Education and Training in Developmental Disabilities - Division on ...

<strong>Education</strong> <strong>and</strong> 

<strong>Tra<strong>in</strong><strong>in</strong>g</strong> 

<strong>in</strong> 

<strong>Developmental</strong> 

<strong>Disabilities</strong> 

Focus<strong>in</strong>g on <strong>in</strong>dividuals with 

cognitive disabilities/mental retardation, autism, <strong>and</strong> related disabilities 

Volume 40 Number 1 March 2005

March 2005 <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong> Vol. 40, No. 1, pp. 1–96

<strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong> 

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

The Council for Exceptional Children 

Editor: Stanley H. Zucker 

Arizona State University 

Consult<strong>in</strong>g Editors 

Mart<strong>in</strong> Agran 

Reuben Altman 

Richard Bartlett 

Phillip J. Belfiore 

Sharon Borthwick-Duffy 

Michael P. Brady 

Fredda Brown 

Mary Lynne Calhoun 

Carol<strong>in</strong>e Dunn 

Lise Fox 

David L. Gast 

Herbert Goldste<strong>in</strong> 

Robert Henderson 

Carolyn Hughes 

Larry K. Irv<strong>in</strong> 

James V. Kahn 

H. Earle Knowlton 

Barry W. Lavay 

Rena Lewis 

Kathleen J. Marshall 

Editorial Assistant: Amy Barry 

Arizona State University 

John McDonnell 

Gale M. Morrison 

Gabriel A. Nardi 

John Nietupski 

James R. Patton 

Edward A. Polloway 

Thomas G. Roberts 

Robert S. Rueda 

Diane L. Ryndak 

Edward J. Sabornie 

Laurence R. Sargent 

Gary M. Sasso 

Tom E. C. Smith 

Scott Sparks 

Fred Spooner 

Robert Stodden 

Keith Storey 

David L. Westl<strong>in</strong>g 

John J. Wheeler 

Mark Wolery 

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<strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong> Vol. 40, No. 1, March 2005, Copyright 2005 by the <strong>Division</strong> on <strong>Developmental</strong> 

<strong>Disabilities</strong>, The Council for Exceptional Children. 

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

The Council for Exceptional Children 

Board of Directors 

Officers 

Past President Andrea Babkie 

President Barbara Gart<strong>in</strong> 

President-Elect Dagny Fidler 

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Secretary C<strong>in</strong>dy Perras 

Treasurer Dan Ezell 

Members 

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Leslie Broun 

Kent Gerlach 

Jim Forristal 

Jennifer Miller (Student Governor) 

Nikki Murdick 

Executive Director 

Tom E. C. Smith 

Publications Chair 

Jack Hourcade 

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

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<strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong> 

VOLUME 40 NUMBER 1 MARCH 2005 

Us<strong>in</strong>g Self-Monitor<strong>in</strong>g to Increase Follow<strong>in</strong>g-Direction Skills of Students with 

Moderate to Severe <strong>Disabilities</strong> <strong>in</strong> General <strong>Education</strong> 3 

MARTIN AGRAN 

THOMAS SINCLAIR 

SANDRA ALPER 

MICHAEL CAVIN 

MICHAEL WEHMEYER 

CAROLYN HUGHES 

Social Integration of Students with Autism <strong>in</strong> Inclusive Sett<strong>in</strong>gs 14 

E. AMANDA BOUTOT 

DIANE P. BRYANT 

Self-Monitor<strong>in</strong>g: Are Young Adults with MR <strong>and</strong> Autism Able to Utilize 

Cognitive Strategies Independently? 24 

JENNIFER B. GANZ 

JEFF SIGAFOOS 

Us<strong>in</strong>g Video Prompt<strong>in</strong>g to Teach Cook<strong>in</strong>g Skills to Secondary Students with 

Moderate <strong>Disabilities</strong> 34 

TARA B. GRAVES 

BELVA C. COLLINS 

JOHN W. SCHUSTER 

HAROLD KLEINERT 

Computer-Based Video Instruction to Teach Students with Intellectual 

<strong>Disabilities</strong> to Verbally Respond to Questions <strong>and</strong> Make Purchases <strong>in</strong> Fast 

Food Restaurants 47 

LINDA C. MECHLING 

LESLIE S. PRIDGEN 

BETH A. CRONIN 

Us<strong>in</strong>g a Personal Digital Assistant to Enhance the Independence of an 

Adolescent with Asperger Syndrome 60 

HEATHER FERGUSON 

BRENDA SMITH MYLES 

TAKU HAGIWARA 

Us<strong>in</strong>g Simultaneous Prompt<strong>in</strong>g for Teach<strong>in</strong>g Various Discrete Tasks to 

Students with Mental Retardation 68 

BUNYAMIN BIRKAN 

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

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

publisher. All other forms of reproduction require permission from the publisher.

Improv<strong>in</strong>g Feed<strong>in</strong>g Skills <strong>and</strong> Mealtime Behaviors <strong>in</strong> Children <strong>and</strong> Youth with 

<strong>Disabilities</strong> 80 

RITA L. BAILEY 

MAUREEN E. ANGELL 

Manuscripts Accepted for Future Publication <strong>in</strong> <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> 

<strong>Developmental</strong> <strong>Disabilities</strong> 2 

Manuscripts Accepted for Future Publication <strong>in</strong> <strong>Education</strong> 

<strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong> 

June 2005 

Concepts of work, leisure <strong>and</strong> retirement <strong>in</strong> adults with an <strong>in</strong>tellectual disability. Trudy L. Cordes 

<strong>and</strong> Robert W. Howard, School of <strong>Education</strong>, University of New South Wales, Sydney, 2052, 

AUSTRALIA. 

Gaze-shift patterns of young children with developmental disabilities who are at risk for be<strong>in</strong>g 

nonspeak<strong>in</strong>g. Kelli Arens, Cynthia J. Cress, <strong>and</strong> Christ<strong>in</strong>e A. Marv<strong>in</strong>, University of Nebraska- 

L<strong>in</strong>coln, 202G Barkley Center, L<strong>in</strong>coln, NE 68583–0732. 

Intervention <strong>and</strong> <strong>in</strong>struction with video for students with autism: A review of literature. Kev<strong>in</strong> 

Michael Ayres <strong>and</strong> John Langone, Department of Special <strong>Education</strong>, The University of Georgia, 

537 Aderhold Hall, Athens, GA 30602–7153. 

Us<strong>in</strong>g a constant time delay procedure to teach aquatic play skills to children with autism. I˙lker 

Yılmaz, Bünyam<strong>in</strong> Birkan, Ferman Konukman, <strong>and</strong> Mert Erkan, Tez Buro Is Sitesi 17, 5. Blok K1 

D2, Ergazi Mh., Batikent-ANKARA 06370, TURKEY. 

Evaluation of contextual variability <strong>in</strong> the prediction of re<strong>in</strong>forcer effectiveness. Olimpia P<strong>in</strong>o <strong>and</strong> 

Carla Dazzi, University of Parma, Department of Psychology, Borgo Carissimi 10, 43100 Parma, 

ITALY. 

Transition supports to students with mental retardation: An exam<strong>in</strong>ation of data from the National 

Longitud<strong>in</strong>al Transition Study 2. Antonis Katsiyannis, Dalun Zhang, Nancy Woodruff, <strong>and</strong> April 

Dixon, Clemson University, School of <strong>Education</strong>, 404-A Tillman Hall, Box 340715, Clemson, SC 

29634–0715. 

Responses to communication breakdowns by nonverbal children with developmental disabilities. 

Dilek Erbas, Anadolu Universitesi, <strong>Education</strong> Research <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> Center for Speech <strong>and</strong> 

Language Disorders, Eskisehir, 26470, TURKEY. 

Improv<strong>in</strong>g the system of least prompts: A comparison of procedural variation. Elizabeth A. West 

<strong>and</strong> Felix Bill<strong>in</strong>gsley, Department of Special <strong>Education</strong>, Boise State University, 1910 University 

Drive, Boise, ID 83725. 

Address is supplied for author <strong>in</strong> boldface type.

Us<strong>in</strong>g Self-Monitor<strong>in</strong>g to Increase Follow<strong>in</strong>g-Direction Skills 

of Students with Moderate to Severe <strong>Disabilities</strong> 

<strong>in</strong> General <strong>Education</strong> 

Mart<strong>in</strong> Agran 

University of Northern Iowa 

S<strong>and</strong>ra Alper <strong>and</strong> Michael Cav<strong>in</strong> 

University of Northern Iowa 

Carolyn Hughes 

V<strong>and</strong>erbilt University 

Thomas S<strong>in</strong>clair 

Eastern Ill<strong>in</strong>ois University 

Michael Wehmeyer 

University of Kansas 

Abstract: We used two multiple basel<strong>in</strong>e designs to <strong>in</strong>vestigate effects of a self-monitor<strong>in</strong>g strategy on follow<strong>in</strong>gdirection 

skills of six middle school students with moderate to severe disabilities <strong>in</strong> general education. Students 

were <strong>in</strong>structed to acknowledge a given direction, complete the task, <strong>and</strong> monitor their performance. Results 

suggest that all students learned the strategy <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed their performance at mastery levels for the 

duration of the ma<strong>in</strong>tenance condition. Social validation data obta<strong>in</strong>ed from participat<strong>in</strong>g general <strong>and</strong> special 

educators supported these f<strong>in</strong>d<strong>in</strong>gs. Implications for promot<strong>in</strong>g student-directed learn<strong>in</strong>g <strong>and</strong> <strong>in</strong>clusive education 

are discussed. 

The value of promot<strong>in</strong>g student-directed 

learn<strong>in</strong>g <strong>in</strong> general curriculum is receiv<strong>in</strong>g 

<strong>in</strong>creased attention (Agran, K<strong>in</strong>g-Sears, Wehmeyer, 

& Copel<strong>and</strong>, 2003; Hughes et al., 2002; 

Wehmeyer, S<strong>and</strong>s, Knowlton, & Kozleski, 

2002). Student-directed learn<strong>in</strong>g <strong>in</strong>volves 

teach<strong>in</strong>g students to use one or more selfdirected 

<strong>in</strong>structional strategies to plan, perform, 

<strong>and</strong> monitor a learn<strong>in</strong>g task (Agran, 

1997). These strategies occasion a shift from 

teacher-directed <strong>in</strong>struction to one that is 

more student-directed, thus provid<strong>in</strong>g students 

opportunities to direct <strong>and</strong> regulate 

their own learn<strong>in</strong>g. Specifically, the strategies 

The study was completed by the second author 

dur<strong>in</strong>g his Ed.D. Graduate degree program at the 

University of Northern Iowa. The study was supported 

<strong>in</strong> part by U.S. Department of <strong>Education</strong> 

grant #H023D9790502-98 awarded to Drs. Agran, 

Hughes, <strong>and</strong> Wehmeyer, <strong>and</strong> does not necessarily 

reflect the op<strong>in</strong>ions of the Office of Special <strong>Education</strong> 

Programs. Correspondence concern<strong>in</strong>g this article 

should be addressed to Mart<strong>in</strong> Agran, Department 

of Special <strong>Education</strong>, 158 SEC, University of 

Northern Iowa, Cedar Falls, IA 50614-0601. E-mail: 

mart<strong>in</strong>.agran@uni.edu 

<strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>, 2005, 40(1), 3–13 

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

allow students to regulate their expectations 

about what they can learn <strong>and</strong> how much; 

make choices <strong>and</strong> decisions about how they 

will learn <strong>and</strong> <strong>in</strong> what sequence; <strong>and</strong> execute, 

monitor, <strong>and</strong> evaluate actions taken (Mithaug, 

Mithaug, Agran, Mart<strong>in</strong>, & Wehmeyer, 2002). 

By us<strong>in</strong>g these strategies, dependence on external 

support is m<strong>in</strong>imized, engagement <strong>and</strong> 

motivation are <strong>in</strong>creased, <strong>and</strong> learn<strong>in</strong>g is maximized. 

Although student-directed learn<strong>in</strong>g strategies 

cont<strong>in</strong>ue to be underutilized (Agran, 

Snow, & Swaner, 1999; Wehmeyer, Agran, & 

Hughes, 2000), the positive effects of studentdirected 

learn<strong>in</strong>g strategies for students with 

moderate to severe disabilities <strong>in</strong> general education 

have begun to be reported <strong>in</strong> the 

research literature. For example, Gilberts, Agran, 

Hughes, <strong>and</strong> Wehmeyer (2001) taught 

five middle school students with severe disabilities 

to monitor 11 classroom survival skills. All 

students were enrolled <strong>in</strong> a variety of general 

education content classes (e.g., Spanish, U.S. 

history). Among the target skills were ask<strong>in</strong>g 

<strong>and</strong> answer<strong>in</strong>g questions, greet<strong>in</strong>g teachers 

<strong>and</strong> students, br<strong>in</strong>g<strong>in</strong>g appropriate materials 

to class, <strong>and</strong> acknowledg<strong>in</strong>g teacher com- 

Self-Monitor<strong>in</strong>g / 3

ments. Students were taught to <strong>in</strong>dicate on a 

self-record<strong>in</strong>g sheet if they performed each of 

the target skills. Positive changes were reported 

for all students. Also Copel<strong>and</strong>, 

Hughes, Agran, Wehmeyer, <strong>and</strong> Fowler 

(2002) taught four high school students, all of 

who were enrolled <strong>in</strong> cosmetology classes, to 

self-regulate their classroom performance. 

Specifically, students were taught to set learn<strong>in</strong>g 

goals for themselves, monitor if they performed 

targeted skills (i.e., correctly responded 

to worksheet assignments), <strong>and</strong> 

evaluate how well they did. Positive f<strong>in</strong>d<strong>in</strong>gs 

were reported for all students, with three of 

the four students receiv<strong>in</strong>g, <strong>in</strong> turn, higher 

report card grades. Additionally, Agran, Blanchard, 

Hughes, <strong>and</strong> Wehmeyer (2002) taught 

four middle school students with autism spectrum 

disorders, <strong>in</strong>tellectual, or multiple disabilities 

to use a self-regulated problem-solv<strong>in</strong>g 

strategy, which <strong>in</strong>volved sett<strong>in</strong>g goals for 

themselves, select<strong>in</strong>g a procedure to achieve 

the goal, implement<strong>in</strong>g the strategy, <strong>and</strong>, last, 

evaluat<strong>in</strong>g their progress. Target behaviors <strong>in</strong>cluded 

contribut<strong>in</strong>g more to class discussion, 

not touch<strong>in</strong>g other students <strong>in</strong>appropriately, 

<strong>and</strong> follow<strong>in</strong>g directions. Dramatic <strong>in</strong>creases 

were reported for all participants. 

Watson <strong>and</strong> Tharp (1989) <strong>in</strong>dicated that 

critical to a student’s success <strong>in</strong> learn<strong>in</strong>g <strong>and</strong> 

task performance is the ability to self-regulate 

his or her own performance. Put simply, selfregulation 

refers to the means <strong>in</strong>dividuals use 

to adapt to circumstances (Mithaug, 1996). 

For a variety or reasons, <strong>in</strong>dividuals self-regulate 

to vary<strong>in</strong>g degrees of success, <strong>and</strong> it is this 

ability that will determ<strong>in</strong>e the extent to which 

an <strong>in</strong>dividual will achieve power <strong>and</strong> control 

of their lives (Mithaug, 1993). Because of devalued 

<strong>and</strong> marg<strong>in</strong>alized perceptions of disability 

by society, highlighted by a belief that 

<strong>in</strong>dividuals with moderate to severe disabilities 

are <strong>in</strong>capable of regulat<strong>in</strong>g their own behavior 

(Wehmeyer et al., 2000), it is not surpris<strong>in</strong>g 

that students with disabilities rema<strong>in</strong> dependent 

on others to direct their behavior. They 

have little experience <strong>in</strong> monitor<strong>in</strong>g their own 

behavior <strong>and</strong> obta<strong>in</strong> <strong>in</strong>formation about the 

quality of their behavioral performance from 

others. Optimal ga<strong>in</strong> is powered by an <strong>in</strong>dividual’s 

discernment that a discrepancy exists between 

a current state (what he or she has) <strong>and</strong> 

a desired one (what he or she wants to have), 

4 / <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>-March 2005 

<strong>and</strong> it is this realization that fuels behavior 

change (Mithaug et al., 2002). 

A self-regulation strategy of great utility for 

students with severe disabilities is self-monitor<strong>in</strong>g. 

Self-monitor<strong>in</strong>g <strong>in</strong>volves a student’s selfobservation 

of a target behavior, followed by 

record<strong>in</strong>g the occurrence. It can be used to 

record the frequency of occurrence of virtually 

any discrete behavior (Agran & Wehmeyer, 

2002). As long as the target behavior 

can be discrim<strong>in</strong>ated <strong>and</strong> its occurrence can 

be recorded <strong>in</strong> some manner (e.g., paper <strong>and</strong> 

pencil tally, wrist counter), self-monitor<strong>in</strong>g 

represents a strategy easily employed by students 

with severe disabilities (Agran, 1997). 

A particular value of the strategy is its selfregulatory 

role <strong>in</strong> promot<strong>in</strong>g behavior 

change. Baer (1984) suggested that self-monitor<strong>in</strong>g 

produces behavior change because it 

serves as a discrim<strong>in</strong>ative stimulus <strong>and</strong> cues 

desired behavior. Self-monitor<strong>in</strong>g allows the 

student to discrim<strong>in</strong>ate the target behavior 

<strong>and</strong> rem<strong>in</strong>d him or her of the present <strong>and</strong> 

future cont<strong>in</strong>gencies <strong>in</strong> the environment (“if I 

perform this response, this will happen”) (Agran 

& Wehmeyer, 2002). With this <strong>in</strong>formation 

it is more likely that the behavior will 

occur. Most importantly, the <strong>in</strong>crease will occur 

on the basis of what the student, rather 

than the teacher, does. 

Although self-monitor<strong>in</strong>g has been advocated 

as a particularly useful <strong>and</strong> potentially 

effective self-directed learn<strong>in</strong>g strategy (Agran, 

1997; Hughes et al., 2002), reports of the 

effects of this strategy on the classroom performance 

of students with severe disabilities <strong>in</strong> 

general education rema<strong>in</strong> limited. Further, although 

educators have acknowledged the 

value of self-monitor<strong>in</strong>g, only a limited number 

of teachers systematically teach their students 

how to use the strategy (Agran et al., 

1999; Wehmeyer et al., 2000). Self-monitor<strong>in</strong>g, 

among other student-directed learn<strong>in</strong>g 

strategies, provides a potentially effective way 

to maximize the participation of students with 

severe disabilities <strong>in</strong> general education <strong>and</strong> to 

enhance their learn<strong>in</strong>g, <strong>and</strong> further study of 

its effects is warranted. The purpose of this 

study was to <strong>in</strong>vestigate the effects of self-monitor<strong>in</strong>g 

<strong>in</strong>struction on the participation of six 

middle school students with moderate to severe 

disabilities <strong>in</strong> general education sett<strong>in</strong>gs; 

specifically, the six students were <strong>in</strong>structed to

monitor their frequency of follow<strong>in</strong>g directions. 

Method 

Participants <strong>and</strong> Sett<strong>in</strong>g 

Six students were selected to participate <strong>in</strong> 

this <strong>in</strong>vestigation based on the follow<strong>in</strong>g criteria: 

(1) identification consistent with state 

guidel<strong>in</strong>es (Iowa) as hav<strong>in</strong>g mental retardation 

<strong>in</strong> the moderate to severe range (Level 

III), (2) middle school grade placements of 

7 th or 8 th , (3) current <strong>in</strong>clusion <strong>in</strong> general 

education classes as a part of their IEP’s, <strong>and</strong> 

(4) teacher evaluation of need for improvement 

<strong>in</strong> follow<strong>in</strong>g directions. 

All participants attended a medium-sized 

midwestern junior high school serv<strong>in</strong>g approximately 

350 7 th <strong>and</strong> 8 th graders. The 

school day was divided <strong>in</strong>to seven 45 m<strong>in</strong> periods 

with a 15 m<strong>in</strong> homeroom at the end of 

the day. Five participants were <strong>in</strong>cluded <strong>in</strong> 

exploratory classes (e.g., <strong>in</strong>dustrial technology, 

art, family consumer science) <strong>in</strong> which 

many specific directions were given to complete 

an activity; for example, “everybody take 

out your plans”, “now measure the width between 

your front wheels,” or “does it comply 

with our st<strong>and</strong>ards?” The sixth was <strong>in</strong>cluded <strong>in</strong> 

a social studies class <strong>in</strong> which the teacher gave 

directions as he moved from one aspect of the 

class to the next; for example, “everybody 

please take out your notebooks,” or “now 

work<strong>in</strong>g <strong>in</strong> pairs, I want you to answer the first 

five questions on the worksheet over Chapter 

10.” 

Among the tasks <strong>in</strong> <strong>in</strong>dustrial technology 

were mak<strong>in</strong>g scale draw<strong>in</strong>gs, manufactur<strong>in</strong>g a 

CO2 powered rac<strong>in</strong>g car, <strong>and</strong> assist<strong>in</strong>g <strong>in</strong> 

build<strong>in</strong>g a concession st<strong>and</strong>. In art, the students 

made pictures with different shapes, 

contrast<strong>in</strong>g colors <strong>and</strong> vary<strong>in</strong>g hues. In family 

consumer science students prepared different 

types of foods (e.g., salads <strong>and</strong> desserts) <strong>and</strong> 

sewed at least one item of cloth<strong>in</strong>g or a stuffed 

animal or ball. Last, <strong>in</strong> social studies the students 

worked on maps of different regions, 

worksheets form the textbook, <strong>and</strong> m<strong>in</strong>iprojects 

over different cultures. 

All participants were male. One student was 

African American (WH), <strong>and</strong> the rema<strong>in</strong><strong>in</strong>g 

five students were Caucasian. Ages ranged 

from 13 to 15 years. Full-scale WISC-III IQ 

scores (Wechsler, 1991) ranged from 30 to 72, 

with a mean of 57. Accord<strong>in</strong>g to teacher reports, 

all participants were identified as hav<strong>in</strong>g 

restrictive adaptive function<strong>in</strong>g <strong>in</strong> follow<strong>in</strong>g 

directions. Two were diagnosed with autism, 

<strong>and</strong> one was assessed as hav<strong>in</strong>g Aspergers Syndrome. 

Participant characteristics are summarized 

<strong>in</strong> Table 1. JB was a 13-year-old adolescent 

who was <strong>in</strong> 7 th grade. He demonstrated obsessive/compulsive 

behavior (e.g., repeatedly 

clean<strong>in</strong>g off tables) <strong>and</strong> was be<strong>in</strong>g assessed for 

Asperger’s Syndrome. JB would fixate on a 

number of tasks, especially when clean<strong>in</strong>g was 

<strong>in</strong>volved. For example, when asked to wipe off 

a table, he would clean the entire table over 

<strong>and</strong> over until he was stopped. JB was <strong>in</strong>cluded 

<strong>in</strong> a home economics class. JB had a peer 

assistant walk with him to <strong>and</strong> from class <strong>in</strong> 

order to make sure he did not w<strong>and</strong>er off to 

another part of the build<strong>in</strong>g. 

JT was a 13-year-old male who was <strong>in</strong> 8 th 

grade. He was mechanically <strong>in</strong>cl<strong>in</strong>ed <strong>and</strong> enjoyed 

work<strong>in</strong>g with his h<strong>and</strong>s putt<strong>in</strong>g th<strong>in</strong>gs 

together or tak<strong>in</strong>g th<strong>in</strong>gs apart. JT was <strong>in</strong>cluded 

<strong>in</strong> an <strong>in</strong>dustrial technology class. Follow<strong>in</strong>g 

directions was difficult for JT because 

he would not focus on the teacher. He was a 

popular young man who attended to his 

peers. His teacher <strong>in</strong>dicated that he had great 

difficulty follow<strong>in</strong>g directions. 

WH was 15-years-old <strong>and</strong> <strong>in</strong> 8 th grade. He 

had many athletic skills <strong>and</strong> participated <strong>in</strong> 

TABLE 1 

Participant Characteristics 

Student 

Age/ 

Grade IQ 1 Classification 2 

Level of 

Support 3 

Group 1: 

JB 13/7 th 60 2 Limited 

JT 13/8 th 55 2 Limited 

WH 15/8 th 72 2 Intermittent 

Group 2: 

CS 14/8 th 50 3 Extensive 

GS 15/8 th 60 3 Extensive 

AH 14/8 th 30 3 Pervasive 

1 Based on WISC–III. 

2 Based on local district requirements <strong>and</strong> us<strong>in</strong>g 

their support term<strong>in</strong>ology (1 least support, 3 

most support). 

3 Based on AAMR Classification. 


several sports. WH was resistant to ask<strong>in</strong>g for 

or accept<strong>in</strong>g help <strong>and</strong> got angry <strong>and</strong> frustrated 

when tasks seemed too difficult for him. 

WH was <strong>in</strong>cluded <strong>in</strong> social studies. 

CS was 14-years-old <strong>and</strong> <strong>in</strong> 8 th grade. He was 

a large young man <strong>and</strong> active <strong>in</strong> sports. CS did 

not follow directions well s<strong>in</strong>ce he did not 

always underst<strong>and</strong> what directions were given. 

He would not usually ask for clarification <strong>and</strong> 

either do the activity the way he thought it 

should be done or not do it at all. CS was 

<strong>in</strong>cluded <strong>in</strong> an <strong>in</strong>dustrial technology class. 

GS was a 15-year-old 8 th grader. He was 

pleasant <strong>and</strong> well liked by his teachers <strong>and</strong> 

peers. GS was diagnosed with autism <strong>and</strong> delayed 

communication <strong>and</strong> <strong>in</strong>teraction with 

others. GS rushed through th<strong>in</strong>gs to get f<strong>in</strong>ished, 

whether or not he followed the directions 

<strong>and</strong> completed all the steps. As a result, 

his work was often <strong>in</strong>accurate <strong>and</strong> <strong>in</strong>complete. 

GS was <strong>in</strong>cluded <strong>in</strong> an <strong>in</strong>dustrial technology 

class. 

AH was a 14-year-old 8 th grader diagnosed 

with autism. He was often off task <strong>and</strong> answered 

questions <strong>in</strong>appropriately. AH had difficultly 

follow<strong>in</strong>g any directions that <strong>in</strong>cluded 

more than a couple of steps. AH was <strong>in</strong>cluded 

<strong>in</strong> an art class <strong>and</strong> had a full-time associate 

who accompanied him to class. 

Dependent Variables 

The primary dependent measure was amount 

of change <strong>in</strong> each student’s performance of 

follow<strong>in</strong>g directions. Observers recorded daily 

the behaviors participants demonstrated <strong>in</strong> 

follow<strong>in</strong>g directions. These behaviors <strong>in</strong>cluded 

acknowledg<strong>in</strong>g the person giv<strong>in</strong>g the 

direction, beg<strong>in</strong>n<strong>in</strong>g the activity, <strong>and</strong> complet<strong>in</strong>g 

the activity. Performance data were calculated 

as the percentage of successfully completed 

steps of the task sequence. A m<strong>in</strong>imum 

of five opportunities to follow directions were 

recorded with<strong>in</strong> a given class period. 

Prior to selection of the target behavior, 

typical peers were observed <strong>in</strong> the general 

education classes <strong>in</strong> which participants were 

<strong>in</strong>cluded. Approximately 10 hours were spent 

observ<strong>in</strong>g these students. Students were observed 

mak<strong>in</strong>g CO2 powered cars, sew<strong>in</strong>g 

projects, complet<strong>in</strong>g worksheets <strong>and</strong> work<strong>in</strong>g 

<strong>in</strong> small group, develop<strong>in</strong>g complimentary 

color charts with pa<strong>in</strong>t based on teacher ad- 

m<strong>in</strong>istered directions, participat<strong>in</strong>g <strong>in</strong> group 

activities, <strong>and</strong> complet<strong>in</strong>g assignments. 

Based on these activities, both general <strong>and</strong> 

special educators were asked what particular 

skills students had difficulty with. All teachers 

<strong>in</strong>dicated that follow<strong>in</strong>g directions was a skill 

difficult for several students. Follow<strong>in</strong>g, the 

participants were shown a list of skills observed 

dur<strong>in</strong>g performance of the above activities 

<strong>and</strong> asked to provide their <strong>in</strong>put. All students 

agreed that they needed more practice 

<strong>in</strong> follow<strong>in</strong>g directions. 

Data Collection 


Both the students <strong>and</strong> the observer recorded 

performance data; these data were based on 

students’ performance of steps <strong>in</strong> the task 

analyses. Students self-monitored their performance 

dur<strong>in</strong>g the <strong>in</strong>tervention <strong>and</strong> ma<strong>in</strong>tenance 

conditions <strong>and</strong> the observer recorded 

their behaviors as they occurred dur<strong>in</strong>g all 

three experimental conditions. Also, the researcher 

computed the agreement between 

the observer’s <strong>and</strong> student’s records of target 

behavior performance. 

Interobserver agreement. Interobserver agreement 

scores were obta<strong>in</strong>ed for approximately 

50% of the sessions throughout all experimental 

conditions. An <strong>in</strong>dependent observer <strong>and</strong> 

the researcher were responsible for data collection 

dur<strong>in</strong>g the assessment across all sessions. 

The observer <strong>and</strong> the researcher scored 

each step of the task analysis, <strong>and</strong> then compared 

scores to determ<strong>in</strong>e degree of agreement. 

A po<strong>in</strong>t-by-po<strong>in</strong>t agreement ratio was used 

to determ<strong>in</strong>e percentage of agreement between 

observers. Po<strong>in</strong>t-by-po<strong>in</strong>t agreement 

was established by divid<strong>in</strong>g number of agreements 

by number of agreements <strong>and</strong> disagreements 

<strong>and</strong> multiply<strong>in</strong>g by 100 (Kazd<strong>in</strong>, 1982). 

Observer tra<strong>in</strong><strong>in</strong>g. A university research assistant 

was hired as the observer across all 

conditions. The researcher served as an observer 

dur<strong>in</strong>g times of <strong>in</strong>terobserver agreement. 

Observer tra<strong>in</strong><strong>in</strong>g consisted of two 

stages. First, each observer was <strong>in</strong>structed <strong>in</strong> 

use of Lovitt’s (2000) self-management package. 

Instruction consisted of operationally def<strong>in</strong><strong>in</strong>g 

the target behaviors <strong>and</strong> underst<strong>and</strong><strong>in</strong>g 

the cod<strong>in</strong>g system. Second, observers roleplayed, 

identified, <strong>and</strong> recorded target behaviors 

of follow<strong>in</strong>g directions <strong>in</strong> relat<strong>in</strong>g to key

<strong>in</strong>structional tasks. When the observers 

reached an 80% agreement on observed behaviors 

for three consecutive sessions, tra<strong>in</strong><strong>in</strong>g 

ended <strong>and</strong> observation of participants <strong>in</strong> the 

general education classroom began. 

Treatment fidelity. To ensure the appropriate 

<strong>and</strong> consistent delivery of the self-monitor<strong>in</strong>g 

strategy <strong>in</strong>struction, the tra<strong>in</strong>er followed 

an <strong>in</strong>structional checklist each session. The 

checklist consisted of steps the tra<strong>in</strong>er used to 

<strong>in</strong>struct the student to follow directions <strong>and</strong> 

monitor their own performance. The checklist 

items were used to determ<strong>in</strong>e if the <strong>in</strong>structional 

protocol was consistently delivered 

<strong>in</strong> each session. The observer used the checklist 

to monitor approximately 25% of tra<strong>in</strong><strong>in</strong>g 

sessions to ensure that the <strong>in</strong>struction was consistent. 

Experimental Design <strong>and</strong> Conditions 

A multiple-basel<strong>in</strong>e design across subjects was 

used to assess effects of an <strong>in</strong>structional program 

designed to tra<strong>in</strong> students to follow directions 

<strong>in</strong> the general education classroom 

(Kazd<strong>in</strong>, 1982; Tawney & Gast, 1984). Because 

of logistical <strong>and</strong> schedul<strong>in</strong>g cont<strong>in</strong>gencies, 

two parallel multiple basel<strong>in</strong>e designs were 

conducted, each with three participants. The 

experimental conditions <strong>in</strong>cluded: basel<strong>in</strong>e, 

<strong>in</strong>tervention, <strong>and</strong> ma<strong>in</strong>tenance. Each is described 

below. 

Basel<strong>in</strong>e. Dur<strong>in</strong>g this condition, the observer 

observed <strong>and</strong> recorded frequency of 

occurrence of each target behavior. A m<strong>in</strong>imum 

of five directions was delivered dur<strong>in</strong>g 

each observation session. If the teacher gave 

less than three directions (e.g., <strong>in</strong> a session 

when a video was played), the data were not 

<strong>in</strong>cluded. No re<strong>in</strong>forcement or corrective 

feedback was provided dur<strong>in</strong>g this condition. 

Intervention was <strong>in</strong>itiated after a stable pattern 

of respond<strong>in</strong>g was observed. 

Intervention. This <strong>in</strong>volved teach<strong>in</strong>g students 

to complete assigned tasks <strong>and</strong> self-monitor 

their performance. Students were <strong>in</strong>structed 

to make a “” mark <strong>in</strong> a box on the 

self-monitor<strong>in</strong>g sheet each time they performed 

a step <strong>in</strong> the task analysis, or a “” <strong>in</strong> 

the box if a step <strong>in</strong> the task analysis was not 

completed. Students were <strong>in</strong>structed on what 

constituted an appropriate response <strong>in</strong>volv<strong>in</strong>g 

follow<strong>in</strong>g directions. These statements were 

pr<strong>in</strong>ted on the self-monitor<strong>in</strong>g sheet to corre- 

spond with steps of the task analysis. Dur<strong>in</strong>g 

the period preced<strong>in</strong>g the general education 

class, self-monitor<strong>in</strong>g <strong>in</strong>struction was provided 

<strong>in</strong> the follow<strong>in</strong>g manner. 

First, the tra<strong>in</strong>er clearly def<strong>in</strong>ed the target 

behavior of follow<strong>in</strong>g directions given by their 

general education teacher. Students were <strong>in</strong>structed 

<strong>in</strong> what constitutes a direction <strong>and</strong> 

how to discrim<strong>in</strong>ate between a direction <strong>and</strong> 

other statements. Examples were provided to 

demonstrate a direction (e.g., “Please open 

your book to page 20 <strong>and</strong> answer the questions 

over the chapter”) versus a statement 

(e.g., “My note book is miss<strong>in</strong>g”). The participant 

was then asked to generate two examples 

of directions that may occur <strong>in</strong> the general 

education classroom <strong>in</strong> which that 

participant participated. Second, the tra<strong>in</strong>er 

expla<strong>in</strong>ed the purpose of self-monitor<strong>in</strong>g. The 

tra<strong>in</strong>er <strong>in</strong>troduced the self-monitor<strong>in</strong>g form 

<strong>and</strong> discussed how the participat<strong>in</strong>g student 

responded to this form. The tra<strong>in</strong>er then 

showed the participant the <strong>in</strong>strument <strong>and</strong> 

discussed the component responses of follow<strong>in</strong>g 

directions. Steps <strong>in</strong>cluded nodd<strong>in</strong>g the 

head or mak<strong>in</strong>g a verbal affirmation, verbally 

restat<strong>in</strong>g the direction, perform<strong>in</strong>g the direction, 

<strong>and</strong> self-monitor<strong>in</strong>g the behaviors performed. 

Next, the tra<strong>in</strong>er demonstrated each 

step <strong>and</strong> self-monitored as he followed a direction. 

The tra<strong>in</strong>er presented both exemplars 

(e.g., “beg<strong>in</strong> to work after the teacher is 

done giv<strong>in</strong>g directions”) <strong>and</strong> non-exemplars 

(e.g., “sitt<strong>in</strong>g at your desk <strong>and</strong> look<strong>in</strong>g around 

after the direction is given”) of follow<strong>in</strong>g directions. 

The tra<strong>in</strong>er acted out each step of 

follow<strong>in</strong>g directions <strong>and</strong> demonstrated the 

use of the self-monitor<strong>in</strong>g device after each 

step was completed. 

Last, role-play<strong>in</strong>g was conducted <strong>in</strong> which 

the student practic<strong>in</strong>g follow<strong>in</strong>g directions 

while the tra<strong>in</strong>er delivered the directions. The 

tra<strong>in</strong>er gave a direction <strong>and</strong> the participant 

acted out all responses of the target behavior 

<strong>and</strong> self-monitored while perform<strong>in</strong>g the direction 

<strong>and</strong> complet<strong>in</strong>g the task. For example, 

the student might be asked to open his book 

to a particular page, choose two oppos<strong>in</strong>g colors, 

or write down what a favorite meal. One 

non-exemplar was used to assist <strong>in</strong> the discrim<strong>in</strong>ation 

between directions <strong>and</strong> statements. 

For example, “I th<strong>in</strong>k that is a nice draw<strong>in</strong>g,” 

“I like the color red,” or “I’m not very fond of 

tacos.” Verbal re<strong>in</strong>forcement was delivered to 


the participants when they demonstrated accurate 

use of the strategy. Corrective feedback 

was provided when a particular step was not 

completed correctly <strong>and</strong> the tra<strong>in</strong>er demonstrated 

a correct response. 

Dur<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g, the observer collected data 

on the students’ use of self-monitor<strong>in</strong>g <strong>and</strong> 

frequency of follow<strong>in</strong>g directions <strong>in</strong> the general 

education class. <strong>Tra<strong>in</strong><strong>in</strong>g</strong> cont<strong>in</strong>ued until 

the student demonstrated mastery of the target 

by ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g at least 80% correct responses 

of the target behavior. 

Ma<strong>in</strong>tenance. After each participant demonstrated 

an 80% mastery criterion of selfmonitor<strong>in</strong>g 

direction follow<strong>in</strong>g for three consecutive 

sessions, direct <strong>in</strong>tervention was 

withdrawn. No further praise or feedback was 

delivered but the tra<strong>in</strong>er cont<strong>in</strong>ued to give 

students a self-monitor<strong>in</strong>g card at the beg<strong>in</strong>n<strong>in</strong>g 

of each class period if they had not 

brought the forms to class. Ma<strong>in</strong>tenance data 

were collected two times per week by the observer 

for one to three months follow<strong>in</strong>g withdrawal 

of tra<strong>in</strong><strong>in</strong>g. Time <strong>in</strong> ma<strong>in</strong>tenance depended 

upon the order <strong>in</strong> which students 

went through the <strong>in</strong>tervention. 

Results 

Interobserver Agreement 

Two agreement measures were calculated. 

First, a procedural reliability of 100% was calculated 

for the teach<strong>in</strong>g procedure. The 

tra<strong>in</strong>er followed all steps of the teach<strong>in</strong>g procedure 

<strong>in</strong> all 25 sessions observed. Second, 

<strong>in</strong>terobserver agreement scores were obta<strong>in</strong>ed 

for approximately 25% of the sessions across 

all of the experimental conditions. A po<strong>in</strong>t-bypo<strong>in</strong>t 

agreement ratio rang<strong>in</strong>g 90 to 100%, 

with a mean of 95% was reported. 

Student Performance 

Figure 1 displays performance data across all 

conditions for students <strong>in</strong> Group 1. Performance 

data for students <strong>in</strong> Group 2 are displayed 

<strong>in</strong> Figure 2. 

Group 1 

Basel<strong>in</strong>e. JB responded consistently at a 

low level of performance. JB performed between 

7% <strong>and</strong> 11% of the steps, with a mean 

of 9%. Dur<strong>in</strong>g n<strong>in</strong>e basel<strong>in</strong>e sessions, JT correctly 

completed between 10% <strong>and</strong> 20% of 

the steps for follow<strong>in</strong>g directions, with a mean 

of 13% correctly completed steps. Last, WH 

correctly completed between 13% <strong>and</strong> 25% 

for 12 basel<strong>in</strong>e sessions, with a mean of 23% 

correctly completed steps. 

Intervention. Dur<strong>in</strong>g <strong>in</strong>tervention, JB correctly 


the steps of the task analysis for follow<strong>in</strong>g 

directions, with a mean of 71% correctly completed 

steps. JB reached the criterion level of 

80% after the fourth <strong>in</strong>tervention session <strong>and</strong> 

ma<strong>in</strong>ta<strong>in</strong>ed that level for three consecutive 

sessions. JT correctly completed between 28% 

<strong>and</strong> 84% of the sessions. JT performed at a 

mean level of 63%. JT reached the criterion 

level after the fifth <strong>in</strong>tervention session <strong>and</strong> 

ma<strong>in</strong>ta<strong>in</strong>ed that level for three consecutive 

sessions. Last, WH correctly completed between 

60% <strong>and</strong> 92%, with mean of 77% correctly 

completed steps. WH reached the criterion 

level of 80% after the fourth <strong>in</strong>tervention 

session <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed that level for three 

consecutive sessions. 

Ma<strong>in</strong>tenance. Dur<strong>in</strong>g ma<strong>in</strong>tenance, JB correctly 


the steps, with a mean of 99%. Ma<strong>in</strong>tenance 

data were collected for two <strong>and</strong> one-half 

months. JT correctly completed between 72% 

<strong>and</strong> 96% of the steps of the task analysis, with 

a mean of 84%. JT was <strong>in</strong> ma<strong>in</strong>tenance for 

n<strong>in</strong>e ma<strong>in</strong>tenance sessions over one <strong>and</strong> onehalf 

months. Last, WH correctly completed 

between 88% <strong>and</strong> 100% of the steps directions 

for the five ma<strong>in</strong>tenance sessions, over one 

month. WH had a mean of 93% correctly 

completed steps. 

Group 2 


Basel<strong>in</strong>e. CS consistently performed the 

target behavior at a low level of frequency. CS 

correctly completed between 7% <strong>and</strong> 14% of 

follow<strong>in</strong>g directions responses, with a mean of 

11% correctly completed steps. GS correctly 

completed between 11% <strong>and</strong> 20% of the 

steps, with a mean of 14%. Last, AH correctly 

completed between 4% <strong>and</strong> 40% of the steps 

with a mean of 15%. 

Intervention. Dur<strong>in</strong>g <strong>in</strong>tervention, CS correctly 


the steps, with a mean of 55%. CS reached the

Figure 1. Percentage of correct responses of JB, JT, <strong>and</strong> WH (Group 1). 

criterion level of 80% after the fourth <strong>in</strong>tervention 

sessions <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed that level for 

three consecutive sessions. GS correctly completed 

between 66% <strong>and</strong> 100% of the steps for 

the five <strong>in</strong>tervention sessions, with a mean of 

86% correctly completed steps. GS reached 

the criterion level of 80% after the third <strong>in</strong>tervention 

session <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed that level 

for three consecutive days. Last, AH correctly 

completed between 40% <strong>and</strong> 86% of the 

steps, with a mean of 60% correctly completed 

steps. AH reached the criterion level of 80% 


Figure 2. Percentage of correct responses for CS, GS, <strong>and</strong> AH (Group 2). 

after the tenth <strong>in</strong>tervention session <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed 

that level for three consecutive sessions. 

Ma<strong>in</strong>tenance. Dur<strong>in</strong>g ma<strong>in</strong>tenance, CS 

correctly completed between 80% <strong>and</strong> 96% of 

the steps, with a mean of 86% correctly completed 

steps. CS ma<strong>in</strong>ta<strong>in</strong>ed that level for two 


months. GS correctly completed between 92% 

<strong>and</strong> 100%, of the steps for the n<strong>in</strong>e ma<strong>in</strong>tenance 

sessions over one <strong>and</strong> one half months, 

with a mean of 97%. Last, AH correctly completed 

between 63% <strong>and</strong> 77% of the steps, 

with a mean of 69% correctly completed. AH 

was <strong>in</strong> ma<strong>in</strong>tenance for 1 month.

Social Validity 

Informal feedback from two special education 

teachers <strong>and</strong> four general education teachers 

regard<strong>in</strong>g their satisfaction of the procedure 

<strong>and</strong> results was obta<strong>in</strong>ed. Both special education 

teachers noted that participants <strong>in</strong> both 

groups were more conscientious about their 

behavior. One teacher made the comment 

that their behavior had improved because students 

did not know when they would be observed. 

They wanted to do a good job <strong>in</strong> all 

their classes because of their participation <strong>in</strong> 

the study. These teachers felt that this was 

positive experience for participants. In addition, 

they <strong>in</strong>dicated that overall ability to follow<strong>in</strong>g 

directions improved both <strong>in</strong> the general 

education <strong>and</strong> special classrooms. 

Four general education teachers commented 

that participants seemed to participate 

more <strong>in</strong> class <strong>and</strong> completed their work 

at a more consistent level than before the 

<strong>in</strong>tervention. The teachers were satisfied with 

the changes <strong>in</strong> student behavior <strong>and</strong> completion 

of work tasks after directions were followed. 

They also noted that as participants 

began to monitor their own behavior, they 

needed less teacher-directed supervision. The 

art teacher commented that, although AH is 

better at follow<strong>in</strong>g directions, he was still unable 

to leave other classmates alone while 

work<strong>in</strong>g. 

Discussion 

These f<strong>in</strong>d<strong>in</strong>gs suggest that students with 

moderate to severe disabilities successfully employed 

self-monitor<strong>in</strong>g to promote their participation 

<strong>in</strong> general education. With appropriate 

supports, there is no question that 

students with moderate to severe disabilities 

will benefit <strong>in</strong> <strong>in</strong>clusive education, <strong>and</strong> selfmonitor<strong>in</strong>g 

represents a potentially effective 

self-directed support (Hughes et al., 2002). 

Dramatic changes <strong>in</strong> performance levels were 

observed for all students, <strong>and</strong> these changes 

were ma<strong>in</strong>ta<strong>in</strong>ed for all participants up to two 

months after the <strong>in</strong>tervention was withdrawn. 

Additionally, the social validation data obta<strong>in</strong>ed 

<strong>in</strong>dicated that both special <strong>and</strong> general 

educators <strong>in</strong>volved <strong>in</strong> the <strong>in</strong>vestigation observed 

positive changes <strong>in</strong> the students’ performance 

<strong>and</strong> believed that the strategy enhanced 

students’ participation <strong>in</strong> class. 

Despite ample illustrations of the positive 

effects of self-monitor<strong>in</strong>g (see Agran, 1997; 

Wehmeyer, Agran, & Hughes, 1998), there 

are relatively few <strong>in</strong>vestigations of self-monitor<strong>in</strong>g 

conducted <strong>in</strong> <strong>in</strong>clusive sett<strong>in</strong>gs with students 

with moderate to severe disabilities (Gilberts 

et al., 2001; Hughes et al., 2002). This 

study provides further evidence that students 

with moderate to severe disabilities can monitor 

their own behavior <strong>in</strong> a general education 

sett<strong>in</strong>g. 

In addition to a lack of empirical studies, 

available data also suggest that a limited number 

of teachers <strong>in</strong>struct their students on how 

to use their strategy. Agran et al. (1999) reported 

that 35% of the teachers <strong>in</strong> their sample 

taught their students to self-monitor, with 

only 3% <strong>in</strong>dicat<strong>in</strong>g that they have observed 

their students us<strong>in</strong>g this strategy. Wehmeyer 

et al. (2000) reported that 50% of the teachers 

<strong>in</strong> their sample taught their students to selfmonitor, 

despite the fact that the majority of 

respondents rated this strategy as be<strong>in</strong>g very 

important. The paucity of <strong>in</strong>vestigations on 

effects of self-monitor<strong>in</strong>g, <strong>and</strong> failure by teachers 

to teach these strategies, are surpris<strong>in</strong>g for 

at least two reasons. First, self-monitor<strong>in</strong>g is 

relatively easy to teach <strong>and</strong> <strong>in</strong>corporate <strong>in</strong>to 

classroom activity (Agran, 1997). It requires 

the student to discrim<strong>in</strong>ate a response <strong>and</strong> 

record its occurrence <strong>in</strong> some manner. There 

are numerous reports that students with severe 

disabilities can acquire these component 

responses (see Agran, 1998; Wehmeyer et al., 

1998). Second, the strategy has great potential 

effectiveness across a variety of adaptive skills. 

