The Effects of a Picture Activity Schedule for Students With Intellectual Disability to Complete a Sequence of Tasks Following Verbal Directions

Abstract

We investigated instruction of independent creation of picture activity schedules (PASs) and how four middle school students with intellectual disability used them to complete tasks independently. A withdrawal design (A-BC-B-A-B) was used to evaluate whether the intervention had an effect on the dependent variable and to test for generalization to a community setting in a pre/post format. After instruction on the PAS, participants learned to self-manage a strategy that served as a reminder for the tasks they needed to complete. All participants exhibited increased abilities to complete a sequence of three or five tasks following verbal directions when using the PAS as compared with the conditions where no PAS was utilized. In addition, these results generalized to the community setting of a mall food court. Our findings have implications for enhancing the independent functioning of individuals with intellectual disability and reducing reliance on others, with the potential for greater levels of self-determination.

Keywords

intellectual disability middle school picture activity schedule independence

Promoting the independence of individuals with intellectual disability is the standard by which all special education teachers should design their instruction. Self-determination is a critical component of instruction leading to independence. Wehmeyer, Gragoudas, and Shogren (2006) described several interrelated components of self-determined behavior that include problem solving, self-regulation, and self-directed learning. When individuals are able to solve problems and use self-management strategies to regulate their behavior, they require fewer external supports. In addition, when they can exert greater control over their lives (i.e., live in a more self-determined way) and begin to direct their own actions, they have greater opportunities related to financial security, employment, and independent living (Wehmeyer & Palmer, 2003).

Whenever student instruction includes prompting of correct responses, the danger exists that the student will become dependent on those prompts. Furthermore, external prompts are normally provided by the teacher, parent, or other person (e.g., employer) working with individuals with disabilities to help them successfully perform required tasks. The goal of transferring stimulus control from prompts given by others to discriminative stimuli in the natural environment can be hindered when students become prompt dependent. To help students succeed and gain the independence that is required in inclusive school, community, and vocational settings, external supports need to be faded. An alternative to relying on, and then fading, external prompts and prompters is to decrease their use early in the instructional process. Reducing reliance on external prompts mediated by others will help individuals with intellectual disability become more self-directed and create more opportunities in their lives (Mechling & Gast, 1997).

Many individuals with intellectual disability have difficulty with memory. Beirne-Smith, Patton, and Kim (2006) reported the long-term memory for most persons with intellectual disability is typically an area of strength, whereas short-term memory is often found to be an area of weakness. In a sample of adolescents with intellectual disability, Van der Molen, Van Luit, Van der Molen, and Jongmans (2010) reported universal delays across memory measures. Such delays have a direct impact on educational achievement (Henry & Winfield, 2010). While working to help students improve their memory so they can be more independent in everyday tasks is important, teaching them strategies to compensate for these memory problems also may help them achieve greater independence and self-determination.

Most people require strategies and supports to complete tasks, remember appointments, and recall items needed at the store. People keep written lists, personal calendars, and digital applications on their smart phones. In terms of self-determination, being able to set goals and problem solve are key for individuals to exert greater autonomy (Wehmeyer & Schalock, 2001). For students with intellectual disability and autism, there have been several efforts aimed at teaching them to use visual supports to be more independent (e.g., Bryan & Gast, 2000; Copeland & Hughes, 2000), but there has yet to be a purposeful attempt to provide support systems to this population that they themselves manage. In most of the existing studies, researchers relied on teacher-created schedules that students look at and manipulate. While this is important, it does not provide students with a complete skill set for managing or regulating their own task completion, an essential behavior in terms of self-determination.

Krantz, MacDuff, and McClannahan (1993) used a multiple-baseline-across-participants design to evaluate the effects a picture activity schedule (PAS) had on the percentage of time students were on-task and on-schedule. Seeing improvements, the same group of authors systematically replicated the study using a delayed multiple-baseline design across three student-and-teacher-aide dyads to investigate whether the use of PAS would increase task engagement and whether this also would lead to a reduction in teacher prompting (Hall, McClannahan, & Krantz, 1995). Disruptive behavior was reduced as students became more engaged in their tasks; consequently, teacher prompting decreased in frequency. Bryan and Gast (2000) and Spriggs, Gast, and Ayres (2007) replicated Krantz et al. (1993) and witnessed similar improvements in on-task and on-schedule behavior by their participants. Using a similar model, Carson, Gast, and Ayres (2008) expanded the evidence base by evaluating the use of PAS in community job settings for high-school-aged students with intellectual disability. In all of these cases, students self-managed the prompts, but the prompts were created for them by others; they were not active participants in the creation or organization of the prompts. Providing individuals with opportunities to engage in the organizing and problem solving involved in planning a course of action is another component of self-determination that, if acquired, could potentially lead to improved outcomes when students transition out of schools. Considering the potential for promoting this level of independence, we attempted to answer the following research questions:

Research Question 1: What effect does a PAS, created by a student, have on their independent completion of a series of tasks?

