The Effects of a Computer-Aided Listening Comprehension Intervention on the Generalized Communication of Students With Autism Spectrum Disorder and Intellectual Disability

Abstract

In this study, a computer-aided listening comprehension intervention package supported both listening comprehension and communication goals for three students with autism spectrum disorder (ASD) and intellectual disability (ID). The package consisted of systematic instruction (i.e., system of least prompts [SLP] procedure) to teach listening comprehension, an iPad-supported electronic communication book, and a peer support arrangement. The students with ASD and ID who participated in the study increased both listening comprehension and communication skills, while showing an increase in generalizing communication turns to interactions with their peers without disabilities. The researchers found a functional relation between the SLP procedure and both dependent variables. All three participants experienced concurrent growth between the dependent variables, implying a connection between text-based listening comprehension and communication outcomes. Further implications for academic instruction for students with ASD who use augmentative and alternative communication as well as for future inquiry concerning cross-modal generalization to social communication discourse are discussed.

Keywords

generalization listening comprehension communication skills system of least prompts

Literacy is an important skill, but students with autism spectrum disorder (ASD) and intellectual disability (ID) may struggle to construct meaning from texts that give context and enrichment to their daily interactions. Recent efforts to define appropriate academic progress for students with disabilities (Turnbull, Turnbull, & Cooper, 2018) serve as a reminder of a well-established barrier: Academic instruction for students with disabilities may not be comprehensive or rigorous enough to result in the benefits experienced by their peers without disabilities (Browder, Wakeman, Spooner, Ahlgrim-Delzell, & Algozzine, 2006). To meet federal mandates, current research has focused on access to the general curriculum for all students, and thus, access to literacy and technology (e.g., Knight, McKissick, & Saunders, 2013) has emerged as a support to accomplish that goal.

Listening Comprehension

Although students may not yet read independently, they can still learn to comprehend texts that another person or assistive technology reads aloud (e.g., Browder, Root, Wood, & Allison, 2015). Given that listening comprehension is necessary for communication, it also can be considered an important literacy learning outcome. As described in the literature (Langenberg et al., 2000), the connection between reading comprehension and listening comprehension is as two gears in a clock whose processes are considered separate but intricately intertwined. Finnegan and Mazin (2016) conducted a literature review on reading comprehension strategies for students with ASD and found a wide range of measures used to determine the comprehension of participants. Some researchers chose to measure reading comprehension by questioning students orally (a method common to all classrooms), thus relying on a student’s ability to use listening comprehension to answer questions about text-based information. A special education instructional example of this is answering questions following read alouds (i.e., text read to the student by another person). For students who are not independent readers, assessing text-based comprehension through the use of read alouds with listening comprehension questions is an alternative. When comprehension of content presented in a read aloud is accompanied by visual augmented text rewritten to accommodate beginning reading levels (adapted texts), the practice is considered text based; thus, text-based supports (e.g., text referencing) can be used.

According to Finnegan and Mazin (2016), the number of studies involving text-based read alouds remains small in comparison to the questions they raise. Chiang and Lin (2007) found that only 4 of 11 studies on reading comprehension instruction for students with ASD published between 1986 and 2004 investigated instructional methods. Still, a number of studies using evidence-based strategies for text-based comprehension have featured read-aloud procedures with emerging therapeutic effects (e.g., Reutebuch, Zein, Kim, Weinberg, & Vaughn, 2015); these include examples of text-to-speech software paired with systematic instruction (e.g., Spooner, Kemp-Inman, Ahlgrim-Delzell, Wood, & Davis, 2015). Recent trends indicate that the number of comprehension interventions in the literature for students with ASD has increased (e.g., Snyder, Ayres, Sartini, Knight, & Mims, 2017).

Communication

Students with ASD struggle with communication skills, making it difficult to state or indicate (e.g., touch a communication symbol) the answers to questions, even if they comprehend what they have heard. Students with ASD, at most levels of ID, are likely to require specialized instruction for both comprehension and communication to experience greater postschool outcomes (Tager-Flusberg, Paul, & Lord, 2005), including increased comprehension responding and engagement in general conversational discourse. The use of augmentative and assistive technology can support students who struggle with verbal communication, allowing them to communicate via pictures and voice output devices (VODs). Communication skills are intertwined with social skills, and promising evidence that teenagers and young adults with ASD benefit from social skill interventions using augmentative and alternative communication (AAC) has emerged. This is based, however, on a small body of research (e.g., Holyfield, Drager, Kremkow, & Light, 2017). In a review of the literature, Mirenda (2001) concluded there was no single best practice for providing AAC supports to individuals with ASD, although recent examinations of the literature concluded that using high-tech AAC to teach social communication skills to individuals with ASD or ID is an evidence-based practice (Morin et al., 2018); thus, studies demonstrating the efficacy of specific practices are needed.

Peers without disabilities have promoted the academic learning of students with ASD as well. For example, McCurdy and Cole (2014) found that peer support in inclusive settings quickly reduced the off-task behaviors of students with ASD. When Collins, Hall, and Branson (1997) involved peers without disabilities in leisure skill instruction for students with disabilities (i.e., ID, ASD) using a system of least prompts (SLP) procedure in which students received increasing assistance as needed, they found that the students with disabilities acquired the target skills and generalized them across the peers. In addition, the intervention provided a structure for facilitating friendships between the students with and without disabilities, as opposed to peer tutor–tutee relationships. In the shift toward AAC interventions with naturally occurring communication opportunities (Snell, Chen, & Hoover, 2006), Carter and Hughes (2005) developed a model for building social skills with students with ASD in free-time social opportunities and found that, when students were paired with same-age peer communication partners without disabilities and when communication and social interaction were reinforced by the teacher, there was a significant increase in communication.

One way to teach students with communication needs to use VOD technology to respond to read alouds is through systematic instruction, such as the SLP procedure. Mims, Hudson, and Browder (2012) taught students with moderate and severe ASD to comprehend grade-appropriate adapted informational texts using read alouds, SLP, and graphic organizers. Likewise, Zakas, Browder, Ahlgrim-Delzell, and Heafner (2013) demonstrated that a graphic organizer could support the learning of middle school students with ASD in comprehending adapted informational text. Graphic organizers, adapted texts, and systematic instruction (i.e., SLP with increasingly intrusive levels of text referencing) are components of instructional packages that have been effective in teaching text-based listening comprehension to this population (e.g., Browder et al., 2015). Response prompting systems used in conjunction with technology (e.g., graphic organizers presented electronically via iPads, personal computers, or interactive whiteboards) are emerging in the research.

