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Education and

Training
in
Autism
and
Developmental
Disabilities
Focusing on individuals with
autism, intellectual disabilities and other developmental disabilities

DADD
Volume 45 Number 3 September 2010
Education and Training in Autism and Developmental Disabilities
The Journal of the Division on Autism and Developmental Disabilities,
The Council for Exceptional Children

Editor: Stanley H. Zucker Editorial Assistant: Dashiell V. Cooper


Arizona State University Arizona State University
Mary Lou Fulton Teachers College Mary Lou Fulton Teachers College

Consulting Editors
Martin Agran David L. Gast John McDonnell Laurence R. Sargent
Reuben Altman Herbert Goldstein Gale M. Morrison Gary M. Sasso
Phillip J. Belfiore Juliet E. Hart Gabriel A. Nardi Tom E. C. Smith
Sharon Borthwick-Duffy Carolyn Hughes John Nietupski Scott Sparks
Michael P. Brady Larry K. Irvin James R. Patton Fred Spooner
Fredda Brown James V. Kahn Edward A. Polloway Robert Stodden
Mary Lynne Calhoun H. Earle Knowlton Thomas G. Roberts Keith Storey
Sharon F. Cramer Barry W. Lavay Robert S. Rueda David L. Westling
Caroline Dunn Rena Lewis Diane L. Ryndak John J. Wheeler
Lise Fox Kathleen J. Marshall Edward J. Sabornie Mark Wolery
Education and Training in Autism and Developmental Disabilities is sent to all members of the Division on Autism and Developmental
Disabilities of The Council for Exceptional Children. All Division members must first be members of The Council for Exceptional Children.
Division membership dues are $25.00 for regular members and $13.00 for full time students. Membership is on a yearly basis. All inquiries
concerning membership, subscription, advertising, etc. should be sent to the Division on Autism and Developmental Disabilities, 1110 North
Glebe Road, Arlington, VA 22201. Advertising rates are available upon request.
Manuscripts should be typed, double spaced, and sent (five copies) to the Editor: Stanley H. Zucker, Mary Lou Fulton Teachers College, Box
875411, Arizona State University, Tempe, AZ 85287-5411. Each manuscript should have a cover sheet that gives the names, affiliations, and
complete addresses of all authors.
Editing policies are based on the Publication Manual, the American Psychological Association, 2001 revision. Additional information is
provided on the inside back cover. Any signed article is the personal expression of the author; likewise, any advertisement is the responsibility
of the advertiser. Neither necessarily carries Division endorsement unless specifically set forth by adopted resolution.
Education and Training in Autism and Developmental Disabilities is abstracted and indexed in Psychological Abstracts, PsycINFO, e-psyche,
Abstracts for Social Workers, International Journal of Rehabilitation Research, Current Contents/Social and Behavioral Sciences, Excerpta
Medica, Social Sciences Citation Index, Adolescent Mental Health Abstracts, Educational Administration Abstracts, Educational Research
Abstracts, and Language and Language Behavior Abstracts. Additionally, it is annotated and indexed by the ERIC Clearinghouse on
Handicapped and Gifted Children for publication in the monthly print index Current Index to Journals in Education and the quarterly index,
Exceptional Child Education Resources.
Education and Training in Autism and Developmental Disabilities Vol. 45, No. 3, September 2010, Copyright 2010 by the Division on Austim
and Developmental Disabilities, The Council for Exceptional Children.

Division on Autism and Developmental Disabilities


The Council for Exceptional Children

Board of Directors
Officers Members Executive Director
Tom E. C. Smith
Past President J. David Smith Mark Francis Publications Chair
President Emily Bouck Linda Laz Jack Hourcade
President-Elect Teresa Taber-Doughty Nicole Mucherino (Student Governor) Communications Chair
Vice President Richard Gargiulo Robert Sandieson Darlene Perner
Secretary Toni Merfeld Debora Wichmanowski Conference Coordinator
Treasurer Gardner Umbarger Dianne Zager Cindy Perras

The purposes of this organization shall be to advance the education and welfare of persons with autism and developmental disabilities, research
in the education of persons with autism and developmental disabilities, competency of educators in this field, public understanding of autism
and developmental disabilities, and legislation needed to help accomplish these goals. The Division shall encourage and promote professional
growth, research, and the dissemination and utilization of research findings.

EDUCATION AND TRAINING IN AUTISM AND DEVELOPMENTAL DISABILITIES (ISSN 2154-1647) (USPS 0168-5000) is pub-
lished quarterly in March, June, September, and December, by The Council for Exceptional Children, Division on Autism and
Developmental Disabilities, 1110 North Glebe Road, Arlington, Virginia 22201-5704. Members’ dues to The Council for Exceptional
Children Division on Developmental Disabilities include $8.00 for subscription to EDUCATION AND TRAINING IN AUTISM AND
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Education and Training in Autism and
Developmental Disabilities
Editorial Policy

Education and Training in Autism and Developmental Disabilities focuses on the


education and welfare of persons with autism and developmental disabilities.
ETADD invites research and expository manuscripts and critical review of the
literature. Major emphasis is on identification and assessment, educational pro-
gramming, characteristics, training of instructional personnel, habilitation, preven-
tion, community understanding and provisions, and legislation.
Each manuscript is evaluated anonymously by three reviewers. Criteria for ac-
ceptance include the following: relevance, reader interest, quality, applicability,
contribution to the field, and economy and smoothness of expression. The review
process requires two to four months.
Viewpoints expressed are those of the authors and do not necessarily conform to
positions of the editors or of the officers of the Division.

Submission of Manuscripts
1. Manuscript submission is a representation that the manuscript is the author’s
own work, has not been published, and is not currently under consideration for
publication elsewhere.
2. Manuscripts must be prepared according to the recommendations in the Pub-
lication Manual of the American Psychological Association (Fifth Edition, 2001).
Laser or high density dot printing are acceptable.
3. Each manuscript must have a cover sheet giving the names and affiliations of all
authors and the address of the principal author.
4. Graphs and figures should be originals or sharp, high quality photographic
prints suitable, if necessary, for a 50% reduction in size.
5. Five copies of the manuscript along with a transmittal letter should be sent to the
Editor: Stanley H. Zucker, Mary Lou Fulton Teachers College, Box 875411,
Arizona State University, Tempe, AZ 85287-5411.
6. Upon receipt, each manuscript will be screened by the editor. Appropriate
manuscripts will then be sent to consulting editors. Principal authors will receive
notification of receipt of manuscript.
7. The Editor reserves the right to make minor editorial changes which do not
materially affect the meaning of the text.
8. Manuscripts are the property of ETADD for a minimum period of six months.
All articles accepted for publication are copyrighted in the name of the Division
on Autism and Developmental Disabilities.
Education and Training in Autism and Developmental
Disabilities
VOLUME 45 NUMBER 3 SEPTEMBER 2010

Long-term Outcomes of Services for Two Persons with Significant Disabilities with
Differing Educational Experiences: A Qualitative Consideration of the Impact of
Educational Experiences 323
DIANE LEA RYNDAK, TERRI WARD, SANDRA ALPER, JENNIFER WILSON MONTGOMERY, and
JILL F. STORCH
Family Perspectives on Post-Secondary Education for Students with Intellectual
Disabilities 339
MEGAN M. GRIFFIN, ELISE D. MCMILLAN, and ROBERT M. HODAPP

Resilience in Families with an Autistic Child 347


ABRAHAM P. GREEFF and KERRY-JAN VAN DER WALT

Professionals’ Attitudes on Partnering with Families of Children and Youth with


Disabilities 356
JAMIE BEZDEK, JEAN ANN SUMMERS, and ANN TURNBULL

Deinstitutionalisation and Adaptation of Adults with Intellectual Disabilities: Results


from Québec 366
HUBERT GASCON and PIERRE MORIN

Training Teachers to Use an Inquiry-Based Task Analysis to Teach Science to Students


with Moderate and Severe Disabilities 378
GINEVRA R. COURTADE, DIANE M. BROWDER, FRED SPOONER, and
WARREN DIBIASE

Description of Communication Breakdown Repair Strategies Produced By Nonverbal


Students with Developmental Disabilities 400
BARIS DINCER and DILEK ERBAS

Enabling a Prelinguistic Communicator with Autism to Use Picture Card as a Strategy


for Repairing Listener Misunderstandings: A Case Study 410
YOSHIHISA OHTAKE, MICHAEL WEHMEYER, NAOMI UCHIDA, AKITAKA NAKAYA, and
MASAFUMI YANAGIHARA

Evaluation of a Personal Digital Assistant as a Self-Prompting Device for Increasing


Multi-Step Task Completion by Students with Moderate Intellectual Disabilities 422
LINDA C. MECHLING, DAVID L. GAST, and NICOLE H. SEID

Effects of Most to Least Prompting on Teaching Simple Progression Swimming Skill


for Children with Autism 440
İLKER YILMAZ, FERMAN KONUKMAN, BINYAMIN BIRKAN, and MEHMET YANARDAǦ

Effects of the TOUCHMATH Program Compared to a Number Line Strategy to Teach


Addition Facts to Middle School Students with Moderate Intellectual Disabilities 449
DALE FLETCHER, RICHARD T. BOON, and DAVID F. CIHAK

Social Skills Instruction Carried Out by Teachers Working at Private Special Education
Institutions in Turkey 459
AYTEN UYSAL and YASEMIN ERGENEKON

Manuscripts Accepted for Future Publication in Education and Training in Autism and
Developmental Disabilities 322

The Division on Autism and Developmental Disabilities retains literary property rights on copyrighted articles. Up
to 100 copies of the articles in this journal may be reproduced for nonprofit distribution without permission from
the publisher. All other forms of reproduction require permission from the publisher.
Manuscripts Accepted for Future Publication in Education
and Training in Autism and Developmental Disabilities
December 2010
Supporting families of young children with disabilities using technology. Phil Parette, Hedda
Meadan, Sharon Doubet, and Jack Hess, Department of Special Education, Campus Box 5910,
Illinois State University, Normal, IL 61790-5910.
Increasing skill performances of problem solving in students with intellectual disabilities. Debra
Cote, Tom Pierce, Kyle Higgins, Susan Miller, Richard Tandy, and Shannon Sparks, California
State University, Fullerton, Dept. of Sp. Education, College Park 570-24, P.O. Box 6868, Fullerton,
CA 92834-6868.
Methods for increasing the intensity of reading instruction for students with intellectual disabili-
ties. Jill H. Allor, Tammi M. Champlin, Diana B. Gifford, and Patricia Mathes, Department of
Teaching and Learning, Southern Methodist University, P.O. Box 750381, Dallas, TX 75275-0381.
Effectiveness of video modeling to teach iPod use to students with moderate intellectual disabili-
ties. Diana L. Hammond, Abigail D. Whatley, Kevin M. Ayres, and David Gast, The University of
Georgia, Department of Special Education, 908 Lance Circle, Lawrenceville, GA 30043.
Newbery award winning books 1975-2009: How do they portray disabilities? Melissa Leininger, Tina
Taylor Dyches, Mary Anne Prater, and Melissa Allen Heath, Brigham Young University, 340-F
McKay Building, Provo, UT 84602.
An analysis of evidence-based practices in the education and treatment of learners with autism
spectrum disorders. Michael R. Mayton, John J. Wheeler, Anthony L. Menendez, and Jie Zhang,
Department of Special Education, West Virginia University, 508-C Allen Hall, Morgantown, WV
26506.
Functional curriculum ⫽ Evidence-based education?: Considering secondary students with mild
intellectual disabilities. Emily C. Bouck and Sarah M. Flanagan, 5146 BRNG Hall, Purdue Univer-
sity, 100 N. University St., West Lafayette, IN 47907.
Emotional intelligence in Asperger Syndrome: Implications of dissonance between intellect and
affect. Janine Montgomery, Adan W. McCrimmon, Vicki L. Schwean, and Donald H. Saklofske,
Psychology Department, 190 Dysart Road, University of Manitoba, Winnipeg, R3T 2N2 CANADA.
Evidence-based principles and practices for educating students with Autism: Self-determination
and social interactions. Michael L. Wehmeyer, Karrie A. Shogren, Dianne Zager, Tom E.C. Smith,
and Richard Simpson, Beach Center on Disability, University of Kansas, 3136 Haworth Hall,
Lawrence, KS 66045.
Research to practice in Autism and Developmental Disabilities. Stanley H. Zucker, Cindy Perras,
Darlene E. Perner, and Emily C. Bouck, Mary Lou Fulton Treachers College, Arizona State
University, Box 875411, Tempe, AZ 85253-5411.

Address is supplied for author in boldface type.


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 323–338
© Division on Autism and Developmental Disabilities

Long-term Outcomes of Services for Two Persons with


Significant Disabilities with Differing Educational
Experiences: A Qualitative Consideration of the Impact of
Educational Experiences
Diane Lea Ryndak Terri Ward
University of Florida College of St. Rose

Sandra Alper
University of Northern Iowa
Jennifer Wilson Montgomery and Jill F. Storch
University of Florida

Abstract: Though research exists related to effective services in inclusive general education settings for students
with significant disabilities, there are no longitudinal investigations of adult outcomes for persons with
significant disabilities who received services in inclusive general education settings. This study uses qualitative
methods to describe two persons with significant disabilities across settings over time. After originally receiving
special education services together in a self-contained special education class in middle school, these individuals
then received services in different types of settings (i.e., one received services in self-contained special education
settings and one received services in inclusive general education settings) for the remainder of their educational
careers. Findings indicated that the individual who received services in inclusive general education settings
appeared to have achieved better adult outcomes as reflected in performance in community living and work
contexts, interactions with schoolmates and co-workers, independent participation in naturally-occurring
activities, and quality and size of a natural support network. In addition, the findings suggest the importance
of a “benefactor” on the quality of long-term outcomes achieved by individuals with significant disabilities.

The documented benefits of inclusive educa- sive education and arguments suggesting that
tion for students with significant disabilities inclusive education may have a negative im-
are many. Research reveals higher teacher ex- pact upon learners (e.g., Sandler, 1999), no
pectations of students, increases in appropri- investigations were found that provided per-
ate social behaviors, increased interactions formance data on students with significant dis-
with others, more positive affect, increased abilities or their general education classmates
friendships, and improved communication that argued against inclusive education. (For
skills, as well as improvements in academic summaries of research regarding inclusive ed-
behaviors and an increased likelihood of par- ucation for students with significant disabili-
ticipation in other inclusive settings (e.g., ties see Fisher & Ryndak [2001]; McGregor &
McLaughlin, Ryndak, & Alper, 2008; Ryndak Vogelsberg [1998]; Ryndak & Fisher.) In fact,
& Fisher, 2003). Although the literature in-
Sharpe, York, and Knight (1994) found the
cludes critiques of various studies about inclu-
opposite—that when serving students with sig-
nificant disabilities in inclusive general educa-
tion classes there was no detrimental effects
Correspondence concerning this article should
on the educational outcomes of the general
be addressed to Diane Lea Ryndak, School of Spe-
cial Education, School Psychology, and Early Child- education students in the class. In addition,
hood Studies, 1403 Norman Hall, PO Box 117050, Peck, Staub, Gallucci, and Schwartz (2004)
University of Florida, Gainesville, FL 32611-7050. found that parents of general education stu-

Long-term Outcomes / 323


dents in classes that included students with pendent on IEP and transition teams during
significant disabilities indicated that placing high school for present and future educa-
their children in the inclusive classes resulted tional decisions, received limited instruction
in several social benefits for their children. in decision-making, received very little train-
Fisher, Sax, and Jorgensen (1998) noted ing related to job skills either at school or in
that in the United States, the educational sys- the community, and were uninformed about
tem is expected to contribute to the prepara- how to obtain continued services after exiting
tion of children for the demands of success as school. As a result, follow-up studies revealed
adults (see also Lipsky & Gartner, 1997). In social isolation, continued reliance on parents
addition, Turnbull, Turnbull, Wehmeyer, and for residential needs, and unemployment or
Park (2003) suggested the use of a quality of underemployment that resulted in reliance
life framework when considering post-school on Supplemental Security Income (SSI) and
outcomes for adults with disabilities. Consid- Medicaid waivers to bring incomes up to the
ering these concepts together the expectation poverty level.
is that, when students with disabilities exit Several researchers have identified strate-
school, they will be prepared for adult life, gies that can lead to more successful adult
their lives will be enriched, and their partici- outcomes (Anderson-Inmann, Knox-Quinn, &
pation in typical community activities, employ- Szymanski, 1999; Caldwell & Heller, 2003;
Doren & Benz, 1998; Head & Conroy, 2005;
ment, and residences will be enhanced. In-
McGlashing-Johnson, Agran, Sitlington,
deed, these assumptions still are reflected in
Cavin, & Wehmeyer, 2004; Wehmeyer &
current discussions about access to general
Palmer, 2003; White & Weiner, 2004). These
education, curriculum, and assessment impli-
strategies include access to general education
cations of No Child Left Behind and the
settings (Ryndak, Morrison, & Sommerstein,
Individuals with Disabilities Education Im-
1999; Zafft, Hart, & Zimbrich, 2004), voca-
provement Act (2004) (Browder, Spooner,
tional training both at school and in commu-
Wakeman, Trela, & Baker, 2006; Lee et al.,
nity job settings (McGlashing-Johnson et al.;
2006; Wehmeyer, 2006).
White & Weiner), instruction leading to self-
Unfortunately, follow-up studies of special
determination (Caldwell & Heller; Head &
education graduates have indicated that the Conroy; McGlashing-Johnson et al.; Weh-
outcomes of schooling often were inconsistent meyer & Palmer, 2003), and assistance to par-
with expectations for positive post-school ad- ents in learning how to advocate for their
justment (Blackorby & Wagner, 1996). The children and obtain and maintain services for
results of several researchers (e.g., Edgar, them when exiting school (Wang, Mannan,
1987; Haring & Lovett, 1990; Johnson et al., Poston, Turnbull, & Summers, 2004).
1995) repeatedly have indicated that, follow- Emphasizing access to general education
ing graduation, students with significant dis- settings and curricula, accountability, valued
abilities: (a) typically are socially isolated, with membership in peer groups, and facilitation
little contact with peers who do not have dis- of friendships that may lead to natural support
abilities; (b) experience high rates of inactiv- networks, inclusive education has been con-
ity; (c) experience a low level of employment sidered not only a practice that is consistent
and that, even when they are employed, sel- with civil rights, but also a way to alleviate the
dom work a full week and earn very low wages; shortcomings and discouraging outcomes of
(d) generally live with a parent, guardian, or follow-up studies, such as those cited above.
relative; and (e) are seldom involved in activ- Although existing research indicates that in-
ities outside of the home. clusive education can benefit students with
The National Organization on Disability significant disabilities during their school
(2000) issued a comprehensive report on years (Fisher & Meyer, 2002; Ryndak et al.,
adult outcomes for students with disabilities. 1999), there have been no longitudinal fol-
The data cited in that report were dismal low-up investigations of the lives of individuals
across all disability labels, but particularly for with significant disabilities who experienced
individuals with the most significant disabili- inclusive education over extended periods of
ties. These individuals were almost totally de- time. There has been no research to date that

324 / Education and Training in Autism and Developmental Disabilities-September 2010


determines whether such individuals lead and was labeled as having cognitive disabilities
more satisfying lives after leaving school, than or multiple disabilities, although school and
those whose educational experiences were in district personnel consistently described her
self-contained special education settings. as having “severe disabilities.” She was reading
This investigation begins to address some of at a 2nd grade level, using math at a 3rd grade
these questions by examining how two individ- level, and used speech that was intelligible
uals with significant disabilities functioned only to people who were familiar to her dur-
across settings over time. These two individu- ing interactions that frequently were inappro-
als originally received special education ser- priate. Phillip was 16 years of age and was
vices together in a self-contained special edu- labeled as having cognitive disabilities, al-
cation class during Year One of this study. The though school and district personnel de-
last month of that academic year the young scribed him as having “mild to moderate dis-
woman began receiving services in general abilities.” He was reading at a 2nd grade level,
education settings, and she remained in those using math at a 3rd grade level, and used
settings during her last six years of educa- speech that was intelligible to all peers and
tional services (see Ryndak et al., 1999, for a adults during frequent and appropriate inter-
description of her services and performance actions. During the observations field notes
in the self-contained and general education were written related to the services delivered
settings). The young man, however, remained to all of the students in the class, as well as the
in self-contained settings for the duration of students’ performances in the class.
his educational career. Having had no contact Melinda and Phillip met again as adults
during the years they received special educa- when both were 25 years old, although Phillip
tion services in different settings, these indi- was several months older than Melinda. Both
viduals met again as adults, developed a rela- were receiving support through the Medicaid
tionship, and married. Thus, this couple Waiver. They and their parents and/or legal
offered a naturally-occurring opportunity that guardians were approached to determine
might suggest long-term effects of instruc- whether they would be interested in partici-
tional settings on their overall performance pating in a study about: (a) the participants’
both immediately, 4 years, and 8 years after educational experiences and performance
exiting school services. during those experiences; (b) the participants’
lives immediately after exiting school services;
Method and (c) the participants’ current lives. Great
care was taken to ensure that the participants
Two individuals with significant disabilities
and their parents/guardians understood and
participated in this qualitative study. These
approved every aspect of this study.
individuals and the methods used to describe
them and the services they received over time
are described below. Data Collection

In his discussion of qualitative research meth-


Participants
odology Patton (2002) stated that “meaning-
Participants were selected using purposeful fulness and insights generated from qualita-
sampling because of their mutual experiences tive inquiry have more to do with the . . .
at different times in their lives. During Year 1 capabilities of the researcher than the sample
of this study the first author met both partic- size” (p. 245). Three of the researchers for
ipants and the family of one of the partici- this study have demonstrated expertise in
pants, Melinda, because of her family’s qualitative research methodology, and two of
advocacy efforts for the development and im- these researchers were intimately involved
plementation of effective services for her in with all aspects of this study. Three of the
general educational settings. At that time ob- researchers collaborated to collect informa-
servations were conducted of Melinda’s self- tion on the participants using various qualita-
contained special education class, in which tive methods.
the other participant, Phillip, was also a stu- First, consistent with qualitative research
dent. At that time Melinda was 15 years of age methodology related to the use of artifacts

Long-term Outcomes / 325


TABLE 1

Summary Descriptors of Melinda Across Years (Note: Italics indicate more positive outcomes).

Year 1: In Self-Contained Exiting School After Meeting After Adult After Adult Living for 8 Years,
Special Education Classes Inclusive Contexts Living for 4 Years Married for 1 Year
for 3 Documented Years for 6 Years

Walks with special No longer walks Lives alone in own Shares an apartment with
education shuffle with special apartment Phillip
education shuffle
Needs high level of Has held part time Has held part time job in the
supervision Works job in the court court system for 7 years;
independently system for 3 years permanent employee with full
Demonstrates low benefits
maturity level Demonstrates Has an extensive
excellent level of natural support Has expanded her natural
Is disruptive in growth during network support network
segregated classroom high school and
college years Uses coping Has increased the life spaces in
Is regressing strategies to assist which she participates
academically Uses strategies to with processing
assist with difficulties Uses literacy at work and in
processing daily life
difficulties Uses literacy at
work and in Is self-assured and confident
Growth/interest daily life across contexts

and records (Hammersley & Atkinson, 1995; participants’ records and artifacts were col-
Mason, 1996), the researchers worked with lected for analysis related to performance lev-
the participants and their parents and/or els in academic content, functional activities,
guardians to obtain records and artifacts rele- interactions with others, and overall behavior.
vant to the participants’ educational and adult Second, consistent with the use of inter-
services, as well as the participants’ perfor- views in qualitative research (Kvale, 1996; Ma-
mance levels over time. For this study records son, 1996; Rubin & Rubin, 1995; Strauss &
were collected starting with two years prior to Corbin, 1998), the researchers conducted in-
Melinda and Phillip being placed in the same terviews with the participants, their families
self-contained special education class during and, when possible, their current service pro-
Year One of this study, at the age of 15 and 16 viders. For the purposes of this study, only
years, respectively. Melinda’s earlier records
interviews conducted with school personnel
indicated that for the previous two years she
related to the performances of all students in
had been in self-contained special education
the self-contained special education class were
classes. Her records after Year 1 indicated that
used from Year 1 (see Tables 1 and 2). After
her placement changed and she was included
in general education classes, with supports Melinda and Phillip remet as adults, however,
and services, for the remainder of her edu- interviews were conducted with them and
cational experiences up through age 21. their parents and/or legal guardians, related
Phillip’s earlier records indicated that for the to their services and performance levels over
two years prior to Year 1 he had received time. Both retrospective and current informa-
services in self-contained special education tion was requested. In addition interviews
classes. His records after Year 1 indicated that were conducted with their current Medicaid
he remained in self-contained special educa- Waiver personnel who provided support in
tion classes through the remainder of his ed- their independent living situations and com-
ucational career, until age 22. In addition to munity access. At the participants’ request, no
determining their educational placement, the interviews were conducted with their co-work-

326 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 2

Summary Descriptors of Phillip Across Years (Note: Italics indicate periods of hope for positive outcomes).

Year 1: In Self-Contained Exiting School After Segregated Meeting After Adult Living After Adult Living for 8
Special Education Classes Classes for 6 More Years for 4 Years Years, Married
for 3 Documented Years for 1 Year

Appearance and behaviors Is anxious with others and Lives with his family in Shares an apartment
are age-appropriate and depressed the parents’ house with Melinda
consistent with peers;
looks average Demonstrates behaviors Has lost several jobs Has a part-time job in
indicative of very low self- the community
Requires moderate level of esteem Works in a sheltered
supervision workshop for tokens Has increased the life
Fears making mistakes and spaces in which he
Demonstrates moderate displeasing others Has only family members participates
maturity level in his natural support
Is reluctant to interact with network Uses members of
Is compliant and not others Melinda’s natural
disruptive in segregated Has had difficulties in the support network for
class Is regressing academically community his own support

Participates willingly in Uses functional literacy Uses advocates when


activities that require only when necessary in difficulty
functional academics
Is anxious with others,
requiring frequent
reassurance

ers, employers, or employment support per- viewees were encouraged to expand their
sonnel. answers, give examples that illustrated a point
Each interview was conducted by one or being made, and reiterate answers in another
more of the researchers and audiotaped. way in order to clarify their points. The audio-
While some interviews were conducted with tapes then were transcribed, comprising over
one individual (e.g., a service provider), most 400 pages of text. These transcriptions were
interviews were conducted with more than submitted to the interviewees for verification
one interviewee present. For instance, the par- and edits of the content. When appropriate,
ents and/or legal guardians participated in changes were made to the initial transcripts,
joint interviews. To accommodate for daily reflecting feedback from the interviewees.
schedules and other responsibilities of the Third, consistent with case study research
multiple interviewees, these interviews were methodology (Bogdan & Taylor, 1975; Mason,
conducted over two or three days, taking two 1996; Patton, 2002; Strauss & Corbin, 1998)
to five hours to complete. Other interviews the researchers conducted observations of
(e.g., interviews with single interviewees) were Melinda and Phillip, and wrote field-notes
completed in one day, taking only one to two during and after the observations. During
hours to complete. All of the interviews fol- Year 1 observations were conducted and field-
lowed accepted qualitative research method- notes were written by only one of the research-
ology guidelines (Creswell, 2003; Kvale, 1996; ers in the self-contained special education
Rubin & Rubin, 1995; Strauss & Corbin, class and other school contexts. After Melinda
1998). Each was conducted using guiding and Phillip remet as adults, three of the re-
questions established in an initial protocol, searchers observed them with their family
but with several probing points per question ‘members in the community, with friends in
to encourage the interviewees to give com- the community, and alone with the research-
plete answers with meanings that were delin- ers both at dinner in the community and in
eated clearly. Whenever possible the inter- their apartment. At their request, no observa-

Long-term Outcomes / 327


tions were conducted at their work sites. In their findings to the participants’ parents
most situations observations were conducted and/or guardians for further verification of
with multiple observers present, each taking the findings (Mertens, 2005).
notes independently. Observations were con- Once the coding and analyses were com-
ducted on multiple days, across multiple con- pleted for the content of each set of data (i.e.,
texts, across two weeks. After each observation records, interviews, field-notes of observa-
when multiple observers were present, the ob- tions), the content was used for triangulation
servers finished their independent notes and to look for consistencies (Hammersley & At-
then discussed what they had observed. The kinson, 1995; Kvale, 1996; Mason, 1996; Silver-
observers then returned to their independent man, 1993). Overall findings then were artic-
notes and made additional comments when ulated and written. These findings again were
appropriate. submitted to the parents and/or legal guard-
ians of the participants for review, with the
Data Analysis option of reviewing the findings with the par-
ticipants. Whether reviewed independently or
Trustworthiness was addressed via collabora- with the participants, the parents and/or legal
tive efforts amongst all the researchers guardians were encouraged to make edits, ad-
involved in this study (Merriam, 1998) in re- ditions, and deletions that would ensure that
lation to both content analysis and triangula- the findings were accurate.
tion. The researchers developed two teams.
One set of two of the researchers completed Findings
the initial analysis of content from the The following sections describe several vari-
records, artifacts, interviews, and observations, ables related to Melinda’s and Phillip’s en-
and organized the records and artifacts for gagement in activities across contexts and
each of the two participants chronologically. time. These variables include their (a) inter-
The set of records for each participant then actions with peers and adults; (b) participa-
was read several times by the team responsible tion in instructional activities on both
for the initial analysis and, consistent with academic and functional content; and (c) ac-
qualitative methodology (Kvale, 1996; Rubin quisition and use of both academic and func-
& Rubin, 1995; Strauss & Corbin, 1998), the- tional content. These sections include percep-
matic codes were developed related to the tions of their engagement in activities and
content of the records. Members of the initial how their engagement changed, as reflected
team independently coded the content of the in interviews, observation field notes, and
records, and then met to compare their codes. records from four time periods: Year 1 of the
A few times differences were found in the study, which was the one school year they
manner in which specific content was coded, received services in the same self-contained
resulting either in the addition of a new code special education class; six years later, which
or clarification of the meaning of an existing was their last year of educational services; four
code. The coding procedure used with the additional years later when they met again as
records and artifacts also was used with the adults; and four additional years later after
content of the final transcripts of interviews they had been married.
and field-notes.
Information from this analysis then was Year One: Services in a Self-Contained Special
shared with the second team of researchers as Education Classroom
a second step to verify the findings. Sugges- During Year 1 of this study Melinda and
tions or concerns were shared with the team Phillip attended the same self-contained spe-
that had completed the initial analysis, and cial education classroom in Melinda’s neigh-
that team made any decisions necessary re- borhood middle school. The class comprised
lated to editing the findings. Once the initial eight students ranging from 13 years-10
team members had agreed on how the con- months to 15 years-9 months of age. At the
tent would be coded, sections of the files with beginning of that school year Melinda was 14
similar codes were grouped and analyzed for years-6 months old and Phillip was 15 years
meaning. The researchers then submitted old.

328 / Education and Training in Autism and Developmental Disabilities-September 2010


Melinda. During interviews both school loudly enough for the entire class to hear; she
personnel and family members stated that would interrupt the seatwork of classmates
Melinda was the “lowest functioning” student who were near to her by kicking them under
in the class. Her records indicated that on the table; she would sweep away her class ma-
norm-referenced assessments Melinda scored terials to stop her instructional activities. In
a 2nd grade 4th month performance in read- addition to these disruptive behaviors in the
ing, and a 3rd grade performance in math. self-contained class, Melinda demonstrated no
Upon reviewing the norm-referenced scores interest in using her knowledge, or in learning
of her classmates, it was noted that Melinda’s new knowledge, when she interpreted a situa-
scores were not the lowest; rather she had the tion as either academic or evaluative in na-
third lowest score for reading and the fifth ture. For instance, whether at school, at home,
lowest score for math in the class of eight or in the community, when Melinda was asked
students. Her performance in class, however, a question or asked to complete an activity
gave the impression of a lower capability both that required reading, writing, or math, she
because of her inappropriate behaviors and responded in a defensive and street-wise man-
the tasks assigned to her. For example, ner that extricated her from the situation. If
Melinda consistently refused to do indepen- she then was pushed to answer the question or
dent seatwork (e.g., math worksheets), read complete the activity, Melinda would either
aloud, or summarize reading content. tantrum (i.e., yell, gesticulate broadly, walk
Records indicated that Melinda’s reading in- away briskly) or “shut down” by being totally
struction incorporated the same materials, at unresponsive and unmovable. She might sit
the same performance level, for 3 consecutive on the floor or sidewalk for up to 30 minutes,
years. Specifically, her reading instruction without speaking or responding to any verbal-
would begin at level 50 of Distar, progress to izations from others.
level 75, and then return to level 50 because of In response to Melinda’s inappropriate be-
her inability to complete the tasks. Her work haviors in the self-contained classroom, in-
in reading, writing, and math incorporated cluding refusals to do work, tantrums, and
2nd grade worksheets, and her annual goals “shutting down,” her records indicated that
included reading at the 2nd grade 5th month she required a high level of adult supervision.
level, writing short lists, memorizing math facts, Although Melinda demonstrated appropriate
completing simple computations, and adding behavior when she was with classmates who
and subtracting amounts of change. When com- did not have disabilities (e.g., chorus, physical
paring her current and past records a clear pat- education, lunch) her records indicated that
tern of regression was observed in her use of she was not allowed to participate in addi-
reading, writing, and math. tional activities with these classmates until she
In relation to social development there was consistently demonstrated appropriate social
a clear difference in Melinda’s behaviors in and learning behaviors in the self-contained
self-contained versus inclusive settings. When classroom.
participating in activities within settings that In addition to challenging behaviors
included schoolmates who did not have dis- Melinda had significant difficulty with speech.
abilities (e.g., at chorus, during assemblies, in Her speech was unintelligible to strangers and
the hallways) Melinda modeled her school- only fully understood by the few people who
mates; therefore, her behavior was compara- spent a great deal of time with her. Constant
ble to her non-disabled peers. In addition, she requests to have her repeat herself, frequently
demonstrated independent functioning dur- without better understanding of her speech,
ing school-related activities, such as navigating frustrated Melinda and resulted in her reluc-
the campus to complete tasks. On the other tance to respond verbally in most situations.
hand, when in the self-contained classroom, In response, Melinda developed many coping
Melinda demonstrated more age-inappropri- mechanisms for her unintelligible speech, in-
ate behaviors than her classmates with disabil- cluding the use of gestures and reliance on
ities. She frequently disrupted instruction and friends and family members to interpret her
learning. She would make off-task and age- speech for others. She also used a handful of
inappropriate comments at any moment, high frequency phrases and words that helped

Long-term Outcomes / 329


her function more independently within her him. His behavior, however, did not interfere
school and community. For example, when with instruction or learning. Instead, he was de-
ordering food in a restaurant, Melinda would scribed as demonstrating “poor judgment” at
place her order with one clear word (e.g., times. With his appropriate social and instruc-
hamburger) instead of using a complete sen- tional behaviors, Phillip rarely required adult
tence. She then would wait for questions from intervention beyond initial directions for class-
the wait person, to which she could respond in room activities. Because of his “poor judgment,”
one or two words (e.g., yes/no; ketchup). however, he was described as requiring “moder-
In physical appearance, Melinda had ac- ate adult supervision”.
quired over her 10 years in self-contained Phillip’s speech was intelligible to everyone,
classes what her parents called “the special ed demonstrating no easily recognized speech
shuffle.” Specifically, she had poor posture, impairment. In addition he was very commu-
consistently looked down at the floor when nicative with both adults and fellow students,
walking, and shuffled her feet along the floor. whether or not he knew them. The content of
Overall she projected a downtrodden appear- his comments was perceived as relevant to the
ance both at school and in the community. contexts in which he was interacting.
Phillip. Phillip was described by both Physically Phillip was not distinguishable in
school personnel and Melinda’s family mem- appearance from his peers without disabilities.
bers as the highest performing student in the When walking down a hallway at school,
class. In several interviews he was described as Phillip was described as having an appropriate
the model learner with disabilities, the one gait, wearing age-appropriate clothing, and
that parents of other students with disabilities making appropriate eye contact with those he
wanted their child to be like. Phillip’s records passed. He also frequently stopped and spoke
indicated that on norm-referenced assess- with others between classes.
ments he scored a 2nd grade 6th month per-
formance in reading, and a 3rd grade 9th Six Years Later: Last Year of Educational Services
month performance in math. He knew word For the following six years Melinda received
families, used word attack skills, indepen- special education and related services in inclu-
dently read and followed directions, and per- sive settings. Five of those years she attended
formed basic computation with a calculator. 8th–12th grade with the same set of students
When compared with his classmates, Phillip’s without disabilities. In the sixth year, as well as
norm-referenced scores for math were indeed her first year of adult services, Melinda au-
the highest. In reading, however, his scores dited classes and lived in a dorm at a private
were the fifth lowest in the class of eight. In four year college out-of-state. In contrast, dur-
the self-contained classroom Phillip attended ing the remainder of his educational experi-
to the teacher, followed directions, remained ences Phillip continued to receive special ed-
on-task, and completed all assignments. ucation services for six years in self-contained
In relation to social development, records academic and vocational classes.
indicated that Phillip had a high self-concept Melinda. During her last year in educa-
and that his independent functioning during tional services Melinda consistently used math
school-related activities was appropriate. and reading during activities that were mean-
When functioning within settings that in- ingful to her both in the college courses she
cluded peers without disabilities, as well as in audited and throughout her daily life (e.g.,
his self-contained classroom, Phillip’s interac- shopping, navigating the community, work ex-
tions were described as “moderately appropri- periences, laundry, dorm activities). She was
ate” when compared with his classmates both willing and able to read familiar content aloud
with and without disabilities. There were no across settings (e.g., reading aloud at a na-
references to differences in his appropriate- tional conference a college newspaper article
ness or maturity across various settings. she had written with support, reflecting a 9th
In relation to behaviors, Phillip was described grade reading level) and to complete tasks
as compliant, very friendly, and always eager to independently in and out of class with accom-
help. His eagerness to help was so extreme, modations. With support Melinda was able to
however, that at times adults were annoyed with write several paragraphs for reports, articles

330 / Education and Training in Autism and Developmental Disabilities-September 2010


for the school newspaper, and letters to her to respond to auditory information (e.g., say-
family and friends. For example, a peer or ing “Give me a minute. I am thinking about
service provider would assist her in transform- that”). As part of her disability awareness pre-
ing independently-typed phrases and short sentations for dorm mates, classmates, and
sentences to hand-written sentences and para- co-workers, Melinda described this difficulty
graphs that expressed her thoughts, allowing and requested that when people gave her di-
her to copy the sentences in longhand or rections, provided feedback, or asked her
enter them into a computer. After using read- questions, that they walk away and leave her
ing, writing, and math successfully to com- alone for a few minutes. They then could
plete meaningful activities over several years return and anticipate a response from her. In
in inclusive settings, Melinda accepted the addition, Melinda requested that, if she said
idea that she did not know everything, and something that was inappropriate, people of-
that it was alright. Her defensiveness about fer suggestions of more appropriate things to
participating in academic or evaluative activi- say. This reaffirmed her own awareness of her
ties had changed to an interest in learning. difficulties and desire to improve her interac-
Over the years she had acquired a lot of the tions with others. Her final IEP noted that
common knowledge addressed in her classes. Melinda had many strengths, including good
Because of these changes in her use of read- nonverbal reasoning abilities, logical think-
ing, writing, and math across inclusive educa- ing, good common sense, and problem-solv-
tional and community settings, Melinda’s par- ing skills.
ents decided to have her take a norm- Melinda’s physical appearance also had
referenced reading test. They expected there changed significantly. She had lost the “spe-
would be a dramatic increase in her scores, cial ed shuffle.” She now walked with good
commensurate with her increase in use of posture, holding her head up and making eye
reading across meaningful inclusive contexts. contact with people she passed. Overall, she
Her test scores, however, remained the same appeared confident, ready to interact with
as those of her last norm-referenced tests people, and ready to participate in any activity
seven years earlier. at school and in the community.
Melinda’s speech was intelligible both to peo- Phillip. During his last year of educational
ple with whom she interacted regularly and to services, Phillip’s records indicated that
strangers. She was noted to have significant he was performing in reading at the 3rd grade
growth in her vocabulary and conversation skills 1st month level (an increase from 2nd grade
when compared with her previous performance. 6th month), and in math at the 4th grade 6th
Most notable was Melinda’s willingness to inter- month level (an increase from 3rd grade 9th
act verbally with peers and adults in both aca- month). Though math was considered a
demic settings and social situations, as well as strength, records indicated that he continued
the ease with which she did so. to work on basic computations with a calcula-
Melinda’s maturity and responsibility were tor. In addition, his IEP stated that he needed
markedly improved. She was reported to make to improve word recognition, reading compre-
friends easily and to have a well-developed hension, and use of reading in his daily life.
natural support network. Melinda volun- Most significantly, school personnel indicated
teered twice a week at an elementary school, that Phillip did not generalize the skills he
taught a class in country line dancing, and learned in school to activities outside of school.
enjoyed watching movies with friends in her In relation to social development, Phillip’s
dorm. In most situations Melinda’s activities, records indicated that he demonstrated “very
and interactions during those activities, were low self-esteem” and a “poor self-concept”. He
comparable to those of her peers. Her natural was reluctant to interact with peers at school and
support network had determined that, when was very depressed. He was fearful of making
Melinda was irritable, she appeared to have mistakes and demonstrated a lot of anxiety
difficulty responding to auditory information when doing assignments in school and when
(e.g., verbal directions or questions). To ac- participating in activities in the community. Al-
commodate for this, Melinda learned coping though he had a well-developed vocabulary and
strategies to use when she needed more time his speech was intelligible to others, Phillip was

Long-term Outcomes / 331


reluctant to engage in interactions. Records in- tinued to model the behaviors of individuals
dicated that he needed to improve the appro- with whom she had contact, and had begun to
priateness of his interactions with adults and recognize the connection between diet, exer-
peers, as well as improve logical thinking, prob- cise, weight, grooming, and how others some-
lem solving, and decision making. Records and times reacted to physical appearance.
observations reflected a major regression in his Although self-sufficient when using the bus
use of social skills over time. There was no in- and train locally, as well as when participating
formation available in the records that was re- in typical daily activities (e.g., shopping),
lated directly to his need for supervision or his Melinda required support through the Med-
physical appearance. icaid Waiver program for activities that were
completed with less frequency, such as bud-
Four Additional Years Later: Meeting as Adults geting, cleaning, and caring for her clothing.
Four years after exiting school services, She also had weekly support from a job coach
Melinda and Phillip met again as adults while who watched for changes in her tasks at work,
riding a bus in their home community. and changes in co-workers or supervisors with
Though neither of them remembered the whom she needed to interact. When such
other from the self-contained special educa- changes occurred, the job coach assisted
tion class they had attended together, they Melinda in adapting to the new variables.
began to interact and establish a relationship. Melinda’s speech across contexts in the
Melinda. Upon returning to her home community was intelligible, and her vocabu-
community after 2 years auditing classes at the lary had increased dramatically to reflect her
out-of-state college, Melinda was living in her experiences and interactions with others. Her
own apartment with periodic support through appearance continued to reflect that of a con-
a Medicaid Waiver. When she and Phillip met fident and capable individual with erect pos-
again as adults, Melinda was taking the bus to ture and eye contact with others, though she
her part-time job with the court system, which periodically needed reminders about her self-
she had held for 3 years. Her job required the care and clothing.
use of literacy and math skills on computers Phillip. When he re-met Melinda on the
and in filing activities. In addition, Melinda bus, Phillip was living in his parents’ home.
used her literacy across many activities in her He had been terminated from numerous food
life in the community, including: (a) reading service jobs in the community and was work-
bus schedules, newspapers, and popular ing in a sheltered workshop, earning five to-
books and magazines; (b) using email; and (c) kens a day. According to Phillip, the tokens
following and participating in activities re- could be spent at the workshop store for
lated to WWF wrestling. She also used her candy, toys, puzzles, or used clothing.
math skills to manage her household budget, Phillip used literacy skills across every day
pay bills, travel by bus and train locally, and activities, such as using lists and reading bus
travel by air for special trips. schedules. His activities at the sheltered work-
Upon returning to her home community, shop, however, did not require either literacy
Melinda developed and used an extensive nat- or math abilities. While Phillip might have
ural support network. With members of her used his math abilities in activities like riding
support network, Melinda participated in pre- the bus and purchasing items at stores, he
ferred leisure activities (e.g., attending WWF frequently did not have money to spend due
wrestling matches; going to the movies), as to unemployment. Since he was living with his
well as less preferred activities (e.g., working family, Phillip also had no need to pay bills or
out at the gym). Her support network was maintain a household budget. In spite of
intimately involved in supporting her both these limitations Phillip had experience inde-
during routine activities and in crisis situa- pendently accessing resources that were be-
tions (e.g., the death of a long-term friend). yond his local community. For instance, he
With her support network, Melinda continued had used a long distance bus company to get
to use and develop new coping strategies to to an amusement park approximately one
assist her when she was having difficulty re- hour from his home community.
sponding to verbal information. Melinda con- Phillip’s natural support network consisted

332 / Education and Training in Autism and Developmental Disabilities-September 2010


of his family members and individuals who expanded to include Phillip’s family, while
were paid to provide a service for him, such as existing members of her network were shared
the support personnel at the sheltered work- with Phillip. Second, she was exposed to addi-
shop. He had no friends or acquaintances tional contexts, or life spaces, in which she
with whom he regularly visited, conversed, or participated in activities independently.
shared activities when at leisure. The only lei- Melinda continued, however, to receive peri-
sure activity in which he participated on a odic support for budgeting, cleaning, and
regular basis was going to BINGO with his clothing care through a Medicaid Waiver.
parents once a week. Phillip continued to be Phillip. Because of Phillip’s relationship
very social, both with individuals he knew and and marriage with Melinda, there were nu-
with strangers. When interacting with others, merous changes in his life. One of these
however, he was anxious and eager to please changes involved his employment status. At
others. Over time his interactions increasingly one point during the three years they were
were described as immature, demonstrating a dating, Melinda was eating at one of the res-
slow rate of growth in reading social cues and taurants she frequented after work. She ob-
using social skills. Consistent with this, Phillip served the owner putting a “Help Wanted”
did not differentiate between (a) people who sign in the restaurant window, indicating that
were trustworthy and untrustworthy, and (b) a dishwasher was needed. Melinda picked up
behaviors that were appropriate and inappro- the sign, took it to the owner, and said “I have
priate. This resulted in him using poor judg- a dishwasher for you.” She then arranged for
ment and making decisions that frequently Phillip to be interviewed, after which he was
resulted in conflict with others in the commu- hired. Phillip did not stay in this position long
nity, in spite of the supervision he had at and, in fact, had held several jobs before and
home and at the sheltered workshop. after he was married. During the last observa-
In appearance Phillip had become distin- tion, Phillip recently had been offered a posi-
guishable from those around him. Though he tion at a local grocery store where he would
continued to have an appropriate gait and assist patrons as they took groceries to their
make appropriate eye contact with those he cars and retrieve carts from the parking lot.
passed, his clothing was ill-fitting and mis- A second change that occurred was in
matched, resulting in a consistently dishev- Phillip’s living arrangements. He no longer
eled and unkempt appearance. lived with his family; rather, he shared an
apartment with Melinda and, for the first time
Four Additional Years Later: Married Life in his life, he shared responsibility for main-
After dating for three years, Melinda and taining a household both financially and lo-
Phillip married. As a result, they shared an gistically. Like Melinda, Phillip received peri-
apartment, along with all of the responsibili- odic support for budgeting, cleaning, and
ties inherent in maintaining a household, in- clothing care through a Medicaid Waiver.
cluding budgeting, paying bills, cleaning the A third change that occurred was in the
apartment, cooking, shopping, and clothing composition of Phillip’s natural support net-
care. In addition, Melinda’s parents had be- work. Although he had not developed his own
come the legal guardians for both Melinda network, he did participate with Melinda and
and Phillip. members of her natural support network. As
Melinda. By this time Melinda had been this progressed, however, Phillip increasingly
an employee of the court system for seven initiated interactions and activities with mem-
years. Because of her longevity in a part time bers of Melinda’s network and, while initially
civil service position, she had become a per- appropriate, his efforts to engage these mem-
manent part-time employee with full benefits. bers often were found to be objectionable. For
She continued to use her literacy and math example, he would call one individual 10
abilities across activities at work, at home, and times a day to obtain reassurance that some-
in the community. thing he was doing (e.g., clothes he was wear-
Her relationship and marriage with Phillip ing) was appropriate; he would call an indi-
resulted in two main changes in Melinda’s life. vidual and ask the same question repeatedly,
First, her natural support network had been to be certain he had the correct answer. These

Long-term Outcomes / 333


behaviors were consistent with Phillip’s anxi- needing a “high level of supervision across
ety and need for constant reassurance and settings,” while with schoolmates and co-work-
approval; however, they began to have a neg- ers in inclusive settings she completed instruc-
ative impact on group members and they be- tional tasks and work activities with minimal
gan to avoid Phillip and, therefore, avoid in- or no supervision. She also lived indepen-
teractions with Melinda. dently in the community with periodic sup-
A fourth change for Phillip was in relation port from her natural support network and
to the life spaces, or contexts, to which he was Medicaid Waiver personnel. In addition,
exposed. Since Melinda frequently partici- Melinda worked for the same employer for
pated in experiences that were complex and seven consecutive years with only periodic job
worldly (e.g., traveling overseas; attending coach support. Fifth, while in her last self-
concerts, plays, and formal parties), Phillip contained special education class, Melinda
began to share these experiences when he and showed regression academically and refused
Melinda began their relationship. to use the academic skills she had acquired
Upon initially meeting Phillip, people usu- (e.g., reading, writing) in either instructional
ally perceived a very social and interactive per- or functional activities. After transitioning to
son who wanted to please people. Only after inclusive contexts, Melinda freely used aca-
observing Phillip in numerous contexts over demic skills in both instructional and func-
time did it become apparent that his interac- tional activities. Finally, Melinda initially had a
tions often occurred in a stereotypic manner; natural support network that was limited to
that is, he consistently used phrases and sen- her family, paid individuals, and a few friends
tences that others used or that he had used in from her activities in the community. While in
the past. His speech had a repetitive and un- inclusive contexts Melinda developed an ex-
imaginative quality that eventually irritated tensive natural support network comprised of
people. As people became irritated, Phillip individuals from her ongoing educational,
then would begin to apologize profusely and work, leisure, and community experiences.
repeatedly seek approval, exacerbating the When considering her educational experi-
discomfort and frustration of others. ences, two variables are significant. First, prior
to being included in general education classes
Differences in Melinda’s Engagement over Time Melinda‘s IEP focused on the development of
There are several ways in which differences academic skills at the “next grade level” (e.g.,
were evident in Melinda’s experiences and from the 2nd grade 3rd month level to the 2nd
performance over time. First, in relation to grade 4th month level), behavior issues (e.g.,
appearance, Melinda initially walked with a compliance), and social issues (e.g., interact-
“special education shuffle” and used unintel- ing appropriately with adults and classmates).
ligible speech. This is in contrast to Melinda Upon moving to inclusive general education
later walking with good posture and speaking classes, Melinda’s IEP focused on the acquisi-
in a manner that allowed strangers to under- tion of general education content and skills
stand her speech. Second, in her last self- acquired through participation with class-
contained special education class Melinda was mates during general education activities, and
disruptive, while when she was in inclusive the use of both general education knowledge
settings she attended to verbal cues from her and functional skills during ongoing general
teachers and schoolmates without disabilities. education and real life activities. When receiv-
She also modeled the behaviors of her school- ing services in a self-contained special educa-
mates during instructional and noninstruc- tion class Melinda’s educational records pre-
tional times. Third, initially Melinda demon- dicted that as an adult she would be placed in
strated inappropriate behaviors that helped a sheltered workshop and in a congregate care
her avoid instructional tasks in the self-con- living facility. After receiving services in inclu-
tained class, while she demonstrated an inter- sive contexts, Melinda’s education program
est in learning and participated in activities shifted to prepare her for supported compet-
across classes and community contexts with itive employment in the community and sup-
individuals who did not have disabilities. ported apartment living.
Fourth, initially Melinda was described as Overall, as there was an increase in Melin-

334 / Education and Training in Autism and Developmental Disabilities-September 2010


da’s participation in general education and reinforcement across contexts. Finally, Phillip
meaningful functional activities within gen- initially had numerous peers without disabili-
eral education contexts with classmates who ties with whom he interacted during school
did not have disabilities, she demonstrated a and school-sponsored activities. As an adult,
higher level of self-assurance and self-confi- however, Phillip’s natural support network in-
dence. Melinda also responded to both in- cluded only family members and paid individ-
structional and social cues available from her uals. As his relationship with Melinda devel-
classmates, resulting in more appropriate be- oped, Phillip accessed members of Melinda’s
havior and appearance. Throughout her inclu- natural support network, instead of develop-
sive educational experiences Melinda developed ing his own network. His inappropriate inter-
skills that allowed her to independently access actions with members of Melinda’s natural
the community-at-large through local, national, support network led to their decreased inter-
and international travel. Finally, Melinda devel- actions with both Phillip and Melinda.
oped the ability to use coping skills to compen- When initially observed, Phillip’s Individu-
sate for her disabilities and to use good judg- alized Education Program (IEP) focused on
ment when making decisions. the development of academic skills to the
“next grade level” (e.g., from the 2nd grade 3rd
month level to the 2nd grade 4th month level).
Differences in Phillip’s Engagement over Time
Over time, however, Phillip’s IEP increasingly
There also were several ways in which differ- focused on appropriate behavior, following
ences were evident in Phillip’s experiences rules, and working with less supervision. His
and performance over time. First, in relation records consistently predicted and focused on
to appearance, Phillip initially was described preparing Phillip to enter a sheltered work-
in a manner that was consistent with that of shop and a congregate care living facility.
his peers without disabilities (e.g., clothing, Overall, as Phillip continued in self-con-
posture, speech, interaction style, confidence tained special education classes, he demon-
level). As he remained in a self-contained spe- strated a lower level of self-assurance and a
cial education class over time, however, Phillip higher level of anxiety across contexts. Phillip
increasingly became disheveled, wore mis- also increasingly required approval and rein-
matched clothing, and was described as hav- forcement for the slightest behavior, resulting
ing low self-esteem. Second, when observed in more inappropriate behavior and interac-
initially Phillip was attentive and compliant tions. Phillip developed skills that allowed him
during both instructional and non-instruc- to independently access frequently used con-
tional activities. Through the remainder of his texts in his community, but he did not develop
educational experiences and beginning of his the skills required to independently access
adult life, however, Phillip was anxious, fearful other contexts in local, state, or international
of mistakes, and in need of constant reassur- communities. Finally, Phillip’s coping skills
ance. Third, when observed initially Phillip and poor judgment frequently resulted in
was described as needing a “moderate level of negative outcomes, such as losing jobs, getting
supervision” during unstructured times. Over into trouble in the community, or alienating
time, however, he increasingly required con- members of Melinda’s natural support net-
stant supervision at work (i.e., in sheltered work.
workshop), he lost several jobs in the commu-
nity, he was involved in several problematic
Discussion
situations in the community, and he contin-
ued to live with his parents. Fourth, when Providing special education services in inclu-
observed initially Phillip appeared to be devel- sive general education contexts has had mul-
oping additional academic skills due to his tiple goals for students with significant disabil-
attention and compliant behavior in school ities. First, it has been considered a practice
(e.g., reading, writing, math). Over time, how- that is consistent with civil rights, focusing on
ever, it became apparent that his skill level was equal access to educational content, highly
not increasing and he required encourage- qualified teachers, instructional activities, and
ment to use his academic skills and constant overall contexts for students with significant

Long-term Outcomes / 335


disabilities. Second, it has promoted the mod- other variables that might have accounted for
ification of educational services so that they differences between the two individuals’ adult
emphasize (a) facilitating the students’ access outcomes. For instance, limited information
to general education curriculum and con- was gathered in relation to either the specific
texts, (b) supporting the students’ participa- services provided in either the self-contained
tion in district and state accountability sys- special education classes or the inclusive gen-
tems, (c) fostering the students’ valued eral education settings, or any activities com-
membership in peer groups, and (d) facilitat- pleted by their school district to influence the
ing friendships between same-aged peers with quality, type, or amount of those services. It is
and without disabilities that may lead to stron- possible, therefore, that the services provided
ger and broader natural support networks. at any point during the students’ educational
Third, it has been considered a way to alleviate experiences in either setting were either ex-
the shortcomings of self-contained special ed- emplary or less than exemplary. Further re-
ucation services, as well as the negative long- search is needed to determine any differences
term outcomes revealed by follow-up studies. in adult outcomes that might result from vari-
This descriptive study examined how two ations in quality, type, or amount of special
individuals with significant disabilities func- education and related services across settings.
tioned across settings over time when, after Similarly, no effort was made to control for
receiving services together in a self-contained the availability or quality of the adult services
special education class in middle school, one for Melinda and Phillip in their home com-
remained in self-contained classes for the re- munities. The same adult services were avail-
maining six years of educational services, and able for both, since geographically they lived
the other changed to educational services in in the same community. Although differences
general education contexts. Melinda, the stu- in services they were utilizing as adults were
dent who received services in inclusive general evident, these differences could not be inter-
education settings, demonstrated more skills preted as related to differences in their home
that were critical to interacting and function- community, county, or state.
ing across contexts in her life, including at It might be argued that the presence of a
school, at home, at work, and in the commu- deeply involved parent advocate who was
nity. As she became a young adult, she devel- knowledgeable about inclusive education and
oped and maintained a life that more closely the rights of students with disabilities could
matched society’s perceptions of a satisfying have accounted for differences between the
and high quality life, even though her IQ and educational experiences and progress made
achievement test scores were lower in compar- by Melinda and Phillip. In his classic study of
ison to many individuals served in self-con- adults with disabilities who had moved from
tained special education settings. Melinda institutional to community living environ-
achieved more positive outcomes than Phillip ments, Edgerton (1967) discussed the influ-
in relation to her use of knowledge and skills ence of a “benefactor” on the lives of those
in meaningful contexts, interactions and rela- individuals. The results of this study appear to
tionships with peers without disabilities, and support his concept. Undoubtedly, the ongo-
access to and use of the various natural envi- ing involvement of parents and other advo-
ronments in her community. In conjunction cates who ensure that special education, re-
with studies reported by Fisher and Meyer lated, and adult services provided for
(2002) and Ryndak et al. (1999), this demon- individuals with significant disabilities reflect
stration of better long-term outcomes adds individual needs and preferences and assist
support for the field’s current focus on the individuals in acquiring and maintaining a
provision of educational services in inclusive high quality of life is critical. Additional re-
general education settings. search is required to understand the influence
It must be considered, however, that the of the presence or absence of a “benefactor”
comparison of outcomes for the two partici- in lives of individuals with significant disabili-
pants addressed in this study was based on ties.
events that occurred naturally in their lives. Another variable that might have influ-
That is, no effort was made to control for enced the outcomes achieved by the individ-