As Baer (1984) noted, self-monitor<strong>in</strong>g may 

function as a discrim<strong>in</strong>ative stimulus to cue 

desired responses. As such, it may also enhance 

generalization <strong>and</strong> ma<strong>in</strong>tenance by 

provid<strong>in</strong>g the student with a self-directed common 

stimulus across sett<strong>in</strong>gs. Last, as a student-directed 

learn<strong>in</strong>g strategy, self-monitor<strong>in</strong>g 

enhances student motivation by 

transferr<strong>in</strong>g ownership of data collection from 

teacher to student <strong>and</strong>, by do<strong>in</strong>g so, permits 

the student to assess <strong>and</strong> evaluate his or her 

own performance. As Wehmeyer et al. (2000) 

noted, many teachers may not <strong>in</strong>struct students 

with moderate to severe disabilities to 

self-monitor, along with other student-directed 

learn<strong>in</strong>g strategies, because they believe 

that such students are <strong>in</strong>capable of learn<strong>in</strong>g 

to use such strategies; <strong>in</strong> effect, 


<strong>in</strong>structional time can be better spent learn<strong>in</strong>g 

more practical <strong>and</strong> relevant skills. In the 

present study, all students across both groups 

learned the strategy <strong>and</strong> achieved the mastery 

criterion <strong>in</strong> from 5 to 11 <strong>in</strong>structional sessions 

(mean 8.3 sessions). Clearly, the participants 

had little difficulty acquir<strong>in</strong>g <strong>and</strong> apply<strong>in</strong>g 

the strategy to achieve positive outcomes. 

This study contributes to the emerg<strong>in</strong>g literature 

support<strong>in</strong>g use of <strong>in</strong>struct<strong>in</strong>g students to 

use student-directed learn<strong>in</strong>g strategies <strong>in</strong> 

general education classrooms. 

A student’s successful access to general education 

<strong>in</strong>volves the performance of a repertoire 

of skills. In an <strong>in</strong>vestigation of the curricular 

skills valued most by general <strong>and</strong> 

special educators for students with severe disabilities 

<strong>in</strong>volved <strong>in</strong> <strong>in</strong>clusive education, respondents 

ranked the acquisition <strong>and</strong> execution 

of self-determ<strong>in</strong>ation <strong>and</strong> studentdirected 

learn<strong>in</strong>g strategies as most important 

for successful <strong>in</strong>clusion (Agran & Alper, 

2000). These strategies allow students to, <strong>in</strong> 

effect, support themselves, <strong>and</strong> they represent 

a critical educational outcome. There is no 

question that successful performance <strong>in</strong> general 

education requires competency <strong>in</strong> many 

skills, <strong>in</strong>clud<strong>in</strong>g core content <strong>and</strong> content facilitation 

or classroom survival skills; <strong>and</strong> follow<strong>in</strong>g 

directions represents one of the most 

critical skills. Jackson, McCaleb, <strong>and</strong> Helwick 

(2002) discussed the importance of “people 

supports” <strong>in</strong> <strong>in</strong>clusive education <strong>and</strong> cautioned 

that the over reliance of such supports 

may produce undesired dependencies. 

Clearly, self-monitor<strong>in</strong>g represents a support 

that potentially can serve to promote <strong>in</strong>dependence, 

self-reliance, <strong>and</strong>, ultimately, self-determ<strong>in</strong>ation. 

Further, Jackson et al. recommend 

the value of personaliz<strong>in</strong>g <strong>in</strong>struction <strong>and</strong> supports 

to <strong>in</strong>dividual students. Needless to say, 

what better a way to personalize <strong>in</strong>struction 

than to teach students to monitor their own 

behavior. 

Overall, the f<strong>in</strong>d<strong>in</strong>gs suggest that all students 

acquired <strong>and</strong> successfully employed the 

self-monitor<strong>in</strong>g strategy <strong>in</strong> a relatively short 

period of time <strong>and</strong> successfully employed it at 

levels dramatically higher than <strong>in</strong> basel<strong>in</strong>e. 

Nevertheless, there are several limitations to 

this study that warrant serious attention. First, 

although we knew the students self-monitored 

their performance <strong>and</strong> participat<strong>in</strong>g teachers 

reported that the students self-monitored 


their behavior for the duration of the <strong>in</strong>vestigation, 

we did not calculate accuracy of their 

self-monitor<strong>in</strong>g. In one sense, this is may not 

be an important issue s<strong>in</strong>ce there is considerable 

research that suggests self-monitor<strong>in</strong>g 

produces desired <strong>and</strong> reactive effects whether 

students accurately or <strong>in</strong>accurately monitored 

their performance (see Agran, 1997; Wehmeyer 

et al., 1998). Nevertheless, it would 

have been of <strong>in</strong>terest to determ<strong>in</strong>e the accuracy 

of the students’ records. Second, although 

participat<strong>in</strong>g teachers positively evaluated 

the value of teach<strong>in</strong>g students to selfmonitor 

their own behavior, logistical <strong>and</strong> 

temporal constra<strong>in</strong>ts prevented collection of 

student social validation data. The fact that 

their use of the strategy produced positive 

changes for all students represents a desired 

outcome, but we do not know what the students’ 

perceptions were regard<strong>in</strong>g their use of 

the strategy. Clearly, future research on effects 

of self-monitor<strong>in</strong>g warrants the collection of 

such data. Additionally, future research 

should obta<strong>in</strong> social validation data from typical 

peers on their op<strong>in</strong>ions about the students’ 

use of this strategy. Third, the <strong>in</strong>vestigation 

failed to <strong>in</strong>vestigate the generalized 

effects of the students’ use of the strategy. The 

fact that students employed the strategy <strong>in</strong> 

different sett<strong>in</strong>gs suggest, at least <strong>in</strong> part, some 

generality, but no systematic efforts were 

made to <strong>in</strong>vestigate generalized effects across 

non-targeted behaviors or sett<strong>in</strong>gs. Such an 

exam<strong>in</strong>ation is warranted <strong>in</strong> future research. 

Despite these limitations, we believe that 

the study contributes to the emerg<strong>in</strong>g literature 

on student-directed tra<strong>in</strong><strong>in</strong>g <strong>in</strong> <strong>in</strong>clusive 

sett<strong>in</strong>gs. There are relatively few applications 

of self-determ<strong>in</strong>ation or student-directed 

learn<strong>in</strong>g strategies with students with moderate 

to severe disabilities <strong>in</strong> <strong>in</strong>clusive classrooms, 

especially students at the junior high 

or middle school level. F<strong>in</strong>d<strong>in</strong>gs of this study 

demonstrate that students with moderate to 

severe disabilities can monitor their own behavior 

<strong>in</strong> general education (Agran, 1997; Agran 

et al., 2003). It is safe to say that failure to 

follow directions will produce unsatisfactory 

educational outcomes for all students. F<strong>in</strong>d<strong>in</strong>gs 

of the present study suggested that students 

with moderate to severe disabilities 

learned to appropriately respond to their 

teachers’ directions <strong>and</strong> completed the tasks 

as directed by employ<strong>in</strong>g a self-directed mon-

itor<strong>in</strong>g procedure. Use of such strategy will 

assuredly enhance learn<strong>in</strong>g <strong>in</strong> general education 

for students. 

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Received: 7 August 2003 

Initial Acceptance: 3 October 2003 

F<strong>in</strong>al Acceptance: 15 February 2004 




Social Integration of Students with Autism 

<strong>in</strong> Inclusive Sett<strong>in</strong>gs 

E. Am<strong>and</strong>a Boutot 

University of Nevada, Las Vegas 

Diane P. Bryant 

University of Texas at Aust<strong>in</strong> 

Abstract: Students with autism are <strong>in</strong>creas<strong>in</strong>gly be<strong>in</strong>g placed <strong>in</strong> general education “<strong>in</strong>clusion” sett<strong>in</strong>gs for the 

purpose of improved social <strong>in</strong>tegration. This article presents <strong>in</strong>formation on the social <strong>in</strong>tegration of ten students 

with autism <strong>in</strong> elementary <strong>in</strong>clusive sett<strong>in</strong>gs. The purposes were to describe three social <strong>in</strong>tegration constructs 

of students with autism <strong>in</strong> <strong>in</strong>clusive classrooms, <strong>in</strong>clud<strong>in</strong>g their acceptance (social preference), visibility (social 

impact), <strong>and</strong> membership <strong>in</strong> a peer group (social network affiliation) <strong>and</strong> to identify the extent to which severity 

of autism characteristics contributed to these social <strong>in</strong>tegration constructs. Results suggest students with autism 

<strong>in</strong> <strong>in</strong>clusive sett<strong>in</strong>gs are as accepted, visible, <strong>and</strong> members of peer groups, as well as both their peers without 

disabilities <strong>and</strong> those with other disabilities. Post hoc observations revealed further factors that may impact these 

constructs as well. 

Historically, literature on social status of children 

suggests that students prefer peers with 

whom they have someth<strong>in</strong>g <strong>in</strong> common, who 

are more like themselves, have good social 

<strong>and</strong> communication skills, who are leaders 

academically or athletically, <strong>and</strong> who do not 

exhibit extreme behaviors (Adler, Kless, & 

Adler, 1992). Children with low <strong>in</strong>cidence disabilities 

such as autism, which by its very def<strong>in</strong>ition 

<strong>in</strong>volves limited social <strong>and</strong> communication 

skills as well as unusual stereotypical 

behaviors, therefore, would be assumed to 

have lower status <strong>and</strong> fewer friendships. Hav<strong>in</strong>g 

important, reciprocal relationships with 

peers is key to a child’s social, emotional, <strong>and</strong> 

even cognitive development (Scheuermann & 

Webber, 2002). Children with autism spectrum 

disorders, by the very nature of their 

disorder, often lack these basic skills (American 

Psychiatric Association, 1994). Increas<strong>in</strong>gly, 

parents <strong>and</strong> professionals are look<strong>in</strong>g to 

<strong>in</strong>clusive sett<strong>in</strong>gs to provide social <strong>in</strong>teractions 

<strong>and</strong> opportunities for children with autism 

that might otherwise be lack<strong>in</strong>g <strong>in</strong> a self-conta<strong>in</strong>ed 

sett<strong>in</strong>g. 

Successful social <strong>in</strong>tegration <strong>in</strong> the general 

Correspondence concern<strong>in</strong>g this article should 

be addressed to E. Am<strong>and</strong>a Boutot, University of 

Nevada, Las Vegas, Department of Special <strong>Education</strong>, 

4505 Maryl<strong>and</strong> Parkway, Box 453014, Las Vegas, 

NV 89154-3014. 


education classroom means be<strong>in</strong>g visible to 

other students (social impact), be<strong>in</strong>g someone 

with whom the other students wish to 

spend time (social preference), <strong>and</strong> be<strong>in</strong>g a 

member of a group of friends that spend time 

together (social network affiliation). Placement 

<strong>and</strong> programm<strong>in</strong>g decisions for students 

with autism can be a difficult task. Often the 

academic abilities of these students fall beh<strong>in</strong>d 

that of their general education peers, 

caus<strong>in</strong>g <strong>in</strong>clusive placements to focus more on 

social <strong>in</strong>tegration benefits than on academic 

ones. A student’s social <strong>in</strong>tegration abilities 

are often considered significant to placement 

<strong>and</strong> programm<strong>in</strong>g decisions. Compared to 

typical students, students with autism often 

have significant social skills deficits that may 

<strong>in</strong>terfere with their acceptance by others. In 

addition, students with autism vary greatly <strong>in</strong> 

terms of severity of autism characteristics that 

may prohibit successful social <strong>in</strong>teractions 

(Mesibov & Shae, 1996). When decid<strong>in</strong>g to 

place a student with autism <strong>in</strong>to <strong>in</strong>clusive classrooms 

for the purpose of social <strong>in</strong>tegration, 

one must consider the characteristics of the 

disability as possible obstacles to success. Accord<strong>in</strong>g 

to the Diagnostic <strong>and</strong> Statistical Manual 

(4 th Edition) of the American Psychiatric 

Association (DSM-IV; 1994), primary characteristics 

of autism fall <strong>in</strong>to three categories: 

communication deficits or delays, stereotypic 

behaviors, <strong>and</strong> limited social relatedness. Sam-

ple characteristics of communication deficits 

<strong>in</strong>clude echolalic speech <strong>and</strong> a delay or failure 

to develop speech. Stereotypic behavior is 

characterized by <strong>in</strong>sistence on sameness, preoccupation 

with certa<strong>in</strong> objects or parts of 

objects, resistance to change, perseverative 

movements such as rock<strong>in</strong>g or h<strong>and</strong> flick<strong>in</strong>g, 

<strong>and</strong> self-<strong>in</strong>jurious behaviors such as headbang<strong>in</strong>g. 

Lack of eye contact <strong>and</strong> lack of social 

<strong>and</strong> emotional reciprocity are examples of social 

relatedness deficits. Each characteristic 

symptom of autism on its own may not directly 

<strong>in</strong>fluence the social <strong>in</strong>tegration of a student 

with autism <strong>in</strong> general education sett<strong>in</strong>g; however, 

severity of the characteristics could contribute 

to social <strong>in</strong>tegration success. Due to 

significant variation among severity <strong>and</strong> types 

of autism characteristics, the current study exam<strong>in</strong>ed 

the degree to which severity of each of 

the three major diagnostic categories for autism 

<strong>in</strong>fluenced social preference, social impact 

<strong>and</strong> social network affiliation of students 

with autism <strong>in</strong> <strong>in</strong>clusive classrooms. Specifically, 

severity of each of the three major diagnostic 

areas described <strong>in</strong> the DSM-IV: communication, 

social relatedness, <strong>and</strong> stereotyped 

behaviors (American Psychiatric Association) 

were exam<strong>in</strong>ed. 

Social Preference 

Social preference refers to the level of social 

acceptance a student has relative to other 

members of the classroom (Farmer & Farmer, 

1996). In studies of students without disabilities, 

Adler et al. (1992) found that students 

tend to prefer others who are (a) more like 

themselves <strong>in</strong> terms of academic or athletic 

ability; (b) more popular; (c) attractive; (d) 

congenial; (e) compliant with rules; (f) leaders; 

(g) from families with higher socioeconomic 

status; <strong>and</strong> (h) good athletes or have 

good grades. Less popular students are typically 

shy, exhibit behavior problems, are noncompliant, 

are less attractive or are perceived 

as “teachers’ pets” (Adler et al.). Differences 

exist between males <strong>and</strong> females, as well, <strong>in</strong>clud<strong>in</strong>g 

that males with high academic ability 

or low athletic ability are less popular, while 

females with high academic ability are more 

popular (Adler et al.). 

Studies on social preference of students 

with mild disabilities <strong>in</strong> <strong>in</strong>clusive classrooms 

have found overwhelm<strong>in</strong>gly that students with 

disabilities have lower preference than their 

typical peers (Coben & Zigmond, 1986; Gottlieb, 

Gottlieb, Berkell, & Levy, 1986; Sabornie, 

Kauffman, Ellis, Marshall, & Elksn<strong>in</strong>, 1987- 

1988; Stiliadis & Wiener, 1989). For example, 

Sabornie, Marshall, <strong>and</strong> Ellis (1990) found 

that students with learn<strong>in</strong>g disabilities differed 

significantly <strong>in</strong> social preference from their 

peers without disabilities. Thus, students with 

mild disabilities were not selected as preferred 

classmates. Similarly, Sabornie <strong>and</strong> Kauffman 

(1985) found that high school students with 

behavior disorders had significantly lower social 

preference than their peers without disabilities 

did. One exception to this f<strong>in</strong>d<strong>in</strong>g was 

a study by Farmer <strong>and</strong> Farmer (1996) that 

found students with LD <strong>and</strong> BD to be well 

<strong>in</strong>tegrated <strong>in</strong>to their <strong>in</strong>clusive classrooms. Relatively 

fewer studies have been done that look 

at more severe or lower <strong>in</strong>cidence disabilities, 

although most noted lower preference for students 

with disabilities than those without 

(Bender, Wyne, Struck, & Bailey, 1984; Sabornie 

& Kauffman, 1987). One exception was 

a study by Piercy, Wilton, <strong>and</strong> Townsend 

(2002), which concluded that cooperative 

learn<strong>in</strong>g techniques improved social acceptance 

of children with low <strong>in</strong>cidence, severe 

disabilities. 

Social Impact 

Social impact refers to amount of visibility a 

student has <strong>in</strong> a classroom, that is, how well a 

student is known by his or her peers (Farmer 

& Farmer, 1996). Students who score low <strong>in</strong> 

the area of preference are often perceived as 

“outcasts,” are “<strong>in</strong>visible,” or that no one 

knows their names. However, Farmer <strong>and</strong> 

Farmer found that students who may not be 

well accepted by their peers (low social preference), 

<strong>in</strong> fact, may be well known (high 

social impact). Most often the student who 

exhibits extreme behaviors <strong>and</strong> noncompliance 

will have low preference comb<strong>in</strong>ed with 

high social impact. However, typically students 

with low preference scores also receive low 

impact scores (Farmer & Farmer). 

Social Networks 

Hav<strong>in</strong>g very low social preference or impact 

scores, however, does not mean that a given 

student is without a peer group. Families iden- 

Social Integration / 15

tify hav<strong>in</strong>g friendships as a priority for their 

children with low <strong>in</strong>cidence disabilities 

(Hamre-Nietupski, Nietupski, & Strathe, 

1992). In addition, students <strong>in</strong> <strong>in</strong>clusion classrooms 

report that they are will<strong>in</strong>g to form 

friendships with students with disabilities who 

are <strong>in</strong> their class (Hendrickson, Shokoohi- 

Yekta, Hamre-Nietupski, & Gable, 1996). 

Thus, development of friendships is of valid 

concern for IEP committees when the committee 

is determ<strong>in</strong><strong>in</strong>g placement <strong>in</strong> <strong>in</strong>clusion 

for a child with a low <strong>in</strong>cidence disability such 

as autism. The term, social network, refers to 

the peer group to which a particular student 

belongs (Farmer & Farmer, 1996). Additionally, 

social networks describe who associates 

with whom <strong>and</strong> who is perceived to belong to 

a particular peer group (Farmer & Farmer). 

F<strong>in</strong>d<strong>in</strong>gs from studies of social networks of 

students have found that even students with 

low social preference or impact had a group 

of friends with whom they associated (Farmer, 

1994; Pearl et al., 1998). Social network affiliation 

among students does not seem to be 

related to disability, but rather to characteristics 

of each student as well as the classroom as 

a whole. For example, Farmer <strong>and</strong> Farmer 

found that students with learn<strong>in</strong>g disabilities 

tended to form groups together, as did students 

with behavior disorders. Moreover, students 

with giftedness tended to form peer 

groups with others who were gifted, but only if 

they were the same gender (Farmer & 

Farmer). Few studies have looked at social 

networks of students with disabilities, yet those 

that have f<strong>in</strong>d these students do have significant 

relationships with peers <strong>in</strong> general education 

classrooms (Farmer & Farmer; Hall & 

McGregor, 2000; Pearl et al.). These studies 

suggest that students who may not be well 

accepted by many peers may still be members 

of social networks. Successful social <strong>in</strong>tegration 

of students with disabilities <strong>in</strong>to <strong>in</strong>clusive 

classrooms implies acceptance (i.e., social 

preference), visibility (social impact), <strong>and</strong> 

membership <strong>in</strong> a peer group with<strong>in</strong> the larger 

classroom (social network affiliation). 

To help students with autism become more 

socially <strong>in</strong>tegrated <strong>in</strong> general education sett<strong>in</strong>gs, 

families <strong>and</strong> teachers must have an underst<strong>and</strong><strong>in</strong>g 

of the social preference, social 

impact, <strong>and</strong> social network affiliation of these 

students. Families <strong>and</strong> teachers mak<strong>in</strong>g placement 

decisions must have a better under- 

st<strong>and</strong><strong>in</strong>g of the characteristics that contribute 

to social preference, social impact, <strong>and</strong> affiliation 

<strong>in</strong> a peer network, <strong>in</strong> order to identify 

the best placement for a given student with 

autism. Teachers also need to be able to teach 

skills or remediate behaviors that may negatively 

impact on a student’s social preference, 

impact or affiliation with a social network. To 

that end, the purpose of this study was twofold. 

First, to determ<strong>in</strong>e if students with autism 

differ from their peers without disabilities 

<strong>in</strong> terms of social preference, social impact, or 

social network affiliation. Second, to determ<strong>in</strong>e 

if there were differences between severity 

of autistic characteristics (communication, 

stereotypic behaviors, <strong>and</strong> social relatedness) 

<strong>and</strong> social preference, social impact, or social 

network affiliation. 

Method 

Participants <strong>and</strong> Sett<strong>in</strong>gs 

Participants were 177 students from n<strong>in</strong>e classrooms 

<strong>in</strong> grades two through five. Of this sample, 

141 were students without any identified 

disabilities <strong>and</strong> 26 were labeled with a disability 

other than autism, such as LD, BD, or 

ADHD. Ten were students with autism or Pervasive 

<strong>Developmental</strong> Disorders-Not Otherwise 

Specified who had been identified as 

such by their pediatrician, neurologist, or a 

licensed psychologist <strong>and</strong> were receiv<strong>in</strong>g special 

education services under the autism category. 

One student was <strong>in</strong> grade two, <strong>and</strong> three 

each were <strong>in</strong> grades three, four, <strong>and</strong> five. Two 

students were <strong>in</strong> the same third grade classroom, 

classroom C. Students with autism 

ranged <strong>in</strong> age from seven years, seven months 

to eleven years, two months. All were white 

males, who spoke English as their native language. 

The students with autism were all receiv<strong>in</strong>g 

educational services <strong>in</strong> a general education 

classroom for 50% or more of the 

school day for at least one academic subject 

area <strong>and</strong> attended a public elementary school 

<strong>in</strong> central Texas. Student demographic <strong>in</strong>formation 

can be found <strong>in</strong> Table 1. 

Procedure 


Prior to data collection, teachers were asked 

to provide demographic <strong>in</strong>formation <strong>in</strong>clud<strong>in</strong>g 

each student’s full name, <strong>in</strong>clud<strong>in</strong>g any

TABLE 1 

Demographic Information, Students with Autism 

Student Grade 

Age 

Diagnosed I.Q. Score/Test 

nicknames, gender, race, <strong>and</strong> any identified 

disability. Each class was given a letter code 

(A-I), <strong>and</strong> each student with<strong>in</strong> each classroom 

was given a correspond<strong>in</strong>g number code (example: 

A1, A2, <strong>and</strong> so on). Photocopied worksheets 

were used to collect data for social preference/social 

impact <strong>and</strong> social network 

affiliation. Worksheets used for social preference 

<strong>and</strong> impact consisted of six questions 

about whom the students would most <strong>and</strong> 

least like to eat lunch, <strong>in</strong>vite to a birthday 

party, <strong>and</strong> work on a class project. Students 

were given “shields” (blue pocket folders) to 

use to conceal their worksheets from others. 

The researcher read each question to the students; 

students with autism were provided assistance 

to write their answers by the <strong>in</strong>structional 

assistant (if one was assigned to the 

student) or by the teacher, if necessary. Because 

students were asked to write <strong>in</strong> names of 

their classmates on the worksheets, a transparency 

with the names of each class member was 

made available from which students could 

copy. This transparency was read aloud before 

students were to write anyth<strong>in</strong>g on their worksheets. 

Every effort was made to secure the 

identity of those whom each student listed on 

their worksheet, <strong>in</strong>clud<strong>in</strong>g ask<strong>in</strong>g the students 

to keep their responses to themselves even 

after the researcher left <strong>and</strong> allow<strong>in</strong>g the students 

to ask only the researcher for help dur<strong>in</strong>g 

data collection. 

Amount of Time <strong>in</strong> General 

<strong>Education</strong> Support <strong>in</strong> General <strong>Education</strong> 

A 4 3,5 95/TONI a 

5 hours One-to-one Paraprofessional 

B 2 2 Unable to Test 7 hours One-to-one Paraprofessional 

C 5 4 86/KABC b 

7 hours None 

D 5 3 93/KABC 6.5 hours, pull out as needed None 

E 4 2 61/KABC 6 hours Paraprofessional <strong>in</strong> class as needed 

F 4 3 79/KABC 6.5 hours None 

G 3 Unknown Unknown 7 hours, pull out as needed One-to-one Paraprofessional 

H 3 5 79/WISC-III c 

7 hours Paraprofessional <strong>in</strong> class as needed 

I 3 4 91/KABC 7 hours Paraprofessional <strong>in</strong> class as needed 

J 5 7 108/KABC 7 hours None 

a TONI, Test of Nonverbal Intelligence (Brown, Sherbenou, & Johnson, 1990). 

b KABC, Kaufman Assessment Battery for Children (Kaufman & Kaufman, 1983). 

c WISC-III, Wechsler Intelligence Scale for Children-III (Wechsler, 1991). 

Measures 

The peer nom<strong>in</strong>ation procedure described <strong>in</strong> 

the Behavior Rat<strong>in</strong>g Profile (BRP) (Brown & 

Hammill, 1990) was used to determ<strong>in</strong>e social 

preference <strong>and</strong> social impact for all students, 

<strong>in</strong>clud<strong>in</strong>g those with autism. The BRP sociogram 

is a rank<strong>in</strong>g procedure <strong>in</strong> which students 

nom<strong>in</strong>ate three classmates with whom they 

would most like to do someth<strong>in</strong>g, <strong>and</strong> three 

classmates with whom they would least like to 

do someth<strong>in</strong>g. Although examples of questions 

are given <strong>in</strong> the test manual, the researcher 

is encouraged to develop his or her 

own questions relative to the research question 

under <strong>in</strong>vestigation (Brown & Hammill). 

To determ<strong>in</strong>e social network affiliation, students 

were each given a piece of typ<strong>in</strong>g paper 

with five circles labeled Groups A through E 

on it. The researcher asked this question of all 

students: “Are there some kids <strong>in</strong> this room 

who hang around together a lot?” The researcher 

clarified this question by ask<strong>in</strong>g: “For 

example, are there some students who seem 

to always eat together, play together at recess, 

or work together when given a choice of work 

partners?” Students were told to list as many 

groups of students, up to five, as they could 

th<strong>in</strong>k of, <strong>and</strong> to list the name of each person 

<strong>in</strong> a given group with<strong>in</strong> the provided circles. 

Students were asked to assign each person to 

only one group; if a person <strong>in</strong> the room 

seemed to hang out with more than one 


group, he or she was to be placed <strong>in</strong> the group 

with which he or she spent the most time. 

Students were told that they should only name 

as many groups as they could th<strong>in</strong>k of, <strong>and</strong> 

that it was okay to only have one or two. In 

addition, students were told that they should 

name all members of each group, but that 

they did not have to use the names of all 

people <strong>in</strong> their class. Students were told that if 

there were some people that did not seem to 

belong to any particular group, they should 

place those names outside the circles. F<strong>in</strong>ally, 

students were asked to <strong>in</strong>clude themselves <strong>in</strong> 

the group with which they associated most of 

the time. Students were asked to list their 

group first <strong>and</strong> to denote themselves with the 

word “me.” 

The Gilliam Autism Rat<strong>in</strong>g Scale (GARS; 

Gilliam, 1995) was used to determ<strong>in</strong>e a severity 

of autism characteristics quotient of each 

student with autism <strong>in</strong> each of the three ma<strong>in</strong> 

characteristic categories: communication, social 

relatedness, <strong>and</strong> stereotypic behavior. 

Quotients were dichotomized as either mild to 

moderate or moderate to severe. 

Data Analyses 

To determ<strong>in</strong>e social preference, the follow<strong>in</strong>g 

steps were taken: (1) students nom<strong>in</strong>ated 

peers with<strong>in</strong> the classroom whom they would 

most <strong>and</strong> least like to play with at recess, <strong>in</strong>vite 

to a birthday party, <strong>and</strong> work with on a class 

assignment; (2) total positive nom<strong>in</strong>ations 

<strong>and</strong> total negative nom<strong>in</strong>ations for each student 

<strong>in</strong> the class were determ<strong>in</strong>ed; (3) negative 

scores were subtracted from positives to 

determ<strong>in</strong>e each student’s overall social preference 

score; (4) scores were rank-ordered from 

highest to lowest; (5) data were dichotomized, 

based on a median score derived from the 

rank<strong>in</strong>g; <strong>and</strong> (6) students listed above the median 

score were considered to have high social 

preference, while those below the median 

score were considered to have low preference. 

To determ<strong>in</strong>e social impact, the follow<strong>in</strong>g 

steps were taken: (1) students nom<strong>in</strong>ated 

peers with whom they would most <strong>and</strong> least 

like to do three activities; (2) <strong>in</strong>stead of subtract<strong>in</strong>g 

the negative nom<strong>in</strong>ations from the 

positive nom<strong>in</strong>ations, the two were added to 

determ<strong>in</strong>e total number of times a student was 

nom<strong>in</strong>ated, regardless of whether the nom<strong>in</strong>ations 

were positive or negative; (3) students 

were then placed <strong>in</strong>to rank order from most 

to least number of times nom<strong>in</strong>ated; (4) data 

were dichotomized, based on a median score 

derived from the rank<strong>in</strong>g; <strong>and</strong> (5) aga<strong>in</strong>, 

those whose score fell above the median were 

considered to have high social preference, 

while those with a score below the median 

were considered to have low preference. 

Social network affiliation was determ<strong>in</strong>ed 

us<strong>in</strong>g a procedure described by Farmer <strong>and</strong> 

Farmer (1996), <strong>and</strong> <strong>in</strong>volved the follow<strong>in</strong>g 

steps: (1) students were asked to list students 

with<strong>in</strong> the class who “hang around together a 

lot”; (2) from these lists, the number of times 

students were named to any group was determ<strong>in</strong>ed 

us<strong>in</strong>g a social network recall matrix; 

(3) the number of times students were named 

together to a group was determ<strong>in</strong>ed us<strong>in</strong>g a 

social network co-occurrence matrix; (4) us<strong>in</strong>g 

a social network correlation matrix , students 

who were named together as a group 

50% or more of the number of times they 

were named to any group were determ<strong>in</strong>ed to 

belong to a group together; <strong>and</strong> (5) students 

were then dichotomized as affiliated or not 

affiliated. Tables 2 <strong>and</strong> 3 present the preference, 

impact, <strong>and</strong> affiliation data by GARS 

scores <strong>and</strong> by participant disability, respectively. 

A2 2 cont<strong>in</strong>gency design was used. Independent 

variables were type of disability (autism 

or no disability) <strong>and</strong> severity of autism 

characteristics. Dependent variables <strong>in</strong>cluded 

social preference, social impact, <strong>and</strong> social 

network affiliation. Fisher’s Exact Test was 

used as an alternative to the Pearson Chi 

Square procedure, because all of the assumptions 

of Chi Square could not be made. Significance 

was set at the .05 level. 

Results 


Results <strong>in</strong>dicated no differences between students 

with autism <strong>and</strong> students without disabilities 

on the social <strong>in</strong>tegrations constructs: 

social preference, social impact, or social network 

affiliation, (Fisher’s Exact Test .7512, 

p .05; .5281, p .05; .3856, p .05, respectively). 

Similarly, results were no significant 

difference between autism characteristics for 

students with autism <strong>and</strong> the social <strong>in</strong>tegration 

constructs: social preference (Fisher’s Exact 

Test 1.0, p .05; 1.0, p .05; 1.0, p 

.05), social impact (Fisher’s Exact Test 1.0,

TABLE 2 

Levels of Social Preference, Impact, <strong>and</strong> Network Affiliation for Students with Autism by GARS Scores 

Average-High 

Preference 

Low-Average 

Preference 

p .05; 1.0, p .05; .20, p .05), <strong>and</strong> social 

network affiliation (Fisher’s Exact .30, p 

.05; 1.0, p .05; .183, p .05). 

Studies have suggested that student social 

preference, impact, <strong>and</strong> network affiliation 

differ accord<strong>in</strong>g to disability type (Bender et 

al., 1984). Therefore, a Fisher’s Exact Test was 

run post hoc to determ<strong>in</strong>e if there was a difference 

between students with autism <strong>and</strong> students 

with other disabilities (i.e., LD, BD, <strong>and</strong> 

ADHD) on each the social <strong>in</strong>tegration constructs. 

No differences were found, suggest<strong>in</strong>g 

that the type of disability did not impact on 

the social <strong>in</strong>tegration constructs: social preference 

(Fisher’s Exact Test .0598, p .05), 

social impact (Fisher’s Exact Test .4593, p 

Average-High 

Impact 

.05), <strong>and</strong> social network affiliation (Fisher’s 

Exact Test .5142, p .05). 


Low-Average 

Impact 

Affiliated 

with a 

Network 

Not 

Affiliated 

with a 

Network N 

Mild-Moderate GARS 

Communication 

Scores 3 3 4 2 4 2 6 

Moderate-Severe GARS 

Communication 

Scores 2 2 2 2 3 1 4 


Behavior Scores 5 4 5 4 7 2 9 


Behavior Scores 0 1 1 0 0 1 2 


Social Scores 3 4 3 4 6 1 7 


Social Scores 2 1 3 0 1 2 3 

TABLE 3 

Levels of Social Preference, Impact <strong>and</strong> Network Affiliation for Participants 

Average-High 

Preference 

Low-Average 

Preference 

The purpose of this study was two-fold. First, 

to identify whether students with autism differed 

from their peers without disabilities on 

three social <strong>in</strong>tegration constructs. Second, to 

determ<strong>in</strong>e if there were differences between 

severity of autistic characteristics <strong>and</strong> social 

preference, social impact, or social network 

affiliation of the students with autism. Additionally, 

an analysis was conducted to determ<strong>in</strong>e 

whether there was a difference between 

students with autism <strong>and</strong> their peers with 

Average-High 

Impact 

Low-Average 

Impact 

Affiliated 

with a 

Network 

Not 

Affiliated 

with a 

Network N 

Students with Autism 50% 50% 60% 40% 70% 30% 10 

Students with Other 

<strong>Disabilities</strong> 69% 31% 38% 62% 81% 19% 26 

Students without 

<strong>Disabilities</strong> 44% 56% 48% 52% 83% 17% 141 


other disabilities on each of the three social 

<strong>in</strong>tegration constructs. 

The social <strong>in</strong>tegration constructs exam<strong>in</strong>ed 

<strong>in</strong> this study were: social preference (acceptance 

or popularity), social impact (visibility), 

<strong>and</strong> social network affiliation (membership <strong>in</strong> 

a peer group). Scores of students with autism 

on each of these three constructs were analyzed 

<strong>in</strong> terms of differences from students 

without disabilities <strong>in</strong> the classes. 

Social Preference 

It appears that students with autism <strong>in</strong> <strong>in</strong>clusive 

classrooms are as likely as their peers to be 

chosen for an activity such as play<strong>in</strong>g at recess, 

attend<strong>in</strong>g a birthday party, or work<strong>in</strong>g on a 

class project. Although this is contrary to a 

large body of research suggest<strong>in</strong>g that students 

with disabilities are more likely to have 

low social preference scores than their peers 

without disabilities (Sabornie et al., 1990; Sabornie 

& Kauffman, 1985, 1987; Sabornie et al., 

1987-1988; Stone & La Greca, 1990), <strong>in</strong>terpretations 

must be made with caution. The small 

<strong>and</strong> relatively uniform sample size makes generalization 

of f<strong>in</strong>d<strong>in</strong>gs to students of differ<strong>in</strong>g 

age, gender, region, or race limited. However, 

f<strong>in</strong>d<strong>in</strong>gs do suggest that future research is 

needed to further determ<strong>in</strong>e the nature of 

social preference for children with autism <strong>in</strong> 

<strong>in</strong>clusion sett<strong>in</strong>gs. 

Social Impact 

In terms of social impact, students with autism 

were neither more nor less visible than their 

peers without disabilities. This may suggest 

that students with autism <strong>in</strong> <strong>in</strong>clusive classrooms 

have the same amount of visibility as 

their peers without disabilities. These f<strong>in</strong>d<strong>in</strong>gs 

are similar to those of previous researchers 

(Farmer, 1994; Farmer & Farmer, 1996). 

Social Network Affiliation 

No differences were found between students 

with autism <strong>and</strong> students without disabilities 

<strong>in</strong> terms of social network affiliation. That is, 

students with autism were considered to be 

members of a very def<strong>in</strong>ite group, as often as 

students without disabilities. This <strong>in</strong>formation 

supports the prevail<strong>in</strong>g belief among some 

advocates of full <strong>in</strong>clusion that <strong>in</strong>clusion will 

assist students with disabilities <strong>in</strong> hav<strong>in</strong>g a circle 

of friends (Sta<strong>in</strong>back & Sta<strong>in</strong>back, 1992). 

It should aga<strong>in</strong> be noted that the limited sample 

size <strong>in</strong> this study requires <strong>in</strong>terpretation 

<strong>and</strong> generalization with caution. However, results 

were not as expected, as previous studies 

on social network affiliation seemed to <strong>in</strong>dicate 

that the likelihood of social networks for 

these students was limited. Thus, further studies 

are needed to gather more <strong>in</strong>formation on 

the accuracy of this phenomenon. 

The second purpose of the study was to 

identify whether severity of autism characteristics 

(communication, stereotypic behavior, 

<strong>and</strong> social relatedness) impacted social preference, 

social impact, or social network affiliation 

of these students. None of the autism 

symptoms had an effect on the social <strong>in</strong>tegration 

constructs. Based on these f<strong>in</strong>d<strong>in</strong>gs, it 

appears that no particular symptom of autism 

outweighs the other with regard to <strong>in</strong>fluence 

on social preference, social impact, or social 

network affiliation. This is surpris<strong>in</strong>g <strong>in</strong> light 

of previous work suggest<strong>in</strong>g that <strong>in</strong>appropriate 

or odd behaviors <strong>and</strong> limited social skills 

negatively impact social <strong>in</strong>tegration (Asher & 

Coie, 1990). 

Post Hoc Statistics 

Previous studies have found differences between 

disability type on social preference <strong>and</strong> 

social impact (Bender et al., 1984; Sabornie & 

Kauffman, 1985, 1986, 1987; Sabornie et al., 

1987-88), an area at first not exam<strong>in</strong>ed <strong>in</strong> the 

current study. However, no significant differences 

between groups were found, suggest<strong>in</strong>g 

that all students, regardless of disability or 

disability type, were as well accepted (social 

preference), as visible (social impact), <strong>and</strong> as 

likely to be a member of a peer group (social 

network affiliation). This is <strong>in</strong> contrast to the 

previous studies, <strong>and</strong> warrants further study. 

Observational F<strong>in</strong>d<strong>in</strong>gs 


In addition to runn<strong>in</strong>g statistics post hoc for 

enrich<strong>in</strong>g f<strong>in</strong>d<strong>in</strong>gs, the researcher made some 

<strong>in</strong>terest<strong>in</strong>g observations from the raw data. 

First, from a descriptive st<strong>and</strong>po<strong>in</strong>t regard<strong>in</strong>g 

social preference <strong>and</strong> impact, students with 

autism received positive votes by their peers 

when it came to play<strong>in</strong>g at recess or be<strong>in</strong>g 

<strong>in</strong>vited to a birthday party. Exam<strong>in</strong>ation of the

esponses given by students <strong>in</strong> the n<strong>in</strong>e classrooms 

showed, however, few of the positive 

votes given to the student with autism were for 

work<strong>in</strong>g on a class project. Students appeared 

to prefer their peer with autism as a playmate 

rather than as a partner on work related tasks. 

Future researchers may wish to exam<strong>in</strong>e this 

variable specifically to determ<strong>in</strong>e if this is <strong>in</strong> 

fact a typical response of the general education 

peers to their classmate with autism. 

Second, <strong>in</strong> one of the classrooms, the student 

with autism was elected as fourth grade 

“class president.” Not surpris<strong>in</strong>gly, this student 

also had high social preference <strong>and</strong> social impact 

scores. What is <strong>in</strong>terest<strong>in</strong>g, however, is 

that this student with autism was not a part of 

a particular social network. In previous studies, 

students who had high social preference 

(particularly students who were considered to 

be among the most popular among their 

peers) tended to be affiliated with a very dist<strong>in</strong>ct 

social group, <strong>in</strong>clud<strong>in</strong>g other “popular” 

students (Farmer & Farmer, 1996). An <strong>in</strong>terest<strong>in</strong>g, 

<strong>and</strong> possibly contribut<strong>in</strong>g factor to this 

student’s high preference <strong>and</strong> visibility, was 

that other students from his classroom had 

participated <strong>in</strong> a tra<strong>in</strong><strong>in</strong>g session early <strong>in</strong> the 

school year regard<strong>in</strong>g autism, its characteristics, 

<strong>and</strong> ways to accommodate the student 

with autism <strong>in</strong> their class. This tra<strong>in</strong><strong>in</strong>g was 

done prior to the student with autism jo<strong>in</strong><strong>in</strong>g 

the class, <strong>and</strong> without him present. It was led 

by an outside consultant <strong>in</strong> autism. Other researchers 

have noted that peer tra<strong>in</strong><strong>in</strong>g can 

help support social acceptance of a student 

with autism <strong>in</strong> an <strong>in</strong>clusive sett<strong>in</strong>g, <strong>and</strong> this 

f<strong>in</strong>d<strong>in</strong>g supports this (Garrison-Harrell, Kamps, 

& Kravits, 1997). 

Another group of students had participated 

<strong>in</strong> a similar tra<strong>in</strong><strong>in</strong>g session early <strong>in</strong> the school 

year, led by the mother of the student with 

autism. In this classroom, the student with 

autism was prone to more aggressive acts <strong>and</strong> 

to tantrums that required his frequent removal 

from class. These are behaviors that 

might typically lead to low social preference 

(popularity), but high social impact (visibility). 

Despite this, the student had high social 

preference as well as high social impact scores. 

This leads to the possibility that the tra<strong>in</strong><strong>in</strong>g 

that students underwent early <strong>in</strong> the year may 

have impacted their perceptions of their peer 

with autism <strong>in</strong> class, perhaps mak<strong>in</strong>g them 

more accept<strong>in</strong>g of this <strong>in</strong>dividual <strong>and</strong> his 

problem behaviors. It is unclear whether hav<strong>in</strong>g 

his mother lead the tra<strong>in</strong><strong>in</strong>g had an impact. 

Another <strong>in</strong>terest<strong>in</strong>g observation is that <strong>in</strong> 

one classroom, the student with autism <strong>and</strong> 

his <strong>in</strong>structional assistant were named <strong>in</strong> a 

group together by one of the members of the 

class. This leads to an <strong>in</strong>terest<strong>in</strong>g question: 

how do the other students <strong>in</strong> the classroom 

where a full time <strong>in</strong>structional assistant is 

present view the student with disabilities? The 

student <strong>in</strong> this classroom apparently viewed 

the student with autism <strong>and</strong> his <strong>in</strong>structional 

assistant as a “group,” by the st<strong>and</strong>ards set by 

the researcher (people <strong>in</strong> this class who “hang 

around together a lot”). It should be noted 

that this child with autism was not found to be 

part of a social network, nor did he have high 

social preference scores. How much hav<strong>in</strong>g a 

one-on-one assistant affected these results cannot 

be answered, but future research may provide 

<strong>in</strong>formation. 

F<strong>in</strong>ally, <strong>in</strong> the classroom <strong>in</strong> which two students 

with autism were both placed, these two 

students were named to a group together by 

all other members of the class; no one else was 

ever named to their group. In another classroom 

the student with autism was named to a 

group conta<strong>in</strong><strong>in</strong>g only those students <strong>in</strong> the 

classroom with other disabilities who were not 

isolates. This is consistent with f<strong>in</strong>d<strong>in</strong>gs by 

Farmer <strong>and</strong> Farmer (1996) <strong>and</strong> Shrum, 

Cheek, <strong>and</strong> Hunter (1988), where students 

with similar traits tended to spend most of 

their time together, as well as with f<strong>in</strong>d<strong>in</strong>gs of 

Diserio <strong>and</strong> Serafica (1986) that students with 

disabilities <strong>in</strong> <strong>in</strong>clusive classrooms tended to 

<strong>in</strong>teract with each other more often than with 

peers without disabilities. It is aga<strong>in</strong> unclear 

whether or not these students were perceived 

as be<strong>in</strong>g a group solely on the basis of their 

disabilities or because they actually did spend 

a great deal of time together. Further studies 

that <strong>in</strong>clude classroom observations may yield 

more <strong>in</strong>formation. 

Limitations <strong>and</strong> Recommendations for Future 

Research 

Researchers who are <strong>in</strong>terested <strong>in</strong> the social 

<strong>in</strong>tegration of students with autism <strong>in</strong> general 

education sett<strong>in</strong>gs are at once cautioned <strong>in</strong> 

generaliz<strong>in</strong>g these results <strong>and</strong> encouraged to 

pursue further study <strong>in</strong>to the possible social 


<strong>in</strong>tegration benefits of <strong>in</strong>clusion for students 

with autism. Several issues are raised <strong>in</strong> this 

study, which may guide future researchers <strong>in</strong> 

this area. One limitation of this study is the 

small sample size <strong>and</strong> limited variation among 

the students with autism who participated <strong>in</strong> 

the study. Future studies <strong>in</strong>volv<strong>in</strong>g a larger 

number of students with autism might yield 

more statistically significant results. Also, students 

with autism from an ethnic group other 

than Anglo as well as who are female need to 

be <strong>in</strong>cluded <strong>in</strong> future studies <strong>in</strong> order for 

f<strong>in</strong>d<strong>in</strong>gs to be more generalizeable. 

Future researchers would be wise also to 

consider several other potential factors that 

may contribute to social <strong>in</strong>tegration. This 

study exam<strong>in</strong>ed the severity of autism characteristics. 

However, particularly because these 

did not produce a significant difference, other 

factors may contribute to social <strong>in</strong>tegration 

<strong>and</strong> need to be exam<strong>in</strong>ed. For example, a 

variety of studies have found that specific 

tra<strong>in</strong><strong>in</strong>g of certa<strong>in</strong> peers with<strong>in</strong> a class can aid 

<strong>in</strong> the social <strong>in</strong>tegration of a student with autism 

(Brady, Shores, McEvoy, Ellis, & Fox, 

1987; Mundschenk & Sasso, 1995), <strong>and</strong> often 

leads to greater acceptance of this student by 

the tra<strong>in</strong>ed peers (Garrison-Harrell et al., 

1997). Future research should <strong>in</strong>vestigate the 

role peer tra<strong>in</strong><strong>in</strong>g plays <strong>in</strong> the acceptance of 

students with disabilities <strong>in</strong> <strong>in</strong>clusive classrooms. 

Also, the role that paraeducators play 

<strong>in</strong> <strong>in</strong>clusive classrooms has been subject of 

recent research. One study found that proximity 

of the paraeducator to the student with 

the disability can contribute to separation 

from classmates, dependence on adults, loss 

of gender identity, <strong>and</strong> can create a social 

barrier aga<strong>in</strong>st peer <strong>in</strong>teractions (Giangreco, 

Luiselli, & MacFarl<strong>and</strong>, 1997). In a similar 

study, researchers found that <strong>in</strong>structional assistants 

considered themselves primarily responsible 

for so much of the education of the 

student with a disability that it necessitated 

their be<strong>in</strong>g <strong>in</strong> constant close proximity to the 

student (Marks, Schrader, & Lev<strong>in</strong>e, 1999). 

