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Using System of Least Prompts to Teach Self-Help Skills to Students Who Are Deafblind

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Title: Using System of Least Prompts to Teach Self-Help Skills to Students Who Are Deafblind
Language: English
Authors: Jill Grattan, MaryAnn Demchak (ORCID 0000-0002-7427-902X)
Source: Research and Practice for Persons with Severe Disabilities. 2024 49(2):107-125.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 19
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Elementary Education
Descriptors: Deaf Blind, Students with Disabilities, Self Help Programs, Daily Living Skills, Teaching Methods, Evidence Based Practice, Intervention, Cues, Reinforcement, Hygiene, Health Education, Elementary School Students, Special Education, Special Schools, Visual Impairments, Visual Stimuli, Hearing Impairments, Preschool Children, Student Diversity, Achievement Gains
DOI: 10.1177/15407969241231204
ISSN: 1540-7969
2169-2408
Abstract: To date, no evidence-based practices are identified for working with students who are deafblind (DB). No evidence-based practices have been identified for teaching basic self-help skills such as dressing. The present study examined the efficacy of an intervention package including the system of least prompts (SLP; i.e., SLP and least-to-most prompting), visual cues, and reinforcement to teach three self-help skills (i.e., wash hands, dry hands, entry routine) to four participants, ages 3-5 years, with vision and hearing impairments and multiple disabilities. A multiple probe across behaviors design, replicated across participants, was used to evaluate the effectiveness of an intervention package including SLP to teach self-help skills. Three of four participants increased their independence for all targeted self-help skills. A functional relation is indicated for three of four participants and provides promising evidence for use of SLP in teaching individuals with multiple disabilities that include DB.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1425505
Database: ERIC
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  Value: <anid>AN0177391715;myx01jun.24;2024May24.06:05;v2.2.500</anid> <title id="AN0177391715-1">Using System of Least Prompts to Teach Self-Help Skills to Students Who Are Deafblind </title> <p>To date, no evidence-based practices are identified for working with students who are deafblind (DB). No evidence-based practices have been identified for teaching basic self-help skills such as dressing. The present study examined the efficacy of an intervention package including the system of least prompts (SLP; i.e., SLP and least-to-most prompting), visual cues, and reinforcement to teach three self-help skills (i.e., wash hands, dry hands, entry routine) to four participants, ages 3-5 years, with vision and hearing impairments and multiple disabilities. A multiple probe across behaviors design, replicated across participants, was used to evaluate the effectiveness of an intervention package including SLP to teach self-help skills. Three of four participants increased their independence for all targeted self-help skills. A functional relation is indicated for three of four participants and provides promising evidence for use of SLP in teaching individuals with multiple disabilities that include DB.</p> <p>Keywords: deafblind; system of least prompts; multiple probe design; self-help</p> <p>Students who are deafblind (DB) are one of the lowest incidence disabilities; yet a diverse group as they present with a range of vision loss (e.g., low vision to totally blind), a range of hearing loss (e.g., mild to profound) and often have other disabilities (e.g., physical and cognitive impairments, complex health care needs; [<reflink idref="bib18" id="ref1">18</reflink>]). Unfortunately, there is a lack of research delineating evidence-based practices (EBPs) for this population across domains ([<reflink idref="bib3" id="ref2">3</reflink>]; [<reflink idref="bib7" id="ref3">7</reflink>]; [<reflink idref="bib24" id="ref4">24</reflink>]). Much of the research with those who are DB consists of case studies where experimental control is not demonstrated ([<reflink idref="bib21" id="ref5">21</reflink>]). Although research aimed at demonstrating a functional relation between interventions and improved outcomes has occurred with this population, there were design weaknesses that limit conclusions. For example, [<reflink idref="bib24" id="ref6">24</reflink>], in a review of augmentative and alternative communication (AAC) with individuals who are DB, found the research to be methodologically weak resulting in inconclusive results. Similarly, [<reflink idref="bib3" id="ref7">3</reflink>] in their research review determined "effective instructional practices have yet to be identified through intervention studies" (p. 441). Finally, [<reflink idref="bib7" id="ref8">7</reflink>] concluded "there is dire need for research" in various areas (p. 85).</p> <p>There is a dearth of research on teaching self-help skills (e.g., dressing, grooming) to individuals who have multiple disabilities and who are DB. Self-help skills are part of daily life, are critical for health, and strongly influence how an individual is perceived and accepted by others. Although self-care is foundational to independence and autonomy, current research in this area is lacking for this population. In a review of single case research in the DB field, [<reflink idref="bib19" id="ref9">19</reflink>] found only eight published studies focusing on daily living skills from 1980 to 1994 and none after 1994. Early work focused on using graduated guidance to teach individuals with DB self-dressing skills ([<reflink idref="bib17" id="ref10">17</reflink>]), using consequence strategies for independent initiation and engagement in toileting ([<reflink idref="bib14" id="ref11">14</reflink>]), and using physical prompts or graduated guidance to teach self-feeding ([<reflink idref="bib15" id="ref12">15</reflink>], [<reflink idref="bib16" id="ref13">16</reflink>]). Research on self-help skills for those with DB appears to be declining, despite advances in systematic instruction research with other populations. Many early studies focusing on individuals with DB would not meet today's research standards (e.g., [<reflink idref="bib31" id="ref14">31</reflink>]) for indicators such as the amount of baseline data, functional relation demonstration, inter-observer agreement, etc.</p> <p>The lack of intervention research with this population means there are no EBPs from which practitioners can select when working with those who have multiple disabilities, including DB. However, there are EBPs identified for other populations including the system of least prompts (SLP; [<reflink idref="bib4" id="ref15">4</reflink>]; [<reflink idref="bib22" id="ref16">22</reflink>]). In SLP, a hierarchy is developed from the least (e.g., gesture) to the most intrusive, controlling prompt (e.g., full physical) with specific wait time between prompts identified. For incorrect responses, prompts are delivered according to the hierarchy until a correct response occurs ([<reflink idref="bib22" id="ref17">22</reflink>]). Consistently applying SLP decreases the probability of errors and facilitates the transfer of stimulus control from prompts to naturally occurring discriminative stimuli. SLP was successfully used to teach self-help skills to participants with disabilities (e.g., intellectual disability, visual impairment, autism) other than DB (e.g., [<reflink idref="bib20" id="ref18">20</reflink>]; [<reflink idref="bib23" id="ref19">23</reflink>]; [<reflink idref="bib26" id="ref20">26</reflink>]; [<reflink idref="bib30" id="ref21">30</reflink>]). Although SLP was not researched to teach self-help skills to individuals with DB, it was used to teach other skills to individuals with DB (e.g., using a walker [[<reflink idref="bib27" id="ref22">27</reflink>]]; preparing breakfast [[<reflink idref="bib29" id="ref23">29</reflink>]]; communicative responses [[<reflink idref="bib9" id="ref24">9</reflink>]]; vocational tasks [[<reflink idref="bib2" id="ref25">2</reflink>]]). Most recently, [<reflink idref="bib28" id="ref26">28</reflink>] adhered to current research standards and showed the efficacy of SLP to teach symbol discrimination to individuals with multiple disabilities, including DB. [<reflink idref="bib22" id="ref27">22</reflink>] indicate that SLP might be the most prevalent response prompting procedure. Given the lack of data supporting SLP to teach self-help skills to those who are DB and that SLP might be the most prevalent response prompting procedure, investigating the use of SLP to teach self-help skills to those with DB is warranted.