etadd_46(4) - Division on Autism and Developmental Disabilities

Education and 

Training 

in 

Autism 

and 

Developmental 

Disabilities 

Cumulative Author Index 

2001-2010 

Focusing on individuals with 

autism, intellectual disabilities and other developmental disabilities 

Volume <strong>46</strong> Number 4 

DAD 

D 

December 2011

Education and Training in Autism and Developmental Disabilities 

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

The Council for Exceptional Children 

Editor: Stanley H. Zucker 

Arizona State University 

Mary Lou Fulton Teachers College 

Consulting Editors 

Martin Agran 

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David L. Gast 

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James V. Kahn 

H. Earle Knowlton 

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Editorial Assistant: Silva Hassert 


Mary Lou Fulton Teachers College 

John McDonnell 

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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 

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Exceptional Child Education Resources. 

Education and Training in Autism and Developmental Disabilities Vol. <strong>46</strong>, No. 3, September 2011, Copyright 2011 by the <strong>Division</strong> on Austim 

and Developmental Disabilities, The Council for Exceptional Children. 

<strong>Division</strong> on Autism and Developmental Disabilities 

The Council for Exceptional Children 

Board of Directors 

Officers 

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The purposes of this organization shall be to advance the education and welfare of persons with autism and developmental disabilities, research 

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

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EDUCATION AND TRAINING IN AUTISM AND DEVELOPMENTAL DISABILITIES (ISSN 2154-1647) (USPS 0168-5000) is published 

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March 2012 

Manuscripts Accepted for Future Publication in 

Education and Training in Autism and Developmental Disabilities 

Beyond time out and table time: Today's applied behavioral analysis for students with autism. E. 

Amanda Boutot and Kara Hume, Frank Porter Graham Child Development Institute, University of 

North Carolina at Chapel Hill, 517 S. Greensboro, Carrboro, NC 27510. 

Experiences of preschoolers with severe disabilities in an inclusive early education setting: A qualitative 

study. Mary Frances Hanline and Silvia M. Correa-Torres, School of Teacher Education, Florida State 

University, Tallahassee, FL 32306. 

Effects of combined repeated reading and question generation intervention on young adults with 

cognitive disabilities. Youjia Hua, William J. Therrien, Jo M. Hendrickson, Suzanne Woods-Groves, 

Pamela S. Ries, and Julia W. Shaw, University of Iowa, College of Education, Department of Teaching 

and Learning, N256 Lindquist Center, Iowa City, IA 52242. 

How and why do parents choose early intensive behaivoral intervention for their young child with 

autism?. Pagona Tzanakaki, Corinna Grindle, Richard P. Hastings, J. Carl Hughes, Hanna Kovshoff, 

and Bob Remington, School of Psychology, Adeilad Brigantia, Penrallt Road, Bangor, Gwynedd LL57 

2AS UK. 

Effects of differential reinforcement of short latencies on response latency, task completion, and 

accuracy of an adolescent with autism. Melanie M. Donohue, Laura Baylot Casey, David F. Bicard, 

and Sara E. Bicard, College of Education, The University of Memphis, 405 Ball Hall, Memphis, TN 

38152. 

Seven reasons to promote standards-based instruction for students with severe disabilities: A reply to 

Ayres, Lowrey, Douglas, & Sievers (2011). Ginevra Courtade, Fred Spooner, Diane Browder, and 

Bree Jimenez, College of Education and Human Development, University of Louisville, Louisville, KY 

40292. 

Assessment of the self-determination of Spanish students with intellectual disabilities and other 

educational needs. María Gómez Vela, Miguel Ángel Verdugo Alonso, Francisca Gil González, Marta 

Badia Corbella, and Michael L. Wehmeyer, University of Salamanca, Institute on Community Integration 

(INICO), Facultad de Psicología, Avda. de la Merced 109-131, 37005 - Salamanca, SPAIN. 

Self-advocacy skills as a predictor of student IEP participation among adolescents with autism spectrum 

disorders. Lucy Barnard-Brak and Danielle D. Fearon, Baylor University, One Bear Place #97301, 

Waco, Texas 76798. 

Teaching play skills to children with autism through video modeling: Small group arrangement and 

observational learning. Sema Batu, Arzu Ozen, and Sema Batu, Anadolu Universitesi, Engelliler 

Arastirma Enstitusu, Eskisehir, 26470 TURKEY. 

The Question Still Remains: What Happens When the Curricular Focus for Students with Severe 

Disabilities Shifts? A Reply to Courtade, Spooner, Browder, and Jimenez (2012). Kevin M. Ayres, K. 

Alisa Lowrey, Karen H. Douglas, and Courtney Sievers, Department of Special Education, The 

University of Georgia, 516 Aderhold Hall, Athens, GA 30602-7153. 

Address is supplied for author in boldface type.

Education and Training in Autism and Developmental Disabilities, 2011, <strong>46</strong>(4), 479-498 

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

Review of Twenty-First Century Portable Electronic Devices 

for Persons with Moderate Intellectual Disabilities and 

Autism Spectrum Disorders 

Linda C. Mechling 

University of North Carolina Wilmington 

Abstract: Use of portable electronic devices by persons with moderate intellectual disabilities and autism spectrum 

disorders is gaining increased research attention. The purpose of this review was to synthesize twenty-first century 

literature (2000-2010) focusing on these technologies. Twenty-one studies were identified which evaluated use 

of: (a) media players with audio playback; (b) cellular/smartphones; (c) handheld computers and handheld 

video players across various skills and settings to assist persons with disabilities. Guidelines and recommendations 

for instruction and future research are provided. 

Persons with moderate intellectual disabilities 

(ID) and those with a diagnosis of autism 

spectrum disorder (ASD) have been shown to 

have the ability to self-manage their own behaviors 

and to independently complete functional, 

daily tasks when provided with the 

proper tools and technologies (Mechling, 

2007; Wehmeyer, Palmer, Smith, Davies, & 

Stock, 2008). With the use of assistive technologies 

or mainstream technologies, one of the 

goals is to increase independence while decreasing 

reliance on other persons for assistance. 

Today’s portable electronic technologies, 

including handheld computers, cellular 

(cell) phones, e-books or electronic readers, 

global positioning systems (GPS) and personal 

media or MP3 players, appear to hold 

potential for assisting persons with moderate 

ID and those with a diagnosis of ASD. These 

portable technologies may be adapted or specially 

designed for persons with disabilities 

(i.e., Community Integration Suite by 

Ablelink Technologies; Cyrano Communicator 

TM by Kiba Technologies, LLC) or generic, 

mainstream technologies such as cell 

phones and the iPod by Apple, Inc. that are 

Correspondence concerning this article should 

be addressed to Linda Mechling, University of 

North Carolina Wilmington, Department of Education 

of Young Children and Special Education, 601 

S. College Road, Wilmington, NC 28404-5940. 

mass produced (Carey, Friedman, & Bryen, 

2005). Their portability and capacity for storing 

large amounts of data formulate a tool for 

providing multiple uses for persons with moderate 

ID and ASD including: (a) remembering 

and performing steps of a complex task (Riffel 

et al., 2005); (b) decision making (Davies, 

Stock, & Wehmeyer, 2003); (c) organization 

and time management (Gillette & DePompei, 

2008); and (d) self-monitoring and self-management 

of behaviors (Cihak, Wright, & Ayres, 

2010). 

While these portable electronic devices are 

rapidly increasing in number and advancing 

in capabilities, research evaluating their applied 

use with persons with disabilities remains 

relatively minute. In their meta-analysis 

of single-subject design studies which evaluated 

use of technology by persons with intellectual 

disabilities, Wehmeyer et al. (2008) 

recommended more research with a wider 

range of technology devices and reported that 

only .9% of the 81 studies they evaluated used 

palmtop computers, 2.2% evaluated palmtop 

computers with audio vibrators, and 4.8% 

evaluated electronic and information technologies 

(i.e., cell phones). 

The purpose of this review was to examine 

the most current research which has applied 

portable electronic devices to increase the independent 

functioning of persons with moderate 

ID and those with a diagnosis of ASD. By 

examining the present status of a relatively 

Twenty-First Century Portable Electronic Devices / 479

new line of research, the review holds potential 

for laying the ground work for additional 

lines and directions for future research. 

Method 

The period of review was limited to those 

studies conducted in the twenty-first century. 

Although a review of this limited extent risks 

exclusion of some earlier findings, devices 

such as personal digital assistants, which have 

been in existence since the beginning of the 

eighties, have only become extensively popular 

in the last few years (Nashville, 2009). Likewise, 

cellular phones were a rarity fifteen years 

ago (Cell Phones.org, 2008), and the popular 

iPod and video iPod by Apple, Inc. were introduced 

in 2000 and 2005 respectively. Therefore, 

due to the relatively recent introduction 

of these portable electronic technologies into 

mainstream society, and the rapidly changing 

nature of technology, this review extended 

from the years 2000–2010. Journal articles 

published between those years were located 

using an electronic search through a university 

EBSCOhost database (Academic Search 

Premier, Eric, MasterFILE Premier, PsychAR- 

TICLES, and PsycINFO). Specific key words 

used in the search were a combination of the 

words disabilities, intellectual disabilities, autism, 

autism spectrum disorders, mental retardation 

and the words personal digital assistants, 

PDAs, handheld computers, palmtop 

computers, pocket PCs, cellular phones, cell 

phones, mobile phones, smartphones, mobile 

technologies, portable electronic devices, 

iPhone, iPod, video iPod, MP3 players, and 

portable media players. In addition to the 

electronic search, a cross-reference, manual 

search was made of previously identified articles. 

In order to be included in the review, articles 

had to meet the following criteria: 

1. Use of a quasi-experimental or single-subject 

research design. 

2. Publication in peer-reviewed journal published 

in the English language. 

3. Primary intervention was the evaluation of 

a form of portable electronic technology: 

handheld computer, cellular phone, MP3 

player. 

4. Participants were diagnosed with a moder- 

ate intellectual disability and/or autism 

spectrum disorder. 

Results 

Twenty-one studies (Table 1) were identified 

and included in this review. Although not 

within the scope of this literature review, readers 

may also wish to review the work being 

conducted with handheld devices and smartphones 

as memory and organization aids with 

persons with traumatic brain injury (i.e., De- 

Pompei et al., 2008; Gentry, Wallace, Kvarfordt, 

& Lynch, 2008; Gillette & DePopmei, 

2008; Hart, Buchhofer, & Vaccaro, 2004; Hart, 

O’Neil-Pirozzi, & Morita, 2003; Wade & Troy, 

2001). The review is organized around three 

types of portable electronic technologies: 

handheld computers and handheld video 

players (17 studies), cellular phones (3 studies), 

and MP3 players (1 study). Skills addressed 

were: functional, multi-step skills (15 

studies); time management and organization 

skills (4 studies), and independent transitions 

(2 studies). The majority of participants were 

15 years of age and older (18 studies) while 

seven studies included students under the age 

of 15 years and two studies included elementary 

age students. The majority of the studies 

evaluated use of portable electronic devices 

with students with moderate ID (17 studies) 

and five of the studies included students with 

ASD. 

Media Players with Audio Playback 

In 2007, Millard reported that “every month a 

new portable MP3 player is on the market” 

with capabilities and functions extending beyond 

music players. She further sites the increased 

use of these players as a creative 

means for providing alternative methods for 

students with disabilities to learn. Simply applied, 

MP3 players can deliver auditory information 

to students in a step-by-step format for 

completing multiple step tasks or they can be 

used to prompt on-task behaviors. Media players 

such as the iPod provide auditory prompts 

and information in much the same way that 

earlier studies used portable cassette players 

(Post & Storey, 2003; Taber, Alberto, & 

Fredrick, 1998), but provide more sophisticated 

means for navigating through recorded 

480 / Education and Training in Autism and Developmental Disabilities-December 2011

TABLE 1 

Overview of Handheld Technology 

Research Design Setting Results 

Author(s) Participants Target Skill 

(Dependent Variable) 

Alternating treatment Domestic living area 

of high school 

Operate debit & copy 

machine 

Media Players with Audio 

Playback 

Taber-Doughty, (2005) n 3CA 15-21yrs 

Moderate ID 

Picture prompting system, 

SLP, & MP 3 Player 

effective & efficient 

procedures. 

Performance superior 

when students used 

their preferred system. 

Center-based Compared to a 

mainstream cell phone, 

participants required 

fewer prompts & made 

fewer errors with the 

Within- Subjects 

paired samples 

Operate adapted 

phone functions & 

mainstream phone 

functions 

n 22 CA 18- 

21yrs Full scale IQ 

range 47–69 

Cellular/Smartphone 

Stock, Davies, Wehmeyer, 

& Palmer (2008) 

adapted phone. 

Participants effectively 

dialed phone numbers. 

Difficulty describing 

School-based. 

Generalization to 

community. 

Multiple probe across 

groups 

Dial phone # from 

printed card when 

lost. Describe 

n 14 CA 11- 

14yrs Moderate ID 

Taber, Alberto, Hughes, 

& Seltzer (2002) 

location. 

location 

Participants effectively 

used speed dial 

function to place 

phone call & to answer 

phone when lost in 

school or community. 

Difficulty describing 

location. 

School-based 

Generalization to 

community. 


students 

Operate speed dial, 

answer phone 

when lost. Describe 

location 

n 6CA 14-18yrs 

Moderate ID 

Taber, Alberto, Seltzer, & 

Hughes (2003) 

(Continued) 


TABLE 1—(Continued) 





n 12 CA 19- 

<strong>46</strong>yrs Full scale IQ 

range 45–90 

PDA with Text, Sound, 

and Light Cues 

Davies, Stock, Wehmeyer 

(2002a) 

PDA with specially 

designed prompting 

software more effective 

than written schedule 

for prompting initiation 

Community 

vocational site 

Two-group withinsubjects 

design 

Compared 

performance of 

tasks on schedule 

using a written 

schedule or PDA 

of tasks. 

School setting Students were able to use 

the PDA as a task 

management tool. 

Maintenance of skill up 

to 8 weeks. 

Quasi-experimental 

pre- & postassessment 

Independent 

operation of PDA 

(enter 

appointments, 

schedules, 

assignments) & 

frequency of use of 

PDA 

n 22 CA 14- 

18yrs Autism 

Gentry, Wallace, 

Kvarfordt, & Lynch 

(2010) 

Highest rate of on-time 

behavior using the 

PDA. 

School-based 

settings 

Comparison of 

incidence rate ratios 

across conditions & 

periods using a 

Poisson regression 

On-time behavior 

using: written time 

& task list; paper 

planner, & PDA 

n 20 CA 6-20yrs 

Mild - moderate 

ID 

Gillette & Depompei 

(2008) 

482 / Education and Training in Autism and Developmental Disabilities-December 2011 

Community settings Increased independent 

transitions between 

tasks. Maintenance up 

to 9 weeks. 


students 

Transition between 

vocational tasks 


Moderate to 

Severe ID 

PDA with Picture Cues 

Cihak, Kessler, & Alberto 

(2008)






Community settings Independent task 

completion using the 

PDA. Maintenance up to 


tasks 

Independent task 

completion of 

progressively more 


Moderate ID 

Cihak, Kessler, & Alberto 

(2007) 

9 weeks. 

difficult tasks 

Self-model pictures on the 

PDA resulted in increased 

task engagement & 

decreased teacher 

ABAB Middle school 

general education 

classrooms 

Self-monitoring of 

task engagement 


High functioning 

autism 

Cihak, Wright, & Ayres 

(2010) 

prompts. 

Use of PDA with specially 

designed software 

incorporating decision 

points resulted in 

increased independence 

& accuracy assembling 

Community 

vocational setting 


design 

Software & Pocket PC 

assembly 

n 40 CA 18- 


range 24–76 

Davis, Stock, & 

Wehmeyer (2003) 

both tasks. 

PDA with specially designed 

software produced 

improved task accuracy & 

decreased reliance on 

Community 

vocational setting 


design 

Assemble pizza boxes 

& package software 

n 10 CA 18- 


range 39–72 

Davies, Stock, & 

Wehneyer (2002b) 

adult prompts. 

Alternating treatment Day activity center Students completed more 

steps independently when 

using the PDA compared 

to a picture based system. 

Steps were also clustered 

into fewer pictures on the 

PDA. 

Cleaning, table 

setting, food 

preparation 


IQ unavailable 

Adaptive Behavior 

Scale, age 

equivalents 2-6.5 

years for daily 

living 

Lancioni, O’Reilly, 

Seedhouse, Furniss, & 

Cunha (2000) 







Use of PDA with specially 

designed software increased 

number of steps performed 

without adult prompting. 

Decrease in duration time 

to complete tasks. 

School, group 

home, retirement 

home, restaurant 


participants 

Table setting, rolling 

silverware, laundry 

Riffel et al. (2005) n 4CA 16-21yrs 

Mild to moderate 

ID, Autism 

PDA with Video Cues & 

Handheld Video 

Players 

ABAB Elementary school Increased independent 

transitioning with video 

models presented on 

video iPod. Performance 

decreased with withdrawal 

Transitions between 

school locations & 

activities 

n 4CA 6-8yrs 


Cihak, Fahrenkrog, 

Ayres, & Smith (2010) 

of video models. 

Use of PDA with multiple 

prompt levels (audio, 

picture, video) resulted in 

immediate increase in 

independent completion of 

cooking recipes. Students 

prompts used. Performance 

Home living area of 

high school 

Food preparation Multiple probe across 

tasks 


Moderate ID 

Mechling, Gast, & Seid 

(2010) 


maintained over time. 

Use of PDA with multiple 


picture, video) replicated 

results of Mechling et al. 

(2010) although use & 

self-adjustment of prompt 

levels differed from 

previous findings. 

Home living area of 

high school 

Food preparation Multiple probe across 

tasks 



Mechling, Gast, & Seid 

(2009)






University campus Use of PDA with multiple 


picture, video) resulted in 

students independently 

locating three different 

destinations. Students selfadjusted 

prompt levels 

used. Maintenance of 


tasks 

Pedestrian travel 

(walking) locating 

landmarks & 

destinations 

Mechling & Seid (2011) n 3CA 21-22yrs 

Moderate ID 

skills over time. 

Alternating treatments Community library Both simultaneous & 

delayed video modelling 

effective. Preferred 

modeling system more 

effective for 2 students. 

Generalization of 

performance across 

Locating books & 

DVDs. Use of 

computer to locate 

call numbers 


Moderate ID 

Taber-Doughty, Patton, & 

Brennan (2008) 

libraries. 

Video prompting & feedback, 

using a Video iPod, 

resulted in an increase in 

correct responding across 

tasks & decrease in adult 

prompting for error 

correction & use of the 

No-kill animal 

shelter 


tasks 

Emptying trash, 

mopping, cleaning 

bathroom, cleaning 

kennels 

n 1CA 17yrs 

Moderate ID 

Van Laarhoven, Van 

Laarhoven-Myers, 

Grider, & Grider 

(2009) 

device. 

Video modeling & feed 

back & least to most 

prompting resulted in 

increased independent 

responding & decrease in 

adult prompting 

Red Robin & 

Applebee’s 

restaurants 


tasks 

Sorting & sanitizing 

silverware, 

portioning recipes, 

cleaning & 

sanitizing work 

area, clocking in & 

out, rolling 

silverware 

n 2CA 18yrs 

Mild to moderate 

ID 

Van Laarhoven, Van 

Laarhoven-Myers, & 

Zurita (2007) 


Figure 1. MP3 Player (Model: SM-320V). Pine 

Technology, Ltd. 

segments on the device. In addition, media 

players such as video iPods now feature video 

playback (see section titled Handheld Computers 

and Handheld Video Players). 

In the only identified study evaluating use 

of a media player with audio playback, Taber- 

Doughty (2005) used a D’music MP3 Player 

(Pine Technology, Ltd) (Figure 1) to deliver 

auditory prompts while comparing the effects 

and efficiency of student choice and task performance 

between prompting methods (MP3 

player, system of least prompts, and picture 

prompts). Data were collected for the percent 

of task steps completed independently and 

the duration of task completion for the tasks 

of operating a copying machine and making 

purchases using a debit card machine. Results 

demonstrated that each system was effective 

and efficient for five high school age students 

with moderate ID and that students’ performances 

were superior when using their system 

of choice. 

Although the experimental design did not 

meet the criteria for inclusion in the current 

literature review, one additional study was 

identified which used a portable cassette 

player to prompt students with moderate intellectual 

and visual disabilities (Lancioni, 

O’Reilly & Oliva, 2001). The study demonstrated 

that although more sophisticated devices 

may be available, researchers and practitioners 

are still finding value in lighter tech 

systems. An interesting finding and focus of 

the study was that following task mastery using 

step-by-step auditory instructions, the partici- 

pants were able to complete tasks when two 

auditory steps from the original instructions 

were clustered together. 

Cellular/Smartphones 

In addition to meeting basic communication 

needs, it is suggested that use of cell phones by 

persons with disabilities can address safety issues 

(i.e., being lost, being stranded if a wheelchair 

breaks down) or be used as a memory 

aid (alarms and reminder features) (Bryen, 

Carey, & Friedman, 2007). In their survey of 

cell phone use by 83 persons with intellectual 

disabilities, Bryen et al. found that in addition 

to day-to-day communication, cell phones 

were most often used for emergencies, storing 

phone numbers, and storing calendar information. 

In the current review, two of the three 

studies which evaluated use of cell phones by 

persons with moderate intellectual disabilities, 

used a cell phone as an intervention for the 

emergency situation of being lost in the community. 

In the first study, Taber, Alberto, 

Hughes, and Seltzer (2002) found that 14 

middle school students were able to use a cell 

phone to dial a number by copying a phone 

number from a printed card and to describe 

their physical location. Sessions were first conducted 

at school and then generalized to a 

community setting. In a final phase, students 

also dialed a different phone number than the 

one used during training. 

Because some students had difficulty dialing 

the phone number in the first study, speed 

dialing was used in a second study by Taber, 

Alberto, Seltzer, and Hughes (2003). In addition 

to the change in dialing, they also evaluated 

six secondary age students’ abilities to 

answer a cell phone and describe their location 

to the caller for those students who were 

not able to recognize that they were lost. Once 

again, training took place in the school setting 

and then generalization sessions occurred in 

two community settings. Results were again 

supportive of cell phone use by students with 

moderate intellectual disabilities when lost in 

the community. One interesting result of each 

of these studies was that in addition to some 

issues with operation of the cell phone itself, 

students had the greatest amount of difficulty 

describing their physical location. 

In spite of their potential benefits, Bryen et 


al. (2007) still found a gap between the use of 

cell phones by people with intellectual disabilities 

compared to persons without disabilities. 

In their report they found that non-use by 

persons with intellectual disabilities was primarily 

due to cost, perception of not needing 

a cell phone, and lack of accessibility. To address 

the issue of cognitive accessibility, Stock, 

Davies, Wehmeyer, and Palmer (2008) evaluated 

a specially designed multimedia software 

prototype, Pocket ACE (AbleLink Technologies), 

with 22 participants with intellectual disabilities 

(range IQ score 47–69). The program 

operated on the Pocket PC 2002 Phone edition 

of a mainstream PDA and incorporated a 

picture-based address book and simplified system 

for operating phone functions of the 

PDA. Adapted features allowed participants to 

place phone calls by tapping pictures on the 

PDA screen and to see a picture of the person 

calling them when they received a call. When 

compared to a mainstream Nokia cell phone, 

participants required fewer prompts and 

made fewer errors when placing and receiving 

calls. 

With the widespread availability and relatively 

inexpensive cost of cell phones, it may 

be time for the field of special education to 

look in-depth into cell phone use beyond 

emergency applications. Other features and 

uses identified by Bryen et al. (2007) were: 

paging and text messaging, connecting to the 

internet, use of voice recognition capabilities, 

speed dialing, voice mail options, transmitting 

computer files, taking digital photographs, 

and video-calling. Incorporating these features 

into a cell phone is now recognized 

within the realm of smartphones. Smartphones 

are electronic handheld devices that 

integrate the functionality of a mobile phone, 

personal digital assistant (PDA), or other information 

appliances to offer features beyond 

making voice calls (www.en.wiktionary.org/ 

wiki/smartphone). Smartphones include devices 

such as BlackBerry, Razr, iPhone and 

Palm Treo (www.sag.org/content/new-mediaglossary). 

Smartphones may also come equipped with 

built-in cameras and screens for visual, realtime 

communications. In the early 1990s 

AT&T introduced its VideoPhone, but the 

bandwidth limitation of dial-up phone lines, 

high cost of entry ($1,000 each), and require- 

Figure 2. Videophone (Avaya Nortel 1535 IP 

model). Retrieved from http://en.wikipedia. 

org/wiki/Videophone 

ments for both communication parties to own 

the videophones, prevented them from taking 

off (www.answers.com/topic/videophone-1). 

High-speed cable and DSL allowed videophoning 

to eventually become popular by using 

a computer and specialized software. In 

2006 Skype popularized the use of videophones 

by offering free worldwide calling 

(www.answers.com/topic/videophone-1). 

In addition to computer-based systems, videophones 

are also available in desktop or land 

line models which provide video and audio 

transmissions for communication between 

people in real-time. These videophones are 

currently popular among deaf persons who 

use them with sign language and among persons 

with limited mobility (www.answers.com/ 

topic/videophone) (Figure 2). 

Video calling and downloading multimedia 

content on mobile smartphones are currently 

available with models such as the Sony-Ericsson 

K800 (www.en.wikipedia.org/wiki/Videophone) 

(Figure 3) and the newly released 

iPhone 4 which allows video chats using a 

feature called FaceTime (www.apple.com/ 

iphone/features/facetime.html) (Figure 4). 

Renblad (1999) reported the positive results 

of using early picture telephones and 

video telephones (videotelephony) to increase 

communication and social interactions 

among persons with intellectual disabilities. In 

his review of the literature of studies con- 


Figure 3. Sony-Ericsson K800. Retrieved from http:// 

www.sonyericsson.com/cws/products/ 

mobilephones/overview/k800i 

ducted in Europe, these technologies were 

reported as beneficial for assisting persons in 

making contacts outside of their work place 

and home which might otherwise be difficult 

to make. Yet, at the time of this review, presenting 

video in a portable cell phone format, 

had not been researched as a tool for independence 

by persons with moderate ID or 

ASD. Future research needs to investigate the 

application of portable electronic devices with 

video capability with persons with moderate 

Figure 4. iPhone 4. Retrieved from http://www. 

apple.com/iphone/features/facetime.html 

ID and ASD. When re-examining the research 

of Taber et al. (2002, 2003) in which students 

had difficult verbally describing their location 

when lost, it appears that incorporating video 

on cell phones would allow students to video 

record and send visual images of their location 

(to the person trying to locate them) 

which would provide an important application 

for this technology. 

Handheld Computers and Handheld Video 

Players 

Handheld computers, often referred to today 

as PDAs (personal digital assistants), are also 

known as palmtop computers and Pocket PCs. 

These PDAs have been around since the beginning 

of the eighties, but have only become 

popular in the last few years due to innovative 

technologies such as 3G mobile telephony 

and wireless connectivity (Nashville, 2009). 

These features provide PDAs with the ability 

to do many of the things that a PC can do, 

such as connecting to the internet, running 

third party applications, and serving as a mobile 

phone (Nashville). In the field of special 

education, PDAs may provide digital content 

(i.e., pictures and video) in flexible formats 

that can be made meaningful to individual 

students with disabilities (Abell, Bauder, Simmons, 

& Sharon, 2003). In their meta-analysis 

of single-subject design studies, Wehmeyer et 

al. (2008) reported palmtop computers to be 

a simple and effective use of technology for 

prompting persons with intellectual disabilities. 

They suggested that these devices are 

highly effective in their use of cognitive access 

features such as touch screens as well as their 

audio and video output and input capabilities. 

Further, their portability, relative affordability, 

customization features, and ability to store 

large amounts of data, provide a means to 

address the needs of persons with intellectual 

disabilities (Stock, Davies, Davies, & Wehmeyer, 

2006). 

In the current review, identification of studies 

using handheld computers and handheld 

video players were categorized as those using: 

(a) text, sound, and light; (b) picture cuing 

with and without voice recording; and (c) 

video recordings. Within those categories, the 

identified purposes of the devices were to 

function as: (a) reminders and tools for time 


management; (b) transition aids; and (c) 

prompts and models for completing multistep 

functional skills. 

PDA with text, sound, and light cues. PDAs, 

which were originally designed to provide 

electronic task organization, can now be programmed 

to include complex activity schedules 

whereby each task can be linked to a 

reminder alarm to prompt students to check 

their schedule (Gentry, Wallace, Kvarfordt, & 

Lynch, 2010). The basic features of text, 

sound, and flashing lights have been used in 

this capacity to remind students to complete 

tasks. Gentry et al. used a quasi-experimental, 

pre- and post-assessment design to evaluate 

the ability of 22 high school students with ASD 

to enter appointments, schedules, and assignments 

onto a Palm Zire 31 PDA with a reminder 

alarm linked to each entry. Results 

showed that students were able to use the PDA 

as an electronic task management tool and to 

maintain their ability to use the cognitive aid 

over an eight-week period following a brief 

training period. 

Davies, Stock, and Wehmeyer (2002a) used 

specially designed software, Schedule Assistant 

(AbleLink Technologies), as a time management 

tool that operated on a Windows CE 

palmtop computer platform. The program 

provided an auditory beep to cue 12 students 

with intellectual disabilities (IQ scores ranged 

from 45–90) to check their PDA schedule followed 

by a recorded auditory cue telling them 

what task to perform. When compared to a 

traditional written schedule, results demonstrated 

that the palmtop computer with schedule 

prompting software was more effective 

than the written schedule for prompting initiation 

of tasks. 

Twenty students with intellectual disabilities 

were included in a comparison study which 

evaluated use of a written time and task list, 

paper planner, and PDA with students with 

mild to moderate ID (Gillette & DePompei, 

2008). Students responded with the highest 

rate of on-time behavior using a 1-Dell Axim 

and a 2-Palm Zire 71 or 72 PDA with an alarm 

function compared to a list or planner. The 

alarm function served as an effective reminder 

to prompt students to read the written message 

on the PDA screen which indicated the 

task to be completed. The researchers attributed 

the positive results to the audible “beep” 

provided by the PDA since each system was 

comprised of a similar list of assigned tasks. 

In light of these positive results using the 

more basic features of a PDA, future research 

may want to include evaluation of alarming or 

auditory signaling features as reminders for 

additional types of tasks from those which 

have been evaluated. These may include selfmanagement 

of health and safety issues such 

as reminders to brush one’s teeth (O’Hara, 

Seafriff-Curtin, Levitz, Davies, & Stock, 2008), 

checking the lock on the front door of an 

apartment, or turning off the kitchen stove. 

Individuals with moderate ID or ASD may 

have the ability to complete these tasks, but 

may require a reminder to do so. For many, 

the inability to remember to complete such 

tasks may prohibit them from participating in 

less restrictive living and work situations or 

require external reminders to be delivered by 

other adults. 

PDA with picture cues. Digital content, in 

the form of pictures, can also be incorporated 

onto handheld devices and have primarily 

been used to provide step-by-step instructions 

for performing multi-step functional skills that 

may be new or difficult for the learner (i.e., 

operating a washing machine) and tasks 

which are performed infrequently (i.e., baking 

a birthday cake). With these systems, information 

is presented on a single picture and 

the student performs the step based on the 

information provided in the picture before 

advancing the system to the next picture 

(step) in the task sequence. 

Lancioni, O’Reily, Seedhouse, Furniss, and 

Cunha (2000) found that six students with 

intellectual disabilities correctly performed a 

greater number of cleaning, food preparation, 

and table setting steps when pictures 

were presented on an IBM 110 palm-top computer 

compared to a card-based picture system. 

The researchers further found that task 

steps could be clustered into fewer pictures as 

students’ task performances improved. One 

reason attributed to the differences in performance 

was the ease of navigation with the 

PDA (pushing one button to advance the program) 

compared to physical manipulation of 

the card system. 

Cihak, Wright, and Ayres (2010) used selfmodeling 

static picture prompts via an HP 

iPAQ Mobile Media Companion handheld 


computer with three middle school students 

diagnosed with high-functioning autism. Different 

photographs showing the individual 

student modeling task engagement (i.e., writing, 

reading) were downloaded onto Power- 

Point slides so that one photograph was displayed 

every 30 seconds and the program 

advanced automatically during the class period. 

In addition to use of the PDA, students 

self-recorded their task engagement on a 3x5 

inch index card as each new picture appeared. 

Results supported prompts delivered by the 

handheld computer and self-recording by students 

for increasing task engagement and decreasing 

teacher directed prompts. Students 

were further able to generalize use of the 

system across general education classrooms 

(i.e., math, science, language arts). 

Picture-based PDA systems can also incorporate 

voice recordings to provide additional 

information to that provided by the visual pictures. 

Students typically touch the picture or a 

button on the PDA to hear a verbal description 

of how to perform the step. Davies, Stock, 

and Wehmeyer (2002b) provided information 

to students using picture voice recording 

format. They evaluated the software program, 

Visual Assistant (AbleLink Technologies), 

which ran on a Windows CE platform of a 

handheld computer. Ten adults with intellectual 

disabilities (Mean IQ 54.8) viewed stepby-step 

pictures along with verbal instructions 

as they completed steps for assembling pizza 

boxes and packaging software. Students demonstrated 

improved task accuracy and decreased 

reliance on adult prompts across both 

tasks within a vocational setting. Using the 

same Visual Assistant program and a Cassiopeia 

TFT palmtop computer, Riffel et al. 

(2005) demonstrated the ability of four transition-age 

students with mild to moderate ID 

and one student with ASD to increase the 

number of steps they completed without external 

adult prompting (i.e., doing laundry, 

rolling silverware, and setting tables) and to 

decrease duration time spent on each task. 

Davies and colleagues (2003) evaluated an 

additional software prototype, Pocket Compass 

(AbleLink Technologies), which incorporated 

decision points into a picture audio 

prompting system. The software application, 

which operated on a Pocket PC palmtop computer 

platform, provided multiple pictures on 

Figure 5. Pocket Compass. AbleLink Technogies. 

the screen and audio instructions which corresponded 

to different options available to the 

student (i.e., different colors of CDs to put 

into a box) (Figure 5). When the student 

touched one of the decision point pictures, 

the program advanced to the corresponding 

sequence of pictures and auditory cues. Forty 

transition-age students with intellectual disabilities 

(mean IQ 55.53) participated in 

the beta test and increased their independence 

and accuracy in completing assembly 

tasks within a vocational setting as well as their 

ability to navigate decision points. 

Cihak, Kessler, and Alberto (2007; 2008) 

conducted two similar studies to evaluate use 

of picture and auditory prompts via a PDA to 

prompt independent task completion and 

transitions by students with moderate intellectual 

disabilities. Each study presented the vi- 


sual and auditory cues on an Axim 30 handheld 

computer by Dell. In the first study four 

students completed four separate communitybased 

tasks (i.e., stocking milk, making subrolls) 

with each subsequent task increasing in 

the number of steps required for completion. 

The PDA, used in conjunction with a least-tomost 

prompting system delivered by the instructor, 

was an effective tool for delivering 

prompts to students and task performance was 

maintained up to 9 weeks. In the second 

study, four of the same tasks were used from 

the first study, along with six additional tasks, 

to evaluate independent transitions between 

tasks by four students with moderate to severe 

intellectual disabilities. Similar results indicated 

that the handheld prompting system 

was an effective tool for increasing independent 

task transitions and skills were once 

again maintained for up to 9 weeks. 

In summary, although similar to picturebased 

booklets, the presentation of pictures 

on electronic PDAs, may provide a more efficient 

and effective means for delivering 

prompts whereby students may find the traditional 

form of presentation to be more cumbersome 

to manipulate and may lose their 

place in the sequence (Lancioni et al., 2000). 

Electronic picture-based systems with and 

without voice recordings were both found to 

be effective in this review. In light of research 

which indicates that students with ASD may be 

stronger visual than auditory learners (Quill, 

1995; West, 2008), what remains unanswered 

is whether it is necessary to include voice recordings 

in conjunction with pictures. In addition 

to examining the need for voice recordings, 

future research should also continue the 

line of investigation initiated by Lancioni et al. 

concerning clustering multiple pictures into 

fewer pictures (2000) and clustering individual 

verbal prompts of steps into longer 

streams of auditory recordings (2001) as tasks 

are acquired. Research will need to examine 

not only students’ abilities to use these features, 

but the flexibility of systems for making 

these adjustments with regards to preparation 

time. The line of research initiated by Davies 

et al. (2003) into the capabilities of PDAs to 

function in a non-linear format also warrants 

more attention. With such programming, pictures 

on one screen can be linked to a different 

sequence of pictures depending on the 

choice or decision made by the user (i.e., 

which recipe to cook, laundry load size for a 

washing machine). 

PDA with video cues and handheld video players. 

In a recent literature review of assistive technology 

devices (including PDAs) used as selfmanagement 

tools for prompting students 

with ID, no studies were available (through 

2005) evaluating the use of video presented 

on handhelds (Mechling, 2007). The current 

review identified eight studies between the 

years 2007 and 2010 addressing use of video 

modeling or prompting presented on portable 

handheld devices as intervention tools for 

students with moderate ID and ASD. 

Video modeling, watching an entire video 

recording demonstrating how to perform a 

task prior to completing the task, was used in 

three of the eight identified studies utilizing 

video on handheld devices. Van Laarhoven, 

Van Laarhoven-Myers, and Zurita (2007) 

worked with two high school aged males with 

mild and moderate intellectual disabilities in 

two employment settings (Red Robin and 

Applebee’s) using video modeling presented 

on an HP iPAQ hg2700 series Pocket PC. Each 

student completed three different tasks (i.e., 

rolling silverware, portioning recipes) using 

video modeling and video feedback (re-watching 

the video after errors occurred) in conjunction 

with a least-to-most prompting system 

delivered by the instructor. Both students 

demonstrated an increase in independent responding 

and a decrease in external adult 

prompting while using the device. 

Taber-Doughty, Patton, and Brennan 

(2008) used a 30GB Apple video iPod (Figure 

6) to deliver simultaneous prompting in a 

library whereby students watched an entire 

video task chain, with audio instructions, 

while simultaneously completing each step. 

This format was used for locating books and 

DVDs and using a computer to obtain call 

numbers by three middle school students with 

moderate intellectual disabilities. This study 

compared simultaneous video modeling and 

delayed video modeling in which a student 

watched a video model at least one hour prior 

to traveling to the library and locating the 

items. The delayed video modeling was presented 

on a VCR/DVD player. Both systems 

were found to be effective and students were 

able to generalize the skills to a second library, 


Figure 6. Video iPod. Apple, Inc. 

however, when using the video iPod with simultaneous 

prompting, acquisition and generalization 

of skills was slightly greater for two 

students for the computer task and for all 

three students when locating DVDs and 

books. Of further interest was the preference 

of two of the students for using the video iPod. 

A video iPod, with video modeling was also 

used by Cihak, Fahrenkrog, Ayres, and Smith 

(2010) to increase independent transition behaviors 

of four elementary students diagnosed 

with ASD within a general education classroom. 

A combination of video self-modeling 

without audio (video clips of the student as 

the model lining up, walking in the hallway, 

and entering the next area of the school) and 

person first point-of-view (students’ vantage 

point as if they were walking to the next area) 

were used to create the video models of ten 

daily transitions. At the beginning of each 

transition the student watched the video 

model on the video iPod followed by a teacher 

prompt to “line up” and begin the transition. 

Students experienced an increase in independent 

transitions when using the handheld 

video device paired with a least-to-most 

prompting system delivered by the instructor 

and descending trends in performance when 

the device was removed. 

A third study also used a video iPod, but 

compared to the previously reviewed studies, 

the researchers used video prompting and 

feedback on the device rather than video 

modeling (Van Laarhoven, Johnson, Van 

Laarhoven-Myers, Grider & Grider, 2009). 

Video prompting requires the user to watch 

one video segment on the device, complete 

the corresponding step, return to the device, 

watch the next video segment in the task sequence 

and so forth. Van Laarhoven and others 

used video prompting and feedback to 

present steps to a 17-year-old young man for 

completing work-related tasks in a no-kill animal 

shelter. Compared to the Van Laarhoven 

et al. (2007) study, the participant referred 

back to individual video segments (rather 

than the entire video) when an error occurred 

on a particular step The program also contained 

still photographs at the beginning of 

each video clip to present critical features of 

steps and a title screen at the end of each 

video clip to prompt the student to stop the 

device and complete the step. Voice over narration 

was also uploaded to the video iPod. 

Introduction of the video-based materials resulted 

in an increase in correct responding by 

the participant across three job-related tasks 

and a decrease in adult prompting for error 

correction and use of the device. 

In the final three studies identified in this 

review, PDAs were used to present multiple 

media options to the users including: voice 

recordings, digital photographs, and digital 

video. Unlike the other studies reviewed 

which incorporated video onto handheld devices, 

each of these studies used a specialized 

assistive technology device rather than a mainstream, 

commercially available product. The 

studies used a Cyrano Communicator TM 

(Kiba Technologies, LLC.) which was originally 

designed as a portable augmentative 

communication device. The device operated 

using specially designed software on a commercially 

available PDA (Hewlett Packard 

iPAQ Pocket PC or Pidion BM-150R) with 

multimedia features that allowed the user to 


access pictures, video, text, and audio all on 

one screen. In each of the three studies the 

PDA was used for prompting step-by-step completion 

of multi-step functional skills. Students 

could look at a picture to receive information, 

repeatedly touch a picture on the 

screen and hear a voice recording, touch a 

video icon and play a video recording, or advance 

the program to subsequent screens 

(task steps). Using these multiple prompting 

features students could choose and self-adjust 

the level of prompting delivered by the device 

for each step of the task. Unlike the studies 

previously reviewed in this section, no external 

adult prompting (i.e., least-to-most 

prompting system) was provided for task completion 

although the instructors did provide 

prompts for use of the device. 

The first study evaluated the effects of multiple 

prompt levels on the independent preparation 

of recipes by three high school age 

students with moderate intellectual disabilities 

(Mechling, Gast, & Seid, 2010). Immediate 

and abrupt increases in the percentage of 

steps completed independently were demonstrated 

by each of the participants following 

introduction of the PDA system and performance 

was maintained over time. Results also 

indicated that participants initially used more 

intrusive levels of prompts and self-faded 

these levels of prompts (i.e., video to photos) 

and later reinstated use of more intrusive 

prompt levels, as needed, during maintenance 

sessions. 

In response to the Mechling et al. (2010) 

study, a second study was implemented in order 

to evaluate the effects of the PDA procedure 

on the same food preparation tasks, but 

with three high school age students with ASD 

(Mechling, Gast, & Seid, 2009). Results replicated 

those of the previous study in support of 

a PDA with video, pictures, and auditory 

prompts as a self-prompting device to assist 

students with ASD to perform multi-step tasks. 

Differences did exist between the two studies 

in regards to the levels of prompts used by 

students with ASD. Although they also selfadjusted 

the use of prompt levels, overall their 

tendency was to continue to rely on prompts 

from the PDA within and across recipes even 

though they were able to complete the recipes 

independently when the PDA was removed. 

In a third study Mechling and Seid (2011) 

Figure 7. Cyrano Communicator TM. Kiba Technologies, 

LLC. 

evaluated the effectiveness of the PDA with 

multiple prompt levels to prompt independent 

pedestrian travel by three transition age 

students with moderate intellectual disabilities. 

Similar to a global positioning system 

(GPS), students who were unable to read 

maps or text used photographs and video recordings 

of landmarks along the routes to 

independently reach three different destinations 

on a college campus (Figure 7). Similar 

to the other studies using multiple prompt 

levels on one screen, the three students selfadjusted 

their use of prompt levels as they 

became more familiar with each route. 

Results of this review on the use of handheld 

computers with students with moderate 

ID and ASD demonstrate that these small portable 

systems provide some definite advantages 

for individuals, including portability. For 


example, in contrast to previous studies examining 

video and transitions, students in the 

Cihak et al. (2010) study did not have to return 

to a “home base” in order to view the 

video on a television or computer screen. Instead, 

the portable device moved with the students 

across environments. Similarly, in the 

Mechling and Seid (2011) and Van Laarhoven 

et al. (2009) studies, students were able to 

walk with the PDA while locating destinations 

and completing job tasks within an animal 

shelter. 

Although the results have all been positive 

when using PDAs with different presentation 

modes (i.e., picture, video), accessibility issues 

remain with these mainstream devices. Stock 

et al. (2006) identified and affectively addressed 

some of these barriers by developing 

and evaluating a simplified multimedia software 

system, Pocket Voyager (AbleLink Technologies) 

for use with a PDA. With their prototype, 

they created: (a) oversized icons to 

address the issue of physical access with small 

icons; (b) digital pictures for identification of 

contacts in the address book for persons who 

had difficulty reading text; (c) audio messages 

to assist understanding of what applications 

were represented by each icon; (d) recorded 

audio files for reading phone numbers in the 

address book; and (e) numbers in larger fonts 

for persons who had difficulty recognizing 

and dialing numbers. They further identified 

the problems persons have with complex PDA 

operating systems and provided greater consistency 

across steps for starting different applications 

in the system. When compared to 

use of a standard Windows CE operating system 

and Pocket PC, 32 participants with intellectual 

disabilities (mean IQ score 56.1) required 

fewer prompts and committed fewer 

errors when using the specially designed software 

program. 

In addition to access when using handheld 

computers, further research and development 

should continue to investigate the following: 

● use of video prompting compared to video 

modeling on portable handheld devices. 

● comparative effects of different systems 

(i.e., picture-based and video-based systems; 

self-operated auditory prompting and video 

prompting) (Taber-Doughty et al., 2008). 

● importance of verbal/voice over recordings 

when using picture-based and video-based 

systems (Rayner, Denholm, & Sigafoos, 

2009). 

● effects of handheld devices on different 

types of task (i.e., fine motor compared to 

gross motor) (Furniss et al., 1999). 

● provision of high-tech handheld systems 

during acquisition of skills followed by use 

of light-tech (picture or auditory) systems 

during review or continuous performance 

of skills. 

● provision of multiple prompt levels (text, 

audio, picture, and video) on one device or 

one screen of a device. 

● ability of users to self-adjust the prompt levels 

used on devices and development of systems 

that permit this adjustment (Van Laarhoven 

& Van Laarhoven-Myers, 2006). 

● effects of clustering multiple pictures of 

steps into fewer pictures (Lancioni et al., 

2000), lengthening or shortening verbal recordings 

(Lancioni et al., 2001), and adjusting 

the length of video recordings (Cannella-Malone 

et al., 2006) as tasks are 

learned and repeated. 

● use of wide screen or zoom shots with photographs 

and videos when presenting different 

components of tasks (Van Laarhoven et 

al., 2007). 

● comparative effects of screen size and images 

for delivering information through pictures 

and video (Stock et al., 2008). 

Discussion and Recommendations for Future 

Research 

Research into the potential benefits of portable 

electronic technologies for persons with a 

diagnosis of moderate intellectual disabilities 

and autism spectrum disorders is in its initial 

stages. Studies to date support the use of these 

technologies across environments including 

work, school, and community settings and 

across skills including functional multi-step 

skills, transitioning between tasks and environments, 

and time and task management. 

In spite of the positive results reported in 

the studies reviewed, persons with intellectual 

disabilities have traditionally accessed cutting 

edge technologies far less often than those 

without disabilities (Carey et al., 2005). In 

their survey of 83 adults with intellectual disabilities, 

Carey and colleagues found that only 


41% used a computer, 25.3% used the Internet, 

27.7 used cell phones, and 10.8% used 

electronic organizers on a regular basis. They 

reported that primary barriers to use included 

lack of access, lack of training and support, 

and expense. They further found that age, 

employment status, and self-perceived ability 

to perform fine motor tasks, significantly affected 

use of these technologies. More specifically, 

younger persons used more technology; 

those employed in competitive employment 

and those unemployed used more technology 

than those in sheltered workshops: and persons 

who were manually able to copy information 

(i.e., write/copy an address from a business 

card) used more technology. 

To address the issues of availability and expense, 

some researchers support the use of 

mainstream, generic devices that are designed 

for the general population in mass quantities 

(Cihak et al., 2008). In developing these generic 

devices, commercial producers are increasingly 

following the principles of universal 

design which allow accessibility to all users (as 

much as possible) without incorporation of 

special designs or customization (Cihak et 

al.). Wehmeyer et al. (2008) recommend future 

research and development across a wide 

range of technologies, including newer electronic 

and information systems which employ 

aspects of universal design to determine their 

applicability to persons with intellectual disabilities. 

In addition to being readily available 

and less expensive, mainstream handheld devices 

and phones are reported to be non-stigmatizing 

means for providing assistance to 

persons with intellectual disabilities because 

they are predominantly used by the general 

public (Davies et al., 2002b; Gentry et al., 

2010; Gillette & DePompei, 2008; Myles, Ferguson, 

& Hagiwara, 2007). Results of the reviewed 

studies further indicate that students 

like handheld devices and are motivated to 

use them (Cihak et al., 2010; Mechling & Seid, 

2011; Taber et al., 2003; Taber-Doughty et al., 

2008; Van Laarhoven et al., 2007). However, 

the old saying, “one size does not fit all” may 

also apply to the use of portable electronic 

devices. For many users, cognitive and physical 

accessibility are concerns and there continues 

to be a need to modify mainstream 

software which operates portable electronic 

devices in order to increase their accessibility 

and use by persons with intellectual disabilities 

(Stock et al., 2006; 2008). Researchers 

may wish to evaluate commercial mainstream 

products such as the video iPod to determine 

if they are as effective as those made specifically 

for persons with disabilities (i.e., Ablelink 

Technologies, Kiba Technologies, LLC.) in 

delivering information and providing access. 

Other directions for future research center 

around the need to explore the application of 

currently available features offered by PDAs 

and smartphones (Gentry et al., 2010) These 

include: 

● text to speech features on portable devices 

so that information (i.e., emails, contact information) 

can be read to the user. Fonix 

VoiceCentral 3.1 (Fonix Speech, 2008) has 

built-in text-to-speech software that allows a 

Pocket PC to read information and Voice- 

Central Black Swan, available for iPhones 

(Riverturn, Inc., 2009–2010), has this capability. 

● voice recognition for operating applications, 

making phone calls etc. Features are 

now being offered through products such as 

Dragon Pdsay (Nuance Communications, 

Inc., 2010) which provides voice input as 

well as text to speech features. 

● video telephoning to increase skills and opportunities 

such as social, communication 

(Renblad, 1999), and safety skills. 

● video playback on smartphones to prompt 

task completion. 

In addition to these directions, it appears 

that special education and related fields 

should also explore development of applications 

that will afford the following: 

● use of electronic readers on a PDA or smartphone 

which would allow instant photographs 

to be taken of text which could be 

converted to speech to allow ready access to 

print materials. This feature, which is available 

on the Intel Reader (Intel Corporation) 

would allow persons with moderate ID 

or ASD to take a photograph in a community 

setting (i.e., street sign, grocery aisle) 

and have the information read to them. 

● simple to use GPS systems which provide 

pictorial, auditory, and video information to 

users with moderate intellectual disabilities 

who are walking (Mechling & Seid, 2011) or 


using public transportation. Devices such as 

the Trekker Breeze (HumanWare, 2005– 

2009) are currently used by persons who are 

blind to provide auditory information about 

locations, directions, routes, and landmarks. 

While considering these listed features, it 

appears relevant to individually evaluate them 

as independent variables as well as to evaluate 

them in conjunction with each other such as 

using a single device for prompting step-bystep 

task completion, providing reminders to 

complete a task, and serving as a travel aid. It 

is important to recognize that future technologies 

that merge functions into one device, 

mainstream or customized, will be made available 

so that students will have access to multiple 

features on one device. 

