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

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

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

<strong>in</strong> 

<strong>Developmental</strong> 

<strong>Disabilities</strong> 

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

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

Volume 44 Number 4 December 2009

December 2009 <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong> Vol. 44, No. 4, pp. 433–588

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

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

The Council for Exceptional Children 

Editor: Stanley H. Zucker 

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<strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong> Vol. 44, No. 4, December 2009, Copyright 2009 by the <strong>Division</strong> on <strong>Developmental</strong> 

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

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

VOLUME 44 NUMBER 4 DECEMBER 2009 

Functional Curriculum Models for Secondary Students with Mild Mental 

Impairment 435 

EMILY C. BOUCK 

Autism Spectrum Disorders <strong>and</strong> Sibl<strong>in</strong>g Relationships: Research <strong>and</strong> Strategies 444 

JULIA F. BEYER 

Impacts of Family Support <strong>in</strong> Early Childhood Intervention Research 453 

ANNA C. FRIEND, JEAN ANN SUMMERS, <strong>and</strong> ANN P. TURNBULL 

Differences Between Employees’ <strong>and</strong> Supervisors’ Evaluations of Work 

Performance <strong>and</strong> Support Needs 471 

KYLE BENNETT, MICHAEL FRAIN, MICHAEL P. BRADY, HOWARD ROSENBERG, <strong>and</strong> 

TRICIA SURINAK 

Review of Interventions to Increase Functional <strong>and</strong> Symbolic Play <strong>in</strong> Children 

with Autism 481 

RUSSELL LANG, MARK O’REILLY, MANDY RISPOLI, KARRIE SHOGREN, 

WENDY MACHALICEK, JEFF SIGAFOOS, <strong>and</strong> APRIL REGESTER 

Acquisition <strong>and</strong> Generalization of Cha<strong>in</strong>ed Tasks Taught with Computer 

Based Video Instruction to Children with Autism 493 

KEVIN M. AYRES, AMY MAGUIRE <strong>and</strong> DESIREE MCCLIMON 

Comparison of Self, Other, <strong>and</strong> Subjective Video Models for Teach<strong>in</strong>g Daily 

Liv<strong>in</strong>g Skills to Individuals with <strong>Developmental</strong> <strong>Disabilities</strong> 509 

TONI VAN LAARHOVEN, LESLIE M. ZURITA, JESSE W. JOHNSON, KATIE M. GRIDER 

<strong>and</strong> KRISTIN L. GRIDER 

Parental Stress <strong>and</strong> Autism: Are There Useful Cop<strong>in</strong>g Strategies? 523 

G. RICHMOND MANCIL, BRIAN A. BOYD, <strong>and</strong> PENA BEDESEM 

Teach<strong>in</strong>g Organizational Skills to Children with High Function<strong>in</strong>g Autism <strong>and</strong> 

Asperger’s Syndrome 538 

KIMBERLY POWERS DORMINY, DEANNA LUSCRE, <strong>and</strong> DAVID L. GAST 

Academic Achievement Profiles of Children with High Function<strong>in</strong>g Autism 

<strong>and</strong> Asperger Syndrome: A Review of the Literature 551 

PEGGY J. SCHAEFER WHITBY <strong>and</strong> G. RICHMOND MANCIL 

A Method to Assess Work Task Preferences 561 

VIRGINIE COBIGO, DIANE MORIN, <strong>and</strong> YVES LACHAPELLE 

Fourth Grade Outcomes of Children with a Preschool History of 

<strong>Developmental</strong> Disability 573 

CHRISTINE E. F. DELGADO 

Index—Volume 44, 2009 580 

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

<strong>Developmental</strong> <strong>Disabilities</strong> 434 

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

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

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

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

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

March 2010 

Teach<strong>in</strong>g students with moderate <strong>in</strong>tellectual disabilities to read: An experimental exam<strong>in</strong>ation of 

a comprehensive read<strong>in</strong>g <strong>in</strong>tervention. Jill H. Allor, Patricia Mathes, Kyle Roberts, Francesca Jones, 

<strong>and</strong> Tammi Champl<strong>in</strong>, Department of Teach<strong>in</strong>g <strong>and</strong> Learn<strong>in</strong>g, Annette Caldwell Simmons School 

of <strong>Education</strong> <strong>and</strong> Human Development, Southern Methodist University, P.O. Box 750381, Dallas, 

TX 75275-0381. 

Friendships with peers with severe disabilities: American <strong>and</strong> Iranian secondary students’ ideas 

about be<strong>in</strong>g a friend. Mohsen Shokoohi-Yekta <strong>and</strong> Jo Hendrickson, The Department of Teach<strong>in</strong>g 

<strong>and</strong> Learn<strong>in</strong>g, N259 L<strong>in</strong>dquist Center, University of Iowa, Iowa City, IA 52242. 

Effects of constant time delay procedure on the Halliwick’s method of swimm<strong>in</strong>g rotation skills for 

children with Autism. I˙lker Yılmaz, Ferman Konukman, Benyam<strong>in</strong> Birkan, Arzu Özen, Mehmet 

Yanardag˘, <strong>and</strong> I˙lhan Çamursoy, The College at Brockport, State University of New York, Dept. of 

Physical <strong>Education</strong> & Sports, Brockport, NY 14420-2989. 

Mild <strong>in</strong>tellectual disabilities: Legacies <strong>and</strong> trends <strong>in</strong> concepts <strong>and</strong> educational practices. Edward A. 

Polloway, Jacquel<strong>in</strong>e Lub<strong>in</strong>, J. David Smith, <strong>and</strong> James R. Patton, Office of Graduate Studies <strong>and</strong> 

Community Advancement, Lynchburg College, Lynchburg, VA 24501. 

Response cards: An effective <strong>in</strong>tervention for students with disabilities. Channon Horn, Department 

of Special <strong>Education</strong>, 229 Taylor <strong>Education</strong> Build<strong>in</strong>g, University of Kentucky, Lex<strong>in</strong>gton, KY 

40506-0001. 

Characteristics <strong>and</strong> hypothesized functions of challeng<strong>in</strong>g behavior <strong>in</strong> a community-based sample. 

Anna Ingeborg Petursdottir, John W. Esch, Rachael A. Sautter, <strong>and</strong> Kelise K. Stewart, Department 

of Psychology, TCU Box 298920, Fort Worth, TX 76129. 

Use of self-model<strong>in</strong>g static-picture prompts via a h<strong>and</strong>held computer to facilitate self-monitor<strong>in</strong>g 

<strong>in</strong> the general education classroom. David F. Cihak, Rachel Wright, <strong>and</strong> Kev<strong>in</strong> M. Ayres, University 

of Tennessee, A412 Claxton Complex, Knoxville, TN 37996-3442. 

Long-term outcomes of services <strong>in</strong> <strong>in</strong>clusive <strong>and</strong> self-conta<strong>in</strong>ed sett<strong>in</strong>gs for sibl<strong>in</strong>gs with comparable 

significant disabilities. Diane Lea Ryndak, Terri Ward, S<strong>and</strong>ra Alper, Jill F. Storch, <strong>and</strong> 

Jennifer Wilson Montgomery, University of Florida, Department of Special <strong>Education</strong>, G315 

Norman Hall, PO Box 117050, Ga<strong>in</strong>esville, FL 32611-7050. 

Mercury <strong>and</strong> autism: A review. Jie Zhang <strong>and</strong> John J. Wheeler, <strong>Education</strong> <strong>and</strong> Human Development, 

SUNY Brockport, 350 New Campus Drive, Brockport, NY 14420. 

Practices <strong>in</strong> early <strong>in</strong>tervention for children with autism: A comparison with National Research 

Council recommended practices. Robyn Conley Downs <strong>and</strong> Andrew Downs, 2543 NW 118th Ter, 

Portl<strong>and</strong>, OR 97229. 

A collaborative approach to implement positive behavior support plans for children with problem 

behaviors: A comparison of consultation versus consultation <strong>and</strong> feedback approach. Dilek Erbas, 

Erciyes Universitesi, Egitim Fakultesi, Ozel Egitim Bolumu, Kayseri, TURKEY. 

Exam<strong>in</strong><strong>in</strong>g the effects of a social communication <strong>in</strong>tervention on the play behaviors of children 

with autism. Jennifer Loncola Walberg <strong>and</strong> Lesley A. Craig-Unkefer, DePaul University, School of 

<strong>Education</strong>, 2320 North Kenmore, Chicago, IL 60614-3250. 

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

Functional Curriculum Models for Secondary Students with 

Mild Mental Impairment 

Emily C. Bouck 

Purdue University 

Abstract: This paper analyzed 10 commercially available functional curriculum models designed for secondary 

students with mild-to-moderate mental impairment. The models were exam<strong>in</strong>ed with respect to the <strong>in</strong>clusion of 

functional curriculum components, the doma<strong>in</strong>s <strong>and</strong> subdoma<strong>in</strong>s of adulthood, the materials identified by the 

model to be used to deliver the curriculum, <strong>and</strong> the <strong>in</strong>corporation of best practices for teach<strong>in</strong>g. Results <strong>in</strong>dicate 

that none of the models reviewed adequately addressed the needs of this population for learn<strong>in</strong>g <strong>in</strong> terms of 

provid<strong>in</strong>g a functional curriculum. Overall, the analysis suggests that more appropriate curriculum models 

need to be developed, such as one that is designed to be balanced, comprehensive, <strong>and</strong> coherent for secondary 

students with mild mental impairment. In addition, more research is needed on functional curricula, <strong>in</strong>clud<strong>in</strong>g 

the components of this approach. 

Follow<strong>in</strong>g recent federal <strong>and</strong> state policies 

(i.e., No Child Left Beh<strong>in</strong>d [NCLB], 2002; Individuals 

with <strong>Disabilities</strong> <strong>Education</strong> Act [IDEA], 

1997, 2004), the focus of special education has 

shifted from process to outcomes. It is now 

m<strong>and</strong>ated that teachers of students with disabilities 

be held accountable for their students’ 

academic progress <strong>and</strong> outcomes. 

Thus, <strong>in</strong> this era of accountability <strong>and</strong> achievement, 

questions arise as to what should be the 

targeted outcomes for students with mild 

mental impairment <strong>and</strong> what educational programm<strong>in</strong>g 

best meets their needs at the secondary 

level <strong>in</strong> terms of successfully achiev<strong>in</strong>g 

post-school outcomes (Bouck, 2004, 2007). 

This article advocates for the use of a functional 

curriculum for secondary students with 

mild mental impairment, yet discusses limitations 

that may be imposed through implementation 

of the functional curriculum models 

currently available. It discusses issues teachers 

need to consider if they use or are consider<strong>in</strong>g 

a currently-available commercialized functional 

curriculum model. 

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

be addressed to Emily C. Bouck, 5146 BRNG Hall, 

Purdue University, 100 N. University St., West Lafayette, 

IN 47907. Email: bouck@purdue.edu 

<strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>, 2009, 44(4), 435–443 

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

Functional Curriculum 

A functional curriculum is a curriculum designed 

to teach functional life skills, or <strong>in</strong> 

other words, the skills necessary to live, work, 

<strong>and</strong> have fun <strong>in</strong> an <strong>in</strong>clusive community 

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

Browder, 1987). Components of a functional, 

or life management, curriculum are presumed 

to <strong>in</strong>clude the functional skills <strong>and</strong> 

applications of core subject areas (academics), 

vocational education, community access, 

daily liv<strong>in</strong>g, f<strong>in</strong>ancial, <strong>in</strong>dependent liv<strong>in</strong>g, 

transportation, social/relationships, <strong>and</strong> selfdeterm<strong>in</strong>ation 

(Patton, Cron<strong>in</strong>, & Jairrels, 

1997). A functional curriculum is utilized 

when students with disabilities are deemed to 

need assistance <strong>in</strong> the above-mentioned critical 

life skills areas, <strong>and</strong> when the educational 

experiences these students are receiv<strong>in</strong>g <strong>in</strong> 

schools through the general education curriculum 

fails to reflect the skills necessary for 

their post-school success (Bouck, 2004; Retish, 

Hitch<strong>in</strong>gs, Horvath, & Schmalle, 1991). 

While us<strong>in</strong>g a functional curriculum to educate 

secondary students with mild mental 

impairment may be at odds with current federal 

policy (i.e., NCLB, 2002; IDEA, 2004) 

(Bouck, 2009), the concerns about the postschool 

success, or lack thereof, by this population 

suggests that a curriculum focused on 

social skills, f<strong>in</strong>ances, vocational skills, <strong>and</strong> 

Functional Curriculum Models / 435

other life skills may be what these students 

need (Patton, Cron<strong>in</strong>, & Bassett, 1997). This is 

especially so consider<strong>in</strong>g the lack of positive 

post-school outcomes for students with mild 

mental impairment. The population is traditionally 

associated with low employment rates, 

low <strong>in</strong>dependent liv<strong>in</strong>g rates, <strong>and</strong> difficulty 

adjust<strong>in</strong>g to life after school (Blackorby & 

Wagner, 1996; Edgar & Polloway, 2004; Neubert, 

Moon, & Grigal, 2004; Wagner, Newman, 

Cameto, & Lev<strong>in</strong>e, 2005). Although recent 

data have suggested improvement <strong>in</strong> 

some post-school outcomes for secondary students 

with mild mental impairment (i.e., decreased 

dropout rates, <strong>in</strong>creased employment 

rates, <strong>in</strong>creased rates of <strong>in</strong>dependent liv<strong>in</strong>g), 

an alternative, such as a functional curriculum, 

to provid<strong>in</strong>g the general education curriculum, 

which is focused on prepar<strong>in</strong>g students 

for high-stakes tests <strong>and</strong> rigorous higher 

education, needs to be exam<strong>in</strong>ed for this 

population which has a statistically low postsecondary 

education rate (13.4% <strong>in</strong> 2003) but 

potential for mean<strong>in</strong>gful post-school contributions 

outside of higher education (Wagner 

et al.). 

Although calls for the use of functional curriculum 

to educate secondary students with 

mild mental impairment have been made 

(Bouck, 2004; Cron<strong>in</strong>, 1996; Dever & Knapczyk, 

1997), the field of special education has 

not given enough deliberation to the curriculum 

models commercially available to implement 

such an approach. This study explored 

<strong>and</strong> reviewed commercially available functional 

curriculum models targeted towards educat<strong>in</strong>g 

secondary students with mild mental 

impairment (i.e., marketed towards students 

with “mild” to “moderate” disabilities). While 

students with mild mental impairment were 

the target population, the curriculum models 

exam<strong>in</strong>ed <strong>in</strong>cluded ones that were geared towards 

students with moderate disabilities, 

given the position that mild mental impairment 

is not a “mild” disability (see Polloway, 

2004). Specifically, this study sought to explore 

functional curriculum model options 

that exist at the secondary level <strong>and</strong> consider 

if these models are appropriate <strong>in</strong> terms of 

serv<strong>in</strong>g the needs of secondary students with 

mild mental impairment <strong>and</strong> support<strong>in</strong>g 

teachers who elect to implement a particular 

model. 

Method 

Materials 

436 / <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>-December 2009 

Ten commercially available functional curriculum 

models were reviewed: The Syracuse 

Community-Reference Guide (Ford et al., 1989); 

Functional Independence Skills H<strong>and</strong>book (Killion, 

2003); Impact: A Functional Curriculum 

H<strong>and</strong>book (Neel & Bill<strong>in</strong>gsley, 1989); Community-Based 

Curriculum (Falvey, 1989); Functional 

Curriculum for Teach<strong>in</strong>g Students with <strong>Disabilities</strong> 

(Bender, Valletutti, Bagl<strong>in</strong>, & Hoffnung, 1996); 

Life Skills Instruction for All Students with Special 

Needs (Cron<strong>in</strong> & Patton, 1993); Functional Curriculum 

for Elementary, Middle, <strong>and</strong> Secondary 

Students with Special Needs (Wehman & Kregel, 

2004); Life Skills Activities for Secondary Students 

with Special Needs (Mannix, 1995); Adaptive 

Liv<strong>in</strong>g Skills Curriculum (Anderson, Bru<strong>in</strong><strong>in</strong>ks, 

Morreau, & Gilman, 1991); <strong>and</strong> Everyday Life 

Skills (American Guidance Service, 2001). 

Brol<strong>in</strong>’s (2004) Life Centered Career <strong>Education</strong> 

(LCCE) is mentioned <strong>in</strong> this review, but is not 

evaluated as it represents a fundamentally different 

functional curriculum model <strong>in</strong> terms 

of cost, professional development opportunities, 

number of revisions, <strong>and</strong> endorsement by 

the Council for Exceptional Children. 

Four charts were created or adapted by the 

researcher to analyze the commercially available 

functional curriculum models (all available 

from the author by request). The first 

chart (Chart A) was created by the researcher 

to analyze basic <strong>in</strong>formation, such as the age 

<strong>and</strong> disability focus, research conducted on 

the curriculum, resources available with the 

curriculum, number of revisions, <strong>and</strong> associated 

professional development opportunities 

available for teachers. It also focused on evidence 

of functional curriculum components, 

as def<strong>in</strong>ed by Patton, Cron<strong>in</strong>, <strong>and</strong> Jairrels 

(1997), with<strong>in</strong> each model, <strong>in</strong>clud<strong>in</strong>g: functional 

academics, vocational education, daily 

liv<strong>in</strong>g, social/relationships, <strong>in</strong>dependent liv<strong>in</strong>g, 

community access or skills, transportation, 

f<strong>in</strong>ancial, self-determ<strong>in</strong>ation, leisure <strong>and</strong> 

recreation, <strong>and</strong> communication skills. The 

second chart (Chart B) was adapted from Mariage 

<strong>and</strong> Patriarca’s (2002) review of “best 

teach<strong>in</strong>g practices.” It identified the <strong>in</strong>structional 

strategies offered <strong>in</strong> each model, such 

as the use of sequenc<strong>in</strong>g, drill <strong>and</strong> practice

eview, segmentation, directed question<strong>in</strong>g 

<strong>and</strong> responses, level of difficulty of tasks, technology, 

group<strong>in</strong>g of students (<strong>in</strong>dividually, 

pairs, small group, whole group), any supplement 

to teacher <strong>and</strong> peer <strong>in</strong>volvement, <strong>and</strong> 

strategy cues. 

The third chart (Chart C) was adapted from 

Cron<strong>in</strong> <strong>and</strong> Patton’s (1993) doma<strong>in</strong>s <strong>and</strong> subdoma<strong>in</strong>s 

of adulthood. The curriculum models 

were analyzed for their <strong>in</strong>clusion of Cron<strong>in</strong> 

<strong>and</strong> Patton’s six doma<strong>in</strong>s of adulthood <strong>and</strong> 23 

subdoma<strong>in</strong>s. The six doma<strong>in</strong>s of adulthood 

<strong>in</strong>cluded: employment/education, home <strong>and</strong> 

family, leisure pursuits, personal responsibilities 

<strong>and</strong> relationships, community <strong>in</strong>volvement, 

<strong>and</strong> physical/emotional health. The 

subdoma<strong>in</strong>s fell with<strong>in</strong> the six doma<strong>in</strong>s <strong>and</strong> 

<strong>in</strong>cluded aspects such as goal sett<strong>in</strong>g, family 

life, general job skills, <strong>and</strong> travel. The fourth 

chart (Chart D) was based off of Hammill <strong>and</strong> 

Bartel’s (1990) materials analysis, which had 

10 major sections: <strong>in</strong>structional areas <strong>and</strong> 

skills, scope <strong>and</strong> sequence; component parts 

of material; level of the material; quality; format; 

support materials; time requirements; 

field test <strong>and</strong> research data; bibliographic <strong>and</strong> 

price; <strong>and</strong> method, approach, or theoretical 

base. 

Procedure 

The functional curriculum models reviewed 

were first selected from a list of commercially 

available functional curriculum models identified 

by the Center for Innovations <strong>in</strong> <strong>Education</strong> 

(n.d.). Major publish<strong>in</strong>g companies were 

also explored for functional curriculum 

model materials. The complete list was narrowed 

by exclud<strong>in</strong>g any curriculum models 

that were deemed as not be<strong>in</strong>g comprehensive 

(i.e., only dealt with a specific functional area, 

such as self-care or self-determ<strong>in</strong>ation), not 

geared towards secondary students, or were 

clearly focused on students with severe mental 

impairment or other severe disabilities. 

Data Analysis 

After select<strong>in</strong>g <strong>and</strong> purchas<strong>in</strong>g the functional 

curriculum models that met the criteria (i.e., 

comprehensive, focused on secondary students 

with mild-to-moderate mental impairment), 

the models were then analyzed with 

respect to the charts previously discussed. 

Thus, the curriculum materials were reviewed, 

the charts completed, <strong>and</strong> then the functional 

curriculum models discussed <strong>in</strong> terms of most 

comprehensive (i.e., covered most components) 

or “best value.” When analyz<strong>in</strong>g the 

models with respect to components covered, 

each curriculum model was given one po<strong>in</strong>t if 

it fully addressed a component (e.g., vocational, 

social skills) <strong>and</strong> a half-po<strong>in</strong>t if they 

partially addressed a component, such as 

with<strong>in</strong> the component of transportation if the 

model discussed walk<strong>in</strong>g safely with<strong>in</strong> the 

community, but not public transportation 

(Charts A <strong>and</strong> C). The other two charts 

(Charts B <strong>and</strong> D) were marked with respect to 

yes or no if they addressed components of 

best teach<strong>in</strong>g or specific <strong>in</strong>formation, such as 

hav<strong>in</strong>g a research base or offer<strong>in</strong>g support 

materials. 

Results 

The 10 functional curriculum models exam<strong>in</strong>ed 

were all marketed towards secondary students 

with disabilities <strong>and</strong>, at a superficial 

analysis, could be considered appropriate for 

use with students with mild mental impairment. 

All models addressed students with 

“mild” or “moderate” disabilities, although 

they used various term<strong>in</strong>ologies, such as developmental 

disabilities, moderate disabilities, 

<strong>and</strong> special needs students. While the models 

supposedly focused on the same curriculum 

components (i.e., functional) <strong>and</strong> the same 

student population, they were quite divergent. 

For example, <strong>in</strong> price alone, the curriculum 

models had a wide range (see Table 1). The 

lowest cost was $29.95 for Life Skills Instruction 

for All Students with <strong>Disabilities</strong> (Cron<strong>in</strong> & Patton, 

1993) while the most expensive was Everyday 

Life Skills at $519.93 (American Guidance 

Service, 2001). Brol<strong>in</strong>’s (2004) Life Centered 

Career <strong>Education</strong> (LCCE), which was not reviewed, 

was priced at $995. Five of the 10 

curriculum models were under $100, two 

more under $200, <strong>and</strong> one was out of pr<strong>in</strong>t 

<strong>and</strong> no longer available for purchase from the 

publisher (i.e., Impact: A Functional Curriculum 

H<strong>and</strong>book, Neel & Bill<strong>in</strong>gsley, 1989). 

All the curriculum models addressed most 

aspects of a functional curriculum, as def<strong>in</strong>ed 

by Patton, Cron<strong>in</strong>, <strong>and</strong> Jairrels (1997): Func- 


TABLE 1 

Functional Curriculum Models’ Price from Lowest to Highest 

Order Title Cost 

1 Life Skills Activities for Secondary Students with Special Needs $29.95 

2 Community-Based Curriculum $30.00 

3 Life Skills Instruction for All Students with Special Needs $39.00 

4 Functional Curriculum for Elementary, Middle, <strong>and</strong> Secondary Age 

Students with Special Needs 

$52.00 

5 The Syracuse Community-Referenced Guide $59.00 

6 Functional Independence Skills H<strong>and</strong>book $62.00 

7 Everyday Life Skills (without extras) $114.97 

8 A Functional Curriculum for Teach<strong>in</strong>g Students with <strong>Disabilities</strong> $125.00 

9 Adaptive Liv<strong>in</strong>g Skills Curriculum $457.50 

10 Everyday Life Skills (with extras) $519.93 

11 Life Centered Career <strong>Education</strong> $995.00 

Note. Impact: A Functional Curriculum H<strong>and</strong>book is out of pr<strong>in</strong>t. 

tional academics, vocational education, daily 

liv<strong>in</strong>g, social/relationships, <strong>in</strong>dependent liv<strong>in</strong>g, 

community access or skills, transportation, 

f<strong>in</strong>ancial, self-determ<strong>in</strong>ation, leisure <strong>and</strong> 

recreation, <strong>and</strong> communication skills (see Table 

2). Functional Curriculum for Elementary, 

Middle, <strong>and</strong> Secondary students with Special Needs 

(Wehman & Kregel, 2004) covered the greatest 

number of functional curriculum components 

with 9 of the 11 categories addressed, 

while Impact: A Functional Curriculum H<strong>and</strong>book 

(Neel & Bill<strong>in</strong>gsley, 1989) had the fewest with 

two skills covered completely <strong>and</strong> one partially. 

The social/relationship skills compo- 

TABLE 2 

Functional Curriculum Models’ Components Covered (Most to Least) 

Order Title 

nent was at least partially addressed by all 10 

functional curriculum models. The next most 

addressed components <strong>in</strong>cluded vocational 

education <strong>and</strong> <strong>in</strong>dependent liv<strong>in</strong>g, <strong>in</strong> which 9 

of the 10 reviewed curriculum models partially 

or totally addressed each component. 

Self-determ<strong>in</strong>ation was addressed <strong>in</strong> the fewest 

number of curriculum models (only five models 

partially or totally <strong>in</strong>cluded it). 

Most of the curricular models exam<strong>in</strong>ed 

consisted of a s<strong>in</strong>gle book, although there 

were variations <strong>in</strong> the structure <strong>and</strong> purposes 

of these books. The few that offered additional 

resources beyond the “teacher’s” guide 

#of 

components 



10 

2 Life Skills Instruction for All Students with Special Needs 9.5 

3 Community-Based Curriculum 9 

Functional Independence Skills H<strong>and</strong>book 9 

Life Skills Activities for Secondary Students with Special Needs 9 

6 The Syracuse Community-Referenced Guide 8.5 

7 A Functional Curriculum for Teach<strong>in</strong>g Students with <strong>Disabilities</strong> 7 

8 Everyday Life Skills 6 

Adaptive Liv<strong>in</strong>g Skills Curriculum 6 

9 Impact: A Functional Curriculum H<strong>and</strong>book 2.5 

438 / <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>-December 2009

TABLE 3 

Functional Curriculum Models’ Adult Life Subdoma<strong>in</strong>s Covered (Most to Least) 

Order Title 

or edition <strong>in</strong>cluded assessment materials (i.e., 

Functional Independence Skills H<strong>and</strong>book, Killion, 

2003), CDs, or other workbooks (i.e., Everyday 

Life Skills, American Guidance Service, 2001). 

Few of the 10 curriculum models analyzed 

addressed any research conducted on the 

model or its implementation <strong>in</strong> classrooms. 

Some curriculum models did provide research 

to support the <strong>in</strong>clusion of specific curriculum 

components (i.e., The Syracuse Community-Referenced 

Guide, Ford et al., 1989 <strong>and</strong> 

Community-Based Curriculum, Falvey, 1989), yet 

these tended to read more like textbooks. 

They had less emphasis on enabl<strong>in</strong>g teachers 

to implement the curriculum <strong>in</strong> the classroom 

<strong>and</strong> more of provid<strong>in</strong>g research to support the 

components or concepts <strong>in</strong>cluded <strong>in</strong> their 

model. Furthermore, no curriculum model 

reviewed addressed any professional development 

opportunities for teachers <strong>in</strong> terms of 

teach<strong>in</strong>g the particular model. Note: LCCE 

discusses professional development. 

Few of the analyzed functional curriculum 

models addressed the ideas <strong>and</strong> teach<strong>in</strong>g strategies 

found <strong>in</strong> the research on “best practices” 

(Mariage & Patriarca, 2002). For example, 

few gave explicit <strong>in</strong>formation regard<strong>in</strong>g the 

philosophy towards implement<strong>in</strong>g the curriculum. 

The majority of the models were structured 

around pr<strong>in</strong>ciples of direct <strong>in</strong>struction, 

as opposed to constructivist approaches (Swanson, 

2001). Furthermore, few of the models 

<strong>in</strong>volved technology, <strong>and</strong> most only implicitly 

addressed issues related to sequenc<strong>in</strong>g the ma- 

#of 

subdoma<strong>in</strong>s 

1 Life Skills Instruction for All Students with Special Needs 23 



17 

3 The Syracuse Community-Referenced Guide 15.5 

4 Everyday Life Skills 15 

5 Community-Based Instruction 14 

6 Adaptive Liv<strong>in</strong>g Skills Curriculum 12 

7 Life Skills Activities for Students with Special Needs 11.5 

8 A Functional Curriculum for Teach<strong>in</strong>g Students with <strong>Disabilities</strong> 9.5 

9 Functional Independence Skills H<strong>and</strong>book 6 

10 Impact: A Functional Curriculum H<strong>and</strong>book .5 

terials, repetition of skills <strong>and</strong> concepts, segmentation, 

<strong>and</strong> controll<strong>in</strong>g for difficulty of 

dem<strong>and</strong>s of tasks. 

None of the curriculum models reviewed 

covered all of Cron<strong>in</strong> <strong>and</strong> Patton’s (1993) six 

doma<strong>in</strong>s of adulthood, aside from Cron<strong>in</strong> <strong>and</strong> 

Patton’s Life Skills Instruction for All Students 

with Special Needs which covered 23 of the 23 

total subdoma<strong>in</strong>s. This particular curriculum 

model was structured around the doma<strong>in</strong>s 

<strong>and</strong> subdoma<strong>in</strong>s of adulthood <strong>and</strong> provided 

resources for materials for each of the subdoma<strong>in</strong>s. 

Although the rema<strong>in</strong><strong>in</strong>g models covered 

many of the six doma<strong>in</strong>s, the subdoma<strong>in</strong>s 

were addressed to vary<strong>in</strong>g degrees (see Table 

3). The adulthood doma<strong>in</strong>s of home <strong>and</strong> family, 

leisure pursuits, <strong>and</strong> personal/responsibility 

<strong>and</strong> relationship were covered across most 

of the rema<strong>in</strong><strong>in</strong>g n<strong>in</strong>e models. The curriculum 

model that addressed the fewest subdoma<strong>in</strong>s 

was Neel <strong>and</strong> Bill<strong>in</strong>gsley’s (1989) Impact: 

A Functional Curriculum H<strong>and</strong>book (.5 of 

23). 

In analyz<strong>in</strong>g the functional curriculum 

models with respect to the material analysis 

(Hammill & Bartel, 1990), the results showed 

that none of the models had an “appropriate” 

form for teachers. While the models consisted 

of different forms, none were assessed to be 

completely appropriate for teach<strong>in</strong>g functional 

curriculum to secondary students with 

mild mental impairment. Some models placed 

too great a dem<strong>and</strong> on teachers acquir<strong>in</strong>g or 

creat<strong>in</strong>g their own materials (i.e., Functional 


Life Skills Instruction for All Students with Special 

Needs; Cron<strong>in</strong> & Patton, 1993), others did not 

have enough application <strong>in</strong> the curriculum, 

<strong>and</strong> others were directed too much at teachers 

(i.e., references <strong>and</strong> citations) as opposed to 

activities or lessons for students (e.g., The Syracuse 

Community-Reference Guide; Ford et al., 

1989). 

Other issues emerg<strong>in</strong>g from the material 

analysis were readability levels, student support 

materials, <strong>and</strong> teacher support. To beg<strong>in</strong> 

with, none of the curriculum models actually 

addressed the readability level of materials 

(Hammill & Bartel, 1990). While the curriculum 

models themselves were mostly directed 

to teachers, so readability level was not an 

issue, the few material pieces with<strong>in</strong> the curriculum 

that were geared towards students 

were assessed to be at a read<strong>in</strong>g level too high 

for the average student with mild mental impairment. 

In addition, not all curriculum 

models had support materials or additional 

components, leav<strong>in</strong>g teachers hav<strong>in</strong>g to create 

or f<strong>in</strong>d various components such as assessments 

or worksheets. The curriculum models 

also did not address teacher tra<strong>in</strong><strong>in</strong>g or support 

for teachers dur<strong>in</strong>g implementation as 

the “teacher’s guide” or “teacher’s edition” 

was the curriculum model itself. In general, 

the models did not consist of separate student 

<strong>and</strong> teacher editions, but rather there was 

only a teacher’s book (or guide or edition), 

with one exception, Everyday Life Skills (American 

Guidance Service, 2001). 

Discussion 

While each functional curriculum model had 

its strengths <strong>and</strong> weaknesses, none was all encompass<strong>in</strong>g 

<strong>and</strong> could be portrayed as a solid, 

complete functional curriculum model for 

secondary students with mild mental impairment, 

when exclud<strong>in</strong>g Brol<strong>in</strong>’s Life Centered 

Career <strong>Education</strong> (2004) from evaluation <strong>and</strong> 

consideration. No one model addressed all 

curricular areas as def<strong>in</strong>ed by Patton, Cron<strong>in</strong>, 

<strong>and</strong> Jairrels (1997). Furthermore, the vary<strong>in</strong>g 

formats were challeng<strong>in</strong>g. Some read more 

like college textbooks than curriculum models, 

mak<strong>in</strong>g implementation difficult <strong>in</strong> a classroom 

(i.e., Community Based Curriculum, 

Falvey, 1989; The Syracuse Community-Referenced 

Guide, Ford et al., 1989). Others models were 


essentially a book of worksheets to give to 

students (i.e., Life Skills Activities for Students 

with Special Needs, Mannix, 1995), while some 

were reference books that told teachers about 

materials, books, <strong>and</strong> videos that could be 

used to “create” their own functional curriculum 

by compil<strong>in</strong>g materials from the identified 

multiple sources (i.e., Life Skills Instruction 

for all Students with Special Needs, Cron<strong>in</strong> & 

Patton, 1993). 

The analysis also revealed vast differences <strong>in</strong> 

functional curriculum component coverage, 

ease of implementation, accessibility of materials 

with students, <strong>and</strong> cost. For an educator 

look<strong>in</strong>g to implement a functional curriculum 

model, any of these issues could be a h<strong>in</strong>drance 

<strong>in</strong> implement<strong>in</strong>g a currently commercially 

available curriculum model. Practitioners 

must weigh compet<strong>in</strong>g dem<strong>and</strong>s, such as 

comprehensiveness versus expense, time to 

devote to teach<strong>in</strong>g a functional curriculum 

with time needed for depth of the different 

components, <strong>and</strong> a scripted curriculum versus 

one that <strong>in</strong>volves supplements <strong>and</strong> teacherconstructed 

materials. In essence, each curriculum 

model comes with trade-offs, whether 

those are cost or coverage, <strong>and</strong> teachers, <strong>in</strong> 

conjunction with other educators, must make 

decisions regard<strong>in</strong>g the needs of their students 

<strong>and</strong> the resources of their program 

<strong>and</strong>/or district. 

Thus, what appears miss<strong>in</strong>g from the collection 

of functional curriculum models reviewed 

for secondary students with mild mental 

impairment is a comprehensive curriculum 

model that addresses all curriculum components 

(Patton, Cron<strong>in</strong>, & Jairrels, 1997), <strong>in</strong>volves 

community <strong>in</strong>struction as well as technology, 

is affordable, appeals to <strong>and</strong> supports 

students <strong>and</strong> teachers (i.e., engages students 

yet has easy implementation), <strong>and</strong> considers 

best practices. The ideas <strong>and</strong> beliefs of the 

functional curriculum, much ab<strong>and</strong>oned for 

this population of students with mild mental 

impairment over recent years, deserves to be 

revisited <strong>and</strong> new models <strong>and</strong> materials created 

that represent a more comprehensive 

approach, address<strong>in</strong>g the needs of teachers 

<strong>and</strong> students (Bouck, 2004). These new functional 

curriculum models need to turn towards 

technology, utiliz<strong>in</strong>g practices, methods, 

<strong>and</strong> lessons that <strong>in</strong>volve CD-ROMs <strong>and</strong> 

web-based <strong>in</strong>structional environments to cap-

ture the attention <strong>and</strong> excitement of both 

students <strong>and</strong> teachers. 

The field needs to move towards provid<strong>in</strong>g 

a balanced, comprehensive, coherent functional 

curriculum for this population of students 

at the secondary level (Bouck, 2008). A 

balanced, yet flexible, functional curriculum 

model would <strong>in</strong>clude utilization of different 

theories of learn<strong>in</strong>g <strong>and</strong> different pedagogical 

approaches (i.e., skills, cognitive apprenticeship, 

model<strong>in</strong>g, social mediation direct <strong>in</strong>struction, 

etc.). It would balance the various 

components of a functional curriculum (e.g., 

functional academics, community access, daily 

liv<strong>in</strong>g skills, f<strong>in</strong>ancial, transportation, leisure 

<strong>and</strong> recreation, communication, self-determ<strong>in</strong>ation, 

social skills, vocational education, <strong>in</strong>dependent 

liv<strong>in</strong>g skills; Patton, Cron<strong>in</strong>, & Jairrels, 

1997). Furthermore, it would balance 

direct skills <strong>in</strong>struction with a cognitive apprenticeship, 

students as consumers with students 

as producers, <strong>and</strong> <strong>in</strong>dividualization with 

community. 

A balanced approach to functional curriculum 

would resemble a balanced literacy approach; 

however, <strong>in</strong>stead of mov<strong>in</strong>g on a cont<strong>in</strong>uum 

from k<strong>in</strong>dergarten through 12 th grade 

<strong>and</strong> shift<strong>in</strong>g emphasis from “learn<strong>in</strong>g to read” 

to “read<strong>in</strong>g to learn” (Duke, Bennett- 

Armistead, & Roberts, 2003; McCartney, 2004; 

National Center to Improve the Tools of <strong>Education</strong>, 

1996), the shift <strong>in</strong> emphasis would 

occur with “learn<strong>in</strong>g to function” (i.e., performance) 

to “function<strong>in</strong>g to learn” (i.e., cognitive 

apprenticeship) (see Figure 1) (Bouck, 

2008). The ascerta<strong>in</strong>ment of functional life 

skills needed for successful post-school outcomes 

would become a learn<strong>in</strong>g process 

across students’ school careers with the goal of 

arm<strong>in</strong>g students with the skills <strong>and</strong> experiences 

necessary to be successful <strong>in</strong> life, much 

like what schools currently do for students go<strong>in</strong>g 

onto traditional post-secondary education. 

Limitations <strong>and</strong> Future Directions 

This study has some limitations. For one, it 

represents one researcher’s analysis of commercially 

available functional curriculum 

models geared towards secondary students 

with mild mental impairment. Thus, curriculum 

models may be miss<strong>in</strong>g that are not widely 

circulated or the researcher’s perceptions may 

Figure 1. A balanced functional curriculum model. 

be biased. In addition, this study does not 

attempt to elicit the op<strong>in</strong>ions <strong>and</strong> perspectives 

of teachers, students, <strong>and</strong> parents as to the 

different functional curriculum models, but 

relies solely on the analysis of the written curriculum 

materials provided. This project also 

did not explore older, less known curriculum 

models such as Problem Solv<strong>in</strong>g Activities for 

Teach<strong>in</strong>g Daily Liv<strong>in</strong>g Skills (Luccas, Lenox, & 

Amey, 1982) or curricula geared to delivery by 

parents or <strong>in</strong> the home, such as Steps to Independence 

(Baker & Brightman, 2004). 

Future research should consider the perspectives 

of teachers, students, <strong>and</strong> parents <strong>in</strong> 

regards to functional curriculum models. Researchers 

should f<strong>in</strong>d ways to capture <strong>and</strong> express 

the op<strong>in</strong>ions of these key stakeholders <strong>in</strong> 

regards to the most essential components of a 

functional curriculum model <strong>and</strong> delivery 

modes. Future research should also seek to 

create new functional curriculum models, 

draw<strong>in</strong>g upon technology, which has the potential 

of creat<strong>in</strong>g curricula that captures students’ 

attention <strong>and</strong> present<strong>in</strong>g them with 

mean<strong>in</strong>gful learn<strong>in</strong>g experiences <strong>in</strong> the community, 

school, home, <strong>and</strong> places of employment. 

Research on functional curricula for 

secondary students with mild mental impairment 

should extend beyond just a review <strong>and</strong> 

analysis of functional curriculum models <strong>and</strong> 

recommendations for the creation of new 

<strong>and</strong> alternative approaches. It should <strong>in</strong>clude 

the exam<strong>in</strong>ation of curricular impact on students’ 

outcomes, such as employment, <strong>in</strong>dependent 

liv<strong>in</strong>g, access to the community, <strong>and</strong> 

social relationships. 

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Received: 19 June 2008 

Initial Acceptance: 19 August 2008 

F<strong>in</strong>al Acceptance: 21 October 2008 




Autism Spectrum Disorders <strong>and</strong> Sibl<strong>in</strong>g Relationships: 

Research <strong>and</strong> Strategies 

Julia F. Beyer 

Lynchburg College 

Abstract: Significant attention has been paid <strong>in</strong> the literature to sibl<strong>in</strong>g relationships <strong>and</strong> the effects of birth 

order, family size, <strong>and</strong> gender on such relationships. Although these are important areas to study, there is 

relatively little research on the effects of autism spectrum disorders (ASD) on sibl<strong>in</strong>g relationships. The existent 

research identifies both positive <strong>and</strong> negative factors <strong>in</strong> such sibl<strong>in</strong>g relationships. This paper analyzes the 

studies that are available on ASD <strong>and</strong> sibl<strong>in</strong>g relationships, discusses f<strong>in</strong>d<strong>in</strong>gs, identifies implications, <strong>and</strong> 

makes recommendations for improv<strong>in</strong>g sibl<strong>in</strong>g relationships when one sibl<strong>in</strong>g has ASD. 

With<strong>in</strong> the family unit sibl<strong>in</strong>gs share a unique 

relationship with one another (Knott, Lewis, 

& Williams, 1995), typically last<strong>in</strong>g the longest 

among all human relationships (Orsmond & 

Seltzer, 2007). Sibl<strong>in</strong>g relationships <strong>in</strong> the 

general population develop along a cont<strong>in</strong>uum 

throughout childhood, adolescence <strong>and</strong> 

adulthood (Dunn, Slomkowski, & Beardsall, 

1994) <strong>and</strong> typical sibl<strong>in</strong>g relationships provide 

sibl<strong>in</strong>gs with experiences that “foster the development 

of emotional underst<strong>and</strong><strong>in</strong>g, selfregulation, 

<strong>and</strong> a sense of belong<strong>in</strong>g <strong>and</strong> comfort” 

(Orsmond & Seltzer, p. 313). 

A number of specific aspects of sibl<strong>in</strong>g relationships 

have been highlighted <strong>in</strong> the research. 

For example, Smith <strong>and</strong> Hart (2002) stated that 

sibl<strong>in</strong>g relationships play a significant role <strong>in</strong> the 

development of children’s underst<strong>and</strong><strong>in</strong>gs of 

others’ emotions <strong>and</strong> thoughts. Kam<strong>in</strong>sky <strong>and</strong> 

Dewey (2001) reported that positive sibl<strong>in</strong>g 

relationships can be an important source of 

social development <strong>and</strong> self-worth <strong>and</strong> are associated 

with lower levels of conduct disorders 

<strong>and</strong> lonel<strong>in</strong>ess <strong>in</strong> children. Further Foden 

(2007) stated <strong>in</strong>terplay between sibl<strong>in</strong>gs profoundly 

affects <strong>in</strong>dividuals’ personalities <strong>and</strong> 

social <strong>and</strong> <strong>in</strong>tellectual development. Howe, 

Petrakos, <strong>and</strong> R<strong>in</strong>aldi (1998) similarly found 

that sibl<strong>in</strong>gs who engage <strong>in</strong> frequent pretend 

play demonstrate a greater underst<strong>and</strong><strong>in</strong>g of 


be addressed to Julia Beyer, 104 Long Hill Lane, 

Chatham, NJ 07928. 

others’ emotions, are more likely to construct 

shared mean<strong>in</strong>gs <strong>in</strong> play, <strong>and</strong> are more likely 

to develop conflict management strategies. In 

addition, El-Ghoroury <strong>and</strong> Romanczky (1999) 

reported that sibl<strong>in</strong>gs are important social 

agents for children with autism spectrum disorders 

(ASD), who often have severe deficits 

<strong>in</strong> social competence. As Reagon (2006) further 

noted, sibl<strong>in</strong>gs are the most frequently 

available play partners. 

Thus, the question of how do autism spectrum 

disorders (ASD) affect sibl<strong>in</strong>g relationships is important 

to answer because positive sibl<strong>in</strong>g relationships 

can foster a better quality of life 

both <strong>in</strong> the present <strong>and</strong> <strong>in</strong> the future, such as 

once parents may be unable to care for their 

child with ASD. This paper addresses factors 

that affect sibl<strong>in</strong>g relationships, analyzes the 

impact of hav<strong>in</strong>g a sibl<strong>in</strong>g with ASD as compared 

to one with other disabilities, discusses 

the f<strong>in</strong>d<strong>in</strong>gs <strong>and</strong> potential makes recommendations 

for improv<strong>in</strong>g sibl<strong>in</strong>g relationships 

when one sibl<strong>in</strong>g has ASD. 

Research on Sibl<strong>in</strong>g Relationships 

Factors 


In addition to the presence of a sibl<strong>in</strong>g with a 

disability, there are many factors that have 

been identified that affect sibl<strong>in</strong>g relationships. 

Kim, McHale, <strong>and</strong> Wayne (2006) reported 

on gender effects on sibl<strong>in</strong>g relationships; 

stat<strong>in</strong>g that girls tend to report more

affection <strong>in</strong> their sibl<strong>in</strong>g relationships than 

boys while Trev<strong>in</strong>o (1979) reported older 

brothers tend to be the least <strong>in</strong>volved with 

their sibl<strong>in</strong>gs. Further, Brody (1998) found 

positive parent-child relationships were connected 

to positive affect <strong>and</strong> pro-social behavior 

of sibl<strong>in</strong>gs. Moreover, Fielder <strong>and</strong> Simpson 

(2006) reported that culture, traditions, <strong>in</strong>terests, 

<strong>and</strong> environmental contexts all have an 

effect on sibl<strong>in</strong>g relationships. The aim of this 

paper is to analyze the research about the 

impact of the presence of a disability, <strong>and</strong> <strong>in</strong> 

particular ASD, on sibl<strong>in</strong>g relationships. 

ASD: Behavioral Barriers to the Sibl<strong>in</strong>g 

Relationship 

Foden (2007) stated that typically develop<strong>in</strong>g 

sibl<strong>in</strong>gs of sibl<strong>in</strong>gs with ASD face the 

daunt<strong>in</strong>g task of form<strong>in</strong>g a healthy sibl<strong>in</strong>g 

bond. Harris (2007) reported the nature of 

ASD makes it difficult for sibl<strong>in</strong>gs who are 

non-disabled to form satisfy<strong>in</strong>g relationships 

with their brother or sister with ASD. That is, 

the majority of <strong>in</strong>dividuals with ASD have 

cognitive limitations as well as social <strong>and</strong> behavioral 

characteristic that may present challenges 

to sibl<strong>in</strong>g relationships (American Psychiatric 

Association, 2000). Such limitations 

<strong>and</strong> characteristics <strong>in</strong>clude deficits <strong>in</strong> underst<strong>and</strong><strong>in</strong>g 

the perspectives <strong>and</strong> emotions of 

others, lack of reciprocity <strong>in</strong> conversations, 

<strong>in</strong>ability to seek out others for comfort, affection, 

<strong>in</strong>ability to <strong>in</strong>itiate play (Rutter & Schopler, 

1987), <strong>and</strong> troubl<strong>in</strong>g behaviors such as 

aggression (Donenberg & Baker, 1993). Further, 

Rivers <strong>and</strong> Stoneman (2003) found <strong>in</strong> a 

study of 50 families with children with ASD 

that sibl<strong>in</strong>gs who are non-disabled reported 

on a self-<strong>in</strong>ventory that they were often disturbed 

by their sibl<strong>in</strong>gs’ behaviors. Kam<strong>in</strong>sky 

<strong>and</strong> Dewey (2001) hypothesized that the social 

deficits shown by <strong>in</strong>dividuals with ASD 

causes their sibl<strong>in</strong>g relationships to be different 

from the relationships of other disorders 

such Down syndrome <strong>and</strong> no disorder. 

Comparison to Other Groups 

To better underst<strong>and</strong> how ASD affects sibl<strong>in</strong>g 

relationships, it is helpful to <strong>in</strong>vestigate studies 

that have compared relationships of sibl<strong>in</strong>gs 

of <strong>in</strong>dividuals with ASD to sibl<strong>in</strong>gs of <strong>in</strong>divid- 

uals with other disorders such as Down syndrome 

(DS), mental retardation (MR), <strong>and</strong> 

developmental delay (DD), as well as sibl<strong>in</strong>gs 

of typically develop<strong>in</strong>g <strong>in</strong>dividuals. In the succeed<strong>in</strong>g 

sections attention is also given to 

prosocial behavior among sibl<strong>in</strong>gs, pride or 

embarrassment of sibl<strong>in</strong>gs, conflict between 

sibl<strong>in</strong>gs, concerns for sibl<strong>in</strong>gs, <strong>and</strong> cop<strong>in</strong>g 

skills, (See, Table 1 for more <strong>in</strong>formation on 

studies discussed below) 

Positive relationships. There have been studies 

that have found positive reports of sibl<strong>in</strong>g 

relationships between typically develop<strong>in</strong>g 

sibl<strong>in</strong>gs <strong>and</strong> sibl<strong>in</strong>gs with ASD. Rivers <strong>and</strong> 

Stoneman (2003) studied 50 families of sibl<strong>in</strong>gs 

of <strong>in</strong>dividuals with ASD ages 7–12 <strong>and</strong> 

reported ma<strong>in</strong>ly positive feel<strong>in</strong>g about their 

sibl<strong>in</strong>g relationships. Mascha <strong>and</strong> Boucher 

(2006) concluded <strong>in</strong> their qualitative study 

that most sibl<strong>in</strong>gs of <strong>in</strong>dividuals with ASD ages 

7-20 recalled positive experiences with their 

sibl<strong>in</strong>gs with ASD, stat<strong>in</strong>g they played outside, 

watched television <strong>and</strong> had fun with their sibl<strong>in</strong>gs. 

Further, Foden (2007) reported that 

typically develop<strong>in</strong>g sibl<strong>in</strong>gs of <strong>in</strong>dividuals 

with ASD spoke of pride <strong>in</strong> teach<strong>in</strong>g their 

sibl<strong>in</strong>g with ASD. In addition, Knott et al. 

(1995) reported that sibl<strong>in</strong>gs of <strong>in</strong>dividuals 

with ASD typically “stage-manage” play with 

their sibl<strong>in</strong>g. Knott et al. also found that <strong>in</strong> 

some cases sibl<strong>in</strong>gs with ASD did <strong>in</strong>itiate play 

with their typically develop<strong>in</strong>g sibl<strong>in</strong>g(s). 

Moreover, Fisman et al. (1996) <strong>and</strong> Kam<strong>in</strong>sky 

<strong>and</strong> Dewey (2001) concluded <strong>in</strong> their study 

of 138 subjects that sibl<strong>in</strong>gs of children with 

ASD reported less conflict <strong>and</strong> greater warmth 

<strong>in</strong> the sibl<strong>in</strong>g relationship than sibl<strong>in</strong>gs of typically 

develop<strong>in</strong>g <strong>in</strong>dividuals. Orsmond <strong>and</strong> 

Seltzer (2007) reported sibl<strong>in</strong>gs of <strong>in</strong>dividuals 

with ASD were closer when the sibl<strong>in</strong>g had 

lower educational levels, lived closer to their 

brother or sister with ASD, used cop<strong>in</strong>g strategies, 

<strong>and</strong> when their sibl<strong>in</strong>g had higher levels 

of <strong>in</strong>dependence. 

Moreover, McHale et al. (1987) reported 

that sibl<strong>in</strong>gs of <strong>in</strong>dividuals with ASD reported 

more positive sibl<strong>in</strong>g relationships when they 

accepted their role as a family member, perceived 

m<strong>in</strong>imal parental favoritism, developed 

cop<strong>in</strong>g skills, understood their sibl<strong>in</strong>gs’ disability, 

<strong>and</strong> were not worried about the future 

of their sibl<strong>in</strong>g with ASD. Similarly, Orsmond 

<strong>and</strong> Seltzer (2007) found that the use of ef- 

ASD <strong>and</strong> Sibl<strong>in</strong>g Relationships / 445

TABLE 1 

How do Autism Spectrum Disorders (ASD) Affect Sibl<strong>in</strong>g Relationships? 

Outcomes: Sibl<strong>in</strong>gs of Individuals 

w/ASD 

Citations N Comparison group Measurement 

Reported significantly less positive 

experiences 

Parents & sibl<strong>in</strong>g 

<strong>in</strong>terviewed & 

completed the 

Eysenck Personality 

Inventory 

Parent/caregiver & 

teacher <strong>in</strong>terviewed 

Sibl<strong>in</strong>g of sibl<strong>in</strong>gs 

w/MR & nondisabled 

Reported less conflict & greater 

warmth 


w/w/out 

disability 

Spoke of pride teach<strong>in</strong>g their 

sibl<strong>in</strong>gs w/ASD 

Sibl<strong>in</strong>g <strong>in</strong>terviewed 

& observational 

Sibl<strong>in</strong>gs of sibl<strong>in</strong>gs 

w/DS & no 

Bagenholm & 

60 subjects b/w 5-20 years old 

Gillberg (1991) 

20 sibl<strong>in</strong>gs of sibl<strong>in</strong>gs w/ASD 

20 sibl<strong>in</strong>gs of sibl<strong>in</strong>gs w/MR 

20 sibl<strong>in</strong>gs of sibl<strong>in</strong>gs 

w/out a disability 

Fisman et al. 

138 subjects 

(1996) 


46 sibl<strong>in</strong>gs of sibl<strong>in</strong>gs w/DS 

46 sibl<strong>in</strong>gs of sibl<strong>in</strong>gs 

w/out a disability 

Foden (2007) Meta-analysis of sibl<strong>in</strong>g 

outcomes 

disability 

Sibl<strong>in</strong>g questionnaire Showed less close & warm 

relationships, slightly worse 

health, higher levels of 

depressive symptoms & less 

contacts 

Sibl<strong>in</strong>g Relationship 

Characterized relationships by less 

Questioner (SRQ) 

<strong>in</strong>timacy, prosocial behavior, & 

nurturance, & reported less 

conflict 

Observed at home Engaged <strong>in</strong> fewer bouts, imitated 

less, & staged managed play 

Sibl<strong>in</strong>g Interviewed & 

Reported greater feel<strong>in</strong>gs of 

observed at home 

embarrassment, & cop<strong>in</strong>g 

strategies resulted <strong>in</strong> more 

positive feel<strong>in</strong>gs, recalled 

positive feel<strong>in</strong>gs about play<strong>in</strong>g 

outside, & watch<strong>in</strong>g tv 


w/DS 

46 subjects 

284 sibl<strong>in</strong>gs of sibl<strong>in</strong>g w/DS 

176 sibl<strong>in</strong>g of sibl<strong>in</strong>g w/ASD 

Hodapp & Urbano 

(2007) 


w/DS & TD 


b/w8&18 

Kam<strong>in</strong>sky & Dewey 

(2001) 


Knott et al. (1995) 30 sibl<strong>in</strong>g pairs Sibl<strong>in</strong>g of sibl<strong>in</strong>g 

w/DS & LD 

Mascha & Boucher 14 subjects ages 7-20 from 


(2006) 

families where there was a 

w/DS 

child diagnosed ASD

TABLE 1—(Cont<strong>in</strong>ued) 

Outcomes: Sibl<strong>in</strong>gs of Individuals w/ 

ASD 

Citations N Comparison group Measurement 

Sibl<strong>in</strong>g questioners No differences <strong>in</strong> relationships 

b/w groups 


w/MR & nondisabled 

90 subjects ages 6-15 

30 sibl<strong>in</strong>gs of sibl<strong>in</strong>g w/ASD 

30 sibl<strong>in</strong>gs of sibl<strong>in</strong>gs w/MR 

30 sibl<strong>in</strong>gs of sibl<strong>in</strong>g w/out a 

disability 

154 subjects ages 21–56 

77 sibl<strong>in</strong>g of sibl<strong>in</strong>gs w/DS 

77 sibl<strong>in</strong>g of sibl<strong>in</strong>g w/ASD 

McHale, Sloan & 

Simensson 

(1987) 

Sibl<strong>in</strong>g questioner Reported less positive affect, 

relationship w/parents 

impacted, development of 

cop<strong>in</strong>g strategies resulted <strong>in</strong> 

more positive feel<strong>in</strong>gs, as did 

lower level of education & 

higher levels of <strong>in</strong>dependence of 


w/DS 

Osmond & Seltzer 

(2007) 

their sibl<strong>in</strong>g 

Reported more positive 

relationships than parents did 

Sibl<strong>in</strong>g Inventory 

Behavior (SIB) & 

Sibl<strong>in</strong>g Relationship 

Questioner (SRQ) 

No comparison 

group: normally 

develop<strong>in</strong>g 

sibl<strong>in</strong>gs & 

parents views 


w/DS & nondisabled 

50 families where there was a 

child diagnosed ASD 

Rivers & Stoneman 

(2003) 

Sibl<strong>in</strong>gs <strong>in</strong>terviewed No differences <strong>in</strong> relationships 

b/w groups 

60 subjects ages 8–14 

20 sibl<strong>in</strong>gs of sibl<strong>in</strong>g w/ASD 

20 sibl<strong>in</strong>gs of sibl<strong>in</strong>g w/MR 

20 sibl<strong>in</strong>gs of sibl<strong>in</strong>gs w/out 

a disability 

25 subjects ages 8-15 of sibl<strong>in</strong>gs 

w/ ASD or no disability 

Roeyers & Mycke 

(1995) 

Sibl<strong>in</strong>gs <strong>in</strong>terviewed Reported more aggressive 

behaviors <strong>in</strong> the relationship 

Sibl<strong>in</strong>gs w/no 

disability 

Ross & Cuskelly 

(2006) 


fective cop<strong>in</strong>g strategies results <strong>in</strong> more positive 

sibl<strong>in</strong>g relationships between typically develop<strong>in</strong>g 

sibl<strong>in</strong>gs <strong>and</strong> sibl<strong>in</strong>gs with ASD. 

Thus, positive relationships (Rivers & Stoneman, 

2003; Mascha & Boucher, 2006; Foden, 

2007; Knott et al., 1995) <strong>and</strong> less conflict (Fisman 

et al., 1996; Kam<strong>in</strong>sky & Dewey, 2001) 

have been reported by sibl<strong>in</strong>gs of a brother or 

sister with ASD. Further, effective cop<strong>in</strong>g strategies 

(McHale et al., 1986; Orsmond & Seltzer, 

2007), m<strong>in</strong>imal perceived parental favoritism, 

underst<strong>and</strong><strong>in</strong>g of sibl<strong>in</strong>g’s disability, <strong>and</strong> 

little concern about futures of sibl<strong>in</strong>g with 

ASD were all found to contribute to positive 

sibl<strong>in</strong>g relationships (McHale et al.). 

Negative relationships. Bagenholm <strong>and</strong> Gillberg 

(1991) conducted a study of 60 sibl<strong>in</strong>gs 

of children with ASD, DD, <strong>and</strong> children who 

are non-disabled <strong>and</strong> their parents <strong>and</strong> found 

sibl<strong>in</strong>gs <strong>and</strong> parents of children with ASD reported 

less favorable attitudes towards their 

brother or sister with ASD <strong>and</strong> significantly 

less positive experiences of their sibl<strong>in</strong>g’s role 

<strong>in</strong> the family. Further, sibl<strong>in</strong>gs <strong>and</strong> parents 

also reported problems with the destructive 

behavior of their sibl<strong>in</strong>g with ASD (Bagenholm 

& Gillberg). Similarly, Ross <strong>and</strong> Cuskelly 

(2006) reported that sibl<strong>in</strong>gs of children with 

ASD ages 8–15 reported more aggression <strong>in</strong> 

their sibl<strong>in</strong>g <strong>in</strong>teractions. 

Further, Kam<strong>in</strong>sky <strong>and</strong> Dewey (2001) also 

reported differences between 90 sibl<strong>in</strong>gs of 

<strong>in</strong>dividuals with ASD <strong>and</strong> other disabilities 

<strong>and</strong> typically develop<strong>in</strong>g <strong>in</strong>dividuals ages 

8–18. That is, they found sibl<strong>in</strong>gs of a brother 

or sister with ASD reported on Sibl<strong>in</strong>g Relationship 

Questioner (SRQ) less <strong>in</strong>timacy, prosocial 

behavior, <strong>in</strong>itiated play <strong>and</strong> nurturance 

with their sibl<strong>in</strong>g than sibl<strong>in</strong>gs of <strong>in</strong>dividuals 

with DS <strong>and</strong> of typically develop<strong>in</strong>g <strong>in</strong>dividuals. 

Knott et al. (1995) compared 30 sibl<strong>in</strong>g 

pairs of <strong>in</strong>dividuals with ASD <strong>and</strong> sibl<strong>in</strong>gs of 

<strong>in</strong>dividuals with DS <strong>and</strong> found that sibl<strong>in</strong>gs of 

<strong>in</strong>dividuals with ASD spent less time with their 

sibl<strong>in</strong>g, reported hav<strong>in</strong>g less close relationships 

<strong>and</strong> contact, <strong>and</strong> were more concerned 

about their sibl<strong>in</strong>gs’ future. Hodapp <strong>and</strong> Urbano 

(2007) conducted a study of 284 subjects 

of sibl<strong>in</strong>gs with DS <strong>and</strong> 174 subjects of sibl<strong>in</strong>gs 

with ASD <strong>and</strong> found sibl<strong>in</strong>gs of <strong>in</strong>dividuals 

with DS reported closer, warmer sibl<strong>in</strong>g relationships 

than sibl<strong>in</strong>gs of <strong>in</strong>dividuals with 

ASD. Further, <strong>in</strong> a study of 154 subjects, Os- 

mond <strong>and</strong> Seltzer (2007) concluded that sibl<strong>in</strong>gs 

of <strong>in</strong>dividuals with ASD reported less 

contact <strong>and</strong> positive affect with their sibl<strong>in</strong>gs 

than sibl<strong>in</strong>gs of <strong>in</strong>dividuals with DS. They also 

found that sibl<strong>in</strong>gs of <strong>in</strong>dividuals with ASD 

were more likely to report that their relationships 

with their parents had been impacted 

more than those with sibl<strong>in</strong>gs with DS. Mascha 

<strong>and</strong> Boucher (2006) found <strong>in</strong> their study of 

14 subjects ages 7–20 that sibl<strong>in</strong>gs of <strong>in</strong>dividuals 

with ASD reported greater feel<strong>in</strong>gs of 

embarrassment than sibl<strong>in</strong>gs of <strong>in</strong>dividuals 

with DD or no disability. 

To conclude, sibl<strong>in</strong>gs of a brother or sister 

with ASD have reported negative sibl<strong>in</strong>g relationships 

such as less contact, less <strong>in</strong>timacy, 

less prosoical behavior <strong>and</strong> less <strong>in</strong>itiated play 

(Bagenholm & Gillberg, 1991; Hodapp & 

Urbano, 2007; Knott, et al., 1995; Orsmond 

& Seltzer, 2007), worry about the future of 

their sibl<strong>in</strong>g with ASD (Knott et al.) concern 

about destructive behavior of sibl<strong>in</strong>g with ASD 

(Bagenbholm & Gillberg, 1991; Ross & 

Cuskelly, 2006; Rivers & Stoneman, 2003), 

<strong>and</strong> embarrassment (Mascha & Boucher, 

2006). 

No differences. In contrast to the above 

studies reported on which showed evidence of 

less positive relationships, Roeyers <strong>and</strong> Mycke 

(1995), <strong>in</strong> their study of 60 subjects ages 8–14, 

reported no differences between sibl<strong>in</strong>g relationships 

of children with ASD when compared 

to sibl<strong>in</strong>gs of children with DS <strong>and</strong> no 

disability. Similarly, <strong>in</strong> a study of 90 subjects 

ages 6–15, McHale et al. (1987) found sibl<strong>in</strong>gs 

of children with ASD, of children with MR, 

<strong>and</strong> of typically develop<strong>in</strong>g children reported 

no differences <strong>in</strong> sibl<strong>in</strong>g relationships. 

Strategies for Improv<strong>in</strong>g Sibl<strong>in</strong>g 

Relationships 


The research f<strong>in</strong>d<strong>in</strong>gs summarized above may 

<strong>in</strong>dicate <strong>in</strong> part a negative impact of ASD on 

sibl<strong>in</strong>g relationships. While there is noth<strong>in</strong>g 

that can be done about the age, ord<strong>in</strong>al position, 

or degrees of ASD, there are strategies 

that can be implemented to facilitate more 

positive relationships between typically develop<strong>in</strong>g 

sibl<strong>in</strong>gs <strong>and</strong> their brother or sister with 

ASD. Strategies address<strong>in</strong>g four areas of concern 

are discussed below.

Teach play skills. Sibl<strong>in</strong>gs are the most frequently 

available play partners (Reagon, 

2006). One strategy for <strong>in</strong>creas<strong>in</strong>g positive <strong>in</strong>teractions, 

prosocial behaviors, <strong>and</strong> play skills 

between sibl<strong>in</strong>gs is to teach sibl<strong>in</strong>gs a game 

that they can play together. Harris <strong>and</strong> Glasber 

(1994) suggested start<strong>in</strong>g with a simple 

skill such as roll<strong>in</strong>g a ball to each other or 

play<strong>in</strong>g catch <strong>and</strong> gradually <strong>in</strong>creas<strong>in</strong>g the 

complexity of the skill as the sibl<strong>in</strong>gs become 

more skillful <strong>and</strong> older, such as go<strong>in</strong>g for a jog 

or shoot<strong>in</strong>g baskets together. Further, older 

typically develop<strong>in</strong>g sibl<strong>in</strong>gs might enjoy 

learn<strong>in</strong>g specific teach<strong>in</strong>g skills so they can be 

the “teacher” of play (Howl<strong>in</strong>, 1988) <strong>and</strong> research 

has shown that sibl<strong>in</strong>gs of a brother or 

sister with ASD can effectively implement behavior 

<strong>in</strong>terventions (Celiberti & Harris, 1993; 

Schreibman, O’Neill & Koegel, 1993). 

Develop cop<strong>in</strong>g skills. As stated earlier, 

McHale et al. (1987) <strong>and</strong> Orsmond <strong>and</strong> Seltzer 

(2007) reported that sibl<strong>in</strong>gs of a brother or 

sister with ASD who had developed effective 

cop<strong>in</strong>g strategies reported more positive relationships. 

Thus, typically develop<strong>in</strong>g sibl<strong>in</strong>gs 

need effective cop<strong>in</strong>g skills <strong>in</strong> order to effectively 

deal with the challenges that come with 

hav<strong>in</strong>g a sibl<strong>in</strong>g with a disability <strong>and</strong> to develop 

a more positive relationship with their 

sibl<strong>in</strong>g with ASD. 

Cop<strong>in</strong>g strategies can be developed by first 

encourag<strong>in</strong>g typically develop<strong>in</strong>g sibl<strong>in</strong>gs to 

share how they are feel<strong>in</strong>g <strong>and</strong> any concerns 

they have for their sibl<strong>in</strong>g with ASD. That is, by 

encourag<strong>in</strong>g sibl<strong>in</strong>gs to openly discuss their 

feel<strong>in</strong>g unnecessary distress can be avoided 

<strong>and</strong> sibl<strong>in</strong>gs can be reassured their feel<strong>in</strong>gs 

are natural. 

Second, Glasberg (2000) stated these sibl<strong>in</strong>gs 

often lack <strong>in</strong>formation or are mis<strong>in</strong>formed 

about their brother’s or sister’s disability 

<strong>and</strong> that approximately one of every 

five sibl<strong>in</strong>gs claim they never heard the sibl<strong>in</strong>g’s 

diagnostic term (autism), thus provid<strong>in</strong>g 

them with accurate age appropriate <strong>in</strong>formation 

about ASD can enable them to cope 

both <strong>in</strong>trapersonally <strong>and</strong> <strong>in</strong>terpersonally by 

deal<strong>in</strong>g more effectively with their own curiosity 

<strong>and</strong> peers’ curiosity (Howl<strong>in</strong>, 1988; & 

McHale et al., 1986). 

Glasperg (2000) suggested when consider<strong>in</strong>g 

how to expla<strong>in</strong> the disability to sibl<strong>in</strong>gs it is 

important to first assess the sibl<strong>in</strong>g’s cognitive 

level <strong>and</strong> to then re-present <strong>in</strong>formation 

throughout the sibl<strong>in</strong>g’s development. Further, 

Harris <strong>and</strong> Glasberg (1994) stated that 

very young sibl<strong>in</strong>gs will not benefit from a 

detailed discussion of ASD, but they need to 

be reassured about their concerns. Smith, Polloway, 

Patton, <strong>and</strong> Dowdy (2008) stated that as 

sibl<strong>in</strong>gs get older they should be provided 

with <strong>in</strong>formation concern<strong>in</strong>g the disability, 

which can be found <strong>in</strong> books, magaz<strong>in</strong>es, <strong>and</strong> 

journal articles. At the same time, however as 

noted by Fiedler, Simpson <strong>and</strong> Clark (2005), 

adults should help sibl<strong>in</strong>gs with comprehension 

for most <strong>in</strong>formation is often presented 

<strong>in</strong> a manner meant for adults. Further, Smith 

et al. stated that sibl<strong>in</strong>gs should be <strong>in</strong>cluded <strong>in</strong> 

the education of their brother or sister with a 

disability because sibl<strong>in</strong>gs who are not <strong>in</strong>cluded 

<strong>in</strong> the education of their brother or 

sister with a disability may often feel isolated 

or guilt about caus<strong>in</strong>g the disability (Meyer, 

2001). 

Third, Rivers <strong>and</strong> Stoneman (2003) hypothesized 

that access<strong>in</strong>g social support could 

shield the harmful effects of stressors on the 

sibl<strong>in</strong>g relationship. Therefore, encourag<strong>in</strong>g 

typically develop<strong>in</strong>g sibl<strong>in</strong>gs to jo<strong>in</strong> support 

groups can allow them to meet others who are 

go<strong>in</strong>g through similar experiences, share their 

own experiences <strong>and</strong> realize they are not 

alone. 

Private special time. Meyer (2001) reported 

that sibl<strong>in</strong>gs of a brother or sister with a disability 

reported feel<strong>in</strong>gs or resentment when 

their sibl<strong>in</strong>g became the focus of the family’s 

attention <strong>and</strong> when he or she was spoiled, 

overprotected, <strong>and</strong> allowed to engage <strong>in</strong> behaviors 

that were unacceptable if done by another 

family member. Thus, <strong>in</strong> order to reduce 

resentment, perceived parental favoritism, 

depression, <strong>and</strong> <strong>in</strong>crease sensitivity <strong>and</strong> <strong>in</strong>timacy 

of typically develop<strong>in</strong>g sibl<strong>in</strong>gs towards 

their brother or sister with ASD, parents 

should purposefully set aside private special 

time to spend with their typically develop<strong>in</strong>g 

child when the child can be the center of 

attention <strong>and</strong> feel like a valued member of the 

family (Harris & Glasberg, 1994). F<strong>in</strong>d<strong>in</strong>g this 

time may not always be easy, but parents can, 

for example, spilt the time between each 

other, spend time with the child while do<strong>in</strong>g 

err<strong>and</strong>s, enlist <strong>in</strong> support from other family 

members such as gr<strong>and</strong>parents, <strong>and</strong> use re- 


spite care for the <strong>in</strong>dividual with ASD (Howl<strong>in</strong>, 

1988). 

Avoid unnecessary emotional <strong>and</strong> physical pressure. 

Smith et al. (2008) stated that the sibl<strong>in</strong>gs 

of a brother or sister with a disability 

often become second parents <strong>in</strong> the areas of 

care <strong>and</strong> discipl<strong>in</strong>e. As mentioned earlier 

Knott et al. (1995) reported that concerns 

about the future of the sibl<strong>in</strong>g with ASD can 

lead to negative sibl<strong>in</strong>g relationships. Thus, 

parents should be conscious of not putt<strong>in</strong>g 

too much responsibility on typically develop<strong>in</strong>g 

sibl<strong>in</strong>gs for support for this puts unneeded 

stress upon them. More specifically, parents 

should plan for the possibly of future residential 

placements of sibl<strong>in</strong>g with ASD long before 

they become too old <strong>and</strong> typically develop<strong>in</strong>g 

sibl<strong>in</strong>gs should be <strong>in</strong>volved <strong>in</strong> the 

process, but not feel obligated for future care 

(Howl<strong>in</strong>, 1988). 