</p> <p>In addition, it is unknown if SLP facilitates the transfer of stimulus control from a prompt to a natural discriminative stimulus (S<sups>D</sups>) when the requirement is for partial participation ([<reflink idref="bib6" id="ref28">6</reflink>]) versus full independence. For example, individuals with multiple disabilities that include DB and other disabilities (e.g., motor impairments) might not have the motor control to complete certain tasks independently (e.g., contractures affecting raising arms above head to dress; hypotonia limiting strength to activate faucets). Despite physical and/or sensory limitations, individuals can learn to participate partially, but actively, to perform as much of a skill as able. Active partial participation includes initiating and completing steps within a routine when presented with a natural S<sups>D</sups> (e.g., when time to wash hands, waves a hand under the faucet as active request for an adult to turn on water). In addition to adapting the motor response as part of partial participation, individuals can partially participate in tasks by using various adaptations, making choices, or communicating. Partial participation is important to allow an individual to participate meaningfully in routines in a way relevant to the individual and task. Further research related to partial participation and individuals with multiple disabilities including DB is needed.</p> <p>To address the research gap regarding effective teaching strategies for individuals with multiple disabilities that include DB, this study examined the efficacy of SLP to increase independence, through full and partial participation, of four participants in completing three self-help skills. The study addressed this research question: Does an intervention package including SLP facilitate the acquisition of three targeted self-help skills (i.e., washing hands, drying hands, class entry routine) for children, ages 3 to 6 years old, with multiple disabilities, including DB?</p> <hd id="AN0177391715-2">Method</hd> <p></p> <hd id="AN0177391715-3">Inclusion Criteria</hd> <p>Participant inclusion criteria were (a) being enrolled in the state's federally-funded DB project, (b) requiring prompts to complete targeted self-help skills, (c) having sufficient motor skills to perform targeted skills with full or partial participation, (d) being enrolled in a school-based, special education program, and (e) being 3 to 6 years of age. Informed consent was obtained following the university's Institutional Review Board process.</p> <hd id="AN0177391715-4">Participants and Settings</hd> <p>Instruction occurred in two schools (i.e., one participant in elementary school; three in a self-contained special education school) in an urban public school district in the Western United States. Special educators, aides, and/or classmates were present during sessions. Participants worked directly with the interventionist, a special education doctoral student, in 1:1 sessions, 1 to 5 days per week in school in regular activities (e.g., wash hands at snack, start of school entry routine). The interventionist had completed all courses to be a Board Certified Behavior Analyst, but had not taken the test; she was working as an in-home behavioral therapist. Participant descriptive information was obtained from school and DB project files. All participants had some vision and hearing (i.e., none was totally blind or profoundly deaf) and thus could access visual prompts (e.g., gestures) as well as verbal praise. Pseudonyms were used for each child.</p> <hd id="AN0177391715-5">Sara and Her Setting</hd> <p>Sara, a 5-year-old Caucasian female in kindergarten, was diagnosed with partial trisomy 5q, was legally blind (i.e., acuity of 20/200) with a mild hearing loss (specific dB level not available). She did not wear hearing aids or glasses. She had global developmental delays, motor impairments (i.e., balance/stability issues on stairs or uneven surfaces, frequent tripping), and displayed characteristics of cortical visual impairment (CVI; as stated in her records). She was non-verbal without an AAC system. Sara engaged in stereotypy (e.g., lip flicking, body rocking, spinning when walking), frequently dropped to floor, and chewed her thumb. She wore a soft thumb brace to prevent skin damage. She drank liquids from a sippy cup and ate pureed foods. Sara was learning to activate toys with noises and lights. She responded to instructions (e.g., "Sit down") with prompts. Adult attention was a potential reinforcer. She received physical, occupational, vision, and speech therapies through her individualized education program (IEP).</p> <p>The elementary school served 738 students, Pre-K through sixth grade. Slightly less than 20% of the students qualified for free or reduced lunch. Sara's self-contained special education class included students in kindergarten through sixth grade. The boys' bathroom, in the main hallway, was used for teaching during the study as it was the bathroom designated by school administration with an adaptive stool (i.e., large stool with stairs, solid sides, and standing platform at the top). Red tape was added to step edges on the stool to aid in visual attention. The bathroom had a paper towel dispenser activated by a pull lever, wall-mounted soap dispenser, and sink with a push down round handle. Yellow tape was added to the soap dispenser and faucet handle. Sara walked down the hall to the classroom for the entry routine; upon entering the classroom, cubbies were about 3 m from the doorway with a table in front of them. Sara walked to the far side of the table to access the cubbies. Bright pink and yellow tape was added to her lunch photo, which was placed at eye level. Red tape was added to the class "sign-in" board.</p> <hd id="AN0177391715-6">Carl</hd> <p>Carl, identical twin of Hispanic descent, turned 5 years old during the study; he received physical, vision, occupational, and speech therapies through his IEP. He had Malan syndrome, agenesis of the corpus callosum, global developmental delays, autism, in-utero drug exposure, hypotonia, CVI, mild hearing loss at 28 dB via sound field testing with reported inconsistent responses to auditory stimuli. He did not wear hearing aids or glasses. He was non-verbal without an AAC system. At times, he led an adult by hand to a preferred activity (e.g., walk to door, place adult's hand on doorknob). Adult attention was a potential reinforcer. Observation and teacher report indicated he responded to directions (e.g., "Sit down") with prompts. Carl ate pureed foods, drank protein drinks, and independently ate a few finger foods. He engaged in stereotypy (e.g., body rocking, hand flapping) and seldom engaged with toys. He turned away from nonpreferred tasks, dropped, walked away, pushed adult hands/arms, and vocally protested.</p> <hd id="AN0177391715-7">Kevin</hd> <p>Kevin was an identical twin to Carl. All descriptive info for Carl is also relevant for Kevin with one difference. Kevin was identified as having a mild hearing loss at 27 dB level.</p> <hd id="AN0177391715-8">Red</hd> <p>Red, a 3-year-old Caucasian female in preschool, received speech, occupational, vision, and physical therapies through her IEP. Red was diagnosed with a genetic syndrome (KCNQ2), CVI, functional hearing loss (i.e., no response to various auditory stimuli such as instruments, voices, environmental sounds), global developmental delays, and seizures. Red did not wear glasses or hearing aids. She frequently looked at objects from the corner of her right eye. Although she was ambulatory, Red had difficulty with balance and stability (e.g., frequently tripped on uneven surfaces). Red primarily received nutrition from a bottle; she was learning to accept and eat food orally (e.g., spoon-fed yogurt mixed with mashed bananas). She was non-verbal without an AAC system. She engaged in tantrum behaviors (e.g., loud crying, dropping, flailing, attempting to leave) when she did not want to participate in an activity. She engaged in stereotypy (e.g., bouncing while looking at a lighted toy) and self-injury (i.e., repetitive hand licking, hands in mouth). Red responded to instructions (e.g., "Sit down") with prompts. She independently pushed buttons on familiar light toys. Adult attention was a potential reinforcer.