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Education and 

Training 

in 

Developmental 

Disabilities 

Focusing on individuals with 

cognitive disabilities/mental retardation, autism, and related disabilities 

Volume 43 Number 3 September 2008

September 2008 Education and Training in Developmental Disabilities Vol. 43, No. 3, pp. 277–408

Education and Training in Developmental Disabilities 

The <strong>Journal</strong> of <strong>the</strong> <strong>Division</strong> on Developmental Disabilities, 

The Council for Exceptional Children 

Editor: Stanley H. Zucker 

Arizona State University 

Consulting Editors 

Martin Agran 

Reuben Altman 

Phillip J. Belfiore 

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Michael P. Brady 

Fredda Brown 

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Sharon F. Cramer 

Caroline Dunn 

Lise Fox 

David L. Gast 

Herbert Goldstein 

Robert Henderson 

Carolyn Hughes 

Larry K. Irvin 

James V. Kahn 

H. Earle Knowlton 

Barry W. Lavay 

Rena Lewis 

Kathleen J. Marshall 

Editorial Assistant: Hannah H. Hainline 

Arizona State University 

John McDonnell 

Gale M. Morrison 

Gabriel A. Nardi 

John Nietupski 

James R. Patton 

Edward A. Polloway 

Thomas G. Roberts 

Robert S. Rueda 

Diane L. Ryndak 

Edward J. Sabornie 

Laurence R. Sargent 

Gary M. Sasso 

Tom E. C. Smith 

Scott Sparks 

Fred Spooner 

Robert Stodden 

Keith Storey 

David L. Westling 

John J. Wheeler 

Mark Wolery 

Education and Training in Developmental Disabilities is sent to all members of <strong>the</strong> <strong>Division</strong> on Developmental Disabilities of The Council 

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Editing policies are based on <strong>the</strong> Publication Manual, <strong>the</strong> American Psychological Association, 2001 revision. Additional information is 

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Education and Training in Developmental Disabilities is abstracted and indexed in Psychological Abstracts, PsycINFO, e-psyche, Abstracts 

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Gifted Children for publication in <strong>the</strong> monthly print index Current Index to <strong>Journal</strong>s in Education and <strong>the</strong> quarterly index, Exceptional Child 

Education Resources. 

Education and Training in Developmental Disabilities Vol. 43, No. 3, September 2008, Copyright 2008 by <strong>the</strong> <strong>Division</strong> on Developmental 

Disabilities, The Council for Exceptional Children. 

<strong>Division</strong> on Developmental Disabilities 

The Council for Exceptional Children 

Board of Directors 

Officers 

Past President Polly Parrish 

President J. David Smith 

President-Elect Emily Bouck 

Vice President Teresa Taber-Doughty 

Secretary Toni Merfeld 

Treasurer Gardner Umbarger 

Members 

Linda Laz 

Nikki Murdick 

Robert Sandieson 

Angie Stone-MacDonald (Student Governor) 

Dianne Zager 

Debora Wichmanowski 

Executive Director 

Tom E. C. Smith 

Publications Chair 

Jack Hourcade 

Communications Chair 

Darlene Perner 

The purposes of this organization shall be to advance <strong>the</strong> education and welfare of persons with developmental disabilities, research in <strong>the</strong> 

education of persons with developmental disabilities, competency of educators in this field, public understanding of developmental disabilities, 

and legislation needed to help accomplish <strong>the</strong>se goals. The <strong>Division</strong> shall encourage and promote professional growth, research, and <strong>the</strong> 

dissemination and utilization of research findings. 

EDUCATION AND TRAINING IN DEVELOPMENTAL DISABILITIES (ISSN 1547-0350) (USPS 0168-5000) is published quarterly in 

March, June, September, and December, by The Council for Exceptional Children, <strong>Division</strong> on Developmental Disabilities, 1110 North 

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Education and Training in Developmental 

Disabilities 

Editorial Policy 

Education and Training in Developmental Disabilities focuses on <strong>the</strong> education and 

welfare of persons with developmental disabilities. ETDD invites research and 

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identification and assessment, educational programming, characteristics, training 

of instructional personnel, habilitation, prevention, community understanding and 

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Viewpoints expressed are those of <strong>the</strong> authors and do not necessarily conform to 

positions of <strong>the</strong> editors or of <strong>the</strong> officers of <strong>the</strong> <strong>Division</strong>. 

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Editor: Stanley H. Zucker, Special Education Program, Box 872011, Arizona 

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6. Upon receipt, each manuscript will be screened by <strong>the</strong> editor. Appropriate 

manuscripts will <strong>the</strong>n be sent to consulting editors. Principal authors will receive 

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articles accepted for publication are copyrighted in <strong>the</strong> name of <strong>the</strong> <strong>Division</strong> on 

Developmental Disabilities.

Education and Training in Developmental Disabilities 

VOLUME 43 NUMBER 3 SEPTEMBER 2008 

Self-Determination in Relation to Having or Not Having a Legal Guardian: 

Case Studies of Two School-Aged Young Adults with Developmental 

Disabilities 279 

DOROTHY SQUATRITO MILLAR 

Factors Impacting <strong>the</strong> Enactment of a Functional Curriculum in Self- 

Contained Cross-Categorical Programs 294 

EMILY C. BOUCK 

Thirty Year Review of Safety Skill Instruction for Persons with Intellectual 


LINDA C. MECHLING 

Enhancing Social and Transition Behaviors of Persons with Autism through 

Activity Schedules: A Review 324 

DEVENDER R. BANDA, and ERIC GRIMMETT 

Therapeutic Interventions in <strong>the</strong> Ne<strong>the</strong>rlands and Belgium in Support of 

People with Profound Intellectual and Multiple Disabilities 334 

CARLA VLASKAMP, and HAN NAKKEN 

Systematic Instruction for Social-Pragmatic Language Skills in Lunchroom 

Settings 342 

MAUREEN E. ANGELL, RITA L. BAILEY, and LAURA LARSON 

Combined Curricular Intervention with Brief Hands Down to Decrease Hand 

Mouthing and <strong>the</strong> Use of Arm Splints for a Young Boy with Profound 


HELEN I. CANNELLA-MALONE, MARK F. O’REILLY, JEFF SIGAFOOS, and JEFFERY M. CHAN 

Effects of a Reciprocal Questioning Intervention on <strong>the</strong> Question Generation 

and Responding of Children with Autism Spectrum Disorder 367 

KELLY WHALON, and MARY FRANCES HANLINE 

Discrimination Skills Predict Effective Preference Assessment Methods for 

Adults with Developmental Disabilities 388 

MAY S. H. LEE, DUONG NGUYEN, C. T. YU, JENNIFER R. THORSTEINSSON, 

TOBY L. MARTIN, and GARRY L. MARTIN 

Teaching Test-taking Strategies to Improve <strong>the</strong> Academic Achievement of 

Students with Mild Mental Disabilities 397 

ALLISON G. KRETLOW, YA-YU LO, RICHARD B. WHITE, and LUANN JORDAN 

Manuscripts Accepted for Future Publication in Education and Training in 

Developmental Disabilities 278 

The <strong>Division</strong> on Developmental Disabilities retains literary property rights on copyrighted articles. Up to 100 

copies of <strong>the</strong> articles in this journal may be reproduced for nonprofit distribution without permission from <strong>the</strong> 

publisher. All o<strong>the</strong>r forms of reproduction require permission from <strong>the</strong> publisher.

Manuscripts Accepted for Future Publication in Education 

and Training in Developmental Disabilities 

December 2008 

Noncontingent escape access to self-reinforcement to increase task engagement for students with 

moderate to severe disabilities. David Cihak and Robert I. Gama, University of Tennessee, A412 

Claxton Complex, Knoxville, TN 37996-3442. 

Individuals with intellectual and developmental disabilities in <strong>the</strong> criminal justice system and 

implications for transition planning. Tammy Smith, Edward A. Polloway, James R. Patton, and Julia 

F. Beyer, Office of Graduate Studies, Lynchburg College, Lynchburg, VA 24501. 

Enhancing <strong>the</strong> job performance of employees with disabilities using <strong>the</strong> Self-Determined Career 

Development Model. Patricia Devlin, The University of Toledo, 2801 W. Bancroft Street, Mail Stop 

#106, Toledo, OH43606-7736. 

Effectiveness of discrete trial teaching with preschool students with developmental disabilities. 

Andrew Downs, Robyn Conley Downs, Michelle Fossum, and Kathryn Rau, Department of Psychology, 

Central Washington University, 400 E. University Way, Ellensburg, WA 98926-7575. 

High tech cooking: A literature review of evolving technologies for teaching a functional skill. 

Linda C. Mechling, University of North Carolina Wilmington, 601 S. College Road, Wilmington, 

NC 28403-5940. 

Attitudes of Israeli teachers and paraprofesionals towards <strong>the</strong> new definition of ID and <strong>the</strong>ir 

willingness to cope with special education law changes. Hefziba Lifshitz, Shoshanna Nissim, and 

Sara Cohen, Bar-Ilan University, School of Education, Ramat-Gan, 52900, ISRAEL. 

A distributive model of treatment acceptability. Stacy L. Carter, 4518 20th St., Lubbock, TX 79407. 

Staff variables that influence responses to challenging behaviour of clients with intellectual 

disability: A review. Greet Lambrechts, Katja Petry, and Bea Maes, Katholieke Universiteit Leuven, 

Faculty of Psychology & Educational Sciences, Vesaliusstraat 2, B-3000 Leuven, BELGIUM. 

Using literacy-based behavioral interventions and social stories to improve work behavior in 

employees with developmental disabilities. Jessica Bucholz, Michael P. Brady, Mary Lou Duffy, Jack 

Scott, and Larry G. Kontosh, University of West Georgia, Department of Special Education, and 

Speech-Language Pathology, Carrolton, GA 30118-5140. 

Implementation of a programme for students with profound intellectual and multiple disabilities 

in schools: Three case studies. Annemarie C. Tadema, Carla Vlaskamp, and Wied Ruijssenaars, 

University of Groningen, Department of Special Education, Grote Rozenstraat 38, Groningen, 

9712 TJ, The NETHERLANDS. 

Teaching grocery store purchasing skills to students with intellectual disabilities using a computerbased 

intruction program. David L. Hansen and Robert L. Morgan, Department of Special 

Education and Rehabilitation, Utah State University, 2865 Old Main Hill, Logan, UT 84322-2865. 

Caregiver-delivered home-based instruction using simultaneous prompting for teaching home 

skills to individuals with developmental disabilities. Sema Batu, Anadolu Universitesi, Engelliler 

Arastirma Enstitusu, Eskisehir, 26470, TURKEY. 

Address is supplied for author in boldface type.

Self-Determination in Relation to Having or Not Having a 

Legal Guardian: Case Studies of Two School-Aged Young 

Adults with Developmental Disabilities 

Dorothy Squatrito Millar 

Saginaw Valley State University 

Abstract: IDEA mandates that all rights accorded to parents transfer to students when <strong>the</strong>y reach <strong>the</strong> age of 

majority, unless <strong>the</strong>ir competence is questioned. Using case studies, this research examined <strong>the</strong> concern that when 

competence is challenged, guardian appointments may occur, thus negatively impacting <strong>the</strong> self-determination 

of school-aged young adults who have developmental disabilities. The assumption that a young adult who had 

a full legal guardian would exhibit fewer, if any, self-determination skills in comparisons to a peer who did not 

have a legal guardian was investigated. Findings include (a) values, beliefs, and knowledge impact guardian 

roles, and (b) more research is needed to determine <strong>the</strong> impact IDEA age of majority and transfer of rights 

mandates are having on families as well as school, law, and agency service providers’ interpretations and 

actions. 

The importance of developing self-determination 

related attributes in youth and young 

adults with disabilities is emphasized in legislation 

(e.g., IDEA; Rehabilitation Act Amendments 

of 1992 and 1998), as well as in an 

abundance of literature (e.g, Algozzine, Browder, 

Karvonen, Test, & Wood, 2001; Test, 

Fowler, Brewer, & Wood, 2005). In addition, 

<strong>the</strong>re is a growing body of research which is 

providing evidence that self-determination 

does positively impact employment outcomes 

(Wehmeyer & Palmer, 2003); post secondary 

education (Field, Sarver, & Shaw, 2003); and 

overall quality of life (Wehmeyer & Schwartz, 

1997). Despite <strong>the</strong> efforts directed toward promoting 

and increasing self-determination of 

youth and young adults with disabilities such 

that <strong>the</strong>y can communicate <strong>the</strong>ir preferences, 

interests, and advocate for <strong>the</strong>mselves, little is 

known about how self-determination is being 

impacted at <strong>the</strong> time students reach <strong>the</strong> age of 

majority, and become legally responsible for 

<strong>the</strong>ir decisions and actions. When a student 

reaches <strong>the</strong> age of majority, IDEA mandates 

Correspondence concerning this article should 

be addressed to Dorothy Squatrito Millar, Saginaw 

Valley State University, College of Education, 7400 

Bay Road, University Center, MI 48710. 

Education and Training in Developmental Disabilities, 2008, 43(3), 279–293 

© <strong>Division</strong> on Developmental Disabilities 

that all <strong>the</strong> rights accorded to <strong>the</strong> parents are 

to transfer to <strong>the</strong> student unless <strong>the</strong> student is 

determined to be incompetent by State law, or 

considered unable to provide informed consent 

with respect to educational programming. 

When competence is in question, States 

are responsible for establishing procedures 

for appointing an individual (e.g., parent) to 

represent <strong>the</strong> educational interests of <strong>the</strong> student 

[614(d)(1)(A)VIII]. 

To date, <strong>the</strong>re is no known investigation 

that examines <strong>the</strong> procedures States have established 

to address <strong>the</strong> mandate, who is determining 

competence, how it is being determined, 

and what criteria is being used to 

determine it. Concern has been raised that 

when students are reaching <strong>the</strong> age of majority, 

and <strong>the</strong>ir competence is questioned, 

guardian appointments might be unnecessarily 

sought (Millar, 2007, 2003; Millar & Renzaglia, 

2002). As it applies to adults, guardianship 

is a process when a judge appoints 

someone (a guardian) to make decisions for 

and handle <strong>the</strong> affairs of ano<strong>the</strong>r (a ward) 

who is believed “partially” or “totally” incompetent 

(Bulcroft, Kielkopf, & Tripp, 1991; Lisi, 

Burns, & Lussenden, 1994). Dependent on a 

court order, guardians can assume complete 

or limited control over decisions related to <strong>the</strong> 

ward’s residence, educational services, voca- 

Self-Determination and Guardianship / 279

tional training, medical treatment, and participation 

in contracts (Lisi et al.). 

It is important to emphasize that legislation, 

which is created by each state, has differing 

levels and scope of guardianship. It might be 

expected, <strong>the</strong>refore, that individuals who exhibit 

few if any self-determination skills would 

need a full (plenary) guardian to make <strong>the</strong> 

majority or all decisions for <strong>the</strong>ir ward, in 

contrast to individuals displaying some selfdetermination 

skills who would be appointed 

a limited guardian to make decisions on specific 

issues (e.g., financial decisions) (Stancliffe, 

Abery, Springborg, & Elkin, 2000). It 

may also be expected that an individual who 

does not need or have a guardian exhibits 

self-determination skills. Essentially, individuals 

who have a full or partial guardian could 

be perceived as having no or limited capability 

to provide informed consent or to exercise 

control over <strong>the</strong>ir life in comparison to persons 

without guardians (Abery & Stancliffe, 

1996). 

Interestingly, <strong>the</strong> research on <strong>the</strong> extent to 

which guardian appointments impact self-determination 

is limited, and in many instances 

dated. In one topic related study, Lindsey and 

Luckasson (1991) suggested that service providers 

frequently allowed or encouraged family 

members to make decisions as if <strong>the</strong>y were 

<strong>the</strong> guardian for an individual with a disability 

who did not legally have one appointed. This 

suggests that some equate disability with incompetence 

and limited ability. In ano<strong>the</strong>r 

study, Lindsey (1994) evaluated 69 adults, who 

had developmental disabilities capacity to give 

informed consent to community residential 

placements. In this study, it was found that 

<strong>the</strong>re were no significant differences regarding 

<strong>the</strong> ability to give informed consent between 

individuals who ei<strong>the</strong>r had or did not 

have a court appointed guardian. This brings 

to question <strong>the</strong> need of legal guardian appointments. 

In a more recent study, Stancliffe, 

et al. (2000) attempted to compare self-determination 

competencies demonstrated by 

adults with disabilities by using results from 

self-determination related scales completed by 

residential agency care providers. Stancliffe et 

al. anticipated that adults with disabilities who 

had no guardian would be perceived as exhibiting 

more self-determination competencies 

and control over <strong>the</strong>ir lives in comparison to 

280 / Education and Training in Developmental Disabilities-September 2008 

<strong>the</strong>ir peers who had guardians. Findings revealed 

that <strong>the</strong> level of personal control exhibited 

by 76 adults (ages ranging between 

20.8 to 71.7, with <strong>the</strong> average age of 37.3, sd 

11.6; full IQ mean scores ranging from 42.3 to 

62.6) who did not have guardians were perceived 

by agency personnel as higher than 

those individuals who had ei<strong>the</strong>r partial or full 

guardians. The authors concluded that <strong>the</strong>ir 

findings “provide objective evidence that individuals 

with less restrictive substitute decisionmaking 

arrangements actually do exercise 

greater control over <strong>the</strong>ir lives.” (p. 417). 

Given <strong>the</strong> findings of <strong>the</strong> studies noted above, 

it is clear that more research is necessary that 

examines <strong>the</strong> complexity of guardianship. 

Fur<strong>the</strong>r, when considering IDEA, and <strong>the</strong> 

impact guardian appointments may or may 

not have on <strong>the</strong> rights of individuals, it is clear 

that research in <strong>the</strong> area of guardianship and 

its impact on self-determination is needed, 

particularly with respect to school-aged adults 

who have disabilities. Interestingly, <strong>the</strong> relationship 

has been rarely been examined. 

Within <strong>the</strong> last 10 years, Millar, and colleague, 

(Millar & Renzaglia, 2002; Millar, 2003) conducted 

studies that investigated guardianship 

in relation to young adults who had developmental 

disabilities that were in <strong>the</strong> transition 

phase of <strong>the</strong>ir education. By reviewing over 

220 guardianship court files, it was found that 

guardians, as stated on court petition forms 

most often completed by parents, were 

needed because <strong>the</strong> student (a) reached <strong>the</strong> 

age of majority (18 years of age), and (b) had 

limited or no ability to make decisions. It was 

also found that <strong>the</strong> evidence used to “prove” 

“incompetence” was unclear, and that in 

100% of <strong>the</strong> cases a guardian (most often a 

parent) was appointed. Review of annual reports 

submitted to courts by guardians found 

that <strong>the</strong> majority of wards’ “conditions” of 

“having limited or no capacity to make decisions” 

reportedly remained unchanged following 

guardian appointments. 

In a related investigation, Millar (2007) 

conducted focus groups with secondary special 

education teachers, parents (both who 

were legal guardians and who were not), and 

young adults with disabilities (both who had 

legal guardians and who did not) to determine 

<strong>the</strong>ir knowledge of guardianship and 

self-determination. It was learned that <strong>the</strong> par-

ticipants (a) believed <strong>the</strong>y exhibited/promoted 

self-determination; (b) did not recognize 

a disconnect between self-determination 

and guardianship; and (c) had limited understanding 

of guardianship and its alternatives. 

Ano<strong>the</strong>r finding was that when asked how 

families first learned about guardianship, students 

and parents shared that it was at an IEP. 

They shared that a teacher asked “Do you 

have a guardian?” when it came to that section 

on <strong>the</strong> IEP form. From that point, parents 

went to court because <strong>the</strong>y thought <strong>the</strong>y were 

supposed to do it and began <strong>the</strong> guardianship 

proceedings without truly understanding what 

guardian appointments entailed. Parents also 

reported that <strong>the</strong>y found it devastating to state 

<strong>the</strong>ir son or daughter was incompetent to 

make decisions. In hindsight, <strong>the</strong>se parents 

questioned whe<strong>the</strong>r a guardian was actually 

needed. 

Based on a review of guardianship and selfdetermination 

literature, it was learned that 

<strong>the</strong>re has not been a study that addressed why 

some school-aged young adults with developmental 

disabilities do not have a guardian 

appointed, while o<strong>the</strong>rs do. This current 

study, <strong>the</strong>refore, builds on <strong>the</strong> previous work 

as it provides an understanding of <strong>the</strong> experiences 

students and families encounter at <strong>the</strong> 

time students with developmental disabilities 

reach <strong>the</strong> age of majority and guardianship is 

considered. In a addition, a purpose of this 

study was to examine why or why not parents 

elected to become guardians, as well as examine 

expectations that those with a full guardian 

were less likely to be self-determined and 

experience personal control than those with 

no guardian. Ultimately, it was hoped that 

through a case study approach, an in-depth 

view to guardianship and self-determination 

would lead to increased awareness as to what 

guardianship is really about, and <strong>the</strong> extent to 

which a guardian impacts a young adult’s life. 

This is <strong>the</strong> first known study that explores how 

families, with young adults with similar educational 

experiences and special education 

school labels, came to very different conclusions 

about guardianship when <strong>the</strong>y attended 

an Individualized Education Program meeting 

(IEP) and it was time for <strong>the</strong> parents’ 

rights to potentially transfer to <strong>the</strong>ir adult 

child. 

Method 

Participants and Settings 

Kevin and Jack, both 21 years of age, were 

purposively identified for this study as <strong>the</strong>y 

both (a) had <strong>the</strong> special education eligibility 

label of “moderately cognitively impaired” 

based on results from IQ assessments, adaptive 

behavior scores, and onset of <strong>the</strong> disability; 

(b) were over <strong>the</strong> age of 18; (c) were 

eligible for services including vocational rehabilitation, 

social security income, Medicaid, 

Department of Mental Health - Services of 

People with Developmental Disabilities 

(DMH); and (d) had high levels of parental 

involvement. One essential criteria was that 

one individual (Jack) had a full (plenary) 

guardian, while one (Kevin) did not. 

The two young men lived in <strong>the</strong> same community, 

attended <strong>the</strong> same high school, and 

had <strong>the</strong> same teachers throughout most of 

<strong>the</strong>ir schooling. Essentially, <strong>the</strong>se two young 

men had grown up toge<strong>the</strong>r, via <strong>the</strong>ir special 

education, since <strong>the</strong> age of four. The suburban 

community where Kevin and Jack lived 

had a population of over 40,000. The high 

school enrollment approximated 500, where 

90% of <strong>the</strong> student body was Caucasian. The 

school district had a solid reputation for preparing 

students for college, and also had a 

reputation across <strong>the</strong> region and state for promoting 

supported community living and job 

experiences for individuals who had developmental 

disabilities. The school’s curriculum 

emphasis was on <strong>the</strong> expanded development 

of Kevin’s and Jack’s life skills (e.g., cooking, 

cleaning, money use) and vocational training. 

Particular emphasis was placed on teaching 

<strong>the</strong>m to fur<strong>the</strong>r develop <strong>the</strong>ir self-advocacy 

and o<strong>the</strong>r related self-determination skills. At 

<strong>the</strong> time <strong>the</strong> study began, both were in <strong>the</strong>ir 

last year of public schooling where <strong>the</strong>y attended 

school for two to three hours a day, 

<strong>the</strong>n were in <strong>the</strong> community – ei<strong>the</strong>r working 

or recreating. 

Both young men, and <strong>the</strong>ir parents, had 

opportunities for becoming aware of <strong>the</strong> various 

transition services available during and 

after high school graduation. Opportunities 

to explore various jobs, options, and agency 

services were available to Kevin and Jack, as 

<strong>the</strong>y were for all students who received special 


education services. Despite <strong>the</strong>se similarities, 

each young man and <strong>the</strong>ir parents responded 

differently to <strong>the</strong> age of majority and transfer 

of rights issues. One family, Kevin’s, secured a 

house, obtained agency support, and were adamant 

that no legal guardian be appointed. 

Ano<strong>the</strong>r family, Jack’s, chose a different path. 

By family choice, <strong>the</strong> young man had no 

agency services and lived with his parents, who 

were also his legal guardians. 

For Kevin, Mary his mo<strong>the</strong>r shared <strong>the</strong> majority 

of information from <strong>the</strong> parental point 

of view. Although Kevin’s fa<strong>the</strong>r was involved 

in his son’s life, Mary stated “Oh, I can speak 

for him.” Mary was initially contacted by <strong>the</strong> 

district’s transition coordinator about <strong>the</strong> 

study, <strong>the</strong>n introduced to <strong>the</strong> author. Mary 

was immediately agreeable to participate in 

<strong>the</strong> study and gave <strong>the</strong> author <strong>the</strong> names and 

phone numbers of people to contact to set up 

times to meet with Kevin. A total of six individuals, 

in addition to Kevin, were interviewed 

who included: Mary (his mom), his dad, and 

<strong>the</strong> school Transition Coordinator. Kevin had 

a case manager through <strong>the</strong> Department of 

Mental Health - Services for People with Developmental 

Disabilities (DMH) whose job 

was to make sure Kevin had <strong>the</strong> supports he 

needed. The case manager, Tyler (Kevin’s 

personal care assistant funded by DMH), and 

Simon (Kevin’s job coach who’s position was 

funded in part by <strong>the</strong> school and vocational 

rehabilitation) were also study participants. 

In Jack’s situation, <strong>the</strong> fa<strong>the</strong>r granted <strong>the</strong> 

family participation in <strong>the</strong> study, however, 

made it clear that both he and his wife would 

attend interviews toge<strong>the</strong>r. In all, four individuals, 

in addition to Jack were interviewed: his 

mom, dad, employer, and <strong>the</strong> school transition 

coordinator. 

The transition coordinator for <strong>the</strong> district 

was contacted by <strong>the</strong> author, following <strong>the</strong> 

advice of <strong>the</strong> district director of special education, 

and given <strong>the</strong> participant criteria, who 

<strong>the</strong>n helped identify participants. As a point 

of reference, <strong>the</strong> transition coordinator 

worked with <strong>the</strong> participants for a three year 

period, and had <strong>the</strong> responsibilities of being a 

teacher and work study coordinator. This individual 

was also responsible for arranging 

presentations throughout <strong>the</strong> school year on 

various topics, including social security, and 

living arrangement options. 

Data Collection 


Several methods and data sources were utilized 

to collect, elaborate and verify information. 

Main data collection methods were <strong>the</strong> 

use of open-ended and semi-structured interviews 

with participants (via telephone or in 

person) and on-site observations. Documents 

and records (e.g., Individualized Education 

Programs, evaluation reports, and student 

performance data provided by <strong>the</strong> transition 

coordinator) were also reviewed. 

Based on <strong>the</strong> recommendation of <strong>the</strong> transition 

coordinator, <strong>the</strong> author conducted <strong>the</strong> 

first interviews with <strong>the</strong> parents by telephone. 

Initial phone calls to parents lasted no more 

than 30 minutes, during which <strong>the</strong> purpose of 

<strong>the</strong> study was reiterated and arrangements for 

fur<strong>the</strong>r interaction were made. A request for 

background information was also made such 

that <strong>the</strong> author could review documents related 

to health, school, employment and nonrelated 

school activities (e.g., recreation/leisure, 

social activities). It was also shared by <strong>the</strong> 

author why <strong>the</strong>ir adult child was selected for 

participation. Subsequent interviews lasted between 

30 minutes to 2 hours, and were tape 

recorded and transcribed for data analysis 

purposes by ei<strong>the</strong>r <strong>the</strong> author or an assistant. 

Sample questions posed to parents, and o<strong>the</strong>r 

participants, included: (a) what type of curriculum 

was emphasized at <strong>the</strong> school (e.g., life 

skills, academics, self-determination skills)?; 

(b) when did <strong>the</strong>y first learn about guardianship 

with regard to <strong>the</strong>ir son?; (c) what experiences 

did <strong>the</strong>y have that related to guardianship?; 

and (d) what type of transition 

information was provided by <strong>the</strong> schools, in 

particular to self-determination, guardianship, 

and guardianship alternatives? Throughout 

<strong>the</strong> study, questions were modified, and 

responses were clarified regarding <strong>the</strong> above 

noted topics. 

On-site observations occurred approximately 

two to seven times a month (ranging 

from one to three hours per observation) over 

a ten month period that began in late August 

(<strong>the</strong> beginning of a school calendar) and 

ended in early July. Observations occurred at 

<strong>the</strong> young adults’ home, school, place of employment, 

and various community settings <strong>the</strong> 

young adults frequented (e.g., mall, community 

recreation center, fast food restaurant).

Field notes were used to document <strong>the</strong> observations. 

During most observations, <strong>the</strong> author 

attempted to minimize impacting or influencing 

daily routines, and in most situations, 

stood or sat back from <strong>the</strong> student, having 

minimal direct interaction with o<strong>the</strong>rs. There 

were times, however, when <strong>the</strong> author did 

interact with <strong>the</strong> student and o<strong>the</strong>r participants 

to clarify what was observed. 

Analysis 

Data analysis began immediately following <strong>the</strong> 

first interviews by reviewing <strong>the</strong> tape transcripts. 

Initially <strong>the</strong> framework, or outline, for 

determining <strong>the</strong>mes was <strong>the</strong> responses to 

questions (e.g., when did you first learn about 

guardianship?). Specifically, under each question 

that was used somewhat as a header, responses 

were sorted and categorized first regarding 

Kevin and <strong>the</strong>n Jack. Following 

transcript review, observation field notes were 

<strong>the</strong>n added to <strong>the</strong> interview data. The author 

and <strong>the</strong> assistant who transcribed interviews, 

separately reviewed at least 20% of randomly 

selected passages and field notes to establish 

inter-coder reliability. Reliability was high 

(over 85%), however, after <strong>the</strong> addition of 

field note observations, it was decided that <strong>the</strong> 

question/response approach framework for 

determining <strong>the</strong>mes was not adequately reflecting 

<strong>the</strong> issues <strong>the</strong> students and <strong>the</strong>ir parents 

encountered. That is, <strong>the</strong> framework 

seemed to fragment <strong>the</strong> findings. Therefore, 

individual case studies were created, with two 

main <strong>the</strong>mes, “Kevin: It takes a Village” and 

“Jack: It takes a Family.” Documents (e.g., 

school records) were used to confirm and supplement 

<strong>the</strong> information collected during interviews 

and observations. 

The initial case studies were shared with <strong>the</strong> 

young men and <strong>the</strong>ir parents (members 

checking) so that <strong>the</strong>y could review and confirm 

<strong>the</strong> information. Following <strong>the</strong>ir review, 

and with little requested revision (nothing of 

content, ra<strong>the</strong>r grammatical concerns), <strong>the</strong> 

final case studies were completed. Prolonged 

engagement in <strong>the</strong> environments students frequented 

occurred, as did triangulation of data 

and members checking on <strong>the</strong> analysis of interviews 

and observational field notes, to ensure 

au<strong>the</strong>nticity and credibility (Bogdan & 

Bilken, 1998; Lincoln & Guba, 1985). In <strong>the</strong> 

subsequent section, each case study is presented. 

Kevin did not have a legal guardian, 

and Jack’s fa<strong>the</strong>r was his legal guardian. 

Case Studies 

Kevin: It Takes a Village 

At <strong>the</strong> time <strong>the</strong> study began, Kevin was a 6 foot 

tall 21 year old Caucasian male who appeared 

physically fit. When he was born, <strong>the</strong>re were 

no apparent signs that he had a disability, and 

it was not until <strong>the</strong> age of three that his parents 

noticed delays, and began an early intervention 

program sponsored by <strong>the</strong> school district 

and family advocacy organization. By age 

nine, Kevin was found by a school psychologist 

to have an IQ and an adaptive behavior score 

that placed him in <strong>the</strong> “trainable mentally 

impaired” school category. As an adult, Kevin 

continued to lack verbal communication skills 

that most same aged peers had, however, he 

did communicate his feelings verbally, as well 

as behaviorally. On occasion, Kevin reportedly 

was “aggressive” and struck o<strong>the</strong>rs. Such actions 

were interpreted by his parents, school 

personnel, and personal assistants as his way 

of communicating that he “does not like what 

was going on.” The transition coordinator 

stated “In a sense, his behavior shows his attempt 

to be self-determined.” Even with his 

limited verbal ability, he was able to understand 

questions and express responses. On 

occasion during observations, Kevin appeared 

sleepy, and according to his personal assistant 

this was “most likely due to his medications” 

that were to help mediate his manic or aggressive 

behaviors. 

Home. Kevin lived in his own home that his 

parents, Mary and Joe, bought for him when 

he turned 18 years of age, while he was still 

enrolled in <strong>the</strong> public school system. “We used 

his money - well what was to be his college 

money - to buy <strong>the</strong> house.” His two bedroom 

house was selected such that it was within <strong>the</strong> 

city limits and near various retail and community 

options. Kevin’s home was located near a 

community recreation center where he 

walked (with support from his assistants) and 

enjoyed playing basketball, swimming, and 

taking karate lessons. Although he could take 

<strong>the</strong> public transportation to various locales, 

his assistants often opted to drive him around. 


“Its easier for me to take him than wait for <strong>the</strong> 

bus” said one assistant. 

Kevin depended on <strong>the</strong> assistance from o<strong>the</strong>rs 

to help him with cooking, cleaning, dressing 

and accomplishing many o<strong>the</strong>r daily living 

tasks. Personal assistants from community service 

agencies came in and out of Kevin’s home 

between 7:00 a.m. and 11:00 p.m. each day. A 

two-way intercom system was installed in <strong>the</strong> 

home so that Kevin’s nightly actions could be 

monitored from 11:00 p.m. until 7:00 a.m. 

That is, a person employed by a human service 

agency monitored Kevin such that if he got 

out of bed, he would be reminded via a 

speaker to go back to his bedroom. Kevin 

received SSI (monthly income via Social Security 

Administration) and Medicaid, and because 

of this, he was eligible for services from 

DMH, who took care of all <strong>the</strong> housecleaning, 

meal preparation, shopping, errands and 

laundry. Support was also offered when it 

came to bathing, dressing, and taking medication. 

Work. Kevin’s jobs were mostly seasonal. 

During <strong>the</strong> fall and winter seasons, he worked 

at <strong>the</strong> community center doing janitorial and 

maintenance work. During <strong>the</strong> spring and 

summer months, he had a lawn maintenance 

and moving service in which he worked 20 

hours a week. Throughout <strong>the</strong> year, he was 

scheduled to work at least 10 hours a week at 

a restaurant, clearing landscape or shoveling 

snow. The school district, in partnership with 

vocational rehabilitation services, sponsored a 

job coach, which Kevin and his parents interviewed 

and helped hire. 

School. Prior to <strong>the</strong> afternoon work schedule, 

Kevin, under <strong>the</strong> supervision of his assistants, 

walked to school most mornings. For a 

two to three hour period at school, he worked 

on daily living activities (e.g., cooking, cleaning, 

recreating) in a simulated apartment, designed 

in a classroom. During <strong>the</strong> blocked 

time, Kevin had a semi-structured schedule 

where, during each half hour to 45 minute 

period, he was given a choice as to what he 

would like to do. As an example, between 9 

and 9:30 a.m., recreation time, he could chose 

to play a card or board game. In addition to 

learning games, an aim was for Kevin to fur<strong>the</strong>r 

develop his social and self-determination 

skills. Recreation and social interaction skills, 

like o<strong>the</strong>r daily living skills, were areas noted 


on Kevin’s IEP, and data were collected in an 

effort to monitor his progress. 

Family values - no legal guardian appointed. 

Mary and Joe, both retired, visited with <strong>the</strong>ir 

son regularly, at least once a week. Kevin 

fished and boated with his Dad and went to 

<strong>the</strong> mall and restaurants with his Mom. His 

parents also stayed in close contact with 

Kevin’s assistants and monitored his money. 

His older bro<strong>the</strong>r by two years, Peter, did not 

live in <strong>the</strong> state, however, he kept in contact 

with Kevin. Two months into <strong>the</strong> study, when 

<strong>the</strong> author phoned Mary to arrange an observation, 

she quickly interjected: 

Boy do I have something to tell you about 

guardianship! We are at a ragged edge with 

this guardianship thing. I just got a phone 

call from <strong>the</strong> special education administrator. 

He said that Kevin was in an assault 

situation at school. He told me he couldn’t 

tell me anything more because I was not 

Kevin’s legal guardian - that because Kevin 

was his own guardian, he could not disclose 

any details of what occurred – He also went 

on to say that Kevin would not understand a 

report that detailed <strong>the</strong> situation and <strong>the</strong>refore 

would not give him <strong>the</strong> report ei<strong>the</strong>r. 

This person had no right to make <strong>the</strong> determination 

of Kevin’s competence. 

Mary volunteered regularly at a community 

family advocacy organization as a consultant 

to and an advocate for people with disabilities 

and <strong>the</strong>ir family members with regard to special 

education, community agency connections, 

social security income and o<strong>the</strong>r issues, 

including guardianship. Mary stated that she 

wanted Kevin, her son, to remain an individual 

who maintained all of his basic rights. 

Through her association with <strong>the</strong> family advocacy 

organization and school sponsored family 

transition topic nights, she learned that she 

could write a ‘letter of intent.’ A letter of 

intent is a document written by parents that 

describes <strong>the</strong> son’s or daughter’s history, current 

status and hopes for <strong>the</strong> future 

(Pierangelo & Giuliani, 2004). Although <strong>the</strong> 

document is not a legal one, judges and o<strong>the</strong>r 

parties can refer to <strong>the</strong> letter for guidance in 

understanding <strong>the</strong> wishes of <strong>the</strong> parents in 

regard to <strong>the</strong>ir son or daughter. Content areas 

of <strong>the</strong> letter can vary: including religion, sib-

ling information, medical history and care, 

recreation/leisure activities, financial information, 

employment and education. The letter 

Kevin’s parents wrote stated that: (a) it was 

<strong>the</strong>ir intention that Kevin always be his own 

guardian; (b) if Kevin was ever involved with 

<strong>the</strong> court system in any way and his parents 

were unavailable, incapacitated, or deceased, 

he was to have <strong>the</strong> services of an attorney, not 

a court appointed attorney, working on his 

behalf; (c) ei<strong>the</strong>r his parents or his trust would 

be responsible for <strong>the</strong> costs of an attorney, 

especially should <strong>the</strong>re be guardianship issues, 

and (d) if an extreme emergency a 

guardian is deemed necessary, his bro<strong>the</strong>r Peter 

was to be appointed, however, should he 

be deceased, an individual approved by <strong>the</strong> 

family advocacy organization [NAME OF OR- 

GANIZATION] was to be appointed. 

Clearly, Mary strongly believed that Kevin 

should remain his own guardian. The letter of 

intent she and her husband wrote was copied 

and presented to all family members and organizations 

(e.g., agency case managers, 

school personnel) Kevin worked with and was 

also posted on <strong>the</strong> refrigerator in Kevin’s 

home for easy access. “No one likes to be 

called or say that <strong>the</strong>y are dumb, incompetent 

or incapacitated” which is something that 

does occur at a guardianship appointment 

hearing. She indicated that <strong>the</strong>re are a number 

of ways in which Kevin, and o<strong>the</strong>r people 

who have disabilities, can have <strong>the</strong> support 

needed when making decisions, without having 

a legal guardian appointed. The alternatives 

for Kevin included <strong>the</strong> support of his 

family, friends, and agency support personnel; 

utilization of person-centered planning; and 

trusts. At one time, his parents were his representative 

payee, however, <strong>the</strong>y opted to discontinue 

this as <strong>the</strong>y no longer wanted to 

write out reports regarding his finances. 

Guardian defined. To reiterate, having a 

guardian appointed means that an individual 

can no longer legally make decisions on his or 

her own behalf. Someone else does <strong>the</strong> decision 

making for <strong>the</strong>m. Kevin did not have a 

court appointed guardian. Because Kevin had 

difficulty verbally sharing information, observations 

across environments occurred in order 

to get a sense of <strong>the</strong> decisions he made. At <strong>the</strong> 

school setting, it was clear that efforts were 

made for him to learn how to communicate 

his wishes. In o<strong>the</strong>r environments, however, 

such efforts were not observed. Specifically, 

Kevin and Tyler (a personal assistant) were 

observed at Kevin’s home and at <strong>the</strong> food 

court in local mall, near a fast food restaurant. 

On a daily basis during breakfast at Kevin’s 

home Tyler made omelets and sausage for 

Kevin. Tyler was asked by <strong>the</strong> author if Kevin 

ever told him what he wanted to eat and if he 

ever helped prepare <strong>the</strong> food. It was observed 

in school that he was being taught how to 

prepare and cook simple foods (e.g., cereal 

and toast). Tyler shared “Well, I was a cook in 

<strong>the</strong> service, and I like to cook, so I pretty much 

spoil him and make him things. Most of his 

o<strong>the</strong>r staff makes him oatmeal.” Kevin wiped 

his mouth with a napkin whenever Tyler told 

him to do so. After breakfast, Tyler placed 

clo<strong>the</strong>s on Kevin’s bed. Kevin was not observed 

picking out his clo<strong>the</strong>s nor asked what 

he would like to wear. 

Below is an example of <strong>the</strong> exchanges that 

occurred on Wednesday and Friday afternoons, 

when Kevin and Tyler regularly went to 

<strong>the</strong> local mall: 

Tyler. “What do you want for lunch Kevin? 

Do you want a hamburger? One or two?” 

Kevin raised two fingers to communicate 

his wishes. 

Tyler. “What do you want to drink? Milk 

or coke?” 

Kevin. “Coke.” 

Tyler. “No, let’s have milk. I’ll get you 

milk.” 

Tyler gave Kevin milk and himself a cola. Tyler 

indicated that he usually ordered Kevin’s food 

for him. At one point, Tyler was asked by <strong>the</strong> 

author whe<strong>the</strong>r Kevin ever ordered his own 

food and <strong>the</strong> reply was “It is easier for me to 

do it.” Tyler shared that he worked with Kevin 

for “about 2 years”, and that he was just a few 

months older than Kevin. Essentially, both 

men had <strong>the</strong> same build (tall, lean and fit) 

and dressed similarly. 

Tyler. “Kevin, take off your jacket” Kevin 

complied and took off <strong>the</strong> coat. 

Regularly, it was observed that Tyler arranged 

Kevin’s food on <strong>the</strong> table. After a few bites of 

his fries, Kevin asked Tyler about students and 


teachers that <strong>the</strong>y both knew at high school. 

Tyler shared that Kevin’s recall of all his classmates 

and teachers impressed him. Following 

some discussions about school, Tyler unwrapped 

Kevin’s cheeseburger. Kevin ate 

slowly, but interacted with both Tyler, and at 

times <strong>the</strong> author. When Tyler was done eating 

one burger, he asked Kevin “Do you want your 

second burger, or do you want to save it for 

later?” The response was “I want some now.” 

Tyler, however, put <strong>the</strong> second burger in his 

coat pocket and said “No. Let’s save it.” The 

turnover rate for working with Kevin ran between 

1 to 2 years. The longest time an attendant 

worked with Kevin was three years, on a 

part-time basis. 

Simon was Kevin’s job coach. Similar to 

what was observed at <strong>the</strong> mall and at Kevin’s 

home, was also observed at <strong>the</strong> work place. 

Simon got <strong>the</strong> supplies Kevin needed to use to 

vacuum, mop floors and clean tables. When 

<strong>the</strong> transition coordinator was <strong>the</strong> job coach, 

an effort was made to provide <strong>the</strong> least 

amount of intrusion so that Kevin would become 

independent at <strong>the</strong> job site. Although 

Kevin did not ever become fully independent 

on <strong>the</strong> majority of steps he needed to do <strong>the</strong> 

job, he was independent at getting his supplies. 

Kevin’s school job portfolio had a task 

analysis and data reflected Kevin’s areas of 

being independent. When asked, Simon indicated 

that he was not concerned about <strong>the</strong> 

quality of Kevin’s work because he would go 

behind him and complete <strong>the</strong> tasks when 

needed. 

Mary indicated that on Mondays and Thursdays 

from 1:00 p.m. to 3:00 p.m., her son was 

scheduled to work at a restaurant to clean <strong>the</strong> 

landscaping and pick up trash. When observations 

were arranged to meet at <strong>the</strong> worksite, 

Kevin and Simon were at least 15 minutes late 

and on four occasions, Kevin did not show. 

Simon indicated that he, not necessarily 

Kevin, did not care for that job and so <strong>the</strong>y did 

not go <strong>the</strong>re on a regular basis. Such information 

was news to Mary when she asked how <strong>the</strong> 

observations were going. Mary worked with 

vocational rehabilitation counselor, DMH 

case manager and transition coordinator to 

ensure that Simon was helping Kevin become 

as independent as possible at <strong>the</strong> job sites. 

Jack: It Takes a Family 


Jack, 21 years of age at <strong>the</strong> time <strong>the</strong> study 

began, and was planning to leave school at <strong>the</strong> 

end of <strong>the</strong> school year. He, like Kevin, began 

an early intervention program at <strong>the</strong> age of 

three. In fact, both young men were in <strong>the</strong> 

same early intervention program class, had 

similar IQ and adaptive behavior scores and 

<strong>the</strong> same special education school label. Unlike 

Kevin, Jack was noticeably small from <strong>the</strong> 

moment he was born. He was born two 

months pre-mature, had a brain tumor, and 

numerous medical scares throughout his life. 

He had a shunt initially placed when he was an 

infant. His parents could not recall <strong>the</strong> exact 

age of <strong>the</strong> first shunt, but <strong>the</strong>y could recall 

that <strong>the</strong> shunt had to be replaced four times. 

Jack was also tube fed for <strong>the</strong> first year of his 

life. 

Jack could have stayed associated with <strong>the</strong> 

schools until <strong>the</strong> age of 26 (state law), but Jack 

and his parents opted that he leave earlier as 

<strong>the</strong>y felt he was not “benefiting from <strong>the</strong> curriculum.” 

His mo<strong>the</strong>r shared “It was decided 

to leave school because he isn’t progressing 

and <strong>the</strong>re is no advantage to staying. He has 

reached his maximum at shopping, and all of 

<strong>the</strong> things that <strong>the</strong> kids do. The only thing we 

think we will miss is <strong>the</strong> social part.” She 

shared that it would be difficult to keep her 

son busy and that <strong>the</strong>y would try to get him to 

stay in contact with his friends, but that “it 

probably will be just too difficult.” They 

planned to keep him socially involved with 

family functions and activities. 

Jack was described by his parents, transition 

coordinator, and his employer as being “someone 

who is nice to be around as he is responsible” 

and “overall, a proper young gentlemen.” 

In terms of stature, Jack, a 21 year old 

blond hair, blue eyed man, was not quite four 

feet tall. 

Fa<strong>the</strong>r. We love being around him. He’s 

very pleasant. We’re very fortunate that we 

have him and that he is small—people think 

of him younger than he is. We see some 

people who are handicapped who don’t 

look it, and it is harder for <strong>the</strong>m because 

people expect a lot from <strong>the</strong>m. 

Mo<strong>the</strong>r. Jack is 21, but he is still my baby.

Home. Jack lived with his mo<strong>the</strong>r and fa<strong>the</strong>r 

in a home that was located just outside 

<strong>the</strong> city limits. Deer and o<strong>the</strong>r wild life maneuvered 

through <strong>the</strong> family’s 30 acres of land. In 

turn, <strong>the</strong> family, who had a long history in <strong>the</strong> 

area, continued to enjoy <strong>the</strong> animal activities. 

Although Jack and his parents attended presentations 

about living/housing options that 

existed in <strong>the</strong>ir community, <strong>the</strong>y were satisfied 

and comfortable with maintaining <strong>the</strong>ir living 

situation. Jack indicated, as did his parents, 

that he was not in any rush to have a home 

away from his parents. Jack had his own room 

and spent time showing <strong>the</strong> author how he, 

with a little assistance from his mo<strong>the</strong>r, redecorated 

it. He picked out <strong>the</strong> blinds and carpet. 

He bought himself a rocking chair and cabinets 

for his room. He proudly showed <strong>the</strong> golf 

clubs he purchased. He played golf and went 

fishing with his dad, who was retired. Interestingly, 

Jack had his driver’s permit and drove a 

car that had been accommodated by having 

<strong>the</strong> foot pedals extended so that his legs could 

control <strong>the</strong> gas and brakes. When asked by <strong>the</strong> 

author “Can you tell me about how you 

learned to drive?” Jack’s response was “I 

wanted to drive. My Dad said you gotta take a 

class. I took a class.” He drove himself to work 

“sometimes”, with his fa<strong>the</strong>r by his side, and to 

a city that was about 20 minutes from where 

he lived. Surprisingly, given his calm demeanor, 

Jack’s taste in music was hard rock, 

which he listened to often. He had his own 

T.V., his own phone and he frequently took 

his parents out to lunch and dinner. His parents 

stated that Jack knew how to use his 

money “cautiously and wisely.” 

Work. Jack had a part-time paying job at a 

nursing home that he could keep upon school 

completion. His tasks involved providing fresh 

ice water to <strong>the</strong> residences and he reportedly 

liked it <strong>the</strong>re. Jack was observed at <strong>the</strong> nursing 

home at which he worked three times a week. 

No assistance from vocational rehabilitation 

services or a specialized job coach were 

needed, nor desired by Jack or his parents. 

Family values – a legal guardian appointed. 

When Jack was just about to turn 18, his parents 

filed a petition to become <strong>the</strong> legal 

guardian of <strong>the</strong>ir son. Jack’s fa<strong>the</strong>r began <strong>the</strong> 

discussion: 

One of <strong>the</strong> things you asked about was for 

us to talk about guardianship and I’ve been 

thinking. I think you can break it down into 

two areas: one with <strong>the</strong> people who are 

more reliant on <strong>the</strong> government and SSI; 

and maybe people that can make it on <strong>the</strong>ir 

own and don’t rely on <strong>the</strong> government. 

When you look at <strong>the</strong> people who don’t rely 

on <strong>the</strong> government, such as ourselves, <strong>the</strong> 

advantage we find with a guardianship is we 

have authority and can make changes in 

Jack’s yearly investments, <strong>the</strong> things that he 

does, and <strong>the</strong> things he buys. Now if you 

were not in <strong>the</strong> position that we are, I think 

<strong>the</strong> role of <strong>the</strong> guardian may change. Not 

sure exactly how. The difficulty that we have 

in trying to give you an assessment as to 

whe<strong>the</strong>r guardianship is a good thing-is that 

we’ve never been challenged on anything or 

had any problems because we take care of 

things ourselves, so it is difficult to give you 

plusses and minuses. 

Unlike Kevin and his parents, Jack and his 

parents did not want any of <strong>the</strong> human service 

agencies involved in <strong>the</strong>ir lives. They did not 

get SSI or Medicaid, and did not wish to have 

Jack surrounded by personal care attendants. 

“Taking care of Jack is <strong>the</strong> family’s responsibility. 

Not <strong>the</strong> governments, or anyone else’s.” 

When Jack’s parents were asked how <strong>the</strong>y 

learned about guardianship, his fa<strong>the</strong>r stated: 

Through <strong>the</strong> schools. It was through <strong>the</strong> 

transition coordinator that we found out. 

Something that I thought was most effective 

about <strong>the</strong> school program was <strong>the</strong> transition 

coordinator gave <strong>the</strong> parents information. 

Then us, <strong>the</strong> parents, could decide what we 

want: to take care of ourselves; or try to 

share those responsibilities. The reason <strong>the</strong> 

flag went up for us about guardianship is 

because of <strong>the</strong> medical situation. If we were 

in ano<strong>the</strong>r city or state or something, <strong>the</strong>y 

may not deliver medical attention to Jack. 

An attorney gave us advice one way. My 

bro<strong>the</strong>r is also involved with a handicapped 

child, as is our sister-in-law. They advised us 

against guardianship. We looked at it as 

what we felt what was best for our son. But 

again, we don’t really know <strong>the</strong> plusses and 

minuses of it because we haven’t been challenged. 

We felt that we had to have <strong>the</strong> 


ability to make decisions in <strong>the</strong> medical area 

and investment area and just his general 

care. We felt much more qualified to make 

<strong>the</strong>se decisions than to have <strong>the</strong> court make 

<strong>the</strong>m. While Karen (mo<strong>the</strong>r) and I are both 

alive, we don’t see any problems because 

<strong>the</strong> estate is very simple. In <strong>the</strong> future, <strong>the</strong>re 

may be some problems and I’m not sure 

how guardianship might fit in. When we did 

this we had as many questions not to do it as 

we did to do it. Since we have done it, we 

think it’s great because we haven’t had any 

problems. However, like I said before, we 

haven’t been challenged. 

Jack’s mo<strong>the</strong>r indicated that <strong>the</strong> only down 

side to being a guardian was that once a year 

<strong>the</strong>y had to submit a form with <strong>the</strong> court, a 

responsibility <strong>the</strong>y did not know about before 

<strong>the</strong>y filed <strong>the</strong> petition. Both of Jack’s parents 

indicated that <strong>the</strong> report had to be done in a 

timely manner and that from <strong>the</strong>ir view point 

it was an extremely confusing form. For <strong>the</strong> 

first two years, <strong>the</strong>y had <strong>the</strong> report sent back to 

<strong>the</strong>m three times, as it was not acceptable by 

<strong>the</strong> court. 

They just needed to know what you’ve spent 

on him in <strong>the</strong> last year, and let <strong>the</strong>m know 

if he’s comfortable. That part is extremely 

easy. Where we’ve had trouble is trying to 

reconcile accounts from one year to <strong>the</strong> 

next, and carrying things forward with <strong>the</strong> 

trust we have set up. 

Jack’s parents indicated that <strong>the</strong>y “felt bad 

that <strong>the</strong> court had to come back” to <strong>the</strong>m to 

find out or have to ask for more information 

as to <strong>the</strong> balance from one year to <strong>the</strong> next. 

“We feel somewhat knowledgeable in this area 

seeing that we’ve been in business for a good 

part of our lives, involved with finance. We got 

thinking, if we’ve gotten in trouble with this, 

imagine <strong>the</strong> o<strong>the</strong>r people.” 

Jack’s parents believe that “<strong>the</strong> Judge’s 

court has been simply outstanding.” This is 

<strong>the</strong>ir experience: 

Author. You found an attorney that you felt 

comfortable to go through <strong>the</strong> process 

with? 

Mo<strong>the</strong>r. Yes, we have our own attorney. 

Author. Can you tell me what happened 

in <strong>the</strong> court? 


Fa<strong>the</strong>r. Well it was fantastic. The judge 

got Jack up on <strong>the</strong> judge’s bench and let 

him take <strong>the</strong> gavel. It was very personal. We 

know <strong>the</strong> Judge very well. 

