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DOI: 10.1177/0741932517721712
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With Learning Disabilities: rase.sagepub.com

An Evidence-Based Practice Synthesis

Emily C. Bouck1, Rajiv Satsangi2, and Jiyoon Park1

Abstract
As researchers and practitioners have increasingly become interested in what practices are evidence based and for whom
in education, different sets of quality indicators and evidence-based practice standards have emerged in the field of special
education. Practices are commonly suggested as evidence based, even without a best evidence synthesis on the existing
research, such as the case with the concrete–representational–abstract (CRA) instructional framework to support students
with disabilities in mathematics. This study sought to support the classification of the CRA instructional framework as an
evidence-based approach for students with learning disabilities by applying quality indicators and standards of evidence-
based practice by Cook et  al. (2014). Based on the application of the indicators and standards, the CRA instructional
framework was determined to be an evidence-based practice for students with learning disabilities who struggle in
mathematics relative to computational problems, such as addition, subtraction, and multiplication, largely with regrouping.

Keywords
mathematics, instruction, manipulatives, evidence-based practice

The importance of mathematics education for students with
disabilities in K–12 education is well documented, as stu-
dent performance in this subject area often serves as an early
indicator for in-school and postschool success (Strickland &
Maccini, 2012). However, despite its significance and the
attention it warrants, students with disabilities often struggle
in this subject area, consistently performing below national
averages on standardized mathematics assessments (National
Center for Education Statistics, 2013). For example, from
the most recent National Assessment of Educational Progress
(NAEP) data available, students with disabilities in fourth
and eighth grade scored consistently lower than students
without disabilities, with the average scores of fourth grad-
ers with disabilities just above the basic mark and the aver-
age score of eighth graders with disabilities just below the
basic mark (The Nation’s Report Card, 2016).
Within the larger group of students with disabilities, stu-
dents with learning disabilities in math face particular
struggles in mathematics. Students with learning disabili-
ties in mathematics can experience multiple challenges,
including organization, problem solving, working and long-
term memory, reading, place value, and computation
(Calhoon, Emerson, Flores, & Houchins, 2007; Fuchs,
Geary, et al., 2010; Geary, Hoard, Byrd-Craven, Nugent, &
Numtee, 2007; Jitendra, DiPipi, & Perron-Jones, 2002;
Parmar, Cawley, & Frazita, 1996). To combat the challenges
students with learning disabilities face in learning mathe-
matics as well as other in other domains, educators often
turn to instructional strategies proven successful in research
and practice. Increasingly, these strategies or practices are
referred to as evidence-based practices. To date, few math-
ematics interventions or approaches have been evaluated or
labeled as evidence-based practices for students with learn-
ing disabilities (for an exception, see Jitendra, Nelson,
Pulles, Kiss, & Houseworth, 2016).
Evidence-Based Practices
Over the past decade, various organizations and individuals
attempted to operationalize how to determine or classify
practices as evidence based. In 2005, the journal Exceptional
Children from the Council for Exceptional Children (CEC)
1
Michigan State University, East Lansing, USA
2
George Mason University, Fairfax, VA, USA
Corresponding Author:
Emily C. Bouck, Michigan State University, 620 Farm Lane, 349A
Erickson Hall, East Lansing, MI 48824, USA.
Email: ecb@msu.edu
Associate Editor: Daniel Maggin
2 Remedial and Special Education 00(0)
produced a special issue devoted to quality indicators for
the four major types of research in special education: group
experimental and quasi-experimental (Gersten, Jordan, &
Flojo, 2005), single case (Horner et al., 2005), correlational
(Thompson, Diamond, McWilliam, Snyder, & Snyder,
2005), and qualitative (Brantlinger, Jimenez, Klinger,
Pugach, & Richardson, 2005). These quality indicators
were created with the goal of helping researchers design
high-quality studies, while assisting reviewers, editors, and
consumers in evaluating such research (Odom et al., 2005).
Since 2005, other quality indicators or standards for deter-
mining the evidence base of an individual instructional
practice using a particular research design have now
emerged. Kratochwill and colleagues (2013)—on behalf of
the What Works Clearinghouse (WWC) and the Institute of
Education Sciences—developed research standards for sin-
gle-case research. More recently, the CEC—as presented in
both CEC (2014) and Cook et al. (2014)—developed stan-
dards for determining the evidence base of educational
practices; the standards apply to both single-case and group
comparison designs. With the ability to evaluate educa-
tional practices to determine if they qualify as evidence-
based practices—including those by Horner et al. (2005);
Gersten, Fuchs, et al. (2005); or Cook et al. (2014)—many
practices commonly used in K–12 mathematics classrooms
would benefit from a greater analysis of their research base.
Mathematics Education for Students
With Learning Disabilities
Within the field of mathematics, researchers have examined
many interventions and approaches to assist students with
learning disabilities in mathematics, including explicit
instruction (e.g., Gersten et al., 2009), computer-assisted
instruction (e.g., Seo & Woo, 2010), mnemonic strategy
instruction (e.g., Manalo, Bunnell, & Stillman, 2000),
schema-based instruction (e.g., Jitendra, DiPipi, & Perron-
Jones, 2002), cognitive strategy instruction (e.g., Montague
& Dietz, 2009), representations (e.g., Jitendra et al., 2016),
and the concrete–representational–abstract (CRA) instruc-
tional framework (e.g., Flores, 2009). The CRA instruc-
tional framework is one with multiple decades of research
and conceptualization (Underhill, 1977; Underhill,
Uprichard, & Heddens, 1980). The CRA instructional
framework is a graduated instructional sequence that sup-
ports students in mathematics (Agrawal & Morin, 2016;
Powell, 2015). The CRA instructional framework, to the
distinction of other approaches, maintains a focus on con-
ceptual understanding, teacher involvement, a fading of
supports, and student mastery of mathematical procedures
across multiple lessons (Flores, 2010). The CRA instruc-
tional framework, unlike some other mathematical inter-
ventions, has been examined across a variety of mathematical
areas, including algebra, place value, addition, subtraction,
multiplication, fractions, word problem solving, and area
and perimeter (Flores, 2010).
With the CRA instructional framework, students transi-
tion from solving mathematical problems (e.g., subtraction
with regrouping, place value) with concrete objects (e.g.,
base 10 block, unifix cubes) to solving problems with rep-
resentational drawings (e.g., handwritten lines or dots; the
phase is also referred to as semiconcrete), to finally solving
problems without any support abstractly (Agrawal & Morin,
2016; Reisman, 1982; Underhill et al., 1980). The CRA
instructional framework uses explicit instruction, which is
recommended mathematics pedagogical approach for stu-
dents with disabilities (S. K. Baker, Gersten, & Lee, 2002;
Gersten et al., 2009; Powell, 2015). Explicit instruction
involves a sequence that moves from the teacher modeling
the mathematical concept, to teachers guiding (i.e., cuing or
prompting) students through the various steps of a mathe-