</p> <hd id="AN0177391715-9">Setting: Carl, Kevin, and Red</hd> <p>Red, Carl, and Kevin attended preschool in a special education school. The school served 112 students, 3 through 22 years old, with a 1:10 teacher-to-student ratio. Almost 35% of the students were listed as economically disadvantaged; the school was designated as Title 1. The classroom bathroom had a changing table, standard toilet, sink, and small portable toilet. The bathroom had a pull-lever paper towel dispenser and a stand-alone soap dispenser, activated by pushing down the top, placed on the counter. The water was turned on by lifting the faucet handle. The classroom sink was embedded in a counter; water was turned on by pushing down on the faucet handle. Folded paper towels, visible at the dispenser's bottom, were pulled down. A soap dispenser was placed next to the faucet. For Red, colored tape was put on the faucet handle and soap dispenser; colored laminated paper was added to the sink and counter to aid visual attention. For the entry routine, participants walked down the hall to the classroom; a row of cubbies was located immediately to the right upon entry with a kidney table parallel to them. For Carl's and Kevin's entry routines, each backpack had a shower curtain ring to aid unzipping.</p> <hd id="AN0177391715-10">Experimental Design</hd> <p>A multiple probe design across behaviors ([<reflink idref="bib8" id="ref29">8</reflink>]) was used to examine the efficacy of SLP to teach three skills. The three skills were counterbalanced across participants in a staggered sequence consistent with the design. Criteria for introducing intervention in later tiers included a clear change in level (i.e., change in ordinate scale value [[<reflink idref="bib13" id="ref30">13</reflink>]] defined for this study as a minimum of doubled as compared with baseline probes) and an accelerating trend.</p> <hd id="AN0177391715-11">Dependent Variable</hd> <p>All targeted self-help skills were taught in total-task presentation; in every session, each step of each skill was taught from the start through skill completion with data collected on each step of each skill. The dependent variable was the percentage of steps independently completed for each skill through active or partial participation as defined (see Table 1 for task analyses [TAs] indicating steps completed independently or with partial participation) for the specific participant. Independent, or correct, responses were scored (a) for steps in which participants completed the step without any response prompts or (b) for steps in which participants partially participated as specified in the TA (e.g., if insufficient strength to activate faucet, touching the faucet, without any prompts, was scored as independent). TA steps could be completed out of order and scored as correct if order completion was not critical (e.g., drying palm/back side of hand could be done out of order). Data were collected on independent and prompted responses (i.e., prompt level) for each step in each skill. The number of independent responses in each skill was divided by the number of steps in the skill to obtain percentage independent. Mastery was defined as completing a minimum of 90% of steps via full or partial participation across 4 consecutive days.</p> <p>Graph</p> <p>Table 1. Task Analyses for Each Participant.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Sara</th><th align="center">Carl and Kevin (identical task analyses)</th><th align="center">Red</th></tr></thead><tbody><tr><td><bold>Wash hands:</bold> Move to sink area Walk upstairs/stool Reach/touch faucet handle (adult lifts on) Both hands reach for water Wet hands Reach for and touch soap dispenser One hand on top of soap dispenser One hand under soap (adult pushes down) Rub palms Rub back of one hand Rub back of other hand Put hands under water and rinse palms Rinse back of one hand Rinse back of other hand Remove hands from water (auto turn off)<bold>Dry hands:</bold> Walk upstairs/stool Turn toward paper towel dispenser Reach for and touch lever or dispenser (adult pulls down lever) Reach for paper towel Touch or grab towel (adult tears off) Take towel; hold in hand Dry palm of one hand Dry back of one hand Switch hand holding towel Dry back of other hand Walk down stairs Walk to trash can Hold towel as walk to trash Drop towel into trash can<bold>Entry routine:</bold> Walk down hallway Walk to classroom Enter classroom Walk to table next to cubby Touch sleeve of jacket (adult then removes and places on table) Reach for jacket Grasp part of jacket Turn to cubby Push jacket into cubby Turn to table Reach/touch zipper or backpack top (adult then opens) Reach into backpack/touch folder (adult removes folder) Push folder to table Reach into backpack/touch lunch box (adult removes) Pushes lunchbox onto table Grasp/touch backpack (adult aids pick-up) Grasp or touch backpack as turn to cubby Push backpack into cubby Turn back to table Grasp or touch lunchbox (adult picks up) Walk to counter Tap counter for adult to place lunchbox Walk to schedule Reach and touch lunch picture Grasp lunch picture Walk to lunch chart Carry lunch picture Put lunch picture on lunch chart Walk to table Sit down</td><td valign="top"><bold>Wash hands:</bold> Move to sink area Turn water on Both hands reach for water Wet hands Reach for and touch soap dispenser One hand on top of soap dispenser One hand under soap (adult pushes down) Rub palms Rub back of one hand Rub back of other hand Put hands under water and rinse palms Rinse back of one hand Rinse back of other hand Push faucet down<bold>Dry hands:</bold> Walk to sink area Turn toward paper towel dispenser Reach for and touch lever Pull lever down Reach for and touch towel Grab towel (adult tears towel) Hold towel Dry palm of one hand Dry back of one hand Switch hand holding towel Dry back of other hand Walk to trash can Drop towel into trash<bold>Entry routine:</bold> Walk down hallway Walk to classroom Enter classroom Walk to cubby Take off backpack Grasp backpack (top loop/shoulder strap) Hold onto backpack Put backpack on table Touch sleeve of jacket Unzip or take jacket off (with adult help) Reach for and pick up jacket Turn to cubby Put jacket in cubby Turn to table Reach and touch keychain on backpack zipper Hold onto keychain on zipper (while adult aids in unzipping) Touch top of backpack (adult aids in opening) Reach into backpack Grasp folder Pull folder out of backpack Hold folder Put folder into tray on table Turn to backpack Reach for backpack Grasp backpack (top loop/shoulder strap) Pick up backpack Hold backpack Turn to cubby while holding backpack Put backpack in cubby</td><td valign="top"><bold>Wash hands:</bold> Move to sink area Reach/touch faucet handle (adult lifts on) Both hands in water and wet hands Reach for and touch soap dispenser One hand on top of soap dispenser One hand under soap (adult pushes down) Rub palms Rub back of one hand Rub back of other hand Put hands under water and rinse palms Rinse back of one hand Rinse back of other hand Reach/touch faucet (adult pushes off)<bold>Dry hands:</bold> Walk to sink area (adult has towel hanging below dispenser) Reach for and touch towel (adult tears and hands to her) Hold towel Dry palm of one hand Dry back of one hand Switch hand holding towel Dry back of other hand Walk to trash Drop towel into trash<bold>Entry routine:</bold> Walk down hallway Walk to classroom Enter classroom Walk to table next to cubby Touch sleeve of jacket (adult then removes and places on table) Reach for jacket Grasp part of jacket Turn to cubby Push jacket into cubby Turn to table Reach and touch zipper or top of backpack (adult then opens) Reach into backpack/touches folder (adult removes folder) Push folder to table or tray Touch top of backpack (adult aids in opening) Reach into backpack (adult aids in taking out bottle) Grasp or touch backpack (adult helps to pick-up) Turn to cubby Push backpack into cubby</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>. Steps completed with partial participation noted parenthetically.</p> <hd id="AN0177391715-12">Procedure</hd> <p></p> <hd id="AN0177391715-13">Pre-Baseline</hd> <p></p> <hd id="AN0177391715-14">Instructional Opportunities</hd> <p>Interviews and observations were conducted with the participants' special educators to identify self-help skills and the times/activities in which to teach the skills. Prior to the study, all targeted skills were addressed within the classes. Upon study onset, the skills were taught only during study sessions with the interventionist absent only 2 days. On those days, staff completed participant routines without delivering any instruction.