336 / Education and Training in Autism and Developmental Disabilities-September 2010


uals in this study was their access to and par- post-school outcomes for youth with disabilities:
ticipation in activities that fostered the Findings from the National Longitudinal Transi-
development of self-advocacy and self-deter- tion Study. Exceptional Children, 62, 399 – 413.
mination. While not specifically considered in Bogdan, R., & Taylor, S. (1975). Introduction to qual-
itative research methods. New York: John Wiley.
this study, the individual included in general
Browder, D. M., Spooner, F., Wakeman, S., Trela,
education contexts had access to role models
K., & Baker, J. N. (2006). Aligning instruction
without disabilities who were developing and with academic content standards: Finding the
using self-advocacy and self-determination in link. Research & Practice for Persons with Severe Dis-
their daily lives. The mere access to these role abilities, 31, 309 –321.
models may have facilitated Melinda’s devel- Caldwell, J., & Heller, T. (2003). Management of
opment of these skills. Additional research, respite and person assistance services in a con-
however, is needed to assist in our under- sumer-directed family support programme. Jour-
standing of the role of such models in inclu- nal of Intellectual Disability Research, 47, 352–366.
sive settings and the long-term outcomes Creswell, J. W. (2003). Research design: Qualitative,
achieved. quantitative, and mixed methods approaches (2nd edi-
tion). Thousand Oaks, CA: Sage Publications.
It seems probable that successful adult out-
Doren, B., & Benz, M. (1998). Employment inequal-
comes for persons with significant disabilities ity revisited: Predictors of better employment out-
are not the result of any one factor. Rather, it comes for young women in transition. The Journal
is likely that best practices in inclusive educa- of Special Education, 31, 425– 442.
tion, the ongoing presence of a benefactor Edgar, E. (1987). Secondary programs in special
and/or advocate, training in self-determina- education: Are many of them justifiable? Excep-
tion, and the availability of quality adult ser- tional Children, 53, 555–561.
vices in the community all interact to produce Edgerton, R. B. (1967). The cloak of competence: Stigma
more positive post-school outcomes. in the lives of the mentally retarded. Berkeley, CA:
While the findings of this investigation sug- University of California Press.
Fisher, M., & Meyer, L. H. (2002). Development and
gest that, when compared with services in self-
social competence after two years for students
contained special education settings, provid-
enrolled in inclusive and self-contained educa-
ing special education in inclusive general tional programs. Research and Practice for Persons
education settings may lead to better out- with Severe Disabilities, 27, 165–174.
comes for students with significant disabilities, Fisher, D., & Ryndak, D. L. (Eds.) (2001). Founda-
these results must be viewed with the limita- tions of inclusive education: A compendium of articles
tions mentioned above. Considerably more re- on effective strategies to achieve inclusive education.
search, involving many more individuals with Baltimore: Paul H. Brookes Publishing.
significant disabilities over several years, is Fisher, D., Sax, C., & Jorgensen, C. M. (1998). Phil-
needed before widespread conclusions can be osophical foundations of inclusive, restructuring
reached about the differential impact of inclu- schools. In C. M. Jorgensen (Ed.), Restructuring
high schools for all students: Taking inclusion to the
sive general education and self-contained spe-
next level (pp. 29 – 47). Baltimore: Paul H. Brookes
cial education settings on adult outcomes. Un-
Publishing.
til such research is conducted, however, this Hammersley, M., & Atkinson, P. (1995). Ethnogra-
study suggests that the current trend to pro- phy: Principles in practice (2nd Edition). London:
vide services for students with significant dis- Routledge Publishing.
abilities in inclusive general education con- Haring, K. A., & Lovett, D. L. (1990). A follow-up
texts may be one factor that facilitates more study of special education graduates. Journal of
positive adult outcomes. Special Education, 23, 463– 477.
Head, M. J., & Conroy, J. W. (2005). Outcomes of
self-determination in Michigan. In R. J. Stancliffe
& K. C. Lakin (Eds.), Costs and outcomes of commu-
References
nity services for people with intellectual disabilities (pp.
Anderson-Inman, L., Knox-Quinn, C., & Szymanski, 219 –240). Baltimore: Paul H. Brookes Publish-
M. (1999). Computer-supported studying: Stories ing.
of successful transition to post-secondary educa- Johnson, D. R., Bloomberg, L., Lin, H-C., McGrew,
tion. Career Development for Exceptional Individuals, K., Bruininks, R. H., & Kim, C. (1995). A secondary
22, 185–212. analysis of the findings from the National Longitudinal
Blackorby, J., & Wagner, M. (1996). Longitudinal Study: An examination of the postschool outcomes of

Long-term Outcomes / 337


youth with severe disabilities. Minneapolis, MN: Uni- Ryndak, D. L., & Fisher, D. (Eds.) (2003). The foun-
versity of Minnesota, Institute on Community In- dations of inclusive education: A compendium of arti-
tegration. cles on effective strategies to achieve inclusive education
Kvale, S. (1996). Interviews: An introduction to quali- (2nd edition). Baltimore, MD: Paul H. Brookes Pub-
tative research interviewing. Thousand Oaks, CA: lishing.
Sage Publications. Ryndak, D. L., Morrison, A. P., & Sommerstein, L.
Lee, S., Amos, B. A., Gragoudas, S., Lee, Y., (1999). Literacy prior to and after inclusion in
Shogren, K. A., Theoharis, R., et al. (2006). Cur- general education settings. Journal of the Associa-
riculum augmentation and adaptation strategies tion for Persons with Severe Handicaps, 24, 5–22.
to promote access to the general curriculum for Sandler, A. G. (1999). Short-changed in the name
students with intellectual and developmental dis- of socialization? Acquisition of functional skills by
abilities. Education and Training in Developmental students with severe disabilities. Mental Retarda-
Disabilities, 41, 199 –212. tion, 37, 148 –150.
Lipsky, D. K., & Gartner, A. (1997). Inclusion and Sharpe, M. N., York, J. L. & Knight, J. (1994). Effects
school reform: Transforming America’s classrooms. Bal- of inclusion on the academic performance of
timore: Paul H. Brookes. classmates without disabilities. Remedial and Spe-
Mason, J. (1996). Qualitative researching. Thousand cial Education, 15, 281–288.
Oaks, CA: Sage Publications. Silverman, D. (1993). Interpreting qualitative data:
McGlashing-Johnson, J., Agran, M., Sitlington, P., Methods for analyzing talk, text and interaction. Thou-
Cavin, M., & Wehmeyer, M. (2004). Enhancing sand Oaks, CA: Sage Publications.
the job performance of youth with moderate to
Strauss, A., & Corbin, J. (1998). Basics of qualitative
severe cognitive disabilities using the self-deter-
research: Techniques and procedures for developing
mined learning model of instruction. Research and
grounded theory (2nd edition). Thousand Oaks, CA:
Practice for Persons with Severe Disabilities, 28, 194 –
Sage Publications.
204.
Turnbull, H., Turnbull, A. P., Wehmeyer, M. L., &
McGregor, G., & Vogelsberg, T. (1998). Inclusive
Park, J. (2003). A quality of life framework for
schooling practices: Pedagogical and research founda-
special education outcomes. Remedial and Special
tions: A synthesis of the literature that informs best
Education, 24, 67–74.
practices about inclusive schooling. Baltimore: Paul
Wang, M., Mannan, H., Poston, D., Turnbull, A. P.,
H. Brookes Publishing.
& Summers, J. A. (2004). Parents’ perceptions of
McLaughlin, T., Ryndak, D. L., & Alper, S. (2008).
The beneficial outcomes of inclusive education: A advocacy activities and their impact on family
research summary. Proceedings of the International quality of life. Research and Practice for Persons with
Conference on Education and Society, Paris, France, Severe Disabilities, 29, 144 –155.
CD Rom. Wehmeyer, M. L. (2006). Beyond access: Ensuring
Merriam, S. (1998). Qualitative research and case study progress in the general education curriculum for
applications in education. San Francisco: Jossey- students with severe disabilities. Research & Prac-
Bass. tice for Persons with Severe Disabilities, 31, 322–326.
Mertens, D. M. (2005). Research and evaluation in Wehmeyer, M. L., & Palmer, S. B. (2003). Adult
education and psychology: Integrating diversity with outcomes for students with cognitive disabilities
quantitative, qualitative, and mixed methods (2nd edi- three-years after high school: The impact of self-
tion). Thousand Oaks: Sage Publications. determination. Education and Training in Develop-
National Organization on Disability (2000). mental Disabilities, 38, 131–144.
N.O.D./Harris Survey of Community Participa- White, J., & Weiner, J. S. (2004). Influence of least
tion. Retrieved October 12, 2007, from http:// restrictive environment and community based
www.nod.org training on integrated employment outcomes for
Patton, M. Q. (2002). Qualitative research and evalu- transitioning students with severe disabilities.
ation methods (3rd ed.). Thousand Oaks, CA: Sage Journal of Vocational Rehabilitation, 21, 149 –156.
Publications. Zafft, C., Hart, D., & Zimbrich, K. (2004). College
Peck, C. A., Staub, D., Gallucci, C., & Schwartz, I. career connection: A study of youth with intellec-
(2004). Parent perception of the impacts of in- tual disabilities and the impact of postsecondary
clusion on their nondisabled child. Research and education. Education and Training in Developmental
Practice for Persons with Severe Disabilities, 29, 135– Disabilities, 39, 45–53.
143.
Rubin, H. J., & Rubin, I. S. (1995). Qualitative inter- Received: 22 February 2009
viewing: The art of hearing data. Thousand Oaks, Initial Acceptance: 27 April 2009
CA: Sage Publications. Final Acceptance: 15 June 2009

338 / Education and Training in Autism and Developmental Disabilities-September 2010


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 339 –346
© Division on Autism and Developmental Disabilities

Family Perspectives on Post-Secondary Education for Students


with Intellectual Disabilities
Megan M. Griffin, Elise D. McMillan, and Robert M. Hodapp
Vanderbilt University

Abstract: This study investigated the issues that families consider when making decisions regarding post-
secondary education (PSE) for young adults with intellectual disabilities. Survey respondents were 108 family
members of transition-aged students with intellectual disabilities. Although respondents were generally positive
about PSE programs, they reported that educators’ attitudes were less supportive. Respondents identified many
barriers that prevent their understanding of PSE options, but a lack of information and guidance was the
barrier cited by the most respondents. When considering PSE options, respondents were most concerned about
student safety, and they considered a focus on employment to be the most important program component.
Continued research is needed to investigate the factors critical in developing successful PSE programs for
students with intellectual disabilities.

Although recent decades have seen a shift ary education (PSE) options. Now numbering
toward providing inclusive, age-appropriate over 150 across the United States, PSE programs
educational opportunities for students with are located on college campuses and allow stu-
intellectual disabilities (Neubert, Moon, Gri- dents with intellectual disabilities to continue
gal, & Redd, 2001), prospects after high school their education alongside typical peers (Consor-
remain bleak for these students, many of whom tium for PSE for Individuals with Developmen-
experience segregation and social isolation tal Disabilities, 2009). In PSE programs, stu-
(Chambers, Hughes, & Carter, 2004). In fact, of dents learn academic material, expand social
all students with disabilities, those with intellec- networks, gain employment skills, and de-
tual disabilities are the least likely to be involved velop independence. Although colleges have
in job training, paid employment, or education historically excluded students with intellectual
after high school (Wagner, Newman, Cameto, disabilities, PSE programs offer these students
Garza, & Levine, 2005). an alternative to traditional college admission
As an alternative to such poor post-school
and participation (Hart, Grigal, Sax, Martinez,
outcomes, a movement has arisen to provide
& Will, 2006).
these young adults with inclusive post-second-
As more PSE programs become available,
families are increasingly considering this op-
tion (Neubert et al., 2001; Hart et al., 2006).
We thank members of the Tennessee Task Force Since families, particularly parents, are instru-
for Post-Secondary Education for Students with In-
mental in transition planning, understanding
tellectual Disabilities for support of survey develop-
ment and dissemination. We especially thank those their perspectives can improve the approaches
who supported the survey distribution, particularly taken by educators and service providers
the Autism Society of Middle Tennessee, the Down (Chambers et al., 2004; Lehmann, Bassett, &
Syndrome Association Middle Tennessee, The Arc Sands, 1999; Morningstar, Turnbull, & Turn-
of Williamson County, the Tennessee Council on bull, 1995). In prior studies, researchers have
Developmental Disabilities, and the Vanderbilt focused on general transition outcomes for stu-
Kennedy Center. Correspondence concerning this
dents with intellectual disabilities compared to
article should be addressed to Megan M. Griffin,
Department of Special Education, Vanderbilt Uni-
typical students (Whitney-Thomas & Hanley-
versity, 230 Appleton Place, Peabody Box 228, Nash- Maxwell, 1996) and to students with other dis-
ville, TN 37203. E-mail: megan.m.griffin@ abilities (Polat, Kalambouka, Boyle, & Nelson,
vanderbilt.edu 2001; Wagner et al., 2005). Not surprisingly,

Family Perspectives / 339


parents of students with intellectual disabilities were excluded if they lived in a different state,
are among the most pessimistic about transi- or if the student was not 14 –25 years old.
tion outcomes, including PSE participation Family members of students with intellectual dis-
(Wagner et al.). abilities. Of the 108 respondents, 94% were
A smaller literature has focused specifically parents or guardians, and 91% were female; in
on the perspectives of parents of students with all, 87% of respondents were the student’s
intellectual disabilities. For example, Kraemer mother. The majority of respondents were
and Blacher (2001) found that the primary White (88%); remaining respondents were
concern for these parents is determining what 8% Black, 1% Hispanic, 1% Asian/Pacific Is-
the young adult will do during the day after lander, and 2% other. The majority of respon-
high school; however, this study did not dis- dents were 40 years or older (87%); from
cuss PSE programs as a transition option. Sim- urban areas (81%); working part or full time
ilarly, Cooney (2002) found that parents were (81%); and had completed college or a
very concerned about the transition process, higher level of education (76%).
but also did not address PSE options. In a Students with intellectual disabilities. The re-
more recent study of both parent and sibling spondents’ family members with intellectual
perspectives, Chambers et al. (2004) found disabilities were 66% male and 34% female.
that respondents considered PSE an impor- The respondents reported diagnoses of the
tant outcome, but that their knowledge of students, and in some cases selected more
programs was limited and they did not think than one category. Their diagnoses were: 35%
their family member would pursue this op- Mental Retardation; 35% Autism Spectrum
tion. Although PSE options are increasingly Disorders; 29% Developmental Disabilities;
available to students with intellectual disabili- 17% Down Syndrome; 10% Cerebral Palsy;
ties, no studies have investigated the issues and 1% Williams Syndrome. Respondents in-
that families consider when making decisions dicated the academic ability of their family
regarding PSE participation. member by estimating the student’s reading
To examine such perspectives, we surveyed level, with 32% indicating that the student
families of high school students with intellec- reads at a First Grade level or lower; 32%
tual disabilities concerning PSE program par- between the Second and Fifth Grade level;
ticipation. We had three goals for this study. and 36% at a Sixth Grade level or higher.
First, we wanted to determine family percep-
tions of transition planning, as well as deter-
Procedure
mine those barriers that families encounter in
learning about PSE programs. Second, we This study was performed in collaboration
wanted to identify those demographic charac- with the Tennessee Task Force for Post-Sec-
teristics that might correlate with differential ondary Education for Students with Intellec-
expectations for students after high school. tual Disabilities, a group that supports the
Third, we wanted to examine both the con- development of PSE programs on Tennessee
cerns that families have about enrolling stu- college campuses. The Task Force is com-
dents in PSE programs, and the program posed of representatives from various stake-
characteristics that families consider most holder groups: the Vanderbilt Kennedy Cen-
important. Our goal was to attain an overall ter, the Tennessee Council on Developmental
sense of families’ knowledge and perceptions Disabilities; the Tennessee Division of Voca-
of PSE programs. tional Rehabilitation Services; community and
disability advocacy groups; the public school
system; higher education institutions; Tennes-
Method see’s Division of Mental Retardation Services;
and involved parents and community mem-
Participants bers.
In conjunction with the Task Force, we cre-
Participants included 108 family members of ated and distributed a survey to learn more
transition-age students with intellectual dis- about family perspectives toward PSE pro-
abilities in Tennessee. Survey respondents grams. The survey was designed in both elec-

340 / Education and Training in Autism and Developmental Disabilities-September 2010


tronic and print formats; it was formatted elec- tus, occupation, marital status, and number of
tronically using web-based survey software children.
(Survey Gold 8). Respondents who completed 2. Information about the student with intellectual
the online survey first read a description of disabilities. Comprised of 22 questions about
the study and an explanation that they could the student with an intellectual disability, ques-
choose to participate or not, withdraw at any tions in this section asked about the student’s
point, and skip questions. Next, respondents age, gender, ethnicity, place of residence and
were directed to the survey; finally, they were disability diagnosis. Other questions ad-
asked if they would like to submit their re- dressed the student’s health, emotional well-
sponses. Respondents could only submit an- being, and adaptive behavior. Questions also
swers to the secure website if they answered addressed functional abilities: respondents
this question affirmatively. Approximately were asked to rate on a 5-point scale (1⫽ not
94% of participants responded via the web- at all; 5 ⫽ very well) how well students per-
based survey. The remaining respondents form various activities (e.g. walking, speaking,
completed and mailed print surveys, which eating, preparing meals, taking medications,
were then manually entered into our data- grooming).
base. This section also included questions about
Participants were recruited in several ways. students’ academic history, attitude toward
The survey was advertised through the Vander- school, and transition plan. Items about aca-
bilt Kennedy Center’s web-based Studyfinder; demic history concerned the student’s IEP,
internal e-mail messages sent through Vander- reading level, most recent school setting, and
bilt University Medical Center; and flyers distrib- prospects for graduating with a regular di-
uted through local newsletters and at commu- ploma. Other questions asked respondents
nity events. In addition, various community whether the student seems to like school, and
agencies that had been involved with the Ten- whether the student seems interested in edu-
nessee Task Force distributed the survey. Be- cational opportunities after high school. Fi-
cause we wanted survey respondents to be as nally, questions asked respondents how aware
candid as possible, we assured them that all they are of PSE options, how they learned
answers would remain anonymous. about them, and what barriers they encoun-
tered during this process.
3. Perspectives on PSE options. This section
Survey Instrument asked respondents about post-secondary op-
tions, and specifically about characteristics of
To develop the survey, we drew on prior re- PSE programs. Items asked respondents what
search that had addressed post-secondary op- their children would most likely do after high
tions for young adults with disabilities (Cham- school, and whether they thought that PSE
bers et al., 2004; Kraemer & Blacher, 2001; programs were a viable option. A series of
Polat et al., 2001; Wagner et al., 2005). Survey questions asked respondents how concerned
development involved collaboration with Task they were about various factors when consid-
Force members, including researchers, dis- ering PSE for their family member. On a
ability advocates, and family members of stu- 5-point scale (1 ⫽ not at all concerned; 5 ⫽
dents with intellectual disabilities. Their feed- very concerned), respondents rated these fac-
back informed the final survey, which was tors (e.g. the student’s health; cost of the pro-
composed of 50 items and divided into four gram; the student’s safety; the student’s ability
sections. to function without parent; similarity to a typ-
1. Information about primary respondents. ical college experience; focus on employment
The first section of the survey asked 12 ques- after program completion; and distance of
tions regarding demographic information program from home).
about the respondent. Using either multiple- Another series of questions asked about the
choice or open-ended formats, this section degree of importance of various program
asked about the respondent’s age, gender, components. On a 5-point scale (1 ⫽ not at all
ethnicity, relationship to the student, place of important; 5 ⫽ very important), respondents
residence, level of education, employment sta- rated the degree of importance that they at-

Family Perspectives / 341


tributed to such PSE program components as addition, only 26% of parents affirmed that
residential options; inclusive learning environ- their child’s IEP included a plan for the time
ments; individual choice in curriculum; struc- immediately following high school; 53% re-
tured social activities; access to a college cam- ported that the IEP did not include this, and
pus; certification in a vocational area; and a 21% were unsure.
focus on employment after completion of pro-
gram.
Barriers to Parents Understanding PSE Options
4. Open-ended questions. The final section
was composed of open-ended questions, in- Beyond inadequate transition planning, par-
cluding: (a) “What would help you make de- ents also reported many other barriers to un-
cisions about the options available to your derstanding PSE options for their children.
child after high school?” (b) “What advice Most respondents (73%) reported a “lack of
would you give to parents of younger children general information or guidance,” and the
with intellectual disabilities to better prepare next most-reported barriers were “school and
them for the transition that their children will other staff did not help me understand”
face after high school?” and (c) “If you could (36%), and “financial constraints” (36%). Fi-
design a program for your child to participate nally, many respondents reported barriers re-
in after high school, what would it look like? lated to services: “different services did not
What would be the most important aspects of work well together” (30%); “long waiting list
the program?” for explanation of services” (26%); and “staff
from different services gave conflicting ad-
vice” (25%). Thirteen percent reported that
Data Analysis “written and online materials were difficult to
understand;” 9% of all respondents reported
All survey data were transferred for analysis to that they did not encounter any barriers.
the Statistical Package for the Social Sci-
ences (SPSS) 16 for Windows. First, we used
descriptive analyses to determine demo- Student Reading Ability as a Correlate to Parent
graphic information for both the primary Perspectives
respondents and the students with intellec- Although as a group parents were generally
tual disabilities. Next, we performed analy- positive about PSE, parents of students with
ses of variance (ANOVAs) to test hypotheses lower reading levels were less likely to think
of group differences. Finally, we employed that PSE would help their children transition
repeated-measures ANOVAs to analyze, to adulthood, F(2, 104) ⫽ 10.73, p ⬍ .01.
within individual respondents, their ratings Parents of these students also thought their
of relative concern about aspects of PSE children were less interested in educational
participation and of relative importance of opportunities after high school, F(2, 104) ⫽
different PSE program components. 13.47, p ⬍ .01; were less often encouraged by
school staff to pursue PSE, F(2, 104) ⫽ 10.40,
p ⬍ .01; and less likely to enroll their child in
Results PSE, F(2, 104) ⫽ 15.44, p ⬍ .01. In each of
these questions, major differences were found
Parental Perspectives on Transition Planning between parents of children at the First Grade
reading level or lower compared to parents
Descriptive findings regarding students’ tran- whose children read at the Second-to-Fifth
sition plans indicated an inconsistency be- Grade and Sixth Grade-or-higher levels (see
tween parent and teacher perspectives. Com- Figure 1).
pared to parents, who indicated that PSE
opportunities would help their child transi-
Parental Concerns and Priorities Regarding PSE
tion to adulthood (M ⫽ 4.0, sd ⫽ 1.25), edu-
Programs
cators were perceived as being less encourag-
ing of these children pursuing PSE (M ⫽ 2.87, Parents also differed in their concern over
sd ⫽ 1.56), t (108) ⫽ 6.79, p ⬍ .0001. In various aspects of PSE participation, F(6,

342 / Education and Training in Autism and Developmental Disabilities-September 2010


Figure 1. Differential parental attitudes toward PSE according to student reading level.

642) ⫽ 26.78, p ⬍ .01. Among 7 different Open-ended Questions


items, parents were by far the most concerned
about their child’s safety; almost 9 in 10 re- Of the 108 respondents, 94 (87%) answered at
spondents rated this item a “5” on a 5-point least one open-ended question.
scale. Conversely, parents were less interested Transition decisions. The first question
that the PSE program provided an experience asked respondents what would help them
similar to a typical college environment; this make transition decisions. Of the 92 respon-
item averaged the lowest rating (3.44) and dents who answered this question, 57% an-
received the lowest proportion of “5” ratings swered that they needed more information to
(30.6%; see Table 1). Similarly, as shown in make educated decisions. Respondents noted
Table 2, respondents reported that the most that such information could come from a va-
important PSE program component involved riety of sources, including teachers, service
a focus on employment, whereas the two least providers, PSE program representatives, and
important program components involved ac- other parents. One respondent wrote, “It
cess to a college campus and residential op- would be great if the school system had the
tions, F(6, 642) ⫽ 8.48, p ⬍ .01. information to give the parents on the options

TABLE 1

Mean Scores of the 7 Parental Concern Items, and Percent of the Sample Giving the Highest Rating (5 ⴝ
Very Concerned)

Concern Regarding PSE Programs Mean Percent Highest

Your child’s safety 4.72 (0.94) 88.0%


Your child’s ability to function without you 4.34 (1.15) 64.8%
Focus on employment after completion of program 4.29 (1.35) 67.6%
Cost of the program 4.06 (1.41) 61.1%
Distance of the program’s campus away from your home 3.94 (1.26) 47.2%
Your child’s physical health 3.81 (1.56) 53.7%
Program similar to a typical college experience 3.44 (1.55) 30.6%

Family Perspectives / 343


TABLE 2

Mean Scores of the 7 PSE Program Component Items, and Percent Giving the Highest Rating (5 ⴝ Very
Important)

Program Component Mean Percent Highest

Focus on employment after completion of program 4.36 (1.15) 67.6%


Structured social activities 4.24 (1.09) 56.5%
Individual choice in curriculum 4.22 (1.12) 57.4%
Inclusive learning environments 4.08 (1.24) 53.7%
Opportunity for certification in a vocational area 4.01 (1.29) 50.0%
Access to a college campus 3.60 (1.43) 38.9%
Residential options 3.47 (1.45) 47.2%

for these children. The school system drops Desired PSE characteristics. The final ques-
the ball with these children.” Many respon- tion asked respondents what an ideal PSE pro-
dents (37%) also wrote about specific pro- gram for their child would be. Of the 85 re-
gram characteristics (e.g. location, cost, safety, spondents that answered this question, 21%
and employment training). Fewer (16%) mentioned practical skills development (e.g.
mentioned student characteristics, and the training in handling money), and 19% em-
importance of matching programs to the spe- phasized the need for skilled teachers who can
cific needs of students. Finally, 6% expressed provide students structure and support. Other
the need for more options; as one respondent respondents (18%) emphasized employment
wrote, “Options should be offered. Opportu- training; another 18% expressed interest in
nities should be everywhere, just like they are social skills training, recreation, and socializ-
for the general public.” ing. Remaining respondents wrote about a
Advice to other families. Of the 84 respon- variety of program components: academics,
dents that answered this question, 56% ad- skills training, inclusion, and similarity to a
vised families to inform themselves about typical college experience.
their rights and to plan ahead, for example, by
placing the student on waiting lists for adult Discussion
services early. A subset of this group (17% of As an initial step in determining the viability
respondents) advised parents to work with of PSE programs, our findings extend prior
schools, community organizations, and other research by investigating the perspectives of
families. In contrast, 10% of all respondents families of students with intellectual disabili-
advised parents not to rely on others. As one ties. Findings emerged in three major areas:
respondent wrote: “Do not wait for your guid- family attitudes toward PSE options; correlates
ance counselor . . . You need to be proactive with differential attitudes toward PSE; and
and persistent in gathering this information.” families’ priorities and concerns about PSE
A final group (15%) emphasized the impor- programs.
tance of high expectations and individualized First, we found that parents considered PSE
goals for students. opportunities to be beneficial for their transi-
An additional 8% expressed their inability tioning children, but that they did not think
to answer the question at all, stating that they that educators encouraged this option. In
needed advice themselves. One respondent comparing ratings of parent versus teacher
wrote, “There is not a good road map. Things encouragement of PSE options, parents rated
have been pretty clear up to this point. Part of themselves more interested than teachers.
this is likely my own unwillingness to look at a Most respondents (73%) lacked information
future that feels pretty bleak. Also, I am just and guidance about planning for PSE and, in
tired of advocating and creating opportunities the open-ended answers, parents wrote that
out of whole cloth.” school staff could do much more to facilitate

344 / Education and Training in Autism and Developmental Disabilities-September 2010


PSE planning. While poor communication has milial characteristics that predispose them to
been well-documented as a general barrier to abuse and exploitation; recent studies report
effective transitions to adulthood, our survey ad- that such individuals suffer abuse at rates from
dressed this issue specifically within the context 2–10 times those noted among non-disabled
of PSE planning. Indeed, while other studies individuals. Thus, while no research has yet
have found that families are generally positive addressed this issue in the context of PSE,
about PSE (Chambers et al., 2004) and have concerns over safety will undoubtedly influ-
documented poor communication between par- ence parental decisions about their student’s
ents and teachers (Lehmann et al., 1999), this participation. PSE programs, in turn, will
survey is the first to document the barriers to need to respond to parental concerns by tak-
PSE planning and access. ing appropriate measures to ensure student
Second, parents of students with lower read- safety and by communicating these efforts to
ing levels were less likely to think that PSE families.
would help their children transition to adult- Parents also reported a strong preference
hood. In this study, the break point was be- for certain PSE program characteristics. Com-
tween the group of students who read at the pared to other program components, parents
First Grade level or lower, compared to stu- want PSE programs to focus on their child’s
dents reading at the Second Grade level and employment; indeed, post-program employ-
higher. This finding mirrors results of the Na- ment was rated as a “5” by 68% of all respon-
tional Longitudinal Transition Study-2 (Wagner dents. While other studies have also found
et al., 2005), which reported that youth with that parents consider employment to be a pri-
higher functional cognitive skills were more mary outcome (Chambers et al., 2004; Krae-
likely to participate in PSE. However, we also mer & Blacher, 2001; Whitney-Thomas &
noted that parents of those students with the Hanley-Maxwell, 1996), none have yet ad-
lowest reading abilities were not wholly nega- dressed this issue in the context of PSE. Addi-
tive about the prospect of PSE for their chil- tionally, although many PSE programs cur-
dren. Although parents of students with the rently include employment training, this
lowest reading abilities were less positive component takes a variety of forms and is
about this option, some of these parents still emphasized to varying degrees (Hart et al.,
considered PSE for their children. 2006). Given our findings, PSE programs
Third, we found that parents harbored both should prioritize preparation for employment
specific fears and specific expectations about as the primary outcome for their students.
PSE programs. Their major fear related to their In contrast, there were also program char-
child’s safety. Indeed, from among 7 potential acteristics that parents did not prioritize. Most
concerns that we surveyed, parents consistently noteworthy in this regard were residential op-
reported their child’s safety as the highest rated tions and the program’s similarity to a typical
concern. As Table 1 shows, this single concern college experience. These views from parents
averaged close to 5 on a 5-point scale, was almost contrast sharply with informal conversations
half of a standard deviation above all other con- that we have had with potential PSE students
cerns, and was rated the highest score by almost themselves. Considering this contrast, we won-
90% of parents. der whether parental attitudes align with the
Although the salience of the students’ safety priorities of their children, who are ultimately
was somewhat surprising to us, it makes sense the participants in PSE programs. Given that
that parents would be most concerned about these students are young adults transitioning
this issue. In addition to parental concerns to full adulthood, understanding and honor-
over their child’s vulnerability (Fisher & ing their perspectives seems especially critical.
Hodapp, 2009; Hanley-Maxwell, Whitney- Taken together, the results of this study
Thomas, & Pogoloff, 1995), individuals with have implications for both families and prac-
intellectual disabilities may actually be more titioners. First, parents’ limited knowledge of
likely to be abused and taken advantage of by transition plans and PSE options is a major
others. As Fisher, Hodapp, and Dykens (2008) concern, one that needs to be addressed by
have recently noted, individuals with intellec- high school educators, parent groups, service
tual disabilities often display personal and fa- providers, and PSE programs. Second, given

Family Perspectives / 345


that educators’ and parents’ post-school ex- Cooney, B. F. (2002). Exploring perspectives on
pectations for students may not align, there transition of youth with disabilities: Voices of
seems to be a need for more effective commu- young adults, parents, and professionals. Mental
nication. Third, educators should offer more Retardation, 40, 425– 435.
Fisher, M. H., & Hodapp, R. M. (2009). Understand-
information about PSE options, even to fami-
ing the social vulnerability of individuals with in-
lies of students with lower academic skills.
tellectual and developmental disabilities. Unpub-
Although an important first step in under- lished manuscript.
standing parental perceptions of PSE pro- Fisher, M. H., Hodapp, R. M., & Dykens, E. M.
grams, this study also has several limitations. (2008). Child abuse among children with disabil-
First, responses were based on the reports of ities: What we know and what we need to know.
family members and not confirmed by school International Review of Research in Mental Retarda-
records, student observations, teacher reports, tion, 35, 251–289.
or other sources. Second, responses may re- Hanley-Maxwell, C., Whitney-Thomas, J., &
flect priorities that were specific to our sam- Pogoloff, S. (1995). The second shock: Parental
perspectives of their child’s transition from
ple. Although we are not certain that our re-
school to adult life. The Journal of the Association for
spondents were more informed about PSE
Persons with Severe Handicaps, 20, 3–16.
options than family members of other stu- Hart, D., Grigal, M., Sax, C., Martinez, D., & Will, M.
dents with intellectual disabilities, their knowl- (2006). Postsecondary educationoptions for stu-
edge of the survey and choice to respond dents with intellectual disabilities. NCSET Issue
indicates that this may have been the case. Brief: Examining Current Challenges in Secondary Ed-
Given that we may have surveyed a “con- ucation and Transition 3(2), 1– 4.
nected” sample of parents, our findings re- Kraemer, B. R., & Blacher, J. (2001). Transition for
garding limited knowledge of PSE options are young adults with severe mental retardation:
even more troubling. School preparation, parent expectations and fam-
ily involvement. Mental Retardation, 39, 423– 435.
Despite these limitations, this study extends
Lehmann, J. P., Bassett, D. S., & Sands, D. J. (1999).
the existing research by identifying barriers
Students’ participation in transition-related ac-
that families encounter when trying to under- tions: A qualitative study. Remedial and Special Ed-
stand PSE options, as well as identifying spe- ucation, 20, 160 –169.
cific parental concerns and priorities regard- Morningstar, M. E., Turnbull, A. P., & Turnbull,
ing PSE programs. Such information has H. R. (1995). What do students with disabilities
implications for families and professionals, tell us about the importance of family involve-
both of whom strongly influence students with ment in the transition from school to adult life?
intellectual disabilities during the transition Exceptional Children, 62, 249 –260.
to adulthood. Our results can also inform Neubert, D. A., Moon, M. S., Grigal, M., & Redd, V.
(2001). Post-secondary educational practices for
PSE program development, providing much-
individuals with mental retardation and other sig-
needed research to guide what has become a
nificant disabilities: A review of the literature.
growing national movement. Journal of Vocational Rehabilitation, 16, 155–168.
Polat, F., Kalambouka, A., Boyle, W. F., & Nelson, N.
References (2001). Post-16 transition of pupils with special
educational needs. (DfES Research Report
Chambers, C. R., Hughes, C., & Carter, E. W. RR315). London: DfES.
(2004). Parent and sibling perspectives on the Wagner, M., Newman, L., Cameto, R., Garza, N., &
transition to adulthood. Education and Training in Levine, P. (2005). After high school: A first look at the
Developmental Disabilities, 39, 79 –94. postschool experiences of youth with disabilities. A report
Consortium for PSE for Individuals with Develop- from the National Longitudinal Transition Study-2
mental Disabilities, University of Massachusetts (NLTS2). Menlo Park, CA: SRI International.
Boston/Institute for Community Inclusion. Whitney-Thomas, J., & Hanley-Maxwell, C. (1996).
(2009, March). The National Institute on Disabil- Packing the parachute: Parents’ experiences as
ity and Rehabilitation Research (NIDRR) estab- their children prepare to leave high school. Ex-
lishes project to research postsecondary educa- ceptional Children, 63, 75– 87.
tion for individuals with intellectual disabilities.
Think College Newsletter, 1, 1. Retrieved April 2, Received: 14 May 2009
2009, from http://thinkcollege.net/newsletter/ Initial Acceptance: 18 July 2009
TC_march2009.pdf. Final Acceptance: 15 September 2009

346 / Education and Training in Autism and Developmental Disabilities-September 2010


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 347–355
© Division on Autism and Developmental Disabilities

Resilience in Families with an Autistic Child


Abraham P. Greeff and Kerry-Jan van der Walt
University of Stellenbosch

Abstract: The primary aim of this study was to identify characteristics and resources that families have that
enable them to adapt successfully and be resilient despite the presence of an autistic child in the family. The study
was rooted within the contextual framework of the Resilience Model of Stress, Adjustment and Adaptation of
McCubbin and McCubbin (1996). Parents of 34 families whose children attend a special school for autistic
learners in the Western Cape, South Africa completed self-report questionnaires and answered an open-ended
question. Resilience factors identified in this study include higher socioeconomic status; social support; open and
predictable patterns of communication; a supportive family environment, including commitment and flexibility;
family hardiness; internal and external coping strategies; a positive outlook on life; and family belief systems.

Autism is a severely debilitating developmen- The presence of an autistic child in the


tal disorder with potentially harmful effects on family may have adverse effects on various
the entire family. It is a chronic disability that domains of family life, including the marital
appears in all racial, ethnic, cultural and social relationship, sibling relationships and adjust-
backgrounds around the world and is more ment, family socialisation practices, as well as
common than childhood cancer, cystic fibro- normal family routines. Because of the de-
sis and multiple sclerosis combined (Autism mands associated with caring for an autistic
Society of America, 2003). A study conducted child, parents do not have much personal
in the United States of America found that time (Court Appointed Special Advocate
autism is now ten times more prevalent than it (CASA) Programme, 2003). The result may be
was in the 1980s (Blakeslee, 2003). Potentially, a weakened affectional bond between parents
270, 000 South African children under the age (Cantwell & Baker, 1984), depression, with-
of six are affected by autism (Autism South drawal of one parent from care-giving respon-
Africa, 2005). Furthermore, the number of sibilities, or even divorce.
children affected is rising by 10 to 17% per Rivers and Stoneman (2003) noted that pa-
year (Autism Society of America, 2003). Be- rental conflict and marital stress lead to be-
cause of the severity of the disorder, many haviour problems, poorer adjustment, lower
families struggle to come to terms with their self-esteem and higher rates of depression in
child’s diagnosis and to adjust to having a
the siblings of children with autism. Other
child with special needs in their home. The
stressors for siblings include increased care-
motivation for the present study rests on two
taking responsibilities, stigmatisation, the loss
factors, namely the increase in prevalence
of normal sibling interaction (Dyson, Edgar,
rates of the disorder and the potentially ad-
& Crnic, 1989), feelings of guilt and shame,
verse effects the disorder may have on family
and changes in family roles, structure and
functioning. Consequently, the aim of this
activities (Rodrigue, Geffken, & Morgan,
study was to identify characteristics and re-
1993).
sources that families have that enable them to
adapt successfully. Family routines are often dictated by the
autistic child and must often be changed at
the last minute to accommodate the child’s
needs. Other factors causing families to isolate
Correspondence concerning this article should
be addressed to Abraham P Greeff, Department of themselves may include difficulty in finding a
Psychology, University of Stellenbosch, Private Bag reliable person to look after the autistic child,
⫻1, Matieland 7602, SOUTH AFRICA. Email apg@ and fatigue or loss of energy due to the con-
sun.ac.za stant burden of care giving (Sanders & Mor-

Resilience in Families / 347


gan, 1997). Despite the challenges faced by ing and utilising resources, as well as problem
the families of autistic children, some families solving, coping and adaptation; (4) support,
are able to cope remarkably well, although including intrafamily and family-community
others have considerable difficulty in dealing support processes that facilitate adaptation;
with these challenges. and (5) patterns of functioning, which in-
volves the elimination, modification and es-
tablishment of patterns of family functioning
Family Resilience Theory
to bring about balance and harmony, as well
In research on families over the last few years, as adaptation (McCubbin et al.).
there has been a shift from a deficit-based Walsh (2003) formulated a process model
model towards a strengths-based model (Haw- of family resilience and highlighted family
ley & DeHaan, 1996), and the concept of re- qualities that may reduce stress and vulnera-
silience has been extended to include family bility during crisis situations. It includes family
resilience (Walsh, 2003). A family resilience belief systems, approaching hardships as a
approach aims at identifying those factors that “shared challenge” (Walsh, p. 407), maintain-
contribute to healthy family functioning, ing a positive outlook in adapting to stress,
rather than family deficits (Hawley & DeHaan; and preserving a shared confidence through
McCubbin, Thompson, & McCubbin, 1996). an adverse situation. Furthermore, most fam-
Definitions of family resilience encompass a ilies are able to find comfort, strength and
number of common ideas. First, resilience ap- guidance through connections to cultural and
pears to surface in the face of family difficul- religious traditions (Walsh). Social and eco-
ties or hardships (McCubbin et al.; Walsh), nomic resources, including kin and social
and inherent in resilience is the property of networks, friends, community groups and re-
buoyancy. ligious congregations, are important contrib-
In an attempt to illustrate and describe the utors to family resilience, particularly where
complex notion of family resilience, McCub- the stressor is ongoing (Walsh). Communica-
bin and McCubbin (1996) developed The Re- tion processes that entail clarity of contents,
siliency Model of Family Stress, Adjustment open emotional expression, collaborative
and Adaptation. The model distinguishes be- problem-solving and effective conflict man-
tween two interrelated phases, namely adjust- agement are vital for family resilience
ment and adaptation (McCubbin et al., 1996). (Walsh).
The family’s level of adjustment depends on Limited research has been documented
numerous essential interacting elements, that contributes specifically to the understand-
namely the stressor and its severity; family vul- ing of the resiliency process in families, or
nerability; established patterns of family func- which identifies resiliency qualities associated
tioning or family typology; resistance resourc- with family adaptation in families faced with a
es; appraisal of the stressor; and family chronic condition. This study, therefore, con-
problem-solving and coping strategies (Mc- tributes to the field of research on resilience
Cubbin et al.). in families with an autistic child, and serves to
Family adaptation includes a series of adap- recognise health and resilient potential in
tation-oriented components and resiliency families where previously there may only have
processes (McCubbin et al., 1996). These in- been decay.
corporate (1) vulnerabilities, which may in-
clude additional life stressors and changes
Method
that undermine or restrict the family’s capac-
ity to achieve a satisfactory level of adaptation; The aim of this study was to identify the char-
(2) resources, which consist of the psycholog- acteristics and resources of families that en-
ical, family, and social resources that families able them to be resilient despite having an
utilise in the process of adaptation; (3) ap- autistic child in the family. A cross-sectional
praisal, which comprises the factors that give survey research design was used. Mixed meth-
meaning to the changes in the family and play ods were used to collect data from one parent
a role in establishing new patterns, eliminat- of each participating family. Qualitative data
ing old patterns, affirming old patterns, creat- were obtained by asking an open-ended ques-

348 / Education and Training in Autism and Developmental Disabilities-September 2010


tion, while quantitative data were collected three from facility 3. Twenty-four females and
through the use of various measuring instru- four males completed the questionnaires,
ments based on the Resiliency Model of Stress, while the remaining six parents did not indi-
Adjustment and Adaptation (McCubbin et al., cate their gender. Most of the participating
1996). parents were aged between 34 and 43 (n ⫽
28), with the mean age of the group being
36.21 (SD ⫽ 6.36). The mean age of the other
Participants and Procedure
parent (n ⫽ 25) in the family was 38.92 (SD ⫽
Permission to conduct this study was obtained 5.31). Most of the families were two-parent
from the Western Cape Education Depart- families (n ⫽ 27), while four parents were
ment and the respective governing bodies of unmarried, one was divorced, one was sepa-
the three facilities through which participants rated and one was widowed. The length of the
were recruited. A letter was then sent via two parental relationship in most families (n ⫽
of the facilities to the families that qualified 23) was between seven and 13 years, with a
for the study based on the following criteria: mean length (n ⫽ 34) of 9.53 years (SD ⫽
(1) the family structure–two-parent families 5.00). Thirty-one of the autistic children were
where both parents are present in the child’s male and three were female. The mean age of
life, (2) the age of the autistic child–not older the autistic children (N ⫽ 34) was 6.48 years
than 10 years, and (3) the families should (SD ⫽ 2.16). Fifteen of the families had one
have known of their child’s diagnosis for a other child apart from the autistic child, while
minimum period of 18 months. The question- 12 had no other children, five had two other
naires were sent with a letter explaining in children, and two families did not indicate
detail the procedure to be followed in answer- whether there were other children. Most of
ing the open-ended question and completing the children (n ⫽ 25) had been diagnosed
the questionnaires. Due to the low response with autism between one and four years pre-
rate to the letters, those families who had not viously. The mean number of years since di-
responded were contacted telephonically in agnosis (n ⫽ 33) was 3.24 years (SD ⫽ 1.90).
order to provide additional information and Eighteen of the families were English speak-
to request their participation. This technique ing, 11 were Afrikaans speaking and five spoke
proved more successful, as the majority of another language at home. Four families were
families agreed to participate. of a lower socioeconomic status, eight were of
The third facility was a private organisation middle socioeconomic status and 21 were of a
that caters primarily for the needs of children higher socioeconomic status. One parent did
with developmental disabilities. In order to not indicate socioeconomic status.
recruit families for the study, the researcher
met with a group of parents at an informal
Measures
gathering held at the organisation’s offices.
After obtaining informed consent, ten ques- Seven self-report questionnaires were used to
tionnaires were handed out to those who were measure various potential resilience variables.
willing to participate and they were asked to All questionnaires were available in both En-
return them to the facility offices at a later glish and Afrikaans. A biographical question-
date. naire was designed to collect information on
Due to the small number of completed family composition, marital status and dura-
questionnaires received by the researcher, the tion of the parental relationship, the age and
decision was made to allow for the inclusion of gender of family members, level of education,
single-parent families. An analysis of variance employment, income and home language.
(ANOVA) revealed no statistically significant The family’s socioeconomic status (SES) was
difference in scores between two-parent and determined using an adapted version of the
single-parent families with regard to the de- composite index derived by Riordan (cited in
pendent variable (family adaptation) (F (1, Tennant, 1996).
30) ⫽ 2.5480, p ⫽ 0.12). The dependent variable in this study is the
In total, 34 families participated in the family’s level of adaptation, given the chronic
study: 16 from facility 1, 15 from facility 2 and stressful circumstances. This was measured us-

Resilience in Families / 349


ing the total score of the Family Attachment and original F-COPES) of .99 (McCubbin et al.,
Changeability Index (FACI8), adapted by Mc- 1996). The Cronbach alpha obtained in this
Cubbin, Thompson, and Elver. It is an ethni- study was .82.
cally sensitive measure of family adaptation The Family Crisis Oriented Personal Evaluation
and functioning that consists of 16 items to be Scales (F-COPES) was developed by McCub-
answered on a five-point Likert-type scale. bin, Larsen, and Olson to distinguish prob-
FACI8 has two subscales, namely attachment lem-solving and behavioural strategies used by
and changeability. The internal reliability families during times of hardship. The
(Cronbach’s alpha) of the total scale and the F-COPES consists of 30 items to be answered
two subscales varies between .73 and .80 (Mc- on a five-point Likert-type scale. The F-COPES
Cubbin et al., 1996), while the alpha values has five subscales, representing two dimen-
obtained in this study for the total scale and sions, namely internal and external coping
the attachment and changeability subscales strategies. Internal coping strategies are the
are .75, .79 and .85 respectively. use of resources within the family to manage
The Family Hardiness Index (FHI), devel- difficulties, while external coping strategies
oped by McCubbin, McCubbin, and Thomp- are the behaviours the family engages in to
son, was used to measure the characteristic of obtain resources outside the family system.
hardiness, which refers to the internal The F-COPES total scale has an internal reli-
strengths and durability of the family unit. ability coefficient (Cronbach’s alpha) of .77
The FHI consists of 20 items to be answered and a test-retest reliability of .71 (McCubbin et
on a five-point Likert-type scale. The overall al., 1996). The internal reliability coefficients
internal reliability (Cronbach’s alpha) of the for the subscales derived from the data in this
FHI is .82, while the internal reliabilities for study are .50 (passive evaluation); .72 (rede-
the three subscales (commitment, challenge fining the problem); .66 (seeking spiritual
and control) are .81, .80, and .65 respectively. support); .70 (looking for social support); and
The alpha values obtained in this study are .67 .53 (mobilising community resources).
for the total scale, and .62, .34 and .82 for the The Family Time and Routine Index (FTRI),
challenge, control and commitment subscales developed by McCubbin, McCubbin, and
respectively. The validity coefficients range Thompson, was used to explore the routines
from .20 to .23 for the variables of family and activities used by families, and to evaluate
satisfaction, time and routines, and flexibility the value placed by families on these practices.
(McCubbin et al., 1996). This measure consists of 30 Likert-type items,
The Social Support Index (SSI), developed by divided into eight subscales. The overall inter-
McCubbin, Patterson, and Glynn, determines nal reliability (Cronbach’s alpha) of the FTRI
the extent to which families find support in is .88, while the validity coefficients range
the communities in which they live. This in- from .24 to .34 with regard to family bonding,
strument consists of 17 items to be answered family satisfaction, marital satisfaction, family
on a five-point Likert-type scale. The SSI has celebrations and family coherence (McCub-
an internal reliability of .82, a test-retest reli- bin et al., 1996). The reliability coefficients
ability of .83 and a validity coefficient of .40 obtained from the data in this study are .77 for
with the criterion of family wellbeing (McCub- the total scale; .48 for the parent-child togeth-
bin et al., 1996). A reliability analysis of the erness subscale; .61 for the couple-together-
data in this study yielded an internal reliability ness subscale; .33 for the child routines sub-
(Cronbach alpha) of .91. scale; .78 for the meals together subscale; .70
The Relative and Friend Support Index (RFSI), for the family time together subscale; .83 for
developed by McCubbin, Larsen, and Olson, the family chores routines subscale; .60 for the
consists of eight items to be answered on a relatives connection routines subscale; and .44
five-point Likert-type scale. The RFSI assesses for the family management routines subscale.
the degree to which families make use of The Family Problem Solving and Communica-
friend and relative support as a strategy to tion Scale (FPSC), developed by McCubbin,
manage stressors and strains. The internal re- McCubbin, and Thompson, consists of ten
liability (Cronbach’s alpha) of the RFSI is .82, items to be answered on a four-point Likert-
with a validity coefficient (correlating with the type scale. The FPSC has two subscales–incen-

350 / Education and Training in Autism and Developmental Disabilities-September 2010


diary communication and affirming commu- TABLE 1
nication. The reliability (Cronbach’s alpha) of
Pearson Correlations between Family Adaptation
the total scale is .89 and that of incendiary and Various Family Variables
communication and affirming communica-
tion is .78 and .86, respectively. The reliability Variable r p
coefficients obtained for this study are .83 for
incendiary communication, .87 for affirming Occupation classification of
communication, and .90 for the total scale. primary breadwinner .56 ⬍.01
The test-retest reliability of the subscales, as Age of autistic child .44 .02
well as of the total FPSC, is .86 (McCubbin et Socioeconomic status .53 ⬍.01
al., 1996). Social support (SSI) .45 .01
The qualitative measure comprised an Family problem solving and
communication (FPSC) .65 ⬍.01
open-ended question regarding the family’s
Affirming communication .68 ⬍.01
perspective of the qualities that have helped
Incendiary communication -.57 ⬍.01
them to adapt to the presence of the autistic Family Hardiness Index (FHI) .76 ⬍.01
child. The question was: “In your own words, Commitment .59 ⬍.01
what are the most important factors, or Challenge .71 ⬍.01
strengths, which have helped your family to Control .47 ⬍.01
adapt to living with your autistic child?” The Family Crisis Oriented Personal
parents were thus required to respond in writ- Evaluation Scales
ing by giving their own personal account of (F-COPES)
factors that have facilitated their family’s ad- Passive appraisal .59 ⬍.01
Family Time and Routine
aptation.
Index (FTRI) .44 .01
Parent-child togetherness .54 ⬍.01
Data Analysis Family time together .52 ⬍.01

In analysing the qualitative data, a process of


inductive reasoning was followed. Initially,
preliminary codes were assigned to the data, cant correlations were positive. Table 1 pro-
after which the codes were refined in order to vides a summary of the correlations found
better depict the data (Lacey & Luff, 2001). between the dependent variable (family adap-
These codes eventually become categories tation) and the various independent family
with which to identify various themes, which variables. Only the results that are significant
could then be used to report the results of the at a 1% level are presented.
qualitative aspect of the study (Pope, 2000). According to Table 1, statistically significant
In order to identify possible independent correlations exist between family adaptation
variables that may be associated with the de- and the following variables: the occupation
pendent variable (family adaptation), Pearson classification of the primary breadwinner, the
product-moment correlation coefficients were age of the autistic child, the socioeconomic
calculated. Multiple regression analysis was status of the family, social support, family
carried out in order to identify which combi- problem solving and communication, affirm-
nations of independent variables could best ing communication and incendiary communi-
predict family adaptation. cation (negative correlation), family hardiness
(commitment, challenge and control), the
coping strategy of passive appraisal, and family
Results
time and routines with the two aspects parent-
In the comparison of the FACI8 scores of child togetherness and family time together.
families with lower, middle and upper socio- In order to identify which combination of
economic status, the ANOVA analysis indi- independent variables would best predict the
cates that those of middle and upper socioeco- dependent variable (family adaptation), a
nomic status adapted better. Except for one best-subsets multiple regression analysis was
correlation (between family adaptation and carried out. Eighty-three percent of the vari-
incendiary communication), all other signifi- ance is explained by the equation (R ⫽ .9099),

Resilience in Families / 351


with the identified factors being relative and peared to play a role in the family’s adapta-
friend support (RFS total score) (p ⫽ .02), tion, with families of middle and upper socio-
family problem solving and communication economic status being better adapted (see
(FPSC total score) (p ⫽ .000), seeking spiri- Table 1). This may be accounted for by the
tual support as a coping style (p ⫽ .15) and increased ability of middle-and upper-class
passive appraisal as a coping style (p ⫽ .000). families to afford better treatment for their
autistic child. This finding is supported by
positive correlations between both socioeco-
Qualitative Results
nomic status and the occupation of the fami-
Thirty-three parents responded to the open- ly’s primary breadwinner with family adapta-
ended question and their responses were ana- tion.
lysed in order to identify categories of family A family’s level of adaptation is associated
resilience. The following five broad categories with the extent to which families find support
emerged: (1) professional help/education– in the communities in which they live (SSI
factors such as school and treatment pro- score). Social support is an important re-
grammes, knowledge of autism and advice source in alleviating the difficulties associated
from experts, (2) personal factors relating to with having a chronic stressor, such as an au-
the parents–this category included factors like tistic child, in the home, and promoting suc-
maintaining a positive outlook, hope, commit- cessful adaptation (McCubbin et al., 1996;
ment and patience, (3) social support from Walsh, 2003). Social support has also been
family, friends, the community and parents of associated with positive family and child out-
other autistic children, (4) factors relating to comes in families with an autistic child (Rivers
the child–treating the child as normal, listen- & Stoneman, 2003). The results of the quali-
ing to the child’s needs, empathy for the tative data support this finding.
child, recreational activities for the child, and Family adaptation is associated with the pat-
(5) factors relating to the family unit– open terns of communication utilised by the family.
communication, strong parental relationship, It is enhanced by affirming communication,
having other children in the household, and while it declines when incendiary patterns of
working together as a family. communication are used (see Table 1). The
The single factors reported most often by quality of the communication in the family
the parents as facilitating the adaptation pro- provides a good indication of the degree to
cess following the diagnosis of an autistic child which families manage tension and strain and
were the school and treatment programmes obtain a satisfactory level of family function-
(52%), knowledge of autism (45%), accep- ing, adaptation and adjustment (McCubbin et
tance of the diagnosis (39%), support and al., 1996). Open communication was reported
involvement of extended family (39%), and in the qualitative data (n ⫽ 4) as a factor that
faith in God (39%). helped families to adapt to the presence of an
autistic child.
Families with a supportive environment and
Discussion
a high degree of cohesion typically demon-
The aim of this study was to identify resilience strate higher degrees of commitment to and
factors in families living with an autistic child. help and support for one another. Such fam-
The parents reported that having other chil- ilies are also more likely to adapt successfully
dren in the home helped the family in the to the presence of a child with autism (Bristol,
adaptation process. This supports Powers’s 1984). The parents in this study reported that
(2000) view that involving the siblings of chil- being committed to helping their autistic
dren with autism in the day-to-day care of the child, working together as a family (family
disabled child, as well as in the child’s treat- hardiness, commitment, seeing crises as chal-
ment programmes (Howlin & Rutter, 1987), lenges), and making their children their top
leads to higher self-esteem and feelings of priority were all family strengths contributing
achievement in siblings and thus has a positive to better adaptation. Families who were will-
influence on the family’s adaptation. ing to experience new things, to learn and to
The socioeconomic status of families ap- be innovative and active showed higher levels

352 / Education and Training in Autism and Developmental Disabilities-September 2010


of family adaptation. Such flexibility is an es- dren. It enables the parents to take positive
sential process in family resilience (Walsh, steps towards helping their autistic child
2003). It involves the ability of families to (Rodrigue, Morgan & Geffken, 1990). In this
adapt to the stressor through the reorganisa- study, the parents highlighted their knowl-
tion of patterns of family interaction to fit the edge of autism as a positive factor resulting in
new demands faced by the family (Walsh). increased resilience. This coping strategy is
Families with an internal locus of control show adaptive, as it assists parents in learning how
higher levels of family functioning than those to help their child and prevents the use of
who perceive their lives as being shaped by maladaptive coping strategies (Rodrigue et
outside influences (hardiness– control). This al.).
finding concurs with those obtained by Bris- Children with autism have a need for strict
tol, and Henderson and Vandenberg (1992), adherence to routines (Aarons & Gittens,
who found that people with an internal locus 1999). Any disruption to their known routines
of control are more likely to engage in behav- often leads to panic, fear or temper tantrums
iours to overcome the adverse effects of the (Sadock & Sadock, 2003). This aversion to
chronic stress of raising an autistic child, and changes in routines results in disruptions in
are thus more likely to achieve successful ad- family life, as the child may refuse to carry out
aptation. any activities unless their specific routine is
A healthy parental relationship leads to bet- followed (Mash & Wolfe, 2002). Parents of
ter adjustment in families with an autistic children with autism have emphasised the im-
child (Rodrigue et al., 1993). This is con- portance of routines in the process of success-
firmed by the parental reports in this study ful adaptation (Howlin & Rutter, 1987). Rou-
(see qualitative results). Powers (2000) argues tines assist parents in organising their time so
that parents should not feel that they must be as to make time for the autistic child, their
with their autistic child at all times and do other children, their spouse and themselves.
everything for him/her. Rather, the child McCubbin et al. (1996) have also identified
should be encouraged to develop skills that family routines as an important resource in
will enable him/her to function as indepen- the adaptation process. This is supported by
dently as possible. The parents in this study the findings of this study, which suggest a
shared this view and believed that making the positive correlation (see Table 1) between the
child as independent as possible was an im- routines and activities used by families and
portant step in the adaptation process. family adaptation. In terms of the qualitative
Families that make use of the internal cop- data, only two parents reported that sticking
ing strategy of passive appraisal appear to ex- to a basic routine was helpful in terms of
hibit higher levels of family adaptation (see achieving successful adaptation.
Table 1, as well as results of regression analy- This study found that families that empha-
sis). Passive evaluation involves accepting the sise family togetherness showed higher levels
stressful situation (the presence of the autistic of family adaptation (see Table 1, family to-
child) and not doing anything about it (Mc- getherness). The Resiliency Model of McCub-
Cubbin et al., 1996). This finding is interest- bin et al. (1996) highlights family celebrations
ing, as it would be logical to think that families and family time together as important re-
would achieve higher levels of adaptation by sources that facilitate family adaptation. It is
actively pursuing solutions to the stressful sit- also important for parents to have time to-
uation. The participants in this study might gether for themselves, without any children, as
have felt that they were doing all they could this allows them to invest in their relationship
for their autistic child and therefore resolved (Bristol, 1984; Powers, 2000). Time away from
to accept the situation. This finding supports the autistic child was reported as being impor-
that of Dyson et al. (1989) and Powers (2000), tant to the adaptation process by one parent
who state that acceptance of the child and in this study.
his/her disorder is an important factor con- Parents reported that maintaining a positive
tributing to adaptation to that child. outlook and remaining hopeful were factors
Information seeking is a coping strategy of- that helped them to adapt to having an autis-
ten employed by the parents of autistic chil- tic child (qualitative results). The importance

Resilience in Families / 353


of a positive outlook has been documented in understand resiliency factors specific to fami-
resilience theory. Families become resilient lies with an autistic child.
when they actively pursue solutions to their This study is characterised by a number of
problems, look beyond the hardships sur- limitations. Only 34 families took part, which
rounding their situation, and focus on making calls for caution in generalising the results to
the best of the options available to them all families with an autistic child in the home.
(Walsh, 2003). A further limitation is the geographic location
Faith in God was rated by the families in this of the participants. All the families participat-
study as an important factor contributing to ing in the study reside in the Cape Town
adaptation. Bristol (1984) found that belief in Metropolitan area, Western Cape Province,
God and/or adherence to clear moral stan- South Africa. This means that additional care
dards mediates the family hardships by giving should be taken in generalising the results,
meaning and purpose to the sacrifices they particularly with regard to families not resid-
make in caring for the autistic child. ing in urban areas. People from rural areas
are likely to experience greater difficulty in
accessing educational services and may have a
Conclusions lower socioeconomic status than the families
participating in this study.
The families that took part in this study were The findings of this study serve a dual role
privileged in the sense that they all had access in terms of their utility in facilitating family
to educational services for their autistic child. adaptation. Firstly, this study confirms that
The importance to the adaptation process and factors such as accessing social support, taking
of having access to schools and other commu- time away from their child, accepting the di-
nity resources is evident from previous re- agnosis, open emotional expression, family ac-
search (Bristol, 1984; Powers, 2000), in resil- tivities and routines, and family commitment
iency theory (McCubbin et al., 1996; Walsh, are all important resilience factors. As such,
2003), and in the results of this study (see they are beneficial for the child’s wellbeing
Table 1). Due to the limitations of the sample and for successful family functioning. Sec-
because of their homogeneity in terms of ac- ondly, the findings may be used to provide
cess to educational services, it is proposed that both professionals and parents with insight
further research is undertaken to identify re- into how to create a family environment that
silience factors in families that do not have will benefit the autistic child, without being
access to such services. The majority of the detriment to the total family system.
families in this study was employed and had a
high socioeconomic status, which means that
it might be access to funds to invest in educa- References
tional services, rather than access to the ser-
Aarons, M., & Gittens, T. (1999). The handbook of
vices themselves, that is the true mediating
autism: a guide for parents and professionals. Lon-
factor. It is further recommended that fami- don: Routledge.
lies from lower socioeconomic backgrounds Autism Society of America. (2003). Retrieved March
be investigated in order to identify the factors 2, 2004 from http://www.autism-society.org/
that facilitate their adaptation to having an Autism South Africa. (2005). Autism South Africa.
autistic child. Retrieved August 7, 2005 from http://www.
Several family qualities described by the Re- autism-sa.org
silience Model of Stress, Adjustment and Ad- Blakeslee, S. (2003). Study shows increase in autism.
aptation (McCubbin et al., 1996) as being im- New York Times. Retrieved January 22, 2006 from
portant in family adaptation were supported http://www.photius.com/feminocracy/autism.
html
by this study. These include social support and
Bristol, M. M. (1984). Family resources and success-
the mobilisation of community resources, ful adaptation to autistic children. In E. Schopler
open communication, and family hardiness, & G. B. Mesibov (Eds.). The effects of autism on the
including commitment and an internal locus family (pp. 289 –310). New York: Plenum.
of control. The Resiliency Model, therefore, Cantwell, D. P., & Baker, L. (1984). Research con-
provides an effective contextual framework to cerning families of children with autism. In E.

