Nova Southeastern University

NSUWorks
CEC Theses and Dissertations College of Engineering and Computing

2014

Helping Children with Autism Learn with

Mathematics Software
Michelle Hansen
Nova Southeastern University, michelle.mhansen@gmail.com

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Helping Children with Autism Learn with Mathematics Software

by

Michelle Hansen

A dissertation report submitted to the Graduate School of Computer and Information Sciences
(GSCIS) in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy in Computer Information Systems

Nova Southeastern University

2014

 
  

 
  

iii
 

Acknowledgements

This dissertation is due in great part to my parents, Yvonne and Wes, and my life partner,
Lenora. All three individuals have stood by through the many years, when times were good and
when they were trying. My parents taught me my first lessons in life; set a goal and stay strong,
choose a pencil over a broom whenever possible, and love with all of your heart and none of
your judgments. This doctoral process proved to be one of perseverance, and through the many
hurdles I have cared as much about not letting down those who love me as I have about myself
and the degree.

I am forever grateful to my advisor, Dr. Trudy Abramson, who not only gave me the advice to
stay strong but modeled positive behavior as she suffered her own deep loss and yet never lost
sight of the ultimate goals in her life. Dr. Abramson told me of the many obstacles that would
pop up during the dissertation process, and every time she proved correct I just shook my head
and thought of “Dr. A” smiling.

Thank you also to Drs. Twomey and O’Mara, who added their advice and counseling along
the dissertation road. Both helped to identify a focus for my work and words of encouragement
to assist in the best written document I could write. I remember the day I graduated with my
Master’s degree and told a professor that I aspired to go after my doctorate. She told me to be
sure that I found something I was passionate about, and I did not understand these words of
wisdom until I was struggling through the Idea Paper process, where it became clear that I
needed to find something that was meaningful to me.

I would also like to acknowledge and appreciate the cooperation from the public school
system and provider of commercial software used in this study. The staff of the Kalamazoo
Regional Educational Service Agency (KRESA), the staff and faculty of Prairie Ridge
Elementary school, and the staff of TeachTown® Incorporated were vital to the success of this
study. Specifically, I would like to thank principal Karen Spencer, teacher Robyn Moyer, and
Wayne Hilley, Vice President of Sales for TeachTown® for all of their assistance and
professionalism throughout the year.

I have heard numerous stories of how ‘the system’ fails the Autistic learner, and felt for many
years that somehow the pairing of HCI (Human-Computer Interaction) and education was a
possible answer. My path to testing a learning software specifically made for young learners
identified to be on the ASD (Autistic Spectrum Disorder) was indeed my passion and one that I
gained much inner satisfaction from while conducting the study.

 
 iv
   

Abstract

Autism spectrum disorders (ASDs) are conditions where a person may exhibit
developmental disabilities, significant social, communication and behavioral challenges, and
process information differently than people without ASD. The Federal Government guidelines
mandate inclusion of all students into the public school facilities. All school age children in the
United States are afforded the same opportunities for public education.
The goal of this investigation was to evaluate the effectiveness of Computer-Aided
Instruction (CAI) as a treatment for teaching mathematics to a group of autistic pupils in an
elementary school environment. The public later elementary school is located in Kalamazoo,
Michigan and had a student enrollment of 488 in grades 3-5 for the 2011-2012 school year
(MDE; http://michigan.gov/mde, February 12, 2014). Questionnaires were used to gather
feedback from teachers and itinerant staff, including social workers, psychologists and speech
and language therapists. Data were gathered using tests developed by teachers and designed to
meet state guidelines. Data analysis involved comparing the test scores of ASD pupils taught by
CAI to those for pupils taught using conventional teacher-led instruction.
The computer-based treatment (TeachTown® software) was compared to the traditional
treatment of teacher-led instruction using data from pre- and post-testing as well as observation,
and was shown to improve both pupil attentiveness (time on task) as well as math test scores. As
schools, educators, staff and parents continue to wrestle with the adverse effects of increased
numbers of diagnosed ASD pupils and decreased dollars dedicated to their human teachers, an
option seems to lie in the use of CAI software and the focusing of resources in matching pupils
to computers. It is recommended that school administration evaluate the cost of CAI and
training as an option to monies appropriated to adding more teachers and teacher human aides. It
is also recommended that more research be conducted to evaluate the use of CAI software with
ASD pupils of larger population size and different socio-economic environments.

 
  

Table of Contents

Approval Page ii
Acknowledgement iii
Abstract iv
List of Tables vi
List of Figures vii

Chapters
1. Introduction 1
Context 1
Problem Statement 2
Dissertation Goal 3
Research Questions 4
Relevance and Significance 4
Limitations and Delimitations 7
Definition and Acronyms 11
Organization of Study 13

2. Review of Literature 14
Characteristics of ASD Pupils 15
Public Education System as Applied to ASD Pupils 21
Interventions 23
Computer-aided Instruction 26
CAI Software 29
Summary 30

3. Methodology 33
Problem and Goal 33
Research Design 34
Approach 39
Experts 39
Implementation 39
Research Questions 42
Data Collection 44
Measures 46
Format for Presenting Results 48
Resources 49
Summary 50

4. Results 52
Implementation 52
Evaluation 53
Qualitative Results 58

 
  

5. Conclusions, Implications, Recommendations and Summary 62

Conclusions 62
Implications 65
Recommendations 66
Summary 66

Appendices
A: DSM-V Criteria for Diagnosing Autism Spectrum Disorder 69
B: IRB approval 72
C. Approval from School to Conduct Study 73
D. IEP; Individualized Education Program (State of Michigan) 74
E. Questionnaire 89
F. Request for Observation and/or Consultation 90
G: Pre- and Post-test for Mathematics 91
H: Signed Consent Form 99
I. Screenshot of TeachTown Basics & Social Skills Products 102
J. Screenshot of TeachTown Six learning Domains 103
K. Screenshot of TeachTown Interactive Interface 104
L. Key Behavior Change Inventory – modified 105
M: PROMIS Anxiety—Short Form 106
N: MEAP Schedule 107
O: MEAP Item Descriptor for Math 108

References 111

 
  
vi
 

List of Tables

Tables

1. Commercially Available Software Tools for Teaching Autistic Children (not limited to
Mathematics)
2. Commercially Available Software Tools for Teaching Autistic Children that Include Math
3. List of Experts Employed at Study Site
4. List of Pupils in ASD Study on TeachTown Intervention
5. Academic School Term Winter 2014
6. Winter 2014 Academic School Calendar Days off Due to Snow
7. Winter 2014 Academic School year and Study Dates
8. Results from Questionnaire
9. Pre-test Scores
10. Pre- and Post-test Scores for L-1
11. Pre- and Post-test scores for L-2
12. Quantitative Data Analysis
13. Likert Table of Professional Responses

 
  

vii
 

List of Figures

Figures
1. Pre- and Post-test Scores, L-1
2. Pre- and Post-test Scores, L-2
3. Quantitative Data Analysis
4. Likert Scale Showing Professional’s Answers
5. Key Behavior Change Inventory
6. PROMIS Anxiety—Short Forum

 
  
1
 

Chapter 1

Introduction

Context

Autism spectrum disorders (ASDs) are conditions where a person may exhibit

developmental disabilities, significant social, communication and behavioral challenges, and

process information differently than people without ASD. The spectrum for this disorder

encompasses a wide range, from mild to severe conditions, with all sharing challenges with

social interaction. ASD is an umbrella term, which under the proposed criteria for the

Diagnostic and Statistical Manual of Mental Disorders, Sixth Edition (DSM-5; American

Psychiatric Association, 2014) encompasses autistic disorder (autism), Asperger’s disorder,

childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified

(Appendix A):

“People with ASD tend to have communication deficits, such as responding

inappropriately in conversations, misreading nonverbal interactions, or having difficulty
building friendships appropriate to their age. In addition, people with ASD may be overly
dependent on routines, highly sensitive to changes in their environment, or intensely
focused on inappropriate items. Again, the symptoms of people with ASD will fall on a
continuum, with some individuals showing mild symptoms and others having much more
severe symptoms. This spectrum will allow clinicians to account for the variations in
symptoms and behaviors from person to person.” (DSM-5, April 14, 2014)

Autism is a type of ASD and a severe form of psychopathology, usually evident before

the age of three years. Autism is a neurobiological disorder and not curable. It is a spectrum

disorder characterized by a unique set of severe and pervasive behavioral deficits and excesses,

which have challenged and driven professionals and lay personnel for over fifty years (Baio,

2014; Cridland, Jones, Magee & Caputi, 2014). Due to the interesting and unusual

characteristics of the disorder, the growing statistics of ASD children, and the inclusive nature of

 
   2
 

its effects, autism has received heightened attention from psychiatrists, pediatricians,

neurologists, speech and language specialists, educators and parents.

All school age children in the United States are afforded the same opportunities for public

education (NCLB; www2.ed.gov/nclb/; accessed April 14, 2014). The usage of computers in public

schools is not a new method for teaching; however, evaluating the effectiveness of Computer-

Aided Instruction (CAI) as a treatment for teaching mathematics to a group of autistic pupils in

an elementary school environment is a new area of research. The true measure of the

effectiveness depended upon data analysis involving comparing the test scores of ASD pupils

taught by CAI to those for pupils taught using conventional teacher-led instruction.

The computer-based treatment (TeachTown® software) was compared to the traditional

treatment of teacher-led instruction using data from pre- and post-testing, as well as observation.

Results showed that ASD pupils were highly motivated and drawn to the computer-aided

instructional treatment, and showed improvements in both the amount of material learned in a

specific time period as well as slightly higher test scores in mathematics assessments.

Problem Statement

The problem is that government guidelines mandate inclusion of all students with

curriculum outcomes for the subject of mathematics, yet traditional methods for teaching

elementary-age children are not conducive in meeting the needs of pupils with Autism. Teachers

need resources to teach math to ASD pupils in a way that meets their learning styles without

disrupting the general classroom. According to Messemer (2010), literature supports a

discrepancy between teachers’ support for the inclusion of all children in general education

classrooms and their reluctance to put this support to action by welcoming students with learning

disabilities into their classrooms.

 
   3
 

Autistic children are predominantly non-auditory, making inter-personal communication

difficult to impossible (Luckevich, 2008). Children with autism process information slowly and

coupled with behavioral issues, they struggle to learn in a traditional k-12 classroom

environment (Luckevich, 2008). Teachers can tailor curriculum delivery for autistic students but

the necessity of large classrooms size of early childhood mainstream classrooms includes autistic

learners rendering it difficult for teachers to devote necessary one-on-one instruction to the ASD

pupils (based on large class sizes). Although our understanding of the strengths and difficulties

of children with autism has grown enormously, relatively little is known about how best to

support their development so that they are able to function well in their classrooms and

community (Koning, 2010).

Dissertation Goal

The goal was to find a successful procedure for helping early childhood pupils with

autism learn and apply mathematics. The alternate treatment for instruction was the computer

software TeachTown®. The usage of a computer program as a teaching tool is beneficial to

ASD pupils, as they are more comfortable with an inanimate object (e.g., computer) than with

humans (e.g., teachers). The focus of the investigation was to evaluate the effectiveness of CAI

compared to traditional teacher-led classroom instruction, using the same mathematics

curriculum chosen by the teacher and school administration. Higher-functioning ASD pupils

were chosen for this research, as previous studies have shown that higher-functioning autistic

children tend to be proficient with elementary mathematics (Mays & Calhoun, 2008). Kaffer

(2010) concluded that ASD children exhibit difficulty in learning new information and may

benefit from alterations to curriculum and teaching strategies. He stated that ASD children

typically require more repetition and hands-on tasks when learning new math concepts. He

 
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concluded that there was no de facto technique for success in teaching mathematics to ASD

children and that further research was needed in this area. CAI offers a human-to-computer

option with built in repetition and will be the alternate treatment evaluated.

Research Questions

For this exploration four research questions were addressed:

1. How does CAI, using animated graphics, impact the comprehension, retention and

application of math skills for children with ASD?

2. How does the absence of text, (presenting material using graphics and sounds), impact

the comprehension, retention and application of math skills by children with ASD?

3. How can children with autism benefit from CAI?

4. How does CAI compare to teacher-led instruction for the purpose of teaching

mathematics to ASD children in the public elementary school environment?

Relevance and Significance

The National Center for Disease Control estimates that one American child in 68 is

affected with an autism spectrum disorder, compared with one in 10,000 a decade ago (Center

for Disease Control (CDC; obtained April 14, 2014). ASD is the second most common

developmental disability, next to mental retardation (Reffert, 2008). One factor affecting the

treatment of ASD is IDEA—the Individuals with Disabilities Education Act, which regulates

resource allocation for children with disabilities (.http://idea.ed.gov/; Accessed April 14, 2014).

According to the Department of Education (2014), IDEA sets parameters for provisions afforded

to children with disabilities and provided by states and public agencies. The growth in the

number of children diagnosed with ASD, as well as strong government legislation, has caused a

heightened sense of urgency in the school systems to accommodate this population of students

 
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without disrupting general classroom learning. Literature supports the use of non-verbal tools

and techniques to teach skills to autistic children, as the general classroom setting can cause ASD

pupils anxiety (Armstong, 2009).

The primary characteristic of ASD is the inability to form or initiate relationships with

other people or the environment. In addition to the consistent social relationship retardation,

autistic children have some or all of the following features; speech delay, non-communicative

nature, mimicked play activities, aversion to changes in environment or routine, strong memory

of mundane information and a lack of imagination (Lanter, 2009; Luckevich, 2008). Students

with ASD may need accommodations to make the environment more comfortable and safe for

them. Once an ASD pupil feels safe they can better focus. Autistic children are less responsive

to humans and to toy play than their non-ASD peers (Koenig, De Los Reyes, Cicchetti, Scahill &

Klin, 2009). As both are part of a social environment, they find these situations stressful.

Further, they are unresponsive to social stimuli, disconnected from the reactions and feelings of

others and prefer to be left alone (Lionello-deNolf, da Silva Barros, & McIlvane. 2008).

Much of the difference between an ASD student and a ‘typical’ student is the way in

which ASD pupils interpret their environment. ASD children must be taught to play,

communicate and learn in ways that they can best function (Diehl, Bennetto, Watson, Gunlogson

& McDonough, 2008). Extensive work has been dedicated to the speech and communication

challenges of autistic children (Gastgeb, 2010); Owen-DeSchryver, Carr, Cale & Blakeley-

Smith, 2008; & Reichow & Volkmar, 2010), yet further research is needed to evaluate autistic

children’s abilities where the learning relationship is between the ASD student and a computer,

thus removing the stress of social interaction.