</p> <hd id="AN0177391715-15">Latency to Respond</hd> <p>Participants were observed in tasks in which they typically overtly responded to determine latency between stimuli presentation and participant response initiation. This latency was used to determine wait time before prompt delivery to ensure participants had independent response opportunities ([<reflink idref="bib12" id="ref31">12</reflink>]). Eating and drinking activities were initiated by all participants immediately upon stimuli presentation. These immediate responses led to a 5 s wait-time (i.e., 5 s to respond before prompt delivery).</p> <hd id="AN0177391715-16">Baseline Probe Condition</hd> <p>Baseline probe trials were conducted 1 to 3 times per day across 4 to 5 days per week during pertinent activities with relevant contextual cues (e.g., paint on hands after art). Trials for wash hands and dry hands began with a relevant verbal direction (e.g., "Wash hands"; "Dry hands") simultaneously presented with a tactile cue (e.g., for washing, participant's hands were gently rubbed together; for drying, a paper towel was rubbed briefly on the palm or forearm). Wash hands and dry hands were linked to participants' activities (e.g., after painting; after recess). For the entry routine, walking in the hallway toward the classroom served as the S<sups>D</sups>; no other cues were used. No consequences were provided for correct or incorrect responses. Baseline probe trials were conducted as fixed opportunity probes ([<reflink idref="bib1" id="ref32">1</reflink>]) and ended if the participant completed the skill or engaged in unrelated behaviors for 30 s (e.g., walked away, engaged in stereotypy, engaged with an adult [teacher, aide]).</p> <hd id="AN0177391715-17">Intervention/Independent Variable</hd> <p>SLP was used to teach participants to complete three self-help skills (i.e., entry routine, wash hands, dry hands). Skills were task analyzed with each step functioning as an S<sups>D</sups> for the next step in the chain ([<reflink idref="bib25" id="ref33">25</reflink>]). A total-task format was used with each step of each task taught in each session from the beginning to the end of the task (see Table 1). In intervention, task directions and tactile cues for task initiation, as described in baseline, were used; similarly, walking in the hall toward the classroom served as the S<sups>D</sups> for the entry routine.</p> <p>Because individuals with vision impairments and multiple disabilities have restricted access to modeled routines, they do not efficiently learn from watching others complete common routines ([<reflink idref="bib10" id="ref34">10</reflink>]) and so modeling prompts were not used in this study. During the first two sessions for each targeted skill, responses were physically prompted as recommended by [<reflink idref="bib10" id="ref35">10</reflink>] as an adaptation to using SLP. In all ensuing sessions, the same SLP hierarchy was used with all participants based on their similar characteristics. If participants did not (a) initiate the self-help skill within 5 s of task direction, (b) initiate a subsequent step within 5 s, (c) complete any step in the targeted skill, or (d) performed an error, the researcher used a prompt hierarchy ordered from least to most intrusive (i.e., SLP). Errors were defined as starting a step but stopping before completion, performing a critical step out of order (e.g., putting backpack in cubby prior to emptying it), or completing any action unrelated to step completion (e.g., pushing chair instead of pulling backpack zipper). Specifically, participants were given the opportunity to respond to the natural cue. If participants made an error or did not respond within 5 s, the researcher provided a gestural prompt (Prompt Level 1: pointing to material). If participants responded correctly, they received brief verbal praise (e.g., "Nice wetting hands."). If participants did not respond or made an error, they were given a slight physical prompt to provide the least amount of physical assistance possible (Prompt Level 2: relevant body part [e.g., arm] given a slight nudge that moved it approximately 2.5-7.5 cm). If participants did not respond or made an error within 5 s to the slight physical prompt, the researcher provided a partial physical prompt (Prompt Level 3: partially, but not fully, guided through response to complete the step). If after Prompt Level 3, participants still did not respond or made an error, the controlling prompt was used (Prompt Level 4: guided to complete response fully through hand-over-hand or hand-under-hand guidance as determined by task step, partial participation, etc.). SLP as described (i.e., gestural and increasing physical prompts without verbal prompts) was applied to each step within the skill, until skill completion. Upon skill completion, participants received verbal praise paired with tickles on hands or arms, back rubs, and/or hugs for on-task behavior, regardless of prompt level and then continued with typical class routines.</p> <p>If a participant repeatedly engaged in behaviors that could lead to injury (e.g., spinning on stool), the researcher immediately moved to a full physical prompt for participant safety and continued with that prompt until the problem behavior ceased. Similarly, if a participant repeatedly engaged in behavior interfering with using SLP hierarchy (e.g., repeatedly turning off the water), the researcher moved to a full physical prompt and continued that prompt until the problem behavior ceased. Moving to the controlling prompt immediately in response to errors is a variation of SLP ([<reflink idref="bib22" id="ref36">22</reflink>]); the researcher then returned to the prompt hierarchy.</p> <hd id="AN0177391715-18">Generalization</hd> <p>Generalization probes for two skills (i.e., wash hands, dry hands) were conducted identical to baseline probes (i.e., no consequences; data collected on each step of targeted skills). Generalization was assessed in participants' homes in the baseline probe condition to determine if participants could complete targeted skills in a setting other than school and in post-intervention to assess generalization across settings. Generalization was not assessed for the entry routine as it was irrelevant to home settings, nor was it relevant for participants to complete an entry routine in a novel classroom in which they were not members. Generalization for wash hands for Sara was assessed in a novel bathroom in the school immediately upon the study ending.</p> <hd id="AN0177391715-19">Reliability</hd> <p></p> <hd id="AN0177391715-20">Interobserver Agreement</hd> <p>Interobserver agreement (IOA) was assessed for a minimum of 30% of sessions across all participants for each condition (i.e., baseline, intervention, generalization). An independent observer (i.e., university researcher familiar with single case research and students with DB) viewed session videos and collected data on participants' responses for each TA step and a point-by-point comparison ([<reflink idref="bib13" id="ref37">13</reflink>]) was then conducted. Total agreements divided by total agreements plus disagreements and multiplied by 100 was used to calculate IOA. IOA for all participants across all skills and all phases resulted in a mean of 94% (range 67-100%). The 67% was ascribed to data errors during a session with extreme problem behavior.</p> <hd id="AN0177391715-21">Procedural Reliability</hd> <p>An independent observer (i.e., university researcher with prior research experience with SLP, familiarity with single case research and students with DB) viewed randomly selected videos and coded researcher behavior using a procedural checklist of baseline (e.g., gain attention, delivery of task direction, absence of teaching) and intervention procedures (e.g., following TA, task direction, prompt hierarchy for each step, verbal praise) across each participant for a minimum of 30% of sessions. Percentage of correctly implemented procedures was calculated by dividing correctly implemented steps by the total steps. Reliability for baseline procedures across all participants and all skills was 98% (range 95-100%). Intervention procedural reliability across all participants and skills was 86% (range 61-98%). Although overall procedural reliability was at an acceptable level, a low percentage occurred in one session with substantial problem behaviors that interfered with the interventionist following procedures.