Hand Over Hand Prompting for Children With Disabilities

Female teacher and schoolboy in classroom

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Prompting is an important tool in teaching children with disabilities, especially those whose disabilities significantly affect their ability to learn functional or life skills. The goal of this technique is to provide instruction and support when a student is learning a new skill by encouraging them through the steps. Prompting is used often in general education classrooms but manifests itself very differently and serves different purposes in a special education setting.

Prompting children with disabilities may require employing either invasive and physical cues or less invasive, nonphysical cues. Prompting helps foster independence in students with disabilities as they become able to perform more tasks for themselves. The appropriate direction depends on the scenario and the child, so be sure to always consider individual needs and think about your relationship with the child when deciding on the best choice. The most common method of physical prompting is the hand over hand technique.

What Is Hand Over Hand Prompting?

Hand over hand prompting is the most invasive of all prompting strategies as it requires a teacher to physically manipulate a child's body. Also known as "full physical prompting," it often involves performing an activity with a student. To use this cueing system, the person teaching a skill places their hand over a student's hand and directs the child's hand with their own. Hand over hand prompting can teach a child how to perform important skills such as properly using a pair of scissors, tying their shoes, or writing their name.

Example of Hand Over Hand Prompting

Emily, a 6-year-old with multiple disabilities, requires a very high level of support when learning gross and fine motor skills. In an example of effective hand over hand facilitation, her aide, Ms. Ramona, places her hand over Emily's as Emily learns to brush her teeth. Ms. Ramona shapes Emily's hand into a proper brush grip and guides her student's hand through the back and forth brushing motion while holding it in her own.

Considerations When Using This Technique

Hand over hand prompting should be used sparingly and is not be used exclusively (in most cases—consult a student's IEP to identify necessary adaptations). Less invasive teaching techniques tend to be most appropriate long-term. For this reason, full physical prompting is best-suited for initial instruction and should be phased out as a new skill is acquired. Visual, written, and other nonphysical prompts should eventually be used in place of hand over hand prompting and multiple types of prompting can be joined together at once to make this transition more fluid.

Examples of Phasing Out Hand Over Hand Prompting

A teacher and student use a pair of scissors together for the first few times the child performs the action. Once the student understands what they are expected to do, the teacher begins to present visual cue cards as they execute the action together and use their hand over the child's hand for less time. Soon, the child will be able to demonstrate the desired behavior using only the cue cards as a reminder.

To replace full hand enclosure when teaching a child to brush their teeth, a teacher can tap a finger on the back of a child's hand to remind them of the grip formation. With enough practice, the student can brush their teeth independently upon verbal direction.

Other examples of nonphysical prompting that can be integrated into a child's routines in order to phase out hand over hand prompting are verbal direction, modeling, photographs or cue cards, hand gestures, and written cues.