Mo<strong>the</strong>r. Jack sat with his attorney. 

Author. Separate from yours? 

Fa<strong>the</strong>r. Yes. So we had our attorney and 

<strong>the</strong>n ano<strong>the</strong>r for Jack to make sure that he 

was defended. I think that was a good thing. 

We wanted to make sure that he was represented 

by someone o<strong>the</strong>r than his guardian. 

I think it is required by <strong>the</strong> court. The attorney 

tried to help explain what he was 

getting into. If he was comfortable with us 

as guardians. Very deep questions. 

Mo<strong>the</strong>r. Simple though. Jack would answer 

“yes” or “no.” It was a great experience 

for him . . . different though . . . in <strong>the</strong> attorney’s 

office, and in <strong>the</strong> court room. 

Author: Did Jack testify in court? 

Mo<strong>the</strong>r. Not really. He just had to say “yes 

or no.” The questions were very simple. The 

judge has a very soft spot for children and 

would probably treat any child very special. 

Jack’s fa<strong>the</strong>r encouraged him to participate in 

conversations. “Tell about when we went to 

<strong>the</strong> Judge’s court. What happened <strong>the</strong>re? Remember 

when we went to <strong>the</strong> court room?” 

Jack said “Oh yeah, I met with my judge, and 

he said what do you want me to do for you? 

And I said I want my Dad, and he said, court 

is adjourned and stuff like that.” To remember 

<strong>the</strong> details of what occurred three years 

ago was a challenge for Jack, but he did recall 

<strong>the</strong> main events. These parents and <strong>the</strong>ir 21 

year old adult son viewed <strong>the</strong>ir experience 

with <strong>the</strong> court as “positive.” 

Jack’s parents were asked whe<strong>the</strong>r <strong>the</strong>y had 

thought about a backup guardian, because a 

court determined need for a guardian stands 

over <strong>the</strong> ward, regardless if <strong>the</strong> guardian dies 

or decides to be relieved of guardianship duties 

and responsibilities. Jack’s mo<strong>the</strong>r shared 

“He’s (<strong>the</strong> fa<strong>the</strong>r) <strong>the</strong> guardian and I’m <strong>the</strong> 

backup. You really have to think long term.” 

The fa<strong>the</strong>r added “What we’ve done is set that 

up with <strong>the</strong> trust. We have looked through 

that process so that 15-20 years from now, Jack 

would be taken care of . . . that’s why we had 

an attorney for him to make sure everything 

was set up. Regardless of what people told us 

not to do, we got everything set up. That’s why

we felt strongly that we needed information. 

So that’s our view, and where we come from.” 

In addition to <strong>the</strong> courts monitoring yearly 

reports, Jack’s mo<strong>the</strong>r shared that a court appointed 

social worker made annual visits to 

<strong>the</strong>ir home. 

Mo<strong>the</strong>r. A social worker comes to <strong>the</strong> door 

very unexpectedly, and comes and checks 

on Jack . . . without any call ahead. 

Fa<strong>the</strong>r. Which I think is really, really neat. 

It is through <strong>the</strong> Judge’s court room, that’s 

how it’s done. I think it’s how <strong>the</strong> system is. 

It’s in <strong>the</strong> law. I think it’s written in <strong>the</strong>re 

but I don’t think people ever do it. I think 

we have one of <strong>the</strong> very few judges who ever 

does this. The visits are very spotty, <strong>the</strong>re’s 

not a pattern to it. 

Mo<strong>the</strong>r. Yeah, <strong>the</strong>re’s no pattern to it. 

You just have a knock at <strong>the</strong> door and I had 

a woman one time and a man this last time. 

They just want to see Jack’s bedroom. 

Guardian defined? Jack, who legally had all 

his decision-making rights taken and given to 

his fa<strong>the</strong>r, made decisions about preparing his 

work station, and deciding which patients at 

<strong>the</strong> nursing home needed water and who did 

not. The nursing home manager acknowledged 

his decision making ability and applauded 

it, frequently asking Jack to train 

o<strong>the</strong>r people. “He learned right away about 

who needed water and who did not. When he 

goes on vacation, he makes sure that a substitute 

is trained and is scheduled to cover for 

him. He does this all on his own. No supports 

or reminders.” 

During observations, Jack not only decided 

what he would do at work, but directed <strong>the</strong> 

author as well. He said, “Put your coat <strong>the</strong>re, 

and follow me.” He told <strong>the</strong> author that “If 

<strong>the</strong>re is a yellow flag on <strong>the</strong> room, I am not to 

go in <strong>the</strong>re because <strong>the</strong> person is sick. I just 

look in each room and check to see if someone 

wants water.” Jack spoke to a few residents 

he stated that he liked to talk to. “I am patient 

with <strong>the</strong> people who think I am <strong>the</strong>ir son.” 

When shopping at <strong>the</strong> mall, Jack walked 

side by side his parents and <strong>the</strong>y engaged in 

causal conversations. 

Fa<strong>the</strong>r. He pays for all his things. 

Jack. I keep an eye on things and stuff like 

that. 

Mo<strong>the</strong>r. He has a savings account. 

Jack. Yeah, a savings account and ah, if I 

don’t know what to do with it (money) I put 

it in <strong>the</strong> savings account and see how much 

I am saving. 

Fa<strong>the</strong>r. How many dollars do you always 

keep in your wallet for going to Mc- 

Donald’s? 

Jack. Oh, a couple dollars. 

Fa<strong>the</strong>r. A little more than a couple 

(laughs). 

Mo<strong>the</strong>r. Jack buys lunch for <strong>the</strong> family a 

lot. 

Jack. Yes, I do. 

Fa<strong>the</strong>r. At <strong>the</strong> nursing home, he is making 

$3,000 to $5,000 per year and after two 

years he has really built up his nest egg. 

Jack. I am making a lot of money. Ah, 

sometimes, if I see a nice shirt I’ll buy it. I 

like looking in <strong>the</strong> mall store, to make sure 

stuffs a good deal. 

Discussion and Implications 

The importance of promoting self-determination 

skills of youth and young adults with disabilities 

during <strong>the</strong> school years continues to 

be emphasized in legislation, literature, and 

research. It has even been suggested that an 

indicator of special education services success 

can be measured by <strong>the</strong> extent to which students 

with disabilities are <strong>the</strong> guiding force of 

<strong>the</strong>ir own lives (Agran, Blanchard, & Wehmeyer, 

2000). For youth who are about to 

become adults, it is imperative to understand 

<strong>the</strong>ir, and <strong>the</strong>ir family members’, values regarding 

self-determination. Grigal, Neubert, 

Moon, and Graham (2003) stated “Undoubtedly 

<strong>the</strong> success of self-determination depends 

on parents’ views of its appropriateness and 

desirability.” (p. 98). Although parent views 

are important, <strong>the</strong> success, as it was found in 

this study, depends heavily on <strong>the</strong> values of 

educators, service providers, and members of 

<strong>the</strong> judiciary (e.g., attorney, judge) who may 

work for and with families. 

IDEA mandates that once students reach 

<strong>the</strong> age of majority, <strong>the</strong>y will assume <strong>the</strong> rights 

once accorded to <strong>the</strong>ir parents, unless <strong>the</strong>ir 

competence is in question. A concern was 

raised that if competence was challenged, 

guardian appointments may occur, thus negatively 

impacting <strong>the</strong> self-determination of <strong>the</strong> 


young adult. In addition to examining <strong>the</strong> 

impact of guardianship, it was anticipated that 

<strong>the</strong> young adults who participated in this study 

would affirm an assumption that a schoolaged 

young adult with developmental disability 

who had full legal guardian appointed 

would exhibit few, if any, self-determination 

skills in comparison to a peer who did not 

have a guardian. Surprisingly, this was not <strong>the</strong> 

case. As a result, <strong>the</strong> findings of <strong>the</strong>se case 

studies extend <strong>the</strong> research by providing <strong>the</strong> 

first examination of how guardians, legal or 

o<strong>the</strong>rwise, impact <strong>the</strong> self-determination opportunities 

for school-aged young adults with 

developmental disabilities. 

Despite <strong>the</strong> importance of family and 

teacher efforts to promote self-determination 

of young adults, o<strong>the</strong>r forces (e.g., school administrator, 

service providers) at times impeded 

<strong>the</strong>m, as was seen with Kevin. This finding 

that a teacher (transition coordinator) 

actively promoted <strong>the</strong> development of students’ 

self-determination skills contrasts <strong>the</strong> 

findings of <strong>the</strong> Wehmeyer, Agran, and 

Hughes (2000) and Katsyannis, Zhang, Woodruff, 

and Dixon (2005) studies where teachers 

realized <strong>the</strong> importance of self-determination 

skills, but did not necessarily teach <strong>the</strong>m. A 

concern raised in this study, ra<strong>the</strong>r, is <strong>the</strong> 

disconnect observed between <strong>the</strong> school administrator’s 

perception of Kevin’s competence 

and <strong>the</strong> parents’ values and teacher’s 

role in helping <strong>the</strong> student demonstrate his 

abilities. It was almost as if <strong>the</strong> fact that Kevin 

had a developmental disability, <strong>the</strong> administrator 

assumed incompetence. 

Turnbull and Turnbull (2001) suggested 

that individuals with developmental disabilities 

most likely will require ongoing support 

from o<strong>the</strong>rs to experience a quality life. Unfortunately, 

in this study it appeared that 

Kevin and his parents would be challenged 

with building alliances that would enable 

Kevin to be self-determined. Although <strong>the</strong> 

transition coordinator and families are applauded 

for teaching self-determination skills, 

a need exists to work on such skill development 

within a larger context, beyond <strong>the</strong> 

school building. Teaching students self-determination 

skills (e.g., making choices) is important, 

but perhaps more important is ensuring 

significant o<strong>the</strong>rs, including personal 

assistants from community agencies, acknowl- 


edge and respect <strong>the</strong> students’ communication. 

It has been argued that individuals with 

disabilities have had limited influence over 

<strong>the</strong>ir lives and conversely have had <strong>the</strong>ir lives 

unnecessarily controlled by o<strong>the</strong>rs (Lisi et al.), 

and as a result, a cycle of dependency and less 

independence may be created. Kevin’s parents 

made substantial effort to establish environments 

where <strong>the</strong>ir son could express and 

fur<strong>the</strong>r develop his self-determination skills, 

however Kevin’s expressions were stifled, even 

in his own home. This finding is in contrast to 

a study conducted by Wehmeyer, Kelchner, 

and Richards (1995) who found that adults 

with developmental disabilities who lived independently 

were more self-determined than 

individuals who lived in group homes. The 

findings from this study are more aligned with 

<strong>the</strong> results from <strong>the</strong> Wehmeyer and Metzler 

(1995) study were adults with developmental 

disabilities indicated that <strong>the</strong>y had limited 

control over important life choices and decisions. 

Wehmeyer and Metzler concluded that 

people with developmental disabilities may be 

in environments that are overly structured or 

protective and do not place emphasis on opportunities 

to make meaningful choices and 

decisions and solve problems. 

This study has also brought to light that 

‘guardian’ may be interpreted in a variety of 

ways. If not having a guardian means an individual 

is living a life based on <strong>the</strong>ir values, 

preferences, and choices without external 

forces, Kevin had a guardian, and in fact several 

– <strong>the</strong>y just were not court appointed. 

Many of <strong>the</strong> decisions he attempted to communicate 

(e.g., desire for a cola instead of 

milk), although not life critical, were not honored. 

For Jack, who had a legal guardian, it 

was clear to whom he interacted with that he 

made many decisions. Jack was exercising selfdetermination, 

even with <strong>the</strong> fact he had a 

legal guardian. The findings from this study 

for one individual, Jack, suggest that guardian 

appointments may not impact <strong>the</strong> day to day 

decision-making of some individuals. His parents 

admitted that <strong>the</strong>y have not needed to 

use <strong>the</strong>ir legal authority, however, since <strong>the</strong>y 

became legal guardians three years earlier. As 

a point of caution, Jack’s situation may be 

exceptional in that he had a family network to 

support him which contrasts findings found in

literature, mostly to do with <strong>the</strong> elderly, where 

abuse and misuse of guardian powers were 

observed (Lisi et al., 1994). 

Jack’s situation fur<strong>the</strong>r reflects <strong>the</strong> finding 

of a study conducted by Stancliffe et al. (2000) 

who found that some adults with guardians 

displayed self-determination competencies 

that were as good or better than o<strong>the</strong>rs who 

had not been assigned a guardian. The authors 

suggested that perhaps <strong>the</strong> self-determination 

skills of some individuals steadily increased 

over time as a result of experiences. 

They also suggested that in <strong>the</strong>se situations 

courts should reevaluate guardian appointments 

or responsibilities, and cautioned that 

if too much time is taken to reconsider guardian 

roles, <strong>the</strong>n a ward’s motivation to exhibit 

self-determination may decrease, or potentially 

deteriorate. It is possible for individuals 

to petition <strong>the</strong> court to modify or remove 

guardian appointments. An interesting finding 

about Jack’s situation is that <strong>the</strong> parents 

were adamant about family taking care of family. 

Curiously, <strong>the</strong>y did not seem to view <strong>the</strong> 

court’s authority, annual reports <strong>the</strong>y had to 

submit to <strong>the</strong> judge, or social worker home 

visits as intrusions. 

It has been suggested that families need to 

have access to information to make informed 

choices regarding guardianship (Millar, 2003; 

Millar & Renzaglia, 2002). In addition to this 

information, each family has to have individualized 

support and guidance by school personnel. 

Although Jack’s family believed <strong>the</strong>y 

were informed, <strong>the</strong>y had at times inaccurate 

or incomplete information. For example, 

medical issues, a main reason for filing a petition 

for <strong>the</strong>ir son, may have sufficiently been 

taken care of in different ways (e.g., ‘next of 

kin,’ ‘power of attorney,’ ‘emergency/temporary 

guardianship). Alternatives could have 

been explored (see Millar, 2007 for potential 

alternatives), hence reducing <strong>the</strong> need for 

<strong>the</strong>m to write reports for <strong>the</strong> courts, and unnecessarily 

limiting <strong>the</strong>ir son’s legal rights. Because 

legal issues can be confusing and complex, 

it is essential that members of <strong>the</strong> 

judiciary (e.g., probate clerks who register 

guardian petitions, attorneys, judges) learn 

about self-determination initiatives and ways 

<strong>the</strong>y too can support individuals with disabilities 

to remain autonomous. Perhaps members 

of <strong>the</strong> judiciary, ei<strong>the</strong>r prior to or at <strong>the</strong> time 

a petition for guardianship is filed with <strong>the</strong> 

courts, can work with families to ensure <strong>the</strong>y 

understand what guardianship entails and its 

alternatives. 

Limitations and Future Research Ideas 

Although this study provides important new 

information, and used sound strategies for 

conducting quality case studies (e.g., prolonged 

observations, members checking, triangulation 

of data), <strong>the</strong>re are limitations. For 

example, in <strong>the</strong> selection of participants, it is 

possible that <strong>the</strong>y are not representative of 

students in similar situations, hence restricting 

<strong>the</strong> ability to generalize <strong>the</strong> findings. A 

case study approach was used, however, because 

exploration in this area of self-determination 

in relation to guardianship for young 

adults is new. It is anticipated that <strong>the</strong> lessons 

learned from this study will help with designing 

future research endeavors where larger 

numbers of individuals can have <strong>the</strong> opportunity 

to participate and have <strong>the</strong>ir voices heard. 

In addition, this study has acted as a catalyst 

by raising several questions that could be addressed 

in future research initiatives. For example, 

how, if at all, has IDEA impacted <strong>the</strong> 

number of young adults having a guardian 

appointed? If a student’s competence is a concern, 

<strong>the</strong>n to what extent are IEP present level 

of functional performance statements, goals, 

and objectives addressing this concern? When 

educators and service providers learn of 

guardian appointments, does <strong>the</strong>ir respect for 

and actions toward <strong>the</strong> individual with <strong>the</strong> 

disability change, and if so how? Ano<strong>the</strong>r 

question to investigate is how prevalent is it 

that families petition courts at <strong>the</strong> time a student 

becomes of legal age? Does <strong>the</strong> awareness 

that a young adult with a disability who 

has been appointed a guardian lead to that 

individual becoming less likely to attempt to 

demonstrate self-determination attributes, or 

was Jack’s situation an exception? O<strong>the</strong>r questions 

could relate to how often guardian appointments 

are modified or revoked if families 

realize that alternatives to guardian 

appointments can be used. 

Awhile ago Halpern (1994) wrote “if <strong>the</strong> 

transition process is to be successful, it must 

begin with helping students to gain a sense of 

empowerment with respect to <strong>the</strong>ir own tran- 


sition planning.” (p. 118). Although <strong>the</strong>re has 

been improvement in supporting students in 

<strong>the</strong>ir role during <strong>the</strong>ir personal transition 

from school to post school environments, it is 

essential that legislation, school initiatives and 

service supports, honor and respect <strong>the</strong> individuals 

<strong>the</strong>y serve, particularly if guardian appoints 

are a result of IDEA mandate interpretations. 

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Received: 14 February 2007 

Initial Acceptance: 18 April 2007 

Final Acceptance: 14 July 2007 




Factors Impacting <strong>the</strong> Enactment of a Functional Curriculum 

in Self-Contained Cross-Categorical Programs 

Emily C. Bouck 

Purdue University 

Abstract: Factors relating to curriculum use in general education have been studied in considerable depth, yet 

little research has been conducted on what factors impact <strong>the</strong> enactment of curriculum in special education. This 

study specifically studied <strong>the</strong> enactment of a functional curriculum in two rural, self-contained, cross-categorical 

programs. The data revealed that it was <strong>the</strong> intersection and union of seven factors (policy/legislation, 

community, school, teachers, paraprofessionals, students, and curriculum materials) that shaped <strong>the</strong> enacted 

functional curriculum in both programs. The association between <strong>the</strong> factors and <strong>the</strong> enactment of <strong>the</strong> 

functional curriculum holds implications for policy, research, and practice. 

“How we define curriculum makes a difference 

in how we think about it and how we 

plan it” (Morrison, 1993, p. 84). Little agreement 

exists among researchers or practitioners 

as to what constitutes curriculum, as it 

can refer to long-lasting educational programs, 

materials used in classrooms (i.e., textbooks), 

and experiences that students receive 

while in school (Morrison; Nolet & McLaughlin, 

2000). Although disagreement exists, it is 

understood that curriculum is complex and 

reflects plans and activities that are to benefit 

students and help <strong>the</strong>m achieve specific goals 

(Nolet & McLaughlin). 

A curriculum is actually comprised of three 

components – <strong>the</strong> written (intended), enacted, 

and received curriculum. The written 

curriculum “is <strong>the</strong> official or adopted curriculum 

often contained in state or district policy”, 

and represents what students are expected to 

learn (Cuban, 1992; Nolet & McLaughlin, 

2000, p. 15). The enacted curriculum “is <strong>the</strong> 

operationalization of <strong>the</strong> intended curriculum”, 

and reflects <strong>the</strong> decisions a teacher 

This study represents <strong>the</strong> author’s doctoral dissertation. 

She would like to thank her dissertation 

committee: Drs. Troy Mariage, Cindy Okolo, Carol 

Sue Englert, and Sandra Wilcox. Correspondence 

concerning this article should be addressed to Emily 

C. Bouck, Department of Educational Studies, Purdue 

University, 5146 BRNG Hall, 100 N. University, 

West Lafayette, Indiana 47907. E-mail: bouck@ 

purdue.edu 

makes during implementation (Nolet & 

McLaughlin, p. 16). It encompasses <strong>the</strong> formal 

and informal lessons and activities, as well 

as teachers’ behaviors, groupings, management 

strategies, beliefs, and comments (Cuban). 

The received curriculum “is what students 

actually learn as a result of being in <strong>the</strong> 

classroom and interacting with <strong>the</strong> intended 

and taught curricula” (Nolet & McLaughlin, 

p. 17). 

Synder, Bolin, and Zumwalt (1992) expanded 

<strong>the</strong> definition of enacted curriculum 

to encompass a co-construction of educational 

experiences by teachers and students. They 

suggested that an enacted curriculum is a 

transactional process where teachers and students 

interact, construct, and make meaning 

of <strong>the</strong> curriculum and educational experiences 

within context. Yet, <strong>the</strong>ir expanded definition 

may still be too narrow. This study 

proposes that <strong>the</strong> enacted curriculum is a 

transactional process, co-constructed by teachers 

and students, and influenced by each 

one’s history; <strong>the</strong> school; <strong>the</strong> communities in 

which <strong>the</strong> school, teachers, and students reside; 

institutional factors, such as federal and 

state policies; and curriculum materials. This 

definition is depicted in Figure 1. 

Factors Impacting Curriculum 


According to Milner (2003) curriculum enactment 

and choice can be influenced by several

Figure 1. Proposed intersection of factors impacting 

<strong>the</strong> enactment of a functional curriculum. 

variables, including federal policies, state standards, 

school factors, and teacher factors. 

Morrison emphasized a sphere of influence 

on curriculum decision making consisting of 

society, legislation/policy, <strong>the</strong> local school district, 

individual people, professional organizations, 

business/industry, foundations/agencies, 

teachers, textbooks, lobbying/special 

interest groups, and testing. 

Institutional policies and legislation. Federal 

policies affect curriculum enactment within 

special education, such as No Child Left Behind 

(NCLB) (2002) and <strong>the</strong> Individuals with Disabilities 

Education Act (IDEA) (1997, 2004). 

NCLB is built upon four pillars: stronger accountability 

for results, more freedom for 

states and communities, encouraging <strong>the</strong> use 

of proven educational methods, and more 

choices for parents. This policy has led to a 

more rigorous general education curriculum 

and a presumed push towards using <strong>the</strong> general 

education curriculum for students with 

disabilities. Under NCLB teachers are to be 

held accountable for students’ progress on 

state standards, suggesting that curricula must 

reflect teaching to <strong>the</strong> standards, or teaching 

to <strong>the</strong> test (Karp, 2003; Patton, Polloway, & 

Smith, 2000). 

The Individuals with Disabilities Education Improvement 

Act of 2004 is <strong>the</strong> reauthorization of 

<strong>the</strong> Individuals with Disabilities Education Act, 

and reflects <strong>the</strong> government’s attempt to align 

IDEA ’97 with NCLB. It is focused on greater 

accountability and having highly qualified special 

education teachers in classrooms. IDEIA 

2004 has also been attributed to an increased 

focus on preparing students with disabilities 

for fur<strong>the</strong>r education. 

Curriculum materials. Morrison (1993) discussed 

textbooks’ deterministic influence on 

curriculum enactment, indicating that <strong>the</strong>y 

tend to cater to <strong>the</strong> lowest ability students in 

<strong>the</strong> classroom, ra<strong>the</strong>r than <strong>the</strong> average or <strong>the</strong> 

more able students. Dyck and Pemberton 

(2002) claimed that textbooks represent a 

central feature of curricula, particularly at <strong>the</strong> 

higher grades. 

School and community factors. Schools can 

influence curriculum through a district’s curriculum 

and philosophy, as well as <strong>the</strong> building’s 

climate (Milner, 2003; Waldrip & Giddings, 

1996). O<strong>the</strong>r school variables affecting 

curriculum are a school’s setting (rural, urban, 

and suburban) and size (see Bouck, 

2005; Monk & Haller, 1993). For example, 

rural schools are more likely to expose students 

to in-school jobs and work experience 

yet generally have fewer vocational educational 

choices (Baer et al., 2003; Hudson & 

Shafer, 2002). Research has suggested that 

rural schools are more likely to have crosscategorical 

programs than urban or suburban 

schools (Bouck, 2005). School size research 

shows similar results, with smaller schools offering 

fewer educational opportunities than 

larger schools (Monk & Haller, 1993). 

Teacher factors. Teachers shape how curriculum 

is enacted in classrooms (Milner, 2003). 

Remillard (1997) suggested that teachers play 

a more direct role than textbooks in <strong>the</strong> enacted 

curriculum as <strong>the</strong>y make <strong>the</strong> final decision 

about what gets taught. Teachers’ pedagogical 

approaches, beliefs about course 

content, knowledge about <strong>the</strong> community in 

which students live, content knowledge, and 

<strong>the</strong>ir own personal experiences all influence 

<strong>the</strong> delivery of curriculum (see Milner; Remillard 

& Bryans, 2003; Weiss, Pasley, Smith, Banilower, 

& Heck, 2003). 

Functional Curriculum 

While literature has explored <strong>the</strong>se factors in 

general education curricula, little has been 

Factors and Functional Curriculum / 295

studied in relation to special education. Although 

special education has a range of 

curricula types (see Bigge, 1988; Sabornie & 

deBettencourt, 1997), this particular study 

chose to focus on functional curricula. 

Functional curriculum has lost favor and 

declined in its use in practice due to recent 

federal policy pushing inclusion, yet it still 

remains an important option for secondary 

students with disabilities (Bigge, Stump, 

Spagna, & Silberman, 1999; Patton, Cronin, 

& Bassett, 1997; Polloway, Patton, Smith, & 

Roderique, 1991). 

Functional curricula represent curriculum 

models created to teach functional life skills, 

or in o<strong>the</strong>r words, <strong>the</strong> skills necessary to live, 

work, and have fun in an inclusive community 

(Brown et al., 1979; Falvey, 1989; Snell & 

Browder, 1987). Functional curricula resulted 

from <strong>the</strong> belief that what was occurring in 

schools failed to reflect <strong>the</strong> skills necessary for 

post-school success (Retish, Hitchings, Horvath, 

Schmalle, 1991). Components of a functional 

or life management curriculum supported 

in <strong>the</strong> literature include <strong>the</strong> functional 

applications of core subject areas (academics), 

vocational education, community access, 

daily living, financial, independent living, 

transportation, social/relationships, and selfdetermination 

(Patton, Cronin, & Jairrels, 

1997). 

In recognition that students with disabilities 

are not well prepared for adult life, <strong>the</strong>re has 

been a growing number of authors calling for 

implementation of a functional curriculum 

(Bouck, 2004; Cronin, 1996; Dever & Knapczyk, 

1997; Patton et al., 2000). Unfortunately 

a functional curricula approach is an underresearched 

area in <strong>the</strong> field of secondary special 

education. This includes its components, 

enactment, and its influence on post-school 

outcomes. Although some researchers and 

practitioners feel that a functional curriculum 

is only appropriate for students with severe 

disabilities (see Clark, 1994), o<strong>the</strong>rs (e.g., Patton 

et al.) have argued that all students with 

disabilities need a functional curriculum, particularly 

at <strong>the</strong> secondary level. Billingsley and 

Alberston (1999) suggested that special education 

students’ quality of life is dependent on 

<strong>the</strong> acquisition of functional skills. 

Research Study 

This research sought to understand <strong>the</strong> factors 

affecting <strong>the</strong> enactment of a functional 

curriculum in two rural secondary self-contained 

cross-categorical programs. This article 

represents one aspect of a larger study of <strong>the</strong> 

enactment of a functional curriculum in <strong>the</strong>se 

two settings. The study sought to answer <strong>the</strong> 

question, what is <strong>the</strong> nature of <strong>the</strong> influence 

of factors on <strong>the</strong> enactment of a functional 

curriculum when factors are hypo<strong>the</strong>sized as 

policy/legislation, community, school, teachers, 

students, and curriculum materials? 

Factors influencing <strong>the</strong> implementation of 

a functional curriculum in secondary special 

education classrooms are important to investigate 

as little current research exists on <strong>the</strong> 

use of a functional curriculum at <strong>the</strong> secondary 

level for students with disabilities educated 

in cross-categorical programs. Yet, a functional 

curriculum represents an essential option 

as it is not only used in practice but also 

desired by practitioners and parents. Research 

has shown that both groups have expressed 

concern that a functional curriculum will be 

replaced by a more academically focused curriculum 

without enough research on a functional 

approach to educating secondary students 

with disabilities (Bouck, 2004; Olson, 

2004; Patton et al., 2000). Finally, knowing 

how well secondary schools prepare students 

with disabilities for <strong>the</strong>ir life and work roles 

should be central to curriculum implementation, 

particularly for secondary students with 

disabilities (Eisenman, 2001; Rabren, Dunn, & 

Chambers, 2002). However before <strong>the</strong> field 

can advocate for implementing a particular 

curriculum, research should be conducted to 

determine what <strong>the</strong> implementation of different 

curricula options look like in <strong>the</strong>se classrooms 

and also what factors affect that implementation. 

This study undertakes this process 

for functional curricula. 

Method 

Participants 


Teachers. One teacher from each of two 

districts participated in <strong>the</strong> project. Both 

teachers started <strong>the</strong>ir respective self-contained 

cross-categorical program and had been

teaching in each program for five years. One 

teacher, Paula, had been a non-traditional 

teacher education student, returning to college 

for her teaching certificate after 25 years 

in <strong>the</strong> business world. The o<strong>the</strong>r teacher, Katie, 

had been a traditional teacher education 

candidate. Katie had focused her preparation 

on secondary special education while Paula 

had prepared herself for elementary special 

education. 

Teachers were selected because <strong>the</strong>y both 

stated <strong>the</strong>y taught a functional curriculum to 

students educated in a cross-categorical selfcontained 

secondary program, <strong>the</strong> study’s target 

population. Both teachers and <strong>the</strong>ir 

schools were also located in <strong>the</strong> same county, 

which was an intentional decision to minimize 

factors related to county services as well as 

geographical variables. Finally, <strong>the</strong> schools 

were selected because <strong>the</strong>y were comparable 

in characteristics and each teacher was <strong>the</strong> 

only teacher in <strong>the</strong> school teaching a selfcontained 

classroom, which differed from <strong>the</strong> 

resource room program at each school. 

Students. Seven of Katie’s 14 students participated 

in <strong>the</strong> study (i.e., observations, interviews, 

and file reviews): one senior, two juniors, 

two sophomores, and two freshmen. 

Three of <strong>the</strong> students were diagnosed as having 

a learning disability, two as having a cognitive 

impairment (mild), one as Autistically 

impaired, and one as o<strong>the</strong>rwise health impaired. 

The average IQ across <strong>the</strong> participating 

students was 77.6. One of Katie’s students 

was female, <strong>the</strong> o<strong>the</strong>r six were male. Paula had 

eight of her nine students participate: one 

senior, three juniors, and four freshmen. Four 

of her students were female and four male. 

The average IQ of Paula’s students was 68.5, 

and her students’ were diagnosed as a learning 

disability (3), having mild mental impairment 

(3), moderate mental impairment (1) 

and emotional impairment (1). All students in 

both classes had utilized special education services 

since early elementary; <strong>the</strong> majority attended 

each district’s pre-primary program 

(PPI, now known as early childhood developmental 

delay program). 

Paraprofessionals. Each school had two 

paraprofessionals that worked with students in 

<strong>the</strong> program, although <strong>the</strong>y were not necessarily 

in <strong>the</strong> room simultaneously. In River 

Bend High School, one paraprofessional 

worked in <strong>the</strong> morning and <strong>the</strong> o<strong>the</strong>r worked 

in <strong>the</strong> afternoon. In <strong>the</strong> second school, Harborville, 

one paraprofessional was assigned to 

<strong>the</strong> program while <strong>the</strong> o<strong>the</strong>r was assigned to 

two students in <strong>the</strong> program with Autism and 

followed <strong>the</strong>m into general education classes. 

Each program also had a transition/job coach 

that served all of <strong>the</strong> students. 

Setting 

Two high schools in <strong>the</strong> state of Michigan 

were utilized for this project. One high school, 

Harborville, had a student count of 622 and 

was located in a rural community. The school 

had a special education rate of 14.1% and 

10.3% of its students were considered economically 

disadvantaged. The school was relatively 

racially and ethnically homogeneous 

(97.1% Caucasian) (Standard & Poor’s, 

2004). Purposeful sampling was used to select 

<strong>the</strong> second school, a rural school within <strong>the</strong> 

same county that also utilized a functional 

curriculum within <strong>the</strong>ir high school self-contained 

cross-categorical program. River Bend 

High School had a student count of 807, 

11.8% special education rate, and 16.9% of its 

population considered economically disadvantaged. 

It was also a relatively racially and 

ethnically homogeneous school district (96% 

Caucasian) (Standard & Poor’s). 

Procedure 

Data were collected through multiple means 

in an effort to triangulate (Stake, 1995). Classroom 

observations were performed and each 

site was observed for an entire school day two 

days a week for three months (see Bogdan & 

Biklen, 2003). A total of 85 hours was spent at 

Harborville and 70 hours spent at River Bend. 

During <strong>the</strong> classroom observations <strong>the</strong> researcher 

took fieldnotes and observed <strong>the</strong> 

events within <strong>the</strong> classroom. Decisions about 

what to observe and when were based on purposeful 

sampling (Patton, 1980), such that 

observations were selected to present <strong>the</strong> most 

likely opportunity to understand and gain insight 

into <strong>the</strong> case. For example, Fridays at 

River Bend were game or movie day. Thus, 

Friday was not selected as a consistent day to 

observe at River Bend High School. The researcher 

also worked with both teachers to 


avoid inservice days, exams, and o<strong>the</strong>r such 

events. In general, <strong>the</strong> researcher observed 

every part of <strong>the</strong> school day for <strong>the</strong> students 

involved when she was present, including 

classroom activities, lunch, community-based 

instruction, and work experiences. 

In addition to classroom observations, document 

reviews were conducted. Students’ 

CA-60 files were analyzed. Data was ga<strong>the</strong>red 

on students’ IQ, achievement test scores 

(reading and ma<strong>the</strong>matics), disability classification, 

years in special education, age, and 

o<strong>the</strong>r pertinent information. Interviews were 

also conducted with <strong>the</strong> teachers, students, 

and paraprofessionals involved in <strong>the</strong> study. 

All were formally interviewed, in addition to 

informal conversations that occurred. Teachers 

were informally interviewed several times 

across <strong>the</strong> data collection period. 

Instruments 

A semi-structured interview protocol was followed 

in <strong>the</strong> teachers’ formal interview (protocol 

available upon request). It focused on 

curriculum choice and understanding how 

curriculum became enacted as well as factors 

influencing <strong>the</strong> curriculum. Students’ formal 

interviews addressed <strong>the</strong> curriculum in <strong>the</strong>ir 

classes and <strong>the</strong>ir ideal curriculum. Students 

were asked to respond to questions regarding 

<strong>the</strong>ir high school experience and what <strong>the</strong>y 

were learning in <strong>the</strong> program (protocol available 

upon request). Paraprofessional formal 

interviews focused on <strong>the</strong> program and <strong>the</strong>ir 

perspectives (protocol available upon request). 

All interviews of participants were audiotaped, 

unless an individual requested that 

s/he not be recorded (1 student out of 15 

requested as such). The interview questionnaires 

were designed by <strong>the</strong> researcher with 

feedback from colleagues and adjusted as 

needed during <strong>the</strong> research project. 

Role of <strong>the</strong> Researcher 

The role of <strong>the</strong> researcher was that of a participant-observer. 

At <strong>the</strong> beginning <strong>the</strong> researcher 

attempted to maintain more of an 

observer role. However, as observations continued 

<strong>the</strong> role shifted to more of a participant. 

At different times <strong>the</strong> researcher had to 

assist with instructional activities and inter- 

vene for behavioral reasons. The more active 

participation was at times sought by <strong>the</strong> 

teacher or students. It was also unsolicited as 

times, such as when student safety or <strong>the</strong> lack 

of instructional assistance to a struggling student 

necessitated involvement. 

Data Analysis 


Data (interviews, field notes, researcher reflection 

notes, and archival review notes) were 

read and re-read, and <strong>the</strong>n parsed along <strong>the</strong> 

research question, specifically noting <strong>the</strong> nature 

of <strong>the</strong> influence of <strong>the</strong> pre-determined 

factors on <strong>the</strong> enactment of functional curriculum: 

policy/ legislation, community, school, 

teachers, students, and curriculum materials. 

Next, data were parsed by patterns that 

emerged. Data that supported or challenged 

<strong>the</strong> factors was color-coded and/or highlighted 

in <strong>the</strong> hard-copy of <strong>the</strong> fieldnotes and 

<strong>the</strong>n cut-and-pasted from <strong>the</strong> electronic version 

of <strong>the</strong> fieldnotes into a working document 

of patterns and emerging <strong>the</strong>mes by 

factor. 

Data analysis began by organizing <strong>the</strong> hard 

copy of <strong>the</strong> fieldnotes, researcher reflective 

notes, and interviews in chronological order 

by school site. The researcher <strong>the</strong>n read each 

site’s hard-copy fieldnotes notebook and 

noted patterns and any potential additions or 

deletions from <strong>the</strong> pre-determined factors. 

This process was repeated several times, both 

condensing and expanding. Key and/or typical 

analytical vignettes were located within <strong>the</strong> 

data to support <strong>the</strong> assertions being made. 

Parsing <strong>the</strong> data by emerging patterns and 

factors occurred for each school site separately 

and <strong>the</strong>n comparisons were made between 

<strong>the</strong> two sites. Overarching patterns were 

noted to cut across both field sites. The patterns 

under each major <strong>the</strong>me were <strong>the</strong>n organized 

with <strong>the</strong> analytical vignettes as well as 

any negative case analysis. While both cases 

had <strong>the</strong> same overarching factors, <strong>the</strong>y differed 

across <strong>the</strong> patterns. 

Triangulation was sought among <strong>the</strong> multiple 

data sources (i.e., observation fieldnotes, 

researcher reflective notes, and interviews). 

Observations formed <strong>the</strong> main source of fieldnotes 

and interviews were used to support or 

challenge what was observed in <strong>the</strong> classrooms. 

Archival or document reviews were

also used to support and challenge <strong>the</strong> data 

from both observations and interviews. 

Results 

Results indicated <strong>the</strong> pre-determined categories 

of policy/legislation, community, school/ 

school district, teachers, students, and curriculum 

materials affected <strong>the</strong> enactment. The 

data also indicated that ano<strong>the</strong>r factor influenced 

enactment, yet was not originally hypo<strong>the</strong>sized 

– paraprofessionals. This factor 

emerged from <strong>the</strong> data as patterns and 

<strong>the</strong>mes were explored. Although <strong>the</strong> enactment 

of a functional curriculum in both secondary 

programs revealed that <strong>the</strong> hypo<strong>the</strong>sized 

factors were influential, <strong>the</strong>y were 

enacted in each program differently and had 

differential impact. 

Factors Influencing <strong>the</strong> Enactment of a 

Functional Curriculum 

Policy/legislation factor. Policy and legislation 

were found to affect <strong>the</strong> curriculum enactment 

in both programs. One of <strong>the</strong> most 

poignant illustrations involved student assessments. 

In Michigan students take <strong>the</strong> Michigan 

Education Assessment Program (MEAP), 

<strong>the</strong> state’s general large scale assessment. Students 

in both programs qualified for one of 

Michigan’s alternate assessments, and took 

<strong>the</strong> one created for students with mild mental 

impairment or who functioned as such. This is 

in opposition to most o<strong>the</strong>r states in which 

alternate assessments have only been created 

for students with more severe impairments 

(see Alper & Mills, 2001; Kleinert & Thurlow, 

2001). 

Both teachers commented that <strong>the</strong>ir program 

planning needed to consider students’ 

participation in state assessments. Katie discussed 

reconsidering her functional ma<strong>the</strong>matics 

class because fractions and graphs appeared 

on <strong>the</strong> alternate assessment but were 

absent from her math curriculum. Katie stated 

that <strong>the</strong> alternate assessment was “a lot more 

in-depth than <strong>the</strong> functional stuff I teach” 

(Interview, January 27, 2005). Katie felt some 

frustration towards <strong>the</strong> policymakers and <strong>the</strong> 

state department of education as she perceived 

<strong>the</strong>m to devalue <strong>the</strong> functional nature 

of classrooms such as hers. She referenced her 

work with <strong>the</strong> state committee on creating this 

particular alternate assessment, saying “we 

tried to state <strong>the</strong> importance of what we do in 

<strong>the</strong> classroom at <strong>the</strong> meetings” (Interview, January 

27, 2005). Paula also stressed <strong>the</strong> importance 

of state assessments, stating, “Oh yes . . . 

it is one of those things driving what I do” 

(Interview, March 15, 2005). 

Yet, <strong>the</strong> teachers implemented <strong>the</strong>ir version 

of a functional curriculum without regard to 

policy or legislation, suggesting that perhaps 

<strong>the</strong> value of this factor was given more “lipservice” 

than <strong>the</strong> role it really played. For example, 

when both teachers were questioned 

about <strong>the</strong> alternate state standards <strong>the</strong> alternate 

assessments were designed to align with 

both admitted that <strong>the</strong>y had not used <strong>the</strong>m to 

guide <strong>the</strong>ir planning. In response to <strong>the</strong> question 

regarding alternate state standards, Paula 

stated that she did “not have time yet to align 

those with my curriculum” (Observation, January 

24, 2005) and Katie did not even possess 

a copy. 

Community factor. The community that 

both schools resided in provided influence 

over <strong>the</strong> enactment of a functional curriculum. 

One of <strong>the</strong> biggest influences was <strong>the</strong> 

location of <strong>the</strong> community (i.e., rural), and 

<strong>the</strong> school. The ruralness made transportation 

difficult and finding jobs for work experience 

more challenging. The lack of public transportation 

primarily limited students’ workbased 

experiences to in-school options. The 

teachers repeatedly commented on <strong>the</strong>ir frustration 

with <strong>the</strong> transportation and its role in 

<strong>the</strong>ir educational programming, stating “The 

hardest part is transportation ...Itishard to 

get students to places for work . . . to walk 

takes a good chunk of time” (Interview, February 

12, 2005) as well as “I think something 

that could make <strong>the</strong> class better is a large van 

or dial-a-ride. Transportation. . . Getting out 

into <strong>the</strong> community is one of <strong>the</strong> weakest areas 

of my program” (Interview, June 12, 

2005). 

At <strong>the</strong> same time, community-based instruction 

opportunities illustrated <strong>the</strong> tolerance 

and acceptance of <strong>the</strong> programs and students 

within <strong>the</strong> community. Katie’s program was 

involved in multiple community-based instruction 

(CBI) experiences including doing inventory 

at <strong>the</strong> local hardware store, cleaning at an 

assistive living home, and painting buildings 


for <strong>the</strong> city parks and recreation department. 

Marilyn, <strong>the</strong> school job coach, organized <strong>the</strong> 

CBI opportunities for <strong>the</strong> students. She discussed 

using a barter system to arrange <strong>the</strong>se 

experiences, stating that knowing her personally 

and using <strong>the</strong> facilities was helpful in getting 

businesses to agree to CBI opportunities 

for <strong>the</strong> students. Community businesses appeared 

to feel a connection to program personnel 

and thus were more willing to provide 

<strong>the</strong> students work-based experiences. 

School and school district factor. One of <strong>the</strong> 

major school factors impacting <strong>the</strong> enactment 

of a functional curriculum involved <strong>the</strong> school 

and its location within <strong>the</strong> community. Both 

schools were situated in a part of <strong>the</strong>ir rural 

communities that was away from <strong>the</strong> business 

district, making walking to work-based opportunities 

for students not possible. The location 

of <strong>the</strong> school also made it difficult to drive 

students to a work-based experience. Thus, 

most work-based experiences for <strong>the</strong> majority 

of students occurred within <strong>the</strong> physical confines 

of <strong>the</strong> school, such as working in <strong>the</strong> 

school store or being an apprentice to a custodian. 

Transportation was a large challenge, 

which Paula iterated in her statement “can’t 

get to downtown, get a good instructional 

work experience, and get back . . . in <strong>the</strong> middle 

of <strong>the</strong> day” (Interview, March 29, 2006). 

Besides <strong>the</strong> school’s location, <strong>the</strong> physical 

location of each classroom was an issue. It 

affected students’ social behavior, particularly 

between classes. Katie’s classroom was located 

in <strong>the</strong> last hallway of <strong>the</strong> school, surrounded 

by o<strong>the</strong>r special education classrooms, which 

was significant since <strong>the</strong>se rooms housed most 

of <strong>the</strong> o<strong>the</strong>r peers that <strong>the</strong> students in Katie’s 

program socialized with outside <strong>the</strong> self-contained 

program. In contrast, Paula’s program 

was surrounded by core content classrooms. 

The influence of <strong>the</strong> physical location of <strong>the</strong> 

classroom was evident in Paula’s program 

when <strong>the</strong> bell rang and she asked students to 

walk around <strong>the</strong> hallways. Her students preferred 

to stay within <strong>the</strong> classroom during 

break between classes. Paula had to instruct 

<strong>the</strong>m every few classes to walk in <strong>the</strong> hallways, 

which was a signal to walk around, look peers 

in <strong>the</strong> eyes, and say hello. The resistance of 

Paula’s students stood in contrast to Katie’s 

students who practically bolted out <strong>the</strong> door 

when <strong>the</strong> bell rang and frequently stood 


around <strong>the</strong> door waiting for it to ring at <strong>the</strong> 

end of class. 

The actual features of <strong>the</strong> classroom were 

also influential on <strong>the</strong> enactment of a functional 

curriculum. When Harborville High 

School expanded, Katie’s program was moved 

from a small room to one specifically designed 

for her program. The most important aspect 

of <strong>the</strong> room was <strong>the</strong> kitchen, which was 

equipped with a refrigerator, a stove, and a 

sink. Katie also purchased o<strong>the</strong>r important 

kitchen necessities, such as dishes, a Kitchenaide, 

a griddle, and microwave. Having a 

kitchen enabled Katie and her students to 

enact daily living skills, such as cooking, within 

<strong>the</strong> confines of <strong>the</strong> classroom. At least once a 

week, <strong>the</strong> students cooked during <strong>the</strong>ir life 

skills class as well as o<strong>the</strong>r times for special 

occasions, such as a student or staff member’s 

birthday. 

In contrast, Paula’s classroom was actually 

two small offices combined to make a room. 

Paula’s classroom did not have kitchen or 

laundry facilities, over which she lamented. 

Paula discussed that she “would love to have 

<strong>the</strong> physical room that home ec does,” and 

emphasized its laundry and kitchen spaces 

(Interview, March 15, 2005). Paula noted that 

she could use <strong>the</strong> facilities of <strong>the</strong> home economics 

room, but she had not done so because 

she felt that <strong>the</strong> room belonged to <strong>the</strong> 

home economics teacher saying, “It was her 

domain.” The importance Paula placed on 

<strong>the</strong>se resources was evident when she discussed 

her ideal curriculum for her program, 

I would have to have a lot of equipment. 

The setting would take place in a mixture of 

reading center with couches and proper 

lighting, technology center where each student 

has access to user-friendly computers, 

and living center like a home economic 

room. Just like home would be and a shop, 

where we would be using hammers, nails, 

and wood. All in one place, we would have 

sewing machines, craft centers. That would 

be <strong>the</strong> setting and I could take it from <strong>the</strong>re. 

Access to <strong>the</strong> community as well, with good 

transportation. And a job liaison to help 

me. I would teach what <strong>the</strong>y need to know 

here. And I would say onsite learning lab, 

like school store (Interview, March 14, 

2005).

Despite Paula’s description of an ideal curriculum, 

her students received little-to-no activities 

in daily living at school. Her life management 

class involved students reading a 

textbook, answering questions, and discussing 

topics, ra<strong>the</strong>r than <strong>the</strong> hands-on activities she 

talked about in interviews. 

Data also revealed an association between 

each school’s philosophy and <strong>the</strong> enactment 

of a functional curriculum. Yet, it was not <strong>the</strong> 

schools’ explicit philosophies “to make lifelong 

learners out of <strong>the</strong>se kids and have <strong>the</strong>m 

participating in <strong>the</strong> community” (Interview, 

March 15, 2005) and “safety and <strong>the</strong> importance 

to learn something new each day and to 

strive to better yourself everyday” (Interview, 

June 14, 2005) that were as relevant as <strong>the</strong> 

schools’ implicit philosophies. 

At Paula’s school, <strong>the</strong> office often asked her 

students to do things that were not asked of 

o<strong>the</strong>r students. One day <strong>the</strong> office called and 

asked Paula if her students could stuff and 

address envelopes <strong>the</strong> next day. Paula agreed 

to <strong>the</strong> request, but expressed distress in her 

comment, “so much for my lesson plans tomorrow” 

(Fieldnotes, January 28, 2005). In 

ano<strong>the</strong>r instance, <strong>the</strong> principal stopped by 

Paula’s classroom and asked if her students 

would clean <strong>the</strong> outside of <strong>the</strong> school that day. 

Even though Paula felt that <strong>the</strong>re was some 

educational value to this activity in terms of 

work experience, as she designed it so students 

had a supervisor and were rewarded for 

hard work, she still felt trapped into doing this 

activity when asked by <strong>the</strong> principal, saying, 

“how could I say no to <strong>the</strong> principal, my boss?” 

(Fieldnotes, March 28, 2005). Paula’s interpretation 

of this situation was evident when a 

student questioned <strong>the</strong> request and she clarified 

why her students take time out of <strong>the</strong>ir 

school day to clean <strong>the</strong> school. 

Why we do it is that we have pride in our 

school. Second reason is that it helps our 

school look nice and helps our custodians. 

And in this class, like Mrs. Murphy’s class 

[middle school cross-categorical program 

teacher] we have more freedom. When <strong>the</strong> 

principal asks us to do something, he looks 

for someone in <strong>the</strong> school who can get <strong>the</strong> 

job done (Fieldnotes, March 28, 2005). 

Paula continued to explain to her students 

why <strong>the</strong>y picked up trash outside <strong>the</strong> school. 

We stop what we are doing and go do that. 

You might think golly <strong>the</strong> o<strong>the</strong>r kids don’t 

do this. But it gets hot in <strong>the</strong> school and 

<strong>the</strong>y are sitting <strong>the</strong>re doing <strong>the</strong>ir homework. 

And if you find money, you get to 

keep it (Fieldnotes, March 28, 2005). 

Although office personnel did not ask Katie’s 

students to engage in work around <strong>the</strong> 

school, o<strong>the</strong>r school personnel interrupted 

Katie’s program and had students participate 

in non-classroom work. Marilyn, <strong>the</strong> school 

job coach, asked Katie’s students to stuff registration 

bags for a community 5K. Marilyn 

requested and Katie agreed that her students 

would take time from classroom activities to 

stuff <strong>the</strong> bags with running information and 

free objects. Katie set aside time in two of her 

classes and indicated that if <strong>the</strong>re was still a lot 

to do her students could start first hour and 

continue throughout <strong>the</strong> class periods until 

<strong>the</strong>y were completed. 

Teacher factor. Although it seems intuitive 

that teachers affected <strong>the</strong> enactment of a functional 

curriculum, it is <strong>the</strong> intricacies of <strong>the</strong> 

teacher factor that are worth discussing. 

Teachers were influential in terms of <strong>the</strong>ir 

histories, preparation, beliefs and philosophies, 

and expectations for students. Both 

teachers had created <strong>the</strong>ir programs. Paula 

started at River Bend five years ago, <strong>the</strong> year 

<strong>the</strong> program was started at <strong>the</strong> high school. 

She was given relative freedom over <strong>the</strong> curriculum 

to choose <strong>the</strong> classes that were included 

in her program and <strong>the</strong> content that 

would go into those classes. Katie assumed <strong>the</strong> 

role of <strong>the</strong> cross-categorical program teacher 

at Harborville <strong>the</strong> year after <strong>the</strong> program was 

started. However, <strong>the</strong> first teacher had done 

little to establish <strong>the</strong> program and Katie was 

able to choose <strong>the</strong> curriculum. Yet, she had 

restrictions on her curriculum in that it was 

suppose to align with <strong>the</strong> state’s general education 

benchmarks and guidelines. 

Teachers’ pre-service preparation was influential. 

Both teachers attended <strong>the</strong> same midsized 

teacher preparation university about 

four years apart, yet, <strong>the</strong>y had different 

teacher preparation experiences. Katie focused 

her preparation on secondary education, 

with a plan to teach at <strong>the</strong> high school 

level. Her field experiences occurred in high 

school programs, both resource and categori- 


cal. She also took a long term subbing position 

at a nearby high school in a categorical 

program before she started teaching at Harborville. 

Paula, who returned to get her bachelor’s 

degree in education following 25 years 

in <strong>the</strong> business world, planned on working in 

an elementary resource room program and 

her pre-service teacher preparation reflected 

this goal. Yet, she ended up working in a high 

school resource room for her first job. Although 

Paula referred to her high schoolers 

as, “not scary . . . same needs, just taller,” she 

seemed to sometimes struggle with <strong>the</strong> fact 

that her students were in high school with 

adolescent issues, needs, and desires (Interview, 

March 15, 2005). Paula’s elementary 

background filtered into <strong>the</strong> classroom. She 

had a tendency to enact more traditional “elementary 

activities” and treat her students in a 

younger fashion. For example, on Valentine’s 

Day she brought in a Valentine’s Day cake, 

Valentine’s Day pencils, and had her students 

engage in Valentine’s Day activities, including 

estimating <strong>the</strong> number of candy hearts in a jar 

and a Valentine’s Day word search. Paula indicated 

that she had not used <strong>the</strong>se activities 

since her elementary field placement. Her students 

acknowledged her predisposition towards 

elementary as well, remarking to her 

and <strong>the</strong> researcher on numerous occasions 

“we aren’t in kindergarten” or o<strong>the</strong>r similar 

statements. 

Teachers’ beliefs and philosophies, both explicit 

and implicit, were influential. Katie articulated 

her philosophy as giving “students an 

opportunity to find something <strong>the</strong>y can relate 

to and to teach <strong>the</strong>m <strong>the</strong> basics of respect. 

Having respect for o<strong>the</strong>rs is probably one of 

<strong>the</strong> most important things for me” (Interview, 

June 14, 2005). However, Katie’s implicit philosophy 

involved a strong devotion to preparing 

students to be employable and to have 

success post-school in terms of employment 

and independent living. For example, Katie 

indicated that cooking was one of <strong>the</strong> most 

important curricular components for students, 

along with budgeting and basic reading 

for job applications, descriptions, and directions. 

Katie expected most of her students to seek 

employment after <strong>the</strong>y graduated and that became 

a focus of <strong>the</strong> program. She discussed 

getting students out into <strong>the</strong> community, al- 


lowing <strong>the</strong>m to see job opportunities, and 

helping <strong>the</strong>m figure out what <strong>the</strong>y might like 

to do. She expected that <strong>the</strong> vast majority of 

her students could hold down jobs, stating 

“. . . maybe a little different, but all can work at 

something.” Katie believed her students could 

be successful in life, yet she knew her students 

would always carry a label with <strong>the</strong>m, commenting 

“stereotypes will always be <strong>the</strong>re. 

These kids will always be that special education 

kid” (Interview, June 14, 2005). 