Listening Comprehension Generalization

In addition to being an academic skill, listening comprehension is needed for social communicative exchanges with peers outside of the classroom. Students who rely on AAC technology (e. g., electronic communication book [ECB]) can be better prepared for leisure conversations when their AAC language reflects current knowledge and age-appropriate current interests. Hughes et al. (2011) examined the effects of a social skills intervention on interactions between students with ID and their peers without disabilities. The intervention took place in inclusive settings and within natural social contexts throughout the school day. The authors concluded that a combination of aided language communication book use and access to interaction opportunities with peers increased conversational initiations and responses in the participants with ASD. Shire and Jones (2015) recommended communication partner orientation or training to support spontaneous communication in naturally occurring contexts. Additional examples of teaching text-based listening comprehension to transition-age students with ASD are warranted, and only a few studies have linked core content skills to transition (e.g., Collins, Karl, Riggs, Galloway, & Hager, 2010). Not only do text-based listening comprehension requirements increase dramatically by the time students reach high school (Mastropieri & Scruggs, 1997), but students at this age will soon transition to postschool life with many listening comprehension demands. More core content research is needed within the context of peer activities (Fetko, Collins, Hager, Schuster, & Spriggs, 2013), as well as within inclusive settings (e.g., Tekin-Iftar, Collins, Spooner, & Olcay-Gul, 2017).

Cross-Modal Generalization

Although an established connection exists between receptive and expressive communication for students with ASD (Wynn & Smith, 2003), few experimental studies have examined the connection, or cross-modal generalization (e.g., Bloom, 1974), between listening comprehension and expressive communication for student AAC-supported discourse (social and interactive exchanges). Cross-modal generalization is defined as the transference of a skill from one mode (comprehension responding) to another mode (communicative turn-taking) of communication. Put another way, cross-modal generalization is the expectation that receptive language growth in the form of listening comprehension will yield expressive language growth in the form of communicative turns taken. Guess and Baer (1973) provided an early example of an attempt to prove this connection that showed, with the right controls in place, cross-modal generalization may be possible; however, no investigations have examined this relationship within social communication discourse. Kleinert et al. (2015) suggested that a positive correlation exists between expressive communication, increased academic skills, and inclusive opportunities in educational settings. Thiemann and Goldstein (2001) investigated the effects of two simultaneous social interventions (i.e., peer training and systematic instruction of social behaviors) on social changes in students with ASD and their peers without disabilities. The results indicated that text-based cues improved social interactions for students with ASD; however, the researchers only measured the effects of social interventions and not academic interventions to improve social outcomes.

Multicomponent interventions designed to help high school students with more severe disabilities build academic skills and address social communication needs are infrequent in the literature (Carter, 2018). Ruppar (2017) used a qualitative analysis to conduct a preliminary study of the literacy experiences of adolescents with a variety of severe disabilities including ASD. Based on this analysis, she called for literacy interventions with communication-rich instruction to teach this population. Several research teams (e.g., Wood, Browder, & Flynn, 2015) responded to this call by designing academic interventions with a demonstration of skills through communication (communication skill interventions using academic content); however, in these cases, communicative skills were explicitly taught, and the question remained whether academic instruction alone may impact the communication of that information.

Kemp-Inman (2016) conducted a study to measure the effects of the SLP procedure in improving listening comprehension as well as generalization to responding in a high school book club discussion with peers without disabilities. While listening comprehension responding in the book club sessions reflected the responding from individual sessions, Kemp-Inman found that students generalized their listening comprehension responding gains to a more social context with peers. Demonstrations of classroom instruction resulting in cross-modal generalization to improve the social communication discourse of students with ASD are imperative given evidence of receptive to expressive communication connections, but there are mixed implications for improving the instruction of students who struggle to understand and express their knowledge (e.g., Wynn & Smith, 2003).

The purpose of the current study was to examine the connection between a specific communicative social skill (i.e., adding to a leisure conversation through conversational turn-taking) and a specific academic skill (i.e., text-based listening comprehension). This study adds to the established research base by demonstrating that an SLP procedure can be implemented to teach computer-aided text-based listening comprehension skills, and communication can be supported by AAC VODs, as well as peer support arrangements that meet the specific communication needs of students with ASD. The specific research questions were as follows: (a) What is the effect of an SLP procedure on the text-based listening comprehension of students with ASD and ID? and (b) What is the effect of an SLP procedure on the number of communicative turns taken by the same students during a leisure conversation with peers without disabilities on topics taught using that SLP procedure?

Method

This study taught text-based listening comprehension to three students with ASD and ID from a suburban southeast high school using computer-aided, adapted, high-interest informational texts. The researchers implemented one intervention (SLP procedure) for increasing accurate responding through text referencing and measured two dependent variables: (a) the impact on correct comprehension question responses and (b) cross-modal generalization to communication turns using that information.

Participants

Students

Three students diagnosed with both ASD and ID between the ages of 16 and 21 years participated in this study. They attended a diverse suburban high school (66% African American, 15.5% Caucasian, 9% Hispanic/Latino, 5% American Indian, and 4% Multiracial) and followed a class schedule of several self-contained courses and two inclusive class periods (e.g., basic art, ceramics). To participate, students had to have (a) a primary diagnosis of ASD, (b) a reading level at or below first grade (according to curriculum-based measures as reported by the teacher), (c) verbal communication skills with peers limited to two-word nonecholalic utterances or less, (d) participation in the state’s alternate assessment and a curriculum based on alternate achievement standards, (e) communication and literacy objectives in their Individualized Education Programs (IEPs), and (f) consistent attendance. The researchers determined which students met inclusion through informal interviews with teachers and a review of current classroom data on listening comprehension and social communication.

Boston was a 21-year-old African American male identified with ASD and ID (IQ = 58) in the 12th grade. In reading, his teacher reported that Boston had high levels of decoding but low listening comprehension responses based on classroom performance. He sang to himself, stated a peer’s name to get attention, and made limited verbal requests. Martin was a 16-year-old African American male identified with ASD and ID (IQ = 45) in the 10th grade. Based on classroom performance, his teacher reported that Martin was a nonreader with moderate listening comprehension responses when text was read aloud. He had a high number of inappropriate, off-topic, and unintelligible utterances. Raj was a 21-year-old African American male identified with ASD and ID (IQ = 37) in the 12th grade. Based on classroom performance, his teacher reported that Raj was a nonreader with low listening comprehension responses when text was read aloud. Raj spoke when prompted and occasionally shouted off-topic comments. All participants had limited vocal ability and relied on low-tech picture symbol boards for complex communication, but none consistently used a designated personal AAC system.