Future Research Areas 

The <strong>in</strong>consistencies that are reported <strong>in</strong> the 

research regard<strong>in</strong>g the effects of ASD on sibl<strong>in</strong>gs 

relationships (e.g., positive vs. negative 

relationships) seem <strong>in</strong>evitable because of <strong>in</strong>terven<strong>in</strong>g 

variables such as the family environment 

(e.g., economic, educational status, 

number, age, <strong>and</strong> gender of children <strong>in</strong> the 

family, presence or absence of stress <strong>in</strong> the 

paternal relationship, development of cop<strong>in</strong>g 

strategies, availability of social support) <strong>and</strong> 

the severity of the disorder of the child with 

ASD. However, the research literature does 

seem to show more negative impacts than positive 

impacts of hav<strong>in</strong>g a sibl<strong>in</strong>g with ASD 

when compared to hav<strong>in</strong>g a sibl<strong>in</strong>g with DS, 

DD, MR, or no disability (Bagenholm & Gillberg, 

1991; Hodapp & Urbano, 2007; Knott 

et al., 1995; Orsmond & Seltzer, 2006; Ross & 

Cuskelly, 2006; Mascha & Boucher, 2006; 

Rivers & Stoneman, 2003). 

Further, it appears that the majority of the 

studies on sibl<strong>in</strong>gs of <strong>in</strong>dividuals with ASD 

group together sibl<strong>in</strong>gs spann<strong>in</strong>g from the 

childhood to adolescence years, which may 

obscure the differences between these life 

stages. In addition, the measurements most 

commonly used (e.g., self-reports) <strong>in</strong> most of 

the studies were dependent on the skills <strong>and</strong> 

development of the sibl<strong>in</strong>gs <strong>and</strong> parents <strong>and</strong> 

thus may not be reliable. 


Given the status of the research f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong> 

this area, it seems reasonable to conclude it is 

not enough to just study the effects of ASD on 

sibl<strong>in</strong>g relationships. Rather, future studies 

need to take a life course approach <strong>and</strong> consider 

the context of life stages <strong>and</strong> also to 

analyze <strong>in</strong> depth the effects of factors such as 

those discussed below. 

A first consideration is the gender of the sibl<strong>in</strong>gs 

with <strong>and</strong> without ASD, Stoneman, Davis, 

Crapps, <strong>and</strong> Malone (1991) reported that 

older sisters with brother or sister with a disability 

had more care giv<strong>in</strong>g responsibilities 

than other sibl<strong>in</strong>gs. Thus, it seems reasonable 

to ask is the sibl<strong>in</strong>g relationship <strong>in</strong> which one 

sibl<strong>in</strong>g has a ASD more likely to be poor if the 

typically develop<strong>in</strong>g sibl<strong>in</strong>g is an older sister 

than if an older brother. Further, it may be 

<strong>in</strong>terest<strong>in</strong>g to look <strong>in</strong>to how the relationship is 

affected if the sibl<strong>in</strong>gs are of the same or 

opposite sex. 

A second area for focus is age of the sibl<strong>in</strong>gs 

with <strong>and</strong> without ASD. That is, future research 

should ask how the relationship is impacted if 

the typically develop<strong>in</strong>g sibl<strong>in</strong>g is older or 

younger than their sibl<strong>in</strong>g with ASD. Brody, 

Stoneman, Davis, <strong>and</strong> Crapps (1991) reported 

that older sibl<strong>in</strong>gs with mental retardation can 

become closer with their younger typically develop<strong>in</strong>g 

sibl<strong>in</strong>g than if they did not have the 

disability, but little research is available on if 

this f<strong>in</strong>d<strong>in</strong>g would also be true of sibl<strong>in</strong>gs with 

ASD. 

Third, while it is well known that hav<strong>in</strong>g a 

child with ASD can put stra<strong>in</strong> on the marital 

relationship, the question rema<strong>in</strong>s as whether 

this stra<strong>in</strong> carries over to sibl<strong>in</strong>g relationships. 

That is, do sibl<strong>in</strong>gs sense stress among parental 

relationships <strong>and</strong> if so are sibl<strong>in</strong>g relationship 

affected by negative or positive <strong>in</strong>teraction 

among parents. 

Fourth, Trev<strong>in</strong>o (1979) reported that the 

larger the family the more the responsibilities 

for the child with a disability are dispersed 

among the family members. Thus, future research 

should address the affects of a larger 

family on relationships among typically develop<strong>in</strong>g 

sibl<strong>in</strong>gs <strong>and</strong> their brother of sister with 

ASD. 

A fifth concern is as mentioned earlier cop<strong>in</strong>g 

strategies have been found to have a positive 

effect on sibl<strong>in</strong>g relationships (McHale et al., 

1986; Orsmond & Seltzer, 2007), but strate-

gies that are the most <strong>and</strong> least effective for 

facilitat<strong>in</strong>g positive relationships among typically 

develop<strong>in</strong>g sibl<strong>in</strong>gs <strong>and</strong> their brother or 

sister with ASD have not been widely documented; 

thus future research should address 

this issue. 

Another area of focus should be the socioeconomic 

status of the family. Seligmam (1983) 

reported that families with f<strong>in</strong>ancial security 

may experience greater difficulty meet<strong>in</strong>g the 

needs of their child with a disability because 

fewer resources are available to pay for services. 

Further research is needed to address 

whether relationships are more positive <strong>in</strong> affluent 

families. 

F<strong>in</strong>ally, other factors that may be important 

are the effects of the severity of the disability, 

the family dynamic, <strong>and</strong> the cognitive abilities 

<strong>and</strong> educational levels of family <strong>in</strong>volvement. 

Moreover, most of the studies reported compared 

sibl<strong>in</strong>gs with ASD to sibl<strong>in</strong>gs with DS 

<strong>and</strong> used one type of assessment such as selfreports 

<strong>and</strong> this alone is not sufficient enough 

to draw any clear conclusions about sibl<strong>in</strong>g 

relationships. Thus comparisons to other populations 

<strong>and</strong> other assessment method needs 

to be used along with self-reports (e.g., observations). 


The Centers for Disease Control <strong>and</strong> Prevention 

(CDC) (2007) released the latest prevalence 

figures for ASD of 1 <strong>in</strong> 150, which is up 

from the 1 <strong>in</strong> 166 figure reported by the CDC 

<strong>in</strong> 2004. Consequently, it appears that hav<strong>in</strong>g 

a brother or sister with ASD is becom<strong>in</strong>g more 

common. For children with ASD, a primary 

concern is the development of social competence 

<strong>and</strong> thus it seems more important than 

ever that sibl<strong>in</strong>g relationships be positive 

given that sibl<strong>in</strong>gs are the most frequently 

available play partners (Reagon, 2006). As detailed 

earlier, positive support, effective cop<strong>in</strong>g 

strategies, open discussion, plann<strong>in</strong>g <strong>and</strong> 

sensitivity can facilitate more positive relationships 

between typically develop<strong>in</strong>g sibl<strong>in</strong>gs 

<strong>and</strong> sibl<strong>in</strong>gs with ASD. 

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Received: 10 July 2008 

Initial Acceptance: 14 September 2008 

F<strong>in</strong>al Acceptance: 4 November 2008

Impacts of Family Support <strong>in</strong> Early Childhood 

Intervention Research 

Anna C. Friend 

Pittsburg State University 

Jean Ann Summers <strong>and</strong> 

Ann P. Turnbull 

University of Kansas 

Abstract: The purpose of this paper is to review <strong>in</strong>tervention research to determ<strong>in</strong>e the types of family support that 

are reported <strong>and</strong> evaluated <strong>in</strong> early childhood. This review <strong>in</strong>cludes 26 articles evaluat<strong>in</strong>g (a) parent tra<strong>in</strong><strong>in</strong>g 

programs; (b) general family-centered practice models which offer comprehensive supports; (c) peer support; 

(d) two-generation programs; <strong>and</strong> (e) respite care. In the article, we focus our discussion on: (a) the def<strong>in</strong>itions 

or description of family support, (b) the family variables or impacts evaluated <strong>and</strong> their f<strong>in</strong>d<strong>in</strong>gs, <strong>and</strong> (c) the 

l<strong>in</strong>k between support <strong>and</strong> impacts to both the ECO outcomes <strong>and</strong> the family quality of life doma<strong>in</strong>s. This review 

<strong>in</strong>dicates a need for specific <strong>and</strong> consistent term<strong>in</strong>ology <strong>in</strong> def<strong>in</strong><strong>in</strong>g family support <strong>in</strong> the early <strong>in</strong>tervention field. 

Further, a family support framework to guide future research to <strong>in</strong>vestigate both long-term <strong>and</strong> short-term 

outcomes for families is warranted. 

Over the past decade, early <strong>in</strong>terventionists 

have recognized that work<strong>in</strong>g with families <strong>in</strong> 

a broader scope by provid<strong>in</strong>g supports to families 

<strong>and</strong> children impacts not only the child’s 

development, but the family’s ability to help 

the child grow <strong>and</strong> develop (Bailey et al., 

1998; Bailey & Bruder, 2005; S<strong>and</strong>all, Hemmeter, 

Smith, & McLean, 2005). Further, the 

statutory underly<strong>in</strong>g premise of early <strong>in</strong>tervention 

services for children with disabilities is “to 

enhance the capacity of families to meet the 

special needs of their <strong>in</strong>fants <strong>and</strong> toddlers 

with disabilities” (Individuals with <strong>Disabilities</strong> 

<strong>Education</strong> Act Amendments of 2004, Title I, 

Part C, Sec. 631(a)(4)), thus strengthen<strong>in</strong>g 

the role of the family as the primary caregiver. 

Family-centered practice is def<strong>in</strong>ed us<strong>in</strong>g 

two primary facets. The first facet is the partnerships 

that are developed between professionals 

<strong>and</strong> parents that culm<strong>in</strong>ate <strong>in</strong> empower<strong>in</strong>g 

the family to make decisions for their 

child (Allen & Petr, 1996; Bailey et al., 1998; 

Mahoney et al., 1999; Turnbull, Turbiville, & 

Turnbull, 2000). The second facet specifies 

that the family itself is a recipient of supports 

for two reasons: because it helps children 


be addressed to Anna Friend, 2900 West 51st Street, 

Westwood, KS 66205. 



grow <strong>and</strong> learn <strong>and</strong> because families are impacted 

by their child’s disability <strong>and</strong> are <strong>in</strong> 

need of supports <strong>in</strong> their own right (Allen & 

Petr, 1996; Mahoney et al., 1999; Poston et al., 

2003). (We are us<strong>in</strong>g the term, family support, 

to refer to assistance provided through formal 

systems (e.g., early <strong>in</strong>tervention programs) 

<strong>and</strong> <strong>in</strong>formal networks (e.g., peer support). 

This article focuses on the nature of family 

support as contrasted to the nature of partnerships 

between professionals <strong>and</strong> parents). 

This second facet of family-centered services is 

the focus of this paper. 

The family as a recipient of support has 

received less emphasis than the relationship 

facet of family-centered practice. In an analysis 

of early <strong>in</strong>tervention literature, family 

choice <strong>and</strong> family strengths perspectives have 

dom<strong>in</strong>ated the literature <strong>in</strong> comparison with 

the delivery of support to the family (Epley, 

2006). In 25 articles, def<strong>in</strong>itions <strong>in</strong>cluded the 

family as a unit of attention only 60% of the 

time; while 88% of the articles identified how 

to provide support to families, only 42% identified 

what types of support should be provided 

to families <strong>in</strong> early <strong>in</strong>tervention. Although 

position papers <strong>and</strong> commentary have 

rema<strong>in</strong>ed strong <strong>in</strong> advocat<strong>in</strong>g the importance 

of establish<strong>in</strong>g partnerships with families 

<strong>and</strong> ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g empower<strong>in</strong>g relation- 

Impacts of Family Support / 453

ships—the how of early <strong>in</strong>tervention—there 

has been relatively less emphasis on the whole 

family as a unit of attention (Epley), <strong>and</strong> more 

specifically, on the delivery of support to families 

to “enhance their capacity”, as the law 

puts it. 

An underst<strong>and</strong><strong>in</strong>g of the types of support, 

both formal <strong>and</strong> <strong>in</strong>formal, families receive is 

particularly important due to recent efforts to 

develop outcome measures related to children 

<strong>and</strong> families <strong>in</strong> early <strong>in</strong>tervention <strong>and</strong> 

early childhood special education. In 2005, 

the Early Childhood Outcome (ECO) Center 

recommended five family outcomes that apply 

to early <strong>in</strong>tervention <strong>and</strong> early childhood 

education. The ECO Center def<strong>in</strong>es family 

outcome as “a benefit experienced as a result 

of services received” (Bailey & Bruder, 2005). 

The five outcomes are (a) families underst<strong>and</strong> 

their children’s strengths, abilities <strong>and</strong> 

special needs, (b) families know their rights 

<strong>and</strong> advocate effectively for their children, 

(c) families help their children learn <strong>and</strong> 

grow, (d) families have support systems, <strong>and</strong> 

(e) families are able to ga<strong>in</strong> access to desired 

services, programs, <strong>and</strong> activities <strong>in</strong> their community 

(Bailey et al., 2006). 

Another more long-term outcome of these 

specific ECO outcomes is family quality of 

life (Summers et al., 2005). Family quality of 

life is a condition <strong>in</strong> which family needs are 

be<strong>in</strong>g met, family members enjoy their life 

together <strong>and</strong> have an opportunity to participate 

<strong>in</strong> the activities that are important to 

them (Park et al., 2003). Based on psychometric 

studies, family quality of life is comprised 

of five doma<strong>in</strong>s: family <strong>in</strong>teraction, parent<strong>in</strong>g, 

emotional well-be<strong>in</strong>g, physical/material wellbe<strong>in</strong>g, 

<strong>and</strong> disability-related support (Hoffman, 

Marquis, Poston, Summers, & Turnbull, 

2006). The Beach Center on Disability def<strong>in</strong>es 

family outcomes as either positive or negative 

impacts that families may experience as a result 

of supports <strong>and</strong> services for themselves 

<strong>and</strong>/or their children with disabilities (Mannan, 

Summer, Turnbull, & Poston, 2006) 

which can be measured us<strong>in</strong>g the family quality 

of life doma<strong>in</strong>s. However, <strong>in</strong> addition to 

assess<strong>in</strong>g family outcomes, it is critical to determ<strong>in</strong>e 

what specific support families are receiv<strong>in</strong>g 

<strong>in</strong> order to l<strong>in</strong>k those services to the 

proposed outcomes. 

An underst<strong>and</strong><strong>in</strong>g of the specific services 


that are l<strong>in</strong>ked to family outcomes might be 

found <strong>in</strong> the Individuals with <strong>Disabilities</strong> <strong>Education</strong> 

Act (IDEA). Part C of IDEA governs 

the manner <strong>in</strong> which <strong>in</strong>fants <strong>and</strong> toddlers with 

disabilities <strong>and</strong> their families receive educational 

services from public agencies. Early <strong>in</strong>tervention 

services are def<strong>in</strong>ed as “developmental 

services that are designed to meet the 

developmental needs of an <strong>in</strong>fant or toddler 

with a disability, as identified by the <strong>in</strong>dividualized 

family service plan team” (Individuals 

with <strong>Disabilities</strong> <strong>Education</strong> Act Amendments 

of 2004, Title 20, Part C, Sec. 1432(4)(C)). 

The family support <strong>in</strong>cluded on the IFSP 

should promote physical, cognitive, communication, 

social/emotional, <strong>and</strong> adaptive development 

of the child. With<strong>in</strong> the statute, the 

follow<strong>in</strong>g developmental services are listed: 

family tra<strong>in</strong><strong>in</strong>g, counsel<strong>in</strong>g <strong>and</strong> home visits; 

special <strong>in</strong>struction; speech-language pathology 

<strong>and</strong> audiology services <strong>and</strong> sign language 

<strong>and</strong> cued sign language services; occupational 

therapy; physical therapy; psychological services; 

service coord<strong>in</strong>ation services; medical 

services only for diagnostic or evaluation purposes; 

early identification, screen<strong>in</strong>g, <strong>and</strong> assessment 

services; health services necessary to 

enable the <strong>in</strong>fant or toddler to benefit from 

the other early <strong>in</strong>tervention services; social 

work services; vision services; assistive technology 

devices <strong>and</strong> assistive technology services; 

<strong>and</strong> transportation <strong>and</strong> related costs that are 

necessary to enable an <strong>in</strong>fant or toddler <strong>and</strong> 

the <strong>in</strong>fant’s or toddler’s family to receive one 

of these services (Individuals with <strong>Disabilities</strong> 

<strong>Education</strong> Act Amendments of 2004, Title I, 

Part C, Sec. 1432(4)(E)). 

However, it is not clear just what this list of 

services means <strong>in</strong> terms of what specific support 

is delivered to families, as opposed to 

child-oriented services. Further concern is 

raised by a review of data concern<strong>in</strong>g types of 

family support on IFSPs. In review<strong>in</strong>g data 

reported by states regard<strong>in</strong>g the number <strong>and</strong> 

percentage of early <strong>in</strong>tervention services reported 

on IFSPs for children ages 0–2 under 

Part C of IDEA, family support has been on a 

downward trend over the past decade (Danaher 

& Armijo, 2005). For example, family 

tra<strong>in</strong><strong>in</strong>g, counsel<strong>in</strong>g <strong>and</strong> home visits; health 

services; medical services; respite care; social 

work services; <strong>and</strong> transportation are early <strong>in</strong>tervention 

services that have decreased <strong>in</strong>

numbers as reported by IFSP data (Danaher & 

Armijo). The exceptions to this appear to be 

services that are child-focused, <strong>in</strong>clud<strong>in</strong>g occupational 

therapy, physical therapy, special 

<strong>in</strong>struction <strong>and</strong> speech <strong>and</strong> language pathology, 

which are rema<strong>in</strong><strong>in</strong>g consistent or <strong>in</strong>creas<strong>in</strong>g 

<strong>in</strong> number (Danaher & Armijo). 

However, problems with this data set <strong>in</strong>dicate 

that states <strong>and</strong> local programs may be def<strong>in</strong><strong>in</strong>g 

these services differently, <strong>and</strong> family support 

may be occurr<strong>in</strong>g <strong>in</strong> the context of other def<strong>in</strong>ed 

services (J. Hurth, personal communication, 

January 23, 2006). It is not clear whether 

these f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong>dicate an actual decl<strong>in</strong>e <strong>in</strong> 

emphasis or amounts of support provided to 

families. It is possible that early <strong>in</strong>terventionists 

are serv<strong>in</strong>g families <strong>in</strong> a variety of ways that 

are not captured <strong>in</strong> the data. Also, it may be 

that def<strong>in</strong>itions of family support are not consistent 

with the actual types of support families 

are receiv<strong>in</strong>g. 

Another possible source of <strong>in</strong>sight <strong>in</strong>to the 

types of support families receive <strong>in</strong> the context 

of early <strong>in</strong>tervention might be found <strong>in</strong> literature 

describ<strong>in</strong>g <strong>and</strong> evaluat<strong>in</strong>g early childhood 

service models. Intervention research 

may <strong>in</strong>clude descriptions of types of family 

support <strong>and</strong> related outcomes of this support. 

The purpose of this paper is to focus on <strong>in</strong>tervention 

research <strong>and</strong> evaluation to determ<strong>in</strong>e 

the types of family support that are reported 

<strong>and</strong> evaluated <strong>in</strong> descriptions of early childhood 

<strong>in</strong>tervention research. The specific questions 

guid<strong>in</strong>g this literature review were: 

1. What types of family-related support are 

<strong>in</strong>cluded <strong>in</strong> evaluations of early <strong>in</strong>tervention 

programs? 

2. How are families impacted by the provision 

of family support? 

3. What specific family outcomes appear to 

be related to these family impacts? 

Method 

We conducted a literature search for <strong>in</strong>tervention 

studies <strong>in</strong> the field of early <strong>in</strong>tervention 

<strong>and</strong> early childhood, <strong>in</strong>clud<strong>in</strong>g programs designed 

both specifically for families <strong>and</strong> children 

with disabilities <strong>and</strong> for families <strong>and</strong> children 

considered “at risk” for disabilities (e.g., 

programs serv<strong>in</strong>g low-<strong>in</strong>come families or adolescent 

parents). “At risk” children <strong>and</strong> fami- 

lies were <strong>in</strong>cluded <strong>in</strong> the population for this 

paper because there were a limited number of 

<strong>in</strong>tervention research articles devoted only to 

families <strong>and</strong> children with disabilities <strong>in</strong> early 

<strong>in</strong>tervention. Therefore, the <strong>in</strong>vestigator exp<strong>and</strong>ed 

the search to <strong>in</strong>clude the “at risk” 

population to provide <strong>in</strong>sight <strong>in</strong>to more types 

of family-oriented services <strong>in</strong> the early <strong>in</strong>tervention 

field. 

The literature search used the follow<strong>in</strong>g descriptors 

to capture the population of <strong>in</strong>terest: 

early <strong>in</strong>tervention, early childhood, preschool, 

<strong>in</strong>fant <strong>and</strong> toddlers, families <strong>and</strong> disabilities. 

The search <strong>in</strong>cluded the follow<strong>in</strong>g key words: 

family outcomes, family services <strong>and</strong> supports, 

family centered services, family <strong>in</strong>teraction, 

parent tra<strong>in</strong><strong>in</strong>g, parent to parent, parental 

stress, parental depression, parent education, 

respite care, rout<strong>in</strong>es-based <strong>in</strong>tervention, 

home visit<strong>in</strong>g, family counsel<strong>in</strong>g, relationship 

<strong>in</strong>tervention, advocacy, social supports, <strong>and</strong> 

support groups. The search also <strong>in</strong>cluded specific 

names of authors known as <strong>in</strong>vestigators 

of family issues <strong>in</strong> the field, e.g., Bailey, 

Bruder, Dunst, McWilliam, Kaiser, Fewell, Mahoney, 

Ramey, <strong>and</strong> S<strong>in</strong>ger. These key words, 

author names, <strong>and</strong> descriptors were used to 

search five primary databases: Psych-INFO, 

PubMed, ERIC, <strong>Education</strong>al Abstracts, <strong>and</strong> 

Wilson Web. Further, we searched websites of 

specific national organizations <strong>in</strong> the field of 

early <strong>in</strong>tervention to identify <strong>in</strong>tervention 

studies. Those websites <strong>in</strong>cluded Parents as 

Teachers (PAT), Early Childhood Outcomes 

Consortium (ECO), <strong>Division</strong> of Early Childhood 

(DEC), Office of Special <strong>Education</strong> 

(OSEP), Adm<strong>in</strong>istration of Children <strong>and</strong> Families 

(ACF), National Early Childhood Technical 

Assistance Center (NECTAC), <strong>and</strong> the 

National Association of Councils of <strong>Developmental</strong> 

<strong>Disabilities</strong> (NACDD). 

Studies selected for this article were limited 

to those published with<strong>in</strong> the last decade from 

the date of the first search <strong>in</strong> 2005. Studies 

<strong>in</strong>cluded <strong>in</strong> this paper used r<strong>and</strong>omized controlled 

designs, meta-analyses, longitud<strong>in</strong>al 

designs, quasi-experimental designs, pilot 

studies, pretest/posttest experimental designs, 

path analysis, <strong>and</strong> correlation designs. 

Literature reviews <strong>and</strong> meta-analyses were <strong>in</strong>cluded, 

especially <strong>in</strong> the case of research evaluations 

with a very large literature base (such 

as home visit<strong>in</strong>g programs). Studies that <strong>in</strong>ves- 


tigated the effectiveness of commercially available 

programs <strong>and</strong> materials were excluded. 

Articles were collected from literature across 

all disability-related discipl<strong>in</strong>es, but did not 

<strong>in</strong>clude those studies narrowly focused on specific 

services listed <strong>in</strong> IDEA that are child focused, 

such as speech, OT, PT, special <strong>in</strong>struction 

<strong>and</strong> assessment or diagnostic test<strong>in</strong>g. The 

<strong>in</strong>tervention studies were restricted to families 

<strong>and</strong> children from the ages of birth to 8, with 

the exception of the <strong>in</strong>tervention studies regard<strong>in</strong>g 

respite care <strong>and</strong> peer support which 

reflect families <strong>and</strong> children with developmental 

disabilities of all ages. The reason for 

this exception was that we were not able to 

locate studies on respite care or peer support 

that were focused on the early childhood age 

range. Some of the programs reviewed were 

evaluations that were specifically focused on 

family support, e.g., respite care <strong>and</strong> peer supports 

(Parent to Parent); the majority, however, 

were general early childhood <strong>in</strong>terventions 

that <strong>in</strong>cluded some family support 

component <strong>in</strong> the context of provid<strong>in</strong>g <strong>in</strong>terventions 

for children. S<strong>in</strong>ce the focus of this 

paper was to identify <strong>and</strong> def<strong>in</strong>e the types of 

support to families that are typically <strong>in</strong>cluded 

<strong>in</strong> such early childhood <strong>in</strong>terventions, these 

studies were of particular <strong>in</strong>terest. 

The articles collected based on the above 

criteria were <strong>in</strong>cluded <strong>in</strong> the f<strong>in</strong>al review 

based upon three stipulations. First, the article 

needed to have specified a clear <strong>in</strong>tervention 

or <strong>in</strong>terventions related to the area of early 

childhood that was “tested” through an empirical 

research design. Second, at least one aspect 

of the <strong>in</strong>tervention needed to target parents 

or family members. Third, the results of 

the <strong>in</strong>tervention research needed a component 

of measurement regard<strong>in</strong>g how the parents 

or family members responded to the <strong>in</strong>tervention 

<strong>in</strong> question. Based on all, we 

<strong>in</strong>cluded a total of 26 articles <strong>in</strong> this review. 

Results 

Table 1 presents a synthesis of these 26 articles. 

The <strong>in</strong>tervention studies reflect <strong>in</strong>tervention 

models <strong>in</strong>clud<strong>in</strong>g studies of support 

for families that were part of evaluations of: 

(a) parent tra<strong>in</strong><strong>in</strong>g programs; (b) general 

family-centered practice models which offer 

comprehensive support, which may <strong>in</strong>clude 

counsel<strong>in</strong>g, parent<strong>in</strong>g skills, respite care, 

<strong>and</strong>/or support groups; (c) peer supports; 

(d) two- generation programs; <strong>and</strong> (e) respite 

care. The follow<strong>in</strong>g sections summarize the 

f<strong>in</strong>d<strong>in</strong>gs of this review related to each of these 

types of family support. The columns <strong>in</strong> Table 

1 describe the type of family support provided, 

a brief summary of results perta<strong>in</strong><strong>in</strong>g 

to families, our judgment of the specific family 

outcomes represented <strong>in</strong> the study <strong>in</strong> terms 

of both ECO Center <strong>and</strong> FQOL family outcomes, 

<strong>and</strong> the reference. Because of the 

focus on family support <strong>in</strong> this article, we 

omitted descriptions of specific child measurements, 

results, <strong>and</strong> outcomes. 

In each of the follow<strong>in</strong>g sections we will 

discuss the three primary questions for this 

review: (a) the def<strong>in</strong>itions or descriptions of 

the types of support families receive, (b) the 

types of family variables or impacts <strong>in</strong>cluded 

<strong>in</strong> the research or evaluation design <strong>and</strong> their 

f<strong>in</strong>d<strong>in</strong>gs, <strong>and</strong> (c) a categorization of the l<strong>in</strong>k 

of these types of supports <strong>and</strong> impacts to both 

the ECO outcomes <strong>and</strong> the family quality of 

life (FQOL) doma<strong>in</strong>s as <strong>in</strong>dicated by the results 

of the evaluation. 

Parent <strong>Tra<strong>in</strong><strong>in</strong>g</strong> Programs 


Parent tra<strong>in</strong><strong>in</strong>g programs encompass <strong>in</strong>tervention 

research that is specifically focused on 

provid<strong>in</strong>g parent tra<strong>in</strong><strong>in</strong>g to improve <strong>in</strong>teractions 

between parents <strong>and</strong> their children. The 

<strong>in</strong>tervention studies <strong>in</strong> Table 1 were focused 

on specific areas of parent education <strong>and</strong>/or a 

specific population: family-<strong>in</strong>fant <strong>in</strong>teraction 

<strong>and</strong> home environment (Bakermans-Kranenburg, 

van Ijzendoorn, & Bradley, 2005); father 

empowerment to improve parent<strong>in</strong>g (Fagan & 

Stevenson, 2002); home-based parent tra<strong>in</strong><strong>in</strong>g 

program <strong>and</strong> support group (Kucuker, 2006); 

skill-build<strong>in</strong>g groups to improve parental wellbe<strong>in</strong>g 

<strong>and</strong> family <strong>in</strong>teraction (Niccols & Mohamed, 

2000); parent management tra<strong>in</strong><strong>in</strong>g 

to reduce behavior problems (Roberts, Mazzucchelli, 

Taylor, & Reid, 2003); Parents As 

Teachers programs (Wagner & Spiker, June 

2001); <strong>and</strong> deaf mentor program for parents 

to improve <strong>in</strong>teractions with their children 

who are deaf (Watk<strong>in</strong>s, Pittman, & Walden, 

1998). Some of these <strong>in</strong>terventions were offered 

<strong>in</strong> the context of a home visit<strong>in</strong>g model, 

while others were provided <strong>in</strong> group sett<strong>in</strong>gs.

TABLE 1 

Family Support Identified <strong>in</strong> the Intervention Literature 

References/Support Identified Results Outcomes 

Bakermans-Kranenburg, 

M. J., van Ijzendoorn, 

M. H., & Bradley, 

R. H. (2005) 

Meta-analysis of early 

childhood <strong>in</strong>tervention 

studies aimed at 

parent<strong>in</strong>g or parentchild 

<strong>in</strong>teraction us<strong>in</strong>g 

the HOME assessment. 

(U.S. & <strong>in</strong>ternational) 

Fagan, J., & Stevenson, 

H. C. (2002) 

Parent tra<strong>in</strong><strong>in</strong>g for 

fathers. 

Kucuker, S. (2006) 

Early <strong>in</strong>tervention 

program, to enhance 

the development of 

children with 

disabilities ages 0–4 

through a parent 

tra<strong>in</strong><strong>in</strong>g program 

(Turkey) 

Niccols, A., & Mohamed, S. 

(2000) 

Parent<strong>in</strong>g skill build<strong>in</strong>g 

group focused on 

attachment theory for 

parents of <strong>in</strong>fants with 

developmental delays 

Type of <strong>in</strong>tervention mode: Parent tra<strong>in</strong><strong>in</strong>g <strong>and</strong> <strong>in</strong>formation programs 

1. Interventions with middle-class, nonadolescent 

parents reported higher effect 

sizes than <strong>in</strong>terventions with low-SES or 

adolescent parents. 

2. Five to 16 home-based <strong>in</strong>tervention 

sessions <strong>in</strong> a limited period were most 

effective. 

3. Interventions start<strong>in</strong>g when the child was 

older than 6 months or started prenatally 

were more effective than <strong>in</strong>terventions 

start<strong>in</strong>g <strong>in</strong> the first 6 months of the 

child’s life. 

1. Resident fathers (those who live at home) 

<strong>in</strong> the parent tra<strong>in</strong><strong>in</strong>g group reported 

significantly greater self-esteem at the end 

of the <strong>in</strong>tervention <strong>in</strong> comparison to 

resident fathers <strong>in</strong> the control group. 

2. Resident fathers <strong>in</strong> the parent tra<strong>in</strong><strong>in</strong>g 

group showed significant improvement <strong>in</strong> 

parent<strong>in</strong>g satisfaction <strong>in</strong> comparison to 

resident fathers <strong>in</strong> the control group. 

3. All fathers <strong>in</strong> the parent tra<strong>in</strong><strong>in</strong>g group 

made significantly greater ga<strong>in</strong>s than 

fathers <strong>in</strong> the control group <strong>in</strong> their 

attitudes about facilitat<strong>in</strong>g the teach<strong>in</strong>glearn<strong>in</strong>g 

process for their child. 

1. The severity of depression scores for both 

mothers <strong>and</strong> fathers had decreased after 

participat<strong>in</strong>g <strong>in</strong> the early <strong>in</strong>tervention 

program with parent tra<strong>in</strong><strong>in</strong>g. 

2. There were no differences reported <strong>in</strong> 

parental stress scores. 

1. Parents <strong>in</strong> the skill-build<strong>in</strong>g group 

reported statistically significant lower 

levels of parent-child dysfunctional 

<strong>in</strong>teraction, parental distress, <strong>and</strong> 

depression. 

2. Parents <strong>in</strong> the comparison groups showed 

a trend towards <strong>in</strong>creased depression. 

3. Parents <strong>in</strong> the skill-build<strong>in</strong>g group 

reported high satisfaction, high 

effectiveness of the content. <strong>and</strong> <strong>in</strong>creased 

support from others. 

4. The majority of parents <strong>in</strong> the skillbuild<strong>in</strong>g 

group (75%) chose consultation 

as their preferred follow-up service 

option. 

ECO outcomes 

● Families help their 

child learn <strong>and</strong> grow 

FQOL Outcomes 

● Parent<strong>in</strong>g 

ECO outcomes 



● Families have support 

systems 

FQOL Outcomes 


● Emotional well-be<strong>in</strong>g 

ECO outcomes 




systems 

FQOL Outcomes 



ECO outcomes 

● Families underst<strong>and</strong> 

their child’s strengths, 

abilities <strong>and</strong> special 

needs 




systems 

FQOL Outcomes 






Roberts, C. et al. (2003) 

Parent management 

tra<strong>in</strong><strong>in</strong>g—review of 

studies for parents of 

preschool-aged 

children with 

developmental 

disabilities (U.S. & 

<strong>in</strong>ternational) 

Wagner, M., & Spiker, D. 

(June 2001) 

Evaluation of Parents as 

Teachers (PAT)— 

home visit<strong>in</strong>g model 

Watk<strong>in</strong>s, S. et al. (1998) 

Parent mentor groups 

1. Comprehensive early <strong>in</strong>tervention programs 

aimed at skill build<strong>in</strong>g through Applied 

Behavior Analysis, Parent Management 

<strong>Tra<strong>in</strong><strong>in</strong>g</strong>, <strong>and</strong> social learn<strong>in</strong>g theory have 

demonstrated positive outcomes for build<strong>in</strong>g 

competencies <strong>and</strong> reduc<strong>in</strong>g behavior problems. 

2. Studies us<strong>in</strong>g a group <strong>in</strong>tervention format of 

PMT <strong>in</strong>dicated some positive effects on child 

behavior, parental stress, parental self-efficacy, 

<strong>and</strong> marital satisfaction. 

3. Studies with <strong>in</strong>dividual families <strong>in</strong>dicate some 

support for generalization of effects to other 

sett<strong>in</strong>gs <strong>and</strong> behaviors. 

ECO outcomes 

● Families help their child 

learn <strong>and</strong> grow 

FQOL Outcomes 



1. The very low <strong>in</strong>come group had more positive ECO outcomes 

effects than the moderate <strong>in</strong>come group <strong>in</strong> the ● Families help their child 

area of language <strong>and</strong> literacy promot<strong>in</strong>g learn <strong>and</strong> grow 

behaviors. 

FQOL Outcomes 

2. PAT families reported be<strong>in</strong>g happier tak<strong>in</strong>g ● Parent<strong>in</strong>g 

care of their families. 


3. After three years, PAT teen mothers had more 

knowledge, greater literacy promot<strong>in</strong>g behaviors 

on HOME, less reports of child maltreatment, 

<strong>and</strong> <strong>in</strong>creased positive home environment 

compared to the control group. 

1. Parents of the children <strong>in</strong> the deaf mentor ECO outcomes 

group reported that they understood what the ● Families underst<strong>and</strong> their 

child was communicat<strong>in</strong>g to them a greater child’s strengths, abilities 

percentage of the time than parents <strong>in</strong> the <strong>and</strong> special needs 

control group. 

FQOL Outcomes 

2. Parents <strong>in</strong> the deaf mentor group reported that ● Parent<strong>in</strong>g 

their children understood them a greater ● Disability-related support 

percentage of the time than the parents of the 


3. Parents <strong>in</strong> the deaf mentor group reported less 

frustration <strong>and</strong> <strong>in</strong>creased number of signs when 

communicat<strong>in</strong>g with their child. 

4. Dur<strong>in</strong>g the <strong>in</strong>tervention, parents <strong>in</strong> the deaf 

mentor group were observed <strong>in</strong> videotaped 

sessions to use more ASL. 

5. Parents <strong>in</strong> the deaf mentor group reported 

perceptions more consistent with the deaf 

culture <strong>and</strong> deaf community. 

Type of <strong>in</strong>tervention model: General family centered practice models—usually offer<strong>in</strong>g comprehensive support; 

<strong>in</strong>cludes some programs that focus primarily on the child but <strong>in</strong>clude evaluations of impacts on families 

Dunst, C. J. et al. (2001) 1. Participation <strong>in</strong> a larger variety of activity ECO outcomes 

Natural learn<strong>in</strong>g 

sett<strong>in</strong>gs was related to parents report<strong>in</strong>g that ● Families help their child 

environments 

they engaged their children <strong>in</strong> more learn<strong>in</strong>g learn <strong>and</strong> grow 

activities. 

FQOL Outcomes 

2. The greater adoption <strong>and</strong> use of the responsive ● Family <strong>in</strong>teraction 

teach<strong>in</strong>g methods by parents, the more the 

children were observed <strong>in</strong>teract<strong>in</strong>g with adults. 

3. Greater adoption <strong>and</strong> use of the responsive 

teach<strong>in</strong>g methods by parents were related to 

enhanced positive child affect. 





Erickson-Warfield, M. E. et 

al. (2000) 

Parent support groups 

Intensity of services 

provided to children 

Hendriks, A. H. C. et al. 

(2000) 

Family-directed 

<strong>in</strong>tervention which may 

<strong>in</strong>clude family support 

groups, counsel<strong>in</strong>g <strong>and</strong> 

respite care (The 

Netherl<strong>and</strong>s) 

Kim, J. M. & Mahoney, G. 

(2003) 

Impact of relationshipfocused 

<strong>in</strong>tervention 

on Korean mothers 

<strong>and</strong> their preschoolaged 

children with 

disabilities (Korea) 

Mahoney, G., & Bella, J. M. 

Family-centered practice 

model <strong>in</strong>volv<strong>in</strong>g an 

array of family 

supports 

Mahoney, G. & Perales, F. 

(2005) 

Relationship-focused 

early <strong>in</strong>tervention—two 

studies 

1. The greatest change between entry <strong>and</strong> 

discharge of EI was <strong>in</strong>creased social 

support networks, both formal <strong>and</strong> 

<strong>in</strong>formal. 

2. More <strong>in</strong>tense service (total hours of 

service) was significantly <strong>and</strong> positively 

correlated with <strong>in</strong>creased family cohesion. 

3. More <strong>in</strong>tensive parent support group 

services <strong>and</strong> more <strong>in</strong>tensive child group 

services were significant predictors of 

<strong>in</strong>creased social support. 

4. The greater number of different services 

provided resulted <strong>in</strong> more parentreported 

ga<strong>in</strong>s <strong>in</strong> social support 

helpfulness. 

5. Maternal education impacted service 

<strong>in</strong>tensity <strong>and</strong> comprehensiveness of 

services. 

1. On average, both mother <strong>and</strong> father 

perceived a positive change <strong>in</strong> well-be<strong>in</strong>g 

10 months after participat<strong>in</strong>g <strong>in</strong> the 

program. 

2. Mothers perceived a greater positive 

change <strong>in</strong> well-be<strong>in</strong>g than fathers. 

1. Mothers <strong>in</strong> the relationship-focused 

<strong>in</strong>tervention group scored significantly 

higher on measures of responsiveness, 

affect, <strong>and</strong> achievement orientation. 

2. Overall, relationship-focused <strong>in</strong>tervention 

reduced parental stress. 

1. There was no overall change on the 

Family Environment Scales. 

2. There were marg<strong>in</strong>al changes <strong>in</strong> maternal 

stress. 

3. Although there was no overall change <strong>in</strong> 

maternal affective styles, enjoyment <strong>and</strong> 

expressiveness significantly decreased 

dur<strong>in</strong>g <strong>in</strong>tervention. 

4. Approximately 45% of families reported 

receiv<strong>in</strong>g a comprehensive array of family 

services, which were characterized by 

extremely high levels of services related 

to their child’s development <strong>and</strong> 

moderate levels of services related to 

family-level concerns. 

1. Mothers who used responsive teach<strong>in</strong>g 

made significant <strong>in</strong>creases <strong>in</strong> 

responsiveness to their children. 

ECO outcomes 




systems 

● Families are able to ga<strong>in</strong> 

access to desired services, 

programs, <strong>and</strong> activities 

<strong>in</strong> their community 

FQOL Outcomes 

● Family <strong>in</strong>teraction 


● Disability-related support 

ECO outcomes 


systems 

FQOL Outcomes 


ECO outcomes 



FQOL Outcomes 



ECO outcomes 




systems 





FQOL Outcomes 




ECO outcomes 



FQOL Outcomes 






Trivette, C. M., Dunst, C. J., 

Boyd, K., & Hamby, 

D. W. (1995) 

Family-centered services, 

us<strong>in</strong>g supports to help 

families access 

<strong>in</strong>formal supports. 

A<strong>in</strong>bider, J. G. et al. (1998) 

Qualitative analysis of 

Parent to Parent 

programs through 

<strong>in</strong>terviews with 24 

parents 

Ireys, H. T. et al. (1996) 

Social support 

<strong>in</strong>tervention for 

mothers of children 

with Juvenile 

Rheumatoid Arthritis 

(ages 2–11). The social 

support <strong>in</strong>tervention 

was a one-to-one 

mentor<strong>in</strong>g match of 

mothers of children 

with JRA. 

Rosenberg, S. A. et al. 

(2002) 

Comparison of nurse 

home visit<strong>in</strong>g model to 

home visit<strong>in</strong>g model 

with tra<strong>in</strong>ed 

paraprofessionals, who 

are all mothers of 

children with special 

health care needs 

1. Helpgivers from more family-centered 

programs who had more frequent contact 

with families reported more positive 

assessments of helpgiv<strong>in</strong>g practices. 

2. Participation <strong>in</strong> family-centered programs 

<strong>in</strong> which parents had frequent contact with 

helpgivers us<strong>in</strong>g empower<strong>in</strong>g helpgiv<strong>in</strong>g 

practices was associated with greater 

<strong>in</strong>dication of personal control. 

Type of <strong>in</strong>tervention model: Peer support 

1. Parent to Parent support is particularly 

helpful when reliable allies have the four 

components: (a) perceived sameness, 

(b) comparable situations for learn<strong>in</strong>g 

relevant skills <strong>and</strong> gather<strong>in</strong>g useful 

<strong>in</strong>formation, (c) availability of support, <strong>and</strong> 

(d) mutuality of support. 

2. Some parents did not f<strong>in</strong>d their experience 

with Parent to Parent to be helpful, but 

expressed belief <strong>in</strong> the value of parent 

connections. 

3. Barriers to unsuccessful matches <strong>in</strong>cluded 

logistics <strong>in</strong> connect<strong>in</strong>g due to bus<strong>in</strong>ess, cost 

for phone bills, lost numbers, or negligent 

follow-up. Barriers also <strong>in</strong>cluded differences 

<strong>in</strong> preferences <strong>and</strong> values regard<strong>in</strong>g 

parent<strong>in</strong>g style, communication style, 

outlook on disability <strong>and</strong> future vision for 

the children. 

1. The mothers receiv<strong>in</strong>g 1:1 mentor<strong>in</strong>g 

reported a decrease <strong>in</strong> mental health 

symptoms compared to the control group. 

Mental health symptoms <strong>in</strong>cluded 

depression, anxiety, anger, <strong>and</strong> cognitive 

disturbance. 

2. The mothers receiv<strong>in</strong>g 1:1 mentor<strong>in</strong>g 

reported greater improvements on 

perceived availability of supports than those 

mothers <strong>in</strong> the control group. 

1. Both groups believed the services they 

received were helpful. The families who 

received visits from the paraprofessionals 

were significantly more positive about their 

experience. 

2. Families who received services from a 

paraprofessional <strong>in</strong>dicated they learned 

more about how to obta<strong>in</strong> medical <strong>and</strong> 

therapy services than the nurse home 

visit<strong>in</strong>g group. 

3. Both groups of mothers showed significant 

improvement on qualities of care giv<strong>in</strong>g 

<strong>and</strong> home environment, as well as 

employment status. 


ECO outcomes 

● Families know their 

rights <strong>and</strong> advocate 

effectively for their 

children 





FQOL Outcomes 



ECO outcomes 


systems 





FQOL Outcomes 



ECO outcomes 


systems 





FQOL Outcomes 



ECO outcomes 

● Families underst<strong>and</strong> their 

child’s strengths, abilities 

<strong>and</strong> special needs 


systems 





FQOL Outcomes 


● Physical/material wellbe<strong>in</strong>g 

● Disability-related support



S<strong>in</strong>ger, G. H. S. et al. 

(1999) 

Peer support 

Gomby, D. S. et al. (1999) 

Evaluation of home 

visit<strong>in</strong>g programs us<strong>in</strong>g 

various models; most 

focused on provid<strong>in</strong>g 

parent <strong>in</strong>formation, 

but also provid<strong>in</strong>g 

supports to parents 

Love, J. M. et al. (2002) 

Two-generation 

<strong>in</strong>tervention model 

provid<strong>in</strong>g 

comprehensive family 

supports for selfsufficiency 

<strong>and</strong> mental 

health; parent tra<strong>in</strong><strong>in</strong>g 

<strong>and</strong> child-oriented 

services. Some 

programs were home 

visit<strong>in</strong>g models, others 

were center-based; 

most were 

comb<strong>in</strong>ation. 

St. Pierre, R. G. et al. 

(1995) 

Two generation service 

programs focus<strong>in</strong>g 

simultaneously on 

improv<strong>in</strong>g outcomes 

for families <strong>and</strong> 

provid<strong>in</strong>g supports 

(usually through 

parent tra<strong>in</strong><strong>in</strong>g) for 

children. 

1. Parents who participated <strong>in</strong> Parent to Parent 

had positive perceptions of their child <strong>and</strong> 

his or her impact on the family. 

2. Initial contacts <strong>in</strong> Parent to Parent were not 

associated with changes <strong>in</strong> parents’ 

perceptions of empowerment. 

3. Parents who participated <strong>in</strong> Parent to Parent 

made statistically greater progress than the 

control group <strong>in</strong> gett<strong>in</strong>g help with their 

<strong>in</strong>itial problem. 

4. Eighty-n<strong>in</strong>e percent of the parents who 

participated <strong>in</strong> Parent to Parent rated it as 

helpful. 

Type of <strong>in</strong>tervention model: Two-generation programs 

1. Home-visit<strong>in</strong>g programs may be associated 

with changes <strong>in</strong> some parent attitudes, 

though not necessarily their behaviors that 

are related to the prevention of abuse <strong>and</strong> 

neglect. 

2. Home visit<strong>in</strong>g may be beneficial <strong>in</strong> 

decreased child maltreatment, though 

evidence was primarily from self-report 

measures. 

3. Only Nurse Home Visit<strong>in</strong>g Program found 

benefits <strong>in</strong> alter<strong>in</strong>g maternal life course for 

poor unmarried women. Women who had 

been home visited had fewer subsequent 

pregnancies <strong>and</strong> births, deferred their 

second birth, spent fewer months on 

welfare, <strong>and</strong> had fewer problems result<strong>in</strong>g 

from substance abuse <strong>and</strong> arrests than the 


1. Families <strong>in</strong> Early Head Start programs 

measured more positive impacts on 

parent<strong>in</strong>g behaviors, <strong>and</strong> support for 

parents’ emotional well-be<strong>in</strong>g. 

2. The programs led to lower levels of 

<strong>in</strong>sensitivity <strong>and</strong> hostile parent<strong>in</strong>g behavior 

<strong>and</strong> the use of less punitive discipl<strong>in</strong>e 

strategies. 

3. At age 3, there were no overall impacts on 

measures of parent’s health or mental health 

<strong>and</strong> family function<strong>in</strong>g. 

4. Overall, results showed cont<strong>in</strong>ued impacts 

on parent tra<strong>in</strong><strong>in</strong>g <strong>and</strong> education activities 

for families <strong>in</strong> the program compared to 

control group families. 

1. Two-generation programs <strong>in</strong>crease the rate 

of participation for both children <strong>and</strong> 

parents <strong>in</strong> social <strong>and</strong> educational services. 

2. Two-generation programs have positive 

effects on parent<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g time spent 

with child, parent teach<strong>in</strong>g skills, 

expectations for child’s success, attitudes 

about child rear<strong>in</strong>g <strong>and</strong> parent-child 

<strong>in</strong>teractions. 

3. Two-generation programs have large positive 

effects on atta<strong>in</strong><strong>in</strong>g a GED. There are no 

effects on mothers’ depression levels, selfesteem, 

<strong>and</strong> social supports. 

4. There was a positive correlation to the 

amount of participation <strong>and</strong> GED 

atta<strong>in</strong>ment. 

ECO outcomes 


systems 





FQOL Outcomes 



ECO Outcomes 




systems 



programs <strong>and</strong> activities <strong>in</strong> 

their community 

FQOL Outcomes 



● Physical/Material wellbe<strong>in</strong>g 

ECO Outcomes 




systems 





FQOL Outcomes 




● Physical/Material well- 

be<strong>in</strong>g 

ECO Outcomes 







FQOL Outcomes 








Zeece, P. D. & Wang, A. 

(1998) 

Two-generational 

program-Head Start 

<strong>and</strong> the Family 

Empowerment Transition 

Program 

Chan, J. B. & Sigafoos, J. 

(2001) 

Respite care 

Cowen, P. S. & Reed, D. A. 

(2002) 

Respite care 

Herman, S. E. & Marcenko, 

M. O. (1997) 

Respite care 

Only half of the articles <strong>in</strong>cluded <strong>in</strong> this section 

of Table 1 were specific to families who 

have children with disabilities; the rema<strong>in</strong>der 

of the articles focused on “at-risk” children 

1. Over a three-year time span, parentcentered 

risk decreased for the participants 

<strong>in</strong> the Head Start Family Empowerment 

Transition Program. 

2. There were no significant differences 

between the two groups regard<strong>in</strong>g family 

economic risk over time. 

Type of <strong>in</strong>tervention model: Respite care 

1. The use of respite care was associated with 

reduced parental stress, especially for 

mothers, <strong>in</strong> the majority of families who 

have children with developmental 

disabilities. 

1. Reported parental stress scores (parentchild 

relationship) were significantly lower 

follow<strong>in</strong>g respite care <strong>in</strong>terventions. 

2. Follow<strong>in</strong>g respite care <strong>in</strong>tervention, scores 

report<strong>in</strong>g parents’ perception of the child’s 

traits were significantly lower. 

1. Respite care use <strong>in</strong>directly effected parental 

depression. The quality of care <strong>and</strong> the 

perception of time the parent has for 

themselves were mediat<strong>in</strong>g variables. 


ECO Outcomes 

● Families know their 

rights <strong>and</strong> advocate 

effectively for their 

children 




systems 





FQOL Outcomes 




ECO Outcomes 


systems 





FQOL Outcomes 


ECO Outcomes 


systems 





FQOL Outcomes 



ECO Outcomes 


systems 





FQOL Outcomes 


<strong>and</strong> families. Programs aimed at families of 

children with disabilities tended to use measures 

of maternal/parental stress or depression 

<strong>and</strong> family <strong>in</strong>teraction; the programs for

“at risk” children <strong>and</strong> families centered more 

on the acquisition of parent<strong>in</strong>g skills <strong>and</strong> <strong>in</strong>volvement 

with their children. 

Effectiveness of parent tra<strong>in</strong><strong>in</strong>g programs 

was typically measured <strong>in</strong> terms of ga<strong>in</strong>s <strong>in</strong> 

child outcomes, e.g., <strong>in</strong> reductions of behavior 

problems or improved child language <strong>and</strong> literacy 

behaviors or other cognitive ga<strong>in</strong>s. Impacts 

on parents that were measured <strong>in</strong>cluded 

the acquisition of parent<strong>in</strong>g skills, parent<strong>in</strong>g 

stress or depression, <strong>and</strong> parent<strong>in</strong>g satisfaction. 

In the <strong>in</strong>tervention studies that also measured 

parents <strong>in</strong> terms of depression or stress 

levels, parents reported reductions of these 

variables (Kucuker, 2006; Niccols & Mohamed, 

2000; Roberts et al., 2003). Last, a 

meta-analysis by Bakersman-Kranenburg, van 

Ijzendoorn <strong>and</strong> Bradley (2005) revealed that 

(a) middle-class, non-adolescent parents benefited 

more from early childhood <strong>in</strong>terventions 

than adolescent or low <strong>in</strong>come parents, 

(b) limited (between 5–16), home-based sessions 

were more effective than <strong>in</strong>terventions 

with sessions number<strong>in</strong>g more than 16, <strong>and</strong> 

(c) sessions for families with children either 

older than six months or dur<strong>in</strong>g the prenatal 

stage were more effective than dur<strong>in</strong>g the first 

six months of a child’s life. 

Based on the ECO Center family outcome 

def<strong>in</strong>itions, we concluded that <strong>in</strong>terventions 

that improve parent<strong>in</strong>g <strong>and</strong> reduce stress or 

depression are consistent with the ECO family 

outcomes of (a) families underst<strong>and</strong> their 

child’s strengths, abilities <strong>and</strong> special needs, 

(c) families help their children learn <strong>and</strong> 

grow, <strong>and</strong> (d) families have support systems. 

We also concluded that the primary area of 

Beach Center family quality of life doma<strong>in</strong>s 

impacted by these programs was the Parent<strong>in</strong>g 

<strong>and</strong> Emotional Well-Be<strong>in</strong>g sub-scales. 

General Family-Centered Practice Models 

A number of <strong>in</strong>vestigators have reported results 

of evaluations of early <strong>in</strong>tervention programs 

described as “family-centered” services. 

These programs may or may not provide 

service components specifically targeted to 

parents (e.g., parent support groups), but 

<strong>in</strong>vestigators describe the programs as familycentered 

<strong>in</strong> the sense of develop<strong>in</strong>g empower<strong>in</strong>g 

partnerships with families <strong>in</strong> decision- 

mak<strong>in</strong>g <strong>and</strong> deliver<strong>in</strong>g services to children 

with disabilities (i.e., the how of familycentered 

practice). Evaluations of studies <strong>in</strong>cluded 

<strong>in</strong> this review <strong>in</strong>clude both those that 

identified specific supports provided to families 

<strong>and</strong> those that did not describe family 

support but did <strong>in</strong>clude family impact measures 

<strong>in</strong> the evaluation design. 

General family-centered practice models 

described <strong>in</strong> this section <strong>in</strong>cluded home visit<strong>in</strong>g 

or center-based programs that provided a 

component of family support <strong>and</strong> collaboration 

(see Table 1). Families <strong>in</strong> these studies 

may have received a variety of types of family 

support depend<strong>in</strong>g on their <strong>in</strong>dividual needs 

<strong>and</strong> preferences. These <strong>in</strong>cluded counsel<strong>in</strong>g, 

parent<strong>in</strong>g skills, respite care, <strong>and</strong>/or support 

groups. Although the <strong>in</strong>terventions may have 

focused primarily on outcomes for children, 

the evaluation of these programs also <strong>in</strong>vestigated 

the impact on families. The general 

theme from this group of research studies 

<strong>in</strong>dicates that early <strong>in</strong>tervention programs 

that provide general family-centered practices 

that focused on relationships between the parent 

<strong>and</strong> child positively impacted parent-child 

<strong>in</strong>teraction <strong>and</strong> improved family communication 

<strong>and</strong> cohesion (Dunst, Bruder, & Trivette, 

2001; Kim & Mahoney, 2003; Mahoney & Perales, 

2003; Mahoney & Perales, 2005). Additionally, 

the parent’s use of responsive teach<strong>in</strong>g 

methods (Dunst et al.) <strong>and</strong> participation 

<strong>in</strong> support groups improved parental emotional 

well-be<strong>in</strong>g (Erickson-Warfield, Hauser- 

Cram, Krauss, Shonkoff, & Upshur, 2000; Mahoney 

& Bella, 1998). Lastly, the child’s 

participation or enrollment <strong>in</strong> an <strong>in</strong>tervention 

program with different types of family support, 

which <strong>in</strong>cluded parent tra<strong>in</strong><strong>in</strong>g <strong>and</strong> 

counsel<strong>in</strong>g, positively impacted parental wellbe<strong>in</strong>g 

<strong>and</strong> family cohesion (Hendriks, De 

Moor, Oud, & Savelberg, 2000). 

In comparisons of the reported outcomes 

from these studies, we concluded that familycentered 

early <strong>in</strong>tervention programs that 

provided an array of family support achieved a 

number of the ECO outcomes for families. 

These <strong>in</strong>cluded (c) families help their child 

grow <strong>and</strong> learn; (d) families have support systems; 

<strong>and</strong> (e) families have access to desired 

services, programs <strong>and</strong> activities <strong>in</strong> their community. 

With respect to family quality of life 

doma<strong>in</strong>s, we concluded that the outcomes re- 


ported were most relevant to Emotional Wellbe<strong>in</strong>g, 

Parent<strong>in</strong>g, <strong>and</strong> Family Interaction. 

Peer Support 

Peer support offers a way for people <strong>in</strong> similar 

circumstances to offer each other emotional 

<strong>and</strong> <strong>in</strong>formational supports, as well as other 

self-help. For families of young children with 

disabilities or at-risk for disabilities, parents 

may be offered one-to-one peer support or 

parent support groups as a component of the 

overall early <strong>in</strong>tervention program. Support 

groups also may be offered for sibl<strong>in</strong>gs of a 

child with a disability or for other extended 

family members such as gr<strong>and</strong>parents. We 

were unable to f<strong>in</strong>d recent specific research 

focus<strong>in</strong>g exclusively on the impact of support 

groups on families, but there were overall evaluations 

of the general family-centered programs 

which <strong>in</strong>cluded support groups, which 

were discussed above. In this section, we discuss 

two types of peer support models for 

which there is evaluation research available, 

the Parent to Parent model (A<strong>in</strong>b<strong>in</strong>der et al., 

1998; S<strong>in</strong>ger et al., 1999) <strong>and</strong> one-to-one peer 

mentor<strong>in</strong>g programs (Ireys, Sills, Kolodner, & 

Walsh, 1996; Rosenberg, Rob<strong>in</strong>son, & Fryer, 

2002). 

Parent to Parent groups match tra<strong>in</strong>ed parents 

with parents who request assistance (A<strong>in</strong>b<strong>in</strong>der 

et al., 1998; S<strong>in</strong>ger et al., 1999). Parent 

to Parent organizations provide parents with 

connection to resources <strong>and</strong> services <strong>in</strong> their 

community, emotional support, <strong>and</strong> practical 

<strong>in</strong>formation about car<strong>in</strong>g for a child with a 

disability (A<strong>in</strong>b<strong>in</strong>der et al.; S<strong>in</strong>ger et al.). 

S<strong>in</strong>ger et al. evaluated Parent to Parent mentor<strong>in</strong>g 

programs <strong>in</strong> multiple sites across five 

states. As a smaller component of the larger 

study, A<strong>in</strong>b<strong>in</strong>der et al. conducted a qualitative 

evaluation of Parent to Parent programs by 

<strong>in</strong>terview<strong>in</strong>g 24 parents. The majority of the 

families participat<strong>in</strong>g <strong>in</strong> these two studies was 

Caucasian <strong>and</strong> married. The children with disabilities 

ranged <strong>in</strong> ages from one to 16, with 

an average age of seven. The population for 

this group of studies was exp<strong>and</strong>ed to <strong>in</strong>clude 

children beyond the age of eight, as we found 

no peer support <strong>in</strong>tervention studies that focused 

exclusively on the early childhood population. 

The evaluation studies of one-to-one peer 


mentor<strong>in</strong>g programs were similar <strong>in</strong> that mentor<strong>in</strong>g 

services were provided by mothers, 

mothers of children with Juvenile Rheumatoid 

Arthritis (Ireys et al., 1996) or mothers of 

children with special needs (Rosenberg et al., 

2002). The study by Rosenberg et al. evaluated 

home visit<strong>in</strong>g services delivered to families 

considered to be <strong>in</strong> an at-risk situation 

due to environmental or caregiv<strong>in</strong>g factors. 

The services were delivered by tra<strong>in</strong>ed paraprofessionals 

who were all mothers of children 

with special needs <strong>and</strong> were recruited 

from the neighborhoods <strong>in</strong> which they provided 

services. The families received two 

visits per month <strong>and</strong> the visits focused on 

build<strong>in</strong>g family strengths, identify<strong>in</strong>g needs, 

assist<strong>in</strong>g with access<strong>in</strong>g services <strong>and</strong> supports 

with<strong>in</strong> the community, <strong>and</strong> provid<strong>in</strong>g 

a parent mentor to guide maternal care 

<strong>and</strong> home safety issues (Rosenberg et al.). 

The mentor<strong>in</strong>g program evaluated by Ireys 

et al. (1996) focused on enhanc<strong>in</strong>g three 

types of social support—<strong>in</strong>formational, affirmational, 

<strong>and</strong> emotional support. Mothers 

<strong>in</strong> the <strong>in</strong>tervention group were <strong>in</strong> contact 

with their peer mentor every two weeks via 

telephone, through home visits held every 6 

weeks, <strong>and</strong> at group events, such as picnics 

or group lunches (Ireys et al.). 

The multi-site Parent to Parent study reported 

that peer supports had a significant 

impact on attitudes regard<strong>in</strong>g acceptance of 

family <strong>and</strong> disability; however, contacts with 

the organization did not change parents’ perception 

of empowerment (S<strong>in</strong>ger et al., 1999). 

Further, successful matches were cont<strong>in</strong>gent 

upon equality <strong>and</strong> mutuality <strong>in</strong> their Parent to 

Parent relationships (A<strong>in</strong>b<strong>in</strong>der et al., 1998). 

The evaluation of the home visit<strong>in</strong>g model 

us<strong>in</strong>g peers as paraprofessionals reported improvement 

for families <strong>in</strong> care giv<strong>in</strong>g skills, 

home environment, <strong>and</strong> employment status 

(Rosenberg et al., 2002). One-to-one peer 

mentor<strong>in</strong>g also decreased the number of reported 

mental health symptoms mothers experienced 

(Ireys et al., 1996). Additionally, 

families who received support from other parents 

who have children with special needs 

made greater progress <strong>in</strong> gett<strong>in</strong>g help with 

their disability-related problems than parents 

did on their own (Ireys et al.; Rosenberg et al.; 

S<strong>in</strong>ger et al.). Overall, participants rated the

programs with peer support as helpful 

(Rosenberg et al.; S<strong>in</strong>ger et al.). 

In compar<strong>in</strong>g these f<strong>in</strong>d<strong>in</strong>gs to def<strong>in</strong>itions 

of the ECO Center family outcomes, we concluded 

that peer support programs typically 

offer families (a) <strong>in</strong>formation to underst<strong>and</strong> 

their children’s strengths, abilities <strong>and</strong> special 

needs, (d) support systems, <strong>and</strong> (e) <strong>in</strong>formation 

to ga<strong>in</strong> access to desired services, programs, 

<strong>and</strong> activities <strong>in</strong> their community. The 

outcomes reported <strong>in</strong> these peer support 

studies also appear to be relevant to the 

family quality of life doma<strong>in</strong>s of Emotional <strong>and</strong> 

Physical/Material Well-Be<strong>in</strong>g <strong>and</strong> Disability- 

Related Support. 

Two-Generation Programs 

The term “two-generation programs” arises 

from the theory that long-term improvements 

<strong>in</strong> outcomes for children from families with 

multiple challenges requires a comprehensive 

<strong>and</strong> <strong>in</strong>tensive array of services that are focused 

simultaneously on <strong>in</strong>terventions for the child 

<strong>and</strong> on supports for the family as a whole 

(St. Pierre, Layzer, & Barnes, 1995). With respect 

to the family enhancement component 

of two-generation programs, these services 

generally <strong>in</strong>volve the development of an <strong>in</strong>dividualized 

family support plan to help parents 

reach goals <strong>in</strong> education (e.g., complet<strong>in</strong>g a 

GED or learn<strong>in</strong>g English), self-sufficiency, 

mental health (e.g., access<strong>in</strong>g substance abuse 

treatment or shelter from domestic violence), 

<strong>and</strong> health <strong>and</strong> nutrition. A part of the child 

enhancement component of two-generation 

programs also typically <strong>in</strong>cludes parent tra<strong>in</strong><strong>in</strong>g 

<strong>and</strong> <strong>in</strong>formation, us<strong>in</strong>g group <strong>and</strong>/or 

home visit<strong>in</strong>g approaches (Love et al., 2002). 

The desired outcomes of two-generation programs 

are to produce improved cognitive <strong>and</strong> 

developmental function<strong>in</strong>g <strong>in</strong> children, as 

well as <strong>in</strong>crease family function<strong>in</strong>g <strong>and</strong> selfsufficiency 

(Love et al.), thus negat<strong>in</strong>g the 

effects of poverty on families. 

One article <strong>in</strong>cluded <strong>in</strong> Table 1 is a review 

of several two-generation programs, <strong>in</strong>clud<strong>in</strong>g 

Avance, Child Family Resource Program, 

Comprehensive Child Development Program, 

Even Start, Head Start Family Service Centers 

<strong>and</strong> New Chance (St. Pierre et al., 1995). The 

second article is a report of a longitud<strong>in</strong>al 

study of the impacts of Early Head Start on 

children <strong>and</strong> families (Love et al., 2002). Also 

<strong>in</strong>cluded is an evaluation of five national 

home visit<strong>in</strong>g models, <strong>in</strong>clud<strong>in</strong>g Nurse Home 

Visitation Program, Hawaii’s Healthy Start, 

Home Instruction Program for Preschool 

Youngsters, Comprehensive Child Development 

Program, <strong>and</strong> Healthy Families America 

(Gomby, Culross, & Behrman, 1999). F<strong>in</strong>ally, 

Table 1 <strong>in</strong>cludes a review of an article evaluat<strong>in</strong>g 

the effects of Head Start plus a Family 

Empowerment Transition<strong>in</strong>g Program for atrisk 

children <strong>and</strong> their families (Zeece & Wang, 

1998). It is important to note that all of these 

studies <strong>in</strong>cluded populations of at-risk children 

<strong>and</strong> families; none were specifically designed for 

families of children with disabilities. 

There was some controversy over the effects 

of two-generation programs on children s<strong>in</strong>ce 

the effect sizes of the programs reviewed by 

St. Pierre, Layzer, <strong>and</strong> Barnes (1995) were relatively 

small. The Early Head Start study found 

modest effect sizes for child outcomes that were 

susta<strong>in</strong>ed until the age of three years (Love et 

al., 2002). Additionally, the Head Start plus 

Family Empowerment Transition<strong>in</strong>g Program 

decreased parent-centered risk (emotional/ 

social issues) <strong>and</strong> improved child developmental 

outcomes over a three-year period 

(Zeece & Wang, 1998). With respect to impacts 

on families, the results are more consistent: 

These programs appeared to have a positive 

impact on parent<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g parentchild 

<strong>in</strong>teractions <strong>and</strong> reductions <strong>in</strong> negative 

discipl<strong>in</strong>e (Gomby et al., 1999; Love et al.; 

St. Pierre et al.). In addition, two-generation 

programs appeared to have an impact on 

improvements <strong>in</strong> parents’ educational atta<strong>in</strong>ments, 

but did not have significant effect on 

parents’ health or mental health (St. Pierre 

et al.). 

In analyz<strong>in</strong>g the reported family outcomes 

of two-generation programs <strong>in</strong> comparison to 

the ECO Center family outcomes, we conclude 

the results were potentially relevant to 

all five outcomes. However, given the variables 

<strong>in</strong> these studies, it appears that two-generation 

programs most often addressed the ECO outcomes 

of (b) families know their rights <strong>and</strong> 

advocate effectively for their children, (c) families 

help their child learn <strong>and</strong> grow, (d) families 

have support systems, <strong>and</strong> (e) families are able 

to ga<strong>in</strong> access to desired services, programs, 

<strong>and</strong> activities <strong>in</strong> their community. Further, 


comparison of the reported results of these 

studies suggests that two-generation programs 

may address family quality of life doma<strong>in</strong>s of 

Family Interaction, Parent<strong>in</strong>g, Emotional Well- 

Be<strong>in</strong>g <strong>and</strong> Physical/Material Well-Be<strong>in</strong>g of 

families. 

Respite Care 

Respite care services provide temporary child 

care <strong>and</strong> support to families with a child with 

a disability (Cowen & Reed, 2002). The use of 

respite care has been proposed as a way to 

reduce stress <strong>and</strong> depression for parents. In 

2002, respite care was only cited on IFSPs a 

total of 135 times for all Part C programs <strong>in</strong> 

the 50 states, <strong>in</strong>clud<strong>in</strong>g DC <strong>and</strong> Puerto Rico 

(Danaher & Armijo, 2005). 

Table 1 <strong>in</strong>cludes data on three articles that 

evaluated the impact of respite care on families. 

All studies focused on measur<strong>in</strong>g families’ 

emotional well-be<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g stress <strong>and</strong> depression 

levels. Unlike the other <strong>in</strong>tervention 

models <strong>in</strong> this paper, we selected respite care 

studies that <strong>in</strong>cluded families with children 

from ages two through 20, because we could 

f<strong>in</strong>d no evaluations of respite care focused 

specifically for young children with disabilities 

<strong>and</strong> their families. The population of these 

studies tended to be Caucasian, low-to-middle 

class families. 

Themes of results from these three articles 

<strong>in</strong>dicate that utiliz<strong>in</strong>g respite care services reduced 

parental stress (Chan & Sigafoos, 2001; 

Cowen & Reed, 2002). The quality of the child 

care <strong>and</strong> the frequency by which parents’ utilized 

the service affected their level of depression; 

the higher the quality of care, the more 

often the services are used, which was associated 

with lower depression levels (Herman & 

Marcenko, 1997). All of these studies focused 

on short-term <strong>in</strong>terventions (18 months or 

less); more <strong>in</strong>formation is needed on the impact 

of long-term use of respite for families 

(Chan & Sigafoos). 

Based on these reported results, we conclude 

that early <strong>in</strong>tervention programs provid<strong>in</strong>g 

or referr<strong>in</strong>g families to respite care services 

may be relevant to the ECO Center 

family outcomes of: (d) families have support 

systems, <strong>and</strong> (e) families are able to ga<strong>in</strong> access 

to desired services, programs <strong>and</strong> activities 

<strong>in</strong> their community. With respect to family 

quality of life doma<strong>in</strong>s, the reported results 

appear to be relevant to improved Family 

Emotional Well-Be<strong>in</strong>g. 


Limitations 

There are some limitations to this review of 

<strong>in</strong>tervention research for family supports. 

First, there are evaluations of commercial programs 

<strong>and</strong> models that are aimed at improv<strong>in</strong>g 

family outcomes that were excluded from 

our review. We chose to exclude commercially 

available curriculum or materials for early <strong>in</strong>tervention 

s<strong>in</strong>ce all Part C programs would 

not have the opportunity to pursue these programs. 

Also, the majority of the studies were 

aimed at mothers, thus limit<strong>in</strong>g generalizations 

of the f<strong>in</strong>d<strong>in</strong>gs to the entire family unit. 

Research Implications 


There are four research implications to consider 

from the results of this literature review. 

They <strong>in</strong>clude (a) <strong>in</strong>consistent <strong>and</strong> loosely def<strong>in</strong>ed 

term<strong>in</strong>ology <strong>in</strong> <strong>in</strong>tervention research articles, 

(b) lack of family outcomes <strong>and</strong> measures 

tailored to families <strong>in</strong> <strong>in</strong>tervention 

research, (c) limited <strong>in</strong>tervention research 

target<strong>in</strong>g families <strong>and</strong> young children with 

disabilities, <strong>and</strong> (d) few evaluations specifically 

focused on family emotional supports. 

First, the <strong>in</strong>tervention research <strong>in</strong>cluded <strong>in</strong> 

this review measured outcomes for families 

us<strong>in</strong>g many different variables. Those variables 

<strong>in</strong>cluded stress or depression levels, 

health benefits, abuse <strong>and</strong> pregnancy rates, 

home environment, self-esteem, satisfaction, 

attitudes, frustration levels, acceptance, negativity, 

parent<strong>in</strong>g behavior, participation, <strong>in</strong>teraction, 

<strong>in</strong>come <strong>and</strong> employment levels, social 

supports, use of teach<strong>in</strong>g practices, family cohesion, 

perceptions, affective styles, number 

of services received, responsiveness, socialization, 

helpgiv<strong>in</strong>g practices, <strong>and</strong> control. The 

def<strong>in</strong>itions <strong>and</strong> model descriptions to evaluate 

family support <strong>and</strong> outcomes <strong>in</strong> <strong>in</strong>tervention 

literature are not mutually exclusive; therefore, 

it is difficult to parcel out what aspect of 

the support is truly impact<strong>in</strong>g the family. For 

example, <strong>in</strong> this review the category of general 

family-centered practices had a variety of dif-

ferent <strong>in</strong>terventions grouped together which 

made it difficult to del<strong>in</strong>eate the specific support 

that was be<strong>in</strong>g offered to families. Either 

the research or model description was vague 

or the field of early <strong>in</strong>tervention has not 

clearly def<strong>in</strong>ed the term<strong>in</strong>ology or def<strong>in</strong>itions 

related to family support. Therefore, more 

specificity is needed <strong>in</strong> the term<strong>in</strong>ology <strong>and</strong> 

def<strong>in</strong>itions that the field uses to guide research 

on family support <strong>and</strong> outcomes. 