Paula stated that her philosophy was simple, 

“to help students reach <strong>the</strong>ir goals and make 

decisions” (Interview, March 15, 2005). Yet, 

she exhibited low expectations of some of her 

students. Paula stated that her students were, 

“really low functioning” and implied that 

some would not live independently. Similarly, 

she indicated that she felt all her students 

would qualify for one of two after-high school 

programs organized for <strong>the</strong> local districts 

through <strong>the</strong> county intermediate school system. 

These programs were designed for students 

with moderate and severe disabilities 

who were in need of additional life skills for a 

greater chance of success post-school. Paula 

also expressed doubts about her students’ performance 

on <strong>the</strong> alternate assessment designed 

for students with mild mental impairment, 

fearing it would be too difficult for her 

students; yet <strong>the</strong> majority of <strong>the</strong>m were students 

with learning disabilities or mild mental 

impairment. 

Paraprofessional factors. Although not originally 

hypo<strong>the</strong>sized as being a factor, paraprofessionals 

were found to influence <strong>the</strong> enactment 

of a functional curriculum. At times <strong>the</strong> 

paraprofessionals acted as teachers and created 

activities, and at o<strong>the</strong>r times <strong>the</strong>ir roles 

were more of an “aide,” where <strong>the</strong>y performed 

duties such as making photocopies. The confusion 

over <strong>the</strong> role was evident in <strong>the</strong> discourse. 

One day Paula told one of her paraprofessionals, 

“You are a teacher. You are 

ano<strong>the</strong>r teacher . . . you are one of us” (Fieldnotes, 

February 15, 2005). Yet <strong>the</strong> paraprofessionals 

did not always see it that way. One 

commented that she lacked power in <strong>the</strong> classroom, 

stating, “I am just a parapro” (Fieldnotes, 

February 25, 2005). She indicated that 

she lacked power because she was not making 

decisions and she did not agree with decisions 

made.

The paraprofessionals at Harborville, Whitney 

and Brenda, positively affected <strong>the</strong> enactment 

of curriculum in Harborville as <strong>the</strong>y assisted 

in <strong>the</strong> construction of curriculum within 

<strong>the</strong> program. This occurred when Katie was 

present and when she was absent, as evident in 

<strong>the</strong> following vignette. 

It is third hour. Katie is not in <strong>the</strong> class. She 

is at an IEP, which started during 1 st hour. 

The students have entered <strong>the</strong> classroom 

and <strong>the</strong> bell has rung. The students are 

sitting and standing around talking. Brenda 

and Whitney are standing around as well. 

Katie has not left anything for lesson plans 

for third hour as she thought she would be 

back from <strong>the</strong> IEP. Whitney speaks up. She 

tells <strong>the</strong> students to get a newspaper, pick 

an article, read it, write at least four sentences 

on it, and be prepared to read what 

<strong>the</strong>y wrote in front of <strong>the</strong> class. The students 

grab a newspaper and start to work (Fieldnotes, 

February 14, 2005). 

Whitney constructed <strong>the</strong> curriculum when Katie 

was absent and no curriculum was prearranged. 

When Katie returned to <strong>the</strong> class, 

she saw <strong>the</strong> directions and told <strong>the</strong> students 

<strong>the</strong>y needed to be prepared to share <strong>the</strong>ir 

article with <strong>the</strong> class; thus, supporting <strong>the</strong> curriculum 

enacted by Whitney. 

However, at o<strong>the</strong>r times, <strong>the</strong> paraprofessionals 

gave students misleading, incorrect, or 

biased information when constructing or assisting 

in <strong>the</strong> construction of <strong>the</strong> curriculum, 

such as telling students <strong>the</strong> Geneva Convention 

did not apply to Iraqi insurgents, ano<strong>the</strong>r 

time stating that people in India and China 

ate food made from blood, and often shutting 

down student comments that differed from 

<strong>the</strong>ir own beliefs. 

The paraprofessionals in Paula’s program 

were assigned to be with students in general 

education classes and/or to help students in 

Paula’s room. Paula described <strong>the</strong>ir role as, 

“to be <strong>the</strong> students’ aide in general education 

classes, but when in my room, it is to help <strong>the</strong> 

students in here” (Interview, March 15, 2005). 

At times, <strong>the</strong>y were also responsible for leading 

instruction. This allowed Paula to do o<strong>the</strong>r 

things, such as grade or talk with an individual 

student. For example, Laura frequently led 

instruction in Paula’s history class. Paula 

would typically tell Laura what she wanted and 

Laura would enact <strong>the</strong> curriculum, while 

Paula graded student work. 

Student factor. The impact of <strong>the</strong> students 

on <strong>the</strong> enactment of <strong>the</strong> curriculum was commented 

on by <strong>the</strong> teachers. Paula stated, “Everything 

I do [in my program] is driven by 

<strong>the</strong>m [<strong>the</strong> students]” (Interview, February 22, 

2005). Students’ personal and school histories 

influenced curriculum enactment and were 

largely tied to being in special education. Students 

may have been in general education 

classes in elementary school, but <strong>the</strong>y were 

placed in pull-out programs by middle school; 

and <strong>the</strong>se experiences in middle school impacted 

what took place in high school. Katie, 

her students, and o<strong>the</strong>r school personnel 

shared that students were asked to do little in 

<strong>the</strong> self-contained middle school program in 

<strong>the</strong> Harborville District. Thus, when <strong>the</strong> students 

came to high school <strong>the</strong>y had little motivation, 

which she saw as one of <strong>the</strong> largest 

impediments to <strong>the</strong> positive enactment of a 

functional curriculum. For example, Adam 

stated that “high school is better than middle 

school, <strong>the</strong>re are more opportunities” (Interview, 

February 4, 2005). Sara echoed similar 

sentiments, saying that middle school did not 

help her as all <strong>the</strong>y did was play games and she 

was not happy nor did she learn anything. 

Brenda, a paraprofessional, supported <strong>the</strong> students’ 

beliefs regarding <strong>the</strong> middle school 

program and its impact on <strong>the</strong> high school 

program, stating, “Forget that <strong>the</strong>y are ruining 

<strong>the</strong>se kids during <strong>the</strong> middle school year. The 

kids hate school over <strong>the</strong>re because <strong>the</strong>y don’t 

do anything” (Interview, February 24, 2005). 

Paula also expressed frustration over her 

students’ middle school experiences and <strong>the</strong> 

impact of <strong>the</strong> program on her own cross-categorical 

program. Her frustration existed with 

<strong>the</strong> teacher. Paula explained that once she 

selected curriculum materials (i.e., textbooks), 

<strong>the</strong> middle school teacher selected 

<strong>the</strong> same textbooks. She felt that this negatively 

affected her curriculum and program as 

students would be forced to possibly learn <strong>the</strong> 

same material twice. 

Students’ personal histories were also important. 

Many students came from single parent 

homes, lived with o<strong>the</strong>r family members 

or in foster care. Katie discussed how some of 

her students could be successful if <strong>the</strong>y were 


able to break away from <strong>the</strong>ir families, that 

some of her students were <strong>the</strong> glue that held 

<strong>the</strong>ir families toge<strong>the</strong>r and that <strong>the</strong>y might 

forever need to come home and “bail <strong>the</strong>m 

out.” Yet, o<strong>the</strong>r students were held back from 

independence out of <strong>the</strong>ir parents’ fear that 

<strong>the</strong>y might <strong>the</strong>n leave <strong>the</strong>m. Katie implied 

that she incorporated independent skills into 

her curriculum through her use of budgeting 

and daily living skills. Katie felt that her students 

would benefit greatly from having a 

school social worker in <strong>the</strong> classroom on a 

daily basis. She expressed that her students 

had a lot of family issues that needed resolving 

and <strong>the</strong> assistance a school social worker 

could provide an important part of curriculum 

enactment. 

Students’ certification or level of functioning 

was also influential. Both teachers spoke 

of <strong>the</strong>ir students’ functioning levels with regards 

to academic abilities and skills. Paula 

indicated that her current students were at 

higher levels than her past students, that her 

previous students had lower reading abilities 

and were generally lower in cognitive ability. 

As a result of her perception that this group of 

students had “higher abilities,” Paula contemplated 

adding some different (and new) 

things to her program. Katie commented on 

<strong>the</strong> opposite, as she felt her current students 

were at a lower ability level that her previous 

groups, and that <strong>the</strong>ir behavior was worse. 

Katie stated that, “when you have more behavior 

problems and self-esteem issues, it impacts 

it [curriculum enactment]. It absorbs more of 

your time.” Katie also mentioned that her current 

group of students had less interest in 

cooking, so <strong>the</strong>y did not do it as much because 

<strong>the</strong> students complained and generally 

seemed not to get much out of <strong>the</strong> experience. 

Curriculum materials factor. Nei<strong>the</strong>r program 

employed a commercially-available a 

functional curriculum model, but instead <strong>the</strong> 

teachers created <strong>the</strong>irs through a piece-meal 

approach. The motto was to use whatever was 

available and “be flexible.” As a result of Katie’s 

and Paula’s “piece-mealing,” <strong>the</strong>ir functional 

curriculum consisted of purchased materials, 

borrowed materials, created materials 

and photocopied materials. Many of Katie’s 

materials were photocopies of workbooks, 

novels, and o<strong>the</strong>r materials. She explained 


that photocopies were used because she did 

not have resources to secure curriculum materials. 

The program was given $800 when it 

was started and it had not received any additional 

funding. To purchase any additional 

materials, such as kitchen equipment, novels, 

and workbooks, Katie used money made from 

<strong>the</strong> school store that her class ran. 

Paula explained that <strong>the</strong> curriculum materials 

in her program were “piece-mealed” because 

of a lack of appropriate materials available 

for her cross-categorical program. Paula 

expressed frustration because <strong>the</strong> reading 

level of materials was often above those of her 

students, stating “most stuff is designed for 

students with learning disabilities. Their reading 

levels [her students] are low, as low as 2.3, 

but generally between 3 and 4” (Fieldnotes, 

January 28, 2005). She indicated that <strong>the</strong> special 

education director at her district encouraged 

<strong>the</strong> use of research-based materials, 

which she could not find any for <strong>the</strong> population 

she taught. The lack of an appropriate 

functional curriculum was supported by <strong>the</strong> 

researcher’s review of functional curricula 

models. Despite that many exist, few were designed 

for this population – students with mild 

mental impairment and learning disabilities. 

Most models were designed for students with 

moderate or severe mental impairment, such 

as The Syracuse community-referenced guide and 

Impact: A functional curriculum handbook (Ford 

et al. 1989; Neel & Billingsley, 1989). Ones 

that focused on students with high incidence 

disabilities were designed as workbooks that 

students filled out ra<strong>the</strong>r than providing application 

of functional curricula components, 

such as Life skills activities for secondary students 

with special needs (Mannix, 1995). 

When Katie started teaching in <strong>the</strong> program, 

she found <strong>the</strong> Life Centered Career Education 

(Brolin, 1997) as <strong>the</strong> only formal model 

available. She referred to <strong>the</strong> curriculum that 

she developed and enacted in terms of “taking 

different things and piecing <strong>the</strong>m toge<strong>the</strong>r” 

(Interview, January 27, 2005). Katie talked 

about <strong>the</strong> varying abilities of students in her 

room and that a range of curricular materials 

would be helpful because students come in at 

different levels and have different interests. 

The lack of a “formal” curriculum model in 

Katie’s program was noted by <strong>the</strong> paraprofessional 

Brenda, “I don’t understand what <strong>the</strong>

Figure 2. Resultant intersection of factors impacting 

<strong>the</strong> enactment of a functional curriculum. 

curriculum is up here” (Interview, February 

24, 2005). Brenda stated that in her previous 

aid positions (at <strong>the</strong> elementary level), <strong>the</strong> 

curriculum was sequential and progressive, 

and <strong>the</strong>refore “everyone knew what was expected 

and what to expect” (Interview, February 

24, 2005). She contrasted this to Katie’s 

program, saying that she had “never seen anything” 

and that she does “not know where to 

go” in terms of helping <strong>the</strong> students and moving 

<strong>the</strong>m forward. 

Discussion 

The nature of <strong>the</strong> impact of factors on <strong>the</strong> 

enactment of a functional curriculum in <strong>the</strong>se 

two cross-categorical self-contained secondary 

special education programs could be discussed 

as a conjuncted process. It was <strong>the</strong> 

intersection and union of <strong>the</strong> seven factors 

that created <strong>the</strong> enacted curriculum, illustrated 

graphically in Figure 2. It was not one 

factor, or even all factors working singularly, 

but <strong>the</strong> union and intersection of <strong>the</strong> different 

factors that enacted <strong>the</strong> functional curriculum 

in both programs, for better or worse. Both 

Katie and Paula would likely have enacted 

different versions of a functional curriculum if 

factors had been different. 

This study raises concerns about use of 

functional curricula in light of current federal 

policy and legislation. The teachers involved 

in this study referenced <strong>the</strong> increasing role of 

policy and legislation with respect to <strong>the</strong>ir 

functional curriculum enactment, particularly 

citing <strong>the</strong> pressure towards academics and increased 

rigor. Yet <strong>the</strong>se teachers were in a 

unique position in that Michigan is one of <strong>the</strong> 

few states that has more than one alternate 

assessment, and one created specifically for 

students with mild mental impairment or 

those who functional as such (i.e., students 

educated in self-contained cross-categorical 

programs). The state test supposedly focused 

on functional independence; yet, <strong>the</strong>se two 

teachers were still concerned and commended 

how <strong>the</strong>y felt <strong>the</strong> alternate assessments 

did not truly value <strong>the</strong> functional curriculum 

<strong>the</strong>ir students were receiving. 

The question of using a functional curriculum 

may be a bigger issue in o<strong>the</strong>r states. If 

states do not have alternate assessments designed 

for this population than most likely <strong>the</strong> 

students would be tested using <strong>the</strong> general 

large scale state assessment. For students in 

<strong>the</strong>se programs, whose average grade level 

equivalency in reading was 3.3 and in math 

was 3.6, it would mean taking an assessment at 

least six years developmentally ahead of <strong>the</strong>ir 

learning. Unfortunately, although a functional 

curriculum holds much potential for 

educating secondary students with disabilities 

and preparing <strong>the</strong>m for post-school success, it 

is not designed to close a learning gap this 

large and thus is not likely to be supported as 

a curriculum option in today’s push towards 

passing state tests. Teachers and schools are 

being forced to decide if <strong>the</strong>y will educate 

<strong>the</strong>ir students with a functional curriculum to 

prepare <strong>the</strong>m for daily living, work, and independent 

living after school or if <strong>the</strong>y will prepare 

<strong>the</strong>m to hopefully, somehow, pass a general 

large-scale state assessment. 

Regardless if states have one test for all 

students or alternate assessment for special 

needs students, all special education teachers 

will be faced with <strong>the</strong> challenge of teaching to 

<strong>the</strong> test. Teaching to <strong>the</strong> test has been cited as 

negatively affecting students’ education. Peha 

(2005) stated that teaching to <strong>the</strong> test resulted 

in less teaching to students and less real learning. 

If teachers like Katie and Paula feel pressure 

to have <strong>the</strong>ir students pass <strong>the</strong> alternate 

assessment, or <strong>the</strong> general large-scale state as- 


sessment, and alter <strong>the</strong>ir curriculum to focus 

more on teaching to <strong>the</strong> test, one has to question 

what will be cut from <strong>the</strong> curriculum. 

Perhaps <strong>the</strong> curriculum will have less focus on 

functional skills, such as daily living and social 

skills as, for example, Michigan’s alternate assessment 

focuses on ma<strong>the</strong>matics, literacy, 

and vocational skills. What about <strong>the</strong> au<strong>the</strong>ntic 

activities within and outside of school that 

have benefited <strong>the</strong>se students? Unless high 

stake assessments are expansive enough to 

capture many of <strong>the</strong> performative experiences 

students should engage in, <strong>the</strong>re is a risk that 

<strong>the</strong>se could be dropped from <strong>the</strong> curriculum, 

fur<strong>the</strong>r narrowing what counts as valued 

learning and a narrowed focus on curriculum 

that disperses information which can be measured 

on paper and pencil tests, and usually 

multiple choice tests at that. 

The seven factors identified in this study as 

influencing curricula enactment may be more 

pronounced in special education than general 

education, as general education teachers typically 

use a formal, commercially-available curriculum, 

published by <strong>the</strong> likes of Prentice 

Hall, Glencoe/McGraw-Hill, and Houghlin- 

Mifflin. Special education is more acurricular, 

particularly so for <strong>the</strong> population of students 

with high incidence disabilities educated in a 

self-contained cross-categorical program, environments 

where debates occur over what curriculum 

is most appropriate. 

The lack of a formal commercially-available 

curriculum model may be <strong>the</strong> very reason that 

<strong>the</strong> identified factors were so pronounced in 

<strong>the</strong> enactment of a functional curriculum for 

<strong>the</strong> students in this study. The few models that 

exist for students with high incidence disabilities 

are designed like worksheets and offer 

little application. Hence, teachers are left to 

piece-meal and construct <strong>the</strong>ir functional curriculum 

from a variety of sources, which are 

dependent on <strong>the</strong>ir community and school 

resources as well as <strong>the</strong>ir own pedagogical 

approach. 

The influence of <strong>the</strong> factors on <strong>the</strong> enactment 

was evident through <strong>the</strong> impact that 

school and community resources played. For 

example, a component of a functional curriculum 

can be learning to use multiple forms of 

transportation, yet public transportation is often 

nonexistent in rural settings, such as <strong>the</strong> 

two schools in this research. Similarly, a func- 


tional curriculum typically involves a community 

access and/or skills component, which 

can be achieved through community-based instruction. 

However, utilization of communitybased 

instruction (CBI) opportunities requires 

businesses or agencies in which to 

conduct <strong>the</strong> CBI, as well as transportation to 

and from <strong>the</strong> site. A rural setting with few 

transportation options and few businesses fur<strong>the</strong>r 

exasperates <strong>the</strong> situation, leading to experiences 

being restricted to <strong>the</strong> school. This 

is what happened in Katie’s and Paula’s program, 

where much of <strong>the</strong> students’ work experience 

was gained in-school through working 

at <strong>the</strong> school store or cleaning <strong>the</strong> school. 

Along similar lines, both teachers’ educational 

programming was influenced by <strong>the</strong> 

resources available in <strong>the</strong> schools, particularly 

resources that supported <strong>the</strong> teaching of functional 

curricula components. The resources 

(or lack of) within a school, such as materials 

and equipment necessary for engaging in 

daily living skills and/or vocational education, 

raises questions about <strong>the</strong> ability to adequately 

provide this curriculum. How can teachers tell 

parents, students, and o<strong>the</strong>r educators <strong>the</strong>y 

are providing a functional curriculum if <strong>the</strong>y 

lack in-school (i.e., a kitchen) and out-ofschool 

(i.e., work experiences, CBI) resources 

to satisfactorily deliver <strong>the</strong> curriculum? Just as 

teachers and parents expect, and demand, <strong>the</strong> 

appropriate resources be made available for 

students to learn ma<strong>the</strong>matics, economics, 

and physics, so should <strong>the</strong> necessary resources 

be available to enact a functional curriculum. 

This consideration, along with o<strong>the</strong>r data 

from <strong>the</strong> study, suggests that a functional curriculum 

is viewed as an inferior approach. 

The education and/or curriculum occurring 

in <strong>the</strong>se programs were not being valued. 

In fact <strong>the</strong> education <strong>the</strong>se students received 

was devalued, as school personnel placed tasks 

such as cleaning and stuffing envelopes or 

bags before <strong>the</strong> intended curriculum. Students 

who are educated in self-contained 

cross-categorical programs have just as much 

right to learn, and to learn what is appropriate 

and what will benefit <strong>the</strong>m in terms of postschool 

outcomes. Although <strong>the</strong> activities 

school personnel asked <strong>the</strong> students to do 

(i.e., stuffing envelopes, cleaning <strong>the</strong> school, 

stuffing bags) might have had some connection 

to vocational experiences and o<strong>the</strong>r

learning opportunities relevant to a functional 

curriculum, <strong>the</strong>y were not designed in 

this capacity. Instead <strong>the</strong>se activities were used 

to assist staff or serve as time-fillers. Ra<strong>the</strong>r 

than demonstrating <strong>the</strong> many functional curriculum 

learning opportunities that could occur 

naturally within a school, <strong>the</strong> data suggested 

that <strong>the</strong>se students, <strong>the</strong>ir educational 

programming, and <strong>the</strong>ir learning were valued 

less than o<strong>the</strong>rs. 

The lack of formal curriculum materials fur<strong>the</strong>r 

suggests that perhaps a comprehensive, 

flexible, balanced functional curriculum heuristic 

needs to be developed for <strong>the</strong> population 

within <strong>the</strong>se programs. The words of a 

paraprofessionals working in one of <strong>the</strong>se programs 

summarized it best when it came to <strong>the</strong> 

enacted curriculum, “I don’t understand what 

<strong>the</strong> curriculum is . . .”. A proposed balanced, 

yet flexible, functional curriculum heuristic 

would include utilization of different learning 

<strong>the</strong>ories and pedagogical approaches (i.e., 

skills, cognitive apprenticeship, modeling, social 

mediation direct instruction, etc.). It 

would attempt to balance <strong>the</strong> various components 

of a functional curriculum (e.g., functional 

academics, community access, daily living 

skills, financial, transportation, leisure and 

recreation, communication, self-determination, 

social skills, vocational education, independent 

living skills) as well as direct skills 

instruction with a cognitive apprenticeship, 

students as consumers with students as producers, 

and individualization with community. 

A balanced approach to a functional curriculum 

would resemble a balanced literacy approach 

(see Duke, Bennett-Armistead, & Roberts, 

2003), moving on a continuum, with 

shifting emphasis from “learning to function” 

(i.e., performance) to “functioning to learn” 

(i.e., cognitive apprenticeship), which is represented 

graphically in Figure 3. The balanced 

approach distributes expertise across 

multiple individuals and activities, to avoid 

self-contained cross-categorical teachers having 

to be all. Although a balanced a functional 

curriculum heuristic is suggested, it must be 

flexible enough to address various factors. 

This heuristic must be flexible to work within 

<strong>the</strong> confines of various community and school 

variables as well as fluid enough to address 

what students bring to <strong>the</strong> program and how 

Figure 3. A balanced a functional curriculum heuristic. 

<strong>the</strong> composition of students will impact <strong>the</strong> 

enactment and curricular decision-making. 

Although <strong>the</strong> data analysis was approached 

with an apriori lens in terms of factors, because 

<strong>the</strong> researcher approached it with an 

open mind and looked for evidence to support 

and challenge <strong>the</strong>se factors, ano<strong>the</strong>r factor 

was found – paraprofessionals. It is likely 

that <strong>the</strong> role of paraprofessionals was not acknowledged 

because <strong>the</strong> limited literature on 

factors influencing an enacted curriculum 

came from general education, in which paraprofessionals 

play less of a role, if present at 

all. Paraprofessionals added benefits and limitations 

to <strong>the</strong> enactment of a functional curriculum. 

One major challenge for paraprofessionals 

involved confusion over <strong>the</strong>ir role. At 

times <strong>the</strong>y were treated and given privileges as 

a teacher and at times that of a secretary or 

assistant, and <strong>the</strong>se two distinct roles hold implications 

for <strong>the</strong> education of students. 

One major contention when discussing 

paraprofessionals and <strong>the</strong>ir impact involves 

<strong>the</strong> fact that <strong>the</strong>y are often instructing or 

teaching some of <strong>the</strong> most vulnerable students 

in schools. Research has suggested that some 

paraprofessionals spend almost 50% of <strong>the</strong>ir 

time providing individual instruction to students 

without a teacher present (Ashbaker & 

Morgan, 2001). Some students have been 

found to receive as much of 80% of <strong>the</strong>ir 

instruction from a paraprofessional, ra<strong>the</strong>r 

than a certified teacher (Ashbaker & Morgan). 

Thus, our students who may be most in 

need of a highly ”qualified” teacher’s assistance 

are fur<strong>the</strong>st away (i.e., secondary students 

educated in self-contained cross-categorical 

programs) and being educated by 

paraprofessionals – individuals who may not 

have a college degree and potentially little 

training in teaching or working with children. 


Limitations 

This study presented several limitations. One 

limitation involved <strong>the</strong> cases, as <strong>the</strong> study consisted 

of two programs, and hence generalizability 

is limited. Ano<strong>the</strong>r limitation is that <strong>the</strong> 

two cases were observed for a bounded period 

of time, although <strong>the</strong> data did become saturated 

prior to ending observations. Additionally, 

<strong>the</strong> cases were not observed for <strong>the</strong> same 

amount of time. More hours of observation 

were recorded at Harborville High School in 

Katie’s program than at River Bend High 

School in Paula’s room. This resulted from 

<strong>the</strong> teacher at River Bend getting sick, <strong>the</strong> 

school having snow days, and students being 

away on field trips. 

Limitations also arose in <strong>the</strong> data collection. 

Not every student in both programs returned 

approved parental consent forms, and/or 

gave student assent. The enactment of a functional 

curriculum in <strong>the</strong> programs was left to 

be understood by only those students for 

whom consent was granted. Little is known 

regarding <strong>the</strong> students for whom consent was 

not obtained, in terms of <strong>the</strong>ir personal and 

school data as well as <strong>the</strong>ir perspective of <strong>the</strong> 

enactment of a functional curriculum. A limitation 

also existed with <strong>the</strong> student interviews. 

Some students had difficulty understanding 

some of <strong>the</strong> interview questions. Even when 

students appeared to understand <strong>the</strong> questions, 

<strong>the</strong>ir responses consisted of a few words 

ra<strong>the</strong>r than expansion of <strong>the</strong>ir thoughts. 

Future Directions 

Research needs to continue to explore not 

only <strong>the</strong> relationship between factors and a 

functional curriculum, but between factors 

and <strong>the</strong> influence of curriculum in special 

education in general. The field needs to better 

understand what is occurring curriculumwise 

in its service-delivery options as well as 

what factors are affecting <strong>the</strong> enactment. Future 

research should examine <strong>the</strong> enactment 

of a functional curriculum given o<strong>the</strong>r factors, 

such as urban or suburban self-contained 

cross-categorical programs. It should also examine 

<strong>the</strong> enactment with o<strong>the</strong>r types of service 

delivery models, such as resource rooms 

and general education classes, if applicable. 

As this study was limited to functional curric- 

ulum models that were “piece-mealed” by <strong>the</strong> 

teachers, as opposed to formal commercially 

available functional curricula, research needs 

to be undertaken to understand <strong>the</strong> enactment 

of commercially available functional 

curricula as well. 

Exploring <strong>the</strong> enactment with different 

teacher characteristics may also lead to understanding. 

The role of teacher preparation on 

<strong>the</strong> enactment was under-explored in this 

study and additional research is needed regarding 

<strong>the</strong> impact of preservice education 

and experience on inservice actions and decisions. 

Variations in o<strong>the</strong>rs factors should also 

be analyzed, such as studying enactment 

across categorical versus cross-categorical programs 

or <strong>the</strong> influence of <strong>the</strong> lack of paraprofessionals. 

Given <strong>the</strong> factors that were found 

to be influential in this study, <strong>the</strong> next step is 

to manipulate <strong>the</strong> factors and study <strong>the</strong> relationship 

between <strong>the</strong> intersection and union 

of <strong>the</strong> various factors and students’ in-school 

and post-school success, such as employment, 

independent living, and life satisfaction. 

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Received: 4 January 2007 

Initial Acceptance: 1 March 2007 

Final Acceptance: 22 May 2007 

310 / Education and Training in Developmental Disabilities-September 2008

Thirty Year Review of Safety Skill Instruction for Persons 

with Intellectual Disabilities 

Linda C. Mechling 

University of North Carolina Wilmington 

Abstract: This review syn<strong>the</strong>sizes <strong>the</strong> empirical literature (1976–2006) focusing on teaching personal safety 

skills to persons with intellectual disabilities. Thirty-six investigations were identified which provided information 

on six areas of instruction: (a) pedestrian/street crossing safety; (b) home accident prevention; (c) 

application of first aid (including identification and reporting of illnesses); (d) response to lures or advancements 

of strangers; (e) fire safety; and (f) emergency use of telephones. Implications for instruction and future 

research are discussed based on <strong>the</strong> results of <strong>the</strong> review. 

Deinstitutionalization and desegregation in 

<strong>the</strong> early 1960’s initiated <strong>the</strong> need to prepare 

persons with disabilities to function in less 

supervised and sheltered environments (Marchetti, 

McCartney, Drain, Hooper, & Dix 

(1983). Today focus continues on providing 

inclusive opportunities for persons with disabilities, 

requiring instruction of skills in preparation 

of integration into communities. By 

nature of <strong>the</strong>ir disabilities, persons may lack 

judgment and skills to recognize, avoid, or 

escape dangerous situations and <strong>the</strong> communication 

skills to report situations or crimes 

against <strong>the</strong>m (Mazzucchelli, 2001; Wilson, 

Seaman, & Nettelbeck, 1996). They may also 

be more dependent on o<strong>the</strong>rs for physical and 

psychological needs and support across environments 

(Matson, 1984; Taber, Alberto, 

Hughes, & Seltzer, 2002). This dependence 

and lack of skills often cause <strong>the</strong>m to be compliant 

and passive towards o<strong>the</strong>rs, which may 

leave <strong>the</strong>m susceptible to victimization (Matson). 

Moving from supervised to semi-independent 

or independent living arrangements and 

from sheltered to competitive work environments 

require planning and programming for 

attainment of increased independence. An increase 

in independence results in decreased 


be addressed to Linda C. Mechling, University of 

North Carolina Wilmington, 601 S. College Road, 

Wilmington, NC 28403-5940. 



dependency on o<strong>the</strong>rs. Less supervision and 

support from adults and transitioning from 

protected environments may lead to an increased 

exposure to risk and unsafe situations. 

Wilson and Brewer (1992) report a significantly 

higher risk of criminal victimization, 

including personal and property offenses, 

among persons with intellectual disabilities 

and that this risk increases for those living 

alone or with someone else with a disability. 

Yet, in spite of <strong>the</strong>se difficult concerns, reasonable 

risk is a necessary part of normal life 

(MacEachron & Janicki, 1983). The right to 

experience normal risk taking is necessary for 

human growth and <strong>the</strong> development of human 

dignity (MacEachron & Janicki), <strong>the</strong>refor, 

<strong>the</strong>re is a need to provide opportunities 

for increased independence and to teach 

skills that minimize risk. 

Personal safety skill instruction is considered 

by many as being as important as teaching 

communication, motor, and social skills to 

persons with disabilities (Collins, Wolery, & 

Gast, 1991). Safety goals are being included 

for students receiving transition planning services 

through <strong>the</strong>ir Individualized Education 

Program (IEP) while teachers seek ways to 

teach strategies and skills to increase personal 

safety through awareness of safe and unsafe 

situations and understanding how to take appropriate 

actions in dangerous situations 

(Collins et al.). 

The focus of this review is <strong>the</strong> syn<strong>the</strong>sis of 

research available on teaching personal safety 

Safety Skill Instruction / 311

skills to persons with disabilities. Clees and 

Gast (1994) defined social safety skills as verbal 

or nonverbal behaviors which may be primarily 

preventative or reactionary. Preventative 

measures serve to avoid potentially 

dangerous situations before <strong>the</strong>y occur while 

reactionary measures allow escape from or termination 

of presently occurring situations. This 

review included studies that focus on ei<strong>the</strong>r 

preventative or reactionary personal safety 

skills. 

Method 

The period of review extended over 30 years 

(1976-2006). Although a review of this extent 

risks inclusion of methods that are outdated, it 

also helps to assure <strong>the</strong> inclusion of effective 

strategies that may not have been conducted 

in recent years. An electronic search of ERIC 

included <strong>the</strong> keywords: safety skills, safety, 

safety instruction, fire safety, pedestrian skills, 

street crossing, telephone skills, first aid, accident 

prevention, lures of strangers, crime prevention, 

child abduction, and molestation. An 

ancestral search was <strong>the</strong>n conducted of <strong>the</strong> 

table of contents of <strong>the</strong> following journals: 

American <strong>Journal</strong> of Mental Retardation, Behavior 

Modification, Exceptionality, Education and 

Training in Developmental Disabilities, Exceptional 

Children, Focus on Autism and O<strong>the</strong>r Developmental 

Disabilities, Focus on Exceptional Children, 

<strong>Journal</strong> of Applied Behavior Analysis, <strong>Journal</strong> of <strong>the</strong> 

Association for Persons with Severe Disabilities, 

<strong>Journal</strong> of Autism and Developmental Disabilities, 

<strong>Journal</strong> of Developmental and Physical Disabilities, 

<strong>Journal</strong> of Early Intervention, <strong>Journal</strong> of Special 

Education, <strong>Journal</strong> of Special Education Technology, 

Mental Retardation, Remedial and Special Education, 

Research and Practice for Persons with 

Severe Disabilities, Topics in Early Childhood Special 

Education, followed by a manual search of 

all reference lists of identified articles. In order 

to be included in <strong>the</strong> review, studies met 

<strong>the</strong> following criteria: 

1. Use of experimental design 

2. Publication in peer-reviewed journal 

3. Evaluation of safety skill instruction 

4. Participants were diagnosed with an intellectual 

disability 

5. Article published in English 

Results 

Thirty six studies (Table 1) and two literature 

reviews were identified. Both literature reviews 

focused on abduction prevention. The 

review by Bevill and Gast (1998) narrowed its 

focus to young children, <strong>the</strong> lures of strangers, 

and sexual abuse while <strong>the</strong> Miltenberger and 

Olsen (1996) review included research with 

children without disabilities and adults with 

intellectual disabilities. While some of <strong>the</strong> 36 

studies evaluated multiple skills, each addressed 

at least one of <strong>the</strong> following personal 

safety skills: (a) pedestrian/street crossing 

safety (7); (b) home accident prevention (6); 

(c) application of first aid (including identification 

and reporting of illnesses (7); (d) response 

to lures or advancements of strangers 

(6); (e) fire safety (6); and (f) emergency use 

of telephones (5). 

Pedestrian/Street Crossing Safety 


While <strong>the</strong> inability to safely move around 

one’s community can hinder independence, a 

single error while crossing a street can have 

crucial consequences (Matson, 1980a). Community 

pedestrian movement and street crossing 

were addressed in eight identified studies. 

Among <strong>the</strong> skills taught were: proper sidewalk 

behavior (ie. walk on right side, do not bump 

into pedestrians) (Matson); recognition of intersections 

(Matson); crossing streets with 

stop signs (look in both directions; use of 

crosswalks) (Horner, Jones, & Williams, 1985; 

Vogelsburg & Rusch, 1979); crossing streets 

with traffic lights (Horner et al.; Page, Iwata, & 

Neef, 1976); and crossing uncontrolled streets 

(Branham, Collins, Schuster, & Kleinert, 

1999; Horner et al.) and parking lots (Spears, 

Rusch, York, & Lilly, 1981). 

Three of <strong>the</strong> studies conducted all sessions 

with community streets (Horner et al. (1985; 

Spears et al., 1981; Vogelsburg & Rusch, 

1979). Two of <strong>the</strong> studies (Matson, 1980a; 

Page et al., 1976) used only simulated instruction, 

and three studies (Branham et al., 1999; 

Collins, Stinson, & Land, 1993; Marchetti et 

al., 1983) used both simulation and community 

instruction. Results of <strong>the</strong> Collins et al. 

study indicated that teaching first in simulation 

did not facilitate or inhibit later instruction 

within <strong>the</strong> community. Branham et al.

TABLE 1 

Safety Skill Studies 

Reference Participants Safety Skill Setting/Simulation Design Results Generalization Maintenance 

Novel settings No report 

All formats effective. 

Classroom CBI 

more efficient 

Multiple probe across 

behaviors 

Pedestrian Classroom CBI, 

Video Model CBI, 

Classroom Video 

n 3 

CA 14–20yrs 

Moderate ID 

Branham, Collins, 

Schuster, & Kleinert 

(1999) 

8wk 

generalization 

to follow-up 

2 of 3 pairs 

generalized 

home & 

school playground 

after 

2 wks. 

Generalization 

reported for 

real injuries - 

2 students 

Generazation to 

playground 

& children’s 

homes 

School and 

community 

settings 

Students learned to 

seek help through 

direct instruction & 

observational 

learning 

Multiple probe across 3 

pairs of students 

Model CBI 

Simulation, school 

bathroom 

First Aid, seek adult 

assistance 

n 6 

CA pre-school 

Mild ID 

Moderate ID 

Christensen, Lignugaris/ 

Kraft, & Fiechtl (1996) 

100% 

maintenance 

after 1 

month 

Maintained 

Time period 

not provided 

1 week, mixed 

results 

Rapid increase in 

performance using 

social modeling 

Multiple baseline 

across students 

Simulation, social 

modeling, kitchen 

area of classroom 

First Aid, seek adult 

assistance 

CTD effective in 

teaching reading of 


participants 

Read words on product 

labels (classroom) 

Product warning 

labels 

words 

Mixed results 1 participant 

consistently 

generalized 

Students learned Words on 

target words and actual 

some incidental and products 

observational words 

No significant 

Community 

difference across streets & pay 

two conditions phones 

Parents performed Performance 

child-care, home measured at 

safety skills using parents’ 

checklist task 

homes 

analysis 

Each group achieved Some use of 

gains in 6 social skill skills across 

areas 

peer 

“confederate” 

Acquisition in 

Failure to 

simulation 

generalize 

until training 

in vivo 


participants 

CTD using multiple 

exemplars in vivo 

Response to lures of 

strangers 

Maintained 2 

wks 

Read words on flash 

cards. 

Product Warning 

Labels Incidental 

learning of 

definitions 

Pedestrian, Pay 

phone 

Christensen, Marchand- n 4 

Martella, Martella, CA pre-school 

Fiechtl, & Christensen Developmental 

(1993) 

delays 

Collins, & Griffen (1996) n 4 

CA 8–11yrs 

Moderate ID 

Collins, Schuster, & n 3 

Nelson (1992) 

CA 38–48yrs 

Severe ID 

Collins, & Stinson (1994– n 4 

1995) 

CA 16–20yrs 

Moderate ID 

Maintained 1 

month 


word pairs, 

replicated across 

participants 

Adapted multiple 

probe across 

participants 


across participants 

In vivo vs Simulation 

In vivo 

n 4 

CA 15–19yrs 

Moderate ID 

Collins, Stinson, & Land 

(1993) 

No report 

Self-instruction with 

audiovisual child 

care manuals 

Home accident 

prevention 

Feldman, & Case (1999) n 10 

CA 23–37yrs 

Mild ID 

No report 


across groups 

Adapted board game 

and verbal response 

Response to sexual 

advancements 

n 6 

CA 24–26yrs 

Mild, Moderate 

ID 

n 4 

CA preschool 

Developmental 

delays 

Foxx, McMorrow, Storey, 

& Rogers (1984) 

Maintained 2–4 

wks after in 

vivo training 


subjects 

CTD, multiple 

examples, simulated 

preschool setting 


strangers 

Gast, Collins, Wolery, & 

Jones (1993) 


TABLE 1—(Continued) 


Mixed results 

across 

injuries 8–12 

wks 

Maintained 10– 

50 days 

Peers without 

disabilities 

All students reached 

criteria 


behaviors replicated 


First aid Simulated injuries using 

costume make-up 

Gast, & Winterling (1992) n 4 

CA 17–21yrs 

Moderate ID 

Performance 

measured 

from 2nd 

bedroom 

All students learned to 

exit home 

Multiple baseline across 

participants 

Fire Safety Bedrooms at home. 

Blow dryer for heat, 

heating pad on door, 

picture of smoke, 

house fire alarm 

Safe response to Curriculum using 

situations of modeling, rehearsal, 

abduction & feedback, & praise 

sexual abuse 

Haney, & Jones (1982) n 4 

CA 12–16yrs 

Moderate to 

Severe ID 

None reported Maintenance of 

skills for 7 of 

8 subjects, 6 

Effective for 7 of 8 

students 

Modified multiple 

baseline across 

subjects 

n 8 

CA 22–45yrs 

Mild ID 

Haseltine, & Miltenberger 

(1990) 

months 

No report 


to nontrained 

streets 

General case 

programming 

effective in teaching 

crossing of trained & 

non-trained streets 

Verbal acquisition 83– 

100% of facts 

Pedestrian Community streets Multiple baseline across 

participants 

n 3 

CA 12–53yrs 

Moderate to 

Severe ID 

Horner, Jones, & Williams 

(1985) 

No report 

No report for 

safety facts 

No report Maintained 2 

wks 


behaviors, replicated 



participants 

Safety facts Non-target feedback 

statements, classroom 

instruction 

Fire safety Simulated bedroom at 

school 

“significant 

improvements” in 

overt behaviors and 

self-report of safety 

skills 

“High level” of mastery 

of skills across 

daytime and 

nighttime scenarios 

Jones, & Collins (1997) n 3 

CA 31–45yrs 

Moderate ID 

Jones, Kazdin, & Haney n 5 

(1981) 

CA 8–9yrs Mild 

ID, no disability 

No report Maintained 5–8 

months 


participants 

Jones, & Thornton (1987) n 4 

CA 30–55yrs 


ID 


No report Maintained 3 

months for 2 

students 

“Significant 

improvements in fire 

safety response for 3 

of 4 participants 


participants 

Fire safety Tape recordings of 

alarms, blow dryer for 

heat, picture of fires, 

taught in apartment 

of participants 

Fire safety Fire drill in residential 

dormitory, tape 

recordings of fire 

alarms & crackling 

fires, blow dryer for 

heat 

Fire safety Tape recording of 

school fire alarm, exit 

from 3rd floor of 

dormitory 

n 4 

CA 17–19yrs 

Blind Mild ID, 

n 1 

Jones, Van Hasselt, & 

Sisson (1984) 

No report 


to night time 

fire drill 

All participants 

mastered sequence 

for exiting building 


participants 

n 8 

CA 10–19yrs 

Blind 

Jones, Sisson, & Van 

Hasselt (1984)



Maintained 66 

wks 

Self-injuries, 

injuries of 

o<strong>the</strong>rs, across 

natural home 

environments 

Nontrained No report 

injuries of 

self and 

o<strong>the</strong>rs 

In vivo more effective Novel settings No report 

Completion of skills 

with puppets 


behaviors, replicated 


First aid Ketchup, red pen marks 

on puppets 

n 4 

CA 7–11yrs 

EBD 

Marchand-Martella, & 

Martella (1990) 

Acquisition and 

performance of skills 

on self and puppets 


participants 

First aid Manufactured simulated 

injuries, puppets 

n 4 

CA 6–12yrs 


ID, EBD 

n 18 

CA 19–59yrs 

Moderate ID 

Marchand-Martella, 

Martella, Christensen, 

Agran, & Young (1992) 

Multiple comparison 

using Tukey HSD 

Pedestrian Classroom scaled 

Model vs in vivo 

Marchetti, McCartney, 

Drain, Hooper, & Dix 

No report 

Community 

streets 

Classroom simulation 

more effective than 

scaled model 

Duncan’s Multiple 

Range Test 

Pedestrian Scaled model, 

Simulation on 

hospital grounds 

Discussion & modeling 

not effective until 

role playing 

introduced 


subjects 

Fire safety, Discussion, model, role 

play in classroom 

(1983) 

Matson (1980a) n 30 

CA 21–55yrs 

Moderate, 

Severe ID 

Matson (1980b) n 5 

CA 25–37yrs 

Moderate ID 

No Maintained 7 

generalization months 

to actual 

emergency 

situations 

Maintained 4 

wks 

None reported No report 

Increase in protective 

behaviors 

First aid Multiple baseline across 

behaviors 

Protective behaviors Discussion, model, role 2 2 repeated 

play at center using measures ANOVA 

“Feel Safe” program 

in a group format 

Self-treatment of Simulated photographic Multiple baseline across 

cold symptoms scenarios 

4 classifications of 

colds 

Mazzucchelli, (2001) n 20 

CA 31–37yrs 

Mild ID 

None reported Decrease in 

performance 

at 1 month 

until 

retraining 

Some 

Most skills 

generalization maintained 

to untaught 1-month 

hazards 

Acquisition of treatment 

of different cold 

types 

O’Reilly, & Cuvo (1989) n 1 

CA 44yrs 

TBI 

Anoxic 

Checklist effective in 

increasing response 

to most hazards. Task 

analysis resulted in 

remediation of skills 

not acquired through 

checklist 

Scaled model effective 

in teaching street 

crossing in natural 

environment 

Variation of multiple 

probe across rooms 

& participants 

Written checklist & task 

analysis 

Home accident 

prevention 

encephalopathy 

n 4 

CA 18–20yrs 

TBI 

O’Reilly, Green, & 

Braunling-McMorrow 

(1990) 


wks 

Community 

streets 

Pedestrian Scaled model Multiple baseline across 

behaviors and 

participants 

n 5 

CA 16–25yrs 


ID 

Page, Iwata, & Neef 

(1976) 





wks 


to untaught 

numbers 

Acquisition of dialing 

and giving 

information 


behaviors and 

participants 

Photo scenarios, picture 

phone directory, in 

classroom 

Emergency 

telephone calls 

None reported No report 

Significant increases for 

all participants 

Newman-Keuls test for 

comparison of means 

Disconnected phones, 

cards with phone 

numbers 

Emergency 

telephone calls 

Independent behavior None reported No report 

attributed to pacing 

prompts 

Acquisition of all tasks None reported Maintained 6– 

12 wks 

Multiple baseline and 

reversal design across 

behaviors 


behaviors 

Pedestrian Parking lot of residental 

facility 

Simulated injuries (i.e. 

betadine), inoperable 

telephones 

First Aid, 

Emergency phone 

calls 

No report 


groups 

Cell phone use in 

classroom role play 

Emergency cell 

phone calls 

Risley, & Cuvo (1980) n 3 

CA 26–52yrs 


ID 

Smith, & Meyers (1979) n 60 

CA 42–49yrs 

Moderate to 

Profound ID 

Spears, Rusch, York, & n 1 

Lilly (1981) 

CA 12yrs 

Severe ID 

Spooner, Stem, & Test n 3 

(1989) 

CA emergency 

Moderate 

ID 

Taber, Alberto, Hughes, & n 14 

seltzer (2002) 

CA 11–14yrs 

Moderate ID 

No report 


to community 

settings & 

phone 

numbers 


to untrained 

intersections 

Acquisition of cell 

phone use: dialing 

number from index 

card & give 

information 

Instructional feedback 


approach & walk 

behaviors. Repeated 

practice required to 

teach “looking” 

behavior 

Improvement for 6 of 7 

students 

Pedestrian Community intersections Multiple baseline across 

subjects with a partial 

sequential reversal 

n 3 

CA 17–21yrs 

Severe, Profound 

ID 

Vogelsburg, & Rusch 

(1979) 


Maintained 14 

days for 6 of 

7 students 


to novel 

situations & 

abductors for 

6of7 

students 

Modified multiple 

probe interrupted 

time series across 

groups 

Classroom, school playground 


strangers 

n 7 

CA 6–8yrs 

Moderate, 

Severe ID 

Watson, Bain, & 

Houghton (1992) 

None reported Maintained 1 

wk. Mixed 

data 1 month 

Treatment package 


safe handling of 

materials 


participants, 

replicated across 

tasks 

Simulated plastic 

materials, glass 

materials 

Handling broken 

materials (plates, 

glasses) 

n 3 

CA 17–21yrs 

Moderate ID 

Winterling, Gast, Wolery, 

& Farmer (1992)

found differences only in efficiency data (favoring 

classroom simulation plus communitybased 

instruction over videotape modeling 

used with community-based instruction and 

videotape modeling used with simulation and 

community-based instruction). In contrast, 

Marchetti et al. found significant differences 

in favor of community training over a classroom 

simulation using a small scaled model of 

streets and moving dolls through intersections. 

Home Accident Prevention 

Measures against home accidents and injuries 

was <strong>the</strong> focus of five identified studies with 

results indicating that person with disabilities 

can learn to both prevent and handle accidents 

within <strong>the</strong> home by following precautionary 

measures. Written checklists of task 

analysis were effective in increasing appropriate 

prevention of potential in-home hazards 

in <strong>the</strong> bathroom, kitchen, living room and 

bedroom in <strong>the</strong> study by O’Reilly, Green, and 

Braunling-McMorrow (1990). Task analysis included 

information on such skills as: proper 

positioning of electric space heaters, use of 

hair dryers in <strong>the</strong> bathroom, disposal of outdated 

medications, and bathtub safety. In a 

second study, Jones and Collins (1997) presented 

safety facts (<strong>the</strong> popcorn popper is hot 

and could burn you) as non-target information 

in instructive feedback statements during 

microwave cooking. Although students were 

required to answer questions and state safety 

facts, measures of safe performance of <strong>the</strong> 

facts were not included in <strong>the</strong> study. 

In two similar studies, Collins and Stinson 

(1994–1995) taught students to read product 

warning labels (i.e. liquid bleach) while Collins 

and Griffen (1996) taught students to 

read labels and respond safely by putting unsafe 

products on a shelf or handing <strong>the</strong>m to 

an adult. 

Using self-instructional, audiovisual childcare 

manuals, Feldman and Case (1999) 

taught parents with intellectual disabilities to 

prevent <strong>the</strong>ir children from being victims to 

home accidents by proper storage and handling 

of matererials (i.e. glass, electrical appliances, 

and sharp objects). The only reactive 

study was conducted by Winterling, Gast, Wolery, 

and Farmer (1992) who taught students 

with disabilities to remove and discard broken 

materials (plates, glasses) from a sink, countertop, 

and floor using simulated (plastic) and 

glass materials. 

First Aid 

Research has also supported <strong>the</strong> ability of persons 

with disabilities to learn and apply minor 

first aid procedures. O’Reilly and Cuvo (1989) 

evaluated written task analysis and picture 

cues depicting cold symptoms (i.e. runny 

nose) to teach identification, monitoring, reporting, 

and self-administration of medications 

for symptoms of illness. 

Students have also been taught to: administer 

first aid for choking (Spooner, Stem, & 

Test, 1989); treat minor burns (Marchand- 

Martella & Martella, 1990); treat minor 

wounds (i.e. wash, dry, apply bandages) 

(Marchand-Martella et al., 1990; Marchand- 

Martella, Martella, Christensen, Agran, & 

Young, 1992; Matson, 1980b; Spooner et al.); 

and apply first aid to an insect bite (Gast & 

Winterling, 1992). Studies by Christensen, 

Lignugaris/Kraft, and Fiechtl (1996) and 

Christensen, Marchand-Martella, Martella, 

Fiechtl, and Christensen (1993) found that 

even preschool children were able to learn to 

report simulated injuries to an adult through 

direct instruction and observational learning. 

Procedures have included: (a) model and 

practice on self (Gast & Winterling, 1992.; 

Spooner et al. 1989); (b) practice on puppets 

(Marchand-Martella & Martella, 1990); and 

(c) model and practice on <strong>the</strong> instructor 

(Spooner et al.). Simulated materials were 

used in each of <strong>the</strong> studies treating minor 

cuts, burns, and insect bites. These ranged 

from using: ketchup (Marchand-Martella & 

Martella, 1990) and betadine (Spooner et al.) 

to simulate blood; costume makeup (Gast et 

al.), and manufactured simulated injuries 

used in first aid training (Christensen et al., 

1993; 1996; Marchand-Martella et al., 1992). 

Two studies evaluated students’ abilities to 

generalize first aid skills to actual injuries to 

follow-up procedures. Christensen et al. 

(1996) reported that two of six preschoolers 

were able to perform some of <strong>the</strong> first aid 

procedures (i.e. covering cut and locating a 

parent) while Marchand-Martella and Martella 

(1990) report that three of four partici- 


pants were reported by <strong>the</strong>ir parents to have 

bandaged real-life injuries of siblings and 

treating self-injuries. 

Abduction/Lures of Strangers/Sexual Abuse 

Due to <strong>the</strong>ir disabilities, children and adults 

may lack social skills, intellectual ability, and 

judgment, making it easier to coerce <strong>the</strong>m 

into dangerous situations (Matson, 1984). Persons 

with disabilities may have poorer interpersonal 

competence (i.e. response to someone 

asking for money) which may impede 

<strong>the</strong>ir ability to decide appropriate behaviors 

and leave <strong>the</strong>m vulnerable (Wilson et al., 

1996). 

The ability to “Just say ‘no’ and walk away” 

in response to confrontation, behaviors, or 

persons that pose harm to persons with disabilities 

is a strategy that has effectively been 

taught to persons with disabilities (Collins, 

Hall, Rankin, & Branson, 1999). Research focus 

has been on <strong>the</strong> instruction of <strong>the</strong>se protective 

skills to both adults (Collins, Schuster, 

& Nelson, 1992; Haseltine & Miltenberger, 

1990; Mazzucchelli, 2001) and young children 

(Gast, Collins, Wolery, & Jones, 1993; Watson, 

Bain, & Houghton, 1992). When teaching 

protective behaviors to adults, procedures 

have included: a) curriculums which follow a 

model of discussion, modeling, and role playing 

(Haseltine, & Miltenberger, 1990; Mazzucchelli, 

2001); b) use of a specially designed 

card deck and <strong>the</strong> table game Sorry to teach 

social/sexual behaviors including appropriate 

response to strangers’ advancements (Foxx, 

McMorrow, Storey, & Rogers, 1984); and c) 

constant time delay with multiple teaching 

exemplars taught in vivo (Collins et al., 1992). 

Procedures used with children also included 

use of constant time delay with multiple exemplars 

of strangers, lures, and sites (Gast et 

al.) and use of guided questions, slide pictures 

of known/unknown persons, and role playing 

(Watson et al.). Both studies taught children 

to say, “No”, “walk” away, and “tell” a familiar 

adult. 

Although results of <strong>the</strong> studies are encouraging, 

mixed results for generalization of behaviors 

to untaught settings is concerning. 

Self-protective behaviors against potentially 

harmful behaviors of o<strong>the</strong>rs should be safely 

used across a range of settings that may be 

experienced by both adults and young children 

with disabilities. 

Fire Safety 

Development of safety skills in response to 

potential fires received research attention during 

<strong>the</strong> 1980s. Although such fire emergencies 

are rare, <strong>the</strong> devastating effects when <strong>the</strong>y do 

occur present <strong>the</strong> need for teaching both prevention 

and reaction to <strong>the</strong>se emergency situations. 

Due to <strong>the</strong>ir cognitive delays, some 

persons with intellectual disabilities may experience 

increased risk of being victims of home 

fires (Jones & Thornton, 1987). Measures for 

preventing fires were addressed under <strong>the</strong> 

previously reviewed studies of “home accident 

prevention”. Studies reporting fires are reviewed 

under “emergency telephone skills”. In 

this section, recognition of fires and teaching 

emergency evacuation skills are presented. 