The interventionist also selected one student with ASD to serve as a training peer during peer orientation. Illijah was a 17-year-old African American male identified with ASD and ID (IQ = 65) in the 12th grade. Based on classroom performance, his teacher reported that he was a high-level reader with moderate listening comprehension responses and did not need the intervention. Although he would say “hi” and “yeah,” he typically only spoke when prompted. He had limited verbal ability but did not use a designated personal AAC system.

Communication partners

A small pool of peers without disabilities served as communication partners. These peers were enrolled in an inclusive class period with the students with ASD, were within 3 years of the age of the students with ASD, and were recommended by their teacher. Boston and Martin attended a ceramics class with one African American male, one African American female, and one Caucasian female without disabilities who served as communication partners. Raj attended a beginners’ art class with two African American females and two Caucasian females without disabilities who served as communication partners. All communication partners participated in a brief communication orientation session with Illijah, which included a general introduction to participant needs, AAC communication norms (based on the Center on Secondary Education for Students with Autism Spectrum Disorders (CSESA) Autism at-a-Glance: Supporting Communication in High School [Butler & Dykstra, 2014a, 2014b] supplemented by descriptions of participants’ personal communication parameters), and practice with the communication procedures.

Researchers

The interventionist was a first-year doctoral student in special education with over 10 years of experience teaching students with ASD and ID. The reliability and fidelity data collector was a third-year doctoral student who attended the same university and had extensive experience working with students with ASD. The interventionist and the reliability and fidelity data collector recorded all data during the study.

Materials

Adapted texts

Each book and corresponding response board was accessible for participants in an electronic presentation format, was delivered via school laptop computer, was easy to navigate, and used a solid, high-contrast background with no additional visuals. Each student accessed the informational passages and accompanying listening comprehension questions and response options using a touchscreen-enabled laptop computer. To facilitate social validity, the researchers selected topics based on feedback from the teacher and paraprofessional, as well as the student participants with and without disabilities, for creating adapted listening comprehension texts. For example, a student who liked bugs might read about newly discovered species. The topic sources were CNN Student News, WikiHow, TeenKids News, and Newsela. In each listening comprehension session, students had three high-interest texts from which to choose (with no topic repeated across sessions). This ensured that the adapted book options were relevant, age and grade appropriate, and of high interest to the participants.

The researchers based the informational passages on age- and grade-appropriate, high-interest content with a target Lexile reading level at or below third grade (in accordance with a recommended read-aloud reading level from Browder, Trela, & Jimenez [2007]). The research team adapted these texts (available from the authors by request) based on content validity across the team but did not conduct external content validity. At the end of each passage (still within the PowerPoint on the computer), five slides contained content-specific listening comprehension questions with corresponding picture-supported response options. The adapted text and listening comprehension questions consisted of three story elements (i.e., main idea, subject, and details). The questions had four possible response options with words and picture symbols (including “I don’t know”) available with voice output on the iPad. Each adapted text used the same format: (a) who or what constituted the topic, (b) main idea, and (c) relevant or interesting details. The researchers created the texts using PowerPoint software, which allowed for electronic delivery (matching the participant’s classroom presentation of informational texts) and reduced the resources necessary to implement the intervention.

ECBs

Each ECB contained a series of graphic organizers displayed on an iPad using the GoTalk Now application. The researchers designed a template for creating each ECB to support communication through vocabulary sequencing and predictably associated vocabulary (Porter & Cafiero, 2009), such that each ECB provided consistent ease of use, reliability, availability of support, student-appropriate output voice (match in tone, style, and dependent on student preference whenever possible), time to generate a message, and role for the communication partner (Baxter, Enderby, Evans, & Judge, 2012). They designed these page sets to support a content-specific activity, while providing access to a limited amount of additional communication designed for individual expression (e.g., “I’m finished.”) through navigation, personalization, and generalization (see Figure 1). The researchers included options (e.g., “Let me talk about something different.”) to express outside those topics without redirection.

Figure 1.

Sample electronic communication book pages, in order of the book sequence starting with the top left.

Settings

Text listening comprehension instruction took place in a small school conference room, while the classroom teacher taught the whole class a similar group literacy read-aloud lesson using similar materials. Immediately following the one-on-one listening comprehension instruction, the participants took part in a conversation role play with the interventionist in the same setting. Generalization took place with communication partners in the students’ regular inclusive art class (i.e., beginner’s art or ceramics), where the researchers collected data during natural conversation opportunities.

Research Design

The researchers implemented a multiple probe across participants design (Gast, Lloyd, & Ledford, 2018) to assess the effectiveness of the intervention package. Following baseline condition, each participant entered intervention in a time-lagged fashion as the previous participant established an accelerating trend for a minimum of three sessions. Upon meeting mastery for both dependent variables (see specific criteria under Dependent Variables and Data Collection), each participant moved into maintenance condition until the last participant participated in one maintenance probe session. The structure of intervention and measurement components are outlined in Table 1.

Table 1.

Overview of Session Structure With Associated Materials.

Intervention Session	Procedure	Materials
Listening comprehension to conversational turn-taking (during typical literacy instructional time)	Introduce text topic conversationally	Data collection sheet used throughout (including semiscripted conversation steps)
	Adapted text read aloud	Computer-delivered adapted text
	Read aloud of text-supported listening comprehension questions Collect data on Dependent Variable 1: independent correct comprehension responses	Multiple-choice, picture-supported comprehension question pages (final pages of adapted text) Data collection sheet prompting hierarchy (used for Intervention phase)
	Enter correct comprehension question responses and participant opinions into ECB	ECB: iPad, GoTalk Now app, preprogramed communication pages (i.e., electronic graphic organizers for a) introduction of the topic, personalized topic-specific entries based on responses to comprehension questions
	Collect data on Dependent Variable 2: role-play conversation with interventionist	ECB: iPad, Go Talk Now app, preprogrammed communication pages (complete with participant opinions, responses, and text-to-life connections)
Conversational turn-taking generalization (during naturally occurring conversational time before and after inclusive classes)	Conversation with a peer Collect data on generalization of Dependent Variable 2: communicative turn-taking	iPad for participant use Semistructured script support for peer use (consistent across all phases)

Note. ECB = electronic communication book.

Dependent Variables and Data Collection

The study had two main, concurrent, dependent variables: (a) listening comprehension of the adapted text and (b) conversational turn-taking with the ECB. The researchers also collected data on alternative forms of conversational turns. The researchers set mastery criterion at 9/10 independent correct responses for listening comprehension as well as 12/14 appropriate conversational turns using the ECB and maintained for at least two of the five consecutive sessions.

