In this guide to cueing in speech therapy, you’ll find the answers to your most pressing cueing questions.
What are the types of cueing? What is the speech therapy cueing hierarchy? How do you count cues?
Ready? Let’s dive in!
What’s A Cue?
A cue is a skilled hint that you give your patient to help them reach a goal. That goal may be to name a picture, speak intelligibly, or swallow safely.
Cueing sounds simple—and it may even look simple—but it takes a lot of skill. To cue successfully, you need to know where your patient is at, where you want them to be, how to get them there, and, finally, how to break that journey down into manageable steps.
Thankfully, you have all that knowledge from your speech therapy education! Now let’s learn how to use this information to cue like a pro.
Types of Cues in Speech Therapy
What are the types of cues in speech therapy?
- Verbal cues. Verbal instructions for how to produce an accurate response
- Visual (or Gestural) cues. Hand gestures, images (tapping a calendar to remind your patient to use aids to recall the date)
- Tactile cues. Touch that helps patients produce an accurate response
- Written cues. Models for writing therapy, written instructions
- Phonemic cues. Specific sounds during aphasia or motor speech therapy
- Articulatory placement cues. Positioning cues of lips, tongue, and teeth
- Environmental cues. Hints in the environment that help produce an accurate response (a visual aid or others engaging in the goal behavior)
- A mixture of cues. Record the amount of cueing provided for each
There are other cues that are specific to the type of treatment you’re doing. Examples are semantic cues during aphasia treatment or physical assistance for a patient learning AAC.
Use the language your facility uses, but try not to sweat it. As long as the language you use is consistent and accurately describes the skilled cues you’re providing, then you’re good!
What Is A Speech Therapy Cueing Hierarchy?
A speech therapy cueing (or prompting) hierarchy is how you’ll increase or fade cues during a task. There are some structured cueing hierarchies out there. But most will be made up by you, on the spot!
Examples of structured cueing hierarchies are Melodic Intonation Therapy for aphasia and Sound Production Treatment for apraxia of speech. These treatment approaches have their own recommended cueing hierarchies.
So how do you cue during all of the other treatments that you use with your patients? Keep scrolling!
How To Cue During Speech Therapy
When working on a task with your patient, ask yourself this one question:
“In this moment, how can I make this task the just-right challenge?”
You want your therapy to meet this middle ground of the just-right challenge. This means not too easy (because then the patient won’t improve). But also not too hard (because this can lead to frustration, less motivation, or can even be unsafe).
Your cueing hierarchy will often consist of fading cues. This means that the hierarchy starts with more supportive cues given more often and then systematically fades down to less supportive cues given less often.
How To Cue: Memory Task Example
Let’s say that you have an orientation goal and will use spaced retrieval to help your patient remember the answer to the question, “Where do you live now?”
Your cueing hierarchy begins with you immediately verbally modeling the target answer as often as it takes until the patient can say it correctly.
Once they can generate the target answer, you systematically decrease how often you cue to every 15 seconds, then every 30 seconds, 1 minute, etc.
Eventually, a laminated sign by the door (an environmental cue) helps them remember where they live now.
If you’re giving lots of cues but your patient is still having a hard time getting to the target response, this may mean that the task is too hard.
If you’re giving no cues, then the task may be too easy or your patient may have mastered it and no longer needs your help.
How To Record Cues
How do you record your cues during a treatment session? First, set aside the clipboard and pencil to really focus on teaching your patient the task.
Take the time you need to explain the task, walk them through the target response, and otherwise warm up. This focused engagement is person-centered care!
Now pull the clipboard closer and do the task with your patient. After each attempt that your patient makes, you’ll jot down how they did.
Here’s how to do that!
- If correct, write “+” next to the answer
- If incorrect, give a minimal cue
- If now correct write “min+”
- If still incorrect, give a moderate cue
- If now correct, write “mod+”
- If still incorrect, give a maximal cue
- If now correct, write “max+”
- If still incorrect, write “-”
Be sure to write down the type of cue that you gave. For example, “min+ verbal” “max+ written”
Of course, as you get the hang of it, you’ll jump to the right level of cueing without going through all the steps!
More Adult Speech Therapy Resources
Good luck in your cueing journey!
For more resources to help you assess, treat, and document, check out The Adult Speech Therapy Starter Pack!