These skills have all been taught in simulated 

environments including: classrooms (Jones, 

Kazdin, & Haney, 1981; Matson, 1980b); dormitory 

rooms (Jones, Van Hasselt, & Sisson, 

1984; Jones, Sisson, & Hasselt, 1984), family 

homes (Haney & Jones, 1982); and participants’ 

apartments (Jones & Thornton, 1987). 

In each study reviewed, instructors primarily 

used discussion, modeling, and behavioral rehearsal 

to teach a series of steps in a task 

analysis for: crawling, checking doorknobs for 

heat, opening windows, and exiting buildings. 

Simulations varied, but included: tape recording 

of house fire alarms, heating pads to heat 

doorknobs, blow dryers to blow hot air into a 

room, and pictures of fire and smoke (Haney 

& Jones; Jones & Thornton). 

Although it is understood that generalization 

to real home fires will hopefully be nonexistent, 

none of <strong>the</strong> reviewed studies taught 

fire safety or measured generalization using 

small, yet contained, fires. Additionally, no 

studies evaluated extinguishing common 

kitchen fires or use of a fire extinguisher. 

Emergency Telephone Skills 


In addition to learning to use a telephone 

(Horner, Williams, & Steveley, 1987; Smith & 

Meyers, 1979; Test, Spooner, Keul, & Grossi, 

1990), making emergency telephone calls to 

obtain assistance is considered an important

skill for integrating persons with disabilities 

into community settings (Risley & Cuvo, 

1980). Students have been taught to use home 

telephones to dial 911 and give relevant information 

(Risley & Cuvo; Spooner et al., 1989); 

dial <strong>the</strong> operator and report a fire (Smith & 

Meyers, 1979); use public pay phones to call 

home when lost in <strong>the</strong> community (Collins et 

al., 1993), and to use a cell phone to call for 

assistance when lost (Taber et al., 2002). 

Skills have been taught in simulation using 

pictorial scenarios (room on fire) (Risley & 

Cuvo, 1980); mock cardboard boxes as phone 

booths (Collins et al., 1993); and disconnected 

telephones (Smith & Meyers, 1979; 

Spooner et al., 1989). Additional aids have 

been used in <strong>the</strong> form of a modified phone 

directory with picture cues (Risley & Cuvo) 

and index cards with printed phone numbers 

(Smith & Meyers; Taber et al. 2002). 

None of <strong>the</strong> current studies evaluated use of 

pre-programmed or picture phones nor was 

valuable information obtained through follow-up 

sessions to determine if students could 

use <strong>the</strong> skills during an actually emergency 

situation to give information to obtain help. 

Discussion and Recommendations for Future 

Research and Practice 

All 36 identified studies reported some degree 

of success in teaching personal safety skills to 

persons with mild to severe disabilities. A 

number of instructional strategies (most relying 

on simulation) were identified. Although 

results of <strong>the</strong> studies are positive, a number of 

issues remain that need to be addressed in 

future research and practice. These issues primarily 

address: procedures for teaching personal 

safety skills; measures of generalization 

to novel situations; and maintenance of critical 

skills over time. Examination of each of 

<strong>the</strong>se issues is provided below. 

Instructional Procedures 

In order to be functional, safety skills must be 

performed consistently at high criteria levels 

or result in personal injury or even death (Collins, 

1992). Two re-occurring issues found in 

this review of <strong>the</strong> literature were where and how 

to safely teach <strong>the</strong>se skills while providing examples 

which closely resemble actual situa- 

tions in which <strong>the</strong>y will be needed. Results of 

this review were consistent with those of 

Miltenberger and Olsen (1996) and Bevill and 

Gast (1998) which found behavioral skills 

training (BST) using verbal and visual instruction, 

modeling, rehearsal, praise, and feedback 

to be effective in teaching safety related 

skills. The key component appears to be inclusion 

of behavioral performance of skills. 

Matson (1980b) found that discussion alone 

was not effective in teaching fire safety skills 

and that student performance showed minimal 

improvement until role playing was 

added. Although completed with children 

without disabilities, Peterson (1984) found 

similar results: reading manuals and discussing 

correct behaviors were not effective until 

explicit behavioral training was included in 

teaching home safety skills such as answering 

<strong>the</strong> door, treating a cut, reaction to a fire, and 

safely preparing a snack. Care should <strong>the</strong>refore 

be taken to follow recommended practices 

that students with disabilities actually perform 

or physically practice <strong>the</strong> skills <strong>the</strong>y will 

be required to use. Instructors should also 

take care to match strategies to <strong>the</strong> intellectual 

abilities of students. A limitation with role 

playing is <strong>the</strong> ability to conceptualize what is 

“pretended”. Matson (1980b) found that 

when persons with moderate disabilities were 

asked to “role play” fire escape scenarios a 

typical response was, “<strong>the</strong>re is no fire”. 

Simulations. There seems to be no argument 

that conducting instruction in natural 

environments where persons will be residing 

and using safety skills, needs to be included 

whenever feasible when teaching safety skills. 

Limited funds and scheduling issues are 

among <strong>the</strong> constraints that may prohibit programs 

from conducting <strong>the</strong> majority of instructional 

sessions within community-based 

settings. Limited teaching trials are also a concern 

when teaching in natural environments. 

Teaching skills such as riding a bus or ordering 

at a fast food restaurant prohibit much 

needed repetition when instruction is limited 

to one teaching trial (unless more than one 

trip is made a day, more than one meal is 

ordered, or <strong>the</strong> person orders for someone 

else). Fur<strong>the</strong>r, issues arise when teaching 

safety skills such as first aid when an injury 

rarely happens in real life. It is not feasible to 

wait for a natural event or injury to occur 


efore beginning instruction (Christensen et 

al., 1996). Simulated instruction is one alternative 

for providing teaching examples when 

care is taken to provide multiple examples 

which replicate functional contexts in which 

<strong>the</strong>y will be used (Horner, McDonell, & Bellamy, 

1986). 

Simulations increase opportunities for 

training trials and increase <strong>the</strong> number of 

trials that can be presented during one session. 

The difficulty identified in <strong>the</strong> reviewed 

studies is providing realistic teaching examples 

that will promote generalization to real 

life situations. While <strong>the</strong> majority of <strong>the</strong> reviewed 

studies support use of simulations, 

some studies reported limited results when 

attempting to simulate real life scenarios. For 

example, Matson (1980a) provided classroom 

instruction using a scale model of intersections 

with small dolls representing “pedestrians” 

that were moved by students. Results indicate 

that inclusion of simulated street 

crossing on <strong>the</strong> hospital grounds were more 

effective than <strong>the</strong> scaled model when generalization 

was measured in community settings. 

Marchetti et al. (1983) likewise found community 

training more effective than a scale model 

when teaching pedestrian skills. Collins et al. 

(1993) found little effects of simulated classroom 

instruction presented prior to in vivo 

instruction when compared to in vivo instruction 

alone. Gast et al. (1993) reported that 

students failed to generalize safe responses to 

<strong>the</strong> lures of strangers until taught in vivo. 

An important consideration when designing 

instructional programs may be <strong>the</strong> features 

of stimuli and how readily <strong>the</strong>y can be 

simulated. Instructors may find representation 

of realistic injuries, using artificial blisters 

or au<strong>the</strong>ntic blood, (Marchand-Martell & 

Martella, 1990) to be more realistic than attempts 

to create a dangerous household fire 

or a busy intersection. Ethical issues must also 

be considered when conducting safety research. 

Fear tactics or threatening personal 

harm are unacceptable and will not pass a 

review board when planning for students to 

respond to situations such as child abduction. 

Setting actual fires or crossing busy intersections 

may pose danger beyond <strong>the</strong> scope of 

ethical research, yet how do teachers teach <strong>the</strong> 

natural consequences of potentially dangerous 

scenarios (Collins, 1992)? Collins suggests 


reading of newspaper articles or watching television 

to witness aversive consequences. Video 

technology is ano<strong>the</strong>r possible means for providing 

realistic examples of difficult to represent 

stimuli. Video technology includes video 

modeling—watching o<strong>the</strong>rs perform a skill 

and completing <strong>the</strong> skill later and video 

prompting—watching a video segment and 

immediately performing a physical response 

before advancing to <strong>the</strong> next segment. A number 

of skills have been taught to students with 

disabilities using video instruction (Mechling, 

2005), and video technology has been used to 

teach students without disabilities to respond 

safely to potential abductors (Caroll-Rowan & 

Miltenberger, 1994; Poche, Yoder, & Miltenberger, 

1988), yet, Branham et al. (1999) was 

<strong>the</strong> only identified study which included videotapes 

to teach safety skills to students with 

disabilities. Video technology appears to address 

<strong>the</strong> need for: repeated practice; sufficient 

teaching trials; over learning of skills; 

and presenting dangerous or emergency scenarios 

that occur infrequently (Cless & Gast, 

1994; Mazzucchelli, 2001). Collins, Wolery, 

and Gast (1992) fur<strong>the</strong>r identify individualization 

as an important component when teaching 

safety skills to students with disabilities. 

Video instruction can provide examples to 

meet <strong>the</strong> specific safety skill needs of each 

student (i.e. video tape of <strong>the</strong> student’s 

kitchen at home). Use of video technology 

shows promise in providing real-life examples 

of dangerous or difficult to simulate examples, 

yet remains a relatively unexplored area 

when teaching safety skills to persons with 

disabilities. 

Measures of Generalization and Maintenance 

In general, while studies evaluating safety 

skills do not support <strong>the</strong> use of simulation 

over community-based instruction, difficulties 

of providing instruction solely in community 

settings is recognized. In order to be functional, 

safety skills must be generalized across 

settings and situations where <strong>the</strong>y will be required, 

<strong>the</strong>refore programs need to at least 

evaluate generalization in natural settings 

even if <strong>the</strong> majority of instruction has occurred 

in simulation (Bevil & Gast, 1998; Gast 

et al., 1993; Hasselton & Miltenberger, 1990). 

Evaluation of actual emergency situations (i.e.

treatment of a burn) may take several months 

to occur, but appears necessary when measuring 

<strong>the</strong> effectiveness of procedures to teach 

preventative or reactionary skills to real life 

events. Following procedures of Marchand-Martella 

and Martella (1990) researchers 

and practitioners may need to rely on follow-up 

reports from parents of participants to 

assess performance when real injuries occur. 

Given <strong>the</strong> critical nature of <strong>the</strong> skills being 

taught and <strong>the</strong> ability to use <strong>the</strong>m over an 

extended period of time, <strong>the</strong> importance of 

maintenance measures is apparent. A difficulty 

addressed in <strong>the</strong> literature is how to 

maintain skills that are seldom needed or 

practiced. Collins (1992) suggests that this issue 

is similar to renewing a first aid certificate 

or conducting fire drills and that retraining or 

follow-up is needed. Spooner et al. (1989) 

recommend retraining at periodic intervals 

similar to refresher CPR courses for persons 

without disabilities. Winterling et al. (1992) 

fur<strong>the</strong>r recommend that persons in <strong>the</strong> student’s 

natural environment should be made 

aware of his/her competencies in performing 

safety skills so that <strong>the</strong>y can reinforce use and 

provide additional training. 

Summary 

Results show that persons with disabilities 

have <strong>the</strong> ability to learn to react to and prevent 

potential emergencies when presented 

with systematic, behavioral approaches to instruction. 

A number of preferred instructional 

strategies were identified in addition to future 

challenges to researchers and practitioners. 

Increased independence and <strong>the</strong> freedom to 

make decisions about one’s own life come 

with additional risks. It is important that persons 

with disabilities learn to recognize, prevent, 

and react to potential emergencies and 

unsafe situations in order to promote human 

dignity through <strong>the</strong> right to experience risk. 

It is of interest to note that of <strong>the</strong> 36 studies 

identified, only two were conducted after <strong>the</strong> 

year 2000. The thrust in <strong>the</strong> area of safety skill 

research appears to have occurred in <strong>the</strong> 80’s 

(38.9% of identified studies) and 90’s (47.2% 

of identified studies). Perhaps, due to technology 

advancements and increased availability 

of assisitive technology in recent years, special 

education and related fields should revisit this 

line of research as it relates to new and innovative 

technologies. Evaluation of technologies 

for: tracking and locating persons and 

destinations; wireless communication; alerting 

devices; and virtual environments for simulation, 

offer new opportunities to teach and 

provide safety information to persons with disabilities. 

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Final Acceptance: 6 June 2007 




Enhancing Social and Transition Behaviors of Persons with 

Autism through Activity Schedules: A Review 

Devender R. Banda and Eric Grimmett 

Texas Tech University 

Abstract: Thirteen studies were reviewed that were conducted using activity schedules with persons with autism 

to improve social interaction skills and decrease problem behaviors. Results across studies indicate that activity 

schedules enhanced social interactions and on-task and transition behaviors. Also, investigators in some studies 

used activity schedules to decrease students’ tantrums and o<strong>the</strong>r problem behaviors during transitions. 

Fur<strong>the</strong>rmore, researchers in several studies that reported generalization indicated that behaviors learned through 

activity schedules generalized across settings and persons. Implications for practitioners and for future 

researchers are discussed. 

Individuals with autism often have difficulty 

with social interactions and communication. 

In addition, <strong>the</strong>se persons may display deficits 

in life skills and/or exhibit problem behaviors 

including stereotypic behaviors, self-injurious 

behaviors, hyper- or hyposensitivity to sound, 

taste, smell, etc. (Scheuermann & Webber, 

2002; Scott, Clark, & Brady, 2000). A majority 

of persons with autism have difficulties with 

social skills, particularly making eye contact, 

recognizing social cues, and participating in 

turn taking activities (Jamieson, 2004). Fur<strong>the</strong>rmore, 

<strong>the</strong>y may display unusual characteristics 

such as resistance to change, ei<strong>the</strong>r 

within <strong>the</strong>ir environment or within <strong>the</strong>ir daily 

activities (e.g., American Psychiatric Association, 

2000; Schreibman, Whalen, & Stahmer, 

2000). Issues with routine changes and transitions 

can particularly be problematic resulting 

in atypical behaviors such as heightened verbal 

and physical aggression, tantrums, noncompliance, 

self-injury, etc. (Schreibman et 

al.). Difficulty with transitions between and 

within activities can limit <strong>the</strong> person’s ability 

to navigate different environments without 

<strong>the</strong> adult supervision and guidance (e.g., For- 


be addressed to Devender Banda, Department of 

Educational Psychology and Leadership, College of 

Education, PO Box 41701, Texas Tech University, 

Lubbock, TX 79416. Email: devender.banda@ 

ttu.edu 


est, Horner, Lewis-Palmer, & Todd, 2004; 

Scheuermann & Webber; Schreibman et al.). 

Because of this, individuals with autism often 

develop dependence on adult caregivers to 

provide support to learn new skills, and to stay 

on-task and on-schedule throughout <strong>the</strong> activities 

at school, home, and o<strong>the</strong>r community 

settings (Heflin & Alaimo, 2007; Scheuermann 

& Webber). Thus, <strong>the</strong> challenge for 

parents and teachers is to decrease <strong>the</strong> dependence 

on adults and to increase <strong>the</strong> person’s 

independence in daily living, communication, 

socialization, and vocational skills. 

Researchers have used visual supports (e.g., 

pictures, videos, activity schedules) to improve 

various behaviors of persons with mental retardation 

including transitions during vocational 

activities and teaching daily living skills 

(e.g., Anderson, Sherman, Sheldon, & Mc- 

Adam, 1997; Morgan & Salzberg, 1992; 

Wacker, Berg, Berrie, & Swatta, 1985). Investigators 

in recent years have also identified 

<strong>the</strong>se visual supports, particularly <strong>the</strong> activity 

schedules as a promising educational strategy 

for persons with autism (e.g., Scheuermann & 

Webber, 2002; We<strong>the</strong>rby & Prizant, 2000). In 

<strong>the</strong> early nineties, investigators in three studies 

(Krantz & McClannahan, 1993; Krantz, 

MacDuff, & McClannahan 1993; and Mac- 

Duff, Krantz, & McClannahan, 1993) conducted 

initial investigations using activity 

schedules and found that <strong>the</strong>se strategies have 

increased social initiations, increased on-task

and on-schedule behavior and decreased disruptive 

behaviors in children with autism. 

These initial studies and numerous o<strong>the</strong>r investigations 

that followed <strong>the</strong>m have used activity 

schedules to teach various daily living, 

social, and transition behaviors to persons 

with autism. 

An activity schedule is a string of photographs, 

images or drawings of daily routines 

that are sequentially arranged on a display 

(e.g., wall, computer, folder, desk) for <strong>the</strong> 

targeted student to follow. These visual supports 

can be a single picture used as a prompting 

device, or multiple picture symbols formatted 

in a sequence. The activity schedule 

can be used between routines, such as moving 

from a classroom to a physical education setting, 

or within <strong>the</strong> student’s daily routines, 

such as moving from shaving to brushing 

teeth during a hygiene activity. Activity schedules 

not only improved transition or daily living 

skills but have also shown promise in enhancing 

social behaviors, social initiation, and 

social interaction in students with autism 

(Heflin & Alaimo, 2007; Scheuermann & 

Webber, 2002). Changes that are to occur 

within <strong>the</strong> anticipated daily activities can be 

reflected on <strong>the</strong> activity schedule, allowing 

increased time for <strong>the</strong> child to enhance participation 

in existing routines or to transition 

to a new activity (Jamieson, 2004). Activity 

schedules may be helpful for persons with 

autism due to several possible explanations. 

Individuals with autism may have difficulty 

processing auditory information, instead responding 

to visual input as <strong>the</strong>ir primary 

source of information (Quill, 1995). Also, <strong>the</strong>y 

often prefer objects over people, and when 

observing ano<strong>the</strong>r person <strong>the</strong>y tend to focus 

on physical features ra<strong>the</strong>r than attending to 

<strong>the</strong> person as a whole (Heflin & Alaimo, 

2007). Visual support systems may prompt students 

with autism to perform a specific action, 

anything from <strong>the</strong> next step in a sequenced 

activity to transitioning to <strong>the</strong> next class in 

<strong>the</strong>ir schedule. In addition, visual systems may 

provide predictability and concrete steps that 

need to be completed within a daily schedule 

(e.g., classroom transitions) or within a single 

activity (e.g., brushing). 

Although numerous investigators have used 

activity schedules with persons with autism, 

<strong>the</strong>re has been no comprehensive review of 

<strong>the</strong>se studies. Recently, however, Stromer, 

Kimball, Kinney, and Taylor (2006) examined 

several studies that used activity schedules for 

persons with autism. In <strong>the</strong>ir article, Stromer 

et al. briefly referred to activity schedule studies 

and presented a case study that addressed 

computer technology as a way to build on <strong>the</strong> 

existing techniques of activity schedules. It is 

crucial for practitioners and researchers to 

know <strong>the</strong> current status of activity schedules in 

terms of <strong>the</strong>ir effectiveness and directions for 

practice and future research. Thus, <strong>the</strong> current 

review seeks to comprehensively analyze 

<strong>the</strong> studies that utilized activity schedules with 

individuals with autism. Specifically, <strong>the</strong> following 

research questions were answered in 

this study: a) Are activity schedules effective 

with persons with autism to enhance appropriate 

behaviors and/or to decrease inappropriate 

behaviors? b) Can <strong>the</strong> effects of activity 

schedules be generalized to o<strong>the</strong>r activities, 

persons, or settings? and, c) Are activity schedules 

socially valid interventions? 

Method 

We conducted a computer search using ERIC 

and PsycInfo. The key words used to search 

databases included autism, Asperger, activity 

schedule, picture schedule, and photographic schedule. 

Study inclusion was contingent upon <strong>the</strong> 

following parameters: a) <strong>the</strong> study was conducted 

with individuals with autism, b) <strong>the</strong> 

study involved some form of activity or picture 

schedule as an intervention, c) <strong>the</strong> study was 

data based, and d) <strong>the</strong> study was published in 

a peer-reviewed journal. Thirteen studies met 

selection criteria. One study had a mixed 

group that contained children who were not 

diagnosed with autism (Hall, McClannahan, & 

Krantz, 1995). In this case, only <strong>the</strong> participant 

with autism was included in this review. 

Ano<strong>the</strong>r study was excluded from final analysis 

because <strong>the</strong> data was not presented in an 

interpretable graph form (Kimball, Kinney, 

Taylor, & Stromer, 2004). Finally, an ancestral 

search from selected studies did not reveal any 

fur<strong>the</strong>r articles that met <strong>the</strong> study parameters. 

All research studies that met <strong>the</strong> inclusion 

criteria were reviewed and analyzed to answer 

<strong>the</strong> research questions posed in this study. 

Table 1 shows <strong>the</strong> summery of activity sched- 

Activity Schedules and Autism / 325

TABLE 1 

Summary of Activity Schedule Studies with Students with Autism 

Author(s) 

Bryan & Gast 

(2000) 

Dauphin et al. 

(2004) 

Dettmer et al. 

(2000) 

Dooley et al. 

(2001) 

Halletal. 

(1995) 

Krantz et al. 

(1993) 

Krantz & 

McClannahan 

(1998) 

MacDuff et al. 

(1993) 

Massey & 

Wheeler 

(2000) 

Participants 

Age/Disability 

1. 8y, autism 

2. 8y, autism 

3. 7y, autism 

4. 8y, autism 

Target 

Behavior(s) 

For all 

participants: 

increase on-task 

and onschedule 

behavior 

1. 3y, autism increase 

sociodramatic 

play, onschedule 

behavior 

1. 7y, autism 

2. 5y, autism 

For all 

participants: 

decrease 

transition 

time 

1. 3y, autism decrease 

tantrum 

behavior 


transition 

time 

1. 8y, autism 

2. 6y, autism 

3. 7y, autism 

1. 5y, autism 

2. 4y, autism 

3. 4y, autism 

1. 9y, autism 

2. 9y, autism 

3. 11y, autism 


For all 

participants: 

increase social 

initiation, 

decrease 

disruptive 

behavior 

For all 

participants: 

increase 

participation 

in social 

exchanges 

For all 

participants: 

increase on-task 

and onschedule 

behavior 

1. 4y, autism increase on-task 

behavior, 

decrease 

problem 

transitions 

Type of 

Schedule(s) 

line drawings one picture 

per page 

in photo 

album 

computer/ 

video, 

photographic 

Mode of 

Presentation Design(s) Results 

computer 

with 

embedded 

video 

clips, 

ABAB 

withdrawal 

design 

matrix 

training 

For all 

participants: 

increased 

independent 

on-task and 

on-schedule 

behavior 

learned social 

scripts, 

increased 


behavior 

line drawings 

notebook 

Velcro ABCB decreased 

strips, reversal latency 

photo design time, 

album, 

decreased 

note 

physical 

cards 

removals 

line drawings PECS-based A-BC-B decreased 

schedule 

problem 

board 

behavior 

photographs photo multiple increased 

album, 1 baseline indepen- 

photo 

dent 

per page 


photographs three ring multiple For all 

binders baseline participants: 

with one across increased 

photograph participants social 

per page 

engagement, 

decreased 

disruption 

photographs notebook multiple For all 

paired with with one baseline participants: 

textual cues photo across increased 

per page participants social 

engagement 

photographs three ring 

binder 

with one 

photograph 

per page 

photographs photo 

placed 

on a 

folder 


multiple 

baseline 

across 

participants 

multiple 

baseline 

across 

activities 

For all 

participants: 

increased 

engagement, 

independent 


increased task 

engagement, 


easier


Author(s) 

Morrison et al. 

(2002) 

Pierce et al. 

(1994) 

Schmit et al. 

(2000) 

Watanabe et al. 

(2003) 

ule studies conducted with persons with autism. 

Results 

Participants 

Age/Disability 

1. 4y, autism 

2. 5y, autism 

3. 3y, autism 

4. 6y, autism 

1. 8y, autism 

2. 9y, autism 

3. 6y, autism 

Demographic Characteristics 

Target 

Behavior(s) 

For all 

participants: 

develop 

independent 

play skills 

For all 

participants: 

develop 

independent 

daily living 

skills 


tantrums 

during 





For all 

participants: 

increase 

independence 

during work 

routines 

Participants. A total of 28 children and 

three adults participated in <strong>the</strong> 13 studies. All 

children were 14 or younger, and 25 were boys 

and three were girls. The three adult participants 

were all men from <strong>the</strong> age of 22 to 40. 

Ages of all participants ranged from three 

years to 40 years, with an average age of 8.8 

years. The average age for <strong>the</strong> children alone 

was 6.53 years. The median age of all participants 

was seven years. All of <strong>the</strong> participants 

had been diagnosed with autism. 

Setting and trainers. The majority of <strong>the</strong> 

studies (7 of 13) were conducted in a classroom 

setting by psychologists, teachers, 

and/or graduate assistants. Four of seven studies 

took place in <strong>the</strong> general education classroom 

while three o<strong>the</strong>r studies were conducted 

in self-contained classrooms. Four of 

Type of 

Schedule(s) 

photographs clipboard 

with 

Velcro, 

photos in 

envelope 

on back 

photographs photo book 

with one 

photo 

per page 

photographs photo 

presented 

in front 

text schedule 

sheet 

Mode of 

Presentation Design(s) Results 

of face 

Schedule 

sheet 

with list 

of nine 

activities 

multiple 

baseline 

across 

participants 

multiple 

baseline 

probe 

design 

across 

behaviors 

multiple 

baseline 

across 

settings 

multiple 

baseline 

across 

participants 

For all 

participants: 

on-task and 


play 

behavior 

increased 

For all 

participants: 

increase in 

on-task daily 

living skills 

reduced 

tantrums, 

increased 


For all 

participants: 

significant 

increase in 

time on 

task 

<strong>the</strong> 13 studies were conducted in <strong>the</strong> home 

setting (Dauphin, Kinney, & Stromer, 2004; 

Dettmer, Simpson, Myles, & Ganz, 2000; 

Krantz et al., 1993; Pierce & Schreibman, 

1994). One of <strong>the</strong> three home-based studies 

also included a participant who engaged in 

community outings as part of <strong>the</strong> study (Dettmer 

et al.), and ano<strong>the</strong>r study included two 

participants trained at home and one in a 

clinical setting (Pierce & Schreibman). One of 

<strong>the</strong> studies was conducted in a group home 

setting (MacDuff et al., 1993). The study with 

adult participants took place in <strong>the</strong>ir adult 

services program building (Watanabe & Sturmey, 

2003). 

Target behaviors. Researchers in a majority 

of <strong>the</strong> studies enhanced social behaviors in 

<strong>the</strong> participants through <strong>the</strong> use of some form 

of activity schedule (i.e., photographic, line 

drawings, video models, computer, text). Researchers 

in three studies specifically targeted 

increasing social exchanges and initiations 

(Dauphin et al., 2004; Krantz & McClannahan, 

1998; Krantz et al., 1993). Researchers in 

two studies focused on decreasing tantrum 


ehaviors such as hitting, kicking, biting, crying, 

and screaming in <strong>the</strong> participant (Dooley, 

Wilczenski, & Torem, 2001; Schmit, Alper, Raschke, 

& Ryndak, 2000). Also, researchers in 

four additional studies targeted problem behaviors 

during transitions while attempting to 

increase on-task and on-schedule behavior between 

activities (Bryan & Gast, 2000; Dettmer 

et al., 2000; MacDuff et al., 1993; Massey & 

Wheeler, 2000). Researchers in one study utilized 

photographs to teach independent daily 

living skills to three young children with autism 

(Pierce & Schreibman, 1994), while ano<strong>the</strong>r 

study focused on increasing independent play 

skills (Morrison, Sainato, Benchaaban, & Endo, 

2002). Similarly, <strong>the</strong> remaining two studies 

both focused on enhancing participation and 

independence within daily activities, one 

within <strong>the</strong> work and writing routines of adults 

with autism (Watanabe & Sturmey, 2003), 

while <strong>the</strong> o<strong>the</strong>r study targeted decreased time 

for a young boy with autism to transition from 

a group activity to working independently 

(Hall et al., 1995). 

Effectiveness of Activity Schedules 

The activity schedules utilized by <strong>the</strong> researchers 

were shown to be effective interventions 

with all 31 individuals with autism. The current 

review indicated that <strong>the</strong> activity schedules 

utilized by <strong>the</strong> researchers increased various 

behaviors in a number of skill areas. 

These behaviors included enhancing social interactions, 

transitions, and on-task behaviors, 

and decreasing disruptive behaviors. 

Researchers targeting social interactions focused 

on increasing social exchanges and social 

initiation in <strong>the</strong>ir study participants (Dauphin 

et al., 2004; Krantz et al., 1993; Krantz & 

McClannahan, 1998). For example, Dauphin 

et al. utilized a combination of matrix training 

and video clips on computer to effectively 

teach sociodramatic play to <strong>the</strong> single participant 

in <strong>the</strong>ir study. Results indicated that <strong>the</strong> 

child learned new play activities following <strong>the</strong> 

introduction of a computer generated activity 

schedule into his daily routines. The o<strong>the</strong>r two 

studies addressing social interaction skills 

used photographs as <strong>the</strong> primary symbol system 

within <strong>the</strong> activity schedules. Krantz et al. 

utilized three-ring binders with one photograph 

to a page to increase participation in 


social exchanges in all three of <strong>the</strong> children 

with autism participating in <strong>the</strong> study. Results 

revealed that <strong>the</strong> introduction of activity 

schedules not only increased social engagement 

and initiation in <strong>the</strong> participants, but 

also decreased disruptive behaviors. These researchers 

used <strong>the</strong> same mode of presentation 

to increase social initiation in three children 

with autism five years later (Krantz & McClannahan); 

employing a script-fading procedure, 

<strong>the</strong> researchers were again showed an increase 

in social exchanges. 

Researchers in several studies focused on 

interventions addressing transitions, particularly 

on-schedule and on-task behaviors and 

decreasing tantrums (Bryan & Gast, 2000; 

Dettmer et al., 2000; Dooley et al., 2001; 

Schmitt et al., 2000; Massey & Wheeler, 2000). 

For instance, Bryan and Gast enhanced ontask 

behaviors in four children with autism by 

utilizing a photo album with one line drawing 

per page when transitioning between activities 

in <strong>the</strong> classroom. These researchers reported 

that all of <strong>the</strong> participants not only were able 

to learn to use an activity schedule quickly but 

also were able to use <strong>the</strong> activity schedule 

independently to stay on-task in <strong>the</strong> classroom. 

In a similar study, Dettmer et al. also 

employed line drawings in both a photo album 

and on a sequence strip to ease transitions 

and to decrease transition time in two 

young children with autism, both at home and 

in <strong>the</strong> community. Results indicated a decrease 

in transition time in both of <strong>the</strong> participants, 

and one participant also began to initiate 

verbal communication by commenting 

on <strong>the</strong> activities displayed on his schedule. 

One study (Dooley et al., 2001) used <strong>the</strong> Picture 

Exchange Communication System 

(PECS; Bondy & Frost, 1993) and a schedule 

board with a single participant to decrease 

tantrum behavior during transitions. Results 

indicated a decrease in tantrum behaviors 

along with a corresponding increase in compliance. 

In ano<strong>the</strong>r study, Schmit et al. also 

targeted tantrum behaviors during transitions 

using photos with a child, with results showing 

a decrease in tantrum behavior in three separate 

transition settings. Massey and Wheeler 

used a simplified activity schedule with a single 

photograph placed on a folder to increase 

on-task behavior and decrease problems during 

transitions (e.g., noncompliance, tan-

trums, aggression) in a four-year-old child 

with autism. 

Self-determination for <strong>the</strong> participants was 

an important element in many of <strong>the</strong> studies, 

and researchers in four studies targeted independence 

as a central goal of <strong>the</strong>ir research 

(Hall et al., 1995; MacDuff et al., 1993; Morrison 

et al., 2002; Pierce et al., 1995; Watanabe 

& Sturmey, 2003). Hall et al. used a photo 

album with one photo per page to increase 

participation and independence in a 7-yearold 

boy with autism during transitions from 

group work to independent writing; <strong>the</strong> participant’s 

dependence on adult prompts also 

decreased during <strong>the</strong> study. MacDuff et al. 

also utilized one photograph per page in a 

three-ring binder to both decrease dependence 

on prompting and to decrease disruptive 

behaviors in a number of recreational and 

daily living tasks for four children with autism 

living in a group home. In this study, stimulus 

control was transferred from adult verbal 

prompts to <strong>the</strong> photographs incorporated in 

<strong>the</strong> activity schedule. In ano<strong>the</strong>r study, Morrison 

et al. used photographs and a clipboard to 

successfully develop independent play skills in 

<strong>the</strong> four children participating in <strong>the</strong> study. A 

similar study by Pierce et al. used a photo 

album with a photo to a page to teach morning 

daily living skills (e.g., getting dressed, 

setting <strong>the</strong> table, making lunch) to three adolescents 

with autism. The single study with 

adult participants with high functioning autism 

also focused on increasing independence 

using a text based schedule sheet during daily 

vocational training activities (Watanabe & 

Sturmey). Results showed increased on-task 

participation in hygiene checks, job searches, 

and letter writing in all three participants. 

Components of Activity Schedules 

Activity schedules have several shared components: 

<strong>the</strong> use of visuals, modes of presentation, 

and training strategies. Visual supports 

including photographs were by far <strong>the</strong> most 

common element, and nine of <strong>the</strong> 13 studies 

utilized photographs in <strong>the</strong>ir activity schedule 

interventions. These nine studies included 20 

participants. This use of photography proved 

to be an effective strategy, with nine of <strong>the</strong> 

participants in <strong>the</strong>se studies showing a marked 

improvement in <strong>the</strong> targeted behavior. The 

o<strong>the</strong>r 11 participants using photographic activity 

schedules also showed a moderate improvement. 

The remaining four studies used 

alternate forms of visual supports (Bryan & 

Gast, 2000; Dettmer et al., 2000; Dooley et al., 

2001; Watanabe & Sturmey, 2003). While only 

two studies utilized line drawings as <strong>the</strong> picture 

symbol within activity schedules, <strong>the</strong> total 

six participants in <strong>the</strong>se studies showed 

marked improvement in <strong>the</strong> targeted behavior 

(Bryan & Gast; Dettmer et al.). The one 

study that used PECS for its activity schedule 

only showed moderate improvement in <strong>the</strong> 

single participant (Dooley et al.). In contrast, 

Watanabe and Sturmey were <strong>the</strong> only investigators 

who used text without any picture support 

to increase task participation in three 

adults with autism. 

The mode of presentation for each activity 

schedule was particularly significant, with 

seven of <strong>the</strong> 13 studies utilizing some form of 

folder or picture album with one symbol 

mounted in <strong>the</strong> center of each page (e.g., 

Bryan & Gast, 2000; Dettmer et al., 2000; Hall 

et al., 1995; Krantz et al., 1993). Within <strong>the</strong>se 

seven studies, 15 participants showed a 

marked improvement in <strong>the</strong> targeted behaviors 

during <strong>the</strong> activity schedule intervention 

phase, while six additional participants improving 

to a lesser degree. A close comparison 

to <strong>the</strong> o<strong>the</strong>r studies included in <strong>the</strong> analysis 

fur<strong>the</strong>r indicated that one picture per page 

folder system as <strong>the</strong> most effective schedule 

format for individuals with autism. 


Researchers in six of 13 studies reported generalization 

of activity schedule skills across settings 

(Dettmer et al., 2000; Dooley et al., 2001; 

Krantz & McClannahan, 1998; Krantz et al., 

1993; MacDuff et al., 1993; Pierce & Schreibman, 

1994). Dooley et al. reported <strong>the</strong>ir participant 

successfully generalized appropriate 

transition behaviors across activities for <strong>the</strong> 

remainder of <strong>the</strong> school year through <strong>the</strong> continued 

use of <strong>the</strong> activity schedule. Similarly, 

Krantz et al. reported that behavior changes 

resulting from <strong>the</strong> introduction of an activity 

schedule within daily routines were maintained 

for extended periods of up to 10 

months in three participants with autism. 

Krantz and McClannahan also reported that 


all <strong>the</strong> participants in <strong>the</strong>ir study were able to 

generalize <strong>the</strong>ir newly learned social initiations 

across trainers. Likewise, participants in 

MacDuff et al. were able to follow new unfamiliar 

activity schedules without any additional 

training. Pierce and Schreibman also 

reported generalization across settings and 

tasks with little additional training, with <strong>the</strong> 

participants learning new tasks at a faster rate 

once <strong>the</strong> initial training period was completed. 

On a more anecdotal note, <strong>the</strong> mo<strong>the</strong>r 

in one additional study (Dettmer et al.) reported 

utilizing activity schedules with her 

child across settings that resulted in a steady 

reduction of latency time between activities. 

Social Validity 

Researchers in five of <strong>the</strong> 13 studies reported 

social validation of <strong>the</strong> intervention by teachers 

and parents (Bryan & Gast, 2000; Hall et 

al., 1995; Massey & Wheeler, 2000; Morrison 

et al., 2002; Schmit et al., 2000). Bryan and 

Gast utilized a Likert scale to collect <strong>the</strong> opinions 

of <strong>the</strong> teachers and o<strong>the</strong>r professionals 

who worked with <strong>the</strong> participants and found 

that all respondents felt that picture symbols 

would be a useful management tool for all 

children in increasing on-task and on-schedule 

behavior. Hall et al. administered a poststudy 

questionnaire to <strong>the</strong> teachers, teachers’ 

aides, and integration coordinator involved in 

<strong>the</strong> study and all surveyed expressed satisfaction 

with <strong>the</strong> program and felt it was a valuable 

tool for increasing independent transitions 

in <strong>the</strong> participant. Likewise, Massey and 

Wheeler developed and administered a social 

validity scale to <strong>the</strong> teachers, mo<strong>the</strong>rs and behavior 

consultant of <strong>the</strong> participants, and 

found a similar satisfaction with <strong>the</strong> intervention, 

concluding that it was an effective and 

beneficial intervention for decreasing problem 

transitions in <strong>the</strong> participant. Similarly, 

Morrison et al. employed a checklist with 

three early intervention teachers to determine 

<strong>the</strong> social validity of <strong>the</strong> study, and all three 

teachers reported that <strong>the</strong> intervention 

seemed effective in improving play behavior 

of preschoolers with autism. The parents of 

<strong>the</strong> participants in this study also reported 

important positive behavior changes in <strong>the</strong>ir 

children following <strong>the</strong> study. Finally, Schmit et 

al. utilized both social comparison and subjec- 

tive evaluation to assess for social validity, concluding 

that reducing tantrum behavior 

meant meaningful growth for <strong>the</strong>ir participant. 



Of <strong>the</strong> 13 studies reviewed, all revealed significant 

benefits to utilizing activity schedules in 

<strong>the</strong> instruction of individuals with autism. Researchers 

in <strong>the</strong> majority of <strong>the</strong> studies focused 

on teaching new social and on-task behaviors 

and transition skills. Also, researchers 

in some studies successfully decreased tantrum 

behaviors in children with autism during 

transitions. Investigators in less than half of 

<strong>the</strong> studies reviewed have examined generalization 

and social validity indicating that fur<strong>the</strong>r 

research in <strong>the</strong>se areas is necessary to 

support <strong>the</strong> wide use and benefits of activity 

schedules for persons with autism. 

Results shown in <strong>the</strong>se studies strongly suggest 

that <strong>the</strong> use of activity schedules with 

persons with autism can lead to an increase in 

several behaviors. There may be several explanations 

for <strong>the</strong> improvement seen in <strong>the</strong> participants. 

Activity schedules may have provided 

a predictable pattern of expected 

behaviors (Bryan & Gast, 2000; Schreibman et 

al., 2000) in <strong>the</strong> form of task analysis (e.g., 

breaking skills into small components for each 

of <strong>the</strong> participants). Research supports <strong>the</strong> 

assumption that persons with autism and 

o<strong>the</strong>r developmental disabilities (e.g., mental 

retardation) respond better when behaviors 

are predictable and presented sequentially in 

a step-by-step manner (e.g., Heflin & Simpson, 

1998; Quill, 1995; Simpson, 2005). Also, 

each picture in <strong>the</strong> activity schedule may have 

served as a discriminative stimulus (S D )orcue 

for initiating <strong>the</strong> next behavior in <strong>the</strong> schedule/activity. 

Fur<strong>the</strong>rmore, it is also highly 

probable that <strong>the</strong> activity schedules served as 

visual prompts for <strong>the</strong> participants leading to 

a completion of <strong>the</strong> target behavior(s). In general, 

visual prompts are helpful for all persons, 

with and without disabilities. For example, 

traffic or road signs and visual directions are 

helpful for all of us. Specifically, <strong>the</strong> research 

on <strong>the</strong> use of concrete visual supports/ 

prompts for persons with autism indicates that 

<strong>the</strong>y respond better when activities are presented 

through visual prompts or pictures

(Quill, 1995). Fur<strong>the</strong>rmore, <strong>the</strong> majority of 

<strong>the</strong> investigators in <strong>the</strong>se studies used some 

form of teaching through modeling and/or 

prompting. It is unknown whe<strong>the</strong>r activity 

schedules alone in <strong>the</strong> absence of supplementary 

instruction or prompts are helpful in acquiring 

necessary behaviors. Future research 

should explore <strong>the</strong> role of instruction when 

using activity schedules to teach various behaviors 

to persons with autism. Some progress 

towards <strong>the</strong> targeted behavior was made by 

every participant in each of <strong>the</strong> studies. However, 

due to <strong>the</strong> wide variance in picture types 

(e.g., photographs, line drawings, PECS) used 

in <strong>the</strong>se studies, conclusions cannot be drawn 

as to <strong>the</strong> comparative effectiveness of <strong>the</strong> different 

types of pictures. Thus, future research 

should also investigate <strong>the</strong> effects of different 

picture types (e.g., line drawings vs. photographs) 

and sizes. In addition, <strong>the</strong> mode of 

presentation seems to be a critical component 

of activity schedules. For instance, using a 

binder or folder with one page per picture 

seems to be more useful for students with 

autism in <strong>the</strong>se studies. It is possible that one 

picture per page may have provided a better 

visual clarity and specificity for some participants. 

It is unclear from this review whe<strong>the</strong>r 

one mode of presentation is superior over <strong>the</strong> 

o<strong>the</strong>r mode(s) because no comparative research 

in this area has been conducted. Future 

research is warranted to study <strong>the</strong> effects 

of different presentations on a variety of behaviors 

in students with autism. 

Finally, results of generalization indicate 

that <strong>the</strong> effects of activity schedules can be 

generalized to o<strong>the</strong>r settings, activities, and 

persons. The participants may have been successful 

generalizing behaviors due to programming 

common stimuli - use of similar 

pictures in <strong>the</strong> activity schedules that are presented 

in <strong>the</strong> child’s natural environment 

(Cooper, Heron, & Heward, 2007). Also, <strong>the</strong> 

participants may have generalized behaviors 

learned through activity schedules due to natural 

reinforcement contingencies or through 

varied reinforcement schedules. Although 

generalization results are promising, only less 

than half of <strong>the</strong> studies reported data on generalization, 

indicating that more research is 

necessary in this area. Specifically, future research 

should be focused on generalization 

effects of activity schedules to new behaviors. 

Implications for Practice 

Several implications could be drawn for practitioners 

from this review. First, activity schedules 

are easy to develop and can be used with 

different routines and in different settings 

(e.g., school, home, work, and play) for persons 

with autism. Fur<strong>the</strong>rmore, this method 

could be used by educators to teach any activity 

that can be broken into sequential steps, 

from educational games to cooking activities. 

This review also suggests that each step of <strong>the</strong> 

activity or skill would simply have to be represented 

by some form of picture symbol representing 

that step, and a manner of display 

(e.g., folder, wall, computer, and desk). In 

addition, it is evident from <strong>the</strong>se studies that 

practitioners need to teach <strong>the</strong> student with 

autism to use or follow <strong>the</strong> activity schedule 

with a range of prompts based on <strong>the</strong> student’s 

needs. Without explicit teaching and 

use of prompts, activity schedules alone may 

not be sufficient to improve behaviors. 

In summary, <strong>the</strong> reviewed studies support 

<strong>the</strong> use of activity schedules as an effective 

intervention strategy for modifying various social, 

daily living, on-task, and transition behaviors 

in persons with autism. Also, <strong>the</strong> review 

indicates that <strong>the</strong> use of activity schedules may 

decrease problem behaviors during transitions. 

More studies are needed to fur<strong>the</strong>r assess 

<strong>the</strong> effectiveness of activity schedule systems 

in persons with o<strong>the</strong>r types of autism 

spectrum disorders, particularly those diagnosed 

with Asperger’s syndrome. Future research 

with activity schedules should identify 

<strong>the</strong> most effective components of <strong>the</strong> technique, 

including types of pictures, displays, 

and size. Finally, future research should continue 

to investigate <strong>the</strong> effects of activity 

schedules on generalization and social validity. 

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Therapeutic Interventions in <strong>the</strong> Ne<strong>the</strong>rlands and Belgium in 

Support of People with Profound Intellectual and 

Multiple Disabilities 

Carla Vlaskamp and Han Nakken 

University of Groningen 

Abstract: For several reasons, people with profound and multiple disabilities may be offered a variety of 

<strong>the</strong>rapeutic interventions. Thus far, researchers have shown a limited interest in providing an empirical base 

for <strong>the</strong>se interventions. Research is needed on <strong>the</strong> <strong>the</strong>oretical rationale (if any), <strong>the</strong> supposed ‘modus operandi’ 

and <strong>the</strong> claimed benefits of <strong>the</strong>rapeutic interventions. As a first step, this paper offers an overview of <strong>the</strong> use of 

<strong>the</strong>se interventions. A total of 48 settings in <strong>the</strong> Ne<strong>the</strong>rlands and Belgium were included in this study. Results 

show that some interventions are very frequently used, with Snoezelen, Sensory Integrative Therapy, Equine 

Therapy, Basic Stimulation and Aroma<strong>the</strong>rapy being <strong>the</strong> most common. Only one of <strong>the</strong>se five has been subjected 

to a number of carefully designed studies. Nearly a third of all <strong>the</strong>rapeutic interventions currently in use are not 

clinically evaluated. Of those that are evaluated, more than half are only evaluated monthly or even less 

frequently. The article ends with a call for an effective research strategy to separate interventions that are 

beneficial to people with PIMD from those that are unsubstantiated. 

In <strong>the</strong> support of people with profound intellectual 

and multiple disabilities (PIMD), practitioners 

in centers for special education, day 

services centers and residential facilities use a 

series of <strong>the</strong>rapeutic interventions that aim to 

achieve a broad spectrum of claimed effects, 

ranging from ‘feeling good’ and ‘restoring a 

natural balance’ to developmental effects and 

regaining functions. These interventions or 

procedures are generally not carried out by 

medical staff but by direct support staff members 

or <strong>the</strong>rapists (such as physio<strong>the</strong>rapists or 

speech <strong>the</strong>rapists). In practice-oriented journals, 

popular magazines and on television and 

<strong>the</strong> internet, a large range of <strong>the</strong>se interventions 

or <strong>the</strong>rapies are documented. They may 

claim ‘to cure’, such as Gentle Teaching, for 

example, which promises to cure self-injurious 

behavior by using unconditional acceptance 

and a gentle touch. They may promise impor- 

The authors would like to thank prof. dr J.H. 

Hogg for his comments on a previous version of <strong>the</strong> 

manuscript. Correspondence concerning this article 

should be addressed to Carla Vlaskamp, Department 

of Health Care Psychology, University of Groningen, 

Grote Rozenstraat 38, 9712 TJ Groningen, 

The NETHERLANDS. Email: c.vlaskamp@rug.nl 


tant sounding but vague benefits, such as 

Therapeutic Touch, which states that <strong>the</strong>re is 

‘a natural human potential which can be actualized 

through <strong>the</strong> intent to help or enhance 

<strong>the</strong> recipients’ own ability to support 

<strong>the</strong>mselves towards wholeness,’ or ‘Dolphin 

<strong>the</strong>rapy’ which states that ‘swimming with dolphins 

makes children with special needs learn 

up to four times faster and more intensively.’ 

These kinds of interventions are used 

throughout <strong>the</strong> human services area, and 

while no area or enterprise has been immune 

to <strong>the</strong> phenomenon of unsubstantiated <strong>the</strong>rapeutic 

interventions, <strong>the</strong> field of profound 

and multiple disabilities appears to be particularly 

vulnerable. This may be due to several 

reasons. Firstly, <strong>the</strong>re is <strong>the</strong> size and complexity 

of <strong>the</strong> disabilities of those with PIMD. In 

addition to <strong>the</strong>ir profound intellectual and 

severe or profound motor disabilities, individuals 

with PIMD also have a high prevalence of 

sensory disability (Nakken & Vlaskamp, 2006; 

Schrojenstein, Lantman-de Valk et al., 1997; 

Van Splunder, Stilma, Bernsen, Arentz, & 

Evenhuis, 2003). Fur<strong>the</strong>rmore, as well as <strong>the</strong>se 

impairments, people with PIMD have an overall 

risk of developing medical complications 

and almost all require regularly administered

medication, for example anticonvulsant 

drugs, sleep medication, medication to prevent 

reflux and sedatives (Hogg, 1992; Kapell 

et al., 1998; Zijlstra & Vlaskamp, 2005). This 

category of people thus forms a physically very 

vulnerable group with a heavy or total dependence 

on personal assistance for everyday 

tasks. This puts a strain on all those who provide 

support. Secondly, those with PIMD obtain 

services from several kinds of professionals 

with different vocational backgrounds, 

using various <strong>the</strong>oretical frameworks and 

ideas. Within all of <strong>the</strong> different professions it 

is possible to find <strong>the</strong>rapeutic interventions 

that may seem to be ‘worth a try’. We lack a 

tradition of <strong>the</strong>rapeutic interventions that are 

specifically designed and developed for people 

with PIMD. Most <strong>the</strong>rapeutic interventions 

that are offered to this category of people are 

originally designed and developed for those 

with less severe disabilities, and have in some 

cases been ‘modified’ by practitioners to fit 

this specific category. Thirdly, <strong>the</strong> size and <strong>the</strong> 

complexity of disabilities will provoke feelings 

of insecurity relating to <strong>the</strong> educational and 

support goals that are operative. These feelings 

of insecurity may render parents and professionals 

powerless, and leave <strong>the</strong>m with a 

strong urge to explore whatever possibilities 

are placed before <strong>the</strong>m. 

The evidence base supporting <strong>the</strong>se types of 

<strong>the</strong>rapeutic intervention is limited as far as 

<strong>the</strong>ir use for people with PIMD is concerned. 

However, even if <strong>the</strong> effectiveness of <strong>the</strong>se 

interventions is unproven, this does not automatically 

mean that <strong>the</strong>y are inherently good 

or bad. None<strong>the</strong>less, <strong>the</strong>re are forms of <strong>the</strong>rapeutic 

intervention or <strong>the</strong>rapies which may 

be likely to cause harm, ei<strong>the</strong>r directly, for 

example a child subjected to passive training 

activities for hours a day, or indirectly, for 

example if applying <strong>the</strong> procedure keeps <strong>the</strong> 

person with PIMD from effective treatment or 

from more pleasurable activities. Such <strong>the</strong>rapies 

could also raise <strong>the</strong> hopes of parents by 

continually promising an improvement in <strong>the</strong> 

child’s condition, a promise that may not be 

fulfilled. 

Many of <strong>the</strong>se <strong>the</strong>rapeutic interventions are 

adopted by well-meaning professionals or parents 

who do not have <strong>the</strong> background, <strong>the</strong> 

skills, or <strong>the</strong> inclination to investigate <strong>the</strong>se 

treatments (Jacobson, Foxx, & Mulick, 2005). 

Researchers have shown limited interest in 

delivering such a supporting base of evidence. 

This might be because studying <strong>the</strong> effectiveness 

of <strong>the</strong>se <strong>the</strong>rapeutic interventions for individuals 

with PIMD is time-consuming and 

methodologically complicated. Thus far, only 

a limited amount of scientific literature documenting 

both <strong>the</strong> inefficacy and efficacy of 

some of <strong>the</strong> <strong>the</strong>rapeutic interventions for people 

with PIMD is available (for example, Lindsay, 

Black, Broxholme, Pitcaithly, & Hornsby, 

2001; Mount & Cavet, 1995; Vlaskamp, de 

Geeter, Huijsmans, & Smit, 2003; Hogg, 

Cavet, Lambe, & Smeddle, 2001; Smith, 

Mruzek, & Mozingo, 2005; Kaplan, Clopton, 

Kaplan, Messbauer, & McPherson, 2006; van 

der Putten, Vlaskamp, Reynders, & Nakken, 

2005a, 2005b). 

Research is needed on <strong>the</strong> <strong>the</strong>oretical rationale 

(if any), <strong>the</strong> supposed ‘modus operandi’ 

and <strong>the</strong> claimed benefits of <strong>the</strong>se <strong>the</strong>rapeutic 

interventions. As a first step, we need an overview 

of <strong>the</strong> interventions actually in use at 

present. 

Method 

Participants and Setting 

Ten Dutch organizations and nine organizations 

in <strong>the</strong> Flemish-speaking part of Belgium 

participated in this study. The facilities were 

randomly chosen and evenly spread throughout 

<strong>the</strong> Ne<strong>the</strong>rlands and Flanders. Each facility 

offers support to people with PIMD in multiple 

settings, such as residential care, day 

services and educational centers. Except for 

four special educational centers who only provide 

support for children with PIMD, all facilities 

offer services to a diverse population of 

those with intellectual disabilities. A total of 48 

settings were included in this study: 23 residential 

care units, 13 day services, 11 special 

educational centers and one respite care 

home. The 23 residential care units provided 

for 1007 people with PIMD, <strong>the</strong> 13 day services 

settings provided for 342 people. The special 

educational centers provided information on 

<strong>the</strong>ir population of 162 children with PIMD, 

and <strong>the</strong> respite care home on six children with 

PIMD. 

Therapeutic Interventions / 335

Instruments 

A questionnaire with four semi-structured 

questions and one open question was developed. 

The semi-structured questions focused 

on <strong>the</strong> use of a particular intervention for 

people with PIMD, and asked how many clients 

were offered this intervention (less than 

30 clients in intervals of two and from 30 

onwards in tens) if it had been used. We subsequently 

asked if (and if so, how often) <strong>the</strong> 

effect of this intervention was evaluated in 

writing. The open question asked which interventions 

not included in <strong>the</strong> list were also 

used in <strong>the</strong> specific setting. A manual was 

included which explained how to complete 

<strong>the</strong> questionnaire. 