</p> <hd id="AN0177391715-22">Social Validity</hd> <p>Social validity was assessed to determine social significance of goals, acceptability of SLP, and importance of outcomes. Prior to baseline, participants' teachers completed a social validity survey regarding perceptions of targeting the skills; questions were open-ended or rated on a 5-point Likert-type scale. Post-study, social validity assessment used the same format and focused on acceptability of SLP and outcome importance (Surveys available upon request.).</p> <hd id="AN0177391715-23">Results</hd> <p>Three participants (i.e., Sara, Carl, Kevin) made substantial gains in independence for all targeted skills. Red's longer acquisition time and health issues led to intervention occurring only for washing hands. A functional relation was demonstrated for three of the four participants.</p> <hd id="AN0177391715-24">Sara</hd> <p>In the baseline probe condition of Sara's first targeted skill (i.e., entry routine; see Figure 1), she completed an average of 9% of steps independently. An approximately zero-celerating slope was observed, with slight variability in data. The introduction of SLP resulted in an almost immediate change in level ([<reflink idref="bib13" id="ref38">13</reflink>]) and trend; only one data point overlapped between baseline probe and intervention for 96.97% of nonoverlapping data (PND). In the sixth session, brightly colored pink and yellow duct tape was added to Sara's lunch photo, the lunch photo was moved to Sara's eye level, and red duct tape was added to the class "sign-in" board. The overall trend throughout intervention was accelerating but with some variability. With SLP intervention, independence within the entry routine increased to a mean of 52.3% across 33 sessions.</p> <p>Graph: Figure 1. Percentage of Independent Responses in Task Analyses for Entry Routine, Wash Hands, and Dry Hands for Sara.</p> <p>For washing hands baseline probes in school, Sara did not consistently complete any steps independently (<emph>M</emph> = 0.5%). Despite an outlier (i.e., one time walking to the stool-stairs independently), the trend remained zero-celerating. Similarly, she did not complete any steps of washing hands when a probe was conducted at home. With the application of SLP, an immediate change in level (approximately 10%) and trend was observed. In Session 8, yellow duct tape was added to the soap dispenser to make it more salient; yellow duct tape was added to the faucet handle in Session 15. In Session 18, red duct tape was added to the edge of each step of the stool-stairs to aid in visual discrimination between steps. Throughout intervention, an accelerating trend was evident, though intervention data were highly variable. SLP resulted in an increase in independence in washing hands to a mean of 37% across 37 sessions. Furthermore, only two data points overlapped between baseline probe and intervention conditions for 94.6% PND.</p> <p>All visual supports for drying hands were in place prior to starting intervention (e.g., yellow tape on paper towel dispenser). Initially, in the drying hands baseline probe condition, Sara's performance was at 0% independent. In Session 9 of the baseline probe condition, she began walking up and down the stool-stairs, which resulted in a change in level to 13%; the trend remained zero-celerating for the remainder of baseline. It is hypothesized a carryover effect from washing hands occurred. In an in-home baseline generalization probe, she did not complete any steps of drying hands independently. When SLP was initially introduced, Sara's percentage independent remained unchanged or decreased for two sessions; these initial two sessions represent the only data that overlapped between the baseline probe and intervention conditions, resulting in 88.9% PND. By the third session, her independence almost doubled as compared with baseline probes. Throughout intervention, data were highly variable with an accelerating trend. SLP resulted in a notable increase in percentage independent, 35.5% across 18 sessions.</p> <p>Two post-intervention generalization probes were conducted with Sara at school in another bathroom that was a mirror image of the training setting. Sara's independence for washing hands was similar to that which occurred in the intervention bathroom (i.e., 65% independent). Probes for dry hands did not occur due to thumb biting to a degree where tissue damage was probable. Sara was unavailable for a post-intervention, in-home generalization probe as she was out of town for several months following the school year ending.</p> <hd id="AN0177391715-25">Carl</hd> <p>Carl was not independent in any steps in the baseline probe condition (school and home generalization probes) of the first targeted skill, wash hands (<emph>M</emph> = 0%; zero-celerating trend; see Figure 2). Intervention resulted in an immediate change in level to 7%. Only three data points overlapped (i.e., 92.3% PND) across baseline and intervention. Two 0% intervention scores were likely related to documented illness. The third overlapping data point is related to problem behavior. In intervention, a slight accelerating trend was evident using a split-middle method though data were highly variable. With intervention, independence increased to a mean of 33% across 40 sessions. Problem behavior occurred throughout intervention and contributed to lower independence. The highest score (86%) occurred in the absence of problem behavior.</p> <p>Graph: Figure 2. Percentage of Independent Responses in Task Analyses for Wash Hands, Dry Hands, and Entry Routine for Carl.</p> <p>In baseline probes (home generalization probe and school), Carl's independence in drying hands remained near 0 (<emph>M</emph> = 0.7%); on one occasion he walked to the sink area which resulted in a slight increase in mean. A slight increase in trend was observed, however, data were stable. Upon introduction of SLP, an immediate change (approximately 15%) in level was observed; no data points overlapped between baseline probe and intervention conditions (i.e., 100% PND). During intervention, a slightly accelerating trend was evident with highly variable data. Intervention resulted in increased independence in drying hands to a mean of 53% (24 sessions).</p> <p>In the entry routine baseline probe condition, Carl completed a mean of 14% of steps independently (e.g., walk down hall, walk into classroom). At the end of the baseline probe condition, he walked to his cubby, raising the final probe score slightly. Baseline probe condition data were variable with zero celeration. Upon introduction of SLP, an immediate change in level occurred; no data overlapped between baseline and intervention conditions (i.e., 100% PND). Throughout intervention, data were highly variable with an accelerating trend. Application of SLP led to an increase in independence within the entry routine to a mean of 44% (14 sessions).</p> <p>Carl's post-intervention generalization probes for wash and dry hands were conducted in his home 11 days post-study. Improved performance did not generalize to his home setting.</p> <hd id="AN0177391715-26">Kevin</hd> <p>In the baseline probe condition for drying hands, Kevin completed an average of 1.1% of steps independently (see Figure 3). Although Kevin touched the paper towel dispenser once, this behavior was not replicated in other sessions. Similarly, he did not complete any steps in drying hands in the in-home generalization probe. A decelerating trend was observed in the baseline probe condition with stable data. Upon introducing SLP, independence for drying hands more than doubled in the first two sessions (8%). Five intervention data points overlapped (i.e., 87.8% PND) with baseline. During intervention, data were highly variable but accelerating. For drying hands implementation of SLP resulted in a mean increase in independence to 33% (41 sessions).</p> <p>Graph: Figure 3. Percentage of Independent Responses in Task Analyses for Dry Hands, Entry Routine, and Wash Hands for Kevin.</p> <p>In the baseline probe condition of the entry routine, Kevin completed an average of 13% of steps independently (e.g., walk down hallway, enter classroom). A decelerating trend was evident in the baseline probe condition with some data variability. Four intervention sessions overlapped with baseline probes (i.e., 81.8% PND). Throughout intervention, an accelerating trend was documented with highly variable data. Implementation of SLP resulted in an increase in mean independence in the entry routine to 33% across 22 sessions.