 
   6
 

Social impairment is a common feature of ASD, and a common misperception is that

these children lack interest in relating to others. Kids with ASD do not choose to alienate

themselves – they are simply missing skills that are essential for developing meaningful peer

relationships. Common social deficits include; opening and closing a conversation, initiating

peer interaction and joining play, decoding facial expressions and body language, observing and

mimicking appropriate social behavior in specific situations and predicting and understanding

the emotions and reactions of others (Snell, 2012). Autism can affect an individual’s nervous

system and other body systems as well as symptoms of this disorder include problems with

muscle tone, gross and fine motor skills and the body’s ability to adapt to the environment (e.g.,

temperature, skin sensitivity). ASD pupils often do not understand social rules or abstract

concepts readily. Typically, they think in concrete terms and are easily distracted from the

teacher (Snell, 2012).

Bajunaid (2010) found that it is vitally important to teach primary skills to children with

autism using systemic methods, as they do not respond well to unstructured adaptive learning,

and that the teacher support the teaching tools. By nature, the characteristics that define a child

as autistic present a direct challenge to the general curriculum of the educational process

(Armstrong, 2009). The environment in which the autistic children are placed is as critical to

their ability to appropriately respond and learn, as is the tool used to teach. A controlled

environment, void of unnecessary noise and activity will allow the learner to focus. Isolating the

skill to be learned will improve the ability of the children to learn a specific skill, without

external nuances or interruptions (Graff, 2007; Knight, McKissick, & Saunders, 2013). Further,

legislation requires the educational system provide equal opportunities and curriculum to all

students.

 
   7
 

Mathematics can be a difficult subject for any student to learn. Technology offers a

mechanism for replacing the stress of human-to-human social interaction and for using motor

skills by creating a learning relationship between student and computer (Slavin & Lake, 2008).

Experienced and new teachers need more information and support to teach this population.

Unfortunately, the first exposure that many teachers have to Autism occurs when the student

enters their classroom. Technology offers non-human instructional methods that can

complement a teacher.

Visually-supported learning via a computer considers the preferences and strengths of

individuals with ASD to process non-transient and visual-spatial information (Aliasgari, Riahinia

& Mojdehavar, 2010). Researchers have shown positive results from using CAI to teach ASD

children English and Communication (Armstrong, 2009; Gulchak, 2008; & Myszak, 2010).

Travers (2010) compared tradition teacher-led instruction to CAI for ASD children. Traditional

learning placed ASD children in groups with non-ASD children and taught using books, while

the CAI methodology placed individual students on computers with minimal interaction with

teachers or other students. The results concluded that both forms of intervention were effective

for ASD children and that there was a greater recognition of alphabet characters among the study

group using CAI.

Limitations and Delimitations

The technology requirements are either currently available or easy to access, while the

human involvement for this exploration may pose challenges. First, willing participants, parents,

teachers and administrators will be identified. Rice (2010) found that there can be trust issues

between parents of ASD children and school personnel. She identified three contributing factors

valuable to the proposed study: major phases of interaction, development of relationships and

 
 8
   

evaluation of the child’s intervention. Clearly, all stakeholders, including parents, teachers,

itinerant staff, and school administrators need to be included in all steps. A thorough

understanding of the problem and goal addressed in this exploration will need to be consistently

communicated to all participants, except the autistic pupils. Input and feedback from all

involved must be obtained and openly communicated to ensure that the student’s best interest is

preserved and anxiety minimized. Kaffer (2010) identified the frustration felt by parents and

teachers of ASD children by the children’s’ unique learning styles. To address this frustration

and to meet the ASD children’s needs, interventions and teaching strategies are often required

(Long, 2012).

A Likert scale will be used to establish a threshold for the data collected. Restall and

Ripat (2008) validated the Likert scale as an objective tool for data collection, allowing

participants a range of options for establishing value to questions. With the objectivity of using

the Likert scale, drawbacks of this measurement tool are present to skew the data trying to be

collected. For instance, respondents may avoid using extreme response categories that will limit

the results due to acquiescence responding. Other limitations are that the respondents may be

overly negative or positive based upon their experience, have a tendency to agree with the given

statements, or answer questions based upon what they feel are socially desirable and alter the

data. Other limitations could be a lower response rate due to privacy issues, fearing a website can

track those who login and monitor their responses. Finally, another limitation could be the lack

of comfort with technology to navigate the web to take the survey, which could lower the

number of responses.

School administrators’ and teachers’ attitudes and willingness to participate are other factors

to consider. Technology has long been given value based on its efficacy and effectiveness. The

 
   9
 

motivation to incorporate a technology comes from an underlying belief that in the end, the

technology will prove beneficial. In the public education environment, the influencing factors as

to whether to use a technology include the teacher’s perception and willingness to try (Graff,

2007; Rice, 2010). A key challenge for individuals with ASD is the inability to understand

personal space, frequently leading to social problems. Vladescu (2010) identified two areas of

concern when assessing educational progress in ASD children; language impairment and social

impairment, therefore a standardized non-verbal assessment tool will need to be designed and

developed.

Professionals working with individuals with ASD know first-hand that structure is a

necessary means of making life more predictable and manageable for pupils (Messemer, 2010).

Teachers who use computers to teach these pupils can mitigate some of the issues unique to ASD

children, including the criticality of structure and the unpredictable influence of social interaction

with other students (Myszak, 2010, Savas, 2007, & Travers, 2010).

Conducting a study involving ‘real world’ participant and environment comes with

assumptions. Evaluating children with autism will also involve parents, as the pupils are minors.

Typically, parents and the primary caregivers, but do not have formal training in working with or

educating ASD children. Parents, especially maternal caregivers, need education and

information to assist in their understanding the ASD child’s needs, behaviors and best interests.

Teachers and practitioners are charged with educating children in a healthy, controlled

environment. The No Child Left Behind Act of 2001 (NCLB) requires schools to develop and

implement standards-based assessments for all students. The combination of NCLB and tighter

state budgets has created an environment of inclusive classrooms, where students with

disabilities are merged and taught with the general population. Typically, ASD children do not

 
  

 
10
 
adapt well in large, general classrooms, as they struggle with the social skills necessary to

flourish.

Parents and teachers need support in dealing with the ASD population. Most parents

do not have the education to guide their ASD child through the public education system, and

most general education teachers perceive ASD children as anti-social and do not have the time or

resources to work with them. Within the confines of the school, communication will meet the

needs of both parents and teachers associated with the ASD participants.

A lack of standardized diagnostic tool, standardized curriculum in classrooms and the

NCLB Act are all limiting factors. There is currently no formal, medical test to diagnose ASD.

Practitioners are left to work with informal tools and techniques for assessing and categorizing

children who exhibit autistic characteristics. While not all children are diagnosed by private

practitioners, most start receiving support in the public school system as a result of teachers and

staff.

Standardized curriculum has become the norm in public school systems. In the state of

Michigan standardized testing within the k-12 system is called the Michigan Education

Assessment Program (MEAP; https://www.michigan.gov/mde/0,1607,7-140-22709_31168---

,00.html, April 14, 2014)). MEAP was developed to meet the mandates of the NCLB Act and

drives the curriculum in most public schools in the state (Bolt, 2011). While the assessments

were standardized, the methodology of instruction was not. Budgetary constraints paired with

traditional practices blend to provide elementary education in a teacher-led classroom. CAI was

used to meet the standardized assessment goals in a non-traditional environment.

 
  
11
 
The scope will be limited by geographic location, demographics, grade levels, sample

size and instructional tool. The targeted location was an elementary school located in

Kalamazoo, Michigan and grade levels included first through the fourth. Targeted demographics

included boys and girls between the ages of six and nine. Sample size was between four and ten,

and the CAI mathematics software was selected from a pre-developed set of applications.

Definitions and Acronyms

ABA: Applied Behavior Analysis; an intervention for children with disabilities.

ABI: Applied Behavior Intervention; the application of ABA as a treatment.

ASD: Autism Spectrum Disorder; a developmental disorder that is characterized by social

deficits.

Autism: a developmental disorder that appears in children by the age of 3 and is characterized

by social and communication issues.

CAI: Computer-aided Instruction; the use of computers to assist in teaching.

CAM: Complementary and Alternative Medicine; medical products and practices that are not

part of standard care.

CBT: Cognitive-behavioral Therapy; a form of psychotherapy emphasizing the importance of

thinking in how we feel and what we do.

DTT: Discrete Trial Testing; a method of instruction that works to shape behavior through the

use of repetition and cause and effect learning.

 
   12
 
EIBI: Early Intensive Behavior Intervention; a scientific method to learning, consisting of

intensive behavioral intervention.

IDEA: the Individuals with Disabilities Act is a law that provides for children with disabilities.

IEP: Individualized Education Program; mandated by IDEA for all student with disabilities, the

IEP is a tool used in the schools to describe how the student learns, how the student best

demonstrates that learning and what teachers and service providers will do to help the

student learn more effectively.

Likert scale: a psychometric scale used most often for questionnaires.

MEAP: Michigan Education Assessment Program is a set of standardized assessments used in

the state of Michigan to meet NCLB mandates.

NCLB: the No child Left Behind Act of 2001 ensures that all students receive a high level of

education via standardized assessments.

Neurobiological disorder: is a disorder that results from damage to the body’s nervous system.

PECS: Picture Exchange Communication System; a form of augmentative and alternative

communication. It is typically used as an aid in communication for children with

disabilities.

PRT: Pivotal Response Training; a naturalistic behavioral intervention developed to facilitate

stimulus and response generalization, increase spontaneity, reduce prompt dependency,

and increase motivation while still relying on the principles of applied behavior analysis.

Psychopathology: the study of mental illness, mental distress mental health disorders.

 
   13
 
TEACCH: Treatment and Education of Autistic and Communication related Children; a highly

structured program designed to facilitate independence and social interaction for students

with Autism.

VBI: Verbal Behavior Intervention; a language-based approach that targets verbal skill-

development using the principals of Applied Behavior Analysis (ABA).

Organization of Study

The study began by identifying parties critical to the analyzing/diagnosing and

identification of pupils on the ASD spectrum amongst the population of students currently

attending Prairie Ridge Elementary School. Potential pupils for this study needed to be

diagnosed by a professional (physician or school itinerant staff) as ASD, so that their goals could

be reviewed for ‘fit’ to the study. Additionally, Consent would need to be collected from all

parents/guardians of study pupils.

Based upon the findings presented in the review of literature, it was clear that

Mathematics as a subject was not as well investigated as English or Social Skills of ASD

students in elementary school. The Computer-aided Instructional tool, Teachtown® software,

was already developed to include Math skills and problem solving for elementary-aged pupils, so

the methodology for using this CAI tool was needed to ensure that the study was effective and

appropriate. Details and data analysis employed myriad techniques, including the Likert scale,

pre- and post-test scores and empirical review to evaluate the effectiveness of the new treatment

(CAI) once implemented within a public school setting.

 
   14
 
Chapter 2

Review of the Literature

A review of the literature specific to ASD pupils in the public education system revealed that

while there have been myriad interventions used to assist in the ability of professionals to work

with these students, no single proven method has emerged and computer-based assistive software

is worth investigating. Medical professionals and researchers do not know the cause of Asperger

Syndrome or any of the Autism Spectrum Disorders. These disorders can affect an individual’s

nervous system and other body systems as well. Symptoms of this disorder include problems

with muscle tone, gross and fine motor skills and the body’s ability to adapt to the environment

(e.g., temperature, skin sensitivity). ASD pupils do not understand simple unwritten school and

social rules that other students learn without much effort. ASD pupils are often unable to

understand abstract concepts readily and tend to think in concrete terms. Additionally, these

pupils have difficulty in social situations. Since the public school classroom is typically a very

social setting and ASD students struggle with social relationships, traditional school classrooms

can be a stressful environment.

There is no known cure for Autism Spectrum Disorders. As the review of literature showed,

medical professionals and researchers have not found a single treatment method that has proven

successful at alleviating or reducing symptoms in all ASD pupils. Further, research on

decreasing the symptoms of the disorder in the classroom does not indicate any single method

that will aid all ASD pupils. Practitioners recommend using repetition and a highly structured

schedule for the ASD pupil’s learning environment. Additional interventions include behavioral

therapy, occupational and speech therapy and alternative treatments. Identifying a set of

 
  
15
 
successful interventions for an ASD pupil can be as unique as the behaviors exhibited by the

individual (Abdullah-Bajunaidan, 2010). The public school system must provide inclusion for

ASD pupils and yet may not have the resources to provide the interventions that will aid these

pupils in learning alongside their non-ASD classmates.

Computer-aided instruction is an intervention that minimizes the social interaction of the

classroom environment, minimizes the amount of time needed from the teacher to work with

each ASD pupil and provides education through graphics and text. TeachTown® (CAI) was

used to aid teachers in delivering and assessing a mathematics curriculum in a manner that

alleviates the common stressors for ASD pupils inherent in a ‘live’ classroom.

Characteristics of ASD Pupils

The definition of autistic disorder dates back to 1943 when Leo Kanner characterized the

syndrome as having six main features: extreme autistic aloneness, language abnormalities,

obsessive desire for the maintenance of sameness, good cognitive potential, normal physical

development and highly intelligent, obsessive and cold parents. Kanner provided the first known

diagnostic label, yet it became problematic due to a lack of clear and objective criteria for

making a diagnosis (Cridland, 2014). While sharing the same diagnoses (ASD), the behaviors

exhibited by autistic children and adults can be significantly different. These differences have

led practitioners to using the autistic spectrum and sub-characterizing its manifestations specific

to the individual (Baio, 2014).

Autism is heterogeneous; no single causal deficiency has been identified. Although there

has been no single core deficit identified, there are four major areas of attention and research:

problems with cognition, feelings and emotion, attention and focus and imitation (NIMH, 2014).

 
   16
 

Problems with cognition, or the theory of mind, focus on developing an individual’s sense of fit

with the environment. Emotional problems are central to those with ASD, and explain their

social awkwardness. Problems with imitation have been suggested as the deficits responsible for

language and communication issues (Brunner, 2009). Deficits in attention and excitement will

be part of this investigation, as the focus will be to enhance the visual stimulation for higher

functioning autistic pupils by using CAI as a teaching tool.

People with autism spectrum disorders typically have very individual diagnostic profiles

with deficits in communication, socialization and imagination/restricted interests. Most

prominent is the impairment in communication and social interaction, a far-reaching challenge

that affects daily activities and relationships at home, school and work (Anderson, Oti, Lord &

Welch, 2009; Muller, 2008). The National Center for Disease Control estimates that one

American child in 68 is affected with an autism spectrum disorder, compared with one in 10,000

a decade ago (CDC; obtained April 14, 2014). ASD is the second most common developmental

disability, next to mental retardation (Reffert, 2008).