354 / Education and Training in Autism and Developmental Disabilities-September 2010


Schopler & G. B. Mesibov (Eds.), The effects of Pope, C. (2000). Analysing qualitative data-qualita-
autism on the family (pp. 41– 63). New York: Ple- tive research in health care, part 2– education and
num. debate. British Medical Journal. Retrieved Novem-
Court Appointed Special Advocate (CASA) Pro- ber 16, 2004 from http://www.findarticles.com/
gramme. (2003). Retrieved March 16, 2004 from p/articles/mi_m0999/is_7227_320/ai_59110536
http://www.supreme.state.az.us/casa/training/ Powers, M. D. (2000). Children with autism: a parents’
Autism/AutIndex.htm guide. Bethesda: Woodbine House.
Dyson, L. L., Edgar, E., & Crnic, K. (1989). Psycho- Rivers, J. W., & Stoneman, Z. (2003). Sibling rela-
logical predictors of adjustment by siblings of tionships when a child has autism: marital stress
developmentally disabled children. American Jour- and support coping. Journal of Autism and Develop-
nal on Mental Retardation, 94, 292–302. mental Disorders, 33, 383–394.
Hawley, D. R., & DeHaan, L. (1996). Toward a Rodrigue, J. R., Geffken, G. R., & Morgan, S. B.
definition of family resilience: integrating life (1993). Perceived competence and behavioural
span and family perspectives. Family Process, 35, adjustment of siblings of children with autism.
283–298. Journal of Autism and Developmental Disorders, 23,
Henderson, D., & Vandenberg, B. (1992). Factors 665– 674.
influencing adjustment in the families of autistic Rodrigue, J. R., Morgan, S. B., & Geffken, G. R.
children. Psychological Reports, 71, 167–171. (1990). Families of autistic children: psychologi-
Howlin, P., & Rutter, M. (1987). Treatment of autistic cal functioning of mothers. Journal of Clinical
children. New York: John Wiley & Sons. Child Psychology, 19, 371–379.
Lacey, A., & Luff, D. (2001). Trent focus for re- Sadock, B. J., & Sadock, V. A. (2003). Synopsis of
search and development in primary health care: psychiatry: behavioural sciences/clinical psychiatry.
qualitative data analysis. Retrieved November Philadelphia: Lippincott Williams & Wilkens.
16, 2004 from http://www.trentfocus.org.uk/ Sanders, J. L., & Morgan, S. (1997). Family stress
Resources/Qualitative%20Data%20Analysis.pdf and adjustment as perceived by parents of chil-
Mash, E. J., & Wolfe, D. A. (2002). Abnormal child dren with autism or Down syndrome: implications
psychology. Belmont: Wadsworth. for intervention. Child and Family Behaviour Ther-
McCubbin, M. A., & McCubbin, H. I. (1996). Resil- apy, 19(4), 15–32.
iency in families: a conceptual model of family Tennant, A. J. (1996). Visual-motor perception: a cor-
adjustment and adaptation in response to stress relative study of specific measures for pre-school South
and crises. In H. I. McCubbin, A. I. Thompson, & African children. Unpublished Masters Thesis, Uni-
M. A. McCubbin (1996). Family assessment: resil- versity of Port Elizabeth, South Africa.
iency, coping and adaptation–Inventories for research Walsh, F. (2003). Normal family processes: growing di-
and practice (pp. 1– 64). Madison: University of versity and complexity (3rd ed.). New York: Guilford
Wisconsin System. Press.
McCubbin, H. I., Thompson, A. I., & McCubbin,
M. A. (1996). Family assessment: resiliency, coping Received: 22 February 2009
and adaptation–Inventories for research and practice. Initial Acceptance: 30 April 2009
Madison, WI: University of Wisconsin System. Final Acceptance: 10 July 2009

Resilience in Families / 355


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 356 –365
© Division on Autism and Developmental Disabilities

Professionals’ Attitudes on Partnering with Families of


Children and Youth with Disabilities
Jamie Bezdek, Jean Ann Summers, and Ann Turnbull
University of Kansas

Abstract: The purpose of this study was to examine the professionals’ perspectives regarding characteristics of
effective partnerships with parents. The sample involved 20 professionals representing the backgrounds of
occupational therapists/physical therapists/speech-language pathologists, special education teachers, parapro-
fessionals, and health professionals. The following three themes were identified through qualitative analysis: (a)
gap between family-centered language and actions; (b) “Goldilocks” perception (i.e., the perception that parents
may be involved too much, too little, or just right); and (c) parental blame. Future directions for research and
practice are suggested.

The idea of partnerships is not new in the have more appropriate goals, services, and
field of special education, particularly partner- equipment and more opportunity to reach
ships between the families of the children be- their goals (Dunst, 2000; McWilliam, Tocci, &
ing served and the providers who serve them. Harbin, 1998; Park, Turnbull, & Park, 2001;
Since 1975, IDEA has recognized the benefits Turnbull, Turnbull, Erwin, & Soodak, 2006;
of family participation for parents, teachers, Turnbull, Turnbull, Summers, & Poston,
and students as best educational practice in 2008).
the education of children with disabilities Despite the importance of partnerships, the
(Turnbull, Zuna, Turnbull, Poston, & Sum- limited evidence available on professionals’
mers, 2007). One of the primary purposes of perceptions of partnerships suggests they do
the 1997 amendments to IDEA was to increase not view families as equal partners. In some
the opportunities for partnerships between cases this may be attributed to barriers such as
parents and professionals (Turnbull & Turn- professional attitudes, lack of training and
bull, 2000). knowledge, and/or lack of experience (Croll
Summers and colleagues (2005) defined
2001; Lee, Ostrosky, Bennett, & Fowler, 2003;
partnerships as “. . .mutually supportive inter-
Luckner & Hanks, 2003; Penney & Wilgosh,
actions between families and professionals, fo-
2000; Shapiro, Monzo, Rueda, Gomez, & Bla-
cused on meeting the needs of children and
cher, 2004). Hilton and Henderson (1993)
families, and characterized by a sense of com-
specifically found that teachers appeared to
petence, commitment, equality, positive com-
value parent involvement in one section of
munication, respect, and trust” (p. 3). These
types of partnerships, based on mutuality and their questionnaire; yet when asked if they
equality, are the primary focus of this study. engaged in specific family-centered practices,
Research and practice guidelines address a limited number of practices were reported
the benefits of quality partnerships for profes- as being used, and others were not used often.
sionals (e.g., to better do their jobs), families The authors concluded, “If parent involve-
(e.g., to be empowered, to be satisfied) and ment is to become a best practice that is im-
students individuals with disabilities (e.g., to plemented, rather than recognized, it appears
some modifications [are necessary]” (p. 210).
While researchers have reported barriers to
Correspondence concerning this article should parent involvement in the attitudes and be-
be addressed to Jamie Bezdek, Haworth Hall, 1200 haviors of teachers, teachers themselves tend
Sunnyside Avenue Room 3136, The University of to attribute barriers to family characteristics
Kansas, Lawrence, KS 66045-7534. (Bhering, 2002; Dinnebeil & Rule, 1994; Fyl-

356 / Education and Training in Autism and Developmental Disabilities-September 2010


ling & Sandvin, 1999; Penney & Wilgosh, included different disciplines and different
2000). Researchers focus on professional bar- age groups served. Thus, the sampling grid
riers that teachers may or may not have seen was a 4 ⫻ 4 matrix. This represented four
in themselves (Bhering, 2002; Campbell & disciplines: occupational therapists/physical
Halbert, 2002; Croll 2001; Hilton & Hender- therapists/speech-language pathologists; spe-
son, 1993; Lee et al., 2003; Luckner & Hanks, cial education teachers; paraprofessionals;
2003; Penney & Wilgosh). Most of the teacher and health professionals. The four service
barriers were related to a lack of understand- ages were: early intervention (0 –3), early
ing or training. For example, Luckner and childhood/elementary (ages 4 –10), middle
Hanks point out that what teachers perceived school (ages 11–14), and high school (ages
as parental apathy or indifference could be 15–21).
attributable to the fact that families may be (a) To locate respondents fitting these charac-
exhausted, (b) unable to coordinate logistics, teristics, the senior author contacted adminis-
(c) uncomfortable interacting with profes- trators or colleagues in area schools, an ex-
sionals, (d) feeling and/or disempowered due tended-school-year camp, a county Part C
to cultural differences. early intervention program, and a develop-
Given that policy, research, and practice mental clinic in a large teaching hospital. Af-
guidelines highlight the usefulness of partner- ter agreeing to participate, the collaborating
ships, there appears to be various barriers re- administrator or colleague distributed letters
lated to the implementation of partnerships. describing the study and contact information
We conducted this study to elucidate profes- to enable prospective respondents to reach
sionals’ perceptions of parent-professional the senior author signaling their interest in
partnerships. It was done in the context of a participating. When contacted, the senior au-
larger study in which a family-professional thor explained the study further; and, if the
partnership scale was piloted with a group of respondent was interested, made an appoint-
professionals. For purposes of this article, the ment for an interview. Twenty-two profession-
primary research question is: What are profes- als contacted the investigator, one declined to
sionals’ perceptions about characteristics of participate (primarily because of scheduling
effective partnerships with parents? difficulties), and one interview was lost due to
a defective audio tape. The final sample con-
sisted of 20 professionals. Table 1 includes
Method
specific demographic information.
This qualitative study reflects a constructivist
approach to grounded-theory development
Data Collection
(Charmaz, 2006), utilizing a constant compar-
ison analysis (Anfara, Brown, & Mangione, Information letters distributed by the collabo-
2002). We extracted themes which became rating administrator or colleague contained a
the basis for a theory describing how profes- description of the study and consent proce-
sionals perceive family partnerships. In the dures. The senior author arranged appoint-
sections that follow, we describe the purposive ments with interested professionals who made
sampling plan and resulting participants, data contact. Participants were told that the scale
collection approach, and analysis. We con- was expected to take 15 minutes or less to
clude with a description of the study’s limita- complete, and the interview was expected to
tions. last an additional 30 minutes. The interviewer
and respondent agreed to meet at a mutually
convenient time and setting that was comfort-
Participants
able for the participant. The interviews took
We utilized a purposive sampling approach place in a variety of locations, including the
(Patton, 2001), meaning that we created a participants’ workplace, home, a library, and
sampling grid to recruit respondents with di- the interviewer’s home. The senior author
verse characteristics expected to represent dif- conducted all interviews.
ferent viewpoints about family-professional re- Participants first completed the pilot part-
lationships. In this case, the characteristics nership scale and then the open-ended inter-

Professionals’ Attitudes on Partnering with Families / 357


TABLE 1

Demographic Characteristics of Participants

1. What is the discipline where you have received the Education (5)
most training? Special education (4)
Occupational therapy (3)
Speech-language pathology (4)
Physical therapy (1)
Psychiatry/Psychology (2)
Nurse (1)
2. What educational level describes you best? Associates degree (1)
Bachelor’s degree (2)
Some graduate school completed (4)
Master’s degree (9)
Doctoral degree (4)
3. What is your job title? Paraprofessional (2)
Certified teacher (7)
Therapist (5)
School psychologists (1)
Clinical instructor (3)
Professor (1)
Nurse (1)
4. How many years of experience do you have in your Mean ⫽ 9.79
field?
5. How many years of experience do you have in your Mean ⫽ 5.43
current position?
6. What setting do you spend most of your work week School setting (13)
in? Client’s homes (1)
Clinic (4)
University (2)
7. What age of clients do you typically serve/work Early childhood (5)
with? Elementary school aged (6)
Middle school/junior high/high school (5)
All ages equally represented (4)

view. The six “grand tour” questions (Miles & scriptions. For purposes of this study, we
Huberman, 1994) focused on asking partici- removed responses related to the pilot part-
pants to (a) talk in general about their expe- nership scale. Transcripts were divided so that
riences working with families, and (b) con- all the responses to the first grand tour ques-
sider the characteristics of the best and least tion were gathered together for reading and
effective partnerships. For each question, the analysis, all of responses to the second grand
interviewer used different probe or follow-up tour question were gathered, and so forth.
questions as appropriate to encourage the re- The section of the transcript for respondent
spondent to explain her thoughts fully. The one/question one was read and the main
open-ended process was intended to gather points were summarized as bullet points.
any unanticipated perspectives or other infor- Then, the section of the transcript for respon-
mation the professionals might have (Rubin & dent two/question one was read and any new
Rubin, 1995). points were added to the working document.
Eventually the points seemed to naturally
group into themes which evolved as more re-
Data Analysis
sponses were read. The investigator pro-
We used a constant comparison method (Pat- ceeded through the all the responses to ques-
ton, 2001) to analyze the open-ended com- tion one in this manner and then began again
ments in the interviews using verbatim tran- with question two and so forth until a majority

358 / Education and Training in Autism and Developmental Disabilities-September 2010


of the comments had been put under the of the professionals as they interacted with
themes. families.
This analytical procedure is termed a con-
stant comparison method because the data
are compared from one transcript to another, Findings
and “categories and their properties emerge In answer to the question, “What are profes-
or are integrated together” (Patton, 2001, p. sionals’ perceptions about the characteristics
32). As data are being coded, responses are of effective partnerships with parents,” three
compared not only within categories, but be- themes emerged. These were: gap between
tween categories as well (Anfara et al., 2002). family-centered language and actions, the
A second investigator (the second author) “Goldilocks” perception (i.e., the perception
checked the first investigator’s coding process that parents may be involved too much, too
and indicated agreements and disagreements. little, or just right), and parental blame.
Following this review, the two investigators
jointly reviewed the coding and resolved any
discrepancies. This procedure is termed a Gap Between Family-Centered Language
credibility check and is analogous to the reli- and Actions
ability process utilized in quantitative methods
Participants made many statements that can
(Anfara et al.). Furthermore, to ensure trans-
be characterized as family-centered in the
ferability, we involved participants from differ-
sense that they spoke in alignment with a
ent professional backgrounds who worked
family-centered philosophy or in support of
with individuals with disabilities and their fam-
partnerships. For example (I is for interviewer
ilies at different life span stages (Lincoln &
and R is for respondent):
Guba, 1985).
I: What are some of the skills and responsi-
bilities that families need to have to have
Limitations good partnerships?
R: . . . to also provide ideas, because some-
As with every study, there were limitations and times the parents know their kid better than
barriers encountered. In this case, the sample the teachers even, and I think parents can
recruited was somewhat unbalanced, with be very valuable in that, in their suggestions.
more representation of professionals from ed-
ucational settings. In addition, the health set- Another participant spoke about how to in-
ting accessed was a university teaching hospi- crease communication by using a notebook
tal; the participants may have been atypical sent home daily.
compared to those in a more typical health R: They can read it, or if they have com-
setting. More participants, as well as greater ments or questions, they can write back.
diversity among the participants, would have They don’t have to write every single day
made the study more beneficial. because it’s probably not a lot of stuff, if
Also, the qualitative interviews with these there isn’t anything to say. But if they do
participants followed their completion of a have concerns, they should be able to write
draft measure of family-professional relation- them in there.
ships. Because of this, it is possible that partic-
ipants were influenced or predisposed by the This comment demonstrates that the respon-
scale’s contents and, therefore, may have spo- dents saw value not only in letting the families
ken in a different manner regarding partner- know what was going on in their child’s day
ships than they would have otherwise. Inter- but also saw value in comments or informa-
viewing participants without an initial tion the parents can provide, all the while
exposure to the contents of the scale might keeping in mind the families’ time con-
have produced different results. Also, a qual- straints.
itative study of this nature ideally would in- Though over 90% of respondents used fam-
clude more extensive interviews as well as the ily-centered language in their interviews, it is
use of other data sources, such as observations important to note that these were almost al-

Professionals’ Attitudes on Partnering with Families / 359


ways in the same interviews where statements R: She’s up there all the time wanting to
reflecting limited actions that could be char- know . . . well why haven’t you worked on
acterized as family-centered. Examples of this. And his therapist says he needs to be
these language-action contradictions are doing this, and why haven’t you been doing
given by two respondents: this, and why haven’t [you been doing that]
. . . So it seems like we are bending over
R: I think the parents should be able to list [backwards]. Like I’ve ordered several
out exactly what they would like to see their books just to make this parent happy just so
child achieve, whether it is personal goals. I can be like, look I am doing research on
You know, basically lay it out in lists they can this, you know. And a lot of times the par-
give to the teacher that really help them ents will go to the Board. So we’ve always
know the student as the child, as a personal got to watch our back . . .
individual. . . . I don’t know what else the R: They might read something coming out
parents would provide. in a journal and why aren’t you doing that
for my child? And then you’re like, Holy
The second example of a contradiction in-
cow, I have eight years of experience, and I
volves the professional speaking in a family-
keep up on that too. Let me do my job!
centered manner about communication note-
They are making progress. This is what
books being sent home to families. During the
we’re doing.
same interview, the respondent made this
comment: “R: The other kid I work with, his Some respondents thought that parents’ in-
mom is in due process, so I try to be as vague volvement meant that the parent did not trust
as possible because I don’t want things used them to do their jobs.
against us . . .”
I: Do you think there is such thing as being
too involved?
Goldilocks Perception R: Yes! Definitely I do! Like earlier, working
as a team, not saying I’m the expert; you’re
We refer to the second theme as the “Gold-
not. I think some parents won’t trust the
ilocks perception” because it appeared the
teacher, so they’ll want to be there for ev-
professionals who participated in the study
erything, be involved for everything, every
had very specific ideas regarding the “just
decision.
right” amount of involvement in which they
R: I think it is great when families are very
believed was appropriate for parents. They
involved–as long as they aren’t totally run-
noted definite lines that parents might cross,
ning the show. And I have seen that happen
resulting in too much involvement. However,
where they try to do that, and it doesn’t
they also described cases in which they be-
work . . . they become a big pain . . . it’s a
lieved parents were not involved enough.
subtle message that maybe you’re not com-
From their point of view, parents had only a
petent enough . . .
narrow window of involvement that might be
considered “just right.” Too little involvement. Though participants
Too much involvement. If a parent crossed in this study were specific about too much
over into the professionals’ area of expertise, involvement, they also expressed frustration
that parent was often considered “too in- when families had too little involvement. Par-
volved.” This sub-theme of too much involve- ents were considered “to have too little in-
ment included both amount and an unwanted volvement when they chose to not participate
type of involvement. In some cases, profession- in activities or did not see the same value in
als were frustrated when a parent entered the the activities the professionals deemed impor-
academic realm or frequently questioned tant. One participant expressed this idea
what they did. The following comments sug- when she said: “Here’s what you can do to
gest that professionals may be threatened by address these at home, and then they don’t
parents who participate to the extent of ac- follow through. I ask the girl, and she is pretty
quiring expertise about interventions for their reliable, and she wouldn’t lie, and I ask “Have
child: you done this with mom?” “No.”

360 / Education and Training in Autism and Developmental Disabilities-September 2010


In the next quote, a respondent expresses Another participant made a similar comment:
her perspective that parents are not participat- I: What are characteristics of good partner-
ing because they do not feel it is their respon- ships you’ve had versus less effective part-
sibility. nerships?
R: Fortunately, I have never really had bad
R: I try to, you know, touch base with the situations. Most of the parents I have had
parent at least once a month and let them have been really supportive.
know what we are working on and sending I: In what ways were they good?
homework home. And I think that [it] is R: Whatever modifications I came up with,
important that the families first be able to they are very willing to help.
read what I want them to do and have the
time to sit down and actually do that with In these cases, families were agreeing with
the kid. I think so much think ‘that it is not professionals on priorities and ways to work
my responsibility’. with the child. Families were pitching in by
working with the child on any “homework” or
Similarly, another participant felt that an in- extra therapy at home with the child to help
effective partnership was one where the fami- generalize it. In general, these participants felt
lies “don’t listen to suggestions that are that “good families” were those that supported
made.” the professional’s guidance about how to work
Most participants who made these types of with the child. When families did their own
comments did not discuss anything that might research and shared suggestions, the involve-
be keeping the family from implementing ment was perceived as too much; and when
goals at home, such as time (e.g., siblings, they did not follow through, the involvement
work, other responsibilities), lack of under- was perceived as too little. The just right in-
standing or confidence, or perhaps that the volvement appeared to be a narrow band on
parents disagreed with the goal altogether the continuum from too much to too little.
(and more discussion is needed). None of the
participants expressed an opinion that par- Parental Blame
ents might have an option to opt out of fol-
lowing the professionals’ advice. The third theme, parental blame, refers to
Just right involvement. While professionals professionals who blame parents for problems
clearly expressed statements of concern with in carrying out partnerships. An example of
too much or too little involvement, they also this given by one participant who described
described what makes a good family partner. her frustration when a family lost materials
Comments about positive partnerships in- needed to work on an activity at home:
cluded the opinion that parents needed to be
R: following though with a home-based pro-
assisting the professional, rather than engag-
gram that the professional worked on after
ing in a true two-way partnership. Just right
hours, because they don’t have time during
participation most often involved following
the day to make-up activities for the child.
the professional’s lead and taking responsibil-
But then they don’t follow-through at all.
ity in follow-through (i.e., home activities).
“We lost them. Can you make them again?”
This was demonstrated in the following
“NO!” It took me four hours. Following
quotes:
through with the things that you go out of
your way to do. Um, those things are big. A
I: What are some things that they do that
lot of my families do that. A lot don’t care.
you’re like, okay this is a great family to
work with? In this example, the professional said that
R: Oh well, when they ask questions. When the family wanted to work on the activity at
you model an activity and show them a cou- home and follow-through; however they lost
ple of varieties, and when the next time you the cards. The professional, having worked
see them they’ve incorporated that into hard on the cards, did not want to spend the
functional routine and generalized it to dif- time again. This person equates losing the
ferent settings you are like, wow! cards with not caring.

Professionals’ Attitudes on Partnering with Families / 361


In a number of comments, respondents did ering how they might feel in the parents’ po-
not appear to give the parent the benefit of sition. For example, one participant noted:
the doubt:
The ones that don’t want to accept it give
pretty much just, they don’t want anything
I: So you are saying that the partnership is
to do with it. You know, and that makes it
failing because the teachers are pulling
really hard when the parents won’t accept
their weight, but the parents aren’t meeting
it, and then they don’t back you up.”
you in the middle?
R: Right. And that is in general. I have a few Another participant appeared to agree that
parents who are very, very good about that parents are “in denial”: “To be open, to have
and some that I never see . . . ideas, to be accepting of it, because I think
R: I am one of those people who believes sometimes parents want to push it off that it is
that that is usually the missing ingredient in some other problem.”
schools–parents/guardians not being in- Alternatively, some respondents particularly
volved enough. sought to “stand in parents’ shoes” seeing
things from their perspective as contrasted to
In this situation, reasons were not stated about blaming them. One more experienced profes-
why it might be extremely difficult for parents sional believed that colleagues who held opin-
to be involved because of other responsibili- ions like those expressed above were not real-
ties or stressors in their life. Rather, when this istic about the emotional impact a diagnosis
professional “never sees” parents, it does not has on the family. She said, “I am fascinated by
appear that there is reflection on what the the idea that we think that families shouldn’t
barriers might be and what some creative op- be upset, like of course they are going to be
tions might be for working around those bar- upset! Why are we surprised by that?”
riers. It is important to note a few of the more
Given this situation, the interviewer tried to experienced professionals spoke of what they
prompt the participants to consider some have learned during the span of their career
other possibilities for parents’ lack of partner- and/or as a result of having children.
ship:
R: . . . I remember being real snippy early
R: If your child is dismissed from a service, on, “Well why wouldn’t you keep this ap-
it is a celebration. Not a “Well, why is he pointment?” since I knew they weren’t
being dismissed? He needs that!” Well, working so . . . why can’t they get here for
you’re taking away his help. No, it’s a cele- this appointment or that? And then it is
bration. . . funny when you finally figure out what re-
I: Do they take it as you’re giving up? ally goes on in their lives, how you can be
R: Yes. Absolutely that is exactly what it is. empathetic and have compassion, because
You’re giving up on them. it is so difficult sometimes to get these kids
I: They don’t qualify any more because that have multiple handicaps up. And then
they. . . when we hear their schedules, about how
R: because they have made minimal or no many different appointments they have with
improvement over one academic year. how many different health care providers,
I: I guess I can understand why they don’t how they even manage to get it all done! So,
necessarily want to celebrate because they I think that has made me a better person
plateaued for over a year. and a better health care provider.
R: Yeah. Right. But you see what I am say- Another professional thought back on her
ing. own growth and change in perspective:
It was not uncommon for participants to R: I was so frustrated and annoyed with
speak about parents who just don’t “accept” them for their lack of ability to follow-
the diagnosis rather than seeking alternative through, and I think more experience and
reasons for the parents’ behavior (e.g., such as being a parent made a huge difference in
not agreeing with an intervention) or consid- my tolerance, and so I think knowledge of

362 / Education and Training in Autism and Developmental Disabilities-September 2010


the disability area that you work in and Future research. The findings of this study
tolerance and understanding that parents present some implications for future research.
have skills on a spectrum just like everybody Professionals repeatedly expressed a narrow
else does help you relate better to most idea of what was an acceptable amount and
parents. type of family partnership, which is in conflict
with published recommended practices. This
is similar to what Campbell and Halbert found
Discussion
in their research. While most professionals in
their study displayed an awareness of the con-
Summary
cepts of family-centered practice, more in-
The overall purpose of this study was to ex- depth comments about actual examples
plore professionals’ attitudes about partner- tended to conflict with family-centered inter-
ships with families. Three themes emerged in vention and other best practices. Similar to
the analysis. These were (a) gap between family- Campbell and Halbeert (2002), we found that
centered language and actions, (b) “Goldilocks” professionals were unhappy with parent part-
perception, and (c) parental blame. nerships, particularly the amount of follow-
First, professionals made family-centered through. Hilton and Henderson (1993) also
statements in the sense that they spoke in found inconsistencies in family– centered lan-
alignment of a family-centered philosophy or guage or between language and actions.
in support of partnerships. Over 90% of par- These findings do not question that some pro-
ticipants made these types of comments, al- fessionals truly held a philosophy of partner-
though these same participants also made ing with families; this is precisely why further
comments that fell in to one or both of the research specifically on this concept needs to
other themes, which were less aligned with occur. Perhaps a deeper understanding may
that philosophy or described actions that were be gained by collecting multiple sources of
not family-centered. The implication is that data (observing the professionals interacting
these professionals may have learned to “talk with parents) for a more objective and com-
the talk” of a family-centered philosophy but prehensive understanding.
not to “walk the walk.” More research is needed to understand why
Second, participants had very specific ideas professionals have this narrow view of what is
of the continuum from too much to too little appropriate as well as to provide insight into
involvement. Professionals’ perceptions that understanding professional’s perceptions of
parents could be both over-and under- appropriate boundaries and what parents do
involved suggested that “just right” partner- that might cross those boundaries. It is impor-
ships (“Goldilocks” theme) might be rather tant to learn what professionals perceive as
narrowly defined in terms of following teacher threatening and why. In this regard, further
recommendations. research on the role of experience might shed
Third, parental blame describes comments light on this apparent contradiction. Our data
made by professionals who appeared to be suggest that professionals with more years ex-
unable to see the situation from the families’ perience tended to express less judgmental
point of view; rather, they saw problems as attitudes and to have, perhaps, more flexible
outside themselves or with the family (i.e., the boundaries in relating to families. Our study
family is in denial, the family doesn’t care). was too limited to allow development of any
The participants, in short, appeared to be un- definitive conclusions about this possibility;
aware of or unwilling to consider changes in future research should focus more specifically
their own behavior that might result in im- on experience as a moderator of attitudes to-
proved family-professional partnerships. ward families.
One theme from this study, parental blame,
compares to literature finding that profession-
Implications
als attributed partnership barriers to family
Much valuable information was obtained from characteristics rather than any professional
this study that leads to implications for future behaviors or structural barriers. Specifically
research and practice. Campbell and Halbert (2002) found that

Professionals’ Attitudes on Partnering with Families / 363


practitioners assigned both issues and solu- Summers and colleagues (2005) of partner-
tions to parents (and therefore out of their ships as “. . . mutually supportive interactions
control). Further research is needed to under- between families and professionals, focused
stand why professionals have come to form on meeting the needs of children and fami-
these opinions. Rather than to criticize profes- lies, and characterized by a sense of compe-
sionals, it is necessary to understand how they tence, commitment, equality, positive commu-
form their opinions, and why they feel the way nication, respect, and trust” (p. 3). In
they do. summary, the themes of this study– gap be-
Practice. Professionals in the field have tween family-centered language and actions,
long been concerned about observed gaps be- Goldilocks perception, and parental blame
tween recommended practices and the actual converge to suggest that we have “miles to go”
implementation of those practices (Carnine, as a field in implementing family-professional
1997; Carta & Greenwood, 1997; Gresham, partnerships.
MacMillan, Beebe-Frankenberger, & Bocian,
2000; Turnbull, Friesen, & Ramirez, 1998).
The findings of this research suggest that pro- References
fessionals may be verbalizing a commitment to
Anfara, V. A., Jr., Brown, K. M., & Mangione, T. L.
family-centered principles and at the same
(2002). Qualitative analysis on stage: Making the
time taking a controlling approach that di- research process more public. Educational Re-
rectly contradicts their own statements. The searcher, 31(7), 28 –38.
apparent lack of awareness that they are en- Bhering, E. (2002). Teachers’ and parents’ percep-
gaged in this conflicting dialogue may lend tions of parent involvement in Brazilian early
some insight into the reasons for the gap years and primary education. International Journal
between ideal and actual practices. An impli- of Early Years Education, 10, 227–241.
cation of this finding is that effective profes- Campbell, P. H., & Halbert, J. (2002). Between re-
sional development might need to incorpo- search and practice: Provider perspectives on
rate some strategies to aid professionals to early intervention. Topics in Early Childhood Special
Education, 22, 213–226.
identify their own conflicts in attitude and
Carnine, D. (1997). Bridging the research-to-prac-
behavior. tice gap. Exceptional Children, 63, 513–521.
This study also found that professionals with Carta, J. J., & Greenwood, C.R (1997). Barriers to
more experience appeared to recognize the the implementation of effective educational prac-
impact of their previous attitudes about par- tices for young children with disabilities. In J. L.
ents and to have more consistent beliefs about Loyd, E. Kamenuii, & D. Chard (Eds.), Issues in the
partnerships with families. This suggests that education of students with disabilities. (pp. 261–275).
professionals’ perceptions of under-or over- New York: Erlbaum.
involvement by parents (i.e., “Goldilocks” Charmaz, K. (2006). Constructing grounded theory: A
theme) may reflect discomfort or defensive- practical guide through qualitative analysis. London:
Sage Publications.
ness on the part of less experienced profes-
Croll, P. (2001). Teacher contact with parents of
sionals, who may view family partnerships as a children with special educational needs: A
threat or as a questioning of their compe- comparison over two decades. Journal of Research
tence. An implication is that less experienced in Special Educational Needs, 1(2). doi:10.1111/
professionals might profit from a more expe- j.1471-3802.2001.00139.x
rienced mentor who is able to model a more Dinnebeil, L. A., & Rule, S. (1994). Variables that
non-defensive and positive attitude toward influence collaboration between parents and ser-
working with families. vice coordinators. Journal of Early Intervention, 18,
The message needs to be conveyed to pro- 349 –361.
fessionals that there is an option for parents to Dunst, C. J. (2000). Revisiting “rethinking early in-
tervention”. Topics in Early Childhood Special Edu-
not participate. Most importantly, there needs
cation, 20, 95–104.
to be initial communication, formal or infor- Fylling, I., & Sandvin, J. T. (1999). The role of
mal, that enables families and professionals to parents in special education: The notion of part-
get to know each other and to reach consen- nership revised. European Journal of Special Needs
sus on expectations as preferences. Education, 14, 144 –157.
We include here, again, the definition of Gresham, F. M., MacMillan, D. L., Beebe-Franken-

364 / Education and Training in Autism and Developmental Disabilities-September 2010


berger, M. E., & Bocian, K. M. (2000). Treatment Shapiro, J., Monzo, L. D., Rueda, R., Gomez, J. A., &
integrity in learning disabilities intervention re- Blacher, J. (2004). Alienated advocacy: Perspec-
search: Do we really know how treatments are tives of Latina mothers of young adults with de-
implemented? Research to Practice, 15, 298 –305. velopmental disabilities on service systems. Mental
Hilton, A., & Henderson, C. J. (1993). Parent in- Retardation, 42, 37–54.
volvement: A best practice or forgotten practice? Summers, J. A., Hoffman, L., Marquis, J., Turnbull,
Education and Training in Mental Retardation, 28, A. P., Poston, D., & Nelson., L. L. (2005). Mea-
199 –211. suring the quality of family-professional partner-
Lee, H., Ostrosky, M. M., Bennett, T., & Fowler, ships in special education services. Exceptional
S. A. (2003). Perspectives of early intervention Children, 72, 65– 83.
professionals about culturally-appropriate prac- Turnbull, A. P., Friesen, B. J., & Ramirez, C. (1998).
tices. Journal of Early Intervention, 25, 281–295. Participatory action research as a model for con-
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic ducting family research. JASH, 23, 178 –188.
inquiry. Beverly Hills, CA: Sage. Turnbull, H. R., & Turnbull, A. P. (2000). Free ap-
Luckner, J. L., & Hanks, J. A. (2003). Job satisfac-
propriate public education (6th ed.). Denver: Love
tion: Perceptions of a national sample of teachers
Publishing Co.
of students who are deaf or hard of hearing.
Turnbull, H. R., Turnbull, A. P., Erwin, E., &
American Annals of the Deaf, 148(1), 5–17.
Soodak, L. (2006). Families, professionals, and excep-
McWilliam, R. A., Tocci, L., & Harbin, G. L. (1998).
tionality: Positive outcomes through partnerships and
Family-centered services: service providers’ dis-
trust (5th ed.). New Jersey: Merrill/Prentice Hall.
course and behavior. Topics in Early Childhood Spe-
Turnbull, A. P., Turnbull, H. R., Summers, J. A., &
cial Education, 18, 206 –221.
Miles, M. B., & Huberman, A. M. (1994). Qualitative Poston, D. (2008). Partnering with families of
data analysis: An expanded sourcebook (2nd ed.). children with developmental disabilities to en-
Thousand Oaks, CA: Sage Publications, Inc. hance family quality of life. In G. Peterson-Karlan,
Park, J., Turnbull, A. P., & Park, H. S. (2001). Qual- R. Ringlaben, & P. Parette, (Eds.), Research-based
ity of partnerships in service provision for Korean and emerging practices in developmental disabilities
American parents of children with disabilities: A (pp. 481–500). Austin, TX: Pro-Ed.
qualitative inquiry. Journal of the Association for Per- Turnbull, A. P., Zuna, N., Turnbull, R., Poston, D.,
sons with Severe Handicaps, 26, 158 –170. & Summers, J. A. (2007). Families as partners in
Patton, M. Q. (2001). Qualitative evaluation and re- educational decision-making: Current implemen-
search methods (2nd ed.). Thousand Oaks, CA: tation and future directions. In S. Odom, R. Hor-
Sage Publications, Inc. ner, M. Snell, & J. Blacher (Eds.), Handbook of
Penney, S., & Wilgosh, L. (2000). Fostering parent- developmental disabilities (pp. 570 –590). New York,
teacher relationships when children are gifted. NY: Guilford Publications, Inc.
Gifted Education International, 14, 217–229.
Rubin, H. J., & Rubin, I. S. (1995). Qualitative inter- Received: 14 April 2009
viewing: The art of hearing data. Thousand Oaks, Initial Acceptance: 12 June 2009
CA: Sage Publications, Inc. Final Acceptance: 4 November 2009

Professionals’ Attitudes on Partnering with Families / 365


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 366 –377
© Division on Autism and Developmental Disabilities

Deinstitutionalisation and Adaptation of Adults with


Intellectual Disabilities: Results from Québec
Hubert Gascon Pierre Morin
Université du Québec à Rimouski Centre de réadaptation en déficience
intellectuelle de Québec

Abstract: During the past twenty years, an important body of research has examined the different impacts of
deinstitutionalisation on the adaptation and quality of life of persons with intellectual disabilities. This
empirical study was conducted with 136 persons with intellectual disabilities following the closure of the Hôpital
Saint-Julien (Québec, Canada). Various questionnaires relating to adaptive and maladaptive behaviors,
mental health problems, medication and to the relocation were completed. The measures were taken following the
exit from institutions and subsequently after 27 months. Improvements are observed on adaptive and
maladaptive behaviors, and on mental health. The relation between medication’s evolution and the one noted
for the maladaptive behaviors and mental health is examined. The relocation variable should be considered in
future studies.

Since the beginning of the 1980s, the support erable number of scientific studies conducted
offered to people with intellectual disabilities throughout the world and summarised in lit-
has positively evolved within the context of a erature reviews edited in the United States
broader movement, in which the social inte- (Kim, Larson, & Lakin, 2001; Larson & Lakin,
gration of people with disabilities in general 1989; Lynch, Kellow, & Wilson, 1997), in the
has been promoted (Mansell, 2006). The pro- United Kingdom (Emerson & Hatton, 1996)
gressive closing of the institutions and the and in other countries, demonstrated the pos-
reorientation of almost all people with intel- itive impacts of the deinstitutionalisation pro-
lectual disabilities in the community, with cess on people who are experiencing social
the contribution of support and adapted ser- rehabilitation.
vices, allowed a progressive transfer of human With the aim of contributing to the enrich-
and financial resources that were previously ment of the data that presently exists on the
assigned in only some institutional contexts subject, an empirical study with repeated mea-
towards a variety of accessible support mea- surements was conducted in the Province of
sures in the community. Since then, a consid- Quebec (Canada) with 136 people with intel-
lectual disabilities, following the closure of
This research was funded through a contract be-
Hôpital Saint-Julien. This institution was
tween the Centre de réadaptation en déficience founded in 1870 by the religious congregation
intellectuelle Chaudière-Appalaches (CRDICA) and of the SŒurs de la Charité de Québec. Located in
the Université du Québec à Rimouski. At the time of a rural small town in the south of the prov-
research, Pierre Morin was Director of Clinical Ser- ince, and composed of a population of less
vices, Research and Planning for CRDICA. We ap- than two thousand habitants, this institution
preciate the careful attention of Luc Saint-Pierre of accommodated people for various reasons:
CRDICA and his colleagues to the data collection. intellectual disabilities, mental or physical
Also, we are grateful to our colleagues Serge health problems or loss of autonomy due to
Sévigny, Université Laval, for his assistance in data
ageing.
analysis; Andrew Freeman, Université Laval, for re-
vising the translation. Correspondence concerning
In 1997, the decision was made to transform
this article should be addressed to Hubert Gascon, this hospital to ensure the deinstitutionalisa-
Departement des Sciences del l’education, UQAR tion of its residents. A transformation plan was
Campus de Levis, 1595, boulevard Alphonse-Desjar- then elaborated (Hôpital Saint-Julien, 1999).
dins, LEVIS (Quebec), G6V 0A6, CANADA. At that time, 83% of the residents were diag-

366 / Education and Training in Autism and Developmental Disabilities-September 2010


nosed with intellectual disabilities. The dein- directed towards a service center of the sur-
stitutionalisation plan recommended the exit rounding area. Of this group, 83% were
of all the residents (N ⫽ 487) in four succes- women (n ⫽ 113) and 17% men (n ⫽ 23).
sive cohorts spread out over a period of four The mean age at time of discharge from the
years between 1999 and 2002. It was planned institution was 52 years old (SD ⫽ 9.05). The
that the residents would be integrated in the severity of the deficit related to the adaptive
community and benefit from various services behavior was measured with the Échelle Québé-
developed by two rehabilitation centers, spe- coise des comportements adaptatifs (ÉQCA) (Ate-
cialized in intellectual disabilities, in sur- lier québécois des professionnels sur le retard
rounding areas. The province of Quebec con- mental, 1993). Based upon this measure,
tains 23 of these public rehabilitation centers. 76.5% of people presented a profound deficit
These centers offer adaptation, rehabilitation (n ⫽ 104), 14.7% a severe deficit (n ⫽ 20),
and social integration services to people with 5.9% a moderate deficit (n ⫽ 8) and 1.4%, a
intellectual disabilities or with Pervasive Devel- mild deficit (n ⫽ 2).
opmental Disorders (PDD), as well as support
services to their families.
Three distinct types of residential services
Measures
are available: resources of family type (RFT), in-
termediate resources (IR) and continuous assistance Relocation. All changes of residence that
residences (CAR). The RFT is a foster family that took place following exit from the institution
accommodates people in their home. The CAR were recorded. Each one was characterized
is a residence in which a high level of support according to the difference in the degree of
(24 hours/7 days a week) is provided by em- support offered by the two residential re-
ployees of the establishment. The IR is a sources involved. The person could be either
mixed model. It is distinguished from the RFT directed towards a model offering less support
by the expertise and the extent of services (CAR towards IR, CAR towards RFT, IR to-
required by the person, which are beyond that wards RFT), same degree of support (CAR
offered in the RFT yet below that found in the towards CAR, RFT towards RFT, IR towards
CAR. In both the IR and RFT, one person is in IR) or more support (IR towards CAR, RFT
charge. Staffs are also present in the IR but do towards IR, RFT towards CAR). The reasons
not intervene on a 24 hours/7 days basis. given for relocation were regrouped in cate-
In the transformation plan, the develop- gories and then consigned according to
ment of an evaluation and monitoring model whether they were related to the person
was conceived to ensure follow-up of the resi- (health, behavior, autonomy, getting closer to
dents’ progress. Consistent with this aim, the the family) or independent of the person in-
focus of the present study was to understand volved (reason related to the RFT or to a
the evolution of the residents who had been reorganization of the residential service).
reoriented in community-based resources fol- Adaptive behavior. Adaptive behaviors were
lowing a long stay in an institution. Variables measured with the Échelle Québécoise des compor-
studied were relocation, adaptative and mal- tements adaptatifs: ÉQCA (AQPRM, 1993) ques-
adaptative behaviors, mental health problems tionnaire with the aim of obtaining an accu-
and medication. This study was based on the rate sense of the persons’ adaptive skills. This
approach in which data is provided from ques- questionnaire contains 324 items, separated
tionnaires, completed by advisors others, sys- into two distinct sections. The first section,
tematically collected and linked to medication which contains 225 items divided into seven
and relocation. spheres, measures various aspects of adaptive
behaviors (autonomy, domestic skills, health
and sensorimotor skills, communication, pre-
Method
school and school skills, socialization, work
skills). Each item is assigned a score from 0 to
Participants
2 (0 ⫽ does not do it; 1 ⫽ do it . . . but only
The sample was composed of 78% (n ⫽ 136) when told to do so, sometimes, not completely
of the residents that left the institution to be . . .; 2 ⫽ do it). The ÉQCA has good test-retest

Deinstitutionalisation and Adaptation / 367


reliability (r ⫽ .92) and good inter-rater reli- atic behaviors: drug abuse, self-mutilation, sui-
ability (r ⫽ .83) (Tassé & Maurice, 1993). cidal tendencies, robbery, inappropriate sex-
Maladaptive behavior. The second section ual behaviors and hyperactivity. A positive
of the ÉQCA measures maladaptive behavior. score is obtained with this evaluation if the
This section contains 99 items divided into total score measured by the eight subscales
seven dimensions. These dimensions are re- exceeds a cutoff or when a major problem is
lated to stereotyped behaviors and odd pos- detected on one of the six items. The transla-
tures, withdrawal and carelessness behaviors, tion and French adaptation of this instrument
unacceptable practices and habits, antisocial was made up by two committees composed of
or inappropriate interpersonal manners, inad- bilingual professionals with expertise in the
equate or divergent sexual behaviors, violence field of mental retardation. The internal co-
or aggression behaviors, and self-mutilation herence indices for the eight sub-scales of the
behaviors. Each item is assigned a score from original version of the instrument vary be-
0 to 3 according to the severity of the inade- tween .57 and .84 and that associated with the
quate behavior (0 ⫽ does not exhibit the be- total score is .84 (Reiss). As is mentioned by
havior; 1 ⫽ mild; 2 ⫽ moderate; 3 ⫽ severe). Lecavalier and Tassé (2001), the translated
A mild inadequate behavior refers to an occa- French version of the instrument adapted to
sional or benign behavior that may require an the Quebec reality obtains similar internal co-
isolated intervention from caregivers. The herence indices, that is, between .53 and .83
moderate type behavior is the one that re- for the eight subscales and .80 for the total
quires a generalized or concerted action lead- score.
ing to the application of a treatment strategy Medication. The data related to psychoac-
to modify the presented behavior. Finally, a tive drug medication were collected and re-
severe behavior is considered to be so when it corded on cards designed for this purpose.
may constitute a danger to the person or The drug’s name and its posology, as well as
other people, or lead to the rejection of the the dates related to some modifications in the
individual. regulation of medication, were recorded. This
Mental health problems. The translation and type of drug could either be in the nerve
transcultural adaptation section (Lecavalier & sedative (antipsychotic) or anxiolytic (benzo-
Tassé, 2001) of the questionnaire Reiss Screen diazepines) families. With the intention of ob-
for Maladaptive Behavior (Reiss, 1988) was used taining a measurement common to the vari-
with the intention of creating a portrait of the ous prescribed drugs, equivalences were
mental health condition of the participants. calculated: the amounts of drug prescribed in
The instrument was originally developed to the nerve sedative family were converted in
detect the presence of mental health prob- CPZ (chlorpromazine) and the amounts for
lems of teenagers and adults presenting intel- those in the anxiolytic family, in Diazépam (or
lectual disabilities. The instrument is com- Valium).
posed of 36 items describing the symptoms of Procedure. The questionnaires used to
one or more mental health issues, as de- measure the adaptive and maladaptive behav-
scribed in the DSM-III. For each item, the iors and mental health problems were com-
respondent must indicate if the behavior does pleted by caregivers who knew the person, in
not represent a problem (0); a problem (1); a collaboration with a member of the staff in
major problem (2); a problem that can be charge of the residence where each resident
identified by one of the multiple criteria de- lived. Each person was evaluated at two time
fining psychopathology: the frequency, the in- points: at the third month (Time 1) at the
tensity, the circumstances of appearance and 27th month (Time 2) following discharge
the impact for the evaluated person or for his from the Hôpital Saint-Julien. For each person,
environment. It is composed of eight sub- a specific personal observation file entitled
scales: aggressiveness, autism, psychosis, para- Individual observation file (IOF) was created.
noia, depression (behavioral signs), depres- This IOF included the instruments, the grids
sion (physical signs), dependent personality of notation and the instructions to be followed
and avoidance disorder. In addition to these with every person evaluated. The original data
eight sub-scales, six items describe problem- were recorded in this file and, in some cases,

368 / Education and Training in Autism and Developmental Disabilities-September 2010


the compilation of the scores obtained were TABLE 1
also preserved. At each evaluation, each per-
Distribution of the Participants According to
son’s IOF number, the data collection date Residence’s Type
and the name of the person in charge were
registered on each page for each completed Time 1 Time 2
file. The IOF’s management was ensured by a
counsellor in charge of the process, who ad- n % n %
hered to a calendar to manage the evaluation
follow-up. Concerning medication, a nurse Resources of family type (RFT) 48 35 51 38
had the responsibility of reading the data and Intermediate ressources (IR) 22 16 44 32
converting the drugs into equivalence CPZ or Continuous assistance
Diazépam for each file. The data capture re- residences (CAR) 66 49 38 28
Other 0 0 3 2
lated to medication (type and posology) was
Total 136 100 136 100
taken at the time of exit from the institution
(Time 1) and on the 27th month (Time 2).

Three transfers were due to a combination of


Results
these reasons.
In this section, only the results obtained at Adaptive behaviors. Table 2 reveals the re-
Time 1 (or at discharge from the institution) sults of the ÉQCA obtained at Time 1 and
and at Time 2 are presented. Statistical analy- Time 2 for all the participants and for the
ses were carried out with SPSS software (Win- same participants but gathered according to
dows’ version 11.5). Only the values for the whether they were or were not relocated fol-
bilateral thresholds of significance appear, lowing their exit of the institution (relocated,
with the intention of gaining a better overview not relocated).
of differences between measures revealed by The results obtained by participants indi-
the application of t tests with repeated mea- cate a significant improvement in the domes-
sures for data obtained with ÉQCA’s and Reiss tic skills’ sphere. No other significant differ-
Screen for Maladaptive Behavior’s scales. ence is observed; the results are quite stable.
Relocation. At the time of the initial exit However, for people that remained at the
date, 52.2% of the people (n ⫽ 71) did not same place (not relocated), significant im-
change residence. Among the 47.8% of the provements in the fields of autonomy, domes-
relocated individuals (n ⫽ 65), 26.5% were tic skills, communication and socialization are
relocated once (n ⫽ 36); 14% twice (n ⫽ 19); observed.
5% three times; less than 1% four times (n ⫽ Maladaptive behaviors. Table 3 presents the
1); and 1.5%, five times (n ⫽ 2). Changes in results for all participants that are related to
the type of residence between Time 1 and the ÉQCA’s scale for the maladaptive behav-
Time 2 indicates that 47.7% of the relocated iors’ section for Time 1 and Time 2. When all
people (n ⫽ 31) were directed towards a participants are considered, a significant dim-
model offering a lower level of support, 40% inution in serious behavioral problems is ob-
towards a model offering comparable level of served. However, it is noted that this improve-
support (n ⫽ 26), and 7.7% towards a model ment is especially observed in people that
offering more support (n ⫽ 5). Table 1 indi- didn’t experience relocation. For those per-
cates the distribution of people according to sons, intermediate behavioral problems also
the type of residence they lived in at Time 1 tend to decrease. No other difference is noted
and at Time 2. for each dimension of this ÉQCA’s section.
We observed 109 changes of residence. Sev- Mental health problems. Table 4 reveals re-
enty percent of these changes (n ⫽ 77) were sults obtained on the Reiss Screen for Maladap-
associated with the person (health [n ⫽ 15], tive Behavior’s scale for all participants. In Ta-
behavior [n ⫽ 57], autonomy [n ⫽ 4]) and ble 5, the same results are presented but
27.5% (n ⫽ 30), to a reason independent of adapted according to whether residents were
the person (reason related to the RFT [n ⫽ 7] or were not relocated following their dis-
or to the service’s orientation [n ⫽ 23]). charge from the institution. When all partici-

Deinstitutionalisation and Adaptation / 369


TABLE 2

EQCA Adaptive Behaviors: Means, SDs, and t Test

N ⫽ 136 Not Relocated (n ⫽ 71) Relocated (n ⫽ 65)

Time 1 M Time 2 M Time 1 M Time 2 M Time 1 M Time 2 M


(SD) (SD) t (SD) (SD) t (SD) (SD) t

Global EQCA 2.92 (2.01) 2.87 (1.69) .60 2.70 (1.89) 2.82 (1.74) ⫺1.43 3.15 (2.11) 2.92 (1.65) 1.53
Autonomy 4.05 (2.27) 4.00 (2.09) .42 3.62 (2.32) 3.83 (2.26) ⫺2.09* 4.51 (2.15) 4.19 (1.89) 1.73
Domestic skills 2.48 (3.15) 2.87 (3.23) ⫺2.32* 2.19 (3.06) 2.75 (3.21) ⫺2.10* 2.78 (3.25) 2.99 (3.28) ⫺1.04
Health and
sensorimotor
skills 2.65 (1.89) 2.65 (1.76) .09 2.4 (1.84) 2.49 (1.80) ⫺1.01 2.94 (1.91) 2.82 (1.72) .83
Communication 2.90 (1.99) 2.97 (1.95) ⫺1.06 2.66 (1.93) 2.86 (1.91) ⫺2.50* 3.16 (2.04) 3.10 (1.99) .50
Pre-school and
school skills 1.64 (2.31) 1.46 (2.09) 1.46 1.52 (2.18) 1.35 (2.07) 1.19 1.76 (2.45) 1.59 (2.12) .91
Socialization 3.06 (2.15) 3.20 (1.93) ⫺1.55 2.83 (2.12) 3.08 (2.01) ⫺2.08* 3.31 (2.16) 3.32 (1.86) .98

* p ⬍ .05.

pants are considered, it can be observed that The observation of the correlation between
the number of people whose scores exceed the scores noted at Time 1 on the total scale of
the cutoff decreased on the total scale and on the Reiss Screen for Maladaptive Behavior’s scale
the subscales. More specifically, a significant (26 items) and on the of the maladaptive be-
reduction in mental health problems is ob- haviors’ part of the ÉQCA’s scale, indicates a
served in two sub-scales of the Reiss Screen for significant correlation R ⫽ .535, p ⬍ .000.
Maladaptive Behavior (aggressiveness and au- Personal characteristics and relocation. Tak-
tism). ing into account the differences observed,
Similar to the adaptive behaviors, improve- whether there was or was not an impact re-
ment was more considerable for people that lated to relocation on the evolution of adap-
were not relocated. In their situation, signifi- tive and maladaptive behaviors and mental
cant improvements are observed on subscales health problems, we wanted to verify if two
related to aggressiveness, psychosis and para- distinct groups could be identified following
noia and on the euphoria item. For people their departure from the institution. The re-
that were relocated, a significant improve- sults of the univariated variance analysis with
ment is observed on the autism subscale. one factor (relocation) applied to the major

TABLE 3

EQCA Maladaptive Behaviors: Means, SDs, and t Test

N ⫽ 136 Not Relocated (n ⫽ 71) Relocated (n ⫽ 65)


EQCA-
Maladaptive Time 1 M Time 3 M Time 1 M Time 3 M Time 1 M Time 3 M
Behaviors (SD) (SD) t (SD) (SD) t (SD) (SD) t

Mild 7.27 (7.15) 7.37 (6.88) ⫺.17 7.63 (7.6) 6.96 (6.18) .97 6.88 (6.66) 7.82 (7.59) ⫺1.07
Moderate 5.11 (5.92) 4.43 (5.40) 1.20 5.1 (6.48) 3.97 (4.97) 1.74 5.12 (5.3) 4.94 (5.82) .19
Severe 0.59 (1.64) 0.21 (0.97) 2.64** .55 (1.49) .17 (.76) 2.78** .63 (1.81) .25 (1.16) 1.453
Maladaptive
behaviors
score 19.26 (15.2) 16.85 (14.16) 1.89 19.48 (17.02) 15.41 (13.62) 2.77** 19.02 (13.07) 18.43 (14.67) .28

* p ⬍ .05. ** p ⬍ .01.