Finally, while it is important to realize these 

portable electronic devices may not be appropriate 

for everyone, and that persons in more 

restrictive settings with fewer task demands 

may have less need for PDAs and smartphones 

(DePompei et al., 2008), it is also possible that 

these innovations will create opportunities for 

access and engagement in living, work, and 

recreational environments that are currently 

not available to persons with more significant 

disabilities. 

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Received: 27 July 2010 

Initial Acceptance: 4 October 2010 

Final Acceptance: 18 November 2010 


Education and Training in Autism and Developmental Disabilities, 2011, <strong>46</strong>(4), 499–513 


Video Modeling and Prompting: A Comparison of Two 

Strategies for Teaching Cooking Skills to Students with Mild 

Intellectual Disabilities 

Teresa Taber-Doughty, Emily C. Bouck, Kinsey Tom, Andrea D. Jasper, 

Sara M. Flanagan, and Laura Bassette 

Purdue University 

Abstract: Self-operated video prompting and video modeling was compared when used by three secondary 

students with mild intellectual disabilities as they completed novel recipes during cooking activities. Alternating 

between video systems, students completed twelve recipes within their classroom kitchen. An alternating 

treatment design with a follow-up and withdrawal probe was used to illustrate the effectiveness of both systems 

on each student’s independent task performance. Results indicated increased independence following video 

system use by all three students with video modeling more effective for two students and video prompting more 

effective for the third. Future directions for research are presented. 

Students with mild intellectual disabilities are 

those who typically face a range of challenges 

related to learning, including difficulty generalizing 

and/or transferring information, inputting 

and retrieving information from 

memory, and short attention spans (Belmont, 

1966; Dunn, 1973; Kirk, 1972; Spitz, 1973; 

Stephens, 1972; Thomas, 1996; Zeaman & 

House, 1963, 1979). Specifically, students with 

mild intellectual disabilities are characterized 

by “significantly subaverage intellectual functioning, 

existing concurrently with related 

limitations in two or more of the following 

applicable adaptive skill areas: communication, 

self-care, home living, social skills, community 

use, self direction, health and safety, 

functional academics, leisure, and work” (Polloway, 

Patton, Smith, & Buck, 1997, p. 298). 

However, despite the term “mild,” these students 

do not necessarily possess mild learning 

challenges (Luckasson et al., 2002; Polloway, 

2004; 2005). They experience numerous 

The final four authors listed provided equal effort 

into to this study and thus, their order should not be 

interpreted as a greater contribution over a preceding 

author. Correspondence concerning this article 

should be addressed to Dr. Teresa Taber-Doughty, 

5162 BRNG Hall, Purdue University, 100 North University 

Street, West Lafayette, IN 47907-2098, 765- 

494-7345, tabert@purdue.edu 

learning challenges considerably impacting 

their functioning in current and potential future 

environments. 

Students with mild intellectual disabilities 

once received a substantial focus in research 

and practice; however, in recent decades, attention 

to the educational issues of these students 

declined (Bouck, 2007; Edgar, 1987; 

Polloway, 2006). This lack of consideration 

extends to issues of curriculum and instruction 

where historically these students theoretically 

received a functional curriculum–a curriculum 

focused on life skills that enable 

adults to be successful in life, work, and participation 

in all facets of an inclusive community 

(Brown et al., 1979; Cronin, 1996; Patton, 

Polloway, & Smith, 2000). However, over the 

past few decades, researchers suggested a decrease 

on a functional or life skills approach 

in practice and research (Alwell & Cobb, 

2009; Billingsley, 1997; Billingsley & Albertson, 

1999; Nietupski, Hamre-Nietupski, 

Curtin, & Shrikanth,1997), although without 

data as to the effectiveness of other curricula. 

For example, Bouck (2004a) reported a 

range of curricular approaches being used by 

teachers for secondary students with mild intellectual 

disabilities including a functional 

curriculum (19.0%), a special education curriculum 

(23.8%), a general education curriculum 

(15.3%), a lower grade level curriculum 

Video Modeling and Prompting / 499

(14.3%), a unique curriculum (13.8%), no 

curriculum (4.8%), and a vocational curriculum 

(1.1%). Her results suggested limited attention 

to a functional curriculum for this 

population, akin to the critique by Patton et 

al. (2000) regarding the practice of educating 

students with mild intellectual disabilities (i.e., 

a watered-down general education curriculum 

lacking specialized instruction and concrete 

educational benefits). 

Currently, the curricular focus for students 

with mild intellectual disabilities is believed to 

be mixed and variable, although educational 

policy within the last decade placed greater 

emphasis on students with mild intellectual 

disabilities receiving and succeeding in a general 

education curriculum (Bouck, 2007; 

Bouck, Bassette, Taber-Doughty, Flanagan, & 

Szwed, 2009; Patton et al., 2000). No Child Left 

Behind (NCLB, 2002) and the Individuals with 

Disabilities Education Act (IDEA, 2004) privilege 

students taking general large scale assessments, 

suggesting the curricular focus is a general 

education curriculum to the detriment of 

other approaches (i.e., functional) (Bouck, 

2007). Patton et al. questioned the availability 

of specialized curriculum currently in schools 

for these students. 

The lack of specialized curriculum for students 

with mild intellectual disabilities may be 

problematic given research suggesting the 

poor postschool outcomes typically experienced 

by this population. For example, students 

typically face lower rates of employment, 

independent living, and postsecondary 

school attendance (Blackorby & Wagner, 

1996; Kaye, 1997; Newman, 2005; Newman, 

Wagner, Cameto, & Knokey, 2009). While typically 

not measured in the instruments assessing 

other outcomes, students with mild intellectual 

disabilities also face challenges related 

to daily living skills (Lynch & Beare, 1990). 

Thus, a need exists for elements of a functional 

curriculum for these students. Alwell 

and Cobb (2009) identified the lack of research 

attention on functional life skills was 

particularly apparent for students with high 

incidence disabilities (e.g., mild intellectual 

disabilities; Reschly, 2002) as well as research 

of high quality on the impact of life skills 

instruction. 

Bouck and Flanagan (2010) note the limited 

current research on teaching functional 

life skills to students with mild intellectual 

disabilities. In a systematic review, the authors 

found seven articles published between 1994 

and 2009 on teaching at least one student with 

a mild intellectual disability a functional curriculum 

or elements of a functional curriculum 

(i.e., functional academics, vocational education, 

community access, daily living, 

financial, independent living, transportation, 

social/relationships, and self-determination) 

(Patton, Cronin, & Jairrels, 1997). Of the 

seven, four focused, in part, on daily living 

skills with three of those related to food, nutrition, 

and/or cooking (Collins, Branson, & 

Hall, 1995; Kennedy, Itkonen, & Lindquist, 

1994; Arnold-Reid, Schloss, & Alper, 1997) 

and one directed at safety (Collins & Stinson, 

1995). Students improved in the targeted 

skills in each intended area; thus, the review 

by Bouck and Flanagan highlighted the minimal 

attention on aspects of functional living 

skills while simultaneously showing the effectiveness 

for skill acquisition using this approach. 

Strategies to Teach Functional Skills 

Strategies used to teach functional skills to 

students with mild intellectual disabilities 

since 1994 included time delay (Collins et al., 

1995; Collins & Stinson, 1995; Kennedy et al., 

1994), one-more-than concept for purchasing 

(Denny & Test, 1995), goal setting (Agran, 

Blanchard, Wehmeyer, & Hughes, 2002), and 

the system of least prompts (Arnold-Reid et 

al., 1997). Each resulted in overall increases in 

functional skill acquisition and generalization 

for students with mild intellectual disabilities. 

Although no study could be found focusing 

on functional skills training in which technology 

as an instructional tool was used, technology 

was used for teaching other skills to this 

population. Computerized instruction (e.g., 

computer assisted instruction, pentop computers) 

was successfully used to teach mathematics 

(Bouck et al., 2009; Fazio & Polsgrove, 

1989), social skills (Margalit, 1995), fact retrieval 

skills (Edyburn, 1991), and word recognition 

skills (Lin, Podell, & Rein, 1991). Thus, 

the potential exists for students with mild intellectual 

disabilities to successfully use various 

forms of technology in acquiring and generalizing 

functional skills. Researchers have 


however taught functional skills, using technology, 

to students with moderate and severe 

intellectual disabilities and autism spectrum 

disorders. 

Various technologies are frequently used 

when teaching functional skills to students 

with moderate and severe intellectual disabilities 

and autism spectrum disorders. Recent 

investigations reported the effectiveness 

of computers (Lancioni, Dijkstra, 

O’Reilly, Groeneweg, & Van den Hof, 2000; 

Lancioni, Van den Hof, Boelens, Rocha, & 

Seedhouse, 1998; Lancioni, Van den Hof, 

Furniss, O’Reilly, & Cunha, 1999; Mechling, 

2003; 2005; Mechling, Gast, & Langone, 

2002), personal digital assistants (PDA) 

(Cihak, Kessler, & Alberto, 2007), MP3 players 

(Taber-Doughty, 2005), and iPods for 

delivering numerous forms of instruction 

incorporating technology in school and 

community settings (Taber-Doughty, Patton, 

& Brennan, 2008; Van Laarhoven, Johnson, 

Van Laarhoven-Meyers, Grider, & 

Grider, 2009; Van Laarhoven & Van Laarhoven-Meyers, 

2006). All resulted in increases 

in skill acquisition, maintenance 

and/or generalization; thus, demonstrating 

the potential for the ongoing use of technology 

in instruction for these populations. 

Two increasingly used strategies for teaching 

skills to students with autism spectrum 

disorder and moderate to severe intellectual 

disabilities incorporate video technology for 

instruction in the form of video prompting 

and video modeling. Video prompting combines 

visual and auditory prompts requiring 

students to view a single step of a video task 

sequence and complete that step before 

watching the next video clip of the subsequent 

step and performing that step (Cihak, 

Alberto, Taber-Doughty, & Gama, 2006; 

Krantz, MacDuff, Wadstrom, & McClannahan, 

1991; Taber-Doughty et al., 2008). 

Video prompting was successfully used to 

teach individuals with disabilities vocational 

skills in an employment setting (Van Laarhoven 

et al. 2009), to use an ATM and debit 

machine (Cihak et al; Mechling, Gast, & 

Barthold, 2003), daily living skills (Cannella- 

Malone, Sigafoos, O’Reilly, de la Cruz, 

Edrisinha, & Lancioni, 2006; Van Laarhoven 

& Van Laarhoven-Meyers, 2006), grocery 

shopping skills (Hutcherson, Langone, Ay- 

res, & Clees, 2004; Mechling et al., 2002), 

and cooking skills (Graves, Collins, Schuster, 

& Kleinert, 2005). Similar success was 

also found with video modeling in which 

students perform a task in the same or alternative 

setting without additional prompting 

only after viewing the entire task sequence 

(Cannella-Malone et al.; Taber-Doughty et 

al.). What may vary with video modeling, 

other than the task, is the delay between 

viewing the video model and the actual performance 

of the task. Reported delays between 

viewing videos and performing tasks 

range from immediately after viewing (Charlop-Christy 

& Daneshvar, 2003; Geiger, Le- 

Blanc, Dillon, & Bates, 2010; Nikopoulos & 

Keenan, 2004) to at least an hour after viewing 

(Alberto, Cihak, & Gama, 2005; 

D’Ateno, Mangiapanello, & Taylor, 2003; 

Taber-Doughty et al.; Wert & Neisworth, 

2003) when teaching students with autism 

spectrum disorder a variety of social, play 

and drawing skills, and numerous functional 

community skills (e.g., library skills, using 

an ATM) with students experiencing moderate 

and severe intellectual disabilities. 

While ongoing evidence is reported about 

the effectiveness of both video prompting 

and modeling for teaching students with autism 

spectrum disorder and moderate to severe 

intellectual disabilities, no studies 

could be found in which these strategies 

were used for teaching skills to students with 

mild intellectual disabilities. At a time when 

video technology is increasingly accessible 

and uncomplicated while concurrently socially 

desirable by peers (Taber-Doughty et 

al. 2008), research should seek to examine 

whether this technology is appropriate for 

use with students who experience mild intellectual 

disabilities. In addition, the need 

exists to refocus research efforts in the area 

of functional skills training for students with 

mild intellectual disabilities (Bouck & Flanagan, 

in press). As such, the purpose of the 

present investigation was to compare the 

effectiveness of video prompts and video 

modeling when used to teach three middle 

school students with mild intellectual disabilities 

to acquire cooking skills when preparing 

a variety of simple recipes. 


TABLE 1 

Student Characteristics 

Student 

Method 

Participants 

Chronological 

Age Ethnicity IQ 

Brittany 12 Caucasian 72 a 

Rose 13 Caucasian 61 a 

Wes 12 African American 63 a 

a WISC-IV. 

b GAC 

c ABAS-II 

d Test Scores unavailable; score given is a teacher estimate 

e Woodcock-Johnson 

Three sixth grade students with mild intellectual 

disabilities served as participants for this 

study. Brittany, Rose, and Wes were nominated 

by their teacher for participation in the 

study based on the following: (a) willingness 

to participate, (b) level of cognitive functioning 

within the mild range of intellectual disabilities, 

(c) no sensory deficits, (d) limited, or 

no experience cooking, and (e) successful 

completion of a pre-training program. Two of 

the participants were Caucasian and one was 

African American and all participants spent 

approximately 80% of their time in a special 

education setting for students with mild intellectual 

disabilities and 20% of their time in 

general education, largely for elective courses 

(i.e., physical education). All participants 

spoke English as their first language. Intelligence, 

adaptive behavior ratings, and reading 

and math levels were obtained from the 

teacher. Table 1 provides a summary for each 

participant. 

Brittany. Brittany was a 12 year-old sixthgrade 

female with a mild intellectual disability. 

Brittany had limited previous cooking experience 

at home and no previous cooking 

experience at school. Additionally, Brittany 

reported she did not have previous experience 

using an iPod. Despite her limited cooking 

experience, Brittany expressed interest in 

using an iPod to learn how to make new recipes. 

Rose. Rose was a 13 year-old sixth-grade 

female with a mild intellectual disability. Rose 

reported she had limited previous cooking 

experience at home, and Rose’s special education 

teacher indicated she did not have previous 

cooking experience at school. Additionally, 

Rose reported she did not have previous 

experience using an iPod, but she did have 

experience using another brand of MP3 

player and thought it was easy to use. Rose was 

also interested in learning how to cook and 

making new recipes using videos although she 

lacked prior experience with these types of 

activities. 

Wes. Wes was a 12 year-old sixth-grade 

male with a mild intellectual disability. Wes 

reported his parents did not typically allow 

him to cook at home. Wes’ teacher indicated 

he did not have previous cooking experience 

at school. Wes also indicated he had no previous 

experience using an iPod, though he did 

state that he was good at “figuring out computers 

and a lot of stuff.” Similar to Brittany 

and Rose, Wes expressed an interest in using 

an iPod to learn how to cook. 

Setting 

Adaptive 

Behavior Reading Math 

44 b 

77 c 

88 b 

4.5 th grade d 

83 e 

87 e 

4.5 th grade d 

45 e 

70 e 

All cooking activities took place in the participants’ 

special education classroom. Upon entering 

the classroom there was a small area 

(approximately one-fourth of the classroom) 

with three sinks, a counter, cooking appliances 

(i.e., toaster oven, toaster, blender, and 

microwave), and a refrigerator. Additionally, a 

round table with six chairs was present for 


students and teachers to eat. Next to the refrigerator, 

near the rear of the classroom, was 

a table with three computers for student use. 

On the other side of the table, also near the 

rear of the classroom, was a desk for the paraeducators. 

In the middle of the classroom was 

a large instructional area where sixteen student 

desks faced the front of the classroom. In 

the front of the classroom next to the teacher’s 

desk was an interactive electronic whiteboard 

students used to complete several academic 

activities (e.g., math worksheets, daily 

oral language, etc.). 

Cooking activities took place in the morning 

between 8:30AM and 11:30AM. Depending 

on the class period, there were 12 to 15 

additional students in the classroom. While 

participating students completed cooking 

tasks, other students in the class were engaged 

in mathematics or Language Arts. These activities 

were typically completed in a group setting 

with the teacher or paraeducator lecturing 

to students and allowing students to raise 

their hands and ask questions. Conversation 

amongst students and teachers occurred often 

while target students engaged in cooking activities. 

Materials 

Recipes. All recipes students followed were 

from the Cooking to Learn books functional 

curriculum from PCI Educational Publishing 

(Anderson, Coxson, Lamontagne, Buteyn, & 

Chapman, 2008; Anderson, Coxson, Britt, 

Haugen-McLane, & Mullins, 1999; Coxson & 

Anderson, 2001). Recipes were written at an 

independent level of reading, allowing students 

to read them without assistance. Recipes 

from the books were re-typed in Microsoft 

Word to allow for changes in the recipes (i.e., 

if a recipe called for an oven, but was changed 

to a toaster oven due to the supplies available) 

and for consistency in how recipes were 

worded (i.e., to read, “Put 1/2 cup of ____,” 

instead of variations on that step/wording 

such as “Add one half cup of _____”). Recipes 

were also retyped to eliminate the preprinted 

checklist of ingredients and supplies at the top 

of each page. Recipes were varied, but all 

required completing seven or more task steps 

using multiple foods and cooking supplies. 

Cooking supplies. Cooking supplies were 

those typically available in a kitchen (e.g., a 

toaster oven, toaster, hot plate, and a microwave). 

Other cooking supplies used included 

pans, a cookie sheet, measuring cups and 

spoons, cooking and eating utensils, and 

plates or bowls. Students were able to use 

these independently without instruction. 

Ingredients. Recipe ingredients were purchased 

prior to baseline and intervention sessions. 

For each recipe, all ingredients were 

placed on the worktable for students to select 

from when completing steps of each recipe. 

Common ingredients used included a variety 

of fruits, milk, crackers, and biscuit dough. 

Videos. Short videos ranging from one 

minute and fifty-seven seconds to six minutes 

and thirty-eight seconds were created using 

iMovie (Apple Inc., 2010) and demonstrated 

how to complete each recipe from start to 

finish. Each video also contained simple audio 

instructions in which task analysis steps were 

read prior to being demonstrated on the 

video. The third author physically and verbally 

modeled each step. All videos had similar pacing 

(i.e., how far apart each step was modeled) 

and view. For example, the video always 

showed the entire measuring cup being filled 

with an ingredient rather than just the specific 

line that to which the cup was being measured; 

or, the video zoomed in when going to 

a temperature or time setting. All videos were 

filmed in the classroom where participants 

performed tasks and used the same equipment 

and ingredients to be used by students 

for completing recipes. 

iPods. Three Apple 8-G iPod Nanos with 

color video capabilities were used in this 

study. The screen display was approximately 

one and one-fourth inches wide and two 

inches in height. Below the screen was the 

control wheel approximately one inch in diameter 

containing the word “menu” at the 

top, play/pause at the bottom, and rewind 

and fast forward on the left and right sides 

respectively. At the center of the wheel was a 

black select button pressed when making a 

selection from the screen. Students turned on 

the iPod by pressing and holding down any 

one of the buttons. In order to access videos, 

once the screen was lit, students pressed the 

menu button. Students moved their thumb 

around the control wheel until the word “vid- 


eos” was highlighted. Students then pressed 

the center select button. From the next list of 

items appearing on the screen, students used 

their thumb to scroll to the word “movies” and 

pressed the center button to confirm that selection. 

On the final screen, students scrolled 

down to the name of the correct recipe video 

and pressed the center select button. Once 

selected, they were able to press the play (or 

pause) button as needed. Students did not 

report any difficulty with being able to view 

the screen. During this study, all students navigated 

the iPods independently. Students 

watched videos and listened to the audio using 

earphones; two students preferred behind-the-ear 

headphones while one preferred 

ear buds. 

Dependent and Independent Variables 

Video modeling and video prompting in conjunction 

with a six level system of least 

prompts were two independent variables used 

to teach students to cook basic recipes. Pairs 

of recipes were matched based on number of 

steps, difficulty of completion, and similarity 

of tasks involved. Students completed 12 total 

recipes using video modeling or video 

prompting during the intervention condition. 

When using video modeling students watched 

the full video of the task to be completed five 

minutes prior to being asked to cook the recipe. 

When video prompting was used, students 

watched individual task steps while cooking 

and paused the video after each step. 

When the system of least prompts was 

needed during video modeling and video 

prompting sessions, the following prompts 

were available: independent student performance 

(no prompt), verbal prompt, gesture, 

modeling, partial physical prompt, and full 

physical prompt. The dependent variable was 

the percent of task analysis steps for each recipe 

each student completed independently 

without prompting. The level of prompting 

needed for students to complete each step was 

also recorded. 

Design and Data Collection 

An alternating treatment design (ATD) with a 

baseline and maintenance condition was used 

to illustrate the effectiveness of the video mod- 

eling and video prompting systems for each 

student. This design was selected as it allowed 

investigators to rapidly compare the effects of 

both interventions to establish if one was more 

effective than another when determining independent 

task performance while concurrently 

demonstrating experimental control 

(Kennedy, 2005). A flip of a coin was used to 

determine the order in which prompting systems 

were used with no more than two consecutive 

administrations of a prompting system 

during intervention. The maintenance 

condition allowed investigators to confirm student 

performance levels achieved during intervention 

using the system that resulted in 

greater independence. 

Each recipe was divided into discrete steps 

of a task analysis. Event recording was used to 

record the number of steps from each task 

analysis students were able to complete independently. 

Using each recipe step, a data 

sheet was created to allow researchers to record 

whether students completed each step 

independently or required a prompt and the 

level of prompt needed. 

Experimental Procedures 

Twenty-three different recipes were used in 

this study across conditions. Recipes were selected 

from the Cooking to Learn curriculum 

books (Coxson & Anderson, 2001) and were 

divided and grouped together into three categories 

based on their number of task analysis 

steps. Specifically, the three groups included 

recipes containing 6–8 steps, 9–11 steps, and 

12 or more steps. Three recipes were included 

in the study from the first group, 15 recipes 

from the second group, and five recipes from 

the third. 

Recipes were randomly selected during all 

phases of the study. Specifically, a total of 37 

recipes were selected and divided into the 

three groups based on their number of steps 

(i.e., 6–8, 9–11, and 12 or more). Six (16%) 

recipes contained 6–8 steps, 20 (54%) contained 

9–11 steps, and 11 (30%) contained 12 

or more steps. During intervention sessions, 

recipes were randomly selected and paired 

based on task difficulty, similarities, and number 

of steps. Overall, 6 recipe pairs or 12 total 

recipes were used during intervention. Each 

recipe pair had a similar number of steps, type 


of food, cooking supplies needed, and preparation 

steps. 

Pretraining. Prior to data collection, students 

were introduced to the iPod Nanos and 

taught how to use the device to watch videos. 

A sample video illustrating a simple task was 

created. To ensure each student was able to 

successfully use the iPod prior to beginning 

the study, each watched the video and completed 

the tasks (i.e., raised their right hand as 

the model on the video did, drew a blue star, 

drew a pink circle, etc.). Each student was 

required to complete the tasks with 80% accuracy 

before beginning baseline. 

Baseline. During this condition, students 

were given a paper copy of a recipe and instructed 

to make the assigned recipe. The students 

were observed while cooking and a 

member of the research team used the system 

of least prompts to correct the students, as 

needed. The percent of steps each student 

completed independently were recorded per 

session. Students continued in the baseline 

condition based on the order they were selected 

to begin the intervention. Brittany began 

intervention first while Rose and Wes continued 

baseline phase using traditional 

instruction. Rose began intervention second; 

Wes continued in the baseline phase using the 

traditional instruction and was the last student 

to begin the intervention. Students only began 

the intervention phase once baseline stability 

was established. 

Intervention. This condition consisted of 

two treatments: video modeling and video 

prompting. Six pairs (12 recipes total) of 

matched recipes were used and each student 

completed one of the matched recipes using 

video modeling and the other recipe using 

video prompting. During video modeling sessions, 

students were individually presented 

with the iPod set to start on the selected video. 

Each was then instructed to watch the entire 

video at his/her desk. Once each student finished 

watching the video, he or she remained 

seated for 5 minutes (5-minute time delay) 

prior to beginning the cooking activity. At that 

time, students were asked to move to the cooking 

area. Once there, students were presented 

with a paper copy of the recipe and directed 

to begin cooking. Throughout each session, 

the system of least prompts was used when the 

student required assistance with a task step. 

During video prompting sessions, each student 

immediately moved to the table in the 

kitchen area where he or she was given the 

iPod set to start at the selected video. Each was 

then instructed to pause the video after each 

step and complete that step before pressing, 

“Play,” to move on to the next step. Students 

were also instructed to rewind the video if a 

step needed to be viewed again before moving 

on to the next step. Finally, each student was 

provided a paper copy of the recipe. As during 

video modeling sessions, the system of least 

prompts was used to assist the students as they 

completed each cooking step. 

Follow-up. Two separate probes over a twoweek 

period were collected during this condition 

in which students completed two additional 

matched recipes. The first probe 

recorded the student’s level of independence 

as he or she continued to use his/her more 

effective intervention used during the previous 

condition. The second follow-up probe 

was conducted one week later where neither 

video system was used. The purpose of this 

final probe was to determine if student performance 

would return to baseline levels. As 

in baseline and intervention, the percent of 

steps completed independently by students 

were recorded and the system of least prompts 

was implemented as needed. 

Interobserver Agreement and Treatment Integrity 

Interobserver agreement data were collected 

by a trained second observer for each student 

across all three conditions. The second observer 

recorded whether the student completed 

steps independently or with prompts. 

Interobserver data were collected by the second 

observer at the same time as the first 

observer. The percent agreement for steps 

completed independently by students was calculated 

by dividing the number of agreements 

by the total of agreements plus disagreements 

and multiplying those by 100. For Rose, data 

were recorded during 33% of the baseline 

sessions, 58% of the intervention sessions, and 

100% of the maintenance sessions. Agreement 

was 100% for baseline and maintenance 

and 97% for intervention. For Brittany, data 

were recorded during 60% of the baseline 

sessions, 50% of the intervention sessions, and 

100% of the maintenance sessions. Agree- 


ment was 100% for baseline and maintenance 

and was 96% for intervention. For Wes, data 

were recorded during 63% of baseline, 67% of 

intervention, and 100% of maintenance sessions. 

Agreement was 100% during baseline 

and maintenance and 95% during intervention. 

A checklist was developed to assess treatment 

integrity during the intervention condition 

to ensure that the student began each 

session by meeting with the researcher(s), 

watching the appropriate video depending on 

the intervention they were receiving for a 

given session (this included having the students 

receive the time delay and prompts as 

needed), and completing the recipe. Treatment 

integrity was collected for 33% of the 

sessions for all three students and was 100% 

for all of the sessions for all three of the 

students 

Results 

Figure 1. Percentage of independent correct steps per session (Brittany). 

Figures 1, 2 and 3 demonstrate the number of 

steps each student was able to complete independently 

using video modeling or video 

prompting while engaged in cooking tasks. 

Visual analysis revealed all students increased 

the number of steps they completed independently 

when using video prompting and modeling 

over baseline levels. Visual analysis indicated 

Brittany’s level of independence was 

higher when using video prompting, while 

Rose and Wes cooked more independently 

when using video modeling. 

Brittany. Figure 1 illustrates the percentage 

of steps Brittany completed independently 

while engaged in cooking tasks. She 

completed 58.5% of the steps independently 

during baseline 77.8% of during intervention 

using video prompting and 74.3% independently 

using video modeling. The difference 

between the percentages of steps completed 

using the two independent variables was 3.5% 

with video prompting resulting in slightly 

greater independent performance. A nonparametric 

analysis (standardized mean difference 

effect size) was used to verify these intervention 

findings and confirmed the positive 

effect of video prompting over video modeling 

for Brittany (d 0.285, r 0.14). During 

the follow-up probe using video prompting, 

Brittany completed 100% of steps independently. 

When video prompting was then withdrawn, 

her level of cooking independence 

dropped to 90%. 


Figure 2. Percentage of independent correct steps per session (Rose). 

Rose. Figure 2 illustrates the percentage of 

steps she completed independently while engaged 

in cooking tasks. Visual analysis indicates 

Rose completed tasks more independently 

when using video modeling. During 

baseline, she completed 52.0% of task analysis 

steps independently. However, this increased 

during intervention where she completed 

78.5% of steps independently using video 

prompting and 87.0% using video modeling. 

To confirm visual analysis findings of intervention 

data, the standard mean difference effect 

size was calculated verifying video modeling 

was slightly more effective than video prompting 

for Rose (d 0.587, r 0.28). During the 

follow-up probe, Rose continued to increase 

her percentage of independent task performance 

by completing 91.0% of steps independently 

using video modeling. When this video 

system was withdrawn during the second 

probe her level of cooking independence increased 

to 100%. 

Wes. Figure 3 illustrates the percentage 

of steps Wes completed independently while 

engaged in cooking tasks. Visual analysis indicates 

he completed more steps independently 

when using video modeling than 

when video prompting was used. During 

baseline, he completed 42.83% of task analysis 

steps independently. This increased to 

65.3% when using video prompting and 

77.5% when using video modeling was used 

during intervention sessions. The difference 

between the percentages of steps completed 

using the strategies (e.g., video modeling 

and video prompting) was 12.2%. To confirm 

these findings, a nonparametric analysis 

(standardized mean difference effect 

size) was conducted verifying that Wes completed 

tasks more independently when using 

video modeling (d 0.706, r 0.33). 

During the first follow-up probe using video 

modeling, Wes continued to increase his 

level of independent task performance by 

completing 91.0% of task analysis steps independently. 

However, when this was withdrawn, 

his level of cooking independence 

dropped to 73%. 

Social Validity 

Each student was informally interviewed prior 

to and following the study in order to determine 

whether they felt learning to cook was 


Figure 3. Percentage of independent correct steps per session (Wes). 

important and if video modeling and prompting 

were effective strategies to use. In addition, 

their teacher was also interviewed to confirm 

the social validity of cooking skills and 

instructional procedures used by students. 

Students unanimously agreed that learning to 

cook was an important skill to learn and video 

prompting and modeling were strategies that 

made tasks “easier to do after seeing it.” Students 

also reported the availability of the written 

recipe in addition to the video prompts 

and models were important for successfully 

completing the cooking activities. 

The teacher reported her students loved 

using the video iPod technology but was concerned 

about using it herself due to her own 

lack of knowledge on how to operate the 

equipment. However, she indicated her intent 

to incorporate the video strategies into her 

“cooking curriculum for next year.” Additionally, 

she noted the potential benefits of using 

video prompting and modeling for students 

who were visual learners and indicated these 

strategies might be beneficial for teaching her 

students in other functional skill areas. 

Discussion 

Ensuring all students with disabilities receive 

access to the general education curriculum is 

not only a legal but ethical obligation for all 

educators (Bechard, 2000; Hitchcock, Meyer, 

Rose, & Jackson, 2002). Special educators 

must also assure students will have access to a 

curriculum that facilitates future autonomous 

functioning in school, domestic, work, and 

other community settings (Clark, Field, Patton, 

Brolin, & Sitlington, 1994). As such, a 

clear need exists for education programs serving 

students with disabilities, including those 

with mild intellectual disabilities, to provide 

concurrent access to the general education 

curriculum and a functional curriculum in 

order to meet students’ academic and functional 

skill needs. The present investigation 

compared the effectiveness of video prompting 

and video modeling delivered via iPod 

Nanos when teaching functional cooking 

skills to students with mild intellectual disabilities. 

The results indicated each student was 

successful in using video prompting and video 

modeling for independently completing novel 


ecipes and improving their accuracy over 

baseline levels. 

Increased independence was evident for 

each student between baseline and intervention 

conditions. For students, baseline levels 

ranged from 42.8% to 58.5%. During intervention 

when video prompting was used, independent 

performance increased from 

65.3% to 78.5%. However, a somewhat higher 

percentage was found for students when video 

modeling was used with percentages of independence 

ranging from 74.3% to 87%. While 

video modeling resulted in slightly greater 

task performance, upon closer examination of 

data, slight differences in student performance 

were measured between the two video 

instructional methods. For example, both Wes 

and Rose were able to complete cooking tasks 

more independently when using video modeling 

whereas Brittany’s performance was 

greater when using video prompting. Interestingly, 

while each student indicated their preferred 

video instructional system, only Rose 

performed better with her nonpreferred system, 

video modeling. Previous studies examining 

student’s preferred instructional methods 

indicate some correlation between 

preference and performance (Taber- 

Doughty, 2005; Taber-Doughty et al., 2008). 

However, this remains an area in need of further 

validation. 

Two separate follow-up probes were conducted 

to determine students’ ongoing level 

of cooking independence. The first probe was 

conducted to confirm the effectiveness of the 

more effective intervention used during the 

previous condition. The second probe examined 

whether each student’s level of independence 

when cooking would return to baseline 

levels following withdrawal of the video system. 

All three students demonstrated a continued 

level of independence as observed during 

intervention when using their more 

effective video system. When those systems 

were removed during the follow-up probe, the 

level of independent functioning decreased 

slightly for both Brittany and Wes while Rose 

increased in her performance level. Thus, students 

either improved in their cooking skills 

or some carry-over effect existed as a result of 

the similarity to the previous recipe completed 

when using the video system. Future 

research may seek to expand this condition 

over more sessions to confirm the effects of 

the video systems on student performance. In 

addition, a more accurate measure of student 

learning might compare student performance 

on similar recipes (e.g., similar number of 

steps, type of food, equipment needed, and 

preparation steps) previously completed using 

a video system as well as novel recipes requiring 

only a few similarities. 

While students in the present investigation 

demonstrated increased independence in 

cooking and following recipes when using 

video modeling or video prompting, only 

three students served as participants. Replication 

is needed to confirm these results when 

used by students who experience mild intellectual 

disabilities. In addition, further studies 

are needed to validate the use of video 

prompting and video modeling by students 

who experience high and low incidence disabilities. 

While there is a growing body of 

literature demonstrating the effectiveness of 

these video strategies with students who experience 

low incidence disabilities (e.g., Cihak et 

al., 2006; Van Laarhoven et al., 2009) and 

autism spectrum disorders (e.g., Charlop- 

Christy & Daneshvar, 2003; Charlop-Christy, 

Le, & Freeman, 2000), this research is still in 

its infancy. When used by students who experience 

mild intellectual disabilities, the present 

investigation may represent the first to 

involve this student population. 

Although students in the current study were 

generally successful in using video prompting 

and modeling, one possible limitation to their 

immediate success and independence may be 

attributed to the equipment used to deliver 

the videos. While lightweight and portable, 

the iPod Nanos contained an extremely small 

viewing screen. Students may have experienced 

limitations while completing cooking 

activities due to an inability to see video details. 

As such, future studies may need to introduce 

similar forms of portable equipment 

yet with larger screens for delivering video 

models and prompts. Another potential limitation 

involves the teacher’s knowledge and 

comfort level with the technology being used 

to deliver the intervention. During the present 

study, the teacher expressed enthusiasm 

about using video prompts and modeling with 

her students yet was hesitant about using the 

iPods dues to her own lack of knowledge in 


how to program and operate the equipment. 

As such, future studies should examine how 

interventions are selected and used based on 

the teacher’s knowledge and comfort level. In 

addition, a second area of study might examine 

the amount of training a teacher receives 

in the use of technology and its subsequent 

use in the classroom. 

More empirical studies are needed examining 

strategies for teaching functional skills 

to students who experience mild intellectual 

disabilities. While acquisition of functional 

skills leads to a greater likelihood for future 

independence and success in school, home 

and community settings (Browder et al., 

2004; Brown et al., 1979), the declining curricular 

focus for students with mild intellectual 

disabilities may result in individuals 

who struggle to complete basic life skills 

(Bouck, 2004b). This study represents one 

recent attempt to address functional programming 

with students who experience 

mild intellectual disabilities while concurrently 

incorporating socially desirable technology 

during intervention. Future studies 

should examine how to integrate new technologies 

in addressing skills for students 

who continue to demonstrate a need for 

functional programming. Additionally, 

noted throughout this investigation were 

numerous positive comments from peers 

who indicated their desire to use the iPod 

Nanos to assist them in completing their 

work beyond the tasks targeted for intervention. 

Future studies may also examine the 

social validity associated with the various 

technologies used to deliver video prompts 

and models to students in an effort to find 

the most effective and those considered 

most socially valid. 

Finally, investigators should examine 

whether or not the video systems are associated 

with the types of tasks targeted for intervention. 

For example, does video prompting 

or video modeling work better with discrete 

trial tasks or those less precise? Can they be 

used for tasks with less clear outcomes such as 

social interactions where appropriate responses 

may vary? Prospective studies might 

investigate whether a linkage exists between 

the video system used and type of task to be 

completed. 

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Received: 29 September 2010 

Initial Acceptance: 2 December 2010 

Final Acceptance: 22 January 2011 




Review of Video Prompting Studies with Persons with 

Developmental Disabilities 

Devender R. Banda 

Texas Tech University 

Rose Marie Matuszny 

Appalachian State University 

Maud S. Dogoe 

St. Cloud State University 

Abstract: We reviewed 18 video prompting studies that were conducted with persons with developmental 

disabilities. Results across the studies indicate that video prompting is a viable method for improving various 

domestic, vocational, and independent living skills. In addition, video prompting strategies facilitated 

maintenance and generalization of learned skills. Also, in several studies when teaching various skills, video 

promptings strategies were more effective than static pictures or video models alone. We discuss the results and 

make suggestions for future researchers and practitioners. 

Use of prompts is one of the most important 

tools used in teaching students with disabilities, 

especially those with developmental disabilities 

(Wolery & Gast, 1984; Wolery, Gast, 

Kirk, & Schuster, 1988). Prompts are events 

that, when added to instruction, increase the 

chances that the student will make a correct 

response (Collins, 2007; Wolery, Ault, & 

Doyle, 1992). Prompting techniques are designed 

to facilitate acquisition of skills, minimize 

errors, and ensure correct responding. 

Prompts, therefore, help learners perform behaviors 

or skills they did not know and decrease 

the chances for errors. Prompts are 

either classified by the sensory modality (auditory, 

visual, and verbal) by which students 

receive the assistance or by the types of behaviors 

teachers engage in to provide assistance 

(Wolery et al.) and can be presented in any 

combination (Cooper, Heron, & Heward, 

2007). Visual prompts have been found to be 

effective for individuals with developmental 

disabilities because they are more permanent 


be addressed to Devender Banda, Associate Professor 

of Special Education, Department of Educational 

Psychology and Leadership, College of Education, 

PO Box 41071, Texas Tech University, 

Lubbock, TX, 79409. Email: devender.banda@ 

ttu.edu 

and concrete than transient auditory prompts 

(Quill, 1997). Bryan and Gast (2000) suggested 

that visual prompts can be presented 

through a variety of means including photographs, 

texts, pictures/line drawings, and symbols. 

Over the years, visual prompts have been 

presented through the use of texts or static 

pictures. In recent years however, video-based 

instructional procedures have been widely 

used to teach a range of adaptive skills and 

behaviors to individuals with developmental 

disabilities. Two types of video-based methods 

have been used in the literature for persons 

with developmental disabilities: video modeling 

and video prompting. In video modeling, 

the learner watches the video of a model performing 

the entire target skill or task prior to 

being provided the opportunity to perform 

the target task (Cannella-Malone et al., 2006). 

Video prompting on the other hand involves 

the learner watching each step or task in the 

chain and performing the step before advancing 

to the next task in the chain (Sigafoos et 

al., 2007). There is indication from the literature 

that video prompting might be more effective 

for some persons with developmental 

disabilities who have difficulty watching 

lengthy videos, as it does not require the same 

cognitive load (i.e., remembering the sequence 

of steps in the target behavior) as is 


necessary in video modeling for such students 

(Sigafoos et al.). Furthermore, literature on 

skill-based instruction indicates that persons 

with developmental disabilities acquire skills 

when tasks are presented in small increments, 

multiple opportunities are provided to perform 

the steps, and when using various 

prompting and fading strategies (see Giangreco, 

2011; Snell, 2007). Thus, the video 

prompting strategy might be more useful for 

persons with moderate and severe developmental 

disabilities. 

Several literature reviews have been conducted 

on video modeling studies with persons 

with autism and other developmental disabilities 

(see Baker, Lang, & O’Reilly, 2009; 

Bellini & Akullian, 2007; Delano, 2007; Coy & 

Hermarisen, 2007; Rayner, Denholm, & Sigafoos, 

2009; Shukla-Mehta, Miller, & Callahan, 

2010). Results across reviews overwhelmingly 

indicate that video modeling strategies are 

useful in teaching social, communication, and 

self-care skills for individuals with autism and 

other developmental disabilities. Since the 

1990s there have been numerous studies conducted 

using the video prompting strategy to 

teach various skills to persons with developmental 

disabilities. However, no review has 

been found that specifically analyzed video 

prompting studies. 

It is therefore important that practitioners 

and researchers have the current knowledge 

base about the video prompting strategy. 

Thus, we conducted the review of video 

prompting studies that were conducted with 

persons with developmental disabilities. Specifically, 

we answered the following questions 

in this study: (a) was video prompting an effective 

method for teaching skills to persons 

with developmental disabilities?; (b) was the 

video prompting strategy more effective compared 

to other interventions?; (c) were the 

skills learned through video prompting maintained 

in the absence of intervention?; (d) 

were the skills learned through video prompting 

generalized across settings, persons, 

and/or behaviors?; and, (e) what was the social 

validity of the video prompting strategy? 

Method 

We searched EBSCO databases which included 

PsychInfo, ERIC, Social Science Index, 

and Psychological Abstracts using the following 

terms: video and intervention, video prompting, 

video modeling, video instruction, developmental 

disabilities, intellectual disabilities, mental 

retardation, autism, technology, teaching strategies, 

and multimedia instruction. We selected studies 

that met the following criteria: (a) researchers 

implemented the video prompting intervention, 

(b) studies included at least one or more 

participants with developmental disabilities, 

and (c) published in a peer-reviewed journal 

between years 1990 and 2010. We also conducted 

an ancestral search for additional studies 

under the reference section of each study 

that we found. Overall, we selected 18 studies 

that met our criteria. We analyzed the selected 

studies on several variables including the demographics, 

target skills, designs, intervention 

effectiveness, maintenance, generalization, social 

validity, etc. Table 1 provides a detailed 

summary of the several variables that were 

analyzed. 

Results 

Participants 

The 18 studies included 68 participants. All 

participants were diagnosed with intellectual 

disability/mental retardation ranging from 

mild to severe. A majority of participants were 

diagnosed with a moderate intellectual disability 

except for one who was diagnosed with 

severe intellectual disability (see Grice & 

Blampied, 1994). In addition, some participants 

were diagnosed with additional disabilities 

such as autism, ADHD, physical disabilities, 

Down Syndrome, Aspergers, behavior 

disorder, Tourette, seizures, and Williams Syndrome. 

Participants’ ages ranged from 8 years 

to 41 years, with an average age of 21.5 years. 

Settings 

Researchers have conducted studies in various 

settings, including: a special school for students 

with intellectual disabilities (Grice & 

Blampied, 1994); resource room/self-contained 

classrooms (Graves, Collins, Schuster, 

& Kleinert, 2005; Norman, Collins, & Schuster, 

2001); a conference room in a high school 

(Mechling, Gast, & Barthold, 2003); a home 

living room in a high school (Mechling, Gast, 

Video Prompting and Developmental Disabilities / 515

TABLE 1 

Video Prompting Studies Conducted with Persons with Developmental Disabilities 

Participants 

Effective/Not 

Effective 

Mode of 

Presentation 

Setting Target Skill Design 

Age Disability 

Author 

Computer Yes for all 


subjects with 

alternating treatment 

Putting away 

grocery 

Table setting 

Kitchen of a vocational 

center 

Mild ID, AUT 

Mod. ID, AUT 

Mod. ID 

Asperger, 

Mod. ID 

Mild ID, AUT 

Mod. ID, AUT 

27 y 

28 y 

32 y 

36 y 

Cannela-Malone et 

al. (2006) 

36 y 

41 y 

Yes, as effective 

as using static 

picture 

5-ft, 8-in. screen 

projected from 

an Epson 

Powerlite S1 

Adapted alternating 

treatment 

Using debit card 

to withdraw 

money from 

ATM to buy 

items 

Classroom and grocery 

store 

Mod. ID 

Mod. ID 

Mod. ID 

Mod. ID 

Mild. ID 

11 y 

12 y 

12 y 

12 y 

12 y 

11 y 

Cihak, et al. 

(2006) 

Mod. ID 

Computer 1 subject reached 

criterion with VP 

alone. All 

reached criterion 

with VP plus 

error correction 

Setting table Multiple baseline 

across participants 

Dining area of 

vocational center 

AUT, Mod. 

MR 

Mod. MR 

AUT, Mild 

MR 

AUT, Mod. 

MR 

33 y 

Goodson et al. 

(2007) 

36 y 

36 y 

34 y 

VCR, TV Yes, 2 of 3 target 

skills 

Cooking Multiple probe across 

Behaviors 

Kitchen area of 

classroom 

Mod. ID 

Mod. ID 

Graves et al. (2005) 16 y 

18 y 


Mod. ID 

20 y 

Yes, 2 

participants with 

VP 

Third participant 

with VP least 

to most prompt 

Laundry skills Multiple baseline 


Laundry room in a 

group home 

MR, AUT 

DD, ADHD 

MR, AUT, 

Behavior 

Disorder 

Horn et al. (2008) 29 y 

17 y 

25 y



Participants 

Effective/Not 

Effective 

Mode of 




Author 

Classroom Technology AB Television Yes for All 

Mod. ID 

Sev. ID 

Mod. ID 

Mod. ID 

Mod. ID, Tourette 

Mod. ID, Phy. Dis 

Mod. ID, ADHD 

13 y 

13 y 

15 y 

18 y 

16y 1m 

17y 11m 

18y 7m 

Le Grice & Blampied 

(1994) 

Computer Yes for all 


participants 

Purchasing 

using a debit 

Conference room in a 

high school 

Mechling et al. 

(2003) 

card 

Yes for all 

Portable DVD 

player 

Demonstration kitchen Cooking Multiple probe across 

tasks 

19 y 

20y 2m 


(2008) 

22y 3m 

Yes 

Personal Digital 

Assistant (PDA) 

Home-living classroom cooking Multiple probe across 

skills 

16y 4m 

17y 4m 


(2009) 

17y 10m 

Video prompting 

was more effective 

compared to static 

pictures for all 6 

participants 

Portable DVD 

player 


treatment 

Cooking-related 

tasks 

Home living room in a 

high school 

Mod. ID 

Mod. ID, DS 

Mod. ID 

Mild ID, AUT 

Mod. ID, AUT 

Mod. ID, AUT 

Mod .AUT 

Mild. AUT 

Mod. AUT 

Mod. AUT 

Mod. AUT 

Mod. AUT 

Mod. ID, 

AD/HD, Seizure 

Mod. ID, DS 

Mod. ID 

Mod. ID 

Mod. ID 

Mod. ID, AD/HD 

17y 8m 

17y 10m 

21y 1m 

16y 3m 

15y 10m 

16y 8m 

18y 7m 

Mechling & 

Gustafson (2008) 


was more 

effective 

compared to 

static pictures for 

all 6 participants 

Portable DVD 

player 


treatment 

Apartment Cooking-related 

tasks 

Mechling & 

Gustafson (2009) 

20y 5m 

22y 1m 

21y 2m 

19y 3m 

22y 6m 




Participants 

Effective/Not 

Effective 

Mode of 




Author 


was more effective 

compared to 

picture-based 

cookbooks for all 

4 participants 

Two of 3 

participants 

learned three tasks 

and the third one 

two tasks. 

Portable DVD 

player 


treatment 

Apartment Cooking-related 

tasks 

Mod. ID 

Mod. ID 

Mod. ID 

Mod. ID, William 

Syndrome 

20y 10m 

19y 9m 

19y 11m 

22y 6m 

Mechling & Stephens 

(2009) 

TV –VCR 

Combo 

Classroom Self-help skills Multiple-probe across 

behaviors and 

participants 

Mod. ID DS 

Mild ID, DS 

Mod. ID, AUT 

Norman et al. (2001) 8y 1m 

9y 8m 

12y 3m 

Computer Yes for 2 of 3 

Delayed multiple 

probe 

A-B-A-follow-up 

Making a bag of 

popcorn in 

Microwave 


center 

Mod ID 

Mod ID 

Mod ID, AUT 

Yes for All 

Portable 

computer 

Dishwashing Multiple baseline 



center 

Mild ID, AUT 

AUT 

Mod AUT 

Sigafoos et al. (2005) 34 y 

36 y 

36 y 

Sigafoos et al. (2007) 27 y 

28 y 

33 y 

Mod. ID, AUT 

Multiple probe Monitor Yes for all 

Exiting skills in 

case of fire 

Bedroom & hallway of 

a group home 

Mild ID 

— 

Mod. ID 

Mod. ID 

Video iPod Yes for all three 

tasks 

Tiong et al. (1992) 21 y 

26 y 

30 y 

35 y 

Van Laarhoven et al. 

(2009) 

17 y Mod. ID Animal shelter Job-related tasks Multiple probe across 

(e.g., cleaning, tasks 

mopping, 

emptying 

garbage) 

18y Mod MR, AUT Home 

Domestic skills Adapted alternating 

17y to 19y Mod. MR classroom 

treatment 

17y to 19y Mod. MR 


Computer For 2 of 3 

participants video 

rehearsal plus 

video prompting 

more effective 

Van Laarhoven & 

Van Laarhoven- 

Myers (2006) 

AD/HD attention deficit/hyperactivity disorder; AUT Autism; DS Down Syndrome; ID intellectual disability; Mod Moderate, MR mental retardation; 

Phy. Dis. physical disability.

& Seid, 2009; Mechling & Gustafson, 2008); a 

resource room and grocery store (Cihak, Alberto, 

Taber-Doughty, & Gama, 2006); a community 

house (Tiong, Blampied, & le Grice, 

1992); the laundry room in a group home 

(Horn et al., 2008); the kitchen of a vocational 

training center (Cannella-Malone et al., 2006; 

Goodson, Sigafoos, O’ Reilly, Cannella, & 

Lancioni, 2007; Sigafoos et al., 2007; Sigafoos 

et al., 2005); an apartment kitchen (Mechling, 

Gast, & Fields, 2008; Mechling & Gustafson, 

2009; Mechling & Stephens, 2009); and an 

animal shelter (Van Laarhoven, Johnson, Van 

Laarhoven-Myers, Grider, & Grider, 2009). 

Overall, most studies were conducted in 

kitchen or home living settings because they 

involved cooking-related tasks. 

Designs 

Researchers in the majority of the studies used 

a multiple baseline/multiple-probe design 

across behaviors/participants (Graves et al., 

2005; Horn et al., 2008; Mechling et al., 2003; 

Mechling et al., 2008; Mechling et al., 2009; 

Norman et al., 2001; Tiong et al., 1992; Van 

Laarhoven et al., 2009). However, in some 

studies a multiple-baseline design was combined 

with an alternating treatment or ABAB 

design: ABAB combined with multiple-baseline 

across participants (Goodson et al., 2007; 

Sigafoos et al., 2007; Sigafoos et al., 2005); a 

multiple-probe across participants with an alternating 

treatment design (Cannella-Malone 

et al., 2006). An adapted alternating treatments 

design was used in five studies (Cihak et 

al., 2006; Mechling & Gustafson, 2008, 2009; 

Mechling & Stephens, 2009; Van Laarhoven & 

Van Laarhoven-Myers, 2006). In one study an 

AB design was replicated across participants 

(Grice & Blampied, 1994). 