matics problem to finally transitioning students to solve
problems independently (The National Mathematics
Advisory Panel, 2008). Within the CRA instructional frame-
work, each lesson involves explicit instruction (Doabler &
Fien, 2013).
In the previous literature, Agrawal and Morin (2016)
referred to the CRA instructional framework in mathemat-
ics as an evidence-based practice, given the quantity of
research published on this practice. Likewise, Powell
(2015) referenced the CRA instructional framework as an
evidence-based practice in the area of mathematics, given it
was highly researched. With multiple individual studies
assessing this strategy and demonstrating its success for
teaching mathematics to students with disabilities, this evi-
dence-based synthesis seeks to support and confirm the
CRA instructional framework as an evidence-based practice
through the application of Cook et al.’s (2014) standards
and quality indicators of an evidence-based practice. The
following research questions guided this analysis:
Research Question 1: Based on a systematic review of
literature from 1975 to 2015, how many studies were
conducted using the CRA instructional framework to
teach mathematics to students with a learning
disability?
Research Question 2: Applying the quality indicators
of Cook et al. (2014), how many studies assessing the
CRA instructional framework to teach mathematics to
students with a learning disability from 1975 to 2015 are
methodically sound?
Research Question 3: Based on the guidelines set forth
by Cook et al. (2014), can the CRA instructional frame-
work be classified as an evidence-based practice for
teaching mathematics standards to students with a learn-
ing disability in mathematics?
Bouck et al. 3
Method
Article Selection
This study presented a synthesis of existing literature on use
of the CRA instructional framework in supporting students
with learning disabilities in mathematics or who have an
Individualized Education Program (IEP) goal in mathemat-
ics but are not identified as having a math learning disabil-
ity. To conduct the synthesis, the authors first obtained
existing articles exploring the CRA instructional framework
for students with learning disabilities. The authors defined
the CRA instructional framework as any intervention in
which students transitioned from learning a mathematical
concept using concrete/physical objects, to using self-made
representational drawings, and finally exhibiting the ability
to solve problems presented in symbolic notation form. All
studies selected for this synthesis implemented the CRA
instructional framework as their primary independent vari-
able. Given that the focus of this best evidence synthesis
was the use of the CRA approach, the authors evaluated
each article that met the predetermined inclusion criteria as
to its implementation of the key components of the CRA
approach: (a) three phases in the sequential order of con-
crete, representational (i.e., pictorial), and abstract; and (b)
a means of determining when students should transition
from one phase to another (e.g., mastery criteria or after a
set number of lesson per phase). If studies solely examined
a concrete–abstract phase without a representational or
semiconcrete phase (in at least one condition), the articles
were excluded. If the study did not explicitly state how or
when students in the study transitioned from concrete to
representational phases and likewise from representational
to abstract phases, the study was excluded from consider-
ation for its evidence.
To find the literature, the first author conducted a keyword
search of the following databases: Proquest, EBSCO,
PsychInfo, and ERIC. The keywords used involved combina-
tions relative to disability, disabilities, disabled, manipulative,
concrete–representational–abstract, CRA, concrete–semicon-
crete–abstract (CSA), CSA, mathematics, and math. These
words were categorized, and one from each category was used
in every search; the categories were as follows: (a) disability,
disabilities, disabled; (b) manipulative, concrete–representa-
tional–abstract, CRA, concrete–semiconcrete–abstract, CSA;
and (c) mathematics and math. Multiple searches were con-
ducted with each database, so that every possible combination
of words was examined. The first author also searched eight
prominent journals that publish research relevant to the field
of learning disabilities using the same keyword combinations:
Learning Disability Quarterly, Learning Disabilities Research
& Practice, Journal of Learning Disabilities, Learning
Disabilities: A Contemporary Journal (starting from 2011),
Exceptional Children, Journal of Special Education, Teaching
Exceptional Children, and Remedial and Special Education.
The authors located 36 articles via the keyword search of
databases and 141 through the search of relevant journals in
the field.
The authors read the abstracts of the articles, and if nec-
essary, the entire study to determine whether they met the
following inclusion criteria: (a) published in a peer-
reviewed journal between 1975 and 2015 (i.e., the signing
of PL 94-142 and through the end of the most recent calen-
dar year); (b) written in English; (c) included at least one
dependent variable relative to mathematics learning or skill
acquisition; (d) the CRA instructional framework was the
principal independent variable or intervention, as stated in
the article (use of CRA or CSA), and CRA was implemented
per the operational definition previously stated by the
authors of this synthesis; (e) the population targeted stu-
dents with learning disabilities; (f) the reported data were
disaggregated—or could be disaggregated—for students
with learning disabilities; and (g) incorporated an experi-
mental design (i.e., single-case design, group comparison
design, pretest–posttest design [correlational]). Studies
were excluded (a) if they were written as a practitioner
piece, rather than presenting empirical research (i.e., a
“how-to” guide for educators; for example, Agrawal &
Morin, 2016; Powell, 2015), (b) if they involved qualitative
research methods, (c) if they were focused on students iden-
tified with alternative disabilities (such as autism or intel-
lectual disability) or when the population could not be
verified as a learning disability (e.g., students receiving
response to intervention [RtI] but not yet identified), and (d)
if the CRA instructional framework was used as part of a
Tier 2 intervention but was not the principal intervention or
independent variable within the study. Tier 2 refers to small
group, targeted interventions within a RtI framework
(Fuchs, Fuchs, & Compton, 2012).
Once the inclusion and exclusion criteria were applied to
the articles retrieved by the keyword search, the first author
next conducted an ancestral search on each accepted article.
In this step, the authors examined the reference lists of each
included study for any additional articles may have quali-
fied for this analysis. After the authors located the addi-
tional articles, they read the abstracts, and, if necessary, the
entire article and applied the inclusion and exclusion criteria.
From the final list of accepted articles (see Tables 1 and 2),
the authors analyzed each article against a set of quality
indicators to determine whether the CRA instructional
framework was an evidence-based practice. The interob-
server agreement (IOA) for the included articles based on
the articles’ data and the inclusion and exclusion criteria—
determined by the number of agreements divided by the
number of agreements plus disagreements between the first
and third authors—was 94%. Disagreements were dis-
cussed among the authors and resolved by each author
4 Remedial and Special Education 00(0)

Table 1.  Cook et al.’s (2014) Quality Indicators Applied to Single-Case CRA Studies Involving Students With Learning Disabilities.

