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Education and
Training
in
Developmental
Disabilities
Focusing on individuals with
cognitive disabilities/mental retardation, autism, and related disabilities
Volume 43 Number 4 December 2008

December 2008 Education and Training in Developmental Disabilities Vol. 43, No. 4, pp. 409–572

Education and Training in Developmental Disabilities
The <strong>Journal</strong> of <strong>the</strong> <strong>Division</strong> on Developmental Disabilities,
The Council for Exceptional Children
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Education and Training in Developmental
Disabilities
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Education and Training in Developmental Disabilities
VOLUME 43 NUMBER 4 DECEMBER 2008
A Distributive Model of Treatment Acceptability 411
STACY L. CARTER
Individuals with Intellectual and Developmental Disabilities in <strong>the</strong> Criminal Justice
System and Implications for Transition Planning 421
TAMMY SMITH, EDWARD A. POLLOWAY, JAMES R. PATTON, and JULIA F. BEYER
Teaching Grocery Store Purchasing Skills to Students with Intellectual Disabilities
Using a Computer-Based Instruction Program 431
DAVID L. HANSEN and ROBERT L. MORGAN
Effectiveness of Discrete Trial Teaching with Preschool Students with
Developmental Disabilities 443
ANDREW DOWNS, ROBYN CONLEY DOWNS, MICHELLE FOSSUM, and KATHRYN RAU
Staff Variables that Influence Responses to Challenging Behaviour of Clients with
an Intellectual Disability: A Review 454
GREET LAMBRECHTS, KATJA PETRY, and BEA MAES
High Tech Cooking: A Literature Review of Evolving Technologies for Teaching a
Functional Skill 474
LINDA C. MECHLING
Using Literacy-Based Behavioral Interventions and Social Stories to Improve Work
Behavior in Employees with Developmental Disabilities 486
JESSICA L. BUCHOLZ, MICHAEL P. BRADY, MARY LOU DUFFY,
JACK SCOTT and LARRY G. KONTOSH
Enhancing <strong>the</strong> Job Performance of Employees with Disabilities Using <strong>the</strong> Self-
Determined Career Development Model 502
PATRICIA DEVLIN
Attitudes of Israeli Teachers and Paraprofessionals towards <strong>the</strong> New Definition of ID
and Their Willingness to Cope with Special Education Law Changes 514
HEFZIBA LIFSHITZ, SHOSHANNA NISSIM, and SARA COHEN
Implementation of a Programme for Students with Profound Intellectual and
Multiple Disabilities in Schools: Three Case Studies 529
ANNEMARIE C. TADEMA, CARLA VLASKAMP, and WIED RUIJSSENAARS
Caregiver-Delivered Home-Based Instruction Using Simultaneous Prompting for
Teaching Home Skills to Individuals with Developmental Disabilities 541
SEMA BATU
Noncontingent Escape Access to Self-Reinforcement to Increase Task Engagement
for Students with Moderate to Severe Disabilities 556
DAVID F. CIHAK and ROBERT I. GAMA
Index—Volume 43, 2008 569
Manuscripts Accepted for Future Publication in Education and Training in
Developmental Disabilities 410
The <strong>Division</strong> on Developmental Disabilities retains literary property rights on copyrighted articles. Up to 100
copies of <strong>the</strong> articles in this journal may be reproduced for nonprofit distribution without permission from <strong>the</strong>
publisher. All o<strong>the</strong>r forms of reproduction require permission from <strong>the</strong> publisher.

Manuscripts Accepted for Future Publication in Education
and Training in Developmental Disabilities
March 2009
State guidelines for mental retardation and developmental disabilities: A revisitation of previous
analyses in light of changes in <strong>the</strong> field. Edward A. Polloway, James R. Patton, J. David Smith,
Jaqueline Lubin, and Karen Antoine, Office of Graduate Studies, Lynchburg College, Lynchburg,
VA 24501.
No Child Left Behind, <strong>the</strong> Individuals with Disabilities Education Act and functional curricula: A
conflict of interest?. Emily C. Bouck, 5146 BRNG Hall, Purdue University, 100 N. University St.,
West Lafayette, IN 47907.
Using simultaneous prompting procedure to promote recall of multiplication facts by middle
school students with cognitive impairment. Shaila Rao and Lynette Mallow, 2034 Quail Cove Drive,
Kalamazoo, MI 49009.
Milieu <strong>the</strong>rapy as a communication intervention: A review of <strong>the</strong> literature related to children with
autism spectrum disorder. G. Richmond Mancil, University of Western Kentucky, College of
Education and Behavioral Sciences, 670 Wakefield Street, Bowling Green, KY 42103.
Decreasing inappropriate behaviors for adolescents with autism spectrum disorder using modified
social stories. Janet E. Graetz, Margo A. Mastropieri, and Thomas E. Scruggs, Oakland University,
420 C Pawley Hall, Rochester, MI 48309.
Presenting chained and discrete tasks as nontargeted information when teaching discrete academic
skills through small group instruction. Karen L. Jones, Belva C. Collins, Johm W. Schuster,
and Harold Kleinert, Department of Special Education & Rehabilitation Counseling, 229 Taylor
Education Building, University of Kentucky, Lexington, KY 40506-0001.
Use of video modeling to teach extinguishing of cooking related fires to individuals with moderate
intellectual disabilities. Linda C. Mechling, David L. Gast, and Melissa R. Gustafson, Department of
Early Childhood & Special Education, University of North Carolina Wilmington, 601 South
College Road, Wilmington, NC 28403-5940.
Effects of direct instruction on <strong>the</strong> reading comprehension of students with autism and developmental
disabilities. Mararet M. Flores and Jennifer B. Ganz, Department of Interdisciplinary
Learning and Teaching, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
78249.
A community-based accomodation program for adults with autism and mental retardation. Robert
Fox, Casey A. Holtz, and Amie M. Moist, Marquette University, Schroeder Health Complex,146,
P.O Box 1881, Milwaukee, WI 85287-2011.
Effects of antecedent prompt and test procedure on teaching simulated menstrual care skills to
females with developmental disabilities. Gulhan Ersoy, Elif Tekin-Iftar, and Gonul Kircaali-Iftar,
Anadolu Universitesi, Engelliler Arastirma Enstitusu, Eskisehir, 26470 TURKEY.
Efficacy of a systematic process for designing function-based interventions for adults in a community
setting. Martha Underwood, John Umbreit, and Carl Liaupsin, University of Arizona, Department
of Special Education, PO Box 210069, Tuscon, AZ 85721-0069.
Treatment of pica using a pica exchange procedure with increasing response effort. Stacy L.
Carter, Texas Tech University, College of Education, Box 41071, Lubbock, TX 79409-3273.
Address is supplied for author in boldface type.

A Distributive Model of Treatment Acceptability
Stacy L. Carter
Texas Tech University
Abstract: A model of treatment acceptability is proposed that distributes overall treatment acceptability into three
separate categories of influence. The categories are comprised of societal influences, consultant influences, and
influences associated with consumers of treatments. Each of <strong>the</strong>se categories are defined and <strong>the</strong>ir interrelationships
within <strong>the</strong> proposed model of treatment acceptability are described. The potential benefits of a
distributive model of treatment acceptability are discussed.
Treatment acceptability has been viewed as both
a limited (Cross-Calvert & Johnston, 1990) and a
highly comprehensive (Lennox & Miltenberger,
1990) concept in <strong>the</strong> evaluation of behavioral
interventions. Wolf (1978) first stressed <strong>the</strong> importance
of <strong>the</strong> concept of treatment acceptability
as a component of social validity, which he
described as a necessary element for maintaining
and expanding <strong>the</strong> use of behavioral procedures
by society. Kazdin (1980) defined treatment
acceptability as judgments of treatments
by actual or potential consumers of <strong>the</strong> treatments,
such as nonprofessionals, clients, laypersons,
and o<strong>the</strong>rs. This definition is most in line
with <strong>the</strong> limited conceptualization of treatment
acceptability described by Cross-Calvert and
Johnston, which only focuses on <strong>the</strong> evaluation
of treatments by <strong>the</strong> consumers of treatments.
The more comprehensive conceptualization
of treatment acceptability described by
Lennox and Miltenberger incorporates factors
influencing treatment acceptability that
may only be available to <strong>the</strong> practitioner designing
or recommending <strong>the</strong> treatment. This
comprehensive view of treatment acceptability
extends <strong>the</strong> more traditional view of treatment
acceptability as defined by Kazdin by
incorporating factors such as <strong>the</strong> ethical
guidelines of a profession, <strong>the</strong> influence of
meta-analyses and literature reviews, <strong>the</strong> expertise
of <strong>the</strong> practitioner, practitioner history
with a treatment, and practitioner bias.
Correspondence concerning this article should
be addressed to Stacy L. Carter, Texas Tech University,
College of Education, P.O. Box 41071, Lubbock,
TX 79409.
Education and Training in Developmental Disabilities, 2008, 43(4), 411–420
© <strong>Division</strong> on Developmental Disabilities
Recent developments such as legislation, research
on functional analysis of problem behaviors,
and <strong>the</strong> influence of Positive Behavior
Support (PBS) models of service delivery appear
to have increased <strong>the</strong> need for research
on treatment acceptability. While <strong>the</strong> consumers
of treatment may have access to and be
influenced by <strong>the</strong>se recent developments, it
appears that practitioners would be more
likely influenced by <strong>the</strong>se factors since <strong>the</strong>y
may have more training in <strong>the</strong>se areas and are
required to remain informed of <strong>the</strong>se types of
developments in order to provide appropriate
services. For example, most individuals who
interact with computers even on a daily basis
are not familiar with <strong>the</strong> most recent developments
in computer technology. Alternatively,
a person who works as a computer technician
or computer salesperson may be required to
be highly knowledgeable of <strong>the</strong> latest developments
in computer technology in order to
conduct <strong>the</strong>ir daily activities and thus <strong>the</strong>y
may be more influenced by <strong>the</strong>se latest developments
than those within o<strong>the</strong>r professions.
The same may be true for practitioners, who
regularly make recommendations regarding
behavioral treatments, because in order for
<strong>the</strong>m to make appropriate and ethical recommendations,
<strong>the</strong>y need to stay informed of <strong>the</strong>
latest developments in <strong>the</strong>ir field even more
so than <strong>the</strong> consumers to whom <strong>the</strong>y make
recommendations. The latest developments
in <strong>the</strong> field influence <strong>the</strong> recommendations
made by <strong>the</strong> practitioner and in turn influence
<strong>the</strong> decisions made by <strong>the</strong> consumers
with whom <strong>the</strong>y interact.
Considering <strong>the</strong> many factors that influence
Distributive Model / 411

<strong>the</strong> acceptability of treatments and <strong>the</strong> various
individuals or organizations that inhibit or enhance
<strong>the</strong>se influences, a new model of treatment
acceptability was proposed. Previous
models of treatment acceptability (see Witt &
Elliott, 1985 and Reimers, Wacker, & Koeppl,
1987) appear to be predictive and focus more
on clear understanding of treatments and how
treatment acceptability may lead to increases
or decreases in factors such as use of treatment,
integrity of treatment, and effectiveness
of treatment. The model of treatment acceptability
proposed in this paper distributes treatment
acceptability along <strong>the</strong> areas of society,
consultant, and consumer, each of which are
considered to be major influences on overall
treatment acceptability. This model extends
Kazdin’s (1980) definition of treatment acceptability
by incorporating Lennox and
Miltenberger’s (1990) conceptualization of
factors influencing treatment acceptability
which go beyond those factors immediately
available to most consumers. In addition, this
model attempts to incorporate <strong>the</strong> recommendations
made by Schwartz and Baer
(1991) which suggests that treatment acceptability
should go beyond just <strong>the</strong> consumers of
treatment and include input from a larger
segment of society. Specifically, this model
(see Figure 1) focuses on broad segments of
society, consultants who develop treatments,
and consumers of treatments that may directly
Figure 1. Distributive model of treatment acceptability.
and indirectly influence treatment acceptability.
This model does not replace previous
models of acceptability but attempts to build
on Reimers et al. model by extending <strong>the</strong>ir
concept of <strong>the</strong> need for a good understanding
of treatment in order to rate <strong>the</strong> acceptability
of treatment by promoting an awareness of
how personal judgments of acceptability are
developed. Each of <strong>the</strong> components proposed
within this model are described along with
<strong>the</strong>ir corresponding interaction with o<strong>the</strong>r
components of <strong>the</strong> model.
Societal Acceptability
412 / Education and Training in Developmental Disabilities-December 2008
Schwartz and Baer (1991) proposed several
recommendations for improving social validity
assessment such as expanding <strong>the</strong> definition
of consumers to represent more individuals
from <strong>the</strong> community and beyond who
may influence <strong>the</strong> use of treatments. By examining
how overall treatment acceptability may
be distributed across several influential factors
such as large segments of society which may
influence <strong>the</strong> development and use of treatments,
<strong>the</strong> concept of societal acceptability
was developed.
Societal acceptability incorporates <strong>the</strong> influences
that arise from a broader segment of
society ra<strong>the</strong>r than just those who are typically
involved in <strong>the</strong> development and implementation
of specific treatments used for individ-

uals. These influences are generally developed
through <strong>the</strong> evaluation of opinions,
arguments, and actions of large groups of people.
Laws and legislation such as <strong>the</strong> Individuals
with Disabilities Education Act (2004)
have promoted <strong>the</strong> use of empirically based
treatments in <strong>the</strong> least restrictive environment.
This in turn appears to designate treatments
without an empirical basis as less acceptable
as well as treatments that are not
implemented in <strong>the</strong> least restrictive environment.
O<strong>the</strong>r large segments of society which
influence <strong>the</strong> acceptability of treatments are
professional associations, parent organizations,
treatment review committees, and university
affiliated training/treatment programs.
Each of <strong>the</strong>se may design new treatments, develop
ethical obligations, and promote movements
that encourage or discourage <strong>the</strong> use of
specific treatments.
An example of how research in <strong>the</strong> assessment
and design of treatments has resulted in
changes in <strong>the</strong> acceptability of treatments can
be seen by examining <strong>the</strong> influence of functional
assessment technology on <strong>the</strong> use of
particular treatments. Research by Carr and
Durand (1985) and Iwata, Dorsey, Slifer, Bauman,
and Richman (1982/1994) has had a
profound influence on educational legislation,
assessment of behavior, and use of treatments
that incorporate specific reinforcement
techniques ra<strong>the</strong>r than punishment. Hanley,
Iwata, and McCord (2003) described how
prior to <strong>the</strong> development of functional analysis
methodologies, treatments typically involved
arbitrary reinforcement or punishment
to overpower unknown sources of reinforcement.
With <strong>the</strong> introduction of functional
analysis approaches <strong>the</strong> source of reinforcement
for behaviors could be determined and
treatments could be designed to exploit specific
reinforcement contingencies. Mccausland,
Grey, Wester, and McClean (2004)
found that treatments based on functional assessment
information for aggressive behavior
were more acceptable than treatments which
were not derived from functional assessments.
These procedures have influenced legislation
such as IDEA (2004) which now mandates
functional behavior assessments under certain
circumstances and have potentially influenced
<strong>the</strong> acceptability of treatments by making
those treatments developed without <strong>the</strong> assis-
tance of a functional assessment potentially
less acceptable due to <strong>the</strong>se legislative mandates.
One movement that has been highly influential
with regard to educational legislation
has been <strong>the</strong> ideology of positive behavior
supports (PBS). This movement has promoted
<strong>the</strong> incorporation of lifestyle considerations
and person-centered values in <strong>the</strong> development
of treatments as well as less use of
consequence-based decelerative techniques
(Anderson & Freeman, 2000). This movement
has been highly influential within society and
has been shown to have a direct influence on
<strong>the</strong> acceptability of treatments by individuals
responsible for <strong>the</strong> development and implementation
of treatments. Michaels, Brown,
and Mirabella (2005) described a possible paradigm
shift based on <strong>the</strong> PBS movement. They
surveyed experts in positive behavior supports
and found a decrease in <strong>the</strong> acceptability of
consequence-based decelerative techniques
and a decrease in <strong>the</strong> use of such procedures
although many had used <strong>the</strong>se types of procedures
in <strong>the</strong> past. The experts indicated that
ethical reasons were most influential in altering
<strong>the</strong>ir acceptability of specific treatments
along with <strong>the</strong> development of more effective
treatment alternatives. Their findings revealed
that treatment acceptability can change
over time especially in <strong>the</strong> face of large scale
movements such as PBS, changing ethical
guidelines, and <strong>the</strong> development of new treatment
methodologies.
All of <strong>the</strong>se influences combine to form <strong>the</strong>
construct of societal acceptability which is considered
a part of overall treatment acceptability.
Societal acceptability may influence overall
treatment acceptability by limiting <strong>the</strong>
possible types or numbers of interventions
that may be considered, by pushing for <strong>the</strong>
use of specific types of interventions, and by
restricting <strong>the</strong> manner in which treatments
may be implemented. In addition, societal acceptability
may influence both consultants
and consumers of treatments. The laws and
regulations that are developed by larger segments
of society have direct influence on consultants
who must abide by ethical and legal
guidelines when developing treatments.
These laws and regulations may have both a
direct and an indirect influence on <strong>the</strong> consumers
of treatments. In many cases <strong>the</strong> asso-
Distributive Model / 413

ciations, boards, and committees responsible
for developing ethical and legal guidelines are
composed of or informed by consultants and
consumers of treatments. While societal acceptability
may directly influence consultants,
it may also influence consumers of treatments
indirectly through consultants who modify <strong>the</strong>
treatments <strong>the</strong>y develop to meet ethical and
legal guidelines. Societal acceptability may
also directly influence consumers of treatments
since <strong>the</strong>y may be members of associations,
committees, etc. and <strong>the</strong>y may be exposed
to <strong>the</strong> research and rhetoric associated
with movements such as PBS, Gentle Teaching
(McGee, Menolascino, Hobbs, & Menousek,
1987), Toughlove (York, York, & Wachtel,
1982), etc.
The influence that societal acceptability has
upon both consultants and consumers is reciprocal
in that societal acceptability is both
directly and indirectly influenced by both consultants
and consumers. Consultants and consumers
may directly influence societal acceptability
by becoming members of <strong>the</strong> boards
and committees that develop laws and ethical
guidelines or through litigation such as class
action lawsuits. They may also indirectly influence
societal acceptability by developing new
treatments or technologies related to treatments
such as functional analysis approaches.
Consultants and consumers of treatments may
indirectly influence societal acceptability
through movements or campaigns for certain
rights associated with treatments. While societal
acceptability appears to influence and be
influenced by consultants and consumers, <strong>the</strong>
most direct and obvious connection appears
to be among societal acceptability and consultants
which will be described next.
Consultant Acceptability
The designers of treatments are typically consultants
who have training and experience
necessary to develop, implement, and monitor
treatments. Consultants can be highly influential
in <strong>the</strong> overall acceptability of treatments
and that influence is referred to as
consultant acceptability within this model.
Consultants may vary greatly with regards to
<strong>the</strong>ir training, history with treatments, and
competencies. Each of <strong>the</strong>se factors can be
highly prominent in <strong>the</strong> types of treatments
414 / Education and Training in Developmental Disabilities-December 2008
that <strong>the</strong>y propose and develop. Consultants
with training in PBS may propose and develop
more treatments that fit with this orientation
than consultants without this training just as
those with training in cognitive behavioral
<strong>the</strong>rapies may propose and develop more
treatments from this orientation. Ethical
guidelines typically require that professionals
practice only within those areas in which <strong>the</strong>y
are competent, and with <strong>the</strong> wealth of information
available and <strong>the</strong> numerous areas of
specialization, most consultants can only be
competent in a limited number of areas.
These limitations influence consultant acceptability
by increasing or decreasing <strong>the</strong>ir experience
and knowledge of certain treatments
and may influence <strong>the</strong>ir judgments of <strong>the</strong> acceptability
of certain treatments. Singh and
Katz (1985) found that formal educational
training could change acceptability ratings of
college students and this implies that <strong>the</strong> formal
training that consultants receive may be
influential in how acceptable <strong>the</strong>y find treatments.
It seems reasonable that consultants
would only recommend treatments that <strong>the</strong>y
consider acceptable <strong>the</strong>mselves and this could
be considered an ethical obligation within
<strong>the</strong>ir profession. This demonstrates how societal
acceptability may be influencing consultant
acceptability.
A more obvious demonstration of how societal
acceptability may combine with and influence
consultant acceptability can be seen
when examining <strong>the</strong> professional affiliations
of consultants. Spreat and Walsh (1994)
found treatment acceptability differences
among members of different divisions of <strong>the</strong>
American Association on Mental Retardation.
They determined that members of <strong>the</strong> Psychology
<strong>Division</strong> rated treatments slightly
more acceptable than members of o<strong>the</strong>r divisions.
Similarly, Fairbanks and Stinnett (1997)
found differences in treatment acceptability
among teachers, school psychologists, and social
workers. Social workers rated punishmentbased
treatments as less acceptable than <strong>the</strong>
o<strong>the</strong>r two professional groups. While membership
in a professional organization has
been shown to influence treatment acceptability,
it does not clarify whe<strong>the</strong>r <strong>the</strong> differences
among <strong>the</strong>se groups were prevalent prior to
membership within <strong>the</strong> group or whe<strong>the</strong>r
membership in <strong>the</strong> group shaped <strong>the</strong>ir judg-

ments of treatment acceptability through
training, experiences, ethical guidelines, etc.
The treatments developed or recommended
by consultants may depend upon several
factors o<strong>the</strong>r than <strong>the</strong>ir past training, history
with specific treatments, or professional
association memberships. Consultants who
continually hone <strong>the</strong>ir skills in efforts to maintain
familiarity with <strong>the</strong> most recent research
developments may be more likely to use treatments
that have only recently been developed
or shown to be highly effective. This can be
seen with <strong>the</strong> advances made in functional
analysis approaches which were described previously.
A consultant who was familiar with
<strong>the</strong>se approaches or who was trained in <strong>the</strong>se
approaches would be more likely to incorporate
<strong>the</strong>se techniques than a consultant who
was not familiar with <strong>the</strong>se approaches. In
addition, a consultant who was not familiar
with <strong>the</strong>se techniques may ethically be discouraged
from using <strong>the</strong>se techniques without
proper training. Consultants who use functional
analysis approaches may be more likely
to recommend certain treatment procedures
suggested by <strong>the</strong> findings of <strong>the</strong> assessment
over o<strong>the</strong>r arbitrary techniques. This is an
example of consultant acceptability where one
treatment is considered more acceptable than
ano<strong>the</strong>r treatment because of <strong>the</strong> familiarity
and use of certain assessment techniques. A
consultant may also influence <strong>the</strong> acceptability
of a potential treatment by simply not presenting
it as an option to a consumer.
Consultants may influence <strong>the</strong> acceptability
of a treatment through <strong>the</strong>ir interactions with
a consumer. A consultant, while ga<strong>the</strong>ring
knowledge about a consumer and <strong>the</strong> consumer’s
situation, may become more or less
inclined to recommend certain treatments.
The consultant may feel that a particular consumer
may respond better to a certain treatment
for a variety of reasons. Factors such as
<strong>the</strong> level of functioning of a consumer, <strong>the</strong>
availability of resources to <strong>the</strong> consumer, or
<strong>the</strong> severity of <strong>the</strong> consumer’s problems may
all influence <strong>the</strong> treatment recommendations
made by a consultant. Consultants may also
influence acceptability by <strong>the</strong> amount of information
that <strong>the</strong>y provide to consumers and
<strong>the</strong> presentation method that <strong>the</strong>y use with
consumers. Singh and Katz (1985) found that
acceptability ratings changed after training
was provided on specific details of treatments,
empirical data on <strong>the</strong> effectiveness of treatments,
and potential side effects of treatments.
This type of information would typically
be provided to <strong>the</strong> consumer by a
consultant who developed <strong>the</strong> treatment. Similarly,
Kazdin and Cole (1981) and Witt, Moe,
Gutkin, and Andrews (1984) found that <strong>the</strong>
terminology or jargon used to described a
treatment such as humanistic or behavioral
jargon influenced <strong>the</strong> acceptability of treatments.
A consultant who uses a specific type of
terminology to describe a treatment to a consumer
may influence <strong>the</strong> acceptability of a
treatment as rated by a consumer. While consultants
would be obligated to provide informed
consent to consumers, <strong>the</strong> amount of
information <strong>the</strong>y provide and <strong>the</strong> manner in
which <strong>the</strong>y present <strong>the</strong> information might vary
depending on <strong>the</strong> complexity of <strong>the</strong> treatment,
<strong>the</strong> restrictiveness of <strong>the</strong> treatment, <strong>the</strong>
characteristics of <strong>the</strong> consumer, or numerous
o<strong>the</strong>r variables. Each of <strong>the</strong> interactions described
between consultants and consumers
may be examples of how consultant acceptability
influences overall treatment acceptability.
Ano<strong>the</strong>r area in which consultants may influence
overall acceptability is through <strong>the</strong>
method used to assess treatment acceptability.
Consultants are frequently <strong>the</strong> individuals
who select <strong>the</strong> manner in which treatment
acceptability will be measured. Consultants
may choose to measure acceptability informally
by asking a few questions or <strong>the</strong>y may
use a more formal instrument that has established
validity and reliability. A consultant who
chooses to use an informal procedure may ask
questions that are not valid or reliable toward
assessing treatment acceptability and <strong>the</strong>reby
obtain measures that are not accurate. Conversely,
some more formal treatment acceptability
instruments do not provide specific cutoff
points for distinguishing between
acceptable and unacceptable treatments.
Some of <strong>the</strong>se formal instruments rely upon
general rule of thumb such as using <strong>the</strong> midpoint
of a scale for cut-off points to distinguishing
acceptable and unacceptable treatments.
Whe<strong>the</strong>r informal procedures or
formal instruments are used, <strong>the</strong> consultant
may still influence <strong>the</strong> acceptability of a treatment
through <strong>the</strong> selection of individuals who
Distributive Model / 415

are allowed to complete <strong>the</strong> acceptability ratings.
The consultant may choose to obtain
acceptability ratings from one person or <strong>the</strong>y
may obtain ratings from numerous individuals
involved with <strong>the</strong> treatment. In addition, consultants
may choose to selectively obtain acceptability
ratings, or <strong>the</strong>y may obtain acceptability
ratings on most or all treatments <strong>the</strong>y
develop. As recommended by Lennox and
Miltenberger (1990) consultants may obtain
several acceptability ratings on highly similar
treatments which <strong>the</strong>y may use to compile
local, regional, or national measures of acceptability.
These more global measures could
be used to influence <strong>the</strong>ir use of specific treatments
or could be used to influence <strong>the</strong> committees
and associations comprising societal
acceptability factors.
The design elements of treatments have
been shown to consistently influence <strong>the</strong> overall
acceptability of <strong>the</strong> treatments. Consultants
construct specific treatments and are frequently
responsible for training <strong>the</strong> components
of treatments to individuals who implement
<strong>the</strong> treatments. This makes <strong>the</strong> actual
treatment elements highly dependent upon
<strong>the</strong> consultant who develops <strong>the</strong>m and are
<strong>the</strong>refore included as part of consultant acceptability.
While <strong>the</strong> actual components of
treatment may independently influence acceptability,
<strong>the</strong>y cannot first be considered unless
<strong>the</strong>y are included and described by <strong>the</strong>
consultant. Several treatment variables have
been found to influence treatment acceptability
and are incorporated into this distributive
model as part of consultant acceptability since
<strong>the</strong>y are considered dependent upon <strong>the</strong> consultant
to include <strong>the</strong>m in <strong>the</strong> development of
a treatment. Treatment variables that have
been found to influence treatment acceptability
include use of reinforcement and punishment
techniques (Kazdin, 1980), amount of
time required to implement treatment (Witt,
Elliott, & Martens, 1984), and <strong>the</strong> apparent
appropriateness of <strong>the</strong> treatment (Cavell,
Frentz, & Kelley, 1986). Each of <strong>the</strong>se treatment
variables would depend upon how <strong>the</strong>
consultant chose to design <strong>the</strong> treatment and
if <strong>the</strong>y chose to include specific treatment
variables such as reinforcement, punishment,
reductions in implementation time, or components
to increase <strong>the</strong> apparent appropriateness
of treatments. O<strong>the</strong>r treatment variables
found to influence acceptability that may be
dependent on <strong>the</strong> consultant could include
treatment efficacy (Brock & Elliott, 1987) and
<strong>the</strong> mediator of <strong>the</strong> treatment (Kalfus & Burk,
1989). Each of <strong>the</strong>se variables may be dependent
on <strong>the</strong> consultant for selecting treatments
considered highly effective and for
training individuals to implement treatments.
While each of <strong>the</strong>se factors may be dependent
upon <strong>the</strong> consultant, <strong>the</strong>y may also independently
influence acceptability when consumers
have prior experience or knowledge of
treatments. This type of influence on acceptability
would not depend on <strong>the</strong> consultant to
provide information on <strong>the</strong> treatment, but
would ra<strong>the</strong>r be a direct influence on <strong>the</strong>
consumer because of <strong>the</strong>ir history with <strong>the</strong>
treatment. The factors that comprise consumer
acceptability will now be described.
Consumer Acceptability
416 / Education and Training in Developmental Disabilities-December 2008
The actual or potential consumers of treatments
have defined by Kazdin (1980) as nonprofessionals,
clients, laypersons, and o<strong>the</strong>rs.
A number of variables related to <strong>the</strong> consumer
have been found to influence treatment
acceptability. Within <strong>the</strong> proposed distributive
model, each of <strong>the</strong>se variables are
described as consumer acceptability which
helps to comprise overall treatment acceptability.
Consumer acceptability is described
within this model as two sets of variables related
to <strong>the</strong> actual clients who potentially receive
treatments and those who may assist in
<strong>the</strong> selection of treatments such as parents,
guardians, mediators of treatments, etc. who
rate <strong>the</strong> acceptability of treatments. Client
variables that have been found to influence
acceptability include <strong>the</strong> severity of client
problem (Kazdin; Tingstrom, 1990). Reimers,
Wacker, Cooper, and De Raad (1992) found
increases in acceptability ratings when less intrusive
treatments such as positive reinforcement
were recommended for less severe behaviors
and when more intrusive treatments,
such as medication were recommended for
more severe behavior problems. This indicated
that selecting a treatment based on <strong>the</strong>
severity of a client’s problem behaviors may
influence <strong>the</strong> acceptability of <strong>the</strong> treatment.
Several variables related to <strong>the</strong> characteristics
of those who rate <strong>the</strong> acceptability of treat-

ments have been found to influence treatment
acceptability. Some of <strong>the</strong>se variables
include <strong>the</strong> gender of raters (Kazdin, 1980;
Miller & Kelley, 1992), <strong>the</strong> raters’ knowledge
of <strong>the</strong> treatment (Singh & Katz, 1985), raters’
socioeconomic class (Heffer & Kelley, 1987),
geographic location of raters’ high school
(Stinnett, Crawford, Gillespie, Cruce, & Langford,
2001), parenting a child with a medical
disorder (Gage & Wilson, 2000; Miller,
Manne, & Palevsky, 1998), and raters’ experiencing
marital distress (Miller & Kelley).
Many of <strong>the</strong>se variables such as gender and
marital distress appear to be completely independent
from influence by a consultant or
from societal factors related to treatments.
Some of <strong>the</strong> o<strong>the</strong>r rater variables such as
knowledge of treatment may be dependent
upon information provided by a consultant or
possibly by societal influences such as professional
training or affiliations with associations
or movements such as PBS. In addition, parents,
friends, or relatives of individuals with
medical or psychiatric diagnoses may frequently
become involved in associations,
movements, or support groups to obtain information.
This may make variables discussed
within societal acceptability especially influential
with <strong>the</strong>se potential raters’ of treatments.
Potential Benefits of a Distributive Model of
Treatment Acceptability
It has been determined that numerous factors
may influence <strong>the</strong> acceptability of treatments.
The proposed distributive model delineates
three primary subdivisions each consisting of
multiple factors that may influence overall
treatment acceptability. Some of <strong>the</strong>se factors
have been demonstrated to influence acceptability
such as <strong>the</strong> PBS movement (Michaels et
al., 2005), consultant membership in associations
(Spreat & Walsh, 1994), and geographic
location of raters’ high school (Stinnett et al.,
2001). O<strong>the</strong>r factors discussed have not been
demonstrated to influence overall treatment
acceptability, but appear to have <strong>the</strong> potential
to influence acceptability. With <strong>the</strong> proposed
model, it may be possible to recognize and
evaluate <strong>the</strong>se o<strong>the</strong>r factors to determine if
and how <strong>the</strong>y may be influential toward treatment
acceptability. The proposed model offers
a method for arranging and potentially
evaluating factors in a more discrete manner
than has been done previously. Research on
treatment acceptability has predominantly
manipulated variables on three levels which
involved manipulations involving <strong>the</strong> actual
treatment components, manipulations involving
<strong>the</strong> characteristics of <strong>the</strong> client targeted
for treatment, and manipulations involving
differences among those rating <strong>the</strong> acceptability
of treatments. While this research has produced
a wealth of information regarding how
treatment acceptability may be influenced, it
appears to combine numerous factors toge<strong>the</strong>r
which might provide more information
if examined separately. Examining treatment
acceptability using <strong>the</strong> proposed distributive
model may allow for comparisons to be made
between <strong>the</strong> distinct subdivisions and provide
information on <strong>the</strong> degree of influence related
to each subdivision. Examining treatment
acceptability along <strong>the</strong>se subdivisions
may also provide information on trends within
organizations, among consultants, and for
consumers with similar characteristics.
The proposed distributive model provides a
framework for examining factors influencing
overall treatment acceptability in at least three
distinct ways. First, <strong>the</strong> research on treatment
acceptability has produced several contradictory
findings. The proposed distributive
model of treatment acceptability may assist in
understanding some of <strong>the</strong>se contradictory
findings by recognizing <strong>the</strong> different subdivisions
of treatment acceptability. For example,
it may be valuable to determine how some very
specific characteristics of consumers such as
geographic location of <strong>the</strong>ir high schools or
<strong>the</strong>ir level of marital distress influence <strong>the</strong>ir
acceptability ratings, but it is not known if or
to what extent this influences <strong>the</strong> development
or selection of treatments by consultants.
The proposed distributive model provides
a means for understanding some of <strong>the</strong>
variability that has been attributed to overall
treatment acceptability. As described by
Hawkins (1991), <strong>the</strong> degree to which a treatment
is considered acceptable by a consultant
may differ markedly from that of a consumer.
Examining only overall treatment acceptability
does not offer insight into how varied acceptability
may be between consultants, consumers,
and society in general.
Although numerous factors may influence
Distributive Model / 417

<strong>the</strong> acceptability ratings of members of each
of <strong>the</strong> subdivisions of this distributive model,
it appears that consumer acceptability would
vary more than <strong>the</strong> o<strong>the</strong>r subdivisions because
of <strong>the</strong> vast number of differences among potential
consumers. While numerous differences
may also exist among consultants, it is
expected that <strong>the</strong>y would have some similarities
ei<strong>the</strong>r in training, familiarity with certain
treatments, or experience that would produce
less variability in <strong>the</strong>ir acceptability ratings. In
addition, societal acceptability would appear
to produce very high or very low variability in
acceptability depending on what segments of
society are evaluated. Certain groups or organizations
would appear to produce minimal
variability in acceptability because <strong>the</strong>se organizations
may be formed from individuals who
voluntarily joined <strong>the</strong> organization because it
fit with <strong>the</strong>ir personal ideologies. O<strong>the</strong>r segments
of society may vary markedly in <strong>the</strong>ir
acceptability of treatments because of extreme
differences in <strong>the</strong> characteristics of <strong>the</strong>se individuals.
The proposed distributive model provides
a means of explaining some of <strong>the</strong> variability
with acceptability ratings and how this
variability can be understood within overall
treatment acceptability. The proposed distributive
model should encourage research to examine
interactions among <strong>the</strong> subdivisions of
<strong>the</strong> model in order to understand some of <strong>the</strong>
previously contradictory findings of treatment
acceptability.
Ano<strong>the</strong>r benefit of <strong>the</strong> proposed distributive
model is that it provides specific subdivisions
of treatment acceptability which may respond
to change in different ways. Finney
(1991) stated that treatment acceptability was
not a static phenomenon and that it should be
constantly reevaluated in order to provide accurate
measures. By examining treatment acceptability
along <strong>the</strong> subdivisions outlined
within <strong>the</strong> proposed distributive model, it
might be possible to gain an understanding of
some of <strong>the</strong> interactions that may be occurring
between large segments of society, consultants,
and consumers. Simultaneously,
obtaining measurements of societal acceptability,
consultant acceptability, and consumer
acceptability may show interactions among
<strong>the</strong>se components of treatments acceptability,
but potentially more importantly, it may be
able to predict trends associated with <strong>the</strong> ac-
ceptability of treatments. These trends may be
difficult to identify using an overall measure
of treatment acceptability, but by examining
acceptability along <strong>the</strong> three subdivisions outlined
within <strong>the</strong> current proposed model, it
might be possible to demonstrate <strong>the</strong> rate in
which acceptability may change within each of
<strong>the</strong>se subdivisions. Michaels et al. (2005)
found a change in acceptability of treatments
among PBS experts which occurred over a ten
to twenty year period. This rate of change
might be very different from changes in acceptability
among consumers. Differences in
acceptability ratings have been found among
parents with and without children with health
impairments, consumers with and without
marital stress, and among consumers of different
socioeconomic classes (Heffer & Kelley,
1987). Each of <strong>the</strong>se factors appear to be
highly erratic and could influence acceptability
ratings to change very rapidly.
Summary
418 / Education and Training in Developmental Disabilities-December 2008
The proposed distributive model supports
Schwartz and Baer’s (1991) recommendations
toward expanding <strong>the</strong> evaluation of treatment
acceptability to more individuals who may influence
<strong>the</strong> use of treatments. The model divides
overall treatment acceptability into three
subdivisions of societal acceptability, consultant
acceptability, and consumer acceptability.
Each of <strong>the</strong>se subdivisions include factors that
may independently influence overall treatment
acceptability and factors which may be
dependent on elements from o<strong>the</strong>r subdivisions
such as consumers’ opportunity to rate
<strong>the</strong> acceptability being dependent upon <strong>the</strong>
consultants’ selection or design of specific
treatments. While each of <strong>the</strong>se subdivisions
may influence overall treatment acceptability
in different ways, it appears that consultant
acceptability has more potential factors that
could influence overall treatment acceptability.
This appears consistent with <strong>the</strong> top-down
social marketing framework proposed by Winett,
Moore, and Anderson (1991) for designing
socially valid treatments. Their description
of <strong>the</strong> steps necessary for developing a socially
valid treatment included having “experts” decide
<strong>the</strong> minimal guidelines for a treatment.
Although consultant acceptability has more
potential factors to influence overall treat-

ment acceptability <strong>the</strong>se factors could be less
influential than factors included in o<strong>the</strong>r subdivisions.
For example, societal factors may
include legislation which could make certain
treatments illegal. This would most likely be
more influential to overall treatment acceptability
than factors such as consultants’ training
orientation or history with a treatment.
While <strong>the</strong> degree to which each subdivision
influences overall treatment acceptability is
currently unknown, <strong>the</strong> recognition that each
of <strong>the</strong>se subdivisions may play a part in determining
overall treatment acceptability appears
advantageous. By recognizing <strong>the</strong> influence
of each of <strong>the</strong>se subdivisions it may be
possible to gain a better understanding of how
treatment acceptability judgments are developed
and eventually assist in predicting how
treatment acceptability may influence o<strong>the</strong>r
outcomes such as treatment integrity and effectiveness.
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Received: 12 April 2007
Initial Acceptance: 10 June 2007
Final Acceptance: 10 August 2007
420 / Education and Training in Developmental Disabilities-December 2008

Individuals with Intellectual and Developmental Disabilities
in <strong>the</strong> Criminal Justice System and Implications for Transition
Planning
Tammy Smith
Campbell County (VA) Schools
Edward A. Polloway
Lynchburg College
James R. Patton
University of Texas at Austin
Julia F. Beyer
Lynchburg College
Abstract: The focus of this manuscript is on <strong>the</strong> challenges faced by individuals with developmental and
intellectual disabilities within <strong>the</strong> criminal justice system. Prevalence data are cited and <strong>the</strong>se data are
interpreted in light of possible rationales for <strong>the</strong> disproportionate number of individuals with disabilities present
within <strong>the</strong> system. Then <strong>the</strong> specific challenges faced by individuals with disabilities are discussed within <strong>the</strong>
context of three key elements of <strong>the</strong> criminal justice system: interrogation and arrest, prosecution, and sentencing
and disposition. The paper concludes with a discussion of <strong>the</strong> implications of this information for life skills
instruction and transition planning. Specific recommendations are provided in terms of curriculum and
instruction as well as community advocacy.
Transition planning is a central focus in <strong>the</strong>
development of individualized educational
programs as students enter <strong>the</strong> middle and
high school years of school. As a part of that
training, especially in cases of students with
developmental and intellectual disabilities
(D/ID), effective planning can help <strong>the</strong>se students
gain as much personal autonomy as possible
and acquire critical self-determination
skills. This process most commonly is accomplished
by teaching skills such as how to maintain
a home, manage finances, arrange leisure
activities, be successful in <strong>the</strong> workplace, and
make important life decisions. However one
important area may be too often overlooked:
teaching students basic information about potential
interactions with <strong>the</strong> criminal justice
Correspondence concerning this article should
be addressed to Edward A. Polloway, Office of Graduate
Studies and Community Advancement, Lynchburg
College, Lynchburg, VA 24501. Email:
polloway@lynchburg.edu
Education and Training in Developmental Disabilities, 2008, 43(4), 421–430
© <strong>Division</strong> on Developmental Disabilities
system. By not addressing this key life domain,
many students with disabilities will leave secondary
education ill-prepared for <strong>the</strong> realities
that may be associated with subsequent encounters
with <strong>the</strong> criminal justice system.
While this area may seem like an incidental
component to life skills education, recent research
establishes a strong case for such an
emphasis. A number of reports have recognized
<strong>the</strong> difficulties that persons with mental
retardation experience within <strong>the</strong> criminal
justice system. Most notably, Perske’s (e.g.,
2000, 2005) work in this area has highlighted
<strong>the</strong> problem and discussed <strong>the</strong> consequences.
The most dramatic attention has been given
to a focus on mental retardation as related to
death penalty cases. Given <strong>the</strong> decision in Atkins
v. Virginia by <strong>the</strong> Supreme Court in 2002,
<strong>the</strong> field of mild mental retardation has experienced
renewed attention to concerns about
definition and identification (Greenspan,
2006; Polloway, 2006) and particularly about
<strong>the</strong> way in which death penalty cases unfold
for defendants with intellectual disabilities
Criminal Justice / 421

(Patton & Keyes, 2006). While our purpose in
this paper is not to suggest that more than a
very few persons with intellectual disabilities
will ever be charged with a capital crime, <strong>the</strong>re
clearly are issues that are highlighted in such
cases that have importance for criminal justice
processes in general.
This paper discusses <strong>the</strong> potential realities
of interactions with <strong>the</strong> criminal justice system
by persons with D/ID. The paper will explore
<strong>the</strong> particular pitfalls that may be easier snares
for persons with D/ID than for o<strong>the</strong>rs without
a disability, with a focus on key aspects of <strong>the</strong>
criminal justice system. Using <strong>the</strong>se problem
areas as a foundation, <strong>the</strong> paper <strong>the</strong>n focuses
on selected implications for transition planning,
including curricular emphases that result
in <strong>the</strong> empowerment of <strong>the</strong> individual
student as well as <strong>the</strong> possible roles that professional
educators can play in ensuring that
persons with disabilities experience justice
within <strong>the</strong> criminal justice system, including
collaboration with community partners.
Criminal Involvement and Persons with
Developmental and Intellectual Disabilities
To understand <strong>the</strong> rates of crime for, and
criminal justice system involvement by, persons
with D/ID, Hasssan and Gordon (2003)
pointed out that definitions rooted in public
policy determine who is identified and not
identified as having a disability, which thus
impacts rate of identification. While prevalence
rates vary depending on <strong>the</strong> particular
research study, <strong>the</strong> consistent finding is that
<strong>the</strong>re is a significant over-representation of
persons with developmental disabilities in <strong>the</strong>
criminal justice system worldwide (Hasssan &
Gordon, 2003). While approximately 2% of
<strong>the</strong> population of <strong>the</strong> United States may be
identified as having a developmental or intellectual
disability, common estimates are that
between 4-5% and 10% of <strong>the</strong> prison and jail
populations in this country (and internationally)
have been identified as having such a
disability (Bowker, 1994; Davis, 2006; Petersilia,
2000a, 2000b), dependent on definitions
used. As Davis (p.14) concluded: “this does
not mean people with disabilities are more
likely to commit crimes, but <strong>the</strong>y are more
likely to get caught if <strong>the</strong>y become involved in
a criminal act (<strong>the</strong>y may or may not realize <strong>the</strong>
422 / Education and Training in Developmental Disabilities-December 2008
act <strong>the</strong>y are involved in is actually a criminal
offense)”.
A comparable trend is also found within
juvenile correctional facilities. Overall, of those
incarcerated in <strong>the</strong> juvenile system, approximately
3.4% of <strong>the</strong> population has been identified
as having mental retardation as a primary
diagnosis (Ru<strong>the</strong>rford, Bullis, Anderson, &
Griller-Clark, 2002). It is important to note that
IDEA is still relevant in terms of access to special
education for <strong>the</strong>se individuals.
To complicate an interpretation of criminal
justice system prevalence data, <strong>the</strong>re are a
number of social and intraindividual factors
that make a risk of involvement in <strong>the</strong> criminal
justice system higher for persons with
D/ID. First, <strong>the</strong>re is an over-representation of
mild retardation in low-income minority
groups, which collectively experience higher
rates of police involvement and police presence
in <strong>the</strong>ir neighborhoods than do those
with fewer economic disadvantages. Approximately
34% of persons with developmental
disabilities live in homes with incomes under
$15,000 (almost triple that of persons without
disabilities) (Petersilia, 2000b); although <strong>the</strong>se
data are not recent, a reasonable adjustment
in income level would still underscore <strong>the</strong>ir
viability for <strong>the</strong> current time.
A related issue is <strong>the</strong> social status of such
individuals. As Petersilia (2000) points out,
individuals with D/ID may be easy targets because,
while <strong>the</strong>y may not be ‘criminal’, <strong>the</strong>y
are persons who tend to skirt along <strong>the</strong> edge
of society simply because <strong>the</strong>y may not fully
understand societal rules and laws. They can
become easy targets to be included in a group
offense for which <strong>the</strong> person who has <strong>the</strong>
disability subsequently may become <strong>the</strong> one
who is blamed for <strong>the</strong> crime.
A key concern is <strong>the</strong> interaction between
certain common characteristics of persons
with D/ID and <strong>the</strong> vulnerabilities that <strong>the</strong>y
may have within <strong>the</strong> criminal justice system.
Table 1, adapted from Patton and Keyes
(2006), provides an overview of key intraindividual
characteristics. Major areas of concern
are <strong>the</strong>n fur<strong>the</strong>r discussed below.
Perske (2000, 2005, 2006a has focused on
<strong>the</strong> fact that numerous individuals with mental
retardation have been documented to have
confessed to serious crimes that <strong>the</strong>y did not
commit. Perske (2006) provided data on 41

TABLE 1
Potential Problematic Characteristics in Criminal Justice System
Characteristic Description Example
Gullibility Phenomenon of being duped or
lied to and often involving
some degree of victimization
Taken advantage of
Talked into doing things for which one
does not understand consequences
Acquiescence Tendency to give in when under Talked into confessing to crime that
pressure
did not commit
Gives in to repeated questions under
interrogation
Naiveté Inexperienced, credulous Accepts what someone says without
question
Does not catch subtlety of situations
Desire to please Interest in pleasing ano<strong>the</strong>r Will do what someone else wants in
order to be accepted
May say what he or she thinks police
want to hear
Concrete thinking Inability to understand abstract
concepts
Does not understand Miranda rights
Not likely to recognize seriousness of
what he or she is being accused of
Memory issues Difficulty with short-term
Likely to get confused as to
memory
complexities of a crime
Does not remember details of a
situation
Language problems Difficulty with receptive and
expressive language
Does not understand what is being said
Cannot articulate what one is thinking
or feeling
Cannot respond appropriately to
critical questions during an
interrogation
Social behaviors Displays certain emotions or
May display a behavior (e.g., laughing)
feelings
that suggests a lack of remorse at an
inappropriate time (e.g., during trial)
Cloak of competence Attempt to pass as ’normal’ May go to great lengths to deny or
hide limitations
May cover for co-defendants in an
effort to appear strong
Adapted from Patton, J. R., & Keyes, D. W. (2006). Death penalty issues following Atkins. Exceptionality, 14,
p. 241.
persons with intellectual disabilities who have
been legally exonerated in cases to which
<strong>the</strong>y had previously confessed guilt. Data on
those accused of less serious crimes were not
presented but <strong>the</strong> generalization to <strong>the</strong> latter
appears to be a reasonable one to make.
Through <strong>the</strong> work of Greenspan (2006a,
Greenspan & Switzky, 2003, 2006), increased
attention has been given to <strong>the</strong> issue of social
vulnerability in general and gullibility in
particular. Greenspan posits that gullibility is a
core characteristic in individuals with mild retardation
and that <strong>the</strong>se individuals are thus
vulnerable to social manipulation, particularly
within <strong>the</strong> criminal justice system. Fur<strong>the</strong>r,
this problem is exacerbated because contem-
Criminal Justice / 423

porary adaptive behavior instruments (discounting
those currently in production) have
not included items that focused on gullibility
and suggestibility as elements within <strong>the</strong> process
of identifying adaptive functioning in individuals
with intellectual disabilities.
Ano<strong>the</strong>r aspect of <strong>the</strong> identification and
prevalence question is that persons with developmental
disabilities are much more likely to
be involved in <strong>the</strong> criminal justice system if
<strong>the</strong>y also have limitations in intellectual functioning
(e.g., mild retardation) (Hasssan &
Gordon, 2003) but not show physical signs of
disability. This complicates matters for many
persons in <strong>the</strong> criminal justice system because
<strong>the</strong>y may less frequently be recognized as having
a disability (Petersilia, 2000). Patton and
Keyes (2006) discussed some of <strong>the</strong> common
misconceptions of <strong>the</strong> public, and attorneys,
judges, and juries, of persons who have mild
mental retardation that lead to failures in
identification. Of course persons with mild
mental retardation typically do not have a particular
appearance (e.g., Down syndrome) or
exhibit childlike actions. As a partial result of
such misconceptions, it is estimated that 75%
of persons with disabilities who are arrested
are not identified as having a disability. Fur<strong>the</strong>r
an estimated 10% of this population goes
unidentified during a subsequent prison term
(Petersilia).
Hasssan and Gordon (2003) noted that persons
with D/ID often have more trouble gaining
access to programs and treatment, and
<strong>the</strong>y may be stigmatized within <strong>the</strong> prison population.
This issue may lead some attorneys to
try to have <strong>the</strong> label removed in order to serve
<strong>the</strong>ir client more efficiently. Ano<strong>the</strong>r facet of
labels is <strong>the</strong>ir view in varying contexts. For
persons in <strong>the</strong> mental health field and teaching
fields, <strong>the</strong> label serves as an informational
tool from which to build strengths. However,
in <strong>the</strong> legal system, <strong>the</strong> label serves to excuse
behavior in some cases and to limit options in
o<strong>the</strong>r cases, especially in capital cases (Patton
& Keyes, 2006)
In summary, persons with disabilities are at
risk for coming into contact with <strong>the</strong> criminal
justice system for various reasons. Additionally,
<strong>the</strong>re are consequences for <strong>the</strong>m whe<strong>the</strong>r
<strong>the</strong>y are identified as having an intellectual or
developmental disability or not.
The Impact of Disability within <strong>the</strong> Criminal
Justice System
The criminal justice system is built upon finding
justice for persons who are <strong>the</strong> victims of
crime and maintaining order in society. While
<strong>the</strong>re are protections built into <strong>the</strong> system to
ensure fairness, it is not a system that was
developed with a full appreciation of <strong>the</strong>
needs and characteristics of all persons in
mind. Persons with disabilities have particular
issues that challenge a system that was built to
ferret out truth and protect rights (Fowler,
Wilensky, LoVoi, & Monger, 2005).
There are a number of processes underlying
<strong>the</strong> criminal justice system. The discussion
in this paper focuses on interrogation and
arrest, prosecution, and sentencing and disposition.
A full discussion of <strong>the</strong> corrections system
is beyond <strong>the</strong> scope of this manuscript.
Each of <strong>the</strong> three relevant categories is discussed
below as related to defendants with
D/ID.
Interrogation and Arrest
424 / Education and Training in Developmental Disabilities-December 2008
The role of <strong>the</strong> police officer at <strong>the</strong> occurrence
of a crime is of course to locate and
arrest <strong>the</strong> perpetrator as quickly as possible,
and this objective increases especially in cases
of serious offenses (Perske, 2003). Many political
battles are waged when crime is seen as
“out of control”. These types of campaigns put
increasing pressure on officers to process
cases as efficiently as possible, especially in
high publicity cases (see Perske, 2005).
In order for police to be able to do <strong>the</strong>ir
job, <strong>the</strong>y have a variety of interrogation tools
available to <strong>the</strong>m that help <strong>the</strong>m to find <strong>the</strong>
criminals and gain <strong>the</strong> truth from <strong>the</strong>m.
These tactics, while falling to a degree into <strong>the</strong>
realm of deception, are allowed by law. As
Perske (1991) stated, “as a citizen, I am a firm
believer in <strong>the</strong> use of police tricks that keep
violent criminals in an interrogation room for
reasonable periods until <strong>the</strong>y truly confess”
(p. 532) to a crime <strong>the</strong>y did commit.
The problem with interrogation arises in
that many tactics are particularly disadvantageous
to persons with intellectual disabilities
for a number of reasons. First, many persons
with disabilities have been taught that police
officers are to be respected and obeyed. They

often try to please <strong>the</strong> officer (Perske, 2000).
Added into this mix, many police officers will
not recognize <strong>the</strong> presence of a disability because
persons with mild retardation may mask
<strong>the</strong>ir limitations, because <strong>the</strong>y are embarrassed
or because <strong>the</strong>y have been taught that it
is not something that <strong>the</strong>y should talk about.
The classic finding of <strong>the</strong> “cloak of competence”
(Edgerton, 1967), which many persons
with intellectual disabilities may exhibit to
mask <strong>the</strong>ir disability, is consistent with this
pattern.
During an interrogation, <strong>the</strong> goal of <strong>the</strong>
officer is to make <strong>the</strong> situation as likely to gain
a truthful confession as possible. To accomplish
this goal, <strong>the</strong>y establish <strong>the</strong> interrogation
room as “a place of total control” (Perske,
2000, p. 532). In order to establish this place,
<strong>the</strong> room is typically located deep in <strong>the</strong> police
station, with <strong>the</strong> individual being placed
fur<strong>the</strong>st away from doors, <strong>the</strong>rmostats, and
light switches, and with few distractions (Perske).
Additionally, <strong>the</strong> police officer will try to
place himself or herself in total control of <strong>the</strong>
room, such that <strong>the</strong> person being questioned
may have to ask for everything. Many people
do not realize that <strong>the</strong>y have not been arrested
and may walk out, however, <strong>the</strong> police officer
attempts to make <strong>the</strong>m believe that he or she
is in complete control, even when that may
not be <strong>the</strong> case. The officer may also expose
<strong>the</strong> person to long waits, a sequence of tiresome
yes-no questions, and a series of routines
where <strong>the</strong> officer minimizes and maximizes
<strong>the</strong> offense, all in order to try to get <strong>the</strong> person
to feel a need or desire to confess (Perske).
This pattern of control involved in interrogation
is a particular concern for a person
with a D/ID because of <strong>the</strong> increased likelihood
of an individual being susceptible to
suggestibility. Hasssan and Gordon (2003)
note that, “<strong>the</strong> reliance on ‘yes-no’ questions
when interviewing developmentally disabled
offenders at each point of <strong>the</strong> criminal justice
process can have devastating impacts on <strong>the</strong>
validity of <strong>the</strong> responses given and <strong>the</strong> subsequent
fate of such offenders” (p. 13).
In a recent analysis of <strong>the</strong> work of Gudjonsson,
Perske (2006, p. 15) identified three
types of interrogational strategies that may impact
on those who have high levels of suggestibility:
“(1) responses to negative feedback,
(2) responses to lead in questions, and (3)
responses to repeated questions”. Each tactic
or strategy is consistent with <strong>the</strong> goals inherent
in an effective interrogation but each never<strong>the</strong>less
coincidentally can result in persons
with D/ID inadvertently confessing to a crime,
against <strong>the</strong>ir best interests.
Gullibility is a significant issue when discussing
interrogation and arrest and it provides a
foundation for social vulnerability that
Greenspan (2006a, 2006b) argues is a universal
trait in mental retardation. Consistent with
this premise, Petersilia (2000b) noted <strong>the</strong> difficulty
that some persons faced when critically
responding to <strong>the</strong> greeting by an authority
figure who says, “I am your friend, I am here
to help you” (p. 24). She reported on a study
by Reynolds (1998) in which persons with disabilities
were asked about <strong>the</strong>ir perceptions in
such situations. Sixty-eight percent of <strong>the</strong> sample
felt that <strong>the</strong>y would be protected. Additionally,
58% said that <strong>the</strong>y would talk to <strong>the</strong>
police before talking to an attorney. While
over half would trust <strong>the</strong> police and talk to
<strong>the</strong>m, only 50% would reveal that <strong>the</strong>y had a
disability. Surprisingly, 38% were reported to
maintain beliefs that <strong>the</strong>y could be arrested
because <strong>the</strong>y had a disability. Everington and
Fulero (1999) fur<strong>the</strong>r reported that persons
with developmental disabilities were more
likely both to change and shift <strong>the</strong>ir answers to
please <strong>the</strong>ir interrogators.
Suggestibility and confessions are a volatile
combination because, as pointed out by Hasssan
and Gordon (2003), “<strong>the</strong> act of confessing
is fur<strong>the</strong>r complicated, in <strong>the</strong> case of developmentally
disabled defendants, as <strong>the</strong>
confession process assumes an understanding
of Miranda rights” (p. 14). It is at <strong>the</strong> point of
interrogation that <strong>the</strong> discussion of <strong>the</strong> waiver
of rights and <strong>the</strong> right to not self-incriminate
is presented. Everington and Fulero (1999)
noted that <strong>the</strong> Miranda rights given at <strong>the</strong>
start of an interrogation are a major issue
because <strong>the</strong>re is reason to suspect <strong>the</strong> validity
of <strong>the</strong> waivers that are agreed to by persons
with mental retardation, thus calling in to
question <strong>the</strong> understanding and concurrence
assumed, for example, with a signature.
A key concern is <strong>the</strong> actual language of <strong>the</strong>
Miranda warnings. Praiss (1989) noted that
persons with retardation are challenged to
understand <strong>the</strong> concepts inherent in Miranda
Criminal Justice / 425

ights and to understand “a standard recitation
of <strong>the</strong> Miranda warnings without fur<strong>the</strong>r
explanation” (p. 2). Petersilia (2000) studied
<strong>the</strong> readability and listening difficulty of <strong>the</strong>se
warnings and determined that in order to fully
comprehend <strong>the</strong>se rights, a person needs to
be functioning at seventh grade reading and
listening levels, respectively. Similarly, Everington
and Fulero (1999) assessed <strong>the</strong> comprehension
of <strong>the</strong> Miranda rights on persons
with mental retardation and reported that
<strong>the</strong>y had much more limited understanding
of <strong>the</strong> rights than those who were not disabled.
When <strong>the</strong>y questioned <strong>the</strong>ir sample of
individuals with disabilities about each of <strong>the</strong>
four parts of <strong>the</strong> rights, <strong>the</strong>y found that approximately
67% had little to no understanding
of one or more of <strong>the</strong> parts of <strong>the</strong> warnings.
As <strong>the</strong>y concluded, “significantly more
persons with mental retardation did not understand
any of <strong>the</strong> substantive portions of
this warning – right to remain silent, potential
use of statements in a court proceeding, and
<strong>the</strong> right to an attorney before and during
questioning” (p. 217). The potential for misunderstanding
of <strong>the</strong>se rights underscores <strong>the</strong>
importance of having an attorney or advocate
present when <strong>the</strong>y are read and before <strong>the</strong>
individual confirms understanding (Davis,
2006).
It is instructive to consider <strong>the</strong> three categories
of false confessions that Gudjonsson
(2003, in Perske, 2006) identified. These include
those that are: voluntarily false, due to
vulnerability from <strong>the</strong> interrogator questioning
him about <strong>the</strong> crime; coerced into compliance,
in order to simply tell <strong>the</strong> interrogator
that which he want to hear; and coerced interrogated,
in which <strong>the</strong> suspect becomes convinced
through <strong>the</strong> process that he actually did commit
<strong>the</strong> crime. While concerns for justice relate
to instances where persons with D/ID did,
as well as did not, commit a crime, <strong>the</strong>se categories
illustrate <strong>the</strong> challenges inherent in
<strong>the</strong> system.
Finally, it is important to note that while
suggestibility indicates an individual’s “acceptance
of <strong>the</strong> information provided or requests
made”, compliance refers to <strong>the</strong> “tendency to
go along with propositions, request, or instructions
for some immediate instrumental
gain” (Perske 2006, p. 16) such as to “get out
of that pressure cooker of an interrogation
room. First, <strong>the</strong>y try to do anything possible to
please <strong>the</strong> police officer. Secondly, <strong>the</strong>y do
everything possible to avoid conflict or confrontation
with him or her” (Gudjonsson,
2003, in Perske, 2006, p. 16). Therein lies <strong>the</strong>
challenge for a fair system of interrogation for
persons with D/ID.
Prosecution
426 / Education and Training in Developmental Disabilities-December 2008
Once formal charges have been filed, persons
with developmental and intellectual disabilities
must navigate <strong>the</strong> prosecutorial system.
Competence within <strong>the</strong> legal system is at issue
when a person enters <strong>the</strong> trial stage of <strong>the</strong>
criminal justice system. The attorney becomes
a central feature at this point in <strong>the</strong> legal
system, and it is imperative upon that attorney
to recognize and understand <strong>the</strong> individual’s
disability in order to help his or her client
(Hasssan & Gordon, 2003).
If <strong>the</strong> attorney does not recognize <strong>the</strong> disability
or understand <strong>the</strong> impact of such a
disability on a person’s decision-making ability,
<strong>the</strong> consequences can be dire. The best
protection for a person with a disability at this
stage in <strong>the</strong> process is an attorney who is
knowledgeable about <strong>the</strong> impact of a developmental
disability on a person. Access to a professionally
trained advocate to assist attorneys
throughout this process also can be a critical
asset (Bowker, 1994; Davis, 2006). Davis notes
that <strong>the</strong> American Bar Association maintains a
directory of attorneys with some experience in
representing clients with D/ID. The preferred
expertise of attorney vis-à-vis mental retardation
is extensive and becomes even more so in
capital punishment cases (see Burr, Cecil,
James, Patton, & Peoples, 2002).
The task becomes more difficult when one
considers that even simple identification of a
person with a developmental or intellectual
disability may still be difficult at this stage. In
fact, when a probation program for persons
with developmental disabilities evaluated how
many of <strong>the</strong>ir participants had been given
competency tests, <strong>the</strong>y found that only approximately
27% had (Bowker, 1994).
At <strong>the</strong> prosecutorial stage, issues of bail and
pre-trial incarceration become important. Petersilia
(2000b) reported that persons with
developmental disabilities had a more difficult
time seeking bail prior to trial and <strong>the</strong>refore