These studies highlight the need for future 

<strong>in</strong>vestigations exam<strong>in</strong><strong>in</strong>g the role of paraeducators, 

<strong>and</strong> the possible factor of proximity, <strong>in</strong> 

acceptance of students with disabilities <strong>in</strong> <strong>in</strong>clusive 

classrooms. Also, such factors as 

amount of time <strong>in</strong> <strong>in</strong>clusion, philosophy <strong>and</strong> 

tra<strong>in</strong><strong>in</strong>g of teachers, <strong>and</strong> demographic <strong>in</strong>formation 

such as gender, race <strong>and</strong> age may 


contribute to social <strong>in</strong>tegration of students 

with autism <strong>in</strong> <strong>in</strong>clusive sett<strong>in</strong>gs <strong>and</strong> should be 

targeted <strong>in</strong> future studies. F<strong>in</strong>ally, future researchers 

should <strong>in</strong>vestigate students with 

more varied <strong>and</strong> severe autism characteristics. 

Further research is needed to both dispel 

the myth that students with low <strong>in</strong>cidence disabilities 

cannot be successfully <strong>in</strong>tegrated socially 

<strong>in</strong>to an <strong>in</strong>clusion classroom <strong>and</strong> to identify 

those factors that will make their 

<strong>in</strong>tegration more successful. 

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Self-monitor<strong>in</strong>g: Are Young Adults with MR <strong>and</strong> Autism able 

to Utilize Cognitive Strategies Independently? 

Jennifer B. Ganz 

University of Texas at San Antonio 

Jeff Sigafoos 

University of Texas at Aust<strong>in</strong> 

Abstract: Effectiveness of a self-monitor<strong>in</strong>g procedure was evaluated for <strong>in</strong>creas<strong>in</strong>g work task completion <strong>and</strong> 

verbal request<strong>in</strong>g <strong>in</strong> two young adult men with autism <strong>and</strong> severe mental retardation. The study was conducted 

<strong>in</strong> a vocational tra<strong>in</strong><strong>in</strong>g program at times when the men were expected to complete vocational tasks <strong>in</strong>dependently. 

A chang<strong>in</strong>g criterion design was used to evaluate the procedure on number of required tasks completed 

<strong>and</strong> number of verbal requests. When the self-monitor<strong>in</strong>g procedure was applied to task completion <strong>and</strong> verbal 

requests for help, performance <strong>in</strong>creased systematically <strong>and</strong> <strong>in</strong> l<strong>in</strong>e with the chang<strong>in</strong>g criteria design for each 

participant. Results suggest that <strong>in</strong>dividuals with autism <strong>and</strong> severe mental retardation can be taught to use 

a self-monitor<strong>in</strong>g procedure to <strong>in</strong>crease <strong>in</strong>dependent task completion <strong>and</strong> verbal request<strong>in</strong>g <strong>in</strong> a vocational 

tra<strong>in</strong><strong>in</strong>g program. 

Self-management, or management of one’s 

own behavior, is considered to be a “pivotal 

behavior,” a technique that potentially will 

have a widespread impact on areas of <strong>in</strong>tervention 

for <strong>in</strong>dividuals with autism spectrum 

disorders (ASD) (Koegel, Koegel, & McNerney, 

2001). Koegel, Koegel, <strong>and</strong> Carter (1999) 

suggest that when <strong>in</strong>dividuals with autism are 

taught to self-manage, they may generalize 

that skill to a variety of sett<strong>in</strong>gs <strong>and</strong> behaviors, 

requir<strong>in</strong>g fewer resources, such as educational 

practitioners, to monitor them. In addition, 

self-monitor<strong>in</strong>g is a positive <strong>in</strong>tervention that 

is “teacher-friendly.” That is, the process of 

teach<strong>in</strong>g <strong>in</strong>dividuals to self-monitor is reward<strong>in</strong>g 

to those <strong>in</strong>dividuals, requires little tra<strong>in</strong><strong>in</strong>g 

for practitioners, requires few materials that 

are not already available <strong>in</strong> the classroom, <strong>and</strong> 

dem<strong>and</strong>s only a small amount of the teacher’s 

time once the student ga<strong>in</strong>s <strong>in</strong>dependence. 

Thus, self-monitor<strong>in</strong>g may be useful for promot<strong>in</strong>g 

greater <strong>in</strong>dependence among <strong>in</strong>dividuals 

with ASD. 

Self-monitor<strong>in</strong>g is a cognitive-behavioral 

strategy that falls under the umbrella of selfmanagement. 

It is a method of chang<strong>in</strong>g 


be addressed to Jennifer Ganz, DISCI, COEHD, 

University of Texas at San Antonio, 6900 N Loop 

1604 W, San Antonio, TX 78249. 


someone’s th<strong>in</strong>k<strong>in</strong>g or private verbal behavior 

to impact his or her overt behavior (Rank<strong>in</strong> & 

Reid, 1995). This strategy is designed to <strong>in</strong>crease 

or decrease an <strong>in</strong>dividual’s behavior by 

hav<strong>in</strong>g that person become cognizant of his or 

her own behavior, then observe <strong>and</strong> record 

that behavior (Maag, 2004). Students who selfmonitor 

may then learn to assess <strong>and</strong> change 

their performances <strong>and</strong> reward themselves 

when they meet preset criteria. Rank<strong>in</strong> <strong>and</strong> 

Reid del<strong>in</strong>eated the follow<strong>in</strong>g steps for implement<strong>in</strong>g 

self monitor<strong>in</strong>g procedures <strong>in</strong> school 

sett<strong>in</strong>gs. 

First, choose the behavior you wish to impact. 

This must be a specific <strong>and</strong> measurable 

behavior (e.g., ask<strong>in</strong>g for a food item at lunch 

by first say<strong>in</strong>g, “please”). Second, basel<strong>in</strong>e data 

must be collected to determ<strong>in</strong>e that <strong>in</strong>dividual’s 

current rate of performance. Third, motivate 

<strong>and</strong> teach the student to use the selfmonitor<strong>in</strong>g 

system. This <strong>in</strong>volves expla<strong>in</strong><strong>in</strong>g to 

the student the value of us<strong>in</strong>g the system (e.g., 

gett<strong>in</strong>g to class on time leads to more free 

time at the end of class). Fourth, teach the 

student to use the system (e.g., mak<strong>in</strong>g tally 

marks, receiv<strong>in</strong>g tokens) <strong>and</strong> provide model<strong>in</strong>g 

<strong>and</strong> practice. If the system is effective, the 

f<strong>in</strong>al step is to fade teacher monitor<strong>in</strong>g. Initially, 

the student <strong>and</strong> teacher will take data at 

the same time, then compare <strong>and</strong> reflect on 

each session’s data. The teacher will then fade

his or her monitor<strong>in</strong>g (e.g., first collect data at 

every other session, then every fourth, then 

periodically). 

Self-monitor<strong>in</strong>g has been used with a wide 

variety of <strong>in</strong>dividuals; however, much of the 

research on self-monitor<strong>in</strong>g has been conducted 

with typically develop<strong>in</strong>g <strong>in</strong>dividuals 

<strong>and</strong> those with mild disabilities (Rank<strong>in</strong> & 

Reid, 1995). Few published studies have <strong>in</strong>cluded 

participants with severe cognitive impairments 

or autism. Studies <strong>in</strong>vestigat<strong>in</strong>g selfmonitor<strong>in</strong>g 

<strong>in</strong> <strong>in</strong>dividuals with moderate to 

severe mental retardation <strong>in</strong> school sett<strong>in</strong>gs 

have demonstrated improvement <strong>in</strong> (a) social 

<strong>in</strong>teractions with general education peers 

(Hughes et al., 2002), (b) task completion <strong>in</strong> 

both general education classrooms (Hughes 

et al.) <strong>and</strong> self-conta<strong>in</strong>ed special education 

sett<strong>in</strong>gs (Hughes & Boyle, 1991), (c) on-task 

behavior (Hughes & Boyle), (d) general education 

“classroom survival skills” (e.g., arriv<strong>in</strong>g 

on time, look<strong>in</strong>g at the teacher when spoken 

to) (Gilberts, Agran, Hughes, & Wehmeyer, 

2001), <strong>and</strong> (e) reduction of echolalia (Dipipi, 

Jitendra, & Miller, 2001). 

The majority of research <strong>in</strong>volv<strong>in</strong>g use of 

self-monitor<strong>in</strong>g <strong>and</strong> self-management with 

children with autism has focused on social 

skills, <strong>in</strong>clud<strong>in</strong>g improvements <strong>in</strong> (a) play behaviors 

with typically develop<strong>in</strong>g preschool 

peers (Shearer, Kohler, Buchan, & McCullough, 

1996; Stra<strong>in</strong>, Kohler, Storey, & Danko, 

1994), (b) conversation skills <strong>in</strong> adolescents 

(Newman, Buff<strong>in</strong>gton, & Hemmes, 1996), (c) 

<strong>in</strong>teractions with peers, <strong>and</strong> (d) shar<strong>in</strong>g (Re<strong>in</strong>ecke, 

Newman, & Me<strong>in</strong>berg, 1999). Studies 

have also found that self-monitor<strong>in</strong>g can lead 

to reductions <strong>in</strong> (a) stereotypic behaviors 

(Koegel & Koegel, 1990), (b) echolalia (Manc<strong>in</strong>a, 

Tankersley, Kamps, Kravits, & Parrett, 

2000), <strong>and</strong> (c) other <strong>in</strong>appropriate behaviors 

(Koegel, Koegel, Hurley, & Frea, 1992). Additionally, 

a few studies have demonstrated improvement 

<strong>in</strong> <strong>in</strong>dividuals with autism <strong>and</strong> similar 

characteristics <strong>in</strong> academic <strong>and</strong> functional 

skills, <strong>in</strong>clud<strong>in</strong>g progress <strong>in</strong> follow<strong>in</strong>g written 

(Newman et al., 1995) <strong>and</strong> picture (Pierce & 

Schreibman, 1994) schedules, <strong>and</strong> stay<strong>in</strong>g ontask 

(O’Reilly et al., 2002; Tabor, Seltzer, Hefl<strong>in</strong>, 

& Alberto, 1999) as a result of teach<strong>in</strong>g 

self-monitor<strong>in</strong>g skills. 

Given this literature, self-monitor<strong>in</strong>g would 

appear to be promis<strong>in</strong>g for improv<strong>in</strong>g a vari- 

ety of behaviors <strong>in</strong> <strong>in</strong>dividuals with developmental 

disabilities. There is a need for extend<strong>in</strong>g 

this research to adults <strong>in</strong> vocational 

tra<strong>in</strong><strong>in</strong>g sett<strong>in</strong>gs. In some vocational sett<strong>in</strong>gs 

<strong>in</strong>dividuals might be expected to work <strong>in</strong>dependently 

<strong>and</strong> there may be limited staff resources 

for supervision (Holloway & Sigafoos, 

1999). As a result, self-monitor<strong>in</strong>g may be 

needed to assist <strong>in</strong>dividuals with <strong>in</strong>dependent 

completion of required vocational tasks. The 

present study <strong>in</strong>vestigated effectiveness of a 

self-monitor<strong>in</strong>g procedure for <strong>in</strong>creas<strong>in</strong>g <strong>in</strong>dependent 

vocational work <strong>and</strong> verbal requests 

for help <strong>in</strong> two adult men with autism 

<strong>and</strong> severe mental retardation. 

Method 

Participants 

The first participant, Alex, was a 20-year-old 

Caucasian with a diagnosis of autism. Accord<strong>in</strong>g 

to school records, Alex met special education 

eligibility under the categories of autism, 

mental retardation, <strong>and</strong> speech/language impairment. 

In addition, Alex was legally bl<strong>in</strong>d 

<strong>and</strong> relied on glasses, large pr<strong>in</strong>t/use of visuals, 

<strong>and</strong> close proximity to materials. His physician 

had noted “abnormal responses” at 2 

months of age, attribut<strong>in</strong>g it to prenatal bra<strong>in</strong> 

damage that may have been related to a viral 

<strong>in</strong>fection dur<strong>in</strong>g pregnancy. No recent IQ 

tests had been adm<strong>in</strong>istered; however, eight 

years earlier he was assessed as hav<strong>in</strong>g an IQ of 

20. At the time of the study, Alex received an 

adaptive behavior age equivalent of 2 years, 6 

months on the V<strong>in</strong>el<strong>and</strong> Adaptive Behavior 

Scales (VABS; Sparrow, Balla, & Cicchetti, 

1985). Relative strengths on the VABS <strong>in</strong>cluded 

motor skills (age equivalent, 3-10) <strong>and</strong> 

daily liv<strong>in</strong>g skills (age equivalent, 3-1) while 

Alex displayed weaknesses <strong>in</strong> communication 

(age equivalent, 1-4) <strong>and</strong> socialization (age 

equivalent, 1-8). As noted <strong>in</strong> Alex’s school 

records <strong>and</strong> observed by the first author, Alex 

had no verbal language <strong>and</strong> had limited use of 

gestures <strong>and</strong> a communication book with pictures 

of wants, needs, <strong>and</strong> emotions. School 

records also noted severe aberrant behaviors 

<strong>in</strong>clud<strong>in</strong>g, tantrums, “stop <strong>and</strong> drop” to the 

floor, non-compliance, push<strong>in</strong>g <strong>and</strong> pull<strong>in</strong>g 

others, <strong>and</strong> bit<strong>in</strong>g his own h<strong>and</strong> so that he 

caused tissue damage. Alex was <strong>in</strong>cluded <strong>in</strong> 

Self-monitor<strong>in</strong>g / 25

this study to <strong>in</strong>crease <strong>in</strong>dependent work completion. 

Prior to the study, it was reported by 

staff that Alex would not complete any work 

without a staff member’s cont<strong>in</strong>ual prompt<strong>in</strong>g. 

The second participant, Troy, was a 19-yearold 

Mexican-American who received special 

education eligibility under the categories of 

mental retardation <strong>and</strong> other health impairment, 

due to seizures. At 2 years, 10 months, a 

school district comprehensive evaluation attributed 

Troy’s disabilities to men<strong>in</strong>gitis <strong>and</strong> a 

stroke at 7 months of age, result<strong>in</strong>g <strong>in</strong> significantly 

decreased use of his right side, lack of 

speech, aberrant behaviors, <strong>and</strong> short attention 

span. At the time of the study, Troy was 

tak<strong>in</strong>g medications for attention, mood disorder, 

<strong>and</strong> seizures; however, he was reportedly 

seizure-free at the time. No recent IQ tests had 

been adm<strong>in</strong>istered; however, six years earlier 

he was assessed as hav<strong>in</strong>g an IQ of 34. At the 

time of the study, Troy received an adaptive 

behavior age equivalent of 4 years, 1 month 

on the VABS (Sparrow et al., 1985). Relative 

strengths on the VABS <strong>in</strong>cluded motor skills 

(age equivalent, above 5-11) <strong>and</strong> daily liv<strong>in</strong>g 

skills (age equivalent, 5-10) while relative 

weaknesses were <strong>in</strong> communication (age 

equivalent, 2-5) <strong>and</strong> socialization (age equivalent, 

3-2). As reported by Troy’s classroom 

teacher <strong>and</strong> observed by the first author, he 

could speak, but <strong>in</strong>frequently did so spontaneously. 

He also reportedly displayed aberrant 

behaviors <strong>in</strong>clud<strong>in</strong>g disrob<strong>in</strong>g, throw<strong>in</strong>g his 

shoes, bit<strong>in</strong>g others, <strong>and</strong> hid<strong>in</strong>g under his 

desk. Troy was <strong>in</strong>cluded <strong>in</strong> this study to <strong>in</strong>crease 

spontaneous speech, specifically, ask<strong>in</strong>g 

for help dur<strong>in</strong>g work sessions. Though he 

was capable of <strong>in</strong>telligible, spontaneous 

speech, he rarely <strong>in</strong>itiated requests for items 

or actions or made comments. 

Sett<strong>in</strong>gs <strong>and</strong> Materials 

Data collection <strong>and</strong> self-monitor<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g 

took place <strong>in</strong> the participants’ classroom <strong>in</strong> a 

self-conta<strong>in</strong>ed vocational public school for students 

with disabilities. Both Alex <strong>and</strong> Troy 

were <strong>in</strong> a class for young adults that focused 

on transitional skills (e.g., functional communication, 

self-help, work skills). Data collection 

<strong>and</strong> tra<strong>in</strong><strong>in</strong>g were adm<strong>in</strong>istered dur<strong>in</strong>g 

vocational tasks. For example, Alex completed 

tasks <strong>in</strong>volv<strong>in</strong>g plac<strong>in</strong>g small objects (e.g., 

co<strong>in</strong>s) <strong>in</strong>to conta<strong>in</strong>ers <strong>and</strong> sort<strong>in</strong>g two objects 

by color. Troy completed tasks <strong>in</strong>clud<strong>in</strong>g sort<strong>in</strong>g 

up to six items by color <strong>and</strong> shape, <strong>and</strong> 

sort<strong>in</strong>g brochures <strong>and</strong> fill<strong>in</strong>g envelopes. 

Self-monitor<strong>in</strong>g materials were <strong>in</strong>dividualized. 

Alex’s materials <strong>in</strong>cluded 3 cm square 

tokens, a small plastic conta<strong>in</strong>er conta<strong>in</strong><strong>in</strong>g 

the number of tokens he was to earn before 

he received his reward, <strong>and</strong> a lam<strong>in</strong>ated sheet 

of paper (approximately 20 13 cm) that 

<strong>in</strong>cluded l<strong>in</strong>e draw<strong>in</strong>gs (approximately 3 cm 

square) <strong>in</strong>dicat<strong>in</strong>g “do work” <strong>and</strong> the reward 

he was to earn (see Figure 1 for an example). 

Rewards that Alex earned for completion of 

work <strong>in</strong>cluded time on the computer, a sp<strong>in</strong>n<strong>in</strong>g 

toy that lit up, <strong>and</strong> a sp<strong>in</strong>n<strong>in</strong>g toy that 

played music. When he completed the set 

amount of work, he was allowed to choose 

which of these activity rewards he wanted <strong>and</strong> 

was allowed to engage <strong>in</strong> that activity for five 

m<strong>in</strong>utes. Troy also had a small conta<strong>in</strong>er that 

conta<strong>in</strong>ed 3 cm blocks that snapped together. 

L<strong>in</strong>e draw<strong>in</strong>gs attached to the conta<strong>in</strong>er <strong>in</strong>dicated 

that he should ask for “help” <strong>and</strong> the 

reward he was to earn (see Figure 2 for an 

example of Troy’s self-monitor<strong>in</strong>g system). 

Troy’s rewards <strong>in</strong>cluded listen<strong>in</strong>g to a cassette 

tape with headphones, a tube that sounded 

like thunder when shook, <strong>and</strong> a pencil with a 

fake spider on the end. When he completed 

the set amount of work, he was allowed to 

choose which of these activity rewards he 

wanted <strong>and</strong> was allowed to engage <strong>in</strong> that 

activity for five m<strong>in</strong>utes. 

Response Def<strong>in</strong>itions 


Target behaviors were def<strong>in</strong>ed <strong>in</strong>dividually for 

each participant <strong>in</strong> consultation with the classroom 

teacher. Alex’s target behavior was to 

complete a task with<strong>in</strong> five m<strong>in</strong>utes. He was 

<strong>in</strong>itially required to complete one task with<strong>in</strong> 

the time limit, but this was gradually <strong>in</strong>creased 

to four by the completion of the study. Each 

task consisted of sort<strong>in</strong>g 10 to 20 items or 

plac<strong>in</strong>g 10 to 20 items <strong>in</strong> a conta<strong>in</strong>er. Troy’s 

target behavior was to verbally request help 

(e.g., “help,” stat<strong>in</strong>g the name of a specific 

item needed) when tasks were sabotaged by 

necessary items be<strong>in</strong>g removed (e.g., sets of 

items to be sorted). Troy was orig<strong>in</strong>ally required 

to make two requests for help with<strong>in</strong>

the five m<strong>in</strong>ute period <strong>in</strong> response to two 

<strong>in</strong>stances of sabotage, but this was <strong>in</strong>creased 

gradually to six requests for help <strong>in</strong> response 

to six <strong>in</strong>stances of sabotage 


Data were collected on occurrence of target 

behaviors dur<strong>in</strong>g each session. For Alex, an 

occurrence was counted each time he completed 

a task with<strong>in</strong> the five m<strong>in</strong>ute session. 

For Troy, an occurrence was counted if he 

asked for help when it was needed <strong>in</strong> response 

to the task be<strong>in</strong>g sabotaged. All verbal requests 

for help were recorded with<strong>in</strong> the five 

m<strong>in</strong>ute work session, regardless of number of 

<strong>in</strong>stances of sabotage (e.g., periodically, Troy 

asked for help two times after one <strong>in</strong>stance of 

sabotage <strong>and</strong> both <strong>in</strong>stances were recorded). 

Data were collected us<strong>in</strong>g event record<strong>in</strong>g of 

the presence of each participant’s target behavior 

(e.g., number of tasks completed, number 

of requests for help) <strong>and</strong> <strong>in</strong>stances of 

Figure 1. Example of Alex’s self-monitor<strong>in</strong>g materials. 

<strong>in</strong>dependent use of the token systems dur<strong>in</strong>g 

each work session. Sessions were a maximum 

of five m<strong>in</strong>utes long, but ended when a participant 

reached the current criterion for his 

target behavior. 

As the project progressed, it was noted anecdotally 

that participants often failed to use 

their token systems. Thus, data were collected 

regard<strong>in</strong>g the necessity of prompts (yes/no) 

for each participant to take the token once it 

had been earned. 

Procedure 

Data were collected <strong>in</strong> five m<strong>in</strong>ute sessions. 

Sessions occurred 1-2 times per day <strong>and</strong> 3-5 

days per week. A chang<strong>in</strong>g criterion design 

was used to demonstrate collateral changes <strong>in</strong> 

target behaviors <strong>in</strong> relation to changes <strong>in</strong> task 

requirements (Hartmann & Hall, 1976). 

Basel<strong>in</strong>e. Basel<strong>in</strong>e sessions were conducted 

under typical classroom conditions. Students 


sat at study carrels with work <strong>in</strong> front of them 

<strong>and</strong> the teacher <strong>in</strong>structed the student to do 

his work. They were not offered rewards for 

work completion (Alex’s target behavior) or 

verbal requests for help (Troy’s target behavior), 

but the teacher did use verbal <strong>and</strong> gestural 

prompts (e.g., po<strong>in</strong>t<strong>in</strong>g to pencils to be 

sorted <strong>and</strong> the conta<strong>in</strong>er they should be 

placed <strong>in</strong>) to rem<strong>in</strong>d them to complete their 

work. 

Assessment of preferred items. Prior to selfmonitor<strong>in</strong>g 

tra<strong>in</strong><strong>in</strong>g, we assessed each participant’s 

preferences regard<strong>in</strong>g rewards. Based 

on teacher <strong>in</strong>put, a variety of items were collected 

(e.g., cassette tape player with headphones, 

sp<strong>in</strong>n<strong>in</strong>g toys with lights <strong>and</strong> music, 

squishy balls). Sets of five or six items were 

placed <strong>in</strong> front of each participant <strong>and</strong> data 

collected on which items were selected most 

frequently. Items selected most frequently 

Figure 2. Example of Troy’s self-monitor<strong>in</strong>g materials. 


were identified as preferred <strong>and</strong> delivered 

cont<strong>in</strong>gent upon target behaviors dur<strong>in</strong>g subsequent 

phases of the study. Alex’s re<strong>in</strong>forcers 

<strong>in</strong>cluded time on the computer <strong>and</strong> two h<strong>and</strong>held 

sp<strong>in</strong>n<strong>in</strong>g toys with lights <strong>and</strong> music. 

Troy’s preferred items were a cassette tape 

player with headphones, a tube that made 

sounds like thunder when shaken, <strong>and</strong> a pencil 

with a fake spider on the end. 

Self-monitor<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g. The first step <strong>in</strong> 

self-monitor<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g with each participant 

was to offer one of the preferred items. Each 

participant was shown a few pictures (approximately 

3 cm square) of preferred items to 

choose from <strong>and</strong> asked what he wished to 

work for. He would then <strong>in</strong>dicate which item 

he preferred. Alex po<strong>in</strong>ted or picked up the 

picture of the item he wanted, while Troy 

po<strong>in</strong>ted <strong>and</strong>/or verbally named the item. The 

participant would then place the picture on

the token system (see Figures 1 <strong>and</strong> 2). Specifically, 

Alex would place it on a lam<strong>in</strong>ated 

sheet of paper (approximately 20 13 cm) 

that <strong>in</strong>cluded a l<strong>in</strong>e draw<strong>in</strong>g stat<strong>in</strong>g “do work” 

<strong>and</strong> pieces of Velcro to receive the tokens he 

would earn. Troy placed his reward picture on 

a small plastic box conta<strong>in</strong><strong>in</strong>g the snap blocks 

he was to earn <strong>and</strong> which had a l<strong>in</strong>e draw<strong>in</strong>g 

attached <strong>in</strong>dicat<strong>in</strong>g, “help.” The experimenter 

would then give a verbal rem<strong>in</strong>der of 

the behavior required to earn the reward 

(e.g., “first, f<strong>in</strong>ish work [po<strong>in</strong>t<strong>in</strong>g to the picture 

<strong>in</strong>dicat<strong>in</strong>g “do work”], then get computer 

[po<strong>in</strong>t<strong>in</strong>g to the photo of the computer],” or 

“ask for help [po<strong>in</strong>t<strong>in</strong>g to the picture <strong>in</strong>dicat<strong>in</strong>g 

“help”], then get headphones [po<strong>in</strong>t<strong>in</strong>g to 

the picture of the headphones]”). 

At the beg<strong>in</strong>n<strong>in</strong>g of tra<strong>in</strong><strong>in</strong>g, both participants 

were shown how to use the token systems. 

Specifically, Alex was shown <strong>and</strong> told 

how to take a token from the conta<strong>in</strong>er as he 

completed each task <strong>and</strong> place it on the lam<strong>in</strong>ated 

sheet. When he had taken all tokens 

out of the conta<strong>in</strong>er, he was <strong>in</strong>structed to take 

the picture of the reward <strong>and</strong> go to his reward, 

most often the computer. The token conta<strong>in</strong>er 

only held the number of tokens correspond<strong>in</strong>g 

with the number of tasks he was 

required to complete dur<strong>in</strong>g that work session. 

Troy was shown how to take a snap block 

out of the conta<strong>in</strong>er each time he verbally 

requested help. His conta<strong>in</strong>er also held only 

the number of blocks correspond<strong>in</strong>g with the 

number of times he was to request help dur<strong>in</strong>g 

that work session. Once he had earned 

<strong>and</strong> snapped together all the blocks, he would 

show blocks to the teacher or experimenter to 

receive his reward, most frequently the headphones. 

Any prompts necessary for the successful 

use of the token system were given, 

<strong>in</strong>clud<strong>in</strong>g h<strong>and</strong>-over-h<strong>and</strong>, po<strong>in</strong>t<strong>in</strong>g, <strong>and</strong> verbal 

rem<strong>in</strong>ders. As dur<strong>in</strong>g basel<strong>in</strong>e, sessions 

lasted for a maximum of five m<strong>in</strong>utes <strong>and</strong> 

ended once the participant had earned his 

reward. Criteria to earn rewards <strong>in</strong>creased 

once the participant demonstrated stability at 

the current level by meet<strong>in</strong>g or exceed<strong>in</strong>g the 

set criteria for two to three consecutive sessions. 

Thus, Alex was required to complete 

one task for the first four tra<strong>in</strong><strong>in</strong>g sessions, two 

tasks for eight sessions, three tasks for five 

sessions, <strong>and</strong> four tasks for the last three sessions. 

Troy was required to make two requests 

for help for two sessions to earn his reward, 

four requests for the next fourteen sessions, 

five requests for three sessions, <strong>and</strong> six requests 

for the last three sessions. 

Self-monitor<strong>in</strong>g booster sessions. We noted anecdotally 

that dur<strong>in</strong>g the first two phases of 

self-monitor<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g, participants were not 

us<strong>in</strong>g the token systems <strong>in</strong>dependently; thus, 

at that time, we collected data establish<strong>in</strong>g 

basel<strong>in</strong>es for <strong>in</strong>dependent use of the token 

systems. We then implemented booster sessions 

to provide repeated practice us<strong>in</strong>g the 

systems. This occurred at the criteria of two 

tasks completed for Alex <strong>and</strong> four requests 

required for Troy, thus prolong<strong>in</strong>g those 

phases for each participant, allow<strong>in</strong>g for collection 

of basel<strong>in</strong>e <strong>and</strong> treatment data regard<strong>in</strong>g 

<strong>in</strong>dependent use of the token systems. 

Alex’s eight booster sessions took place over 

two days, while Troy’s 10 booster sessions all 

occurred <strong>in</strong> one day. Alex received fewer per 

day due to the appearance of self-<strong>in</strong>jurious 

behavior, bit<strong>in</strong>g his own arm, after four sessions 

back-to-back. Booster sessions for Alex 

consisted of present<strong>in</strong>g him with shortened 

tasks. For example, a task <strong>in</strong>volv<strong>in</strong>g sort<strong>in</strong>g 

different colored straws <strong>in</strong>cluded approximately 

1/3 of the previous number. Tasks 

were presented <strong>and</strong> completed rapidly, followed 

by delayed prompt<strong>in</strong>g to teach him to 

use his tokens. If he did not take a token after 

five seconds, he was prompted to take it <strong>and</strong> 

place it on the token sheet. Dur<strong>in</strong>g the first 

day of booster sessions, he completed two 

tasks at each session before receiv<strong>in</strong>g his re<strong>in</strong>forcer; 

this was <strong>in</strong>creased to three the second 

day, after which he received two m<strong>in</strong>utes access 

to his re<strong>in</strong>forcer. Troy’s booster sessions 

<strong>in</strong>volved sitt<strong>in</strong>g at his study carrel without the 

presence of a task <strong>and</strong> tell<strong>in</strong>g him he needed 

to, “ask for help to earn a block.” Each time he 

verbally asked for help, he received a block. 

Delayed prompt<strong>in</strong>g was utilized for Troy as 

well. Once he had earned four blocks, he 

received two m<strong>in</strong>utes access to his re<strong>in</strong>forcer. 

Once participants were <strong>in</strong>dependently us<strong>in</strong>g 

their token systems the majority of the time, 

booster sessions were discont<strong>in</strong>ued. Subsequent 

to booster sessions, the delayed prompt<strong>in</strong>g 

technique rema<strong>in</strong>ed <strong>in</strong> place for their use 

of the token systems. 


Inter-Observer Agreement 

Inter-observer agreement was assessed on 

Alex’s target behavior, task completion, for 

61% of the sessions <strong>and</strong> was assessed on his 

<strong>in</strong>dependent use of the token system for 40% 

of possible sessions. Troy’s target behavior, 

verbal request<strong>in</strong>g, was measured by two observers 

for 64% of his sessions <strong>and</strong> for <strong>in</strong>dependent 

use of his token system, for 52% of 

possible sessions. Inter-observer agreement 

was calculated by divid<strong>in</strong>g the smaller number 

of responses recorded by an observer by the 

larger number of responses recorded by the 

other observer (Richards, Taylor, Ramasamy, 

& Richards, 1999). Mean <strong>in</strong>ter-observer agreement 

for Alex was calculated at 100% for task 

completion data <strong>and</strong> 92% (range 50 to 100%) 

for <strong>in</strong>dependent use of the token system data, 

<strong>and</strong> for Troy was calculated at 98% (range 57 

to 100%) for request<strong>in</strong>g data <strong>and</strong> 94% (range 

60 to 100%) for <strong>in</strong>dependent use of the token 

system data. 

Results 

Figure 3 shows number of tasks completed 

<strong>and</strong> number of tokens taken <strong>in</strong>dependently 

dur<strong>in</strong>g each session by Alex. Figure 4 shows 

number of requests for help <strong>and</strong> number of 

tokens taken <strong>in</strong>dependently dur<strong>in</strong>g each session 

by Troy. 

Dur<strong>in</strong>g basel<strong>in</strong>e, Alex did not complete any 

tasks <strong>and</strong> Troy did not make any verbal requests 

for help. After self-monitor<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g, 

both students showed <strong>in</strong>creases <strong>in</strong> their target 

behaviors. Alex <strong>in</strong>creased number of tasks 

completed <strong>in</strong> response to changes <strong>in</strong> required 

number of tasks. That is to say, each time the 

required number of tasks <strong>in</strong>creased from one 

to two, then three, then four, Alex met that 

requirement <strong>and</strong> earned his reward. Similarly, 

Troy <strong>in</strong>creased his verbal requests for help <strong>in</strong> 

response to number of times the task was sabotaged. 

That is to say that he met or exceeded 

his requirement (i.e., two requests, then four, 

then five, then six) dur<strong>in</strong>g all but two sessions 

dur<strong>in</strong>g the <strong>in</strong>tervention phases. On <strong>in</strong>stances 

where he exceeded the requirement, he chose 

to cont<strong>in</strong>ue work<strong>in</strong>g once he had earned his 

re<strong>in</strong>forcer, usually headphones, or he made 

multiple, repeated requests for help when the 

teacher did not respond quickly. 

Data on whether students took their earned 

token <strong>in</strong>dependently were collected beg<strong>in</strong>n<strong>in</strong>g 

with Session 9 for Alex <strong>and</strong> Session 14 for 

Troy. Prior to booster tra<strong>in</strong><strong>in</strong>g neither Alex 

(Sessions 9-11) nor Troy (Sessions 14-16) took 

any tokens <strong>in</strong>dependently. After booster tra<strong>in</strong>- 

Figure 3. Alex: Task completion <strong>and</strong> <strong>in</strong>dependent use of token system. 

30 / <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>-March 2005

<strong>in</strong>g, number of token taken <strong>in</strong>dependently 

<strong>in</strong>creased for both students. 


Figure 4. Troy: Request<strong>in</strong>g help <strong>and</strong> <strong>in</strong>dependent use of token system. 

This study <strong>in</strong>vestigated effects of self-monitor<strong>in</strong>g 

with two young adult males with mental 

retardation <strong>and</strong> autism. Specifically, this research 

sought to determ<strong>in</strong>e if self-monitor<strong>in</strong>g 

would <strong>in</strong>crease target behaviors, if such students 

could learn to use the self-monitor<strong>in</strong>g/ 

token system <strong>in</strong>dependently, <strong>and</strong> what modifications, 

if any, would be needed to <strong>in</strong>crease 

their <strong>in</strong>dependence. Initially, participants 

demonstrated no occurrences of their target 

behaviors. Use of prompts (e.g., verbal <strong>and</strong> 

gestural cues) was not sufficient to <strong>in</strong>crease 

task completion or verbal requests for help. 

However, results <strong>in</strong>dicate that that the <strong>in</strong>tervention 

was effective <strong>in</strong> systematically <strong>in</strong>creas<strong>in</strong>g 

respond<strong>in</strong>g for both participants’ target 

behaviors. Collateral effects were noted anecdotally 

for each participant, <strong>in</strong>clud<strong>in</strong>g <strong>in</strong>creased 

will<strong>in</strong>gness to complete work <strong>and</strong> <strong>in</strong>- 

creased verbal <strong>in</strong>teractions outside of tra<strong>in</strong><strong>in</strong>g 

sessions. 

Initial tra<strong>in</strong><strong>in</strong>g, which was associated with 

an <strong>in</strong>crease <strong>in</strong> target behaviors, was not sufficient 

to ensure students would take tokens 

they earned. Consequently, additional tra<strong>in</strong><strong>in</strong>g 

was implemented to establish <strong>in</strong>dependent 

selection of earned tokens. With this 

additional <strong>in</strong>tervention, each participant 

learned to <strong>in</strong>dependently use his token system 

the majority of the time, with the supplementation 

of <strong>in</strong>tensive booster session tra<strong>in</strong><strong>in</strong>g 

<strong>and</strong> a delayed prompt<strong>in</strong>g procedure. Independent 

use of the token systems was not 

always high, however. While booster sessions 

<strong>and</strong> prompt delay strategy were effective <strong>in</strong> 

<strong>in</strong>creas<strong>in</strong>g number of times participants took 

their earned tokens <strong>in</strong>dependently, even after 

the booster sessions, they cont<strong>in</strong>ued to require 

prompt<strong>in</strong>g dur<strong>in</strong>g several sessions (see 

Figure 3, Session 21 <strong>and</strong> Figure 4, Sessions 

27-30, 33 <strong>and</strong> 35). Further research replicat<strong>in</strong>g 

<strong>and</strong> extend<strong>in</strong>g this study could determ<strong>in</strong>e 

if, given more time, the prompt delay strategy 


would result <strong>in</strong> complete <strong>in</strong>dependence with 

the token system or if there is another strategy 

that would be more effective <strong>and</strong> efficient. 

Results contribute to research on self-monitor<strong>in</strong>g 

<strong>in</strong> several ways. First, it adds to <strong>and</strong> is <strong>in</strong> 

agreement with previous, though limited, research 

on use of self-monitor<strong>in</strong>g <strong>and</strong> self-management 

to improve social <strong>and</strong> academic performance 

<strong>in</strong> students with severe disabilities, 

<strong>in</strong>clud<strong>in</strong>g moderate to severe mental retardation 

<strong>and</strong> autism. Current results are consistent 

with previous research that self-monitor<strong>in</strong>g 

may <strong>in</strong>crease on-task behavior (O’Reilly et al., 

2002; Pierce & Schreibman, 1994; Tabor et al., 

1999) <strong>in</strong> <strong>in</strong>dividuals with autism. Current f<strong>in</strong>d<strong>in</strong>gs 

also extend previous research on implementation 

of self-monitor<strong>in</strong>g <strong>and</strong> self-management 

with <strong>in</strong>dividuals with moderate to severe 

mental retardation by consider<strong>in</strong>g its impact 

on social <strong>in</strong>teractions. Specifically, this study 

demonstrated that Troy’s spontaneous verbal 

requests for help were <strong>in</strong>creased dur<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g 

sessions <strong>and</strong> it was noted anecdotally by 

the classroom staff that Troy <strong>in</strong>creased other 

types of spontaneous verbal <strong>in</strong>teractions outside 

of tra<strong>in</strong><strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g bids for attention 

(e.g., “Teacher, come here!”) upon completion 

of work. 

There are a few limitations that necessitate 

discussion. One limitation was absence of 

ma<strong>in</strong>tenance data. The study was completed 

approximately one week prior to the end of 

the school year, thus, no time rema<strong>in</strong>ed to 

determ<strong>in</strong>e if the <strong>in</strong>tervention would be ma<strong>in</strong>ta<strong>in</strong>ed. 

Additionally, generalization data regard<strong>in</strong>g 

use of self-monitor<strong>in</strong>g on additional 

behaviors for each participant might have 

been valuable, given more time. Generalization 

was also not assessed under additional 

conditions, such as <strong>in</strong> additional sett<strong>in</strong>gs or 

with practitioners other than the classroom 

teacher <strong>and</strong> first author. Despite these limitations, 

several strengths must be noted. First, 

this research took place <strong>in</strong> a real classroom 

sett<strong>in</strong>g, as opposed to a cl<strong>in</strong>ic. Participant 

ga<strong>in</strong>s were observed quickly <strong>and</strong> were of cl<strong>in</strong>ical 

significance. F<strong>in</strong>ally, as a result of selfmonitor<strong>in</strong>g 

tra<strong>in</strong><strong>in</strong>g, students required less <strong>in</strong>tervention 

(e.g., fewer prompts, fewer 

redirects) from classroom staff. 

There are also several implications for future 

research. Replication of this research 

with additional young adults with severe dis- 

abilities is necessary. Such replications would 

lend more support for use of self-monitor<strong>in</strong>g 

with the targeted population. Further research 

may also consider the necessity of additional 

modifications <strong>in</strong> tra<strong>in</strong><strong>in</strong>g <strong>in</strong>dividuals 

with severe disabilities to use self-monitor<strong>in</strong>g 

strategies. 

Outcomes of the self-monitor<strong>in</strong>g <strong>in</strong>terventions 

with these participants have positive implications 

for practitioners work<strong>in</strong>g with 

young adults with autism <strong>and</strong> mental retardation. 

First, self-monitor<strong>in</strong>g is a teacher-friendly 

<strong>in</strong>tervention. This technique requires little 

tra<strong>in</strong><strong>in</strong>g for the practitioner. Most teachers 

are already familiar with token systems, thus, 

will need only to transfer control of the system 

to the student. Self-monitor<strong>in</strong>g requires little 

to no time to implement once the student has 

been tra<strong>in</strong>ed to use a token system. Additionally, 

it requires few materials outside of those 

already available <strong>in</strong> the classroom (e.g., access 

to favorite activities, such as computer; snap 

blocks or tokens). F<strong>in</strong>ally, self-monitor<strong>in</strong>g has 

the potential to lead to more <strong>in</strong>dependent 

function<strong>in</strong>g (Koegel et al., 1999). This is especially 

important for young adult <strong>in</strong>dividuals 

with disabilities who will soon leave school <strong>and</strong> 

transition to the adult world. As suggested by 

Pierce <strong>and</strong> Schreibman (1994), self-management 

may easily be generalized to novel skills 

<strong>and</strong> situations, requir<strong>in</strong>g little effort from 

practitioners <strong>and</strong> result<strong>in</strong>g <strong>in</strong> decreased reliance 

on caregivers <strong>and</strong> teachers. 

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Received: 25 September 2003 

Initial Acceptance: 25 November 2003 

F<strong>in</strong>al Acceptance: 1 March 2004 




Us<strong>in</strong>g Video Prompt<strong>in</strong>g to Teach Cook<strong>in</strong>g Skills to Secondary 

Students with Moderate <strong>Disabilities</strong> 

Tara B. Graves 

Frankl<strong>in</strong> County Schools 

Belva C. Coll<strong>in</strong>s, John W. Schuster, 

<strong>and</strong> Harold Kle<strong>in</strong>ert 

University of Kentucky 

Abstract: Three secondary students with moderate disabilities acquired cook<strong>in</strong>g skills through a constant time 

delay procedure used with video prompt<strong>in</strong>g. A multiple probe design was used to evaluate effectiveness of the 

procedure to teach preparation of a food item (a) on a stove, (b) <strong>in</strong> a microwave, <strong>and</strong> (c) on a counter top. The 

procedure was effective for each student. Guidel<strong>in</strong>es for us<strong>in</strong>g videotapes <strong>in</strong> the <strong>in</strong>struction of functional skills 

are discussed. 

The purpose of special education is to teach 

students to live as <strong>in</strong>dependently as possible. 

This means students with moderate to severe 

disabilities must learn to perform daily liv<strong>in</strong>g 

skills, such as food preparation. Learn<strong>in</strong>g to 

prepare food enhances <strong>in</strong>dependence <strong>in</strong> the 

home <strong>and</strong> also may lead to employment <strong>in</strong> the 

community. Numerous <strong>in</strong>vestigations have focused 

on teach<strong>in</strong>g food preparation skills to 

students with disabilities (e.g., Johnson & 

Cuvo, 1981; Mart<strong>in</strong>, Rusch, James, Decker, & 

Trtol, 1982; Rob<strong>in</strong>son-Wilson, 1977; Schleien, 

Ash, Kiernan, & Wehman, 1981). For example, 

Schuster, Gast, Wolery, <strong>and</strong> Guilt<strong>in</strong>an 

(1988) used a constant time delay (CTD) procedure 

to teach food preparation skills (i.e., 

mak<strong>in</strong>g a s<strong>and</strong>wich, boil<strong>in</strong>g a bag item, bak<strong>in</strong>g 

canned biscuits) to four students with moderate 

disabilities <strong>in</strong> a one-to-one format. 

In later <strong>in</strong>vestigations, Hall, Schuster, Wolery, 

Gast, <strong>and</strong> Doyle (1992) used a CTD procedure 

to teach food preparation (i.e., mak<strong>in</strong>g 

a Spanish omelet, microwav<strong>in</strong>g a cake, 

bak<strong>in</strong>g a tuna casserole) to two dyads of students 

with moderate mental disabilities, <strong>and</strong> 

This <strong>in</strong>vestigation was completed to partially satisfy 

the thesis requirement for a Master’s degree at 

the University of Kentucky. Correspondence concern<strong>in</strong>g 

this article should be addressed to Dr. Belva 

C. Coll<strong>in</strong>s, University of Kentucky, Department of 

Special <strong>Education</strong> <strong>and</strong> Rehabilitation Counsel<strong>in</strong>g, 

229 Taylor <strong>Education</strong> Build<strong>in</strong>g, Lex<strong>in</strong>gton, KY 

40506-0001. E-mail: bcoll01@uky.edu 


Griffen, Wolery, <strong>and</strong> Schuster (1992) used a 

CTD procedure to teach food preparation 

skills (i.e., prepar<strong>in</strong>g a milkshake, scrambled 

eggs, <strong>and</strong> pudd<strong>in</strong>g) to a triad of students with 

moderate mental disabilities. In both <strong>in</strong>vestigations, 

students learned their target skills 

<strong>and</strong> many steps of the skills taught to others <strong>in</strong> 

the group. Schuster <strong>and</strong> Griffen (1993) extended 

this approach when they used a simultaneous 

prompt<strong>in</strong>g procedure to teach four 

students with moderate mental disabilities to 

make juice. F<strong>in</strong>ally, Fiscus, Schuster, Morse, 

<strong>and</strong> Coll<strong>in</strong>s (2002) used a CTD procedure to 

teach food preparation skills (i.e., mak<strong>in</strong>g 

cheese <strong>and</strong> crackers, waffles with syrup, <strong>and</strong> 

chocolate milk) to four elementary students 

with moderate mental disabilities <strong>and</strong> found 

that the students acquired 80 to 100% of the 

nontarget <strong>in</strong>formation, presented as <strong>in</strong>structive 

feedback dur<strong>in</strong>g each trial. Types of nontarget 

<strong>in</strong>formation were related to the task 

(i.e., identification of words <strong>and</strong> sentences <strong>in</strong> 

the picture recipe book) as well as unrelated 

to the task (i.e., identification of kitchen utensils). 

Each of these <strong>in</strong>vestigations comb<strong>in</strong>ed a 

systematic response prompt<strong>in</strong>g procedure 

(i.e., CTD or simultaneous prompt<strong>in</strong>g) with a 

picture recipe book to teach food preparation 

skills. 

Jones <strong>and</strong> Coll<strong>in</strong>s (1997) used another systematic 

response prompt<strong>in</strong>g procedure, the 

system of least prompts (SLP), to teach three 

women with moderate disabilities to prepare 

food (i.e., hot chocolate, popcorn, <strong>and</strong> baked

potatoes) <strong>in</strong> a microwave. Use of a hierarchy 

of <strong>in</strong>direct verbal, direct verbal, gestural, <strong>and</strong> 

model prompts gave the <strong>in</strong>structor the opportunity 

to embed nontarget <strong>in</strong>formation <strong>in</strong> 

each step of each trial. This <strong>in</strong>cluded safety 

<strong>and</strong> nutrition facts <strong>in</strong> delivery of prompts as 

well as <strong>in</strong> delivery of feedback at the end of 

steps. Participants acquired the nontargeted 

<strong>in</strong>formation as well as the target skills. 

Research has shown that use of video can be 

both an effective <strong>and</strong> an efficient way to teach 

daily liv<strong>in</strong>g skills to students with disabilities. 

For example, <strong>in</strong>vestigators have used video <strong>in</strong> 

teach<strong>in</strong>g community skills to students with 

moderate mental disabilities (Branham, Coll<strong>in</strong>s, 

Schuster, & Kle<strong>in</strong>ert, 1999), self-protection 

skills to k<strong>in</strong>dergarten <strong>and</strong> first grade students 

(Poche, Yoder, & Miltenberger, 1988), 

oral hygiene skills to children <strong>in</strong> a Headstart 

program (Murray & Epste<strong>in</strong>, 1981), <strong>and</strong> selfcare 

skills to students with moderate mental 

disabilities (Norman, Coll<strong>in</strong>s, & Schuster, 

2001). 