1.1 2.1 2.2 3.1 3.2 4.1 4.2 5.1 5.2 5.3 6.1 6.2 6.3 6.5 6.6 6.7 7.1 7.2 7.3 7.4 7.5 8.2
Single-case design studies
a
Flores (2009) Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
a
Flores, Hinton, and Schweck Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
(2014)
a
Harris, Miller, and Mercer Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
(1995)
a
Maccini and Hughes (2000) Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
a
Maccini and Ruhl (2000) Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
a
Mancl, Miller, and Kennedy Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
(2012)
Miller and Mercer (1993b) Y Y Y Y Y Y Y N N N Y Y Y Y Y Y Y Y N Y N Y
Peterson, Hudson, Mercer, and Y N Y N N Y Y N N N Y Y Y Y Y Y Y Y Y Y N Y
McLeod (1990)
Scheuermann, Deshler, and Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y Y Y Y
Schumaker (2009)
a
Sealander, Johnson, Lockwood, Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
and Medina (2012)
Strickland and Maccini (2012) Y Y Y Y Y Y Y Y Y Y Y Y Y N Y Y Y Y Y N Y Y

Note. Y = yes, quality indicator present; N = no, quality indicator not present. Quality indicators 6.4, 6.8, 6.9, 7.6, 8.1, and 8.3 only applied to group
design studies, and hence are not reflected here. Cook et al. (2014) have 28 total quality indicators: 22 apply to single-case designs and 24 to group
design. See Cook et al. (2014) for the complete list of quality indicator (e.g., 1.1–8.2). CRA = concrete–representational–abstract.
a
The study met all quality indicators.

Table 2.  Cook et al.’s (2014) QI Applied to Group Design CRA Studies Involving Students With Learning Disabilities.

1.1 2.1 2.2 3.1 3.2 4.1 4.2 5.1 5.2 5.3 6.1 6.2 6.3 6.4 6.8 6.9 7.1 7.2 7.3 7.4 7.5 7.6 8.1 8.3
CRA studies—Group design
a
Butler, Miller, Crehan, Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
Babbitt, and Pierce
(2003)
Hudson, Peterson, Not a group comparison study; QIs were not applied as only applicable to group comparison designs
Mercer, and McLeod
(1988)
Mercer and Miller Not a group comparison study; QIs were not applied as only applicable to group comparison designs
(1992)
Miller, Harris, Strawser, Y Y Y Y Y Y Y N N N Y Y N Y Y Y Y Y Y Y N N Y Y
Jones, and Mercer
(1998)
Miller and Kaffar (2011) Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N
Miller and Mercer Not a group comparison study; QIs were not applied as only applicable to group comparison designs
(1993a)
Miller, Mercer, and Not a group comparison study; QIs were not applied as only applicable to group comparison designs
Dillon (1992)
Peterson, Mercer, and Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N N Y Y Y
O’Shea (1988)
Witzel (2005) Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y Y N N Y Y

