. The data sheet shows 0/10 independent requests and 10/10 with full physical prompting across 15 days. The teacher concludes, 'He doesn't initiate, so we need to keep the physical prompt.' The SLP notes that Andre will reach for a cracker when it is held out of reach and that he looks at the para's hand before the prompt. The classroom has 8 students, 3 paraprofessionals, and a snack routine at 10:15 daily. The IEP goal says 'Andre will request wants and needs using PECS with 80% independence across three consecutive sessions.' The team meets to revise the plan.
1. What does the data pattern suggest about the function of the physical prompt, and what is wrong with the current teaching procedure?
Read the worked answer
The data pattern-0/10 independent and 10/10 with full physical prompting for 15 days-suggests prompt dependency. The paraeducator's hand guidance has become the discriminative stimulus for requesting: Andre waits for the prompt because the prompt reliably predicts the cracker. The procedure also fails to provide a clear opportunity for an independent response; the prompt is delivered immediately, and the reinforcer follows the prompted response. This teaches 'wait for hand-over-hand,' not 'exchange a picture.' The fact that Andre reaches for a cracker held out of reach and looks at the para's hand supports this: he is motivated and aware of the routine, but the prompt has overshadowed the picture. The current plan is not evidence that Andre 'can't do it'; it is evidence that the teaching procedure needs to change. The team should shift to a plan that makes the picture, not the adult's hand, the signal for reinforcement.
2. Design a step-by-step plan to increase independent requesting while maintaining communication success.
Read the worked answer
Plan: (1) Conduct a brief preference assessment to identify three high-value snacks. (2) Arrange the environment: place the picture card within reach, hold the snack visible but out of reach, and do not hold the card. (3) Use a constant time delay: on the first trial, provide an immediate model or point prompt; on subsequent trials, wait 3–5 seconds before prompting. (4) Use least-to-most prompting-gesture, point, partial physical, full physical-and fade within and across trials. (5) Reinforce every independent exchange immediately with the requested item plus praise; for prompted exchanges, still honor the request but do not add extra reinforcement. (6) Train the paraeducator with modeling, a fidelity checklist, and video review. (7) Collect trial-by-trial data on independent, gestural, and physical prompts. (8) Across five days, start with one highly preferred item and one adult, then add a second item and a second adult. (9) If independent requests do not increase, reassess preference and the response requirement. The goal is more independent communication, not perfect silence.
3. How should the team respond if the paraeducator continues to use full physical prompting after training?
Read the worked answer
First, treat it as a training and fidelity issue, not insubordination. The teacher should review the data with the paraeducator, model the time-delay procedure, and provide a written checklist. A brief video of the paraeducator's own session can be used for self-monitoring. The teacher should give positive feedback for approximations and set a specific goal for the next session, such as 'wait three seconds before prompting on five trials.' If the paraeducator continues to use full physical prompting, the teacher should document the discrepancy, re-train, and involve the principal or special education supervisor. The teacher remains responsible for IEP implementation and must ensure the plan is followed. If the behavior poses a safety risk or the paraeducator refuses, follow district personnel procedures. Throughout, keep the focus on Andre's communication and avoid blaming the paraeducator in front of students. A systems issue-lack of training or supervision-may be the root cause.