Targeted Skills 

Researchers in several studies (n 7) targeted 

food preparation or cooking-related skills 

(Graves et al., 2005; Mechling et al., 2008; 

Mechling et al., 2009; Mechling & Gustafson, 

2008, 2009; Mechling & Stephens, 2009; Sigafoos 

et al., 2005) and in one study cooking 

tasks (such as microwaving pizza) were combined 

with other tasks such as washing a table 

and folding laundry (Van Laarhoven & Van 

Laarhoven-Myers, 2006). Investigators targeted 

self-help skills and/or other daily living 

skills in a number of studies, such as: purchasing 

and banking skills (Cihak et al., 2006; 

Mechling et al., 2003), table setting (Goodson 

et al., 2007), setting the table and putting away 

groceries (Cannella-Malone et al., 2006), doing 

laundry (Horn et al., 2008), dish washing 

(Sigafoos et al., 2007), cleaning sunglasses, 

putting on a wristwatch, and zipping a jacket 

(Norman et al., 2001). In a few of the studies 

investigators targeted other skills, such as operating 

video and computer devices (Grice & 

Blampied, 1994); job-related tasks including 

cleaning a bathroom, mopping floors, taking 

out garbage, and cleaning kennels at an animal 

shelter (Van Laarhoven et al., 2009); and 

safely exiting bedrooms in the event of fire 

(Tiong et al., 1992). Overall, a majority of the 

tasks involved cooking and self-care/independent 

living skills. 

Video Prompting Material 

Types of video prompts. The video prompts 

were mainly consistent across the studies. 

Video prompts were prepared either from the 

participant’s viewpoint or spectator’s viewpoint. 

A majority of the videos were prepared 

from the spectators’ viewpoint with verbal or 

voice-over instructions (Goodson et al., 2007; 

Grice & Blampied, 1994; Mechling et al., 

2009; Mechling & Gustafson, 2008, 2009; 

Mechling & Stephens, 2009; Tiong et al., 

1992; Van Laarhoven et al., 2009). In one 

study, the investigators mentioned that the 

videos were prepared from the spectators’ 

viewpoint (Van Laarhoven & Van Laarhoven- 

Myers, 2006); however, they did not mention 

whether any verbal instructions were used in 

the video prompt. Researchers in several 

other studies used video prompts from the 

participants’ viewpoint or with other combinations, 

including: participants’ viewpoint with 

voice-over instructions (Cannella-Malone et 

al., 2006; Graves et al., 2005; Sigafoos et al., 

2007; Sigafoos et al., 2005), participants’ viewpoint 

with voice-over instructions and text display 

(Norman et al., 2001), participant’s viewpoint 

(Horn et al., 2008), and participants’ 

and spectators’ viewpoint with voice-over instructions 

(Mechling et al., 2008). 


Length of video clips. Researchers in 8 of 18 

studies described the length of video clips. 

Prompt lengths varied: 4 s (Cihak et al., 2006), 

4 to 12 s (Sigafoos et al., 2005), 4 to 30 s 

(Sigafoos et al., 2007), 9 to 13 s (Goodson et 

al., 2007), 10 to 15 s (Grice & Blampied, 

1994), 12 to 42 s (Cannella-Malone et al., 

2006), and 12 to 25 s (Mechling & Gustafson, 

2008, 2009). The average length could not be 

determined because only ranges were provided 

in these studies. 

Mode of Presentation 

A majority of the videos were presented on 

laptop computers (Cannella-Malone et al., 

2006; Goodson et al., 2007; Horn et al., 2008; 

Sigafoos et al., 2007; Sigafoos et al., 2005; Van 

Laarhoven & Van Laarhoven-Myers, 2006). 

However, in one study a computer with a 

touch screen program was used (Mechling et 

al., 2003). Televisions were used to present 

the tasks in 4 of the 18 studies (Graves et al., 

2005; Grice & Blampied, 1994; Norman et al., 

2001; Tiong et al., 1992) and in three other 

studies a portable DVD player was used 

(Mechling et al., 2008; Mechling & Gustafson, 

2008; Mechling & Stephens, 2009). Researchers 

in two studies presented the videos on 

small devices such as personal digital assistant 

(PDA; Mechling et al., 2009) or a video iPod 

(Van Laarhoven et al., 2009). Finally, the 

video prompts were presented on the screen 

in one study (Cihak et al., 2006). 

Effectiveness of the Strategy 

Overwhelmingly, the video prompting strategy, 

sometimes combined with other prompting 

or error correction strategies, has enhanced 

various skills in the majority of 

participants (n 67; 99%) with developmental 

disabilities. However, one of three participants 

in Sigafoos et al. (2005) did not acquire 

the targeted skill. Sigafoos and colleagues 

taught three adults with developmental disabilities 

to use a microwave oven to make 

popcorn. Results showed that two of three 

participants learned to make the popcorn and 

maintained the skill in the follow-up probes. 

However, the third participant failed to reach 

the criterion. The investigators indicated that 

the third participant showed lack of interest in 

making the popcorn and was on anti-depressant 

medication. Also, in another study Graves 

et al. (2005) reported that the three participants 

in their study learned two of three cooking 

tasks (i.e., stovetop, microwave, countertop 

cooking skills) with the video prompting 

strategy. The authors mentioned that due to 

the end of the school year they did not have 

sufficient time to collect data for the third 

task. 

Video Prompting Combined with Other Strategies 

Researchers in several studies combined the 

video prompting with strategies such as constant 

time delay (CTD), video feedback, 

and/or error correction methods. For example, 

Goodson et al. (2007) used the video 

prompting strategy to train three adults with 

developmental disabilities to teach a domestic 

skill (table setting). The authors combined 

video prompting with an error correction 

strategy. During the error correction strategy, 

the investigators replayed the step on the 

video. If the participant still could not perform 

the step of the task after viewing the 

video clip, the researchers demonstrated 

through in vivo (live model) modeling. Results 

indicated that the participants were able 

to learn the table setting tasks with 90% or 

more accuracy when video prompting was 

combined with error correction than with 

video prompting alone. Similarly, Van Laarhoven 

et al. (2009) played videos on an iPod 

combined with an error correction strategy 

(video feedback) to teach three job-related 

tasks (i.e., cleaning a bathroom, mopping 

floors and taking out garbage, and cleaning 

kennels) to a 17-year-old person with a developmental 

disability. The participant was able 

to learn all three tasks quickly, required fewer 

prompts as the study progressed, and was able 

to operate the iPod independently. 

In quite a few studies least-to-most prompting 

methods were implemented. For example, 

Tiong et al. (1992) trained four adults with 

intellectual disabilities in fire safety using the 

video prompting strategy. The authors also 

used various levels of prompting (least to most 

prompting) to train the participants in different 

scenarios in case of fire. Initially, the investigators 

read out a description of a scenario 

and asked the participants “What would you 


do?” If the participant did not respond, the 

trainer provided a non-specific verbal prompt. 

If the participant still did not respond to a 

verbal prompt, he was shown a video of the 

step then was asked to perform the step. Results 

indicated that all four participants acquired 

the tasks and were able to perform the 

tasks in transfer settings. Furthermore, the 

level and number of prompts decreased at the 

end of the intervention. Similarly, Mechling et 

al. (2009) used the least-to-most prompting 

method (i.e., picture-prompt, picture auditory 

prompt, and video prompt voice over) 

to train three adults with autism in cooking 

skills using a personal digital assistant (PDA). 

Results showed that the PDAs with video, picture, 

and auditory prompts were effective as 

they served as a self-prompting method to 

improve participants’ cooking skills. Authors 

indicated that the self-prompting device may 

serve a dual purpose; an antecedent prompting 

as well as permanent prompting system. 

Also, Horn et al. (2008) taught three adults 

with developmental disabilities laundry skills. 

Two of three participants acquired the skills 

with the video prompting procedure alone. 

However, one of the participants acquired the 

skill when the investigators added least-tomost 

prompting along with video prompting. 

Results were idiosyncratic across participants. 

Likewise, Cihak et al. (2006) compared video 

prompting with static picture prompting with 

two groups of three students with intellectual 

disabilities to teach purchasing and banking 

skills. The investigators provided instruction 

in groups using the least-to-most prompt procedure. 

Results indicated that both the video 

prompting and the static picture prompting 

were equally effective across participants. 

Norman et al. (2001) used video modeling 

and video prompting combined with CTD to 

teach self-help skills to three children with 

intellectual disabilities. Initially, the entire 

task was presented to the participants through 

video modeling and later the participants 

were shown each step through video prompting 

combined with time delay. Results indicated 

that two participants learned all three 

tasks (cleaning sunglasses, putting on a wristwatch, 

and zipping a jacket) and the third 

participant learned two of three tasks (cleaning 

sunglasses and zipping a jacket). Similarly, 

Graves et al. (2005) initially showed the entire 

task of the video model and later showed 

video clips of each task combined with the 

CTD procedure with three students with developmental 

disabilities. Results indicated that 

all three participants successfully learned two 

of three cooking tasks. Likewise, Mechling et 

al. (2003) used video-based instruction (video 

modeling, video prompting, and still photographs) 

to teach debit card use with three 

adults with moderate intellectual disabilities. 

The authors combined video prompting with 

CTD. All three participants acquired the skills 

and learned to use the debit card in the community 

and novel stores. 

Video Prompting and Fading 

Prompt dependency is one of the main concerns 

when teaching persons with developmental 

disabilities. Thus, decreasing prompts 

is an important part of instruction to enhance 

independence. Results show that researchers 

in several studies have attempted to reduce 

prompts or directly withdrew the intervention 

to see the effects of the video prompting strategy. 

In a study, Sigafoos et al. (2007) explicitly 

faded video prompting when teaching three 

adults with developmental disabilities dish 

washing skills. Initially, the authors showed 

the video clips individually and asked the participants 

to perform the task. Subsequently, 

more steps were added to each video clip until 

all of the steps of the task had been combined 

into a single video clip. At the end of the 

study, video prompting was removed. Results 

indicated that the participants were able to 

learn the task and maintain at 1, 2, and 3 

months. In another study, Sigafoos et al. 

(2005) taught three adults with developmental 

disabilities to make popcorn in the microwave 

with the video prompting strategy. Participants 

were able to retain the skills 

following the withdrawal of the intervention 

which showed that fading was not required. In 

another study that involved domestic skills 

(washing a table, microwaving pizza, and folding 

laundry), Van Laarhoven and Van Laarhoven-Myers 

(2006) showed that the students 

were able to fade the video prompts on their 

own and move to picture prompts. Finally, 

Mechling et al. (2008) investigated the effects 

of the video prompting strategy in which the 

participants operated a portable DVD player 


to learn three cooking tasks. Results indicated 

that all participants learned to operate the 

DVD player and were able to correctly perform 

the steps of the cooking tasks. 

Video Prompting versus Other Interventions 

Researchers in 6 of 18 studies compared video 

prompting with other picture/video-based interventions 

(Cannella-Malone et al., 2006; 

Cihak et al., 2006; Mechling & Gustafson, 

2008, 2009; Mechling & Stephens, 2009; Van 

Laarhoven & Van Laarhoven-Myers, 2006). 

For example, Van Laarhoven and Van Larhoven-Myers 

compared three video-based 

strategies (video rehearsal, video rehearsal 

plus photos, and video rehearsal and in-vivo 

video prompting) to teach daily living skills 

with three young adults with developmental 

disabilities. Results showed that the video rehearsal 

combined with video prompting was 

more effective with two participants when 

compared to the two other conditions (video 

modeling and video modeling plus photos). 

For one participant, the video modeling plus 

photo condition was effective to increase task 

acquisition. In another study, Canella-Malone 

and colleagues compared video modeling and 

video prompting strategies with six adults with 

developmental disabilities. The investigators 

trained the adults to set the table and put away 

groceries. Results indicated that video 

prompting was more effective than video 

modeling in teaching both tasks; table setting 

and putting away groceries. 

Researchers in four studies compared video 

prompting versus static pictures (Cihak et al., 

2006; Mechling & Gustafson, 2008, 2009; 

Mechling & Stephens, 2009). Mechling and 

Gustafson trained six adults with autism in 

cooking-related tasks. The investigators compared 

the video prompting and static pictures 

using an adapted alternating treatment design. 

Results indicated that all participants acquired 

the skills faster in the video prompting 

method compared to the static pictures during 

the intervention phase of the study. Also, 

in another study Mechling and Gustafson 

compared the video prompting and static picture 

prompting while training six adults in 

cooking-related tasks. Results showed that the 

video prompting strategy was more effective 

than the static picture prompting across all of 

the participants. Likewise, Mechling and Stephens 

compared the video instruction as a 

self-prompting strategy and static picturebased 

cookbooks to train four students with 

moderate intellectual disabilities in cookingrelated 

tasks. Results indicated that the video 

self-prompting strategy was more effective 

than the picture-based cookbook across all 

four participants. However, in one study the 

video prompting and static pictures were 

equally effective with the participants. Cihak 

et al. investigated the effects of the video 

prompting versus static picture prompting 

with two groups of three students with intellectual 

disabilities to teach purchasing and 

banking skills (withdrawing money from ATM 

and purchasing). The authors used group instructional 

procedures (model and test) and 

also provided community based instruction 

using a least-to-most prompt procedure. Results 

indicated that both the video prompting 

and the static picture prompting were equally 

effective. Overall, results of 5 of 6 studies 

showed that video prompting methods were 

more effective than the static picture interventions. 

Maintenance and Generalization Data 

Investigators in 7 of 18 studies reported maintenance 

data but did not report the generalization 

data (Cihak et al., 2006; Graves et al., 

2005; Horn et al., 2008; Mechling et al., 2009; 

Sigafoos et al., 2007; Sigafoos et al., 2005; Van 

Laarhoven et al., 2009). Participants in Cihak 

et al. study maintained the purchasing skills 

learned through video prompting and static 

picture prompting strategies. Similarly, Sigfoos 

et al. collected maintenance data in their 

study which was conducted with three adults 

with developmental disabilities to teach them 

to microwave popcorn. Two of three participants 

successfully learned the skill and maintained 

it at 2, 6, and 10 weeks after the intervention. 

In another study, Sigafoos et al. 

trained three adults with developmental disabilities 

to do dish washing and maintenance 

data showed that they were able to perform 

the skill at 1, 2, and 3 month probes. Also, 

Mechling et al. assessed for maintenance of 

cooking skills using video-based instruction 

delivered on PDA with three individuals with 

autism. All three students maintained the skill 


following the intervention. Likewise, Graves et 

al. collected maintenance data with the participants 

after they reached criterion during the 

intervention. Results indicated that all participants 

learned the cooking tasks and maintained 

at least one or two tasks two weeks 

following the intervention. Results from Horn 

et al. also indicated that two of three participants 

in the study maintained the learned 

skills (laundry) two weeks following the intervention. 

Van Laarhoven et al. trained an adult 

with developmental disability using video iPod 

as a prompting design to complete three job 

related tasks (cleaning bathroom, mopping 

floors and taking out garbage, cleaning kennels) 

at an animal shelter. The participant 

quickly acquired the skills and required few 

prompts. Maintenance data indicated that the 

participant was able to perform the task without 

video iPod prompt at 10 weeks following 

the intervention. 

Investigators in one study reported generalization 

data but no maintenance data (Grice 

& Blampied, 1994). Le Grice and Blampied 

trained four individuals with intellectual disabilities 

to operate video equipment and the 

computer using the video prompting strategy. 

All four participants learned the skill and generalized 

to novel video players and computer 

equipment. 

Investigators in 4 of 18 studies reported 

both maintenance and generalization data 

(Mechling et al., 2003; Norman et al., 2001; 

Tiong et al., 1992; Van Laarhoven & Van Laarhoven-Myers, 

2006). Van Laarhoven and Van 

Larhoven-Myers collected post intervention 

and generalization data. The three participants 

were able to perform the steps (microwave 

pizza) in novel instructional settings and 

post intervention data indicated that participants 

were able to maintain the tasks. Also, 

Mechling et al. trained three adults with intellectual 

disabilities to make purchases using a 

debit card. Maintenance data were collected 

for two of three participants 1 week and 6 

weeks following instruction. Maintenance 

data showed both participants were able to 

make purchases. In addition, all three participants 

generalized the debit card use in community 

and novel stores. Similarly, Norman et 

al. taught self-help skills to three children with 

developmental disabilities (cleaning sunglasses, 

putting on a wristwatch, and zipping a 

jacket) using the video modeling and video 

prompting strategies combined with CTD. Results 

showed that all three participants 

learned the skill and maintained the skill; 

however, maintenance probes ranged between 

1 to 13 weeks across three participants. 

For the task of cleaning glasses, the investigators 

assessed for generalization across persons 

with two participants and also assessed for 

generalization of putting on wristwatch with 

one of the participants across material. No 

generalization probes were conducted with 

the third participant. Finally, Tiong et al. assessed 

both generalization and maintenance 

of fire safety skills with four adults with intellectual 

disabilities using the video prompting 

strategy. Results indicated that the participants 

were able to transfer the training to a 

novel setting and maintain the skills 4–5 

weeks post intervention. 


Social validity was assessed in 4 of 18 studies 

(Mechling et al., 2009; Tiong et al., 1992; Van 

Laarhoven et al., 2009; Van Laarhoven & Van 

Laarhoven-Myers, 2006). In a study, Tiong et 

al. trained participants with intellectual disabilities 

to escape from the bedroom in the 

event of fire. The authors used a questionnaire 

to assess the satisfaction of the staff and 

the participants. Results indicated that the 

staff expressed medium level of satisfaction 

and the participants expressed high level of 

satisfaction. However, the staff also expressed 

concerns about the video quality and indicated 

that the training program was boring 

and two of the participants indicated that they 

were more concerned about the fire safety. 

Similarly, Van Laarhoven et al. conducted social 

validity assessments through informal interviews 

with the study participant, his 

mother, and the employers about the video 

iPod and video feed back intervention. The 

participant indicated that he liked the video 

iPod and he felt that the device helped him to 

do tasks independently. In addition, the 

mother and the employers expressed satisfaction 

with the results and were impressed with 

the effectiveness of the video iPod. The employers 

indicated that they thought the video 

iPod would benefit other employers when 

training new employees in their setting. Also, 


Van Laarhoven and Van Laarhoven-Myers assessed 

the social validity of intervention with 

parents who indicated that they were satisfied 

with the way the participants acquired the 

steps with the strategy. In addition, two participants 

stated that they enjoyed watching the 

videos on the computer and one participant 

stated that she would have preferred watching 

on the television. Finally, Mechling and colleagues 

assessed social validity by asking the 

participants about their preference by presenting 

a portable DVD player, PDA, and picture 

cookbook. The study was conducted using 

PDAs to deliver video-based instruction. 

Two participants preferred the portable DVD 

player and the third participant preferred the 

PDA. 


Results of this review show that video prompting 

is a viable intervention for teaching individuals 

with a range of developmental disabilities 

for various domestic, life, vocational, and 

independent living skills. Results of several 

studies also show that the video prompting 

strategy is more effective when compared to 

static picture use. Furthermore, participants 

in several studies maintained the skills learned 

through video prompting and generalized the 

learned skills to novel settings or behaviors. 

The video prompting strategy is a robust 

method for enhancing several skills in persons 

with developmental disabilities. There may be 

several possible reasons for its success. The 

method is based on task analysis, prompting, 

repetition, and feedback which are fundamental 

principles of teaching and are likely to 

increase skill acquisition in persons with developmental 

disabilities (Giangreco, 2011; 

Snell, 2007). In addition, video prompting involves 

consistency through video clips which 

can be repeatedly presented to participants at 

an individual pace until they are proficient. 

Furthermore, video clip information can be 

presented to learners in multiple modes including 

auditory, visual, and animated cues 

(Mechling et al., 2008). Research also supports 

that repeated practice is likely to enhance 

skill acquisition (Ayres & Langone, 

2005; Giangreco, 2011) and because many 

studies involved participants with autism, it is 

likely that persons with autism, are especially 

likely to respond to visual mode of presentations 

(Quill, 1997). 

This review indicates that video prompting 

was predominantly used with cooking-related, 

vocational, and/or domestic skills with young 

adults or adults with developmental disabilities. 

Although few studies have attempted other 

skills, such as purchasing and safety, none of the 

studies attempted to teach social skills or selfhelp 

skills such as dressing, grooming, brushing, 

shaving, etc. It is possible that the complex nature 

of social skills requires a combination of 

variables (e.g., initiate, respond, terminate conversations, 

share) and that students may be better 

able to respond to other interventions such 

as direct teaching, peer modeling, and video 

modeling. However, the question for future researchers 

that remains is whether video prompts 

can be used to teach social or self-help skills in 

persons with developmental disabilities. In addition, 

more studies are needed with preschoolage 

and/or young children with developmental 

disabilities. 

Researchers in several studies combined 

video prompting with CTD and used least-tomost 

prompting and/or video feedback as error 

correction methods to teach tasks. Research 

supports the use of such strategies to 

teach chained tasks in persons with developmental 

disabilities (see Dogoe & Banda, 2009; 

Wolery et al., 1992). Several studies also show 

that video prompting along with least-to-most 

prompting was effective in teaching various 

skills. Future researchers should investigate if 

other prompting methods, such as graduated 

guidance with video prompting, improve skills 

in persons with developmental disabilities (see 

Sigafoos et al., 2005). In addition, it remains 

to be verified whether video feedback is an 

effective way to correct participants’ errors 

during video instruction (Van Laarhoven et 

al., 2009). 

Investigators in several studies used multiple 

interventions such as video prompting 

combined with video modeling, video 

prompts with voice-over instructions and/or 

text display, static pictures, etc. Although 

package interventions seem to be effective 

with the participants, the individual effectiveness 

of each variable is difficult to assess in 

many of the studies. Future researchers 

should investigate the individual effects of 

each intervention such as video prompts with 


and without voice over instructions or video 

prompting with or without text display, etc. 

(see Mechling et al., 2003). 

Results show that few studies have attempted 

to fade the video prompts. An exemplary 

model developed by Sigafoos et al. 

(2007) can be replicated. In addition, it 

should be worth examining whether video 

prompts can be faded to picture prompts and, 

later, to verbal prompts which are natural. 

Also, researchers in few studies successfully 

trained the participants in using hand-held 

devices such as PDA or video iPOD to deliver 

video prompts (Mechling et al., 2009; Van 

Laarhoven et al., 2009). Training persons with 

developmental disabilities to operate video devices 

on their own is likely to decrease the 

need for prompts and likely to improve independent 

functioning. 

This study indicates that only 5 of 18 studies 

have assessed for generalization. The importance 

of generalization is very essential when 

skills are taught to persons with developmental 

disabilities because they have difficulties 

generalizing tasks across behaviors, settings, 

and/or persons. Thus, it is important for future 

researchers to incorporate generalization 

training using various strategies (e.g., multiple 

exemplars, using natural contexts, varying 

stimuli) and to assess for generalization when 

video prompting studies are conducted. 

Although video prompting is an appealing 

intervention, in only 4 of 18 studies was social 

validity assessed. Thus, it is difficult to conclude 

whether video prompting interventions 

are easy to develop, easy to implement, and 

feasible in applied settings. Similar concerns 

appear in other studies (see Grice & Blampied, 

1994; Van Laarhoven et al., 2009). It is 

essential for practitioners to select a functional 

skill, task analyze the skill, video tape 

the sequence, edit, consider whether to use 

prompts, operate a video device (e.g., DVD, 

iPod, PDA), collect data, monitor, and assess 

for maintenance and generalization. Also, 

some tasks may involve too many steps and it 

may be cumbersome to present each step to 

the participant as a video prompt (e.g., having 

30 or more steps in a complex cooking skill). 

Future investigators should include such social 

validity components of video prompting 

interventions or the strategy may not sustain 

in practitioner community. 

Conclusions 

This review supports the findings that persons 

with developmental disabilities can learn various 

domestic and independent living skills 

through the video prompting strategy. Video 

prompts appear to be more effective when 

compared to picture prompts. The strategy is 

also effective in the maintenance and generalization 

of learned skills. Because of the robust 

research findings, it is important for future 

researchers to continually assess social 

validity and make it more accessible for teachers 

and practitioners working with persons 

with developmental disabilities. 

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Initial Acceptance: 5 November 2010 

Final Acceptance: 15 December 2010 




Simultaneous Prompting: An Instructional Strategy for Skill 

Acquisition 

Rebecca E. Waugh, Paul A. Alberto, and Laura D. Fredrick 

Georgia State University 

Abstract: Errorless learning is an instructional approach designed to eliminate and/or reduce the number of 

errors students produce in traditional trial-and-error approaches (Mueller, Palkovic, & Maynard, 2007). 

Various response prompting strategies are employed to produce errorless learning. Simultaneous prompting is an 

errorless learning strategy that has a growing body of literature to support its use spanning two decades. This 

paper provides a comprehensive review of the literature including (a) skills targeted for instruction, (b) 

populations targeted for instruction, (c) strengths and weaknesses of simultaneous prompting, and (d) future 

areas of research. 

Errorless learning is an instructional approach 

designed to reduce the number of 

errors students make in traditional trial-anderror 

approaches (Mueller, Palkovic, & Maynard, 

2007). During errorless learning procedures 

stimulus control is transferred from the 

controlling prompt to the discriminative stimulus. 

This transfer is achieved through the use 

of response prompting strategies. Response 

prompting strategies consist of additional information 

which results in the correct response 

being emitted (Wolery, Ault, & Doyle, 

1992). The underlying purpose of errorless 

learning is the transfer of stimulus control 

from a response prompt to the natural stimulus. 

Wolery and Gast (1984) identified four 

common response prompting strategies that 

commonly are employed to transfer stimulus 

control: (a) most-to-least prompts, (b) least-tomost 

prompts, (c) graduated guidance, and 

(d) time delay. Most-to-least prompts consists 

of employing the most intrusive prompt 

needed to assist the student in emitting the 

correct response and fading the intensity of 

the prompt until the student is correctly responding 

to the discriminative stimulus independently. 

Least-to-most prompts provide the 


be addressed to Rebecca E. Waugh, Georgia State 

University, Department of Educational Psychology 

and Special Education, PO Box 3979, Atlanta, GA 

30302-3979. Email: rwaugh1@gsu.edu 

student with an opportunity to respond independently 

to the discriminative stimulus. If 

the student responds incorrectly a prompt is 

provided which gradually increases in intensity 

until the student responds correctly to the 

discriminative stimulus. “Graduated guidance 

is a technique combining physical guidance 

and fading in which the physical guidance is 

systematically and gradually reduced and then 

faded completely” (Foxx, 1982, p. 129). Graduate 

guidance relies heavily on the teacher’s 

judgment whether or not a prompt is required 

or the degree of prompt required. There are 

two forms of graduated guidance. During one 

form a teacher shadows a student’s movement 

when teaching a task to provide guidance during 

each step or to remove the physical 

prompt. During a second form of graduated 

guidance the teacher may provide constant 

contact but gradually and systematically reduce 

the intrusiveness and placement of the 

prompt (Foxx, 1981; Wolery & Gast, 1984). 

Time delay is the fourth common response 

prompting strategy which results in near errorless 

learning by transferring stimulus control 

from a controlling prompt to the discriminative 

stimulus by inserting a delay between 

the presentation of the discriminative stimulus 

and the controlling prompt (Snell & Gast, 

1981; Touchette, 1971). Two forms of time 

delay are reported in the literature, progressive 

time delay (PTD) and constant time delay 

(CTD). During PTD a systematically increased 


delay is inserted between the presentation of 

the discriminative stimulus and the controlling 

prompt (Cooper, Heron, & Heward, 

2007). In contrast, CTD consists of only two 

prompting conditions, a zero-second delay 

condition and a three- or five-second delay 

condition. During the zero-second delay condition, 

the stimulus and controlling prompt 

are delivered concurrently. During the threeor 

five-second delay condition the stimulus is 

presented with the specified delay inserted 

prior to the delivery of the controlling prompt 

to allow for independent responding. Acquisition 

during both PTD and CTD is measured 

by correct responses during the delayed trials 

in which the student responds to the stimulus 

prior to the presentation of the controlling 

prompt. 

Purpose 

The purpose of this paper is to review the 

research literature on simultaneous prompting, 

a fifth prompting strategy that results in 

near errorless learning. This review includes 

skills and individuals taught using simultaneous 

prompting and strengths and weaknesses 

of simultaneous prompting as identified in 

the literature. 

Simultaneous Prompting 

Simultaneous prompting is a response 

prompting strategy that results in near errorless 

learning. During this procedure the instructional 

cue and controlling prompt are 

presented concurrently or simultaneously 

with probes conducted prior to the instructional 

session to measure skill acquisition 

(Gibson & Schuster, 1992; Schuster, Griffen, 

& Wolery, 1992). Simultaneous prompting 

consists of three components (a) baseline or 

full probe sessions, (b) assessment or daily 

probe sessions, and (c) instructional sessions. 

During baseline/full probe sessions, data are 

collected on the students’ identification or 

completion of all stimuli within the program. 

Baseline/full probe sessions are presented 

prior to the beginning of instruction and typically 

following mastery of a set of stimuli prior 

to presentation of the next set of stimuli. Full 

probe sessions may serve as baseline conditions 

as well as maintenance conditions. As- 

sessment/daily probe sessions which measure 

acquisition of the stimuli targeted for instruction, 

are presented prior to each instructional 

session. Assessment/daily probe sessions provide 

for independent responding opportunities 

for the students. Instructional sessions are 

conducted following assessment/daily probe 

sessions each day. During instructional sessions 

the stimulus and the controlling prompt 

are presented concurrently. 

Method 

An electronic search of ERIC was conducted 

with simultaneous prompting used as the keyword. 

Articles also were identified through the 

reference lists of research articles and a published 

review of the literature on simultaneous 

prompting (Morse & Schuster, 2004). Articles 

were included if (a) they employed simultaneous 

prompting in an experimental design and 

(b) were published in a peer review journal. A 

total of 35 peer reviewed articles and one 

review of the literature were identified. Investigations 

that were not included in the initial 

review of the literature are included in Tables 

1 and 2. 

Demographic Variables 

Participants. A total of 35 published studies 

spanning eighteen years (1992–2010) and 

one review of the literature on simultaneous 

prompting are included. In an initial review of 

the literature Morse and Schuster (2004) 

identified 18 published studies which examined 

simultaneous prompting including 74 

participants. Since the initial review of the 

literature an additional 17 studies have been 

identified with an additional 62 participants 

for a total of 35 published studies and 136 

participants. 

Simultaneous prompting has been employed 

predominately with students in elementary 

school (Akmanoglu & Batu, 2004; 

Batu, 2008; Birkan, 2005; Griffen, Schuster, & 

Morse, 1998; Kurt & Tekin-Iftar, 2008; Parrott, 

Schuster, Collins, & Gassaway, 2000; Schuster 

& Griffen, 1993; Schuster, Griffen, & Wolery, 

1992; Singleton, Schuster, & Ault, 1995; Tekin 

& Kircaali-Iftar, 2002; Tekin-Iftar, 2008; Tekin- 

Iftar, Kurt, & Acar, 2008; Waugh, Fredrick, & 

Alberto, 2009) but also has been implemented 

Simultaneous Prompting / 529

TABLE 1 

Summary of Demographic and Procedural Variables 

Independent Variable 

(Controlling Prompt) Error Rates 

Authors Participants (Target Participants) Setting Pupil: Teacher Ratio Dependent Variable 

Instruction 10.4% 

Probe 45% 

Modeling prompt paired 

with verbal prompt 

Preschool 

Expressive identification 

of relatives 

2 with Autism; 5.5 years old Classroom for children 

with Autism in a 

university unit for 

children with 

development delays 

Akmanoglu-Uludag & Batu 

(2005) 

Instruction (1:1) 

Verbal 38.5%, 

Motor 0%; (4:1) 

Verbal 49%, 

Motor 0% 

Probe (1:1) Verbal, 

Motor, and Instructive 

Feedback 41.6%; (4: 

1) Verbal 25%, 

Motor 24.2%, 

Instructive Feedback 

30% 

Instruction Everyday 

probes 0–3.5% 

Every 4th day probes 

0–4.3% 

Probes First 8 days 

50% First 2 every 4th day 

28.1% 

Full physical prompt to 

perform play action 

paired with a verbal 

model of language 

(1) acquisition and 

training trials of target 

pretend play expressive 

vocabulary skills (2) 

pretend play motor 

skill (3) instructive 

feedback - expressive 

vocabulary skills 

(1:1) 

Public preschool 

Classroom (1:1 and 

4:1) 

4 with pervasive developmental 

disorder and developmental 

disabilities; 3–4 years old; 

Para delivered instruction 

Colozzi, Ward, & Crotty 

(2008) 

Verbal model of correct 

response 

Classroom (1:1) 14 transportation words 

and 11 line drawings 

(2 words per condition; 

3 conditions 

Everyday probes, Every 

fourth day probes and 

control) 

Reichow & Wolery (2009) 1 with speech language 

impairment, 1 English 

Language Learner, 1 with 

typical development, 1 at-risk 

for school failure; 4–5 years 

old 

Instruction 34–64% 

Probe not reported 

Not Reported 

Modeling plus verbal 

prompt 

Verbal direction paired with 

modeling 

Instruction 0% 

Probes 26–35% 

Verbal Model of correct 


Instruction Not 

reported Probes (CTD 

1–16%) (SP 2–15%) 

CTD vs Simultaneous 

Prompting (Intermittent 

probes) 

Elementary 

Akmanoglu & Batu (2004) 3 with Autism; 6–17 years old Classroom at university Receptive identification 

school (1:1) 

of numerals 1–9 

Batu (2008) 4 with Developmental Delays Home-based instruction (1) Caregiver 

(IQ 41–50); 6-9 years old; 

implementation (2) 

Caregiver-delivered 

Acquisition of home- 

instruction 

living skills (e.g., 

wearing socks, making 

bed, etc) 

Birkan (2005) 1 MID, 2 MoID; 6–13 years old Classroom at research 3 discrete tasks (sight 

university (1:1) 

words, receptive 

identification of digits, 

telling time 

Kurt & Tekin-Iftar (2008) 4 with Autism; 6–8 years old School - Classroom, Turning on CD player 

cafeteria, free-play 

and taking a digital 

area, and hall 

picture 



Summary of Demographic and Procedural Variables 


(Controlling Prompt) Error Rates 

Participants (Target 

Participants) Setting Pupil: Teacher Ratio Dependent Variable 

Authors 

Instruction 0% Probes 

14–19% 

Model with verbal 

description 

11 - 15 step task analysis 

for purchasing 

Community settings 

(grocery store, pastry 

shop, and dry cleaning 

store) 


Probes 7.5% 



Tekin-Iftar (2008) 3 with Autism, 1 with 

MoID; 7–12 years old; 

Parent-delivered 

instruction 

Tekin-Iftar, Kurt, & Acar (2008) 2 with mental retardation; 

7-8 years old 

Instruction not reported 

Probes not reported 

Verbal model of correct 


3 students with MoID; 

9–11 years old 

Waugh, Fredrick, & Alberto 

(2009) 

Not reported 



5 with MoID (IQ 40– 

<strong>46</strong>); 12-15 years old 

Alberto, Waugh, & Fredrick 

(2010) 


Probes 6.57% 

Verbal prompt paired with a 

model 

3 with MID, 2 with 

MoID; 11–14 years 

Gursel, Tekin-Iftar, & Bozkurt 

(2006) 

Verbal prompt paired with a Not reported 

model 

Verbal of correct response Instruction 8.6%– 17.6% 

Probes 15.2%–26.4% 

University Unit (1:1) Tool identification with 

instructive feedback; 

intermittent probe 

Conditions 

Self-contained classroom Correct reading of sight- 

in public school (1:1) words, letter-sound 

correspondences, and 

blending skills 

Middle School 

Self-contained classroom Verbal reading and 

in public school (2:1 motoric demonstration 

and 3:1) 

of comprehension of 

individual sight words 

and connected text 

Classroom (2:1); 

Discrete skills - 

heterogeneous dyadic identification of 

grouping 

provinces, rivers, and 

border countries on 

Turkish map and 

expressive identification 

of math symbols 

Self-contained classroom 12-step task analysis for 

(1:1) 

subtraction with decimals 

Classroom (1:1) Recall of multiplication 

Facts 

Not reported 

CTD vs Simultaneous 

Prompting 

Different discrete tasks - 

(1) expressively read 

words from general 

education vocabulary 

lists (2) Verbally define 

key vocabulary words 

Acquisition of community 

signs with instructive 

feedback 

Special education and 

general education 

classrooms (large 

group) 

Rao & Kane (2009) 2 with Educable Mental 

Impairement 

Rao & Mallow (2009) 2 with cognitive 

impairments (IQ 

49 & 62) 

Riesen et al. (2003) 1 with autism, 2 with 

multiple disabilities 

(IQ 50–55), 1 with 

MID (IQ 58–70); 2 

paraprofessionals 


Probes 2.21% 



Counselor’s Office in a 

public school (tutor 

dyads) 

Tekin-Iftar (2003) 4 typical peers, 4 with 

developmental 

disabilities; 10-13 

years old 

Instruction 0% 

Probes 29% 



Expressive identification of 

first aid materials and 

instructive feedback 

Classroom in a public 

school (1:1) 

Tekin-Iftar, Acar, & Kurt (2003) 3 with MID; 13–14 years 

old 


TABLE 2 

Summary of Outcome Variables 

Authors Design Results Maintenance Generalization Social Validity 

Parent Questionnaire 

Across materials, settings, 

and trainers 

Preschool 

1, 2, and 4 weeks 

following mastery 

criterion 

Does not specify when 

collected 

Multiple Probe All students acquired 

targeted skills 

Akmanoglu-Uludag & Batu 

(2005) 

Questionnaire – 

Parents, Preschool 

Teachers and 

Paraprofessionals 

Across people, setting, 

and materials 

Colozzi et al. (2008) Multiple Probe Simultaneous prompting 

effective - met criterion. 

No significant 

differences in probe 

errors for verbal and 

motor responses 

between 1:1 and small 

Not reported Not reported Not reported 

group 

3 of 4 participants 

acquired target stimuli 

under both 

simultaneous prompting 

conditions; 1 student 

acquired target stimuli 

in the every 4th day 

condition only 

Reichow & Wolery (2009) Adapted Alternating 

Treatments 

Across materials Parent Questionnaire 

Across trainers Semi-structured 

interview 

Across setting and 

Not reported 

materials 

Not reported 16 instructors and 

professors 

completed 

Questionnaire 

Across settings Mother and Student 


Multiple exemplars Not reported 

Elementary 

Akmanoglu & Batu (2004) Multiple Probe All students met Criterion 1, 2, and 4 weeks 

following 

demonstration of 

mastery 

Batu (2008) Multiple Probe All students met Criterion 1 and 3 weeks 

following 


mastery 

Birkan (2005) Multiple Probe All students met Criterion 7, 18, and 25 days after 


Kurt & Tekin-Iftar (2008) Adapted Alternating Both equally effective with 1, 2, and 4 weeks 

Treatments 

mixed efficiency data 

following 


mastery 

Tekin-Iftar (2008) Multiple Probe All students met criterion 2 and 5 weeks 

following 


mastery 

Tekin-Iftar, Kurt, & Acar Multiple Probe All students met criterion 1, 2, and 4 weeks 

(2007) 

following 


mastery 



Summary of Outcome Variables 

Authors Design Results Maintenance Generalization Social Validity 

Preschool 

Waugh et al. (2009) Changing Criterion All 3 students met 

Measured during the Across materials Teacher Interview 

criterion through 

study due to 

Blending Set 2, one 

summer break; not 

student met criterion 

measured followed 

through Blending Set 5 

mastery of all phases 

and one student met 

of instruction 

criterion through 

Blending Set 3 

Middle School 

Alberto et al (2010) Changing Criterion All students met criterion Not measured Across materials Teacher 

embedded in a 


Multiple Baseline 

across groups 

Gursel et al. (2006) Multiple Probe All students met criterion 2 and 6 weeks 

Across people and 

Not reported 

following 

materials 


mastery 

Rao & Kane (2009) Multiple Probe Both students met 

10 days following 

Across settings, materials, Not reported 



and professionals 

mastery 

Rao & Mallow (2009) Multiple Probe Both students met 

1 and 3 weeks 

Across format, setting, 

Not reported 


following 

and personnel 


mastery 

Riesen et al. (2003) Adapted Alternating 3 students reached 

Not reported Not reported Not reported 

Treatments 

criterion under both 

conditions, 1 student 

reached criterion under 

simultaneous prompting 

condition only 

Tekin-Iftar (2003) Multiple Probe All met criterion 1 week following 

Across people Not reported 


mastery 

Tekin-Iftar, Acar, & Kurt Multiple Probe All met criterion 1, 2, and 4 weeks 

Not reported Not reported 

(2003) 

following 


mastery 


with students in preschool (Akmanogu- 

Uludag & Batu, 2005; Colozzi, Ward, & Crotty, 

2008; Dogan & Tekin-Iftar, 2002; Gibson & 

Schuster, 1992; MacFarland-Smith, Schuster, 

& Stevens, 1993; Reichow & Wolery, 2009; 

Sewell, Collins, Hemmeter, & Schuster, 1998), 

middle school (Alberto, Waugh, & Fredrick, 

2010; Fickel, Schuster, & Collins, 1998; Gursel, 

Tekin-Iftar, & Bozkurt, 2006; Rao & Kane, 

2009; Rao & Mallow, 2009; Riesen, McDonnell, 

Johnson, Polychronis, & Jameson, 2003; 

Tekin-Iftar, 2003; Tekin-Iftar, Acar, & Kurt, 

2003), and high school (Fetko, Schuster, Harley, 

& Collins, 1999; Johnson, Schuster, & Bell, 

1996; Parker & Schuster, 2002; Singleton, 

Schuster, Morse, & Collins, 1999), and with 

adults (Maciag, Schuster, Collins, & Cooper, 

2000; Palmer, Collins, & Schuster, 1999). The 

procedure has been employed in 19 studies 

with a total of 51 participants with moderate 

intellectual disabilities (MoID) (Alberto et al., 

2010; Batu, 2008; Birkan, 2005; Dogan & 

Tekin-Iftar, 2002; Fickel et al., 1998; Griffen et 

al., 1998; Gursel et al., 2006; Maciag, et al., 

2000; Parker & Schuster, 2002; Parrott, et al., 

2000; Rao & Mallow, 2009; Riesen et al., 2003; 

Schuster & Griffen, 1993; Schuster et al., 1992; 

Singleton et al., 1995; Singleton et al., 1999; 

Tekin & Kircaali-Iftar, 2002; Tekin-Iftar, 2008; 

Waugh et al., 2009). The procedure also has 

been employed in 13 studies with a total of 23 

participants with mild intellectual disabilities 

(MID) (Birkan, 2005; Dogan & Tekin-Iftar, 

2002; Fickel et al., 1998; Gursel et al., 2006; 

Johnson et al., 1996; Palmer et al.,1999; 

Parker & Schuster, 2002; Rao & Kane, 2009; 

Rao & Mallow, 2009; Riesen et al., 2003; Tekin 

& Kircaali-Iftar, 2002; Tekin-Iftar, 2003; Tekin- 

Iftar et al., 2003), 7 studies with a total of 18 

participants with autism (Akmanoglu & Batu, 

2004; Akmanoglu-Uludag & Batu, 2005; 

Colozzi et al., 2008; Kurt & Tekin-Iftar, 2008; 

Parrott et al., 2000; Riesen et al., 2003; Tekin- 

Iftar, 2008), 5 studies with a total of 10 participants 

with typical development (Fickel et al., 

1998; Gibson & Schuster, 1992; Parker & 

Schuster, 2002; Reichow & Wolery, 2009; 

Tekin-Iftar et al., 2003), 4 studies with a total 

of 11 participants with severe intellectual disabilities 

(SID) (Colozzi et al., 2008; Fetko et 

al.,1999; Maciag et al., 2000; Parrott et al., 

2000), 4 studies with 12 participants with developmental 

delays (Gibson & Schuster, 1992; 

MacFarland-Smith et al., 1992; Sewell et al., 

1998; Wolery et al., 1993), one study with a 

total of three participants with learning disabilities 

(Johnson et al., 1996), one study with 

a participant with spina bifida (Gibson & 

Schuster, 1992), one study with a participant 

classified as a slow learner (Tekin-Iftar, 2003), 

and one study which included a student with a 

speech-language impairment, a student who 

was classified as an English Language Learner, 

and a student identified as at-risk for school 

failure (Reichow & Wolery, 2009). 

In the same way that simultaneous prompting 

has been employed with a variety of participants, 

a variety of individuals have implemented 

the procedure. While this procedure 

predominately has been implemented by 

classroom teachers (Griffen et al., 1998; Gursel 

et al., 2008; Waugh et al., 2009), it also has 

been implemented by paraprofessionals 

(Colozzi et al., 2008; Riesen et al., 2003), parents 

(Tekin-Iftar, 2008), caregivers (Batu, 

2008), sibling tutors (Tekin & Kircaali-Iftar, 

2002), and peer tutors (Tekin-Iftar, 2003). Simultaneous 

prompting is executed with a 

high level of procedural fidelity, ranging from 

84100% across all implementers. 

Instructional Grouping 

The majority of studies which have employed 

simultaneous prompting have used individual 

instructional formats (Akmanoglu & Batu, 

2004; Akamanoglu-Uludag & Batu, 2005; 

Batu, 2008; Birkan, 2005; Dogan & Tekin- 

Iftar, 2002; Fetko et al., 1999; Gibson & Schuster, 

1992; Griffen et al., 1998; Parrott et al., 

2000; Rao & Kane, 2009; Rao & Mallow, 2009; 

Reichow et al., 2009; Riesen et al., 2003; Schuster 

et al., 1992; Singleton et al., 1999; Tekin & 

Kircaali-Iftar, 2002; Tekin & Iftar, 2003; Tekin- 

Iftar et al, 2003; Tekin-Iftar et al, 2008). Six 

studies have implemented the instructional 

strategy in a group format, ranging from a 2:1 

format to an 11:1 format. Singleton et al. 

(1995) were the first to examine simultaneous 

prompting in a group format using dyads. The 

researchers found that simultaneous prompting 

could be implemented effectively in dyads 

to teach basic discrete identification of community 

signs to students with MoID. Maciag et 

al. (2000) further examined the use of simultaneous 

prompting in teaching a chained vo- 


cational task in a dyadic group format to 

adults with SID. Gursel et al. (2006) also examined 

a heterogeneous dyadic group format 

in teaching discrete skills to students with developmental 

disabilities. Fickel et al. (1998) 

and Parker and Schuster (2002) further expanded 

the literature on simultaneous 

prompting in a group format by teaching a 

heterogeneous group of students discrete 

skills. Students were taught different tasks using 

different stimuli in a group format of 4:1 

(Fickel et al., 1998) and 5:1 (Parker & Schuster, 

2002). Johnson et al. (1996) conducted 

instructional sessions in the largest group format 

of 11:1 in teaching high school students 

with mild disabilities. Across all studies, simultaneous 

prompting implemented in both individual 

and group formats has been effective 

in teaching targeted skills. 

Only one study directly compared the effects 

of simultaneous prompting in individual 

and group formats (Colozzi et al., 2008). 

Colozzi and colleagues compared the effectiveness 

of simultaneous prompting in individual 

format (1:1) and a group format (4:1) in 

teaching four students with autism pretend 

play vocabulary and motor skills. While group 

instruction required more instructional sessions 

and resulted in more instructional errors 

there were no significant differences in probe 

errors across the two instructional formats. 

Although group instruction required more instructional 

sessions to mastery, the implementation 

of group instruction may allow for the 

acquisition of additional skills through the use 

of nontargeted instructional feedback and observational 

learning. 

Observational Learning and Instructive Feedback 

Observational learning consists of learning 

through observing others engaging in an activity 

or being taught a specific activity. In 

order for observational learning to occur students 

must demonstrate imitative behaviors 

(Wolery et al., 1992). Some students with 

moderate to severe intellectual disabilities 

who demonstrate imitative behaviors can acquire 

nontargeted skills through observational 

learning. Several studies which employed 

simultaneous prompting in a group 

format have examined the acquisition of nontargeted 

information through observational 

learning (Fickel et al., 1998; Gursel et al., 

2006; Parker & Schuster, 2002; Singleton et 

al., 1999). Fickel et al. found that students 

acquired 66% to 100% of their peer’s target 

stimuli through observational learning. Similarly, 

Gursel et al. found students acquiring 

33% to 100% of their peer’s target stimuli 

through observational learning. Parker and 

Schuster and Singleton et al. measured observational 

learning of target stimuli as well as 

instructive feedback. 

Instructive feedback consists of additional 

information that provides the student with 

supplementary details about the target stimulus 

(Tekin-Iftar et al., 2008). Instructive feedback 

has been used widely in the teaching of 

target skills using simultaneous prompting 

(Colozzi et al., 2008; Griffen et al., 1998; Gursel 

et al., 2006; Parker & Schuster, 2002; Singleton 

et al., 1999; Tekin-Iftar, 2003; Tekin- 

Iftar et al., 2003; Tekin-Iftar et al., 2008). 

While observational learning requires a group 

format, instructive feedback can be implemented 

and measured in both individual and 

group formats. Wolery, Holcombe, Werts, and 

Cipolloni (1993) provided instructive feedback 

to teach classification of food and drink 

items while teaching receptive identification 

of rebus symbols of specific food and drink 

items to preschool students with developmental 

disabilities. Students were provided with 

information concerning the classification of 

when (e.g., We eat cereal for breakfast) and 

how (e.g., Juice is a drink). Two of the five 

students correctly classified all the target stimuli 

and the remaining three students correctly 

classified some of the target stimuli. Gursel et 

al. (2006) taught a heterogeneous group of 

middle school students with MID and MoID a 

variety of discrete skills ranging from map 

skills to mathematical symbol identification. 

Instructive feedback included additional geographical 

information. Students acquired 33 

to 100% of the instructive feedback. Parker 

and Schuster taught a variety of discrete skills 

to two high school students with typical development 

and two students with MID/MoID. 

Three of four of the student acquired some of 

their targeted instructive feedback (range 25– 

83% accuracy) and some of their group members 

targeted instructive feedback (range 

9–38% accuracy). Singleton et al. reported 

similar findings with elementary-aged students 


with MoID acquiring some of their peer’s target 

stimuli (47–54%) and instructive feedback 

(61–81%) through observational learning. 

Targeted Skills 

Simultaneous prompting has been used to 

teach a variety of discrete and chained skills. 

Skills taught using simultaneous prompting 

include literacy skills (Birkan, 2005; Gibson & 

Schuster, 1992; Griffen et al., 1998; Johnson, 

et al., 1996; Parker & Schuster, 2002; Reichow 

& Wolery, 2009; Riesen et al., 2003; Schuster 

et al., 1992; Singleton et al., 1995; Singleton et 

al., 1999; Tekin-Iftar, 2003; Waugh et al., 

2009), math skills (Akmanoglu & Batu, 2004; 

Birkan, 2005; Fickel et al., 1998; Gursel et al., 

2006; Rao & Kane, 2009; Rao & Mallow, 2009), 

communication skills (Akmanoglu-Uludag & 

Batu, 2005; Dogan & Tekin-Iftar, 2002; Fickel 

et al., 1998; Tekin & Kircaali-Iftar, 2002; 

Tekin-Iftar et al., 2003; Tekin-Iftar, 2008; Wolery 

et al., 1993), daily living skills (Batu, 2008; 

Fetko et al., 1999; Parrott et al., 2000; Schuster 

& Griffen, 1993; Sewell et al., 1998; Tekin- 

Iftar, 2008), leisure skills (Colozzi et al., 2008; 

Kurt & Tekin-Iftar, 2008), and vocational skills 

(Maciag et al., 2000). 