</p> <p>Across all baseline probes for washing hands (school and home generalization probe), Kevin's mean (<emph>M</emph> = 0%) and zero-celerating trend remained stable. With the introduction of SLP, an immediate and sustained increase in independence occurred (i.e., 20% independence in first intervention session). No data overlap occurred between intervention and baseline probes (i.e., 100% PND). Throughout intervention, an accelerating trend was evident with variable data. Intervention resulted in an increase in mean independence to 40% across 14 sessions.</p> <p>Kevin's generalization probes for wash hands and dry hands were conducted in his home 11 days post-intervention. Improved behavior did not generalize with performance at 0%.</p> <hd id="AN0177391715-27">Red</hd> <p>Red's performance for wash hands (see Figure 4), throughout baseline probes, remained near 0 (<emph>M</emph> = 0.8%); only once did she independently walk to the sink. Similarly, Red did not independently complete any steps for washing hands in her in-home generalization probe (0%). The baseline probe condition trend was zero-celerating and stable. Introduction of SLP did not result in any change in the first 10 sessions; the percentage independent remained at 0. Colored tape was added to the faucet handle and soap dispenser to aid visual attention (Session 12 through study end). At Session 15, laminated colored paper was added to the sink and counter to aid with visual attention. Twenty intervention sessions resulted in little progress. The mean increased to 0.9, as a result of two sessions in which she rubbed her palms, with a stable zero-celerating trend.</p> <p>Graph: Figure 4. Percentage of Independent Responses in Task Analyses for Wash Hands, Entry Routine, and Dry Hands for Red. Note. SLP = system of least prompts; TA = task analyses.</p> <p>Based on these data and continued problem behavior (e.g., tantrum, dropping) hindering SLP, the decision was made to move from a total-task format to backward chaining. In the backward chain, a full prompt was provided for each step; SLP hierarchy was applied to the final step in the chain (i.e., touch faucet). The trend and mean (0%) did not change; data were stable.</p> <p>Subsequently, SLP in a total-task format as delineated in the procedures (i.e., SLP provided for each step) was reintroduced, which resulted in a change in mean and an accelerating trend; however, intervention data were highly variable. With the application of SLP, a sustained increase in independence occurred (<emph>M</emph> = 20%) across all sessions. Three data points overlapped with the previous backward chaining phase. Red's percentage of independence in the targeted skill (wash hands) showed an increase approximately 10 days prior to the end of the school year.</p> <p>The school year ended prior to intervening with the other targeted self-help skills (i.e., dry hands, entry routine). The mean and trend for both dry hands (<emph>M</emph> = 0%) and entry routine (<emph>M</emph> = 13.7%) remained stable throughout the baseline condition, which extended to the study's end.</p> <p>In addition, a generalization probe, identical to baseline, was conducted at Red's home 22 days post-intervention. Results were similar to baseline probes (i.e., 0% independent).</p> <hd id="AN0177391715-28">Prompts Delivered</hd> <p>Table 2 shows the number of steps prompted as well as the number of prompts delivered at each prompt level for the three participants for whom a functional relation was demonstrated. When a full physical prompt (the controlling prompt) was delivered it meant that a total of four prompts were provided to reach that level; if 10 steps were prompted at full physical, 40 prompts were provided. Similarly, if a participant responded on a step with a gesture prompt, that means only one prompt was delivered. Reviewing the data in Table 2 shows that each participant had almost all steps for each skill prompted with a full physical at the start of intervention, meaning it was necessary for the interventionist to deliver the entire prompt hierarchy for almost all steps. However, by the last intervention session for each participant for each skill, the number of prompts needed for participants to complete steps decreased dramatically. By the last intervention session, the need to deliver the entire hierarchy through full physical prompts occurred less frequently and a range of the other prompt levels in the hierarchy (e.g., slight physical, gesture) facilitated participant performance. As a result, the total number of prompts delivered decreased dramatically from the first to last intervention sessions.</p> <p>Graph</p> <p>Table 2. Prompting for First and Last Intervention Sessions for Each Participant for Each Skill.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="center" colspan="6">Number of prompts</th></tr><tr><th /><th align="center" colspan="2">Entry routine</th><th align="center" colspan="2">Washing hands</th><th align="center" colspan="2">Drying hands</th></tr><tr><th align="left">Name</th><th align="center">First intervention session:# steps prompted (# prompts provided)</th><th align="center">Last intervention session:# steps prompted (# prompts provided)</th><th align="center">First intervention session:# steps prompted (# prompts provided)</th><th align="center">Last intervention session:# steps prompted (# prompts provided)</th><th align="center">First intervention session:# steps prompted (# prompts provided)</th><th align="center">Last intervention session:# steps prompted (# prompts provided)</th></tr></thead><tbody><tr><td>Sofia</td><td>FP: 27 (108) PP: 0 (0) SP: 0 (0) G: 0 (0) Prompts = 108</td><td>FP: 1 (4) PP: 0 (0) SP: 8 (16) G: 1 (1) Prompts = 21</td><td>FP: 13 (52) PP: 0 (0) SP: 0 (0) G: 1 (1) Prompts = 53</td><td>FP: 1 (4) PP: 2 (6) SP: 1 (2) G: 0 (0) Prompts = 12</td><td>FP: 13 (52) PP: 0 (0) SP: 0 (0) G: 0 (0) Prompts = 52</td><td>FP: 7 (28) PP: 2 (6) SP: 0 (0) G: 1 (1) Prompts = 35</td></tr><tr><td>Carl</td><td>FP: 19 (76) PP: 0 (0) SP: 1(2) G: 0(0) Prompts = 78</td><td>FP: 4 (16) PP: 2 (6) SP: 1 (2) G: 0 (0) Prompts = 24</td><td>FP: 12 (48) PP: 0 (0) SP: 2 (4) G: 0 (0) Prompts = 52</td><td>FP: 1 (4) PP: 4 (12) SP: 2 (4) G: 0 (0) Prompts = 20</td><td>FP: 7 (28) PP: 1 (3) SP: 0 (0) G: 2 (2) Prompts = 33</td><td>FP: 5 (20) PP: 1 (3) SP: 2 (4) G: 1 (1) Prompts = 28</td></tr><tr><td>Kevin</td><td>FP: 17 (68) PP: 2 (6) SP: 0 (0) G: 0 (0) Prompts =74</td><td>FP: 3 (12) PP: 3 (9) SP: 6 (12) G: 0 (0) Prompts =33</td><td>FP: 6 (24) PP: 0 (0) SP: 1 (2) G: 0 (0) Prompts = 26</td><td>FP: 1 (4) PP: 1 (3) SP: 1 (2) G: 1 (1) Prompts = 10</td><td>FP: 7 (28) PP: 3 (9) SP: 0 (0) G: 0 (0) Prompts = 37</td><td>FP: 0 (0) PP: 0 (0) SP: 3 (6) G: 0 (0) Prompts = 6</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. Number of steps prompted at full physical (FP), partial physical (PP), slight physical (SP), and gesture (G). Parenthetically total number of prompts provided at each level of the prompt hierarchy with total number of prompts provided for the session.</p> <hd id="AN0177391715-29">Social Validity</hd> <p></p> <hd id="AN0177391715-30">Pre-Intervention Social Validity</hd> <p>Both classroom teachers responded to pre-baseline social validity surveys and completed surveys for each of their respective participants. Responses to these surveys indicated teachers viewed all targeted skills as important. The teacher of three participants (Carl, Kevin, Red) indicated strong agreement (rating of 5) with the statement, "it is important that my student [completes skill] independently." Sara's teacher assigned lesser importance to this statement across all three skills and stated partial participation in routines was more important than independence (i.e., "Would like her to be able to complete with allowing some adult support at least"). In response to being asked for descriptions of how participants completed each self-help skill, teachers made statements such as: "Needs full support and guidance, lots of redirections."</p> <hd id="AN0177391715-31">Post-Intervention Social Validity</hd> <p>Both teachers completed post-intervention surveys for each of their student-participants. The teachers indicated strong agreement with the statement, "outcomes were helpful to you the teacher" (rating of 5 by each teacher for all targeted skills). Teachers reported outcomes were helpful to the students with strong agreement. The teachers had ambivalence about whether or not SLP was generally an effective teaching strategy. One provided a rating of 5 (strongly agree) in regard to SLP being an effective way to teach a new skill; whereas the other teacher provided a rating of 3 (neutral). In regard to SLP being an effective prompting strategy to teach a new skill for their specific students, responses were similar with the average rating of 3.5 (range = 3-5). Comments indicated SLP allowed participants to show independence without unnecessary prompting; increased independence made it easier during school for staff. Social validity results indicated the teachers found SLP to be an acceptable procedure and outcomes to be beneficial.