Secondly, the overlap <strong>in</strong> variables measured 

leads to confusion <strong>in</strong> <strong>in</strong>terpret<strong>in</strong>g the outcomes 

for families. In this review, we attempted 

to categorize the results of each study 

accord<strong>in</strong>g to the ECO outcomes <strong>and</strong> Beach 

Center family quality of life doma<strong>in</strong>s as a 

framework for discuss<strong>in</strong>g family support outcomes. 

A framework for the field <strong>in</strong> measur<strong>in</strong>g 

family outcomes, both short-term <strong>and</strong> longterm, 

is needed. To meet this goal, measurements 

with psychometric properties tailored 

to assess families’ outcomes are warranted. 

Further research on family support is needed 

that specifically measures both short-term <strong>and</strong> 

long-term family outcomes. 

The third research implication is the limited 

<strong>in</strong>tervention research target<strong>in</strong>g families 

<strong>and</strong> young children with disabilities. Because 

a primary purpose of this article was to determ<strong>in</strong>e 

how family support is def<strong>in</strong>ed <strong>and</strong> delivered 

<strong>in</strong> early <strong>in</strong>tervention studies, we broadened 

our search beyond programs focused on 

families of children with disabilities <strong>in</strong> order 

to <strong>in</strong>clude more types of family support <strong>in</strong> this 

analysis. This necessity <strong>in</strong> itself underscores 

the lack of emphasis on supports for families 

of children with disabilities. Only 18 of the 26 

articles <strong>in</strong> this paper evaluated <strong>in</strong>terventions 

for this population. There were more <strong>in</strong>tervention 

studies available that sampled general 

early childhood populations, especially <strong>in</strong> regard 

to parent tra<strong>in</strong><strong>in</strong>g programs <strong>and</strong> twogeneration 

programs. In this article, only approximately 

half of the articles <strong>in</strong>cluded <strong>in</strong> the 

parent tra<strong>in</strong><strong>in</strong>g programs category measured 

parent<strong>in</strong>g aspects <strong>in</strong> relation to families with 

children hav<strong>in</strong>g disabilities. None of the studies 

evaluat<strong>in</strong>g two-generation programs sampled 

families <strong>and</strong> children with disabilities. 

The <strong>in</strong>tervention <strong>in</strong> these two areas is promis<strong>in</strong>g; 

however, the research needs to be extended 

to deliberately <strong>in</strong>clude families <strong>and</strong> 

children with disabilities. 

Another research implication from this review 

is the limited number of <strong>in</strong>tervention 

research target<strong>in</strong>g families <strong>and</strong> young children 

with disabilities evaluat<strong>in</strong>g family emotional 

support. One category of <strong>in</strong>tervention 

models, peer support, exam<strong>in</strong>ed the <strong>in</strong>tervention 

research on emotional supports for families. 

Included were studies evaluat<strong>in</strong>g Parent 

to Parent <strong>and</strong> peer mentor<strong>in</strong>g programs. 

There were no studies specifically evaluat<strong>in</strong>g 

support groups as the primary <strong>in</strong>tervention 

for families. Support groups were evaluated as 

part of more comprehensive <strong>in</strong>terventions <strong>in</strong> 

the category of general family-centered services, 

therefore, mak<strong>in</strong>g it difficult to determ<strong>in</strong>e 

the specific impact group supports had 

on families. Family emotional support would 

be an area for further research. 

Policy Implications 

There are two policy implications that have 

evolved from this literature review. They <strong>in</strong>clude 

(a) policy adoption of an established set 

of family outcomes us<strong>in</strong>g specific def<strong>in</strong>itions 

of family support <strong>and</strong> (b) policy adoption of 

evidence-based family support <strong>in</strong> IDEA. 

First, policy must adopt an established set of 

family outcomes us<strong>in</strong>g specific def<strong>in</strong>itions <strong>and</strong> 

term<strong>in</strong>ology for family support. This paper 

has attempted to l<strong>in</strong>k family support <strong>in</strong>tervention 

research with outcomes def<strong>in</strong>ed by the 

ECO Center <strong>and</strong> the Beach Center family 

quality of life doma<strong>in</strong>s. The goals developed 

by the ECO Center reflect short-term outcomes, 

though long-term impacts also need to 

be emphasized. Long-term family outcomes 

are reflected <strong>in</strong> the Beach Center’s family 

quality of life doma<strong>in</strong>s. A challenge to develop<strong>in</strong>g 

an established set of family outcomes <strong>in</strong> 

policy is the overlap or lack of specificity <strong>in</strong> 

term<strong>in</strong>ology <strong>and</strong> def<strong>in</strong>itions of family support. 

As previously recommended <strong>in</strong> this paper, research 

needs to del<strong>in</strong>eate the specific term<strong>in</strong>ology 

for def<strong>in</strong><strong>in</strong>g family support. Once del<strong>in</strong>eated 

through research, the family support 

def<strong>in</strong>itions <strong>and</strong> terms need to be <strong>in</strong>corporated 

<strong>in</strong>to a framework for family outcomes. Further, 

a family outcome framework should be 

adopted <strong>in</strong>to federal policy, such as IDEA Part 

C <strong>and</strong> the DD Act. 

Second, policy must adopt evidence-based 

family support <strong>in</strong> the next reauthorization of 


IDEA. The <strong>in</strong>tervention research evaluat<strong>in</strong>g 

outcomes for families is limited <strong>in</strong> scope to 

only a few types of support outl<strong>in</strong>ed <strong>in</strong> IDEA. 

There is a gap between the types of supports 

stated <strong>in</strong> IDEA <strong>and</strong> evidence-based family support 

reviewed <strong>in</strong> this article. For example, 

IDEA does not require agencies to provide 

families with respite care, though the <strong>in</strong>tervention 

research <strong>in</strong>dicates respite care enhances 

the emotional well-be<strong>in</strong>g of families by 

decreas<strong>in</strong>g parents’ stress <strong>and</strong> depression levels. 

Similar positive outcomes for Parent to 

Parent <strong>and</strong> peer mentor<strong>in</strong>g programs were 

reported. Families reported receiv<strong>in</strong>g emotional 

<strong>and</strong> <strong>in</strong>formational support from peers. 

In know<strong>in</strong>g the positive impacts respite care 

programs <strong>and</strong> peer support have on families, 

it would seem feasible to <strong>in</strong>clude these types of 

family support <strong>in</strong> the available services outl<strong>in</strong>ed 

<strong>in</strong> IDEA under Part C <strong>in</strong> the next reauthorization. 

Policy should m<strong>and</strong>ate the types 

of family support that are empirically validated. 

Summary 

We have reviewed <strong>in</strong>tervention studies that 

evaluated support for families which <strong>in</strong>cluded 

parent tra<strong>in</strong><strong>in</strong>g programs, general family-centered 

practice models offer<strong>in</strong>g comprehensive 

family support, peer support, two-generation 

programs, <strong>and</strong> respite care. The majority of 

studies reviewed did not clearly def<strong>in</strong>e the 

specific support provided to families <strong>and</strong>, 

thus, it is not often clear just what the <strong>in</strong>terventions 

entailed. However, we are able to 

identify impacts on families of this support, 

both those that were specifically def<strong>in</strong>ed (e.g., 

respite care, peer supports) <strong>and</strong> those that 

were broadly comprehensive. Intervention research 

suggests that parent tra<strong>in</strong><strong>in</strong>g programs 

improved parent<strong>in</strong>g skills <strong>and</strong> parent satisfaction 

<strong>and</strong> reduced parental stress (Niccols & 

Mohamed, 2000; Roberts et al., 2003). Additionally, 

general family-centered practice 

models offer<strong>in</strong>g an array of support improved 

overall family cohesion <strong>and</strong> parental emotional 

well-be<strong>in</strong>g (Dunst et al., 2001; Erickson- 

Warfield et al., 2000; Hendriks et al., 2000; 

Mahoney & Bella, 1998). An evaluation of 

peer supports <strong>in</strong>dicated parental attitudes towards 

family <strong>and</strong> disability improved, but not 

parental empowerment (S<strong>in</strong>ger et al., 1999). 

Two-generation programs positively impacted 

parent<strong>in</strong>g (Gomby et al., 1999; Love et al., 

2002) <strong>and</strong> improved parents’ educational atta<strong>in</strong>ments, 

but did not have significant effects 

on parental health or mental health (St. 

Pierre et al., 1995). F<strong>in</strong>ally, respite care has 

short-term effects of reduc<strong>in</strong>g parental stress 

(Chan & Sigafoos, 2001; Cowen & Reed, 

2002). The <strong>in</strong>tervention research reviewed <strong>in</strong> 

this article, overall, reported positive outcomes 

for families. Most often, the evaluations 

focused on child outcomes <strong>and</strong> family impacts 

were <strong>in</strong>cidental <strong>in</strong> the report<strong>in</strong>g of the f<strong>in</strong>d<strong>in</strong>gs 

of the study. The outcomes for families 

could be characterized by the family quality of 

life doma<strong>in</strong>s of family <strong>in</strong>teraction, parent<strong>in</strong>g, 

emotional <strong>and</strong> physical/material well-be<strong>in</strong>g, 

<strong>and</strong> disability-related supports, as well as by 

the categories of family outcomes def<strong>in</strong>ed by 

the ECO Center. In review<strong>in</strong>g the <strong>in</strong>tervention 

research, it is apparent that the implication 

for the early <strong>in</strong>tervention field is to adopt 

consistent term<strong>in</strong>ology def<strong>in</strong><strong>in</strong>g family support. 

Research on family support is also needed 

that specifically l<strong>in</strong>ks to family outcomes, thus 

guid<strong>in</strong>g future policy decisions for families <strong>and</strong> 

young children with disabilities. 

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Received: 23 April 2008 

Initial Acceptance: 25 June 2008 



Differences Between Employees’ <strong>and</strong> Supervisors’ Evaluations 

of Work Performance <strong>and</strong> Support Needs 

Kyle Bennett, Michael Fra<strong>in</strong>, <strong>and</strong> 

Michael P. Brady 

Florida Atlantic University 

Tricia Sur<strong>in</strong>ak 

Broward County Public Schools 

Howard Rosenberg 

Florida International University 

Abstract: Assessment systems are needed that are sensitive to employees’ work performance as well as their need 

for support, while <strong>in</strong>corporat<strong>in</strong>g the <strong>in</strong>put from both employees <strong>and</strong> their supervisors. This study exam<strong>in</strong>ed the 

correspondence of one such evaluation system, the Job Observation <strong>and</strong> Behavior Scale (JOBS) <strong>and</strong> the JOBS: 

Opportunity for Self-Determ<strong>in</strong>ation (JOBS: OSD), to establish whether performance <strong>and</strong> support evaluations 

adm<strong>in</strong>istered by work supervisors would match self-determ<strong>in</strong>ed perceptions of the same variables by sheltered <strong>and</strong> 

supported employees with disabilities. Results showed that JOBS rat<strong>in</strong>gs established by supervisors did not 

correspond closely to employees’ self-determ<strong>in</strong>ed rat<strong>in</strong>gs for any of the JOBS’ subscales (Work-Required Daily 

Liv<strong>in</strong>g Activities, Work-Required Behavior, <strong>and</strong> Work-Required Job Duties). Results also showed that employees 

consistently overestimated their work performance <strong>and</strong> underestimated their support needs relative to supervisors’ 

rat<strong>in</strong>gs. These results suggest that major discrepancies exist between supervisors’ <strong>and</strong> employees’ perceptions of 

their work performance <strong>and</strong> support needs. These discrepancies may be important as job coaches, teachers, 

rehabilitation professionals, <strong>and</strong> employees <strong>and</strong> students with disabilities participate <strong>in</strong> employment preparation 

<strong>and</strong> transition plann<strong>in</strong>g. 

For most adults, employment is <strong>in</strong>tricately tied 

to culture <strong>and</strong> social values, <strong>and</strong> is central to 

the roles adults hold <strong>in</strong> their communities <strong>and</strong> 

with<strong>in</strong> their families. Because most people 

spend the majority of each day work<strong>in</strong>g, work 

is significant <strong>in</strong> how adults def<strong>in</strong>e themselves 

(Abrams, DonAroma, & Karan, 1997; Grossi, 

Schaaf, Steigerwald, & Mank, 2002; Kolstoe, 

1961). For most adults, employment has personal 

benefits <strong>in</strong>clud<strong>in</strong>g self-confidence, direction, 

<strong>and</strong> <strong>in</strong>creased life satisfaction (Griff<strong>in</strong>, 

Rosenberg, Cheyney, & Greenberg, 1996; 

Sk<strong>in</strong>ner, 2003). Economic benefits <strong>in</strong>clude 

the opportunity to shape one’s own f<strong>in</strong>ancial 

<strong>in</strong>dependence <strong>and</strong> to decrease reliance on 

families <strong>and</strong> others for economic support (Anthony, 

1994; Kim & Morn<strong>in</strong>gstar, 2005; Reisman 

& Reisman, 1993). Work also provides 


be addressed to Kyle Bennett, Florida Atlantic University, 

Department of Exceptional Student <strong>Education</strong>, 

777 Glades Road, Boca Raton, Florida 33431. 



social benefits <strong>in</strong>clud<strong>in</strong>g the opportunity to 

establish mean<strong>in</strong>gful relationships <strong>and</strong> the opportunity 

to contribute to one’s community 

(Mancuso, 1990; Storey, 2002). 

Unfortunately, the benefits of work have yet 

to reach many <strong>in</strong>dividuals with disabilities, 

<strong>and</strong> community employment cont<strong>in</strong>ues to be 

an elusive goal (Brady & Rosenberg, 2002a). 

For example, nearly 2/3 of adults with disabilities 

rema<strong>in</strong> unemployed or under-employed, 

or only have access to employment <strong>in</strong> sheltered 

workshops (Levy, Jessop, Rimmerman, 

Francis, & Levy, 1993; Murphy, Rogan, H<strong>and</strong>ley, 

K<strong>in</strong>caid, & Royce-Davis, 2002). Access to 

community employment is particularly troublesome 

for <strong>in</strong>dividuals with more complex 

disabilities <strong>and</strong> behavior challenges (Hurlbutt 

& Chalmers, 2004; Mank, Cioffi, & Yovanoff, 

1998; McDermott, Mart<strong>in</strong>, & Butkus, 1999; 

Muller, Schuler, Burton, & Yates, 2003). 

For community employment to be a successful 

outcome, many <strong>in</strong>dividuals with disabilities 

require explicit <strong>and</strong> purposeful employment 

Evaluations of Work Performance <strong>and</strong> Support Needs / 471

<strong>and</strong> transition plann<strong>in</strong>g. This <strong>in</strong>cludes active 

<strong>in</strong>terventions to improve work performance 

(such as job coach<strong>in</strong>g) <strong>and</strong> attention to the 

design <strong>and</strong> delivery of work supports (Brady & 

Rosenberg, 2002a; Mancuso, 1990; Stodden, 

1998; Targett, Wehman, McK<strong>in</strong>ley, & Young, 

2004). In addition, employment evaluations 

need to be sensitive to these two separate, but 

<strong>in</strong>ter-related dimensions. To date, evaluations 

of supported <strong>and</strong> sheltered employees have 

seldom been l<strong>in</strong>ked directly both to demonstrated 

work performance <strong>and</strong> employment support 

needs (Brady, Rosenberg, & Fra<strong>in</strong>, 2008). 

As important as it is to evaluate both of 

these employment dimensions (performance 

<strong>and</strong> support needs), it is equally important 

that employment evaluations <strong>in</strong>clude the perceptions 

of both employers <strong>and</strong> the employees 

themselves. In most community employment 

sett<strong>in</strong>gs, work supervisors are most responsible 

for these evaluations; employment factors 

such as promotions, raises, <strong>and</strong> retention rely 

heavily on the perceptions of performance by 

supervisors (Graffam, Sh<strong>in</strong>kfield, Smith, Polz<strong>in</strong>, 

2002; Hamilton & Shumate, 2005; Krantz, 

1971). However, for <strong>in</strong>dividuals with disabilities 

<strong>and</strong> other employment challenges, ga<strong>in</strong><strong>in</strong>g 

<strong>in</strong>put from employees directly is critical 

when mak<strong>in</strong>g employment decisions (Brady et 

al., 2008; Lynn, Sumsion, McWilliam, & Mac- 

K<strong>in</strong>non, 2004; Wehman, 2006), particularly 

when plann<strong>in</strong>g <strong>in</strong>terventions to promote job 

skills or develop<strong>in</strong>g employment <strong>and</strong> transition 

plans (Mart<strong>in</strong> & Huber Marshall, 1996; 

Menchetti & Garcia, 2003; Olney & Salomone, 

1992; Rogan, Banks & Howard, 2000). Unfortunately, 

few employment evaluations <strong>in</strong>clude 

self-determ<strong>in</strong>ation when establish<strong>in</strong>g <strong>in</strong>structional 

or support goals <strong>and</strong> transition plans 

for community employment (Thoma, Williams, 

& Davis, 2005; Wehmeyer & Schwartz, 

1997). Fewer still <strong>in</strong>clude both employer <strong>and</strong> 

employee perceptions of work performance 

<strong>and</strong> support needs (Shaw, McMahon, Chan, & 

Hannold, 2004; Valenzuela & Mart<strong>in</strong>, 2005). 

If employment evaluations are go<strong>in</strong>g to be 

helpful <strong>in</strong> develop<strong>in</strong>g employment <strong>and</strong> transition 

plans for <strong>in</strong>dividuals with disabilities, 

then assessment <strong>in</strong>formation is needed along 

all four of these dimensions. First, it is important 

to establish whether or not an employee’s 

work productivity matches the productivity of 

other employees without disabilities. This per- 


formance dimension is typically the focus of 

employer <strong>and</strong> supervisor evaluations (Hamilton 

& Shumate, 2005; Morgan & Alex<strong>and</strong>er, 

2005). Second, for an employment evaluation 

to be useful <strong>in</strong> a supported employment context, 

it needs to <strong>in</strong>corporate <strong>in</strong>put on the type 

<strong>and</strong> level of support an employee uses to establish 

that level of performance (Rogan et 

al., 2000; Targett et al., 2004). Third, s<strong>in</strong>ce 

employers are responsible for the cont<strong>in</strong>ued 

operation of the bus<strong>in</strong>ess or enterprise, the 

evaluation necessarily <strong>in</strong>cludes the employer’s 

perception of an employee’s performance 

<strong>and</strong> support needs (Graffam et al., 2002). F<strong>in</strong>ally, 

if transition <strong>and</strong> employment plans are 

to be developmental <strong>in</strong> nature – that is, the 

plans are to promote growth <strong>and</strong> opportunity 

<strong>in</strong> employees with disabilities – then evaluations 

must <strong>in</strong>clude employees’ own self-determ<strong>in</strong>ed 

perspectives of their performance <strong>and</strong> 

support needs (Brady et al., 2008). 

An evaluation model that <strong>in</strong>corporates 

these four employment dimensions will provide 

important <strong>in</strong>formation when develop<strong>in</strong>g 

transition <strong>and</strong> employment plans, <strong>and</strong> select<strong>in</strong>g 

potential job roles, work placements, performance 

<strong>in</strong>terventions, <strong>and</strong> support. The 

evaluation data could establish, for example, 

that a supported employee’s work performance 

is not sufficient to ma<strong>in</strong>ta<strong>in</strong> cont<strong>in</strong>ued 

employment, <strong>and</strong> that some type of employment 

support (e.g., adapt<strong>in</strong>g materials or rout<strong>in</strong>es; 

restructur<strong>in</strong>g a complex job <strong>in</strong>to several 

s<strong>in</strong>gle tasks) is necessary to improve that performance. 

Numerous models of supported 

<strong>and</strong> sheltered employment exist that use evaluation 

data to make employment decisions 

such as this (Brady & Rosenberg, 2002a; Nisbet 

& Callahan, 1987; Olney & Salomone, 

1992; Wehman, 1996). However, few models 

of assessment exist which <strong>in</strong>corporate both 

employee <strong>and</strong> employer perceptions of performance 

<strong>and</strong> support, <strong>and</strong> the extent to 

which these different perceptions correspond 

is relatively unknown. 

The purpose of the study was to <strong>in</strong>vestigate 

the correspondence between employees’ <strong>and</strong> 

supervisors’ evaluations of work performance 

<strong>and</strong> support needs of people with disabilities 

<strong>in</strong> supported <strong>and</strong> sheltered employment. In 

areas where there was a lack of correspondence, 

we sought to establish the direction of 

any differences (over-estimations or under-

estimations) of the two groups, <strong>and</strong> whether 

there were differences across the dimensions 

of performance vs. support. 

Method 

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

N<strong>in</strong>eteen employees with developmental disabilities 

(11 males <strong>and</strong> 8 females) participated 

<strong>in</strong> this study. Fifteen of the participants were 

diagnosed with a cognitive impairment, <strong>and</strong> 

four were diagnosed with an autism spectrum 

disorder. All participated <strong>in</strong> supported (n 

14) or sheltered (n 5) employment programs. 

The employees ranged <strong>in</strong> age from 20 

years <strong>and</strong> 11 months to 54 years <strong>and</strong> 3 months 

(M 36 years, 4 months). All <strong>in</strong>dividuals who 

gave consent participated <strong>in</strong> this study, <strong>and</strong> no 

compensation was provided for participation. 

All employees worked on a part-time basis, 

rang<strong>in</strong>g from 6 hours to 30 hours per week on 

the job. Job tasks for the five sheltered employees 

<strong>in</strong>cluded sort<strong>in</strong>g, collat<strong>in</strong>g, <strong>and</strong> prepar<strong>in</strong>g 

mail<strong>in</strong>gs for local bus<strong>in</strong>esses; job tasks 

for the 14 supported employees <strong>in</strong>cluded 

child <strong>and</strong> animal care, custodial <strong>and</strong> kitchen 

duties, bagg<strong>in</strong>g groceries, <strong>and</strong> work<strong>in</strong>g as a 

cashier <strong>and</strong> office assistant. At the time of this 

study, employees had been <strong>in</strong> their job roles 

from 5 months to 9 years (M 4 years, 1 

month). 

Dependent Measures 

The Job Observation <strong>and</strong> Behavior Scale (JOBS) 

(Rosenberg & Brady, 2000) was used to gather 

supervisors’ evaluations of the employees; 

the Job Observation <strong>and</strong> Behavior Scale: Opportunity 

for Self-Determ<strong>in</strong>ation (JOBS: OSD) (Brady, 

Rosenberg, & Fra<strong>in</strong>, 2006) was used to gather 

employees’ self-rat<strong>in</strong>gs. The two <strong>in</strong>struments 

comprise a system of evaluation <strong>in</strong> which both 

external evaluators’ (supervisors, job coaches, 

teachers) rat<strong>in</strong>gs <strong>and</strong> employees’ own self-determ<strong>in</strong>ed 

rat<strong>in</strong>gs are used for employment 

<strong>and</strong> tra<strong>in</strong><strong>in</strong>g decisions. Both <strong>in</strong>struments target 

critical vocational behaviors <strong>and</strong> support 

needs of people <strong>in</strong> community employment 

sett<strong>in</strong>gs. The evaluation assists employment 

professionals to evaluate an <strong>in</strong>dividual’s work 

performance <strong>and</strong> support needs, then to compare 

these results to the norms for other peo- 

ple who perform similar jobs <strong>in</strong> sheltered or 

supported employment. Validity, reliability, 

<strong>and</strong> st<strong>and</strong>ardization data are available for 

three groups: secondary students with disabilities, 

adults <strong>in</strong> supported <strong>and</strong> sheltered work 

sett<strong>in</strong>gs, <strong>and</strong> adults <strong>in</strong> entry level community 

jobs (Brady & Rosenberg, 2002b; Brady et al., 

2008). Both JOBS <strong>and</strong> JOBS: OSD conta<strong>in</strong> the 

same 30 items organized <strong>in</strong>to three subscales 

titled Work-Required Daily Liv<strong>in</strong>g Activities, 

Work-Required Behavior, <strong>and</strong> Work-Required 

Job Duties. The three subscales <strong>and</strong> a summary 

of items are found <strong>in</strong> Table 1. 

Although the scales <strong>and</strong> items are identical 

on both <strong>in</strong>struments, there are alternate 

phras<strong>in</strong>gs for the JOBS: OSD items for <strong>in</strong>stances 

when an employee has difficulty determ<strong>in</strong><strong>in</strong>g 

what is be<strong>in</strong>g asked. In addition, scor<strong>in</strong>g 

protocols differ slightly for the JOBS <strong>and</strong> 

the JOBS: OSD. For each item on the JOBS, the 

supervisor rates each employee on the Quality 

of Performance, Type of Support needed, <strong>and</strong> 

whether any Adaptive or Prosthetic Materials are 

needed. Quality of Job Performance is rated 

with a 5-po<strong>in</strong>t Likert-type scale with 5 <strong>in</strong>dicat<strong>in</strong>g 

superior performance, 4 <strong>in</strong>dicat<strong>in</strong>g above 

average performance, 3 <strong>in</strong>dicat<strong>in</strong>g average 

performance, 2 <strong>in</strong>dicat<strong>in</strong>g below average performance, 

<strong>and</strong> 1 <strong>in</strong>dicat<strong>in</strong>g performance 

which is not acceptable for competitive employment. 

The Type of Support is also rated 

on a 5-po<strong>in</strong>t scale with a rat<strong>in</strong>g of 5 mean<strong>in</strong>g 

that no unique supervision or support is 

needed beyond that provided to other workers. 

A rat<strong>in</strong>g of 4 <strong>in</strong>dicates that <strong>in</strong>termittent 

supervision is needed from a co-worker <strong>and</strong> a 

rat<strong>in</strong>g of 3 <strong>in</strong>dicates that <strong>in</strong>termittent supervision 

is needed from the job coach or supervisor. 

Rat<strong>in</strong>gs of 2 <strong>and</strong> 1 respectively <strong>in</strong>dicate 

that supervision from the job coach or supervisor 

is needed either frequently or cont<strong>in</strong>uously. 

Because JOBS: OSD requires a self-assessment 

from <strong>in</strong>dividuals with a wide range of 

cognitive <strong>and</strong> communication abilities, several 

alterations exist for the scor<strong>in</strong>g. First, each 

JOBS: OSD item is modified <strong>in</strong>to a self-determ<strong>in</strong>ation 

question format so that the <strong>in</strong>formation 

can be obta<strong>in</strong>ed through a st<strong>and</strong>ardized <strong>in</strong>terview. 

This response format requires that data 

be obta<strong>in</strong>ed from <strong>in</strong>dividual employees (an 

<strong>in</strong>ternal source of <strong>in</strong>formation) rather than 

from work supervisors, job coaches, or reha- 


TABLE 1 

Summary of JOBS <strong>and</strong> JOBS: OSD Items <strong>and</strong> Subscales 

bilitation counselors (an external evaluation 

source). Second, the scor<strong>in</strong>g protocol is simplified 

to a 3-po<strong>in</strong>t scale. For Quality of Performance 

rat<strong>in</strong>gs, respondents report (a) 

“Yes”, (b) “Sometimes”, or (c) “No, not really” 

to the <strong>in</strong>terviewer’s query about how well the 

<strong>in</strong>dividual performs each item. For Type of 

Support rat<strong>in</strong>gs an <strong>in</strong>terviewer asks respondents 

to select one of three options to <strong>in</strong>dicate 

their need for support: 

“Can you do it by yourself?” 

“Can you do it with some help?” 

“Do you need a lot of help?” 

Procedure 

Subscale Number of items Item examples 

Work-Required Daily Liv<strong>in</strong>g 13 Attendance; Punctuality; Personal Hygiene; Travel; 

Communication; Money; Read<strong>in</strong>g; Math; Self 

Identification; Work & Personal Schedul<strong>in</strong>g; 

Work Facilities; Motivation 

Work-Required Behavior 8 Stress Tolerance; Interpersonal Work & Social 

Interactions; Changes <strong>in</strong> Rout<strong>in</strong>es; Honesty; 

Reaction to Criticism; Work Initiative & 

Endurance 

Work-Required Job Duties 9 Quality & Quantity of Work; Speed of Learn<strong>in</strong>g 

New Tasks; Performance on Previously Learned 

& Multiple Tasks; Organization of Work Tasks; 

Safety; Cleanl<strong>in</strong>ess of Work Environment 

For each employee, a work supervisor or job 

coach (hereafter referred to as supervisor) 

completed a JOBS record<strong>in</strong>g <strong>and</strong> scor<strong>in</strong>g 

form. Each of the supervisors had worked directly 

with the employees previously, <strong>and</strong> had 

the knowledge necessary to complete the 

form. After the supervisors scored the <strong>in</strong>dividuals, 

the forms were returned to the <strong>in</strong>vestigators 

for data entry <strong>and</strong> analysis. The <strong>in</strong>vestigators 

tallied the total of po<strong>in</strong>ts scored for each 

of the three subscales (Work-Required Daily 

Liv<strong>in</strong>g Activities, Work-Required Behavior, 

<strong>and</strong> Work-Required Job Duties) for Quality of 

Performance <strong>and</strong> Type of Support. 

Next, each employee was <strong>in</strong>terviewed by 

one of the authors to obta<strong>in</strong> the JOBS: OSD 

rat<strong>in</strong>gs. Interviews were conducted <strong>in</strong> a private 

area at the employees’ worksites. Supervisors 

were not present dur<strong>in</strong>g the <strong>in</strong>terviews. Employees 

were <strong>in</strong>formed of the answer choices 

prior to the <strong>in</strong>terview <strong>and</strong> items <strong>and</strong> answer 

choices were restated as needed. To adm<strong>in</strong>ister 

the JOBS: OSD, the <strong>in</strong>terviewer read each 

item to the employee. The alternate phras<strong>in</strong>g 

provided <strong>in</strong> the evaluation protocol was provided 

if an employee needed clarification on 

the <strong>in</strong>itial word<strong>in</strong>g of the item. The <strong>in</strong>vestigators 

then totaled the scores for each of the 

three subscales for Quality of Performance 

<strong>and</strong> Type of Support. 

Data Analysis 


Data were h<strong>and</strong> scored by the lead author <strong>and</strong> 

then analyzed us<strong>in</strong>g SPSS 15.0. The means 

<strong>and</strong> st<strong>and</strong>ard deviations were computed for 

each of the subscales <strong>and</strong> for the overall scores 

for both JOBS <strong>and</strong> JOBS: OSD. Next, Pearson 

product-moment correlation coefficients were 

computed between the supervisors’ <strong>and</strong> employees’ 

rat<strong>in</strong>gs for each subscale, as well as 

for the overall scores, to determ<strong>in</strong>e the degree 

of correspondence between the groups. A related 

samples t-test was used to study any difference 

between employees’ <strong>and</strong> supervisors’ 

perceptions on employees’ Quality of Performance 

<strong>and</strong> Types of Support needs for each 

subscale for both JOBS <strong>and</strong> JOBS: OSD (Work- 

Required Daily Liv<strong>in</strong>g Activities, Work-Required 

Behavior, <strong>and</strong> Work-Required Job Duties). 

Prior to this analysis; however, scores 

were transformed to a st<strong>and</strong>ard score on a

TABLE 2 

St<strong>and</strong>ardized Means, St<strong>and</strong>ard Deviations, <strong>and</strong> Correlations for Subscale <strong>and</strong> Overall Scores N 19 for 

Each Scale 

JOBS 

Construct 

l<strong>in</strong>ear scale from 0-100, with 0 be<strong>in</strong>g the lowest 

score <strong>and</strong> 100 be<strong>in</strong>g the best possible score. 

The formula for this transformation followed 

Holmes <strong>and</strong> Shea’s (1998) transformation formula: 

Transformed St<strong>and</strong>ard Score (100 [Total 

Possible Score # of Items on Scale]) 

[Actual Score # of Items on Scale]. 

For example, the raw Quality of Performance 

score for Daily Liv<strong>in</strong>g Activities for each employee 

was converted to a transformed st<strong>and</strong>ard 

score on a l<strong>in</strong>ear scale as follows: 

Transformed St<strong>and</strong>ard Score for Quality of 

Performance for Daily Liv<strong>in</strong>g Activities 

(100 [65 13]) [Actual Participant 

Score 13]. 

Us<strong>in</strong>g this formula, each employee’s JOBS <strong>and</strong> 

JOBS: OSD raw scores were transformed to a 

st<strong>and</strong>ardized score so that their rat<strong>in</strong>gs could 

be compared. 

Results 

Supervisor Employee 

Mean SD Mean SD 

N<strong>in</strong>eteen pairs of surveys were completed for 

a total of 38 surveys (19 JOBS; 19JOBS: OSD). 

Means <strong>and</strong> st<strong>and</strong>ard deviations for each of the 

three subscales, <strong>and</strong> for overall scores for each 

Supervisor & 

employee correlation 

Work-Required Daily Liv<strong>in</strong>g Activities subscale 

QOP 76.5 15.9 83.0 12.0 .13 

TOS 80.1 16.1 74.5 18.8 .10 

Work-Required Behavior subscale 

QOP 68.7 19.8 87.5 12.0 .08 

TOS 70.5 18.5 80.9 15.4 .00 

Work-Required Job Duties subscale 

QOP 72.0 16.9 79.5 17.2 .19 

TOS 71.5 17.1 74.0 10.3 .15 

Total scores 

QOP 73.3 14.7 82.2 7.3 .09 

TOS 75.4 14.5 75.6 13.5 .12 

QOP Quality of Performance 

TOS Type of Support 

of the <strong>in</strong>struments are provided <strong>in</strong> Table 2. 

The means <strong>and</strong> st<strong>and</strong>ard deviations for this 

sample were similar to the normative sample 

for both JOBS <strong>and</strong> JOBS: OSD (Brady et al., 

2006; Rosenberg & Brady, 2000). For <strong>in</strong>stance, 

the raw scores for <strong>in</strong>dividuals on the JOBS:OSD 

Work Related Activities of Daily Liv<strong>in</strong>g QOP 

scale <strong>in</strong> our sample was 34.6 (3.1); very similar 

to the normative sample of Brady et al. which 

found raw scores of 34.3 (4.1). (For more 

<strong>in</strong>formation on normative samples please refer 

to Brady & Rosenberg, 2002b, <strong>and</strong> Brady et 

al., 2008). 

Also seen <strong>in</strong> Table 2 are the Pearson product-moment 

correlation coefficients between 

the two groups for each subscale. These coefficients 

<strong>in</strong>dicated generally low correlations, 

<strong>and</strong> <strong>in</strong> three <strong>in</strong>stances (Quality of Performance 

rat<strong>in</strong>gs for both Daily Liv<strong>in</strong>g Activities 

<strong>and</strong> Work-Required Behavior, <strong>and</strong> Type of 

Support scores for Work-Required Behavior) 

showed a reverse correlation. That is, as employees’ 

scores improved on JOBS: OSD, the 

supervisors’ scores for these employees decreased 

on JOBS. This trend was also seen <strong>in</strong> 

overall scores for both scales. The subscale 

correlations ranged from .13 to .19 Correlation 

coefficients for the overall scores were 

.09 for Quality of Performance <strong>and</strong> .12 for 


TABLE 3 

Related Sample t-test Analysis Summary (N 38) 

Measures 

Mean difference 

Supervisor-employee 

Type of Support. These f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong>dicate that 

there was generally a very small correlation 

between the supervisors’ scores <strong>and</strong> the employees’ 

scores of themselves. None of the 

correlations were statistically significant (p 

.05). 

Results of the related samples t-test compar<strong>in</strong>g 

employees’ <strong>and</strong> supervisors’ perceptions 

of the employees’ rat<strong>in</strong>gs of their Quality of 

Performance <strong>and</strong> Type of Support needs for 

the three subscales are <strong>in</strong>cluded <strong>in</strong> Table 3. 

This table shows that significant differences 

exist between employees’ <strong>and</strong> supervisors’ rat<strong>in</strong>gs 

<strong>in</strong> the employees’ overall Quality of Performance 

scores, as well as on the Work-Required 

Behavior subscale. 

Given the small sample size <strong>in</strong> this study, the 

statistical power necessary to f<strong>in</strong>d a significant 

difference between the two sets of rat<strong>in</strong>gs was 

low; the power to f<strong>in</strong>d statistical significance at 

the .05 level, if it existed at a medium effect 

size was .69. Therefore, an alternate way of 

look<strong>in</strong>g at the results was also pursued. This 

<strong>in</strong>volved establish<strong>in</strong>g the effect sizes for the 

differences. Effect sizes present the differences 

between scores <strong>in</strong> st<strong>and</strong>ard deviation 

terms [where the Difference (Mean of Supervisors’ 

Scores – Mean of Employees’ 

Scores/St<strong>and</strong>ard Deviation)]. This allowed 

for more practical significance to be exam<strong>in</strong>ed. 

In social science research, Cohen (1988) 

95% confidence <strong>in</strong>terval 

Upper Lower t sig ES 

Quality of Performance 

Total Score 8.8 1.2 16.5 2.3 .02 .75 

DLA 6.4 2.7 15.6 1.4 .16 .46 

BEH 18.7 8.0 29.5 3.5 .001 1.18 

JD 2.5 1.7 16.9 .5 .66 .55 

Type of Support 

Total Score .2 9.0 9.4 .04 .97 .01 

DLA 5.6 17.1 5.9 .98 .33 .32 

BEH 10.4 .81 21.6 1.8 .07 .62 

JD 7.6 1.7 16.8 1.7 .11 .14 

DLA Work-Required Daily Liv<strong>in</strong>g Activities 

BEH Work-Required Behavior 

JD Work-Required Job Duties 


<strong>in</strong>dicated that the practical significance of the 

size of an effect should be compared to the 

follow<strong>in</strong>g st<strong>and</strong>ards: (a) for a large effect, d 

.80; (b) for a medium effect, d .50; <strong>and</strong> 

(c) for a small effect, d .20. In this study, 

effect sizes show that employees rated themselves 

higher <strong>in</strong> every scale, but one, when 

compared to their supervisors. Effect sizes 

ranged from a low of .14 (small effect) for the 

Type of Support for Work-Required Job Duties 

to a large effect size of 1.18 for the Quality 

of Performance Work-Required Behavior subscale. 

In all, five of the eight paired samples 

had effect sizes that would be considered a 

medium to large effect; this <strong>in</strong>cluded Quality 

of Performance for Work-Required Daily Liv<strong>in</strong>g 

Activities, Work-Required Behavior, Work- 

Required Job Duties subscales; the Total Quality 

of Performance rat<strong>in</strong>g; <strong>and</strong> the Type of 

Support rat<strong>in</strong>g for the Work-Required Behavior 

subscale. Two rat<strong>in</strong>gs fell <strong>in</strong> the small effect 

size range, <strong>in</strong>clud<strong>in</strong>g the Type of Support 

rat<strong>in</strong>g for the work required Job Duties, <strong>and</strong> 

the Type of Support rat<strong>in</strong>g for the Work-Required 

Daily Liv<strong>in</strong>g Activities subscale (.14 <strong>and</strong> 

.32, respectively). These f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong>dicate that 

supervisors’ rat<strong>in</strong>gs were approximately half 

of a st<strong>and</strong>ard deviation below employees’ selfdeterm<strong>in</strong>ed 

rat<strong>in</strong>gs. Only the Type of Support 

overall rat<strong>in</strong>gs failed to show an effect. It is 

important to note that all comparisons <strong>in</strong>di-

cate effect size differences <strong>in</strong> the direction 

<strong>in</strong>dicat<strong>in</strong>g that supervisors were always significantly 

lower <strong>in</strong> their perceptions than employees, 

with one exception. The Type of Support 

rat<strong>in</strong>g for the Work-Required Daily Liv<strong>in</strong>g Activities 

subscale was the only one <strong>in</strong> which 

employers scored higher than employees. 


Overall, these results <strong>in</strong>dicate that employees 

<strong>and</strong> their supervisors have a very different 

op<strong>in</strong>ion concern<strong>in</strong>g the quality of work accomplished 

by employees with disabilities. 

S<strong>in</strong>ce the number of comparison pairs was 

relatively small <strong>in</strong> this <strong>in</strong>itial study, significance 

levels are better addressed by effect 

sizes than statistical significance test<strong>in</strong>g. In this 

case, most of the pair comparisons for the six 

subscales <strong>and</strong> two overall scores showed important 

differences between how supervisors 

rated employees <strong>and</strong> how employees rated 

themselves <strong>in</strong> terms of Quality of Performance. 

There is a similar disconnect on the 

Type of Support that is needed by employees 

to do their jobs, also demonstrated by the 

effect sizes. It may be that employees are overconfident 

of their abilities, or employers 

might focus more on aspects of the job with 

which they are not satisfied. It also may be that 

employees with disabilities are unaware of 

how their work performance is judged by employers. 

Alternatively, it is possible that many 

<strong>in</strong>dividuals with disabilities have <strong>in</strong>herent difficulty 

with skills associated with self-determ<strong>in</strong>ation 

(such as self-assessment) <strong>and</strong> may not 

be proficient <strong>in</strong> evaluat<strong>in</strong>g their strengths <strong>and</strong> 

needs accurately. In one study that supports 

this notion, Wehmeyer <strong>and</strong> Schwartz (1998) 

reported that educational plans rarely targeted 

self-determ<strong>in</strong>ation skills for secondary 

students with cognitive impairments, <strong>and</strong> recommended 

that these skills be given priority 

for development. In the current study, it is 

important to note that the results (both the 

large effect sizes <strong>and</strong> the low correlations) 

show that employers rated the quality of performance 

differently <strong>and</strong> lower <strong>in</strong> most every 

category compared to employees. 

Overall <strong>and</strong> subscale scores <strong>in</strong> this study 

were very similar to the normed sample for 

JOBS: OSD on all of the Quality of Performance, 

<strong>and</strong> Type of Support measures. This 

<strong>in</strong>dicates that <strong>in</strong> terms of work performance, 

the employees <strong>in</strong> this study were similar (all 

scores well with<strong>in</strong> one st<strong>and</strong>ard deviation of 

the normative group) to the sample on which 

this measure was normed. Although when 

compar<strong>in</strong>g this sample to others who were <strong>in</strong> 

work experience or supported employment 

(<strong>in</strong> the normed sample), the Type of Support 

scores for the Job-Related Duties subscale <strong>and</strong> 

the overall scores were somewhat higher for 

those <strong>in</strong> this study. Thus, it may be that this 

sample had slightly less work related support 

needs than those <strong>in</strong> the past sample. 

There are many uses for employment <strong>and</strong> 

transition assessments, particularly when assessment 

systems <strong>in</strong>corporate the multiple dimensions 

targeted <strong>in</strong> this study (productivity 

vs. support needs; employees’ vs. supervisors’ 

perceptions). The JOBS evaluation system 

(Brady et al., 2006; Rosenberg & Brady, 2000) 

is one such example, <strong>and</strong> this study <strong>in</strong>dicates 

a new area of use for such assessments. The 

discrepancy scores found <strong>in</strong> this study <strong>in</strong>dicate 

that employers <strong>and</strong> employees disagreed 

about the quality of work <strong>and</strong> the support 

needs of entry-level workers with disabilities. 

While not know<strong>in</strong>g who was “right” <strong>in</strong> this 

debate, different theories emerge. It may be 

that employees with disabilities overestimate 

their ability level <strong>and</strong> need professionals <strong>in</strong> 

the field to give them honest feedback concern<strong>in</strong>g 

how their performance will be judged 

by future employers. One way of us<strong>in</strong>g JOBS to 

achieve this aim is to ask <strong>in</strong>dividuals <strong>in</strong> the 

early days of employment (or before be<strong>in</strong>g 

employed) to evaluate for themselves how 

other workers are do<strong>in</strong>g, <strong>and</strong> then compare 

those rat<strong>in</strong>gs to their own self-determ<strong>in</strong>ed 

rat<strong>in</strong>gs. 

An alternate explanation for the discrepancy 

<strong>in</strong> scores could be employers underestimat<strong>in</strong>g 

the skills of these employees. It may be 

that employers have preconceived ideas about 

how well employees with disabilities will perform 

on a job, <strong>and</strong> unknow<strong>in</strong>gly hold a rater 

bias when judg<strong>in</strong>g the quality of employees’ 

work performance. It is also possible that the 

mere presence of a disability predisposes supervisors 

to watch these employees differently 

or more closely. It may be that any employee 

who is watched closely could obta<strong>in</strong> many suggestions 

from an employer on how to improve 

one’s work. Employment professionals can 


share this <strong>in</strong>formation with employers, <strong>and</strong> 

perhaps have them rate other very successful 

<strong>and</strong> marg<strong>in</strong>ally successful employees on the 

job. These rat<strong>in</strong>gs could be compared to the 

<strong>in</strong>dividual with a disability to underst<strong>and</strong> 

whether there is a need for improved performance, 

or whether the employee is perform<strong>in</strong>g 

at an acceptable or normative rate. 

The different rat<strong>in</strong>gs obta<strong>in</strong>ed by employees 

<strong>and</strong> supervisors can be used to identify 

changes needed for successful employment to 

be ma<strong>in</strong>ta<strong>in</strong>ed. Employment professionals, for 

example, could use these scores to create specific 

target goals based on these assessment 

scores. For <strong>in</strong>stance, if an employee reported 

that his or her job was conducted with a high 

degree of safety, but the supervisor reported 

that this only happens some of the time, the 

two can work with a job coach so that both 

underst<strong>and</strong> what constitutes safe job performance. 

They could then develop an <strong>in</strong>tervention 

to reach that goal. Support <strong>in</strong>terventions 

can be developed <strong>in</strong> a similar fashion, with the 

goal of educat<strong>in</strong>g community employers 

about the types of supports that are available 

to help employees successfully perform their 

jobs. For <strong>in</strong>stance, if employees identify that 

they always need help to get back from breaks 

on time, the employment professional can discuss 

with the supervisor <strong>and</strong> employees the 

various ways to get the help needed to get 

back to work on time. For example, a coworker 

can be recruited to rem<strong>in</strong>d an employee 

when break time is over, or an alarm 

watch might be used as an adaptation to rem<strong>in</strong>d 

an employee that it is time to return to 

work. 

F<strong>in</strong>ally, employment professionals can th<strong>in</strong>k 

about us<strong>in</strong>g supervisors’ <strong>and</strong> employees’ 

scores on the JOBS system as a measure of 

when successful employment has been 

achieved. Currently, many people with disabilities 

only receive employment support on a 

temporary basis, <strong>and</strong> lose such support when a 

rehabilitation counselor affirms that the employment 

status of the person is stable. This 

leads to many cases be<strong>in</strong>g closed before the 

<strong>in</strong>dividual is <strong>in</strong> a successful long-term employment 

situation. By <strong>in</strong>clud<strong>in</strong>g JOBS <strong>and</strong> JOBS: 

OSD rat<strong>in</strong>gs <strong>in</strong>to an Individual Plan for Employment 

(IPE), these data could be used to 

determ<strong>in</strong>e whether the <strong>in</strong>dividual with a disability 

is stable <strong>in</strong> his or her work behavior, 

<strong>and</strong> likely to cont<strong>in</strong>ue success on the job (as 

<strong>in</strong>dicated by m<strong>in</strong>imum performance scores, 

<strong>and</strong> the support scores needed to ma<strong>in</strong>ta<strong>in</strong> 

success). By <strong>in</strong>putt<strong>in</strong>g these criteria <strong>in</strong>to an 

IPE, employment professionals can be more 

confident that employees are not los<strong>in</strong>g jobs 

due to <strong>in</strong>accurate perceptions of work skills 

<strong>and</strong> premature term<strong>in</strong>ation of services (Mart<strong>in</strong> 

et al., 2006). 

Historically, people with disabilities have 

had difficulty obta<strong>in</strong><strong>in</strong>g <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g community 

employment (Brady & Rosenberg, 

2002a; Levy et al., 1993; Murphy et al., 2002). 

There are many factors that contribute to this 

situation. These factors <strong>in</strong>clude provid<strong>in</strong>g <strong>and</strong> 

fad<strong>in</strong>g support (Rogan, Lueck<strong>in</strong>g, & Grossi, 

2007), fund<strong>in</strong>g for supported employment efforts 

(Rusch & Braddock, 2004), <strong>and</strong> <strong>in</strong>tegrat<strong>in</strong>g 

employees with disabilities <strong>in</strong>to the culture 

of the workplace (Rogan, Callahan, Griff<strong>in</strong>, & 

Hammis, 2007). An additional variable that 

may impact the employment status of people 

with disabilities is the degree to which their 

self-determ<strong>in</strong>ed evaluations of their own work 

performance <strong>and</strong> support needs correspond 

with those of their supervisors’ evaluations. 

Thus, it seems prudent for supervisors, employment 

professionals, <strong>and</strong> related service 

providers to obta<strong>in</strong> the self-evaluations of employees 

with disabilities (see Brady et al., 2008; 

Lynn et al., 2004), <strong>and</strong> compare those evaluations 

to supervisors’ evaluations. In addition 

to learn<strong>in</strong>g the employees’ perspective, such 

<strong>in</strong>formation may highlight any exist<strong>in</strong>g discrepancies 

<strong>and</strong> allow supervisors <strong>and</strong> employees 

to address these areas of concern prior to 

any changes to the <strong>in</strong>dividual’s employment 

status. 

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Received: 19 March 2008 

Initial Acceptance: 17 May 2008 

F<strong>in</strong>al Acceptance: 26 September 2008 


Review of Interventions to Increase Functional <strong>and</strong> Symbolic 

Play <strong>in</strong> Children with Autism 

Russell Lang, Mark O’Reilly, M<strong>and</strong>y Rispoli, <strong>and</strong> Karrie Shogren 

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

Wendy Machalicek 

Portl<strong>and</strong> State University 

April Regester 

University of California at Santa Barbara 

Jeff Sigafoos 

Victoria University of Well<strong>in</strong>gton 

Abstract: Play is widely acknowledged to be an <strong>in</strong>tegral part of human development <strong>and</strong> children with autism 

often experience substantial delays <strong>in</strong> the development of play behaviors. This review updates older reviews by 

cover<strong>in</strong>g the last 10 years of research target<strong>in</strong>g functional <strong>and</strong> symbolic play <strong>in</strong> children with autism. The review 

differs from other reviews concern<strong>in</strong>g play by <strong>in</strong>clud<strong>in</strong>g all conceptual models <strong>and</strong> <strong>in</strong>tervention environments, 

while also limit<strong>in</strong>g <strong>in</strong>clusion to studies demonstrat<strong>in</strong>g experimental control. Additionally, this is the first review 

of play studies to report results <strong>in</strong> quantifiable terms (e.g. PND). Studies are grouped <strong>in</strong>to two categories (i.e. 

studies of functional versus symbolic play). Three components (i.e. model<strong>in</strong>g, prompt<strong>in</strong>g with cont<strong>in</strong>gent 

re<strong>in</strong>forcement, <strong>and</strong> child directed or “naturalistic” <strong>in</strong>struction) appear related to successful play <strong>in</strong>terventions. 

The results of this review suggest that these components underlie the effectiveness of successful play <strong>in</strong>tervention 

for children with autism. 

Play is widely acknowledged to be an <strong>in</strong>tegral 

part of human development <strong>and</strong> a large percentage 

of typically develop<strong>in</strong>g children’s 

time is spent engaged <strong>in</strong> play (Boutot, Guenther, 

& Crozier, 2005; Sigelman & Rider, 

2006). As children develop, play serves <strong>in</strong>creas<strong>in</strong>gly 

more complex <strong>and</strong> vital functions 

(Rutherford & Rogers, 2003; Williams, 2003). 

For example, play has been l<strong>in</strong>ked to the development 

of sensory process<strong>in</strong>g systems 

(Ruff, 1984), communication skills (Bakeman 

& Adamson, 1984, Toth, Munson, Meltzoff, & 

Dawson, 2006), cognition (Piaget, 1962; Rutherford 

& Rogers, 2003; Vygotsky, 2000), <strong>and</strong> 

social <strong>and</strong> emotional <strong>in</strong>teractions (Erikson, 

1951). Delayed or abnormal development of 

The authors would like to thank the Eli <strong>and</strong> 

Edythe L. Broad Center for Asperger’s Research at 

the Koegel Autism Center, University of California, 

Santa Barbara for their support. Correspondence 

concern<strong>in</strong>g this article should be addressed to Russell 

Lang, Department of Special <strong>Education</strong>, 1 University 

Station D5300, The University of Texas at 

Aust<strong>in</strong>, Aust<strong>in</strong>, TX 78712. 



play behaviors can aversely affect an <strong>in</strong>dividual 

across their lifespan (Sigelman & Rider, 2006) 

Children with autism <strong>and</strong> related developmental 

disabilities often experience substantial 

delays <strong>in</strong> the development of play behavior 

(Baron-Cohen, 1987). In a longitud<strong>in</strong>al study, 

Sigafoos, Roberts-Pennell, <strong>and</strong> Graves (1999) 

reported that while other areas of adaptive 

behavior showed ga<strong>in</strong>s over a 3-year period, 

there was very little improvement <strong>in</strong> play 

among a sample of 13 preschool children with 

autism <strong>and</strong> related developmental disabilities. 

Even when matched with children accord<strong>in</strong>g 

to mental age, children with autism engage <strong>in</strong> 

significantly more stereotypic <strong>and</strong> repetitive 

behaviors <strong>and</strong> fewer appropriate play behaviors 

(W<strong>in</strong>g, Gould, Yeates, & Brierley, 1977). 

Indeed, these deficits are central to the def<strong>in</strong>ition 

of autism (DSM-IV; APA, 1994) <strong>and</strong> 

items related to play are <strong>in</strong>tegral components 

on autism diagnostic tools (e.g. Autism Diagnostic 

Observation Schedule, Autism Diagnostic 

Interview). Deficits <strong>in</strong> play behavior can 

further exacerbate the social <strong>and</strong> communication 

delays experienced by children with au- 

Review of Play Interventions / 481

tism <strong>and</strong> make play an important area for 

early <strong>in</strong>tervention (Jarrold, Boucher, & Smith, 

1993). 

Given that play deficits are prevalent, persistent, 

<strong>and</strong> a core feature of autism, it is not 

surpris<strong>in</strong>g that a considerable amount of <strong>in</strong>tervention 

research has focused on develop<strong>in</strong>g 

successful procedures for teach<strong>in</strong>g play 

skills to children with autism (Terpstra, Higg<strong>in</strong>s, 

& Pierce, 2002; Stahmer, Ingersol, & 

Carter, 2003). In addition to <strong>in</strong>creases <strong>in</strong> diversity, 

flexibility, <strong>and</strong> spontaneity of play 

skills, successful play <strong>in</strong>terventions have also 

been associated with improvements <strong>in</strong> socialization, 

language, cognition, functional use of 

objects, motor skills, <strong>and</strong> exercise (Brown & 

Murray, 2001). 

In the current review, we aim to assist practitioners 

with implement<strong>in</strong>g evidence-based 

practice, by review<strong>in</strong>g research that has focused 

on teach<strong>in</strong>g play to children with autism. 

This focus is important because children 

with autism are known to have more profound 

<strong>and</strong> global deficits <strong>in</strong> play (Boutot et al., 

2005). In addition, unlike previous reviews, we 

have aimed for a more <strong>in</strong>clusive <strong>and</strong> comprehensive 

review by <strong>in</strong>clud<strong>in</strong>g studies derived 

from a range of conceptual models (e.g. behaviorism, 

developmental, sensory <strong>in</strong>tegration) 

(cf. Luckett, Bundy, & Roberts, 2007; 

Stahmer et al., 2003), <strong>and</strong> sett<strong>in</strong>gs (e.g. school 

or home based <strong>in</strong>terventions) (cf. Terpstra et 

al., 2002). To ensure the certa<strong>in</strong>ty of evidence, 

which is important for guid<strong>in</strong>g evidence-based 

practice (Schlosser & Sigafoos, 2007), we limited 

the current review to studies <strong>in</strong> which 

experimental control was demonstrated <strong>and</strong> 

summarized results <strong>in</strong> quantifiable terms. 

Method 

Search Procedures <strong>and</strong> Selection Criteria 

Systematic computerized literature searches 

were conducted on two databases: the <strong>Education</strong>al 

Resources Information Clear<strong>in</strong>g House 

(ERIC) <strong>and</strong> PsychINFO to identify research 

studies target<strong>in</strong>g play behaviors <strong>in</strong> children 

with autism. The search was limited to English 

language journal articles published between 

1998 <strong>and</strong> July 2008. Comb<strong>in</strong>ation of the follow<strong>in</strong>g 

search terms were entered <strong>in</strong>to the 

keywords field: autism, autistic, symbolic play, 

sociodramatic play, functional play, object manipulation, 

toy play, stereotypic play, leisure skills, 

games, <strong>and</strong> pretend. This <strong>in</strong>itial search resulted 

<strong>in</strong> the identification of 425 studies. The titles 

<strong>and</strong> abstracts of these studies were then 

screened for general appropriateness. The 

reference lists from the result<strong>in</strong>g 65 studies 

were then h<strong>and</strong> searched for additional relevant 

studies lead<strong>in</strong>g to the identification of a 

total of 73 studies. 

These 73 studies were then <strong>in</strong>cluded or excluded 

based on the follow<strong>in</strong>g criteria. To be 

<strong>in</strong>cluded a study: (a) conta<strong>in</strong>ed participants 

ages 0 to 8 years old diagnosed with autism; 

(b) <strong>in</strong>cluded the improvement <strong>in</strong> toy play as a 

dependent variable; <strong>and</strong> (c) experimental 

control was demonstrated by means of s<strong>in</strong>glecase 

or control-group experimental designs 

(Kennedy, 2005). Studies <strong>in</strong> which the <strong>in</strong>tervention 

procedures were not described <strong>in</strong> sufficient 

detail to enable replication or that did 

not demonstrate experimental control were 

excluded (e.g. Bernard-Opitz, Ing, & Kong, 

2004). Also excluded were studies <strong>in</strong> which 

play was used as a context to <strong>in</strong>crease communication 

or other social skills because the focus 

of these <strong>in</strong>terventions was not on improv<strong>in</strong>g 

play skills (e.g. Baker, Koegel & Koegel, 

1998; Bevill, Gast, Maguire, & Vail, 2001; 

Kohler, Anthony, Steighner, & Hoyson, 2001; 

Krantz & McClannahan, 1998; Loncola & 

Craig-Unkefer, 2005; Shabani, Katz, Wilder, 

Beauchamp, Taylor, & Fisher, 2002). Studies 

<strong>in</strong> which the topography of the play behavior 

was unclear (e.g., “targeted play skill”) or did 

not require functional or symbolic play (provision 

of sensory stimulation) were also excluded 

(e.g. Ingersoll, Schreibman, & Tran, 

2003). 

Fifteen studies met the <strong>in</strong>clusion criteria. 

These 15 studies <strong>in</strong>cluded a total of 53 participants. 

Table 1 provides a summary of each 

<strong>in</strong>cluded study. 

Cod<strong>in</strong>g <strong>and</strong> Summary of the Studies 


The 15 studies were coded us<strong>in</strong>g a data sheet 

designed specifically for this review (available 

from the first author upon request). Every 

article was read <strong>in</strong> its entirety <strong>and</strong> pert<strong>in</strong>ent 

<strong>in</strong>formation was extracted <strong>and</strong> recorded on 

the data sheet. 

Each study was classified <strong>in</strong>to one of two

TABLE 1 

Studies Categorized <strong>in</strong>to Functional <strong>and</strong> Symbolic Play Behaviors, Lists Number of Participants, 

Independent <strong>and</strong> Dependent Variables, Experimental Design, <strong>and</strong> Results <strong>in</strong> Percent Non-overlapp<strong>in</strong>g Data 

(PND) or as Reported by Authors 

Citation & 

Category 

I. Functional 

Play 

D’Ateno, 

Mangiapanello 

& Taylor 

(2003) 

Gillet & LeBlanc 

(2007) 

H<strong>in</strong>e & Wolery 

(2006) 

Hume & Odom 

(2007) 

Nuzzolo- 

Gomez,Leonard, 

Ortiz,Rivera & 

Greer (2002) 

II. Symbolic Play 

Barry & Burlew 

(2004) 

Dauph<strong>in</strong>, 

K<strong>in</strong>ney & 

Stromer 

(2004) 

Ingersoll & 

Schreibman 

(2006) 

Kasari, Freeman 

& Paparella 

(2006) 

MacDonald, 

Clark 

Garrigan & 

Vangala, 

(2005) 

n Independent 

Variables 

Experimental 

Design 

1 Video Model<strong>in</strong>g MBL* across 

toys 

3 Parentimplement 

Natural 

Language 

Paradigm 

2 Po<strong>in</strong>t-of-View 

Video 

Model<strong>in</strong>g 

2 TEACHH 

developed 

Structured 

Work Systems 

3 Pair<strong>in</strong>g toy play 

with 

re<strong>in</strong>forcer 

MBL across 

part a 

Multiple 

probe 

across play 

behaviors 

Reversal 

(ABAB) 

MBL across 

part 

2 Social Stories MBL across 

part 

1 Video Enhanced 

Activity 

Schedules & 

Matrix 


5 Reciprocal 

Imitation 


21 Comb<strong>in</strong>ed 

Behavioral 

Drill & Milieu 

Teach<strong>in</strong>g 

Reversal & 

Component 

Analysis 

MBL across 

part & 

behaviors 

F Statistics <strong>in</strong> 

mixed 

effect 

regression 

models 

2 Video Model<strong>in</strong>g Multiple 

probe 

across toys 

Dependent Variables & Results 

Modeled play behaviors <strong>in</strong>creased M b PND c 87% 

(range, 60% to 100%) 

Novel play behaviors <strong>in</strong>creased with some toys but not 

with others M b PND c 18% (range, 0% to 50%) 

Functional play <strong>in</strong>creased M PND 93% (range, 80% 

to 100%) 

Stereotypy was not affected by <strong>in</strong>tervention M PND 

0% 

Modeled play <strong>in</strong>creased M PND 94% (range, 85% to 

100%) 

On task behaviors <strong>in</strong>creased M PND 100% 

Teacher delivered prompts to play decreased M PND 

83.5% (range, 81% to 86%) 

Number of play materials utilized <strong>in</strong>creased M PND 

100% 

Functional play <strong>in</strong>creased M PND 55% 

Stereotypy decreased M PND 33% (range, 0 to 

100%) Note: variable rates of behavior <strong>in</strong> 

basel<strong>in</strong>e lowered PND Visual analysis of data 

<strong>in</strong>dicates a more powerful positive effect 

Teacher delivered prompts to play decreased M PND 

97.25% (range, 94.5% to 100%) 

Symbolic play <strong>in</strong>creased M PND 100% 

Modeled play behaviors <strong>in</strong>creased 

Novel play behaviors <strong>in</strong>creased Note: Data could not 

be converted <strong>in</strong>to PND, Results were positive for 

both variables. 

Total symbolic play <strong>in</strong>creased M PND 29% (range, 

0 to 60%) Spontaneous symbolic play <strong>in</strong>creased M 

PND 27% (range, 0 to 63%) Note: 1 of the 5 

parts made no improvements <strong>in</strong> play skills 

Significant group x time <strong>in</strong>teraction, play 

<strong>in</strong>tervention group showed significantly greater 

improvements over time <strong>in</strong> both functional <strong>and</strong> 

symbolic play skills compared to a jo<strong>in</strong>t attention 

<strong>in</strong>tervention group <strong>and</strong> a no treatment control 

group 

Modeled behaviors <strong>in</strong>creased M PND 100% 

Novel play behaviors decreased Note: Only means 

were reported for novel play behaviors, therefore 

PND calculation is not possible 



Citation & 

Category 

Morrison, 

Sa<strong>in</strong>ato, 

Benchaaban & 

Endo, (2002) 

Newman, 

Re<strong>in</strong>ecke & 

Me<strong>in</strong>berg, 

(2000) 

Paterson & Arco 

(2007) 

Reagon, Higbee 

& Endicott 

(2006) 

Zercher, Hunt, 

Schuler & 

Webster (2001) 

n Independent 

Variables 

4 Correspondence 

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

Activity 

Schedules 

2 Self 

Management 

Experimental 

Design 

MBL across 

part 

MBL across 

part 

possible categories accord<strong>in</strong>g to the type of 

play skill targeted for <strong>in</strong>tervention. The two 

categories of play skills were (a) functional 

play <strong>and</strong> (b) symbolic play (termed <strong>in</strong> some 

studies as “pretend play”, “sociodramatic play” 

or “imag<strong>in</strong>ative play”). A study was classified as 

functional play if the behavior targeted <strong>in</strong>volved 

use of a toy <strong>in</strong> a manner consistent with 

its <strong>in</strong>tended function preserv<strong>in</strong>g the unique 

physical properties of the toy. Examples of 

functional play <strong>in</strong>clude (a) plac<strong>in</strong>g puzzle 

pieces <strong>in</strong>to a puzzle, (b) us<strong>in</strong>g toy tools to 

build (c) str<strong>in</strong>g<strong>in</strong>g beads, (d) stirr<strong>in</strong>g a bowel 

with a spoon <strong>in</strong> a toy cook<strong>in</strong>g set (e) look<strong>in</strong>g 

at a picture book. These studies are presented 

<strong>in</strong> the first section of Table 1. 

A study was classified as symbolic play if the 

behavior targeted <strong>in</strong>volved any of the follow<strong>in</strong>g 

(a) use of one object to st<strong>and</strong> for another 

object (e.g. a hairbrush used as a microphone), 

(b) appears to use someth<strong>in</strong>g that is 

not present (e.g. strums an imag<strong>in</strong>ary guitar), 

(c) uses a toy figure as if it were capable of 

perform<strong>in</strong>g actions (e.g. makes a teddy bear 

dance <strong>and</strong> s<strong>in</strong>g), (d) uses a toy as a prop (e.g. 

Dependent Variables & Results 

On task symbolic play <strong>in</strong>creased M PND 100% 

Variability of play <strong>in</strong>creased M PND 91.5% (range, 

90% to 93%) 

2 Video Model<strong>in</strong>g Reversal Appropriate play <strong>in</strong>creased M PND 100% 

embedded Stereotypy decreased M PND 100% 

<strong>in</strong>to a MLB 

across toys 

1 Video Model<strong>in</strong>g MBL across 

play 

2 Integrated Play 

Therapy 

scenarios 

MBL across 

part 

* Multiple basel<strong>in</strong>e 

a 

Participants 

b 

Mean 

c 

Percent Non-Overlapp<strong>in</strong>g Data 

Italics denote the name of the dependent variable 


Model behaviors <strong>in</strong>creased M PND 100% Note: Only 

1 basel<strong>in</strong>e data po<strong>in</strong>t 

Symbolic play <strong>in</strong>creased M PND 72% (range, 50% 

to 94%) 

a book becomes a ramp for a car), or (e) 

adopts a role or persona that does not belong 

to the child (e.g. acts as if they are a parent, 

teacher, or super hero). When a study targeted 

both functional <strong>and</strong> symbolic play, that 

study was classified as symbolic because symbolic 

play is considered to be more advanced. 

These studies are presented <strong>in</strong> the second 

section of Table 1. 

For each study <strong>in</strong> the review, Table 1 summarizes 

the follow<strong>in</strong>g variables: (a) number of 

participants (b) <strong>in</strong>dependent variable <strong>in</strong>tended 

to <strong>in</strong>crease play skills (c) experimental 

design <strong>and</strong> (d) effectiveness of the <strong>in</strong>tervention 

on <strong>in</strong>creas<strong>in</strong>g play behaviors. Other dependent 

variables that are not directly related 

to play are not listed (e.g. language <strong>and</strong> social 

skills). Intervention effectiveness is reported 

as either percentage of non-overlapp<strong>in</strong>g data 

(PND), the statistical f<strong>in</strong>d<strong>in</strong>gs reported by the 

author (e.g. Kasari et al., 2006), or when basel<strong>in</strong>e 

data prevented the use of PND, the authors’ 

visual analysis of the results are reported 

(e.g. Dauph<strong>in</strong> et al., 2004). 

PND is one method of synthesiz<strong>in</strong>g s<strong>in</strong>gle

subject data (Scruggs & Mastropieri, 1998). A 

higher PND suggests that the participant’s behavior 

changed <strong>in</strong> the desired direction (i.e. 

<strong>in</strong>creased or decreased) dur<strong>in</strong>g or follow<strong>in</strong>g 

<strong>in</strong>tervention. A lower PND suggests that the 

<strong>in</strong>tervention may have failed to change behavior 

<strong>in</strong> the desired direction. While several 

other methods for synthesiz<strong>in</strong>g s<strong>in</strong>gle subject 

data exist (e.g. St<strong>and</strong>ard Mean Difference, 

Percentage Reduction Measure) a recent review 

<strong>and</strong> empirical comparison of these methods 

found consistent results across methods 

(Olive & Smith, 2005). Therefore, PND was 

chosen for its simplicity. 

To calculate PND for behavior reduction, 

the lowest basel<strong>in</strong>e data po<strong>in</strong>t is identified. 

Next, the data po<strong>in</strong>ts <strong>in</strong> the <strong>in</strong>tervention 

phase that fall below the lowest basel<strong>in</strong>e po<strong>in</strong>t 

are counted. This number is then divided by 

the total number of data po<strong>in</strong>ts <strong>in</strong> the <strong>in</strong>tervention 

phase (data po<strong>in</strong>ts below lowest basel<strong>in</strong>e 

po<strong>in</strong>t data po<strong>in</strong>ts equal to <strong>and</strong> above 

lowest basel<strong>in</strong>e po<strong>in</strong>t). The quotient is then 

converted to a percentage by multiply<strong>in</strong>g by 

100%. For behaviors <strong>in</strong> which an <strong>in</strong>crease is 

desired, the highest basel<strong>in</strong>e po<strong>in</strong>t is identified 

<strong>and</strong> identical calculations are made; except 

that the number of <strong>in</strong>tervention data 

po<strong>in</strong>ts above (<strong>in</strong>stead of below) the highest 

basel<strong>in</strong>e po<strong>in</strong>t is used as the divisor. PND cannot 

be calculated when a zero quantity is <strong>in</strong> 

the basel<strong>in</strong>e of reduction studies or a maximum 

possible quantity is found <strong>in</strong> behavior 

<strong>in</strong>crease studies (Olive & Smith, 2005). When 

a design conta<strong>in</strong>s more than one basel<strong>in</strong>e 

phase (e.g. an ABAB design), the lowest or 

highest basel<strong>in</strong>e po<strong>in</strong>t was identified across all 

basel<strong>in</strong>e phases. 

When s<strong>in</strong>gle subject data cannot be converted 

<strong>in</strong>to PND, due to the presence of an 

extreme basel<strong>in</strong>e po<strong>in</strong>t, the methodology 

used by Machalicek et al. (2008) was used to 

describe results as positive, negative, or mixed. 

“Positive” meant that all the participants experienced 

some improvement from basel<strong>in</strong>e levels 

dur<strong>in</strong>g or follow<strong>in</strong>g <strong>in</strong>tervention. “Mixed” 

meant that, although one or more participants 

experienced some improvement, one or 

more participants did not. “Negative” meant 

that no participants <strong>in</strong> the study benefited 

from the <strong>in</strong>tervention. No study <strong>in</strong> this review 

reported negative f<strong>in</strong>d<strong>in</strong>gs. 

This review is organized <strong>in</strong>to three sections: 

(a) results, (b) discussion, <strong>and</strong> (c) future research. 

The results section presents an overview 

of the studies with<strong>in</strong> each category (i.e. 

functional or symbolic play) <strong>and</strong> two studies 

are discussed <strong>in</strong> detail to illustrate the <strong>in</strong>terventions 

that typify the category. The discussion 

section evaluates the reviewed studies towards 

identify<strong>in</strong>g common components of 

successful play <strong>in</strong>terventions. The f<strong>in</strong>al section 

highlights possible areas of future research. 

Results 

Increas<strong>in</strong>g Functional Play 

Five studies (n 11 participants) evaluated 

<strong>in</strong>terventions designed to <strong>in</strong>crease the functional 

play skills of children with autism 

(D’Ateno, Mangiapanello & Taylor, 2003; Gillet 

& Leblanc, 2007; H<strong>in</strong>e & Wolery, 2006; 

Hume & Odom, 2007; Nuzzolo-Gomez, Leonard, 

Ortiz, Rivera & Greer, 2002). Two of 

these studies evaluated the use of video model<strong>in</strong>g 

(D’Ateno et al., 2003; H<strong>in</strong>e & Wolery, 

2006). Other <strong>in</strong>dependent variables <strong>in</strong>cluded 

natural language paradigm (Gillett & LeBlanc, 

2007), structured work systems (Hume & 

Odom, 2007), <strong>and</strong> pair<strong>in</strong>g (Nuzzolo-Gomez et 

al., 2002). Dependent variables, other than 

functional play <strong>in</strong>cluded, stereotypy (Gillett & 

LeBlanc, 2007; Nuzzolo-Gomez et al., 2002) 

verbal communication variables (D’Ateno et 

al., 2003; Gillett & LeBlanc, 2007), off task 

behavior (Hume & Odom, 2007), <strong>and</strong> teacher 

delivered prompts (Hume & Odom, 2007). 