Research Question 2: Once acquired, will the creation and use of the PAS generalize to other settings and tasks?

Method

Participants

The study was approved by the Institutional Review Boards at the authors’ university and the participating school system. Four students were selected for participation in this study based on the following criteria: (a) age range from 11 to 15 years; (b) cognitive level within the mild-moderate range of intellectual functioning; (c) within-average range of visual and auditory functioning (based on successfully passing school system’s vision and hearing screenings); (d) ability to independently complete tasks used in study without supervision; (e) goals in his or her Individualized Education Plan (IEP) that included skills emphasizing independence in the self-contained classroom, general education classroom, and community settings; (f) no prior training in independently setting up picture prompts as a self-management strategy for accurately completing multitask verbal directives; and (g) parental permission for participation. Three students in the same middle school classroom as the participants were excluded due to lack of prerequisite skills. The nonparticipating students received educational instruction from their paraprofessional when study sessions were conducted.

All students received special education services in a self-contained classroom with instruction focused on adapted curriculum in math, language arts/reading, and social studies, as well as functional and community skills. They all took part in two general education elective courses per semester (i.e., physical education and music) and participated, with some support, in other general education area content courses (described later).

Each participant had a history of using picture symbols to follow a daily activity schedule, task schedule (e.g., hygiene routine), and simple steps in a prevocational activity (e.g., sorting and assembly). In addition, picture symbols had been used previously to support comprehension of text in the literature (e.g., current event newspapers), the general curriculum, and the community (e.g., shopping lists and picture menus). It is important to note that participants’ prior histories with accessing picture symbol support had been teacher initiated and managed. See Table 1 for psychometric information on each participant.

Table 1.

Psychometric Description of Participants.

Participant	Age (years)/grade	Disability (primary/secondary)	Achievement measures	Adaptive behavior scales	Cognitive measures
Katie	13/7th	Other health impaired/mild intellectual disability	WJ-3: Reading: 60	VABS-2:	DAS-2: 70
				57
Hillary	13/6th	Autism/mild intellectual disability	WJ-3: 37–78	ABAS-2:	SB-5: 53
				61
Donovan	14/8th	Mild intellectual disability	WRAT-3: reading/spelling: first grade Arithmetic: third grade	VABS-2:	SB-5: 58
				65
Tristan	13/6th	Mild intellectual disability/orthopedic impairment	WIAT-2: 59–81	ABAS-2: 57	DAS-2: 67

Note: WJ-3 = Woodcock–Johnson–Third Edition (Woodcock, McGrew, & Mather, 2001), standard scores; VABS-2 = Vineland Adaptive Behavior Scales–Second Edition (Sparrow, Cicchetti, & Balla, 2005), composite standard score; DAS-2 = Differential Ability Scales–Second Edition (Elliot, 2007), composite standard score; ABAS-2 = Adaptive Behavior Assessment System–Second Edition (Harrison & Oakland, 2003), composite standard score; SB-5 = Stanford–Binet Intelligence Test–Fifth Edition (Roid, 2003), composite standard score; WRAT-3 = Wide Range Achievement Testing–Third Edition (Wilkinson, 1993), grade equivalent scores for reading, spelling, and arithmetic; WIAT-2 = Wechsler Individual AchievementTest–Second Edition (Wechsler, 2001), standard scores.

Katie

Katie was diagnosed with Angelman syndrome, which led to her eligibility of other health impaired for special education services. She participated in general education for inclusion science (adapted curriculum) with special education teacher support. Katie’s general education teachers modified her academic expectation in those classes and encouraged peer-helper support as well. Katie had relative strengths in computer skills and could complete simple PowerPoint projects. Katie had difficulty maintaining attention to task, usually requiring prompts throughout an activity or task. She took Adderall twice daily.