370 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 4

ERDCP: Means, SDs, and t Test, Number of Participants Above the Suggested Cut-off (N ⴝ 136)

N of
Participants
Having Signs
of Mental
Health
Time 1 Time 2 Problems

ERDCP Sub-Scales Mean SD Mean SD t T1 T3

Agressiveness 1.33 1.97 0.94 1.69 2.07* 6 4


Autism 0.67 1.06 0.44 0.78 2.23* 1 0
Psychosis 0.52 1.21 0.35 0.99 1.67 2 1
Paranoia 0.65 1.17 0.46 1.03 1.68 2 1
Depression (behavioral signs) 0.92 1.43 0.70 1.22 1.61 2 1
Depression (Physical signs) 0.64 1.07 0.63 1.04 .07 3 2
Dependent personality 0.86 1.23 0.69 1.11 1.45 0 0
Avoidance disorder 0.66 1.22 0.55 1.03 .90 1 0
ERDCP items (N ⫽ 136)
Alcohol/Drug abuse 0 0 0 0 – 0 0
Hyperactivity 0.13 0.44 0.07 0.28 1.68 5 1
Self-mutilation 0.24 0.52 0.26 0.49 .28 6 3
Inappropriate sexual behavior 0.07 0.31 0.04 0.21 1.42 2 0
Robbery 0.18 0.49 0.15 0.43 1.00 6 4
Suicidal tendencies 0 0 0.01 0.12 1.42 0 0
Total ERDCP scale (26 items) 5.58 7.07 4.32 5.59 1.93 23 19

* p ⬍ .05.

scale of the Reiss Screen for Maladaptive Behavior tive (r ⫽ .183), p ⫽ .033 were significantly
(total scale, subscales, items), to the ÉQCA related to relocation. However, these two vari-
(adaptive behaviors) and to the ÉQCA (light, ables predicted less than 10% of relocation
moderate and serious maladaptive behaviors) (yes/no) when they are both treated with a
indicate that the two groups are quite differ- logistic regressions model.
ent on two variables: autonomy on the ÉQCA Medication. Table 6 presents the evolution
F(1, 134) ⫽ 5.331, p ⫽ .022 and hyperactivity on of medication. For those in the nerve sedatives
the Reiss Screen for Maladaptive Behavior’s scale family, analysis indicates an increase of 22% of
F(1, 134) ⫽ 4.646, p ⫽ .040. People that were posology prescribed at departure from the in-
relocated seemed more autonomous and stitution (n ⫽ 30). Concerning the type of
more hyperactive. Also, on each sub-scale of medication taken by people at that same mo-
the ÉQCA, we observe an average score a little ment, a similar rise is also observed 18% (n ⫽
higher for this group. With the intention of 24). For the drugs in the anxiolytic family,
examining the predictive value of certain per- Table 6 reveals an increase of 8% (n ⫽ 11)
sonal characteristics on the relocation vari- related to the number of people that received
able, correlations between this variable and a prescription for that type of medication at
others measured with subscales of three in- Time 2, compared to the number at Time 1.
struments (ÉQCA/adaptive behaviors, ÉQCA/ In total, 14% of people started receiving a
maladaptive behaviors and Reiss Screen for Mal- prescription of that last type or saw their med-
adaptive Behavior) were examined, followed by ication’s posology increase.
a regression analysis. At Time 1, the variables The Marginal homogeneity test (using SPSS
ÉQCA/autonomy (r ⫽ .196), p ⫽ .022 and procedure) shows that changes between Time
Reiss Screen for Maladaptive Behavior/hyperac- 1 and Time 2 are significant for the drugs of

Deinstitutionalisation and Adaptation / 371


TABLE 5

ERDCP: Means, SDs, and t Test, Number of Participants Above the Suggested Cut-off According Relocation

Not Relocated (N ⫽ 71) Relocated (N ⫽ 65)

ERDCP Sub-Scales T1 T3 t T1 T3 t

Agressiveness 1.28 (1.93) .69 (1.3) 2.74** 1.38 (2.03) 1.2 (2.01) .58
Autism .53 (.93) .39 (.70) 1.76 .82 (1.18) .49 (.85) 1.90
Psychosis .41 (.97) .23 (.75) 2.10* .64 (1.42) .48 (1.18) .87
Paranoia .59 (1.0) .31 (.73) 2.79** .71 (1.32) .62 (1.25) .41
Depression (behavioral signs) .69 (1.17) .58 (.97) .76 1.16 (1.64) .84 (1.43) .35
Depression (physical signs) .48 (.89) .53 (.96) .30 .8 (1.21) .74 (1.12) .35
Dependent personality .72 (1.11) .53 (.94) 1.45 1 (1.34) .85 (1.25) .76
Avoidance disorder .58 (1.01) .51 (.02) .53 .75 (1.41) .61 (1.04) .71

ERDCP Items

Alcohol/Drug abuse 0 0 – 0 (0) 0 (0) –


Hyperactivity .05 (.23) .04 (.26) .58 .22 (.57) .09 (.29) 1.59
Self-mutilation .21 (.48) .20 (.4) .24 .28 (.57) .32 (.56) ⫺.52
Inappropriate sexual behaviors .11 (.4) .06 (.23) 1.42 .03 (.17) .03 (.17) –
Robbery .2 (.52) .14 (.42) 1.27 .15 (.44) .15 (.44) –
Suicidal tendancies 0 0 – 0 (0) .03 (.17) ⫺1.45
Total ERDCP scale (26 items) 4.75 (6.09) 3.38 (4.52) 1.93 6.46 (7.93) 5.31 (6.42) 1.00

* p ⬍ .05, ** p ⬍ .01, *** p ⬍ .001.

the nerve sedatives family (MH ⫽ 15, p ⬍ significant (MH ⫽ 14, p ⬍ .05). The Wilcoxon
.001). Furthermore, a Wilcoxon test reveals test also shows in that case that the two distri-
that the two related distributions are different butions are different (Z ⫽ ⫺2.416, p ⬍ .05).
(Z ⫽ ⫺5.446, p ⬍ .001). For the anxiolitic Medication and maladaptive behaviors or mental
medication family, analysis reveals that health problems. The relation between medi-
changes between Time 2 and Time 1 are also cation’s evolution (difference between Time 1

TABLE 6

Evolution of Medication Between Time 1 and Time 2

Drugs Type and Daily Posology in Miligram Number of People Medication Evolution

Time 1 Time 2 Decrease Stable Increase

Nerve sedative (antipsychotic) 0 mg 98 68 5 (3.8%) 74 (55.6%) 54 (40.6%)


CPZ equivalence 1–15 mg 8 7
(Daily posology) 16–59 mg 6 12
60 mg or ⫹ 24 46
Total 136 133
Anxiolytic (benzodiazepine) 0 mg 119 108 8 (6%) 107 (80%) 19 (14%)
Diazépam equivalence 1–15 mg 10 16
(Daily posology) 16–59 mg 4 7
60 mg or ⫹ 3 3
Total 136 134

Note. At Time 2: Missing data for three participants concerning nerve sedative and for two participants
concerning anxiolytic.

372 / Education and Training in Autism and Developmental Disabilities-September 2010


and Time 2) and the one noted for the mal- 7.7% of removals were towards resources with
adaptive behaviors and mental health prob- more intensive support. At first view, this ten-
lems were evaluated by measuring the Pearson dency leads us to believe that people skills are
correlation coefficient. It was possible to de- improving or that the initial orientation re-
tect the existence of a statistical inverse signif- source over-estimated their need for support.
icant relation between the evolution of the The majority of residence changes were moti-
nerve sedative’s drugs and the one noted for vated by reasons related to the person’s con-
the variable Serious maladaptive behaviors of the dition and 30% for different reasons.
ÉQCA (r ⫽ –.397), p ⬍ .000. A relation is also On the adaptive behaviors dimension, and
noticed between the anxiolitic medication when all participants are considered, the do-
family’s evolution and the one related to the mestic skills’ variable represents the dimen-
aggressivity variable of the Reiss Screen for Mal- sion that most significantly improved. It can
adaptative Behavior scale (r ⫽ –.201), p ⫽ .026. be supposed that the fact of staying in a reg-
ular residence, of being exposed daily to do-
mestic activities, and of being possibly encour-
Discussion aged to take part in those activities, supports
the progressive development of such skills.
The few studies that observed the impacts of Other authors have also noted improvements
deinstitutionalisation provided no informa- from this perspective. In their literature re-
tion on changes of residence following depar- view of 11 studies related to the evolution of
ture from the institution. As revealed by our adaptive behaviors, Lynch et al. (1997) ob-
results, a significant proportion of people are served that this dimension is the one that
relocated in such circumstances, and some- reveals more consistent positive improvement
times more than once. In 1993, a Quebec from one study to another.
study conducted by Lalonde and Lamarche For individuals who stayed at the same place
with 21 persons leaving the Hôpital Louis-H.- following their exit, the improvement noted
Lafontaine revealed that all residents that left touches a wider variety of adaptive behaviors.
the institution re-located in the 45 months In addition to domestic skills, we notice im-
following their exit. The authors concluded provements on the three dimensions of auton-
their discussion on the potential repercus- omy, communication and socialisation.
sions of such movements by insisting on the These results are quite similar to the con-
importance of ensuring that people who inte- clusions revealed in literature reviews con-
grate in the community benefit from more ducted on the same subject in the United
stable living conditions. Recently, in a text States (Kim et al., 2001; Larson & Lakin, 1989;
about psychopathology and intellectual dis- Lynch et al., 1997) and in the United King-
abilities, Ionescu (2003) mentions some work dom (Emerson & Hatton, 1996) and in re-
completed in the 1970s that was interested in search more recently conducted in England
the syndrome of relocation. Because half of our (Ager, Myers, Kerr, Myles, & Green, 2001;
participants were relocated, it seemed to us Golding, Emerson, & Thornton, 2005), Aus-
quite pertinent to distinguish in our analyses tralia (Young & Ashman, 2004; Young, 2006)
those who were relocated from those who and in the United States (Lerman, Hall Apgar,
were not. & Jordan, 2005; Spreat, Conroy, & Fullerton,
Efforts required to ensure a good quality 2004). In Kim et al. (2001) literature review,
adaptation to a new residential medium can almost all of the 33 studies retained by the
influence the final results of individuals’ evo- authors according to pre-established scientific
lution related to several variables of interest. criteria, and published between 1988 and
This distinction, which we believe to be quite 1998, revealed results indicating a significant
important, will be present throughout this dis- improvement in adaptive behaviors of people
cussion. Although residential stability can be following deinstitutionalisation. Two of these
an interesting objective to be attained, it is, previous authors found similar results in an-
however, quite interesting to note that in our other literature review in which 21 American
study people were relocated mainly towards studies published between 1978 and 1988
resources with less intensive support. Only were analyzed (Larson & Lakin, 1989). Nine-

Deinstitutionalisation and Adaptation / 373


teen of these studies (90%) revealed signifi- evaluating these behaviors with a question-
cant improvement in adaptive behaviors. For naire, two investigations indicated an im-
their part, Emerson and Hatton (1996) ana- provement, three a deterioration and nine
lyzed 71 studies carried out in the United no difference. These results are not consis-
Kingdom and published between 1980 and tent, similar to the findings of the three
1994, among which 24 measured adaptive be- following studies published more recently. A
haviors. Skill improvements on that dimen- Norwegian study conducted during an eight
sion were observed in 16 studies and any dif- years period by Nøttestad and Linaker
ference in the eight other studies, which led (1999) with a sample of 109 individuals
the authors to conclude that deinstitutional- noted a deterioration of behavioral prob-
isation is generally accompanied by an im- lems, in particular with behaviors related to
provement in adaptive behaviors, a conclusion aggressiveness, to breaking material and to
also shared by Lynch et al. passivity. However, in the Australian study
For maladaptive behaviors, as measured by undertaken by Young, Ashman, Sigafoos,
the ÉQCA, results indicate a significant reduc- and Grevell (2001) with 95 individuals one
tion in serious inadequate behaviors and in year following their departure from the in-
behaviors judged of a moderate gravity, albeit stitution, an improvement of these behav-
non-significant, when all participants are con- iors was observed. Improvement was also
sidered. However, the reduction observed in noted in the study undertaken with 12 peo-
serious behaviors is especially associated with ple in England by Golding et al. (2005).
people who were not relocated, for whom the Various reasons have been proposed. First,
reduction in these behaviors is more impor- as McGillivray and McCabe (2005) noted, it
tant than that revealed for those individuals is possible that in institutions, several behav-
who were relocated. These data are consistent iors pass unnoticed that are not tolerated in
with those obtained with the Reiss Screen for integrated services. This argument is valid
Maladaptive Behaviors scale, as supported by when measurements are taken before and
the correlation between the two instruments. following the transfer. However, what has
The results revealed by that scale indicate a been said about repeated measurements
reduction in the number of people presenting taken only following transfer? According to
indices of mental health problems. This Kim et al. (2001), the variation could be
means that those person’s scores exceed the attributable to the fact that from the begin-
critical points on each subscale, on the total ning of the movement in favour of integra-
scale (26 items) and on each item. If we more tion, a tendency to transfer people present-
precisely consider these results, significant im- ing good capacities first existed. This means
provements are revealed for autism and ag- that during the last years of deinstitutional-
gressiveness dimensions and, although non- isation, transferred people could have pre-
significant, for the total scale (26 items) and sented more important incapacities. This
for scales related to the psychosis, paranoia, might explain differences observed among
hyperactive and euphoria variables. As for the various studies. Obviously, non-comparable
inadequate behaviors variable measured by samples may also explain such variations in
the Reiss Screen for Maladaptive Behaviour scale, results related in the studies considered.
stronger improvements are shown by people However, when we examine the literature
that were not relocated. reviews more precisely, the listed studies in-
Concerning the evolution of behavioral dicate the number of people, their age and
problems following transfer from the institu- the severity of their intellectual disabilities.
tion towards more integrated settings, the sci- Variations between studies do not seem to
entific literature has not revealed consistent be attributable to sample differences. Kim et
findings. Of the 33 studies analyzed by Kim et al. also underline that the selection of the
al. (2001), 10 studies revealed a significant or participants can involve a bias because peo-
tending-towards-significance improvement, ple whose condition worsens on the adap-
six a deterioration, with the others not re- tive behaviors or behavioral problems are
vealing any difference. In Emerson and Hat- re-institutionalized. Indeed, excluding from
ton’s (1996) literature review of 14 studies studies people that were re-institutionalized

374 / Education and Training in Autism and Developmental Disabilities-September 2010


involves a bias and represents missing infor- are consistent with those related by Spreat et
mation from studies selected. al. (2004). These authors compared the evo-
These various reasons can explain such vari- lution of percentages of people taking drugs
ations. However, changes in people’s condi- according to whether they lived in institutions
tion are not only attributable to the fact of (n ⫽ 279) or were deinstitutionalized (n ⫽
being transferred from an institution towards 167) between 1994 and 2000. The increase in
integrated services offered in the community. the percentage of people taking drugs of var-
The nature of services offered in their social ious categories (anxiolytic, antidepressants
environment also plays a determining role. and atypical antipsychotic) was higher than
With the exception of residential facilities, all that observed in people that remained in in-
other services are not well described in the stitutions. In 2000, 41.3% of integrated people
scientific literature. took psychotropic medication. This percent-
Such information might well explain the age decreased to 30.5% for those who re-
differences observed. In our study, the pres- mained in institution, a percentage which is
ence of a mobile team composed of educa- even lower than that revealed in a study con-
tional counsellors especially trained to ensure ducted in Oklahoma in 2000, which consid-
the clinical follow-up of each person present- ered the entire population selected. Effec-
ing behavioral difficulties or mental health tively, 34% of the 3 187 individuals evaluated
problems can explain, partly, the improve- took at least one type of psychotropic drug.
ment noted in behaviors of person or, at least, Other studies have not mentioned any
the absence of deterioration. Their support change. Thinn, Clarke and Corbett (1990) did
role with staff from the different residential not find any difference between the medica-
resources and from the daycare centers, their tion taken two years before the exit and six
collaboration with the health department, months after for 34 individuals. In a recent
their willingness to promote interventions Norwegian study interested in the medication
based on principles related to a positive ap- of 109 people (Nøttestad & Linaker, 2003), no
proach (Fraser & Labbé, 1993; Kroegel, Kroe- significant change was observed after eight
gel, & Dunlap, 1996) combined with a phar- years for the nerve sedative consumption. As
macological intervention, might explain some mentioned earlier, Nøttestad and Linaker
of the positive results of our study. (1999) observed deterioration in maladaptive
Following exit from the institution, an in- behaviors for this same group of people. In a
crease in medication also was noted. More comparative study interested in the difference
precisely, this increase is related to a rise in between medication taken according to the
the number of people to whom drugs were residential medium where 873 participants
prescribed (nerve sedatives or anxiolytic) or lived, McGillivray and McCabe (2005) recog-
in the posology taken, in some instances. How- nized that the transfer in the community can
ever, the nerve sedative family medication re- be associated with an improvement of peo-
mains stable or decreases for 59.4% of indi- ple’s living conditions but that such a change
viduals. For medication in the anxiolytic is not necessarily accompanied by a reduction
family, this percentage is calculated at 86%. in medication. In their study, they did not
This medication contributed to improvements observe any difference between consumption
in people’s condition, as proved by the statis- in institutions or in the community.
tical inverse significant relation revealed be-
tween medication and results obtained on the
Conclusion
behavioral problems component of the ÉQCA
and on the aggressiveness component of the The present study tracked the evolution of
Reiss Screen for Maladaptive Behavior scale. various indicators for individuals with intellec-
To this medication component, the analysis tual disabilities following their departure from
of studies undertaken elsewhere revealed an institution. In this perspective, the tenden-
quite variable results. Some recorded an in- cies related to deteriorations or improvements
crease in psychotropic medication (Conroy, observed in certain people’s evolution, and
1996; Hill, Balow, & Bruininks, 1985; Inta- revealed by our analysis, were then transmit-
gliata & Rinck, 1985). These studies’ findings ted to counsellors in annual meetings. This

Deinstitutionalisation and Adaptation / 375


practice may have had an influence on the References
interventions, but it would be quite difficult to
measure the intensity and influence that mon- Ager, A., Myers, F., Kerr, P., Myles, S., & Green, A.
itoring could exert on the results. However, (2001). Moving home: Social integration for
we believe that such a difference is quite min- adults with intellectual disabilities resettling into
community provision. Journal of Applied Research in
imal since the decisions concerning services
Intellectual Disabilities, 14, 392– 400.
provided to a person or a small group of peo-
Atelier québécois des professionnels sur le retard
ple are often determined by rules defined in a mental (1993). Échelle québécoise de comportements
clinical process distinct from one establish- adaptatifs: Manuel technique. Montréal: UQAM.
ment to the other. The results of such a study, Conroy, J. (1996). Patterns of community placement II:
which are related to the transformation of The first 27 months of the Coffelt settlement. Ardmore,
only one institution, cannot be generalized. PA: Center for Outcome Analysis.
The sample is not representative and each Emerson, E., & Hatton, C. (1996). Deinstitutional-
transformation of institution constitutes in it- ization in the UK and Ireland: Outcomes for ser-
vice users. Journal of Intellectual and Developmental
self a unique case. The allocated resources,
Disability, 21, 17–37.
the qualification and the preparation of the Fraser, D., & Labbé, L. (1993). L’approche positive de
staff involved, the support given, the organi- la personne:Une conception globale de l’intervention.
zation of services and the clinical program- Laval: Éditions Agence d’Arc et Éditions de la
ming are some of the many factors that can Collectivité.
influence the results, in one direction or an- Golding, L., Emerson, E., & Thornton, A. (2005).
other. As well, the history of the intramural An evaluation of specialized community-based
services from which a person can benefit also residential supports for people with challenging
behaviour. Journal of Intellectual Disabilities, 9, 145–
has to be considered.
154.
This being said, the contribution of this Hill, B., Balow, E., & Bruininks, R. (1985). A na-
study made it however possible to isolate an tional study of prescribed drugs in institutions
important variable that should be considered and community residential facilities for mentally
in future studies: Indeed, relocation has insuf- retarded people. Psychopharmacology Bulletin, 21,
ficiently been mentioned in studies. It is also 279 –284.
important to mention that results obtained Hôpital Saint-Julien (1999). Plan de transformation
are not only attributable to the fact of being des ressources en un modèle intégré à la communauté
1999 –2003. Bernierville: Author.
transferred from an institution towards ser-
Intagliata, J., & Rinck, C. (1985). Psychoactive drug
vices integrated into the community, but are use in public and community residential facilities
quite possibly mainly due to the particular for mentally retarded persons. Psychopharmacology
characteristics of the new services offered. Bulletin, 21, 279 –284.
Negative prejudices related to people present- Ionescu, S. (2003). La psychopathologie. In Tassé
ing intellectual disabilities remain present and M. J., & Morin D. (Eds.). La déficience intellectuelle
strong. With respect to deinstitutionalisation, (pp. 282–302). Boucherville: Gaétan Morin Édi-
these attitudes can represent huge obstacles. teur.
Kim, S., Larson, S. A., & Lakin, K. C. (2001). Behav-
The results of this study made it possible to
ioural outcomes of deinstitutionalisation for peo-
show that deinstitutionalisation is beneficial to
ple with intellectual disability: A review of US
people. As others have mentioned, impacts studies conducted between 1980 and 1999. Jour-
are also noted in other dimensions of person’s nal of Intellectual & Developmental Disability, 26,
condition and more particularly in their qual- 35–50.
ity of life. The many studies that have focused Kroegel, L. K., Kroegel, R. L., & Dunlap, G. (1996).
upon the evolution of the quality of life of Positive behavioral support: Including people with dif-
these individuals are quite unanimous: the ficult behavior in the community. Baltimore: Brookes.
benefits are real and important. In several Lalonde, F., & Lamarche, C. (1993). De l’Hôpital
Louis-H. Lafontaine à la rue Lafontaine. Revue
countries, there still exist an important num-
francophone de la déficience intellectuelle, 4, 103–120.
ber of great institutions (World Health Orga- Larson, S. A., & Lakin, K. C. (1989). Deinstitution-
nization, 2007). Results that emerge from alization of persons with mental retardation: Be-
studies on deinstitutionalisation can lead to havioral outcomes. Journal of the Association for
an important reflection on their futures. Persons with Severe Handicaps (JASH), 14, 324 –332.

376 / Education and Training in Autism and Developmental Disabilities-September 2010


Lecavalier, L., & Tassé, M. J. (2001). Traduction et Spreat, S. M., Conroy, S. J., & Fullerton, A. J. (2004).
adaptation transculturelle du Reiss Screen for Statewide longitudinal survey of psychotropic
maladaptive behavior. Revue francophone de la défi- medication use for persons with mental retarda-
cience intellectuelle, 12, 31– 44. tion: 1994 to 2000. American Journal on Mental
Lerman, P., Hall Apgar, D., & Jordan, T. (2005). Retardation, 109, 322–331.
Longitudinal changes in adaptive behaviors of Tassé, M. J., & Maurice, P. (1993). Étude de la
movers and stayers: Findings from a controlled stabilité et de la concordance de l’échelle québé-
research design. Mental Retardation, 43, 25– 42. coise de comportements adaptatifs. Revue Franco-
Lynch, P. S., Kellow, J. T., & Wilson, V. L. (1997). phone de la Déficience Intellectuelle, 4, 57– 67.
The impact of deinstitutionalization on the adap- Thinn, K., Clarke, D. J., & Corbett, J. A. (1990).
tive behavior of adults with mental retardation: A Psychotropic drugs and mental retardation: II. A
meta-analysis. Education and Training in Mental comparison of psychoactive drug use before and
Retardation and Developmental Disabilities, 32, 255– after discharge from hospital to community. Jour-
261.
nal of Mental Deficiency Research, 34, 397– 407.
Mansell, J. (2006). Deinstitutionalisation and com-
World Health Organization (2007). Atlas: Global re-
munity living: Progress, problems and priorities.
sources for persons with intellectual disabilities 2007.
Journal of Intellectual and Developmental Disability,
Switzerland: World Health Organization.
31, 65–76.
Young, L., Ashman, A., Sigafoos, J., & Grevell, P.
McGillivray, J., & McCabe, M. (2005). The relation-
(2001). Closure of the Challinor Centre II: An
ship between residence and the pharmacological
management of challenging behavior in individ- extended report on 95 individuals after 12
uals with intellectual disability. Journal of Develop- months of community living. Journal of Intellectual
mental & Physical Disabilities, 17, 311–325. and Developmental Disability, 26, 51– 66.
Nøttestad, J. A., & Linaker, O. M. (2003). Psycho- Young, L., & Ashman, A. (2004). Deinstitutionaliza-
tropic drug use among people with intellectual tion for older adults with severe mental retarda-
disability before and after deinstitutionalization. tion: Results from Australia. American Journal on
Journal of Intellectual Disability Research, 47, 664 – Mental Retardation, 109, 397– 412.
471. Young, L. (2006). Community and cluster centre
Nøttestad, J. A., & Linaker, O. M. (1999). Psychiatric residential services for adults with intellectual dis-
health needs and services before and after com- ability: Long-term results from an Australian-
plete deinstitutionalization of people with intel- matched sample. Journal of Intellectual Disability
lectual disability. Journal of Intellectual Disability Re- Research, 50, 419 – 431.
search, 43, 523–530.
Reiss, S. (1988). Reiss screen for maladaptive behavior Received: 4 June 2009
test manual. Worthington, OH: IDS Publishing Initial Acceptance: 1 August 2009
Corporation. Final Acceptance: 5 December 2009

Deinstitutionalisation and Adaptation / 377


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 378 –399
© Division on Autism and Developmental Disabilities

Training Teachers to Use an Inquiry-Based Task Analysis


to Teach Science to Students with Moderate and
Severe Disabilities
Ginevra R. Courtade Diane M. Browder, Fred Spooner,
University of Louisville and Warren DiBiase
University of North Carolina at Charlotte

Abstract: Federal mandates as well as the National Science Education Standards call for science education for
all students. IDEA (2004) and NCLB (2002) require access to and assessment of the general curriculum,
including science. Although some research exists on teaching academics to students with significant disabilities,
the research on teaching science is especially limited. The purpose of this investigation was to determine if
teachers of students with moderate and severe intellectual disabilities could learn to use a task analysis for
inquiry-based science instruction and if this training increased student responding. The findings of this study
demonstrated a functional relationship between the inquiry-based science instruction training and teacher’s
ability to instruct students with moderate and severe disabilities in science.

In 1983 the National Commission on Excel- called for the scientific education of all stu-
lence in Education published A Nation at Risk, dents. Similarly, when the National Research
calling for reform in science education. The Council (NRC) published the National Sci-
report claimed that the educational perfor- ence Education Standards (NSES) in 1996 the
mance of American students in scientific areas focus was “. . . science standards for all stu-
was mediocre and would lead to competitors dents . . . regardless of age, gender, cultural or
(e.g., Japan, South Korea, Germany) overtak- ethnic background, disabilities, aspirations, or
ing the United State’s dominance in scientific interest and motivation in science.” (NRC,
areas. Following the report, the American As- 1996, p. 2)
sociation for the Advancement of Science Although these science initiatives targeted
(AAAS) began an initiative entitled Project “all students,” there were few discussions of
2061: Science for all Americans (1985). The pur- applications for students with severe intellec-
pose of the initiative was to develop a scientif- tual disabilities until No Child Left Behind
ically literate society by the year 2061. Both A (NCLB, 2002) required the assessment of all
Nation at Risk and Project 2061: Science for all students in science. To meet this requirement
Americans used inclusive terminology that states could include students with significant
cognitive disabilities in large scale testing
through the use of alternate assessments, de-
Support for this research was provided in part by scribed by the U.S. Department of Education
Grant No. H324M03003 of the U.S. Department of (2003) as “an assessment designed for the
Education, Office of Special Education Programs, small number of students who are unable to
awarded to the University of North Carolina at participate in the State assessment even with
Charlotte. The opinions expressed do not necessar- appropriate accommodations (p. 3).” Al-
ily reflect the position or policy of the Department though states have been required to develop
of Education, and no official endorsement should
science assessments, and by default teachers
be inferred. Correspondence concerning this arti-
cle should be addressed to Ginevra Courtade, Col-
have needed to provide science instruction to
lege of Education and Human Development, De- prepare students for these assessments, there
partment of Teaching and Learning, Room 138, has been almost no research on teaching sci-
University of Louisville, Louisville, KY 40292. Email: ence to students with severe disabilities. A
g.courtade@louisville.edu comprehensive literature review of science in-

378 / Education and Training in Autism and Developmental Disabilities-September 2010


struction for this population uncovered a lim- skills (e.g., reading, math), and other areas
ited number of studies (Courtade, Spooner, & (e.g., creativity, logical thinking; Shymansky,
Browder, 2007). Of the 11 studies that were Kyle, & Alport, 1983). Some research also sug-
discovered, eight dealt with concepts that re- gests that students with mild disabilities may
lated to only one content area of the National improve performance when taught with an
Science Education Content Standards (Con- inquiry method as compared to a more tradi-
tent Standard F: Science in Personal and So- tional textbook approach (Scruggs, Mas-
cial Perspectives). While these studies were tropieri, Bakken, & Brigham, 1993).
designed to address daily living skills they had In contrast, there may be limitations to the
content that overlapped with science. use of an inquiry approach. The first is that
Although the number of studies that ad- many teachers do not have training to use this
dress some aspect of science is limited, they do approach. Even science teachers within gen-
offer guidance for developing effective in- eral education have expressed a lack of prep-
structional strategies. In general, these studies aration for inquiry-based instruction (Roehrig
followed principles of applied behavior analy- & Luft, 2004). Second, some experts have
sis methodology of operationalizing behavior, questioned the whole premise of minimal
using procedures to promote and transfer guidance during instruction as being inconsis-
stimulus control from teacher prompting to tent with research on how students learn
stimulus materials, and the use of feedback (Kirschner, Sweller, & Clark, 2006). Learners
and reinforcement of correct responses (Al- may need guidance until they have sufficiently
berto & Troutman, 2009). One common fea- high prior knowledge to self-direct their learn-
ture of several of the studies identified by ing. Scruggs and Mastropieri (1995) also
Courtade et al. (2007) was the use of a task found that students with intellectual disabili-
analysis to break skills down into the steps ties need “something more” than an inquiry-
required to complete a response chain (e.g., based instruction alone such as reductions in
Gast, Winterling, Wolery, & Farmer 1992; vocabulary demands, the use of graphic orga-
Marchand-Martella, Martella, Christensen, nizers, the use of multiple presentations, care-
Agran, & Young 1992; Spooner, Stem, & Test, fully structured questioning, familiarizing stu-
1989). dents with science materials, and guided
None of the studies analyzed by Courtade et coaching.
al. (2007) addressed one of the most funda- When students with moderate and severe
mental aspects of science: the process of in- intellectual disabilities participate in an in-
quiry. The National Research Council asserts quiry process, this “something more” for an
that “inquiry is a set of interrelated processes inquiry-based lesson may be instruction on
by which scientists and students pose ques- each step of a task analysis. The questions that
tions about the natural world and investigate could be raised are whether this is still inquiry
phenomena; in doing so, students acquire and what benefit this would have over the
knowledge and develop a rich understanding traditional task analysis of a specific daily liv-
of concepts, principles, models, and theories ing skill that includes some science. A task
(NRC, 1996, p. 214).” Within the National analytic approach would still be considered
Science Education Standards, inquiry is de- inquiry if the instruction contains the essential
scribed as a critical component of a science features of classroom inquiry. However, this
program. Inquiry-based instruction requires variation involves less learner self-direction
more than hands-on activities. Students also and more direction from the teacher and ma-
learn to follow a problem solving process that terials used (NRC, 2000). That is, students
can be applicable to the real world. Some would be using strategies to derive some in-
research suggests that the use of an inquiry- formation about the materials to be explored,
based approach vs. a traditional science cur- but would do so through interaction with the
riculum (i.e., one based on facts, laws, and teacher. According to the National Research
theories with the secondary use of hands-on Council, the essential features of classroom
activities) reveals a positive impact on student inquiry include: (a) the learner engages in
performance criteria that includes: achieve- scientifically oriented questions, (b) the
ment, process skills, analytic skills, related learner gives priority to evidence in respond-

Inquiry-Based Science Instruction / 379


ing to questions, (c) the learner formulates research has used multi-component proce-
explanations from evidence, (d) the learner dures to change staff behaviors.
connects explanations to scientific knowledge, An antecedent strategy that Jahr (1998)
and (e) the learner communicates and justi- found to be effective was modeling. Modeling
fies explanations. Each of these essential fea- is a procedure during which the supervisor
tures can be simplified and defined as a task demonstrates the correct procedures and
analysis for inquiry. then the staff member applies the same pro-
There are at least two advantages to using a cedures to a specific individual. Like Dem-
task analysis of the process of inquiry versus of chak, Jahr found that modeling was most of-
a specific daily living skill. First, an inquiry task ten used as part of a multi-component staff
analysis may have applicability across chang- training intervention.
ing science content. That is, students may Kazdin, Kratochwill, and VandenBos (1986)
learn a generalized method for interacting propose the use of standardized manuals to
with materials during a science lesson. Sec- train staff in research-based methods. They
ond, this generalized method can be used for propose that manuals provide detailed, ex-
science content that goes beyond daily living plicit guidelines that are cost effective, and
skills such as fossils, volcanoes, and chemical can be updated based on new findings. One of
reactions. These broader topics are not only the studies reviewed by Demchak (1987) in-
part of the general content standards that cluded the use of a training manual as part of
states are required to assess, but also may fos- an effective multi-component training pack-
ter leisure interests (e.g., volcanoes), future
age (Reid et al., 1985). The use of the training
career options (e.g., work in a lab or mu-
manual combined with investigator feedback
seum), or safety skills (e.g., avoiding mixing
and praise, produced improved behaviors for
chemicals) for students with intellectual dis-
both the teachers and students involved.
abilities.
In the current study, a multi-component
The purpose of this investigation was to
treatment package including a video model,
determine if training teachers of students with
role play, feedback, and a specific script (the
moderate and severe intellectual disabilities in
task analysis) was used to train special educa-
the use of a task analysis for inquiry-based
tion teachers to use an inquiry method. The
instruction could be applied across science
task analysis was based on Magnusson and
content. Further objectives of this study were
to determine if training the teachers would Palincsar’s (1995) phases of an inquiry-based
increase students’ participation in an inquiry- approach that include: (a) engage, (b) inves-
based lesson. tigate and describe relationships, (c) con-
The independent variable was an inquiry- struct an explanation, and (d) report. Each
based instructional training package based on phase was divided into specific steps for the
reviews of research studies involving training teachers to use during instruction.
staff who work with individuals with develop- The primary research question was: What is
mental disabilities (Demchak, 1987; Jahr, the effect of a multi-component teacher train-
1998). Demchak reviewed behavioral staff ing approach on teacher acquisition of steps
training in special education settings and to implement an inquiry based science lesson?
compared antecedent, contingency manage- The second research question examined the
ment, and multi-faceted procedures. Anteced- effect of this teacher training on generaliza-
ent procedures focus on training staff before tion across content of the science lessons. A
the skills are to be applied. Antecedent proce- third research question was: What is the con-
dures include instructions, modeling, and current effect of teacher’s use of an inquiry-
role-playing. Contingency management fo- based lesson on student acquisition of inquiry
cuses on following certain staff behaviors with skills needed to participate in science lessons?
consequences. Feedback techniques (i.e., writ- The final research question was: What is the
ten, verbal, video, posted), performance lot- effect of participation in inquiry-based science
teries, and monetary contingencies were all lessons on the concurrent effect of use of
contingency management techniques. Most science terms?

380 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 1

Demographic Information for Students

Student Age Gender Grade Race IQ Verbal

1 13 F 7 AA 40 (WISC-III) yes
2 12 M 7 C 40 (WISC-III) yes
3 12 F 6 H 54 Leiter-R yes
35-49 FS (verbal-46, nonverbal,
4 15 F 8 AA 46)-WISC-III yes
5 13 M 8 AA 41-LIPS-R yes
6 14 M 8 AA 49-LIPS-R yes
7 13 F 8 AA 39-SBIS yes
yes (1 to 2 word
8 11 M 6 C no IQ score (unable to calculate) vocalizations)

AA ⫽ African American, C ⫽ Caucasian, H ⫽ Hispanic.

Method grades 6 – 8, and (e) consistent attendance


(absent less than two times per month). One
Participants and Setting student did not have a calculable IQ score but
had been classified with moderate intellectual
Teachers. Four teachers were recruited to
disabilities based on his developmental level.
participate in this investigation who met the
Student demographic information is pre-
following inclusion criteria: (a) teacher of a
sented in Table 1. All students were verbal and
middle school class for students with moder-
none were English Language Learners (ELL).
ate and severe intellectual disabilities (b) min-
For further information about student partic-
imum of one year of teaching experience, (c)
minimum of two students who met student ipants (see Table 1).
eligibility criteria, (d) intent to continue Setting. The study took place in a large,
teaching in his/her particular classroom for urban district located in the southeastern
the remainder of the school year, and (e) United States. The teachers were recruited
agreed to teach science a minimum of three from a pool of teachers in the school district’s
times per week. All teachers were female. Specialized Academic Curriculum (SAC)
Their ages ranged from 34 to 44. The teach- classrooms. Three of the SAC classrooms were
er’s years of special education teaching expe- located in inclusive public schools within the
rience ranged from 1½ to 13 years. All teach- district. The remaining SAC classroom was
ers had at least a Bachelors of Arts degree. housed at a public separate school. The SAC
Two teachers also had a Masters of Education classrooms were designed for students with
degree. All teachers were licensed to teach moderate to severe intellectual disabilities
special education, specifically students with in- who need specialized adaptations to access the
tellectual disabilities. general curriculum. The SAC classrooms typ-
Students. Each teacher recruited two of ically served eight students with one teacher
their students (n ⫽ 8 students) to participate and one paraprofessional. This investigation
in the investigation. Students were eligible for took place as part of the ongoing instructional
participation if they met the following selec- program implemented by the teacher. All sci-
tion criteria: (a) an IQ score that characterizes ence instruction took place in the students’
the student as having a moderate intellectual special education classrooms and was con-
disability (40 –55) or severe intellectual dis- ducted by the classroom teachers in a small
ability (25–39), (b) adequate vision and hear- group with the two target students. Some
ing to interact with the materials, (c) an ability teachers also included other members of their
to communicate verbally or with an augmen- class in the science lessons. The lessons were
tative communication system, (d) enrolled in conducted with students seated or standing

Inquiry-Based Science Instruction / 381


around a small instructional table (depending of the steps of the inquiry-based science lesson
on what was needed to access the materials). as defined for this investigation. The first au-
The teacher stood behind or beside the table thor examined the results of the observation
to demonstrate with the materials and provide and modified the instrument as recom-
students opportunities to respond. mended by the two observers. The same two
To introduce the research and middle individuals were then asked to observe and
school science concepts, a teacher workshop code a second videotaped lesson. The inter-
was held at a central office building located in observer agreement was above 85%; there-
the school district. The individual teacher fore, the operational definitions were ac-
trainings occurred in meeting spaces (e.g., cepted for use in the study.
conference rooms) at each teacher’s school. In single subject research, the social validity
of a measure also is means to support the
appropriateness of the measure (Kazdin,
Dependent Variables
1977; Schwartz & Baer, 1991; Wolf, 1978).
Checklists for an inquiry based science lesson. This was especially important in the current
The task analysis of inquiry instruction used in investigation to determine that the task anal-
this research was called the Checklist for an ysis met the criteria for inquiry, but still tar-
Inquiry Based Science Lesson. A member of the geted responses that would be meaningful for
research team was present for direct observa- students with intellectual disabilities. The re-
tions of the teachers implementing science searcher asked an expert in science educa-
lessons in their classrooms and used this tion, two science curriculum specialists, and
checklist to score the task analysis. Each teach- an expert in the education of students with
er’s performance was measured as the num- severe disabilities to review the task analysis
ber of steps the teacher implemented cor- and make suggested changes. The content
rectly. To promote reliable data collection, specialists were asked whether it met the prin-
the criteria for performance of each step was ciples of inquiry and the special educator was
operationalized as shown in Table 2. Each asked to review the types of responses as ap-
teaching step could receive one of four codes. propriate and meaningful for the students. All
If the teacher completed a step independently agreed that the task analysis met the stated
and correctly, with no prompting, the step was goals (inquiry; appropriate and meaningful
marked with an “I.” If the teacher completed responses) and had no revisions.
the step correctly after she was reminded by a The data collected on the checklist were
member of the research team, the step was summarized as the number of steps correct for
marked with a “P.” If the teacher attempted teaching. Interobserver agreement for the
the step, but did not meet the criteria for task analysis checklist was obtained by having a
performance, the step was marked with an second observer (doctoral student) observe in
“E.” If the teacher did not perform a step, the the classrooms and independently score a sub-
step was marked with an “O (see Table 2).” set (36%) of lessons. Coding of each step was
Because this measure was developed by the compared for exact agreement and interob-
first author, its reliability and validity were server agreement was computed as agree-
evaluated as part of this research. In this study ments divided by total number of steps ⫻
interobserver agreement was established by 100%.
piloting the instrument with the two observers Generalization of inquiry across science content.
who were trained to collect data for this study The second research question examined the
(a research associate and a doctoral student in variation in science content taught by the
special education). The first author provided teachers to determine if teachers generalized
each individual with Checklist for an Inquiry- the inquiry approach across multiple contents
based Science Lesson. The operational defini- in science. This dependent variable was mea-
tions and coding procedures were explained sured by creating a code for each science con-
to each individual. The individuals were then tent area identified in the National Science
asked to watch a videotaped inquiry-based sci- Education Standards (e.g., Physical Science,
ence lesson that included a participant with Earth & Space Science, Science & Technol-
severe disabilities and code the teacher’s use ogy), and then assigning the code for the

382 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 2

Steps in Task Analysis for Teachers and Criteria for Correct Completion of Steps

Phase A: Engagement

1. Show the students a picture or material related to the science skill being taught
Correct Response-Shows the student a picture, Incorrect Response-Discusses the skill being taught
picture symbol, or object related to the without showing a visual
science skill
2. Ask the students to tell you what the picture/material is
Correct response-Requests that a student tells Incorrect response-Tells the student what the
what he/she thinks the picture/material is; picture/material is; does not offer a student
if the student is not verbal, gives a choice of who is not verbal choices to make a comment;
symbols for the student to use to make a tells the student his/her identification is wrong
comment; leads the student by asking
questions
3. Ask the students what they think the picture/material does (what they know about it)
Correct response-Requests that a student tells Incorrect response-Tells the student what the
what he/she thinks the picture/material picture/material does; does not offer a student
does; if the student is not verbal, gives a who is not verbal choices to make a comment;
choice of symbols for the student to use to tells the student his/her identification is wrong
make a comment; guides the student by
asking questions
4. Ask the students what they would like to find out about the picture/material
Correct response-Requests that a student tells Incorrect response-Responds for the student; does
what he/she would like to know about the not provide choices if needed; discounts a
picture/materials; gives picture choices if student’s answer
necessary to elicit a response, guides the
student by asking questions
Phase B: Investigate and Describe Relationships

5. Ask students how they will gather information about the subject
Correct response-Requests that a student tells Incorrect response-Responds for the student; does
what he/she will find out more about the not provide choices if needed; discounts a
picture/materials; gives picture choices if student’s answer
necessary to elicit a response, guides the
student by asking questions
6. Ask students to tell you what is the same (pattern)
Correct response-guides students to observe Incorrect-Points out the pattern immediately; does
patterns by pointing out characteristics to not guide students; does not give choices
observe; gives choices of patterns if
necessary
7. Ask students to tell you what is different (pattern)
Correct response-guides students to observe Incorrect-Points out the pattern immediately; does
patterns by pointing out characteristics to not guide students; does not give choices
observe; gives choices of patterns if
necessary
Phase C: Construct Explanation

8. Explain relevant accepted scientific knowledge


Correct response-Explains knowledge using Incorrect-explains knowledge without showing a
pictures, symbols, etc.; knowledge is visual; knowledge is irrelevant to what students
relevant and may help students explain have observed; connection to explanations of
what they have observed what students have observed is cannot be
discerned

Inquiry-Based Science Instruction / 383


TABLE 2 (Continued)

9. Guide students to explanations (prediction)


Correct response-points out characteristics and Incorrect response-uses no visual materials;
relevant facts verbally and with visual tells the student what the explanation is
materials to help students create explanations
10. Test explanations (if possible)
Correct response-guides students through an Incorrect response-does not involve students
experiment using their explanations; allows in experimentation; does not gives
students to perform some steps of the students the chance to make an
experimentation independently independent response during
experimentation
Phase D: Report

11. Give each student a turn to report what he/she has found
Correct response-allows students to express what Incorrect response-reports for the students;
they found; if student is not verbal, provides does not give a student who is nonverbal
choices for student to respond a way to respond
12. Reinforce concept learned using literal questioning
Correct response-asks all students at least one Incorrect response-does not ask literal
question about the concept learned; provides questions; questions do not reinforce
answer choices if necessary concept (e.g., Did you have fun?); does
not provide answer choices if necessary

concept taught during each science lesson erationalized. A member of the research team
(e.g., a lesson addressing the concept of prop- coded each step using one of four codes. If
erties of matter would be coded as Physical the student independently participated in the
Science). The topics for each lesson, also, step, regardless of a correct or an incorrect
were submitted to a science curriculum spe- answer, the step was marked with an “I.” If the
cialist who coded the science standard for student needed verbal, model, or physical
each lesson independently to check for inter- prompt to participate the step, it was marked
observer agreement. At the end of data collec- with a “P.” A step was considered prompted
tion, the total number of lessons coded in not only if the teacher reminded the student
each content standard for each teacher was to perform the step, but also if a paraprofes-
added, divided by the total number of lessons sional or another student did so. If the student
coded for each teacher in all content stan- did not participate in the step in any way, the
dards, and multiplied by 100%. This number step will be marked with an “N.” If a student
represented the percentage of lessons taught was not given the opportunity to perform the
in each content standard. Interobserver agree- step, an “N/O” was marked. If the student
ment for coding content was computed by performed the step correctly, a ⫹ was added
comparing for exact match codes and com- to the assigned code. If the step was per-
puting the number of agreements over total formed incorrectly, a –was added to the as-
codes and multiplying by 100%. signed code. Steps 2, 3, and 4 were only as-
Checklist for student acquisition of inquiry skills. signed a ⫹ (gave an answer) or N because the
The third research question examined the stu- students were being asked to provide individ-
dents’ acquisition of inquiry skills during a ual answers that were not judged as right or
science lesson as shown in Table 3. This de- wrong. Reliability and validity of this measure
pendent variable was a task analysis of student were determined using the same approach
responding measured using the Checklist for used for the Checklist for an Inquiry-based Science
Student Acquisition of Inquiry Skills. This assess- Lesson (see Table 3 for the 12 steps being
ment occurred during direct observations of measured, operational definitions, and exam-
the students participating in science lessons. ples).
In order to ensure reliable data collection, the Total of new science terms used. The fourth
criteria for performance of each step was op- research question examined the students’ use

384 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 3

Student Measurement and Examples of Student Steps

Example Lesson Steps 1. Magnetism


Lesson 2. Simple Machines Examples of Correct
Student Steps (Inclined Plane Lesson) Student Responses Incorrect Responses

A. Engage 1. Students were asked to look at and 1. Look at and touch 1. Does not touch
1. Student touches or touch different objects on a table materials on the or eyegaze to
looks at the picture/ (including objects of different table picture/material
material being shown materials-wood, plastic, metal and
magnets)
2. Students were asked to look at two 2. Look at the pieces
pieces of plywood (i.e., piece of of wood
wood leaned up against the top of
a shelving unit and a piece of
wood lying flat on the floor)
2. Student tells what 1. Students were asked to tell the 1. Independently 2. Does not
he/she thinks the teacher what they thought each respond to the respond
picture/material is object was (verbally or by pointing teacher’s request
to a picture choice) to identify the
materials
2. Students were asked to tell the 2. Independently
teacher what they thought the respond to the
object was (verbally or by pointing teacher’s request
to a picture choice) to identify the
object
3. Student tells what 1. Students were asked to tell the 1. Independently 3. Does not
he/she think the teacher what they knew about the respond to the respond
picture/material does objects (e.g., what they were made teacher’s request
(what they know out of; some of the objects were to tell what they
about it) called magnets; magnets stuck to knew about the
other objects) objects
2. Students were asked to tell the 2. Independently
teacher what they knew about the respond to the
wood (verbally or by pointing to a teacher’s request
picture choices; e.g., it was leaning; to tell what they
it was on the floor) knew about the
wood
4. Student tells what 1. Students were asked what they 1. Independently 4. Does not
he/she would like to would like to find out about the respond to the respond
find out about the materials and were given verbal teacher’s request
picture/material and picture choices to help make to tell what they
decisions (e.g., What do the would like to know
magnets stick to?) about the objects
2. Students were asked what they 2. Independently
would like to find out about the respond to the
wood and were given verbal and teacher’s request
picture choices to help make to tell what they
decisions (e.g., What could we do would like to know
with the wood?) about the pieces
of wood

of science terms. This dependent variable was previous lessons correctly. The first author tal-
measured using a count of the number of lied the number of times terms were used
times students used science terms taught in during the science lessons they observed.

Inquiry-Based Science Instruction / 385


TABLE 3 (Continued)

Example Lesson Steps 1. Magnetism


Lesson 2. Simple Machines Examples of Correct Student
Student Steps (Inclined Plane Lesson) Responses Incorrect Responses

B. Investigate & Describe 1. Students were asked to tell 1. Independently respond 5. Does not
Relationships the teacher how they would to the teacher’s request respond;
5. Student tells how he/ gather information to find to tell how they would responds with a
she will gather out what they would like to gather information sense that is
information about the know and were given verbal incorrect-
subject (use of 5 senses) and picture choices to help example-eating
them make decisions (e.g., something that
ask the teacher, look in a is not edible
book, experiment (try out)
the materials)
2. Same as example 1 2. Same as example 1
6. Student tells what is the 1. Students were given some 1. Independently provide a 6. Does not
same (pattern) of the materials and asked correct response to the respond;
to respond to what was the teacher’s request to tell chooses
same about some of the what was the same about dissimilar
objects (given verbal and the objects they were characteristics;
picture choices; e.g., looking at chooses an
students were shown incorrect pattern
objects that were the same
color or size)
2. Students were asked to 2. Independently provide a
look at the two pieces of correct response to the
wood and respond to what teacher’s request to tell
was the same (given verbal what was the same about
and picture choices; e.g., the two pieces of wood
they were both the same they were looking at
size, same color)
7. Student tells what is 1. Students were given some 1. Independently provide a 7. Incorrect-Does
different (pattern) of the materials (i.e., 1 correct response to tell not respond;
object made of wood, 1 what was different about chooses similar
object made of plastic; one the objects they were characteristics;
object made of metal) and looking at chooses an
asked to respond to what incorrect pattern
was different about the
objects (give verbal and
picture choices)
2. Students were asked to 2. Independently provide a
look at the two pieces of correct response to the
wood and respond to what teacher’s request to tell
was different (given verbal what was different about
and picture choices; e.g., the two pieces of wood
one is on the floor; one is they were looking at
leaning on the shelving)

Teachers were asked to tally the number of the use of the terms by the students outside of
times the terms were used by the students a science lesson. The teachers were asked to
during any lessons that were not observed by a record which term was used and the context
data collectors and keep anecdotal records of in which the term was used.