All of these studies used s<strong>in</strong>gle-case experimental 

designs (e.g., ABAB reversal design, 

multiple-basel<strong>in</strong>e), The three studies that assessed 

social validity reported that parents <strong>and</strong> 

educators found the <strong>in</strong>terventions to be successful, 

acceptable, <strong>and</strong> target<strong>in</strong>g important 

skills (Gillett & LeBlanc, 2007; H<strong>in</strong>e & Wolery, 

2006; Hume & Odom, 2007). Ma<strong>in</strong>tenance 

data was collected <strong>in</strong> two studies. Acquired 

play skills were ma<strong>in</strong>ta<strong>in</strong>ed at 1 month (Hume 

& Odom, 2007) <strong>and</strong> 2 months (H<strong>in</strong>e & Wolery, 

2006). Generalization of newly acquired 

play skills to new toys <strong>and</strong> sett<strong>in</strong>gs was reported 

<strong>in</strong> one study (H<strong>in</strong>e & Wolery, 2006). 

Across all the functional play studies, the 

mean PND for <strong>in</strong>creas<strong>in</strong>g functional play skills 

was 88% (range, 60% to 100%). This <strong>in</strong>dicates 

that participants improved more than the best 


asel<strong>in</strong>e po<strong>in</strong>t across 88% of the <strong>in</strong>tervention 

<strong>and</strong> post <strong>in</strong>tervention sessions, on average. 

H<strong>in</strong>e <strong>and</strong> Wolery (2006) evaluated the effects 

of video model<strong>in</strong>g on <strong>in</strong>creas<strong>in</strong>g toy-play 

skills of two children with autism (ages 30 

months <strong>and</strong> 43 months). The first targeted 

play skill <strong>in</strong>volved us<strong>in</strong>g a toy garden<strong>in</strong>g set to 

dig holes, put soil <strong>in</strong>to empty pots, <strong>and</strong> plant 

toy flowers. The second play skill <strong>in</strong>volved us<strong>in</strong>g 

a toy cook<strong>in</strong>g to set the table <strong>and</strong> perform 

cook<strong>in</strong>g motions with the toys (e.g. stir a 

bowel). Po<strong>in</strong>t-of-view video model tapes were 

made by hold<strong>in</strong>g the camera at the child’s eye 

level without <strong>in</strong>clud<strong>in</strong>g any people <strong>in</strong> the camera 

shot. This camera angle was used to show 

the environment as the child would see it if 

they were perform<strong>in</strong>g the targeted behaviors. 

The effects of po<strong>in</strong>t-of view video model<strong>in</strong>g 

were evaluated <strong>in</strong> a multiple probe design 

across both participants <strong>and</strong> both sets of toys. 

The <strong>in</strong>tervention was effective at <strong>in</strong>creas<strong>in</strong>g 

the participants’ engagement <strong>in</strong> the modeled 

behaviors (M PND 94% range, 85% to 

100%). 

H<strong>in</strong>e <strong>and</strong> Wolery also collected generalization, 

social validity, <strong>and</strong> ma<strong>in</strong>tenance data. 

Generalization probes showed mixed results. 

Both children demonstrated the ability to generalize 

to new play materials but only one 

participant generalized to a second environment. 

Social validity was evaluated by a group 

of 10 graduate students for each participant. 

Graduate students watched pre/post tra<strong>in</strong><strong>in</strong>g 

videos <strong>and</strong> rated the children’s play behaviors 

on a 5 po<strong>in</strong>t Likert Scale. Raters concluded 

that <strong>in</strong> the post-tra<strong>in</strong><strong>in</strong>g videos children were 

more engaged, used multiple actions/materials, 

played appropriately, enjoyed the activity, 

<strong>and</strong> needed less help than dur<strong>in</strong>g basel<strong>in</strong>e 

videos. Ma<strong>in</strong>tenance data shows that the participants 

still engaged <strong>in</strong> the modeled behaviors 

two months after the <strong>in</strong>tervention had 

ceased. 

Gillett <strong>and</strong> LeBlanc (2007) evaluated the 

effects of a natural language paradigm (NLP) 

<strong>in</strong>tervention, implemented by participants’ 

parents, on <strong>in</strong>creas<strong>in</strong>g the appropriate play 

<strong>and</strong> decreas<strong>in</strong>g the <strong>in</strong>appropriate play of 

three children with autism between the ages 

of 4 <strong>and</strong> 5 years old. Appropriate play was 

def<strong>in</strong>ed as “us<strong>in</strong>g the toy <strong>in</strong> the manner it was 

<strong>in</strong>tended”. Inappropriate play <strong>in</strong>cluded “use 

of the toy <strong>in</strong> a stereotyped manner”. The mod- 

ified NLP procedures used <strong>in</strong> this study consisted 

of six steps; (a) display<strong>in</strong>g three toys to 

the child, (b) prevent<strong>in</strong>g access to these toys, 

(c) provid<strong>in</strong>g an action model for 5s <strong>and</strong> then 

a vocal model, (d) re<strong>in</strong>forc<strong>in</strong>g appropriate 

child responses with access to the selected toy, 

(e) repetition with a novel modeled play behavior, 

<strong>and</strong> (f) cont<strong>in</strong>ued play model<strong>in</strong>g 

throughout sessions. A multiple basel<strong>in</strong>e 

across participants was used to evaluate the 

effects on appropriate <strong>and</strong> <strong>in</strong>appropriate play 

behaviors. Results showed that all 3 parents 

learned to correctly implement the NLP <strong>in</strong>tervention 

<strong>and</strong> that while appropriate play <strong>in</strong>creased 

(M PND 93% range: 80% to 100%) 

<strong>and</strong> that levels of <strong>in</strong>appropriate play (i.e. challeng<strong>in</strong>g 

behavior or stereotypy) rema<strong>in</strong>ed the 

same from basel<strong>in</strong>e to <strong>in</strong>tervention (PND 

0%) suggest<strong>in</strong>g no reduction <strong>in</strong> <strong>in</strong>appropriate 

play. Social validity data was collected via written 

questionnaire from 2 of the 3 parents who 

found the <strong>in</strong>tervention to be “very useful”, 

“very easy”, <strong>and</strong> “very helpful”. 

Increas<strong>in</strong>g Symbolic Play 


Ten studies, <strong>in</strong>clud<strong>in</strong>g a total of 42 participants 

(21 from Kasari et al., 2006), evaluated 

<strong>in</strong>terventions designed to <strong>in</strong>crease the symbolic 

play skills of children with autism (Barry 

& Burlew, 2004; Dauph<strong>in</strong> et al., 2004; Ingersoll 

& Schreibman, 2006; Kasrai et al., 2006; 

McDonald, Clark, Garrigan & Vangala, 2005; 

Morrison, Sa<strong>in</strong>ato, Benchaaban & Endo, 2002; 

Newman, Re<strong>in</strong>ecke & Me<strong>in</strong>berg, 2000; Paterson 

& Arco, 2007; Reagon, Higbee & Endicott, 

2006; Zercher, Hunt, Schuler & Webster, 

2001). Three of these studies evaluated some 

form of video model<strong>in</strong>g (MacDonald et al., 

2005; Paterson & Arco, 2007; Reagon et al., 

2006). Other <strong>in</strong>dependent variables <strong>in</strong>cluded 

Social Stories TM (Barry & Burlew, 2004), activity 

<strong>and</strong> matrix tra<strong>in</strong><strong>in</strong>g (Dauph<strong>in</strong> et al., 

2004), reciprocal imitation tra<strong>in</strong><strong>in</strong>g (Ingersoll 

& Schreibman, 2006), behavioral drill <strong>and</strong> milieu 

teach<strong>in</strong>g (Kasari et al., 2006), activity 

schedules (Morrison et al., 2002), self management 

(Newman et al., 2000), <strong>and</strong> <strong>in</strong>tegrated 

play therapy (Zercher et al., 2001). 

Dependent variables, other than symbolic 

play, <strong>in</strong>cluded stereotypy (Paterson & Arco, 

2007), off-task behavior (Morrison et al., 

2002), <strong>and</strong> teacher delivered prompts (Barry

& Burlew, 2004). All studies, with the exception 

of Kasari <strong>and</strong> colleagues (2006), used 

s<strong>in</strong>gle subject designs. Kasari <strong>and</strong> colleagues 

(2006) utilized a group design. The mean 

PND across the symbolic play studies that used 

s<strong>in</strong>gle subject designs was 86% (range, 27% to 

100%). This <strong>in</strong>dicates that, on average, participants 

improved symbolic play skills more 

than the best basel<strong>in</strong>e po<strong>in</strong>t across 86% of the 

<strong>in</strong>tervention <strong>and</strong> post <strong>in</strong>tervention sessions. 

The five studies that assessed social validity 

reported that parents <strong>and</strong> educators found 

the <strong>in</strong>terventions to be successful, acceptable, 

<strong>and</strong> target<strong>in</strong>g important skills (Barry & Burlew, 

2004; Ingersoll & Schreibman, 2006; Morrison 

et al., 2002; Paterson & Arco, 2007; Reagon 

et al., 2006; Zercher et al., 2001). 

Ma<strong>in</strong>tenance data was collected <strong>in</strong> four studies. 

Acquired play skills were ma<strong>in</strong>ta<strong>in</strong>ed at 1 

week (Paterson & Arco, 2007), 1 month (Ingersoll 

& Schreibman, 2006; Newman et al., 

2000) <strong>and</strong> 2 months (McDonald et al., 2005). 

Generalization of new play skills to (a) new 

sett<strong>in</strong>gs was reported <strong>in</strong> two studies (Barry & 

Burlew, 2004; Ingersoll & Schreibman, 2006), 

(b) new toys <strong>in</strong> two studies (Ingersoll & Schreibman, 

2006; Paterson & Arco, 2007), (c) new 

play partners <strong>in</strong> three studies (Ingersoll & 

Schreibman, 2006; Kasari et al., 2006; Reagon 

et al., 2006) <strong>and</strong> to (d) new comb<strong>in</strong>ations of 

play behaviors <strong>in</strong> one study (Dauph<strong>in</strong> et al., 

2004). 

Ingersoll <strong>and</strong> Schreibman (2006) evaluated 

the effects of a naturalistic behavioral <strong>in</strong>tervention 

on the language, imitation, jo<strong>in</strong>t attention, 

<strong>and</strong> pretend (i.e. symbolic) play skills 

of five children with autism. Naturalistic behavioral 

<strong>in</strong>terventions are a hybrid of behavioral 

techniques (e.g. prompt<strong>in</strong>g, shap<strong>in</strong>g, 

cont<strong>in</strong>gent re<strong>in</strong>forcement) <strong>and</strong> child lead 

teach<strong>in</strong>g procedures (e.g. <strong>in</strong>cidental teach<strong>in</strong>g, 

milieu teach<strong>in</strong>g, pivotal response tra<strong>in</strong><strong>in</strong>g). 

The <strong>in</strong>tervention used <strong>in</strong> this study consisted 

of five phases. In the first phase, the therapist 

used the follow<strong>in</strong>g two strategies (a) cont<strong>in</strong>gent 

imitation (<strong>in</strong> which the therapist imitated 

the child’s actions <strong>and</strong> language) <strong>and</strong> 

(b) l<strong>in</strong>guistic mapp<strong>in</strong>g (<strong>in</strong> which the therapist 

provided a verbal description of the actions of 

the child). In the second phase, requests for 

the child to imitate the therapist were <strong>in</strong>terspersed 

with the therapist’s cont<strong>in</strong>gent imitation 

of the child. For example, the therapist 

would move the toy <strong>in</strong> the same manner as the 

child for several repetitions <strong>and</strong> would then 

prompt the child to imitate the therapist’s 

novel movement with the toy. In the third 

phase, more novel <strong>and</strong> familiar movements 

were modeled with familiar toys. In the fourth 

phase, novel <strong>and</strong> familiar movements were 

aga<strong>in</strong> modeled with the same toy <strong>and</strong> familiar 

movements were modeled with novel toys. In 

the f<strong>in</strong>al phase, novel movements were modeled 

with novel toys. Dur<strong>in</strong>g each phase systematic 

prompt<strong>in</strong>g for the modeled behavior 

was used <strong>and</strong> re<strong>in</strong>forcement <strong>in</strong> the form of 

praise was given cont<strong>in</strong>gent on the child’s imitation 

of the play behavior. Each phase lasted 

2 weeks. 

A s<strong>in</strong>gle-subject multiple-basel<strong>in</strong>e design 

across participants (Kennedy, 2005) was used 

to evaluate the effects of the <strong>in</strong>tervention. 

Symbolic play was def<strong>in</strong>ed <strong>in</strong> two ways (a) total 

pretend play (“child performs a dist<strong>in</strong>ct action 

with m<strong>in</strong>iature objects, directs a pretend action 

towards self, adult or <strong>in</strong>animate object, 

uses object as if it were another object, attributes 

properties to an object which it does 

not have or refers to an object that is not 

present”) <strong>and</strong> (b) spontaneous pretend play 

(child performs a pretend play scheme that is 

not imitative of a therapists movements with<strong>in</strong> 

the last 30 s). Average total pretend play <strong>in</strong>creased 

(Mean PND 29 %, range 0 to 60%). 

Average spontaneous pretend play <strong>in</strong>creased 

(Mean PND 29%, range 0 to 90%). However, 

the overall results were mixed because 1 

out of the 4 participants did not have any 

ga<strong>in</strong>s <strong>in</strong> play behaviors. 

Newman, Re<strong>in</strong>ecke, <strong>and</strong> Me<strong>in</strong>berg (2000) 

implemented a self-management <strong>in</strong>tervention 

designed to <strong>in</strong>crease the variability of play 

behaviors <strong>in</strong> 3 children with autism. The selfmanagement 

<strong>in</strong>tervention consisted of first 

teach<strong>in</strong>g the participants to take a penny follow<strong>in</strong>g 

novel play responses by provid<strong>in</strong>g verbal 

prompts <strong>and</strong> cont<strong>in</strong>gent social praise. The 

pennies were traded <strong>in</strong> for re<strong>in</strong>forcers follow<strong>in</strong>g 

the play sessions. Once the participants 

learned to collect the penny follow<strong>in</strong>g novel 

play behaviors the therapist stopped provid<strong>in</strong>g 

the verbal prompts <strong>and</strong> praise. 

A s<strong>in</strong>gle-subject multiple-basel<strong>in</strong>e design 

across participants (Kennedy, 2005) was used 

to evaluate the effects of the self-management 

<strong>in</strong>tervention. All three participants learned to 


engage <strong>in</strong> a variety of novel play behaviors. 

Average number of different play behaviors 

per session <strong>in</strong>creased (M PND 94 %, range 

90% to 95%). Follow-up data, collected 1 

month after the <strong>in</strong>tervention had been removed, 

<strong>in</strong>dicated that the participants cont<strong>in</strong>ued 

to engage <strong>in</strong> less repetitive <strong>and</strong> more 

dynamic topographies of play. 


Identification of Common Components of 

Successful Play Interventions 

The most common <strong>in</strong>tervention component 

found <strong>in</strong> studies target<strong>in</strong>g both functional <strong>and</strong> 

symbolic play is model<strong>in</strong>g of appropriate play 

behavior. Model<strong>in</strong>g was a component <strong>in</strong> 3 of 

the 5 functional play studies <strong>and</strong> 8 of the 10 

symbolic play studies. Model<strong>in</strong>g <strong>in</strong>volves the 

participant attend<strong>in</strong>g to another person (<strong>in</strong> 

vivo or on film) engag<strong>in</strong>g <strong>in</strong> the targeted behavior. 

Model<strong>in</strong>g has been shown to be effective 

<strong>in</strong> teach<strong>in</strong>g many complex skills to children 

with autism, such as conversational 

speech (Charlop & Milste<strong>in</strong>, 1989) <strong>and</strong> perspective 

tak<strong>in</strong>g (Charlop & Daneshvar, 2003). 

Model<strong>in</strong>g has been identified <strong>in</strong> other reviews 

as a promis<strong>in</strong>g practice for <strong>in</strong>creas<strong>in</strong>g the play 

behaviors of children with autism (Stahmer et 

al., 2003). This review provides additional <strong>and</strong> 

quantifiable support for this assertion. 

Given the evidence support<strong>in</strong>g the use of 

model<strong>in</strong>g to teach children with autism functional 

<strong>and</strong> symbolic play, it would seem that 

model<strong>in</strong>g is an important <strong>in</strong>structional strategy 

for teach<strong>in</strong>g play. However, the use of 

model<strong>in</strong>g to <strong>in</strong>crease play behaviors has been 

criticized by some researchers who reason that 

imitative behaviors may not be true forms of 

play because they lack spontaneity (e.g. Luckett 

et al., 2007). This concern is compounded 

when the model<strong>in</strong>g also <strong>in</strong>volves some form of 

vicarious re<strong>in</strong>forcement (i.e., the observer witnesses 

the model receive re<strong>in</strong>forcement for 

their behavior) (B<strong>and</strong>ura, 1965) because 

many feel play should be <strong>in</strong>ternally motivated 

(Luckett et al., 2007). 

H<strong>in</strong>e <strong>and</strong> Wolery (2006) offer several reasons 

for target<strong>in</strong>g modeled actions as dependent 

variables <strong>in</strong> a play <strong>in</strong>tervention. First, an 

<strong>in</strong>crease <strong>in</strong> appropriate play behaviors (even if 

imitative) may reduce stereotypic or challeng- 


<strong>in</strong>g behaviors. Second, an <strong>in</strong>crease <strong>in</strong> recognizable 

behaviors should also <strong>in</strong>crease the 

number of appropriate behaviors on which an 

adult can comment. This leads to an <strong>in</strong>crease 

<strong>in</strong> opportunities for language <strong>in</strong>struction. 

Third, an <strong>in</strong>crease <strong>in</strong> modeled behavior 

should reduce apparent differences between 

the child with autism <strong>and</strong> his typically develop<strong>in</strong>g 

classmates: potentially allow<strong>in</strong>g for an 

<strong>in</strong>creased opportunity for <strong>in</strong>clusion <strong>in</strong> social 

activities. 

The next most common component used <strong>in</strong> 

both functional <strong>and</strong> symbolic play <strong>in</strong>terventions 

was systematic prompt<strong>in</strong>g <strong>and</strong> cont<strong>in</strong>gent 

re<strong>in</strong>forcement of the target behavior. 

The comb<strong>in</strong>ation of prompt<strong>in</strong>g <strong>and</strong> re<strong>in</strong>forcement 

was used <strong>in</strong> 2 of the 5 functional play 

studies <strong>and</strong> 7 of the 10 symbolic play studies. 

Prompt<strong>in</strong>g <strong>and</strong> re<strong>in</strong>forcement were implemented 

both from a discrete trail <strong>in</strong>structional 

format (e.g. Kasari et al., 2006) <strong>and</strong> 

from a child directed <strong>in</strong>structional format 

(e.g. Ingersoll & Schreibman, 2006). 

Prompts are behaviors provided by the 

teacher or parent that <strong>in</strong>crease the likelihood 

that the participant will engage <strong>in</strong> the desired 

behavior. Prompts vary from highly <strong>in</strong>trusive 

(e.g. physically guid<strong>in</strong>g the participants h<strong>and</strong> 

to manipulate the toy appropriately) to very 

covert (e.g. the teacher uses her eye gaze to 

signal to the participant what item is used next 

<strong>in</strong> the play sequence). All studies <strong>in</strong> which 

prompts were used employed a least-to-most 

prompt<strong>in</strong>g hierarchy. In this system the least 

<strong>in</strong>trusive prompt is used first <strong>and</strong> more direct 

prompts are used only when the lesser 

prompts fail to produce the desired behavior. 

Cont<strong>in</strong>gent re<strong>in</strong>forcement was used <strong>in</strong> all of 

the studies that <strong>in</strong>cluded prompt<strong>in</strong>g. Cont<strong>in</strong>gent 

re<strong>in</strong>forcement <strong>in</strong>volves provid<strong>in</strong>g the 

participant with a reward (pleasant consequence) 

follow<strong>in</strong>g the occurrence of the target 

behavior. A re<strong>in</strong>forcer can come <strong>in</strong> many 

forms, for example, preferred edible items 

(e.g. H<strong>in</strong>e & Wolery, 2006) or praise from an 

adult (e.g. Barry & Burlew, 2004). When a 

behavior is re<strong>in</strong>forced it is more likely to occur 

aga<strong>in</strong>. 

Some have suggested that approaches that 

<strong>in</strong>volve external re<strong>in</strong>forcement (re<strong>in</strong>forcement 

delivered from the environment) do not 

teach “play” but <strong>in</strong>stead teach a child to 

merely appear to be play<strong>in</strong>g (e.g. Luckett et

al., 2007) because play is <strong>in</strong>ternally motivated 

(Garvey, 1991; Wolfberg, 2003). Several studies 

<strong>in</strong> this review that utilize cont<strong>in</strong>gent re<strong>in</strong>forcement 

also collected ma<strong>in</strong>tenance data. In 

these <strong>in</strong>stances, re<strong>in</strong>forcement was used <strong>in</strong> the 

<strong>in</strong>itial teach<strong>in</strong>g of play behaviors, but was then 

withdrawn when the <strong>in</strong>tervention phase 

ended. The participants <strong>in</strong> these studies cont<strong>in</strong>ued 

to engage <strong>in</strong> the new play behaviors for 

as long as two months without programmed 

external re<strong>in</strong>forcement (e.g. H<strong>in</strong>e & Wolery, 

2006; Ingersoll & Schriebman, 2006). While 

the numbers of participants <strong>in</strong> each of these 

studies are limited, it does suggest play behaviors 

<strong>in</strong>itially paired with external re<strong>in</strong>forcers 

may become “<strong>in</strong>ternally re<strong>in</strong>forc<strong>in</strong>g” over 

time (Nuzzolo-Gomez et al., 2002). 

Another common strategy used <strong>in</strong> both 

functional <strong>and</strong> symbolic play <strong>in</strong>terventions was 

child directed or “naturalistic” <strong>in</strong>struction. Interventions 

conta<strong>in</strong><strong>in</strong>g this component <strong>in</strong>volved 

attend<strong>in</strong>g to the participant’s focus, 

imitat<strong>in</strong>g the participant’s play behaviors, 

identify<strong>in</strong>g toys the participant prefers for use 

<strong>in</strong> the <strong>in</strong>tervention, <strong>and</strong> conduct<strong>in</strong>g the <strong>in</strong>tervention 

<strong>in</strong> a natural play sett<strong>in</strong>g (e.g. on the 

floor as opposed to seated at a desk). Naturalistic 

<strong>in</strong>struction is an <strong>in</strong>tegral part of the Natural 

Language Paradigm (Gillett & Leblanc, 

2007), Reciprocal Imitation <strong>Tra<strong>in</strong><strong>in</strong>g</strong> (Ingersoll 

& Schreibman, 2006), Milieu Teach<strong>in</strong>g 

(Kasari et al., 2006), <strong>and</strong> Integrated Play Therapy 

(Zercher et al., 2001). 

Kasari et al. (2006) evaluated a play <strong>in</strong>tervention 

consist<strong>in</strong>g of all three of the above 

identified components (i.e. model<strong>in</strong>g, 

prompt<strong>in</strong>g with cont<strong>in</strong>gent re<strong>in</strong>forcement, 

<strong>and</strong> naturalistic teach<strong>in</strong>g) <strong>in</strong> a rigorous experimental 

design. Specifically, Kasari et al. r<strong>and</strong>omly 

assigned 58 children with autism between 

3 <strong>and</strong> 4 years old to a play <strong>in</strong>tervention 

group (n 21), a jo<strong>in</strong>t attention <strong>in</strong>tervention 

group (n 20), or a no treatment control 

group (n 17). The impact on play skills 

(<strong>and</strong> jo<strong>in</strong>t attention, although only the result 

related to play will be discussed <strong>in</strong> this review) 

were then compared across the three groups. 

The symbolic play <strong>in</strong>tervention consisted of 

model<strong>in</strong>g, systematic prompt<strong>in</strong>g <strong>and</strong> re<strong>in</strong>forc<strong>in</strong>g 

of play skills followed by milieu teach<strong>in</strong>g. 

The Milieu teach<strong>in</strong>g component of the same 

<strong>in</strong>tervention consisted of (a) follow<strong>in</strong>g the 

child’s lead <strong>and</strong> <strong>in</strong>terest <strong>in</strong> activities, (b) talk- 

<strong>in</strong>g about what the child was do<strong>in</strong>g, (c) repeat<strong>in</strong>g 

back what the child said <strong>and</strong> exp<strong>and</strong><strong>in</strong>g 

on it, (d) stay<strong>in</strong>g close <strong>in</strong> proximity <strong>and</strong> mak<strong>in</strong>g 

eye contact, <strong>and</strong> (e) mak<strong>in</strong>g environmental 

adjustments designed to encourage 

engagement. While all three groups demonstrated 

improvements <strong>in</strong> play over time, the 

group that received the play <strong>in</strong>tervention 

showed significantly more diverse types of play 

<strong>and</strong> a greater overall play level over time compared 

to both the jo<strong>in</strong>t attention <strong>and</strong> the control 

group. Thus the play <strong>in</strong>tervention produced 

significantly more types of symbolic 

play <strong>and</strong> greater overall play than either the 

jo<strong>in</strong>t attention or the control group. 

Despite concerns that the nature of play 

precludes the use of external motivators (re<strong>in</strong>forcement), 

prompt<strong>in</strong>g, <strong>and</strong> modeled examples, 

no recent research has been conducted 

without us<strong>in</strong>g these components <strong>in</strong> 

some manner to teach play skills to children 

with autism. However, recent research does 

suggest that these components may <strong>in</strong> some 

<strong>in</strong>stances be best used with<strong>in</strong> a child-directed 

<strong>in</strong>structional format <strong>and</strong> with<strong>in</strong> natural environments 

(e.g. on the floor as opposed to 

seated at a desk). Additionally, there seems to 

be little difference <strong>in</strong> the manner <strong>in</strong> which 

functional play <strong>and</strong> symbolic play are taught. 

Therefore, when design<strong>in</strong>g any play <strong>in</strong>tervention, 

practitioners should strongly consider <strong>in</strong>corporat<strong>in</strong>g 

the three common components 

of play <strong>in</strong>terventions reviewed above. 

Future Research 

A number of <strong>in</strong>terventions to teach functional 

<strong>and</strong> symbolic play behaviors to children with 

autism have been exam<strong>in</strong>ed <strong>in</strong> the literature. 

This review suggests that the most commonly 

used strategies are model<strong>in</strong>g, systematic 

prompt<strong>in</strong>g with cont<strong>in</strong>gent re<strong>in</strong>forcement, 

<strong>and</strong> naturalistic teach<strong>in</strong>g procedures. Several 

research questions have emerged from this 

review. 

First, no research identified <strong>in</strong> this review or 

<strong>in</strong> past reviews attempts to isolate the effects of 

any one s<strong>in</strong>gle component with<strong>in</strong> a multi-component 

play <strong>in</strong>tervention. H<strong>in</strong>e <strong>and</strong> Wolery 

(2006) evaluated the effects of video model<strong>in</strong>g 

without any additional prompt<strong>in</strong>g or re<strong>in</strong>forcement. 

However, only one of the two participants 

improved. The second participant 


did not improve until cont<strong>in</strong>gent re<strong>in</strong>forcement 

was added (i.e. small edible given follow<strong>in</strong>g 

occurrence of the modeled behavior). 

Such an example demonstrates the necessity 

of a better underst<strong>and</strong><strong>in</strong>g of how to <strong>in</strong>itially 

design these <strong>in</strong>terventions <strong>in</strong> order to be most 

efficient <strong>and</strong> effective. Future research could 

be conducted <strong>in</strong> which common components 

are systematically evaluated <strong>in</strong>dividually <strong>and</strong> 

then <strong>in</strong> t<strong>and</strong>em <strong>in</strong> order to identify the most 

effective <strong>and</strong> parsimonious play <strong>in</strong>tervention 

tailored to the specific characteristics of the 

child. 

Second, many researchers <strong>and</strong> practitioners 

report that stereotypic behavior (e.g. rock<strong>in</strong>g, 

sp<strong>in</strong>n<strong>in</strong>g <strong>and</strong> mouth<strong>in</strong>g toys) often <strong>in</strong>terferes 

with attempts to teach play skills (Baker, 2000; 

Honey, Leekam, Turner, McConachie, 2007; 

Koegel, Firestone, Kramme, & Dunlap; 1974). 

Block<strong>in</strong>g or restrict<strong>in</strong>g these stereotypic behaviors 

may elicit challeng<strong>in</strong>g behavior (e.g. 

tantrum, aggression, self <strong>in</strong>jury) (Green & 

Striefel, 1988) further complicat<strong>in</strong>g play <strong>in</strong>terventions. 

Several of the reviewed studies address 

this issue by collect<strong>in</strong>g data regard<strong>in</strong>g 

challeng<strong>in</strong>g behavior <strong>and</strong> stereotypy while 

evaluat<strong>in</strong>g <strong>in</strong>terventions designed to <strong>in</strong>crease 

play skills (e.g. Gillett & LeBlanc, 2007; Hume 

& Odom, 2007; Paterson & Arco, 2007). 

Results of these studies suggest that a negative 

correlation between stereotypy <strong>and</strong> play 

skills may exist for some children. Evidence of 

such a relationship is also suggested when an 

<strong>in</strong>tervention designed to decrease challeng<strong>in</strong>g 

behaviors also occasions an <strong>in</strong>crease <strong>in</strong> appropriate 

play behaviors (e.g. Koegel et al., 1974). 

When <strong>in</strong>appropriate behavior decreases follow<strong>in</strong>g 

a successful play <strong>in</strong>tervention, the exact 

mechanism of action for the decrease is 

often not apparent beyond the assertion that 

the more time spent play<strong>in</strong>g appropriately 

leaves less time available dur<strong>in</strong>g the session for 

challeng<strong>in</strong>g behavior <strong>and</strong> stereotypy. However, 

this is not always the case. For example, 

Gillett <strong>and</strong> LeBlanc (2007) successfully <strong>in</strong>creased 

play behaviors, but found no difference 

<strong>in</strong> challeng<strong>in</strong>g behavior <strong>and</strong> stereotypy 

between basel<strong>in</strong>e <strong>and</strong> <strong>in</strong>tervention. Such an 

example highlights the need for future research 

concern<strong>in</strong>g the relationship between 

stereotypy, challeng<strong>in</strong>g behavior, <strong>and</strong> play <strong>in</strong> 

children with autism. 

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Received:14 May 2008 

Initial Acceptance: 8 July 2008 



Acquisition <strong>and</strong> Generalization of Cha<strong>in</strong>ed Tasks Taught with 

Computer Based Video Instruction to Children with Autism 

Kev<strong>in</strong> M. Ayres 

The University of Georgia 

Amy Maguire <strong>and</strong> Desiree McClimon 

S<strong>and</strong>box Learn<strong>in</strong>g Co. 

Abstract: Three elementary aged students with autism participated <strong>in</strong> an evaluation of computer based video 

<strong>in</strong>struction that targeted functional life skills. The effects of the software were analyzed <strong>in</strong> the context of a 

multiple probe design across <strong>and</strong> replicated across participants. This study represents a departure from more 

traditional video based <strong>in</strong>struction for <strong>in</strong>dividuals with autism because it comb<strong>in</strong>es video model<strong>in</strong>g as well as 

computer based simulation tra<strong>in</strong><strong>in</strong>g <strong>in</strong> absence of any <strong>in</strong>-vivo <strong>in</strong>struction. All <strong>in</strong>struction took place on the 

computer <strong>and</strong> student’s performance <strong>in</strong> vivo was the primary dependent measure. The participants each 

mastered all the skills they were taught via the computer <strong>and</strong> generalized this to the natural environment. They 

ma<strong>in</strong>ta<strong>in</strong>ed the skills after a two-week follow up. 

Learn<strong>in</strong>g functional life skills is the cornerstone 

of many Individualized <strong>Education</strong> Plans 

for students with autism. A focus on functional 

skill <strong>in</strong>struction allows students the opportunity 

to learn valuable skills that lead to greater 

<strong>in</strong>dependence <strong>and</strong> autonomy (Brown, 1979). 

One of the key features of special education 

services is the ability of educators <strong>and</strong> parents 

to focus <strong>in</strong>struction <strong>and</strong> curriculum on those 

areas where a student needs the greatest 

amount of assistance to <strong>in</strong>crease their <strong>in</strong>dependence. 

In the classroom, prov<strong>in</strong>g student 

with frequent enough practice, sufficient 

guided repetition, <strong>and</strong> opportunities to use a 

wide range of materials to promote generalization 

can be a challenge when a teacher has 

a group of learners with heterogeneous needs 

who all require <strong>in</strong>tensive <strong>in</strong>struction. One solution 

to this logistical challenge is to staff 

more paraprofessionals or teacher’s aides <strong>in</strong> 

the classroom to provide more <strong>in</strong>dividualized 

attention to students. Another solution is to 

plan ways for students to <strong>in</strong>dependently engage 

<strong>in</strong> learn<strong>in</strong>g activities that do not require 

direct teacher supervision. 

Learn<strong>in</strong>g activities centered on functional 

skills <strong>and</strong> supported by video or computer 


be addressed to Kev<strong>in</strong> Ayres, University of Georgia, 

College of <strong>Education</strong>, Department of Special <strong>Education</strong>, 

537 Aderhold Hall, Athens, GA 30602-7153. 



based video <strong>in</strong>struction (CBVI) have a small 

but grow<strong>in</strong>g body of literature support <strong>and</strong> 

may be one way to address students’ needs for 

<strong>in</strong>dividualized <strong>in</strong>struction. The use of CBVI 

takes many forms but relies heavily on the 

grow<strong>in</strong>g body of evidence that suggests video 

can be a powerful teach<strong>in</strong>g tool (Ayres & 

Langone, 2005). For example, Charlop- 

Christy, Le, <strong>and</strong> Freeman (2000) used video 

model<strong>in</strong>g to effectively teach hygiene skills 

(among other pre-academic <strong>and</strong> social skils). 

Alberto, Cihak, <strong>and</strong> Gama (2005) used video 

as an <strong>in</strong>structional tool to teach the use of an 

ATM mach<strong>in</strong>e to middle school aged students. 

Similarly, Sigafoos et al. (2005) employed 

video model<strong>in</strong>g to teach microwave 

use to adults with developmental disabilities. 

Even when students are taught to access video 

<strong>in</strong>dependently (on video tape or DVD), adult 

<strong>in</strong>teraction is still <strong>in</strong>tegral to the <strong>in</strong>struction. 

The role of the adult may not be as a teacher 

per se, but their role is important to the <strong>in</strong>structional 

arrangement because they often 

set up the <strong>in</strong>structional sett<strong>in</strong>g for the video or 

aide the student <strong>in</strong> mov<strong>in</strong>g from video to <strong>in</strong>vivo 

practice. 

CBVI allows greater student <strong>in</strong>dependence 

dur<strong>in</strong>g <strong>in</strong>structional activities because the 

video <strong>in</strong>teractions are mediated by computer 

which provides prompt<strong>in</strong>g (often <strong>in</strong> the form 

of video) <strong>and</strong> an opportunity for the student 

to practice aspects of the target behavior. In 

Computer Based Video Instruction / 493

this way, the <strong>in</strong>struction becomes more of an 

active simulation. In 2004, Simpson, Langone, 

<strong>and</strong> Ayres used CBVI to effectively deliver social 

skills <strong>in</strong>struction to young students with 

autism <strong>in</strong> teach<strong>in</strong>g the students to appropriately 

engage <strong>in</strong> social protocols like turn tak<strong>in</strong>g 

<strong>and</strong> wait<strong>in</strong>g for a turn. Mechl<strong>in</strong>g, Pridgen, 

<strong>and</strong> Cron<strong>in</strong> (2005) used CBVI to teach verbal 

responses to questions that a student would 

encounter <strong>in</strong> fast food restaurant. This particular 

<strong>in</strong>tervention required teacher <strong>in</strong>volvement 

(prompt<strong>in</strong>g <strong>and</strong> error correction) however, 

it provides an example of how as 

technology improves, there is greater potential 

for students to engage <strong>in</strong> more <strong>in</strong>dependent 

learn<strong>in</strong>g activities. In 2007, Mechl<strong>in</strong>g 

<strong>and</strong> Ortega-Hurndon used CBVI to teach 

three complex cha<strong>in</strong>ed tasks to young adults 

with developmental disabilities. Similar to the 

methodology used <strong>in</strong> Mechl<strong>in</strong>g et al. (2005), 

computer controlled the delivery of video <strong>and</strong> 

the teacher assisted with prompt<strong>in</strong>g. Ayres, 

Langone, Boon, <strong>and</strong> Norman (2006) used 

CBVI to teach purchas<strong>in</strong>g skills to middle 

school aged students with <strong>in</strong>tellectual disabilities. 

In this case, all <strong>in</strong>struction <strong>and</strong> prompt<strong>in</strong>g 

were delivered by the computer <strong>and</strong> students 

worked <strong>in</strong>dependently dur<strong>in</strong>g this 

portion of <strong>in</strong>struction. Participants still engaged 

<strong>in</strong> related purchas<strong>in</strong>g skill <strong>in</strong>struction 

with a teacher though. Mitchell, Parsons, <strong>and</strong> 

Leanoard (2007) present one of the most 

technologically advanced examples of comb<strong>in</strong><strong>in</strong>g 

video <strong>and</strong> computer <strong>in</strong>teraction for 

students with autism. They used a virtual reality 

environment to <strong>in</strong>struct teenaged students 

how to <strong>in</strong>teract <strong>in</strong> a café (order food, sit at a 

table etc). In the cases listed above, teachers 

were an <strong>in</strong>tegral part of facilitat<strong>in</strong>g the <strong>in</strong>teractions 

of the student with the technology <strong>and</strong> 

video. With one of the potential values of 

CBVI be<strong>in</strong>g <strong>in</strong>dependent student usage, further 

efforts are needed to exam<strong>in</strong>e how students 

can engage <strong>in</strong> technology based <strong>in</strong>struction 

with their teachers play<strong>in</strong>g a more limited 

role. 

The current study focused on teach<strong>in</strong>g 

cha<strong>in</strong>ed tasks with CBVI without direct 

teacher support. Advances <strong>in</strong> technology have 

revolutionized the types of simulations that 

can be used to supplement or augment <strong>in</strong>struction. 

Tak<strong>in</strong>g note of that, Brown<strong>in</strong>g, 

White, Nave, <strong>and</strong> Bark<strong>in</strong>s (1986) cautioned 

about the importance of similarities of stimuli 

between natural <strong>and</strong> contrived tra<strong>in</strong><strong>in</strong>g environments, 

researchers have cont<strong>in</strong>ued to look 

for ways to improve simulations <strong>in</strong> various 

ways. For example, Cihak, Alberto, Kessler, 

<strong>and</strong> Taber (2004) documented the superior 

efficiency of comb<strong>in</strong>g <strong>in</strong>-vivo <strong>in</strong>struction with 

simulation <strong>in</strong>struction over <strong>in</strong>-vivo or simulated 

<strong>in</strong>struction alone for teach<strong>in</strong>g fax mach<strong>in</strong>e, 

ATM, debit mach<strong>in</strong>e, <strong>and</strong> copy mach<strong>in</strong>e 

use. This implies that students benefit 

greatly from the repeated practice <strong>and</strong> extension 

that simulation tra<strong>in</strong><strong>in</strong>g affords but they 

also need the <strong>in</strong>-vivo <strong>in</strong>struction to ensure efficient 

generalization. 

This <strong>in</strong>vestigation was built around the rationale 

that CBVI is a powerful <strong>in</strong>tervention 

that can present students a range of multiple 

exemplars <strong>and</strong> provide <strong>in</strong>structional prompt<strong>in</strong>g 

<strong>and</strong> feedback. Further, if students are able 

to engage <strong>in</strong> a behavior that is topographically 

related to the criterion behavior (the behavior 

expected <strong>in</strong>-vivo), the behavior may generalize 

to the natural environment without additional 

<strong>in</strong>-vivo <strong>in</strong>struction. This would allow 

teachers the ability to provide <strong>in</strong>dividualize 

<strong>in</strong>structional opportunities to students for 

functional skills while maximiz<strong>in</strong>g time <strong>and</strong> 

reduc<strong>in</strong>g cost on <strong>in</strong>structional materials (e.g. 

food, consumable products) or travel (to appropriate 

<strong>in</strong>-vivo locations <strong>in</strong> the community 

or school). 

The fundamental research question addressed 

<strong>in</strong> this <strong>in</strong>vestigation is whether students 

acquire a functional skill (mak<strong>in</strong>g soup, 

mak<strong>in</strong>g a s<strong>and</strong>wich <strong>and</strong> sett<strong>in</strong>g the table) us<strong>in</strong>g 

CBVI <strong>and</strong> then generalize this skill to an 

<strong>in</strong>-vivo sett<strong>in</strong>g without additional <strong>in</strong>struction. 

Method 

Participants 


This study was approved by school system, 

private, <strong>and</strong> university IRBs. Three participants 

were recruited through the local school 

system as well with the assistance of the Autism 

Society of America <strong>in</strong> a medium sized southern 

city to take part <strong>in</strong> this study. All three 

participants were diagnosed with autism by 

the TEACCH program <strong>in</strong> North Carol<strong>in</strong>a <strong>and</strong> 

had autism special education eligibilities. In 

addition to hav<strong>in</strong>g autism, participants also

had to: consent to participate, have parental 

permission to participate, be elementary 

school aged, have sufficient f<strong>in</strong>e motor skills 

to complete the target tasks, use a mouse to 

move the cursor <strong>and</strong> click on icons, <strong>and</strong> attend 

to a computer screen for at least 10 

m<strong>in</strong>utes. Lastly, all potential participants were 

screened <strong>and</strong> to be <strong>in</strong>cluded <strong>in</strong> this study, 

students had to be perform<strong>in</strong>g below 60% 

<strong>in</strong>dependent (averaged across skills) on the 

tasks targeted by <strong>in</strong>tervention. This liberal criterion 

meant that one student (Stephen) was 

allowed to participate despite demonstrat<strong>in</strong>g 

above 60% <strong>in</strong>dependence for one of the target 

skills. 

Depend<strong>in</strong>g on the school system, different 

st<strong>and</strong>ardized test <strong>in</strong>formation was available to 

the researchers <strong>and</strong> not all exist<strong>in</strong>g <strong>in</strong>formation 

was made available. Therefore caution is 

warranted relative to the generality of f<strong>in</strong>d<strong>in</strong>gs 

to others with autism diagnoses. In the descriptions 

below we have attempted to detail 

as much as possible about the students. The 

first student, Stephan was a 9 year 2 month old 

male student who enjoyed us<strong>in</strong>g the computer. 

He showed stereotypical behavior when 

excited or after successfully complet<strong>in</strong>g tasks 

by flapp<strong>in</strong>g his h<strong>and</strong>s <strong>and</strong> rock<strong>in</strong>g. School 

records <strong>in</strong>dicated that Stephen was perform<strong>in</strong>g 

significantly below grade level <strong>in</strong> academic 

areas <strong>and</strong> that he exhibited characteristics of 

ADHD. The second student, Natalie, was 9 

years <strong>and</strong> 6 months old at the beg<strong>in</strong>n<strong>in</strong>g of 

the study. She had difficulty pay<strong>in</strong>g attention 

to task for long periods of time <strong>and</strong> she was 

especially distracted by other student behavior 

<strong>and</strong> noises. The Bayley Scales of Infant Development 

II (Bayley, 1993) <strong>in</strong>dicated that she 

had an IQ of 53. Her adaptive behavior was 

evaluated with the V<strong>in</strong>el<strong>and</strong> Adaptive Behavior 

Scales (Sparrow, Balla, & Cicchetti, 1984), 

which showed st<strong>and</strong>ard scores of 43 for daily 

liv<strong>in</strong>g, 52 for socialization, 55 for communication 

with a composite of 55. Like Stephan, she 

was highly distractible <strong>and</strong> would occasionally 

walk away from <strong>in</strong>-vivo probes. Dur<strong>in</strong>g the 

game, she wore headphones to reduce distractions. 

The third student, Ray, was a quiet, soft 

spoken 7 year 7 month old boy who would 

respond to greet<strong>in</strong>gs verbally but only after 

be<strong>in</strong>g rem<strong>in</strong>ded. He was very sensitive to sensory 

simulation <strong>and</strong> gagged if he got mustard 

or mayonnaise on his f<strong>in</strong>gers dur<strong>in</strong>g test<strong>in</strong>g. 

Ray would exhibit signs of frustration <strong>and</strong> anxiety 

(wh<strong>in</strong><strong>in</strong>g, mak<strong>in</strong>g faces, <strong>and</strong> not respond<strong>in</strong>g) 

when presented with difficult tasks. He 

enjoyed us<strong>in</strong>g the computer <strong>and</strong> could turn 

on the computer <strong>and</strong> log <strong>in</strong> to his favorite 

games. He had a history of refus<strong>in</strong>g to respond 

to st<strong>and</strong>ardized assessment tests. The 

only test scores available for Ray were from the 

Preschool Language Scale 3 rd Edition (Zimmerman, 

Ste<strong>in</strong>er, & Pond, 1992) that showed 

st<strong>and</strong>ard scores of 68 for auditory comprehension, 

52 for expressive communication with a 

composite score of 56 for language. 

Sett<strong>in</strong>g <strong>and</strong> Instructional Arrangement 

The study took place <strong>in</strong> multiple locations <strong>and</strong> 

<strong>in</strong>cluded both home <strong>and</strong> classroom environments. 

Ray received CBVI <strong>in</strong> his home on a 

W<strong>in</strong>dows computer. Natalie <strong>and</strong> Stephen received 

CBVI <strong>in</strong> their respective classrooms on 

a Mac laptop with an attached mouse. In-vivo 

probes took place <strong>in</strong> the school for Natalie 

<strong>and</strong> Stephen <strong>and</strong> <strong>in</strong> the home for Ray. 

The arrangement of CBVI sett<strong>in</strong>g <strong>and</strong> <strong>in</strong>vivo 

sett<strong>in</strong>g for Ray was <strong>in</strong> his home kitchen 

<strong>and</strong> d<strong>in</strong><strong>in</strong>g room. For Natalie <strong>and</strong> Stephen 

CBVI <strong>and</strong> <strong>in</strong>-vivo sett<strong>in</strong>g were <strong>in</strong> different areas 

of their schools <strong>in</strong>clud<strong>in</strong>g at the classroom 

snack area (all 3 skills), <strong>in</strong> the cafeteria (all 3 

skills), <strong>and</strong> at a picnic table outside (s<strong>and</strong>wich 

<strong>and</strong> sett<strong>in</strong>g the table). 

Materials 

Materials for the <strong>in</strong>-vivo probes varied depend<strong>in</strong>g 

on the task. For prepar<strong>in</strong>g soup, students 

were provided an <strong>in</strong>dividual serv<strong>in</strong>g sized 8oz 

microwavable conta<strong>in</strong>er of soup (Campbell’s 

or Progresso <strong>and</strong> different k<strong>in</strong>ds such as 

chicken <strong>and</strong> stars, vegetable, etc.) situated approximately 

1 ft from a microwave. Each conta<strong>in</strong>er 

had a metal lid (with sharp edges) that 

was removed prior to <strong>in</strong>struction. For mak<strong>in</strong>g 

s<strong>and</strong>wiches, students were provided a cafeteria 

tray with two slices of bread, meat (turkey, 

chicken, bologna, or salami), cheese (Swiss, 

American, baby Swiss, or provolone), <strong>and</strong> a 

condiment (mayonnaise or mustard) <strong>in</strong> a preopened 

s<strong>in</strong>gle serv<strong>in</strong>g package. These materials 

were situated on a tray to the left of the 

food preparation area. After <strong>in</strong>tervention <strong>and</strong> 

once students demonstrated mastery of mak- 


<strong>in</strong>g a s<strong>and</strong>wich, a full bottle of the condiments 

was used from which students would have to 

squeeze an appropriate amount. Dur<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g, 

a pre-opened package was used to reduce 

the chance that f<strong>in</strong>e motor difficulty would 

prevent the student from open<strong>in</strong>g the package 

<strong>and</strong> not complet<strong>in</strong>g the task. F<strong>in</strong>ally, for 

sett<strong>in</strong>g the table, students’ materials were positioned 

to the left of the child <strong>in</strong> r<strong>and</strong>om 

order. Materials <strong>in</strong>cluded with a plate, fork, 

spoon, knife, napk<strong>in</strong>, <strong>and</strong> cup. The specific 

materials varied but <strong>in</strong>cluded paper, plastic, 

<strong>and</strong> ceramic plates; plastic <strong>and</strong> metal flatware; 

cloth <strong>and</strong> paper napk<strong>in</strong>s (folded <strong>in</strong> triangles 

or rectangles; <strong>and</strong> glass, Styrofoam <strong>and</strong> plastic 

cups. 

Dur<strong>in</strong>g CBVI, students sat at a computer 

<strong>and</strong> used a two button mouse to <strong>in</strong>teract with 

the software program called I Can!- Daily Liv<strong>in</strong>g 

<strong>and</strong> Community Skills (S<strong>and</strong>box Learn<strong>in</strong>g 

Company, unpublished) software was developed 

by S<strong>and</strong>box Learn<strong>in</strong>g Company (owned 

by the second <strong>and</strong> third authors). The software 

<strong>in</strong>cluded video models <strong>and</strong> required the 

student to manipulate images on the screen 

that simulated the natural environment. The 

<strong>in</strong>structional procedures <strong>and</strong> <strong>in</strong>teraction are 

detailed <strong>in</strong> the procedures section. 

The images that the student saw dur<strong>in</strong>g 

CBVI consisted of video images filmed from a 

1 st person perspective (c.f. Ayres & Langone, 

2007) which are depicted <strong>in</strong> the left column of 

Figure 1. Videos showed a narrated step-bystep 

walk-through of each target skill. Items 

used <strong>in</strong> the film<strong>in</strong>g mak<strong>in</strong>g a s<strong>and</strong>wich <strong>in</strong>cluded 

two different types of bread (wheat 

<strong>and</strong> white), two types of cheese (Swiss <strong>and</strong> 

cheddar), two condiments (mustard <strong>and</strong> mayonnaise) 

<strong>and</strong> two types of meat (turkey <strong>and</strong> 

bologna). The video for mak<strong>in</strong>g soup used 

two different but similar microwaves <strong>and</strong> three 

different types of soup. The materials filmed 

for the table sett<strong>in</strong>g sequences <strong>in</strong>cluded white 

ceramic <strong>and</strong> white Styrofoam plates, plastic 

<strong>and</strong> sta<strong>in</strong>less steel silverware, a white Styrofoam 

cup <strong>and</strong> a blue plastic cup, <strong>and</strong> white 

<strong>and</strong> orange napk<strong>in</strong>s. These were comb<strong>in</strong>ed <strong>in</strong> 

various comb<strong>in</strong>ations for each skill to produce 

five video examples of each task be<strong>in</strong>g completed. 

The longest video was 1:10 m<strong>in</strong>utes 

(sett<strong>in</strong>g the table). The average video length 

was 50s. 

In addition to video models, students saw 


professionally illustrated materials designed to 

mirror the stimuli they depicted <strong>in</strong> the videos 

(see right column of Figure 1). These materials 

(e.g. a slice of bread) were drawn to facilitate 

programm<strong>in</strong>g the computer game <strong>and</strong> 

allow the programmers maximal control over 

manipulat<strong>in</strong>g movement of the images. Every 

video image had an illustrated counterpart 

that was used dur<strong>in</strong>g the <strong>in</strong>teractive <strong>in</strong>structional 

portion of the program. The students 

manipulated these materials to mirror <strong>in</strong>-vivo 

actions. This will be described <strong>in</strong> the procedures 

section. 

Response Def<strong>in</strong>itions 

In-vivo. All three target behaviors were 

task analyzed (see Table 1) <strong>and</strong> dur<strong>in</strong>g <strong>in</strong>-vivo 

probes, students were presented the task <strong>in</strong> a 

total task format (Alberto & Troutman, 2003) 

whereby they had the opportunity to respond 

correctly or <strong>in</strong>correctly for each <strong>in</strong>dividual 

step of the task analysis regardless of whether 

or not they correctly responded to earlier 

steps of the task analysis. A correct response 

occurred when a student began the response 

with<strong>in</strong> 5s of the task direction (e.g. “Please set 

the table) or with<strong>in</strong> 5s of complet<strong>in</strong>g the previous 

step (e.g. beg<strong>in</strong>n<strong>in</strong>g to place a piece of 

meat on a slice of bread with <strong>in</strong> 5s of plac<strong>in</strong>g 

the bread on the plate) <strong>and</strong> the student the 

student had to complete the step with<strong>in</strong> 5s of 

start<strong>in</strong>g the step. Any other response was 

scored as <strong>in</strong>correct. This <strong>in</strong>cluded not beg<strong>in</strong>n<strong>in</strong>g 

a response soon enough after the task 

request or previous step completion (latency 

error or no response), fail<strong>in</strong>g to complete the 

step with<strong>in</strong> 5s of beg<strong>in</strong>n<strong>in</strong>g the step (duration 

error), or engag<strong>in</strong>g <strong>in</strong> a topographically <strong>in</strong>correct 

behavior given the step on the task analysis 

(topography error). 

In cases where the student made any error 

(latency, duration, topography), the researcher 

stopped the student, blocked the student’s 

view of the task materials, <strong>and</strong> corrected 

or completed the step without allow<strong>in</strong>g 

the student to see what was be<strong>in</strong>g done. The 

rationale beh<strong>in</strong>d this procedure was two fold. 

First, the step was completed or corrected to 

allow the student the opportunity to respond 

correctly to subsequent steps of the task analysis 

rather than term<strong>in</strong>at<strong>in</strong>g the session <strong>and</strong> 

scor<strong>in</strong>g all steps after the error as <strong>in</strong>correct.

Figure 1. Screen captures of the <strong>in</strong>structional software. Images on the left side show screen images of the 

video models. Images on the right column show clips of different parts of the <strong>in</strong>teractive software. 

Second, the completion of one step <strong>and</strong> the 

arrangement of the stimuli are the S D for the 

subsequent steps; therefore, <strong>in</strong> order to evaluate 

student knowledge of the subsequent 

steps, the stimuli had to be properly placed. 

This total task presentation provides a conservative 

estimate of basel<strong>in</strong>e behavior because it 

allows measurement of student performance 

on all steps. 

It is important to note the difference <strong>in</strong> 

latency parameters between <strong>in</strong>-vivo <strong>and</strong> CBVI. 

With <strong>in</strong>-vivo the latency for a correct response 

was 5s whereas on the computer, the latency 

for responses (<strong>and</strong> prompt<strong>in</strong>g) was set at 10s. 


TABLE 1 

Task Analysis of Target Skills 

Sett<strong>in</strong>g the Table Mak<strong>in</strong>g Soup Mak<strong>in</strong>g a S<strong>and</strong>wich 

1. Pick up the plate 1. Open the microwave 1. Pick up a piece of bread 

2. Put the plate on the mat 2. Get the soup 2. Put the bread on the plate 

3. Pick up the napk<strong>in</strong> 3. Put the soup <strong>in</strong> the microwave 3. Pick up the condiment 

4. Put the napk<strong>in</strong> to the left of 4. Close the microwave door 4. Spread the condiment on the 

the plate 

5. Press “Stop/Clear” 

bread 

5. Pick up the fork 

6. Press “Time” 

5. Put the package <strong>in</strong> the trash 

6. Put the fork on the napk<strong>in</strong> 7. Press “1” 

6. Pick up the meat 

7. Pick up the knife 

8. Press “3” 

7. Put the meat on the condiment 

8. Put the knife to the right of 9. Press “0” 

8. Pick up the cheese 

the plate 

10. Press “Start” 

9. Put the cheese on the meat 

9. Pick up the soon 

10. Pick up the bread 

10. Put the spoon to the right of 

the knife 

11. Pick up the cup 

12. Put the cup to above the knife 

<strong>and</strong> spoon 

11. Put the bread on the cheese 

This was a function of software cod<strong>in</strong>g <strong>in</strong> this 

prototype where coord<strong>in</strong>ation of the programm<strong>in</strong>g 

to allow record<strong>in</strong>g <strong>and</strong> multiple “events” 

to take place simultaneously on the computer 

made a 5s latency too short for student response. 

Based on our pilot test<strong>in</strong>g with a 5s 

latency, students did not have a reasonable 

amount of time to identify the appropriate 

target to “click” <strong>and</strong> then <strong>in</strong>itiate mov<strong>in</strong>g the 

mouse toward the target. We found that 10s 

allowed a much more reasonable time. 

Computer Based Video Instruction. Dur<strong>in</strong>g 

CBVI, four responses were scored. Independent 

correct responses were scored if the student 

completed the correct step of the task 

analysis with<strong>in</strong> 10s of the task direction (for 

the <strong>in</strong>itial step) or with<strong>in</strong> 10s of complet<strong>in</strong>g 

the previous step. Prompted corrects were 

scored when students did not respond with<strong>in</strong> 

10s of the task direction or completion of the 

previous step but responded correctly after 

the computer delivered a prompt. Three types 

of prompted corrects were possible: verbal, 

verbal plus model, verbal plus stimulus 

prompt. To have a prompted correct that was 

verbal plus model or verbal plus stimulus 

prompt the student would have to have not 

responded at all to the less <strong>in</strong>trusive levels of 

prompt<strong>in</strong>g. These prompt levels <strong>and</strong> their application 

are def<strong>in</strong>ed below <strong>in</strong> the section detail<strong>in</strong>g 

the <strong>in</strong>structional methodology. Only 


<strong>in</strong>dependent corrects were counted toward 

meet<strong>in</strong>g the mastery criteria. The program 

recorded responses <strong>and</strong> reported the total 

percent <strong>in</strong>dependent correct after the student 

completed the session. 

General Procedures 

In-vivo probes. Students were brought to 

the test<strong>in</strong>g area (part of the classroom, school 

kitchen, or home kitchen), one of the researchers 

(second author) po<strong>in</strong>ted at the materials 

for the task <strong>and</strong> gave the task direction 

(e.g. “Make the soup”). Students were allowed 

5s to beg<strong>in</strong> the response. If they failed to 

beg<strong>in</strong> the response, the researcher shielded 

the student from view<strong>in</strong>g the correct response 

<strong>and</strong> completed the step on the task analysis 

for the student <strong>and</strong> then repeated the task 

direction. This was an attempt to prevent the 

student from acquir<strong>in</strong>g the skill by watch<strong>in</strong>g 

the researcher model the response. In some 

<strong>in</strong>stances, this shield<strong>in</strong>g would not wholly 

keep the participant from see<strong>in</strong>g what occurred. 

For example, several steps of the task 

analyses required the student to pick up an 

object. In these <strong>in</strong>stances, the researcher would 

place her body or clipboard between the student 

<strong>and</strong> the materials, pick up the correct 

material <strong>and</strong> place it <strong>in</strong> the student’s h<strong>and</strong>. 

If students responded <strong>in</strong>correctly or ex-

ceeded the allowable duration for the response, 

the researcher <strong>in</strong>terrupted the response, 

placed the materials <strong>in</strong> the correct 

place for the next step of the task sequence 

<strong>and</strong> repeated the task direction. We believed 

that these efforts were the most prudent way 

to allow students a complete opportunity to 

demonstrate how to perform as many steps of 

the task analysis as possible while recogniz<strong>in</strong>g 

the risk that students might “learn” from the 

<strong>in</strong>tervention of the researcher. After students 

completed the entire task, they were allowed 

to consume whatever food they made if they 

wanted. Sessions for <strong>in</strong>dividual skills lasted approximately 

10 m<strong>in</strong> (shorter once students 

mastered the skills) <strong>and</strong> all three skills were 

probed <strong>in</strong> succession on the same day. 

CBVI procedures. Pilot test<strong>in</strong>g of the software 

with other students with autism revealed 

that the computer <strong>in</strong>terface was <strong>in</strong>tuitive <strong>and</strong> 

that the <strong>in</strong>structions <strong>in</strong> the program (e.g. 

“Now we are go<strong>in</strong>g to watch a video, when the 

video f<strong>in</strong>ishes press the arrow button”; or 

“Now it is your turn, use the mouse to 

______.”) were sufficient to tra<strong>in</strong> students to 

use the software. Because of this previous test<strong>in</strong>g, 

no additional tra<strong>in</strong><strong>in</strong>g was planned or 

needed. The teacher or parent assisted the 

student with logg<strong>in</strong>g <strong>in</strong>to the computer program. 

Once <strong>in</strong> the program, the student 

viewed two narrated video models of the target 

task be<strong>in</strong>g completed. After the first video 

ended, the second video exemplar played. Figure 

1 shows screen captures of videos for each 

skill <strong>in</strong> the left h<strong>and</strong> column. 

Once the student completed view<strong>in</strong>g the 

video models, the program asked them to 

complete the skill <strong>in</strong> a computer simulation. 

Figure 1 shows screen captures of the <strong>in</strong>teractive 

simulation screens for each task. The computer 

displayed an image of all materials on 

the screen <strong>and</strong> then issued a task direction 

(e.g. “Make a s<strong>and</strong>wich”). Students responded 

by us<strong>in</strong>g the mouse to click on items, move 

items across the screen, <strong>and</strong> then click on 

locations to drop or place items. For example, 

part of the <strong>in</strong>-vivo task analysis for mak<strong>in</strong>g a 

s<strong>and</strong>wich consisted of these steps: pick up the 

bread, place the bread on the plate, pick up 

the meat, place the meat on the bread. On the 

computer, these steps were identical. The student 

had to click on the bread to pick it up, 

move the bread to the place, <strong>and</strong> place the 

bread on the plate by click<strong>in</strong>g on the plate. 

The click<strong>in</strong>g response on the bread to pick it 

up was one step of the TA <strong>and</strong> then click<strong>in</strong>g 

the plate to place the bread on the plate was 

another step of the TA. Each of these was 

prompted as needed <strong>in</strong> a modified system of 

least prompts (SLP) <strong>in</strong>structional arrangement 

(Wolery, Ault, & Doyle, 1992). 

Students were allowed 10s to respond us<strong>in</strong>g 

the mouse, if they did not respond, or began 

an <strong>in</strong>correct response (e.g. clicked on the 

wrong item to pick up), the computer stopped 

them <strong>and</strong> delivered the next level <strong>in</strong> the 

prompt hierarchy. The SLP procedure consisted 

of levels: 

1. Independent: student beg<strong>in</strong>s a response 

<strong>and</strong> f<strong>in</strong>ishes the response with<strong>in</strong> 10s of the 

previous step or task direction. 

2. Verbal: computer provides an auditory response 

prompt tell<strong>in</strong>g the student what to 

do (e.g. “Put the bread on the plate”). 

3. Model prompt: computer shows a visual 

response prompt <strong>in</strong> the form of a video 

model where a live actor completes the 

step (identical to the pre-session video 

models). The middle image <strong>in</strong> the right 

column of figure one displays the model 

prompt be<strong>in</strong>g delivered. 

4. Stimulus Prompt: analogous to a “partial 

physical” prompt <strong>in</strong> terms of level of <strong>in</strong>trusion, 

the stimulus prompt created a bright 

yellow “halo” on the location where the 

student needed to click. The image <strong>in</strong> the 

top right of Figure 1 shows the spoon be<strong>in</strong>g 

highlighted. 

5. “Full Physical”: the computer controlled 

the images on the screen <strong>and</strong> completed 

the step for the student. 

If students responded correctly before any 

prompt<strong>in</strong>g was required, the response for that 

step of the TA was scored as <strong>in</strong>dependent. If 

the student did not respond until after a 

prompt, the highest level of prompt required 

for the student to respond correctly was 

scored. If the student made an error, the computer 

prompted them <strong>and</strong> allowed them to 

complete the step, the response was scored 

based on the highest level of prompt required 

<strong>and</strong> a notion was made that the student made 

an error on that step before complet<strong>in</strong>g the 

step. All sessions were scored <strong>and</strong> recorded by 

the computer. 


No programmed re<strong>in</strong>forcement was provided 

for correct responses dur<strong>in</strong>g CBVI. A 

re<strong>in</strong>forcer game was available non-cont<strong>in</strong>gently 

on student performance after the student 

completed the simulation. A teacher, or 

a parent (for Ray <strong>in</strong> the home), supervised all 

CBVI sessions <strong>and</strong> did not provide any feedback 

to the student. They were present only to 

monitor the performance of the computer 

program <strong>and</strong> to keep students on task. Dur<strong>in</strong>g 

the course of the study, students generally 

displayed eagerness to work on the program 

<strong>and</strong> no attention problems were noted. Students 

usually engaged <strong>in</strong> two sessions per day 

with each session last<strong>in</strong>g approximately 5 m<strong>in</strong> 

total. Inter-session <strong>in</strong>tervals varied based on 

school <strong>and</strong> home schedules. 

Experimental Design 

CBVI was evaluated <strong>in</strong> the context of a multiple 

probe design across behaviors <strong>and</strong> replicated 

across students. The sequence of target 

behaviors was counterbalanced across participants. 

Pre/post <strong>in</strong>-vivo probes were used to 

evaluate generalization <strong>and</strong> were the pr<strong>in</strong>ciple 

measure of <strong>in</strong>terest. Pre/Intervention probes 

functioned as the basel<strong>in</strong>e measure. All students 

were evaluated <strong>in</strong>-vivo on all target skills 

prior to receiv<strong>in</strong>g <strong>in</strong>struction on the computer. 

Once their data were stable across at 

least three sessions, each student began computer-based 

<strong>in</strong>tervention on their first skill. 

Once a student responded <strong>in</strong>dependently to 

90% or more of the steps of the task analysis 

dur<strong>in</strong>g CBVI for his or her target skill on at 

least three occasions (consecutive sessions at 

90% were not required), the researcher tested 

for generalization with <strong>in</strong>-vivo probes on all 

skills <strong>and</strong> the student began <strong>in</strong>tervention on 

their next skill. This cont<strong>in</strong>ued until each student 

had received <strong>in</strong>tervention on all target 

skills. The criterion for mov<strong>in</strong>g to <strong>in</strong>-vivo test<strong>in</strong>g 

was set at 90% <strong>in</strong>dependent on three separate 

occasions for multiple reasons. First, we 

wanted to evaluate <strong>in</strong>-vivo performance as 

soon as possible but yet allow adequate acquisition 

time on the computer <strong>and</strong> second we 

wanted students to have an opportunity to 

engage <strong>in</strong> all skills (if possible) as quickly as 

experimentally possible <strong>and</strong> us<strong>in</strong>g a 90% criterion 

seemed like a reasonable compromise. 

Reliability 


The primary observer scored student responses 

dur<strong>in</strong>g the <strong>in</strong>-vivo probes. All <strong>in</strong>-vivo 

sessions were video taped to allow for collection 

of reliability <strong>and</strong> procedural fidelity data. 

Interobserver agreement (IOA) data were 

gathered for student responses as well as procedural 

fidelity. For <strong>in</strong>-vivo sessions, data were 

collected by an observer <strong>in</strong> real time. A second 

observer viewed video of at least 20% sessions 

for each student (mean of 27.69% of all sessions) 

on each skill before <strong>and</strong> after <strong>in</strong>tervention 

<strong>and</strong> scored student behavior as well as 

procedural fidelity. IOA was calculated by divid<strong>in</strong>g 

the number of agreements on student 

responses by the sum of the agreements <strong>and</strong> 

disagreements <strong>and</strong> this number was multiplied 

by 100. Interobserver agreement for 

these averaged 98% with a range of 96.2- 

100%. The disagreements on student performance 

were always a matter of differences <strong>in</strong> 

count<strong>in</strong>g response time. For example, one observer 

saw the student beg<strong>in</strong> the response 

with<strong>in</strong> the specified time frame where as the 

other observer scored the behavior as <strong>in</strong>correct 

because the behavior was on started 

with<strong>in</strong> the allotted time. 

Procedural fidelity was calculated by scor<strong>in</strong>g 

researcher behavior for all critical steps of the 

<strong>in</strong>-vivo probe <strong>in</strong>teraction. These <strong>in</strong>cluded 1) 

sett<strong>in</strong>g out the appropriate materials, 2) provid<strong>in</strong>g 

the student with a verbal <strong>in</strong>struction to 

beg<strong>in</strong> the target task. Then for each step of 

the task analysis, the researchers behavior was 

scored for whether they 3) responded correctly 

to the student action whether they had 

to <strong>in</strong>terrupt an <strong>in</strong>correct response or allow the 

participant to condition, <strong>and</strong> 4) whether or 

not they adhered to the latency limit before 

mov<strong>in</strong>g the student to the next step. Because 

these last two components were scored for 

each step of the task analysis, the total number 

of steps varied based on the skill. The number 

of correctly performed researcher responses 

was divided by the sum of appropriate <strong>and</strong> 

<strong>in</strong>appropriate responses <strong>and</strong> multiplied by 

100. Procedural fidelity was 96.6%, calculated 

by divid<strong>in</strong>g the total number of procedural 

steps followed by the total number of procedural 

steps scripted to be followed <strong>and</strong> then 

multiply<strong>in</strong>g by 100. The procedural steps that 

were not followed were always related to la-

tency <strong>in</strong>tervals <strong>and</strong> the researcher allow<strong>in</strong>g 1-2 

additional seconds for a student to <strong>in</strong>itiate a 

response. 

Dur<strong>in</strong>g <strong>in</strong>tervention, the computer collected 

all data on student responses. Prior to 

deploy<strong>in</strong>g the program, it was extensively 

tested <strong>and</strong> reviewed by the software development 

team <strong>and</strong> the researchers. No procedural 

or scor<strong>in</strong>g errors were reported dur<strong>in</strong>g 

this evaluation. The teacher, researcher or 

parent completed a protocol checklist after 

each session to record any irregularities <strong>in</strong> 

computer function dur<strong>in</strong>g <strong>in</strong>tervention. However, 

with this prototype software, the program 

did not log <strong>and</strong> save student data for 

each session keyed to students’ names <strong>and</strong> dates. 

Results 

Figures 2 through 4 show student performance 

data for <strong>in</strong>-vivo probes. All students 

demonstrated improvement dur<strong>in</strong>g <strong>in</strong>-vivo 

probes follow<strong>in</strong>g mastery of the target skill on 

the computer. The percent of non-overlapp<strong>in</strong>g 

data (PND) from pre-<strong>in</strong>tervention to 

post-<strong>in</strong>tervention <strong>in</strong>-vivo for Stephan <strong>and</strong> Ray 

was 0% for all skills. The PND for Natalie was 

16% for mak<strong>in</strong>g a s<strong>and</strong>wich <strong>and</strong> 0% on sett<strong>in</strong>g 

the table. 

Stephen 

Stephen showed low levels of accurate respond<strong>in</strong>g 

dur<strong>in</strong>g <strong>in</strong>-vivo probes for sett<strong>in</strong>g the 

table with a mean percentage correct of 11% 

(See Figure 2). After he reached criterion on 

the computer simulation <strong>in</strong> six sessions, he 

scored 100% correct on <strong>in</strong>-vivo probes for 

three consecutive sessions after which his performance 

dipped slightly to 92% correct before 

rebound<strong>in</strong>g to 100% <strong>and</strong> back to 92%. 

Two weeks after <strong>in</strong>tervention he responded at 

100% correct for three consecutive sessions. 

Stephen demonstrated slightly higher abilities 

with mak<strong>in</strong>g a s<strong>and</strong>wich. Prior to CBVI, he 

averaged 65% of steps correct. Once he met 

the 90% criteria <strong>in</strong> CBVI <strong>in</strong> 11 sessions, he 

demonstrated complete <strong>in</strong>dependence dur<strong>in</strong>g 

<strong>in</strong>-vivo probes <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong>ed 100% accuracy 

at a two week follow up probe. With micro-wav<strong>in</strong>g 

soup, he showed stable respond<strong>in</strong>g 

<strong>in</strong>-vivo prior to <strong>in</strong>tervention where his mean 

performance was 39% correct. In ten sessions 

of CBVI he met criterion <strong>and</strong> generalized his 

performance to <strong>in</strong>-vivo probes where he responded 

correctly for 100% of the steps across 

three sessions <strong>and</strong> then ma<strong>in</strong>ta<strong>in</strong>ed at 90% 

correct at a two week follow up. 

Natalie 

Natalie’s first skill was mak<strong>in</strong>g a s<strong>and</strong>wich. 

Prior to <strong>in</strong>tervention, she responded at low 

levels averag<strong>in</strong>g 34% correct (See Figure 3). 

The only step she consistently got correct was 

putt<strong>in</strong>g the f<strong>in</strong>al piece of bread on the s<strong>and</strong>wich. 

After she <strong>in</strong>itially met criteria on CBVI 

<strong>in</strong> n<strong>in</strong>e sessions, she demonstrated higher <strong>in</strong>dependent 

performance <strong>in</strong>-vivo by respond<strong>in</strong>g 

correctly for but was not complet<strong>in</strong>g the 

task <strong>in</strong>dependently. The decision was made to 

return to <strong>in</strong>tervention until she met criterion 

aga<strong>in</strong> <strong>and</strong> she also received probes on the 

rema<strong>in</strong><strong>in</strong>g skills <strong>and</strong> began <strong>in</strong>tervention on 

sett<strong>in</strong>g the table. Once Natalie reached criterion 

on mak<strong>in</strong>g a s<strong>and</strong>wich for the second 

time (eight additional sessions) she was 

probed <strong>in</strong>-vivo aga<strong>in</strong> <strong>and</strong> showed more consistently 

high performance than previous <strong>in</strong>-vivo 

probes but she was not respond<strong>in</strong>g at 100%. 