Autism Spectrum Disorder does not discriminate according to race, ethnicity or

socioeconomic status, however boys are five times more likely to exhibit the characteristics,

compared to girls of the same age (CDC; http://www.cdc.gov). The Free Appropriate Public

Education (FAPE; www.fape.org) is a federal program linking families, educators , service

providers and policymakers to ensure conformity with the IDEA mandates. Researchers and

practitioners agree on three main characteristics used to determine ASD, usually present in

children by the age of three, but often not addressed until children enter the school system.

Deficits in social interaction, verbal and nonverbal communication issues and repetitive

behaviors and interests comprise the three characteristics (Howlin, 2008, Lanter, 2009, NICHD,

 
   17
 
2011; Reffert, 2008). Due to social and communication characteristics and the young age by

which autism is evident, this syndrome adversely affects a children’s educational performance

(ASM; http://www.autism-mi.org; April 14, 2014).

There are a variety of factors that lead to a diagnosis of an autism spectrum disorder

when they occur together. One characteristic of ASD is the presence of delays or deviations in

language and communication. Both expressive and receptive language may be affected, although

typically expressive language is a strength for those diagnosed with ASD (Gastgeb, 2010). These

individuals may sound like "little professors," even at a very young age, and particularly if they

are talking about an area of special interest. However, understanding language (what they read or

hear), answering questions and using language socially are typically more of a challenge for

them. ‘Small talk’ can be difficult for those with ASD, both because of the fast pace and back-

and-forth nature of it, as well as the mundane topics such as weather, jobs, family members, etc.

(Slavin, 2008).

The differences or delays that are typically identified as being in the social

participation area include:

>Initiating and/or sustaining a social interaction,

>Turn-taking (reciprocal relationships), whether in activities or conversations,

>Adherence to own rituals, rules and routines,

>Difficulty noticing, understanding, or responding effectively to unwritten social rules,

>Emotional regulation, and understanding of emotions in others (and responding effectively),

>Theory of Mind (understanding that others have their own ideas, feelings, interests, etc. and

using that information to guide interactions with others),

>Peer to peer relationships (often individuals with ASD have an easier time interacting with

 
  
18
 
people much younger or older than they are, especially during childhood and adolescence)

(Myszak, 2010).

So much of our daily communication takes place outside of the actual words that are

spoken or written. Instead, meaning is derived from context, tone of voice, body language and

facial expressions. People with ASD naturally gravitate toward the actual words, and often miss

the intended meaning because they have difficulty "reading" the other factors (noticing them,

understanding their significance and responding effectively) (Reichow, 2010). Some individuals

with ASD do not use verbal language to communicate, or have very limited words or signs to

indicate their needs or thoughts. Assisted communication, sign language and other methods can

help some individuals with ASD to connect with others in a way that had been previously

unavailable to them (Muller, 2008).

Simple language tends to be more of a strength for individuals with ASD than complex

language. When we "say what we mean and mean what we say," we are communicating in a way

that is more likely to be understood by those with ASD. We can also help by "using our words"

to explain our thought process, and to clue them into the facial expressions, body language and

context clues that contribute to intended meaning as they participate in social interactions with

others (Brunner, 2009). Using visual cues, and providing plenty of "think time" as they retrieve

information stored in their memory can help those with ASD be more successful in their

interactions with others.

Researchers and practitioners have noted differences in imagination abilities in people with

ASD. Differences include engaging in more realistic imaginative play, exhibiting imaginative

abilities only within the realm of their special interests, or being restricted by their imagination

(Heiman, 2012). These differences can impact how ASD children interact socially, as typically

 
  
19
 
people filter social responses by first passing an internal "imagination test," where, through

theory of mind (or the ability to imagine what another person knows, thinks, feels, etc.) or other

developmental strategies they have imagined responses and how others might respond to it

before we do or say something (Koning, 2010; Myszak, 2010).

Another aspect of a diagnosis of ASD is "restricted interests." Often people with ASD have a

special interest that is unusual in its focus and intensity. It may be similar to the interests of one's

peers, or vastly different. But this interest (sometimes referred to as a "perseveration") typically

occupies the time, conversations, physical space and emotional energies of the person with ASD

(Giarelli, Wiggins, Rice, Levy, Kirby, Pinto-Martin, & Mandell, 2010). Although this aspect can

make it difficult for parents and professionals to gain the attention of the person who would

rather be talking or thinking about an area of special interest, it can also be used for motivation,

rewards and possibly even for a career path. This has been the case for Temple Grandin, author

of "The Way I See It" and "Developing Talents," who has used her love for animals and her

incredible ability to think in pictures to become very successful in designing humane livestock

handling facilities (http://www.templegrandin.com, 08/08/2012).

When a person's sensory system is not well-integrated, he or she may:

>Have difficulty screening out unnecessary noises, struggle to focus on the important ones

and may sense some sounds as unusually painful,

>Have difficulty paying attention to important details without being distracted by tags in

clothing, temperature, or other sensory input,

>Be intolerant of different textures when eating or touching things,

>Slam doors or use too much force in other areas, since the proprioceptive system is not

signaling how heavy the door is and how much force is needed,

 
  
20
 
>Walk into things or step on people's toes, due to a lack of understanding of where his/her

body is in space,

>Be bothered by too much visual input--fluorescent lighting, too many objects or colors, too

much activity or motion,

>Stand too close while talking with someone, or complain that someone else is too close,

since he/she lacks an awareness of appropriate personal space,

>Use a voice that is too loud or too soft for the current social context,

>Shut down or melt down, when the sensory system becomes over-stressed (Rice, 2010).

In addition to the ‘soft’ characteristics seen in most autistic children, there are also more

disruptive behaviors, shared by other impaired children, which make traditional classroom

learning difficult. ASD children, like peers afflicted with other forms of retardation, can be self-

injurious (e.g., scratching, gouging, cutting, etc.), and prone to severe tantrums (Reichow, 2010).

These behaviors are both disruptive and destructive to a learning environment, frustrating ASD

children, peers and teachers. Despite the long history of diagnosing ASD, research has been

sparse and there has been no sign of significant improvements in the behavior and ability to learn

in autistic children (Aman, Hollway, McDougle, Scahill, Tierney, McCracken et al., 2008).      

Autistic children are less responsive to humans and to toy play than their non-ASD peers

(Koenig, 2009). As both are part of a social environment, they find these situations stressful.

Further, they are unresponsive to social stimuli, disconnected from the reactions and feelings of

others and prefer to be left alone (Heiman, 2012; Lionello-deNolf, 2008). Extensive work has

been dedicated to the speech and communication challenges of autistic children (Beaumont &

Sofronoff, 2008; Brunner, 2009; Gastgeb, 2010; Owen-DeSchryver, 2008; & Reichow, 2010),

yet further research is needed to evaluate autistic children’s abilities where the learning

 
   21
 

relationship is between the ASD student and a computer, thus removing the stress of social

interaction.

Children with autism can be classified as visual thinkers, having music and math minds

and work specialists (Geurts, Corbett & Solomon, 2009; Ogletree & Crawford, 2009). Visual

thinkers are best at visual tasks, like drawing, and weaker in more abstract areas. Music and

math minds tend to think and relate in patterns and are weaker in creative non-factual skills, like

creative writing. Word specialists are skilled at reciting facts and best at memorization, while

being weaker with creative tasks, like drawing. Tailoring curriculum to the autistic children’s

strengths and tendencies is best, as it will eliminate the need for the student to use his

imagination and assumptions and supports a consistent set of expectations.

Public Education System as Applied to ASD Pupils

Government Acts and legislation have brought more children with disabilities into the

public school system as well as raising the standards of education these pupils are to receive.

The NCLB Act requires that all states provide a fair, equal and significant opportunity to a high-

quality education to all pupils (http://www2.ed.gov). IDEA specifies standards of education for

students with disabilities. NCLB ensures that all students be part of the general population at

public schools, and IDEA dictates that pupils with disabilities be afforded the same high

standards of education and be integrated into the general education classrooms, so that they

receive the same teaching resources as their peers. Myszak (2010) concluded that inclusion in

general education classrooms poses challenges and opportunities for both students and teachers.

She further concluded that teachers who are not specifically trained to support children with

disabilities are unable to provide adequate social and educational aspects of a classroom to ASD

children.

 
  
22
 
Federal mandates have dictated that public schools afford the same educational

opportunities to all children, regardless of any disability, yet there is no standard for the training

and support of the teachers for these youth. Many teachers in the public school system began

their career long before the establishment of IDEA and NCLB. Teachers need professional

development in the form of skills and knowledge specific to ASD children and interventions for

successfully assisting their pupils. (Trowbridge, 2012). Like most people, teachers are shaped by

their experiences and most have perceptions of children with ASD as being anti-social. Teacher

perception can be re-shaped and improved if afforded training and education in the area of

autistic pupils (Syriopoulou-Delli, Cassimos, Tripsianis, & Polychronopoulou, 2012). Cloke

(2012) conducted training of public school teachers using evidence-based interventions focused

on ASD pupils which showed positive results. Autistic children can be overwhelmed by the

environment of a public school setting so the support provided to educate and train caregivers of

ASD pupils can make a profound impact on their educational experience (Ruble, McDuffie,

King, & Lorenz, 2008).

The public school system has made significant improvements in the area of vocabulary

and language for autistic children and their special needs. Strength-based assessment has

identified language as a primary need in all children, and of particular urgency for those with

ASD (Brunner, 2009; Owen-DeSchryver, 2008; Gastgeb, 2010; & Reichow, 2010). Research

has focused on the vocabulary development of autistic children and public school practitioners

are responding with programs, assessments, ancillary teaching tools and additional human

resources to address these needs; however the same cannot be shown in the discipline of

mathematics.

When it follows a typical pattern, the social and cognitive development of children is

 
  
23
 
relatively effortless. In addition to being taught the social rules of their culture, children

everywhere enjoy the company of others (Naber, Bakermans-Kranenburg, van IJzendoorn,

Swinkels, Buitelaar, &. van Engeland, 2008). By contrast, children with ASD do not seem to

share this natural pleasure in the company of other children or adults (Anderson, 2009; & Muller,

Gorrow, & Fiala, 2011). They must be taught to play, communicate and learn in ways that they

can best function (Diehl, 2008). An area of growing research is that of ASD children at play, as

an intervention for social skills (Gossiaux, 2010). People with ASD are often missing valuable,

relevant social information about themselves and others and can be helped through Social

Stories, Social Behavior Mapping, The Incredible 5-Point Scale, The Hidden Curriculum, The

Social Response Pyramid and many other tools or strategies (Chang, 2009).

Classroom treatments for ASD pupils have included both the traditional and the unique.

One traditional method is Applied Behavior Intervention (ABI). ABI has shown good success in

recent studies (Spreckley & Boyd, 2009). Prior studies involving ABI have used this treatment

to enhance and improve the social and communication skills of their participants. Group therapy

is a unique approach to ASD children, as this treatment seems counterproductive to the autistic

characteristic of social skill struggles.

Interventions

There is no cure for autism, yet there are myriad treatments (interventions) available and

used. Medications can be prescribed to manage characteristics, including high energy, issues

with focus, depression, or seizures (Aman, 2008). Medical professionals have attempted to

modify ASD behaviors through the use of medical treatments. Aman studied the used of

Risperdone and found little improvement. Antipsychotics have also shown little to no

improvement in the behavior or quality of life of ASD children (Ikeda, Hinckson, & Krageloh,

 
  
24
 
2014). Other treatments that have been used and found to make little if any improvements in

behavior include anti-depressants and hormones. The hormone secretin was studied in a

laboratory environment, and found to have some positive effects on ASD behaviors (Tonje, Bull,

Brereten & Wilson, 2014).

Dietary treatments to remove certain foods and substitute vitamins and mineral

supplements have been used to improve the behavior of an autistic child (Balbo, 2010). The

most controversial types of treatments fall into the Complementary and Alternative (CAM)

category. These include chelating, biological and body-based systems, all of which very rarely

show up in literature.

Behavior and communication approaches to intervention are by far the most popular and

widely accepted practices by professionals and parents. Applied Behavior Analysis (ABA)

encourages positive behavior and discourages negative behavior using documented processes.

There are four common types of ABA; Discrete Trial Testing (DTT), Early Intensive Behavior

Intervention (EIBI), Pivotal Response Training (PRT) and Verbal Behavior Intervention (VBI).

ABA treatments have been used extensively with young ASD children in an attempt to modify

behavior and calm children in a social setting (Abdullah-Bajunaidan, 2010).

Abdullah-Bajunaidan (2010) found that it is vitally important to teach primary skills to

children with autism using systemic methods, as they do not respond well to unstructured

adaptive learning, and that the teaching tools be supported by the teacher. By nature, the

characteristics that define a child as autistic present a direct challenge to the general curriculum

of the educational process (Armstrong, 2009). The environment in which the autistic children

are placed is as critical to their ability to appropriately respond and learn, as is the tool used to

teach. A controlled environment, void of unnecessary noise and activity will allow the learner to

 
  
25
 
focus. Isolating the skill to be learned will improve the ability of the children to learn a specific

skill, without external nuances or interruptions (Graff, 2007; Knight, 2013). Further, legislation

requires the educational system provide equal opportunities and curriculum to all students (e.g.,

FAPE, IDEA, NCLB). Snell (2012) showed limited success using group therapy as an

intervention for adolescent ASD youth. The combination of traditional and unique treatments is

another option, and one that has only been documented in a few studies (Rogers & Vismara,

2008a).

Traditional teacher-led classroom instruction uses many tools, including verbal

explanations, text examples and storyboarding. Storyboarding in this setting refers to the use of

flashcards and other graphics to teach mathematics. Other alternative treatments for teaching

ASD pupils include; ABA, the Developmental, Individual Difference, Relationship-based model

(DIR/floortime), PECS, social stories and the Treatments and TEACCH (Ryan, Hughes,

Katsiyannis, McDaniel, & Sprinkle, 2011).

Occupational Therapy, Sensory Integration Therapy and Speech Therapy are additional

interventions where specially-trained personnel work individually with autistic children to help

modify behavior. These therapies have been effective in a global sense; however are not a

practical solution within the public school setting (Lionello-deNolf, 2008). Occupational

therapists have made great strides in introducing "sensory diets" in classrooms to provide the

feedback so many students need, whether swinging, pushing or pulling heavy objects, "brushing"

(the Wilbarger method), weighted vests, bouncy seats or balls to sit on while working (Muller,

2008).

The Teaching and Education of Autistic and related Communication-handicapped Children

(TEACCH) and Picture Exchange Communication System (PECS) both use picture cards to

 
  
26
 
assist ASD children in communication. Cognitive-behavioral Therapy (CBT) has shown

promising results for improving learning in pupils with ASD (Koning, 2010; McNally-Keehn,

2010).