were more likely to be incarcerated. The court
seeks to determine a risk level when considering
bail. Persons with developmental disabilities
do not fare well in this area because <strong>the</strong>y
are less likely to be employed or have substantial
community ties, which are two key considerations
when determining whe<strong>the</strong>r or not to
set bail. When a person is incarcerated at <strong>the</strong>
time of trial, all o<strong>the</strong>r factors being equal, <strong>the</strong>
person is more likely to be convicted of <strong>the</strong>
crime (Petersilia).
McGillivray and Watterman (2003) examined
<strong>the</strong> attitudes of attorneys within <strong>the</strong> justice
system. They found that while <strong>the</strong> majority
of attorneys understood that persons with
D/ID may need services that were different
than o<strong>the</strong>r offenders, <strong>the</strong>re was less consensus
on many o<strong>the</strong>r beliefs, including that such
persons can be led into crimes more easily,
that <strong>the</strong>se individuals may fear authority, and
that <strong>the</strong>y may try to cloak or mask <strong>the</strong>ir disability
when confronted by an authority figure.
More significant, <strong>the</strong>y reported that
35.4% of attorneys were unaware that a person
with a developmental disability may not
understand <strong>the</strong> part of <strong>the</strong> Miranda warning
which allows a person to remain silent (Gillivray
& Watterman, 2003). In fact, Petersilia
(2000b), in her review of <strong>the</strong> literature, noted
that persons with developmental disabilities
concede guilt more quickly than <strong>the</strong>ir peers
who are non-disabled, provide more self-incriminating
material than o<strong>the</strong>r defendants,
and are unable to participate in plea bargaining
as easily as o<strong>the</strong>rs.
Sentencing and Disposition
If a person with a disability is convicted, <strong>the</strong>y
may be at a greater risk of receiving longer
sentences from <strong>the</strong> court. McGillivray and
Watterman (2003) reported that persons with
an intellectual disability run a greater risk at
sentencing because many may have previously
violated bail conditions or <strong>the</strong> communities in
which <strong>the</strong>y reside may lack <strong>the</strong> appropriate
kinds of community options that can ensure
subsequent success. In addition <strong>the</strong>y may lack
<strong>the</strong> social capital needed to secure <strong>the</strong>ir freedom.
Fur<strong>the</strong>r, with <strong>the</strong> degree of variability
within attorney knowledge as noted above,
competent representation can impact sentencing.
This set of complicated and interwo-
ven issues places persons with D/ID at a
greater risk than those who do not have disabilities.
Once a sentence has been given, <strong>the</strong>re remain
additional significant concerns for persons
with disabilities ei<strong>the</strong>r within <strong>the</strong> prison
system or if within a community-based program
such as probation or parole. Glaser and
Deane (1999) point to a subtle shift that has
had a significant impact upon <strong>the</strong> lives of
persons with disability. As society has normalized
environments (and thus has re-defined
<strong>the</strong> concept of disability; see Smith & Polloway,
2008), this transformation has resulted in
an increased expectation that persons with
disabilities be held accountable to <strong>the</strong> same
expectations as <strong>the</strong>ir peers who are non-disabled.
However, as Glaser and Deane (1999)
pointed out, “offenders with an intellectual
disability are more likely to be uneducated,
unemployed, poor, members of an indigenous
minority, have suffered from childhood
neglect or abuse, have deficits in social communications
skills, and suffer from a behavior
or psychiatric disorder” (p. 339).
While <strong>the</strong> movement to “normalization”
clearly reflects a positive trend in <strong>the</strong> societal
inclusion and acceptance of persons with disabilities,
it is never<strong>the</strong>less, and inadvertently,
related to a corresponding shift in <strong>the</strong> goal
within <strong>the</strong> correctional system that may lead to
unfair consequences for persons with disabilities.
Thus within <strong>the</strong> prison setting, <strong>the</strong> disadvantages
that <strong>the</strong>se persons face are likely to
impact not only daily life activities within <strong>the</strong>
setting but also <strong>the</strong>ir length of stay. While
those under <strong>the</strong> age of 22 are eligible to still
receive services under IDEA, <strong>the</strong>se needs exist
for older persons as well. Davis (2006) noted
that a key focus should be on finding an alternative
placement but she acknowledged <strong>the</strong>
difficulty in doing so given <strong>the</strong> limited number
of specialized programs available. Clearly
<strong>the</strong> nature of <strong>the</strong> setting can have an impact
on success after release from <strong>the</strong> system (Alexander,
Crouch, Halstead, & Pichard, 2006).
Implications for Transition Planning
While a small minority of adolescents and
adults with intellectual disabilities will have
adversarial encounters with <strong>the</strong> criminal justice
system, never<strong>the</strong>less <strong>the</strong> available data
Criminal Justice / 427

suggest that this minority is sufficient to warrant
<strong>the</strong> professional attention of educators.
Fur<strong>the</strong>r, <strong>the</strong> challenges that persons with retardation
face within <strong>the</strong> system underscore
<strong>the</strong> importance of educational interventions
to prevent subsequent problems. It is within
this vein that <strong>the</strong> importance of including attention
to <strong>the</strong> criminal justice system within
<strong>the</strong> process of transition planning becomes
most apparent.
The transition planning process is intended
to be a comprehensive one that involves both
skill development in students as well as coordination
with <strong>the</strong> community in which <strong>the</strong>
individual will live. With reference to <strong>the</strong> need
for planning vis-à-vis <strong>the</strong> criminal justice system,
two main areas are addressed below: programming
to empower individuals and working
within <strong>the</strong> community.
Empowering <strong>the</strong> Individual
Through <strong>the</strong> work of <strong>the</strong> Arc and o<strong>the</strong>r organizations,
information has typically been available
to adults with mental retardation to assist
<strong>the</strong>m in navigating <strong>the</strong> criminal justice system.
While <strong>the</strong>se are beneficial to those with access
to this information, it is important that it also
be provided to adolescents with D/ID through
<strong>the</strong> same type of direct instruction that is used
within o<strong>the</strong>r key domains within <strong>the</strong> school
curriculum (e.g., reading, ma<strong>the</strong>matics). The
recommendations below follow from this basic
assumption.
First, <strong>the</strong> topics related to <strong>the</strong> criminal justice
system need to be addressed directly
within <strong>the</strong> curriculum. These topics are appropriate
components of broader curricular emphases
on <strong>the</strong> development of self-determination
skills and self-advocacy skills.
Second, given <strong>the</strong> fact that most individuals
with disabilities are being taught in inclusive
general education classrooms (US Department
of Education, 2006), a key focus should
be in reviewing <strong>the</strong> educational standards for
a particular state that relate to coursework in
government, civics, and/or political science.
An example relates to teaching students <strong>the</strong>
Virginia Standard of Learning CE. 3, which
states that “The student will demonstrate
knowledge of citizenship and <strong>the</strong> rights, duties
and responsibilities of citizens by . . . describing
<strong>the</strong> First Amendment freedoms of
428 / Education and Training in Developmental Disabilities-December 2008
religion, speech, press, assembly, and petition,
and <strong>the</strong> rights guaranteed by due process and
equal protection of <strong>the</strong> laws; [and] describing
<strong>the</strong> duties of citizenship, including obeying
<strong>the</strong> laws, paying taxes, defending <strong>the</strong> nation,
and serving in court” (Board of Education,
2001). Instruction on a standard such as this
one provides an excellent opportunity to incorporate
individuals’ rights when being suspected
of a crime by a police officer. A lesson
in which <strong>the</strong> entire class goes to a local police
station and discusses <strong>the</strong> topic with a police
officer could be au<strong>the</strong>ntic, motivating, and
have a powerful effect on <strong>the</strong> class.
Third, in situations where teachers may
have significantly greater control over curriculum
design (e.g., pull-out programs), opportunities
to fur<strong>the</strong>r develop topics relevant to
<strong>the</strong> criminal justice system can be explored
along with specific instructional instances in
to which career and life skills can be infused.
Polloway, Patton, and Serna (2008) discuss
this approach within <strong>the</strong> context of school
curriculum while Cronin, Patton and Wood
(2007) provide a detailed discussion of how to
create courses, units, and/or infusion topics
for specific subjects. For example, when creating
life skills lessons that include instruction
on <strong>the</strong> criminal justice system, teachers must
first be familiar with specific life skills (Cronin
et al.). Then teachers can identify life skills
areas, develop or identify a unit on <strong>the</strong> topic,
plan for teaching <strong>the</strong> unit, and deliver <strong>the</strong>
unit. Fur<strong>the</strong>rmore, a chart can be developed
to outline <strong>the</strong> process and ensure that <strong>the</strong>se
steps are followed.
Cronin et al. (2007) identified a major series
of life domains/skills (e.g., home and
family, leisure pursuits, community involvement)
and <strong>the</strong>n, under each domain/skill,
identified subdomains and life demands. Specifically
under <strong>the</strong> domain of community involvement,
<strong>the</strong>se authors listed understanding
legal rights and judicial procedures and obeying
laws. When a teacher is addressing this
subdomain with his/her students, it would be
a logical opportunity to incorporate topics
within <strong>the</strong> criminal justice system.
Regardless of setting in which instruction
occurs, one of <strong>the</strong> most significant foci should
be direct instruction accompanied by role
playing for persons with disabilities of <strong>the</strong>ir
responses if <strong>the</strong>y come into contact with <strong>the</strong>

criminal justice system. To this end, <strong>the</strong> Arc of
New Mexico Justice Program developed a curriculum
that included an alternate warning
that can be used to discuss Miranda rights (see
Davis, 2006). An analysis of <strong>the</strong> language and
meanings of <strong>the</strong> words in this warning should
be a critical component of life skills instruction.
Ano<strong>the</strong>r helpful resource, focused on
<strong>the</strong> juvenile justice system, was developed by
Dershowitz, Jouet-Nikinyang, Gill, and LoVoi
(2004).
Involving School Personnel with <strong>the</strong> Community
To complement <strong>the</strong> above curricular emphases,
education programs can also involve
school resource officers in <strong>the</strong> classroom to
create exposure and to teach relational skills
with police officers. This education can include
teaching and role playing, such as what
“you have <strong>the</strong> right to remain silent” actually
means, as well as o<strong>the</strong>r key features of <strong>the</strong>
Miranda warnings.
The involvement of school resource personnel
also provides a linkage to opportunities
for community-based education related to <strong>the</strong>
criminal justice system. While classroom field
trips to local jails and courts of course can be
unnecessarily negative if handled improperly,
never<strong>the</strong>less students can learn to appreciate
<strong>the</strong> nature of <strong>the</strong> system better when <strong>the</strong>y
experience it in a concrete form by meeting
with and discussing <strong>the</strong> justice system with
individuals who are responsible for its implementation.
Fur<strong>the</strong>r, as discussed below, such
an opportunity provides <strong>the</strong>se public servants
with an occasion to learn more about developmental
and intellectual disabilities and to
have a greater sensitivity to individuals who
<strong>the</strong>y may subsequently encounter within <strong>the</strong>
system.
Teachers have an opportunity to play a
unique role in advocacy for <strong>the</strong>ir students and
former students and for <strong>the</strong> community at
large. In addition to strategies for building
curriculum and providing instruction, teachers
may be individuals’ best advocates if <strong>the</strong>y
have an interaction with <strong>the</strong> criminal justice
system as adolescents or young adults. Special
educators have <strong>the</strong> best understanding of <strong>the</strong>
learning, behavioral, and personality characteristics
of individuals with intellectual disabilities
and can greatly assist police officers, pros-
ecutors, defense attorneys, and judges in
understanding, for example, <strong>the</strong> nature of
mental retardation and intellectual disabilities
in general and <strong>the</strong> characteristics of <strong>the</strong> individual
person in particular.
For communities in which <strong>the</strong>re is not a
presence of mental retardation professionals,
such as in small towns and rural areas, teachers
are likely to be <strong>the</strong> best informed for educating
professionals within <strong>the</strong> criminal justice
system about intellectual disabilities.
Opportunities for exchange of information
can be critical in this regard because such
information can serve in a preventive fashion
by, for example, alerting law enforcement to
<strong>the</strong> likelihood of suggestibility and gullibility
as traits of persons with intellectual disabilities
as well as to making <strong>the</strong>m aware of <strong>the</strong> common
preference of some individuals to mask
<strong>the</strong>ir disability and adapt a cloak of competence
even when it is not to <strong>the</strong>ir advantage.
The result can be <strong>the</strong> prevention of unnecessary
arrests and convictions (Davis, 2006) as
well as <strong>the</strong> assurance of fair treatment within
<strong>the</strong> system.
While model programs and <strong>the</strong> education
of persons within <strong>the</strong> system may, over <strong>the</strong>
long-term, create change, school program
changes are imperative now. Instruction in
basic skills may prevent <strong>the</strong> injustice of a child
sitting in <strong>the</strong> classroom today, who may be an
adult disadvantaged in <strong>the</strong> criminal justice system
tomorrow. An adoption of a focus on <strong>the</strong>
criminal justice system within life skills and
transition planning and programs is a clear
recognition of <strong>the</strong> realities of community living
for all individuals and particularly for
those with developmental and intellectual disabilities.
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Received: 27 February 2007
Initial Acceptance: 15 April 2007
Final Acceptance: 12 July 2007
430 / Education and Training in Developmental Disabilities-December 2008

Teaching Grocery Store Purchasing Skills to Students with
Intellectual Disabilities Using a Computer-Based Instruction
Program
David L. Hansen
Granite School District, UT
Robert L. Morgan
Utah State University
Abstract: This research evaluated effects of a multi-media computer-based instruction (CBI) program designed
to teach grocery store purchasing skills to three high-school students with intellectual disabilities. A multiple
baseline design across participants used measures of computer performance mastery and grocery store probes to
evaluate <strong>the</strong> CBI. All participants initially performed at low percentages of correct responses in purchasing items
at grocery store checkout stands. Following introduction of CBI, all participants increased correct purchasing
skills. Additionally, all participants performed at high levels in generalization probes at three different grocery
stores and in a 30-day follow-up probe. Participants and parents rated purchasing skills higher following
treatment. Results are discussed in terms of increased purchasing skills using CBI, generalization, maintenance,
and implications for practice.
Teaching community purchasing skills to individuals
with disabilities is a high priority because
it allows children and youth to access
new environments and participate as valued
citizens (Ayres & Langone, 2002; Donnell &
Laughlin, 1989). However, most school-based
programs face resource constraints which
limit <strong>the</strong> number of opportunities for instruction
to occur in community-based settings
(Wissick, Lloyd, & Kinzie, 1992). Considerable
research has examined ways to teach shopping
skills to students with intellectual disabilities
(see Morse, Schuster, & Sandknop, 1996 for a
review). One method of simulating community
instruction of purchasing involves com-
This research served as partial fulfillment of a
Masters of Science Degree for <strong>the</strong> first author. Authors
wish to thank Dr. Thomas Langone, Professor,
Department of Communication Sciences and Special
Education, University of Georgia, for loaning a
copy of <strong>the</strong> Project Shop DVD and CD-ROM to <strong>the</strong>
authors; and to Albertson’s, Ream’s, Harmon’s, and
Smith’s Supermarkets. Correspondence concerning
<strong>the</strong> article should be addressed to Robert Morgan,
Department of Special Education and Rehabilitation,
Utah State University, 2865 Old Main Hill, Logan,
UT. 84322-2865. Email: bob.morgan@usu.edu
Education and Training in Developmental Disabilities, 2008, 43(4), 431–442
© <strong>Division</strong> on Developmental Disabilities
puter-based instruction (CBI) (Ayers &
Langone). For example, Wissick et al. used
CBI to train three youth with intellectual disabilities
how to locate and purchase snack
items in convenience store settings. An interactive
videodisc presented text, graphics, photographs
and motion video to participants in
effort to teach skills. Following treatment,
youth located items more efficiently, required
fewer teacher prompts, and increased independent
performance in <strong>the</strong> community setting.
Ayres and Langone (2002) evaluated <strong>the</strong>
effects of a CBI program called Dollar Plus.
This program is similar to o<strong>the</strong>rs requiring a
purchaser to submit one dollar more than <strong>the</strong>
number needed to purchase (e.g., Colver &
Collins, 1996), however, all training steps are
embedded within <strong>the</strong> CBI. A software package
employed video, photos, and animations in a
computer simulation to teach purchasing of
grocery items. Participants were three children
from ages 6-10with mild to moderate
intellectual disabilities. The researchers measured
accurate initiation and completion of
<strong>the</strong> purchase using Dollar Plus and <strong>the</strong>n assessed
generalization in community-based
Computer-Based Instruction / 431

probes. While Ayres and Langone reported
increased scores on computer trials, <strong>the</strong>y did
not find generalized accuracy in purchasing at
<strong>the</strong> grocery store.
Langone, Clees, Rieber, and Matzko (2003)
developed a CBI program called Project Shop as
a part of a federally funded grant for teaching
shopping skills to learners with intellectual
disabilities. The program consisted of two
main elements. First, a DVD video with three
10-min presentations provided models of correct
and incorrect grocery shopping skills.
Video actors consisted of two pairs of young
adults playing roles of roommates, including
individuals with disabilities. Demonstrated
skills included making a shopping list using a
picture book, going to <strong>the</strong> grocery store, finding
items in <strong>the</strong> store, and checking out. A
narrator described correct and incorrect
shopping procedures demonstrated by actors
on video. Second, an interactive CD-ROM provided
learners with a virtual shopping experience
including instructional activities and skill
practice. During instructional activities, <strong>the</strong>
narrator described actors’ actions in video
demonstrations. During skill practice, <strong>the</strong> narrator
provided affirmative or corrective feedback
regarding learner performance. In <strong>the</strong>
design of <strong>the</strong> CD-ROM, activities were embedded
in a short story of a grocery store shopping
trip. Interactive activities targeted: (a)
making a grocery store list, (b) finding items
on a grocery store shelf, (c) maneuvering a
shopping cart properly, (d) counting items in
a shopping cart, (e) identifying <strong>the</strong> shortest
check-out line, (f) paying for groceries using
<strong>the</strong> Dollar Plus method, and (g) taking coin
change, receipt, and groceries.
Hutcherson, Langone, Ayres, and Clees
(2004) investigated <strong>the</strong> effects of <strong>the</strong> same
CBI program on locating shelf items in four
middle school students with significant intellectual
disabilities. All students quickly increased
accurate location skill using <strong>the</strong> CBI
program. However, although all participants
eventually located more items in <strong>the</strong> community
shopping component, performance of
some participants indicated marginal and
gradual gains.
Ayres, Langone, Boon, and Norman (2006)
examined effects of <strong>the</strong> Project Shop CBI program
in promoting generalization of Dollar
Plus purchasing skills in grocery store probes
of four middle school students with intellectual
disabilities. Results indicated that with
CBI, three of four participants increased Dollar
Plus purchasing skills in grocery store
probes; <strong>the</strong> lowest-performing participant may
have been adversely affected by medication
changes.
This study extends <strong>the</strong> Ayres et al. (2006)
investigation of Project Shop by (a) assessing
effects of CBI according to a five-step purchasing
sequence (from choosing shortest checkout
line to taking coin change, receipt, and
groceries), (b) involving participants of high
school age with intellectual disabilities, (c)
probing generalization in one initial grocery
store and subsequently in three different
ones, and (d) probing maintenance of skills
30 days following conclusion of <strong>the</strong> study. Additionally,
this study included a measure of
<strong>the</strong> social significance of <strong>the</strong> CBI treatment.
Specifically, research questions examined in
this study included <strong>the</strong> following:
1. Given CBI, to what extent do participants
with significant intellectual disability increase
percentage of correct purchasing
responses in grocery store generalization
probes?
2. To what extent do participants’ purchasing
skills (a) generalize to different grocery
stores, and (b) maintain after 30
days?
3. Do participants and <strong>the</strong>ir parents/guardians
rate purchasing skills higher in posttest
than in pretest?
Method
Participants
432 / Education and Training in Developmental Disabilities-December 2008
Three participants were chosen from a high
school classroom of 12 students who experienced
intellectual disabilities. Criteria for selection
as participants included (a) IEP goals
related to grocery shopping, (b) parent/
guardian consent, (c) high percentages of
school attendance, (d) visual and auditory
acuity within normal range, (e) motor ability
to make selections on <strong>the</strong> computer screen
using a standard or adapted mouse, and (e)
ability to maintain attention to task at a computer
terminal for 30 min. Of 10 students who

met <strong>the</strong>se criteria, a role-play pretest of purchasing
grocery items was conducted to identify
those with limitations in purchasing skills.
Three participants receiving lowest percentages
of correct responses (0 – 40% correct)
were selected. The remaining seven students’
scores ranged from 60 – 100% correct.
Mr. Red, age 17, was a high school senior.
His special education file indicated an IQ
score of 55 and an adaptive behavior standard
score of 65. Money, shopping, and banking
skills had been targeted on his Individual Education
Program (IEP). In <strong>the</strong> role-play pretest,
Mr. Red correctly responded to two
(choosing <strong>the</strong> shortest line and placing <strong>the</strong>
groceries on <strong>the</strong> conveyor with a divider) of
five purchasing steps.
Mr. Blue, age 17, was a high school senior
with an IQ score of 45 and an adaptive behavior
score of 46. He had worked on Dollar Plus
skills for two school years with minimal skill
acquisition. In <strong>the</strong> role-play pretest, Mr. Blue
did not correctly respond to any steps.
Mr. Green, age 16, was a high school junior
with an IQ score of 45 and an adaptive behavior
score of 51. Money, shopping, and banking
skills were targeted on his IEP. In <strong>the</strong>
role-play pretest, Mr. Green correctly responded
to one of five purchasing steps (i.e.,
response to <strong>the</strong> “paper or plastic” question by
indicating one alternative).
Settings and Materials
The study took place in two settings: a high
school computer lab near <strong>the</strong> participants’
classroom and grocery stores near <strong>the</strong> participants’
school. For CBI training, individual
participants positioned <strong>the</strong>mselves in front of
a computer in a lab containing 20 computer
stations. Except for an observer, no o<strong>the</strong>r persons
were in <strong>the</strong> computer lab with a participant.
For grocery store probes, <strong>the</strong> observers
held a timing device and a task analysis sheet
to mark correct/incorrect performance during
each grocery store trial. Grocery probes
were conducted at Albertson’s. Different store
probes were conducted at Ream’s, Harmon’s,
and Smith’s. All stores were franchise supermarkets
located in <strong>the</strong> Western U.S. The particular
stores were chosen because of proximity
to <strong>the</strong> school where <strong>the</strong> study took place.
Response Definitions
Responses were recorded in both computer
performance mastery assessment (i.e., participants’
responses at <strong>the</strong> computer) and in grocery
store generalization probes (i.e., participants’
responses in stores independent of
training). Computer assessments and store
probes consisted of responses to a five-step
purchasing sequence: (a) selecting <strong>the</strong> checkout
stand with <strong>the</strong> shortest line or <strong>the</strong> one
marked 15 items or less; (b) placing three items
on <strong>the</strong> checkout stand conveyor; (c) providing
<strong>the</strong> correct Dollar Plus amount; (d) responding
to <strong>the</strong> cashier’s question about bagging
preference (i.e., “Paper or Plastic”), and (e)
taking coin change, receipt, and groceries.
Selection of shortest line or <strong>the</strong> one marked 15
items or less. Different responses were targeted
in selecting shortest lines in grocery
probes compared with computer assessment.
In <strong>the</strong> computer assessment, a participant
chose <strong>the</strong> shortest checkout line from three
photos presented in a trial by clicking <strong>the</strong>
mouse on <strong>the</strong> correct line. In grocery probes,
after scanning <strong>the</strong> number of customers in
checkout lines, <strong>the</strong> first author (<strong>the</strong> participants’
classroom teacher and primary observer)
walked with <strong>the</strong> participant to a starting
point within 3mof<strong>the</strong>longest line or to
a point far<strong>the</strong>st from <strong>the</strong> shortest line. Each
participant was taught to identify <strong>the</strong> shortest
checkout line based on three decision rules:
(a) choose <strong>the</strong> checkout stand marked 15
items or less if <strong>the</strong>re were three or fewer customers;
(b) if not “a”, choose a checkout stand
with no customers; or (c) if nei<strong>the</strong>r “a” or “b”
yielded a clear checkout line, select <strong>the</strong> line
with <strong>the</strong> fewest customers. If <strong>the</strong> participant
failed to scan lines but chose <strong>the</strong> closest and
longest line, <strong>the</strong> response was scored as incorrect.
If <strong>the</strong> participant scanned <strong>the</strong> lines but
selected a line o<strong>the</strong>r than <strong>the</strong> shortest (based
on <strong>the</strong> decision rules), <strong>the</strong> response was
scored as incorrect. If <strong>the</strong> participant scanned
<strong>the</strong> lines and selected <strong>the</strong> shortest line, <strong>the</strong>
response was scored as correct. The participant
had 15 s to choose a check stand line
after he and <strong>the</strong> first author had reached <strong>the</strong>
starting point.
Placement of three items. In both computer
assessment and store probes, <strong>the</strong> participant
was required to place three grocery items
Computer-Based Instruction / 433

from his basket onto <strong>the</strong> conveyor. In each
assessment, three items were delivered to <strong>the</strong>
participant for purchasing because <strong>the</strong> computer
assessment was configured in this manner.
In <strong>the</strong> computer assessment, <strong>the</strong> participant
had 10 s to click <strong>the</strong> mouse to drag
pictures of first, a divider, and second, grocery
items, to a picture of a check-stand conveyor.
In <strong>the</strong> grocery probe, <strong>the</strong> participant first
placed a divider between <strong>the</strong> preceding customer’s
items and his items within 10 s of
space becoming available.
Payment of correct amount. In both computer
assessment and grocery probes, <strong>the</strong> participant
had to pay <strong>the</strong> correct Dollar Plus
amount (i.e., dollar amount plus one more)
after <strong>the</strong> total cost was announced. The participant
had 5stoinitiate a response by starting
to count his money and 20 s from initial
response to complete <strong>the</strong> step. Therefore, a
correct response required correct dollar
amount, no more than 5 s for initiation, and
no more than an additional 20 s for completion.
In computer assessment, when a video
clip showed a cashier announcing <strong>the</strong> total of
<strong>the</strong> purchase, <strong>the</strong> participant responded by
clicking on <strong>the</strong> number of dollar bills needed.
The software contained 36 videos displaying
four different cashiers asking for various purchase
amounts ranging from $1.03 to $9.93.
The software randomly selected <strong>the</strong> video for
a purchase. In grocery probes, purchase
amounts ranged from $1.00 to $9.00. For consistency
across probes and participants, three
and only three items were provided for purchase.
Response to “paper-or-plastic” question. In
computer assessment, <strong>the</strong> participant chose
paper or plastic by clicking on a picture of
ei<strong>the</strong>r a plastic or a paper bag within 3 s of <strong>the</strong>
narrator’s question. A correct response required
a clicking response within 3sof<strong>the</strong>
question to ei<strong>the</strong>r picture. In grocery probes,
<strong>the</strong> participant was required to make a verbal
response to <strong>the</strong> cashier’s paper-or-plastic question
within 3 s. Ei<strong>the</strong>r response was scored as
correct as long as it was audible. No response,
an inaudible one, or a gesture was scored as
incorrect.
Collection of change, receipt, and groceries. In
computer assessment, when a dispenser
showed coin change, <strong>the</strong> participant clicked
<strong>the</strong> mouse and dragged <strong>the</strong> change and re-
434 / Education and Training in Developmental Disabilities-December 2008
ceipt to a wallet. The participant <strong>the</strong>n clicked
on <strong>the</strong> groceries. The participant had 5sto
take <strong>the</strong> receipt and change from <strong>the</strong> dispenser,
and ano<strong>the</strong>r 5stotake <strong>the</strong> bagged
groceries. In grocery probes, <strong>the</strong> participant
was required to take change, receipt and
bagged groceries when offered by <strong>the</strong> cashier
according to <strong>the</strong> same time parameters.
Data Collection
Primary data collection included computer
performance mastery assessments and grocery
store probes. These data collection activities
are described below.
Computer performance mastery assessment. In
CBI, a computer performance mastery assessment
scored individual participants on correct/incorrect
responses on each of <strong>the</strong> five
responses in sequence. This assessment applied
<strong>the</strong> same time limits as <strong>the</strong> grocery store
probe but required mouse clicking responses.
The computer collected and stored data. The
score was expressed as percent of five responses
performed correctly. The first author
developed software to collect computer performance
mastery assessment data. This assessment,
not included in <strong>the</strong> original CBI program,
determined whe<strong>the</strong>r participants
performed responses in <strong>the</strong> purchasing sequence
using <strong>the</strong> computer. Assessments were
conducted after 4-5 CBI sessions (i.e., at <strong>the</strong>
end of each week). Participants received <strong>the</strong>
computer assessment prior to weekly grocery
probes. The first author incorporated numerous
photographs of checkout stands with varying
numbers of customers into <strong>the</strong> computer
software. For individual participants, <strong>the</strong> software
randomly selected a set of three photographs
from which <strong>the</strong> participant selected
<strong>the</strong> shortest line or <strong>the</strong> one marked 15 items or
less. For <strong>the</strong> payment using Dollar Plus step, <strong>the</strong>
first author programmed 32 different
amounts from which <strong>the</strong> computer randomly
selected one for each trial. No participant received
feedback on <strong>the</strong> computer assessment
for correct/incorrect responses because resources
were unavailable for such programming
when this research was conducted.
Grocery Store Probes
Data were collected during grocery store
probe sessions by <strong>the</strong> first author (primary

observer). An assistant acting as a second observer
collected data during 30% of total sessions
for each participant. Observers scored
probe responses in one of two ways:
1. Correct: an accurate response within
<strong>the</strong> time limit.
2. Incorrect: a response of an incorrect
topography performed within <strong>the</strong> specified
time limit, a response of a correct
topography but beyond <strong>the</strong> specified
time limit, or no response.
When a participant initiated an incorrect response
but corrected his response with <strong>the</strong>
time limit, this response was scored as correct.
Each step counted as 20 % with a maximum
score of 100 % available for correct completion
of all five tasks.
All grocery probes took place during school
hours at varying times during mornings or
early afternoons. Researchers scheduled one
grocery probe per participant per week.
Probes were conducted during both baseline
and treatment. During baseline, grocery
probes were conducted to assess individual
participants’ purchasing skills prior to CBI.
Individual participants were accompanied to
Albertson’s by <strong>the</strong> first author. Prior to <strong>the</strong>
first grocery store trip, shopping skills such as
cart safety, asking for help, and locating items
were taught. In all grocery probe sessions, <strong>the</strong>
first author provided each participant with
three items and 10 one-dollar bills, stating:
“Here are three items I want you to purchase.
Choose <strong>the</strong> best checkout stand, and correctly
purchase <strong>the</strong>se three items with <strong>the</strong> money I
gave you. You may begin.” The first author
delivered <strong>the</strong>se instructions after positioning
himself and <strong>the</strong> participant nearest <strong>the</strong> checkout
line with <strong>the</strong> most customers. Participants
had to move 4-6 m to find <strong>the</strong> shortest line.
The first author moved to <strong>the</strong> bagging side of
<strong>the</strong> checkout stand about 1 m from <strong>the</strong> participant
and refrained from delivering any
form of prompt. Using <strong>the</strong> clipboard and timing
device, he scored each of five purchasing
responses. Prior to <strong>the</strong> study and given approval
from <strong>the</strong> store manager, <strong>the</strong> first author
prompted cashiers not to assist <strong>the</strong> participant.
The manager and cashiers agreed to
cooperate by refraining from prompting participants.
Prior to each purchase, <strong>the</strong> first au-
thor reminded <strong>the</strong> cashier to avoid prompting
by showing a printed sign on <strong>the</strong> back of a
clipboard with <strong>the</strong> words no help please. Also,
<strong>the</strong> sign reminded <strong>the</strong> cashier to ask paper-orplastic
question and do not tell <strong>the</strong> shopper to take
change. If a cashier prompted a participant,
<strong>the</strong> observer noted it on <strong>the</strong> data sheet and
<strong>the</strong> response was scored correct.
Measures of Attention to Task during CBI
On 30% of <strong>the</strong> CBI sessions, an observer collected
data to assess percent of observations
during which <strong>the</strong> individual participant was
attentive to <strong>the</strong> CBI task. These data were
collected to confirm that a participant was
attentive to CBI so changes in performance
could be attributable to <strong>the</strong> computer program
and not o<strong>the</strong>r variables. During <strong>the</strong> last
15 min of <strong>the</strong> selected session, an observer
collected momentary time sampling data at
fixed 1-min intervals on whe<strong>the</strong>r <strong>the</strong> participant
was attentive to CBI. Attention to task was
defined as eye contact with <strong>the</strong> computer
screen, hand placed on computer mouse, earphones
placed on ears and absence of conversation
with peers. Observations of on-task performance
were divided by 15 total
observations times 100 to produce a percentage
of observations with attention to task.
Generalization Probes: Different Grocery Stores
Following <strong>the</strong> completion of four to eight grocery
store probes, individual participants were
taken to three different stores scheduled
about three school days apart. Identical probe
procedures were followed in <strong>the</strong> new stores.
However, differences existed in physical environments
and checkout routines in <strong>the</strong>se
stores compared to Albertsons’s. For example,
Ream’s used a linear conveyor belt ra<strong>the</strong>r
than <strong>the</strong> circular one at Albertson’s. Additionally,
Ream’s did not have coin dispensers; instead,
<strong>the</strong> cashier handed change and a receipt
to a customer. Although coin change
and receipts were hand delivered, participants
were still scored on whe<strong>the</strong>r <strong>the</strong>y extended a
hand to take change and receipt. Smith’s
checkout stands used linear conveyors and
included a coin dispenser. Harmon’s configured
a checkout stand with no conveyor, divider,
or coin dispenser. The customer pulled
Computer-Based Instruction / 435

<strong>the</strong> cart up to <strong>the</strong> cashier who removed groceries
from <strong>the</strong> cart one at a time. Coin
change was handed to <strong>the</strong> customer. With no
conveyor at this store, one step was removed
from <strong>the</strong> task analysis producing four steps to
complete <strong>the</strong> task, each worth 25%.
30-day Follow-up Assessment
Maintenance of purchasing skills was assessed
30 days following completion of <strong>the</strong> Different
Grocery Stores generalization probe. For each
participant, follow-up data were collected in
one CBI performance mastery assessment and
one grocery probe at Albertson’s.
Skill Ratings by Parents and Participants
Prior to <strong>the</strong> study, parents were asked to rate
<strong>the</strong>ir child’s purchasing skills using a fivepoint
Likert scale. Following <strong>the</strong> study, parents
again rated performance on <strong>the</strong> same
scale. Additionally, participants were asked to
rate <strong>the</strong>ir performance prior to and following
<strong>the</strong> study.
Procedure
CBI consisted of instructional activities on
DVD and CD-ROM. Participants were individually
and sequentially introduced to CBI. The
first author remained with each participant to
answer questions or assist with computer issues,
but did not deliver instruction. However,
in some sessions, <strong>the</strong> first author provided
technical aid in use of software and watched
for technical errors, such as clicking <strong>the</strong>
mouse in <strong>the</strong> wrong place to view videos or
teaching <strong>the</strong> participant to navigate <strong>the</strong> software.
DVD videos. Three DVD videos were shown
to individual participants in one 30-min. session
per week in a computer lab. Individual
participants viewed <strong>the</strong> DVD videos showing
correct and incorrect ways to shop and purchase
groceries. The DVD narrator described
correct and incorrect performance of <strong>the</strong> actors
in each video.
CD-ROM instruction. CD-ROM instruction
took place in <strong>the</strong> computer lab four to five
days a week in 30-min sessions. The software
consisted of several pages, or screens. The participant
navigated from one page to <strong>the</strong> next
using a button near <strong>the</strong> bottom of each
screen. As <strong>the</strong> participant entered a page, <strong>the</strong>
narrator verbally explained <strong>the</strong> skill to be
learned. The narrator provided affirmative or
corrective feedback regarding <strong>the</strong> participant’s
performance. The narrator, whose
script was open captioned, cued <strong>the</strong> participant
to click on training videos, and <strong>the</strong>n
asked <strong>the</strong> participant to click on a practice
button to play an interactive learning game.
The CD-ROM first presented five video clips
on how to identify a short checkout line using
<strong>the</strong> decision rules described above. An activity
provided <strong>the</strong> participant with three pictures of
checkout stands, and required <strong>the</strong> participant
to manipulate <strong>the</strong> mouse to move a picture of
a shopping cart to <strong>the</strong> shortest checkout line.
Second, <strong>the</strong> CD-ROM presented four video
clips demonstrating <strong>the</strong> proper time to place
<strong>the</strong> groceries on <strong>the</strong> conveyor and how to
place a divider between <strong>the</strong> participant’s groceries
and those of preceding customers.
Third, <strong>the</strong> CD-ROM demonstrated <strong>the</strong> response
to <strong>the</strong> paper-or-plastic question by verbalizing
one alternative. The participant did
not practice this step. Fourth, <strong>the</strong> CD-ROM
provided instruction on how to pay for groceries
using Dollar Plus and how take change and
a receipt. A practice activity provided participants
opportunities to pay for <strong>the</strong> groceries by
clicking on a set of dollar bills. A computer
voice counted each dollar as it was clicked.
When <strong>the</strong> participant ascertained <strong>the</strong> correct
amount, he clicked on an icon indicating his
decision to purchase. If correct, <strong>the</strong> narrator
voice stated “good job.” If incorrect, <strong>the</strong> narrator
provided corrective feedback by verbally
counting <strong>the</strong> correct amount (along with a
visual cue showing each dollar bill being
counted). The software contained 36 videos
displaying four different cashiers asking for
varied amounts of money ranging from $1.03
to $9.93. The software randomly chose a video
for each session. Fifth, <strong>the</strong> computer demonstrated
a coin dispenser providing change.
The participant did not practice this step.
Experimental Design
436 / Education and Training in Developmental Disabilities-December 2008
A multiple baseline design across three participants
(Kennedy, 2005) was used to evaluate
<strong>the</strong> effects of CBI. To safeguard <strong>the</strong> assumption
of independence of subject data associ-

ated with multiple baseline designs (Tawney &
Gast, 1984), all sessions (CBI, computer performance
mastery assessments, grocery
probes, and maintenance probes) were conducted
with individual participants. Measures
of percent correct in <strong>the</strong> five-step task analysis
were collected in grocery store probes across
baseline and treatment, different grocery
store probes and 30-day follow-up. Measures
in computer performance mastery assessment
and participant attentiveness were collected
during treatment. Parent and participant ratings
of purchasing skills were collected before
and after treatment.
Inter-Observer Agreement
In grocery probes, <strong>the</strong> first author served as
primary observer standing 1 m in front of <strong>the</strong>
participant at <strong>the</strong> end of <strong>the</strong> checkout stand.
In 30% of probes, a second observer stood 1 m
behind <strong>the</strong> participant in <strong>the</strong> checkout line.
Prior to <strong>the</strong> study, primary and secondary observers
scored performance of consumers at
<strong>the</strong> same Albertson’s grocery store. Agreement
was calculated using <strong>the</strong> point-by-point
method (Kennedy, 2005), in which <strong>the</strong> number
of agreements is divided by agreements
plus disagreements times 100%. An agreement
was defined as <strong>the</strong> two observers recording
<strong>the</strong> same response for a step in <strong>the</strong> task
analysis. The observers used <strong>the</strong> software and
response definitions as a reference while scoring
consumers. Inter-observer training continued
until observers achieved 100% agreement
for each step in <strong>the</strong> task analysis for two consecutive
sessions (across a total of eight customers).
Inter-Observer Agreement Results
Of <strong>the</strong> 15 grocery store probes, inter-observer
data were collected five times (i.e., Sessions 2,
3, 6, 9, and 13). For five data collection sessions,
<strong>the</strong>re were 75 possible agreements or
disagreements (i.e., three participants times
five sessions times five steps in <strong>the</strong> task analysis).
Four disagreements and 71 agreements
were recorded, or 94.6% inter-observer agreement.
Results
Computer Performance Mastery Results
As shown in Figure 1, computer performance
mastery assessment commenced in Session 4.
Beginning at this point, three participants
consistently scored between 60% - 100% in
<strong>the</strong> computer performance mastery assessment.
Mr. Red and Mr. Green performed at
<strong>the</strong> 100% level in every session. Mr. Blue’s
performance varied between 60% - 100%
from Sessions 6 to 8, but maintained at 100%
from Sessions 9-15.
Grocery Probe Results
Probes during baseline. As shown in Figure 1,
Mr. Red performed at <strong>the</strong> 60% level in three
baseline sessions. However, his performance
was inconsistent in terms of particular steps he
performed correctly. For example, in two of
three sessions, he correctly placed <strong>the</strong> groceries
on <strong>the</strong> conveyor correctly and paid using
<strong>the</strong> Dollar Plus strategy. In one session, he did
not correctly take change. He did not locate
<strong>the</strong> shortest checkout line during baseline. In
Session 1, he was prompted by <strong>the</strong> cashier to
take coin change.
Mr. Blue scored at <strong>the</strong> 0% level in three of
four sessions. In his first session, he was
prompted by a cashier to take his change. This
response was scored as correct but is noted in
Figure 1. When paying for his groceries, he
handed all of his money to <strong>the</strong> cashier to
count. When asked <strong>the</strong> “paper or plastic”
question, he hesitated <strong>the</strong>n pointed to <strong>the</strong>
plastic bag. The cashier asked him, “Do you
mean plastic?” These behaviors were scored as
incorrect because he did not make a verbal
response.
Mr. Green scored at 20% correct in his first
three sessions. He correctly responded to <strong>the</strong>
“paper and plastic” question. However, he did
not locate <strong>the</strong> shortest line and sometimes
waited longer than 15 s to put his groceries on
<strong>the</strong> conveyor. He placed <strong>the</strong> divider on <strong>the</strong>
conveyor after, not before, his groceries, contrary
to CBI instructions. He consistently paid
<strong>the</strong> cashier one dollar short. Also, in each
session, he walked away from his dispensed
coin change. In Session 4, Mr. Green placed
<strong>the</strong> groceries on <strong>the</strong> conveyor correctly. In
Computer-Based Instruction / 437

Figure 1. Grocery store and CBI performance mastery assessments in baseline, treatment, different grocery
stores, and 30-day follow-up.
438 / Education and Training in Developmental Disabilities-December 2008

this session, both observers noted that he appeared
to imitate actions of <strong>the</strong> customer in
front of him.
Probes during CBI. Mr. Red was <strong>the</strong> first
participant to receive probes of CBI effects in
<strong>the</strong> grocery store. As shown in Figure 1, performance
increased from baseline levels of
60% to 80% in Sessions 4–6.During Sessions
4 and 5, Mr. Red did not pay <strong>the</strong> correct Dollar
Plus amount. During Session 6, he failed to
place a divider before his groceries, but performed
correctly on <strong>the</strong> Dollar Plus amount. In
remaining probes, Mr. Red performed at
100% correct.
Mr. Blue’s performance increased from
60% to 100% in Sessions 6-9.InSessions 6
and 7, Mr. Blue offered too few dollar bills
and did not pick up his change. In Session 8,
he paid <strong>the</strong> right amount but did not pick up
change. In subsequent probes, he performed
each step correctly.
Mr. Green participated in four generalization
probes. His performance increased to
100% except for Session 9 when he provided
too few dollar bills.
Different grocery stores. At <strong>the</strong> first store
(Ream’s), Mr. Red and Mr. Green performed
at 100% correct, but Mr. Blue provided too
much money to <strong>the</strong> cashier for a score of 80%.
At Smith’s and Harmon’s, all three participants
performed at 100% correct.
30-day Follow-up Results
All participants scored 100% in both <strong>the</strong> computer
performance mastery assessment and
grocery store probe. The grocery probe was
conducted at <strong>the</strong> original Albertson’s store.
Results of Attention to Task during CBI
For Mr. Red, attentiveness data were collected
in 14 CBI sessions. In <strong>the</strong> first nine sessions,
Mr. Red performed on task in 100% of observations.
In <strong>the</strong> last five sessions, Mr. Reds’
attentiveness decreased to a mean of 81% of
observations (range 76% - 90%). For Mr.
Blue, attentiveness data were collected in 12
sessions and averaged 94% (range 73 to
100%). For Mr. Green, attentiveness data were
collected in seven sessions. He performed on
task in 100% of observation <strong>the</strong> first five ses-
sions <strong>the</strong>n decreased to a mean of 83% in <strong>the</strong>
last two sessions.
Skill Ratings by Parents and Participants
As shown in Table 1, mean ratings of both
parents and participants regarding participant
purchasing skills increased from pre-study to
post-study. Participants rated <strong>the</strong>ir pre-study
purchasing skills higher than parents, but
post-study ratings were highest for both parents
and participants.
Discussion
In summary, all participants significantly increased
correct responses in grocery probes
when CBI was introduced. Additional generalization
measures in three different stores
yielded 100% correct responses for all participants
except in one session. All participants
performed at 100% correct responses in 30day
maintenance probes. Generally, participants
remained attentive to <strong>the</strong> CBI instruction
throughout treatment and evidenced
high levels of correct responses. Parents and
participants rated purchasing skills higher after
<strong>the</strong> study than before <strong>the</strong> study.
Although previous research (Ayers &
Langone, 2002; Hutcherson et al., 2004) presented
equivocal results regarding generalized
effects of CBI, results of <strong>the</strong> present study
show high levels of correct performance in
grocery stores. This finding requires some explanation,
given that stores included stimuli
not present in CBI, such as shoppers, a variety
of employees, and TV ads playing on television
screens located at many checkout stands
potentially making successful navigation
through <strong>the</strong> task analysis more difficult. Additionally,
<strong>the</strong> study was conducted during <strong>the</strong>
end-of-calendar-year holiday season when
shopper traffic was relatively high. Yet, CBI
stimuli were apparently similar enough to
those encountered in <strong>the</strong> initial probe store
and three different stores to produce generalized
responding.
Participant performance in <strong>the</strong> different
stores is noteworthy in that purchasing responses
generalized to each of three different
grocery stores despite checkout stands of different
configurations. This finding is somewhat
surprising given <strong>the</strong> CBI did not present
Computer-Based Instruction / 439

TABLE 1
Mean Rating Scale Scores of Parents and Participants on Purchasing Skills.
Mr. Red
1 no ability
5 very capable
different checkout configurations. The performance
in <strong>the</strong> different grocery stores demonstrates
not only stimulus generalization but
<strong>the</strong> performance of different responses as
well. Perhaps <strong>the</strong> participants learned to discriminate
new stimuli in <strong>the</strong> original grocery
store, such as actions of o<strong>the</strong>r shoppers or
cashiers, as cues for new responses. When
presented with new checkout configurations,
participants may have relied on previous discriminations
to influence <strong>the</strong>ir purchasing
responses.
Participants in this study demonstrated
more rapid skill acquisition on computer and
grocery store generalization probes than Ayers
et al. (2006) where researchers only examined
<strong>the</strong> Dollar Plus component of purchasing
sequence. Multiple factors may explain more
Participant
Pre-study
Participant
Post-study
Parent
Pre-study
Parent
Post-study
Selection of shortest line. 3 5 4 5
Placement of three items. 3 5 3 5
Payment of correct amount. 2 5 4 5
“Paper or plastic?” 3 5 4 5
Collection of change, receipt, and groceries. 3 5 4 5
Mean 2.8 5.0 3.8 5.0
Mr. Blue
1 no ability
5 very capable
Participant
Pre-study
Participant
Post-study
Parent
Pre-study
Parent
Post-study
Selection of shortest line. 5 5 3 4
Placement of three items. 4 4 3 5
Payment of correct amount. 5 5 2 4
“Paper or plastic?” 4 5 1 4
Collection of change, receipt, and groceries. 4 5 1 4
Mean 4.4 4.8 2.0 4.2
Mr. Green
1 no ability
5 very capable
Participant
Pre-study
Participant
Post-study
Parent
Pre-study
Parent
Post-study
Selection of shortest line. 3 5 2 5
Placement of three items. 4 5 3 5
Payment of correct amount. 4 4 1 4
‘Paper or plastic?‘ 4 5 3 5
Collection of change, receipt, and groceries. 4 5 1 5
Mean 3.8 4.8 2.0 4.8
440 / Education and Training in Developmental Disabilities-December 2008
rapid acquisition of <strong>the</strong> purchasing skills in
this study as compared to Ayers et al. including
age, previous shopping experiences of <strong>the</strong>
participants, teaching methods, and maturity.
First, participants of <strong>the</strong> Ayers et al. study were
middle school students with significant intellectual
disabilities and a mean age of 14 years.
Participants in this study had a mean age of 17
years. Participants in both studies had similar
IQ and adaptive behavior standard scores. Participants
in this research may have had more
experience in both CBI and community shopping
environments. Second, participants in
this study had past exposure to <strong>the</strong> Dollar Plus
concept with role play and direct instruction
in a classroom setting in previous school years.
However, baseline data in this study indicate
skills had not generalized prior to CBI. Addi-

tionally, participants of this study may have
had more exposure to various kinds of computer
teaching software and easily adapted to
this interactive software. These factors may
have influenced a quicker and more complete
acquisition of Dollar Plus purchasing skills.
Third, teaching methods were different in two
ways: <strong>the</strong> sequence of purchasing steps versus
individual responses and grocery store probes
versus simulations. This study focused on <strong>the</strong>
entire purchasing sequence, ra<strong>the</strong>r than single
responses in <strong>the</strong> Ayers et al. study. While
<strong>the</strong> current purchasing sequence was more
complex, it may have helped <strong>the</strong> participant
discriminate <strong>the</strong> relevance and functionality
of <strong>the</strong> five steps. That is, successful completion
of one step may have established <strong>the</strong> stimuli
for <strong>the</strong> next step in sequence, whereas training
on individual steps (Ayers et al.) may have
isolated stimuli and limited learning of a successive
set of responses. Fourth, unlike Ayers
et al., this study used DVD video instruction.
The DVD videos presented shopping trips
from beginning to end, potentially facilitating
acquisition of shopping skills. Fifth, highschool
age participants in this study compared
to middle school students in <strong>the</strong> Ayers et al.
may have had increased motivation to learn
purchasing skills, ei<strong>the</strong>r because of increased
maturity, parents’ expectations, or motivations
to perform skills similar to non-disabled
peers.
All participants and parents rated purchasing
performance higher in posttest compared
to pretest. Anecdotal reports from parents after
<strong>the</strong> study indicated <strong>the</strong>y were pleased with
<strong>the</strong> newly acquired skills. Mr. Red’s mo<strong>the</strong>r
stated that she now trusts her son to go to <strong>the</strong>
store, purchase a few items, and bring back
<strong>the</strong> correct amount of change. Mr. Green’s
mo<strong>the</strong>r commented, “This opens a much
wider world for my son.”
Limitations of Research
Four limitations are discussed in regards to
this research. First, computer performance
mastery assessments were not conducted in
<strong>the</strong> baseline phase of this study, but instead,
commenced only in <strong>the</strong> treatment phase. This
discontinuity makes it impossible to evaluate
directly <strong>the</strong> functional relationship between
<strong>the</strong> assessment and <strong>the</strong> CBI treatment effect.
However, <strong>the</strong> grocery store probes do provide
a consistent measure of checkout skills from
baseline throughout treatment and offer evidence
of generalization effects only when CBI
commenced. Future research should use consistent
measures across phases. Second, <strong>the</strong>
first author and, in some cases, a second observer
were present each time a participant
made a purchase. This study provides no evidence
of whe<strong>the</strong>r generalization may occur to
situations in which no familiar person is
present. More research is needed, perhaps
using video, to assess generalization. Third, all
purchases were less than $10.00. Students
were given 10 one-dollar bills and asked to pay
using Dollar Plus procedures. However, <strong>the</strong>
Project Shop CBI program teaches using
amounts up to 25 one-dollar bills. This study
provides no evidence of whe<strong>the</strong>r generalization
would occur if purchase amounts were
greater than $10.00. More research is needed
to investigate <strong>the</strong> generalization effects with
varying amounts of money. Finally, on a related
note, <strong>the</strong>re were no variations in numbers
of items purchased. In all cases, participants
placed and paid for three items. This
study provides no evidence of whe<strong>the</strong>r generalization
would occur to more extensive purchases.
More research is needed to examine
<strong>the</strong> effects of CBI on purchasing differing
quantity of items.
Implications for Practice
This study adds to <strong>the</strong> extant research literature
suggesting CBI is an effective tool in
teaching purchasing skills to individuals with
disabilities. Moreover, results indicate skills
generalized to multiple community settings
and maintained over time, thus providing educators
with early evidence that, under prescribed
circumstances, youth with intellectual
disabilities may be able to learn community
skills using CBI. While additional research
must be conducted, such a finding would have
important impact on practices in secondary
school settings needing cost efficient teaching
materials. If a computer or website could be
accessed when community field trips could
only be used sparingly, <strong>the</strong>n educators might
find <strong>the</strong> right combination to teach generalized
skills. Although <strong>the</strong> Project Shop CBI program
is not commercially available, similar
Computer-Based Instruction / 441

programs might be constructed for a variety of
community skills. However, as recommended
by Morse et al. (1996), any such development
must be carefully designed to include relevant
community stimuli with multiple exemplars to
promote generalization.
References
Ayres, K. M., & Langone, J. (2002). Acquisition and
generalization of purchasing skills using a video
enhanced computer instructional program. <strong>Journal</strong>
of Special Education Technology, 17, 15–28.
Ayres, K. M., Langone, J., Boon, R. T., & Norman, A.
(2006). Computer-based instruction for purchasing
skills. Education and Training in Developmental
Disabilities, 41, 253–263.
Colver, S. P., & Collins, B. C. (1996). Using natural
cues within prompt levels to teach <strong>the</strong> next dollar
strategy to students with disabilities. <strong>Journal</strong> of
Special Education, 30, 305–318.
Hutcherson, K., Langone, J., Ayres, K., & Clees, T.
(2004) Computer assisted instruction to teach
item selection in grocery stores: An assessment of
acquisition and generalization. <strong>Journal</strong> of Special
Education Technology, 19, 33–42.
Kennedy, C. H. (2005). Single case designs for educational
research. Boston: Allyn & Bacon.
Langone, J., Clees, T. J., Rieber, L., & Matzko, M.
(2003). The future of computer-based interactive
technology for teaching individuals with moderate
to severe disabilities: Issues relating to research
and practice. <strong>Journal</strong> of Special Education
Technology, 18, 5–16
McDonnell, J., & Laughlin, B. (1989). A comparison
of backward and concurrent chaining strategies
in teaching community skills. Education and Training
in Mental Retardation, 24, 230–238.
Morse, T. E., Schuster, J. W., & Sandknop, P. A.
(1996). Grocery shopping skills for persons with
moderate to profound intellectual disabilities: A
review of <strong>the</strong> literature. Education and Treatment of
Children, 19, 487–517.
Tawney, J. W., & Gast, D. L. (1984). Single subject
research in special education. New York: Merrill Mc-
Millan.
Wissick, C. A., Lloyd, J. W., & Kinzie, M. B. (1992).
The effects of community training using a videodisc-based
simulation. <strong>Journal</strong> of Special Education
Technology, 11, 208–221.
Received: 6 August 2007
Initial Acceptance: 1 October 2007
Final Acceptance: 14 January 2008
442 / Education and Training in Developmental Disabilities-December 2008

Effectiveness of Discrete Trial Teaching with Preschool
Students with Developmental Disabilities
Andrew Downs, Robyn Conley Downs, Michelle Fossum, and Kathryn Rau
Central Washington University
Abstract: There is a great need to identify instructional methods that effectively promote positive skill development
in young children with developmental disabilities. This 2-year longitudinal study evaluated <strong>the</strong> practicality
and effectiveness of two delivery models of providing Discrete Trial Teaching (DTT) to children with
developmental disabilities within an existing public preschool program. At baseline all participants demonstrated
significant developmental delay in several areas of functioning (communication, motor skills, language,
social/adaptive behavior, and cognition). In year 1 of <strong>the</strong> intervention each participant received DTT in three
10-15-minute intervals each school day. In year 2 participants received DTT in one 30-45-minute interval each
school day. Participants who were exposed to both delivery models acquired new skills significantly faster and
learned more in year 2, suggesting greater instructional efficiency and effectiveness when DTT was provided in
one longer session. The results indicated that DTT has <strong>the</strong> potential to be used practically and effectively within
existing public preschool programs to positively impact <strong>the</strong> learning and development of young children with
developmental disabilities. Implications and directions for future research are discussed.
Since 1968 federal legislation has mandated
<strong>the</strong> provision of preschool programs for children
who are at educational risk due to experiencing
developmental disabilities (Handicapped
Children’s Early Education Assistance
Act). As early intervention (EI) and early
childhood special education (ECSE) programs
have become more widely available, educators
and researchers have worked to develop
and identify practices that positively
impact <strong>the</strong> development of young children
with developmental disabilities. Significant
progress has been made, and in 2005 <strong>the</strong> <strong>Division</strong>
of Early Childhood (DEC) of <strong>the</strong> Council
for Exceptional Children (CEC) summarized
<strong>the</strong> relevant research and published <strong>the</strong>
The authors thank <strong>the</strong> families and children who
participated in <strong>the</strong> study, as well as <strong>the</strong> many research
assistants who provided instructional services
and collected data. This study was partially supported
by <strong>the</strong> Faculty Research Fund of Central
Washington University, Ellensburg, Washington.
Correspondence concerning this article should be
addressed to Dr. Andrew Downs, Department of
Social and Behavioral Sciences, University of Portland,
5000 N. Willamette Blvd., Portland, OR 97203.
Email: downs@up.edu.
Education and Training in Developmental Disabilities, 2008, 43(4), 443–453
© <strong>Division</strong> on Developmental Disabilities
DEC Recommended Practices in EI/ECSE
(Sandall, Hemmeter, Smith, & McLean).
The DEC Recommended Practices provide
general guidelines for professionals across several
components of EI/ECSE programs including
assessment; interventions; familybased
practices; interdisciplinary models;
technology applications; policies, procedures,
and systems change; and personnel preparation
(Sandall et al., 2005). For example, in <strong>the</strong>
area of intervention one of <strong>the</strong> recommended
practices is “systematic naturalistic teaching
procedures such as models, expansions, incidental
teaching, mand-model procedure, and
naturalistic time delay are used to promote
acquisition and use of communication and
social skills” (Sandall et al., p. 89). Such research-based
guidelines hold promise for improving
<strong>the</strong> quality of EI/ECSE programs.
However, despite <strong>the</strong> guidelines provided
by <strong>the</strong> DEC, research indicates that many EI/
ECSE professionals may experience difficulty
translating <strong>the</strong> recommended practices into
effective assessment and intervention techniques
that can be used in <strong>the</strong> classroom. This
is because many EI/ECSE professionals do
not receive adequate formal training in assessment
and instructional methods that <strong>the</strong>y can
Discrete Trial Teaching with Preschool Students / 443

use in <strong>the</strong> classroom to facilitate <strong>the</strong> development
of young children with developmental
disabilities (Bricker, 1995; Schepis, Reid,
Ownby, & Parsons, 2001). Given <strong>the</strong> increasing
number of paraeducators working in EI/
ECSE settings (Giangreco & Doyle, 2002; Giangreco,
Edelman, Broer, & Doyle, 2001) this
problem may actually be worsening, as many
paraeducators have lower levels of education
and training than teachers (Riggs & Mueller,
2001).
In addition to <strong>the</strong> training issues, <strong>the</strong>re is an
apparent lack of consensus among professionals
and researchers regarding how assessment
and instructional techniques can be used most
effectively in EI/ECSE settings. For example,
some researchers have noted that conventional
norm-based tests dominate assessment
in <strong>the</strong> field, but have argued against <strong>the</strong> use of
such tests and advocated <strong>the</strong> use of curriculum
and criterion-based assessments that are
explicitly linked to intervention efforts (Bagnato,
2005; Downs & Strand, 2006; Macy,
Bricker, & Squires, 2005; McConnell, Priest,
Davis, & McEvoy, 2002; Vanderheyden, 2005).
Regarding instructional methods, some professionals
insist that child-directed approaches
are most appropriate (Greenspan & Weider,
1999), whereas o<strong>the</strong>rs tout <strong>the</strong> merits of teacher-directed
approaches to educating young
children with developmental disabilities (Engelmann
& Osborn, 1970; Lovaas, 2003).
Not surprisingly, <strong>the</strong>se philosophical differences
and <strong>the</strong> relative inadequacy of formal
training of EI/ECSE professionals and paraprofessionals
in specific assessment and instructional
methods lead to significant variance
in <strong>the</strong> quality and content of EI/ECSE
programs. As a result, <strong>the</strong> developmental and
educational outcomes of many children with
developmental disabilities are likely to be less
than optimal as EI/ECSE educators struggle
with <strong>the</strong> question of how to deliver an appropriate
education for each student with whom
<strong>the</strong>y work. Indeed, although research suggests
that well designed and implemented preschool
programs can lead to significant developmental
gains for children (Guralnick, 1997;
Ramey & Ramey, 2004), <strong>the</strong>re is little doubt
that many preschool programs are not as effective
as <strong>the</strong>y could be (Downs & Strand,
2006; Ramey & Ramey, 1998, 2004).
There is a clear need to continue identify-
444 / Education and Training in Developmental Disabilities-December 2008
ing and empirically validating effective assessment
and instructional techniques that lead to
significant developmental gains for children
with developmental disabilities. Such techniques
should be consistent with <strong>the</strong> DEC Recommended
Practices, and it is critical that
educators are able to implement <strong>the</strong> methods
within EI/ECSE settings. To that end, assessment
and instructional techniques that are
simple, practical, cost-effective, flexible, and
that have clear and efficient training procedures
are likely to be most helpful. Of course,
it is of primary importance that <strong>the</strong> methods
used by EI/ECSE educators lead to observable
and measurable developmental gains for children
with developmental disabilities. In addition,
researchers and educators must continue
to identify and document <strong>the</strong> specific assessment
and instructional methods that tend to
be more effective for children with specific
developmental, diagnostic, and/or cultural
characteristics.
Discrete Trial Teaching (DTT) is an instructional
method that has been used for decades
to improve <strong>the</strong> developmental and educational
outcomes of children with autism and
developmental delay (Lovaas, 1987, 2003;
McEachin, Smith, & Lovaas, 1993; Smith,
1999, 2001). Grounded in <strong>the</strong> experimental
analysis of behavior, DTT (described in <strong>the</strong>
methods section) is a specific type of teacherdirected
instruction that individualizes and
simplifies educational interactions to improve
children’s learning. DTT has been used to
help children with autism acquire a wide
range of skills including receptive and expressive
language (Lovaas, 1977; Howlin, 1981;
Young, Krantz, McClannahan, & Poulson,
1994); imitation (Coe, Matson, Fee, Manikam,
& Lanarello, 1990; Young et al.); grammar
and syntax (Risely, Hart, & Doke, 1972); play
skills (Coe et al.); conversational skills (Krantz
& McClannahan, 1981); and social and emotional
skills (Downs & Smith, 2004).
Often, <strong>the</strong> gains children with autism make
in response to DTT are quite impressive. For
example, studies by Lovaas and his colleagues
showed that 47% of young children with autism
treated intensively with DTT achieved
normal (i.e., average or above) levels of intellectual
and academic functioning after two to
three years of treatment and that those gains
were maintained over several years (Lovaas,

1987; McEachin et al., 1993). Those accomplishments
are particularly impressive considering
<strong>the</strong> relatively severe developmental difficulties
typically associated with autism and
extremely poor prognosis for children with
<strong>the</strong> disorder prior to <strong>the</strong> use of DTT methods
(Klinger & Dawson, 1997; Rutter, 1985).
In addition to <strong>the</strong> efficacy DTT has demonstrated
with children who have autism and
developmental delay, <strong>the</strong> technique has several
advantages that make it a promising strategy
for work with children who have developmental
disabilities o<strong>the</strong>r than autism in EI/
ECSE settings. As noted, DTT has proven
particularly useful in teaching young children
with autism to acquire a wide range of new
skills. As such, educators who learn <strong>the</strong> relatively
simple procedure can work to facilitate
skill development in young children across
desired domains depending on <strong>the</strong> individual
child’s needs and strengths. In addition, because
one component of DTT is ongoing data
collection tracking student progress in learning
important skills, educators are able to conduct
a continuous, curriculum-based formative
assessment of student progress. This
integration of assessment and instruction is
considered critical by researchers in <strong>the</strong> field
(Downs & Strand, 2006; Macy et al., 2005;
Vanderheyden, 2005) and allows educators to
provide a truly individualized and developmentally
appropriate education for young
children with developmental disabilities.
Ano<strong>the</strong>r strength of DTT includes <strong>the</strong> use
of extremely short instructional units (i.e., typically
one to five seconds) that facilitate rapid
skill acquisition and allow for up to 200 learning
opportunities per hour (Smith, 2001),
thus making <strong>the</strong> procedure quite efficient.
The short instructional units are also developmentally
appropriate for preschool age children
who typically have limited attentional
capacities. In addition, <strong>the</strong> emphasis DTT
places on shaping and positive reinforcement
of child learning inevitably results in a high
rate of positive interaction between educator
and student as children receive both desired
tangible rewards and teacher praise throughout
learning sessions. Lastly, <strong>the</strong> short DTT
instructional units also allow EI/ECSE educators
to flexibly engage in learning activities
with children throughout <strong>the</strong>ir school day as
dictated by student and program needs. For
example, discrete trials can be embedded into
<strong>the</strong> ongoing activities of <strong>the</strong> preschool (Bride
& Schwartz, 2003) or can be used as an adjunct
to regular EI/ECSE programming much
as speech <strong>the</strong>rapy and o<strong>the</strong>r services currently
are (Downs, Downs, Johansen, & Fossum,
2007).
Importantly, <strong>the</strong>re are clear and efficient
training procedures that can be used to teach
EI/ECSE educators (teachers, paraeducators,
tutors, and caregivers) to implement DTT
across environments. With appropriate supervision
just about any person in a young child’s
life can learn how to facilitate <strong>the</strong> child’s skill
development through <strong>the</strong> use of DTT. This
not only allows for more learning opportunities
for <strong>the</strong> child throughout <strong>the</strong> day, but also
can help facilitate <strong>the</strong> ability of <strong>the</strong> child to
generalize skills <strong>the</strong>y have learned in <strong>the</strong> preschool
across time, people, and environments.
In this way <strong>the</strong> use of DTT can lead to significant
improvements in <strong>the</strong> adaptive functioning
of children with developmental disabilities.
Considering those strengths noted and <strong>the</strong>
striking success of DTT with children who
have autism and developmental delay it is
somewhat surprising that this method has not
been implemented widely with children who
have developmental disabilities o<strong>the</strong>r than autism.
This is especially true when one considers
that young children with developmental
disabilities often display some characteristics
that are similar to young children with autism
such as attentional and social skills deficits,
developmental delay, and behavior problems
(Lovaas, 2003). Fur<strong>the</strong>r, because children
with autism often display more severe difficulties
across areas than children with o<strong>the</strong>r developmental
disabilities one would logically
expect that <strong>the</strong> latter may respond even more
favorably to DTT.
In order to evaluate that possibility Downs
and colleagues (2007) investigated <strong>the</strong> effectiveness
of providing DTT to young children
with various developmental disabilities who
were enrolled in a public developmental preschool
program. This setting was chosen because
it was important to determine whe<strong>the</strong>r
DTT could be implemented in a practical,
time-limited (i.e., cost effective) manner
within <strong>the</strong> existing structure in which <strong>the</strong> majority
of children with developmental disabili-
Discrete Trial Teaching with Preschool Students / 445