Literacy skills. The most common skill 

taught employing simultaneous prompting is 

literacy instruction. Of the 35 studies conducted 

employing simultaneous prompting, 

16 studies examined some component of literacy 

instruction with the majority of those 

studies focused on sight-word instruction. The 

words targeted for instruction include grocery 

words (Parker & Schuster, 2002; Schuster et 

al., 1992; Singleton et al., 1999), environmental 

words (Griffen et al., 1998), academic vocabulary 

words (Johnson et al., 1996; Riesen et 

al., 2003), occupational words (Parker & 

Schuster, 2002), community words and/or 

signs (Singleton et al., 1995; Tekin-Iftar, 

2003), thematic words (Reichow & Wolery, 

2009), and controlled vocabulary (Alberto et 

al., 2010; Birkan, 2005; Gibson & Schuster, 

1992; Waugh et al., 2009). Simultaneous 

prompting was employed with a total of 50 

participants ranging from typically developing 

students (Reichow & Wolery, 2009) to students 

with MoID (e.g., Waugh et al.) and was 

effective in teaching sight words to 49 of 50 

participants. While most studies taught sight 

words in isolation, two studies expanded upon 

the individual approach to sight-word instruction 

to include reading of connected (Alberto 

et al., 2010) and expanding to phonics instruction 

(Waugh et al.). Alberto et al. systematically 

taught five students with MoID to read 

individual sight words composed of various 

parts of speech. Students also were taught to 

read the individual sight words in various 

forms of connected text and demonstrate 

comprehension of what was read. All five students 

read the sight words in both individual 

and connected text formats and were able to 

demonstrate comprehension. Waugh et al. 

also expanded on the use of simultaneous 

prompting to teach sight words to students 

with MoID by first teaching three elementary 

students with MoID to read targeted sight 

words and then teaching corresponding phonics 

skills. The students were taught to read 

four sight words using simultaneous prompting. 

Once students reached mastery on the 

four sight words, they were taught the corresponding 

letter-sound correspondences for 

the graphemes in each word. Students were 

then taught the skill of blending to read the 

previously taught sight words. The students 

successfully acquired the sight words and various 

numbers of the blending words. The students 

were able to read some but not all generalization 

words. 

Math skills. Of the 35 studies which implemented 

simultaneous prompting, 6 of the 

studies addressed math skills. Of these six 

studies, five taught discrete skills, such as number 

identification (Akmanoglu & Batu, 2005; 

Birkan, 2005), math symbol identification 

(Gursel et al., 2006), multiplication facts identification 

(Rao & Mallow, 2009), addition facts 

identification (Fickel et al., 1998), and telling 

time (Birkan, 2005). Only one study examined 

the use of simultaneous prompting to 

teach the chained math skill of subtraction 

with decimals (Rao & Kane, 2009). Using simultaneous 

prompting Rao and Kane taught 

the chained academic skills of subtraction to 

two students (reported IQ scores 47–50). Students 

mastered subtraction with regrouping 

in 25 or fewer sessions and maintained and 

generalized the math skills. Simultaneous 

prompting was employed with a total of 11 

participants and was effective in teaching 

math skills to all of the participants. 


Communication skills. Simultaneous prompting 

has been used to teach communication 

skills in 7 of the 35 published studies. Communication 

skills taught include expressive 

naming of relatives for preschool students 

with autism (Akmnaoglu-Uludag & Batu, 

2004), receptive identification of occupation 

picture cards for two preschool students with 

MoID and one preschool student with MID 

(Dogan & Tekin-Iftar, 1998), manual sign production 

of six communication symbols for 

three middle school students with MID/MoID 

and one student without disabilities (Fickel et 

al., 1998), receptive identification of animals 

for three elementary students with MID/ 

MoID (Tekin & Kircaali-Iftar, 2002), expressive 

identification of first aid materials for 

three middle school students with MID 

(Tekin-Iftar et al., 2003), and expressive identification 

of tools for two elementary students 

with intellectual disabilities (Tekin-Iftar et al., 

2008). The one receptive skill taught was identification 

of rebus symbols by five preschool 

students with developmental disabilities (Wolery 

et al., 1993). Across these seven studies 

simultaneous prompting was effective in 

teaching 21 of 23 participants with the remaining 

two participants not reaching mastery 

criteria but demonstrating an increase in 

performance over baseline. 

Daily living skills. Of the 35 studies examining 

simultaneous prompting, 6 studies examined 

the acquisition of daily skills (Batu, 

2008; Fetko et al., 1999; Parrott et al., 2000; 

Schuster & Griffen, 1993; Sewell et al., 1998; 

Tekin-Iftar, 2008). Simultaneous prompting 

was employed to teach home living skills, such 

as setting the table, preparing sandwiches, 

hanging clothes, folding clothes, etc (Batu, 

2008), making juice (Schuster & Griffen, 

1993) dressing skills (Sewell et al., 1998), 

opening a key lock (Fetko et al., 1999), hand 

washing skills (Parrott et al., 2000), and purchasing 

skills (Tekin-Iftar, 2008). This strategy 

was successful in teaching 20 of the 23 participants. 

The use of simultaneous prompting to 

teach daily living skills was implemented predominately 

by classroom teachers. Tekin-Iftar 

(2008) was the first to examine the effectiveness 

of implementation of the procedure in a 

natural setting by a parent. Four students with 

developmental delays were taught purchasing 

skills in the natural setting (i.e., grocery store, 

pastry shop, and dry cleaning store). The students 

acquired the targeted purchasing skills 

and were able to generalize those skills to 

purchasing of items in different locations. The 

parents effectively delivered simultaneous 

prompting at an average of 91% accuracy. 

Batu (2008) further examined the implementation 

of caregiver-delivered simultaneous 

prompting to teach home skills (e.g., setting 

the table, preparing food, hanging clothes, 

etc) to four elementary students with developmental 

delays. All four students acquired the 

targeted stimuli and maintained the skills over 

time. Students were able to generalize the 

skills across individuals in the naturalistic setting. 

This study provided initial support for 

the implementation of simultaneous prompting 

with caregivers of students with disabilities. 

Across all students and caregivers, reliability 

data were reported at a range of 87%– 

100% accuracy. These studies also support the 

ease with which simultaneous prompting can 

be implemented reliably. 

Leisure skills. Colozzi et al. (2008) and 

Kurt and Tekin-Iftar (2008) examined the effects 

of simultaneous prompting in teaching 

leisure/play skills to students with autism. 

Colozzi et al. analyzed the effects of simultaneous 

prompting in teaching pretend play 

skills to preschool students with autism in 

both individual and group instructional formats. 

Students were taught vocabulary and 

motor skills to represent the pretend play activity. 

All students acquired the targeted skills 

and maintained the skills at 100% accuracy, 

and individual instruction was more efficient, 

requiring fewer instructional sessions than 

group instruction. However, group instruction 

allowed for the acquisition of observational 

learning responses. Kurt and Tekin- 

Iftar compared the response prompting 

strategies of CTD and simultaneous prompting 

in teaching four students with autism to 

engage in two leisure skills of turning on a 

compact disc player and taking a digital picture. 

Both procedures were effective in teaching 

the targeted leisure skills to students with 

autism. Efficiency data produced mixed results 

as in previous studies with two students 

requiring the leisure skills in fewer sessions 

with CTD and two students requiring fewer 

sessions with simultaneous prompting. 


Vocational task. To date one study has examined 

the effectiveness of simultaneous 

prompting in teaching a vocational task. Ten 

adults with MoID and SID were taught to assemble 

boxes at a sheltered work site in 

groups of two (Maciag et al., 2000). Simultaneous 

prompting was effective for teaching 4 

of the 5 dyads. The remaining dyad was unable 

to complete the task to criterion due to 

time constraints. The employees acquired the 

targeted skill within a maximum of twenty 

sessions and maintained the skill fifteen weeks 

after instruction at a range of 73–93% accuracy. 

Comparison of Instructional Strategies 

In order to determine the effectiveness and 

efficiency of simultaneous prompting, researchers 

have compared simultaneous 

prompting to other response prompting strategies. 

Simultaneous prompting has been compared 

to CTD (Kurt & Tekin-Iftar, 2008; Riesen 

et al., 2003; Schuster et al., 1992; Tekin & 

Kircaali-Iftar, 2002) and antecedent-prompt 

and test procedure (Singleton et al., 1999). 

Simultaneous prompting is considered an adaptation 

of these two differing response 

prompting procedures (Schuster et al., 1992). 

In CTD, simultaneous prompting is comparable 

to the zero-second delay interval (Schuster 

et al., 1992). However, simultaneous prompting 

does not transition to increased delayed 

intervals as in CTD. 

During the antecedent-prompt and test procedure 

the teacher presents the stimulus and 

controlling prompt together and then provides 

an opportunity for the student to respond 

independently to the stimulus during 

probe or test trials (Wolery, Ault, & Doyle, 

1992). In the antecedent-prompt and test procedure 

trials in which the stimulus and controlling 

prompt are presented together always 

occur prior to probe trials (Wolery et al.). In 

contrast, during simultaneous prompting 

probes are conducted prior to instructional 

sessions. 

Constant time delay. Schuster et al. (1992) 

first examined the effectiveness of simultaneous 

prompting by comparing the procedure 

to CTD in teaching four elementary students 

with MoID to read grocery words. While both 

procedures were effective in teaching sight 

words to students with MOID, simultaneous 

prompting required fewer instructional sessions 

and less instructional time and resulted 

in fewer errors. It should be noted that the 

reduction in instructional time with simultaneous 

prompting was minimal for three of the 

four students ranging from 30-seconds to 

3-minutes and substantial for one student (11minutes). 

Maintenance data for the procedure 

was mixed with two students producing 

better maintenance with words taught with 

CTD and two students producing better maintenance 

with words taught with simultaneous 

prompting. This study provided initial support 

for the use of simultaneous prompting in 

teaching students with MoID. 

Riesen et al. (2003) further compared the 

effectiveness and efficiency of CTD and simultaneous 

prompting in teaching two junior 

high school students to read academic words 

and two junior high school students to define 

academic vocabulary words within an embedded-instruction 

format. Three students 

reached criterion under both conditions 

while one student reached criterion only in 

the simultaneous prompting condition. This 

study further validated the use of simultaneous 

prompting as an effective instructional 

strategy for teaching literacy skills to students 

with disabilities. 

Tekin and Kircaali-Iftar (2003) examined 

the effects of simultaneous prompting and 

CTD in teaching students with MID and MoID 

to receptively identify animals. Three students 

with MID/MoID were taught by sibling tutors 

to identify animals receptively. Both procedures 

were implemented with a high level of 

fidelity by sibling tutors. Both procedures 

were effective in teaching receptive identification 

of animals with no difference in maintenance 

data across the two procedures. Efficiency 

data were inconclusive with CTD more 

efficient in the number of sessions and number 

of trials to criterion and simultaneous 

prompting more efficient in the number of 

errors and total training time to criterion. 

Kurt and Tekin-Iftar (2008) compared the 

effects of simultaneous prompting and CTD 

in teaching the leisure skills of turning on a 

compact disc player and taking a digital picture 

to four boys with autism. Both procedures 

were equally effective in the acquisition and 

maintenance of the targeted skills. Efficiency 


data were inconclusive with CTD more efficient 

for two students and simultaneous 

prompting more efficient for two students. 

Across the four studies that have compared 

simultaneous prompting to CTD, the data 

have showed minimal differences between the 

two strategies with both strategies demonstrating 

effectiveness in teaching discrete skills and 

demonstrating mixed results in efficiency with 

simultaneous prompting more efficient for 

some students and CTD more efficient for 

some students. 

Antecedent-prompt and test procedure. Singleton 

et al. (1999) compared the effectiveness of 

simultaneous prompting and the antecedentprompt 

and test procedure in teaching four 

students with MoID to read grocery words. 

Both procedures were effective. However, efficiency 

data supported the antecedentprompt 

and test procedure over simultaneous 

prompting. The antecedent-prompt and test 

procedure required fewer sessions, less probe 

time, and resulted in fewer probe errors to 

criterion. Despite the data supporting the antecedent-prompt 

and test procedure, maintenance 

data supported simultaneous prompting 

with students maintaining a higher 

percentage of words taught in the simultaneous 

prompting condition. These data indicate 

an important difference between simultaneous 

prompting and the antecedent-prompt 

and test procedure. During the antecedentprompt 

and test procedure probes are conducted 

following instruction thereby indirectly 

measuring transfer of skills to shortterm 

memory. However, simultaneous 

prompting conducts probes prior to instruction 

each day measuring transfer of skills to 

long-term memory. 

Strengths and Weaknesses of Simultaneous 

Prompting 

Simultaneous prompting may provide certain 

advantages over other response prompting 

strategies for various reasons. First, simultaneous 

prompting does not require changes in 

teacher behavior as in CTD (Schuster et al., 

1992), system of least prompts, most prompts, 

and graduated guidance. Each instructional 

session is completed in the same sequence 

until mastery is reached, decreasing the likelihood 

that teachers will emit procedural er- 

rors. Second, simultaneous prompting does 

not require differential reinforcement because 

only one correct response is reinforced 

(Schuster et al.). Third, unlike CTD in which 

students must exhibit a wait response, simultaneous 

prompting eliminates the need for 

this response (Schuster et al.). Simultaneous 

prompting also reduces the need to keep direct 

data during instructional sessions because 

transfer of stimulus control is measured during 

probes. Avoiding the need to keep data 

during instructional sessions may be preferred 

by teachers when conducting group instruction 

because it eliminates the problems associated 

with keeping track of multiple students’ 

responses and maintaining student attention 

and focus. 

Across 35 peer-reviewed studies, simultaneous 

prompting has an effectiveness rate of 

93%, with 126 out of 136 participants reaching 

criterion during instruction with simultaneous 

prompting. Ten participants across the 

35 studies did not reach criterion. Rationale 

for not reaching criterion is often noted as 

time constraints associated with the end of the 

school year. Although the number of participants 

who did not reach criterion is minimal 

and all students demonstrated an increase in 

performance over baseline, the literature does 

reveal some problems associated with simultaneous 

prompting. The goal of errorless learning 

procedures is to ensure that students do 

not have opportunities to make errors or practice 

incorrect responses. While instructional 

sessions attempt to control the production of 

errors by providing a controlling prompt concurrently 

with the discriminative stimulus, errors 

can often be emitted during probe sessions 

when students have an opportunity to 

independently respond to the discriminative 

stimulus. As such, error rates vary greatly between 

daily probes (4–54% of trials) and instructional 

sessions (0–5% of trials) (Morse & 

Schuster, 2004). A second obstacle noted concerning 

simultaneous prompting is the need 

to conduct probe sessions and thereby impact 

efficiency (Schuster et al., 1992). Alternate 

response prompting strategies allow students 

to respond independently during instructional 

trials, however, in order for students to 

have an opportunity to respond independently 

to a stimulus during simultaneous 

prompting, a probe session must be conduct- 


ed; thereby adding to the amount of time 

required to fully employ the strategy. Despite 

the fact that probe time is often minimal, it is 

in addition to instructional time. 

Future Research Areas 

There are currently four main areas for future 

research on simultaneous prompting. The 

first is to expand the procedure to examine its 

effectiveness with individuals with profound 

intellectual disabilities (Morse & Schuster, 

2004). To date, no studies have investigated 

the effectiveness of the procedure with individuals 

with profound intellectual disabilities 

and only a few studies have been conducted 

with individuals with severe intellectual disabilities. 

Second, researchers have recommended 

that future investigations examine 

the effects of previous learning histories on 

the effects of simultaneous prompting (Singleton 

et al., 1995). Does previous experience 

with errorless learning strategies impact acquisition 

rates? 

The third and fourth recommendations are 

designed to examine methods for reducing 

the number of errors students emit during 

probe sessions in order to increase the degree 

of errorless learning associated with simultaneous 

prompting. The third recommendation 

is to provide error correction during daily/ 

assessment probes (Birkan, 2005; Colozzi et 

al., 2008; Dogan & Tekin-Iftar, 2002; Fickel et 

al., 1998; Tekin-Iftar, 2003; Tekin-Iftar et al., 

2003). Traditional procedures during daily/ 

assessment probes are to provide verbal reinforcement 

for correct responses and to ignore 

incorrect or no responses. To date five studies 

have provided error correction during daily/ 

assessment probes (Alberto, Waugh, & 

Fredrick, 2010; Johnson et al., 1996; Parker & 

Schuster, 2002; Tekin-Iftar, 2003; Waugh et 

al., 2009) and one study has directly compared 

the effects of traditional simultaneous 

prompting and simultaneous prompting with 

error correction during daily/assessment 

probes (Johnson et al., 1996). Johnson et al. 

conducted a direct comparison of simultaneous 

prompting with error correction during 

daily probes and simultaneous prompting 

without error correction during daily/assessment 

probes in teaching science vocabulary 

words to five high school students with learn- 

ing disabilities and mild intellectual disabilities. 

Both conditions were effective for teaching 

science vocabulary. Compared to sessions 

in which no error correction was provided 

fewer sessions to criterion were required and 

fewer errors were emitted when error correction 

was provided during daily/assessment 

probes. Social validity indicated that students 

preferred when they were provided with error 

correction during daily/assessment probes. 

Four other studies have included error correction 

during daily/assessment probes but have 

not directly examined the impact of error correction. 

While simultaneous prompting with 

error correction may be more efficient in the 

acquisition of targeted stimuli, this procedural 

modification has been examined only with a 

limited number of participants and in a limited 

disability area. Further research should 

be conducted with individuals with various 

disabilities to determine if daily/assessment 

probes with error correction are more efficient 

than without error correction. 

The fourth recommendation for future research 

is to provide intermittent probes versus 

daily/assessment probes (Birkan, 2005; 

Dogan & Tekin-Iftar, 2002; Fickel et al., 1998; 

Gibson & Schuster, 1992; Griffen et al., 1998; 

Johnson et al., 1996; Maciag et al., 2000; 

Parker & Schuster; 2002; Tekin-Iftar et al., 

2008; Wolery et al., 1993). Intermittent probes 

are probes conducted prior to every second or 

third session of instruction instead of prior to 

each session. By conducting probes prior to 

every second or third session of instruction 

students are allowed fewer opportunities to 

respond independently to the stimulus and 

possibly make fewer errors. To date two studies 

have employed intermittent probes 

(Reichow & Wolery, 2009; Tekin-Iftar et al., 

2008). Tekin-Iftar et al. employed intermittent 

probes to examine the effects of simultaneous 

prompting in teaching object identification to 

two students with intellectual disabilities (level 

of functioning not reported). Researchers 

conducted probes prior to every third instructional 

session. Tekin-Iftar et al. report that 

employing intermittent probes did not reduce 

the number of errors emitted during probe 

sessions, although a direct comparison was 

not made. Without a direct comparison, it is 

unclear if these students would have produced 

lower error rates with intermittent versus daily 


probes. Reichow and Wolery recently conducted 

a direct comparison of daily versus 

intermittent probes during simultaneous 

prompting. The researchers taught four preschool 

students to read vehicle transportation 

words (i.e., car, bus, truck, etc). The students 

included one student with speech language 

impairment, one student who was an English 

Language Learner, one typically developing 

student, and one student identified as at-risk 

for school failure. Reichow and Wolery provided 

no error correction during probe sessions. 

All four students reached mastery during 

intermittent probe conditions with three 

of the four students reaching mastery during 

the daily probe conditions. Efficiency data 

were mixed with the one student who did not 

reach mastery in the daily probe condition, 

one student who reached mastery in fewer 

sessions during intermittent probes, one student 

who required the same number of sessions 

across both conditions and one student 

who required fewer sessions during daily 

probe conditions. While the researchers did 

not report direct percentages of error rates 

across probe and instructional sessions, they 

did provide initial data to support intermittent 

probes. During the first eight sessions 

during daily probes 50% of student trials resulted 

in errors versus the first two sessions of 

the intermittent probe condition which resulted 

in errors in 28.1% of student trials. 

However, due to the limited number of participants 

and the lack of details concerning 

characteristics of the participants (i.e., IQ 

scores, etc), further research should be conducted 

to determine if intermittent probes 

produce more efficient student learning when 

employing simultaneous prompting. 

Simultaneous prompting is an errorless 

learning strategy with a research base to support 

its use to teach a variety of skills across 

various groups of ability levels. Despite the 

research base to support its usage, continued 

research is needed to further examine alternatives 

to increase its efficiency and examine 

its usage with students with profound intellectual 

disabilities. 

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Initial Acceptance: 25 September 2010 





Teaching Money Computation Skills to High School Students 

with Mild Intellectual Disabilities via the TouchMath© 

Program: A Multi-Sensory Approach 

Hugh E. Waters and Richard T. Boon 

The University of Georgia 

Abstract: This study investigated the effects of the TouchMath© program (Bullock, Pierce, & McClellan, 1989) 

to teach students with mild intellectual disabilities to subtract 3-digit money computational problems with 

regrouping. Three students with mild intellectual disabilities in high school received instruction in a special 

education mathematics self-contained classroom. A multiple-probe across participants design (Alberto & 

Troutman, 2009) was used to evaluate the effectiveness of the TouchMath© program using the “touch-points” 

strategy to facilitate the student’s mathematics performance. The results revealed the TouchMath© program 

improved all three of the students’ ability to subtract 3-digit mathematics operations using money applications; 

however, maintenance results were mixed, as the students exhibited difficulty with maintaining the necessary 

skills once the intervention was withdrawn. Limitations, recommendations for classroom teachers and future 

research directions are presented. 

With the growing trend of providing proven, 

scientifically-validated practices in the classroom, 

teaching students’ mathematics instruction 

at the secondary-level, especially those 

with intellectual disabilities, can be a challenging 

and often overwhelming task. With recent 

mandates from federal policies like, the No 

Child Left Behind Act of 2001 (NCLB, 2001) 

and the Individuals with Disabilities Education 

Improvement Act (IDEA, 2004), schools 

are now mandated that all students have equal 

access to the general education academic curriculum 

and national and state standards (National 

Council of Teachers of Mathematics, 

2000; U. S. Department of Education, 2007). 

Thus, an increasing number of students with 

mild intellectual disabilities are now receiving 

instruction and being placed into general education 

classrooms where they are not only 

expected to succeed in the classroom, but also 

on high-stakes assessments such as the Georgia 

End of Course Test (EOCT) and the Geor- 


be addressed to Richard T. Boon, The University of 

Georgia, Department of Communication Sciences 

& Special Education, 557 Aderhold Hall, Athens, 

GA 30602-7153. E-mail: rboon@uga.edu 

gia High School Graduation Test (GHSGT). 

These new classroom rigors include moving 

away from functional academics and replacing 

them with more traditional academic skills. 

While this is a positive move toward allowing 

all students regardless of their disability the 

opportunity to graduate with a high school 

diploma and prepare them to attend further 

educational and occupational prospects, this 

does not allow students with mild intellectual 

disabilities the chance to learn the essential 

life skills (e.g., money computation) that are 

crucial for their survival in the community as 

independent members of society. 

Students with mild intellectual disabilities 

often exhibit deficits in basic mathematics instruction, 

especially in the area of money computation 

(e.g., purchasing skills), which has 

been well documented (Browder & Grasso, 

1999; Browder, Spooner, Ahlgrim-Delzell, 

Harris, & Wakeman, 2008; Butler, Miller, Kithung, 

& Pierce, 2001; Jitendra & Xin, 1997; 

Kroesbergen & Van Luit, 2003; Mastropieri, 

Bakken, & Scruggs, 1991; Miller, Butler, & 

Lee, 1998; Swanson & Jerman, 2006, Xin & 

Jitendra, 1999). In 2000, the National Council 

of Teachers of Mathematics (NCTM, 2000) stated 

in a comprehensive report five main components 

of mathematics instruction standards 


that all students are required to achieve, one 

of which focuses explicitly on the ability to 

measure attributes of objects such as time and 

money applications, which is commonly problematic 

for a large number of students with 

mild intellectual disabilities. Fortunately, a 

growing research-base of new and innovative 

interventions, like the TouchMath© program, 

has been developing in the literature and has 

shown some promising results to be effective 

in increasing students with and without disabilities 

mathematics performance. 

The TouchMath© program (Bullock et al., 

1989), a multi-sensory “dot-notation” system, 

previously employed by Kramer and Krug 

(1973) was used to teach mathematics skills to 

students with disabilities. The TouchMath© 

program uses “dot-notations” often referred 

to as “touch-points” either with one dot, for 

numbers 1 to 5, or a dot-notation with a circle 

around them, to indicate two or double touchpoints 

to assist students with and without disabilities 

with basic counting and computation 

skills. The TouchMath© program using the 

touch-points strategy, has been shown in previous 

research to be effective for students with 

mathematical disabilities in basic mathematics 

instruction (e.g., adding single, double-digit 

mathematics problems with and without regrouping) 

at the elementary level for students 

with specific learning disabilities and moderate 

intellectual disabilities (Scott, 1993; Simon 

& Hanrahan, 2004), autism spectrum disorders 

(Cihak & Foust, 2008), and more recently, 

at the middle school level including 

students with autism spectrum disorders and 

moderate intellectual disabilities (Fletcher, 

Boon, & Cihak, 2010). However, no studies to 

date have attempted to explore the effectiveness 

of the TouchMath© program, using 

money computation skills, with students with 

mild intellectual disabilities in a high school 

classroom setting. 

Therefore, the purpose of this study was to 

examine the effects of the TouchMath© program 

on the acquisition of subtracting 3-digit 

money computational problems with regrouping 

for three students with mild intellectual 

disabilities in a high school special education 

self-contained classroom. Prior research on 

the efficacy of the TouchMath© program has 

focused only on students with specific learning 

disabilities, moderate intellectual disabilities, 

and autism spectrum disorders at the elementary 

and middle school grade levels, and has 

not addressed the benefits of such a strategy 

for students with mild intellectual disabilities 

at the high school level. Although previous 

studies have investigated the use of the touchpoints 

strategy to teach basic addition using 

single and double-digit mathematics problems; 

no studies have explored the benefits of 

the touch-points strategy on money applications. 

Research Questions 

Thus, the two main research questions posed 

were: (a) What are the effects of the Touch- 

Math© program on the mathematics performance 

of solving subtraction 3-digit money 

computational problems with regrouping for 

students with mild intellectual disabilities at 

the high school grade level? And (b) What are 

the students, teachers, and parents perceptions 

of the TouchMath© program to improving 


mathematics performance? 

Method 

Participants 

Three students with mild intellectual disabilities, 

two of which had a dual-diagnosis of autism 

as well, from the same special education 

high school self-contained classroom participated 

in the study. The students’ ages ranged 

from 14 to 16 years-old, with a mean of 14.75 

and intellectual quotients (IQ) scores varied 

from 61 to 64, with a mean of 63. All of the 

students were classified with a disability based 

on the county, state, and federal criteria, 

which indicated having below average intellectual 

ability, deficits in adaptive behavior 

scores, which both negatively affected their 

academic performance. Demographic and educational 

information is depicted in Table 1. 

All of the students received special education 

services since entering high school where they 

were in a self-contained special education 

classroom setting for three block periods a day 

and participated in only one general education 

course elective. The students were taught 

all of their academic subjects including mathematics 

instruction in the same self-contained 

Touchmath© and Money Skills / 545

TABLE 1 

Student Demographic Information 

classroom from the same teacher for all three 

block periods. Finally, all three students 

scored well-below grade level in mathematics, 

based on the Woodcock-McGrew-Werder Mini-Battery 

of Achievement (MBA; 1994) test results. 

Students were selected based on their gradelevel, 

special education classification and 

mathematical ability. All of the students were 

unable to properly and accurately subtract numerical 

or monetary values without a calculator. 

The classroom instructor had previously 

taught the students to use calculators to determine 

purchase price in order to facilitate accuracy 

and fluency in the classroom and community-based 

setting. 

Trent. Trent was a ninth grader and was 

15 years, 10 months old at the outset of the 

study. Trent had received special education 

services for ten years for a mild intellectual 

disability and autism. Placement was supported 

with a Full Scale IQ score of 64 from 

the WISC-III (Wechsler, 1991) and the ABAS-II 

(Harrison & Oakland, 2003), with a 72 conceptual 

score; 75 social score; 91 practical 

score, and a general adaptive composite score 

of 83. Trent’s IEP (Individualized Educational 

Plan) goals covered several academic and life 

skill areas, as he had a mathematics academic 

goal of becoming more proficient in basic 

mathematics skills. His teacher said that he is 

Trent Michael Alex 

Chronological Age 15–0 14–11 16–1 

Grade 9 th 

9 th 

10 th 

Sex Male Male Male 

IQ* 64 61 64 

Adaptive Behavior 

Score Composite** 

83 54 71 

Math Composite*** 

(Grade Equivalent) 

5.1 4.2 2.8 

Primary Eligibility Mild Intellectual Mild Intellectual 

Mild Intellectual 

Disabilities/Autism Disabilities Disabilities/Asperger’s Syndrome 

* WISC-III COG Wechsler Intelligence Scale for Children (3 rd ed.) by D. Wechsler. Copyright 1991 by Psychological 

Corp, San Antonio, TX. 

** ABAS-II Adaptive Behavior Assessment System (2 nd ed.) by P. Harrison & T. Oakland. Copyright 2003 by 

Psychological Corp, San Antonio, TX. 

*** MBA Mini-Battery of Achievement by R. Woodcock, K. McGrew, & J. Werder. Copyright 1994 by Riverside 

Publishing, Chicago, IL. 

consistently willing to work hard to complete 

his assignments and complies with directions 

from the classroom teacher and paraprofessionals. 

Michael. Michael entered his first year of 

high school as a ninth grader during the study 

at 14 years, 11 months old and turned 15 

within the study’s span. He struggles with all 

academic subjects as evident by his instructors’ 

observations during the daily education 

sessions and receives one to four instructions 

daily for his academics. Michael has received 

special education services since his entrance 

into the school system in self-contained classrooms 

for students with mild intellectual disabilities. 

According to the WISC-III (Wechsler, 

1991) Michael had a Full Scale IQ score of 61, 

with a 53 conceptual score; 70 social score; 53 

practical score, and a general adaptive composite 

score of 54. The results from the 

ABAS-II (Harrison & Oakland, 2003) instrument 

determined Michael lacked adaptive behavior 

skills and met criterion for classification 

for a mild intellectual disability. 

Increasing basic mathematics skills was one of 

his academic (IEP) goals. His teacher stated 

that he is cooperative during instruction and 

puts forth much effort towards his classroom 

work. 

5<strong>46</strong> / Education and Training in Autism and Developmental Disabilities-December 2011

Alex. Alex was a tenth grade student being 

served in the same self-contained special education 

classroom as Trent and Michael. He 

was 16 years, 1 month at the beginning of the 

study and has received special education services 

for thirteen years with an eligibility of a 

mild intellectual disability and Asperger’s Syndrome. 

Alex’s placement was determined by a 

WISC-III (Wechsler, 1991) Full Scale IQ score 

of 64 and on the ABAS-II (Harrison & Oakland, 

2003) he had a 70 conceptual score, 77 

social score, 75 practical score, and a general 

adaptive composite score of 71. He had two 

money mathematics skills goals on his (IEP), 

which included adding and subtracting two 

and three-digit mathematics problems without 

a calculator and to write checks, make deposits, 

and balance a checkbook. He had demonstrated 

a lack of restraint and cooperation 

with teachers in the past, but has not shown 

these behaviors since entering high school, as 

his teachers have stated that he has been very 

obliging and receptive to instruction. 

Setting and Arrangements 

The public high school consisted of approximately 

1,500 students, with grades nine 

through twelfth, and was located in a southeastern 

region of the United States. The 

county school system population was considered 

low-income, with a low socio-economic 

status (SES) with manufacturing as the major 

employer in the area. Data collection, training, 

and intervention procedures were conducted 

in that same self-contained special education 

mathematics classroom. The 

classroom dimensions were 3 m 6.5 m and 

the room consisted of 12 student desks and 

two teacher desks. The teacher desks faced the 

student desks located to the side of the student 

desks and immediately in front of one 

teacher desk, was a podium. The students 

were instructed at a distance of 1 meter, facing 

the teacher, and two student desks were directly 

in front of the teacher. The TouchMath© 

poster displaying the touch-points for the 

numbers 1 to 9 was placed on the wall between 

the student and teacher desks as a reminder 

and visual cue during the training and intervention 

phases. No other students were in the 

classroom during the block period and all 

phases of the study. 

Materials 

The TouchMath© program (Bullock et al., 

1989) was the intervention utilized during the 

intervention phase to teach students to subtract 

3-digit money computational problems 

with regrouping. The researcher and classroom 

teacher collected the data for all phases 

of the study. The researcher and classroom 

teacher were trained to use the TouchMath© 

program via the teacher training DVD and 

instructional materials, that were sent by the 

publisher. The TouchMath© system is based on 

the placement of dots (e.g., dot-notations) on 

numbers (1 to 9). For example, the student 

would be asked to state the number aloud 

then the student was expected to count aloud 

as he made contact on the touch-points; however, 

for subtraction problems, the students 

must be able to count backwards from 20. 

When regrouping, the students were expected 

to be able to mark through the number borrowed 

from and then place a 1 next to the 

previous number and subtract the numbers. 

TouchMath© made a point of ensuring the 

number borrowed was the same size as the 

other digits. Worksheets were provided by the 

publisher that the researcher and classroom 

teacher utilized to introduce, instruct, practice, 

and assess all of the students. The worksheets 

were designed based on the specific 

steps previously mentioned above and consisted 

of examples on how to count forward 

and add with and without regrouping. A 

poster with the touch-points for each of the 

numbers 1 to 9 was posted on the wall in the 

classroom. In addition, mini-posters were provided 

to the students and laminated on their 

desktop as a reference, while learning the 

touch-points strategy (see Figure 1 for an example 

of the mini-posters). 

Assessment Materials 

Researcher developed worksheets with the 

same font and size as the publisher’s were 

employed as the probe during the intervention 

and maintenance phases (see Figure 2 for 

an example of the worksheets). The measures 

served as permanent products to collect data. 

These worksheets consisted of 10 subtraction 

3-digit money computational problems with 

regrouping. All probes consisted of different 


Figure 1. Example of the mini-poster that was provided 

to the students and laminated on 

their desktop as a reference, while learning 

the touch-points strategy. Touch- 

Math® TouchPoints. By permission of J. 

Bullock and Innovative Learning Concepts 

Inc., Colorado Springs, CO. All 

rights reserved. 

mathematics problems so the students would 

not be able to memorize the answers. 

Procedure 

General procedure. All instruction, training 

sessions, observations and probes occurred 

during the regular school day during the first 

block period from 8:30–10:00 a.m. There 

were five sessions per week for ten weeks and 

each student received instruction in the selfcontained 

special education classroom. The 

training and intervention sessions lasted in 

duration from 10 to 15 minutes on the Touch- 

Math© procedures to subtract numbers with 

regrouping and probes were designed to take 

no longer than 10 to 15 minutes. Maintenance 

sessions extended long enough to complete 

the probe (10 to 15 minutes). These sessions 

were held concurrently with the last three intervention 

sessions of subsequent student’s 

sessions. The intervention was introduced to 

subsequent students based on the student 

reaching criterion, which was established as 

the students’ average score increase to be 

above 40% of the average baseline score for 

80% of the sessions. Baseline stability followed 

the 80/30 guideline to establish a trend before 

the intervention was implemented. 

Intervention began with identifying each of 

the numbers (1 to 9) and where the touchpoints 

were located on the numbers. Next, the 

students were taught how to count the touchpoints 

in a certain order, as described in the 

publisher’s manual. According to the Touch- 

Math© procedures, the students are to count 

aloud during instruction, while learning the 

touch-points on each of the numbers. In addition, 

counting backwards was also taught 

and practiced while utilizing the touch-points 

strategy. Once these skills had been mastered, 

Figure 2. Example of the subtraction 3-digit money computational problems with regrouping worksheet used 

during the intervention and maintenance phases. 


the students could move on to actual subtraction 

problems with regrouping. With the subtraction 

problems, the students were taught 

to: (a) state the problem aloud, (b) state the 

first number aloud, (c) count backwards using 

the touch-points on the second number (if 

the student reaches 0 before finishing counting 

the bottom number, then regroup), (d) 

mark-out the number borrowed from, write 

lowered number above on the line, (e) place a 

1 next to the number on the right making 

sure it is the same size, (f) count backwards 

using the touch-points on the second number, 

(g) place the difference in the answer blank, 

and finally (h) repeat the problem aloud with 

the answer. 

Experimental Procedures 

Baseline. Before baseline probes were delivered, 

prerequisite skills were taught until 

100% of the students’ mastery was achieved. 

The student had to be able to learn to count 

backwards, place the touch-points on the 

numbers 1 to 9, and count those touch-points 

in a proper pattern. The first student was administered 

a minimum of three probes to establish 

trend stability, which consisted of 10 

subtraction 3-digit money computational 

problems with regrouping without the use of 

the touch-points strategy. Once stability was 

established, the touch-points intervention began. 

Subsequent students were probed concurrently 

with the last three intervention sessions 

of the previous student. Verbal cues and 

praise were offered for correct and/or incorrect 

behaviors. 

Intervention. First, the TouchMath© strategy 

was introduced to each of the students, which 

consisted of the instructor modeling how to 

count the “dot-notations” on each of the numbers 

1 to 9 to solve a subtraction problem. The 

students were then given an opportunity to 

practice one problem along with the special 

education teacher using the touch-points 

strategy. Second, the teacher demonstrated 

the proper steps and verbal cues to solve a 

subtraction problem. Afterwards, the student 

was asked to carry out the task independently 

as performed by the teacher. During the problem-solving 

procedures, the instructor provided 

positive verbal corrective feedback to 

redirect any operational errors performed by 

the student. The student then practiced the 

steps a minimum of five times. Third, the 

instructor modeled the proper steps of the 

TouchMath© program and verbal cues to solve 

a subtraction problem. The student was then 

asked to perform the task as modeled. During 

the problem-solving procedures, the instructor 

provided positive verbal corrective feedback 

to redirect any operational errors performed 

by the student for the first two 

practice problems and then was asked to solve 

a minimum of five problems independently. 

And finally, in the fourth step, the instructor 

modeled the proper steps and verbal cues to 

solve a subtraction problem. The student was 

then expected to solve 10 3-digit money subtraction 

computational problems with regrouping 

using the touch-points intervention 

independently. 

Maintenance. During the maintenance 

phase, the students were provided no instruction 

or visual cues from the TouchMath© materials 

to perform the operational steps to subtract 

a 3-digit money computational problem 

with regrouping. After the student had 

reached criteria for three consecutive days, a 

minimum of two sessions without instruction 

lapsed before a maintenance probe was given. 

These probes consisted of 10 3-digit subtraction 

problems with regrouping following the 

same format as those mentioned in the baseline 

and intervention sessions. Concurrent 

with subsequent students being presented 

their last two intervention probes, each previous 

student was given a minimum of one 

maintenance probe every five days until the 

conclusion of the study with the last student. 

These probes indicated whether the touchpoint 

system could be maintained for other 

problem sets. Generalization was monitored 

throughout the study with subtraction problems 

at the end of each probe. These problems 

also accompanied maintenance sessions. 

These three problems, consisting of the same 

skills addressed during the intervention phase 

were presented to the students from different 

stimuli, workbooks and instructor made worksheets. 

This measure determined if the students 

could generalize TouchMath© techniques 

and procedures to the same math 

behaviors from different stimuli. 


Experimental Design 

This study employed a multiple-probe across 

participants design (Alberto & Troutman, 

2009) to examine the effectiveness of the 

touch-points strategy to teach students with 

mild intellectual disabilities to subtract 3-digit 

money computational problems with regrouping. 

Reliability 

Inter-observer agreement. Inter-observer reliability 

data was collected across all conditions 

using a point-by-point agreement formula. 

The special education teacher’s paraprofessional 

was a second observer and was asked to 

independently score the probes and evaluate 

the procedural fidelity measures. The paraprofessional 

was familiar with the training materials 

in conjunction with the special education 

teacher and researcher and was present 

during a minimum of 20% of the sessions. 

Inter-observer agreement was calculated 

based on the point-by-point reliability and calculated 

by counting the number of agreements 

between the special education teacher 

and the paraprofessional and dividing this 

number by the total number of agreements 

and disagreements and then multiplied by 

100% (Cooper, Heron, & Heward, 2007). 

Procedural reliability. Procedural reliability 

was assessed by the special education classroom 

teacher and paraprofessional in the selfcontained 

special education classroom with a 

written procedural protocol checklist and was 

set for a minimum of 90%. Procedural reliability 

data was collected during the same sessions 

as the inter-observer agreement data were 

taken by both teachers on a minimum of 20% 

of the sessions. A point-by-point agreement 

formula (Cooper et al., 2007) was again used 

and was calculated by counting the number of 

times the special education teacher and/or 

paraprofessional agreed that a behavior either 

occurred or did not occur during the sessions. 

This number was then divided by the total 

number of agreements and disagreements 

and multiplied by 100%. Finally, for each of 

the three students their percentage agreement 

was recorded for each behavior on the 

procedural checklist. 


A 10-item survey was administered to the students, 

teachers, and parents to determine the 

social validity (Wolf, 1978) of the TouchMath© 

program using the touch-points strategy in 

mathematics instruction. The items in the social 

validity survey were rated on a 5-point 

Likert scale ranging from 1 (strongly disagree) 

to 5 (strongly agree). The social validity 

data was collected upon conclusion of the 

study and the survey was completed by the 

students and teachers (e.g., special education 

teacher and paraprofessional) in the high 

school classroom, while another version of the 

survey for the parents was mailed to their 

residence to compete and return back to the 

special education teacher. The social validity 

survey consisted of the following items: (1) 

TouchMath© is a beneficial strategy to help me 

with my subtraction problems; (2) Subtraction 

is an important skill to have for real-life situations; 

(3) Subtraction is an important skill to 

learn before leaving high school; (4) I would 

recommend this strategy to someone else; (5) 

I understood the TouchMath© strategy and 

what was expected of me; (6) TouchMath© was 

easy to use; (7) TouchMath© was an effective 

strategy to subtract money values; (8) The 

target skills are necessary for grade level requirements; 

(9) The target skills are necessary 

for classroom requirements; and (10) The target 

skills are necessary for community-life requirements. 

Results 

Reliability 

Inter-observer and procedural reliability was 

collected during 7 (20%) of the 35 sessions. 

Of the 49 probes graded, two were found to 

have different scores between the scorers, the 

special education teacher and paraprofessional. 

On the two probes, each had one response 

in conflict between the scorers due to 

disagreement over identifying a particular 

digit in the response. The mean percent of 

agreements for each student was as follows: 

Trent, 100%; Michael, 93.3%; and Alex, 95%. 

The mean procedural reliability was 100% for 

all researcher behaviors across all experimental 

conditions. Of the observed sessions, 56% 


Figure 3. Percentage of subtraction 3-digit money computational problems with regrouping using the touchpoints 

strategy answered correctly by Trent, Michael, and Alex. 

were conducted during the training phase, 

while 44% were completed in the probe sessions. 

The inter-observer agreement was 

100%. 

Effectiveness of the Intervention 

Figure 3 illustrates the percentage of correct 

responses the students received on the subtraction 

problems with regrouping using 

money computations during the baseline, intervention, 

and maintenance phases. 

Trent. Trent’s baseline mean score was 

6.66% across all 3 sessions, which demonstrates 

a stable trend in the data. A substantial 

immediate positive score increase was observed 

when the intervention probes were issued, 

which showed the touch-points strategy 

was an effective intervention for acquiring 

subtraction problems with regrouping using 

money values. The average score across all 


intervention sessions was 75.55% demonstrating 

a continual, stable, and maintained acquisition 

of the target skills set needed to calculate 

the correct answers, which was a 68.88% 

increase from the baseline phase. Trent 

reached criteria within the preset number of 

sessions, which was established when 80% of 

the probe scores were 40% higher than the 

baseline scores. There was no data point overlap 

observed from the baseline to the intervention 

phases signifying an immediate positive 

increase that was maintained throughout 

the intervention. The trend from the intervention 

through the maintenance phase was positive 

and the data points within the trend were 

reasonably stable. Trent’s mean score during 

intervention was 75.55% and increased to 

83% during the maintenance phase, indicating 

a continual improvement in skill level with 

additional opportunities to utilize the strategy. 

There was an 83% overlap between the intervention 

and maintenance phase, though 

Trent was able to increase his mean scores 

during maintenance. This indicates that Trent 

was able to prolong his ability to solve the 

subtraction problems with regrouping and, 

based on his scores during the maintenance 

phase, improve his scores over time. The intervention 

strategy was successful initially and 

in sustaining Trent’s ability to solve subtraction 

problems with regrouping. 

Michael. Michael’s mean score during the 

baseline phase was 5% indicating that he had 

established a flat and stable baseline measure. 

However, Michael’s mean score during the 

intervention phase increased to 88%, which 

was an 83% increase from the baseline phase. 

This abrupt level change and 0% overlapping 

data points from baseline to intervention substantiated 

that the touch-points intervention 

strategy was effective for Michael in acquiring 

the subtraction skills with regrouping. Michael 

met criteria after only four sessions. 

There was a level trend after the abrupt level 

change from the baseline to the intervention 

phase indicating a consistent calculation skill 

aptitude. The mean maintenance score for 

Michael was 45% with a median score of 35%. 

There was 100% data point overlap from intervention 

to the maintenance phase. A continual 

decreasing trend occurred during the 

maintenance phase ending in a 20% score on 

the final probe session. Michael did not revert 

to his previous baseline scores, but further 

probes would be needed to determine sustained 

skill retention. The intervention strategy 

was confirmed to be effective over a relatively 

short period of time, as further strategy 

instruction may prove beneficial for Michael’s 

continued success. 

Alex. Alex’s baseline phase extended for 9 

sessions, while maintaining a flat and stable 

trend with a mean score of 2.22%. However, 

during the intervention phase, Alex demonstrated 

a positive level change with the first 

intervention probe session. The second probe 

score increased significantly from 20% to 

70%, then faltering back to 30% causing an 

unstable level change with the first four sessions. 

The fifth session established the start of 

an observable stable level change. Due to beginning 

unstable scores, Alex required the 

greatest time to meet criteria. Criteria were 

met after ten sessions with an average score of 

76% and a 90% median score, which was a 

73.77% increase from the baseline measures. 

The touch-points intervention strategy was effective 

for Alex to subtract 3-digit money problems 

with regrouping. Between the baseline 

and intervention phases there was 0% data 

point overlap, demonstrating a positive level 

change though five additional sessions were 

required until stability and criteria were met. 

There was 100% overlap from intervention to 

maintenance phase. The mean maintenance 

score for Michael was 100%. From the beginning 

of the baseline to the end of the maintenance 

phase, there was a steady increasing 

data score trend and overall the touch-points 

intervention strategy proved to be effective for 

Alex. 

Social Validity Survey 

In general, the students, teachers, and parents 

indicated in the social validity survey that the 

TouchMath© program using the touch-points 

intervention was beneficial. The students 

stated that the strategy was easy to use and 

understand and improved their ability to solve 

subtraction problems with regrouping involving 

money computations. The teachers reported 

they appreciated the students’ abilities 

to quickly acquire and successfully follow the 

number of steps needed to solve the subtrac- 


tion problems with regrouping. All involved 

agreed that others would benefit from exposure 

to the TouchMath© program and that it 

was easy to learn and use in the classroom. 

The ease of use was also evaluated and the 

students stated that once they understood the 

steps and sequence (e.g., counting the dotnotations 

on the numbers, etc.), the touchpoints 

strategy was a fun, and an easy way to 

learn how to solve subtraction problems. In 

addition, all of the groups indicated that they 

agreed or strongly agreed that the skills 

gained were necessary for the students to have 

before leaving high school to prepare them 

for real-life situations. All involved agreed that 

the skill was grade appropriate and necessary 

for classroom requirements. The students reported 

that they were neutral when considering 

the skills crucial for grade-level requirements; 

however, they all agreed that the 

touch-points strategy was helpful to learning 

mathematics and would recommend the strategy 

to their peers. Finally, all of the respondents 

agreed that money computation skills 

are an important and critical skill essential for 

independent living in the community. 


The purpose of this study was to examine the 

effects of the TouchMath© program on the 

acquisition of subtracting 3-digit money computational 

problems with regrouping for 

three students with mild intellectual disabilities 

in a high school special education selfcontained 

classroom. The findings indicated 

that the use of the touch-point strategy was 

effective for all three students in acquiring 

3-digit money computational problems with 

regrouping. Findings from this study not only 

add to the previous literature base on the 

TouchMath© program, but also provide new 

insights into applications to teach money computational 

skills to students at the high school 

level. As previous studies have suggested, the 

touch-points strategy procedures have been 

shown to be effective to increase the mathematics 

performance for elementary-age students 

with specific learning disabilities, moderate 

intellectual disabilities, and autism spectrum 

disorders (Cihak & Foust, 2008; Scott, 1993; 

Simon & Hanrahan, 2004), and at the middle 

school level including students with autism 

spectrum disorders and moderate intellectual 

disabilities (Fletcher et al.). Thus far, no research 

has been conducted on the use of the 

TouchMath© program with money values, including 


at the high school level. 

During the baseline phase, all three of the 

students demonstrated an inability to solve 

3-digit subtraction problems with regrouping. 

There was an abrupt level change for all three 

students with no overlapping data points indicating 

an increase in performance and continued 

level of competence. An ascending trend 

was observed for the students during the intervention 

phase exhibiting marked performance 

when the intervention was employed. 

These observations provide evidence that the 

intervention was effective in teaching the students 

via the touch-points strategy to subtract 

3-digit money values with regrouping. During 

the intervention probes phase, two of the 

three students, Trent and Michael, showed 

dramatic increases in their mathematics performance 

and reached criterion in the allotted 

amount of time, five sessions. However, 

the third student, Alex, required a total of 10 

sessions to reach criterion. During the second 

session, Alex scored well on the second probe 

but only scored 30% on the following probe. 

This low score caused Alex not to reach criterion 

in the allotted amount of time. On subsequent 

probe scores, Alex averaged 91.4% 

over the last seven probes. If the one probe 

were erased then Alex would have reached 

criterion in five sessions. Finally, during the 

maintenance phase, all three of the students’ 

mathematics performance showed great variability. 

For example, Trent sustained an ascending 

trend throughout the study. After six 

sessions, Trent retained the necessary target 

skill set to solve the subtraction problems with 

regrouping. Michael demonstrated a descending 

trend across four of the maintenance sessions 

with a median score of 35%. After the 

minimum two-day period, Alex completed 

one maintenance session with a score of 100% 

before the conclusion of the study. Clearly, 

further research is needed to determine the 

ability for students with mild intellectual disabilities 

to sustain the skills necessary to subtract 

3-digit money values with regrouping. To 


help continue maximum skill proficiency over 

time, refresher sessions to review the steps and 

procedures of the touch-points method would 

be required and additional maintenance 

probes may need to be conducted. 

Limitations of the Study 

The following limitations need to be considered 

to interpret the findings of this study. 

First, the number of students, only three students, 

makes it difficult to support arguments 

for generalization of the touch-points strategy 

to all students at the high school level. Also, 

the sample only included students with mild 

intellectual disabilities and/or autism spectrum 

disorders and does not represent the 

characteristics of typical school-age populations. 

So, the findings cannot be generalized 

to other disability categories, age, grade, race, 

and/or other genders. For instance, all three 

of the students were male in ninth and tenth 

grade levels. Second, the instructional procedures 

were conducted on a one-to-one basis 

and would need to be modified for group 

instruction. Third, during the intervention 

and maintenance phases, the students were 

provided the “dot-notations” on the numbers 

and a line to write the lowered number for 

regrouping on the worksheets; however, this 

limits their ability to fully apply and generalize 

the strategy to novel situations. Also, the procedures 

included only one specific target skill 

set (e.g., 3-digit subtraction problems with regrouping 

with money values) limiting the ability 

to generalize these findings to other mathematical 

skills. Fourth, due to student 

capability levels, addition and subtraction 

without regrouping were not considered nor 

were higher skill level problems. Maintenance 

data was inconsistent and only one probe was 

gathered from the last student, Alex, due to a 

holiday and conclusion of the project, as further 

investigations are obviously warranted examining 

maintenance capacities of the touchpoints 

strategy. 

