Autism spectrum disorder (ASD) is characterized by stereotyped patterns of behavior, communication difficulties, and social impairments (Crosland & Dunlap, 2012). Autism spectrum disorder can significantly vary in magnitude and by its topography or shape. Antecedent procedures are individualized strategies used for people with ASD that manipulate the environment to evoke a response or decrease a challenging behavior (Crosland & Dunlap, 2012). Common antecedent interventions consist of visual schedules, verbal prompts, modeling, prompt training, and auditory prompts. (Crosland & Dunlap, 2012). It is critical to decide which practical skill to teach and selecting which technology to use for persons with developmental disabilities.Auditory prompts are a common form of stimulus prompt. However, the amount of research in this area is limited (Lancioni, Klaase, & Goossens, 1995). According to Mechling and Savidge (2011), “a critical skill for students with autism spectrum disorder is the ability to function independently throughout the day, which includes moving from one location to the next and completing tasks within those locations” (p. 687). Moving between daily activities scheduled at school, work, home, or treatment centers is defined as transitions (Palmen, Didden, Verhoeven, 2012). Many individuals with ASD have issues making transitions in their daily functioning, including moving locations and steps within an activity. It is important that children learn to independently make transitions without problem behavior (Ferguson, Ashbaugh, O’Reilly, & McLaughlin, 2004). Therefore, decreasing problem behavior during transitions increases independence and improves the quality of life for the individual with ASD. For most parents of individuals with ASD, the primary goal is to increase their independence (May & Heflin, 2011). Some research has been done using external stimuli such as auditory cues preceding the occurrence of behaviors to promote independence (Mechling & Gustafson, 2009). Research has shown that auditory cues have been successful in promoting independence in completing tasks (Lancioni, Klaase, & Goossens, 1995). It has also shown that auditory cues using handheld systems have helped individuals transition independently through vocational tasks (Cihak, Kessler &, Alberto, 2008).Axelrod, M. I., & Zank, A. J. (2012). Increasing classroom compliance: Using a high-probability command sequence with noncompliant students. Journal of Behavioral Education, 21(2), 119-133.Axelrod and Zank (2012) examined the use of high probability commands sequences on two elementary-age students who engaged in high rates of noncompliance within the general education setting. High probability commands sequences (HPCS) consist of simple commands that have high probability (High-p) of compliance prior to a command that has a lower probability of compliance (Low-p). The momentum of compliance from the High-p commands increase the likelihood of compliance to the Low-p commands. Baseline consisted of the teachers choosing Low-p commands and using verbal praise when the students were compliant and ignoring any noncompliance, waiting a minute before issuing another Low-p command. In the intervention condition teachers gave three High-p commands and then one Low-p command. A multiple-baseline design was used across the participants that measured the percentage of compliance. The percentage of compliance for commands were higher for both participants in the intervention rather than the baseline. A limitation to this study was the commands were given by two different teachers, therefore compliance could have been different depending on which teacher delivered the command.Cihak, D., F., Kessler, K., & Alberto, P. A. (2008). Use of a handheld prompting system to transition independently through vocational tasks for students with moderate and severe intellectual disabilities. Education and Training in Developmental Disabilities, 43(1), 102-110.A multiple-probe design conducted by Cihak, Kessler, and Alberto (2008) examined the use of a handheld prompting system to transition independently through vocational tasks. Participants have moderate to severe intellectual disabilities. This study used event recording of the number of times a participant would transition independently to ten separate vocational tasks. Baseline recorded student’s independent transitions without any assistance. Supervisors would only aid after a ten-second interval with no response. During the intervention, students were provided with the prompting system and headphones. The handheld prompting device provided the student with a picture and an auditory prompt of the task when the student pressed icons. Results showed that when students were using the handheld system to transition, independence was increased and then maintained at 100%. A limitation to this study was that the tasks were all familiar. They were not new, which may contribute as to why the independent transitions were at 100% with the handheld prompting system.Ferguson, A., Ashbaugh, R., O’Reilly, S., & McLaughlin, T. F. (2004). Using prompt training and reinforcement to reduce transition times in a transitional kindergarten program for students with severe behavior disorders. Child and Family Behavior Therapy, 26(1), 17–24.Ferguson, Ashbaugh, O’Reilly, and Mclaughlin (2004) conducted research on the prompt training and reinforcement to decrease transition time in a kindergarten program. A multiple baseline design was used across fourteen boys with severe behavior disorders in a special education kindergarten classroom. Morning sessions had six young males while the afternoon had eight. Baseline consisted of transitions being signaled by an auditory prompt and a verbal prompt, students who did not follow directions were instructed again and then if no response was given they were eventually physically assisted. Prompt training consisted of the teaching the students to freeze when hearing the bell and listening for instructions. Prompt training and reinforcement condition consisted of the same auditory prompt of the bell and verbal prompting and students who both transitioned immediately and cleaned up were given an edible reinforcement. Results indicated that students receiving prompt training decreased the amount of problem behavior during transition. A limitation of this study was the variation in both time of day and activity the training occurred in as there may have been a difference between transition times in the morning sessions versus the afternoon sessions.Lancioni, G. E., Klaase, M., & Goossens, A. (1995). Brief report: pictorial vs. auditory prompt systems for promoting independent