Listening comprehension

The researchers measured independent correct responses to listening comprehension questions as part of an intervention package. After reading the adapted text aloud from a computer, the interventionist read each question aloud and waited 5 s for a response. The interventionist scored responses during intervention as independent correct (+) or incorrect (−), also indicating the necessary prompt level. She encouraged each student to turn the pages of the adapted text during the read aloud, and, if the student initiated text referencing to answer a question, she read aloud the selected page a second time. The interventionist used a total of two informational texts per session, each with 5 listening comprehension questions, for a total of 10 questions per session.

Conversational turns

The researchers collected data on a second dependent variable of appropriate conversational turns made with the same conversational supports in place across conditions. They defined an appropriate turn as any complete expressed thought often represented by a short series of programed locations on the voice output AAC device (e.g., “I thought that” [location 1] + Lincoln’s false teeth were gross” [location 2]) that added to the discussion. Conversational role play took place following the creation of the ECBs at the end of listening comprehension sessions. Data collection included recording all communicative turns during each conversation (i.e., use of ECB or speech). The researchers scored responses as “I” for independent communication with the ECB, “a+” for appropriate independent responses using an alternative form of communication, “a−” for inappropriate responses using an alternative form of communication, or “−” for prompted or no responses (with prompt levels recorded during intervention only). Within each session, researchers collected data on two topics of conversation, with additional turns taken on further topics noted anecdotally. Finally, they collected anecdotal data on communication turns that occurred outside of formal sessions.

Independent Variable Methods

The intervention package included (a) adapted, high-interest, informational texts; (b) the SLP procedure; (c) activity-specific communication response boards relevant to the listening comprehension questions for each adapted text; and (d) ECBs. The adapted text and listening comprehension questions appeared at the end of the PowerPoint presentation for each adapted book; the interventionist verbally presented these to the student. Using a semistructured listening comprehension intervention script (available on request), the interventionist guided each participant through intervention for listening comprehension and communication role play.

Peer communication partner orientation

Prior to baseline data collection, the interventionist provided peer communication partners with a 10-min orientation session adapted from Shire and Jones (2015). She encouraged peers to interact in ways that mirrored typical peer interactions to facilitate generalization. Orientation included instruction on the script and materials, discussion of participant-directed conversation, and role play with script support that specifically addressed communication with students with ASD in high school settings (CSESA; Butler & Dykstra, 2014a, 2014b). The interventionist explained her role, so communication partners knew she was available to provide support and answer questions prior to and following their conversations with the students instead of during the exchanges.

General procedures

Each text listening comprehension session across conditions consisted of four activities: (a) selecting and hearing a high-interest adapted informational text read aloud by the interventionist from a computer, (b) answering listening comprehension questions read aloud by the interventionist from a computer (i.e., What was this story about? What was the main idea? What was one detail from the story? What was another detail from the story? What did you like about this book?) using the response board, (c) entering correct answers to listening comprehension questions into an ECB, and (d) role-playing a leisure conversation using the ECB with the interventionist. During a separate session to assess generalization, each student had leisure time with a peer communication partner to discuss topics of choice supported by the ECB. The interventionist encouraged on-task behavior (e.g., positive comments on behavior).

Baseline condition

Baseline sessions for each student took place for a minimum of five sessions or until data were stable. Baseline consisted of the following components: (a) two computer-delivered adapted text read alouds per session, each followed by five comprehension questions and a communication response board, (b) discussion with the interventionist using a story-specific ECB on the iPad using GoTalk software, and (c) generalization discussion sessions using the same ECBs with peers during leisure time.

Listening comprehension

The interventionist began baseline sessions by introducing possible topics for informational text listening comprehension instruction. She asked the participant to choose one of the three novel topics and to listen as she read the selected text aloud, as it was presented electronically on the computer. The interventionist then asked five listening comprehension questions per text (total of 10 questions per session across two adapted texts) following the listening comprehension intervention steps listed on the data collection sheet, with freedom to add statements to improve conversational flow (e.g., “I think you might like this next story; it’s about baseball.”). She asked listening comprehension questions without providing prompting, feedback, or error correction.

ECB

After the student answered listening comprehension questions in baseline condition, the interventionist introduced the ECB by saying “Let’s put what you said into your communication book.” She provided the iPad with the ECB, and the student entered the correct answer independently, entered the correct answers with help, or watched the interventionist model for the input of the correct answers (e.g., “I read about a space station.”). When a student did not respond with an appropriate “I think” response, the interventionist modeled the input of a true statement from the story. When ECB pages were completed, the interventionist initiated a conversation on the topic, saying “Let’s talk about what we read today.”

Communication with interventionist

During baseline condition, the students with ASD had 14 opportunities to take conversational turns supported by the ECB during role play with the interventionist following each listening comprehension session. The interventionist followed a communication script with general response cues to promote responding without providing additional feedback or error correction in the following manner. If the student failed to respond after 5 s, the interventionist cued the student by repeating their previous conversational turn. If the student failed to respond after 5 s, the interventionist/peer either modeled an appropriate comment with the iPad (advancing page on iPad if necessary) or delivered a gestural cue (i.e., pointed to iPad) before taking their next communicative turn. Alternative communication responses by the students with ASD (i.e., verbal comments) were also recorded. Alternative communication was defined as communication without the support of the ECB when, either verbally or nonverbally, communication occurred without the ECB being used as a VOD, reference, or guide, even if the topics of conversation included content from the ECB.

Communication with peer communication partners

Following the introductory session, in which peers followed each step of the semistructured conversation script with the training peer, they participated in communication generalization sessions with the target participants. In separate weekly sessions during naturally occurring inclusive opportunities with peer communication partners, the students with ASD had the opportunity to talk about leisure topics supported by their ECBs using the same role-play procedures. If a student made a comment with or without the ECB, the interventionist encouraged the peer to respond as if to a peer without a disability using the communication script as a guide for the type and number of responses to provide.

Intervention

Intervention consisted of the following components: (a) two computer-delivered adapted text read alouds per session, each followed by five comprehension questions and a communication response board, (b) SLP procedure for response prompting, (c) discussion with the interventionist using a story-specific ECB on the iPad using GoTalk software, and (d) generalization discussion sessions using the same ECBs with peers during leisure time.

Teaching text-based listening comprehension

Intervention sessions for teaching text listening comprehension took place in a one-on-one format in which the interventionist read an adapted informational text and asked the student to answer listening comprehension questions. The interventionist discussed text options before providing a choice to the student. Using a laptop computer, the student chose a text that the interventionist read aloud as slides progressed through the text PowerPoint file.