Implications 

Based on the results of this study and previous 

findings, there are a number of implications 

for classroom teachers, both general and spe- 

cial education to consider. The TouchMath© 

program is an easy, simple, and teacherfriendly 

method to employ as a component of 

the instructional lesson in a self-contained, 

remedial and/or inclusive classroom setting. 

The results support a promising and growing 

research-base for the use of the TouchMath© 

strategy to help students not only with mild 

intellectual disabilities and/or autism, but 

other disability categories, as well as students 

without disabilities, that exhibit difficulties in 

basic mathematics instruction. Also, the program 

allows teachers to adapt their instruction, 

at a developmentally appropriate level, 

to meet the student’s individual needs and 

learning styles. More recently, TouchMath© 

has developed a variety of new products to 

teach such concepts as money applications, 

coins and counting, mathematics manipulatives 

(e.g., math fans), and a software program 

known as TouchMath Tutor©, that can easily be 

modified for students to teach functional skills 

in a variety of classroom and communitybased 

settings. 

Future Research 

In the current research literature base, no 

published, empirical studies have examined 

the effectiveness of the TouchMath© strategy 

to teach students with mild intellectual disabilities 

to subtract money values, in fact, even 

more noteworthy, no studies have explored 

this technique with high school populations, 

as much of the limited research-base focuses 

almost exclusively on elementary-age populations. 

Future research should address the use 

of the touch-points method with not only addition 

and subtraction problems, but with 

multiplication and division problems, with two 

and three-digits, with and without regrouping, 

for students with different types of disabilities 

in the secondary grade levels. Also, future 

studies should employ experimental group 

designs to determine if the strategy can be 

implemented on a larger scale to reach more 

than one student at a time. Further consideration 

towards fading the intervention and providing 

students additional training time to 

memorize and independently mark the touchpoints 

properly on the numbers before solving 

the problem is necessary to determine the 

efficacy of the strategy. Finally, the probe 


problems employed in this study presented 

one instance of regrouping within the problem; 

therefore, generalization to more difficult 

skills such as multiple regrouping opportunities 

or regrouping with zero in the 

problem should be examined. 

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225. 



Final Acceptance: 23 February 2011 




Effects of Computer-Based Practice on the Acquisition and 

Maintenance of Basic Academic Skills for Children with 

Moderate to Intensive Educational Needs 

Julie M. Everhart 

Westerville City Schools 

Sheila R. Alber-Morgan 

The Ohio State University 

Ju Hee Park 

Wheelock College 

Abstract: This study investigated the effects of computer-based practice on the acquisition and maintenance of 

basic academic skills for two children with moderate to intensive disabilities. The special education teacher 

created individualized computer games that enabled the participants to independently practice academic skills 

that corresponded with their IEP objectives (e.g., letter-sound correspondence, word identification, number 

identification). The computer games provided discrete learning trials with immediate feedback for each response. 

A multiple baseline across skills design demonstrated that computer-based practice resulted in the successful 

acquisition of basic academic skills for both participants. Additionally, both participants maintained at least 

two mastered skills for two to four weeks. 

In this dynamic age of technology, the use of 

computers permeates many facets of our daily 

living, learning, working, and entertainment. 

The pervasiveness of rapidly changing technology 

and the corresponding need for computer 

literacy has required schools to embed 

technology into academic instruction in order 

to prepare students to live and work in a high 

tech society. In fact, the National Educational 

Technology Plan (2004) developed by the 

U.S. Department of Education as part of the 

No Child Left Behind Act recommends that 

states and districts “encourage ubiquitous access 

to computers and connectivity for each 

student” (p. 43). 

In addition to preparing students for the 

requirements of the real world, student engagement 

with computer technology has been 

effective for increasing academic skills (e.g., 

Fitzgerald, Koury, & Mitchum, 2008; Hall, 

Hughes, & Filbert, 2000). For example, computer 

assisted instruction (CAI) has been 

demonstrated to increase reading skills for at 

Correspondence concerning this article should be 

addressed to Sheila Alber-Morgan, Ohio State University, 

A356 PAES Building, 305 W. 17 th Ave, Columbus, 

OH 43229. E-mail: morgan.651@osu.edu 

risk first graders (Chambers et al. 2008), oral 

reading fluency for children with attention 

deficit/hyperactivity disorder (Clarfield & 

Stoner, 2005), social studies content knowledge 

for fifth graders with learning disabilities 

(Jerome & Barbetta, 2005), comprehension of 

history text by high school students (Twyman 

& Tindal, 2006), sight word recognition for 

children with developmental disabilities (Lee 

& Vail, 2005), and basic academic skills 

(shape, color, and number identification) for 

preschoolers (Hitchcock & Noonan, 2000). 

CAI may be effective because it utilizes active 

student responding with immediate feedback 

and/or reinforcement for each response 

(e.g., Hall et al., 2000; Macaruso & Walker, 

2008; Sorrell, Bell, & McCallum, 2007). Research 

demonstrates that students with more 

intensive disabilities can benefit a great deal 

from frequent opportunities for active student 

responding (e.g., Barbetta, Heron, & Heward, 

1993). Although CAI has substantial research 

support for increasing academic skills, most 

CAI research has focused on typically developing 

students or students with mild to moderate 

disabilities. Students with moderate to intensive 

disabilities can also benefit from CAI 

of academic skills, but most of the technology 


esearch for this population has focused on 

functional skills and communication skills 

(e.g., Calculator, 2009; Cihak, Kessler, & Alberto, 

2008; Lancioni et al., 2009; Mechling, 

2008). Therefore, to better substantiate the 

effectiveness of CAI, it is necessary to further 

investigate the effects of CAI on academic 

skills for students with moderate to intensive 

disabilities. The purpose of this study was to 

examine the effects of computer assisted instruction 

on the acquisition and maintenance 

of basic skills for children with moderate to 

intensive disabilities. 

Method 

Participants and Setting 

Participants were two students with moderate 

to intensive educational needs, Joe and Nate, 

who received individualized instruction in a 

self-contained special education classroom. 

Both participants also received speech therapy, 

occupational therapy, physical therapy, 

and adapted physical education. They each 

qualified for alternative assessments because 

of their cognitive and fine motor needs. Joe 

was a 9-year-old African American boy who was 

diagnosed with traumatic brain injury (TBI). 

He participated in a general education second 

grade class for approximately 15 minutes per 

day. Nate was a 6-year-old Caucasian boy who 

was diagnosed with Down syndrome and participated 

in a general education kindergarten 

class for approximately 30–40 minutes each 

day. Joe and Nate were selected to participate 

in this study because both students had basic 

academic skill needs identified in their individual 

education programs and both children 

had severe learning challenges. Additionally, 

Joe and Nate had the following prerequisite 

skills needed to participate in this study: (a) 

the ability to focus attention on a computer 

screen, (b) the ability to visually discriminate 

between three different academic stimuli on 

the computer screen (e.g., letters), and (c) 

the ability to use a computer mouse to select 

an item on the screen. 

Experimental sessions were conducted in a 

self-contained special education classroom in 

a suburban public elementary school. The 

classroom consisted of seven K-2 students with 

multiple disabilities, four paraprofessionals, 

and one special education teacher (i.e., the 

first author). Computer practice took place 

during breaks in the morning or afternoon 

when students were typically engaged in individualized 

activities. During these sessions, 

two to six other students were present working 

with paraprofessionals in other areas of the 

classroom away from the computers. The 

paraprofessionals also served as observers who 

collected IOA and procedural reliability data. 

Definition and Measurement of Dependent 

Variable 

The dependent variable was acquisition of basic 

academic skills, which was measured by the 

number of correct academic responses from 

10 response prompts per session presented on 

flashcards. Flashcard probes were used to assess 

academic skill acquisition and maintenance 

because the participants were accustomed 

to this form of assessment in their daily 

routine. The flashcards also provided a consistent 

visual cue for the participants throughout 

the study. 

For Joe, a correct response was scored each 

time he stated the correct answer within 5-s of 

the flashcard presentation and verbal prompt. 

For example, the special education teacher 

showed Joe a flashcard with a number printed 

on it and said “What number?” A correct response 

was scored when Joe stated the correct 

response within 5-s. An incorrect response was 

scored when Joe stated an answer that did not 

correspond to the item presented or made no 

response within 5-s. If Joe responded incorrectly 

and then self-corrected, the response 

was scored as incorrect. 

Because of Nate’s difficulties producing 

oral language, his responses were measured by 

observing his gestures. Specifically, Nate’s special 

education teacher presented him with two 

flashcards and verbally prompted him to 

touch or point to the correct response. For 

example, one flashcard showed the number 

“11” and the other flashcard showed the number 

“15.” The special education teacher verbally 

prompted, “Touch 15.” A correct response 

was counted when Nate touched or 

pointed to the correct flashcard within 5-s. An 

incorrect response was recorded when Nate 

touched the wrong card, touched both cards 

Computer-Based Practice / 557

at the same time, or did not respond within 

5-s. 

The experimenters identified three target 

academic skills for each participant based on 

their IEP objectives. For each target skill, 10 

items (i.e., letters, numbers, or words) were 

selected and used as response prompts for 

computer practice and flashcards. The following 

basic skills were selected for each participant 

in order of when the intervention was 

introduced. 

Joe: number identification (11–20), lettersound 

identification (K-T), and color word 

identification (e.g., red, blue). 

Nate: color word identification (e.g., red, 

blue), letter identification (A-J), and number 

identification (11–20). 

Flashcard probes were always conducted 

one day after computer practice prior to the 

next computer practice, and flashcards were 

presented in random order during each assessment. 


The independent variable was independent 

practice of the target skills using computer 

games that were designed by the teacher using 

the Microsoft PowerPoint® program. With 

this program, the teacher digitally recorded 

and embedded her voice into each game in 

the form of verbal prompts, feedback, and 

praise. The materials used in this experiment 

included a computer, a computer mouse, individualized 

computer games, a digital timer, 

and flashcards. 

When each participant began the game, he 

was presented with a digital verbal prompt to 

select a specific item from a choice of three 

items (e.g., A, B, C). The games provided 

visual and auditory praise for correct responses. 

When the student responded correctly, 

a written praise statement appeared on 

the computer screen (e.g., “Great job”) accompanied 

by the teacher’s voice enthusiastically 

saying the praise statement. The praise 

screen was immediately followed by animations 

and sound effects (e.g., a car going 

across the screen with the sound of the engine, 

a fish swimming across the screen with a 

gurgling noise and bubbles). After presenting 

praise and reinforcement for correct responses, 

the game advanced to the next learning 

trial. 

When a student emitted an incorrect response, 

the next screen showed the words 

“Try again,” accompanied by the teacher’s 

monotone voice saying “Try again.” No additional 

sound effects or animations were provided 

for incorrect responses. The student was 

then presented with another opportunity to 

attempt the learning trial. The computer program 

did not advance to a new learning trial 

until the student emitted the correct response. 

For each session, the computer response 

prompts were presented in random 

order. 

During computer practice sessions, the participants 

were provided one trial for each of 

10 items with a maximum of 3-min to play 

each game. For example, for letter identification, 

the participant was given one opportunity 

to identify each of the 10 selected letters. 

After three minutes of computer practice, 

whether or not the participant finished all 10 

learning trials, the practice session ended for 

that game and the participant was directed to 

another computer game (e.g., number identification) 

or a different classroom activity. If 

the participant finished the 10 trials before 

three minutes had elapsed, he or she was also 

directed to the next task. 

Experimental Design and Procedure 

A multiple-baseline across skills design was 

used to examine the effects of computer practice 

on acquisition and maintenance of basic 

skills. The experimental conditions consisted 

of baseline, training, computer practice, and 

maintenance. For each student, each tier of 

the multiple baseline design shows the data 

for one of three different target skills. Baseline 

data were collected for all three target 

skills. Intervention began with the skill that 

showed the lowest and most stable baseline 

data. When the participants attained 60% accuracy 

on three consecutive sessions for the 

first skill, intervention began with the next 

skill on the second tier. When 60% accuracy 

was attained on three consecutive sessions for 

the second skill, intervention began for the 

third skill on the final tier. The intervention 

continued for each target skill until the par- 


ticipant attained 80% accuracy on three consecutive 

sessions. Then the maintenance condition 

was implemented. 

Baseline. During baseline, the special education 

teacher sat across from the participant 

at a table and presented three sets of flash 

cards, one set for each skill. The teacher held 

up each flashcard and provided a verbal 

prompt (e.g., “What word?”), and recorded 

correct and incorrect responses. Joe was expected 

to provide verbal responses. Nate was 

presented with two flashcards and asked to 

point to the correct response (e.g., “Touch 

red.”). When the student responded correctly, 

the teacher delivered a praise statement (e.g., 

“Good! You got it!”). Feedback was not provided 

for incorrect responses. If the student 

responded incorrectly, the teacher said nothing 

and presented the next flashcard. If the 

participant became distracted or off-task (e.g., 

looking around, attempting to leave the table), 

the teacher used prompts to re-direct 

him back to the task (e.g., “Almost done,” 

“Three more,” “We’re working now.”). 

Training. Prior to beginning the intervention, 

the teacher provided the participants 

with training for using the computer mouse to 

select items on the computer screen. Training 

sessions were about three minutes in duration 

and included verbal directions, modeling, 

least-to-most prompting, guided practice, and 

systematic error correction. Once the participants 

were observed using the mouse independently 

to move the cursor to an object on 

the screen and click on a selection, they began 

the computer practice condition. Nate received 

this training on two consecutive days 

and Joe received training on six consecutive 

days. 

Computer practice. During computer practice, 

the teacher set up the game and 

prompted the participant to go to the computer 

and play the game. The participants 

completed the games independently, receiving 

feedback only from the computer game 

itself. Each computer game ended with an 

audible signal and a blank screen after the 10 

trials had been completed or after the three 

minutes had elapsed, whichever occurred 

first. An observer monitored the participants 

to make sure they did not leave the computer 

before they were finished with the game. If the 

participants had attempted to leave the task, 

the observer would have redirected the participant 

back to the computer, however, no students 

attempted to leave the computer during 

any of the practice sessions. The flashcard 

probes used to assess acquisition were administered 

the following day prior to the next 

computer practice session. 

Maintenance. After the participants attained 

80% mastery on three consecutive sessions 

for one skill, computer practice was discontinued 

for that skill. For example, if a 

student achieved 80% accuracy on three consecutive 

sessions with letter-sound identification, 

but did not meet the 80% criteria for 

number and sight word recognition, computer 

practice was discontinued for lettersound 

recognition only. Maintenance probes 

were administered using the same flashcard 

procedures used throughout the study and 

were administered approximately two days 

each week. 

Interobserver Agreement (IOA) and Procedural 

Reliability 

IOA was assessed on 20% of the sessions. A 

second observer was present to record the 

participant’s responses to the flashcard 

prompts. IOA was calculated by dividing the 

number of agreements by the number of 

agreements plus disagreements and multiplying 

by 100. 

Procedural reliability was assessed on 20% 

of the sessions for computer practice and 

flashcard probes. Procedural reliability checklists 

were used to determine the extent to 

which the intervention was implemented as 

planned. A second observer checked off the 

steps that were completed correctly and in the 

correct sequence. The number of steps completed 

correctly was divided by the total number 

of steps and then multiplied by 100 to 

calculate the percentage of procedural reliability. 

Results 

Figure 1 shows the number of correct responses 

across skills and conditions for Joe, 

and Figure 2 shows the number of correct 

responses across skills and conditions for 

Nate. During baseline, Joe’s data were stable, 

ranging between zero and four correct re- 


Figure 1. Correct responses for Joe for number identification, letter-sound identification, and color word 

identification. 


Figure 2. Correct responses for Nate for color word identification, letter identification, and number identification. 


sponses for each skill. No trends were apparent 

during baseline for Joe. Nate’s baseline 

data were more variable, ranging between 

zero and six correct responses across skills. 

Additionally, Nate’s second tier (letter identification) 

shows a slight upward trend during 

baseline. When the intervention was introduced, 

both students showed a clear upward 

trend of correct responding for each skill. 

Joe’s second tier (letter-sound identification) 

shows a delayed upward trend beginning on 

the fifth intervention session followed by rapid 

progress to mastery (i.e., 4 sessions). Both 

participants also demonstrated maintenance. 

Nate demonstrated maintenance for all three 

skills and Joe demonstrated maintenance for 

letters and numbers. Although Joe’s color 

word proficiency increased, he was unable to 

reach the criteria for beginning the maintenance 

phase for color words in the time available 

for data collection. 

Interobserver Agreement and Procedural Reliability 

Interobserver agreement (IOA) was assessed 

in each condition for each participant on 20% 

of the sessions. Across all phases, skills, and 

participants, mean IOA was 99.4% (ranging 

from 80% to 100%). Procedural reliability was 

assessed on 20% of the sessions for the computer 

practice procedures and the flashcard 

assessment procedures. Procedural reliability 

was 100% for computer practice and 97% for 

the flashcard assessment procedures. 


Results of this study demonstrate that computer-based 

practice was functionally related to 

acquisition and maintenance of basic skills by 

two children with moderate to intensive disabilities. 

Although each participant showed 

variations in rate and pattern of responding, 

they both achieved substantial improvement 

of basic academic skills over the course of 

12–14 weeks. Both participants also demonstrated 

maintenance for at least two academic 

skills over two to four weeks. 

Joe’s correct responding was low and stable 

in baseline. When computer practice was introduced, 

Joe’s data show upward trends for 

each skill (see Figure 1). For letter sounds, Joe 

did not begin to show improvement until the 

fifth intervention session when his pattern of 

correct responding increased substantially. 

The experimenters were unable to determine 

the reason for the delayed, then substantial, 

increase in correct responding for letter 

sounds. During maintenance, Joe consistently 

attained 90–100% accuracy for number identification 

and letter sounds. He was unable to 

begin the maintenance phase for color words 

due to the limited time for data collection, but 

based on his data trend on the third tier, he 

probably would have met mastery for color 

words if given more time. 

Nate’s data were highly variable throughout 

the study until he began the maintenance 

phase (see Figure 2). Because he selected the 

correct answer from two flashcards, Nate had 

a 50% chance of getting the answer correct. 

This may have inflated his percent of correct 

responses and produced increased variability 

throughout the experiment. However, during 

maintenance, similar to Joe, Nate demonstrated 

consistently accurate responding at 

90–100%. The findings of this study support 

previous research that computer assisted instruction 

is an effective tool for increasing 

academic performance (e.g., Chambers et al., 

2008; Clarfield & Stoner, 2005; Jerome & Barbetta, 

2005) and extends the findings of computer 

assisted instruction to children with 

moderate to intensive disabilities. Aspects of 

computer practice that likely increased the 

effectiveness of the intervention include consistent 

visual and auditory response prompts, 

frequent opportunities for active responding, 

and immediate feedback for each response. 

The results of this study are also consistent 

with previous research demonstrating the effectiveness 

of active student responding with 

immediate feedback for students with more 

intensive disabilities (e.g., Barbetta et al., 

1993). 

Limitations and Future Research 

While this study provides evidence of a functional 

relationship between computer practice 

and basic skills acquisition and maintenance, 

several limitations should be considered. First, 

each student attended a general education 

classroom for 15 to 40 minutes each day to 

increase their social interactions with typically 

developing peers. The experimenters were 


unable to control the amount of exposure to 

the target skills outside of the special education 

classroom (including home and community 

settings). Future research should attempt 

to control for exposure to the target skills in 

other settings. 

A limitation that may have influenced the 

students’ rate of learning is the amount of 

practice they received. Due to time restraints 

and the participants’ limited attention spans, 

each game was confined to three minutes 

which only allowed for one practice trial for 

each item. The students’ rates of learning may 

have been faster if they spent more time practicing. 

Future research should attempt to determine 

the optimum number of learning trials 

needed to promote mastery of basic 

academic skills for students with moderate to 

intensive disabilities. 

Throughout the study, flashcard probes 

were administered to assess progress of basic 

skills. Repeated exposure as well as feedback 

for correct responses during the flashcard 

probes may have contributed to the participants’ 

increased proficiency with basic skills. 

Consequently, the participants’ performance 

may have been the result of the combined 

effects of computer practice and flashcard 

probes as opposed to computer practice 

alone. The upward trend during baseline in 

the second tier of Figure 2 indicates this possibility 

for Nate. However, Joe’s baseline data 

for each skill displays hardly any change in 

responding until computer practice was implemented. 

Future research should attempt to 

identify a way to assess the outcomes of computer 

practice without introducing possible 

confounding variables associated with assessment. 

Another limitation of this study is that the 

experimenters did not assess generalization of 

the target skills to other settings or situations. 

Future research would be strengthened by 

measures of skill generalization to other classrooms 

or settings, with different teachers or 

peers, in different instructional arrangements, 

or with different application activities. One 

type of generalization, response maintenance, 

was measured in this study. However, the end 

of the school year limited the amount of maintenance 

data collected to only a few weeks. 

Future research should attempt to implement 

longer maintenance phases or collect follow-up 

data. 

The research on academic interventions for 

children with moderate to intensive disabilities 

is an important area of need in the field of 

special education. Future research should 

continue to investigate and identify effective 

strategies for teaching a range of academic 

and functional skills to individuals moderate 

to intensive educational needs. 

Implications for Practice 

Students with moderate to intensive disabilities 

need individualized instruction, repeated 

practice with immediate feedback, and frequent 

opportunities to increase their independent 

functioning. Customized computer 

games can provide a means for meeting these 

student needs. The flexibility of programming 

instruction with computers allows for a wide 

range of possibilities. Computer games can be 

customized to each student’s IEP objectives, 

modes of responding, and reinforcer preferences 

(e.g., animated characters, colors, 

sound effects). 

In this study, the special education teacher 

created individualized computer games that 

the participants could play independently. 

The results demonstrated that computer practice 

enables students with moderate to intensive 

disabilities to work independently for at 

least brief periods of time. While the participants 

were only playing each game for a maximum 

of three minutes (totaling nine minutes 

if they reached criteria to play the games for 

all three skills), none of the participants attempted 

to leave the computer area while 

playing. Anecdotally, the classroom staff observed 

the participants smiling, giggling, clapping 

their hands, and repeating sounds while 

they were engaged in computer practice; and 

both participants requested to play the computer 

games when it was not their designated 

time to play. Additionally, using the teacher’s 

voice for auditory prompts and feedback may 

have promoted student motivation as well as 

generalized responding. 

Creating customized computer games for 

this study required a little creativity, a basic 

understanding of Microsoft PowerPoint®, and 

time to construct the games. The first game 

can take up to an hour to create, but could 


then be used as a template for quicker creation 

of additional games. Once the teacher 

creates the games, she can use them throughout 

the school year and modify them as 

needed for individual students. In addition, 

Microsoft PowerPoint® is a standard feature 

on most school computers, so teachers can 

create their own games for free. In fact, one of 

the reasons that the teacher in this study designed 

the customized games using Microsoft 

PowerPoint® was that appropriate computer 

software was unavailable for her students. 

Equipment and materials for students with 

significant disabilities tends to be expensive, 

however, Microsoft PowerPoint® was already 

available throughout the school district at no 

additional cost. Considering the potential for 

increased academic achievement and opportunities 

to work independently, this intervention 

can have an excellent cost-benefit ratio. 

Teachers of students with moderate to intensive 

disabilities can learn to make customized 

computer games designed to meet each of 

their students’ unique academic learning 

needs. 

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Final Acceptance: 20 November 2010 




Providing Choice Making in Employment Programs: The 

Beginning or End of Self-Determination? 

Martin Agran and Michael Krupp 

University of Wyoming 

Abstract: Choice making represents the central element of self-determination, and efforts are being made across 

all service programs to promote choice making for consumers with intellectual and developmental disabilities. 

Although choice making appears to be a relatively simple response for a consumer to perform (selecting one 

stimulus over another), it is a complex phenomenon involving several different components. This paper provides 

a selected review of the choice-making research literature, relative to employment service delivery. The paper 

examines the relationship of choice making to self-determination, how choice making can promote engagement 

and motivation for employees, and what barriers may exist that thwart meaningful choice making. Recommendations 

to support personnel and practitioners on practices to promote effective choice making are provided. 

Self-determination refers to strategies that enable 

individuals to regulate their own behavior, 

independent of external control, and allow 

them to have control over choices and 

decisions that impact their lives (e.g., where 

and how they want to work, where they live). 

These strategies aim to teach individuals to set 

appropriate goals for themselves, monitor 

their performance, identify solutions to present 

or future problems, verbally direct their 

own behavior, reinforce themselves, or evaluate 

their own performance. Self-determined 

individuals make choices, act on those 

choices, experience the results, and then 

make new choices (Martin, Woods, Sylvester, 

& Gardner, 2006). 

Although data on the relationship between 

self-determination and employment outcomes 

remain limited, several researchers have suggested 

that individuals who are more self-determined 

attain more positive transition outcomes. 

Wehmeyer and Schwartz (1997) 

examined adult outcomes of a sample of students 

with learning or intellectual disabilities 

one year after they left high school. Those 


be addressed to Martin Agran, Department of Special 

Education, College of Education, Department 

3374, 1000 E. University Avenue, University of Wyoming, 

Laramie, Wyoming, 82071. Email: magran@ 

uwyo.edu 

with higher levels of self-determination were 

more than twice as likely to be employed and 

earned, on average, $2.00 per hour more than 

employees with lower self-determination levels. 

Also, Wehmeyer and Palmer (2003) examined 

the adult status of 94 individuals with 

intellectual disabilities 1 and 3 years after 

graduation. One year after high school, employees 

with higher levels of self-determination 

were more likely to have moved from 

where they were living during high school, 

and by year 3 were still more likely to live 

somewhere other than their high school 

home. Additionally, individuals who scored 

higher in self-determination made statistically 

significant advances in obtaining job benefits, 

including vacation, sick leave, and health insurance, 

than their peers with lower self-determination 

levels. Further, Wehmeyer and 

Schwartz (1997) reported that among 50 

adults with intellectual disabilities higher selfdetermination 

scores predicted a higher quality 

of life. Last, Wehmeyer (2003) indicated 

that consumers served through the vocational 

rehabilitation system achieve better outcomes 

when they are actively involved in planning 

and related decision-making. 

Choice Making and Self-Determination 

Choice making is regarded as the central element 

of self-determination (Wehmeyer et al., 

Choice Making / 565

2007). Choice making initiates the self-determination 

process and prompts action (Deci & 

Ryan, 1985; Schloss, Alper, & Jayne, 1993). 

Opportunities to make choices allows employees 

to select work tasks and jobs that best 

match their wishes, interests, and capabilities, 

and, in doing so, promotes greater engagement 

and motivation on their part (Mithaug, 

2005). To a large extent, self-determination is 

largely understood in terms of personal 

choice. For example, when asked what strategies 

constitute self-determination, 91% of the 

educators in the sample identified choice 

making (Agran, Snow, & Swaner, 1999). Promoting 

choice making has become an important 

focus of disability services and supports 

and a basic component in service delivery 

(Wehmeyer, 2001), and serves as the foundational 

credo for many educational and human 

services (Bambara, 2004). It provokes self-determination 

and self-regulation by allowing individuals 

with intellectual disabilities to express 

their preferences, make choices based 

on those preferences, and, subsequently, act 

on those choices. Since these actions have 

been historically denied to these individuals, 

choice making is thought now as a universal 

right and entitlement (Brown & Brown, 2009; 

Mithaug, 1998; Powers, 2005). 

That is, there is widespread agreement that 

people with disabilities have the right to choose 

and, on the basis of government policy, are 

entitled to this right (Brown & Brown). However, 

it should be noted that, although both 

employment and transition programs are directed 

to maximize active student or consumer 

involvement, choice making is regarded 

as a best practice rather than a legally 

mandated right. 

For individuals with intellectual disabilities, 

choice making is clearly the self-directed 

learning strategy that has received the most 

attention in both the research literature and 

in adult and support services. More than any 

other skill associated with self-determination, 

choice making has been a focal point in the 

self-advocacy and self-determination movement 

(Agran & Wehmeyer, 2003). As has often 

been the case, individuals with intellectual 

disabilities have not been provided opportunities 

to make choices and decisions based on 

their own preferences (Stancliffe & Abery, 

1997; Wehmeyer & Metzler, 1995). As Bodgan 

(1996) noted, individuals with intellectual disabilities 

have always been told what to do, 

where to go, and what to do next so it is not 

surprising that many individuals do not know 

how to make choices and need targeted, systematic 

instruction on this skill. Consequently, 

much of the choice-making research has involved 

demonstrations that individuals with 

intellectual disabilities do have preferences 

and can be taught to make choices based on 

these preferences (see Martin et al., 2003; 

Powers, 2005; Wehmeyer et al., 2007). However, 

the types of choice-making opportunities 

provided to consumers and the extent to 

which their choices are supported warrants 

further research. 

This paper examined the relationship of 

choice making to self-determination. Specifically, 

practices to promote choice making, engagement, 

and motivation were presented. 

Also, the need to support employees’ choices 

was discussed, as well as barriers to choice 

making. 

Capacity and Opportunity 

It is well acknowledged that to ensure choice 

making is an integral component in work for 

individuals with intellectual and developmental 

disabilities, efforts must be made to infuse 

it into the daily work routine for individuals 

(Bambara, 2004; Brown & Brown, 2009). In 

one study that directly asked consumers 

served by a variety of employment preparation, 

supported employment, and sheltered 

employment programs their opinions about 

choice making, 77% of individuals in the sample 

indicated that their job coaches wanted 

them to make choices every day, and 55% 

indicated that they made choices each day; 

twenty-two percent (22%) indicated that they 

didn’t, and 23% refrained from responding 

(Agran, Storey, & Krupp, 2010). Although 

these figures are specific to the programs included 

in the sample, integrating choice making 

into work routines is increasingly being 

implemented, and we can assume that most 

employees are being provided frequent 

choice-making opportunities of one sort or 

another at work (Bambara, 2004). It is clear 

that increasing choice-making opportunities 

will expose individuals to a pool of potentially 

rich choice options to experience—for exam- 


ple, different work tasks and settings—and, 

thus, provide an experiential basis (familiarity) 

for them to make informed decisions. 

However, Bambara noted that “more choices” 

does not necessarily mean “better choices,” 

and this is a critical issue that warrants consideration. 

As indicated previously, choice making is 

arguably the self-directed learning strategy 

that has received the most attention in both 

the research literature and in adult and support 

services; in effect, choice making and 

self-determination have become synonymous. 

More than any other skill associated with selfdetermination, 

choice making, and the right 

of people with disabilities to make choices, has 

been a focal point in the self-determination 

movement (Agran & Wehmeyer, 2003). However, 

associated with this “notoriety” may be 

the mistaken belief that the act of choosing is 

sufficient in promoting self-determination; in 

other words, choice making in and of itself 

produces self-determination (Agran, Wehmeyer, 

& Krupp, 2009). Accordingly, service 

providers may opt to teach the former but 

refrain from teaching other self-directed strategies. 

For example, in the Agran et al. study in 

which consumers were asked to share their 

opinions about choice making (as well as 

other self-determination strategies), less than 

20% of the respondents indicated that they 

were taught to self-reinforce (provide their 

own verbal reinforcement) or self-monitor 

(count the number of times they performed a 

desired behavior). In another study that examined 

the extent to which individuals with 

intellectual disabilities, who were served in 

employment and community living programs, 

were taught different self-determination strategies, 

approximately half were taught to selfmonitor 

but less than half were taught to selfinstruct 

(verbally remind themselves of what 

they needed to do) or self-schedule (develop 

and follow a schedule of daily activities) (Wehmeyer, 

Agran, & Hughes, 2000). Wehmeyer 

(1998) commented that choice making is an 

important component of self-determination 

but it is only one of several components (e.g., 

problem solving, goal setting, self-evaluation). 

As Wehmeyer noted, our intent is not just to 

teach individuals to choose but to take control 

over their lives. Expressing preferences and 

making choices based on these preferences is 

a critical first step but it is just that. Choice 

making has a vital and integral role in promoting 

self-determination but it does not necessarily 

ensure it. An employee may choose to 

perform a certain work task with a preferred 

co-worker at a preferred time but this will not 

promote self-determination if other program 

components (e.g., goal setting, evaluation, 

level of support) continue to be controlled by 

the supervisor. 

Critical to self-determination is the dynamic 

relationship between capacity and opportunity 

(Mithaug, Mithaug, Agran, Martin, & Wehmeyer, 

2003). Capacity refers to an individual’s 

skills, interests, and motivations, and 

opportunity is the existing situation that will 

allow the individual to either realize his or her 

wishes (achieve his or her choices) or not 

fulfill them. When capacity and opportunity 

are in sync (i.e., the former is sufficient to 

benefit from the latter), an individual’s wishes 

can potentially be realized. However, life is of 

course replete with tensions in which capacity 

and opportunity are not compatible, and the 

extent to which we derive satisfaction is based 

on our assessment as to whether we have the 

capacity to positively respond to and gain 

from a situation, or if the situation is one that 

demands skills or resources that we don’t have 

or one that is not worth all the effort that may 

be required. Optimally, the value of providing 

individuals with opportunities to make 

choices is predicated on the belief that the 

choices individuals make are realistic (they 

can be fulfilled) and that supports are present 

so that such fulfillment can be achieved. The 

mere provision of choice making opportunities 

is of limited value if it is not accompanied 

by instruction that allows individuals to assess 

if their choices are realizable—that is, as Mithaug 

et al. suggested, there is a “just-right” 

match between capacity and opportunity. If 

not, consumer expectations and motivation 

will decrease and their self-determination 

thwarted. As Brown and Brown (2009) noted, 

we cannot expect an individual to make an 

informed choice if he or she is not familiar 

with the stimuli available. Thus, broadening 

an individual’s array of choice-making opportunities 

is potentially of great value in facilitating 

such access, but providing these opportunities 

without assurance that the individual is 

considering capacity and opportunity when 

Choice Making / 567

making choices is clearly not in the consumers’ 

best interests. For many individuals with 

intellectual disabilities who have had few, if 

any, experience making choices, systematic instruction 

is necessitated, and the relationship 

between capacity and opportunity should be 

incorporated into it. 

Promoting Engagement and Motivation 

As Mithaug (1993) noted, engagement is a 

behavioral manifestation of motivation and reflects 

the observable level to which someone is 

motivated. The degree to which people are 

engaged to reach a goal is directly related to 

the match between capacity and opportunity. 

When people are provided with choice situations 

and they feel the decision will enable 

them to reach their goal, their levels of engagement 

and motivation will rise commensurately. 

When consumers believe a circumstance 

offers a manageable and meaningful 

opportunity, they regulate their choices and 

actions to arrive at the results they expect 

(Mithaug et al., 2003) and experience increased 

levels of engagement. These beliefs 

underscore the importance of matching consumers’ 

capacities with manageable opportunities. 

By repeatedly striving to match capacity 

and opportunity within a real-life context for 

the consumer, individuals have multiple opportunities 

to practice making meaningful 

choices and responding with engagement and 

motivation in the way they adjust to the consequences 

of those choices. Mithaug (1996) 

contextualized the need for an accurate 

match between consumers’ capacities and 

manageable opportunities in his assertion that 

by “optimizing the match between individual 

capacity and social opportunity [people experience] 

more frequent expressions of self-determination” 

(p. 2). That is, individuals can 

begin to experience a level of personal control 

that they may not have experienced before. 

As suggested previously, because many consumers 

have not learned to make choices, 

their sense of self-efficacy will remain low and, 

as a result, they will continue to be passive in 

their approaches to completing tasks; that is, 

others will continue to make decisions for 

them. Instead of exercising skills in self-regulation, 

including practicing making meaningful 

choices, they rely on others to make 

choices for them and to set goals for them. 

Rather than being engaged in reaching a goal, 

consumers take a passive role and fail to control 

the situation. This results in disengagement 

and lack of motivation. Individuals in 

these passive states quickly acquire an approach 

of learned helplessness, and (a) believe 

they are helpless to control the direction 

of their learning, and (b) perceive a limited 

number of choices available to deal with the 

situation (Mithaug et al., 2003). Therefore, 

they may be likely to avoid being engaged in 

the task. For example, a consumer working in 

a public library is asked to reorganize a book 

section for a specific type of book (e.g., science-fiction). 

The consumer, working independently, 

would be expected to make 

choices and adjustments as he or she began to 

accomplish this task. However, staff at the library 

(like so many other support personnel) 

may assume the choice-making role by determining 

for the consumer which task to do 

first, when to have it done, how to do it, what 

to do next, then reinforce the consumer when 

the job is completed, or direct the consumer 

to make needed correction (e.g., instructs the 

consumer in making necessary adjustments). 

After such experiences, the consumer quickly 

learns he or she has little say in what is going 

to happen, what is happening, and what will 

happen. There are no meaningful choices to 

make, and, therefore, little or no opportunity 

to be self-determined. In fact, there is no reason 

to be engaged or motivated to accomplish 

the task. 

There are ways of breaking this cycle of 

learned helplessness. Earlier, the point was 

raised that direct support personnel need to 

provide opportunities for consumers to practice 

making meaningful choices by matching 

consumers’ capacities with meaningful opportunities. 

Mithaug et al. (2003) described the 

foundation that leads to engagement by stating 

that: 

[when consumers] believe a circumstance 

offers a valuable and manageable opportunity 

for gain, they engage it by regulating 

their expectations, choices, and actions to 

produce a result that yields a satisfactory 

change in circumstances—usually a gain toward 

some end. This in turn produces an 

experience of control over the circum- 


stance that positively affects subsequent beliefs 

about the opportunities for gain in that 

situation (p. 19). 

As consumers learn to make choices as a 

result of being provided those opportunities 

to exercise this control, they more readily and 

accurately learn to self-regulate and problem 

solve as a result of making an informed, meaningful 

choice. Confidence and competence 

increase engagement, motivation, and persistence 

(Mithaug, 1993), and it is imperative 

consumers are provided with opportunities to 

practice becoming more self-determined in 

their lives. 

Mithaug (2005) suggested “before we can 

engage in our self-interested pursuits in life we 

must have an opportunity to do so, or at least 

believe we do” (p. 163), and that “opportunities 

[to make meaningful choices] will provoke 

the regulation of choice making to satisfy 

a need or interest” (p. 164). The level of engagement 

demonstrated by consumers is in 

direct relation to the meaningful experiences 

they are provided to practice making informed, 

meaningful choices (Mithaug, 1993; 

Mithaug et al., 2003). As consumers come to 

realize what it means to have some control 

over their ability to achieve a target goal, concurrent 

with support personnel providing opportunities 

for them to gain more experience 

in making meaningful choices, they will demonstrate 

increased levels of motivation because 

they are engaged in the process of selfregulating 

through adjustment, and are more 

likely to improve their abilities to engage in 

self-regulated problem solving to reach a goal 

state and, ultimately, achieve some degree of 

self-determined behavior. 

Choice Making and Job Matching 

As Stock, Davies, Secor, and Wehmeyer 

(2003) indicated, an underlying assumption 

in service delivery for people with intellectual 

disabilities is that their career goals and work 

placements will be based on their preferences 

and interests. As they noted, the assumption 

when providing rehabilitation services is that 

services will be driven with an explicit emphasis 

on providing individuals with the tools to 

express preferences and make informed 

choices. That said, several researchers have 

suggested instead that people with intellectual 

disabilities have not been provided the opportunities 

to make choices and decisions based 

on their own preferences (Canella, O’Reilly, 

& Lancioni, 2005; Wehmeyer et al., 2007) and 

employment decisions continue to be made 

by others (Stock et al.; Wehmeyer et al., 1998). 

The reasons that individuals do not make 

choices based on individual preferences vary 

(e.g., lack of choice-making skills, lack of support), 

but such a lack of choice-making opportunities 

appears to be universal (Wehmeyer & 

Metzler, 1995). To contribute to the problem, 

traditional vocational assessments (e.g., aptitude 

measurement, work sample, job analyses) 

have not used individual work setting or 

job preferences as the basis for placement 

decisions. As a result, this often resulted in job 

dissatisfaction or termination for employees. 

In contrast, placement methods that use individual 

preferences appear to produce more 

successful outcomes, including: increased engagement, 

motivation, job satisfaction, and 

productivity (Martin, Mithaug, Oliphant, 

Husch, & Frazier, 2002; Martin et al., 2003). 

When assessing job preferences, Martin et 

al. (2002) recommended that individuals express 

their preferences regarding setting characteristics 

(e.g., quiet vs. loud workplace, work 

alone vs. work with lots of people), as well as 

job task and activities. Individuals should be 

provided repeated opportunities to identify 

what they like, spend time observing specific 

jobs, evaluate their initial choices, then 

choose again making any needed adjustments 

based on what they learned from their visit to 

the job site. For instance, an employee initially 

may have chosen a job site with many employees 

as a characteristic preference, but after 

spending time at this job site she learned that 

she preferred a job with fewer employees. She 

then expressed this preference during the 

next assessment round. Employees may need 

to repeat this process until reliable task and 

characteristics choices emerge. 

Prior to job site visits, for example, employees 

identify job characteristics they “think” 

they like. Afterward, their results are graphed 

to show cumulative choices made across time. 

After visiting several job sites representing 

many of the chosen characteristics, employees 

choose again while making any adjustments 

based on what they learned. The process is 

Choice Making / 569

epeated until stable choice patterns emerge. 

Martin et al. (2002) used this approach with 

more than 750 individuals with disabilities and 

found that those who used the self-directed 

employment assessment process had statistically 

significant better job results than those 

who obtained a job selected by a support person. 

Interestingly, Martin et al. (2006) compared 

the vocational choices made by individuals 

with severe cognitive disabilities with those 

made by caregivers on their behalf. The 

choices made by the individuals with disabilities 

seldom matched those made by their caregivers. 

These findings regrettably were aligned 

with those reported by Stancliffe (2000) who 

reported that consumers who had a proxy 

respond for them to choice questions experienced 

fewer choice opportunities than consumers 

who presented their choices themselves. 

Similarly, Martin et al. (2002) reported 

that, although custodial jobs were the least 

frequently selected job type by consumers, it 

was the most frequently selected job type by 

practitioners, and clerical work, although the 

most frequently selected job by consumers, 

was the least frequently selected by practitioners. 

Martin et al. (2003) emphasized the 

need for sensitive and response procedures be 

used to ensure that consumer input is secured 

and employed. Although practitioners and 

caregivers may be confident that they understand 

consumers’ needs and preferences, such 

beliefs may be presumptive and unfounded at 

best. As discussed later in this manuscript, this 

problem is exacerbated for consumers who 

are nonverbal and have communication challenges. 

Making Meaningful Choices 

Shevin and Klein (1984) defined choice as 

“the act of an individual’s selection of a preferred 

alternative from among several familiar 

options” (p. 232). The fact that an informed 

choice requires an element of familiarity is 

critical to the act of making a valued choice 

and ties directly into the discussion earlier 

about the need for support personnel to provide 

meaningful opportunities matched to 

consumers’ individual capacities. It is suggested 

that consumers’ preferences be solicited 

and identified, but these preferences 

need to be informed by experience (Storey, 

2005). Experience must be actively provided 

to consumers whenever possible. Indeed, Martin 

et al. (2003) suggested a structured 

method of identifying meaningful choices 

that includes (a) repeated opportunities to 

make choices, (b) asking the consumer his or 

herself about those choices, (c) conducting 

the inquiries over time, and (d) narrowing 

preference selections down to a list of preferred 

and nonpreferred items. By providing 

opportunities to identify and express preferences, 

consumers have the opportunities to 

engage in and gain experience in making 

meaningful choices. By gaining experience in 

making meaningful choices informed by experience 

and not simply expressing preferences, 

consumers can begin to develop skills 

that will allow them to engage in a self-regulated 

problem solving process that is the essence 

of self-determination (Mithaug, 2005). 

Choice Making Leading to Problem Solving 

The immediate benefit of providing choicemaking 

opportunities to consumers is that it 

allows them to select a preferred stimulus or 

condition to one that is least preferred. Such 

a manipulation will potentially provide a reinforcing 

consequence and enhance engagement 

and motivation. Desirable outcomes that 

may be achieved include greater productivity, 

more on task time, greater job satisfaction, 

and fewer behavioral episodes, among others. 

These are valuable outcomes but there is an 

ultimate outcome that hopefully will be 

achieved—the capacity to engage in self-regulated 

learning. Choice making is beneficial in 

that it provides consumers with a means to 

express a preference, but it is not specifically 

designed to teach individuals how to evaluate 

the relative “weight” or value of the choices 

they make; in other words, which choices allow 

them to make greater progress in achieving 

self-selected goals, or which choices provide 

more benefits (reduces the discrepancy 

between an actual state {what one has} and a 

goal state {what one wants}. Mithaug (1993) 

described this discrepancy between a goal 

state and an actual state as a motivating factor 

and that the desire to reduce this discrepancy 

is a key ingredient to making choices and 

subsequent problem solving as a self-deter- 


mined person. The dissonance created by the 

goal-state/actual-state discrepancy will hopefully 

cause the person to engage in reducing 

the discrepancy. The effort to reduce this discrepancy 

results in a means-ends chain that 

allows a person to seek solutions using a selfregulated, 

problem-solving strategy that allow 

him or her to reach a goal. Consequently, the 

“solution searching and solution testing lead 

to consequences that feed back and alter subsequent 

discrepancies, expectations, searches, 

and selections” (p. 12). It is a loop of choosing, 

acting, evaluating, and adjusting. Consequently, 

although choice making and problem 

solving are typically not associated, it is 

clear that the latter operation (problem solving) 

can be achieved only after the former 

operation (choice making) has been fully experienced 

by consumers. 

Agran and Hughes (1997) described problem 

solving as a process of “determining the 

most appropriate and efficient response to a 

given problem” (p. 172). People experience a 

discrepancy (the problem), consider and implement 

their solution, evaluate, and adjust as 

much as necessary to reach the goal state. 

Unfortunately, as consumers have historically 

received little exposure to making meaningful 

choices, and consequently little practice at 

solving problems, they are not able to regulate 

their lives as independently as they could. One 

cannot select an efficient response to a problem 

(or achieve a goal) unless one has familiarity 

with the various consequences that may 

be experienced (e.g., greater productivity 

leads to more financial compensation, which 

provides more goods and services). The first 

step in problem solving is identifying the 

problem or stating a goal (achieving an outcome). 

This is similar to choice making—what 

choice should be made. The next step that 

follows is determining the relative weight or 

consequences of choices—if I opt for Choice 

A, this will happen; if I opt for Choice B, this 

will happen. With this understanding individuals 

can determine which actions are in their 

best interests—in effect, problem solve. It is 

strongly recommended that consumers are 

not only taught to choose one stimulus over 

another but to also learn to evaluate the relative 

benefits and disadvantages of their 

choices. For example, if an employee asks to 

work at a fast-food restaurant, he or she may 

find him- or herself in a work environment, 

which has characteristics he or she doesn’t 

prefer (e.g., many people, work standing up). 

By understanding the need for consumers to 

practice choice making and problem solving, 

support staff can provide opportunities to improve 

consumers’ capacity to successfully perform 

self-regulated problem solving and begin 

to take more ownership and control over their 

lives. Self-determined individuals are aware of 

their needs and make decisions to meet those 

needs by setting goals, taking action, and adjusting 

through ongoing self-evaluation in order 

to meet those goals. Without opportunities 

to make meaningful choices and practice 

the problem-solving process, consumers will 

continue to be dependent on others, living in 

an other-determined state. 

Barriers to Choice Making 

Although well acknowledged as both a best 

practice and service requirement, choice making 

represents a potentially disquieting event 

to service delivery and traditional practice, 

and may be difficult to provide to consumers 

in a meaningful way. As discussed previously, 

the impetus for choice making is to drive and 

plan vocational and habilitation programs 

based on consumer input, but there are several 

barriers that challenge both its purpose 

and impact on an individual’s lifestyle. 

No choice making. Agran et al. (2010) investigated 

the extent to which consumers with 

intellectual and severe intellectual disabilities 

were provided choice-making opportunities 

and the types of choices they were asked to 

make. For the participants at one agency that 

provided sheltered employment, they were 

asked once a year at their Individual Program 

Plan meetings if they wanted to work elsewhere 

such as a supported employment placement. 

However, this agency did not offer supported 

employment, so, although the 

consumers were asked to make a choice, in 

effect there was no “real” choice involved. 

Also, as Storey (2005) suggested, even though 

an adult service agency is committed to providing 

a full continuum of work placements, it 

is unlikely that consumers will be able to 

choose any placement option since there may 

be limitations in the resources available; the 

agency may not have the capacity (i.e., staff, 

Choice Making / 571

transportation, commitment) to provide this 

full range of services; and consumers may be 

directed to certain job placements to keep the 

continuum viable (keep all placement options 

available). As Storey noted, such a situation 

provides an “illusion of choice” in which a 

menu of services is theoretically possible, but 

might not be achievable due to budgetary or 

other constraints. In both of these cases 

choices might have been provided but no real 

choice making occurred since consumers’ 

preferences and choices were not supported--in 

short, the action of choice making occurred 

but no meaningful change occurred 

due to it. As Agran et al. (2010) noted, this 

practice is disingenuous and may suggest that 

choice making is an activity that must be provided 

to consumers but one that has little or 

no influence on the nature or quality of their 

work experiences. As Brown, Bayer, and 

Brown (1992) indicated, individuals with intellectual 

disabilities need to believe that 

change is possible before they engage in selfdirected 

actions to promote such change. 

Additionally, Ward (2005) suggested that 

service providers must be committed to provide 

a variety of choice options consistent with 

an individual’s interests and preference. Consequently, 

when given a choice that involves 

either engaging in an activity or not—“Do you 

want to go bowling or not?,” this really isn’t 

choice making, since no other options are 

available. Far too enough such dichotomous 

choice-making opportunities are provided. As 

Bambara (2004) recommended, individuals 

should be exposed to option-rich environments 

in which they will have ample opportunities 

to identify, evaluate, and experience the 

consequences of their expressed preferences 

and choices. Having the choice of taking what 

is offered or nothing at all has little instructive 

value and does little to enhance the quality of 

an individual’s lifestyle. This type of choice 

making is referred to as a “Hobson’s Choice” 

(Brown, 2005) and, regrettably, may represent 

many of the choice-making situations provided 

to persons with disabilities. Ward suggested 

that choice making at a minimum 

should involve deciding which of two or more 

options the individual wishes to engage in. 

Further, the magnitude or scope of the life 

choices consumers make warrant further 

study. The available research suggests that 

choices involving minor or routine changes 

(e.g., time for a coffee break) are offered far 

more frequently than choices that may have a 

major impact on an individual’s life (e.g., 

change of job) (Burton Smith, Morgan, & 

Davidson, 2005; Stancliffe & Wehmeyer, 

1995). For example, Agran et al. (2010) reported 

that more consumers in their sample 

were asked what they wanted for lunch or 

what they wanted to do after work than if they 

wanted another job, who they wanted as a 

support person, or who they wanted to work 

with it. It would appear that major life decisions 

continue to be made others and consumers 

may be restricted to a small set of 

choice options that will have little or no impact 

on their quality of life. In this respect 

personal choice and autonomy are curtailed, 

and choice making is restricted to a relatively 

small pool of opportunities. Major work and 

life decisions continue to be externally controlled 

and consumers have a seemingly minor 

role in the direction their lives take. Consequently, 

the purpose of choice making— 

providing a means to express and control 

one’s life decisions—is greatly compromised. 

To correct this situation, it is critical that we 

not only provide consumers with ample 

choice-making opportunities but that we endeavor 

to provide choices that are personally 

meaningful and important. 