task performance in adolescents with multiple handicaps. Behavioral Interventions, 10(4), 237–244.Research conducted by Lancioni, Klaase and Goossens (1995) assessed whether pictorial prompt systems or auditory prompt systems were more effective for promoting independent task performance. Participants consisted of a boy and girl both age thirteen with multiple handicaps. Baseline consisted of tasks being presented without prompts. The tasks were then considered finished when the participants stated they were completed. Participants were given compliments and a sticker for their participation. The prompt condition was preceded by twelve sessions in which participants were familiarized with the prompts. The participants were given a choice at the beginning of each session on which prompt system they wanted. Participants used the pictorial prompt system and auditory prompt system on their own and were given guidance if not used correctly. At the end of the intervention sessions, compliments and stickers were also given at the completion of the task. The results of the study indicated that pictorial and auditory prompt systems were both effective in promoting independent completion of tasks.  Limitations of this study were the time-consuming use of the cassettes and the participants having a choice of prompting systems which may have skewed the results as one prompting system may have been selected more than the other.Matheson, A. S., & Shriver, M. D. (2005). Training teachers to give effective commands: effects on student compliance and academic behaviors. School Psychology Review, 34(2), 202–219.Matheson and Shriver (2005) conducted research on the effects of command training teachers on student’s compliance rates and academic engagement. Participants included three students and three general education teachers. Percentage of student compliance to teacher’s commands was measured as the primary dependent variable. A multiple-baseline design was used; baseline consisted of recording the percentage of compliance of the three students when the teachers gave a command without any command training. The teachers were trained to give effective commands that were specific, given one at a time, precise, have a distinct outcome (alpha commands). Alpha commands also included only one verb in a quiet tone and positively stated. Teachers were also trained to give verbal praise. The intervention consisted of teachers implementing the learned effective commands with verbal praise and recorded percentage of compliance. All students showed an overall increase in compliance with the use of effective commands and all teachers increased the use of effective commands after the training phase. A limitation of this study is that it fails to do a component analysis of what part of speech or dictation of the command was effective or if it was all of the components of the alpha commands.Mays, N. M., & Heflin, L. J. (2011). Increasing independence in self-care tasks for children with autism using self-operated auditory prompts. Research in Autism Spectrum Disorders, 5(4), 1351–1357.Research conducted by Mays and Heflin (2011) evaluated the effects of self-operated auditory prompt systems on self-care tasks for children with autism spectrum disorder and intellectual disabilities. The prompt systems consisted of tape recorders with prerecorded verbal prompts of washing hands and brushing teeth. A multiple baseline across participants was used to evaluate effectiveness. Baseline consisted of one opportunity for participants to complete all the steps in a task with all materials present and one verbal cue. In the intervention condition participants were given the cassette tape and given one verbal cue to “wash your hands” or “brush your teeth”. In each condition every step was marked as independent if completed correctly or absent if skipped. Results indicated that the self-operating auditory prompt systems were effective in teaching independence skills for hand washing and brushing teeth. A limitation of this study is it lacks comparison to other prompts and teaching methods; therefore, the knowledge of its effectiveness is limited.Mechling, L. C., & Gustafson, M. (2009). Comparison of the effects of static picture and video prompting on completion of cooking related tasks by students with moderate intellectual disabilities. Exceptionality, 17(2), 103–116.An adapted alternating treatments design with baseline conducted by Mechling and Gustafson (2009) compared the effects of static picture and video prompting on the independent performance of cooking related tasks. Participants consisted of six young adults, in high school, with moderate intellectual abilities. Baseline condition demonstrated the participants performance on twenty cooking tasks without presence of static picture or video prompts. Static picture systems were laminated photographs matching the dimensions of a DVD screen depicting the steps needed to complete the tasks. Video prompting consisted of an adult model completing a step with verbal cues and pausing for the participant to complete the step. Data was collected by percentages of correct performance of cooking related tasks. Results indicated that there was a functional relation of static picture and video prompting increasing the percentage correct performance. Video prompting also showed to have higher percentages than static picture. A limitation of this study is that video modeling should have been broken down by component showing if the verbal cues on the video had an effect to the video modeling.Mechling, L., & Savidge, E. (2011). Using a personal digital assistant to increase completion of novel tasks and independent transitioning by students with autism spectrum disorder. Journal of Autism & Developmental Disorders, 41(6), 687–704.Mechling and Savidge (2011) evaluated the use of a personal digital assistant on the completion of novel tasks and independent transitioning on participant with autism spectrum disorder. Participants consisted of two males and one female all middle school aged diagnosed with autism spectrum disorder. A multiple probe design was used across three sets of novel tasks. The personal digital assistant has multiple levels of prompts including, video, picture, and auditory. Baseline condition consisted of probes to evaluate the participants abilities to complete sets of novel tasks without the use of the personal digital assistant However during transitions participants were already familiar with a picture-based task strip system and that was continued use during baseline. During intervention the personal digital assistant used multi-level prompting to assist participants