The intervention procedure reflected the same procedure as in baseline condition with only one difference: The interventionist used an SLP procedure (based on that used by Mims, Hudson, & Browder, 2012) to prompt correct responses to all the listening comprehension questions as follows. The interventionist read the first listening comprehension question and waited 5 s for a response. If the student provided a correct response, the interventionist provided verbal praise and continued to the next question. If the student failed to provide a correct response within 5 s, the interventionist provided a verbal prompt (i.e., said “listen again” and read relevant paragraph). If the student again failed to provide a correct response within 5 s, the interventionist delivered a more intrusive verbal prompt (i.e., said “listen again” and read relevant sentence). If the student still failed to provide a correct response within 5 s, the interventionist delivered an even more intrusive verbal prompt (i.e., said “listen again” and reread relevant words and/or phrase). Finally, if the student still failed to provide a correct response within 5 s, the interventionist delivered a verbal model prompt (i.e., said “say [relevant word/phrase],” modeling correct response) with a visual model, if necessary. The interventionist then proceeded to create the ECB with the student followed by the communication role play. The communication session with peer communication partners also continued as in baseline condition.

Maintenance

Students entered maintenance condition once they met mastery criteria for both dependent variables (i.e., listening comprehension and communication) or after completing at least five data points in intervention (a variation necessary for Raj and Boston as opportunities for sessions became limited by the impending end of the school year), at which point the interventionist conducted probe sessions at least once every eight sessions across all students. She conducted maintenance sessions using the same methods as intervention sessions. Data collection continued until all students participated in at least one maintenance probe session.

Reliability

Interobserver agreement (IOA)

An observer collected interobserver data for 36.9% of experimental sessions across baseline, intervention, and generalization conditions. The researchers calculated IOA by dividing the number of agreements by the number of agreements plus disagreements and multiplying by 100 (Kazdin, 1982). Mean IOA across participants in baseline and intervention conditions was 91.5% (range = 82.6–100%). The observer collected IOA for Martin for 40% of sessions in baseline condition and 42.8% of sessions in intervention. IOA in baseline condition was 100% for listening comprehension and 80.9% (range = 80–81.8%) for communication. His intervention IOA averaged 93.3% (range = 80–100%) for listening comprehension and 84.9% (range = 70–100%) for communication. The observer collected IOA for Raj in 37.5% of baseline sessions and 28.5% of intervention sessions. IOA in baseline condition averaged 96.6% (range = 90–100%) for listening comprehension and 87.5% (range = 83.3–100%) for communication. His intervention IOA was 100% for listening comprehension and averaged 90.8% (range = 62.5–100%) for communication. The observer collected IOA for Boston in 30.7% of baseline sessions and 42% of intervention sessions. IOA for baseline condition averaged 97.5% (range = 90–100%) for listening comprehension and 85.75% (range = 75–100%) for communication. His intervention IOA was 90% (range = 70–100%) for listening comprehension and 90.4% (range = 85.7–100%) for communication. Low IOA numbers for communication data across participants prompted observer retraining (i.e., revisiting the criteria for appropriate communicative turns and evaluating conversation samples until agreement reached 100%).

Procedural fidelity

To establish procedural fidelity, an observer collected data on adherence to procedures and a script checklist for 36.9% of sessions across baseline and intervention conditions across students. The researchers calculated procedural fidelity by dividing the number of correctly implemented steps by the total number of planned steps then multiplying by 100 (Billingsley, White, & Munson, 1980). Mean procedural fidelity across students and conditions was 99.7% (range = 96.2–100%). The observer collected fidelity data for Martin for 40% of baseline sessions and 42.8% of intervention sessions. In baseline condition, listening comprehension fidelity was 100% and communication fidelity was 96.2% (range = 93.3–100%). During intervention, listening comprehension and communication fidelity were 100%. The observer collected fidelity data for Raj for 37.5% of baseline sessions and 28.5% of intervention sessions and collected fidelity data for Boston for 30.7% of baseline sessions and 42% of intervention sessions. Fidelity agreement for both Raj and Boston was 100% across baseline and intervention conditions. For one session across students, fidelity agreement with peers was 100%.

Social Validity

Following intervention, the interventionist collected data through informal conversations with target students, peers, the special education teacher, and the special education paraprofessionals to determine the social validity of the intervention across listening comprehension and communication. For example, the interventionist asked the teacher for her general impression of the study’s methods, results, and impact.

Results

Graphic displays for each target student are shown in Figures 2 and 3 (correct response to listening comprehension questions and communicative turns, respectively). As shown, the researchers collected data on the number of independent correct responses to 10 listening comprehension questions per session and the total number of communication turns students took using the ECB across a minimum of 14 opportunities (see alternative turns in Table 2).

Figure 2.

Graphed computer-aided, text-based listening comprehension data across participants.

Figure 3.

Graphed communication data across participants. Shading indicates mastery.

Table 2.

Alternative Communication Responses (Verbalizations or Gestures) Across Participants.

Participants	Mean	Range
Martin
Baseline	2	0–5
Intervention	3.56	0–6
Raj
Baseline	2.6	1–4
Intervention	6.45	3–19
Boston
Baseline	0.88	0–2
Intervention	4.23	1–10

Note. All communicative acts that were relevant to the conversation, even a change in discussion topic, were recorded for all augmentative and alternative communication (AAC) use, verbalizations, and gestures. This covered the full range of communicative acts for the participants in this study. Any communicative act not using AAC device for voice output is reported here as an “alternative communication response.” One example of a communicative act by a participant that was not recorded in the data was an instance wherein a participant repeated a line from a favorite movie at the beginning of the conversation as a continuation of an established self-stimulatory behavior.

Intervention Data Across Students

Across all three participants with ASD, the intervention package was associated with a therapeutic effect (concurrent functional relations) for both listening comprehension and communicative turn-taking. Data indicated an immediate change in level from baseline to intervention conditions and an increasing trend during intervention. While data showed some variability, there was minimal overlap between baseline and intervention conditions. All participants reached criterion level for both listening comprehension and communication, with Martin only meeting mastery criteria in 2/5 sessions due to the end of the school year.

Martin

Baseline data for Martin were initially high for both listening comprehension (mean = 5.6/10 correct responses, range = 4–7 correct responses with decreasing trend) and communication (mean = 9.4 turns, range = 8–11 turns). During listening comprehension sessions, Martin demonstrated an immediate increase in level and an increasing trend with only one overlapping data point, meeting criterion (i.e., 9/10 correct responses) in the second and third sessions and maintaining at criterion level during 3/3 sessions. During communication sessions, Martin met criterion (i.e., 12/14 turns) during the third and sixth sessions, then maintained at criterion level for three additional sessions.