In particular, Har<strong>in</strong>g, Kennedy, Adams, <strong>and</strong> 

Pitts-Conway (1987) showed a videotape of 

peers without disabilities model<strong>in</strong>g purchas<strong>in</strong>g 

skills to facilitate generalization <strong>in</strong> three 

adults with autism before tak<strong>in</strong>g them <strong>in</strong>to the 

community. Poche et al. (1988) found that 

use of video with behavior rehearsals was more 

efficient than other strategies <strong>in</strong> teach<strong>in</strong>g abduction 

prevention skills to 74 children. Charlop 

<strong>and</strong> Milste<strong>in</strong> (1989) found video model<strong>in</strong>g 

to be effective <strong>in</strong> teach<strong>in</strong>g generalized 

conversational skills to three students with autism. 

Cuvo <strong>and</strong> Klatt (1992) found that a comb<strong>in</strong>ation 

of flashcard <strong>in</strong>struction <strong>and</strong> video 

resulted <strong>in</strong> generalization of read<strong>in</strong>g survival 

words <strong>in</strong> the community by six students with 

mild to moderate disabilities. F<strong>in</strong>ally, Alcantara 

(1994) used videotapes to teach purchas<strong>in</strong>g 

skills <strong>in</strong> the community to three students 

with autism. 

Several <strong>in</strong>vestigations have comb<strong>in</strong>ed video 

with systematic response prompt<strong>in</strong>g procedures 

to teach daily liv<strong>in</strong>g skills. For example, 

LeGrice <strong>and</strong> Blampied (1994) comb<strong>in</strong>ed a 

CTD procedure with video to teach four participants 

with moderate disabilities to use a 

computer <strong>and</strong> a video recorder. Branham et 

al. (1999) used a CTD procedure to teach 

community skills (i.e., mail<strong>in</strong>g a letter, cash<strong>in</strong>g 

a check, <strong>and</strong> cross<strong>in</strong>g a street) to three stu- 

dents with moderate mental disabilities <strong>in</strong> the 

follow<strong>in</strong>g formats: (a) community-based <strong>in</strong>struction 

(CBI) alone, (b) classroom simulation 

plus CBI, <strong>and</strong> (c) videotape <strong>in</strong>struction 

plus CBI. While all three formats were effective, 

the use of videotape <strong>in</strong>struction plus CBI 

was the most time efficient. Norman et al. 

(2001) also used a CTD procedure with video 

when they taught self-care skills (i.e., clean<strong>in</strong>g 

sunglasses, putt<strong>in</strong>g on a wristwatch, <strong>and</strong> zipp<strong>in</strong>g 

a jacket) to three students with moderate 

disabilities. While Branham et al. used videotape 

show<strong>in</strong>g still frames of peers without disabilities 

perform<strong>in</strong>g the target skills, Norman 

et al. used a subjective viewpo<strong>in</strong>t of the task 

(student’s viewpo<strong>in</strong>t of the task as he or she 

would perform it) <strong>and</strong> added visual words to 

the auditory prompt<strong>in</strong>g on the videotape. 

Like Branham et al., Norman et al. showed a 

preview of the entire task before show<strong>in</strong>g the 

students a video of each step separated by 

dark frames. Aga<strong>in</strong>, the procedure was effective. 

Video also has been streamed on computers 

to teach functional skills. For example, Mechl<strong>in</strong>g, 

Gast, <strong>and</strong> Langone (2002) used computer-based 

video to teach grocery skills to four 

students with moderate mental disabilities. Us<strong>in</strong>g 

a SLP procedure <strong>in</strong> conjunction with multiple 

exemplars of video of grocery stores 

streamed on the computer screen, the <strong>in</strong>structors 

prompted the students through locat<strong>in</strong>g 

items on a grocery list, touch<strong>in</strong>g the correct 

aisle sign, <strong>and</strong> touch<strong>in</strong>g the item on the shelf. 

The students were able to generalize the skills 

they acquired to a novel grocery store. 

Cook<strong>in</strong>g programs often demonstrate food 

preparation on television, <strong>and</strong> these programs 

can be used repeatedly for <strong>in</strong>struction if videotaped. 

Although the literature conta<strong>in</strong>s numerous 

<strong>in</strong>vestigations on the systematic <strong>in</strong>struction 

of food preparation skills <strong>and</strong> 

numerous <strong>in</strong>vestigations on systematic <strong>in</strong>struction 

us<strong>in</strong>g video, no <strong>in</strong>vestigation has used 

videotape to teach food preparation skills to 

students with disabilities. Because most 

schools <strong>and</strong> homes have access to a videotape 

player <strong>and</strong> because the use of video has been 

effective <strong>in</strong> teach<strong>in</strong>g other skills, this <strong>in</strong>vestigation 

focused on teach<strong>in</strong>g food preparation 

skills through systematic <strong>in</strong>struction us<strong>in</strong>g 

video. Unlike the previous <strong>in</strong>vestigations (Branham 

et al., 1999; Norman et al., 2001), the 

Video Prompt<strong>in</strong>g / 35

<strong>in</strong>structor <strong>in</strong> the present <strong>in</strong>vestigation did not 

deliver verbal prompts or correct errors with 

physical guidance. Specifically, the <strong>in</strong>vestigation 

attempted to answer two questions: (a) Is 

video prompt<strong>in</strong>g effective <strong>in</strong> teach<strong>in</strong>g food 

preparation skills to secondary students with 

moderate disabilities, <strong>and</strong> (b) will the skills 

generalize to novel tra<strong>in</strong>ers, sett<strong>in</strong>gs, <strong>and</strong> materials? 

Method 

Participants 

One male <strong>and</strong> two females <strong>in</strong> a self-conta<strong>in</strong>ed 

public high school classroom for students with 

functional mental disabilities (FMD) (i.e., 

moderate to severe disabilities) were participants 

<strong>in</strong> the <strong>in</strong>vestigation. Joe was a 16 year 

old male with a moderate mental disability 

<strong>and</strong> Down syndrome. He participated with 

modification <strong>in</strong> keyboard<strong>in</strong>g <strong>and</strong> drama 

classes <strong>and</strong> received speech/language <strong>and</strong> occupational 

therapy. Based on the Wechsler 

Intelligence Scale for Children - Revised 

(WISC-R, Wechsler, 1974), Joe had an IQ of 

51. His Individual <strong>Education</strong> Plan (IEP) <strong>in</strong>cluded 

objectives for speech production, communication, 

social skills, <strong>and</strong> domestic skills 

(i.e., shopp<strong>in</strong>g <strong>and</strong> food preparation). Joe was 

socially outgo<strong>in</strong>g <strong>and</strong> had a strong work ethic. 

He could stay on task <strong>and</strong> follow directions. 

Joe’s weakness was his <strong>in</strong>ability to read all 

written directions. 

Alley was an 18 year old female with a moderate 

mental disability <strong>and</strong> a communication 

disorder. She received special education services 

on a resource basis, participated <strong>in</strong> community-based 

<strong>in</strong>struction (CBI), <strong>and</strong> used 

modifications <strong>in</strong> physical education <strong>and</strong> basic 

guitar classes with peers without disabilities. 

Alley received speech/language <strong>and</strong> occupational 

therapy services. Based on the WISC-R 

(Wechsler, 1974), she had an IQ of 45. Her 

IEP <strong>in</strong>cluded objectives for domestic skills 

(i.e., survival word recognition <strong>and</strong> cook<strong>in</strong>g), 

math skills (i.e., money <strong>and</strong> shopp<strong>in</strong>g skills), 

<strong>and</strong> communication. Alley had the ability to 

identify people, follow directions, <strong>and</strong> rema<strong>in</strong> 

on task. Her weakness was the <strong>in</strong>ability to 

speak <strong>in</strong>telligibly <strong>and</strong> <strong>in</strong> complete sentences. 

Kelly was a 20 year old female with a moderate 

mental disability. Based on the WISC-R 

(Wechsler, 1974), Kelly had an IQ of 49. She 

received special education services on a resource 

basis, participated <strong>in</strong> CBI, <strong>and</strong> used 

modifications <strong>in</strong> drama <strong>and</strong> human development 

classes with peers without disabilities. 

Kelly’s IEP objectives were for social skills, 

functional academics (i.e., written expression 

<strong>and</strong> read<strong>in</strong>g), <strong>and</strong> math skills (i.e., shopp<strong>in</strong>g 

<strong>and</strong> food preparation). While her read<strong>in</strong>g <strong>and</strong> 

comprehension skills were strengths, she had 

weaknesses <strong>in</strong> the ability to stay on task. Kelly 

often gazed around the room while twist<strong>in</strong>g 

her hair <strong>and</strong> was easily distracted by her surround<strong>in</strong>gs. 

The teacher assessed the follow<strong>in</strong>g prerequisite 

skills through observations: (a) ability to 

wait 5 s, (b) ability to attend to task for 20 m<strong>in</strong>, 

(c) ability to follow a verbal direction, (d) 

ability to imitate a visual model, <strong>and</strong> (e) visual 

acuity to watch a videotape. Parent permissions 

were obta<strong>in</strong>ed for all participants. 

Sett<strong>in</strong>g 

The teacher conducted screen<strong>in</strong>g, basel<strong>in</strong>e, 

<strong>and</strong> tra<strong>in</strong><strong>in</strong>g sessions <strong>in</strong> a one-to-one format 

with each participant. Instruction took place 

<strong>in</strong> the kitchen area of the FMD resource classroom. 

The students stood <strong>in</strong> front of the television 

<strong>and</strong> counter, stove, or microwave while 

perform<strong>in</strong>g the task presented on the video. 

Other students were engaged <strong>in</strong> seatwork or 

small group <strong>in</strong>struction at their desks or classroom 

tables. The teacher or classroom assistant 

verbally redirected any students who distracted 

the participants dur<strong>in</strong>g <strong>in</strong>struction. 

Materials <strong>and</strong> Equipment 


Materials <strong>and</strong> equipment for the <strong>in</strong>vestigation 

<strong>in</strong>cluded a 25 <strong>in</strong>. color television with a VCR 

<strong>and</strong> a video prompt<strong>in</strong>g tape for each targeted 

cook<strong>in</strong>g skill (i.e., stove item, microwave item, 

<strong>and</strong> counter item). Additional materials <strong>in</strong>cluded 

data sheets, cook<strong>in</strong>g supplies (e.g., 

pots, pans, spoons), <strong>and</strong> food items. 

The video prompt<strong>in</strong>g tapes used a subjective 

viewpo<strong>in</strong>t (Norman et al., 2001) to demonstrate 

the cook<strong>in</strong>g tasks so that the student 

saw the task performed on the video from the 

same viewpo<strong>in</strong>t that would be seen if the student 

performed the task. Each video started 

by verbally stat<strong>in</strong>g the Sd (e.g., “Cook the

.”), <strong>and</strong> the teacher alternated between 

videotapes that used male <strong>and</strong> female voices. 

Follow<strong>in</strong>g the Sd for the task, the videotape 

showed a model of the task from start to f<strong>in</strong>ish 

<strong>and</strong> then aga<strong>in</strong> delivered the verbal Sd. A 

delay <strong>in</strong>terval of 0sor5sthen occurred. On 

the 0 s delay videotape, a verbal prompt 

paired with a model prompt of the first step of 

the cha<strong>in</strong>ed task immediately occurred, <strong>and</strong>, 

on the 5 s delay videotape, a verbal prompt 

paired with a model prompt of the first step 

occurred follow<strong>in</strong>g a5sdelay <strong>in</strong>terval. After 

each step was prompted, a 20 s colored frame 

appeared, giv<strong>in</strong>g the student 20 s to perform 

the prior step <strong>and</strong>/or the next step of the 

cha<strong>in</strong> before the videotape prompted a subsequent 

step of the task analysis. 

Skill Selection 

The teacher selected the target food preparation 

skills through preference test<strong>in</strong>g of the 

participants <strong>and</strong> <strong>in</strong>terviews with their parents, 

tak<strong>in</strong>g <strong>in</strong>to account the availability of the 

foods <strong>and</strong> equipment <strong>in</strong> the home sett<strong>in</strong>g. 

The target skills were similar <strong>in</strong> difficulty <strong>and</strong> 

number of steps per task analysis. The IEPs of 

each participant conta<strong>in</strong>ed cook<strong>in</strong>g or food 

preparation objectives, <strong>and</strong> the parents had 

addressed these skills <strong>in</strong> plann<strong>in</strong>g for future 

assisted liv<strong>in</strong>g. Based on this <strong>in</strong>formation, the 

<strong>in</strong>vestigators targeted the follow<strong>in</strong>g skills: (a) a 

stovetop skill of prepar<strong>in</strong>g noodles (i.e., Ramen 

Noodles), (b) a microwave skill of prepar<strong>in</strong>g 

macaroni (i.e., Mac n M<strong>in</strong>utes), <strong>and</strong> 

(c) a countertop skill of mak<strong>in</strong>g a s<strong>and</strong>wich 

(i.e., peanut butter <strong>and</strong> jelly). Task analyses 

for each of these skills can be found <strong>in</strong> Table 

1. 


The teacher collected data on each participant’s 

ability to perform each step of the task 

analysis dur<strong>in</strong>g screen<strong>in</strong>g, basel<strong>in</strong>e, <strong>and</strong> tra<strong>in</strong><strong>in</strong>g 

sessions. She recorded a () for each 

correct response <strong>and</strong> a () for each <strong>in</strong>correct 

response. She def<strong>in</strong>ed a correct response as 

complet<strong>in</strong>g the step <strong>in</strong>dependently with<strong>in</strong> the 

allotted response <strong>in</strong>terval (20 s) follow<strong>in</strong>g the 

Sd or the previously completed step. She def<strong>in</strong>ed 

an <strong>in</strong>correct response as (a) not perform<strong>in</strong>g 

the step correctly (topographical er- 

ror), (b) not perform<strong>in</strong>g the step <strong>in</strong> the 

correct order (sequence error), (c) not complet<strong>in</strong>g 

the step with<strong>in</strong> the allotted response 

<strong>in</strong>terval (20 s) follow<strong>in</strong>g the Sd or previously 

completed step (duration error), or (d) fail<strong>in</strong>g 

to <strong>in</strong>itiate a response with<strong>in</strong> 5softhe 

verbal Sd or previously completed step. 

Until a participant performed 100% correct 

responses for two sessions, the teacher used 

videotapes conta<strong>in</strong><strong>in</strong>g a 0-s response <strong>in</strong>terval. 

Dur<strong>in</strong>g all subsequent <strong>in</strong>structional sessions, 

she used videotapes with a 5-s delay <strong>in</strong>terval. 

Dur<strong>in</strong>g these CTD sessions, the teacher recorded 

a () <strong>in</strong> the “before” column when 

the students completed a step correctly <strong>and</strong> 

<strong>in</strong>dependently with<strong>in</strong> the allotted response <strong>in</strong>terval 

(20 s) follow<strong>in</strong>g the Sd or the previously 

completed step <strong>and</strong> a () <strong>in</strong> the “after” column 

when the student completed the step 

correctly with<strong>in</strong> 20 s follow<strong>in</strong>g the video 

prompt. The teacher recorded a () <strong>in</strong>the 

“before” column for each <strong>in</strong>correct response 

with<strong>in</strong> 20 s follow<strong>in</strong>g the Sd or the previously 

completed step <strong>and</strong> a () <strong>in</strong> the “after” column 

for each <strong>in</strong>correct response with<strong>in</strong> 20 

follow<strong>in</strong>g the prompt. The teacher also recorded 

a “T” for each topographical error, an 

“S” for each sequential error, <strong>and</strong> a “D” for 

each duration error. If a participant failed to 

<strong>in</strong>itiate a response with<strong>in</strong> 5softheprompt, 

the teacher recorded “NR” for no response. 

Procedure 

General procedures. The teacher taught the 

target food preparation skills <strong>in</strong> a one-to-one 

format us<strong>in</strong>g a CTD procedure with video 

prompt<strong>in</strong>g. As previously described, the 

teacher used videotapes that gave the student 

either 0sor5sto<strong>in</strong>itiate a step <strong>and</strong> 20 s to 

complete a step. If the student did not <strong>in</strong>itiate 

the step dur<strong>in</strong>g the response <strong>in</strong>terval (e.g., 

5 s), the video provided a verbal prompt 

paired with a model prompt. Dur<strong>in</strong>g <strong>in</strong>struction, 

each student stood <strong>in</strong> front of the microwave, 

the stove, or the counter with the television 

positioned so the student could view the 

videotape while perform<strong>in</strong>g the target skill. 

Sessions took place Monday through Friday. 

Each session began with the teacher deliver<strong>in</strong>g 

the attentional cue (i.e., “Are you ready to 

cook?”). Us<strong>in</strong>g a multiple opportunity format, 

the teacher allowed the students to complete 


TABLE 1 

Task Analyses of Target Food Preparation Skills 

all of the steps of the task analysis, even if 

errors occurred. 

Basel<strong>in</strong>e/probe procedures. Basel<strong>in</strong>e conditions 

occurred prior to <strong>in</strong>tervention. The 

teacher collected basel<strong>in</strong>e data on each skill <strong>in</strong> 

a one-to-one format for a m<strong>in</strong>imum of two 

sessions or until data were stable. A trial began 

with the teacher stat<strong>in</strong>g the Sd (i.e., “Cook the 

.”). She then waited 5 s for the student to 

<strong>in</strong>itiate the first step of the task <strong>and</strong> 20 s for 

the student to complete the first step of the 

task. If the student completed the step correctly, 

the teacher marked a () on the data 

sheet, delivered verbal praise, <strong>and</strong> waited 5 s 

for the student to <strong>in</strong>itiate the next step <strong>and</strong> 

20 s for the student to complete the step. If 

the student made an <strong>in</strong>correct response or no 

response, the teacher recorded the type of 

error <strong>and</strong> told the student to turn away while 

Microwav<strong>in</strong>g Macaroni <strong>and</strong> Cheese 

1. Wash h<strong>and</strong>s. 1. Wash h<strong>and</strong>s. 1. Wash h<strong>and</strong>s. 

2. Get saucepan. 2. Get Mac-cheese packet. 2. Get out plate. 

3. Get spoon. 3. Get medium size bowl. 3. Get two slices of bread. 

4. Get Ramen Noodles. 4. Get spoon. 4. Get peanut butter. 

5. Get 1 C. measur<strong>in</strong>g cup. 5. Get 1/3 C. measur<strong>in</strong>g cup. 5. Get jelly. 

6. Place saucepan on front 

left burner. 

6. Open macaroni packet. 6. Get knife. 

7. Go to s<strong>in</strong>k with 

measur<strong>in</strong>g cup. 

7. Put macaroni <strong>in</strong> bowl. 7. Open peanut butter. 

8. Fill measur<strong>in</strong>g cup to top 8. Fill 1/3 C. measur<strong>in</strong>g cup 8. Open jelly. 

with water. 

with water. 

9. Pour <strong>in</strong> saucepan. 9. Pour <strong>in</strong>to bowl. 9. Put knife <strong>in</strong> jar <strong>and</strong> get 

peanut butter. 

10. Fill measur<strong>in</strong>g cup to top 10. Fill 1/3 C. measur<strong>in</strong>g cup 10. Spread peanut butter on one 

with water. 

with water. 

bread slice. 

11. Pour <strong>in</strong>to saucepan. 11. Pour <strong>in</strong>to bowl. 11. Put knife <strong>in</strong> jar <strong>and</strong> get jelly. 

12. Turn temperature dial to 12. Put bowl <strong>in</strong>to microwave. 12. Spread jelly on other bread 

10. 

slice. 

13. Wait for water to boil. 13. Set microwave for 4 m<strong>in</strong>utes. 13. Put two slices together. 

14. Open Ramen Noodles. 14. Wait for beep. 14. Clean up. 

15. Put noodles only <strong>in</strong>to 

water. 

15. Take bowl out of microwave. 

16. Set timer for 3 m<strong>in</strong>utes. 16. Open cheese packet. 

17. Wait 3 m<strong>in</strong>utes. 17. Pour cheese onto noodles. 

18. Turn dial to off. 18. Stir with spoon. 

19. Open season<strong>in</strong>g packet. 

20. Pour contents <strong>in</strong>to water. 

21. Stir. 

22. Clean up. 

19. Clean up. 


she completed the step for the student. She 

then stated a verbal Sd to perform the next 

step <strong>and</strong> waited 5 s for the student to <strong>in</strong>itiate 

the step <strong>and</strong> 20 s for the student to complete 

the step. The process cont<strong>in</strong>ued until the student 

completed the task analysis. Throughout 

the session, the teacher praised attention on a 

variable ratio schedule of every two steps 

(VR2). 

Independent variable. The teacher began <strong>in</strong>struction 

after basel<strong>in</strong>e data were stable. Instructional 

sessions occurred <strong>in</strong> a one-to-one 

format with the student st<strong>and</strong><strong>in</strong>g <strong>in</strong> front of 

the television. The teacher counterbalanced 

which student went first each day <strong>and</strong> used a 

CTD procedure with video prompt<strong>in</strong>g to 

teach each targeted cook<strong>in</strong>g skill. Each <strong>in</strong>structional 

session began with the teacher deliver<strong>in</strong>g 

an attentional cue (i.e., “Let’s cook.”).

While hear<strong>in</strong>g the verbal directions on the 

videotape, the student watched the video 

model of the entire task. The video then delivered 

the verbal Sd for the task. Dur<strong>in</strong>g 0 s 

delay sessions, the videotape showed a model 

of the first step of the task analysis accompanied 

by a verbal prompt. The videotape then 

froze with a colored frame, <strong>and</strong> the student 

had 20 s to perform the step before delivery of 

the prompt for the next step. <strong>Tra<strong>in</strong><strong>in</strong>g</strong> sessions 

used videotapes with a 0-s delay <strong>in</strong>terval 

until the student reached 100% for two days. 

Dur<strong>in</strong>g 5 s delay sessions, the student had 5 s 

to <strong>in</strong>itiate a step before the delivery of the 

video prompt. This was followed by a still colored 

frame of 20 s to complete the step <strong>and</strong> 

<strong>in</strong>itiate the next step of the task analysis. If the 

student performed an <strong>in</strong>correct response before 

the prompt, the teacher said, “No, wait if 

you are not sure.” If the student performed an 

<strong>in</strong>correct response after the prompt, the 

teacher rewound the videotape to show the 

prompt until the student performed the response 

correctly. If the student required more 

than 20 s to complete a step, the teacher 

paused the videotape until the student completed 

the step <strong>and</strong> recorded a duration error. 

Dur<strong>in</strong>g <strong>in</strong>structional sessions, the teacher 

praised correct responses on a cont<strong>in</strong>uous re<strong>in</strong>forcement 

schedule (CRF) until the student 

reached 100% criterion for two days. She then 

th<strong>in</strong>ned praise to a variable ratio schedule of 

every four steps (i.e., VR4) until the students 

performed at 100% criterion for one additional 

day. 

Ma<strong>in</strong>tenance. The teacher conducted 

ma<strong>in</strong>tenance sessions dur<strong>in</strong>g the second week 

after each student reached criterion on a skill. 

There were no video prompts dur<strong>in</strong>g ma<strong>in</strong>tenance 

sessions. The teacher praised correct 

responses on a VR4 schedule. She <strong>in</strong>terrupted 

all <strong>in</strong>correct responses <strong>and</strong> modeled the correct 

response for the students. She also encouraged 

students to use the skills at home 

<strong>and</strong> then conducted telephone <strong>in</strong>terviews to 

monitor home performance. 

Experimental Design 

The authors used a multiple probe across behaviors 

design replicated across students to 

evaluate the effectiveness of the CTD procedure 

with video prompt<strong>in</strong>g. The <strong>in</strong>structor 

(first author) taught the second skill after the 

first skill reached criterion but could not 

teach the third skill due to the school year 

end<strong>in</strong>g. 

Reliability 

A classroom team teacher who held a degree 

<strong>in</strong> moderate/severe disabilities or a classroom 

assistant collected dependent <strong>and</strong> <strong>in</strong>dependent 

variable reliability data on a weekly basis 

for a total of 26% of all sessions across participants. 

The measured teacher behaviors (<strong>in</strong>dependent 

variable) <strong>in</strong>cluded (a) giv<strong>in</strong>g a 

general attention cue, (b) complet<strong>in</strong>g the 

data sheet, (c) hav<strong>in</strong>g materials ready, (d) 

start<strong>in</strong>g the videotape, (e) manipulat<strong>in</strong>g the 

prompt<strong>in</strong>g on the videotape with a remote 

control (i.e., forward<strong>in</strong>g or rew<strong>in</strong>d<strong>in</strong>g), <strong>and</strong> 

(f) prais<strong>in</strong>g correct responses. The teacher 

calculated <strong>in</strong>dependent variable reliability 

agreement by divid<strong>in</strong>g the number of observed 

behaviors by the number of planned 

behaviors <strong>and</strong> multiply<strong>in</strong>g by 100 for each 

variable (Brown & Snell, 2000). Independent 

variable reliability agreement was 93% or 

higher throughout the <strong>in</strong>vestigation, with a 

mean of 100% for Joe, 94% for Alley, <strong>and</strong> 97% 

for Kelly. Procedural errors consisted of the 

teacher fail<strong>in</strong>g to deliver verbal praise after 

correct responses. 

The teacher calculated dependent variable 

reliability agreement by us<strong>in</strong>g the po<strong>in</strong>t-bypo<strong>in</strong>t 

method <strong>and</strong> divid<strong>in</strong>g the total number 

of agreements by the total number of agreement 

plus disagreements <strong>and</strong> multiply<strong>in</strong>g by 

100 (Brown & Snell, 2000). Dependent variable 

reliability agreement was 86% or higher 

throughout the <strong>in</strong>vestigation with a mean of 

90% for Joe, 92% for Alley, <strong>and</strong> 94% for Kelly. 

Results 

Figures 1, 2, <strong>and</strong> 3 present performance data 

for this <strong>in</strong>vestigation <strong>and</strong> <strong>in</strong>dicate the effectiveness 

of a CTD procedure with video 

prompt<strong>in</strong>g <strong>in</strong> teach<strong>in</strong>g food preparation skills 

(i.e., Ramen noodles on the stove, Mac n M<strong>in</strong>utes 

<strong>in</strong> the microwave, <strong>and</strong> peanut butter <strong>and</strong> 

jelly on the countertop) to 3 students with 

moderate disabilities. Participants reached criterion 

on two target skills <strong>in</strong> an average of 10.3 

sessions each. 


Figure 1. Graphic data for Joe. Open circles represent correct responses before the prompt, <strong>and</strong> open 

triangles represent correct responses after the prompt. 


Figure 2. Graphic data for Alley. Open circles represent correct responses before the prompt, <strong>and</strong> open 



Figure 3. Graphic data for Kelly. Open circles represent correct responses before the prompt, <strong>and</strong> open 



Joe met criterion of 100% correct responses 

for three sessions when cook<strong>in</strong>g noodles (total 

of 10 sessions) <strong>and</strong> mak<strong>in</strong>g a s<strong>and</strong>wich (total 

of seven sessions). He made only sequential 

errors dur<strong>in</strong>g <strong>in</strong>struction <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed the 

skills over time. Total tra<strong>in</strong><strong>in</strong>g time for cook<strong>in</strong>g 

noodles was 1 hr 59 m<strong>in</strong> for noodles with 

a mean of 13 m<strong>in</strong> per session (range 11 to 

18 m<strong>in</strong>). Total tra<strong>in</strong><strong>in</strong>g time for mak<strong>in</strong>g a 

s<strong>and</strong>wich was 19 m<strong>in</strong> with a mean of 4 m<strong>in</strong> per 

session. 

Alley met criterion of 100% correct responses 

for three sessions when mak<strong>in</strong>g a 

s<strong>and</strong>wich (total of 12 sessions) <strong>and</strong> microwav<strong>in</strong>g 

macaroni (total of eight sessions). She 

made sequential <strong>and</strong> topographical errors 

dur<strong>in</strong>g <strong>in</strong>struction <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed the skills 

over time. Total tra<strong>in</strong><strong>in</strong>g time for mak<strong>in</strong>g a 

s<strong>and</strong>wich was 60 m<strong>in</strong> with a mean of 6 m<strong>in</strong> per 

session (range 3 to 11 m<strong>in</strong>). Total tra<strong>in</strong><strong>in</strong>g 

time for microwav<strong>in</strong>g macaroni was 1 hr 31 

m<strong>in</strong> with a mean of 13 m<strong>in</strong> per session 

(range 10 to 18 m<strong>in</strong>). 

Kelly met criterion of 100% correct response 

for three sessions when microwav<strong>in</strong>g 

macaroni (total of n<strong>in</strong>e sessions) <strong>and</strong> cook<strong>in</strong>g 

noodles (total of n<strong>in</strong>e sessions). She made 

sequential <strong>and</strong> topographical errors dur<strong>in</strong>g 

<strong>in</strong>struction <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed the skills over 

time. Total tra<strong>in</strong><strong>in</strong>g time for microwav<strong>in</strong>g 

macaroni was 1 hr <strong>and</strong> 30 m<strong>in</strong> with a mean of 

9 m<strong>in</strong> per session (range 7 to 16 m<strong>in</strong>). Total 

tra<strong>in</strong><strong>in</strong>g time for cook<strong>in</strong>g noodles was 1 hr 22 

m<strong>in</strong> with a mean of 14 m<strong>in</strong> per session. 

In addition to the number of sessions to 

criterion <strong>and</strong> <strong>in</strong>structional time (which <strong>in</strong>cluded 

down time while items were cook<strong>in</strong>g), 

the teacher also calculated the cost of materials. 

The total food cost for the entire <strong>in</strong>vestigation 

was $34.64. The mean cost per skill per 

student was $8.67 for macaroni, $2.88 for noodles, 

<strong>and</strong> $5.77 for peanut butter <strong>and</strong> jelly 

s<strong>and</strong>wiches. There was no cost for mak<strong>in</strong>g the 

videotape s<strong>in</strong>ce this was done by school personnel 

<strong>and</strong> students <strong>in</strong> a video class; the 

teacher only had the expense of purchas<strong>in</strong>g 

blank videotapes. 


Data <strong>in</strong>dicate that the CTD procedure with 

video prompt<strong>in</strong>g was an effective way to teach 

food preparation skills (i.e., Ramen noodles 

on a stove, Mac n M<strong>in</strong>utes <strong>in</strong> the microwave, 

<strong>and</strong> peanut butter <strong>and</strong> jelly s<strong>and</strong>wich on the 

countertop). The participants required the 

same or fewer sessions to criterion on the 

second skill taught, <strong>in</strong>dicat<strong>in</strong>g that they 

were “learn<strong>in</strong>g to learn” with the procedure. 

Factors that may have contributed to the 

success of the procedure could <strong>in</strong>clude the 

students’ familiarity with the CTD procedure, 

motivation due to the novelty of learn<strong>in</strong>g 

from videotape, <strong>and</strong> the natural re<strong>in</strong>forcement 

of consum<strong>in</strong>g the cooked food 

items. 

Although the teacher did not collect formal 

data dur<strong>in</strong>g summer vacation, parents reported 

to the teacher that each participant 

generalized each skill to the home sett<strong>in</strong>g. Joe 

was mak<strong>in</strong>g Ramen Noodles <strong>and</strong> peanut butter 

<strong>and</strong> jelly s<strong>and</strong>wiches <strong>in</strong>dependently at 

home for his family members <strong>and</strong> had generalized 

the skills to mak<strong>in</strong>g soup <strong>and</strong> other 

types of s<strong>and</strong>wiches (e.g., ham <strong>and</strong> cheese). 

He had made lunch for his father several 

times dur<strong>in</strong>g the summer. Alley made peanut 

butter <strong>and</strong> jelly s<strong>and</strong>wiches <strong>and</strong> Mac n M<strong>in</strong>utes 

at her gr<strong>and</strong>mother’s vacation home. 

Kelly made Mac n M<strong>in</strong>utes <strong>and</strong> Ramen Noodles 

at home; however, the microwave <strong>in</strong> her 

home differed from the one <strong>in</strong> the classroom 

<strong>and</strong> was adapted by plac<strong>in</strong>g a sticker by 4 m<strong>in</strong> 

on the dial. Her home measur<strong>in</strong>g cup also was 

adapted by plac<strong>in</strong>g a sticker at the correct 

marker. In summary, all three participants 

generalized <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed the skills they acquired 

through video prompt<strong>in</strong>g. S<strong>in</strong>ce the 

data show the CTD procedure with video 

prompt<strong>in</strong>g to be effective <strong>in</strong> teach<strong>in</strong>g cook<strong>in</strong>g 

skills to students with moderate disabilities, 

teachers may consider produc<strong>in</strong>g similar videotapes 

for both cook<strong>in</strong>g as well as for other 

skills (e.g., community skills). 

One factor to consider <strong>in</strong> replicat<strong>in</strong>g this 

<strong>in</strong>vestigation is the mak<strong>in</strong>g of the videotape. 

Instead of produc<strong>in</strong>g the videotape herself, 

the teacher relied on the experience of others 

(i.e., video class <strong>in</strong>structor <strong>and</strong> students) to 

help produce the videotape. It took a good 

deal of time to produce videotapes us<strong>in</strong>g both 

male <strong>and</strong> female voices <strong>and</strong> to <strong>in</strong>sert blank 

frames for 0 s <strong>and</strong> 5 s delay <strong>in</strong>tervals <strong>and</strong> 20 s 

response <strong>in</strong>tervals. The process required multiple 

edits before the f<strong>in</strong>al videotapes were 


eady. An additional challenge <strong>in</strong> us<strong>in</strong>g videotapes 

was the difficulty the teacher had dur<strong>in</strong>g 

<strong>in</strong>struction <strong>in</strong> fast forward<strong>in</strong>g to the next 

prompt when a tape was set up for a special 

delay <strong>in</strong>terval. She found that she often fast 

forwarded through the step <strong>and</strong> had to 

rew<strong>in</strong>d. These problems, however, were 

m<strong>in</strong>or. 

A problem <strong>in</strong>herent to the task itself was 

that students experienced down time while 

wait<strong>in</strong>g for water to boil or items to cook. 

Others who teach cook<strong>in</strong>g skills us<strong>in</strong>g video 

prompt<strong>in</strong>g may want to use this downtime <strong>in</strong> a 

productive manner by <strong>in</strong>sert<strong>in</strong>g nontarget <strong>in</strong>formation. 

For example, Jones <strong>and</strong> Coll<strong>in</strong>s 

(1997) stated safety <strong>and</strong> nutrition facts while 

potatoes were cook<strong>in</strong>g <strong>in</strong> the microwave, <strong>and</strong> 

Fiscus et al. (2002) followed <strong>in</strong>structional trials 

by present<strong>in</strong>g <strong>and</strong> nam<strong>in</strong>g cook<strong>in</strong>g utensils. 

If words or sentences are presented on the 

videotape, the <strong>in</strong>structor could use downtime 

to call attention to <strong>and</strong> review these based on 

the results of the Fiscus et al. study <strong>in</strong> which 

the students learned to read words <strong>and</strong> sentences 

that accompanied pictures <strong>in</strong> their recipe 

books. 

A limitation to the <strong>in</strong>vestigation is that the 

students only learned two skills each due to 

the end of the school year. There were, however, 

six replications of the effectiveness of the 

procedure by the time the <strong>in</strong>vestigation 

ended, which is sufficient to build believability 

<strong>in</strong> the procedure. 

In spite of this limitation <strong>and</strong> other problems 

mentioned above, video prompt<strong>in</strong>g appears 

to be an efficient way to teach cook<strong>in</strong>g 

skills. Once the teacher purchased the blank 

videotapes, there were no other costs of produc<strong>in</strong>g 

the videotape s<strong>in</strong>ce a bus<strong>in</strong>ess teacher 

from the high school <strong>and</strong> a few students from 

his Video Production class recorded <strong>and</strong> produced 

the videotape at no cost us<strong>in</strong>g iMovie 

software <strong>and</strong> an iMac computer. They downloaded 

the task from a video recorder to a 

VHS tape us<strong>in</strong>g a TV/VCR available <strong>in</strong> the 

school’s library. While produc<strong>in</strong>g videotape 

was a good class project (<strong>and</strong> would make a 

good service learn<strong>in</strong>g project), the procedure 

was easy enough that the teacher, if needed, 

could have done this <strong>in</strong>dependently follow<strong>in</strong>g 

m<strong>in</strong>imal <strong>in</strong>struction. In the Branham et al. 

(1999) <strong>in</strong>vestigation, the teacher <strong>in</strong>dependently 

made the videotape us<strong>in</strong>g school equip- 


ment, <strong>and</strong>, <strong>in</strong> the Norman et al. (2001) <strong>in</strong>vestigation, 

the teacher made the videotape at no 

cost with the assistance of a university staff 

person. 

The authors of this <strong>in</strong>vestigation have several 

recommendations for other teachers who 

might want to use video prompt<strong>in</strong>g (Coll<strong>in</strong>s, 

2003). First, select functional skills for <strong>in</strong>struction; 

community cha<strong>in</strong>ed tasks can be taught 

with videotapes <strong>in</strong> simulations (Branham et 

al., 1999; Mechl<strong>in</strong>g et al., 2002) while domestic 

or self-care tasks (Norman et al., 2001) can 

be taught directly from videotapes <strong>in</strong> the classroom 

sett<strong>in</strong>g. Second, construct task analyses 

prior to shoot<strong>in</strong>g the videotape; the task analyses 

can be a guide for edit<strong>in</strong>g the videotape 

(e.g., <strong>in</strong>sert<strong>in</strong>g delay <strong>in</strong>tervals). Third, determ<strong>in</strong>e 

the viewpo<strong>in</strong>t prior to shoot<strong>in</strong>g the videotape; 

a subjective viewpo<strong>in</strong>t may be more 

appropriate for tasks that use f<strong>in</strong>e motor skills 

(e.g., cook<strong>in</strong>g) while a view of the target student 

or another person (e.g., peer) at a distance 

may be more appropriate for community 

tasks with gross motor skills (e.g., cross<strong>in</strong>g 

a street). Fourth, consider <strong>in</strong>volv<strong>in</strong>g students, 

peers, <strong>and</strong> other personnel <strong>in</strong> the shoot<strong>in</strong>g of 

the videotape; also, consider us<strong>in</strong>g a tripod for 

videotap<strong>in</strong>g stationary tasks <strong>and</strong> a h<strong>and</strong>held 

camera with a zoom lens for shoot<strong>in</strong>g tasks 

that require difficult angles. Fifth, after shoot<strong>in</strong>g 

the videotape, determ<strong>in</strong>e if it should be 

edited; students can either watch a videotape 

(with or without audio <strong>and</strong> graphics) <strong>in</strong> its 

entirety before perform<strong>in</strong>g a task or can watch 

<strong>in</strong>dividual steps with <strong>in</strong>serted response <strong>in</strong>tervals 

for perform<strong>in</strong>g one step at a time. Sixth, 

use video prompt<strong>in</strong>g with<strong>in</strong> the context of a 

systematic response prompt<strong>in</strong>g procedure; 

while this study used CTD, other procedures 

(e.g., simultaneous prompt<strong>in</strong>g, system of least 

prompts) also may be effective. Seventh, decide 

who will operate the videotape; while the 

teacher used the remote control as the students 

attended to cook<strong>in</strong>g <strong>in</strong> this <strong>in</strong>vestigation, 

teach<strong>in</strong>g students to use the remote control 

<strong>in</strong>dependently may free up teacher time. 

Eighth, determ<strong>in</strong>e a schedule for collect<strong>in</strong>g 

data on student performance; the teacher <strong>in</strong> 

this <strong>in</strong>vestigation collected data on a daily basis, 

but the use of a simultaneous prompt<strong>in</strong>g 

procedure would require the teacher to collect 

data only dur<strong>in</strong>g probe trials (which could 

be less frequent) <strong>and</strong> not dur<strong>in</strong>g <strong>in</strong>structional

trials. N<strong>in</strong>th, determ<strong>in</strong>e the teacher’s role <strong>in</strong> 

deliver<strong>in</strong>g consequences; the teacher can either 

allow the student to self-correct after rew<strong>in</strong>d<strong>in</strong>g 

the tape or the teacher can <strong>in</strong>tercede 

to help the student correct the error. F<strong>in</strong>ally, 

consider add<strong>in</strong>g nontargeted <strong>in</strong>formation to 

the task (Fiscus et al., 2002; Jones & Coll<strong>in</strong>s, 

1997) to <strong>in</strong>crease the efficiency of learn<strong>in</strong>g; 

for example, students may learn to read words 

<strong>and</strong> sentences from repeated exposure while 

watch<strong>in</strong>g the videotape. 

The <strong>in</strong>vestigation adds to the research literature 

on <strong>in</strong>struction with video (e.g., Branham 

et al., 1999; Norman et al., 2001; Poche et al., 

1988) because it focused on cook<strong>in</strong>g skills. In 

addition, the teacher was less <strong>in</strong>volved <strong>in</strong> <strong>in</strong>struction 

than <strong>in</strong> other <strong>in</strong>vestigations, s<strong>in</strong>ce 

she rewound the videotape to show students 

how to correct their own errors <strong>in</strong>stead of 

physically <strong>in</strong>terven<strong>in</strong>g. Future research should 

<strong>in</strong>clude replicat<strong>in</strong>g the study across other sett<strong>in</strong>gs 

(e.g., community, home, employment) 

<strong>and</strong> other across skills (e.g., domestic, vocational, 

self-help, leisure). In addition, comparison 

studies should compare video prompt<strong>in</strong>g 

with CTD to video prompt<strong>in</strong>g with other response 

prompt<strong>in</strong>g procedure (e.g., SLP, simultaneous 

prompt<strong>in</strong>g), as well as cont<strong>in</strong>u<strong>in</strong>g 

to <strong>in</strong>vestigate the stream<strong>in</strong>g of video on computers 

to teach functional skills (Mechl<strong>in</strong>g et 

al., 2002). 

Video prompt<strong>in</strong>g can be a motivat<strong>in</strong>g procedure 

for teach<strong>in</strong>g students new tasks. The 

participants <strong>in</strong> this <strong>in</strong>vestigation appeared to 

enjoy watch<strong>in</strong>g the videotapes as they cooked. 

They often repeated the steps out loud with 

the videotape <strong>and</strong> giggled when they completed 

the step correctly with the model on 

the videotape. It is possible that video prompt<strong>in</strong>g 

could be successful <strong>in</strong> teach<strong>in</strong>g skills to 

students with less teacher <strong>in</strong>volvement (e.g., 

hav<strong>in</strong>g students operate the remote control 

themselves), free<strong>in</strong>g up more time for teachers 

to deliver <strong>in</strong>struction to other students <strong>in</strong> 

the class. Also, video prompt<strong>in</strong>g can provide a 

permanent model for the students that can be 

used across sett<strong>in</strong>gs. For example, as <strong>in</strong> the 

present <strong>in</strong>vestigation, video prompt<strong>in</strong>g could 

be used to provide a video cookbook for each 

student to enhance both generalization <strong>and</strong> 

ma<strong>in</strong>tenance. 

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Initial Acceptance: 25 September 2003 

F<strong>in</strong>al Acceptance: 15 January 2004

Computer-Based Video Instruction to Teach Students with 

Intellectual <strong>Disabilities</strong> to Verbally Respond to Questions <strong>and</strong> 

Make Purchases <strong>in</strong> Fast Food Restaurants 

L<strong>in</strong>da C. Mechl<strong>in</strong>g, Leslie S. Pridgen, <strong>and</strong> Beth A. Cron<strong>in</strong> 

The University of North Carol<strong>in</strong>a at Wilm<strong>in</strong>gton 

Abstract: Computer-based video <strong>in</strong>struction (CBVI) was used to teach verbal responses to questions presented by 

cashiers <strong>and</strong> purchas<strong>in</strong>g skills <strong>in</strong> fast food restaurants. A multiple probe design across participants was used 

to evaluate the effectiveness of CBVI. Instruction occurred through simulations of three fast food restaurants on 

the computer us<strong>in</strong>g video captions, still photographs, <strong>and</strong> voice record<strong>in</strong>gs. Generalization <strong>and</strong> ma<strong>in</strong>tenance of 

skills were measured with<strong>in</strong> the three community fast food restaurants. Results <strong>in</strong>dicate that verbal responses to 

questions <strong>and</strong> fast food restaurant purchas<strong>in</strong>g skills can be taught to students with moderate to severe 

<strong>in</strong>tellectual disabilities through CBVI. 

The importance of acquir<strong>in</strong>g functional community 

skills to promote <strong>in</strong>dependence is supported 

<strong>in</strong> the field of special education. These 

<strong>in</strong>clude such skills as: shopp<strong>in</strong>g, purchas<strong>in</strong>g, 

travel <strong>and</strong> mobility, bank<strong>in</strong>g, <strong>and</strong> participation 

<strong>in</strong> recreational activities. The ability to 

access restaurants, <strong>in</strong>clud<strong>in</strong>g fast food, “sit 

down,” <strong>and</strong> family restaurants, is also reported 

as functional <strong>and</strong> mean<strong>in</strong>gful for person with 

disabilities (Snell & Brown, 2000; Storey, 

Bates, & Hanson, 1984; Westl<strong>in</strong>g & Fox, 2000) 

<strong>and</strong> is a skill that can be used repeatedly <strong>and</strong> 

across multiple environments. A number of 

important sub-skills are necessary when us<strong>in</strong>g 

a restaurant <strong>in</strong>clud<strong>in</strong>g: order<strong>in</strong>g, pay<strong>in</strong>g, eat<strong>in</strong>g, 

travel, safety, <strong>and</strong> social etiquette. A limited 

number of studies have evaluated <strong>in</strong>struction 

of these skills with the majority focus<strong>in</strong>g 

on fast food establishments (Berg et al., 1989- 

90; Cooper & Browder, 1998; Marhol<strong>in</strong>, 

O’Toole, Torchette, Berger, & Doyle, 1979; 

McDonnell, 1987; McDonnell & Ferguson, 

1988; Rotholz, Berkowitz, & Burberry, 1989; 

Sowers & Powers, 1995; Van Den Pol et al., 

1981). In addition to fast food establishments, 

skills for us<strong>in</strong>g family restaurants (Bates, Cuvo, 


be addressed to L<strong>in</strong>da C. Mechl<strong>in</strong>g, Department of 

Curricular Studies, The University of North Carol<strong>in</strong>a 

at Wilm<strong>in</strong>gton, 601 South College Road, Wilm<strong>in</strong>gton, 

NC 28403-5940. 



M<strong>in</strong>er, & Korabek, 2001), concession areas 

(Schleien, Certo, & Mucc<strong>in</strong>o, 1984; Test, Howell, 

Burkhart, & Beroth, 1993) <strong>and</strong> vend<strong>in</strong>g 

mach<strong>in</strong>es (Browder, Snell, & Wildonger, 

1988; Nietupski, Clancy, & Christiansen, 1984; 

Sprague & Horner, 1984) have also been evaluated. 

Order<strong>in</strong>g procedures implemented <strong>in</strong> 

each of these sett<strong>in</strong>gs have <strong>in</strong>cluded use of 

verbally order<strong>in</strong>g (Sowers & Powers; Van Den 

Pol et al.), written <strong>in</strong>structions (Berg et al.), 

augmentative communication devices (Doss 

et al., 1991; Rothloz et al.), sign language 

(Rothloz et al.), <strong>and</strong> picture cues (Cooper & 

Browder; McDonnell). Methods to teach these 

skills have focused on teach<strong>in</strong>g through community-based 

<strong>in</strong>struction (Cooper & Browder; 

Marhol<strong>in</strong> et al.; McDonnell; Rotholz et al.; 

Schle<strong>in</strong> et al.; Storey et al.; Test et al.), simulation 

(Van Den Pol et al.) <strong>and</strong> a comb<strong>in</strong>ation 

of simulation <strong>and</strong> community-based <strong>in</strong>struction 

(Bates et al.; Berg et al.; McDonnell et al.; 

McDonnell & Ferguson). 

