Simultaneous Prompting for Students with Significant Cognitive Disabilities: A Systematic Review and Meta-Analysis of Evidence-Based Practice

Background: Students with significant cognitive disabilities (SCD) require intensive, systematic instruction to acquire academic and functional skills while minimizing error rates that can lead to frustration and disengagement. Simultaneous prompting (SP) is an errorless learning procedure with established efficacy, yet limited recent synthesis has specifically examined its application for students with SCD. This systematic review evaluated the evidence base for SP interventions targeting students with SCD. Methods: Following PRISMA guidelines, we searched five electronic databases (Web of Science, EBSCOhost, PubMed, ScienceDirect, JSTOR) on 20 May 2026 and identified 47 studies meeting inclusion criteria: (a) single-case designs, (b) participants under age 18 who were either explicitly identified as having moderate to severe intellectual disabilities, or had a reported IQ below 50, or receiving alternate assessment services, and (c) SP as part of the intervention. Results: Across 38 studies meeting WWC standards with or without reservations, SP produced a large overall effect (pooled Tau-U = 0.90, 95% CI [0.84, 0.96]), with between-study variance accounting for 12.9% of total variance. Interventions targeted reading/literacy (40.4%), math (19.1%), social/cognitive skills and daily living (12.8% each), and communication skills (8.5%), primarily in one-to-one formats (78.7%) within classroom settings (74.5%). Teachers (57.4%) were the most common implementers, with limited representation of paraprofessional-delivered (8.5%), peer-mediated (8.5%), and caregiver-delivered (4.3%) approaches. While treatment fidelity was universally reported (100%), generalization (21.3% unassessed) and long-term maintenance (>3 months: 2.1%) were inconsistently documented. Social validity was reported in 55.3% of studies. Discussion: These findings establish SP as an evidence-based practice for students with SCD with large effects across skill domains. However, gaps remain in generalization programming, maintenance assessment, and implementation by peers and caregivers. Implications for instructional practice and future research priorities are discussed.