TABLE 1
Age, Diagnosis, and Areas of Significant Delay of Participants at Intake
Age in Months Diagnosis Areas of Delay ( 2 SD Below Normed Mean)
46 Cerebral Palsy Cognitive, Language, Communication, Daily
Living Skills, Socialization, Motor Skills,
Adaptive Behavior
44 Developmental Delay Cognitive, Language, Communication, Daily
Living Skills, Socialization, Motor Skills,
Adaptive Behavior
48 Autism Cognitive, Language, Communication, Daily
Living Skills, Socialization, Motor Skills,
Adaptive Behavior
ties currently receive services (McBride &
Schwartz, 2003). The results of this study indicated
that children who were “pulled out” of
<strong>the</strong>ir regular preschool programming in 10- to
15-minute blocks of time in order to receive
DTT in an adjacent classroom or on <strong>the</strong> playground
made significant developmental gains
that were not observed in children enrolled in
<strong>the</strong> preschool who did not receive DTT. Specifically,
at <strong>the</strong> end of <strong>the</strong> academic year <strong>the</strong>
children who received DTT showed significant
developmental gains in communication,
daily living skills, social skills, and overall adaptive
behavior, whereas children in <strong>the</strong> control
group (who received <strong>the</strong> same amount of
overall teacher attention) did not make such
gains. In addition, data indicated that exposure
to DTT resulted in significant learning
across several important skill areas for each
child in <strong>the</strong> study (Downs et al.).
Although <strong>the</strong> results of this study were
promising and provide support for <strong>the</strong> use of
DTT with young children who have developmental
disabilities, questions were raised regarding
<strong>the</strong> best way to provide those services
within public preschool settings. For example,
it was noted that some of <strong>the</strong> children had
significant difficulty with <strong>the</strong> multiple transitions
that were required to pull <strong>the</strong>m out and
place <strong>the</strong>m back into <strong>the</strong> regular preschool
setting three times each day (Downs et al.,
2007). Considering <strong>the</strong> difficulty students appeared
to have with transitions <strong>the</strong>re were two
alternative possibilities to explore regarding
service delivery. First, DTT could be embedded
within <strong>the</strong> ongoing activities of <strong>the</strong> preschool.
Second, DTT could be provided as an
additional service ei<strong>the</strong>r directly following or
prior to <strong>the</strong> regular preschool hours. The purpose
of <strong>the</strong> present study was to evaluate <strong>the</strong>
effectiveness of providing DTT to children
with developmental disabilities as an additional
service when compared to <strong>the</strong> “pullout”
model used in <strong>the</strong> Downs et al. study.
Method
Participants
Participants were three children (two boys
and one girl) who were enrolled in a publicly
funded developmental preschool for two consecutive
academic years and whose parents
elected to have <strong>the</strong>m participate in <strong>the</strong> research
project. All three students demonstrated
significant cognitive and language delay
(i.e., 2 or more standard deviations below
<strong>the</strong> mean) as well as significant delays in additional
areas of functioning. Table 1 presents
information for each student regarding age
and diagnostic and developmental status. As a
result of <strong>the</strong>ir developmental disabilities all
three were at serious risk for poor educational,
behavioral, and psychosocial outcomes.
Procedure
446 / Education and Training in Developmental Disabilities-December 2008
DTT Instruction. Each DTT unit of instruction
lasts for approximately 3-10 seconds and
consists of five parts, as follows (see Lovaas,
2003 and Smith, 2001 for a more detailed
description of DTT procedures):

1. Discriminative Stimulus (Cue): The instructor
presents a brief instruction or
question to <strong>the</strong> student (e.g., “What color
is it?” or “Touch your nose”).
2. Prompt: In conjunction with or immediately
after <strong>the</strong> cue, <strong>the</strong> instructor assists
<strong>the</strong> student in responding correctly to <strong>the</strong>
cue (e.g., <strong>the</strong> teacher physically or orally
models <strong>the</strong> response or takes <strong>the</strong> student’s
hand and guides him/her to perform <strong>the</strong>
response). As instruction progresses <strong>the</strong>
prompt is gradually faded and eventually
eliminated so that <strong>the</strong> student responds to
<strong>the</strong> cue alone.
3. Response: The student gives a correct or
incorrect answer to <strong>the</strong> cue.
4. Consequence: Correct responses are immediately
reinforced with verbal praise,
access to toys, or o<strong>the</strong>r things <strong>the</strong> particular
student enjoys. If an incorrect response
is given <strong>the</strong> instructor withholds
positive reinforcement or provides corrective
feedback (e.g., “No”).
5. Inter-trial interval: After <strong>the</strong> consequence,
<strong>the</strong> instructor pauses for 1-5 seconds before
presenting <strong>the</strong> cue for <strong>the</strong> next learning
trial.
Students typically spend 15 minutes or less in
each DTT session and take an approximately
5- to 15-minute play break in between each
session during which time <strong>the</strong> instructor prepares
materials for <strong>the</strong> next session and
checks <strong>the</strong> just collected data for accuracy and
completeness. The data collection consists of
a documentation of each learning trial that
includes information on <strong>the</strong> items targeted,
student responses, and <strong>the</strong> level and type of
any prompt that was used. This ongoing data
is used to continuously modify instruction and
goals to ensure maximum benefits and efficacy.
DTT Training. The lead experimenter, a
clinical psychologist with extensive training
and experience in DTT, provided training in
DTT procedures to undergraduate and graduate
student research assistants at <strong>the</strong> beginning
of each academic year, as well as at two
additional training sessions within each school
year. Research assistants assigned to provide
DTT (hereafter referred to as instructors) received
between 15 and 20 hours of didactic
training, modeling, and practice with correc-
tive feedback provided by <strong>the</strong> lead experimenter
and a graduate student who also had
several years experience providing DTT. The
two primary trainers assessed instructor competence
in correct use of DTT instructional
procedures and recording of student responses
(assessment) in vivo following <strong>the</strong>
training period using an adaptation of definitions
and procedures outlined by Koegel,
Russo, and Rincover (1977). Inter-observer reliability
was calculated for 25% of <strong>the</strong> instructor
competence ratings with agreement ranging
from 90 to 100%. Competence of
individual instructors following training
ranged from 79 to 96% correct use of DTT
instructional and assessment procedures.
Implementation of DTT. Students attended
<strong>the</strong> preschool for two hours per day an average
of three days per week (6 hours total per
week). In year 1 of <strong>the</strong> study students were
“pulled out” of <strong>the</strong>ir regular preschool programming
in 10- to 15-minute blocks of time
in order to receive <strong>the</strong> DTT instruction on a
one-to-one basis in an adjacent classroom or
outside on <strong>the</strong> playground. In year 2 of <strong>the</strong>
study students received DTT instruction on a
one-to-one basis in an adjacent classroom in
three consecutive 10-15 minute blocks of time,
separated by play breaks, following <strong>the</strong>ir regular
preschool programming. In year 1 each
student received between 32 and 42 hours of
DTT over <strong>the</strong> course of <strong>the</strong> 27 weeks of <strong>the</strong>
intervention for an average of 1.30 to 1.58
hours of DTT per week. In year 2 each student
received between 16 and 60 hours of DTT
over <strong>the</strong> school year for an average of 1.05 to
2.28 hours of DTT per week.
DTT procedures were used to teach <strong>the</strong>
students skills in several developmental areas
including receptive and expressive language
(e.g., identification of objects, behaviors, emotions,
colors, shapes), socialization (e.g., conversational
skills, turn-taking), pre-academics
(e.g., letters, numbers, counting), imitation
(e.g., gross and fine motor), daily living skills
(e.g., following directions), and fine motor
skills (e.g., drawing, cutting). Following baseline
assessments and consultation with caregivers
and <strong>the</strong> regular preschool teacher, an
individualized curriculum was developed for
each student using materials adapted from
Lovaas (2003) and Leaf and McEachin
(1999). Due to varying strengths and weak-
Discrete Trial Teaching with Preschool Students / 447

nesses not every student received instruction
in every domain (e.g., two children did not
receive instruction in <strong>the</strong> expressive identification
of numbers and letters, whereas one
did). Whenever possible, instruction was balanced
across developmental areas for each
student and explicitly linked to desired learning
objectives.
Procedural integrity. To ensure treatment fidelity,
<strong>the</strong> lead experimenter and/or a graduate
assistant with extensive training and experience
implementing DTT supervised all
sessions, and daily feedback was given to each
instructor orally and via a structured checklist.
The checklist was developed using definitions
provided by Koegel et al. (1977) and was utilized
daily until <strong>the</strong> instructors achieved at
least 90% competence in all skill areas of instruction
and assessment. After achieving at
least 90% competence, instructors were rated
on <strong>the</strong> checklist and provided feedback a minimum
of once per week, while also continuing
to receive daily oral feedback. Inter-rater reliability
for <strong>the</strong> structured checklist was assessed
periodically throughout <strong>the</strong> school year (i.e.,
every 3 weeks), with agreement ranging from
87 to 100%. Daily data also was collected to
assess <strong>the</strong> amount of intervention provided
and <strong>the</strong> extent to which instruction was provided
across all programs in each student’s
curriculum.
Caregivers of <strong>the</strong> students were provided
training in DTT and <strong>the</strong> availability of ongoing
supervision, and were encouraged to provide
additional in-home instruction for <strong>the</strong>ir
child. However, none of <strong>the</strong> caregivers reported
providing in-home DTT to <strong>the</strong>ir children,
with each citing time constraints as <strong>the</strong>
major barrier to doing so. Thus, only <strong>the</strong> designated
DTT instructors provided DTT instruction
to students. Additionally, it is important
to note that none of <strong>the</strong> students were
reported by <strong>the</strong>ir caregivers as receiving any
services in <strong>the</strong> home or community o<strong>the</strong>r than
those provided at <strong>the</strong> preschool.
Results
DTT Programs and Item Mastery
Tables 2, 3, and 4 summarize data regarding
<strong>the</strong> number of items within each DTT program
area that each student did not know at
TABLE 2
Items Mastered Within Discrete Trial Teaching
Programs in Year 1 and Year 2 for Student 1
Program
Year 1 Items
Mastered
Year 2 Items
Mastered
Receptive Instructions 10 17
Receptive Shapes 3 7
Receptive Body Parts 6 11
Receptive Emotions 5 13
Receptive Letters 3 9
Receptive Numbers 2 9
Receptive Objects 13 23
Receptive Behaviors 0 5
Receptive Colors 11 0
Verbal Imitation 9 0
Motor Imitation 7 0
Come Here 4 0
Total Items 73 94
baseline and mastered by <strong>the</strong> end of year 1
and year 2. Items were considered mastered if
<strong>the</strong> student responded correctly at least 80%
TABLE 3
Items Mastered Within Discrete Trial Teaching
Programs in Year 1 and Year 2 for Student 2
Program
448 / Education and Training in Developmental Disabilities-December 2008
Year 1 Items
Mastered
Year 2 Items
Mastered
Receptive Instructions 26 15
Receptive Shapes 0 9
Receptive Body Parts 22 29
Receptive Emotions 12 15
Receptive Letters 0 17
Receptive Numbers 0 11
Receptive Objects 20 29
Expressive Colors 0 12
Expressive Objects 10 23
Expressive Body Parts 0 3
Expressive Emotions 0 5
Expressive Letters 0 7
Expressive Numbers 0 11
Counting 2 0
Verbal Imitation 24 24
Motor Imitation 8 0
Block Building 0 12
Drawing 0 7
Cutting 0 3
Conversation Skills 0 6
Total Items 124 238

TABLE 4
Items Mastered Within Discrete Trial Teaching
Programs in Year 1 and Year 2 for Student 3
Program
Year 1 Items
Mastered
Year 2 Items
Mastered
Receptive Instructions 5 19
Receptive Colors 3 11
Receptive Objects 6 17
Receptive Emotions 2 0
Receptive Body Parts 1 0
Receptive Numbers 1 0
Imitation With Objects 0 20
Motor Imitation 5 10
Verbal Imitation 3 0
Sign Language 0 3
Drawing 0 7
Total Items 26 87
of <strong>the</strong> time over at least two days, with two
different instructors. The number of specific
programs in each student’s curriculum on any
given day ranged from a low of six for student
3 to a high of 15 for student 2. As shown in <strong>the</strong>
tables <strong>the</strong> number of total items mastered by
each student was greater in year 2 than in year
1, with student 1 showing a modest increase
and students 2 and 3 showing much larger
increases in number of items mastered.
Rate of Learning within DTT Programming
Table 5 presents data regarding <strong>the</strong> number
of items mastered per hour and per day of
TABLE 5
DTT intervention. Although student 1 showed
only a modest increase in <strong>the</strong> total number of
items mastered in year 2 compared to year 1,
this was mainly a result of <strong>the</strong> student missing
approximately half of <strong>the</strong> academic year due
to illness. As seen in Table 5, <strong>the</strong> learning rate
(i.e., <strong>the</strong> number of items mastered per hour
and per day of DTT intervention) of student 1
increased substantially in year 2 compared to
year 1 as he learned more than twice as many
items per hour and per day in year 2 compared
to year 1. Similarly, students 2 and 3
also demonstrated substantial increases in
learning rate in year 2 when compared to year
1. Student 2 learned almost twice as many
items per hour and more than twice as many
items per day in year 2. Student 3 learned
more than twice as many items per hour and
more than three times as many items per day
in year 2. It is also important to note that
students 1 and 2 (<strong>the</strong> children with developmental
disabilities o<strong>the</strong>r than autism) both
mastered more items per hour and per day
than student 3 (<strong>the</strong> child with autism) in both
years 1 and 2.
Discussion
Results of <strong>the</strong> present study and those from
year 1 of <strong>the</strong> intervention (Downs et al., 2007)
indicate that even relatively small amounts of
instruction (i.e., 30-45 minutes per day) provided
in a discrete trials format can lead to
significant learning and developmental gains
Number of Items Mastered Per Day and Per Hour of DTT for Students in Year 1 and Year 2
Student and Year Total DTT Hours Total DTT Days
Items Mastered Per
DTT Hour
Items Mastered
Per DTT Day
Student 1
Year 1 31.92 62 2.29 1.18
Year 2 16.83 39 5.59 2.41
Student 2
Year 1 35.10 67 3.53 1.85
Year 2 37.46 58 6.35 4.10
Student 3
Year 1 41.10 91 0.63 0.29
Year 2 60.18 92 1.45 0.95
DTT Discrete Trial Teaching
Discrete Trial Teaching with Preschool Students / 449

for children with a range of developmental
disabilities enrolled in public preschool programs.
This may be particularly true for children
who have developmental disabilities
o<strong>the</strong>r than autism, as <strong>the</strong> results from years 1
and 2 suggested that such children evidenced
significantly higher rates of learning and
larger developmental gains than did children
with autism. In addition, providing DTT in
one block of time per day as an additional
service may be more effective than providing
DTT in shorter blocks of time as a “pull-out”
service. Although year 1 of <strong>the</strong> study demonstrated
that <strong>the</strong> “pull-out” model resulted in
significant skill gains and accelerated development
across domains (Downs et al.), all three
students exposed to both delivery models mastered
a higher number of learning items and
exhibited a faster rate of skill acquisition when
DTT was provided via <strong>the</strong> additional service
model.
There are several possible explanations for
<strong>the</strong>se findings. First, it is possible that <strong>the</strong>
students learned more in year 2 of <strong>the</strong> study
simply because <strong>the</strong>y received more hours of
DTT. This certainly was true for student 3 who
received over 60 hours of DTT in year 2 compared
to only 41 hours in year 1. However,
closer examination of <strong>the</strong> data reveals that this
student mastered over three times as many
total items and over twice as many items per
hour in year 2. Thus, <strong>the</strong> observed increase in
learning was <strong>the</strong> result of more efficient learning,
not simply more time receiving DTT. Indeed,
student 1 received less than 17 hours of
DTT in year 2 and over 31 hours in year 1, yet
mastered a higher number of items in year 2
and learned almost two and a half times more
items per hour in year 2. Similarly, student 2
only received 2.36 more total hours of DTT in
year 2, but mastered almost twice as many
total items and learned almost twice as many
items per hour as in year 1.
Ano<strong>the</strong>r, more likely, explanation for <strong>the</strong>
improved learning in year 2 is that <strong>the</strong> time
each child spent within DTT sessions was used
more efficiently. Behavioral observations conducted
over both years of <strong>the</strong> intervention
indicated that all three students exhibited significantly
less off-task behavior in year 2 compared
to year 1. This resulted in a higher rate
of learning trials conducted with each student
in year 2, thus allowing more teaching and
450 / Education and Training in Developmental Disabilities-December 2008
learning to occur. Although, one could argue
that <strong>the</strong> increase in on-task behavior was simply
due to shaping and <strong>the</strong> students becoming
acclimated to <strong>the</strong> DTT procedures, it appears
more likely that <strong>the</strong> increase in on-task behavior
was <strong>the</strong> result of removing <strong>the</strong> multiple
transitions students were exposed to in year 1
of <strong>the</strong> intervention (Downs, et al., 2007). This
is because we did not observe a gradual increase
in on-task behavior over <strong>the</strong> course of
<strong>the</strong> two-year intervention. Ra<strong>the</strong>r, on-task behavior
improved slightly and inconsistently
over <strong>the</strong> course of year 1, and <strong>the</strong>n improved
rapidly and extremely consistently in year 2
when <strong>the</strong> multiple transitions were no longer
required. Off-task behaviors were still observed
at times during year 2, but at a much
lower rate than in year 1 for all three students.
The finding that more efficient use of DTT
instructional time was associated with increased
learning is an important one. Publicly
funded EI/ECSE services are provided to
young children with developmental disabilities
in <strong>the</strong> hope that such services will improve
<strong>the</strong>ir learning outcomes. If <strong>the</strong> promise of
such programs is to be fully realized it is critical
that early childhood educators efficiently
use whatever time <strong>the</strong>y have with students in
order to facilitate learning to <strong>the</strong> greatest extent
possible. As noted earlier, many preschool
educators and paraeducators receive
little formal training in specific instructional
and assessment methods (Bricker, 1995; Schepis
et al., 2001). As a result, it is highly likely
that many students with developmental disabilities
are receiving less efficient instruction
and learning much less than <strong>the</strong>y could. One
relatively simple way of improving instructional
efficiency is organizing assessment and
instructional activities within a discrete trials
format.
This is not to say that <strong>the</strong> only appropriate
method for working with young children with
developmental disabilities is traditional teacher-directed
DTT. Indeed, many professionals
recognize <strong>the</strong> benefits of using naturalistic
and activity-based instruction, and child-directed
learning (Delprato, 2001; Greenspan &
Weider, 1999; Sandall et al., 2005). Although
often portrayed as contrasting approaches,
DTT and naturalistic, activity-based instruction
are not incompatible. McBride and
Schwartz (2003) demonstrated that preschool

teachers could be efficiently and effectively
trained to embed discrete trial instruction
within ongoing preschool activities. Following
training <strong>the</strong> teachers engaged in higher rates
of instruction geared toward important child
skills, and <strong>the</strong> students subsequently practiced
<strong>the</strong> skills more frequently and learned <strong>the</strong>m
more effectively. The findings of <strong>the</strong> McBride
and Schwartz study and our own work suggest
that increasing <strong>the</strong> amount of instruction that
is provided to young children with developmental
disabilities in a DTT format leads to
improved instructional efficiency, as well as
significant and observable gains in student
learning. This is true whe<strong>the</strong>r <strong>the</strong> DTT format
is used within child-initiated, play-based activities
or within teacher-initiated learning sessions.
Why is DTT so effective in facilitating learning
and skill development in young children
with developmental disabilities? DTT requires
that educators be intentional and systematic
in how <strong>the</strong>y approach instruction. Specific
critical skills across developmental domains
can be identified a priori and educators are
prompted to engage in instructional activities
designed to teach those skills with sufficient
frequency and intensity. In addition, DTT provides
assessment data that can be used for
several purposes, <strong>the</strong> most important of which
is monitoring student learning in response to
intervention and tracking student progress on
critical skill development over time. This feedback
mechanism fur<strong>the</strong>r increases <strong>the</strong> likelihood
that students with developmental disabilities
will make important developmental
gains when enrolled in EI/ECSE programs. As
noted in <strong>the</strong> DEC Recommendations, it is important
that effective instruction be provided
to children with developmental disabilities
within contexts that are developmentally appropriate,
motivating, and aligned with student
interests (Sandall et al., 2005). Certainly
play and child-directed activities are an important
part of EI/ECSE programs. However, as
noted by McBride and Schwartz (2003) simply
providing an appropriate learning context is
not sufficient to ensure children with developmental
disabilities will make gains. If children,
particularly those with disabilities, are to learn
and develop critical skills, EI/ECSE educators
need to explicitly target those skills and find a
way to teach <strong>the</strong>m. Although a variety of meth-
ods may achieve that result, DTT provides a
simple, effective, and efficient way to do so.
There is a tremendous need to identify
methods that significantly improve <strong>the</strong> developmental
and educational outcomes of students
with disabilities enrolled in EI/ECSE
programs. This problem is a significant one
considering <strong>the</strong> large number of students that
receive publicly funded special education services
throughout <strong>the</strong>ir school years. Many students
and educators could benefit from having
access to a simple and effective approach
designed specifically to help build skills and
accelerate development in students with developmental
disabilities. The present results
are consistent with previous research (Downs
et al., 2007; Lovaas, 1987, 2003; McBride &
Schwartz, 2003; McEachin at al., 1993) and
suggest that organizing instructional and assessment
activities in a DTT format facilitates
child learning and development across domains,
and can lead to tangible improvements
in school readiness for children with various
developmental disabilities. In addition, EI/
ECSE educators with no previous experience
can easily be trained to effectively implement
DTT as one part of existing preschool programs,
ei<strong>the</strong>r embedded within ongoing preschool
activities (McBride & Schwartz) or as
an adjunct to regular preschool programming
(Downs et al.).
Additional research is needed to analyze
how DTT and o<strong>the</strong>r specific instructional and
assessment methods may most effectively be
used to accelerate development in students
displaying specific diagnostic and developmental
profiles. This analysis should include
an examination of <strong>the</strong> level of service required
for students with differing characteristics to
realize significant gains. Future studies should
also evaluate <strong>the</strong> long-term outcomes of students
with developmental disabilities who are
exposed to DTT and o<strong>the</strong>r methods in <strong>the</strong>
preschool years and <strong>the</strong> long-term cost-effectiveness
of such methods. EI/ECSE programs
provide publicly funded services to some of
our most vulnerable young citizens, and it is
critical that educators and paraeducators have
access to simple, practical, and efficient methods
such as DTT that will allow <strong>the</strong>m to maximize
<strong>the</strong> effectiveness of intervention to <strong>the</strong>
greatest extent possible.
Discrete Trial Teaching with Preschool Students / 451

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Discrete Trial Teaching with Preschool Students / 453

Education and Training in Developmental Disabilities, 2008, 43(4), 454–473
© <strong>Division</strong> on Developmental Disabilities
Staff Variables that Influence Responses to Challenging
Behaviour of Clients with an Intellectual Disability: A Review
Greet Lambrechts, Katja Petry, and Bea Maes
Katholieke Universiteit Leuven
Abstract: This study gives a systematic and recent overview of studies that focus on staff variables that may have
an influence on <strong>the</strong> origin and maintenance of challenging behaviour of clients with an intellectual disability.
Thirty three studies were identified through computerized searches of <strong>the</strong> PsycInfo and ERIC-databases on <strong>the</strong>
basis of specific search terms and inclusion criteria. The results were syn<strong>the</strong>sized by using a narrative <strong>the</strong>matic
syn<strong>the</strong>sis. Many studies discussed staff beliefs about <strong>the</strong> causes of challenging behaviour and staff stress and
emotional reactions to challenging behaviour. Fur<strong>the</strong>rmore, <strong>the</strong> relationship between attributions and emotions
and between emotional reactions and levels of optimism and willingness to offer help were investigated. Finally,
<strong>the</strong> least presented topic was staff responses to challenging behaviour.
Research about staff variables that may influence
<strong>the</strong>ir responses to challenging behaviour
of individuals with intellectual disabilities is
recently increasing. A very important and frequently
mentioned factor in <strong>the</strong> origin and
<strong>the</strong> maintenance of challenging behaviour is
<strong>the</strong> interaction between <strong>the</strong> individual with an
intellectual disability and his or her caregiver.
Initially, <strong>the</strong> principles of applied behavioural
analysis have dominated <strong>the</strong> literature concerning
<strong>the</strong> causes and management of challenging
behaviour. At present, more and
more attention has been given to <strong>the</strong> psychological
effects of challenging behaviours on
o<strong>the</strong>rs (Hastings, 2002).
Challenging behaviour is considered to be
functional and adaptive, shaped through interaction
with <strong>the</strong> physical and social world,
more precisely through <strong>the</strong> environmental
consequences (Emerson, 1995). These consequences
are termed reinforcers. Oliver (1995)
noticed that <strong>the</strong> effect of self-injury and o<strong>the</strong>r
challenging behaviours on <strong>the</strong> behaviour of
o<strong>the</strong>rs has become a subject of research. In
this context, mutual reinforcement processes
are discussed, ‘with self-injury being rewarded
Correspondence concerning this article should
be addressed to Greet Lambrechts, Katholieke Universiteit
Leuven, Faculty of Psychology and Educational
Sciences, Vesaliusstraat 2, B-3000 Leuven,
BELGIUM. Email: greet.lambrechts@ped.kuleuven.be
454 / Education and Training in Developmental Disabilities-December 2008
by <strong>the</strong> responses of o<strong>the</strong>rs and <strong>the</strong> rewarding
responses of o<strong>the</strong>rs <strong>the</strong>mselves being negatively
reinforced by <strong>the</strong> termination of selfinjury’
(Oliver). In this context, many studies
are based on functional analysis methodologies.
In <strong>the</strong>se studies, <strong>the</strong> functional relationships
between challenging behaviour and specific
environmental events are studied (for
example Iwata, Dorsey, Slifer, Bauman, &
Richman, 1994). Only staff behaviour is examined
without involving staff psychological effects
that may be active in <strong>the</strong>se situations.
Hastings (2002) has proposed a psychological
mechanism for <strong>the</strong> impact of client challenging
behaviours on staff well-being. This
mechanism is based on Oliver’s (1995) model
about mutual reinforcement processes in <strong>the</strong>
maintenance of self-injurious behaviour. Hastings
(2002) suggested that challenging behaviours
lead to negative emotional reactions of
staff and that <strong>the</strong>se reactions accumulate over
time with an important impact on <strong>the</strong> wellbeing
(stress and burnout) of staff. Staff negative
emotional reactions to challenging behaviours
are proposed to mediate <strong>the</strong> impact
of challenging behaviours on staff psychological
well-being. In a 2005 review, Hastings has
extended this mechanism in developing a
broad framework based on research literature
on challenging behaviour in settings for individuals
with developmental disabilities. He
stated that <strong>the</strong> connections between challeng-

ing behaviour, staff emotional reactions to
<strong>the</strong>se behaviours, and staff behaviour are
probably <strong>the</strong> most robust relationships. Three
o<strong>the</strong>r variables that are connected with <strong>the</strong>
variables already mentioned are staff beliefs,
staff psychological resources, and service and
organizational factors and service culture.
Studies in this research domain not only examine
staff and client behaviour and possible
relations in between, but also pay attention to
variables that can have an influence on <strong>the</strong>se
behaviours.
The aim of this review is to give a systematic
and recent overview of studies that focus on
staff variables that can have an influence on
<strong>the</strong> origin and maintenance of challenging
behaviour. Our purpose is to involve all empirical
studies in this area and offer recent
developments and findings. Consequently,
<strong>the</strong> main research question of this review is:
‘Which recent empirical studies are published
concerning staff variables that may influence
<strong>the</strong>ir responses to challenging behaviour of
clients with an intellectual disability?’. We will
discuss <strong>the</strong> methods that are used in <strong>the</strong>se
studies, give an overview of <strong>the</strong> main results
and end with conclusions and implications for
fur<strong>the</strong>r research.
Method
Inclusion Criteria
The studies that we have included in our review
had to consider staff variables that may
influence <strong>the</strong>ir responses to challenging behaviour.
Clients involved in <strong>the</strong> studies had to
be people with an intellectual disability and
challenging behaviour. We only selected empirical
studies, published in a peer reviewed
journal, because <strong>the</strong>se journals guarantee a
certain level of quality. We searched all studies
concerning this <strong>the</strong>me in two important databases
(<strong>the</strong> ‘Educational Resources Information
Center (ERIC)’ database and PsycINFO)
and only selected articles published between
1995 and 2006 because we chose for a broad
perspective and wanted to present a recent
overview; ra<strong>the</strong>r than start from a <strong>the</strong>oretical
perspective.
Identification and Screening
Searches began in November 2006 in two databases:
ERIC and PsycINFO. For ‘intellectual
disability’, we used <strong>the</strong> terms ‘disability’, ‘mental
retardation’, ‘complex needs’, ‘high support
needs’, ‘cognitive impairment’ and
‘learning difficulty’. For ‘challenging behaviour’,
we used <strong>the</strong> terms ‘challenging behaviour’,
‘problem behaviour’, ‘aggression’, ‘self-injury’
and ‘self-injurious behaviour’. We considered
both US and UK terminology and where necessary,
singular and plural forms. We searched
for <strong>the</strong>se terms in <strong>the</strong> categories ‘title’ and
‘descriptors’; a combination of both clusters
yielded 2414 articles. Because we wanted to
examine articles about staff variables, we combined
<strong>the</strong> search instruction just mentioned,
with <strong>the</strong> terms ‘staff’, ‘carer’, ‘care worker’
and ‘special educator’ in <strong>the</strong> category ‘title’ or
‘descriptors’. Again we considered singular
and plural forms of <strong>the</strong> terms. This instruction
yielded 87 articles.
The following step was a fur<strong>the</strong>r investigation
of <strong>the</strong> resulting articles, based on <strong>the</strong>
o<strong>the</strong>r inclusion criteria. Eight articles were not
published in a peer reviewed journal. Five
studies were not empirical: four reviews and
one collection of reflections on a study. However,
<strong>the</strong>y served as sources of relevant research.
Four search results referred to books or
were book reviews and four referred to resource
kits or guides. In ano<strong>the</strong>r three articles,
instruments or guidelines were discussed. In
eight studies <strong>the</strong> participants didn’t meet <strong>the</strong>
preconceived criteria: one was a study with
general hospital staff, three studies focused on
family carers, two studies focused on staff of
children with disabilities in general (next to
children with intellectual disabilities, also children
with only autism were included), one
study focused on practitioners working with
young people with challenging and complex
problems but <strong>the</strong>se participants didn’t need
to have an intellectual disability and in one
article, <strong>the</strong> perspectives and experiences of
paraeducators working with students were
studied. Ten articles had ano<strong>the</strong>r focus than
<strong>the</strong> focus chosen by us. In one article, setting
events in association with challenging behaviour
were studied. In ano<strong>the</strong>r study, an episode
of sexual assault was explored. In a third
study, researchers examined <strong>the</strong> relationship
Staff Variables / 455

among staff and resident characteristics on
<strong>the</strong> one hand, and group home quality on <strong>the</strong>
o<strong>the</strong>r hand. The capacities of several agencies,
readmission rates and emergency medication
or seclusion were investigated in three o<strong>the</strong>r
articles. In two articles, moving from institutional
to community living was stressed. Finally,
two studies examined only staff recording
of occurrence and frequency of
challenging behaviours. In thirteen studies, interventions
or training programs were discussed.
Because we only wanted to give an
overview of studies that investigate staff variables
<strong>the</strong>mselves, without manipulating <strong>the</strong>m,
also <strong>the</strong>se articles were omitted. One article
wasn’t available. Eventually, 31 articles were
selected for this review. In two articles, two
studies are described; so in total, 33 studies
are involved in this review.
Syn<strong>the</strong>sis of Research Designs
Because of <strong>the</strong> variable designs and types of
results and because of <strong>the</strong> variety of variables
considered in <strong>the</strong> studies, comparisons of outcomes
were very difficult. Consequently, we
couldn’t syn<strong>the</strong>size <strong>the</strong> results using a metaanalysis.
Therefore, we considered a narrative
<strong>the</strong>matic syn<strong>the</strong>sis. We will give an overview of
<strong>the</strong> selected articles on <strong>the</strong> basis of <strong>the</strong> following
characteristics: a description of <strong>the</strong> aims of
<strong>the</strong> study; staff characteristics; client characteristics;
description of <strong>the</strong> challenging behaviour;
and <strong>the</strong> method used to carry out <strong>the</strong>
study. Next, we will syn<strong>the</strong>size <strong>the</strong> results of
<strong>the</strong> articles and discuss <strong>the</strong>ir implications for
fur<strong>the</strong>r research.
Results
Overview of Descriptive Characteristics
Table 1 gives an overview of all <strong>the</strong> selected
articles. We will briefly describe <strong>the</strong> aims of
<strong>the</strong> studies, discuss what <strong>the</strong> participants (care
staff) and <strong>the</strong> clients are like, explore what
kind of challenging behaviours are involved in
<strong>the</strong> studies, and what methods are used. Unfortunately,
some articles are very limited in
reporting this kind of information. The following
text is based on <strong>the</strong> studies that give
information about <strong>the</strong>se topics.
456 / Education and Training in Developmental Disabilities-December 2008
The aims of <strong>the</strong> studies. Some articles are
ra<strong>the</strong>r descriptive and explore one or several
staff variables, but in most articles, relationships
between two or more staff variables have
been investigated. Most frequently, <strong>the</strong> views
of staff on (clients with) challenging behaviour
(n 11) and staff stress and emotional
reactions to challenging behaviour (n 11)
have been studied. Responses to challenging
behaviours were <strong>the</strong> subject in five studies.
Ano<strong>the</strong>r topic that was frequently investigated
are <strong>the</strong> relations between views of staff, emotional
reactions and willingness to help (n
9).
The participants (staff) and <strong>the</strong> clients. The
number of participants differed enormously
among <strong>the</strong> studies: <strong>the</strong> study with <strong>the</strong> smallest
sample existed of eight participants and <strong>the</strong>
study with <strong>the</strong> greatest sample existed of 246
participants. In most of <strong>the</strong> studies, much
more participants were female. The age range
of <strong>the</strong> participants was very broad and <strong>the</strong>
mean age fluctuated for most of <strong>the</strong> studies
around 30 to 40 years. Consequently, <strong>the</strong> years
of experience in working with people with
intellectual disabilities, differed equable.
Three studies distinguished between experienced
and inexperienced staff.
Also <strong>the</strong> number of clients that was referred
to, differed enormously, namely from two to
261. In nine studies, no real clients, but scenarios
(n 2), vignettes (n 5), or videos
(n 1) that present clients with challenging
behaviour, and a list of challenging behaviours
were involved. In one study, responses of
staff to challenging behaviour of real clients
and challenging behaviour described in vignettes
were compared. In contrast with <strong>the</strong>
participants, most of <strong>the</strong> clients were male and
most of <strong>the</strong> studies dealt with adults. Only one
study explicitly referred to children. It is striking
that in many of <strong>the</strong> studies; <strong>the</strong> group of
clients isn’t specified. In 21 of <strong>the</strong> 33 studies,
one only referred to a very general term like
‘intellectual disability’ (n 9), ‘learning disability’
(n 7), ‘mental retardation’ (n 2),
‘mentally handicapped’ (n 2), or ‘learning
difficulties’ (n 1). The o<strong>the</strong>r studies explained
<strong>the</strong> intellectual disability of <strong>the</strong>ir clients
more in detail and focused on ‘mild intellectual
disability’ (n 7), ‘moderate
intellectual disability’ (n 8), ‘severe intellec-

TABLE 1
Characteristics of <strong>the</strong> studies about staff variables concerning challenging behaviour of clients with intellectual disabilities
Staff Clients
CB Description Instruments
# age (y) a # age (y) a ID
Aims of <strong>the</strong> study
Description
1st author P Y
questionnaires (CB, SIB,
attributions, emotional
responses), Likert scales
(optimism, willingness
to help), observations
(interaction staff-client)
ID SIB and o<strong>the</strong>r
types of CB
43 19,5-50
(35,02)
43 22-65
(40,95)
Bailey 2006 to investigate <strong>the</strong>
relationships between
care staff attributions,
emotions and <strong>the</strong>ir
responses to actual CB
and to compare care
staff attributions,
emotions and
responses to SIB in
comparison to o<strong>the</strong>r
forms of CB
24 LD severe CB questionnaires (social
desirability,
psychological wellbeing,
staff support,
organizational variables,
emotions, attitudes)
Bell 2002 to extend <strong>the</strong>
information available
on staff satisfaction,
and on emotions and
attitudes held by staff
interview (characteristics
of setting and of <strong>the</strong>
service user,
interventions),
questionnaires (causes
of CB, emotional
reaction, stress)
LD CB: aggression,
self-injury,
disruption,
screaming,
destructiveness,
inappropriate
social
approaches,
running away,
70 5-58
(26,3)
Bromley 1995 to explore <strong>the</strong> reported
emotional reactions of
staff to CB, <strong>the</strong>
constructs used by staff
to understand a
person’s CB and <strong>the</strong>
perceived causes of
stress
questionnaires (CB,
disability assessment,
psychopathology,
burnout, demographic
variables and work
satisfaction, work
perceptions)
CB: stereotypic
behaviour and
odd and
bizarre
behaviour,
SIB, aggressive
towards o<strong>the</strong>rs,
26 (37) 31 (35,71) learning
difficulties
Chung 1995 to present some primary
data on staff’s level of
burnout and of
satisfaction and
dissatisfaction
Staff Variables / 457

TABLE 1—(Continued)
Staff Clients
CB Description Instruments
# age (y) a # age (y) a ID
1st author P Y Aims of <strong>the</strong> study Description
questionnaire
(attributions), 7-point
ratings scales (evaluation
of behaviour, potential
for changing each
behaviour, willingness to
provide extra effort to
help, emotional
response)
(33,95) LD moderate levels
of CB
40
(20
20) 1
Dagnan 1998 to explore <strong>the</strong> role of
carers’ evaluation of a
person with CB and
learning disabilities and
of <strong>the</strong> CB <strong>the</strong>mselves in
<strong>the</strong>ir responses to CB
questionnaires
(attributions,
explanations in respect
to SIB), 7-point rating
scales (emotional
response, helping
intention, responsibility)
62 (36,2) 1 scenario2 ID aggression to
o<strong>the</strong>rs: pulling
hair and/or
hitting out
Dagnan 2005 to examine <strong>the</strong>
importance of staff
judgements of
responsibility for CB in
predicting <strong>the</strong>ir
emotional and
intended helping
responses
3-point rating scales (CB,
importance to intervene
in some way)
50 (40,25) list of CB2 MR CB: behaviours
having negative
effects on <strong>the</strong>
individual with
MR and
behaviours
having a
negative effect
on staff, o<strong>the</strong>r
people or
services
Elgie 2002 to investigate <strong>the</strong>
behaviours identified as
having an impact
primarily on <strong>the</strong>
individual with mental
retardation and those
behaviours that
primarily have <strong>the</strong>ir
impact on support staff,
o<strong>the</strong>r people or services
458 / Education and Training in Developmental Disabilities-December 2008
open-ended, unstructured
interviews (perceptions
of aggressive incidents
and <strong>the</strong>ir management)
16 9 LD aggressive
incidents
Fish 2005 to ask staff and clients
about <strong>the</strong>ir experiences
of incidents of
aggression and physical
intervention

TABLE 1—(Continued)
Staff Clients
CB Description Instruments
# age (y) a # age (y) a ID
1st author P Y Aims of <strong>the</strong> study Description
semi-structured interview
(definitions, training,
programmes, reasons for
CB, dealing with CB, <strong>the</strong>
ideal service, feelings,
stress)
SE CB: self-injury,
aggression
towards o<strong>the</strong>r
people,
property
destruction
19 18-51
(32,5)
Hastings 1995 to explore staff work and
<strong>the</strong>ir views on issues
relating to CB and to
explore <strong>the</strong> informal
service culture
questionnaire (reasons for
<strong>the</strong> CB)
CB: self-injurious,
aggressive and
stereotyped
behaviour
3 vignettes2 mentally
handicapped
246
(148
98) 1
1995 to determine <strong>the</strong> nature
of health care workers’
beliefs about <strong>the</strong>
causation of CB, based
on experience of
working and
topography of CB
Hastings
et al.
7-point rating scale
(attributions)
SIB, aggressive
behaviour and
stereotyped
behaviour
3 vignettes2 mentally
handicapped
94
(55
39) 1
Hastings 1997 to discuss <strong>the</strong> potential
role of causal
attributions in
determining staff
responses to CB
semi-structured interviews
(experiences before,
during and after <strong>the</strong>
physical intervention)
ID CB, behavioural
incidents
8 18-43
(29,5)
8 26-53
(36,62)
Hawkins 2005 to explore <strong>the</strong> personal
impact of receiving and
implementing physical
interventions on service
users and staff
questionnaires
(attributional style,
coping style,
understanding SIB), 7point
rating scales
(emotional response,
helping intention)
33 2 scenarios2 LD aggressive to
o<strong>the</strong>rs by
pulling hair
and hitting out
Hill 2002 to explore <strong>the</strong> relative
impact upon helping
intentions of
attributions, emotions
and coping style in
response to CB in
support staff
Staff Variables / 459

TABLE 1—(Continued
Staff Clients
CB Description Instruments
# age (y) a # age (y) a ID
1st author P Y Aims of <strong>the</strong> study Description
cognitive behavioural
interview (incident,
emotions, perceptions,
feelings, reactions)
MI, MO self-injury,
destructiveness and
aggression
6 34-49
(41,6)
37 24-60
(42,3)
Jahoda 2005 to explore <strong>the</strong>
interpersonal
perceptions of staff, to
evoke <strong>the</strong> immediate
thoughts and feelings
of staff at <strong>the</strong> time of
<strong>the</strong> incident
questionnaires (adaptive
behaviour, CB, demands
of job, psychological
well-being, staff support,
staff perceptions of CB)
LD aggressive behaviours
and o<strong>the</strong>r types of
CB
78 40 26-71
(46,7)
Jenkins 1997 to explore stress in directcare
staff
123 (35,92) 2 videos2 SE SIB questionnaires (affective
responses, causal
attributions), 7-point
rating scale (helping
behaviour)
Jones 2003 to conceptualize and
measure causal
attributions and
emotional reactions to
CB and to determine
<strong>the</strong> counter-habilitative
nature of staff ’helping’
behaviour
questionnaire
(attributions), group
enquiry (predictions
concerning <strong>the</strong>
vignettes)
3 vignettes2 ID CB: stereotyped
behaviour, SIB and
aggression
180 22-37
(25)
Lambert 2002 to test <strong>the</strong> hypo<strong>the</strong>sis that
staff’s beliefs about <strong>the</strong>
causes of CB are
determinant for <strong>the</strong>
responses to <strong>the</strong>m
460 / Education and Training in Developmental Disabilities-December 2008
questionnaires (emotional
reactions, coping
strategies, burnout,
social desirability)
83 (32,43) MR aggression towards
self, property
destruction, or
physical aggression
towards staff/o<strong>the</strong>rs
Mitchell 2001 to test whe<strong>the</strong>r
challenging behaviourrelated
coping and
emotional reactions are
predictive of staff
burnout
recording sheets (assaults,
staff sickness levels)
6 MI, SE severely CB: verbally
and physically
assaults directed at
o<strong>the</strong>rs
Murray 1999 to examine <strong>the</strong>
relationship between
staff sickness levels and
client assault levels

TABLE 1—(Continued)
Staff Clients
CB Description Instruments
# age (y) a # age (y) a ID
1st author P Y Aims of <strong>the</strong> study Description
interview (perceptions of
<strong>the</strong> CB)
34 MO, SE aggressive
behaviour
Noone 2006 to explore staff
attributions
questionnaires (functional
hypo<strong>the</strong>ses, CB,
attributions)
23 2 MO aggressive
behaviour:
kicking,
hitting,
punching and
slapping
to investigate <strong>the</strong>
relationship between
care staff attributions
and CB causal variables
focus group interviews
(experiences of working
with adults with CB and
<strong>the</strong>ir stress reactions)
19 adults MI, MO, SE CB, significant
challenging
behavioural
incident of
physical
aggression
towards o<strong>the</strong>rs
or property
Raczka 2005 to ga<strong>the</strong>r information
about staff experiences
of stress, <strong>the</strong> types of
CB that <strong>the</strong>y had been
exposed to and <strong>the</strong>ir
emotional responses to
those challenges
50 65 ID CB survey questionnaires
(stress, job strain, wellbeing,
sick leave, work
satisfaction, intended
turnover)
157 18-62
(36)
Robertson 2005 to collect descriptive
information on levels of
staff stress, strain,
emotional distress, job
satisfaction and
intended job turnover
101 (33,65) adults ID CB questionnaires (burnout,
emotional reactions)
Rose 2004 to test <strong>the</strong> association
between negative
emotional reactions to
CB and staff well-being
(burnout)
questionnaire (burnout),
7-point rating scales
(negative emotions)
99 (35,24) 3 vignettes2 ID CB: SIB,
stereotyped
behaviour and
aggression
towards o<strong>the</strong>rs
to test <strong>the</strong> association
between negative
emotional reactions to
CB and staff well-being
(burnout)
Staff Variables / 461

TABLE 1—(Continued)
Staff Clients
CB Description Instruments
# age (y) a # age (y) a ID
1st author P Y Aims of <strong>the</strong> study Description
107 (35,73) adults ID CB questionnaires
(attributions,
perceptions of stress,
burnout, CB), Likert
scales (emotional
reactions, optimism,
helping behaviour,
perceived CB)
Rose 2005 to test <strong>the</strong> applicability of
a more explicit model
for <strong>the</strong> impact of
perceived stress on <strong>the</strong>
quality of care by
examining attributions
questionnaires (CB,
responses towards CB)
harmful,
disturbing or
dangerous CB
MI, MO, SE,
PR
261 18-75
(39)
Saloviita 2002 to explore <strong>the</strong> frequency
and severity of CB and
staff responses to it
questionnaire
(attributions), Likert
scales (severity of
behaviour)
42 2 vignettes2 MI,SE aggressive
behaviours:
kick and
punch people,
pull <strong>the</strong>ir hair
and physically
push <strong>the</strong>m
Tynan 2002 to examine <strong>the</strong> effects of
service user’s level of
intellectual impairment
on <strong>the</strong> attributions
made by carers
7-point rating scales
(attributions, emotions,
optimism, helping
behaviour, CB, <strong>the</strong>
person), interview
(incident, emotions and
interpersonal appraisals)
MI, MO serious incidents
of verbal or
physical
aggression
34-49
(41,6)
6 and 2
vignettes2 38 24-60
(42,7)
Wanless 2002 to examine <strong>the</strong> cognitive
and emotional
responses of staff to CB
and helping behaviour
in explaining staff
reactions to CB
462 / Education and Training in Developmental Disabilities-December 2008
questionnaire
(attributions), interview
(expressed emotion)
15 2 MO screaming,
throwing
objects,
obsessional-like
behaviours
Weigel 2006 to explore <strong>the</strong> relationship
between attributions
and expressed
emotions of staff

TABLE 1—(Continued)
Staff Clients
CB Description Instruments
# age (y) a # age (y) a ID
1st author P Y Aims of <strong>the</strong> study Description
semi-structured interview
(understanding of <strong>the</strong>
problem or concern and
understanding of <strong>the</strong>
development of <strong>the</strong>
problem over time)
LD CB: sexual
approaches to
staff,
withdrawal
from activities,
hitting people,
verbal abuse
and violence,
ripping
clo<strong>the</strong>s, anal
poking,
18 20-69 10 27-73
(40)
Whittington 2005 to elucidate <strong>the</strong> nature of
staff beliefs and feelings
about CB and how
<strong>the</strong>se may result in
dilemmas within
practice
interview (discourses used
in <strong>the</strong> construction of
aggressive challenging
behaviour)
behaviour which
caused direct
physical harm
to o<strong>the</strong>r
people
10 26-58 10 19-60 MI, MO, SE,
PR
Wilcox 2006 to investigate
constructions of
aggressive behaviour
among care staff and to
explore gender as a site
for enactment of power
relationships
observations (multiple staff
responses, <strong>the</strong> severity of
resident behaviours)
26 ID violence or <strong>the</strong>
treat of violent
action, verbal
abuse, noncompliance
or
avoidance of
tasks, verbally
inappropriate,
crying
Wilson 1995 to examine <strong>the</strong>
procedures adopted by
staff in <strong>the</strong>ir response
to perceived CB, <strong>the</strong>
relationship between
<strong>the</strong> CB and <strong>the</strong> staff
response, and <strong>the</strong>
influence of
contingencies of
negative reinforcement
Note. PY publication year. Age (y) age in years. ID intellectual disability. LD learning disability. MR mental retardation. MI mild intellectual disability.
MO moderate intellectual disability. SE severe intellectual disability. PR profound intellectual disability. CB challenging behaviour(s). SIB self-injurious
behaviour.
a
Age is presented by range and mean between brackets.
1
In some studies, two groups of staff members were investigated.
2
In some studies, vignettes, videos or scenarios were used to describe clients with CB; in one study, a list of challenging behaviours was used.
Staff Variables / 463

tual disability’ (n 8), and/or ‘profound intellectual
disability’ (n 2).
Description of challenging behaviour. Although
<strong>the</strong> specific descriptions of challenging
behaviours differed (see Table 1), most
studies referred to aggressive behaviour,
sometimes in combination with self-injurious
behaviour and/or stereotyped behaviour.
Some authors only talked about challenging
or problem behaviour, without describing <strong>the</strong>
behaviour in more detail. One study explored
only reactions to self-injurious behaviour.
Some studies gave a numeration of behaviours
like screaming, pulling hair, and verbal abuse.
Instruments. In more than half of <strong>the</strong> studies,
data were assembled by using questionnaires
(n 9), interviews or group inquiries
(n 8), or a combination of <strong>the</strong>se two methods
(n 3). Questionnaires and interviews
were also combined with rating scales (n 7,
respectively n 1). Direct observations of staff
and client behaviour were once combined
with questionnaires and rating scales and
once used without ano<strong>the</strong>r instrument. In two
studies, only rating scales were used and in
ano<strong>the</strong>r study, only recording sheets.
Analysis of <strong>the</strong> Results
First, we will discuss staff beliefs about <strong>the</strong>
causes of challenging behaviour. Next, stress
and emotional reactions of staff to challenging
behaviour, and <strong>the</strong>ir responses to challenging
behaviour are discussed. In <strong>the</strong> last
paragraph, we focus on <strong>the</strong> relationship between
attributions and emotions and between
emotional reactions and levels of optimism
and willingness to offer help.
The views of staff on (clients with) challenging
behaviour. In this part, staff beliefs about <strong>the</strong>
causes of challenging behaviour are discussed.
These beliefs are mostly referred to as attributions.
In this context, three types of attributions
have been distinguished. First, <strong>the</strong> origin
of <strong>the</strong> challenging behaviour can be situated
within <strong>the</strong> client (internal) or not (external).
Second, <strong>the</strong> distinction between a permanent
(stable) and a temporary (unstable) cause is
made. Third, <strong>the</strong> client can be in control of
his or her behaviour (controllable) or not
(uncontrollable). Sometimes a fourth distinction
is made: <strong>the</strong> given cause can be unique to
<strong>the</strong> client (personal) or not (universal).
464 / Education and Training in Developmental Disabilities-December 2008
Noone, Jones, and Hastings (2006) interviewed
staff about <strong>the</strong> client that <strong>the</strong>y named
as <strong>the</strong> most challenging <strong>the</strong>y worked with to
explore staff attributions. They found that
staff generally made attributions about challenging
behaviour that were stable, personal,
controllable, and internal to <strong>the</strong> client. This
method yielded little variability in staff attributions
and one could conclude that staff
wasn’t that sensitive to likely variations in challenging
behaviour including its causal factors.
But because it was possible that all staff members
had selected behaviours with similar underlying
characteristics, Noone et al. carried
out a second study. Staff completed a questionnaire
concerning two clients with <strong>the</strong>
same aggressive behaviour, but <strong>the</strong> functions
of this behaviour were hypo<strong>the</strong>sized to be different.
The results of this second study suggested
that staff may be sensitive to <strong>the</strong> underlying
causes of challenging behaviours
because <strong>the</strong>y made different attributions for
<strong>the</strong> two different clients. Hastings (1995) used
semi-structured interviews and discussed a list
of topics (perceptions of definitions of challenging
behaviours, <strong>the</strong> causes of challenging
behaviours, interventions for such behaviours,
relevant staff training, and service organisation)
with care staff. They stated that challenging
behaviours were to be controlled or
changed and that service users engaged in
<strong>the</strong>se behaviours intentionally. Hastings suggested
that staff may be more concerned with
reducing challenging behaviour than understanding
it. A study by Lambert (2002) consisted
of a quantitative part (a questionnaire)
and a qualitative part (group discussions
about hypo<strong>the</strong>ses concerning challenging behaviour
mentioned in vignettes). In <strong>the</strong> quantitative
part of his research, factors concerning
<strong>the</strong> material environment, needs, development,
frustrations, and <strong>the</strong> social environment
appeared very important to understand
challenging behaviours. In <strong>the</strong> qualitative
part, organic factors and lack of staff experience
were added as important in causing challenging
behaviour. Jahoda and Wanless
(2005) concluded by means of interviews that
<strong>the</strong> range of views expressed by staff members
pointed to <strong>the</strong> complex nature of <strong>the</strong>ir relationships
with <strong>the</strong> clients. Ano<strong>the</strong>r important
finding was that workers may hold more than
one perspective about a person’s behaviour.

Bromley and Emerson (1995) combined interviews
with questionnaires to ga<strong>the</strong>r information
about characteristics of <strong>the</strong> setting and
<strong>the</strong> service user, specific interventions for
challenging behaviour and <strong>the</strong> opinion of
care staff. This study indicated that <strong>the</strong> most
commonly held beliefs about <strong>the</strong> causes of
challenging behaviours were very general factors
over which staff may feel <strong>the</strong>y have little
control. Beliefs concerning causal factors over
which staff may <strong>the</strong>mselves exercise some control
appeared much less.
In three studies, <strong>the</strong> consequences of <strong>the</strong>
challenging behaviour for <strong>the</strong> client and for
<strong>the</strong> environment were explicitly compared.
Noone et al. (2006) found that behaviours
impacting on staff or services are more likely
to be defined as challenging than behaviours
that have <strong>the</strong>ir primary effects on clients. Elgie
and Hastings (2002) used a self-report questionnaire
to compare behaviours primarily
having negative effects on <strong>the</strong> individual with
intellectual disabilities and behaviours primarily
having negative effects on <strong>the</strong> environment.
They concluded that staff rated <strong>the</strong> first
type of behaviours as less challenging and less
in need of intervention than <strong>the</strong> second type
of behaviours. These results are in line with
<strong>the</strong> previous study. Wilcox, Finlay, and Edmonds
(2006), who analysed interviews with
staff using discourse analysis, concluded that
accounts focusing on factors internal to <strong>the</strong>
client (individual pathology discourse) as well
as accounts focusing on contextual factors
(context discourse) were represented. Fur<strong>the</strong>rmore,
a conclusion of this study was that
gender stereotypes had a powerful impact on
supposedly objective understandings of a person’s
actions.
Some authors investigated if any difference
exists between <strong>the</strong> attributions or beliefs of
experienced and inexperienced staff or between
younger and older staff. Hastings, Remington,
and Hopper (1995) explored differences
in beliefs between experienced and
inexperienced staff on <strong>the</strong> basis of vignettes.
The experienced group underlined more <strong>the</strong>
role of biological factors in <strong>the</strong> determination
of challenging behaviours, whereas <strong>the</strong> inexperienced
participants referred more to <strong>the</strong>
roles of emotional states and environmental
antecedents. Two years later, Hastings, Reed,
and Watts (1997) examined <strong>the</strong> attributions of
experienced staff and inexperienced students
by means of three vignettes describing a fictitious
young man’s challenging behaviour. In
contrast with <strong>the</strong> previous findings, <strong>the</strong> experienced
staff in this study referred to environmental,
emotional, and biological factors as
likely causes of challenging behaviour. Fur<strong>the</strong>rmore,
<strong>the</strong> answers of <strong>the</strong> experienced staff
were more conforming to aspects of behavioural
models of challenging behaviours that
are dominant in research and intervention
literature (Hastings et al., 1995). Their beliefs
about <strong>the</strong> causes of challenging behaviours
also varied with <strong>the</strong> topography of behaviour
that <strong>the</strong>y were asked to consider (stereotypy,
aggression and self-injury) (Hastings et al.,
1995, 1997). Stereotypy was viewed as an activity
that achieves stimulation, whereas selfinjury
and aggression were thought more
likely to be caused by emotional and social
factors. In Hastings et al. (1995), inexperienced
participants did not distinguish as
clearly between different topographies of
challenging behaviours, whereas in Hastings
et al. (1997), no significant differences between
experienced and inexperienced staff
were found. Wanless and Jahoda (2002) used
questionnaires with two brief vignettes describing
incidents of physical and verbal aggression
to compare <strong>the</strong> beliefs of younger
and older staff. They concluded that younger
staff tended to evaluate <strong>the</strong> clients and <strong>the</strong>ir
behaviour more negatively than older staff. In
contrast with <strong>the</strong>se findings, no relation between
experience/training variables and beliefs
about challenging behaviours were found
in <strong>the</strong> study of Elgie and Hastings (2002).
Tynan and Allen (2002) were interested in
<strong>the</strong> attributions of care staff on aggressive behaviour
concerning clients with a mild disability
in comparison with clients with a severe
disability. They used two vignettes, one describing
a girl with mild intellectual disabilities
and challenging behaviour and one describing
a girl with severe intellectual
disabilities and challenging behaviour and
asked care staff to complete three questionnaires.
Participants in <strong>the</strong> mild disability condition
rated <strong>the</strong> aggressive behaviour to be
due to factors significantly more under <strong>the</strong>
control of <strong>the</strong> service user and perceived <strong>the</strong>
aggressive behaviour as significantly less challenging
than those in <strong>the</strong> severe disability con-
Staff Variables / 465

dition. Care staff in both conditions didn’t
differ in <strong>the</strong>ir answers about attributions of
locus and stability and selected both emotional
and learned behaviour causal explanations
for <strong>the</strong> aggressive behaviour, besides
physical environmental factors. However, <strong>the</strong>
participants in <strong>the</strong> severe disability condition
considered <strong>the</strong> biomedical model to be of
significantly greater causal relevance.
Stress, well-being, and emotional reactions to
challenging behaviours. In several studies, possible
causes of staff stress (and o<strong>the</strong>r related
variables like burnout and job turnover) and
staff well-being in relation to working with
clients with challenging behaviour are investigated.
Next, in some studies, staff emotional
reactions to challenging behaviour are emphasized.
Finally, <strong>the</strong> relationship between
emotional reactions on challenging behaviour
on <strong>the</strong> one hand, and stress (burnout and
coping strategies) on <strong>the</strong> o<strong>the</strong>r hand is discussed.
In Robertson et al. (2005), staff members
completed questionnaires on potential
sources of stress, well-being, sick leave, job
strain, intended turnover and work satisfaction.
All staff members worked with adults
with intellectual disabilities and challenging
behaviour, but one group of staff members in
a non-congregate supported setting and ano<strong>the</strong>r
group in a congregate supported setting.
Around a third of all staff members was
likely to seek new employment in <strong>the</strong> next
year. The main reasons for this turnover may
not be related to <strong>the</strong> demands of working with
people with challenging behaviour, but ra<strong>the</strong>r
because of job insecurity and poor pay. In
contrast with staff of congregate settings, staff
of non-congregate settings reported greater
stress because of a lack of procedures to deal
with challenging behaviour. The results of
Chung, Corbett, and Cumella (1995) also indicated
that staff burnout wasn’t associated
with direct contact with clients with challenging
behaviour but ra<strong>the</strong>r with managerial issues
such as shift work, lack of support from
management, and <strong>the</strong> need for training. They
investigated staff burnout by means of interviews
and questionnaires in staff working with
people with learning difficulties and challenging
behaviour. In Bromley and Emerson
(1995), <strong>the</strong> absence of any effective way of
dealing with <strong>the</strong> challenging behaviour was
466 / Education and Training in Developmental Disabilities-December 2008
mentioned as a source of stress when asking
<strong>the</strong> opinion of staff members with questionnaires
and interviews. However, in this study
<strong>the</strong> challenging behaviour itself also formed a
stressor for staff members. Definite or ‘strong’
sources of stress were that <strong>the</strong> client’s challenging
behaviour was wearing over time, <strong>the</strong>
unpredictability of <strong>the</strong> behaviour and <strong>the</strong> difficulty
of understanding <strong>the</strong> behaviour. In Jenkins,
Rose, and Lovell (1997), psychological
well-being of staff in a challenging behaviour
group and a non-challenging behaviour
group was explored by means of questionnaires.
Staff in <strong>the</strong> challenging behaviour
group generally felt less supported and were
more anxious than staff in <strong>the</strong> non-challenging
group and <strong>the</strong>re was a non-significant
trend of higher reported levels of depression
in comparison with <strong>the</strong> non-challenging
group. Also in this study, both of <strong>the</strong> previously
mentioned two causes were found, dependent
on <strong>the</strong> emotion: challenging behaviour
and job demands were <strong>the</strong> best predictors
of staff anxiety and lack of staff support was
<strong>the</strong> best predictor of depression. Bell and Espie
(2002) investigated staff satisfaction and
emotion by using questionnaires. In contrast
with <strong>the</strong> previous findings, <strong>the</strong>y concluded
that staff felt confident and well supported in
practical terms, but again this group of staff
members showed dissatisfaction in many areas
regarding support from <strong>the</strong>ir seniors and
from management. Raczka (2005) used focus
group interviews by staff working with people
with challenging behaviours to discuss <strong>the</strong>ir
experiences of stress. Staff indicated that <strong>the</strong>y
were exposed to high levels of potential workrelated
stressors and in this study; <strong>the</strong> highest
rating of stressfulness was violent service user
behaviour. In contrast to <strong>the</strong>se findings are
<strong>the</strong> results of Murray, Sinclair, Kidd, Quigley,
and McKenzie (1999), wherein daily records
of assault and staff sickness levels were recorded
over a period of 18 months. No significant
relationships were found between assault
levels and staff sickness levels.
In <strong>the</strong> following studies, emotional reactions
to challenging behaviour are emphasized.
In Raczka (2005), a number of staff
described intense emotional reactions of fear
and helplessness and persistent re-experiencing
of events in <strong>the</strong> form of intrusive thoughts
and dreams with associated distress. Bromley

and Emerson (1995) concluded that care staff
typically experienced a range of emotional
reactions depending on <strong>the</strong> type of challenging
behaviour. To episodes of aggression,
most respondents answered to react with annoyance,
anger, and fear and to episodes of
self-injury, with feelings of sadness, despair,
anger, annoyance, and disgust. In Bell and
Espie (2002), staff expressed positive attitudes
towards <strong>the</strong> residents with challenging behaviour.
This manifested itself in feelings of high
confidence, empathy, and need to help, and
low levels of feelings of excitement, fear, and
disgust, despite a degree of work-related
stress. Whittington and Burns (2005) interviewed
staff members about <strong>the</strong> dilemmas
<strong>the</strong>y encounter in <strong>the</strong>ir practice. Dilemmas
were experienced about how to deal with
emotional reactions. They experienced a
number of unpleasant feelings like fear and
frustration. Fur<strong>the</strong>rmore, staff members described
ambivalence about whe<strong>the</strong>r to see <strong>the</strong>
behaviour as ‘learned’ and respond ‘firmly’ or
to see it as ‘communication’ and respond
‘kindly’. In Wanless and Jahoda (2002), questionnaires
regarding two brief vignettes describing
incidents of aggression and a cognitive
behavioural interview to elicit emotions
and interpersonal appraisals experienced in a
real situation were used. They concluded that
real incidents of aggression evoked stronger
emotional responses and more negative evaluations
of clients and <strong>the</strong>ir behaviour in comparison
with hypo<strong>the</strong>tical scenarios.
In this last section, relationships between
emotional reactions on challenging behaviour
on <strong>the</strong> one hand, and stress (burnout and
coping strategies) on <strong>the</strong> o<strong>the</strong>r hand are discussed.
In Rose, Horne, Rose, and Hastings
(2004), staff members completed two questionnaires
about burnout and emotional reactions.
Staff’s emotional reactions to challenging
behaviour were associated with emotional
exhaustion and depersonalization burnout.
These are <strong>the</strong> two dimensions of burnout that
are conceptually focused on relationships with
or feelings towards service users. Mitchell and
Hastings (2001) asked staff members to complete
questionnaires on emotional reactions,
coping strategies and burnout. They found
three key dimensions to coping strategies that
staff used when working with challenging behaviours:
adaptive strategies, disengagement
coping, and denial coping. Adaptive strategies
were predictive on increased feelings of personal
accomplishment, whereas disengagement
strategies predicted both emotional exhaustion
and less positive feelings of personal
accomplishment. Fur<strong>the</strong>rmore, depersonalization
and emotional exhaustion were related
to depression and anger to challenging
behaviour.
Responses to challenging behaviours. In this
part, studies are discussed that go fur<strong>the</strong>r into
<strong>the</strong> responses of staff to challenging behaviour.
In Hastings (1995), reactions of staff
were investigated by means of interviews. Saloviita
(2002) used questionnaires and examined
<strong>the</strong> relation between <strong>the</strong> severity of challenging
behaviour and staff reactions. Wilson,
Reed, and Bartak (1995) observed clients and
staff during a period of nine months to assess
staff responses. Hastings concluded that, in
<strong>the</strong> short term, control and <strong>the</strong> prevention of
harm were mentioned, whereas <strong>the</strong> goals in
<strong>the</strong> longer term were different. In <strong>the</strong>ir comments
about longer-term interventions for
challenging behaviour, ‘improved life conditions’
was <strong>the</strong> most frequently mentioned
topic. Ano<strong>the</strong>r finding was that responses to
challenging behaviours were not closely related
to conceptual frameworks with appropriate
causal explanations for challenging behaviours.
The results of Saloviita showed that all
kinds of responses increased in frequency
when <strong>the</strong> behaviour became more severe, but
negative responses increased more than positive
or neutral approaches. However, negative
responses were also frequently seen in reactions
to problems that were reported as mild.
A wide use of various restrictive measures to
control challenging behaviour was mentioned
by care staff. To control dangerous behaviour,
punishment, environmental restrictions, and
mechanical restraints were used. Wilson et al.
found that staff used verbal strategies to react
on problem behaviours in <strong>the</strong> majority of
cases. The only time-out without some degree
of verbal intervention was used when a resident
had hit a staff member. Ano<strong>the</strong>r interesting
result was that staff often used several
strategies, one after ano<strong>the</strong>r; in an attempt to
stop problem behaviour and that <strong>the</strong>y always
wanted to immediately stop <strong>the</strong> behaviour,
with no apparent consideration for <strong>the</strong> longterm
consequences on <strong>the</strong> frequency and in-
Staff Variables / 467

