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Software to Teach Nonverbal Persons with Severe Autism and

Retardation to Communicate by Pointing to Pictures
Matthew L. Israel, Lisa Ruthel, Michael Bates, & Nancianne Smith
Behavior Research Institute
Providence, Rhode Island 02909
Little sojiware exists for nonverbal persons with severe
and profound autism and retardation. PoinToCount” is a
set of self-teaching computer programs that teaches such
persons how to communicate basic needs by pointing to
pictures. Self-abusive and aggressive behaviors, often
displayed by autistic and retarded persons, are sometimes
thought to be the only means such persons possess to
make their needs known. By teaching a more acceptable
f orm of communication, PoinToCount TM serves an
important treatment function. The software also teaches a
variety of basic skills, including beginning reading and
math skills, and skills to enable vision testing.
Programmed instruction, behavior modification, and
precision teaching features, such as devices (Figure 1) that
automatically dispense edible rewards when certain criteria
(e.g. rate correct and rate incorrect) are met, are
Persons with severe autism and retardation often cannot
speak. Some believe that the aggression and self-abuse
that such individuals often display derives from their
inability to communicate. One method of communication
such individuals can learn is to point to pictures. Anideal
vehicle for teaching this would be self-teaching computer
software. However, no software for this purpose has been
available until now.
Behavior Research Institute (BRI) has developed such
software, called “PoinToCountrM,” and has tested it, over
a two-year period, with approximately 40 of its students
with autismand retardation.
Program content
The topics covered include the following:
Pointing to a stationary shape;
Tracking a shape from one position to another;
Learning to touch the screen or not, in response to a
direction fromthe computer;
Learning to match-to-sample items of similar shape;
Matching E’s (vision-testing skill);
Matching letters and numbers;
Associating lower and upper case letters;
Typing letters and numbers in response to their
dictated names;
Counting the shapes in a set, and typing the result;
Matching symbol pictures;
Pointing to a picture when the computer says its
Asking for an item by pointing to it in response to
the computer’s question, “What do you want?”
pi ct ure, causi ng aut omat i c reward
dispenser (right) t o del i ver f ood reward.
0-8186-2730-1/92 $3.00 0 1992 IEEE
Program features
The software incorporates concepts from behavior
modification [l], programmed instruction [2,3], and
precision teaching [4,5].
Programmed instructional design
The target skills have been analyzed into their basic
components, and taught in a carefully programmed order.
Each programteaches only one small skill beyond those
already taught in previous programs. In the early programs
of the series, the student points to answers, using a
touchscreen. In later programs, the student types answers
on thekeyboard.
The programs build fromsimple to complex skills.
The first programhas no prerequisites and involves merely
touching the touchscreen. The last programin the series
involves hearing the computer say, “What do you want?’
and responding by touching a picture symbol to indicate
thedesired item.
Figure 2 shows twelve steps in the sequence of
programs that teaches communicating by pointing to
pictures, and illustrates the small steps and the
“prompting” techniques that help insure correct answers.
1. In the first program, the student touches a shape
which always appears in the center of the screen.
Step 1 Step 2
Step 5 Step 6
[Computer:] ”Poin;
to the bathroom.
i i
Step 9 Step 10
5 .
On the next few programs, the shape appears in a
different place on the screen on each trial. In these
programs the student must look at the screen to
find where the shape is, before pointing to it.
Three transparent templates-with 1, 5, and 10
holes respectively-are provided to help the
student make a clear-cut pointing response.
The student learns first to touch the shape at the
top of the screen (the “sample”) and then to touch
the same shape in the line below (the “choices”).
The line below has some incorrect choices, but
these are easy to reject, because they differ from
the sample in size, shape, and color.
On this step, the same skill as in step 2 is
required. The only difference is that the shapes that
appear as the sample and as the correct choice are
now different ones from the one the student
became accustomed to in steps 1 and 2.
The incorrect choices are now slightly larger.
However, they still differ from the sample in
color, size and shape.
The wrong choices now differ only in color and
shape. They are now the same size as the sample.
Now the wrong choices differ only in shape.
However, the student is still prompted to respond
correctly by the fact that all of the incorrect
choices are identical to each other.
Here the wrong choices are no longer identical
shapes. Each is now a different shape.
Step 7
[Computer:] “What
Step 11
[Computer:] “What
do vou want?“
Step 4
Step 8
[Computer:] “What
do you want?”
Step 12
Figure 2. Twelve steps i n programs that teach communicating by pointing t o pictures
12. This is thesame as #11, except that the choice is
made by pointing to a photograph.
Measurement of rates correct and incorrect
xl .o
0 10 20 30 40
Figure 3. Sampl e graph showi ng rates
correct and i ncorrect duri ng learning
On this program, the student matches E’s in
differing orientations. The sample is eventually
displayed on a computer screen that is separate
from that on which the choices are displayed. The
computer screen on which the sample appears is
gradually moved further and further away from the
student, until the situation resembles the task a
student needs to handle when he or she is given an
acuity eye examination. The student indicates
whether he or she can see the E’s at a distance by
the correctness of the matching-to-sample
The student now uses his or her matching-to-
sample skills to match picture symbols which will
later be used to make requests. Other programs at
this level use photographs instead of picture
The computer names an item. The student selects
the corresponding picture symbol (or photograph).