386 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 3 (Continued)

Example Lesson Steps 1. Magnetism


Lesson 2. Simple Machines Examples of Correct Student
Student Steps (Inclined Plane Lesson) Responses Incorrect Responses

C. Construct Explanation 1. Students pointed to or 1. Touches sentence or 8. Does not touch


8. Student touches or read with the teacher as reads sentence with or eyegaze to
looks at the information she read sentences about a teacher as she reads it picture/material
being shown science concept to the
students (e.g., Magnets
stick to most metals. This
paper clip is metal. The
magnet will stick to it.)
2. Students pointed to or 2. Same as example 1.
read with the teacher as
she read sentences about a
science concept to the
students (e.g., A ramp is a
simple machine. Simple
machines make work
easier. It is easier to push
an object up a ramp than
to lift it up.)
9. Student provides an 1. Using the same concept, 1. Independently make a 9. Does not
explanation (prediction) students made a prediction prediction or answer a provide an
about whether the magnet prediction question based explanation;
would stick to another on the science concept chooses an
material (e.g., This pencil (e.g., This pencil is made explanation that
is made of wood. The out of wood. Will the is not relevant to
magnet will not stick to it.) magnet stick to it? Yes or the previously
no?) provided
information
2. Using the same concept, 2. Independently make a
students made a prediction prediction or answer a
about whether it is easier prediction question based
to lift something or push it on the science concept
up a ramp (e.g., I need to (e.g., I need to get this
get this crate on top of the crate on top of the book
book shelf. It will be easier shelf. Will it be easier to
to use the ramp than to lift use the ramp than to lift
it up) it up? Yes or no?)
10. Student participates in 1. Students participated by 1. Independently partici- 10. Does not
testing explanation touching magnets to pate by physically respond
objects made of wood, manipulating the objects
plastic, and metal or directing partners to
2. Students participated 2. Independently participate
attempting to lift the crate by physically
and push the crate up the manipulating the objects
ramp or directing partners to

Experimental Design and Analysis teacher’s use of the steps of inquiry-based sci-
ence instruction and the concurrent effects
A multiple probe across participants single on student participation in an inquiry les-
subject research design was used to evaluate son. A multiple probe design is a variation of
the effect of the multi-component training on a multiple baseline design in which data are

Inquiry-Based Science Instruction / 387


TABLE 3 (Continued)

Example Lesson Steps 1. Magnetism


Lesson 2. Simple Machines Examples of Correct Student
Student Steps (Inclined Plane Lesson) Responses Incorrect Responses

D. Report 1. Students answered questions 1. Independently provide a 11. Does not


11. Student or reported information correct statement or respond; makes
reports what he/ about what they discovered answer to a question incorrect choices
she found during the experiment (i.e., about what they or provides
What the magnet stuck to?) discovered (e.g., The incorrect
magnet stuck to the information about
paper clip. No, the what was found
magnet did not stick to
the book)
2. Students answered questions 2. Independently provide a
or reported information correct statement or
about what they discovered answer to a question
during the experiment (i.e., about what they
It was easier to push the crate discovered (e.g., The
up the ramp. ramp made it easier to
get the crate on the shelf.
It was harder to pick up
the crate than push it up
the ramp)
12. Student answers 1. Students responded to 1. Independently provide a 12. Does not answer
questions about questions about the science correct statement or literal questions;
the information concept (i.e., Magnets stick to answer to a question answers questions
most metals) about what they the incorrectly
science concept (i.e., Q:
What kind of materials to
magnets stick to? A: Most
metals)
1. Students responded to 2. Independently provide a
questions about the science correct statement or
concept (i.e., A ramp is a answer to a question
simple machine. It is easier to about what they the
push an object up a ramp science concept (i.e., Q:
than to lift it up.) Did this simple machine
make our work, moving
the crate, easier or
harder? A: Easier)

collected intermittently in order to estimate ities may receive little to no exposure to sci-
trends and patterns in the data within and be- ence instruction, all teachers received a one
tween tiers (Horner & Baer, 1978; Kennedy, day workshop that included a general over-
2005). Specifically, “probes” (observations of sci- view of science from the first author and sci-
ence lessons) were conducted for all teachers ence curriculum experts prior to the begin-
and students prior to each teacher and student ning of data collection. Each special
pair entering intervention. Ongoing data were education teacher was asked to invite a gen-
collected once the teacher entered intervention. eral education science teacher to the work-
shop with them. Specifically, the inservice con-
Procedure
sisted of information on five topics: (a)
Pre-baseline. Because teachers of students Science and Students with Significant Disabil-
with moderate and severe intellectual disabil- ities (the first author described why the re-

388 / Education and Training in Autism and Developmental Disabilities-September 2010


search was being done and what is known training components, (b) a training manual,
about teaching science to students with signif- (c) verbal explanation of the contents of the
icant disabilities), (b) Middle School Science training manual, (d) a videotaped model of
Content Overview (two school district science an inquiry based science lesson in which a
curriculum personnel gave an overview of student with severe disabilities was being in-
middle school science content, including state structed, and (e) an opportunity to develop a
science standards and core concepts that are science lesson for which the first author mod-
addressed in grades 6 – 8), (c) How Do We Get eled the components and gave feedback.
There? Strategies for Accessing the General During the individual teacher training ses-
Curriculum (the first author provided strate- sion, the researcher first played the video-
gies such as adaptations and modifications, taped science lesson and gave the teacher a
systematic instructional procedures, the use of guided notes handout to help her identify the
functional activities and the use of technol- steps of the inquiry instruction. Next, the re-
ogy), (d) Extending State Standards (a doc- searcher did a verbal presentation of the train-
toral student gave specific examples of how to ing manual which the teacher followed in her
design grade-level appropriate science activi- own copy. The manual was based on the Pro-
ties based on state standards), and (e) Plan- fessional Development Standards from the
ning Lessons (the special education and gen- National Science Education Standards (NRC,
eral education teachers worked together to 1996), research related to teaching inquiry
adapted lesson plans to meet the needs of (Germann, Aram, & Burke, 1996; Keys &
students with severe disabilities). Providing Kennedy, 1999; Palincsar, Anderson, & David,
this general information prior to baseline was 1993), and research related to staff training
important to determine whether the individ- (Demchak, 1987). The manual was 30 pages
ual teacher training package was needed. and included: (a) an overview of inquiry-based
Baseline. During baseline, teachers were science instruction, (b) a rationale for the use
asked to teach a science lesson they had de- of inquiry based instruction for general edu-
veloped. No instruction was given to the teach- cation students and students with disabilities,
ers about the content, structure, or delivery of (c) general education science lessons demon-
the lesson other than the general information strating plans for an inquiry based lesson, (d)
they received in the pre-baseline workshop. steps included in the adapted inquiry process
Data on the four teachers and the eight stu- (task analysis), (e) examples for each step of
dents were collected using the task analysis for the task analysis, (f) sample lessons applying
the teacher (Checklist for an Inquiry-based Science the task analysis to specific science content for
Lesson) and the student (Checklist for Student students with moderate and severe disabilities,
Acquisition of Inquiry Skills). As described, the (g) ideas for choosing a first lesson, (h) ideas
first author and two observers collected all for individualizing lessons for each student
data through direct observation in the class- (e.g., assistive technology), and (i) a lesson
rooms. No feedback was given to the teachers planning form (the task analysis with space to
after the lessons. Baseline data were collected fill in specific materials and activities for each
on each of the teacher and student pairs three step).
times. The data were graphed and visually As part of training, teachers were instructed
inspected. on how to use the system of least prompts
Intervention. When the baseline was found procedure to promote student responding on
to be stable for a teacher and student pair, each step of the task analysis. The system of
that teacher received a 4-hour training session least prompts was chosen based on evidence
from the first author. The training took place of its effectiveness with students with severe
in a one-on-one context between the teacher disabilities who are learning chained tasks
and the first author at the teacher’s school in (Demchak, 1990). Teachers were instructed
a private setting (e.g., tutoring room, empty to move through the following prompts if the
office). The intervention was a multi-compo- student was not responding to a question or
nent training program that included: (a) a request: (a) verbal, (b) model, and (c) physi-
fidelity checklist that the researcher followed cal guidance. The first author also noted the
to ensure each teacher received all the same importance of praising correct responses and

Inquiry-Based Science Instruction / 389


responding to errors by interrupting them it was feasible to instruct this student popula-
and giving the next level of prompting. tion using inquiry-based methods. A second
After the manual and information on using survey was given to the teachers to determine
the system of least prompts was reviewed, the they perceived the intervention itself to be
teacher used the planning form to create a socially valid.
lesson and then role played it with the first
author. The first author gave feedback on any
Results
steps omitted and on the use of prompting
and feedback. Following the individual train-
Lesson Implementation
ing, the first author or other observers would
also give feedback on any steps omitted and Each teacher began implementing the science
the use of prompting and feedback during the lessons within three days of the individualized
classroom observations in intervention by intervention training. All lessons took place in
meeting with the teacher briefly at the end of the special education classrooms the students
the lesson. During intervention, the observers regularly attended. Lessons lasted approxi-
also gave prompts during the lesson if the mately 20 –30 minutes. Lessons were taught in
teacher overlooked a step or began to respond small groups that ranged from 2– 6 students.
for the student (e.g., by saying “What does Each teacher taught 2–3 science lessons per
Monica know about the material?” or “I won- week.
der who knows what’s the same?”).
Fidelity for Researcher’s Training of the Teachers
Procedural Fidelity
Procedural fidelity for the researcher’s train-
In order to strengthen the ability to demon- ing of the teachers was monitored for pre-
strate a functional relationship between the baseline training as well as the individual
independent and dependent variables and to teacher training (intervention). Fidelity for
provide reliable training across teachers, treat- the pre-baseline workshop was monitored by
ment integrity (Billingsley, White, & Munson, the two trained observers. Fidelity of the indi-
1980) was measured using a checklist of each vidual teacher trainings was monitored by one
component (verbal explanation of inquiry in- of the trained observers. Procedural fidelity
struction and rationale for use, videotape ex- for the pre-baseline workshop was 100%. Pro-
ample, strategies for adapting inquiry-based cedural fidelity for the individual teacher
instruction and science content for students trainings had a mean of 93.43%.
with severe intellectual disabilities, planning,
implementation, feedback). A second mem-
Interobserver Agreement
ber of the research team attended two of the
four individual teacher sessions and measured Interobserver agreement on 6 of the 13
the treatment integrity for teacher training. (46.2%) probes taken during the baseline pe-
Because the focus of this study was teacher riod using the Checklist for an Inquiry-based Sci-
behavior change, the Checklist for an Inquiry- ence Lesson (teacher data) ranged from 92%–
based Science Lesson served as the treatment 100% with a mean of 96%. Interobserver
integrity checklist for the student’s interven- agreement on 16 of 48 (33.33%) probes taken
tion. after intervention using the Checklist for an
Social validity. A threat to validity in an Inquiry-based Science Lesson (teacher data)
educational intervention is that the outcomes ranged from 83%–100% with a mean of
may not be of practical significance to key 97.43%.
stakeholders (Wolf, 1978). To address this Interobserver agreement on 6 of the 13
threat, a survey was sent to the students’ par- (46.2%) probes taken during the baseline pe-
ents to determine if they perceived science riod using the Checklist for Student Acquisition of
instruction to be important for their children. Inquiry Skills (student data) ranged from 92%–
Also, surveys were conducted with the teach- 100% with a mean of 96.67%. Interobserver
ers in the study to determine if the variables agreement on 16 of 48 (33.33%) probes taken
being measured were socially important and if after intervention using the Checklist for Student

390 / Education and Training in Autism and Developmental Disabilities-September 2010


Acquisition of Inquiry Skills (student data) Teacher 3. During baseline, Teacher 3’s
ranged from 83%–100% with a mean of scores ranged from 3 to 4 steps of the lesson
93.89%. When interobserver agreement fell correct. Her score during the baseline probes
below 85%, the data collectors were retrained ranged from 4 to 5 steps correct. An addi-
on the data collection procedures and opera- tional probe was conducted because the
tional definitions by the first author. teacher’s performance showed some accelera-
Observers noted the concept of each lesson tion after the first teacher’s intervention.
being taught by the teachers. Fifty-six lessons Teacher 3 performed 3 steps correct during
were coded by the first author (content area the additional probe. Her post-intervention
of 5 lessons was missing) and the science con- scores ranged from 10 to 12 with a majority of
tent expert. Of the 21 different concepts the scores (88%) at 12.
taught (concepts were taught multiple times Teacher 4. During baseline, Teacher 4’s
by multiple teachers), the first author and scores ranged from 1 to 3 steps of the lesson
science content expert agreed on the content correct. Teacher 4’s scores during baseline
area for 18 of the concepts (86%). The first and the probe phases indicated a stable trend
author mistakenly identified three concepts and level. Her post-intervention scores ranged
(i.e., gravity as an Earth Science concept, sim- from 7 to 12 with a majority of the scores
ple machines and work as Physical Science (75%) at 10 or higher.
concepts). The science content expert cor-
rected the misconceptions (i.e., gravity is a
Physical Science concept; simple machines
and work are Science and Technology con- Effects of Training Teachers on Generalization
cepts). across Content Area

All four teachers generalized the use of the


Effect of Training Teachers in Inquiry-based
inquiry-based task analysis across three or
Instruction on Science Lessons
more areas. Lessons were taught that ad-
Figure 1 presents the number of steps on the dressed concepts in Physical Science, Life Sci-
Checklist for an Inquiry-based Science Lesson each ence, Earth and Space Science, and Science
teacher performed correctly. For all four and Technology. No lessons were taught that
teachers, there was a change in level and trend addressed concepts in the areas of Science in
after the training in inquiry-based science in- Personal and Social Perspectives or History
struction. Maintenance probes were only and Nature of Science. All four teachers
taken with Teacher 2 because the school year taught lessons in Physical Science. Lessons
came to an end before more probes could be taught that represented this content area in-
taken. cluded concepts such as magnetism, gravity,
Teacher 1. During baseline, Teacher 1’s force, friction, motion, speed, and density. All
scores ranged from 2 to 3 lesson components four teachers also taught lessons in Life Sci-
correct. Her post-intervention scores ranged ence. Lessons taught that represented this
from 7 to 12 with a majority of the scores content area included concepts such as plants
(75%) at 10 or higher (criteria for teacher and plant cells, parts of the human body, the
performance was set at 10 or above). The last respiratory system, cells, and heredity. Three
two data points show a decelerating trend that of the four teachers taught lessons in Earth
may have been related to her personal circum- and Space Science. Lessons taught that repre-
stances. Teacher 1 had to drop from the study sented this content area included concepts
because of a death in her immediate family. such as earth’s crust, volcanoes, shadows/sun-
Teacher 2. During baseline, Teacher 2’s light, day/night, and gravity. Teacher 2 taught
scores ranged from 3 to 4 steps of the lesson two lessons in Science and Technology). The
correct. Her post-intervention scores ranged lesson concepts coded as Science and Tech-
from 10 to 12 with a majority of the scores nology included simple machines and work.
(55%) at 12. Two maintenance probes were No lessons were coded as content areas F (Sci-
conducted. Teacher 2 scored 11 on both ence in Personal and Social Perspectives) or G
maintenance probes. (History and Nature of Science).

Inquiry-Based Science Instruction / 391


Figure 1. Teacher’s number of steps of task analysis correctly implemented during science lesson.

392 / Education and Training in Autism and Developmental Disabilities-September 2010


Effects of Inquiry-based Science Instruction on most helpful component of the training; (2)
Students’ Acquisition of Inquiry Skills Least helpful; and (3) Suggestions for improv-
ing/changing training for future studies. All
Figures 2 and 3 summarize the number of four of the teachers (100%) returned the sur-
inquiry responses made by the students. For vey. Scores for each of the seven questions
clarity of presentation, one student from each ranged from 5– 6. Examples of comments to
teacher’s classroom is presented in each the open ended questions included: Learning
graph (e.g., Monica and Kyle both received the task analysis in order to teach all the components
instruction from Teacher 1). There was a of an inquiry lesson was the most helpful; more
change in level and trend after the training in sample lessons & more time for planning with reg-
inquiry-based science instruction for all eight ular educators.
students. Baseline scores ranged from 1 to 3 The teachers also were sent a feasibility sur-
lesson components correct. Post-intervention vey. The survey contained seven questions
scores ranged from 3 to 12, with a majority of which could be answered using a 5-point Lik-
the scores in classes 2, 3 at 9 (75%) or higher. ert scale (i.e., 5⫽strongly agree, 1⫽strongly
Both students in class 1 had to discontinue disagree). All four of the teachers (100%)
participation in the study when their teacher returned the survey and responses ranged
requested to be removed due to a death in the from 3 to 5. Examples of additional comments
family. Two maintenance probes were con- included: I appreciate being involved in this grant.
ducted in class 2. Valerie scored 10 and 11 on It has made me more aware of how to teach science
the probes and Charlotte scored 9 and 10 on that would be most beneficial to my students. The
the probes indicating an ability to maintain more I conduct inquiry science lesson plans, the more
the high skill acquisition over time (see Fig- comfortable I feel; Planning for inquiry lessons is
ures 2 and 3). time consuming.

Students’ Use of Science Terms Discussion


Only one teacher (Teacher 2) reported stu- The purpose of this investigation was to deter-
dent’s use of a new term (“skull”) outside of a mine if teachers of students with moderate
lesson. During observed lessons, students with and severe intellectual disabilities could learn
Teacher 2 also initiated use of newly intro- to teach the process of inquiry using a task
duced terms (metal, magnet, dense, liquid, analysis. A further objective of this study was to
solid, and dissolved). There were no other determine if training the teachers would in-
observations of student initiation of science crease students’ participation in inquiry sci-
terms. ence lessons. The findings of this study dem-
onstrated a functional relationship between
Social Validity Results the multi-component teacher training pack-
age (videotape, manual, application, role play,
Following the intervention, a parent survey in vivo feedback) and teacher’s ability to in-
was sent to the parent/guardian of each stu- struct students with moderate and severe in-
dent involved in the study that used a 5-point tellectual disabilities in the steps of inquiry.
Likert scale (i.e., 5⫽strongly agree, The teachers generalized the task analytic in-
1⫽strongly disagree. Only three of the eight struction across science content areas. All stu-
(38%) parents/guardians returned the survey dents increased the number of responses to
and responses ranged from 4 –5 (see Table 4). participate in an inquiry lesson and one stu-
Although the return rate was low, the survey dent used a science term outside the lesson
was not sent out again because the school year and in another instance students initiated use
ended. Similarly, a validity survey was sent to of the terms in the science lesson. Finally,
the teachers involved in the study. The survey social validity measures indicated a high de-
contained seven questions which could be an- gree of teacher satisfaction with the interven-
swered using a 6-point Likert scale (i.e., 1⫽I tion and its intended outcomes. Parent re-
disagree, 6⫽I agree). Three open ended ques- sponse rate was low, but those who responded
tions were also included: (1) What was the were satisfied with the intervention.

Inquiry-Based Science Instruction / 393


Figure 2. Number of inquiry skills completed independently by the students during inquiry lesson (Students
1, 3, 5, 7).

394 / Education and Training in Autism and Developmental Disabilities-September 2010


Figure 3. Number of inquiry skills completed independently by the students during inquiry lesson (Students
2, 4, 6, 8).

Inquiry-Based Science Instruction / 395


TABLE 4 Another aspect of the training that may
Results of Parent Survey
have made it effective for the teachers was that
although an inquiry-based approach was new,
Item Mean Range the use of task analytic instruction was not.
Task analytic instruction has been shown to be
1. I think it is important effective with a wide range of domestic and
for my son/daughter community living, safety, and academic skills
to learn science skills. 4.33 4-5 for students with significant intellectual dis-
2. My son/daughter
abilities (e.g., fire safety (Bannerman, Shel-
should receive
don, & Sherman, 1991), first aid (Spooner et
science instruction on
a daily basis. 4.00 3-5 al., 1989), and communicating being lost in
3. It is important to me the community (Taber, Alberto, Hughes, &
that my son/daughter Seltzer, 2002)). One of the advantages of
is instructed in training in this “generic” task analysis for in-
science as quiry is that teachers gained a template that
recommended by the
could be used for a wide variety of science
National Science
Education Standards. 4.33 4-5
content. In this study, teachers planned and
4. My son/daughter has implemented the inquiry-based task analysis
expressed interest in in four areas of science (Physical Science,
the science skills he/ Earth and Space Science, Life Science, and
she is learning. 4.33 4-5 Science and Technology). Previous research
focusing on teaching science to students with
moderate and severe disabilities was mainly
Although an inquiry-based approach to in- focused in one content standard (Science in
struction may be new for some teachers, espe- Personal and Social Perspectives, Courtade et
cially those who were trained primarily to al., 2007; Spooner, DiBiase, & Courtade-Little,
work with students with severe disabilities, 2006). Giving teachers a generalizable
professional development can be an effective method for instruction provides a tool for
way to build this capacity. In contrast, this accessing the varied content of science. In this
professional development may need to be study, the students’ acquisition of the inquiry
more intensive than the typical group work- responses reflected generalized responding
shop. In the current study, the general train- across different materials. That is, not only did
ing in science and the process of inquiry did the teachers generalize the inquiry instruction
not result in teachers using steps of inquiry across materials, so did the students.
during baseline. Literature reviews of staff The limitation of this generic task analysis
training conducted by Demchak (1987) and
approach is that that students learned to en-
Jahr (1998) have found that multi-component
gage with science materials, but it is unclear
training procedures that involve modeling,
whether they learned science concepts per
role play, and feedback are effective. A critical
say. As described in the results, only a few of
component of the training in the current
the students began to initiate use of the sci-
study may have been the use of a videotape
model in which the teachers could see a stu- ence terms. For example, McDonnell, John-
dent with a severe intellectual disabilities us- son, Polychronis, and Riesen (2002) embed-
ing inquiry. It also was important for the ded time delay instruction in the context of a
teachers to have the opportunity to practice general education setting to teach vocabulary
creating an inquiry lesson and role-play its including some science terms. Students might
use. The teachers also received in vivo feed- also need to practice generalizing the vocab-
back on their application of the inquiry-based ulary in daily living activities. For example, the
task analysis. Other research on staff training students might have noted that they can “con-
has found benefits for giving teachers imme- serve” water not letting the water run contin-
diate feedback during classroom instruction uously as they wash their hands or how the
(e.g., Demchak, Kontos, & Neisworth, 1992). rain caused “erosion” on the athletic field.

396 / Education and Training in Autism and Developmental Disabilities-September 2010


Science for Students with Severe Disabilities and possibly a planning template to prepare
for teaching students to generalize the inquiry
Because science instruction is a new direction skills across contexts.
in education for students with severe disabili- Although this study focused primarily on
ties, ongoing discussion is needed about the the process of inquiry, the goal of students
outcomes proposed and achieved. One possi- with moderate and severe intellectual disabil-
ble goal would be increased access to the ed- ities mastering science concepts may be a
ucational opportunity of science content. Stu- topic for future research. One option might
dents in the current study did not have be to teach students to recognize science
regularly scheduled science lessons prior to terms as sight vocabulary and then apply this
the implementation of this study, but had vocabulary to perform an activity. For exam-
three lessons per week once intervention be- ple, Browder and Minarovic (2000) taught
gan. In the following school year, science in- supported employees to recognize job words
struction became a school system and state and use them to follow a job schedule. Stu-
requirement for this population to prepare dents might learn a term like “erosion” and
for upcoming NCLB-related assessments. This then use a model to demonstrate how this
study provided an early model for how to occurs or find an example in a community
structure this instruction to build on long setting.
standing principles of task analytic instruc- Besides access to science curricula, learning
tion. In contrast, one of the three parents who inquiry, and mastering science concepts, a
returned the social validation survey was “not fourth goal of science education might be
sure” about the importance of his/her child increased opportunity to learn in general ed-
receiving science instruction. The need exists ucation science classes. Some studies have
to articulate clearer outcomes for science shown that students with severe intellectual
learning for this population beyond simple disabilities and their peers without disabilities
access. can benefit from inclusion in general educa-
One such outcome might be for students to tion settings (Cushing & Kennedy, 1997;
acquire the skills involved in an inquiry pro- Kennedy, Cushing, & Itkonen, 1997; Kennedy
cess. Students in the current study were learn- & Itkonen, 1994). Future researchers may
ing to focus their attention on novel materials, want to try combining instruction in inquiry
compare and contrast them (“What is the with the embedded trials demonstrated by Mc-
same/different?”), make predictions, and Donnell et al. (2002) to create an adaptation
drawn conclusions. The generalization of of the current intervention with utility within
these skills across a variety of materials was an general education science classes.
important outcome. In contrast, what future
research and practice should target is the gen-
Summary and Recommendations for Future
eralization of these skills to non-instructional
Research
contexts. For example, could the student be
taught to apply these skills in visiting a mu- This study was the first to train teachers to use
seum, going on a nature hike, setting up job a form of inquiry with students with moderate
parts, and so on? and severe intellectual disabilities. The task
For this to occur, teachers might need ad- analysis the teachers used was applicable
ditional training in teaching this generaliza- across science content and promoted student
tion. In this study, there were some “not sure” responding. One limitation of the current
responses from the teachers about their con- study to address in future replications is that
fidence in using inquiry. Similarly general ed- students’ performance was constrained by the
ucators trained to use inquiry in their class- teachers’ skill in following the task analysis.
rooms have sometimes expressed a lack of There were no baseline data showing how
confidence (Keys & Kennedy, 1999; Roehrig students may have responded to a teacher
& Luft, 2004). Two teachers indicated that the experienced in inquiry prior to receiving in-
more they conducted the lesson, the more struction. In contrast, student data showed
“comfortable/confident” they felt. Similarly, gradual vs. immediate change once interven-
teachers may have needed training, practice, tion began; indicating the change in student

Inquiry-Based Science Instruction / 397


data was not simply an artifact of the teachers Demchak, M., Kontos, S., & Neisworth, J. T. (1992).
offering opportunities. To prevent this limita- Using a pyramid model to teach behavior man-
tion, future studies should include a baseline agement procedures to childcare providers. Top-
for students conducted by a teacher experi- ics in Early Childhood Special Education, 12, 458 –
enced in inquiry who creates the opportunity 477.
Gast, D. L., Winterling, V., Wolery, M., & Farmer,
for all steps of the task analysis to be per-
J. A. (1992). Teaching first-aid skills to students
formed. Future research may also give more
with moderate handicaps in small group instruc-
consideration to inquiry as an independent tion. Education & Treatment of Children, 15, 101–
variable. 124.
For example, if students master the steps of Germann, P. J., Aram, R., & Burke, G. (1996). Iden-
inquiry are they able to gain information on a tifying patterns and relationships among the re-
new topic with minimal teacher guidance? Do sponses of seventh-grade students to the science
they generalize communication skills gained process skill of designing experiments. Journal of
during inquiry to other contexts? Future re- Research in Science Teaching, 33, 79 –99.
search may also want to consider how to pro- Horner, R. D., & Baer, D. M. (1978). Multiple-probe
mote student’s acquisition of concepts within technique: A variation of the multiple baseline.
inquiry. For example, can students learn a Journal of Applied Behavior Analysis, 11, 189 –196.
concept like chemical reactions and apply it Individuals with Disabilities Education Improve-
ment Act of 2004, 20 U.S.C. §1400 et seq. (2004).
across materials and contexts?
Jahr, E. (1998). Current issues in staff training. Re-
search in Developmental Disabilities, 19, 73– 87.
References Kazdin, A. E. (1977). Assessing the clinical or ap-
plied significance of behavior change through
Alberto, P. A., & Troutman, A. C. (2009). Applied social validation. Behavior Modification, 1, 427– 452
behavior analysis for teachers (8th ed.). Upper Saddle Kazdin, A. E., Kratochwill, T. R., & VandenBos,
River, NJ: Merrill/Pearson. G. R. (1986). Beyond clinical trials: Generalizing
American Association for the Advancement of Sci- from research to practice. Professional Psychology:
ence (1990). Project 2061: Science for all Americans. Research and Practice, 17, 391–398.
New York: Oxford University Press. Kennedy, C. H. (2005). Single-case design for educa-
Bannerman, D. J., Sheldon, J. B., & Sherman, J. A.
tional research. Boston: Pearson/Allyn and Bacon.
(1991). Teaching adults with severe and pro-
Kennedy, C., Cushing, L., & Itkonen, T. (1997).
found retardation to exit their homes upon hear-
General education participation improves the so-
ing the fire alarm. Journal of Applied Behavior Anal-
cial context and friendship networks of students
ysis, 24, 571–578.
with severe disabilities. Journal of Behavioral Edu-
Billingsley, F. F., White, O. R., & Munson, R. (1980).
cation, 7, 167–189.
Procedural reliability: A rationale and an exam-
Kennedy, C., & Itkonen, T. (1994). Some effect of
ple. Behavioral Assessment, 2, 229 –241.
regular class participation on the social contact
Browder, D. M., & Minarovic, T. J. (2000). Utilizing
and social networks of high school students with
sight words in self-instruction training for employ-
ees with moderate mental retardation in compet- disabilities. The Journal of the Association for Persons
itive jobs. Education and Training in Mental Retar- with Severe Handicaps, 19, 1–10.
dation and Developmental Disabilities, 35, 78 – 89. Keys, C. W., & Kennedy, V. (1999). Understanding
Courtade, G., Spooner, F., & Browder, D. (2007). A inquiry science teaching in context: A case study
review of studies with students with significant of an elementary teacher. Journal of Science Teacher
cognitive disabilities that link to science stan- Education, 10, 315–333.
dards. Research and Practice for Persons with Severe Kirschner, P. A., Sweller, J., & Clark, R. E. (2006).
Disabilities, 32, 43– 49. Why minimal guidance during instruction does
Cushing, L., & Kennedy, C. (1997). Academic ef- not work: An analysis of the failure of construc-
fects of providing peer supports in general edu- tivist, discovery, problem-based, experiential, and
cation classrooms on students without disabilities. inquiry-based teaching. Educational Psychologist,
Journal of Applied Behavior Analysis, 20, 139 –151. 41, 75– 86.
Demchak, M. (1987). A review of behavioral staff Marchand-Martella, N. E., Martella, R. C., Chris-
training in special education settings. Education tensen, A. M., Agran, M., & Young, K. R. (1992).
and Training in Mental Retardation, 22, 205–217. Teaching a first aid skill to students with disabil-
Demchak, M. (1990). Response prompting and fad- ities using two training programs. Education &
ing methods: A review. American Journal on Mental Treatment of Children, 15, 15–31
Retardation, 94, 603– 615. Magnusson, S. J., & Palincsar, A. S. (1995). The

398 / Education and Training in Autism and Developmental Disabilities-September 2010


learning environment as a site of science educa- Scruggs, T. E., & Mastropieri, M. A. (1995). Science
tion reform. Theory into Practice, 34, 43–50. and students with mental retardation: An analysis
McDonnell, J., Johnson, J.W., Polychronis, S., & of curriculum features and learner characteris-
Riesen, T. (2002). The effects of embedded in- tics. Science Education, 79, 251–271.
struction on students with moderate disabilities Scruggs, T. E., Mastropieri, M. A., Bakken, J. P., &
enrolled in general education classes. Education Brigham, F. J. (1993). Reading versus doing: The
and Training in Mental Retardation and Developmen- relative effects of textbook-based and inquiry-ori-
tal Disabilities, 37, 363–377. ented approaches to science learning in special
The National Commission on Excellence in Educa- education classrooms. The Journal of Special Educa-
tion (1983). A nation at risk. Retrieved March 1, tion, 27, 1–15.
2005, from http://www.goalline.org/Goal%20 Shymansky, J. A., Kyle, W. C., Jr., & Alport, J. M.
Line/NatAtRisk.html (1983). The effects of new science curricula on
National Research Council. (1996). National science student performance. Journal of Research in Science
education standards. Washington, DC: National Teaching, 20, 387– 404.
Academy Press. Spooner, F., DiBiase, W., & Courtade-Little, G.
National Research Council. (2000). Inquiry and the (2006). Science standards and functional skills:
national science education standards: A guide for teach- Finding the links. In D. Browder & F. Spooner
ing and learning. Washington, DC: National Acad- (Eds.), Teaching language arts, math, and science to
emy Press. students with significant cognitive disabilities (pp.
No Child Left Behind Act of 2001, 20 U.S.C. 70 § 229 –243). Baltimore: Paul H. Brookes.
6301 et seq. (2002). Spooner, F., Stem, B., & Test, D. W. (1989). Teach-
Palincsar, A. S., Anderson, C., & David, Y. M. (1993). ing first aid skills to adolescents who are moder-
Pursuing scientific literacy in the middle grades ately mentally handicapped. Education and Train-
through collaborative problem solving. Elementary ing in Mental Retardation, 24, 341–351.
School Journal, 93, 643– 658. Taber, T. A., Alberto, P. A., Hughes, M., & Seltzer,
Reid, D. H., Parsons, M. B., McCarn, J. E., Green, A. (2002). A strategy for students with moderate
C. W., Phillips, J. F., & Schepis, M. M. (1985). disabilities when lost in the community. Research
Providing a more appropriate education for se- and Practice for Persons with Severe Disabilities, 27,
verely handicapped persons: Increasing and vali- 141–152.
dating functional classroom tasks. Journal of Ap- U.S. Department of Education. (2003, December
plied Behavior Analysis, 18, 289 –301. 9). Federal Register, 68(236), 68698.
Roehrig, G. H., & Luft, J. A. (2004). Constraints Wolf, M. M. (1978). Social validity: The case for
experienced by beginning secondary science subjective measurement, or how applied behavior
teachers in implementing scientific inquiry les- analysis is finding its heart. Journal of Applied Be-
sons. International Journal of Science Education, 26, havior Analysis, 11, 203–214.
3–24.
Schwartz, I. S., & Baer, D. M. (1991). Social validity Received: 14 May 2009
assessments: Is current practice state of the art? Initial Acceptance: 25 July 2009
Journal of Applied Behavior Analysis, 24, 189 –204. Final Acceptance: 25 September 2009

Inquiry-Based Science Instruction / 399


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 400 – 409
© Division on Autism and Developmental Disabilities

Description of Communication Breakdown Repair Strategies


Produced By Nonverbal Students with Developmental
Disabilities
Baris Dincer Dilek Erbas
Anadolu University Erciyes University

Abstract: This study describes the communication repair behaviors used by nonverbal students with develop-
mental disabilities in the interactions they were involved in with their teachers during free play activities. All
children were students at centers serving student with developmental disabilities at Anadolu University in
Turkey. Data were collected by videotaping the students during free play sessions at the centers they attended.
The tapes were observed by the researchers, and any communication repair behaviors displayed by the students
and communication breakdowns used by their teachers was recorded. The results of this study revealed that
repetition, no response, addition, and recast were most frequent communication breakdown strategies displayed
by nonverbal students with developmental disabilities, respectively. In addition, results showed that there was
a positive correlation between the way teachers expressed communication breakdowns and the communication
strategies the students used, which may be interpreted as the more teachers made use of asking for clarification,
the more students utilized recast, addition and repetition strategies.

Failing behind their peers in many skill areas, strategies among student with disabilities have
students with developmental disabilities are examined the frequency and type of strategies
also poor communicators (Scudder & Tre- used by students with developmental disabili-
main, 1992). Being an effective communica- ties who have verbal skills (Alexander, Weth-
tor requires a child to fulfill both listener and erby, & Prizant, 1997; Brinton & Fujiki, 1991;
speaker roles. Students should have ability to Calculator & Delaney, 1986; Coggins & Soel-
respond to listeners’ communication at- Gammon, 1982; Geller, 1998; Paul & Cohen,
tempts. Also, they should be able to recognize 1984; Scudder & Tremain, 1992). Analyzing
that their message is not understood by listen- the use of repair strategies by students with
ers, and repair accordingly. However it is developmental disabilities is an important
more difficult for individuals with develop- part of the assessment process for understand-
mental disabilities to recognize and repair ing their communication system. However, ex-
communication breakdown than typically de- amining the repair strategies used by nonver-
veloping individuals (Halle, Brady, & Dras- bal students with disabilities is equally
gow, 2004; Scudder & Tremain). Therefore, important for our understanding of their
individuals with developmental disabilities communication skills. But, currently little re-
face communication breakdowns more often search is available focusing on the repair strat-
than other people (Halle et al.; Keen, 2005) egies used by students with disabilities who are
Majority of the research concerning repair nonverbal (Brady, McLean, & Johnston 1995;
Keen, 2005; McLean, McLean, Brady, & Etter,
1991).
This study was completed by the first author as These studies used different assessment ap-
partial fulfillment of the requirements for a Master
proaches while examining repair strategies;
of Science degree in the Department of Speech and
Language Pathology at Anadolu University. Corre-
structured approach and naturalistic ap-
spondence concerning this article should be ad- proach. In structured approach, researchers
dressed to Dilek Erbas, College of Education, De- typically create situations to evoke communi-
partment of Special Education, Erciyes University, cation opportunities (e.g., preferred toys
Kayseri, Turkey. Email: dderbas@anadolu.edu.tr within view, but out of reach). When the child

400 / Education and Training in Autism and Developmental Disabilities-September 2010


reaches for the item, the researcher purpose- other than English. The purpose of this study
fully might ignore, ask a question (what do was to analyze communication repair strate-
you want), or give an incorrect response (e.g., gies produced by twenty-six nonverbal stu-
food instead of the toy requested by child) to dents with developmental disabilities while in-
create communication breakdown. In natural- teracting with their teachers during free play.
istic approach, on the other hand, the re- The following questions were addressed:
searcher observes interactions of student with
a social partner during natural routines (e.g., 1. How frequently did students initiate com-
child and mother interaction during free munication, what percentage of initiation
play). Then, s/he evaluates how frequently resulted in communication breakdown,
breakdowns occur, how frequently student at- and what percentage of breakdowns was
tempts to repair, and how often these repair repaired by the students?
attempts are understood by social partners. 2. What types of repair strategies were pro-
Each approach has both advantages and duced by the students during interactions
disadvantages. An advantage of structured ap- with their teachers?
proach is that all of the participants receive 3. Did repair strategies used by students vary
equal number of opportunities to respond to according to the type of breakdowns pro-
a communication breakdown; therefore, it is duced by teachers?
feasible to compare repair strategies across
students. Another advantage is that the ap- Method
proach is time efficient because it is possible
to sample a great number of behaviors in a
Participants
very short time. However, we cannot assess
frequency of communication breakdowns us- Teacher participants. All teacher partici-
ing this approach. In such case, naturalistic pants were female. Four of the five teachers
approach would be more appropriate. An- who participated in this study had Bachelor’s
other advantage to naturalistic approach may degrees, and one had a master’s degree in
be that student might be able to understand special education. Their teaching experiences
the communicative intent of social partners ranged from two to 12 years. Participants were
more easily (e.g. mother and teachers) than selected based on two criteria: (a) had non
they do that of an unfamiliar partner. Simi- verbal students with disabilities in their class-
larly, it might be more difficult for social part- rooms, (b) willing to participate into this
ners to interpret and respond to student’s study.
communication behaviors. Therefore, stu- Student participants. Participants of the
dents are more likely to persist in their com- study were twenty-six students with develop-
munication attempts with familiar partners ment disabilities. There were 19 boys and 7
(Halle et al., 2004). girls with a mean age of 6.23 (ranging from 4
To date, only one study included communi- to 11). They were recruited in two different
cation breakdown of students who are nonver- units serving students with developmental dis-
bal in natural environment. Keen (2005) ex- abilities located in a university in Turkey (In-
amined the communication repair strategies stitute of Research for the Handicapped; and
of six non verbal young students with autism. Education, Training, and Research Center for
Results of this study showed that participants Speech and Language Disorders). Table 1 il-
attempted to repair breakdowns in communi- lustrates student demographic information.
cation with their mothers using repetitions, As can be seen in Table 1, students’ diagnoses
augmentations and substitutions. However, included mental retardation, Down syn-
authors analyzed the breakdown repair strate- drome, and autism/mental retardation. In
gies displayed by only six students with autism Turkey, because there are no reliable and
who were nonverbal during mother child in- valid standardized tools available to diagnose
teraction. This study should be replicated and students with disabilities and evaluate their
extended to larger number of student as well cognitive and language abilities, these stu-
as other contexts. It is also critical to extend dents typically were evaluated based on infor-
the study to another culture and to a language mal evaluations by varying professionals (e.g.,

Communication Breakdown / 401


TABLE 1

Students’ Description

Subject Age Gender Diagnosis Primary Communication Form Used by Participant

1 4 Male Down Syndrome Gestures (reaching, pulling someone’s hand, etc)


and vocalizations
2 6 Male Down Syndrome Gestures and word approximations.
3 5 Male Down Syndrome Gestures (pointing, reaching, giving/offering,
showing an object, etc) and vocalizations
4 8 Female Down Syndrome Gestures, two words (e.g. mummy, want) and
word approximations.
5 9 Male Down Syndrome Gestures and word approximations.
6 4 Male Down Syndrome Gestures (pointing, vocalizing, reaching, giving/
offering, showing an object, etc.) and
vocalizations
7 6 Male Down Syndrome Gestures and word approximations.
8 8 Male Down Syndrome Gestures, two words (e.g. mummy, go) and word
approximations.
9 5 Male Down Syndrome Gestures (pointing, vocalizing, reaching, giving/
offering, showing an object, etc.) and
vocalizations
10 4 Male Down Syndrome Gestures (pointing, vocalizing, reaching, giving/
offering, showing an object, etc.) and
vocalizations
11 4 Male Down Syndrome Gestures (pointing, vocalizing, reaching, giving/
offering, showing an object, etc.) and
vocalizations
12 9 Female Down Syndrome Gestures, three words (e.g. mummy, want, go)
and word approximations.
13 4 Male Down Syndrome Gestures (pointing, vocalizing, reaching, giving/
offering, showing an object, etc.) and
vocalizations
14 4 Female Down Syndrome Gestures and vocalizations
15 6 Female Down Syndrome Gestures, one word (e.g. mummy), and word
approximations.
16 4 Male Down Syndrome Gestures (pointing, vocalizing, reaching, giving/
offering, showing an object, etc.) and
vocalizations
17 6 Male Autism Gestures, one word (e.g. mummy) and word
approximations.
18 6 Male Autism Gestures, one word (e.g. mummy) and word
approximations.
19 4 Male Autism Gestures (pointing, vocalizing, reaching, giving/
offering, showing an object, etc.) and
vocalizations
20 1 Female Pervasive developmental Gestures, two words (e.g. mummy, go) and word
disabilities approximations.
21 7 Female Pervasive developmental Gestures, two words (e.g. mummy, want) and
disabilities word approximations.
22 9 Male Pervasive developmental Gestures, three words (mummy, go, want) and
disabilities word approximations.
23 8 Male Pervasive developmental Gestures, three words (e.g., mummy, dady, want)
disabilities and word approximations.

402 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 1 (Continued)

Subject Age Gender Diagnosis Primary communication form used by participant

24 4 Male Pervasive developmental Gestures pointing, vocalizing, reaching, giving/


disabilities offering, showing an object, etc.) and
vocalizations
25 10 Female Pervasive developmental Gestures, four words (e.g. mommy, daddy, go,
disabilities come) and word approximations.
26 7 Male Pervasive developmental Gestures, three (e.g., mummy, go, want) words
disabilities and word approximations.

M ⫽ 6.23

special education teachers, speech and lan- books). Number of student present during
guage pathologists). Therefore, the students’ the free play varied and it ranged from one
current diagnoses may not be accurate. For child to six students.
the same reason, we limited information re- Each student was video-taped for a 60-
garding their cognitive and language abilities. minute-period during free play activities that
The students in this study were selected by were held in the classrooms. The first ten
interviewing speech and language patholo- minutes of the observation were excluded
gists and special education teachers. The fol- from analysis to minimize the effect of ob-
lowing criteria were used in the selection pro- server and camera in the classroom. From
cess: (a) use of non-symbolic forms of remaining 50 minutes, 30-minute segments
communication (e.g., gestures, pointing, etc), were randomly selected. The samples were
and/or vocabulary limited with five words obtained in the presence of background
(e.g., mommy, want, go, etc.) and (b) a devel- noise; so, the sample would be more typical of
opmental disability (e.g., Down syndrome, Au- those occurring during everyday communica-
tism, etc.). In addition, none of the students tion breakdowns and repair strategy use.
demonstrated a history of hearing loss, neuro- Moreover, neither students nor teachers were
logical impairments, visual problems, or a informed about which recording would be
physical disability. analyzed; and since they were not informed,
All students were able to complete daily the video samples were as natural as they
living skills such as toileting, dressing, or tak- could be. The context of the interaction was
ing a shower with verbal or physical assistance. determined by the teacher in a way that would
They were able to follow one or two steps lead to optimal communicative interaction
instructions (e.g., “look”, “write”, “open your among student.
bag, and get your book”). When their names
were called by others, they were able to recog-
Data Coding
nize and acknowledge the communication
partner. Finally, they were able to identify ba- Video tapes were analyzed, and interactions
sic concepts such as primary colors, and between students and teachers were coded for
shapes. They could turn their head toward the communication breakdowns used by their
sound when their name was called. teachers and type of repair behaviors used by
the students. The first and second author dis-
cussed potential categories and their defini-
Data Collection
tions based on prior research.
Data were collected in participants’ class- Definition of initial communication behav-
rooms. Classrooms were similar in size (e.g., 5 ior was adapted from Golinkoff (1986) and
to 8 students). The classrooms typically con- Keen (2005). An initial communication be-
tained six tables and ten chairs, a variety of havior is defined as the child’s behavior that
toys (e.g., balls, dolls, etc.) and educational (a) was a gesture or vocalization; (b) was di-
materials (e.g., drawing books, pens, story rected toward a teacher to interact; and (c)

Communication Breakdown / 403


served a communicative function. In this Repetition. When a student exactly repeats
study, communication breakdowns were clas- what s/he did or said in the previous commu-
sified in the following ways. They were nicative behaviors, repetition is recorded. For
adapted from Brady & Halle (2002), and example, the student asks for the ball from the
Halle et al., 2004). teacher by only pointing to it; then, s/he re-
Requesting clarification. Requesting clarifi- peats the exact behavior without any additions
cation means that the teacher indicates that or reductions.
the message uttered by the student is not un- Recast. Recast is changing the form of the
derstandable and asks for clarification. For previous communicative behaviors while
example, the student points the toy car, and keeping the content of the message exactly
the teacher says “What do you mean?”, “What the same. For instance, the teacher asks
do you want?”, or “I don’t understand”; or “Where did daddy go?” by showing a picture
following the communicative behavior of the to the student, and the student replies “/E:/”
student, the teacher raises his/her eyebrows, (trying to say “/EVE/”). But, the teacher re-
narrows his/her eyes, and shakes his/her peats the same question, and the student, this
head once laterally, or projects his/her arms time, only points to the ‘house’ figure in the
with his/her palms facing up and jerks his/ picture that the teacher is holding, and says
her shoulders. nothing.
Non-acknowledgements. The teacher gives Addition. Addition means that the student
no verbal or nonverbal acknowledgement to adds either vocal or gestural elements to his/
the participant’s attempts to communicate. her previous message, and in the meantime,
also exactly repeats whatever s/he did or said
For instance, during an activity which focuses
in the preceding message. For instance, the
on animal sounds, one of the students’ points
student asks for the ball by only pointing to it
to the kitchen set nearby, but the teacher does
(with his/her index finger); and after the re-
not response and continues the activity as if
sponse by the teacher, s/he both yells and
the student did not do anything.
points the ball.
Topic shift. Following the communicative
behaviors of the student, the teacher directs
the student’s attention from what s/he is en- Interobserver Reliability
gaged to a different topic or thing. For exam-
Videotapes of seven students (25% of the stu-
ple, while the teacher and the student are dents) were randomly selected to be coded by
painting a picture, the student points to a toy, an independent observer to assess scoring re-
and the teacher says “Now, we are painting liability. Interobserver reliability was evaluated
our picture, and we should paint these parts as for each of the student’s communication re-
well”. Another example is that; during a pair behaviors (no response, repetition, re-
matching activity which requires finding iden- cast, and addition or reduction), and teach-
tical pairs of some shapes, the student begins ers’ communication breakdowns (requesting
playing with one of the pieces as if it was a car, clarification non-acknowledgements, topic
and the teacher says “Now, let’s collect the shift). Interobserver reliability was calculated
pairs that are the same”. on a point by point basis by dividing number
Coding definitions of repair categories were of agreements by the total number of agree-
adapted from Brady and Halle (2002), Halle ments and disagreements, which was subse-
et al. (2004). Repair behaviors were classified quently multiplied by 100. An agreement oc-
in following four ways. curred when both observers assigned the same
No response. No response is defined as dis- code to the repair strategy. A disagreement
continuance of communication initiated by occurred when different codes were assigned
the student. In other words, the student gives by the two observers. In other words, if one
up his communication goal and or ignores the observer recorded a repair strategy as occur-
teacher’s communication signals. For exam- ring, and the other did not, a disagreement
ple, the student points the ball, teacher does was scored. The percentages of interobserver
not response, and the student discontinues reliability for repetition, recast, addition, and no
communication. response, requesting clarification, non-acknowledge-

404 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 2

Student Data for Initiations, Communication Breakdowns Encountered, Repairs of Communication


Breakdowns, and No Response (Discontinue Communication)

Number and
Percentage of
Number of Communication Total Use of Percentage of No Response
Communication Breakdowns Repair Repaired (Discontinue
Subject Initiations Encountered Strategies Initiations Communication)

1 17 14 (82%) 7 50% 7
2 16 13 (81%) 7 54% 6
3 29 27 (93%) 22 81% 5
4 15 11 (73%) 6 54% 5
5 14 13 (93%) 9 69% 4
6 15 13 (87%) 5 38% 8
7 11 10 (91%) 9 90% 1
8 14 8 (57%) 6 46% 7
9 13 9 (69%) 4 44% 5
10 10 8 (80%) 5 55% 4
11 10 6 (60%) 7 70% 3
12 16 9 (56%) 3 33% 6
13 12 9 (72%) 6 66% 3
14 15 13 (87%) 8 100% 0
15 13 9 (69%) 10 100% 0
16 11 9 (69%) 5 63% 3
17 12 10 (83%) 3 75% 4
18 9 9 (100%) 6 86% 1
19 9 9 (100%) 1 20% 4
20 11 8 (73%) 7 88% 1
21 10 10 (100%) 5 63% 3
22 13 8 (62%) 7 78% 2
23 9 7 (78%) 7 88% 1
24 7 7 (100%) 3 50% 3
25 13 5 (38%) 7 78% 2
26 14 8 (57%) 6 67% 3
M⫽ 13 10.07 3.5 65.57% 6.57
SD ⫽ 4.14 3.75

ments, topic shift were 93%, 95.50%, 92%, behaviors, percentage, frequency distribution,
90.50%, 91.25%, 93.75%, and 92% respec- and measures of central tendency were calcu-
tively. lated. In addition, inferential statistical analy-
ses and one-way analysis of variance (ANOVA)
were computed based on research questions
Data Analysis
of interests.
Data obtained from interactions between
teacher and student participants were loaded
into a data file for analysis using SPSS-Win- Results
dows, ver. 13.0 by the second author, a grad-
uate student in Speech and Language Pathol- This study describes the repair strategies used
ogy. Data analyses were conducted by using by non-verbal students with developmental
both descriptive and inferential statistics. To disabilities for the communication break-
describe teacher participants’ communication downs occurring in the interaction with their
breakdowns and student participants’ repair teachers during free play activities.

Communication Breakdown / 405


Descriptive Analysis TABLE 3

The first research question focused on deter- Students Data for the Frequency and Percentage
mining how frequently students initiated com- of Repair Behavior
munication, what percentage of initiation re-
sulted in communication breakdowns and Communication Breakdown Repair
Behaviors
what percentage of breakdowns were repaired
by the student participants. Total Use
Table 2 displays individual student partici- of Repair
pant’s data for frequency of communication Subject Repetition Recast Addition Behaviors
initiations, frequency and percentage of com-
munication breakdowns encountered by 1 5 0 2 7
teacher participants, total use of repair strate- 2 5 0 2 7
gies, percentage of initiations repaired by us- 3 8 6 8 22
ing one of the strategies described earlier, and 4 4 0 2 6
no response by students. A total of 338 com- 5 4 0 5 9
6 3 1 1 5
munication behaviors were initiated by the
7 5 1 3 9
students during free play with their teachers. 8 4 0 2 6
All students initiated at least seven communi- 9 3 1 0 4
cation behaviors. Mean of communication 10 3 0 2 5
breakdowns encountered by all students was 11 5 1 1 7
10.07 (range 5–27). All students utilized at 12 2 0 1 3
least one communication repair strategy in 13 4 1 1 6
response to the communication breakdowns 14 5 0 3 8
displayed by their teachers. 15 5 1 4 10
Table 3 displays the percentages and fre- 16 3 0 2 5
17 2 0 1 3
quencies of no response, repetition, recast
18 4 0 2 6
and addition; which are types of repair strate- 19 0 0 1 1
gies utilized by the students for the communi- 20 4 0 3 7
cation breakdowns during free play activities. 21 4 1 0 5
As Table 3 clearly depicts, non-verbal stu- 22 5 0 2 7
dents with developmental disabilities used 23 6 0 1 7
repetition the most (60.23%) and recast the 24 2 1 0 3
least (8.71%) for communication breakdowns 25 4 1 2 7
occurring during their interaction with their 26 4 0 2 6
teachers in the classroom. M⫽ 3.96 0.57 2.03 6.57
SD ⫽ 1.53 1.20 1.68 3.75
Frequency 103 15 53 171
Inferential Statistical Analyses Percentage 60.23% 8.71% 30.79% 100%

Correlation was used to find out if there was a


relation between the repair strategies applied
by the students and the behaviors displayed by is one more moderate positive relation be-
teachers to indicate communication break- tween no indication of communication
down. breakdown by teachers and no response
Table 4 shows that there are moderate (r ⫽ .576, p ⬍ .01) and repetition (r ⫽ .420,
positive relations between requesting clarifi- p ⬍ .05) by students. Another result of the
cation by teachers and recasting by students analysis points again a moderate positive re-
(r ⫽ .629, p ⬍ .01), between again request- lation between topic shift by teachers and
ing clarification by teachers and addition by both recast (r ⫽ .538, p ⬍ .01) and addition
students (r ⫽ .645, p ⬍ .01), and finally once (r ⫽ .636, p ⬍ .01) by students. No relation
again requesting clarification by teachers was established between the ignoring behav-
and repetition by students (r ⫽ .620, p ⬍ ior of teachers and any of the repair strate-
.01). The results also demonstrate that there gies.

406 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 4

Correlation Between Behaviors of Teachers and Students

Student Behaviors

Teacher Behaviors No Response Repetition Recast Addition

Requesting Clarification .620** .629** .645**


No indication of Communication Breakdown .576** .420*
Topic Shift .538** .636**
Ignoring

* p ⬍ .05, ** p ⬍ .01

Discussion ficulties in conveying, assessing, and repairing


their messages (Scudder & Tremain).
This study describes the repair behaviors used
In terms of the relationships between com-
by nonverbal students with developmental dis-
munication repair strategies used by the stu-
abilities for the communication breakdowns
dents and the behaviors displayed by their
occurring in their interaction with their teach-
teachers to indicate communication break-
ers during free play activities.
downs, several moderate positive relations
The percentage of repaired initiations
were observed. For example, moderate posi-
ranged from 20% to 100% with a mean of
tive relations between requesting clarification
65.57%. This is consistent with earlier re-
by teachers and recasting by the students and
search demonstrating that students with devel-
opmental disabilities have the ability to repair between again requesting clarification by the
communication in response to their teachers’ teachers and addition by students, and finally
communication breakdowns (Brady et al., once again between requesting clarification by
1995; Keen, 2005). the teachers and repetition by the students
Another finding consistent with earlier were found. From this, it is possible to con-
studies is that nonverbal students with devel- clude that the use of recast, addition, and
opmental disabilities use repetition the most repetition increases as the teachers require
and recast the least as communication break- clarification from their students.
down strategies (Alexander et al., 1997; Cal- Moderate positive relation between no indi-
culator & Delaney, 1986; Golinkoff, 1986). cation of communication breakdown by the
However, Brady et al. (1995) reported more teachers and no response and repetition by
recasts than repetitions in their sample of the students were also observed. So, it will not
nonverbal students with developmental dis- be naive to state that no indication of commu-
abilities; which indicates a difference between nication breakdown increases the use of both
their findings and those of this study. That the no response and repetition.
students do not have a variety of communica- As the teachers displayed topic shift, the
tion behaviors in their inventories may be a students used both recast and addition. This
reason for repetition to be the mostly-utilized leads to the interpretation that topic shift by
strategy instead of recast. the teachers may cause frequent use of recast
The students cannot judge if their message and addition strategies by the students. Fur-
is understood by their teachers or not, and thermore, no relation was established between
this may account for the higher frequency of the ignoring behavior of teachers and any of
repetition and no response over other strate- the repair strategies. The overall interpreta-
gies. It is widely known that individuals with tion of the correlation analysis might set forth
developmental delays suffer from inadequa- that the teachers working with nonverbal stu-
cies of speech and language skills (Scudder & dents who are developmentally disabled
Tremain, 1992). Constrained by speech and should always indicate that the message is not
language problems, these individuals face dif- understood and there is a communication

Communication Breakdown / 407


breakdown whenever it is the case. Hence, the possess the skills to respond appropriately to
students may use one of the repair strategies the listener feedback in a communication sit-
in his/her inventory to make his/her message uation, which is not motivating for the stu-
clearer. dent. In planning intervention programs for
Although findings of the study are very en- communication problems, the teacher should
couraging, still there exist some limitations. prepare various motivating situations to evoke
The limitation of the study is that all the data and encourage students’ communication and
were collected during free play; teachers em- repair behaviors.
ployed a wide range of free play activities. For
example, in one activity, a student just draws
something at a desk, and another student
looks at the pictures in a book with his/her References
teacher. Considering the density of interac-
tion between the student and the teacher, we Alexander, D., Wetherby, A., & Prizant, B. (1997).
can say that there was little communicative The emergence of repair strategies in infants and
interaction during the drawing activity. On toddlers. Seminars in Speech and Language, 18, 197–
the contrary, the student looking at a book 212.
Brady, N. C., & Halle, J. W. (2002). Breakdowns and
with his/her teacher was given many more
repairs in conversations between beginning AAC
opportunities to communicate. users and their partners. In J. Reichle, D. R. Beu-
Another limitation was the lack of student kelman, J. C. Light (Eds.), Exemplary practices for
descriptions. In other words, individuals who beginning communicators implications for AAC,
are nonverbal may differ markedly one from (pp.323–353). Baltimore: Brookes Publishing Co.
another; so, it is critical to account for this Brady, N. C., McLean, L. K., & Johnston, S. (1995).
variability. Therefore, the students with dis- Initiation and repair of intentional communica-
abilities were described in as much in detail as tion behaviors by adults with severe to profound
possible to make it clear to readers that the cognitive disabilities. Journal of Speech and Hearing
students were chosen based on their teachers’ Research, 38, 1334 –1348.
Brinton, B., & Fujiki, M. (1991). Reponses to re-
and speech and language pathologists’ obser-
quests for conversational repair by adults with
vations. However, we did not provide results of mental retardation. Journal of Speech and Hearing
standardized language and cognitive tests; be- Research, 34, 1087–1095.
cause, there are no standardized language Calculator, S. N., & Delaney, D. (1986). Comparison
and cognitive tests in Turkey. of nonspeaking and speaking mentally retarded
In summary, the present results contributed adults’ clarification strategies. Journal of Speech and
to the literature in two ways. First, communi- Hearing Disorders, 51, 252–259.
cation breakdowns and repairs were measured Coggins, T. E., & Soel-Gammon, C. (1982). Clarifi-
during real communication exchanged at cation strategies used by four Down’s syndrome
school. Previous research focused on student student for maintaining normal conversational
interaction. Education and Training of the Mentally
responses to scripted communication break-
Retarded, 17, 65– 67.
downs. Secondly, the study extends research Geller, E. (1998). An investigation of communica-
to nonverbal students with developmental dis- tion breakdowns and repairs in verbal autistic
abilities living in a different culture and learn- student. The British Journal of Developmental Disabil-
ing a language other than English. Also, there ities, 44, 71– 85.
are two implications, which should be helpful Golinkoff, R. M. (1986). ‘I beg your pardon?’The
to teachers and parents. First, results provide preverbal negotiation of failed messages. Journal
information about effectiveness of different of Child Language, 13, 455– 476.
listener feedbacks or breakdowns to evoke Halle, J. W., Brady, N., & Drasgow, E. (2004). En-
participant’s repair behaviors. If people in the hancing socially adaptive communicative repairs
of beginning communicators with disabilities.
students’ environment are aware of them and
American Journal of Speech-Language Pathology, 13,
use them, they will not fail to display repair 43–54.
behaviors. Therefore, they would successfully Keen, D. (2005). The use of non-verbal repair strat-
engage in communicative interactions. Sec- egies by children with autism. Research in Develop-
ond, parents and teachers should also remem- mental Disabilities, 26, 243–254.
ber that students with disabilities might not McLean, J. E., McLean, L. K., Brady, N. C., & Etter,

408 / Education and Training in Autism and Developmental Disabilities-September 2010


R. (1991). Communication profiles of two types tingent queries in adults with mental retardation
of gesture using nonverbal persons with severe to and pervasive developmental disorders. Applied
profound mental retardation. Journal of Speech and Psycholinguistics, 5, 349 –357.
Hearing Research, 34, 294 –308.
Scudder, R. R., & Tremain, D. H. (1992). Repair
behaviors of student with and without mental Received: 14 April 2009
retardation. Mental Retardation, 30, 277–282. Initial Acceptance: 8 June 2009
Paul, R., & Cohen, D. J. (1984). Responses to con- Final Acceptance: 1 October 2009

Communication Breakdown / 409


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 410 – 421
© Division on Autism and Developmental Disabilities

Enabling a Prelinguistic Communicator with Autism to Use


Picture Card as a Strategy for Repairing Listener
Misunderstandings: A Case Study
Yoshihisa Ohtake Michael Wehmeyer
University of Okayama University of Kansas

Naomi Uchida
The Special School Affiliated with the Faculty of Education
Akitaka Nakaya and Masafumi Yanagihara
University of Okayama

Abstract: The purpose of this case study was to examine the effects of a time-delay prompting procedure on the
acquisition of skills for repairing multiple listener misunderstandings. A prelinguistic student with autism was
taught to use picture cards as a strategy to repair listener misunderstandings in a setting where the student had
to ask the listener to pick up a pen to paint a TV logo that was one of his preoccupations. The listener
intentionally provided the student a pen with non-preferred attributions (brand, color, or size) to provide the
student opportunities to repair the communication breakdown. The type and number of attributions misun-
derstood by the listener in a communication episode changed as the student met the predetermined criterion.
Results of a changing-criterion design demonstrated that the intervention was effective in enabling the student
to use picture cards in a way that took into consideration which attributions the listener misunderstood.