When us<strong>in</strong>g simulation (teach<strong>in</strong>g outside of 

the natural environment where skills will be 

used), the importance of closely replicat<strong>in</strong>g 

actual stimuli <strong>and</strong> responses found <strong>in</strong> natural 

sett<strong>in</strong>gs (Brown<strong>in</strong>g, White, Nave, & Bark<strong>in</strong>, 

1986) <strong>and</strong> use of multiple teach<strong>in</strong>g examples 

(Neef, Lensbower, Hockersmith, DePalma, & 

Gray, 1990) are reported as important for promot<strong>in</strong>g 

generalization of skills. One means for 

creat<strong>in</strong>g simulations with realistic, life-like scenarios, 

is through video technology. Use of 

Computer-Based Video Instruction / 47

video record<strong>in</strong>gs can provide multiple teach<strong>in</strong>g 

examples, replicate stimuli <strong>in</strong> the environment, 

<strong>and</strong> allow repetitive practice of skills. A 

number of skills have been taught us<strong>in</strong>g this 

technology with students with <strong>in</strong>tellectual disabilities 

<strong>in</strong>clud<strong>in</strong>g: assembly tasks ((Mart<strong>in</strong>, 

Mithaug, & Frazier, 1992); read<strong>in</strong>g community 

words (Cuvo & Klatt, 1992); shopp<strong>in</strong>g 

(Har<strong>in</strong>g, Breen, We<strong>in</strong>er, Kennedy, & Bednersh, 

1995; Kyhl, Alper, & S<strong>in</strong>clair, 1999); 

appropriate behaviors (Brown & Middleton, 

1998); self-help skills (Lasater & Brady, 1995; 

Norman, Coll<strong>in</strong>s, & Schuster, 2001); requests 

for assistance (Morgan & Salzberg, 1992); fire 

safety (Tiong, Blampied, & Le Grice, 1992); 

<strong>and</strong> other community skills such as mail<strong>in</strong>g 

letters, cash<strong>in</strong>g checks, <strong>and</strong> cross<strong>in</strong>g streets 

(Branham, Coll<strong>in</strong>s, Schuster, & Kle<strong>in</strong>ert, 

1999). Further, by comb<strong>in</strong><strong>in</strong>g video technology 

<strong>and</strong> computer-based <strong>in</strong>struction, <strong>in</strong>teractive 

learn<strong>in</strong>g environments can be generated 

through software programs such as Hyperstudio 

4.0 (Roger Wagner Publish<strong>in</strong>g, Inc.) <strong>and</strong> 

PowerPo<strong>in</strong>t (Microsoft) which access video record<strong>in</strong>gs 

saved on the computer, an external 

drive, or compressed onto CD-ROM. Computerbased, 

video <strong>in</strong>struction (CBVI) has recently 

been evaluated as a medium for teach<strong>in</strong>g skills 

to students with <strong>in</strong>tellectual disabilities. Skills 

<strong>in</strong>clude: purchas<strong>in</strong>g us<strong>in</strong>g the “next dollar” 

strategy (Ayres & Langone, 2002) or a debit 

card (Mechl<strong>in</strong>g, Gast, & Barthold, 2003); grocery 

shopp<strong>in</strong>g (Mechl<strong>in</strong>g, 2004; Mechl<strong>in</strong>g & 

Gast, 2003; Mechl<strong>in</strong>g, Gast, & Langone, 

2002); choice mak<strong>in</strong>g (Ellerd, Morgan, & Salzberg, 

2002); photograph recognition (Mechl<strong>in</strong>g 

& Langone, 2000); <strong>and</strong> shopp<strong>in</strong>g <strong>in</strong> a 

convenience store (Wissick, Lloyd, & K<strong>in</strong>zie, 

1992). Although a body of research exists that 

supports video technology to teach verbal 

skills to students with disabilities, <strong>in</strong>clud<strong>in</strong>g 

autism, emotional <strong>and</strong> behavior disorders, 

<strong>and</strong> learn<strong>in</strong>g disabilities (Buggey, Toombs, 

Gardener, & Cervetti, 1999; Charlop-Christy, 

Le, & Freeman, 2000; Sherer et al., 2001; Taylor, 

Lev<strong>in</strong>, & Jasper, 1999; Thiemann & Goldste<strong>in</strong>, 

2001; Wert & Neisworth, 2003) none 

were identified which <strong>in</strong>cluded teach<strong>in</strong>g verbal 

skills to students with moderate to severe 

<strong>in</strong>tellectual disabilities (Buggey, 1995; Hitchcock, 

Dowrick, & Prater, 2003; Mechl<strong>in</strong>g, <strong>in</strong> 

press). The current study exp<strong>and</strong>ed on available 

research by evaluat<strong>in</strong>g use of CBVI to 

teach verbal skills to students with <strong>in</strong>tellectual 

disabilities with<strong>in</strong> context of functional activities. 

The primary questions addressed were: 1. 

Would CBVI <strong>in</strong>crease the percentage of correct 

verbal responses made by students follow<strong>in</strong>g 

questions by cashiers <strong>in</strong> fast food restaurants? 

2. Would CBVI <strong>in</strong>crease the percentage 

of steps completed correctly by students us<strong>in</strong>g 

a fast food restaurant? 

Method 

Participants 


Three students (two male <strong>and</strong> one female), 

ages 17 to 20 years participated <strong>in</strong> the study. 

Each was enrolled <strong>in</strong> a high school class for 

students with moderate to severe <strong>in</strong>tellectual 

disabilities <strong>and</strong> was selected based on age, <strong>in</strong>tellectual 

disability, need for community skills, 

<strong>and</strong> <strong>in</strong>terest <strong>in</strong> us<strong>in</strong>g fast food restaurants. 

The school had a strong community-based 

program <strong>in</strong> which students traveled to community 

sett<strong>in</strong>gs approximately three times per 

week us<strong>in</strong>g a city bus, school transportation, 

or walk<strong>in</strong>g. Instruction <strong>in</strong> the community focused 

on social skills, mobility, purchas<strong>in</strong>g, 

<strong>and</strong> recreation. Students were screened for 

the follow<strong>in</strong>g entry level skills prior to the 

study: (a) visual ability to make selections on 

the computer screen; (b) physical ability to 

make selections on the computer screen <strong>and</strong> 

complete steps at restaurants; (c) wait response 

of 3 s; (d) ability to make verbal requests; 

(e) generalized verbal imitation to 

make requests <strong>in</strong> response to computer audio 

prompts. Students were screened for verbal 

imitation us<strong>in</strong>g a commercial software program. 

All three students had received <strong>in</strong>struction 

us<strong>in</strong>g constant time delay (CTD) <strong>and</strong> 

computer-based <strong>in</strong>struction. 

David was a 17-year, 2 month old male diagnosed 

with autism <strong>and</strong> a moderate <strong>in</strong>tellectual 

disability (IQ 46, Stanford-B<strong>in</strong>et 

Intelligence Scale, Fourth Edition). He communicated 

verbally <strong>in</strong> short sentences, but 

needed wait time to process his thoughts. He 

frequently chose not to speak when questioned 

<strong>and</strong> rarely <strong>in</strong>itiated conversation. In 

unfamiliar situations he would look at his 

teacher or an adult to communicate for him. 

He breathed heavily when <strong>in</strong> stressful situations 

<strong>and</strong> exhibited physical aggression when 

upset <strong>in</strong>clud<strong>in</strong>g throw<strong>in</strong>g objects <strong>and</strong> destroy-

<strong>in</strong>g materials. He traveled <strong>in</strong> the community 

with assistance <strong>and</strong> was learn<strong>in</strong>g to pay for 

items <strong>in</strong>dependently. He was able to locate 

many departments with<strong>in</strong> stores <strong>and</strong> read 

most prices. He was able to care for most of his 

personal hygiene needs <strong>and</strong> dress <strong>and</strong> undress 

himself. He enjoyed us<strong>in</strong>g the computer <strong>and</strong> 

was able to type his personal <strong>in</strong>formation. His 

needs <strong>in</strong>cluded: (a) select<strong>in</strong>g preferred items 

to purchase; (b) complet<strong>in</strong>g toilet<strong>in</strong>g skills; 

(c) refra<strong>in</strong><strong>in</strong>g from “dissect<strong>in</strong>g” food (take 

apart <strong>and</strong> eat one item at a time); (d) <strong>in</strong>creased 

task endurance; (e) appropriate reaction 

to stress; <strong>and</strong> (f) decreas<strong>in</strong>g reliance on 

an adult to speak for him. At fast food restaurants 

he relied on an adult to place his order 

or to verbally prompt him to speak. 

Joseph was a 20-year, 2 month old male 

diagnosed with Down syndrome <strong>and</strong> a moderate 

<strong>in</strong>tellectual disability (IQ 36, Stanford- 

B<strong>in</strong>et Intelligence Scale, Fourth Edition). He 

spoke <strong>in</strong> short sentences, exhibited some articulation 

difficulties pronounc<strong>in</strong>g blends, 

<strong>and</strong> frequently held his head down <strong>and</strong> 

“mumbled” un<strong>in</strong>telligibly. He demonstrated 

some aggressive behavior when upset (some 

classmates exhibited behaviors to <strong>in</strong>crease the 

probability that he would become agitated), 

was <strong>in</strong>volved <strong>in</strong> a behavior support plan, <strong>and</strong> 

took psychotropic medication to decrease aggression 

<strong>and</strong> disruptive behavior. He was described 

as be<strong>in</strong>g very “neat” <strong>and</strong> organized. He 

was able to wash, dry, fold, <strong>and</strong> iron cloth<strong>in</strong>g 

with m<strong>in</strong>imal assistance. He used most kitchen 

appliances with assistance <strong>and</strong> enjoyed prepar<strong>in</strong>g 

foods for himself us<strong>in</strong>g visual cues for 

sett<strong>in</strong>gs <strong>and</strong> recipes. He also enjoyed talk<strong>in</strong>g 

to friends <strong>and</strong> family on the telephone <strong>and</strong> 

watch<strong>in</strong>g sport<strong>in</strong>g events on television <strong>and</strong> <strong>in</strong> 

the community. His needs <strong>in</strong>cluded: (a) purchas<strong>in</strong>g 

<strong>in</strong> stores; (b) mak<strong>in</strong>g bank deposits; 

(c) carry<strong>in</strong>g a wallet; (d) tell<strong>in</strong>g time; (e) recogniz<strong>in</strong>g 

co<strong>in</strong>s; <strong>and</strong> (f) us<strong>in</strong>g digital appliances. 

In fast food restaurants he relied on 

po<strong>in</strong>t<strong>in</strong>g to choices on the display board <strong>and</strong> 

answer<strong>in</strong>g, “yes”/no“ to questions from the 

cashier or look<strong>in</strong>g at an adult for assistance. 

On occasions he would also say a number such 

as ”one“ while po<strong>in</strong>t<strong>in</strong>g to the display board. 

Hanna was a 17-year, 1 month old female 

diagnosed with partial agenesis of the corpus 

callosum with associated lipoma of the corpus 

callosum <strong>and</strong> a moderate <strong>in</strong>tellectual disability 

(IQ 40, WISC-III). She was able to speak <strong>in</strong> 

complete sentences, however, her verbalizations 

were often <strong>in</strong>appropriate for the context 

or social situation. She would also make <strong>in</strong>appropriate 

exclamations such as “ouch,” giggle, 

or obsessively talk about a topic. She was described 

as be<strong>in</strong>g both pleasant <strong>and</strong> cooperative 

<strong>and</strong> enjoyed social <strong>in</strong>teractions. She was 

able to write her first name <strong>in</strong> manuscript, 

recognize letters of the alphabet <strong>and</strong> some 

basic sight words. She could count to 20 with 

manipulatives <strong>and</strong> write numerals 1-5. Hanna 

was able to complete most personal management 

skills <strong>in</strong>clud<strong>in</strong>g dress<strong>in</strong>g <strong>and</strong> undress<strong>in</strong>g, 

but needed assistance with groom<strong>in</strong>g. Her 

needs <strong>in</strong>cluded: (a) walk<strong>in</strong>g <strong>in</strong>dependently 

without rem<strong>in</strong>ders <strong>and</strong> without lean<strong>in</strong>g on 

walls <strong>and</strong> furniture; (b) us<strong>in</strong>g a napk<strong>in</strong>; (c) 

sett<strong>in</strong>g a table; (d) carry<strong>in</strong>g a tray; (e) throw<strong>in</strong>g 

items away; (f) refra<strong>in</strong><strong>in</strong>g from star<strong>in</strong>g; (g) 

simple food preparation; (h) us<strong>in</strong>g a telephone; 

<strong>and</strong> (i) operation of dials for cook<strong>in</strong>g. 

In fast food restaurants she stood <strong>in</strong> front of 

the cashier <strong>and</strong> giggled, looked to an adult for 

prompt<strong>in</strong>g, failed to order, or ordered <strong>in</strong>appropriate 

items for the sett<strong>in</strong>g. 

Sett<strong>in</strong>gs <strong>and</strong> Instructional Arrangements 

All <strong>in</strong>structional sessions were implemented 

us<strong>in</strong>g the computer-based video program. Sessions 

were conducted <strong>in</strong>dividually <strong>in</strong> a secluded 

room <strong>in</strong> the library of the students’ 

high school. Generalization probe sessions 

were conducted <strong>in</strong> three community fast-food 

restaurants: McDonald’s, Wendy’s, <strong>and</strong> Hardee’s. 

The restaurant cha<strong>in</strong>s were chosen due to 

their frequency of use by participants <strong>and</strong> 

range of stimulus <strong>and</strong> response requirements 

(Table 1). In addition, the particular store 

with<strong>in</strong> each cha<strong>in</strong> was selected due to its proximity 

to the students’ high school. Generalization 

sessions <strong>in</strong> the community were conducted 

before the lunch rush hour (10:30- 

11:00 a.m.). 

Dur<strong>in</strong>g <strong>in</strong>structional sessions, a laptop computer 

with touch screen was placed on a table 

<strong>in</strong> front of the student. The <strong>in</strong>structor sat to 

the right <strong>and</strong> slightly beh<strong>in</strong>d the student with 

a clipboard to record data, provide <strong>in</strong>termittent 

re<strong>in</strong>forcement <strong>and</strong> error correction, <strong>and</strong> 

to advance the computer program follow<strong>in</strong>g 

verbal response by students. A digital video 

camera was positioned on an adjacent table 

dur<strong>in</strong>g reliability data collection sessions. 


TABLE 1 

Task Analysis for Verbal <strong>and</strong> Motor Response Requirements Across Three Restaurants 

McDonald’s Hardee’s Wendy’s 

“s<strong>and</strong>wich name” “s<strong>and</strong>wich name” “here” 

“small french fry” “small french fry” “s<strong>and</strong>wich name” 

“small” “name of dr<strong>in</strong>k” “small” “name of dr<strong>in</strong>k” “small french fry” 

“here” “here” “small” “name of dr<strong>in</strong>k” 

unzip wallet <strong>and</strong> give bill unzip wallet <strong>and</strong> give bill unzip wallet <strong>and</strong> give bill 

take change, put <strong>in</strong> wallet take change, put <strong>in</strong> wallet take change, put <strong>in</strong> wallet 

obta<strong>in</strong> tray obta<strong>in</strong> tray obta<strong>in</strong> tray 

obta<strong>in</strong> dr<strong>in</strong>k obta<strong>in</strong> dr<strong>in</strong>k obta<strong>in</strong> napk<strong>in</strong> 

obta<strong>in</strong> napk<strong>in</strong> obta<strong>in</strong> napk<strong>in</strong> locate table <strong>and</strong> sit down 

locate table <strong>and</strong> sit down locate table <strong>and</strong> sit down throw away trash 

throw away trash 

Materials <strong>and</strong> Equipment 

Equipment. A Dell Latitude laptop computer 

with zip drive <strong>and</strong> CD player was used to deliver 

<strong>in</strong>struction along with a TouchW<strong>in</strong>dow 

(Edmark Corporation) for direct selection on 

the computer screen. The software program, 

Hyperstudio 4.0 (Roger Wagner Publish<strong>in</strong>g, 

Inc.) was used to create <strong>and</strong> deliver the multimedia 

<strong>in</strong>structional programs. Video captions 

were made us<strong>in</strong>g a Sony digital video camera 

<strong>and</strong> still photographs of items <strong>in</strong> the fast food 

restaurant were made us<strong>in</strong>g a Sony digital camera. 

Video record<strong>in</strong>gs were burned to a compact 

disk, downloaded to the computer hard 

drive, <strong>and</strong> then accessed through the Hyperstudio 

4.0 program. Digital photographs were 

stored directly <strong>in</strong> Hyperstudio 4.0, which was 

used to create a visual simulation of order<strong>in</strong>g 

at a fast food restaurant through use of these 

still photographs <strong>and</strong> video record<strong>in</strong>gs. Computer-based 

video programs were made for 

each fast food restaurant. Programs were <strong>in</strong>dividualized 

for each participant by <strong>in</strong>clud<strong>in</strong>g 

photographs of the student eat<strong>in</strong>g at the restaurant 

or by vary<strong>in</strong>g food orders based on 

student’s <strong>in</strong>dividual preferences, result<strong>in</strong>g <strong>in</strong> 

two different computer-based video programs 

developed for each student. Food <strong>and</strong> dr<strong>in</strong>k 

preferences were determ<strong>in</strong>ed before the study 

by ask<strong>in</strong>g students, parents, <strong>and</strong> teachers. 

Students paid for food orders by giv<strong>in</strong>g the 

cashier a prespecified amount of money ($10 

or $20 bill) that was large enough to pay for 

the order. The bill was placed <strong>in</strong> a wallet with 

a zipper closure. Dur<strong>in</strong>g CBVI, students responded 

to the video simulation <strong>and</strong> com- 

puter prompt by remov<strong>in</strong>g the s<strong>in</strong>gle bill from 

the wallet <strong>and</strong> plac<strong>in</strong>g it on the table. Change 

from the cashier dur<strong>in</strong>g generalization sessions 

or the <strong>in</strong>structor dur<strong>in</strong>g CBVI was placed 

back <strong>in</strong>to the wallet by the student. 

Video Models. Video record<strong>in</strong>gs were made 

depict<strong>in</strong>g the entire process for verbally order<strong>in</strong>g 

<strong>and</strong> us<strong>in</strong>g a fast food restaurant. Video 

record<strong>in</strong>gs served as models <strong>and</strong> specific segments 

were delivered by the computer-based 

program as stimuli to elicit a response by the 

student or follow<strong>in</strong>g a student response. An 

adult familiar to the students <strong>and</strong> actual employees 

at the restaurants appeared <strong>in</strong> video 

record<strong>in</strong>gs. Students viewed video segments of 

the adult model perform<strong>in</strong>g steps they would 

later perform <strong>in</strong> the restaurant or the restaurant 

cashier mak<strong>in</strong>g verbal requests (e.g. “Is 

this for here or to go?”) <strong>and</strong> perform<strong>in</strong>g tasks 

(stimuli) that the student would respond to <strong>in</strong> 

the restaurant (e.g. giv<strong>in</strong>g change). 

General Procedures 


Students received <strong>in</strong>dividual <strong>in</strong>struction us<strong>in</strong>g 

a 3 s CTD procedure <strong>and</strong> computer-based 

video program. Instruction occurred 1-2 times 

per day (morn<strong>in</strong>g <strong>and</strong>/or afternoon), 4-5 days 

per week. Each session lasted approximately 

15 m<strong>in</strong>, with delivery of 3 trials (1 trial per 

restaurant) <strong>in</strong> total task format. Criteria was 

reached when each student performed 100% 

unprompted corrects for 4 of 5 trials.

Generalization Probe Procedures 

Prior to the first student receiv<strong>in</strong>g CBVI, generalization 

probe measures were taken one 

time at each of the three restaurants to determ<strong>in</strong>e 

each student’s ability to verbally place 

orders <strong>and</strong> to complete the steps for us<strong>in</strong>g a 

fast food restaurant. In addition, probe data 

were collected at each fast food restaurant 

immediately prior to the second <strong>and</strong> third 

student receiv<strong>in</strong>g CBVI. Students traveled together 

to each of the fast food establishments. 

Upon enter<strong>in</strong>g the restaurant, students were 

seated at a back table farthest away from the 

counter to prevent model<strong>in</strong>g responses. The 

<strong>in</strong>structor then told the first student, “It’s your 

turn to order your food.” The <strong>in</strong>structor 

waited 3 s for the student to <strong>in</strong>itiate a response. 

Table 2 describes stimulus <strong>and</strong> response 

requirements for one restaurant. Students 

were scored on the follow<strong>in</strong>g verbal 

steps: (a) say, “here” (to <strong>in</strong>dicate location for 

consum<strong>in</strong>g items); (b) say name of s<strong>and</strong>wich; 

(c) say “small french fries”; <strong>and</strong> (d) say “small” 

<strong>and</strong> the name of the dr<strong>in</strong>k. Students were also 

scored on the follow<strong>in</strong>g motor steps: (a) unzip 

wallet <strong>and</strong> give bill to cashier; (b) take change 

<strong>and</strong> place <strong>in</strong> wallet; (c) pick up tray; (d) walk 

to <strong>and</strong> obta<strong>in</strong> dr<strong>in</strong>k from dr<strong>in</strong>k mach<strong>in</strong>e; (e) 

walk to <strong>and</strong> obta<strong>in</strong> a napk<strong>in</strong>; (f) locate a table 

<strong>and</strong> sit down; <strong>and</strong> (g) place trash <strong>in</strong> trash can. 

Students could perform each step correctly, 

<strong>in</strong>correctly, or not respond. Incorrect verbal 

responses <strong>in</strong>cluded request<strong>in</strong>g an item not on 

the menu, request<strong>in</strong>g a wrong size, request<strong>in</strong>g 

an item not identified as preferred, po<strong>in</strong>t<strong>in</strong>g 

to the menu display, or say<strong>in</strong>g “to go.” Incorrect 

motor responses were obta<strong>in</strong><strong>in</strong>g an item 

or complet<strong>in</strong>g a step out of sequence, <strong>and</strong> 

obta<strong>in</strong><strong>in</strong>g too many or <strong>in</strong>correct items. A no 

response was def<strong>in</strong>ed as fail<strong>in</strong>g to verbalize, or 

fail<strong>in</strong>g to obta<strong>in</strong> an item or complete a step 

with<strong>in</strong>3sofcomplet<strong>in</strong>g a prior step. A correct 

response (unprompted correct) was def<strong>in</strong>ed 

as complet<strong>in</strong>g a motor response with<strong>in</strong> 3sof 

complet<strong>in</strong>g the prior step or verbally respond<strong>in</strong>g 

with<strong>in</strong>3sofacashier’s question. Incorrect 

or no verbal responses resulted <strong>in</strong> the <strong>in</strong>structor 

hold<strong>in</strong>g up a 3 5 <strong>in</strong>dex card with the 

correct written response for the cashier to 

read. Incorrect or no motor response resulted 

<strong>in</strong> skipp<strong>in</strong>g the step (e.g., not obta<strong>in</strong><strong>in</strong>g a 

napk<strong>in</strong>) or the <strong>in</strong>structor perform<strong>in</strong>g the step 

out of view of the student (e.g., pay<strong>in</strong>g for 

item, obta<strong>in</strong><strong>in</strong>g a dr<strong>in</strong>k). 

Students received non-specific verbal praise 

<strong>and</strong> pats on the back on the average of every 

third step (VR3) for general attend<strong>in</strong>g <strong>and</strong> 

attempts to perform the task. Students received 

natural re<strong>in</strong>forcement of eat<strong>in</strong>g <strong>and</strong> 

dr<strong>in</strong>k<strong>in</strong>g items obta<strong>in</strong>ed at the restaurant. 

Follow<strong>in</strong>g <strong>in</strong>struction with the computerbased 

video program, students returned to the 

fast food restaurants <strong>and</strong> were evaluated on 

their ability to generalize verbal respond<strong>in</strong>g 

<strong>and</strong> complet<strong>in</strong>g steps for us<strong>in</strong>g the restaurant. 

Students who reached criteria with the computer-based 

video program <strong>and</strong> completed 

the generalization condition were evaluated 

for skill ma<strong>in</strong>tenance <strong>in</strong> subsequent probe sessions 

at fast food restaurants. 

Computer-Based Video Instruction (CBVI) 

CBVI was conducted with the first student 

immediately follow<strong>in</strong>g the first generalization 

probe condition. Each session began with the 

<strong>in</strong>structor ga<strong>in</strong><strong>in</strong>g the attention of the student 

<strong>and</strong> deliver<strong>in</strong>g a task direction such as, “Let’s 

practice go<strong>in</strong>g to Wendy’s.” Follow<strong>in</strong>g the task 

direction, the computer-based video program 

began with a video segment of the adult 

model enter<strong>in</strong>g the restaurant <strong>and</strong> walk<strong>in</strong>g to 

the counter. A video segment then showed the 

employee ask<strong>in</strong>g a question such as, “May I 

take your order?” (Table 2) followed by a still 

photograph of the employee “wait<strong>in</strong>g for the 

answer.” Intervention began with a0sdelay. 

Each student rema<strong>in</strong>ed at 0 s until he/she had 

100% correct wait responses (correct responses 

after the computer or <strong>in</strong>structor 

prompt) for three trials. For steps requir<strong>in</strong>g a 

verbal response, the controll<strong>in</strong>g prompt was a 

photograph of the correct answer paired with 

the correct verbal response (e.g., photograph 

of student eat<strong>in</strong>g at the restaurant paired with 

a recorded voice say<strong>in</strong>g, “here” or photographs 

of food items paired with a recorded 

voice say<strong>in</strong>g the item names) (Figure 1). Correct 

verbal responses, after the computer 

prompt, were def<strong>in</strong>ed as the student say<strong>in</strong>g: 

(a) say, “here” (to <strong>in</strong>dicate location for consum<strong>in</strong>g 

items); (b) say name of s<strong>and</strong>wich; (c) 

say “small french fries”; <strong>and</strong> (d) say “small” 

<strong>and</strong> the name of the dr<strong>in</strong>k. Students were 

taught to say a generic name for a s<strong>and</strong>wich 

(e.g., “cheeseburger”), which could be ap- 


TABLE 2 

Stimulus, Response Requirements, <strong>and</strong> Controll<strong>in</strong>g Prompt of Computer-Based Video Program Us<strong>in</strong>g 

Hyperstudio 4.0 for Hardee’s Restaurant <strong>and</strong> David’s Response 

Stimulus (video) Stimulus (photo) Response Controll<strong>in</strong>g Prompt 

Adult model enters 

restaurant <strong>and</strong> walks 

to counter 

Cashier says, “Hi, can I 

help you?” 

Cashier says, “Is that for 

here or to go?” 

Cashier says, “three 

dollars <strong>and</strong> twentytwo 

cents” 

Cashier gives change to 

adult model 

Instructor gives change 

to student 

Adult model picks up 

tray 

Adult model walks to 

dr<strong>in</strong>k mach<strong>in</strong>e, 

obta<strong>in</strong>s: ice, Sprite, 

straw 

Places lid on cup 


napk<strong>in</strong> dispenser 

pulls out napk<strong>in</strong>, 

places napk<strong>in</strong> on tray 


table, pulls out chair 

<strong>and</strong> sits down 


trash can, puts trash 

<strong>in</strong> can, places tray on 

top of trash can, 

walks out of 

restaurant 

Cashier wait<strong>in</strong>g for 

response 





Napk<strong>in</strong> dispenser 

Table with chairs 

Tray on counter 


Dr<strong>in</strong>k mach<strong>in</strong>e 



Trash can 


Dr<strong>in</strong>k dispenser 

Trash can 



Trash can 


plied to any restaurant, rather than a specific 

name such as “Big Mac.” For dr<strong>in</strong>k <strong>and</strong> french 

fry orders, students were taught to say “small” 

rather than “regular,” “medium,” or “biggie.” 

For steps requir<strong>in</strong>g a motor response, the con- 

“Cheeseburger, small 

french fry, small 

Sprite” 

3 photos: cheeseburger, 

small French fry, small 

Sprite with Hardee’s 

wrappers 

Record<strong>in</strong>g: 

“cheeseburger, small 

french fry, small 

Sprite” 

“here” Photo of David eat<strong>in</strong>g at 

Hardee’s 

Record<strong>in</strong>g: “here” 

Unzip wallet <strong>and</strong> place 

bill on table 

Take change <strong>and</strong> place <strong>in</strong> 

wallet 

Video model of adult 

giv<strong>in</strong>g bill to cashier 

Video model of adult 

tak<strong>in</strong>g change 

Touch photo of tray Photos rema<strong>in</strong> on screen 

Touch photo of dr<strong>in</strong>k 

mach<strong>in</strong>e 

Touch photo of napk<strong>in</strong> 

dispenser 

Touch photo of table <strong>and</strong> 

chairs 


Photos rema<strong>in</strong> on screen 



Touch photo of trash can Photos rema<strong>in</strong> on screen 

troll<strong>in</strong>g prompt was the <strong>in</strong>structor po<strong>in</strong>t<strong>in</strong>g to 

the correct photograph represent<strong>in</strong>g the correct 

step <strong>in</strong> the sequence of the task analysis 

(pick up tray, obta<strong>in</strong> dr<strong>in</strong>k, obta<strong>in</strong> napk<strong>in</strong>, sit 

at table, or throw away trash); or demonstrat-

Figure 1. Hyperstudio “card” with controll<strong>in</strong>g prompt of photographs <strong>and</strong> verbal record<strong>in</strong>g of item names. 

Correct <strong>and</strong> <strong>in</strong>correct buttons advanced the program by the <strong>in</strong>structor dependent on student 

response. 

<strong>in</strong>g the step (remov<strong>in</strong>g $10 or $20 bill from 

the wallet <strong>and</strong> plac<strong>in</strong>g it on the table <strong>and</strong> 

tak<strong>in</strong>g change <strong>and</strong> putt<strong>in</strong>g it <strong>in</strong> the wallet). 

Correct motor responses were def<strong>in</strong>ed as: (a) 

touch<strong>in</strong>g a correct photograph on the computer 

screen to <strong>in</strong>dicate correct step <strong>in</strong> sequence 

of the task analysis (pick up tray, obta<strong>in</strong> 

dr<strong>in</strong>k, obta<strong>in</strong> napk<strong>in</strong>, sit at table, <strong>and</strong> 

throw away trash); (b) remov<strong>in</strong>g $10 or $20 

bill from the wallet <strong>and</strong> plac<strong>in</strong>g it on the table; 

<strong>and</strong> (c) tak<strong>in</strong>g change from <strong>in</strong>structor <strong>and</strong> 

putt<strong>in</strong>g it <strong>in</strong> the wallet. Follow<strong>in</strong>g 0 s delay 

trials, CTD trials implement<strong>in</strong>g a 3 s delay 

<strong>in</strong>terval were provided after the question was 

delivered by the cashier or completion of the 

previous step. Us<strong>in</strong>g the CTD procedure, a 

student response was recorded as: (a) unprompted 

correct (<strong>in</strong>itiat<strong>in</strong>g <strong>and</strong> complet<strong>in</strong>g 

a correct verbal or motor response with<strong>in</strong> 3 s 

of a question or completion of a previous step 

<strong>and</strong> before delivery of the controll<strong>in</strong>g 

prompt); (b) unprompted <strong>in</strong>correct (<strong>in</strong>cor- 

rect verbal or motor response with<strong>in</strong> 3sofa 

question or previous step; (c) prompted correct 

(correct verbal or motor response after 

the computer or <strong>in</strong>structor prompt); (d) 

prompted <strong>in</strong>correct (<strong>in</strong>correct verbal or motor 

response after the computer or <strong>in</strong>structor 

prompt); <strong>and</strong> (e) no response (failure to <strong>in</strong>itiate 

a verbal or motor response with<strong>in</strong> 3sof 

the computer or <strong>in</strong>structor prompt). An unprompted 

or prompted correct verbal response 

was followed by the <strong>in</strong>structor advanc<strong>in</strong>g 

the computer-based program to the next 

video segment. Unprompted <strong>in</strong>correct verbal 

response or no response was followed by the 

<strong>in</strong>structor advanc<strong>in</strong>g the program to show the 

controll<strong>in</strong>g prompt (e.g., photograph of food 

items paired with the correct verbal response) 

(Table 2) (Figure 1). Prompted <strong>in</strong>correct verbal 

response or no response after the prompt 

was followed by the <strong>in</strong>structor say<strong>in</strong>g the correct 

response. For steps requir<strong>in</strong>g a motor 

response, students were required to <strong>in</strong>teract 


with the computer-based program by touch<strong>in</strong>g 

photographs on the computer screen us<strong>in</strong>g 

the TouchW<strong>in</strong>dow. Three photographs appeared 

across the bottom of the screen <strong>and</strong> 

the <strong>in</strong>structor asked, “What do you do next?” 

(Figure 2). An unprompted or prompted correct 

response activated an <strong>in</strong>visible “button” 

positioned on the photograph which advanced 

the computer program to show a video 

segment correspond<strong>in</strong>g to the photograph 

(e.g., selection of napk<strong>in</strong> dispenser photograph 

followed by video segment of adult 

model obta<strong>in</strong><strong>in</strong>g a napk<strong>in</strong> at the fast food 

restaurant) (Table 2). An unprompted <strong>in</strong>correct 

motor response or no response resulted 

<strong>in</strong> the photographs rema<strong>in</strong><strong>in</strong>g on the screen. 

If the student made a prompted <strong>in</strong>correct 

response or no response after the computer 

prompt, the <strong>in</strong>structor po<strong>in</strong>ted to the correct 

photograph. 


A multiple probe design across three students 

(Tawney & Gast, 1984) was used to evaluate 

effectiveness of the computer-based video program 

to teach verbal responses <strong>and</strong> use of fast 

food restaurants. Verbal <strong>and</strong> motor skills for 

us<strong>in</strong>g three fast food restaurants were taught 

us<strong>in</strong>g constant time delay (CTD) <strong>and</strong> the computer-based 

video program. Experimental 

conditions <strong>in</strong>cluded generalization probes <strong>in</strong> 

the natural environment (three fast food restaurants) 

prior to <strong>and</strong> follow<strong>in</strong>g <strong>in</strong>struction, 

CBVI, <strong>and</strong> ma<strong>in</strong>tenance probes across the 

three fast food restaurants. Prior to <strong>in</strong>struction, 

probe measurements were conducted for 

all three restaurants. Probe measures were followed 

by CBVI for the first student. When 

criteria (100% unprompted corrects, 4 of 5 

trials) was reached for a particular student, 

generalization probe measures were aga<strong>in</strong> collected 

at the three restaurants followed by 

<strong>in</strong>struction for the second student. Subsequent 

generalization probe sessions served as 

ma<strong>in</strong>tenance checks for each student. This 

generalization probe <strong>and</strong> CBVI format cont<strong>in</strong>ued 

until each student reached criteria. 

Reliability Measures 

Interobserver agreement <strong>and</strong> procedural reliability 

data were collected simultaneously on 

100% of generalization probe <strong>and</strong> ma<strong>in</strong>tenance 

sessions <strong>and</strong> 33% of all CTD, CBVI 

sessions. Dur<strong>in</strong>g probe sessions <strong>in</strong> the community, 

one <strong>in</strong>structor <strong>and</strong> one reliability observer 

were present, whereas videotapes were 

made dur<strong>in</strong>g CBVI sessions <strong>and</strong> <strong>in</strong>dependently 

evaluated by the reliability observer. 

Interobserver agreement was reported for 

each step of the task analysis us<strong>in</strong>g the po<strong>in</strong>tby-po<strong>in</strong>t 

method <strong>in</strong> which number of <strong>in</strong>structor 

<strong>and</strong> observer agreements was divided by 

number of agreements plus disagreements 

<strong>and</strong> multiplied by 100. Procedural reliability 

data were collected on the follow<strong>in</strong>g <strong>in</strong>structor 

<strong>and</strong> computer behaviors: (a) delivery of 

attentional cues; (b) ensur<strong>in</strong>g attentional response; 

(c) deliver<strong>in</strong>g task directions; (d) respond<strong>in</strong>g 

to student errors (CBVI only); (e) 

advanc<strong>in</strong>g the computer program dependent 

on student responses (CBVI only); <strong>and</strong> (f) 

delivery of <strong>in</strong>termittent verbal re<strong>in</strong>forcement. 

Procedural reliability agreement was determ<strong>in</strong>ed 

by divid<strong>in</strong>g number of observed <strong>in</strong>structor 

behaviors by number of opportunities 

Figure 2. Hyperstudio “card” with photographs selected by student to <strong>in</strong>dicate correct motor response <strong>in</strong> 

sequence of the task analysis. 


to emit the behaviors, multiplied by 100 (Bill<strong>in</strong>gsley, 

White, & Munson, 1980). 

Results 

Reliability 

Mean <strong>in</strong>terobserver agreement was 99.4% 

across all participants <strong>and</strong> conditions, 100% 

for generalizations sessions <strong>in</strong> fast food restaurants, 

<strong>and</strong> 99.2% dur<strong>in</strong>g CBVI (range 81.8- 

100). Disagreement dur<strong>in</strong>g CBVI occurred 

due to Joseph mumbl<strong>in</strong>g his response on two 

occasions result<strong>in</strong>g <strong>in</strong> difficulty <strong>in</strong>terpret<strong>in</strong>g 

his response. Mean procedural agreement was 

98.1% across all participants <strong>and</strong> conditions, 

97.4% for generalization sessions <strong>in</strong> fast food 

restaurants (range 83.3-100) <strong>and</strong> 98.2% 

dur<strong>in</strong>g CBVI (range 66.7-100). Procedural 

disagreement dur<strong>in</strong>g CBVI was due to the 

computer program fail<strong>in</strong>g to advance when 

the student touched the correct photograph 

on the screen. The <strong>in</strong>structor manually advanced 

the program with the computer mouse 

on these occasions. Disagreement dur<strong>in</strong>g generalization 

probe conditions at the restaurants 

was attributed to the cashiers fail<strong>in</strong>g to direct 

questions to students or verbally prompt<strong>in</strong>g 

student answers. 

Effectiveness 

Figure 3 shows the effectiveness of the computer-based 

video program <strong>in</strong> teach<strong>in</strong>g students 

to verbally respond to questions <strong>and</strong> 

make purchases <strong>in</strong> fast food restaurants. Data 

are reported for generalization probe sessions 

<strong>in</strong> each of the three fast food establishments, 

<strong>in</strong>struction with CBVI, <strong>and</strong> ma<strong>in</strong>tenance of 

skills. Data are separated <strong>in</strong>to verbal <strong>and</strong> motor 

responses. Closed circles represent the 

percentage of correct verbal responses for 

each trial dur<strong>in</strong>g generalization <strong>and</strong> the mean 

response per session dur<strong>in</strong>g CBVI. Results <strong>in</strong>dicate 

<strong>in</strong>creased correct verbal responses for 

each student immediately follow<strong>in</strong>g CBVI. 

Prior to CBVI, none of the students verbally 

responded more than 25% correct on any 

trial. Correct verbal respond<strong>in</strong>g was 0% for 

David <strong>and</strong> Joseph. Hanna r<strong>and</strong>omly ordered 

items such as “hot dog,” “cheese s<strong>and</strong>wich,” 

<strong>and</strong> “kids meal” or failed to order an item, 

while Joseph po<strong>in</strong>ted to the display board <strong>and</strong> 

David did not attempt to make a verbal re- 

sponse. Follow<strong>in</strong>g CBVI, mean correct verbal 

respond<strong>in</strong>g <strong>in</strong>creased to 100% for David, 75% 

for Joseph <strong>and</strong> Hanna. Furthermore, students 

ma<strong>in</strong>ta<strong>in</strong>ed their ability to verbally respond 

correctly <strong>in</strong> the fast food restaurants. David 

performed 100% mean correct verbal responses 

after 30 <strong>and</strong> 56 days while Joseph 

averaged 91.7% correct after 26 days <strong>and</strong> 

Hanna averaged 75% correct after 17 days. 

David reverted back to po<strong>in</strong>t<strong>in</strong>g to the display 

dur<strong>in</strong>g one session <strong>and</strong> failed to answer “here” 

dur<strong>in</strong>g two sessions follow<strong>in</strong>g CBVI while 

Hanna did not order a chicken s<strong>and</strong>wich as 

taught dur<strong>in</strong>g CBVI, but rather ordered a 

cheeseburger dur<strong>in</strong>g each of the generalization 

<strong>and</strong> ma<strong>in</strong>tenance sessions <strong>in</strong> the actual 

fast food restaurants. 

Due to previous exposure, each student was 

able to correctly perform some motor skills <strong>in</strong> 

the fast food restaurant dur<strong>in</strong>g basel<strong>in</strong>e probe 

prior to CBVI. Each was able to consistently 

locate a table to sit down <strong>and</strong> Joseph was able 

to consistently take his change, take his tray, 

<strong>and</strong> obta<strong>in</strong> a dr<strong>in</strong>k from the dr<strong>in</strong>k mach<strong>in</strong>e. 

David’s mean performance was 35% correct 

dur<strong>in</strong>g the <strong>in</strong>itial probe sessions while Joseph’s 

mean performance was 70% correct 

<strong>and</strong> Hanna’s mean performance was 55% correct. 

Each student demonstrated an <strong>in</strong>crease 

<strong>in</strong> his/her ability to perform the motor steps 

correctly immediately follow<strong>in</strong>g CBVI. David 

ma<strong>in</strong>ta<strong>in</strong>ed his ability to perform motor steps 

after 30 days, but failed to obta<strong>in</strong> a napk<strong>in</strong> 56 

days follow<strong>in</strong>g CBVI. Likewise, Joseph only 

obta<strong>in</strong>ed a napk<strong>in</strong> dur<strong>in</strong>g one session <strong>and</strong> 

Hanna never obta<strong>in</strong>ed a napk<strong>in</strong> <strong>in</strong> the restaurant. 

Efficiency 

Measures of efficiency were calculated for 

number of <strong>in</strong>structional trials to criteria with 

CBVI. David needed the least number of <strong>in</strong>structional 

trials (16) while Joseph needed 37 

trials <strong>and</strong> Hanna needed 41. Joseph demonstrated 

the greatest difficulty acquir<strong>in</strong>g the 

sequence of motor skills while Hanna demonstrated 

more difficulty learn<strong>in</strong>g verbal responses. 

An adaptation to the orig<strong>in</strong>al computer-based 

video program was needed for 

each student. Follow<strong>in</strong>g the question, “May I 

take your order”? or “How may I help you?” 

students failed to <strong>in</strong>itiate a verbal response 

prior to delivery of the controll<strong>in</strong>g prompt by 


Figure 3. Graph of students’ performance, circles: verbal response; squares: motor response. 

the computer. It appeared that students did 

not underst<strong>and</strong> that they were expected to 

respond to the question prior to see<strong>in</strong>g the 

screen with photographs of three items paired 

with the verbal record<strong>in</strong>g nam<strong>in</strong>g each item. 

After 12 trials for each student, a verbal direction, 

“What do you say?” was <strong>in</strong>serted by the 


<strong>in</strong>structor follow<strong>in</strong>g the cashier’s question. 

Figure 3 <strong>in</strong>dicates an immediate <strong>in</strong>crease <strong>in</strong> 

percentage of correct responses for each student 

follow<strong>in</strong>g the adaptation (<strong>in</strong>dicated by 

two slash marks on the graph). 

Number of errors after the prompt was also 

calculated. Dur<strong>in</strong>g 0 s delay, no errors oc-

curred after the prompt. Dur<strong>in</strong>g 3 s delay, 

3.5% errors were committed after the prompt 

for David, 7.1% for Hannah, <strong>and</strong> 11.3% for 

Joseph. Joseph had difficulty respond<strong>in</strong>g to 

the controll<strong>in</strong>g prompt for motor responses 

while Hannah’s errors occurred follow<strong>in</strong>g the 

controll<strong>in</strong>g prompt for verbal responses. 


Results <strong>in</strong>dicate that verbal skills <strong>and</strong> fast food 

restaurant purchas<strong>in</strong>g skills can be taught to 

students with moderate to severe <strong>in</strong>tellectual 

disabilities through CBVI. Each student 

learned to respond correctly to requests of 

cashiers <strong>and</strong> complete motor skills for obta<strong>in</strong><strong>in</strong>g 

items across three restaurants. Although 

the study supports the computer-based, video 

program as an <strong>in</strong>tervention for teach<strong>in</strong>g verbal 

skills, these skills were limited to order<strong>in</strong>g 

three generic food <strong>and</strong> dr<strong>in</strong>k items <strong>and</strong> answer<strong>in</strong>g 

the location for consum<strong>in</strong>g items 

(“here”). Generalization sessions <strong>in</strong> the community, 

follow<strong>in</strong>g CBVI, demonstrated the 

need for additional verbal skills, <strong>in</strong>clud<strong>in</strong>g: 

reject<strong>in</strong>g items <strong>in</strong>correctly suggested by the 

cashier; cancel<strong>in</strong>g part of an order; <strong>and</strong> nam<strong>in</strong>g 

specific items. In addition to extend<strong>in</strong>g 

students’ verbal repertoire, future research 

should cont<strong>in</strong>ue to evaluate use of computerbased 

<strong>in</strong>struction as a “st<strong>and</strong> alone” means to 

deliver <strong>in</strong>struction. Us<strong>in</strong>g a constant time delay 

procedure, the current computer program 

delivered the controll<strong>in</strong>g prompt <strong>and</strong> for motor 

responses, the computer program <strong>in</strong>dependently 

advanced the program dependent 

on student responses. However, dur<strong>in</strong>g verbal 

responses, the <strong>in</strong>structor advanced the program 

to a subsequent screen, which then provided 

re<strong>in</strong>forcement to the response or delivered 

the controll<strong>in</strong>g prompt. To <strong>in</strong>crease the 

usefulness of computer-based programs to deliver 

<strong>in</strong>struction, features such as speech recognition 

may be <strong>in</strong>corporated <strong>and</strong> evaluated 

<strong>in</strong> future research. 

Further, some motor skills may not be as 

effectively taught us<strong>in</strong>g observation alone 

through computer-based <strong>in</strong>struction. For example, 

only David was able to locate a napk<strong>in</strong> 

follow<strong>in</strong>g CBVI. Unlike pay<strong>in</strong>g for items <strong>and</strong> 

putt<strong>in</strong>g change <strong>in</strong> the wallet, the computerbased, 

video program required students to 

touch a photograph on the screen to <strong>in</strong>dicate 

which motor skill to perform next, however, 

students did not actually perform the motor 

task dur<strong>in</strong>g CBVI. Future research may exam<strong>in</strong>e 

use of simulation plus community-based 

<strong>in</strong>struction to teach skills requir<strong>in</strong>g specific 

motor responses not readily replicated 

through computer-based simulation. 

In addition, future research should evaluate 

CBVI to teach skills across more formal or 

complex restaurants. Additional skills such a 

social behaviors (e.g. us<strong>in</strong>g a napk<strong>in</strong>) <strong>and</strong> social 

communication skills (e.g., appropriately 

enter<strong>in</strong>g a conversation) should be <strong>in</strong>cluded 

thereby teach<strong>in</strong>g a cha<strong>in</strong> of <strong>in</strong>dependent skills 

needed with<strong>in</strong> restaurant <strong>and</strong> community sett<strong>in</strong>gs. 