Note. Y = yes, quality indicator present; N = no, quality indicator not present. Quality indicators 6.5, 6.6, 6.7, and 8.2 only applied to single-case studies,
and hence are not reflected here. Cook et al. (2014) have 28 total quality indicators: 22 apply to single-case design and 24 to group design. See Cook
et al. (2014) for the complete list of quality indicator (e.g., 1.1–8.2). When QIs were not applied—because the study did not employ a comparison
group design—the study was not considered as the evidence for determination of evidence-based practice. QI = quality indicators; CRA = concrete–
representational–abstract.
a
The study met all quality indicators.
Bouck et al. 5
reading said article and then a majority determination, if the
decision was not unanimous after reconsideration.
Evidence-Based Practice Standards
From the list of included articles in the literature, the authors
applied the quality indicators and standards as reported by
Cook et al. (2014) for classifying practices as evidence
based in the field of special education. The standards were
“developed, vetted, and piloted” by seven special education
researchers, as commissioned by the CEC (2014, p. 212).
An interrater reliability pilot of the standards by Cook et al.
(2014) reported an overall Kappa of .67, with a Kappa of
.64 for single-case studies and .70 for group comparison
studies. The evidence-based standards consist of two ele-
ments: (a) quality indicators to determine whether each
individual study is methodologically sound and (b) criteria
for determining if a practice rises to the level of being clas-
sified as evidence based (Cook et al., 2014).
Cook et al. (2014) reported 28 total quality indicators:
twenty four apply to group comparison design studies and
22 to single-case design studies. The 28 quality indicators
fall within eight areas: context and setting (one quality indi-
cator [1.1]—setting able to be determined), participants
(two quality indicators—[2.1] participant demographics,
and [2.2] disability status and means of determining disabil-
ity status), intervention agent (two quality indicators—[3.1]
intervention agent described and [3.2] interventionist
achieved training or credentials needed to implement inter-
vention), description of practice (two quality indicators—
[4.1] procedures of intervention and [4.2] materials needed
for study), implementation of fidelity (three quality indica-
tors—[5.1] implementation fidelity measures; [5.2] dosages
or exposure reports of fidelity of implementation; and [5.3]
fidelity of implementation is reported across phase, set-
tings, or participants during intervention), internal validity
(nine quality indicators—[6.1] the independent variable is
controlled and manipulated by researcher; [6.2] baseline or
control conditions are described; [6.3] limited access to the
intervention is provided control or baseline conditions;
[6.4] the assignment to groups is described and includes
random, nonrandom but matched, nonrandom but control
differences statistically, or nonrandom with cutoff point
[group design]; [6.5] three demonstrations of experimental
effect across three different [single case]; [6.6] for single
case requiring baseline at least 3 data points provided and
nonincreasing trend [single case]; [6.7] threats to internal
validity controlled by design [single case]; [6.8] low attri-
tion rates [group design]; and [6.9] low differences in attri-
tion among groups [group]), outcome measures or
dependent variables (six quality indicators—[7.1] socially
important outcomes; [7.2] dependent variables measure-
ment is provided; [7.3] effect provided or can be calculated;
[7.4] appropriate frequency and timing of dependent vari-
ables; [7.5] adequate form of reliability is provided, includ-
ing IOA; and [7.6] adequate validity provided [group
comparison]), and data analysis (three quality indicators—
[8.1] analysis of data is appropriate [group]; [8.2] graphs
provided for all targeted dependent variables [single case];
and [8.3] effect size reported or can be calculated [group];
see Cook et al., 2014, for a more detailed descriptive list of
quality indicators).
The evidence-based standards offer five options for an
educational practice to be classified: evidence-based prac-
tice, potential evidence-based practice, practice with mixed
effects, insufficient evidence, and practice with negative
effects. Each classification level has conditions that must be
met, including how many methodologically sound studies
exists per design (group vs. single case), number of partici-
pants, and a ratio of positive to negative effects. Only stud-
ies that meet all applicable quality indicators—dependent
on group design or single case—can be included in the
analysis for the practice meeting the evidence-based stan-
dards (see Cook et al., 2014, for a complete list of the evi-
dence-based standards and classification).
Data Analysis and Evaluation Procedures
To conduct an evidence-based practice synthesis of the lit-
erature on the CRA instructional framework for students
with learning disabilities, the authors first analyzed whether
each study met the quality indicators for either a group com-
parison design or a single-case design (see Tables 1 and 2).
The authors followed the suggestions by Cook et al. (2014)
regarding the quality indicators and characteristics that
resulted in the quality indicators being met or not. For each
quality indicator, the researchers marked one of the follow-
ing: (a) no, the quality indicator was not present; (b) yes, the
quality indicator was present; or (c) not applicable because
the quality indicator was relevant to only one design (e.g.,
group comparison), and the study being analyzed was of the
alternative design (e.g., single case). The three authors—
two who have PhDs in special education, and the third who
is completing hers and who have all conducted research
involving mathematical interventions for students with dis-
abilities and/or using the CRA instructional framework spe-
cifically—recorded their individual and independent
responses to each of the quality indicators via a Google
form. Only after all were reported did the first author exam-
ine the responses in a Google sheet to conduct interrater
reliability.
To train, each author independently but simultaneously
reviewed the Cook et al. (2014) quality indicators as well as
the one published study to date employing said quality indi-
cators (Losinski, Wiseman, White, & Balluch, 2015). The
authors then met to discuss the quality indicators and what
6 Remedial and Special Education 00(0)
characteristics would qualify or disqualify a given study on
each indicator, based on Cook et al. (2014). Following Cook
et al. (2014), a general consensus was agreed upon regard-
ing the standard for each indicator. The authors attempted to
follow the standards literally set by Cook et al. (2014),
rather than employing their own interpretations. For exam-
ple, the authors decided to hold 3 data points in baseline
(Quality Indicator 6.6) as a firm criterion for meeting that
indicator. One caveat allowed by the authors involved 8.2
for single-case studies; the researchers did not require that
authors report or independently determine all standard
visual analysis techniques for each dependent variable, so
long as the graphs were present. The authors of this synthe-
sis independently analyzed each graph for visual analysis.
Following training, each author independently coded the set
percentage of single-case and group design studies for the
calculation of IOA. When IOA was the acceptable level
(above 90%), the authors randomly divided and coded the
remaining studies individually. Any issues were discussed
as a team and resolved.
After analyzing each study for its 22 (single case) or 24
(group comparison) quality indicators, the authors recorded
the number of students with learning disabilities in each
study, whether the study was methodologically sound, and
whether the study resulted in positive, negative, or neutral/