         Pupils with ASD are known to adhere to routines and rituals. However, when a person lives in

a world full of events and responses that appear random, as is often the case for those with ASD

due to their difficulties with generalizing, executive functioning, theory of mind, gestalt

processing, sensory integration, etc., it makes sense that they would grasp onto those things in

life that are routine, predictable and comfortable. Schedules, routines, calendars and clocks can

all provide predictability and valuable reassurance for those who struggle to make sense of an

otherwise seemingly chaotic environment (Lytle & Todd, 2009). We can help by providing

advanced notice when things are going to change, using calming strategies (like visuals) to help

guide them through transitions and by recognizing when it might be better to ensure that a

comfortable routine can be followed, at least for a time.

There is pressure on parents of ASD pupils to find the ‘right’ intervention choices for their

children (Conroy, 2010). Some researchers have evaluated using psycho-educational

interventions (Eikeseth, 2009). Early, intensive behavioral intervention is another option

(Eldevik, Hastings, Hughes, Jahr, Eikeseth, Cross, 2009). Cloke (2012) evaluated video-

enhanced activity schedules as a tool for teaching young ASD pupils. Snell (2012) investigated

the effects of teaching ASD youth in a therapeutic, activity-based program centered on social

skills. None of these studies showed strong results.  

Computer-aided Instruction

The primary stressor in the educational setting for autistic children is the social interaction

with other humans. Replacing teachers and peers with technology can make learning more

 
 31  

 
27
 
comfortable and help reduce the majority of their stress, thus promoting academic success

(Reffert, 2008). There have been significant changes and advancements in technology since

Reffert’s 2008 study, making a more current test of CAI as a tool for learning relevant (Moosavi,

2009). An interesting fact is that both the documented number of children with ASD and the

innovations to technology have grown significantly over the past decade. CAI as a category

includes software tools that use graphics and illustrations and is commercially available in the

forms of simulations, games and video modeling.

The inclusion of CAI as a teaching tool for ASD children is a worthwhile study, as is the

comparison of this teaching mode to the traditional teacher-led instruction (Dille, 2009).

Robbins (2010) also evaluated the efficacy of these two types of instruction. His work identified

that most teachers surveyed approved of using technology as a teaching aid for autistic children,

however the majority admitted to feeling unprepared to use this tool or any other, specifically for

their ASD students. The findings supported the need for much more research in this area, as

teachers admitted to needing teaching aids as well as professional development for working with

ASD children.

         Robbins (2010) evaluated the efficacy of CAI to teacher-led instruction and identified

that class size is typically large, (20-30 students on average), standards of assessment are rigid

and external aid is minimal. Additionally, Balbo (2010) identified a critical need for timely and

accurate paperwork for children with special needs. An increase in the number of ASD children

is evident in school across the country. This increase has led to a need for further studies

focused on this population and their needs (Robbins, 2010; Quinn, 2011).

The typical characteristics of autistic children may hold the key for finding successful

interventions in the classroom. CAI offers a technology tool that is heavy in graphics and needs

 
   28
 

no communication skills to operate. CAI has been evaluated as a tool for teaching ASD pupils,

with most of the focus on language and vocabulary skills. Rhee (1997) conducted an

investigation of using hypermedia to teach whole number addition to children with learning

disabilities. The focus was on pre- and post-testing to compare results for both baseline and

intervention groups of pupils taught basic math addition via CAI. Although the results of the

Rhee study were supportive of using CAI to teach math to students with learning disabilities, few

studies followed.

Pitts-Lathan (2006) developed her own CAI software tool, The Math Training Station, to

teach basic math skills to a small group of middle school students with learning disabilities. The

software contained both audio and video components and the study followed twenty-four

participants for a semester. Pre- and post-testing were used to demonstrate skill progress, and

statistics supported using CAI as a teaching tool of math for students with learning disabilities.

In 2009 Wild investigated the usage of CAI for teaching phonological skills to

elementary pupils with autism (Wild, 2009). Her investigation compared a group of ASD pupils,

who were taught using the intervention to a control group of students, taught the same math

skills via a paper-based format. Pre- and post-testing was used to assess specific math skills and

the ASD pupils taught using the intervention showed better phonological skills than the control

group.

CAI offers an interactive, customizable training mechanism that is also measurable

(Luckevich, 2008; Travers, 2010). Savas (2007) stated that technology in education is a valuable

tool for teaching children with social interaction sensitivity. CAI also removes social interaction,

the primary stressor for ASD children. Enhancing the learning of mathematics for young,

 
  
29
 
autistic children is important, and there is a vast selection of available CAI tools for this

discipline.  

CAI Software

There is evidence that computer-aided instruction is well accepted by ASD pupils and

provides improved skills in language, mathematics and behavioral skills (Armstrong, 2009; Ayer

& Hudziak, 2009; Gulchak, 2008; Koning, 2010; Luckovich, 2008; & Myszak, 2010; Travers,

2010). Despite the recommendations of research works, however, the field remains relatively

unexplored (Crawford, 2008; Slavin, 2008). CAI multimedia offers a learning environment that

rigidity and inflexibility in thinking (Pitts-Lathen, 2006; Rhee, 1997; & Wild, 2009).

Myriad commercially-available software tools offer math learning strategies to both educators

and parents. These tools can be obtained in either CD-ROM/DVD formats or accessed via the

Internet. Table 1 shows some of the most popular CAI tools designed specifically for teaching

ASD pupils. Table 2 lists many of the CAI tools designed to teach the subject of Mathematics.

Selection for the CAI tool to serve as the intervention was based on the following criteria:

>Online accessibility; CAI to be administered in school computer lab via Internet service,

>Curriculum-based skills and assessments; enabling teachers to meet MEAP commitments,

>Offering k-6 grade skill sets,

>Learning involves a simulation or game environment,

>Cost.

In addition to research, there have been documented examples of the usage of CAI to teach

math to ASD pupils. MathRecovery® was evaluated as a mathematics CAI in secondary

education (Rossiter, 2012). This toolset combines online lessons with textbooks and ancillary

materials to support teachers in the classroom, but is not focused on pupils with learning

 
   30
 
disabilities by offering an environment tailored to their challenges.

TeachTown® is a suite of tools designed specifically for autistic learners. The interactive

website (www.teachtown.com) offers CAI options for teaching language, social skills,

communication skills, emotional development and curriculum skills. The Basics CAI targets

ASD pupils ages 2-7 and is curriculum-based designed to meet standardized assessments. The

lessons were developed to meet the framework of ABA, DTT and PRT by having pupils

complete discrete tasks that receive positive reinforcement (e.g., smiley faces and “You did it”

messages). Byers and Reinke documented their success teaching 30 ASD students math over the

past three years using this tool (http://www.autism-society.org/news/computer-aided-

instruction.html, 04/14/2014). Reinke states that her students showed improved skills,

heightened attention spans and “they generalize skills to everyday experiences. These are all

great learning attributes of computer-aided instruction to support children with autism.”

A basic search on the Internet illustrates the vast difference between the amount of software

tools available for teaching ASD pupils, compared to those available for teaching Mathematics to

elementary-aged students. This fact is apparent, when comparing Tables 1 and 2, that illustrate

the number of commercially-available software tools for teaching autistic children.

Summary

The challenges facing pupils with ASD include social impairment, communication

impairment and the limitation of behaviors and interests (American Psychiatric Association,

2014, Diagnostic and Statistical Manual of Mental Disorders). Pupils with ASD may not be able

to express needs in a ‘normal’ or acceptable manner, lack interest or the ability for appropriate

play with toys and peers (Heiman,2012), have difficulty interpreting nonverbal signals from

others (Snell, 2012), and may engage in disruptive behavior (Center for Disease Control, 2014).

 
   31
 
Without appropriate intervention, deficits in the areas of social, behavioral and communication

skills can limit a student’s educational progress (National Research Council, 2014). Effective

intervention for ASD continues to be early and intensive education to address these core

symptoms (National Research Council, 2014). According to the National Research Council,

social, behavioral, communication, play, life and academic skills are important targets for

instruction (http://  nationalacademies.org/nrc/, 04/14/2014).  

CD-­‐
ROM/  
DVD   Gaming  
Product  /   Soft-­‐-­‐ Curriculum   Custom-­‐ Math   Environme
Reference   ware   Online   Based   k-­‐6   izable   Lessons   nt   Notes  

DynaVox   Offering  specialized  devices  

www.dynavoxte for  learners  with  
ch.com               X               disabilities..  
FastForWord   Language,  reading  and  
www.scilearn.co literacy  products  for  
m       X       X           X   learners  with  disabilities.  
Products  designed  
TeachTown   specifically  for  autistic  
www.teachtown learners.    Works  with  IEP  
.com   X       X   X       X   X   goals.  
VizZle   6-­‐pupil  set.  
www.monarcht Library  of  lessons.  
eachtech.com/vi Use  pictures  to  create  
zzle/       X       X   X   X       lesson  plan.  
Mathematics  flash  cards  on  
a  thumb  drive  with  
Flash!Pro   workbooks  and  materials  
/aba-­‐ Flash   on  CD-­‐ROM  and  
materials.com/   X           X       Cards       workbooks.  
Data  collection  capability.  
Dttrainer   Graphics,   Provides  ABA  
/aba-­‐ audio    +   reinforcement  to  pupils  as  
materials.com/   X       X   X       X   text.   they  progress.  
Autism  
Solutions  
www.slatersoft Design  social  stories  to  
ware.com/autis teach  behavioral  and  
m.html   X           X   X           communication  skills.  
Digital  Vista   Focused  on  teaching  
www.autismaca behavioral  skills  to  ASD  
demy.com   X           X               pupils.  
Social  Express  
thesocialexpress Focused  on  teaching  social  
.com/       X       X           X   skills  to  ASD  pupils.  
Social  Skill   Focused  on  problem  
Builder   solving,  life  skills,  critical  
www.socialskillb thinking  and  behavioral  
uilder.com   X           X               skills.  
Table 1: Commercially Available Software Tools for Teaching Autistic Children (not limited to including Math).

 
  
32
 

The Individuals with Disabilities Education Act (NICHCY, National Dissemination Center

for Children with Disabilities, 2014) provides funding for states to provide students with

disabilities, ages 3–21 years, a free and appropriate public education (FAPE). In addition, The

No Child Left Behind Act of 2001 (P.L. 107–110, Section 1001) requires teachers to show

annual progress for students with disabilities and emphasizes that teachers use evidence-based

practices for students with ASD (DoE, 2014). Despite these two pieces of national legislation,

teachers and ancillary staff do not always find the implementation of research-based practices

feasible (Abdullah-Bajunaidan, 2012; Quinn, 2011; Sanchez, 2010).

A review of the literature identified myriad interventions for pupils with ASD, including

CBT, PRT, ABA, PECS, visual support systems and CAI (Balbo, 2010; Ryan, 2011, & Tonge,

2014). CAI has shown positive usage with improvements in language, reading and social

behaviors for ASD pupils (Dille, 2009; Moosavi, 2009; Quinn, 2011; & Robbins, 2010). A

review of available CAI tools revealed many more resources for teaching a particular subject

(e.g., mathematics), than resources focused specifically on ASD pupils. A single commercial

CAI software tool, TeachTown®, will be used to aid ASD pupils in learning mathematics.

   

 
   33
 

  Chapter  3  

Methodology  

Problem and Goal

Increasing numbers of children diagnosed as being on the Autism spectrum, decreasing state

dollars budgeted to public school systems on an annual basis and a mandate by the federal

government to afford all educational opportunities to all young students have merged to create

big issues for both the public school system and academic researchers. The problem is that,

while the number of ASD pupils attending public schools is increasing, teachers are not prepared

to meet their special needs and the expectations of school administration. According to the

Center for Disease Control, 1 in 68 children was identified as ASD in 2010, compared to 1 in

150 reported in 2000 (http://www.cdc.gov, 2014). In the state of Michigan, teachers are

required to have a college degree with a major in education and be state certified (MDE, 2014).

The degree and certification are both in general studies at the elementary level. Support and

training on how to handle ASD children typically comes from ancillary personnel from within

the school district, including social workers, occupational and physical therapists and

psychologists. Teachers work with personnel to ease some of the social stressors ASD pupils

have in school, however the academic expectations for quality and mode of delivery are the same

for all students. An aid for teachers for the delivery of a mathematics curriculum to ASD pupils

is commercial software programs.

This investigation evaluated the effectiveness of CAI, specifically TeachTown® software, as

an alternate treatment for teaching mathematics to a group of autistic pupils, ages 6 to 10, in an

elementary public school in Kalamazoo, Michigan. Once approval from the Nova IRB

 
   34
 
(Institutional Review Board, Appendix B; June 13, 2013) was secured, the next step was

securing approval for this investigation comparing teacher instruction to the use of a software

treatment required approval from the public school and its board of education (Appendix C).

Relevancy is based on three factors: 1) government-mandated inclusion of ASD pupils in the

general education classroom, 2) an increase in the number of ASD pupils in the public school

environment and 3) ASD pupil’s poor response to conventional teaching treatments.

Research Design

Research Design was based on the principles outlined by Krathwohl (1988 p. 29) and proven

successful in numerous studies (Bernard, 2009; Charles, 2009; Hau, 2011). Six aspects of

research design include subjects, situation, measures, treatment, basis for comparison to evaluate

efficacy of treatment and procedure plan. Krathwohl’s principles and set of aspects remains

highly respected in research, forming a strong foundation for establishing the necessary

relevancy to the body of research knowledge.

The subjects were ASD pupils in a public elementary school, and the situation was the

computer lab in the school. The measures were the pre- and post-test data and the observations

that measured the effects of an alternate treatment. The treatment was CAI, and the basis for

comparing CAI to traditional instruction was the measure of skill tests and pupil comfort level

gathered and evaluated. The procedure plan was to run the study during one full academic

semester at the elementary school, whereby the subjects were taught mathematics using both

traditional and alternative treatments over a 15-week period of time.

Collet-Klingenberg (2008) identified a comprehensive list of steps for implementing CAI as a

teaching tool for ASD pupils. Published by the National Professional Development Center on

Autism Spectrum Disorders (http://autismpdc.fpg.unc.edu/, 04/14/2014), the steps are:

 
   35
 
1. Identified the target of instruction. Using tools such as the IEP, math skills were

identified for improvement. CAI was the treatment to teach the math skills and

measurement was observed based on testing.

2. Collected baseline data. Data was collected on ASD pupils’ skill level specific to the

target math skills. Data was collected from a variety of sources, including tests, lessons

and exercises. Data was collected a minimum of three occasions to form an accurate

baseline.