Interpreting Choices 

Choice making (and other forms of self-determination) 

is contingent on the assumption 

that a consumer’s expression of a choice or 

wish is understood by service providers or support 

personnel. Accordingly, communication 

competence is synonymous with self-determination 

(Brown, Gothelf, Guess, & Lehr, 1998). 

However, as Brown et al. noted, consumers 

who have severe communication challenges 

may employ nonsymbolic, idiosyncratic, inconsistent, 

or self-selected modes of communication 

to express their choices. Consequently, 

choice making for these individuals 

presumes that the communication receivers 

(e.g., caregivers, support people) can interpret 

such communication. In this respect, selfdetermination 

may be wholly dependent on 

others and is meaningful only to the extent 

that the choice is correctly interpreted. Most 


importantly, we must be certain that the message 

received is the message intended. Typically 

choice making is observed when an individual 

verbally or physically selects one 

stimulus (e.g., a specific support person) over 

another stimulus (e.g., another support person). 

For consumers who have communication 

challenges, oftentimes their preferences 

and choices need to be inferred through such 

responses as time engaged (e.g., more time 

more engaged, the more preferred the task), 

facial expressions (e.g., frown may suggest a 

non-preferred task), or sound production 

(e.g., a hum may suggest a preferred task). 

The responsiveness of partners then becomes 

a factor critical in choice making and reminds 

us that choice making is not a single, isolated 

behavior but one that involves reciprocal exchanges 

and environmental support (Bambara, 

2004). 

One method used to facilitate choice making 

for consumers who have communication 

challenges is the use of proxies. The assumption 

here is that a support person who knows 

a consumer well is in a good position to represent 

that person and make choices believed 

to be in that individual’s best interests. However, 

as discussed above, this assumes that the 

proxy truly knows what the consumer’s preferences 

are. Additional studies have examined 

this relationship and found great discrepancies 

between the choices made by consumers 

and the choices made by support personnel 

on their behalf (Neeley-Barnes, Marcenko, & 

Weber, 2008; Stancliffe, 1995). For example, 

Martin et al. (2006) reported that there was 

only an 18–36% agreement between consumers 

and caregivers when asked to indicate 

their preferred settings (job sites), activities 

(work tasks), and characteristics (ecological 

features of the job sites). Neely-Barnes et al. 

reported that the more proxies, the fewer 

choices individuals made. Last, Stancliffe indicated 

that when the agreement between consumers 

self-reports (choices) was compared to 

third-party reports the correlation when corrected 

for chance by kappa was uniformly low. 

In all, there appears to be a great discrepancy 

between support staff perceptions of what 

they believe consumers desire and the opinions 

of the consumers themselves. Hence, staff 

perceptions of the self-determination needs of 

consumers may be markedly different than 

those expressed by consumers. Brown and 

Brown (2009) suggested that proxy assessment 

is both invalid and challenging. For nonverbal 

individuals such procedures as using 

computer touch screens and microswitches 

have been suggested (Wehmeyer et al., 2007). 

Whatever methods we use it is obvious that we 

need to secure the opinions of consumers to 

ensure that programs are indeed driven by 

their preferences, needs, and interests. 

Employment-Related Choices 

As noted previously, transition and employment 

services are predicated on the assumption that 

consumers’ interests and preferences will drive 

skill development programs (improving consumer 

capacity) and job placement decisions 

(Martin et al., 2002). Asking an individual if he 

or she would like to work in a bowling alley 

when one does not exist in the community 

achieves the goal of providing choices but not its 

purpose—matching jobs to an employee’s preferences 

and interests so that appropriate planning 

can occur. A second and related assumption 

is that the choices of consumers will be 

honored and are compatible with existent work 

routines. Choice-making opportunities need to 

be perceived by consumers as natural and integral 

to work routines if they are to promote 

autonomy and independence. 

Choice-making opportunities are typically 

thought of as consumers choosing job types or 

preferred work tasks. With this information 

support personnel can develop and deliver 

skills development programs accordingly. 

However, as West and Parent (1992) suggested, 

numerous other choice-making opportunities 

can be incorporated into employment 

programs. These include: selecting 

support personnel or service providers, proximity 

to preferred co-workers, training methods, 

adaptive devices, changing job responsibilities, 

or resigning from a current position. 

Additionally, Martin et al. (2002) suggest that 

we take the next step and try to understand 

why consumers prefer certain jobs or work 

tasks. This is done by asking consumers if they 

prefer, for example, working alone or with 

others, or if they prefer to work where speed is 

important or not. By obtaining input from 

consumers about preferred work characteristics, 

a better match between job and employee 

Choice Making / 573

can be made. Last, because consumers may 

not be able to initially select job type, work 

task, or characteristic preferences, asking consumers 

to identify preferences and make 

choices should be conducted several times until 

there is a consistent pattern in responding 

(i.e., discernable preferences). 

Summary 

Choice making represents a critical step in 

facilitating consumers’ attainment of self-determination. 

It is believed that choice making 

initiates the self-determination process and 

provokes greater self-regulation by allowing 

individuals to make choices, act on these 

choices, and evaluate the resultant consequences. 

On the other hand, service providers 

may think of choice making as essentially another 

term for self-determination; that is, providing 

the former will produce the latter. In 

this respect choice making is thought of as an 

outcome rather than a means to achieve selfdetermination. 

Rather, it was recommended 

in this paper that choice making initiates a 

process that involves self-regulated planning 

to achieve a desired outcome, a means to 

evaluate this action, and the application of a 

further adjustment if satisfactory progress is 

not being made. The outcome of self-determination 

is achieved when consumers perform 

self-determined behaviors. As mentioned previously, 

for self-determination to be achieved 

we need to enhance an individual’s capacity 

and the opportunities we provide so that 

choices can match interests and preferences 

(Mithaug, 2005). It is critical that meaningful 

choices are naturally integrated into work routines 

and consumers are taught to perform a 

repertoire of self-determination strategies. By 

doing so, we will certainly ensure consumers’ 

autonomy and independence. 

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Received: 24 August 2010 



Choice Making / 575



Review of the Choice and Preference Assessment Literature 

for Individuals with Severe to Profound Disabilities 

Christopher A. Tullis, Helen I. Cannella-Malone, Abby R. Basbigill, 

Amanda Yeager, Courtney V. Fleming, Daniel Payne, and Pei-Fang Wu 

The Ohio State University 

Abstract: Since 2002, the body of literature examining choice interventions and preference assessments for 

individuals with severe to profound disabilities has grown substantially. This paper is an extension of the 

Lancioni, O’Reilly, & Emerson (1996) and Cannella, O’Reilly, & Lancioni (2005) papers and reviews 50 

studies conducted between 2002 and 2010 that were divided into five categories: (a) effectiveness of various 

preference assessment formats and methodologies, (b) comparisons of specific components of preference assessments, 

(c) underlying mechanisms of preference, (d) effects of choice on behavior, and (e) staff and participant 

training. Findings from these studies support previous research findings in that choice was an effective 

intervention for changing behavior, reinforcers were identified for individuals with severe to profound 

disabilities using preference assessments, and participants were taught to make, and staff were trained to 

provide, choices. Other major findings highlight some mechanisms that underlie preference and provide insight 

into some nuances of the various preference assessment methodologies. The findings are discussed in terms of 

their implications on practice related to individuals with severe to profound disabilities and suggestions for 

future research are provided. 

Research has demonstrated that individuals 

with severe to profound disabilities can demonstrate 

clear preferences through methodologically 

rigorous assessments and can make 

choices that have resulted in increased appropriate 

behavior and decreased challenging behavior 

(e.g., Cannella, O’Reilly, & Lancioni, 

2005; Lancioni, O’Reilly, & Emerson, 1996). 

Based on the available research, it appears 

that the provision of choice and identification 

of preferred stimuli among individuals with 

severe to profound disabilities is increasing, 

thus potentially increasing their overall quality 

of life. 

Although there appears to be a clear evidence-base 

supporting the use of preference 

assessments to identify reinforcers and choice 

interventions to change behavior, much of 

this research has been conducted by researchers 

rather than the direct-care providers (Cannella 

et al., 2005). Questions remain regard- 


be addressed to Helen I. Cannella-Malone, A348 

PAES Building, 305 W 17th Avenue, Columbus, OH 

43210. Email: malone.175@osu.edu 

ing how these assessments and interventions 

should be implemented in home, school, and 

work settings by parents, teachers, and other 

care providers. It is also unclear if one method 

of assessing preference is more appropriate 

for a particular type of individual, how reinforcing 

items identified through a preference 

assessment might might be in various contexts, 

or if choice provision is meaningful in 

all contexts. To determine if these and other 

questions regarding choice interventions and 

preference assessment methodologies have 

been addressed, this paper will review studies 

that have examined such interventions and 

assessments with individuals who have severe 

to profound disabilities. It represents an extension 

of the Lancioni et al. (1996) and Cannella 

et al. (2005) papers as it includes studies 

published between 2002 and 2010. During 

this time period, 50 studies examined the effects 

of choice making and preference assessments 

for individuals with severe to profound 

disabilities. 

After providing an overview of the available 

research literature, this paper will discuss the 

literature in relation to the following ques- 


tions: (a) Are choice interventions successful 

at reducing challenging behavior and increasing 

appropriate behaviors, and how have 

these interventions changed over time?, (b) 

How successful are preference assessments at 

identifying reinforcing stimuli, and how has 

their administration changed in recent years?, 

(c) How accessible are preference assessments 

and choice interventions to parents and staff 

who care and work for individuals with severe 

to profound disabilities?, and (d) What populations 

of individuals may benefit the most 

from preference assessment methodologies? 

Finally, potential lines for future research will 

be explored. 

Method 

Studies were included in this review based on 

the following criteria: each study (a) was an 

assessment or intervention study concerned 

with either choice or preference, (b) had at 

least one participant with a severe to profound 

disability, and (c) was published between 2002 

and 2010. Studies in which preference assessments 

were used but were not the focus of the 

study were excluded (e.g., if a preference assessment 

was used to identify items used in 

mand training). 

Articles that did not meet the inclusion criteria 

were excluded from the review. For example, 

studies were excluded if participants 

were not sufficiently described such that the 

reader could determine if the participants had 

a severe to profound disability. For example, 

Ciccone, Graff, and Ahearn (2007) was excluded 

because participants were described as 

having a diagnosis of a developmental disability 

and/or autism, no other information was 

available to determine severity of the disability 

(e.g., limited communication). 

Electronic searches were conducted using 

ERIC, PsycINFO, MedLine, and Google 

Scholar. Hand searches were also conducted 

using the reference sections of the articles 

identified through the electronic searches to 

identify a more complete set of articles. Sixtythree 

studies were identified and 50 studies 

met the inclusion criteria. Two independent 

readers summarized <strong>46</strong>% of the articles. Each 

summary included the reference, sample size, 

age of participants, stimuli used in the preference 

assessments, experimental design (if ap- 

plicable), type of preference assessment used, 

and the reported findings (i.e., positive, negative, 

or mixed). No major discrepancies were 

observed across readers (i.e., both readers 

noted the same information in the summaries). 

Studies included in this review were divided 

into five categories and are presented in Table 

1. Studies in the first category examined the 

effectiveness of various preference assessment 

formats and methodologies (e.g., Hanley, 

Iwata, Lindberg, & Conners, 2003; O’Reilly, 

Lancioni, & Sigafoos, 2004). Studies included 

in the second category compared the effects 

of various preference assessment formats or 

components within a preference assessment 

(e.g., Horrocks & Morgan, 2009; Kodak, 

Fisher, Kelley, & Kisamore, 2009). Studies in 

the third category examined the underlying 

mechanisms of preference for individuals with 

severe to profound disabilities (e.g., DeLeon, 

Frank, Gregory, & Allman, 2009: Glover, 

Roane, Kadey, & Grow, 2008). Studies in the 

fourth category examined the effects of 

choice on both appropriate and challenging 

behavior (e.g., Carlson, Luiselli, Slyman, & 

Markowski, 2008; Hoch, McComas, Johnson, 

Faranda, & Guenther, 2002). Finally, studies 

in the fifth category examined methods for 

training staff to provide choices as well as 

teaching individuals with severe to profound 

disabilities to make choices (e.g., Clevenger & 

Graff, 2005; Roscoe, Fisher, Glover, & Volkert, 

2006). 

For each study, Table 1 reports the number 

of participants with severe to profound disabilities 

(n), their age, the stimuli provided (e.g., 

tangible items), the experimental design used 

(where given), the preference assessment format, 

and the major findings. Eight preference 

assessment formats were examined in the 

studies reviewed and included: single stimulus 

(SS), paired choice (PC), multiple stimulus 

with replacement (MSW), multiple stimulus 

without replacement (MSWO), free operant 

(FO), response restriction (RR), concurrent 

operant (CO), and questionnaires (Q). In the 

SS assessment, a single stimulus was presented 

to the participant. In the PC assessment, participants 

could choose one of two options. In 

the MSW and MSWO assessments, an array of 

stimuli were presented to the participant, who 

was allowed to choose one item at a time from 

Review of Choice and Preference Assessment / 577

TABLE 1 

Studies Listed According to Categories with Number and Age of Participants (only those with a severe to profound disability), Experimental Design, Type of 

Stimuli Presented, Choice Format, and Results 

Stimuli Choice Format Results 

Category/Article Name n Age Design 12 

Assessing Preference 

Ahearn, Clark, DeBar, & Florentino. (2005). 2 11–13 ME Tangible items SS Positive 

On the role of preference in response competition. 

Cobigo, Morin, & Lachapelle. (2009). 19 23–58 N/A Work materials/ pictures PC Mixed 

A method to assess work task preferences. 

Didden, Korzilius, Kamphuis, Sturmey, Lancioni, & Curfs. (2006). 105 1–45 N/A N/A Q Positive 

Preference in individuals with angelman syndrome assessed by a modified 

choice assessment scale. 

Didden, Korzilius, Sturmey, Lancioni, & Curfs. (2008). 81 Mean Group Design N/A Q Positive 

Preference for water-related items in angelman syndrome, down 

age: 

syndrome, and non-specific intellectual disability. 

12 

Dozier, Vollmer, Borrero, Borrero, Rapp, Bourett, & Guiterrez. (2007). 2 6, 14 Reversal w/ AT Access to baseline or CO Positive 

Assessment for behavioral treatment versus baseline conditions. 

treatment conditions 

Fisher, Adelinis, Volkert, Keeney, Neidert, & Hovanetz. (2005). 2 13, 14 Reversal/AT Access to positive or CO Positive 

Assessing preferences for positive and negative reinforcement during 

negative reinforcement 

treatment of destructive behavior with functional communication 

training. 

4 14–21 Reversal Tangible/edible items PC Positive 

Fleming, Wheeler, Cannella-Malone, Basbagill, Chung, & Graham-Day. 

(2010). 

An evaluation of the use of eye gaze to measure preference of individuals 

with severe physical and developmental disabilities. 


Hanley, Iwata, Lindberg, & Conners. (2003). 2 34–66 N/A Leisure activities RR Positive 

Response-restriction analysis: I. assessment of activity preferences. FO Positive 

Hanley, Piazza, Fisher, & Maglieri. (2005). 2 5–8 ME Tangible items CO Positive 

On the effectiveness of and preference for punishment and extinction 

Reversal w/ Access to attention, FCT, CO Positive 

components of function-based interventions. 

ME 

punishment, 

reinforcement

TABLE 1 —(Continued) 





Keen & Pennell. (2010). 4 4–5 Reversal Leisure activities FO Mixed 

Evaluating an engagement-based preference assessment for children with 

autism. 

N/A Positive 

Kreiner & Flexer. (2009). 29 16–22 N/A Pictures of leisure 

Assessment of leisure preferences for students with severe developmental 

activities 

disabilities and communication difficulties 

Lattimore, Parsons, & Reid. (2003). 5 26–38 N/A Work materials MSW Positive 

Assessing preferred work among adults with autism beginning supported 

jobs: Identification of constant and alternating preferences. 

Mechling & Moser. (2010). 1 11–13 N/A Video clips N/A Positive 

Video preference assessment of students with autism for watching self, 

adults, or peers. 

O’Reilly, Lancioni, & Sigafoos. (2004). 1 5 Reversal Activities/toys PC Positive 

Using paired-choice assessment to identify variables maintaining sleep 

problems in a child with severe disabilities. 

10 32–52 AT Electronic devices CO Mixed 

Saunders, Saunders, Mulugeta, Henderson, Kedziorski, Hekker, & Wilson. 

(2005). 

A novel method for testing learning and preferences in people with 

minimal motor movement 

Smaby, MacDonald, Ahearn, & Dube. (2007). 3 4–7 N/A Social consequences SS post EXT Positive 

Assessment protocol for identifying preferred social consequences. 

Smith, Bihm, Tavkar, & Sturmey. (2005). 9 Adults N/A N/A FO Positive 

Approach-avoidance and happiness indicators in natural environments: a 4 7–9 N/A Staff members and tasks FO Positive 

preliminary analysis of the stimulus preference coding system 







Spevack, Yu, Lee, & Martin. (2006). 2 8, 12 Reversal Sensoryactivities SS Positive 

Sensitivity of passive approach during preference and reinforcer 

assessments for children with severe and profound intellectual 

disabilities and minimal movement 

Olfactory stimuli PC Mixed 

Wilder, Schadler, Higbee, Haymes, Bajagic, & Register. (2008). 2 13–38 Reversal w/ 

Identification of olfactory stimuli as reinforcers in individuals with autism: 

ME 

A preliminary investigation. 

Preference Assessment Comparisons 

Graff & Gibson. (2003). 2 14–20 Reversal Edible items, pictures PC Positive 

Using pictures to assess reinforcers in individuals with developmental 

disabilities. 

Graff, Gibson, & Gallatsatos. (2006). 4 14–15 Reversal w/ AT Tangible items/pictures PC Positive 

The impact of high- and low-preference stimuli on vocational and 

academic performances of youths with severe disabilities. 

Groskreutz & Graff. (2009). 5 15–17 Reversal Edible items PC Positive 

Evaluating pictorial preference assessment: The effect of differential 4 15–17 Reversal w/ AT Edible items PC Mixed 

outcomes on preference assessment results. 

Horrocks & Morgan. (2009). 3 18–22 N/A Work materials PC vs. Positive 

Comparison of a video-based assessment and a multiple stimulus to identify 

MSWO 

preferred jobs for individuals with significant intellectual disabilities. 


Kodak, Fisher, Kelley, & Kisamore. (2009). 4 3–10 Reversal Food/toys FO vs. MSW Mixed 

Comparing preference assessments: Selection- versus duration-based 

preference assessment procedures. 

Reed, Luiselli, Magnuson, Fillers, Vieira, & Rue. (2009). 1 19.5 AT Edible Items PC vs. Positive 

A comparison between traditional economical and demand curve analyses 

MSWO vs. 

of relative reinforcer efficacy in the validation of preference assessment 

FO 

predictions.






Reid, Parsons, Towery, Lattimore, Green, & Brackett. (2007). 12 29–76 N/A Work materials MSWO vs. Mixed 

PC vs. Q 

Identifying work preferences among supported worked s with severe 

disabilities: Efficiency and accuracy of a preference-assessment 

protocol. 

Thomson, Czarnecki, Martin, Yu, & Martin. (2007). 11 Adults N/A Edible/tangible PC vs. SS Positive 

Predicting optimal preference assessment methods for individuals with 

developmental disabilities. 

Mechanisms Underlying Preference 

DeLeon, Frank, Gregory, & Allman. (2009). 1 9–20 N/A Leisure items PC Positive 

On the correspondence between preference assessment outcomes and 

progressive-ration schedule of assessments of stimulus value. 

Glover, Roane, Kadey, & Grow. (2008). 3 10–16 AT w/ CC Unspecified PC Positive 

Preference for reinforcers under progressive- and fixed-ratio schedules: A 

CC w/ Reversal Positive 

comparison of single and concurrent arrangements. 

Lee, Yu, Martin, & Martin. (2010). 2 35, 37 Reversal Edible items PC Positive 

On the relation between reinforcer efficacy and preference. 

Kodak, Lerman, Volkert, & Trosclair. (2007). 1 4–8 ME/Reversal Edible/tangible items CO Positive 

Further examination of factors that influence preference for positive 1 Reversal Positive 

versus negative reinforcement. 

1 Reversal Positive 

Milo, Mace, & Nevin. (2010). 3 6–10 CC w/ Reversal Edible items CO Positive 

The effects of constant versus varied reinforcers on preference and 

resistance to change. 







Effects of Choice 

Cannella-Malone, DeBar, & Sigafoos. (2009). 2 11–13 MB CC VOCA/picture exchange CO Positive 

An examination of preference for augmentative and alternative 

communication devices with two boys with significant intellectual 

disabilities. 

Carlson, Luiselli, Slyman, & Markowski. (2008). 2 3–15 MB Clothing PC Positive 

Choice-making as intervention for public disrobing in children with 

developmental disabilities. 

Dixon & Falcomata. (2004). 1 31 N/A Not specified MSWO Positive 

Preference for progressive delays and concurrent physical therapy 

exercise in an adult with acquired brain injury. 

Harding, Wacker, Berg, Barretto, & Lee. (2005). 2 2–5 CC w/ Reversal Toys/parent attention CO Positive 

An evaluation of choice responding during assessment and treatment of 

problem behavior. 

Harding, Wacker, Berg, Winborn-Kemmerer, & Lee. (2009). 2 4 CC w/ Reversal Toys/parent attention CO Positive 

Evaluation of choice allocation between positive and negative 

reinforcement during functional communication training with young 

children. 

Positive 

Positive 

Negative 

Leisure activities Paired vs. 

alone 

Hoch, McComas, Johnson, Faranda, & Guenther. (2002). 3 9–11 AT or Reversal 

The effects of magnitude on choice and responding during play activities. 

w/ MB 


Positive 

Humenik, Curran, Luiselli, & Child. (2008). 1 7 Reversal Food Choice vs. 

Intervention for self-injury in a child with autism: effects of choice and 

no choice 

continuous access to preferred stimuli. 

Positive 

Reed, Pace, & Luiselli. (2009). 1 16 ME Tangible items Choice vs. 

An investigation into the provision of choice in tangible conditions of a 

no choice 

functional analysis.






CO Negative 

Positive 

Positive 

CO Positive 

Positive 

Sigafoos, Green, Payne, Son, O’Reilly, & Lancioni. (2009). 1 15 AT 

Speech generating 

A comparison of picture exchange and speech-generating devices: 

AT device/picture exchange 

Acquisition, preference and effects on social interaction. 

Reversal 

(PE) 

Sigafoos, O’Reilly, Ganz, Lancioni, & Schlosser. (2005). 2 12–13 MB VOCA 3 

Supporting self-determination in AAC interventions by assessing 

VOCA/PE 

preference for communication devices. 

Son, Sigafoos, O’Reilly, & Lancioni. (2006). 3 3–4 AT VOCA/PE CO Positive 

Comparing two types of augmentative and alternative communication 

systems for children with autism. 

Spevak, Martin, Hiebert, Yu, & Martin. (2005). 4 23–45 AT Work tasks N/A Negative 

Effects of choice of work tasks on on-task, aberrant, happiness, and 

unhappiness behaviors of persons with developmental disabilities. 

Tasky, Rudrud, Schulze, & Rapp. (2008). 3 21–42 Reversal Work tasks N/A Positive 

Using choice to increase on-task behavior in individuals with traumatic 

brain injury. 

Teaching Individuals to Make Choices and Training Staff to Provide Choice 

Opportunities 

Clevenger & Graff. (2005). 6 9–16 Reversal Edible items/pictures PC Mixed 

Assessing object-to-picture and picture-to-object matching as prerequisite 

skills for pictorial preference assessments. 

Positive 

Positive 

Leisure items PC 

CO 

3 N/A N/A 

CC 

Machalicek, O’Reilly, Chan, Rispoli, Lang, Davis, Shogren, Sorrells, 

Lancioni, Sigafoos, Green, & Langthorne. (2009). 

Using videoconferencing to support teachers to conduct preference 

assessments with students with autism and developmental disabilities. 

(Participants were undergraduate pre-service teachers) 







Positive 

Reid, Green, & Parsons. (2003). 2 N/A MP N/A Q, PC 4 

An outcome management program for extending advances in choice 

research into choice opportunities for supported workers with severe 

multiple disabilities. (Participants were job coaches) 

Roscoe & Fisher. (2008). N/A ME N/A MSWO/PC 4 

Positive 

Evaluation of an efficient method for training staff to implement stimulus 8 

preference assessments.(Participants were clinic trainees) 

Positive 

Roscoe, Fisher, Glover, & Volkert. (2006). 4 N/A MB w/ AT N/A MSWO/PC 4 

Evaluating the relative effects of feedback and contingent money for staff 

training of stimulus preference assessments. (Participants were clinic 

trainees) 

1 

ME: multi-element; AT: alternating treatments; CC: concurrent chains; MB: multiple baseline; MP: multiple probe. 

2 

For studies with multiple experiments, each experiment is presented separately as indicated by a split cell. 

3 

Voice output communication aid. 

4 

The choice formats presented represent the assessment methodologies on which the staff participants were trained in these training studies. 


the array; items were replaced in the array 

following a choice in the MSW and not replaced 

in the MSWO. In the FO assessment, 

items were arranged in an array and participants 

were allowed to engage with any or all 

items for the duration of the assessment. In 

the RR assessment, sessions were similar to the 

FO assessment, but once an item was determined 

to be preferred, it was not longer included 

in the array of items. In the CO assessment, 

participants selected a treatment from 

an array; following a treatment session, they 

were given the opportunity to choose what 

treatment they would receive in the next session. 

In the Q assessment, the participants’ 

parents and/or staff were asked what the participant 

preferred. 

The findings in Table 1 are classified as 

positive, negative, and mixed. In the first category, 

positive indicates that the study successfully 

identified a reinforcer hierarchy for all 

included participants, whereas mixed indicates 

that the study was successful in identifying a 

reinforcer hierarchy for some, but not all participants 

(Wilder et al., 2008). In the second 

category, positive indicates that when two different 

preference assessment formats (e.g., 

Horrocks & Morgan, 2009) were compared, 

the most effective reinforcers were identified 

by the same method for all participants. Mixed 

indicates that when different preference assessment 

formats or methodologies were compared, 

the most effective reinforcers were not 

identified by the same method for all participants. 

In the third category, positive is used to 

indicate that the high preference stimulus 

identified was the one that maintained responding 

under higher response requirements 

(e.g., DeLeon et al., 2009). Mixed is 

used to describe results indicating that stability 

of preference was not maintained for all 

participants (e.g., Cobigo, Morin, & 

Lachapelle, 2009) or that some but not all 

participants had a preference for a particular 

reinforcement magnitude. In the forth category, 

positive refers to those studies in which 

the provision of choice led to changes in behavior 

(e.g., Carlson et al., 2008). Negative is 

used either when no change in behavior was 

found (e.g., Sigafoos et al., 2009) or when no 

difference in behavior was found between 

choice and no choice interventions (e.g., Spevack, 

Martin, Hiebert, Yu, & Martin, 2005). In 

the final category, positive indicates that staff 

(or participants) were successfully trained to 

provide (or make) a choice. 

Overview of Studies 

Assessing Preference 

Nineteen studies assessed the preferences of 

individuals with severe to profound disabilities 

(Ahearn, Clark, DeBar, & Florentino, 2005; 

Cobigo et al., 2009; Didden et al., 2006; Didden, 

Korzilius, Sturmey, Lancioni, & Curfs, 

2008; Dozier et al., 2007; Fisher et al., 2005; 

Fleming et al., 2010; Hanley et al., 2003; Hanley, 

Piazza, Fisher, & Maglieri, 2005; Keen & 

Pennell, 2010; Kreiner & Flexer, 2009; Lattimore, 

Parsons, & Reid, 2003; Mechling, & 

Moser, 2010; O’Reilly, Lancioni, & Sigafoos, 

2004; Saunders et al., 2004; Smaby, MacDonald, 

Ahearn, & Dube, 2007; Smith, Bihm, Tavkar, 

& Sturmey, 2005; Spevack, Yu, Lee, & 

Martin, 2006; Wilder et al., 2008). For example, 

Ahearn et al. used a single stimulus preference 

assessment to identify preferred stimuli 

that were presumed to match—and not 

match—the sensory properties of stereotypy 

for two adolescent participants diagnosed with 

autism and severe to profound mental retardation. 

Items identified as high preference 

were then provided, and the effects of both 

matched and unmatched stimuli on levels of 

stereotypy were assessed using a multi-element 

design. For both participants, significantly 

lower levels of stereotypy were observed when 

matched or unmatched items were presented. 

Items presumed to match the sensory properties 

of stereotypy did not produce lower levels 

relative to unmatched stimuli, suggesting that 

the activities that do not match properties of 

stereotypy could also displace responding. 

Preference Assessment Comparisons 

Eight studies compared the effects of various 

preference assessment formats and methodologies 

(Graff & Gibson, 2003; Graff, Gibson, & 

Galiasatos, 2006; Groskreutz & Graff, 2009; 

Horrocks & Morgan, 2009; Kodak, Fisher, Kelley, 

& Kisamore, 2009; Reed, Pace, & Luiselli, 

2009; Reid et al., 2007; Thomson, Czarnecki, 

Martin, Yu, & Martin, 2007). For example, 

Kodak et al. compared the results of selection- 


(i.e., MSW) and duration-based (i.e., FO) 

preference assessments to determine which 

method identified the item that produced the 

highest rates of responding for four participants 

between the ages 2 and 10 with autism 

and other developmental disabilities. All participants 

engaged in limited communication 

and only one followed instructions requiring 

multiple steps. Following the preference assessments, 

reinforcer assessments were conducted 

comparing the high-preferred (HP) 

stimulus from each assessment. For two participants, 

the HP items identified with the 

MSW were more effective than the HP item 

identified with the FO. The remaining two 

participants engaged in undifferentiated responding 

during the reinforcer assessments, 

and the HP items maintained responding in 

reinforcer assessments. 

Mechanisms Underlying Preference 

Five studies evaluated the mechanisms underlying 

preference in individuals with severe to 

profound disabilities (DeLeon et al., 2009; 

Glover et al., 2008; Kodak, Lerman, Volkert, & 

Trosclair, 2007; Lee, Yu, Martin, & Martin, 

2010; Milo, Mace, & Nevin, 2010). For example, 

DeLeon et al. examined if items that differed 

in placement on a preference hierarchy 

would have different break points under a 

progressive ratio (PR) schedule of reinforcement 

with four participants with severe to profound 

disabilities. Paired choice preference 

assessments were conducted to identify a hierarchy 

of leisure items, followed by three PR 

analyses in random order. Prior to sessions, 

participants completed a known task three 

times, then they were given access to a high, 

medium, or low preference item. During PR 

sessions, the same item remained in view and 

one verbal prompt to complete the task that 

was presented. The stimulus being assessed 

was delivered on a PR schedule beginning 

with one response (e.g., single completion, 

two completions, etc.). The data indicated 

that participants completed more work when 

a more highly preferred stimulus was delivered 

and supports the conclusion that items 

on different ends of a preference hierarchy 

may support different amounts of work. 

Effects of Choice 

Thirteen studies assessed the effects of choice 

on task engagement, challenging behavior, 

and the affect of individuals with severe to 

profound disabilities (Cannella-Malone, Debar, 

& Sigafoos, 2009; Carlson et al., 2008; 

Dixon & Falcomata, 2004; Harding, Wacker, 

Berg, Barretto, & Lee, 2005; Harding, Wacker, 

Berg, Winborn-Kemmerer, & Lee, 2009; Hoch 

et al., 2002; Humenik, Curran, Luiselli, & 

Child, 2008; Reed, Pace, & Luiselli, 2009; Sigafoos 

et al., 2009; Sigafoos, O’Reilly, Ganz, 

Lancioni, & Schlosser, 2005; Son, Sigafoos, 

O’Reilly, & Lancioni, 2006; Spevack et al., 

2005; Tasky, Rudrud, Schulze & Rapp, 2008). 

For example, Tasky et al. evaluated the effects 

of choice on the task engagement of three 

women with traumatic brain injuries. For each 

participant, a list of tasks—requiring 10 to 15 

min to complete—designed to increase daily 

living skills was created. During baseline, participants 

were given tasks, asked to complete 

the tasks in the order presented, and return 

the completed list. In the choice condition, 

participants chose activities from a list and 

were instructed to complete the list in any 

order. In the yoked no choice condition, the 

activities chosen in the previous choice condition 

were assigned. Using a reversal design, 

the researchers found that all three participants 

engaged in higher levels of task engagement 

when they were given the opportunity to 

choose the task and completion order. 

Teaching Individuals to Make Choices and 

Training Staff to Provide Choice Opportunities 

Five studies focused on training staff to provide 

choice opportunities (Reid, Green, & 

Parsons, 2003) and implement preference assessments 

(Machalicek et al., 2009; Roscoe & 

Fisher, 2008; Roscoe et al., 2006), or teaching 

individuals with severe to profound disabilities 

to make choices (Clevenger & Graff, 2005). 

For example, Reid et al. taught two job 

coaches to provide choice opportunities to 

five supported workers with severe to profound 

disabilities. Job coaches were trained to 

provide different types of choices (e.g., location, 

task), use different formats (e.g., openended, 

two-option choice), and deliver the 

stimuli or activities once the choice was made. 


After training, feedback was provided to the 

job coaches on their performance in relation 

to baseline. Results indicated that increased 

choice provision occurred and was maintained 

above baseline for one-year for both 

job coaches. The supported workers responded 

to 94% of all choices. 

In the study by Clevenger and Graff (2005), 

prerequisite skills for pictorial preference assessments 

were assessed for six participants 

between the ages of 9 and 16 with autism and 

other developmental disabilities. In the first 

phase, picture to object and object to picture 

matching tests were conducted and three participants 

demonstrated matching skills with 

both tests. The remaining three participants 

engaged in some matching behavior, but not 

at a level of mastery. Paired choice preference 

assessments were then conducted with both 

the tangible item and a pictorial representation 

of the item. After preference hierarchies 

were identified, reinforcer assessments were 

conducted. For the three participants with 

matching skills, items identified with both the 

tangible item and pictorial preference assessments 

functioned as reinforcers. Only the tangible 

item preference assessment was successful 

in identifying reinforcers for the 

participants without matching skills, suggesting 

that matching (object to picture or picture 

to object) may be a prerequisite skill for using 

pictures to assess preferences. 


Comments on the Overall Effectiveness of Choice 

Interventions and Preference Assessment 

Methodologies 

As shown in Table 1, 14 of the 18 studies 

investigating various preference assessment 

methodologies and 10 of the 13 studies investigating 

the effects of choice on behavior reported 

positive results for the entire experiment. 

Overall, five studies reported mixed 

results and one reported clearly negative results. 

Four studies reported mixed or negative 

results for one experiment within the investigation. 

As in Cannella et al. (2005) a large 

number of studies reported positive results. 

The continued replication and extension of 

previous research on choice and preference 

assessments with positive outcomes has 

strengthened the literature base. The studies 

reviewed support the use of preference assessment 

methodologies as an effective means of 

identifying preferred stimuli for individuals 

with severe to profound disabilities and using 

preferred stimuli as a component in effective 

interventions. 

Positive outcomes for the choice interventions 

reviewed in the current paper—in combination 

with studies reviewed by Lancioni et 

al. (1996) and Cannella et al. (2005)—support 

the conclusion that choice interventions 

may be viewed as an evidence-based practice 

for individuals with severe to profound disabilities 

(Horner et al., 2005). Horner et al. outlined 

five standards that could be used to 

determine if an intervention or practice was 

evidence based: (a) the practice is described 

so that replication is possible, (b) outcomes 

and context associated with practice are defined, 

(c) a functional relation is demonstrated, 

(d) experimental control was demonstrated 

across a sufficient number of authors, 

settings, and participants, and (e) procedural 

integrity was documented and reported. 

First, the practice is described so that others 

may replicate the procedures. The continued 

expansion of literature on choice interventions 

in the past 14 years (cf., Cannella et al., 

2005; Lancioni et al., 1996; Table 1) supports 

the conclusion that procedures are clearly defined. 

For example Cannella-Malone et al. 

(2009) and Son et al. (2006) replicated the 

investigation of preference for augmentative 

and alternative communication devices by Sigafoos 

et al. (2005). 

Second, context and outcomes associated 

with practice are defined. Although it is impossible 

to define all potential contexts and 

outcomes, the present literature base contains 

a number of examples that may guide future 

research, such as participant age and the context 

where treatment occurs. The participant 

ages for the choice interventions included in 

the current review ranged from 2 to 40 years 

of age. Training contexts included home 

(e.g., Harding et al., 2009), play (e.g., Hoch et 

al., 2002), and community settings (e.g., Carlson 

et al., 2008). Similarly, diverse outcomes 

were present in the studies in the current 

review, including reducing challenging behavior 

(e.g., Carlson et al.; Humenik et al., 2008), 

increasing on-task behavior (e.g., Tasky et al., 


2008), and increasing adaptive behavior (e.g., 

Cannella-Malone et al., 2009; Harding et al.). 

Third, a functional relation is demonstrated 

between the treatment and resulting change 

in the target behavior. Thirteen studies on the 

effects of choice interventions on behavior are 

present across the current review (Cannella et 

al., 2005; Lancioni et al., 1996) with positive 

results. Positive in all three reviews indicated 

that the provision of choice led to a change in 

behavior indicating a functional relation. In 

the current review, 12 out of 13 studies implemented 

a single subject experimental design 

that demonstrated a functional relation. 

Three studies implemented a multiple baseline 

design (Cannella-Malone et al., 2009; 

Carlson et al., 2008; Sigafoos et al., 2005) 

where experimental control is demonstrated 

when and only when the intervention is implemented. 

Four studies implemented a reversal 

design (Harding et al., 2005; Harding et 

al., 2009; Humenik et al., 2008; Tasky et al., 

2008) in which experimental control is demonstrated 

when a behavior change is observed 

when and only when the intervention is implemented, 

and when the intervention is withdrawn, 

the target behavior returns to previously 

observed levels without treatment. Two 

studies implemented an alternating treatments 

design (Son et al., 2006; Spevack et al., 

2005) and one implemented a multielement 

design (Reed et al., 2009). In these designs, 

experimental control is demonstrated when 

one data path increases or decreases to a 

greater degree than the other independent 

variables tested. Finally, two used multiple experimental 

designs (Hoch et al., 2002; Sigafoos 

et al., 2009) to demonstrate experimental 

control. 

Fourth, experimental control was demonstrated 

across a sufficient range of studies, 

researchers, and participants. In the current 

review, nine of the thirteen studies focusing 

on choice interventions did not have overlapping 

first authors. That is, the first author of a 

study did not appear again in the literature 

search as first author on another study. Of 

these nine studies, results were positive for 

eight and negative for one. The eight studies 

with positive results included a total of 16 

individuals with various severe to profound 

disabilities, including traumatic brain injury 

(Tasky et al., 2008), autism (Carlson et al., 

2008), and developmental disabilities (Sigafoos 

et al., 2009). 

Lastly, practices were not implemented with 

documented fidelity. Studies included in the 

current review did not include data on treatment 

integrity, limiting support for choice interventions 

to be considered an evidencebased 

practice. Although a functional relation 

was demonstrated in the majority of studies— 

indicating the treatment was responsible for 

the behavior change—the extent to which the 

treatment was implemented as it was outlined 

should be viewed with some caution. 

Horner et al. (2005) suggested a criterion 

of five single-subject studies with acceptable 

experimental control, across at least three different 

researchers, and at least 20 participants 

across the five studies. Although treatment 

integrity data is lacking, the four other criteria 

have clearly been met, suggesting that choice 

interventions can be considered an evidencebased 

practice for individuals with severe to 

profound disabilities as defined by Horner et 

al. 

In addition to the support for choice interventions 

to be considered an evidence-based 

practice, the findings on preference assessments 

also have practical implications for the 

assessment of preferred stimuli and the guidance 

of interventions to encourage more independence 

and involve the individual in 

treatment implementation. For example, 

Hanley et al. (2005) assessed preference for 

treatment components in a functional communication 

training (FCT) package using a 

concurrent chains procedure. Participants 

demonstrated a clear preference for the treatment 

package that included FCT and punishment 

over the package that consisted of FCT 

and extinction. These data indicated that 

treatment selection may be guided empirically 

while still taking the individual’s treatment 

preference into account. 

One of the most significant areas where 

preference assessments and choice interventions 

may be useful is in implementing quality 

services for individuals with severe to profound 

disabilities. Cannella et al. (2005) suggested 

the use of preference assessments and 

choice interventions as an aid to guide the IEP 

process and enhance person-centered planning. 

Current research, though still applicable 

to a younger student population, may also 


have implications for supported work environments. 

As students grow older, a greater 

emphasis may be placed on vocational opportunities 

and independence in these settings. 

In the current review, seven studies 

were conducted in vocational settings or focused 

on vocational tasks (Cobigo et al., 

2009; Graff et al., 2006; Horrocks & Morgan, 

2009; Lattimore et al., 2003; Reid et al., 

2007; Spevack et al., 2008; Tasky et al., 

2008). For example, Lattimore et al. implemented 

multiple stimuli with replacement 

(MSW) preference assessments outside of 

the work context with five individuals to 

determine preference for specific work 

tasks. After preferences were identified, participants 

were given the choice of tasks to 

complete during their daily work routine. 

Data indicated that the MSW assessment was 

effective in identifying preferred work preferences 

for the participants. Increases in 

choice making were observed in participants 

who did not display stable work preferences, 

and stable choice making was observed in 

participants who displayed stable preferences 

during the MSW. These data suggest 

that including a choice component may enhance 

the vocational planning process for 

adults with severe to profound disabilities. 

Although a large number of investigations 

reported positive results, these results should 

be viewed with a degree of caution. Of the 

studies cited, 11 reported mixed findings overall 

or findings that were negative or mixed for 

at least one experiment in the investigation. 

For example, Sigafoos et al. (2009) reported 

positive findings in the final two phases, but 

negative findings in the first phase of the investigation. 

These findings are important to 

consider when replicating procedures for future 

research as well as in clinical practice. 

First, the findings may indicate further areas 

of research into the implementation of choice 

and preference assessment methodology. The 

failure of an assessment methodology to yield 

positive results may be an indicator of the 

need for procedural refinement. Second, 

mixed results may be an indication that specific 

procedures are not appropriate for use 

with certain populations of individuals or under 

specific environmental conditions. 

Accessibility of Preference Assessments and Choice 

Interventions 

All four studies focusing on staff training reported 

clearly positive results, indicating the 

potential to successfully teach direct-care staff 

members to implement choice interventions 

(Reid et al., 2003) and preference assessments 

(Roscoe & Fisher, 2008; Roscoe et al., 2006; 

Machalicek et al., 2009). Although these studies 

reported positive results, a potential limitation 

in the training literature is the degree 

that these procedures may be effective in 

training parents or other care providers in 

more naturalistic environments. Participants 

in all four studies were employed at the facility 

where the research was conducted or were 

supervised by the first author of the study, and 

training for two studies (Roscoe & Fisher, 

2008; Roscoe et al.) was conducted outside of 

the natural context. Both the population (i.e., 

therapists, job coaches) and the settings have 

the potential to limit the accessibility of choice 

and preference procedures to specific environments 

and individuals for three studies 

(Reid et al.; Roscoe & Fisher, 2008; Roscoe et 

al.). In contrast Machalicek et al. demonstrated 

a method of providing supervision and 

training in implementing preference assessment 

methodology via teleconference. The 

use of technology allowed the researchers to 

assess skill acquisition of the participants (preservice 

teachers) in the natural context with 

their students. 

Although it is important for professionals to 

know how to implement choice and preference 

methodologies, it may be even more useful 

to parents or other caregivers. Three articles 

that implemented choice interventions 

(Carlson et al., 2008; Harding et al., 2009; 

Humenik et al., 2008) and one preference 

assessment study (O’Reilly et al., 2004) included 

a parent, teacher, or other care provider 

as the interventionist. Carlson et al. implemented 

a choice intervention to decrease 

urinary incontinence and public disrobing for 

two individuals. Teachers were trained to implement 

the intervention, but data on their 

skill acquisition and treatment fidelity were 

not presented. Data indicated that the choice 

intervention decreased the occurrence of incontinence 

and disrobing for both participants. 

Additionally, the teachers did not re- 


port difficulty implementing the intervention 

nor did the experimenters observe difficulties. 

These data—along with those discussed previously—are 

promising for implementing preference 

assessments and choice interventions 

across a wide range of caregivers and practitioners 

in varied settings. 

Comments on Complexity of Preference 

In recent years, there has been a shift from 

assessing preference and comparing methodologies 

to investigating the underlying mechanisms 

of preference. Specifically, the extent 

to which availability, magnitude, and response 

effort may impact the effectiveness of an item 

identified as being highly preferred. For example, 

Glover et al. (2008) evaluated PR 

schedules when two stimuli were evaluated 

under single and concurrent arrangements 

and found that participants responded more 

for high preference stimuli under PR schedules 

than low preference stimuli, regardless of 

the presentation format. During single stimulus 

arrangements, low preference stimuli functioned 

as reinforcers for two participants. 

These results suggest that responding for high 

preference stimuli was not disrupted by the 

concurrent availability of a low preference 

stimulus and that a LP stimulus may be effective 

as a reinforcer under less effortful response 

requirements. 

These studies may have implications for the 

application of preference assessment methodologies 

in both clinical and classroom settings. 

Magnitude, availability, and persistence of a 

stimulus to function as a reinforcer may be 

manipulated to increase responding for adaptive 

behavior or to decrease inappropriate behavior. 

For example, during an academic program, 

reinforcement may be altered on a 

given dimension depending on the task difficulty 

to increase the probability of task compliance. 

Additionally, stimulus availability may 

be structured in a manner to decrease competition 

between two highly preferred items, 

which may increase the relative value of stimuli 

during instructional opportunities. 

Concluding Comments and Future Research 

In this paper, studies focusing on preference 

assessment methodologies and choice inter- 

ventions for individuals with severe to profound 

disabilities were summarized and discussed. 

Based on the results of these studies, 

research on choice is strengthening the evidence 

of its efficacy, and research on preference 

seems to be progressing toward a more 

complete description of the mechanisms and 

processes that underlie preference. 

The answers to the research questions 

posed at the beginning of this review are relatively 

clear, but should be further clarified. 

First, choice interventions continue to be effective 

for reducing challenging behavior and 

increasing appropriate behavior. Overall procedures 

have changed little. These procedures 

continue to have implications for enhancing 

programming in special education and noneducational 

settings (e.g., vocational settings, 

community, home, etc.). 

Second, preference assessments continue to 

be effective in identifying items that function 

as reinforcers. The most common methods 

for assessing preference in the studies reviewed 

were the PC and MSWO. Twenty studies 

used a PC preference assessment and six 

included an MSWO. The type of stimuli used 

in these assessments has expanded beyond 

edible and leisure items. For example, Wilder 

et al. (2008) assessed preference for olfactory 

stimuli with three adults diagnosed with autism 

and severe to profound mental retardation. 

A PC preference assessment was implemented 

to determine a hierarchy of preferred 

smells. In the subsequent reinforcer assessments, 

all participants engaged in increased 

levels of responding in relation to baseline, 

indicating that the highly preferred stimuli 

functioned as reinforcers. 

Third, preference and choice technologies—though 

very effective—may be inaccessible 

to individuals who are not systematically 

trained. The research-base supports the implementation 

of choice- and preference-based 

interventions to increase independence, decrease 

challenging behavior, and teach appropriate 

behavior, and that the available training 

protocols have been demonstrated to be effective 

(e.g., Roscoe & Fisher, 2008). One major 

limitation of this literature is the absence of 

training procedures that have been shown to 

be effective in teaching caregivers specific procedures. 

Without easily implemented procedures 

or training programs, research findings 


may be of little use to caregivers or other 

individuals without specialized training. 

Lastly, preference and choice methodologies 

seem to be beneficial for a wide range of 

individuals with severe to profound disabilities. 

Implementation of choice and preference 

technologies is effective for identifying 

various potentially reinforcing stimuli (e.g., 

edible items, leisure items, smells). Less apparent 

are strategies that are more effective 

with specific populations or individual characteristics. 

The effectiveness of the most widely 

used preference assessments (i.e., PC & 

MSWO) may be influenced by each individual’s 

behavioral repertoire or physical ability. 

For example, if an individual has a physical 

impairment (e.g., cerebral palsy) an MSWO 

may be ineffective as a means of determining 

preference due to limited mobility, whereas a 

PC assessment using eye gaze may be more 

appropriate (Fleming et al., 2010). Clevenger 

and Graff (2005) demonstrated that pictorial 

preference assessments were more appropriate 

for individuals who engaged in object-topicture 

matching. The effectiveness of any 

preference assessment methodology to identify 

reinforcers may be impacted by individual 

differences such as behavioral repertoire and 

physical ability. 

One method that may be promising is assessing 

prerequisite skills that may be required 

for an assessment to be applicable to a given 

population of individuals. Thomson et al. 

(2007) tested the efficacy of SS and PC preference 

assessments with 11 individuals diagnosed 

with severe disabilities. In the preassessment 

phase, participants were assessed with 

the Assessment of Basic Learning Abilities 

(ABLA; Kerr, Meyerson, & Flora, 1977) to 

determine individual skill levels. PC and SS 

assessments were then conducted with the 

participants. The data indicated that either 

assessment was effective in identifying highand 

low-preference items for individuals who 

had mastered two-choice discriminations on 

the ABLA. Although these results are positive, 

Thomson et al. did not conduct reinforcer 

assessments to determine the predictive validity 

of the assessments. Additionally the authors 

did not assess the effectiveness of the preference 

assessments with individuals that did not 

demonstrate mastery of two item discriminations 

on the ABLA. 

With regard to future research, it may be 

especially relevant to determine if there are 

prerequisite skills that influence the results of 

specific preference assessment methodologies 

and resulting choice interventions or specific 

individuals who may benefit from one type of 

assessment over another. No clear criteria exist 

to guide the use of one preference assessment 

over another, to determine who would 

benefit from a specific type of preference assessment, 

how much of the stimulus should be 

available (e.g., duration, magnitude), or what 

overall method is the most efficient and effective. 

Graff and Gibson (2003) reported mixed 

results when assessing preferences using pictures 

of stimuli and similar results were reported 

by Cobigo et al. (2009). These results 

indicate the potential for a requisite skill set 

for this type of assessment to be accurate. 

Another area of future research is on the 

complexity of preference. For example, what 

magnitude of a preferred stimulus is most 

effective, or how durable are the results of a 

preference assessment? Further understanding 

of preference may be required for assessments 

and interventions based on choice to 

be effective in less controlled environments 

(e.g., home or classroom). Current research 

supports the efficacy of using highly preferred 

items as reinforcers under lean schedules of 

reinforcement and that this effect is persistent 

in the presence of low preference stimuli 

(e.g., Glover et al., 2008). It is unknown if 

response allocation in the presence of other 

highly preferred items or moderately preferred 

items would yield the same or similar 

results. 

Additionally, methods for increasing the effectiveness 

of low preference stimuli to function 

as reinforcers may also be useful. Glover 

et al. (2008) demonstrated the reinforcing 

effectiveness of low preference items at a low 

schedule requirement. Further investigating 

the mechanisms that underlie preference may 

also shed light on methods of increasing preference 

measures for low preference items. 

This information may also be useful for increasing 

the effectiveness of lower preferred 

items to function as reinforcers (Hanley et al., 

2003). 

New research may also seek to determine 

the extent to which magnitude influences 

preference for items. Altering the magnitude 


of a preferred item while continuing to observe 

an increased response rate may have a 

great impact on the use of choice interventions 

in non-clinical settings. If a teacher, parent, 

or paraprofessional can deliver a small 

amount of a reinforcer and continue to observe 

persistent levels of a target behavior, the 

probability of that intervention continuing 

may increase. The effects of differing magnitudes 

may also impact the long-term effectiveness 

of choice interventions to decrease challenging 

behavior across settings and 

individuals. For example, magnitude of reinforcement 

may be increased or decreased depending 

on the probability of challenging behavior 

occurring in a specific environment. 