Aga<strong>in</strong> she returned to <strong>in</strong>tervention for four 

sessions <strong>and</strong> then back to <strong>in</strong>-vivo where she 

aga<strong>in</strong> responded better than dur<strong>in</strong>g basel<strong>in</strong>e 

but not at 100%. She consistently <strong>and</strong> correctly 

responded for the f<strong>in</strong>al four steps of the 

task analysis. Her errors were always with the 

first four steps. For sett<strong>in</strong>g the table, Natalie’s 

performance was low <strong>and</strong> stable with a mean 

of 19% <strong>in</strong>dependent dur<strong>in</strong>g <strong>in</strong>-vivo probes. 

Her errors were <strong>in</strong>consistent across sessions. 

Upon beg<strong>in</strong>n<strong>in</strong>g <strong>in</strong>tervention, she responded 

slowly at first <strong>and</strong> ultimately required 20 CBVI 

sessions to meet criterion. She engaged <strong>in</strong> one 

additional CBVI session beyond criteria. In 

post <strong>in</strong>tervention (<strong>and</strong> ma<strong>in</strong>tenance probes) 

she generalized her performance to the natural 

sett<strong>in</strong>g with a mean of 79% of steps correct. 

Natalie did not have enough time to beg<strong>in</strong> 

CBVI for mak<strong>in</strong>g soup because the school year 

ended, however, her performance data rema<strong>in</strong>ed 

low <strong>and</strong> stable throughout the <strong>in</strong>tervention. 

Ray 

The evaluation of performance with the software 

was <strong>in</strong>tended to be conducted <strong>in</strong> the 


Figure 2. Response data for Stephen. Closed circles represent responses <strong>in</strong>-vivo <strong>and</strong> open circles represent 

responses on the computer. 

context of a multiple probe design (like with 

Stephen <strong>and</strong> Natalie), however, it was discovered 

through the session logs on Ray’s computer 

that he likely ga<strong>in</strong>ed access to all three 


<strong>in</strong>structional programs prior to demonstrat<strong>in</strong>g 

mastery on the first skill. In addition, reviews 

of the logs revealed that Ray accessed 

the program three additional times for his

Figure 3. Response data for Natalie. Closed circles represent responses <strong>in</strong>-vivo <strong>and</strong> open circles represent 


first skill (microwav<strong>in</strong>g soup) after he had 

demonstrated mastery. Therefore his graph 

(see Figure 4) essentially reflects three con- 

current AB designs because we believed this 

would be the most conservative way to present 

his data because he could not have access the 


Figure 4. Response data for Ray. Closed circles represent responses <strong>in</strong>-vivo <strong>and</strong> open circles represent 


software until after he completed <strong>in</strong>itial basel<strong>in</strong>e 

test<strong>in</strong>g <strong>in</strong>-vivo. After he saw how to log 

<strong>in</strong>to the software dur<strong>in</strong>g the first session, he 

could then have accessed the program at any 

time <strong>and</strong> on multiple times dur<strong>in</strong>g the same 

day. His data are displayed as if he accessed 


the software for all skills immediately after 

hav<strong>in</strong>g access to it. 

Ray showed low levels of <strong>in</strong>dependent performance 

for micro-wav<strong>in</strong>g soup with a mean 

of 23% correct dur<strong>in</strong>g pre-<strong>in</strong>tervention 

probes. Ray required 19 CBVI sessions to mas-

ter micro-wav<strong>in</strong>g soup after which he demonstrated 

<strong>in</strong>dependent performance dur<strong>in</strong>g the 

first six post <strong>in</strong>tervention <strong>in</strong>-vivo probes. After 

11 sessions on CBVI for mak<strong>in</strong>g soup, Ray’s 

performance had stagnated, he was probed 

for his performance on the rema<strong>in</strong><strong>in</strong>g skills, 

with the <strong>in</strong>tention of beg<strong>in</strong>n<strong>in</strong>g <strong>in</strong>tervention 

on sett<strong>in</strong>g the table. At this time, because of 

the high degree of <strong>in</strong>dependent performance, 

it was discovered that Ray had accessed the 

rema<strong>in</strong><strong>in</strong>g skills on the computer. The computer 

tracked his activity however <strong>and</strong> this 

showed that after 11 sessions of access<strong>in</strong>g 

CBVI for sett<strong>in</strong>g the table, <strong>and</strong> 10 for mak<strong>in</strong>g 

a s<strong>and</strong>wich, Ray had achieved mastery on the 

computer. Dur<strong>in</strong>g pre-<strong>in</strong>tervention probes for 

sett<strong>in</strong>g the table, Ray had averaged 11% correct 

responses <strong>and</strong> dur<strong>in</strong>g post <strong>in</strong>tervention 

he demonstrated a mean of 93%; achiev<strong>in</strong>g 

100% accuracy dur<strong>in</strong>g several sessions. Ray’s 

pre-<strong>in</strong>tervention ability to make a s<strong>and</strong>wich 

was higher relative to the other target skills. 

His pre-<strong>in</strong>tervention performance ranged 

from 36 to 73% correct with a mean of 58%. 

He averaged 93% correct dur<strong>in</strong>g post <strong>in</strong>tervention 

with several sessions at 100% correct. 

Dur<strong>in</strong>g <strong>in</strong>-vivo probes, Ray would regularly 

repeat the verbal prompts from the software 

verbatim. 

Social Validity 

A social validity survey was given to parents, 

teachers, teach<strong>in</strong>g assistants, speech therapists, 

<strong>and</strong> occupational therapists work<strong>in</strong>g 

with the participants. Half of the surveys returned 

were from parents, <strong>and</strong> half were from 

service providers. A 5-po<strong>in</strong>t Likert Scale was 

used (1 strongly disagree; 5 strongly 

agree) for <strong>in</strong>dividuals to respond to attitud<strong>in</strong>al 

questions about the goals <strong>and</strong> procedures 

of the study. Parents <strong>and</strong> professionals felt 

elementary school rather than pre-school, 

middle school, or high school was the time to 

learn these skills (4.4 average). Parents <strong>and</strong> 

professionals would use a version of this game 

to teach other functional skills for <strong>in</strong>dependence, 

work, or leisure (4.8, 4.4, <strong>and</strong> 4.6 average, 

respectively). Professionals were asked additional 

questions about the game but only 

four responses out of the six surveys were 

completed s<strong>in</strong>ce they were not <strong>in</strong>volved <strong>in</strong> 

us<strong>in</strong>g this <strong>in</strong>struction. Overall, professionals 

felt the students enjoyed the game (average 

4.8), but they did not feel it reduced the time 

they would spend teach<strong>in</strong>g mak<strong>in</strong>g a s<strong>and</strong>wich, 

sett<strong>in</strong>g the table, or us<strong>in</strong>g a microwave 

(2.5, 2.8, 2.5, respectively). 

Judg<strong>in</strong>g the social validity of the study outcomes 

came from <strong>in</strong>formal feedback from 

parents. One saw their child microwave someth<strong>in</strong>g 

<strong>and</strong> set the table. Another reported that 

their child used the microwave <strong>and</strong> made a 

s<strong>and</strong>wich. One saw the child complete all of 

the skills. The parents were not asked to <strong>in</strong>volve 

the children <strong>in</strong> these skills at home so 

they were not directly tested <strong>in</strong> this environment. 

In an email one parent wrote, “he has 

talked about sett<strong>in</strong>g the table s<strong>in</strong>ce then. He 

told me just last night that I was putt<strong>in</strong>g the 

napk<strong>in</strong>s on the wrong side of the plate.” Anecdotal 

reports from parents <strong>and</strong> teachers as 

well as observations of students confirmed 

that they enjoyed us<strong>in</strong>g the game. All participants 

wanted to work on the game <strong>and</strong> all 

participants tried to access the other skills <strong>in</strong> 

the game before they mastered the target 

skills on which they were work<strong>in</strong>g. 


To consider us<strong>in</strong>g a computer game to teach a 

functional life skill, seems, on the surface, 

impractical <strong>and</strong> counter<strong>in</strong>tuitive. Results of 

this study demonstrated that it can be accomplished 

<strong>and</strong> that the student will generalize 

the skill to the natural environment. This begs 

the question as to why one would use computer 

technology to teach these skills when 

they might be best taught <strong>in</strong>-vivo us<strong>in</strong>g the 

natural materials. 

Us<strong>in</strong>g technology to teach functional skills 

<strong>in</strong> this way has dist<strong>in</strong>ct advantages that are 

important considerations for <strong>in</strong>struction. 

First, technology is “recyclable” <strong>in</strong> that once 

the lesson is developed (scheduled, program, 

<strong>in</strong>dividualized), the teacher does not have to 

prepare for the lesson <strong>in</strong> the same way every 

time. Similarly, with a lesson that is tightly 

structured <strong>and</strong> delivered reliably through 

technology, the teacher does not have to 

worry about procedural variations that other 

staff may <strong>in</strong>troduce as a child is acquir<strong>in</strong>g a 

skill. For example, if a teacher is teach<strong>in</strong>g a 

student to wash clothes <strong>in</strong> a wash<strong>in</strong>g mach<strong>in</strong>e 

<strong>and</strong> teaches the student to load the clothes, 


turn on the water, wait for the water to reach 

the top, <strong>and</strong> then put <strong>in</strong> the powdered detergent 

but another professional is teach<strong>in</strong>g the 

student to turn the water on <strong>in</strong> the wash<strong>in</strong>g 

mach<strong>in</strong>e, put <strong>in</strong> the soap <strong>and</strong> then load the 

clothes, the student may fail to acquire the 

skill as quickly as he or she would have if they 

were <strong>in</strong>itially taught a s<strong>in</strong>gle correct way to 

complete the task. 

Beyond the computer’s ability to deliver 

consistent <strong>in</strong>struction ad nauseum, it also provides 

the opportunity for <strong>in</strong>dependent learn<strong>in</strong>g. 

The teacher is freed to work 1:1 or <strong>in</strong> 

small groups with other students; perhaps 

other students who are try<strong>in</strong>g to generalize 

what they learned on the computer. In terms 

of generalization, computer <strong>and</strong> video technology 

allow for a wide range of examples to 

be <strong>in</strong>serted <strong>in</strong>to a lesson beyond what a 

teacher could reasonably assemble for use <strong>in</strong> 

the classroom. For example, <strong>in</strong> the current 

study, five different place sett<strong>in</strong>gs comb<strong>in</strong>ations 

were used to teach sett<strong>in</strong>g the table <strong>and</strong> 

these were depicted <strong>in</strong> different sett<strong>in</strong>gs <strong>and</strong> 

on different tables. Technology can br<strong>in</strong>g that 

all <strong>in</strong>to one place <strong>and</strong> allow the teacher to 

control the degree of variability <strong>in</strong> an attempt 

to prompt stimulus generalization. If this sort 

of technology proves to be successful <strong>in</strong> replications, 

it is reasonable to assume, if adopted, 

students would be able to spend more time <strong>in</strong> 

the community work<strong>in</strong>g on social skill related 

tasks that are more difficult to program on a 

computer <strong>and</strong> less time focused on repeated 

trials of functional skills. 

Limitations 

This study attempted to control for threats to 

<strong>in</strong>ternal validity by us<strong>in</strong>g a multiple probe design 

across behaviors <strong>and</strong> then replicat<strong>in</strong>g that 

across participants. The logistics of this design 

made it difficult for one of the students, Natalie, 

to complete all of her target skills; yet, 

<strong>in</strong>tra <strong>and</strong> <strong>in</strong>tersubject replication of effect 

were still demonstrated. More narrowly, to <strong>in</strong>terpret 

these results, one must be cautious of 

the accelerat<strong>in</strong>g basel<strong>in</strong>e data for Natalie on 

mak<strong>in</strong>g a s<strong>and</strong>wich <strong>and</strong>, to a lesser extent on 

sett<strong>in</strong>g the table. Ray also exhibited some variable 

data with some basel<strong>in</strong>es show<strong>in</strong>g slight 

accelerations. 

In terms of research design, Stephen’s re- 


sults document the most conv<strong>in</strong>c<strong>in</strong>g evidence 

that the software was an effective <strong>in</strong>structional 

tool with three demonstrations of effect. To a 

lesser extent, Natalie’s mastery of two of the 

skills she had time to do show promise. Ray’s 

results have to be approached with the greatest 

caution s<strong>in</strong>ce the three AB designs, though 

illustrat<strong>in</strong>g acquisition, fail to achieve the experimental 

control offered by the evaluation 

on Stephen’s data. However, Ray’s violation of 

the procedural protocols <strong>and</strong> access<strong>in</strong>g skills 

that were to rema<strong>in</strong> <strong>in</strong> basel<strong>in</strong>e may yield one 

of the most valuable f<strong>in</strong>d<strong>in</strong>gs of the study. 

Ray’s exploration of the software <strong>and</strong> eagerness 

to engage with the activities may have led 

to him learn the target skills (the experimental 

design does not permit this conclusion to 

be drawn though) <strong>and</strong> be motivational but 

beyond this, his <strong>in</strong>itiative demonstrates the 

ease with which systematically designed software 

can be used by a student without a great 

deal of adult supervision. The design could 

have been tightened more by requir<strong>in</strong>g a criterion 

level of 90% or 100% over three consecutive 

sessions rather than three sessions. 

Admittedly, the decision to use the more relaxed 

criteria (90% <strong>in</strong>dependent or better 

across three sessions) was one of expedience 

than experimental rigor but the results still 

<strong>in</strong>dicated that once students were able to meet 

the criteria, they were able to generalize the 

skill to the natural environment. 

Other limitations that impact the external 

validity of this study <strong>in</strong>clude the availability of 

the software to teachers. Currently this study 

evaluated proprietary software to answer research 

questions about the possibility of teach<strong>in</strong>g 

functional skills with CBVI. However, <strong>in</strong> 

the future, when such software is more widely 

available, teaches will be able to <strong>in</strong>corporate 

this <strong>in</strong>to their <strong>in</strong>struction. Until that time, this 

study does demonstrate that <strong>in</strong>teractive CBVI 

can lead to positive outcomes <strong>and</strong> teachers 

can <strong>in</strong>corporate some of these techniques <strong>in</strong>to 

simple author<strong>in</strong>g tools like IntelliStudio <strong>and</strong> 

even PowerPo<strong>in</strong>t. 

Another limitation that should be considered 

is that, from an <strong>in</strong>structional st<strong>and</strong>po<strong>in</strong>t, 

strictly def<strong>in</strong><strong>in</strong>g the order of steps for mak<strong>in</strong>g 

a s<strong>and</strong>wich may seem arbitrary <strong>and</strong> <strong>in</strong> some 

ways limits the generality of these results. In 

other words, one can make a s<strong>and</strong>wich by 

plac<strong>in</strong>g a slice of bread on a plate, then meat,

then condiments, then cheese <strong>and</strong> then the 

last slice of bread. This is certa<strong>in</strong>ly a socially 

valid way to construct a s<strong>and</strong>wich. However, 

for the purposes of this study, we were <strong>in</strong>terested 

<strong>in</strong> evaluat<strong>in</strong>g whether such tight stimulus 

control could be achieved on the computer 

<strong>and</strong> then generalized to the natural 

sett<strong>in</strong>g. Therefore the sequence of all steps <strong>in</strong> 

all skills became critical. One should note that 

no student, regardless of sequenc<strong>in</strong>g preference 

was able to perform any of the skills <strong>in</strong> 

basel<strong>in</strong>e to the same level of mastery that they 

did follow<strong>in</strong>g <strong>in</strong>tervention. While sequence errors 

were evident dur<strong>in</strong>g pre-<strong>in</strong>tervention 

probes, many of the student errors were latency 

or duration errors. This <strong>in</strong>dicates that 

they would not have been able to perform the 

skills fluently if at all without <strong>in</strong>tervention. 

Lastly, had the software been able to track 

daily student data by session <strong>and</strong> step <strong>and</strong> log 

that <strong>in</strong>formation, we may have been able to 

make data based decisions that could have led 

to faster acquisition. 

Future Directions 

While this study demonstrated the impact of 

CBVI on the acquisition <strong>and</strong> generalization of 

functional skills for three students with autism, 

future <strong>in</strong>vestigations could consider a 

broader range of skills. With<strong>in</strong> CBVI, no consistent 

evidence base exists for what prompt<strong>in</strong>g 

strategy is the best. For example, Mechl<strong>in</strong>g 

<strong>and</strong> Ortega-Hurndon (2007) used a constant 

time delay <strong>and</strong> this study used a modified 

system of least prompts. Future research can 

exam<strong>in</strong>e the relative efficiency of these two 

procedures with<strong>in</strong> the delivery model of CBVI. 

Further research is also warranted for the evaluation 

of how students <strong>in</strong>teract with the software. 

This study required to students to complete 

mouse click<strong>in</strong>g <strong>and</strong> mov<strong>in</strong>g operations 

that were mirrored on the screen as genu<strong>in</strong>e 

movement. With new <strong>in</strong>put computer devices 

becom<strong>in</strong>g available (e.g. N<strong>in</strong>tendo Wii) that 

<strong>in</strong>expensively allow a user to <strong>in</strong>teract with a 

game us<strong>in</strong>g gross <strong>and</strong> f<strong>in</strong>e motor movements 

<strong>in</strong> topographically similar ways one would use 

<strong>in</strong>-vivo, the possibility of allow<strong>in</strong>g a student to 

actually rehearse the motor movements required 

for a task <strong>in</strong>creases <strong>and</strong> may impact 

acquisition. 

Us<strong>in</strong>g technology to teach, specifically, 

CBVI, is not substitute for teacher directed 

<strong>in</strong>-vivo <strong>in</strong>struction. However, if researchers are 

able to consistently document the efficacy of 

CBVI to teach generalized functional skills to 

students with autism <strong>and</strong> <strong>in</strong>tellectual disabilities, 

these can become powerful supplements 

to traditional <strong>in</strong>struction <strong>and</strong> all the classroom 

teacher greater freedom to spend <strong>in</strong>dividual 

time with students. 

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F<strong>in</strong>al Acceptance: 15 December 2008 


Comparison of Self, Other, <strong>and</strong> Subjective Video Models for 

Teach<strong>in</strong>g Daily Liv<strong>in</strong>g Skills to Individuals with 

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

Toni Van Laarhoven, Leslie M. Zurita, Jesse W. Johnson, Katie M. Grider, 

<strong>and</strong> Krist<strong>in</strong> L. Grider 

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

Abstract: This study compared the effectiveness of self-, other-, <strong>and</strong> subjective- video models on teach<strong>in</strong>g daily 

liv<strong>in</strong>g skills to three <strong>in</strong>dividuals with developmental disabilities. Results <strong>in</strong>dicated that all conditions were 

effective <strong>in</strong> promot<strong>in</strong>g <strong>in</strong>dependent correct respond<strong>in</strong>g <strong>in</strong> both <strong>in</strong>structional <strong>and</strong> generalization sett<strong>in</strong>gs <strong>and</strong> that 

the effects ma<strong>in</strong>ta<strong>in</strong>ed over time. Two of the three participants engaged <strong>in</strong> more <strong>in</strong>dependent correct respond<strong>in</strong>g 

when they were taught skills with the other model condition, while the other participant engaged <strong>in</strong> more 

<strong>in</strong>dependent respond<strong>in</strong>g on the target skill when the subjective model condition was the <strong>in</strong>structional procedure. 

However, there were significant differences between the model types when time needed to create the stimulus 

materials was considered. Creation of self-model<strong>in</strong>g materials required almost twice as much time as the other<strong>and</strong> 

subjective-model<strong>in</strong>g materials, which made self-models less cost effective <strong>in</strong> terms of teacher time <strong>and</strong> 

outcomes. 

Video <strong>in</strong>struction is considered a “promis<strong>in</strong>g 

practice” for teach<strong>in</strong>g a variety of skills such as 

cook<strong>in</strong>g, clean<strong>in</strong>g, spell<strong>in</strong>g, social skills, communication, 

as well as other life skills to <strong>in</strong>dividuals 

with developmental disabilities. It <strong>in</strong>volves 

show<strong>in</strong>g learners a video of a model 

(i.e., self, peer, expert, or “first person viewpo<strong>in</strong>t”) 

perform<strong>in</strong>g a skill or skill sequence. 

Typically, these videos are viewed either on a 

television or computer prior to task engagement 

(video model<strong>in</strong>g) <strong>and</strong> the learner is expected 

to perform the skill shortly after view<strong>in</strong>g 

the video. To date, researchers who have 

studied video-based <strong>in</strong>struction have demonstrated 

that it usually results <strong>in</strong> faster skill acquisition 

on the part of the learners <strong>and</strong> that 

the skills can often generalize to untra<strong>in</strong>ed 

sett<strong>in</strong>gs (Ayres & Langone, 2005; Hitchock, 

Dowrick, & Prater, 2003; Mechl<strong>in</strong>g, 2005). 

Although video <strong>in</strong>struction appears to be a 

very effective <strong>in</strong>structional tool, there are 

many variables associated with video <strong>in</strong>struc- 


be addressed to Toni Van Laarhoven, Department 

of Teach<strong>in</strong>g & Learn<strong>in</strong>g, Northern Ill<strong>in</strong>ois University, 

Dekalb, IL 60115-2854. 



tion that need to be evaluated to determ<strong>in</strong>e 

how it can be more efficient <strong>and</strong> effective for 

the learners as well as the educators who will 

be responsible for creation of the materials. 

Research is needed to <strong>in</strong>vestigate the comb<strong>in</strong>ations 

of variables that will result <strong>in</strong> the most 

effective <strong>and</strong> efficient implementation package 

for video-based <strong>in</strong>struction (Cihak, Alberto, 

Kessler, Taber-Doughty, & Gama, 

2006). 

Type of Model (self, other, subjective) 

One of the variables associated with video 

model<strong>in</strong>g that is <strong>in</strong> need of further study <strong>in</strong>volves 

the type of model that is depicted <strong>in</strong> the 

video sequences. Some researchers have used 

self models (Buggey, 2005), peer models 

(Har<strong>in</strong>g, Kennedy, Adams, & Pitts-Conway, 

1987; Lasater & Brady, 1995), adult models 

(Alcantara, 1994; Charlop & Milste<strong>in</strong>, 1989), 

first person or “subjective viewpo<strong>in</strong>t” (where 

video is shown from the perspective of the 

<strong>in</strong>dividual perform<strong>in</strong>g the task) (Schreibman, 

Whalen, & Stahmer, 2000), or a comb<strong>in</strong>ation 

of models (Morgan & Salzberg, 1992; Van 

Laarhoven & Van Laarhoven-Myers, 2006; Van 

Laarhoven, Van Laarhoven-Myers, & Zurita, 

Comparison of Self, Other, <strong>and</strong> Subjective Video Models / 509

2007). Although all of these <strong>in</strong>vestigations resulted 

<strong>in</strong> improved performance, it is unclear 

whether or not one type of model would be 

better than the others or if one type of model 

would be more effective for a particular type 

of skill (e.g., social versus academic skill). 

Self-model<strong>in</strong>g. Video self-model<strong>in</strong>g (VSM) 

is a technique that allows learners to observe 

themselves engag<strong>in</strong>g <strong>in</strong> positive performances 

of a target behavior <strong>and</strong> has been used to 

teach skills such as math (Schunk & Hanson, 

1989), language (Buggey, 1995; 2005), <strong>and</strong> 

social skills (Buggey, 2005; Lonnecker, Brady, 

McPherson, & Hawk<strong>in</strong>s, 1994). Video selfmodel<strong>in</strong>g 

is thought to be effective because 

the learners can view themselves successfully 

perform<strong>in</strong>g a skill that may be difficult. By 

view<strong>in</strong>g their own successful performances, 

the learners are thought to be more <strong>in</strong>terested 

<strong>and</strong> more confident <strong>in</strong> their abilities. The <strong>in</strong>structional 

materials are developed by either 

prompt<strong>in</strong>g the <strong>in</strong>dividual to perform the task 

dur<strong>in</strong>g tap<strong>in</strong>g <strong>and</strong> edit<strong>in</strong>g out the “prompter”, 

or by videotap<strong>in</strong>g the learner over a period of 

time <strong>and</strong> us<strong>in</strong>g only the footage that shows the 

<strong>in</strong>dividual perform<strong>in</strong>g the skill successfully. 

The drawback to this type of model is the time 

required to create the stimulus materials (videos). 

Because the learners serve as their own 

models, a great deal of time must be spent 

edit<strong>in</strong>g out the prompter or edit<strong>in</strong>g footage 

that has been videotaped over an extended 

period of time. 

Other models. Several researchers have used 

models other than the learner to demonstrate 

skills, or to serve as models <strong>in</strong> <strong>in</strong>structional 

videos. Most cite the work of B<strong>and</strong>ura (1977) 

<strong>and</strong> his Social Learn<strong>in</strong>g Theory, which describes 

how humans can learn from observ<strong>in</strong>g others 

engag<strong>in</strong>g <strong>in</strong> behaviors <strong>and</strong> by observ<strong>in</strong>g the 

consequences that follow. Based on this work, 

other models (typically adults) <strong>and</strong> peer models 

have also been used with video-based <strong>in</strong>struction. 

Some researchers have followed the 

work of B<strong>and</strong>ura (1969) <strong>and</strong> have suggested 

that the most effective “other” models are 

those who share common features with the 

learners (e.g., age, gender) <strong>and</strong> have chosen 

peers to serve as <strong>in</strong>structional models. Peer 

models have been used to <strong>in</strong>struct persons on 

community skills (Branham, Coll<strong>in</strong>s, Schuster, 

& Kle<strong>in</strong>ert, 1999; Har<strong>in</strong>g et al., 1987), vocational 

skills (Mart<strong>in</strong>, Mithaug, & Frazier, 


1992), social skills (Nikopoulos & Keenan, 

2004), <strong>and</strong> cook<strong>in</strong>g skills (Bidwell & Rehfeldt, 

2004; Rehfeldt, Dahman, Young, Cherry, & 

Davis, 2003). Videos us<strong>in</strong>g models of other 

<strong>in</strong>dividuals <strong>in</strong>stead of peer models have been 

used for a variety of skills <strong>in</strong>clud<strong>in</strong>g social <strong>and</strong> 

communication skills (Charlop & Milste<strong>in</strong>, 

1989; Charlop-Christy, Le, & Freeman, 2000; 

Conyers, et al., 2004; LeBlanc, et al., 2003), 

daily liv<strong>in</strong>g skills (Van Laarhoven & Van Laarhoven-Myers, 

2006), <strong>and</strong> community skills (Alcantara, 

1994; Ayers & Langone, 2002). Typically, 

the use of other models requires less 

time for material creation because the models 

that are depicted usually have the skills of 

<strong>in</strong>terest <strong>in</strong> their repertoire <strong>and</strong> less edit<strong>in</strong>g 

time is required. However, depend<strong>in</strong>g on the 

age <strong>and</strong>/or cognitive level of the models, peer 

model<strong>in</strong>g can require more time than that of 

adult models. On the other h<strong>and</strong>, it would 

probably require less time than is required for 

the creation of video self models. In one of the 

very few comparative studies that exist with 

video-based <strong>in</strong>struction, Sherer, et al., (2001), 

compared video self-model<strong>in</strong>g with other 

models to teach conversation skills to five children 

with autism. Results <strong>in</strong>dicated that, although 

there was some variability among participants, 

both conditions were equally 

effective <strong>in</strong> terms of percentage correct engagement 

<strong>and</strong> rate of acquisition. 

Subjective models. Another approach that 

m<strong>in</strong>imizes the need for extensive edit<strong>in</strong>g is the 

use of subjective viewpo<strong>in</strong>t models or firstperson 

perspective models. With this approach, 

the learner watches the video as if 

they were complet<strong>in</strong>g the task themselves. 

Typically, there is no model present, but 

rather, learners watch a video that shows what 

it would look like if they were complet<strong>in</strong>g the 

task. Subjective models have been used for 

video <strong>in</strong>struction of various skills, <strong>in</strong>clud<strong>in</strong>g 

self help skills (Norman, Coll<strong>in</strong>s, & Schuster, 

2001), daily liv<strong>in</strong>g skills (Shipley-Benamou, 

Lutzker, & Taubman, 2002), behavior regulation/transition<strong>in</strong>g 

from one activity to the 

next (Schreibman, et al., 2000), <strong>and</strong> cook<strong>in</strong>g 

skills (Graves, Coll<strong>in</strong>s, Schuster, & Kle<strong>in</strong>ert, 

2005). In a comparative study, Ayres <strong>and</strong> 

Langone (2007) compared first-person (subjective) 

models with third-person (other) 

models <strong>and</strong> found that although there was

some variability among participants related to 

efficiency, both models were equally effective. 

Although different types of models have 

been used to teach various skills, several questions 

still rema<strong>in</strong> unanswered <strong>in</strong> the research 

literature. For example, is one type of model 

(self, other, subjective) more conducive or 

more effective <strong>and</strong> efficient for teach<strong>in</strong>g specific 

types of skills to <strong>in</strong>dividuals with disabilities? 

And, are any of the model types more 

cost effective <strong>in</strong> relation to teacher requirements 

(time needed to create materials) <strong>and</strong> 

student outcomes (e.g., time <strong>and</strong> number of 

sessions to criterion; growth between pre- <strong>and</strong> 

post-measures)? 

The purpose of this study was to compare 

different types of models depicted with<strong>in</strong> the 

<strong>in</strong>structional sequences to determ<strong>in</strong>e if there 

were differences regard<strong>in</strong>g the effectiveness of 

each model. Cost benefit or “efficiency analyses” 

were conducted <strong>in</strong> order to assess the 

practical utility of each video-based procedure. 

These “costs” were compared to the accrued 

benefit to the participants as measured 

by the relative effectiveness of each condition. 

Method 

Participant Selection 

Participants were recruited from high school 

programs located <strong>in</strong> the suburbs of Chicago. 

To recruit, a description of the study was emailed 

to teachers <strong>in</strong> several school districts. 

Of those who responded, a follow-up questionnaire 

was sent to: 1) identify specific skills 

for <strong>in</strong>struction, 2) determ<strong>in</strong>e availability of the 

participant, <strong>and</strong> 3) obta<strong>in</strong> personal <strong>in</strong>formation 

for the participant to obta<strong>in</strong> <strong>in</strong>formed 

consent <strong>and</strong> assent. Participants were then selected 

from the pool of respondents based on 

similarity of IQ scores, skills requir<strong>in</strong>g <strong>in</strong>struction, 

<strong>and</strong> scores on pretests. 

Participants 

Two females <strong>and</strong> one male with moderate 

disabilities (IQ range 35–55) between the ages 

of 12–17 participated. All participants came 

from homes where Spanish was the primary 

language, all had similar skills requir<strong>in</strong>g <strong>in</strong>struction, 

<strong>and</strong> all were function<strong>in</strong>g with<strong>in</strong> the 

moderate range of mental retardation. 

Pablo was a 17-year-old high school student 

with Down syndrome who functioned <strong>in</strong> the 

moderate range of mental retardation. His 

full-scale IQ score on the WAIS-III (Wechsler, 

1997) was 40. He received special education 

services <strong>in</strong> a self-conta<strong>in</strong>ed classroom to meet 

his <strong>in</strong>dividualized needs. He was also <strong>in</strong>volved 

<strong>in</strong> a vocational tra<strong>in</strong><strong>in</strong>g program <strong>and</strong> worked 

on skills such as item assembly, wash<strong>in</strong>g tables 

<strong>and</strong> chairs, <strong>and</strong> also worked on functional 

academic skills such as money h<strong>and</strong>l<strong>in</strong>g <strong>and</strong> 

read<strong>in</strong>g. He generally required direct <strong>in</strong>struction 

<strong>and</strong> practice/repetition to acquire or atta<strong>in</strong> 

new <strong>and</strong>/or difficult skills <strong>and</strong> prompt<strong>in</strong>g 

to stay on task. Behaviorally, Pablo was fairly 

even tempered, but did have a tendency to 

exhibit non-compliant behaviors when asked 

to complete tasks that were outside of his normal 

rout<strong>in</strong>e, were unfamiliar, or non-preferred. 

Alanna was a 15-year-old female who functioned 

with<strong>in</strong> the moderate range of mental 

retardation. Her full-scale IQ score on the 

Leiter International Performance Scale-Revised 

(Roid & Miller, 1997) was 30. She received 

special education services <strong>in</strong> a selfconta<strong>in</strong>ed 

classroom where she practiced 

academic skills, basic domestic skills such as 

cook<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g, <strong>and</strong> vocational skills 

such as gather<strong>in</strong>g recycl<strong>in</strong>g <strong>and</strong> sort<strong>in</strong>g <strong>and</strong> 

assembl<strong>in</strong>g piece work. Alanna was quite distractible 

<strong>and</strong> required cue<strong>in</strong>g, prompt<strong>in</strong>g, <strong>and</strong> 

redirection to focus on the task <strong>in</strong> which she 

was engaged, <strong>and</strong> also needed a great deal of 

repetition <strong>and</strong> direct <strong>in</strong>struction to acquire 

new skills. 

Breanne was a 12-year-old girl who was function<strong>in</strong>g 

with<strong>in</strong> the moderate range of mental 

retardation. Although her files <strong>in</strong>dicated that 

the Stanford-B<strong>in</strong>et-Fourth Edition (Thorndike, 

Hagen, & Sattler, 1986) was adm<strong>in</strong>istered 

several years prior to her participation 

<strong>in</strong> the study, there was no IQ score listed. 

However, the report <strong>in</strong>dicated that she was 

function<strong>in</strong>g with<strong>in</strong> the moderate range. Breanne 

received special education services <strong>in</strong> a 

self-conta<strong>in</strong>ed classroom where she was work<strong>in</strong>g 

on functional academic skills such as read<strong>in</strong>g 

sight words, tell<strong>in</strong>g time, count<strong>in</strong>g money, 

as well as daily liv<strong>in</strong>g <strong>and</strong> pre-vocational skills. 

She had a very pleasant personality <strong>and</strong> was 

will<strong>in</strong>g to work hard on whatever task she was 


given. She frequently praised her own work as 

well as the work of others (e.g., “you did it”)! 

Sett<strong>in</strong>g 

Instructional sessions were conducted <strong>in</strong> three 

different areas <strong>in</strong> the school. Cook<strong>in</strong>g hot 

dogs was done <strong>in</strong> a café <strong>in</strong> the school. It was a 

large room that had two l-shaped kitchenettes 

on one wall <strong>and</strong> then long rectangular tables 

or circular-shaped tables spread throughout 

the rema<strong>in</strong>der of the room. The room appeared 

to have been used as a home economics 

room <strong>in</strong> the past. Clean<strong>in</strong>g a s<strong>in</strong>k was done 

<strong>in</strong> a bathroom that was located <strong>in</strong> a “mock 

house” that was <strong>in</strong> the school, <strong>and</strong> chang<strong>in</strong>g 

batteries was done at a d<strong>in</strong><strong>in</strong>g table that was 

connected to the mock house. Once participants 

met criterion (80% <strong>in</strong>dependent correct 

respond<strong>in</strong>g for three consecutive sessions), 

they were assessed on their ability to 

generalize the skill to novel environments 

(sett<strong>in</strong>gs other than those used dur<strong>in</strong>g <strong>in</strong>struction) 

while us<strong>in</strong>g different stimulus materials 

than were used dur<strong>in</strong>g <strong>in</strong>structional sessions 

(e.g., different microwaves, br<strong>and</strong>s of hot 

dogs, cook<strong>in</strong>g equipment, battery-operated 

devices, <strong>and</strong> clean<strong>in</strong>g supplies). The generalization 

sessions for cook<strong>in</strong>g hot dogs were 

conducted <strong>in</strong> the mock house kitchen, clean<strong>in</strong>g 

the s<strong>in</strong>k was done <strong>in</strong> a bathroom that was 

connected to a classroom, <strong>and</strong> chang<strong>in</strong>g batteries 

was done at a table <strong>in</strong> the café. 

Instructional <strong>and</strong> Generalization Stimulus 

Materials 

All video-based materials were developed <strong>in</strong> 

the sett<strong>in</strong>gs where <strong>in</strong>structional sessions took 

place. In addition, participants used a different 

set of materials <strong>in</strong> the <strong>in</strong>structional sessions 

than were used <strong>in</strong> the generalization 

sett<strong>in</strong>gs. For example, Oscar Mayer hot dogs, 

Jewel br<strong>and</strong> buns, a black oven mitt, blackh<strong>and</strong>led 

silverware, a blue plate, <strong>and</strong> a microwave 

<strong>and</strong> refrigerator located <strong>in</strong> the café were 

used for <strong>in</strong>structional sessions for cook<strong>in</strong>g hot 

dogs. Ekrich hot dogs, Wonder hot dog buns, 

a green oven mitt, green-h<strong>and</strong>led silverware, a 

green plate <strong>and</strong> different microwaves <strong>and</strong> refrigerator 

located <strong>in</strong> the mock house were 

used for generalization sessions. For the battery 

tasks, different battery operated devices 

were used <strong>in</strong> <strong>in</strong>structional (i.e., Roomba wall 

unit with D-sized batteries) versus generalization 

conditions (i.e., Tetris h<strong>and</strong>held game 

with AA-sized batteries). The batteries differed 

by br<strong>and</strong> <strong>and</strong> size, as did the types of 

screwdrivers that were used. Similarly, clean<strong>in</strong>g 

buckets that held different br<strong>and</strong>s/colors 

of clean<strong>in</strong>g supplies (i.e., p<strong>in</strong>k sponge, Fantastik 

cleaner, white bucket) were used <strong>in</strong> the 

mock house bathroom for <strong>in</strong>structional sessions 

while a different colored bucket <strong>and</strong> 

clean<strong>in</strong>g supplies were used to clean <strong>in</strong> the 

generalization sett<strong>in</strong>g (bathroom off of a classroom). 

Skills Selected for Instruction 


Each participant was taught three different 

skills (one per <strong>in</strong>structional condition). The 

targeted skills fell with<strong>in</strong> the domestic or daily 

liv<strong>in</strong>g doma<strong>in</strong>, however, each student was 

taught skill sequences from three different 

sub-doma<strong>in</strong>s with<strong>in</strong> the domestic realm (i.e., 

cook<strong>in</strong>g, clean<strong>in</strong>g, ma<strong>in</strong>tenance) to ensure 

that the responses across the skill sequences 

were mutually exclusive <strong>and</strong> <strong>in</strong>dependent of 

one another. These skills <strong>in</strong>cluded cook<strong>in</strong>g a 

microwave hot dog, clean<strong>in</strong>g a bathroom s<strong>in</strong>k, 

<strong>and</strong> us<strong>in</strong>g a screwdriver <strong>and</strong> chang<strong>in</strong>g batteries 

<strong>in</strong> different devices (i.e., a Roomba wall 

unit <strong>and</strong> a h<strong>and</strong>held game). 

Controll<strong>in</strong>g for Task Difficulty <strong>and</strong> Practice 

Effects 

Once several skills were identified for possible 

<strong>in</strong>clusion <strong>in</strong> the study, task analyses were written 

for each sequence <strong>and</strong> four different 

teachers who had been teach<strong>in</strong>g for at least 

two years rated them accord<strong>in</strong>g to complexity 

<strong>and</strong> difficulty (easy, moderately difficult, & 

difficult). They then ranked skills with<strong>in</strong> each 

difficulty level to determ<strong>in</strong>e which skills were 

equivalent <strong>in</strong> terms of complexity. Results of 

the rat<strong>in</strong>gs were used as a guide for determ<strong>in</strong><strong>in</strong>g 

skills to be targeted for <strong>in</strong>struction. In 

addition, participants’ pretest scores were 

used to equate the skills. In order to control 

for participant skill level prior to <strong>in</strong>struction, 

the scores for <strong>in</strong>structional pretests <strong>and</strong> generalization 

pretests were averaged <strong>and</strong> ranked. 

Each participant’s task with the highest score 

was r<strong>and</strong>omly assigned to one of the three

TABLE 1 

Task Assignment Across Type of Model <strong>and</strong> 

Participant 

Participant Self Subjective Other 

Pablo Hot dog Clean s<strong>in</strong>k Batteries 

Alanna Batteries Hot dog Clean s<strong>in</strong>k 

Breanne Clean s<strong>in</strong>k Batteries Hot dog 

different conditions <strong>and</strong> the tasks with the 

lowest scores were assigned to three different 

conditions when possible. To control for practice 

effects, all participants were videotaped 

engag<strong>in</strong>g <strong>in</strong> all three of the tasks prior to 

<strong>in</strong>struction. This was done to reduce the likelihood 

that practice would improve their performance 

with<strong>in</strong> the self model condition. 

Design 

The design for this study was a with<strong>in</strong>-subject 

adapted alternat<strong>in</strong>g treatments design (Wolery, 

Bailey, & Sugai, 1988). It differs from the 

alternat<strong>in</strong>g treatments design <strong>in</strong> that the treatments 

are applied to different but equally difficult, 

<strong>in</strong>dependent behaviors/skills, whereas, 

<strong>in</strong> the alternat<strong>in</strong>g treatments design, the treatments 

are applied to the same behavior/skill. 

With this design, two or more treatment conditions 

are <strong>in</strong>troduced <strong>in</strong> a rapidly alternat<strong>in</strong>g 

fashion with the order of presentation be<strong>in</strong>g 

r<strong>and</strong>omized. Each participant was taught a 

different skill with<strong>in</strong> each condition <strong>and</strong> the 

skills were counter-balanced across conditions 

<strong>and</strong> subjects to control for task difficulty. The 

skills were assigned as <strong>in</strong>dicated <strong>in</strong> Table 1. 

Independent Variables 

Condition 1: Self Model. Participants viewed 

a video-based multimedia sequence of themselves 

engaged <strong>in</strong> the skill prior to task engagement. 

Condition 2: Subjective Model. Participants 

viewed a video-based multimedia sequence 

that was created as if they were perform<strong>in</strong>g the 

skill sequence (i.e., what it would look like 

from a first person perspective). 

Condition 3: Other Model. Participants 

viewed a video-based multimedia sequence of 

another person (an adult female) engag<strong>in</strong>g <strong>in</strong> 

skill sequence prior to task engagement. 

Instructional Materials 

The lead author/experimenter, who is an 

adult female, served as the model for both the 

“other” <strong>and</strong> “subjective” conditions, <strong>and</strong> the 

participants served as their own models dur<strong>in</strong>g 

the “self-model” conditions. Video segments 

were shot <strong>in</strong> the sett<strong>in</strong>gs where <strong>in</strong>struction 

took place. For the “other” condition, a 

comb<strong>in</strong>ation of wide angle (full view of the 

model) <strong>and</strong> a few zoom shots (show<strong>in</strong>g the 

arm of the model reach<strong>in</strong>g for hot dogs) were 

used. When the subjective model was created, 

the videographer placed the camera on the 

lead author’s shoulder while she performed 

the task. The result<strong>in</strong>g materials showed the 

task be<strong>in</strong>g completed from a first person perspective 

<strong>and</strong> usually only the h<strong>and</strong>s of the 

experimenter were shown. For the “self” models, 

each participant was videotaped engag<strong>in</strong>g 

<strong>in</strong> the skill sequence <strong>and</strong> the prompter 

<strong>and</strong>/or mistakes were edited out of the video. 

Aga<strong>in</strong>, to m<strong>in</strong>imize practice effects for the 

self-model conditions, all participants were 

videotaped engag<strong>in</strong>g <strong>in</strong> all three skill sequences; 

however, only one self-model video was 

used for each participant dur<strong>in</strong>g the study. 

Skill sequences (e.g. mak<strong>in</strong>g a microwave 

hot dog) were broken <strong>in</strong>to short video segments 

(for each step). Photos of the most 

salient feature of the steps (e.g., a still of water 

be<strong>in</strong>g squeezed from a sponge) were 

“grabbed” out of the video <strong>and</strong> placed at the 

beg<strong>in</strong>n<strong>in</strong>g of each video segment. Each video 

segment, or each step of the task was edited 

us<strong>in</strong>g P<strong>in</strong>nacle Studio 10.1 (P<strong>in</strong>nacle Systems, 

2005) <strong>and</strong> saved as a separate file <strong>and</strong> 

then later placed on a PowerPo<strong>in</strong>t, 2003 

presentation. Each slide <strong>in</strong> the PowerPo<strong>in</strong>t 

had written directions for each step on the top 

of the screen, the “grabbed” photo visible <strong>in</strong> 

the middle of the screen, <strong>and</strong> narration that 

described the step to be completed. The slide 

show was set so that the participants had to 

move the cursor to the photo <strong>and</strong> use a mouse 

click to view the video <strong>and</strong> a mouse click on a 

hyperl<strong>in</strong>ked “next” button on the bottom 

right of the screen to advance to the next 

slide. Please refer to Figure 1 for an example 

screenshot. 


Figure 1. Screen shot of PowerPo<strong>in</strong>t Slide with 

Embedded Video File. 

Instructional Sessions 

Video model<strong>in</strong>g, or view<strong>in</strong>g the video-based 

sequence prior to task engagement, was used 

for all of the <strong>in</strong>structional sessions. Participants 

sat at a large d<strong>in</strong><strong>in</strong>g table <strong>in</strong> the mock 

house <strong>in</strong> the school <strong>and</strong> <strong>in</strong>dependently navigated 

through the PowerPo<strong>in</strong>t presentation 

that was loaded on a laptop computer. Once 

participants viewed the video sequences, they 

then immediately engaged <strong>in</strong> the <strong>in</strong>structional 

task. 

<strong>Tra<strong>in</strong><strong>in</strong>g</strong> Participants to Use Technology/photos 

Prior to engag<strong>in</strong>g <strong>in</strong> <strong>in</strong>structional sessions, 

each participant was taught to operate the 

laptop <strong>and</strong> to navigate through the Power- 

Po<strong>in</strong>t presentation (i.e., us<strong>in</strong>g a mouse click 

to view the video segment <strong>and</strong> advance to the 

next slide) <strong>in</strong>dependently for two consecutive 

sessions before they engaged <strong>in</strong> the <strong>in</strong>structional 

sessions. 

Data Collection Procedures 

Dur<strong>in</strong>g pre/post-test<strong>in</strong>g, acquisition phases, 

<strong>and</strong> generalization test<strong>in</strong>g, task analytic data 

were collected with correct <strong>and</strong> <strong>in</strong>correct performance 

be<strong>in</strong>g reported on each step of the 

skill sequence. A ‘’ was recorded for <strong>in</strong>dependent 

correct responses, a ‘A’was recorded 

for <strong>in</strong>correct attempts, an ‘N-’ was recorded 

for no attempt, <strong>and</strong> an ‘S-’ was 

recorded for a sequence error. Dur<strong>in</strong>g acquisition 

phases, data were also collected on 


prompt levels <strong>and</strong> a ‘√’ was recorded for each 

prompt given at each step (with a maximum 

of two per step). To obta<strong>in</strong> data on prompt 

levels, a two-level prompt<strong>in</strong>g hierarchy was 

used. In the event of an error or no attempt 

with<strong>in</strong> 5 seconds of the natural discrim<strong>in</strong>ative 

stimulus, participants were given a verbal 

prompt to respond. If the verbal prompt was 

not sufficient to prompt a correct response, a 

gestural or physical prompt was provided (depend<strong>in</strong>g 

on what was necessary for the particular 

step) to ensure correct respond<strong>in</strong>g. 

Dependent Measures 

Percentage of <strong>in</strong>dependent correct responses. 

Participants were assessed on how <strong>in</strong>dependently 

they performed the skills selected for 

<strong>in</strong>struction prior to engag<strong>in</strong>g <strong>in</strong> the <strong>in</strong>structional 

sequences (pretest), dur<strong>in</strong>g <strong>in</strong>struction 

(acquisition), <strong>and</strong> follow<strong>in</strong>g <strong>in</strong>struction (posttest). 

The score was determ<strong>in</strong>ed by divid<strong>in</strong>g 

the number of steps with <strong>in</strong>dependent respond<strong>in</strong>g 

by the total number of steps <strong>in</strong> the 

skill sequence <strong>and</strong> multiply<strong>in</strong>g by 100. Pre/ 

post tests differed from <strong>in</strong>structional sessions 

<strong>in</strong> that participants were expected to perform 

the skill <strong>in</strong> the tra<strong>in</strong><strong>in</strong>g/generalization environment 

without video models. In addition, 

no prompts were delivered dur<strong>in</strong>g test<strong>in</strong>g. If 

participants made errors dur<strong>in</strong>g the test<strong>in</strong>g 

phases, the experimenter asked them to turn 

away or close their eyes as the step with the 

error was completed for them. Post-tests were 

conducted <strong>in</strong> the <strong>in</strong>structional sett<strong>in</strong>g one or 

two days after participants met criterion on all 

three tasks <strong>and</strong> the generalization <strong>and</strong> ma<strong>in</strong>tenance 

post-tests were conducted 1- <strong>and</strong> 6weeks 

follow<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g (<strong>in</strong> environments 

that were different than the <strong>in</strong>structional sett<strong>in</strong>g). 

Percentage of prompts. Participants were assessed 

on the number of external prompts 

they needed to complete the skill sequence 

dur<strong>in</strong>g acquisition phases of the study. The 

score was determ<strong>in</strong>ed by divid<strong>in</strong>g the number 

of prompts given by the total number of 

prompts possible (i.e., two per step) <strong>and</strong> multiply<strong>in</strong>g 

by 100. 

Number of sessions to reach criterion. The acquisition 

criteria for each skill sequence was a 

score of 80% <strong>in</strong>dependent correct responses 

or higher for three consecutive sessions. The

number of <strong>in</strong>structional sessions required for 

the participant to reach criterion was counted 

to determ<strong>in</strong>e if any of the <strong>in</strong>structional conditions 

resulted <strong>in</strong> faster acquisition. 

Percentage of <strong>in</strong>dependent correct responses on 

measures of generalization. Prior to <strong>and</strong> follow<strong>in</strong>g 

<strong>in</strong>struction (at 1- & 6-weeks), participants 

performed the skill <strong>in</strong> novel environments 

without video materials or prompt<strong>in</strong>g to obta<strong>in</strong> 

basel<strong>in</strong>e levels <strong>and</strong> to determ<strong>in</strong>e if their 

skills generalized to untra<strong>in</strong>ed environments 

<strong>and</strong> stimulus materials follow<strong>in</strong>g <strong>in</strong>struction. 

Efficiency measures. An efficiency score was 

computed by consider<strong>in</strong>g the ratio of each 

participant’s growth (from pre-test to posttest) 

to the measured ”cost“ of m<strong>in</strong>utes required 

to create <strong>in</strong>structional materials [i.e., 

(posttest-pretest)/(m<strong>in</strong>utes of preparation)]. 

To determ<strong>in</strong>e the number of m<strong>in</strong>utes of preparation, 

a stop-watch was used to calculate the 

number of m<strong>in</strong>utes to videotape, capture the 

video, edit the video, <strong>and</strong> to prepare the video-based 

<strong>in</strong>structional sequences. 

Data Analysis 

Experimental control was determ<strong>in</strong>ed primarily 

through visual <strong>in</strong>spection of the data <strong>and</strong> 

through comparisons of means for each condition. 

With the adapted alternat<strong>in</strong>g treatments 

design, experimental control is demonstrated 

by a consistent level <strong>and</strong>/or trend 

difference between the <strong>in</strong>terventions (Wolery 

et al., 1988). At a quick glance, one can determ<strong>in</strong>e 

if one <strong>in</strong>tervention is better than the 

other if there is little or no overlap between 

the data paths. In addition, although basel<strong>in</strong>e 

measures are not necessary with the alternat<strong>in</strong>g 

treatments design, the pre/post scores for 

each condition were also compared. 

Reliability 

Additional authors conducted reliability sessions 

for 28% of all sessions (<strong>in</strong>clud<strong>in</strong>g pre/ 

post-tests <strong>and</strong> <strong>in</strong>structional sequences). The 

percentage agreement <strong>in</strong>dex (i.e., number of 

agreements divided by number of agreements 

plus disagreements <strong>and</strong> multiplied by 100) 

was used to calculate <strong>in</strong>terobserver agreement. 

Agreement for <strong>in</strong>dependent correct responses 

averaged 98% (range 93–100). 

Agreement for Instructional prompts across 

sessions resulted <strong>in</strong> a mean score of 95% 

(range 83–100). In addition, the second 

observer collected procedural reliability data 

(Bill<strong>in</strong>gsley, White, & Munson, 1980). These 

measures <strong>in</strong>cluded the follow<strong>in</strong>g: a) check<strong>in</strong>g 

to ensure that the correct condition was be<strong>in</strong>g 

applied to the <strong>in</strong>tended task for each participant, 

b) check<strong>in</strong>g to determ<strong>in</strong>e if the order of 

tasks were presented as stated <strong>in</strong> the research 

protocol, c) check<strong>in</strong>g to make sure that the 

correct stimulus materials were used, <strong>and</strong> d) 

that the prompt<strong>in</strong>g hierarchy was delivered as 

<strong>in</strong>tended. Reliability was calculated by divid<strong>in</strong>g 

number of correct measures by the total 

number of assessed variables <strong>and</strong> multiply<strong>in</strong>g 

by 100. Procedural reliability agreement averaged 

100%. 

Results 

All of the <strong>in</strong>structional procedures were effective 

<strong>in</strong> <strong>in</strong>creas<strong>in</strong>g <strong>in</strong>dependent respond<strong>in</strong>g 

<strong>and</strong>/or decreas<strong>in</strong>g prompt<strong>in</strong>g dur<strong>in</strong>g acquisition 

for all participants, however, some differential 

effects were observed between the conditions. 

Percentage of <strong>in</strong>dependent correct responses. 

When the percentage of <strong>in</strong>dependent correct 

responses were measured across conditions/ 

tasks, the data clearly <strong>in</strong>dicated that all conditions 

or models were effective <strong>in</strong> <strong>in</strong>creas<strong>in</strong>g 

<strong>in</strong>dependent respond<strong>in</strong>g for all participants. 

Dur<strong>in</strong>g acquisition, Pablo <strong>and</strong> Breanne engaged 

<strong>in</strong> more <strong>in</strong>dependent correct respond<strong>in</strong>g 

dur<strong>in</strong>g acquisition with the “other” model 

condition while Alanna engaged <strong>in</strong> more <strong>in</strong>dependent 

respond<strong>in</strong>g dur<strong>in</strong>g the “subjective” 

model condition (see Figure 2). 

Pablo engaged <strong>in</strong> more <strong>in</strong>dependent correct 

respond<strong>in</strong>g when the “other” model condition 

was used (M 87) followed by “self” 

model (M 81) <strong>and</strong> “subjective” model (M 

73). Breanne also had higher <strong>in</strong>dependent 

correct respond<strong>in</strong>g when the “other” model 

was used (M 90) followed by the “subjective” 

model (M 84) <strong>and</strong> then “self” model 

(M 71). Alanna engaged <strong>in</strong> more <strong>in</strong>dependent 

correct respond<strong>in</strong>g when the “subjective” 

model was presented (M 88) followed by 

“self” model (M 69) <strong>and</strong> “other” model 

(M 66). 

Dur<strong>in</strong>g post-test phases, participants no 

longer viewed the videos prior to task engage- 


Figure 2. Percentage of <strong>in</strong>dependent correct respond<strong>in</strong>g across phases <strong>and</strong> participants. 


ment. This was done to determ<strong>in</strong>e if the participants 

improved their <strong>in</strong>dependent correct 

respond<strong>in</strong>g without video-based supports. 

They were tested us<strong>in</strong>g <strong>in</strong>structional materials 

<strong>in</strong> the <strong>in</strong>itial post-test one or two days after 

reach<strong>in</strong>g criterion on all three tasks. They 

were then given a generalization post-test one 

week later <strong>and</strong> aga<strong>in</strong> at six weeks after reach<strong>in</strong>g 

criterion. 

When post-test data were analyzed, Pablo 

cont<strong>in</strong>ued to engage <strong>in</strong> more <strong>in</strong>dependent 

correct respond<strong>in</strong>g with the task he was taught 

us<strong>in</strong>g the “other” video model dur<strong>in</strong>g <strong>in</strong>structional 

<strong>and</strong> generalization post-tests <strong>and</strong> these 

effects ma<strong>in</strong>ta<strong>in</strong>ed over a 6-week period of 

time. Although Breanne also cont<strong>in</strong>ued to 

have more <strong>in</strong>dependent correct respond<strong>in</strong>g 

with the “other” model condition as measured 

by the <strong>in</strong>structional post-tests, she had more 

<strong>in</strong>dependent correct respond<strong>in</strong>g with the 

“subjective” model condition when generalization 

was measured with the generalization 

post-test. However, this was not ma<strong>in</strong>ta<strong>in</strong>ed 

<strong>and</strong> she performed better with the “other” 

model condition at the 6-week ma<strong>in</strong>tenance 

post-test. Alanna cont<strong>in</strong>ued to engage <strong>in</strong> more 

<strong>in</strong>dependent correct respond<strong>in</strong>g when the 

“subjective” model was used as the <strong>in</strong>structional 

method <strong>and</strong> these skills also generalized 

to other sett<strong>in</strong>gs <strong>and</strong> materials <strong>and</strong> were 

ma<strong>in</strong>ta<strong>in</strong>ed over time. 

Although every attempt was made to identify 

tasks of equal difficulty <strong>and</strong> to account for 

skill level prior to <strong>in</strong>struction, the clean<strong>in</strong>g 

s<strong>in</strong>k task appeared to be the most difficult for 

all participants regardless of condition. However, 

each participant engaged <strong>in</strong> that task 

<strong>and</strong> the tasks were counter-balanced across all 

three model<strong>in</strong>g conditions. When the mean 

scores of participants were comb<strong>in</strong>ed accord<strong>in</strong>g 

to the type of model, the “subjective” 

model condition was associated with the highest 

<strong>in</strong>dependent correct respond<strong>in</strong>g dur<strong>in</strong>g 

acquisition (M 82) followed closely by the 

“other” model condition (M 81) <strong>and</strong> the 

“self” model condition (M 74) (see Figure 

3). When the mean scores of participants were 

comb<strong>in</strong>ed across conditions dur<strong>in</strong>g <strong>in</strong>structional 

post-tests, the “other” model condition 

was associated with the highest <strong>in</strong>dependent 

correct respond<strong>in</strong>g (M 98) followed by the 

“subjective” model condition (M 95) <strong>and</strong> 

the “self” model condition (M 88). Similar 

Figure 3. Mean percentages of <strong>in</strong>dependent correct 

respond<strong>in</strong>g across phases <strong>and</strong> conditions. 

results were found with the one-week generalization 

post-tests with the “other” model condition 

be<strong>in</strong>g associated with the highest scores 

(M 92) followed by the “subjective” model 

condition (M 90) <strong>and</strong> the “self” model condition 

(M 86). At the 6-wk test, the “subjective” 

model condition had the highest mean 

scores (M 90) while the “other” <strong>and</strong> “self” 

model conditions were not far beh<strong>in</strong>d (M 

88). Overall, it appears that all three of the 

model<strong>in</strong>g conditions resulted <strong>in</strong> relatively 

high percentages of <strong>in</strong>dependent correct respond<strong>in</strong>g 

across all phases of the study. The 

“other” <strong>and</strong> “subjective” model conditions 

were associated with slightly higher percentages 

of <strong>in</strong>dependent correct respond<strong>in</strong>g dur<strong>in</strong>g 

both acquisition <strong>and</strong> generalization, while 

all three conditions appeared to be somewhat 

similar <strong>in</strong> terms of ma<strong>in</strong>tenance. 

Percentage of prompts. Dur<strong>in</strong>g <strong>in</strong>structional 

sessions, if the participants made errors, a twostep 

error correction prompt<strong>in</strong>g sequence was 

provided if necessary. Follow<strong>in</strong>g errors, participants 

were first given a verbal prompt to perform 

the step. If they responded correctly, no 

additional prompts were given. If the participants 

made another error, a controll<strong>in</strong>g model<strong>in</strong>g 

or physical prompt was delivered to ensure 

correct respond<strong>in</strong>g. As was expected, 

participants received fewer prompts <strong>in</strong> the 

conditions where they had the most <strong>in</strong>dependent 

correct respond<strong>in</strong>g. Pablo <strong>and</strong> Breanne 

received the fewest prompts when the “other” 

model condition was used while Alanna received 

the fewest percentage of prompts when 

the “subjective” model was used. When the 

mean scores were comb<strong>in</strong>ed across participants, 

the “other” model was associated with 


the fewest external prompts (M 11), followed 

by the “subjective” model (M 13) <strong>and</strong> 

“self” models (M 16) (see Figure 4). 

Number of sessions to criterion. To determ<strong>in</strong>e 

if any of the model<strong>in</strong>g conditions were more 

efficient than the others, the number of sessions 

to reach criterion (i.e., three consecutive 

sessions with 80% or higher <strong>in</strong>dependent correct 

responses) was also analyzed. Alanna <strong>and</strong> 

Breanne reached criterion more quickly when 

the “subjective” model was presented, while 

Pablo reached criterion more quickly when 

the “other” model was used. When the mean 

number of sessions were comb<strong>in</strong>ed across participants 

<strong>and</strong> model<strong>in</strong>g conditions, the “subjective” 

<strong>and</strong> “other” model conditions required 

an average of 9.33 sessions to criterion 

while the “self” model condition required an 

average of 11.33 sessions to criterion (see Figure 

5). 

Efficiency measures. In order to determ<strong>in</strong>e 

which of the procedures was more cost effective, 

an efficiency score was calculated by consider<strong>in</strong>g 

the ratio of each participant’s growth 

(from pre-test to post-test) to the measured 

“cost” or m<strong>in</strong>utes that were required to prepare 

the <strong>in</strong>structional materials. This score 

was calculated to determ<strong>in</strong>e if one type of 

model would be more efficient than the others 

<strong>in</strong> terms of teacher/caregiver time to create 

the materials <strong>and</strong> to measure the practical 

utility of each procedure. Results <strong>in</strong>dicated 

that the “other” model condition was more 

cost effective for two of the participants while 

the “subjective” model condition was more 

cost effective for the third participant. With 

the exception of Pablo, the “self” models were 

the least efficient of the models (see Figure 6). 

When the efficiency scores were comb<strong>in</strong>ed 

across participants, the “other” model condition 

was the most efficient (M 1.25), followed 

by the “subjective” model condition 

(M 1.17), <strong>and</strong> f<strong>in</strong>ally the “self” model condition 

(M .61). In essence, each m<strong>in</strong>ute of 

time spent creat<strong>in</strong>g the materials “bought” an 

<strong>in</strong>crease of 1.25 percentage po<strong>in</strong>ts from preto 

post-test scores for the “other” model, 1.17 

percentage po<strong>in</strong>ts for the “subjective” model, 

<strong>and</strong> .61 percentage po<strong>in</strong>ts for the “self” 

model, <strong>in</strong>dicat<strong>in</strong>g that the other <strong>and</strong> subjective 

models were almost twice as efficient as 

the self models. 



In summary, all three of the video models 

were effective at <strong>in</strong>creas<strong>in</strong>g <strong>in</strong>dependent correct 

respond<strong>in</strong>g for all three participants. 

When means were comb<strong>in</strong>ed across conditions, 

the “other” <strong>and</strong> “subjective” models appeared 

to be more effective <strong>and</strong> efficient than 

“self” models across all of the dependent measures. 

The “other” model condition was associated 

with somewhat higher scores <strong>in</strong> terms 

of <strong>in</strong>dependent correct respond<strong>in</strong>g for two of 

the participants for acquisition, ma<strong>in</strong>tenance, 

<strong>and</strong> generalization, while the other participant 

performed better dur<strong>in</strong>g acquisition, 

ma<strong>in</strong>tenance, <strong>and</strong> generalization when the 

“subjective” model was used. Fewer external 

prompts were also used for two of the participants 

when the “other” model condition was 

<strong>in</strong> place while the third participant required 

fewer external prompts when the “subjective” 

model condition was <strong>in</strong> place. When the number 

of sessions to reach criterion were evaluated, 

two of the participants met criterion 

faster when the “subjective” model was presented 

while the third participant met criterion 

faster when the “other” model condition 

was <strong>in</strong> place. In addition, both the “other” <strong>and</strong> 

“subjective” models were far more efficient 

than “self” models when the time to create the 

materials were considered <strong>in</strong> relation to the 

amount of growth under each condition. 

Self models appeared to be the least effective 

of all the model types across the different 

dependent measures, <strong>in</strong> particular, when the 

efficiency scores were calculated. Because the 

participants served as their own models <strong>and</strong> 

were not adept at perform<strong>in</strong>g the skill sequences, 

the videotap<strong>in</strong>g <strong>and</strong> edit<strong>in</strong>g necessary 

for the development of the “self” model<strong>in</strong>g 

materials required far more time than the 

“other” <strong>and</strong> “subjective” models, thus mak<strong>in</strong>g 

it less efficient. This is an important f<strong>in</strong>d<strong>in</strong>g 

especially consider<strong>in</strong>g that a frequent criticism 

of video-based <strong>in</strong>struction is that the time 

to create the materials is a shortcom<strong>in</strong>g that 

prevents its widespread use <strong>in</strong> applied sett<strong>in</strong>gs. 

To reduce this limitation, it makes sense to 

use models that are more efficient <strong>and</strong> cost 

effective <strong>and</strong> perhaps us<strong>in</strong>g “other” or “subjective” 

models when teach<strong>in</strong>g functional 

skills is the most logical <strong>and</strong> practical approach. 

In addition, us<strong>in</strong>g video-based mate-

Figure 4. Percentage of prompts across participants <strong>and</strong> conditions. 


Figure 5. Number of sessions to criterion across 

participants <strong>and</strong> conditions. 

rials that present “other” <strong>and</strong> “subjective” 

models has the added advantage of be<strong>in</strong>g used 

across learners whereas “self” models do not. 

In addition to be<strong>in</strong>g less efficient <strong>in</strong> terms 

of the time required to create the <strong>in</strong>structional 

materials, “self” models also resulted <strong>in</strong> 

lower scores when <strong>in</strong>dependent correct respond<strong>in</strong>g 

was analyzed across participants. 

One surpris<strong>in</strong>g outcome of this study was that 

the participants seemed to respond somewhat 

differently when they viewed the “self” models 

versus the “other” or “subjective” models. Although 

they were excited to see themselves on 

the computer <strong>and</strong> would often say th<strong>in</strong>gs like, 

“Look! That’s me!”, they also often commented 

on th<strong>in</strong>gs that were unrelated to the 

task. For <strong>in</strong>stance, Pablo frequently po<strong>in</strong>ted 

out the bruise on his arm <strong>in</strong> the hot dog video 

<strong>and</strong> then wanted to discuss how he got it from 

fight<strong>in</strong>g with his brother. Alanna <strong>and</strong> Breanne 

frequently commented on the clothes they 

were wear<strong>in</strong>g <strong>in</strong> the video (e.g., “That’s my 

favorite shirt”, “I’m wear<strong>in</strong>g that same outfit 

today!”) <strong>and</strong> they all seemed to attend more to 

the irrelevant stimuli that were present <strong>in</strong> the 

“self” model videos rather than the task that 

Figure 6. Efficiency measures across participants 

<strong>and</strong> conditions. 


was be<strong>in</strong>g presented. A possible explanation 

for the lower mean scores with <strong>in</strong>dependent 

correct respond<strong>in</strong>g with the self model<strong>in</strong>g 

tasks might be attributed to the fact that the 

participants were “star struck” <strong>and</strong> were attend<strong>in</strong>g 

to themselves or what they were wear<strong>in</strong>g 

<strong>in</strong> the videos rather than the task that was 

be<strong>in</strong>g presented. 

Although all of the video models appeared 

to be effective, one limitation to the study is 

that the participants performed less well when 

they were clean<strong>in</strong>g the s<strong>in</strong>k. This was def<strong>in</strong>itely 

a non-preferred task for all of the participants 

<strong>and</strong> it appeared to be somewhat 

more difficult than the other tasks regardless 

of the type of model that was used. Pablo <strong>and</strong> 

Alanna, <strong>in</strong> particular, did not like clean<strong>in</strong>g the 

s<strong>in</strong>k <strong>and</strong> often verbalized their displeasure 

with hav<strong>in</strong>g to clean it. Pablo often engaged <strong>in</strong> 

avoidance behaviors dur<strong>in</strong>g the task (e.g., pretend<strong>in</strong>g 

to dry his h<strong>and</strong>s on the heat<strong>in</strong>g vents; 

frequently adjust<strong>in</strong>g the bl<strong>in</strong>ds on the bathroom 

w<strong>in</strong>dow to obta<strong>in</strong> the best light; repeatedly 

wr<strong>in</strong>g<strong>in</strong>g the sponge with exaggerated 

force), <strong>and</strong> although his antics were quite 

amus<strong>in</strong>g at times, prompts often needed to be 

delivered to get him to complete the next step 

<strong>in</strong> the task sequence <strong>and</strong> this resulted <strong>in</strong> fewer 

steps with <strong>in</strong>dependent correct respond<strong>in</strong>g. 

Alanna also would throw the sponge <strong>in</strong> the 

s<strong>in</strong>k after she completed a few steps <strong>and</strong> would 

declare that she “was done”. In addition, the 

clean<strong>in</strong>g task was probably more difficult because 

the stimulus/response relationships 

were less clear than with the other tasks. For 

example, once the hot dog was <strong>in</strong> the microwave, 

it was more clear that the next response 

would be to set the timer, whereas, after wip<strong>in</strong>g 

the <strong>in</strong>side of the s<strong>in</strong>k, the next step was 

not as obvious. However, all of the participants 

were required to engage <strong>in</strong> this task <strong>and</strong> 

each model type was represented. By comb<strong>in</strong><strong>in</strong>g 

the means across dependent measures it 

was possible to identify the differential effects 

of each of the model<strong>in</strong>g conditions. 

Although all the video models <strong>in</strong>creased 

<strong>in</strong>dependent respond<strong>in</strong>g across tasks, they 

were used <strong>in</strong> conjunction with a two step 

prompt<strong>in</strong>g sequence. As a result of us<strong>in</strong>g this 

comb<strong>in</strong>ation, it cannot be stated that the 

video model<strong>in</strong>g procedures alone were responsible 

for the changes <strong>in</strong> student respond<strong>in</strong>g. 

Future research might be directed at <strong>in</strong>-

vestigat<strong>in</strong>g use of the video sequences <strong>in</strong> 

isolation rather than <strong>in</strong> conjunction with a 

prompt<strong>in</strong>g system (e.g., system of least 

prompts) or with<strong>in</strong> the context of fad<strong>in</strong>g approaches 

(gradually fad<strong>in</strong>g out video models). 

Research on video-based <strong>in</strong>struction to date 

has <strong>in</strong>volved the use of different types of models 

to teach a broad range of skills; however, 

several questions still rema<strong>in</strong> unanswered <strong>in</strong> 

the research literature. For example, is one 

type of model (self, other, subjective) more 

conducive or more effective <strong>and</strong> efficient for 

teach<strong>in</strong>g specific types of skills to <strong>in</strong>dividuals 

with disabilities? Are different skill categories 

(academic/cognitive, social/communicative, 

<strong>and</strong> behavioral/self-regulatory skills), more 

conducive to specific types of models when 

teach<strong>in</strong>g <strong>in</strong>dividuals with disabilities? And, depend<strong>in</strong>g 

on the type of skill that is taught, are 

any of the model types more cost effective <strong>in</strong> 

relation to teacher requirements (time 

needed to create materials) <strong>and</strong> student outcomes 

(e.g., time <strong>and</strong> number of sessions to 

criterion; rate of acquisition)? Future research 

should focus on answer<strong>in</strong>g these questions, as 

well as others, to ensure that the most efficient 

<strong>and</strong> effective models are used to improve the 

practicality <strong>and</strong> efficacy of video-based <strong>in</strong>struction 

across different types of tasks <strong>and</strong> populations. 

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Received: 14 May 2008 


F<strong>in</strong>al Acceptance: 12 November 2008 


Parental Stress <strong>and</strong> Autism: 

Are There Useful Cop<strong>in</strong>g Strategies? 

G. Richmond Mancil 

University of Louisville 

Pena Bedesem 

University of Central Florida 

Brian A. Boyd 

University of North Carol<strong>in</strong>a at Chapel Hill 

Abstract: Accord<strong>in</strong>g to previous researchers, parents of children diagnosed with Autism Spectrum Disorders 

(ASD) consistently report more stress than parents of typically develop<strong>in</strong>g children or children with other 

developmental disorders (e.g., Down syndrome). This has peaked <strong>in</strong>terest <strong>in</strong> the field <strong>in</strong> a related area, that 

be<strong>in</strong>g, identify<strong>in</strong>g the cop<strong>in</strong>g strategies parents use to deal with the stressors of rear<strong>in</strong>g a child on the autism 

spectrum. The available literature on cop<strong>in</strong>g strategies primarily has focused on <strong>in</strong>terview<strong>in</strong>g parents to f<strong>in</strong>d out 

what strategies they currently use <strong>and</strong> if these are effective, which has resulted <strong>in</strong> mixed f<strong>in</strong>d<strong>in</strong>gs. A selected 

synthesis of the stress literature perta<strong>in</strong><strong>in</strong>g to cop<strong>in</strong>g strategies is provided to highlight the high levels of reported 

stress already experienced by families of children with ASD <strong>and</strong> what strategies the parents report aid them <strong>in</strong> 

cop<strong>in</strong>g with the stress. This literature review is presented for two purposes: (a) highlight relevant f<strong>in</strong>d<strong>in</strong>gs <strong>and</strong> 

methodological issues with current research, <strong>and</strong> (b) discuss implications for researchers <strong>and</strong> practitioners 

work<strong>in</strong>g with children with ASD <strong>and</strong> their families who exhibit <strong>in</strong>creased levels of stress. 

