How does a cueing hierarchy function in AOS therapy?

• A. Start with strong cues (modeling, touch cues) and progressively fade cues as accuracy improves, moving toward independent production.
• B. Start with no cues and increase cues over time.
• C. Use cues only for the most difficult utterances.
• D. Maintain constant cues throughout therapy.

Answer: (B)

The main idea behind a cueing hierarchy in AOS therapy is to scaffold practice by adding supports as needed to guide correct speech movements. You start with attempts that have no external cues, allowing the client to attempt production independently. If accuracy isn’t achieved, you incrementally introduce prompts—more cues are provided as tasks demand greater control or as errors occur—so the learner receives the right level of guidance to shape the motor pattern. This gradual increase in cueing helps ensure successful productions earlier in the learning process and builds a stable motor plan that can later be produced with less support once mastery is closer.

Over time, as the client’s accuracy improves, cues can be faded again to promote independence. The approach contrasts with starting with strong cues, using cues only on the hardest items, or keeping cues constant across therapy, all of which undermine the progressive, responsive scaffolding intended by the cueing hierarchy.