tensity of <strong>the</strong> target behaviour. Wilson et al.
also concluded that staff were negatively reinforced
by withdrawal of a problem behaviour;
<strong>the</strong>y were more likely to use <strong>the</strong> procedures
which have been seen to work in <strong>the</strong> past and
failed to change <strong>the</strong> behaviour on a permanent
basis.
The last two studies focused on <strong>the</strong> experiences
of staff as well as clients about <strong>the</strong> use of
physical interventions. In Fish and Culshaw
(2005), clients with learning disabilities as well
as direct care staff were interviewed about incidents
which required <strong>the</strong> use of physical
intervention. The authors concluded that <strong>the</strong>
use of a physical intervention is sometimes
unnecessary, and can be distressing for clients
as well as for staff. Clients mentioned that <strong>the</strong>y
sometimes felt pain during incidents of physical
intervention. Sometimes, <strong>the</strong>y construed
<strong>the</strong> use of it as a punishment and it could
make <strong>the</strong>m feel more frustrated and aggressive.
A point of discussion between clients and
staff was <strong>the</strong> question whe<strong>the</strong>r psychical intervention
methods were used as <strong>the</strong> last resort.
Clients taught that in some situations, o<strong>the</strong>r
methods would have sufficed and felt that <strong>the</strong>y
had a right to complain. Staff mentioned that
clients should take <strong>the</strong> responsibility for aggressive
behaviour ra<strong>the</strong>r than blaming it on
staff. An alarming topic in <strong>the</strong> interviews was
that sometimes <strong>the</strong> use of physical intervention
could remind clients of abuse <strong>the</strong>y may
have experienced in <strong>the</strong> past. Two positive
findings were that clients were aware of <strong>the</strong>
reasons why such interventions are generally
used and <strong>the</strong>y were able to specify strategies
which would help to reduce <strong>the</strong>ir feelings of
aggression. By both clients and staff, trust was
seen as an important part of <strong>the</strong> professional
relationship. Hawkins, Allen, and Jenkins
(2005) worked out a similar study and asked
for <strong>the</strong> experiences of service users with intellectual
disabilities and challenging behaviour
and staff members concerning <strong>the</strong> use of physical
interventions by means of semi-structured
interviews. Again, <strong>the</strong> service users complained
about negative experiences of physical
interventions. The most frequently felt
body sensations during <strong>the</strong>se interventions
were pain and discomfort. Their experiences
were more negative than <strong>the</strong> staff had believed.
Both service users and staff referred to
negative emotional reactions during a physi-
468 / Education and Training in Developmental Disabilities-December 2008
cal intervention, which could influence <strong>the</strong>
interaction between <strong>the</strong> two parties. However,
staff mentioned also positive aspects: <strong>the</strong>y experienced
some positive emotions during a
physical intervention, demonstrated positive
regard for a service user’s feelings, wanted to
get <strong>the</strong> techniques right and engaged in selfdebriefing
to lessen <strong>the</strong> negative impact.
Relations between views of staff, emotional reactions,
and willingness to help. Like we described
before, a distinction between four
types of attributions is often made: internal/
external, stable/unstable, controllable/uncontrollable
and personal/universal attributions.
In a number of studies, Weiner’s
attributional model of helping behaviour
(Weiner, 1985, 1986) has been examined. According
to this model, <strong>the</strong> prediction can be
made that <strong>the</strong> attribution of internality, controllability
and stability will determine <strong>the</strong>
emotional reactions of less sympathy or more
anger in <strong>the</strong> observer, and <strong>the</strong>se reactions will
consequently influence <strong>the</strong> possibility of <strong>the</strong>
observer offering less help. However, not all
<strong>the</strong> studies provided support for <strong>the</strong>se hypo<strong>the</strong>ses
and many authors concluded that Weiner’s
model may not be applicable in this context.
First, we will review <strong>the</strong> studies who
investigated <strong>the</strong> relation between beliefs/attributions
and emotions. Second, <strong>the</strong> relations
between emotional reactions and levels of optimism
and willingness to offer help are discussed.
In Weigel, Langdon, Collins, and O’Brien
(2006), <strong>the</strong> relationship between attributions
and expressed emotions was investigated by
means of a questionnaire and a short interview.
They found that staff working with a
client with challenging behaviour made attributions
about <strong>the</strong> challenging behaviour as
internal to <strong>the</strong> client and controllable by <strong>the</strong>
client. Fur<strong>the</strong>rmore, <strong>the</strong>y found an association
between high expressed emotions on <strong>the</strong>
one hand and internal and controllable attributions
on <strong>the</strong> o<strong>the</strong>r hand. They also concluded
that working with a client with challenging
behaviour and showing high
expressed emotions are associated with giving
critical comments. Bailey, Hare, Hatton, and
Limb (2006) examined attributions, emotional
responses, optimism, and willingness to
help with questionnaires and rating scales.
They concluded that internal, stable and un-

controllable attributions were associated with
feelings of anger and depression in care staff
for both self-injurious behaviours and o<strong>the</strong>r
forms of challenging behaviours. For self-injurious
behaviour, <strong>the</strong> correlation was highest
between <strong>the</strong> stable attribution scores and negative
emotions in care staff; for <strong>the</strong> o<strong>the</strong>r
forms of challenging behaviours, <strong>the</strong> highest
correlation coefficients were found between
<strong>the</strong> internal attribution scores and negative
emotions in care staff. However, Dagnan,
Trower, and Smith (1998) who examined <strong>the</strong>
same variables as Bailey et al. and also used
questionnaires and rating scales, found that
<strong>the</strong> attribution of controllability was significantly
positively correlated with negative emotion,
<strong>the</strong> negative evaluation of <strong>the</strong> behaviour,
and <strong>the</strong> negative evaluation of <strong>the</strong> person and
was negatively correlated with positive emotion.
Also, in Hawkins et al. (2005) who discussed
<strong>the</strong> use of physical interventions with
service users and staff members, a relationship
was found between perceptions of a high level
of controllability and <strong>the</strong> elicitation of negative
emotions. These findings are in contrast
to <strong>the</strong> results of Jones and Hastings (2003)
who investigated attributions, emotional reactions,
and helping behaviour by presenting
videos. They concluded that staff, who perceived
<strong>the</strong> causes of self-injurious behaviour as
something to do with <strong>the</strong> client or uncontrollable
by external forces, reported less negative
affect. One of <strong>the</strong> aims of Wanless and Jahoda
(2002) was to investigate <strong>the</strong> utility of Weiner’s
model of helping behaviour in explaining
staff reactions to challenging behaviour by
means of questionnaires with two brief vignettes.
They found that negative appraisals
of <strong>the</strong> clients were associated with strong negative
emotions and <strong>the</strong> view that <strong>the</strong> clients
were in control of <strong>the</strong>ir behaviour. Dagnan
and Cairns (2005) presented questionnaires
and rating scales to staff about attributional
style, emotional responses, helping intention,
responsibility for <strong>the</strong> development and
change of challenging behaviour, and explanations
with regard to self-injurious behaviour.
They observed significant positive correlations
between internality and anger and
negative correlations between internality and
sympathy. Stability correlated positively with
sympathy. Fur<strong>the</strong>rmore, <strong>the</strong>y found that <strong>the</strong>
attribution of controllability was correlated
with <strong>the</strong> judgement of responsibility for <strong>the</strong>
development and change of challenging behaviour.
In Rose and Rose (2005) who investigated
<strong>the</strong> impact of stress on attributions of
challenging behaviour with questionnaires
and rating scales, no strong correlation was
found between <strong>the</strong> beliefs staff held about
challenging behaviour and <strong>the</strong> way <strong>the</strong>y were
emotionally affected by it.
The second part of <strong>the</strong> predictions, based
on Weiner’s attributional model of helping
behaviour (Weiner, 1985, 1986), implies that
staff’s emotional reactions of less sympathy or
more anger will lead to <strong>the</strong> possibility of <strong>the</strong>
staff members offering less help. Sometimes
optimism regarding changing <strong>the</strong> challenging
behaviour is expected to play a role in this
process. Following Bailey et al. (2006), low
levels of negative emotions were not associated
with high levels of optimism with regard
to changing self-injurious behaviours and
challenging behaviours, whereas Dagnan et al.
(1998) and Rose and Rose (2005) concluded
that negative emotions were correlated to a
lower level of optimism. Next to this, <strong>the</strong> relation
between high levels of optimism and
high levels of reported willingness to help was
also not found by Bailey et al.. However, Dagnan
et al. concluded that <strong>the</strong>re was a correlation
between lower level of optimism and less
willingness to offer extra help. In Dagnan and
Cairns (2005), <strong>the</strong> intention to offer help was
positively correlated with responsibility for
change and sympathy. This study demonstrated
that responsibility for behaviour plays
an important part in <strong>the</strong> judgement of sympathy.
In Hill and Dagnan (2002), two scenarios
were presented to staff and <strong>the</strong>y completed
three questionnaires and two rating scales
concerning attributional style, emotional response,
helping intention, coping styles, and
<strong>the</strong> understanding of self-injurious behaviour.
The results of this study showed, at <strong>the</strong> level of
simple correlations, that if support staff used a
practical problem solving coping style, made
fewer internal attributions and experienced
more sympathy, <strong>the</strong>y were more likely to put
effort into helping. Regression analysis demonstrated
that both practical problem solving
and wishful thinking significantly and independently
predicted effort in helping. The
more internal and <strong>the</strong> more controllable <strong>the</strong>
behaviour was considered to be, <strong>the</strong> less effort
Staff Variables / 469

in helping was predicted. Anger seemed not
significantly related to offering help. However,
<strong>the</strong>re was a significant correlation between
sympathy and offering help. Bailey et al.
concluded that willingness to help was positively
correlated with observed ‘processing’
and negatively correlated with <strong>the</strong> care staff
being ‘not present’. Rose and Rose stated that
reduced staff optimism was related to global
attributions regarding challenging behaviour.
Discussion and Implications for Fur<strong>the</strong>r
Research
After this overview of literature, it is clear that
in many studies <strong>the</strong> interaction between staff
and clients is emphasized. Also more and
more attention is given to what staff experience
in <strong>the</strong> critical situations <strong>the</strong>y encounter
every day. However, this research domain is
very broad and it leaves us with a lot of diverging
results about <strong>the</strong> relationships between
various staff and client variables. Ano<strong>the</strong>r aspect,
important to consider, are <strong>the</strong> methods
used in <strong>the</strong> studies. These aspects make it
difficult to compare studies or to come to
general conclusions.
Despite all <strong>the</strong>se obstacles, we will try to
summarize some findings. Concerning <strong>the</strong>
views of staff on challenging behaviour, <strong>the</strong>
origin of challenging behaviour is often situated
within <strong>the</strong> client. Fur<strong>the</strong>rmore, it seems
that behaviours that have negative effects on
<strong>the</strong> environment are experienced as more
challenging than behaviours that have negative
effects on <strong>the</strong> client himself. Comparing
<strong>the</strong> views of experienced and inexperienced
staff haven’t yet yielded clear results. In many
studies about stress and emotional reactions
to challenging behaviours, staff members
agreed that lack of procedures to deal with
challenging behaviour and lack of support are
important stressors in <strong>the</strong>ir work with clients
who show challenging behaviour. However, in
some studies, staff also referred to <strong>the</strong> challenging
behaviour itself as source of stress.
Little studies focus on staff responses to challenging
behaviour. Mostly, interviews and
questionnaires are used to measure responses
and all studies accentuate o<strong>the</strong>r relating variables.
Only in one study, staff and client behaviour
was directly observed. Of all <strong>the</strong> relations
that were investigated between staff
470 / Education and Training in Developmental Disabilities-December 2008
attributions and emotional reactions, most evidence
was found for <strong>the</strong> relation between <strong>the</strong>
view that clients are in control of <strong>the</strong>ir behaviour
and negative staff emotions. Never<strong>the</strong>less,
some studies didn’t find this relationship.
Fur<strong>the</strong>rmore, situating <strong>the</strong> origin of <strong>the</strong> challenging
behaviour within <strong>the</strong> client also seems
to be attended with negative staff emotions. A
lot of studies examined <strong>the</strong> relation between
emotional reactions and level of optimism
about changing challenging behaviour and
<strong>the</strong> willingness to offer help. These results are
very diverging.
Two aspects that contribute to <strong>the</strong> extensiveness
of this domain are <strong>the</strong> various types of
challenging behaviour that are involved in <strong>the</strong>
studies and <strong>the</strong> fact that many studies aren’t
specific about <strong>the</strong> intellectual disability of <strong>the</strong>
clients. Like we mentioned in <strong>the</strong> overview of
<strong>the</strong> studies, many studies only refer to ‘challenging
behaviour’ without specifying what
<strong>the</strong>y exactly mean by this term. But even when
<strong>the</strong> challenging behaviour is specified, it is
clear that it can involve various types of behaviour.
In future research, it is important to
clearly describe what is meant by challenging
behaviour, so that it is possible to compare <strong>the</strong>
reactions to different types of challenging behaviour.
Moreover, to indicate <strong>the</strong> intellectual
disabilities of <strong>the</strong> clients that show challenging
behaviour, many authors use a general term
like ‘intellectual or learning disabilities’. However,
we think that it is very important to
distinguish between different levels of intellectual
disabilities. Depending on <strong>the</strong> level of
intellectual disability, challenging behaviour
may have a totally different function and expression
and elicit different staff reactions and
emotions (Borthwick-Duffy, 1994; Emerson,
1995).
Because of <strong>the</strong> variety of studies and results,
for now it is impossible to come to durable
and reliable conclusions. Although we have
chosen for a broad perspective, it seems better
to syn<strong>the</strong>size all <strong>the</strong> sub domains and depart
from a kind of <strong>the</strong>oretical framework. A more
systematic approach is needed. Hastings
(2005) has already proposed such a framework.
In this framework, he refers to relationships
between staff behaviour, children’s
problem behaviour, staff negative emotional
reactions and staff stress. Also <strong>the</strong> influence of
staff beliefs on staff behaviour and staff psy-

chological resources is mentioned. Fur<strong>the</strong>rmore,
<strong>the</strong> relationship between service and
organizational factors and service culture on
<strong>the</strong> one hand and staff beliefs and staff stress
on <strong>the</strong> o<strong>the</strong>r hand, are taken into account. We
think that it would be very effective to take this
framework as a guideline for fur<strong>the</strong>r research.
Although this framework is focusing on children,
<strong>the</strong> same framework may be useful for
adults. Only if researchers will approach <strong>the</strong>
relationships between several variables in a
more systematic way, efficient research would
be possible and clear conclusions could be
made.
Even more important to consider, are <strong>the</strong>
methods used in <strong>the</strong> studies. Overall, questionnaires
and interviews are used. In only two
studies, a more objective method, namely direct
observation, was used. Never<strong>the</strong>less, besides
self-report methods, it is necessary to
consider more objective measures. This is
something to take into account in future research.
Fur<strong>the</strong>rmore, data analysis has to be
ano<strong>the</strong>r point of attention. Often only correlations
are mentioned, but to conclude relationships,
more sophisticated data analyses
are needed.
Despite all <strong>the</strong>se comments on recent research,
it is a fact that more and more attention
is given to this topic and to <strong>the</strong> role of <strong>the</strong>
relationship between staff and clients in <strong>the</strong>
origin and maintenance of challenging behaviour.
It is promising to note that not only <strong>the</strong>
behavioural and functional processes are investigated,
but that also <strong>the</strong> more psychological
and indirect variables are taken into account.
Next to <strong>the</strong>se <strong>the</strong>oretical studies, more
and more intervention studies are published
(Allen, 1999; Gavidia-Payne & Hudson, 2002).
Mostly, behavioural support based on functional
analysis is given. Despite <strong>the</strong> existence
of many training programs and intervention
studies, <strong>the</strong>re seems to be a great demand for
more support and procedures to react to challenging
behaviour. Obviously, bringing <strong>the</strong>oretical
knowledge about good working intervention
programs into clinical practice seems
to be a challenge for <strong>the</strong> future. Fur<strong>the</strong>rmore,
it is clear that staff attributions about challenging
behaviour have an influence on staff emotions
and consequently on <strong>the</strong>ir behaviour.
Additional to more practical support, more
information and guidance in this context is
needed.
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Received: 12 April 2007
Initial Acceptance: 12 June 2007
Final Acceptance: 15 October 2007
Staff Variables / 473

Education and Training in Developmental Disabilities, 2008, 43(4), 474–485
© <strong>Division</strong> on Developmental Disabilities
High Tech Cooking: A Literature Review of Evolving
Technologies for Teaching a Functional Skill
Linda C. Mechling
University of North Carolina Wilmington
Abstract: This review syn<strong>the</strong>sizes <strong>the</strong> empirical literature (1986-2006) focusing on teaching cooking skills to
persons with moderate to severe intellectual disabilities. Twenty-two studies were identified which provided
information on four forms of technologies currently being used to teach food preparation: (a) picture-based
systems; (b) Palmtop personal (hand-held) computer-based systems; (c) auditory systems; and (d) video-based
systems. Implications for instruction and future research are discussed based on <strong>the</strong> results of review.
Over <strong>the</strong> past two decades food preparation
has been frequently studied and identified as
an essential skill for living independently
across a range of settings (Graves, Collins,
Schuster, & Kleinert, 2005; Horsfall & Maggs,
1986; Martin, Rusch, James, Decker, & Trtol,
1982; Schuster, 1988). In addition to providing
nutrition, preparing meals has added
value including social opportunities (i.e. cooking
with friends), recreation (i.e. watching cable
cooking shows; joining cooking classes),
choice making, and employment opportunities
in <strong>the</strong> food industry (Schuster). Compared
to eating out, ordering in, or hiring
someone else to cook, preparation of meals at
home may be more economically feasible for
persons with disabilities (Schuster). Cost efficiency
of pre-prepared meals may also be a
concern for some persons living on a fixed or
supported income. For example, although it
may require fewer steps for preparation, <strong>the</strong>
cost of microwavable macaroni and cheese per
ounce (compared to box preparation) may be
an important factor when selecting meals to
purchase, prepare, and teach.
A number of studies have been conducted
to evaluate <strong>the</strong> effectiveness of teacher delivered
prompts and procedures for teaching
cooking skills to persons with disabilities. The
strategies have included: constant time delay
Correspondence concerning this article should
be addressed to Linda C. Mechling, University of
North Carolina Wilmington, 601 S. College Road,
Wilmington, NC 28403-5940.
474 / Education and Training in Developmental Disabilities-December 2008
(Bozkurt & Gursel, 2005; Schuster, Gast, Wolery,
& Guiltinan, 1988); teaching in dyads
(Hall, Schuster, Wolery, Gast, & Doyle, 1992;
Wolery, Ault, Gast, Doyle, & Griffen, 1991);
teaching chained tasks in specific order versus
functional order (Wright & Schuster, 1988);
teaching in a total task versus backward chaining
format (Kayser, Billingsley, & Neel, 1986);
system of least prompts (Demchak, 1992;
Horsfall & Maggs, 1986; Jones & Collins, 1997;
Schleien, Ash, Kiernan, & Wehman, 1981;
Steege, Wacker, & McMahon, 1987); and
graduated guidance (Demchak, 1992). These
studies found each of <strong>the</strong> procedures to be
effective in <strong>the</strong> acquisition of food preparation
skills when instructors used a set of prescribed
prompting and instructional procedures.
Concern exists, however, for <strong>the</strong>
transfer of stimulus control from adult lead
instruction to natural sets of prompts that can
be independently used over an extended period
of time and across a range of stimuli
while cooking. Decreasing <strong>the</strong> need for continuous
supervision and prompting by o<strong>the</strong>rs
continues to be an educational focus when
designing instructional programs for persons
with disabilities.
Persons without disabilities use permanent
prompts such as written notes and text based
messages to direct <strong>the</strong>ir own behavior. Cook
books and recipe cards, for example, provide
permanent prompts to adults for meal preparation.
These prompts prohibit <strong>the</strong> need to
memorize step sequences and allow preparation
of simple to complex meals. These

prompts are permanent resources in many
kitchens and it is recognized that it would not
be functional to take away <strong>the</strong>se examples of
visual prompts for food preparation. When a
person has an intellectual disability it may be
more critical that prompts are permanently
available to <strong>the</strong>m so that multiple and varying
recipes are available regardless of <strong>the</strong>ir length
and complexity.
Encouraging research on cooking instruction
for persons with disabilities has shifted
<strong>the</strong> control away from <strong>the</strong> instructor to stimulus
materials and equipment that can serve
to teach or prompt completion of tasks. These
materials have traditionally been in <strong>the</strong> form
of picture based systems, but <strong>the</strong> use of auditory
prompting became <strong>the</strong> focus of research
in <strong>the</strong> 1990s as well as <strong>the</strong> emergence of videobased
procedures. The purpose of this review
was to examine <strong>the</strong> published, empirical literature
evaluating technology to assist persons
with disabilities to complete cooking tasks.
The focus of this review is technology applications
for teaching food preparation skills to
persons with moderate to severe intellectual
disabilities, including those with a diagnosis of
autism spectrum disorder. The review included
studies that used both light tech (picture
prompts and audio recording devices),
mid tech (VCR, DVD players) and high tech
devices (Palmtop PC, computer-based systems).
Studies reviewed included those using
technology to teach new cooking skills or
those which used technology as an independent
self-prompting device (used alone by <strong>the</strong>
person) for completing a cooking skill.
Method
Studies conducted over <strong>the</strong> past 20 years
(1986-2006) were reviewed. Those identified
and included in <strong>the</strong> review met <strong>the</strong> following
criteria:
1. Empirical study
2. Publication in peer-reviewed journal
3. Evaluation of food preparation skills
4. Participants were diagnosed with a moderate
to severe intellectual disability
5. Article published in English
Studies were located by conducting an electronic
search of ERIC using <strong>the</strong> key search
words: cooking, food, food preparation, nutrition,
meal preparation, snack, drink, recipe,
microwave, stovetop, oven, and kitchen skills.
A manual search was completed by examining
<strong>the</strong> table of contents for <strong>the</strong> following relevant
journals: American <strong>Journal</strong> of Mental Retardation,
Exceptionality, Education and Training in Developmental
Disabilities, Exceptional Children, Focus
on Autism and O<strong>the</strong>r Developmental Disabilities,
Focus on Exceptional Children, <strong>Journal</strong> of Applied
Behavior Analysis, <strong>Journal</strong> of <strong>the</strong> Association for
Persons with Severe Disabilities, <strong>Journal</strong> of Autism
and Developmental Disabilities, <strong>Journal</strong> of Developmental
and Physical Disabilities, <strong>Journal</strong> of Special
Education, <strong>Journal</strong> of Special Education Technology,
Mental Retardation, and Remedial and Special
Education. Lastly, an ancestral search was
made of all reference lists of identified articles.
Studies emerged which focused on technology
for: a) teaching new food preparation
skills; and b) controlling antecedents for selfprompting
food preparation.
Results
Twenty-two studies and two reviews were identified.
An earlier review, conducted by Schuster
(1988), reported <strong>the</strong> results of six studies
focusing on cooking instruction with persons
with intellectual disabilities while Marchand-
Martella, Smith, and Agran (1992) focused
<strong>the</strong>ir review on both food preparation and
meal planning for persons with disabilities.
The technology identified in <strong>the</strong> current review
included: (a) picture prompts (7 studies);
(b) Palmtop personal (hand held) computer-based
systems (3 studies); (c) audio
cassette players (5 studies); and (d) videobased
systems (7 studies). Table 1 provides
fur<strong>the</strong>r information concerning <strong>the</strong> design of
each study, participants, cooking skills taught,
and results.
The review found a range of technology
that was effective for teaching both new cooking
tasks and self-operation of devices to guide
completion of cooking tasks independent of
instructor prompts. The first part of <strong>the</strong> paper
reviews each of <strong>the</strong> identified studies and
structures <strong>the</strong> review around types of technology.
The final part of <strong>the</strong> paper addresses
implications for current practice and suggestions
for future research.
High Tech Cooking / 475

TABLE 1
Overview of Technology Based Cooking Instruction for Persons with Disabilities
Cooking Task
(Dependent Variable) Procedure Design Results
Reference Participants
2 of 3 students made sack lunches
in correct sequece. Genera
lization across novel customers.
Each student learned each task.
Maintenance 1 wk later.
Multiple baseline
across participants
Sack lunch Single photos turned
over
n 3CA 14–16yrs
Moderate, Severe ID
n 3CA 10–13yrs
Moderate ID
Picture Based Systems
Agran, Fodor-
Davis, Moore &
Martella (1992)
Griffen, Wolery, &
Schuster (1992)
Independent task completion.
Generalization across settings &
tasks. Maintenance of
performance.
Effective with 3 of 4 students
Generalization across materials.
Maintenance until “end of
school year.
Effective for all students. 12
months maintenance.
Milk shake,
Black & white line Multiple probe
scrambled eggs, drawings, test, in across students &
pudding
book
tasks
Making lunch Color photos in Multiple probe
book
across behaviors,
replicated across
children
Cheese & crackers, Picture recipe book Multiple probe
waffles & syrup,
across behaviors,
chocolate milk
replicated across
students
Kool-Aid Colored line
Multiple probe
drawing & text 2 across students
sided index
card
Orange juice Black & white line Multiple probe
drawing in book across students
n 3CA 6–9yrs
Autism
Pierce &
Schreibman
(1994)
n 4CA 8–12yrs
Moderate, Severe ID
Fiscus, Schuster,
Morse, & Collins
(2002)
n 5CA 9–12yrs
Moderate ID
Schuster & Griffen
(1991)
Effective for all students.
Generalization across settings
and materials. Maintenance 60
days.
Acquisition and maintenance of
multi-step meal preparation.
n 4CA 9–12yrs
Moderate ID
Schuster & Griffen
(1993)
Multiple baseline
across subjects
Pineapple mousse Black & white line
drawings in book
n 3CA adults
Profound ID
476 / Education and Training in Developmental Disabilities-December 2008
Palmtop PC with vibration,
auditory prompts, & picture
cues was more effective than
picture cards.
Clustering of picture instructions
on Palmtop PC effective for
maintaining task performance.
Palmtop PC Alternating
treatment
Pudding, soup,
cookies, fruit
dessert
n 6CA 23–47yrs
Severe
Developmental
Disability
n 3 Selected based
on 90% maintenance
performance from
Study 1
Singh, Oswald,
Ellis, & Singh
(1995)
Palmtop Personal
Computers
Lancioni, O’Reilly,
Seedhouse,
Furniss, &
Cunha (2000)
Tasks from study 1 Alternating
treatment

TABLE 1—(Continued)
Cooking Task
(Dependent Variable) Procedure Design Results
Reference Participants
Palmtop PC Alternating treatment Palmtop PC with auditory prompts
& step-by-step picture instruct
ions effective for task completion.
Presenting instruction in clusters
maintained high levels of
Soup, cookies, 2
desserts
n 4CA 19–39yrs
Severe ID
Lancioni, O’Reilly,
Van den Hof,
Furniss,
Seedhouse, &
Rocha (1999)
performance.
Palmtop PC with auditory prompts,
vibration, & pictures resulted in
significantly higher levels of
correct performance than
pictures.
Palmtop PC Alternating treatment with
reversal
Soup, cookies, fruit
dessert
n 3CA 20–36
Severe ID
Lancioni, Van den
Hof, Boelens,
Rocha, &
Seedhouse (1998)
Audio cassette player Multiple baseline across tasks Four students learned all tasks.
Maintenance of skill after audio
removed.
Audio cassette player Alternating treatments Auditory and pictorial prompting sy
stems equally effective.
Cup of soup, peanut
butter & jelly
sandwich
Omelet, pudding,
mushroom sauce,
pizza bread, fruit
drinks
Stuffed cake,
pudding, dessert
cake, appetizer,
cheese salad
n 4CA 12–16yrs
Moderate, Severe ID
n 2CA 13yrs Mild
ID Multiple
Disabilities
Auditory Systems
Alberto, Sharpton,
Briggs, & Stright
(1986)
Lancioni, Klaase, &
Goossens (1995)
Audio cassette player Alternating treatments Single step instructions effective in
increasing task performance.
Clusters of verbal instructions
maintained high level of
performance. Decrease in
performance when audio
n 3CA 19–22 Mild
ID Visual
Lancioni, O’Reilly,
& Oliva (2001)
removed.
Increases in independent task
completion. Generalization to
untrained settings. Maintenance
of performance after 6 months
Students completed steps using tape
recorded recipes. Generalization
to similar and more complex
recipes.
Coffee Audio cassette player Multiple baseline across
behaviors, replicated across
2 adults
n 2CA 37, 48yrs
Mild ID,
Schizophrenia
Steed & Lutzker
(1999)
Audio cassette player Multiple baseline across
behaviors
Microwave pizza,
French fries,
popcorn; cake,
brownies; cheesecake,
tea, coffee,
pudding
n 3CA 17–21yrs
Developmental
Disability, Visual
Impairment
Trask-Tyler, Grossi,
& Heward (1994)
Mastery of tasks. Generalization
across settings, stimuli, & people.
Maintenance 1 month later for 2
of 3 students.
Coffee Video modeling Multiple baseline across
participants
n 3CA 33–72yrs
Severe, Profound ID
Video-Based Systems
Bidwell & Rehfeldt
(2004)
High Tech Cooking / 477

TABLE 1—(Continued)
Cooking Task
(Dependent Variable) Procedure Design Results
Reference Participants
Effective for each
student.
Maintenance of
skills after 2 weeks.
Increased task
fluency.
Generalization
across tasks.
Maintenance after
removing video.
Mastery of tasks.
Generalization
across settings.
Maintenance after 1
month.
Effective in
acquisition of
skills.
Maintenance of
results after 1
month.
Acquisition for 2 of
3 students.
Maintenance after
video prompting
removed 2, 6, 10
wks.
All procedures
effective.
Video photos &
video in vivo
prompting more
efficient than
video modeling
alone.
Multiple probe across
behaviors &
replicated across
participants
Video prompting.
Subjective point of
view
Macaroni & cheese,
Ramen noodles,
peanut butter &
jelly sandwich
School lunch, peanut
butter & jelly
sandwich
n 3CA 16–20yrs
Moderate ID
Graves, Collins,
Schuster, Kleinert
(2005)
Video self-modeling Multiple baseline
across tasks
n 2CA 14–15yrs
Developmental
Disability, Behavior
Disorder
Lasater & Brady
(1995)
Video modeling Multiple probe across
participants
Peanut butter & jelly
sandwich
n 3CA 22–37yrs
Moderate, Severe ID
Rehfeldt, Dahman,
Young, Cherry, &
Davis (2003)
Multiple probe across
tasks & replicated
across participants
Orange juice Video modeling
Subjective point of
view
n 3CA 5 yrs
Autism
Shipley-Benamou,
Lutzker, &
Taubman (2002)
Microwave popcorn Video prompting Multiple probe across
participants
n 3CA 34–36yrs
Moderate ID
Sigafoos et al.
(2005)
478 / Education and Training in Developmental Disabilities-December 2008
Within subjects
alternating
treatments design
Microwave pizza Video modeling,
video modeling
photos, video
modeling in vivo
video prompting
n 3CA 17–19yrs
Moderate ID
Van Laarhoven &
Van Laarhoven-
Myers (2006)

Picture Based Systems
To accommodate for a lack of text reading
skills, picture prompts, in <strong>the</strong> form of recipe
cards, were researched as early as 1977 (Robinson-Wilson).
Early picture-based systems relied
on hand drawn illustrations and were frequently
paired with written instructions
(Browder, Hines, McCarthy, & Fees, 1984;
Johnson & Cuvo, 1981). Preparation of picture
systems <strong>the</strong>n evolved to film based development
of black and white photographs, color
photographs, Xerox copies of photographs,
and scanned images onto computer based systems.
Currently, digital photography and
downloaded images from internet sources are
also available for developing picture-based systems.
The current review identified seven studies
employing <strong>the</strong> use of picture based systems to
teach food preparation skills. The format of
<strong>the</strong> system and number of pictures per page
varied among <strong>the</strong> studies. Agran, Fodor-Davis,
Moore, and Martella (1992) presented single
photographs of items to be placed into sack
lunches for customers. Photographs were
turned over as items were placed into <strong>the</strong> bag.
O<strong>the</strong>r researchers used single pictures per
page to represent one step of a task analysis
and assembled <strong>the</strong> pages into book form using
metal ring binders (Griffen,Wolery, & Schuster,
1992; Pierce & Schreibman, 1994; Schuster
& Griffen, 1993). O<strong>the</strong>rs have presented
recipes (task analysis) in book form with more
than one picture per page (Fiscus, Schuster,
Morse, & Collins, 2002; Singh, Oswald, Ellis, &
Singh, 1995; Schuster & Griffen, 1991).
Commercially made cookbooks for persons
unable to read have also become available to
practitioners and present individual steps or
small clusters of steps on single pages (Stepwise
Lunch Cookbook: Jackson, 1998) and multiple
pictures per page (Look’n Cook Microwave: Easyto-Make
Illustrated Recipes: Hanson, 1999; Visual
Recipes: A Cookbook for Non-Readers: Orth,
2000). It is unclear from <strong>the</strong> literature reviewed
whe<strong>the</strong>r a single picture per page or
multiple pictures per page are more effective
for certain learners. Multiple pictures decrease
<strong>the</strong> need to turn pages and possibly
losing one’s place, while o<strong>the</strong>r students may
find it difficult to follow multiple pictures on a
page and may lose <strong>the</strong>ir place if temporarily
distracted.
Palmtop Personal Computers
As one of <strong>the</strong> most newly emerging forms for
prompting task completion, palmtop personal
computers also represent one of <strong>the</strong> “highest
tech” forms of technology being used as antecedent
prompts for persons with intellectual
disabilities. They are presented next in <strong>the</strong>
current review because to date <strong>the</strong>y are primarily
a picture based system. Using features
of a “touch screen”, persons access digital photographs
by touching a dynamic display on a
hand-held system. The system can be programmed
to move to <strong>the</strong> next step (next photograph)
by pressing a “Done” or “Next” button
on <strong>the</strong> touch screen. One advantage that
<strong>the</strong>se systems may have over traditional static
picture systems is <strong>the</strong> incorporation of audio.
By touching a photograph, “Play”, or “Start”
button, a description of how to complete <strong>the</strong>
step is heard. A student can repeat <strong>the</strong> auditory
and visual step as often as needed.
Recent evaluations have been importing
digital photographs onto Palmtop personal
computers to provide antecedent prompts for
food preparation to persons with intellectual
disabilities (Lancioni et al., 1999; Lancioni,
O’Reilly, Seedhouse, Furniss, & Cunha, 2000;
Lancioni, Van den Hof, Boelens, Rocha, &
Seedhouse, 1998). In two interesting comparison
studies, Lancioni and o<strong>the</strong>rs (1998; 1999)
found that <strong>the</strong> Palmtop PC programs with
auditory prompts and step-by-step instructions
were more effective than traditional picture
cards when measuring <strong>the</strong> percentage of steps
performed correctly on tasks. They attribute
<strong>the</strong> difference to students losing <strong>the</strong>ir place
and mishandling <strong>the</strong> manual pictures. The
portable systems also included auditory and
vibrating prompts to cue students to initiate
steps of a task analysis, features unavailable
with manual picture systems. Also of interest
was <strong>the</strong> comparison made between single pictures
for each task step and multiple steps
clustered into a picture in <strong>the</strong> Lancioni et al.
(1999) study. Results indicated that students
were able to maintain high levels of task performance
when steps were clustered toge<strong>the</strong>r
into one picture.
Commercially available hand-held products
High Tech Cooking / 479

(Cyrano Communicator, One Write Company;
Independent Living Suite, AbleLink Technologies)
(Figure 1) are appearing on <strong>the</strong> market
and are being distributed among companies
that sell products specifically designed for individuals
with disabilities (i.e. Mayer-Johnson
LLC). Cost is one argued disadvantage of
<strong>the</strong>se systems, although it is predicted that
similar to o<strong>the</strong>r evolving technologies, costs
will continue to decrease (Davies, Stock, &
Wehmeyer, 2002; Swan, Swan, Van Hover, &
Bell, 2002). Ano<strong>the</strong>r disadvantage for <strong>the</strong>
hand-held system is that although <strong>the</strong> systems
are manufactured with some features already
built into <strong>the</strong>m, <strong>the</strong>y do require some computer
skills and initial set-up time to customize
settings, photographs, and tasks.
Auditory Systems
Figure 1. Hand–held prompting devices: Cyrano Communicator and Independent Living Suite.
Traditionally, auditory systems used portable
cassette players with recorded step-by-step
prompts for completing a task. As described in
<strong>the</strong> previous review section, use of hand-held
electronic devices such as Palmtop PCs, are
beginning to replace <strong>the</strong> traditional use of
auditory cassette players for delivering audi-
480 / Education and Training in Developmental Disabilities-December 2008
tory cues to persons with disabilities. These
systems now have <strong>the</strong> advantage of presenting
both visual and auditory information simultaneously.
None <strong>the</strong> less, five studies were identified
which effectively taught students with
disabilities to complete multi-step cooking
tasks using auditory prompts (Alberto, Sharpton,
Briggs, & Stright, 1986; Lancioni, Klaase,
& Gooseens, 1995; Lancioni, O’Reilly, &
Oliva, 2001; Trask-Tyler, Grossi, & Heward,
1994; Steed & Lutzker, 1999). In addition, one
of <strong>the</strong> studies compared <strong>the</strong> effects of pictures
alone to auditory prompting and found no
significant differences between <strong>the</strong> two
prompting procedures (Lancioni et al. 1995).
A second study compared single word instructions
(one word corresponding to each step of
a task analysis) to clustering of instructions
(two or more steps heard by <strong>the</strong> student when
“Play” was selected on <strong>the</strong> cassette player).
Results supported students’ abilities to follow
multiple word prompts to complete food
preparation tasks.
While <strong>the</strong> audio system used by Lancioni et
al. (1995) allowed <strong>the</strong> cassette recorder to
stop automatically after each prompt, and repetition
of prompts, most systems rely on <strong>the</strong>

following sequence of steps : a) a “beep” to
signal <strong>the</strong> end of a step; pushing a “Stop”
button; completion of <strong>the</strong> step; and pushing a
“Start” button to hear <strong>the</strong> next step; or b)
recording of a pause between instructions to
allow for completion of <strong>the</strong> step before <strong>the</strong>
next direction was provided. These requirements
may make auditory systems difficult for
persons with intellectual disabilities to operate
and to repeat steps when errors are made. A
distinct advantage of new technologies such as
hand-held computer-based systems are provision
for repetition of steps (touch a photograph)
while including digital images for persons
who are not strong auditory learners.
Video Based Systems
The majority of <strong>the</strong> work investigating video
instruction for persons with disabilities began
in <strong>the</strong> mid to late 1990s (Mechling, 2005).
Understandably, with <strong>the</strong> increased availability
of VCRs, classroom teachers and researchers
began to implement <strong>the</strong> use of video to
teach a range of skills. With <strong>the</strong> exception of
one identified study (Lasater & Brady, 1995)
all of <strong>the</strong> studies in <strong>the</strong> current review on
teaching cooking skills were completed in <strong>the</strong>
21 st century.
Use of video to instruct can be presented
through four primary modes (Mechling,
2005):
1. Video Modeling. Student watches a complete
video segment of a skill performed by
someone else (i.e. peer or adult) and later
performs <strong>the</strong> task.
2. Video Self-Modeling. Student watches
him/herself in an edited video in which it
appears that he/she is proficient at <strong>the</strong> task
to be learned. Video is created by editing
out errors or by taping segments so that
adult prompting cannot be seen in <strong>the</strong> final
version.
3. Video Prompting. Student watches a step
of a task and <strong>the</strong>n completes that step before
continuing on with <strong>the</strong> next video segment.
4. Subjective Point of View. Video modeling
or video prompting is presented from <strong>the</strong>
student’s perspective as if <strong>the</strong> student were
completing <strong>the</strong> task (i.e. walking through a
store) (Norman, Collins, & Schuster,
2001).
The current review found that <strong>the</strong> majority of
<strong>the</strong> studies teaching cooking skills used video
modeling (Bidwell, & Rehfeldt, 2004; Rehfeldt,
Dahman, Young, Cherry, & Davis, 2003;
Shipley-Benamour, Lutzker, & Taubman,
2002; Van Laarhoven & Van Laarhoven-Myers,
2006), while self-modeling was used in <strong>the</strong>
earlier study by Lasater and Brady (1995) and
video prompting was used to teach microwave
use (Sigafoos et al., 2005). Additionally,
Graves et al. (2005) used video prompting by
presenting cooking tasks using subjective
point of view and Shipley et al. conducted one
of <strong>the</strong> first studies evaluating subjective point
of view to teach functional skills (including
preparation of orange juice).
As expected, earlier studies frequently used
a VCR to present video instruction to learners,
however, evolving technology is bringing an
increase in <strong>the</strong> use of laptop computers and
portable DVD players to present video instruction.
Advantages to <strong>the</strong>se mediums of instruction
are portability and ease of use. Similar to
<strong>the</strong> advantages of hand-held computer-based
systems over audio cassettes, a portable DVD
player or laptop computer allow <strong>the</strong> learner to
replay and skip video segments to precise locations,
whereas a VCR is often controlled by
<strong>the</strong> instructor (Graves et al., 2005). Four of
<strong>the</strong> seven studies teaching cooking skills with
video used laptop or portable computer-based
systems (Bidwell & Rehfeldt, 2004; Rehfeldt et
al., 2003; Sigafoos et al., 2005; Van Laarhoven
& Van Laarhoven-Myers, 2006).
All of <strong>the</strong> reviewed studies show promise for
presenting information to students through
video technology. Results support researchers
who have found that video can present information
in “real life” scenarios (Alcantara,
1994), provide multiple teaching examples
(Charlop-Christy, Le, & Freeman, 2000), and
can add <strong>the</strong> features of motion and sound that
allow learners to experience actual actions in
process (Stephens & Ludy, 1975).
Although <strong>the</strong> merits of video seem apparent,
<strong>the</strong> advantage of video instruction over
static picture presentation is unclear and will
continue to require future investigation.
While video-based systems may include
more information and cues than can be obtained
from static pictures, future research
should include comparison between <strong>the</strong>se two
modes of presentation.
High Tech Cooking / 481

Researchers are also investigating <strong>the</strong> combined
strength of using both video and pictures.
For example, Van Laarhoven and Van
Laarhoven-Myers (2006) found that video
modeling with pictures and video modeling
with in vivo video prompting were more efficient
(although all were equally effective)
than video modeling presented alone to teach
students to complete daily living skills (including
cooking microwave pizza).
Ano<strong>the</strong>r area of interest is whe<strong>the</strong>r one
form of video instruction (i.e. video prompting
versus video modeling) holds particular
advantage for some learners. Although not
conducted with a cooking related task, Cannella-Malone
et al. (2006) found video
prompting to be effective in teaching multistep
daily living tasks to adults with intellectual
disabilities while video modeling was “generally
shown to be ineffective.” These results
appear to have implications for persons developing
video-based prompting systems for food
preparation. The researchers state that <strong>the</strong>
differences may have been due to use of brief
video clips (video prompting) versus <strong>the</strong> attentional
and retentional requirements of
watching an entire task. In this current review
of <strong>the</strong> literature, cooking tasks taught using
video modeling were: orange juice (Shipley-
Benamou et al., 2002); microwave pizza (Van
Laarhoven & Van Laarhoven-Myers, 2006);
peanut butter and jelly sandwich (Rehfeldt et
al., 2003; Lasater & Brady, 1995); school lunch
(Lasater & Brady); and coffee (Bidwell & Rehfeldt,
2004). Although <strong>the</strong>se tasks had multiple
steps, complete recipes and meal preparation
with more than one item, tend to be
more complex. It appears that recipes presented
in a step-by-step format through video
prompting may hold particular value for
teaching cooking tasks that individuals will
face in <strong>the</strong>ir daily lives. An additional avenue
of research will be <strong>the</strong> application of step-bystep
video prompting on portable hand held
devices as <strong>the</strong> capability of presenting video
on <strong>the</strong>se devices increases.
Discussion
Attention to increasing independence and opportunities
for persons with disabilities
through teaching functional skills such as
cooking will likely continue to evolve just as it
482 / Education and Training in Developmental Disabilities-December 2008
has for <strong>the</strong> last 20 years covered in this review.
As technology advances, so will <strong>the</strong> demands
for response in special education to stay
abreast of how <strong>the</strong>se advances can be applied
to improving <strong>the</strong> lives of persons with disabilities.
Increasingly, novice technology users will
likely become familiar with <strong>the</strong> process of
making <strong>the</strong>ir own personal CDs, DVDs, and
computer-based programs. Joined with this increase
will be opportunities to develop customized
programs to meet <strong>the</strong> individual
needs and styles of learners. For example, personalized
DVDs or CDs could be made for
preparing a recipe, step-by-step, with video
footage taken in <strong>the</strong> learner’s personal
kitchen. Persons following <strong>the</strong> DVD or CD can
watch a step, pause <strong>the</strong> player, complete <strong>the</strong>
step, and so forth while watching <strong>the</strong> task
being completed with <strong>the</strong> exact appliances
and utensils that <strong>the</strong>y will be using and while
viewing exactly where items are stored within
<strong>the</strong>ir own kitchen.
Research supports <strong>the</strong> efficient presentation
of information to learners with disabilities.
While handheld devices and portable
prompting systems with video capabilities provide
promise for delivering information in a
format that can be operated independently by
students to direct <strong>the</strong>ir own behavior, <strong>the</strong> importance
of “traditional” light tech applications
and combination of systems should not
be overlooked. Findings from this review suggest
some implications for future research to
enhance instruction in <strong>the</strong> area of food preparation:
1. More studies comparing video prompting
and video modeling to teach complex meal
preparation.
2. Generalization measures of systems such of
video prompting to untaught recipes (similar
to cooking new recipes from a cookbook).
3. Comparison of video-based systems and
static picture systems.
4. Comparison of picture-based systems using:
a. single pictures per page versus multiple
pictures per page
b. single step per picture versus clustering
of steps per picture
5. Studies combining static pictures and video-based
systems.
6. More studies regarding hand-held systems

and portable DVD players that can be used
in <strong>the</strong> kitchen to deliver picture based or
video based instruction.
7. Social validation of <strong>the</strong> various procedures
and student preference for use.
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Received: 8 March 2007
Initial Acceptance: 5 May 2007
Final Acceptance: 20 July 2007
High Tech Cooking / 485

Education and Training in Developmental Disabilities, 2008, 43(4), 486–501
© <strong>Division</strong> on Developmental Disabilities
Using Literacy-Based Behavioral Interventions and Social
Stories to Improve Work Behavior in Employees with
Developmental Disabilities
Jessica L. Bucholz
University of West Georgia
Michael P. Brady, Mary Lou Duffy, and Jack Scott
Florida Atlantic University
Larry G. Kontosh
West Virginia University
Abstract: This study was designed to examine <strong>the</strong> effects of Literacy-Based Behavioral Interventions and social stories
to improve <strong>the</strong> work behavior of employees with developmental disabilities. Two experiments were conducted. In <strong>the</strong>
first experiment a multiple baseline across subjects was used to examine <strong>the</strong> effects of <strong>the</strong> intervention on employees’
requests for materials and supplies, and any resulting improvements in <strong>the</strong>ir work engagement. The second
experiment employed a multiple baseline across time periods, with an embedded ABAB design, to assess whe<strong>the</strong>r <strong>the</strong>
intervention would increase independence and improve “on-time” return-to-work. Results showed that employees with
developmental disabilities made substantial improvements in <strong>the</strong>ir work behavior as a result of <strong>the</strong> Literacy-Based
Behavioral Intervention, and similar improvements were observed in co-workers as well.
Many people with developmental disabilities
have learning and performance problems that
interfere with <strong>the</strong>ir roles in employment and
o<strong>the</strong>r community settings. These individuals
frequently have difficulty developing fluent
work routines, or generalizing <strong>the</strong> skills
needed for community settings, including
work settings (Brady & Rosenberg, 2002;
Langone, Clees, Oxford, Malone, & Ross,
1995). These problems often affect <strong>the</strong> ability
of people with disabilities to obtain and maintain
meaningful employment.
There are a number of interventions available
that promote learning and performance
in people with developmental disabilities. For
example, <strong>the</strong> literature is replete with instructional
strategies based on direct instruction
(Storey, 2002), strategy instruction (Fletcher &
The preparation of this manuscript was made
possible by a grant from <strong>the</strong> Donald P. Hammill
Foundation. Correspondence concerning this article
should be addressed to Jessica Bucholz, University
of West Georgia, Department of Special Education,
and Speech-Language Pathology, Carrolton,
GA 30118-5140.
486 / Education and Training in Developmental Disabilities-December 2008
Bray, 1995), peer supports (Hughes & Carter,
2000), video and audio coaching (Lasater &
Brady, 1995), self-management procedures
(Lancioni & O’Reilly, 2001), and o<strong>the</strong>r approaches.
Each set of instructional strategies
has a knowledge base grounded in solid empirical
work, and each has helped adults with
developmental disabilities acquire and generalize
a wide range of skills and behavioral
routines across various community environments.
Within <strong>the</strong> last decade, ano<strong>the</strong>r strategy has
included Literacy-Based Behavioral Interventions
(LBBI). LBBIs incorporate <strong>the</strong> fundamental
principles of behavioral self control, along
with practice opportunities and prompts to
respond, into text media. Although examples
of LBBIs include cartoon strips, reflection
journals, social scripts, and multimedia stories
(Ganz, Tap Scott, & Earles-Vollrath, 2006;
Hagiwara & Myles, 1999; Rogers, & Myles,
2001; Thiemann, & Goldstein, 2001), <strong>the</strong>
most common example of an LBBI to date
involves social stories (Gray, 2000). Social stories
typically have been used to teach social
skills or as a behavior management technique.

Social stories are short stories which describe
situations which pose behavioral challenges
to individuals. The stories are used to
allow an individual to examine <strong>the</strong> sequence
of events leading up to a challenging situation,
and <strong>the</strong>n follow a strategy for resolving it
(Gray, 2000). These stories were originally developed
as a means for improving <strong>the</strong> social
understanding of students with autism spectrum
disorders when faced with challenging
events (Gray & Garand, 1993), and guidelines
for <strong>the</strong>ir development and use have been advocated.
These guidelines include a typology
of social story sentence structures and directions
governing <strong>the</strong> ratio of sentence types.
Despite <strong>the</strong>ir popularity in practice, <strong>the</strong> empirical
evidence to support <strong>the</strong> use of social
stories is limited (Delano & Snell, 2006; Sansosti
& Powell-Smith, 2004). Many claims of
success have relied on anecdotal reports, and
little evidence exists to support <strong>the</strong> guidelines
and directions for <strong>the</strong>ir development. Currently,
<strong>the</strong> strongest empirical support for social
stories involves <strong>the</strong>ir use with children
with autism and Asperger syndrome, and generally
has been limited to behavior management
outcomes (Bledsoe, Myles, & Simpson,
2003; Ivey, Heflin, & Alberto, 2004; Kuttler,
Myles, & Carlson, 1998; Swaggart et al., 1995).
Only two published reports exist that extend
social stories to populations not on <strong>the</strong>
autism spectrum. In <strong>the</strong> first, a case study,
Moore (2004) used a social story intervention
for a 4-year old boy with learning disabilities
who had problems sleeping. The boy would
only sleep in his parents’ room with his
mo<strong>the</strong>r, took up to two hours to fall asleep,
woke several times during <strong>the</strong> night to demand
milk, and woke very early each morning.
If any of <strong>the</strong>se demands were not met, <strong>the</strong>
result was a tantrum of screaming and aggressive
behavior. A social story was written to
outline a new bedtime routine and explain
<strong>the</strong> positive consequences (a sticker for each
“good night”) for cooperation. Stickers could
be traded in for a visit to <strong>the</strong> treat box. Anecdotal
results indicated that <strong>the</strong> child accepted
<strong>the</strong> new sleep arrangements with little difficulty.
In <strong>the</strong> second report, Toplis and Hadwin
(2006) expanded <strong>the</strong> use of social stories
to five students not identified as having any
disability. The youngsters displayed challenging
behavior during lunchtime. The research-
ers used an ABAB design to evaluate a social
story using Gray’s (2000) basic sentence ratio
on entering and taking a seat in school cafeteria
within two minutes of being dismissed
from class. This study found social stories to
be effective for three out of <strong>the</strong> five children
who participated in <strong>the</strong> study.
If social stories and o<strong>the</strong>r LBBIs are indeed
an effective tool for individuals with o<strong>the</strong>r
types of disabilities (including learning, emotional,
cognitive, and language disabilities) in
a wide variety of situations (Gray, 1995), <strong>the</strong>n
a research base of effective demonstrations is
needed. The purpose of this study was to expand
<strong>the</strong> research on <strong>the</strong> use of social stories
and Literacy-Based Behavioral Interventions.
Two separate studies were conducted. Experiment
One addressed <strong>the</strong> following two research
questions: 1) Will a social story intervention
improve work behavior for employees
with mental retardation or o<strong>the</strong>r developmental
disabilities? and 2) Will a social story intervention
have any impact on <strong>the</strong> participants’
co-workers in close proximity?
The research question for Experiment Two
was: Will a Literacy-Based Behavioral Intervention
reduce <strong>the</strong> level of prompting needed to
improve <strong>the</strong> work behavior of an employee
with mental retardation?
Experiment One
Method
Participants
Two women with mental retardation participated
in Experiment One. These women were
selected from a pool of 10 employees who
were nominated by a supervisor based on having
work related skill deficits. Criteria for participation
included: (a) need for skill improvement
in at least one critical employment
behavior, (b) willingness to participate, (c)
ability to discuss <strong>the</strong> content of a work-related
story and demonstrate <strong>the</strong> targeted behavior,
(d) written diagnosis of mental retardation,
(e) employment for a minimum of five hours
per day, and (f) regular work attendance.
Ruby and May were 48 and 26 years old
respectively. Ruby had worked at <strong>the</strong> job site
for 18 years, had a recorded IQ of 29, and
Literacy-Based Behavioral Interventions / 487

took Depakote daily. May had two years work
experience at <strong>the</strong> site, had a recorded IQ
below 59, and took no medication. Nei<strong>the</strong>r
participant could read, however, both could
print <strong>the</strong>ir first names. Both women could
recognize some letters of <strong>the</strong> alphabet.
Two co-workers in closest proximity to Ruby
and May also were observed. Jay was Ruby’s
nearest co-worker, and sat diagonally across
<strong>the</strong> work table from her. Jay was a 48 year old
woman with mental retardation and a physical
impairment which impaired her ability to
walk. Winnie was May’s closest co-worker, and
sat directly across from May at <strong>the</strong> work table.
Winnie was 46 years old and also was diagnosed
with mental retardation. Both worked
at <strong>the</strong> workshop for at least 11 years.
Setting
Ruby, May, Jay, and Winnie were employed 7
hours per day in a sheltered work setting.
Their employment consisted of mass mailings
or assembling products, and <strong>the</strong>y were paid
for each item <strong>the</strong>y completed. Ruby and May
both worked in <strong>the</strong> same large workroom, but
at separate tables, with a different work supervisor
assigned to each table. When <strong>the</strong> social
story intervention was implemented, it was
done in a separate area located approximately
200 feet from <strong>the</strong>ir work table. This private
location allowed <strong>the</strong> story to be read and discussed
without distraction.
Task Selection
The Jobs Observation and Behavior Scale
(JOBS) (Rosenberg & Brady, 2000) was administered
by a work supervisor to select employment
skills for improvement. Ruby and
May earned <strong>the</strong>ir lowest Quality of Performance
scores on <strong>the</strong> JOBS’ Work-Related Behavior
subscale. The Quality of Performance scale
ranges from 1-5, where 1 indicates that <strong>the</strong>
performance is not acceptable for competitive
employment, and 5 indicates that <strong>the</strong> performance
is superior. Four of nine items on this
subscale earned ratings of two or below for
Ruby, and five of May’s items earned this rating.
Based on <strong>the</strong> JOBS ratings, consultation
with <strong>the</strong> work supervisor, and direct observation,
<strong>the</strong> skill selected for <strong>the</strong> social story in-
tervention for Ruby and May was Requesting
Additional Materials or Supplies.
Behavioral Measures
Three dependent variables were selected for
each employee. Making a Request was identified
as <strong>the</strong> primary dependent variable for
both Ruby and May. Making a Request was defined
as verbalizing a direct, specific question
or statement to <strong>the</strong> table supervisor related to
(a) requesting assistance (e.g., “Can you help
me?”), (b) asking for more supplies or materials
(e.g., “I need more boxes”), (c) asking
for a break (e.g., “Can I go to <strong>the</strong> bathroom?”),
or (d) when <strong>the</strong> employee gestured
to <strong>the</strong> table supervisor for assistance or attention.
Data also were collected on two o<strong>the</strong>r behaviors:
Peer Interactions and Work Engagement.
Both of <strong>the</strong>se behaviors were recorded to determine
whe<strong>the</strong>r demonstrating initiative at
work might affect o<strong>the</strong>r related behaviors. Peer
Interactions were defined as any socially appropriate
participant interaction with ano<strong>the</strong>r
employee. This included initiating or responding
to o<strong>the</strong>r employees verbally or physically
(e.g., tapping someone’s shoulder,
handing materials to a co-worker, speaking to
a co-worker). Work Engagement was defined as
any independent or cooperative work on an
assigned task, while actively using <strong>the</strong> materials
required for <strong>the</strong> work task. This included
touching and manipulating <strong>the</strong> materials necessary
to complete <strong>the</strong> task.
Data Collection
488 / Education and Training in Developmental Disabilities-December 2008
A partial interval recording system was used to
collect data on Peer Interactions, Work Engagement,
and Making a Request. A 15-minute observation
session was established during which
observers recorded whe<strong>the</strong>r or not Ruby, May,
and <strong>the</strong>ir co-workers displayed any of <strong>the</strong> target
behaviors. Participants were observed for
10 seconds, followed by an additional 10 seconds
to record <strong>the</strong> observations. For <strong>the</strong> code
Making a Request, observers recorded each occurrence
of a request. Resulting data produced
a record of <strong>the</strong> number and percent of
intervals during which Peer Interactions and
Work Engagement were observed, and a total
frequency of all Requests. Data on Making a

TABLE 1
Interobserver Agreement Results in Experiment One
Request were converted to “rate of requests” by
dividing <strong>the</strong> number of requests by <strong>the</strong> total
time in which <strong>the</strong> behavior was observed.
Data for <strong>the</strong> co-workers were collected in
<strong>the</strong> same manner as for Ruby and May. Jay was
simultaneously observed with Ruby during <strong>the</strong>
observation sessions. Winnie was simultaneously
observed with May during her observation
sessions. Both co-workers were observed
on every session.
Interobserver agreement. An investigator and
a graduate student in special education served
as <strong>the</strong> observers. Both observers were trained
to collect data by observing workers at a university
library. Observations began only when
both observers reached at least 80% agreement
on each behavior code. During <strong>the</strong>
study, <strong>the</strong> agreement checks were conducted
with both observers standing behind and to
<strong>the</strong> side of <strong>the</strong> employees. This allowed <strong>the</strong>
observers to hear <strong>the</strong> recorded prompts to
look and record, but assured that <strong>the</strong>ir data
collection sheets were not observable to one
ano<strong>the</strong>r.
Interobserver agreement for Work Engagement
and Peer Interactions was calculated by
totaling <strong>the</strong> number of intervals in which both
Baseline Intervention Follow-Up
Ruby
Peer Interaction
Mean 96% 95% 100%
Range (89–100%) (86–100%) NA
Work Engagement
Mean 80% 97% 100%
Range (80–100%) (93–100%) NA
Requests
Mean 100% 92% 100%
Range NA (67–100%) NA
May
Peer Interaction
Mean 95 92% NA
Range (80–100%) (75–100)
Work Engagement
Mean 92% 97% 100%
Range (78–100%) (94–100%) NA
Requests
Mean 100% 100% NA
Range NA NA
observers recorded <strong>the</strong> target behavior, dividing
that total by disagreements plus agreements,
and multiplying <strong>the</strong> result by 100
(Kennedy, 2005). Interobserver agreement
for Making a Request was calculated by comparing
each request occurrence, dividing <strong>the</strong>
agreements by <strong>the</strong> disagreements plus agreements,
and multiplying <strong>the</strong> result by 100
(Kennedy). This resulted in an exact agreement
score for <strong>the</strong> frequency of requests.
Agreement checks were conducted for 40% of
Ruby’s sessions, and 42% of May’s sessions.
The mean agreement across all participants
and all behavior codes was 95%. A summary of
<strong>the</strong> interobserver agreement for each dependent
variable is presented in Table 1.
Experimental Procedures
Experiment One consisted of four phases.
The first phase included participant selection,
pre-assessment, task selection, and creation of
<strong>the</strong> data collection system. The second phase
included baseline. During baseline, participants
continued <strong>the</strong>ir daily work routines
without any intervention or direction o<strong>the</strong>r
than those which had been provided prior to
Literacy-Based Behavioral Interventions / 489

this experiment. During this phase individual
social stories were prepared for each participant.
The social stories for Ruby and May were
written following Gray’s (2000) proscribed
sentence ratio, and were within <strong>the</strong> employees’
levels of listening comprehension. Unlike
<strong>the</strong> line drawing illustrations advocated by
Gray, Ruby and May’s social stories included
interspersed photographs depicting <strong>the</strong>m and
<strong>the</strong>ir co-workers engaged in work behavior, or
requesting more work. The photographs also
depicted <strong>the</strong>ir supervisors showing approval
of <strong>the</strong>ir positive work behavior. Ruby’s social
story consisted of six descriptive sentences,
two perspective sentences and two directive
sentences. May’s social story contained nine
descriptive sentences, one perspective sentence,
and two directive sentences. Social stories
were created in a book format with one or
two sentences, and one or more photographs
on each page.
The third phase, delivery of <strong>the</strong> social story
intervention, was implemented independently
for Ruby and May. During <strong>the</strong> intervention a
personalized social story was read to <strong>the</strong> employees
by an investigator. After reading <strong>the</strong>
story <strong>the</strong> employee and investigator discussed
<strong>the</strong> story, and <strong>the</strong> employee was asked to
model <strong>the</strong> target skills. Each employee <strong>the</strong>n
returned to <strong>the</strong>ir assigned work station and
asked to complete <strong>the</strong>ir work. At this time <strong>the</strong>
observer(s) began <strong>the</strong> observation session.
The fourth phase included follow-up observations
to determine whe<strong>the</strong>r <strong>the</strong> primary target
behavior, Making a Request, had been
maintained once <strong>the</strong> story was no longer read
to <strong>the</strong> women. The follow-up observations occurred
10 and 11 weeks after <strong>the</strong> social story
intervention had been removed for Ruby, and
6, 9, 10, and 11 weeks after <strong>the</strong> social story
intervention had been removed for May.
Experimental Design
A multiple baseline design across participants
was used to evaluate <strong>the</strong> effects of <strong>the</strong> social
story intervention on <strong>the</strong> work behavior of
both employees. Baseline data for Ruby were
collected until <strong>the</strong> social story intervention
was implemented on session 7. On session 20
Ruby’s intervention was withdrawn and follow-up
observations were made to assess potential
maintenance. For May, baseline data
were collected until <strong>the</strong> social story intervention
was implemented on session 11. May’s
intervention was withdrawn on session 24.
Results
490 / Education and Training in Developmental Disabilities-December 2008
Figure 1 depicts <strong>the</strong> rate of requests made by
each employee, and shows <strong>the</strong> direct effect of
<strong>the</strong> social story intervention. Figure 2, <strong>the</strong> employees’
Work Engagement and Peer Interactions,
shows <strong>the</strong> extended impact of <strong>the</strong> intervention
and requests on <strong>the</strong> two additional target
behaviors. Comparing <strong>the</strong> information on
both figures demonstrates <strong>the</strong> cumulative impact
of <strong>the</strong> intervention on work engagement
and productivity.
Figure 1: Request rates. The top graph in
Figure 1 shows <strong>the</strong> rate of requests for Ruby,
<strong>the</strong> first employee to receive <strong>the</strong> social story
intervention. During baseline, Ruby seldom
requested work or materials (.13 requests per
minute to no requests at all). When <strong>the</strong> intervention
was introduced, Ruby’s request rate
increased immediately. Throughout <strong>the</strong> intervention,
her requests were variable but substantially
increased; on 12 of 13 days of intervention,
Ruby’s request rate was consistently at
.4 per minute or higher. On <strong>the</strong> two observations
after <strong>the</strong> intervention was removed, Ruby’s
rate of requests again varied from .93 on
<strong>the</strong> first follow-up day to .13 on <strong>the</strong> second
day.
May’s request rate (bottom graph in Figure
1) during baseline ranged from a high of .27
requests per minute to a low of zero. When
<strong>the</strong> social story intervention was applied,
May’s requests increased immediately. On 6 of
13 days May made at least .48 requests per
minute, and on <strong>the</strong> remaining days her request
rate equaled her highest rates during
baseline. During <strong>the</strong> follow-up observations
after <strong>the</strong> intervention was removed, May’s rate
of requests ranged from 0 to .67.
Figure 2: Work engagement and peer interactions.
To understand <strong>the</strong> effect of <strong>the</strong> social story
intervention more fully it is necessary to examine
two o<strong>the</strong>r variables: Work Engagement
and Peer Interactions. The top graph in Figure 2
shows <strong>the</strong> Work Engagement and Peer Interactions
for Ruby. During baseline, Ruby’s work engagement
was uniformly low (zero work on
three of <strong>the</strong> six days). When <strong>the</strong> intervention
was provided, Ruby’s work engagement in-

creased steadily and dramatically, and remained
high during <strong>the</strong> follow-up observations
(96% and 100% engagement). The
social story intervention had an opposite effect
on her peer interactions. During baseline,
Ruby’s interactions with co-workers was quite
variable (2% to 38%), but remained at or
Figure 1. Making a request.
above 27% on three of <strong>the</strong> six baseline days.
When <strong>the</strong> intervention was introduced, Ruby’s
peer interactions gradually and steadily
dropped, and remained at or below 13% on
10 of <strong>the</strong> 13 days. Her interaction level remained
low during <strong>the</strong> follow-up observation
(7% and 2%).
Literacy-Based Behavioral Interventions / 491