Raj

Raj demonstrated a low level of listening comprehension (mean = 2.2/10 correct responses) and a moderate level of communication (mean = 2.8 turns, range = 1–7 turns with decreasing trend) during baseline condition. During intervention, data for Raj showed no overlapping data points during listening comprehension intervention and an immediate change in level. When Raj failed to show additional progress after seven sessions, the interventionist changed the order in which she read the answer choices aloud. Following this change, Raj’s data showed an increasing trend and reached criterion level of 9/10 correct responses, which he also demonstrated in his only maintenance session. As in listening comprehension intervention, Raj’s communication data showed immediacy of effect with only one overlapping data point and an increasing trend. He met criterion (i.e., 12/14 turns) during the fifth session, with 10/12 turns during his maintenance session.

Boston

During baseline condition, Boston demonstrated some variability in both listening comprehension (mean = 3.2 correct responses, range = 1–5 correct responses) and communication (mean = 4.2 turns, range = 3–5 turns). During listening comprehensions intervention, Boston’s data showed an immediate change in level and an increasing trend with no overlapping data points. Boston reached criterion level (i.e., 9/10 correct responses) during the sixth session but failed to meet mastery before the conclusion of the study. Despite this, his single data point during maintenance was high (8/10 correct responses). During the communication data collection, Boston’s data showed an immediate change in level with no overlapping data points and an increasing trend. He reached criterion of 12/14 in the second session, and his data stabilized with little variability, with his highest data point during his maintenance session.

Generalization

Generalization probe sessions for communication with peers across baseline, intervention, and maintenance conditions can be found in Figure 3. All three participants took some communicative turns during baseline condition (i.e., Martin = 8 turns during one session, Raj = mean of 3.5 turns across two sessions, Boston = mean of 6 turns across four sessions). Intermittent probe data show that Martin, Raj, and Boston all met criterion on taking turns during intervention (i.e., two sessions for Martin, three sessions for Raj, and one session for Boston). During maintenance, Martin met criterion of 12 turns in 2/4 sessions (mean = 9.3, range = 1–13), while Raj and Boston met criterion during single sessions with a minimum of 14 turns each.

Social Validity Data

During an informal interview, the special education teacher confirmed that Martin was communicating more appropriately with his peers, while both Raj and Boston were initiating appropriate conversation more willingly and extending their communicative exchanges. The special education teacher also requested copies of the adapted informational texts, so she could expand the use of the intervention to other students and in subsequent school years. In addition, the participants both with and without disabilities expressed a desire to participate in the intervention and have conversations with each other.

Discussion

Research and Practice Implications

Findings from the current study show that students with ASD can demonstrate text listening comprehension given a systematic instructional intervention package that included adapted, age- and grade-appropriate, high-interest, computer-assisted informational text read alouds with an SLP procedure. The students simultaneously demonstrated increased communication outcomes using an ECB presented on an iPad. They generalized communication from the interventionist to leisure conversations with general education peers in naturally occurring inclusive contexts. Due to the simultaneous nature of an increase in text listening comprehension and communication for the students and the fact that baseline condition with peer support arrangements and technology already in place controlled for the novelty of the intervention, the results imply a relationship between text listening comprehension gains and communication gains in this study. These findings represent the first demonstration of cross-modal generalization between listening comprehension instruction and AAC communication of the same content, building on findings for generalization technologies (Stokes & Baer, 1977) and from the applied behavior analysis literature (e.g., Guess & Baer, 1973; Wynn & Smith, 2003).

This study built on the findings from Mims et al. (2012) in using a text read-aloud strategy, graphic organizers, and systematic instruction to provide students with severe ASD access to age- and grade-appropriate text-based listening comprehension. In contrast to their methods, the current study modeled the text-referencing strategy without explicitly teaching it. Future replications might emphasize more autonomous student learning strategies. The current study also included high school students and used inclusive settings for generalization. These findings also support the use of iPads, adapted graphic organizers, computer-based adapted texts, and high-interest content in searching for effective listening comprehension teaching practices for this population. In addition to listening comprehension, this study provides implications for teaching social skills to students with ASD. The findings here support the use of peer arrangements in generalizing intervention effects and in using naturally occurring social opportunities (Carter & Hughes, 2005, Kemp-Inman, 2016).

Throughout the study, the interventionist kept notes on student performance for any anomalies or deviations from the norm for each participant. While Martin’s data showed that he already engaged in a high level of off-topic or self-talk communication turns with his peers (which were not counted in the data toward communicative turns for the conversation), the interventionist noted that Martin had more appropriate and relevant turns with his peers during intervention. An outlier occurred in Session 15 when Martin asked for and received a hug from his peer, after which Martin appeared to be overstimulated and unable to interrupt self-stimulatory behavior to continue the conversation. While Raj was vocal during baseline condition, he typically vocalized off-topic turns that were not counted toward his independent correct communication responses. Although intervention showed an initial effect on Raj’s listening comprehension, his growth stalled at 4/5 correct responses for seven sessions. The interventionist noted that he tended to respond to all response choices except the last one whenever the correct answer was not apparent to him, so she began reading the response options in a new order (consistently read 1-2-4-3, as opposed to the previous order of 1-2-3-4). This change seemed to interrupt Raj’s response pattern, and data showed an increase toward mastery criterion of 8/10 correct listening comprehension responses. In Raj’s final maintenance conversation, he communicated with the ECB 10 times and with his voice 19 times for a total of 29 communicative turns (more than double the level of mastery for this study). This data point reflects a shift in communicative behavior for this student and a generalization of the skills attained with augmentative communication support and toward unsupported communication. Boston’s data were less variable when compared with other participants, reflecting his observed tendency toward communicating in strict patterns (e.g., repeating the same conversational comments from session to session with little variation).

Limitations

While a functional relation was established for both dependent variables, there are some limitations to consider. First, the text-based listening comprehension instruction could not be taught in isolation from other reading instruction. While all participants were receiving the same literacy instruction delivered by the same teacher and in the same way, there is a possibility that history could have affected participant growth in this case; however, due to the immediacy of effect for all three participants, history is an unlikely mediating factor. Due to the inclusion of picture supports on the response boards for the AAC user participants in this study, another concern was the potential for faulty stimulus control with students matching pictures as opposed to responding to the comprehension question. Anecdotal data on communicative turns, however, indicated that no student was consistently relying on the juxtaposition of the pictures presented by referencing the text in the first prompt to get a correct answer.