Another area of future research that has 

vast practical implications is training. Of the 

research currently reviewed, training participants 

consisted of professionals who were required 

to implement specific procedures as 

part of their job. Future research should investigate 

training packages to determine what 

type of training is the most efficient in teaching 

parents or other non-professionals to implement 

choice interventions and preference 

assessments. Further research in training professionals 

is also warranted. Only three studies 

presented data on skill acquisition of the intervention 

implementers (Machalicek et al., 

2009; Reid et al., 2007; Roscoe & Fisher, 2008; 

Roscoe et al., 2006). Future research should 

focus on what aspects of the training procedures 

were necessary and sufficient for skill 

acquisition to occur. These procedures should 

also be implemented with parents, paraprofessionals, 

teachers, and other direct-care providers 

to a greater degree to further demonstrate 

efficacy. 

The current literature base contains support 

for choice interventions to be classified as 

an evidence-based practice for individuals 

with severe to profound disabilities. One limitation 

is the lack of data on treatment fidelity. 

Future researchers should present this data in 

order to provide more support for a functional 

relation. Documenting treatment fidelity 

in a controlled setting may also aid researchers 

in constructing effective training 

programs for parents and other caregivers, 

which would allow for a higher degree of control 

over training before implementing the 

procedures in a more naturalistic context. 

Information from the current review supports 

the efficacy and utility of preference 

assessment methodologies and choice interventions 

for individuals with severe to profound 

disabilities and extends the findings of 

Cannella et al. (2005) and Lancioni et al. 

(1996). Overall, the area of choice and preference 

research seems to be shifting toward a 

more complete explanation of the mechanisms 

of preference, rather than primarily focusing 

on assessment. As choice and preference 

methodologies are refined, it will be 

important to collect data on the integrity of 

treatment implementation, the generality of 

methods to natural contexts, and the training 

of caregivers. Advancements in these areas are 

needed and would lend further support for 

choice and preference methodologies as evidence-based 

practice for individuals with severe 

to profound disabilities. 

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Effects of a Treatment Package on Imitated and Spontaneous 

Verbal Requests in Children with Autism 

Jennifer B. Ganz 

Texas A&M University 

Margaret M. Flores 

Auburn University 

Erin E. Lashley 

Northside Independent School District, San Antonio, TX 

Abstract: Students with autism spectrum disorders (ASD) have difficulties with verbal language. Many 

interventions to remediate such deficits require numerous materials and significant teacher time. This study 

sought to determine if a simple multi-component intervention that incorporated noncontingent reinforcement 

(NCR) and verbal modeling would result in increased spontaneous verbal requesting in two preschool boys with 

autism. Results indicated that the participants did increase use of spontaneous and imitated verbal requests. 

Implications are discussed. 

Deficits in communication and speech are a 

hallmark of autism spectrum disorders (ASD; 

American Psychiatric Association [APA], 

2000). Many individuals with ASD do not 

speak or have delayed communication skills 

(APA), including limited communication 

functions (e.g., requests and refusals; Ogletree, 

2008). Some have difficulty maintaining 

conversations and use repetitive or echolalic 

speech (APA; Janzen, 2003). Other aspects of 

speech may be delayed, including articulation, 

content, grammar, and using abstract concepts 

in language (Janzen). 

The National Research Council (2001) recommends 

that programming for children 

with ASD includes at least 25 hours per week 

of systematic instruction, focusing on functional 

and spontaneous communication. Such 

instruction may cost up to $60,000 per year 

(National Research Council). Thus, it is important 

to determine if some children with 

ASD respond to less costly, effective strategies, 

which allow precious resources, including personnel 

training time and cost, instructional 

time, and materials, to be reserved for those 


be addressed to Jennifer Ganz, Texas A&M University, 

Department of Educational Psychology, 4225 

TAMU, College Station, TX 77843-4225. Email: 

jeniganz@tamu.edu 

students who require costly and intensive interventions. 

Koegel, Koegel, Shoshan, and Mc- 

Nerney (1999) report that children with autism 

who demonstrate more frequent 

spontaneous communication, including nonverbal 

communication, prior to communication 

treatment respond better to such treatment. 

Several methods have been proposed to replace 

challenging behaviors with socially acceptable 

communication skills in children 

with ASD. Noncontingent reinforcement 

(NCR) focuses on increasing socially relevant 

skills and has been proven effective with individuals 

with a variety of disabilities. Further, 

elements of incidental teaching and time-delay 

have had promising results. 

Modeling of behaviors has been used to 

improve a variety of skills in children with ASD 

(Matson, Matson, & Rivet, 2007; Stahmer, Ingersoll, 

& Carter, 2003). This procedure, 

when used for modeling names of items for 

requesting, had also been called mand-modeling 

(Mobayed, Collins, Strangis, Schuster, & 

Hemmeter, 2000). Research has supported 

the use of in vivo modeling of peers and adults 

to promote labeling (Charlop, Schreibman, & 

Tryon, 1983) and following directions (Egel, 

Richman, & Koegel, 1981). In vivo modeling 

has also resulted in improved play and social 

skills in children with autism, including dis- 


playing affect (Gena, Couloura, & Kymissis, 

2005), cooperative play skills (Tryon & Keane, 

1986), and independent play (Jahr, Elevik, & 

Eikeseth, 2000). Thus, repeated, verbal modeling 

of names of preferred items may have 

potential in improving the communication 

skills in such children. 

Noncontingent reinforcement (NCR) involves 

giving children access to reinforcement 

regardless of whether or not they perform 

desired behaviors (Heflin & Alaimo, 2007; 

Tucker, Sigafoos, & Bushnell, 1998). NCR has 

been demonstrated to be effective in a few 

studies with individuals with ASD and developmental 

delays. Carr, Dozier, Patel, Adams, 

and Martin (2002) implemented NCR with 

response blocking to reduce object mouthing. 

Lalli, Casey, and Kates (1995) implemented 

NCR with and without extinction procedures, 

resulting in reduced aggressive and self-injurious 

behaviors. Roscoe, Iwata, and Goh (1998) 

compared the use of NCR with extinction and 

found both to be effective in reducing selfinjurious 

behaviors. Butler and Luiselli (2007) 

used noncontingent escape, combined with 

other interventions, to decrease aggression, 

self-injury, and tantrums in a child with autism. 

One study (Marcus & Vollmer, 1996) 

successfully demonstrated the combination 

NCR with differential reinforcement of alternative 

behavior to improve communication 

skills in children with mental retardation and 

autism. Similarly, Mildon et al. (2004) implemented 

noncontingent escape with functional 

communication training to improve verbal 

communication and compliance in a young 

child with autism. Finally, Ganz, Heath, 

Rispoli, and Earles-Vollrath (2010) noted a 

small increase in related speech during a noncontingent 

reinforcement plus verbal modeling 

procedure for a three-year-old with autism, 

which was not found during 

implementation of the Picture Exchange 

Communication System. 

Time-delay, when used to promote the use 

of speech in individuals with ASD, usually involves 

offering a child a reinforcing item, 

modeling the name of the item, and withholding 

the item until the child repeats the correct 

name of the item (Ross & Greer, 2003). Such 

a procedure is often limited to children who 

already speak, but need to learn new words. 

This procedure has also been successfully im- 

plemented within an incidental teaching 

model to teach speech within natural contexts 

(Charlop-Christy & Carpenter, 2000; McGee, 

Almeida, Sulzer-Azaroff, & Feldman, 1992; 

McGee, Krantz, Mason, & McClannahan, 

1983). 

The purpose of this study was to investigate 

the impact of implementing a multi-component 

instructional package, including NCR in 

combination with repeated verbal modeling, 

on spontaneous and imitated verbalizations in 

children with autism. The following research 

question was investigated: can children with 

autism who do not speak spontaneously (but 

can imitate 1–2 word phrases) learn to make 

spontaneous or imitated verbal requests with 

NCR and verbal modeling? While increases in 

spontaneous speech were preferable, data 

were also collected on imitated verbalizations; 

increased use of imitated speech may emerge 

before spontaneous speech in children with 

ASD and such progress in echolalic speech 

indicates an increased likelihood for further 

language development (Carpenter & Tomasello, 

2000). 

Method 

Participants and Materials 

Participants were recruited from a private 

school for children with ASD and other developmental 

disabilities. They were diagnosed 

with autism independently of this research by 

certified medical professionals according to 

the Diagnostic and Statistical Manual of Mental 

Disorders (DSM-IV-TR; American Psychiatric Association, 

2000) criteria. The participants’ diagnoses 

were then confirmed via the Childhood 

Autism Rating Scale (CARS; Schopler, Reichler, 

& Renner, 1988) and the Autism Diagnostic 

Observation Schedule (ADOS; Lord, Rutter, Di- 

Lavore, & Risi, 1999). Two children with autism 

were identified as potential participants, 

met the inclusion criteria, and completed this 

study. Participant descriptions given below reflect 

information obtained from the researchers’ 

administration of the CARS based on 

observations and the researchers’ administrations 

of the ADOS. 

Josiah was 3-years, 6-months old and was 

diagnosed with autism. He fell within the autism 

range on the ADOS and mild/moderate 

Multi-Component Communication Intervention / 597

autism on the CARS. Regarding social interactions, 

he would respond when an adult persisted 

in attempting to gain his attention, 

though he was not as responsive as typicallydeveloping 

peers. Josiah’s verbal communication 

was characterized by one-word utterances 

that were clearly articulated and infrequent 

spontaneous verbal requests. Josiah did not 

engage in severe problem behaviors, however, 

he often snatched or grabbed items he wanted 

due to a lack of more socially acceptable 

means of requesting. That is, he demonstrated 

spontaneous, but nonconventional means of 

communication. 

Ari was 4-years, 11-months old and was diagnosed 

with autism and speech impairment. 

He fell within the autism range on the ADOS 

and the mild/moderate autism range on the 

CARS. Specifically, Ari did not respond to a 

social smile, used few facial expressions directed 

at others, and did not initiate joint 

attention. Further, Ari’s verbal communication 

was characterized by infrequent use of 

one-word phrases, poorly articulated word approximations 

(e.g., he frequently left off final 

consonant sounds), and infrequent spontaneous 

use of verbal requests. Ari frequently engaged 

in tantrums (crying and screaming) 

when he did not obtain items he wanted. Ari 

did communicate spontaneously, using nonconventional 

means. 

Setting 

Both of the participants were enrolled in a 

private school for children with autism and 

developmental disabilities in three classes that 

served children from age two through elementary 

ages. The study took place in the school 

therapy room and in an office which was also 

used as an assessment clinic. The researcher 

sat within arm’s reach of the participants at a 

table or on the floor. Materials included a 

variety of toys and food items that the children 

preferred. 

Response Definitions and Measurement 

Each session included five opportunities, or 

trials, to request items. Each trial began when 

the researcher enticed the child by showing 

the item and ended 10 s after the participant 

was given the item (with or without correctly 

naming the item). Data were only recorded 

for trials during which the child showed interest 

in the item presented by gesturing or 

reaching for it or requesting it verbally. If the 

child did not show interest in the item, another 

item was presented. 

The researchers collected data on three dependent 

variables. For each opportunity to 

request an item, the observers recorded 

whether () or not (-) the participant engaged 

in that behavior. The dependent variables 

included (a) requested with verbal model 

(did the participant use the correct, intelligible 

name for the item following a verbal 

model from the researcher?), (b) requested independently 

(did the participant correctly name 

the item using a single word or phrase that 

correctly applied to the item shown and without 

a verbal model?), and (c) word approximations 

(did the participant use a correct word 

approximation with or without a verbal model 

[at least two phonemes from the actual 

word]?). Data for these variables were reported 

in percentage correct per session. The 

researchers also recorded word-for-word what 

the participants said during each trial. Data 

were collected during all intervention sessions. 

Experimental Design 

A multiple baseline design across object sets 

(3 reinforcing items per set) was used. The 

study was implemented in three phases across 

the three sets for each participant. The criterion 

for a phase change, that is implementation 

of intervention with the next set, was 

three consecutive sessions of 80–100% requested 

independently or word approximations, if 

the participant had poor articulation but was 

comprehensible. 

Procedure 

Reinforcer assessment. First, the participants’ 

parents completed reinforcer checklists. Then 

the experimenter offered each participant two 

to four items at a time, changing placement of 

the items for each presentation. Food items 

were offered separately from toys. The experimenter 

recorded tally marks to assess which 

items each participant chose most frequently. 

Each participant’s preferred items were di- 


vided into three sets that were approximately 

equivalent in terms of reinforcing value or 

topographic use. For example, Josiah’s set 1 

included a wind-up zebra, a laser disk, and 

light-up clackers; set 2 included a wind-up 

monkey, a sound stick, and stretchy string; 

and set 3 included a wind-up car, glitter wand, 

and fun fruit. 

Baseline. First, baseline data were collected. 

The experimenter held one of the 

child’s preferred items and enticed him by 

shaking the item, playing with it herself, holding 

it out as if to hand it to the child, or saying 

something to get the child’s attention, but did 

not name the item. If the participant showed 

interest in the item (e.g., reached for it, tried 

to grab it, gesturing toward it) without requesting 

it verbally, the experimenter would 

hold onto the item for a5stime delay. If the 

child did independently request the item or 

used a word approximation, the experimenter 

would immediately give the item to the child. 

If the participant did not correctly name the 

item, he would not be given the item until the 

end of the 5 s delay. Then, he would have brief 

(approximately 10 s) access to the item. At 

least two items from the current set were used 

during a single session. That is, the researcher 

would entice the participant with at least two 

items throughout the session, although the 

participant did not necessarily initiate trials 

with both. 

Multi-component instructional program. The 

intervention phase was identical to the baseline 

conditions with the addition of verbal 

models and expansion of delayed access to 

reinforcers. Intervention incorporated Tucker 

et al.’s (1998) suggestions regarding NCR: following 

initial continuous reinforcement 

(baseline), reinforcement should be faded to 

a lower frequency, and NCR should be combined 

with educational interventions (e.g., 

modeling). This implementation of NCR was 

a slight variation from how NCR is typically 

implemented in that the items were not freely 

available, but were frequently available without 

a prerequisite behavior. 

The experimenter would entice the child as 

in baseline. When the participant initiated a 

trial, the experimenter would give up to a5s 

time delay. If the child did not initiate a verbal 

request, following the 5 s delay, the examiner 

would continue to hold the item and correctly 

name it up to three times, pausing approximately 

2 s between each verbal model. If the 

child correctly requested the item at any time, 

he would be given access to the item for approximately 

10 s. Once he requested independently 

or requested following a verbal model, 

the verbal models would cease for the remainder 

of the trial, however, if he used a word 

approximation, he would immediately be 

given access to the item and the experimenter 

would continue to correctly model the word. 

If the child did not request independently or 

approximate the name, he would receive the 

item 2 s following the third verbal model and 

have access to it for 10 s. That is, he would 

non-contingently obtain the item, but after a 

delay. Making a request independently or a 

request following a verbal model resulted in 

quicker access to the item. 

Generalization. Generalization involved implementation 

of the intervention with a novel 

experimenter for one session for each set with 

the participants who completed all three intervention 

phases. These sessions took place 

within the two days following the completion 

of intervention. Procedures were identical to 

those described above in the previous section. 

Follow-up. Follow-up data were collected 3 

weeks following the cessation of intervention 

for each of the participants who completed all 

three phases of intervention. Follow-up followed 

the procedures described above in the 

intervention section. 

Analysis 

Results were analyzed via visual analysis of the 

graphically displayed data for each participant 

to determine if there was a functional relation 

between the intervention and the communication 

behaviors. Visual analysis inspected for 

ascending or descending trends, swiftness of 

change in trend and change in mean. Data 

were also analyzed via an effect size, the Improvement 

Rate Difference (IRD) (Parker, 

Vannest, & Brown, 2009). IRD calculates the 

amount of overlap between data points in different 

phases (e.g., baseline versus intervention) 

or between different treatments. IRD: 

(a) has a lengthy record in medicine, as “risk 

difference;” (b) has a known sampling distribution, 

thus p-values and confidence intervals 

may be calculated, and (c) correlates with 


other effect size measures and with visual analysis 

(Parker et al.). IRD measures the difference 

in “improvement rates” between two 

phases or interventions. “Improved” data 

points in phase A are larger than expected. 

Parker et al. recommend the following guidelines 

when interpreting IRD scores: IRDs of 

below 0.50 signify small or questionable effects, 

IRDs between 0.50 and 0.70 suggest 

moderate effects, and IRD scores at approximately 

0.70 or 0.75 or higher are large or very 

large effects. 

Inter-observer Agreement and Treatment Fidelity 

The observers included two college professors 

and a graduate research assistant, who are the 

authors of this article. Inter-observer agreement 

was assessed by using a point-by-point 

agreement ratio. The number of agreements 

was divided by the total number of agreements 

plus disagreements and multiplied by 

100 (Kazdin, 1982). An agreement occurred 

when two observers independently recorded 

the same score for a dependent variable during 

a trial. During baseline, inter-observer 

agreement was assessed for 58% of Josiah’s 

sessions and 64% of Ari’s sessions. Mean interobserver 

agreement for baseline was calculated 

at 100% and 98% (range 80%–100%), 

respectively. During intervention, inter-observer 

agreement was assessed for 81% of Josiah’s 

sessions and 85% of Ari’s sessions. Mean 

inter-observer agreement for intervention was 

calculated at 96% (range 73%–100%) and 

97% (range 80%–100%). Inter-observer 

agreement was assessed during generalization 

sessions for one (33%) of Josiah’s sessions and 

was calculated at 100%, and for two (67%) of 

Ari’s sessions and was calculated at 77% 

(range 73%–80%). Inter-observer agreement 

was assessed for one (33%) of Josiah’s 

follow-up sessions and was calculated at 100% 

and for all (100%) of Ari’s follow-up sessions 

and was calculated at 100%. Coefficients of 

agreement broken down by dependent variables 

are available by request from the authors. 

Treatment fidelity was assessed on six days 

of intervention. The following steps or components 

of intervention were assessed by an 

observer and she recorded whether or not the 

interventionist correctly implemented each 

step or component of intervention: (a) held 

item within view; (b) waited for the child to 

initiate for 5 s; (c) when the child did not 

initiate, chose another item; (d) when child 

initiated, but did not say the word or an approximation, 

gave verbal model of word; (e) 

gave up to three verbal models before giving 

the item; (f) waited approximately 2 s between 

verbal models of word; (g) if the child said the 

word or approximation, or after all verbal 

models, gave the item immediately; and (h) 

allowed the child to play with the item for at 

least 10 s. Treatment fidelity was assessed as 

100% for all observed sessions. 

Results 

Josiah 

Figure 1 presents Josiah’s requests following a 

verbal model, those that were requested independently, 

and the use of word approximations 

to make requests. 

Requested following a verbal model. There 

were no opportunities for Josiah to request 

following a verbal model during baseline sessions. 

During intervention for set 1, Josiah 

quickly began requesting following a verbal 

model at a high rate (mean 36%, range 

0–100% of the trials), however, these rapidly 

dropped in level as independent requests increased. 

During generalization for set 1, Josiah 

requested following a verbal model during 

0% of the trials. At follow-up, Josiah 

requested following a verbal model during 

40% of the trials. During intervention for set 

2, Josiah requested following a verbal model at 

a lower rates (mean 13%, range 0–40% 

of the trials). During generalization and follow-up 

for set 2, Josiah never requested following 

a verbal model. During intervention for 

set 3, Josiah requested following a verbal 

model at a low, but variable rates (mean 

33% range 0–100% of the trials). During 

generalization and follow-up for set 3, Josiah 

did not request following a verbal model. 

Requested independently. For set 1, Josiah infrequently 

requested independently (mean 

13%, range 0–20% of the trials) during 

baseline sessions. During intervention, Josiah 

gradually began independently requesting the 

items at a high rate (mean 60%, range 

0–100% of the trials). During generalization 


Figure 1. Josiah: Percentage of trials during which he requested following a verbal model, requested independently, 

and used word approximations. 

for set 1, Josiah independently requested the 

items during 60% of the trials. At follow-up, 

Josiah independently requested items during 

40% of the trials. For set 2, Josiah infrequently 

requested independently (mean 10%, 

range 0–20% of the trials) during baseline 

sessions. During intervention, Josiah began independently 

requesting the items at a higher 

rate (mean 73%, range 40–100% of the 

trials). During generalization for set 2, Josiah 

independently requested the items during 

60% of the trials. At follow-up, Josiah independently 

requested items during 60% of the trials. 

For set 3, Josiah never independently 

named the items during baseline sessions. 

During intervention, Josiah gradually began 

independently requesting the items at a 

higher rate (mean 57%, range 0–100% 

of the trials). During generalization for set 3, 

Josiah independently requested the items during 

100% of the trials. At follow-up, Josiah 

independently requested items during 80% of 

the trials. Overall IRD for Josiah’s independent 

(i.e., not following a verbal model) requesting 

was 0.73, 90% CI [0.47, 0.86], p 

.000. This suggests moderate to large effects 

for this participant and this dependent variable. 

Word approximations. For set 1, Josiah 

never used word approximations to make re- 


quests during baseline sessions. During intervention, 

Josiah used word approximations at a 

low rate (mean 6%, range 0–40% of the 

trials). During generalization for set 1, Josiah 

used word approximations during 40% of the 

trials. At follow-up, Josiah used word approximations 

during 20% of the trials. For set 2, 

Josiah infrequently used word approximations 

(mean 5%, range 0–20% of the trials) 

during baseline sessions. During intervention, 

Josiah infrequently used word approximations 

(mean 13%, range 0–40% of the trials). 

During generalization for set 2, Josiah used 

word approximations during 40% of the trials. 

At follow-up, Josiah used word approximations 

during 20% of the trials. For set 3, Josiah 

never used word approximations during baseline 

sessions. During intervention, Josiah used 

word approximations during only one session 


During generalization for set 3, Josiah did not 

use word approximations. At follow-up, Josiah 

used word approximations during 20% of the 

trials. Visual analysis clearly demonstrates that 

the intervention was far more effective for 

independent requests for Josiah, thus, IRD 

was not calculated for word approximations. 

Ari 

Figure 2 presents Ari’s correct requests with a 

verbal model, those that were correctly requested 

independently, and his use of word 

approximations to make requests. 

Requested following a verbal model. There 

were no opportunities for Ari to request following 

a verbal model during baseline. For set 

1, during intervention, Ari began requesting 

following a verbal model at a low rate 


During generalization and follow-up for set 1, 

Ari did not request following a verbal model 

during any of the trials. For set 2, during 

intervention, Ari correctly requested the items 

during only one session (mean 8%, range 

0–40% of the trials). During generalization 

and follow-up for set 2, Ari did not request 

following a verbal model during any of the 

trials. During intervention for set 3, Ari infrequently 

requested following a verbal model 



Ari did not request following a verbal model. 

Requested independently. For set 1, Ari never 

correctly and independently named the items 

he was requesting during baseline sessions. 

During intervention, Ari correctly and independently 

requested the items at low rates 



Ari never correctly and independently requested 

the items. For set 2, Ari did not correctly 

and independently name the items he 

was requesting during any baseline sessions. 

During intervention, Ari correctly and independently 

requested the items during only 

one session (mean 8%, range 0–80% of 

the trials). During generalization and follow-up 

for set 2, Ari did not correctly and 

independently request the items during any of 

the trials. For set 3, Ari infrequently correctly 

and independently named the items (mean 

6%, range 0–20% of the trials) during baseline 

sessions. During intervention, Ari correctly 

and independently requested the items 

at a low rate (mean 28%, range 0–80% of 

the trials). During generalization for set 3, Ari 

correctly and independently requested the 

items during 20% of the trials. At follow-up, 

Ari did not correctly and independently request 

items during any of the trials. Visual 

analysis clearly illustrates that the intervention 

had a greater impact on word approximations 

for Ari, thus, IRD was not calculated for independent 

requests. 

Word approximations. For set 1, Ari never 

used word approximations to make requests 

during baseline sessions. During intervention, 

Ari used word approximations at a high rate 


During generalization and follow-up for 

set 1, Ari used word approximations during 

100% of the trials. For set 2, Ari never used 

word approximations during baseline sessions. 

During intervention, Ari frequently 

used word approximations (mean 84%, 

range 20–100% of the trials). During generalization 

and follow-up for set 2, Ari used 

word approximations during 100% of the trials. 

For set 3, Ari used some word approximations 

(mean 20%, range 0–60% of the 

trials) during baseline sessions, using more 

near the end of baseline data collection. During 

intervention, Ari used word approximations 

frequently (mean 72%, range 20– 

100% of the trials). During generalization and 


Figure 2. Ari: Percentage of trials during which he requested following a verbal model, requested independently, 

and used word approximations. 

follow-up for set 3, Ari used word approximations 

during 80% of the trials. Overall IRD for 

Ari’s use of word approximations was 1.00, 

90% CI [0.75, 1.00], p .000. This intervention 

had large effects for word approximations 

for Ari. 


Both participants made progress in targeted 

behaviors, one in independent requests and 

the other in use of word approximations. Jo- 

siah rapidly began imitating the correct names 

and eventually began to spontaneously use the 

correct names. Following implementation in 

sets 2 and 3, Josiah rapidly began to independently 

request the items he was requesting. 

During generalization probes with a new communicative 

partner, he used the requests, 

though at a lower rate for set 2. At follow-up, 

Josiah maintained the use of correct and independent 

requests, though at lower rates 

than during intervention phases. While Josiah 

did use some word approximations, his artic- 


ulation was generally clear and he was able to 

correctly pronounce the names for the items 

most of the time. 

Ari also made sufficient progress during intervention, 

however, he had some difficulties 

with articulation and used word approximations 

more frequently than requests, either 

following a verbal model or independently. 

Ari did quickly meet criterion for word approximations 

for all sets and was able to get 

his message across. Further, he generalized 

use of the word approximations to a new communicative 

partner at high rates and maintained 

the use of the word approximations 

during follow-up. While, preferably, Ari would 

have increased in spontaneous communication 

during intervention, an increase in imitated 

verbalizations often precedes spontaneous 

communication in individuals with ASD 

and is a positive indicator of language development 

(Carpenter & Tomasello, 2000). 

Though we did not collect data on the independent 

use of word approximations, we did 

anecdotally note that, during the last sessions 

of intervention for each set, Ari began using 

word approximations without requiring an 

immediate verbal model. 

The implications of this study indicate that 

it may be possible to improve imitated or 

spontaneous speech skills in some students 

with autism with less costly and less intensive 

intervention packages, such as a combination 

of NCR and verbal modeling. One question 

that remains is what types of students would 

be most likely to respond to such interventions 

and which would require more intensive 

interventions. Considering the results of this 

study, it may be that children with higher rates 

of spontaneous communication skills, including 

nonconventional and less sophisticated 

skills (e.g., grabbing, reaching), and those 

who initially respond to others’ initiations 

more frequently (e.g., responding to their 

name) may more easily respond to simpler 

interventions. Further, younger students and 

those with more complicated health issues 

and those with more severe scores on diagnostic 

instruments may require more intensive 

and costly interventions. 

NCR has been shown to decrease mouthing 

behaviors (Carr et al., 2002), reduce aggressive 

and self-injurious behaviors (Lalli et al., 

1995). There is little research in which NCR 

has been used to increase communication. 

Therefore, the current study extended the 

line of research on the use of a treatment 

package, which included NCR and communication 

instruction, to increase communication 

behaviors (i.e., Marcus & Vollmer, 1996; Mildon 

et al., 2004). This intervention package 

incorporated Tucker et al.’s (1998) recommendations 

to fade initially high rates of reinforcement 

to lower rates and to combine NCR 

with educational interventions. Further, this 

study evaluated a modification on how NCR is 

typically implemented. 

This study has some limitations. First, due to 

the implementation of this study during the 

summer, follow-up data was collected only 

once, three weeks following the cessation of 

intervention. It is not possible to assess the 

long term outcomes of this intervention without 

the collection of maintenance data several 

months following the cessation of intervention. 

Further, the researchers did not systematically 

collect data on the independent use of 

word approximations. Though the researchers 

noted anecdotally that Ari began using 

independent word approximations near the 

end of intervention, it would have been useful 

to determine the extent to which he did so. 

Clearly, many children with ASD will require 

far more intensive communication interventions. 

Another limitation is the use of intervention 

conditions when measuring generalization 

and follow up. Without a true return to 

baseline conditions, it is unclear whether or 

not Josiah and Ari would continue to make 

independent requests without continued 

training, though they did demonstrate use of 

previously learned skills with minimal instruction. 

A final limitation is the use of a multielement 

intervention; because we always combined 

NCR with verbal modeling, it may be 

the case that modeling alone would have been 

sufficient and that NCR was irrelevant. Without 

investigating each component separately, 

we are unable to make the case that the combined 

intervention is necessary. 

The current study included a small sample 

of children and was an initial demonstration 

of the combination of naturalistic teaching 

and NCR. Further replication is needed to 

generalize the results and refine the procedures. 

Future research is needed with children 

with varied characteristics, within differ- 


ent settings, such as inclusive learning 

environments, and with larger groups of children. 

Future research is needed to investigate 

whether NCR would affect more complex 

communication behaviors. 

Another area of future research is the use of 

NCR combined with verbal modeling by parents, 

caregivers, and teachers in natural settings 

such as home and childcare settings. 

Implementation in these settings might allow 

for varied and more complex requests than 

were allowed with the design of the current 

study. Future research might investigate the 

ease with which these strategies might be implemented 

by parents, caregivers, and teachers 

as well as their effectiveness in increasing 

others types of communication behaviors 

across settings. 

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Received: 31 August 2010 






Effects of Presession Satiation on Challenging Behavior and 

Academic Engagement for Children with Autism during 

Classroom Instruction 

Mandy J. Rispoli 

Texas A&MUniversity 

Jeff Sigafoos 

Victoria University of Wellington 

Soyeon Kang 

University of Texas at Austin 

Richard Parker 

Texas A&MUniversity 

Mark F. O’Reilly 

University of Texas at Austin 

Russell Lang 

Texas State University 

Giulio Lancioni 

University of Bari 

Abstract: We evaluated the effects of presession satiation on challenging behavior and academic engagement 

during subsequent classroom activities for three 5–6 year-old children with autism. The percentage of 10-s 

intervals with challenging behavior and academic engagement during 20-min classroom activity sessions was 

observed under two conditions. One condition involved presession satiation, in which participants were given 

unrestricted access to tangible items that maintained their challenging behavior prior to the classroom sessions. 

This presession satiation continued until the children rejected the tangible item three times. The second condition 

did not entail presession satiation prior to the beginning of classroom sessions. Effects of the two conditions on 

challenging behavior and academic engagement were evaluated using individual participant alternating 

treatments designs. Results demonstrated that the presession satiation condition was associated with consistently 

lower percentages of intervals with challenging behavior and consistently higher percentages of intervals with 

academic engagement. 

Children with autism spectrum disorder 

(ASD) often engage in challenging behaviors, 

which can lead to social isolation and decreased 

time spent in instruction (Horner, 

Albin, Sprague, & Todd, 2000). Antecedent 

interventions have been successfully used to 

decrease challenging behavior (Kern, 

Choutka, & Sokol, 2002). Antecedent interventions 

involve altering the environment to 

eliminate variables that set the occasion for 

challenging behavior (Luiselli, 2006). Recently, 

a subcategory of antecedent interventions 

for challenging behavior has gained at- 


be addressed to Mandy J. Rispoli, Texas A & M 

University, 4225 TAMU, College Station, TX 77843. 

Email: mrispoli@tamu.edu 

tention. This category focuses on addressing 

an individual’s motivation to engage in a specific 

behavior and is referred to as the manipulation 

of motivating operations (MO) (Laraway, 

Snycerski, Michael, & Poling, 2003). An 

MO is an event that alters the value of reinforcement 

and the frequency of behavior previously 

correlated with such reinforcement 

(Laraway, et al. 2003). 

In some cases, biological events, such as 

hunger, lack of sleep, or illness can function 

as MOs by altering an individual’s motivation 

to engage in a specific behavior (e.g. Carr & 

Smith, 1995; O’Reilly, 1995; O’Reilly, 1997). 

For example, Kennedy and Meyer (1996) conducted 

a functional analysis of three individual’s 

challenging behavior across several weeks. 

They found that when the participants had 

less sleep (two participants) or were experi- 

Effects of Presession Satiation / 607

encing allergy symptoms (one participant), 

they engaged in higher levels of challenging 

behavior in relation to instructional demands. 

Thus, these biological-setting events appeared 

to make demands more aversive, thereby increasing 

the participant’s motivation to escape 

or avoid those tasks. This change in motivation 

resulted in an increase in challenging 

behavior, which had in the past enabled the 

individuals to escape from or avoid the tasks. 

Previous access to reinforcement can also 

impact an individual’s motivation to engage in 

challenging behavior. For example, McComas, 

Thompson, and Johnson (2003) examined 

the effects of prior attention on levels of 

challenging behavior. Participants were exposed 

to a functional analysis procedure similar 

to that described by Iwata and colleagues 

(1982/1994), following 10-min of presession 

attention or following 10-min of no attention. 

Results showed that the functional analysis 

that followed presession access to attention 

was associated with lower levels of challenging 

behavior than the functional analysis following 

presession periods without attention. Presession 

attention may have functioned as an 

abolishing operation (i.e., satiation) thus reducing 

levels of attention-seeking behavior 

while no presession attention may have functioned 

as an establishing operation (i.e., deprivation) 

and thus subsequently increasing 

the value of attention and the frequency of 

attention-maintained challenging behavior. 

A core diagnostic feature for autism spectrum 

disorder according to the Diagnostic 

and Statistical Manual (DSM-IV) is engagement 

in compulsive or repetitive behaviors 

(American Psychiatric Association, 1994). Previous 

research has demonstrated that individuals 

with autism can engage in these repetitive 

interactions with tangible items. For example, 

Reese and colleagues (2003) conducted a 

functional assessment interview with caregivers 

of 100 young children with ASD. They 

found that 85% of participants engaged in 

perseverative behavior with 30% of the children 

engaging in challenging behavior in order 

to access perseverative activities. Based on 

these findings, it may be important to consider 

interventions that can successfully decrease 

the motivation to engage in such perseverative 

activities among individuals with 

ASD. 

Over the course of several studies, we have 

developed a methodology to evaluate and 

treat challenging behavior by altering the individual’s 

motivation to engage in such behavior 

(O’Reilly, et al. 2008; O’Reilly et al. 2009; 

Lang, et al. 2009; Lang, et al. in press; Rispoli 

et al. in press). This methodology involves 

conducting an analogue functional analysis to 

determine the maintaining consequence for 

the individual’s challenging behavior. Next, 

we evaluate the child’s mands to determine 

when they have reached a level of satiation. 

Communication of satiation was defined as 

the individual’s rejection of the maintaining 

consequence (e.g., a highly preferred toy) of 

their challenging behavior. Satiation was believed 

to be achieved once the participant 

rejected the toy three times. Following the 

third rejection, the child enters into the problematic 

situation that was previously associated 

with challenging behavior. Results from 

these studies demonstrated that the participants 

engaged in lower levels of challenging 

behavior following the satiation condition 

when compared to a no presession access condition. 

The purpose of this study was to replicate 

and extend these procedures to classroom settings. 

Specifically, we evaluated the influence 

of presession satiation on levels of challenging 

behavior and academic engagement for three 

boys with autism in their classrooms during 

group instruction. 

Method 

Participants 

Three boys with autism participated in this 

study. Participants were referred to the study 

by their teachers or administrators who reported 

that participants engaged in challenging 

behavior during group instruction when 

preferred items were in sight but unavailable. 

Preferred items were identified via a preference 

assessment described below. Each participant 

was assessed using the Vineland Adaptive 

Behavior Scales (Sparrow, Balla & 

Cicchetti, 1984) and the Childhood Autism 

Rating Scale (Schopler, Reichler, & Renner, 

1988). Analogue functional analyses (Iwata, et 

al. 1994) were conducted to assess the function 

of each participant’s challenging behav- 


TABLE 1 

Participant Characteristics 

Participant Gender Age Ethnicity Diagnosis CARS 

Jacob Male 5 African American PDD-NOS 33 (mild to 

moderate 

autism) 

Geoffrey Male 6 Asian American Autism 30.5 (mild to 

moderate 

autism) 

Donovan Male 6 African American Autism, speech 

impairment 

iors. Table 1 provides participant descriptions 

with respect to gender, age, ethnicity, diagnosis, 

and diagnostic assessment results. 

Jacob was a 5-year-old African-American 

male diagnosed with Pervasive Developmental 

Disorder, Not Otherwise Specified (PDD- 

NOS). Jacob attended a self-contained classroom 

in a private school for children with 

disabilities. Jacob scored 33 on the CARS, 

which placed him in the mild to moderate 

range on the autism spectrum. His overall 

adaptive age equivalency on the Vineland 

Adaptive Behavior Scales was 2 years 9 

months. Jacob communicated spontaneously 

using 5 to 6 word phrases. A preferred toy for 

Jacob was a toy microphone. When left alone 

with the microphone, Jacob would repeatedly 

sing the same song, “Twinkle, Twinkle, Little 

Star.” If Jacob was unable to access the microphone 

he would engage in challenging behavior 

including (a) elopement: moving at least 2 

feet away from the instructional area without 

the teacher’s permission, (b) aggression: striking 

others with hand or object, and (c) protesting: 

loud vocalizations including “no,” 

“stop,” “go away,” or crying. 

Geoffrey was a 6-year-old Asian-American 

male diagnosed with autism. Geoffrey attended 

an inclusive kindergarten class in a 

small private school. He received a score of 

30.5 on the CARS, which placed him in the 

mild to moderate range of autism and had an 

overall age equivalency of 1 year 8 months on 

the Vineland Adaptive Behavior Scales. Geoffrey 

communicated using two to three word 

utterances and manual signs. Geoffrey at- 

49 (severe 

autism) 

Vineland 

adaptive age 

equivalent 

2 years 9 

months 

Vineland adaptive 

behavior composite 

standard score 

tended an inclusion classroom for part of his 

day. In this classroom, Geoffrey often played 

with a plastic ball slide. Geoffrey would watch 

the balls roll down the slide and count each 

ball. When access to the ball slide was prevented, 

Geoffrey’s challenging behavior included 

(a) hand mouthing: placement of fingers 

past the plane of the lips in order to suck 

or bite, and (b) elopement: pushing his body 

away from table or teacher in an attempt to 

leave the instructional area. 

Donovan was a 6-year-old African-American 

male diagnosed with autism and speech impairment. 

Donovan attended a self-contained 

classroom for students with autism in a public 

school. Donovan obtained a score of 49 on the 

CARS, which placed him in the severe range 

of autism. His overall adaptive age equivalency 

was 1 year on the Vineland Adaptive Behavior 

Scales. Donovan communicated requests by 

leading adults by the hand to items or activities 

in the room. Following verbal prompts, 

Donovan could request items using vocal approximations. 

Donovan’s preferred toy in the 

classroom was a Magna Doodle®. Donovan 

would write the capital and lower case form of 

letters on the Magna Doodle®. When he 

could not access the Magna Doodle®, Donovan 

would engage in challenging behaviors 

including (a) elopement: rising from his chair 

in an attempt to leave the instructional area, 

(b) aggression: biting or attempting to bite 

others, and/or hitting others with his hands, 

and (c) jumping up and down on his toes 

repetitively. 

64 

1 year 8 months 40 

1 year 0 months 37 


Assessments 

Preference assessment. Classroom teachers 

and parents were asked to provide a list of 

eight toys that they believed the participant 

preferred while at school. The participant’s 

preference for these items was then assessed 

using a paired choice preference assessment 

(Fisher et al., 1992). Specifically, participants 

were presented with two toys at a time and the 

toy that the participant selected was recorded. 

Each of the eight items was paired with each 

of the other items in a randomized sequence 

with the location of each item alternated between 

the left and right side of the table to 

control for potential position biases. Trials 

continued until each toy had been paired with 

all other toys in each possible position. The 

percentage of opportunities in which each toy 

was selected was calculated to establish a rank 

order of toys from most to least preferred. 

Each participant’s most preferred toy was used 

in the tangible condition of the functional 

analysis and in the presession satiation conditions. 

Functional analysis. Eligibility for participation 

in this study required evidence that 

each child’s challenging behavior was maintained 

by positive reinforcement in the form 

of access to preferred toys. Analogue functional 

analyses were conducted with each participant 

to determine the maintaining consequence(s) 

for his challenging behavior using 

individual multielement experimental designs 

(Barlow, Nock, & Hersen, 2009). The functional 

analysis consisted of four 5-min conditions: 

(a) attention, (b) tangible, (c) escape, 

and (d) play. The sequence of these conditions 

was held constant across each participant. 

Procedures were similar to those described 

by Iwata et al. (1994), however, an 

alone condition was not conducted because of 

school policy (children were not allowed to go 

unsupervised). 

Analogue functional analyses were conducted 

in a conference room or an empty 

classroom within each participant’s school. 

These rooms contained a table and at least 

three chairs and were void of extraneous instructional 

or play materials. During the functional 

analysis materials related to the assessment 

conditions were present. These 

included papers for the researcher to “read” 

during the attention condition of the functional 

analysis, the most preferred item identified 

via a paired choice preference assessment 

(Fisher et al., 1992) for the tangible 

phase, and instructional materials related to 

the participant’s Individualized Education 

Program (IEP) goals. Instructional materials 

consisted of items such as shapes, letters, lacing 

cards, picture cards of animals, and colored 

blocks. 

Results of the analogue functional analyses 

demonstrated that each participant’s challenging 

behavior was maintained, at least in 

part, by access to their most preferred toy. 

(Functional analysis session by session data are 

available from the corresponding author 

upon request). Jacob engaged in challenging 

behavior in the tangible (M 77%; range 

50% to 100%) and attention conditions (M 

19%; range 3% to 33%) of the analogue functional 

analysis. Geoffrey’s challenging behavior 

occurred primarily in the tangible condition 

(M 22%; range 3% to 43%) with lower 

levels of challenging behavior in the demand 

(M 4%; range 3% to 17%), and attention 

conditions (M 3%; range 3% to 13%). Donovan’s 

challenging behavior occurred primarily 

in the tangible condition (M 43%; range 

20% to 70%) with lower levels of challenging 

behavior in the attention (M 3%; range 0% 

to 10%), and play conditions (M 5%; range 

0% to 27%). Donovan also showed an increasing 

trend in challenging behavior during the 

demand condition (M 32%; range 3% to 

77% of intervals) of the functional analysis. 

Communication of rejection. Following the 

analogue functional analysis, behavioral indicators 

of satiation were assessed according to 

the methodology described by O’Reilly et al 

(2009). Teachers and parents were asked to 

identify how each participant communicated 

they no longer wanted to play with a toy or 

engage in an activity. To verify that participants 

used these behaviors to communicate 

rejection, each participant was exposed to two 

conditions: (a) access to a highly preferred 

item and (b) access to a non-preferred item. 

Each condition lasted 10 min and was conducted 

five times with each participant using 

an alternating treatments experimental design 

(Barlow et al., 2009). 

In the highly preferred item condition, the 

participant was presented with a highly pre- 


TABLE 2 

Operationalized Definitions for Target Behaviors 

Participant Challenging behavior Rejecting Behavior 

Jacob Moving at least 2 feet from instructional area, 

hitting others with hand or object, verbal 

protesting/crying 

Geoffrey Hand mouthing, moving hands in air 

repetitively, pushing away from 

table/therapist 

Donovan Lifts bottom off chair, biting or attempts to 

bite, hitting others with hands, jumping up 

and down 

ferred item, identified during the paired 

choice preference assessment. Using a partial 

interval recording system, data were collected 

on the percentage of 10-s intervals in which 

the participant engaged in the identified rejecting 

behavior. The first author was present 

during each session but did not interact with 

the participant except to re-present the item 

to the participant following rejecting behavior. 

In the non-preferred item condition, the 

participant was presented with a non-preferred 

item. This item was the lowest ranked 

item according to the results of the paired 

choice preference assessment. Procedures 

during this condition were identical to those 

used in the highly preferred item condition 

and data were collected on the percentage of 

10-s intervals in which the participant engaged 

in the identified rejecting behavior. Table 2 

provides operational definitions for each participant’s 

challenging behaviors and rejecting 

behavior. 

Presession Satiation versus No Presession Access 

Conditions 

Participants were exposed to two conditions 

(a) presession satiation of preferred toy versus 

(b) no presession access to the preferred toy 

(i.e., deprivation) prior to 20-min classroom 

sessions. An alternating treatments design 

(Barlow et al., 2009) was used to compare the 

effects of the two conditions on each participant’s 

subsequent challenging behavior and 

academic engagement during the 20 min 

classroom sessions. 

Says “He’s all done,” or 

“Finished” 

Pushes item away 

Walks 2 feet from item 

Setting and materials. Classroom sessions 

were conducted in the participant’s typical 

classroom during group instructional activities. 

These instructional activities varied across 

participants but were held constant for each 

participant. For example, group instruction in 

Donovan’s and Jacob’s class activities included 

listening to a story, watching a video, and 

building with blocks. Group instruction for 

Geoffrey focused on academic skills such as 

completing phonics worksheets, writing in a 

journal, and listening to poems. During the 

classroom sessions, three to four students were 

seated at a table or on the floor with access to 

instructional materials. The item maintaining 

challenging behavior (i.e., each participant’s 

preferred tangible toy) was visible but not accessible 

during the classroom sessions. 

Data collection. Two dependent variables, 

challenging behavior and academic engagement, 

were defined and measured in this 

study. Challenging behavior was defined individually 

for each participant. Operationalized 

definitions of these behaviors are presented in 

Table 2. Challenging behavior data were collected 

using 10-s partial interval recording. 

Academic engagement was defined as being 

appropriately involved with the instructional 

materials (c.f., O’Reilly et al., 2005). Appropriate 

involvement required that the participant 

engage with the materials in the manner 

intended, for example placing puzzle pieces 

in a puzzle, looking at picture books, and 

placing pegs into pegboards. Academic engagement 

was measured during classroom sessions 

using 10-s whole interval recording. 


Interobserver agreement. A second observer 

simultaneously and independently recorded 

data on the target behaviors for at least 30% of 

all sessions for each participant during each 

phase of the study. Interobserver agreement 

(IOA) was calculated by dividing the total 

number of agreements for each interval by the 

total number of intervals. IOA scores for each 

session were added together and divided by 

the total number of sessions in which reliability 

data were gathered in order to calculate 

the overall mean IOA. The mean IOA combined 

across all sessions, dependent variables, 

and participants was 96% (range, 82% to 

100%). 

Procedural fidelity. Task analyses of the procedural 

steps were created for each phase of 

this study. Procedural fidelity was calculated 

by dividing the number of steps completed 

correctly by the total number of steps in the 

procedure and multiplying by 100%. Procedural 

fidelity was assessed by an independent 

observer for 33% of sessions for each participant 

in each phase of the study with 100% 

correct implementation. 

Procedure 

Presession conditions. During the presession 

satiation condition, participants were 

given free access to their preferred tangible 

item in an empty conference room or classroom 

within the school. The first author 

handed the preferred item to the participant 

and instructed him to play with the item. The 

first author remained in the room but did not 

provide any additional attention or instruction. 

If the participant engaged in rejecting 

behavior, the first author re-presented the 

item to the participant. This procedure was 

followed for the first and second instances of 

rejecting behavior. Following three rejections, 

the presession condition was terminated and 

the participant immediately entered into the 

classroom session. 

The no presession access condition involved 

prohibiting the participant from accessing 

the preferred tangible prior to the 

classroom session that day. The participant 

participated in all school routines, but did not 

have access to his or her preferred tangible 

item. Classroom sessions were held at the 

same time of day for each participant. This 

allowed the duration of the no presession access 

condition to remain constant for each 

participant. 

Classroom sessions. Classroom sessions immediately 

followed presession conditions. 

During classroom sessions, participants were 

seated at a table or on the floor near three to 

four peers. Instructional materials were available 

and all students were instructed to interact 

with the materials. The first author sat with 

the participant on the floor or at the table. 

Classroom sessions were characterized by low 

levels of demands and high levels of attention, 

which approximated typical classroom conditions 

and served to control escape-maintained 

and attention-maintained challenging behaviors. 

The first author modeled appropriate 

use of the materials but never prompted the 

participant to engage with the instructional 

materials. Additionally, the first author provided 

attention (praise) to the participant every 

30 seconds. The first author did not respond 

to instances of challenging behavior 

except to physically guide the individual back 

to the instructional area or to block access to 

the preferred tangible. The discriminative 

stimulus (S D ) for challenging behavior (each 

child’s preferred tangible item) was present 

but unavailable throughout the classroom session. 

Results 

Figure 1 shows the percentages of 10-s intervals 

with challenging behavior across classroom sessions 

and under the two conditions for each 

participant. All three children had higher levels 

of challenging behavior under the no presession 

access condition and lower levels of challenging 

behavior following presession satiation. Jacob 

engaged in higher levels of challenging behavior 

in the classroom following no presession 

access (M 64%; range <strong>46</strong>% to 95%) than 

following the presession satiation condition 

(M 0.2%; range 0% to 1%). Similarly, Geoffrey 

engaged in higher levels of challenging behavior 

following the no presession access condition 

(M 16%, range 10% to 23%) compared 

to the presession satiation condition (M 3%; 

range 1% to 4%). Donovan engaged in comparatively 

higher levels of challenging behavior following 

the no presession access condition (M 

28%, range 20% to 35%) and lower levels of 


Figure 1. Percentage of intervals with challenging behavior. 


challenging behavior in the presession satiation 

condition (M 4%, range 3% to 6%). 

Figure 2 presents the effect of the MO manipulation 

on academic engagement. Higher 

levels of academic engagement following presession 

satiation to the preferred tangible 

were observed for all three participants. Following 

presession satiation to the microphone 

Jacob engaged in very high levels of academic 

engagement in the classroom (M 91%; 

range 85% to 100%). In the no presession 

access condition Jacob’s academic engagement 

in the classroom was considerably lower 

(M 26%; range 5% to <strong>46</strong>%). In the presession 

satiation condition Geoffrey demonstrated 

high levels of academic engagement 

(M 91%; range 88% to 96%). During the no 

presession access condition, Geoffrey had 

lower levels of academic engagement (M 

43%; range 26% to 58%). In the presession 

satiation condition Donovan demonstrated 

higher levels of academic engagement (M 

79%, range 57% to 91%). During the no presession 

access condition, Donovan had lower 

levels of academic engagement (M 29%, 

range 17% to <strong>46</strong>%). 

A NAP (Non-overlap of All Pairs) analysis 

(Parker & Vannest, 2009) was conducted for 

each participant’s data across the two conditions 

of presession satiation and no presession 

access using the dominance statistic, Mann- 

Whitney U, (MW-U) within the NCSS statistical 

package (Hintze, 2004). MW-U outputs 

smaller and larger U values (US and UL), and 

NAP equals their difference divided by their 

sum: (UL - US)/(UL US). The resulting 

NAP value was 1, indicating that 100% percent 

of the data showed no overlap between the 

two conditions for each participant on both 

challenging behavior and academic engagement. 

Therefore the two data clusters were 

highly separated. 

The non-overlap NAP indices calculated for 

the three separate series (one for each participant) 

were then combined, using Meta-analysis 

methods in the free software package, 

WinPEPI (Abramson & Gahlinger, 2001). 

NAP values and their standard errors were 

entered into WinPEPI, and were combined 

using a fixed effects model, which assumes 

that each individual series is an estimation of 

the same true effect. The combining method 

was based on weighted averages, with the 

weights being reciprocals of the variances. 