May’s work engagement (bottom graph in
Figure 2) showed substantial variability during
baseline (0 to 73%). On five out of 10 baseline
Figure 2. Work engagement and peer interactions.
492 / Education and Training in Developmental Disabilities-December 2008
days, May’s work engagement was below 25%,
and on 8 days her work engagement was below
50%. After <strong>the</strong> social story intervention was

introduced, May’s work engagement remained
at 78% or higher for all but one day,
and on 8 of <strong>the</strong> 13 days she was engaged in
work at least 90% of <strong>the</strong> time. This increased
work engagement maintained during <strong>the</strong> follow-up
observations (at or above 93% on all
four days). Like Ruby, <strong>the</strong> intervention had an
opposite effect on May’s interactions with
peers. Although her baseline interactions were
variable (0 to 73%), her interaction reached or
exceeded 16% on five of 10 baseline. When <strong>the</strong>
intervention was provided, May’s interactions reduced
substantially, with interactions at or below
4% on 10 of <strong>the</strong> 13. During <strong>the</strong> follow-up sessions
May interacted with her co-workers between
0 and 20% of <strong>the</strong> time.
Taken toge<strong>the</strong>r, results shown in Figure 1
and Figure 2 indicate that when <strong>the</strong> social
story intervention was introduced each employee
showed a marked improvement in
<strong>the</strong>ir work behavior. As each employee’s requests
for work, assistance, or materials increased,
<strong>the</strong> percentage of Work Engagement
also increased. Fur<strong>the</strong>rmore, as <strong>the</strong> Work Engagement
and Requests increased, <strong>the</strong> Peer Interactions
reduced substantially.
Impact co-workers. Although <strong>the</strong> social story
interventions did not include Ruby and May’s
co-workers, nor did <strong>the</strong> co-workers receive any
part of <strong>the</strong> intervention, <strong>the</strong>ir Work Engagement
and Peer Interactions were observed to assess any
potential extended effects from <strong>the</strong> changes in
Ruby and May. Results of <strong>the</strong> observations of <strong>the</strong>
co-workers are found in Table 2.
During Ruby’s baseline, her closest coworker,
Jay, engaged in work just over 25% of
<strong>the</strong> time. Jay increased her work to more than
55% when <strong>the</strong> intervention was implemented
with Ruby, and yielded 100% engagement
during Ruby’s follow-up session. Ruby’s intervention
had an opposite effect on Jay’s interactions
with co-workers. During Ruby’s baseline,
Jay interacted with her co-workers an average of
3% each day. This level of interaction decreased
to near zero when <strong>the</strong> intervention was implemented
for Ruby. She did not interact with coworkers
at all during Ruby’s follow-up.
A similar pattern was seen with Winnie, May’s
co-worker. During May’s baseline, Winnie’s average
work engagement was 56.3%. When <strong>the</strong>
intervention was implemented with May, Winnie
increased her Work Engagement to 95.3%,
and averaged 100% during May’s follow-up.
TABLE 2
Impact of Ruby and May’s Changes on Co-
Workers
Like Jay, Winnie also decreased her interactions
with co-workers from 1.6% to .4% corresponding
to May’s baseline and social story interventions.
Her interactions with co-workers increased,
however, during May’s follow-up
observations (4.5%).
Summary: Experiment One
Baseline Intervention Follow-Up
Jay (Ruby’s co-worker)
Peer Interactions
Mean 3% .2% 0%
Range 0–7% 0–2% N/A
Work Engagement
Mean 25.5% 55.6% 100%
Range 0–98% 0–100% N/A
Winnie (May’s co-worker)
Peer Interactions
Mean 1.6% .4% 4.5%
Range 0–13% 0–5% 2–7%
Work Engagement
Mean 56.6% 95.3% 100%
Range 11–100% 64–100% N/A
The specific goal of Experiment One was to
determine whe<strong>the</strong>r <strong>the</strong> Literacy-Based Behavioral
Intervention, specifically a social story
would increase Ruby and May’s requests for
work, and if so, whe<strong>the</strong>r <strong>the</strong>re would be any
fur<strong>the</strong>r impact on <strong>the</strong>ir actual work engagement,
or reduction in <strong>the</strong>ir interactions with
co-workers. Additionally Experiment One explored
<strong>the</strong> potential impact of <strong>the</strong> intervention
and <strong>the</strong> increases in Ruby and May’s work
behavior, on co-workers in close proximity.
Results showed that Ruby and May’s requests
for work, and <strong>the</strong>ir actual work behavior, increased
significantly. Results also showed that
<strong>the</strong>ir interactions with co-workers, a variable
reported by <strong>the</strong>ir supervisors as interfering
with <strong>the</strong>ir work, reduced as <strong>the</strong>ir work engagement
increased. Both women had been nominated
for this study by <strong>the</strong>ir work supervisors
because when <strong>the</strong>y were not actively engaged
in work, <strong>the</strong>y would wander off, distract o<strong>the</strong>r
employees, daydream, and at times became
argumentative. Increasing <strong>the</strong>ir work engagement
reduced helped to reduce <strong>the</strong>se prob-
Literacy-Based Behavioral Interventions / 493

lems with co-workers. Finally, <strong>the</strong> LBBI also
had an impact on <strong>the</strong> work engagement and
peer interactions of Ruby and May’s co-workers
in closest proximity. As Ruby and May
increased <strong>the</strong>ir work productivity and decreased
<strong>the</strong>ir interaction with co-workers, <strong>the</strong>
co-workers also increased <strong>the</strong>ir productivity.
Although <strong>the</strong> results of Experiment One
were quite positive, <strong>the</strong>y also led to new questions.
While both employees had significant
cognitive disabilities, both were able to communicate
fluently with co-workers and supervisors,
and were familiar with written language
(although nei<strong>the</strong>r could actually read). To
extend <strong>the</strong> intervention to people with more
significant disabilities, it seemed apparent that
significant alterations in <strong>the</strong> design of <strong>the</strong> intervention
would be needed to respond to
more complex language and cognitive characteristics.
Therefore, Experiment Two was implemented
to extend <strong>the</strong> intervention to ano<strong>the</strong>r
employee with more complex
disabilities, and with o<strong>the</strong>r employment challenges
including a high need for prompts. In
addition, in Experiment Two, <strong>the</strong> ratio and
design of <strong>the</strong> literacy-based intervention were
modified substantially from <strong>the</strong> formula and
guidelines advocated by Gray (2000).
Experiment Two
Method
Participant
Lou, a 57 year old man with Down syndrome,
was selected to participate in Experiment
Two. Lou had worked at <strong>the</strong> job site for 4
years, and had a recorded IQ of 30. He did not
take any regular medication. Lou was able to
recognize his first name in print, print his first
name and last initial, identify 12 letters of <strong>the</strong>
alphabet, and name 9 different numerals. Lou
communicated in one, two, and three word
utterances, many of <strong>the</strong>m short phrases he
used repeatedly for different situations. Lou
was selected from a pool of four employees
who were nominated by a work supervisor as
most in need of support for <strong>the</strong>ir employability
challenges. Criteria for participation included:
(a) need for skill improvement in at
least one critical employment behavior, (b)
willingness to participate, (c) ability to respond
to <strong>the</strong> content of a work-related story
and demonstrate <strong>the</strong> targeted behavior, (d)
written diagnosis of severe mental retardation,
(e) employment for a minimum of five hours
per day, and (f) regular work attendance.
Setting
Lou worked in a sheltered work setting with
vocational training programs in culinary production,
mailroom skills, custodial management,
and computer data entry. Lou worked
in a mailroom training area with two supervisors.
The LBBI was provided to Lou in a private
location in <strong>the</strong> cafeteria near <strong>the</strong> mailroom.
In addition, Lou took his morning
break in that cafeteria, and ate lunch in a
separate break room. On some days Lou
would take his morning break and lunch outside
at a picnic table. All of <strong>the</strong>se locations
were within 300 yard of <strong>the</strong> mailroom.
Task Selection
As in Experiment One, a work supervisor administered
JOBS to select employment skills
for improvement. Lou scored low in all <strong>the</strong>
JOBS’ subscales categories, with Quality of Performance
scores of 2 or below on 8 of 13 Work-
Required Daily Living Activities items, 9 of 9
Work-Required Job Duties items, and 2 of 8
Work-Required Behavior items. Based on <strong>the</strong>
JOBS’ results, workroom supervisor recommendation,
and through observation, Returning
to Work at a more independent level after
morning and lunch breaks was identified as
<strong>the</strong> target work behavior for Lou.
Behavioral Measures
494 / Education and Training in Developmental Disabilities-December 2008
Returning to Work was defined as Lou leaving
<strong>the</strong> break or lunch area, walking to his mailroom,
and entering <strong>the</strong> room. The length of
time in minutes to return to work from <strong>the</strong>
break area also was recorded. Third, <strong>the</strong>
prompt level necessary to get Lou to return to
work was recorded. The following prompt hierarchy
was established to determine Lou’s
level of independence when returning to
work: (a) Independent Return to Work, (b) Social
Return to Work, (c) Verbal Prompt, (d) Physical
Prompt, and (e) Escorted Return. AnIndependent

Return to Work was defined as Lou cleaning up
from his break, leaving <strong>the</strong> break room, and
returning to his work table in <strong>the</strong> mailroom
without a co-worker or supervisor providing
him with any type of prompt to do so. Social
Return to Work was defined as Lou returning to
work along with one or more co-workers or
supervisor in a social context, but without
prompts to do so. A Social Return could include
verbal interactions or walking along
with co-workers or supervisors, in a social context,
but without any direct or indirect
prompts to return to work. Verbal Prompts were
defined as any direct statement by a co-worker
or supervisor to Lou telling him to return to
work (e.g., “Lou, break is over, get back to
work” or “Lou, it is time to go back to work”).
Physical Prompts were defined as a co-worker or
supervisor physically touching or directing
Lou for an intermittent period of time to assist
him to return to work. This included pulling
his arm or hand, pushing his shoulder, or
tugging on his shirt. Escorted Return was defined
as Lou being taken back to work continuously
by a supervisor or co-worker. Escorted
returns frequently included verbal, and at
times physical prompts.
Data Collection
Lou was required to return to work from
break at 10:30 am and from lunch at 12:00
pm. Observations started three minutes prior
to, and 15 minutes after Lou was scheduled to
be back at work. Two data collection systems
were employed. First, <strong>the</strong> frequency of each
type of prompt given to Lou was recorded.
Second, a latency system was used to record
<strong>the</strong> number of seconds Lou returned late
from his breaks. A digital watch which displayed
<strong>the</strong> time with seconds was used to
record <strong>the</strong> time Lou entered his mailroom
following <strong>the</strong> end of break or lunch. If <strong>the</strong>
time exceeded 15 minutes past <strong>the</strong> required
time, <strong>the</strong> observation was stopped, and <strong>the</strong>
observer recorded <strong>the</strong> time as 15 minutes.
Interobserver agreement. Agreement checks
were conducted for Lou on 38% of <strong>the</strong> observation
sessions. An investigator and a second
employee with mild mental retardation at <strong>the</strong>
work site collected all data. This individual
worked as part of <strong>the</strong> environmental staff at
<strong>the</strong> site, and at a local science museum as a
TABLE 3
Interobserver Agreement Results in Experiment
Two
Baseline Intervention
Morning Break
Social Return
Mean NA 50%
Range (0–100%)
Verbal Prompt
Mean 94% 100%
Range (83–100%)
Physical Prompt
Mean 100% NA
Escorted Return
Mean 100% NA
Lunch
Social Return
Mean NA 100%
Verbal Prompt
Mean 90% 88%
Range (80–100%) (75–100%)
Physical Prompt
Mean 50% NA
Escorted Return
Mean 100% NA
guide for children who visited <strong>the</strong> museum.
Observer training and practice was conducted
prior to <strong>the</strong> study until observers reached 90%
agreement or better on <strong>the</strong> codes. During <strong>the</strong>
study, <strong>the</strong> two observers stood or sat several
feet away from Lou during each break period
to allow <strong>the</strong>m to hear any comments made by
co-workers or supervisors with respect to returning
to work. Observers maintained a relatively
close proximity, but were positioned so
<strong>the</strong> individual data collection sheets were not
observable to one ano<strong>the</strong>r.
Agreement on <strong>the</strong> level of prompts was calculated
by totaling <strong>the</strong> number of sessions in
which both observers recorded a target behavior,
dividing <strong>the</strong> total by disagreements plus
agreements, and multiplying <strong>the</strong> result by 100.
Agreement on time late to work was calculated
by dividing <strong>the</strong> smaller amount of time by <strong>the</strong>
larger amount of time, and multiplying by 100
(Kennedy, 2005). Overall agreement on combined
codes was 90 %. Interobserver agreement
results for specific codes are summarized
in Table 3.
Literacy-Based Behavioral Interventions / 495

Experimental Procedure
Experiment Two consisted of five phases. The
first phase included participant selection, preassessment,
task selection, and creation of <strong>the</strong>
data collection system. The second phase included
baseline. During baseline, data were
collected while Lou continued his daily break
routines with his typical levels of prompting
from supervisors or co-workers; no intervention
was in place. An individual story for <strong>the</strong>
behavior Return to Work was written, but not
delivered, during this time. Lou’s story varied
substantially from Gray’s (2000) guidelines in
several ways. First, his story included second
and third person directive sentences. In addition,
<strong>the</strong> ratio of sentence types differed from
Gray’s guidelines (7 directive sentences, 5 descriptive
sentences, and one perspective sentence).Third,
his story was created in a book
format with one to three sentences and a photograph
on each page. Finally, <strong>the</strong> story was
written to provide Lou with practice opportunities
where he acted out <strong>the</strong> process of cleaning
up from break and returning to <strong>the</strong> mailroom
in a timely manner.
The third phase of Experiment Two included
delivery of <strong>the</strong> LBBI intervention. During
<strong>the</strong> intervention, experimental procedures
were implemented independently for
each break period. Each day Lou was accompanied
to <strong>the</strong> cafeteria where his personalized
story was read to him prior to <strong>the</strong> break period.
Lou <strong>the</strong>n proceeded to his break. Three
minutes prior to <strong>the</strong> end of <strong>the</strong> break period
<strong>the</strong> observations began as described previously.
During <strong>the</strong> fourth phase, <strong>the</strong> intervention
was withdrawn for two days. Lou was not
read his story, and he proceeded to each
break period as he had during <strong>the</strong> first baseline
phase. During <strong>the</strong> final phase, Lou’s story
intervention was re-introduced. Lou was again
accompanied to <strong>the</strong> break room to hear his
story.
Experimental Design
A multiple baseline design across break periods
(Morning and Lunch Breaks) was used to
evaluate <strong>the</strong> effects of <strong>the</strong> intervention on
Lou’s return to work, and <strong>the</strong> level of prompting
necessary for him to return. In addition to
<strong>the</strong> multiple baseline, a simultaneous with-
drawal of <strong>the</strong> intervention was applied to evaluate
whe<strong>the</strong>r removing <strong>the</strong> story intervention
would result in (a) a decrease in Lou’s independence
(i.e., an increase in prompt level),
or (b) an increase in <strong>the</strong> lateness of his return
to work. Finally, a re-introduction of <strong>the</strong> story
intervention was applied to replicate <strong>the</strong> effects
of <strong>the</strong> intervention.
Results
496 / Education and Training in Developmental Disabilities-December 2008
Prompt levels. The top graph in Figure 3
represents level of prompts needed by Lou to
return from <strong>the</strong> Morning Break period. During
<strong>the</strong> first baseline, Lou did not return to
work within <strong>the</strong> 15 minute time period on one
day, and required an escort to return on <strong>the</strong>
o<strong>the</strong>r three days. When <strong>the</strong> story intervention
was introduced, Lou required only verbal
prompts to return to work from <strong>the</strong> Morning
Break. When <strong>the</strong> intervention was withdrawn
on sessions 14 and 15, Lou required an escort
on both days to return to work. Finally, when
<strong>the</strong> intervention was re-introduced on session
16, Lou required prompts on two of four days,
and made a social return to <strong>the</strong> mailroom with
his co-workers on two o<strong>the</strong>r days.
The bottom graph in Figure 3 represents
<strong>the</strong> level of prompts Lou needed to return
from his Lunch breaks. During baseline, Lou
required an escort to return to work on four
days. On four o<strong>the</strong>r days, Lou did not return
to work from lunch within <strong>the</strong> 15 minute time
period. When <strong>the</strong> story intervention was introduced,
Lou returned to work with only verbal
prompts on four days, and independently returned
on one day. During <strong>the</strong> two-day withdrawal,
Lou did not return to work within <strong>the</strong>
15 minute time period. Finally, when <strong>the</strong> story
intervention was re-introduced, Lou returned
to work from lunch with verbal prompts on
two days. On <strong>the</strong> remaining days, he returned
with peers or independently.
Timely returns. Figure 4 represents <strong>the</strong>
number of minutes that Lou was late in returning
to work. The top graph shows Lou’s
returns from his Morning Break. During baseline
Lou always returned late, although <strong>the</strong>re
was wide variability, and a high level of
prompting (including returning with an escort
When <strong>the</strong> intervention was provided, Lou’s
lateness to work showed a substantial decline.
On <strong>the</strong> last two days of this intervention, Lou

Figure 3. Level of prompt required for Lou to return to work.
was less than one minute late returning to
work from his Morning Break. When <strong>the</strong> in-
tervention was withdrawn, Lou was over nine
minutes late, and required an escort to return
Literacy-Based Behavioral Interventions / 497

Figure 4. Minutes late returning to work following break.
498 / Education and Training in Developmental Disabilities-December 2008

on both days. Finally, when <strong>the</strong> intervention
was re-introduced, Lou’s tardy return again
decreased substantially.
The bottom graph included in Figure 4 represents
Lou’s late returning to work from his
Lunch break. During baseline Lou was not
late on one occasion, and on that day he was
escorted back to work; on four days Lou failed
to return to work from his lunch break within
<strong>the</strong> 15 minute time period. When <strong>the</strong> intervention
was provided, Lou’s lateness declined,
substantially. During <strong>the</strong> withdrawal, Lou
failed to return to work from Lunch on both
days. When <strong>the</strong> story intervention was re-introduced,
Lou was only late on one day, and was
actually early on <strong>the</strong> final two days of <strong>the</strong>
study.
Summary: Experiment Two
The specific goal of Experiment Two was to
determine whe<strong>the</strong>r a LBBI would reduce
Lou’s needs for prompts to return to <strong>the</strong> mailroom
from his break periods. It also evaluated
whe<strong>the</strong>r or not <strong>the</strong> intervention would have
an impact on how late Lou was in returning to
work after his morning and lunch break periods.
Unlike <strong>the</strong> previous work in <strong>the</strong> area, <strong>the</strong>
intervention differed substantially from <strong>the</strong>
structure and format for social stories advocated
by Gray (2002). Results showed that an
LBBI, structured to accommodate an employee’s
significant cognitive and language impairments,
can be useful in reducing prompt dependence
and increasing a timely return to
work.
Discussion
The purpose of this study was to examine <strong>the</strong>
effects of LBBIs on <strong>the</strong> work behavior of employees
with developmental disabilities. LBBIs
were effective in changing <strong>the</strong> work behavior
of <strong>the</strong> three employees with moderate to severe
mental retardation. For <strong>the</strong> two employees
where follow-up data were collected, maintenance
of <strong>the</strong> behavior changes was
observed.
For Ruby and May, <strong>the</strong> participants in <strong>the</strong>
first experiment, an increase in <strong>the</strong>ir rate of
making requests were seen with <strong>the</strong> introduction
of <strong>the</strong> intervention. Ruby’s rate of requests
reached a high of 1.2 per minute on
one day of <strong>the</strong> intervention and was at an
overall high of .4 per minute on 12 out of <strong>the</strong>
13 intervention days. May’s rate of requests
increased to a high of .67 per minute on one
day of <strong>the</strong> intervention and was at .48 per
minute on almost half (6 out of 13) of <strong>the</strong>
intervention days. These results have greater
impact when examined in conjuncture with
<strong>the</strong> two o<strong>the</strong>r variables: work engagement and
peer interactions. Ruby’s level of work engagement
and peer interactions varied during <strong>the</strong>
baseline phase. The introduction of <strong>the</strong> social
story intervention resulted in a steady and
dramatic increase in work engagement to a
level of 100% on four of <strong>the</strong> 13 intervention
days. Ruby’s rate of peer interactions decreased
with <strong>the</strong> introduction of <strong>the</strong> intervention.
May’s level of work engagement increased
and her rate of peer interactions
decreased when <strong>the</strong> social story intervention
was in place. On eight out of <strong>the</strong> 13 days in
which <strong>the</strong> intervention was in place, May’s
work engagement was at or above 90%. May’s
peer interactions were at or below 4% on 10 of
<strong>the</strong> 13 intervention days.
Prior to <strong>the</strong> intervention, <strong>the</strong> supervisors for
Ruby and May indicated that <strong>the</strong>ir interactions
with co-workers were often a result of not
being engaged in <strong>the</strong>ir assigned work task.
The intervention taught <strong>the</strong>se two women to
be pro-active at <strong>the</strong>ir jobs by requesting more
work materials when necessary, <strong>the</strong>refore reducing
<strong>the</strong>ir need to interact with co-workers
as a way to keep busy.
The social story intervention also affected
<strong>the</strong> co-workers who worked in closest proximity
to Ruby and May. When <strong>the</strong> intervention
was implemented with Ruby and May, <strong>the</strong>
level of work engagement increased for both
Jay and Winnie while <strong>the</strong> level of peer interaction
decreased for both women.
A more directive LBBI was effective in decreasing
<strong>the</strong> level of prompts needed for Lou
to return to work after break on time. When
<strong>the</strong> intervention was in place, <strong>the</strong> highest level
of prompt required by Lou to return to work
following ei<strong>the</strong>r break was a verbal prompt.
Fur<strong>the</strong>rmore, on five occasions Lou returned
to work ei<strong>the</strong>r independently or socially with a
co-worker. The directive LBBI also reduced
<strong>the</strong> number of minutes that Lou was late in
returning to work, with Lou returning to work
Literacy-Based Behavioral Interventions / 499

from his lunch break early on <strong>the</strong> final two
days of Experiment Two.
This study was conducted in part to expand
<strong>the</strong> research on social stories and LBBIs to
o<strong>the</strong>r populations of people with disabilities,
specifically adults with developmental disabilities.
This study expands upon previous reports
by demonstrating <strong>the</strong> efficacy of <strong>the</strong> interventions
with adults, including those with
serious cognitive disabilities. The current
study also used LBBIs to increase participants’
work behavior (punctuality, making requests),
outcomes not explored previously in <strong>the</strong> social
story literature
An additional outcome of this study includes
<strong>the</strong> extended effects of <strong>the</strong> social story
intervention on <strong>the</strong> participants’ closest coworkers.
There have been numerous reports
that have implemented social stories in school
settings (Gray & Garand, 1993; Hagiwara &
Myles, 1999; Norris & Datillo, 1999) where
spread effects to peers might have produced
very positive outcomes. For example, numerous
students could benefit from learning
morning classroom routines (Gray & Garand),
increasing on-task behavior (Hagiwara
& Myles), or replacing inappropriate verbalizations
with positive peer interactions (Norris
& Dattilo). To date, however, none of <strong>the</strong>
social story investigations have examined <strong>the</strong>
impact of <strong>the</strong>se interventions on classmates or
peers. In <strong>the</strong> current study (Experiment
One), <strong>the</strong> participants’ co-workers (Jay and
Winnie) increased <strong>the</strong>ir work engagement by
at least 30% when <strong>the</strong> social story intervention
was in place for Ruby and May. Decreases in
<strong>the</strong>ir co-worker interactions were seen at <strong>the</strong>
same time. This outcome is an important extension
of this body of literature, and suggests
new directions for future studies as well.
The present study investigated whe<strong>the</strong>r LB-
BIs including social stories would improve <strong>the</strong>
work behavior of adult employees with developmental
disabilities, and whe<strong>the</strong>r any positive
effects might spread to co-workers in close
proximity. The results are quite encouraging,
and provide empirical support for LBBIs for
individuals with a range of learning and performance
problems in employment settings.
Additional applications, modified for different
populations including non-readers and individuals
with severe disabilities, indicate that
LBBIs are an important contribution in <strong>the</strong>
search for positive, effective, empirically-based
instructional strategies.
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Received: 25 April 2007
Initial Acceptance: 30 June 2007
Final Acceptance: 1 October 2007
Literacy-Based Behavioral Interventions / 501

Education and Training in Developmental Disabilities, 2008, 43(4), 502–513
© <strong>Division</strong> on Developmental Disabilities
Enhancing <strong>the</strong> Job Performance of Employees with
Disabilities Using <strong>the</strong> Self-Determined Career Development
Model
Patricia Devlin
University of Toledo
Abstract: The purpose of this study was to examine <strong>the</strong> impact of <strong>the</strong> Self-Determined Career Development Model
(SDCDM) on <strong>the</strong> job performance of four adults with moderate intellectual disabilities employed in competitive
work settings. Employees learned to set work-related goals, develop an action plan, implement <strong>the</strong> plan, and
adjust <strong>the</strong>ir goals and plans as needed. A multiple baseline design across employees was implemented. All four
participants achieved <strong>the</strong>ir self-selected goal at levels that exceeded <strong>the</strong>ir supervisor and job coach expectations.
Findings extend <strong>the</strong> current line of research utilizing <strong>the</strong> SDCDM and support <strong>the</strong> use of <strong>the</strong> model by personnel
providing support to individuals with disabilities in work settings.
For over a decade promoting <strong>the</strong> self-determination
of people with disabilities has greatly
impacted both practice and policy in <strong>the</strong> fields
of special education and adult service delivery
(Agran & Hughes, 2005). In both systems,
self-determination is viewed as a basic human
right promising that individuals can and
should exert control over <strong>the</strong>ir own lives.
There has been emerging evidence of <strong>the</strong> direct
relationship between enhanced self-determination
and positive adult outcomes in lives
of people with disabilities (Wehmeyer &
Schwartz, 1998; 1997). For example, a recent
investigation examining <strong>the</strong> impact of self-determination
on young people with disabilities
three years post graduation indicates that individuals
exhibiting high self-determination
fared better as adults than those with low selfdetermination
in many major life areas including
employment, access to health and
o<strong>the</strong>r benefits, financial independence, and
independent living (Wehmeyer & Palmer,
2003).
Self-determination has been defined as volitional
actions that enable one to act as <strong>the</strong>
Correspondence concerning this article should
be addressed to Patricia Devlin, The University of
Toledo, 2801 W. Bancroft Street, Mail Stop #954,
Toledo, OH 43606-7736. E-Mail: patricia.devlin@
utoledo.edu
502 / Education and Training in Developmental Disabilities-December 2008
primary causal agent in ones life and to maintain
or improve one’s quality of life (Wehmeyer,
2005). Experts in <strong>the</strong> field remind us
that all individuals, including those with significant
challenges, can become more selfdetermined
given <strong>the</strong> skills, opportunities and
necessary supports (Agran et al. 2005, Ward,
2005; Wehman, 2006; Wehmeyer). The literature
suggests that <strong>the</strong> role of educators in
enhancing self-determination is through
teaching youth with disabilities <strong>the</strong> knowledge
and skills related to component elements of
self-determined behavior (i.e. choice-making,
decision-making, problem-solving, goal-setting,
self-regulation). Although <strong>the</strong>re is consensus
in special education that promoting
<strong>the</strong>se elements is important, evidence exists
that self-determination has been given limited
instructional emphasis. Research indicates
that student IEP goals related to self-determination
are minimal or nonexistent (Agran,
Snow, & Swaner, 1999; Powers, Gil-Kashiwabara,
Powers, & Greenen, 2005; Wehmeyer
et al., 1998). Additionally, teachers report lack
of knowledge, training, and experience in
teaching self-determination skills (Mason,
Field, & Sawilowsky, 2004; Thoma,
Nathanson, Baker, & Tamura, 2002). Consequently,
many youth with disabilities are leaving
<strong>the</strong> educational system with little knowledge
or skills in obtaining <strong>the</strong> outcomes <strong>the</strong>y

desire in major life events such as employment
and independent living.
The importance of service providers promoting
self-determination to young adults
with disabilities post graduation is also reported
in <strong>the</strong> literature. There is growing evidence
in <strong>the</strong> field of vocational rehabilitation
(VR) that enhancing choice opportunities
leads to better VR-related outcomes. For example,
Farley, Bolton, and Parkerson (1992)
evaluated <strong>the</strong> impact of consumer choice
strategies and found that individuals who were
actively involved in VR planning enhanced
<strong>the</strong>ir vocational career development outcomes.
Similarly, an investigation compared
<strong>the</strong> costs, services and outcomes achieved for
people served through <strong>the</strong> typical VR system
and those involved in a “Consumer Choice
Demonstration Project” in Vermont (Hartnett,
Collins, & Tremblay, 2002). The Choice
group was two times more likely to have completed
rehabilitation and earned a mean income
that was 2.7 times higher. The literature
suggests that a major role of adult service
providers is to continue to foster self-determination
and self-advocacy skills to adult consumers
through education and training strategies
(Lamb, 2003).
The essence of self-determination is empowering
people by providing skill instruction
and practice so <strong>the</strong>y can obtain <strong>the</strong> outcomes
<strong>the</strong>y desire (Ward, 2005). A noteworthy model
has emerged both in <strong>the</strong> fields of special education
and adult service delivery for teaching
individuals a process in becoming causal
agents in <strong>the</strong>ir own lives. The Self-Determined
Learning Model of Instruction (SDLMI) was developed
for educators to teach students how
to become self-regulated problem solvers and
to self direct <strong>the</strong> instructional process toward
self-selected goals (Mithaug, Wehmeyer, Agran,
Martin, & Palmer, 1998). Students learn a
series of questions that form a problem solving
sequence: “What is my learning goal?”
“What is my plan?” and “What have I learned?”
Through a self-regulated learning process, students
are actively in control of <strong>the</strong>ir learning
from goal setting through evaluation. The
teaching model, based on component elements
of self-determination and principals of
self-regulated problem solving, has shown to
be effective in enabling students to gain educationally
valued goals and significantly en-
hance <strong>the</strong>ir self-determination (Agran, Blanchard,
& Wehmeyer, 2000; Wehmeyer,
Palmer, Agran, Mithaug, & Martin, 2000).
In recent years, <strong>the</strong> value of this model was
recognized by adult services. The SDLMI was
modified for Vocational Rehabilitation (VR)
personnel to use in supporting adults receiving
VR services. The Self-Determined Career Development
Model (SDCDM) is identical in organization
and function to <strong>the</strong> SDLMI however
focuses specifically on job and career related
goals for adults (Wehmeyer, Lattimore, Jorgenson,
Palmer, Thompson, & Schumaker,
2003). The model provides a framework for
teaching individuals to set career or job related
goals, develop action plans, solve problems,
and self-regulate <strong>the</strong>ir work behavior. A
pilot study utilizing <strong>the</strong> model involved five
adults seeking employment who were receiving
services from a VR counselor (Wehmeyer
et al.). Participant’s target goals were related
to improving social interactions with supervisors
and co-workers, ga<strong>the</strong>ring and responding
to job-related information leading to employment,
developing organization and time
management skills, and improving personal
presentation. Although action plan implementation
was limited to role-play or simulations,
positive increases toward goal attainment
was observed in four of <strong>the</strong> five adults.
The SDCDM enabled individuals to identify
meaningful goals for <strong>the</strong>mselves and take action
towards achieving <strong>the</strong>m. In turn, consumers
were able to achieve more positive VR
outcomes.
Participant outcomes are promising for use
of The Self-Determined Career Development Model
in adult service delivery, although application
in real-life settings is limited. In addition to
promoting greater consumer involvement in
job attainment, it is hypo<strong>the</strong>sized that <strong>the</strong>
model would also be an effective tool in enhancing
job performance after an individual
secured employment. The purpose of this
study was to extend <strong>the</strong> line of research utilizing
<strong>the</strong> SDCDM by examining <strong>the</strong> impact of
<strong>the</strong> model on <strong>the</strong> job performance of four
individuals recently employed in competitive
employment settings. The research was conducted
at a Midwestern university, which has a
unique program providing a comprehensive
approach to employment, job retention, and
career advancement for individuals with dis-
Enhancing Job Performance / 503

TABLE 1
Participant Characteristics
Employee Sex
abilities on <strong>the</strong> college campus (Project
SCOUT – Securing Career Opportunities at
<strong>the</strong> UT). The program has been in existence
for two years and offers customized job matching
and ongoing supports in collaboration
with community adult service agencies. At <strong>the</strong>
time of <strong>the</strong> study, adult service agency partners
provided ongoing support to individuals
qualifying for services.
Method
Participants
Age
(years) Classification a
The study involved four adult males with moderate
intellectual disabilities employed at <strong>the</strong>
University of Toledo as custodians through
Project SCOUT. At <strong>the</strong> time of <strong>the</strong> study, all
four participants worked 20 hours per week
and had been employed between two and four
months. All four employees had active case
files with adult services and received initial
and follow-up services from three job coaches.
As a component of <strong>the</strong> program, all participants
had received an initial one-month evaluation
from <strong>the</strong>ir supervisor that focused on
employee strengths and specific job-related
areas needing improvement. Two supervisors
at <strong>the</strong> university selected employee participants
on <strong>the</strong> basis of <strong>the</strong>ir need for increased
independence and autonomy in <strong>the</strong>ir work
performance. Participants ranged in age from
20 to 32 with a mean age of 26. Table 1
displays participant characteristics. Employees
Support needs b
expressed interest in <strong>the</strong> process and provided
informed consent to participate in <strong>the</strong> study.
Setting
Dependent Variable
Fred M 32 Moderate intellectual disability Limited Reading work related words and
phrases
4
Matt M 20 Moderate intellectual disability
Attention deficit disorder
Limited Job tasks completed correctly 2
Kevin M 21 Mild intellectual disability Limited Job task completion Time to 3
Gross motor deficits
complete tasks
Steve M 30 Moderate intellectual disability
Mild Cerebral Palsy
Limited Use public transit 3
Mos. in
job
a
Based on program terminology used during employee screening process
b
Based on support hierarchy from Mental retardation: Definition, Classification, and Systems of Support,
American Association on Mental Retardation (AAMR)
504 / Education and Training in Developmental Disabilities-December 2008
Work placements were part-time custodial positions
at two adjacent buildings on <strong>the</strong> university
campus. There were two employees in
each building with work schedules during <strong>the</strong>
same time each day. All four employees had
general cleaning duties on different floors of
<strong>the</strong> designated buildings. Fred, Matt, Kevin,
and Steve had <strong>the</strong> following common duties:
cleaning sinks and countertops in classrooms,
vacuuming and sweeping classroom and faculty
offices, sweeping and mopping hallways,
sweeping stairwells, and cleaning windows,
doors, and window ledges. Matt had <strong>the</strong> additional
duty of cleaning two bathrooms. Kevin’s
additional task was to clean <strong>the</strong> foyer, lounge
area, and outdoor balcony on his floor. In
addition to overall cleaning tasks, Steve also
vacuumed a large auditorium. Since Fred
completed his assigned tasks in a timely manner,
he was given <strong>the</strong> additional duty of checking-in
with Kevin to assist him on an as-needed
basis. The study took place over eight weeks
during university summer sessions. During
that time of year <strong>the</strong>re was moderate activity
throughout <strong>the</strong> time period <strong>the</strong> custodians
were working.

Dependent Measures
The dependent measure for <strong>the</strong> study included
<strong>the</strong> percentage of correct responses
for each participant. Employees selected a targeted
goal that <strong>the</strong>y believed was important
for improved independence and job performance.
Participants met individually with <strong>the</strong>
project facilitator, trainer, and job coach at
<strong>the</strong> onset of <strong>the</strong> project to determine a work
related goal <strong>the</strong>y wished to achieve. Employees
were asked to respond to <strong>the</strong> following
questions (Phase 1): What do you do at your
job? What do you like most about your job?
What tasks do you do well? What tasks do you
sometimes need help with? What task would
you like to improve in to become better in
your job? With <strong>the</strong> responses to <strong>the</strong>se questions
as a starting point, each employee chose
a job-related target skill <strong>the</strong>y wanted to perform
more independently. Goals chosen were
also areas identified as needing improvement
on recent evaluations for two of <strong>the</strong> four employees.
After identifying a goal that was of
most interest, employees were asked what <strong>the</strong>y
needed to do to meet <strong>the</strong>ir goal. The project
trainer and job coach clarified <strong>the</strong> action steps
suggested and presented possible ideas to
each employee for his approval.
The four participants chose a variety of
goals. Fred’s goal involved learning to read
work-related words and phrases. He was passionate
about learning to read and to ultimately
obtain a driver’s license. Fred’s supervisor
acknowledged advantages to being able
to communicate with him via written notes
regarding work-related tasks. Importance was
placed on words representing daily tasks along
with temporal words such as “daily”, “weekly”
and “every o<strong>the</strong>r day”. The dependent measure
developed for Fred involved a list of 30
work related words and short phrases determined
to be important by Fred and his supervisor.
The second participant, Matt, was <strong>the</strong>
least experienced employee in that he had
recently transitioned from high school. Matt’s
goal focused on his ability to determine if
tasks were completed correctly when cleaning
<strong>the</strong> bathrooms. The dependent measure developed
to record baseline and progress for
Matt included a five-task sequence with sequential
steps for each task.
Kevin chose task completion and duration
of time needed to complete tasks as his target
goal. He displayed concern with his recent
evaluation stating that at times he is not able
to finish all of his tasks. The dependent measure
involved a task sequence with sequential
steps in <strong>the</strong> three areas indicated as being
problematic for Kevin. Finally, Steve identified
that he would like to learn how to take <strong>the</strong>
local bus transit system to and from work. His
supervisor had also commented that Steve was
periodically late for work due to personal issues.
The dependent measure developed involved
a ten- task sequence focused on getting
to and from <strong>the</strong> work site. All four employeeparticipants
acknowledged that <strong>the</strong>y wanted
to work towards successful performance of
<strong>the</strong>ir targeted goal.
Observation and Recording Procedures
Four trained observers collected data on a
regular basis throughout <strong>the</strong> baseline, training,
and maintenance conditions of <strong>the</strong> study.
Data were collected at <strong>the</strong> employees respective
work location with <strong>the</strong> exception of Steve,
who was observed on his way to work. Each
participant was observed two to four times per
week for approximately eight weeks. The four
observers collected individual coded data
sheets on all participant employees. Each observer
completed coded data sheets indicating
employee response.
Observer Training
Observers were university staff and graduate
students who had an interest in <strong>the</strong> transition
of students from school to work. Observer
training took place prior to collection of baseline
data over four sessions. The initial training
session introduced phases of <strong>the</strong> SDSDM
model to all observers. After an employee goal
and action plan was established, each observer
was subsequently trained in <strong>the</strong> use of coding
sheets for each participant. Since data collected
differed based on target behavior of
each participant, observers were trained in
observable criteria specific to each employee
response. In general, participants earned a
“” for tasks completed or criteria met, or “0”
for tasks not completed or met. Beginning
and ending time was additionally recorded for
Kevin, who had <strong>the</strong> additional goal of com-
Enhancing Job Performance / 505

pleting tasks in an appropriate timeframe.
Training observations were conducted until
observers met an 80% reliability criterion
across two consecutive sessions.
Interobserver Agreement
Interobserver data were ga<strong>the</strong>red on approximately
30% of all observations across participants
and conditions. A Point-by-point comparison
was used to calculate inter-observer
agreement. Agreement was computed by dividing
<strong>the</strong> number of agreements by <strong>the</strong> number
of agreements plus disagreements and
multiplying by 100. Mean agreement during
baseline was 100%. During training, mean
agreement was 95% and 98% in <strong>the</strong> maintenance
condition.
Goal Attainment Scaling
The Goal Attainment Scaling (GAS) process
(Kiresuk, Smith, & Cardiillo, 1994) was used
to measure employee goal attainment. The
process involves establishing goals and specifying
a range of outcomes or behaviors that
indicate progress in achieving <strong>the</strong>se goals
(Carr, 1979). The success of <strong>the</strong> model cannot
be determined until <strong>the</strong> employee has satisfactorily
achieved his self-selected goal. GAS
scores were determined through <strong>the</strong> following
sequence of actions. After talking with each
participant about his goal and action plan, <strong>the</strong>
supervisor and job coach collaboratively determined
a possible outcome among a five-scaled
continuum from <strong>the</strong> most unfavorable outcome
of employee progress to <strong>the</strong> most favorable
potential outcome. The five outcomes
are described quantifiably (e.g. percent correct)
and assigned a numerical value ranging
from 2to2. The midpoint on <strong>the</strong> scale (0)
is <strong>the</strong> expected outcome, which is what <strong>the</strong> supervisor
and job coach would consider a satisfactory
outcome from <strong>the</strong> training process. At <strong>the</strong>
end of <strong>the</strong> instructional period, <strong>the</strong> supervisor
and job coach referred to <strong>the</strong> five potential
outcomes and selected <strong>the</strong> one that best described
each employee’s actual progress on
<strong>the</strong>ir goal. Using a raw-score conversion key
for GAS developed by Cardillo (1994), raw
scores were converted to standardized
T-scores with a mean of 50 and a standard
deviation of 10. The conversion of raw scores
to a standardized score allows comparison between
goal areas and subjects, independent of
<strong>the</strong> particular goal area. When interpreting
scores from <strong>the</strong> GAS it is important to note
that <strong>the</strong> converted T-score of 50 represents an
acceptable outcome, where an acceptable outcome
means that <strong>the</strong> employee achieved <strong>the</strong>
goal to <strong>the</strong> level expected by <strong>the</strong> supervisor/ job
coach. Standardized scores of 40 or below indicate
that <strong>the</strong> employee did not achieve an
acceptable outcome, and scores of 60 and
above indicate that <strong>the</strong> employee’s progress
exceeded expectations.
Social Validation
At <strong>the</strong> conclusion of <strong>the</strong> training period, information
was ga<strong>the</strong>red from supervisors and
job coaches regarding <strong>the</strong>ir perception of <strong>the</strong>
SDCDM. Specifically, <strong>the</strong>y were asked to describe
each employee’s performance before
and after using <strong>the</strong> model, and <strong>the</strong>ir view of
<strong>the</strong> various phases. Data of employee perception
was obtained from responses to questions
(Phase III) at <strong>the</strong> conclusion of training regarding
participant feelings about <strong>the</strong>ir goals.
Additionally, anecdotal information was obtained
from employees.
Treatment Integrity
The project trainer was a Project SCOUT staff
member and a previous special education
teacher. To ensure integrity of <strong>the</strong> treatment,
<strong>the</strong> trainer was observed by <strong>the</strong> project director
and a job coach during training. An agreement
was scored when both observers recorded
each step of a training sequence
protocol. This procedure was followed for
each participant employee during treatment
condition. Percent agreement was calculated
by dividing <strong>the</strong> number of agreements by <strong>the</strong>
number of agreements and disagreements
and multiplying by 100. Training was implemented
with 100% accuracy over all four participants.
The SDCDM
506 / Education and Training in Developmental Disabilities-December 2008
The Self-Determined Career Development
Model was developed to enable adult service
providers to support individuals in becoming
self-regulated problem solvers, to self-direct in

TABLE 2
Phases, Problem, Overall Objective, and Questions of <strong>the</strong> Self-Determined Career Development Model
Phase Problem/Overall Objective Questions
I. Set a career/job goal Problem to Solve: What are my career and
job goals?
● Enable person to identify strengths/
needs and current status in relation to
job and career
II. Take action Problem to Solve: What is my plan?
● Assist person to ga<strong>the</strong>r information
about opportunities/barriers/supports
in relation to achieving prioritized job
or career goal
III. Assess/adjust goal
or plan
Problem to Solve: What have I achieved?
● Enable person to self-evaluate prograss
toward goal and adjust as needed
<strong>the</strong> career decision-making process, and to
gain enhanced self-determination (Wehmeyer
et al., 2003). Three phases constitute <strong>the</strong>
framework of <strong>the</strong> model, each presenting a
problem to be addressed by <strong>the</strong> individual
(Table 2). The model uses a generic set of
questions that can be altered based on individual
understanding of <strong>the</strong> basic concept.
The essential factor is that questions in each
phase represent steps in <strong>the</strong> problem-solving
sequence. Specifically, individuals answering
<strong>the</strong> questions must: (a) identify a problem,
(b) identify potential solutions to <strong>the</strong> problem,
(c) identify barriers to solving <strong>the</strong> problem,
and (d) identify consequences of each
solution. These steps form <strong>the</strong> means-end
problem solving sequence represented by
questions in each phase. Questions that follow
this basic framework allow individuals to modify
<strong>the</strong>ir own behavior, and thus become selfdirected
in reaching <strong>the</strong>ir goal.
Within <strong>the</strong> SDCDM manual, employment
objectives and supports are identified for use
in each phase. Objectives provide intermediate
steps or ideas to assist facilitators in enabling
individuals to work through <strong>the</strong> questions.
Employment supports are supplemental
skill development materials and strategies that
What career and job do I want?
What do I know about it now?
What must change to achieve
this?
What can I do to make this
happen?
What actions can I take to
reach my career or
employment goal?
What could keep me from
taking this action?
What can I do to remove <strong>the</strong>se
barriers?
When will I take action?
What actions have I taken?
What barriers have been
removed? What has changed?
Have I achieved what I want to
achieve?
provide resources for teaching individuals to
“teach <strong>the</strong>mselves”. Strategies are derived
from <strong>the</strong> self-management literature and involve
teaching individuals to modify and regulate
<strong>the</strong>ir own behavior (Agran, King-Sears,
Wehmeyer, & Copeland, 2003). Commonly
used strategies are antecedent cue regulation
and picture cues, self-instruction, self-monitoring,
self-evaluation, and self-reinforcement.
The SDCDM manual provides examples of facilitator
questions and participant responses
that are useful with understanding of basic
objectives within each phase.
Experimental Design and Conditions
A multiple baseline across employees was used
to evaluate effects of <strong>the</strong> training model. Experimental
conditions included baseline,
training, and maintenance. Prior to collecting
baseline data, Phase I of <strong>the</strong> SDCDM was administered
to each participant culminating in
<strong>the</strong> establishment of self-selected goals. Dependent
measures were <strong>the</strong>n identified for
each goal and baseline data collection began
for all participants. Phase II of <strong>the</strong> SDCDM
was subsequently administered to secure an
approved action plan from each participant.
Enhancing Job Performance / 507

Instruction and self-monitoring strategies
were taught and used by employees within <strong>the</strong>
SDCDM process during this condition. The
mastery performance criterion for all participants
was 80% of targeted behavior on <strong>the</strong>
dependent measure over two consecutive
days.
Baseline. During <strong>the</strong> baseline data collection
phase, participant’s performance of target
behaviors related to self-selected goals was
observed and recorded. No reinforcement or
feedback was provided to employees during
this condition. The criterion for movement
into <strong>the</strong> next phase was a minimum of three
consecutive days of stable responding with no
apparent trends.
Training. The training condition involved
implementation of Phase II of <strong>the</strong> Self-Determined
Learning Model of Instruction. Participants
initially addressed <strong>the</strong> following questions
important to this segment of <strong>the</strong> model:
What are ways to reach my goal? What could
keep me from reaching my goal? What can I
do so that this doesn’t happen? When will I
take action? During this process <strong>the</strong> project
trainer, job coach and employee worked toge<strong>the</strong>r
to identify specific self-directed strategies
in <strong>the</strong> formation of individual action
plans. A key component with each plan involved
teaching participants a self-monitoring
strategy – to observe <strong>the</strong>ir own behavior and
indicate whe<strong>the</strong>r or not a target behavior had
been achieved. The project trainer developed
a teaching script for each participant consisting
of direct instruction on how to use a strategy,
modeling of <strong>the</strong> strategy by <strong>the</strong> trainer,
and independent practice by <strong>the</strong> employee.
During this condition, job coaches were
present with <strong>the</strong> project trainer for at least
one day of implementation depending on employee
follow-up services. Awareness of <strong>the</strong>
model and initial action-plan input was important,
however job coaches observed <strong>the</strong>
project trainer during actual training sessions.
Since Fred’s goal did not include work-related
tasks, training and subsequent practice
took place during his break. Fred and <strong>the</strong>
trainer discussed strategies to learn to read
work-related words and toge<strong>the</strong>r decided on
<strong>the</strong> use of a picture cue strategy paired with
self-monitoring. Flashcards were made with
text on one side and text with picture cues on
<strong>the</strong> o<strong>the</strong>r side. Fred learned to read words and
508 / Education and Training in Developmental Disabilities-December 2008
phrases utilizing a dual-self monitoring system.
He would check to see if he correctly
read each word by turning over <strong>the</strong> card, placing
<strong>the</strong> card in one of two piles (correct/
incorrect), and subsequently marking his response
as ei<strong>the</strong>r a “” or “0” on a checklist.
Fred and <strong>the</strong> trainer agreed that five new
words would be introduced each session. Fred
stated that lack of practice would keep him
from reaching his goal and was given a second
set of flashcards to keep at home. Matt’s action
plan involved teaching him to use picture
cues in order to self-evaluate if <strong>the</strong> bathroom
was cleaned to specifications. With positive
examples (tasks completed properly) and negative
examples (tasks completed incorrectly),
Matt was first taught to distinguish between
pictures. He was <strong>the</strong>n taught to compare his
work to <strong>the</strong> picture and use a self-monitoring
form to mark a “” if his work looked like <strong>the</strong>
picture and a “0” if it did not.
Kevin agreed that he had trouble remembering
all <strong>the</strong> steps involved in his work-related
tasks and would often skip an entire
assigned area due to <strong>the</strong> length of time it took
to complete tasks. Initially, Kevin chose <strong>the</strong>
sequence of his routine given a list of assigned
areas and tasks. The hallway, lounge and balcony
were targeted areas in this study.
Through modeling and role-play he was
taught to correctly complete all daily tasks in
<strong>the</strong>se areas and mark a checklist as each task
was completed. Kevin’s beginning and ending
time of specific work areas was also recorded
each day. Steve was initially introduced to procedures
for establishing a consistent pick-up
and drop-of time with <strong>the</strong> local bus transit
service. The process was simulated with practice
provided in calling <strong>the</strong> service. A task
sequence was <strong>the</strong>n developed using his watch
alarm as an antecedent auditory cue for beginning
his task sequence each morning. Additionally,
Steve utilized a pocket-sized selfmonitoring
card with picture cues paired with
words. He circled <strong>the</strong> picture if he completed
<strong>the</strong> step independently and placed an “X”
through <strong>the</strong> picture if he did not complete <strong>the</strong>
task independently.
Maintenance. Maintenance data were collected
on all participants. During maintenance
participants were observed for correct
completion of <strong>the</strong>ir task sequence with no
additional training, praise, or feedback about

<strong>the</strong>ir performance. Phase III of SDLMI was
implemented at <strong>the</strong> conclusion of <strong>the</strong> maintenance
condition. Employees were asked to
respond to <strong>the</strong> following questions and were
shown a Likert scale to reflect <strong>the</strong>ir feeling
about <strong>the</strong>ir goals: (a) <strong>the</strong> goal that I made was
too hard, too easy, just right; (b) keeping track
of my goal was good, not so good, too hard for
me to keep track of; (c) my plan of action was
good, not so good, and I need to try something
else, and (d) I feel <strong>the</strong> progress that I
made was good but I didn’t meet my goal,
good – I made my goal, or I didn’t meet my
goal.
Results
Figure 1 displays <strong>the</strong> percentages of correct
responses for <strong>the</strong> four participant employees
for each phase of <strong>the</strong> study. Following <strong>the</strong>
presentation of individual performance data,
GAS scores and social validation data are presented.
Fred. During baseline Fred’s knowledge of
reading work-related words ranged from 50%
to 53% with a mean of 51%. After just one
training session, Fred’s performance rose to
70%. After three training sessions, Fred’s performance
reached <strong>the</strong> criterion of 80% even
though <strong>the</strong>re was a gap of two days between
training sessions. Fred stated that he did practice
reading <strong>the</strong> words at home with <strong>the</strong> second
set of flashcards. During <strong>the</strong> intervention
condition Fred’s performance ranged from
70% to 80% with a mean of 77%. During <strong>the</strong>
maintenance condition Fred performed between
77% and 96% with a mean of 82% over
a seven-session period (approximately 2
weeks).
Matt. Matt performed between 34% and
48% accuracy of his tasks with a mean of 42%
during baseline. In <strong>the</strong> intervention-training
condition, his performance ranged from 72%
to 93% with a mean of 86%. Matt also had an
immediate rise in task accuracy and task completion
after learning his self-monitoring strategy.
After two consecutive days of performing
over 80% he was moved to <strong>the</strong> maintenance
phase. During this condition Matt’s performance
rose significantly ranging from 93% to
100% with a mean of 96% over a two-week
period.
Kevin. During baseline, Kevin’s performance
was inconsistent ranging from 14% to
36% with a mean of 22% task completion.
Beginning and ending time was also collected
for Kevin. During baseline, <strong>the</strong> average length
of time to complete all tasks in designated
areas was 40 minutes. After four training sessions
Kevin achieved <strong>the</strong> goal of 80% task
completion over two consecutive days. During
this second condition Kevin performed between
32% and 100% with a mean of 74%. His
average time for task completion was 51 minutes.
In <strong>the</strong> maintenance condition, Kevin
performed at a 77%-91% level with a mean of
86% and an average time for task completion
of 53 minutes.
Steve. Steve’s level of performance during
baseline was 44%. There was a gap in baseline
data collection due to staffing issues, however
Steve’s performance remained consistent over
two three-consecutive sessions. During <strong>the</strong>
training phase, his performance ranged from
64 – 88% with a mean of 76%. Steve was
moved into maintenance, where his mean performance
was 79% over four sessions (approximately
1 week).
GAS Scores
All employees exceeded supervisor/ job coach
expectation for achievement of <strong>the</strong>ir goals.
Kevin and Matt obtained a GAS score of 70;
Fred and Steve obtained a GAS score of 60.
Employees attained a score higher than <strong>the</strong>
satisfactory level of achievement (50). Thus,
all participants achieved <strong>the</strong>ir personal goals
above supervisor/ job coach expected outcome
levels.
Social Validation
At <strong>the</strong> conclusion of <strong>the</strong> study, job coaches (3)
and supervisors (2) responded to questions
regarding <strong>the</strong>ir perception of employee goal
attainment and use of <strong>the</strong> SDCDM phases.
The two supervisors were impressed with each
employee’s progress towards <strong>the</strong>ir goal, especially
Matt and Kevin’s improvement. Nei<strong>the</strong>r
had prior experience supervising individuals
with cognitive impairments and thought it
would take a longer period of time to obtain
<strong>the</strong> results that were seen with <strong>the</strong>se employees.
Supervisors were very satisfied with <strong>the</strong>
Enhancing Job Performance / 509

Figure 1. Percentage of correct responses of Fred, Matt, Kevin, and Steve across experimental conditions.
510 / Education and Training in Developmental Disabilities-December 2008

program and saw value in using <strong>the</strong> model for
o<strong>the</strong>r custodial employees. Both reported <strong>the</strong>
benefit of self-selected work goals and believed
strategies chosen improved employee
productivity. Job coaches also confirmed <strong>the</strong>
benefit of teaching self-monitoring strategies
to increase employee independence and responsibility.
Overall, <strong>the</strong>y reported <strong>the</strong> value
in using <strong>the</strong> SDCDM for follow up services,
however one job coach doubted that consumers
would always chose appropriate target
goals. All job coaches commented that <strong>the</strong>
model was easy to learn and implement.
Employees provided feedback on <strong>the</strong>ir participation
in <strong>the</strong> process. All participants reported
<strong>the</strong>y were happy with gains and
achievements <strong>the</strong>y had made. Fred wanted to
continue learning additional words and commented
that <strong>the</strong> pictures helped him learn to
read. All participants stated that it made <strong>the</strong>m
feel good about <strong>the</strong>mselves to set a goal and
try to achieve it. Matt noted that now o<strong>the</strong>rs
are not telling him that a task “needs more
work” which makes him feel proud. Although
Kevin’s time to clean specific areas did not
decrease, he was able to finish more areas
before his break and complete all daily tasks
on a regular basis. Steve commented that he
had not been late for work in a while and was
very proud to be “like <strong>the</strong> o<strong>the</strong>r guys” in taking
<strong>the</strong> transit bus to and from work.
Discussion
The overall findings indicate that <strong>the</strong> Self-Determined
Career Development Model represents an
effective method to teach problem solving
and suggests a functional relationship between
employee’s use of <strong>the</strong> model and observed
changes in job performance. All four
employees improved work-related performances
after following <strong>the</strong> three phases of <strong>the</strong>
Self-Determined Career Development Model. Positive
changes were evident between baseline
and intervention conditions and continued in
<strong>the</strong> maintenance phase. In addition, findings
from <strong>the</strong> Goal Attainment Scaling process indicate
that all employees exceeded expectations
of <strong>the</strong>ir supervisors/ job coach in achieving
work-related goals. Participants showed
that <strong>the</strong>y could set goals related to <strong>the</strong>ir current
employment, participate in designing interventions
to achieve those goals, implement
and self-monitor those goals, and make
progress toward those goals.
The essence of <strong>the</strong> SDCDM model is teaching
individuals a problem-solving process. Participants
are instructed by means-end questions
to perceive and resolve a gap between a
present situation and a desired goal. A key
starting point of <strong>the</strong> SDCDM model is helping
an individual establish a self-selected goal. Research
indicates that one of <strong>the</strong> most important
aspects of helping individuals attain happiness,
success and competence is <strong>the</strong> process
of helping <strong>the</strong>m set goals (Copeland &
Hughes, 2002). In <strong>the</strong> current investigation
this first step took considerable time, as most
participants needed explicit examples to understand
<strong>the</strong> concept of choosing and setting
work-related goals. It would have been easier
to simply acquire information from each employee’s
supervisor. However, it is believed
that gains toward goal attainment may not
have been as dramatic if <strong>the</strong>y weren’t selfselected.
Goals that have personal meaning
are more likely to be attained (Doll & Sands,
1998). This powerful step empowered employees
to take control of success in <strong>the</strong>ir job.
The second phase of <strong>the</strong> SDCDM model
involved assisting employees in identifying an
action plan to reach <strong>the</strong>ir goal and barriers
that could impede <strong>the</strong>ir progress. Skills taught
enabled participants to modify and self-regulate
<strong>the</strong>ir actions. Picture cues, antecedent
cues, and self-monitoring strategies proved to
be very motivating to participant employees.
For example, after using a checklist for a short
period of time, Kevin was very proud to show
o<strong>the</strong>rs his completed list and requested that
additional checklists be made for o<strong>the</strong>r areas
that he cleaned. Matt commented that “I work
so my card has all ’s”. A picture and audio
cue was very effective in supporting Steve as he
completed a sequence of steps in his action
plan for independently using public transportation.
Picture cues also served as self-correction
symbols for Fred in checking to see that
he read a word correctly. Fred also noted that
lack of practice would be a barrier to learning
his words, and was consistent in practicing his
words and phrases at home. All of <strong>the</strong>se selfdirected
instructional strategies enabled employees
to implement and follow <strong>the</strong>ir action
plans, evaluate <strong>the</strong> outcomes, and alter <strong>the</strong>ir
strategies when necessary.
Enhancing Job Performance / 511

The third and final phase of <strong>the</strong> SDCDM
involved employee reflection. Individually, participants
were asked to think about <strong>the</strong>ir actions
and progress toward <strong>the</strong>ir goal. All employees
were extremely proud of <strong>the</strong> progress <strong>the</strong>y had
made in a short period of time. This step involved
self-awareness and self-knowledge about
strengths and limitations in <strong>the</strong> process. Phase
III is important in promoting beliefs and attitudes
that enable an individual to act in an
empowered or self-realizing manner. This phase
supported employee beliefs that <strong>the</strong>y had control
over <strong>the</strong>ir actions and ultimately attainment
of <strong>the</strong>ir goal.
The Self-Determined Career Development Model
was developed to promote greater consumer
involvement in career and job decision-making
and specifically to promote career and job attainment.
Findings from this study extend <strong>the</strong>
line of research utilizing <strong>the</strong> SDCDM as a
method to enhance work performance for individuals
having secured employment in real-life
settings. The present study provides supporting
evidence that <strong>the</strong> model is a valuable tool for
case managers, job coaches, supervisors, and additional
personnel providing support to adults
with disabilities in work settings. The model
challenges adult service providers to create opportunities
for individuals to perceive and resolve
gaps in <strong>the</strong>ir work performance in employment
settings. Within job training and follow-up
services, <strong>the</strong> SDCDM provides a process for promoting
continued job success and acquisition of
skills needed for individuals to become causal
agents in <strong>the</strong>ir lives.
There are limitations to this study, and results
should be interpreted cautiously for several
reasons. First, <strong>the</strong> sample size was small
and included participants in one type of employment.
Researchers should continue to
conduct investigations utilizing <strong>the</strong> model
with employees in a variety of work settings.
Second, performance data obtained in <strong>the</strong>
maintenance phase was limited for some participants
due to observer scheduling at <strong>the</strong>
end of <strong>the</strong> semester. Analysis of longer maintenance
phases would enable readers to discern
if participants maintained improved levels
of job performance over an extended
period. Third, due to <strong>the</strong> nature of <strong>the</strong> program
participants had been involved in a consumer-directed
process in originally obtaining
employment. Therefore, a “match’ between
individual interests and employee needs was
previously established. Different results may
have been attained from individuals whose
placements were a mismatch between workers’
preference and <strong>the</strong>ir job environments.
Fourth, it is suggested that instruction in <strong>the</strong>
model enhanced employee competency in
goal setting, self-regulation and self-evaluation
presumably leading to enhanced self-determination.
Extension of <strong>the</strong> study utilizing assessments
such as The Arc’s Self-Determination Scale
(Wehmeyer & Kelchner, 1995), before and
after training would provide data on <strong>the</strong> degree
to which an individuals’ sense of selfdetermination
was enhanced.
Despite <strong>the</strong> above limitations, <strong>the</strong> Self-Determined
Career Development Model proved to be an
effective method of instruction for increasing
<strong>the</strong> job performance of employees hired
through Project SCOUT at <strong>the</strong> University of
Toledo. Participants learned a process of
problem solving that allowed each of <strong>the</strong>m to
achieve a desired work-related outcome. Additional
participant accomplishments have
also been observed. Steve uses public transportation
for traveling to various places in <strong>the</strong>
community. Kevin is receiving supports to obtain
his own apartment. Fred is now working
30 hours per week and actively pursuing his
goal of acquiring a driver’s license. Since <strong>the</strong>
time of <strong>the</strong> study, Project SCOUT has expanded
so that program supports, students,
and a supervisor are utilizing <strong>the</strong> SDCDM
phases for improving job performance of employees
with disabilities at <strong>the</strong> university. The
model provides a promising approach for
teaching skills and attitudes believed to enhance
an individual’s self-determination.
When acting on <strong>the</strong> basis of <strong>the</strong>se skills and
attitudes, individuals have greater ability to
take control of <strong>the</strong>ir lives and assume <strong>the</strong> role
of successful adults in our society (Field, Martin,
Miller, Ward, & Wehmeyer, 1998).
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Received: 1 March 2007
Initial Acceptance: 26 April 2007
Final Acceptance: 26 July 2007
Enhancing Job Performance / 513

Education and Training in Developmental Disabilities, 2008, 43(4), 514–528
© <strong>Division</strong> on Developmental Disabilities
Attitudes of Israeli Teachers and Paraprofessionals towards
<strong>the</strong> New Definition of ID and Their Willingness to Cope with
Special Education Law Changes
Hefziba Lifshitz, Shoshanna Nissim, and Sara Cohen
Bar-Ilan University
Abstract: Attitudes of teachers (N96) and paraprofessionals (N 48) working with students with intellectual
disability (ID) towards <strong>the</strong> new definition of ID (Luckasson et al., 1992, 2002), was examined. The main
innovation of <strong>the</strong> new definition of ID is <strong>the</strong> cancellation of <strong>the</strong> four ID levels, suggesting an optimistic view,
especially towards individuals with severe/profound ID. Participants’ attitudes towards modifiability and <strong>the</strong>
acquisition of new skills by students with severe/profound ID were investigated. Their willingness to cope with
<strong>the</strong> changes stemming from <strong>the</strong> implementation of <strong>the</strong> Special Education Law (1988) was also examined as well
as <strong>the</strong>ir general educational attitudes (conservatism vs. progressiveness) according to role and type of population.
Findings yielded low attitudes towards modifiability of students with severe/profound ID (2-4 out of 6).
The Denial Culture and <strong>the</strong> Integrated Threat Theory of prejudice explain <strong>the</strong>se findings. The “control <strong>the</strong>ory”
and <strong>the</strong> top-down approach explain <strong>the</strong> low scores in willingness to cope with changes stemming from <strong>the</strong> Special
Education Law. The research hypo<strong>the</strong>sis was supported. Paraprofessionals express a higher level of conservatism
and lower scores in <strong>the</strong> attitudes towards <strong>the</strong> new definition of ID than teachers, especially those working with
students with severe and profound ID. These findings suggest that it is not only <strong>the</strong> education level, but also
<strong>the</strong> type of occupation that determine <strong>the</strong> worker’s orientation.
A new definition for intellectual disability
(ID) was developed by Luckasson et al. in
1992 and was modified in 2002, with <strong>the</strong>
main innovation being a cancellation of <strong>the</strong>
four retardation levels and relating to individuals
with ID according to <strong>the</strong>ir weaknesses,
strengths and levels of support.
These changes suggest an optimistic view,
especially towards latent abilities and potential
of students with severe/profound ID.
The main goal of <strong>the</strong> current study was to
examine <strong>the</strong> attitudes of teachers (N 96)
and paraprofessionals (N 42) working in
schools for students with mild/moderate
and severe/profound ID, towards <strong>the</strong> new
definition of intellectual disability (Luckasson
et al., 1992; 2002). More specifically, <strong>the</strong>
objective was to examine <strong>the</strong>ir attitudes towards
<strong>the</strong> capability of students with severe/
Correspondence concerning this article should
be addressed to Hefziba Lifshitz, School of Education,
Bar-Ilan University, Ramat-Gan 52900, IS-
RAEL. Email: lifshih1@mail.biu.ac.il
514 / Education and Training in Developmental Disabilities-December 2008
profound ID to be modified in ADL and
instrumental skills, conceptual and social
domains. Although <strong>the</strong> new definition of ID
has not yet been implemented in Israel, a
change emerging from <strong>the</strong> definition has
been applied in schools of students with ID
as a consequence of <strong>the</strong> Special Education
Law. These changes are expressed by inclusion
of students with severe/profound ID in
schools for those with mild/moderate ID.
Fur<strong>the</strong>rmore, <strong>the</strong> schools’ curricula include
adaptive behavior skills as well as literacy
and academic skills. The students’ achievements
are quantified to national standards
and <strong>the</strong> teachers are required to demonstrate
achievements in <strong>the</strong>se two parts according
to a standard national scale. Therefore,
<strong>the</strong> participants’ willingness to cope
with <strong>the</strong> changes stemming from <strong>the</strong> Special
Education Law was also examined, as well as
<strong>the</strong>ir general educational attitudes (conservatism/progressiveness),
with reference to
<strong>the</strong>ir role (teachers/paraprofessionals) and
<strong>the</strong>ir students’ level of ID (mild/moderate
or severe/profound ID).