The concurrent growth between the computer-aided listening comprehension intervention and the communication growth or these participants should be viewed with caution. Due to the variable nature of their social behavior data, all participants demonstrated growth in communication without strong stability. The influence of the novel peer support arrangements also must be considered. While experimental control was demonstrated for this variable, both baseline and intervention procedures were likely influenced by the communication peer orientation shifting the general education student’s focus to the participants, eliminating competing focus on other variables (e.g., preparing or packing up for class, talking with other peers or with the teacher), and creating a possible cumulative effect. Further inquiry is needed to reaffirm the relationship between text-based listening comprehension and communication. Researchers may try using preexisting and established peer support relationships as an inclusion criterion for participants. In addition, because coaching kept peers consistently responding to students across the study, it is possible that participating peers could have increased their fidelity over the course of the study, resulting in slow improvements in communicative turns taken by the students with ASD. Any potential growth, however, would not account for the immediacy of effect noted in the data, which indicates a functional relation was present between the intervention and the communicative turn-taking dependent variable.

Subsequent inquiry should address the generalizability of these results. This could be accomplished using a larger number of participants or using participants with a different set of demographic makeup (including students representing other disability categories, ages, and grades). The generalizability of this study also was affected by the time- and labor-intensive interventionist-developed materials. This intervention involved identifying high-interest, web-based texts, adapting those texts, creating book-specific communication boards, and programing the iPad GoTalk Now software with book-specific responses. Subsequent studies could use resources that are both readily available and easily adaptable for classroom teachers.

Adding to the recommendations for research examining text comprehension for students with ASD outlined by Snyder, Ayres, Sartini, Knight, and Mims (2017), the use of symbols to teach students who use AAC requires not only the use of multiple plausible answers but also near examples that use other pictures or symbols from the symbol/picture-supported adapted texts. The current study used this strategy to insulate the experimental results from faulty stimulus control for picture matching. Research of this type could remove symbols from the text-based read aloud such that symbols are present in either the adapted texts or the response boards, depending on student needs.

The methods of this study also revealed limitations. While the overall interobserver reliability was within an acceptable range, several individual instances of communication data collection fell far below the acceptable standard triggering retraining. Due to live data collection with videotaping only being permissible with some participants, the fast pace of exchanges between communication partners, the difficulty with inconsistently comprehensible utterances from participants, and the competing noise from the school environment increased the difficulty of accurate and reliable data collection on the appropriate number of turns taken. Future studies collecting communicative turn-taking data in inclusive settings with this population should consider expanding video permissions to all present students and staff.

Summary

While previous inquiry has provided evidence of the effectiveness of the strategies included in the intervention package within their relative disciplines, this study is the first to examine tertiary outcomes for the SLP strategy being designed to increase listening comprehension. The results of this study suggest that cross-modal generalization may be more consistent than previously demonstrated (e.g., Bloom, 1974), and future inquiry into the use of alternative language communication environments can include academic aspects in addition to social aspects. Overall, this study presents evidence that the design of listening comprehension interventions should be considerate of the target student’s communication goals, as this integration is fundamental for the language learning of students who rely on AAC. Moreover, this study provides an example of precisely how students with ASD and significant cognitive disability can reap the multifaceted benefits of intensive academic instruction.

Footnotes

Authors' Note

This study was conducted as an extension of the grant for the Center on Secondary Education for Students with Autism Spectrum Disorder in partnership with the University of North Carolina at Chapel Hill Frank Porter Graham Child Development Institute, the University of Wisconsin-Madison Waisman Center, the Vanderbilt University Kennedy Center, the University of Texas, Austin, San Diego State University, and the CSESA advisory board.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This research was funded by the CSESA grant (No. 13-2002).

References

Baxter

Enderby

Evans

Judge

(2012). Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: A systematic review and qualitative synthesis. International Journal of Language and Communication Disorders, 47, 115–129.

Billingsley

White

O. R.

Munson

(1980). Procedural reliability: A rationale and example. Behavioral Assessment, 2, 229–241.

Bloom

(1974). Talking, understanding, and thinking: Developmental relationship between receptive and expressive language. In Schiefelbusch

Lloyd

(Eds.), Language perspectives: Acquisition, retardation and intervention (pp. 285–311). Baltimore MD: University Park Press.

Browder

D. M.

Trela

K. C.

Jimenez

B. A.

(2007). Training teachers to follow a task analysis to engage middle school students with moderate and severe developmental disabilities in grade-appropriate literature. Focus on Autism and Other Developmental Disabilities, 22, 206–219.

Browder

D. M.

Root

J. R.

Wood

Allison

. (2015). Effects of a story-mapping procedure using the iPad on the comprehension of narrative texts by students with autism spectrum disorder. Focus on Autism and Other Developmental Disabilities. doi:10.1177/1088357615611387

Browder

D. M.

Wakeman

S. Y.

Spooner

Ahlgrim-Delzell

Algozzine

(2006). Research on reading instruction for individuals with significant cognitive disabilities. Exceptional Children, 72, 392–408.

Butler

Dykstra

(2014a, February). Supporting communication in high school (Autism at-a-Glance Brief). Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, CSESA Development Team.

Butler

Dykstra

(2014b, February). Supporting functional communication in high school (Autism at-a-Glance Brief). Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, CSESA Development Team.

Carter

E. W.

(2018). Supporting the social lives of secondary students with severe disabilities: Considerations for effective intervention. Journal of Emotional and Behavioral Disorders, 26, 52–61. doi:10.1177/1063426617739253

10.

Carter

E. W.

Hughes

(2005). Increasing social interaction among adolescents with intellectual disabilities and their general education peers: Effective interventions. Research & Practice for Persons With Severe Disabilities, 30, 179–193.

11.

Chiang

H. M.

Lin

Y. H.

(2007). Reading comprehension instruction for students with autism spectrum disorders: A review of the literature. Focus on Autism and Other Developmental Disabilities, 22, 259–267.

12.

Collins

B. C.

Hall

Branson

T. A.

(1997). Teaching leisure skills to adolescents with moderate disabilities. Exceptional Children, 63, 499–512. doi:10.1177/001440299706300405

13.

Collins

B. C.

Karl

Riggs

Galloway

C. C.

Hager

K. D.

(2010). Teaching core content with real-life applications to secondary students with moderate and severe disabilities. Teaching Exceptional Children, 43, 52–59.

14.

Fetko

E. E.

Collins

B. C.

Hager

K. D.

Schuster

J. W.

Spriggs

(2013). Using peer tutors and a simultaneous prompting procedure to teach a leisure skill to students with disabilities. Education and Training in Autism and Developmental Disabilities, 48, 400–411.

15.

Finnegan

Mazin

A. L.

(2016). Strategies for increasing reading comprehension skills in students with autism spectrum disorder: A review of the literature. Education and Treatment of Children, 39, 187–219.

16.

Gast

D. L.

Lloyd

B. P.

Ledford

J. R.

(2018). Multiple baseline and multiple probe designs. In Gast

D. L.

(Ed.), Single case research methodology (pp. 239–281). New York, NY: Routledge.