Accord<strong>in</strong>g to previous researchers, parents of 

children diagnosed with Autism Spectrum Disorders 

(ASD) consistently report more stress 

than parents of typically develop<strong>in</strong>g children 

(Dyson, 1993; Wolf, Noh, Fisman, & Speechley, 

1989) <strong>and</strong> children with other developmental 

disorders (e.g., Down syndrome) 

(Boyd, 2002; S<strong>and</strong>ers & Morgan, 1997). Further, 

parents of children with ASD report 

more symptoms of anxiety <strong>and</strong> marital dissatisfaction 

than parents of children with other 

types of disabilities (Dunn, Burb<strong>in</strong>e, Boers, & 

Dunn, 2001; Holroyd & McArthur, 1976; Konstantareas 

& Homatidis, 1989). Researchers 

purport that the treatment of children with 

ASD may be compromised when parents are 

experienc<strong>in</strong>g overwhelm<strong>in</strong>g levels of stress, 

exhibit<strong>in</strong>g symptoms of psychopathology 

(e.g., anxiety, depression), or hav<strong>in</strong>g difficulty 

liv<strong>in</strong>g with <strong>and</strong> rear<strong>in</strong>g their child with ASD 


be addressed to G. Richmond Mancil, Kentucky 

Austism <strong>Tra<strong>in</strong><strong>in</strong>g</strong> Center, College of <strong>Education</strong> <strong>and</strong> 

Human Development, University of Louisville, Louisville, 

KY 40292. Email: rich.mancil@louisville.edu 



(Robb<strong>in</strong>s, Dunlap, & Plienis, 1991). Thus, effective 

treatments for this population must 

provide support to parents as well as their 

children. However, little is known about cop<strong>in</strong>g 

strategies parents employ to effectively 

deal with these various stressors or how to 

design effective parental education programs 

to combat perceived stressors. 

The available literature on cop<strong>in</strong>g strategies 

for parents of children with autism primarily 

has focused on <strong>in</strong>terview<strong>in</strong>g parents to f<strong>in</strong>d 

out what strategies they currently use <strong>and</strong> if 

these are effective. Previous researchers have 

found that parents used a variety of strategies 

to cope with stressors related to hav<strong>in</strong>g a child 

with autism. Parents noted that professional 

services (Donovan, 1988) <strong>and</strong> spousal support 

(Higg<strong>in</strong>s, Bailey, & Pearce, 2005) are effective 

cop<strong>in</strong>g strategies. Others have reported that 

plann<strong>in</strong>g appropriate responses to challeng<strong>in</strong>g 

behavior (e.g., if the child tantrums, I will 

ignore the behavior) <strong>and</strong> keep<strong>in</strong>g children 

with ASD <strong>and</strong> comorbid behavior challenges 

separated from sibl<strong>in</strong>gs also helps (Gray, 

2003). Still others have noted that extended 

family support <strong>and</strong> social withdrawal decrease 

Stress <strong>and</strong> Autism / 523

stress (1994). The parents expla<strong>in</strong>ed it was 

easier to keep to themselves <strong>and</strong> avoid embarrass<strong>in</strong>g 

<strong>in</strong>cidents (e.g., tantrum) that results <strong>in</strong> 

stares <strong>and</strong> comments from others. Given the 

variety of cop<strong>in</strong>g strategies reported by parents, 

it is not surpris<strong>in</strong>g that conflict<strong>in</strong>g research 

f<strong>in</strong>d<strong>in</strong>gs exist. For example, Erguner- 

Tek<strong>in</strong>alp <strong>and</strong> Akkok (2004) found social 

support was not an effective cop<strong>in</strong>g strategy 

for parents of children with autism. In contrast, 

the sample of parents <strong>in</strong> the study by 

Dunn et al. (2001) reported that social supports 

were effective cop<strong>in</strong>g mechanisms for 

deal<strong>in</strong>g with the daily stress of rear<strong>in</strong>g a child 

with autism. These discrepancies may be related 

to the differences between studies, 

which <strong>in</strong>cluded socio-economic status, parent 

occupation, parent education, age of child, 

<strong>and</strong> severity of the child. However, the researchers 

did not provide any data expla<strong>in</strong><strong>in</strong>g 

possible reasons for differences. In addition to 

conflict<strong>in</strong>g f<strong>in</strong>d<strong>in</strong>gs, some of the strategies 

parents report as effective may only be provid<strong>in</strong>g 

short term solutions <strong>and</strong> although temporarily 

effective may have unanticipated longterm 

outcomes. For example, the parents who 

keep children separated from sibl<strong>in</strong>gs <strong>and</strong> use 

social withdrawal as a means to cope may experience 

decreased levels of stress at first; 

however, this approach only temporarily displaces 

the problem, result<strong>in</strong>g <strong>in</strong> stress later 

that may be much worse <strong>in</strong> severity (Beck, 

1995). In addition, the separation from sibl<strong>in</strong>gs 

<strong>and</strong> social withdrawal may <strong>in</strong>hibit improvement 

<strong>in</strong> the social communicative behaviors 

of their children with ASD (Quill, 

1995). 

Although the aforementioned researchers 

have questioned parents regard<strong>in</strong>g what cop<strong>in</strong>g 

strategies they f<strong>in</strong>d effective for deal<strong>in</strong>g 

with stressors related to rear<strong>in</strong>g a child with 

ASD, there is sparse research on design<strong>in</strong>g 

educational or counsel<strong>in</strong>g programs to help 

parents cope with these various stressors. 

Some research has exam<strong>in</strong>ed the correlation 

between child, parent, <strong>and</strong> environmental 

characteristics <strong>and</strong> that of parent stress 

(Bishop, Richler, Ca<strong>in</strong>, & Lord, 2007; Mash & 

Johnston, 1990). Mash <strong>and</strong> Johnston’s f<strong>in</strong>d<strong>in</strong>gs 

suggest that child characteristics are the 

primary contributor to parent-child stress <strong>in</strong> 

families of hyperactive children. In addition, 

they found that parental cognitions <strong>in</strong>fluence 

parent behavior, which then can effect the 

parents’ relationships with their children. 

However, this has not been connected to educational 

or counsel<strong>in</strong>g services for parents of 

children on the autism spectrum. 

In summary, researchers have noted elevated 

stress levels <strong>in</strong> parents of children with 

ASD s<strong>in</strong>ce the 1970s (Lilly, 1977) <strong>and</strong> the 

need to address the problem, but much less 

<strong>in</strong>formation is known about effective cop<strong>in</strong>gs 

strategies. Therefore, the purpose of this paper 

is to (a) review the literature on cop<strong>in</strong>g 

strategies parents of children with ASD use to 

deal with various stressors, <strong>and</strong> (b) discuss 

implications for researchers <strong>and</strong> practitioners 

work<strong>in</strong>g with children with ASD <strong>and</strong> their 

families who exhibit <strong>in</strong>creased levels of stress. 

Method 


The literature review conducted on cop<strong>in</strong>g 

strategies for parents of children with ASD 

began with a search of electronic databases 

(ERIC, <strong>Education</strong>, PsycINFO, <strong>and</strong> Academic 

Search Premier) us<strong>in</strong>g various comb<strong>in</strong>ations 

of the follow<strong>in</strong>g keywords: autism, autism 

spectrum disorders, aspergers syndrome, pervasive 

developmental disabilities, children, 

cop<strong>in</strong>g strategies, family, mothers, fathers, 

parents, sibl<strong>in</strong>gs, <strong>and</strong> stress. Follow<strong>in</strong>g the 

electronic data base search, a h<strong>and</strong> search was 

conducted of the follow<strong>in</strong>g journals: American 

Journal of Mental Retardation, Journal of 

Autism <strong>and</strong> <strong>Developmental</strong> Disorders, Family 

Process, Journal of Abnormal Child Psychology, 

American Journal of Mental Deficiency, 

Community Mental Health Journal, <strong>and</strong> Focus 

on Autism <strong>and</strong> Other <strong>Developmental</strong> <strong>Disabilities</strong>. 

F<strong>in</strong>ally, after review<strong>in</strong>g the retrieved articles, 

an ancestral search was conducted. 

These searches produced <strong>in</strong> excess of 50 articles, 

19 of which met the follow<strong>in</strong>g predeterm<strong>in</strong>ed 

<strong>in</strong>clusion criteria: (a) reported empirical 

f<strong>in</strong>d<strong>in</strong>gs or a summary of those f<strong>in</strong>d<strong>in</strong>gs 

on familial stress <strong>and</strong> cop<strong>in</strong>g strategies to help 

reduce stress, (b) focus of study was families 

with children who have a diagnosis of ASD, 

<strong>and</strong> (c) published <strong>in</strong> a peer-reviewed journal. 

The 19 articles that met the criteria were 

reviewed to determ<strong>in</strong>e what cop<strong>in</strong>g strategies 

were effective for parents of children with 

ASD. Particularly, the studies were analyzed to

determ<strong>in</strong>e the characteristics of parents, children, 

<strong>and</strong> major f<strong>in</strong>d<strong>in</strong>gs across studies. 

Results 

Characteristics of Study Participants 

Parent characteristics. As outl<strong>in</strong>ed <strong>in</strong> Table 

1, there were 594 parents across studies. The 

majority of researchers reported the mean 

chronological age of parents by gender. In 

addition, most studies <strong>in</strong>cluded the education 

level of parents, with only a few <strong>in</strong>clud<strong>in</strong>g 

additional <strong>in</strong>formation on the number of children 

<strong>in</strong> the household. The reported ages of 

mothers across studies ranged from 25 to 67 

years, with the mean ages rang<strong>in</strong>g from 32.46 

to 42.4 years (see Table 1). Similarly, the reported 

ages of fathers across studies ranged 25 

to 67 years, with the mean ages rang<strong>in</strong>g from 

35.12 to 43.44 years. 

Parents’ education levels differed with<strong>in</strong> 

<strong>and</strong> across studies. The education levels of 

parents ranged from the completion of some 

high school to the atta<strong>in</strong>ment of a doctoral 

degree (both mothers <strong>and</strong> fathers). For example, 

the study by Dunn et al. (2001) conta<strong>in</strong>ed 

participants with partial high school, high 

school, partial college, college, <strong>and</strong> graduate 

school, with the majority hav<strong>in</strong>g partial college 

or greater. In contrast, 22 out of 33 

(66.7%) of the participants <strong>in</strong> Gray’s (1994) 

study had a high school education or less. As 

shown <strong>in</strong> Table 1, the majority of mothers <strong>in</strong> 

each of the 11 (out of 19) studies with reported 

education levels completed high 

school <strong>and</strong>/or attended college. Similarly, the 

majority of the reported fathers’ education 

levels <strong>in</strong>dicated the completion of high school 

<strong>and</strong> the attendance <strong>and</strong>/or completion of a 

college degree. 

In contrast to the reports of chronological 

ages <strong>and</strong> education level of parents, only 7 of 

the 19 studies reported the number of children 

<strong>in</strong> the household. Of the few studies that 

reported number of children, the number of 

children <strong>in</strong> the household ranged from one to 

eight. Future researchers may want to <strong>in</strong>clude 

data on the number of people, both children 

<strong>and</strong> adults, <strong>in</strong> the household as it may be 

related to parental stress levels. 

Child characteristics. Similar to parent characteristics, 

child characteristics varied with<strong>in</strong> 

<strong>and</strong> across studies (see Table 2). The chronological 

age of children ranged from 13 

months to 26 years, with the mean ages across 

studies rang<strong>in</strong>g from 28.35 months to 15.2 

years. The study samples of children ranged <strong>in</strong> 

size from 3 to 141. Only two of the articles 

<strong>in</strong>cluded the mental age or I.Q. of the children. 

Donovan (1988) reported an I.Q. range 

of eight to 83, <strong>and</strong> these data were collected 

from <strong>in</strong>dependent agencies that had previously 

served the children. Rodrigue, Morgan, 

<strong>and</strong> Geffken (1990) reported a mean mental 

age of 2.82 years, with a mean chronological 

age of 10.71 years, accord<strong>in</strong>g to the V<strong>in</strong>el<strong>and</strong> 

Adaptive Behavior Scale. All children <strong>in</strong>cluded 

<strong>in</strong> the literature review were diagnosed 

with an autism spectrum disorder; however, 

some articles did <strong>in</strong>clude only children with 

other disabilities (these articles were not <strong>in</strong>cluded 

<strong>in</strong> the table or the overall literature 

review). The researchers did not describe the 

<strong>in</strong>struments that were used to confirm the 

child’s diagnosis. The majority of diagnoses 

were recorded from cumulative folders of the 

children. No studies reported the grade level 

or academic measures on the children. Further, 

only six of the 18 studies reported severity 

of symptoms or level of symptomology of 

the children. The researchers noted that the 

more severe the symptoms <strong>and</strong> challeng<strong>in</strong>g 

behaviors were <strong>in</strong> the children, the more 

stress parents reported (Baker-Ericzen, Brookman-Frazee, 

& Stahmer, 2005; Feldman & 

Werner, 2002; Hast<strong>in</strong>gs & Johnson, 2001; Higg<strong>in</strong>s 

et al., 2005; Pakenham, Sohronoff, & 

Samios, 2004; Tunali & Power, 2002). 

Major F<strong>in</strong>d<strong>in</strong>gs 

Researchers have used different <strong>in</strong>struments 

to measure parental stress levels across the 

studies. They also noted several types of stress 

affected parents. Further, researchers noted 

that parents used various strategies to cope with 

the stress, some more effective than others. 

Instruments. Researchers used a variety of 

<strong>in</strong>struments to measure stress. Several researchers 

utilized stress measures previously 

developed, studied, <strong>and</strong> psychometrically validated 

for reliability. For example, Pakenham 

et al. (2004) used several tested <strong>in</strong>struments 

such as the COPE (Carver, Scheier, & We<strong>in</strong>traub, 

1989) <strong>and</strong> the Parental Self-Efficacy 


TABLE 1 

Characteristics of the Parents 

Age of 

Father* Mother’s <strong>Education</strong> Father’s <strong>Education</strong> Sibl<strong>in</strong>gs 

Age of 

Mother* 

Study N 

NR 

HS (7%) 

Some College (48%) 

College (19%) 

Graduate (30%) 

HS (7%) 


College (22%) 

Graduate (14%) 

M 35.12 

(SD 5.41) 

64 M 32.46 

(SD 3.36) 

Baker-Ericzen, 

Brookman-Frazee, 

& Stahmer 2005 

Donovan 1988 36 M 41.7 N/A N/R N/R M 1.81 

Dunn, Burb<strong>in</strong>e, 

58 M 36.84 (SD 9.21) - both Partial HS (3%) 

N/R 

Bowers, & 

High School Graduate (21%) 

Tantleff-Dunn 

Partial College (30%) 

2001 

College Graduate (33%) 

Partial or Completed Graduate 

School (13%) 

Erguner-Tek<strong>in</strong>alp, & 10 M 42.40 (SD 7.02) - both N/R N/R 

Akkok 2004 

Feldman & Werner 18 (EG) M 39.05 M 42.17 HS Graduate (n 8) 

HS Graduate (n 6) 

N/R 

2002 

18 (CG) (SD 10.36) (SD 7.58) Community College Diploma Community College Diploma 

(EG) 

(EG) 

(n 4) 

(n 0) 

M 39.5 M 42.13 University Graduate (n 0) (EG) University Graduate (n 2) (EG) 

(SD 10.36) (SD 12.45) HS Graduate (n 6) 

HS Graduate (n 7) 

(CG) 

(CG) CC Diploma (n 5) 

CC Diploma (n 3) 

University Graduate (n 2) (CG) University Graduate (n 2) (CG) 

Gray 1994 33 N/R N/R HS <strong>Education</strong> or Less (66.7%) N/R 

Gray 2003 53 N/R N/R N/R N/R N/R 

Hast<strong>in</strong>gs & Brown 46 M 41.04 M 43.50 College (15.3%) College (25%) N/R 

2002 

(SD 5.00) (SD 5.06) 

Hast<strong>in</strong>gs & Johnson 141 M 37.41 (SD 4.87) - both College (45.4%) M1.22% 

2001 

(SD0.80) 

Hast<strong>in</strong>gs et al. 2005 135 M 37.75 M 40.76 College (27%) College (37%) N/R 

(SD 5.00) (SD 5.14) 

Higg<strong>in</strong>s, Bailey & 52 N/R N/R N/R N/R N/R 

Pearce 2005 


Table 1—(Cont<strong>in</strong>ued) 

Age of 

Father* Mother’s <strong>Education</strong> Father’s <strong>Education</strong> Sibl<strong>in</strong>gs 

Age of 

Mother* 

Study N 

Hutton & Caron 21 N/R N/R N/R N/R N/R 

2005 

Leyser & Dekel 1991 82 M 34.16 M 36.46 N/R Bible School Graduate (84%) M 5.74 

(SD 6.72) (SD 7.88) 

(SD 2.82) 

Luther, Canham, & 18 N/R N/R N/R N/R M 2.3 

Cureton 2005 

Pakenham, 

59 M 40.99 M 43.44 HS (47%) 

HS (50%) 

M 2.51 

Sofronoff, & 

(SD 5.03) (SD 3.79) College (53%) 

College (50%) 

(SD .97) 

Samios 2004 

(Mother) 

M 2.25 

(SD .71) 

(Father) 

Rodrigue, Morgan, 20 M 38.75 N/R N/R N/R Most had two 

& Geffken 1990 

Stoneman & 

67 M 33 M 36 Some HS (9%) 

Some HS (15%) 

M 2.3 

Gavidia-Payne 

(SD 6.01) (SD 7.26) HS Graduate (30%) 

HS Graduate (24%) 

2006 





Masters/Doctoral Degree (7%) Masters/Doctoral Degree (13%) 

Tarakeshwar & 

45 N/R N/R HS Graduate (15.6%) 

N/R 

Pargament 2001 

Some College (37.8%) 

BS Degree (24.4%) 

Some Graduate School (8.9%) 

Graduate Degree (13.3%) 

Tunali & Power 58 N/R N/R Some College (n 48) N/R Most had two 

2002 

(n 30) 

Note. M mean; SD st<strong>and</strong>ard deviation; N/R not reported; N/A not applicable; EG experimental group; CG control group; HS high school; BS 

bachelors degree; CC community college; *Age is <strong>in</strong> years unless otherwise notated. 


TABLE 2 

Characteristics of Children 

Study N Chronological Age* MA* Diagnosis 

Baker-Ericzen, Brookman-Frazee, 

& Stahmer 2005 

37 M 28.35 months N/R Autism 

Donovan 1988 22 M 14.3 8–83 Autism 

Dunn, Burb<strong>in</strong>e, Bowers, & 

Tantleff-Dunn 2001 

N/R M 7.47 (SD 3.31) N/R Autism 

Erguner-Tek<strong>in</strong>alp, & Akkok 2004 10 M 15.2 (SD 1.93) N/R Autism 

Feldman & Werner 2002 5 (EG) M 11.33 (SD 3.56) (EG) 

N/R Autism 

6 (CG) M 10.76 (SD 5.38) (CG) 

Gray 1994 N/R Range 6-12 N/R Autism 

Gray 2003 32 Median 12 (5-26) N/R Autism 

Hast<strong>in</strong>gs & Brown 2002 46 M 12.15 (SD 2.49) N/R Autism 

Hast<strong>in</strong>gs & Johnson 2001 141 M 4.98 (SD 1.50) N/R Autism 

Hast<strong>in</strong>gs, Kovshoff, Brown, Ward, 

Esp<strong>in</strong>osa, & Rem<strong>in</strong>gton 2005 

51 M 24.5 (SD 4.40) N/R Autism 

Higg<strong>in</strong>s, Bailey & Pearce 2005 58 M 10.8 N/R ASD 

Hutton & Caron 2005 21 Range 3-16 N/R Autism 

Leyser & Dekel 1991 3 M 6.84 (SD 2.36) N/R Autism 

Luther, Canham, & Cureton 2005 21 Range 5-13 N/R Autism 

Pakenham, Sofronoff, & Samios 59 M 10.77 (SD .98) (Mother) N/R AS 

2004 

M 10.67 (SD 1.15) (Father) 

Rodrigue, Morgan, & Geffken 

1990 

20 M 10.71 M 2.82 Autism 

Stoneman & Gavidia-Payne 2006 3 M 45 months (13-72 months) N/R Autism 

Tarakeshwar & Pargament 2001 45 Range 4-24 N/R Autism 

Tunali & Power 2002 29 M 9.7 (SD 2.4) N/R Autism 

Note. M mean; SD st<strong>and</strong>ard deviation; N/R not reported; N/A not applicable; EG experimental 

group; CG control group; MA mental age; ASD autism spectrum disorder; AS asperger syndrome; 

*Age is <strong>in</strong> years unless otherwise notated. 

Scale (Sofronoff & Farbotko, 2002). In contrast, 

a few researchers solely relied on <strong>in</strong>terviews 

developed for their particular studies. 

(see Gray 1994, 2003 as an example). As 

shown <strong>in</strong> Table 3, four research teams used a 

comb<strong>in</strong>ation of formal <strong>and</strong> <strong>in</strong>formal stress 

measures (Hast<strong>in</strong>gs & Brown, 2002; Luther, 

Canham, & Curekon, 2005; Tarakeshwar & 

Pargament, 2001; Tunali & Power, 2002). 

The <strong>in</strong>strument types <strong>in</strong>cluded scales, questionnaires, 

<strong>in</strong>terviews, <strong>in</strong>ventories, checklists, 

<strong>and</strong> stress <strong>in</strong>dexes. As shown <strong>in</strong> Table 3, the 

most common of these <strong>in</strong>struments used 

across the identified studies were the Hospital 

Anxiety <strong>and</strong> Depression Scale (Zigmond & 

Snaith, 1983; 2 out of 19) <strong>and</strong> versions of the 

COPE (6 out of 19). These were the only 

commonalities <strong>in</strong> <strong>in</strong>struments across studies 

other than several researchers who used <strong>in</strong>terviews 

developed for their respective studies. 


Stress <strong>and</strong> other psychological factors. Research 

teams discovered numerous types of 

stress reported by parents of children with 

ASD. The types of stress (<strong>and</strong> other psychological 

factors) commonly identified by the 

researchers were child related stress (e.g., acceptability, 

hyperactivity), depression, anxiety, 

frustration, social isolation, <strong>and</strong> spousal relationship 

problems (see Table 3). Although 

the researchers listed these stresses with<strong>in</strong> separate 

categories, they are not necessarily mutually 

exclusive. For example, one parent 

noted that the social isolation she felt made 

her more anxious <strong>and</strong> frustrated (Feldman & 

Werner, 2002). 

Stress reduction strategies. Across studies, 

there was no one strategy found to be successful 

for reduc<strong>in</strong>g parental stress. While 

some studies found similar results, others contrasted 

their f<strong>in</strong>d<strong>in</strong>gs. Donovan (1988) found

TABLE 3 


Stress Reduction Strategies 

Effective Ineffective 

Study Instrument(s) Types of Stress 

N/R 

Children with autism were 

enrolled <strong>in</strong> an <strong>in</strong>clusion 

childcare program. 

Mothers showed significant 

reductions <strong>in</strong> child-related 

stress only. 

There were no significant 

reductions for fathers. 

Child-related stress 

(adaptability, acceptability, 

dem<strong>and</strong><strong>in</strong>gness, mood, 

distractiblitiy/hyperactivity, 

re<strong>in</strong>forces parent) 

Parent-related stress 

(depression, attachment, 

restriction of role, sense of 

competence, social 

isolation, relationship with 

The Parent<strong>in</strong>g Stress Index (PSI), 

Child Doma<strong>in</strong> subscales, Parent 

Doma<strong>in</strong> subscales 

Baker-Ericzen, 

Brookman-Frazee, & 

Stahmer 2005 

Optimistic def<strong>in</strong>ition of the 

situation. 

Mobilization of family resources. 

Ma<strong>in</strong>tenance <strong>and</strong> improvement of 

their own psychological well-be<strong>in</strong>g. 

spouse, parent health) 

General (e.g., f<strong>in</strong>ances) Reliance upon professional 

resources <strong>and</strong> programs 

outside the family. 

Donovan 1988 The Questionnaire on Resources 

<strong>and</strong> Stress-Revised (QRS), The 

Locke-Wallace Marital 

Adjustment Scale-Short Form, 

The Cop<strong>in</strong>g Health Inventory 

Escape-avoidance 

Distanc<strong>in</strong>g 

External locus of control 

Positive reappraisal 

Confrontive cop<strong>in</strong>g 

Seek social support 

Depression 

Social Isolation 

Spousal Relationship 

Problems 

for Parents, Form D 

The Inventory of Socially 

Supportive Behaviors, Ways of 

Cop<strong>in</strong>g Questionnaire-Revised, 

PSI, Internal-External Locus of 

Control Scale, Life Experiences 

Survey 

QRS, Cop<strong>in</strong>g Strategy Indicator, 

Beck Hopelessness Scale 

Interviews 

Dunn, Burb<strong>in</strong>e, 

Bowers, & Tantleff- 

Dunn 2001 

Child related stress N/R Cop<strong>in</strong>g Skills <strong>Tra<strong>in</strong><strong>in</strong>g</strong> Program: 

- Underst<strong>and</strong><strong>in</strong>g stress <strong>and</strong> cop<strong>in</strong>g 

- General cop<strong>in</strong>g strategies 

- Problem solv<strong>in</strong>g 

- Relaxation tra<strong>in</strong><strong>in</strong>g 

- Positive th<strong>in</strong>k<strong>in</strong>g 

- Social support 

Erguner-Tek<strong>in</strong>alp, & 

Akkok 2004 






N/R 

Child related stress Behavior Parent <strong>Tra<strong>in</strong><strong>in</strong>g</strong> (BPT) 

is a full service, which <strong>in</strong>cluded 

a comprehensive functional 

assessment, a treatment plan, 

parent tra<strong>in</strong><strong>in</strong>g, <strong>and</strong> weekly 

home visits. 

The experimental group consisted 

of families that graduated from 

BPT with<strong>in</strong> the last 5 years. 

Child Behavior Management 

Survey (CBMS), QRS-SF, Beck 

Depression Inventory (BDI), 

Interpersonal Support Evaluation 

List (ISEL), Family Quality of 

Life Questionnaire 

Feldman & 

Werner 2002 

N/R 

N/R 

Self-efficacy was not a 

mediat<strong>in</strong>g variable <strong>in</strong> 

father’s anxiety or 

depression 

Gray 1994 Interviews (Researcher Developed) General Use of treatment services 

Family support 

Religion 

Social withdrawal 

Individualism 

Other 

Gray 2003 Semi-Structured Interviews 

Frustration Plann<strong>in</strong>g appropriate responses 

(Researcher Developed) 

Tak<strong>in</strong>g th<strong>in</strong>gs one day at a time 

Work<strong>in</strong>g with their child as a 

participant <strong>in</strong> their therapeutic 

regimen 

Keep<strong>in</strong>g their autistic child 

separated from their sibl<strong>in</strong>gs 

Talk<strong>in</strong>g to friends <strong>and</strong> family 

Spousal support 

Religious cop<strong>in</strong>g 

Hast<strong>in</strong>gs & Brown Teacher Report version of the 

Anxiety 

Self-efficacy was a mediat<strong>in</strong>g 

2002 

<strong>Developmental</strong> Behavior 


variable <strong>in</strong> mother’s anxiety <strong>and</strong> 

Checklist Parent Questionnaire 

depression 

(Researcher Developed), 

Hospital Anxiety <strong>and</strong> Depression 

Scale 






N/R 

Adaptive cop<strong>in</strong>g strategies 

Informal social support sources 

Beliefs about the efficacy of the 


Parent <strong>and</strong> Family Problems 

Pessimism 

Autism Behavior Checklist, QRS, 

Family Support Scale, Family 

Cop<strong>in</strong>g Strategies 

Hast<strong>in</strong>gs & Johnson 

2001 

Avoidance cop<strong>in</strong>g 

<strong>in</strong>terventions 

Positive refram<strong>in</strong>g 

Religious cop<strong>in</strong>g 


Mental Health Problems 

N/R 

Spousal support 

Optimism 

Positive self-esteem 

Physical 

Emotional 

F<strong>in</strong>ancial 

Marital relationship stress 

N/R 

Hast<strong>in</strong>gs et al. 2005 Brief-Cop<strong>in</strong>g Orientations to 

Problems Experienced Scale 

(COPE), Hospital Anxiety <strong>and</strong> 

Depression Scale 

Higg<strong>in</strong>s, Bailey & 

Demographic questionnaire, 

Pearce 2005 

Family Adaptability <strong>and</strong> 

Cohesion Evaluation Scales 

(FACES II), Quality Marriage 

Index (QMI), Rosenberg Self- 

Esteem Scale, Cop<strong>in</strong>g Health 

Inventory for Patients (CHIP) 

Hutton & Caron 2005 Parent Interview (Researcher 

Developed) 

N/R 

Stress on marriage 

Adapt<strong>in</strong>g family schedules 

Safety concerns 

Structure <strong>in</strong> the home 

Fear of children with autism 

hurt<strong>in</strong>g themselves or 

others 

F<strong>in</strong>ancial status 

Close contact with family 

Lack of community support members 

Seek<strong>in</strong>g advice <strong>and</strong> <strong>in</strong>formation 

from health care 

professionals 

Spiritual guidance 

General Parent support groups 

Refram<strong>in</strong>g (perception of 

stressful experience) 

Social support 

Avoidance 

Leyser & Dekel 1991 Parent Interview (Researcher 

Developed) 

Spiritual support 

Full-COPES, Demographic 

questionnaire (Researcher 

Developed) 

Luther, Canham, & 

Cureton 2005 






N/R 

Benefit f<strong>in</strong>d<strong>in</strong>g strategy (positive 

personality change) 

Sense mak<strong>in</strong>g strategy 

(underst<strong>and</strong><strong>in</strong>g ASD) 


Anxiety 

Emotional stress 

Demographic questionnaire 

(Researcher Developed), The 

Childhood Asperger Syndrome 

Test (CAST), ABCX, Eyberg 

Child Behaviour Inventory 

(ECBI), Modified version of the 

Social Readjustment Rat<strong>in</strong>g Scale 

(SRRS), Brief Social support 

Questionnaire, Parental Stress <strong>in</strong> 

the Management of Asperger 

Syndrome Scale, Parental Self- 

Efficacy Scale, COPE, Short 

Version of the Depression 

Anxiety Stress Scale (DASS21), 

Social Adjustment Self-report 

Questionnaire (SAS-SR), 

Parent<strong>in</strong>g Sense of Competence 

Scale, Ways of Cop<strong>in</strong>g Scale, 

Marital Adjustment Scale, 

FACES, Impact-on-Family Scale, 

Mother-child <strong>in</strong>teraction 

(videotaped session), Social 

Support Questionnaire 

32-item Dyadic Adjustment Scale, 

Hassles <strong>and</strong> Uplifts Scale, COPE 

Pakenham, Sofronoff, 

& Samios 2004 

Self-blame 

Information seek<strong>in</strong>g 

Wish-fulfill<strong>in</strong>g fantasy 

Frustration 

Anxiety 

Tenseness 

Rodrigue, Morgan, & 

Geffken 1990 


Problem-focused strategies 

were not related to better 

family adjustments for 

mothers. 

Problem-focused strategies 

were not effective for 

mothers or fathers with 

daily hassles. 

Problem-focused strategies were 

related to better family 

adjustment for fathers. 

Family adjustment 

Daily Hassles 

Stoneman & Gavidia 

2006





N/R Negative Religious Cop<strong>in</strong>g Strategies 

(God as unhelpful <strong>in</strong> parent<strong>in</strong>g 

their child, perception of religious 

experiences as aversive to the 

cop<strong>in</strong>g process, <strong>and</strong> feel<strong>in</strong>gs of 

punishment or hav<strong>in</strong>g doubts about 

the benevolence of God) 

Positive Religious Cop<strong>in</strong>g Strategies 

(be<strong>in</strong>g part of God’s plan, an 


Anxiety 

Center for Epidemiological 

Research-Depressed Mood Scale, 

State-Trait Anxiety Inventory, 

Stress-Related Growth Scale, 

Brief COPE Semi structured 

Interviews (Researcher 

Developed) 

Tarakeshwar & 

Pargament 2001 

opportunity for spiritual growth) 

N/R 

N/R Placed less emphasis on their 

careers <strong>and</strong> more on their 

parental role 

Engaged <strong>in</strong> more leisure 

activities with extended family 

members 

Placed less emphasis on others’ 

op<strong>in</strong>ions about their child’s 

behavior 

Placed more emphasis on 

spousal support <strong>and</strong> the 

parental role <strong>in</strong> their 

discussions of marriage 

Experienced more ambiguity <strong>in</strong> 

their child’s behavior 

Showed a tendency toward a 

greater overall tolerance of 

ambiguity 

Tunali & Power 2002 Semi structured Interviews 

(Researcher Developed), Home/ 

Career Questionnaire Revised 

Scale for Ambiguity Tolerance 

(AT-20), Self-Rat<strong>in</strong>g Depression 

Scale, Short-Marital Adjustment 

Test (SMAT) 

Note. M mean; SD st<strong>and</strong>ard deviation; N/R not reported; N/A not applicable. 


that parents who relied on professional resources 

<strong>and</strong> programs outside the family experienced 

decreased levels of stress. They further 

discovered that hav<strong>in</strong>g an optimistic 

def<strong>in</strong>ition of the situation, mobilization of 

family, <strong>and</strong> ma<strong>in</strong>tenance <strong>and</strong> improvement of 

their own psychological well-be<strong>in</strong>g were not 

identified as effective for decreas<strong>in</strong>g stress. 

Families <strong>in</strong> a study conducted by Luther et al. 

(2005) effectively coped with stress through 

parent support groups <strong>and</strong> social support. 

However, those researchers did not f<strong>in</strong>d spiritual 

support to be effective, which is <strong>in</strong> contrast 

to families <strong>in</strong> the studies by Leyser <strong>and</strong> 

Dekel (1991) <strong>and</strong> Gray (1994). Further, several 

parents across studies noted that spousal 

support helped them cope with stress (Gray, 

2003; Higg<strong>in</strong>s et al., 2005); yet, spousal relationship 

problems was a common type of 

stress experienced by some parents (Baker- 

Ericzen et al., 2005; Dunn et al., 2001; Hutton 

& Caron, 2005). 


Researchers who study familial stress f<strong>in</strong>d that 

parents of children with ASD are at an <strong>in</strong>creased 

risk for high stress levels <strong>in</strong> comparison 

to parents of children with other developmental 

disorders or typically develop<strong>in</strong>g 

children. The exact source of their stress is 

undeterm<strong>in</strong>ed, but may be attributed to difficulty 

f<strong>in</strong>d<strong>in</strong>g an accurate diagnosis, deal<strong>in</strong>g 

with characteristics of the child, <strong>and</strong> access<strong>in</strong>g 

social support (Dunn et al., 2001). Further, 

the anxiety related to rais<strong>in</strong>g ag<strong>in</strong>g children 

with disabilities <strong>in</strong>creases over time as does the 

vulnerability to disruption <strong>in</strong> <strong>in</strong>formal supports 

(White & Hast<strong>in</strong>gs, 2004). Thus, professionals 

need to provide education <strong>and</strong> support 

services early <strong>and</strong> longitud<strong>in</strong>ally. 

The perceived parental stress associated 

with rear<strong>in</strong>g a child with ASD is a consistent 

f<strong>in</strong>d<strong>in</strong>g (Feldman & Werner, 2002; Gray, 

2003; Hutton & Caron, 2005). If a parent is 

concurrently experienc<strong>in</strong>g high levels of stress 

because of the recent diagnosis of the child, 

then the service provider may be <strong>in</strong>advertently 

add<strong>in</strong>g an additional stressor. Access to formal 

(e.g., parent support groups) <strong>and</strong> <strong>in</strong>formal 

sources (e.g., family, friends) of social support 

can provide a cop<strong>in</strong>g mechanism for 


families of children with autism (Boyd, 2002). 

In a review of the literature on the social 

support needs of mothers of children with 

autism, Boyd found that contact with supportive 

family members <strong>and</strong> parents of other children 

with autism decreased parental stress. It 

is important to note that high levels of parental 

stress are associated with an <strong>in</strong>creased likelihood 

that the child with autism will be 

placed out-of-home (Raif & Rimmerman, 

1993). Unfortunately for parents, as the age of 

their child <strong>in</strong>creases, their number of support 

options often decreases. In a follow-up study 

of 31 Australian parents conducted ten years 

after the orig<strong>in</strong>al, Gray (2002) found that as 

children with autism aged, the number of 

treatment <strong>and</strong> support options for them reduced. 

In addition, M<strong>in</strong>nes <strong>and</strong> Woodford 

(2005) found that 65% of parents reported 

age-related change adversely affected their 

life. For example, as parents aged, they worried 

more about lack of services for an older 

child with ASD <strong>and</strong> future guardianship of 

their child with ASD. Although levels of parental 

stress related to such areas as diagnosis 

<strong>and</strong> early <strong>in</strong>tervention tend to subside overtime 

(Gray, 2002), parents’ feel<strong>in</strong>gs of anxiety 

about their children’s future come to the forefront. 

Obviously, parents need cont<strong>in</strong>ued access 

to treatment services <strong>and</strong> residential 

placement options for their ag<strong>in</strong>g children. 

Hopefully, this will help to avoid the feel<strong>in</strong>gs 

of “pessimism about their child’s future” 

S<strong>and</strong>ers <strong>and</strong> Morgan (1997) found among 

parents of children with ASD <strong>and</strong> Down syndrome. 

Parents of children with ASD also report 

less <strong>in</strong>volvement <strong>in</strong> recreational <strong>and</strong> 

sport<strong>in</strong>g activities, which may contribute to 

social isolation <strong>and</strong> subsequently higher stress 

levels. Provid<strong>in</strong>g parents respite care services 

for their children or <strong>in</strong>formation on programs 

that provide modifications <strong>and</strong> accommodations 

for <strong>in</strong>dividuals with disabilities may allow 

parents to participate <strong>in</strong> more leisure-type activities 

to help them cope, which has been reported 

to be an effective cop<strong>in</strong>g strategy for 

several parents (Dunn et al., 2001; Luther et al., 

2005). M<strong>in</strong>nes <strong>and</strong> Woodford (2005) found that 

the two greatest concerns of parents with children 

with ASD were limited access to parent 

support groups <strong>and</strong> parent education.

Implications for Practitioners <strong>and</strong> Researchers 

In the field of education, our roles as service 

providers are sometimes blurred as we offer 

counsel<strong>in</strong>g, friendship, <strong>and</strong> support to the 

family who has a child with disabilities. Although 

these services typically are performed 

<strong>in</strong> an effort to provide family-centered support, 

practitioners can cross the l<strong>in</strong>e <strong>in</strong>to unfamiliar 

territory, which may lead to ill-conceived 

advice be<strong>in</strong>g given <strong>and</strong> or to the 

estrangement of the parent-provider relationship. 

One mother’s brief account of her 

child’s diagnostic evaluation provides such an 

example: “Well, the speech therapist came out 

of the room <strong>and</strong> just flat out told me that 

Matthew had autism, <strong>and</strong> I was floored by that, 

but then she proceeded to say that there was a 

50/50 chance that the baby I was carry<strong>in</strong>g 

would have autism too” (personal communication, 

1999). Thus, co<strong>in</strong>cid<strong>in</strong>g with <strong>in</strong>terventions 

for children with ASD, it is imperative 

for practitioners <strong>and</strong> researchers to (a) help 

parents cope with stress, <strong>and</strong> (b) exam<strong>in</strong>e options 

for ag<strong>in</strong>g <strong>in</strong>dividuals with ASD. 

Address Parental Stress 

Researchers need to exam<strong>in</strong>e the various cop<strong>in</strong>g 

strategies identified <strong>in</strong> this review <strong>and</strong> 

other literature <strong>and</strong> determ<strong>in</strong>e what strategies 

work best for various types of parents. The 

research also should match the appropriate 

strategies to parents with similar characteristics 

<strong>and</strong> determ<strong>in</strong>e the effects on parental 

stress. For example, researchers may exam<strong>in</strong>e 

the impact of parental education level or socioeconomic 

status on the reported parental 

stress <strong>and</strong>/or strategies that are effective. In 

addition, future research may exam<strong>in</strong>e how 

cultural or l<strong>in</strong>guistic diversity affect parental 

stress <strong>and</strong>/or cop<strong>in</strong>g strategies that are effective. 

For example, are parents for whom English 

is not their first language more stressed 

because of limited access to support groups or 

<strong>in</strong>formation provided <strong>in</strong> their first (or native) 

language? However, to do this research, researchers 

may need more uniformity <strong>in</strong> measures 

used to measure stress <strong>in</strong> parents. When 

the cop<strong>in</strong>g strategies are identified <strong>and</strong> 

matched to particular stressors <strong>and</strong> parental 

characteristics <strong>in</strong> the research, practitioners 

may then teach parents to use the strategies 

that best align to their particular situation <strong>and</strong> 

characteristics. 

Practitioners also could help strengthen <strong>in</strong>formal 

<strong>and</strong> formal sources of support for parents. 

For example, practitioners could provide 

<strong>in</strong>formation on counsel<strong>in</strong>g services for the 

family or marriage counsel<strong>in</strong>g. However, practitioners 

should be careful about immediately 

assum<strong>in</strong>g couples need <strong>in</strong>tensive marriage 

counsel<strong>in</strong>g. In addition, practitioners could 

identify programs such as ‘parent night out’ 

where organizations provide care for children 

with ASD so couples can focus on strengthen<strong>in</strong>g 

their relationships. 

Options 

Another area under researched that is related 

to stress of parents of children with ASD, particularly 

to those of ag<strong>in</strong>g children, is treatment 

<strong>and</strong> options for older <strong>in</strong>dividuals on the 

autism spectrum. For example, what do parents 

do who have ag<strong>in</strong>g children with lower 

function<strong>in</strong>g autism? Currently, there is little to 

no research with this sub-population. Also, 

parents need to know service options that may 

help them plan for transitions to work or postsecondary 

placements. These options may <strong>in</strong>clude 

such services as vocational rehab, private 

organizations that provide tra<strong>in</strong><strong>in</strong>g, a 

university that has support programs for <strong>in</strong>dividuals 

with ASD. Provid<strong>in</strong>g parents with these 

supports <strong>and</strong> options may help alleviate some 

stress. 

Conclusion 

In summary, the reported parental stress associated 

with rear<strong>in</strong>g a child with autism is a 

consistent f<strong>in</strong>d<strong>in</strong>g (Feldman & Werner, 2002; 

Gray, 2003; Hutton & Caron, 2005). As a result 

of this f<strong>in</strong>d<strong>in</strong>g, a number of researchers 

have begun to identify cop<strong>in</strong>g strategies parents 

employ to cope with the stressors of rear<strong>in</strong>g 

a child with ASD. The research <strong>in</strong> this area 

has not been consistent. Across studies identified 

<strong>in</strong> the current literature review, there was 

no one strategy found to be successful for 

reduc<strong>in</strong>g <strong>and</strong>/or cop<strong>in</strong>g with parental stress. 

Future research teams should exam<strong>in</strong>e the 

various cop<strong>in</strong>g strategies identified <strong>in</strong> this review 

<strong>and</strong> other literature <strong>and</strong> determ<strong>in</strong>e what 

strategies work best for various types of par- 


ents. Research also should match the appropriate 

strategies to parents with similar characteristics 

<strong>and</strong> determ<strong>in</strong>e the effects on 

parental stress. 

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Received: 26 March 2008 

Initial Acceptance: 1 June 2008 

F<strong>in</strong>al Acceptance: 15 November 2008 




Teach<strong>in</strong>g Organizational Skills to Children with High 

Function<strong>in</strong>g Autism <strong>and</strong> Asperger’s Syndrome 

Kimberly Powers Dorm<strong>in</strong>y, Deanna Luscre, <strong>and</strong> David L. Gast 

University of Georgia 

Abstract: A multiple basel<strong>in</strong>e design across participants was used to evaluate the effectiveness of a file box system 

plus self-monitor<strong>in</strong>g on the organizational skills of four fourth <strong>and</strong> fifth grade students with high function<strong>in</strong>g 

autism (HFA) <strong>and</strong> Asperger’s Syndrome (AS). Instruction took place <strong>in</strong> general education classrooms <strong>and</strong> 

consisted of teach<strong>in</strong>g students to arrange academic materials (worksheets, note pages, study guides etc.) <strong>in</strong> a 

portable file box with hang<strong>in</strong>g folders. Students were also taught to self-monitor their accuracy. The percentage 

of correctly filed items <strong>and</strong> the number of seconds it took students’ to retrieve requested items were the dependent 

variables assessed across conditions. Results showed that the percentage of correctly filed items <strong>in</strong>creased <strong>and</strong> the 

number of seconds required to locate specific items decreased with the use of the file system box. These f<strong>in</strong>d<strong>in</strong>gs 

demonstrate how a simple non<strong>in</strong>vasive <strong>and</strong> affordable classroom modification can improve performance of 

children with HFA <strong>and</strong> AS <strong>in</strong> general education classrooms. 

Autistic disorder (AD) is a neurodevelopmental 

disability with vary<strong>in</strong>g degrees of qualitative 

impairments <strong>in</strong> social <strong>in</strong>teraction <strong>and</strong> communication, 

stereotypic repetitive <strong>in</strong>terests or behaviors, 

<strong>and</strong> delays <strong>in</strong> social <strong>in</strong>teraction, communicative 

language or play (American 

Psychiatric Association, 2000). Children with 

Asperger’s Syndrome (AS) subsume the social 

impairment of AD, but reta<strong>in</strong> an <strong>in</strong>terest <strong>in</strong> 

others, whom they distance by their socially 

odd behaviors (Elder, Cater<strong>in</strong>o, Chao, Shacknai, 

& De Simone, 2006). Circumscribed <strong>in</strong>terests 

are present as <strong>in</strong> AS, but often are 

conf<strong>in</strong>ed to amass<strong>in</strong>g large amounts of <strong>in</strong>formation 

about a specific topic (Tantam, 1991). 

Unlike AD, speech develops normally <strong>in</strong> children 

with AS, but nonverbal pragmatic abnormalities 

make social conversations pedantic 

<strong>and</strong> unproductive (Asperger, 1991). Absent 

from diagnostic criteria, yet prom<strong>in</strong>ent <strong>in</strong> 

both autism <strong>and</strong> Asperger syndrome (Penn<strong>in</strong>gton, 

Bennetto, McAlcer, & Roberts, 1996) 

are difficulty with <strong>in</strong>hibition, <strong>in</strong>itiation, attention, 

flexibility, <strong>and</strong> self regulation, commonly 

associated with the “organizational aspect of 


be addressed to Deanna Luscre, 3250 Brown 

Thrasher Trace, Cumm<strong>in</strong>g, GA 30041. 


executive function” (Killiani, Moore, Rehbe<strong>in</strong>, 

& Moss, 2005). 

Executive functions are “bra<strong>in</strong>-based skills” 

(p. 817) that beg<strong>in</strong> to develop <strong>in</strong> the first years 

of life (Griffith, Penn<strong>in</strong>gton, Wehner, & Rogers, 

1999) <strong>and</strong> result <strong>in</strong> “the ability to ma<strong>in</strong>ta<strong>in</strong> 

an appropriate problem-solv<strong>in</strong>g set for atta<strong>in</strong>ment 

of a future goal” (Welsh & Penn<strong>in</strong>gton 

(1988, p.201). Children with autism spectrum 

disorders (ASD) have consistently demonstrated 

impaired executive function<strong>in</strong>g deficits 

on tests that measure plann<strong>in</strong>g, <strong>in</strong>hibit<strong>in</strong>g 

pre-potent responses, <strong>and</strong> mental flexibility 

(Hill, 2003). Deficiencies <strong>in</strong> executive function<strong>in</strong>g 

may be primary cognitive deficits <strong>in</strong> 

autism (Ozonoff & Jensen, 1999). 

Although more positive outcomes are associated 

with AS than AD (Kl<strong>in</strong>, Sparrow, Marans, 

Carter, & Volkmar, 2000), both disorders 

result <strong>in</strong> classroom performance deficits. 

Neuropsychological profiles of children with 

AS, which <strong>in</strong>clude deficits <strong>in</strong> f<strong>in</strong>e <strong>and</strong> gross 

motor skills, visual motor <strong>in</strong>tegration, visual 

spatial perception, nonverbal concept formation 

<strong>and</strong> visual memory, are consistent with 

nonverbal learn<strong>in</strong>g disabilities (Kl<strong>in</strong>, McPartl<strong>and</strong>, 

& Volkmar, 2005, p. 103). <strong>Education</strong>al 

<strong>in</strong>terventions (e.g., develop<strong>in</strong>g visual-spatial 

organizational skills) used for children with 

high function<strong>in</strong>g autism (HFA), Asperger’s

Syndrome (AS), <strong>and</strong> nonverbal learn<strong>in</strong>g disabilities 

(NLD) are often <strong>in</strong>terchangeable 

(Hooper & Bundy, 1998). 

Students with HFA <strong>and</strong> AS, are <strong>in</strong>creas<strong>in</strong>gly 

return<strong>in</strong>g to general education classrooms 

from pull-out programs (T<strong>in</strong>cani, 2007; Simpson, 

2004). A summary objective when teach<strong>in</strong>g 

students with disabilities <strong>in</strong> a general education 

classroom is to provide them with 

skills to become <strong>in</strong>dependent learners. Children 

with HFA or AS often depend on adults 

for complet<strong>in</strong>g assignments, transition<strong>in</strong>g between 

activities, <strong>and</strong> stay<strong>in</strong>g on-task (Bryan & 

Gast, 2000; Giangreco, Edelman, Luiselli, & 

MacFarl<strong>and</strong>, 1997). Once adult support is provided 

they frequently learn to rely on support 

<strong>in</strong> the future. Young, Simpson, Myles, <strong>and</strong> 

Kamps (1997) reported that when paraprofessionals 

were more than 2 feet from assigned 

students with autism, greater <strong>in</strong>teraction occurred 

with the general education classroom 

teacher. In order to reduce reliance on adults 

<strong>and</strong> prompt dependency students with ASD 

need to be taught how to <strong>in</strong>dependently access 

<strong>in</strong>formation (Simpson, 2001, 2004). 

Students with ASD commonly experience 

difficulty organiz<strong>in</strong>g their thoughts <strong>and</strong> process<strong>in</strong>g 

auditory stimuli. When teachers, students, 

<strong>and</strong> educational personnel can enter a 

classroom <strong>and</strong> underst<strong>and</strong> classroom expectations, 

structure is <strong>in</strong> place (Iovannone, Dunlap, 

Huber, & K<strong>in</strong>caid, 2003). Visual supports 

for children with autism compensate for difficulties 

they experience <strong>in</strong> attention, auditory 

process<strong>in</strong>g, sequenc<strong>in</strong>g, <strong>and</strong> organization 

(Hodgdon, 1995). These supports serve as visual 

cues that <strong>in</strong>crease compliance by rem<strong>in</strong>d<strong>in</strong>g 

students of behaviors they are expected to 

exhibit (Odom et al., 2003). When correctly 

implemented, visual supports can help children 

with ASD sequence daily events, organize 

their environment, <strong>and</strong> prepare for transition<strong>in</strong>g 

to another activity (Quill, 1995; Hodgdon, 

1995). Structured teach<strong>in</strong>g <strong>and</strong> environmental 

modifications will <strong>in</strong>crease the child’s <strong>in</strong>dependence 

by mak<strong>in</strong>g the environment <strong>and</strong> 

its expectations more underst<strong>and</strong>able (Mesibov, 

Shea, & Schopler, 2005, chap. 4). 

Organization is a fundamental pr<strong>in</strong>ciple of 

structure that supports the acquisition of language, 

appropriate behavior, social <strong>in</strong>teractions, 

<strong>and</strong> academic goals (Iovannone et al., 

2003). Visual organizational supports, such as 

picture schedules or work systems are visual 

strategies considered as st<strong>and</strong>ard for many 

children with autism (Prizant & Wetherby, 

2005; Odom et al., 2003). Children with autism 

frequently have difficulty organiz<strong>in</strong>g personal 

belong<strong>in</strong>gs <strong>and</strong> school related materials 

(Arick, Krug, Fullerton, Loos, & Falco, 2005). 

A recent <strong>in</strong>vestigation of the needs of college 

students with ASD emphasized that for student 

success there is a need for organizational 

strategies, due to executive function<strong>in</strong>g deficits, 

(Adreon & Durocher, 2007). The earlier 

students on the autism spectrum are taught 

organizational strategies the greater the likelihood 

they will succeed <strong>in</strong> their educational, 

vocational <strong>and</strong> personal pursuits. 

Visual schedules have been shown to be 

effective <strong>in</strong> help<strong>in</strong>g students with ASD organize 

their daily activities. They have also been 

shown to be effective <strong>in</strong> teach<strong>in</strong>g students to 

transition <strong>in</strong>dependently, thus reduc<strong>in</strong>g the 

need for adult prompt<strong>in</strong>g. Dettmer, Simpson, 

Myles, <strong>and</strong> Ganz (2000), for example, taught 

two elementary aged boys with autism to follow 

a portable schedule of daily activities assembled 

<strong>in</strong> a photo album. This resulted <strong>in</strong> a 

substantial decrease <strong>in</strong> prompts delivered by 

the teacher <strong>and</strong> a reduction <strong>in</strong> the time it took 

students to respond to adult <strong>in</strong>structions at 

home <strong>and</strong> <strong>in</strong> the community. Visual activity 

schedules have also been successful <strong>in</strong> <strong>in</strong>creas<strong>in</strong>g 

the on-task <strong>and</strong> on-schedule behaviors of 

elementary students with ASD (Bryan & Gast, 

2000). Stromer, Kimball, K<strong>in</strong>ney, <strong>and</strong> Taylor 

(2006) demonstrated how activity schedules, 

presented on a computer, could enhance students’ 

ability to use multiple cues <strong>and</strong> then 

generalize <strong>in</strong>formation to the classroom environment. 

They admitted, however, that computers 

were more expensive, more time consum<strong>in</strong>g, 

<strong>and</strong> less portable than simple visual 

activity schedules. 

Self-monitor<strong>in</strong>g has also been shown to be 

an effective strategy for <strong>in</strong>creas<strong>in</strong>g <strong>in</strong>dependent 

performance by children with ASD. 

Shearer, Kohler, Buchan, <strong>and</strong> McCullough 

(1996) taught three preschoolers to monitor 

their activity engagement <strong>and</strong> social <strong>in</strong>teraction 

by mov<strong>in</strong>g beads to <strong>in</strong>dicate a completed 

social exchange, a self-management skill as 

efficient as prompt<strong>in</strong>g by an adult. Students 

who learn self-regulation strategies require 

less support from peers <strong>and</strong> adults, <strong>and</strong> are 

Teach<strong>in</strong>g Organizational Skills / 539

viewed by others as hav<strong>in</strong>g greater learn<strong>in</strong>g 

potential than previously demonstrated (Wehmeyer, 

Yeager, Bold<strong>in</strong>g, Agran, & Hughes, 

2003). Shimabukuro, Prater, Jenk<strong>in</strong>s, <strong>and</strong> 

Edelen-Smith (1999) <strong>in</strong>vestigated the effects 

of self-monitor<strong>in</strong>g on the academic performance 

of students with learn<strong>in</strong>g disabilities. 

Results were <strong>in</strong>creased academic productivity, 

accuracy, <strong>and</strong> on-task behavior dur<strong>in</strong>g <strong>in</strong>dependent 

work. Ga<strong>in</strong>s <strong>in</strong> productivity were 

greater than ga<strong>in</strong>s <strong>in</strong> accuracy, but an improvement 

was seen <strong>in</strong> both areas once students 

learned the self-monitor<strong>in</strong>g procedure 

(Shimabukuro et al., 1999). 

Self-evaluation <strong>in</strong> the form of goal sett<strong>in</strong>g, 

<strong>and</strong> self-graph<strong>in</strong>g the number of daily homework 

assignments completed, resulted <strong>in</strong> enhanced 

homework completion for middle 

school students with learn<strong>in</strong>g disabilities 

(Trammel & Schloss 1994). A seventeen year 

old boy with AS <strong>in</strong>creased <strong>in</strong>dependent homework 

assignment record<strong>in</strong>g across academic 

subjects through the use of a personal digital 

assistant (Myles, Ferguson, & Hagiwara, 2007). 

Results suggest that teach<strong>in</strong>g students with 

HFA <strong>and</strong> AS to self-monitor their academic 

behaviors is a useful skill throughout their 

education. 

Effective organizational strategies are required 

for success <strong>in</strong> all educational sett<strong>in</strong>gs 

regardless of level. Elementary age students 

with ASD, for example, need to learn how to 

retrieve books, notebooks, papers etc. from an 

array of materials, when requested to do so, 

<strong>and</strong> they need to do so <strong>in</strong> a reasonable 

amount of time. This requires that that they 

learn an effective <strong>and</strong> efficient strategy that 

doesn’t call undue attention to their executive 

function<strong>in</strong>g deficits. By the time students transition 

to middle school, particularly if they are 

fully <strong>in</strong>cluded <strong>in</strong> the general education program, 

they are expected to <strong>in</strong>dependently organize 

their school materials <strong>and</strong> locate items 

with<strong>in</strong> a reasonable time period. With this 

objective <strong>in</strong> m<strong>in</strong>d, the current study was designed 

to answer the follow<strong>in</strong>g questions: Will 

elementary age children with HFA <strong>and</strong> AS, a) 

<strong>in</strong>crease the percentage of items correctly 

filed across a school day, <strong>and</strong> b) decrease the 

number of seconds needed to retrieve a requested 

item when us<strong>in</strong>g a file box organizational 

system? 

Method 

Participants 


Four Caucasian male students attend<strong>in</strong>g a 

public school <strong>in</strong> a large metropolitan city <strong>and</strong> 

rang<strong>in</strong>g <strong>in</strong> ages 9 years 4 months to 10 years 3 

months participated <strong>in</strong> this study. 

All students met Georgia eligibility requirements 

for autism which were characteristics 

impact<strong>in</strong>g (1) developmental rates <strong>and</strong> sequences, 

(2) social <strong>in</strong>teraction <strong>and</strong> participation 

<strong>and</strong> (3) verbal <strong>and</strong> non-verbal communication 

result<strong>in</strong>g <strong>in</strong> an adverse effect on a 

student’s educational performance (Georgia 

Department of <strong>Education</strong>, 2008a). Three of 

the students were eligible for special education 

services under Georgia autism eligibility 

criteria because of behaviors associated with 

Asperger’s Syndrome (AS). Georgia autism eligibility 

can apply to students with other 

DSM-IV spectrum disorders <strong>in</strong>clud<strong>in</strong>g Asperger’s 

syndrome (Georgia Department of <strong>Education</strong>, 

2008b). One student received Georgia 

autism eligibility based on characteristics associated 

with high function<strong>in</strong>g autism. Table 1 

presents diagnostic <strong>and</strong> related <strong>in</strong>formation. 

All students were <strong>in</strong>cluded full time <strong>in</strong> a general 

education classroom <strong>and</strong> received support 

services from the special education 

teacher or a paraprofessional two to five hours 

per day. The rema<strong>in</strong><strong>in</strong>g time <strong>in</strong> the general 

education classroom was spent without special 

support. 

Evan received autism support five hours per 

day <strong>in</strong> the general education fourth grade 

classroom <strong>and</strong> attended the gifted education 

program for four hours per week. Although 

Evan had an above average cognitive ability, 

his lack of organizational skills adversely affected 

his performance <strong>in</strong> the classroom. He 

completed assignments accurately <strong>and</strong> 

quickly, but put them <strong>in</strong> his desk where they 

were forgotten, lost or thrown away before 

they were turned <strong>in</strong> to teachers to be graded. 

Ben, a fifth grader, received two <strong>and</strong> a half 

hours of special education support per day <strong>in</strong> 

the general education classroom. Despite an 

average full scale IQ, Ben had difficulty organiz<strong>in</strong>g 

his school materials. Due to a deficit <strong>in</strong> 

fluency, he did not f<strong>in</strong>ish work <strong>in</strong> the time 

allotted <strong>and</strong> was expected to complete it at 

a later time. He often put unf<strong>in</strong>ished assign-

TABLE 1 

Description of Participants 

St<strong>and</strong>ardized Achievement 

Scores 

Autism 

Eligibility SPED Support WISC-IV* 

Participants Grade Age 

WJ-III** : 

Oral Expression: 108 

Broad Read<strong>in</strong>g: 114 

Academic Skills: 122 

Academic Knowledge: 110 

WJ-III**: 

Oral language: 117 

Story Recall: 144 

Academic Fluency: 77 

Writ<strong>in</strong>g fluency: 83 

Applied Problems: 105 

WJ-III**: 

Broad read<strong>in</strong>g: 99 

Basic read<strong>in</strong>g skills: 110 

Academic skills: 100 

Academic fluency: 102 

K-TEA***: 

Read<strong>in</strong>g Decod<strong>in</strong>g: 98 

Read<strong>in</strong>g Comprehension: 88 

Full Scale: 120 

Verbal: 102 

Perceptual 

Reason<strong>in</strong>g: 135 

5 hrs autism per day 

4 hrs gifted per wk 

Asperger 

Syndrome 

Evan fifth 9 years 4 

months 

2.5 hrs autism per day Full Scale: 100 

Verbal: 119 

Perceptual 


Asperger 

Syndrome 

Ben fifth 10 years 3 


Autism 3 hrs. autism per day No Full Scale IQ 

Available 

Jake fourth 9 years 10 


5.5 hrs. autism per day Full Scale: 86 

Verbal: 110 

Perceptual 


Asperger 

Syndrome 

Patrick fourth 9 years 11 


* WISC-IV Wechsler Intelligence Scale for Children-Fourth Edition (Wechsler, 2004). 

** WJ-III Woodcock Johnson III (Woodcock, McGrew & Mather, 2000). 

*** K-TEA Kaufman Test of <strong>Education</strong>al Achievement (Kaufman & Kaufman, 1985). 

Special <strong>Education</strong> support from autism program was not one/one, but shared with other students with autism placed <strong>in</strong> the regular education classroom. 


ments <strong>in</strong> his desk, under books, or with other 

assignments <strong>and</strong> forgot or lost them. Fail<strong>in</strong>g to 

complete or turn <strong>in</strong> assignments negatively 

affected Ben’s grades. 

Jake received three hours of special education 

support per day <strong>in</strong> the general education 

classroom. Although Jake completed gradelevel 

assignments rapidly <strong>and</strong> accurately, he 

did not put them <strong>in</strong> the appropriate folder, 

but put them <strong>in</strong> his desk where they became 

lost <strong>and</strong> subsequently were not turned <strong>in</strong> to be 

graded. Jake needed to improve his ability to 

file completed work <strong>in</strong> the classroom. Jake 

had deficits <strong>in</strong> gross/f<strong>in</strong>e motor abilities, preservative/stereotypical 

behaviors, <strong>and</strong> delays 

<strong>in</strong> pragmatic language. 

Patrick received five <strong>and</strong> a half hours of 

special education support per day <strong>in</strong> the general 

education classroom where his performance 

was <strong>in</strong> the “low average” range. Three 

of these hours were provided <strong>in</strong> a one-on-one 

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

from the special educator or paraprofessional. 

Support was provided to help 

Patrick complete his assignments <strong>and</strong> submit 

them to the appropriate teacher <strong>in</strong> a timely 

manner. Patrick f<strong>in</strong>ished assignments <strong>and</strong>, 

like other participants, put them <strong>in</strong> his desk or 

<strong>in</strong>side unrelated books <strong>and</strong> when asked was 

unable to f<strong>in</strong>d them result<strong>in</strong>g <strong>in</strong> a zero grade. 

Prior to the study all participants were assisted 

by the special education teacher or 

paraprofessional to retrieve <strong>and</strong> organize required 

materials. Over time, it became evident 

that for these students to become successful 

learners, <strong>in</strong>dependent fil<strong>in</strong>g <strong>and</strong> retriev<strong>in</strong>g 

strategies needed to be learned. Participants’ 

IEPs <strong>in</strong>cluded goals to improve organizational 

skills. None of the participants had previous 

experience with the file box system to organize 

class materials, but did have experience 

with visual strategies, <strong>in</strong>clud<strong>in</strong>g activity schedules 

<strong>and</strong> behavioral prompts (e.g., posted 

classroom rules, h<strong>and</strong> gestures etc.). No other 

organizational strategies had been attempted 

with students. 

Students were selected for participation <strong>in</strong> 

the study because of their full <strong>in</strong>clusion <strong>in</strong> the 

general education classroom, with the expectation 

that they could perform at grade level, 

<strong>and</strong> their organizational skill deficits that negatively 

impacted their progress. All students 

had good attendance records hav<strong>in</strong>g missed 

six or fewer school days the previous year. 

Parents signed consent forms <strong>and</strong> students 

signed assent forms prior to the start of the 

study. 

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

Basel<strong>in</strong>e <strong>and</strong> <strong>in</strong>tervention conditions were 

conducted <strong>in</strong> three general education classrooms 

(two fourth grade classes <strong>and</strong> one fifth 

grade class) throughout the school day. Generalization 

assessments were adm<strong>in</strong>istered <strong>in</strong> 

students’ homes by parents. Classroom arrangements 

were similar <strong>in</strong> each of the classrooms. 

Student desks were arranged <strong>in</strong> clusters 

of five to six desks. Participants did not sit 

at the same cluster. Dur<strong>in</strong>g <strong>in</strong>tervention each 

student had his fil<strong>in</strong>g box sitt<strong>in</strong>g on the floor 

beside his desk for easy access. Most of the 

academic <strong>in</strong>struction took place at a dry erase 

board on the front wall of each classroom that 

was easily visible to all students. The daily 

schedule was posted on the front wall of the 

classroom. Students also had a copy of their 

daily schedules at their desks. The general 

education teacher <strong>and</strong> special education 

teacher collaborated <strong>in</strong> classroom <strong>in</strong>struction 

<strong>and</strong> provided assistance to students as needed. 

The special education teacher <strong>and</strong> first author 

was the primary <strong>in</strong>vestigator <strong>in</strong> this study. 

Materials 


Dur<strong>in</strong>g basel<strong>in</strong>e condition, seven two-pocketed 

9½ <strong>in</strong> 12 <strong>in</strong> card stock weight file 

folders were available to students for organiz<strong>in</strong>g 

materials. These file folders were to be 

stored <strong>in</strong> students’ desks. Student organizational 

materials used dur<strong>in</strong>g <strong>in</strong>tervention <strong>and</strong> 

generalization conditions <strong>in</strong>cluded a 14 <strong>in</strong> 9 

<strong>in</strong> 11 <strong>in</strong> plastic file box, seven 9½ <strong>in</strong> 12 <strong>in</strong> 

green hang<strong>in</strong>g file folders with ½ <strong>in</strong> 2<strong>in</strong> 

labels, <strong>and</strong> an 8 <strong>in</strong> 5 <strong>in</strong> plastic pencil box. A 

label was attached to the top of each folder 

identify<strong>in</strong>g the follow<strong>in</strong>g curricular content 

areas: math, read<strong>in</strong>g, grammar, spell<strong>in</strong>g, social 

studies, <strong>and</strong> science. The seventh folder 

was designated for 8½<strong>in</strong> 11 <strong>in</strong> wide ruled 

notebook paper. These materials were to be 

used by students to place all assignments related 

to each of the curricular content areas <strong>in</strong> 

the appropriate folder <strong>and</strong> <strong>in</strong> the file box. 

Students’ self-monitor<strong>in</strong>g charts were divided

<strong>in</strong>to seven columns, one for the date <strong>and</strong> one 

for each curricular content area sequenced to 

follow the student’s daily schedule. In the 

home sett<strong>in</strong>g, neither the file box nor the 

self-monitor<strong>in</strong>g chart was used by parents. Students 

brought home the file folder for the 

curriculum content area <strong>in</strong> which they had 

homework. 

Dependent Variables 

The dependent variables <strong>in</strong> this study were: a) 

percentage of papers, notes, h<strong>and</strong>outs, study 

guides, books, <strong>and</strong> workbooks filed <strong>in</strong> the appropriate 

folder for each curriculum area <strong>and</strong> 

b) number of seconds it took a student to 

retrieve a requested item. Each classroom had 

1-2 items to be filed per curriculum area each 

day, result<strong>in</strong>g <strong>in</strong> 6-12 items that should be 

filed daily. Dur<strong>in</strong>g the generalization condition, 

the number of completed homework assignments 

placed <strong>in</strong> the correct file folder was 

recorded upon the student’s return to school. 

Retrieval time was recorded by count<strong>in</strong>g the 

number of seconds it took a student to locate 

<strong>and</strong> submit a requested item. These data were 

collected on the average of every three days 

across all conditions with a m<strong>in</strong>imum of three 

days <strong>in</strong> any one condition. 

Experimental Design 

A multiple basel<strong>in</strong>e design across participants 

was used to evaluate the effectiveness of the 

file box organizational system. Initially basel<strong>in</strong>e 

data were collected on all four students’ 

fil<strong>in</strong>g <strong>and</strong> item retrieval behaviors dur<strong>in</strong>g the 

same time period. Once basel<strong>in</strong>e data were 

stable for a m<strong>in</strong>imum of three days, the <strong>in</strong>tervention 

(file box) condition was <strong>in</strong>troduced to 

the first student, while the other students rema<strong>in</strong>ed 

<strong>in</strong> basel<strong>in</strong>e (file folder) condition. 

Once the first student’s data reached criterion, 

the file box system was <strong>in</strong>troduced to the 

second student, <strong>and</strong> so on until all students 

were <strong>in</strong>troduced to the <strong>in</strong>tervention. Experimental 

control would be demonstrated with<strong>in</strong> 

the context of a multiple basel<strong>in</strong>e design 

across participants if: a) stable basel<strong>in</strong>e levels 

were ma<strong>in</strong>ta<strong>in</strong>ed for each participant prior to 

the <strong>in</strong>troduction of the file box system; b) the 

<strong>in</strong>troduction of the <strong>in</strong>tervention was systematically 

staggered across participants; c) upon 

<strong>in</strong>troduction of <strong>in</strong>tervention, not before, 

there was an immediate <strong>in</strong>crease <strong>in</strong> the percentage 

of items filed correctly <strong>and</strong> a concomitant 

decrease <strong>in</strong> the number of seconds it 

took a student to retrieve requested items; <strong>and</strong> 

d) this effect was replicated across each of the 

four participants (i.e., <strong>in</strong>ter-subject direct replication) 

(Kennedy, 2005). 

General Procedure 

To assure students understood what was expected 

of them, the special education teacher 

approached each student before first period 

class, waited for eye contact, <strong>and</strong> then delivered 

the prime, “Don’t forget to keep your 

materials organized today”. Student file folders 

(basel<strong>in</strong>e condition) <strong>and</strong> file boxes (<strong>in</strong>tervention 

condition) were checked 5 days a 

week at the end of the school day prior to 

dismissal. The teacher <strong>and</strong> student spent 5-10 

m<strong>in</strong> check<strong>in</strong>g whether study guides, notes, 

textbooks, h<strong>and</strong>outs, worksheets etc. were 

filed correctly. No re<strong>in</strong>forcement system was 

<strong>in</strong> place for fil<strong>in</strong>g or retriev<strong>in</strong>g items dur<strong>in</strong>g 

basel<strong>in</strong>e or <strong>in</strong>tervention conditions. 

Procedure 

Basel<strong>in</strong>e condition. Dur<strong>in</strong>g basel<strong>in</strong>e condition, 

data were collected on students’ fil<strong>in</strong>g 

skills, us<strong>in</strong>g manila file folders, <strong>and</strong> without 

the use of the file box system <strong>in</strong>tervention. At 

the beg<strong>in</strong>n<strong>in</strong>g of each school day, the special 

education teacher delivered the verbal prime, 

“Don’t forget to keep your desk organized 

today.” At the end of each academic period, 

students were expected to place unf<strong>in</strong>ished 

<strong>and</strong> completed work, notes, h<strong>and</strong>outs etc. <strong>in</strong>to 

one of two pockets <strong>in</strong> their file folder for the 

appropriate curricular area. At the end of the 

school day, the teacher checked student folders 

for the number of appropriately filed 

items, <strong>and</strong> when <strong>in</strong>correct, <strong>in</strong>structed students 

to put items “<strong>in</strong> the correct folder.” No re<strong>in</strong>forcement 

was provided for correctly fil<strong>in</strong>g 

items. 

File box system condition. On the first day of 

the <strong>in</strong>tervention condition when students 

were to use the file box system, the special 

education teacher taught participants how to 

use the file box system <strong>and</strong> self-monitor<strong>in</strong>g 

chart. Individual tra<strong>in</strong><strong>in</strong>g was conducted dur- 


<strong>in</strong>g one 10-15 m<strong>in</strong> session <strong>in</strong> the general education 

classroom at the beg<strong>in</strong>n<strong>in</strong>g of the first 

school day. The teacher placed curriculum 

folders <strong>in</strong> the file box on the floor beside each 

participant’s desk <strong>and</strong> arranged them <strong>in</strong> sequential 

order follow<strong>in</strong>g the classroom daily 

schedule. The student was <strong>in</strong>structed to remove 

everyth<strong>in</strong>g from his desk <strong>and</strong> to file each 

paper <strong>and</strong> textbook <strong>in</strong> its appropriate folder 

<strong>in</strong>side the file box. Once all items <strong>in</strong> the students’ 

desk were filed correctly, the student’s 

desk was turned 180 degrees so that he could 

not put any work or materials <strong>in</strong>side the desk. 