Theoretical Background
The 2002 AAMR Definition of Intellectual
Disability
According to <strong>the</strong> 8 th AAMR definition, “Mental
retardation refers to significantly sub average
intellectual functioning resulting in or
associated with concurrent impairments in
adaptive behavior and manifested during <strong>the</strong>
developmental period” (Grossman, 1983 in
Luckasson et al., 2002, p. 22). The diagnosis of
mental retardation is comprised of an IQ 70
or below on a standardized measure of intelligence
and significant limitations in individuals’
effectiveness in meeting <strong>the</strong> standards of
maturation, learning, personal independence,
or social responsibility that are expected
for his/her age level and cultural
group. According to <strong>the</strong> definition, individuals
with mental retardation were classified into
four levels according to <strong>the</strong> IQ and adaptive
behavior functioning: mild, moderate, severe
and profound ID.
The revised 2002 AAMR definition (after
<strong>the</strong> 1992 definition) defines intellectual disability
as “A disability characterized by significant
limitation both in intellectual functioning
and adaptive ability as expressed in
conceptual, social and practical skills. The disability
originates before age 18” (Luckasson et
al., 2002, p. 23). The new definition is anchored
in <strong>the</strong> social ecology approach (Landesman,
Ramy, Dossett, & Echols, 1997), postulating
that <strong>the</strong> educational environment
plays an important role in determining <strong>the</strong>
individual’s functioning. Therefore, two people
with <strong>the</strong> same IQ level can function differently
following appropriate educational-environmental
interventions. This orientation is
compatible with Feuerstein and Rand’s (1974)
“active modifying” and Jensen’s (1990)
Change Model which emphasize <strong>the</strong> impact of
mediation on <strong>the</strong> individual’s cognitive functioning.
In contrast to <strong>the</strong> Stability Model (traditional
concept of <strong>the</strong> IQ), which views <strong>the</strong>
individual’s cognitive abilities as fixed, <strong>the</strong>
Change Model considers cognitive abilities as
modifiable even among students with intellectual
disability.
The new definition of ID led to two major
changes. A) Viewing ID as a current and dynamic
condition, and B) Cancellation of label-
ing into levels of ID, but ra<strong>the</strong>r classification
according to <strong>the</strong> individual’s limitations and
strengths and <strong>the</strong> intensity of support needed
to overcome <strong>the</strong> barriers and fulfill <strong>the</strong> individual’s
potential (Luckasson et al., 2002).
Although <strong>the</strong> new definition has been familiar
for over a decade, <strong>the</strong>re is no actual consensus
regarding <strong>the</strong> scientific philosophy
upon which it is based. The main criticism of
<strong>the</strong> 1992 definition was that classification of
<strong>the</strong> population with ID according to levels of
needs and support cannot be a substitute criterion
for determining <strong>the</strong> level of ID
(Greenspan, 1999; MacMillan et al., 1993;
Switzky & Greenspan, 2003). Fur<strong>the</strong>rmore, it
was argued that <strong>the</strong> cancellation of IQ levels
will have a negative effect on academic research
(Leffert & Siperstein, 2002). These
claims were raised by academic scholars and
policy makers. The present study is, to <strong>the</strong> best
of our knowledge, <strong>the</strong> first to empirically examine
<strong>the</strong> attitudes of field workers toward
this definition and its implications.
Change in <strong>the</strong> Education System
Fucks (1995) and Sarason (1982) define
change within <strong>the</strong> educational framework as
exchanging <strong>the</strong> current behavior patterns of
workers in <strong>the</strong> school with different and new
behavior patterns. It affects all partners involved
in <strong>the</strong> system, including students,
teachers, parents, administrators and community
members. It is a dynamic process that
requires constant communication and evaluation
and has implications for curriculum, instruction,
assessment and professional development
(Fucks; Richardson, 1994). Regular
teacher attitudes to changes were examined
during curriculum reform efforts in science
(Sevilla & Marsh, 1992), technology (Hope,
1995), ma<strong>the</strong>matics (Shotsberger & Crawford,
1999), reading and writing (Stroble &
Bratcher, 1990). ERIC and PsycINFO searches
did not yield any studies on coping with
changes in special education schools.
Organizational resistance to change can be
explained by several <strong>the</strong>ories. The Control
Theory (Friedman & Lackey, 1991) claims
that a person’s behavior is motivated by <strong>the</strong>
need to increase his control over <strong>the</strong> environment
in <strong>the</strong> various fields of life. A state of
control leads to positive feelings, helps in <strong>the</strong>
Attitudes towards <strong>the</strong> New Definition of ID / 515

adjustment to changes and contributes to <strong>the</strong>
workers’ mental balance. The sense of lack of
control will be greater when <strong>the</strong> initiative for
<strong>the</strong> changes originates from an external factor,
without <strong>the</strong> cooperation of <strong>the</strong> people
within <strong>the</strong> organization, where <strong>the</strong>y have no
choice regarding <strong>the</strong> timing of <strong>the</strong> change,
<strong>the</strong> schedule of <strong>the</strong> change, etc.
Allport’s (1960) three components of attitude,
i.e. cognitive, affect and behavioral, can
also serve as an explanation for resistance to
change. The cognitive component is composed
of <strong>the</strong> individual’s knowledge, attitudes
and beliefs regarding <strong>the</strong> change. Cognitive
resistance is expressed mainly in locating and
analyzing <strong>the</strong> flaws of <strong>the</strong> change. The affect is
expressed in negative emotions such as anger
and hostility towards contents of <strong>the</strong> change
and towards <strong>the</strong> agent of change and <strong>the</strong> policy
makers. The behavioral component is composed
of <strong>the</strong> individual’s behavior in accordance
with his opinions and feelings.
These <strong>the</strong>ories and o<strong>the</strong>rs did not suggest
empirical measures to examine <strong>the</strong> willingness
or resistance to change. The present study
<strong>the</strong>refore used <strong>the</strong> new version of Hall,
George, and Ru<strong>the</strong>rford (1986) based on Fuller’s
(1969) Concerns Based Adoption Model
(CBAM) for measuring teacher concerns during
a reform effort. Concerns are defined as
‘<strong>the</strong> composite representation of <strong>the</strong> feelings,
preoccupations, thoughts and considerations
given to a particular issue or task’ within <strong>the</strong>
context of educational innovation (Hall et
al.). The CBAM questionnaire is built around
<strong>the</strong> concept that teachers go through different
stages of concern – relating to what <strong>the</strong>y are
worried or concerned about or while being
involved in a particular innovation. The seven
stages are Awareness, Informational, Personal,
Management, Consequences Collaboration
and Refocusing. Fucks (1995) draws four profiles
based on <strong>the</strong>se stages, as follows: Towards
a process of change, The split person, The
focused concern and <strong>the</strong> Multi-focal profile:
(see method section).
General Educational Attitudes
Teachers’ perceptions and attitudes towards
various educational issues can be measured by
two dimensions (conservatism/progressiveness),
each of which is presented on a bipolar
516 / Education and Training in Developmental Disabilities-December 2008
continuum, from favorable to unfavorable
(Kerlinger, 1967, 1980; Morrison & McIntry,
1980).
According to <strong>the</strong> traditional approach, <strong>the</strong>
aim of education is <strong>the</strong> students’ mastery of
knowledge and skills, and obedience and conformity
to society’s norms. It is based on intrinsic
objectives, which stem from society’s
needs. Conservative teachers thus perceive
<strong>the</strong>mselves as agents for passing on society’s
values. These teachers believe that students
with special needs may interfere with <strong>the</strong>
class’s progress. In contradistinction, <strong>the</strong> progressive
approach promotes student flexibility,
self-direction in learning and thinking capabilities,
and enables <strong>the</strong> development of a
full and integrated personality. It stems from
intrinsic objectives anchored in <strong>the</strong> student’s
needs and focuses on <strong>the</strong> child’s ability to
achieve maximal self-fulfillment and enhance
his self-esteem by being an integral part of
society.
ERIC and PsycINFO searches yielded few
studies that indicate an association between
<strong>the</strong> general educational attitudes of teachers
and <strong>the</strong>ir attitudes toward disability (Johnson,
1993; Lifshitz & Glaubman, 2004). It was
found that regular and special education
teachers with a progressive orientation were
willing to include students with special needs
in <strong>the</strong> regular classroom more than teachers
with conservative attitudes.
Studies indicate an association between
workers’ level of education and <strong>the</strong>ir attitudes
to disability. Health and social workers with a
higher education were more liberal, exhibited
less authority towards individuals with disability
and favored <strong>the</strong>ir social integration, autonomy
and independence. In contradistinction,
non-professional workers exhibited conservative
attitudes expressed by authoritative behavior
towards <strong>the</strong>ir patients, restriction of <strong>the</strong>ir
autonomy and favored <strong>the</strong>ir segregation
(Gannon & MacLean, 1995; Parasuram, 2002;
Shanley & Guest, 1995; Slevin & Sines, 1996).
The objectives of <strong>the</strong> present study were (a)
to examine <strong>the</strong> attitudes of educators towards
<strong>the</strong> new definition of ID, <strong>the</strong>ir belief about <strong>the</strong>
modifiability of students with severe/profound
ID and <strong>the</strong>ir ability to invent new skills
in various domains; (b) to examine <strong>the</strong> participants’
willingness to cope with <strong>the</strong> implementation
of <strong>the</strong> Special Education Law (i.e., in-

TABLE 1
Subjects’ distribution according to role and student ID level (N 138)
Student ID levels
cluding students with severe/profound ID
with students with moderate/mild ID and curricula
including adaptive behavior and literature
skills); (c) to examine <strong>the</strong>ir general educational
attitudes (conservatism/progressiveness)
with reference to role (teachers/paraprofessionals)
and <strong>the</strong>ir students’ level of ID
(mild/moderate versus severe/profound).
Study Hypo<strong>the</strong>ses
Role type. Teachers with a higher level of
education will exhibit more progressive general
educational attitudes and higher scores in
<strong>the</strong> study’s dependent variables: attitudes towards
<strong>the</strong> new definition of ID and <strong>the</strong> Special
Education Law changes, than <strong>the</strong> paraprofessionals.
Correlations between <strong>the</strong> study variables. Correlations
will be found between general educational
attitudes and <strong>the</strong> study’s dependent
variables (attitudes towards <strong>the</strong> new definition
of ID and <strong>the</strong> Special Education Law
changes), i.e. participants with conservative
general educational attitudes will exhibit
lower scores in <strong>the</strong> two study variables and vice
versa.
The Students’ ID Level. Due to <strong>the</strong> meagerness
of research in this area, we pose a question:
Will differences in <strong>the</strong> above variables be
found between educators working with students
with severe/profound compared to
those working with students with mild/moderate
ID levels? Correlations between <strong>the</strong> research
variables and <strong>the</strong> demographic variables
(age and seniority) were also examined.
Method
A total of 138 teachers (N 96) and paraprofessionals
(N 42) working with students with
Teachers Paraprofessionals Total
N % N % N %
Mild/Mod ID 67 73.6 24 26.4 91 100
Sev/Prof ID 29 61.7 18 38.3 47 100
Total 96 69.56 42 30.4 138 100
Mod Moderate ID, Sev Severe ID, Prof Profound ID
ID (aged 6-21) in seven schools (four for students
with mild/moderate ID and three for
students with severe/profound ID) in <strong>the</strong> center
of <strong>the</strong> country participated in <strong>the</strong> study. Of
<strong>the</strong> participants, 66% (N 91) work with
students with mild/moderate ID and 34%
(N 47) with students with severe/profound
ID. Chi square analysis revealed no significant
differences in <strong>the</strong> distribution of students with
mild/moderate or severe/profound ID with
reference to <strong>the</strong> educator’s role 2 (1) 2.08,
p .05. The subjects’ distribution according
to role and levels of ID is presented in Table 1.
Chi square analysis indicated that <strong>the</strong> frequency
of a high school education was significantly
higher among <strong>the</strong> paraprofessionals
(85%) than among <strong>the</strong> teachers (25%). The
frequency of a BA or MA degree was higher
among <strong>the</strong> teachers (65%) than among <strong>the</strong>
paraprofessionals (10%), 2 78.40, p .001.
No significant difference was found in <strong>the</strong>
level of education of those working with students
with mild/moderate ID and those working
with students with severe/profound ID.
The mean age of <strong>the</strong> teachers and paraprofessionals
was M 29.33; SD 4.61, M 28.11;
SD 3.2, respectively, (range 22-41), with
no significant difference in age between <strong>the</strong>
teachers and <strong>the</strong> paraprofessionals (t 0.87;
p .05). The mean years of working ranged
from 1-25, with no significant differences according
to role (t .60; p .05) or types of
population (t .40; p .05).
Measures
Attitudes towards <strong>the</strong> new definition of intellectual
disability questionnaire. Since <strong>the</strong> main
change in <strong>the</strong> definition is <strong>the</strong> cancellation of
ID levels and relating to individuals with ID
Attitudes towards <strong>the</strong> New Definition of ID / 517

according to <strong>the</strong>ir strengths and needs, a 27items
questionnaire on 6-point Likert scale
(1strongly disagree, 6strongly agree, a
higher score expressing a more positive attitude
towards <strong>the</strong> students’ ability and vice
versa) was constructed with <strong>the</strong> aim of examining
<strong>the</strong> attitudes of educators towards <strong>the</strong>
ability of students with severe/profound ID to
acquire skills in three domains of <strong>the</strong> adaptive
behavior clusters according to <strong>the</strong> new definition
of ID (2002). 15 statements of <strong>the</strong> questionnaire
were adapted from o<strong>the</strong>r scales examining
attitudes towards mild/moderate ID
for use on individuals with severe and profound
ID (Brolin, 1995; Cronin & Patton,
2001; Hibbert, Kostinas, & Luiselli, 2002;
Henry, Keys, Jopp, & Balcazar, 1996). The
reliability of <strong>the</strong> questionnaire was .93.
Content validation was performed by interjudge
validity of three experts, two academic
scholars and a principal of a school of students
with ID. A 100% between-judge agreement
was found regarding <strong>the</strong> statements in
<strong>the</strong> questionnaire. VARIMAX factor analysis
yielded five factors that explain 68% of <strong>the</strong>
variance: (a) Practical skills including activities
of daily living and instrumental activities,
i.e. students with severe/profound ID can
learn to eat with a knife, tie shoelaces, can
learn to prepare a salad ( .89); (b) Conceptual
skills including language, reading and
complex occupational skills, i.e. students with
severe/profound ID can learn to read sign
words, can learn to make choices, can have
self-directed goals and can learn to perform
complex vocational work (that demands reading
instructions, counting, working according
to a given sequence, etc.) ( .80); (c) Social
domains, i.e. students with severe/profound
ID can develop interpersonal relations, can
develop intimacy relations, are insulted by being
labeled as retards, can learn to wait in line
( .90); (d) Attitudes towards <strong>the</strong> cancellation
of <strong>the</strong> classification of ID and its implications,
i.e. <strong>the</strong> belief that inclusion of students
with all levels of ID will contribute to all of
<strong>the</strong>m: students with mild/moderate ID may
also benefit from studying with students with
severe/profound ID ( .70); (e) The sense
of self-efficacy of <strong>the</strong> educators to work with
students with severe/profound ID, i.e. I have
knowledge, ability and strategies for working
518 / Education and Training in Developmental Disabilities-December 2008
with students with severe/profound ID (
.96).
The CBAM (Hall et al., 1986) based on Hall
and Loucks’ (1978) and Fuller’s (1969) questionnaire,
was used to examine <strong>the</strong> willingness
of education workers to cope with changes
implemented by <strong>the</strong> Special Education Law.
The questionnaire was on an eight-point Likert
scale (0strongly disagree, 7strongly
agree): <strong>the</strong> higher <strong>the</strong> score, <strong>the</strong> higher <strong>the</strong>
subject’s willingness to cope with <strong>the</strong> process
of change and vice versa. The 35 items are
classified into seven stages of concerns and
needs which are not necessarily hierarchical:
subjects can identify with several stages simultaneously.
The seven concern stages are as
follows ( .89) (Hall, et al.):
Stage 0 (Awareness): Teachers have little
awareness of <strong>the</strong> innovation and are not likely
to be concerned about it.
Stage 1 (Informational): Teachers seek an
understanding of <strong>the</strong> innovation itself.
Stage 2 (Personal): Teachers express concerns
about <strong>the</strong>ir ability to meet changing
expectations.
Stage 3 (Management): Teachers focus on
implementation concerns.
Stage 4 (Consequences): Teachers express
concerns about <strong>the</strong> impact of <strong>the</strong> innovation
on <strong>the</strong>ir students or families.
Stage 5 (Collaboration): Teachers begin to
seek relationships that will assist <strong>the</strong>m in implementing
<strong>the</strong> innovation.
Stage 6 (Refocusing): Teachers express an
interest in adapting <strong>the</strong> innovation or considering
alternative innovations.
Fucks (1995) draws four profiles based on
<strong>the</strong>se stages, as follows:
1. Towards a process of change (higher
scores in stages 0-2 and low in <strong>the</strong> o<strong>the</strong>rs).
2. The teacher with some awareness of <strong>the</strong>
change wants information on <strong>the</strong> change
in spite of his concerns.
3. The split person (higher scores in stage
2): The teacher is busy with his personal
needs, is worried about his personal problems
that are related to <strong>the</strong> change.
4. The focused concern: The teacher is in a
process of change and is focused on a
specific concern or need. When <strong>the</strong> teacher’s
scores in stages 3-6 are high, <strong>the</strong> profile
indicates a teacher who is involved in

<strong>the</strong> process of change, whereas when his
scores in <strong>the</strong>se stages are low <strong>the</strong> teacher
has little interest in <strong>the</strong> process of change.
5. Multi-focal profile: A teacher whose needs
are not focused in a particular stage, but
are dispersed over several stages. For example,
a high score in stage 3 indicates
difficulties in action and a high score in
stage 6 indicates ideas regarding an improvement.
General educational attitudes questionnaire (Kerlinger,
1958, 1967, 1980). The aim of this
questionnaire was to examine <strong>the</strong> educational
attitudes of educators regarding conservatism
and progressiveness. The questionnaire includes
30 statements on a six-point Likert
scale (1strongly disagree, 6strongly agree),
16 of which express a progressive attitude and
14 express a conservative attitude. The reliability
in <strong>the</strong> present study was .75, and
.84 for <strong>the</strong> conservatism and progressiveness
scales, respectively.
Demographic information questionnaire. This
questionnaire included questions on <strong>the</strong> subject’s
gender, age, education and duration of
service.
Procedure
The core battery (demographic questionnaire,
attitudes towards <strong>the</strong> new ID definition,
<strong>the</strong> CBAM and <strong>the</strong> general educational attitudes
questionnaire) was administered to
teachers and paraprofessionals eight months
after <strong>the</strong> changes required by <strong>the</strong> Special Education
Law were implemented in <strong>the</strong> schools,
i.e. inclusion of students with severe/profound
ID in <strong>the</strong> schools for students with
mild/moderate ID and activating <strong>the</strong> new curriculum.
In one of <strong>the</strong> schools for students
with severe/profound ID, most of <strong>the</strong> teachers
refused to answer <strong>the</strong> questionnaires, claiming
that <strong>the</strong>y object to <strong>the</strong> inclusion of students
with severe/profound ID with students
with mild/moderate ID. This school was thus
excluded from <strong>the</strong> study.
Results
Attitudes towards <strong>the</strong> 2002 Definition of ID
In order to examine whe<strong>the</strong>r differences in
attitudes towards <strong>the</strong> new definition of ID
would be found between teachers and paraprofessionals,
a 2 2 MANOVA (role X students’
ID level) was carried out. The dependent
variables were <strong>the</strong> five domains of <strong>the</strong>
attitudes questionnaire. A significant main effect
was found for students’ ID level,
F(6,123) 4.79, p .001; 2 .26, for role
F(6,123) 2.67, p .05; 2 .11. However,
<strong>the</strong> results did not yield any significant interaction
between role X ID level, F(6,124)
1.62, p .05. Univariate analyses were performed
separately for each of <strong>the</strong> five domains.
The means, SD and F values for attitudes
towards <strong>the</strong> definition of ID according
to role and students’ levels of ID are presented
in Table 2.
Table 2 indicates lower scores of <strong>the</strong> attitudes
towards <strong>the</strong> new definition of ID in <strong>the</strong>
various domains (2 to 4 out of 6).
Role. Univariate analyses for each of <strong>the</strong>
five domains separately confirmed <strong>the</strong> study
hypo<strong>the</strong>sis: The teachers exhibited higher
scores than <strong>the</strong> paraprofessionals’ in four out
of <strong>the</strong> five domains.
Students’ level of ID. Univariate analyses
performed separately for each of <strong>the</strong> five domains
confirmed <strong>the</strong> study hypo<strong>the</strong>sis: The
educators of <strong>the</strong> students with mild/moderate
ID exhibited higher scores in three domains
compared to <strong>the</strong> educators of <strong>the</strong> students
with severe/profound ID. In contradistinction,
<strong>the</strong> latter exhibited higher scores in selfefficacy
than those working with students with
mild/moderate ID.
Concern Based Adopted Model
A two-way MANOVA (roles X ID level) was
performed in order to examine whe<strong>the</strong>r differences
would be found in <strong>the</strong> willingness of
<strong>the</strong> education workers to cope with <strong>the</strong>
changes stemming from <strong>the</strong> Special Education
Law (1988). A significant main effect was
found for role, F(1,119) 2.88, p .01, 2
.10. However, no differences were found for
levels of ID, F(1,119) 0.96, p .05 and no
significant interaction was found between role
x ID levels, F(1,119) 1.98, p .05. Univariate
analyses for each of <strong>the</strong> stages of <strong>the</strong>
questionnaire were performed separately in
order to examine <strong>the</strong> source for <strong>the</strong> variance.
Means and standard deviations, F values according
to role and <strong>the</strong> students’ level of ID
Attitudes towards <strong>the</strong> New Definition of ID / 519

TABLE 2
Means, SD and F values for attitudes towards <strong>the</strong> new definition of ID according to role and student ID
level
Domains
Mil/Mod
Level
Teachers
(N 96)
Sev./Pro
Level
are presented in Table 3, which indicates that
<strong>the</strong> means scores of all groups in all stages
ranged from 3-5 (out of 8). The highest scores
were found in <strong>the</strong> personal and collaboration
stages.
Role. Univariate analyses performed separately
for each of <strong>the</strong> seven stages confirmed
partially <strong>the</strong> study hypo<strong>the</strong>sis: The teachers
Paraprofessionals
(N 42)
Mil/Mod
Level
Sev/Pro
Level
Mil/Mod
Workers
Total
N 138 F F
Sev/Pro
Workers
Role
(1,122)
ID Level
(2,122)
Prac. skills M 3.62 3.4 2.81 3.2 3.45 3.33 3.88* .30NS
SD .93 1.01 .91 .58 1.97 .93
Conc. skills M 3.04 2.69 2.43 2.51 2.89 2.73 5.40* 4.13*
SD .98 .98 .99 .74 .98 .92
Soc. skills M 3.96 3.55 3.54 3.4 3.85 3.52 3.34* 5.46*
SD .97 1.01 .90 .85 .96 .97
Cancell. ID M 4.01 3.86 3.84 3.73 3.98 3.58 16.22*** 4.17*
SD .78 .65 1.00 .53 .85 .92
Self-efficacy M 3.82 5.05 3.44 4.77 3.72 5.18 .90NS 30.01***
SD 1.01 1.02 1.02 1.02 .96 .94
* p .05, ** p .01, *** p .001 Mil mild, Mod Moderate ID, Sev Severe ID, Prof Profound
ID, Prac practical skills, Conc conceptual skills, Soc social skills, Cancell. ID attitudes towards <strong>the</strong>
cancellation of ID levels
TABLE 3
exhibited higher scores than <strong>the</strong> paraprofessionals
in three stages: awareness, informational
and management.
Interactions. Univariate analysis yielded significant
role X ID level interactions: The
scores of <strong>the</strong> educators of <strong>the</strong> students with
mild/moderate ID were significantly higher in
three stages than <strong>the</strong> scores of <strong>the</strong> educators
Means, SD and F values for attitudes towards <strong>the</strong> new definition of ID according to role and type of
population
Coping with
change
Teachers N 91 Paraprofessionals N 96
Mild/Mod. ID Sev/Prof ID Mild/Mod ID Sev/Prof ID
F Role
F Role
X ID level
M SD M SD M SD M SD (1,122) (2,122)
Awareness 4.80 1.02 4.59 .88 4.00 1.36 4.09 1.22 8.68** .47
Information 4.24 .79 4.57 .91 3.67 1.11 3.89 .73 12.47*** .10
Personal 5.14 1.04 5.23 1.01 4.75 1.05 5.54 1.03 2.00 1.75
Management 4.63 1.01 4.36 1.00 3.20 1.02 4.10 1.05 8.31** 3.94*
Consequences 3.74 1.00 3.66 1.06 3.56 1.01 4.64 1.03 2.74 5.57*
Collaboration 5.27 1.00 5.05 1.06 4.67 1.00 5.47 1.00 .15 4.33*
Re-focusing 4.89 .91 4.65 .92 4.11 1.05 4.73 1.03 2.54 3.94*
* p .05, ** p .01, *** p .001
Mod Moderate ID, Sev Severe ID, Prof Profound ID
520 / Education and Training in Developmental Disabilities-December 2008

of students with severe/profound ID. In contradistinction,
<strong>the</strong> scores of <strong>the</strong> paraprofessionals
working with students with severe/profound
ID were significantly higher compared
to <strong>the</strong>ir peers working with students with
mild/moderate ID.
General Educational Attitudes
A two way MANOVA (roles X ID level) was
performed in order to examine whe<strong>the</strong>r differences
would be found in conservatism/progressiveness.
A significant main effect was
found for role, F(2,130) 3.83, p .05, 2
.15 and for population type, F(2,130) 3.82,
p .05, 2 .16. No significant role x type of
population interaction was found, F(1,130)
0.56, p .05. Univariate analyses for each
measure separately indicated that <strong>the</strong> mean
scores of all groups in both measures ranged
between 3 and 4 (out of 6). The paraprofessionals
exhibited higher scores in conservatism
than <strong>the</strong> teachers F(1,130) 7.4, p .01
and those working with students with severe/
profound ID exhibited higher scores than
those working with students with mild/moderate
ID, F(1,130) 3.72, p .01. However,
no significant differences in progressiveness
were found between role or population type.
Pearson correlations. Pearson correlations
were calculated for <strong>the</strong> entire sample and with
reference to role and students’ level of ID in
order to examine whe<strong>the</strong>r a correlation would
be found between attitudes towards <strong>the</strong> new
definition of ID and CBAS. The results yielded
significant correlations for <strong>the</strong> entire sample
(r .22-.35, p .05), in relation to role (r
.22-.55, p .05) and among <strong>the</strong> workers with
students with mild/moderate ID (r .35-.55,
p .01). No significant correlations were
found between <strong>the</strong> two questionnaires among
<strong>the</strong> workers with students with severe/profound
ID.
Pearson correlations were also calculated
between <strong>the</strong> attitudes towards <strong>the</strong> new definition
of ID questionnaire and <strong>the</strong> general educational
attitudes questionnaire. Significant
positive correlations were found between progressiveness
and four out of <strong>the</strong> five domains
in <strong>the</strong> attitudes towards <strong>the</strong> new definition
(r .30-.49, p .01). No significant correlations
were found between <strong>the</strong> ID attitudes
questionnaire and conservatism. Fur<strong>the</strong>r-
more, no significant correlations were found
between <strong>the</strong> Concerns Adopted Model and
<strong>the</strong> general educational attitudes questionnaire
for <strong>the</strong> total sample, role and type of
population.
No significant correlations were found between
<strong>the</strong> three dependent research variables
(attitudes towards <strong>the</strong> new definition of ID,
willingness to cope with change and general
educational attitudes) and demographic variables
such as age and seniority.
Discussion
The study’s objective was to examine attitudes
of educators working in schools for students
with ID towards <strong>the</strong> new definition (Luckasson,
1992, 2002) and <strong>the</strong>ir attitudes towards
<strong>the</strong> ability of students with severe/profound
ID to be modified and invent new skills. Participants’
willingness to cope with <strong>the</strong> changes
stemming from <strong>the</strong> implementation of <strong>the</strong>
Special Education Law (1988) was also examined,
as well as <strong>the</strong>ir general educational attitudes
(conservatism vs. progressiveness) according
to role and type of population.
Our findings indicated that <strong>the</strong> results of
both questions were interrelated and can be
explained by two <strong>the</strong>oretical frameworks: Social
psychology <strong>the</strong>ories related to <strong>the</strong> acceptance
of weak segments of <strong>the</strong> society and
<strong>the</strong>ories dealing with changes in <strong>the</strong> education
system.
Attitudes towards <strong>the</strong> New Definition of ID
Findings indicate relatively low scores of both
<strong>the</strong> teachers and <strong>the</strong> paraprofessionals in four
out of <strong>the</strong> five domains, ranging between 2
and 4 (out of 6), i.e. between tending to disagree
to tending to agree.
Scores of practical skills (including daily living
and instrumental activities) range between
tending to agree and tending not to agree
(M 2.98, 3.55) for teachers and paraprofessionals,
respectively. Thus, even in <strong>the</strong> adaptive
behavior domain, <strong>the</strong> attitudes of <strong>the</strong>
teachers and <strong>the</strong> paraprofessionals reflect pessimism
towards <strong>the</strong> ability of <strong>the</strong>ir students
with severe/profound ID to eat with a knife, to
prepare a salad, etc.
Scores in <strong>the</strong> conceptual domain are lower
among <strong>the</strong> teachers and <strong>the</strong> paraprofession-
Attitudes towards <strong>the</strong> New Definition of ID / 521

als, respectively (M 2.46, 2.93). The subjects
do not credit individuals with severe/profound
ID as being able to read sign words,
understand math concepts, be self-directed after
modification and being able to perform
complex vocational tasks.
Scores in <strong>the</strong> social domain were higher
than in <strong>the</strong> previous ones, but ranged around
<strong>the</strong> tendency not to agree (M 3.48, 3.84).
The participants were pessimistic regarding
<strong>the</strong> ability of students with severe/profound
ID to develop social and intimacy relations, to
wait in a line, to be part of <strong>the</strong> community.
Cancellation of <strong>the</strong> classification according to <strong>the</strong>
IQ levels. The subjects did not agree with <strong>the</strong>
statements that inclusion of students with all
levels of ID will contribute to all of <strong>the</strong>m, and
that students with mild/moderate ID may also
benefit from studying with students with severe/profound
ID. The results, which range
around <strong>the</strong> tendency not to agree (M 3.79-
3.96), indicate a pessimistic approach, similar
to <strong>the</strong> four above domains.
The Denial Culture and <strong>the</strong> Integrated
Threat Theory of Prejudice can serve as explanations
for <strong>the</strong>se findings. The term Denial
Culture is directed towards devalued and marginalized
groups who suffer from racial discrimination
(Kliewer, Biklen, & Kasa-Hendrickson,
2006). From a psychological point
of view denial is a defense mechanism which
entails ignoring or refusing to believe an unpleasant
reality or internal thoughts and feelings.
It protects a person’s psychological wellbeing
in situations that produce anxiety or
conflict (Encyclopedia of Mental Disorders,
2006).
Kliewer et al. (2006) use <strong>the</strong> term Denial
Culture to express society’s attitudes towards
individuals with disability, postulating that society
is still exhibiting a denial of literate citizenship
for people with perceived intellectual
disabilities. This attitude is expressed by excluding
<strong>the</strong>m from <strong>the</strong> community and segregating
<strong>the</strong>m in residential, educational and
vocational facilities. The denial culture was
expressed in our study by <strong>the</strong> subjects’ low
score in <strong>the</strong> new definition of ID questionnaire.
It should be noted that <strong>the</strong> teachers’
attitudes towards <strong>the</strong> abilities of students with
severe/profound ID in <strong>the</strong> different domains
are not zero reject or zero total. None<strong>the</strong>less,
<strong>the</strong>y refuse to admit <strong>the</strong>ir potential and ability
522 / Education and Training in Developmental Disabilities-December 2008
to benefit from mediation in practical social
conceptual domains, especially in <strong>the</strong> latter.
According to Heider’s (1958) <strong>the</strong>ory of homeostasis,
people are motivated to preserve a
harmonious cognitive, emotional and behavioral
homeostasis between <strong>the</strong>ir three components
of attitudes. A state of incompetence
can cause “external dissonance” – bewilderment,
confusion and psychological tension
and is fertile ground for attitudinal change.
The subjects in <strong>the</strong> present study preferred to
take an ambiguous or neutral attitude which
means denial, ignorance of <strong>the</strong> strength of
students with severe/profound ID or <strong>the</strong>ir
ability to modification. The denial attitude
that was found in our study is apparently a
convenient state for <strong>the</strong> subjects. Recognition
of <strong>the</strong> potential of students with severe/profound
ID would force <strong>the</strong> teachers and <strong>the</strong>
paraprofessionals to search for new methods
and strategies for helping <strong>the</strong>m fulfill <strong>the</strong>ir
potential.
The integrated threat <strong>the</strong>ory of prejudice
(Stephan et al., 1994; Stephan & Stephan,
2001), which was originally used to explain
prejudice towards immigrants and minority
groups in <strong>the</strong> population, can be joined to <strong>the</strong>
above explanations. Apparently, students with
severe/profound ID still cause a sense of fear
and anxiety even among those who work with
<strong>the</strong>m. They pose a real and symbolic threat to
<strong>the</strong> workers’ self-efficacy and self-concept. The
workers <strong>the</strong>refore label <strong>the</strong>m and attribute
<strong>the</strong>m with low ability and an inability to
change.
Ano<strong>the</strong>r explanation of <strong>the</strong> above findings
can be explained by <strong>the</strong> awareness of <strong>the</strong> new
definition of ID. Polloway et al. (1999) reviewed
<strong>the</strong> three major journals in <strong>the</strong> field of
ID (American <strong>Journal</strong> on Mental Retardation, Education
and Training in Mental Retardation and
Developmental Disabilities, Mental Retardation)
and found that between <strong>the</strong> years 1993-1997,
98.5% (N 270) of <strong>the</strong> researches used <strong>the</strong>
traditional classification (Grossman, 1983)
and only two researchers used <strong>the</strong> 1992 support
levels. Polloway, Chamberlain, and Denning
(2000) found that 44 out of <strong>the</strong> 50 states
in <strong>the</strong> United States (86.2%) still use <strong>the</strong> traditional
definition for classification (Grossman,
1983). The new definition (Luckasson et
al., 1992) is used in Kansas and partially in
New Jersey, Tennessee and West Virginia

(5.9%), whereas Kentucky, Massachusetts and
Michigan use <strong>the</strong>ir own definition. No change
has taken place even after modification of <strong>the</strong>
definition in 2002 (American Association on
Intellectual and Developmental Disability,
email, 2006).
In Israel <strong>the</strong> new definition has not yet been
adopted by <strong>the</strong> Ministry of Education, <strong>the</strong>
Ministry of Welfare or <strong>the</strong> Ministry of Health
and <strong>the</strong> traditional definition is still used for
classification. It is <strong>the</strong>refore not surprising
that teachers and paraprofessionals expressed
resistance to this definition. The new definition
should probably be adopted first and
foremost by <strong>the</strong> education and welfare policy
makers. Only <strong>the</strong>n will it be possible to lead to
an improvement in <strong>the</strong> attitudes of teachers
and paraprofessionals towards this definition.
Willingness to cope with changes implemented by
<strong>the</strong> Special Education Law. The total scores of
<strong>the</strong> subjects in <strong>the</strong> various stages of <strong>the</strong> CBAM
questionnaire range from 3-5 (out of 8), i.e.
<strong>the</strong> educators’ willingness to cope with
changes resulting from <strong>the</strong> implementation of
<strong>the</strong> Special Education Law (1988) is moderate.
Both groups exhibited higher scores in
collaboration and personal stages, medium
scores in awareness, information and management
stages and low scores in <strong>the</strong> consequences
stage. The profile exhibited for both
groups is “focused concern” which reflects
concern regarding <strong>the</strong> collaboration <strong>the</strong>y
would receive from <strong>the</strong>ir colleagues and about
<strong>the</strong> effect of <strong>the</strong> change on <strong>the</strong>ir personal
position.
Current results are compatible with o<strong>the</strong>rs
who used <strong>the</strong> same questionnaire and also
indicated low willingness among teachers in
regular schools to cope with reform (Codding,
1997; Fullan & Miles, 1992; Hargreaves,
1994). As far as we know, our study is <strong>the</strong> first
to conduct this questionnaire in special education
schools.
The top/down-bottom/up approaches and
<strong>the</strong> Control Theory can explain our findings.
Changes according to <strong>the</strong> top-down approach
are directed by political and social forces, or
by organization leaders who are fixated by <strong>the</strong>
need to control and predict <strong>the</strong> actions of
everyone in <strong>the</strong> organization (Bushnell, 2003;
Fullan, 1991; Mclaughlin, Talbert, & Bascia,
1990). The bottom-up approach is anchored
in a liberal perception that encourages <strong>the</strong>
planning of education changes by <strong>the</strong> decentralization
of authority, by enabling <strong>the</strong> teachers
to participate in planning <strong>the</strong> change via
change agents, support systems, training and
instruction (Fullan 1993; Jenkins et al., 1994).
Fullan and Miles (1992) and Richardson
(1994), argue that <strong>the</strong> teachers’ commitment
to <strong>the</strong> newly aligned organization may be low
when pushing reform by <strong>the</strong> top-down approach.
The Control Theory (Friedman &
Lackey, 1991) postulates that a sense of control
causes positive feelings, contributes to <strong>the</strong>
teachers’ well-being and helps in <strong>the</strong>ir adjustment
to changes. Teachers’ identification with
<strong>the</strong> proposed changes will lead to <strong>the</strong>ir willingness
to carry <strong>the</strong>m out.
The subjects in <strong>the</strong> present study experienced
a top-down change that was forced as a
consequence of <strong>the</strong> Special Education Law
(1988). Apparently, <strong>the</strong>ir sense of loss of control
is expressed in <strong>the</strong>ir low scores in <strong>the</strong>
willingness to implement <strong>the</strong> changes. Bushnell
(2003) claims that education reforms
should be conducted as a co-constructed process,
ra<strong>the</strong>r than as a unidirectional (top-down
or bottom-up) process. This will afford educators,
policymakers and researchers a better
understanding of <strong>the</strong> complexities involved in
implementing a successful prototype. The key
for successful implementing of <strong>the</strong> change is
<strong>the</strong> involvement and support of teachers, principals,
superintendents, parents, students and
board members to create and sustain reform.
Implementation of <strong>the</strong> new definition of ID
and changes stemming from <strong>the</strong> Special Education
Law should be administered using <strong>the</strong>
above approach. The definition should be accepted
by special education policy makers in
<strong>the</strong> Ministry of Education and its implementation
by <strong>the</strong> fieldworkers should be carried
out concomitantly. Only simultaneous activity
of special education policy makers and among
special educational schools and teachers will
contribute to <strong>the</strong> implementation of <strong>the</strong> definition
and its implications for students with
severe/profound ID. The teachers should be
encouraged to be agents of <strong>the</strong> change and
must understand <strong>the</strong> <strong>the</strong>oretical basis of <strong>the</strong>
definition and its application to reality.
It is recommended to conduct a workshop
on <strong>the</strong> new definition of ID for <strong>the</strong> teachers
and paraprofessionals prior to its implementation.
The new definition should be pre-
Attitudes towards <strong>the</strong> New Definition of ID / 523

sented, as well as its <strong>the</strong>oretical based model.
It is recommended to shape <strong>the</strong> differences
between <strong>the</strong> two definitions by presenting examples
of diagnosis and Individuals Educational
Program (IEP) of students with ID according
to <strong>the</strong> traditional (Grossman, 1983)
and <strong>the</strong> new definitions (Luckasson et al.,
2002).
General educational attitudes (progressiveness
and conservatism) in relation to role and students
level of ID. Our hypo<strong>the</strong>sis was partially confirmed.
The paraprofessionals exhibited
higher scores in conservatism than <strong>the</strong> teachers.
However, no differences in progressiveness
were found between <strong>the</strong> two groups.
It should be noted that <strong>the</strong> teachers scored
significantly higher in four out of <strong>the</strong> five
domains of <strong>the</strong> new definition of ID questionnaire.
They believe in <strong>the</strong> modifiability of students
with severe/profound ID in practical,
social, and cognitive domains and support <strong>the</strong>
cancellation of IQ levels. The results of <strong>the</strong>
CBAM questionnaire also confirm <strong>the</strong> hypo<strong>the</strong>sis.
The scores of <strong>the</strong> teachers were significantly
higher than those of <strong>the</strong> paraprofessionals
in three out of <strong>the</strong> seven stages.
The study findings are compatible with
o<strong>the</strong>r studies indicating that university and
academic workers which were less authoritative,
favored autonomy and integration of individuals
with intellectual disability and mental
illness compared with direct staff and
paraprofessionals (Shanley & Guest, 1995;
Slevin & Sines, 1996).
The pattern between <strong>the</strong> teachers and <strong>the</strong>
paraprofessionals in our study can be explained
by <strong>the</strong> “cognition need” concept (Cacioppo,
Petty, Kao, & Rodriguez, 1986). Cognition
need is defined as a “stable individual
differences in dealing with cognitive activity
and enjoying it”. Those with a high level of
cognition need gain pleasure from <strong>the</strong> cognitive
process and not necessarily from <strong>the</strong> final
result. High cognition need reflects internal
motivation for acquiring fur<strong>the</strong>r information,
a higher level of thinking and problem solving
and is also expressed in an acceptance of
changes (Israel & Nitzan, 2005). Lassister,
Briggs, and Slaw (1991), found that subjects
with a high need of cognition use a larger
amount of knowledge to cope with <strong>the</strong>
change, compared to those with a low need of
cognition. The level of cognition needs was
524 / Education and Training in Developmental Disabilities-December 2008
not empirically examined in this study. However,
we permit ourselves to use this concept
as one of <strong>the</strong> explanations for <strong>the</strong> differences
between <strong>the</strong> teachers and <strong>the</strong> paraprofessionals
in progressiveness/conservatism, in <strong>the</strong> attitudes
towards <strong>the</strong> new definition of ID and
in <strong>the</strong> concerns and needs.
Differences According to Students’ Level of ID
The workers with students with severe/profound
ID exhibited significantly higher scores
in conservatism than those working with students
with mild/moderate ID. Univariate
analysis indicated that <strong>the</strong> paraprofessionals
who work with students with severe/profound
ID exhibited higher scores in conservatism
than <strong>the</strong> teachers. This finding is unique to
<strong>the</strong> current study, and confirms <strong>the</strong> claim that
<strong>the</strong> conservatism level is influence by <strong>the</strong> type
of occupation, and not only by <strong>the</strong> education
level. Work with students with severe/profound
ID focuses mainly on activities daily
living skills (Hilton & Gerlach, 1997; Mansell
& Elliot, 2001) and <strong>the</strong> workers experience
less success and progress than those working
with students with mild/moderate ID. The
type of occupation apparently shapes <strong>the</strong>
workers’ perception and orientation in various
areas of life. It is <strong>the</strong>refore one of <strong>the</strong>
reasons for <strong>the</strong> low scores in conservatism and
in <strong>the</strong> two dependent variables in our study.
This explanation is speculative, and fur<strong>the</strong>r
research is needed to support this claim.
Paraprofessionals play an important role in
<strong>the</strong> life of individuals with ID (Berryman,
Evans, & Kalbag, 2001; Felce & Perry, 1995;
Rice & Rosen 1991; Rose, Jones, & Elliott,
2000). Edelstein and Glenwick (2001) found
that paraprofessionals succeeded in identifying
psychiatric disorders among students with
severe/profound ID in many cases, and
reached <strong>the</strong> right decisions regarding <strong>the</strong>ir
referral for <strong>the</strong>rapy. A manifestation regarding
<strong>the</strong> positions, employment, training and
management of paraprofessionals working
with students with ID (Hilton & Gerlach,
1997) postulates that <strong>the</strong> paraprofessionals’
legal and moral rights should be defined.
They should be awarded instruction and training
prior and during <strong>the</strong>ir work as well as
opportunities for professional development.
Such actions will contribute to an increase in

<strong>the</strong> paraprofessionals’ level, to a change in
<strong>the</strong>ir educational attitude including in <strong>the</strong>
fields which are <strong>the</strong> subject of <strong>the</strong> current
research.
One of <strong>the</strong> interesting findings was <strong>the</strong> relatively
high scores of <strong>the</strong> education workers
who work with students with severe/profound
ID in <strong>the</strong> field of self-efficacy (in <strong>the</strong> attitude
towards <strong>the</strong> new definition questionnaire)
compared with <strong>the</strong> lower scores of those working
with students with mild/moderate ID.
Similar findings were found in Britain (Rose,
Horne, Rose, & Hastings, 2004; Bell & Espie,
2002) among caretakers of students with severe/profound
ID. Although <strong>the</strong> caretakers
reported negative emotions such as anger,
sadness, helplessness and dissatisfaction from
<strong>the</strong> level of support offered <strong>the</strong>m, <strong>the</strong>y did not
experience a decrease in <strong>the</strong> sense of achievement
and self-efficacy regarding <strong>the</strong>ir work
with students with severe/profound ID. This
finding may be explained by a sense of mission
experienced by this group of workers. It is
possible that <strong>the</strong> lower level of <strong>the</strong> students in
this group, <strong>the</strong>ir dependence and <strong>the</strong>ir helplessness
result in a special bond between <strong>the</strong>
caretakers and <strong>the</strong>ir protégés, which is expressed
in higher scores in <strong>the</strong>ir self-efficacy.
Our findings also indicate that those working
with students with severe/profound ID
exhibited significantly higher scores in six out
of <strong>the</strong> seven stages of <strong>the</strong> CBAM questionnaire
than those who work with students with mild/
moderate ID. This finding is supported and
will be explained by Pearson correlations between
<strong>the</strong> study variables.
Correlations between <strong>the</strong> Study Variables
Pearson correlations between attitudes towards
<strong>the</strong> new definition of ID and <strong>the</strong> willingness
to cope with <strong>the</strong> changes implemented
by <strong>the</strong> Special Education Law (1988)
were found for <strong>the</strong> entire sample, among <strong>the</strong>
teachers, among <strong>the</strong> paraprofessionals and
among educators working with students with
mild/moderate ID. However, no correlations
between <strong>the</strong>se two variables were found
among those working with <strong>the</strong> severe/profound
ID group.
As stated, changes in population and curricula
have taken place mainly in <strong>the</strong> schools for
students with mild/moderate ID, whereas <strong>the</strong>
changes are hardly felt in <strong>the</strong> schools for students
with severe/profound ID. The fact that
<strong>the</strong>se schools remained with <strong>the</strong> same students
and with <strong>the</strong> same curriculum may explain
<strong>the</strong> lack of correlation in <strong>the</strong> study variables
among educators working with students
with severe/profound ID. The attitudes of
<strong>the</strong>se educators towards <strong>the</strong> new definition of
ID are low. However, since <strong>the</strong>y are not forced
to cope with changes, <strong>the</strong>ir willingness to cope
with <strong>the</strong> changes is relatively higher.
The hypo<strong>the</strong>sis about a correlation between
<strong>the</strong> participants’ general educational attitudes
and <strong>the</strong> two dependent variables was partially
confirmed. A significant negative correlation
between attitudes towards <strong>the</strong> new definition
of ID and <strong>the</strong> conservative attitude was found
in all groups, i.e. participants with high scores
in conservatism revealed low scores regarding
<strong>the</strong> new definition of ID. However, <strong>the</strong> lack of
correlations between <strong>the</strong> Concern Based
Adoption Model and <strong>the</strong> general educational
attitudes may stem from <strong>the</strong> different nature
of <strong>the</strong> two questionnaires. The Concerns
Based Adoption Model focuses on emotional
attitudes towards changes, whereas <strong>the</strong> general
educational attitudes questionnaire focuses
on <strong>the</strong> cognitive aspect. These explanations
are speculative, fur<strong>the</strong>r studies are
needed to support <strong>the</strong>se explanations.
Limitations, Implications and Future Research
One limitation refers to conducting <strong>the</strong>
CBAM questionnaire only eight months after
<strong>the</strong> implementation of <strong>the</strong> changes stemming
from <strong>the</strong> Special Education Law. In future
research it is recommended to use <strong>the</strong> prepost
design and to obtain base-line scores of
willingness to cope with changes before <strong>the</strong>
change is implemented and after a period of
time in order to assess <strong>the</strong> effect of <strong>the</strong> change
on <strong>the</strong> participants.
The present study revealed low attitudes towards
students with severe ID. Wolfensberger
(2002) claims that: “When a person is . . . or
severe/profoundly mentally retarded - what
<strong>the</strong>n? What happens to <strong>the</strong> person will depend
almost entirely on how o<strong>the</strong>rs ....and
whe<strong>the</strong>r <strong>the</strong>y value him positively and deeply”
(Wolfensberger, p. 255).
The Special Education Department in <strong>the</strong>
Israeli Ministry of Education established a spe-
Attitudes towards <strong>the</strong> New Definition of ID / 525

cial committee for preparing a national educational
curriculum program for students with
severe and profound ID. It was decided that
actions aimed at changing <strong>the</strong> attitude of education
workers towards this weak population
are to be an integral part of <strong>the</strong> new curriculum.
The new definition of ID will be introduced
to education workers and its contribution
to <strong>the</strong>se individuals will be clarified.
Studies and o<strong>the</strong>r strategies including movies,
stories demonstrating <strong>the</strong> abilities in this
group should be presented.
The implementation of <strong>the</strong> new curriculum
for students with severe/profound ID and <strong>the</strong>
new definition of ID should take into account
<strong>the</strong> <strong>the</strong>ories regarding changes in <strong>the</strong> education
system and should be conducted by applying
both top-down and bottom-up approaches.
Teachers should be partners in <strong>the</strong> change process
and should serve as agents of change. The
effect of <strong>the</strong> suggested interventions programs
on attitudinal change towards individuals with
severe/profound ID should be examined. Our
findings revealed that paraprofessionals exhibited
lower scores than teachers in <strong>the</strong> study variables.
It is <strong>the</strong>refore recommended to empower
this group of workers.
The present study focused on education
workers. Expanding <strong>the</strong> sample to welfare and
health care workers working with populations
with ID will shed light on this subject from
<strong>the</strong>ir point of view.
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Received: 20 March 2007
Initial Acceptance: 25 May 2007
Final Acceptance: 18 November 2007
528 / Education and Training in Developmental Disabilities-December 2008

Implementation of a Programme for Students with Profound
Intellectual and Multiple Disabilities in Schools: Three Case
Studies
Annemarie C. Tadema
Talant, Beetsterzwaag
Carla Vlaskamp and Wied Ruijssenaars
University of Groningen
Abstract: Until recently in <strong>the</strong> Ne<strong>the</strong>rlands, students with profound intellectual and multiple disabilities
(PIMD) rarely made use of <strong>the</strong> educational facilities available. As a result of a new law passed in 2003, an
increasing number of students attend school. A specific curriculum has been developed, but no knowledge has
been gained regarding <strong>the</strong> implementation of this curriculum. The purpose of <strong>the</strong>se three case studies is to explore
<strong>the</strong> implementation process in three schools after <strong>the</strong>y had completed a training programme in working with <strong>the</strong>
curriculum. The results show that <strong>the</strong> implementation of <strong>the</strong> new curriculum is difficult and can be
accompanied by many problems. The implications of <strong>the</strong> results are discussed.
Inclusion of students with special needs in
society has attracted increasing attention over
<strong>the</strong> last ten years. Students with disabilities
must be able to make use of regular provisions
as far as possible and be given every opportunity
to participate fully in society. As a result of
a policy directed at inclusive education in
2003 <strong>the</strong> Dutch Ministry of Education introduced
a new education act. This act reorganized
<strong>the</strong> special and general education systems
and provided support for inclusive
education for all students with special needs.
The new act also affected <strong>the</strong> education of
students with profound intellectual and multiple
disabilities (PIMD) as schools were no
longer allowed to reject <strong>the</strong>se students on
grounds of <strong>the</strong> severity of <strong>the</strong>ir disabilities. Until
<strong>the</strong>n, <strong>the</strong>se students (which <strong>the</strong> Dutch government
refers to as students with an IQ below 35
and additional problems) rarely made use of <strong>the</strong>
educational facilities available. Although <strong>the</strong>y
had <strong>the</strong> formal right to attend school, most parents
applied to a Centre for Special Education
Correspondence concerning this article should
be addressed to Carla. Vlaskamp, University of Groningen,
Department of Special Education, Grote
Rozenstraat 38, 9712 TJ Groningen, The NETHER-
LANDS.
Education and Training in Developmental Disabilities, 2008, 43(4), 529–540
© <strong>Division</strong> on Developmental Disabilities
(CSE) instead. Such centres provide many kinds
of educational and care facilities for students
with disabilities in <strong>the</strong> age range 320. Although
CSEs are not formal educational institutes
(as <strong>the</strong>y are funded by <strong>the</strong> Ministry of
Health), planned and purposeful attention is
paid to <strong>the</strong> development of <strong>the</strong> students.
As a consequence of <strong>the</strong> new law, schools
must be capable of providing <strong>the</strong>se students
with appropriate educational programmes. As
staff at such schools has o<strong>the</strong>r qualifications
than those who work in centres for special
education, and because <strong>the</strong> institution is an
educational one, <strong>the</strong>re was a need for a new
curriculum with corresponding instruments
and procedures. Several approaches in curriculum
design for <strong>the</strong>se students have been developed
in <strong>the</strong> past decades (Horner, 1994;
Logan, Alberto, Kona, & Waylor-Bowen, 1993;
Orelove & Sobsey, 1996; Orelove, Sobsey, &
Silberman, 2004; Rainforth & York- Barr,
1997; Ware & Healey, 1994). However, <strong>the</strong>
research literature provides limited documentation
regarding effective curriculum strategies
for students with PIMD that lead to student
outcomes in <strong>the</strong> areas of academic and
functional skills acquisition (Dymond & Orelove,
2001; Nietupski, Hamre-Nietupski, Curtin,
& Shrikanth, 1997).
Students with Profound Intellectual and Multiple Disabilities / 529

The Ministry of Education <strong>the</strong>refore supported
<strong>the</strong> development of an assessment procedure
and <strong>the</strong> development of a suitable curriculum
(Tadema, Vlaskamp, & Ruijssenaars,
2005; Tadema, Vlaskamp, & Ruijssenaars,
2006; Tadema, Vlaskamp, & Ruijssenaars,
2007). Both were developed specifically for
<strong>the</strong> education of students with PIMD. All eligible
schools were provided with <strong>the</strong>se materials
in <strong>the</strong> summer of 2005. However, it was
not clear whe<strong>the</strong>r <strong>the</strong> materials that had been
developed and distributed actually worked in
practice. No knowledge had been gained regarding
<strong>the</strong> implementation of this curriculum.
Studies investigating <strong>the</strong> implementation
of research-based practices in classrooms show
us how difficult <strong>the</strong> implementation task actually
is (Snell, 2003). Simply having a curriculum
does not guarantee successful implementation.
Apparently, it is not only <strong>the</strong> quality of
<strong>the</strong> new practice that is important, as o<strong>the</strong>r
factors also contribute to <strong>the</strong> success of any
implementation process. The extent to which
an intervention is implemented as intended
seems to play an important role. This process
is referred to as implementation fidelity
(Chen, 2005; Gersten et al., 2005; Martens,
Witt, Elliott, & Darveaux, 1985). Classrooms
are extremely complex places and new approaches
found to be effective in research
settings are likely to fail if something goes
wrong during implementation (Gerstens et
al.). Implementing a curriculum requires
teachers to become familiar with new content,
adapt <strong>the</strong>ir new skills to new materials, and
take <strong>the</strong> initiative to create changes in <strong>the</strong>
classroom (Field & Hofman, 2002). Fur<strong>the</strong>rmore,
instructional practices must reflect and
fit within <strong>the</strong> details of daily classroom instruction.
In addition, <strong>the</strong> degree to which participants
like a programme, or <strong>the</strong> degree of
programme acceptability, will affect <strong>the</strong> degree
to which <strong>the</strong>y use it (Wolf, 1978).
In addition to <strong>the</strong> general problems that are
likely to occur with regard to <strong>the</strong> implementation
of practices and programmes in
schools, more specific implementation problems
may occur regarding <strong>the</strong> implementation
of <strong>the</strong> curriculum developed for students
with PIMD. On <strong>the</strong> student level, <strong>the</strong> severity
and complexity of <strong>the</strong>ir disabilities and <strong>the</strong>ir
apparent lack of progress forms an additional
barrier, as it makes <strong>the</strong> provision of an educational
programme extremely difficult.
Related to this, on <strong>the</strong> teacher level, implementation
problems may also occur, as sensitivity
towards <strong>the</strong> complexity of <strong>the</strong> disabilities
is required. Ano<strong>the</strong>r vision of progress (not
only in terms of developing new skills, but also
in extending existing skills, accepting reduced
support in completing a task, or increase of
engagement) is also needed (Barber & Goltbart,
1998; Marvin, 1998). In addition, most
teachers lack experience with respect to educating
such students (as <strong>the</strong>y have only just
arrived in schools). This may create o<strong>the</strong>r difficulties.
Teachers need to be prepared to
extend <strong>the</strong>ir knowledge and skills with regard
to educating students with PIMD.
Finally, on <strong>the</strong> organizational level, specific
problems may occur if <strong>the</strong> organization does
not support and facilitate <strong>the</strong> implementation.
As <strong>the</strong> quality of <strong>the</strong> educational programme
for a student with PIMD depends
largely on <strong>the</strong> degree to which team members
can work toge<strong>the</strong>r and communicate (Orelove
& Sobsey, 1996), <strong>the</strong> organization needs
to facilitate this process. In addition, extra
personnel may be essential in order to successfully
teach such students. Providing services to
students with PIMD often requires contributions
from many professionals (Dule, Korner,
Williams, & Carter, 1999). A lack of qualified
and skilled personnel may lead to problems
with <strong>the</strong> implementation of <strong>the</strong> curriculum.
Because of <strong>the</strong> problems that may occur
during <strong>the</strong> implementation, and <strong>the</strong> importance
of implementation for <strong>the</strong> success of a
programme, it is essential to investigate <strong>the</strong>
implementation of <strong>the</strong> new curriculum for
students with PIMD. This study explores <strong>the</strong>
implementation process in three schools that
undertook training in working with <strong>the</strong> curriculum.
As all three schools followed <strong>the</strong>
same training programme and were asked to
implement <strong>the</strong> programme at <strong>the</strong> same time
and in <strong>the</strong> same manner, comparisons can be
made between <strong>the</strong>m. This may give us more
understanding of what factors affect <strong>the</strong> new
curriculum implementation strategy.
Method
530 / Education and Training in Developmental Disabilities-December 2008
The study that was conducted had an explorative
nature. Multiple case studies were con-

ducted as <strong>the</strong>y take into account <strong>the</strong> holistic
and meaningful characteristics of real-life
events, and give a detailed description of <strong>the</strong>
phenomenon studied (Yin, 2003). Case studies
allowed us to investigate factors that contributed
to student outcomes. By examining
multiple cases we were able to explore joint
experiences as well as different experiences
across schools.
The Programme
The programme is based on <strong>the</strong> scientific information
available with regard to educating
students with PIMD, and was developed in
cooperation with representatives from Dutch
schools and CSEs. Some basic assumptions
underlie <strong>the</strong> programme. Since <strong>the</strong>re is no
clear sequence in what students with severe
disabilities should learn, teachers must use
principles or frameworks to guide <strong>the</strong>ir
choices and decisions about what to teach
(Ferguson, Willis, & Meyer, 1996; Ford et al.,
1989). Therefore, <strong>the</strong> programme is not a set
curriculum, but consists of a framework that
needs to be adapted for each student. Directions
are available for each step that has to be
taken. As <strong>the</strong> quality of <strong>the</strong> educational programme
for students with multiple disabilities
largely depends on <strong>the</strong> degree to which team
members can work toge<strong>the</strong>r and communicate
(Orelove & Sobsey, 1996), collaborative
teamwork and collaborative goal setting are
expected (Cloninger, 2004; Rainforth & York-
Barr, 1997).
The learning process must start with a thorough
assessment (Carpenter, 1995). Therefore,
<strong>the</strong> Checklist of Child Characteristics
(CCC) (Tadema et al., 2005; Tadema et al.,
2007) is used. The outcomes result in a ‘profile
description’ which gives information
about <strong>the</strong> stronger and weaker capabilities of
a student, and shows clearly what forms of
support are necessary for <strong>the</strong> particular student
(Tadema et al.). This profile forms <strong>the</strong>
basis for setting long-term goals, mid-term
goals and short-term goals. Long-term goals
ought to be achieved in a school year, midterm
goals in a semester, and short-term goals
in a period of approximately four weeks. The
achievement of several sequential short-term
goals leads to <strong>the</strong> achievement of mid-term
goals. If both mid-term goals are achieved, <strong>the</strong>
long-term goals can be evaluated positively as
well.
Both long-term goals and mid-term goals
are formulated during a collaborative meeting
attended by teachers, <strong>the</strong>rapists and parents
(Giangreco, 1996; Orelove & Sobsey, 1996).
There are guidelines available to structure <strong>the</strong>
collaborative meeting in order to decide on
long-term goals and mid-term goals. Shortterm
goals are set by teachers and <strong>the</strong>rapists
independently. Goals can be formulated
within several areas: communication and interaction,
sensory development, play, motor
development and social-emotional development.
Directions are given with regard to <strong>the</strong>
technical criteria that have to be met in setting
<strong>the</strong>se goals (Poppes, Vlaskamp, De Geeter, &
Nakken, 2002).
Guidelines are available with regard to <strong>the</strong>
evaluation criteria necessary for determining
whe<strong>the</strong>r <strong>the</strong> goals have been achieved
(Poppes et al., 2002). Evaluation dates need to
be set in order to prevent <strong>the</strong> formulation of
goals with standards that are ei<strong>the</strong>r too low or
too demanding (Poppes et al.). Goal Attainment
Scaling (GAS; Kiresuk, & Sherman,
1968) is used as <strong>the</strong> evaluation tool, because it
provides an individualized, criterion-referenced
approach to describing even small
changes in <strong>the</strong> performance of students
(Roach & Elliot, 2005). Following all of <strong>the</strong>se
steps within <strong>the</strong> curricular framework will lead
to an Individual Educational Programme
(IEP) for <strong>the</strong> student.
Participants and Selection Procedures
Research took place in <strong>the</strong> school year 2005/
2006. Before <strong>the</strong> school year started, special
schools in <strong>the</strong> Ne<strong>the</strong>rlands were contacted by
e-mail to solicit participation in <strong>the</strong> study. This
e-mail included a brief letter explaining <strong>the</strong>
purpose of <strong>the</strong> study. Initially, fourteen
schools were interested and asked for fur<strong>the</strong>r
information. Eventually, three schools were
selected for location, willingness to follow a
training programme and having five students
with IQ35 and additional problems who
could participate in <strong>the</strong> study. None of <strong>the</strong>
schools had any experience with <strong>the</strong> curriculum.
Schools 1 and 2 are special schools for students
aged 420. Student levels range from
Students with Profound Intellectual and Multiple Disabilities / 531