Procedure 

Firstly, an inventory of interventions that were 

frequently recommended to practitioners in 

<strong>the</strong> Ne<strong>the</strong>rlands and <strong>the</strong> Flemish-speaking 

part of Belgium was made. This overview was 

based on information in practice-oriented 

journals and internet sites that target professionals 

involved in <strong>the</strong> support of people with 

profound intellectual disabilities. From this 

list, which contained 23 interventions, seven 

were omitted as <strong>the</strong>y were primarily designed 

for use by parents at home (such as Brain Net 

and Saito Therapy) or demanded specific situations 

and funding (such as Dolphin <strong>the</strong>rapy). 

Subsequently, <strong>the</strong> researchers asked health 

care psychologists to cooperate in ga<strong>the</strong>ring 

data. In <strong>the</strong> Dutch context, researchers informed 

health care psychologists working in 

<strong>the</strong> field by telephone, explaining <strong>the</strong> aim of 

<strong>the</strong> study and asking about <strong>the</strong>ir willingness to 

complete a questionnaire. In Belgium, health 

care psychologists working with those with 

PIMD were asked <strong>the</strong> same question during 

<strong>the</strong>ir biannual meeting. The questionnaire 

was mailed to those who consented. The list 

consisted of 16 interventions: Aroma<strong>the</strong>rapy 

(Diego, Jones, & Field, 1998), Basic Stimulation 

(Fröhlich, 1991), CranioSacral Therapy 

(Upledger & Vredevoogd, 1983), Discrete 

Trial Training (Lovaas, 1987), Gentle Teaching 

(McGee, 1992), Haptonomy (Veldman, 

2003), Equine Therapy/Hippo<strong>the</strong>rapy (Ionatamamishvili, 

Tsverava, Loriya, Sheshaberidze, 

& Rukhadze, 2004), Mobility Opportunities 

Via Education (Bidabe & Lollar, 1990), Shantala 

Massage (Leboyer, 1987), Sensory Integrative 

Therapy (Ayers, 1972), Sherborne Developmental 

Movement (Loots & Malschaert, 

1999), Snoezelen (Hulsegge & Verheul, 

1987), Tibetan Cymbals (Jansen, 1990), Therapeutic 

Touch (Courcey, 2001), Touch for 

Health (Thie, 2005) and Watsu Therapy 

(Dull, 1997). 

Only half of <strong>the</strong> facilities responded before 

<strong>the</strong> due date. Two weeks after <strong>the</strong> due date 

researchers sent a reminder and most responded 

<strong>the</strong>reafter, with <strong>the</strong> exception of 

three psychologists who could not be contacted 

even after several attempts, and a fur<strong>the</strong>r 

three that were no longer willing to participate 

due to lack of time. Data were 

analyzed using descriptive measures. 

Results 


All facilities that participated use at least one 

(as was <strong>the</strong> case in two facilities) or more (with 

a maximum of eleven in one facility) <strong>the</strong>rapeutic 

interventions, with <strong>the</strong> exception of <strong>the</strong> 

respite care home. In this setting, none of <strong>the</strong> 

<strong>the</strong>rapeutic interventions from our list is used 

and <strong>the</strong>refore it is excluded from <strong>the</strong> results. 

Two <strong>the</strong>rapeutic interventions, Mobility Opportunities 

via Education and Touch for 

Health, were not mentioned at all by <strong>the</strong> respondents 

and are also excluded from <strong>the</strong> 

tables. In Table 1, <strong>the</strong> number and percentage 

of <strong>the</strong> use of <strong>the</strong>se interventions in 47 settings 

are given. The table shows that some <strong>the</strong>rapeutic 

interventions are only offered in a limited 

number of settings. O<strong>the</strong>rs, such as 

Snoezelen and Sensory Integrative Therapy 

are offered in more than half of <strong>the</strong> participating 

settings. Snoezelen is used in 87.2% 

and is by far <strong>the</strong> most popular intervention. 

Some <strong>the</strong>rapeutic interventions are offered 

to a large number of clients in each setting. 

Gentle Teaching and Snoezelen are offered to 

a high number of clients at least once a week 

(120129 and 100109, respectively). O<strong>the</strong>rs, 

for example Discrete Trial Training, CranioSacral 

Therapy, and Therapeutic Touch 

are not offered to more than six clients per 

setting. Table 2 shows <strong>the</strong> ranges between <strong>the</strong> 

least number and highest number of clients

TABLE 1 

Number of Facilities That Use Therapeutic Interventions 

that are offered a specific intervention at least 

once a week in a specific setting. 

We also inquired whe<strong>the</strong>r <strong>the</strong> <strong>the</strong>rapeutic 

interventions were evaluated and if so, at what 

point. Table 3 shows that 65.3% of <strong>the</strong> <strong>the</strong>rapeutic 

interventions used are clinically evalu- 

Residential Units Day Services Special Education Total 

NL 

(N 14) 

B 

(N 9) 

NL 

(N 11) 

B 

(N 2) 

NL 

(N 6) 

B 

(N 5) 

NL B 

(N 47) 

NL B 

(%) 

Aroma<strong>the</strong>rapy 3 5 3 1 3 15 31.9 

Basic Stimulation 3 7 2 1 2 5 19 40.4 

CranioSacral Therapy 1 1 2 4.3 

Discrete Trial 1 1 2 4.3 

Training 

Gentle Teaching 2 1 2 1 2 8 17.0 

Haptonomy 5 1 1 8 17.0 

Equine Therapy 6 4 7 1 3 21 44.7 

S.I.T. 8 2 6 6 2 24 51.1 

Shantala Massage 1 5 3 2 3 14 29.8 

Sherborne 6 2 1 4 13 27.7 

Snoezelen 9 9 11 2 5 5 41 87.2 

Therapeutic Touch 1 1 2 4.3 

Tibetan Cymbals 2 2 5 1 1 11 23.4 

Watsu Therapy 3 3 6.4 

TABLE 2 

ated in writing, but in only 39.8% of <strong>the</strong>se 

cases does <strong>the</strong> evaluation follow directly after 

<strong>the</strong> intervention, or on <strong>the</strong> same day. Ano<strong>the</strong>r 

3.5% of cases are evaluated weekly, <strong>the</strong> o<strong>the</strong>r 

56.6 % being evaluated less frequently (ei<strong>the</strong>r 

monthly, annually or even less often). The 

Ranges (Lowest-Highest) in Number of Clients Receiving Therapeutic Interventions 

Number of 

Settings Providing 

Treatment Form 

Least Number of 

Clients 

(Number of Settings) 

Highest Number of 

Clients 

(Number of Settings) 

Aroma<strong>the</strong>rapy 15 1–3 (2) 60–69 (1) 

Basic Stimulation 19 1–3 (2) 60–69 (1) 

CranioSacral Therapy 2 4–6 (1) 4–6 (1) 

Discrete Trial Training 2 1–3 (1) 1–3 (1) 

Gentle Teaching 8 1–3 (4) 120–129 (1) 

Haptonomy 8 4–6 (1) 13–15 (1) 

Equine Therapy 21 1–3 (3) 28–30 (1) 

S.I.T 24 1–3 (2) 10–12 (2) 

Shantala Massage 14 1–3 (4) 40–49 (1) 

Sherborne 13 1–3 (3) 16–18 (1) 

Snoezelen 41 1–3 (7) 100–109 (1) 

Therapeutic Touch 2 1–3 (1) 4–6 (1) 

Tibetan Cymbals 11 1–3 (2) 16–18 (1) 

Watsu Therapy 3 1–3 (1) 10–12 (2) 


TABLE 3 

Clinical Evaluation of Therapeutic Interventions 

table also shows that <strong>the</strong> question with regard 

to evaluation was not answered in a small 

number of cases. 

In addition to <strong>the</strong> <strong>the</strong>rapeutic interventions 

provided by <strong>the</strong> questionnaire, facilities mentioned 

ano<strong>the</strong>r 21 used in <strong>the</strong>ir own daily 

practice. These range from one that was 

adapted from existing <strong>the</strong>rapeutic interventions 

(a combination of Haptonomy and Sensory 

Integrative Therapy) to 15 that were ‘self 

invented’ (for example, an intervention called 

<strong>the</strong> ‘Spoil Room’) and 7 existing <strong>the</strong>rapeutic 

interventions that were not included in our 

questionnaire. With <strong>the</strong> exception of two: foot 

reflex <strong>the</strong>rapy, which was mentioned twice, 

and <strong>the</strong> Halliwick concept (a method of motor 

rehabilitation in water, Lambeck & Stanat, 

2000), which was mentioned five times, <strong>the</strong>se 

o<strong>the</strong>r <strong>the</strong>rapeutic interventions are only mentioned 

by one respondent. 

Conclusion and Discussion 

Evaluated Directly 

Our research included 16 <strong>the</strong>rapeutic interventions 

of which 14 were used in <strong>the</strong> participating 

facilities. Some are ra<strong>the</strong>r frequently 

used in Dutch and Flemish practice, with 

Snoezelen, Sensory Integrative Therapy, 

Equine Therapy, Basic Stimulation and Aroma<strong>the</strong>rapy 

being most frequently used. However, 

<strong>the</strong> application of <strong>the</strong>se interventions 

End of 

Day Weekly O<strong>the</strong>r 

Not 

Evaluated Missing 

Aroma<strong>the</strong>rapy (15) 9 3 3 3 4 2 

Basic Stimulation (19) 17 4 1 12 2 

CranioSacral Ther. (2) 2 

Discrete Trial Train. (2) 1 1 1 

Gentle Teaching (8) 2 1 1 6 

Haptonomy (8) 5 1 2 2 2 1 

Equine Therapy (21) 9 3 1 5 8 4 

SIT (24) 22 3 1 2 16 2 

Shantala Massage (14) 8 3 1 4 6 

Sherborne (13) 9 2 2 5 4 

Snoezelen (41) 21 2 7 12 20 

Therapeutic Touch (2) 2 2 

Tibetan Cymbals (11) 6 2 1 1 2 3 2 

Watsu Therapy (3) 2 2 1 


without feedback on effectiveness occurs too 

often. Nearly a third of all <strong>the</strong>rapeutic interventions 

used are not evaluated in writing at 

all. Of those that are evaluated in practice, 

more than half are only evaluated monthly or 

even less often. 

Our study has several limitations with respect 

to <strong>the</strong> estimated use of <strong>the</strong>se <strong>the</strong>rapeutic 

interventions. Firstly, we obtained information 

from one member of staff only, which 

may lead to an under or overestimation of <strong>the</strong> 

use of <strong>the</strong>rapeutic interventions. However, 

our respondents were all able to provide an 

expert judgment, given <strong>the</strong>ir position within 

<strong>the</strong>ir organization and <strong>the</strong>ir specialist interest 

in people with PIMD. Secondly, no explicit 

rules were given for <strong>the</strong> use of <strong>the</strong> intervention. 

This left <strong>the</strong> respondents room for interpretation. 

It may very well be that in one 

setting <strong>the</strong> burning of incense in <strong>the</strong> residential 

care unit is understood as ‘aroma<strong>the</strong>rapy’ 

for 10 people while in ano<strong>the</strong>r setting staff use 

specific oils or scents for clients in individual 

sessions. The possibility of different interpretations 

might have led to a bias in <strong>the</strong> results 

of this study. 

As for <strong>the</strong> five most popular <strong>the</strong>rapeutic 

interventions, only one has been subjected to 

a number of carefully designed studies, 

namely ‘Snoezelen.’ Research has been undertaken 

with respect to <strong>the</strong> effects of

Snoezelen on a variety of behaviors, such as 

changes in affect, challenging behavior, relaxation, 

behavior states and interactions (for 

example, Ashby, Lindsay, Pitcaithly, Broxholme 

& Geelen, 1995; Lindsay et al., 2001; 

Mount & Cavet, 1995; Vlaskamp et al., 2003). 

Some studies show positive outcomes, especially 

with regard to relaxation, but several 

show negative results, and <strong>the</strong>re is little evidence 

on which to base any generalizations 

(Hogg et al., 2001). 

Aroma<strong>the</strong>rapy has also been subjected to 

research, but to far less an extent than 

Snoezelen. Lindsay et al. (2001) showed that 

aroma<strong>the</strong>rapy has a limited effect on <strong>the</strong> communication 

levels of those with PIMD. While 

<strong>the</strong>re is a growing body of research on <strong>the</strong> 

practice of aroma<strong>the</strong>rapy, <strong>the</strong>re are only a few 

empirical studies on <strong>the</strong> effects of it (Maddock-Jennings 

& Wilkinson, 2004), and none 

with specific regard to people with PIMD. 

We did find two studies that have been conducted 

on <strong>the</strong> effectiveness of Sensory Integrative 

Therapy (SIT) for people with PIMD. 

One study by Brody, Thomas, Brody and 

Kucherawy (1977) used a well-established research 

design (for example, random assignment, 

use of intervention manual and validated 

outcome measures) and found no 

significant difference between <strong>the</strong> SIT group 

and <strong>the</strong> control group. In <strong>the</strong> o<strong>the</strong>r study by 

Close, Carpenter and Cibiri (1986), no random 

assignment, no intervention manual and 

no validated outcome measures were used. 

They showed that <strong>the</strong> SIT group improved 

more than <strong>the</strong> control group. Smith et al. 

(2005), in an overview of research (or <strong>the</strong> lack 

of it) on SIT, stress <strong>the</strong> need for research 

support in <strong>the</strong> future. 

The influence of Equine Therapy on <strong>the</strong> 

motor and social-emotional behavior of children 

with disabilities has been examined in 

several studies, but none of <strong>the</strong>se studies is 

related to <strong>the</strong> population of children with 

PIMD. In <strong>the</strong>ir literature review, Rolandelli 

and Dunst (2003) stated that most of <strong>the</strong>se 

studies report benefits, but methodological 

and procedural problems raise questions 

about <strong>the</strong> efficacy of <strong>the</strong> practice. 

Finally, Basic Stimulation has not been subjected 

to research, although some of <strong>the</strong> underlying 

principles have been examined. This 

is viewed by its creator as an indirect argument 

in support of <strong>the</strong> intervention (Bienstein & 

Fröhlich, 2003). Apparently, <strong>the</strong> scientific underpinning 

proving <strong>the</strong> effectiveness of <strong>the</strong>se 

frequently used <strong>the</strong>rapeutic interventions 

does not have priority. It also seems that if 

results and outcomes of research do not conform 

to prevailing beliefs, such results and 

outcomes are easily overlooked. 

The use of ineffective <strong>the</strong>rapeutic interventions 

is costly, not only in terms of raising false 

hopes or running <strong>the</strong> risk of injuring <strong>the</strong> person 

with PIMD, but also in monetary terms. 

Quite a number of <strong>the</strong>rapeutic interventions, 

especially some of those based on refuted 

models of human behavior such as Therapeutic 

Touch, start with training sessions or workshops 

for those who will apply <strong>the</strong> intervention. 

These training sessions or workshops are 

not cheap. Fur<strong>the</strong>rmore, some of <strong>the</strong>se <strong>the</strong>rapeutic 

interventions use expensive equipment, 

while o<strong>the</strong>rs are not costly in terms of 

material but are costly in terms of time. As a 

result of <strong>the</strong> lack of research, <strong>the</strong> expenditure 

by services on such <strong>the</strong>rapies may not be based 

on rational decisions, and could actually conflict 

with and undermine <strong>the</strong> effectiveness of 

support. The lack of ‘evidence-based’ <strong>the</strong>rapeutic 

interventions for people with PIMD 

makes services vulnerable: if services are unable 

to demonstrate <strong>the</strong> effectiveness of <strong>the</strong>ir 

care, <strong>the</strong> willingness of those who are responsible 

for <strong>the</strong> actual costs (such as health insurers, 

or local systems providing financial assistance) 

will decrease or decline. 

Studying <strong>the</strong> effectiveness of <strong>the</strong>rapeutic interventions 

for individuals with PIMD is timeconsuming 

and methodologically complicated. 

Therefore we need an efficient 

research strategy to separate <strong>the</strong> <strong>the</strong>rapeutic 

interventions that are actually beneficial to 

people with PIMD from those that are that are 

damaging, or have no effect at all but do 

consume time and money. A logical starting 

point would be an investigation of <strong>the</strong>rapeutic 

interventions that are used most frequently. 

Ano<strong>the</strong>r approach could be to examine <strong>the</strong> 

type of claim that is made. It can be argued 

that a claim that feelings of wellbeing or relaxation 

improvement is of little concern relative 

to a claim for restored functions or for 

<strong>the</strong> stimulation of cognitive or motor development. 

The stronger <strong>the</strong> claim, <strong>the</strong> more reason 

<strong>the</strong>re is to determine whe<strong>the</strong>r or not this 


claim is truthful. If a claim for <strong>the</strong> restoration 

of functions is made, at least two thorough 

between-group design experiments should be 

expected. With more modest claims, a series 

of single-case experiments (preferably with a 

waiting-list control group) would be sufficient. 

It is also possible that <strong>the</strong> positive anecdotal 

evidence for some of <strong>the</strong> interventions relates 

to <strong>the</strong> social-emotional interactions between 

staff and service users – regardless of <strong>the</strong> materials 

or ‘treatment’. Therefore ano<strong>the</strong>r interesting 

area for research could be <strong>the</strong> study 

of <strong>the</strong> interactions that occur while applying 

treatments such as Shantala Massage, 

Snoezelen, Therapeutic Touch or Haptonomy. 

In some of <strong>the</strong> <strong>the</strong>rapeutic interventions 

that are used, an ‘approach’ is stated and 

no clear directions, for example, a manual or 

guidelines for its use, are given. The availability 

of a manual or guidelines for <strong>the</strong> use of an 

intervention is necessary for evaluation. The 

lack of such guidelines means that a well-designed 

evaluation study will be impossible. 

The above-mentioned research efforts must 

be accompanied by fur<strong>the</strong>r discussion about 

<strong>the</strong> treatment forms used specifically by parents 

ei<strong>the</strong>r within <strong>the</strong> home (such as Brain 

Net) or outside (such as hyperbaric oxygen 

<strong>the</strong>rapy). This does not mean that <strong>the</strong>se types 

of <strong>the</strong>rapeutic intervention should be advised 

against in all cases. We need to be open to new 

ideas as well as to ideas that still lack scientific 

underpinning, but <strong>the</strong> rhetoric about <strong>the</strong> suitability 

and possible efficacy of <strong>the</strong>rapeutic interventions 

that are new or have not been 

validated must be replaced by empirical studies 

and an analysis of <strong>the</strong> functional role of <strong>the</strong> 

intervention in <strong>the</strong> measured outcome. 

Thereby, we can differentiate between wellintended 

but ungrounded <strong>the</strong>rapeutic interventions 

and <strong>the</strong>rapeutic interventions that 

are effective and beneficial and <strong>the</strong>refore may 

provide sound ‘treatment’ options for people 

with PIMD. 

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Received: 25 October 2006 

Initial Acceptance: 8 January 2007 





Systematic Instruction for Social-Pragmatic Language Skills in 

Lunchroom Settings 

Maureen E. Angell, Rita L. Bailey, and Laura Larson 

Illinois State University 

Abstract: This study involved <strong>the</strong> extension and adaptation of systematic instructional procedures suggested by 

Light and Binger (1998) to increase <strong>the</strong> social-pragmatic language skills of five high school students with 

moderate cognitive disabilities. Within a single-subject multiple probe research design, we also assessed 

intervention effects on two skills targeted by classroom teachers. The three primary target behaviors were taking 

obligatory turns, taking nonobligatory turns, and asking partner-focused questions. The two secondary target 

behaviors were conversing with appropriate eye contact and using appropriate tone of voice in conversational 

speech. Overall, results showed positive effects of <strong>the</strong> intervention on participants’ skills with some variability in 

student performance in generalization (lunchroom) settings. Fur<strong>the</strong>r research on <strong>the</strong> effects of various systematic 

instructional strategies on <strong>the</strong> social-pragmatic skills of individuals with various disabilities in multiple settings 

is recommended. 

Students with disabilities, particularly those requiring 

augmentative and alternative communication 

(AAC) systems, often have difficulty 

participating in social communication exhanges 

(Furick, 2003; Hatton, 1998). Successful 

communication exchanges in social environments 

involve competent use of language, 

or pragmatic language skills. Pragmatic language 

skills have been described as <strong>the</strong> use of 

communication to carry out communication 

interactions in a social environment (Levinson, 

1983). Pragmatics has been defined as 

“rules for using language contextually for social 

purposes” (Beukelman & Mirenda, 1998, 

p. 332). Knowledge and skills related to interpreting 

and sending appropriate nonverbal 

messages (i.e., eye contact, facial expressions, 

and body language) are also required for competent 

use of pragmatic language. Development 

and use of appropriate social and pragmatic 

language skills is important to 

maximizing <strong>the</strong> quality of life of students with 

intellectual disabilities. Appropriate communication 

interactions among peers with and 


be addressed to Maureen E. Angell, Illinois State 

University, Department of Special Education, Campus 

Box 5910, Normal, IL 61790-5910. 


without disabilities are important for developing 

meaningful relationships. 

Unfortunately, students with intellectual 

disabilities often experience difficulties in interacting 

successfully with peers (DeGeorge, 

1998). According to <strong>the</strong> National Joint Committee 

on Learning Disabilities (1998), people 

with intellectual disabilities often demonstrate 

problems in self-regulatory behaviors, social 

perceptions, and social and pragmatic interactions. 

The development of appropriate sociorelational 

skills plays a key role in <strong>the</strong> development 

of communicative competence 

(Light, Binger, Agate, & Ramsay, 1999). This 

may be a particularly important skill for 

school-age children, as behavior and communication 

patterns developed during <strong>the</strong> school 

years may impact students’ ability to form and 

maintain relationships and friendships for a 

lifetime. 

Making friends is a natural result of human 

interaction that involves many complex verbal 

and nonverbal transactions (DeGeorge, 

1998). Impaired development of social and 

pragmatic language skills may negatively affect 

<strong>the</strong> forging of friendships between students 

with and without disabilities. Typical interactions 

between peers with and without disabilities 

have been reported as ‘asymmetrical’ 

with more of <strong>the</strong> communication responsibil-

ity being on <strong>the</strong> communication partner without 

disabilities (Ratcliff & Cress, 1998). Individuals 

with disabilities have also been 

reported to experience more frequent communication 

breakdowns and greater difficulty 

in using communication repair strategies than 

peers without disabilities (Fishman, Timler, & 

Yoder, 1985; Kraat, 1985). These social and 

pragmatic language difficulties can be detrimental 

to <strong>the</strong> social success of students with 

communication impairments. 

During school days, a greater number of 

opportunities for naturalistic social interactions 

often occur during traditionally nonacademic 

times such as recess and lunch. School 

lunchtimes are typically social times, when students 

typically interact while consuming <strong>the</strong>ir 

meals. Unstructured, naturalistic communication 

times may pose a greater challenge for 

students with impaired social and pragmatic 

language skills than more structured academic 

settings (Beukelman, & Mirenda, 

1998). Yet, <strong>the</strong>se naturalistic social times may 

also provide wonderful opportunities for 

learning and generalizing social and pragmatic 

language skills. 

Often, students with impaired social and 

pragmatic skills require additional support to 

develop <strong>the</strong>se important language skills. Interaction 

patterns between students with disabilities 

and <strong>the</strong>ir peers in inclusive settings have 

been well-researched (e.g., Chadsey-Rusch, 

1990; Evans, Salisbury, Palombaro, Berryman, 

& Hollowood; 1992; Hanline, 1993; Hughes, 

1999; Mu, Siegel, & Allinder, 2000). Collectively, 

<strong>the</strong> research has demonstrated that although 

students with disabilities and <strong>the</strong>ir 

peers may be in physical proximity to one 

ano<strong>the</strong>r, limited social interaction occurs between 

<strong>the</strong>m without direct programming or 

supports by interventionists. 

Many students with disabilities exhibit inappropriate 

pragmatic behaviors that may prevent 

social interaction. There is evidence that 

social interaction between students with disabilities 

and <strong>the</strong>ir peers benefit from structured 

facilitation techniques that enhance 

communication interactions and relationships. 

In addition to promoting social gains, 

<strong>the</strong> research suggests that intervention strategies 

can also have academic benefits for students 

with disabilities (e.g., Brown & Holvoet, 

1982; Haring, Breen, Pitts-Conway, Lee, & 

Gaylord-Ross, 1987; Kamps, Locke, Delquadri, 

& Hall, 1989; McDonnell, Mathot-Buckner, & 

Thorson, 2001; Strain, Kerr, & Ragland, 

1979). McGee, Almeida, Sulzer-Azaroff, and 

Feldman (1992) evaluated <strong>the</strong> effects of peer 

incidental teaching as a strategy for increasing 

reciprocal peer interactions in students with 

disabilities that adversely affected <strong>the</strong>ir pragmatic 

communication skills. While gains were 

made in number and quality of communication 

interactions in an academic setting in this 

study, <strong>the</strong>se gains did not generalize to school 

mealtimes. 

Use of systematic instruction has been 

shown to be effective in facilitating skills acquisition 

for students with disabilities. One 

such program (Light & Binger, 1998) was designed 

specifically to enhance communicative 

competence for youths with disabilities across 

multiple pragmatic-social communication areas. 

This program describes systematic instructional 

procedures for teaching students who 

use AAC systems how to use introduction strategies, 

improve communication turn-taking, 

and increase <strong>the</strong>ir use of partner-focused 

questions. The program also includes a description 

of how instructional procedures can 

be adapted to specifically teach specific communication 

skills. 

Light’s and Binger’s (1998) program has 

been used effectively with multiple groups of 

individuals who use AAC systems (e.g., Light, 

Binger, Agate, et al., 1999; Light, Binger, Dilg, 

et al., 1996). This program has been used 

successfully across several academic settings. 

However, generalization of classroom-based 

systematic instructional programs in specific 

pragmatic language and social skills development 

have not been evaluated in less structured 

school social settings such as school 

lunchrooms. 

The purpose of this investigation was to 

evaluate <strong>the</strong> application of a classroom-based 

systematic instructional program on five identified 

social and pragmatic language skills in a 

high school lunchroom environment. Specifically, 

we adapted Light’s and Binger’s (1998) 

classroom-based systematic instruction program 

to increase our participants’ use of partner-focused 

questions, obligatory turn-taking, 

non-obligatory turn-taking, appropriate eye 

contact, and appropriate tone of voice. 

Social-Pragmatic Language Skills Instruction / 343

TABLE 1 

Participants’ Demographic Information 

Participant Age Gender Primary Diagnosis 

Method 

Participants 

Five high school students, all from <strong>the</strong> same 

special education program, participated in 

this study. These students were between 15 

and 19 years of age. Each had been identified 

with moderate cognitive disabilities. Categories 

of cognitive disability were established in 

compliance with <strong>the</strong> criteria stated in <strong>the</strong> Individuals 

with Disabilities Educations Act (P.L. 

105–117). Licensed psychologists and students’ 

eligibility teams had determined <strong>the</strong> 

students’ classification via appropriate measures 

of general intellectual functioning and 

adaptive behavior. Each participant primarily 

used oral speech as his or her primary communication 

mode, but all participants also consistently 

used AAC systems to augment speech 

and language use at school. These AAC supports 

included consistent use of personal and classroom 

visual strategies or aids such as visual 

schedules, visual behavior programs, social stories, 

communication boards, sentence completion 

aids, and classroom rules and instructions 

(Downing, 1999; Gray & Garand, 1993; Hodgdon, 

1995). Special education teachers and/or 

general education classroom personnel identified 

participants as having difficulty using appropriate 

pragmatic-social communication skills in 

social education settings. All participants had at 

least one Individualized Education Program 

(IEP) goal that suggested deficits in social and 

pragmatic language skills. See Table 1 for participant 

demographic characteristics. 

Primary Mode of 

Communication Primary AAC Support 

Bob 17 Male Fragile-X Verbal Visual strategies and supports 

TJ 18 Male Mental and Cognitive 

Impairment 

Verbal Visual strategies and supports 

Devin 19 Male TBI-Cognitive 

Verbal Communication boards/pages 

Impairment 

Visual supports 

Eric 15 Male Down syndrome Verbal Visual strategies and supports 

Jen 19 Female Cognitive 

Impairment 

Verbal Visual strategies and supports 

* Names have been changed to protect confidentiality 


Bob. Bob was a 17-year-old male diagnosed 

with Fragile-X syndrome. His primary mode of 

communication with peers and teaching staff 

was oral speech. His verbal communication 

was augmented with pictorial representations 

of items or ideas (i.e., visual strategies) in <strong>the</strong> 

classroom as needed. Bob appeared to have 

adequate functional vocabulary and sentence 

structure in structured classroom routines. He 

initiated and responded to communication, 

although approximately 80% of his communication 

consisted of responses. Bob participated 

in structured academic activities and 

frequently took his communication turns in 

<strong>the</strong>se structured educational settings. 

Occasionally, breakdowns in communication 

exchanges were observed when Bob was 

in group/classroom situations. For example, 

when he verbally responded to questions from 

teaching staff, he often did not make eye contact, 

turned his body away from his communication 

partner, and used an inappropriately 

high pitch and sarcastic tone of voice. During 

<strong>the</strong>se times, his sentence length also became 

notably reduced. Bob’s Speech-Language Pathologist 

(SLP) had instituted a visual prompting 

AAC system that consisted of pictorial 

prompts with printed words for each academic 

lesson that functioned as a sentence 

completion strip. The purpose of this system 

was to facilitate longer verbal utterances, but 

Bob did not use it without verbal reminders 

from teaching staff. Therefore, Bob’s spontaneous 

communication interactions were often 

limited to one- or two-word phrases and two

communication turns (i.e., initiation and response). 

Bob did not use socially appropriate 

gestures o<strong>the</strong>r than greetings (i.e., saying “excuse 

me”) in appropriate situations and he 

appeared to have extreme difficulty reading 

o<strong>the</strong>rs’ nonverbal or gestural communication. 

His tone of voice was judged as typically inappropriate 

and characterized by teaching staff 

and graduate student observers as sarcastic or 

negative in most interactions. 

Pragmatic and social communication goals 

found in Bob’s IEP included (a) improving 

<strong>the</strong> ability to read 10 specific nonverbal body 

gestures and explain what <strong>the</strong>y mean, (b) saying 

“excuse me” and using o<strong>the</strong>r socially appropriate 

phrases in a variety of social situations, 

(c) increasing successful use of <strong>the</strong> 

visual sentence completion system to create 

longer utterances, and (d) using correct body 

orientation when conversing. 

TJ. TJ was an 18-year-old male with a moderate 

cognitive disability of unknown origin. 

His primary mode of communication was oral 

speech. His verbal communication was augmented 

with pictorial representations of items 

or ideas (i.e., visual strategies) in <strong>the</strong> classroom 

as needed as well as <strong>the</strong> use of a laminated 

page depicting his behavior management 

program. This laminated page was used 

across school settings. TJ had functional oral 

communication skills in structured academic 

contexts. When his speech was intelligible, he 

was able to carry on a conversation and convey 

and receive basic messages successfully. Unfortunately, 

his articulation was consistently 

poor, which decreased his intelligibility in 

most situations. TJ did not maintain appropriate 

eye contact when communicating with 

peers and teaching staff. He habitually spoke 

with low intensity and his tone of voice was 

often judged sarcastic in nature by <strong>the</strong> teaching 

staff. TJ’s pragmatic and social communication 

goals listed in his IEP included (a) 

identifying visual cues given by a listener that 

indicated a lack of intelligibility and self-correcting 

those errors, (b) using appropriate 

social phrases and greetings depending on <strong>the</strong> 

situation, and (c) identifying appropriate responses 

for given situations. 

Devin. Devin was a 19-year-old male with 

cognitive impairment due to traumatic brain 

injury that occurred in early childhood. His 

primary mode of communication was oral 

speech. Devin typically communicated with 

staff and peers using single and multi-word 

utterances. He was moderately intelligible in 

familiar contexts. To augment his communication, 

Devin utilized communication boards 

that appeared to also function as a tool for 

learning new vocabulary and sentence structure. 

He spontaneously used several pre-made 

communication boards in classroom activities. 

Devin required prompting from teaching staff 

to use a visual communication system that was 

intended to cue him to use longer utterances. 

In less structured social settings, Devin consistently 

produced loud speech. During interactions, 

he repeated multiple times any words 

or phrases that he appeared to find funny. He 

often laughed out loud after producing loud, 

repetitious speech. He also consistently chose 

to leave classroom group activities and return 

to his desk without warning and consistently 

required a verbal or visual cue to remind him 

to ask permission to leave a group activity. 

Devin did not maintain appropriate eye contact 

during communication interactions with 

peers or school personnel. Although no visual 

deficits were noted in his case history, Devin 

typically oriented his face toward his communication 

partner but his eyes appeared to look 

toward <strong>the</strong> floor. His tone of voice was observed 

to be appropriate during <strong>the</strong> majority 

of classroom time, but occasionally he used a 

loud vocal tone which appeared to function as 

a way to entertain his peers. Devin’s tone of 

voice was characterized as sounding angry 

when he was asked to rejoin group activities 

after he had moved away from <strong>the</strong>m. Devin’s 

IEP goals related to social and pragmatic language 

included (a) attempting to correctly 

re-pronounce words when listeners appeared 

to misunderstand, (b) using a communication 

board to create longer sentences, (c) asking 

“May I...”toleave his chair to get materials 

or leave work space, and (d) reducing <strong>the</strong> 

number of repetitions of silly phrases and 

jokes in spontaneous conversations. 

Eric. Eric was a 15-year-old male diagnosed 

with Down syndrome. Initial classroom and 

mealtime observations yielded <strong>the</strong> following 

summary of findings: Eric’s primary mode of 

communication was oral speech, augmented 

with communication books and visual strategies 

in <strong>the</strong> classroom. He had moderate difficulty 

making his wants and needs understood 


verbally due to largely unintelligible speech. 

He was judged unintelligible by unfamiliar 

listeners and by familiar listeners in unfamiliar 

contexts. Eric’s eye contact was limited during 

initial observations. When he spoke about a 

topic that he initiated, he tended to maintain 

appropriate eye contact. Eye contact was inconsistent 

when communication interactions 

were initiated by o<strong>the</strong>rs. Eric’s tone of voice 

tended to sound monotonous with limited inflection. 

His IEP communication goals related 

to social and pragmatic language included (a) 

maintaining appropriate eye contact with 

communication partners, (b) using a communication 

book as needed to clarify or expand 

his utterances when misunderstood by communication 

partners, and (c) making requests 

to unfamiliar individuals following a verbal 

plus visual model in community-based activities. 

Jen. Jen was a 19-year-old female diagnosed 

with moderate cognitive impairment of 

unknown origin. Jen’s primary mode of communication 

was oral speech. Her verbal communication 

was augmented with pictorial representations 

of items or ideas (i.e., visual 

strategies) in <strong>the</strong> classroom as needed. She 

spoke in sentences with mostly well-formed 

grammatical structures and had a large functional 

vocabulary. She appeared to understand 

most social conversation rules in roleplaying 

situations, but had difficulty following 

<strong>the</strong>se rules in typical conversation. During 

communication interactions she tended to 

talk quietly and keep her head down without 

making appropriate eye contact with communication 

partners. Jen often made comments 

about events or o<strong>the</strong>rs’ actions that could be 

characterized as inappropriate or rude. These 

comments appeared to interfere with communication 

maintenance. Jen did not maintain 

appropriate eye contact with peers or teaching 

staff during initial observations. Her tone of 

voice was described by a member of <strong>the</strong> teaching 

staff as “negative and sarcastic.” Jen’s 

laughing at inappropriate times was also consistently 

noted in initial observations. Her IEP 

goals related to social and pragmatic language 

included (a) using correct volume during 

classroom activities, (b) lifting her head up to 

look at <strong>the</strong> person talking to her, and (c) 

controlling her excitement by reducing <strong>the</strong> 

frequency of exaggerated arm motions and 

inappropriate laughing episodes. 

Research Design and Procedure 


We employed a single-subject multiple probe 

design across three target social and pragmatic 

language skills and replicated across five 

students. Within <strong>the</strong> multiple probe design, 

we also assessed effects of <strong>the</strong> intervention (a 

systematic teaching strategy) on two skills that 

<strong>the</strong> classroom teachers asked <strong>the</strong> research 

team to address. The three primary target behaviors 

were taking obligatory turns, taking 

nonobligatory turns, and asking partner-focused 

questions. The two secondary target behaviors 

were conversing with appropriate eye 

contact and using appropriate tone of voice in 

conversational speech. According to subjective 

information provided by teaching staff 

and recorded baseline data, <strong>the</strong>se were deficient 

skill areas for all participants. 

Prior to initiation of <strong>the</strong> project, graduate 

students in a Department of Speech Pathology 

and Audiology in a midwestern university 

were trained in data collection, systematic instruction 

methods, and role-playing strategies 

by members of <strong>the</strong> research team. Graduate 

students were instructed to initiate a total of 

15 scripted interaction opportunities and discretely 

document participant responses and 

interactions related to <strong>the</strong> five targeted social 

and pragmatic communication skills. Graduate 

students were asked to participate as communication 

partners and respond as naturalistically 

as possible to any communication 

attempts made by study participants. They 

were fur<strong>the</strong>r instructed in two levels of structured 

cues to facilitate participants’ use of 

target skills. They were instructed to refrain 

from providing additional verbal or nonverbal 

communication facilitation cues. Observation 

of role-playing scenarios between graduate 

students by members of <strong>the</strong> research team was 

used to determine training efficacy prior to 

initiating <strong>the</strong> project. Training activities continued 

until all graduate students demonstrated 

accuracy in project procedures, data 

collection, and systematic instruction methods.

Definitions of Target Behaviors and Responses 

Obligatory turns were defined as turns that 

follow a partner’s direct questions. We defined 

nonobligatory turns as turns that follow 

a partner’s comment or statement or turns 

that start a conversation. Taking turns frequently 

during interactions, including those 

that are obligatory and those that are not 

obligatory, is one way for individuals to let 

partners know that <strong>the</strong>y are interested and 

involved in <strong>the</strong> conversation and that <strong>the</strong>y are 

competent communicators. Partner-focused 

questions are questions that individuals ask 

<strong>the</strong>ir communication partners about <strong>the</strong>ir 

thoughts, feelings, and experiences (Light & 

Binger, 1998). Appropriate eye contact was 

defined as SLP graduate student judgment 

that a participant’s eye contact was adequate 

to assist <strong>the</strong> participant in conveying his/her 

message. Similarly, appropriate tone of voice 

was defined as graduate SLP student judgment 

that a participant’s tone of voice was 

appropriate for <strong>the</strong> response, comment, or 

question that was made. Use of an appropriate 

tone of voice was scored as correct when tone 

of voice was appropriate, whe<strong>the</strong>r or not obligatory 

turns, nonobligatory responses, and 

partner-focused questions were used correctly. 

No response was scored as inappropriate tone 

of voice. Graduate students used <strong>the</strong> same 

probes during each lunchtime data collection 

session. (See Figure 1 for probe statements or 

questions). Slight variations in stimulus cues 

were listed to allow graduate students to modify 

stimulus cues for participants’ unique situations 

and in an attempt to keep conversations 

as naturalistic as possible. 

Baseline condition (A). During <strong>the</strong> baseline 

condition (A) within <strong>the</strong> context of <strong>the</strong> multiple 

probe design, graduate SLP students observed, 

documented, and graphically displayed 

baseline student performance data for 

five specific pragmatic-social communication 

behaviors across a minimum of three lunchtime 

sessions per participant. During baseline 

observations, graduate students sat next to or 

across from high school student participants. 

Intervention condition (B). During <strong>the</strong> intervention 

condition (B), participants engaged 

in two consecutive 20-minute systematic group 

instructional sessions (one instructional session 

per week) for each of <strong>the</strong> three identified 

target social and pragmatic language skills 

(use of obligatory responses, use of non-obligatory 

responses, and asking partner-focused 

questions). These sessions were led by <strong>the</strong> 

third author, a graduate SLP student. Instruction 

targeting use of appropriate eye contact 

and tone of voice was introduced and reinforced 

as a part of every instructional session. 

Group instruction was followed by 20-25 minutes 

of structured individualized role-play sessions 

provided by individual graduate students, 

each assigned to work with a single high 

school participant for <strong>the</strong> duration of <strong>the</strong> 

project. In order to promote generalization of 

<strong>the</strong> skill to more naturalistic communication 

environments, role-playing sessions were 

structured to target <strong>the</strong> social and language 

skill taught during <strong>the</strong> group instructional session. 

To conduct generalization probes during 

<strong>the</strong> intervention condition (B), graduate students 

sat with participants during two lunch 

periods per week. Graduate students and high 

school participants remained paired throughout 

<strong>the</strong> study to ensure procedural reliability 

and consistency across all conditions. During 

each lunchtime session, <strong>the</strong> graduate SLP students 

initiated 15 scripted communication opportunities 

specifically designed to assess individual 

participants’ demonstration of target 

social and pragmatic language skills taught 

during <strong>the</strong> previous instructional session(s) 

(see Figure 1). Use of appropriate eye contact 

and tone of voice were evaluated in each of 

<strong>the</strong> 15 interaction opportunities. Graduate 

students verbally reinforced appropriate use 

of social and pragmatic language skills targeted 

during <strong>the</strong> previous instructional session as <strong>the</strong>y 

documented high school participants’ responses 

to all 15 stimulus communication opportunities. 

If a participant did not accurately 

respond to an initial opportunity (natural cue), 

<strong>the</strong> graduate student provided one or two additional 

predetermined levels of prompts designed 

to elicit <strong>the</strong> correct response. This leveled 

prompting system was a simplified version 

of Light’s and Binger’s (1998) original fourlevel 

prompting system. The first prompt consisted 

of an expectant look along with a repeated 

stimulus statement or question. If this 

prompt elicited an appropriate response, <strong>the</strong> 

graduate student verbally reinforced <strong>the</strong> high 

school student for emitting a correct re- 


sponse, but recorded <strong>the</strong> response as incorrect. 

If a correct response was not elicited with 

<strong>the</strong> expectant look with repeated stimulus 

Figure 1. Probe statements or questions. 


cue, <strong>the</strong> graduate student modeled <strong>the</strong> correct 

response for <strong>the</strong> participant. If <strong>the</strong> participant 

emitted a correct response, <strong>the</strong> graduate

student gave <strong>the</strong> participant positive verbal 

reinforcement but recorded <strong>the</strong> initial response 

as incorrect. Correct responses were 

recorded only when participants responded 

accurately with a natural stimulus cue. 

A slightly different prompting system was 

used to facilitate appropriate eye contact and 

tone of voice. The first level prompt remained 

<strong>the</strong> same, consisting of an expectant look and 

<strong>the</strong> repetition of <strong>the</strong> stimulus cue. The second 

level prompt consisted of pointing to a pictorial 

prompt. The first pictorial prompt depicted 

a pair of open eyes to prompt <strong>the</strong> participant 

to make eye contact with <strong>the</strong> 

communication partner. The graduate student 

pointed to <strong>the</strong> picture and repeated <strong>the</strong> 

original stimulus cue, indicating that <strong>the</strong> participant 

should respond again, but with appropriate 

eye contact. The pictorial prompt depicting 

use of appropriate voice was a picture 

of a face, with an arrow pointing toward <strong>the</strong> 

mouth and throat to facilitate use of appropriate 

tone of voice. Participants’ instruction during 

each group instructional and individual 

role-playing session included <strong>the</strong> use of <strong>the</strong>se 

prompting systems, so <strong>the</strong>y were familiar with 

<strong>the</strong> meaning both pictorial prompts. 

When a participant reached his/her predetermined 

performance criterion for one target 

pragmatic-social communication skill, instruction 

for <strong>the</strong> subsequent target skill was 

taught during <strong>the</strong> next individual portion of 

<strong>the</strong> instructional session, following <strong>the</strong> roleplaying 

activity. The research team made an a 

priori decision to discontinue target skill instruction 

if a participant did not reach <strong>the</strong> 

predetermined performance criterion within 

four probe sessions. In this case, <strong>the</strong> team 

began instruction for <strong>the</strong> student’s next identified 

target skill. 

Generalization condition (A'). During <strong>the</strong> 

maintenance (A') condition, graduate students 

continued to initiate <strong>the</strong> 15 pragmatic 

and social language communication opportunities, 

delivered without <strong>the</strong> leveled prompting 

system or verbal positive reinforcement. 

When <strong>the</strong> (A') condition was initiated for a 

previously targeted social and pragmatic language 

skill, a new social and pragmatic language 

skill was systematically taught during 

<strong>the</strong> instructional sessions. Data on student responses 

for all five target areas were collected 

during each session of <strong>the</strong> (A') condition. 

Setting 

All instructional sessions and collection of participants’ 

performance data and graduate students’ 

procedural reliability occurred within a 

single high school. Instructional sessions took 

place in a single classroom one morning per 

week and data collection for students’ performance 

took place in <strong>the</strong> high school lunchroom 

two days per week. Graduate students 

sat with <strong>the</strong> same assigned participant during 

all instructional and data collection sessions. 

Interrater Performance and Procedural Reliability 

Participant performance data and graduate 

student procedural reliability data were collected 

by additional graduate SLP students 

trained as interraters. These interraters were 

not o<strong>the</strong>rwise involved in <strong>the</strong> investigation. 

One research team member trained <strong>the</strong>se students 

in scoring interventionists’ procedures 

and participant responses. During lunchtime 

data collection sessions, interraters sat close 

enough to <strong>the</strong> high school participants and 

graduate SLP communication partners to 

hear communication exchanges. They did not 

make eye contact or engage ei<strong>the</strong>r <strong>the</strong> graduate 

student or participant in conversation; 

however, <strong>the</strong>y were instructed to respond appropriately 

to communication attempts initiated 

by participants. 

Results 

Overall results indicated that <strong>the</strong> group systematic 

instructional strategy involving individualized 

role playing was effective in improving 

<strong>the</strong> social-pragmatic skills of <strong>the</strong> 

participants. Generalization probes in <strong>the</strong> 

high school lunchroom revealed variable results 

across participants. See Figures 2 to 6 for 

graphic displays of individual participants’ 

performance data. These figures show data for 

three primary target behaviors and secondary 

behaviors assessed within <strong>the</strong> single-subject 

multiple probe design. Experimental control 

was established as all participants demonstrated 

a change in <strong>the</strong>ir target behaviors only 

when <strong>the</strong> intervention was applied to each 

behavior within <strong>the</strong> multiple probe design. 


Bob’s Performance Data Related to Primary Target 

Behaviors 

As shown in Figure 2, Bob used obligatory 

turns appropriately with a mean of 44% during 

<strong>the</strong> baseline condition (A). During Condition 

B, Bob’s mean use of obligatory turns 

was measured at 45%, a mean increase of 1%. 

With generalization probes (A'), Bob’s use of 

obligatory turns increased to a mean 71% of 

opportunities. A total mean increase of 27% 

in use of obligatory turns was measured from 

baseline through generalization conditions. 

Baseline data for Bob’s use of nonobligatory 

turns was measured at a mean 38%. During 

Condition B, Bob’s mean appropriate use of 

nonobligatory turns was measured at 70%. 

During <strong>the</strong> generalization condition (A'), Bob 

decreased his use of nonobligatory turns at a 

mean 2%, resulting in a mean use of 62%. A 

total mean increase of 24% in use of appropriate 

nonobligatory turns was measured from 

baseline through generalization conditions. 

Bob used appropriate partner-focused questions 

in a mean 31% of opportunities during 

<strong>the</strong> baseline condition (A). This mean increased 

to 35% during <strong>the</strong> intervention condition 

(B). Bob’s mean use of appropriate 

partner-focused questions increased during 

<strong>the</strong> generalization (A') condition to a mean 

40% of opportunities. This resulted in a mean 

9% increase from baseline through generalization 

conditions. 

Bob’s Performance Data Related to Eye Contact 

and Tone of Voice 

Bob’s mean percentage gain of appropriate 

eye contact from <strong>the</strong> baseline through generalization 

conditions was 6% with opportunities 

for taking obligatory turns and 13% with 

opportunities for taking nonobligatory turns. 

His percentage of appropriate eye contact decreased 

2% with opportunities for asking partner-focused 

questions from baseline through 

generalization conditions. 

Bob’s use of appropriate tone of voice with 

opportunities for taking obligatory turns decreased 

by 9% throughout <strong>the</strong> program. With 

opportunities for taking nonobligatory turns, 

Bob demonstrated no mean increase in his use 

of appropriate tone of voice from baseline 

through generalization, although he increased 


performance on this behavior during <strong>the</strong> intervention 

condition. Bob also demonstrated a 

mean decrease of 15% in his use of appropriate 

tone of voice from baseline through generalization 

conditions with opportunities for asking 

partner-focused questions. 

TJ’s Performance Data Related to Primary Target 

Behavior 

During Condition A, TJ exhibited use of appropriate 

obligatory turns at a mean rate of 

84% of opportunities. This mean decreased 

during Condition B to a rate of 70%. In Condition 

A', TJ’s mean use of appropriate obligatory 

turns occurred at a mean 98% of opportunities. 

This resulted in a total mean increase 

of 14% from <strong>the</strong> baseline through generalization 

conditions. See Figure 3 for TJ’s performance 

data. 

TJ’s mean use of appropriate nonobligatory 

turns in <strong>the</strong> baseline condition (A) occurred 

at a mean rate of 58% of opportunities. During 

<strong>the</strong> instructional condition (B), this mean 

rate increased to 70%. In <strong>the</strong> generalization 

condition (A') his mean use of appropriate 

nonobligatory turns occurred at a rate of 86% 

of opportunities, resulting in a total mean 

increase of 28%. 

In <strong>the</strong> baseline condition (A), TJ’s use of 

appropriate partner-focused questions occurred 

at a mean rate of 22%. This mean 

increased to 53% during <strong>the</strong> instructional 

condition (B). In <strong>the</strong> generalization condition 

(A'), TJ’s mean use of appropriate partnerfocused 

questions occurred at a rate of 35% of 

opportunities with a total mean increase of 

13% across all conditions. 

TJ’s Performance Data Related to Eye Contact and 

Tone of Voice 

Figure 3 shows TJ’s performance data across 

conditions for eye contact and tone of voice. 

With opportunities for taking obligatory 

turns, TJ demonstrated a total mean increase 

of 41% in <strong>the</strong> use of appropriate eye contact. 

He increased appropriate eye contact by a 

mean 50% across conditions with opportunities 

for taking nonobligatory turns. With opportunities 

for asking partner-focused questions, 

TJ’s mean use of appropriate eye

Figure 2. Bob’s performance data. 


Figure 3. TJ’s performance data. 


contact increased 41% from baseline through 

generalization conditions. 

TJ’s use of appropriate tone of voice increased 

64% throughout <strong>the</strong> program with 

opportunities for taking obligatory turns. 

With opportunities for taking nonobligatory 

turns, TJ demonstrated a mean increase of 

73% use of appropriate tone of voice across all 

conditions. TJ’s mean use of appropriate tone 

of voice increased a mean 53% across conditions 

as measured within his program related 

to asking partner-focused questions. 

Devin’s Performance Data Related to Primary 

Target Behaviors 

As shown in Figure 4, baseline data revealed 

Devin’s mean use of obligatory turns at 16% of 

opportunities. His mean use of appropriate 

obligatory turns increased to a mean 40% during 

<strong>the</strong> instructional condition and his obligatory 

turn-taking dramatically increased to a 

mean 80% of opportunities in <strong>the</strong> generalization 

condition. An overall 64% increase in 

Devin’s mean use of obligatory turns was recorded 

from baseline through generalization 

conditions. 

Baseline (A) data for Devin’s nonobligatory 

turn-taking showed a mean rate of 49% of 

opportunities. His mean nonobligatory turntaking 

decreased 4% during <strong>the</strong> intervention 

condition (B), but increased to a mean 84% 

of opportunities during <strong>the</strong> generalization 

condition (A'). This represents a mean 35% 

increase from baseline through generalization 

conditions for Devin’s nonobligatory turn-taking. 

Devin’s mean use of partner-focused questions 

during <strong>the</strong> baseline condition was measured 

at 25% of opportunities. During <strong>the</strong> 

intervention condition, his use of partner-focused 

questions increased to a mean 35% of 

opportunities. However, Devin’s mean use of 

partner-focused questions decreased to 28% 

of opportunities during <strong>the</strong> generalization 

condition (A'). This represented an overall 

mean 3% increase for Devin’s use of partnerfocused 

questions. 

Devin’s Performance Data Related to Eye Contact 


Figure 4 also shows Devin’s performance data 

related to appropriate eye contact and tone of 

voice within conversations. Given opportunities 

for taking obligatory turns, Devin demonstrated 

a total increase of 55% mean use of 

appropriate eye contact from <strong>the</strong> baseline 

condition (A) through <strong>the</strong> generalization condition 

(A'). Throughout <strong>the</strong> program, he also 

showed a mean increase of 49% in his use of 

appropriate eye contact during opportunities 

for taking nonobligatory turns but he demonstrated 

an overall mean 1% decrease in his use 

of appropriate eye contact during opportunities 

for asking partner-focused questions. 

Devin’s mean use of appropriate tone of 

voice increased by 70% from <strong>the</strong> baseline 

through generalization conditions within opportunities 

for taking obligatory turns and increased 

by 54% within opportunities for taking 

nonobligatory turns. Within opportunities 

for asking partner-focused questions, Devin 

demonstrated an overall increase of 9% for 

mean use of appropriate tone of voice 

throughout <strong>the</strong> program. See Figure 4 for 

Devin’s tone of voice data. 

Eric’s Performance Data Related to Primary 

Target Behaviors 

Baseline data indicate that Eric took obligatory 

turns during 72% of opportunities provided 

during lunchtime conversations. During 

<strong>the</strong> intervention condition, Eric’s mean use of 

obligatory turns increased to 95% of opportunities. 

This mean rate decreased to 82% during 

<strong>the</strong> generalization condition, representing 

a total mean increase of 10% from baseline 

through generalization conditions, as shown 

in Figure 5. 

Eric’s rate of taking nonobligatory turns was 

measured at a mean 53% of opportunities 

during Condition A. During Condition B, his 

mean use of appropriate nonobligatory turns 

increased to a rate of 60% of opportunities. 

Eric’s mean use of appropriate nonobligatory 

turns was measured at a mean 69% during 

Condition A'. As seen in Figure 5, Eric increased 

his use of nonobligatory turns by a 

mean 16% from Condition A through Condition 

A'. 

During <strong>the</strong> baseline phase, Eric’s asking of 

appropriate partner-focused questions during 

lunchtime conversations was measured at a 

mean rate of 40% of opportunities he had. 

During <strong>the</strong> intervention condition, this mean 


Figure 4. Devin’s performance data. 


Figure 5. Eric’s performance data. 


decreased to 15%. In <strong>the</strong> generalization condition, 

Eric asked appropriate partner-focused 

questions at a mean rate of 44% of opportunities. 