Individuals with autism who exclusively rely on standings in socially acceptable manner, the
prelinguistic communication modes (i.e., vo- probability of obtaining the desired outcome
calization and gesture) face frequent commu- increases, which in turn may contribute to
nication breakdowns due to the ambiguity in enhancing their self-determination (Brown,
nature in sending a message (Brady & Halle, Gothelf, Guess, & Lehr, 1998; Wehmeyer, Ag-
2002; Halle, Brady, & Drasgow, 2004, Keen, ran, & Hughes, 1998).
2005). When prelinguistic communicators Recent studies (Keen, 2005; Meadan, Halle,
with autism face communication breakdowns, Watkins, & Chadsey, 2006; Ohtake et al.,
the occasion calls for repair (Wetherby, Alex- 2005) have revealed that prelinguistic commu-
ander, & Prizant, 1998). Communication re- nicators with autism can repair a variety of
pair is referred to as a perseverative commu- communication breakdowns when (a) the re-
nication act that is emitted when the questing behaviors were not attended to, (b)
communication initiation is not followed by the respondent asked for clarification vocally
the desired outcome within a reasonable
or gesturally, or (c) the communication break-
amount of time (Halle et al.). If they repair
down was followed by a wrong response by the
communication breakdown by repeating the
listener. In addition, it was found that prelin-
original communication forms or modifying
guistic communicators with autism used vari-
them in ways that promote listener’s under-
ous types of repair strategies, including re-
peating the first communication forms,
adding new forms, recasting the original
Correspondence concerning this article should
be addressed to Yoshihisa Ohtake, University of
forms and using new forms instead, and re-
Okayama University, 3-1-1 Tushima-naka, Okayama- ducing the part of the original forms.
Shi, Okayama 700-8530, JAPAN. Email: ohtake@ Furthermore, when they modified their
cc.okayama-u.ac.jp communication forms in response to a com-

410 / Education and Training in Autism and Developmental Disabilities-September 2010


munication breakdown, prelinguistic commu- with autism. The exception is Sigafoos, Dras-
nicators with autism were able to do so in a gow et al. (2004) that attempted to teach
way that added information that was not part VOCA use as a repair strategy for two prelin-
of the original communication initiation guistic students with autism. They taught the
(Ohtake et al., 2005). To illustrate, suppose repair skills in a setting where highly pre-
that an individual with autism exhibited an ferred food was shown outside the student’s
open-palm gesture that led to a communica- reach. Using a time-delay procedure, the re-
tion initiation. Faced with the communication searchers attempted to enable the students to
breakdown, as communication repair, she use VOCA within 10 s when the listener did
then grabbed the listener’s hand and led the not attend to the communication initiation
listener to the item she wanted. The first com- (e.g., pointing, reaching, touching bowl).
munication form sends a message that the Both students acquired the use of VOCA as a
individual wants something but does not send repair strategy in a condition where they
a message about what she wants. In contrast, wanted their preferred food.
the second communication form (i.e., com- Thus, Sigafoos, Drasgow et al. (2004) dem-
munication repair) sends a specific message onstrated that it is possible to teach students
about what the individual wants. with autism to use VOCA when they meet a
Research has also revealed that prelinguistic communication breakdown in which their
communicators with autism are likely to first prelinguistic forms of request were not
choose more rudimental communication attended to by the listener. However, it is un-
forms (e.g., direct touch to the listener) or known if a systematic prompting procedure in
increase the intensity of the original commu- highly motivating request contexts enables
nication forms (e.g., banging objects or
prelinguistic communicators with autism to
screaming) when they attempt to repair com-
repair other types of communication break-
munication breakdowns (Keen, 2005; Meadan
downs (e.g., misunderstanding, spoken or ges-
et al., 2006; Ohtake et al., 2005; Sigafoos, Dras-
tural request for clarification). Additionally, it
gow et al., 2004). Without being taught alter-
is unclear if the same intervention strategy
native communication forms, these communi-
enables prelinguistic communicators with au-
cators could continue to resort to more
tism to repair multiple breakdowns (e.g., two
rudimental and intensified forms, which occa-
or more consecutive breakdowns).
sionally would lead to challenging behaviors
Communication breakdowns in instances
(Keen, 2003). On the other hand, if we sys-
tematically teach them in ways that replace the where the listener misunderstands what the
rudimental and intensified forms of commu- individual wants and, therefore, provides a
nication repair with functionally equivalent wrong item are likely to encourage prelinguis-
but more symbolic forms (e.g., manual sign, tic communicators with autism to use commu-
picture cards, voice output communication nication repairs that specify what exactly they
system: hereafter referred to as VOCA), it is want. Such situations can be excellent teach-
possible for them to use the alternative forms able moments at which prelinguistic commu-
as a repair strategy (Halle et al., 2004). nicators with autism could efficiently acquire
Numerous studies have investigated the ef- alternative forms (e.g., picture cards) as a re-
fectiveness of teaching picture cards, VOCA, pair strategy that are functionally equivalent
or sign language as an initiation strategy for to but more effective at specifying what they
prelinguistic communicators with autism want than the rudiment forms they typically
(Brady, 2000; Charlop-Christy, Carpenter, Le, use (Horner & Day, 1991; Keen, Sigafoos, &
LeBlanc, & Kellet, 2002; Frea, Arnold, & Vit- Woodyatt, 2001).
timberga, 2001; Ganz & Simpson, 2004; Rich- The purpose of this study was to extend
man, Wacker, & Winborn, 2001; Sigafoos, Sigafoos, Drasgow et al.’s research (2004) by
O’Reilly, Seely-York, & Edrisinha, 2004; Son, investigating the effects of using a systematic
Sigafoos, O’Reilly, & Lancioni, 2006; Tincani, prompting procedure in a highly motivating
2004). However, few studies have explored request context on enabling a prelinguistic
effective strategies for teaching communica- communicator with autism to touch the pic-
tion repair to prelinguistic communicators ture card that corresponds to a misunder-

Picture Card Strategy / 411


stood attribution when two consecutive misun- other students with autism in a self-contained
derstandings occur. classroom led by two teachers. All sessions
were conducted at a table using a one-to-one
Method format during a highly structured teaching
period when communication skills were tar-
Participant geted. The room was divided into three spaces
by partitions and lockers. Each of the spaces
The study participant was Takao, a 12-year-old
(2 ⫻ 3 m) was assigned to a different activity
boy who was diagnosed with autism by a neu-
to help Takao predict what activity he was
ropediatrician according to the DSM-IV (APA,
assigned to do. During the sessions, only
1994). The child’s hearing, vision, and motor
Takao and his teacher were in the room.
development were within the normal range.
At each session, Takao and the teacher sat
According to the Kyoto Scale of Psychological
at a desk. A few plates of pens were placed
Development (Ikusawa, Matsushita, & Nakase,
horizontally on a table in view of the student,
2002), his overall development was equivalent
but out of reach (i.e., approximately 2 m in
to 2:3. He could follow one-step spoken direc-
front of him). The distance between each
tions used in the routine. When he wanted
plate was approximately 30 cm. Picture cards
something, he exclusively relied on prelinguis-
(6 ⫻ 7 cm) were placed within easy reach
tic communication modes, including vocaliza-
(20 –30 cm), at a distance of approximately 1
tion, open palms, reaching, or pointing.
cm between each. The pens used in this study
When a written word was shown to him, he did
consisted of five brands (TOMBOTM, MIT-
not emit the correct corresponding sounds.
However, the vocalization synchronized with SUBISHITM, UNITM, ZEBRATM, SAKURATM),
pointing to each syllable. Further, he was able four colors (red, black, blue, green), and two
to write a few words, but did not use letters in sizes (thick and thin).
functional ways. Before starting the session, the teacher pro-
At the beginning of the study, Takao had vided Takao an opportunity to access the table
never been taught to use picture cards as a where the pens were placed to let him know
mode of requesting behavior. According to what pens were available. Then the teacher
the repair assessment, which followed proce- invited him to sit at a desk where an A6 size of
dures proposed by Ohtake et al. (2005), in paper (10 ⫻ 15 cm) and picture cards were
free-play situations, Takao exhibited persis- placed and waited for his communication ini-
tent requests when he faced with any types of tiation.
communication breakdowns (i.e., asking for
clarification vocally or gesturally, not attend- Assessment for Preoccupied Attributions
ing and not responding, misunderstandings)
in all breakdown opportunities across play ac- In a one-hour interview with his special edu-
tivities (e.g., trampoline, swing, bike riding). cation teacher, Takao demonstrated a strong
In addition, he frequently used communica- interest in painting the logo of a specific TV
tion forms that specified what he wanted (e.g., program (“Comedy Focus”). When he painted
pointing to, reaching for, or leading listener’s the logo, he persistently pointed to or reached
hand toward the object) in response to the for a pen of a specific brand (TOMBO or
listener’s misunderstandings. For example, in MITSUBISHI), a specific size (thin), and a
situation where his teacher presented a shovel specific combination of color (red and black).
and said “You want to play shovel?” in re- During all trials conducted in the study, we
sponse to his open palm used for requesting double-checked to see if he (a) accepted when
“pushing swing,” Takao threw the shovel and a pen with these preferred attributions was
led his teacher’s hand toward the chain of the provided and (b) rejected when a pen without
swing. these preferred attributions was provided. All
of Takao’s accepting and rejecting behaviors
were consistent with the information on pre-
Settings and Materials
occupied attributions collected from the inter-
Takao attended a special school affiliated with view.
a university, where he was educated with two During the first baseline condition, Takao

412 / Education and Training in Autism and Developmental Disabilities-September 2010


demonstrated a specific pattern in coloring. vorite TV logo. A First Repair was the commu-
For example, if red and black pens were avail- nication behavior used to request his
able among several colors, he first asked his preferred pen when the first misunderstand-
teacher to pick up a black pen to draw the ing occurred (i.e., a non-preferred pen was
outline of the logo. He then picked up a red presented). A Second Repair represented the
pen to paint the inside of the outline for a communication behavior used to request his
while. He repeated the pattern of alternating preferred pen when the second misunder-
the use of black and red pens whenever he standing occurred.
drew the logo. This pattern informed the On Standard Opportunities, all initiations
teacher which color Takao wanted in a given were immediately reinforced by providing a
turn. preferred pen. On Repair Probes, all initia-
tions were immediately followed by presenting
a non-preferred pen to provide one or two
Session Schedule and Data Collection
opportunities to use a picture card as a repair
Data were collected during approximately 15- strategy (see Conditions). A Correct Repair was
minute sessions twice a week during the reg- recorded only when Picture Use or Combined
ular class periods. Within each session, Takao Use occurred in all repair turns during a Re-
requested his preferred pens in terms of pair Probe. Takao were allowed 5 s to make a
brand name, color, and size, 8 to 10 times, to correct repair (i.e., touching the picture card
paint the logo in his favorite ways. Two types that corresponded to a misunderstood at-
of opportunities, Standard Opportunities and tribute). If he touched any card depicting
Repair Probes (Sigafoos et al., 2004; described non-preferred attributions even once, the re-
in detail below), occurred within the request sponse was classified as incorrect.
opportunities. All sessions were videotaped
and the videotaped communication behaviors
Conditions
were later analyzed to record the presence or
absence of the target behaviors on an episode- Two conditions (One Attribute Repair and
by-episode basis. The video camera was incon- Two Attribute Repair) were set up, each con-
spicuously placed on a tripod approximately sisting of three phases, to enable Takao to
2 m from the table where the student and repair multiple misunderstandings. Follow-
teacher were seated. The student never no- ings are detailed descriptions of each phase.
ticed the camera.
One Attribute Repair
Response Definitions
In the first condition, Takao was required to
Three topographies were recorded; that is, repair one communication breakdown in
Behavior Indication, Picture Use, and Com- which one attribution of a pen was misunder-
bined Use. Behavior Indication was recorded stood by the listener. This condition consisted
if Takao attempted to obtain a pen by reach- of three phases, Brand, Color, and Size.
ing for or pointing to the pen, moving toward Brand. In this phase, the attribution mis-
the pen, or pushing out a non-preferred pen. understood by the listener was brand name.
Picture Use was recorded if Takao touched Three plates of pens were placed horizontally
the picture card that corresponded to his pre- on the table behind the teacher. The three
ferred attribution. Finally, Combined Use was plates consisted of one preferred brand (i.e.,
recorded if Takao simultaneously used both TOMBO) and two non-preferred brands (i.e.,
Behavior Indication and Picture Use in re- SAKURA and ZEBRA). Each plate included
sponse to a communication breakdown. four different colors of pens, two of which
These responses were further classified de- were preferred colors (i.e., black and red) and
pending on whether each occurred as the the remaining two non-preferred colors (i.e.,
Initiation, as the First Repair, or as the Second blue and green). The size of all the pens was
Repair. An Initiation was defined as the first the preferred attribution (i.e., thin). Three
communication behavior used to initiate a re- picture cards, each of which depicted
quest when he needed a pen to draw his fa- TOMBO, SAKURA, or ZEBRA, were placed

Picture Card Strategy / 413


within easy reach. The instructional goal in Takao’s degree of preoccupation with the at-
the Brand phase was defined as follows: tribution. The teacher perceived that brand
name was the attribution that preoccupied
When the communication initiation is mis- Takao the most, followed by color and size in
interpreted and a plate of pens of a non- order. Therefore, these three phases were
preferred brand (i.e., SAKURA or ZEBRA) taught sequentially, starting with Brand, fol-
is presented, Takao will touch the picture lowed by Color and then Size. We included
card symbolizing the preferred brand (i.e., one or two non-preferred attribution cards as
TOMBO) within 5 s with 80% accuracy for distractors from the first phase within the
three consecutive blocks. same attribution because Takao’s ability to
In this study one block consisted of 5 Repair discriminate different shapes, colors, and
Probes. logos was considered excellent by his special
Color. In this phase, the attribution mis- education teacher. In the Size phase, only one
understood by the listener was color. Four non-preferred attribution (thick) card was
TOMBO pens (preferred brand) were placed used as a distractor because no brand of pens
horizontally on the table behind the teacher. included more than two dimensions of size
The colors were two preferred (i.e., red and (i.e., thin or thick).
black) and two non-preferred (i.e., blue and
green). The size of the all pens was the pre- Two Attribute Repair
ferred attribution (i.e., thin). Four picture
cards, each of which depicted one of the col- The second condition required Takao to re-
ors of the pens, were placed within easy reach. pair two consecutive communication break-
The instructional goal in the Color phase was downs in which two attributions of a pen were
defined as follows: misunderstood by the listener. This condition
also consisted of three phases (i.e., Brand-
When the communication initiation is mis- Color, Color-Size, and Size-Brand), as de-
interpreted by the listener and a pen of a scribed below.
non-preferred color (i.e., blue or green) is Brand-Color. In this phase, attributions
presented, Takao will touch the picture misunderstood by the listener were brand and
card depicting a preferred color (i.e., black color. Four plates of pens were placed on the
or red) within 5 s with 80% accuracy for table behind the teacher. The four plates con-
three consecutive blocks. sisted of two black pens (preferred color), two
Size. In this phase, the attribution misun- red pens (preferred color), two blue pens
derstood by the listener was size. Two plates of (non-preferred color), and two green pens
TOMBO pens were placed horizontally on the (non-preferred color), respectively. Two pens
table behind the teacher. One of the plates on each plate consisted of a preferred brand
included thin pens and the other thick pens. (MITSUBISHI) and a non-preferred brand
Each case included four pens, two preferred (UNI or ZEBRA). All pens on the four plates
(i.e., red and black) and two non-preferred were the preferred size (i.e., thin). Three pic-
(i.e., blue and green) colors. Two picture ture cards, each depicting MITSUBISHI, UNI,
cards, depicting a symbol of thin or a symbol or ZEBRA, and four picture cards, each de-
of thick, were placed within easy reach. The picting red, black, blue, or green, were placed
instructional goal in the Size phase was de- within easy reach. The instructional goal in
fined as follows: the Brand-Color phase was defined as follows:

When the communication initiation is mis- When the communication initiation is mis-
interpreted and thick pens are presented, interpreted and a thin pen of a non-pre-
Takao will touch the picture card depicting ferred brand (e.g., UNI) and a non-pre-
a symbol of thin within 5 s with 80% accu- ferred color (e.g., blue) is presented, Takao
racy for three consecutive blocks. will touch the picture card depicting the
preferred brand (i.e., MITSUBISHI) or pre-
The order of the phases was determined by ferred color (i.e., red or black) within 5 s. In
the teacher based on her intuition of the addition, when the first communication re-

414 / Education and Training in Autism and Developmental Disabilities-September 2010


pair is misinterpreted and a thin pen of a pens. The remaining two plates consisted of
non-preferred brand (e.g., UNI) or non- pens with a non-preferred brand (i.e., UNI or
preferred color (e.g., blue) is presented, ZEBRA). Of the latter two plates, one con-
Takao will touch the picture card depicting sisted of four thick pens and the other of four
the preferred color or preferred brand, de- thin pens. Two picture cards, each symboliz-
pending on the attribution that the listener ing thin or thick, and three picture cards,
misunderstood in the second breakdown, each symbolizing MITSUBISHI, ZEBRA, or
within 5 s with 80% accuracy for two con- UNI, were placed within easy reach. The in-
secutive blocks. structional objective in the Size-Brand phase
was defined as follows:
Color-Size. In this phase, the attributions
misunderstood by the listener were color and
When the communication initiation is mis-
size. Four plates of pens were placed on the
interpreted and a plate of pens of a non-
table behind the teacher. The four plates con-
preferred brand (e.g., UNI) and non-pre-
tained two black pens, two red pens, two blue
ferred size (e.g., thick) is presented, Takao
pens, and two green pens, respectively. The
will touch a picture card depicting the pre-
two pens on each plate were of a preferred
ferred brand (i.e., MITSUBISHI) or pre-
size (i.e., thin) and a non-preferred size
ferred size (i.e., thin) within 5 s. In addi-
(thick). All pens on the four plates were a
tion, when the first communication repair is
preferred brand (i.e., MITSUBISHI). Two pic-
misinterpreted and a plate of pens of a
ture cards, each symbolizing thin or thick, and
non-preferred brand (e.g., UNI) or non-
four picture cards, each colored red, black,
preferred size (e.g., thick) is presented,
blue, or green, were placed within easy reach.
Takao will touch a picture card depicting
The instructional objective in the Color-Size
preferred brand or preferred size, depend-
phase was defined as follows:
ing on the attribution that the listener mis-
understood in the second breakdown,
When the communication initiation is mis-
within 5 s with 80% accuracy for two con-
interpreted and a pen of a preferred brand
secutive blocks.
(e.g., MITSUBISHI), non-preferred color
(e.g., blue), and non-preferred size (e.g.,
Following the first repair responses made by
thick) is presented, Takao will touch a pic-
Takao, the teacher provided the second type
ture card depicting the preferred color
of misunderstanding in which a pen with one
(i.e., black or red) or preferred size (i.e.,
non-preferred attribution and two preferred
thin) within 5 s. In addition, when the first
attributions was presented (e.g., a pen of a
communication repair is misinterpreted
non-preferred size, a preferred brand, and a
and a pen of a non-preferred color (e.g.,
preferred color). Which non-preferred attri-
green) or non-preferred size (e.g., thick) is
bution was presented depended on Takao’s
presented, Takao will touch a picture card
first repair response. For example, if he
depicting the preferred color or preferred
touched a picture card depicting black (pre-
size, depending on the attribution that the
ferred color) within 5 s after a green (non-
communication partner misunderstood in
preferred color), thick (non-preferred size),
the second breakdown, within 5 s with 80%
and MITSUBISHI pen (preferred brand) was
accuracy for two consecutive blocks.
presented in the first breakdown, the teacher
Size-Brand. In this phase, the attributions presented a MISUBISHI (preferred size),
misunderstood by the listener were brand and black (preferred color), and thick (non-pre-
size. Four plates of pens were placed on the ferred size) pen in the second breakdown. If
table behind the teacher. Each plate included Takao touched a picture card depicting black
four pens of two preferred colors (i.e., red and (preferred color) and then a picture depict-
black) and two non-preferred colors (i.e., blue ing thin (preferred size) within 5 s after a
and green). Two of the four plates consisted MITSUBISHI (preferred brand), thick (non-
of pens of a preferred brand (i.e., MITSUB- preferred size), and green (non-preferred
ISHI). Of these two plates, one consisted of color) pen was presented, the teacher hon-
four thick pens and the other of four thin ored the one he touched longer (e.g., thin)

Picture Card Strategy / 415


and provided Takao a pen with thin (the hon-
ored attribution), MITSUBISHI (preferred
brand), and green (non-preferred color). Re-
ducing the number of wrong attributions one
by one as Takao exhibited a repair attempt in
Two Attribute Repair was viewed as analogous
to a gradual understanding by the listener on
the basis of a piece of information provided by
Takao, which typically occur in their daily in-
teractions.

Procedure Figure 1. One Attribute Repair intervention flow-


chart. C ⴝ Takao, T ⴝ Special educa-
Baseline. During baseline, Standard Op- tion teacher.
portunities and Repair Probes were presented
with a 1-to-1 ratio. On Standard Opportuni-
ties, when a communication initiation oc-
curred, the teacher immediately exhibited ac- procedures for Standard Opportunities were
knowledgment (e.g., nodding or saying OK), the same as those in the baseline sessions. On
moved to the table to pick up a pen or a plate Repair Probes, a constant time-delay proce-
of pens, and provided a pen or a plate of pens dure was employed to enable Takao to use a
that Takao requested. On Repair Probes, picture card that corresponded to the misun-
when a communication initiation occurred, derstood attribution any time a misunder-
the teacher immediately nodded or said “OK” standing occurred. Specifically, when he did
to show her acknowledgment, moved to the not touch a card that corresponded to the
table to pick up a pen or a plate of pens, and misunderstood attribution within 5 s after a
provided a pen or a plate of pens with one communication breakdown occurred, the
non-preferred attribution (One Attribute Re- teacher provided a model prompt as a con-
pair), or two non-preferred attributions (Two trolling prompt across all phases. Takao failed
Attribute Repair). When Takao exhibited a to exhibit the target behavior after the con-
correct response within 5 s after the first trolling prompt was provided once across all
breakdown, the teacher immediately provided phases. To deal with the unexpected re-
the requested pen (One Attribute Repair) or sponse, a physical prompt was provided. As in
a pen with one non-preferred attribution baseline, the order of picture cards was
(Two Attribute Repair). When the target be- changed every session.
havior did not occur within 5 s, the teacher The intervention procedures in One At-
provided the pen requested by Takao (One tribute Repair and Two Attribute Repair were
Attribute Repair) or a pen with one non-pre- presented in Figure 1 and 2, respectively.
ferred attribution (Two Attribute Repair).
With regard to Two Attribute Repair, when
the student exhibited a correct response Research Design
within 5 s after the second breakdown oc-
curred, the teacher immediately nodded or One Attribute Repair required Takao to re-
said “OK” to show her acknowledgment, pair a misunderstanding with a wrong attribu-
moved to the table to pick up a pen, and tion. Two Attribute Repair required him to
provided the requested pen. When the target repair two misunderstandings with two wrong
behavior did not occur within 5 s, the teacher attributions. Therefore, a changing-criteria
provided the pen requested by Takao. The design across two conditions was used to dem-
order of picture cards was changed every ses- onstrate two occurrences of behavior change
sion. immediately after the constant time-delay pro-
Interventions. During intervention, Stan- cedure was introduced. In addition, baseline
dard Opportunities and Repair Probes were and intervention were inserted in each of the
presented with a 1-to-3 or 1-to-4 ratio. The phases.

416 / Education and Training in Autism and Developmental Disabilities-September 2010


Figure 2. Two Attribute Repair intervention flowchart. C ⴝ Takao, T ⴝ Special education teacher.

Inter-Observer Agreement and Treatment Fidelity pairs across all phases. Data are plotted in
blocks. One block consists of 5 Repair Probes.
The first author recorded topography of be-
havior and correct repair. A trained graduate
student independently recorded an average of
35.9% of all trials across all conditions. If the
One Attribute Repair
two raters recorded the same category, an
agreement was scored. If not, a disagreement
As illustrated, during baseline in the Brand
was scored. Mean point-by-point agreement
phase, Takao never exhibited correct repairs.
for topography of behavior (Behavior Indica-
Instead, he exclusively relied on reaching for
tion, Picture Use, Combined Use) and target
behaviors (correct or incorrect repair) was or pointing to the preferred brand of pens.
93.8% and 95.7%, respectively. However, once the intervention was intro-
The first author scored treatment fidelity by duced, the percentage of correct repairs in-
checking if the special education teacher cor- creased and stabilized at 80 to 100%. In the
rectly implemented the procedures in the Color phase, Takao exhibited 100% accuracy
Standard Opportunities and Repair Probes. If of repair responses for three consecutive
all procedures were implemented correctly, blocks. During baseline in the Size phase,
the trial was scored as a correct treatment Takao never used the picture card in repair
procedure. The first author recorded approx- turns to request the pen of a preferred size.
imately 50% of all of the trials across sub- Instead, as seen in the Brand phase, he exclu-
phases. The percentage of correct procedures sively relied on reaching for or pointing to the
was 92.7%. preferred size of pens. Immediately after in-
troducing the intervention, however, the per-
centage of correct repairs dramatically in-
Results
creased and maintained at 80% or higher for
Figure 3 shows the percentage of correct re- three consecutive blocks.

Picture Card Strategy / 417


Figure 3. Percentages of correct repair in One Attribute Repair and Two Attribute Repair. One block
consisted of five repair probes for baseline and intervention. B-C ⴝ Brand-Color, C-S ⴝ Color-Size,
S-B ⴝ Size-Color, BL ⴝ Baseline, IV ⴝ Intervention.

Two Attribute Repair to the picture that corresponded to a misun-


derstood attribute. Therefore, no interven-
During baseline in the Brand-Color phase, no
tions were needed to reach the pre-set crite-
correct repair occurred. Takao exclusively
rion with two consecutive blocks in both
used the picture of his favorite color (i.e.,
phases.
black or red) to repair the first wrong re-
sponse (i.e., wrong color and brand). In this
sense, he exhibited correct responses with Discussion
100% accuracy in the first repair. Therefore,
in Figure 3, the data point of the baseline is The purpose of this study was to extend the
plotted on the level of 100% in One Attribute work of Sigafoos, Drasgow et al. (2004) by
Repair. When the partner presented a pen of teaching a prelinguistic communicator with
a preferred color and non-preferred brand in autism to use picture cards as a repair strategy
response to the first repair response, Takao when he encounters single and multiple in-
did not use brand as a repair strategy. Instead, correct responses. Takao’s repair skills im-
he exclusively pointed to the picture of his proved only when a constant time-delay pro-
preferred color. Introducing interventions cedure was implemented in One Attribute
did not produce any correct repair in the first Repair and in Two Attribute Repair. In addi-
block. As in the baseline condition, he exclu- tion, within One Attribute Repair, two occa-
sively touched the picture of his preferred sions (i.e., in the Brand and Size phases) were
color in the first repair response. However, observed in which behavior change occurred
from the second intervention block, his per- immediately after a constant time-delay proce-
formance improved dramatically and met the dure was initiated. We acknowledge that our
acquisition criteria in the fourth intervention design was a pseudo-changing criterion design
block. because the number of criterion changed was
During baselines in the Color-Size and Size- only one. In this regard, this study should be
Brand phases, the percentages of correct re- called a case study. However, given that behav-
pair reached the criterion line or above from ior change occurred more than one time
the very first sessions. That is, Takao pointed upon introducing repair training, it can be

418 / Education and Training in Autism and Developmental Disabilities-September 2010


stated that the training program may have ploying the framework developed by Weh-
contributed to enabling the student to use a meyer and Mithaug (2003). These authors de-
picture card as a repair strategy any time a fined self-detemined behavior as persistent
misunderstanding occurred. behaviors that are directed by the individual
The study provided a maximum of two to fill a gap between where he wants to be and
breakdown opportunities per episode. Never- where he is. Specifically, the self-determined
theless, Takao never terminated his attempt to person (a) realizes a gap between where he
repair the communication breakdowns. One wants to be and where he is, (b) develops a
of the reasons for his perseverance may be the strategy to fill the gap and implement the
nature of the activity selected for teaching strategy, (c) evaluates if the gap disappeared,
repair skills. Coloring the logo of a favorite TV (d) determines what should be changed when
program was one of Takao’s most preferred the gap did not disappeared, and (e) contin-
activities. In addition, the wrong response ues the process until the gap disappeared. In
made by the teacher consisted of a wrong an episode in Two Attribute Repair, Takao
brand, color, and size—attributions with touched a card depicting red when a piece of
which Takao was highly preoccupied. Utiliz- paper was given but his preferred pen was out
ing his perseverative interests (Frost & Bondy, of reach. It can be described that he realized a
2002) may have helped develop a teaching gap between where he wants (i.e., obtaining
context where Takao had a high level of mo- his preferred pen) and where he is (i.e., his
tivation to repair multiple misunderstanding preferred pen is not available), developed a
opportunities presented by the teacher. As plan to fill the gap (i.e., touching a red card),
Halle et al. (2004) argued, the level of moti- and implement the plan. Next, Takao
vation to communicate is one of the critical touched a red card again when the teacher
factors determining whether or not the indi- presented a pen with wrong color and brand.
vidual repairs communication breakdowns. In this process, he realized that the gap re-
Utilizing highly preferred activities and preoc- mains large, decided a strategy to fill the gap,
cupied attributions may influence the effec- and implemented the strategy. Third, Takao
tiveness of our instructions. touched a brand card when the teacher pre-
We did not use a multiple-probe design in sented a pen with correct color but wrong
which baseline data of all the six phases were brand. In this process he realized that the gap
taken at the beginning of the study and at the decreased but still existed, decided a strategy
time when a target behavior receiving the to fill the gap, and implemented the strategy.
treatment was improved. Therefore, caution Finally, Takao showed a satisfied face and re-
must be used in concluding that Takao’s re- ceived a pen to paint when the teacher pre-
pair skills acquired in the Brand phase gener- sented a pen with correct color and brand. In
alized to the Color phase, or that his repair this process he realized that the gap disap-
skills acquired in the Brand-Color phase gen- peared and the problem was solved. This is
eralized to the Color-Size and Size-Brand exactly what Wehmeyer et al. described as be-
phases. However, it is safe to conclude that ing self-determined. In this sense, enabling
Takao’s repair skills acquired in the Brand prelinguistic communicators with autism to
and Color phases did not generalize to the use AAC to repair multiple breakdowns may
Size phase and that his repair skills acquired contribute to nurturing a self-determined per-
in One Attribute Repair did not generalize to son in a micro-unit of daily life.
the Brand-Color phase in Two Attribute Re- He occasionally pointed to two correct
pair. cards (e.g., preferred color and brand) when
In the typical correct repair in Two At- a pen with two wrong attributions (e.g., non-
tribute Repair, Takao touched the card corre- preferred color and brand) was presented.
sponding to one of the two misunderstood However, this study did not honor the beyond-
attributions in the first breakdown and expected response. Instead, our procedure
touched the card corresponding to the misun- was to honor only the attribution that he
derstood attribution in the second break- pointed to longer by providing him another
down. The target behaviors acquired by Takao opportunity to repair. Before implementing
maybe called a self-determined behavior em- this procedure, we discussed with Takao’s

Picture Card Strategy / 419


teacher whether we should fully honor “point- same level of effectiveness of the training can-
ing to two correct cards” (i.e., provide a pen not automatically be expected in a student
with two preferred attributions) in the first with a more severe level of autism. Finally, the
repair turn or whether we should only partly study failed to investigate if Takao’s repair
honor the same response (i.e., provide a pen strategy used for listener misunderstandings
with one of the two preferred attributions) in in daily activities changed as a result of the
the turn and provide one more opportunity to systematic instruction implemented.
repair. We agreed with the teacher that this The present study demonstrated the poten-
study should emphasize skills of using picture tial of using systematic prompting procedures
cards in response to two consecutive wrong in a highly motivating context (e.g., request-
responses. Takao’s mother and teacher recog- ing preoccupied activities and attributions) to
nized that he frequently faced multiple mis- teach more conventional forms as a strategy
understandings. Enabling him to touch the for repairing multiple listener misunderstand-
card in ways that take into consideration what ings. The most intriguing finding was that the
the listener misunderstands in more than a instruction enabled a student with autism to
single opportunity was considered a priority, repair communication breakdowns by taking
given his daily experiences where he fre- into consideration which attributions were
quently faced gradual understanding by the missing. Future research needs to utilize a
listener (e.g., “Oh, you want this. No, you want more rigorous design (e.g., a multiple-probe
that. No, you want this . . .”). design), a variety of developmental levels of
This was the first study to teach a student participants, and various settings outside of
with nonverbal autism to repair when the stu- structured classrooms (e.g., playground, cafe-
dent’s request was misunderstood by the lis- teria, communities) to enhance the internal
tener. In addition, this was the first study to and external validity of using perseverative
demonstrate the possibility that we can teach interests and a systematic prompt procedure
students with autism to repair multiple break- to teach responses to multiple listener misun-
downs in ways that take into consideration derstandings.
which information the listener misunder-
stood. However, this study should be called
preliminary due to the following limitations. References
First, this study changed the criterion one
time, which is not considered rigorous in ex- American Psychiatric Association. (1994). Diagnostic
perimental control. At the beginning of the and Statistical Manual of Mental Disorders (4th ed.).
study, we planned one more criterion change Washington, DC: Author.
in which Takao was required to repair three Brady, N. C. (2000). Improved comprehension of
consecutive misunderstanding. However, we object names following voice output communica-
did not conduct any interventions in the con- tion aid use: Two case studies. AAC: Augmentative
and Alternative Communication, 16, 197–204.
dition due to the end of the school year. A
Brady, N. C., & Halle, J. (2002). Breakdowns and
multiple-baseline or probe design across dif- repairs in conversations between beginning AAC
ferent wrong responses would have been users and their partners. In J. Reichle, D. Beukel-
more appropriate for enhancing internal va- man, & J. Light (Eds.), Exemplary practices for begin-
lidity. However, we decided not to use a mul- ning communicators: Implications for AAC (pp. 323–
tiple-baseline or probe design because Takao 351). Baltimore: Paul H. Brookes Publishing
would be confused if he received different Company.
baselines simultaneously. Second, the study Brown, F., Gothelf, C. R., Guess, D., & Lehr, D. H.
demonstrated the effectiveness of the pro- (1998). Self-determination for individuals with
gram with only one participant and one object the most severe disabilities: Moving beyond chi-
mera. The Journal of the Association for Persons with
(i.e., pen) with three specific attributions (i.e.,
Severe Handicaps, 23, 17–26.
color, brand, and size). As mentioned earlier, Charlop-Christy, M. H., Carpenter, M., Le, L., Le-
this student had been able to use prelinguistic Blanc, L. A., & Kellet, K. (2002). Using the Pic-
communication forms as a repair strategy for ture Exchange Communication System (PECS)
an incorrect listener response in ways that with children with autism: Assessment of PECS
specified what he wanted. Therefore, the acquisition, speech, social-communicative behav-

420 / Education and Training in Autism and Developmental Disabilities-September 2010


ior, and problem behavior. Journal of Applied Be- gies used by elementary-age beginning communi-
havior Analysis, 35, 213–231. cators with autism: A preliminary descriptive
Frea, W. D., Arnold, C. L., & Vittimberga, G. L. study. Focus on Autism and Other Developmental Dis-
(2001). A demonstration of the effects of aug- orders, 20, 158 –168.
mentative communication on the extreme aggres- Richman, D. M., Wacker, D. P., & Winborn, L.
sive behavior of a child with autism within an (2001). Response efficiency during functional
integrated preschool setting. Journal of Positive Be- communication training: Effects of effort on re-
havior Interventions, 3, 194 –198. sponse allocation. Journal of Applied Behavior Anal-
Frost, L., & Bondy, A. (2002). PECS: The picture ysis, 34, 73–76.
exchange communication system training manual (2nd Sigafoos, J., Drasgow, E., Halle, J. W., O’Reilly, M.,
ed.). Cherry Hill, NJ: Pyramid Educational Con- Seely-York, S., Edrisinha, C., et al. (2004). Teach-
sultants. ing VOCA use as a communicative repair strategy.
Ganz, J. B., & Simpson, R. L. (2004). Effects on Journal of Autism and Developmental Disorders, 34,
communicative requesting and speech develop- 411– 422.
ment of the Picture Exchange Communication Sigafoos, J., O’Reilly, M., Seely-York, S., & Edrisinha,
System in children with characteristics of autism. C. (2004). Teaching students with developmental
Journal of Autism and Developmental Disorders, 34, disabilities to locate their AAC device. Research in
395– 409. Developmental Disabilities, 25, 371–383.
Halle, J. W., Brady, N. C., & Drasgow, E. (2004).
Son, S. H., Sigafoos, J., O’Reilly, M., & Lancioni, G.
Enhancing socially adaptive communicative re-
(2006). Comparing two types of augmentative
pairs of beginning communicators with disabili-
and alternative communication systems for chil-
ties. American Journal of Speech–Language Pathology,
dren with autism. Pediatric Rehabilitation, 9, 389 –
13, 43–54.
395.
Horner, R. H., & Day, H. M. (1991). The effects of
Tincani, M. (2004). Comparing the picture ex-
response efficiency on functionally equivalent
change communication system and sign language
competing behaviors. Journal of Applied Behavior
training for children with autism. Focus on Autism
Analysis, 24, 719 –732.
and Other Developmental Disabilities, 19, 152–163.
Ikusawa, M., Matsushita, H., & Nakase, J. (2002).
Shinpan-K-shiki-hattatsu-kensa 2001 jisshi-tebiki-sho Wehmeyer, M. L., Agran, M., & Hughes, C. (1998).
[The manual of Kyoto Scale of Psychological De- Teaching self-determination to students with disabili-
velopment 2001]. Kyoto, Japan: Kyoto Interna- ties: Basic skills for successful transition. Baltimore:
tional Social Welfare Center. Paul H. Brookes Publishing Co.
Keen, D. (2005). The use of non-verbal repair strat- Wehmeyer, M. L., & Mithaug, D. (2003). Self-deter-
egies by children with autism. Research in Develop- mination and mental retardation: Causal agency
mental Disabilities, 26, 243–254. theory. In H. Switzky, R., Shalock, & M. Wehm-
Keen, D. (2003). Communicative repair strategies eyer (Eds.), Current perspectives on individual differ-
and problem behaviours of children with autism. ences in personality and motivation in persons with
International Journal of Disability, Development and mental retardation and other developmental disabilities
Education, 50, 53– 64. (Vol. 1). San Diego, CA: Academic Press.
Keen, D., Sigafoos, J., & Woodyatt, G. (2001). Re- Wetherby, A. M., Alexander, D. G., & Prizant, B. M.
placing prelinguistic behaviors with functional (1998). The ontogeny and role of repair strate-
communication. Journal of Autism and Developmen- gies. In A. M. Wetherby, S. F. Warren, & J. Reichle
tal Disorders, 31, 385–398. (Eds.), Communication and language intervention se-
Meadan, H., Halle, J. W., Watkins, R. V., & Chadsey, ries: Vol. 7. Transition in prelinguistic communication
J. G. (2006). Examining communication repairs (pp. 135–161). Baltimore: Paul H. Brookes Pub-
of 2 young children with autism spectrum disor- lishing Co.
der: The influence of the environment. American
Journal of Speech-Language Pathology, 15, 57–71. Received: 14 May 2009
Ohtake, Y., Yanagihara, M., Nakaya, A., Takahashi, Initial Acceptance: 18 July 2009
S., Sato, E., & Tanaka, M. (2005). Repair strate- Final Acceptance: 18 September 2009

Picture Card Strategy / 421


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 422– 439
© Division on Autism and Developmental Disabilities

Evaluation of a Personal Digital Assistant as a Self-Prompting


Device for Increasing Multi-Step Task Completion by
Students with Moderate Intellectual Disabilities
Linda C. Mechling David L. Gast
University of North Carolina Wilmington University of Georgia

Nicole H. Seid
University of North Carolina Wilmington

Abstract: The purpose of this study was to evaluate whether the use of a personal digital assistant (PDA), with
picture, auditory, and video prompts, would serve as a portable self-prompting device to facilitate independent
task performance by high school age students with moderate intellectual disabilities. A multiple probe design was
used across three cooking recipes and replicated across three students to evaluate the effectiveness of the
self-prompting program. Results indicate that students were able to independently use a PDA to self-prompt
completion of the three cooking recipes without the need for external adult prompting, to maintain use of the
device over time, and to self-adjust the levels of prompts used within and across recipes.

Researchers continue to investigate use of self- preparation (Singh, Oswald, Ellis, & Singh,
operated prompting systems, operated by per- 1995); assembly tasks (Martin, Mithang, & Fra-
sons with intellectual disabilities, as tools for zier, 1992); dusting, setting tables, and vacu-
increasing independence and decreasing reli- uming (Steed & Lutzker, 1997); packaging
ance on external prompts delivered by adults (Johnson & Miltenberger, 1996); taking cus-
or peers. Self-operated prompting systems tomer orders and preparing sack lunches (Ag-
may be used to prompt: completion of tasks ran, Fodor-Davis, Moore, & Martella 1992),
with multiple steps (i.e., washing dishes); a and daily living skills (i.e., setting a table, mak-
sequence of tasks such as following a daily ing a bed) (Pierce & Schriebhan, 1994). Au-
schedule; or transitioning independently be- ditory-based systems have also been used as
tween activities (MacDuff, Krantz, & McClan- self-prompting devices whereby students oper-
nahan, 1993). Traditionally self-prompting ate a portable cassette player (Davis, Brady,
systems for completion of multi-step tasks Williams, & Burta, 1992; Grossi, 1998; Taber,
have been in the form of picture-based mate- Seltzer, Heflin, & Alberto, 1999; Hughes, Al-
rials (Lancioni, O’Reilly, & Oliva, 2001; Mech- berto, & Fredrick, 2006) or MP3 player
ling, 2007) whereby students look at a static (Taber-Doughty, 2005) by listening to a de-
picture depicting a step of a task analysis, com- scription of how to complete a step, or cluster
plete the step, return to the system, mark off of steps, of a task analysis, complete the step,
the picture corresponding to the completed and advance the system to the next step.
step or turn a page in a book, proceed to the Researchers have further evaluated use of
next picture and so forth. Static picture video based prompting systems to support in-
prompting has been used to prompt: food dependent task completion by persons with
intellectual disabilities. Similar to picture or
auditory based systems, students watch a video
Correspondence concerning this article should
segment of a step of the task being completed,
be addressed to Linda Mechling, University of pause the video tape, complete the step, and
North Carolina Wilmington, Department of Early return to the prompting device to watch the
Childhood and Special Education, 601 S. College next step. Video prompting has been used
Road, Wilmington, NC 28403-5940. effectively to teach a range of multi-step tasks

422 / Education and Training in Autism and Developmental Disabilities-September 2010


(Mechling, 2005) including: self-help skills bile technologies, have incorporated text
(Norman, Collins, & Schuster, 2001); cooking (Ferguson, Smith-Myles, & Hagiwara, 2005)
(Graves, Collins, Schuster, & Kleinert, 2005; and text and auditory prompts (Davies, Stock,
Mechling, Gast, & Fields, 2008); microwave & Wehmeyer, 2002a) to teach time manage-
oven use (Sigafoos et al., 2005); putting away ment and task completion. Pictures and audi-
groceries (Cannella-Malone et al., 2006); and tory prompts, presented on a small hand held
setting a table (Cannella-Malone et al.; Good- digital display, have also been used to teach
son, Sigafoos, O’Reilly, Cannella, & Lancioni, completion of vocational and independent liv-
2007). Unlike picture or auditory based sys- ing tasks (Cihak, Kessler, & Alberto, 2007;
tems, video prompting devices hold the advan- Riffel et al., 2005); transitioning between vo-
tage of offering the student both visual and cational tasks (Cihak, Kessler, & Alberto,
auditory cuing. In addition, video can provide 2008); and packaging and assembly tasks (Da-
animated, real-life simulations of the task vies, Stock, & Wehmeyer, 2002b; 2003; Furniss
(Mechling). Although Cihak, Alberto, Taber- et al., 1999).
Doughty, and Gama (2006) found no signifi- Presentation of video-based instruction
cant differences between static picture within the realm of portable systems is also
prompting and video prompting when teach- beginning to receive research attention.
ing use of an ATM and debit card machine to Mechling et al. (2008) used a portable DVD
six students with moderate intellectual disabil- player to deliver video prompts to three young
ities, Mechling and Gustafson (2009) found adults with moderate intellectual disabilities
that six young adults with moderate intellec- when the system was placed on a kitchen
tual disabilities independently completed a counter. Video displayed on portable PDA sys-
greater number of tasks when using video tems was also explored in two recent studies
prompting compared to static pictures. Mech- (Taber-Doughty, Patton, & Brennan, 2008;
ling and Gustafson (2008) report similar find- Van Laarhoven, Van Larrhoven-Myers, &
ings in favor of video prompting in their study Zurita, 2007). Both Taber et al. and Van Laar-
with six young men with a diagnosis of autism. hoven et al. used video modeling procedures
Tasks evaluated in each study were compo- to present information to students on hand
nent steps of recipes (i.e., opening crescent held systems. Video modeling differs from
rolls), whereby Mechling and Stephens video prompting by requiring the individual
(2009) included multiple step cooking recipes to watch an entire video recording followed by
in their study. Results of the study support immediate performance of the entire task or
video prompting over static picture prompt- performance of the skill at a later time. Lim-
ing for increasing independent performance ited research exists comparing the two proce-
of tasks for four students with moderate intel- dures, however Cannella-Malone et al. (2006)
lectual disabilities. found video prompting more effective than
In addition to investigating differences in video modeling in promoting acquisition of
skill acquisition using different self-prompting table setting skills and putting away groceries
devices (picture, audio, video), an area of in- by six adults with developmental disabilities.
terest concerning self-prompting systems is Although video prompting has been shown to
portability. Although a paper-based picture be an effective tool for presenting information
system can be portable (i.e., small notebooks and instruction to students with moderate in-
or flip cards) some researchers have found tellectual disabilities (Cannella-Malone et al.;
that students loose their place with such sys- Graves et al., 2005; Mechling et al.; Mechling
tems (Lancioni, O’Reilly, Seedhouse, Furniss, & Stephens, 2009; Norman et al., 2001; Si-
& Cunha, 2000; Mechling & Stephens, 2009) gafoos et al., 2005), to date no research has
and they do not provide auditory feedback. To been reported in the literature evaluating the
address these concerns and keeping abreast effects of video prompting on a PDA system.
with developing technologies, research is be- The purpose of the current study was to
ing conducted on the use of personal digital evaluate the effectiveness of a PDA self-
assistants (PDAs) by persons with disabilities. prompting system which combined the use of
These hand held systems, referred to by To- video, picture, and auditory prompts. While
masino, Doubek, and Ormiston (2007) as mo- previous research has shown these individual

Personal Digital Assistant / 423


components to be effective prompting sys- adaptable to varying abilities across students
tems, no study has evaluated a system using a (Mechling et al., 2008). The current study
combination of these three components nor sought to answer the following research ques-
has research addressed presentation of a com- tions: a) Would a hand-held self-prompting
bination system on a portable hand-held de- system, using video, picture, and auditory
vice. Advantages for combining the systems prompt levels, increase the percentage of
have been noted by researchers. Van Laar- cooking steps completed independently by
hoven and Van Laarhoven-Myers (2006) students with moderate intellectual disabili-
found that combination systems (video mod- ties?; and b) Would students with moderate
eling paired with photographs and video mod- intellectual disabilities self-adjust their use of
eling paired with video prompting) resulted prompt levels when using the PDA?
in more independent correct responses and
were more efficient in terms of sessions to
Method
criterion than video modeling alone when
teaching community daily livings skills to
Participants
young adults with developmental disabilities.
Mechling and Stephens (2009) report that Three young adults (2 females and 1 male)
some students may by be able to perform with moderate intellectual disabilities partici-
some steps of a task using pictures while need- pated in the study. Each had experience in
ing video descriptions for more difficult steps. food preparation, computer-based instruc-
Van Laarhoven and Van Laarhoven-Myers tion, and use of picture-based prompting al-
found that students, although not permitted though none had used video based prompting
to do so in the study, tried to self-fade and rely or a handheld system. Students were screened
on picture prompts rather than use of video for the following prerequisite skills prior to
prompts as they learned tasks. Similarly, the start of the study: (a) visual ability to see
Taber-Doughty et al. (2008) found that stu- video and pictures on a small 2 inch ⫻ 3 inch
dents began to rely only on auditory prompts digital display; (b) ability to hear auditory
and self-faded looking at video models on a prompts delivered by the system; (c) fine mo-
PDA system that provided both video models tor ability to touch the PDA screen or use a
and auditory cues. Based on their findings, small 1/8 inch diameter stylus; (d) cognitive
Van Laarhoven and Van Laarhoven-Myers ability to recognize pictures and icons; (e)
suggest a “scaffolding approach” whereby stu- ability to attend to video stimuli; and (f) imi-
dents use more intrusive prompts of a system tation skills. Because the purpose of the study
during initial trials and progress to a less in- was to evaluate the PDA system as a self-
trusive level of prompting as they become fa- prompting tool, students were also evaluated
miliar with a task. on their ability to perform individual compo-
In the current study students could: look at nents of each task analysis. These included:
a still photograph on a hand held device, (a) operation of a digital kitchen timer; (b)
touch the photograph and hear an auditory operation of dials on an electric stove and
prompt, or watch a video segment with audi- toaster oven; (c) use of a microwave oven; (d)
tory prompting, depending on how much in- ability to lift off plastic lids; (e) ability to twist
formation was needed. In addition, as they lids on and off of jars; (f) use of a bread clip;
learned steps of the task analysis, and did not (g) cutting with scissors; (h) ability to open
need additional information, students could cheese slices; (i) removing and putting on a
progress the system to the next photograph cooking spray lid; and (j) operating cooking
without receiving further prompts. The inten- spray. In addition, the following skills were
tion of the combination prompting system in adapted to ensure students’ abilities to com-
this study was to allow for adaptations as stu- plete the component steps of the task analysis:
dents’ needs for prompts changed (Van Laar- (a) using a bread clip rather than a twist tie;
hoven & Van Laarhoven-Myers, 2006), to pro- (b) placing food items into plastic storage
vide different prompt levels depending on the containers rather than zip lock bags in which
complexity of the step (Mechling & Stephens, they were purchased; (c) cutting open bags
2009), and to provide a system that could be with scissors rather than tearing or pulling

424 / Education and Training in Autism and Developmental Disabilities-September 2010


them open; (d) using oven mitts rather than worked well in a quiet and structured environ-
pot holders; and (e) using color coded mea- ment with frequent praise and reinforcement.
suring cups. Andy enjoyed choir, community outings, and
Andy was a 15 year, 11 month old male working on the computer.
diagnosed with Williams syndrome, mild au- Monica was a 17 year, 3 month old female
tism traits, and a moderate intellectual disabil- diagnosed with Down syndrome and a moder-
ity (IQ 55, Kaufman Assessment Battery for Chil- ate intellectual disability [IQ 51, Wechsler Intel-
dren: Kaufman & Kaufman, 1983; Adaptive ligence Scale for Children–Third Edition (WISC-
Behavior Composite Score 48, Vineland Adap- III): Wechsler, 1997; Adaptive Behavior
tive Behavior Scales: Sparrow, Balla, & Cicchetti, Composite Score 70, Vineland Adaptive Behav-
1984). He read simple sight words and some ior Scales: Sparrow et al., 1984]. She had a mild
letter sounds and was working on identifying hearing loss and wore eye glasses. She read on
main ideas and themes in stories as well as a late kindergarten/early first grade level and
increasing his ability to read and match words recognized simple sight words. She knew the
to pictures. He was able to write his name, sounds for all letters and was working on
address, phone number and emergency con- sounding out and blending sounds to read
tact information. He could also write the days words. She had difficulty with comprehension
of the week and the months of the year. He and often answered, “I don’t know” to ques-
was working on completing forms, writing sen- tions about what she had read. She was able to
tences with assistance and writing a grammat- write simple sentences in a journal and copied
ically correct simple sentence. He could count sentences dictated to her teacher. She used
objects, rote count to 100 by 1s, 5s, 10s and modified spelling and often omitted articles
complete simple addition problems using tally when writing sentences. Her needs included
marks. He was also able to count sets of nickels increasing her ability to write simple sentences
and dimes, but not in combination. His short using periods and to write personal informa-
term objectives included use of a calculator tion and prepare a written grocery list. Monica
and telling time on the hour and half hour. used a calculator to solve computation prob-
He used appropriate language to ask for help lems with addition and subtraction and was
and to interact with others with clear articula- able to tell time to the hour and half hour.
tion and a strength in pragmatic language. His She used a digital clock and watch for all other
needs included increasing his vocabulary, use times. One of her short term objectives was to
of descriptive words in sentences, and answer- understand which hour is next and what time
ing simple who, what when, and where ques- of day events happened. She was unable to
tions. He had difficulty processing auditory recognize coins or state their value and had
information and performed tasks better with difficulty counting by fives and tens. She was
visual cues. Andy’s needs further included able to take care of her personal needs, was
demonstration of effective listening skills in working on folding clothes with a model, and
class when directions were being given. He was able to hang shirts and pants with some
was able to care for all of his self-care needs prompts for positioning on the hanger. She
and perform simple home living tasks such as needed assistance making a bed and cooked
making a bed and washing dishes. He was able with supervision and assistance. Her needs in-
to operate a microwave oven with visual cues cluded working on planning meals making a
and a toaster oven, but required supervision grocery list, shopping for items, and prepar-
for all cooking related tasks. He was described ing meals. She could operate a microwave and
as being very social, polite, courteous and en- oven and needed assistance with a stove top.
joyed adult attention. He greeted people ap- She was described as being very outgoing and
propriately and had a good memory for peo- well liked by her classmates and teachers.
ple’s names and facts about them. He Monica enjoyed free time, working puzzles,
continued to have difficulty with peer relation- coloring, and computer games. She liked
ships, impulse control, and concentration and Hanna Montana and enjoyed searching web-
was easily frustrated. He frequently left his sites pertaining to the topic.
chair and stared out the window and asked for Wanda was a 17 year, 9 month old female
drinks of water or to use the restroom. He diagnosed with a moderate intellectual dis-

Personal Digital Assistant / 425


ability (IQ 44, Stanford-Binet Intelligence Scales instructor stood to the right of the student
–Fourth Edition: Thorndike, Hagan, & Sattler, and when present, the reliability data collec-
1986; Adaptive Behavior Composite Score 58, tor stood behind and to the left of the student.
Vineland Adaptive Behavior Scales: Sparrow et
al., 1984]. She was able to read 25 sight words
Materials and Equipment
on a primer level and knew the sounds for all
letters. She was working on blending sounds A Cannon ZR 830 digital video camcorder was
to read words. Her comprehension skills were used to make all video recordings and still
stronger when read to than when she read a photographs. The camera record button was
passage. She copies sentences and was work- stopped between recordings of each video
ing on writing simple three word sentences. prompting segment (step of the task analysis)
She used a calculator to complete simple ad- for each recipe. Video recordings were made
dition and subtraction problems with remind- using an adult model unfamiliar to the stu-
ers for entering decimal points. She could tell dents. During recording of each step a voice
time on the hour and half hour and need to over procedure was used to record directions
tell time on five minute intervals. She could (verbal prompts) provided by the person op-
count by fives and tens, recognized all coins erating the camera. Video recordings were
and their values and was working on counting downloaded through the fire wire port of the
coin and dollar combinations to $5. She was camera to a Dell Latitude ⫻ 300 laptop. Video
able to care for all of her self-care needs ex- captions were edited using Windows Movie
cept for difficult fasteners. Wanda could make Maker, and saved on the hard drive of the
her bed, wash dishes, take out the trash, and laptop for later importing onto the PDA. Like-
follow simple recipes with pictures using a wise, photographs were downloaded to the
microwave, stove, and oven with close super- laptop computer through the USB port, con-
vision. Her needs included planning and verted to a JPEG files, saved into picture files,
cooking healthy meals, writing a grocery list, and later imported onto the PDA. The Per-
and locating items in the grocery store. She sonal Digital Assistant (PDA) used in the study
liked to socialize in the hallways of the high was the Cyrano Communicator TM (Hewlett
school and had many friends from her com- Packard iPAQ Pocket PC with pre-installed
munity. She was working on appropriate ver- software by One Write Company). The soft-
bal behavior and body language in the hall- ware pre-installed onto the PDA allowed for
ways. In addition to socializing with friends, importing of pictures and video links directly
she enjoyed making puzzles, working on the onto available templates, linking of presenta-
computer, physical education class, and play- tion slides, and recording of auditory
ing basketball. prompts. The program also allowed use of
larger photographs on the displays which
could be more readily seen and touched with
Settings and Arrangements
a finger rather than a stylus. The template
Probe, intervention, and history training ses- selected for the current study contained three
sions, took place in the home living room at blocks (Figure 1). A presentation slide, using
the students’ high school. The kitchen area of the template, was created for each step of a
the home living room was arranged with all of task analysis. The top or largest block con-
the appliances (refrigerator, stove, dish- tained a photograph corresponding to the
washer, and sink) positioned in a single row step of the task analysis. Photographs were
along the wall with counter space separating downloaded from the laptop, stored on the
each appliance. The microwave was posi- PDA, and attached to each presentation slide.
tioned on a countertop next to the refrigera- An auditory prompt was recorded directly
tor and the toaster oven was positioned on a onto the PDA and played when the picture
counter top next to the electric stove. All sil- block was touched by the student (using a
verware, utensils, skillets etc. were kept in the finger or the stylus). The bottom left block
cabinets above and below the counters along contained the label “movie” and linked to the
the wall. The PDA was placed flat on the video prompt when touched. Movie files were
counter between the sink and the stove. The downloaded from the laptop, and stored di-

426 / Education and Training in Autism and Developmental Disabilities-September 2010


boxes, bags, jars, measuring cups, spatula, dig-
ital timer) and responses (i.e., stirring, turn-
ing, pouring, holding) (Table 1).