TABLE 1
Information with regard to <strong>the</strong> teaching assistants and teachers who participated in <strong>the</strong> training
moderate to profound intellectual disabilities.
In both schools only a small group of students
have profound disabilities. School 3 is a combination
of a special school and a CSE. The
students are aged 220, with most students
having severe to profound intellectual disabilities.
In all three schools physio<strong>the</strong>rapy and
speech <strong>the</strong>rapy are available to students when
needed. Seven teachers and four assistant
teachers agreed to follow <strong>the</strong> training and
participate in <strong>the</strong> study. Table 1 provides information
with regard to <strong>the</strong> participating
teachers.
School 1 (range) School 2 (range) School 3 (range)
Number of teachers 5 3 3
Age 38.2 (26–52) 42.3 (33–48) 30.3 (28–35)
Degree
special teacher 1 1 1
teacher 2 2 -
assistant teacher 2 - 2
Teaching experience in years 12.5 (1.5–30) 10.7 (2–22) 4.7 (3–7)
Experience with students
with PIMD in years 3.9 (1.5–7) 12.3 (4–24) 7.7 (5–10)
TABLE 2
Information with regard to <strong>the</strong> student
The three schools all selected five students
who could participate in <strong>the</strong> study. The teachers
who participated were mainly responsible
for designing and working on <strong>the</strong> programme
with one or two students in <strong>the</strong>ir class. Test
results (e.g. Bayley Scales of Infant Development
II-NL; Van der Meulen, Ruiter, Lutje
Spelberg, & Smrkovsky, 2002) show that students
had an estimated IQ of below 35 and
additional problems. The participation of <strong>the</strong>
students was with <strong>the</strong> consent of <strong>the</strong>ir parents.
Table 2 shows information related to <strong>the</strong> students.
School 1 School 2 School 3
Student 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
Gender M F F F F M F M M M M M F F F
Age 13 17 13 8 8 9 8 9 17 13 14 6 9 10 9
Health problems
Vision problems
Motor problems
Epilepsy
Feeding problems
Asd 1
Behavioral problems
Therapy 2
s/p s/p s/p s/p s/p s s/p s/ph s/p p s m m
Living situation 3
gh f f f f f f f gh f gh f f f f
1 asd Autism spectrum disorders
2 s speech and language <strong>the</strong>rapy, p physio<strong>the</strong>rapy, m music <strong>the</strong>rapy
3 gh group home, f family/parents
532 / Education and Training in Developmental Disabilities-December 2008

Procedure
Training. At <strong>the</strong> start of <strong>the</strong> school year
training was given to all participating teaching
assistants and teachers. The training consisted
of five four-hour sessions. The aim of <strong>the</strong>
training was to provide teachers with basic
knowledge of <strong>the</strong> steps that had to be taken in
order to design and use an IEP. The first
session allowed participants to learn some of
<strong>the</strong> <strong>the</strong>ory behind <strong>the</strong> programme, <strong>the</strong> kind of
students for whom <strong>the</strong> programme was intended,
and <strong>the</strong> assumptions underlying <strong>the</strong>
programme. Information on <strong>the</strong> use of assessment
instruments and how to obtain a profile
description was given in <strong>the</strong> second session.
Practising <strong>the</strong> use of those instruments was
also part of this session. The third session paid
attention to setting goals. Information on <strong>the</strong>
use of <strong>the</strong> evaluation tool was given in <strong>the</strong>
fourth session. The use of this tool was also
practised. The fifth session consisted of information
on how to implement <strong>the</strong> programme
in <strong>the</strong> school.
Programme implementation. Participating
teachers were expected to use <strong>the</strong> programme
with one or two participating students for a
period of approximately nine months following
<strong>the</strong> training. All consecutive steps in <strong>the</strong>
programme (from assessment to evaluation)
had to be taken. Participating teachers were
expected to work collaboratively with <strong>the</strong>rapists
involved with <strong>the</strong> student. Teaching assistants
were to be involved in <strong>the</strong> programme
of <strong>the</strong> students. In Schools 1, 2 and 3, three,
four and four assistants and teachers were
involved respectively.
Throughout <strong>the</strong> study, support was available
to assist teachers with questions about <strong>the</strong>
programme. Fur<strong>the</strong>rmore, feedback was provided
on <strong>the</strong> technical aspects of goals and
evaluation.
Measures
The use of a conceptual framework helps to
syn<strong>the</strong>size <strong>the</strong> complex reality of <strong>the</strong> schools
involved in <strong>the</strong> study into a reliable and manageable
description (Ghesquière, Maes, &
Vandenberghe, 2004). Therefore, we used a
framework that consisted of three different
domains:
A. <strong>the</strong> fidelity of <strong>the</strong> programme implementation
(Gerstens et al., 2005). Several programme
features were taken into account,
which included surface features (<strong>the</strong> extent
to which <strong>the</strong> expected intervention is
implemented) and quality features (how
well <strong>the</strong> intervention is implemented)
B. <strong>the</strong> perceptions of and opinions about <strong>the</strong>
programme held by <strong>the</strong> teachers involved
C. <strong>the</strong> impact of <strong>the</strong> programme on students
in terms of <strong>the</strong> number of goals that were
achieved in a period of nine months
To examine <strong>the</strong> implementation of <strong>the</strong> programme
in a wider context, data on aspects of
team collaboration were also collected.
Data Collection and Instruments
Data were collected during <strong>the</strong> school year
2005/2006. Schools were visited by a researcher
on several occasions during <strong>the</strong>
school year. A data-collection protocol was
used to ensure consistency of data that were
collected across schools and participants during
<strong>the</strong> school year.
Data triangulation is necessary in case studies
in order to raise <strong>the</strong> credibility of findings
(Karvonen, Flowers, Browder, Wakeman, &
Algozzine, 2006). Therefore combinations of
qualitative and quantitative methods were
used. Data sources included documents, observations
and questionnaires. Reliable and
valid instruments were chosen where possible.
Documents that were collected included <strong>the</strong>
Profile descriptions, STG- forms which give a
description of each short-term goal, activities,
evaluation criteria, and <strong>the</strong> planned date of
evaluation. Evaluation forms, which contain
<strong>the</strong> date of evaluation, a description of <strong>the</strong>
course, and <strong>the</strong> GAS score were also collected.
Observation records were made during <strong>the</strong>
collaborative meetings in which long-term
goals were set. Fur<strong>the</strong>rmore, two questionnaires
were used to follow <strong>the</strong> implementation:
A. <strong>the</strong> CCC (Tadema et al., 2005). This is a
valid and reliable instrument that takes
into account child characteristics that
are of importance with regard to designing
an IEP.
B. <strong>the</strong> Programme Evaluation Question-
Students with Profound Intellectual and Multiple Disabilities / 533

naire (PEQ). This is a reliable instrument
that measures teachers’ perceptions
and opinions (Vlaskamp, Van
Wijck, Zijlstra, & Van der Putten, 2006).
A three-point Likert scale was used. Response
options range from ‘agree’ to
‘not agree’. Scores range from 0 to 2
with higher values indicating higher acceptability.
Thirty-six items are included
in this study in order to measure teacher
perceptions. These items are divided
into five topics:
1. satisfaction with regard to <strong>the</strong> content
of <strong>the</strong> curriculum (e.g. ‘Working with
this curriculum suits me’)
2. perceived effects on own actions (e.g.
‘I work more systematically’)
3. perceived mastery of <strong>the</strong> programme
(e.g. ‘I feel capable of formulating
short-term goals’)
4. use/usefulness of <strong>the</strong> programme
(e.g. ‘The forms that can be used for
setting goals are useful’)
5. satisfaction with <strong>the</strong> collaborative
teamwork (e.g. ‘I feel supported by my
colleagues while using <strong>the</strong> programme’)
Data Analysis
A cross-site analysis (Miles & Huberman,
1994) was used to analyse <strong>the</strong> data. This
means that all cases were screened for common
<strong>the</strong>mes between <strong>the</strong> cases as well as for
unique findings within <strong>the</strong> separate cases.
Data was analysed according to <strong>the</strong> three domains
mentioned. For measuring implementation
fidelity a checklist was used, containing
all programme features. Record was made of
<strong>the</strong> extent to which <strong>the</strong> features occurred
within <strong>the</strong> intervention and <strong>the</strong> quality of
some of <strong>the</strong> features was taken into account as
well. The programme features that were taken
into account are shown in Table 3.
Teachers’ perceptions and opinions were
analysed using <strong>the</strong> PEQ (Vlaskamp et al.,
2006). The impact on students of working
with <strong>the</strong> programme was analysed by taking
into account <strong>the</strong> percentage and number of
goals that were partly achieved during <strong>the</strong>
nine months of <strong>the</strong> study. The score on <strong>the</strong>
Goal Attainment Scale is <strong>the</strong>refore taken into
account.
Results
First, results of <strong>the</strong> way teachers implemented
<strong>the</strong> programme will be discussed. Second, <strong>the</strong>
perceptions of <strong>the</strong> teachers with regard to <strong>the</strong>
programme are given. Third, <strong>the</strong> impact of
<strong>the</strong> programme on <strong>the</strong> students will be analysed.
Implementation Fidelity
534 / Education and Training in Developmental Disabilities-December 2008
The implementation fidelity is measured by
taking into account <strong>the</strong> deviation between
what teachers have achieved, compared to <strong>the</strong>
expectation of implementation. Table 4 shows
to what extent <strong>the</strong> programme features were
adequately implemented.
As can be seen in Table 4 <strong>the</strong>re are differences
between <strong>the</strong> three schools with regard
to <strong>the</strong> features ‘time’, ‘evaluation’ and ‘duration
of short-term goals’. Whereas School 1 is
able to follow <strong>the</strong> steps that are prescribed,
<strong>the</strong> o<strong>the</strong>r two schools have more difficulty
implementing <strong>the</strong> curriculum.
For School 1, on average it took almost
three weeks to plan collaborative meetings for
setting long-term goals and mid-term goals.
During <strong>the</strong> school year teachers worked on
short-term goals for approximately 70% of <strong>the</strong>
time (113 days). There are little differences in
implementation across students as is reflected
in <strong>the</strong> standard deviation. Evaluation took
place in time, and most short-term goals were
drawn up for four-week periods, as recommended.
School 2 planned a collaborative meeting
immediately, intending to set long-term goals
and mid-term goals, but on average short-term
goals can be found for only 91 days (55.8% of
<strong>the</strong> school year). There are differences in implementation
between students (for example,
<strong>the</strong> number of days short-term goals could be
found ranges from 80 to 111 days across students).
School 3 had difficulty planning a collaborative
meeting to set long-term and mid-term
goals. In addition, on average, during a great
part of <strong>the</strong> school year (55% of <strong>the</strong> time) no
short-term goals can be found. However, <strong>the</strong>
variance between students is high; <strong>the</strong> number
of day’s short-term goals could be found
ranges from 46 to 93 days. For three students
no new mid-term goals were set after one se-

TABLE 3
Programme features taken into account
Programme feature Prescribed intervention
Assessment The Checklist of Child Characteristics is filled in by
parents and by teachers.
A profile description is written by <strong>the</strong> teacher based on
<strong>the</strong> results of <strong>the</strong> Checklist of Child Characteristics
(CCC).
Collaborative meeting A first collaborative meeting is held at <strong>the</strong> beginning of
<strong>the</strong> school year, in which long-term and mid-term
goals (first semester) are set.
Evaluation data are set.
A second collaborative meeting is held halfway through
<strong>the</strong> school year in order to evaluate <strong>the</strong> first midterm
goal and to set a second mid-term goal (second
semester).
Working on short-term goals Short-term goals are set for a period of approximately
four weeks.
Evaluation criteria are set.
Evaluation data are set.
Evaluation of goals takes place on set data.
Time Assessment and collaborative meeting take place at <strong>the</strong>
beginning of <strong>the</strong> school year.
Once goals are set, teachers work on <strong>the</strong> programme
during <strong>the</strong> rest of <strong>the</strong> year.
Quality of goals Short-term goals lead to attainment of mid-term and
long-term goals (i.e. a sequence leading to long-term
goals must be established).
Three quality criteria are used in formulating <strong>the</strong> goals:
1. <strong>the</strong> goal is measurable (i.e. a goal meets fixed
standards)
2. <strong>the</strong> goal is defined as result (i.e. <strong>the</strong> desired result
that one wants to be achieved must be described)
3. <strong>the</strong> goal is clear (i.e. a goal is not open to multiple
interpretations).
mester. Lack of time to set goals and sustained
illness of <strong>the</strong> teacher are given as <strong>the</strong> main
reasons why <strong>the</strong> programme was not followed.
With regard to <strong>the</strong> feature ‘collaborative
meeting’ it is notable that two meetings were
prescribed, however, more meetings were recommended
in order to facilitate <strong>the</strong> transfer
of information between all those involved in
<strong>the</strong> process. The three schools applied different
strategies, School 1 held a meeting every
46 weeks (total of seven in eight months), in
which <strong>the</strong> IEP of all students was briefly discussed.
School 2 held three meetings (including
<strong>the</strong> two that were prescribed) in which <strong>the</strong>
IEP of all students was discussed. School 3 also
held separate extra meetings for each student,
with an average of 3.6 meetings (ranging from
25 collaborative meetings per student).
With regard to <strong>the</strong> quality of goals, all <strong>the</strong>
schools had difficulties setting clear goals (i.e.
not open to more than one interpretation).
School 2 also had difficulty setting goals that
were sequential (logically following each
o<strong>the</strong>r).
Teachers’ Perceptions
Below, teachers’ perceptions are taken into
account with regard to several aspects of <strong>the</strong>
programme. Results are shown in Table 5.
Teachers in School 1 were on average most
satisfied working with <strong>the</strong> programme and
Students with Profound Intellectual and Multiple Disabilities / 535

TABLE 4
Implementation of <strong>the</strong> programme features
Programme feature School 1 School 2 School 3
Assessment
CCC filled in 100% 100% 100%
Profile written by teacher 100% 100% 100%
Collaborative meeting
Long-term goals set 100% 100% 100%
Mid-term goal set (1 st semester) 100% 100% 100%
Mid-term goal set (2 nd semester) 100% 100% 40%
Time*
Nr of schooldays long-term goals &
mid-term goals 149.4 1 (sd 2.2) 163 2 (sd .00) 125 3 (sd 4.5)
Nr of schooldays short term goals 112.8 (sd .48) 91.2 (sd 11.8) 73.4 (sd 20.0)
Working on short-term goals
Number of goals 24 23 16
Duration** 79.2% (19) 69.6% (16) 37.5% (6)
Evaluation criteria set 100% 91.3% 87.5%
Evaluation on set date 100% 56.5% 75%
Quality of short-term goals
Measurable 100% 100% 93.8%
Defined as a result 95.8% 100% 81.3%
Clear 79.2% 73.9% 75%
Sequence established 100% 61% 100%
* time is taken into account by counting <strong>the</strong> average number of school days in 2005/2006 in which <strong>the</strong>re
was an IEP containing long-term goals and short-term goals for all five children per school, starting from <strong>the</strong>
second week of October, following <strong>the</strong> end of <strong>the</strong> training (163 days in total)
** record is made of goals which are drawn for a period of four weeks
1 Long-term goals set at <strong>the</strong> end of October, beginning of November; 2 long-term goals set at <strong>the</strong> beginning
of October; 3 long-term goals set at <strong>the</strong> end of November, beginning of December
with <strong>the</strong> collaborative teamwork. Teachers in
School 3 were least satisfied with <strong>the</strong> programme.
They also felt least capable of working
with <strong>the</strong> programme, and had a more
negative attitude with regard to <strong>the</strong> usefulness
of <strong>the</strong> programme compared to <strong>the</strong> o<strong>the</strong>r two
schools.
TABLE 5
Teachers’ perceptions
Category
Number of
items
Impact of <strong>the</strong> Programme on Students
The numbers of long-term and short-term
goals that were achieved or partly achieved are
shown in Table 6.
Long-term goals were rarely achieved in any
of <strong>the</strong> schools. Mid-term goals in <strong>the</strong> first se-
Range
scores
School 1
(n 5)
mean (sd)
School 2
(n 3)
mean (sd)
School 3
(n 3)
mean (sd)
Perceived effects on own actions 3 0–6 6.00 (.00) 5.67 (.58) 3.67 (1.2)
Satisfaction working with <strong>the</strong> programme 9 0–18 14.00 (2.1) 12.00 (3.0) 9.00 (2.0)
Satisfaction with <strong>the</strong> collaborative teamwork 6 0–12 11.4 (2.1) 7.7 (2.08) 6.67 (.21)
Perceived mastery 7 0–14 11.6 (2.3) 12.7 (.58) 10.00 (4.4)
Use/usefulness of <strong>the</strong> programme 11 0–22 17.8 (2.4) 18.00 (1.0) 14.00 (3.0)
536 / Education and Training in Developmental Disabilities-December 2008

TABLE 6
Number of goals that are achieved
goals School 1 School 2 School 3
Long-term goals
Number of goals set 5 5 5
Achieved 1 0 1
Mid-term goals
Nr of goals set (1 st semester) 5 5 5
Nr of goals achieved (1 st semester) 5 1 2
Nr of goals set (2 nd semester) 5 5 2
Number of goals achieved (2 nd semester) 0 1 0
Short-term goals
Number of goals set 24 23 16
totally achieved* 58.3% 21.7% 43.8%
partly achieved** 37.5% 13% 25%
* score on <strong>the</strong> Goal Attainment Scale of 2 meaning <strong>the</strong> goal is totally achieved
** score on <strong>the</strong> Goal Attainment Scale of 1 meaning <strong>the</strong> goal is partly achieved
mester were achieved for all students in
School 1, and for 1 and 2 students in School 2
and 3 respectively. The percentages of shortterm
goals achieved differ strongly across
schools.
The fact that long-term goals were not
achieved was mainly due to <strong>the</strong> late starts in
working on mid-term goals and short-term
goals. The reasons why mid-term goals were
not achieved varied across students and
schools. As School 1 started working on midterm
and short-term goals late after <strong>the</strong> first
mid-term evaluation <strong>the</strong>re was little time
left. Therefore <strong>the</strong> mid-term goals in <strong>the</strong> second
semester could not be achieved. In
School 2 mid-term goals were evaluated in
time. However, <strong>the</strong>se goals appeared to overestimate
<strong>the</strong> abilities of <strong>the</strong> student, in 4 out of
5 cases (for example, it was expected that a
student would be able to perform activities
independently, however, <strong>the</strong> evaluation
showed that <strong>the</strong> students still needed much
support from <strong>the</strong> teacher, although some
progress had been made). School 3 started
working on mid-term goals and short-term
goals late, and as a result few mid-term goals
could be achieved.
The reasons why short-term goals were not
achieved also varied across students and
schools. Organizational failures such as lack of
materials, broken materials (for example,
communication devices that did not work for
a long period of time), sustained illness of <strong>the</strong>
student or <strong>the</strong> teachers, as well as goals that
were not appropriate (that is, goals that overestimated
<strong>the</strong> ability of <strong>the</strong> student to learn
something new, for example: ‘<strong>the</strong> student can
use two reference objects’, when after four
weeks it turned out that <strong>the</strong> student had only
been able to learn to use one in this period of
time). O<strong>the</strong>r goals were unclear in <strong>the</strong>ir formulation,
which made it hard to determine
whe<strong>the</strong>r <strong>the</strong> goal was achieved or not.
Conclusion and Discussion
The aim of <strong>the</strong> research was to follow three
schools during <strong>the</strong> implementation of a programme
for students with PIMD and to obtain
greater understanding of factors that seem to
affect <strong>the</strong> implementation strategy. The programme
is based upon criteria that can be
found in literature concerned with educational
programmes for students with PIMD.
However, it was not certain that <strong>the</strong> programme
that was developed would work in
schools. The implementation of a new programme
had been found to be difficult and
could be accompanied by many problems.
Failed implementation is <strong>the</strong> most common
reason for failed outcomes (Mills & Ragan,
2000).
In this study <strong>the</strong> differences between <strong>the</strong>
three schools are noticeable. All schools had
Students with Profound Intellectual and Multiple Disabilities / 537

<strong>the</strong> same training, but applied <strong>the</strong> programme
differently. School 1 followed all steps ra<strong>the</strong>r
conscientiously and achieved a reasonable
number of goals. Schools 2 and 3 deviated
from <strong>the</strong> programme on a number of features,
such that two important features ‘evaluation
of goals’ and ‘working on short-term goals’
were not adequately met. No norms are available
with regard to <strong>the</strong> degree to which <strong>the</strong>
programme features that are prescribed
should be followed. However, it does seem
that if <strong>the</strong>se programme features are not adequately
met, it has an impact on <strong>the</strong> number
of goals that will be achieved. The study’s
findings also indicate differences in opinion
and perceptions of teachers with regard to
working with <strong>the</strong> programme.
Points of consideration can be made with
regard to reliability and validity, which are of
concern while conducting case studies. The
internal validity may be threatened by <strong>the</strong>
small group of students, who, fur<strong>the</strong>rmore,
were not chosen at random. Differences between
schools can be due to differences in
students. However, <strong>the</strong> prevalence of additional
problems seems to be comparable
across schools. All schools had no experience
in working with <strong>the</strong> programme and followed
<strong>the</strong> same training at <strong>the</strong> same time. This increases
<strong>the</strong> internal validity, as <strong>the</strong> schools are
comparable on <strong>the</strong>se aspects. However,
School 1 sent five participants to <strong>the</strong> course,
whereas Schools 2 and 3 only sent three participants.
The number of participants in <strong>the</strong>
course may be related to <strong>the</strong> implementation
fidelity as well as <strong>the</strong> impact on <strong>the</strong> students,
but is not taken into account in this study.
To increase reliability a protocol was used to
ensure consistency across participants and
schools and use was made of reliable instruments.
With regard to <strong>the</strong> external validity, a
point of consideration is <strong>the</strong> small sample size
of <strong>the</strong> study. It restricts its focus to three
schools, eleven trained teachers and fifteen
students in total. Although it gives insight into
<strong>the</strong> implementation process, <strong>the</strong> multiple case
design does not allow for generalization beyond
<strong>the</strong> small sample. A larger scale study is
<strong>the</strong>refore necessary.
In addition to <strong>the</strong> reliability and validity of
<strong>the</strong> case studies, o<strong>the</strong>r comments can be made
with regard to <strong>the</strong> implementation process
and <strong>the</strong> effects of <strong>the</strong> implementation. With
538 / Education and Training in Developmental Disabilities-December 2008
regard to <strong>the</strong> implementation strategy, factors
such as precisely following <strong>the</strong> intervention,
collaboration within <strong>the</strong> team and being content
with <strong>the</strong> new programme seem to have an
impact on <strong>the</strong> outcomes. However, no school
was able to follow <strong>the</strong> prescribed implementation
precisely and variation could also be
found between students. Schweinhart (2002)
states that teachers make moment-to-moment
decisions that are determined not just by <strong>the</strong>
model’s guiding principles, goals and objectives,
but also by <strong>the</strong>ir own experience. They
apply <strong>the</strong> model ra<strong>the</strong>r than merely comply
with it. This can account for <strong>the</strong> deviation
from <strong>the</strong> original programme and <strong>the</strong> differences
that can be found between students in
all three schools. Yet, assumptions with regard
to implementation fidelity are not without
controversy. Opponents argue that change is a
necessary part of <strong>the</strong> adoption of any programme,
thus discrepancy between a programme
plan and <strong>the</strong> observable implementation
of <strong>the</strong> plan is desirable and should be
encouraged (Chen, 2005).
When it comes to factors that contributed
to student outcomes, <strong>the</strong> collaboration within
<strong>the</strong> team and <strong>the</strong> support team members give
to each o<strong>the</strong>r seem crucial in following <strong>the</strong>
programme and achieving a considerable
number of goals. This is in line with <strong>the</strong> findings
of Little (1993) who states that collegial
networks can increase teacher capacity by allowing
teams of teachers to capitalize on joint
expertise. Fur<strong>the</strong>rmore, higher satisfaction
and a feeling of mastery of <strong>the</strong> programme
seem to be connected with implementation
fidelity and student outcomes. This is consistent
with <strong>the</strong> findings of Wolf (1978).
With regard to <strong>the</strong> curriculum itself it
should be noted that <strong>the</strong> use of a framework
does have disadvantages as more creativity is
expected from <strong>the</strong> teachers. They must be
able to develop this framework to suit each
student, again based on <strong>the</strong> specific information
<strong>the</strong>y have about that student. There is
little to go by, and this is more demanding for
<strong>the</strong> teacher, and may be even more difficult if
a teacher is not experienced in teaching children
with PIMD. The case studies reveal that
teachers indeed have difficulty with setting
proper goals. Attention should be paid to setting
short-term goals and evaluation of <strong>the</strong>se
goals. The percentage of goals achieved varies

across schools. In care settings, achievement
rates for short-term goals have been set to
78% (Zijlstra, 2003), meaning that 78% of all
short-term goals should be evaluated positively
(that is, totally achieved) on <strong>the</strong> evaluation
date in order to be effective. No achievement
rates have yet been set for educational
settings, but none of <strong>the</strong> schools was able to
achieve <strong>the</strong> 78% rate. Although 78% may not
be <strong>the</strong> most convenient rate for schools, a
standard achievement rate should be specified
in order to guarantee <strong>the</strong> quality of education.
It is acknowledged that teachers have difficulty
setting goals that are clearly formulated
(Giangreco, Dennis, Edelman, & Cloninger,
1994; Poppes et al., 2002). It is noteworthy
that although <strong>the</strong> teachers followed a course
and were aware of <strong>the</strong> quality criteria, some
still had difficulty setting goals that could be
attained within <strong>the</strong> set period. It may take
time to learn to master a new strategy perfectly.
Teachers especially need to become
better judges of what a student will be able to
learn in a set period. Although criteria with
regard to setting goals were brought to <strong>the</strong>ir
attention during <strong>the</strong> training programme, a
more extensive training programme specifically
directed to setting goals may give better
results (Poppes et al.).
This study has shown once more that educating
students with PIMD is difficult. Even a
programme that is specially developed for
such students does not necessarily lead to <strong>the</strong>
desired results. These students have poor
health and some are frequently absent due to
illness (Zijlstra & Vlaskamp, 2005). Moreover,
progression is sometimes hard to see or measure.
However, this cannot be an excuse for
not or only partly implementing a programme.
These students have, as any student,
<strong>the</strong> right to good quality education. This cannot
be guaranteed without good quality IEPs.
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Received: 9 May 2007
Initial Acceptance: 15 July 2007
Final Acceptance: 22 October 2007
540 / Education and Training in Developmental Disabilities-December 2008

Caregiver-Delivered Home-Based Instruction Using
Simultaneous Prompting for Teaching Home Skills to
Individuals with Developmental Disabilities
Sema Batu
Anadolu University
Abstract: It is very important for individuals with all kinds of developmental disabilities to learn skills in order
to be independent at home. The purposes of <strong>the</strong> study were twofold; (1) to examine <strong>the</strong> effectiveness of
caregiver-delivered home-based instruction using simultaneous prompting to children with moderate developmental
disabilities on teaching chained home skills and (2) to find out whe<strong>the</strong>r <strong>the</strong> caregivers would be able to
implement simultaneous prompting procedure correctly throughout <strong>the</strong> study. Moreover, maintenance and
generalization of <strong>the</strong> acquired skills were also evaluated. Participants of <strong>the</strong> study included four children with
moderate mental retardation and <strong>the</strong>ir caregivers. After <strong>the</strong> caregivers were trained to use <strong>the</strong> simultaneous
prompting procedure at <strong>the</strong> beginning of <strong>the</strong> study and were expected to teach three different chained-home skills
to <strong>the</strong>ir children. Results of <strong>the</strong> study revealed that caregivers were successful in using <strong>the</strong> simultaneous
prompting procedure. The children acquired target skills of <strong>the</strong> study conducted with multiple exemplars. Results
also showed that <strong>the</strong> children maintained <strong>the</strong>m one and three weeks after <strong>the</strong> training sessions were completed,
and generalized <strong>the</strong>m across trainers. Results of <strong>the</strong> study were extensively discussed.
Receiving training only at school might not be
enough for some individuals with developmental
disabilities (DD) in order to carry out
<strong>the</strong>ir lives independently. For this reason, besides
formal school training, some children
with DD require additional training approaches
at various settings delivered by parents
or o<strong>the</strong>r professionals. One of <strong>the</strong>se approaches
that has been recognized and
studied is to use parents or primary caregivers
as trainers of <strong>the</strong>ir children at home or o<strong>the</strong>r
settings (Cavkaytar, 2007; Collins, 2007).
Once caregivers are trained to act as trainers
of <strong>the</strong>ir children with DD, <strong>the</strong>y can use <strong>the</strong>
strategies or competencies <strong>the</strong>y were taught
The author would like to thank to <strong>the</strong> participant
children and <strong>the</strong>ir caregivers for <strong>the</strong>ir patience, efforts
and willingness for <strong>the</strong> study. The author is also very
grateful to Professor Gonul Kircaali-Iftar, Dr. Elif
Tekin-Iftar, and Dr. Ibrahim H. Diken for <strong>the</strong>ir supporting
and insightful reviews and feedback and also
to Serhat Yildirim for her support and help during <strong>the</strong>
study. Correspondence concerning this article should
be addressed to Sema Batu, Anadolu University, Engelliler
Arastirma Enstitusu, Eskisehir, TURKEY,
26470. Email: esbatu@anadolu.edu.tr
Education and Training in Developmental Disabilities, 2008, 43(4), 541–555
© <strong>Division</strong> on Developmental Disabilities
during various skill or behavior instructions to
<strong>the</strong>ir children at home. Since children with
moderate to severe disabilities do not have <strong>the</strong>
advantage of observational learning in natural
environments, <strong>the</strong>ir primary caregivers can be
efficient home-trainers for <strong>the</strong>ir children.
The importance of parental or primary
caregivers’ involvement in <strong>the</strong> educational
programs of <strong>the</strong>ir children has been recognized
and getting great attention in both policies
and practices. It has been reported that
<strong>the</strong> involvement of parents and caregivers into
<strong>the</strong> educational program of <strong>the</strong>ir children
may result in various positive outcomes for
children with DD and <strong>the</strong>ir parents. For example,
results of <strong>the</strong> studies indicated that
when parental involvement occurred, children
easily generalized <strong>the</strong> acquired skills, <strong>the</strong>
interventions started at school continued successfully
at home, and <strong>the</strong> parents felt more
satisfied about being a part of <strong>the</strong> educational
program of <strong>the</strong>ir children (Collins, 2007;
Spann, Kohler, & Soenksen, 2003).
Regarding using parents or caregivers efficiently
on teaching, several studies reported
that parents and caregivers were effective on
teaching various skills to <strong>the</strong>ir children with
Caregiver-Delivered Home-Based Instruction / 541

DD. The skills taught in <strong>the</strong>se studies included
self-care and domestic skills (Cavkaytar, 2007),
community skills (Tekin-Iftar, in press), laundry
skills (Morrow & Bates, 1987), language
and communication skills (Seung, Ashwell, Elder,
& Valcante, 2006; Tait, Sigafos, Woodyatt,
O’Reilly, & Lancioni, 2004), snack preparation
skills (Wall & Gast, 1997a), restaurant
skills (Alvey & Aeschleman, 1990), purchasing
skills (DiPipi-Hoy & Jitendra, 2004), and leisure
skills (Wall & Gast, 1997b). In <strong>the</strong> related
literature, <strong>the</strong>re is evidence about parents’
success in teaching many skills to <strong>the</strong>ir children
with DD. However, in order to expand
<strong>the</strong>se practices as evidence-based, more studies
using parents or caregivers as trainers of
<strong>the</strong>ir children to teach various skills at home
as <strong>the</strong> most naturalistic setting, are needed.
Simultaneous Prompting (SP) is one of <strong>the</strong>
response prompting teaching techniques
known to be a user-friendly procedure (Akmanoglu
& Batu, 2004; Akmanoglu-Uludag
&Batu, 2005; Morse & Schuster, 2004; Tekin-
Iftar, 2003; Wolery, Ault, & Doyle, 1992).
While using SP, since <strong>the</strong> controlling prompt is
provided right after <strong>the</strong> target stimuli, <strong>the</strong> participant
does not have <strong>the</strong> chance to give incorrect
responses. For this reason, before each
training session, a daily probe session needs to
be conducted in order to see <strong>the</strong> effectiveness of
<strong>the</strong> teaching procedure on <strong>the</strong> participant. Several
advantages of <strong>the</strong> SP have been reported by
teachers and o<strong>the</strong>r practitioners such as parents
and caregivers. While using SP, <strong>the</strong> participant
(child or student) does not need to be taught a
waiting response (which is usually a problem for
children with DD). Ano<strong>the</strong>r advantage is <strong>the</strong>
similarity of sessions during <strong>the</strong> teaching procedure.
At this point, practitioners need to learn
only 0 sec. delay teaching procedure. In <strong>the</strong> SP
procedure, type of correct response is only one
type for <strong>the</strong> learner. Therefore, <strong>the</strong> practitioner
does not need to use different types of reinforcement
systems (Parrott, Schuster, Collins, & Gassaway,
2000; Tekin & Kircaali-Iftar, 2001).
In several studies, <strong>the</strong> effectiveness of SP has
been reported. For example, it has been
found effective on teaching discrete skills such
as relative names (Akmanoglu-Uludag & Batu,
2005), pointing to <strong>the</strong> numerals (Akmanoglu
& Batu, 2004), community signs (Tekin-Iftar,
2003), receptive picture identification (Tekin
& Kircaali-Iftar, 2002), identifying occupa-
542 / Education and Training in Developmental Disabilities-December 2008
tions (Dogan & Tekin-Iftar, 2002), receptive
manual sign identification (Palmer, Collins, &
Schuster, 1999), reading grocery sight words
(Singleton, Schuster, Morse, & Collins, 1999),
word identification (Griffen, Schuster, &
Morse, 1998), science vocabulary words (Johnson,
Schuster, & Bell, 1996), community signs
(Singleton, Schuster, & Ault, 1995) and
chained skills such as community skills (Tekin-
Iftar, in press), academic skills (Riesen, Mc-
Donnell, Johnson, Polychronis, & Jameson,
2003), hand washing (Parrott et al., 2000),
construction of shipping boxes (Maciag,
Schuster, Collins, & Cooper, 2000), vocational
task (Fetko, Schuster, Harley, & Collins,
1999), dressing (Sewell, Collins, Hemmeter, &
Schuster, 1998), and making juice (Schuster
& Griffen, 1993). Results of <strong>the</strong> above studies
revealed that SP was effective in teaching
chained skills to individuals with DD. Literature
on SP shows that studies conducted on
teaching chained skills by using SP are limited.
Most of <strong>the</strong> studies conducted were with
teachers by using SP. There are limited studies
carried out by o<strong>the</strong>rs ra<strong>the</strong>r than teachers using
SP to teach various skills. For example,
Tekin and Kircaali-Iftar (2002) studied <strong>the</strong> SP
delivered by siblings, Tekin-Iftar, (2003) used
peers to carry out <strong>the</strong> SP procedure and in
Tekin-Iftar (2008), <strong>the</strong> SP procedure was delivered
by <strong>the</strong> parents of participants. In order
to promote <strong>the</strong> evidences of <strong>the</strong>se practices,
more studies are need to be conducted by <strong>the</strong>
SP delivered by people o<strong>the</strong>r than <strong>the</strong> teachers
of <strong>the</strong> students with DD.
In order to be real partners in <strong>the</strong> community,
individuals with DD need to learn different
kinds of skills. Self-care skills, communitybased
skills, daily living skills, home skills,
prevocational skills, and vocational skills are
vital skills to be learned during <strong>the</strong> life span
for individuals with DD to act as a part of <strong>the</strong>
community (Cavkaytar, 2007; Smith, Patton, &
Ittenbach, 1994). Among <strong>the</strong>se skills, daily living
and home skills are basic skills for individuals
to be independent at home (Westling,
1996), while <strong>the</strong> o<strong>the</strong>r skills are <strong>the</strong> ones to be
independent in <strong>the</strong> community. Home skills
are considered as age-appropriate functional
skills for individuals with moderate DD (Browder
& Bambara, 2000; Collins, 2007). In order
to be independent at home, it is critical for
individuals with moderate DD to learn and

practice home skills efficiently. In Turkey, when
teaching students with moderate DD is considered,
<strong>the</strong>re is a general national curriculum in
state schools to teach <strong>the</strong>se students. However,
teaching home skills is not part of this curriculum.
Therefore, alternative solutions are
needed to fill this gap, and studies regarding
teaching home skills to children with DD are
needed in order to find out <strong>the</strong> effectiveness of
caregiver provided SP on teaching home skills
to <strong>the</strong>ir children with DD. Based on <strong>the</strong> needs
mentioned both in related literature and practice
in Turkey, <strong>the</strong> present study was designed to
examine effectiveness of caregiver-delivered
home-based instruction using SP for teaching
chained home skills to individuals with DD. Related
to this general purpose, <strong>the</strong> following research
questions were addressed: (1) Is caregiver
provided SP effective on teaching home
skills to target children with DD?, (2) Are target
children going to maintain acquired skills one
and three weeks after <strong>the</strong> training sessions are
completed?, (3) Are target children going to
generalize <strong>the</strong> acquired skills across trainers?,
(4) Are target caregivers going to be able to use
<strong>the</strong> SP procedure reliably during <strong>the</strong> study?, and
(5) What do target caregivers think about <strong>the</strong>
caregiver-delivered home–based instruction using
SP to teach home skills?
Method
Participants
Participants were four children with DD and
<strong>the</strong>ir caregivers. Three children were male
and <strong>the</strong>ir caregivers were <strong>the</strong>ir mo<strong>the</strong>rs, and
one of <strong>the</strong> children was female and her caregiver
was her grandmo<strong>the</strong>r. Ages of <strong>the</strong> children
ranged between 6-9 years and <strong>the</strong> caregivers’
ages ranged between 30-50 years. All
<strong>the</strong> caregivers were housewives and all of <strong>the</strong>m
have finished primary school. All of <strong>the</strong> children
functioned within <strong>the</strong> moderate range of
mental retardation (full scale IQ 40-51) and
were attending regular schools (Mehmet and
Ali were attending <strong>the</strong> first grades of different
primary schools, Hasan was attending to a
pre-school and Ceyda was attending a selfcontained
class of a regular school).
In order to participate, <strong>the</strong> caregivers were
asked to volunteer. They were also asked if
<strong>the</strong>y would like to teach home skills to <strong>the</strong>ir
children after <strong>the</strong>y were taught to use a specific
teaching method. The following prerequisite
skills were considered for target children:
(a) to keep attention on an activity for at
least 5-10 minutes (during <strong>the</strong> pilot study, it
was determined that sessions would last a maximum
of 10 minutes), (b) to follow successfully
simple verbal instructions (i.e., take <strong>the</strong>
spoon, put some yogurt into <strong>the</strong> spoon, etc.),
and (c) to be willing to learn <strong>the</strong> selected skills
from his/her caregiver.
All of <strong>the</strong> target children were able to perform
some basic self-help skills such as toileting,
dressing and undressing. They all had limited
verbal communication (e.g., when <strong>the</strong>y tried to
request something from <strong>the</strong> people around
<strong>the</strong>m, people usually had difficulties understanding
<strong>the</strong> words correctly). They were all provided
with special education from a university
center for <strong>the</strong> children with DD in a group for
three years, and are currently having 1-1 lessons
twice a week from a private special education
school or from <strong>the</strong> university unit.
Settings
While <strong>the</strong> first caregiver training session was
conducted in <strong>the</strong> author’s office, most of <strong>the</strong>
sessions were carried out in <strong>the</strong> houses of
participants. Sessions took place in places relevant
to teaching a particular target skill (e.g.,
teaching wearing socks was conducted in <strong>the</strong>
bedroom, setting <strong>the</strong> table was conducted in
<strong>the</strong> kitchen or living room, making <strong>the</strong> bed
was conducted in <strong>the</strong> bedroom, etc.).
Some of <strong>the</strong> sessions were conducted in <strong>the</strong>
unit for children with DD in <strong>the</strong> Research
Institute for <strong>the</strong> Handicapped at Anadolu
University. In order to conduct <strong>the</strong> study in a
multiple exemplar format, sessions were conducted
in related settings in <strong>the</strong> university unit
(e.g., setting <strong>the</strong> table was conducted in <strong>the</strong>
kitchen, making <strong>the</strong> bed was conducted in <strong>the</strong>
physio<strong>the</strong>rapy room where <strong>the</strong>re was a bed for
<strong>the</strong> patients, etc.). In all settings, <strong>the</strong> author,
target caregiver and target child were toge<strong>the</strong>r
except <strong>the</strong> first caregiver training session.
Materials
Materials were selected among <strong>the</strong> daily materials
in <strong>the</strong> houses of participants. For each
target skill, different materials were needed
Caregiver-Delivered Home-Based Instruction / 543

and used: (a) For setting <strong>the</strong> table: Two sets of
plates, spoons, forks, glasses, and a pitcher
were used. (b) For preparing yogurt drink:
two glasses, two spoons, one pitcher, some
salt, and a cup of yogurt were used. (c) For
preparing sandwich: four slices of bread, two
slices of cheese, and two slices of salami were
used. (d) For hanging trousers: Two trousers
and two hangers were used. (e) For hanging
shirts: Two shirts and two hangers were used.
(f) For wearing socks: Two pairs of socks were
used. (g) For folding sweatshirt: Two sweatshirts
were used. (h) For making bed: Sheet,
pillow, and a quilt were used. (i) For tying
shoe laces, a pair of shoes and laces was used.
Caregivers were told to provide different materials
for every session in order to conduct
<strong>the</strong> study in a multiple exemplar format. In
<strong>the</strong> university unit, materials being regularly
used in <strong>the</strong> unit were used in <strong>the</strong> study.
The author brought tangible reinforcers
(e.g., M&Ms, candies, juices, biscuits, etc.) for
every session to <strong>the</strong> houses and also to <strong>the</strong>
center. Data collection forms were used for
data collection. The author videotaped sessions
by using a handy cam camera.
Task Analyses
For each skill, task analyses were developed by
<strong>the</strong> author. In <strong>the</strong> first caregiver training session,
after training <strong>the</strong> caregivers, each caregiver
was asked to select <strong>the</strong> target skills to be
taught to <strong>the</strong>ir children. Through <strong>the</strong> home
skills checklist prepared by <strong>the</strong> author, caregivers
selected three skills <strong>the</strong>ir children could
not manage at home independently. After determining
target skills for each child, task
analyses of those skills were given to caregivers
to read and give feedback about <strong>the</strong> manageability
of <strong>the</strong> tasks through <strong>the</strong> analyses. After
discussing with caregivers, some of <strong>the</strong> analyses
were modified depending on <strong>the</strong> conditions
of <strong>the</strong> participants’ houses and <strong>the</strong> materials
used in <strong>the</strong> natural environments. Out
of eight target skills, two of <strong>the</strong> task analyses
are presented as examples in Table 1.
Dependent Measures
Two kinds of dependent measures were examined.
The first was <strong>the</strong> caregivers’ implementation
of SP and <strong>the</strong> o<strong>the</strong>r was <strong>the</strong> acquisition
of target skills by target children. Caregivers’
implementation of home-based instruction
with SP was examined for treatment integrity
purposes. Children’s acquisition of <strong>the</strong> target
skills were also examined through <strong>the</strong> steps
acquired correctly in <strong>the</strong> task analyses of each
skill during probe sessions.
Procedure
544 / Education and Training in Developmental Disabilities-December 2008
Experimental procedure consisted of parent
training sessions, and full probe, daily probe,
training, maintenance, and generalization sessions.
All sessions were conducted by caregivers
ei<strong>the</strong>r at <strong>the</strong>ir homes or in <strong>the</strong> university
center for children with DD. Two daily probe
sessions and two training sessions were conducted
in every visit.
Parent training sessions. Caregivers were
trained through a training procedure by
Tekin-Iftar (2003, 2008) and found to be effective
on teaching <strong>the</strong> intervention to <strong>the</strong>
parents and siblings. In caregiver training sessions,
caregivers were trained through a verbal
description, role modeling, guided practice,
and performance feedback sequence in a 1-1
teaching format.
Caregiver training sessions took an average
of 40 minutes with each caregiver. During
training sessions, caregivers were first informed
about <strong>the</strong> instructional concepts (e.g.,
controlling prompt, response interval, reinforcement,
etc.) without using any technical
terms. Then, <strong>the</strong> author role-played and modeled
SP by using both positive and negative
examples. Each caregiver was asked about <strong>the</strong>
negative examples in <strong>the</strong> modeling and what
<strong>the</strong> author should have done instead. After
that, caregivers were asked to be <strong>the</strong> teachers
and <strong>the</strong> author would be <strong>the</strong>ir student. During
this step, <strong>the</strong> author provided feedback to <strong>the</strong>
caregivers until <strong>the</strong>y performed <strong>the</strong> SP procedure
with 100% accuracy.
Full probe sessions. Full probe sessions were
conducted before all <strong>the</strong> skills were taught as
a determination of performance level of <strong>the</strong>
target children. Also full probe sessions were
conducted after <strong>the</strong> criterion was met by children
during training sessions for each target
skill. During all full probe sessions, three target
skills were asked to be performed by target
children. Each target skill was asked three
times. After children met criterion with <strong>the</strong>

TABLE 1
Task analyses
Making Yogurt Drink
1. Takes <strong>the</strong> spoon with right hand
2. Puts <strong>the</strong> spoon into <strong>the</strong> yogurt cup
3. Puts some yogurt into <strong>the</strong> spoon
4. Takes <strong>the</strong> spoon out of <strong>the</strong> yogurt cup
5. Puts <strong>the</strong> yogurt into <strong>the</strong> glass
6. Mixes <strong>the</strong> yogurt by turning <strong>the</strong> spoon in <strong>the</strong> glass
7. Leaves <strong>the</strong> spoon in <strong>the</strong> glass
8. Takes <strong>the</strong> pitcher with right hand
9. Puts some water into <strong>the</strong> glass
10. Leaves <strong>the</strong> pitcher onto <strong>the</strong> table
11. Takes <strong>the</strong> spoon with right hand
12. Mixes <strong>the</strong> water with yogurt by turning <strong>the</strong> spoon in <strong>the</strong> glass
13. Takes salt by left hand
14. Puts some salt into <strong>the</strong> glass
15. Mixes all <strong>the</strong> ingredients by turning <strong>the</strong> spoon in <strong>the</strong> glass
16. Takes <strong>the</strong> spoon out of <strong>the</strong> glass
17. Puts <strong>the</strong> spoon on <strong>the</strong> table
Setting Table
1. Takes <strong>the</strong> plates from <strong>the</strong> counter with both hands
2. Puts <strong>the</strong> plates onto <strong>the</strong> table
3. Goes back to <strong>the</strong> counter
4. Takes spoons and forks from <strong>the</strong> counter
5. Puts <strong>the</strong> spoons and forks on <strong>the</strong> table
6. Takes <strong>the</strong> spoons with right hand
7. Puts <strong>the</strong> spoons to <strong>the</strong> right sides of <strong>the</strong> plates
8. Takes <strong>the</strong> forks with right hand
9. Puts <strong>the</strong> forks to <strong>the</strong> left sides of <strong>the</strong> plates
10. Goes to <strong>the</strong> counter
11. Takes one glass to each hand
12. Puts <strong>the</strong> glasses on <strong>the</strong> right sides of <strong>the</strong> plates above <strong>the</strong> spoons
13. Goes back to <strong>the</strong> counter
14. Takes <strong>the</strong> pitcher with both hands
15. Takes <strong>the</strong> pitcher to <strong>the</strong> table
16. Puts <strong>the</strong> pitcher on <strong>the</strong> table
first target skill, <strong>the</strong> second full probe session
was conducted. Similarly, after meeting criterion
with <strong>the</strong> second target skill, third full
probe session was conducted, and lastly, after
meeting criterion with <strong>the</strong> third target skill,
last full probe session was conducted. The
same procedure was followed by all children.
Full probe sessions were conducted as follows:
(a) <strong>the</strong> materials (e.g., shirts and hangers, jellies,
biscuits) were placed in <strong>the</strong> room where target
skills were to be taught, (b) caregiver and <strong>the</strong>
child were asked to take <strong>the</strong>ir places in <strong>the</strong>
room, (c) an attentional que (i.e., “Mehmet, are
you ready?”) was provided by <strong>the</strong> caregiver to
<strong>the</strong> participant, and a task direction (i.e., “Mehmet,
wear your socks”) was given by <strong>the</strong> caregiver,
(d) a4swaiting interval was provided for
<strong>the</strong> participant child’s response, (e) correct responses
were rewarded verbally, and incorrect
responses were ignored by <strong>the</strong> caregiver. The
next trial was conducted 5 min after <strong>the</strong> previous
one was completed.
Correct responses of participants were rewarded
verbally by caregivers during full probe
sessions (i.e. well done, yes, that’s right, etc.).
Responses were considered as correct when <strong>the</strong>
target child performed successfully <strong>the</strong> steps of
<strong>the</strong> target skill while responses were considered
Caregiver-Delivered Home-Based Instruction / 545

incorrect when target child was doing o<strong>the</strong>r
things ra<strong>the</strong>r than performing steps of <strong>the</strong> target
skill, performing <strong>the</strong> steps after <strong>the</strong> 4 s interval,
or doing anything at all in 4 s. For encouraging
target children to cooperate and attend <strong>the</strong> full
probe sessions, children were praised verbally by
<strong>the</strong>ir caregivers, and were provided tangible reinforcers
by <strong>the</strong> author at <strong>the</strong> end of <strong>the</strong> full
probe sessions.
Daily probe sessions. According to <strong>the</strong> SP
teaching procedure, <strong>the</strong> participant receives
an immediate controlling prompt which does
not allow him/her to respond independently
to task directions. Therefore, daily probe sessions
were conducted before each training session
in order to give participants <strong>the</strong> chance to
respond independently. During all daily probe
sessions each target skill was asked once.
The only difference between full probe sessions
and daily probe sessions was that, during
full probe sessions all target skills were asked,
during daily probe sessions, only <strong>the</strong> target skill
being taught was asked. As during full probe
sessions, correct responses were rewarded with
verbal praise, whereas all incorrect responses
were ignored by <strong>the</strong> caregiver. Also, attention
and cooperation of participants were reinforced
at <strong>the</strong> end of each daily probe session.
SP training sessions. Home-based instruction
with SP was used to teach different skills
to children with DD by <strong>the</strong>ir caregivers. During
training sessions, <strong>the</strong> caregiver provided
<strong>the</strong> task direction and controlling prompt simultaneously
(0 s). During training sessions,
caregivers were asked to perform target skills
twice. Response intervals were 4 s for all <strong>the</strong>
steps of <strong>the</strong> target skills, and inter-trial intervals
were 5 min during training sessions. Controlling
prompts used during training sessions
were modeling plus verbal prompting. Training
sessions were continued until three consecutive
90-100% correct responses were given
during daily probe sessions.
Training sessions were conducted as follows:
(a) materials related with <strong>the</strong> target skill (e.g.
two sets of plates, forks, spoons, glasses, and a
pitcher) were prepared and placed in <strong>the</strong> instructional
environment (e.g., kitchen table),
(b) introduction took place (i.e., “Now we are
going to learn how to set our table for lunch.
First I am going to do <strong>the</strong> step and you will listen
and watch me. Then, I am going to ask you to do
<strong>the</strong> same steps and you will do <strong>the</strong> same.”), (c)
546 / Education and Training in Developmental Disabilities-December 2008
an attentional cue was provided to <strong>the</strong> participant
(i.e., “Ali, are you ready to work?”), (d)
Task direction was given (i.e., “Ali, put <strong>the</strong> plates
on <strong>the</strong> table.”), (e) verbal and modeling
prompts were delivered (i.e., “Ali, look, I put my
plates on <strong>the</strong> table. Now you do <strong>the</strong> same.”), (f)
participant’s response interval of 4 s was waited,
(g) correct responses (e.g., if Ali put <strong>the</strong> plates
on <strong>the</strong> table) resulted with verbal praise (i.e.,
“well done”, “correct”, etc.), and incorrect responses
(were defined <strong>the</strong> same as in probe
sessions) or no responses within 4 s resulted with
error correction (e.g., <strong>the</strong> caregiver told “you
should put <strong>the</strong> plates on <strong>the</strong> table” and did <strong>the</strong>
step for target child in order to keep <strong>the</strong> skill
continue), (h) <strong>the</strong> procedure was repeated until
<strong>the</strong> performance of last step of <strong>the</strong> target skill,
and (i) 4 min waiting interval was conducted
before <strong>the</strong> next trial. At <strong>the</strong> end of each training
session, participants were provided verbal praise
by <strong>the</strong>ir caregivers and tangible reinforcers by
<strong>the</strong> author for <strong>the</strong>ir attention and cooperation.
Maintenance and generalization probe sessions.
Maintenance sessions were conducted one
and three weeks after <strong>the</strong> last full probe session
was conducted with each participant.
Maintenance sessions were conducted <strong>the</strong>
same as full probe sessions in <strong>the</strong> houses of
participants. Each target skill was asked once
to target children by caregivers. As in <strong>the</strong>
o<strong>the</strong>r probe sessions, participants were
praised orally by <strong>the</strong>ir caregivers and were
reinforced with tangible reinforcers at <strong>the</strong> end
of <strong>the</strong> sessions by <strong>the</strong> author.
Generalization data were collected across
trainers. Pre- and post-test sessions were conducted
in order to evaluate <strong>the</strong> generalization
of <strong>the</strong> acquired skills. Before <strong>the</strong> pre-test sessions,
each trainer was given information
about <strong>the</strong> SP procedure and what <strong>the</strong>y were
expected to do during <strong>the</strong> generalization sessions.
Also before <strong>the</strong> post-test generalization
sessions, trainers were reminded about <strong>the</strong>
information provided before <strong>the</strong> pre-test sessions.
During <strong>the</strong>se sessions, instead of target
caregivers, different people with whom target
children interact most frequently during <strong>the</strong>ir
daily lives were <strong>the</strong> trainers (e.g., for Mehmet,
his aunt; for Hasan, his aunt; for Ali his
teacher who was coming home three times a
week; and for Ceyda, her aunt). Pre-test generalization
sessions were conducted before
training sessions started and post-test general-

ization sessions were conducted after training
sessions were completed. Generalization sessions
were conducted <strong>the</strong> same as probe sessions.
Correct responses of participants were
praised orally and incorrect responses were
ignored by <strong>the</strong> generalization trainer.
Experimental Design
A multiple probe design across behaviors was
used and was replicated across four participants
in order to examine effectiveness of caregiver-delivered
home-based instruction using
SP on teaching three different skills to children
with DD. The dependent measure was
<strong>the</strong> percent of correctly performing steps of
<strong>the</strong> target skills. The independent variable was
caregiver-delivered home-based instruction
using SP procedure.
Reliability
Two kinds of reliability data were collected:
inter-observer reliability for dependent measures
and treatment (procedural) reliability
for independent variable. Reliability data were
collected by an independent observer. Out of
all sessions, 20 % of all sessions of training,
probe, and maintenance were selected randomly
to collect <strong>the</strong> reliability data. Inter-observer
reliability was calculated by number of
agreements divided by number of agreements
plus disagreements multiplied by 100 (Tawney
& Gast, 1984; Tekin & Kircaali-Iftar, 2001).
Treatment reliability was calculated by dividing
number of caregiver behaviors observed
by number of caregiver behaviors planned
multiplied by 100 (Tekin & Kircaali-Iftar,
2001). Caregiver behaviors observed were as
follows: (1) controlling materials, (2) securing
attention, (3) delivering task direction, (4)
delivering controlling prompt (for only training
sessions), (5) waiting for <strong>the</strong> 4 s response
interval, (6) giving appropriate responses for
<strong>the</strong> participants’ responses (error correction
was conducted during training), and (7) waiting
for inter-trial interval.
Social Validation
Social validity data were ga<strong>the</strong>red via semistructured
interviews conducted by <strong>the</strong> author
with target caregivers. Interviews were con-
ducted in houses of participants during <strong>the</strong>
pre-determined appointment times. Eight
questions were asked during <strong>the</strong> interviews.
These were: (a) Do you think that it is important
for you to learn how to use SP for teaching
different skills to your child?, (b) Do you
think that it is easy to learn and use SP for
teaching different skills to your child?, (c) Do
you think <strong>the</strong> skills you taught to your child
are important for him/her? If yes, in what
ways?, (d) What are <strong>the</strong> important parts of <strong>the</strong>
study we’ve conducted with your child?, (e)
Are <strong>the</strong>re any parts of <strong>the</strong> study that you did
not like? If yes, please indicate, (f) Are <strong>the</strong>re
any differences in your child after <strong>the</strong> study
was completed? If yes, please indicate, (g) Did
you enjoy acting like a teacher of your child?,
and (h) Do you think <strong>the</strong>re are any problems
about <strong>the</strong> participation of your child in a study
similar to <strong>the</strong> study we’ve conducted? Can you
tell <strong>the</strong> reason for your answer in a few sentences?
Answers of caregivers were taken as
notes by <strong>the</strong> author simultaneously.
Results
Effectiveness of Acquisition and Maintenance
As shown in Figures 1-4 and Table 2, caregiver
delivered home-based instruction with SP was
effective on teaching home skills to children
with DD and also on maintenance of acquired
skills for three weeks time. Two procedural modifications
were needed during <strong>the</strong> study. Those
were Hasan’s and Ceyda’s controlling prompts
during learning to wear socks and tie shoe laces.
The controlling prompts were modified as modeling
plus verbal prompt with partial physical
prompt for ga<strong>the</strong>ring <strong>the</strong> socks in his hands with
moving his fingers for Hasan. For Ali, for putting
one of <strong>the</strong> laces into <strong>the</strong> hole in order to
make <strong>the</strong> tying, <strong>the</strong> prompt was modified as
modeling plus verbal prompt with partial physical
prompt as well. The Figures show that presentation
of SP delivered by caregivers resulted
in <strong>the</strong> criterion level performances for each target
skill by target children.
Maintenance
Maintenance data show that all target children
maintained target skills one and three
weeks after <strong>the</strong>y met <strong>the</strong> criterion. Figures 1-4
Caregiver-Delivered Home-Based Instruction / 547

Figure 1. Percentage of correct responses for Mehmet during baseline, intervention, maintenance and generalization
sessions.
show that target children maintained <strong>the</strong> skills
acquired during training sessions. Mehmet
maintained skills taught 100%, Ali maintained
skills taught 100%, Hasan maintained skills
taught 94.5% (range 89-100) and Ceyda
maintained skills taught 93.5% (range 87-
100) during maintenance sessions.
Effectiveness on Generalization
548 / Education and Training in Developmental Disabilities-December 2008
Generalization across trainers data were collected
with different people with whom <strong>the</strong> children
interacted most frequently during <strong>the</strong>ir
daily lives. During pre-test all target children
performed target skills with 0% accuracy except

Figure 2. Percentage of correct responses for Ali during baseline, intervention, maintenance and generalization
sessions.
Ali’s 33% accuracy in setting table, and Ceyda’s
25% accuracy in preparing yogurt drink. During
post-test, all target children performed target
skills with 100% accuracy except Hasan’s 89%
accuracy in wearing socks, and Ceyda’s 87% accuracy
in tying her shoe laces.
Caregiver-Delivered Home-Based Instruction / 549

Figure 3. Percentage of correct responses for Hasan during baseline, intervention, maintenance and generalization
sessions.
Reliability Data
Dependent variable reliability (inter-observer
reliability) data indicated 100% agreement
during full probe, training and maintenance
and generalization sessions for Mehmet. For
550 / Education and Training in Developmental Disabilities-December 2008
Ali <strong>the</strong>re was an agreement of 100% during
<strong>the</strong> full probe, training and maintenance and
generalization sessions. For Hasan, <strong>the</strong>re was
an agreement of 87% (80-100%) during <strong>the</strong>
full probe, training and maintenance and gen-

Figure 4. Percentage of correct responses for Ceyda during baseline, intervention, maintenance and generalization
sessions.
eralization sessions. For Ceyda <strong>the</strong>re was an
agreement of 90% (87-100%) during <strong>the</strong> full
probe, training and maintenance and generalization
sessions.
Results of independent variable reliability
(treatment reliability) revealed that caregivers
implemented <strong>the</strong> planned steps successfully
during <strong>the</strong> full probe, daily probe, training
Caregiver-Delivered Home-Based Instruction / 551