The student was then taught to self-monitor 

his fil<strong>in</strong>g responses on a daily organizational 

chart by circl<strong>in</strong>g “” if all items were filed 

correctly, or “” when misfiled. 

Dur<strong>in</strong>g <strong>in</strong>tervention, students were rem<strong>in</strong>ded 

at the beg<strong>in</strong>n<strong>in</strong>g of the day “Don’t 

forget to keep your desk organized today.” 

They were expected to <strong>in</strong>dependently file 

their curricular materials throughout the day. 

At the end of each academic period as <strong>in</strong>structed 

dur<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g, students looked <strong>in</strong>to 

their file box, organized their materials, <strong>and</strong> 

then <strong>and</strong> circled or – if their items for that 

subject were organized. At the end of the 

school day, the special education teacher entered 

the general education classroom, <strong>and</strong> as 

the student observed, she recorded the number 

of correctly <strong>and</strong> <strong>in</strong>correctly filed items <strong>in</strong> 

the student’s file box. Dur<strong>in</strong>g <strong>in</strong>tervention, 

participants were rated on how accurately they 

placed materials <strong>in</strong> the fil<strong>in</strong>g box, <strong>and</strong> how 

long it took them to file specific academic 

materials. 

The percentage of correctly filed items was 

calculated <strong>and</strong> the data graphed. Duration 

per occurrence data on the length of time it 

took for the student to locate <strong>and</strong> h<strong>and</strong> the 

teacher a specific requested item from his file 

box were collected on the average of once 

every three days at a different time of day. As 

<strong>in</strong> basel<strong>in</strong>e condition no adult prompts, corrections, 

or re<strong>in</strong>forcers were delivered dur<strong>in</strong>g 

the <strong>in</strong>tervention condition. 

Reliability 

The paraprofessional support<strong>in</strong>g students <strong>in</strong> 

the general education classroom collected reliability 

data 20% of all sessions across both 

conditions for all students on the number of 


correctly filed items. A m<strong>in</strong>imum one reliability 

check was made per condition. Duration 

per occurrence reliability data was collected 

on 20% of all sessions <strong>and</strong> at least once per 

condition for each student. Interobserver reliability 

data were calculated us<strong>in</strong>g the po<strong>in</strong>tby-po<strong>in</strong>t 

method <strong>in</strong> which the number of 

agreements were divided by the number of 

agreements plus disagreements <strong>and</strong> multiplied 

by 100 (Cooper, Heron, & Heward, 

2007). Overall mean <strong>in</strong>terobserver agreement 

was 97.3% (92.8%-100%). 

Procedural reliability checks on teacher behaviors 

(deliver<strong>in</strong>g the daily prime, “Don’t forget 

to keep your desk/box organized”; no 

adult prompt<strong>in</strong>g dur<strong>in</strong>g <strong>in</strong>tervention; no re<strong>in</strong>forcement 

for correct fil<strong>in</strong>g) occurred <strong>in</strong> 20% 

of all sessions across both conditions for all 

students. Procedural reliability was calculated 

by divid<strong>in</strong>g the number of correct adult behaviors 

by the number of planned behaviors 

<strong>and</strong> multiply<strong>in</strong>g by 100 (Bill<strong>in</strong>gsley, White, & 

Munson, 1980). The mean accuracy for classroom 

adults follow<strong>in</strong>g prescribed procedures 

was 94.6% (89.2%-100%). 

Results 

Effectiveness data. Figure 1 presents the 

percentage of items filed correctly across basel<strong>in</strong>e 

(file folder) <strong>and</strong> <strong>in</strong>tervention (file box 

system plus self monitor<strong>in</strong>g) conditions. As 

shown for each of the four students, after a 

stable basel<strong>in</strong>e was established <strong>and</strong> upon <strong>in</strong>troduction 

of the <strong>in</strong>tervention, there was an 

immediate <strong>in</strong>crease <strong>in</strong> the percentage of daily 

assignments filed correctly, not before. Figure 

2 summarizes the percent of items filed correctly 

for each participant <strong>in</strong> basel<strong>in</strong>e <strong>and</strong> file 

box conditions, <strong>in</strong> a bar graph. Summary data 

show that the four students filed between 45% 

71% of items correctly dur<strong>in</strong>g the basel<strong>in</strong>e 

condition (Jake M 72%, 71%–73%; Ben 

M 55.7%, 50%–62%; Evan M 56.7%, 

50%–73%; Patrick M 53.75%, 45%–67%), 

while dur<strong>in</strong>g the <strong>in</strong>tervention condition they 

filed between 70%–100% of items correctly 

(Jake M 97.96%, 80%–100%; Ben M 

95.9%, 80%–100%; Evan M 94.6%, 75%– 

100%; Patrick M 88.75%, 70%–100%). Substantial 

<strong>in</strong>creases <strong>in</strong> the percentage of items 

filed correctly were replicated across students 

only upon <strong>in</strong>troduction of the <strong>in</strong>tervention

Figure 1. Percentage of correctly filed items <strong>in</strong> basel<strong>in</strong>e <strong>and</strong> file box paired with self-monitor<strong>in</strong>g. 


Figure 2. Percentage of correctly filed items for 

each participant dur<strong>in</strong>g basel<strong>in</strong>e <strong>and</strong> file 

box condition. 

condition. Percentage of Nonoverlapp<strong>in</strong>g 

Data (PND) across basel<strong>in</strong>e trend <strong>and</strong> <strong>in</strong>tervention 

condition was 100% for all students, 

further show<strong>in</strong>g the effectiveness of the file 

box system plus self-monitor<strong>in</strong>g. 

Efficiency data. Figure 3 presents students’ 

mean number of seconds to retrieve teacher 

requested items across basel<strong>in</strong>e <strong>and</strong> <strong>in</strong>tervention 

conditions. These data show an immediate 

<strong>and</strong> susta<strong>in</strong>ed decrease <strong>in</strong> retrieval time 

duration for all four students upon <strong>in</strong>troduction 

of the file box organizational system. For 

<strong>in</strong>dividual participants mean duration from 

basel<strong>in</strong>e to <strong>in</strong>tervention conditions decreased 

as follows: Jake, M 42.3s (R 40s-45s) to 

12.75s (R 10s-20s); Ben, M 46.5s (R36s- 

57s) to 13.6 (R 10s-26s); Evan, 45.8s (R 

36s-53s) to 17.25s (R 10s-28s); Patrick, 54s 

(R 50s-66s) to 17.31s (R 15s-20s). The net 

mean improvement <strong>in</strong> duration retrieval time 

was 29.55s for Jake, 32.9s for Ben, 28.55s for 

Evan, <strong>and</strong> 36.63s for Patrick. The PND for 

duration retrieval time was 100% for all four 

participants 

Social validity data. General education 

teachers rated participants’ organizational 

skills pre <strong>and</strong> post <strong>in</strong>tervention, <strong>and</strong> saw an 

improvement <strong>in</strong> classroom performance of 

the students when they began us<strong>in</strong>g the fil<strong>in</strong>g 

system. Students turned their work <strong>in</strong> on time 

<strong>and</strong> did not ask for extra copies of assignments 

as often as they had before us<strong>in</strong>g the 

fil<strong>in</strong>g system. When students were assigned 

homework <strong>in</strong> different subject areas, they 

pulled correspond<strong>in</strong>g file folders from the file 

box <strong>and</strong> placed them <strong>in</strong>to their backpack. 

Parents reported that once the fil<strong>in</strong>g system 

began, their child did not have as many miss<strong>in</strong>g 

assignments that had to be re-done; how- 

ever, better fil<strong>in</strong>g at school did not result <strong>in</strong> 

improved organization of school papers at 

home. 



Results of this study demonstrate that a simple 

file box system paired with self-monitor<strong>in</strong>g is a 

more effective <strong>and</strong> efficient organizational approach 

than a traditional file folder approach 

<strong>in</strong> which students’ store their academic assignments 

<strong>and</strong> materials <strong>in</strong>side their desks. Students, 

all of whom were diagnosed with ASD, 

learned how to use the file box system <strong>and</strong> 

self-monitor<strong>in</strong>g chart with<strong>in</strong> one 10-15 m<strong>in</strong> 

tra<strong>in</strong><strong>in</strong>g session on one day. An immediate 

improvement <strong>in</strong> a) percentage of items correctly 

filed <strong>and</strong> b) number of seconds to retrieve 

an item requested by their teacher was 

observed for all four students. Students with 

HFA <strong>and</strong> AS, as well as other students (learn<strong>in</strong>g 

disabilities, <strong>in</strong>tellectual disabilities) who 

have difficulties organiz<strong>in</strong>g their school materials 

may benefit from this simple <strong>and</strong> affordable 

organizational system for keep<strong>in</strong>g track 

of their notes, worksheets, assignments, books, 

<strong>and</strong> materials kept at their desks. The file box 

system allowed students to locate their work 

more quickly when asked <strong>and</strong> it decreased the 

frequency of their comments related to frustration 

when classroom materials could not be 

found. Locat<strong>in</strong>g assignments so they can be 

turned <strong>in</strong> on time can positively impact classroom 

performance <strong>and</strong> grades. 

Self-monitor<strong>in</strong>g charts <strong>in</strong> the current study 

served as visual rem<strong>in</strong>ders to keep their file 

boxes organized. Unlike Bryan <strong>and</strong> Gast 

(2000), <strong>in</strong> which graduated guidance was used 

to teach students with HFA <strong>and</strong> AS to use 

visual activity schedules, the current <strong>in</strong>vestigation 

required only one 10-15 m<strong>in</strong> session to 

teach students how to use both the file box 

system <strong>and</strong> self-monitor<strong>in</strong>g chart. Systematic 

prompt fad<strong>in</strong>g was not required. If systematic 

<strong>and</strong> often time consum<strong>in</strong>g prompt fad<strong>in</strong>g 

strategies are not required, they should not be 

used. Teachers <strong>and</strong> therapists need to assess 

students’ need for assistance prior to select<strong>in</strong>g 

a teach<strong>in</strong>g strategy. As <strong>in</strong> the case of participants 

<strong>in</strong> this study, all of whom were imitative, 

a simple adult model plus verbal description 

teach<strong>in</strong>g approach was effective <strong>in</strong> teach<strong>in</strong>g 

how to use the <strong>in</strong>tervention. Prompt depen-

Figure 3. Number of seconds it took students to locate specific items. 

dency is not uncommon among children on 

the autism spectrum <strong>and</strong>, as described by Giangreco, 

et al. (1997) <strong>and</strong> Young et al. (1996) 

difficult to change once established. As demonstrated 

<strong>in</strong> this study a simple visual teach<strong>in</strong>g 

strategy (model<strong>in</strong>g) <strong>and</strong> simple visual organi- 

zational system (file box) plus self-monitor<strong>in</strong>g 

immediately elim<strong>in</strong>ated the need for adult assistance 

to help students organize their class 

materials. 

A strength of this <strong>in</strong>vestigation is that it the 

<strong>in</strong>tervention was designed <strong>and</strong> implemented 


y a special education teacher, <strong>in</strong> a public 

school, serv<strong>in</strong>g n<strong>in</strong>e children with ASD <strong>in</strong> a 

collaborative arrangement with<strong>in</strong> general education 

classrooms. Because of this the ecological 

validity of the f<strong>in</strong>d<strong>in</strong>gs is <strong>in</strong>creased. As 

previously mentioned the <strong>in</strong>tervention was 

low cost both <strong>in</strong> teacher time expenditure <strong>and</strong> 

material costs. There were, however, limitations 

to the study to which we recommend 

procedural changes. First, reliability data were 

not collected on the number of seconds it 

took students to retrieve items requested by 

the teacher. This was an unfortunate oversight 

that requires that retrieval time duration f<strong>in</strong>d<strong>in</strong>gs 

be viewed as tentative. These data should 

be taken a m<strong>in</strong>imum of 20% of all sessions <strong>in</strong> 

which data were collected <strong>and</strong> reported <strong>and</strong> at 

least once <strong>in</strong> each condition. Second, social 

data were not collected from student participants. 

Although effective, the use of a plastic 

file box may have been embarrass<strong>in</strong>g for students 

to use s<strong>in</strong>ce they are not commonly used 

by “typical” peers <strong>in</strong> general education classrooms. 

F<strong>in</strong>ally, it rema<strong>in</strong>s to be determ<strong>in</strong>ed 

whether or not students would cont<strong>in</strong>ue to 

use the file box system over a prolonged period 

without prompt<strong>in</strong>g. 

Future research should address generalization 

of f<strong>in</strong>d<strong>in</strong>gs to other sett<strong>in</strong>gs (home, vocational 

etc.) <strong>and</strong> other populations who exhibit 

executive function<strong>in</strong>g deficits that impede 

their academic performance. Students with 

AS have been shown to benefit from visual 

supports to underst<strong>and</strong> auditory-based <strong>in</strong>struction 

(Griswold, Barnhill, Myles, Hagiwara, 

& Simpson, 2002). The file box system 

could decrease the amount of time required 

to complete homework assignments if it were 

used at home as well as at school. If parents 

were to use a similar file system at home to 

help organize their child’s home rout<strong>in</strong>es, 

their reliance on auditory prompts to get their 

son to complete assigned chores may be decreased. 

It would be useful to determ<strong>in</strong>e if the 

file box system plus self-monitor<strong>in</strong>g would be 

effective for students on the spectrum when 

complet<strong>in</strong>g long term school projects. Also, 

studies <strong>in</strong>vestigat<strong>in</strong>g whether the file box system 

could be modified to assist students with 

locker <strong>and</strong> book bag organization are warranted. 

Although the current study targeted 

elementary age students, older students with 

HFA <strong>and</strong> AS who attend middle <strong>and</strong> high 

schools may benefit from a similar organizational 

system, tak<strong>in</strong>g <strong>in</strong>to consideration the 

age appropriateness of materials, due to the 

complexity, variety <strong>and</strong> quantity of their assignments. 

In spite of study limitations, this <strong>in</strong>vestigation 

adds to the applied research literature 

related to the remediation of executive function<strong>in</strong>g 

skill deficits exhibited by children with 

ASD. The <strong>in</strong>tervention was effective <strong>and</strong> efficient, 

as well as affordable, <strong>and</strong> warrants consideration 

by teachers <strong>and</strong> others work<strong>in</strong>g 

with <strong>in</strong>dividuals special needs. 

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Academic Achievement Profiles of Children with High 

Function<strong>in</strong>g Autism <strong>and</strong> Asperger Syndrome: A Review of the 

Literature 

Peggy J. Schaefer Whitby 

University of Central Florida 

G. Richmond Mancil 

Western Kentucky University 

Abstract: High function<strong>in</strong>g autism (HFA) <strong>and</strong> Asperger syndrome (AS) are foremost social disorders (Church, 

Alisanski, & Amanullah, 2000; Myles & Simpson, 2001) yet many students with HFA/AS experience 

difficulties with academic function<strong>in</strong>g. Educators report difficulties <strong>in</strong> teach<strong>in</strong>g <strong>and</strong> identify<strong>in</strong>g appropriate 

educational <strong>in</strong>terventions for children with HFA/AS. Research <strong>in</strong> the area of academic achievement of children 

with HFA/AS is <strong>in</strong> the stage of <strong>in</strong>fancy <strong>and</strong> more research is needed (Prior, 2003). To address the need for 

development of appropriate academic <strong>in</strong>terventions, several research studies have been conducted to determ<strong>in</strong>e 

the academic achievement profile of children with AS/ HFA (Barnhill, Hagiwara, Smith Myles, & Simpson, 

2000; Mayes & Calhoun, 2003a, 2003b, 2008; Goldste<strong>in</strong>, M<strong>in</strong>shew, & Siegel, 1994; Griswold, Barnhill, 

Smith Myles, Hagiwara, & Simpson, 2002; M<strong>in</strong>shew, Goldste<strong>in</strong>, Taylor, & Siegel, 1994). This article 

provides a synthesis of the literature on the academic achievement of students with HFA/AS from 1981 to the 

present to help determ<strong>in</strong>e if an academic profile for students with HFA/AS emerges. 

While there is no exact population study, <strong>in</strong> 

the United States of America, there are an 

estimated 560,000 of children between the 

ages of 0-21 with an autism spectrum disorder 

(Center for Disease Control, 2007). This number 

is expected to <strong>in</strong>crease as approximately 1 

<strong>in</strong> 150 children are be<strong>in</strong>g diagnosed with an 

autism spectrum disorder (ASD). One of the 

reasons for the <strong>in</strong>crease <strong>in</strong> children with an 

autism spectrum disorder is due to better assessment 

<strong>and</strong> broaden<strong>in</strong>g of the diagnostic 

criteria (Rutter, 2005). It is estimated that 

between 48% of <strong>in</strong>dividuals diagnosed with 

autism spectrum disorders have IQs below 70 

(Bertr<strong>and</strong>, Mars, & Boyle, 2001) leav<strong>in</strong>g the 

other 52% of people diagnosed with autism 

spectrum disorders <strong>in</strong> the high function<strong>in</strong>g 

range. Further, as early <strong>in</strong>tervention methods 

are identified <strong>and</strong> successfully impact the lives 

of children with autism spectrum disorders, 

academic goals are atta<strong>in</strong>able (O’Connor & 

Kle<strong>in</strong>, 2004). 


be addressed to Peggy J. Schaefer Whitby, University 

of Central Florida, 1407 Cather<strong>in</strong>e Street, Orl<strong>and</strong>o, 

FL 32801. 



Children with autism <strong>in</strong> the high-function<strong>in</strong>g 

range are often referred to as hav<strong>in</strong>g high 

function<strong>in</strong>g autism (HFA) or Asperger syndrome 

(AS). AS was re-<strong>in</strong>troduced by W<strong>in</strong>g <strong>in</strong> 

1981 (W<strong>in</strong>g, 1981). W<strong>in</strong>g’s 1981 def<strong>in</strong>ition of 

AS was the same as autistic disorder as def<strong>in</strong>ed 

by the DSM-IV TR, except W<strong>in</strong>g described 

<strong>in</strong>dividuals with AS as hav<strong>in</strong>g better social language 

skills (Prior, 2003). AS is listed as one of 

the five pervasive developmental disorders <strong>in</strong> 

the DSM-IV TR (2000). The criteria listed <strong>in</strong> 

the DSM-IV TR is different than previous conceptualizations 

<strong>in</strong> research (Prior, 2003). Because 

of the discrepancy <strong>in</strong> the AS diagnostic 

criteria, many authors use their own def<strong>in</strong>ition 

of AS <strong>in</strong> research studies, mak<strong>in</strong>g it very 

difficult to determ<strong>in</strong>e a useable def<strong>in</strong>ition <strong>and</strong> 

compare data across research studies (Schoplar, 

1998). Furthermore, the validity of AS as a 

dist<strong>in</strong>ct disorder accord<strong>in</strong>g to the DSM-IV TR 

is questionable as many research studies <strong>in</strong>dicate 

that <strong>in</strong>dividuals with AS meet criteria for 

both AS <strong>and</strong> autism (Prior, 2003). 

As a result of the discrepancies, there has 

been much debate regard<strong>in</strong>g the diagnostic 

differences between HFA <strong>and</strong> AS. Many experts 

now suggest that AS is high function<strong>in</strong>g 

autism (Ozonoff, South & Miller, 2000; Prior 

Academic Achievement of Children with HFA <strong>and</strong> AS / 551

et al., 1998; W<strong>in</strong>g, 1998). While studies have 

documented differences between HFA <strong>and</strong> 

AS, these studies did not control for differences 

<strong>in</strong> <strong>in</strong>telligence quotients <strong>and</strong> cognitive 

function<strong>in</strong>g levels (Prior, 2003). Studies controll<strong>in</strong>g 

for IQ have documented no significant 

difference <strong>in</strong> HFA <strong>and</strong> AS (Prior, 2003). 

Thus, for purposes of this literature review, 

subjects will <strong>in</strong>clude both <strong>in</strong>dividuals with 

HFA <strong>and</strong>/or AS as def<strong>in</strong>ed by an IQ of 70 or 

greater. 

Academic achievement becomes <strong>in</strong>creas<strong>in</strong>gly 

important as the number of children on 

the autism spectrum served <strong>in</strong> the general 

education sett<strong>in</strong>g <strong>in</strong>creases. Accord<strong>in</strong>g to the 

Twenty-seventh Annual Report to Congress, 

27% of children with autism spend less than 

21% of the day outside of the general education 

sett<strong>in</strong>g. Fifty-one percent of children with 

autism graduated with a st<strong>and</strong>ard diploma, 

twenty three percent of children with autism 

plan to attend college, <strong>and</strong> 17.6% dropped 

out of school (Wagner, Newman, Cameto, & 

Lev<strong>in</strong>e, 2006). As more children are diagnosed 

with autism <strong>and</strong> expected to meet the 

same academic st<strong>and</strong>ards of their neuro-typical 

peers, there is a dem<strong>and</strong> for <strong>in</strong>tervention 

strategies that will enable children with 

HFA/AS to perform academically. 

Academic performance will enable <strong>in</strong>dividuals 

with HFA/AS to attend college <strong>and</strong> obta<strong>in</strong> 

mean<strong>in</strong>gful employment. Although <strong>in</strong>dividuals 

with HFA/AS have the <strong>in</strong>telligence as 

measured by IQ, to compete they need appropriate 

<strong>in</strong>terventions <strong>and</strong> accommodations to 

reach their full potential (Smith Myles, 2005). 

This is critical as Temple Gr<strong>and</strong><strong>in</strong> suggests 

that <strong>in</strong>dividuals with HFA/AS need to become 

specialized <strong>in</strong> a field so that people are will<strong>in</strong>g 

to pay for their unique skill <strong>and</strong> overlook the 

social skill deficits (Gr<strong>and</strong><strong>in</strong>, Duffy, & Atwood, 

2004). Gr<strong>and</strong><strong>in</strong>’s comment suggests that academic 

function<strong>in</strong>g <strong>and</strong> specialized skill development 

may be as important as social skills 

tra<strong>in</strong><strong>in</strong>g for <strong>in</strong>dividuals with HFA/AS. If <strong>in</strong>dividuals 

with HFA/AS lose the opportunity to 

attend college because of poor academic performance 

<strong>in</strong> school, they may not obta<strong>in</strong> 

mean<strong>in</strong>gful employment. Mean<strong>in</strong>gful employment 

also may provide <strong>in</strong>dividuals with 

HFA/AS access to people who have similar 

<strong>in</strong>terests <strong>and</strong> allow social <strong>in</strong>teractions to de- 

velop. The lack of mean<strong>in</strong>gful employment, 

therefore, may cause further isolation for <strong>in</strong>dividuals 

with HFA/AS. 

To accomplish these academic goals, <strong>in</strong>formation 

on academic function<strong>in</strong>g is needed to 

develop a foundation for underst<strong>and</strong><strong>in</strong>g the 

academic achievement strengths <strong>and</strong> weaknesses 

of students with HFA/ AS (Griswold et 

al., 2002). Once a foundation of academic 

function<strong>in</strong>g is established, educational <strong>in</strong>terventions 

<strong>and</strong> best practices can be identified. 

To address the need for development of appropriate 

academic <strong>in</strong>terventions, several research 

studies have been conducted to determ<strong>in</strong>e 

the academic achievement profile of 

children with AS or HFA (Dickerson Mayes, & 

Calhoun, 2003a, 2003b, 2008; Barnhill et al., 

2000; Goldste<strong>in</strong> et al., 1994; Griswold et al., 

2002; M<strong>in</strong>shew et al., 1994). Thus, the purpose 

of this review is to provide a synthesis of 

the literature on the academic achievement of 

students with high function<strong>in</strong>g autism <strong>and</strong> Asperger 

syndrome to determ<strong>in</strong>e if an overall 

academic achievement profile emerges. First, 

analysis of the characteristics of the participants, 

the research design <strong>and</strong> the major f<strong>in</strong>d<strong>in</strong>gs 

across studies is provided. Second, an 

overall summary of an academic achievement 

profile for <strong>in</strong>dividuals with HFA/AS based 

upon the articles is presented. F<strong>in</strong>ally, implications 

for practitioners <strong>and</strong> researchers are 

provided. 

Method 


The literature review consisted of searches of 

academic search premier, ERIC, Middle Search Premier, 

Primary Search, PsychARTICLES, Psych 

INFO <strong>and</strong> Pubmed us<strong>in</strong>g various comb<strong>in</strong>ations 

of the follow<strong>in</strong>g terms: Asperger syndrome, 

autism, high function<strong>in</strong>g autism, education, 

<strong>and</strong> academic achievement. Then a h<strong>and</strong> 

search was conducted of the follow<strong>in</strong>g journals 

cover<strong>in</strong>g the time span from 1981 to 

present: The Journal of Autism <strong>and</strong> Other <strong>Developmental</strong> 

Disorders, Focus on Autism <strong>and</strong> <strong>Developmental</strong> 

<strong>Disabilities</strong>, <strong>and</strong> The Journal of Cl<strong>in</strong>ical 

<strong>and</strong> Experimental Neuropsychology. The year 

1981 was chosen because W<strong>in</strong>g re<strong>in</strong>troduced 

AS <strong>in</strong> that year <strong>and</strong> the debate over HFA/AS 

subtype differentiation began. F<strong>in</strong>ally, after review<strong>in</strong>g 

the retrieved articles an archival

TABLE 1 

Characteristics of Subjects 

Diagnostician <strong>and</strong> Assessment 

Tool 

ASD Subtypes 

Cognitive Level Gender 

Study N CA 

Dickerson Mayes & Calhoun, 2003a n 116 3 to 15 years old Autism 82% male DSM-IV 

Mean 6.7 Low 1Q 80 18% female Psychologist 

High IQ 80 Child Psychiatrist 

Dickerson Mayes & Calhoun, 2003b n 164 3 to 15 years old Autism 77% male DSM-IV 

Mean 5.9 Low 1Q 80 23% female Psychologist 

High IQ 80 Child Psychiatrist 

Dickerson Mayes & Calhoun, 2008 n 54 6 to 14 years old HFA 89% male DSM-IV 

Psychologist, confirmatory 

diagnosis by psychiatrist, 

psychologist, pediatric 

neurologist, or pediatrician 

Checklist for Autism <strong>in</strong> Young 

Children Pediatric Behavior 

Mean 8.2 IQ70 11% female Scale Cl<strong>in</strong>ical Observation 

Two groups: 

13 or 14 

Goldste<strong>in</strong>, M<strong>in</strong>shew, & Siegel, 1994 n 64 

years old Autism 100 % male DSM-IV 

n 46 Mean 16.11 IQ 80 0% females ADI 

matched controls ADOS 

Griswold, Barnhill, Smith Myles, 

Hagiwara, & Simpson, 2002 n 21 6 to 17 years old AS/HFA 100 % male DSM-IV 

IQ Full Scale 

Physician, Psychiatrist, or 

psychologist 

66-144 0 % female 

Mean: 10.0 

DSM-IV 

ADI 

ADOS 

100% male 

0% female 

Autism 

IQ70 

Median age:14 

years old 

n 54 

n 41 matched 

controls 

M<strong>in</strong>shew, Goldste<strong>in</strong>, Taylor, & 

Siegel, 1994 

Note. DSM-IVDiagnostic <strong>and</strong> Statistical Manual Fourth Edition; ADIAutism Diagnostic Inventory; ADOSAutism Diagnostic Observation Scale 


TABLE 2 

Research Design 

Study Research Question 

Dickerson Mayes & 

Calhoun, 2003a 


Calhoun, 2003b 


Calhoun, 2008 

Goldste<strong>in</strong>, M<strong>in</strong>shew, 

& Siegel, 1994 

Griswold, Barnhill, 

Smith Myles, 

Hagiwara, & 

Simpson, 2002 

M<strong>in</strong>shew, Goldste<strong>in</strong>, 

Taylor, & Siegel, 

1994 

Del<strong>in</strong>eate strengths 

& weaknesses to 

determ<strong>in</strong>e a 

difference as a 

function of age 

<strong>and</strong> IQ. 

To underst<strong>and</strong> the 

differences <strong>in</strong> 

ability based 

upon age <strong>and</strong> 

IQ. 

To determ<strong>in</strong>e if 

neuropsychological 

<strong>and</strong> learn<strong>in</strong>g 

profiles emerge 

<strong>and</strong> to compare 

f<strong>in</strong>d<strong>in</strong>gs from 

the WISC III 

<strong>and</strong> WIAT <strong>in</strong> 

previous 

research 

To <strong>in</strong>vestigate age 


the academic 

profile of people 

with HFA as 

compared to 

neurotypical 

controls 

What are the 

academic 

characteristics of 

youth with AS? 

To <strong>in</strong>vestigate the 


academic ability 

between HFA 

<strong>and</strong> controls. 

search was conducted. This search resulted <strong>in</strong> 

five research studies where academic achievement 

profiles of <strong>in</strong>dividuals with AS were the 

primary area assessed. Criteria for <strong>in</strong>clusion <strong>in</strong> 

the review were: subjects were diagnosed with 

HFA/AS, an experimental or quasi-experi- 

Type of Assessment 

Instrument Tests Statistical Analysis 

Intelligence 

Academic 

Achievement 

Intelligence 

Non-verbal 

<strong>in</strong>telligence 

Visual Motor 

Achievement 

Intelligence 

Academic 

Achievement 

Academic 

Achievement 

Achievement 

Problem Solv<strong>in</strong>g 

Stanford B<strong>in</strong>et IV 

WISC –III 

<strong>Developmental</strong> Test 

of Visual Motor 

Integration 

WIAT 

WJ Tests of 

Achievement 

Bayley Mental Scale 

Stanford B<strong>in</strong>et 

Test of Visual 

motor 

Integration 

Leiter International 

performance 

scale 

Test of Nonverbal 

Intelligence 

WIAT 

WJ Tests of 

Achievement 

WISC-IV 

WIAT-II 

Detroit Tests of 

Learn<strong>in</strong>g-2 

Woodcock Johnson 

Read<strong>in</strong>g Mastery 

tests-R 

Kaufman Test of 

<strong>Education</strong>al 

Achievement 

WIAT 

TOPS-R 

TOPS-A 

Achievement Detroit Tests of 

Learn<strong>in</strong>g-2 

Woodcock Johnson 

Read<strong>in</strong>g Mastery 

tests-R 

Kaufman Test of 

<strong>Education</strong>al 

Achievement 

t tests with a 

Bonferroni 

correction 

Pearson Correlation 

Coefficients 


Coefficients 

t tests 

t Tests 

Cohen’s d effect size 

ANOVA 

Bonferroni t tests 


Stepwise L<strong>in</strong>ear 

Regression 

ANOVA 

Friedman Two Way 

analysis of Variance 

Post Hoc 

Comparisons 

Independent Group t 

tests 

Note. WISC-IIIWeschler Intelligence Scale for Children; WIATWeschler Individual Achievement Tests; 

TOPS-RTest of Oral Problem Solv<strong>in</strong>g Revised; TOPS-ATest of Oral Problem Solv<strong>in</strong>g for Adolescents 


mental design was employed, <strong>and</strong> the study 

used a norm referenced achievement battery 

to determ<strong>in</strong>e achievement level. For each 

study, characteristics of subjects, research design 

<strong>and</strong> major f<strong>in</strong>d<strong>in</strong>gs were identified. The 

data is presented <strong>in</strong> Tables 1, 2, <strong>and</strong> 3.

TABLE 3 

Major F<strong>in</strong>d<strong>in</strong>gs <strong>in</strong> Academic Achievement (HFA) 

Study Profile strengths Profile Weaknesses Academic Implications Research Question Answer 


Calhoun, 2003a 


Calhoun, 2003b 


Calhoun, 2008 

Goldste<strong>in</strong>, 

M<strong>in</strong>shew, & 

Siegel, 1994 

Read<strong>in</strong>g, math & 

writ<strong>in</strong>g were <strong>in</strong> 

average range 

<strong>and</strong> 

commensurate 

with IQ 

Math read<strong>in</strong>g 

<strong>and</strong> spell<strong>in</strong>g 

correlated with 

IQ 

Read<strong>in</strong>g <strong>and</strong> 

Math were 

commensurate 

with IQ. 

Verbal <strong>and</strong> 

Visual 

Reason<strong>in</strong>g 

Young Group: 

Decod<strong>in</strong>g, 

Rote 

Mechanical 

Function<strong>in</strong>g, 

Normal 

performance 

<strong>in</strong> early years 

Graphomotor 

Writ<strong>in</strong>g 

Attention 

Comprehension: 

social language 

& reason<strong>in</strong>g 

7% qualified for 

read<strong>in</strong>g SLD 


math SLD 


writ<strong>in</strong>g SLD 

Academic <strong>in</strong>terventions 

may need to focus 

on attention, 

language, social 

skills, writ<strong>in</strong>g <strong>and</strong> 

graphomotor skills 

Written expression Use visual strength 

while bypass<strong>in</strong>g 

writ<strong>in</strong>g weaknesses 

Non-verbal <strong>and</strong> verbal 

<strong>in</strong>telligence gap 

closed between the 

age of 9-10. 

Therefore, early 

<strong>in</strong>tervention should 

focus on verbal 

Written Expression 

Attention 

Process<strong>in</strong>g Speed 

Language 

comprehension 

<strong>and</strong> social 

reason<strong>in</strong>g 

Complex 

process<strong>in</strong>g 

across doma<strong>in</strong>s 

Comprehension 

Oral directions 

L<strong>in</strong>guistically 

Complex material 

weakness 

17% qualified for math 

learn<strong>in</strong>g disability 

63% qualified for a 

writ<strong>in</strong>g learn<strong>in</strong>g 

disability 

37% qualified for a 

read<strong>in</strong>g learn<strong>in</strong>g 

disability 

Teach to the child’s 

verbal <strong>and</strong> visual 

reason<strong>in</strong>g skills while 

compensat<strong>in</strong>g for 

the writ<strong>in</strong>g, 

attention, process<strong>in</strong>g 

speed, language <strong>and</strong> 

social reason<strong>in</strong>g 

weaknesses 

People with HFA may 

perform as well or 

better than peers on 

many age-normed 

tasks until a certa<strong>in</strong> 

grade level, beyond 

which they do 

substantially less well 

The research del<strong>in</strong>eates 

the strengths <strong>and</strong> 

weakness of children 

with HFA. The 

research suggests that 

there is a difference 

based on IQ <strong>and</strong> age. 

IQ <strong>in</strong>creased up to the 

age of eight 

The WISC-IV <strong>and</strong> the 

WIAT-II appear to be 

an improved 

assessment 

<strong>in</strong>strument for 

children with HFA 

FSIQ was the best 

predictor of academic 

achievement 

Profile emerged: 

deficits <strong>in</strong> attention, 

graphomotor, <strong>and</strong> 

process<strong>in</strong>g speed; 

strengths <strong>in</strong> verbal 

<strong>and</strong> visual reason<strong>in</strong>g 

Three longitud<strong>in</strong>al age 

patterns emerged: 

1. Some academic 

skills rema<strong>in</strong> at or 

above average levels 

2. Underst<strong>and</strong><strong>in</strong>g 

<strong>and</strong> perform<strong>in</strong>g 

l<strong>in</strong>guistically complex 

materials were deficit 

<strong>in</strong> both age groups 

3. Normal 

performance <strong>in</strong> early 

years but does not 

ma<strong>in</strong>ta<strong>in</strong> over time 



Results 

Study Profile strengths Profile Weaknesses Academic Implications Research Question Answer 

Griswold, Barnhill, 

Smith Myles, 

Hagiwara, & 

Simpson, 2002 

M<strong>in</strong>shew, 

Goldste<strong>in</strong>, Taylor, 

& Siegel, 1994 

Basic Read<strong>in</strong>g 

Oral Expression 

Average 

Language 

Composite 

Basic ability to 

read, spell <strong>and</strong> 

perform 

mathematical 

calculations 

Characteristics of Study Participants 

Numerical 

Operations 

Listen<strong>in</strong>g 


Read<strong>in</strong>g 


Written Expression 

Problem Solv<strong>in</strong>g 

Lowest subtests <strong>in</strong> 

arithmetic <strong>and</strong> 


Impaired 


<strong>and</strong> <strong>in</strong>terpretive 

skills of 

<strong>in</strong>structions <strong>and</strong> 

text 

The majority of the researchers presented 

gender, chronological age, autism spectrum 

disorder diagnosis subtype with <strong>in</strong>tellectual 

function<strong>in</strong>g level, <strong>and</strong> diagnostic <strong>in</strong>strument 

(See Table 1). Eighty eight percent of the 

subjects were male, which is a slightly higher 

representation of males than the population 

as ASD is four times more likely to occur <strong>in</strong> 

males than females (Center for Disease Control, 

2007). 

For most studies, participants ranged from 

3–17 years old with a mean of 10.5 years <strong>in</strong> 

chronological age. Two studies reported a median 

age of 14 <strong>and</strong> divide the group <strong>in</strong>to two 

categories: studies with participants under 14 

years old or above 14 years old. The purpose 

of the division of the group was to determ<strong>in</strong>e 

if age differences appeared to impact academic 

achievement. 

ASD diagnosis <strong>and</strong> level of <strong>in</strong>tellectual function<strong>in</strong>g 

was reported for every study. Most 

studies <strong>in</strong>cluded persons with HFA/AS <strong>and</strong> 

had an IQ of greater than 80. Several studies 

<strong>in</strong>cluded persons with ASD who had IQ’s of 

Huge Range of 

function<strong>in</strong>g, know<strong>in</strong>g 

that a child has AS 

has little value to the 

teacher 

Teachers need the 

<strong>in</strong>dividual item 

analysis of these tests 

to build the IEP 

Build student portfolios 

paired with formal 

assessment 

Perform rote tasks <strong>and</strong> 

<strong>in</strong>voke simple 

associative processes 

The use of global 

scores to assess 

academic function<strong>in</strong>g 

<strong>in</strong> read<strong>in</strong>g <strong>and</strong> 

mathematics may fail 

to identify deficits 

less than 80, however, the data was used for 

comparison to the group of persons with IQs 

above 80. One study classified persons with 

HFA as hav<strong>in</strong>g IQ levels above 70. In the study 

that <strong>in</strong>cluded persons with AS only, it was 

<strong>in</strong>terest<strong>in</strong>g to note that after the Weschler 

Intelligence Scale for Children was adm<strong>in</strong>istered, 

it was revealed that the subjects IQ 

ranged from 66 to 144. 

All subjects met criteria for HFA/AS based 

upon the DSM-IV-TR. Two studies used the 

Autism Diagnostic Inventory (ADI) <strong>and</strong> the 

Autism Diagnostic Observation Scale (ADOS) 

to determ<strong>in</strong>e if the DSM-IV TR criterion were 

met. All but two of the studies reported diagnosis 

that was determ<strong>in</strong>ed by a psychologist, 

psychiatrist or a physician. The two studies 

that did not report the person mak<strong>in</strong>g the 

diagnosis were authored <strong>and</strong> conducted by 

persons with the credentials to make the cl<strong>in</strong>ical 

diagnosis. 



Profile emerged, 

however, <strong>in</strong>-depth 

assessments may be 

needed to identify 

weaknesses <strong>and</strong> 

portfolio assessments 

are needed to 

determ<strong>in</strong>e student 

needs. 

There is a profile that is 

different than neurotypical 

peers 

While the research question for each study 

varied slightly, the majority of the research 

studies focused on underst<strong>and</strong><strong>in</strong>g the achieve-

ment or ability of students with HFA/AS or 

underst<strong>and</strong><strong>in</strong>g the underly<strong>in</strong>g achievement or 

ability so that <strong>in</strong>terventions could be developed 

(See Table 2). One study <strong>in</strong>vestigated 

the relationship between age <strong>and</strong> IQ with academic 

achievement <strong>in</strong> order to ga<strong>in</strong> a better 

underst<strong>and</strong><strong>in</strong>g of the <strong>in</strong>tervention needs of 

students as the progress through school. Two 

of the studies used age <strong>and</strong> IQ matched controls 

groups, two research studies compared 

scores based upon discrepancy from IQ <strong>and</strong> 

between age groups <strong>and</strong> two research studies 

compared subtests with verbal, performance 

or full scale IQ. 

The ma<strong>in</strong> focus of each study was academic 

achievement. However, some studies <strong>in</strong>cluded 

<strong>in</strong>struments other than academic achievement 

assessments to help ascerta<strong>in</strong> ability profiles 

or strengths <strong>and</strong> deficits as it relates to 

school. Each study, except one, <strong>in</strong>cluded an 

IQ test <strong>in</strong> the data collection process. Many of 

the additional assessment <strong>in</strong>struments measured 

areas that are considered weaknesses <strong>in</strong> 

HFA/AS, such as visual motor process<strong>in</strong>g, motor 

coord<strong>in</strong>ation <strong>and</strong> problem solv<strong>in</strong>g. 

Data analysis varied for the studies. Several 

studies used <strong>in</strong>dependent t tests for group 

comparisons as well as dependent t tests to 

compare discrepancy between IQ <strong>and</strong> various 

subtests. Correlation coefficients were used <strong>in</strong> 

two studies to determ<strong>in</strong>e the relationship between 

two variables. Two-way analysis of variance 

also was used to determ<strong>in</strong>e the differences 

between two or more variables. 


Overall f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong>dicate that read<strong>in</strong>g, math 

<strong>and</strong> writ<strong>in</strong>g were commensurate with IQ 

(Dickerson Mayes & Calhoun., 2003a; Dickerson 

Mayes & Calhoun., 2008) <strong>and</strong> that basic 

read<strong>in</strong>g, encod<strong>in</strong>g, rote skills <strong>and</strong> <strong>in</strong>formation 

was <strong>in</strong>tact (See Table 3) (Mayes & Calhoun, 

2003a; Dickerson Mayes & Calhoun., 2003b, 

Goldste<strong>in</strong> et al., 1994; Griswold et al., 2002; 

M<strong>in</strong>shew et al., 1994). Accord<strong>in</strong>g to this review, 

weaknesses for children with HFA/AS lie 

<strong>in</strong> the area of writ<strong>in</strong>g <strong>in</strong>clud<strong>in</strong>g graphomotor 

<strong>and</strong> organizational skills, attention, complex 

process<strong>in</strong>g across doma<strong>in</strong>s <strong>in</strong>clud<strong>in</strong>g problem 

solv<strong>in</strong>g, numerical operations, listen<strong>in</strong>g comprehension 

<strong>and</strong> read<strong>in</strong>g comprehension 

(Barnhill et al, 2000; Mayes & Calhoun, 2003a, 

2003b, 2008; Goldste<strong>in</strong>, et al., 1994; Griswold 

et al., 2002; M<strong>in</strong>shew et al., 1994). The lowest 

subtests areas were <strong>in</strong> arithmetic <strong>and</strong> comprehension 

(M<strong>in</strong>shew et al.). 

Furthermore, it appears that IQ <strong>in</strong>creases 

up to the age of eight (Mayes & Calhoun, 

2003b). Children below the age of eight had 

weaker verbal skills. The non-verbal <strong>and</strong> verbal 

<strong>in</strong>telligence gap closed between the age of 

9-10, suggest<strong>in</strong>g that <strong>in</strong>terventions prior to the 

age of eight focus on verbal skill acquisition. 

Individuals with HFA/AS may perform as well 

or better than peers on many age-normed 

tasks until a certa<strong>in</strong> grade level, beyond which 

they do substantially less well (Goldste<strong>in</strong> et al., 

1994). The use of global scores to assess academic 

function<strong>in</strong>g <strong>in</strong> read<strong>in</strong>g <strong>and</strong> mathematics 

may fail to identify deficits (M<strong>in</strong>shew et al., 

1994). 


Overall, the review of the literature suggests 

that <strong>in</strong>dividuals with HFA/AS present with a 

general profile of academic function<strong>in</strong>g. Individuals 

with HFA/AS have deficits <strong>in</strong> the areas 

of comprehension, written expression, graphomotor 

skills, l<strong>in</strong>guistically complex materials, 

complex process<strong>in</strong>g across all doma<strong>in</strong>s <strong>and</strong> 

problem solv<strong>in</strong>g. The deficits <strong>in</strong> academic 

function<strong>in</strong>g may not become apparent until 

learn<strong>in</strong>g moves from rote tasks to abstract, 

conceptual learn<strong>in</strong>g (Goldste<strong>in</strong> et al., 1994). 

Deficits may result <strong>in</strong> academic difficulties <strong>in</strong> 

read<strong>in</strong>g, writ<strong>in</strong>g <strong>and</strong> mathematics. Proper assessment 

<strong>and</strong> analysis of subtest doma<strong>in</strong>s is 

needed to determ<strong>in</strong>e the strengths <strong>and</strong> weaknesses 

of a student with HFA/AS as the disorder 

present a range of function<strong>in</strong>g. 

Read<strong>in</strong>g 

The academic profile <strong>in</strong> read<strong>in</strong>g suggests that 

basic read<strong>in</strong>g <strong>and</strong> decod<strong>in</strong>g skills are <strong>in</strong>tact for 

students with HFA/AS. Read<strong>in</strong>g ability is commensurate 

with IQ up to around age 8. Dur<strong>in</strong>g 

the early years, students perform at or above 

their peers on read<strong>in</strong>g tasks. After age eight, 

read<strong>in</strong>g <strong>in</strong>struction focuses more on comprehension 

<strong>in</strong>clud<strong>in</strong>g abstract concepts such as 

ma<strong>in</strong> ideas, <strong>in</strong>ferences <strong>and</strong> causes/effect. Material 

becomes less explicit which may expla<strong>in</strong> 

the decrease <strong>in</strong> read<strong>in</strong>g ability when com- 


pared to neuro-typical peers. Comprehension 

deficits are an area identified as part of the 

academic profile <strong>in</strong> HFA/AS. Read<strong>in</strong>g comprehension 

due to the critical th<strong>in</strong>k<strong>in</strong>g <strong>and</strong> 

verbal reason<strong>in</strong>g components also may be impacted 

by the theory of m<strong>in</strong>d <strong>and</strong> attention 

deficits (Griswold et al., 2002). 

Writ<strong>in</strong>g 

Both written expression <strong>and</strong> graphomotor 

skills are identified as weaknesses for students 

with HFA/AS. Graphomotor skill deficits may 

be caused by motor coord<strong>in</strong>ation difficulties. 

Written expression may be impacted by the 

organization <strong>and</strong> attention deficits. Sixty percent 

of <strong>in</strong>dividuals with HFA/AS also have 

writ<strong>in</strong>g learn<strong>in</strong>g disabilities (Mayes & Calhoun, 

2003a, 2008). 

Mathematics 

Review of the literature suggests that children 

with HFA/AS have average mathematical abilities. 

Computational skills appear to be <strong>in</strong>tact 

for this population. However, complex problem 

solv<strong>in</strong>g with<strong>in</strong> this doma<strong>in</strong> impacts applied 

mathematical ability. Organizational 

<strong>and</strong> attention skills may also impact multiple 

step problem solv<strong>in</strong>g. Read<strong>in</strong>g comprehension 

deficits may also impact grade level word 

problems. Deficit areas other than mathematical 

computation may account for the significant 

difference between average to above average 

IQ <strong>and</strong> average mathematical ability 

f<strong>in</strong>d<strong>in</strong>gs. Dickerson Mayes <strong>and</strong> Calhoun 

(2003a, 2008) report that 23% of the students 

with HFA/AS meet criteria for a mathematics 

learn<strong>in</strong>g disability. 

Implications for Practitioners 

The review of the literature suggests that there 

is an academic profile of students with 

HFA/AS (Mayes & Calhoun, 2003a 2003b; 

Barnhill et al., 2000; Goldste<strong>in</strong> et al., 1994; 

Griswold et al., 2002; M<strong>in</strong>shew et al., 1994). 

The value of know<strong>in</strong>g the profile allows for a 

basic underst<strong>and</strong><strong>in</strong>g of how to teach children 

with HFA/AS (Griswold et al.). However, what 

is true for the group may not be true for each 

<strong>in</strong>dividual (Mayes & Calhoun, 2003a). Given 

the heterogeneous nature of the disorder, a 

huge range of function<strong>in</strong>g across students 

may exist. Know<strong>in</strong>g that a child has HFA/AS 

may be little value to the teacher. The use of 

global scores to assess academic function<strong>in</strong>g 

<strong>in</strong> read<strong>in</strong>g <strong>and</strong> mathematics may fail to identify 

deficits (M<strong>in</strong>shew et al.) Therefore, It is 

important to look at the whole child as well as 

item analysis of subtest performances to guide 

<strong>in</strong>dividual <strong>in</strong>terventions (Griswold et al.). 

Teachers need the <strong>in</strong>dividual subtest analysis 

of assessments to build <strong>in</strong>dividual education 

plans. For example, know<strong>in</strong>g that a student 

with HFA/AS scores <strong>in</strong> the 95 th percentile on 

overall academic skills on the Woodcock Johnson 

Tests of Achievement is less important 

then know<strong>in</strong>g that the student scored <strong>in</strong> the 

47 th percentile rank<strong>in</strong>g on read<strong>in</strong>g comprehension 

<strong>and</strong> the 76 th percentile rank<strong>in</strong>g <strong>in</strong> 

applied problems. The subtest scores allow a 

teacher to create an educational plan based 

upon the support needs of the student as well 

as the strengths of the student that a teacher 

can build upon. Build<strong>in</strong>g student portfolios 

<strong>and</strong> pair<strong>in</strong>g the <strong>in</strong>formation with formal assessment 

may give a teacher the best <strong>in</strong>dication 

of academic function<strong>in</strong>g (Griswold et al.). 

Once a teacher has developed an underst<strong>and</strong><strong>in</strong>g 

of the specific needs of the student, then 

he/she must have access to research-based 

practices to address the student’s academic 

needs. 

In addition, practitioners can educate parents 

so they do not become frustrated with a 

perceived decl<strong>in</strong>e <strong>in</strong> academic function<strong>in</strong>g 

when tasks become more conceptual. Dur<strong>in</strong>g 

this process, it is important for teachers to 

communicate effectively. This will <strong>in</strong>volve 

teach<strong>in</strong>g the parents about the new areas <strong>in</strong> 

the academics <strong>and</strong> strategies that may be beneficial. 

Further, the teachers should expla<strong>in</strong> 

the tests to the parents <strong>in</strong> terms that are underst<strong>and</strong>able 

(i.e., m<strong>in</strong>us the professional jargon). 

Implications for Researchers 


As aforementioned, researched-based academic 

<strong>in</strong>terventions for this population of students 

are sparse (Simpson, 2005). S<strong>in</strong>ce teachers 

typically are not tra<strong>in</strong>ed <strong>in</strong> research-based 

<strong>in</strong>terventions for their students with HFA/ AS 

(Smith Myles, 2005), they often rely on strategies 

researched with children with learn<strong>in</strong>g

disabilities yet children with HFA/AS may 

need further accommodations (Adreon & Durocher, 

2007). The effectiveness of the learn<strong>in</strong>g 

disability <strong>in</strong>terventions, when used for 

children with HFA/AS, has not been adequately 

assessed. Researchers could beg<strong>in</strong> to 

explore the effectiveness of these <strong>in</strong>terventions 

with the HFA/ AS population. When 

do<strong>in</strong>g this, research could test learn<strong>in</strong>g strategies 

<strong>and</strong> meta-cognitive strategies that have 

proved successful for learn<strong>in</strong>g disabilities <strong>and</strong> 

determ<strong>in</strong>e the necessary adaptations to meet 

the unique cognitive <strong>and</strong> academic needs of 

children with HFA/AS. By develop<strong>in</strong>g strategies 

that remediate or support the conceptual 

learn<strong>in</strong>g of <strong>in</strong>dividuals with HFA/AS as their 

needs change dur<strong>in</strong>g adolescences, quality of 

life outcomes may be improved by successful 

performance school that may lead to successful 

post-secondary education <strong>and</strong> mean<strong>in</strong>gful 

employment. In addition, researchers should 

beg<strong>in</strong> extend<strong>in</strong>g the researched based practices 

that have proved successful <strong>in</strong> remediat<strong>in</strong>g 

the social <strong>and</strong> communicative deficits to 

the classroom sett<strong>in</strong>g. 

Conclusions 

In summary, children with HFA/AS have the 

potential to become highly productive, contribut<strong>in</strong>g 

members of society <strong>and</strong> can develop 

their specific skills so they are admired <strong>and</strong> 

hired for their talent (Gr<strong>and</strong><strong>in</strong>, Duffy, & Atwood, 

2004). Students with HFA/AS need to 

ga<strong>in</strong> skill <strong>in</strong> all academic areas <strong>in</strong> order to 

graduate with a st<strong>and</strong>ard diploma, obta<strong>in</strong> satisfactory 

SAT or ACT scores <strong>and</strong> become admitted 

to college. However, research <strong>in</strong> the 

area of academic achievement of children 

with HFA/AS is <strong>in</strong> the stage of <strong>in</strong>fancy; result<strong>in</strong>g 

<strong>in</strong> teachers often hav<strong>in</strong>g to use strategies 

researched with <strong>in</strong>dividuals with learn<strong>in</strong>g disabilities. 

Future research teams should evaluate 

the effectiveness <strong>and</strong> efficiency of these 

strategies with <strong>in</strong>dividuals with HFA/AS. 

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F<strong>in</strong>al Acceptance: 12 January 2009 


A Method to Assess Work Task Preferences 

Virg<strong>in</strong>ie Cobigo 

Queen’s University 

Yves Lachapelle 

Université du Québec à Trois-Rivières 

Diane Mor<strong>in</strong> 

Université du Québec à Montréal 

Abstract: Persons with <strong>in</strong>tellectual disability may encounter difficulties <strong>in</strong> mak<strong>in</strong>g choices <strong>and</strong> express<strong>in</strong>g 

preferences because of restricted communication skills or a tendency to acquiesce. In addition, many studies 

provide evidence that these persons have less opportunity to make choices <strong>and</strong> express their preferences. The aim 

of this study was to conduct a field test of an <strong>in</strong>novative method to assess vocational preferences us<strong>in</strong>g choice 

<strong>and</strong> task completion observations. Sixteen educators were tra<strong>in</strong>ed to use this method. They were recruited through 

local developmental disability agencies specializ<strong>in</strong>g <strong>in</strong> services for persons with <strong>in</strong>tellectual disability <strong>in</strong> the 

Prov<strong>in</strong>ce of Quebec (Canada). N<strong>in</strong>eteen persons with <strong>in</strong>tellectual disability were assessed. Occurrences of four 

types of behaviors (choice, refusal, positive emotional <strong>and</strong> off-task behaviors), as well as length of time spent 

work<strong>in</strong>g on the task, were computed to determ<strong>in</strong>e levels of preferences. Interviews were conducted with the 

educators to collect their perceptions regard<strong>in</strong>g the effectiveness <strong>and</strong> usefulness of the method as a measure of its 

value <strong>in</strong> use. Results suggest that this method is useful to assess vocational preferences with persons with 

<strong>in</strong>tellectual disability. Interviews conducted with educators reveal a high satisfaction with the method. 

Vocational preferences assessment should rely on frequency of choices, as other behaviors previously considered 

as express<strong>in</strong>g preferences are not reliable. This study also provides further evidence that proxy op<strong>in</strong>ions may 

differ from one’s actual preferences. 

The aim of support<strong>in</strong>g persons with <strong>in</strong>tellectual 

disability is to provide them with a good 

quality of life, as well as self-determ<strong>in</strong>ed life 

outcomes. Current legislation <strong>and</strong> policies uphold 

these major objectives <strong>and</strong> recommend 

that professionals <strong>and</strong> caregivers take the preferences 

<strong>and</strong> personal goals of these persons 

<strong>in</strong>to account when mak<strong>in</strong>g decisions concern<strong>in</strong>g 

their lives. Recently, assess<strong>in</strong>g choices <strong>and</strong> 

preferences, which are def<strong>in</strong>ed as repeated 

This research was funded with doctoral grants 

from the Consortium national de recherche sur 

l’<strong>in</strong>tégration sociale (National consortium on social 

<strong>in</strong>tegration, www.cnris.org), the Fonds de recherche 

québécois sur la société et la culture (Society <strong>and</strong> culture 

research Quebec funds, www.fqrsc.gouv.qc.ca) <strong>and</strong> 

the Quebec chapter of the American Association on 

Intellectual <strong>and</strong> <strong>Developmental</strong> <strong>Disabilities</strong> (www. 

aaidd.org). Correspondence concern<strong>in</strong>g this article 

should be addressed to Virg<strong>in</strong>ie Cobigo, Queen’s 

University, Department of Community Health <strong>and</strong> 

Epidemiology, 21 Arch Street, Abramsky Hall, 3rd 

Floor, K<strong>in</strong>gston, ON K7L 3N6, CANADA. Email: 

virg<strong>in</strong>ie.cobigo@gmail.com 



choices of a same option, was highlighted as 

one of the ma<strong>in</strong> relevant research doma<strong>in</strong>s 

(Emerson, Hatton, Thompson, & Parmenter, 

2004). Direct measures of preferences are 

necessary s<strong>in</strong>ce preferences expressed by the 

person him- or herself may differ from those 

hypothesized by proxies, especially if the latter 

rely on subjective <strong>in</strong>formation (Perry & Felce, 

2002; Reid, Everson, & Green, 1999; Stancliffe, 

1995). However, all direct measures may 

not be suitable for every person with <strong>in</strong>tellectual 

disability. Questionnaires <strong>and</strong> <strong>in</strong>terviews 

may be <strong>in</strong>effective with persons with <strong>in</strong>tellectual 

disability because of limitations <strong>in</strong> their 

receptive or expressive communication skills 

(Cameron & Murphy, 2002). Persons with <strong>in</strong>tellectual 

disability also have a tendency to 

acquiesce on yes-say<strong>in</strong>g questions or to choose 

the second of two parallel either/or questions 

(F<strong>in</strong>lay & Lyons, 2002; Perry & Felce, 2002). 

Cognitive limitations are other important barriers 

to expression of preferences, particularly 

on complex abstract issues (Perry, 2004). Consequently, 

persons with <strong>in</strong>tellectual disability 

Assessment of Work Task Preferences / 561

may benefit from direct observation while 

they are manipulat<strong>in</strong>g or consum<strong>in</strong>g options 

presented dur<strong>in</strong>g a valid preference assessment 

procedure. Pictorial presentations us<strong>in</strong>g 

still pictures or videos are likely to compromise 

preferences assessment as they may be 

too abstract, given an <strong>in</strong>dividual’s cognitive 

skills. Most of the studies on direct observation 

assessment methods describe assessment 

of preferences for tangible stimuli (edibles, 

sensory activity, etc). Further research is 

needed to implement direct observation 

methods for assess<strong>in</strong>g more symbolic objects 

that represent important life outcomes, such 

as vocational activities (Cobigo, Mor<strong>in</strong>, & 

Lachapelle, 2007; Hatton, 2004; Hughes, Pitk<strong>in</strong>, 

& Lorden, 1998; Lohrmann-O’Rourke & 

Browder, 1998). This study aims to present 

field test results of a method to assess vocational 

preferences us<strong>in</strong>g direct observation 

while a person selects an option <strong>and</strong> works on 

the correspond<strong>in</strong>g task. Furthermore, it assesses 

the value <strong>in</strong> use of the assessment 

method by <strong>in</strong>terview<strong>in</strong>g the 16 job coaches 

who conducted assessment on 19 persons with 

<strong>in</strong>tellectual disability. 

Method 

Participants 

Sixteen job coaches (all women) were recruited 

through four local developmental disability 

agencies that provide public services to 

persons with <strong>in</strong>tellectual disability <strong>in</strong> the Prov<strong>in</strong>ce 

of Quebec (Canada). Fourteen had a 

college or university degree. Fourteen of them 

had worked with persons with <strong>in</strong>tellectual disability 

for at least 10 years. They assessed work 

task preferences for n<strong>in</strong>eteen persons with 

<strong>in</strong>tellectual disability (8 women, 11 men) who 

encountered difficulties express<strong>in</strong>g their preferences 

verbally. The evaluated persons were 

between 23 to 58 years old (mean 35). Their 

levels of adaptive behaviors were assessed us<strong>in</strong>g 

the Échelle québécoise des comportements adaptatifs 

(Quebec Adaptive Behavior Scale; Maurice, 

Mor<strong>in</strong>, Tassé, Garc<strong>in</strong>, & Vaillant, 1997) 

which is a reliable French <strong>in</strong>strument to assess 

adaptive behaviors of persons with <strong>in</strong>tellectual 

disability aged 3 years <strong>and</strong> older. It gives reliable 

<strong>and</strong> comparable descriptions of the participants, 

us<strong>in</strong>g a global score which describes 

the general adaptive skills of each participant. 


It also provides seven partial scores, <strong>in</strong>clud<strong>in</strong>g 

communication <strong>and</strong> vocational skills levels. 

These two scores provided <strong>in</strong>terest<strong>in</strong>g <strong>in</strong>formation 

on the participants’ function<strong>in</strong>g <strong>in</strong> 

terms of the research goals. The computed 

global scores <strong>in</strong>dicated that all the evaluated 

persons had a severe to profound deficit <strong>in</strong> 

their adaptive skills, except for one who had a 

mild deficit (participant 14). Their deficits <strong>in</strong> 

communication skills were severe to profound, 

except for one who was reported as 

hav<strong>in</strong>g a mild deficit (participant 16). All were 

assessed as hav<strong>in</strong>g important limitations <strong>in</strong> express<strong>in</strong>g 

or underst<strong>and</strong><strong>in</strong>g complex language. 

One had no deficit <strong>in</strong> his vocational skills 

(participant 14), five had a mild deficit (participants 

3, 4, 6, 7, 15), seven a moderate 

deficit, <strong>and</strong> six a severe to profound deficit <strong>in</strong> 

their vocational skills. Most of them received 

constant supervision, <strong>and</strong> had held the same 

job for more than a year. Work sett<strong>in</strong>gs were 

diverse: participants worked <strong>in</strong> schools, stores 

or community centers. Consequently, work 

tasks presented dur<strong>in</strong>g the assessment were 

different from one participant to another (for 

example, sort<strong>in</strong>g clothes, count<strong>in</strong>g 100 screws 

with a caliber, putt<strong>in</strong>g price stickers on products, 

shredd<strong>in</strong>g paper, etc.). Three of them 

were <strong>in</strong> an assessment period to determ<strong>in</strong>e 

which job best suited them. Twelve had known 

the evaluator for at least a year, <strong>and</strong> six had 

got to know her with<strong>in</strong> the last six months. 

They all had weekly contact with the evaluators, 

except for one who saw his or her evaluator 

once a month. 


A work task preference assessment method 

was designed follow<strong>in</strong>g an <strong>in</strong>tegrative review 

(Jackson, 1989) of studies assess<strong>in</strong>g vocational 

preferences <strong>in</strong> persons with <strong>in</strong>tellectual disability 

or evaluat<strong>in</strong>g the reliability of such assessment 

methods (Cobigo, Mor<strong>in</strong> et al., 

2007). This review allowed the researcher to 

make decisions on stimuli presented, assessment 

context <strong>and</strong> procedure, as well as behaviors 

to observe <strong>and</strong> to design a valid <strong>and</strong> reliable 

method to assess vocational preferences 

with persons with <strong>in</strong>tellectual disability. The 

designed method was then validated by five 

experts <strong>in</strong> the <strong>in</strong>tellectual disability field, <strong>and</strong> 

pre-experimentation was conducted with two 

job coaches (Cobigo, Lachapelle, & Mor<strong>in</strong>,

2007). The 16 job coaches who agreed to participate 

were tra<strong>in</strong>ed to conduct work task 

preference assessment us<strong>in</strong>g the method designed 

by the researcher. They chose one or 

two persons they wished to assess. Job coaches 

chose four tasks that existed at each person’s 

work sett<strong>in</strong>g. If necessary, the person was 

tra<strong>in</strong>ed beforeh<strong>and</strong> to know which behaviors 

were needed to complete a task. 

Dur<strong>in</strong>g the assessment, two choices were 

presented simultaneously us<strong>in</strong>g tangible objects 

normally required to complete the tasks. 

Pictograms were used with two participants 

(participants 6 <strong>and</strong> 14) as they already communicate 

us<strong>in</strong>g images at the job site. Objects 

or pictograms were presented at an equal distance 

from the person, so he could reach both 

of them. The evaluator asked the person to 

pick one of the objects, without nam<strong>in</strong>g the 

correspond<strong>in</strong>g activities. The evaluator recorded 

selections <strong>and</strong> refusals on an observation 

grid. Selection was def<strong>in</strong>ed as po<strong>in</strong>t<strong>in</strong>g to 

an object, touch<strong>in</strong>g it or nam<strong>in</strong>g the activity it 

represented. The person be<strong>in</strong>g evaluated was 

allowed to change his choice with<strong>in</strong> a fivesecond 

period, <strong>in</strong> which case the second 

choice was considered as selected. Refusals 

were def<strong>in</strong>ed as throw<strong>in</strong>g an object away, 

push<strong>in</strong>g it away, or refus<strong>in</strong>g to choose one of 

the options. If both options were refused, the 

pair of objects was removed <strong>and</strong> the next pair 

was presented. Once a choice was recorded, 

the person be<strong>in</strong>g evaluated was prompted to 

work on the selected task with<strong>in</strong> a threem<strong>in</strong>ute 

period. The evaluator used a chronometer 

to assess the length of time spent 

work<strong>in</strong>g on the task <strong>in</strong> the three-m<strong>in</strong>ute period. 

The evaluator also recorded off-task behaviors 

which were what the person did when 

the chronometer was off (off-task behaviors). 

The evaluator also observed positive emotional 

behaviors such as smil<strong>in</strong>g <strong>and</strong> laugh<strong>in</strong>g, 

as well as idiosyncratic vocalizations or gestures 

express<strong>in</strong>g pleasure. A timer rang when 

the three m<strong>in</strong>utes were up. The task was removed 

<strong>and</strong> the second pair of choices was 

presented follow<strong>in</strong>g the same procedure. The 

sequences of the pairs were predeterm<strong>in</strong>ed 

r<strong>and</strong>omly, as well as alternat<strong>in</strong>g object presentation 

side (right <strong>and</strong> left). In a session, all 

possible pairs had to be presented. In this 

study, four tasks were presented, so six pairs 

were possible. Evaluators were provided with 

observation grids that <strong>in</strong>cluded <strong>in</strong>formation 

about sequences <strong>in</strong> pair presentations <strong>and</strong> alternat<strong>in</strong>g 

right-left positions. Seven sessions 

were conducted <strong>in</strong> an eight-week maximum 

period. Research assistants observed 30% of 

the assessment sessions <strong>in</strong> order to conduct 

reliability checks. The first two sessions were 

not <strong>in</strong>cluded <strong>in</strong> the assessment results, as they 

were designed for mak<strong>in</strong>g any necessary adjustments 

to the set-up, <strong>and</strong> for acqua<strong>in</strong>t<strong>in</strong>g 

both the evaluator <strong>and</strong> the person be<strong>in</strong>g evaluated 

with the assessment procedure. For the 

behaviors recorded dur<strong>in</strong>g sessions three to 

seven, the evaluator computed percentages of 

choice <strong>and</strong> refusal for each task. Percentages 

of off-task <strong>and</strong> positive emotional behaviors 

were calculated on the number of choices for 

each task. The evaluator also calculated the 

mean duration of on-task behavior <strong>in</strong> a threem<strong>in</strong>ute 

period. This provided a profile of the 

most <strong>and</strong> least preferred activities among the 

four tasks presented. In concordance with 

previous research (Lancioni, O’Reilly, Campodonico, 

& Mant<strong>in</strong>i, 1998a; Lancioni, O’Reilly, 

Campodonico, & Mant<strong>in</strong>i, 1998b; Parsons, 

Reid, & Green, 1998; Reid, Parsons, & Green, 

1998), we expected that the most preferred 

activities were chosen over 70% of the time 

they were presented, they had the longest duration 

of on-task behaviors, the highest frequency 

of positive emotional behaviors, <strong>and</strong> 

the lowest frequency of off-task behaviors. In 

contrast, a least-preferred activity is expected 

to be chosen less than 50% of the time it was 

presented; to have the highest frequency of 

off-task behaviors, the lowest duration of ontask 

behaviors <strong>and</strong> lowest frequency of positive 

emotional behaviors. For each participant, 

tasks were classified from most to least preferred 

us<strong>in</strong>g frequencies of choice. We analyzed 

if levels of preferences have an impact 

on emotional <strong>and</strong> off-task behavior frequencies, 

us<strong>in</strong>g repeated measures ANOVA. 

Once the assessment was f<strong>in</strong>ished, a research 

assistant conducted a semi-structured 

<strong>in</strong>terview with each job coach to collect data 

on her perceptions of the assessment method. 

Interviews were designed follow<strong>in</strong>g the utilization-focused 

assessment approach (Patton, 

1997) to assess the method’s value <strong>in</strong> use. It 

could be def<strong>in</strong>ed as the value of an <strong>in</strong>strument 

or a product <strong>in</strong> relation to its users’ needs <strong>and</strong> 

use conditions. Thus, <strong>in</strong>terviewers were tra<strong>in</strong>ed 


to follow an <strong>in</strong>terview guide that listed specific 

questions <strong>and</strong> topics to be covered. Interview 

themes were: 1. general perceptions of the 

method used; 2. facilitat<strong>in</strong>g factors observed; 3. 

barriers encountered; 4. assessment outcomes; 

5. assessment of the expected <strong>and</strong> unexpected 

outcomes; <strong>and</strong> 6. perceptions of the advantages 

of the method. Interviews lasted about 30 to 60 

m<strong>in</strong>utes. Research assistants transcribed audiotaped 

<strong>in</strong>terviews, <strong>and</strong> an <strong>in</strong>dependent assistant 

checked all the transcripts. 

Qualitative data were analyzed <strong>in</strong> six recommended 

steps to prevent bias <strong>in</strong> <strong>in</strong>terpretation 

(L’Écuyer, 1990; Miles & Huberman, 1994; 

2003). First, the experimenter read transcripts 

twice to get an overall underst<strong>and</strong><strong>in</strong>g of the 

material. Transcripts were cut <strong>in</strong>to mean<strong>in</strong>gful 

segments. Each passage was categorized us<strong>in</strong>g a 

grid of codes. This grid was developed accord<strong>in</strong>g 

to <strong>in</strong>terview themes <strong>and</strong> study goals. Two 

assistants tried this grid with 30% of the transcripts 

<strong>and</strong> made comments to enhance its reliability. 

The experimenter then analyzed the material 

<strong>and</strong> assigned a code to each section 

follow<strong>in</strong>g the modified grid. Two other assistants 

<strong>in</strong>dependently analyzed 30% of the transcripts 

us<strong>in</strong>g the same grid to check <strong>in</strong>ter-coder 

agreement. The grid conta<strong>in</strong>ed 29 codes <strong>in</strong> six 

categories (general perceptions, facilitat<strong>in</strong>g factors, 

barriers encountered, assessment outcomes, 

other <strong>in</strong>struments to assess preferences 

<strong>and</strong> how to enhance the assessment method) 

<strong>and</strong> these are described <strong>in</strong> Table 1. Descriptive 

analyses were conducted to describe the experience 

<strong>and</strong> perceptions of participants <strong>in</strong> terms of 

the above-mentioned themes. 

Results 

Preference Assessment 

The percentage of <strong>in</strong>ter-observer agreement 

was estimated by divid<strong>in</strong>g the number of 

agreements by the number of agreements plus 

disagreements <strong>and</strong> multiply<strong>in</strong>g by 100%. Inter-observer 

agreement ranged between 73% 

<strong>and</strong> 100%, depend<strong>in</strong>g on the participants, 

with overall <strong>in</strong>ter-observer agreement be<strong>in</strong>g 

85%. Inter-observer agreement also varied depend<strong>in</strong>g 

on the k<strong>in</strong>d of behaviors recorded. 

Agreement was lower for positive emotional 

behaviors (71%) which are discrete <strong>and</strong> sometimes 

idiosyncratic. Furthermore, evaluators 

may have wrongly recorded participant char- 


acteristics, such as attentiveness or degree of 

concentration, as positive emotional behaviors. 

These observation errors were corrected before 

calculat<strong>in</strong>g frequencies of emotional behaviors. 

Other agreements ranged from 82% (off-task 

behaviors) to 98% (selection). However, the offtask 

behavior category was misunderstood by 

several observers who recorded off-task behaviors 

even if the person be<strong>in</strong>g evaluated did not 

stop work<strong>in</strong>g on the task. Once these errors 

were corrected, <strong>in</strong>ter-observer agreement on 

off-task behaviors was 88%. 

Overall, results show that most preferred 

work tasks could be evaluated for 12 participants 

out of 19. Figures 1 <strong>and</strong> 2 show assessment 

results for each participant. Results vary 

considerably among participants. The percentages 

of choices clearly demonstrate the 

most-preferred <strong>and</strong> less-preferred work tasks 

for the majority of participants. However, no 

obvious preference profile could be demonstrated 

for participants 2, 6, 14 <strong>and</strong> 18 as 

frequencies of choice were equivalent for all 

the four tasks (around 40% <strong>and</strong> 60%). Participants 

11 <strong>and</strong> 12 demonstrated no most-preferred 

activity, but frequencies of choice for 

moderately-preferred <strong>and</strong> non-preferred activities 

vary between 27% <strong>and</strong> 67%. The percentages 

of choices were not reliable for participant 

10. Throughout the assessment, he 

chose the left-positioned stimulus. Experimenters 

were careful not to present the same 

stimulus always on the right or left side, but 

did not equally balance right <strong>and</strong> left positions 

for each task. Task 1 was presented 80% 

of the time on the left side. 