This program is the only one that requires the
presence of a teacher. The computer says, “What
do you want?” The student selects the picture
symbol for the desired item. The teacher then
delivers to the student the item heor she requested.
The rates of correct answers per minute and of
incorrect answers per minute are calculated automatically
by the computer. These af t displayed at a regular interval
pre-selected by the teacher. In an option under
development, they may also be displayed after each set of
problems. These measured rates permit an analysis of the
student’s progress, using the tools of precision teaching
[4,5]. For example, in Figure 3, separate charting of rate
of correct answers (shown to bemaintaining at the same
rate-a “celeration” of x 1.0-0ver four weeks) and of
incorrect answers (shown to bedecelerating by a factor of
1.3 from week to week) shows that the student’s progress
is due to a gradual elimination of errors, rather than to an
increase in the rate of correct responding. (Only 30days of
data during 34 calendar days are plotted.)
Mastery required before advancement
Each program offers an unlimited number of problems
covering the skill currently being taught. The student is
not permitted to advance from one problem to the next
until he or she answers the current problem correctly. The
teacher advances the student to the next only when he or
she demonstrates adequate mastery (in terms of rates
correct and incorrect) of the current program. An option
under development will permit correct and incorrect target
rates to be preset as a software option, with the student
advancing automatically when those targets are met.
Signalled or automatically-delivered rewards
Correct answers produce immediate positive feedback,
both auditory (an immediate beep) and visual (the correct
answer flashes on the screen when the student touches it).
This enables hearing-impaired students to use the
programs. After completing a certain number of problems
correctly, a repeating beep signal is emitted by the
computer, signalling the teacher or aide to come over to
the student, in order to reward himor her. Altematively,
the software may be set to actuate an automatic reward
device in accordance with a schedule of reward (see below)
selected by the teacher. Automatic reward devices
successfully used at BRI are: (1) a vending-type machine
(Figure 1) which can be loaded with food items or
pennies; (2) an M&M dispenser; or (3) an automatically
timed period during which a TV, radio, or battery-
operated toy operates.
Schedules of reward
Other Benefits
Rewards, whether the computer simply signals the
teacher to deliver them, or whether the computer dispenses
themautomatically, may be arranged according to various
“schedules.” For example, when the student first starts to
use the computer, a reward may begiven after the student
does a very small number of problems-1 or 2, perhaps.
The number may be gradually increased-up to 50 or 60,
for example-until the student is working for several
minutes between rewards. This gradual upward adjustment
of the requirement may be made by the teacher, or (in an
option under development) automatically by the software.
The number of correct responses required per reward
can be set to be a fixed number, or can differ fromone set
of problems to the next, averaging around some value.
In an alternative option under development, the
computer signals or delivers a reward only if the student is
performing at or above a certain target rate correct and at
or below a certain target rate incorrect. These targets can
gradually be made more demanding. The adjustment may
be made either by the teacher or automatically by the
Error feedback procedures
When the student answers a problemincorrectly, one,
both, or neither of the following error feedback procedures
may be manged: (1) thecomputer may say “Wrong. . .
try again”; (2) a “time-out” feedback delay may be
arranged, during which the screen gradually fills with
white. During this delay, any responses to the keyboard
will have no effect. If the student touches the touchscreen
during the delay, the delay interval is re-started. The length
of this delay is adjustable by the teacher or, at the
teacher’s option, the entire feedback delay feature may not
be used at all. Figure 3 shows data for one student at BRI
for whoman adjustment in the length of the feedback
delay was introduced during the last week of theproject.
The programs enable even the lowest-functioning
students to usea computer in order to help themto learn
to use pictures to communicate basic needs. Students
experience a high rate of success. Students at BRI, who
use the software for several hours each day, find
themselves making thousan’ds of correct responses each
day. High rates of responding-up to 70 per minute-are
permitted. Each student advances at his or her own
individual pace and the teacher is freed fromthe need to
provide 1-1 supervision.
System Requirements
Most of the programs have been designed to run bn an
Apple IIe (128k) with AppleColor Composite Monitor, or
on an Apple IIgs with Applecolor RGB Monitor,
equipped with an Edmark TouchWindow0. Programs that
involve sound require an Echo0 I1 Speech Synthesizer.
Programs which use photos, or which are used to teach
beginning reading skills, have been designed for a
Macintosh equipped with a touchscreen.’
1. Skinner, B. F. (1953). Science and a beha v&. New
York: Macmillan,.
2. Skinner, B. F. (1958). Teaching machines. Science, 128,
3. Vargas, E. A. and Vargas, J. S . (1991). Programmed
instruction: what it is and how to do it.
Behavioral Education, L(2), 235-251
(1972). Handbook of the standard behavior c m
Kansas City, Kansas: Precision Media.
from B.F. Skinner. Joumal of Beh av‘ i - ,
4. Pennypacker, H. S . , Koenig, C. H., & Lindsley, 0. R.
5. Lindsley, 0. R. (1991). Precision teaching’s unique legacy
1( 2) , 253-266.
1. Correspondence should be directed to Matthew L. Israel, Behavior
Research Institute, 240 Laban Street, Providence, Rhode Island
02909. Tel (401)944-1186;Fax(401)946-4190