mixed effects. The number of participants, methodological
soundness, and the effect were relevant to the classification
of the CRA instructional sequence as an evidence-based
practice. Consistent with Cook et al. (2014), a study was
methodologically sound if all of its relevant quality indica-
tors were met. The authors also used the Cook et al. (2014)
suggestions to set guidelines for effect. For group compari-
son designs, a positive effect was met when an effect size
was reported greater than or equal to .40, a negative effect
when an effect size was less than −.40, and a neutral/mixed
effect when the effect size was between −.40 and .40. For
single-case designs, a positive effect occurred when a func-
tional relation existed between the independent and depen-
dent variables, and meaningful change resulted for at least
three fourths of the cases, with a minimum of three cases,
and no case experienced harmful results. A negative effect
for single-case designs occurred when a negative or harm-
ful relation between the independent and dependent vari-
ables existed for a minimum of three fourths of the cases
with at least three cases of replication. A neutral or mixed
effect involved all studies not classified as having positive
or negative effects. Note that when studies involved multi-
ple cases per student (i.e., each student served as his or her
own case relative to multiple mathematical domains; for
example, addition, subtraction), the three fourths were
examined across the total cases, although the number of stu-
dents remained the same (e.g., three students with data col-
lected across three mathematical tasks would result in three
students but nine cases). The authors also opted to include a
study as supporting evidence-based practices if, when mul-
tiple dependent variables existed, at least one of the depen-
dent variables resulted in a positive effect and none of the
dependent variables result in a negative effect, and the over-
all effect across all cases regardless of dependent variables
was positive (i.e., three fourths resulted in meaningful
change).
The first author examined all studies (i.e., graphs and
data) for a report of an effect size as well as for the estab-
lishment of a functional relation (i.e., experimental control;
done via visual analysis), rather than solely relying on an
author’s statements. A functional relation was defined as
one in which the original study authors reported at least
three different chances for the independent variable to be
manipulated and determine the impact on the dependent
variable (Lane & Gast, 2014). Hence, the authors confirmed
that all included single-case studies had designs to support
experimental control (e.g., ABAB and multiple baseline;
Kratochwill et al., 2013); the first author examined each
article, and the second author conducted IOA on a mini-
mum of 33% of the articles to confirm a functional relation
(IOA 100%).
To calculate effect size, the first author of this synthesis
independently conducted two different measures of effect
size: percentage of nonoverlapping data (PND) and Tau-U
(Parker, Vannest, & Davis, 2011). To conduct PND, the first
author analyzed each individual graph for each case in each
article; the second author conducted IOA for a minimum of
33.3% of individual graphs to determine PND. The IOA for
PND was 100%. To calculate Tau-U for each graph for each
case in each article, the authors used DigitizeIt (Rakap,
Rakap, Evran, & Cig, 2016), which allowed the authors to
get the raw data points for each graph. Previous researchers
suggested that using such programs to extract data from
graphs was reliable and valid (Rakap et al., 2016). With the
raw data, the researchers used the online Tau-U calculator
to calculate each Tau-U score (see http://www.singlecaser-
esearch.org/calculators/tau-u; Vannest, Parker, & Gonen,
2011). Tau-U effects greater than 93% are large, between
66% and 92% medium, and small if less than 65% (Parker,
Vannest, & Brown, 2009).
The synthesis authors also conducted visual analysis
relative to level and trend for each graph in each article. To
calculate stability, the authors used the 80-25 rule: Data are
stable if 80% falls within 25% of the median (Gast &
Spriggs, 2014). Hence, using the extracted data points, the
authors determined the median, and then calculated if 80%
of the data for each graph fell within the 25% envelope of
the median. The authors determined trend via the split-mid-
dle method. They found the middle, midrate, and middate
during intervention for each graph, and drew a line between
the midrate and middate to determine acceleration, decel-
eration, or zero-celeration (Gast & Spriggs, 2014; White &
Haring, 1980). The second author independently coded a
Bouck et al. 7
minimum of 33.3% of graphs of the included articles to
determine the IOA for trend; IOA was 97.5%. The two
authors discussed any differences, came to an agreed con-
clusion, and the first author independently coded the
remaining graphs for trend.
Finally, the authors calculated the total number of stud-
ies in each design—group and single case—that were meth-
odologically sound with positive effects. The authors
summed the total number of participants with learning dis-
abilities across the methodologically sound and positive
effect studies. The authors completed the same calculations
for methodologically sound studies with mixed/neutral
effects and methodologically sound studies with negative
effects (effective in this synthesis was operationalized as
provided by Cook et al., 2014, with respect to effect sizes or
functional relation established, as discussed in greater detail
in the preceding paragraph). The authors also coded each
study for (a) the type of learning disability for each student
as well as how their status as a student with a learning dis-
ability was determined, (b) the dependent variable and
mathematics content, (c) the concrete manipulative used in
the CRA instructional framework, and (d) the intervention-
ist in the study.
IOA
To determine IOA, each of the three authors independently
coded 35.7% of the single-case study articles and 36.4% of
the group design study articles. To code, each author inde-
pendently evaluated the randomly selected studies and
entered his or her responses to each quality indicator as 0
(implying the measure was not present or not met), 1 (denot-
ing the measure was present and met), or 2 (indicating not
applicable, as some measures only applied to single subject
and others only to group comparison designs) into a Google
Docs form. After this was complete, the first author accessed
the subsequent Google document to compare IOA. IOA
agreement was based on the following elements: (a) deter-
mining whether the study was methodologically sound; (b)
determining whether the effect was positive, negative, or
neutral/mixed; (c) assessing the number of students with
learning; and (d) a response of yes, no, or not applicable to
every quality indicator (i.e., 22 for single case and 24 for
group comparison). For the single-case studies, the IOA
between the three authors was 100% for determination of
the study as methodologically sound and determination of
the effect (i.e., positive, negative, or mixed/neutral). The
IOA for the number of students with learning disabilities
was 93.3%, and IOA was 97.8% for the quality indicators
for the single-case studies (i.e., 22 indicators). The IOA for
the methodological soundness of the group design studies
selected for was 100%; the four selected were all deemed
not methodologically sound due to the lack of a comparison
design, which is required for the CEC evidence-based
standards (Cook et al., 2014). The authors then completed
IOA for three group design studies that were comparison
studies. The IOA for methodological soundness and the
number of students was 100%; the IOA for the quality indi-
cators for group comparison designs was 94.4% (i.e., 24
indicators). Any disagreements were discussed among the
authors and resolved by a determination by the majority of