Only four participants exhibited refusals 

dur<strong>in</strong>g the assessment. Frequency of refusals 

for participant 12 should be <strong>in</strong>terpreted with 

caution s<strong>in</strong>ce refusals were hard to dist<strong>in</strong>guish 

from his epileptic symptoms. Participant 

5 exhibited refusals with two tasks that he 

selected at least 80% of the time they were 

presented. However, each task was only refused 

once. It is <strong>in</strong>terest<strong>in</strong>g to note that participant 

5 is diagnosed with a pervasive developmental 

disorder. Participants 7 <strong>and</strong> 14 

exhibited refusals with moderately-preferred 

tasks. No refusal was exhibited with non-preferred 

activities. 

Only four participants did not exhibit offtask 

behaviors dur<strong>in</strong>g the assessment. Nonetheless, 

no concordance was observed be-

TABLE 1 

Qualitative Analysis Grid 

Categories Codes 

General perceptions a) Satisfaction 

b) Dissatisfaction 

c) Reluctance 

d) Persons who could benefit from the assessment 

e) Professionals who could use the method. 

Facilitat<strong>in</strong>g factors a) Related to the assessment context 

b) Related to the evaluated person’s characteristics 

c) Related to the assessment method itself 

d) Related to the tra<strong>in</strong><strong>in</strong>g received on the assessment 

method 

e) Related to the evaluator’s professional tra<strong>in</strong><strong>in</strong>g <strong>and</strong> 

experience 

f) Other facilitat<strong>in</strong>g factors. 

Barriers encountered a) Related to the assessment context 

b) Related to the evaluated person’s characteristics 

c) Related to the assessment method itself 

d) Related to the tra<strong>in</strong><strong>in</strong>g received on the assessment 

method 

e) Related to the evaluator’s professional tra<strong>in</strong><strong>in</strong>g <strong>and</strong> 

experience 

f) Other barriers encountered. 

Assessment outcomes a) Knowledge of the evaluated person’s preferences 

b) Agreement between assessed preferences <strong>and</strong> preferences 

assumed by the evaluator before the assessment 

c) Lack of agreement between assessed <strong>and</strong> assumed 

preferences 

d) Knowledge of work<strong>in</strong>g condition preferences 

e) Plann<strong>in</strong>g vocational activities 

f) Other outcomes. 

Other <strong>in</strong>struments to assess preferences a) Validated <strong>in</strong>strument 

b) Informal tool 

c) No other tool known 

How to enhance the assessment method a) Suggestions for enhanc<strong>in</strong>g the assessment method 

b) Expression of no possible improvements 

c) Expression of no known improvements 

tween the frequency of choices <strong>and</strong> the 

frequency of off-task behaviors. Repeated 

measures ANOVA were non significant (p 

0.05), suggest<strong>in</strong>g that there is no impact of the 

level of preference on the frequency of offtask 

behaviors. Off-task behaviors were exhibited 

with most-preferred as well as less-preferred 

activities. For example, participant 9 

exhibited off-task behaviors while complet<strong>in</strong>g 

his two most-preferred tasks, but none 

with his less-preferred ones. Participant 13 

exhibited off-task behaviors <strong>in</strong> almost 100% 

of the observation periods. The length of 

time spent work<strong>in</strong>g on the task was also 

recorded but is not reported <strong>in</strong> this article 

because no significant difference between 

tasks <strong>and</strong> participants is clearly demonstrated. 

All the computed means are above 

two m<strong>in</strong>utes on a three-m<strong>in</strong>ute period <strong>and</strong> 

are not congruent with other behaviors recorded. 

Most of the time, positive emotional behaviors 

were exhibited while complet<strong>in</strong>g a task that 

was selected over 70% of the time it was presented. 

However, positive emotional behaviors 

were also exhibited with less-preferred <strong>and</strong> 

non-preferred tasks. Repeated measures 

ANOVA were not significant (p 0.05). Fre- 


quency of positive emotional behaviors did not 

vary proportionally to frequency of choices. 

Utilization-focused Assessment 

Codes utilized to analyze transcripts of <strong>in</strong>terviews 

with the job coaches were divided <strong>in</strong> 6 

categories: 1. general perceptions of <strong>in</strong>terview- 

Figure 1. Assessment results by participant. 


ees concern<strong>in</strong>g the assessment method, 2. facilitat<strong>in</strong>g 

factors <strong>in</strong> the implementation of the 

method, 3. barriers encountered, 4. appreciation 

of the assessment outcomes, 5. other tools 

to assess vocational preferences known by <strong>in</strong>terviewees, 

6. recommendations to enhance 

the assessment method. To facilitate readers’

comprehension, results for both category 2 

<strong>and</strong> 3 will be presented <strong>in</strong> the same paragraph. 

General Perceptions 

All <strong>in</strong>terviewees expressed their appreciation of 

the method <strong>and</strong> recommended its use s<strong>in</strong>ce 

they need such assessment methods to enhance 

observation <strong>and</strong> underst<strong>and</strong><strong>in</strong>g of their clients. 

They found the method pleasant <strong>and</strong> easy to 

use. However, three of them were dissatisfied 

with the assessment results which they qualified 

as <strong>in</strong>sufficient or unclear. These three job 

coaches respectively assessed participants 10, 12 

<strong>and</strong> 13, <strong>and</strong> 17. Participant 10 is the person who 

chose all objects presented on his left. Results 

for participants 12, 13 <strong>and</strong> 17 are ambiguous 

because of a lack of congruence among behaviors 

observed. Only one job coach declared that 

she was not <strong>in</strong>terested <strong>in</strong> us<strong>in</strong>g the assessment 

method s<strong>in</strong>ce she was already aware of her clients’ 

preferences before the assessment. However, 

she thought that young job coaches could 

f<strong>in</strong>d the method useful. Accord<strong>in</strong>g to the <strong>in</strong>terviewees, 

the method could be used by various 

types of professionals, irrespective of their academic 

background, s<strong>in</strong>ce it is easy to implement. 

Job coaches <strong>and</strong> psychologists were the most 

common professional categories cited. Two <strong>in</strong>terviewees 

also recommended that school professionals 

use this method to help students discover 

their vocational orientation. Furthermore, 

some <strong>in</strong>terviewees thought that the method 

could be useful for assess<strong>in</strong>g <strong>in</strong>terests for leisure 

<strong>and</strong> home tasks. Interviewees highlighted the 

usefulness of this method for assess<strong>in</strong>g the preferences 

of persons who have limited communication 

skills, especially those who have not been 

tra<strong>in</strong>ed to communicate us<strong>in</strong>g alternative communication 

means (signs, pictograms, etc.). 

Most of the <strong>in</strong>terviewees added that persons 

with <strong>in</strong>tellectual disabilities may have difficulty 

express<strong>in</strong>g their preferences because of a tendency 

to acquiesce with or to please their caregivers, 

even if they have no major communication 

limitations. Persons with or without 

<strong>in</strong>tellectual disability may benefit from this 

method if they have language, auditory or visual 

difficulties. Several <strong>in</strong>terviewees said that the 

method is useful for quickly identify<strong>in</strong>g a new 

client’s preferences <strong>in</strong> order to plan his vocational 

orientation. Twelve <strong>in</strong>terviewees were re- 

luctant to use the assessment method. They 

feared that they would not have enough time to 

conduct the assessment, they would be disturbed 

by other clients, the person be<strong>in</strong>g evaluated 

would not cooperate, or the method would 

be too complicated. All of their fears disappeared 

when they used the method. 

Facilitat<strong>in</strong>g Factors <strong>and</strong> Barriers Encountered 

More than 80% of the <strong>in</strong>terviewees identified 

contextual factors as conditions that would 

facilitate implementation of the method, <strong>and</strong> 

75% found that contextual factors could be 

barriers to its use (see Figure 3). The assessment 

context seems to be an important issue 

to consider when evaluat<strong>in</strong>g the effectiveness 

of the method. Job coaches could choose to 

either conduct the assessment <strong>in</strong> the natural 

work sett<strong>in</strong>g or <strong>in</strong> a separate room <strong>in</strong> a oneon-one 

situation with the person be<strong>in</strong>g evaluated. 

Those who chose to conduct the assessment 

<strong>in</strong> a separate room identified this factor 

as a facilitator. Natural work conditions make 

the assessment more difficult s<strong>in</strong>ce other clients 

may need attention or someone could 

<strong>in</strong>terrupt a session. The person be<strong>in</strong>g evaluated 

is also more distracted because of <strong>in</strong>teractions 

with peers. If the assessment is conducted 

<strong>in</strong> a natural work sett<strong>in</strong>g, <strong>in</strong>terviewees 

recommended that a colleague take over from 

them <strong>and</strong> that tasks be assigned to the other 

clients so they will not disturb the assessment. 

They also recommended choos<strong>in</strong>g an appropriate 

time for conduct<strong>in</strong>g a session. Most of 

them chose times when some clients were absent, 

or when there was no rush <strong>in</strong> the production 

schedule, etc. Other contextual factors 

identified as facilitators or barriers had an 

impact on the client’s motivation to complete 

the task. For example, it is necessary to prepare 

enough material to last the entire session. 

When material was <strong>in</strong>sufficient <strong>and</strong> the evaluated 

person completed the task before the three 

m<strong>in</strong>utes were over, the evaluator had to undo 

the work already completed <strong>and</strong> then prompt 

the client to redo the same task. Interviewees 

observed a lack of <strong>in</strong>terest <strong>in</strong> their clients for 

redo<strong>in</strong>g a task they had already done. A solution 

could be hav<strong>in</strong>g separate work stations for each 

task <strong>and</strong> prompt<strong>in</strong>g the client to walk toward the 

correspond<strong>in</strong>g work station after his choice. 

This would also reduce the time needed to pre- 


pare the material dur<strong>in</strong>g a session. A similar 

impact on the client’s motivation to choose <strong>and</strong> 

complete a task could be the sequence of work 

tasks he had completed before the assessment. 

He could be prone to choos<strong>in</strong>g different tasks 

from those he had already done. 

Figure 2. Assessment results by participant. 


More than 80% of <strong>in</strong>terviewees listed characteristics 

of the person be<strong>in</strong>g evaluated as 

facilitat<strong>in</strong>g conditions: his cooperation dur<strong>in</strong>g 

the assessment <strong>and</strong> his concentration <strong>and</strong> attention 

skills. On the other h<strong>and</strong>, 56% of 

<strong>in</strong>terviewees described personal characteris-

Figure 3. Facilitat<strong>in</strong>g factors <strong>and</strong> barriers encountered by job coaches. 

tics as barriers, especially dual diagnoses that 

could <strong>in</strong>terfere with the assessment, such as 

pervasive developmental disorders or mental 

health disorders. 

In accordance with the general positive perception 

expressed by <strong>in</strong>terviewees, most of 

the factors related to the method were considered 

to be facilitat<strong>in</strong>g conditions. N<strong>in</strong>ety-four 

percent of the <strong>in</strong>terviewees appreciated the flexibility 

of the method which allowed for <strong>in</strong>terruptions 

<strong>and</strong> provided choice of an appropriate 

time to conduct a session, the length of 

time needed, <strong>and</strong> the first two tra<strong>in</strong><strong>in</strong>g sessions. 

Seventy-five percent of <strong>in</strong>terviewees 

identified barriers related to the method itself. 

Some behaviors to be observed were too 

ambiguous or difficult to observe. Calculat<strong>in</strong>g 

the results was also considered to be difficult. 

Some job coaches thought that the method 

restricted the choice of tasks to be assessed. 

For example, they would have liked to <strong>in</strong>clude 

<strong>in</strong> the assessment tasks that were unknown to 

the client. 

<strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> the method seems to be an 

important facilitat<strong>in</strong>g factor. Interviewees 

highlighted the importance of the supervision 

given by a research assistant <strong>and</strong> the experimenter 

<strong>in</strong> choos<strong>in</strong>g the tasks <strong>and</strong> prepar<strong>in</strong>g 


the material dur<strong>in</strong>g the first two sessions. They 

also found the document describ<strong>in</strong>g the 

method, which they received dur<strong>in</strong>g the tra<strong>in</strong><strong>in</strong>g, 

to be very useful. However, some clients 

were distracted by the presence of the research 

assistant dur<strong>in</strong>g the assessment. Professional 

experience <strong>and</strong> academic background, 

as well as an ongo<strong>in</strong>g relationship with the 

client, were considered to be assets <strong>in</strong> observ<strong>in</strong>g 

<strong>and</strong> <strong>in</strong>terpret<strong>in</strong>g behavior. They facilitate 

the recognition of undesirable variables that 

could <strong>in</strong>terfere with the assessment. 

Assessment Outcomes 

Twelve job coaches reported a lack of concordance 

between preferences assessed <strong>and</strong> the 

preferences they had hypothesized before the 

assessment. Eleven <strong>in</strong>terviewees found preference 

assessment useful for plann<strong>in</strong>g vocational 

activities best suited to clients. Twelve 

<strong>in</strong>terviewees reported unexpected outcomes. 

The assessment allowed them to stop <strong>and</strong> 

th<strong>in</strong>k about their clients, the number of tasks 

they were able to do, <strong>and</strong> the concordance 

between client preferences <strong>and</strong> task plann<strong>in</strong>g. 

Another important outcome was the significant 

impact on the quality of life of clients as 

the method helps job coaches <strong>in</strong>troduce 

choices on a daily basis <strong>and</strong> plan preferred 

vocational activities. Furthermore, some job 

coaches felt that this experience enhanced 

their competencies <strong>in</strong> observ<strong>in</strong>g <strong>and</strong> underst<strong>and</strong><strong>in</strong>g 

their clients. 

Other Preference Assessment Tools 

Forty-four percent of <strong>in</strong>terviewees did not 

know of other tools for assess<strong>in</strong>g work task 

preferences. Forty-four percent cited the Inventaire 

visuel des <strong>in</strong>térêts professionnel (Dupont, 

G<strong>in</strong>gras, & Tétreau, 2000) which is an <strong>in</strong>strument 

for assess<strong>in</strong>g vocational <strong>in</strong>terests us<strong>in</strong>g 

80 pictures of work areas. They described its 

<strong>in</strong>adequacies for assess<strong>in</strong>g the work task preferences 

of persons with <strong>in</strong>tellectual disability 

s<strong>in</strong>ce it is not concrete enough for some of 

them. Some persons with <strong>in</strong>tellectual disability 

lack the necessary language <strong>and</strong> <strong>in</strong>sight skills 

that are required for assessments which use 

pictures. One <strong>in</strong>terviewee also mentioned a 

computerized assessment tool. Consequently, 

job coaches tend to assess vocational prefer- 

ences by giv<strong>in</strong>g choices that are embedded <strong>in</strong> 

the client’s rout<strong>in</strong>e. 

How Can the Assessment Method Be Enhanced? 

Thirteen <strong>in</strong>terviewees suggested enhancements 

to the method. They recommended 

more concrete <strong>and</strong> detailed def<strong>in</strong>itions of behaviors 

to observe s<strong>in</strong>ce some were ambiguous. 

They also suggested decreas<strong>in</strong>g the time 

needed for the evaluation, for example, by 

hold<strong>in</strong>g 4 to 5 sessions <strong>in</strong>stead of 7. They 

asked that a way be found to make calculation 

of the results easier. Furthermore, they suggested 

<strong>in</strong>tegrat<strong>in</strong>g the assessment <strong>in</strong>to a more 

complete assessment program that would <strong>in</strong>clude 

more tasks, <strong>in</strong>clud<strong>in</strong>g tasks unknown to 

the client. The assessment should help to estimate 

performance on the tasks <strong>and</strong> the <strong>in</strong>fluence 

of variables such as diversity versus 

repetition of the tasks or <strong>in</strong>teractions with 

peers on the expressed preferences. A more 

detailed assessment would be helpful <strong>in</strong> plann<strong>in</strong>g 

a client’s vocational orientation, which is 

more useful than just know<strong>in</strong>g which tasks are 

preferred. 



This study provides further evidence of the 

behaviors which should be considered when 

assess<strong>in</strong>g or def<strong>in</strong><strong>in</strong>g choices <strong>and</strong> preferences. 

It is also a first attempt to assess the value <strong>in</strong> 

use of a work task preference assessment. Its 

important f<strong>in</strong>d<strong>in</strong>gs will help to provide job 

coaches with an effective tool for assess<strong>in</strong>g 

preferences. This k<strong>in</strong>d of program evaluation 

is of particular <strong>in</strong>terest as it assesses the adequacy 

between a product <strong>and</strong> its users’ needs. 

It also provides important <strong>in</strong>formation on how 

to enhance the product to best suited its users’ 

competencies <strong>and</strong> work habits. As a consequence, 

this approach is a useful l<strong>in</strong>k between 

research <strong>and</strong> practice as it could help to transfer 

research results <strong>in</strong>to practice. Results from 

this study suggest that the assessment method 

responds to diverse needs expressed by job 

coaches, especially consider<strong>in</strong>g the lack of <strong>in</strong>strument 

to assess vocational preferences. In 

addition, an important difference between exist<strong>in</strong>g 

<strong>in</strong>struments <strong>and</strong> this assessment method 

is that it assesses preferences for tasks available 

<strong>in</strong> the person’s work environment. Exist<strong>in</strong>g

<strong>in</strong>struments rely on a st<strong>and</strong>ard set of tasks that 

captures important dimensions of vocational 

tasks. However, some of these predeterm<strong>in</strong>ed 

tasks are not always available for the person 

be<strong>in</strong>g assessed <strong>and</strong>, consequently, are not useful 

for vocational plann<strong>in</strong>g. 

Most of the participants expressed preferences 

by select<strong>in</strong>g objects or pictograms represent<strong>in</strong>g 

work tasks. This study supports previous 

studies which <strong>in</strong>dicate that selection 

behaviors are reliable <strong>in</strong>dicators for assess<strong>in</strong>g 

preferences (Mithaug & Hanawalt, 1978; 

Mithaug & Mar, 1980; Parsons et al., 1998; 

Reid et al., 1998). Few refusals were observed 

dur<strong>in</strong>g the assessment, <strong>and</strong> they were not consistent 

with frequency of choice. We could 

wonder if the tendency to acquiescence <strong>and</strong> 

social desirability had an impact on the frequency 

of refusals. On-task <strong>and</strong> off-task behaviors 

appeared to be unreliable <strong>in</strong>dicators for 

assess<strong>in</strong>g preferences. Contradictory results 

have been published with regards to these 

behaviors (Hatton, 2004; Worsdell, Iwata, & 

Wallace, 2002), but we could hypothesize that 

task engagement <strong>in</strong>creases <strong>in</strong> conditions 

where there is choice, but not necessarily with 

preferred tasks. Positive emotional behaviors 

are also <strong>in</strong>consistent <strong>in</strong> assessment sessions. 

Previous research argues that persons with 

greater communication limitations are likely 

to exhibit more emotional behaviors <strong>in</strong> order 

to communicate their preferences (Campbell 

& Fletcher, 1993). In this study, all participants 

had important communication limitations 

but they did not all exhibit emotional 

behavior. Furthermore, evaluators observed 

the impact of contextual variables (for example, 

<strong>in</strong>teractions with a peer) on the occurrence 

of positive emotional behaviors. Consequently, 

preference assessment should rely on 

frequency of choices def<strong>in</strong>ed as physical selection 

of an option. Task engagement <strong>and</strong> positive 

emotional behaviors are useful for gather<strong>in</strong>g 

<strong>in</strong>formation on the <strong>in</strong>fluence of 

contextual factors which are important variables 

to consider when plann<strong>in</strong>g vocational 

tasks that best suit the person. Further research 

is needed to determ<strong>in</strong>e which personal 

or contextual factors have an impact on the 

reliability <strong>and</strong> efficiency of the assessment 

method. Experimental or quasi-experimental 

designs should be used to accurately assess the 

impact of contextual <strong>and</strong> personal variables. 

Interviewees gave useful suggestions on how 

to identify the variables to target. Their comments 

also highlighted the importance of 

tra<strong>in</strong><strong>in</strong>g. Evaluators should be tra<strong>in</strong>ed to observe 

relevant behaviors <strong>in</strong> order to assess 

preferences. This tra<strong>in</strong><strong>in</strong>g should <strong>in</strong>clude operational 

def<strong>in</strong>itions of behaviors to avoid confusion 

with personal characteristics or personal 

judgment, such as attentiveness or 

degree of concentration. Supervision <strong>in</strong> the 

first sessions also seems to be appreciated by 

the evaluators <strong>and</strong> could <strong>in</strong>crease reliability of 

the method. Interviewees <strong>in</strong>sisted on the need 

to make the assessment easier <strong>and</strong> quicker. 

Multiple stimuli without replacement method 

(MSWO) is currently considered to be the 

easiest <strong>and</strong> quickest assessment procedure 

(Hagopian, Long, & Rush, 2004). It consists 

on the simultaneous presentation of all possible 

pairs as opposed to the pair presentation. 

Once a stimulus chosen, it is not presented 

aga<strong>in</strong> to the person be<strong>in</strong>g assessed. However, 

no research has assessed reliability of MSWO 

for assess<strong>in</strong>g work tasks preferences. Further 

research is still needed to extend f<strong>in</strong>d<strong>in</strong>gs 

from previous studies on the assessment of 

tangible stimuli preferences to vocational activity 

preferences. The results of this study 

support the idea that the preference assessment 

method could be embedded <strong>in</strong>to rout<strong>in</strong>e 

staff practice. Future research will help to 

identify conditions for its use <strong>and</strong> its reliability 

<strong>and</strong> validity. To conclude, this study provides 

additional evidence that proxies are not always 

reliable when determ<strong>in</strong><strong>in</strong>g a person’s 

preferences, s<strong>in</strong>ce the preferences attributed 

by proxies may differ from those assessed us<strong>in</strong>g 

direct measures. 

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Received: 10 July 2008 

Initial Acceptance: 21 September 2008 

F<strong>in</strong>al Acceptance: 15 November 2008

Fourth Grade Outcomes of Children with a Preschool History 

of <strong>Developmental</strong> Disability 

Christ<strong>in</strong>e E. F. Delgado 

University of Miami 

Abstract: Special education outcomes were evaluated for 3,608 children (2,513 males) with a preschool history 

of developmental disability. Sixty-six percent of the children had an identified disability <strong>in</strong> fourth grade. The 

percentage of children with a disability at outcome varied across preschool disability categories from 54% to 

96%. The consistency of classification at preschool <strong>and</strong> outcome was relatively high for children with tra<strong>in</strong>able 

mental h<strong>and</strong>icap/profound mental h<strong>and</strong>icap (TMH/PMH), emotional h<strong>and</strong>icap/severe emotional disturbance 

(EH/SED), specific learn<strong>in</strong>g disability (SLD), <strong>and</strong> autism (AT) <strong>and</strong> lower for children with educable 

mental h<strong>and</strong>icap (EMH), speech <strong>and</strong>/or language impairment (SI/LI), <strong>and</strong> developmental delay (DD). 

Underst<strong>and</strong><strong>in</strong>g the nature <strong>and</strong> course of developmental disabilities can <strong>in</strong>form early <strong>in</strong>tervention services, 

service plann<strong>in</strong>g, <strong>and</strong> resource management. 

Underst<strong>and</strong><strong>in</strong>g the nature <strong>and</strong> course of developmental 

disabilities over time is both theoretically 

<strong>and</strong> cl<strong>in</strong>ically important. One way 

to improve our knowledge of developmental 

disabilities is to longitud<strong>in</strong>ally monitor 

special education placement. Awareness of 

the future special education placement of 

preschoolers with disabilities can <strong>in</strong>form 

early <strong>in</strong>tervention services, service plann<strong>in</strong>g, 

<strong>and</strong> resource management. Research <strong>in</strong> this 

area, however, has been largely limited to 

This research was supported by the Children’s 

Registry <strong>and</strong> Information System (CHRIS) <strong>and</strong> 

FDLRS-UM, a specialized university center of the 

Florida Diagnostic <strong>and</strong> Learn<strong>in</strong>g Resources System. 

Both CHRIS <strong>and</strong> FDLRS-UM are special projects 

funded by the State of Florida, Department of <strong>Education</strong>, 

Bureau of Exceptional <strong>Education</strong> <strong>and</strong> Student 

Services (BEESS). CHRIS is funded through 

federal assistance under the Individuals with <strong>Disabilities</strong> 

<strong>Education</strong> Act (IDEA), Part B <strong>and</strong> general 

revenue sources. FDLRS-UM is funded from general 

revenue sources. The support of the Florida Department 

of <strong>Education</strong> for provid<strong>in</strong>g the records is 

gratefully acknowledged. The authors would also 

like to thank Olga Camacho <strong>and</strong> Antonio Gonzalez 

for their assistance <strong>in</strong> prepar<strong>in</strong>g the dataset. Correspondence 

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

addressed to Christ<strong>in</strong>e Delgado, Department of 

Psychology, University of Miami, PO Box 248185, 

Coral Gables, Florida, 33124-0751. Email: cdelgado 

@umiami.edu 



preschoolers with developmental delay <strong>and</strong> 

speech-language impairments. 

<strong>Developmental</strong> delay is an eligibility category 

that is only applicable to young children. 

As children mature, they must be identified 

with a more traditional disability to rema<strong>in</strong> 

eligible for special education services. The majority 

of preschool children identified with 

developmental delay enter special education 

programs <strong>in</strong> elementary school (Bernheimer, 

Keogh, & Coots, 1993; Dale, Jenk<strong>in</strong>s, Mills, & 

Cole, 2005; Delgado, Vagi, & Scott, 2006; 

Keogh, Coots, & Bernheimer, 1996; Mills, 

Dale, Cole, & Jenk<strong>in</strong>s, 1995). The most common 

disability reclassifications for children 

with DD are learn<strong>in</strong>g h<strong>and</strong>icaps, speech <strong>and</strong> 

language h<strong>and</strong>icaps, <strong>and</strong> mild mental retardation 

(Bernheimer et al.; Delgado et al.; Keogh 

et al.). 

Preschool speech-language disorders are associated 

with language <strong>and</strong> academic difficulties 

that persist throughout childhood <strong>and</strong> 

adolescence (Aram, Ekelman, & Nation, 1984; 

Beitchman, Wilson, Brownlie, Walters, & Lancee, 

1996b; Johnson et al., 1999; Silva, McGee, 

& Williams, 1983; Stothard, Snowl<strong>in</strong>g, Bishop, 

Chipchase, & Kaplan, 1998; Young et al., 

2002). A l<strong>in</strong>k between early speech-language 

impairments <strong>and</strong> later learn<strong>in</strong>g <strong>and</strong> read<strong>in</strong>g 

disabilities has been well established (Catts, 

1993; Leitão & Fletcher, 2004; Paul, 2000; 

<strong>Developmental</strong> Disability Outcome / 573

Silva et al., 1983; Silva, Williams, & McGee, 

1987; Stothard et al.; Young et al.). Preschool 

speech-language impairments are also associated 

with later behavior problems (Beitchman 

et al., 1996a; Silva et al., 1987). 

The long-term monitor<strong>in</strong>g of preschool 

children with speech-language impairments 

has “helped speech-language pathologists to 

evaluate long-term prognoses, set realistic goals, 

develop suitable service models, <strong>and</strong> advocate 

appropriate social policies” (Johnson et al., 

1999, p. 744). Similar benefits would be expected 

for the track<strong>in</strong>g of special education 

placements for young children with other disabilities. 

This study utilizes extant statewide 

datasets to exp<strong>and</strong> our knowledge of the subsequent 

educational outcomes of preschool 

children with developmental disabilities. 

Method 

Database Integration 

Data from the Children’s Registry <strong>and</strong> Information 

System (CHRIS) database were <strong>in</strong>tegrated 

with Florida Department of <strong>Education</strong> 

public school records. Preschool disability status 

was obta<strong>in</strong>ed from CHRIS. CHRIS is a 

statewide database developed at the University 

of Miami <strong>in</strong> 1990 <strong>in</strong> response to the need to 

track children who receive services under 

IDEA, Part B. The CHRIS database conta<strong>in</strong>s 

referral, screen<strong>in</strong>g, evaluation, <strong>and</strong> eligibility 

<strong>in</strong>formation for preschool children throughout 

Florida. The data conta<strong>in</strong>ed <strong>in</strong> CHRIS 

provide the Florida Department of <strong>Education</strong> 

with a means of document<strong>in</strong>g Child F<strong>in</strong>d efforts 

to locate, evaluate, <strong>and</strong> provide necessary 

services to at-risk preschool-aged children. 

Outcome disability status was obta<strong>in</strong>ed from 

the Florida Department of <strong>Education</strong> public 

school record database. This database conta<strong>in</strong>s 

educational <strong>in</strong>formation (<strong>in</strong>clud<strong>in</strong>g primary 

exceptionality) for all children attend<strong>in</strong>g 

a Florida public school. 

Database <strong>in</strong>tegration was accomplished us<strong>in</strong>g 

automated data l<strong>in</strong>kage techniques whereby a 

child’s unique record was identified <strong>in</strong> each 

database <strong>and</strong> jo<strong>in</strong>ed across datasets to establish 

one record. This data l<strong>in</strong>kage method was 

based on previously established techniques 

(Boussy & Scott, 1993; Newcombe, 1988; Redden, 

Mulvihill, Wall<strong>and</strong>er, & Hov<strong>in</strong>ga, 2000). 

Records were l<strong>in</strong>ked based on an exact match 

of a child’s last name, first name, gender, <strong>and</strong> 

date of birth. If any of the match<strong>in</strong>g variables 

differed, the pair was considered a non-match 

<strong>and</strong> was not <strong>in</strong>cluded <strong>in</strong> the l<strong>in</strong>ked sample. All 

identify<strong>in</strong>g <strong>in</strong>formation was removed immediately 

follow<strong>in</strong>g the automated data l<strong>in</strong>kage 

process <strong>and</strong> prior to data analysis to ma<strong>in</strong>ta<strong>in</strong> 

confidentiality. 

Diagnostic Criteria 

Preschool disability status was def<strong>in</strong>ed as the 

primary exceptionality listed <strong>in</strong> the CHRIS 

database. Outcome disability status was def<strong>in</strong>ed 

as the primary exceptionality listed <strong>in</strong> 

the Florida public school record database. Primary 

exceptionality determ<strong>in</strong>ation at both 

time po<strong>in</strong>ts was based on the criteria specified 

<strong>in</strong> the Florida Statutes <strong>and</strong> State Board of 

<strong>Education</strong> Rules (2001). Criteria for eligibility 

vary by disability but typically <strong>in</strong>volve the review 

of st<strong>and</strong>ardized assessments <strong>and</strong> other 

<strong>in</strong>formation (e.g., parent report or observations). 

All eligibility determ<strong>in</strong>ations were 

made at an eligibility staff<strong>in</strong>g meet<strong>in</strong>g <strong>and</strong> 

were based on Florida Statute. 

Sample 


The sample consisted of 3,608 children (2,513 

males). The racial/ethnic distribution of the 

children was 59% White, 27% Black, 12% Hispanic, 

<strong>and</strong> 2% Other. The children were 

identified with one of the follow<strong>in</strong>g developmental 

disabilities as a preschooler: autism 

(AT), developmental delay (DD), emotional 

h<strong>and</strong>icap or severe emotional disturbance 

(EH/SED), educable mental h<strong>and</strong>icap (EMH), 

speech <strong>and</strong>/or language impairment (SI/LI), 

specific learn<strong>in</strong>g disability (SLD), tra<strong>in</strong>able 

mental h<strong>and</strong>icap or profound mental h<strong>and</strong>icap 

(TMH/PMH). All children were between 

the ages of 2 years, 6 months <strong>and</strong> 5 years at 

preschool diagnosis (average age 3 years, 11 

months). 

The children also attended fourth grade at 

a Florida public school. Outcome disability 

classification options were identical to those 

for preschool children with the exception of 

DD. Per Florida law, to rema<strong>in</strong> eligible for 

special education services, all children with a 

DD classification must be reclassified with a

TABLE 1 

Preschool disability classification by fourth grade disability classification (number of children) 

traditional disability category by the age of 6 

years (Florida Statutes, 2001). Preschool children 

with all other disability classifications 

studied could ma<strong>in</strong>ta<strong>in</strong> the same classification 

<strong>in</strong> elementary school. At outcome, some children 

had primary exceptionality classifications 

that were not <strong>in</strong>cluded <strong>in</strong> the preschool 

sample. These disabilities <strong>in</strong>cluded orthopedically 

impaired, deaf or hard of hear<strong>in</strong>g, visually 

impaired, gifted, hospital/homebound, 

traumatic bra<strong>in</strong> <strong>in</strong>jured, <strong>and</strong> other health impaired 

<strong>and</strong> were considered “Other” for analysis 

purposes. 

Results 

Overall results are presented <strong>in</strong> Table 1. Results 

which follow represent a prospective look 

at outcomes for preschoolers with developmental 

disabilities. It is also possible to exam<strong>in</strong>e 

the results retrospectively, look<strong>in</strong>g from 

outcome back to preschool. These results will 

not be discussed but can be <strong>in</strong>terpreted from 

Table 1. 

Sixty-six percent of children with a preschool 

history of developmental disability 

were identified with a disability <strong>in</strong> fourth 

grade. The percentage of children with a disability 

at both the preschool <strong>and</strong> fourth grade 

time po<strong>in</strong>ts varied across preschool disability 

categories: 54% for SI/LI, 77% for DD, 84% 

for EH/SED, 85% for SLD, 93% for EMH, 

95% for TMH/PMH, <strong>and</strong> 96% for AT. 

The distribution of outcome disability classifications 

by preschool disability classification 

Fourth Grade Disability 

Preschool Disability SI/LI SLD EMH EH/SED TMH/PMH AT Other None Total 

SI/LI 437 371 46 82 9 18 134 948 2,045 

SLD 12 132 12 16 6 4 10 34 226 

EMH 5 24 89 5 26 8 7 12 176 

EH/SED 3 17 0 66 0 6 4 18 114 

TMH/PMH 0 1 12 0 60 14 7 5 99 

AT 2 3 2 0 4 81 2 4 98 

DD 83 233 133 69 36 48 52 196 850 

Total 542 781 294 238 141 179 216 1217 3,608 

are displayed <strong>in</strong> Figure 1. Children without an 

identified disability at outcome were not <strong>in</strong>cluded 

<strong>in</strong> this figure to improve visual clarity. 

Therefore, the denom<strong>in</strong>ator for the percentages 

provided <strong>in</strong> the figure <strong>and</strong> referenced 

below was the number of children with a disability 

<strong>in</strong> preschool who also had a disability at 

outcome. The highest rates of consistency of 

classification were identified for children with 

AT. Eighty-seven percent of children identified 

with AT <strong>in</strong> preschool were also classified 

as AT <strong>in</strong> fourth grade. Consistency of classification 

rates for the other disabilities studied 

were 70% for SLD, 69% for EH/SED, 64% for 

TMH/PMH, 54% for EMH, <strong>and</strong> 40% for 

SI/LI. In Florida, DD is not available as a 

disability classification for children over the 

age of 5, <strong>and</strong> therefore, children with a preschool 

diagnosis of DD could not ma<strong>in</strong>ta<strong>in</strong> the 

same disability classification at outcome. 

The nature of changes <strong>in</strong> classification from 

preschool to fourth grade outcome are presented 

<strong>in</strong> Figure 1. Preschool children with 

DD, SI/LI, <strong>and</strong> EMH were the most likely to 

have been reclassified with another disability. 

For preschool children with DD who had a 

disability at outcome, SLD (35%) <strong>and</strong> EMH 

(20%) were the most common outcome classifications. 

Over one-third (34%) of preschool 

children with SI/LI who had a disability at 

outcome were reclassified as SLD. Preschool 

children with EMH who had a disability at 

outcome were most commonly reclassified as 

TMH/PMH (16%) or SLD (15%). 


Figure 1. Distribution of outcome disabilities by preschool disability classification. For visual clarity, only children 

with an outcome disability are <strong>in</strong>cluded <strong>in</strong> the pie charts. Children identified with a disability <strong>in</strong> preschool 

who were not identified with a disability <strong>in</strong> 4th grade are not <strong>in</strong>cluded <strong>in</strong> this figure. AT autism, 

SLD specific learn<strong>in</strong>g disability, EH/SED emotional h<strong>and</strong>icap/severe emotional disturbance, 

TMH/PMH tra<strong>in</strong>able mental h<strong>and</strong>icap/profound mental h<strong>and</strong>icap, EMH educable mental h<strong>and</strong>icap, 

SI/LI speech <strong>and</strong>/or language impairment, DD developmental delay. 



The use of extant datasets enabled the longitud<strong>in</strong>al 

track<strong>in</strong>g of over 3,600 children with a 

preschool history of developmental disability. 

Results of the study concur with exist<strong>in</strong>g research 

<strong>in</strong> DD <strong>and</strong> SI/LI <strong>and</strong> exp<strong>and</strong> our underst<strong>and</strong><strong>in</strong>g 

of the long-term special education 

outcomes of children with AT, EH/SED, 

EMH, SLD, <strong>and</strong> TMH/PMH. 

Early identification efforts are, for the most 

part, identify<strong>in</strong>g children who will cont<strong>in</strong>ue to 

meet criteria for special education services. 

The majority of children identified with a disability 

<strong>in</strong> preschool were also identified with 

a disability at outcome. With the exception of 

preschool children with SI/LI, over threefourths 

of preschool children with a disability 

cont<strong>in</strong>ued to have a disability at outcome. The 

greatest percentages were seen for the more 

severe disabilities, AT (96%) <strong>and</strong> TMH/PMH 

(95%); however, the rate for EMH (93%) was 

also high. Although the reason some children 

with a disability at preschool were not identified 

with a disability at outcome cannot be 

identified <strong>in</strong> this study, the potential role of 

early <strong>in</strong>tervention efforts should be the focus 

of future research. 

Although the majority of children cont<strong>in</strong>ued 

to meet criteria for special education services, 

specific disability classifications often 

changed. Consistency of classification varied 

quite a bit across preschool disability categories. 

DD is unique <strong>in</strong> that preschool children 

identified as DD were not able to ma<strong>in</strong>ta<strong>in</strong> 

that classification at outcome. Per Florida law, 

all children with a preschool diagnosis of DD 

who cont<strong>in</strong>ued <strong>in</strong> special education were reclassified 

with a traditional disability by 4th 

grade. The majority (77%) of children identified 

with DD <strong>in</strong> preschool rema<strong>in</strong>ed <strong>in</strong> special 

education at outcome. The most common 

outcome disability classifications for preschool 

children with DD were SLD (35%), 

EMH (20%), <strong>and</strong> SI/LI (13%). These f<strong>in</strong>d<strong>in</strong>gs 

are consistent with previous research 

(Bernheimer et al., 1993; Dale et al., 2005; 

Delgado et al., 2006; Keogh et al., 1996; Mills 

et al., 1995). 

Preschool classifications of SI/LI <strong>and</strong> EMH 

were associated with the greatest <strong>in</strong>consistencies 

<strong>in</strong> disability classification at outcome. 

Children identified with SI/LI as preschoolers 

showed the lowest rates of cont<strong>in</strong>ued special 

education <strong>in</strong> fourth grade (54%). Of those 

children identified with SI/LI <strong>in</strong> preschool 

who had a disability at outcome, 40% ma<strong>in</strong>ta<strong>in</strong>ed 

the SI/LI classification <strong>and</strong> 34% were 

classified as SLD at outcome. The change <strong>in</strong> 

classification from SI/LI to SLD is consistent 

with previous research <strong>in</strong>dicat<strong>in</strong>g that many 

children with SI/LI <strong>in</strong> preschool or k<strong>in</strong>dergarten 

demonstrate learn<strong>in</strong>g <strong>and</strong>/or read<strong>in</strong>g 

disabilities at later ages (Catts, 1993; Stothard 

et al., 1998). Preschool speech <strong>and</strong> language 

impairments have also been associated with 

later behavior problems <strong>and</strong> mild mental retardation 

(Aram et al., 1984; Beitchman et al., 

1996a; Silva et al., 1987). These associations 

were identified <strong>in</strong> the present study with 7% of 

children with SI/LI <strong>in</strong> preschool who had a 

disability at outcome identified with EH/SED 

<strong>and</strong> 4% identified with EMH at outcome. 

Interest<strong>in</strong>gly, preschool children with EMH 

had one of the highest rates of cont<strong>in</strong>ued 

special education <strong>in</strong> fourth grade (93%); however, 

only a little over half of the children who 

had a disability at outcome ma<strong>in</strong>ta<strong>in</strong>ed the 

EMH classification. The rema<strong>in</strong><strong>in</strong>g children 

were reclassified as TMH/PMH (16%), SLD 

(15%), AT (5%), Other (4%), EH/SED (3%), 

<strong>and</strong> SI/LI (3%). Although these children were 

identified early, changes <strong>in</strong> classification were 

common. Additional research is required to 

more fully underst<strong>and</strong> the nature of the deficits 

of preschool children identified with 

EMH <strong>and</strong> the reasons for reclassification. 

Such research would <strong>in</strong>form <strong>and</strong> potentially 

improve early identification practices for 

EMH. 

For the rema<strong>in</strong>der of the disabilities studied, 

consistency between preschool <strong>and</strong> outcome 

classifications was quite high, 64% for 

TMH/PMH, 69% for EH/SED, 70% for SLD, 

<strong>and</strong> 87% for AT. The high consistency <strong>in</strong> classification 

for children with AT is not surpris<strong>in</strong>g 

as expression of autism symptoms is considered 

to be very stable (Eaves & Ho, 1996). 

Although this study provides a foundation 

from which to build, it is important that future 

work exam<strong>in</strong>e changes <strong>in</strong> classification status 

<strong>in</strong> more detail to better determ<strong>in</strong>e which children 

will leave special education <strong>and</strong> which 

will stay as well as to determ<strong>in</strong>e the factors that 

result <strong>in</strong> changes <strong>in</strong> disability classifications. 


Although the use of large, extant databases 

enables the track<strong>in</strong>g of large numbers of children, 

this method of research lacks important 

detail. Primary exceptionality <strong>in</strong>formation was 

available, but other <strong>in</strong>formation that undoubtedly 

plays a key role <strong>in</strong> outcomes for children 

with disabilities was unavailable. Additional research 

is needed to exam<strong>in</strong>e other factors important 

to disability outcome such as severity 

of impairment, exact nature of the impairment, 

IQ, secondary impairments, <strong>and</strong> the 

wide range of parent, family, <strong>and</strong> child factors 

that could <strong>in</strong>fluence child outcomes (Beitchman 

et al., 1996b; Catts, 1993; Eaves & Ho, 

1996; O’Brien, 2001). 

A better underst<strong>and</strong><strong>in</strong>g of the future disabilities 

that children are likely to be assigned 

has numerous benefits. This <strong>in</strong>formation can 

assist school systems with plann<strong>in</strong>g <strong>and</strong> manag<strong>in</strong>g 

resources <strong>in</strong> order to provide services to 

these children. It can also <strong>in</strong>form early identification 

practices, prognostic accuracy, <strong>and</strong> 

the nature of the <strong>in</strong>terventions provided to 

these children, further improv<strong>in</strong>g outcomes. 

In addition, such <strong>in</strong>formation can assist cl<strong>in</strong>icians 

<strong>in</strong> mak<strong>in</strong>g realistic plans, anticipat<strong>in</strong>g 

probable or possible difficulties, develop<strong>in</strong>g 

balanced expectations, <strong>and</strong> relay<strong>in</strong>g <strong>in</strong>formation 

to parents. 

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F<strong>in</strong>al Acceptance: 15 December 2008 


INDEX—VOLUME 44, 2009 

AUTHORS 

Allor, Jill. Research-based techniques for 

teach<strong>in</strong>g early read<strong>in</strong>g skills to students with 

<strong>in</strong>tellectual disabilities .................. 356 

Andrews, Alonzo. See Machalicek, Wendy . 207 

Anto<strong>in</strong>e, Karen. See Polloway, Edward A . . . 14 

Antonucci, Massimo. See Machalicek, Wendy 207 

Ayres, Kev<strong>in</strong>. Acquisition <strong>and</strong> generalization of 

cha<strong>in</strong>ed tasks taught with computer based 

video <strong>in</strong>struction to children with autism .. 493 

Baker, Joshua N. See Mims, Pamela J ..... 409 

B<strong>and</strong>a, Devender R. See Dogoe, Maud .... 177 

Bassette, Laura. See Bouck, Emily C. ...... 367 

Bedesem, Pena. See Mancil, G. Richmond . 523 

Bennett, Kyle. It all depends on where you 

st<strong>and</strong>: Differences between employee’s <strong>and</strong> 

supervisor’s evaluations of work performance 

<strong>and</strong> support needs .............. 471 

Beyer, Julia. Autism spectrum disorders <strong>and</strong> 

sibl<strong>in</strong>g relationships .................... 444 

Blanks, A. Brooke. Multiculturalism, religion, 

<strong>and</strong> disability: Implications for special education 

practitioners ..................... 295 

Bouck, Emily C. Functional curriculum models 

for secondary students with mild mental impairment 

.............................. 435 

Bouck, Emily C. No Child Left Beh<strong>in</strong>d, the Individuals 

with <strong>Disabilities</strong> <strong>Education</strong> Act <strong>and</strong> 

functional curricula: A conflict of <strong>in</strong>terest? . 3 

Bouck, Emily C. Pentop computers as tools for 

teach<strong>in</strong>g multiplication to students with mild 

<strong>in</strong>tellectual disabilities .................. 367 

Boyd, Brian A. See Mancil, G. Richmond . . . 523 

Brady, Michael P. See Bennett, Kyle ....... 471 

Browder, Diane. See Mims, Pamela J ...... 409 

Campbell, L<strong>in</strong>dsay. See Schwartzman, Lisa 

J.V. .................................. 271 

Carter, Stacy L. See Wheeler, John ........ 187 

Carter, Stacy L. Treatment of pica us<strong>in</strong>g a pica 

exchange procedure with <strong>in</strong>creas<strong>in</strong>g response 

effort .......................... 143 

Cavkaytar, Atilla. Effectiveness of Parent <strong>and</strong> 

Therapist Collaboration Program (PTCP) for 

teach<strong>in</strong>g self-care <strong>and</strong> domestic skills to <strong>in</strong>dividuals 

with autism ................... 381 


Cavkaytar, Atilla. See Ozcan, Nihal ........ 237 

Champl<strong>in</strong>, Tammi. See Allor, Jill ........... 356 

Chan, Jeffrey M. See Machalicek, Wendy . . 207 

Cheatham, Jennifer P. See Allor, Jill ....... 356 

Chitiyo, Morgan. See Wheeler, John ....... 187 

Cobigo, Virg<strong>in</strong>ie. Field test of a method to assess 

work task preferences ............. 561 

Coll<strong>in</strong>s, Belva C. See Jones, Karen L. ...... 127 

Danbrook, Matthew. See Schwartzman, Lisa 

J.V. .................................. 271 

Davis, Tonya. See Machalicek, Wendy ..... 207 

Delgado, Christ<strong>in</strong>e E. F. Fourth grade outcomes 

of children with a preschool history of 

developmental disability ................ 573 

Didden, Robert. See Machalicek, Wendy . . . 207 

Dogoe, Maud. Review of recent research us<strong>in</strong>g 

constant time delay to teach cha<strong>in</strong>ed 

tasks to persons with developmental disabilities 

.................................. 177 

Dorm<strong>in</strong>y, Kimberly Powers. Teach<strong>in</strong>g organizational 

skills to children with high function<strong>in</strong>g 

autism <strong>and</strong> asperger’s syndrome ..... 538 

Dyches, T<strong>in</strong>a Taylor. Juvenile literature <strong>and</strong> the 

portrayal of developmental disabilities .... 304 

Eisenman, Laura. Secondary <strong>and</strong> postsecondary 

community activities of youth with significant 

<strong>in</strong>tellectual disabilities ............. 168 

Elmensdorp, Sharon. See Ruef, Mike ...... 343 

Ersoy, Gulhan. Effects of antecedent prompt 

<strong>and</strong> test procedure on teach<strong>in</strong>g simulated 

menstrual care skills to females with developmental 

disabilities .................... 54 

Feldman, Maurice. See Schwartzman, Lisa 

J.V. .................................. 271 

Flanagan, Sara M. See Bouck, Emily C. .... 367 

Flexer, Robert W. See Kre<strong>in</strong>er, Janice ...... 280 

Flores, Mararet M. Effects of direct <strong>in</strong>struction 

on the read<strong>in</strong>g comprehension of students 

with autism <strong>and</strong> developmental disabilities . 39 

Fox, Robert. A community-based accomodation 

program for adults with autism <strong>and</strong> mental 

retardation ......................... 118 

Fra<strong>in</strong>, Michael. See Bennett, Kyle .......... 471 

Fridel, Sara. See Lifshitz, Hefziba .......... 196

Friend, Anna. Impacts of family support <strong>in</strong> early 

childhood <strong>in</strong>tervention research .......... 453 

Ganz, Jennifer B. See Flores, Mararet M. . . . 39 

Gast, David L. See Dorm<strong>in</strong>y, Kimberly Powers 538 

Gast, David L. See Mechl<strong>in</strong>g, L<strong>in</strong>da C. ..... 67 

Geiman, Allison. See Eisenman, Laura ..... 168 

Glaubman, Rivka. See Lifshitz, Hefziba ..... 196 

Graetz, Janet E. Decreas<strong>in</strong>g <strong>in</strong>appropriate behaviors 

for adolescents with autism spectrum 

disorder us<strong>in</strong>g modified social stories . 91 

Grider, Katie M. See Van Laarhoven, Toni . . 509 

Grider, Krist<strong>in</strong> L. See Van Laarhoven, Toni . . 509 

Gustafson, Melissa R. See Mechl<strong>in</strong>g, L<strong>in</strong>da C. 67 

Hagiwara, Mayumi. See Meadan, Hedda . . . 421 

Harris, Kathleen C. See Ruef, Mike ........ 343 

Herold, Julie. See Meadan, Hedda ........ 421 

Hoekstra, Sarah. See Meadan, Hedda ..... 421 

Holtz, Casey A. See Fox, Robert .......... 118 

Huang, Ann. See Wheeler, John ........... 187 

Johnson, Jesse W. See Van Laarhoven, Toni . 509 

Jones, Karen L. Present<strong>in</strong>g cha<strong>in</strong>ed <strong>and</strong> discrete 

tasks as nontargeted <strong>in</strong>formation when 

teach<strong>in</strong>g discrete academic skills through 

small group <strong>in</strong>struction ................. 127 

Kane, Martha T. See Rao, Shaila .......... 244 

Kircaali-Iftar, Gonul. See Ersoy, Gulhan .... 54 

Kle<strong>in</strong>ert, Harold. See Jones, Karen L. ...... 127 

Kre<strong>in</strong>er, Janice. Assessment of leisure preferences 

for students with severe developmental 

disabilities <strong>and</strong> communication difficulties 280 

Lachapelle, Yves. See Cobigo, Virg<strong>in</strong>ie .... 561 

Lancioni, Giulio. See Machalicek, Wendy . . . 207 

Lang, Russell. See Machalicek, Wendy .... 207 

Lang, Russell. Review of teacher <strong>in</strong>volvement 

<strong>in</strong> the applied <strong>in</strong>tervention research for children 

with autism spectrum disorders ...... 481 

Langthorne, Paul. See Machalicek, Wendy . 207 

Lee, Angel. See Mims, Pamela J. .......... 409 

Lee, EunJung. Effects of <strong>in</strong>structional rubrics 

on class engagement behaviors <strong>and</strong> the 

achievement of lesson objectives by students 

with mild mental retardation <strong>and</strong> their 

typical peers .......................... 396 

Lee, SoHyun. See Lee, EunJung .......... 396 

Le<strong>in</strong><strong>in</strong>ger, Melissa. See Dyches, T<strong>in</strong>a Taylor . 304 

Liaups<strong>in</strong>, Carl. See Underwood, Martha .... 25 

Lifshitz, Hefziba. Why do <strong>in</strong>dividuals with <strong>in</strong>tellectual 

disability turn to religion: A comparison 

between adolescents <strong>and</strong> adults ..... 196 

Lub<strong>in</strong>, Jaquel<strong>in</strong>e. See Polloway, Edward A. . 14 

Luscre, Deanna. See Dorm<strong>in</strong>y, Kimberly Powers 

................................... 538 

Machalicek, Wendy. See Lang, Russell .... 481 

Machalicek, Wendy. Us<strong>in</strong>g videoconferenc<strong>in</strong>g 

to conduct functional analysis of challeng<strong>in</strong>g 

behavior <strong>and</strong> develop classroom support 

plans for students with autism ........... 207 

Maguire, Amy. See Ayres, Kev<strong>in</strong> .......... 

Mallow, Lynette. See Rao, Shaila .......... 80 

Mancil, G. Richmond. Milieu therapy as a communication 

<strong>in</strong>tervention: A review of the literature 

related to children with autism spectrum 

disorder .......................... 105 

Mancil, G. Richmond. See Schaefer Whitby, 

Peggy J. .............................. 551 

Mancil, G. Richmond. Parental stress <strong>and</strong> autism: 

Are there useful cop<strong>in</strong>g strategies ... 523 

Manser, Samantha. See Meadan, Hedda . . . 421 

Mart<strong>in</strong>, Garry L. See Schwartzman, Lisa J. V. 

....................................... 271 

Mastropieri, Margo A. See Graetz, Janet E. . 91 

Mathes, Patricia. See Allor, Jill ............ 356 

Mayton, Michael R. See Wheeler, John ..... 187 

McClimon, Desiree. See Ayres, Kev<strong>in</strong> ...... 493 

Meadan, Hedda. Evaluat<strong>in</strong>g the acceptability 

<strong>and</strong> effectiveness of family assessment portfolios 

................................. 421 

Mechl<strong>in</strong>g, L<strong>in</strong>da C. Comparison of selfprompt<strong>in</strong>g 

of cook<strong>in</strong>g skills via picture-based 

cookbooks <strong>and</strong> video recipes ............ 218 

Mechl<strong>in</strong>g, L<strong>in</strong>da C. Use of video model<strong>in</strong>g to 

teach ext<strong>in</strong>guish<strong>in</strong>g of cook<strong>in</strong>g related fires 

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

............................... 67 

Menendez, Anthony L. See Wheeler, John . . 187 

Millar, Dorothy Squatrito. Comparison of transition-related 

IEP content for young adults 

with disabilities who do or do not have a 

legal guardian ......................... 151 

Mims, Pamela J. Increas<strong>in</strong>g comprehension of 

students with significant <strong>in</strong>tellectual disabilities 

<strong>and</strong> visual impairments dur<strong>in</strong>g shared 

stories ................................ 409 

Moist, Amie M. See Fox, Robert ........... 118 

Mor<strong>in</strong>, Diane. See Cobigo, Virg<strong>in</strong>ie ........ 561 

Nefdt, Nicolette. See Ruef, Mike ........... 343 

O’Reilly, Mark. See Lang, Russell .......... 481 

Openden, Daniel. See Ruef, Mike ......... 343 

O’Reilly, Mark. See Machalicek, Wendy .... 207 

Ozcan, Nihal. Parents as teachers: Teach<strong>in</strong>g 

parents how to teach toilet skills to their children 

with autism <strong>and</strong> mental retardation .. 237 

Parette, Howard P. Assistive technology user 

group perspectives of early childhood professionals 

............................. 257 

Patton, James R. See Polloway, Edward A. . 14 

Perner, Darlene E. See Zucker, Stanley H. . . 291 

Index, Volume 44 / 581

Perras, C<strong>in</strong>dy. See Zucker, Stanley H. ..... 291 

Perr<strong>in</strong>gton, Carol. See Eisenman, Laura .... 168 

Pollard, Elena. See Cavkaytar, Atilla ....... 381 

Polloway, Edward A. State guidel<strong>in</strong>es for mental 

retardation <strong>and</strong> developmental disabilities: 

A revisitation of previous analyses <strong>in</strong> 

light of changes <strong>in</strong> the field ............. 14 

Prater, Mary Anne. See Dyches, T<strong>in</strong>a Taylor . 304 

Rao, Shaila. Teach<strong>in</strong>g students with cognitive 

impairment cha<strong>in</strong>ed mathematical task of 

decimal subtraction us<strong>in</strong>g simultaneous 

prompt<strong>in</strong>g ............................. 244 

Rao, Shaila. Us<strong>in</strong>g simultaneous prompt<strong>in</strong>g 

procedure to promote recall of multiplication 

facts by middle school students with cognitive 

impairment. ....................... 80 

Regester, April. See Lang, Russell ......... 481 

Rispoli, M<strong>and</strong>y. See Lang, Russell ......... 481 

Rispoli, M<strong>and</strong>y. See Machalicek, Wendy . . . 207 

Rob<strong>in</strong>son, Suzanne. See Ruef, Mike ....... 343 

Rosenberg, Howard. See Bennett, Kyle .... 471 

Ruef, Mike. Learn<strong>in</strong>g by do<strong>in</strong>g: A collaborative 

model for tra<strong>in</strong><strong>in</strong>g teacher-c<strong>and</strong>idate graduate 

students <strong>in</strong> Autism .................. 343 

Schaefer Whitby, Peggy J. Academic achievement 

profiles of children with high function<strong>in</strong>g 

autism <strong>and</strong> Asperger Syndrome: A review 

of the literature ................... 551 

Schuster, John W. See Jones, Karen L. .... 127 

Schwartzman, Lisa J. V. Predict<strong>in</strong>g the learn<strong>in</strong>g 

ability of children with autism: The assessment 

of basic learn<strong>in</strong>g abilities test versus 

parents’ predictions ................ 271 

Scruggs, Thomas E. See Graetz, Janet E. . . 91 

Shogren, Karrie. See Lang, Russell ........ 481 

Shogren, Karrie. See Machalicek, Wendy . . . 207 

Sigafoos, Jeff. See Lang, Russell .......... 481 

Sigafoos, Jeff. See Machalicek, Wendy .... 207 

Smith, J. David. See Blanks, A. Brooke ..... 295 

Smith, J. David. See Polloway, Edward A. . . 14 

Smith, J. David. See Zucker, Stanley H. .... 291 

Spillane, Anne. See Wang, Peishi .......... 318 

Spooner, Fred. See Mims, Pamela J. ....... 409 

Stephens, Er<strong>in</strong>. See Mechl<strong>in</strong>g, L<strong>in</strong>da C. .... 218 

Stoner, Julia B. See Parette, Howard P. .... 257 

Summers, Jean Ann. See Friend, Anna ..... 453 

Sur<strong>in</strong>ak, Tricia. See Bennett, Kyle .......... 471 

Szwed, Kathryn. See Bouck, Emily C. ...... 367 

Taber-Doughty, Teresa. See Bouck, Emily C. 

....................................... 367 

Tanverdi, Annie. See Eisenman, Laura ..... 168 

Tek<strong>in</strong>-Iftar, Elif. See Ersoy, Gulhan ......... 54 

Thompson, James R. See Meadan, Hedda . 421 


Turnbull, Ann P. See Friend, Anna ......... 453 

Umbreit, John. See Underwood, Martha .... 25 

Underwood, Martha. Efficacy of a systematic 

process for design<strong>in</strong>g function-based <strong>in</strong>terventions 

for adults <strong>in</strong> a community sett<strong>in</strong>g . 

Van Laarhoven, Toni. Comparison of self, 

25 

other, <strong>and</strong> subjective video models for 

teach<strong>in</strong>g daily liv<strong>in</strong>g skills to <strong>in</strong>dividuals with 

developmental disabilities ............... 509 

Vause, Tricia. See Schwartzman, Lisa J. V. . 271 

Wang, Peishi. Evidence-based social skills <strong>in</strong>terventions 

for children with autism: A metaanalysis 

.............................. 318 

Watts, Emily H. See Parette, Howard P. .... 257 

Weiss, Izhak. ............................ 196 

Wheeler, John. An assessment of treatment 

<strong>in</strong>tegrity <strong>in</strong> behavioral <strong>in</strong>tervention studies 

conducted with persons with mental retardation 

.................................. 187 

Yu, C. T. See Schwartzman, Lisa J. V. ...... 271 

Zucker, Stanley H. Best practices <strong>in</strong> cognitive 

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

related disabilities ...................... 291 

Zurita, Leslie M. See Van Laarhoven, Toni . . 509 

TITLES 

A community-based accomodation program 

for adults with autism <strong>and</strong> mental retardation. 

Robert Fox, Casey A. Holtz, <strong>and</strong> Amie 

M. Moist .............................. 118 

Academic achievement profiles of children with 

high function<strong>in</strong>g autism <strong>and</strong> Asperger Syndrome: 

A review of the literature. Peggy J. 

Schaefer Whitby <strong>and</strong> G. Richmond Mancil . 551 

Acquisition <strong>and</strong> generalization of cha<strong>in</strong>ed tasks 

taught with computer based video <strong>in</strong>struction 

to children with autism. Kev<strong>in</strong> Ayres, Amy 

Maguire, <strong>and</strong> Desiree McClimon ........ 493 

An assessment of treatment <strong>in</strong>tegrity <strong>in</strong> behavioral 

<strong>in</strong>tervention studies conducted with persons 

with mental retardation. John Wheeler, 

Michael R. Mayton, Stacy L. Carter, Morgan 

Chitiyo, Anthony L. Menendez, <strong>and</strong> Ann 

Huang ................................ 187 

Assessment of leisure preferences for students 

with severe developmental disabilities 

<strong>and</strong> communication difficulties. Janice 

Kre<strong>in</strong>er <strong>and</strong> Robert W. Flexer ........... 280 

Assistive technology user group perspectives 

of early childhood professionals. Howard P. 

Parette, Julia B. Stoner, <strong>and</strong> Emily H. Watts 257 

Autism spectrum disorders <strong>and</strong> sibl<strong>in</strong>g relationships. 

Julia Beyer ...................... 444 

Best practices <strong>in</strong> cognitive disabilities/mental 

retardation, autism, <strong>and</strong> related disabilities. 

Stanley H. Zucker, C<strong>in</strong>dy Perras, Darlene E. 

Perner, <strong>and</strong> J. David Smith ............. 291

Comparison of self, other, <strong>and</strong> subjective video 

models for teach<strong>in</strong>g daily liv<strong>in</strong>g skills to <strong>in</strong>dividuals 

with developmental disabilities. Toni 

Van Laarhoven, Leslie M. Zurita, Jesse W. 

Johnson, Katie M. Grider, <strong>and</strong> Krist<strong>in</strong> L. 

Grider ................................ 509 

Comparison of self-prompt<strong>in</strong>g of cook<strong>in</strong>g skills 

via picture-based cookbooks <strong>and</strong> video recipes. 

L<strong>in</strong>da C. Mechl<strong>in</strong>g <strong>and</strong> Er<strong>in</strong> Stephens 

....................................... 218 

Comparison of transition-related IEP content 

for young adults with disabilities who do or 

do not have a legal guardian. Dorothy Squatrito 

Millar ............................. 151 

Decreas<strong>in</strong>g <strong>in</strong>appropriate behaviors for adolescents 

with autism spectrum disorder us<strong>in</strong>g 

modified social stories. Janet E. Graetz, 

Margo A. Mastropieri, <strong>and</strong> Thomas E. 

Scruggs .............................. 91 

Effectiveness of Parent <strong>and</strong> Therapist Collaboration 

Program (PTCP) for teach<strong>in</strong>g selfcare 

<strong>and</strong> domestic skills to <strong>in</strong>dividuals with 

autism. Atilla Cavkaytar <strong>and</strong> Elena Pollard . 381 

Effects of antecedent prompt <strong>and</strong> test procedure 

on teach<strong>in</strong>g simulated menstrual care 

skills to females with developmental disabilities. 

Gulhan Ersoy, Elif Tek<strong>in</strong>-Iftar, <strong>and</strong> 

Gonul Kircaali-Iftar ..................... 54 

Effects of direct <strong>in</strong>struction on the read<strong>in</strong>g comprehension 

of students with autism <strong>and</strong> developmental 

disabilities. Mararet M. Flores 

<strong>and</strong> Jennifer B. Ganz .................. 39 

Effects of <strong>in</strong>structional rubrics on class engagement 

behaviors <strong>and</strong> the achievement of 

lesson objectives by students with mild mental 

retardation <strong>and</strong> their typical peers. Eun- 

Jung Lee <strong>and</strong> SoHyun Lee ............. 396 

Efficacy of a systematic process for design<strong>in</strong>g 

function-based <strong>in</strong>terventions for adults <strong>in</strong> a 

community sett<strong>in</strong>g. Martha Underwood, 

John Umbreit, <strong>and</strong> Carl Liaups<strong>in</strong> ........ 25 

Evaluat<strong>in</strong>g the acceptability <strong>and</strong> effectiveness 

of family assessment portfolios. Hedda 

Meadan, James R. Thompson, Mayumi 

Hagiwara, Julie Herold, Sarah Hoekstra, 

<strong>and</strong> Samantha Manser ................. 421 

Evidence-based social skills <strong>in</strong>terventions for 

children with autism: A meta-analysis. Peishi 

Wang <strong>and</strong> Anne Spillane ............... 318 

Field test of a method to assess work task 

preferences. Virg<strong>in</strong>ie Cobigo, Diane Mor<strong>in</strong>, 

<strong>and</strong> Yves Lachapelle ................... 561 

Fourth grade outcomes of children with a preschool 

history of developmental disability. 

Christ<strong>in</strong>e E. F. Delgado ................. 573 

Functional curriculum models for secondary 

students with mild mental mpairment. Emily 

C. Bouck ............................. 435 

Impacts of family support <strong>in</strong> early childhood 

<strong>in</strong>tervention research. Anna Friend, Jean 

Ann Summers, <strong>and</strong> Ann P. Turnbull ...... 453 

Increas<strong>in</strong>g comprehension of students with 

significant <strong>in</strong>tellectual disabilities <strong>and</strong> visual 

impairments dur<strong>in</strong>g shared stories. Pamela 

J. Mims, Diane Browder, Joshua N. Baker, 

Angel Lee, <strong>and</strong> Fred Spooner ........... 409 

It all depends on where you st<strong>and</strong>: Differences 

between employee’s <strong>and</strong> supervisor’s evaluations 

of work performance <strong>and</strong> support 

needs. Kyle Bennett, Michael Fra<strong>in</strong>, Michael 

P. Brady, Howard Rosenberg, <strong>and</strong> Tricia 

Sur<strong>in</strong>ak ............................... 471 

Juvenile literature <strong>and</strong> the portrayal of developmental 

disabilities. T<strong>in</strong>a Taylor Dyches, 

Mary Anne Prater, <strong>and</strong> Melissa Le<strong>in</strong><strong>in</strong>ger . 304 

Learn<strong>in</strong>g by do<strong>in</strong>g: A collaborative model for 

tra<strong>in</strong><strong>in</strong>g teacher-c<strong>and</strong>idate graduate students 

<strong>in</strong> Autism. Mike Ruef, Nicolette Nefdt, 

Daniel Openden, Sharon Elmensdorp, Kathleen 

C. Harris, <strong>and</strong> Suzanne Rob<strong>in</strong>son . . . 343 

Milieu therapy as a communication <strong>in</strong>tervention: 

A review of the literature related to children 

with autism spectrum disorder. G. Richmond 

Mancil .......................... 105 

Multiculturalism, religion, <strong>and</strong> disability: Implications 

for special education practitioners. 

A. Brooke Blanks <strong>and</strong> J. David Smith .... 295 

No Child Left Beh<strong>in</strong>d, the Individuals with <strong>Disabilities</strong> 

<strong>Education</strong> Act <strong>and</strong> functional curricula: 

A conflict of <strong>in</strong>terest?. Emily C. Bouck . 3 

Parental stress <strong>and</strong> autism: Are there useful 

cop<strong>in</strong>g strategies. G. Richmond Mancil, 

Brian A. Boyd, <strong>and</strong> Pena Bedesem ...... 523 

Parents as teachers: Teach<strong>in</strong>g parents how to 

teach toilet skills to their children with autism 

<strong>and</strong> mental retardation. Nihal Ozcan <strong>and</strong> 

Atilla Cavkaytar ........................ 237 

Pentop computers as tools for teach<strong>in</strong>g multiplication 

to students with mild <strong>in</strong>tellectual 

disabilities. Emily C. Bouck, Laura Bassette, 

Teresa Taber-Doughty, Sara M. Flanagan, 

<strong>and</strong> Kathryn Szwed .................... 367 

Predict<strong>in</strong>g the learn<strong>in</strong>g ability of children with 

autism: The assessment of basic learn<strong>in</strong>g 

abilities test versus parents’ predictions. Lisa 

J. V. Schwartzman, Tricia Vause, Garry L. 

Mart<strong>in</strong>, C. T. Yu, L<strong>in</strong>dsay Campbell, Matthew 

Danbrook, <strong>and</strong> Maurice Feldman . . . 271 

Present<strong>in</strong>g cha<strong>in</strong>ed <strong>and</strong> discrete tasks as nontargeted 

<strong>in</strong>formation when teach<strong>in</strong>g discrete 

academic skills through small group <strong>in</strong>struction. 

Karen L. Jones, Belva C. Coll<strong>in</strong>s, Johm 

W. Schuster, <strong>and</strong> Harold Kle<strong>in</strong>ert ........ 127 

Research-based techniques for teach<strong>in</strong>g early 

read<strong>in</strong>g skills to students with <strong>in</strong>tellectual 

disabilities. Jill Allor, Patricia Mathes, Tammi 

Champl<strong>in</strong>, <strong>and</strong> Jennifer P. Cheatham .... 356 

Index, Volume 44 / 583

Review of recent research us<strong>in</strong>g constant time 

delay to teach cha<strong>in</strong>ed tasks to persons with 

developmental disabilities. Maud Dogoe 

<strong>and</strong> Devender R. B<strong>and</strong>a ................ 177 

Review of teacher <strong>in</strong>volvement <strong>in</strong> the applied 

<strong>in</strong>tervention research for children with autism 

spectrum disorders. Russell Lang, 

Wendy Machalicek, Mark O’Reilly, Jeff Sigafoos, 

M<strong>and</strong>y Rispoli, Karrie Shogren, <strong>and</strong> 

April Regester ......................... 481 

Secondary <strong>and</strong> postsecondary community activities 

of youth with significant <strong>in</strong>tellectual 

disabilities. Laura Eisenman, Annie Tanverdi, 

Carol Perr<strong>in</strong>gton, <strong>and</strong> Allison Geiman 168 

State guidel<strong>in</strong>es for mental retardation <strong>and</strong> developmental 

disabilities: A revisitation of previous 

analyses <strong>in</strong> light of changes <strong>in</strong> the 

field. Edward A. Polloway, James R. Patton, 

J. David Smith, Jaquel<strong>in</strong>e Lub<strong>in</strong>, <strong>and</strong> Karen 

Anto<strong>in</strong>e ............................... 14 

Teach<strong>in</strong>g organizational skills to children with 

high function<strong>in</strong>g autism <strong>and</strong> asperger’s syndrome. 

Kimberly Powers Dorm<strong>in</strong>y, Deanna 

Luscre, <strong>and</strong> David L. Gast .............. 538 

Teach<strong>in</strong>g students with cognitive impairment 

cha<strong>in</strong>ed mathematical task of decimal subtraction 

us<strong>in</strong>g simultaneous prompt<strong>in</strong>g. 

Shaila Rao <strong>and</strong> Martha T. Kane ......... 244 


Treatment of pica us<strong>in</strong>g a pica exchange procedure 

with <strong>in</strong>creas<strong>in</strong>g response effort. 

Stacy L. Carter ........................ 143 

Use of video model<strong>in</strong>g to teach ext<strong>in</strong>guish<strong>in</strong>g 

of cook<strong>in</strong>g related fires to <strong>in</strong>dividuals with 

moderate <strong>in</strong>tellectual disabilities. L<strong>in</strong>da C. 

Mechl<strong>in</strong>g, David L. Gast, <strong>and</strong> Melissa R. 

Gustafson ............................ 67 

Us<strong>in</strong>g simultaneous prompt<strong>in</strong>g procedure to 

promote recall of multiplication facts by middle 

school students with cognitive impairment. 

Shaila Rao <strong>and</strong> Lynette Mallow .... 80 

Us<strong>in</strong>g videoconferenc<strong>in</strong>g to conduct functional 

analysis of challeng<strong>in</strong>g behavior <strong>and</strong> develop 

classroom support plans for students 

with autism. Wendy Machalicek, Mark 

O’Reilly, Jeffrey M. Chan, Russell Lang, 

M<strong>and</strong>y Rispoli, Tonya Davis, Karrie 

Shogren, Jeff Sigafoos, Giulio Lancioni, 

Massimo Antonucci, Paul Langthorne, 

Alonzo Andrews, <strong>and</strong> Robert Didden .... 207 

Why do <strong>in</strong>dividuals with <strong>in</strong>tellectual disability 

turn to religion: A comparison between adolescents 

<strong>and</strong> adults. Hefziba Lifshitz, Izhak 

Weiss, Sara Fridel, <strong>and</strong> Rivka Glaubman . 196

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