17.

Guess

Baer

D. M.

(1973). An analysis of individual differences in generalization between receptive and productive language in retarded children. Journal of Applied Behavior Analysis, 6, 311–329.

18.

Holyfield

Drager

K. R.

Kremkow

J. D.

Light

(2017). Systematic review of AAC intervention research for adolescents and adults with autism spectrum disorder. Augmentative and Alternative Communication, 33, 201–212. doi:10.1080/07434618.2017.1370495

19.

Hughes

Golas

Cosgriff

Brigham

Edwards

Cashen

(2011). Effects of a social skills intervention among high school students with intellectual disabilities and autism and their general peers. Research & Practice for Persons With Severe Disabilities, 36, 46–61.

20.

Kazdin

A. E.

(1982). Single-case research designs: Methods for clinical and applied settings. New York, NY: Oxford University Press.

21.

Kemp-Inman

(2016). The effects of systematic and explicit instruction with shared stories on comprehension and generalization of responding during book club for students with severe disabilities (Doctoral dissertation). The University of North Carolina at Charlotte.

22.

Kleinert

Towles-Reeves

Quenemoen

Thurlow

Fluegge

Weseman

Kerbel

(2015). Where students with the most significant cognitive disabilities are taught: Implications for general curriculum access. Exceptional Children, 81, 312–328. doi:10.1177/0014402914563697

23.

Knight

V. F.

Sartini

(2015). A comprehensive literature review of comprehension strategies in core content areas for students with autism spectrum disorder. Journal of autism and developmental disorders, 45, 1213–1229.

24.

Langenberg

D. N.

Correro

Ehri

Ferguson

Garza

Kamil

M. L.

… Yatvin

(2000). Report of the National Reading Panel: Teacher education and reading instruction: Reports of the subgroups. Bethesda, MC: National Institute of Child Health and Human Development, National Institutes of Health. Retrieved from https://www.nichd.nih.gov/publications/pubs/nrp/Documents/report.pdf

25.

Mastropieri

M. A.

Scruggs

T. E.

(1997). Best practices in promoting reading comprehension in students with learning disabilities: 1976 to 1996. Remedial and Special Education, 18, 197–213.

26.

McCurdy

E. E.

Cole

C. L.

(2014). Use of peer support intervention for promoting academic engagement of students with autism in general education settings. Journal of Autism and Developmental Disabilities, 44, 883–893.

27.

Mims

P. J.

Hudson

M. E.

Browder

D. M.

(2012). Using read-alouds of grade-level biographies and systematic prompting to promote comprehension for students with moderate to severe developmental disabilities. Focus on Autism and Other Developmental Disabilities, 27, 67–80. doi:10.1177/1088357612446859

28.

Mirenda

(2001). Autism, augmentative communication and assistive technology: What do we really know? Focus On Autism and Other Developmental Disabilities, 16, 141–151. doi:10.1177/1525740114558254

29.

Morin

K. L.

Ganz

J. B.

Gregori

E. V.

Foster

M. J.

Gerow

S. L.

Genç-Tosun

Hong

E. R.

(2018). A systematic quality review of high-tech AAC interventions as an evidence-based practice. Augmentative and Alternative Communication, 34, 104–117.

30.

Porter

Cafiero

J. M.

(2009). Pragmatic organization dynamic display (PODD) communication books: A promising practice for individuals with autism spectrum disorders. Perspectives on Augmentative and Alternative Communication, 18, 121–129. doi:10.1044/aac18.4.121

31.

Reutebuch

C. K.

El Zein

Kim

M. K.

Weinberg

A. N.

Vaughn

(2015). Investigating a reading comprehension intervention for high school students with autism spectrum disorder: A pilot study. Research in Autism Spectrum Disorders, 9, 96–111.

32.

Ruppar

A. L

. (2017). “Without being able to read, what’s literacy mean to them?”: Situated beliefs about literacy for students with significant disabilities. Teaching and Teacher Education, 67, 114–124.

33.

Shire

S. Y.

Jones

(2015). Communication partners supporting children with complex communication needs who use AAC: A systematic review. Communication Disorders Quarterly, 37, 3–15. doi:10.1177/1525740114558254

34.

Snell

M. S.

Chen

L. Y.

Hoover

(2006). Teaching augmentative and alternative communication to students with severe disabilities: A review of intervention research 1997–2003. Research and Practice for Persons With Severe Disabilities, 3, 203–214.

35.

Snyder

S. M.

Ayres

K. M.

Sartini

E. C.

Knight

V. F.

Mims

P. J.

(2017). Single case design elements in text comprehension research for students with developmental disabilities. Education and Training in Autism and Developmental Disabilities, 52, 405–421.

36.

Spooner

Kemp-Inman

Ahlgrim-Delzell

Wood

Ley Davis

(2015). Generalization of literacy skills through portable technology for students with severe disabilities. Research and Practice for Persons With Severe Disabilities, 40, 52–70.

37.

Stokes

T. F.

Baer

D. M.

(1977). An implicit technology of generalization. Journal of applied behavior analysis, 10, 349–367.

38.

Tager-Flusberg

Paul

Lord

(2005). Language and communication in autism. In Volkmar

F. R.

Klin

Paul

Cohen

D. J.

(Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 335–364). Hoboken, NJ: Wiley.

39.

Tekin-Iftar

Collins

B. C.

Spooner

Olcay-Gul

(2017). Teaching teachers to use systematic instruction to teach core content to students with ASD. Teacher Education and Special Education, 42, 225–245. doi:10.1177/0888406417703751

40.

Thiemann

K. S.

Goldstein

(2001). Social stories, written text cues, and video feedback: Effects on social communication of children with autism. Journal of Applied Behavior Analysis, 34, 425–446.

41.

Turnbull

H. R.

Turnbull

A. P.

Cooper

D. H.

(2018). The Supreme Court, Endrew, and the appropriate education of students with disabilities. Exceptional Children, 84, 124–140. doi:10.1177/0014402917734150

42.

Wood

Browder

D. M.

Flynn

(2015). Teaching students with intellectual disability to use a self-questioning strategy to comprehend social studies text for an inclusive setting. Research and Practice for Persons With Severe Disabilities, 40, 275–293.

43.

Wynn

J. W.

Smith

(2003). Generalization between receptive and expressive language in young children with autism. Behavioral Interventions, 18, 245–266.

44.

Zakas

Browder

D. M.

Ahlgrim-Delzell

Heafner

(2013). Teaching social studies content to students with autism using a graphic organizer intervention. Research in Autism Spectrum Disorders, 7, 1075–1086.