the authors. The authors set 90% as an acceptable level of
agreement; acceptable IOA was reached for each element
analyzed.
Results
The study answered the following research questions:
Research Question 1: Based on a systematic review of
literature from 1975 to 2015, how many studies were
conducted using the CRA instructional framework to
teach mathematics to students with a learning
disability?
Research Question 2: Applying the quality indicators
of Cook et al. (2014), how many studies assessing the
CRA instructional framework to teach mathematics to
students with a learning disability from 1975 to 2015 are
methodically sound?
Research Question 3: Based on the guidelines set forth
by Cook et al. (2014), can the CRA instructional frame-
work be classified as an evidence-based practice for
teaching mathematics standards to students with a learn-
ing disability?
Existing Literature
Twenty studies were published between 1975 and 2015 that
examined the CRA instructional framework to teach math-
ematics to students with a learning disability (see Tables 1
and 2). Eleven of the 20 were single-case design studies,
and nine were group design studies. Of the 20 studies, 14
involved elementary students, whereas seven involved mid-
dle school students (one involved elementary and middle
school students). The total number of students with learning
disabilities across the 20 studies was 372. The most pre-
dominant mathematical topic was subtraction (n = 7), fol-
lowed by multiplication (n = 6), and then place value (n = 5;
some studies addressed more than one mathematical area).
Three studies address addition, division, and algebra; while
two addressed money; and one involved fractions.
Methodologically Sound Studies
Eight of the 20 included studies exploring the CRA instruc-
tional framework were deemed to be methodologically
sound: Seven single-case design studies and one group
comparison study met all their Cook et al.’s (2014)
8 Remedial and Special Education 00(0)
respective methodological quality indicators (see Table 3).
For six of the seven single-case design studies, an overall
positive effect was found (i.e., a meaningful and beneficial
change occurred in the dependent variable due to the inde-
pendent variable for at least 75% of the participants, with a
minimum of three cases, and for no cases did the dependent
variable indicate a “negative effect,” Cook et al., 2014, p.
10); for the seventh single-case study, a mixed/neutral effect
was found. All seven involved a multiple-baseline or multi-
ple-probe design (Kratochwill et al., 2013). The one group
comparison study demonstrated a neutral or mixed effect,
with calculated effect sizes ranging from 0.08 to 4.78 and an
overall MANOVA effect size of 0.265 (to be a positive
effect, group comparison studies required an effect size
greater than 0.40).
In terms of the mathematics content covered, seven of
the eight methodologically sound studies focused on teach-
ing basic operations (e.g., subtraction with regrouping, mul-
tiplication) and one study addressed fractions. With respect
to the types of manipulatives used in the studies, three
involved base 10 blocks, one paper plates and plastic count-
ing pieces, two algebra tiles, one fraction pieces, and one
used what was only described as “manipulative objects.”
Five of the eight studies focused on elementary-aged stu-
dents (i.e., fifth grade and below), while three involved
middle or high school students (i.e., sixth grade and above;
see Table 3). All eight studies employed all elements of the
CRA instructional framework, per inclusion criteria. The
only caveat to the CRA instructional framework occurred in
the one group design studies. Butler, Miller, Crehan,
Babbitt, and Pierce (2003) compared students receiving the
CRA instructional framework with students who received a
representational-abstract instructional framework (i.e., sim-
ilar to the CRA instructional framework but without the
concrete phase).
Studies found not to be methodologically sound. Of the 12
CRA instructional framework studies found to be not meth-
odologically sound, four were single-case design studies
and eight were group designs (see Tables 1 and 2). One of
the largest disqualifying factors for the group design studies
was the lack of group comparison (i.e., the studies were in a
pretest–posttest format). The standards by Cook et al.
(2014) are focused only on single-case and group compari-
son studies. If a CRA instructional framework study was a
group design but was not a comparison (i.e., a study involv-
ing two or more groups in which an intervention is manip-
ulated in one group, while a control or alternative
intervention is applied in the other groups; Cook et al.,
2014), it could not be included in the evaluation for evi-
dence-based practice. Multiple CRA instructional frame-
work group design studies possessed a pretest–posttest
format without comparative groups. A group comparison
or a single-case CRA instructional framework study was
deemed not methodologically sound if it did not include all
the respective quality indicators. Indicators disqualifying a
group comparison design study included no IOA data
(Peterson, Mercer, & O’Shea, 1988), inability to calculate
effect size for students with learning disabilities (Miller &
Kaffar, 2011), and a lack of fidelity of implementation (Wit-
zel, 2005; refer to Table 2). Indicators that disqualified a
single-case design study included a lack of 3 or more base-
line data points for one or more participants (Strickland &
Maccini, 2012), a lack of demographic information pro-
vided for the participants (Peterson, Hudson, Mercer, &
McLeod, 1990), and a lack of fidelity of implementation
reported (Miller & Mercer, 1993b; Scheuermann, Deshler,
& Schumaker, 2009). Although explanations may have
been provided by study authors providing rationale for why
a certain indicator may not be met (e.g., Strickland & Mac-
cini, 2012, discussed why one student only had two baseline
points), the authors of this study made judgment decisions
in accordance with Cook et al. (2014; for example, a mini-
mum of 3 baseline points were absolutely necessary to con-
clude a study was methodologically sound and use it for
determining if the CRA instructional framework was an
evidence-based practice).
Evidence-Based Determination
Based on the criteria set forth by Cook et al. (2014), the
authors concluded that the CRA instructional framework
for students with learning disabilities is an evidence-based
practice. The CRA instructional framework was determined
to be an evidence-based practice due to the existence of at
least “five methodologically sound single case studies with
positive effects and at least 20 total participants” (Cook
et al., 2014, p. 11). There were six methodologically sound
single-case studies supporting the CRA instructional frame-
work that met all quality indicators while demonstrating
positive effects for students with learning disabilities. The
total number of participants with learning disabilities across
the six studies was 33.
Discussion
The goal of this study was to support and confirm the CRA
instructional framework as an evidence-based approach for
students with learning disabilities (Agrawal & Morin, 2016;
Powell, 2015). Despite its touted use and multiple research
studies examining this framework (refer to Tables 1 and 2),
no previous study applied quality indicators/standards to
the existing CRA research base to evaluate the CRA instruc-
tional framework as an evidence-based practice. Based on
our findings gathered from a systematic review of literature
and an evidence-based practice synthesis (Cook et al.,
2014), the authors support the determination of the CRA
instructional framework as an evidence-based practice in
 Table 3.  Evidence-Based Classification Support for the CRA Framework for Students With LD—Studies With Sound Methods.
Study Design Effects and EBP ES Visual analysis Demos of students Info on students with LD LD status DV (includes math content) CM Int.