When faced with limited ability to travel to 

community sett<strong>in</strong>gs to teach skills, <strong>and</strong> the 

need for repetitive practice, presentation of 

<strong>in</strong>struction through multimedia programs appears 

to be an effective means for replicat<strong>in</strong>g 

life-like scenarios with<strong>in</strong> a simulated, classroom 

environment. Of <strong>in</strong>terest will be the 

application of more advanced technology features 

as they become more readily available 

<strong>and</strong> <strong>in</strong>corporated <strong>in</strong>to special education programs. 

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Us<strong>in</strong>g a Personal Digital Assistant to Enhance the 

Independence of an Adolescent with Asperger Syndrome 

Heather Ferguson, Brenda Smith Myles, <strong>and</strong> Taku Hagiwara 

University of Kansas 

Abstract: The Personal Digital Assistant (PDA), while <strong>in</strong> use <strong>in</strong> the ma<strong>in</strong>stream population, is not generally 

utilized by <strong>in</strong>dividuals with disabilities. Us<strong>in</strong>g a multiple-basel<strong>in</strong>e design across sett<strong>in</strong>gs we tested effectiveness 

of us<strong>in</strong>g a PDA to <strong>in</strong>crease the <strong>in</strong>dependence of an adolescent with Asperger Syndrome (AS). Results <strong>in</strong>dicated 

use of the PDA was effective <strong>in</strong> decreas<strong>in</strong>g the student’s reliance on adults to complete tasks at home <strong>and</strong> at 

school. 

Accord<strong>in</strong>g to the Individuals with <strong>Disabilities</strong> 

<strong>Education</strong> Act Amendments of 1997 <strong>and</strong> the 

Technology-related Assistance for Individuals 

with <strong>Disabilities</strong> Act of 1988 as Amended <strong>in</strong> 

1994, school districts must provide technology 

<strong>and</strong> related services to support students with 

disabilities <strong>in</strong> the general education curriculum 

(Mirenda, Wilk, & Carson, 2000). This act 

<strong>in</strong>troduced assistive technology as a means of 

help<strong>in</strong>g <strong>in</strong>dividuals with disabilities overcome 

the obstacles that <strong>in</strong>hibit them from fully tak<strong>in</strong>g 

part <strong>in</strong> activities at school, home <strong>and</strong> the 

community, <strong>in</strong>clud<strong>in</strong>g enhanc<strong>in</strong>g tasks that 

<strong>in</strong>volve memory <strong>and</strong> organization skills 

(Bremer & Rauch, 1998; Bull, Bull, Garofalo, 

& Harris, 2002; Lewis, 1998, 2000). 

Assistive technology <strong>in</strong>cludes a variety of 

supports rang<strong>in</strong>g from augmentative communication 

devices to more commonly used 

desktop <strong>and</strong> laptop computers. One device 

that appears promis<strong>in</strong>g for students with disabilities 

is the PDA (Swan, Swan, & Van Hover, 

2002). The PDA, a h<strong>and</strong>held computer that 

ma<strong>in</strong>ly serves as a personal <strong>in</strong>formation organizer, 

allows data <strong>in</strong>put via an on-screen keyboard 

or h<strong>and</strong>writ<strong>in</strong>g recognition program us<strong>in</strong>g 

a stylus. With multimedia capabilities, it is 

capable of play<strong>in</strong>g both sound <strong>and</strong> video clips. 

Pictures <strong>and</strong> other visual representations are 


be addressed to Brenda Smith Myles, Department of 

Special <strong>Education</strong>, University of Kansas, Joseph R. 

Pearson Build<strong>in</strong>g, 5 th Floor, 1122 W. Campus Road, 

Lawrence, KS 66045-3101. E-mail: bmyles@ku.edu 


vivid <strong>and</strong> precise due, <strong>in</strong> part, to the highresolution 

color screens. In addition, the PDA 

can be hooked up to a computer to synchronize 

<strong>in</strong>formation <strong>and</strong> connected to network 

systems, <strong>in</strong>clud<strong>in</strong>g the Internet for exchang<strong>in</strong>g 

e-mails <strong>and</strong> explor<strong>in</strong>g the World Wide 

Web. In addition, portable keyboards can connect 

to the Pocket PC to create a discrete 

word-process<strong>in</strong>g system, enabl<strong>in</strong>g <strong>in</strong>formation 

such as names, addresses, phone numbers, 

dates, <strong>and</strong> personal schedules to be stored for 

easy access <strong>and</strong> retrieval. Schedul<strong>in</strong>g <strong>and</strong> time 

management programs are <strong>in</strong>cluded as default 

functions <strong>in</strong> the PDA (Lewis, 1998; Swan 

et al.). 

Despite their use <strong>in</strong> the ma<strong>in</strong>stream, few 

studies have been conducted on the impact of 

PDAs. Nevertheless, the follow<strong>in</strong>g has been 

established to date. For <strong>in</strong>dividuals without 

disabilities, the PDA has assisted students <strong>in</strong> 

organiz<strong>in</strong>g classroom notes <strong>and</strong> prepar<strong>in</strong>g for 

tests (Norris & Soloway, 2003). PDAs have also 

been used to support <strong>in</strong>dividuals with special 

needs <strong>in</strong> career <strong>and</strong> leisure activities (Furniss 

et al., 2001) <strong>and</strong> to <strong>in</strong>crease <strong>in</strong>dependence 

<strong>and</strong> self-determ<strong>in</strong>ation (Davies, Stock, & 

Wehmeyer, 2002). Davies et al. found that 

persons with disabilities who used PDAs functioned 

more <strong>in</strong>dependently, learned more, 

<strong>and</strong> required less assistance from support personnel. 

The purpose of this study was to add to the 

literature base on PDA use with students with 

special needs. Specifically, this study was designed 

to determ<strong>in</strong>e whether a PDA could

enhance the <strong>in</strong>dependence of an adolescent 

with AS at home <strong>and</strong> at school. 

Method 

Participant 

Kent, a Caucasian male <strong>in</strong> his f<strong>in</strong>al year of 

public middle school <strong>in</strong> the Midwestern 

United States was the participant. He was 14years 

old, <strong>and</strong> had a diagnosis of AS made by 

a medical professional us<strong>in</strong>g criterion <strong>in</strong> the 

Diagnostic <strong>and</strong> Statistical Manual of Mental 

Disorders – 4 th Edition (American Psychiatric 

Association, 1994). Kent’s <strong>in</strong>telligence quotient 

was <strong>in</strong> the above average range <strong>and</strong> his 

grades were average. He had considerable difficulty 

with his h<strong>and</strong>writ<strong>in</strong>g, f<strong>in</strong>d<strong>in</strong>g it both 

tiresome <strong>and</strong> tedious. 

A Behavior Assessment System for Children 

(Reynolds & Kamphaus, 1992) was adm<strong>in</strong>istered 

to Kent’s resource room teacher, his 

mother, <strong>and</strong> Kent himself. His teacher reported 

that Kent was rated “At-Risk” <strong>in</strong> Attention 

Problems, <strong>and</strong> was identified as “Cl<strong>in</strong>ically 

Significant” <strong>in</strong> Anxiety, Atypicality, <strong>and</strong> 

Withdrawal. Kent’s mother classified him as 

“At-Risk” <strong>in</strong> Hyperactivity, Anxiety, School 

Problems, Learn<strong>in</strong>g Problems, Withdrawal, 

Adaptive Skills, <strong>and</strong> Behavioral Symptom Index; 

he received “Cl<strong>in</strong>ically Significant” scores 

<strong>in</strong> Atypicality <strong>and</strong> Attention Problems. The 

discrepancy <strong>in</strong> responses between Kent’s 

teacher <strong>and</strong> mother appears consistent with 

other reports by educators <strong>and</strong> parents address<strong>in</strong>g 

the characteristics of a child with AS 

(Barnhill et al., 2000; Myles, Ferguson, & 

Hagiwara, 2003). Kent rated himself as “At- 

Risk” <strong>in</strong> Anxiety <strong>and</strong> Atypicality; other areas 

fell <strong>in</strong> “Average” or above ranges <strong>in</strong> his report. 

An Adolescent/Adult Sensory Profile 

(Brown & Dunn, 2002) was also completed by 

Kent. This measure <strong>in</strong>dicated that Kent 

avoided sensation much more than most people, 

was more sensitive to sensory stimuli than 

most people, <strong>and</strong> exhibited registration <strong>and</strong> 

sensory seek<strong>in</strong>g behaviors <strong>in</strong> a manner similar 

to most people. 


The study took place <strong>in</strong> Kent’s math <strong>and</strong> social 

studies classes, <strong>and</strong> <strong>in</strong> his home. Kent’s math 

<strong>in</strong>struction occurred <strong>in</strong> the resource room <strong>in</strong> 

a small group sett<strong>in</strong>g that <strong>in</strong>cluded two other 

students, <strong>and</strong> his social studies class was held 

<strong>in</strong> a general education classroom with 20 

other students. 

Target Behavior 

Kent relied heavily on prompts from his parents 

<strong>and</strong> teachers to complete his daily activities. 

Without multiple prompts from his 

mother to f<strong>in</strong>ish rout<strong>in</strong>e daily tasks, for example, 

Kent would become distracted <strong>and</strong> stop 

his rout<strong>in</strong>e. In school, Kent’s teachers 

prompted him to gather the appropriate materials 

before class, pay attention dur<strong>in</strong>g class, 

submit his homework, record his homework 

assignments, <strong>and</strong> transition to his next class. 

Kent needed to function more <strong>in</strong>dependently 

to complete rout<strong>in</strong>e daily tasks, especially as 

dem<strong>and</strong>s for greater <strong>in</strong>dependence <strong>in</strong>crease 

by age <strong>and</strong> grade level. Thus, the behavior 

targeted for this study was to <strong>in</strong>crease Kent’s 

<strong>in</strong>dependence dur<strong>in</strong>g morn<strong>in</strong>g home activities, 

school tasks, <strong>and</strong> even<strong>in</strong>g home activities 

by decreas<strong>in</strong>g his dependence on the adults <strong>in</strong> 

his life. 

Instruments 

A Hewlett Packard Jornada 560 Personal Digital 

Assistant (Hewlett-Packard, 2001) with Microsoft 

W<strong>in</strong>dows for Pocket PC Software 2002 

(Microsoft, 2002) was <strong>in</strong>troduced to <strong>in</strong>crease 

Kent’s <strong>in</strong>dependence when complet<strong>in</strong>g early 

morn<strong>in</strong>g, school, <strong>and</strong> even<strong>in</strong>g tasks. Kent, his 

mother, <strong>and</strong> resource room teacher received 

tra<strong>in</strong><strong>in</strong>g on the PDA. In essence, the PDA 

rema<strong>in</strong>ed the same as the product available to 

the general public. The calendar <strong>and</strong> alarm 

functions that are a part of the Microsoft W<strong>in</strong>dows 

for the Pocket PC were used <strong>in</strong> implement<strong>in</strong>g 

the <strong>in</strong>tervention. 

A data collection sheet was designed to outl<strong>in</strong>e 

the four morn<strong>in</strong>g tasks <strong>and</strong> desired times 

when Kent needed to complete each task every 

morn<strong>in</strong>g <strong>in</strong> his home. A second data sheet, 

created us<strong>in</strong>g the same format, listed four 

even<strong>in</strong>g activities. The data collection form 

listed each task <strong>and</strong> its start time on the left. 

Three additional columns on the right allowed 

Kent’s mother to <strong>in</strong>dicate (a) if he completed 

the task <strong>in</strong>dependently, (b) if he com- 

Pocket PC <strong>and</strong> Asperger Syndrome / 61

pleted the task with prompts, <strong>and</strong> (c) the time 

when the task was completed. Kent’s mother 

completed this form. A similar data sheet list<strong>in</strong>g 

six tasks dur<strong>in</strong>g social studies <strong>and</strong> math 

over a 50-m<strong>in</strong>ute period was used <strong>in</strong> the 

school sett<strong>in</strong>g <strong>and</strong> was completed by the first 

author. Figures 1, 2, <strong>and</strong> 3 present the morn<strong>in</strong>g, 

school, <strong>and</strong> even<strong>in</strong>g data sheets, respectively. 

Procedure 

A multiple-basel<strong>in</strong>e design across sett<strong>in</strong>gs was 

used to evaluate the effectiveness of us<strong>in</strong>g a 

Figure 1. Morn<strong>in</strong>g data collection sheet. 


PDA to improve the time management <strong>and</strong> 

task completion rate of a junior high student 

with AS. Sett<strong>in</strong>gs were morn<strong>in</strong>g tasks, school 

tasks, <strong>and</strong> even<strong>in</strong>g tasks. 

Dur<strong>in</strong>g the basel<strong>in</strong>e phase, Kent was given a 

list of tasks <strong>and</strong> associated times for the follow<strong>in</strong>g 

activities: (a) <strong>in</strong> the morn<strong>in</strong>g as he was 

gett<strong>in</strong>g ready for school; (b) at school dur<strong>in</strong>g 

math <strong>and</strong> social studies classes; <strong>and</strong> (c) <strong>in</strong> the 

even<strong>in</strong>g prior to go<strong>in</strong>g to bed. A task was 

considered completed <strong>in</strong>dependently if Kent 

f<strong>in</strong>ished the task with<strong>in</strong> two m<strong>in</strong>utes of the 

time listed on his task list. Each of these tasks 

were known to Kent prior to the study <strong>and</strong> had

een a part of the expected rout<strong>in</strong>e for several 

months. 

Dur<strong>in</strong>g the <strong>in</strong>tervention phases, an alarm 

was set on the PDA to alert Kent to start each 

of the targeted tasks. The alarm sounded audibly 

<strong>and</strong> also flashed visually. Kent’s mother 

recorded the number of morn<strong>in</strong>g tasks he 

completed <strong>in</strong>dependently with the support of 

his PDA, <strong>and</strong> the number of tasks that she 

needed to prompt him to complete, along 

with the time that each task was completed. 

The first author recorded the number of 

school tasks Kent completed <strong>in</strong>dependently 

with the support of his PDA, the number of 

tasks that he required prompts to complete, 

Figure 2. School data collection sheet. 

<strong>and</strong> the time that each task was completed. 

The number of tasks Kent completed <strong>in</strong>dependently 

was divided by the total number of 

tasks to arrive at a percent of tasks completed. 

Reliability 

Interobserver reliability, assessed on 20% of 

data days by Kent’s paraprofessional, was 

100%. 

Results 

As illustrated <strong>in</strong> Figure 4, dur<strong>in</strong>g basel<strong>in</strong>e, 

Kent completed 0% of his morn<strong>in</strong>g <strong>and</strong> 


even<strong>in</strong>g tasks <strong>in</strong>dependently, <strong>and</strong> 63% of his 

school tasks without prompts. Dur<strong>in</strong>g the <strong>in</strong>tervention 

phases, us<strong>in</strong>g the PDA as a primary 

prompt, Kent <strong>in</strong>dependently completed a 

mean of: 47% of morn<strong>in</strong>g tasks, 87% of school 

tasks, <strong>and</strong> 33% of his even<strong>in</strong>g tasks. The study 

was carried out over a 20-day period. Data 

were taken for 15 days at school because the 

school year ended. The break <strong>in</strong> the data l<strong>in</strong>es 

dur<strong>in</strong>g the morn<strong>in</strong>g <strong>and</strong> even<strong>in</strong>g activities on 

Day 15 represents the transition between the 

last day of school <strong>and</strong> the start of summer 

vacation. 


The purpose of this <strong>in</strong>vestigation was to determ<strong>in</strong>e 

if a PDA could assist an adolescent <strong>in</strong> 

complet<strong>in</strong>g home- <strong>and</strong> school-based tasks <strong>in</strong>dependently. 

Results should be <strong>in</strong>terpreted 

carefully with limitation considerations given 

Figure 3. Even<strong>in</strong>g data collection sheet. 

to the length of <strong>in</strong>tervention <strong>and</strong> use of s<strong>in</strong>glesubject 

design procedures. 

Conclusions 


Results of this study could, <strong>in</strong> part, be attributed 

to the novelty of the PDA. This device 

appeared to appeal to Kent <strong>and</strong> may have 

helped to ease the transition <strong>in</strong>to the <strong>in</strong>tervention. 

He quickly learned how to manipulate 

the PDA <strong>and</strong> required rem<strong>in</strong>ders to ma<strong>in</strong>ta<strong>in</strong> 

the sett<strong>in</strong>gs dur<strong>in</strong>g the <strong>in</strong>tervention phases 

<strong>and</strong> not “adjust” them. While Kent required 

little tra<strong>in</strong><strong>in</strong>g to use the PDA, by comparison, 

his teacher <strong>and</strong> mother experienced difficulty 

learn<strong>in</strong>g how to use the technology, even after 

multiple tra<strong>in</strong><strong>in</strong>g sessions. This is significant 

<strong>in</strong> that technology use <strong>in</strong> educational sett<strong>in</strong>gs 

can only be successful when adequate support 

provided (Mirenda et al., 2000). 

Kent’s data <strong>in</strong>dicate that generalization may 

have occurred across sett<strong>in</strong>gs. That is, <strong>in</strong>de-

Figure 4. Kent’s performance on complet<strong>in</strong>g tasks <strong>in</strong> morn<strong>in</strong>g, school, <strong>and</strong> even<strong>in</strong>g sett<strong>in</strong>gs. 


pendent task completion <strong>in</strong>creased dur<strong>in</strong>g 

basel<strong>in</strong>e <strong>in</strong> the third sett<strong>in</strong>g before the PDA 

was <strong>in</strong>troduced <strong>and</strong> after the <strong>in</strong>tervention had 

been <strong>in</strong>troduced <strong>in</strong> other sett<strong>in</strong>gs. This f<strong>in</strong>d<strong>in</strong>g 

appears consistent with the <strong>in</strong>vestigations 

by Bock (1994, 1999) who found a similar 

pattern of generalization when teach<strong>in</strong>g categorization 

strategies to students with autism 

spectrum disorders. 

Kent’s mother commented that dur<strong>in</strong>g the 

<strong>in</strong>tervention phase Kent checked the time the 

<strong>and</strong> announced, “Come on! It’s time to go [to 

school]!” This was significantly different from 

his mother’s prior reports that she had to 

cont<strong>in</strong>uously cajole <strong>and</strong> argue with her son to 

get him to leave the house to go to school on 

time each morn<strong>in</strong>g. In addition, Kent used his 

PDA to record his appo<strong>in</strong>tments <strong>and</strong> personal 

<strong>in</strong>formation. He also set his PDA so that an 

alarm sounded <strong>and</strong> a light at the top of the 

device flashed. The light <strong>and</strong> alarm would 

alert Kent to open the PDA, where his rem<strong>in</strong>der 

would be displayed visually on the 

screen. Perhaps, given Kent’s sensory issues, 

the stimulation of multiple senses allowed him 

to beg<strong>in</strong> his tasks <strong>in</strong>dependently (Dunn, 

Myles, & Orr, 2002). 

Similar to studies by Davies et al. (2002) <strong>and</strong> 

Norris <strong>and</strong> Soloway (2003), the PDA was effective 

<strong>in</strong> address<strong>in</strong>g a student’s target behavior. 

Although few studies have been conducted 

with PDAs, cautious optimism exists 

regard<strong>in</strong>g the use of this technology. In particular, 

the PDA <strong>and</strong> similar technology may 

be a viable tool for <strong>in</strong>dividuals with special 

needs. Positive aspects of palmtop computers 

<strong>in</strong>clude their portability, small size, <strong>and</strong> <strong>in</strong>creas<strong>in</strong>g 

popularity among the general public. 

Thus, the <strong>in</strong>conspicuous nature of the PDA 

allows users to support themselves <strong>in</strong> a variety 

of sett<strong>in</strong>gs without call<strong>in</strong>g attention to any 

additional differences. Use of this type of technology 

to render assistance to <strong>in</strong>dividuals with 

disabilities, <strong>in</strong>clud<strong>in</strong>g those with AS, may assist 

<strong>in</strong> <strong>in</strong>creased levels of participation <strong>in</strong> the community 

(Davies et al.; Norris & Soloway). 

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Us<strong>in</strong>g Simultaneous Prompt<strong>in</strong>g for Teach<strong>in</strong>g Various Discrete 

Tasks to Students with Mental Retardation 

Bunyam<strong>in</strong> Birkan 

Anadolu University 

Abstract: Effectiveness of a simultaneous prompt<strong>in</strong>g procedure was evaluated for students with mental 

retardation at different levels of schools (preschool, primary <strong>and</strong> secondary grades) us<strong>in</strong>g various discrete tasks. 

Participants <strong>in</strong>cluded three students whose function<strong>in</strong>g levels ranged from typically develop<strong>in</strong>g to mild <strong>and</strong> 

moderate mental disabilities. Effectiveness of a simultaneous prompt<strong>in</strong>g procedure was evaluated through use 

of a multiple probe design across behaviors <strong>and</strong> replicated across students. Results <strong>in</strong>dicated that the procedure 

was successful <strong>in</strong> teach<strong>in</strong>g targeted behaviors to all students. Students ma<strong>in</strong>ta<strong>in</strong>ed target behaviors at high rates 

up to 7, 18, <strong>and</strong> 25 weeks after tra<strong>in</strong><strong>in</strong>g <strong>and</strong> generalized responses across people, materials, <strong>and</strong> sett<strong>in</strong>gs. 

Limitations <strong>and</strong> implications for future research are discussed. 

Special educators strive for effective teach<strong>in</strong>g 

strategies that m<strong>in</strong>imize errors <strong>in</strong> education 

sett<strong>in</strong>gs (Gibson & Schuster, 1992; Tek<strong>in</strong> & 

Kircaali-Iftar, 2001) Several effective, near-errorless 

teach<strong>in</strong>g procedures used to teach children 

with disabilities a variety of skills dur<strong>in</strong>g 

the acquisition phase of learn<strong>in</strong>g have been 

discussed <strong>in</strong> the literature (Wolery, Ault, & 

Doyle, 1992) <strong>and</strong> <strong>in</strong>clude constant <strong>and</strong> progressive 

time delay. In addition to these procedures, 

simultaneous prompt<strong>in</strong>g (Gibson & 

Schuster) also results <strong>in</strong> low student error 

rates (Fetko, Schuster, Harley, & Coll<strong>in</strong>s, 

1999). 

Simultaneous prompt<strong>in</strong>g is a systematic 

form of the antecedent prompt <strong>and</strong> test procedure 

because all trials are conducted with 

zero second delays between the discrim<strong>in</strong>ative 

stimulus <strong>and</strong> the teacher’s prompt. However, 

simultaneous prompt<strong>in</strong>g procedures are different 

from antecedent prompt <strong>and</strong> test strategies 

<strong>in</strong> two dist<strong>in</strong>ct ways. First, when us<strong>in</strong>g 

simultaneous prompt<strong>in</strong>g, a controll<strong>in</strong>g 

prompt is always used. Antecedent prompt 

The author is grateful to Dr. Gonul Kircaali-Iftar, 

Director, Research Institute for the H<strong>and</strong>icapped, 

for her <strong>in</strong>sightful review <strong>and</strong> feedback, <strong>and</strong> to Gazi 

Acar, special education teacher, Research Institute 

for the H<strong>and</strong>icapped, for collect<strong>in</strong>g reliability data. 

Correspondence concern<strong>in</strong>g this article should be 

addressed to Bunyam<strong>in</strong> Birkan, Anadolu Universitesi, 

Engelliler Arastirma Enstitusu, 26470, Eskisehir, 

TURKEY. E-mail: bbirkan@anadolu.edu.tr 


<strong>and</strong> test procedures traditionally have not 

used controll<strong>in</strong>g prompt as evidenced by variable 

<strong>and</strong> sometimes high learner error rates 

(Gibson & Schuster, 1992; Schuster & Griffen, 

1993; Johnson, Schuster, & Bell, 1996). Second, 

when us<strong>in</strong>g antecedent prompt <strong>and</strong> test 

procedures, probe or test trials can occur at 

any po<strong>in</strong>t <strong>in</strong> time but usually have occurred 

immediately after tra<strong>in</strong><strong>in</strong>g trials <strong>in</strong> a modellead-test 

format (Wolery et al., 1992). The 

probe trials used dur<strong>in</strong>g simultaneous 

prompt<strong>in</strong>g always occur immediately prior to 

<strong>in</strong>struction. 

Accord<strong>in</strong>g to Schuster <strong>and</strong> Griffen (1993), 

when us<strong>in</strong>g simultaneous prompt<strong>in</strong>g, “A natural 

discrim<strong>in</strong>ative stimulus is presented <strong>and</strong> 

is followed immediately by a controll<strong>in</strong>g 

prompt. Learners then imitate the prompt. 

S<strong>in</strong>ce learners never have an <strong>in</strong>dependent opportunity 

to respond dur<strong>in</strong>g <strong>in</strong>structional trials, 

probe trials are conducted to assess the 

transfer of stimulus control from the controll<strong>in</strong>g 

prompt used dur<strong>in</strong>g <strong>in</strong>structional trials to 

the natural discrim<strong>in</strong>ative stimulus” (p. 300). 

Although not extensively researched like 

other <strong>in</strong>structional strategies appear<strong>in</strong>g <strong>in</strong> the 

literature, research has shown some examples 

of the effectiveness of simultaneous prompt<strong>in</strong>g 

<strong>in</strong> teach<strong>in</strong>g tasks to students with mild <strong>and</strong> 

moderate mental disabilities (Gibson & Schuster, 

1992; Schuster & Griffen). 

Though the number of studies report<strong>in</strong>g 

use of simultaneous prompt<strong>in</strong>g is limited, re-

search <strong>in</strong>dicates that it has been used successfully 

with elementary-aged students <strong>and</strong> preschoolers 

to teach both discrete <strong>and</strong> cha<strong>in</strong>ed 

tasks (Ault, Wolery, Gast, Doyle, & Mart<strong>in</strong>, 

1990; Dogan & Tek<strong>in</strong>-Iftar, 2002; Doyle, Gast, 

Wolery, Ault, & Meyer, 1992; S<strong>in</strong>gleton, Schuster, 

Morse, & Coll<strong>in</strong>s, 1999). 

Schuster, Griffen, <strong>and</strong> Wolery (1992) found 

simultaneous prompt<strong>in</strong>g to be slightly more 

efficient <strong>in</strong> teach<strong>in</strong>g elementary age students 

with moderate mental disabilities to identify 

grocery words expressively. In an efficiency 

study that has been reported to date, simultaneous 

prompt<strong>in</strong>g was found to be more efficient 

than constant time delay when the procedures 

were used to teach grocery sight 

words to elementary students with moderate 

mental retardation (Schuster et al., 1992). In 

the only study that has reported us<strong>in</strong>g simultaneous 

prompt<strong>in</strong>g to teach a cha<strong>in</strong>ed task, 

Schuster <strong>and</strong> Griffen (1993) found that the 

procedure was effective <strong>in</strong> teach<strong>in</strong>g four elementary 

students to make juice from frozen 

concentrate. S<strong>in</strong>gleton, Schuster, <strong>and</strong> Ault 

(1995) used simultaneous prompt<strong>in</strong>g to teach 

two elementary students with moderate retardation 

to expressively identify photographs of 

community signs (e.g., stop <strong>and</strong> exit) <strong>and</strong> <strong>in</strong>corporated 

<strong>in</strong>structive feedback about signs 

(e.g., ‘Exit means to go out’). Some of the 

<strong>in</strong>structive feedback was acquired by the participants. 

In addition, simultaneous prompt<strong>in</strong>g 

has been effective when teach<strong>in</strong>g sight 

word read<strong>in</strong>g to student with moderate mental 

retardation at the elementary (Griffen, 

Schuster, & Morse, 1998) as well as the high 

school level (S<strong>in</strong>gleton et al., 1999). 

Although limited <strong>in</strong> number, several studies 

have reported the effectiveness of simultaneous 

prompt<strong>in</strong>g when used <strong>in</strong> one-to-one 

arrangements to teach discrete tasks. Gibson 

<strong>and</strong> Schuster (1992) found simultaneous 

prompt<strong>in</strong>g to be effective <strong>in</strong> teach<strong>in</strong>g three of 

four preschool children with <strong>and</strong> without developmental 

delays, to read nouns that had 

been selected from storybooks. MacFarl<strong>and</strong>- 

Smith, Schuster, <strong>and</strong> Stevens (1993) taught 

three preschool children with developmental 

delays to identify fruits <strong>and</strong> vegetables, while 

Wolery, Holcombe, Werts, <strong>and</strong> Cipolloni 

(1993) used simultaneous prompt<strong>in</strong>g to teach 

five preschoolers with developmental delays to 

identify rebus symbols. Wolery et al. also <strong>in</strong>cluded 

classification <strong>in</strong>formation perta<strong>in</strong><strong>in</strong>g 

to the rebus symbols as <strong>in</strong>structive feedback, 

<strong>and</strong> found that participants acquired some of 

this <strong>in</strong>formation when simultaneous prompt<strong>in</strong>g 

was used. Tek<strong>in</strong> <strong>and</strong> Kircaali-Iftar (2002) 

found that both simultaneous prompt<strong>in</strong>g <strong>and</strong> 

constant time delay were effective but simultaneous 

prompt<strong>in</strong>g was more efficient than 

constant time delay <strong>in</strong> term of the number of 

tra<strong>in</strong><strong>in</strong>g errors <strong>and</strong> tra<strong>in</strong><strong>in</strong>g time through criterion 

<strong>in</strong> teach<strong>in</strong>g three preschoolers with developmental 

delays receptively identify<strong>in</strong>g animals. 

Dogan <strong>and</strong> Tek<strong>in</strong>-Iftar (2002) found 

that simultaneous prompt<strong>in</strong>g was effective <strong>in</strong> 

teach<strong>in</strong>g three preschoolers with developmental 

delays receptively identify<strong>in</strong>g occupations 

from picture cards. 

Students with mental retardation are likely 

to have different educational goals. No study 

was found that taught various tasks to each 

student <strong>in</strong> the same study us<strong>in</strong>g one to one 

<strong>in</strong>structional arrangement. Only two studies 

were located <strong>in</strong> which different stimuli were 

used to teach different tasks <strong>in</strong> a small group 

arrangement. In the first study (Brown & Holvoet, 

1982), one student was taught to open 

an envelope, remove an advertisement, <strong>and</strong> 

attach it to a cork board. A second student was 

taught to manually sign ‘picture’ when shown 

a photograph. In the second study (Fickel, 

Schuster, & Coll<strong>in</strong>s, 1998), one student was 

taught to identify expressively 12 unlabeled 

outl<strong>in</strong>es of states from maps of the United 

States. A second student was taught to verbally 

state the sums of six addition facts. A third 

student was taught to demonstrate the manual 

signs for six communication picture symbols. 

And a fourth student was taught to expressively 

identify 24 national flags. 

S<strong>in</strong>ce simultaneous prompt<strong>in</strong>g has been experimentally 

evaluated <strong>in</strong> only a limited number 

of <strong>in</strong>vestigations, the lack of research 

where subjects are taught various tasks, <strong>and</strong> 

absence of response prompt<strong>in</strong>g research with 

students with mental retardation, additional 

research is warranted (Dogan & Tek<strong>in</strong>-Iftar, 

2002; Gibson & Schuster, 1992; S<strong>in</strong>gleton et 

al., 1999; Tek<strong>in</strong> & Kircaali-Iftar, 2002). 

This study addresses three research questions: 

(a) Will simultaneous prompt<strong>in</strong>g be effective 

<strong>in</strong> teach<strong>in</strong>g different discrete tasks to 

three students with mental retardation for 

read<strong>in</strong>g sight words, receptively identify<strong>in</strong>g 

digit numbers, <strong>and</strong> tell<strong>in</strong>g time <strong>in</strong> hours, 

halves, <strong>and</strong> quarters? (b) Will students ma<strong>in</strong>- 

Simultaneous Prompt<strong>in</strong>g for Teach<strong>in</strong>g Discrete Tasks / 69

ta<strong>in</strong> the acquired tasks overtime? (c) Will students 

generalize the acquired tasks across people, 

materials, <strong>and</strong> sett<strong>in</strong>gs? 

Method 

Participants 

Three students referred to the developmental 

disabilities unit of the Research Institute for 

the H<strong>and</strong>icapped at Anadolu University, Turkey 

to enroll <strong>in</strong> a special education support 

service participated. They were <strong>in</strong>tegrated <strong>in</strong> 

regular education classrooms at various levels 

(preschool, primary, <strong>and</strong> secondary grades). 

Each student was taught a different discrete 

task us<strong>in</strong>g different stimuli. Students ranged 

<strong>in</strong> age from 6 to 13 years. No student received 

medication or had known sensory impairments 

that affected his or her participation. 

Erol was a six year four month old, male. He 

functioned <strong>in</strong> the mild range of mental retardation 

with an IQ score of 58 accord<strong>in</strong>g to the 

Stanford-B<strong>in</strong>et Intelligence Scale (SBIS). He 

was able to <strong>in</strong>itiate <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong> communication. 

He performed many gross motor <strong>and</strong> 

f<strong>in</strong>e motor skills of his age. He was able to 

perform most self-care skills <strong>in</strong>dependently. 

His weaknesses were <strong>in</strong> problem solv<strong>in</strong>g, acquir<strong>in</strong>g 

some concepts such as positions <strong>and</strong>, 

contrast. He attended a preschool program 

four days a week for four hours each day <strong>and</strong> 

was <strong>in</strong> a regular class with 16 other children. 

He attended morn<strong>in</strong>g sessions. 

Yunus was an eight year 10 month old, 

male. He had Down syndrome <strong>and</strong> functioned 

<strong>in</strong> the moderate range of mental retardation 

with an IQ score of 38 accord<strong>in</strong>g to the SBIS. 

Yunus’ strengths were his gross <strong>and</strong> f<strong>in</strong>e motor 

skills, performed most self-care skills <strong>in</strong>dependently. 

Areas of weaknesses <strong>in</strong>cluded receptive 

<strong>and</strong> expressive communication skills, social 

peer <strong>in</strong>teraction, <strong>and</strong> perceptual discrim<strong>in</strong>ation 

skills. He attended a primary school program 

five days a week for three hours each day 

<strong>and</strong> was <strong>in</strong> a regular class with 25 other children. 

He attended afternoon sessions. 

Yasem<strong>in</strong> was a 13 year 8 month old, female. 

She functioned <strong>in</strong> the moderate range of 

mental retardation with an SBIS IQ score of 

45. Her weaknesses <strong>in</strong>cluded vocational skills, 

communication skills, community skills, <strong>and</strong> 

social peer <strong>in</strong>teraction, while her strengths 

<strong>in</strong>cluded basic read<strong>in</strong>g, math, <strong>and</strong> money 

skills. She attended a secondary school program 

five days a week for three hours each day 

<strong>and</strong> was <strong>in</strong> a regular class with 30 other children. 

She attended morn<strong>in</strong>g sessions. 

Prerequisite skills were determ<strong>in</strong>ed through 

tra<strong>in</strong>er observation prior to <strong>in</strong>itiation of the 

study. Each student (a) could attend to a task 

for 10-15 m<strong>in</strong>, (b) possessed adequate visual 

acuity to see target words, numbers, <strong>and</strong> time 

on a clock when they were presented <strong>in</strong> their 

various forms, (c) possessed adequate auditory 

acuity to hear the discrim<strong>in</strong>ative stimulus, 

controll<strong>in</strong>g prompt, <strong>and</strong> praise statements, 

<strong>and</strong> (d) could verbally <strong>and</strong> physically imitate a 

teacher’s model. In addition, Yasem<strong>in</strong> named 

numbers 1 to 12, <strong>and</strong> named hour h<strong>and</strong> <strong>and</strong> 

m<strong>in</strong>ute h<strong>and</strong> of any clock. Secondary re<strong>in</strong>forcers 

also were identified for each student prior 

to the study. 

The author conducted all experimental sessions, 

<strong>and</strong> a special education teacher tra<strong>in</strong>ed 

<strong>in</strong> data collection procedures collected reliability 

data. 


All experimental sessions were conducted <strong>in</strong>dividually 

<strong>in</strong> a room (6 mX6m)located at 

the Research Institute for the H<strong>and</strong>icapped. 

Instruction was <strong>in</strong> a 1:1 arrangement. Tra<strong>in</strong>er 

<strong>and</strong> student sat face to face at a table. Sessions 

occurred on week days. 


A multiple probe design across behaviors <strong>and</strong> 

replicated across students was used to evaluate 

effectiveness of simultaneous prompt<strong>in</strong>g procedures. 

Experimental control is demonstrated 

when a change <strong>in</strong> the dependent variable 

occurred only after the <strong>in</strong>dependent 

variable was implemented <strong>in</strong> a time lagged 

fashion (Tawney, & Gast, 1984). 

General Procedures 


The tra<strong>in</strong>er used a simultaneous prompt<strong>in</strong>g 

procedure to teach students with mental retardation. 

Tasks for each student <strong>in</strong>itially <strong>in</strong>cluded 

three sets of stimuli. The tra<strong>in</strong>er conducted 

one session per day, which consisted of 

a daily probe session followed by the tra<strong>in</strong><strong>in</strong>g 

session. The maximum amount of time allocated 

for each session was about 10 m<strong>in</strong>. Ses-

sions were conducted week days after school 

hours for two students <strong>and</strong> dur<strong>in</strong>g school 

hours for one student. 

Screen<strong>in</strong>g <strong>and</strong> Task Selection 

Digit numbers, expressive words, <strong>and</strong> tell<strong>in</strong>g 

time <strong>in</strong> hours, halves, <strong>and</strong> quarters were selected 

for the follow<strong>in</strong>g reasons: (a) targeted 

stimuli <strong>in</strong>cluded the same task taught <strong>in</strong> <strong>in</strong>clusive 

classrooms, (b) ability to read digit numbers, 

expressive words, <strong>and</strong> tell<strong>in</strong>g time <strong>in</strong> 

hours, halves, <strong>and</strong> quarters facilitates <strong>in</strong>dependent 

life skills, (c) acquisition of targeted stimuli 

reduces negative attention from peers 

when <strong>in</strong> <strong>in</strong>clusive classrooms, <strong>and</strong> (d) each 

student’s IEP <strong>in</strong>cluded an objective for read<strong>in</strong>g 

digit numbers, <strong>and</strong> expressive words, <strong>and</strong> 

tell<strong>in</strong>g time. Screen<strong>in</strong>g procedures resulted <strong>in</strong> 

25 unknown words for Yunus, n<strong>in</strong>e digit numbers 

for Erol, <strong>and</strong> tell<strong>in</strong>g time <strong>in</strong> hours, halves, 

<strong>and</strong> quarters for Yasem<strong>in</strong>. 

The tra<strong>in</strong>er presented each potential item 

twice us<strong>in</strong>g a 1:1 format <strong>and</strong> recorded student 

responses as (a) correct, (b) <strong>in</strong>correct, or (c) 

no response. Length of the response <strong>in</strong>terval 

was 4 s follow<strong>in</strong>g the task direction <strong>and</strong> presentation 

of the stimulus. The tra<strong>in</strong>er praised 

correct responses <strong>and</strong> ignored <strong>in</strong>correct <strong>and</strong> 

no responses. Students received praise for attention 

on the average of every fourth response. 

At the end of each screen<strong>in</strong>g session, 

students chose a re<strong>in</strong>forcer (e.g., pretzel, 

c<strong>and</strong>y, cracker, sticker etc.). For each student, 

an item was targeted for <strong>in</strong>struction if <strong>in</strong>correct 

or no responses occurred <strong>in</strong> all screen<strong>in</strong>g 


Erol’s task was to identify whether or not he 

receptively identified digit numbers (i.e., 1-2- 

3-4-5-6-7-8-9) across three sets (i.e., three digit 

numbers per set). Erol’s teacher selected the 

task based on which curriculum-based skills he 

had not acquired <strong>in</strong> <strong>in</strong>clusive classroom. Each 

digit number was marked <strong>in</strong> red on Mat Book 

(Kilicoglu, Micozkadioglu, & Dede, 2001) 

used <strong>in</strong> <strong>in</strong>clusive classrooms for preschool 

grades. Screen<strong>in</strong>g for Erol consisted of present<strong>in</strong>g 

him with n<strong>in</strong>e digit numbers from Mat 

Book (as described above). N<strong>in</strong>e unknown 

digit numbers were r<strong>and</strong>omly assigned as target 

stimuli (three sets of three numbers). 

Yunus’ task was to expressively identify 20 

expressive words grouped across four sets 

(i.e., five expressive words per set). Yunus’ 

teacher selected the task based on which curriculum-based 

skills he had not acquired <strong>in</strong> 

<strong>in</strong>clusive classroom. Yunus had learned to recognize 

a few of the expressive words of Let’s 

Start Read<strong>in</strong>g (Dogan, Guden, & P<strong>in</strong>ar, 2001) 

used <strong>in</strong> <strong>in</strong>clusive classrooms for primary 

grades but not many other words. Screen<strong>in</strong>g 

for Yunus consisted of show<strong>in</strong>g him 20 flashcards 

(measur<strong>in</strong>g 8 cm by 12 cm) pr<strong>in</strong>ted 

approximately 3 cm high us<strong>in</strong>g a permanent 

black marker on <strong>in</strong>dex cards. N<strong>in</strong>e unknown 

expressive words (father, board, table, desk, 

w<strong>in</strong>dow, plot, sister, mother, door) were r<strong>and</strong>omly 

assigned as target stimuli (three sets of 

three words). 

Yasem<strong>in</strong>’s task was to verbally state time on 

a clock (three sets of five stimuli each) when 

presented with clock <strong>and</strong> hear<strong>in</strong>g the teacher 

state the position of hour h<strong>and</strong> <strong>and</strong> m<strong>in</strong>ute 

h<strong>and</strong> of the clock. The tra<strong>in</strong>er selected target 

behaviors of tell<strong>in</strong>g time for Yasem<strong>in</strong> at her 

teachers <strong>and</strong> parents request. Screen<strong>in</strong>g for 

Yasem<strong>in</strong> consisted of (a) present<strong>in</strong>g her with 

15 different time situations (one at a time) 

which were r<strong>and</strong>omly ordered (five stimuli of 

hours, five stimuli of halves, <strong>and</strong> five stimuli of 

quarters), (b) stat<strong>in</strong>g the position of the 

h<strong>and</strong>s <strong>and</strong> (c) ask<strong>in</strong>g to tell the time. 

Materials 

Instructional sessions required stimulus cards, 

<strong>and</strong> a clock. The tra<strong>in</strong>er selected target digit 

numbers for Erol from the Mat Book used <strong>in</strong> 

<strong>in</strong>clusive classrooms for preschool grades. 

Digit numbers were pr<strong>in</strong>ted approximately 7 

cm high us<strong>in</strong>g a permanent black marker on 

<strong>in</strong>dex cards measur<strong>in</strong>g 10 cm by 15 cm. The 

tra<strong>in</strong>er selected target expressive words for 

Yunus from the Let’s Start Read<strong>in</strong>g Book to learn 

read<strong>in</strong>g <strong>and</strong> writ<strong>in</strong>g used <strong>in</strong> <strong>in</strong>clusive classrooms 

for primary grades. Words were pr<strong>in</strong>ted 

approximately 3 cm high us<strong>in</strong>g a permanent 

black marker on <strong>in</strong>dex cards measur<strong>in</strong>g 8 cm 

by 12 cm. The tra<strong>in</strong>er selected a clock with a 

diameter of 19 cm <strong>and</strong> hour numbers pr<strong>in</strong>ted 

2 cm high us<strong>in</strong>g a permanent black marker, 

<strong>and</strong> with the m<strong>in</strong>ute h<strong>and</strong> turn<strong>in</strong>g just like a 

real clock. 

Full Probe Conditions 

Prior to <strong>in</strong>struction, the teacher conducted a 

m<strong>in</strong>imum of three full probe sessions (a full 


probe condition) with each student across all 

stimulus sets <strong>in</strong> the task us<strong>in</strong>g the 1:1 <strong>in</strong>struction 

format. He presented each item three 

times <strong>in</strong> r<strong>and</strong>om order for a total of 353 trials 

dur<strong>in</strong>g <strong>in</strong>itial full probe conditions (93 trials 

for Erol, 95 trials for Yunus, 165 trials for 

Yasem<strong>in</strong>). The teacher secured the student’s 

attention, presented the stimulus followed by 

the task direction, <strong>and</strong> waited 4sforaresponse. 

If the student responded correctly, 

the teacher delivered praise <strong>in</strong> the form of 

smil<strong>in</strong>g, nodd<strong>in</strong>g affirmatively, <strong>and</strong> say<strong>in</strong>g 

“yes” or “good.” The teacher waited an <strong>in</strong>ter 

trial-<strong>in</strong>terval of 4 s <strong>and</strong> presented the next 

stimulus. If the student did not respond or 

responded <strong>in</strong>correctly, the teacher waited the 

<strong>in</strong>ter-trial <strong>in</strong>terval <strong>and</strong> presented the next 

stimulus. Student attention was praised on a 

VR4 schedule. The teacher offered a tangible 

re<strong>in</strong>forcement (e.g., pretzel, c<strong>and</strong>y, cracker, 

or sticker etc.) at the end of each probe session. 

Full probe conditions also occurred after 

each student reached criterion on each stimulus 

set. These full probe sessions were conducted 

<strong>in</strong> the 1:1 <strong>in</strong>struction format. Intervention 

cont<strong>in</strong>ued when data trend for the 

untra<strong>in</strong>ed sets was stable. 

Daily Probe Sessions 

The tra<strong>in</strong>er conducted a daily probe session 

immediately prior to every tra<strong>in</strong><strong>in</strong>g session to 

assess acquisition of stimuli currently be<strong>in</strong>g 

tra<strong>in</strong>ed. Daily probe sessions began when 

basel<strong>in</strong>e data for all students were stable. The 

tra<strong>in</strong>er used the same format as described for 

full probe sessions. Each student received one 

trial per stimulus item. Data collected dur<strong>in</strong>g 

daily probe sessions were used to determ<strong>in</strong>e 

when each set met criterion (80% accuracy for 

three days). 

Instructional Procedures 

The tra<strong>in</strong>er used a simultaneous prompt<strong>in</strong>g 

procedure dur<strong>in</strong>g <strong>in</strong>struction sessions. One 

<strong>in</strong>structional session occurred each day immediately 

follow<strong>in</strong>g daily probe session. Each student 

was taught a different task with each task 

consist<strong>in</strong>g of three to five sets of stimuli. Student 

attention was praised on a VR4 schedule. 

The maximum time allocated for each <strong>in</strong>struction 

session was 5 to 10 m<strong>in</strong>. At the end of 


each session, students received descriptive 

praise for participat<strong>in</strong>g <strong>and</strong> were allowed to 

choose a re<strong>in</strong>forcer. 

Each digit number for Erol received three 

trials for a total of n<strong>in</strong>e trials per session. A 

trial began with the teacher secur<strong>in</strong>g attention 

by say<strong>in</strong>g, “Hi Erol, we are together aga<strong>in</strong> to 

study numbers. Are you ready?” The tra<strong>in</strong>er 

then placed the stimulus cards on the table <strong>in</strong> 

front of Erol <strong>and</strong> said, “Name the red number?” 

<strong>and</strong> immediately provided the answer 

(i.e., the controll<strong>in</strong>g prompt). If Erol responded 

correctly with<strong>in</strong> 4 s, the tra<strong>in</strong>er said, 

“Yes, that is great” <strong>and</strong> went to the next trial. 

No responses or <strong>in</strong>correct responses resulted 

<strong>in</strong> the tra<strong>in</strong>er repeat<strong>in</strong>g the question <strong>and</strong> provid<strong>in</strong>g 

the prompt a second time. <strong>Tra<strong>in</strong><strong>in</strong>g</strong> 

sessions cont<strong>in</strong>ued until Erol reached 100% 

correct respond<strong>in</strong>g <strong>in</strong> three consecutive daily 

probe sessions. 