TABLE 2
Participants’ Instructional Data Through Criterion
Caregivers Full/daily probe Training Maintenance
Nermin Having ready 100% Having ready 100% Having ready 100%
Securing attention 100% Securing attention 100% Securing attention 100%
Presenting direction 100% Presenting direction 100% Presenting direction 100%
Providing prompt 100% Providing prompt 100%
Presenting consequences 100% Presenting consequences 70% Presenting consequences 100%
Across steps 100% 94% 100%
Figen Having ready 100% Having ready 100% Having ready 100%
Securing attention 100% Securing attention 100% Securing attention 100%
Presenting direction 100% Presenting direction 70% Presenting direction 90%
Providing prompt 85% Providing prompt 90%
Presenting consequences 70% Presenting consequences 80% Presenting consequences 84%
Across steps 94% 87% 93%
Seda Having ready 100% Having ready 100% Having ready 90%
Securing attention 100% Securing attention 100% Securing attention 100%
Presenting direction 85% Presenting direction 85% Presenting direction 90%
Providing prompt 80% Providing prompt 95%
Presenting
Consequences 80% Presenting consequences 75% Presenting consequences 85%
Across steps 91% 88% 92%
Aten Having ready 100% Having ready 100% Having ready 100%
Securing attention 100% Securing attention 90% Securing attention 100%
Presenting direction 100% Presenting direction 100% Presenting direction 100%
Providing prompt 100% Providing prompt 100%
Presenting
Consequences 100% Presenting consequences 100% Presenting consequences 100%
Across steps 100% 98% 100%
and maintenance sessions. Nermin implemented
<strong>the</strong> planned steps with 100% accuracy
for Mehmet, Fatma implemented <strong>the</strong> planned
steps with 100% accuracy for Ali, Seda implemented
<strong>the</strong> planned steps with 93% accuracy
for Hasan, and Ayten implemented <strong>the</strong>
planned steps with 87% accuracy for Ceyda.
Social Validation
Social validity data were collected through an
eight item questionnaire. Views of caregivers
were very positive in general. They all thought
that it was important for <strong>the</strong>m to learn and use
<strong>the</strong> SP procedure for teaching different skills
to <strong>the</strong>ir children with DD and pointed out <strong>the</strong>
ease of <strong>the</strong> procedure. They all agreed that
target skills which <strong>the</strong>y taught to <strong>the</strong>ir children
were important. One of <strong>the</strong> caregivers
(Ayten) mentioned that she had never imagined
her grand daughter would tie her shoe
laces independently; <strong>the</strong>refore, she was very
grateful about that. Two of <strong>the</strong> caregivers indicated
that learning SP was <strong>the</strong> most important
part of <strong>the</strong> study because <strong>the</strong>y would be
able to use this procedure for teaching any
skills that <strong>the</strong>ir children would need in <strong>the</strong>
future. Target caregivers mentioned any part
of <strong>the</strong> study that <strong>the</strong>y did not like. Although
target caregivers pointed out <strong>the</strong> difficulty in
being teachers of <strong>the</strong>ir own children, <strong>the</strong>y all
stated <strong>the</strong> enjoyment of acting as <strong>the</strong>ir children’s
teachers. Lastly, <strong>the</strong>y all indicated that
<strong>the</strong>y would be very happy with involvement of
<strong>the</strong>ir children in similar studies in <strong>the</strong> future.
Discussion
552 / Education and Training in Developmental Disabilities-December 2008
Looking at <strong>the</strong> results presented in Figures
1-4, it can be said that SP provided by <strong>the</strong>
caregivers was effective in teaching chained
home skills to children with DD. Results also

evealed that target children maintained target
skills one and three weeks after <strong>the</strong> interventions,
and <strong>the</strong>y could generalize acquired
skills across trainers. These results were consistent
with results of <strong>the</strong> studies that examined
effectiveness of SP in teaching chained
skills to individuals with DD (Fetko et al.,
1999; Maciag et al., 2000; Parrott et al., 2000;
Riesen et al., 2003; Schuster & Griffen, 1993;
Sewell et al., 1998; Tekin-Iftar, 2008). The
studies mentioned above provide evidence
about <strong>the</strong> effectiveness of SP on maintenance
of <strong>the</strong> acquired skills in more controlled educational
settings. In this point, this study expands
<strong>the</strong> evidence by showing that it is also
effective on maintenance when <strong>the</strong> instruction
was provided in home settings which is a
less controlled educational setting.
Results of <strong>the</strong> study also showed that caregivers
were successful in using SP while teaching
three different chained home skills to
<strong>the</strong>ir children with DD. This result was consistent
with results of studies that explored <strong>the</strong>
success of implementers o<strong>the</strong>r than teachers
who delivered SP to <strong>the</strong>ir children with DD
(Tekin-Iftar, 2008; Tekin-Iftar, 2003; Tekin &
Kircaali-Iftar, 2002). Although <strong>the</strong>re were
studies showing <strong>the</strong> effectiveness of SP provided
by people o<strong>the</strong>r than teachers, this is <strong>the</strong>
only study which combined <strong>the</strong> SP procedure
and home skills at home; <strong>the</strong>refore, this study
will extend <strong>the</strong> current literature in this way.
During <strong>the</strong> implementations, two major
procedural modifications were conducted.
These were <strong>the</strong> modifications of <strong>the</strong> controlling
prompts for Hasan (wearing socks) and
Ceyda (tying shoe laces). For teaching o<strong>the</strong>r
target skills, <strong>the</strong> controlling prompt was determined
as modeling plus verbal prompting.
These two skills were <strong>the</strong> only left skills that
children participants did not have in <strong>the</strong>ir
repertoire from <strong>the</strong> home skills check list and
<strong>the</strong>y were really hard skills regarding <strong>the</strong>ir age
and developmental performances. Therefore
<strong>the</strong> controlling prompt was modified as modeling,
verbal plus partial physical prompting.
For Hasan <strong>the</strong> criteria was determined as 80%
correct responses for wearing socks, whereas
for Ceyda it was 100% just as <strong>the</strong> o<strong>the</strong>r target
skills for all <strong>the</strong> children participants.
Ano<strong>the</strong>r point to be mentioned about <strong>the</strong>
study is that caregivers were asked not to provide
<strong>the</strong> same materials for training and probe
sessions. In any of <strong>the</strong> two consecutive sessions,
<strong>the</strong> same materials were provided to
target children. The various materials in some
of <strong>the</strong> skills were used. For example, for wearing
socks, green, wool, yellow, multi-colored,
acrylic, etc. were used; for folding sweatshirt,
different colored and patterned sweatshirts
were used; for preparing sandwich, cheese,
salami, tomatoes, black olives, and lettuce
were used. However, for some skills such as
making bed (e.g., different sheets and pillows
with one blanket and one quilt), setting table
(e.g., porcelain plates with different patterns,
melamine plates with different patterns,
glasses with different sizes and shapes), material
variety consisted less materials depending
on <strong>the</strong> material presented at homes of <strong>the</strong>
participants. By considering this, generalization
during training and probe sessions was
aimed. Since target children would do <strong>the</strong>
skills with different materials during all <strong>the</strong>
probe and training sessions, <strong>the</strong> procedure
would be similar to <strong>the</strong> real life, and by so
generalization of <strong>the</strong> acquired skills would be
realized during <strong>the</strong> implementation. As can
be seen in Figures 1-4, all target children acquired
<strong>the</strong> skills with success. Therefore, only
generalization across trainers part was conducted
formally during <strong>the</strong> study. Also in <strong>the</strong>
generalization across trainers sessions, <strong>the</strong>
participant children performed with 100% accuracy
except Hasan’s 89% accuracy in wearing
socks, and Ceyda’s 87% accuracy in tying
her shoe laces.
Regarding <strong>the</strong> social validity findings of <strong>the</strong>
present study, it can be said that all answers
that caregivers provided were positive. They
thought that <strong>the</strong> procedure was easy to implement,
target skills were important for <strong>the</strong>ir
children, it was difficult to act as a teacher of
<strong>the</strong>ir own children but very enjoyable as well
and <strong>the</strong>y were happy about taking part in <strong>the</strong>
study. These findings were also consistent with
<strong>the</strong> results of many studies conducted so far
(Akmanoglu & Batu, 2004; Akmanoglu-
Uludag & Batu, 2005; Morse & Schuster, 2004;
Tekin-Iftar, 2003; Wolery, Ault, & Doyle,
1992).
An important part of <strong>the</strong> study to be discussed
is <strong>the</strong> length of <strong>the</strong> training sessions.
Since <strong>the</strong> implementers were caregivers, <strong>the</strong>
very close relationship between <strong>the</strong> caregivers
and <strong>the</strong>ir children might have caused <strong>the</strong>
Caregiver-Delivered Home-Based Instruction / 553

length of training sessions. As a result, target
children sometimes had difficulties in seeing
<strong>the</strong>ir caregivers as authority figures at home.
The present study should be considered under
some limitations that may affect <strong>the</strong> results.
First, single opportunity method was
used during <strong>the</strong> baseline probe sessions. This
might be a disadvantage for target children,
because <strong>the</strong>ir performance for all steps of <strong>the</strong>
task analysis could not be determined. Therefore,
use of multiple opportunity method
could be suggested especially for practical
purposes in order to see <strong>the</strong> actual performance
of participants throughout <strong>the</strong> whole
task analysis of target skills.
Ano<strong>the</strong>r limitation was that <strong>the</strong> types of errors
that occurred were not examined. Therefore,
an error correction procedure was not
conducted during this study. Even with <strong>the</strong>
limitations noted, <strong>the</strong> experimental design of
<strong>the</strong> study allows attribution of effect of <strong>the</strong>
independent variable.
Some suggestions to be presented can be as
follows: First, it can be suggested to evaluate
effectiveness of SP delivered by people o<strong>the</strong>r
than teachers of children with DD in future
studies. Second, effectiveness and efficiency of
SP and o<strong>the</strong>r response prompting procedures
can be compared when provided by people
o<strong>the</strong>r than <strong>the</strong> teachers of children with DD.
Third, error types can be examined and error
correction can be conducted in similar studies.
Fourth, a formal multiple exemplar implementations
can be conducted in future studies.
In conclusion it can be said that SP provided
by caregivers seems to be a user friendly
method to be used for teaching chained home
skills. Results of <strong>the</strong> present study reveal similarities
with results of many o<strong>the</strong>r studies conducted
so far.
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Received: 23 January 2008
Initial Acceptance: 29 March 2008
Final Acceptance: 13 May 2008
Caregiver-Delivered Home-Based Instruction / 555

Education and Training in Developmental Disabilities, 2008, 43(4), 556–568
© <strong>Division</strong> on Developmental Disabilities
Noncontingent Escape Access to Self-Reinforcement to
Increase Task Engagement for Students with Moderate to
Severe Disabilities
David F. Cihak
University of Tennessee-Knoxville
Robert I. Gama
Georgia State University
Abstract: This study determined <strong>the</strong> effectiveness of noncontingent escape access to self-reinforcement, as a
student-directed intervention. Three students successfully used a break card to systematically decrease inappropriate
behavior maintained by negative reinforcement while increasing task engagement. In addition, teachers
completed an Intervention Rating Profile-15 that assessed <strong>the</strong> social acceptability of this interventions. All
teachers indicated that self-reinforcement was socially acceptable for classroom settings and <strong>the</strong>y would
recommend it to o<strong>the</strong>r teachers.
Implementation of antecedent-based interventions
diverges considerably from responsebased
interventions. Ra<strong>the</strong>r than imposing a
consequence following <strong>the</strong> occurrence of a
problem behavior, antecedent-based interventions
focus on <strong>the</strong> reducing <strong>the</strong> likelihood of
problem behavior occurring initially (Luiselli,
1998). Antecedent-based interventions are
used as proactive and preventative strategies.
Antecedent interventions typically involve an
environmental rearrangement. That is, stimuli
or events that occur prior to <strong>the</strong> problem
behavior are altered in some manner to reduce
<strong>the</strong> probability of occasioning <strong>the</strong> occurrence
of <strong>the</strong> problem behavior. Developing
antecedent-based interventions require identifying
<strong>the</strong> variables or conditions that are associated
with <strong>the</strong> problem behavior. A critical
first step involves conducting a functional behavioral
assessment (Dunlap & Kern, 1993).
The outcome of a functional assessment is
<strong>the</strong> identification of environmental variables
associated with <strong>the</strong> occurrence or absence of
<strong>the</strong> problem behaviors. Asmus et al. (2004)
examined <strong>the</strong> data of 138 individuals who
Correspondence concerning this article should
be addressed to David Cihak, University of Tennessee,
A412 Claxton Complex, Knoxville, TN 37996-
3442.
556 / Education and Training in Developmental Disabilities-December 2008
performed behaviors including aggression, disruption,
destruction, and stereotypic responses.
Results indicated that when <strong>the</strong> inappropriate
behavior was observed, distinct conditions for
<strong>the</strong> behavior were identified in 96% of <strong>the</strong>
cases. This information is directly pertinent to
intervention development in that <strong>the</strong> implicated
variables can be modified to produce an
antecedent intervention.
In particular, <strong>the</strong> use of self-management
has been recognized as a viable antecedentbased
intervention (Koegel, Harrower, &
Koegel, 1999; Smith & Nelson, 1997; Wehmeyer,
Agran, & Hughes, 1998). Ra<strong>the</strong>r than
relying on a teacher directed approach in which
teachers are fully responsible for delivering
instruction, monitoring behaviors, and delivering
consequences, <strong>the</strong>re is a shift to increase
student’s responsibility (Wehmeyer, Agran, &
Hughes, 2000). Agran (1997) described four
strategies of self-management including selfmonitoring
or self-recording, self-assessment
or self-evaluation, self-instruction, and selfreinforcement.
While <strong>the</strong> functional properties
of some of <strong>the</strong>se strategies may differ,
self-management strategies enhance <strong>the</strong> student’s
ability to manage <strong>the</strong>ir own behavior
and act more independently.
One of <strong>the</strong> most frequently researched selfmanagement
strategies is self-monitoring and

self-recording (e.g., Gilberts, Agran, Hughes,
& Wehmeyer, 2001; Hughes et al., 2002; Webber,
Scheurmann, McCall, & Coleman, 1993).
Self-monitoring and self-recording consists of
students being taught to discriminate between
targeted and desired behaviors and to record
its occurrences during a predetermined activity
or timeframe. Self-monitoring interventions
have proven to be effective in reducing
sensory-related behaviors (Koegel & Koegel,
1990), disruptive behaviors (Koegel et al.
1999), noncompliance (Agran et al., 2005;
O’Reilly, Lancioni, Gardiner, Tiernan, & Lacy,
2002); and increasing task completion (Hughes
et al.), academic performance (Gilberts et al.;
Hughes et al.; Koegel et al.), and physical
activity (Todd & Reid, 2006). Self-monitoring
interventions also have been effective with students
with moderate disabilities (Agran et al.;
Hughes et al.; O’Reilly et al.; Rankin & Reid,
1995), severe intellectual disabilities (Agran et
al.; Ganz & Sigafoos, 2005; Koegel et al.; Mancina,
Tankersley, Kamps, Kravits, & Parrett,
2000), and autism (Gilberts et al.; Koegel &
Koegel; Todd & Reid). Although self-monitoring
has demonstrated positive improvements
with various academic and social behaviors for
students with mild to severe disabilities including
autism, Agran et al. and Ganz and Sigafoos
noted that self-monitoring continues to be underutilized.
Ano<strong>the</strong>r type of self-management strategy is
self-reinforcement. In most classrooms, teachers
arrange contingencies by identifying expected
behaviors and <strong>the</strong> consequences for
performing those behaviors. Self-reinforcement
allows students to be involved in administering
<strong>the</strong>ir own reinforcing consequences. Students
were taught successfully to self-administer
tokens (Shapiro & Klein, 1980), coins (Rusch,
McKee, Chadsey-Rusch, & Renzaglia, 1988),
and stars (Shapiro, McGonigle, & Ollendick,
1980). Most often, self-reinforcement procedures
were taught in conjunction with selfmonitoring
and self-recording. Shapiro and
Klein taught four students with mild intellectual
disabilities to reinforce <strong>the</strong>mselves for engaging
in on-task behavior. Students were
taught using a three-step fading procedure.
The teacher first gave <strong>the</strong> students tokens
from a container placed directly in front of <strong>the</strong>
student. The teacher <strong>the</strong>n verbally prompted
<strong>the</strong> students to take <strong>the</strong> tokens <strong>the</strong>mselves.
Finally, <strong>the</strong> teacher motioned to <strong>the</strong> student
to take <strong>the</strong> token without verbal prompts. All
students maintained on-task behaviors when
self-reinforcing. In a follow-up study, Shapiro
et al. used self-reinforcement to increase ontask
behaviors for five students with mild to
moderate intellectual disabilities. Similarly,
students were taught using fading prompt procedures.
A cup of stars was placed directly in
front of each student. The teacher verbally
prompted students, who were observed ontask,
to take a star and place it on a chart.
Music also was paired with <strong>the</strong> teacher’s prompt.
Teacher prompts <strong>the</strong>n were gradually reduced
over seven sessions. Results indicated
that when self-reinforcement training was provided,
on-task behaviors maintained at levels
analogous when <strong>the</strong> teacher administered <strong>the</strong>
reinforcer.
Transitioning from teacher-directed to student-directed
management programs must be
gradual and students must be explicitly taught
to use self-reinforcement. Hughes and Agran
(1992) suggested teaching self-reinforcement
strategies included several training components.
Individuals first learn to discriminate
and label <strong>the</strong> problem behavior. Next, roleplaying
is used to teach self-evaluation of <strong>the</strong>
person’s behavior or actions. At times, picture
prompts, displaying appropriate and inappropriate
behaviors, are used to represent
discriminating behaviors. After self-evaluating,
individuals self-administer a reinforcer. With
similar training packages, previous self-reinforcement
studies have shown that students
with mild and moderate intellectual disabilities
can learn to self-reinforce and improve
academic, work, and social behaviors.
Self-reinforcement procedures are often dependent
upon self-monitoring procedures.
Mahoney and Thoresen (1974) noted selfmonitoring
sets <strong>the</strong> stage for self-reinforcement.
Students must first determine that <strong>the</strong>
target behavior has occurred prior to reinforcing
<strong>the</strong>mselves. DiGangi and Maag (1992) investigated
<strong>the</strong> relationships of self-monitoring
and self-reinforcement. Results indicated that
nei<strong>the</strong>r strategy was as effective as when used
in combination to decrease inappropriate verbalizations.
Agran (1997) noted research was
needed to examine <strong>the</strong> specific relationships
between self-reinforcement and self-monitoring.
Noncontingent Escape Self-Reinforcement / 557

Ganz and Sigafoos (2005) used self-monitoring
and self-reinforcement to increase task
completion and asking for help. Students first
choose a reinforcer, which <strong>the</strong>y received contingently
upon performing <strong>the</strong> target behavior.
Students <strong>the</strong>n were taught how to use a
token system. One student was required to
place tokens from a container to a self-monitoring
board after performing <strong>the</strong> behavior
while ano<strong>the</strong>r student was required to snap
blocks toge<strong>the</strong>r to monitor <strong>the</strong> target behavior
occurrence. After <strong>the</strong> students earned
all <strong>the</strong>ir tokens or snapped all blocks, <strong>the</strong>
students received <strong>the</strong>ir choice reinforcer. Agran
(1997) suggested ensuring that <strong>the</strong> student
was actually managing <strong>the</strong>ir own behavior;
<strong>the</strong> student must be free to partake in <strong>the</strong>
reinforcer at any time, whe<strong>the</strong>r or not a particular
response was performed. However, in
<strong>the</strong> self-reinforcement studies noted (Gangi &
Maag, 1992; Ganz & Sigafoos; Gardner, Cole,
Berry, & Nowinshi, 1983; Shapiro & Klein,
1980; Shapiro et al., 1980), students only had
access to reinforcement contingent on <strong>the</strong>
performance of <strong>the</strong> target behavior. Therefore,
to ensure that students are actually managing
<strong>the</strong>ir own behavior, <strong>the</strong> student should
have <strong>the</strong> opportunity to self-administer reinforcers
noncontingently.
Noncontingent reinforcement (NCR) involves
<strong>the</strong> delivery of reinforcers that is response
independent. Mace and Lalli (1991)
used NCR to treat vocalizations of students
with moderate intellectual disabilities. NCR
resulted in near elimination of <strong>the</strong> students’
vocalizations. Vollmer, Iwata, Zarcone, Smith,
and Mazaleski (1993) compared <strong>the</strong> effects of
differential reinforcement of o<strong>the</strong>r behaviors
(DRO) and NCR on self-injurious behaviors
of students with developmental disabilities.
Results indicated that both interventions were
functionally equivalent. However, Vollmer et
al. suggested NCR has several advantages over
DRO including a relative easiness of implementation.
In most applications of NCR, reinforcers
were initially delivered under dense
schedules that produced higher rates of reinforcement
than those during baseline. These
dense NCR schedules may produce decreases
in responding by altering <strong>the</strong> establishing operation
(Michael, 1993) for problem behavior.
That is, NCR produces a state of satiation
as a result of frequent reinforcer delivery.
558 / Education and Training in Developmental Disabilities-December 2008
With this in mind, NCR may be used to examine
if students are actually self-managing.
In addition, <strong>the</strong> applications of noncontingent
escape (NCE) techniques have emerged
as a promising intervention for escape maintained
problem behavior (Vollmer, Marcus,
Ringdahl, 1995). NCE is <strong>the</strong> removal of an
aversive stimulus (e.g., demand, task) independent
of a student’s response delivered on
a fixed-time schedule. NCE also has been referred
to as fixed-time escape (FTE) by Reed,
Ringdahl, Wacker, Barretto, and Andelman
(2005). Davenport (1968) suggested that NCE
may reduce a students’ motivation to engage
in behavior maintained by negative reinforcement
in <strong>the</strong> form of escape from demands.
NCE was used successfully to reduce selfinjurious
(Vollmer et al.) and disruptive behaviors
(Colman & Holmes, 1998). Students
in both studies were verbally prompted by <strong>the</strong>
investigator to “take a break” on a fixed-time
schedule. Fixed-time schedules were increased
systematically by 30 sec or 1 min intervals and
students were allowed 20 to 30 min to escape
from tasks. Moreover, Colman and Holmes
included data on compliance, and <strong>the</strong> results
indicated increased levels following NCE.
Reed et al. also noted <strong>the</strong> positive effects of
NCE or FTE for increasing compliance and
reducing property destruction and aggressive
behaviors. Similarly, students received breaks
from tasks by <strong>the</strong> investigator; however, <strong>the</strong>
schedule was ei<strong>the</strong>r dense (45 sec or 60 sec) or
lean (i.e., 150 sec or 170 sec). During FTE
lean-schedules, students were observed engaging
in low levels of problem behaviors and
high levels of compliance. Conversely, during
FTE dense-schedules, students were observed
engaging in moderate levels of problem behaviors
and low levels of compliance. Although
previous studies demonstrated successful applications
in changing behaviors, <strong>the</strong> interventions
were instructor or teacher-directed.
With this in mind, if NCE or FTE included
a picture cue (e.g., break-card) for students
to self-administer <strong>the</strong> break <strong>the</strong>n it may be
used to examine if students are actually selfmanaging.
The purpose of this study was to examine
<strong>the</strong> effects of noncontingent escape access
to self-reinforcement as an antecedent-based
strategy on inappropriate behavior maintained
by negative reinforcement or an escape func-

tion of behavior. Specifically, what are <strong>the</strong> effects
of NCE on inappropriate and appropriate
behaviors when students are provided <strong>the</strong> use of
a break-card to self-reinforce? Also, this study
sought to determine teachers’ perceptions of
change as a result of <strong>the</strong> intervention.
Method
Participants and Setting
Three students participated based on <strong>the</strong> following
(a) middle school attendance, (b) age
range from 11 to 14 years old, (c) level of
cognitive functioning within <strong>the</strong> moderate to
severe range of mental retardation (IQ 20–
55), (d) regular participation in classroom
vocational training, (e) performance of inappropriate
behavior which impedes job training,
(f) able to complete all steps of <strong>the</strong> job
task independently, (g) parental permission,
and (h) verbal agreement to participate following
being told of <strong>the</strong> study activities and
viewing <strong>the</strong> materials. Additionally, all students
had a confirmed function of behavior of
negative reinforcement in <strong>the</strong> form of escape
from demands.
Three teachers recommended students for
participation. The primary investigator observed
each student in <strong>the</strong> classroom to confirm
<strong>the</strong> students met <strong>the</strong> participating criteria.
Final selection was determined after a
brief-FA confirmed <strong>the</strong> function of behavior
as escape from work tasks. Brief-FA were conducted
by <strong>the</strong> primary investigator. Adele
was 12 years olds with a full-scale IQ of 48.
Barron and Camilla were 13 years old with a
full-scale IQ of 50 and 40, respectfully. IQ’s
were assessed using <strong>the</strong> Wechsler Intelligence
for Children (Wechsler, 1991) for Adel and
Camilla. The Stanford Binet (Thorndike,
Hagen, & Sattler, 1986) was used to assess
Barron. According to teachers’ reports, students
were able to complete individual tasks
independently, however, each student would
usually engage in some form of off-task behavior
to avoid or escape <strong>the</strong> task. In addition, all
phases of this study occurred in each student’s
school resource classroom.
Materials
Materials consisted of five three by five inch
index cards. Each card was colored read with
<strong>the</strong> word break written on it. Task materials
consisted of a storage organizer, colored reams
of paper, copy machine, flowers, and wooden
barrels. A stapler, magazines, radio, games,
and toys also were used.
Response Measurement and Reliability
The target inappropriate behavior was reported
by each student’s teacher. Adele demonstrated
a variety of disruptive behaviors.
The behavior problem that Adele’s teacher
was most concerned with was frequent outbursts.
Outbursts were defined as yelling and
attempting to throw task materials on <strong>the</strong>
floor. Barron’s teacher was concerned with
loud vocalizations. Vocalizations were defined
as a high pitch noise that could be heard from
a distance of 10-feet. Camilla’s teacher was
concerned with Camilla’s sitting on <strong>the</strong> floor.
Sitting on <strong>the</strong> floor was defined as Camilla’s
body on floor with legs crossed. Target behaviors
were confirmed by <strong>the</strong> investigator during
functional analysis procedures. For all sessions,
<strong>the</strong> investigator recorded <strong>the</strong> occurrences
of <strong>the</strong> students’ target behavior via paper
and pencil using a continuous 10 s partialinterval
recording. Reliability estimates for
target behavior were calculated by dividing
agreements by agreements plus disagreements
and multiplying by 100%. Agreements were
defined as identically marked intervals, and
disagreements were defined as intervals that
contained different recordings between observers.
Mean agreements for target behavior
were 98% (range, 95–100%) for Adele, for
Barron, 96% (range, 93–100%), and for
Camilla, 100%.
The alternative behavior for all students was
task engagement. Task engagement was defined
as directing eyes towards <strong>the</strong> work activity,
performing a step of <strong>the</strong> task, or manipulating
task materials in <strong>the</strong> absence of <strong>the</strong>
target inappropriate behavior. For all sessions,
<strong>the</strong> investigator recorded <strong>the</strong> occurrences of
<strong>the</strong> students’ task engagement via paper and
pencil using a continuous 10 s partial-interval
recording. Reliability estimates for task engagement
were calculated by dividing agreements
by agreements plus disagreements and
multiplying by 100%. Agreements were defined
as identically marked intervals, and
disagreements were defined as intervals that
Noncontingent Escape Self-Reinforcement / 559

contained different recordings between observers.
Mean agreements for task engagement
were 98% (range, 95–100%) for Adele,
for Barron, 96% (range, 93–100%), and for
Camilla, 100%.
Procedural integrity also was assessed during
functional analysis and self-reinforcement
sessions. The second observer recorded <strong>the</strong>
investigators behavior during a minimum of
two sessions for each phase throughout <strong>the</strong>
study. Procedural integrity was derived from
dividing <strong>the</strong> number of observed behaviors
by <strong>the</strong> number of planned behaviors and
multiplying by 100 (Billingsley, White, &
Munson, 1980). Procedural behaviors included
(a) instructing students to task, (b) implementing
a system of least prompts, (c) delivering
reinforcement, (d) removing task
materials, (e) providing attention, and (f) supplying
break cards for self-reinforcement.
The mean procedural integrity was calculated
for each student throughout each phase of
<strong>the</strong> study. The mean procedural integrity were
94% for Adele, (range, 90–100%), for Barron,
98%, (range, 97–100%), and 99% (range, 99–
100%) for Camilla.
Procedure
Overview. The investigator conducted all
procedures in <strong>the</strong> classroom setting. Brief-FA
procedures were conducted to confirm <strong>the</strong>
results of <strong>the</strong> teachers’ interviews. Students
<strong>the</strong>n were exposed to a self-reinforcement intervention
that was fur<strong>the</strong>r examined.
Pretreatment Assessment
Teacher interview. Teachers were interviewed
by <strong>the</strong> investigator to identify <strong>the</strong> student
target behaviors. A semi-structured interview
(O’Neill, et al., 1997) narrowed and
defined <strong>the</strong> range of variables that occasioned
and maintained <strong>the</strong> behavior of concern. Primary
and secondary reinforcers also were
identified.
Brief functional analysis. Following <strong>the</strong>
teacher interview, a brief-FA was conducted to
experimentally confirm <strong>the</strong> results of <strong>the</strong> interview.
The brief-FA included a series of conditions
similar to those described by Iwata,
Dorsey, Slifer, Bauman, and Richman (1982/
1994) and Northup et al. (1991). The assess-
560 / Education and Training in Developmental Disabilities-December 2008
ment conditions included escape from task
demands, attention, and control. Students
participated in one 10 min session for each
condition, with a 15 min break between conditions.
Escape Condition. Based on <strong>the</strong> teacher interview,
each task was considered difficult, yet
could be completed independently. Moreover,
each student’s task was associated previously
with high levels of <strong>the</strong> inappropriate
target behavior. Adele was required to stock
paper according to color into a storage organizer.
Barron was required to make copies
using a copy machine. Camilla was required to
sort two types of flowers according to color
into large wooden barrels.
A three-prompt procedure was used for all
students to encourage task completion. The
first prompt was a verbal task request. If no
response was initiated within 5 s, verbal and
gestural prompts were used. If no response
was initiated within 5 s, <strong>the</strong> investigator physically
guided <strong>the</strong> student’s hand as <strong>the</strong> verbal
request was repeated. If <strong>the</strong> student responded
correctly and engaged in <strong>the</strong> task
during ei<strong>the</strong>r of <strong>the</strong> first two prompts, verbal
or physical attention was delivered. Contingent
on <strong>the</strong> presence of target behavior, <strong>the</strong>
investigator removed <strong>the</strong> task and turned away
for 15 s. After 15 s, <strong>the</strong> investigator, again,
presented <strong>the</strong> task and prompting sequence.
Attention. During <strong>the</strong> attention condition,
all students were required to use a stapler to
staple a two-page newsletter. For all students,
teachers considered stapling an easy task and
not associated previously with high levels of
inappropriate behaviors. Stapling was a task
that had not been previously associated with
high levels of inappropriate behaviors based
on <strong>the</strong> teacher interview. The investigator ignored
all behaviors except <strong>the</strong> target behavior,
for which <strong>the</strong> investigator provided attention
with a verbal statement.
Control. During <strong>the</strong> control condition, all
students were observed during scheduled free
time activities. During free time, students had
access to leisure materials including computer,
radio, magazines, games, and toys. Free
time was considered an enriched activity with
an abundance of visual and auditory stimulation
in which relatively few target behaviors
occurred according to <strong>the</strong> teacher interview.
No demands were presented during <strong>the</strong> con-

trol condition and <strong>the</strong> investigator provided
noncontingent attention to <strong>the</strong> student. In addition,
no specific reinforcement (i.e., escape,
attention) was provided following target inappropriate
behaviors. The investigator recorded
if an inappropriate behavior occurred,
which also counted as an interruption in taskengagement.
Confirmatory analysis. Students participated
in three additional sessions immediately following
completion of <strong>the</strong> functional analysis.
The condition with <strong>the</strong> highest level of target
behaviors during <strong>the</strong> brief-FA (i.e., escape)
was repeated twice, alternated with <strong>the</strong> condition
that produced <strong>the</strong> second most occurrences
of target behaviors (i.e., attention).
This analysis was conducted to verify <strong>the</strong> consistency
of <strong>the</strong> occurrence of <strong>the</strong> target behavior
across specific conditions. Escape and
attention condition sessions were identical to
those conducted and analyzed during <strong>the</strong>
previous standard assessment phase.
Self-Reinforcement Training
Students were taught to use a break card by
<strong>the</strong>ir teacher. Training took place over three
weeks during tasks associated with escape behavior.
These structured training sessions were
conducted twice daily for 10 min. For example,
Adel’s task involved stocking paper according
to color. The investigator engaged
her in <strong>the</strong> task for several minutes, introduced
a step that was difficult, and <strong>the</strong>n verbally and
physically prompted her to touch and deliver
<strong>the</strong> break card to <strong>the</strong> investigator. After Adele
presented <strong>the</strong> break card, Adele was provided
with 2 min break. A digital timer was used to
alert Adele when break was over and to begin
work. Prompts were withdrawn for each student
using a combination of fading techniques
including delayed prompting. The investigator
waited 5 s before prompting students to
use a break card to allow each student to respond
independently. Fading continued until
<strong>the</strong> student used <strong>the</strong> break card without any
verbal or physical prompts. This criterion was
considered met when <strong>the</strong> student delivered
<strong>the</strong> break card five consecutive times independent
of verbal, gesture, or physical prompts
(Adele and Barron met criterion after 10
school days, and Camilla met criterion 16
school days).
Non-Contingent Escape Self-Reinforcement
After students reach training criterion, students
were provided with five break cards to
use to request a break from task. The same
task used during <strong>the</strong> brief-FA also was used in
self-reinforcement. Students could access reinforcers
noncontingently. Similar to training,
students were provided a 2 min break after
delivering <strong>the</strong> break card to <strong>the</strong> teacher. A
digital timer again was used to alert students
when break was over and to begin work.
Fading break cards. Contingent on <strong>the</strong> reduction
of target inappropriate behavior,
which criterion equals 50% interval occurrence
less than <strong>the</strong> previous phase for three
consecutive sessions, break cards were systematically
reduced by one. That is, five break
cards to four break cards, and <strong>the</strong>n four break
cards to three break cards, and so on. When
<strong>the</strong> student was provided three break cards, a
withdrawal of <strong>the</strong> intervention was conducted
for three sessions. The no break card phase
allowed <strong>the</strong> teacher to examine student target
and replacement behaviors absent of intervention.
The criteria to reinstate <strong>the</strong> intervention
phase occurred when <strong>the</strong> trend of <strong>the</strong> intervention
withdrawal progressed in <strong>the</strong> opposite
direction of intervention.
Design
An abbreviated multielement design (Sindelar,
Rosenberg, & Wilson, 1985) was conducted
during <strong>the</strong> brief-FA phase. To verify
student responding under specific conditions,
a confirmation phase was performed. That is,
<strong>the</strong> condition (escape) which resulted in <strong>the</strong>
most target inappropriate behaviors was repeated
twice alternated between <strong>the</strong> conditions
(attention) which resulted in <strong>the</strong> second
most occurrences of target inappropriate behavior.
A changing criterion with an imbedded
withdrawal designs was used to evaluate <strong>the</strong>
effects of self-reinforcement on target and alternative
behaviors (Barlow & Hersen, 1984).
Experimental control for changing criterion
designs is demonstrated when changes in <strong>the</strong>
target behavior match precisely, or correspond
closely to, at least three shifts in performance
criteria (Horner et al., 2005). Moreover,
with <strong>the</strong> application of a withdrawal
Noncontingent Escape Self-Reinforcement / 561

Figure 1. Adele’s percentage of interval occurrences of profanity across brief-FA conditions and changing
criterion. FA functional analysis, Eescape, Ccontrol, Aattention
design, conclusions of intervention effects
are streng<strong>the</strong>ned by comparing no intervention
to reinstatement of <strong>the</strong> intervention
(Kazdin, 1982).
Social Validity
At <strong>the</strong> conclusion of <strong>the</strong> study, <strong>the</strong> three
teachers were asked to complete <strong>the</strong> Intervention
Rating Profile (IRP)-15 (Martens, Witt,
Elliot, & Darveaux, 1985). The IRP-15 is a 15
item Likert-type scale that assesses general acceptability
of interventions. The Likert scale
ranges from one-strongly disagree to sixstrongly
agree. Higher scores indicate greater
acceptance of <strong>the</strong> intervention and ratings
above 52.5 are considered to reflect acceptability
by <strong>the</strong> rater (Brock & Elliott, 1987).
Results
Figures 1, 2, and 3 show <strong>the</strong> percentage of
intervals in which students performed target
and task engagement behaviors across
brief-FA and self-reinforcement phases. For
Adele (see Figure 1), <strong>the</strong> mean percentage of
intervals of outbursts during <strong>the</strong> brief-FA
across conditions included, escape 53.6%, attention
6.5%, and control 5%. The mean percentage
of intervals of task engagement during
<strong>the</strong> brief-FA across conditions included,
562 / Education and Training in Developmental Disabilities-December 2008
escape 46.3%, attention 93.5%, and control
95%. The brief-FA results indicated that
Adele’s outbursts were negatively reinforced
in <strong>the</strong> form of escape from demand. For
Barron, <strong>the</strong> mean percentage of intervals of
vocalizations during <strong>the</strong> brief-FA across conditions
included, escape 70.6%, attention 10%,
and control 0%. The mean percentage of intervals
of task engagement during <strong>the</strong> brief-FA
across conditions included, escape 29.3%, attention
90%, and control 100%. The brief-FA
results indicated that Barron’s vocalizations
were negatively reinforced in <strong>the</strong> form of escape
from demand. For Camilla, <strong>the</strong> mean
percentage of intervals of sitting on <strong>the</strong> floor
during <strong>the</strong> brief-FA across conditions included,
escape 76.3%, attention 16.5%, and
control 2%. The mean percentage of intervals
of task engagement during <strong>the</strong> brief-FA across
conditions included, escape 23.7%, attention
83.5%, and control 98%. The brief-FA results
indicated that Camilla’s sitting on <strong>the</strong> floor
behaviors were negatively reinforced in <strong>the</strong>
form of escape from demand.
During self-reinforcement, Adel’s outbursts
decreased to a mean of 37.8% intervals and
task engagement increased to a mean of
63.2% intervals when five break cards were
made available to self-reinforce (see Figure 1).
Adel’s outbursts continued to decrease to a
mean of 16% intervals and task engagement

Figure 2. Barron’s percentage of interval occurrences of clearing surfaces across brief-FA conditions and
changing criterion. FA functional analysis, Eescape, Ccontrol, Aattention.
increased to a mean of 84% intervals when
four break cards were available. When three
break cards were available, Adele’s outbursts
decrease to a mean of 7.4% intervals and task
engagement increased to a mean of 92.6%
intervals. However, when break cards and <strong>the</strong>
opportunity to self-reinforce were withdrawn,
Adele’s outbursts increased to a mean of 16%
intervals and task engagement decreased to a
mean of 84% intervals. During <strong>the</strong> reimplementation
of three self-reinforcement break
cards, Adele’s outbursts decreased to a mean
of 10% intervals and task engagement increased
to a mean of 90% intervals. Outbursts
fur<strong>the</strong>r decreased to a mean of 3.8% intervals
and .7% intervals when provided with two and
one self-reinforcement break cards, respectfully.
Task engagement increased to a mean of
96.3% intervals and 99.3% intervals when two
and one break cards were made available to
self-reinforce.
For Barron (see Figure 2), self-reinforcement
decreased vocalizations to a mean of
39% intervals and task engagement increased
to a mean of 61% intervals when five break
cards were made available to self-reinforce.
Barron’s vocalizations continued to decrease
to a mean of 15.4% intervals and task engagement
increased to a mean of 84.6% intervals
when four break cards were available. When
three break cards were available, Barron’s vo-
calizations decrease to a mean of 8.6% intervals
and task engagement increased to a
mean of 91.4% intervals. However, when
break cards and <strong>the</strong> opportunity to selfreinforce
were withdrawn, Barron’s vocalizations
increased to a mean of 24% intervals
and task engagement decreased to a mean of
76% intervals. During <strong>the</strong> reimplementation of
three self-reinforcement break cards, Barron’s
vocalizations decreased to a mean of 14.3%
intervals and task engagement increased to a
mean of 85.7% intervals. Vocalizations fur<strong>the</strong>r
decreased to a mean of 5.5% intervals and
2.3% intervals when provided with two and
one self-reinforcement break cards, respectfully.
Task engagement increased to a mean of
94.5% intervals and 97.6% intervals when two
and one break cards were made available to
self-reinforce.
For Camilla (see Figure 3), self-reinforcement
decreased sitting on <strong>the</strong> floor to a
mean of 53% intervals and task engagement
increased to a mean of 47% intervals when
five break cards were made available to selfreinforce.
Camilla’s sitting on <strong>the</strong> floor continued
to decrease to a mean of 25% intervals
and task engagement increased to a mean of
75% intervals when four break cards were
available. When three break cards were available,
Camilla’s sitting on <strong>the</strong> floor decrease to
a mean of 10% intervals and task engagement
Noncontingent Escape Self-Reinforcement / 563

Figure 3. Camilla’s percentage of interval occurrences of sitting on floor across brief-FA conditions and
changing criterion. FA functional analysis, Eescape, Ccontrol, Aattention
increased to a mean of 90% intervals. However,
when break cards and <strong>the</strong> opportunity to
self-reinforce were withdrawn, Camilla’s sitting
on <strong>the</strong> floor increased to a mean of 25%
intervals and task engagement decreased to a
mean of 75% intervals. During <strong>the</strong> reimplementation
of three self-reinforcement break
cards, Camilla’s sitting on <strong>the</strong> floor decreased
to a mean of 14% intervals and task engagement
increased to a mean of 86% intervals.
Sitting on <strong>the</strong> floor fur<strong>the</strong>r decreased to a
mean of 4% intervals and 3.6% intervals when
provided with two and one self-reinforcement
break cards, respectfully. Task engagement increased
to a mean of 96% intervals and 96.4%
intervals when two and one break cards were
made available to self-reinforce.
Social Validity
Each student’s teacher completed <strong>the</strong> social
validity IRP-15 rating scale. Following <strong>the</strong>
study, all teachers rated self-reinforcement
above 53 suggesting <strong>the</strong> intervention was socially
acceptable. Specifically, Adels’s teacher
rated break card self-reinforcement an 81,
Barron’s teacher rated <strong>the</strong> intervention a 75
and Camilla’s teacher an 85. In particular,
teachers strongly agreed that (a) most teachers
would find <strong>the</strong> intervention procedures
suitable for <strong>the</strong> behavior problem described,
(b) <strong>the</strong> intervention was a fair way to handle
<strong>the</strong> child’s problem behavior, (c) I liked <strong>the</strong>
procedures used in this intervention, (d) I
would suggest <strong>the</strong> use of this intervention to
o<strong>the</strong>r teachers, and (e) <strong>the</strong> intervention did
not result in negative side-effects for <strong>the</strong> child.
Discussion
564 / Education and Training in Developmental Disabilities-December 2008
The purpose of this study was to examine <strong>the</strong>
effects of noncontingent access to self-reinforcement
as an antecedent-based intervention
on inappropriate behavior maintained
by negative reinforcement or an escape function
of behavior. This study also sought to
investigate <strong>the</strong> effects of NCE on inappropriate
and appropriate behaviors when students
were provided <strong>the</strong> use of a break-card to selfreinforce?
Additionally, this study examined
teachers’ perceptions of change as a result of
<strong>the</strong> intervention. The brief-FA indicated that
target behaviors of <strong>the</strong> three students were
maintained by negative reinforcement in <strong>the</strong>
form of escape from demands. The selfreinforcement
intervention was designed to
match <strong>the</strong> function of behavior. As demonstrated
by <strong>the</strong> changing criterion and withdrawal
design, noncontingent access to selfreinforcement
in <strong>the</strong> form of escape from task
decreased students’ target behaviors while
concurrently improving task engagement.

These findings confirm previous investigations
that demonstrated positive use of selfreinforcement
(e.g., Ganz & Sigafoos, 2005;
Shapiro & Klein, 1980; Shapiro et al., 1980).
Student-directed strategies, such as selfreinforcement,
provide one means that allow
students to manage <strong>the</strong>ir own behaviors ra<strong>the</strong>r
than relying on o<strong>the</strong>rs to direct and monitor
<strong>the</strong>ir performance. These results display a
functional relationship that noncontingent escape
access to self-reinforcement was responsible
for decreasing target behaviors and improving
task engagement. Moreover, studentdirected
interventions do not require teachers
to monitor student behaviors continuously.
Since self-reinforcement was student-directed,
teachers could use <strong>the</strong> intervention while also
addressing <strong>the</strong> needs of o<strong>the</strong>r students in
same classroom. This study supports o<strong>the</strong>r
studies (Agran et al., 2005; Ganz & Sigafoos,
2005, Gilberts et al., 2001; Hughes et al., 2002;
O’Reilly et al., 2002; Todd & Reid, 2006),
which concluded teachers indication of selfmanagement
interventions as socially acceptable
for students with moderate to severe intellectual
disabilities.
These findings extend previous investigation
in several ways. First, noncontingent escape
access to self-reinforcement was used to
ensure that students had access to reinforcers
whe<strong>the</strong>r targeted behaviors were performed
or not. Kazdin (1984) and Agran (1997) suggested
that access to reinforcement whe<strong>the</strong>r
<strong>the</strong> targeted behavior was demonstrated or
not was necessary to determine it students
were truly self-managing. This study demonstrated
<strong>the</strong> use of noncontingent access to
self-reinforcement as a means of ensuring
that students are truly self-managing <strong>the</strong>ir behavior,
as <strong>the</strong>y could freely partake in reinforcement
at any time. This suggests that selfreinforcement
may function independent of
self-monitoring and self-recording.
Secondly, <strong>the</strong> noncontingent escape (NCE)
self-reinforcement intervention was derived
from functional analysis outcomes. The identification
of <strong>the</strong> conditions in which students’
demonstrated targeted behaviors assisted in
<strong>the</strong> selection of reinforcement. This study
supports previous research in <strong>the</strong> successful
use of NCE techniques for reducing problem
behavior and increasing appropriate behaviors
(Colman & Holmes, 1998; Reed et al.,
2005; Vollmer et al., 1995). The use of breakcards
extends <strong>the</strong> research of NCE or FTE by
providing students <strong>the</strong> opportunity to selfreinforce.
In this study, as break-cards or <strong>the</strong>
students’ opportunity to self-reinforce were
faded to one occurrence, student target behaviors
continued to decrease while task engagement
increased persistently. Students
benefited from <strong>the</strong> leaner schedule of NCE/
FTE, also observed in Reed et al. However,
when no break-cards to self-reinforce occurred,
student target behavior increased and
<strong>the</strong> level of task engagement decreased.
Within sessions, students were observed initially
using <strong>the</strong>ir break-cards at <strong>the</strong> beginning
of most session. However, as <strong>the</strong> study progressed
and break-cards were gradually faded
to one break-card, students were more likely
to save and use <strong>the</strong> cards later during <strong>the</strong>
session. While satiation effects of fewer demands
may explain a decrease in <strong>the</strong> observation
of avoidant behaviors at first, it was less
likely when students were provided only one
or two break cards per session. Vollmer et al.
(1995) suggested similar conclusion in which
during early sessions <strong>the</strong>re was relatively no
aversive stimulation from which to escape.
That is, early sessions relied on alternating
establishing operations. During later sessions,
<strong>the</strong> learner schedule of NCE discussed earlier
provides a possible conclusion to observations
of students saving and using <strong>the</strong> break-cards
later within <strong>the</strong> session.
Third, self-management strategies frequently
promote shifts in stimulus control through
manipulation of antecedent conditions. The
use of break cards shifted stimulus control
from <strong>the</strong> teacher to <strong>the</strong> student. By providing
an external stimulus (break card) to assist with
self-regulation of one’s behavior, students were
prompted of present and future contingencies
in <strong>the</strong> environment. Self-reinforcement,
among o<strong>the</strong>r student-directed intervention
strategies, provided an effective way to optimize
students with moderate to severe intellectual
disabilities participation in classroom
tasks and activities.
Fourth, this study specifically sought to use
NCE self-reinforcement to address task avoidant
behaviors. Negative reinforcement in <strong>the</strong> form
of escape from demands or tasks was <strong>the</strong> most
occurring maintaining consequence for students
with disabilities (Derby et al., 1992:
Noncontingent Escape Self-Reinforcement / 565

Iwata, Pace et al., 1994). This study extends
<strong>the</strong> literature of self-management for students
with disabilities in that it specifically addressed
<strong>the</strong> students’ function of behavior, which occurs
frequently in classroom settings. Additionally,
teachers may prefer to use breaks
from tasks as reinforcers for appropriate behavior
instead of tangible or classroom activity
reinforcers. NCE self-reinforcement may provide
ano<strong>the</strong>r intervention option for teachers
and students to manage behaviors.
Several limitations of this study may have
affected <strong>the</strong> overall results and interpretations.
First, <strong>the</strong> brief-FA only examined behaviors
maintained by negative reinforcement.
Behaviors maintained by positive reinforcement
and/or automatic reinforcement may
require additional procedural adaptations.
Secondly, students demonstrated no target behaviors
transitioning to tasks from breaks. Students
were most likely to demonstrate targeted
behaviors after briefly initiating <strong>the</strong> task
in order to avoid <strong>the</strong> entire task. Third, <strong>the</strong>
use of beginning with five break-cards was arbitrary
determined. Fourth, although teacher
acceptability of self-reinforcement was evident,
student social acceptability was not assessed.
Despite <strong>the</strong> fact that student use of <strong>the</strong> intervention
resulted in positive outcomes and
that <strong>the</strong> self-reinforcement was presented noncontingently,
specific student perceptions of
this intervention was unknown.
Future research is needed to verify <strong>the</strong> results
of <strong>the</strong> brief-FA and <strong>the</strong> results of <strong>the</strong>
NCE self-reinforcement intervention. Future
research should attempt to replicate <strong>the</strong>se results
across different tasks (e.g., discrete versus
chained, self-help versus leisure) and functions
of behavior (e.g., attention, sensory,
multiple functions). Additionally, future research
is needed to investigate <strong>the</strong> long-term
effects NCE self-reinforcement. The generalization
NCE self-reinforcement interventions
across settings and behaviors also warrant future
investigations. Fur<strong>the</strong>rmore, future research
is needed to investigate student perceptions
of self-reinforcement interventions.
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Received: 21 February 2007
Initial Acceptance: 22 April 2007
Final Acceptance: 10 June 2007
568 / Education and Training in Developmental Disabilities-December 2008

INDEX—VOLUME 43, 2008
AUTHORS
Aguilera, Antonio. See Moreno, Javier ...... 162
Alberto, Paul A. See Cihak, David .......... 102
Angell, Maureen E. Systematic instruction for
social-pragmatic language skills in lunchroom
settings .......................... 342
Asmus, Jennifer M. See Boyd, Brian A ...... 186
Bailey, Rita L. See Angell, Maureen E ...... 342
Banda, Devender R. Enhancing social and
transition behaviors of persons with autism
through activity schedules: A review ...... 324
Batu, Sema. Caregiver-delivered home-based
instruction using simultaneous prompting for
teaching home skills to individuals with developmental
disabilities. ................. 541
Beck, Ann R. Comparison of PECS and <strong>the</strong>
use of a VOCA: A replication ............ 198
Bergeron, Renee. States’ eligibility guidelines
for mental retardation: An update and consideration
of part scores and unreliability of
IQs ................................... 123
Beyer, Julia F. See Smith, Tammy .......... 421
Bock, Stacey J. See Beck, Ann R .......... 198
Bodkin, Amy E. See Kuhn, Laura R ......... 37
Bouck, Emily C. Factors impacting <strong>the</strong> enactment
of a functional curriculum in self-contained
cross-categorical programs ........ 294
Boyd, Brian A. Descriptive analysis of classroom
setting events on <strong>the</strong> social behaviors
of children with autism spectrum disorder . 186
Boyd, Christina M. Effects of <strong>the</strong> STAR intervention
program on interactions between
campers with and without disabilities during
inclusive summer day camp activities ..... 92
Brady, Michael P. See Bucholz, Jessica .... 486
Browder, Diane M. See Jimenez, Bree A .... 266
Bucholz, Jessica. Using literacy-based behavioral
interventions and social stories to improve
work behavior in employees with developmental
disabilities. ................. 486
Campbell, Dennis J. Comparison of assessment
results of children with low incidence
disabilities ............................. 217
Cannella-Malone, Helen I. Combined curricular
intervention with brief hands down to decrease
hand mouthing and <strong>the</strong> use of arm
splints for a young boy with profound disabilities
................................... 360
Carter, Stacy L. A distributive model of treatment
acceptability ...................... 411
Carter, Stacy L. Fur<strong>the</strong>r conceptualization of
treatment acceptability .................. 135
Chan, Jeffery M. See Cannella-Malone, Helen
I ...................................... 360
Cihak, David. Noncontingent escape access to
self-reinforcement to increase task engagement
for students with moderate to severe
disabilities. ............................. 556
Cihak, David. Use of a handheld prompting
system to transition independently through
vocational task for students with moderate to
severe intellectual disabilities ............ 102
Cohen, Sara. See Lifshitz, Hefziba ......... 514
Collins, Belva C. See Godsey, Janet Read . . 111
Colozzi, Gail A. Comparison of simultaneous
promting precedures in 1:1 and small group
instruction to teach play skills to preschool
students with pervasive developmental disorder
and developmental disabilities ...... 226
Conroy, Maureen A. See Boyd, Brian A ..... 186
Courtade, Ginevra R. See Jimenez, Bree A . . 266
Crotty, Kerry E. See Colozzi, Gail A ........ 226
Devlin, Patricia. Enhancing <strong>the</strong> job performance
of employees with disabilities using
<strong>the</strong> Self-Determined Career Development
Model ................................. 502
Devlin, Sandy. See Kuhn, Laura R .......... 37
Doggett, R. Anthony. See Kuhn, Laura R .... 37
Downs, Andrew. Effectiveness of discrete trial
teaching with preschool students with developmental
disabilities .................... 443
Downs, Robyn Conley. Downs, Andrew ..... 443
Duffy, Mary Lou. See Bucholz, Jessica ..... 486
Dymond, Stacy. Inclusive high school service
learning programs: Methods for and barriers
to including students with disabilities ...... 20
Floyd, Randy G. See Bergeron, Renee ...... 123
Fogal, Tina. See Stoner, Julia B ............ 77
Fossum, Michelle. Downs, Andrew ......... 423
Index, Volume 43 / 569

Fraiman, Jeffrey L. See Boyd, Christina M . . . 92
Gama, Robert I .......................... 556
Godsey, Janet Read. Peer-implemented time
delay procedures on <strong>the</strong> acquisition of
chained tasks by students with moderate
and severe disabilities .................. 111
Grimmett, Eric. See Banda, Devender R .... 324
Hager, Karen D. Utah’s alternative assessment:
Evidence regarding six aspects of validity
.................................. 144
Hanline, Mary Frances. See Whalon, Kelly . . 367
Hansen, David L. Teaching grocery store purchasing
skills to students with intellectual
disabilities using a computer-based intruction
program ........................... 431
Hawkins, Kelly A. See Boyd, Christina M .... 92
Henley, Joan. See Campbell, Dennis J ..... 217
Jimenez, Bree A. Teaching an algebraic equation
to high school students with moderate
developmental disabilities ............... 266
Jordan, LuAnn. See Kretlow, Allison ........ 397
Jung Chun, Eul Jung. See Dymond, Stacy . . 20
Kessler, Kelby. See Cihak, David .......... 102
Kleinert, Harold L. See Godsey, Janet Read . 111
Kontosh, Larry G. See Bucholz, Jessica .... 486
Kretlow, Allison. Teaching test-taking strategies
to improve <strong>the</strong> academic achievement
of students with mild mental disabilities ... 397
Kuhn, Laura R. Using pivotal response training
with peers in special education to facilitate
play in two children with autism .......... 37
Labin, Jennifer M. See Boyd, Christina M . . . 92
Lambrechts, Greet. Staff variables that influence
responses to challenging behaviour of
clients with intellectual disability: A review . 454
Larson, Laura. See Angell, Maureen E ...... 342
Lee, May S. H. Discrimination skills predict
effective preference assessment methods
for adults with developmental disabilities .. 388
Lifshitz, Hefziba. Attitudes of Israeli teachers
and paraprofesionals towards <strong>the</strong> new definition
of ID and <strong>the</strong>ir willingness to cope with
special education law changes ........... 514
Lingo, Amy Shearer. See Godsey, Janet Read 111
Lo, Ya-yu. See Kretlow, Allison ............. 397
Maes, Bea. See Lambrechts, Greet ........ 454
Mancil, G. Richmond. See Boyd, Brian A . . . 186
Martin, Garry L. See Lee, May S. H ......... 388
Martin, Toby L. See Lee, May S. H ......... 388
McKenney, Elizabeth L.W. See Boyd, Brian A . 186
Mechling, Linda C. High tech cooking: A literature
review of evolving technologies for
teaching a functional skill ................ 474
570 / Education and Training in Developmental Disabilities-December 2008
Mechling, Linda C. Thirty year review of safety
skill insruction for persons with intellectual
disability ............................... 311
Millar, Dorothy Squatrito. Self-determination in
relation to having or not having a legal
guardian: Case studies of two school-aged
young adults with developmental
disabilities ............................. 279
Moreno, Javier. Do parents prefer special
schools for <strong>the</strong>ir children with Autism?. .... 162
Morgan, Robert L. See Hansen, David L .... 431
Nakken, Han. See Vlaskamp, Carla ......... 334
Nguyen, Duong. See Lee, May S. H ........ 388
Nissim, Shoshanna. See Lifshitz, Hefziba . . . 514
O’Reilly, Mark F. See Cannella-Malone,
Helen I ................................ 360
Ohtake, Yoshihisa. See Okada, Shingo ..... 46
Okada, Shingo. Effects of perspective sentences
in Social Stories on improving <strong>the</strong>
adaptive behaviors of students with autism
spectrum disorders and related disabilities . 46
Parette, Howard P. See Stoner, Julia B ..... 77
Patton, James R. See Smith, Tammy ....... 421
Payne, Erin M. Guardianship: Its role in <strong>the</strong>
transition process for students with developmental
disabilities ...................... 3
Petry, Katja. See Lambrechts, Greet ........ 454
Polloway, Edward A. See Smith, Tammy .... 421
Rau, Kathryn. See Downs, Andrew ......... 423
Reilly, AmySue. See Campbell, Dennis J .... 217
Renzaglia, Adelle. See Dymond, Stacy ..... 20
Roll-Pettersson, Lise. Teacher’s perceived efficacy
and <strong>the</strong> inclusion of a pupil with dyslexia
or mild mental retardation: Findings
from Sweden .......................... 174
Ruijssenaars, Wied. See Tadema, Annemarie
C ..................................... 529
Saldana, David. See Moreno, Javier ........ 162
Schuster, John W. See Godsey, Janet Read . 111
Scott, Jack. See Bucholz, Jessica .......... 486
Shands, Elizabeth I. See Bergeron, Renee . . 123
Sigafoos, Jeff. See Cannella-Malone, Helen I . 360
Sitlington, Patricia L. See Payne, Erin M ..... 3
Slocum, Timothy A. See Hager, Karen D .... 144
Smith, Tammy. Individuals with intellectual and
developmental disabilities in <strong>the</strong> criminal justice
system and implications for transition
planning. .............................. 421
Stoner, Julia B. Preschool teacher perceptions
of assistive technology and professional development
responses ................... 77
Stoner, Julia B. See Beck, Ann R ........... 198
Sutter, Mary Beth. See Boyd, Christina M . . . 92

Tadema, Annemarie C. Implementation of a
programme for students with profound intellectual
and multiple disabilities in schools:
Three case studies ..................... 529
Tekin-Iftar, Elif. Parent-delivered communitybased
instruction with simultaneous prompting
for teaching community skills to children
with developmental disabilities ........... 249
Thorsteinsson, Jennifer R. See Lee, May S. H . 388
Tien, Kai-Chien. Effectiveness of <strong>the</strong> picture
exchange communication system as a functional
communication intervention for individuals
with Autism Specturm Disorders: A
practice-based research syn<strong>the</strong>sis ........ 61
Vlaskamp, Carla. See Tadema, Annemarie C . 529
Vlaskamp, Carla. Therapeutic interventions in
<strong>the</strong> support of people with profound intellectual
and multiple disabilities .............. 334
Wahl, Meghan R. See Boyd, Christina M .... 92
Ward, Louise W. See Colozzi, Gail A ....... 226
Watts, Emily H. See Stoner, Julia B ......... 77
Whalon, Kelly. Effects of a reciprocal intervention
on <strong>the</strong> question generation and responding
of children with autism spectrum
disorder ............................... 367
White, Richard B. See Kretlow, Allison ...... 397
Wojcik, Brian W. See Stoner, Julia B ........ 77
Yanagihara, Masafumi. See Okada, Shingo . 46
Yu, C. T. See Lee, May S. H ............... 388
TITLES
A distributive model of treatment acceptability.
Stacy L. Carter ......................... 411
Attitudes of Israeli teachers and paraprofesionals
towards <strong>the</strong> new definition of ID and <strong>the</strong>ir
willingness to cope with special education
law changes. Hefziba Lifshitz, Shoshanna
Nissim, and Sara Cohen ................ 514
Caregiver-delivered home-based instruction
using simultaneous prompting for teaching
home skills to individuals with developmental
disabilities. Sema Batu, Cihak and Robert
I. Gama ............................... 541
Combined curricular intervention with brief
hands down to decrease hand mouthing and
<strong>the</strong> use of arm splints for a young boy with
profound disabilities. Helen I. Cannella-Malone,
Mark F. O’Reilly, Jeff Sigafoos, and
Jeffery M. Chan ........................ 360
Comparison of assessment results of children
with low incidence disabilities. Dennis J.
Campbell, AmySue Reilly, and Joan Henley 217
Comparison of PECS and <strong>the</strong> use of a VOCA:
A replication. Ann R. Beck, Julia B. Stoner,
and Stacey J. Bock ..................... 198
Comparison of simultaneous promting precedures
in 1:1 and small group instruction to
teach play skills to preschool students with
pervasive developmental disorder and developmental
disabilities. Gail A. Colozzi,
Louise W. Ward, and Kerry E. Crotty ..... 226
Descriptive analysis of classroom setting
events on <strong>the</strong> social behaviors of children
with autism spectrum disorder. Brian A.
Boyd, Maureen A. Conroy, Jennifer M. Asmus,
Elizabeth L.W. McKenney, and G.
Richmond Mancil ....................... 186
Discrimination skills predict effective preference
assessment methods for adults with
developmental disabilities. May S. H. Lee,
Duong Nguyen, C. T. Yu, Jennifer R. Thorsteinsson,
Toby L. Martin, and Garry L. Martin
.................................... 388
Do parents prefer special schools for <strong>the</strong>ir children
with Autism?. Javier Moreno, Antonio
Aguilera, and David Saldana ............ 162
Effectiveness of discrete trial teaching with
preschool students with developmental disabilities.
Andrew Downs, Robyn Conley
Downs, Michelle Fossum, and Kathryn Rau . 443
Effectiveness of <strong>the</strong> picture exchange communication
system as a functional communication
intervention for individuals with Autism
Specturm Disorders: A practice-based research
syn<strong>the</strong>sis. Kai-Chien Tien ......... 61
Effects of a reciprocal intervention on <strong>the</strong> question
generation and responding of children
with autism spectrum disorder. Kelly Whalon
and Mary Frances Hanline .............. 367
Effects of perspective sentences in Social Stories
on improving <strong>the</strong> adaptive behaviors of
students with autism spectrum disorders and
related disabilities. Shingo Okada, Yoshihisa
Ohtake, and Masafumi Yanagihara ....... 46
Effects of <strong>the</strong> STAR intervention program on
interactions between campers with and without
disabilities during inclusive summer day
camp activities. Christina M. Boyd, Jeffrey L.
Fraiman, Kelly A. Hawkins, Jennifer M. Labin,
Mary Beth Sutter, and Meghan R. Wahl 92
Enhancing social and transition behaviors of
persons with autism through activity schedules:
A review. Devender R. Banda and Eric
Grimmett .............................. 324
Enhancing <strong>the</strong> job performance of employees
with disabilities using <strong>the</strong> Self-Determined
Career Development Model. Patricia Devlin . 502
Factors impacting <strong>the</strong> enactment of a functional
curriculum in self-contained cross-categorical
programs. Emily C. Bouck ....... 294
Fur<strong>the</strong>r conceptualization of treatment acceptability.
Stacy L. Carter .................. 135
Guardianship: Its role in <strong>the</strong> transition process
for students with developmental disabilities.
Erin M. Payne and Patricia L. Sitlington . . . 3
Index, Volume 43 / 571

High tech cooking: A literature review of evolving
technologies for teaching a functional
skill. Linda C. Mechling ................. 474
Implementation of a programme for students
with profound intellectual and multiple disabilities
in schools: Three case studies. Annemarie
C. Tadema, Carla Vlaskamp, and
Wied Ruijssenaars ...................... 529
Inclusive high school service learning programs:
Methods for and barriers to including
students with disabilities. Stacy Dymond,
Adelle Renzaglia, and Eul Jung Chun .... 20
Individuals with intellectual and developmental
disabilities in <strong>the</strong> criminal justice system and
implications for transition planning. Tammy
Smith, Edward A. Polloway, James R. Patton,
and Julia F. Beyer .................. 421
Noncontingent escape access to self-reinforcement
to increase task engagement for
students with moderate to severe disabilities.
David ............................. 556
Parent-delivered community-based instruction
with simultaneous prompting for teaching
community skills to children with developmental
disabilities. Elif Tekin-Iftar ......... 249
Peer-implemented time delay procedures on
<strong>the</strong> acquisition of chained tasks by students
with moderate and severe disabilities. Janet
Read Godsey, John W. Schuster, Amy
Shearer Lingo, Belva C. Collins, and Harold
L. Kleinert ............................. 111
Preschool teacher perceptions of assistive
technology and professional development
responses. Julia B. Stoner, Howard P. Parette,
Emily H. Watts, Brian W. Wojcik, and
Tina Fogal ............................. 77
Self-determination in relation to having or not
having a legal guardian: Case studies of two
school-aged young adults with developmental
disabilities. Dorothy Squatrito Millar .... 279
Staff variables that influence responses to
challenging behaviour of clients with intellectual
disability: A review. Greet Lambrechts,
Katja Petry, and Bea Maes .............. 454
States’ eligibility guidelines for mental retardation:
An update and consideration of part
scores and unreliability of IQs. Renee
Bergeron, Randy G. Floyd, and Elizabeth I.
Shands ................................ 123
572 / Education and Training in Developmental Disabilities-December 2008
Systematic instruction for social-pragmatic language
skills in lunchroom settings. Maureen
E. Angell, Rita L. Bailey, and Laura Larson . 342
Teacher’s perceived efficacy and <strong>the</strong> inclusion
of a pupil with dyslexia or mild mental retardation:
Findings from Sweden. Lise Roll-Pettersson
................................ . . 174
Teaching an algebraic equation to high school
students with moderate developmental disabilities.
Bree A. Jimenez, Diane M. Browder,
and Ginevra R. Courtade ........... 266
Teaching grocery store purchasing skills to
students with intellectual disabilities using a
computer-based intruction program. David
L. Hansen and Robert L. Morgan ........ 431
Teaching test-taking strategies to improve <strong>the</strong>
academic achievement of students with mild
mental disabilities. Allison Kretlow, Ya-yu Lo,
Richard B. White, and LuAnn Jordan ..... 397
Therapeutic interventions in <strong>the</strong> support of
people with profound intellectual and multiple
disabilities. Carla Vlaskamp and Han
Nakken ................................ 334
Thirty year review of safety skill insruction for
persons with intellectual disability. Linda C.
Mechling .............................. 311
Use of a handheld prompting system to transition
independently through vocational task
for students with moderate to severe intellectual
disabilities. David Cihak, Kelby
Kessler, and Paul A. Alberto ............. 102
Using literacy-based behavioral interventions
and social stories to improve work behavior
in employees with developmental disabilities.
Jessica Bucholz, Michael P. Brady,
Mary Lou Duffy, Jack Scott, and Larry G.
Kontosh ............................... 486
Using pivotal response training with peers in
special education to facilitate play in two
children with autism. Laura R. Kuhn, Amy E.
Bodkin, Sandy Devlin, and R. Anthony Doggett
................................... 37
Utah’s alternative assessment: Evidence regarding
six aspects of validity. Karen D.
Hager and Timothy A. Slocum ........... . . 144

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