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International Journal of Disability,

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Self-Operated Verbal Instructions

for People with Intellectual
and Visual Disabilities: Using
instruction clusters after task
acquisition
Giulio E. Lancioni , Mark F. O'Reilly & Doretta Oliva
Published online: 21 Jul 2010.

To cite this article: Giulio E. Lancioni , Mark F. O'Reilly & Doretta Oliva (2001) Self-
Operated Verbal Instructions for People with Intellectual and Visual Disabilities: Using
instruction clusters after task acquisition, International Journal of Disability, Development
and Education, 48:3, 303-312, DOI: 10.1080/10349120120073430

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 International Journal of Disability, Development and Education, Vol. 48, No. 3, 2001

Self-Operated Verbal Instructions for

People with Intellectual and Visual
Disabilities: using instruction clusters
after task acquisition
GIULIO E. LANCIONI*
Downloaded by [University of Ulster Library] at 03:19 12 November 2014

Department of Psychology, University of Leiden, Wassenaarseweg 52,

2333 AK Leiden, The Netherlands

MARK F. O’REILLY
University College Dublin, Ireland

DORETTA OLIVA
Lega F. D’Oro Research Centre, Osimo, Italy

ABSTRACT Three adults with intellectual and visual disabilities were taught vocationally
relevant tasks through the use of a self-operated verbal instruction system. During training,
the system presented one verbal instruction per task step, individually. After training, the
system presented instructions arranged in clusters/groups of two. Data showed that during
training all participants achieved percentages of correct task performance exceeding 90. The
subsequent use of instruction clusters was effective in maintaining high levels of correct
performance for each adult, whereas a deterioration of performance occurred when instruc-
tions were not available. Implications of the Ž ndings are discussed.

Introduction
One of the main goals of rehabilitation programs for people with intellectual and
multiple disabilities is to help them acquire and maintain constructive task engage-
ment (Alberto, Sharpton, Briggs, & Stright, 1986; Anderson, Sherman, Sheldon, &
McAdam, 1997; Briggs et al., 1990; Lancioni, Klaase, & Goossens, 1995; Steed &
Lutzker, 1997, 1999). Task engagement is considered important for a variety of
reasons including: promoting adaptive responses and reducing withdrawal or be-
havioural problems, enriching sensory/vestibular input, improving general image and
social status, and opening new occupational or job opportunities within domestic

* Lancioni@FWS.LeidenUniv.NL

ISSN 1034-912X (print)/ISSN 1465-346X (online)/01/030303-10 Ó 2001 Taylor & Francis Ltd
DOI: 10.1080/10349120120073430
 304 G. E. Lancioni et al.

environments or normal work contexts (Beyer, Kilsby, & Willson, 1995; Brown &
Chamove, 1993; Morgan, Ames, Loosli, Feng, & Taylor, 1995; Trask-Tyler,
Grossi, & Heward, 1994).
Three strategies used for establishing satisfactory and independent task engage-
ment with people with intellectual and multiple disabilities are the use of cards with
drawings (pictorial instructions), the use of computer-aided systems with pictorial
instructions and prompts, and the use of verbal instruction systems (conventional or
adapted cassette players with recorded verbal instructions) (Lancioni et al., 1999;
Lancioni, Van den Hof, Boelens, Rocha, & Seedhouse, 1998; Singh, Oswald, Ellis,
& Singh, 1995; Steed & Lutzker, 1997, 1999; Taber, Alberto, & Fredrick, 1998;
Wacker, Berg, Berrie, & Swatta, 1985). Cards with pictorial instructions are the
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most common and most economical/practical strategy; systems with verbal instruc-
tions might be the best alternative to cards and computer-aided systems for people
with intellectual and visual disabilities who have sufŽ cient receptive language skills
(Lancioni, O’Reilly, Oliva, & Pellegrino, 1997; Steed & Lutzker, 1999; Taber et al.,
1998).
Following the work of Alberto et al. (1986) and Briggs et al. (1990), recent studies
have underlined the effectiveness of self-operated verbal instruction systems for
teaching people with moderate intellectual disability, or combinations of intellectual
and sensory disabilities, task performance or transitions across sequences of tasks
(Lancioni et al., 1995, 1997; Steed & Lutzker, 1999; Taber et al., 1998). In all
studies, instructions for the single task steps or the single tasks of the sequence were
presented individually . Subsequent checks to verify whether the people could
perform without the instructions provided mixed results. While Alberto et al. (1986)
and Steed and Lutzker (1999) showed maintenance of successful performance after
the withdrawal of instructions, Lancioni et al. (1995, 1997) and Taber et al. (1998)
reported a deterioration of performance. These Ž ndings suggest that people with
intellectual or multiple disabilities may not necessarily become totally independent
of instructions.
A compromise goal, that one might envisage as an alternative to total indepen-
dence, is using instructions in small clusters/groups (e.g., whenever the person
operates the system, two instructions for two task steps are presented in succession;
cf. Lancioni et al., 1999). Adopting instruction clusters leads to a reduction in the
number of instruction occasions. This in turn would help increase the person’s
autonomy and self-control (extending occupation time free of instructions), and may
enhance general behaviour and social image (Nietupski, Hamre-Nietupski, Vander-
hart, & Fishback, 1996; Rapley & Beyer, 1996; Wehmeyer, 1994).
This study was designed to assess whether instruction clusters would be sufŽ cient
to maintain satisfactory task performance with three people with intellectual disabil-
ity and visual or multiple impairments. The people were initially taught vocationally
relevant tasks with a self-operated verbal instruction system presenting instructions
for the single task steps, individually . Subsequently, participants were to perform the
tasks with the system presenting instructions in clusters. A control condition without
system and instructions was also used.
 Self-Operated Verbal Instructions 305