3. Identified technology support. Technology support personnel were identified within the

school and district. Technology use policies were acquired and reviewed to establish

compliance. Prior to purchasing the CAI software, the study and tools were discussed

with technology support personnel.

4. Identified available computers for use. Computers were located in the classroom and

identified to check specifications for all software loaded.

5. Identified appropriate software. CAI software tool was selected and discussed with

school personnel, including technology support.

6. Selected and installed software. The selected CAI software tool was explicitly used to

teach the target math skill, was age appropriate with ASD pupil demographics and was

tailored to meet school curriculum needs.

7. Learned the software. The CAI software tool was loaded onto the classroom computers

and tested prior to participants’ usage.

8. Completed a task analysis of steps for using software. A comprehensive set of steps was

written for participants to use computer resources and CAI software tool independently.

 
   36
 
This set of steps included turning the computers on / off, starting the CAI software,

accessing the target skill lessons and saving work prior to closing application.

*Based on the task analysis, a troubleshooting guide was developed to walk participants

through common computer usage issues (e.g., what to do if CAI program does not

launch).

9. Taught the software to others who support the learner. Teachers, support personnel and

school practitioners were trained in the CAI software.

10. Taught the learner basic computer skills, as necessary. Depending on the computer use

skill level of the ASD pupils, additional training was needed in basic computer use skills

(e.g., turning computer on / off, using mouse and keyboard, opening / closing software

programs, etc.)

11. Introduced learner to software. ASD pupil participants were introduced to the CAI

software tools, risk analysis was covered and pupils were given the opportunity to try out

the CAI software.

12. Provided learners with multiple opportunities to use computer resources. ASD pupils

were given exposure to the CAI software to ensure comfort and ease with navigation.

13. Provided on-going support to learners. In addition to the risk analysis and

troubleshooting guide, live support was provided to the ASD pupils using the computers.

14. Collected data on acquisition of target skills. Data was collected using the same

instruments as used for collecting baseline data (lessons, exercises and tests).

The CAI application was from previously developed software tools available on the Internet

and featuring desired features. The purpose of comparing the two instructional methodologies

(teacher-led classroom and CAI) was to establish if CAI is effective in aiding autistic children

 
   37
 
with retention and application of specific math skills (Dille, 2009). Direct observation in an

educational setting, whether open-ended or using structured checklists, is a good format for

assessment by teachers (Folk, 2008; Romanelli, 2009; & Schroeder, 2014). Data analysis from

the qualitative observations included the numerical data collected from the Likert scales to

illustrate differences, both positive and negative (Mays, 2011; & Muller, 2011).

Approach

The instrumentation included a limited sample size (Whalen, Moss, Ilan, Vaupel, Fielding,

MacDoanld, Cernich, & Symon, 2010). The small sample size was recommended for working

with ASD pupils. The first step in identifying possible candidate pupils for this investigation

involved meeting with itinerant staff from the Intermediate Schools district: Social Workers and

Therapists, and teachers from the school, who all work directly with students. Professionals

were asked to review the ROCs (Request for Observation and Consultation) for individual

students to identify pupils who had been diagnosed as ASD. The IEP (Individualized Education

Program) requires the evaluation and input of many professionals to effectively qualify a student

for services associated with the regional Intermediate School District and follows the ROC.

Experts

A questionnaire was developed to identify participant ASD pupils. The questionnaire was

reviewed and approved by a review panel, including a Teacher, Psychiatrist, Social Worker,

Occupational Therapist and/or a Speech & Language Therapist, all specializing in ASD pupils.

The questionnaire was developed and approved by the panel of experts as a tool for identifying

candidate pupils for the study, both to be part of the traditional teacher-led classroom and to

learn via new treatment, TeachTown® software. The full identification of potential candidates

for any academic study involves myriad factors, including; current diagnosis of any disabilities,

 
   38
 
past record of achievement as well as issues, current record of medications to control disabilities

and the agreement of professional staff to work closely with study pupils throughout the duration

of the test to ensure that the pupils are happy and agreeable staying in the study parameters.

Pre- and post-testing has been shown to be an effective tool for evaluating skills sets in pupils

(Burns & Boice, 2009; Jenkins, Graff & Miglioretti, 2009). It is common practice for the

teachers in the public school system to use standardized tests designed by book publishers to

meet specific curriculum guidelines. This was the case in this study; the teacher used

standardized tests developed by the book publisher to meet math lesson goals.

The sample design was comprised of one small group, eight ASD pupils, between the

ages of six and nine and then separated into two sub-groups of ASD pupils who were taught a

specific and consistent mathematics curriculum. Based on the special needs of the pupils,

limiting the sample size to a small number was desirable and feasible (Whalen, 2010). One sub-

group was taught math via conventional teacher-led practices within the general classroom, and

the other sub-group was taught the same math curriculum using an alternative treatment (CAI)

using school computers. Last, ASD pupils involved in this evaluation had permission to do so

from their parent or legal guardian. Of the possible candidate pupils, eight were selected to take

part in this study, and Consent Forms were signed by the parents of all eight pupils (Appendix H;

signed Consent Forms).

 
   39
 

List of Pupils in ASD Study on TeachTown® Intervention  

                         
                       Type  of  Instruction  
Name       Age       Grade                            Teacher/Intervention  
Amber  S.   6   Kindergarten   TeachTown  
Jacob  L.  
    6     Kindergarten   Teacher-­‐led  
Trent  N.  
    7     1st   TeachTown  
Steven  S.  
    7     1st   Teacher-­‐led  
Grace  C.  
    9     3rd   TeachTown  
Cal  B.  
    9     3rd   TeachTown  
Steve  A.  
    9     3rd   Teacher-­‐led  
Troy  H.  
    9     3rd   Teacher-­‐led  
     
Table 4. List of Pupils in ASD Study on TeachTown® Intervention

Implementation

The computer-based treatment implemented was TeachTown® software, a Computer-aided

Instruction application tailored to ASD pupils. According to its website, “TeachTown is a

scientifically proven software for children with Autism and Special Needs.”

(web.teachtown.com, accessed on April 14, 2014) TeachTown® has been reviewed and

recommended as an instructional aid for ASD pupils based on its inherent ability to meet the

environmental needs and language of this population (Doctor & Naqvi, 2010). In her book,

Doctor uses the Theory of Mind to explain why this software is a trending solution to teaching

ASD pupils (Doctor, 2010, p. 186-192). One of TeachTown®’s original developers, Whalen

described the software application as a program based on curriculum that uses evidence-based

best practices from Applied Behavior Analysis, speech and language pathology therapy and

developmental psychology (Whalen & Vaupel, 2011). Whalen states, “TeachTown®: Basics can

provide convenient and excessive data collection, management tools for large IEP/treatment

teams, it can provide alternatives to working effectively with multiple children and offers

additional resources for lesson/IEP/treatment goal planning.” (Whalen & Vaupel, 2011, p. 4)

TeachTown® offers two product lines; Basics and Social Skills and the Computer Interface is

very user friendly, with child-like characters and activities (Appendix I). There are six learning

 
  

  40
 

domains addressed by the TeachTown® software; adaptive skills, cognitive skills, language arts,

language development, math and social & emotional skills (Appendix J). This software self-

adjusts based on student progress and is customizable by parents and teachers (Appendix K).

Collet-Klingenberg (2008) developed a comprehensive list of implementation steps for using

software to teach ASD pupils. In addition to this list, direct observation has been shown to be

effective in the assessment of ASD pupils (Folk, Lee, Beaver & Boldt, 2008; Romanelli, Bird &

Ryan, 2009; & Schroeder, Cappadocia, Bebko, Pepler, & Weiss, 2014). Likert scales were used

to illustrate differences in data, based on past success in research studies (Mays, Beal-Alvarez &

Jolivette, 2011; Muller, 2011).

Data collection involved numerous elements, proven useful in other studies. Empirical and

numerical data were used to measure skills in ASD pupils (Matthews, 2011; & Poirier, Martin,

Gaigg & Bowler, 2011). Key Behavior Change Inventory (Daniels, Halladay, Shih, Elder &

Dawson, 2014)(Appendix M), the PROMIS Anxiety tool (NIH, 8/12/2012)(Appendix N) and

pre- and post-testing (Blinkoff, 2010; Eilers, 2010) were used. Likert scales were used to

illustrate data results, both baseline and pre- and post-testing.

The eight ASD pupils were diagnosed prior to the 2014 study by professionals, either

physicians or Itinerant staff, including social workers, psychologists and a speech and language

therapist from the local Intermediate School District, using a standardized evaluation tool. The

target of using a questionnaire was to identify participant ASD pupils. The ROC and IEP tools

are mandated by the Federal Government, as part of the IDEA protocol and provide the bridge

between the school teacher, who believes he/she has a student exhibiting odd behaviors and the

objective support professionals (itinerant staff) who assess the pupils and make

recommendations and plans for working with the students. The State of Michigan requires a

 
  

  41
 

standardized form be completed by school personnel for any student needing special or extra

assistance in learning. This form, an Individualized Education Program (IEP) was used to track

issues and progress with mathematics as well as a tool for facilitating meetings with parents.

The study was scheduled to begin in January, 2014 with the new school term, however

due to precarious weather in Michigan, the study was both delayed and interrupted due to ‘snow

days’. Due to hazardous weather this winter in Michigan, professionals had the opportunity to

revise and approve the questionnaire (Table 6). Validity of this tool was based on the feedback

from experts and reliability will be based on a regression analysis of the final questionnaire

answers.

Winter  2014  Academic  School  Year  Calendar  (January  1-­‐  June  1,  2014)  
School  in-­‐session  
Month       Day       Y/N       Study  Goal  
Meeting  to  get  Consent  
January       6       N  (snow)       Forms  completed  
Meeting  to  get  Consent  
January       7       N  (snow)       Forms  completed  
Meeting  to  get  Consent  
January       8       N  (snow)       Forms  completed  
Meeting  to  get  Consent  
January       17       N  (snow)       Forms  completed  
Meeting  to  get  Consent  
January       24       N  (snow)       Forms  completed  
Met  with  Parents  to  explain  
study  and  get  Consent  
January       27       N  (snow)       Forums  signed  
Met  with  Parents  to  explain  
study  and  get  Consent  
January       28       N  (snow)       Forums  signed  
Met  with  Parents  to  explain  
study  and  get  Consent  
January       29       N  (snow)       Forums  signed  
February       2       N  (snow)       Study  running-­‐-­‐no  data  
February       5       N  (snow)       Study  running-­‐-­‐no  data  
February       10       N  (snow)       Study  running-­‐-­‐no  data  
February       27       N  (snow)       Study  running-­‐-­‐no  data  
February       12       N  (snow)       Study  running-­‐-­‐no  data  
Table 6. Winter 2014 Academic School Calendar Days off Due to Snow

 
   42
 
Upon agreement and approval of the Questionnaire, scores from the previous year Michigan

Educational Assessment Program (MEAP) tests, a standardized assessment developed by the

State of Michigan, paired with the IEPs and ROCs for students assisted school professionals in

identifying pupils diagnosed as ASD and as good candidates for this study (Appendices N and

O:MEAP schedule and Item Description for Mathematics). Qualitative research methodology

for this evaluation needed to be respectful of the very small sample size. Standardized pre- and

post-testing has proven successful as a quantitative tool for assessing change in ASD children as

part of a small sample size (Burns, 2009; & Jenkins, 2009).

Research Question #1 How does CAI, using animated graphics, impact the comprehension,

retention and application of math skills for children with ASD? Without any exception, pupils

using the TeachTown® CAI software, were very excited to use this application, stayed on task

longer than pupils learning mathematics via the teacher-led classroom and IEPs following up the

study stated that these pupils enjoyed the experience overall. Data were accumulated using pre-

and post-tests. The observations by school personnel and support professionals assisted in

assuring the best learning conditions for the participants in the experiment. Observation is a

viable tool for comparing educational curriculum lessons and tasks. He further stated that for

teachers, work comes first and the passion for pupil learning is the central goal to their work

(Schroeder, 2014).

Research Question #2. How does the absence of text, (presenting material using graphics and

sounds), impact the comprehension, retention and application of math skills by children with

ASD? The Intervention, TeachTown® software, used very few text questions, instead using

shapes and characters to teach mathematics skills including addition, subtraction, multiplication,

division and simple story problems. The alternative treatment was measured and evaluated,

 
   43
 

specific to comprehension, retention and application of math skills using pre- and post-tests

developed by the teachers. Data collection was accomplished using a relational database and

comparison reports and graphs were produced from the database application. Pupil’s skill levels

were compared both between the two sub-sets, as well as to the pupil’s performance data from

prior semesters. This data comparison substantiated whether the alternative treatment helps ASD

pupils learn mathematics in the general education environment.

Research Question #3. How can children with autism benefit from CAI? Aside from the data

collected based on mathematics assessment scores, the pupils in this study benefitted by

interacting less with teachers and fellow students, thereby decreasing their angst at being in a

classroom with others. The benefits to ASD pupils from learning from an alternative treatment

can be behavioral as well as literal. Unambiguous questions were asked of parents, teachers and

support personnel to evaluate benefits to the ASD pupils using the alternative treatments. The

Likert scale assigned numerical values to the questionnaire answers, providing structured data.

Data from both the Likert scaled questionnaire as well as from the pre- and post-tests were

entered into the database to provide graphs and reports for comparison and evaluation.

Research Question #4. How does CAI compare to teacher-led instruction for the purpose of

teaching mathematics to ASD children in the public elementary school environment? While

there are explicit results based on quantitative assessment scores, there are also implicit

advantages for ASD pupils who interact with a computer versus with a teacher or fellow student.

ASD pupils typically get stressed and anxious when dealing on a social front with other people,

so the ability to interact with a computer lowered this anxiety and allowed these pupils to

concentrate on the lesson and tasks at hand. Comparison of the treatments was evaluated based

on two sets of data: the pre- and post-test results and the observation of the effects of using an

 
 44
 
 

alternate treatment, as measured by a Likert scale. Data from the skill testing were entered into a

database application and instruments for comparison were produced (e.g., graphs). Observations

of the effects of using an alternate treatment were measured and the emotional impact on the

pupils and their attitudes toward learning mathematics in the school setting.
 
Data Collection

         Experiments provide empirical and pragmatic data needed to measure skills and knowledge

retention in ASD pupils (Matthews, 2011; & Poirier, 2011). The instruments of measurement for

this experiment included mathematics pre- and post-test scores, (generated from tests written by

the teacher and book publisher), to meet curriculum expectations. The quantitative data were

both definable and repeatable. The ability to compare a treatment group to a control group has

successfully been used in social investigations for years (Macuruso, & Rodman, 2009). The

procedure for collecting the test scores involved manually inputting the test scores into a data

analysis tool. Differences between test scores for the two sub-groups helped to validate if CAI,

as an intervention, was an effective teaching tool of Mathematics to ASD pupils.