with novel tasks and transitioning between tasks. Results showed task completion to be higher for two out of three participants using the personal digital assistant. A limitation of this study is that adults were present during the use of the personal digital assistant and stopped the participants after five minutes on each task therefore it cannot be evaluated in this study as a true self-prompting device.Palmen, A., Didden, R., & Verhoeven, L. (2012). A personal digital assistant for improving independent transitioning in adolescents with high-functioning autism spectrum disorder. Developmental Neurorehabilitation, 15(6), 401–413.Research conducted by Palmen, Didden and Verhoeven (2012) examined the effects of a personal digital assistant on improving independent transitioning in adolescents, with high functioning autism spectrum disorder. Participants consisted of four young adults ages 14-23 years old with high functioning autism spectrum disorder. The study was conducted in a day treatment facility and six regular staff members implemented the intervention and recorded transition behavior. In the baseline condition a personal digital assistant was not used and regular staff prompting was used during transitions. The staff received training on how to use the personal digital assistants prior to intervention. During intervention auditory prompts from the personal digital assistant alerted transitions to participants. Event recording was used to record the participants correct independent transitions, prompted incorrect independent transitions and unprompted incorrect independent transitions per day. A multiple baseline design across participants was used; results indicated a significant improvement in transitioning independently for three participants. A limitation of this study is that the participants were already given the same prompts by staff that were within the participants repertoire. In the future, a study may evaluate the effects of a personal digital assistant on skill acquisition and new transitions.Wilder, D. A., Atwell, J., & Wine, B. (2006). The effects of varying levels of treatment integrity on child compliance during treatment with a three-step prompting procedure. Journal of Applied Behavior Analysis, 39(3), 369–373.A multielement design with a baseline phase conducted by Atwell and Wine (2006) examined the effects of varying levels of treatment integrity (100%, 50% and 0%) on compliance during treatment with a three-step prompting procedure. Participants included two preschool children that were typically developing. Sessions were conducted in a small tutoring room or on the playground at the participant’s school. This study’s dependent variable was percentage of compliance, and the independent variable was levels of treatment integrity. Baseline consisted of simple demands (“give snack”, “toy away” and “come here”) that if participants were compliant resulted in a brief praise. Intervention consisted of the same instructions present during baseline however if participants were not compliant, they provided first a verbal prompt, then a modeling and finally a slight physical prompt if still not compliant. Three different levels of treatment integrities were implemented either 100% of the time compliance was reinforced, 50% of the time compliance was reinforced or 0% of the time compliance was reinforced. Results indicated that 100% integrity resulted in the highest percentage of compliance. A limitation of this study is that no preference assessments were conducted therefore it is unlikely to know the probability of the commands.For more details about different ABA therapy services we offer, please click here.

The reviewed research conducted on the use of auditory signals has shown effectiveness in increasing independence and reducing behaviors during transitions on individuals with autism spectrum disorder. These studies examined the use of various methods of auditory prompts such as handheld systems, personal digital assistants, self-operated auditory prompts, and video prompting with auditory cues. Participants ranged from typically developing to having varying developmental disorders and their ages were from elementary aged to adults. Post and Storey (2002) concluded further research is needed to assess more individuals varying in different communities and work settings. Also assessed, was the lack of studies commenting on the social appropriateness of using an auditory prompt system as it may be stigmatizing to individuals using the system. Issues may arise of the time and cost needed to pre-record these prompts as well. Post and Storey (2002) also suggest expanding on the schedule and delivery of these auditory prompts and to what extent these auditory prompts can be faded. It is also beneficial to study what are the needed skills of individuals with autism spectrum disorder in using an auditory prompt. When studying the comparison of static picture versus video prompting with auditory cues Mechling and Gustafson (2009) found that both were successful in increasing performance. Further research could be done on comparing auditory prompting versus other antecedent interventions on increasing independence during transition. Direct observation of larger sample sizes in various communities such as schools and places of work would produce greater internal and external validity. Research on the steps needed to fade an auditory prompt would also be beneficial to therapists who wish to apply auditory prompting increasing its social validity. An alternating treatments design with baseline could be used to compare auditory prompting versus a visual schedule on their effects during classroom transitions. A reversal design could also be used to determine the effectiveness of a using a bell as an auditory prompt in the classroom to signal transition to activities. Overall, research has assessed and indicated that auditory prompts are an effective treatment in increasing independence and increasing performance during transitions in children with autism spectrum disorder. Additionally, increasing individual’s ability to transition with less problem behaviors opens their learning abilities, independence skills, and improves quality of life.For related research, news and updates, follow us on Facebook, Instagram, LinkedIn, and Twitter

Crosland, K., & Dunlap, G. (2012). Effective strategies for the inclusion of children with autism in general education classrooms. Behavior Modification, 36(3), 251–269.Post, M., & Storey, K. (2002). Review of using auditory prompting systems with persons who have moderate to severe disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 37(3), 317-327.