Single-case design studies

Flores (2009) Multiple-probe Positive effect PND 100% for all; Tau-U 100% for all I. trend: AC for all; I. level: 4 (+2 not identified): 3rd LD; receive math services Met criteria set by state No. of correct digits on Base 10 blocks SER
across students Yes EBP variable for all graders; four males; and received failing math for LD; determined two-digit subtraction with
five Hispanic and one grades by evaluation outside regrouping problems
Caucasian of study
Flores, Hinton, Multiple-probe Positive effect PND 60%, 60%, 71%, and 42%; Tau-U I. trend: AC for all; I. level: 4: Two 4th and two 5th LD; receive math and 1 through RtI and 3 by No. of correct digits on Base 10 blocks SER
and Schweck across students Yes EBP 50%, 52%, 61%, and 5% variable for all graders; three males; reading services discrepancy model multiplication with regrouping
(2014) two Caucasian, one problems within 2 min
Latino, and one African
American
Harris, Miller, Multiple-baseline Overall positive effect PND for comp. ≥75% for 72.7% of the I. trend: AC for 9/11 for 11: 2nd graders; eight LD; nine performing Does not specify, but No. of correct and incorrect Paper plates Elem. T
and Mercer design across (>75% of cases). cases for correct digits and 45.5% correct comp.; 5/11 for males; all Caucasian; eight below ability in reading provides IQ and math digits on one-digit and plastic
(1995) classes (two Positive for correct for incorrect digits. PND for wp. incorrect comp.; 8/11 for received free or reduced and math, two below achievement data multiplication computation counting disks
studies occurring comp., correct wp, ≥75% for 81.8 of cases for correct correct wp; and 2/11 for lunch (one student/ ability in reading but at problems percentage of
simultaneously) incorrect wp; mixed/ digits and 72.7% for incorrect digits. incorrect wp. I. level: All case with LD removed or above ability in math, problems solved in learning
neutral for incorrect Tau-U ≥ 96% for 45.5% for correct variables for correct and as baseline was only 2 one ability in reading sheets for multiplication
comp. comp., 27.3% for incorrect comp., incorrect for comp. and wp., points) but below in math computation and word
Yes EBP 81.1% for correct wp. and 72.27% for except one student (wp. problems
incorrect wp. Tau-U 66%–92% for correct)
36.4% correct comp and incorrect
comp. and 9.1% for correct and
incorrect wp.
Maccini and Multiple-probe Positive effect for both PND 100% for 96.1% of the cases I. trend: AC for 10/21 graphs 6: Three 9th, two 10th, LD; math goals on IEP and LD status determined Percentages of accurate rep. Algebra tiles SER
Hughes (2000) across students DVs rep. and sol. across students and DVs for across cases across DVs for and one 12th grader; two below grade level for by meeting state of problems and percentages
Yes EBP representation (rep.); PND 100% for rep. and 5/21 across cases males; five Caucasian and math achievement guidelines by school of accurate sol. in the
73.1% of the cases across students across DVs for sol. I. level: 1 African American subtraction, multiplication and
and DVs for solution (sol.). Tau-U ≥ All stable across cases and division word problems with
96% for 85.8% of rep. cases across DVs for rep. and sol. integers
DVs and 72.5% of sol. cases across
DVs
Maccini and Ruhl Multiple-probe Positive effect PND 100%, 100%, and 83% for solution I. trend AC for 2 and DC for 1 3: 8th graders; all male; LD; below grade level for LD status determined Percentages of accurate rep. Algebra tiles SER
(2000) design across Yes EBP (sol.); PND 100%, 100%, and 33% for on sol; ZC for 1 and DC for two Caucasian and one math calculations by primary disability of problems; percentages of
students representation (rep.); Tau-U for rep. 2 on rep. I. level: All stable African American on IEP (local school sol.; percentage of strategy
100%, 100%, and 71%; Tau-U for sol. for rep. and sol. district) use; and generalization
100%, 92%, and 100% in subtraction of integers
problems
Mancl, Miller, Multiple-probe Positive effect PND 100% for all; Tau-U 100% for allI. trend AC for 3 and ZC for 5: 4th and 5th graders; LD in math; receive Tier LD status determined Percentage correct on 10 Base 10 blocks SET
and Kennedy across students Yes EBP 2. I. level: 4 stable and 1 three males; four 3/special education math by meeting state multidigit subtraction with
(2012) variable Hispanic intervention guidelines regrouping problems
Sealander, Multiple-probe Mixed/neutral effect— PND 67%, 80%, 60%, 100%, and 50% I trend: DC for all 5 for 5 (+3 without LD); LD (no further Does not specify, but Number of correct and Objects 3 SETs
Johnson, across students Positive for incorrect for correct; 67%, 40%, 40%, 33%, incorrect digits; AC for 4 1st and 2nd graders; five explanation provided) average range IQs and incorrect responses to
Lockwood, but mixed/neutral 50% for incorrect; Tau-U 93%, 70%, for correct digits (1 ZC). I. males; two Caucasian and stated classified as LD subtraction problems with
and Medina for correct (overall 73%, 100%, and 21% for correct; level: All variables except two African American minuends between 0 and 9
(2012) positive for 7/10 Tau-U 33%, 70%, 27%, 73%, and 42% one—Correct
cases) for incorrect
No EBP
Group—Random assignment at level of class
Butler, Miller, Pretest–posttest Neutral/mixed effect Range of Cohen’s d from 0.08 to 4.78 NA 42: 6th, 7th, and 8th 42 LD in math (22 in Does not specify, but Posttest scores: Three subtests Fraction circles, 2 SETs
Crehan, group No EBP for pretest to posttest changes per graders; of the 50—27 CRA and 20 in RA); all stated classified as LD from Brigance Comprehensive beans, and
Babbitt, and comparison group; eta square for MANOVA males (50) received math in Inventory of Basic Skills– constructed
Pierce (2003) design (CRA was .265 resource room Revised and two designed by fraction
to RA) researchers involving fractions squares