One of the most frustrating limitations/barriers faced in this investigation was the harsh

weather in Michigan this winter, As seen in Table 7, the study was both delayed by an entire

month (January) and interrupted five additional days due to school cancellation based on high

amounts of snow and hazardous conditions. The actual usage of the alternative treatment was

evaluated between February 1 and May 31, 2014.

 
   45
 

Winter  2014  Academic  School  Year  Calendar  (January  1-­‐  June  1,  2014)  and  Study  Goals  
                           
School  in-­‐
session  
Month       Day       Y/N       Study  Goal  
January       6       N  (snow)       Meeting  to  get  Consent  Forms  completed  
January       7       N  (snow)       Meeting  to  get  Consent  Forms  completed  
January       8       N  (snow)       Meeting  to  get  Consent  Forms  completed  
January       17       N  (snow)       Meeting  to  get  Consent  Forms  completed  
January       24       N  (snow)       Meeting  to  get  Consent  Forms  completed  
Met  with  Parents  to  explain  study  and  get  
January       27       N  (snow)       Consent  Forums  signed  
Met  with  Parents  to  explain  study  and  get  
January       28       N  (snow)       Consent  Forums  signed  
Met  with  Parents  to  explain  study  and  get  
January       29       N  (snow)       Consent  Forums  signed  
February       3       N  (snow)       Study  running-­‐-­‐no  data  
February       5       N  (snow)       Study  running-­‐-­‐no  data  
February       10       N  (snow)       Study  running-­‐-­‐no  data  
February       11-­‐14       Y       Start  Study-­‐-­‐Pre-­‐Testing  
February       17-­‐21       Y       Study  running  
February       24,  25,  26       Y       Study  running  
February       27       N  (snow)       Snow  Day-­‐-­‐no  school  
February       28       Y       Study  running  
March       3-­‐7       Y       Study  running  
March       10,  11       Y       Study  running  
February       12       N       Snow  Day-­‐-­‐no  school  
February       13,  14       Y       Study  running  
February       17-­‐21       Y       Study  running  
March       24-­‐28       y       Study  running  
March       31       N       No  School-­‐-­‐mid-­‐semester  break  
April       1-­‐4       Y       Study  running  
April       7-­‐11       Y       Study  running  
April       14-­‐18       Y       Study  running  
April       21-­‐25       Y       Study  running  
April       28-­‐30       Y       Study  running  
May       1,2       Y       Study  running  
May       5-­‐9       Y       Study  running  
May       12-­‐16       Y       Study  running  
May       19-­‐23       Y       Study  running  
May       26-­‐30       Y       Finish  Study  &  get  Post-­‐tests  
Table 7: Winter 2014 academic School Year and Study Data

 
   46
 

Measures

School teachers and practitioners who works directly with the student population were

asked to provide information on the following:

Demographic Data. Teachers and personnel were asked a variety of questions,

including; pupil status, age, gender, race / ethnicity, education level, if/when/how pupil was

diagnosed as ASD, relationship to pupil, length of time working with pupil and amount of time

spent working with pupil. These questions were integrated throughout the questionnaire. Two

sub-groups were identified based on this questionnaire; ASD-diagnosed pupils between the ages

of 6-9, one sub-group to be taught in the general classroom by the teacher (a.k.a. ‘the control

group’) and the other to be taught the same content at a computer using a CAI tool.

Results  of  Questionnaire  

Currently   Student   Diagnosed   Method  of  Learning  

Name   Age   Grade  Level   Ethnicity  
Enrolled   Gender   as  ASD   while  in  Study  (Math)  

Amber  S.   Y   6   F   Kindergarten   W   Y   TeachTown  

Jacob  L.   Y   6   M   Kindergarten   W   Y   Teacher-­‐led  
Trent  N.   Y   7   M   1st   W   Y   TeachTown  
Steven  S.   Y   7   M   1st   W   Y   Teacher-­‐led  
Grace  C.   Y   9   F   3rd   W   Y   TeachTown  
Cal  B.   Y   9   M   3rd   W   Y   TeachTown  
Steve  A.   Y   9   M   3rd   B   Y   Teacher-­‐led  
Troy  H.   Y   9   M   3rd   W   Y   Teacher-­‐led  
Table 8: Results from Questionnaire

Key Behavior Change Inventory – modified (Appendix M). Daniels (2014) assessed

behavioral changes in patients by asking caregivers to rate the degree to which a condition

applied to their patient. Daniels used many questions and evaluated the following; inattention,

impulsivity, unawareness of problem, apathy, interpersonal difficulty, communication problems,

somatic difficulties and emotional adjustment. A Likert-type scale was used to gather

 
   47
 

quantifiable data.

The teacher and Itinerant staff, who work directly with the students, were asked a series

of questions, including the categories of inattention, impulsivity, apathy, interpersonal difficulty,

communication problems and emotional adjustment. Based on the fact that these questions were

subjective and contained two less categories than the original survey developed by Daniels, the

questionnaire contained less than 64 questions. As a qualitative instrument, Likert scale

questionnaires have proven effective with small sample size studies involving ASD children

(Alexandrov, 2010; Cavanaugh, 2010; Cook, 2009). A Likert-type scale was used to rate the

answers, with 1= Not True, 2= Somewhat True, 3= Often True, and 4= Always True.

PROMIS Anxiety – Short Form (PROMIS; Appendix N). The Patient-Reported

Outcomes Measurement System (PROMIS) anxiety short form is an instrument that assesses an

individual’s subjective experience of anxiety symptoms such as fear and arousal. Developed by

the National Institute of Health (http://www.nih.gov; April 14, 2014) this tool asks participants to

rate how often they have experienced specific symptoms over a 7-day period. Question answers

are rated on a Likert-type scale and scoring is based on a T-score algorithm. Higher T-scores

equate to higher levels of anxiety. A key characteristic for most ASD children is anxiety, and a

goal of this study was to reduce the level of a pupil’s anxiety by using CAI as an intervention.

Questions were developed to assess pupil’s level of anxiety as characterized by fear,

forgetfulness and nervousness.

Standardized Pre- and Post-Tests

Schools in the state of Michigan must meet rigorous standards of quality in education in

order to be eligible for funding. The Board of Education for the state of Michigan assesses the

quality of education provided by its schools using the MEAP (Michigan Educational Assessment

 
 48
   

Program) assessment. MEAP tests and scores are the instrument Michigan uses to meet federal

NCLB standards. MEAP testing is conducted in all Michigan schools in the month of October

(Appendix O), and schools typically receive their results before the school year ends. The

criticality of the MEAP tests dictates the curriculum taught in the schools. Permission from the

State of Michigan was acquired prior to using the MEAP assessment by the school district.

Mathematics is one field of study measured by MEAP testing beginning with the third grade. In

the later elementary schools, teachers design English and Mathematics curriculum based on

descriptors of subject items, as published by the Michigan Department of Education (Appendix

P). Due to the deadline on submitting this study, there is no comparison of MEAP scores

available between the academic years of 2014 and 2015.

Tests were developed by teachers and administered to pupils both before instruction on

specific content areas (pre-test) and after content instruction is delivered (post-test). Evaluations

have proven successful for evaluating ASD pupils in the educational system (Blinkoff, 2010;

Eilers, 2010). Content instruction was delivered using two methods; traditional, teacher-led

classroom instruction and CAI via computer terminals in the same classroom (students using the

TeachTown® intervention will use headphones to restrict interferences). Curriculum, content

and tests were the same for both methods of instruction. Test scores were plotted and regression

analysis identified differences between groups, if any.

Format for Presenting Results

Validation is a key factor in any study. Here, validation of the treatment was in the form of

comparison. The alternative treatment (CAI) was compared to the traditional treatment of

teacher-led instruction using data from pre- and post-testing as well as observation. Cross-

validation is possible, as there were two sub--sets of pupils to be evaluated; one taught via

 
  
49
 

traditional classroom instruction and the other taught the identical curriculum and tested using

identical pre- and post-tests after being taught using the alternative treatment.

The selection of a mathematics-focused CAI software product was complete, as

TeachTown®, a previously- established software web-based application was used and only the

specifics linked to the teacher’s curriculum were modified as a procedural implementation. The

ISD social worker practitioner agreed to assist, by diagnosing the participants, completing

subjective reviews of the pupil’s emotional states and by assisting with the implementation.

Instruments, including the pre- and post-tests and questionnaire, were validated by the ASD

teacher, social worker and ancillary staff prior to any data collection. The Assent and Consent

forms, (approved by the IRB on 6/13/13) were used during a meeting with candidate pupils. The

creation of questions for the survey and the committees were developed paralleling the

maturation of the school year. Public school teachers wrote all pre- and post-tests to meet

curriculum expectations and goals.

Resources

People

Two categories of resources were needed to complete this exploration. First, human

resources included ASD-diagnosed early childhood pupils (diagnosed by professionals other than

the Teacher). Next, the parents or legal guardians of the children needed to be included and their

permission documented. Last, school personnel and other clinicians assisted with this work,

including working with the students and parents, as well as assisting in the collection of data and

information.

Technology

 
 50
 
 

Technology is the other form of resource needed for running TeachTown® software. The

public elementary school system had two PCs to run the software applications in the classroom,

so there was no need to remove pupils from their traditional classroom. This made the transition

very comfortable for the pupils, as it is customary for students to use these PCs during class-time

and therefore their participation in the study went unnoticed by their peer students.

Miscellaneous

In addition to the two categories of resources listed above, there are also miscellaneous

supplies that were needed to be employed. IEPs, student evaluations (completed by school and

ISD personnel), ROCs-plans for development (of the autistic children), MEAP and test scores

and meeting spaces are some of the elements that were included in this study.

Summary

The growth in the number of identified pupils with ASD in the public school system is an area

of research deserving of support and interventions. For this study, a small demographic of pupils

in the elementary school system were identified as ASD. To meet compliance requirements, the

curriculum for these pupils was standardized and met the prescribed learning goals established

by teachers, administrators and the state of Michigan. Questionnaires were used to determine

pupil candidates and quantitative data was gathered from standardized pre- and post-tests. Data

were then compared to that of pupils not taught using the alternative treatment, TeachTown®.

Formats for presenting results included the Likert scale and data analysis. The Likert scale is

an effective tool for illustrating the results of a 5-point questionnaire, using close-ended

questions. Data analysis used graphs and tables to illustrate test scores for both students taught

 
 51
   

using the alternative treatment and those taught using conventional instructor-led classroom

practices. The data points for the test scores from the ASD pupils taught in the traditional

classroom provided the benchmark that the data points from the group taught via CAI can be

compared to.

Resources were either present in the school system or available commercially. Computers,

printers, teachers, pupils and ancillary staff were all present in the school system. The vendor for

TeachTown® resources was contacted to request donation of their commercial software. In the

end, the researcher purchased the commercial software in an effort to meet time restrictions. The

primary focus on resources was on working with school personnel to select pupil candidates,

then communicating with parents to ensure complete understanding and approval for their

children’s participation.

 
  
52
 
Chapter 4

Results

The fact that young children are being identified/diagnosed as being on the Autism

Spectrum Disorder (APA, April 14, 2014) at an alarmingly increased number every year is

alarming. Pair that fact with state budgets that continue to use school budgets as a source of

saving dollars versus spending on our youth (MDoE, April 14, 2014), there is a significant need

in our society for an answer to assisting school teachers that is not human in nature. Add to this

fact that the federal government uses legislation, like NCLB, FAPE and IDEA to mandate the

fairness in treating all pupils to the same learning opportunities and holding them to the same

standards as children without any disabilities, and our society has a real problem in servicing

students in our public school system.

Implementation

This study took place in a public elementary school in Michigan, where eight ASD-diagnosed

pupils were selected to take part in an attempt to evaluate the usage of alternative treatment

(TeachTown®) software as a viable alternative to the traditional teacher-led classroom where the

subject was mathematics. The study lasted for 15 weeks and was interrupted a few times due to

the hazardous weather of a Michigan winter. Parental consent forms were signed at the end of

January and the study began during the first week of February. The Mathematics curriculum and

assessment tests were pre-set by the book publisher (Pearson-Vue) and the State of Michigan.

There were a total of eight study pupils, with four in the control group where they were taught

via a teacher and the other four were taught the same math curriculum via the intervention

 
   53
 

TeachTown® software. The students represented grades Kindergarten through the 3rd grade and

were assigned as follows:

Pupils  in  ASD  Study  on  TeachTown  Intervention  

           
               
Type  of  Instruction  
Name       Age       Grade       Teacher/Intervention  
Amber  S.(TT)   6   Kindergarten   TeachTown  
Jacob  L.     6     Kindergarten     Teacher-­‐led  
Trent  N.  (TT)     7     1st     TeachTown  
Steven  S.     7     1st     Teacher-­‐led  
Grace  C.  (TT)     9     3rd     TeachTown  
Cal  B.  (TT)     9     3rd     TeachTown  
Steve  A.     9     3rd     Teacher-­‐led  
Troy  H.     9     3rd     Teacher-­‐led  
Table 4: List  of    Pupils  in  the  
  ASD  study  on  TeachTown®  
  Intervention

Evaluation

The control group as well as the pupils taught via the interventions were taught the

Mathematical lessons (1 and 2) by the Teacher for 15 weeks. At the end of each lesson, the

teacher would place the four pupils taught view intervention at the PCs, where they could pick

up working wherever they left off the last time. Pupils remaining with their peers in the teacher-

led classroom would then learn the math principles from examples illustrated by the teacher.