The same <strong>in</strong>structional procedures were 

used for teach<strong>in</strong>g Yunus words. Yunus received 

three trials on each word for a total of 

n<strong>in</strong>e trials per session. Yunus’ trials began with 

the teacher secur<strong>in</strong>g attention by say<strong>in</strong>g, “It is 

time to learn some words Yunus. Are you 

ready?” After receiv<strong>in</strong>g an affirmative answer 

the tra<strong>in</strong>er placed the stimulus cards on the 

table <strong>in</strong> front of Yunus. The teacher said, 

“Show me, which one is the door?” <strong>and</strong> immediately 

provided the answer (i.e., the controll<strong>in</strong>g 

prompt). If Yunus responded correctly 

with<strong>in</strong> 4 s the tra<strong>in</strong>er said “Yes, that is great” 

<strong>and</strong> went to the next trial. No responses or 

<strong>in</strong>correct responses resulted <strong>in</strong> the tra<strong>in</strong>er repeat<strong>in</strong>g 

the question <strong>and</strong> provid<strong>in</strong>g the 

prompt a second time. <strong>Tra<strong>in</strong><strong>in</strong>g</strong> sessions cont<strong>in</strong>ued 

until the Yunus reached 100% correct 

respond<strong>in</strong>g <strong>in</strong> three consecutive daily probe 


Yasem<strong>in</strong> received two trials per stimulus 

item for a total 10 trials per session (five different 

time situations were r<strong>and</strong>omly assigned 

for each <strong>in</strong>structional session of each stimulus 

set). Yasem<strong>in</strong>’s trials began with the teacher 

secur<strong>in</strong>g attention by say<strong>in</strong>g, “Well Yasem<strong>in</strong>, 

are you ready to learn tell<strong>in</strong>g time?” He then 

presented the stimulus time on the clock <strong>and</strong> 

said, “What time is it?” <strong>and</strong> immediately provided 

the answer. When Yasem<strong>in</strong> responded 

correctly, the teacher provided verbal confirmation. 

<strong>Tra<strong>in</strong><strong>in</strong>g</strong> sessions cont<strong>in</strong>ued until 

Yasem<strong>in</strong> reached 100% correct respond<strong>in</strong>g <strong>in</strong> 

three consecutive daily probe sessions.

Ma<strong>in</strong>tenance Probe Procedures 

Ma<strong>in</strong>tenance probe sessions on targeted tasks 

were built <strong>in</strong>to the full probe sessions that 

occurred <strong>in</strong> the multiple probe design. Each 

time a set of stimuli reached criterion, ma<strong>in</strong>tenance 

data were collected on the previously 

tra<strong>in</strong>ed sets. In addition, us<strong>in</strong>g a 1:1 format as 

described for screen<strong>in</strong>g sessions, ma<strong>in</strong>tenance 

probe sessions also occurred 7, 18, <strong>and</strong> 25 days 

after the f<strong>in</strong>al set of stimuli for each student 

reached criterion. These sessions occurred <strong>in</strong> 

an identical format to screen<strong>in</strong>g sessions. 

Generalization Probe Procedures 

The <strong>in</strong>clusive classroom teacher conducted 

generalization probe sessions prior to the <strong>in</strong>itial 

full probe condition <strong>and</strong> follow<strong>in</strong>g all 

tra<strong>in</strong><strong>in</strong>g. These sessions occurred <strong>in</strong> the <strong>in</strong>clusive 

classrooms <strong>and</strong> stimulus cards <strong>and</strong> objectives 

used dur<strong>in</strong>g these sessions were different 

<strong>in</strong> color or size from those used dur<strong>in</strong>g <strong>in</strong>struction. 

Moreover, the targeted behaviors 

were required from students by their teachers 

<strong>in</strong> <strong>in</strong>clusive classrooms. 

Reliability 

Dependent <strong>and</strong> <strong>in</strong>dependent variable reliability 

data were collected on at least 30% of daily 

<strong>and</strong> full probe sessions, <strong>and</strong> <strong>in</strong>structional session; 

50% of ma<strong>in</strong>tenance <strong>and</strong> generalization 

probe sessions by reliability observers. The 

tra<strong>in</strong>er used the po<strong>in</strong>t-by-po<strong>in</strong>t method to calculate 

the dependent measure reliability. 

Number of agreements was divided by number 

of agreements plus disagreements <strong>and</strong> 

multiplied by 100 (Tawney, & Gast, 1984). 

The tra<strong>in</strong>er calculated <strong>in</strong>dependent variable 

reliability by divid<strong>in</strong>g number of teacher 

behaviors observed by number of teacher 

behaviors planned <strong>and</strong> multiply<strong>in</strong>g by 100 

(Bill<strong>in</strong>gsley, White, & Munson, 1980). Independent 

variable reliability measured the follow<strong>in</strong>g 

teacher behaviors, when appropriate: 

(a) hav<strong>in</strong>g materials ready, (b) provid<strong>in</strong>g an 

attentional cue, (c) present<strong>in</strong>g the stimulus 

card or object, (d) deliver<strong>in</strong>g the prompt, (e) 

wait<strong>in</strong>g 4 s, (f) deliver<strong>in</strong>g correct consequences, 

(g) provid<strong>in</strong>g attentional praise on 

the correct schedule, <strong>and</strong> (h) wait<strong>in</strong>g the <strong>in</strong>ter-trial 

<strong>in</strong>terval. 

Results 

Reliability 

Reliability data <strong>in</strong>dicated 100% agreement 

dur<strong>in</strong>g full probe sessions, 90% (range 87- 

100) agreement dur<strong>in</strong>g daily probe sessions, 

100% agreement dur<strong>in</strong>g generalization, <strong>and</strong> 

80% (range 77-100) agreement dur<strong>in</strong>g 

ma<strong>in</strong>tenance probe sessions on the dependent 

variable. 

Independent variable reliability data collected 

dur<strong>in</strong>g probe sessions <strong>in</strong>dicated that 

the teacher implemented the behaviors with 

an overall mean accuracy of 100%. Independent 

variable reliability data collected dur<strong>in</strong>g 

tra<strong>in</strong><strong>in</strong>g sessions <strong>in</strong>dicated that the teacher 

implemented the procedures appropriately 

with an overall mean accuracy of 100%. 

Effectiveness 

Percentage of correct responses to targeted 

stimuli dur<strong>in</strong>g probe (basel<strong>in</strong>e, full, daily, <strong>and</strong> 

ma<strong>in</strong>tenance) sessions for each of the three 

students are shown <strong>in</strong> Figures 1, 2, <strong>and</strong> 3, 

respectively. Open circles represent percentage 

of correct respond<strong>in</strong>g dur<strong>in</strong>g full probe 

<strong>and</strong> <strong>in</strong>structional sessions, ma<strong>in</strong>tenance <strong>and</strong> 

generalization session. All subjects met criteria 

after <strong>in</strong>troduction of simultaneous prompt<strong>in</strong>g. 

These data revealed that simultaneous 

prompt<strong>in</strong>g was effective <strong>in</strong> teach<strong>in</strong>g different 

discrete tasks to children with mental retardation 

<strong>in</strong> <strong>in</strong>clusive classrooms. 

Instructional data for each student, number 

of tra<strong>in</strong><strong>in</strong>g sessions, number of tra<strong>in</strong><strong>in</strong>g trials, 

number <strong>and</strong> percentage of tra<strong>in</strong><strong>in</strong>g errors, 

amount of tra<strong>in</strong><strong>in</strong>g time, amount of daily 

probe time, <strong>and</strong> number <strong>and</strong> percentage of 

probe errors are shown <strong>in</strong> Table 1. 

Ma<strong>in</strong>tenance Data 

Ma<strong>in</strong>tenance probe sessions were built <strong>in</strong>to 

the study by us<strong>in</strong>g a multiple probe design. 

This allowed monitor<strong>in</strong>g the acquired stimuli 

throughout the study dur<strong>in</strong>g full probe conditions. 

Ma<strong>in</strong>tenance data also were collected 

7, 18, <strong>and</strong> 25 days follow<strong>in</strong>g the f<strong>in</strong>al full 

probe sessions. These data are <strong>in</strong>cluded <strong>in</strong> 

Figures 1-3. Students responded to targeted 

stimuli with a mean 100% dur<strong>in</strong>g the 7, 18, 

<strong>and</strong> 25 days ma<strong>in</strong>tenance probe sessions. 


Figure 1. Number of correct responses for Erol dur<strong>in</strong>g full, daily, ma<strong>in</strong>tenance <strong>and</strong> generalization probe 

sessions. Closed circles represent daily probe, full probe, <strong>and</strong> ma<strong>in</strong>tenance probe data, <strong>and</strong> open 

circles represent generalization probe data. 

Generalization Data 

Generalization probe data were collected on 

students’ performance across different people, 

stimuli, <strong>and</strong> sett<strong>in</strong>gs before <strong>and</strong> after 

tra<strong>in</strong><strong>in</strong>g. Before <strong>in</strong>struction, students were 

given a generalization pre-test. Dur<strong>in</strong>g the 

pre-test students could not identify their targeted 

stimuli. After <strong>in</strong>struction, all students 

responded with 100% accuracy on all stimulus 

sets dur<strong>in</strong>g post-test for generalization probe 

session. 



The purpose of this study was to assess the 

effectiveness of simultaneous prompt<strong>in</strong>g for

Figure 2. Number of correct responses for Yunus dur<strong>in</strong>g full, daily, ma<strong>in</strong>tenance <strong>and</strong> generalization probe 



teach<strong>in</strong>g various tasks to students with mental 

retardation. In addition, ma<strong>in</strong>tenance <strong>and</strong> 

generalization of the targeted stimuli were assessed. 

Several conclusions can be drawn from 

the results of this study. 

First, simultaneous prompt<strong>in</strong>g was effective 

<strong>in</strong> teach<strong>in</strong>g various tasks to students with mental 

retardation. All students acquired their targeted 

stimuli with<strong>in</strong> 93 tra<strong>in</strong><strong>in</strong>g sessions (con- 

ducted over a period of 2 months) <strong>and</strong> 

ma<strong>in</strong>ta<strong>in</strong>ed the behaviors up to 7, 18, <strong>and</strong> 25 

days with 100% accuracy. Data collected dur<strong>in</strong>g 

pretests <strong>and</strong> posttests <strong>in</strong>dicated that students 

generalized their acquired behaviors 

across persons, sett<strong>in</strong>gs, <strong>and</strong> materials with 

100% accuracy. Previous studies have used simultaneous 

prompt<strong>in</strong>g with preschoolers 

(Dogan & Tek<strong>in</strong>-Iftar, 2002; Gibson & Schus- 


Figure 3. Number of correct responses for Yasem<strong>in</strong> dur<strong>in</strong>g full, daily, ma<strong>in</strong>tenance <strong>and</strong> generalization probe 



ter, 1992; MacFarl<strong>and</strong> et al., 1993; Tek<strong>in</strong> & 

Kircaali-Iftar, 2002; Wolery et al., 1993), elementary 

students (Schuster et al., 1992; Schuster 

& Griffen, 1993; S<strong>in</strong>gleton et al., 1995) <strong>and</strong> 

high school students (Johnson et al., 1996). 

S<strong>in</strong>ce this study was conducted with preschool 

<strong>and</strong> elementary students for teach<strong>in</strong>g discrete 

tasks, the f<strong>in</strong>d<strong>in</strong>gs of the study extend the 

current literature about simultaneous prompt- 


<strong>in</strong>g procedure when students’ levels of schools 

are taken <strong>in</strong>to consideration. In addition, 

these f<strong>in</strong>d<strong>in</strong>gs, taken with those from previous 

on simultaneous prompt<strong>in</strong>g, <strong>in</strong>dicate that the 

procedure is easy to use (e.g., Gibson & Schuster). 

Thus, it may have broad application <strong>in</strong>clusive 

sett<strong>in</strong>gs <strong>in</strong> early <strong>and</strong> elementary education 

contexts (Wolery et al., 1993). 

Second, students were taught several tasks

TABLE 1 

Instructional Data for Each Student <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> Set Through Criterion 

Student/Set 

No. 

tra<strong>in</strong><strong>in</strong>g 

sessions 

No. 


trials 

No. 


errors 

<strong>in</strong> the same study. Only one other study was 

located that taught more than one tasks us<strong>in</strong>g 

different stimuli to a small group of students 

(Fickel et al., 1998). Us<strong>in</strong>g different prompts 

(i.e., verbal <strong>and</strong> manual) across students is 

also an additional contribution. Accord<strong>in</strong>g to 

Fickel et al., “This is important given the trend 

toward the use of <strong>in</strong>clusive sett<strong>in</strong>gs with students 

with disabilities. This trend will require 

students to learn <strong>in</strong> more heterogeneous sett<strong>in</strong>gs 

<strong>and</strong> group will place dem<strong>and</strong>s on teachers 

for teach<strong>in</strong>g diverse students with<strong>in</strong> the 

same <strong>in</strong>structional group” (p. 239). 

Third, several reasons may exist for conduct<strong>in</strong>g 

research <strong>in</strong> which effective <strong>and</strong> systematic 

strategies are exam<strong>in</strong>ed for teach<strong>in</strong>g 

students with mental retardation <strong>in</strong> <strong>in</strong>clusive 

classrooms. Almost all teachers want to: (a) 

teach their students with maximum effectiveness 

<strong>in</strong> a m<strong>in</strong>imum amount of time, (b) overcome 

barriers for children who have diverse 

learn<strong>in</strong>g needs, (c) teach different concepts 

<strong>and</strong> skills, <strong>and</strong> (d) avoid teach<strong>in</strong>g different 

k<strong>in</strong>ds of tasks with different stimuli across students 

with vary<strong>in</strong>g cognitive abilities because 

of perceived difficulty. However, our <strong>in</strong>dependent 

variable reliability data <strong>in</strong>dicated that the 

tra<strong>in</strong>er implemented the required teacher behaviors 

with a high degree of accuracy. Whatever 

the reason, as more students with mental 

% 


errors 

<strong>Tra<strong>in</strong><strong>in</strong>g</strong> time 

(m<strong>in</strong>:sec) 

Daily probe 

time 

(m<strong>in</strong>:sec) 

No. of 

Probe 

errors 

% probe 

errors 

Erol 

1 15 45 0 0 135 m<strong>in</strong> 18 s 45 m<strong>in</strong> 05 s 17 37 



Total 31 93 0 0 280 m<strong>in</strong> 18 s 93 m<strong>in</strong> 25 s 31 33 

Yunus 





Yasem<strong>in</strong> 





Gr<strong>and</strong> Total 93 353 0 0 831 m<strong>in</strong> 36 s 324 m<strong>in</strong> 45 s 127 35 

retardation, especially those with low <strong>in</strong>cidence 

disabilities, move <strong>in</strong>to heterogeneous 

<strong>and</strong> <strong>in</strong>clusive classroom sett<strong>in</strong>gs for <strong>in</strong>structional 

purposes, additional research will be 

needed to guide the <strong>in</strong>structional efforts of 

classroom teachers <strong>and</strong> paraprofessionals 

(Fickel et al., 1998). 

Fourth, amount of time that is spent on 

daily probe sessions must be considered when 

implement<strong>in</strong>g a simultaneous prompt<strong>in</strong>g procedure. 

In this study, simultaneous prompt<strong>in</strong>g 

<strong>in</strong>volved high probe time to criterion. However, 

this <strong>in</strong>structional procedure resulted <strong>in</strong> 

high student performance dur<strong>in</strong>g ma<strong>in</strong>tenance 

<strong>and</strong> generalization probe sessions as it 

was <strong>in</strong> other studies with simultaneous 

prompt<strong>in</strong>g (e.g., S<strong>in</strong>gleton et al., 1999). S<strong>in</strong>ce 

a major goal of education for students is to 

ma<strong>in</strong>ta<strong>in</strong> <strong>and</strong> generalize acquired behaviors, 

the additional probe time that may be associated 

with simultaneous prompt<strong>in</strong>g may be defensible. 

However, additional research is 

needed before def<strong>in</strong>itive statements can be 

made (S<strong>in</strong>gleton et al.,). 

F<strong>in</strong>ally, the students with mild <strong>and</strong> moderate 

disabilities are believed to have benefited 

from this <strong>in</strong>struction. Although they had no 

history with simultaneous prompt<strong>in</strong>g procedure, 

they acquired <strong>and</strong> generalized all of 

their targeted <strong>in</strong>formation <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed 


the acquisitions with 100% accuracy. In addition, 

some <strong>in</strong>appropriate behaviors often observed 

dur<strong>in</strong>g <strong>in</strong>struction <strong>in</strong> <strong>in</strong>clusive classrooms 

(e.g., be<strong>in</strong>g off-task, non compliance, 

<strong>and</strong> aggression toward others) did not occur 

dur<strong>in</strong>g this study. The subjects were observed 

to smile, cooperate, <strong>and</strong> participate appropriately 

throughout the study. Future research 

should assess levels of <strong>in</strong>appropriate behaviors 

exhibited by students when engaged <strong>in</strong> various 

group <strong>and</strong> one-to-one <strong>in</strong>struction arrangements 

as well as with various <strong>in</strong>structional 

strategies (e.g., simultaneous prompt<strong>in</strong>g, 

model-lead-test, system of least prompts) <strong>and</strong> 

techniques (e.g., active versus passive error 

correction procedures). 

Although results of this study were positive, 

data should be viewed cautiously s<strong>in</strong>ce several 

limitations exist. First, there are several arguments 

aga<strong>in</strong>st one-to-one <strong>in</strong>struction provided 

out of <strong>in</strong>clusive classrooms such as removal of 

students from the regular classroom for certa<strong>in</strong> 

periods, <strong>and</strong> difficulties <strong>in</strong> provid<strong>in</strong>g coord<strong>in</strong>ation 

between resource room <strong>and</strong> regular 

classroom (All<strong>in</strong>gton & Johnston, 1989; 

Kircaali-Iftar, 1992; Reisberg & Wolf, 1986; 

Ste<strong>in</strong>, Le<strong>in</strong>hardt, & Bickel, 1989). Second, although 

all tasks taught <strong>in</strong> this study were discrete 

tasks, they have different forms. Therefore, 

these skills may require different 

learn<strong>in</strong>g abilities. Third, <strong>in</strong>struction was delivered 

<strong>in</strong> a room that is not located <strong>in</strong> the 

students’ schools. Fourth, a high rate of probe 

errors occurred <strong>in</strong> the study. This is consistent 

with other studies us<strong>in</strong>g simultaneous prompt<strong>in</strong>g 

procedures (Gibson & Schuster, 1992; 

Griffen et al., 1998; Schuster et al., 1992; S<strong>in</strong>gleton 

et al., 1995; Fickel et al., 1998). On the 

other h<strong>and</strong>, no tra<strong>in</strong><strong>in</strong>g error occurred dur<strong>in</strong>g 

tra<strong>in</strong><strong>in</strong>g with all students; whereas 33% 

errors occurred dur<strong>in</strong>g daily probe sessions 

with Erol, 26% errors occurred dur<strong>in</strong>g daily 

probe sessions with Yunus, <strong>and</strong> 43% errors 

occurred dur<strong>in</strong>g daily probe sessions with 

Yasem<strong>in</strong>. These f<strong>in</strong>d<strong>in</strong>g are consistent with 

f<strong>in</strong>d<strong>in</strong>g of previous studies (e.g., S<strong>in</strong>gleton et 

al., 1999). Future research may assess effects 

of <strong>in</strong>termittent daily probe sessions on acquisition 

of the target behaviors. Additionally, 

provid<strong>in</strong>g corrective feedback <strong>in</strong> the consequent 

event dur<strong>in</strong>g these daily probe sessions 

may decrease error rates currently found. 

In conclusion, results suggest the possibility 

of further research with students across <strong>in</strong>tel- 

lectual function<strong>in</strong>g levels. This is particularly 

important as the trend <strong>in</strong> education moves 

towards more <strong>in</strong>clusive sett<strong>in</strong>gs. Teachers <strong>in</strong> 

<strong>in</strong>clusion classes are expected to be responsible 

for teach<strong>in</strong>g many skills to more than one 

child with differ<strong>in</strong>g diagnoses. In this case, 

this study can be replicated with small <strong>and</strong> 

large group arrangement to help teachers 

<strong>and</strong> observational learn<strong>in</strong>g can be <strong>in</strong>vestigated. 

In addition, similar skills can be exam<strong>in</strong>ed 

us<strong>in</strong>g the effectiveness of different 

teach<strong>in</strong>g methods. Moreover, although simultaneous 

prompt<strong>in</strong>g has been compared to 

other <strong>in</strong>structional procedures when teach<strong>in</strong>g 

discrete tasks (i.e., Schuster et al., 1992), the 

effects <strong>and</strong> efficiency of the simultaneous 

prompt<strong>in</strong>g procedure should be compared to 

other strategies (e.g., progressive time delay, 

constant time delay, system of least prompts, 

etc.) with various discrete tasks so that teachers 

can provide the most appropriate <strong>in</strong>struction 

possible to students (Parrott, Schuster, 

Coll<strong>in</strong>s, & Gassaway, 2000). 

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Improv<strong>in</strong>g Feed<strong>in</strong>g Skills <strong>and</strong> Mealtime Behaviors <strong>in</strong> Children 

<strong>and</strong> Youth with <strong>Disabilities</strong> 

Rita L. Bailey <strong>and</strong> Maureen E. Angell 

Ill<strong>in</strong>ois State University 

Abstract: A s<strong>in</strong>gle-subject multiple treatment design counterbalanced across n<strong>in</strong>e participants with moderate to 

severe <strong>and</strong> multiple disabilities was used to determ<strong>in</strong>e the efficacy of a school-based multi-treatment package (a 

comb<strong>in</strong>ed dysphagia treatment <strong>and</strong> positive re<strong>in</strong>forcement behavior management program) for children <strong>and</strong> 

youth (ages 4-17) with feed<strong>in</strong>g problems as compared to use of a dysphagia treatment program or a positive 

re<strong>in</strong>forcement behavior management program alone. While results found improvement <strong>in</strong> development of feed<strong>in</strong>g 

skills <strong>and</strong> positive mealtime behaviors with all <strong>in</strong>tervention programs, the comb<strong>in</strong>ed <strong>in</strong>tervention package was 

the most effective <strong>in</strong>tervention strategy. These results may help professionals establish best practices for treatment 

of feed<strong>in</strong>g problems <strong>in</strong> schools. 

Problematic mealtime behaviors are a common 

f<strong>in</strong>d<strong>in</strong>g <strong>in</strong> children diagnosed with feed<strong>in</strong>g 

<strong>and</strong>/or swallow<strong>in</strong>g problems collectively 

known as dysphagia (Arvedson, 1997; Kerw<strong>in</strong>, 

1999; Logemann, 2000; Munk & Repp, 1994). 

These behaviors may develop for a variety of 

reasons <strong>and</strong> range from those that are socially 

<strong>in</strong>appropriate to those that have a detrimental 

effect on nutrition <strong>and</strong> health. These challenges 

often make mealtimes unpleasant. 

Many problems that children experience <strong>in</strong> 

the areas of feed<strong>in</strong>g, growth, <strong>and</strong> food acceptance 

have been attributed to a comb<strong>in</strong>ation 

of the medical or physical condition of the 

child, <strong>in</strong>appropriate food selection, <strong>and</strong>/or 

<strong>in</strong>appropriate dynamics dur<strong>in</strong>g feed<strong>in</strong>g (Satter, 

1990). Inappropriate caregiver-child <strong>in</strong>teractions 

that have been found to precipitate 

problems may <strong>in</strong>clude attention for negative 

behaviors, responses to attempts at forced 

feed<strong>in</strong>g, <strong>and</strong> reduction of feed<strong>in</strong>g choices due 

to food selectivity preferences <strong>in</strong> children 

(Christophersen & Hall, 1978). 

Children with dysphagia may f<strong>in</strong>d mealtimes 

stressful <strong>and</strong> unpleasant. If children 

have experienced airway compromise such as 

occurs with aspiration <strong>and</strong> chok<strong>in</strong>g, they may 

associate these negative experiences with the 


be addressed to Rita L. Bailey, Department of Special 

<strong>Education</strong>, Ill<strong>in</strong>ois State University, Campus 

Box 5910, Normal, IL 61790-5910. 

act of eat<strong>in</strong>g. Medically fragile children are 

often subjected to medically necessary but <strong>in</strong>trusive 

<strong>and</strong> aversive oral/facial sensory <strong>in</strong>puts. 

Suction<strong>in</strong>g, oral <strong>and</strong> nasal gastric tube placement, 

<strong>and</strong> the use of facial tape to secure 

tubes may lead to tactile defensiveness <strong>and</strong> 

oral hypersensitivity (Comrie & Helm, 1997). 

Early experiences with oral sensory stimuli are 

often limited for children with neurological 

<strong>and</strong>/or physical impairments, especially for 

those who experience extensive episodes of 

hospitalization. This may limit new <strong>and</strong> repeated 

exposure to foods. This lack of oral 

sensory experiences may lead to food aversions 

<strong>and</strong> refusals, a common f<strong>in</strong>d<strong>in</strong>g <strong>in</strong> children 

with eat<strong>in</strong>g disturbances (Pelchat & 

Pl<strong>in</strong>er, 1986). Early experience <strong>and</strong> repeated 

exposure to new foods contributes to development 

of food acceptance patterns <strong>and</strong> control 

of food <strong>in</strong>take. In fact, most children are likely 

to reject new foods <strong>in</strong>itially, but they learn to 

like them with time <strong>and</strong> repeated neutral exposure 

(Birch, Johnson, & Fisher, 1995; Birch 

& Marl<strong>in</strong>, 1982). It is clear that eat<strong>in</strong>g does 

not exist <strong>in</strong> isolation from the context <strong>in</strong> 

which it takes place. Caregiver <strong>in</strong>fluences, 

physical conditions, social, psychological factors, 

<strong>and</strong> the feed<strong>in</strong>g environment impact the 

development of feed<strong>in</strong>g. 

Statement of the Problem 


Children with comb<strong>in</strong>ed dysphagia <strong>and</strong> problematic 

mealtime behaviors present a particu-

lar challenge for school personnel <strong>in</strong>volved <strong>in</strong> 

supervision <strong>and</strong> feed<strong>in</strong>g of children <strong>and</strong> youth 

with disabilities. Several authors have described 

programs for <strong>in</strong>creas<strong>in</strong>g oral-motor 

skills <strong>and</strong> oral-sensory awareness <strong>in</strong> children 

(e.g., Alex<strong>and</strong>er, 1987; Bahr, 2001; Gaebler & 

Hanzlik, 1996; Hall, 2001; Morris & Kle<strong>in</strong>, 

1987), direct <strong>and</strong> compensatory therapies for 

improv<strong>in</strong>g feed<strong>in</strong>g <strong>and</strong> swallow<strong>in</strong>g skills (e.g. 

Arvedson, 1998; Hall; Kovar, 1997; Larnert & 

Ekberg, 1995; Logemann, 2000) <strong>and</strong> behavior 

management programs to improve behavior 

at mealtimes (Kerw<strong>in</strong>, 1999; Munk & Repp, 

1994; Rasnake & L<strong>in</strong>scheid, 1987; Sisson & 

Dixon, 1986). Unfortunately, these have not 

been widely used <strong>in</strong> educational sett<strong>in</strong>gs. In 

fact, dysphagia treatment by speech-language 

pathologists (SLPs) has historically occurred 

predom<strong>in</strong>ately <strong>in</strong> medical sett<strong>in</strong>gs (Silliman, 

2000). 

Management of feed<strong>in</strong>g <strong>and</strong> swallow<strong>in</strong>g disorders 

has become an issue for school-based 

SLPs. The American Speech Language <strong>and</strong> 

Hear<strong>in</strong>g Association addressed this issue <strong>in</strong> 

their Technical Report Executive Summary 

(2002) stat<strong>in</strong>g, 

The area of pediatric swallow<strong>in</strong>g <strong>and</strong> feed<strong>in</strong>g 

disorders is one of the most rapidly evolv<strong>in</strong>g 

patient care areas for medically-based 

SLPs <strong>and</strong> other professionals serv<strong>in</strong>g children. 

In addition, as an <strong>in</strong>creas<strong>in</strong>g number of highrisk 

<strong>in</strong>fants survive <strong>and</strong> enter educational programs, 

SLPs must acquire medical knowledge 

<strong>and</strong> skills to manage swallow<strong>in</strong>g <strong>and</strong> feed<strong>in</strong>g 

disorders (p. 76). 

Additionally, while behavior management 

programs <strong>and</strong> dysphagia treatment for management 

of feed<strong>in</strong>g problems have been described, 

there are relatively few studies that 

have <strong>in</strong>vestigated comb<strong>in</strong>ed treatments for 

dysphagia co-exist<strong>in</strong>g with behavioral feed<strong>in</strong>g 

problems. The comparative use <strong>and</strong> efficacy of 

dysphagia treatment programs, behavior management 

programs, <strong>and</strong> comb<strong>in</strong>ed treatment 

programs is unknown. This <strong>in</strong>formation is 

necessary to establish best practices for treatment 

of feed<strong>in</strong>g problems <strong>in</strong> children <strong>and</strong> 

youth. 

Dysphagia Treatment Methods 

Therapies for pediatric dysphagia <strong>in</strong>clude direct 

<strong>in</strong>tervention strategies such as oral-motor 

exercises <strong>and</strong> swallow<strong>in</strong>g maneuvers (Loge- 

mann, 2000). Compensatory strategies <strong>in</strong>clude 

position<strong>in</strong>g for optimal safety <strong>and</strong> airway 

protection, specialized feed<strong>in</strong>g techniques 

to change the feed<strong>in</strong>g pattern (i.e., 

therapeutic feed<strong>in</strong>g methods), sensory enhancement 

procedures, nutritional enhancement, 

<strong>and</strong> the use of adaptive feed<strong>in</strong>g equipment 

to encourage heightened awareness, 

maximization of skills, <strong>and</strong> improved <strong>in</strong>dependence 

<strong>in</strong> feed<strong>in</strong>g (Alex<strong>and</strong>er, 1987; Arvedson, 

1997; Arvedson & Brodsky, 1993; Gaebler & 

Hanzlik, 1996; Hall, 2001; Logemann; Morris 

& Kle<strong>in</strong>, 1987). Methods chosen vary accord<strong>in</strong>g 

to the specific needs <strong>and</strong> cognitive abilities 

of the child. 

Behavior Management Methods 

While a variety of behavior management programs 

are available, this study employed positive 

re<strong>in</strong>forcement procedures. Positive re<strong>in</strong>forcement 

protocols use social praise, 

attention <strong>and</strong> encouragement, together with 

the selective presentation of preferred re<strong>in</strong>forcers 

as social <strong>and</strong>/or tangible rewards. A 

pre-session assessment of re<strong>in</strong>forcer preference 

protocol (Gast et al., 2000) was the 

method used to determ<strong>in</strong>e re<strong>in</strong>forcement 

preferences <strong>in</strong> this study. 

The purpose of this study was to determ<strong>in</strong>e 

the efficacy of a multi-treatment feed<strong>in</strong>g skill 

<strong>and</strong> mealtime behavior <strong>in</strong>tervention package 

<strong>and</strong> evaluate: (a) effects of a dysphagia treatment 

program on development of feed<strong>in</strong>g 

skills <strong>and</strong> positive mealtime behaviors, (b) effects 

of a positive re<strong>in</strong>forcement behavior 

management program (PRBMP) on development 

of feed<strong>in</strong>g skills <strong>and</strong> positive mealtime 

behaviors, (c) effects of a comb<strong>in</strong>ed dysphagia 

<strong>and</strong> PRBMP program package on development 

of feed<strong>in</strong>g skills <strong>and</strong> positive mealtime 

behaviors, (d) comparative effectiveness of 

each <strong>in</strong>tervention or <strong>in</strong>tervention package on 

development of feed<strong>in</strong>g skills <strong>and</strong> positive 

mealtime behaviors <strong>in</strong> children <strong>and</strong> youth 

with disabilities, <strong>and</strong> (e) whether improvements 

<strong>in</strong> development of feed<strong>in</strong>g skills <strong>and</strong> 

positive mealtime behaviors will be ma<strong>in</strong>ta<strong>in</strong>ed 

when <strong>in</strong>terventions are provided by 

tra<strong>in</strong>ed school staff members. 

Feed<strong>in</strong>g Skills <strong>and</strong> Mealtime Behaviors / 81

Method 


The sett<strong>in</strong>g was an elementary <strong>and</strong> a junior 

high school with<strong>in</strong> a public school district, 

located with<strong>in</strong> a town of approximately 45,000 

people, with 10,416 students mak<strong>in</strong>g up the 

district’s population. Of this number, 1470 

students received special education <strong>and</strong> related 

services. Three participants ate their 

meals <strong>in</strong> the lunchroom with peers, while six 

participants were fed by school personnel <strong>in</strong> 

their classrooms, due to safety concerns, need 

for proximity to healthcare personnel, <strong>and</strong>/or 

perceived negative effects of the distract<strong>in</strong>g 

lunchroom environment. 

Participants 

Participants were n<strong>in</strong>e children <strong>and</strong> youth 

with moderate to severe/profound cognitive 

disabilities between the ages of 4 <strong>and</strong> 17. All 

participants received special education services 

<strong>and</strong> had been previously identified with 

feed<strong>in</strong>g impairments to the extent to which 

they were fed, assisted <strong>in</strong> feed<strong>in</strong>g, or supervised 

dur<strong>in</strong>g self-feed<strong>in</strong>g <strong>in</strong> the school environment. 

Categories of cognitive <strong>and</strong> physical 

disability were established <strong>in</strong> compliance with 

the criteria stated <strong>in</strong> the Individuals with <strong>Disabilities</strong> 

<strong>Education</strong> Act (P.L. 101-476). Licensed 

psychologists <strong>and</strong> students’ eligibility 

teams had made a determ<strong>in</strong>ation of participants’ 

classification through use of appropriate 

measures of general <strong>in</strong>tellectual function<strong>in</strong>g 

<strong>and</strong> adaptive behavior. See Table 1 for 

participant demographic characteristics <strong>and</strong> 

goal targets. Two participant groups (1 <strong>and</strong> 2) 

were formed by convenience, that is, they 

were grouped by classroom <strong>and</strong> schedules. 

Group 3 was formed with one participant 

from one classroom <strong>and</strong> two participants from 

another classroom to achieve equal numbers 

<strong>in</strong> each group. 

Brett, Participant 1, was a 15-year-old male 

diagnosed with Fragile X syndrome <strong>and</strong> associated 

developmental delays. His cognitive disability 

was estimated at moderate/severe. Observation, 

<strong>in</strong>terviews, <strong>and</strong> the Schedule for Oral 

Motor Assessment (SOMA) (Skuse, Stevenson, 

Reilly, & Mathisen, 1995) evaluation revealed 

the follow<strong>in</strong>g feed<strong>in</strong>g characteristics: (a) stuff<strong>in</strong>g 

his mouth with large bites of food, (b) 


often not swallow<strong>in</strong>g between bites, <strong>and</strong> (c) 

apparent decreased awareness of food on his 

face as evidenced by lack of appropriate napk<strong>in</strong> 

use. Brett was considered at risk for chok<strong>in</strong>g 

due to the large bites of food <strong>in</strong> his mouth 

prior to swallow<strong>in</strong>g. Additionally, these mealtime 

behaviors were not considered to be socially 

acceptable. Two primary goals were 

identified for Brett (see Table 1). 

Jason, Participant 2, was a 17-year-old male 

diagnosed with Down syndrome <strong>and</strong> associated 

developmental delays. His level of cognitive 

disability was estimated at moderate/severe. 

Observation, <strong>in</strong>terviews, <strong>and</strong> the SOMA 

evaluation revealed the primary feed<strong>in</strong>g characteristics: 

(a) stuff<strong>in</strong>g his mouth with large 

bites of food, (b) often not swallow<strong>in</strong>g between 

bites; (c) decreased chew<strong>in</strong>g ability, (d) 

severe tongue thrust, <strong>and</strong> (e) apparent decreased 

awareness of food on his face as evidenced 

of lack of appropriate napk<strong>in</strong> use. 

Two primary goals were identified for Jason 

(see Table 1). 

Denver, Participant 3, was a 14-year-old 

male diagnosed with seizure disorder <strong>and</strong> developmental 

delays of unknown orig<strong>in</strong>. His 

level of cognitive disability was estimated at 

moderate. Observation, <strong>in</strong>terviews, <strong>and</strong> the 

SOMA evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g 

characteristics: (a) many food spills from 

the spoon <strong>and</strong> the mouth while eat<strong>in</strong>g <strong>and</strong> (b) 

open mouth/lips with chew<strong>in</strong>g. While these 

characteristics did not place him at a high risk 

for chok<strong>in</strong>g, they were determ<strong>in</strong>ed to decrease 

social acceptability. Therefore, two 

goals were identified for Denver (see Table 1). 

Nate, Participant 4, was a 6-year-old male 

diagnosed with Trisomy 13, a secondary seizure 

disorder, <strong>and</strong> m<strong>in</strong>imal vision. The level 

of Nate’s cognitive disability was estimated at 

severe. Although Nate had a percutaneous 

endoscopic gastronomy (PEG) tube, it was reportedly 

used only when he was ill. Nate exhibited 

sensory defensiveness by cry<strong>in</strong>g or 

mov<strong>in</strong>g away when touched around or <strong>in</strong> the 

mouth. Observation, <strong>in</strong>terviews, <strong>and</strong> the 


characteristics: (a) a passive oral manipulation 

of food for “textured” pureed consistency 

<strong>and</strong> (b) total dependence on the feeder 

for the provision of food, although Nate had 

the physical ability to br<strong>in</strong>g his h<strong>and</strong> toward 

his face <strong>in</strong> other circumstances. Two primary 

goals were identified for Nate (see Table 1).

TABLE 1 

Participant Demographic Characteristics <strong>and</strong> Target Goals: Groups 1, 2, <strong>and</strong> 3 

Target Goals <strong>and</strong> Codes Feed<strong>in</strong>g Goals (FG) 

Mealtime Behavior Goals (MBG) 

Level of 

Cognitive Function Feed<strong>in</strong>g Supports 

Participant <strong>and</strong> 

Group Number Diagnosis Age Gender 

Fragile X Syndrome 15 M Moderate Supervision 1. Take small bites (MBG) 

2. Swallow between bites (FG) 

Down Syndrome 17 M Moderate to Severe Supervision 1. Use napk<strong>in</strong> with request (MBG) 

2. Swallow between bites (FG) 

Unknown, Seizure Disorder 14 M Moderate Supervision 1. No spills on self or tray (MBG) 

2. Close lips with chew<strong>in</strong>g (FG) 

6 M Severe Staff feeds; PEG-tube; wheel 1. Assist <strong>in</strong> self-feed<strong>in</strong>g with spoon (MBG) 

chair with head supports; 2. Rhythmic sequence of 2 or more jaw 

pureed diet; thick liquids movements with chew<strong>in</strong>g (FG) 

7 F Severe Staff feeds; pureed diet; adaptive 1. Open mouth <strong>in</strong> anticipation of spoon 

spoon; PEG-tube; wheel chair, (MBG) 

position<strong>in</strong>g supports 

2. Close lips with spoon<strong>in</strong>g (FG) 

4 F Severe Staff feeds; pureed diet; wheel 1. Assist <strong>in</strong> self-feed<strong>in</strong>g with spoon (MBG) 

chair with head supports; soft 2. Active lips with spoon<strong>in</strong>g (FG) 

spoon, tra<strong>in</strong><strong>in</strong>g cup; thick 

liquids 

11 M Severe Supervision 1. Eat a non-preferred food. (MBG) 

2. Clean face with no request. (FG) 

Trisomy 13 Seizure Disorder 

Visual Impair-ment 

Cerebral Palsy Seizure 

Disorder 

Unknown Bl<strong>in</strong>d Seizure 

Disorder 

Group 1 

Participant 1 

Brett 

Group 1 

Participant 2 

Jason 

Group 1 

Participant 3 

Denver 

Group 2 

Participant 4 

Nate 

Group 2 

Participant 5 

Stacy 

Group 2 

Participant 6 

Jessica 

Seizure at birth; effects of 

encephalitis 

1. Assist <strong>in</strong> self-feed<strong>in</strong>g with spoon<strong>in</strong>g. 

(MBG) 

2. Active lips with spoon<strong>in</strong>g. (FG) 

Group 3 

Participant 7 

Dust<strong>in</strong> 

Group 3 

Participant 8 

Kyle 

1. Eat a non-preferred food. (MBG) 

2. Clean face without request. (FG) 

Cerebral Palsy 4 M Severe Staff spoons; bottle for liquids; 

adaptive bowl, spoon; diced 

food; wheel chair with head, 

chest supports 

Unknown 13 F Severe Staff feeds; pureed diet; thick 

liquids; adaptive cup, spoon 

Group 3 

Participant 9 

Anna 


Stacy, Participant 5, was a 7-year-old female 

with a diagnosis of cerebral palsy. She presented 

with a severe physical impairment with 

mixed muscle tone. Her level of cognitive 

function<strong>in</strong>g was estimated at severe. Stacy had 

a PEG tube, with which she was given all liquids, 

as well as two tube feed<strong>in</strong>gs per school 

day. Accord<strong>in</strong>g to teacher report, oral feed<strong>in</strong>g 

had been attempted on a daily basis at school 

with variable results. 

Stacy’s diet was restricted to pureed consistency 

only. Observation, <strong>in</strong>terviews, <strong>and</strong> the 


characteristics: (a) an open-mouth posture 

with spoon<strong>in</strong>g, (b) <strong>in</strong>consistent orientation 

to the spoon or the feeder, <strong>and</strong> (c) 

<strong>in</strong>consistent open<strong>in</strong>g of the mouth <strong>in</strong> anticipation 

of the spoon. See Table 1 for two primary 

goals identified for Stacy. 

Jessica, Participant 6, was a 4-year-old female 

with developmental delays of unknown 

orig<strong>in</strong>, a secondary seizure disorder <strong>and</strong> bl<strong>in</strong>dness. 

Her level of cognitive function<strong>in</strong>g was 

estimated at severe. Jessica’s diet was pureed, 

with liquids thickened <strong>and</strong> given through a 

“sippy” cup. Jessica was fed <strong>in</strong> a wheel chair 

with head supports <strong>and</strong> fed with a soft spoon, 

due to an active bite reflex. Results of observation, 

<strong>in</strong>terviews, <strong>and</strong> the SOMA evaluation 

revealed the follow<strong>in</strong>g feed<strong>in</strong>g characteristics: 

(a) m<strong>in</strong>imal lip movements to clean the 

spoon, (b) <strong>in</strong>consistent bite reflex, (c) m<strong>in</strong>imal 

lateral jaw movements with chew<strong>in</strong>g, <strong>and</strong> 

(d) total dependence on the feeder for spoon<strong>in</strong>g, 

although she was able to br<strong>in</strong>g h<strong>and</strong>s 

toward face <strong>in</strong> other circumstances. Jessica 

also exhibited extreme tactile/sensory defensiveness 

by pull<strong>in</strong>g away <strong>and</strong>/or cry<strong>in</strong>g, particularly 

when touched on the h<strong>and</strong>s, but also 

when touched on the face. Two primary goals 

were identified for Jessica (see Table 1). 

Dust<strong>in</strong>, Participant 7, was an 11-year-old 

male diagnosed with cognitive deficits follow<strong>in</strong>g 

a severe seizure at birth, as a result of 

encephalitis. Dust<strong>in</strong>’s level of cognitive disability 

was estimated at severe. He was also identified 

as hav<strong>in</strong>g a behavior disorder. Dust<strong>in</strong> 

was able to <strong>in</strong>dependently eat a regular diet, 

with verbal prompt<strong>in</strong>g to attend to the feed<strong>in</strong>g 

task. Observation, <strong>in</strong>terviews, <strong>and</strong> the SOMA 

evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g 

characteristics: (a) categorical refusal of fruit, 

(b) decreased evidence of sensory awareness 

as evidenced by no napk<strong>in</strong> use with food on 


his lips or face, (c) giggl<strong>in</strong>g <strong>and</strong> self-stimulat<strong>in</strong>g 

h<strong>and</strong> flapp<strong>in</strong>g, f<strong>in</strong>ger <strong>in</strong> eye, <strong>and</strong> hair 

twirl<strong>in</strong>g movements while eat<strong>in</strong>g, (d) stuff<strong>in</strong>g 

his mouth at the beg<strong>in</strong>n<strong>in</strong>g of a meal, but 

refus<strong>in</strong>g to eat after a few bites. Two primary 

goals were identified for Dust<strong>in</strong> (see Table 1). 

Kyle, Participant 8, was a 4-year-old male 

with a diagnosis of cerebral palsy <strong>and</strong> associated 

physical impairment <strong>and</strong> developmental 

delays. His level of cognitive disability was estimated 

at severe. Observation, <strong>in</strong>terviews, <strong>and</strong> 


characteristics: (a) decreased lip closure 

to clean the spoon <strong>and</strong> (b) no <strong>in</strong>dependent 

use of utensils although he was able to f<strong>in</strong>ger 

feed. Two goals were identified for Kyle (see 

Table 1). 

Anna, Participant 9, was a 13-year-old female 

with developmental delays <strong>and</strong> physical 

impairment of unknown orig<strong>in</strong>. The level of 

her cognitive disability was estimated at severe. 

Observation, <strong>in</strong>terviews, <strong>and</strong> the SOMA 

evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g 

characteristics: (a) marked food preferences 

<strong>and</strong> expell<strong>in</strong>g non-preferred foods, (b) complete 

reliance on the feeder for spoon<strong>in</strong>g (but 

<strong>in</strong>dependent cup use), (c) food spillage from 

the lips, (d) apparent sensory defensiveness 

with touch to the face evidenced by turn<strong>in</strong>g 

rapidly away when her face was wiped, <strong>and</strong> (e) 

m<strong>in</strong>imal lateral tongue movements, (f) delayed 

oral stages of swallow<strong>in</strong>g. Two primary 

goals were identified for Anna (see Table 1). 

Methods Used to Determ<strong>in</strong>e Feed<strong>in</strong>g Skill <strong>and</strong> 

Mealtime Behavior Goals 

Basel<strong>in</strong>e data (Condition A) of feed<strong>in</strong>g skills 

<strong>and</strong> mealtime behaviors were collected us<strong>in</strong>g 

the SOMA evaluations <strong>and</strong> observations 

(Skuse et al., 1995). Basel<strong>in</strong>e probes were conducted 

at each participant’s home school, 

with the same feeders <strong>and</strong> with<strong>in</strong> the sett<strong>in</strong>g 

where they were currently be<strong>in</strong>g fed <strong>and</strong>/or 

supervised dur<strong>in</strong>g feed<strong>in</strong>g. The Pr<strong>in</strong>cipal Investigator 

(PI), a licensed, certified SLP, conducted 

these basel<strong>in</strong>e evaluations. All evaluations 

were videotaped to allow for further 

analysis by the PI <strong>and</strong> for purposes of calculat<strong>in</strong>g 

<strong>in</strong>terrater reliability percentages by an 

additional licensed SLP. The additional SLP 

viewed all SOMA evaluation videotapes <strong>and</strong> 

videotapes of three pre-<strong>in</strong>tervention mealtime 

observations. The PI <strong>and</strong> additional SLP <strong>in</strong>di-

vidually identified feed<strong>in</strong>g skill deficits us<strong>in</strong>g 

the SOMA scor<strong>in</strong>g sheet descriptions <strong>and</strong> a 

written description of normal development of 

feed<strong>in</strong>g skills (Guerra & Vaughn, 1994). The 

PI <strong>and</strong> additional SLP <strong>in</strong>dividually listed feed<strong>in</strong>g 

skill deficits that each identified as primary 

for each participant. These two <strong>in</strong>dividuals 

met <strong>and</strong> compared their lists of primary 

feed<strong>in</strong>g skill deficits. When a feed<strong>in</strong>g skill deficit 

was identified by both the PI <strong>and</strong> the 

additional SLP, it was added to a list of potential 

feed<strong>in</strong>g skill goals for that participant. The 

PI <strong>and</strong> additional SLP reviewed tapes together 

<strong>and</strong> discussed potential goals until the two 

came to an agreement regard<strong>in</strong>g the primary 

feed<strong>in</strong>g skill deficit for each participant. The 

SOMA evaluation was used as a structured 

method for assist<strong>in</strong>g <strong>in</strong> identification of feed<strong>in</strong>g 

skill deficits only. SOMA scores were not 

computed because the test was devised for 

<strong>in</strong>fants <strong>and</strong> young children. 