Experimental Design and General Procedures


A multiple probe design across three cooking
recipes and replicated with three students was
used to determine the effectiveness of a hand-
held self-prompting system, using video, pic-
ture, and auditory prompt levels, to teach
food preparation (Gast, 2009). The PDA was
operated individually by each student and
Figure 1. Illustration of one page on the Cyrano used to deliver all prompts for task comple-
Communicator TM PDA. tion. One cooking task was performed during
each session and only one session was con-
ducted per day, 3– 4 days per week. Experi-
rectly on the PDA. The video caption played mental conditions occurred in the following
immediately, using Windows Media Player, sequence: history training for PDA operation,
(available on the PDA) which was automati- cooking task probe without the PDA (three
cally opened when the block was touched. recipes), PDA prompting (first recipe), cook-
After the video caption was complete, the ing task probe without the PDA (three reci-
movie stopped, the student closed Windows pes), PDA prompting (second recipe), PDA
Media Player using the stylus, and the pro- prompting probe (mastered recipe), cooking
gram then returned to the presentation slide. task probe without the PDA (two recipes) and
The block in the bottom right corner con- so on. Subsequent probe sessions with the
tained a picture of an arrow pointing to the PDA following mastery of a recipe were con-
right and an auditory prompt which said, ducted to evaluate use of the device over time
“Next”. This block was linked to the subse- (maintenance).
quent presentation slide corresponding to the
next step of the task analysis. When the arrow
Dependent Measure and Data Collection
block was touched by the student (using a
finger or a stylus) the program automatically During each condition, data were recorded
advanced to the next slide. A student could for each step of the recipe task analyses shown
repeatedly touch a picture on a page and hear in Table 1. Data were calculated and reported
the auditory prompt or touch the video block for the percentage of steps completed inde-
and replay the video recording as often as pendently using the PDA regardless of the
needed until the step was completed, how- prompt level used on the PDA. Although the
ever, the program only advanced forward and primary dependent variable was the percent-
students could not go back or “rewind” to a age of steps completed independently correct
step. The last presentation slide for each cook- for each recipe, the type of prompt level the
ing recipe contained a photograph of the fin- student used on the PDA in order to complete
ished food item, an auditory prompt “fin- the step (independent, picture only, pic-
ished”, and a video recording of the finished ture ⫹ auditory, or video) was also recorded.
food item on a plate with the voice over, “Fin-
ished, you may eat the ____.”
History Training
Three cooking recipes were selected which
sampled three modes of food preparation: Prior to the first probe session, students par-
stove top (grilled ham and cheese sandwich), ticipated in instructional sessions to teach op-
microwave (Hamburger Helper Microwave eration of the PDA. A washer and dryer were
Singles), and toaster oven (individual serving present in the home living area and a self-
size pizza). Recipes ranged from 19 to 25 steps prompting program with five presentation
and required use of a range of stimuli (i.e., slides was developed for operation of the

Personal Digital Assistant / 427


TABLE 1

Task Analysis for Cooking Recipes

Hamburger Helper Microwave Singles (19 steps)


Get box of Hamburger Helper from cabinet and put on counter
Get 1 cup measuring cup from drawer and put on counter
Get small spoon from drawer and put on counter
Get 2 oven mitts from on top of the microwave and put on counter
Get white mixing bowl from cabinet and put on counter
Open box and take out one packet
Get scissors from drawer, cut open packet and pour contents into bowl
Fill measuring cup with water from sink and pour water into bowl
Stir mixture 8 times, put spoon on counter
Put bowl in microwave, close door, Press “5” “0” “0” “Start:
Wait 5 min for microwave to “ding”
Take bowl out of microwave using oven mitts, put on counter, close microwave door and stir mixture 8
times
Close box and put in cabinet
Put oven mitts on top of microwave
Put measuring cup in sink
Put spoon in sink
Throw empty packet in trash can
Put scissors in drawer
Stop
Grilled Ham and Cheese Sandwich (24 steps)
Get skillet from cabinet and put on front right stove burner
Get plate from cabinet and put on counter
Get spatula from drawer and put on counter
Get cooking spray from cabinet and put on counter
Get bread from refrigerator and put on counter
Get 2 slices of cheese from refrigerator shelf and put on counter
Get package of ham from refrigerator shelf and put on counter
Take off lid of cooking spray and spray bottom of skillet 6 times
Open bread and place 2 slices of bread in skillet
Unwrap 2 slices of cheese and place one slice on each slice of bread
Open package of ham and place one slice of ham on top of one cheese slice
Turn stove dial to “medium”
Get kitchen timer from kitchen drawer
Press minute button two times and press “start”
Wait 2 minutes for timer to beep
Turn stove dial to “off”
Get spatula and place one slice of bread/cheese/ham on top of other, lift sandwich from skillet with
spatula and place on plate
Close bread with bread clip and put in refrigerator
Put ham in refrigerator
Place lid on cooking spray and put in cabinet
Put cheese wrappers in trash can
Put spatula in sink
Put timer in drawer
Stop
Individual Serving Size Pizza (25 steps)
Get plate from cabinet and put on counter
Get knife from drawer and put on counter
Get pizza dough packet from refrigerator and put on counter
Get pizza sauce bottle from refrigerator and put on counter
Get cheese package from refrigerator and put on counter
Continued

428 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 1 (Continued)

Get pepperoni package from refrigerator and put on counter


Get mushroom container from refrigerator and put on counter
Get oven mitts from on top of microwave and put on counter
Open pizza dough packet and put one piece on plate
Open pizza sauce and squirt 3 rotations on dough
Hold knife and spread sauce around on dough
Open cheese package and sprinkle one handful of cheese on dough/sauce
Open pepperoni package and place 5 slices on top of dough/sauce/cheese
Open mushroom container and place 5 pieces of mushrooms on top of dough/sauce/cheese/pepperoni
Open toaster oven door, place pizza on cooking sheet inside oven
Close toaster oven door, turn top dial to “bake” and bottom dial to “5 minutes”
Wait for timer to ding, put on oven mitts, open door, pull out cooking sheet and place on top of stove,
close toaster oven door
Get spatula from drawer and use to place pizza on plate
Put oven mitts on top of microwave
Put spatula in sink
Put knife in sink
Close mushrooms and put back in refrigerator
Close sauce and put back in refrigerator
Put pepperoni, cheese, and dough back in refrigerator
Stop

dryer. The self-prompting program followed cooking recipes prior to instruction and with-
the same format as those used for the three out use of the self-prompting system. Initial
cooking tasks. Students were taught individu- probe sessions were conducted individually
ally how to operate the different functions of for a minimum of three sessions per recipe or
the PDA using a stylus and their fingers. These until data stabilized. Subsequent probe condi-
functions included: (a) looking at the picture tions without the PDA system were conducted
prompt; (b) touching the photograph to hear for one session per recipe immediately follow-
an auditory prompt; (c) touching the “movie” ing mastery of a cooking task (Probe 2– 4).
block to watch the video prompt; (d) closing Each session consisted of one trial for one of
the movie by touching a small box in the the recipes. Trials began with the instructor
upper right corner of the digital display using showing the student a photograph of the item
the stylist; and (e) touching the arrow block to to be prepared and delivering the task direc-
advance to the next presentation slide. Stu- tion, “It’s time to cook ______,” or “Cook the
dents were also taught to touch the screen if it ____.” The instructor then waited 3 seconds
went blank during the activity. The PDA was for the student to respond by initiating the
programmed to shut down after a period of first step for preparing the recipe. Students
approximately 25 seconds of non-use in order could perform each step of the task analysis
to conserve the battery. In addition to opera- correctly, incorrectly, or not respond. Steps
tion of the device, students were taught to for each task analysis were performed by an
complete a step and return to the PDA before adult without disabilities prior to the study to
advancing the program to the next slide. His- determine criterion levels for duration. A cor-
tory training, using a system of least prompts rect response was recorded if the student ini-
procedure, continued until a student was able tiated a step within 3 seconds of the previous
to independently operate all functions of the step and completed the step within 30 seconds
device to complete the clothes drying task. following initiation of the step. Incorrect re-
sponse was defined as: (a) initiation within 3
seconds, but failure to complete a step within
Probe Procedures: Cooking without the PDA
30 seconds of the previous step (duration);
The first probe condition served to evaluate (b) initiation within 3 seconds of the last step,
each student’s ability to complete the three but failure to complete the step correctly (to-

Personal Digital Assistant / 429


pographic); and (c) no response, character- corresponding presentation slide (indepen-
ized by failure to initiate a step within 3 sec- dent).
onds of the end of the previous step. Failure to For each step of the recipe a student could
complete a step or initiate a step was also perform a step correctly or incorrectly, or not
recorded if a student verbally expressed that respond. An unprompted correct response
he/she did not know how to complete a step. was defined as initiating a step within 3s and
If a student performed a critical step incor- completing a step within 30s following the
rectly or did not respond, the instructor PDA prompt. Students could also navigate
blocked the student’s view and performed the their way through the prompt levels. For ex-
critical step. A step was considered critical if ample, a student could look at the photo-
subsequent steps could not be completed graph (picture only) and decide that he/she
without the step’s completion (e.g. putting needed a more intrusive prompt. He/she
the dough on the plate so that the sauce, then touched the photograph and listened to
mushrooms etc. could be placed on the the verbal prompt (picture ⫹ auditory). He/
dough). Students received verbal praise for she could attempt to complete the step or
attempting steps and for attending to the ma- progress to a more intrusive prompt level –
terials on an average of every third step (VR- video prompt. In order to be considered an
3). Students could also eat the food at the end unprompted correct response, the student
of the session, offer it to another classmate or was required to initiate the next prompt level
staff member, or save it for later consumption within 3s of hearing and/or seeing the less
if they so desired. intrusive prompt. A student could also return
to the system for further prompting on the
same level or to receive prompting on a more
Self-Prompting PDA Procedure
intrusive level after a step was initiated. In this
During each cooking session, using the self- case, an unprompted correct response was re-
prompting system, the PDA was placed on the corded if the student did so within 30s of
kitchen counter and was used by the student initiating the step.
to navigate through each step of the task anal- An incorrect response was defined as (a)
ysis. Each session began with the instructor initiation of a step within 3s following the
turning on the PDA and locating the correct prompts, but incorrect performance of the
recipe. The first presentation slide contained step (topographic); (b) initiation within 3s
a photograph of the recipe to be prepared but failure to complete the step within 30s of
and an arrow block at the bottom right side of the prompt (duration); or (c) no response,
the page. The student was given the task di- whereby the student failed to initiate a re-
rection, “Touch the arrow and start cooking sponse within 3s of the PDA prompt. If an
the _____using the iPAQ,” (the PDA was re- incorrect response occurred, the instructor
ferred to as an iPAQ rather than a Cyrano prompted the student (i.e., said, “Touch the
Communicator because this was the label ______” while pointing to the block) to use
found on the outside of the PDA). The stu- the PDA to perform the step correctly
dent then touched the arrow block which (prompted correct). When the instructor
linked to the next presentation slide contain- prompted the student back to the PDA, she
ing prompts for the first step of the task anal- pointed to the next intrusive prompt level. For
ysis. Following the model of the system of least example, if the student touched the photo-
prompts (SLP) the student could look at the graph, listened to the verbal prompt (pic-
photograph on the slide and complete the ture ⫹ auditory) and responded incorrectly,
step (picture only), touch the photograph and the instructor prompted the student to touch
hear an auditory prompt (i.e., “put the dough the video block.
on the plate”) (picture ⫹ auditory), and/or If a student failed to perform a step cor-
touch the video block and watch a video cap- rectly after being directed through all of the
tion of the step being modeled along with a prompt levels on the PDA (incorrect
verbal description of the step (video). The prompted response), the instructor per-
student could also complete steps of the task formed any critical steps (while blocking the
analysis without advancing the system to the students view) followed by directing the stu-

430 / Education and Training in Autism and Developmental Disabilities-September 2010


dent to touch the arrow block to advance to condition for level of prompt used by the
the next presentation slide. If the step was student (range ⫽ 94.7%–100%)
not defined as critical (subsequent steps did Procedural reliability data were recorded
not rely on its completion) the student was for the following instructor behaviors when
immediately prompted to touch the arrow implementing the study: (a) prompting use of
block. No other prompts were provided for the PDA; (b) delivery of reinforcement; (c)
task completion by the instructor. Students blocking student’s view when completing crit-
received descriptive verbal praise on a VR-3 ical steps; (d) assuring that materials and
schedule of reinforcement for unprompted equipment were in proper locations and work-
and prompted correct responses. At the end ing order; and (e) turning on the PDA and
of the session the student could also eat the delivering task directions. Agreement was cal-
prepared food item, package it to be eaten culated by dividing the number of each ob-
at a later time, or offer it to another student served instructor behavior by the number of
or staff member. After criteria was reached opportunities, multiplied by 100 (Billingsley,
for one recipe (100% unprompted correct White, & Munson, 1980). Mean procedural
for one session), one probe session was con- accuracy was 97.9% (range ⫽ 90.9%–100%).
ducted to evaluate the student’s completion Errors occurred, for example, when a high
of the currently mastered recipe and any school staff member removed the bowl from
remaining recipes without use of the PDA. the cabinet, the safety cap was not removed in
In addition, mastered recipes were probed advance from a new bottle of pizza sauce,
using the PDA during subsequent training Wanda left to go to the bathroom and the
conditions to measure maintenance. skillet was removed from the stove to prevent
burning, student held finger on “next” icon
too long and the program jumped ahead of
Social Validity
the target slide, bread clip was not placed on a
On the day that each student finished the last new loaf of bread, and the handle broke on
probe session, each was shown the PDA, a the measuring cup.
portable DVD player, and a picture-based
cookbook. The instructor showed each stu-
Results
dent a portion of a recipe and operation of
the portable DVD player (video and voice over Figures 2, 3, and 4 show the percentage of
prompts). The instructor also explained one steps performed independently correct by
recipe and how to look at and cross off pic- each student across the three cooking recipes
tures in the cookbook. The instructor then during probe sessions without the self-prompt-
showed the student a box of pudding and ing device and during PDA self-prompting ses-
asked, “If you were going to make the pud- sions. Visual inspection of the figures reveals
ding, which of these would you like to use?” an immediate and abrupt increase in steps
completed independently after introduction
of the PDA system and that performance was
Reliability
maintained over time. Although students
Interobserver agreement and procedural reli- could perform some steps prior to use of the
ability data were recorded simultaneously on PDA, performance remained low during
33.3% of all sessions across probe and self- probe sessions with the exception of Wanda
prompting PDA conditions. Interobserver for making individual serving size pizza. It is
agreement was calculated using the point-by- possible that her level of performance in-
point method in which the number of instruc- creased prior to use of the PDA because she
tor and observer agreements was divided by saw the final product (pepperoni, cheese etc.
the number of agreements plus disagreements on the pizza) when her classmates brought the
and multiplied by 100. Mean interobserver pizza into the classroom to share with class-
agreement for student independent correct mates. In addition, some steps were repeated
responses was 98.8% across all students and across recipes and Monica, for example, be-
conditions (range ⫽ 94.7%–100%) and 98.1% gan to obtain potholders independently be-
across all students during the self-prompting fore using the PDA on her last recipe.

Personal Digital Assistant / 431


Figure 2. Percentage of steps performed correctly by Andy across the three cooking recipes.

432 / Education and Training in Autism and Developmental Disabilities-September 2010


Figure 3. Percentage of steps performed correctly by Monica across the three cooking recipes.

Personal Digital Assistant / 433


Figure 4. Percentage of steps performed correctly by Wanda across the three cooking recipes.

434 / Education and Training in Autism and Developmental Disabilities-September 2010


Figure 5. Percentage of steps performed using each PDA prompt level across three cooking recipes and
three students.

As reflected in Figures 2– 4 students were incorrectly and was prompted by the instruc-
able to learn to independently use the PDA tor to look at the picture (next prompt level).
self-prompting system to complete recipes Figure 5 presents the percentages for each
without instructor prompts. Andy and Monica prompt level used by each student across the
required the greatest number of sessions to three cooking recipes during self-prompting
criteria on their first recipe, however, Wanda and probe sessions with the PDA. Students
increased her number of sessions to criteria showed trends toward requiring less intrusive
on the second recipe. Although the ham and prompt levels (video and picture ⫹ audio)
cheese recipe (Wanda’s first recipe) required within and across tasks. All three students
24 steps (compared to 19 steps for microwave used video for the greatest amount of time
hamburger helper), it appears that students during the first session of the their first recipe
found this recipe less difficult to perform (Andy 78.9%, Monica 72%, and Wanda 37.5),
when using the PDA. Errors across all recipes but quickly faded it’s use within the second
were most frequently committed when stu- session (Andy 0%, Monica 2%, and Wanda
dents initiated completion of a step without 8.3%) and subsequently relied less on video
using the PDA and performed the step incor- across the first session of the remaining reci-
rectly, thus requiring the instructor to prompt pes (i.e., use of video on first session of second
them to use the devise. This behavior oc- recipe: Andy 13.6%, Monica 25%, and Wanda
curred with Wanda when completing her sec- 21.1%). With the exception of Monica on her
ond recipe. She proceeded to perform a step last recipe, students infrequently used the pic-

Personal Digital Assistant / 435


ture ⫹ audio feature of the PDA, but instead for more difficult steps (Mechling & Stephens,
they frequently accessed the picture prompt if 2009) or may need to refer back to more
they were unable to perform a step indepen- intrusive prompt levels when a task is not con-
dently. This behavior continued for each stu- tinuously performed
dent into maintenance sessions when students The small number of students participating
were presented with the PDA for use with in the study calls for future research to repli-
previously mastered recipes. cate the findings. Furthermore, additional
studies are needed to investigate use of self-
prompting systems with multiple prompt lev-
Social Validity
els across other disabilities and tasks. Of inter-
When presented with a choice of the PDA, est, for example, would be how students with
portable DVD player, or picture cookbook to autism use the system and on which prompt
hypothetically cook pudding, all three stu- levels they would rely (visual, auditory, video).
dents responded that they would like to use Further evaluation of different tasks may pro-
the portable DVD player because it had mov- vide information concerning whether some
ies. Imitating a cable television cooking pro- activities or steps are better suited for video
gram, Monica further said that she wanted to, modeling or prompting or whether pictures
“Watch the movies and be an iron chef.” or auditory prompts will suffice. Furniss et al.
(1999) stated that the nature of the task rather
than students’ abilities likely influenced suc-
Discussion
cessful use of a PDA in their study.
As the technology of PDA systems progresses A limitation of the current study was that
and prices lower (Swan, Swan, Van Hover, & there was no further clustering of task steps as
Bell, 2002), handheld computers may be a they were learned or a change in the photo-
low-cost, effective means for students to have graphs or video segments used. As tasks are
access to information anywhere at anytime learned it may be beneficial to cluster steps
(van ‘t Hooft & Vahey, 2007). The current into fewer pictures or combine multiple video
study supports previous research reporting segments into fewer segments (Furniss et al.,
that students with intellectual disabilities can 1999). Students may initially require video
learn to use an electronic, portable, handheld prompting and then move to lengthier video
prompting system to independently complete segments that resemble video modeling (Can-
tasks (Cihak et al., 2008; Davies et al., 2002b, nella-Malone et al., 2006). It is important to
2003; Riffel et al., 2005; Taber-Doughty et al., select methods of instruction that match the
2008; Van Laarhoven et al., 2007). The study needs of the individual students (Simpson,
extends the research literature evaluating 2005). One critical advantage of a PDA is the
handheld self-prompting systems by using a ability to individualize the system to meet the
system that provided picture, auditory, and needs of each student (Furniss et al., 1999).
video prompting within one program. Future studies may wish to investigate the
Students demonstrated the ability to inde- adaptability of prompts as a student’s perfor-
pendently use a PDA to self-prompt comple- mance progresses, presentation of cues at the
tion of the three cooking recipes without the student’s own individual pace (Davies et al.,
need for external adult prompting. An impor- 2003), and other customization features that
tant contribution of the current study was can be adapted to the individual. For exam-
demonstrating the ability of students to deter- ple, realistic photographs and video segments
mine what level of prompting they needed or from the student’s actual environment may
preferred. Students initially used more intru- assist with acquisition of skills compared to
sive levels of prompts if needed and self-faded generic stimuli on commercial programs. The
these levels of prompts (i.e., video to photos), current study used custom-made photographs
later re-instituted use of more intrusive and video recordings that exemplified each
prompt levels when needed (i.e., during main- student’s cooking environment. Future re-
tenance sessions), or used no prompts at all. search may need to compare the benefits of
These results show that students may initially customized verses commercially available soft-
need video prompts rather than photographs ware programs for prompting tasks. Although

436 / Education and Training in Autism and Developmental Disabilities-September 2010


easier to obtain, commercially available prod- use by the general public (Davies et al.,
ucts may be more costly. The question re- 2002b) and their non-obtrusive format that
mains, are commercial products as effective as does not make students stand out among
those made specifically for each student? In peers in school (Myles, Ferguson, & Hagiwara,
addition, auditory recordings pertinent to the 2007).
student such as key words or a student’s name
may be used to gain attention before present-
ing a step. References
Researchers have also identified the impor- Agran, M., Fodor-Davis, J., Moore, S. C., & Martella,
tance of allowing students to select their own R. C. (1992). Effects of peer delivered self-instruc-
preferred method of prompting (Taber- tional training on a lunch-making work task for
Doughty, 2005; Taber-Doughty et al., 2008). students with severe disabilities. Education and
Taber-Doughty found that students increased Training in Mental Retardation, 27, 230 –240.
their skill acquisition and decreased their time Billingsley, F. F., White, O. R., & Munson, R. (1980).
to complete tasks when provided a choice be- Procedural reliability: A rational and an example.
tween prompting systems (adult, pictures, au- Behavioral Assessment, 2, 229 –241.
ditory). In the current study students could Cannella-Malone H., Sigafoos, J., O’Reilly, M., De
La Cruz, B., Edrisinha, C., & Lancioni, G. E.
choose within the system what to use (i.e.,
(2006). Comparing video prompting to video
picture, video), but were limited to using the modeling for teaching daily livings skills to six
hand-held system. Further, although students adults with developmental disabilities. Education
were asked at the completion of the study and Training in Developmental Disabilities, 41, 344-
which system they preferred, students need to 356.
have opportunities to use all of the systems Cihak, D., Alberto, P. A., Taber-Doughty, T., &
before they determine their preferred system Gama, R. I. (2006). A comparison of static picture
(Taber-Doughty et al.). prompting and video prompting simulation strat-
Another factor to consider when interpret- egies using group instructional procedures. Focus
ing results and determining what role a PDA on Autism and Other Developmental Disabilities, 21,
89 –99.
can play in supporting programming for per-
Cihak, D. F., Kessler, K., & Alberto, P. (2007). Gen-
sons with disabilities is that the current study eralized use of a handheld prompting system.
used the device to prompt completion of Research in Developmental Disabilities, 28, 397– 408.
multi-step tasks, for which students could al- Cihak, D. F., Kessler, K., & Alberto, P. (2008). Use of
ready perform the component steps, rather a handheld prompting system to transition inde-
than instruction or acquisition of a new task. pendently through vocational tasks for students
The instructor also turned on the PDA and with moderate and severe intellectual disabilities.
found the target recipe. Further indepen- Education and Training in Developmental Disabilities,
dence could be increased by setting up a 43, 102–110.
home page with photographs of the recipes or Davies, D. K., Stock, S. E., & Wehmeyer, M. L.
(2002a). Enhancing independent time manage-
tasks to be completed and to evaluate stu-
ment skills of individuals with mental retardation
dents’ abilities to navigate through a range of using a palmtop personal computer. Mental Retar-
available task analyses. Additional studies are dation, 40, 358 –365.
needed to evaluate use of the extensive fea- Davies, D. K., Stock, S. E., & Wehmeyer, M. L.
tures available through these developing tech- (2002b). Enhancing independent task perfor-
nologies. Future studies may also address fea- mance for individuals with mental retardation
tures for prompting and using lists of tasks through use of a handheld self directed visual and
and daily schedules for organizational skills, audio prompting system. Education and Training
self prompting across a range of complex in Mental Retardation and Developmental Disabilities,
tasks, and students abilities to enter and use 37, 209 –218.
Davies, D. K., Stock, S. E., & Wehmeyer, M. L.
information on the systems through text, au-
(2003). A palmtop computer-based intelligent aid
ditory and video recordings and taking their for individuals with intellectual disabilities to in-
own photographs. Portable digital assistants crease independent decision making. Research &
and other hand-held electronic devices ap- Practice for Persons with Severe Disabilities, 28(4),
pear to hold promising potential for persons 182–193.
with disabilities due to their non-stigmatizing Davis, C. A., Brady, M. P., Williams, R. E., & Burta,

Personal Digital Assistant / 437


M. (1992). The effects of self operated auditory photographic activity schedules: Maintenance
prompting tapes on the performance fluency of and generalization of complex response chains.
persons with severe mental retardation. Education Journal of Applied Behavior Analysis, 26, 89 –97.
and Training in Mental Retardation, 27, 39 –50. Martin, J. E., Mithaug, D. E., & Frazier, E. S. (1992).
Ferguson, H., Smith Myles, B., & Hagiwara, T. Effects of picture referencing on PVC chair, love
(2005). Using a personal digital assistant to en- seat, and settee assemblies by students with men-
hance the independence of an adolescent with tal retardation. Research in Developmental Disabili-
Asperger Syndrome. Education and Training in De- ties, 13, 267–286.
velopmental Disabilities, 40, 60 – 67. Mechling, L. C. (2005). The effect of instructor-
Furniss, F., Ward, A., Lancioni, G., Rocha, N., created video programs to teach students with
Cunha, B., Seedhouse, et al. (1999). A palmtop- disabilities: A literature review. Journal of Special
based job aid for workers with severe intellectual Education Technology, 20, 25–36.
disabilities. Technology and Disability, 10, 53– 67. Mechling, L. C. (2007). Assistive technology as a
Gast, D. L. (Ed) (2009). Single subject research meth- self-management tool for prompting students
odology in behavioral sciences. New York: Routledge with intellectual disabilities to initiate and com-
Publishers. plete daily tasks: A literature review. Education and
Goodson, J., Sigafoos, J., O’Reilly, M., Cannella, H., Training in Developmental Disabilities, 42, 252–269.
& Lancioni, G. E. (2007). Evaluation of a video- Mechling, L. C., Gast, D. L., & Fields, E. A. (2008).
based error correction procedure for teaching a Evaluation of a portable DVD player and system
domestic skill to individuals with developmental of least prompts to self-prompt cooking task com-
disabilities. Research in Developmental Disabilities, pletion by young adults with moderate intellec-
28, 458 – 467. tual disabilities. Journal of Special Education, 42,
Graves, T. B., Collins, B. C., Schuster, J. W., & Klein- 179 –190.
ert, H. (2005). Using video prompting to teach Mechling, L. C., & Gustafson, M. (2009). Compari-
cooking skills to secondary students with moder- son of the effects of static picture and video
ate disabilities. Education and Training in Develop- prompting on completion of cooking related
mental Disabilities, 40, 34 – 46. tasks by students with moderate intellectual dis-
Grossi, T. A. (1998). Using a self-operated auditory abilities. Exceptionality, 17, 103–116.
prompting system to improve the work perfor- Mechling, L. C., & Gustafson, M. (2008). Compari-
mance of two employees with severe disabilities. son of static picture and video prompting on the
Journal of the Association for the Severely Handicapped, performance of cooking related tasks by students
23, 149 –154. with autism. Journal of Special Education Technology,
Hughes, M. A., Alberto, P. A., & Fredrick, L. L. 23(3), 31– 45.
(2006). Self-operated auditory prompting systems Mechling, L. C., & Stephens, E. (2008). Comparison
as a function-based intervention in public com- of self-prompting of cooking skills via picture-
munity settings. Journal of Positive Behavior Interven- based cookbooks and video recipes. Education and
tions, 8, 230 –243. Training in Developmental Disabilities, 44, 218 –236.
Johnson, R. R., & Miltenberger, R. G. (1996). The Myles, B. S., Ferguson, H., & Hagiwara, T. (2007).
direct and generalized effects of self instructions Using a personal digital assistant to improve the
and picture prompts on vocational task perfor- recording of homework assignments by an ado-
mance. Behavioral Interventions, 11, 19 –34. lescent with Asperger syndrome. Focus on Autism
Kaufman, A. S., & Kaufman, N. L. (1983). Kaufman and Other Developmental Disabilities, 22 (2), 96 –99.
assessment battery for children. Circle Pines: Ameri- Norman, J. M., Collins, B. C., & Schuster, J. W.
can Guidance Service. (2001). Using an instructional package including
Lancioni, G. E., O’Reilly, M. F., & Oliva, D. (2001). video technology to teach self help skills to ele-
Self-operated verbal instructions for people with mentary students with mental disabilities. Journal
intellectual and visual disabilities: Using instruc- of Special Education Technology, 16, 5–18.
tion cluster after task acquisition. International One Write Company (2006). Cyrano Communicator
Journal of Disability, Development and Education, 48, TM. Lancaster, OH; Author.
304 –312. Pierce, K. L., & Schreibman, L. (1994). Teaching
Lancioni, G. E., O’Reilly, M. F., Seedhouse, P., daily living skills to children with autism in unsu-
Furniss, F., & Cunha, B. (2000). Promoting inde- pervised settings through pictorial self-manage-
pendent task performance by persons with severe ment. Journal of Applied Behavior Analysis, 27, 471–
developmental disabilities through a new com- 481.
puter-aided system. Behavior Modification, 24, 700 – Riffel, L. A., Wehmeyer, M. L., Turnbull, A. P.,
718. Davies, D., Stock, S., & Fisher, S. (2005). Promot-
MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. ing independent performance of transition-re-
(1993). Teaching children with autism to use lated tasks using a palmtop PC-based self-directed

438 / Education and Training in Autism and Developmental Disabilities-September 2010


visual and auditory prompting system. Journal of student preferences. Journal of Special Education
Special Education Technology, 20, 5–14. Technology, 23(1), 1–18.
Sigafoos, J., O’Reilly, M., Cannella, H., Upadhyaya, Taber, T. A., Seltzer, A., Heflin, L. J., & Alberto,
M., Edrisinha, C., Lancioni, G. E., et al. (2005). P. A. (1999). Use of self-operated auditory
Computer-presented video prompting for teach- prompts to decrease off-task behavior for a stu-
ing microwave oven use to three adults with de- dent with autism and moderate mental retarda-
velopmental disabilities. Journal of Behavioral Edu- tion. Focus on Autism and Other Developmental Dis-
cation, 14, 189 –201. abilities, 14, 159 –166.
Simpson, R. L. (2005). Evidence-based practices Thorndike, R. L., Hagan, E. P., & Sattler, J. M.
and students with autism spectrum disorders. Fo- (1986). Stanford-Binet intelligence scale. Itasca, IL:
cus on Autism and Other Developmental Disabilities, Riverside Publishing.
20, 140 –149. Tomasino, C., Doubek, K., & Ormiston, M. (2007).
Singh, N. N., Oswald, D. P., Ellis, C. R., & Singh, Can handhelds make a difference? Lessons
S. D. (1995). Community-based instruction for learned from large and small scale implementa-
independent meal preparation by adults with pro- tions. Educational Technology, 47, 29 –32.
found mental retardation. Journal of Behavioral Van Laarhoven, T., & Van Laarhoven-Myers, T.
Education, 5, 77–91. (2006). Comparison of three video based instruc-
Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). tional procedures for teaching daily living skills to
Vineland adaptive behavior scales. Circle Pines, MN: persons with developmental disabilities. Education
American Guidance Service. and Training in Developmental Disabilities, 41, 365–
Steed, S. E., & Lutzker, J. R. (1997). Using picture 381.
prompts to teach an adult with developmental Van Laarhoven, T., Van Laarhoven-Myers, T., &
disabilities to independently complete vocational Zurita, L. M. (2007). The effectiveness of using a
tasks. Journal of Developmental and Physical Disabili- Pocket PC as a video modeling and feedback
ties, 9, 117–133. device for individuals with developmental disabil-
Swan, K. O., Swan, G. M., Van Hover, S. D., & Bell, ities in vocational settings. Assistive Technology Out-
R. L. (2002). A novice’s guide to handheld com- comes and Benefits, 14(1), 28 – 45.
puting. Learning & Leading with Technology, 29, van ‘t Hooft, M., & Vahey, P. (2007). Handheld
22–27. computers in education: An industry perspective.
Taber-Doughty, T. (2005). Considering student Educational Technology, 47, 40 – 42.
choice when selecting instructional strategies: A Wechsler, D. (1997). Wechsler Adult Intelligence Scale-
comparison of three prompting systems. Research III. San Antonio, TX: Psychological Corporation.
in Developmental Disabilities, 26, 411– 432.
Taber-Doughty, T., Patton, S. E., & Brennan, S. Received: 22 February 2009
(2008). Simultaneous and delayed video model- Initial Acceptance: 20 April 2009
ing: An examination of system effectiveness and Final Acceptance: 28 July 2009

Personal Digital Assistant / 439


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 440 – 448
© Division on Autism and Developmental Disabilities

Effects of Most to Least Prompting on Teaching Simple


Progression Swimming Skill for Children with Autism
İlker Yılmaz Ferman Konukman
Anadolu University The College at Brockport, SUNY

Binyamin Birkan Mehmet Yanardağ


Tohum Autism Foundation, İstanbul Anadolu University

Abstract: Effects of most to least prompting on teaching simple progression swimming skill for children with
autism were investigated. A single subject multiple baseline model across subjects with probe conditions was
used. Participants were three boys, 9 years old. Data were collected over a 10-week with session three times a week
period using the single opportunity method as an intervention. Results indicated that all the boys increased their
simple progression swimming skill significantly during intervention phase. In addition, participants main-
tained their successful skills during first, second and fourth week of generalization phases. Results showed that
most to least prompting was an effective way of increasing and maintaining simple progression swimming skill
of children with autism.

Autism is a lifelong developmental disability having a hard time finding trained teachers to
that causes delays in verbal and nonverbal accommodate the needs of students with the
communication and social interaction as well disorder (Block, Block, & Halliday, 2006).
as exhibition of ritualistic and compulsive be- There are 1.5 million Americans who have
haviors (Loovis & Ersing, 1979). Autism is a autism and 15 million more Americans, such
brain disorder that impairs a person’s ability as family, teachers and health care workers
to communicate, form relationships, socially who are indirectly affected (Crollick, Mancil,
interact, and respond appropriately within a & Stopka, 2006).
given environment. Children with autism have several stereotyp-
Children with autism have severe communi- ical motor behaviors (e.g., swinging their bod-
cation, language, and social interaction prob- ies backward and forward, playing with their
lems compared to their nondisabled peers. fingers, moving their head in a circular mo-
Children with autism have several difficulties tion and jumping). These behaviors cause
in four general areas: Speech, language and
communication and learning problems for
communication; relating people, objects,
children with autism. However, it is possible to
events; responses to sensory stimuli; develop-
decrease these behaviors via teaching physical
mental discrepancies (Houston-Wilson &
activity and games (Leaf & McEaching, 1999;
Lieberman, 2003). Therefore, teaching games
Smith, 2001). Several studies found that phys-
and physical activity is an important necessity
ical activity interventions such as jogging, ball
to improve vital social skills of children with
autism (Leaf & McEaching, 1999; Maurice, throwing, swimming, and vigorous physical ac-
Green, & Fox, 2001). tivity reduced stereotypical motor behaviors
Autism is the fastest growing developmental (Levinson & Reid, 1993; Richmond, 2000;
disability in the nation and school districts are Yɹlmaz, Birkan, Konukman, & Erkan, 2005a).
In addition, Sherrill (2006) indicated that
some of these stereotypical behaviors can be
Correspondence concerning this article should
used to teach skills similar in behavior such as
be addressed to İlker Yımaz, Anadolu University, swimming (e.g., swinging their bodies back-
School of Physical Education & Sports, Eskisehir, ward and forward, moving arms up and
26470, TURKEY. E-mail: ilkery@anadolu.edu.tr down).

440 / Education and Training in Autism and Developmental Disabilities-September 2010


The therapeutic use of aquatic activities or for individuals with mental retardation and
swimming can promote language, self concept autism. For example, researchers have taught
and improve adaptive behaviors for children leisure skills (Vuran, 2008), learning pedes-
with disabilities. In addition, these activities trian skills (Batu, Ergenekon, Erbas, & Ak-
provide an appropriate educational setting for manoglu, 2004), food preparation skills (Kay-
many early interventions (Prupas, Harvey, & ser, Billingsley, & Neel, 1986), banking skills
Benjamin, 2006; Killian, Joyce-Petrovic, (Donnell & Ferguson, 1988), and verbal label-
Menna, & Arena, 1984; Yɹlmaz et al., 2005a). ing (Richmond & Lewallen, 1983). Conse-
Researchers have shown that children with quently, all of these studies showed that most
autism have success in aquatic activities and to least prompting method was an effective
these activities reported as enjoyable and help- intervention in teaching for individual with
ful to improve motor skills. Moreover, these disabilities.
studies indicated aquatic and swimming activ- Although there have been studies about the
ities as popular activities among the children effects of most to least prompting procedure
with autism (Campion, 1985; Dewey 1973; on different disabilities in the literature, there
Dulcy, 1992; Huetting & Darden-Melton, is no research on the effects of most to least
2004; Killian et al., 1984; Mosher, 1975; Op- prompting procedure on the simple progres-
penheim, 1977; Wing, 1976; Yɹlmaz, Birkan, sion of swimming skill for children with au-
Yanardaq̌, & Konukman, 2005b) tism. Therefore, the aim of the current inves-
Although in the past researchers have tigation was to examine the effectiveness of
shown that children with autism have normal most to least prompting procedure on the
motor development patterns, a recent study simple progression swimming skill of children
found that autistic children have very low per-
with autism who acquired mental adjustment
formance in motor skills. Therefore, it is rec-
to the water. Also, maintenance and general-
ommended that autistic children be encour-
ization effects of the procedure were assessed.
aged to participate in games and other
Simple progression swimming skill was gath-
physical activities for motor skill development
ered from the Halliwick’s method of teaching
(Smith, 2001).
swimming skills. This method was designed by
Several studies have been published where
James McMillan who taught at Halliwick
successful of teaching of individuals with au-
School for Girls in Southgate, London. The
tism or moderate to severe intellectual disabil-
Halliwick’s method is based on scientific prin-
ities play skills such as bowling has been dem-
onstrated (Zhang, Bridget, Shihui, & John, ciples of hydrodynamics and body mechanics.
2004), playing darts (Schleien, Kiernan, & Weh- It has been found to be very safe for people of
man, 1981), pinball (Hill, Wehman, & Horst, all ages, and individual with disabilities as well
1982), frisbee (Horst, Wehman, Hill, & Bailey, as for the able bodied (Martin, 1981). Swim-
1981), Also, Cameron and Capello (1993) mers trained on a one-to-one ratio of instruc-
taught specific sport skills to individuals with tor until complete independence achieved.
autism or severe intellectual disabilities. More- The swimmer-instructor pair becomes a unit
over, a recent study revealed that most to least within a group activity so that the swimmer
prompting was an effective method in teach- gains the advantages of social interaction with
ing leisure skills to an adult with autism (Vu- his peers while at the same time enjoying the
ran, 2008). unobtrusive but constant attention of an indi-
Most to least prompting is an errorless vidual instructor. Groups became aware of
teaching technique that requires giving the properties and behavior of water and how to
strongest prompt for the student to respond control their own specific balance problems.
correctly. When the student starts to perform Swimmers disengaged from instructor when
skills independently from the provider, the they learned initial mental adjustment to the
strength of the prompt is decreased. Thus, the water and balance control principles learned.
student becomes independent from the cues This method provides a sport, recreation and
(Tekin & Kircaali-Iftar, 2001). There are sev- exercise as wells as an opportunity for friend-
eral studies indicated that most to least ship, equality, and competition. The Halli-
prompting was an effective teaching method wick’s method has ten stages and divided into

Most to Least Prompting / 441


TABLE 1 pated in an early special education program
when he was 4 –5 years old. In addition, he
Stages of The Halliwick’s Swimming Method
had an individual special education service
four times a week when he was 6 year old. At
Phases Skills Purpose
the time of the study, Soner had been a main-
Phase 1 Mental adjustment Adjustment to the stream student at a public school for a year.
Disengagement water He had reading, writing, and all simple math-
Phase 2 Vertical rotation Rotations in the water ematical skills. Similar to other participants
Lateral rotation Soner had problems in social interaction,
Combined rotation communication, and language skills. None of
Phase 3 Up thrust Control of movement the participants had any systematic interven-
Balance in the water tion in most to least prompting method prior
Turbulent gliding
to the study.
Phase 4 Simple progression Movement in the
Basic progression water
Trainers
The intervention phase was applied by three
four phases. Table 1 shows phases of the Hal- researchers. Researchers had degrees in spe-
liwick’s method of teaching swimming skills. cial education and physical therapy with prior
research experience in special education.
Method
Settings
Participants
All instructional, probe, maintenance and
Three boys with autism, ages 9 years, partici- generalization sessions occurred at the An-
pated. Three prerequisite conditions were es- adolu University indoor swimming pool. The
tablished for participants applying three swimming pool was divided into two parts with
phases of the Halliwick’s method before the a rope. At the beginning, all students partici-
study: 1) Adjustment to water skills, 2) Ability pated in fun water activities (e.g. jumping,
to use rotations skills in the water, 3) Control splashing water, and walking hand by hand)
of movement in water skills. All participants with instructors on the right side of the pool.
met these criteria. The names of participants Each student then was transferred individually
were given pseudonymously in the study. to the left side of the pool for instruction and
Ömer was a 9 year old boy with autism. He intervention. In addition, all sessions occurred
participated in an early special education pro- in a one-to-one format for 10 weeks, three
gram when he was 3–5 years old. In addition, times a week, between 7:30 am and 8:30 am.
he had an individual special education service There was also a writing board at the swim-
twice a week when he was 6 years old. At the ming pool.
time of the study he was being mainstreamed
student at a public school for the past three
Materials
years. Ömer had reading, writing, and simple
mathematical skills. However, he had diffi- No special equipment was used during the
culty in social interaction, communication study. However, a video recorder, video tapes,
and use of appropriate language skills. data collection forms, a writing board and
Yener was a 9 year old boy with autism. He pencil were employed to collect data. Social
also participated in an early special education reinforcers were used for motivational pur-
program when he was 4 –5 years old. Yener poses (e.g., free time game activities, jumping
also is mainstream student at a public school in the water up ward).
for two years, and he had reading, writing, and
simple mathematical skills. He also had prob-
Screening Procedure for Target Behaviors
lems in communication and language skills.
Soner was a 9 year old boy with autism and The main purpose of this study was to teach
he is the twin brother of Yener. He partici- simple progression swimming skill for chil-

442 / Education and Training in Autism and Developmental Disabilities-September 2010


dren with autism. Therefore, this skill was se- when he initiated the correct steps in 5-s and
lected as a main task from the Halliwick’s kept it 15-s. Incorrect responses were defined
method of teaching swimming (Martin, 1981). as not initiating a step in 5 s, initiating but not
Each child trained on water adjustment skills completing in 15-s, and initiating an incorrect
before the implication of study. step of the task analysis is not considered. In
addition, if the first response was incorrect
then the rest of steps in the task analysis were
Experimental Design and Procedure
recorded as incorrect (Wolery, Ault, & Doyle,
A multiple baseline design across subjects was 1992).
used to determine the effectiveness of the
most to least prompting (Alberto & Trout-
Most to Least Prompting Instructional (B)
man, 1995; Tawney & Gast, 1984).
Conditions
A 1 to 1 instructional format was used dur-
ing all experimental sessions. There were There are three stages in application of most
probe, probe, maintenance, and generaliza- to least prompting. In the first stage, physical
tion sessions in the study. Trainer and partic- cues and verbal direct prompts were provided.
ipants were face to face in all sessions, and all Trainer says how to do this stage to subject as
participants were ready in the pool before the well as a physical cue such as “Lay back now”
start of the study. and trainer provides support with his hands
from student’s back. In addition, trainer gives
verbal reinforcement like “Good Job” and as
Baseline (A) Conditions
soon as task is over another step starts. Trainer
A probe condition was implemented before says “Okay, let’s go on. Now, stick your fingers
the training of the target behavior, and after together and place your arms to your side”
the criterion was reached in training of that with a physical assistance to subject. Verbal
target behavior for a minimum of three probe reinforcement provided when subject com-
sessions. Probe sessions occurred prior to pleted his task correctly in 100%. In second
training target behavior and after the crite- stage, verbal directed prompt and gesture-
rion was met for that target behavior. Each mimic prompt provided. Trainer provides ver-
probe condition had a minimum of three con- bal cues and reinforces every step in 5 s. The
sistent probe sessions. third stage started when the participant could
A single opportunity procedure was used complete his task at 100% correct. In the final
during all probe sessions. The trainer pre- stage, only verbal cues were provided and par-
sented the task direction and recorded the ticipant asked to swim such as “Ömer let’s
participants response to steps of the task anal- swim” to get attention of subjects during
ysis. When the subject initiated an incorrect teaching sessions. Training session was ended
response, performed an incorrect response or when subject completed all steps successfully
no response, he was interrupted by the at the end of the final stage.
teacher and the subject’s response was re- There were five types of subject responses
corded as a minus (⫺) and the rest of the during instructional sessions: correct response
steps in the task analysis were recorded as before cueing; correct response after cueing,
incorrect. When a participant performed a wrong response before cueing, wrong re-
correct step he got a plus (⫹) (Brown & Snell, sponse after cueing, and no response. Correct
2000). For example, the trainer took his place response before cueing was defined as com-
in the pool and said, “Soner, are you ready to pleting a step of the task correctly within 5-s
perform simple progression movement in the after the prompt. Correct response after cue-
water?” to get his attention. Once an affirma- ing was defined as attempt to completing a
tive verbal or physical response was received, step of task correctly within 5-s after the
the trainer delivered the task direction, “Do prompt and completing it within 5-s. During
the simple progression movement in the wa- teaching sessions correct responses recorded
ter.” Then the trainer waited 5-s for the par- as a plus (⫹) and other responses were re-
ticipant to initiate a response. The child was corded as a minus (⫺). All correct responses
reinforced with a descriptive verbal phrase were before after cueing reinforced to com-

Most to Least Prompting / 443


plete other steps (Tekin & Kɹrcaali-İftar, sulted in an overall percentage of 95% (80%
2001). to 100%) during instruction for Soner. Also,
this teacher implemented maintenance and
generalization sessions with 100% accuracy.
Reliability
Reliability data were collected during at least
Maintenance and Generalization Sessions
35% of all the experimental sessions. Inter-
observer reliability was calculated by using Maintenance sessions were collected two, and
point by point method with a formula of the four weeks after the instruction had stopped.
number of agreements divided by the number Maintenance data showed that the partici-
of agreements plus disagreements multiplied pants maintained the rotation skills taught to
by 100 (Tawney & Gast, 1984). them at criterion level one, two, and four
The mean percent of the inter-observer weeks after the instruction. Generalization
agreement for the simple progression skill across persons was examined by a pre-post test
during baseline was 98% (90% to 100%); dur- design. These sessions occurred before train-
ing instruction was 93% (80% to 100%); ing and at the end of teaching the simple
during maintenance was 100% and during swimming skills. Generalization sessions were
generalization was 96% (90% to 100%). Inde- identical baseline but in another settings. One
pendent variable reliability (procedural reli- to one teaching arrangement and single op-
ability) was calculated by dividing the number portunity methods were used during both
of teacher behaviors observed by the number maintenance and generalization. Generaliza-
of teacher behaviors planned and multiplied tion data showed that all participants retained
by 100 (Billingsley, White, & Munson, 1980). the simple swimming skills taught to them
The following teacher behaviors were ob- across people 100%.
served for procedural reliability during train-
ing session: (a) having the materials ready, (b)
Results
securing the participants attention, (c) deliv-
ering the task direction, (d) delivering the
Most to Least Prompting Instructional Data
controlling prompt in time (if appropriate),
(e) waiting for the response interval, (f) deliv- Table 2 shows instructional data for each stu-
ering the correct behavioral consequences, dent through the criterion. Ömer, Yener, and
(g) waiting for the inter-trail interval. The Soner needed 9 training sessions to reach cri-
same steps were observed during probe, main- terion on simple progression swimming skill.
tenance, and generalization sessions except Baseline and training data for Ömer, Yener
for delivery of control prompts. and Soner shown in Figure 1 respectively.
Procedural reliability measures resulted in The open circles represent the percentage
an overall percentage of 100% during base- of correct responding during full baseline and
line for Ömer. Procedural reliability measures insturtional sessions, maintenance and gener-
resulted in an overall percentage of 96% (87% alization session. As seen in Figure 1, all sub-
to 100%) during instruction for Ömer. This jects meet criteria after the introduction of
teacher implemented maintenance and gen- most to least prompting. This data showed
eralization sessions with 100% accuracy for that most-to-least prompting was effective on
Ömer. Procedural reliability measures re- teaching simple progression swimming skill
sulted in an overall percentage of 100% dur- for children with autism.
ing baseline for Yener. Procedural reliability Ömer, Yener, Soner performed no correct
measures resulted in an overall percentage of responses during the baseline sessions. When
98% (86% to 100%) during instruction for instruction of the simple progression using
Yener. This teacher implemented mainte- “physical prompt and verbal prompt” started,
nance and generalization sessions with 100% they performed with 100% accuracy in the
accuracy for the lateral rotation skill. Finally, first three session, and continued the perfor-
procedural reliability measures resulted in an mance (100 %) while using “verbal and ges-
overall percentage of 100% during baseline ture/prompt” in sessions 4, 5, 6. All subjects’
for Soner. Procedural reliability measures re- performance continued 100% in sessions 7, 8,

444 / Education and Training in Autism and Developmental Disabilities-September 2010


TABLE 2

Instructional Data for Each Student through Criterion

Students Behaviors Thru Criterion Number of Sessions

Ömer Simple progression Physical ⫹ Verbal Prompt 3


Verbal ⫹ Gesture/Mimic Prompt 3
Verbal Prompt 3
Total 9
Yener Simple progression Physical ⫹ Verbal Prompt 3
Verbal ⫹ Gesture/Mimic Prompt 3
Verbal Prompt 3
Total 9
Soner Simple progression Physical ⫹ Verbal Prompt 3
Verbal ⫹ Gesture/Mimic Prompt 3
Verbal Prompt 3
Total 9

9 while using only “verbal prompt.” During can be concluded that all participants re-
the maintenance and generalization sessions ceived the same amount of sessions and all
he continued to perform the skill with 100% subjects did not have any error in their per-
accuracy. formance during the intervention. Consider-
ing the difficulties subjects such as attention
and communication skills, this study proved
Discussion
that most to least prompt was an effective
The main purpose of this study was to deter- procedure to teach the simple progression
mine the effects of most to least prompting on swimming skill. Moreover, procedural reliabil-
the simple progression swimming skills for ity measures showed that all teachers applied
children with autism. In addition, generaliza- most to least prompting procedure consis-
tion and follow up data was collected. Results tently between 87%–100%. In the literature it
of the study were analyzed using graphic illus- is recommended that procedural reliability
trations. Results indicated that all subjects in- which is minimally 80% and above 90% is
creased their correct target skills in simple highly regarded (Wolery, Bailey, & Sugai,
progression swimming skills with a significant 1988). This study also showed that procedural
amount during the intervention phase. More- reliability was high for teachers during the
over, subjects maintained their successful sim- sessions. As a result, it can be concluded that
ple progression skills during the first, second, all teachers effectively applied the procedures
and fourth weeks of generalization phases. of most to least prompting to teach the simple
Literature review proved that most to least progression swimming skill for children with
prompting method is an effective intervention autism. Also all participants performed this
to teach leisure skills to an adult with autism skill very well in early sessions with this inter-
(Vuran, 2008), learning pedestrian skills vention in a limited time. Therefore, this pro-
(Batu et al., 2004), food preparation skills cedure is highly recommended for further re-
(Kayser et al., 1986), banking skills (Donnell search attempts.
& Ferguson, 1988), teaching verbal labels The present study has two important con-
(Richmond & Lewallen, 1983). Consequently, tributions to literature: 1) support of the liter-
similar to these findings, this study demon- ature that most to least prompting was an
strated that most to least prompting was an effective method to teach certain tasks to in-
effective method to teach and maintain a sim- dividuals with disabilities: 2) first research at-
ple progression swimming skill to children tempt to determine the effects of most to least
with autism. procedure on simple progression swimming
Based on the graphic illustration of data, it skill for children with autism.

Most to Least Prompting / 445


Figure 1. Percentage of correct responses after the prompt for simple progression swimming skill during full
probe, instructional, maintenance, and generalization probe sessions. Closed circles represent
correct responses during full probe, instructional, and maintenance sessions. Open circles repre-
sent correct responses during generalization sessions.

446 / Education and Training in Autism and Developmental Disabilities-September 2010


Data from this study resulted in several rec- (Eds.), Instruction of students with severe disabilities
ommendations for future research. First, 1 to (5th ed., pp. 173–206). Columbus, OH: Merrill.
1 teaching arrangement and single opportu- Cameron, M. J., & Capello, M. J. (1993). We’ll cross
nity method to teach simple progression swim- that hurdle when we get to it. Teaching athletic
ming skill was used. The findings from this performance within adaptive physical education.
Behavior Modification, 17, 136 –147.
study can be replicated using instructional
Campion, R. M. (1985). Hydrotherapy in pediatrics.
group arrangements and other instructional
London: William Heinemann Medical Books,
methods such as cooperative learning, direct Inc.
instruction, peer tutoring, class wide peer tu- Crollick, J. L., Mancil, G. R., & Stopka, C. (2006).
toring. Second, simple progression swimming Physical activity for children with autism spec-
skill was selected from the Halliwick’s swim- trum disorders. Teaching Elementary Physical Educa-
ming education program (Martin, 1981). tion, 17, 30 –34.
Thus, all children became ready to participate Dewey, M. (1973). Recreation for autistic and emo-
and learn actual swimming skill patterns. tionally disturbed children. Rockville, MD: Na-
Therefore, it is recommended to teach differ- tional Institute of Mental Health (ERIC Docu-
ent swimming skills, and educational games to ment Reproduction Service No. ED 0940495).
children with autism for future experimental Dulcy, F. H. (1992). An integrated developmental
research. Third, trainers reported that all chil- aquatic program (IDAP) for children with autism.
National Aquatics Journal, 8, 7–10, 16.
dren enjoyed this aquatic drill during all ses-
Hill, J. W., Wehman, P., & Horst, G. (1982). Toward
sions, and improved their social and commu-
generalization of appropriate leisure and social
nication skills with peers in comparison to behavior in severely handicapped youth: Pinball
their out of pool behaviors. Fourth, most im- machine use. The Journal of the Association for the
portant, trainers witnessed that autistic chil- Severely Handicapped, 6, 38 – 44.
dren had less stereotypical autistic motor be- Horst, G., Wehman, P., Hill, J. W., & Bailey, C.
haviors (e.g., swinging their bodies backward (1981). Developing age appropriate leisure skills
and forward, playing fingers, moving head in a in severely handicapped adolescents. Teaching Ex-
circular motion and, jumping) in the water ceptional Children, 14, 11–16.
during training. Huetting, C., & Darden-Melton, B. (2004). Acquisi-
As a result, findings of this research re- tion of aquatic skills by children with autism.
vealed that most to least prompting is an ef- Palestra, 20, 20 –25, 45– 46.
fective and applicable method of increasing Houston-Wilson, C., & Lieberman, L. J. (2003).
Strategies for teaching students with autism in
and maintaining a simple swimming skill for
physical education. Journal of Physical Education,
children with autism. Also, it is reasonable
Recreation & Dance, 74, 40 – 44.
that teachers can teach many different activi-
Kayser, J. E., Billingsley, F. F., & Neel, R. S. (1986).
ties using this simple progression swimming A comparison of in-context and traditional in-
skill. structional approaches: Total task, single trial ver-
sus backward chaining, multiple trials. Journal of
the Association for Persons with Severe Handicaps, 11,
References 28 –38.
Killian, Joyce-Petrovich R, A., Menna, L., & Arena, S.
Alberto, P. A., & Troutman, A. C. (1990). Applied (1984). Measuring water orientation and begin-
behavior analysis for teachers. New York: McMillan. ner swim skills of autistic individuals. Adapted Phys-
Batu, S., Ergenekon, Y., Erbas, D., & Akmanoglu, N. ical Activity Quarterly, 1, 287–295.
(2004). Teaching pedestrian skills to individuals Leaf, R., & McEaching, J. (1999). A work in progress:
with developmental disabilities. Journal of Behav- Behavior management strategies and a curriculum for
ioral Education, 13, 147–164. intensive behaviors treatment of autism. New York:
Block, E. M., Block, E. V., & Halliday, P. (2006). DRL Books.
What is autism? Teaching Elementary Physical Edu- Levinson, L. J., & Reid, G. (1993). The effects of
cation, November, 7–11. exercise intensity on the stereotypic behaviors of
Billingsley, F., White, O. R., & Munson, R. (1980). individuals with autism. Adapted Physical Education
Procedural reliability: A rationale and an exam- Quarterly, 10, 255–268.
ple. Behavioral Assessment, 2, 229 –241. Loovis, E. M., & Ersing, W. F. (1979). Assessing and
Brown, F., & Snell, M. E. (2000). Measurement, programming gross motor development for children.
analysis, and evaluation. In M. E. Snell & F. Brown Cleveland Heights, OH: Ohio Motor Assessment.

Most to Least Prompting / 447


Martin, J. (1981). The Halliwick Method. Physiother- yanlis᝺siz öǧretim yöntemleri (Errorless learning pro-
apy, 67, 288 –291. cedures in special education). Ankara: Nobel
Maurice, C., Green, G., & Fox, R. M. (2001). Making Yayɹnevi.
a difference: Behavioral intervention for autism. Aus- Vuran, S. (2008). Empowering leisure skills in
tin, TX: ProEd. adults with autism: An experimental investigation
McDonnell, J., & Ferguson, B. (1988). A compari- through the most to least prompting procedure.
son of time delay and decreasing prompt hierar- International Journal of Special Education, 23, 174 –
chy strategies in teaching banking skills to stu- 181.
dents with moderate handicaps. Journal of Applied Wing, L. (1976). Diagnosis, clinical description and
Behavior Analysis 22, 85–91. prognosis. In L. Wing (Ed.), Early childhood autism.
Mosher, R. (1975). Perceptual-motor training and New York: Pergamon Press.
the autistic child. Journal of Leisurability, 2, 29 –35. Wolery, M., Ault, M. J., & Doyle, P. M. (1992).
Oppenheim, R. C. (1977). Effective teaching methods Teaching students with moderate to severe disabilities:
for autistic children. Springfield, II: Thomas. Use of response prompting strategies. New York: Long-
Prupas, A., Harvey, W. J., & Benjamin, J. (2006).
man Publishing Group.
Early intervention aquatics: A program for chil-
Wolery, M., Bailey, D. B., & Sugai, G. M. (1988).
dren with autism and their families. Journal of
Effective teaching: Principles and procedures of applied
Physical Education, Recreation & Dance, 77, 46 –51.
behavioral analysis with exceptional students. Boston:
Richmond, G., & Lewallen, J. (1983). Facilitating
Allyn and Bacon.
transfer of stimulus control when teaching verbal
Zhang, J., Bridget, C., Shihui, C., & John, L. (2004).
labels. Education and Training of the Mentally Re-
The effect of a constant time delay procedure on
tarded, 18, 111–116.
Richmond, L. (2000). The effect of physical activity on teaching an adult with severe mental retardation
stereotypical behavior of autistic children. Unpub- a recreation bowling skill. The Physical Educator,
lished doctoral dissertation, Texas A & M Univer- 61, 63–74.
sity, Commerce. Yɹlmaz, İ., Birkan, B., Konukman, F., & Erkan, M.
Smith, M. J. (2001). Teaching play skills to children with (2005a). Using a constant time delay procedure
autistic spectrum disorder. New York: DRL Books. to teach aquatic play skills to children with au-
Schleien, S. J., Kiernan, J., & Wehman, P. (1981). tism. Education and Training in Developmental Dis-
Evaluation of an age-appropriate leisure skills abilities, 40, 171–182.
program for moderately retarded adults. Educa- Yɹlmaz, İ., Birkan, B., Yanardaq̌, M., & Konukman,
tion and Training of the Mentally Retarded, 16, 13– F. (2005b). The effects of progressive time delay
19. procedure on teaching basic progression swim-
Sherill, C. (2006). Adapted physical education and rec- ming skills for children with autism. Research
reation; A Multidisciplinary Approach (6th ed.) New Quarterly for Exercise & Sport, 76 (1), (Supple-
York: McGraw Hill. ment), A-119.
Tawney, J. W., & Gast, D. L. (1984). Single subject
research in special education. Columbus, Ohio: Bell Received: 8 January 2009
and Howell. Initial Acceptance: 12 March 2009
Tekin, E., & Kɹrcaali-İftar, G. (2001). Özel eq̌itimde Final Acceptance: 2 June 2009

448 / Education and Training in Autism and Developmental Disabilities-September 2010


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 449 – 458
© Division on Autism and Developmental Disabilities

Effects of the TOUCHMATH Program Compared to a


Number Line Strategy to Teach Addition Facts to Middle
School Students with Moderate Intellectual Disabilities
Dale Fletcher and Richard T. Boon
The University of Georgia
David F. Cihak
The University of Tennessee

Abstract: The purpose of this study was to systematically replicate and extend previous studies of the
TOUCHMATH program, a multi-sensory mathematics program (Bullock, Pierce, & McClellan, 1989). Three
middle school students with moderate and multiple disabilities (e.g., autism and moderate intellectual
disabilities) participated. Students were taught how to solve single-digit mathematics problems using TOUCH-
MATH and a number line. An alternating-treatments design across participants (Barlow & Hersen, 1984)
was utilized to evaluate and compare the effects of both strategies. Results indicated that the TOUCHMATH
strategy was more effective and efficient in teaching students’ single-digit addition problems compared to the use
of the number line. Limitations of the study, implications for practice for classroom teachers, and suggestions
for future research are discussed.