This represented a mean increase of 

4% from <strong>the</strong> baseline condition through <strong>the</strong> 

generalization condition. 

Eric’s Performance Data Related to Eye Contact 


Eric demonstrated a total mean increase of 

17% occurred from baseline condition (A) to 

generalization condition (A') for mean use of 

appropriate eye contact with opportunities for 

taking obligatory turns. With opportunities 

for taking nonobligatory turns, Eric’s use of 

appropriate eye contact increased a total 

mean 11% across <strong>the</strong> three study conditions. 

As seen in Figure 5, a total 24% mean increase 

in Eric’s use of appropriate eye contact occurred 

from Condition A through Condition 

A' with opportunities for asking partner-focused 

questions. 

Figure 5 also shows a total mean 17% increase 

in Eric’s use of appropriate tone of 

voice with opportunities for taking obligatory 

turns from <strong>the</strong> baseline condition through <strong>the</strong> 

generalization condition. Eric increased his 

use of appropriate tone of voice by 12% across 

<strong>the</strong> three study conditions with opportunities 

for taking nonobligatory turns. A total mean 

increase of 20% for Eric’s use of appropriate 

tone of voice was noted with opportunities for 

asking partner-focused questions from baseline 

through generalization conditions. 

Jen’s Performance Data Related to Primary Target 

Behavior 

As indicated in Figure 6, Jen took appropriate 

obligatory turns at a mean appropriately 64% 

during <strong>the</strong> baseline condition (A). During <strong>the</strong> 

intervention condition (B), her mean rate of 

obligatory turn-taking increased to 80%. During 

generalization probes, Jen appropriately 

took obligatory turns during 99% of opportunities 

provided. Results indicate an accelerating 

trend in Jen’s appropriate responses when 

given opportunities for taking obligatory 

turns. 

Baseline data for Jen’s nonobligatory turntaking 

revealed a mean usage of 76%. During 

<strong>the</strong> intervention condition, her mean appro- 

priate use of nonobligatory turns was measured 

at 95% of opportunities. Generalization 

data showed a slight decrease in nonobligatory 

turn usage, with a mean of 93% appropriate 

responding during <strong>the</strong> A' condition. 

Baseline data for Jen’s use of partner-focused 

questions revealed a mean of 34% of 

opportunities. A mean of 30% was recorded 

during <strong>the</strong> intervention condition for her use 

of partner-focused questions. Evaluation of 

generalization of use of partner-focused questions 

found a decrease in Jen’s use of appropriate 

partner-focused questions. A mean appropriate 

use of 12% was recorded in <strong>the</strong> 

generalization condition. 

Jen’s Performance Data Related to Eye Contact 


Jen demonstrated a mean 54% increase from 

baseline (A) to generalization (A') for use of 

appropriate eye contact during opportunities 

for taking obligatory turns. A 35% mean increase 

of appropriate eye contact occurred 

across all conditions during opportunities for 

making nonobligatory turns. With opportunities 

for asking partner-focused questions, Jen 

increased appropriate eye contact by 48% 

from baseline through generalization conditions. 

Jen increased her use of appropriate tone of 

voice by a mean 30% from baseline through 

generalization conditions with opportunities 

for taking obligatory turns. She showed a 25% 

mean increase in her use of appropriate tone 

of voice across all conditions with opportunities 

for taking nonobligatory turns. Data also 

revealed a mean 21% increase in Jen’s use of 

appropriate tone of voice from baseline 

through generalization conditions. 

Reliability Data 


Performance reliability data were collected 

during approximately 20% of all sessions 

across all conditions. Trained graduate students 

who were not involved in <strong>the</strong> investigation 

previously collected interrater data. Overall 

interobserver agreement for participant 

performance data ranged from 94-100% (M 

95.1). 

Performance reliability data for Eric were 

collected during five out of 22 (22.7%) ses-

Figure 6. Jen’s performance data. 


sions. The mean interobserver agreement rate 

for Eric’s performance was 95.2%. Reliability 

data for Devin were collected for five out of 22 

(22.7%) sessions. The mean interobserver reliability 

rate for Devin’s performance was 

95.2%. Performance reliability data for TJ 

were collected for four out of 18 (22%) sessions 

and revealed a mean interobserver rate 

of 97%. Performance reliability data for Jen 

were ga<strong>the</strong>red for four out of 22 (18%) sessions 

and mean interobserver agreement was 

calculated at 94%. Interobserver reliability 

data for Bob were collected for four out of 22 

(18%) sessions and showed a mean interobserver 

agreement rate of 94%. 

Data related to procedural reliability were 

also collected for approximately 20% of all 

sessions. Independent raters documented 

whe<strong>the</strong>r or not graduate students used an attentional 

cue prior to initiating a facilitating 

comment or question, perceived naturalness 

of conversations, use of predetermined cueing 

levels, and use of positive reinforcement during 

intervention conditions. Results indicated 

an overall procedural reliability rating of 96% 

across all graduate students. This percentage 

indicated an acceptable level of procedural 

reliability. 


This study’s results indicate an overall functional 

relationship between a systematic instructional 

approach and increased socialpragmatic 

skills for high school students with 

moderate cognitive disabilities. Specifically, 

participants generally increased <strong>the</strong>ir skills related 

to taking obligatory turns, taking nonobligatory 

turns, asking partner-focused questions, 

using appropriate eye contact, and 

using appropriate tone of voice. While some 

performance variability was indicated, general 

improvement was documented in multiple areas 

for all participants. Individual learning 

and personality characteristics as well as naturally 

occurring distractions in <strong>the</strong> generalization 

setting may have contributed to this variability. 

This study also shows that high school 

lunchroom environments may serve as naturalistic 

settings for facilitating and assessing 

students’ generalization of pragmatic-social 

language skills. Our results extend <strong>the</strong> find- 

ings of McGee and colleagues (1992) who 

found that peer incidental teaching resulted 

in gains by students with disabilities in reciprocal 

peer communicative interactions in an 

academic setting but that <strong>the</strong>se skills did not 

generalize to school mealtimes. Strategies for 

promoting pragmatic-social skills in naturalistic 

settings need to be fur<strong>the</strong>r investigated. 

We recommend more research investigating 

<strong>the</strong> effectiveness of various systematic instructional 

strategies on <strong>the</strong> social-pragmatic 

skills of students of varying ages and ability 

levels. The current study contributes to <strong>the</strong> 

literature base that supports structured facilitation 

techniques that enhance communication 

interactions and relationships between 

students with disabilities and <strong>the</strong>ir peers. However, 

we recommend enhancing <strong>the</strong> generalizability 

of <strong>the</strong> current study’s findings by implementing 

similar systematic instructional 

procedures to o<strong>the</strong>r populations and settings 

such as community-based and vocational educational 

sites. For example, extending <strong>the</strong> 

findings of Ingersoll, Dvortcsak, Whalen, and 

Sikora (2005) on <strong>the</strong> effectiveness of developmental 

social-pragmatic language intervention 

approaches beyond children with autism 

spectrum disorders may encourage more research-based 

practice in spontaneous speech 

and communicative interactions between 

peers with and without disabilities in naturalistic 

environments. 

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and Developmental Disorders, 9, 41–54. 







Combined Curricular Intervention with Brief Hands Down to 

Decrease Hand Mouthing and <strong>the</strong> Use of Arm Splints for a 

Young Boy with Profound Disabilities 

Helen I. Cannella-Malone 

The Ohio State University 

Mark F. O’Reilly 

The University of Texas at Austin 

Jeff Sigafoos 

Victoria University of Wellington 

Jeffery M. Chan 

The University of Texas at Austin 

Abstract: Hand mouthing is highly prevalent in individuals with severe to profound developmental disabilities. 

Frequent hand mouthing may interfere with appropriate responding, have negative health impacts, and result 

in restrictive interventions, such as <strong>the</strong> application of arm splints, to prevent this challenging behavior. The 

continuous application of arm splints can have negative health outcomes and can interfere with daily activities. 

The purpose of this study was to replace arm splints with appropriate curricular activities in a 10-year-old boy 

with profound disabilities. An intervention package involving <strong>the</strong> provision of curricular activities and a brief 

hands down procedure was evaluated using a combined alternating treatments and reversal design across 

several hours of <strong>the</strong> school day to demonstrate <strong>the</strong> effectiveness of <strong>the</strong> intervention on <strong>the</strong> reduction of hand 

mouthing. The intervention was successfully implemented across several hours of <strong>the</strong> student’s school day within 

his natural school environments. Limitations, implications, and directions for future research are discussed. 

The prevalence of hand mouthing, a form of 

stereotypic behavior, has been estimated to 

occur in up to 16% of individuals with severe 

to profound disabilities (Rast & Jack, 1992). 

Hand mouthing can be detrimental to an individual’s 

health, adaptive behavior, and social 

functioning (Pelios, Morren, Tesch, & Axelrod, 

1999; Wallace, Iwata, Zhou, & Goff, 

1999), because it can lead to tissue damage, 

hematoma, salivary dermatitis, scarring, and 

skin breakage (Ball, Campbell, & Barkemeyer, 

1980; Fisher, Piazza, Bowman, Hanley, & Adelinis, 

1997; Luiselli, 1989). It can also interfere 

with participation in daily educational 

and living activities, because <strong>the</strong> individual’s 


be addressed to Helen I. Cannella-Malone, The 

Ohio State University, PAES Building, Room A348, 

305W17 th Avenue, Columbus, OH 43210. Email: 

malone.175@osu.edu 


hands are consistently in his or her mouth 

(McClure, Moss, McPeters, & Kirkpatrick, 

1986). Additionally, it is considered to be socially 

maladaptive because of <strong>the</strong> repulsive 

sights and smells it produces (Realon, Favell, 

& Cacace, 1995). 

A variety of interventions have been used to 

reduce <strong>the</strong> occurrence of hand mouthing in 

individuals with severe to profound disabilities, 

including overcorrection (Foxx & Azrin, 

1973), contingent sensory reinforcement 

(Barmann, 1980; Case-Holden & Hupp, 

1989), differential reinforcement of o<strong>the</strong>r behaviors 

(Favell, McGimsey, & Schell, 1982; Mc- 

Clure et al., 1986), differential reinforcement 

in combination with punishment (Lockwood 

& Williams, 1994; Mazaleski, Iwata, Rodgers, 

Vollmer, & Zarcone, 1994; Minness, 1980), 

environmental enrichment (Realon et al., 

1995), and response restriction via mechanical 

restraint, such as arm splints (Ball et al., 

1980; Luiselli & Waldstein, 1994).

The use of arm splints has been successful 

at eliminating hand mouthing by preventing 

<strong>the</strong> individual from being able to move his or 

her hands to <strong>the</strong> mouth. While effective as a 

preventative strategy, <strong>the</strong> use of arm splints 

has several potential disadvantages, including 

possible negative impacts on health, adaptive 

behavior, and social functioning of persons 

who wear <strong>the</strong>m (Fisher et al., 1997; Luiselli, 

1989). Additionally, researchers have found 

that long-term wearing of arm splints can 

cause health problems such as bone demineralization, 

shortening of tendons, muscle atrophy, 

arrested motor development, contractures, 

and restricted circulation (Fisher et al.; 

Oliver, Murphy, Hall, Arron, & Leggett, 

2003). These findings cast doubt on <strong>the</strong> ethical 

aspects of <strong>the</strong> long-term use of arm splints 

for reducing hand mouthing in individuals 

with severe to profound disabilities. 

Due to <strong>the</strong> ethical issues raised by <strong>the</strong> use of 

arm splints as a preventative intervention, it is 

important to examine o<strong>the</strong>r antecedent interventions 

that can be implemented to prevent 

<strong>the</strong> occurrence of hand mouthing. Several 

studies have investigated <strong>the</strong> use of various 

forms of environmental enrichment to prevent 

<strong>the</strong> occurrence of hand mouthing. For 

example, Vollmer, Marcus, and LeBlanc 

(1994) provided three individuals with severe 

disabilities who engaged in hand mouthing 

and hand biting access to an array of highly 

preferred stimuli and noted decreases in challenging 

behavior and increases in appropriate 

behavior across 10 min sessions. For one participant, 

explicit reinforcement of appropriate 

behaviors and a brief (5 s) time out was 

required. Realon et al. (1995) found reductions 

in hand mouthing when preferred toys 

were consistently made available to one participant 

with profound mental retardation 

across 5 min sessions. 

Although interventions have been successful 

at reducing challenging behavior, <strong>the</strong>y often 

only examine <strong>the</strong> effectiveness of an intervention 

over a short period of time (e.g., 10 

min) and within only one environment. One 

purpose of <strong>the</strong> present study was to evaluate 

<strong>the</strong> effects of an intervention package for 

eliminating <strong>the</strong> use of arm splints in a boy with 

profound disabilities who had a long history of 

wearing arm splints to prevent hand mouthing. 

The intervention package included <strong>the</strong> 

provision of curricular activities and a brief 

hands down procedure. A second purpose of 

this study was to examine <strong>the</strong> effectiveness of 

<strong>the</strong> intervention across <strong>the</strong> student’s entire 

school day in his natural environments. 

Method 

Participant, Settings, and Materials 

Mat<strong>the</strong>w was a 10-year-old, Caucasian boy with 

profound mental retardation, cerebral palsy, 

and hydrocephalus. He did not speak or use 

any alternative form of symbolic communication. 

At <strong>the</strong> beginning of this study, Mat<strong>the</strong>w 

would respond to one-sentence requests, such 

as “Push <strong>the</strong> switch to tell me you’re here”. By 

<strong>the</strong> time <strong>the</strong> intervention was implemented, 

he had been taught by his classroom teacher 

to respond to one-sentence requests by pointing 

to <strong>the</strong> correct answer or his choice when 

presented with an array of items and/or photographs. 

He was non-ambulatory and spent 

<strong>the</strong> majority of his school day seated in a 

wheel chair or on a bean bag or mat on <strong>the</strong> 

floor. Mat<strong>the</strong>w was completely dependent on 

o<strong>the</strong>rs for all of his daily functioning (e.g., 

toileting, feeding, washing, etc.). He attended 

a functional life skills classroom at a school for 

individuals with severe to profound developmental 

disabilities. When he engaged in hand 

mouthing, his teachers would give him one 

verbal warning. After <strong>the</strong> warning, he would 

often stop hand mouthing for approximately 

30 s while looking at <strong>the</strong> teacher, <strong>the</strong>n begin 

hand mouthing again if no fur<strong>the</strong>r direction 

or engagement was provided. If he continued 

to engage in hand mouthing, his teachers 

would put arm splints on both arms. Once <strong>the</strong> 

arm splints were placed on Mat<strong>the</strong>w, <strong>the</strong>y 

were generally not removed until <strong>the</strong> end of 

<strong>the</strong> school day when he left <strong>the</strong> school. 

All intervention sessions were conducted in 

Mat<strong>the</strong>w’s natural school environments, 

which included his classroom, <strong>the</strong> library, <strong>the</strong> 

gymnasium, and an outdoor playground. Materials 

for <strong>the</strong> curricular activities included 

picture books, non-interlocking puzzles, and 

various pieces of gym equipment, such as 

balls. 

Combined Curricular Intervention / 361

Target Behavior 

Hand mouthing was defined as <strong>the</strong> insertion 

of any part of <strong>the</strong> hand into <strong>the</strong> mouth or <strong>the</strong> 

protrusion of <strong>the</strong> tongue out of <strong>the</strong> mouth 

onto <strong>the</strong> hand. For a new occurrence of hand 

mouthing to be recorded, Mat<strong>the</strong>w’s hand 

had to be completely removed from his 

mouth <strong>the</strong>n reinserted or <strong>the</strong> tongue completely 

removed from <strong>the</strong> hand and <strong>the</strong>n reapplied 

to <strong>the</strong> hand. 

Data Collection and Interobserver Agreement 

Data were collected in real time using a scatterplot 

data collection system (Touchette, 

MacDonald, & Langer, 1985). Data were collected 

during two different time blocks during 

<strong>the</strong> day. Time Block A (i.e., 11:30–1:00) was 

broken into six 15 min intervals, and Time 

Block B (i.e., 1:00–2:45) was broken into 

seven 15 min intervals. During each interval, 

<strong>the</strong> occurrence of hand mouthing was indicated 

for <strong>the</strong> first three occurrences for ease 

of data collection and interpretation 

(Touchette et al.). Therefore, hand mouthing 

could be scored 18 times in Time Block A and 

21 times in Time Block B. 

To determine inter-observer agreement, 

two observers (i.e., <strong>the</strong> first author and a graduate 

student) independently scored data on 

<strong>the</strong> target behavior for at least 30% of all 

sessions. Data from <strong>the</strong> two observers were 

compared for agreements and disagreements. 

An agreement was scored if both observers 

recorded <strong>the</strong> occurrence or non-occurrence 

of hand mouthing within each 15 min interval. 

In <strong>the</strong> intervention, an agreement was 

scored if each observer recorded <strong>the</strong> same 

number of occurrences of hand mouthing 

within each 15 min interval. Any discrepancy 

between <strong>the</strong> two observers was counted as a 

disagreement. Interobserver agreement on 

<strong>the</strong> dependent measure was calculated on an 

interval-by-interval basis using <strong>the</strong> formula: 

Agreements/(Disagreements Agreements) 

100%. Inter-observer agreement data were 

collected for 33% of <strong>the</strong> sessions and overall 

agreement was calculated to be 96.7% (range 

83.3–100%). 

Experimental Design 

A combination reversal and alternating treatments 

design across two time blocks was used 

(Kazdin, 1982). During Time Block A, <strong>the</strong> 

reversal design utilized an ABAB reversal pattern, 

while Time Block B utilized a non-reversal 

ABC pattern. 

Intervention 


During baseline, Mat<strong>the</strong>w’s arm splints were 

removed and occurrences of hand mouthing 

were recorded within his natural settings (e.g., 

classroom, gymnasium, library, etc.). His 

teachers were asked to do what <strong>the</strong>y would 

normally do, but were asked not to put his 

arm splints on. The first author sat in a corner 

of <strong>the</strong> room and observed Mat<strong>the</strong>w. During 

each 15 min interval, <strong>the</strong> first three occurrences 

of hand mouthing were recorded on 

<strong>the</strong> scatterplot data sheet. Once three occurrences 

of hand mouthing occurred in an interval, 

no fur<strong>the</strong>r data were collected during 

that interval, and data recording resumed at 

<strong>the</strong> beginning of <strong>the</strong> next 15 min interval. 

Baseline data were collected from 11:30 a.m. 

to 2:45 p.m. (i.e., Time Blocks A and B). During 

most baseline sessions, Mat<strong>the</strong>w was 

placed in a bean bag or on a mat on <strong>the</strong> floor 

and provided ei<strong>the</strong>r free access to <strong>the</strong> television 

or switch activated access to <strong>the</strong> radio or 

a book on tape. Very little interaction typically 

occurred with Mat<strong>the</strong>w. 

The intervention consisted of <strong>the</strong> provision 

of curricular activities and a brief hands down 

procedure. During intervention, <strong>the</strong> first author 

placed curricular materials within Mat<strong>the</strong>w’s 

reach and waited 10 s for him to initiate 

appropriate engagement with <strong>the</strong> materials. If 

he did not engage in <strong>the</strong> activity within 10 s, a 

least-to-most prompting hierarchy was used to 

prompt engagement. Specifically, <strong>the</strong> <strong>the</strong>rapist 

would first provide a verbal prompt (e.g., 

“Ok Mat<strong>the</strong>w, let’s work on <strong>the</strong> puzzle.”), <strong>the</strong>n 

a gestural prompt (e.g., pointing to <strong>the</strong> puzzle), 

<strong>the</strong>n a model prompt (e.g., placing one 

puzzle piece in place), and finally a physical 

prompt (e.g., guiding his hand to pick up and 

place a puzzle piece). Curricular activities presented 

to Mat<strong>the</strong>w included reading books to 

him while he turned <strong>the</strong> pages, having him 

complete his choice of non-interlocking puz-

Figure 1. Intervention results for Mat<strong>the</strong>w across Time Blocks A and B. 

zles, going for walks while he pushed himself 

in his wheelchair, and playing games in <strong>the</strong> 

gymnasium. Mat<strong>the</strong>w was provided a choice of 

what activity he wanted to engage in by showing 

him <strong>the</strong> activities in an array of photographs 

and having him point to <strong>the</strong> activity he 

wanted. All activities were part of his individualized 

educational plan. 

When <strong>the</strong> class engaged in group activities, 

<strong>the</strong> first author provided one-on-one assistance 

to Mat<strong>the</strong>w as needed within <strong>the</strong> group 

setting. When <strong>the</strong> class engaged in center activities, 

<strong>the</strong> first author provided Mat<strong>the</strong>w with 

an array of curricular activities to choose from 

and followed <strong>the</strong> previously described procedures. 

If Mat<strong>the</strong>w engaged in hand mouthing, 

<strong>the</strong> first author immediately removed Mat<strong>the</strong>w’s 

from his mouth, said “hands down”, 

and held his hands in his lap for 10 s. Following 

<strong>the</strong> 10 s, Mat<strong>the</strong>w was prompted to engage 

with <strong>the</strong> curricular materials. 

In <strong>the</strong> reversal back to baseline in Time 

Block B, <strong>the</strong> teachers began to interact with 

Mat<strong>the</strong>w in a manner different than in all 

o<strong>the</strong>r baseline phases. Therefore, this phase 

was relabeled as <strong>the</strong> teacher intervention. Dur- 

ing this phase, <strong>the</strong> classroom teacher and her 

teaching assistants began to include Mat<strong>the</strong>w 

in regular small group (SG) and one-to-one 

(1:1) instruction, which <strong>the</strong>y had not done in 

any of <strong>the</strong> o<strong>the</strong>r baseline sessions. While <strong>the</strong> 

teachers did provide curricular activities, <strong>the</strong>y 

did not implement <strong>the</strong> brief hands down procedure. 

Additionally, he was not placed in a 

beanbag or on a mat during this phase, and he 

was no longer given free access to <strong>the</strong> television 

or switch-activated access to <strong>the</strong> radio or 

books on tape. During 10 of <strong>the</strong> 31 intervals, 

Mat<strong>the</strong>w was given an independent task and 

was not engaged with <strong>the</strong> teacher, her assistants, 

or his peers. The teachers shifted <strong>the</strong>ir 

instruction independently and without 

prompting from <strong>the</strong> researcher. As in all o<strong>the</strong>r 

baseline conditions, <strong>the</strong> teachers did not apply 

Mat<strong>the</strong>w’s splints, even when he did engage 

in hand mouthing. 

Results 

Figure 1 shows <strong>the</strong> number of occurrences 

(up to three per interval) of hand mouthing 

for <strong>the</strong> two time blocks in which daily sessions 


were conducted. During <strong>the</strong> initial baseline 

phase in Time Block A (sessions 1–12), Mat<strong>the</strong>w 

engaged in hand mouthing an average 

of 11.4 times (range 2–18) per session. When 

<strong>the</strong> intervention was introduced in Time 

Block A (sessions 13–15), occurrences of hand 

mouthing decreased dramatically to 0–2 occurrences. 

Upon a return to baseline (sessions 

16–18), hand mouthing increased to an average 

of 13.7 times (range 6–18) per session. In 

<strong>the</strong> final return to intervention (sessions 19– 

21), hand mouthing did not occur once over 

three sessions. 

During <strong>the</strong> baseline phase in Time Block B 

(sessions 1–6), hand mouthing occurred an 

average of 9 times (range 6–15) per session. 

When <strong>the</strong> intervention was implemented (sessions 

7–12), an immediate decrease in <strong>the</strong> 

occurrence of hand mouthing to an average 

of 1.3 times (range 0–2) per session was observed. 

When <strong>the</strong> intervention was removed in 

session 13 and <strong>the</strong> teachers began to intervene, 

<strong>the</strong> average occurrence of hand mouthing 

increased to an average of 5.8 times 

(range 3–9) per session in <strong>the</strong> remaining five 

sessions. During this last phase in Time Block 

B, Mat<strong>the</strong>w was out of <strong>the</strong> classroom (na) for 

four full sessions and <strong>the</strong> final 15 min interval 

for all but <strong>the</strong> first session. 


By prompting engagement with curricular materials 

and implementing a brief hands down 

procedure, we were able to remove Mat<strong>the</strong>w’s 

arm splints and maintain low levels of hand 

mouthing across a two hour and forty five 

minute period in several school environments. 

Because Mat<strong>the</strong>w was not in arm 

splints and was provided with curricular activities, 

he engaged in higher levels of appropriate 

behavior. Additionally, with no training, 

<strong>the</strong> teachers in <strong>the</strong> classroom began to independently 

implement <strong>the</strong> curricular component 

of <strong>the</strong> intervention successfully during 

Time Block B. 

While <strong>the</strong>se results are promising, several 

issues should be considered. First, we were 

only able to complete this study with one participant. 

Although this intervention was successful 

with our participant, it is not known if 

this procedure would have similar effects with 

o<strong>the</strong>r students. This study should <strong>the</strong>refore be 


replicated within natural contexts with o<strong>the</strong>r 

participants who have severe to profound disabilities 

and engage in hand mouthing. 

A second consideration is that <strong>the</strong> intervention 

utilized both a curricular intervention 

and a brief hands down component. One 

might argue that, even though both procedures 

were in effect, <strong>the</strong> decrease in hand 

mouthing might have been due to only one 

component of <strong>the</strong> intervention (i.e., curricular 

intervention or brief hands down). Based 

on all of <strong>the</strong> intervention data in both Time 

Blocks A and B, <strong>the</strong> use of <strong>the</strong> brief hands 

down procedure was only utilized in 10% of 

<strong>the</strong> intervention intervals, and implemented 

only 14 times out of 234 possible opportunities. 

This might suggest that <strong>the</strong> brief hands 

down component of <strong>the</strong> intervention could 

naturally be faded out as hand mouthing continued 

to decrease. This data also suggests that 

<strong>the</strong> curricular intervention had a significant 

impact on hand mouthing, as 85% of <strong>the</strong> 

intervals in <strong>the</strong> intervention phases had no 

occurrences of hand mouthing. 

On <strong>the</strong> o<strong>the</strong>r hand, when <strong>the</strong> teachers implemented 

<strong>the</strong> intervention without <strong>the</strong> brief 

hands down component, <strong>the</strong> decrease in hand 

mouthing was not as significant as during intervention 

sessions conducted by <strong>the</strong> researcher. 

One reason for <strong>the</strong> decreased effectiveness 

of <strong>the</strong> teacher intervention might be 

that <strong>the</strong> teachers did not implement <strong>the</strong> brief 

hands down component. A second reason may 

be due to <strong>the</strong> fact that <strong>the</strong> teachers were not 

trained to implement any component of <strong>the</strong> 

intervention, but simply began to include Mat<strong>the</strong>w 

in curricular activities. The data do indicate 

that when <strong>the</strong> teachers were working with 

Mat<strong>the</strong>w, he only engaged in hand mouthing 

four times out of 63 possible opportunities, 

which is an average of less than one occurrence 

per session. This might suggest that by 

<strong>the</strong> time <strong>the</strong> teachers began to independently 

implement <strong>the</strong> curricular aspect of <strong>the</strong> intervention, 

<strong>the</strong> brief hands down procedure was 

no longer necessary. A final reason for <strong>the</strong> 

increased occurrence during <strong>the</strong> teacher intervention 

might be that Mat<strong>the</strong>w was more 

likely to engage in high levels of hand mouthing 

when given independent tasks that did not 

involve any engagement with an adult. Mat<strong>the</strong>w 

was given such tasks in 10 of <strong>the</strong> 31 

teacher intervention sessions. In <strong>the</strong>se 10 ses-

sions, he engaged in hand mouthing an average 

of 83% of <strong>the</strong> time, which indicates that 

<strong>the</strong> teachers were able to implement <strong>the</strong> intervention 

effectively when working with Mat<strong>the</strong>w, 

but that independent seatwork led to a 

return to baseline levels of hand mouthing. 

The above data suggests ano<strong>the</strong>r limitation 

to this study in that we did not address times 

when Mat<strong>the</strong>w would be given independent 

tasks to complete. During <strong>the</strong> majority of <strong>the</strong> 

baseline conditions, Mat<strong>the</strong>w was allowed free 

access to television or switch activated access 

to <strong>the</strong> radio or books on tape. During <strong>the</strong>se 

times, his hand mouthing occurred at high 

rates. Although we were able to reduce his 

hand mouthing by incorporating significantly 

more activity into his day, it may not be possible, 

or beneficial, for a student to have no 

independent or free time during <strong>the</strong> day. It is 

possible that a traditional use of environmental 

enrichment using items that would keep 

<strong>the</strong> hands occupied would be effective during 

<strong>the</strong>se independent times during <strong>the</strong> day. Future 

research should examine <strong>the</strong> effectiveness 

of targeting challenging behavior within 

<strong>the</strong> context of group work, one-on-one work, 

and independent work. 

Ano<strong>the</strong>r limitation to this study is that <strong>the</strong>re 

was no clear reversal in Time Block B. This 

likely occurred because <strong>the</strong> teachers began 

including Mat<strong>the</strong>w in <strong>the</strong> small group and 

one-on-one activities in Time Block B, which 

<strong>the</strong>y did not do during Time Block A. The 

teacher intervention phase in Time Block B 

did indicate an increase in hand mouthing 

from an average of 1.3 times per session in 

intervention to an average of 5.8 times per 

session in <strong>the</strong> teacher intervention, though 

this was a decrease from <strong>the</strong> initial baseline 

phase (average 9 times per session). The possible 

reasons for this data were explained 

above. Although <strong>the</strong> independent change in 

teacher behavior did reduce <strong>the</strong> level of experimental 

control in Time Block B, <strong>the</strong> 

change in <strong>the</strong>ir behavior was meaningful for 

Mat<strong>the</strong>w and we did not want to instruct <strong>the</strong>m 

to discontinue <strong>the</strong>ir change. Additionally, a 

very clear reversal was seen in Time Block A, 

suggesting that <strong>the</strong> intervention was effective 

for Mat<strong>the</strong>w. 

Two final considerations are that, due to 

time constraints, we were unable to collect 

maintenance data within Mat<strong>the</strong>w’s classroom 

with his teachers to examine whe<strong>the</strong>r <strong>the</strong> reduced 

levels of hand mouthing would maintain 

over time as well as determine if <strong>the</strong> 

teachers would be able to maintain <strong>the</strong> intervention. 

We were also unable to transfer <strong>the</strong> 

role of data collection to <strong>the</strong> teachers during 

this study, so it is not known if <strong>the</strong>y would be 

able to both implement <strong>the</strong> intervention and 

maintain accurate data collection. However, 

because we used a scatterplot to collect <strong>the</strong> 

data, teachers would only need to collect data 

on <strong>the</strong> first three occurrences of a behavior 

during an interval, ra<strong>the</strong>r than on each occurrence 

of <strong>the</strong> behavior. Research should also 

consider <strong>the</strong> use of scatterplot data collection 

in natural environments to monitor <strong>the</strong> effectiveness 

of interventions across <strong>the</strong> entire day. 

While some might consider <strong>the</strong> use of <strong>the</strong> 

scatterplot as a limitation because it is less 

sensitive to behavior change than interval recording, 

this method is more amenable to 

collecting data over <strong>the</strong> course of several 

hours and is likely to be more feasible for 

teachers to implement than 10 s interval recording 

systems. Additionally, in Time Block 

A especially, clear changes in behavior were 

observed from baseline to intervention 

phases. Finally, using scatterplot data, we were 

able to examine <strong>the</strong> effectiveness of <strong>the</strong> intervention 

across several hours, ra<strong>the</strong>r than over 

10 min sessions, which enhances <strong>the</strong> social 

validity of this study. 

While a clear reversal was not observed in 

Time Block B, <strong>the</strong>re are several advantages to 

this study that compensate for <strong>the</strong> reduced 

level of experimental control. First, because 

<strong>the</strong> intervention was conducted within Mat<strong>the</strong>w’s 

natural environments, he was able to 

remain in his classroom and participate in 

activities with his peers. In line with that, <strong>the</strong> 

teachers were able to observe <strong>the</strong> intervention 

being implemented and <strong>the</strong> changes in Mat<strong>the</strong>w’s 

behavior. Although <strong>the</strong> teachers were 

never trained to implement <strong>the</strong> intervention, 

<strong>the</strong>y independently began implementing <strong>the</strong> 

curricular intervention with Mat<strong>the</strong>w in Time 

Block B, suggesting that <strong>the</strong> ease of implementing 

<strong>the</strong> intervention was such that it 

could be implemented within <strong>the</strong> natural context 

of a classroom. Future research should 

continue to examine <strong>the</strong> effectiveness of interventions 

implemented by teachers and <strong>the</strong>ir 


assistants within <strong>the</strong> natural contexts of a participant’s 

daily schedule. 

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Received: 14 February 2007 

Initial Acceptance: 12 April 2007 



Effects of a Reciprocal Questioning Intervention on <strong>the</strong> 

Question Generation and Responding of Children with 

Autism Spectrum Disorder 

Kelly Whalon 

The College of William and Mary 

Mary Frances Hanline 

Florida State University 

Abstract: A multiple baseline design across participants was used to investigate <strong>the</strong> effects of reciprocal 

questioning strategy instruction delivered in cooperative pairs on <strong>the</strong> question generation and responding of 

children with autism spectrum disorder. Three children with autism spectrum disorder and nine general 

education peers participated in <strong>the</strong> study. Following intervention, children with autism increased frequency of 

question generation and responding using a story map framework. Social validity data indicated children with 

autism spectrum disorder and <strong>the</strong>ir general education peers found <strong>the</strong> intervention helpful, and parents 

perceived a change in <strong>the</strong>ir child’s reading and language skills. 

“Learning to read builds on cognitive, linguistic, 

and social skills that have developed from 

<strong>the</strong> earliest age” (Rayner, Foorman, Perfetti, 

Pesetsky, & Seidenberg, 2001, p. 34). Basic to 

reading development is a child’s proficiency 

in language (Rayner et al.). For children with 

autism spectrum disorder (ASD), however, 

<strong>the</strong> reliance on language development to facilitate 

reading skills is problematic, as children 

with ASD typically experience difficulty 

in acquiring <strong>the</strong> linguistic skills needed for 

effective reading (Myles et al., 2002; Norbury 

& Bishop, 2002). Because of <strong>the</strong> variability in 

acquisition of cognitive, linguistic and social 

skills, it is likely that learning to read will 

present a range of challenges for children 

with ASD. 

In comparison to typically developing 

peers, children with autism generally acquire 

speech late, and “a substantial minority” fail to 

develop fluent speech by adolescence or 

adulthood (Lord & Paul, 1997, p. 204). Children 

with ASD that develop speech, typically 

demonstrate good mechanics of language 


be addressed to Kelly Whalon, The College of William 

and Mary, P.O. Box 8795, Williamsburg, VA 

23187-8795. Email: kjwhal@wm.edu 



(Minshew, Goldstein, & Siegel, 1995) with accurate 

articulation, and phonological development 

similar to that of <strong>the</strong>ir general education 

peers (Tager-Flusberg, Paul, & Lord, 2005), 

yet have difficulty with more complex syntax 

and semantics as well as pragmatic aspects of 

language (Tager-Flusberg & Joesph, 2003). 

Some children with ASD appear to only have 

difficulties with social aspects of language 

ra<strong>the</strong>r than syntactic or semantic difficulties, 

and o<strong>the</strong>rs may make gains in social aspects of 

language but continue to have limited spoken 

language (Tager-Flusberg et al.). 

The scale of difficulties children with ASD 

experience with language can potentially impact 

<strong>the</strong> reading process. Evidence suggests 

that we can only comprehend text to <strong>the</strong> degree 

we comprehend language (Rayner et al., 

2001). Although many children with ASD can 

develop average or better decoding skills, 

<strong>the</strong>se decoding strengths generally accompany 

problems with reading comprehension 

(Frith, 2003; Mayes & Calhoon, 2003a; 2003b; 

Calhoon, 2001; Lord & Paul, 1997; Minshew, 

Goldstein, Taylor, & Seigel, 1994; Nation, 

Clarke, Wright, & Williams, 2006); however, 

extreme variability has been noted in reading 

development across <strong>the</strong> autism spectrum (Nation 

et al., 2006). Despite variability in reading 

Reciprocal Questioning / 367

ability, studies have consistently shown that 

students with ASD frequently have difficulty 

comprehending text (Mayes & Calhoun, 

2003a; 2003b; Nation et al.; Minshew et al.; 

Wahlberg & Magliano, 2004). 

Promoting Reading Skills of Learners with Autism 

Research regarding how to promote effective 

reading skills among children with ASD is 

minimal. Although <strong>the</strong> research targeting 

reading development is limited, children with 

ASD with varying levels of language and cognitive 

ability have successfully developed reading 

skills following <strong>the</strong> implementation of a 

variety of intervention methods including behavioral 

(Rosenbaum & Breiling, 1976), cooperative 

learning/peer tutoring (Kamps, Barbetta, 

Leonard, & Delquadri, 1994; Kamps, 

Leonard, Potucek, & Garrison-Harrell, 1995), 

incidental teaching (McGee, Krantz, & Mc- 

Clannahan, 1986), computer assisted instruction 

(Heiman, Nelson, Tjus, & Gillberg, 1995; 

Tjus, Heimann, & Nelson, 1998; Williams, 

Wright, Callaghan, & Coughlan, 2002), and 

anaphoric cuing (O’Connor & Klein, 2004). 

Many of <strong>the</strong> studies focused on sight word 

identification (Heiman et al.; McGee et al.; 

Rosenbaum & Breiling, 1976; Tjus et al.; Williams 

et al.), two targeted reading comprehension 

(Kamps et al.; O’Connor & Klein,), and 

one reading fluency (Kamps et al., 1994). 

Reading comprehension. This scarce literature 

base of reading intervention studies consists 

of only two studies emphasizing reading 

comprehension (Kamps et al., 1995; 

O’Connor & Klein, 2004). Kamps and colleagues 

targeted <strong>the</strong> reading comprehension 

skills of one child identified as having “high 

functioning autism” and two children with autism 

and a moderate cognitive disability along 

with <strong>the</strong>ir general education peers in an in <strong>the</strong> 

context of cooperative groups (Kamps et al.). 

Classroom instruction included direct instruction 

of vocabulary, story concepts, main idea, 

sequencing, and story mapping. In <strong>the</strong> cooperative 

learning condition, groups of four students, 

one with ASD, completed 3 activities: 

(1) a peer tutoring of vocabulary words, (2) 

responding to wh comprehension questions 

following reading, (3) comprehension game 

of characters, and facts from stories read in 

class. All participants, including general edu- 


cation peers, showed increased levels of academic 

engagement and social interaction following 

<strong>the</strong> intervention, but <strong>the</strong> authors 

reported greater variability in reading results 

associated with <strong>the</strong> participant’s level of cognitive 

ability. Distinctly, participants described 

by <strong>the</strong> authors as having autism and a moderate 

cognitive disability did not produce as 

many gains in <strong>the</strong> area of reading comprehension 

as <strong>the</strong> student described as having high 

functioning autism and general education 

counterparts. 

The second study focused on increasing 

reading comprehension of children with ASD 

(O’Connor et al., 2004) through <strong>the</strong> use of 

procedural facilitation. Procedural facilitation 

consisted of four different conditions in which 

<strong>the</strong> researcher provided prompting to facilitate 

processes needed for comprehension during 

reading. That is, <strong>the</strong> researcher set up <strong>the</strong> 

task/materials to facilitate <strong>the</strong> processes 

needed to comprehend <strong>the</strong> text. Specifically, 

participants were asked to read 5 stories aloud 

in 4 conditions: (1) one in a prereading condition, 

(2) one in an anaphoric cuing condition, 

(3) one in a cloze condition, and (4) two 

in a control condition. Following each condition, 

a researcher made test consisting of 12 

items that included free retelling, identifying 

<strong>the</strong> main idea, generating a title, detecting 

incongruous sentences from <strong>the</strong> story, inference 

why and how questions, and factual who, 

what, where, when questions was administered. 

Following <strong>the</strong> anaphoric cuing condition, 

performance on <strong>the</strong> comprehension 

measure of more than half of <strong>the</strong> participants 

resulted in medium effect size gains, whereas 

gains from prereading questions and cloze 

conditions were not statistically significant. 

Also, in both <strong>the</strong> anaphoric cuing and cloze 

conditions <strong>the</strong> participants completed <strong>the</strong> task 

with approximately 80% accuracy, but only 

anaphoric cueing facilitated comprehension 

of text. 

The purpose of this study is to extend <strong>the</strong> 

research base on reading comprehension of 

children with ASD to include direct comprehension 

strategy instruction. The National 

Reading Panel (NPR) acknowledged that 

within comprehension research, “<strong>the</strong> strongest 

scientific evidence was found for <strong>the</strong> effectiveness 

of asking readers to generate questions 

during reading” (NICHD, 2000, pp.

4-45). Because <strong>the</strong> No Child Left Behind Act 

(NCLB, 2002) calls for evidence-based strategies 

identified by <strong>the</strong> NRP to teach reading 

and children with disabilities have access to 

<strong>the</strong> general education curriculum through 

<strong>the</strong> Individuals with Disabilities Education Act 

(IDEA) (34. C.F.R. & 300.26(b)(3)(ii), research 

on how to facilitate <strong>the</strong> learning of 

children with ASD using strategies appropriate 

for <strong>the</strong> general population is needed. 

In a review of <strong>the</strong> question generation literature, 

Rosenshine, Meister, and Chapman 

(1996) determined that studies providing procedural 

checklists, visual cues, signal words 

and generic questions or question stems as 

prompts produced positive effects (Rosenshine 

et al.). These are strategies deemed effective 

for teaching a variety of skills. Specifically, 

<strong>the</strong> use of visuals (Krantz, MacDuff, & 

McClannahan, 1993; MacDuff, Krantz, & Mc- 

Clannahan, 1993; Pierce & Schreibman, 

1994), scripts (Krantz & McClannahan, 1993, 

1998; Matson, Sevin, Box, Francis, & Sevin, 

1993; Sarokoff, Taylor, & Poulson, 2001; 

Stevenson, Krantz, & McClannahan, 2000), 

and self-monitoring (Koegel & Frea, 1993; 

Koegel, Koegel, Hurley, & Frea, 1992; Mancina, 

Tankersley, Kamps, Kravits, & Parrett, 

2000) have been effective in increasing independence, 

social communication, and prosocial 

behaviors of children with ASD. 

The availability of self-monitoring, visuals, 

and scripts during reading comprehension instruction 

may elicit gains in reading achievement 

for <strong>the</strong> general education population, 

children with effective decoding but limited 

comprehension skills, and potentially children 

with ASD. Hence, it is not surprising that 

researchers have encouraged teachers of children 

with ASD to use visual cues and checklists 

to augment receptive and expressive communication 

(Mirenda & Erikson, 2000; Quill, 

1995) and promote independence (Koegel, 

Koegel, & Parks, 1995; Quill). What remains 

unclear is whe<strong>the</strong>r <strong>the</strong> use of <strong>the</strong>se instructional 

practices will prove successful in interventions 

focusing on <strong>the</strong> reading comprehension 

of children with ASD. 

In this study, we used an adapted guided 

reciprocal questioning intervention (See 

King, 1994; King & Rosenshine, 1993) coupled 

with self-monitoring and visual cues to 

teach children with ASD to ask and respond to 

questions using a story map framework while 

taking turns reading with a general education 

peer. The following research questions were 

addressed. 

Question 1: What is <strong>the</strong> functional relationship 

between guided reciprocal questioning 

strategy instruction delivered in cooperative 

pairs and question generation 

and responding of children with autism 

spectrum disorder? 

Question 2: To what extent are children 

with autism spectrum disorder, general education 

peers, and parents of children with 

autism satisfied with <strong>the</strong> intervention? 

Method 

Participants 

Three elementary aged boys with ASD (as defined 

by <strong>the</strong> DSM IV) participated in <strong>the</strong> 

study. They were administered <strong>the</strong> Peabody 

Picture Vocabulary Test-III (PPVT-III), <strong>the</strong> Expressive 

One-Word Picture Vocabulary Test 

(EOWPVT), and <strong>the</strong> Oral Reading Fluency 

(ORF) and Retell Fluency (RF) subtests of <strong>the</strong> 

Dynamic Indicators of Basic Early Literacy 

(DIBELS) prior to initiation of <strong>the</strong> study. Table 

1 presents <strong>the</strong> results of this testing along 

with IQ scores taken from participant cumulative 

folders. 

Scores of all three participants on <strong>the</strong> PPVT- 

III were at least one standard deviation below 

<strong>the</strong> mean, indicating difficulty with receptive 

vocabulary. Scores on <strong>the</strong> EOWPVT were 

greater than one standard deviation below <strong>the</strong> 

mean for two participants, demonstrating difficulty 

with both receptive and expressive language, 

and in <strong>the</strong> average range for <strong>the</strong> one 

participant indicating a discrepancy between 

receptive and expressive language. In addition, 

participants were administered <strong>the</strong> 

DIBELS ORF subtest paired with <strong>the</strong> RF 

subtest. The RF is considered a “comprehension 

check” to determine whe<strong>the</strong>r <strong>the</strong> ORF 

score reflects overall reading proficiency to 

include comprehension. The RF score should 

be approximately half of <strong>the</strong> ORF score to be 

considered a good indicator of overall reading 

ability. Scores of participating students with 

ASD were considerably less than half <strong>the</strong>ir 


TABLE 1 

Participants’ Test Scores 

PPVT-III EOWPVT ORF 1 

ORF scores suggesting a reading comprehension 

concern (Good & Kaminski, 2003). 

Austin. Austin was 7 years 5 months old at 

<strong>the</strong> onset of <strong>the</strong> study. He is an Asian/Hispanic 

male with Asperger syndrome. Austin 

received his reading instruction in a self-contained 

classroom setting. In a review of his 

cumulative folder, Austin’s reported strengths 

included determining relationships between 

abstract figures, as well as detecting patterns. 

He has greater difficulty with tasks that involve 

defining words and stating similarities between 

words. On <strong>the</strong> Differential Ability Scales 

(DAS), Austin received a general conceptual 

ability score of 101. His score on nonverbal 

reasoning subtests was significantly higher at 

133 than his verbal reasoning score, 73. Fur<strong>the</strong>r, 

Austin’s scores on <strong>the</strong> PPVT-III was over 

one standard deviation below <strong>the</strong> mean, 83, 

yet his score on <strong>the</strong> EOWPVT was in <strong>the</strong> average 

range for his chronological age, 92, indicating 

a discrepancy between expressive and 

receptive language. On <strong>the</strong> ORF subtest, Austin 

read 78 words per minute, which is above 

benchmark for his age (i.e., 40 words per 

minute). Yet, on <strong>the</strong> RF subtest when asked to 

tell about what he just read, his retell consisted 

of five words related to <strong>the</strong> story. 

Barry. When <strong>the</strong> study began, Barry was 8 

years 7 months old. Barry is a Hispanic male 

with autism. He received reading instruction 

in both his self-contained and mainstream settings. 

His reported IQ score in his cumulative 

folder of 112 was obtained from <strong>the</strong> Leiter-R 

test of nonverbal intelligence, and is considered 

average for his chronological age. On 

language measures, Barry’s scores were suggestive 

of difficulty with both expressive and 

receptive language. Specifically, Barry’s performance 

on <strong>the</strong> EOWPVT was over one stan- 

RF 2 

IQ Score 

Austin 83 92 78 5 101 

Barry 70 78 87 3 112 

Chris 76 68 66 0 92 

1 Reported in words per minute 

2 Reported in words related to <strong>the</strong> story 


dard deviation below <strong>the</strong> mean, and his score 

on <strong>the</strong> PPVT-III was two standard deviations 

below <strong>the</strong> mean for his age. On <strong>the</strong> DIBELS 

ORF subtest, Barry read 87 words per minute, 

just below <strong>the</strong> 2 nd grade benchmark of 90 

words; however, on <strong>the</strong> RF subtest he was able 

to retell three words related to <strong>the</strong> story. 

Chris. Chris was 7 years 8 months at pretesting. 

He is a Caucasian male with pervasive 

developmental disorder. He receives his reading 

instruction in both a self-contained and 

mainstream classroom setting. On <strong>the</strong> 

Leiter-R nonverbal intelligence test, Chris received 

an IQ score of 92, an average score for 

his age. Strengths noted in his cumulative 

folder included performance on visual matching 

tasks, and his ability to discriminate information 

and complete concrete tasks. On 

preliminary descriptive measures, Chris demonstrated 

difficulty on both expressive and 

receptive assessments. Chris scored more than 

one standard deviation below <strong>the</strong> mean on <strong>the</strong> 

PPVT-III, and greater than two standard deviations 

below <strong>the</strong> mean on <strong>the</strong> EOWPVT. On 

<strong>the</strong> DIBELS ORF subtest, Chris read 66 words 

per minute, which is below <strong>the</strong> 2 nd grade 

benchmark of 90 words a minute. When asked 

to tell everything he remembered about what 

he read on <strong>the</strong> RF subtest, Chris did not respond. 

Nine general education peers participated 

in <strong>the</strong> study. Peers attended <strong>the</strong> same school 

and grade level as <strong>the</strong> student with ASD, and 

were students with whom <strong>the</strong> children with 

ASD had <strong>the</strong> opportunity to interact during a 

typical school day. General education students 

were recruited because of <strong>the</strong>ir effective interpersonal 

skills as determined by each participant’s 

mainstream teacher.

TABLE 2 

Codes of Student Question Generation and Responding 

Setting 

Code Code Definition Subcategories and Subcategory Definition 

Student Generated 

Question 

All three students with ASD received <strong>the</strong>ir 

education in a self-contained special education 

classroom. Each participant was mainstreamed 

in a general education classroom 

setting for at least one class, approximately 60 

minutes each day. The intervention occurred 

in a small room located outside <strong>the</strong> general 

and special education classrooms. The classroom 

was used for parent pick-up and dropoff, 

occupational <strong>the</strong>rapy, special area activities, 

etc. The setting was familiar to all 

participants with ASD. 

Experimental Design 

A student generated 

question directed 

toward peer 

Student Responses Any communicative 

act in response to a 

peer question that 

is unprompted 

A single-subject multiple baseline design 

across participants was employed to clearly 

establish <strong>the</strong> effects of <strong>the</strong> intervention on 

each participant’s ability to generate and respond 

to questions related to a reading selection. 

Fur<strong>the</strong>r, <strong>the</strong> multiple baseline design is 

well-suited to <strong>the</strong> practical requirements of 

applied research and does not require <strong>the</strong> 

Related: A question in direct reference to <strong>the</strong> story 

that contains a question word (who, what, when, 

where, why, how) and an element of <strong>the</strong> story 

(character, setting, event, problem, solution) 

Unrelated: A question containing an appropriate 

question word and information unrelated to <strong>the</strong> 

story 

Prompted: A related question formed following a 

researcher prompt (i.e., verbal prompt, 

modeling, or corrective feedback) 

Unprompted: A related question formed without a 

preceding researcher prompt (i.e., verbal 

prompt, modeling, or corrective feedback) 

Related response: Any communication act directly 

related to <strong>the</strong> story in response to a question that 

does not follow corrective feedback/modeling 

from <strong>the</strong> researcher 

Unrelated response: Any communication act unrelated 

to <strong>the</strong> story in response to a question 

Echoic: Any imitation of an utterance in response to 

a question 

withdrawal of intervention procedures (Neuman 

& McCormick, 1995). 

Dependent Measures 

To formulate a question about text, <strong>the</strong> reader 

must process <strong>the</strong> information read and create 

a question that reflects content (Palinscsar & 

Brown, 1984; Rosenshine et al., 1996; Slavin, 

Hurley, & Chamberlain, 2003). Forming questions 

in direct relation to content requires <strong>the</strong> 

responder to interpret meaning from <strong>the</strong> text 

(Palinscsar & Brown). Question generation 

has also demonstrated improvements in student 

ability to respond to questions focusing 

on <strong>the</strong> main idea (NICHD, 2000). Therefore, 

dependent measures focused on <strong>the</strong> participants’ 

ability to generate and respond to questions 

related to <strong>the</strong> content of reading material. 

The frequency of student-generated 

questions was coded as related or unrelated to 

<strong>the</strong> book and as prompted or unprompted. 

Table 2 provides a description of each of <strong>the</strong> 

codes. 


Data Collection 

All sessions were videotaped using a digital 

camcorder and downloaded to a computer for 

analysis. The researcher transcribed, <strong>the</strong>n 

coded and graphed <strong>the</strong> data to include <strong>the</strong> 

frequency of student generated questions and 

responses, and researcher prompting. 

Procedure 

Pre-Baseline. A 2-session pre-baseline phase 

was included to determine <strong>the</strong> impact of preinstruction 

procedures on participant question 

generation and responding. In pre-baseline, 

each child with ASD and one general education 

peer took turns reading a storybook aloud. One 

book was read each session of pre-baseline, taking 

approximately 20 minutes. The general education 

peer was selected randomly each day 

from a consistent group of three general education 

peers for each child with ASD. Before reading, 

<strong>the</strong> researcher prompted <strong>the</strong> students to ask 

<strong>the</strong>ir friend questions, “It is time to read with 

your friend. Remember to ask each o<strong>the</strong>r questions 

while you read.” The researcher provided 

no guidance or prompts related to question 

generation. 

Figure 1. Story cards 


Elements of a story instruction. Elements of a 

story instruction occurred after pre-baseline 

and seven school days prior to baseline. This 

instruction ensured that participants had a 

preliminary understanding of <strong>the</strong> setting, 

characters, events, problem and solution of a 

story. To be eligible to begin baseline, students 

were required to accurately match 80% 

of note cards to <strong>the</strong> appropriate element of a 

story card. All students met criteria by <strong>the</strong> 

second day of instruction. Details on teaching 

<strong>the</strong> elements of a story follow. 

During <strong>the</strong> first day, <strong>the</strong> researcher taught 

<strong>the</strong> elements of a story to each child with ASD 

in a group with three general education peers. 

The researcher reviewed <strong>the</strong> elements of a 

story (i.e., setting, characters, event, problem 

and solution) using <strong>the</strong> familiar story, Goldilocks 

and <strong>the</strong> Three Bears. Participants were 

asked questions about each element using <strong>the</strong> 

tag board materials and story cards shown in 

Figure 1. Table 3 includes examples of questions 

related to each story element. If students 

had difficulty answering any of <strong>the</strong> questions, 

<strong>the</strong> researcher modeled looking up <strong>the</strong> answer 

in <strong>the</strong> storybook. 

Next, each participant was given five note-

TABLE 3 

Examples of Elements of a Story Questions 

Element Question 

Setting Generic Question: “Where does <strong>the</strong> story take place?” 