The control group would apply principles using classroom lesson plans, while the intervention

group would apply principles using the software application. After four weeks, both sets of

pupils were tested for the Lesson 1 Mathematics skills and applicability, with the following

results:

 
   54
 

Table 9: Pre-­‐test  Scores  for  Study  Pupils  

Name       Grade       Score  
Amber  (TT)       K       1  
Pre-test Scores Jacob       K       0  
Trent  (TT)       1       4  
For Study Pupils Steven       1       6  
Grace  (TT)       3       8  
Cal  (TT)       3       9  
Steve       3       9  
Troy       3       10  

Following this first Math assessment, students were given a daily lesson plan, with the control

group learning the math skills from the teacher in the classroom while the other four ASD pupils

learned the same skills via the software treatment. Once the teacher had finished the skills

lessons and all students had completed the practice exercises, they all took the L-1 Math skills

post-test. The following illustrates the results, both pre- and post-test for the ASD pupils:

Pre-­‐test  
Name   Post-­‐test  Score  
Score  
Amber  
1   2  
(TT)  
Jacob   0   2  
Trent  (TT)   4   4   Table 10: Pre- and Post-test Scores for Study
Steven   6   8  
Grace   Pupils, Lesson 1
8   8  
(TT)  
Cal  (TT)   9   9  
Steve   9   9  
Troy   10   9  

 
   55
 

This data can also be compared using a chart:

Figure 1: Pre- and Post-test Scores for Pupils, Lesson 1

12  
10  
8  
6  
Pre-­‐test  Score  
4  
2   Post-­‐test  Score  
0  

The eight participant pupils were then given the pre-test for mathematics (Appendix G) and

earned the following scores for Lesson 2 test:

Pre-­‐  and  Post-­‐test  Scores  for  Study  Pupils;  L2  

Post-­‐test  
Name   Pre-­‐test    Score    Score  

Amber  (TT)   0   1  
Table 11: Pre- and
Jacob   0   2  
Post-test scores
Trent  (TT)   2   2  

for L-2 test. Steven   1   2  

Grace  (TT)   12   14  

Cal  (TT)   2   8  

Steven   8   8  

Troy   15   15  

 
   56
 
This data can also be compared using a chart:

16  
14  
12   Pre-­‐  and  Post-­‐test  
10   Scores  for  Study  
8   Pupils;  L2  Pre-­‐test    
6   Score  
4   Pre-­‐  and  Post-­‐test  
2   Scores  for  Study  
0   Pupils;  L2  Post-­‐test  
 Score  

Figure 2: Pre- and Post-test Scores, L-2

The remaining eleven weeks were dedicated to the mathematical skills associated with the

Lesson 2 material. At the end of the 15-week study, the following quantitative results were

documented:

Quantitative  Data  Analysis  

    L1   L2    
    Pre   Post   Pre   Post  
Amber  (TT)   1   2   0   1  
Table 12: Quantitative Data Analysis  
Jacob   0   2   0   2  
Trent  (TT)   4   4   2   2  
Steven   6   8   1   2    
Grace  (TT)   8   8   12   14  
Cal  (TT)   9   9   2   8  
 
Steven   9   9   8   0  
Troy   10   9   15   15  
Mode   9   9   2   2    
Median   8   8   2   2  
Mean   5.875   6.375   5   5.5  
 

 
  

 
57
 
This data can also be compared using a chart:

16  
14   Quanitaive  Data  
12   Analysis  L1  Pre  
10  
8   Quanitaive  Data  
6   Analysis  L1  Post  
4   Quanitaive  Data  
2   Analysis  L2  Pre  
0  
Quanitaive  Data  
Analysis  L2  Post  

Figure 3: Quantitative Data Analysis

The conclusion here is that for all but one (Troy), the post-test score was at least as high, if not

higher, for the ASD pupils than those for the same pupils taking the pre-test. The other

conclusion is that the post-test scores for all pupils using the treatment were higher than their

scores for the pre-test. Last, the post-test score for Amber, a pupil taught by the intervention,

was twice the score she earned on the pre-test.

Due to the dramatic intensity change between L-1 and L-2, there was also a dramatic change

in the pupil’s performance with these skills. To illustrate the numerical or empirical change,

figure 2 shows the trends for both teacher-led and Intervention-led pupils. Pupils taught using

the intervention, TeachTown® software, are Amber, Trent, Grace and Cal, all of whom showed

significant improvement from the pre- to post-test.

Of the quantitative data, the number that sticks out the most is the rise in the mean for both

lessons 1 and 2—demonstrating that the average scores did rise for the ASD pupils taught using

the intervention for Mathematics.

 
   58
 
Qualitative Results

The next piece of data was accumulated from the five professionals who work daily or weekly

with the ASD pupils; the teacher, two Social Workers, an Occupational therapist and a Physical

Therapist.

Likert  Scale  for  Evaluating  ASD  Pupils  

Strongly  
  Strongly  
    Disagree   Disagree   Undecided   Agree    Agree  
1.    I  would  consider  the  8  ASD  pupils  as  Anxious.                   5  
2.    I  would  describe  the  8  ASD  pupils  as  Social  (enjoy  the  company  of  fellow  students).   4   1              
3.    I  see  no  use  for  computers  as  a  replacement  or  augmentation  for  teachers.   1   1   1   2      
4.    I  see  the  social  advantages  of  human-­‐computer  interaction  for  ASD  pupils.   1       1   2   1  
5.    The  ASD  pupils  seem  anxious  about  this  study.   4   1              
6.    The  parents  of  the  ASD  pupils  seem  anxious  about  this  study.   5                  
7.    I  have  heard  that  the  ASD  pupils  are  being  harassed  about  the  study.   5                  
8.    This  is  a  ridiculous  study.   5                  
9.    I  think  the  budget  will  increase  for  public  schools  in  the  near  future.   5                  
10.    Students  do  not  like  working  on  PCs.   5                  
11.    The  level  of  anxiety  in  the  ASD  students  has  risen  due  to  the  study.       5              
12.    The  ASD  pupils  enjoy  the  TeachTown  software.               1   4  
13.    Most  students  want  to  try  the  TeachTown  software.                   5  
14.    The  ASD  pupils  seem  to  enjoy  learning  from  the  PC.                   5  
15.    I  see  value  in  this  study.                   5  
Table 12: Likert Table of Professional Responses to ASD Pupil Anxiety Questions

 
  
59
 
Figure 4: Likert Results of Professional Responses to ASD Pupil Anxiety Questions

6  
5  
4  
3  
Strongly  Disagree  
2  
1   Disagree  
0   Undecided  
5.    The  ASD  pupils  

12.    The  ASD  pupils  

14.    The  ASD  pupils  

1.    I  would  consider  the  
2.    I  would  describe  the  

6.    The  parents  of  the  

7.    I  have  heard  that  
8.    This  is  a  ridiculous  
9.    I  think  the  budget  
10.    Students  do  not  

13.    Most  students  

15.    I  see  value  in  this  

11.    The  level  of  anxiety  
4.    I  see  the  social  
3.    I  see  no  use  for  

Agree  

Strongly  Agree  

The results from the Likert scale showed little to no additional anxiety seen in the ASD

pupils due to the study. Most professionals associated with the study, including the teacher and

social workers, commented on how much the ASD pupils enjoyed the time on PC and learning

via intervention. In addition to the quantitative data, it is important to this study to review

qualitative data, as it relates to the pupils as well as the study.

A Likert study set of results give a good start to what is already known about ‘typical’ ASD

pupils—they are much more comfortable with machines than with people. This study also

wanted to gather the observations of the professionals who work on a routine basis with these

ASD pupils, both to capture what these pupils are like on a ‘normal’ day and how, if at all, the

evaluation impacted the ASD pupils. The next set of data collected were from the Key Behavior

change Inventory, where the typical behaviors of the ASD pupils are seen through the

professionals’ eyes.

 
  
60
 
Figure 5: The Key Behavior Change Inventory of the ASD Pupils

6  

5  

4  

3  

2   Not  True  

1   Somewhat  
True  
0  
Oken  
True  

Always  
True  

In addition to the Likert scale and the Key Behavior Change Inventory, there was one more tool

for collecting qualitative data; the PROMIS Form—short version. This form allowed for the five

professionals, who work with these ASD pupils on a daily basis, to evaluate the anxiety levels. It

is critical, in the evaluation of this assistive intervention, that the treatment not add to the anxiety

level of the ASD pupils, as this is one characteristic already present in many of these young

people.

 
  
61
 
Figure 6: PROMIS Anxiety—Short Form

All  of  
During  the  15-­‐week  study,  were   the  Time  
pupils  unselled.  
During  the  15-­‐week  study,  pupils   Most  of    
were  nervous.   the  Time  
During  the  15-­‐week  study,  pupils  
Some  of  
found  it  hard  to  focus  on  
the  ime  
During  the  15-­‐week  study,  pupils  
felt  worried.   a  Lille  of  
During  the  15-­‐week  study,  pupils   the  Time  
felt  anxious.  
None  of  
During  the  15-­‐week  study,    
the  Time  
pupils  felt  fearful.      
0   1   2   3   4   5  

The PROMIS anxiety short form asked the professionals to evaluate the anxiety and worried

condition of the ASD pupils. Overall, the PROMIS tool demonstrated that the ASD students

were worried and a little anxious, but according to these professionals and research, no more

than they typically demonstrate.

 
  
62
 
Chapter 5

Conclusions, Implications, Recommendations and Summary

In this final chapter, conclusions are drawn regarding the use of an intervention in the form of

a computer software as an ancillary resource for teachers of ASD pupils. Implications and

recommendations are made regarding the impact of the findings as they apply to public

education and specifically the subject of Mathematics. Ideas for future research regarding the

use of CAI technologies in public education are also presented.

Conclusions

Research Question #1 How does CAI, using animated graphics, impact the comprehension,

retention and application of math skills for children with ASD? Without exception, pupils using

the TeachTown® CAI software, were very excited to use this application, stayed on task longer

than pupils learning mathematics via the teacher-led classroom and IEPs following up stated that

these pupils enjoyed the experience overall. Data Analysis was used to measure the impact of

teaching mathematics without the use of text. Data were accumulated using pre- and post-tests.

The observations by school personnel and support professionals assisted in assuring the best

learning conditions for the participants in the experiment. With such a small control and test

group of pupils, it was difficult to find any clear, quantifiable improvement based on the

intervention, however it was clear from the professionals’ observations that the anxiety level of

the ASD pupils was decreased due to the lessening of their need to interact with teachers and

fellow students.

 
   63
 

The qualitative data proved that the stress level, and therefore the social and emotional

satisfaction, of the ASD pupils increased as a result of the intervention. While the study group

and shortness of study time did not show quantifiable improvements that were significant, due to

the intervention, the feedback from the teacher and other professionals validated that the ASD

pupils who used the intervention to learn math were much more focused and excited about

learning the material, than the control group of students, who learned in the classroom from the

teacher. This is a significant finding, as the comfort and stress level of a pupil identified as ASD

is an important identifier in their ability to be successful with academics.

Research Question #2. How does the absence of text, (presenting material using graphics and

sounds), impact the comprehension, retention and application of math skills by children with

ASD? The Intervention, TeachTown® software, used very few text questions, instead using

shapes and characters to teach mathematics skills including addition, subtraction, multiplication,

division and simple story problems. The alternative treatment was measured and evaluated,

specific to comprehension, retention and application of math skills using pre- and post-tests

developed by the teachers. Data collection was accomplished using a relational database and

comparison reports and graphs were produced from the database application. Pupil’s skill levels

were compared both between the two sub-sets, as well as to the pupil’s performance data from

prior semesters. This data comparison substantiated whether the alternative treatment helps ASD

pupils learn mathematics in the general education environment. The true test of whether the

absence of text, audible or in written form, was evaluated based on the anxiety level of the ASD

pupils and the number of questions they asked. The findings showed that the ASD pupils asked

no more questions regarding text than the other students in their group.

 
  
64
 
Research Question #3. How can children with autism benefit from CAI? Aside from the data

collected based on mathematics assessment scores, the pupils benefitted by interacting less with

teachers and fellow students, thereby decreasing their angst at being in a classroom with others.

The benefits to ASD pupils from learning from an alternative treatment can be behavioral as well

as literal. Unambiguous questions were asked of parents, teachers and support personnel to

evaluate benefits to the ASD pupils using the alternative treatments. The Likert scale assigned

numerical values to the questionnaire answers, providing structured data. Data from both the

Likert scaled questionnaire as well as from the pre- and post-tests were then entered into the

database to provide graphs and reports for comparison and evaluation. The quantitative results

showed little to no improvement based on the use of an intervention over the use of teachers,

however the qualitative comments made by professionals validated the lessened anxiety of these

ASD pupils based on the usage of the treatment; CAI software. It was commented many times,

by the ASD pupils, the preference to use the CAI software over sitting listening to a teacher

explain lessons and exercises.

Research Question #4. How does CAI compare to teacher-led instruction for the purpose of

teaching mathematics to ASD children in the public elementary school environment? While

there are explicit results based on quantitative assessment scores, there are also implicit

advantages for ASD pupils who interact with a computer versus with a teacher or fellow student.

ASD pupils typically get stressed and anxious when dealing on a social front with other people,

so the ability to interact with a computer lowered this anxiety and allowed these pupils to

concentrate on the lesson and tasks at hand. Comparison of the treatments was based on two sets

of data: the pre- and post-test results and the observation of the effects of using an alternate

treatment, as measured by a Likert scale. Data from the skill testing were entered into a database

 
   65
 

application and instruments for comparison were produced (e.g., graphs). Observations of the

effects of using an alternate treatment were measured and the emotional impact on the pupils and

their attitudes toward learning mathematics in the school setting.

The quantitative results showed little to no improvement in mathematics skills due to the use

of a treatment versus traditional teacher-led classroom instruction. Some of this lack of efficacy

is attributed to the fact that the sample size was small (only 8 pupils), On the other hand, the

qualitative results focused on the Likert scale, PROMIS and Key Behavior Change Inventories,

as well as follow-up IEPs, where it was apparent from comments that the CAI software treatment

was a preferred method of instruction for ASD pupils. The pupils made it clear that they would

prefer learning all lessons via the CAI software, with no interaction amongst fellow students or

teachers.

Implications

Despite myriad limitations, including the small sample size (of eight) and the numerous

missed days of school (due to hazardous weather), it was clear that there is a place for computer

software as an ancillary teaching tool for teachers with ASD pupils. As these pupils have a

preference for learning from machines versus humans, their focus seemed better when learning

from the computer than when being distracted by other students in a classroom.

TeachTown® was the computer-based software treatment used in this evaluation, however

there are others on the market tailored to the needs and preferences of ASD pupils. Mathematics

was the subject being investigated, yet there are many other research studies that have focused on

English and Social Skills. Any subject being taught to the ASD pupils would qualify as a need

for evaluating software as a teaching tool.

 
  
66
 
Recommendations

It is recommended that continuing research investigate a variety of software treatments.

Another recommendation would be to increase the sample size so that more ASD pupils are

evaluated and over a longer time period than 15-weeks. This longer time period would allow for

the usage of federal assessment scores, like MEAP. Last, it is recommended that an

investigation look at traditional subjects other than English, Mathematics and Social Skills. For

any mandated program to be effectively provided to all pupils there needs to be ancillary tools

available to teachers to meet the needs of all students.

Summary

Federal statistics show that the number of ASD pupils has grown to at least 1 in 68, yet the

amount of state budget dollars associated with public programs has declined over the past five

years. Federal systems enact programs like NCLB and IDEA to ensure that all students are

afforded the same quality education, yet the actual delivery of quality is dependent upon the

amount of money dedicated to the teachers, curriculum and professional staff assigned to the

delivery of such education.