Method
Participants
Two men aged 21 and 22 years (Participants 1 and 2) and a woman aged 19 years
(Participant 3) were involved in the study. All of them lived at home with their
parents and daily attended an education and activity centre where teaching focused
on self-help skills, occupational engagement, and socialisation. Their verbal IQs
(Wechsler Adult Intelligence Scale; Wechsler, 1955) were reported to be about 50,
65, and 50, respectively. Their age equivalents on the Vineland Adaptive Behavior
Scales (Sparrow, Balla, & Cicchetti, 1984) were about 5, 4, and 3.5 years, respect-
ively, on daily living skills; and 4.5, 6, and 4.5 years on communication. Participant
1 was blind in the right eye and had severely reduced sight in the left eye (estimated
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visual acuity of about 0.1; see Geruschat, 1992). Participant 2 was totally blind.
Participant 3 had severe visual impairment (with visual acuity of about 0.1) and
spasticity, and used a wheelchair. All participants were reported to have difŽ culties
in retaining sequences of responses for task performance.

Setting and Instruction System

The study was carried out in the centre that the participants attended. For Partici-
pants 1 and 2, a kitchen and an activity room were used. Participant 3 used a
multipurpose room where she sat at a table equipped with a round rotating top. The
rotating top was familiar to her and allowed her to move objects that were distant
closer to her. The instruction system consisted of a compact cassette recorder that
had been supplemented with a solid state audio record/replay circuit and external
control electronics. The system, which was equipped with audio cassettes containing
prerecorded sequences of task instructions, had an operation key on its side and was
worn at the waist by the participants. Pushing the key caused the occurrence of an
instruction or instruction cluster (the Ž rst/next of the sequence). The system would
automatically stop after the instruction or instruction cluster (i.e., the participants
were not required to make any response to stop it; cf. Taber et al., 1998).

Tasks, Measures, and Reliability

Ten vocationally relevant tasks were available; Ž ve concerned food preparation (i.e.,
stuffed cake, yoghurt pudding, dessert cake, appetizer, and cheese salad) and Ž ve
concerned practical jobs (i.e., putting seeds and small plants in pots, or assembling
a lamp, a wall decoration, a table decoration, and a special container). Participant
1 was taught all 10 tasks; Participants 2 and 3 were taught eight tasks (four
concerning food preparation and four concerning practical jobs). The number of
steps per task ranged between 32 and 46 (M 5 37). Some variations in the number
or types of steps were made for Participant 3 given her physical disability. The task
steps had been deŽ ned through a series of task analyses. The instructions for the
steps were simple sentences of 3 to 6 words. Table I lists the step-by-step instruc-
 306 G. E. Lancioni et al.

TABLE I. Step instructions for “Putting

Seeds and Small Plants in Pots”

1. Take the bucket with earth

2. Take the bottle with water
3. Empty the bottle in the bucket
4. Put away the bottle
5. Take a pot
6. Put earth in the pot
7. Take the container with seeds
8. Put seeds in the pot
9. Put more earth in the pot
10. Put the pot in the crate
11. Take another pot
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12. Put earth in the pot