Behavior goals were identified by <strong>in</strong>terviews 

with teachers, related services staff, <strong>and</strong> parents/caregivers 

of the participants. Follow<strong>in</strong>g 

<strong>in</strong>terviews, the PI completed <strong>in</strong>formal observations 

of mealtimes to confirm presence of 

behaviors. Next, a list of potential behavior 

goals was created for each participant. The PI 

<strong>and</strong> Co-PI (a university Department of Special 

<strong>Education</strong> faculty member <strong>and</strong> behavior specialist) 

used the list to determ<strong>in</strong>e a primary 

positive mealtime behavior goals for each participant. 

Design 

An A-BC-C-BC2-BC multiple treatment design 

across three groups of three participants 

(Baer, Wolf, & Risley, 1968) with brief withdrawal 

conditions (Birnbrauer, Peterson, & 

Solnick, 1974; Herson & Barlow, 1976) was 

used to evaluate the effectiveness of an <strong>in</strong>tervention 

package (B – a dysphagia treatment 

program <strong>and</strong>C–aPRBMP) on the dependent 

variables (<strong>in</strong>dividually identified feed<strong>in</strong>g skill 

<strong>and</strong> positive mealtime behavior goals) of <strong>in</strong>dividuals 

with moderate, severe, or multiple disabilities. 

Consider<strong>in</strong>g the ethical implications 

of a withdraw<strong>in</strong>g all treatments for children 

with severe feed<strong>in</strong>g problems, the researchers 

chose to implement a brief withdrawal of one 

of the two <strong>in</strong>terventions dur<strong>in</strong>g the withdrawal 

conditions. With<strong>in</strong> this design, the dependent 

variables were measured under basel<strong>in</strong>e con- 

ditions, <strong>and</strong> the <strong>in</strong>terventions were <strong>in</strong>troduced 

<strong>in</strong> a counterbalanced sequence to three 

groups of children <strong>and</strong> youth. The multiple 

treatment design was chosen as it has been 

reported as useful <strong>in</strong> ask<strong>in</strong>g, “Would X <strong>in</strong>tervention 

work better than Y <strong>in</strong>tervention” (Holcombe, 

Wolery, & Gast, 1994). Individual performance 

data were recorded for each 

<strong>in</strong>tervention session. Individual <strong>and</strong> comparative 

group results were obta<strong>in</strong>ed across each 

study condition. 

Each participant group was exposed to six 

conditions. Basel<strong>in</strong>e condition (A) consisted 

of a SOMA evaluation <strong>and</strong> pre-<strong>in</strong>tervention 

observations. The BC condition <strong>in</strong>volved a 

dysphagia treatment program comb<strong>in</strong>ed with 

a PRBMP. For the B <strong>and</strong> C conditions, either 

the dysphagia treatment program alone or the 

PRBMP alone was implemented (i.e., either B 

or C was withdrawn). The B <strong>and</strong> C conditions 

were counterbalanced across groups. The BC2 

condition <strong>in</strong>volved a return to the dysphagia 

treatment program comb<strong>in</strong>ed with the 

PRBMP. The BC condition <strong>in</strong>volved the dysphagia 

treatment program comb<strong>in</strong>ed with the 

PRBMP implemented by the tra<strong>in</strong>ed classroom 

staff <strong>and</strong> personnel. 

Basel<strong>in</strong>e Condition 

The PI <strong>and</strong> graduate students with<strong>in</strong> a university 

Department of Speech Pathology <strong>and</strong> Audiology 

charted basel<strong>in</strong>e percentages of accurate 

responses. Dur<strong>in</strong>g basel<strong>in</strong>e condition, 

participants were fed by the same school staff 

as dur<strong>in</strong>g the SOMA evaluations. The graduate 

students were tra<strong>in</strong>ed <strong>in</strong> the use of a plus () 

<strong>and</strong> m<strong>in</strong>us (-) system to chart accurate performance 

of target skills <strong>and</strong> behaviors. In this 

system, graduate students recorded a plus () 

sign if participants performed the target skill 

or behavior <strong>and</strong> a (-) sign if participants did 

not perform the target behavior for each bite 

or opportunity. Graduate students demonstrated 

a functional underst<strong>and</strong><strong>in</strong>g of the 

<strong>and</strong> – system prior to <strong>in</strong>itiation of the first 

basel<strong>in</strong>e session. One of Denver’s goals required 

an <strong>in</strong>terval record<strong>in</strong>g method. For this 

method, graduate students were <strong>in</strong>structed to 

use a stopwatch <strong>and</strong> make a slash mark for 

number of events that occurred dur<strong>in</strong>g each 

<strong>in</strong>terval. At the end of each session, marks 

were tallied <strong>and</strong> divided by the number of 

m<strong>in</strong>utes <strong>in</strong> the session to yield the rate of 


occurrences. Observations dur<strong>in</strong>g a m<strong>in</strong>imum 

of three lunchtime meals were used to collect 

basel<strong>in</strong>e data for each participant prior to 

<strong>in</strong>troduction of sequential treatment conditions. 

Intervention Conditions 

Interventions were provided by graduate students 

at the lunchtime meal four days per 

week for a total of 11 weeks. School staff provided 

the <strong>in</strong>terventions dur<strong>in</strong>g the f<strong>in</strong>al three 

weeks of the study. Prior to <strong>in</strong>troduction of all 

<strong>in</strong>terventions, graduate students <strong>and</strong> school 

staff received tra<strong>in</strong><strong>in</strong>g together <strong>in</strong> use of positive 

re<strong>in</strong>forcement behavior management 

strategies, data collection methods, methods 

for adm<strong>in</strong>istration <strong>and</strong> evaluation of preference 

assessments, procedural reliability, <strong>and</strong> 

the dysphagia treatment techniques. All persons 

provid<strong>in</strong>g <strong>in</strong>terventions were supervised 

by licensed, certified SLPs dur<strong>in</strong>g the study. 

Prior to each treatment session us<strong>in</strong>g behavior 

management programs, a pre-session assessment 

of re<strong>in</strong>forcer preferences (Gast et 

al., 2000) was conducted for each participant. 

Students with moderate disabilities who had 

<strong>in</strong>tact communication systems or who could 

gesture toward actual re<strong>in</strong>forcers or visual representations 

of them <strong>in</strong>dicated their preferred 

re<strong>in</strong>forcer for each session by verbally stat<strong>in</strong>g 

or po<strong>in</strong>t<strong>in</strong>g to it. The PRBMP <strong>in</strong>cluded sensory 

<strong>and</strong> social re<strong>in</strong>forcers or token re<strong>in</strong>forcement 

systems (O’Brien, Repp, Williams, & 

Christophersen, 1991). Participants <strong>in</strong> Group 

1 used a sticker re<strong>in</strong>forcement chart <strong>and</strong> token 

exchange system as their positive re<strong>in</strong>forcement 

program. Immediate sensory <strong>and</strong> 

social re<strong>in</strong>forcers were used as the positive 

re<strong>in</strong>forcement program for Groups 2 <strong>and</strong> 3. 

Sequence of Conditions 

Each group was exposed to each of the six 

conditions, which were counterbalanced by 

groups <strong>in</strong> order to reduce both maturational 

<strong>and</strong> sequence effects. The basel<strong>in</strong>e condition 

(A) <strong>in</strong>volved assessment of current performance 

levels for target feed<strong>in</strong>g skills <strong>and</strong> positive 

mealtime behaviors. Graduate students 

recorded occurrence of target skills <strong>and</strong> behaviors 

for three mealtimes prior to <strong>in</strong>troduction 

of any <strong>in</strong>terventions. 

The (BC) condition consisted of a com- 


b<strong>in</strong>ed dysphagia treatment program (B) with 

the PRBMP (C). The dysphagia treatment 

program package consisted of a 5-m<strong>in</strong> oralmotor 

stimulation program (OMSP) described 

by Gaebler <strong>and</strong> Hanzlik (1996) <strong>and</strong> 

modified by the PI for use with older children. 

The same OMSP was used for each child. Additional 

components of the dysphagia treatment 

program package <strong>in</strong>cluded a group 

oral-motor exercise program <strong>and</strong> direct <strong>in</strong>struction 

<strong>and</strong> model<strong>in</strong>g of target skills <strong>and</strong> 

behaviors. 

Position<strong>in</strong>g for optimal swallow<strong>in</strong>g, modification 

of foods <strong>and</strong> consistencies to meet participants’ 

abilities, use of adaptive equipment, 

therapeutic feed<strong>in</strong>g methods, <strong>and</strong> nutrition 

enhancement were considered absolutely necessary 

for ensur<strong>in</strong>g each participant’s safety 

<strong>and</strong> needs were implemented as a part of 

every feed<strong>in</strong>g session. These components of 

the dysphagia treatment program were not 

withdrawn at any time dur<strong>in</strong>g the study. The 

BC condition was implemented four days per 

week for three weeks. 

The (B) condition (dysphagia treatment 

program) <strong>in</strong>volved remov<strong>in</strong>g the PRBMP (C). 

The (B) condition consisted of adm<strong>in</strong>ister<strong>in</strong>g 

the OMSP <strong>and</strong> group oral-motor exercise program 

as a part of every <strong>in</strong>tervention session. 

The OMSP was completed on an <strong>in</strong>dividual 

basis with each participant prior to the mealtime. 

Oral-motor exercises were completed after 

each meal so as not to fatigue the system 

prior to eat<strong>in</strong>g. The dysphagia treatment program 

also <strong>in</strong>cluded a direct <strong>in</strong>structional component, 

with verbal <strong>and</strong> visual model<strong>in</strong>g of 

target skills <strong>and</strong> positive mealtime behaviors 

<strong>and</strong> an oral-hygiene program (i.e., tooth 

brush<strong>in</strong>g). The B condition was implemented 

four days per week for two weeks. 

The behavior management withdrawal condition 

(C) <strong>in</strong>volved remov<strong>in</strong>g the dysphagia 

treatment program. The (C) condition consisted 

of positive social, sensory, or tangible 

re<strong>in</strong>forcement as determ<strong>in</strong>ed dur<strong>in</strong>g the presession 

m<strong>in</strong>i preference assessment for performance 

of target skills <strong>and</strong> behaviors. The (C) 

condition occurred four days per week for two 

weeks. 

The (BC) condition was then repeated for 

an additional 3-week time period, us<strong>in</strong>g the 

same <strong>in</strong>terventions as <strong>in</strong> the previous (BC) 

condition <strong>and</strong> was identified as (BC2). 

Prior to the <strong>in</strong>itiation of the f<strong>in</strong>al phase

(i.e., before the <strong>in</strong>troduction of Condition 

BC), the PI, Co-<strong>in</strong>vestigator, <strong>and</strong> graduate 

students reviewed tra<strong>in</strong><strong>in</strong>g <strong>in</strong> adm<strong>in</strong>istration 

of the dysphagia treatment program <strong>and</strong> the 

PRBMP at the school site for school personnel 

with the same methods, h<strong>and</strong>outs, <strong>and</strong> read<strong>in</strong>gs 

as presented dur<strong>in</strong>g the previous tra<strong>in</strong><strong>in</strong>g 

sessions. School staff members were also given 

a written packet conta<strong>in</strong><strong>in</strong>g the pre-session 

preference assessment materials, the OMSP, 

<strong>and</strong> daily activities <strong>and</strong> materials for oral-motor 

exercises. The BC condition occurred for 

a 3-week time period. Guidance <strong>and</strong> <strong>in</strong>struction 

by the PI, Co-PI, <strong>and</strong> graduate students 

were systematically faded as the classroom personnel 

exhibited skill <strong>in</strong> specialized feed<strong>in</strong>g 

<strong>and</strong> behavior management techniques. By the 

start of the third week of condition BC, the 

school staff provided 100% of the <strong>in</strong>terventions. 

To counterbalance <strong>in</strong>terventions, Group 1 

followed an A-BC-B-C-BC2-BC condition 

sequence, Group 2 followed an A-B-BC-C- 

BC2-BC sequence, <strong>and</strong> Group 3 followed an 

A-C-BC-B-BC2-BC sequence. Individual performance 

data were collected dur<strong>in</strong>g each session. 

Additional graduate students conducted 

<strong>in</strong>dependent analysis of at least 20% of all 

sessions to calculate performance <strong>and</strong> procedural 

reliability (Bill<strong>in</strong>gsley, White, & Munson, 

1980; Tawney & Gast, 1984). 

Trend <strong>and</strong> Level Analysis 

Frequency data for target skills <strong>and</strong> behaviors 

dur<strong>in</strong>g each phase of treatment were 

converted <strong>in</strong>to percentages of accurate responses. 

Changes <strong>in</strong> levels <strong>and</strong> trends were 

analyzed accord<strong>in</strong>g to percentages of dependent 

<strong>and</strong> <strong>in</strong>dependent variables. Kazd<strong>in</strong>’s 

(1982) <strong>and</strong> Tawney <strong>and</strong> Gast’s (1984) techniques 

for calculation <strong>and</strong> statistical analysis 

for s<strong>in</strong>gle-subject experimental design were 

employed. 

Reliability <strong>and</strong> Validity 

To establish reliability, an <strong>in</strong>dependent licensed 

SLP observed <strong>and</strong> rated videotaped 

records of all evaluations. To ensure reliability 

<strong>in</strong> provision of <strong>in</strong>terventions, programs were 

implemented by the same feeders/cl<strong>in</strong>icians 

over the course of the <strong>in</strong>vestigation. The PI 

<strong>and</strong> two additional licensed SLPs supervised 

on-site 4 days per week. The Co-PI was present 

dur<strong>in</strong>g <strong>in</strong>itial weeks of the project <strong>and</strong> provided 

on-site support <strong>in</strong>termittently dur<strong>in</strong>g 

the study <strong>and</strong> consistently dur<strong>in</strong>g the BC 

phase. Interrater <strong>and</strong> procedural reliability 

measures were completed for 20% of all <strong>in</strong>tervention 


To control for extraneous variables, the PI 

<strong>and</strong> Co-PI provided all tra<strong>in</strong><strong>in</strong>g us<strong>in</strong>g the same 

materials, methods, <strong>and</strong> h<strong>and</strong>outs for all graduate 

students <strong>and</strong> school staff members. All 

<strong>in</strong>terventions were adm<strong>in</strong>istered under direct 

supervision of the research team. This helped 

to ensure procedural reliability across <strong>in</strong>terventionists. 

The brief withdrawal conditions 

also helped to isolate the <strong>in</strong>tervention(s) that 

produced the greatest effect. 

To attempt to show generalizability <strong>in</strong> this 

<strong>in</strong>vestigation, two different graduate students 

provided <strong>in</strong>terventions for the first 11 weeks of 

the study <strong>and</strong> the school staff provided all 

<strong>in</strong>terventions for the last three weeks. Data 

were collected <strong>in</strong> the same manner by the 

same graduate students dur<strong>in</strong>g the entire 14week 

study period as a way of demonstrat<strong>in</strong>g 

<strong>in</strong>tervention effects across <strong>in</strong>terventionists 

<strong>and</strong> participants. 

Results 

Figures 1, 2, <strong>and</strong> 3 present <strong>in</strong>dividual participant 

data for three selected participants (one 

participant from each group) relative to <strong>in</strong>dividual 

goals. Tables 2 <strong>and</strong> 3 present group <strong>and</strong> 

<strong>in</strong>dividual data relative to feed<strong>in</strong>g skill <strong>and</strong> 

positive mealtime behavior goals. Comparison 

of participants’ performances dur<strong>in</strong>g study 

conditions provides clear evidence of effectiveness 

of the <strong>in</strong>terventions. 

Group Trends - Feed<strong>in</strong>g Skill <strong>and</strong> Positive 

Mealtime Behavior Goals 

Group results were compared across all feed<strong>in</strong>g 

skill goals to assess trends <strong>in</strong> <strong>in</strong>tervention 

results (see Table 2). For all participants, therapeutic 

ga<strong>in</strong>s were made <strong>in</strong> feed<strong>in</strong>g skills from 

the basel<strong>in</strong>e condition (A) through the comb<strong>in</strong>ed 

<strong>in</strong>tervention condition with staff provid<strong>in</strong>g 

<strong>in</strong>terventions (BC). Visual <strong>in</strong>spection of 

data revealed that greater ga<strong>in</strong>s were made <strong>in</strong> 

feed<strong>in</strong>g skills <strong>in</strong> the comb<strong>in</strong>ed (BC) treatment 

condition than <strong>in</strong> the other conditions for 

Groups 1 <strong>and</strong> 2. Group 3 made greater ga<strong>in</strong>s 


Figure 1. Graphic display of Brett’s performance data for two goals across conditions. 

<strong>in</strong> the BC2 condition. Mean percentage ga<strong>in</strong>s 

<strong>in</strong> feed<strong>in</strong>g skills dur<strong>in</strong>g the first BC condition 

across all groups was 15%, 7% <strong>in</strong> the BC2 

condition, <strong>and</strong> 6% <strong>in</strong> the B condition. A mean 

percentage decrease of 1% occurred <strong>in</strong> feed<strong>in</strong>g 

skill acquisition <strong>in</strong> the C condition <strong>and</strong> 7% 

<strong>in</strong> the BC condition. The greatest overall 


mean ga<strong>in</strong>s <strong>in</strong> feed<strong>in</strong>g skills were observed <strong>in</strong> 

Group 1 (A-BC-B-C-BC2-BC). This group 

ga<strong>in</strong>ed 41% from the basel<strong>in</strong>e condition (A) 

to the BC condition. From basel<strong>in</strong>e (A) to 

the BC condition, Group 3 (A-C-BC-B-BC2- 

BC) ga<strong>in</strong>ed 14% <strong>and</strong> Group 2 (A-B-BC-C- 

BC2-BC) ga<strong>in</strong>ed 9%.

Figure 2. Graphic display of Nate’s performance data for two goals across conditions. 

Group results were compared across positive 

mealtime behavior goals to assess 

trends <strong>in</strong> <strong>in</strong>tervention results (see Table 3). 

Across all participants, ga<strong>in</strong>s were made <strong>in</strong> 

mealtime behaviors from the basel<strong>in</strong>e (A) 

condition through the comb<strong>in</strong>ed treatments 

(BC) condition. Visual <strong>in</strong>spection of the 

data also show that greater ga<strong>in</strong>s were made 

<strong>in</strong> positive mealtime behaviors <strong>in</strong> the comb<strong>in</strong>ed 

treatment (BC) condition for Group 

1, <strong>in</strong> the B condition for Group 2, <strong>and</strong> <strong>in</strong> the 

C condition for Group 3. The BC condition 

yielded a mean ga<strong>in</strong> of 25% across all 

groups. The mean ga<strong>in</strong> recorded across all 

groups <strong>in</strong> the C condition was 13%, 10% <strong>in</strong> 

the B condition, 4% <strong>in</strong> the BC2 condition, 

<strong>and</strong> 10% <strong>in</strong> the BC condition. The greatest 

overall mean ga<strong>in</strong>s <strong>in</strong> identified mealtime 

behaviors were observed <strong>in</strong> Group 2 (A-B- 

BC-C-BC2-BC) with a ga<strong>in</strong> of 74%. Group 1 

(A-BC-B-C-BC2-BC) ga<strong>in</strong>ed 61% from the 

basel<strong>in</strong>e condition (A) through the BC 

condition <strong>and</strong> Group 3 (A-C-BC-B-BC2- 

BC) ga<strong>in</strong>ed 53%. 


Figure 3. Graphic display of Kyle’s performance data for two goals across conditions. 

Comb<strong>in</strong>ed Results for Mealtime Behavior <strong>and</strong> 

Feed<strong>in</strong>g Skill Acquisition 

The greatest mean percentage ga<strong>in</strong> (20%) 

across comb<strong>in</strong>ed behavior <strong>and</strong> skill goals for 

all three groups occurred <strong>in</strong> the BC condition. 

Participants ga<strong>in</strong>ed a mean 8% for comb<strong>in</strong>ed 

mealtime behaviors <strong>and</strong> feed<strong>in</strong>g skills <strong>in</strong> the B 


condition <strong>and</strong> a mean 6% <strong>in</strong> the C condition. 

A mean ga<strong>in</strong> of 6% <strong>in</strong> the BC2 condition <strong>and</strong> 

2% <strong>in</strong> the BC condition occurred across all 

groups <strong>and</strong> goals. Comparison of group 

means across all behaviors, conditions, <strong>and</strong> 

sequence of <strong>in</strong>terventions yielded a mean ga<strong>in</strong> 

of 42% from the basel<strong>in</strong>e condition (A)

TABLE 2 

Individual <strong>and</strong> Group Data 

Mean Percent Change Across Conditions-Target Feed<strong>in</strong>g Skills 

through the BC condition. Group results 

were not considered as strong as <strong>in</strong>dividual 

data due to the small number of participants 

<strong>and</strong> variability <strong>in</strong> goals <strong>and</strong> <strong>in</strong>terventions. 

Individual Results 

Group 1 

Brett. Brett’s performance data are shown 

<strong>in</strong> Figure 1. Basel<strong>in</strong>e data for Goal 1 (take 

small bites) revealed a mean accurate response 

rate of 47%. Mean accurate response 

rate was 82% <strong>in</strong> the BC condition, 90% <strong>in</strong> the 

B condition, <strong>and</strong> 96% <strong>in</strong> the C condition. In 

the BC2 condition, a mean rate of 94% was 

recorded, followed by 96% <strong>in</strong> the BC condition. 

Brett ga<strong>in</strong>ed an overall mean of 49% 

from the basel<strong>in</strong>e condition (A) through the 

BC condition for Goal 1. Brett’s Goal 2 (swallow 

between bites) began with a mean of 55% 

accurate responses <strong>in</strong> the basel<strong>in</strong>e condition. 

In the BC condition, his mean accurate response 

rate rose 24% to 79%. In the B condition, 

this rate decreased by 2%. In the C condition, 

Brett’s mean accurate response rate 

Basel<strong>in</strong>e 

Mean BC B C BC2 BC 

Total 

Mean Ga<strong>in</strong> 

Brett (Swallow Between Bites) 55 24 2 18 5 8 43 

Jason (Swallow Between Bites) 66 22 9 3 1 1 30 

Denver (Close Lips) 24 36 20 10 0 5 51 

Comb<strong>in</strong>ed Group Means 48 27 9 2 1 5 41 

Group 2 


Mean B BC C BC2 BC 

Total 


Nate (Rhythmic Sequence of 3 or More 

Jaw Movements with Chew<strong>in</strong>g) 70 6 3 11 8 6 12 

Stacy (Close Lips with Spoon<strong>in</strong>g) 15 8 34 8 6 38 6 

Jessica (Active lips with spoon<strong>in</strong>g) 4 11 0 4 20 18 9 

Comb<strong>in</strong>ed Group Means 30% 8 12 2 7 17 9 

Group 3 


Mean C BC B BC2 BC 

Total 


Dust<strong>in</strong> (Clean Face-No Request) 6 6 1 1 45 27 12 

Kyle (Active Lips with Spoon<strong>in</strong>g) 68 0 15 4 4 4 27 

Anna (Clean Face-No Request) 1 1 6 0 0 1 4 


was 95%. Brett’s mean performance decreased 

by 5% to 90% <strong>in</strong> the BC2 condition. A 

mean accurate response rate of 98% was observed 

<strong>in</strong> the BC condition. This represents a 

mean ga<strong>in</strong> of 43% from the basel<strong>in</strong>e condition 

(A) through the BC condition for 

Brett’s Goal 2. 

Jason. Basel<strong>in</strong>e data for Goal 1 (use napk<strong>in</strong> 

with request) revealed a mean accurate 

response rate of 7%. In the BC condition, this 

rate <strong>in</strong>creased by 90% to 97%. In the B condition, 

mean accurate response rate rose to 

100%. He ma<strong>in</strong>ta<strong>in</strong>ed a 100% accurate response 

rate through the follow<strong>in</strong>g C, BC2, <strong>and</strong> 

BC conditions. Jason ga<strong>in</strong>ed a total mean of 

93% from the <strong>in</strong>itial basel<strong>in</strong>e condition (A) 

through the BC condition for Goal 1. Jason’s 

basel<strong>in</strong>e data for Goal 2 (swallow between 

bites) was recorded at a mean 66% accurate 

response rate. In the BC condition, this rate 

<strong>in</strong>creased to 88%. In the B condition, a mean 

ga<strong>in</strong> of 9% yielded an accurate response rate 

of 97%. In the C condition, this rate decreased 

to 94%. A mean rate of 95% <strong>in</strong> the 


TABLE 3 

Individual <strong>and</strong> Group Data 

Mean Percent Change Across Conditions-Target Mealtime Behaviors 

Group 1 

BC2 condition <strong>and</strong> 96% <strong>in</strong> the BC condition 

was recorded. A total mean ga<strong>in</strong> of 30% from 

the basel<strong>in</strong>e condition (A) to the BC condition 

was recorded for Jason’s Goal 2. 

Denver. Basel<strong>in</strong>e data for Goal 1 (no spill<strong>in</strong>g 

on self or tray) revealed a mean accurate 

response rate of 12%. A mean 44% accurate 

response was achieved <strong>in</strong> the BC condition 

<strong>and</strong> decreased to 37% <strong>in</strong> the B condition. In 

the C condition, Denver <strong>in</strong>creased his accurate 

response rate to 52% <strong>in</strong> the C condition 

but decreased to a mean 49% <strong>in</strong> the BC2 

condition. He improved <strong>in</strong> the BC condition 

to a mean of 54%. Denver ga<strong>in</strong>ed a total mean 

of 42% from the basel<strong>in</strong>e condition (A) to the 

BC condition for Goal 1. Basel<strong>in</strong>e data for 

Denver’s Goal 2 (close lips with chew<strong>in</strong>g) revealed 

a mean accurate response rate of 24%. 

In the BC condition, his mean rate <strong>in</strong>creased 

by 36% to 60% correct responses <strong>and</strong> <strong>in</strong>creased 

to a mean 80% <strong>in</strong> the B condition. In 

the C condition, Denver’s mean accurate response 

rate decreased to 70%. This rema<strong>in</strong>ed 

unchanged <strong>in</strong> the BC2 condition, but <strong>in</strong>creased 

by 5% to 75% <strong>in</strong> the BC condition. 


Mean BC B C BC2 BC 

Total 


Brett (Take Small Bites) 47 35 8 6 2 2 49 

Jason (Use Napk<strong>in</strong> with Request) 7 90 3 0 0 0 93 

Denver (No Spills on Self or Tray) 12 32 7 15 3 5 42 


Group 2 


Mean B BC C BC2 BC 

Total 


Nate (Assist <strong>in</strong> Self-Feed<strong>in</strong>g with Spoon) 8 47 27 14 2 2 88 

Stacy (Open Mouth <strong>in</strong> Anticipation of Spoon) 44 27 11 2 8 8 52 

Jessica (Assist <strong>in</strong> Self-Feed<strong>in</strong>g with Spoon) 8 1 16 14 36 17 82 


Group 3 


Mean C BC B BC2 BC 

Total 


Dust<strong>in</strong> (Eat Non-preferred Foods) 9 20 5 7 1 37 60 

Kyle (Self-feed with Spoon) 70 3 8 2 14 0 23 

Anna (Eat Non-preferred Foods) 4 46 16 7 16 23 76 



Denver ga<strong>in</strong>ed a total mean of 51% from the 

<strong>in</strong>itial basel<strong>in</strong>e condition (A) through the 

BC condition for Goal 2. 

Nate. Nate’s performance data are shown 

<strong>in</strong> Figure 2. Basel<strong>in</strong>e data for Goal 1 (assist <strong>in</strong> 

self-feed<strong>in</strong>g with spoon) revealed a mean accurate 

response rate of 8%. This rate rose to 

55% <strong>in</strong> the B condition, to 82% <strong>in</strong> the BC 

condition, <strong>and</strong> to 96% <strong>in</strong> the C condition. In 

the BC2 condition, Nate’s accurate response 

rate decreased by 2% to 94%. In the BC 

condition, this rate <strong>in</strong>creased to 96%. Percent 

ga<strong>in</strong> from the basel<strong>in</strong>e condition (A) to the 

BC condition was 88%. Nate’s h<strong>and</strong>-tomouth 

movements improved throughout the 

study from requir<strong>in</strong>g maximal assistance to 

<strong>in</strong>dependent performance. 

Basel<strong>in</strong>e data for Nate’s Goal 2 (rhythmic 

sequence of 3 or more jaw movements with 

chew<strong>in</strong>g) revealed a mean accurate response 

rate of 70%. This rate <strong>in</strong>creased to 76% <strong>in</strong> the 

B condition <strong>and</strong> to 79% <strong>in</strong> the BC condition. 

In the C condition, Nate’s mean accurate response 

rate decreased to 68% but <strong>in</strong>creased to 

76% <strong>in</strong> the BC2 condition. In the BC condi-

tion, this rate <strong>in</strong>creased to 82%. Total percent 

ga<strong>in</strong> for Nate’s Goal 2 from the basel<strong>in</strong>e condition 

(A) to the BC condition was 12%. 

Stacy. Basel<strong>in</strong>e data for Stacy’s Goal 1 

(open mouth <strong>in</strong> anticipation of spoon) was 

measured at a mean 44% accurate response 

rate. This rate rose to 71% <strong>in</strong> the B condition 

<strong>and</strong> 82% <strong>in</strong> the BC condition, but decreased 

to 80% <strong>in</strong> the C condition. In the BC2 condition, 

Stacy’s mean accurate response rate rose 

to 88% <strong>and</strong> 96% <strong>in</strong> the BC condition. Stacy’s 

total mean ga<strong>in</strong> from the basel<strong>in</strong>e condition 

(A) to the BC condition was 52% for Goal 1. 

Basel<strong>in</strong>e data for Stacy’s Goal 2 (close lips with 

spoon<strong>in</strong>g) was a mean accurate response rate 

of 15%. In the B condition, this rate rose 23% 

to 75%. In the BC condition, accurate responses 

decreased to a mean rate of 57% but 

<strong>in</strong>creased to 65% <strong>in</strong> the C condition. Stacy’s 

mean accurate response rate decreased to 

59% <strong>in</strong> the BC2 condition. In the BC condition, 

Stacy’s mean accurate response rate was 

21%, correspond<strong>in</strong>g to a decrease of 38%. 

Total mean ga<strong>in</strong> from the basel<strong>in</strong>e condition 

(A) to the BC condition was 6% for Goal 2. 

Jessica. Basel<strong>in</strong>e data for Goal 1 (assist <strong>in</strong> 

self-feed<strong>in</strong>g with spoon) revealed a mean accurate 

response rate of 8%. In the B condition, 

this rate decreased to a mean 7%, but 

<strong>in</strong>creased to a mean 23% <strong>in</strong> the BC condition. 

In the C condition, Jessica’s mean accurate 

response rate <strong>in</strong>creased to 37% <strong>and</strong> to 73% <strong>in</strong> 

the BC2 condition. In the BC condition, 

Jessica ga<strong>in</strong>ed an additional 17% <strong>in</strong> accurate 

responses to a mean 90%. From the basel<strong>in</strong>e 

condition (A) to the BC condition, Jessica 

ga<strong>in</strong>ed a mean 82% accurate responses. Basel<strong>in</strong>e 

data for Jessica’s Goal 2 (active lips with 

spoon<strong>in</strong>g) was 4% for mean accurate responses. 

In the B condition, this rate was 15% 

<strong>and</strong> rema<strong>in</strong>ed stable throughout the BC condition, 

but fell to 11% <strong>in</strong> the C condition. In 

the BC2 condition, Jessica’s mean rate of accurate 

responses <strong>in</strong>creased to 31%. In the 

BC condition, her mean rate decreased to 

13%. Total ga<strong>in</strong> from the basel<strong>in</strong>e condition 


Dust<strong>in</strong>. Basel<strong>in</strong>e data for Goal 1 (eat nonpreferred 

food) was measured at a mean accurate 

response rate of 9%. In the C condition, 

this rate <strong>in</strong>creased to 29% but decreased 

to 24% <strong>in</strong> the BC condition. Dust<strong>in</strong>’s mean 

accurate response rate improved to 31% <strong>in</strong> 

the B condition, 32% <strong>in</strong> the BC2 condition, 

<strong>and</strong> improved by 37% to 69% <strong>in</strong> the BC 

condition. Total mean ga<strong>in</strong> from basel<strong>in</strong>e condition 


Basel<strong>in</strong>e data for Dust<strong>in</strong>’s Goal 2 (use napk<strong>in</strong> 

without request) revealed a mean accurate 

response rate of 6%. In the C condition, this 

rate dropped to a mean 0%, <strong>in</strong>creased to 1% 

<strong>in</strong> the BC condition, <strong>and</strong> decreased aga<strong>in</strong> to 

0% <strong>in</strong> the B condition. In the BC2 condition, 

Dust<strong>in</strong>’s mean rate of accurate responses <strong>in</strong>creased 

to 45% but decreased by 27% to 18% 

<strong>in</strong> the BC condition. Total <strong>in</strong>crease <strong>in</strong> mean 

rate of accurate responses from the basel<strong>in</strong>e 

condition (A) to the BC condition was 12% 

for Dust<strong>in</strong>’s Goal 2. 

Kyle. Kyle’s performance data are shown 

<strong>in</strong> Figure 3. Basel<strong>in</strong>e data for Goal 1 (assist <strong>in</strong> 

self-feed<strong>in</strong>g with spoon<strong>in</strong>g) revealed a mean 

rate of accurate responses of 70%. In the C 

condition, this rate was 73%, <strong>in</strong>creased to 81% 

<strong>in</strong> the BC condition, <strong>and</strong> decreased to 79% <strong>in</strong> 

the B condition. In the BC2 condition, Kyle’s 

mean rate of accurate responses <strong>in</strong>creased to 

93% <strong>and</strong> was ma<strong>in</strong>ta<strong>in</strong>ed <strong>in</strong> the BC condition. 

Dur<strong>in</strong>g the BC condition, Kyle demonstrated 

<strong>in</strong>dependent spoon<strong>in</strong>g, an act that had 

previously required full physical assistance to 

complete. Total ga<strong>in</strong> from the basel<strong>in</strong>e condition 

(A) to the f<strong>in</strong>al condition (BC) was 23% 

for Kyle’s Goal 1. Basel<strong>in</strong>e data (A) for Kyle’s 

Goal 2 (active lips with spoon<strong>in</strong>g) revealed a 

mean rate of accurate responses of 68%. In 

the C condition, this rate was unchanged. In 

the BC condition, the mean accurate response 

rate <strong>in</strong>creased to 83%, to 87% <strong>in</strong> the B condition, 

to 91% <strong>in</strong> the BC2 condition, <strong>and</strong> to 95% 

<strong>in</strong> the BC condition. Total ga<strong>in</strong> from the 

basel<strong>in</strong>e condition (A) to the BC condition 

was 27% for Kyle’s Goal 2. 

Anna. Basel<strong>in</strong>e data for Goal 1 (accept 

non-preferred foods) revealed a mean accurate 

response rate of 4%. In the C condition, 

this rate <strong>in</strong>creased 46% to 50%. Anna’s mean 

accurate response <strong>in</strong>creased to 66% <strong>in</strong> the BC 

condition, <strong>and</strong> to 73% <strong>in</strong> the B condition, but 

decreased to 57% <strong>in</strong> the BC2 condition. This 

rate <strong>in</strong>creased to 80% <strong>in</strong> the BC condition. 

Total ga<strong>in</strong> from the basel<strong>in</strong>e condition (A) 

through the BC condition was 76% for Goal 

1. Basel<strong>in</strong>e data for Anna’s Goal 2 (accept face 

wip<strong>in</strong>g) revealed a mean rate of accurate responses 

of 4%. In the C condition, this rate 

<strong>in</strong>creased by 46% to 50% <strong>and</strong> rema<strong>in</strong>ed stable 

throughout the BC condition. In the B condi- 


tion, this rate <strong>in</strong>creased to 66% <strong>and</strong> to 93% <strong>in</strong> 

the BC2 condition. In the BC condition, the 

mean rate of accurate responses decreased by 

33% to 60%. Total ga<strong>in</strong> from the basel<strong>in</strong>e 

condition (A) through the BC condition was 

56% for Goal 2. Additionally, Anna began 

us<strong>in</strong>g her napk<strong>in</strong> to make attempts to wipe 

her face dur<strong>in</strong>g the BC condition. 

Reliability Data 

Data relat<strong>in</strong>g to <strong>in</strong>terrater agreement on participant 

performance <strong>and</strong> <strong>in</strong>terventionists’ 

procedural fidelity were collected simultaneously 

dur<strong>in</strong>g at least 20% of all sessions <strong>and</strong> 

across all conditions (Bill<strong>in</strong>gsley et al., 1980; 

Tawney & Gast, 1984). These data were collected 

by videotape <strong>and</strong> by on-site raters (graduate 

students), who were <strong>in</strong>dividually tra<strong>in</strong>ed 

<strong>in</strong> the <strong>and</strong> – scor<strong>in</strong>g system <strong>and</strong> <strong>in</strong> the 

<strong>in</strong>terval record<strong>in</strong>g system. These two methods 

yielded both <strong>in</strong>terrater agreement coefficients 

for participant performance data <strong>and</strong> procedural 

reliability coefficients. 

Mean <strong>in</strong>terrater agreement on participant 

performance was .93 (range: .89-.98) <strong>and</strong> considered 

acceptable. A total of 45 <strong>in</strong>terrater 

reliability rat<strong>in</strong>gs were recorded via videotape 

<strong>and</strong> 61 on-site rat<strong>in</strong>gs were completed by the 

graduate students. Procedural reliability 

agreement data (Bill<strong>in</strong>gsley et al., 1980) were 

recorded across all <strong>in</strong>terventionists. A procedural 

reliability coefficient of .98 was calculated 

for graduate student <strong>in</strong>terventionists 

<strong>and</strong> a coefficient of .90 was calculated for 

school staff <strong>in</strong>terventionists <strong>in</strong> the BC condition. 


Limitations 

A number of limitations were identified <strong>in</strong> this 

study. First was the <strong>in</strong>ability to control feed<strong>in</strong>g 

methods or environments outside of the 

school sett<strong>in</strong>gs. It is not known how alternative 

feed<strong>in</strong>g environments <strong>and</strong>/or methods affected 

outcomes of this study. It is possible 

that poor feed<strong>in</strong>g techniques occurr<strong>in</strong>g <strong>in</strong> 

other sett<strong>in</strong>gs may have limited <strong>in</strong>dividual participants’ 

progress toward feed<strong>in</strong>g skill or positive 

mealtime behavior goals. 

Second was that only observable feed<strong>in</strong>g 

skills <strong>and</strong> mealtime behaviors were measured. 

Researchers did not have access to videofluoroscopic 

evaluations of swallow<strong>in</strong>g for pre<strong>and</strong> 

post<strong>in</strong>tervention measures of swallow<strong>in</strong>g. 

The SOMA evaluation was not st<strong>and</strong>ardized 

for use with older children <strong>and</strong> youth. Therefore, 

an objective pre- <strong>and</strong> post<strong>in</strong>tervention 

assessment of all phases of swallow<strong>in</strong>g was not 

conducted. 

Discussion of Research F<strong>in</strong>d<strong>in</strong>gs 


A functional relationship was established between 

the dysphagia treatment program <strong>and</strong> 

development of feed<strong>in</strong>g skills for all participants. 

A mean ga<strong>in</strong> of 6% was achieved across 

all <strong>in</strong>dividuals <strong>and</strong> groups across <strong>in</strong>dividualized 

feed<strong>in</strong>g skill goals dur<strong>in</strong>g the dysphagia 

treatment condition (B). Individual participants 

(i.e., Denver, Jessica) made ga<strong>in</strong>s of over 

10% dur<strong>in</strong>g the B condition toward their feed<strong>in</strong>g 

skill goals. A mean ga<strong>in</strong> of a 6% performance 

rate by children with moderate to severe 

disabilities that affect motor, sensory, <strong>and</strong> 

cognitive arenas supports use of dysphagia 

treatment methods for development of feed<strong>in</strong>g 

skills. These f<strong>in</strong>d<strong>in</strong>gs support previous research 

regard<strong>in</strong>g effects of dysphagia treatment 

programs on improvement of feed<strong>in</strong>g 

skills (Domaracki & Sisson, 1989; Gaebler & 

Hanzlik, 1996; Helfrich-Miller, Rector, & 

Straka, 1986). 

No overall functional relationship was 

found between the PRBMP <strong>and</strong> improvement 

of feed<strong>in</strong>g skills. A mean decrease of 1% occurred 

<strong>in</strong> feed<strong>in</strong>g skill acquisition <strong>in</strong> the C 

condition across all participants. While <strong>in</strong>dividual 

results varied (i.e., Brett <strong>and</strong> Stacy’s 

goals), positive re<strong>in</strong>forcement for exhibit<strong>in</strong>g a 

desired feed<strong>in</strong>g skill did not appear to be 

generally effective <strong>in</strong> facilitat<strong>in</strong>g development 

of feed<strong>in</strong>g skills. However, a functional relationship 

was established between PRBMP <strong>and</strong> 

development of positive mealtime behaviors. 

A mean ga<strong>in</strong> of 13% was measured across all 

participants for positive mealtime behavior 

goals dur<strong>in</strong>g the C condition. Two <strong>in</strong>dividual 

participants’ results (i.e., Dust<strong>in</strong> <strong>and</strong> Anna) 

were especially promis<strong>in</strong>g, with mean ga<strong>in</strong>s of 

20% <strong>and</strong> 46% respectively (see Table 3). 

These results confirm previous research regard<strong>in</strong>g 

effects of systematic positive re<strong>in</strong>forcement 

on improvement of positive mealtime 

behaviors (Kahng, Tarbox, & Wilke, 

2001; Kerw<strong>in</strong>, 1999; O’Brien et al., 1991).

A functional relationship was established 

between use of a comb<strong>in</strong>ed <strong>in</strong>tervention package 

<strong>and</strong> development of feed<strong>in</strong>g skills. Across 

all participants <strong>and</strong> feed<strong>in</strong>g skills, a mean ga<strong>in</strong> 

of 15% was made <strong>in</strong> the BC condition <strong>and</strong> 7% 

<strong>in</strong> the BC2 condition. This is remarkable 

progress, given the developmental nature of 

feed<strong>in</strong>g skill acquisition (Guerra & Vaughn, 

1994). Several participants (i.e., Brett, Jason, 

Denver, <strong>and</strong> Stacy) exhibited ga<strong>in</strong>s of more 

than 20% <strong>in</strong> the BC condition. A functional 

relationship was also found between use of the 

comb<strong>in</strong>ed <strong>in</strong>tervention package <strong>and</strong> development 

of positive mealtime behaviors. A mean 

ga<strong>in</strong> of 25% was recorded for all participants 

<strong>and</strong> across positive mealtime behavior goals <strong>in</strong> 

the BC condition. An additional mean ga<strong>in</strong> of 

4% was recorded <strong>in</strong> the BC2 condition. Several 

participants (i.e., Brett, Jason, Denver, 

<strong>and</strong> Stacy) exhibited mean ga<strong>in</strong>s above 20% <strong>in</strong> 

the BC condition. Dust<strong>in</strong> <strong>and</strong> Anna exhibited 

mean ga<strong>in</strong>s above 20% <strong>in</strong> the BC2 condition. 

A stronger relationship was found between 

improvement of feed<strong>in</strong>g skills <strong>and</strong> positive 

mealtime behaviors with use of the comb<strong>in</strong>ed 

<strong>in</strong>tervention package (BC) than with use of 

the dysphagia treatment program (B) alone 

or the PRBMP (C) alone. Across all participants 

<strong>and</strong> goals, the comb<strong>in</strong>ed <strong>in</strong>tervention 

package yielded the greatest improvements 

(20%). Ga<strong>in</strong>s recorded <strong>in</strong> the BC were greater 

than ga<strong>in</strong>s made <strong>in</strong> the B condition (8%) or <strong>in</strong> 

the C condition (6%). Greater mean ga<strong>in</strong>s 

were recorded <strong>in</strong> improvement of positive 

mealtime behaviors (25% <strong>in</strong> BC) with the 

comb<strong>in</strong>ed <strong>in</strong>tervention approach than <strong>in</strong> development 

of feed<strong>in</strong>g skills (15% <strong>in</strong> BC) 

across all participants. These results may <strong>in</strong>dicate 

that development of feed<strong>in</strong>g skills may be 

a more difficult process than changes <strong>in</strong> behavior. 

These results support use of a comb<strong>in</strong>ed 

<strong>in</strong>tervention package for treatment of 

both feed<strong>in</strong>g skill deficits <strong>and</strong> problematic 

mealtime behaviors across a variety of disability 

conditions <strong>and</strong> ages. While significant evidence 

exists that feed<strong>in</strong>g problems often 

<strong>in</strong>volve a comb<strong>in</strong>ation of physical <strong>and</strong> behavioral 

issues (e.g., Arvedson, 1997; Gisel, Birnbaum, 

& Schwartz, 1997; Logemann, 2000), 

the efficacy of dysphagia <strong>and</strong> PRBMP treatment 

<strong>in</strong>terventions has not been previously 

evaluated <strong>in</strong> a way that determ<strong>in</strong>es the effects 

of each <strong>in</strong>tervention separately <strong>and</strong> <strong>in</strong> comb<strong>in</strong>ation 

to isolate the effects of the <strong>in</strong>terven- 

tions. This <strong>in</strong>vestigation used a multiple treatment 

design across n<strong>in</strong>e participants with 

moderate to severe <strong>in</strong>tellectual disabilities, a 

wide range of ages, diagnoses, <strong>and</strong> feed<strong>in</strong>g 

skill <strong>and</strong> mealtime behavior deficits <strong>in</strong> three 

school sett<strong>in</strong>gs. 

A mean decrease of 7% <strong>in</strong> feed<strong>in</strong>g skills was 

recorded across all participants <strong>in</strong> the BC 

condition, although results varied across participants 

(see Table 2). This f<strong>in</strong>d<strong>in</strong>g underscores 

the need for advanced tra<strong>in</strong><strong>in</strong>g <strong>and</strong> 

support for school staff members work<strong>in</strong>g with 

children <strong>and</strong> youth with feed<strong>in</strong>g problems. No 

participant returned to pre<strong>in</strong>tervention levels 

as a result of staff implemented <strong>in</strong>terventions. 

A positive f<strong>in</strong>d<strong>in</strong>g was that a mean ga<strong>in</strong> of 10% 

occurred across groups <strong>in</strong> behavior goals 

when school staff members provided <strong>in</strong>terventions 

<strong>in</strong> the BC condition. Further research 

is needed to confirm f<strong>in</strong>d<strong>in</strong>gs of this study <strong>and</strong> 

to determ<strong>in</strong>e effects of additional <strong>in</strong>tervention 

comb<strong>in</strong>ations that will enhance the nutrition 

<strong>and</strong> health of children <strong>and</strong> youth with disabilities. 

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research <strong>in</strong> special education. Columbus, OH: Merrill. 

Received: 14 October 2003 

Initial Acceptance: 10 December 2003 

F<strong>in</strong>al Acceptance: 15 April 2004

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