More specific: “Where do <strong>the</strong> 3 bears live?” 

Characters Generic Question: “Who are <strong>the</strong> characters in <strong>the</strong> story?” 

More specific: “Who went into <strong>the</strong> 3 bears house without permission?” 

Event Generic Question: “What does <strong>the</strong> character do in <strong>the</strong> story?” 

More specific: “What did Goldilocks do when she got in <strong>the</strong> 3 bears house? 

Problem Generic Question: “What is <strong>the</strong> problem in <strong>the</strong> story?” 

More specific: “What did Goldilocks do to <strong>the</strong> bears house?” 

Solution Generic Question: “How does <strong>the</strong> character solve <strong>the</strong> problem? 

More specific: “What did Goldilocks do when <strong>the</strong> bears came home?” 

cards with statements specific to one of <strong>the</strong> 

elements of a story from Goldilocks and <strong>the</strong> 

Three Bears. With assistance from <strong>the</strong> researcher, 

students matched <strong>the</strong> notecards with 

<strong>the</strong> appropriate element by placing <strong>the</strong> Velcro 

notecard on <strong>the</strong> tagboard. For example, “Goldilocks” 

is placed next to <strong>the</strong> characters story 

card on <strong>the</strong> tag board, and “Goldilocks tasted 

<strong>the</strong> porridge” next to <strong>the</strong> events card. After all 

of <strong>the</strong> notecards were placed on <strong>the</strong> tagboard, 

<strong>the</strong> researcher and students reviewed <strong>the</strong> story 

elements. 

On <strong>the</strong> second day, using <strong>the</strong> note cards from 

<strong>the</strong> previous lesson and <strong>the</strong> tag board story 

cards shown in Figure 1, <strong>the</strong> researcher asked 

students to independently match <strong>the</strong> note 

card on <strong>the</strong> tag board next to <strong>the</strong> appropriate 

element of a story card. Following <strong>the</strong> review, 

<strong>the</strong> researcher read Cloudy with a Chance of 

Meatballs to <strong>the</strong> students. Each student had a 

copy of <strong>the</strong> story, his or her own story cards 

containing <strong>the</strong> element of a story, a small 

individual tag board/story board and 10 note 

cards with statements specific to each of <strong>the</strong> 

elements of <strong>the</strong> story read. The researcher 

asked students to match <strong>the</strong>ir notecards to <strong>the</strong> 

appropriate element of a story on <strong>the</strong>ir own 

tagboard. During <strong>the</strong> task, <strong>the</strong> researcher provided 

corrective feedback. For example, if a 

student placed a note card describing <strong>the</strong> 

problem on <strong>the</strong> tag board next to event, <strong>the</strong> 

researcher asked <strong>the</strong> student to look at <strong>the</strong> 

story card. Then, <strong>the</strong> researcher read <strong>the</strong> generic 

question on <strong>the</strong> story card: “What does 

<strong>the</strong> character do in <strong>the</strong> story?” “On your note 

card it says that <strong>the</strong> food falling from <strong>the</strong> sky is 

too large and destroying <strong>the</strong> town of Chewandswallow.” 

“Is that something <strong>the</strong> character 

did in <strong>the</strong> story?” “Let’s look at <strong>the</strong> problem 

card.” “It says, What is <strong>the</strong> problem in <strong>the</strong> 

story?” “If <strong>the</strong> food is destroying <strong>the</strong> town, is 

that a problem?” 

SCORE instruction. The SCORE curriculum 

was introduced after elements of a story 

instruction and one week prior to baseline. 

Each day for one week, <strong>the</strong> researcher provided 

direct instruction of cooperative behaviors 

using <strong>the</strong> SCORE curriculum with each 

participant and 3 general education cooperative 

partners in small groups of 4 students 

(Vernon, Schumaker, & Deshler, 1996). This 

curriculum has been used successfully in previous 

studies teaching academic content to 

students with ASD in cooperative groups (Dugan, 

Kamps, & Leonard, 1995; Kamps et al., 

1995; 2002). SCORE includes <strong>the</strong> following 

cooperative learning behaviors: Share ideas, 

Compliment o<strong>the</strong>rs, Offer help or encouragement, 

Recommend changes nicely, and Exercise 

self-control. At <strong>the</strong> end of each lesson, 

students applied <strong>the</strong> skill during role play. 

After <strong>the</strong> role play session, <strong>the</strong> researcher and 

students discussed examples of skill application. 

To reach criterion, all students defined 

and provided an example of <strong>the</strong> skill at <strong>the</strong> 

end of <strong>the</strong> lesson and each consecutive lesson 

until <strong>the</strong> SCORE curriculum ended. Lessons 

lasted approximately 30 minutes each day. 

Baseline. Baseline conditions were <strong>the</strong> 

same as pre-baseline except that baseline followed 

Elements of a Story and SCORE instruction. 

That is, each child with ASD and one 


general education peer took turns reading 

one storybook aloud during each session. Before 

reading, <strong>the</strong> researcher prompted <strong>the</strong> 

students to ask <strong>the</strong>ir friend questions, “It is 

time to read with your friend. Remember to 

ask each o<strong>the</strong>r questions while you read.” The 

researcher provided no guidance or prompts 

related to question generation. Also, throughout 

baseline, <strong>the</strong> researcher provided students 

with stickers on a SCORE chart as cooperative 

behaviors were observed. 

Intervention. On <strong>the</strong> first day of <strong>the</strong> cooperative 

pairs intervention condition, <strong>the</strong> researcher 

randomly assigned <strong>the</strong> child with 

ASD to one of <strong>the</strong> three typical peers participating 

in <strong>the</strong> study. On each successive day, 

general education participants were rotated. 

Participants had access to <strong>the</strong> following materials: 

(a) copies of a storybook from Marc 

Brown’s Author series for each participant, 

(b) laminated self-monitoring checklist and 

vis-à-vis pen, (c) story cards containing elements 

of a story, corresponding picture, and 

generic question (d) question word cards 

(i.e., who, what, when, where, why and how), 

and (e) a manipulative velcro storyboard (see 

Figures 1-3). Also, <strong>the</strong> researcher continued to 

provide students with stickers on <strong>the</strong> SCORE 

chart after students demonstrated a behavior 

consistent with <strong>the</strong> SCORE curriculum. Sessions 

took place four days a week for approximately 

40 minutes. 

The researcher began instruction by verbally 

“walking” <strong>the</strong> students through each 

mental process used to construct a question 

during reading. When generating a question, 

<strong>the</strong> researcher placed <strong>the</strong> story card illustrating 

<strong>the</strong> relevant element of a story on <strong>the</strong> 

Velcro storyboard followed by <strong>the</strong> appropriate 

question card (see Figure 3). After reading 

four pages of <strong>the</strong> book, <strong>the</strong> researcher asked 

<strong>the</strong> children, “Who wants to ask a question?” 

At that point, questioning was alternated between 

<strong>the</strong> two children and <strong>the</strong> researcher. 

The following is a detailed description of <strong>the</strong> 

initial intervention session as it distinctly related 

to reciprocal questioning (i.e., <strong>the</strong> During 

Reading step on <strong>the</strong> checklist in Figure 2). 

1. The researcher explained: “Good questions 

start with a question word such as 

who, what, when, where, why, and how. 

Also, a good question asks about important 


elements of <strong>the</strong> story such as, setting, characters, 

events, a problem, or a solution” 

while pointing to <strong>the</strong> story cards shown in 

Figure 1. The researcher <strong>the</strong>n read <strong>the</strong> 

generic question from story cards aloud. 

2. The researcher presented <strong>the</strong> story cards 

containing <strong>the</strong> elements of a story, corresponding 

picture and generic questions as 

well <strong>the</strong> removable question words (See 

Figure 3). 

3. The researcher read <strong>the</strong> story, stopping to 

ask questions before turning each page. 

4. The researcher asked questions by picking 

<strong>the</strong> question word, looking at <strong>the</strong> book, 

and restating what was read. For example, 

“I just found out what Arthur has for homework, 

so I can ask a question about an event 

because it is something <strong>the</strong> character has to 

do [<strong>the</strong> researcher placed <strong>the</strong> event card 

on <strong>the</strong> storyboard] (see Figure 3). Because 

I want to ask about ‘what’ Arthur has for 

homework, I will start my question with 

‘what’ [researcher placed <strong>the</strong> what card on 

<strong>the</strong> storyboard]. So, my question is ‘What 

does Arthur have for homework?’” Or, if 

restating what was read would lead to a 

response, <strong>the</strong> researcher made a generic 

statement followed by a question such as 

“Wow, Arthur has a problem. What is 

Arthur’s problem?” Table 4 provides examples 

of researcher dialogue related to all 

five elements of a story including questions, 

question words, and think aloud discussions. 

5. The researcher directed <strong>the</strong> question (generated 

in step 4 immediately above) to one 

of <strong>the</strong> students. If <strong>the</strong> student responded to 

<strong>the</strong> question correctly, <strong>the</strong> researcher 

praised <strong>the</strong> student. If <strong>the</strong> student responded 

incorrectly, <strong>the</strong> researcher provided 

corrective feedback by putting <strong>the</strong> 

student’s response in context and <strong>the</strong>n 

modeling <strong>the</strong> appropriate answer by locating 

<strong>the</strong> answer in <strong>the</strong> text. If <strong>the</strong> student 

failed to respond in five seconds or repeated 

<strong>the</strong> question, <strong>the</strong> researcher rephrased 

for clarity or used restated using 

binary choice. If <strong>the</strong> student did not respond 

or responded inappropriately, <strong>the</strong> 

researcher provided corrective feedback 

and put <strong>the</strong> response in context, and <strong>the</strong>n 

explained <strong>the</strong> correct answer. The scaffolding 

procedures are outlined in Table 5.

Figure 2. Self-monitoring checklist 


6. After <strong>the</strong> researcher asked three questions 

(as outlined in step 4 above), she verbally 

prompted a participant to ask a question: 

“Who would like to ask a question?” 

If <strong>the</strong> student did not ask a question in 

five seconds, <strong>the</strong> researcher provided a 

verbal prompt: “What did we learn about 

on this page?” Did we just learn about a 

character or an event?” 

If <strong>the</strong> student failed to ask a question in 

5 seconds, <strong>the</strong> researcher modeled question 

generation. 

7. The researcher and participants rotated 

around <strong>the</strong> table asking each o<strong>the</strong>r questions 

during this initial session. 

After session 2, <strong>the</strong> researcher no longer 

generated questions with participants and 

provided scaffolding to include verbal 

prompting, modeling and corrective feedback 

as needed (see Table 5). Scaffolding was used 

when children with ASD and/or <strong>the</strong>ir general 

education peers had difficulty forming/re- 

Figure 3. Reciprocal questioning materials 

sponding to questions. Students had access to 

all needed materials during each session, including 

<strong>the</strong> self- monitoring checklist (Figure 

2). 

Interrater Reliability 


A special education graduate student was 

taught to code student and researcher behavior 

for reliability purposes. To learn coding 

procedures, <strong>the</strong> researcher and student assistant 

watched videotapes taken during a pilot 

study of storybook reading using <strong>the</strong> same 

procedure but in a one-to-one situation with a 

researcher and student. The graduate student 

and researcher watched <strong>the</strong> videos and coded 

researcher and student behaviors until 80% 

agreement was reached for three out of five 

consecutive coding sessions. Agreement was 

reached by session 3. At this time, <strong>the</strong> graduate 

student began coding intervention data 

for reliability. 

Interrater reliability was calculated by divid-

TABLE 4 

Example Question Words, Think Aloud Procedures, and Questions 

Story 

Element 

Question 

Word Think Aloud Question 

Setting Where “I just learned something new about <strong>the</strong> 

setting.” I am going to ask a question 

using ‘where’ because ‘where’ is a good 

question word when asking about 

setting.” 

Character Who “We just found out about a character. 

‘Who’ is a good question word when 

asking a character question.” 

Event Why “We found out that Arthur did something. 

He borrowed books from <strong>the</strong> Brain. So 

I can ask a question about an event.” 

Problem Why “Oh, Arthur is not sleeping well. I am 

going to ask a question about <strong>the</strong> 

problem using why.” 

Solution What “We just found out that Mr. Ratburn 

helped solve Arthur’s problem. I am 

going to ask a question about <strong>the</strong> 

solution, using what.” 

ing <strong>the</strong> number of agreements by <strong>the</strong> number 

of agreements plus disagreements and multiplying 

by 100. In addition, a Kappa coefficient 

was calculated. Interrater reliability was assessed 

for 30% of all collected student data. 

Reliability of prompted and unprompted student 

generated questions was 85% with a 

Kappa value of .62, considered “good” agreement 

(Cooper & Hedges, 1994). Reliability of 

unprompted and prompted student responses 

was 90% with a Kappa value of .68, also considered 

“good” agreement (Cooper & 

Hedges). 

Data Analysis 

To gain a better understanding of <strong>the</strong> intervention 

effects on individual performance, all 

data obtained are presented graphically (Parsonson 

& Baer, 1992). The data were graphed 

and visually inspected by investigating <strong>the</strong> degree 

as well as variability of change to determine 

intervention effects (Barlow & Hersen, 

1984; Kamil, 1995). 

Treatment Fidelity 

A graduate student coded a randomly selected 

30% of all intervention and baseline sessions 

“Where did Arthur have 

his pet business?” 

“Who is helping Arthur 

write his story?” 

“Why did Arthur borrow 

books from <strong>the</strong> 

Brain?” 

“Why is Arthur not 

sleeping well?” 

“What did Mr. Ratburn 

do to help Arthur 

solve his problem?” 

to document <strong>the</strong> specified intervention procedures 

(see procedures section for a description). 

Data collection consisted of frequency 

counts of researcher prompting, instructional 

steps completed, and presence of needed materials. 

The researcher adhered to procedures 

during all baseline and intervention segments 

viewed 100% of <strong>the</strong> time. Fur<strong>the</strong>r, appropriate 

materials were presented in 100% of all baseline 

sessions, and 92% of <strong>the</strong> time during 

intervention. 

Results 

Visual inspection of <strong>the</strong> data (presented in 

Figures 4 and 5) reveals a functional relationship 

between <strong>the</strong> implementation of a reciprocal 

questioning intervention delivered in cooperative 

pairs and question generation and 

responding of <strong>the</strong> three children with ASD. 

That is, once intervention began, all three 

children increased frequency of unprompted 

question generation and responding during 

reading. 

Question Generation 

Figure 4 illustrates <strong>the</strong> frequency of unprompted 

and prompted questions generated 


TABLE 5 

Researcher Scaffolding Procedure 

Teacher Prompt Situation Definition 

Verbal Prompt ● Child fails to initiate a question Question 

● Child asks for help ● “What does your checklist tell you to do?” 

● Child repeats a generic question ● “What is a good question word when 

● Child repeatedly asks a question asking a character question?” 

about <strong>the</strong> same element of a ● “What elements of <strong>the</strong> story did you just 

story 

read about?” 

● Child does not respond to a peer 

question 

by all three participants with ASD. Because 

participants did not ask any questions unrelated 

to <strong>the</strong> story, <strong>the</strong> graph consists of <strong>the</strong> 

frequency of unprompted versus prompted 

question generation only. The change in frequency 

of unprompted question generation 

was immediate for Austin and Barry. Chris 

also showed an increase in <strong>the</strong> number of 

unprompted questions asked, but with greater 

variability. The frequency of unprompted 

questions increased from 0–1 at baseline to a 

range of 1–6, 1–4, and 0–4 during intervention 

for Austin, Barry, and Chris respectively. 

Prompting decreased as children began generating 

questions independently. 

As demonstrated in Table 6, unprompted 

and prompted question generation was not 

● “What did you just read about?” 

Comment 

● “Don’t forget to follow your checklist.” 

● “Remember to make your question about 

something you just read.” 

● “Try to ask a question about .” 

Modeling Child Generated Question The teacher models how to ask an 

● Child does not respond to a appropriate question by: 

verbal prompt ● placing <strong>the</strong> appropriate story and word 

● After corrective feedback 

card on <strong>the</strong> storyboard 

following a child generated ● asking a question directly related to <strong>the</strong> 

question 

element of <strong>the</strong> story identified on <strong>the</strong> 

story card 

Corrective Feedback Child Response 

● The teacher uses <strong>the</strong> child’s response in 

● Child gives an incorrect 

context, and <strong>the</strong>n provides <strong>the</strong> correct 

response to a question 

response 

● Child asks an unclear or 

● The teacher explains why <strong>the</strong> question 

inappropriate question 

does not ask something about <strong>the</strong> chosen 

Child Generated Question 

part of <strong>the</strong> story <strong>the</strong>n, models an 

● Child asks an unclear or 

appropriate question 

inappropriate question 

● The teacher explains why <strong>the</strong> question 

● Child gives an incorrect 

does not ask something about <strong>the</strong> chosen 

response to a question 

part of <strong>the</strong> story <strong>the</strong>n, models an 

appropriate question 


consistent among children with ASD, yet <strong>the</strong>y 

were representative of <strong>the</strong>ir general education 

peers. Similarities among individual children 

with ASD and <strong>the</strong>ir general education counterparts 

were observed in <strong>the</strong> percentage of 

unprompted questions posed. 

Austin. The proportion of unprompted versus 

prompted questions was high for Austin 

when generating questions related to characters, 

but lower when generating questions pertaining 

to an event or problem (see Table 6). 

The content of initial questions generated by 

Austin were generic, reflective of questions 

printed on <strong>the</strong> storycards, and primarily focused 

on characters and setting. Over time, 

Austin began asking more specific questions 

that went beyond character and setting iden-

Figure 4. Frequency of prompted and unprompted student generated questions by children with autism 

spectrum disorder 

tification to interpretation of events, problems, 

and solutions. For example, in beginning 

sessions, Austin asked <strong>the</strong> following, 

“Where are <strong>the</strong>y going?”; “Who is Arthur telling 

to go away?” In later sessions, Austin’s 

unprompted questions were specific and 

clearly stated, “Why does Arthur have to clean 

up his room before mommy gets home?”; 

“What did Arthur and Buster fight about?” 

Barry. Barry posed few character and setting 

questions, and needed higher levels of 

prompting when questions targeted an event 

as opposed to o<strong>the</strong>r story elements (see Table 

6). Unlike o<strong>the</strong>r participants with ASD, Barry 

effectively asked “why” questions throughout 

intervention, which most often reflected <strong>the</strong> 

problem in <strong>the</strong> story. However, during initial 

sessions, Barry started <strong>the</strong> majority of his questions 

using <strong>the</strong> question word “why.” Later, he 

effectively asked a range of questions using 

question words o<strong>the</strong>r than “why” (e.g., “What 

did Arthur’s puppy do?”; “What happened to 


TABLE 6 

Question Generation by Element of a Story 

Participants 

<strong>the</strong> computer?”). By <strong>the</strong> end of intervention, 

Barry used a number of question words, and 

only received prompting when questions did 

not reflect <strong>the</strong> element of a story. 

Chris. In comparison to o<strong>the</strong>r children with 

ASD, Chris demonstrated <strong>the</strong> highest percentage 

of unprompted questions when asking 

about a problem and <strong>the</strong> lowest percentage 

when asking about characters and events (see 

Table 6). Chris’s difficulty forming character 

questions was a result of using “who” and 

“what” question words interchangeably, “Who 

is mommy doing?” Chris relied primarily on 

modeling to ask a question during beginning 

sessions. By session 6, he was consistently asking 

more unprompted than prompted questions 

during reading. During initial sessions, 

Chris used a lot of self-talk, “I can ask an 

element. Setting is an element.” By <strong>the</strong> end of 

session 5, Chris asked his first specific problem 

question, “Why did Muffy trip <strong>the</strong> brain?” 

Throughout <strong>the</strong> intervention, Chris progressively 

asked more specific questions reflecting 

story content, “Why is <strong>the</strong>ir house all messy?” 

Self-talk remained prominent, but instances 

of failing to ask a question decreased steadily 

after session eight. At <strong>the</strong> end of <strong>the</strong> intervention, 

Chris continued to use “who” and “what” 

question words interchangeably. 

Unprompted Responses 

Characters Setting Event Problem Solution Totals 

UP P UP P UP P UP P UP P UP P 

Figure 5 shows <strong>the</strong> frequency of unprompted 

responses by each child. Immediately after intervention 

began, general education peers increased 

question generation. Because <strong>the</strong> intervention 

involved reciprocal questioning, 

<strong>the</strong> responses of <strong>the</strong> children with ASD were 

Total # 

Generated 

Cole 11 2 12 1 16 8 4 6 0 2 43 19 62 

Cole’s Ps 23 2 2 2 6 13 6 8 0 1 36 26 63 

Dean 1 1 1 2 9 6 17 4 0 4 28 17 45 

Dean’s Ps 3 2 5 0 12 14 7 4 1 0 28 20 48 

Nate 3 7 3 1 13 9 9 3 1 5 29 25 54 

Nate’s Ps 6 5 7 2 13 7 15 5 0 0 30 30 60 


highly dependent on questions posed by general 

education peers. That is, all three children 

with ASD show a general pattern of increased 

unprompted responses with an 

increase in <strong>the</strong> questions posed by peers, although 

with individual variations in relation 

to consistency. The number of times participants 

with ASD responded to questions generated 

by peers without prompting ranged 

from 2–6, 1–6 and 1–5 for Austin, Barry and 

Chris respectively. 

Participants with ASD and <strong>the</strong>ir general education 

peers had <strong>the</strong> opportunity to respond 

to a variety of questions focusing on each of 

<strong>the</strong> 5 elements of a story (see Table 7). The 

proportion of unprompted versus prompted 

responses was variable. Participants with ASD 

and <strong>the</strong>ir peers received <strong>the</strong> least amount of 

prompting when responding to character and 

setting questions. Responses to problem questions 

showed greater variability. Fur<strong>the</strong>r, solution 

questions were asked very infrequently by 

participants, making it difficult to note any 

patterns in responding behavior. Very few participants 

failed to respond or responded with 

“I don’t know.” 

Questions that required a response beyond 

text recall required prompting more often 

than responses directly found in text. That is, 

if a response required interpretation of a character’s 

behavior or summarizing a character’s 

actions or events, <strong>the</strong> need for prompting increased. 

For example, in <strong>the</strong> story Arthur Goes 

to Camp, Rocky (<strong>the</strong> boy’s camp counselor) is 

yelling at <strong>the</strong> boys about <strong>the</strong>ir physical shape. 

Earlier in <strong>the</strong> story, references were made 

about sporting competitions between <strong>the</strong> boys 

and girls camps, and Rocky is yelling at <strong>the</strong>

Figure 5. Frequency of unprompted student responses by children with autism spectrum disorder by 

frequency of peer generated questions 

boys about getting in better shape. One participant 

asked, “Why is Rocky being so mean 

to <strong>the</strong> boys?” To answer this question, first, <strong>the</strong> 

student must interpret Rocky’s behavior as 

“mean.” Then, <strong>the</strong> participant has to link 

Rocky’s pushing <strong>the</strong> boys to get into better 

shape as a reflection of his desire to win <strong>the</strong> 

competition. This takes summarizing information 

from within text and linking it to what <strong>the</strong> 

participant already knows about competition. 

Social Validity 

Social validity data were collected including 

interviews with parents of children with ASD, 

interviews of children with ASD, and interviews 

with 8 of 9 participating general education 

peers. Parents were interviewed regarding 

degree of change noticed in <strong>the</strong>ir child’s 

reading and social behavior, and whe<strong>the</strong>r or 

not <strong>the</strong>y felt <strong>the</strong> intervention was important 


TABLE 7 

Unprompted and Prompted Responses by Element of a Story 

Participants 

Characters Setting Event Problem Solution Totals 

UP P UP P UP P UP P UP P UP P 

Cole 24 1 3 1 14 5 8 6 1 0 50 13 63 

Cole’s P’s 11 3 11 2 20 5 4 4 2 0 48 14 62 

Dean 4 1 5 0 18 8 6 5 0 1 33 15 48 

Dean’s P’s 1 0 2 1 15 4 15 5 1 1 34 11 45 

Nate 9 2 8 1 15 5 9 11 0 0 41 19 60 

Nate’s P’s 5 0 3 1 18 5 14 1 6 1 48 6 54 

and necessary for <strong>the</strong>ir child. Later, parents 

were shown a video of <strong>the</strong> first intervention 

session followed by a video of <strong>the</strong> last session, 

and were asked to describe any changes in 

<strong>the</strong>ir child’s reading and language skills. Children 

with ASD and <strong>the</strong>ir general education 

peers were interviewed separately. Questions 

pertained to usefulness of <strong>the</strong> reading intervention. 

Fur<strong>the</strong>r, children were asked about 

relationships established with <strong>the</strong>ir reading 

partners during intervention. 

All participants with ASD stated <strong>the</strong> intervention 

helped <strong>the</strong>m understand what <strong>the</strong>y 

read. Barry and Austin reported <strong>the</strong>y still ask 

questions when <strong>the</strong>y read. When asked what 

<strong>the</strong>y liked best about <strong>the</strong> intervention, Austin 

focused on <strong>the</strong> books and reading with peers, 

Barry reported a preference for working with 

one peer, and Chris enjoyed using <strong>the</strong> checklist. 

Austin described positive attributes of all 

three of his peers, and Barry favored one peer 

he thought of as “cool.” 

All general education peers indicated <strong>the</strong> 

intervention was helpful, and <strong>the</strong>y enjoyed 

participating. General education participants 

stated <strong>the</strong>y learned new words (n 3) and 

how to ask questions (n 3). Also, one participant 

noted she was able to take time to 

read, ano<strong>the</strong>r mentioned feeling encouraged 

to read more, and a third thought <strong>the</strong> book 

helped him learn. Fur<strong>the</strong>r, six participants 

reported <strong>the</strong>y continued to ask questions 

when reading and reported <strong>the</strong>y talked to <strong>the</strong> 

children with ASD more often. When asked 

what <strong>the</strong>y thought of <strong>the</strong>ir peers with ASD, all 

communicated differences in perception. For 

example, one of Austin’s peers stated that before 

intervention he found Austin “a little 


Total # 

Posed 

weird,” but after intervention he thought of 

Austin as “a good friend.” Similarly, one of 

Chris’s peers believed Chris was “a nice person” 

prior to intervention, and after she considered 

him “nice” and “smart.” In fact she 

stated: “. . . he didn’t really need my help at all 

because he was really smart.” Overall, six of 

<strong>the</strong> seven peers would participate in <strong>the</strong> reading 

intervention again, and one indicated he 

might. 

Parents of children with ASD were shown a 

video of <strong>the</strong> first intervention session followed 

by a video of <strong>the</strong> last session and were <strong>the</strong>n 

asked to describe any changes in her child’s 

reading and language skills from <strong>the</strong> first to 

last session. Austin’s mo<strong>the</strong>r reported improvement 

in Austin’s question formation and 

attention while reading. Barry’s parents and 

Chris’s mo<strong>the</strong>r acknowledged a positive gain 

in reading fluency including rate, accuracy 

and/or expression. Chris’s mo<strong>the</strong>r noted 

forming questions remained difficult for him 

and stated he had trouble “. . . coming up with 

words.” Austin’s mo<strong>the</strong>r and Barry’s parents 

observed a decrease in <strong>the</strong> level of prompting 

prior to and following intervention while 

Chris’s mo<strong>the</strong>r noticed less prompting related 

to initiation of a question. 

Overall, Austin and Chris’s mo<strong>the</strong>rs, as well 

as Barry’s parents, agreed that <strong>the</strong> intervention 

was valuable. Austin’s mo<strong>the</strong>r and Barry’s 

parents suggested <strong>the</strong> intervention was important 

for both reading and language. Moreover, 

Barry’s parents indicated it improved 

Barry’s “conversational skills.” Chris’s mo<strong>the</strong>r 

valued <strong>the</strong> intervention because Chris no 

longer responded to questions with “I don’t 

know.” Fur<strong>the</strong>r, all interviewees would like

<strong>the</strong>ir children to participate in a similar intervention 

again. 


The purpose of this study was to determine 

<strong>the</strong> effect of a reciprocal questioning comprehension 

strategy delivered in <strong>the</strong> context of 

cooperative pairs on <strong>the</strong> question generation 

and responding of three children with ASD. 

All children with ASD were able to learn and 

effectively utilize a question generation strategy 

and increased frequency of question generation 

and responding during reading. In 

addition, social validity data documented that 

both children with and without ASD enjoyed 

participating in <strong>the</strong> intervention and thought 

it beneficial. Parents of all three children with 

ASD also felt <strong>the</strong> intervention was important 

and had a positive effect on <strong>the</strong>ir child. 

Individual Variation in Question Generation 

Immediate and consistent gains experienced 

by Austin may be representative of his language 

ability. On descriptive receptive/expressive 

language measures, Austin scored 

higher than his peers with ASD. Yet, he demonstrated 

a discrepancy between scores, scoring 

higher on <strong>the</strong> expressive than receptive 

language measure, not uncommon for children 

with Asperger syndrome (Tantum, 

2000). It is possible that Austin had less trouble 

forming questions initially, resulting in his 

ability to focus his attention on meaning, i.e., 

content related to <strong>the</strong> story ra<strong>the</strong>r than on <strong>the</strong> 

mechanics of question formation. 

In contrast to Austin, Barry and Chris 

scored at least one standard deviation below 

<strong>the</strong> mean on both expressive and receptive 

language measures given prior to intervention. 

During beginning intervention sessions, 

Barry and Chris had greater difficulty forming 

questions, attending more to <strong>the</strong> form and 

function of question generation. From <strong>the</strong> onset 

of intervention, Barry was able to generate 

‘why’ questions effectively, but had greater 

difficulty posing questions with an alternate 

question word. For example, “Elements of a 

story, because Arthur is doing something in 

<strong>the</strong> story.” Similar to Barry, Chris also had 

trouble forming questions during beginning 

sessions, “I can ask an element. Setting is an 

element.” This is consistent with <strong>the</strong> research 

on language development of children with 

ASD, that is, many children with ASD have 

difficulty understanding how to use language 

to obtain a specific goal (We<strong>the</strong>rby, 1986). 

Over <strong>the</strong> course of intervention, Barry began 

forming questions using various question 

words, and Chris began generating content 

specific questions. Therefore, initial intervention 

effects may reflect an expansion in communicative 

function for Barry and Chris, specifically, 

<strong>the</strong> function of asking and 

responding to questions interactively during 

reading. 

Gestalt Learning 

Children with autism often begin using language 

by imitating vocalizations. As children 

with ASD use <strong>the</strong>se vocalizations in context, 

<strong>the</strong>y begin to understand <strong>the</strong>ir meaning and 

function. As a result, more inventive language 

emerges as imitative, rigid vocalizations decrease 

(Schuler, Prizant, & We<strong>the</strong>rby, 1997). 

This pattern of language development has 

been described as a Gestalt learning style 

(We<strong>the</strong>rby, Prizant, & Schuler, 2000). The Gestalt 

learning style has been explained as 

learning in chunks. When applied to language 

development, <strong>the</strong> child interprets a chunk of 

language as meaning associated with <strong>the</strong> context 

in which it was originally heard or 

learned. Initially, chunks of language are repeated 

with little comprehension of function, 

sometimes taking on unconventional forms of 

language. As <strong>the</strong> child begins to understand 

<strong>the</strong> function or intent to a greater extent, 

he/she begins personalizing vocalizations by 

modifying repeated phrases. Through experience 

using and modifying <strong>the</strong>se phrases, more 

spontaneous speech occurs (We<strong>the</strong>rby et al.). 

Both Austin and Chris used story cards to 

build questions during initial sessions, “What 

is <strong>the</strong> problem in <strong>the</strong> story?”; “What is <strong>the</strong> 

character doing in <strong>the</strong> story?” Later, both participants 

became more flexible with question 

generation. For example, Austin asked, “What 

is Mrs. McGrady, Fern and Binky doing?” and 

Chris, “Why did Muffy trip <strong>the</strong> brain?” The 

initial success of using <strong>the</strong> story card to form a 

question could be a reflection of <strong>the</strong> gestalt 

learning style associated with autism. That is, 

participants began using <strong>the</strong> direct model, 


and <strong>the</strong>n modified questions to fit <strong>the</strong> context 

of <strong>the</strong> story, becoming more creative with 

question generation. 

Similarly, Barry initially generated questions 

using only ‘why.’ This heavy reliance on 

‘why’ questions during beginning sessions 

may signify familiarity with <strong>the</strong> form and function 

of <strong>the</strong>se questions. It is conceivable that 

as Barry became more comfortable with and 

began to comprehend <strong>the</strong> purpose and function 

of generating questions during reading, 

his creativity with question formation increased 

by expanding question word use (i.e., 

who, how, what). Also, all three participants 

increased <strong>the</strong> frequency of unprompted responses 

beyond answering using information 

directly stated in text or immediate recall to 

interpretation of events within text. 

Results Indicative of Age 

All participants with autism as well as <strong>the</strong>ir 

general education peers received variable levels 

of prompting when questions required interpretation 

of text beyond factual information. 

If <strong>the</strong> participant had to summarize 

information from <strong>the</strong> text or use prior knowledge 

or experience to generate or respond, 

instances of prompting were greater. For example, 

both children with ASD and <strong>the</strong>ir general 

education peers had more difficulty with 

questions and/or responses reflecting a problem 

in <strong>the</strong> story. To generate and/or respond to 

a question concerning a problem, one has to 

summarize and interpret what was read as a 

problem for <strong>the</strong> character(s) in <strong>the</strong> story often 

sequencing and summarizing information from 

within text, and linking it to what <strong>the</strong> participant 

already knows about <strong>the</strong> topic read. 

Although lower levels of prompting were 

recorded for all participants over <strong>the</strong> course 

of intervention, <strong>the</strong> abstract nature of <strong>the</strong> task 

may account for existence of prompting at <strong>the</strong> 

end of intervention. The ability to independently 

participate in higher order processing 

activities that involve abstract thought differs 

by age. During middle childhood years (ages 

6-10) children have more limited capacity for 

abstract thought, and generally require <strong>the</strong> 

assistance of concrete materials and/or adult 

scaffolding to participate in activities that require 

abstract processing (Devitt & Ormrod, 

2002). Therefore, developmentally all partici- 

pating children to varying degrees needed 

concrete supports as well as researcher 

prompting. Consequently, <strong>the</strong> intervention established 

a truly reciprocal relationship in 

which students with ASD learned alongside 

typically developing peers. 

Typically, question generation strategies including 

reciprocal teaching are used for students 

in third grade through adult years (Rosenshine 

& Meister, 1994; Rosenshine, et al., 1996). 

This does not mean that question generation is 

not an important strategy for students in early 

elementary grades. Children as young as kindergarten 

have increased <strong>the</strong> quality of questioning 

related to story comprehension (Glaubman, 

Glaubman, & Ofir, 1997). Moreover, research 

suggests that students reading/comprehending 

on grade level by third grade will not necessarily 

comprehend on grade level in future grades, 

indicating a need for explicit, systematic comprehension 

instruction beginning in primary 

grades (Snow, 2002). Fur<strong>the</strong>r, results from this 

study indicate that students began to generate 

more questions that required respondents to 

summarize information from within text and 

link it to independent knowledge and experiences. 

Over time increased experiences in generating 

and responding to such questions may 

increase <strong>the</strong> student’s ability to independently 

respond to like questions (Palincsar & Brown, 

1984). 

Results of this study suggest that direct comprehension 

strategy instruction in <strong>the</strong> form of 

reciprocal questioning intervention has <strong>the</strong> 

potential to be a powerful tool for increasing 

question generation and responding of children 

with ASD during <strong>the</strong> context of storybook 

reading with peers. Results also show 

that both <strong>the</strong> children with ASD and <strong>the</strong>ir 

general education peers learned a new strategy 

simultaneously. Therefore, children with 

ASD can learn reading comprehension strategies 

suggested by NRP alongside <strong>the</strong>ir typical 

peers with <strong>the</strong> typical peers also benefiting 

from <strong>the</strong> intervention. Both <strong>the</strong> children with 

and without ASD enjoyed learning toge<strong>the</strong>r, 

and, as such, <strong>the</strong> integrated setting may increase 

motivation for learning. 

Limitations 


Results of <strong>the</strong> study, however, should be interpreted 

with caution. The small sample size

and lack of random selection makes it impossible 

to generalize <strong>the</strong> results to o<strong>the</strong>r children. 

Also, in a multiple baseline design it is 

preferred to vary <strong>the</strong> length of <strong>the</strong> baseline 

condition across participants (Cooper, Heron, 

& Heward, 1987). Although baseline sessions 

were lagged between participants and <strong>the</strong> 

number of days spent in <strong>the</strong> baseline condition 

varied, <strong>the</strong> number of baseline sessions 

was three for all participants. However, data 

revealed stable or descending baseline behavior 

across all participants. Fur<strong>the</strong>r, because 

<strong>the</strong> proposed study incorporates a treatment 

package, when a change in behavior occurs, it 

is difficult to determine if <strong>the</strong> entire package 

or a component of <strong>the</strong> intervention impacted 

that change. 

Implications for Practice and Fur<strong>the</strong>r Research 

Research replicating <strong>the</strong> present study and 

examining <strong>the</strong> effects of direct comprehension 

strategy instruction on reading comprehension 

is needed. Not only should <strong>the</strong> effects 

of reciprocal questioning intervention on 

reading comprehension be studied, but <strong>the</strong> 

effects of o<strong>the</strong>r NRP strategies on <strong>the</strong> reading 

comprehension of learners with ASD should 

be researched. Outcomes of teaching students 

with ASD with <strong>the</strong>ir typical peers should be 

conducted. Studies should assess <strong>the</strong> longitudinal 

impact of reading comprehension interventions 

and <strong>the</strong> generalization of reading 

comprehension skills to o<strong>the</strong>r areas of development 

(i.e., expressive, receptive, social communication, 

and cognitive development), to 

comprehension in curriculum content areas, 

and to performance on question and answer 

assessments. Also, future studies should investigate 

<strong>the</strong> amount and intensity of instruction 

required for children with ASD to increase 

and maintain reading comprehension abilities. 

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Discrimination Skills Predict Effective Preference Assessment 

Methods for Adults with Developmental Disabilities 

May S. H. Lee, Duong Nguyen, C. T. Yu, Jennifer R. Thorsteinsson, 

Toby L. Martin, and Garry L. Martin 

University of Manitoba and St. Amant Research Centre 

Abstract: We examined <strong>the</strong> relationship between three discrimination skills (visual, visual matching-to-sample, 

and auditory-visual) and four stimulus modalities (object, picture, spoken, and video) in assessing preferences 

of leisure activities for 7 adults with developmental disabilities. Three discrimination skills were measured using 

<strong>the</strong> Assessment of Basic Learning Abilities Test. Three participants mastered a visual discrimination task, but 

not visual matching-to-sample and auditory-visual discriminations; two participants mastered visual and 

visual matching-to-sample discriminations, but not auditory-visual discrimination, and two participants 

showed all three discriminations. The most and least preferred activities, identified through paired-stimulus 

preference assessment using objects, were presented to each participant in each of <strong>the</strong> four modalities using a 

reversal design. The results showed that (1) participants with visual discrimination alone showed a preference 

for <strong>the</strong>ir preferred activities in <strong>the</strong> object modality only; (2) those with visual and visual matching-to-sample 

discriminations, but not auditory-visual discrimination, showed a preference for <strong>the</strong>ir preferred activities in <strong>the</strong> 

object but not in <strong>the</strong> spoken modality, and mixed results in <strong>the</strong> pictorial and video modalities; and (3) those with 

all three discriminations showed a preference for <strong>the</strong>ir preferred activities in all four modalities. These results 

provide partial replications of previous findings on <strong>the</strong> relationship between discriminations and object, 

pictorial, and spoken modalities, and extend previous research to include video stimuli. 

Preference assessments are important tools 

for educators and caregivers who work with 

individuals with developmental disabilities. 

Educators and caregivers can use preference 

assessments to identify reinforcers that can be 

used to streng<strong>the</strong>n adaptive skills of individuals 

with developmental disabilities during 

training programs (Green et al., 1988; Logan 

et al., 2001; Pace, Ivancic, Edwards, Iwata, & 

Page, 1985). Fur<strong>the</strong>rmore, allowing individuals 

with developmental disabilities to make 

choices contributes to <strong>the</strong>ir quality of life 

We thank <strong>the</strong> participants for <strong>the</strong>ir cooperation 

throughout <strong>the</strong> study, and Leah Enns, Sara Spevack, 

Aynsley Verbeke, Kerri Walters, and Georgina 

Johnston for <strong>the</strong>ir assistance with reliability assessments. 

This research was supported by grant 

MOP77604 from <strong>the</strong> Canadian Institutes of Health 

Research. Correspondence concerning this article 

should be addressed to C. T. Yu, 440 River Road, 

Winnipeg, Manitoba, Canada R2M 3Z9. Email: 

yu@stamant.mb.ca. Or Garry Martin, 129 St. Paul’s 

College, 70 Dysart Road, Winnipeg, Manitoba, Canada, 

R3T 2M6. Email: gmartin@cc.umanitoba.ca 


(Hughes, Hwang, Kim, Eisenman, & Killian, 

1995; Stock, Davies, Secor, & Wehmeyer, 

2003). 

Preference assessment effectiveness (i.e., 

<strong>the</strong>ir ability to distinguish high preference 

items from less preferred items) depends both 

on <strong>the</strong> presentation modality of <strong>the</strong> items or 

activities used, and on <strong>the</strong> discrimination skills 

of <strong>the</strong> individuals whose preferences are assessed. 

Conyers et al. (2002), for example, 

measured visual, visual matching-to-sample, 

and auditory-visual discrimination skills of 

nine persons with mental retardation using 

<strong>the</strong> Assessment of Basic Learning Abilities (ABLA) 

Test (Kerr, Meyerson, & Flora, 1977; Martin & 

Yu, 2000). In <strong>the</strong>ir first experiment with food 

items, <strong>the</strong>y found that (a) all three participants 

who passed <strong>the</strong> visual discrimination 

assessment, but failed both <strong>the</strong> visual matching-to-sample 

and <strong>the</strong> auditory-visual discrimination 

assessments on <strong>the</strong> ABLA test could 

consistently select <strong>the</strong>ir most preferred item 

in object preference assessment but not in 

picture or verbal preference assessments; (b)

all three participants who passed both visual 

and visual matching-to-sample discrimination 

assessments, but failed <strong>the</strong> auditory-visual discrimination 

assessment on <strong>the</strong> ABLA test 

could consistently select <strong>the</strong>ir most preferred 

item in both object and picture preference 

assessments but not when <strong>the</strong> choices were 

spoken; and (c) all three participants who 

passed <strong>the</strong> visual, visual matching-to-sample, 

and auditory-visual discrimination assessments 

on <strong>the</strong> ABLA test could consistently select 

<strong>the</strong>ir most preferred item in all three modalities. 

In <strong>the</strong> second experiment when nonfood 

items were presented, Conyers et al. observed 

similar results for seven of <strong>the</strong> nine 

participants with mixed results obtained for 

two participants with visual and visual matching-to-sample 

discriminations. 

Schwartzman, Yu, and Martin (2003) replicated 

<strong>the</strong> results of Conyers et al. (2002) using 

food items with six adults with developmental 

disabilities, and Clevenger and Graff (2005) 

showed that object-to-picture and picture-toobject 

matching skills might be prerequisite 

skills for making consistent choices in preference 

assessments involving pictures of food 

items. In addition, de Vries et al. (2005) systematically 

replicated <strong>the</strong> procedures of Conyers 

et al. using leisure activities with persons 

with developmental disabilities. They found 

that eight of <strong>the</strong> nine participants in <strong>the</strong>ir 

study showed a preference for <strong>the</strong>ir preferred 

activities in two-choice preference assessments 

when stimulus modalities “matched” <strong>the</strong>ir discrimination 

skills. Most recently, Reyer and 

Sturmey (2006) also partially replicated <strong>the</strong> 

procedures of Conyers et al. using work tasks 

with adults with developmental disabilities 

and intellectual disability. These studies underscore 

<strong>the</strong> importance of matching stimulus 

modalities used in preference assessments to 

<strong>the</strong> discrimination skills of individuals. 

However, many leisure activities and work 

tasks are protracted and involve multiple stimuli 

that may be impractical or impossible to 

present in object or pictorial modalities. Object 

and pictorial presentations are relatively 

static and may not adequately present <strong>the</strong> various 

aspects of an activity. Moreover, <strong>the</strong> stimuli 

captured by object and pictorial presentations 

may not be <strong>the</strong> reinforcing aspects of an 

activity for <strong>the</strong> individual. It may be possible to 

overcome <strong>the</strong>se limitations by using video presentations. 

Recent studies have investigated <strong>the</strong> effectiveness 

of video presentation in identifying 

job preferences for individuals with developmental 

disabilities. For example, Ellerd, Morgan, 

and Salzberg (2002) measured <strong>the</strong> job 

preferences of four verbal adults with developmental 

disabilities. They provided five job 

options via video presentations using singlestimulus 

and paired-stimulus presentation 

procedures in <strong>the</strong> first and <strong>the</strong> second preference 

assessments respectively for each participant. 

Ellerd et al. observed differential preferences 

for all participants; however, <strong>the</strong> 

assessment using paired-stimulus presentation 

procedure was more sensitive in identifying a 

preference hierarchy than <strong>the</strong> single-stimulus 

presentation procedure. Stock et al. (2003) 

examined <strong>the</strong> effectiveness of a computerbased 

job preference assessment of 25 adults 

with intellectual disabilities. In <strong>the</strong> assessment, 

participants engaged in a self-paced computer 

program in which <strong>the</strong>y were allowed to watch 

videos representing different job options and 

were allowed to make choices among <strong>the</strong> twochoice 

presentation trials. Results indicated 

that in general, job preferences identified by 

<strong>the</strong> computer-based preference assessment 

were positively correlated to <strong>the</strong> preferences 

predicted by <strong>the</strong> educators and agency professionals 

who relied on <strong>the</strong> participants’ previous 

assessment results and <strong>the</strong>ir past experience 

with <strong>the</strong> participants. The same 

educators and agency professionals agreed 

that <strong>the</strong> computer-based job preference assessment 

was more effective than <strong>the</strong> most 

popular job assessment tools in <strong>the</strong> existing 

job placement system (e.g., Career Decision 

Maker). Stock et al. explained that because 

video presentation provided more information 

about jobs than picture and verbal presentations, 

individuals had a better understanding 

among job options before making 

any decision. The functioning levels of participants 

in <strong>the</strong> above studies were not reported 

although <strong>the</strong>y appeared to be relatively high 

functioning. Individuals in <strong>the</strong> Ellerd et al. 

study were verbal and those in <strong>the</strong> Stock et al. 

study were able to follow instructions to interact 

with <strong>the</strong> computer program. It is unclear 

whe<strong>the</strong>r individuals with more severe disabilities, 

with no speech or auditory discrimina- 

Discrimination Skills / 389

TABLE 1 

Participant Characteristics 

Participant Sex Age Diagnosis Communication Skills 

tions, could respond to video stimuli in preference 

assessments. 

Considering <strong>the</strong> relationship between discrimination 

skills and stimulus modalities 

used in preference assessments reported in 

previous research, and <strong>the</strong> potential of video 

presentations in presenting protracted activities, 

<strong>the</strong> purpose of this study was to systematically 

replicate previous research on discrimination 

skills and object, pictorial, and spoken 

stimuli in assessing preferences for leisure activities, 

and to include video presentation as 

one of <strong>the</strong> stimulus modalities. 

Method 

Participants and Setting 

Participants were seven adults recruited from 

River Road Place of St. Amant, a residential 

and community resource facility for persons 

with developmental disabilities. They were selected 

based on <strong>the</strong>ir ABLA assessments conducted 

at <strong>the</strong> beginning of <strong>the</strong> study. The 

ABLA assessment procedures can be found in 

Conyers et al. (2002), de Vries et al. (2005), 

and Martin and Yu (2000). Participants 1, 2, 

and 3 passed <strong>the</strong> visual discrimination task 

(referred to as Level 3 on <strong>the</strong> ABLA test) but 

failed both <strong>the</strong> visual matching-to-sample 

(Level 4) and <strong>the</strong> auditory-visual discriminations 

(Level 6). Participants 4 and 5 passed 

both Levels 3 and 4, but failed Level 6. Participants 

6 and 7 passed all three levels. Characteristics 

for each participant were obtained 

from <strong>the</strong>ir health records and are provided in 

Table 1. 

All sessions were conducted in a small quiet 

room with minimal distractions. The experimenter 

sat across a table from <strong>the</strong> participant 

during each session, and an observer attended 

some of <strong>the</strong> sessions to conduct reliability 

checks. 

Research Design 

ABLA Levels 

Passed* 

1 F 41 Severe developmental 

disabilities 

None 3 

2 F 39 Profound developmental 

disabilities 

None 3 

3 M 33 Autism None 3 

4 F 37 Severe developmental 

disabilities 

None 3 and 4 

5 M 49 Severe developmental Little speech; socially 

3 and 4 

disabilities 

responsive 

6 F 41 Severe developmental Little speech; difficult to 3, 4, and 6 

disabilities 

understand 

7 F 50 Moderate developmental Little or no recognizable 3, 4, and 6 

disabilities 

speech; understands 

simple instructions 

and questions 

* Level 3 visual discrimination, Level 4 quasi-identity visual matching-to-sample discrimination, Level 

6 auditory-visual discrimination. 


Each participant received an initial preference 

assessment using actual objects to identify 

his or her most preferred and least preferred 

leisure activities. Next, <strong>the</strong> most and 

least preferred leisure activities were presented 

in four modalities (object, picture, 

video, and spoken) using a replication design, 

with each modality assessed at least twice.

TABLE 2 

Leisure Activities Used in <strong>the</strong> Preference Assessments 

Leisure Activity Stimuli Presented During a Trial 

Coloring Crayons and coloring book 

Doing a puzzle 3-pieces 

Listening to music Tape recorder with pop music 

Painting Paint, paint brush, paper, and water 

Playing cards Deck of playing cards 

Playing with a light toy Rattle-shaped light toy called “Meteor Storm” about 20 cm 

tall 

Playing with object-sound 

related toy 

A cow-shaped plastic toy 

Playing with a velcro-ball Tennis ball wrapped with velcro and two rackets with velcro 

on one side 

Playing with a carpentry set Mini tool kit 

Playing with a toy car A miniature sport car about 6 cm long 

Playing with a xylophone A miniature xylophone (24 cm 11 cm) 

Reading magazines Three types of magazines 

Shaking a rattle Rattle 

Touching a lighting ball Plasma lighting ball about 33 cm tall 

Turning on and off a fan that 

lights up 

Battery operated hand-held fan 

Washing and applying lotion to 

hands 

Hand soap, sponge, water and hand lotion 

Watering plants Plastic plants and watering can 

Initial Object Preference Assessment 

Six activities were identified for each participant 

based on recommendations from <strong>the</strong> 

participant’s caregivers and on practical considerations 

in presenting and performing <strong>the</strong> 

activities during sessions. Table 2 lists all <strong>the</strong> 

leisure activities used and <strong>the</strong> object stimuli 

presented on each trial. 

A paired-stimulus presentation procedure 

was used (Fisher et al., 1992; Piazza, Fisher, 

Hagopian, Bowman, & Toole, 1996). Each 

stimulus was paired with every o<strong>the</strong>r stimulus 

twice, totaling 30 trials. Order and positions of 

<strong>the</strong> stimuli were counterbalanced across trials. 

Trials were spread across two to four sessions 

depending on <strong>the</strong> participant’s level of functioning. 

On each trial, <strong>the</strong> experimenter presented 

<strong>the</strong> objects representing <strong>the</strong> two leisure 

activities concurrently on <strong>the</strong> table. 

Verbal prompts and gestures were provided to 

<strong>the</strong> participant to attend to each stimulus. The 

experimenter <strong>the</strong>n asked <strong>the</strong> participant to 

“pick one”. Once <strong>the</strong> participant made an 

approach response (touching or pointing to a 

stimulus), <strong>the</strong> non-selected stimulus was removed 

immediately, and <strong>the</strong> participant was 

allowed to engage in <strong>the</strong> chosen activity for 

approximate 30 s. If <strong>the</strong> participant tried to 

approach both stimuli or did not choose an 

activity after 10 s, <strong>the</strong> trial was repeated. 

At <strong>the</strong> end of <strong>the</strong> assessment, <strong>the</strong> preference 

measure for a stimulus was calculated by 

dividing <strong>the</strong> number of trials in which that 

stimulus was chosen by <strong>the</strong> total number of 

trials that particular stimulus was available 

during <strong>the</strong> assessment, multiplied by 100%. 

The most and least frequently preferred stimuli 

were used in <strong>the</strong> next phase (see Table 3). 

Stimulus Modalities and Presentation Procedures 

Four stimulus modalities were evaluated in a 

replication design. Presentations using objects 

(O) were given to each participant during <strong>the</strong> 

first phase, followed by presentations using 

pictorial (P), video (V), and spoken (S) stimuli 

in subsequent phases. The order for P, V, 

and S phases was randomized and <strong>the</strong> four 


TABLE 3 

Percentage of Trials that <strong>the</strong> Most and Least Frequently Preferred Activities Were Chosen for Each 

Participant During <strong>the</strong> Initial Object Preference Assessment 

Participant 

Most Frequently Chosen 

Activity % Least Frequently Chosen Activity % 

1 Touching a lighting ball 70 Watering plants 10 

2 Playing with a velcro-ball 70 Watering plants 20 

3 Playing with a toy car 70 Coloring 20 

4 Watering plants 70 Listening to music 40 

5 Playing with a carpentry set 80 Playing with a velcro-ball 20 

6 Playing with a light toy 100 Coloring 20 

7 Playing with a light toy 70 Washing and applying lotion to hands 30 

phases were <strong>the</strong>n repeated for each participant. 

Additional replications were conducted 

for three participants because <strong>the</strong>ir results 

were varied across phases and inconsistent 

with our predictions. In all modalities, activities 

were presented using a paired-stimulus 

procedure, and <strong>the</strong> most and least preferred 

leisure activities identified during <strong>the</strong> initial 

object preference assessment were used on 

each trial. Each phase consisted of two sessions, 

with six trials per session. The left-right 

positions of <strong>the</strong> two leisure activities were 

counterbalanced across trials within each 

phase. 

Object presentation. During <strong>the</strong> object 

phase, <strong>the</strong> presentation procedures were <strong>the</strong> 

same as in <strong>the</strong> initial object preference assessment 

except that only two items, representing 

<strong>the</strong> most and <strong>the</strong> least preferred activities were 

used. 