This study showed little improvement in quantifiable data when an alternative treatment,

TeachTown® software, was used in lieu of teacher-led instruction of mathematical lessons. On

the other hand, observations by professionals, including teachers, social workers and therapists

all agree that the anxiety level associated with ASD pupils was effectively lowered by the use of

computer-aided software as an alternative to human interaction in the classroom.

The quantitative results showed minor validation for using the intervention as a teaching tool,

yet the Qualitative feedback from professionals was clear that an intervention, in the form of

 
  
67
 
computer software, is a viable addition to classroom-teaching ASD pupils. Some of this lack of

quantifiable efficacy is attributed to the fact that the sample size was small (only 8 pupils). On

the other hand, the qualitative results focused on the Likert scale, PROMIS and Key Behavior

Change Inventories, as well as follow-up IEPs, where it was apparent from comments that the

CAI software treatment was a preferred method of instruction for ASD pupils. The pupils made

it clear that they would prefer learning all lessons via the CAI software, with no interaction

amongst fellow students or teachers. As ASD pupils have a preference for learning from

machines versus humans, this study showed pupils’ focus seemed better when learning from the

computer than when being distracted by other students in a classroom.

As the economy grows slowly and technology improves quickly, it is only realistic to look at

CAI as a plausible means for instructing pupils who benefit from CHI over human interaction.

Children with disabilities are part of our general population and therefore deem it necessary for

academics and professionals to review options to traditional classroom teaching. The federal

government has enacted protocols to ensure equality in our school system, including NCLB,

IDEA and FAPE. States use standardized testing, like the Michigan MEAP, to ensure equality in

assessment. Academic studies and field professionals have validated the high stress level among

autistic pupils caused by human interaction. Technology is already in most of our public school

systems, so it seems viable to look at this resource as an answer to assisting ASD pupils and their

teachers with classroom instruction so that the ASD pupils are more focused and are more

successful in the academic setting.

 
   68
 

Appendices

 
 69
 
 

Appendix A: DSM-V Criteria for Diagnosing Autism Spectrum Disorder

An autism screening tool must meet all three primary areas defined by the DSM-IV description for
autistic disorder (#'s 1-3 under A below) to qualify for a positive rating from First Signs:

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each
from (2) and (3):

(1)Qualitative  impairment  in  social  interaction,  as    

manifested  by  at  least  two  of  the  following:          
(a)  marked  impairment  in  the  use  of  multiple    
nonverbal  behaviors,  such  as  eye-­‐to-­‐eye  gaze,  
facial  expression,  body  postures,  and  gestures  
to  regulate  social  interaction.  
(b) failure to develop peer relationships  
appropriate to developmental level.
(c) a lack of spontaneous seeking to share  
enjoyment, interests, or achievements with
other people (e.g., by a lack of showing,
bringing, or pointing out objects of interest).
(d) lack of social or emotional reciprocity.  
   
(2) Qualitative impairments in  
communication, as manifested by at least one
of the following:
(a) delay in, or total lack of, the  
development of spoken language (not
accompanied by an attempt to compensate
through alternative modes of
communication such as gesture or mime).
(b) in individuals with adequate speech,  
marked impairment in the ability to initiate
or sustain a conversation with others.
(c) stereotyped and repetitive use of  
language or idiosyncratic language.
(d) lack of varied, spontaneous make-  
believe play or social imitative play
appropriate to developmental level.
   
(3) restricted, repetitive, and stereotyped  
patterns of behavior, interests, and activities as
manifested by at least one of the following:

 
   70
 

(a) encompassing preoccupation with one or  

more stereotyped and restricted patterns of
interest that is abnormal either in intensity
or focus.
(b) apparently inflexible adherence to  
specific, nonfunctional routines or rituals.
(c) stereotyped and repetitive motor  
mannerisms (e.g., hand or finger flapping or
twisting or complex whole-body
movements).
(d)  persistent  preoccupation  with  parts  of    
objects.  
   
B. Delays or abnormal functioning in at least  
one of the following areas, with onset prior to
age 3 years: (1) social interaction, (2) language
as used in social communication, or (3)
symbolic or imaginative play.
   
C. The disturbance is not better accounted for  
by Rett's disorder or childhood disintegrative
disorder.
 

Autism Spectrum Disorder

One  of  the  most  important  changes  in  the  fifth  edition  of  the  Diagnostic  and  Statistical  Manual  of  
Mental  Disorders  (DSM-­‐5)  is  to  autism  spectrum  disorder  (ASD).  The  revised  diagnosis  represents  a  
new,  more  accurate,  and  medically  and  scientifically  useful  way  of  diagnosing  individuals  with  
autism-­‐related  disorders.    
Using  DSM-­‐IV,  patients  could  be  diagnosed  with  four  separate  disorders:  autistic  disorder,  
Asperger’s  disorder,  childhood  disintegrative  disorder,  or  the  catch-­‐all  diagnosis  of  pervasive  
developmental  disorder  not  otherwise  specified.  Researchers  found  that  these  separate  diagnoses  
were  not  consistently  applied  across  different  clinics  and  treatment  centers.  Anyone  diagnosed  with  
one  of  the  four  pervasive  developmental  disorders  (PDD)  from  DSM-­‐IV  should  still  meet  the  criteria  
for  ASD  in  DSM-­‐5  or  another,  more  accurate  DSM-­‐5  diagnosis.  While  DSM  does  not  outline  
recommended  treatment  and  services  for  mental  disorders,  determining  an  accurate  diagnosis  is  a  
first  step  for  a  clinician  in  defining  a  treatment  plan  for  a  patient.  
The  Neurodevelopmental  Work  Group,  led  by  Susan  Swedo,  MD,  senior  investigator  at  the  National  
Institute  of  Mental  Health,  recommended  the  DSM-­‐5  criteria  for  ASD  to  be  a  better  reflection  of  the  
state  of  knowledge  about  autism.  The  Work  Group  believes  a  single  umbrella  disorder  will  improve  
the  diagnosis  of  ASD  without  limiting  the  sensitivity  of  the  criteria,  or  substantially  changing  the  
number  of  children  being  diagnosed.    

 
  
71
 
People  with  ASD  tend  to  have  communication  deficits,  such  as  responding  inappropriately  in  
conversations,  misreading  nonverbal  interactions,  or  having  difficulty  building  friendships  
appropriate  to  their  age.  In  addition,  people  with  ASD  may  be  overly  dependent  on  routines,  highly  
sensitive  to  changes  in  their  environment,  or  intensely  focused  on  inappropriate  items.  Again,  the  
symptoms  of  people  with  ASD  will  fall  on  a  continuum,  with  some  individuals  showing  mild  
symptoms  and  others  having  much  more  severe  symptoms.  This  spectrum  will  allow  clinicians  to  
account  for  the  variations  in  symptoms  and  behaviors  from  person  to  person.    
Under  the  DSM-­‐5  criteria,  individuals  with  ASD  must  show  symptoms  from  early  childhood,  even  if  
those  symptoms  are  not  recognized  until  later.  This  criteria  change  encourages  earlier  diagnosis  of  
ASD  but  also  allows  people  whose  symptoms  may  not  be  fully  recognized  until  social  demands  
exceed  their  capacity  to  receive  the  diagnosis.  It  is  an  important  change  from  DSM-­‐IV  criteria,  which  
was  geared  toward  identifying  school-­‐aged  children  with  autism-­‐related  disorders,  but  not  as  useful  
in  diagnosing  younger  children.    
The  DSM-­‐5  criteria  were  tested  in  real-­‐life  clinical  settings  as  part  of  DSM-­‐5  field  trials,  and  analysis  
from  that  testing  indicated  that  there  will  be  no  significant  changes  in  the  prevalence  of  the  
disorder.  More  recently,  the  largest  and  most  up-­‐to-­‐date  study,  published  by  Huerta,  et  al,  in  the  
October  2012  issue  of  American  Journal  of  Psychiatry,  provided  the  most  comprehensive  
assessment  of  the  DSM-­‐5  criteria  for  ASD  based  on  symptom  extraction  from  previously  collected  
data.  The  study  found  that  DSM-­‐5  criteria  identified  91  percent  of  children  with  clinical  DSM-­‐IV  PDD  
diagnoses,  suggesting  that  most  children  with  DSM-­‐IV  PDD  diagnoses  will  retain  their  diagnosis  of  
ASD  using  the  new  criteria.  Several  other  studies,  using  various  methodologies,  have  been  
inconsistent  in  their  findings.    
 
DSM  is  the  manual  used  by  clinicians  and  researchers  to  diagnose  and  classify  mental  disorders.  The  American  
Psychiatric  Association  (APA)  will  publish  DSM-­‐5  in  2013,  culminating  a  14-­‐year  revision  process.  
APA  is  a  national  medical  specialty  society  whose  more  than  36,000  physician  members  specialize  in  the  diagnosis,  
treatment,  prevention  and  research  of  mental  illnesses,  including  substance  use  disorders.  Visit  the  APA  at  
www.psychiatry.org.  For  more  information,  please  contact  Eve  Herold  at  703-­‐907-­‐8640  or  press@psych.org.  
©  2013  American  Psychiatric  Association  

 
  
72
 
Appendix B: IRB Approval

 
  
73
 

Appendix C: Approval from School to Conduct Study

 
   74
 
Appendix D: Individualized Education Program (IEP) as Mandated by IDEA

 
  
75
 

 
  
76
 

 
  
77
 

 
  
78
 

 
  
79
 

 
  
80
 

 
  
81
 

 
  
82
 

 
  
83
 

 
  
84
 

 
  
85
 

 
  
86
 

 
  
87
 

 
  
88
 

 
  
89
 

Appendix E: Questionnaire

The following are statements that may apply to <student name>, a student in your school and
classroom. Think of this student, read the statement, and check the box that you feel best
describes the student to the statement.

1. Student is currently enrolled at this school. Yes/No

2. Student is: Male/Female
3. Student is: 6 years old, 7years old, 8 years old, 9 years old
4. Student has been diagnosed as ASD. Yes/no
5. Student is: White/Caucasian, Black, Latino, Asian, Native American, Indian
6. Student is in the following grade: 3 4 5 6
7. Your relationship to this student is: Teacher, Social Worker, Social Psychologist,
Occupational Therapist, Speech/Language Therapist
8. How many years have you worked with this student? 0 1 2 3 4 5
9. In a typical week, how long do you spend with this student? ____hours, _____days
10. Student receives mathematical lessons via: general classroom instruction or special
education classroom

 
  
90
 
Appendix F: Request for Observation and Consultation

Kalamazoo Regional Intermediate School District

Request for Observation and/or Consultation (ROCs)
rev. 10-02-10
Student Name:___________________________ Birthdate:__________
Parent(s) Name:____________________ Home Phone:_____________
School District:__________________ Building:___________ Grade:___
School/Team Contact Person:_______ Phone/E-mail:________________
The applicable building team members have been informed about this
ROCs

Describe Presenting Problem (be specific):

Check Consultation Requested:

Visually Impaired TC (submit to KRESA) PT (submit to KRESA)
Hearing Impaired TC (submit to KRESA) OT (submit to local OT)
Autism Spectrum Disorder TC (submit to KRESA) Work Experience (submit to KRESA)
Emotionally Impaired TC (submit to BEC) Assistive Tech. (submit to KRESA)
Cognitively Impaired TC (submit to KRESA) Other (submit to KRESA)
FBA-BIP (submit to local psychologist)

Check Placement Option to be Considered:

Instructional Base (submit to KRESA)
Young Adult Program/MiCI Program (submit to KRESA)
Bert Goens Learning Center (submit to BGLC)
Behavioral Education Center (submit to BEC)
Other: (please specify)
Operating District Administrator Signature_______________ Date________

**NOTE:
· “Submit to ISD” Special Education Department Supervisor or Secretary located at
the Special Services Center
· Additional Information may be requested after receipt of this ROCs

------------------------------------------(for office use only) -----------------------------

------------
Date Action Taken by Assigned Staff: Date
Attach Written Response to this ROCs

Date Received:_________________ Initials:____ Staff Assigned:_________

 
  
91
 
Appendix G: Pre- and Post-tests of Mathematics Skills for Grades Kindergarten-3rd Grade

 
  
92
 

 
  
93
 

 
  
94
 

 
  
95
 

 
  
96
 

 
  
97
 

 
  
98
 

 
   99
 
Appendix H: Parental Consent Form

 
  
100
 

 
  
101
 

 
  
102
 
Appendix I: Screenshot of TeachTown® Basics & Social Skills Products

 
   103
 
Appendix J: Screenshot of Teachtown® six Learning Domains

 
  
104
 
Appendix K: Screenshot of TeachTown® Interactive Interface

 
  
105
 
Appendix L: Key Behavior Change Inventory (blank)

The  following  is  a  series  of  statements  that  can  apply  to  young  students.  We  would  like  
to  know  how  well  each  of  these  statements  describes  ___________.    Think  of  this  
student,  read  each  statement,  and  choose  the  one  option  that  best  applies.  
 
 
 

                                                                                                                                                                             Not          Somewhat      Often        Always    

                                                                                                                                                                             True            True                      True              True    

1.  Says  things  that  don't  make  sense.                                                                                                  

2.  Cares  about  others.                                                                                                                                                  
3.  Talks  too  loudly  or  softly.                                                                                                                            
4.  Listens  carefully  and  responds  normally  when    

       talking  with  others.                                                                                                                                                  

 
5.  Talks  in  a  way  that  makes  sense  (it  is  easy  to    

       follow  his/her  train  of  thought).                                                                                                            

6.  Is  sensitive  to  the  feelings  of  others.                .                                                                            

7.  Listens  carefully  to  Teacher.                                                                                                                      

 
  
106
 
Appendix M: PROMIS Anxiety—Short Form

The following is a series of statements that can apply to young students. We would like to know how
well each of these statements describes ___________. Think of this student, read each statement,
and choose the one option that best applies to _________ over the past 7 days.

                                                                                                                                     None  of                A  Little  of          Some  of            Most  of                  All  of    
In  the  past  7  days  ___________  …                          the  Time                  the  Time              the  Time          the  Time                  Time

a.  Student  felt  fearful.                                                                                                                                                  

 
b.  Student  felt  anxious.                                                                                                                                              
 
c.  Student  felt  worried.                                                                                                                                              
 
d.  Student  found  it  hard  to  focus  on  
       anything  other  than  their  anxiety.                                                                                                      
 
e.  Student  was  nervous.                                                                                                                                            
 
f.  Student  was  unsettled.                                                                                                                                          
 

 
  
107
 
Appendix N: MEAP Schedule

 
  
108
 
Appendix O: MEAP Item Descriptor for Mathematics

 
  
109
 

 
  
110
 

 
  
111
 
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