Many students with disabilities at the middle problem-solving activities (Mastropieri, Scruggs,
school level, particularly those with moderate & Shiah, 1997; Morin & Miller, 1998). For
intellectual disabilities have difficulty meeting example, students with moderate intellectual
the curriculum demands in content-area class- disabilities are less proficient and use less ef-
rooms such as mathematics instruction (see fective strategy instruction in completing and
Browder & Grasso, 1999; Browder, Spooner, solving mathematics problems than their “typ-
Ahlgrim-Delzell, Harris, & Wakeman, 2008; ically” functioning peers (Goldman, Pelle-
Butler, Miller, Kit-hung, & Pierce, 2001; Jiten- grino, & Mertz, 1988). However, performing
dra & Xin, 1997; Kroesbergen & Van Luit, basic computational mathematics is essential
2003; Mastropieri, Bakken, & Scruggs, 1991; for student success and to foster independent
Miller, Butler, & Lee, 1998; Swanson & Jer- living skills. Acquiring these computational
man, 2006, Xin & Jitendra, 1999; for reviews). skills for many students with moderate intel-
Specifically, students with moderate intellec- lectual disabilities may require the use of ma-
tual disabilities frequently have difficulties nipulatives.
with mathematics, including basic skills (Nes-
Using manipulative materials has been used
bitt-Vacc & Cannon, 1991; Podell, Tournaki-
to assist in teaching basic computational math-
Rein, & Lin, 1992; Luit & Naglieri, 1999;
ematics skills for students with moderate intel-
Young, Baker, & Martin, 1990), money applica-
lectual disabilities. For instance, Burns (1996)
tions (Test, Howell, Burkhart, & Beroth, 1993;
indicated that manipulative materials were
Fredrick-Dugan, Test, & Varn, 1991; Sand-
used at all levels and that teachers could not
knop, Schuster, Wolery, & Cross, 1992), and
teach without them. There are various ma-
nipulatives that are used in teaching basic
computational mathematics skills. For exam-
Correspondence concerning this article should
be addressed to Richard T. Boon, The University of ple, one widely used mathematics strategy to
Georgia, Department of Communication Sciences teach mathematics is the number line (Ernest,
& Special Education, 537 Aderhold Hall, Athens, 1985). Copeland, Hughes, Agran, Wehmeyer,
GA 30602-7153. Email: rboon@uga.edu and Fowler (2002) used a number line and

Touch Math and Number Lines / 449


systematic instruction to teach four students were taught the touch-points strategy for
with moderate intellectual disabilities to addition and subtraction problems within a
match numbers at the secondary level. The multiple-probe design across mathematics
use of a number line is one multi-sensory ap- skills. The target skills were adding two-digit
proach to teach addition utilizing a count-all numbers with regrouping, adding columns
to count-on approach (Secada, Fuson, & Hall, of two-digit numbers with regrouping, and
1983). In counting-all, entities must be subtracting single-digits up to 18, subtract-
present for each addend, and students count ing two-digit numbers with regrouping, and
all the entities. For instance, students begin subtracting three digit numbers with re-
counting “one” and count to “m ⫹ n.” Where grouping. Results indicated that all three
as counting-on, the student begins with “m” participants were successful in using the
and continues counting on “m ⫹ n” (Secada
TOUCHMATH program. In another study,
et al., 1983). For example, if a student was
Simon and Hanrahan (2004) utilized the
given the following problem 4 ⫹ 5, the stu-
TOUCHMATH program to evaluate the
dent would start counting-on from four and
learning of addition computational skills
say, “five, six, seven, eight, and nine.”
Another type of manipulative strategy for with students with learning disabilities.
teaching computational mathematics skills Three students with learning disabilities in
is the use of a “dot-notation” as a represen- mathematics instruction were examined to
tative approach. Kramer and Krug (1973) see if they could be taught three-row, dou-
introduced the dot-notation approach for ble-digit addition problems using the dot-
teaching mathematics skills to students with notation method. Results revealed that the
disabilities, which students begin learning to students were able to learn and apply the
count-all, and progress to using the count- dot-notation method and were able to retain
ing-on approach. Kokaska (1975) examined the method from 6 weeks and 18 weeks after
the effectiveness of the dot notation system completing instruction.
with four students with mild disabilities. With different manipulative materials avail-
These students were pre-tested in their ad- able, the suitability of a particular manipula-
dition and subtraction skills. Two of the stu- tive is a concern, especially if a student is
dents were unable to independently com- dependent upon a manipulative system to
plete any problems, while the other two complete computational problems later in life
students were only able to complete a partial (Kramer et al., 1973). To date, there are a
number of the problems. Then, these stu- limited number of studies involving students
dents were taught the dot-notation system with moderate and multiple disabilities using
for solving addition and subtraction prob- a dot-notation method. Moreover, previous
lems. Results showed that two of the four studies have only included elementary-aged
students were able to solve addition prob-
students and no studies using the dot-notation
lems ranging from single-digits to a combi-
strategy in the middle school grades were
nation of two or more digits. Moreover, stu-
found.
dents solved problems accurately if the
Therefore, the purpose of this study was to
problems were presented either horizontally
replicate and extend on the use of the “touch
or vertically. These results support the use of
multi-sensory manipulative programs such point” strategy to teach addition problem-solv-
as the TOUCHMATH program. ing skills to students with moderate intellec-
The TOUCHMATH Program (Bullock et tual disabilities at the middle school level. In
al., 1989) which is similar to that of the addition, a secondary purpose of this study
dot-notation introduced by Kramer and was to compare the effectiveness and effi-
Krug (1973) was used with large numbers of ciency of touch points and number lines for
students in the general education class- teaching single-digit addition problems to de-
room. Scott (1993) examined the use of the termine if there are functional differences be-
TOUCHMATH program with elementary stu- tween the two strategies for students with
dents with mild disabilities in the fourth moderate intellectual disabilities (e.g., autism
grade. Three students with mild disabilities and moderate intellectual disabilities).

450 / Education and Training in Autism and Developmental Disabilities-September 2010


Method Behavior Scale were also in the low range as her
standard scores of adaptive skills were as fol-
Participants and Setting lows: Communication, 54; Daily Living Skills, 52;
Socialization, 89; Motor Skills, 49; and Composite,
The sample consisted of three middle school 56. Ashley was not currently taking any medi-
students with moderate intellectual disabili- cations; however, based on her last IEP, she
ties. Two of the students were diagnosed with was functioning approximately in the lower
autism in addition to having a moderate intel- first grade level in mathematics. Moreover,
lectual disability. Formal educational assess- Ashley had a mild articulation disorder and
ments were conducted on these two students, received speech and language services and
particularly with autism, as well as the local also displayed deficits in writing (i.e., poor
educational agency’s school psychologist graph-motor control) and had problems with
within four years preceding the study. The her short-term attention abilities.
teacher participating in the study had three Robert. Robert was a 13-year-old male in
years of teaching experience in a self-con- the seventh grade and according to the Stan-
tained special education classroom working ford-Binet Intelligence Scale–Fourth Edition
with students with mild to moderate intellec- (Thorndike, Hagan, & Sattler, 1986) his
tual disabilities, while the paraprofessional scores showed the following: Verbal Reasoning,
had four years experience in an early educa- 70; Visual Reasoning, 63; Quantitative Reasoning
tion classroom setting and one year in a self- 66; Short-Term Memory, 49; and Test Composite,
contained special education classroom envi- 54. As indicated by his Peabody Picture Vocabu-
ronment. The study was conducted within a lary Test-R scores, Robert was within the mod-
self-contained classroom, which instruction erate intellectual disability range. Robert was
commonly occurred for these students. All the also administered the Gilliam Autism Rating
students demonstrated the prerequisite skills Scale (Gilliam, 1995) and was diagnosed with
of counting and writing to 20. autism. The scores from the Gilliam Autism
Ashley. Ashley was a 13-year-old female in Rating Scale (GARS) are as follows: Stereotyped
the sixth grade that on the Wechsler Intelligence Behaviors, 8; Communication 9; Social Interaction,
Scale for Children – WISC IV (Wechsler, 1991) 8; Developmental, 9; and Autism Quotient, 85.
had a Full Scale IQ score of 40 and was diag- Additionally, his scores from the Vineland
nosed with a moderate intellectual disability. Adaptive Behavior Scale were in the low range,
Ashley’s Verbal Comprehension and Perceptual as average scores range from 85–115 and his
Reasoning were also below average, as her stan- standard scores of adaptive skills were as fol-
dard scores were 53 and 47, respectively. Also, lows: Communication, 53; Daily Living Skills, 44;
her Working Memory and Processing Speed were Socialization, 64; and Composite, 50. Prior to
likewise far below average with a standard beginning the study, Robert could only add
score of 50. According to her Peabody Picture single-digit addition problems that involved
Vocabulary Test-4 scores, her receptive lan- one as one of the numbers. Robert was also
guage skills were also very low with a standard Hearing Impaired and used two hearing aides
score of 50; similarly Ashley’s expressive lan- and was not currently taking any medications.
guage skills on the Expressive One-Word Picture Ken. Ken was a 14-year-old male in the
Vocabulary Test were below average with a stan- eighth grade and had a Full Scale IQ score of
dard score of 48. In addition, Ashley’s basic 45 on the Wechsler Intelligence Scale for Children
academic skills were also well below average, – WISC III (Wechsler, 1991), which suggested
specifically her phonemic decoding skills were he had a moderate intellectual disability.
below average on the WJ-III Word Attack subtest Ken’s Verbal Comprehension and Perceptual Rea-
with a standard score of 31, word identifica- soning were also below average, as his standard
tion skills on the WJ-III Letter-Word Identification scores were 55 and 53, respectively. Also, his
Test with a standard score of 37, and finally on Working Memory and Processing Speed were like-
the WJ-III Spelling and Calculation subtests, with wise far below average with standard scores of
standards scores of 36 and 7, respectively, 56 and 53, respectively. Similar to Ashley, ac-
which were both well below average. Further- cording to Ken’s Peabody Picture Vocabulary
more, her scores from the Vineland Adaptive Test-4 scores, his receptive language skills were

Touch Math and Number Lines / 451


also extremely low with a standard score of 60. placement on the sheets. While similar prob-
Ken was also administered the Childhood Au- lems were presented on both Forms A and B,
tism Rating Scale (Schopler, Reichler, & Ren- the same worksheet was never presented to
ner, 1988) and was diagnosed with moderate the students twice during the intervention
autism, with a standard score on the (CARS) phases.
of 31. In addition, his scores from the Vineland
Adaptive Behavior Scale were in the low range,
Data Collection and Experimental Research
as his standard scores of adaptive skills were as
Design
follows: Communication, 72; Daily Living Skills,
65; Socialization, 66; and Composite, 66. Prior to The data collection procedures for each ses-
the study, Ken was unable to add single-digit sion consisted of the permanent product re-
addition problems independently during cording from each of the three students. In
mathematics instruction. Lastly, Ken was tak- order to calculate the student’s percentage of
ing Stratera 40mg once a day for his attention correct mathematics problems, each of the
deficit disorder (ADD). sessions were calculated by taking the number
of correct mathematics problems completed
independently and dividing by the total num-
Materials
ber of problems presented to calculate the
The materials used in this study consisted of total number of problems completed correctly
two forms, Form A and Form B, of which each for each of the sessions. The criterion for
form contained 10 single-digit addition math- acquisition of the student’s performance of
ematics problems. Form A consisted of the the mathematics problem-solving was 100%
TOUCHMATH (Bullock et al., 1989) single- correct for three consecutive sessions. The
digit addition problems worksheets with the strategy to first achieve criterion was then rep-
“touch points” presented on the numbers, licated using the content from the strategy
while Form B contained the opposite prob- that did not meet criterion. An alternating-
lems and in a different order on the page for treatments design (Barlow & Hersen, 1984)
use with the number line strategy. For in- was used to examine and compare the differ-
stance; if Form A had the problem 5 ⫹ 8, then ential effects of the TOUCHMATH program
Form B presented the problem as 8 ⫹ 5 lo- using “touch points” and the number line
cated in a different order of the worksheet. A strategy on the acquisition of mathematics
number line with numbers from 0 to 20 also performance for each of the three students.
was used.
Procedure
Dependent and Independent Variables
Baseline. In the baseline phase, the stu-
The dependent variable was the percentage of dents were provided a worksheet with 10 sin-
single-digit mathematics problems performed gle-digit addition mathematics problems to
correctly by the three students, while the in- complete. During this phase, the probe was
dependent variables were the use of the completed when the students answered all 10
TOUCHMATH program using “touch points” of the mathematics problems or if there were
and the number line strategy. There were two no written response on the worksheet after a
mathematics worksheets with different single- period of 15 minutes from the student. In this
digit mathematics problems of similar diffi- phase, the students also did not receive any
culty. Also, the worksheets (both Form A and additional teacher assistance, as they com-
B) presented single-digit addition problems pleted the worksheet. In addition, before pro-
presented vertically with comparable prob- ceeding to the intervention phases, a mini-
lems for the students to solve. For example, if mum of three consecutive sessions of stable
worksheet Form A had 3 ⫹ 5 then worksheet, data collection were required for all three
Form B had 5 ⫹ 3 except in a different order students.
on the page that was semi-randomly assigned. Intervention procedures. During both inter-
Every effort was made to ensure that the prob- ventions, the TOUCHMATH program using
lems were not situated in the same order or “touch points” and the use of the number line

452 / Education and Training in Autism and Developmental Disabilities-September 2010


strategy, the students were seated at their mented first or second during the testing ses-
desks with the instructor in their classroom. sions. Students completed one mathematics
An adapted model-lead-test procedure (Ad- worksheet with the 10 single-digit addition
ams & Engelmann, 1996) was utilized to teach mathematics problem per session using either
the students how to use the “touch points” the “touch points” or number line strategy.
and number line strategy. In this procedure, Sessions ranged from 5 to 15 minutes. In ad-
the teacher modeled the correct responses, dition, students received verbal praise for cor-
lead the students by having them state the rect responses. However, if a student required
correct responses with the teacher, and then assistance, a least-to-most prompt hierarchy
tested them by having the student indepen- was used until the students provided a re-
dently state the correct responses. In the first sponse without assistance using a 10-second
three sessions following the baseline phase, interval between each prompt level (a) verbal
the teacher provided model training sessions. prompting, (e.g. “Do you see what numbers
During the “touch point” instruction, the stu- need to be added? Do you see the number
dents were explicitly and directly instructed line? Do you see the touch points?”), (b) fol-
on the dot-notation positions of the numbers lowed when needed by gesturing (e.g. point-
1 through 9, using the TOUCHMATH pro- ing to the first number on the number line or
gram. Then, the teacher provided the stu- touch points after the verbal prompting has
dents with one worksheet per session of 10 received a response with no further actions
single-digit addition problems with illustrated from the student), and (c) modeling or dem-
“touch points”, which consisted of numbers onstrating (ensuring the students repeated
with single or double black dots on the work- what the teacher said and pointed and stated
sheets. The students were instructed to count the number and counted correctly).
aloud the number of dots, while touching Replication. During the replication phase,
each dot, of both numbers (count-all) and the first strategy to achieve the criterion was
then write the last number they had stated. then replicated using the content from the
During the number line strategy instruction nonpreferred strategy. The criterion was an-
condition, the teacher provided the students swering problems with 100% accuracy for
with a number line from 0 to 20. Students three consecutive sessions.
were asked to place their fingers on the num-
ber line at the number that matches the first
Reliability
number in the problem; then locate the other
number and move that many spaces counting The investigator, classroom teacher, and the
aloud (count-on); and then write the number. paraprofessional in the classroom collected
In this condition, the teacher praised the stu- data for inter-observer reliability and proce-
dent orally for the correct response followed dural reliability measures. Inter-observer and
by an immediate imitation (lead) of the procedural reliability data was collected dur-
model, which was identical to the “touch ing the baseline, intervention, and replication
points” phase. Finally, the remaining sessions phases. The observers independently and si-
for both the “touch points” and number line multaneously recorded the number of single-
strategy were considered test sessions to be digit addition mathematics problems scored
recorded by the researcher. correctly, and the required prompt level. The
The test sessions for both of the strategies inter-observer agreement was calculated by di-
“touch points” and the number line interven- viding the number of agreements of student
tion were presented once a day in the morn- responses by the number of agreements plus
ing of the school day, with at least a 30 minute disagreements and multiplying by 100 for 25%
but not more than one hour break between of the sessions during each of the phases.
each testing session. During the break ses- Inter-observer reliability ranged from 99% to
sions, the students were instructed to work on 100% agreement across all three phases. The
other academic content-areas and homework inter-observer reliability agreement for each
assignments. The presentations of both inter- student across baseline, interventions, and
ventions were administered semi-randomly to replication phases was 99% for Ashley, 99%
counterbalance which strategy was imple- for Robert, and 100% for Ken.

Touch Math and Number Lines / 453


Procedural reliability probes measured the fourth session, she could not maintain that
teacher’s performances of implementing the accuracy over three sessions until the 28th
correct mathematical strategy, responding to session. In the replication phase, she
correct and incorrect responses, prompting dropped to a 90% in the second session of
hierarchy, and response time. The investiga- the replication phase, but then she was able
tor modeled both intervention strategies (e.g., to maintain 100% accuracy. Ashley was ob-
“touch points” and number line) and prompt- served using the “touch point” method dur-
ing hierarchy to both the teacher and para- ing four of the number line strategy ses-
professional using a checklist of specified sions. In sessions 9, 16, 20 and 23, Ashley
teacher behaviors. Upon completion of three had a peak in her score with using the num-
consecutive trials with 100% accuracy, the ber line strategy, and a dip of 30% in the
teacher was considered to have mastered the “touch point” strategy when she was ob-
procedures. Procedural reliability probes were served carrying over one strategy to another.
conducted in 25% of sessions in each phase of However, the use of the touch points was
this study. The procedural agreement level determined to be more effective and effi-
was calculated by dividing the number of ob- cient based upon Ashley reaching criterion
served teacher behaviors by the number of quicker than using the number line. During
planned teacher behaviors and multiplying the replication, the content used during the
that by 100. Procedural reliability ranged from number line strategy was presented to Ash-
98% to 100%, with a mean of 99%. ley. Using the touch-point strategy, Ashley’s
single-digit addition performance improved
Results to a mean of 98%.
Robert. Robert was unable to complete any
As illustrated in Figure 1, all three of the
of the single-digit addition problems during
students across baseline, interventions, and
the baseline phase. However, he was able to
replication phases of the intervention
attain 100% accuracy by the 8th and 9th ses-
showed significant improvements using the
sions for both strategies, but could not main-
“touch points” method compared to the
tain that accuracy to achieve criterion until
number line strategy to solve single-digit ad-
the 25th session using the “touch point” strat-
dition mathematics problems. Moreover,
egy. In the last three sessions in the number
the results indicated that all three of the
students were able to utilize the “touch line phase, Robert’s performance was ob-
point” strategy faster and more accurately served descending following a relatively incon-
than the number line intervention. During sistent performance for using the number line
the baseline phase, the students averaged strategy. When replicated, the content used
4% of the single-digit mathematics problems during the number line strategy was presented
accurately, however, while in the “touch and Robert’s single-digit addition perfor-
points” phase the students averaged 92% of mance improved to a mean of 100% using the
the problems correctly, compared to only touch-point strategy.
30% while using the number line strategy. Ken. Ken could not complete with accu-
Furthermore, all three of the students aver- racy any single-digit addition problems during
aged 96% correct during the replication the baseline phase. However, Ken was able to
phase. obtain 100% accuracy using the “touch point”
Ashley. During the baseline phase, Ash- strategy by the 7th session, but did not achieve
ley was only able to complete one single- criterion until the 17th session. Ken also dem-
digit mathematical problem correctly. Al- onstrated that using the touch point strategy
though she improved with the “touch point” was more effective for him than using the
strategy faster, her data indicated an ascend- number line. During the number line strategy
ing pattern with both strategies, but was able phase, Ken’s performance was ascending, but
to reach criterion sooner with the “touch he was unable to achieve 40% accuracy or
point” strategy. In fact, she did not reach better. Ken solved single-digit addition prob-
criterion until session 28 even though she lems and reached criterion faster using the
was able to achieve 90% accuracy by the touch point method.

454 / Education and Training in Autism and Developmental Disabilities-September 2010


Figure 1. Percentage of single-digit addition mathematics problems using the number line and touch points
strategies answered correctly by Ashley, Robert, and Ken

Touch Math and Number Lines / 455


Discussion ity to use the “touch points”? Do the students
with various disabilities need to be constantly
The purpose of this study was to replicate and reminded? Do they need to be refreshed in
extend a previous study by Cihak and Foust the “touch point” methods? For example, with
(2008) comparing the effectiveness of the Ken, he was quickly able to achieve high
TOUCHMATH program using “touch points” scores after the instructional sessions using
and number lines for teaching single-digit ad- the “touch points” strategy. Perhaps more lon-
dition problems to students with moderate gitudinal studies are needed using the
intellectual disabilities. The results revealed TOUCHMATH program with students with a
that the students performed better using the vast array of disabilities beginning in the ele-
“touch point” strategy over the number line in mentary schools and following the students
acquiring single-digit addition problem-solv- throughout their secondary grade levels.
ing skills. The “touch points” strategy was This was the beginning skills in using
functionally more effective when comparing TOUCHMATH and further acquisition skills
the number lines and touch points. In addi- would include counting-on rather than the
tion, this study also supports previous research counting-all method that was performed in
studies that have demonstrated that “touch this study. In addition to learning these basic
points” have the potential to be an effective beginning skills obtained using the TOUCH-
intervention to teach single-digit addition MATH program, students are eventually using
problems to students with a variety of disabil- their skills and adding or subtracting without
ities (Kokaska, 1975; Scott, 1993; Simon & the use of the dots on the numbers. This
Hanrahan, 2004; Wisnieski & Smith, 2002). phase of the TOUCHMATH program was not
However, no previous research besides the examined in this study. Using the dot-notation
Cihak & Foust study was found that could find method allows those students who struggle
any comparison differentiating instructional with rote memorization to use the count-all or
strategies using the TOUCHMATH program count-on strategy. This strategy also is more
and number lines, or any other interventions, feasible to use out in the public, for example,
for teaching computational skills to students while shopping and purchasing grocery items
in middle school with moderate intellectual as there is no other manipulative to carry
disabilities. While there were differences in around such as a number line or blocks, which
the students learning and differences in how often can be cumbersome and uncomfortable
long it took them to obtain their acquisition of to carry around as a manipulative.
the strategies, all three of the students showed Future research is warranted to investigate
the “touch point” strategy was more effective. the learning of other mathematical problem-
However, there are several limitations in solving skills, such as multiple-digit addition
this study that need to be addressed. First, the and subtraction problems with and without
study employed a single-subject design and re-grouping and multiplication and division
only examined single-digit mathematics prob- using the TOUCHMATH program for students
lems using only three students with moderate with a variety of diverse learning and aca-
intellectual disabilities in a self-contained demic disabilities. In addition, further re-
classroom in a middle school, which limits the search is needed to explore the use of the
generalizability of the intervention to larger TOUCHMATH program for students with and
populations. So, larger samples must be inves- without disabilities in self-contained and in-
tigated before broad conclusions can be made clusive classroom settings across a range of
and more rigorous treatment-control designs age, grade, and disability categories.
are needed. Second, prior knowledge of the
TOUCHMATH program was unknown at the
time of this study and with the carry over References
effects that were noted with Ashley, the poten- Adams, G., & Engelmann, S. (1996). Research on
tial of this prior knowledge can alter the out- direct instruction: 25 years beyond DISTAR. Seattle,
come of the study. If the students were ex- WA: Educational Achievement Systems.
posed to using the TOUCHMATH program in Barlow, D. H., & Hersen, M. (1984). Single case
elementary school, what happens to their abil- experimental designs: Strategies for studying behavior

456 / Education and Training in Autism and Developmental Disabilities-September 2010


change (2nd ed.). Needham Heights, MA: Allyn & ucational needs: A meta-analysis. Remedial and Spe-
Bacon. cial Education, 24, 97–114.
Browder, D. M., & Grasso, E. (1999). Teaching Mastropieri, M. A., Bakken, J. P., & Scruggs, T. E.
money skills to individuals with mental retarda- (1991). Mathematics instruction for individuals
tion: A research review with practical applica- with mental retardation: A perspective and re-
tions. Remedial and Special Education, 20, 297–308. search synthesis. Education and Training in Mental
Browder, D. M., Spooner, F., Ahlgrim-Delzell, L., Retardation, 26, 115–129.
Harris, A., & Wakeman, S. Y. (2008). A meta- Mastropieri, M., Scruggs, T., & Shiah, R. (1997).
analysis on teaching mathematics to students with Can computers teach problem-solving strategies
significant cognitive disabilities. Exceptional Chil- to students with mild mental retardation? Reme-
dren, 74, 407– 432. dial and Special Education, 18, 157–165.
Bullock, J., Pierce, S., & McClellan, L. (1989). Touch Miller, S. P., Butler, F. M., & Lee, K. (1998). Vali-
Math. Colorado Springs, Co: Innovative Learning dated practices for teaching mathematics to stu-
Concepts. dents with learning disabilities: A review of liter-
Burns, M. (1996). How to make the most of math ature. Focus on Exceptional Children, 31, 1–24.
manipulatives. Instructor, 105, 45–51. Morin, V., & Miller, S. (1998). Teaching multiplica-
Butler, F. M., Miller, S. P., Kit-hung, L., & Pierce, tion to middle school students with mental retar-
T. (2001). Teaching mathematics to students dation. Education & Treatment of Children, 21, 22–
with mild-to-moderate mental retardation: A re- 33.
view of the literature. Mental Retardation, 39, Nesbitt-Vacc, N., & Cannon, S. (1991). Cross-age
20 –31. tutoring in mathematics: Sixth graders helping
Cihak, D., & Foust, J. (2008). Comparing number students who are mentally handicapped. Educa-
lines and touch points to teach addition facts to tion and Training in Mental Retardation, 26, 89 –97.
students with autism. Focus on Autism and Other
Podell, D., Tournaki-Rein, N., & Lin, A. (1992).
Developmental Disabilities, 23, 131–137.
Automatization of mathematics skills via Comput-
Copeland, S. R., Hughes, C., Agran, M., Wehmeyer,
er-assisted instruction among students with mild
M. L., & Fowler, S. E. (2002). An intervention
mental handicaps. Education and Training in Men-
package to support high school students with
tal Retardation, 27, 200 –206.
mental retardation in general education class-
Sandknop, P., Schuster, J., Wolery, M., & Cross, D.
rooms. American Journal on Mental Retardation,
(1992). The use of an adaptive device to teach
107, 32– 45.
students with moderate mental retardation to se-
Earnest, P. (1985). The number line as a teaching
lect lower priced grocery items. Education and
aid. Educational Studies in Mathematics, 16, 411–
Training in Mental Retardation, 27, 219 –229.
424.
Schopler, E., Reichler, R. J., & Renner, B. R. (1988).
Fredrick-Dugan, A., Test, D., & Varn, L. (1991).
Acquisition and generalization of purchasing Childhood Autism Rating Scale. Los Angeles: West-
skills using a calculator by students who are men- ern Psychological Services.
tally retarded. Education and Training in Mental Scott, K. S. (1993). Multisensory mathematics for
Retardation, 26, 381–387. children with mild disabilities. Exceptionality, 4,
Gilliam, J. (1995). Gilliam Autism Rating Scale. Aus- 97–111.
tin, TX: Pro-Ed. Secada, W. G., Fuson, K. C., & Hall, J. W. (1983).
Goldman, S., Pellegrino, J., & Mertz, D. (1988) Ex- The transition from counting-all to counting-on
tended practice of basic addition facts: Strategy in addition. Journal for Research in Mathematics Ed-
changes in learning disabled students. Cognition ucation, 14, 47–57.
and Instruction, 5, 223–265. Simon, R., & Hanrahan, J. (2004). An evaluation of
Jitendra, A. K., & Xin, Y. (1997). Mathematical the touch math method for teaching addition to
problem solving instruction for students with students with learning disabilities in mathematics.
mild disabilities and students at risk for math European Journal of Special Needs Education, 19,
failure: A research synthesis. The Journal of Special 191–209.
Education, 30, 412– 438. Swanson, H. L., & Jerman, O. (2006). Math disabil-
Kokaska, S. (1975). Classroom techniques: A nota- ities: A selective meta-analysis of the literature.
tion system in arithmetic skills. Education and Review of Educational Research, 76, 249 –274.
Training of the Mentally Retarded, 10, 96 –101. Test, D., Howell, A., Burkhart, K., & Beroth, T.
Kramer, T., & Krug, D. A. (1973). A rationale and (1993). The one-more-than technique as a strat-
procedure for teaching addition. Education and egy for counting money for individuals with mod-
Training of the Mentally Retarded, 8, 140 –145. erate mental retardation. Education and Training
Kroesbergen, E. H., & Van Luit, J. (2003). Mathe- in Mental Retardation, 28, 232–241.
matics interventions for children with special ed- Thorndike, R. L., Hagen, E. P., & Sattler, J. M.

Touch Math and Number Lines / 457


(1986). Stanford-Binet Intelligence Scale. Fourth Edi- Young, M., Baker, J., & Martin, M. (1990). Teaching
tion. Chicago: Riverdale. basic number skills to students with a moderate
Van Luit, J., & Naglieri, J. (1999). Effectiveness of intellectual disability. Education and Training in
the MASTER program for teaching special chil- Mental Retardation, 25, 83–93.
dren multiplication and division. Journal of Learn- Xin, Y. P., & Jitendra, A. K. (1999). The effects of
ing Disabilities, 32, 98 –107. instruction in solving mathematical word prob-
Wisniewski, Z. G., & Smith, D. (2002). How effective lems for students with learning problems: A meta-
is touch math for improving students with special analysis. The Journal of Special Education, 32, 207–
needs academic achievement on math addition 225.
mad minute timed tests? Indiana University:
South Bend, IN. (ERIC Documents Reproduction
Service No. ED469445).
Wechsler, D. (1991). Wechsler Intelligence Scale for Received: 14 April 2009
Children-Third Edition. San Antonio, TX: Psycho- Initial Acceptance: 14 June 2009
logical Corporation. Final Acceptance: 8 September 2009

458 / Education and Training in Autism and Developmental Disabilities-September 2010


Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 459 – 466
© Division on Autism and Developmental Disabilities

Social Skills Instruction Carried Out by Teachers Working at


Private Special Education Institutions in Turkey
Ayten Uysal and Yasemin Ergenekon
Anadolu University

Abstract: As social beings, humans have to learn social behaviors, too. The social behavior repertoire is increased
by learning, and is affected by any factors that may impact learning. Individuals with developmental
disabilities need systematic teaching in order to acquire social skills (SS) in natural settings. Via SS instruction,
SS are taught to individuals who have social inadequacies or, in other words, such individuals are taught how
to use the skills they already have in their repertoire. In this study, in order to determine the SS teaching practices
of teachers who work at private special education centers, semi-structured interviews were conducted and the
data collected have been analyzed by using inductive analysis procedures. The participants of this study were
14 teachers. The results demonstrated that teachers were having serious problems and inadequacies regarding
SS instruction. It can be said that, there is a need for supportive services for systematic planning of SS
instruction for pre-service and in-service teachers.

Humans are defined as social beings. In order ties have difficulties to adapt in social environ-
to be a social being, a person has to learn ments, to build up relationships, to demon-
social behaviors just like any other behavior. strate self-control and to obtain a job during
SS instruction is supposed to be a lifelong both school years and adulthood (Cartledge &
learning process (Driscoll & Carter, 2004). Kiarie, 2001; Hillier, Fish, Cloppert & Bevers-
The most critical time in a child’s life in this dorf, 2007; Pierce-Jordan & Lifter, 2005).
process is the early childhood period. Any Individuals with developmental disabilities
delay in the child’s SS development during need systematic teaching experiences to learn
early childhood may result to some limitations SS as well as the other skills necessary in their
in this area in adulthood (Driscoll & Carter, daily lives, since the acquisition of SS is related
2004; Elliott & Gresham, 1987; Odom et al., to the adequacy of their cognitive and com-
1999). munication skills (Driscoll & Carter, 2004; Gu-
The social behavior repertoire, increased as ralnick, 1999; Guralnick et al., 2003). Demon-
it is by learning, is affected by any learning
strating social behaviors requires the
impacting factors (Guralnick, Neville, Connor
exhibition of an appropriate reaction to a
& Hammond, 2003). Thus, some of the indi-
prompt that is received from a situation or a
viduals who have typical development and
person. Individuals with developmental dis-
most individuals with developmental disabili-
abilities learn social behaviors in forms, but
they have trouble in using these forms in the
The authors would like to thank to the partici- appropriate situations (Driscoll & Carter,
pant teachers for their patience, efforts and willing- 2004).
ness for the study. The authors are also very grateful SS instruction is one of the most important
to Dr. Ozlem Kaya, Dr. E. Sema Batu and Dr. Arzu developmental areas that needs to be taken
Ozen for their supporting and insightful reviews into consideration in different periods of de-
and feedback during the study and also to Dr. Dimi- velopment with different approaches (Driscoll
tris Agouridas for checking the manuscript as a
& Carter, 2004; Licciardello, Harchik & Luis-
native speaker. Correspondence concerning this ar-
ticle should be addressed to Ayten Uysal, Anadolu
selli, 2008; Pierce-Jordan & Lifter, 2005). SS
University, Research Institute for the Handicapped, practices have to be appropriate for the age of
Eskisehir, 26470, TURKEY. Email: auysal@anadolu. the child concerned. Especially, for children
edu.tr between the ages of 0 and 3, practices should

Social Skills Instruction / 459


focus on the important adults in the child’s mediated SS instruction (Hansen, Nangle &
life. However, the families’ beliefs, attitudes Meyer, 1998), activities related to play, and
and knowledge of the child’s adequacy, im- generalization of spare time play are men-
pact his/her SS learning process. If the be- tioned in the SS instruction related literature
liefs, attitudes and knowledge in question are (Pierce-Jordan & Lifter, 2005; Vauhgn et al.,
positive it would be possible for the family to 2003).
raise a child that has positive relationships SS instruction consists of the introduction
with both peers and adults (Guralnick, Con- of positive behavior and strategies, behavior
nor, Neville & Hammond, 2006; Guralnick et and strategy modeling, trying positive behav-
al., 2003). If, however, the family’s attitudes iors and strategies in natural or pretend set-
are negative, it becomes crucial to include SS tings, and teaching self-observation, evalua-
instruction as a part of the special education tion, and reinforcement in different settings
services received by the child, in order to re- (Rutherford, Chipman, Digangi & Anderson,
duce the impacts of the family’s negative atti- 1992; Kenneth & Forness, 1999). Moreover,
tudes. individual and small group SS instruction is
With SS instruction, SS teaching is offered usually based on working together, sharing,
to individuals who have social inadequacies, and collaborating (Bierman, 2001).
or, in a similar vain, such individuals are Teachers should have the necessary compe-
taught how to use the skills they already have tencies to implement the aforementioned in-
in their repertoire in appropriate settings. struction methods and arrangements. There
However, in school, academic instruction is are some courses providing practice skills in
prioritized, and therefore, most frequently, programs which train special education teach-
teachers assign very little, if any, time to SS ers in Turkey. However, there is not a separate
instruction. Hence, it appears to be quite im- course for teaching SS. Programs usually try to
portant to include SS instruction in curricula close this gap by providing such knowledge in
for individuals with developmental disabilities courses that are related to skills instruction in
and inadequate SS (Cartledge & Kiarie, 2001). general.
During the instruction planning stage, the uti- The perceived necessity of including SS
lization of evidence-based practices on SS in- teaching in the education programs of chil-
struction can provide teachers with effective dren with developmental disabilities (Lic-
teaching practices and efficient educational ciardello et al., 2008) directed the researchers
time. of this study to determine the practices of
There are various methods of improving teachers in this area, and to initiate some
the social functions of individuals with devel- necessary programs of SS instruction develop-
opmental disabilities referred to in the rele- ment. Thus, the purpose of this study was to
vant literature. These methods can be listed as determine the practices related to SS instruc-
direct instruction (Sargent, 1991; Sugai & tion of those teachers who work at private
Lewis, 1996), peer-mediated practices (Gena, special education centers for children with
2006), collaborative teaching (Avcıoglu, developmental disabilities.
2005), social stories (Cartledge & Kiarie, 2001;
Delano & Snell, 2006), cognitive process ap-
Method
proach (Cifci & Sucuoglu, 2004), adult medi-
ated methods (Disalvo & Oswald, 2002), writ-
Participants
ten prompts (Thiemann & Goldstein, 2004),
natural instruction methods (Brown, Odom & The subjects were 10 female and four male
Conroy, 2001), and video supported record- teachers who volunteered to participate in this
ings, discussion and role playing (Elias & Ma- study and who worked at private special edu-
her, 1983). There are also methods such as cation centers in Eskisehir at least for one
modeling, prompting, shaping, behavioral year. Six of the participants had undergradu-
practices, providing feedback, social rein- ate degrees in special education, and eight of
forcement, and fading used in SS instruction them were elementary school teachers who
(Schloss & Smith, 1994; Zirpoli & Melloy, received in-service training and had obtained
1997). In addition to these methods, video- a certificate in special education.

460 / Education and Training in Autism and Developmental Disabilities-September 2010


Before the study, the authors explained the cedures is to constitute the themes or catego-
goal of the study and the process to be fol- ries that were driven from raw data in order to
lowed to the participants. Furthermore, they make the complex data understandable to
stated that the interviews could be recorded readers (Thomas, 2003). The steps of analysis
and both the recordings and transcriptions are explained below:
would only be handled by the authors with no
exceptions. Teachers and authors signed the 1. Each interview was transcribed verbatim.
informed consent forms specifying the above 2. The second author checked if the tran-
information. scriptions were correct and separated the
paragraphs of related interview docu-
ments.
Development of Data Collection Instrument 3. The first author checked the paragraphs
Interview questions were prepared in order to of related interview documents.
determine the practices of the SS instruction 4. The second author collected the answers
practice of teachers who work with children of each participant for each question in
with developmental disabilities in private spe- different folders.
cial education centers. The last form of ques- 5. Both authors coded the data indepen-
tions was given after the inspection of the dently.
specialists in the field. Seven questions were 6. Then, the authors worked together until
asked during the interviews. they reached an agreement on codes.
7. Both authors created themes and sub-
themes from the codes independently.
Data Collection 8. The authors worked together until they
Data were collected between February 19th agreed on the themes and sub-themes.
and 27th of 2008. Interviews were carried out 9. Themes and sub-themes were written
on the dates and times that teachers deter- from the raw data after the agreement of
mined at the centers they worked. All the the authors in order to reach the results of
interviews were conducted by the first author. the study.
The interviews took 12–25 minutes and all
interviews were tape recorded. As a result of Results
the transcription of these interviews a total of
145 pages of data were collected. All teachers As a result of the data analysis, seven main
were given pseudonyms in order to be used themes were found. These were:
during the study.
All interview questions were asked of all 1. Determining the SS that will be taught
participants by the first author. If needed, the 2. The content of SS instruction
author would ask extra questions to elaborate 3. The cause of inadequacy throughout SS
the subject. If teachers could not understand instruction
the questions, the author proceeded to clari- 4. The stages that were felt inadequate
fications, cautious of any possible diversion. throughout SS instruction
5. The importance of SS instruction
6. The self-evaluation of teachers regarding
Design SS instruction
In this study semi-structured interviews were 7. Suggestions regarding SS instruction
conducted with the teachers who worked at
private special education centers for at least Determining SS that will be Taught
one year and the data collected were analyzed
by using inductive analyses procedures. The participants’ opinions on this issue were
divided in two.
a. The criteria for determining SS. Teachers
Data Analysis
take into account different criteria when de-
The data were analyzed inductively (Creswell, termining the SS that will be taught. Six of the
2005). The purpose of inductive analysis pro- teachers reported that they determine SS ac-

Social Skills Instruction / 461


cording to the current environment of the struction. Moreover, Banu, Dilek and Serpil
children, whereas two of them said that they said “I would have remembered SS instruc-
determine SS in relation to their future envi- tion, if they would have taught.”
ronment. For example, Banu stated that she c. Teachers who did not have adequate knowledge
determines SS by “looking at the relationship on SS instruction. Seven of the teachers stated
of children among each other” in the current that they did not receive adequate informa-
environment, and Zeynep said she preferred tion about SS instruction during their under-
to determine SS by considering “what could graduate education and certificate programs.
happen in the future in children’s life, what Only one teacher stated that he gained some
would await them in the future.” skills during his last year practicum. Hasan
Moreover, five teachers reported that they said they were “given some notes as under-
determine SS according to the child’s perfor- graduates and trained themselves by reading
mance, four teachers reported that they deter- them.” However Asli, Ferhat and Gulsum said
mine SS as a result of observation, three of that “SS instruction was not emphasized and
them said they consider the family’s requests they were not given any kind of documents
and two of them said they determine SS ac- about the subject.” They also added that had
cording to the needs of the children. For ex- they been given “any kind of information, they
ample, Ziya said he decided SS that he would would have developed their skills on SS in-
teach by looking at “the results of rough eval- struction.” Ziya reported that they gained
uations,” while Gulsum and Hande reported “some knowledge and learned how to prepare
that they decide to teach those “skills that some programs during the last year practi-
children lack.” cum.”
b. SS that are a priority according to teachers.
Four of the teachers reported that they teach
The Causes of Inadequacy throughout SS
those SS that they consider a priority. Asli and
Instruction
Yesim said they taught children how to say
“hello, how are you, goodbye” prior to any Four different opinions were stated regarding
other skills, and Banu said she preferred to this theme.
teach children how to use “you” politely when a. Teachers who find the instruction theoretical.
they interact with elders as a sign of respect. Five teachers reported that SS instruction was
described briefly or they were only given
course notes and the information they were
Content of SS Instruction
provided was theoretical. Asli, Gulsum, Hasan
Three different opinions surfaced on this and Mehmet described the information that
theme. was provided as “theoretical.” Moreover Fer-
a. Teachers who were unaware of the content of hat said that they were given photocopies and
SS. Seven of the teachers gave some exam- CD’s and added “I guess they thought this is a
ples of SS they were teaching. Dilek taught classroom teacher, he should know how to
“how to wear a sweater,” Zeynep taught “cook- teach SS to a child.”
ing pasta and doing laundry,” and Ferhat b. Teachers who could not apply theoretical infor-
taught “which bus to take and finding home” mation in practice. Four teachers reported
as SS. Also, Banu said she taught “going to that they were provided with information on
bakery, post office, and picnic and riding a SS instruction during undergraduate and cer-
horse as SS, whereas Mehmet asked the inter- tificate programs, but they were unable to ap-
viewer to give him an example of SS. ply this knowledge. Banu, Hande and Mehmet
b. Teachers who did not have any background said; “We cannot implement anything that
related to SS instruction. Most of the teachers training provided us with. We are doing every-
(10) reported that they did not have any train- thing by experience.”
ing on SS instruction during undergraduate c. Teachers who did not know what to do. Five
courses and certificate programs. Ziya said he teachers stated that they did not know where,
took courses about skills and concept instruc- when, and how to start SS instruction. Banu,
tion during his undergraduate studies, but he Gulsum and Serpil expressed their opinions
did not receive any knowledge about SS in- by saying; “I don’t know and I can’t say any-

462 / Education and Training in Autism and Developmental Disabilities-September 2010


thing else”, while Mehmet said; “It is necessary collaboration with the families, my work will
to handle children with love.” not have any results.” Ferhat, Hande and Me-
d. Teachers who did not do systematic teaching. hmet stated that the family role on SS instruc-
Six teachers reported that they do not plan in tion is “of the utmost importance.” However,
advance, they taught when the proper time Banu and Melek reported that families were
came and when it was necessary. Hande said, often somewhat overprotective, a fact which,
“We are doing it whenever necessary. There is in turn, would prevent them from allowing
no planning but we do it when we think it is their children to practice the acquired SS in
necessary.” Serpil explained how she taught their natural settings.
SS by saying, “I am always talking to the stu-
dent and encouraging him/her to talk. There
is nothing else I can do right now.” The Importance of SS Instruction

Eight teachers expressed the opinion that it is


The Stages when Teachers felt Inadequate important for children with developmental
Regarding SS Instruction disabilities to receive SS instruction in order
to be accepted by the community and live
Teachers expressed two different opinions
independently. Ferhat, Melek and Ziya em-
about this theme.
phasized the importance of SS instruction by
a. Teachers who felt inadequacy about planning.
saying that children without SS are “more rec-
Seven teachers reported that they feel inade-
ognizable” in the community and their fami-
quate when planning SS instruction. Dilek,
lies are “bothered” by this. Pakize stated that
Ferhat and Mehmet had trouble about find-
SS instruction helps children have better ac-
ing “books or resources” regarding planning.
ceptance levels in inclusion classrooms.
Ziya and Pakize had trouble “making deci-
sions on the method” that is appropriate for
the SS, which they planned to teach. The Self-Evaluation of Teachers Regarding SS
b. Teachers who felt inadequacy about generali- Instruction
zation. Most of the teachers (13) declared
that they feel inadequate about generaliza- Teachers expressed four different opinions
tion. Five teachers stated their opinions on on this topic.
inadequacy about teaching generalization and a. The preferred methods of teaching SS.
eight teachers stated their opinions about Eleven teachers stated their views on their
family involvement on SS instruction. preferred methods of SS instruction. Teachers
b1. Teachers who had inadequacy about teaching preferred to teach SS by using modeling (7),
generalization. Five teachers stated that the SS drama (4), story telling (3) and teaching by
taught by them in the educational environ- doing and living techniques (3). They re-
ment were not observed functioning in the ported other techniques as well, such as pro-
natural environment of children. Melek and viding verbal reminders (2), creating needs
Yesim reported that they mostly taught SS in a (2), errorless instruction (2), reinforcing (2),
structured environment more than in daily, showing models (2), explaining what to do
living ones. Zeynep stated that there was a (1), demonstration (1), taking roles (1), peer
problem with the generalization of the skills training (1), and repetition. Asli, Dilek, Gul-
she taught, due to the resilience of the people sum, Hande, Hasan, Melek and Ziya declared
in the given environment that such a general- their preference for modeling, as evidenced
ization occurs. by the phrase “First I do, and then I wait for
b2. Teachers who found family involvement in- the kids to do as well.”
sufficient. Eight teachers sustained that fami- b. Teachers who thought they possessed an inad-
lies should exhibit some more interest in their equate SS instruction competence. Four teachers
children acquiring SS. They also stated that affirmed that they found themselves inade-
family plays a very important role when it quate regarding the subject without stating a
comes to the generalization of learned SS. reason for their feeling. Banu, Gulsum, Hasan
Gulsum emphasized the importance of the and Pakize stated that they were “inadequate”
role of the family by saying, “If there is no as regards SS instruction, and Pakize added

Social Skills Instruction / 463


that “she felt very inadequate in real life SS nities by saying “I may ace the exam, but this is
instruction.” not important. What is important is how to
c. Teachers who found themselves adequate in implement this knowledge.” Hande, Hasan,
planning SS instruction. Two of the teachers Pakize and Zeynep stated that it would be
mentioned that they had no trouble while helpful “if videos were played in the classes.”
planning SS instruction. Zeynep and Hasan The numerals in the brackets show the fre-
said “there isn’t anything too difficult for me” quencies of the statements.
in this.
d. Teachers who did not take responsibility of SS
Discussion and Suggestions
instruction. Two teachers stated that there is
nothing that they can do about SS instruction The purpose of this study was to examine the
as teachers. Banu stated her opinion on SS practices of teachers who provided services to
instruction by saying, “there is nothing we can children with developmental disabilities at pri-
do for them.” Furthermore, Ferhat said, “we vate special education centers.
are asking from these children to exhibit SS Half of the teachers emphasized the impor-
that are possible only for children who are tance of SS instruction for children with de-
typically developed.” Thus he stated his opin- velopmental disabilities. This coincides with
ion that children with developmental disabil- the literature on this area (Cartledge & Kiarie,
ities could not acquire SS like their peers with- 2001; Driscoll & Carter, 2004; Elliott & Gresh-
out disabilities. am, 1987; Hillier et al., 2007; Odom et al.,
1999; Pierce-Jordan & Lifter, 2005). However,
it was interesting to see that teachers do not
Suggestions Concerning SS Instruction
exercise any systematic planning and practices
Eleven teachers made suggestions about SS of SS instruction even though they constantly
instruction. Those teachers’ suggestions were emphasized the importance of it. Although
as follows: (a) practice opportunities should some teachers emphasized the importance of
be provided while teachers were trained, in SS instruction, it was interesting to see that
order to acquire the competencies necessary they did not feel responsible for SS instruc-
for SS instruction (6), (b) teachers should tion. In this context, it is possible to increase
have the opportunity to watch examples of SS the awareness of teachers by emphasizing the
instruction (4), (c) teachers in training function of SS for the children with DD in
should be provided with the time necessary their daily lives.
for the development of a SS instruction com- Like all other skills instruction, the first step
petence (3), (d) there should be a separate SS for SS instruction is to decide which skills to
instruction course (2), (e) there should be teach. The literature suggests deciding which
in-service training or conferences on the sub- skills to teach according to the child’s devel-
ject (2), (f) there should be planning for gen- opmental level and his/her performance
eralization (2), (g) there should be a variety of (Cartledge & Kiarie, 2001; Driscoll & Carter,
instructed techniques (2), (h) there should be 2004; Licciardello et al., 2008; Pierce-Jordan &
community training (1), (i) there should be Lifter, 2005). However, participants in this
more research on SS instruction (1), (j) the study determined the SS to be instructed by
concept of SS instruction should be broad- looking at the skills that children lack in the
ened (1), (k) teachers should be given exam- environment where they work together. It is
ples of SS instruction plans (1), (l) teachers possible for teachers to have expectations ac-
should be given examples of different SS in cording to the child’s physical development
different environments (1), (m) children and chronological age, when they do not take
should be taught SS by group instruction (1), into account the developmental level and per-
(n) there should be separate SS programs for formance of the child. In this situation, teach-
every child (1), (o) there should be an appro- ers may be unsuccessful in teaching SS, which
priate environment for SS instruction (1), (p) children were not developmentally ready to
there should be two or more teachers in the be taught. In fact, in this study teachers felt
classroom (1). Banu, Hande and Yesim em- unsuccessful without stating any reason which
phasized the importance of practice opportu- supports this possibility. Also, teachers re-

464 / Education and Training in Autism and Developmental Disabilities-September 2010


ported that they did not know which skills to steps of SS instruction concerns the generali-
work on in the concept of SS instruction. This zation of skills (Driscoll & Carter, 2004). In
feeling may be a result of the lack of knowl- this study, fifty percent of the participants
edge of SS instruction in the undergraduate found family involvement to be insufficient in
courses and in-service trainings they received. order for the children to use SS functionally
In order to close this knowledge gap, there and to become able to generalize these skills
could be separate courses for SS instruction in their natural environments. The low expec-
specifically, in special education departments, tation of families may prevent encouraging
or the content of SS instruction could be in- their children to use SS in their daily lives
creased in other skills courses. For teachers (Guralnick et al., 2006). However, teachers
who are in the field at the moment, there can solve the generalization issue in systematic
could be seminars and in-service training on instruction by using effective teaching meth-
SS instruction. ods. This situation once again brings to mind
The second step of SS instruction is to de- the participants’ inadequacy when it comes to
cide how to teach. The literature suggests de- planning. As a remedy for this, the course
ciding how to teach SS according to the contents could be widened, in order to give
child’s developmental level and to the severity the necessary skills for generalization instruc-
of the disability of the child. The literature tion to pre-service teachers.
also suggests that for young children it is ap- In sum, interviews demonstrated that teach-
propriate to teach SS with their parents and ers in the field had serious problems and in-
peers in play, and that in later years it is ap- adequacies regarding SS instruction. The sit-
propriate to teach SS by peer tutoring uations reported by the participants, in which
(Driscoll & Carter, 2004; Guralnick et al., they feel inadequate, such as determining
2006; Guralnick et al., 2003; Licciardello et al., which skills to teach and planning SS instruc-
2008; Pierce-Jordan & Lifter, 2005). More- tion, impacted negatively their other teaching
over, the selection could be planned accord- practices. The participants required informa-
ing to the severity of the disability in environ- tion related to a training that would help
ments that are natural or very structured them increase their skills on SS instruction. As
(Rutherford et al., 1992; Kenneth & Forness, a result, in order to have a systematic planning
1999). However, teachers in this study re- and practicing on SS instruction, there should
ported that they taught SS when necessary, be supportive services for both pre-service and
without any systematic planning and that they in-service teachers. In a few years, another
used role modeling as the teaching method. study could be conducted with the same par-
These results are inconsistent with the litera- ticipants to see the effect of such supportive
ture on this subject. However, some partici- services for these teachers.
pants stated that the information they re-
ceived on SS instruction was very theoretical
and they did not feel competent to determine References
a method according to the child’s develop- Avcıoglu, H. (2005). Etkinliklerle sosyal beceri öǧretimi
mental level, the severity of the disability and (Social skills teaching through activities). Ankara: Kök
the particular skills that need to be taught. Yayıncılık.
Also, they stated that they felt inadequate to Bierman, L. K. (2001). Social competence. Gale Ency-
put their knowledge into practice. Almost fifty clopedia of Psychology.
percent of the participants reported that they Brown, H. W., Odom, S. L., & Conroy, M. A. (2001).
did not know what to do about SS instruction. An intervention hierarchy for promoting young
It seems impossible for teachers to implement children’s peer interactions in natural environ-
appropriate methods of SS instruction with- ments. Topics in Early Childhood Special Education,
21, 162–175.
out previously closing the gap of knowledge in
Cartledge, G., & Kiarie, M. W. (2001). Learning
this area. Although it might not be possible to social skills: Through literature for children and
have time to practice SS instruction in adolescents. Teaching Exceptional Children, 34(2),
courses, it might be possible to show videos of 40 – 47.
suggested methods supported by research. Creswell, J.W. (2005). Educational research: Planning,
The last and one of the most important conducting, and evaluating quantitative and qualita-

Social Skills Instruction / 465


tive research. (2nd Ed.). New Jersey: Pearson Pren- on the autism spectrum. Focus on Autism and Other
tice Hall. Developmental Disabilities, 22, 107–115.
Cifci, I., & Sucuoglu, B. (2004). Bilis᝺el süreç Kenneth, K., & Forness, S. R. (1999). Social skills
yaklas᝺ımıyla sosyal beceri öǧretimi (Social skills teaching training. In G.N. Siperstein (Eds.), Efficacy of spe-
through cognitive process approach). Ankara: Kök Yay- cial education and related services. (pp. 49 –59).
ıncılık. AAMR.
Delano, M., & Snell, M. E. (2006). The effects of Licciardello, C. C., Harchik, A. E., & Luisselli, J. K.
social stories on the social engagement of chil- (2008). Social skills interventions for children
dren with autism. Journal of Positive Behavior Inter- with autism during interactive play at a public
ventions, 8(1), 29 – 42. elementary school. Education and Treatment of Chil-
Disalvo, A. C., & Oswald, D. P. (2002). Peer-medi- dren, 31(1), 27–37.
ated interventions to increase the social interac- Odom, S. L., McConnell, S. R., McEvoy, M. A.,
Peterson, C. A., Ostrosky, M., & Chandler, L. K.
tion of children with autism: Consideration of
(1999). Relative effects of interventions support-
peer expectancies. Focus on Autism and Other De-
ing the social competence of young children with
velopmental Disabilities, 17(4), 6 – 41.
disabilities. Topics in Early Childhood Special Educa-
Driscoll, C., & Carter, M. (2004). Spatial density as a
tion, 19, 75–91.
setting event for the social interaction of pre-
Pierce-Jordan, S., & Lifter, K. (2005). Interaction of
school children. International Journal of Disability, social and play behaviors in preschoolers with and
Development and Education, 51(1), 7–37. without pervasive developmental disorder. Topics
Elias, M., & Maher, C. (1983). Social an effective in Early Childhood Special Education, 25(1), 34 – 47.
development of children: A programmatic per- Rutherford, R., Chipman, J., Digangi, S., & Ander-
spective. Exceptional Children, 49, 339 –346. son, K. (1992). Teaching social skills: A practical
Elliott, N. S., & Gresham, F. M. (1987). Children’s instructional approach. Reston, VA: Exceptional In-
social skills assessment and classification prac- novations.
tices. Journal of Counseling and Development, 66, Sargent, L. R. (1991). Social skills for school and com-
96 –99. munity: Systematic instruction for children and youth
Gena, A. (2006). The effects of prompting and so- with cognitive delay. Washington, D. C: The Divi-
cial reinforcement on establishing social interac- sion on Mental Retardation of the Council for
tions with peers during the inclusion of four chil- Exceptional Children.
dren with autism in preschool. International Schloss, P. J., & Smith, M. A. (1994). Applied behavior
Journal of Psychology, 41, 541–554. analysis in the classroom. Boston: Allyn & Bacon.
Guralnick, M. J. (1999). Family and child influences Sugai, G., & Lewis, T. J. (1996). Preferred and prom-
on the peer-related social competence of young ising practices for social skills instruction. Focus on
children with developmental delays. Mental Retar- Exceptional Children, 29, 1–14.
dation and Developmental Disabilities Research Re- Thiemann, S. K., & Goldstein, H. (2004). Effects of
views, 5, 21–29. peer training and written text cueing on social
Guralnick, M. J., Connor, R. T., Neville, B., & Ham- communication of school age children with per-
mond, M. A. (2006). Promoting the peer-related vasive developmental disorder. Journal of Speech,
social development of young children with mild Language and Hearing Research, 47, 126 –145.
Thomas, D. R. (2003). “A general inductive ap-
developmental delays: Effectiveness of a compre-
proach for qualitative data analysis,” http://www.
hensive intervention. American Journal on Mental
fmhs.auckland.ac.nz/soph/centres/hrmas/_docs/
Retardation, 111, 336 –356.
Inductive2003.pdf
Guralnick, M. J., Neville, B., Connor, R. T., & Ham-
Vauhgn, S., Kim, A. H., Sloan, C. V. M., Hughes,
mond, M. A. (2003). Family factors associated
M. T., Elbaum, B., & Sridhar, D. (2003). Social
with the peer social competence of young chil-
skills interventions for young children with dis-
dren with mild delays. American Journal on Mental abilities. Remedial and Special Education, 24(1),
Retardation, 108, 272–287. 2–13.
Hansen, J. D., Nangle, D. W., & Meyer, K. A. (1998). Zirpoli, T. J., & Melloy, J. K. (1997). Behavior man-
Enhancing the effectiveness of social skills inter- agement: Application for teachers and parents (2nd
vention with adolescents. Education and Treatment Ed.). New Jersey: Prentice Hall.
of Children, 21(4), 10 –13.
Hillier, A., Fish, T., Cloppert, P., & Beversdorf, D. Q. Received: 18 March 2009
(2007). Outcomes of a social and vocational skills Initial Acceptance: 10 May 2009
support group for adolescents and young adults Final Acceptance: 8 September 2009

466 / Education and Training in Autism and Developmental Disabilities-September 2010


Look! I'm in College! DVD

Look, I’m in College! Is a half-hour documentary that follows four students through an
extraordinary time in their lives. Terence, Benny, Rayquan, and Donald are New York
City public school students from high-need communities. They all have autism and
intellectual disabilities, and they are the charter class in a college-based inclusion
program. Through collaborative efforts of the New York City District 75 and Pace
University, these four young men from challenging socio-economic backgrounds met with
success as they participated in a college community among their age-appropriate peers.

By the Division on Autism and Developmental Disabilities (DADD). 2008. 31 minutes.

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