Pictorial presentation. During <strong>the</strong> pictorial 

phase, <strong>the</strong> presentation procedures were similar 

to <strong>the</strong> object phase except colored pictures 

(22 cm 27 cm) of <strong>the</strong> object stimuli 

were shown on each trial. At <strong>the</strong> beginning of 

each trial, <strong>the</strong> two colored pictures were 

placed, side by side, face down on <strong>the</strong> table in 

front of <strong>the</strong> participant. The experimenter 

held up <strong>the</strong> picture on <strong>the</strong> left to <strong>the</strong> participant’s 

eye level and said, “look”. Once <strong>the</strong> 

participant looked at <strong>the</strong> picture, <strong>the</strong> experimenter 

placed <strong>the</strong> picture on <strong>the</strong> table faced 

down, and repeated <strong>the</strong> procedure for <strong>the</strong> 

picture on <strong>the</strong> right. The experimenter <strong>the</strong>n 

held up both pictures simultaneously and 

asked <strong>the</strong> participant to “pick one”. After <strong>the</strong> 

participant made a selection, <strong>the</strong> pictures 


were removed and <strong>the</strong> chosen activity was provided 

immediately to <strong>the</strong> participant for 30 s. 

Video presentation. During <strong>the</strong> video phase, 

<strong>the</strong> presentation procedures were similar to 

<strong>the</strong> picture phase except that video clips of 

<strong>the</strong> leisure activities were presented instead of 

<strong>the</strong> colored pictures. On each trial, <strong>the</strong> experimenter 

first presented <strong>the</strong> video for <strong>the</strong> activity 

on <strong>the</strong> left side of a 43 cm monitor while 

<strong>the</strong> right side was blank, and asked <strong>the</strong> participant 

to look at <strong>the</strong> video, while pointing to 

<strong>the</strong> video. Once <strong>the</strong> participant looked at <strong>the</strong> 

video, <strong>the</strong> experimenter repeated <strong>the</strong> procedure 

for <strong>the</strong> activity on <strong>the</strong> right side of <strong>the</strong> 

monitor. Then, <strong>the</strong> experimenter played both 

videos simultaneously and asked <strong>the</strong> participant 

to “pick one”. Once <strong>the</strong> participant 

pointed to one of <strong>the</strong> two videos, <strong>the</strong> experimenter 

turned off <strong>the</strong> computer screen and 

provided <strong>the</strong> chosen activity to <strong>the</strong> participant 

for 30 s. The sound was turned off for all video 

presentations. 

Spoken presentation. During <strong>the</strong> spoken 

phase, <strong>the</strong> presentation procedures were <strong>the</strong> 

same as in <strong>the</strong> picture phase except that two 

sheets of white paper were used instead of <strong>the</strong> 

pictures and <strong>the</strong> experimenter stated <strong>the</strong> 

names of <strong>the</strong> activities. At <strong>the</strong> beginning of 

each trial, <strong>the</strong> experimenter held up <strong>the</strong> paper 

to <strong>the</strong> left of <strong>the</strong> participant’s eye level, 

stated <strong>the</strong> name of <strong>the</strong> activity in a neutral 

tone, and put <strong>the</strong> paper back on <strong>the</strong> table. 

This was repeated with <strong>the</strong> paper/activity on 

<strong>the</strong> right. Then, <strong>the</strong> experimenter held up 

both papers and asked <strong>the</strong> participant to “pick 

one”. After <strong>the</strong> participant made an approach 

response (e.g., pointing to <strong>the</strong> paper), both

papers were removed and <strong>the</strong> activity that corresponded 

to <strong>the</strong> selected paper was provided 

to <strong>the</strong> participant for 30 s. 

Reliability Assessments 

ABLA discrimination assessment. Interobserver 

reliability checks were conducted on 

<strong>the</strong> initial ABLA discrimination assessments 

for all participants. The experimenter and an 

observer independently recorded <strong>the</strong> participant’s 

response on each trial during <strong>the</strong> assessment. 

Agreement on a trial was defined as 

<strong>the</strong> experimenter and <strong>the</strong> observer both recording 

<strong>the</strong> same response; o<strong>the</strong>rwise, it was 

considered a disagreement. Percent agreement 

for each discrimination task was calculated 

by dividing <strong>the</strong> number of agreements 

by <strong>the</strong> number of agreements plus disagreements, 

and <strong>the</strong>n multiplying by 100% (Martin 

& Pear, 2007). Percent agreement was 100% 

for all participants. 

The observer also conducted procedural integrity 

checks using a pre-defined checklist, 

which included whe<strong>the</strong>r <strong>the</strong> testing materials 

were placed in <strong>the</strong> correct positions, verbal 

instructions were provided correctly, correction 

procedures were conducted properly following 

an incorrect response, and reinforcers 

were given immediately following a correct 

response. A trial was scored as correctly delivered 

if no errors were made. Procedural integrity 

was 100% for all participants. 

Initial object preference assessment. Interobserver 

reliability checks were conducted for 

each participant and <strong>the</strong> percentage of trials 

observed by a second observer ranged from 

23% to 100% across participants. The experimenter 

and <strong>the</strong> observer recorded <strong>the</strong> participant’s 

selection on each trial. The mean percent 

agreement across participants was 99%, 

with a range of 86% to 100%. 

Procedural integrity checks for preference 

assessment were also conducted for each participant 

and <strong>the</strong> percentage of trials observed 

by a second observer ranged from 23% to 

100% across participants. On each trial, <strong>the</strong> 

observer recorded whe<strong>the</strong>r <strong>the</strong> correct stimuli 

were presented and in <strong>the</strong> correct positions, 

whe<strong>the</strong>r correct verbal cues were provided, 

and whe<strong>the</strong>r <strong>the</strong> consequence was delivered 

properly following a selection. A trial was 

scored as correct if no errors occurred. The 

mean percentage of trials delivered correctly 

across participants was 100%. 

Stimulus modalities presentation. Interobserver 

reliability checks were conducted for 

each participant and for each modality. The 

percentage of sessions observed ranged from 

25% to 100% across participants. A trial was 

scored as an agreement only if both <strong>the</strong> experimenter 

and <strong>the</strong> observer recorded <strong>the</strong> 

same response. The mean percent agreement 

across sessions and participants was 99%, with 

a range of 96% to 100%. 

Procedural integrity checks were also performed 

for each participant and <strong>the</strong> percentage 

of sessions observed ranged from 25% to 

100% across participants. Each trial was 

scored using a checklist similar to <strong>the</strong> one 

used described above for preference assessment. 

A trial was considered correctly delivered 

if all <strong>the</strong> steps on <strong>the</strong> checklist were 

performed correctly. The mean percentage of 

trials delivered correctly across sessions and 

participants was 99%, ranging from 99% to 

100%. 

Results 

Figure 1 shows <strong>the</strong> percentage of trials that 

each participant chose <strong>the</strong>ir most preferred 

leisure activity for each presentation method. 

The top three graphs show <strong>the</strong> results of Participants 

1 through 3, who passed <strong>the</strong> visual 

discrimination assessment (Level 3) but failed 

both visual matching-to-sample (Level 4) and 

auditory-visual (Level 6) discriminations on 

<strong>the</strong> ABLA Test. During object presentation 

phases, <strong>the</strong> participants selected <strong>the</strong>ir most 

preferred leisure activity on an average of 97% 

across phases (range 92% to 100%). During 

<strong>the</strong> pictorial presentation phases, <strong>the</strong> average 

was 57% (range 50% to 67%), which is approximately 

chance level in a two-choice arrangement. 

During <strong>the</strong> video presentation 

phases, <strong>the</strong> average was 49% (range 8% to 

67%). Except for <strong>the</strong> first video phase for 

Participant 1, who showed a low preference 

for <strong>the</strong> high preference activity (8%), preference 

levels for <strong>the</strong> preferred activity during 

subsequent phases and for <strong>the</strong> o<strong>the</strong>r participants 

were approximately chance level. During 

<strong>the</strong> spoken presentation phases, preference 

for <strong>the</strong> preferred activity averaged 47% 

(range 33% to 58%). 


Figure 1. Percentage of trials that <strong>the</strong> most preferred leisure activity was chosen during object (O), pictorial 

(P), video (V), and spoken (S) presentation phases for each participant. Participants at Level 3 

passed only <strong>the</strong> visual discrimination, participants at Level 4 passed both visual and visual matchingto-sample 

discriminations, and participants at Level 6 passed visual, visual matching-to-sample, and 

auditory-visual discriminations. 

Results of Participants 4 and 5, who passed 

both visual and visual matching-to-sample discrimination 

assessments, but failed <strong>the</strong> auditory-visual 

discrimination assessment on <strong>the</strong> 

ABLA Test, are shown in <strong>the</strong> second row of 


Figure 1. During object presentation phases, 

<strong>the</strong> two participants selected <strong>the</strong>ir most preferred 

leisure activity on an average of 80% 

across phases (range 75% to 100%). During 

<strong>the</strong> pictorial presentation phases, <strong>the</strong> average

was 68% (range 42% to 83%). In <strong>the</strong> video 

presentation phases, <strong>the</strong> average was 62% 

(range 33% to 83%). Lastly, in <strong>the</strong> spoken 

phases, <strong>the</strong> average was 50% (range 42% to 

58%). 

Participants 6 and 7 passed <strong>the</strong> visual, visual 

matching-to-sample, and auditory-visual discrimination 

assessments on <strong>the</strong> ABLA Test. 

They selected <strong>the</strong>ir preferred activity on all 

trials (100%) during object, pictorial, and 

video phases, and on an average of 85% of <strong>the</strong> 

spoken phase trials (range 83% to 92%). 


Concerning <strong>the</strong> object, pictorial, and spoken 

modalities, <strong>the</strong> results replicate <strong>the</strong> findings of 

previous research except for <strong>the</strong> pictorial modality 

with Participant 5. First, we anticipated 

that Level 3 participants would select <strong>the</strong>ir 

preferred activity more frequently during object 

phases, but at approximately chance level 

during pictorial and spoken phases. This was 

confirmed. Second, we anticipated that Level 

4 participants would select <strong>the</strong>ir preferred activity 

more frequently during object and pictorial 

phases, but at approximately chance 

level during spoken phases. This was confirmed 

except for <strong>the</strong> pictorial modality with 

Participant 5. His preference toward <strong>the</strong> preferred 

leisure activity was inconsistent during 

pictorial phases. He selected his preferred activity 

on an average of 63% across phases. 

Participant 5 did not select his preferred activity 

during object phases as frequently as 

o<strong>the</strong>r participants (i.e., on an average of 75% 

across phases vs. on an average of 96% across 

phases for o<strong>the</strong>r participants). This suggests 

that <strong>the</strong> activity was not as strongly preferred 

and this may have contributed to <strong>the</strong> mixed 

results. Overall, Participant 4 selected her preferred 

leisure activity during pictorial phases 

more frequently even though her preference 

toward <strong>the</strong> preferred activity was inconsistent 

across phases and <strong>the</strong> effect is small (i.e., on 

an average of 75% across phases). Third, we 

anticipated that <strong>the</strong> Level 6 participants would 

select <strong>the</strong>ir preferred activity more frequently 

during all three stimulus modalities. This was 

confirmed in all modalities. Except for Participant 

5’s performance in <strong>the</strong> pictorial modality, 

<strong>the</strong>se results are consistent with previous 

findings (e.g., Conyers et al., 2002; de Vries et 

al., 2005). 

The present study extends previous research 

by examining <strong>the</strong> use of video presentations 

in preference assessments with persons 

with severe and profound developmental disabilities. 

During video presentations, all participants 

at Level 3 did not show a preference 

for <strong>the</strong>ir preferred over <strong>the</strong> less preferred activities, 

while both participants at Level 6 

chose <strong>the</strong>ir preferred activities consistently. 

The two participants at Level 4 showed mixed 

results, with Participant 4 choosing her preferred 

activity more frequently than <strong>the</strong> less 

preferred activity even though her performance 

was inconsistent across phases, whereas 

Participant 5 did not. Given <strong>the</strong> small number 

of participants, <strong>the</strong>se results should be interpreted 

cautiously. Fur<strong>the</strong>r research with additional 

participants, especially at Level 4, is 

needed. However, if <strong>the</strong> present results are 

generalizable, it suggests that quasi-identity 

matching performance involving 3-dimensional 

objects (<strong>the</strong> ABLA Level 4 discrimination) 

may not predict a person’s ability to 

consistently select his/her preferred activity 

using video presentation. 

Research is needed to examine <strong>the</strong> relative 

importance of <strong>the</strong> visual and auditory components 

of video presentations. In this study, <strong>the</strong> 

video clips were presented without sound because 

we speculated that sounds associated 

with <strong>the</strong> two videos presented concurrently 

might have been confusing to <strong>the</strong> participants, 

especially those who had not passed <strong>the</strong> 

auditory-visual discrimination (Level 6) on <strong>the</strong> 

ABLA Test. However, sounds and visual stimuli 

associated with different activities usually 

occur as a compound stimulus in <strong>the</strong> natural 

environment and one is often exposed to multiple 

stimuli simultaneously. For <strong>the</strong> Level 4 

participants, who had failed to perform <strong>the</strong> 

ABLA Level 6 auditory-visual discrimination, it 

is quite possible that <strong>the</strong>y may be able to discriminate 

some non-speech sounds. Therefore, 

distinctive sounds accompanying different 

activities might facilitate video 

discriminations even for participants who 

have not demonstrated <strong>the</strong> ABLA Level 6 discrimination. 

Alternatives to concurrent presentations 

of videos with sound, such as successive 

presentations, may help to reduce 

potential interference. 


Research on video presentation in preference 

assessment has been limited for persons 

with severe developmental disabilities, and <strong>the</strong> 

relationship between discrimination skills and 

<strong>the</strong> effectiveness of <strong>the</strong> video presentation in 

preference assessments has been unexplored. 

The potential of video presentation appears to 

lie in its ability to present complex activities 

more accurately (Ellerd et al., 2002; Stock et 

al., 2003). It is possible that individuals with 

severe developmental disabilities who have 

difficulties responding to pictorial and spoken 

stimuli in preference assessments could respond 

to or learn to respond to video presentations 

more readily. Thus, future research is 

much needed to examine <strong>the</strong> conditions under 

which video presentation will be most effective 

(relative to o<strong>the</strong>r modalities) and to 

develop effective procedures to teach individuals 

to indicate <strong>the</strong>ir preferences by responding 

to video presentations. 

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Received: 15 November 2006 

Initial Acceptance: 2 February 2007 



Teaching Test-taking Strategies to Improve <strong>the</strong> Academic 

Achievement of Students with Mild Mental Disabilities 

Allison G. Kretlow, Ya-yu Lo, Richard B. White, and LuAnn Jordan 

University of North Carolina at Charlotte 

Abstract: This study examined <strong>the</strong> effects of teaching a test-taking strategy to 4 fourth- and fifth-grade students 

with mild mental disabilities on reading and math achievement. The intervention consisted of a direct and 

explicit instructional method using a mnemonic strategy. The participants’ acquisition and application of <strong>the</strong> 

test-taking strategy on reading and math probes were evaluated using a multiple probe across participants 

design. All participants demonstrated <strong>the</strong> ability to apply <strong>the</strong> strategy on probes during <strong>the</strong> intervention, 2-week 

maintenance, and generalization conditions. Significant gains in achievement were observed for all participants. 

Implications of teaching test-taking strategies to students with mild to moderate mental disabilities were 

discussed. 

As achievement accountability measures continue 

to increase in <strong>the</strong> public education system, 

so do <strong>the</strong> expectations for students with 

disabilities. Current legislation enforces <strong>the</strong> 

need for students with disabilities to have access 

to <strong>the</strong> general education curriculum, and 

in turn for states to assess those students 

through standardized achievement measures. 

The No Child Left Behind Act (NCLB) of 

2001 requires that all students in grades three 

through eight take state-wide achievement 

tests in reading and math (Goertz & Duffy, 

2003). The NCLB Act in combination with <strong>the</strong> 

amendments to <strong>the</strong> Individuals with Disabilities 

Education Improvement Act (IDEIA, 

2004), which states that all students must be 

included in state and district assessments, 

present challenges of test-taking to students 

with disabilities (Washburn-Moses, 2003). 

The performance of students with disabilities 

on standardized achievement tests is at 

least, in part, responsible for states attaining 

what <strong>the</strong> federal government outlined in <strong>the</strong> 

NCLB Act as Adequately Yearly Progress 

(AYP). To meet AYP, schools must attain goals 

related to achievement for certain targeted 

groups of students, including students with 


be addressed to Allison G. Kretlow, 11027 Heritage 

Green Drive, Cornelius, NC 28031. Email: 

awgraves@uncc.edu 



disabilities. As a result, performance on standardized 

achievement tests has high stakes for 

students with disabilities. Additionally, school 

districts may use test scores of students with 

disabilities to decide placement, grade level 

promotion, or to determine whe<strong>the</strong>r or not a 

student graduates (Heubert & Hauser, 1999). 

By <strong>the</strong> nature of <strong>the</strong>ir disabilities, many students 

in special education programs have difficulty 

demonstrating knowledge through 

standardized achievement tests. Specifically, 

students with disabilities have difficulty with 

cognitive and metacognitive task demands. 

They often need help to approach a learning 

activity (such as test taking), and require systematic 

methods of training to acquire thinking 

skills (Henley, Ramsey, & Algozzine, 

2005). Students with disabilities also often 

have difficulty organizing information and responding 

to complex questions. For example, 

a student with a learning disability may have 

content knowledge (e.g., in math or science), 

but have difficulty demonstrating <strong>the</strong> knowledge 

in a standardized format. In o<strong>the</strong>r words, 

students’ lack of test taking skills may appear 

as academic deficiencies (Scruggs & Marsing, 

1988). 

In many states, students with learning disabilities 

(LD) and emotional and behavioral 

disabilities (EBD) have long been participating 

in standardized achievement tests with or 

without modifications and accommodations. 

Teaching Test-taking Strategies / 397

However, in accordance with <strong>the</strong> NCLB Act, 

more states now require students with mild 

mental disabilities to participate in state-wide 

testing programs. Many students with mild 

mental disabilities have traditionally been 

placed in more restrictive, separate settings 

(Henley et al., 2006) which may have led to 

less access to <strong>the</strong> general curriculum, and 

<strong>the</strong>refore less exposure to standardized test 

formats or test-taking strategies typically used 

in general education classrooms. 

Prior research has shown <strong>the</strong> importance 

and effectiveness of teaching test-taking strategies 

to students with and without disabilities. 

Studies conducted with general education students 

demonstrate that students benefit from 

test-taking instruction that includes training 

on test formats, reasoning and deduction 

strategies, time management, practice, and 

coaching (Beidel, Turner, & Taylor-Ferreira, 

1999; Bunting & Mooney, 2001; Kenny & 

Faunce, 2004; Towns & Robinson, 1993). Additionally, 

several research studies have found 

that students with LD (Lee & Alley, 1981; 

Scruggs, Mastropieri, & Tolfa-Veit, 1986; Winnery 

& Fuchs, 1993) and EBD (Hughes & 

Deshler, 1993; Scruggs & Marsing, 1988) outperformed 

students in control groups in 

achievement on content areas after being 

taught test-taking strategies. 

One effective approach for applying testtaking 

strategies is <strong>the</strong> use of mnemonic learning, 

which has shown its efficacy in improving 

testing-taking skills and achievement of students 

with high incidence disabilities such as 

LD and EBD (Hughes & Deshler, 1993; 

Hughes & Schumaker, 1991; Mason, Snyder, 

Sukhram, & Kedem, 2006; Scanlon, 2002; 

Wehrung-Schaffner & Sapona, 1990). For example, 

Hughes and Schumaker taught a mnemonic 

test-taking strategy to 6 seventh and 

eighth graders with LD. Students were taught 

a sequence of cognitive and behavioral testtaking 

strategy steps using a first-letter mnemonic 

device (i.e., PIRATES: Prepare to succeed, 

Inspect <strong>the</strong> instructions, Read, 

remember, and reduce, Answer or abandon, 

Turn back, Estimate, Survey). Using a multiple 

probe across participants design, <strong>the</strong> authors 

measured <strong>the</strong> percent of items correct 

on 10 probes designed to measure students’ 

use of <strong>the</strong> test-taking strategy. All students 

scored at or above mastery criterion on all 


probe tests and maintained <strong>the</strong>ir mastery of 

<strong>the</strong> test-taking strategy after 3 to 11 weeks. 

Additionally, <strong>the</strong> generalization data showed 

that <strong>the</strong> students improved <strong>the</strong>ir performance 

on regular class tests by an average of 14% 

after <strong>the</strong> intervention was implemented. Similar 

results were observed in a systematically 

replicated study with 6 seventh- and eighthgrade 

students with EBD (Hughes & Deshler, 

1993). 

Empirical evidence supporting <strong>the</strong> efficacy 

of mnemonic strategy-based instruction for 

students with mental disabilities is relatively 

limited. Morin and Miller (1998) delivered 

mnemonic strategy instruction to teach multiplication 

facts and word problems to three 

7 th -grade students with mental disabilities. 

Students were first instructed how to compute 

multiplication facts, <strong>the</strong>n were taught to use 

<strong>the</strong> mnemonic DRAW (Discover <strong>the</strong> sign, 

Read <strong>the</strong> problem, Answer, Write <strong>the</strong> answer) 

to complete multiplication word problems. 

Using a multiple baseline across subjects design, 

<strong>the</strong> authors evaluated students’ performance 

on 21 probes and reported that all 

students achieved mastery on all except four 

probes. Similarly, Mastropieri and Scruggs 

(1994) used mnemonic strategies to teach science 

and social studies content to students 

with mild mental disabilities who had not mastered 

<strong>the</strong> concepts after various methods of 

instruction (e.g., textbook materials, outlining, 

computer programs) from <strong>the</strong> special education 

teacher. Instruction on <strong>the</strong> mnemonic 

devices greatly improved all students’ 

mastery in naming state capitals and body 

parts. 

Despite <strong>the</strong> positive outcomes of mnemonic-based 

instruction on test-taking strategies 

for students with and without disabilities, research 

is limited in two areas. First, <strong>the</strong> majority 

of studies contained teaching test-taking 

strategies to students with high incidence disabilities 

with limited evidence supporting <strong>the</strong> 

effects of strategy instruction for students with 

mental disabilities. As <strong>the</strong> demand of including 

students with mental disabilities in <strong>the</strong> 

state-wide and district-wide assessments increases, 

so does <strong>the</strong> need for strategy instruction 

for <strong>the</strong>se students. Second, scarce research 

addressed test-taking instruction with 

elementary aged students. In order to prepare 

students for long-term standardized test tak-

ing experiences beginning at <strong>the</strong> elementary 

level, it is warranted to provide students with 

skills in <strong>the</strong>ir early schooling. The purpose of 

this study was, <strong>the</strong>refore, to address <strong>the</strong>se issues 

by examining <strong>the</strong> effects of direct and 

explicit mnemonic test-taking strategy instruction 

on <strong>the</strong> reading and math achievement 

test scores of students with mild mental disabilities 

in grades four and five. Measurements 

were taken to evaluate <strong>the</strong> degree to 

which <strong>the</strong> participants applied <strong>the</strong> taught 

strategies to tests and improved <strong>the</strong>ir achievement 

test scores, both on practice probes and 

regular classroom tests. 

Method 

Participants 

Four students with mild mental disabilities 

in grades four and five participated in this 

study. All participants had an IQ score falling 

between 60 and 72 on previously administered 

Weschler Intelligence Scales for Children 

(Weschler, 1991), which qualified <strong>the</strong>m for 

special education in <strong>the</strong> educable mental 

disability (EMD) category based on <strong>the</strong> state 

guidelines. The participants’ achievement 

scores in reading and math were at least two 

grade levels behind <strong>the</strong>ir peers without disabilities 

on previously administered Woodcock 

Johnson Test of Achievement (Woodcock, 

McGrew, & Ma<strong>the</strong>r, 1977) and various classroom-based 

assessments including <strong>the</strong> Brigance 

Diagnostic Comprehensive Inventory of Basic 

Skills-Revised (Brigance, 1999) and Corrective 

Reading assessments (Englemann, Hanner, & 

Johnson, 1999). 

Brandy was a 10-year-old female student in 

<strong>the</strong> fifth grade. She exhibited delays in cognitive 

ability, academic ability, and adaptive behavior 

when compared to her same age peers. 

She had a full scale IQ of 69, with relative 

strengths in memory and perceptual reasoning. 

Brandy demonstrated basic reading skills 

on an upper first grade level and reading comprehension 

skills on a mid-first grade level. 

Her math and writing skills were on an upper 

second grade level. Testing accommodations 

on Brandy’s Individualized Education Program 

(IEP) included testing in a separate setting, 

read aloud for math, reading aloud to 

self for reading passages, and multiple test 

sessions. 

John was a 10-year-old male student in <strong>the</strong> 

fifth grade. He exhibited delays in cognition, 

academics, and adaptive behavior, and was 

diagnosed with Attention-Deficit/Hyperactivity 

Disorder (ADHD). John received medication 

for his ADHD; however, he continued to 

experience significant difficulty with focusing, 

and demonstrated frequent impulsive behaviors 

throughout <strong>the</strong> study. John had a full 

scale IQ of 61, with a relative strength in verbal 

comprehension. John read and comprehended 

on a late first grade level, and his 

math and writing skills were on a late second 

grade level, as measured by <strong>the</strong> Woodcock Johnson 

Test of Achievement. John received speech 

language <strong>the</strong>rapy for articulation delays. Testing 

accommodations on John’s IEP included 

testing in a separate setting, read aloud for 

math, student reads aloud to self for reading, 

extended time, and multiple test sessions. 

Sarah was a 9-year-old female in <strong>the</strong> fourth 

grade. She exhibited significant delays in cognitive 

ability, academic skills, and adaptive behavior. 

Sarah’s last psycho-educational evaluation 

was completed in preschool, in which she 

demonstrated a general cognitive ability score 

of 71, with relatively higher non-verbal skills. 

Based on <strong>the</strong> preschool evaluation, her academic 

skills were on a kindergarten level. 

However, Sarah’s teacher reported that based 

on curriculum based measurement, Sarah’s 

reading skills were on an upper second grade 

level, math skills on a lower first grade level, 

and writing skills on a lower second grade 

level. Sarah received speech language <strong>the</strong>rapy 

for articulation delays. Testing accommodations 

on Sarah’s IEP included testing in a 

separate setting, read aloud for math, student 

reads aloud to self for reading, extended time, 

and multiple test sessions. 

Amy was a 9-year-old female in <strong>the</strong> fourth 

grade. Amy was diagnosed with Velo-Cardial 

Facial Syndrome (VCFS), which is a genetic 

disorder associated with cleft palate, heart 

problems, speech delays, and learning difficulties. 

On a previous evaluation, Amy exhibited 

significant delays in cognition, academics, and 

adaptive behavior, with a full scale IQ of 71, 

making her eligible for special education as 

EMD. However, during <strong>the</strong> course of <strong>the</strong> study 

Amy completed a required triennial compre- 


hensive evaluation, in which her category was 

changed from EMD to O<strong>the</strong>r Health Impaired 

(OHI) due to <strong>the</strong> impact of VCFS on her 

learning. On <strong>the</strong> current evaluation, Amy 

demonstrated a full-scale IQ of 77, reading 

scores on an upper second grade level, and 

math and writing scores on a lower second 

grade level. Due to <strong>the</strong> VCFS, Amy demonstrates 

significant speech and language impairments. 

Her speech is often unintelligible; 

<strong>the</strong>refore she uses a combination of conventional 

speech and assistive technology to communicate. 

She used both speaking and a computer 

to interact with <strong>the</strong> researcher during 

<strong>the</strong> study. Testing accommodations on Amy’s 

IEP included testing in a separate setting, extended 

time, read aloud for math, student 

reads aloud to self for reading, and multiple 

test sessions. 

Setting 

The setting was a self-contained classroom 

(grades three to five) for students with mild to 

moderate disabilities. All students in <strong>the</strong> class 

functioned significantly below <strong>the</strong>ir peers in 

academics, intellectual ability, and adaptive 

skills. The classroom housed one special education 

teacher, one classroom teacher assistant, 

and eight students. Classroom instruction 

focused on each student’s IEP goals and 

objectives on <strong>the</strong>ir instructional level along 

with <strong>the</strong> state curriculum standards in reading, 

math, and writing. 

Experimenter 

The primary experimenter, trainer, and data 

collector (first author) for this study was a 

graduate student and exceptional children 

program specialist in a rural school district. 

The experimenter had been previously 

trained in learning strategy instruction and 

taught learning strategies to students with various 

high incidence disabilities during her two 

years of classroom teaching experience. 

Data Collection Procedures 

Dependent variables. Two dependent variables 

were measured in <strong>the</strong> study. The first 

dependent variable was <strong>the</strong> student achievement 

scores on reading and math multiple 


choice probes (i.e., achievement probes), as 

measured by <strong>the</strong> percentage of items answered 

correctly on <strong>the</strong> probes. Each probe 

had 20 items organized into four sections: (a) 

reading words, (b) reading and answering 

questions, (c) math problems, and (d) math 

word problems. The section on reading words 

included fill-in-<strong>the</strong>-blank items in which <strong>the</strong> 

students read sentences <strong>the</strong>n supplied <strong>the</strong> 

missing word from four choices (e.g., “Every 

night I go to bed at a _____ time. My parents 

say that getting enough rest is very important. 

(a) certain, (b) several, (c) circus, (d) sure”). 

The reading and answering questions section 

included a passage followed by literal and 

non-literal comprehension questions. The 

math problems section included computation 

problems and numeration tasks (e.g., place 

value, numbers in standard form) and <strong>the</strong> 

final section, math word problems, included 

applied math problems involving various 

math skills (e.g., geometric shapes, interpreting 

tables and graphs). Each section had five 

questions. For each question, <strong>the</strong> participants 

were to choose <strong>the</strong> most appropriate answer 

from a choice of four. The first author constructed 

<strong>the</strong> probe items in <strong>the</strong> reading words, 

math problems, and math word problems sections 

of each probe by adapting practice endof-grade 

exams items provided by <strong>the</strong> state. 

Passages in <strong>the</strong> reading and answering questions 

section of each probe were taken from 

five practice standardized tests (Coan, 2003) 

used by <strong>the</strong> classroom teacher. The test items 

represented skills taught throughout <strong>the</strong> reading 

and math curriculum on <strong>the</strong> state’s Standard 

Course of Study for each participant’s 

specified grade level. Probes were administered 

individually. The first author scored 

each student’s probe upon completion. 

The second dependent variable was <strong>the</strong> percent 

of steps applied correctly on <strong>the</strong> pretest, 

five controlled practice tests, and <strong>the</strong> posttest, 

designed to measure students’ correct use of 

<strong>the</strong> test-taking strategy, as well as additional 

five advanced practice tests (i.e., achievement 

probes). The pretest, controlled practice tests, 

and posttest were directly retrieved from The 

Test Taking Strategy instructor’s manual 

(Deshler, Hughes, Mercer, & Schumaker, 

1993). Each of <strong>the</strong> tests had four sections 

comprised of true/false items, multiple choice 

questions, fill-in-<strong>the</strong>-blank items, and one

short essay question. Items were ei<strong>the</strong>r easy to 

answer (used to determine students’ deduction 

strategies, e.g., “In school, most students 

sit at: (a) a lounge chair, (b) a couch, (c) a 

desk, (d) a rocking chair”) or fictitious (used 

to determine students’ estimating strategies, 

e.g., “During <strong>the</strong> neoplenic period, <strong>the</strong> 

wea<strong>the</strong>r was (a) often unpredictable, (b) 

never cold, (c) always below freezing, (d) 

mostly temperate”). Using a checklist provided 

in <strong>the</strong> manual, <strong>the</strong> experimenter sat 

next to each student and placed a check next 

to <strong>the</strong> steps of <strong>the</strong> strategy <strong>the</strong> student completed 

correctly. Percent of <strong>the</strong> strategy steps 

applied correctly was calculated for each student. 

Interobserver agreement. To establish interobserver 

agreement, <strong>the</strong> classroom special education 

teacher and <strong>the</strong> first author both 

scored 30% of <strong>the</strong> probes across conditions 

for each student. The two scorers’ recordings 

were compared item by item. The percentage 

of agreement was calculated by dividing <strong>the</strong> 

number of agreements by <strong>the</strong> number of 

agreements plus disagreements and multiplying 

by 100. Interobserver reliability was found 

to be 100% on all selected probes. 

Procedural reliability. To ensure procedural 

reliability, <strong>the</strong> special education teacher observed 

30% of <strong>the</strong> instructional sessions. The 

teacher determined <strong>the</strong> accuracy with which 

<strong>the</strong> first author implemented <strong>the</strong> strategy by 

completing a procedural checklist to determine 

if <strong>the</strong> instructor (a) followed <strong>the</strong> script, 

(b) followed <strong>the</strong> instructional sequence outlined 

in <strong>the</strong> strategy, and (c) gave adequate 

repetition and corrective feedback as outlined 

in <strong>the</strong> procedures. The teacher was provided 

with a copy of <strong>the</strong> Test-Taking Strategy manual 

to follow during <strong>the</strong> observed sessions. 

Procedural reliability for each session was calculated 

by dividing <strong>the</strong> number of procedural 

items followed correctly by <strong>the</strong> total number 

of procedural items to be observed (i.e., 7) 

and multiplying by 100. Procedural reliability 

was assessed to be at 100%. 

Social validity data. Social validity data were 

collected before <strong>the</strong> study began and again 

after <strong>the</strong> study was completed to measure <strong>the</strong> 

social importance of teaching test-taking strategies 

to students with mental disabilities and 

<strong>the</strong> perceived outcomes of <strong>the</strong> instruction. Using 

a consumer satisfaction questionnaire, 

parents of <strong>the</strong> participants, <strong>the</strong> classroom special 

education teacher, and one general education 

teacher provided <strong>the</strong>ir responses. 

Experimental Design and Procedures 

The experimental design was a single-subject 

multiple probe across participants design 

(Tawney & Gast, 1984). The initial baseline 

lasted a minimum of three sessions for all 

participants, or until baseline was stable. The 

training began with Brandy first, with <strong>the</strong> remaining 

participants in <strong>the</strong> baseline condition, 

during which a probe was given to each 

participant weekly. When Brandy demonstrated 

80% accuracy on two consecutive 

probes during post-training, <strong>the</strong> training was 

introduced to John. The same criterion applied 

to Sarah and Amy in <strong>the</strong> subsequent 

order. 

Baseline. During baseline, no test-taking 

strategies were taught. The participants received 

regular instruction in reading and 

math in <strong>the</strong> self-contained classroom. The participants 

were given achievement probes to 

complete daily for at least three days or until 

baseline was stable. The probes were administered 

individually by <strong>the</strong> first author in a separate 

setting (various quiet locations available 

in <strong>the</strong> school). Students were given an unlimited 

amount of time to complete <strong>the</strong> probes. 

Participants received all modifications listed 

on <strong>the</strong>ir IEPs, including read aloud for <strong>the</strong> 

math problems, reading aloud to <strong>the</strong>mselves 

during reading passages, and extended time. 

Intervention. The instructional procedures 

were developed based on The Test Taking Strategy 

by Deshler and colleagues (Deshler et al., 

1993) and consisted of nine stages (see Table 

1). Each participant received 12 instructional 

sessions, each lasting approximately 20 min. 

In <strong>the</strong> first stage, participants were given <strong>the</strong> 

pretest. Due to <strong>the</strong> advanced reading level of 

<strong>the</strong> pretest and participants’ IEP modifications, 

all questions were read aloud. The first 

author scored <strong>the</strong> pretests, and <strong>the</strong>n gave individual 

feedback on <strong>the</strong> pretest to each participant. 

Participants <strong>the</strong>n each wrote a goal 

stating what <strong>the</strong>y wanted to learn and how 

<strong>the</strong>y would improve by using <strong>the</strong> test-taking 

strategy. In stage two <strong>the</strong> first author described 

<strong>the</strong> test-taking strategy and <strong>the</strong> purpose 

of <strong>the</strong> test-taking strategy to participants. 


TABLE 1 

Instructional Stages 

Stages Description 

1. Pretest Students take pretest measuring strategy use. 

2. Describe Instructor gives purpose and rationale for strategy and briefly 

previews each step. 

3. Model Instructor directly and explicitly models each step of <strong>the</strong> 

PIRATES strategy. 

4. Verbal rehearsal Instructor leads students in verbal repetition of each step and 

sub-step of <strong>the</strong> strategy to aid memorization and acquisition. 

5. Controlled practice Students apply strategy to practice tests designed to measure 

strategy use. 

6. Advanced practice and 

Students apply strategy to “real” tests. 

feedback 

7. Posttest Students take posttest measuring strategy use. 

8. Maintenance Instructor evaluates whe<strong>the</strong>r students have maintained strategy 

use at <strong>the</strong> end of 2-week post training on tests designed to 

measure strategy use. 

9. Generalization Instructor teaches students to generalize strategy to o<strong>the</strong>r settings 

(e.g., different subjects or courses). 

In stage three participants were trained to 

apply <strong>the</strong> “PIRATES” first letter mnemonic 

test-taking strategy as listed below: 

The first author modeled each step of <strong>the</strong> 

strategy on a sample test while enlisting a cognitive 

think aloud strategy. First, students were 

instructed to write <strong>the</strong> acronym “PIRATES” on 

<strong>the</strong> front top of <strong>the</strong>ir test page. Then, in <strong>the</strong> 

“P” step of PIRATES, “Prepare to Succeed”, 

students were taught to write <strong>the</strong>ir names on 

each page of <strong>the</strong> test and count <strong>the</strong> number of 

sections and types of questions on <strong>the</strong> test. 

Next, students learned to order <strong>the</strong> sections of 

a test by level of difficulty to help <strong>the</strong>m determine 

where to start on a test. Participants were 

shown how to begin working on <strong>the</strong> test by 

starting with <strong>the</strong> section determined by <strong>the</strong> 

test-taker to be easiest (See Figure 1). 

In step two of PIRATES, participants were 

trained to “Inspect <strong>the</strong> Instructions” by reading 

<strong>the</strong> directions on <strong>the</strong> test and underlining 

<strong>the</strong> words that tell <strong>the</strong> test-taker what to do. In 

step three, participants learned to “Read, Remember, 

and Reduce” by reading each test 

item and eliminating answer choices that were 

clearly incorrect. In step four, “Answer or 

Abandon,” <strong>the</strong> participants were trained to 

answer <strong>the</strong> question if <strong>the</strong>y were sure of <strong>the</strong> 

answer, or abandon <strong>the</strong> question if <strong>the</strong>y were 

unsure of <strong>the</strong> answer. Participants learned to 


mark abandoned items with a symbol (e.g., a 

star). Participants were taught to repeat all 

previous steps for all remaining test items in 

<strong>the</strong> section <strong>the</strong>y were working on, <strong>the</strong>n to go 

on to <strong>the</strong> section <strong>the</strong>y indicated to complete 

next (based on order of difficulty). Participants 

were instructed to again “Inspect <strong>the</strong> 

Instructions” for <strong>the</strong> next section and continue 

<strong>the</strong> strategy for <strong>the</strong> remaining sections 

and test items. In step five, “Turn Back,” participants 

were trained to return to <strong>the</strong> beginning 

of <strong>the</strong> test, locate <strong>the</strong> symbol for abandoned 

items, and ei<strong>the</strong>r answer, or “Estimate.” 

Participants learned several estimating techniques 

including: avoiding absolute words, 

choosing <strong>the</strong> longest answer, and estimating 

similar choices. In <strong>the</strong> last step, “Survey,” participants 

were instructed to look over all <strong>the</strong> 

test items to make sure <strong>the</strong>y had answered 

each item, but not to change any answers 

unless <strong>the</strong>y were certain it was incorrect. 

During stage four, verbal rehearsal, participants 

repeated each step and sub-step of PI- 

RATES using flash cards and fading prompts 

until <strong>the</strong>y memorized it and had been individually 

checked for mastery using <strong>the</strong> checklist 

provided in <strong>the</strong> test-taking instructor’s manual. 

When participants reached 90% mastery 

on memorization, <strong>the</strong>y proceeded to stage five 

of instruction, which involved participants’ ap-

plication of <strong>the</strong> test-taking strategy to controlled 

practice tests. The first author scored <strong>the</strong> controlled 

practice tests and provided individual 

feedback to participants. Steps of <strong>the</strong> strategy 

were re-taught after each test if <strong>the</strong> participant 

failed to reach a 90% mastery level. Once participants 

reached 90% mastery on one controlled 

practice test, <strong>the</strong> training ended and participants 

proceeded to stage six. 

In stage six, advanced practice and feedback, 

participants applied <strong>the</strong> test-taking strategy 

to five achievement probes. Once a participant 

completed all five probes, <strong>the</strong>y 

completed <strong>the</strong> posttest (i.e., stage seven). During 

stage eight, <strong>the</strong> participants were evaluated 

at <strong>the</strong> end of 2-week post training to 

determine if <strong>the</strong>y maintained <strong>the</strong> use of strategy. 

During stage nine, <strong>the</strong> participants were 

taught to apply <strong>the</strong> test-taking strategy to a 

variety of regular classroom tests. 

Figure 1. “PIRATES” mnemonic test-taking strategy. 

Generalization probes. Generalization included 

an examination of <strong>the</strong> participants’ 

use of <strong>the</strong> test-taking strategy and <strong>the</strong>ir 

achievement on regular classroom tests. During 

generalization, <strong>the</strong> special education 

teacher administered two regular classroom 

reading and math tests. The first author 

scored <strong>the</strong> regular classroom tests and <strong>the</strong> 

participant’s use of <strong>the</strong> test-taking strategy. 

Maintenance. Maintenance included one 

additional achievement probe which was administered 

two weeks after each participant 

completed <strong>the</strong> training. 

Results 

The intervention of teaching <strong>the</strong> test-taking 

strategies was effective for all students in that 

<strong>the</strong> instruction increased <strong>the</strong> percent correct 


TABLE 2 

Percent Correct on <strong>the</strong> Acquisition and Application of Test-taking Strategies 

by at least 10 points for each participant on 

both <strong>the</strong> tests measuring strategy application 

and <strong>the</strong> probes measuring achievement. All 

students reached 80% mastery on achievement 

probes and <strong>the</strong> tests designed to measure 

test-taking application. 

Strategy Application 

Test Brandy John Sarah Amy 

Pretest 19 40 28 27 

Training 

Controlled Practice 1 83 86 88 89 

Controlled Practice 2 75 92 72 85 

Controlled Practice 3 81 – 86 79 

Controlled Practice 4 86 – 92 81 

Controlled Practice 5 93 – – 90 

Post-training (with feedback) 

Advanced Practice 1 100 100 86 79 





Posttest 90 92 86 85 

Post-training (without feedback) 

Maintenance 93 86 86 86 

Generalization 1 86 58 55 83 

Generalization 2 86 86 80 80 

Results on <strong>the</strong> test-taking application showed 

that Brandy and John both memorized <strong>the</strong> 

steps of <strong>the</strong> test-taking strategy as demonstrated 

by verbal repetition in only two attempts. 

Sarah and Amy had some difficulty 

memorizing <strong>the</strong> steps of <strong>the</strong> test-taking strategy, 

taking <strong>the</strong>m five and six attempts, respectively, 

to verbally repeat <strong>the</strong> strategy correctly. 

Both Sarah and Amy had lower verbal ability 

scores on previous evaluations among all participants, 

thus it is possible that <strong>the</strong>ir difficulty 

memorizing and repeating <strong>the</strong> strategy could 

be attributed to <strong>the</strong> lower verbal ability. 

Data were also collected to determine <strong>the</strong> 

level of accuracy with which each participant 

applied <strong>the</strong> test-taking strategy prior to training, 

during training, and post training, as 

measured by percent correct on <strong>the</strong> pretest, 

controlled practice tests, advanced practice 

tests, and posttest. All participants reached 

mastery of 80% correct during controlled 

practice and advanced practice, and demonstrated 

significant gains from pretest to posttest 

in <strong>the</strong>ir test-taking ability. Results are presented 

in Table 2. 

Achievement Probes 


Achievement probes results (see Figure 2) 

also support <strong>the</strong> effectiveness of <strong>the</strong> intervention. 

Brandy obtained a mean percent score of 

55 (range 50–60) on achievement probes during 

baseline and a mean percent score of 77.4 

(range 55–90) during post-training sessions. 

Her lowest score, at 55 percent during <strong>the</strong> 

second post-training session, could be attributed 

to <strong>the</strong> level of reading difficulty of <strong>the</strong> 

probe. The first author observed her having 

difficulty reading <strong>the</strong> passages in <strong>the</strong> probe 

which negatively impacted her score, and adjusted 

<strong>the</strong> subsequent probes to match her 

instructional reading level. John obtained a 

mean percent score of 55 (range 55–65) on 

baseline probes and improved his score to 

82.4 (range 80–84) during post-training. Similarly, 

Sarah and Amy demonstrated substantial 

improvements on achievement probes, 

from a mean percent score of 45.5 (range 

35–55) and 49.1 (range 30–65), respectively,

Figure 2. Percent correct on <strong>the</strong> achievement probes. 


during baseline to a mean percent score of 

77.8 (range 60–85) and 84.4 (range 70–100), 

respectively, during post-training. All participants 

maintained a minimum of 80% correct 

on <strong>the</strong> maintenance achievement probe two 

weeks after <strong>the</strong> training was terminated. 

Generalization data on achievement probes 

showed much variability for all participants. 

Specifically, Brandy scored a mean percent of 

56 (range 33–73), John 66.3 (range 44–80), 

Sarah 57.5 (range 40–75), and Amy 64 (range 

53–75) on <strong>the</strong>ir regular classroom tests. 

Social Validity Data 

Parents and <strong>the</strong> special education teacher of 

<strong>the</strong> participants felt that students with mental 

disabilities were not prepared to take tests and 

that <strong>the</strong>y ei<strong>the</strong>r had no or only limited knowledge 

of test formats, while <strong>the</strong> general education 

teacher felt that students with mental 

disabilities were somewhat prepared to take 

tests and had some knowledge of test formats. 

All of <strong>the</strong> respondents felt that students with 

mental disabilities would benefit from testtaking 

strategy instruction. Regarding <strong>the</strong> perceived 

outcomes, all respondents agreed that 

<strong>the</strong> participants were more prepared to take 

tests after being taught <strong>the</strong> test-taking strategy. 


To extend current research and practice limitation 

on <strong>the</strong> use of test-taking strategies with 

elementary-age students with mental disabilities, 

<strong>the</strong> primary purpose of this study was to 

examine <strong>the</strong> effects of teaching a direct and 

explicit test-taking strategy on <strong>the</strong> reading and 

math achievement of students with mild mental 

disabilities in grades four and five. 

All participants demonstrated <strong>the</strong> ability to 

acquire and apply a comprehensive, mnemonic 

test-taking strategy. Specifically, <strong>the</strong> 

participants required five or fewer controlled 

practices during training to reach a 90% mastery 

criterion on <strong>the</strong>ir use of test-taking strategies. 

All participants achieved a minimum 

level of 80% criterion on all five advanced 

practices during post training, with <strong>the</strong> exception 

of Sarah and Amy for whom feedback was 

provided only once when <strong>the</strong>y failed to reach 

<strong>the</strong> criterion (i.e., Advanced Practice 2 for 

Sarah and Advanced Practice 1 for Amy). Ad- 


ditionally, all participants maintained <strong>the</strong>ir acquisition 

of <strong>the</strong> test-taking strategy on <strong>the</strong> 

posttest, 2-week maintenance assessment, and 

two generalization measurements of regular 

classroom tests. These results are consistent 

with previous research in two ways. First, students 

with mild mental disabilities effectively 

learned and applied <strong>the</strong> test-taking strategy 

through use of <strong>the</strong> nine-stage instructional 

sequence found in o<strong>the</strong>r learning strategy research 

with students with LD or EBD (Ellis, 

Deshler, Lenz, Schumaker, & Clark, 1991; 

Hughes & Deshler, 1993; Hughes & Schumaker, 

1991; Morin & Miller, 1998). Thus, 

this study provides additional support to <strong>the</strong> 

efficacy and usefulness of teaching mnemonic 

test-taking strategies for students with disabilities. 

Second, <strong>the</strong> results support previous research 

in that students with disabilities not 

only can apply a test-taking strategy to tests, 

but also can maintain <strong>the</strong> skill over time and 

generalize use of <strong>the</strong> strategy to o<strong>the</strong>r testtaking 

situations (Hughes & Deshler, 1993; 

Hughes & Schumaker, 1991). 

Results on participants’ achievement 

probes demonstrated a functional relationship 

between <strong>the</strong> test-taking strategy instruction 

and percent correct on math and reading 

achievement tests. During baseline, Brandy 

and Sarah received 60% correct or lower on 

all of <strong>the</strong> achievement probes while John and 

Amy scored 70% correct or lower on <strong>the</strong>ir 

achievement probes. During post training and 

2-week maintenance conditions, all participants 

scored higher than <strong>the</strong>ir baseline performance 

on all of <strong>the</strong>ir five achievement 

probes, with <strong>the</strong> exception of <strong>the</strong> second data 

point for Brandy. Therefore, an experimental 

control was apparent in this study, supporting 

previous research on <strong>the</strong> efficacy of test-taking 

instruction in improving students’ achievement 

scores (Beidel et al., 1999; Bunting & 

Mooney, 2001; Kenny & Faunce, 2004; Lee & 

Alley, 1981; Scruggs et al., 1986; Scruggs & 

Marsing, 1988; Towns & Robinson, 1993; Winnery 

& Fuchs, 1993) and maintaining positive 

achievement outcomes over time (Hughes & 

Deshler, 1993; Hughes & Schumaker, 1991). 

However, <strong>the</strong> generalization data for <strong>the</strong> 

achievement probes were inconclusive. Although 

all participants improved <strong>the</strong> mean 

percent correct on <strong>the</strong> generalization achievement 

probes by 1% to 15% compared to <strong>the</strong>

aseline probes, data were highly variable and 

an experimental control was not achieved due 

to <strong>the</strong> lack of generalization data prior to <strong>the</strong> 

intervention. The low and variable generalization 

achievement scores may result from <strong>the</strong> 

participants’ academic skill levels. Specifically, 

all participants applied <strong>the</strong> test-taking strategy 

with a high level of accuracy to <strong>the</strong> generalization 

probes, however <strong>the</strong>y sometimes had 

low overall scores because <strong>the</strong> content knowledge 

was too difficult or unfamiliar, or <strong>the</strong> test 

materials were not matched to <strong>the</strong>ir instructional 

reading levels. It is important to note 

that a test-taking strategy is not intended to 

compensate for gaps in content knowledge or 

reading ability. This may explain why <strong>the</strong> participants 

did not generalize <strong>the</strong>ir achievement 

outcomes to regular classroom tests, a finding 

inconsistent with previous research conducted 

with students who have high incidence disabilities 

(Hughes & Deshler, 1993; Hughes & 

Schumaker, 1991; Lee & Alley, 1981). Future 

research is warranted to develop strategies in 

promoting generalization across types of 

achievement tests and to develop appropriate 

tests measuring general education content 

with lower reading levels. 

Some limitations were noted in this study. 

First, a large portion of <strong>the</strong> test-taking strategy 

training used in <strong>the</strong> current study relied 

heavily on print. Although modifications were 

made to <strong>the</strong> materials, and accommodations 

were given during <strong>the</strong> sessions, participants’ 

success was still somewhat contingent upon 

<strong>the</strong>ir reading ability. In order for <strong>the</strong> testtaking 

strategy to be most effective, <strong>the</strong> training 

materials should be matched to <strong>the</strong> participants’ 

instructional reading level. The 

materials developed by Deshler and colleagues 

(1993) were intended to be used with 

adolescents with LD, thus <strong>the</strong> reading levels 

were too difficult for elementary students with 

mild mental disabilities. Because <strong>the</strong> participants 

benefited from <strong>the</strong> content of <strong>the</strong> strategy, 

it would be beneficial for <strong>the</strong> reading 

level of <strong>the</strong> training materials to be modified 

for elementary students. Future research 

should include using <strong>the</strong> same procedures, 

but with lower level readability. Second, generalization 

data were only available post intervention 

and were not measured during baseline 

or training, making it difficult to evaluate 

<strong>the</strong> extent to which <strong>the</strong> participants general- 

ized positive achievement outcomes to regular 

classroom tests. Future research is needed to 

more systematically collect and evaluate generalization 

data throughout <strong>the</strong> course of <strong>the</strong> 

study. Finally, during <strong>the</strong> course of <strong>the</strong> study, 

Amy changed eligibility categories from Educable 

Mentally Disabled to O<strong>the</strong>r Health Impaired. 

Although her IQ score was still in <strong>the</strong> 

borderline range, it is possible that she performed 

better than o<strong>the</strong>r participants due to a 

higher cognitive ability level, making her results 

difficult to compare to those of students 

with EMD. 

Despite <strong>the</strong> limitations, this study offers important 

research and practice implications. 

The No Child Left Behind Act of 2001 and <strong>the</strong> 

Individuals with Disabilities Education Improvement 

Act (2004) state that students with 

mild mental disabilities must be exposed to 

and assessed on general curriculum grade appropriate 

standards. States most often assess 

students’ achievement through <strong>the</strong> use of 

standardized tests, thus it is critical that students 

with mild mental disabilities continue to 

be taught direct and explicit test-taking strategies. 

This study demonstrates that students 

who are identified as having mild mental disabilities 

can be taught effectively a comprehensive 

test-taking strategy which may consequently 

improve achievement. Teachers and 

educators working with students with mild 

mental disabilities may utilize test-taking strategy 

instruction as a promising and valid 

method for improving students’ test-taking 

skills and academic achievement. In addition, 

this study points to <strong>the</strong> need for modifications 

in teaching students with mild mental disabilities 

who have lower academic skills and more 

reading delays. Participants in this study received 

instruction in a one-on-one setting, 

with direct instruction, verbal rehearsal, cue 

cards and fading prompts used as instructional 

methods to teach <strong>the</strong> test-taking strategy. 

Complex wording in <strong>the</strong> training materials 

was simplified or read aloud to students. If 

students with mild mental disabilities are to be 

held accountable through high stakes, standardized 

achievement testing, appropriate 

modifications must be made to allow <strong>the</strong>se 

students to fully demonstrate <strong>the</strong>ir competence. 

Similarly, it is vital that appropriate 

training and test materials are developed so 

that <strong>the</strong>y match to students’ instructional 


eading levels for <strong>the</strong> maximum outcomes. In 

short, with carefully designed instruction and 

appropriate test materials, students with mild 

mental disabilities can be supported to successfully 

participate and demonstrate <strong>the</strong>ir 

learning in standardized assessments. 

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Received: 15 November 2006 

Initial Acceptance: 5 February 2007

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