This more heavily weights longer data series 

(Abramson, 2004). The omnibus NAP nonoverlap 

for the three individual series for challenging 

behavior and all three individual series 

for academic engagement was 100%, with 

95% confidence limits 0.57 to 1.43. Therefore, 

for our obtained overall NAP of 1 for challenging 

behavior and NAP of 1 for academic 

engagement, we can be 95% sure that the true 

NAP is somewhere between 0.57 and 1.43. 


The purpose of this study was to evaluate the 

effect of presession satiation on challenging 

behavior and academic engagement for three 

boys with autism who engaged in tangibly 

maintained challenging behavior. Participants 

were exposed to one of two conditions prior 

to group instruction sessions in their classroom: 

presession satiation or no presession 

access to their preferred tangible item. It was 

hypothesized that participants would engage 

in lower levels of challenging behavior following 

presession access to the preferred tangible. 

This access decreases the reinforcement 

value of the tangible item and correspondingly 

decreases the frequency of challenging 

behavior previously correlated with accessing 

the tangible (i.e., toys). It was also hypothesized 

that following presession satiation, participant 

academic engagement would increase 

as a by-product of the reduction in challenging 

behavior based on previous study outcomes 

(Rispoli et al., in press). Results of the 

MO manipulation support these hypotheses. 

All participants engaged in lower levels of 

challenging behavior and higher levels of academic 

engagement following presession satiation. 

These results also support previous research 

demonstrating reductions in 

challenging behavior as a result of presession 

manipulations (e.g. Lang et al., 2009; McComas, 

Thompson, & Johnson, 2003; O’Reilly, 

2008; Rispoli et al., in press). 

One explanation for these results is the manipulation 

of the MO. In this study, satiation 

may have been achieved by providing the participants 

with presession access to their highly 

preferred tangible. By creating a state of satiation 

the reinforcing value of the tangible may 

have been reduced. The participant’s rejec- 


Figure 2. Percentage of intervals with academic engagement. 


tion of the preferred item signaled a reduction 

in that item’s reinforcing value and functioned 

as a behavioral indicator of satiation. 

This presession access may have also contributed 

to the increase in academic engagement 

in the subsequent classroom session. By 

decreasing each child’s motivation to engage 

in challenging behavior, the child may have 

allocated his behavior towards accessing reinforcement 

derived from academic engagement. 

With the decrease in the reinforcing 

value of the tangible item, the participants 

may have had more opportunity to seek out 

and access novel communities of reinforcement. 

Interactions with the classmates, the 

teacher, or instructional materials may have 

become more reinforcing relative to the tangible 

item following presession satiation. Additionally, 

most of the participants’ topographies 

of challenging behavior conflicted with 

academic engagement. For instance elopement 

and aggression are incompatible with 

academic engagement. Thus, by reducing the 

frequency of challenging behavior there may 

have been an increase in opportunities for 


The reductions in challenging behavior in 

the classroom following the presession satiation 

condition suggest that the MO was successfully 

isolated and manipulated. In all classroom 

conditions tangibly maintained 

challenging behavior was placed on extinction 

such that the participants were never given 

access to the tangible items. By holding consequences 

constant across the two conditions, 

the only manipulation was presession access to 

the tangible item. Furthermore, classroom activities 

were held constant for each participant 

thereby reducing the influence of possible extraneous 

variables such as task preference, on 

levels of challenging behavior. 

While presession satiation may explain the 

reduction in challenging behavior, other variables 

may have also contributed to the effectiveness 

of this intervention. For example, the 

effectiveness of the presession satiation condition 

on reducing challenging behavior may 

have been enhanced by the consideration of 

functional analysis results. Previous research 

has shown that MO interventions may not be 

effective when they are not matched to the 

function of challenging behavior (McComas 

et al., 2003). In light of this, each participant’s 

challenging behavior was first assessed using 

analogue functional analyses. The presession 

satiation condition was then carefully designed 

to reflect the tangible function of the 

participants’ challenging behavior. Furthermore, 

the tangible item used was confirmed 

by the results of a paired choice preference 

assessment and presession access was determined 

by behavioral indicators of satiation. 

Thus, the MO manipulation was directly 

linked to assessment results for each participant. 

The decrease in challenging behavior and 

increase in academic engagement reported 

here may also depend, in part, on the characteristics 

of the participants. Each participant 

had a diagnosis of an autism spectrum disorder. 

It is possible that the MO manipulation 

addressed a core behavioral characteristic of 

autism. The Diagnostic and Statistical Manual 

(DSM-IV) describes individuals with autism as 

often engaging in compulsive or repetitive behaviors. 

All participants in this study engaged 

with their preferred tangible in a restrictive 

and repetitive manner. Jacob sang “Twinkle, 

twinkle litter star” into his microphone repeatedly 

and would verbally protest when asked to 

sing a different song. Geoffrey counted each 

ball as it exited the plastic ball drop. Finally, 

Donovan drew the uppercase and lowercase 

letters F and R on the Magna Doodle®. The 

presession access to the toys may have reduced 

the value of the participants’ compulsive engagement 

with these items thereby allowing 

them to engage in other behaviors, including 


Several limitations of this study must be considered 

when interpreting these results. First, 

the influence of MOs is only one explanation 

for the changes in performance. Other behavioral 

mechanisms (e.g., schedules of reinforcement) 

may have influenced the results 

even though the manipulation of the MO fits 

conceptually with the outcomes of this study 

and supports previous research in this area. 

Second, the experimental design did not include 

a baseline phase. Thus, while the effects 

of the presession satiation condition appeared 

to improve both dependent variables as compared 

to the no presession access condition, a 

comparison against baseline levels of these 

responses cannot be made. Third, the duration 

of presession satiation conditions varied 


across and within participants. The mean 

lengths of presession satiation conditions were 

11, 21, and 23 minutes for Jacob, Geoffrey, 

and Donovan, respectively. Such variability 

may present an additional consideration when 

scheduling and implementing this intervention 

in regular public school settings. 

Results from this study have several implications 

for practitioners. First, this intervention 

may be especially useful when the discriminative 

stimulus for challenging behavior cannot 

be removed from the environment. In such 

instances, addressing the motivation to engage 

in challenging behavior may provide an 

effective means of reducing challenging behavior 

(O’Reilly et al., 2008). Classroom 

teachers may incorporate periods of free access 

to the maintaining consequence for challenging 

behavior in their daily classroom 

schedule. If a student is known to engage in 

tangibly-maintained challenging behavior 

during a particular activity, the teacher may 

provide the student with access to the tangible 

item for periods of time immediately prior to 

the difficult activity. 

Second, presession interventions may reduce 

the need for one-on-one support in inclusive 

classrooms. By abolishing the value of 

reinforcement for challenging behavior prior 

to a classroom situation, the individual may be 

less likely to engage in such behavior and thus 

require less behavioral support from teachers 

and staff. Another benefit that is particularly 

noteworthy is the effect of this MO manipulation 

on multiple outcomes. Students with autism 

often require multiple interventions for 

decreasing challenging behaviors (Reese et 

al., 2003) and additional interventions for increasing 

appropriate skills. Implementing numerous 

interventions for multiple students in 

a classroom may impede treatment fidelity 

and overwhelm service providers. Therefore, 

the efficiency of this intervention may be appealing 

to practitioners. More research is 

needed to examine the use of MOs to affect 

multiple response classes of behavior simultaneously. 

This study highlights several areas that warrant 

further empirical attention. First, researchers 

should explore the application of 

MO interventions in other applied settings 

including the community and home environments. 

Second, previous research has shown 

that preferences for specific tangible items 

may vary across time (Zhou, Iwata, Goff, & 

Shore, 2001). As a result, a tangible item that 

does not evoke challenging behavior one day 

may evoke such behavior on another day. For 

individuals whose challenging behavior is 

maintained by access to multiple tangible 

items, it may be helpful to assess preferences 

prior to MO manipulations regularly in order 

to enhance intervention effectiveness. 

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Final Acceptance: 21 October 2010 




Ten-year Cumulative Author Index of the Journals Education 

and Training in Mental Retardation and Developmental 

Disabilities, Education and Training in Developmental 

Disabilities, and Education and Training in Autism and 

Developmental Disabilities 2001, 36(1) through 2010, 45(4) 

Stanley H. Zucker and Silva Hassert 


Abstract: This cumulative author index was developed as a service for the readership of Education and 

Training in Autism and Developmental Disabilities. It was prepared as a resource for scholars wishing to access 

the 391 articles published in volumes 36–45 of this journal. It also serves as a timely supplement to the 25-year 

(1966-1990) cumulative author index published in 1991 and the 10-year (1991-2000) cumulative author 

index published in 2001. 

Since many literature reviews may involve tracking authors and their research programs across a variety of 

studies, and individual authors may not always be “first” authors, this index was prepared with a crossreference 

of all authors to each citation. In total, 1163 author citations are included. It is our hope that this 

bibliographic index will help facilitate access to available information on research, practice, and issues related 

to autism, intellectual disabilities, and other developmental disabilities. 

Aborn, L. (2004). See citation #279. 

Acar, C. (2004). See citation #120. 

Agran, M. (2001). See citation #369. 

Agran, M. (2002). See citation #170. 

1. Agran, M., & Krupp, M. (2010). A preliminary 

investigation of parents’ opinions about 

safety skills instruction: An apparent discrepancy 

between importance and expectation. 

45(2), 303–311. 

2. Agran, M., Alper, S., & Wehmeyer, M. (2002). 

Access to the general curriculum for students 

with significant disabilities: What it means to 

teachers. 37(2), 123–133. 

3. Agran, M., Sinclair, T., Alper, S., Cavin, M., 

Wehmeyer, M., & Hughes, C. (2005). Using 

self-monitoring to increase following-direction 

skills of students with moderate to severe 

disabilities in general education. 40(1), 3–13. 

4. Agran, M., Wehmeyer, M., Cavin, M., & Palmer, 

S. (2010). Promoting active engagement in 


be addressed to Stanley H. Zucker, Mary Lou Fulton 

Teachers College, Arizona State University, 1050 S. 

Forest Ave., PO Box 871811, Tempe, AZ 85287- 

1811. E-mail: <strong>etadd</strong>@asu.edu. 

the general education classroom and access 

to the general education curriculum for students 

with cognitive disabilities. 45(2), 163– 

174. 

Aguilera, A. (2008). See citation #249. 

5. Akmanoglu, N., & Batu, S. (2004). Teaching 

pointing to numerals to individuals with autism 

using simultaneous prompting. 39(4), 

326–336. 

6. Akmanoglu-Uludag, N., & Batu, S. (2005). 

Teaching naming relatives to individuals with 

autism using simultaneous prompting. 40(4), 

401–410. 

Alant, E. (2007). See citation #35. 

Alazetta, L. (2006). See citation #352. 

Alberto, P. (2006). See citation #49. 

Alberto, P. A. (2002). See citation #329. 

Alberto, P. A. (2008). See citation #80. 

Algozzine, B. (2006). See citation #178. 

Allinder, R. M. (2005). See citation #316. 

7. Allor, J. H., Champlin, T. M., Gifford, D. B., & 

Mathes, P. (2010). Methods for increasing 

the intensity of reading instruction for students 

with intellectual disabilities. 45(4), 

500–511. 

8. Allor, J. H., Mathes, P., Roberts, K., Jones F., & 

Champlin, T. (2010). Teaching students with 

Cumulative Author Index, Volumes 36–45 / 619

moderate intellectual disabilities to read: An 

experimental examination of a comprehensive 

reading intervention. 45(1), 3–22. 

9. Allor, J., Mathes, P., Champlin, T., & Cheatham, 

J. P. (2009). Research-based techniques for 

teaching early reading skills to students with 

intellectual disabilities. 44(3), 356–366. 

Alper, S. (2002). See citation #2. 




10. Alpern, C. S., & Zager, D. (2007). Addressing 

communication needs of young adults with 

autism in a college-based inclusion program. 

42(4), 428–436. 

Amos, B. A. (2006). See citation #202. 

Anderson, H. (2003). See citation #167. 

Andrews, A. (2009). See citation #217. 

Angell, M. E. (2005). See citation #18. 

Angell, M. E. (2006). See citation #19. 

11. Angell, M. E., Bailey, R. L., & Larson, L. (2008). 

Systematic instruction for social-pragmatic 

language skills in lunchroom settings. 43(3) 

342–359. 

Anthony, A. (2002). See citation #265. 

Antoine, K. (2009). See citation #288. 

Antonucci, M. (2009). See citation #217. 

Archwamety, T. (2002). See citation #180. 

Arens, K. B. (2007). See citation #89. 

12. Arens, K., Cress, C. J., & Marvin, C. A. (2005). 

Gaze-shift patterns of young children with 

developmental disabilities who are at risk for 

being nonspeaking. 40(2), 158–170. 

13. Arthur, M. (2003). Socio-communicative variables 

and behavior states in students with 

profound and multiple disabilities: Descriptive 

data from school settings. 38(2), 200– 

219. 

Asmus, J. M. (2008). See citation #<strong>46</strong>. 

Aspy, R. (2007). See citation #254. 

Aucoin, M. (2007). See citation #330. 

Ayres, K. M. (2004). See citation #317. 




14. Ayres, K. M., & Langone, J. (2005). Intervention 

and instruction with video for students 

with autism: A review of literature. 40(2), 183– 

196. 

15. Ayres, K. M., Langone, J., Boon, R. T., & Norman, 

A. (2006). Computer-based instruction 

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16. Ayres, K., Maguire, A., & McClimon, D. (2009). 

Acquisition and generalization of chained 

tasks taught with computer based video instruction 

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508. 

17. Baer, R. M., Flexer, R. W., & Dennis, L. (2007). 

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Bailey, R. L. (2008). See citation #11. 

18. Bailey, R. L., & Angell, M. E. (2005). Improving 

feeding skills and mealtime behaviors in children 

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98. 

19. Bailey, R. L., Stoner, J. B., Parette, H. P. Jr., & 

Angell, M. E. (2006). AAC team perceptions: 

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Bak, S. (2003). See citation #204. 

Baker, J. N. (2009). See citation #245. 

Baker, S. R. (2001). See citation #349. 

Balboni, G. (2003). See citation #326. 

Bambara, L. (2001). See citation #209. 

20. Bambara, L. M., & Gomez, O. N. (2001). Using 

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complex problem-solving skills to adults with 

moderate and severe disabilities. 36(4), 386– 

400. 

Banda, D. (2010). See citation #101. 

Banda, D. R. (2009). See citation #102. 

21. Banda, D. R., & Grimmett, E. (2008). Enhancing 

social and transition behaviors of persons 

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43(3), 324–333. 

Barnhill, G. P. (2003). See citation #257. 

Barnhill, G. P. (2001). See citation #255. 

Barton-Arwood, S. (2006). See citation #175. 

Bashinski, S. (2002). See citation #368. 

Bassette, L. (2009). See citation #43. 

Batterman, N. (2003). See citation #73. 

Batu, S. (2004). See citation #5. 

Batu, S. (2005). See citation #6. 

22. Batu, S., Cihak, D., & Gama, R. I. (2008). Caregiver-delivered 

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Bayliss, P. (2004). See citation #51. 

Beare, P. (2002). See citation #129. 

Beck, A. R. (2005). See citation #33. 

23. Beck, A. R., Stoner, J. B., & Bock, S. J. (2008). 

Comparison of PECS and the use of a VOCA: 

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24. Beck, A. R., Thompson, J. R., Clay, S. L., 

Hutchins, M., Vogt, W. P., Romaniak, B., & 

Sokolowski, B. (2001). Preservice professionals’ 

attitudes toward children who use aug- 


mentative/alternative communication. 36(3), 

255–271. 

Becker, S. (2004). See citation #256. 

Bedesem, P. (2009). See citation #221. 

Belfiore, P. J. (2001). See citation #36. 

25. Bennett, K., Frain, M. Brady, M. P., Rosenberg, 

H., & Surinak, T. (2009). It all depends on 

where you stand: Differences between employee’s 

and supervisor’s evaluations of work 

performance and support needs. 44(4), 471– 

480. 

Berger, S. (2002). See citation #141. 

26. Bergeron, R., Floyd, R. G., & Shands, E. I. 

(2008). States’ eligibility guidelines for mental 

retardation: An update and consideration of 

part scores and unreliability of IQs. 43(1), 

123–143. 

27. Beyer, J. (2009). Autism spectrum disorders 

and sibling relationships: Research and strategies 

44(4), 444–452. 

Beyer, J. F. (2008). See citation #325. 

28. Bezdek, J., Summers, J., & Turnbull, A. (2010). 

Professionals’ attitude on partnering with 

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45(3), 356–365. 

Billingsley, F. (2005). See citation #373. 

29. Bingham, M. A. Spooner, F., & Browder, D. 

(2007). Training paraeducators to promote 

the use of augmentative and alternative communication 

by students with significant disabilities. 

42(3), 339–352. 

30. Birkan, B. (2005). Using simultaneous prompting 

for teaching various discrete tasks to students 

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Birkan, B. (2005). See citation #378. 



Blackmountain, L. (2004). See citation #136. 

Blair, C. (2004). See citation #132. 

31. Blair, K. C., Liaupsin, C. J., Umbreit, J., & 

Kweon, G. (2006). Function-based intervention 

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Blais, M. (2002). See citation #214. 

32. Blanks, A. B., & Smith, J. D. (2009). Multiculturalism, 

religion, and disability: Implications 

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295–303. 

Bock, S. J. (2008). See citation #23. 

33. Bock, S. J., Stoner, J. B., Beck, A. R., Hanley, 

L., & Prochnow, J. (2005). Increasing functional 

communication in non-speaking preschool 

children: Comparison of PECS and 

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Bodkin, A. E. (2008). See citation #195. 

Boisvert, J. (2002). See citation #214. 

Bolger, K. E. (2004). See citation #132. 

34. Bonggat, P. W., & Hall, L. J. (2010). Evaluation 

of the effects of sensory integration-based 

intervention by a preschool special education 

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Boon, R. (2010). See citation #131. 

Boon, R. T. (2006). See citation #15. 

35. Bornman, J., Alant, E., & Lloyd, L. L. (2007). A 

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42(2), 190–208. 

36. Bosner, S. M., & Belfiore, P. J. (2001). Strategies 

and considerations for teaching an adolescent 

with Down Syndrome. 36(1), 94– 

102. 

37. Bouck, E. C. (2009). Functional curriculum 

models for secondary students with mild 

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38. Bouck, E. C. (2004). State of curriculum for 


39(2), 169–176. 

39. Bouck, E. C. (2005). Impact of factors on curriculum 

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40(3), 309–319. 

40. Bouck, E. C. (2008). Factors impacting the 

enactment of a functional curriculum in selfcontained 

cross-categorical programs. 

43(3), 294–310. 

41. Bouck, E. C. (2009). No Child Left Behind, the 

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and functional curricula: A conflict of interest? 

44(1), 3–13. 

Bouck, E. C. (2010). See citation #390. 

42. Bouck, E. C., & Flanagan, S. M. (2010). Functional 

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43. Bouck, E. C., Bassette, L., Taber-Doughty, T., 

Flanagan, S. M., & Szwed, K. (2009). Pentop 

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44(3), 367–380. 

44. Boutot, E. A., & Bryant, D. P. (2005). Social 

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settings. 40(1), 14–23. 

45. Boutot, E. A., Guenther, T., & Crozier, S. 

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Boyd, B. A. (2009). See citation #221. 

<strong>46</strong>. Boyd, B. A., Conroy, M. A., Asmus, J. M., 

McKenney, E. L. W., & Mancil, G. R. (2008). 

Descriptive analysis of classroom setting 

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47. Boyd, C. M., Fraiman, J. L., Hawkins, K. A., 

Labin, J. M., Sutter, M., & Wahl, M. R. (2008). 


Effects of the STAR intervention program on 

interactions between campers with and without 

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48. Bozkurt, F., & Gursel, O. (2005). Effectiveness 

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49. Bradford, S., Shippen, M. E., Alberto, P., 

Houchins, D. E., & Flores, M. (2006). Using 

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Brady, M. P. (2005). See citation #182. 



50. Brady, M. P., & Rosenberg, H. (2002). Job 

observation and behavior scale: A supported 

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51. Broekaert, E., Van Hove, G., Bayliss P., & 

D’Oosterlinck, F. (2004). The search for an 

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Brotherson, M. J. (2001). See citation #269. 

Browder, D. (2007). See citation #29. 

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52. Browder, D. M., Fallin, K., Davis, S., & Karvonen, 

M. (2003). Consideration of what may 

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53. Brown, J., & Murray, D. (2001). Strategies for 

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54. Bryan, T. Stiles, N., Burstein, K. Ergul, C., & 

Chao, P. (2007). “Am I supposed to understand 

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55. Bucholz, J., Brady, M. P., Duffy, M., Scott, J., & 

Kontosh, L. G. (2008). Using literacy-based 

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56. Bui, Y. N., & Turnbull, A. (2003). East meets 

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57. Burt, T. L., Porretta, D. L., & Klein, R. E. (2007). 

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58. Cameron, D. L., & Cook, B. G. (2007). Attitudes 

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59. Campbell, D. J., Reilly, A., & Henley, J. (2008). 

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Campbell, L. (2009). See citation #307. 

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60. Cannella, H., Sigafoos, J., O’Reilly, M., de la 

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61. Cannella-Malone, H. I., O’Reilly, M. F., Sigafoos, 

J., & Chan, J. M. (2008). Combined 

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62. Carothers, D. E., & Taylor, R. L. (2004). Social 

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63. Carpenter, L. B. (2001). Utilizing travel cards 

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Carter, E. W. (2004). See citation #74. 

Carter, M. (2002). See citation #152. 

Carter, M. (2006). See citation #184. 

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64. Carter, S. L. (2007). Review of recent treatment 

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65. Carter, S. L. (2008). A distributive model of 

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66. Carter, S. L. (2008). Further conceptualization 

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67. Carter, S. L. (2009). Treatment of pica using a 

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68. Carter, S. L., Wheeler, J. J., & Mayton, M. R. 

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69. Carter, S., & Wheeler, J. J. (2007). Functional 

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70. Caspar, L. A., & Glidden, L. M. (2001). Sexuality 

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71. Cavkaytar, A. (2007). Turkish parents as 

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73. Certo, N. J., Mautz, D., Pumpian, I., Sax, C., 

Smalley, K., Wade, H. A., Noyes, D., Luecking, 

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Chambers, C. R. (2005). See citation #77. 

74. Chambers, C. R., Hughes, C., & Carter, E. W. 

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76. Chen, L., & Zhang, D. (2003). Transition services 

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79. Cihak, D. F., Wright, R., & Ayres, K. M. (2010). 

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80. Cihak, D., Kessler, K., & Alberto, P. A. (2008). 

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81. Cobigo, V. Morin, D., & Lachapelle, Y. (2007). 

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82. Cobigo, V., Morin, D., & Lachapelle, Y. (2009). 

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INDEX—VOLUME <strong>46</strong>, 2011 

AUTHORS 

Abenis-Cintron, Anna. See Hausmann-Stabile, 

Carolina ............................... 3 

Agran, Martin. Providing choice making in employment 

programs: The beginning or end of 

self-determination? ..................... 565 

Alber-Morgan, Sheila R. See Everhart, Julie M. 556 

Alberto, Paul A. See Waugh, Rebecca E. . . . 528 

Alexander, Melissa. Developing the social 

skills of young adult special olympics athletes 

................................. 297 

Ali, Emad. Effectiveness of combining tangible 

symbols with the picture exchange communication 

system to teach requesting skills to 

children with multiple disabilities including 

visual impairment ...................... 425 

Angell, Maureen E. See Bailey, Rita L. ...... 352 

Ayres, Kevin M. See Bramlett, Virginia ...... 454 

Ayres, Kevin. I can identify Saturn but I can’t 

brush my teeth: What happens when the 

curricular focus for students with severe disabilities 

shifts .......................... 11 

Baer, Robert. Disproportionality in transition 

services: A descriptive study ............ 172 

Bailey, Rita L. Improving literacy skills in students 

with complex communication needs 

who use augmentative/alternative communication 

systems ........................ 352 

Bambara, Linda M. See Papay, Clare ....... 78 

Banda, Devender R. See Dogoe, Maud ..... 204 

Banda, Devender. Review of video prompting 

studies with persons with developmental disabilities 

............................... 514 

Basbigill, Abby R. See Tullis, Christopher A. . 576 

Bassette, Laura. See Taber-Doughty, Teresa . 499 

Behrmann, Michael M. See Evmenova, Anna 

S...................................... 315 

Bobzien, Jonna. See Gear, Sabra Bostian . . . 40 

Boon, Richard. See Waters, Hugh E. ....... 544 

Boone, Randall. See Travers, Jason C. ..... 326 

Bouck, Emily C. A snapshot of secondary education 

for students with mild intellectual disabilities 

................................ 399 

Bouck, Emily C. See Taber-Doughty, Teresa . 499 

Bramlett, Virginia. Effects of computer and 

classroom simulation to teach students with 

various exceptionalities to locate apparel 

sizes ................................. 454 

Browder, Diane. Using shared stories and individual 

responses modes to promote comprehension 

and engagement in literacy for 

students with multiple, severe disabilities . 339 

Brown, Jennifer. See Kroeger, K. A. ........ 470 

Calzada, Esther. See Hausmann-Stabile, Carolina 

................................. 3 

Cannella-Malone, Helen. See Tullis, Christopher 

A. ................................ 576 

Carter, Mark. See Stephenson, Jennifer ..... 276 

Cihak, David F. See Bramlett, Virginia ...... 454 

Collins, Belva. Addition of functional content 

during core content instruction with students 

with moderate disabilities ............... 22 

Collins, Belva. See Smith, Bethany ......... 251 

Courtemanche, Andrea B. See Leaf, Justin . . 186 

Cuhadar, Selmin. Effectiveness of instruction 

performed through activity schedules on the 

leisure skills of children with Autism ...... 386 

Darcy, Cynthia. See Werts, Margaret ....... 134 

Daviso III, Alfred. See Baer, Robert ......... 172 

Denton, Stephen J. See Alexander, Melissa . 297 

Diken, Ibrahim H. See Cuhadar, Selmin ..... 386 

Djuric-Zdravkovic, Aleksandra. Arithmetic operations 

and attention in children with intellectual 

disabilities ....................... 214 

Dogoe, Maud S. See Banda, Devender ..... 514 

Dogoe, Maud. Teaching generalized reading 

of product warning labels to young adults 

with Autism using the constant time delay 

procedure ............................. 204 

Dotson, Wesley H. See Leaf, Justin ......... 186 

Douglas, Karen H. See Ayres, Kevin ........ 11 

Douglas, Karen H. See Bramlett, Virginia .... 454 

Dummer, Gail M. See Alexander, Melissa . . . 297 

Everhart, Julie M. Effects of computer-based 

practice on the acquisition and maintenance 

of basic academic skills for children with 

moderate to intensive education needs .... 556 

Evmenova, Anna S. Research-based strategies 

for teaching content to students with 

intellectual disabilities: Adapted videos .... 315 


Feinstein, Rita. See Dogoe, Maud .......... 204 

Flanagan, Sara M. See Taber-Doughty, Teresa 499 

Fleming, Courtney V. See Tullis, Christopher 

A. .................................... 576 

Flexer, Robert W. See Baer, Robert ........ 172 

Flores, Margaret M. See Ganz, Jennifer ..... 596 

Fredrick, Laura D. See Waugh, Rebecca E. . 528 

Galloway, Carey Creech. See Collins, Belva . 22 

Ganz, Jennifer. Effects of a treatment package 

on imitated and spontaneous verbal requests 

in children with autism ........... 596 

Gast, David L. See Southall, Candice ....... 155 

Gear, Sabra Bostian. Teaching social skills to 

enhance work performance in a child care 

setting ................................ 40 

Hager, Karen L. See Collins, Belva ......... 22 

Hassert, Silva. See Zucker, Stanley H. ...... 619 

Hausmann-Stabile, Carolina. Ganando confianza: 

Research focus groups with immigrant 

Mexican mothers ...................... 3 

Higgins, Kyle. See Travers, Jason C. ....... 326 

Hoffman, Elin Meyers. See Werts, Margaret . 134 

Horrocks, Erin L. See Morgan, Robert L. .... 52 

Hourcade, Jack J. See Pool, Juli .......... 267 

Hunnicutt, Jenny R. See Mechling, Linda . . . 369 

Japundza-Milisavljevic, Mirjana. See Djuric- 

Zdravkovic, Aleksandra ................. 214 

Jasper, Andrea D. See Taber-Doughty, Teresa 499 

Johnson, Valerie A. See Leaf, Justin ........ 186 

Judge, Sharon. See Gear, Sabra Bostian . . . 40 

Kang, Soyeon. See Rispoli, Mandy ......... 607 

Klein, Pnina S. See Lifshitz, Hefziba ........ 106 

Kleinert, Harold. See Smith, Bethany ....... 251 

Koutromanos, George. See Zisimopoulos, 

Dimitrios ............................... 238 

Kroeger, K. A. Placebo medication use for behavior 

management in an adult with autism . 470 

Krupp, Michael. See Agran, Martin ........ 565 

Lancioni, Giulio. See Rispoli, Mandy ....... 607 

Lang, Russell. See Rispoli, Mandy ......... 607 

Lashley, Erin E. See Ganz, Jennifer ........ 596 

Leaf, Justin. Effects of no-no prompting on 

teaching expressive labeling of facial expressions 

to children with and without a pervasive 

developmental disorder .......... 186 

Lee, Angela. See Browder, Diane ......... 339 

Lifshitz, Hefziba. Mediation between staff-elderly 

persons with intellectual disability with 

Alzheimer disease as a means of enhancing 

their daily functioning ................... 106 

Lock, Robin H. See Dogoe, Maud ......... 204 

Lowrey, K. Alisa. See Ayres, Kevin ........ 11 

Macesic-Petrovic, Dragana. See Djuric- 

Zdravkovic, Aleksandra ................. 214 

MacFarland, Stephanie Z. See Ali, Emad . . . 425 

Matuszny, Rose Marie. See Banda, Devender 514 

Mechling, Linda. Computer-based video selfmodeling 

to teach receptive understanding 

of prepositions by students with intellectual 

disabilities ............................ 369 

Mechling, Linda. Review of Twenty-first century 

portable electronic devices for persons 

with moderate intellectual disabilities and 

autism spectrum disorders .............. 479 

Mechling, Linda. Use of a hand-held personal 

digital assistant (PDA) to self-prompt pedestrian 

travel by young adults with moderate 

intellectual disabilities .................. 220 

Miller, Susan. See Travers, Jason C. ........ 326 

Mims, Pam. See Browder, Diane .......... 339 

Mims, Pamela. See Skibo, Holly ........... 124 

Moon, Sherril. Perceptions of supported employment 

providers: What students with developmental 

disabilities, families, and educators 

need to know for transition planning . 94 

Morgan, Robert L. Correspondence between 

video-based preference assessment and 

subsequent community job performance .. 52 

Munde, Vera. Determining alertness in individuals 

with profound intellectual and multiple 

disabilities: The reliability of an observation 

list ................................... 116 

Nakken, Han. See Munde, Vera ........... 116 

Neubert, Debra A. See Moon, Sherril ...... 94 

O’Reilly, Mark F. See Rispoli, Mandy ....... 607 

Oppenheim, Misty L. See Leaf, Justin ...... 186 

Papay, Clare. Postsecondary education for 

transition-age students with intellectual and 

other developmental disabilities: A national 

survey ................................ 78 

Park, Ju Hee. See Everhart, Julie M. ........ 556 

Parker, Richard. See Rispoli, Mandy ....... 607 

Payne, Daniel. See Tullis, Christopher A. .... 576 

Pierce, Tom. See Travers, Jason C. ........ 326 

Pool, Juli. Developmental screening: A review 

of contemporary practice ............... 267 

Queen, Rachel McMahan. See Baer, Robert . 172 

Raver, Sharon A. See Gear, Sabra Bostian . 40 

Richter, Sharon. Effects of multimedia social 

stories on knowledge of adult outcomes and 

opportunities amont transition-ages youth 

with significant cognitive disabilities ...... 410 

Rispoli, Mandy. Effects of presession satiation 

on challenging behavior and academic engagement 

for children with autism during 

classroom instruction ................... 607 

Ruijssenaars, Wied. See Munde, Vera ...... 116 

Index, Volume <strong>46</strong> / 643

Runes, Sandra. See Hausmann-Stabile, Carolina 

................................... 3 

Schuster, John W. See Smith, Bethany ..... 251 

Seid, Nicole H. See Mechling, Linda ....... 220 

Sheldon, Jan B. See Leaf, Justin .......... 186 

Sherman, James A. See Leaf, Justin ....... 186 

Sievers, Courtney. See Ayres, Kevin ....... 11 

Sigafoos, Jeff. See Rispoli, Mandy ......... 607 

Sigafoos, Jeff. See Zisimopoulos, Dimitrios . 238 

Simonsen, Monica L. See Moon, Sherril .... 94 

Skibo, Holly. Teaching number identification to 

students with severe disabilities using response 

cards .......................... 124 

Smeltzer, Ashley. See Alexander, Melissa . . 297 

Smith, Bethany. Using simultaneous prompting 

to teach restaurant words and classifications 

as non-target information to secondary students 

with moderate to severe disabilities . 251 

Southall, Candice. Self-management procedures: 

A comparison across the Autism 

spectrum ............................. 155 

Spooner, Fred. See Skibo, Holly ........... 124 

Stephenson, Jennifer. Use of multisensory environments 

in schools for students with severe 

disabilities: Perceptions from schools . 276 

Stoner, Julia B. See Bailey, Rita L. ......... 352 

Taber-Doughty, Teresa. Video modeling and 

prompting: A comparison of two strategies 

for teaching cooking skills to students with 

mild intellectual disabilities .............. 499 

Tandy, Richard. See Travers, Jason C. ..... 326 

Test, David. See Richter, Sharon .......... 410 

Tom, Kinsey. See Taber-Doughty, Teresa . . 499 

Travers, Jason C. Emergent literacy skills of 

preschool students with Autism: A comparison 

of teacher-led and computer-assisted 

instruction ............................. 326 

Tullis, Christopher A. Review of the choice and 

preference assessment literature for individuals 

with severe to profound disabilities .. 576 

Umbreit, John. See Ali, Emad ............. 425 

Vlaskamp, Carla. See Munde, Vera ........ 116 

Waters, Hugh E. Teaching Money Computation 

Skills to High School Students with Mild 

Intellectual Disabilities via the TouchMath© 

Program: A Multi-Sensory Approach ...... 544 

Waugh, Rebecca E. Simultaneous prompting: 

An instructional strategy for skill acquisition 

....................................... 528 

Werts, Margaret. Acquisition of instructive 

feedback: Relation to target stimulus ..... 134 

Wheeler, John J. See Zhang, Jie .......... 62 

Whinnery, Keith W. See Whinnery, Stacie B. . 436 

Whinnery, Stacie B. Effects of functional mobility 

training for adults with severe disabilities 

................................... 436 

Wu, Pei-Fang. See Tullis, Christopher A. .... 576 

Yeager, Amanda. See Tullis, Christopher A. . 576 

Yokotani, Kenji. Avoidant attachment style indicates 

job adaptation of people with high 

functional Autistic spectrum disorders ..... 291 

Zayas, Luis H. See Hausmann-Stabile, Carolina 

................................... 3 

Zhang, Jie. A meta-analysis of peer-mediated 

interventions for young children with autism 

spectrum disorders ..................... 62 

Zisimopoulos, Dimitrios. Using video prompting 

and constant time delay to teach an Internet 

search basic skill to students with intellectual 

disabilities .................... 238 

Zucker, Stanley H. Ten-year Cumulative Author 

Index of the Journals Education and 


Disabilities, Education and Training 

in Developmental Disabilities, and Education 

and Training in Autism and Developmental 

Disabilities 2001, 36(1) through 2010, 45(4) 

....................................... 619 

TITLES 

A meta-analysis of peer-mediated interventions 

for young children with autism spectrum 

disorders. Jie Zhang and John J. 

Wheeler .............................. 62 

A snapshot of secondary education for students 

with mild intellectual disabilities. Emily 

C. Bouck ............................. 399 

Acquisition of instructive feedback: Relation to 

target stimulus. Margaret Werts, Elin Meyers 

Hoffman, and Cynthia Darcy ............ 134 

Addition of functional content during core content 

instruction with students with moderate 

disabilities. Belva Collins, Karen L. Hager, 

and Carey Creech Galloway ............ 22 

Arithmetic operations and attention in children 

with intellectual disabilities. Aleksandra 

Djuric-Zdravkovic, Mirjana Japundza- 

Milisavljevic, and Dragana Macesic- 

Petrovic .............................. 214 

Avoidant attachment style indicates job adaptation 

of people with high functional Autistic 

spectrum disorders. Kenji Yokotani ....... 291 

Computer-based video self-modeling to teach 

receptive understanding of prepositions by 

students with intellectual disabilities. Linda 

Mechling and Jenny R. Hunnicutt ........ 369 

Correspondence between video-based preference 

assessment and subsequent community 

job performance. Robert L. Morgan and 

Erin L. Horrocks ....................... 52 


Determining alertness in individuals with profound 

intellectual and multiple disabilities: 

The reliability of an observation list. Vera 

Munde, Carla Vlaskamp, Wied Ruijssenaars 

and Han Nakken ...................... 116 

Developing the social skills of young adult special 

olympics athletes. Melissa Alexander, 

Gail M. Dummer, Ashley Smeltzer, and Stephen 

J. Denton ........................ 297 

Developmental screening: A review of contemporary 

practice. Juli Pool and Jack J. Hourcade 

................................. 267 

Disproportionality in transition services: A descriptive 

study. Robert Baer, Alfred Daviso 

III, Rachel McMahan Queen, and Robert W. 

Flexer ................................ 172 

Effectiveness of combining tangible symbols 

with the picture exchange communication 

system to teach requesting skills to children 

with multiple disabilities including visual impairment. 

Emad Ali, Stephanie Z. MacFarland, 

and John Umbreit ................ 425 

Effectiveness of instruction performed through 

activity schedules on the leisure skills of children 

with Autism. Selmin Cuhadar and Ibrahim 

H. Diken .......................... 386 

Effects of a treatment package on imitated and 

spontaneous verbal requests in children with 

autism. Jennifer Ganz, Margaret M. Flores, 

and Erin E. Lashley .................... 596 

Effects of computer and classroom simulation 

to teach students with various exceptionalities 

to locate apparel sizes. Virginia Bramlett, 

Kevin M. Ayres, Karen H. Douglas, and 

David F. Cihak ......................... 454 

Effects of computer-based practice on the acquisition 

and maintenance of basic academic 

skills for children with moderate to 

intensive education needs. Julie M. Everhart, 

Sheila R. Alber-Morgan, and Ju Hee 

Park .................................. 556 

Effects of functional mobility training for adults 

with severe disabilities. Stacie B. Whinnery 

and Keith W. Whinnery .................. 436 

Effects of multimedia social stories on knowledge 

of adult outcomes and opportunities 

amont transition-ages youth with significant 

cognitive disabilities. Sharon Richter and 

David Test ............................. 410 

Effects of no-no prompting on teaching expressive 

labeling of facial expressions to children 

with and without a pervasive developmental 

disorder. Justin Leaf, Misty L. Oppenheim, 

Wesley H. Dotson, Valerie A. Johnson, Andrea 

B. Courtemanche, Jan B. Sheldon, and 

James A. Sherman ..................... 186 

Effects of presession satiation on challenging 

behavior and academic engagement for children 

with autism during classroom instruction. 

Mandy Rispoli, Mark F. O’Reilly, Jeff 

Sigafoos, Russell Lang, Soyeon Kang, Giulio 

Lancioni, and Richard Parker ......... 607 

Emergent literacy skills of preschool students 

with Autism: A comparison of teacher-led 

and computer-assisted instruction. Jason C. 

Travers, Kyle Higgins, Tom Pierce, Randall 

Boone, Susan Miller, and Richard Tandy . 326 

Ganando confianza: Research focus groups 

with immigrant Mexican mothers. Carolina 

Hausmann-Stabile, Luis H. Zayas, Sandra 

Runes, Anna Abenis-Cintron, and Esther 

Calzada .............................. 3 

I can identify Saturn but I can’t brush my teeth: 

What happens when the curricular focus for 

students with severe disabilities shifts. Kevin 

Ayres, K. Alisa Lowrey, Karen H. Douglas, 

and Courtney Sievers .................. 11 

Improving literacy skills in students with complex 

communication needs who use augmentative/alternative 

communication systems. 

Rita L. Bailey, Maureen E. Angell, and 

Julia B. Stoner ......................... 352 

Mediation between staff-elderly persons with 

intellectual disability with Alzheimer disease 

as a means of enhancing their daily functioning. 

Hefziba Lifshitz and Pnina S. Klein . . . 106 

Perceptions of supported employment providers: 

What students with developmental disabilities, 

families, and educators need to 

know for transition planning. Sherril Moon, 

Monica L. Simonsen, and Debra A. Neubert 94 

Placebo medication use for behavior management 

in an adult with autism. K. A. Kroeger 

and Jennifer Brown .................... 470 

Postsecondary education for transition-age 

students with intellectual and other developmental 

disabilities: A national survey. Clare 

Papay and Linda M. Bambara .......... 78 

Providing choice making in employment programs: 

The beginning or end of self-determination? 

Martin Agran and Michael Krupp . 565 

Research-based strategies for teaching content 

to students with intellectual disabilities: 

Adapted videos. Anna S. Evmenova and Michael 

M. Behrmann .................... 315 

Review of the choice and preference assessment 

literature for individuals with severe to 

profound disabilities. Christopher A. Tullis, 

Helen Cannella-Malone, Abby R. Basbigill, 

Amanda Yeager, Courtney V. Fleming, Daniel 

Payne, and Pei-Fang Wu ............. 576 

Review of Twenty-first century portable electronic 

devices for persons with moderate intellectual 

disabilities and autism spectrum 

disorders. Linda Mechling .............. 479 

Index, Volume <strong>46</strong> / 645

Review of video prompting studies with persons 

with developmental disabilities. Devender 

Banda, Maud S. Dogoe and Rose 

Marie Matuszny ....................... 514 

Self-management procedures: A comparison 

across the Autism spectrum. Candice 

Southall and David L. Gast ............. 155 

Simultaneous prompting: An instructional strategy 

for skill acquisition. Rebecca E. Waugh, 

Paul A. Alberto, and Laura D. Fredrick . . . 528 

Teaching generalized reading of product warning 

labels to young adults with Autism using 

the constant time delay procedure. Maud 

Dogoe, Devender R. Banda, Robin H. Lock, 

and Rita Feinstein ...................... 204 

Teaching Money Computation Skills to High 

School Students with Mild Intellectual Disabilities 

via the TouchMath© Program: A 

Multi-Sensory Approach . Hugh E. Waters 

and Richard Boon ..................... 544 

Teaching number identification to students 

with severe disabilities using response 

cards. Holly Skibo, Pamela Mims, and Fred 

Spooner ............................... 124 

Teaching social skills to enhance work performance 

in a child care setting. Sabra Bostian 

Gear, Jonna Bobzien, Sharon Judge, and 

Sharon A. Raver ........................ 40 

Ten-year Cumulative Author Index of the Journals 

Education and Training in Mental Retardation 

and Developmental Disabilities, 


Disabilities, and Education and Training in 

Autism and Developmental Disabilities 

2001, 36(1) through 2010, 45(4). Stanley H. 

Zucker and Silva Hassert ................ 619 

Use of a hand-held personal digital assistant 

(PDA) to self-prompt pedestrian travel 

by young adults with moderate intellectual 

disabilities. Linda Mechling and Nicole H. 

Seid .................................. 220 

Use of multisensory environments in schools 

for students with severe disabilities: Perceptions 

from schools. Jennifer Stephenson, 

and Mark Carter ........................ 276 

Using shared stories and individual responses 

modes to promote comprehension and engagement 

in literacy for students with multiple, 

severe disabilities. Diane Browder, Angela 

Lee, and Pam Mims ................ 339 

Using simultaneous prompting to teach restaurant 

words and classifications as non-target 

information to secondary students with moderate 

to severe disabilities. Bethany Smith, 

John W. Schuster, Belva Collins, and Harold 

Kleinert ................................ 251 

Using video prompting and constant time delay 

to teach an Internet search basic skill to 

students with intellectual disabilities. Dimitrios 

Zisimopoulos, Jeff Sigafoos, and 

George Koutromanos ................... 238 

Video modeling and prompting: A comparison 

of two strategies for teaching cooking skills 

to students with mild intellectual disabilities. 

Teresa Taber-Doughty, Emily C. Bouck, Kinsey 

Tom, Andrea D. Jasper, Sara M. Flanagan, 

and Laura Bassette ................ 499 

6<strong>46</strong> / Education and Training in Autism and Developmental Disabilities-December 2011

Statement of Ownership, Management, and Circulation 

(Act of August 12, 1970, Section 3685 Title 39, United States Code) 

1. Title of publication: EDUCATION AND TRAINING IN AUTISM AND DEVELOPMENTAL DIS- 

ABILITIES. 2. Publication number: 0013-1237. 3. Date of Filing: September 30, 2011. 4. Frequency of 

issue: Quarterly in March, June, September, and December. 5. No. of issues published annually: 4. 

6. Annual subscription price: $60 domestic; $64 foreign; $195 institution; $199.50 foreign. 7. Location 

of known office of publication: The Council for Exceptional Children, 2900 Crystal Drive, Suite 1000, 

Arlington, Virginia 22202-3557. 8. Location of headquarters of general business offices of the publishers: 

The Council for Exceptional Children, 2900 Crystal Drive, Suite 1000, Arlington, Virginia 22202- 

3557. 9. Names and addresses of publisher and editor: Publisher—The Council for Exceptional 

Children, 2900 Crystal Drive, Suite 1000, Arlington, Virginia 22202-3557; Editor—Dr. Stanley H. Zucker, 

Special Education Program, Farmer 404, Arizona State University, PO Box 871811, Tempe, AZ 85287- 

1811. 10. Owner: The Council for Exceptional Children, <strong>Division</strong> on Autism and Developmental 

Disabilities, 2900 Crystal Drive, Suite 1000, Arlington, Virginia 22202-3557, no stockholders. [11. Not 

applicable.] 12. For completion by nonprofit organizations authorized to mail at special rates: The 

purpose, function, and nonprofit status of this organization and the exempt status for Federal Income 

Tax purposes have not changed during the preceding 12 months. 13. Publication name: EDUCATION 

AND TRAINING IN AUTISM AND DEVELOPMENTAL DISABILITIES. 14. Issue date for circulation 

data below: September 2011. 15. Extent and nature of circulation: 

Average no. 

copies ea. issue 

for past 12 mos. 

No. of copies 

of issue nearest 

filing date 

A. Total no. copies printed 

B. Paid circulation 

4,909 5,1405 

1. Sales through dealers and carriers, street vendors, and 

counter sales 

125 130 

2. Mail subscription 4,568 4,864 

C. Total paid circulation 4,693 4,994 

D. Free distribution by mail; samples, complimentary, and 

other free copies 

75 60 

E. Free distribution outside the mail; carriers or other means 0 0 

F. Total free distribution 75 60 

G. Total distribution 

H. Copies not distributed 

4,768 5,054 

1. Office use, left-over, unaccounted, spoiled after printing 141 86 

2. Returns from news agents 0 0 

I. Total 4,909 5,140 

J. Percent paid and/or requested circulation 98.42% 98.81% 

16. This statement of ownership will be printed in the Vol. <strong>46</strong> No. 4 DEC 11 issue of this 

publication. 

17. Signature and title: 

Bruce A. Ramirez Executive Director September 30, 2011

Look! I'm in College! DVD 

Look, I’m in College! Is a half-hour documentary that follows four students through an 

extraordinary time in their lives. Terence, Benny, Rayquan, and Donald are New York 

City public school students from high-need communities. They all have autism and 

intellectual disabilities, and they are the charter class in a college-based inclusion 

program. Through collaborative efforts of the New York City District 75 and Pace 

University, these four young men from challenging socio-economic backgrounds met with 

success as they participated in a college community among their age-appropriate peers. 

By the <strong>Division</strong> on Autism and Developmental Disabilities (DADD). 2008. 31 minutes. 

Member Price: $ 34.95 

Non-Member Price: $ 39.95 

http://www.cec.sped.org/ScriptContent/orders/ProductDetail.cfm?pc=D5890

Education and Training in Autism and 

Developmental Disabilities 

Editorial Policy 

Education and Training in Autism and Developmental Disabilities focuses on the 

education and welfare of persons with autism and developmental disabilities. 

ETADD invites research and expository manuscripts and critical review of the 

literature. Major emphasis is on identification and assessment, educational programming, 

characteristics, training of instructional personnel, habilitation, prevention, 

community understanding and provisions, and legislation. 

Each manuscript is evaluated anonymously by three reviewers. Criteria for acceptance 

include the following: relevance, reader interest, quality, applicability, 

contribution to the field, and economy and smoothness of expression. The review 

process requires two to four months. 

Viewpoints expressed are those of the authors and do not necessarily conform to 

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

Submission of Manuscripts 

1. Manuscript submission is a representation that the manuscript is the author’s 

own work, has not been published, and is not currently under consideration for 

publication elsewhere. 

2. Manuscripts must be prepared according to the recommendations in the Publication 

Manual of the American Psychological Association (Sixth Edition, 2009). 

Laser or high density dot printing are acceptable. 

3. Each manuscript must have a cover sheet giving the names and affiliations of all 

authors and the address of the principal author. 

4. Graphs and figures should be originals or sharp, high quality photographic 

prints suitable, if necessary, for a 50% reduction in size. 

5. Five copies of the manuscript along with a transmittal letter should be sent to the 

Editor: Stanley H. Zucker, Mary Lou Fulton Teachers College, Box 871811, 

Arizona State University, Tempe, AZ 85287-1811. 

6. Upon receipt, each manuscript will be screened by the editor. Appropriate 

manuscripts will then be sent to consulting editors. Principal authors will receive 

notification of receipt of manuscript. 

7. The Editor reserves the right to make minor editorial changes which do not 

materially affect the meaning of the text. 

8. Manuscripts are the property of ETADD for a minimum period of six months. 

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

on Autism and Developmental Disabilities.

13th International Conference on 

Autism, Intellectual Disabilities, 

& Developmental Disabilities 

Research to Practice 

Council for Exceptional Children 

<strong>Division</strong> on Autism & Developmental Disabilities 

The Board of Directors for CEC‛s <strong>Division</strong> on Autism and Developmental Disabilities (DADD), is pleased to 

extend an invitation to join us in Miami Beach, Florida, January 18 - 20, 2012, for a stellar professional 

learning opportunity! 

DADD‛s 13 th International Conference on Autism, Intellectual Disabilities and Developmental Disabilities 

will integrate research and practice, reflecting the need for evidence-based strategies within this 

diverse field. 

The program features more than 100 lecture and poster presentations; conference delegates may also 

attend an in-depth pre-conference training institute on Autism Spectrum Disorders: Practical Solutions to 

Everyday Challenges, ledbyDr.BrendaSmithMyles. 

Featured speakers include Robert Pio Hajjar (Self-Advocate), Dr. Robert Stodden, Dr. Tom E.C. Smith, 

Dr. Michael Wehmeyer, Dr. Amanda Boutot, Taylor Crowe (Self-Advocate) and Dr. David Crowe. 

Our Conference will be held at the historic Deauville Beach Resort, one of the Grande-Dame hotels in 

Miami Beach. 

For further information, please contact: 

Cindy Perras 

Conference Co-ordinator 

CEC-DADD 

cindy.perras@cogeco.ca 

www.daddcec.org

December 2011 Education and Training in Autism and Developmental Disabilities Vol. <strong>46</strong>, No. 4, pp. 477–648

etadd_46(4) - Division on Autism and Developmental Disabilities

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