13. Take the container with seeds
14. Put seeds in the pot
15. Put away the container
16. Put more earth in the pot
17. Put the pot in the crate
18. Call your supervisor
19. Ask to take the crate
20. Take a yellow box
21. Take a pot from the box
22. Put earth in the pot
23. Put a plant in the pot
24. Put the pot in the crate
25. Take another pot from the box
26. Put earth in the pot
27. Put a plant in the pot
28. Put the pot in the crate
29. Take another pot from the box
30. Put earth in the pot
31. Put a plant in the pot
32. Put the pot in the crate
33. Put away the yellow box
34. Take a sponge
35. Clean the table with the sponge
36. Put away the bucket with earth
37. Put away the sponge

tions for one of the tasks. The instructions were interspersed with encouragement or
praise messages (see Briggs et al., 1990; Steed & Lutzker, 1999).
Recording concerned the number of task steps that were carried out correctly
without intervention by the researcher. Interrater agreement was checked in 18% of
all sessions, across all participants and conditions. The percentages of agreement,
computed by dividing agreements by agreements plus disagreements and multiply-
ing by 100%, ranged from 79 to 100 with means exceeding 95.
 Self-Operated Verbal Instructions 307

Experimental Conditions
After an initial baseline, the participants were trained on the tasks selected with
instructions presented for each task step, individually. Training was divided into
criterion training and consolidation training. Subsequently, instruction clusters were
used for maintaining the performance of the tasks previously trained. Instruction
clusters were initially used for one half of the tasks (e.g., the food preparation tasks)
while a noninstruction (control) condition was used for the other tasks, according to
an alternating treatments design (Barlow & Hersen, 1984). Then, the tasks previ-
ously exposed to the instruction clusters were exposed to the noninstruction con-
dition, and vice versa, according to a cross-over procedure (Bourke, Daly, &
McGilvray, 1985). Only one task was presented per session. There were two to Ž ve
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sessions per day (four or Ž ve days a week).

Baseline. At the start of a session, the participants were asked to perform a task and
were shown the task materials. Such materials were available on the rotating table
top and the chairs next to it (for Participant 3) or on tables and other regular places
such as shelves and cupboards (for Participants 1 and 2). No system or instructions
were used. Each task was presented two times nonconsecutively. A task (session)
was terminated when the participants failed to perform any step for 3 min. In that
case, all the steps omitted were scored incorrect. After the sessions, the participants
received praise for their efforts and a token. Preset numbers of tokens led to small
back-up reinforcers.

Criterion training. This training period was introduced by six practice sessions using
the instruction system with one or two tasks. During these sessions, the researcher
provided verbal and physical prompts, as needed, to acquaint the participants with
the use of the system and the response requirements. During the following sessions,
the participants were to use the instruction system on their own. For each verbal
instruction emitted by the system, the participants were to carry out a task step.
Then they pressed the system key to obtain the next task instruction. Researcher
intervention occurred if the participants did not perform a step or performed a step
not matching the instruction. At the end of the sessions, praise and a token were
provided as in baseline. Training continued on the same task until three consecutive
sessions had occurred with at least 90% of the steps performed correctly.

Consolidation training. This training period served to consolidate the participants’

task performance. Participants received between 8 and 12 training sessions per task
(Participant 3 had more sessions than the other participants, given her physical
disability). General conditions were comparable with those available in the criterion
training period.

Instruction clusters and noninstruction condition. In the instruction clusters condition,

over 80% of the task instructions (the percentages varied slightly across tasks) were
arranged in clusters of two. By pressing the system key, the participant would receive
 308 G. E. Lancioni et al.

two instructions for two consecutive task steps, usually two actions on the same
object or the same/corresponding action on more objects (e.g., “take a pot; put earth
in the pot”) (cf. Abbeduto & Short, 1994). For the task of Table I, for example, the
instruction clusters concerned steps 2 and 3; 5 and 6; 7 and 8; 9 and 10; 11 and 12;
13 and 14; 16 and 17; 18 and 19; 21 and 22; 23 and 24; 25 and 26; 27 and 28; 29
and 30; 31 and 32; 34 and 35; and 36 and 37. In the noninstruction condition, the
participants were to perform the tasks without system and instructions. In both
(instruction clusters and noninstruction) conditions, the researcher would intervene
to correct errors and ensure task completion. Praise, tokens, and back-up reinforcers
continued to be used as before.
Initially, there were two or four practice sessions with both conditions. Then, the
instruction clusters were used with one group of tasks (e.g., the food preparation
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tasks), and the noninstruction condition with the other tasks (the practical jobs).
There were Ž ve nonconsecutive sessions on each of the tasks (see Lancioni et al.,
1999). At the end of this period, instruction clusters were used with the tasks
previously exposed to the noninstruction condition, and vice versa. The entire phase
included 50 sessions with instruction clusters and 50 sessions with the noninstruc-
tion condition (Participant 1) or 40 sessions with each of the two conditions
(Participants 2 and 3).