</p> <hd id="AN0177391715-32">Discussion</hd> <p>This study examined the efficacy of an intervention package including SLP, visual cues, and reinforcement to teach self-help skills to children with multiple impairments that include DB. A functional relation was demonstrated for three participants, who made substantial gains in all targeted skills, increasing their independence and decreasing the number of prompts needed to facilitate their performance. These results address the significant gap in the literature regarding effective instructional strategies for this population. More specifically, there is a dearth of research on effectively and efficiently teaching self-help skills to children with multiple disabilities and DB, even though self-help skills are foundational to health, independence, and self-determination. According to [<reflink idref="bib11" id="ref39">11</reflink>], "Arguably, children with multiple disabilities...are among the most at risk of failing to develop the necessary skills to meet their own basic health and wellness needs..." (p. 252).</p> <p>This study contributes to the literature and provides promising evidence ([<reflink idref="bib31" id="ref40">31</reflink>]) as data demonstrate SLP in an intervention package is effective to teach self-help skills to children with multiple disabilities, including DB. Social validity results also supported the acceptability of SLP as a teaching procedure. Although mastery was not achieved due to the school year ending, substantial increases in independence and active participation were achieved in targeted skills for three of four participants. These results are similar to that of other studies in which participants with extensive support needs increased independence but did not meet mastery criteria (e.g., [<reflink idref="bib5" id="ref41">5</reflink>]; [<reflink idref="bib11" id="ref42">11</reflink>]). Complexity of disabilities may have contributed to longer acquisition times and mastery criteria not being met. Individuals with multiple disabilities with DB may not respond to traditional teaching methods ([<reflink idref="bib16" id="ref43">16</reflink>]) and may require longer acquisition time ([<reflink idref="bib11" id="ref44">11</reflink>]; [<reflink idref="bib26" id="ref45">26</reflink>]).</p> <p>Although Red made gains in independence in washing hands, the increase came at the end of the study. Multiple reasons might explain lack of improvement earlier. Red had a major seizure requiring hospitalization prior to study onset, resulting in loss of skills in her repertoire prior to the seizure (e.g., walking, holding her bottle with one hand while drinking). During the study, lost skills returned gradually. It is possible the acquisition delay was influenced by the seizure and her general loss of other skills; the return of prior skills might have influenced acquisition of the study's targeted skills. She also appeared to be sick for the study's duration (e.g., colored mucus, ears draining, intermittent cough). The seizure's effects and ongoing illness may have affected Red's skill acquisition. Finally, Red was the youngest participant at 3 years old while others were 5 years old; it might be that her young age affected skill acquisition.</p> <p>Red is the only participant for whom backward chaining was added as a modification given her lack of progress. Although a functional relation is not evident, it is possible the use of backward chaining with SLP applied only to the last step in the skill, contributed to increased independence when SLP was subsequently reapplied to each step in the TA. The full physical prompting on the earlier steps in the chain may have aided acquisition of those steps.</p> <p>Although SLP in an intervention package was an effective teaching strategy and resulted in the transfer of stimulus control from prompts to natural occurring stimuli, other prompting strategies might be more efficient. With SLP, participants are provided with sequentially more intrusive prompts until the controlling prompt (i.e., prompt most likely to facilitate a correct response) is provided. This procedure allows for participant errors prior to the controlling prompt. In this study, three prompt levels were provided prior to the controlling prompt. Each ineffective prompt potentially increased the time required for acquisition and allowed errors. Specifically, ineffective prompts may hinder transfer of stimulus control from researcher-provided prompts to natural cues ([<reflink idref="bib26" id="ref46">26</reflink>]; [<reflink idref="bib30" id="ref47">30</reflink>]).</p> <hd id="AN0177391715-33">Limitations</hd> <p>A functional relation was demonstrated even though the end of the school year resulted in the study ending prior to participants achieving mastery. It is probable, based on accelerating trends, with further sessions, mastery would be achieved. Research documents the necessity of longer instructional periods for participants with multiple disabilities to achieve mastery of targeted skills (e.g., [<reflink idref="bib11" id="ref48">11</reflink>]; [<reflink idref="bib26" id="ref49">26</reflink>]). All participants also had numerous absences throughout the study, which likely contributed to slower acquisition.</p> <p>As part of her professional responsibilities (and independent of study procedures), Sara's visual impairment teacher added visual supports (e.g., colored tape) to draw Sara's attention to task details for the entry routine and washing hands after intervention started. Data indicate that it does not appear the visual supports changed the trend of Sara's responses. However, for experimental control, the visual supports should have been present in baseline.</p> <p>Adult attention was identified via observation as a potential reinforcer for participants. Stimulus preference assessments (SPAs) were not done in the pre-baseline. SPAs could have identified stimuli that might have functioned as stronger reinforcers than adult attention.</p> <p>Maintenance probes were not conducted as the study ended with the school year ending. With the start of the new school year, the participants moved to new schools and/or to new teachers in new classrooms, preventing maintenance probes from being conducted.</p> <hd id="AN0177391715-34">Future Research</hd> <p>Research is needed on effective and efficient prompting strategies for those with severe, multiple impairments, including DB. It is possible that a most-to-least prompting strategy or a single prompt strategy (e.g., simultaneous prompting) might be effective with fewer participant errors. Future research should examine other prompting strategies as well as participant characteristics that influence the selection of response prompting strategies.</p> <p>In addition, future research should strive to meet the criteria for high-quality research (e.g., [<reflink idref="bib31" id="ref50">31</reflink>]) and thus contribute to identifying EBPs. EBPs are needed to provide teachers with strategies for effective teaching of individuals with multiple disabilities that include DB.</p> <hd id="AN0177391715-35">Practical Implications and Conclusion</hd> <p>Increasing participation and independence within self-help routines are foundational to future independence, which can affect participants' quality of life and that of their caregivers. This study provides evidence that SLP as part of an intervention package is effective in teaching self-help skills to young children with multiple disabilities that include DB. Although mastery criterion was not achieved, SLP was effective in increasing the independence and participation of three of four young participants with multiple disabilities and DB in three targeted self-help skills (wash hands, entry routine, dry hands). Individuals with multiple disabilities that include DB frequently require extensive support through all activities of daily living; progress toward independence, even if the individual still requires some support or modifications to complete the skill, is notable. Teachers of young children with multiple disabilities including DB have evidence from this study that SLP is effective in teaching self-help skills. The results of this study can guide teachers of young children with multiple disabilities that include DB in selecting teaching procedures (i.e., SLP) that have research support specific to the population.