Note. CEC (2014). EBP refers to supporting EBP classification; Comp. refers to computation and wp. for word problem. Effects refer to that denoted by CEC (2014), regarding a positive effect for a single-case study involves a functional
relationship for at minimum 75% of the cases in the study of which at least three cases are included in the study and zero cases result in a negative change. Visual analysis refers to trend (I stands for intervention and AC stands for
accelerating, DC for decelerating, and ZC for zero celebrating; White & Haring, 1980). CRA = concrete–representational–abstract; ES = effect size; DV = dependent variable; CM = concrete manipulative; Int. = Interventionists; PND =
percentage of nonoverlapping data; IEP = Individualized Education Program; SER = special education researcher; Elem T = elementary teacher; SET = special education teacher; LD = learning disability; rep = representation; sol = solution.

9
10 Remedial and Special Education 00(0)
mathematics for students with learning disabilities relative
to computational instruction (i.e., basic operations [subtrac-
tion, multiplication] or what Flores, 2010, p. 196, referred
to as “fact instruction”), as suggested by other scholars (cf.
Agrawal & Morin, 2016; Powell, 2015).
After applying the quality indicators set forth by Cook
et al. (2014), eight CRA studies were deemed methodologi-
cally sound. Six of the seven single-case design studies dem-
onstrated positive effects in their results, whereas the one
group comparison design study and one single-case design
study were both found to have neutral/mixed effects. With
more than five methodologically sound positive effect single-
case studies in existence—possessing a total number of cases
greater than 20—the CRA instructional framework qualifies
as an evidence-based practice for students with learning dis-
abilities with specific respect to those identified with a learn-
ing disability in mathematics or have a learning disability
along with IEP mathematics goals, receive mathematics ser-
vices, or experience difficulty with mathematics (refer to
Table 3). However, given the content of the mathematics in
the methodologically sound studies with positive effect, the
evidence-based practice determination is limited to when the
mathematics content being taught is computation or basic
facts (e.g., subtraction with regrouping, multiplication). In
other words, the CRA instructional framework as an evi-
dence-based practice is limited to the mathematics content
examined in the research studies found to be methodologi-
cally sound and with positive effects: subtraction (n = 4),
multiplication (n = 3), and division (n = 1); some studies
addressed more than one mathematical area. The authors
here do not assert that the CRA instructional framework is an
evidence-based practice for other mathematical areas (e.g.,
fractions, place value, algebra, area, and perimeter), given the
lack of methodologically sound studies in those areas.
Implications for Practice
The confirmation of the CRA instructional framework as an
evidence-based practice, with regard to particular mathe-
matical content, holds significant implications for practice.
Given the attention and interest directed toward identifying
and using evidence-based practices in education, a mathe-
matics instructional framework demonstrated effective for
students with learning disabilities who struggled in mathe-
matics is significant. Based on the results of this evidence-
based synthesis, the findings of individual studies within
the synthesis, and the recommendations of other researchers
(e.g., Agrawal & Morin, 2016; Powell, 2015), the CRA
instructional framework should be considered for use in
elementary and middle school mathematics classrooms as a
special education intervention to help students with learn-
ing disabilities to develop understanding of mathematics,
particularly mathematics related to operations (e.g., sub-
traction and multiplication).
It should be noted that while the goal of the CRA instruc-
tional framework is to develop conceptual understanding
along with skill development (i.e., procedural mastery), the
dependent variables, and hence what is measured in the
studies included in this evaluation, focused on said proce-
dural skills (e.g., subtraction with regrouping; Flores, 2010).
Although advocates of the CRA instructional framework
believe that it helps students develop conceptual under-
standing in addition to procedural skills (e.g., Flores, 2010;
Gagnon & Maccini, 2001; Miller & Hudson, 2006; Miller,
Stringfellow, Kaffar, Ferreira, & Mancl, 2011), research is
needed which explicitly measures conceptual gain as well
as procedural skills improvement. With a total of eight stud-
ies in this analysis involving elementary students, a reason-
able amount of literature across these grade levels exists
supporting the use of the CRA instructional framework. The
literature on the middle grade level (i.e., sixth grade and
above) is more limited—two studies—not only suggesting
the potential of this framework for benefiting students but
also highlighting where more high-quality research relative
to the CRA instructional framework is needed. Related, the
existing literature also points to the need for research
exploring the application of the CRA instructional frame-
work to higher order mathematics, such as algebra and
geometry.
Another implication of the use of the CRA instructional
framework as an evidence-based practice for students with
learning disabilities in the mathematical domains related to
basic operations is the potential to expand the implementa-
tion of the CRA instructional framework to populations
beyond students with disabilities. A logical extension is the
use of the CRA instructional framework for students who
have not yet been identified with a learning disability but
are receiving interventions and services within the RtI
model (i.e., students served in Tier 2 or Tier 3 services).
Another extension involves elementary general education
teachers implementing the CRA instructional framework,
or a modified version, within their mathematics classes for
all students. The CRA instructional framework provides
teachers an opportunity to differentiate within their math-
ematics teaching. While teachers have been differentiating
for years as well as using concrete, representational, and
abstract teaching with manipulatives is common, many
general education teachers fail to move from one phase to
another within the CRA instructional framework in an indi-
vidualized and systematical manner. For example, a gen-
eral education teacher can begin to teach a mathematical
concept—such as double-digit subtraction with regroup-
ing—to the whole class with concrete base 10 blocks. As
the teacher notices some students are proficient, she or he
can allow those students to move into the representational
phase of drawing blocks on their paper to solve problems.
Other students can continue to use the concrete manipula-
tive while the teacher, during small-group instruction or
Bouck et al. 11
station time, reinforces the concept with the manipulative.
As students continue to demonstrate an understanding of
the content within each phase (i.e., concrete, representa-
tional, abstract), they can gradually transition into the next,
with the ultimate goal of all students being able to under-
stand the content without the use of manipulatives or draw-
ings. Throughout this sequence, each student can be aided
with targeted supports based on where she or he is within
the learning process.
A final implication of the CRA instructional framework
as an evidence-based practice is the need to teach this
framework to all preservice special education teachers, if
teacher preparation programs are not already doing so. As
educators are expected to implement evidence-based prac-
tices for students with disabilities, they need to be explicitly
taught educational frameworks that are evidence based and
proven effective for specific populations of students.
Special education teacher preparation programs that do not
currently provide their teacher candidates with CRA instruc-
tional framework experiences should integrate instruction
and field practice of the CRA instructional framework into
their mathematics methods curriculum for special education
teaching candidates. New teachers should be shown how to
capitalize on the flexibility of this instructional framework
for whole-class instruction, small-group instruction for stu-
dents who served by Tier 2 or Tier 3 supports, and small
group or individualized instruction for students with learn-
ing disabilities.
Limitations and Future Directions
A potential limitation of all systematic reviews and/or syn-
theses—including this one—is that despite the extensive
search protocol, one or more articles may not have been
found. However, the authors worked to ensure that all rele-
vant and potential articles were collected and analyzed.
Related, the authors only explored articles published in
English-based journals, and hence dissertations, theses, and
research presented solely in book chapters—or not pub-
lished in any form—were excluded. The authors also applied
strict inclusion criteria to articles, including how the CRA
instructional framework was articulated in the article. Hence,
articles were excluded if they did not explicitly provide con-
crete, representational, and abstract phases as well as if they
did not state criteria for students’ transitioning phases.
Hence, studies that indicated they were examining the CRA
but did not meet the criteria established for this synthesis
(e.g., Cass, Cates, Smith, & Jackson, 2003) were excluded.
Similar to the authors retroactively applying an operational
definition of CRA to previous studies, the authors were ret-
roactively applying quality indicators and standards to stu-
dents prior to the establishment of said quality indicators and
standards. Hence, studies involving CRA were excluded
from the evidence-based practice determination for failure
to include elements that may not have been explicitly stated
as needed to reflect a quality single-case study at the time of
their publication.
Another limitation of our analysis is that, to a certain
extent, judgment calls were made regarding the quality indi-
cators established by Cook et al. (2014). As indicated by
Cook et al. (2014), reviewers applying the quality indicators
have some discretion to determine if an indicator is met.
However, the IOA for the quality indicators in this study was
high across the three authors, thus minimizing the likely
impact of this limitation. The judgment extended to deter-
mining effect, effect size, and trend. The synthesis included
some older studies, whose graphs were not as clear as per-
haps they would be with more modern graphs. Yet, the
authors conducted IOA relative to effect size (PND). Related,
the initial search included articles that are explicitly not
included in the Cook et al. (2014) standards (i.e., group pre–
posttest designs). The authors elected to include these arti-
cles as the first research question involved the scope of the
literature of the CRA instructional framework for students
with disabilities. Yet, these studies were excluded as not
methodologically sound in the application of the quality
indicators (Cook et al., 2014) to answer Research Questions
2 and 3. Related to judgment, the authors used a digital tool
to extract data points from the graphs to find the raw data
points for calculating Tau-U. While such data extraction pro-
grams as DigitizeIt are deemed to be creditable (Rakap et al.,
2016), the authors do acknowledge that the raw data points
for calculating effect sizes and stability were extracted rather
than produced by original authors.
Future research should continue to explore the CRA
instructional framework, especially for students with other
disabilities for whom this instructional framework could be
beneficial (e.g., students with mild intellectual disability,
autism spectrum disorder). The extension to high school
students is another area of potential expansion for the CRA
instructional framework research; research currently does
not exist on the CRA instructional framework for high
school students, yet success was found for middle school
students. While the authors broadly stipulate that the CRA
instructional framework is an evidence-based practice in
mathematics for students with learning disabilities, relative
to the areas of mathematics examined in the existing litera-
ture, it would be more advantageous for researchers and
practitioners alike to analyze and conclude that the CRA
instructional framework is an evidence-based practice to
teach individual concepts such as subtraction with regroup-
ing and multiplication separately as well as separately for
different ages or grade spans (i.e., elementary vs. middle
school). As noted, there are seven studies at the elementary
level but only four at the middle school level (i.e., sixth
grade and above). Additional research is also needed on the
CRA instructional framework in other areas of mathemat-
ics, such as fractions, algebra, and area and perimeter.
12 Remedial and Special Education 00(0)
Finally, researchers should take advances in technology
into consideration, and determine whether concrete manipu-
latives are still the most appropriate form of manipulative for
students with learning disabilities. As emerging research sug-
gests that virtual manipulatives (online or apps for mobile
devices) are just as effective for students with disabilities as
concrete manipulatives—and are often preferred by students
over the concrete form (Bouck, Satsangi, Doughty, &
Courtney, 2014; Satsangi & Bouck, 2015; Satsangi, Bouck,
Taber-Doughty, Bofferding, & Roberts, 2016), future
research should examine the benefits of virtual manipulatives
for students with learning disabilities. Specifically, a virtual–
representational–abstract instructional framework should be
researched to determine the best application for virtual
manipulatives for instructional purposes.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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