Results
The mean percentages of task steps performed correctly by the three participants
during baseline, criterion training, consolidation training, and the use of the instruc-
tion clusters and noninstruction condition are presented in Figure 1. During
baseline, which included 16 to 20 sessions (see numerals above the data bars in
Figure 1), the mean percentages did not exceed 6. The criterion training phase,
which included between 63 and 77 sessions, showed mean percentages of correct
steps of 80 to 85. The consolidation training phase, which included 70 to 93
sessions, led to mean percentages of correct steps of 94 to 98. The use of instruction
clusters resulted in mean percentages of correct steps of 93 to 98. The noninstruc-
tion condition resulted in mean percentages of correct steps of 41 to 72. The highest
percentages with the instruction clusters and noninstruction condition were shown
by Participant 1; the lowest percentages by Participant 3.

Discussion
The use of the system with individual instructions led to high levels of correct task
performance during training. Although simple AB designs (rather than a multiple
baseline; see Barlow & Hersen, 1984) were used for the participants, one could
hardly have expected their near-zero baseline levels to show such a drastic increase
through task exposure only (see also the outcome of the noninstruction condition).
The data obtained with the instruction clusters indicate that they were effective in
maintaining high levels of correct responding, whereas the noninstruction condition
 Self-Operated Verbal Instructions 309
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FIG . 1. The three panels summarise the data of the three participants during baseline, criterion
training, consolidation training, and the use of the instruction clusters and noninstruction condition.
Each bar represents the mean percentage of task steps performed correctly over a block of sessions.
The number of sessions included in the block is indicated by the numeral above the bar.

led to a deterioration of responding (cf. Alberto et al., 1986; Steed & Lutzker,
1999).
The effectiveness of clusters underlines the possibility of reducing instruction
occasions after task acquisition. People may become capable of following sentences
conveying information for two (or more) successive task steps and perform such
steps appropriately, with beneŽ ts in terms of independence and, possibly, also
self-conŽ dence and social image (cf. Bihm, Sigelman, & Westbrook, 1997; Etzel &
LeBlanc, 1979; Merrill & Mar, 1987; Nietupski et al., 1996; Wehmeyer, 1994).
These data on the clustering of verbal instructions fully support previous research
Ž ndings concerning the clustering of pictorial instructions (see Lancioni et al.,
1999). In that research, combinations of two pictorial instructions were found to be
highly effective for maintaining task performance whereas a noninstruction con-
dition led to a performance decline.
 310 G. E. Lancioni et al.

Clustering instructions automatically results in longer utterances (sentences).

Long sentences might be very difŽ cult to analyse and respond to at the beginning of
a program, when people have not yet identiŽ ed key words on which to focus and
have no familiarity with task steps and contextual cues (Etzel & LeBlanc, 1979;
Soraci, Deckner, Baumeister, & Carlin, 1990; Taber et al., 1998). Long sentences
may prove much less demanding, however, after extended training with shorter
sentences has made people familiar with key words as well as task steps and
environmental conditions (as in the present study) (Brown & Xiang, 1998; Fletcher
& Bray, 1995; Merrill & Mar, 1987; Nailos, Whitman, & Maxwell, 1994).
In conclusion, several points could be made. First, self-operated verbal instruction
systems may be highly useful self-management tools for people with intellectual and
visual disabilities who have sufŽ cient receptive language skills (Briggs et al., 1990;
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Lancioni et al., 1995, 1997; Trask-Tyler et al., 1994). Second, although no

generalisation checks were carried out in this study, one may easily assume that
small, self-operated instruction systems could be used across settings and could help
people generalise their task performance (Briggs et al., 1990; Steed & Lutzker, 1999;
Taber et al., 1998). Third, the use of such systems may be adjusted over time (i.e.,
with the rearrangement/clustering of the instructions) to allow people more exten-
sive levels of independence without serious risks of failure (Lancioni et al., 1997,
1998; Martin & Rusch, 1987). Fourth, new research should (a) extend the evalu-
ation of the present clustering approach with people with intellectual and multiple
disabilities, (b) determine the possible links between individual levels of functioning
or familiarity with task steps and materials and ability to cope with various instruc-
tion complexities, and (c) provide guidelines for instruction lengths and structures
(Barlow & Hersen, 1984; Etzel & LeBlanc, 1979; Mechling & Gast, 1997; Nailos
et al., 1994; Taber et al., 1998; Trask-Tyler et al., 1994).

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