</p> <ref id="AN0177391715-36"> <title> References </title> <blist> <bibl id="bib1" idref="ref32" type="bt">1</bibl> <bibtext> Alexander J. L., Ayres K. M., Shepley S. B., Smith K. A., Leford J. R. (2017). Comparison of probe procedures in the assessment of chained tasks. 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Institute of Education Sciences, U.S. Department of Education.</bibtext> </blist> </ref> <ref id="AN0177391715-37"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Support for this study came from the Mary Demchak Memorial Award for Doctoral Research in Intellectual Disability, granted to Jill Grattan by the University of Nevada, Reno, College of Education and Human Development.</bibtext> </blist> <blist> <bibtext> MaryAnn Demchak</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-7427-902X</bibtext> </blist> <blist> <bibtext> Editor-in-Charge: Charles Dukes</bibtext> </blist> </ref> <aug> <p>By Jill Grattan and MaryAnn Demchak</p> <p>Reported by Author; Author</p> <p></p> <p>Dr. Jill Grattan recently received her Ph.D. in special education at the University of Nevada, Reno and currently provides in-homer therapy. Her research interests include implementing behavior analysis strategies with fidelity to meet educational needs of children with disabilities.</p> <p>MaryAnn Demchak, Ph.D., BCBA-D, is a Professor of special education at the University of Nevada, Reno. Her research focuses on instruction of students with intellectual disabilities and multiple disabilities, including deafblindness as well as appropriate application of applied behavior analysis in special education.</p> </aug> <nolink nlid="nl1" bibid="bib18" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib24" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib21" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib19" firstref="ref9"></nolink> <nolink nlid="nl5" bibid="bib17" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib14" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib15" firstref="ref12"></nolink> <nolink nlid="nl8" bibid="bib16" firstref="ref13"></nolink> <nolink nlid="nl9" bibid="bib31" firstref="ref14"></nolink> <nolink nlid="nl10" bibid="bib22" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib20" firstref="ref18"></nolink> <nolink nlid="nl12" bibid="bib23" firstref="ref19"></nolink> <nolink nlid="nl13" bibid="bib26" firstref="ref20"></nolink> <nolink nlid="nl14" bibid="bib30" firstref="ref21"></nolink> <nolink nlid="nl15" bibid="bib27" firstref="ref22"></nolink> <nolink nlid="nl16" bibid="bib29" firstref="ref23"></nolink> <nolink nlid="nl17" bibid="bib28" firstref="ref26"></nolink> <nolink nlid="nl18" bibid="bib13" firstref="ref30"></nolink> <nolink nlid="nl19" bibid="bib12" firstref="ref31"></nolink> <nolink nlid="nl20" bibid="bib25" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib10" firstref="ref34"></nolink> <nolink nlid="nl22" bibid="bib11" firstref="ref39"></nolink>
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  Label: Title
  Group: Ti
  Data: Using System of Least Prompts to Teach Self-Help Skills to Students Who Are Deafblind
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  Label: Language
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  Data: English
– Name: Author
  Label: Authors
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  Data: <searchLink fieldCode="AR" term="%22Jill+Grattan%22">Jill Grattan</searchLink><br /><searchLink fieldCode="AR" term="%22MaryAnn+Demchak%22">MaryAnn Demchak</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-7427-902X">0000-0002-7427-902X</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Research+and+Practice+for+Persons+with+Severe+Disabilities%22"><i>Research and Practice for Persons with Severe Disabilities</i></searchLink>. 2024 49(2):107-125.
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 19
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Deaf+Blind%22">Deaf Blind</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Help+Programs%22">Self Help Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Teaching+Methods%22">Teaching Methods</searchLink><br /><searchLink fieldCode="DE" term="%22Evidence+Based+Practice%22">Evidence Based Practice</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Cues%22">Cues</searchLink><br /><searchLink fieldCode="DE" term="%22Reinforcement%22">Reinforcement</searchLink><br /><searchLink fieldCode="DE" term="%22Hygiene%22">Hygiene</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Education%22">Health Education</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+School+Students%22">Elementary School Students</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Education%22">Special Education</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Schools%22">Special Schools</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+Impairments%22">Visual Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+Stimuli%22">Visual Stimuli</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Diversity%22">Student Diversity</searchLink><br /><searchLink fieldCode="DE" term="%22Achievement+Gains%22">Achievement Gains</searchLink>
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  Label: DOI
  Group: ID
  Data: 10.1177/15407969241231204
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  Label: ISSN
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  Data: 1540-7969<br />2169-2408
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: To date, no evidence-based practices are identified for working with students who are deafblind (DB). No evidence-based practices have been identified for teaching basic self-help skills such as dressing. The present study examined the efficacy of an intervention package including the system of least prompts (SLP; i.e., SLP and least-to-most prompting), visual cues, and reinforcement to teach three self-help skills (i.e., wash hands, dry hands, entry routine) to four participants, ages 3-5 years, with vision and hearing impairments and multiple disabilities. A multiple probe across behaviors design, replicated across participants, was used to evaluate the effectiveness of an intervention package including SLP to teach self-help skills. Three of four participants increased their independence for all targeted self-help skills. A functional relation is indicated for three of four participants and provides promising evidence for use of SLP in teaching individuals with multiple disabilities that include DB.
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  Data: 2024
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  Data: EJ1425505
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1425505
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        Value: 10.1177/15407969241231204
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 19
        StartPage: 107
    Subjects:
      – SubjectFull: Deaf Blind
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Self Help Programs
        Type: general
      – SubjectFull: Daily Living Skills
        Type: general
      – SubjectFull: Teaching Methods
        Type: general
      – SubjectFull: Evidence Based Practice
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Cues
        Type: general
      – SubjectFull: Reinforcement
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      – SubjectFull: Hygiene
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      – SubjectFull: Health Education
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      – SubjectFull: Elementary School Students
        Type: general
      – SubjectFull: Special Education
        Type: general
      – SubjectFull: Special Schools
        Type: general
      – SubjectFull: Visual Impairments
        Type: general
      – SubjectFull: Visual Stimuli
        Type: general
      – SubjectFull: Hearing Impairments
        Type: general
      – SubjectFull: Preschool Children
        Type: general
      – SubjectFull: Student Diversity
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      – SubjectFull: Achievement Gains
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    Titles:
      – TitleFull: Using System of Least Prompts to Teach Self-Help Skills to Students Who Are Deafblind
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              Type: published
              Y: 2024
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