Hillary

Hillary did not require the support of a special education teacher or paraprofessional while in general education elective classes. She participated in a collaborative sixth-grade-science class in which her special education teacher provided her with the supports and modifications required for her to access the adapted-sixth-grade curriculum. The general education teachers made modifications needed for her to participate. Hillary required minimal guidance to navigate the school for her class changes. She completed relatively complex jobs at the school like getting the school mail from the outside mailbox and then making a delivery to front-office personnel using a self-managed task analysis. Hillary explored her favorite Internet sites with minimal assistance. Academically, her strengths included word recall, reading fluency, spelling, and using a calculator for simple math computation. Areas in need of continuing instruction included reading comprehension, solving simple word problems, counting mixed coin/bill amounts, paying with dollar plus, independently completing tasks, telling time, and interacting in a socially appropriate manner.

Donavon

Donavon participated in a collaborative eighth-grade-science class in which a special education paraprofessional provided the supports and modifications required to access the adapted-eighth-grade curriculum. He did not require the support of a special education teacher or paraprofessional while in general education elective classes. The general education teachers made the modifications needed for him to successfully participate and complete coursework. Academically, Donovan’s strengths included using a calculator for math computation, counting money, determining change back using whole-dollar amounts, telling time to the 1-min interval, and listening comprehension. His weaknesses included word recall, reading fluency, writing a sentence, and determining the correct operation for functional word problems.

Tristan

Tristan had a lower extremity orthopedic impairment that required him to use a wheelchair as his primary means of mobility. He participated in a collaborative sixth-grade-science class in which his special education teacher provided him with the supports and modifications required to access the adapted-sixth-grade curriculum. He did not require the support of a special education teacher or paraprofessional while in general education elective classes. The general education teachers made the modifications needed for him to successfully participate. Academically, Tristan’s strengths included word recall, reading fluency, math computation, telling time to the 1-min interval, counting bill/coin combinations, and listening comprehension. His weaknesses included reading comprehension, solving simple word problems in which the operation is not listed, rushing through assignments, writing skills, and self-management of hygiene skills.

Settings and Arrangements

Baseline, instructional, and intervention phases were conducted in the public middle school attended by all participants. The school was located in a suburban community of middle- to upper-middle-socioeconomic class in the state of Georgia. The study was conducted in the participants’ self-contained classroom, the hall immediately adjacent to the classroom, and the bathroom on this hallway. The bathroom was situated off the hallway and located 18 m from the entrance of the classroom. For the generalization phase, the study was conducted at the food court of a local mall in the suburban area. The food court area was approximately 36.5 m × 36.5 m. This location was selected because all participants regularly accessed this community setting during community-based instruction.

The baseline, instructional, and intervention sessions took place in a one-on-one format at the participants’ desks or at tables located in the classroom with the first author, who was the participants’ classroom teacher. Sessions began when the teacher placed the PAS materials in front of the participant. During the generalization phase, the teacher placed the PAS on a food court table directly in front of the seated participant.

Independent Variable

The PAS contained picture symbols obtained from Boardmaker® v.6 software. Boardmaker symbols, depicting tasks to be completed (e.g., erasing dry-erase board, washing hands, returning book to shelf), were mounted on index cards, cut into a 4-cm square, and laminated. Velcro buttons were affixed to the back of each square. A 15.2 cm × 30 cm piece of heavy card stock served as a base for the picture schedules. The card stock was divided vertically down the middle. The left half of the base was labeled tasks, and the right half was labeled to do. The base was laminated, and Velcro buttons were attached under each heading so that the 4-cm cards depicting student tasks could be mounted on either side. See Figure 1 for an example.

Figure 1.

Example of the student’s PAS for a school-based set of activities.

The teacher prepared the PAS by semirandomly placing five-to-eight pictures on the left side of the base card stock in a column titled “tasks.” These prompts included the pictures that corresponded to tasks that were to be assigned in the upcoming session. The PAS then was placed on the participant’s classroom desk. The session began when the teacher stated the participant’s name, waited for eye contact from the participant, and gave the verbal directions, “I need you to do a few things for me. Please do Task 1, (3 s wait), Task 2, (3 s wait), Task 3, (3 s wait), Task 4 (when applicable, 3 s wait), and Task 5 (when applicable).”

As participants moved through the sequence of tasks, the teacher provided noncontingent verbal praise such as “nice work” at two varying times during each session. This was provided regardless of correct or incorrect responses, or the level of prompting required for continued responding. As the participant was completing the final task, the teacher waited in the general location of the participant’s desk. The participant knew she or he would have the opportunity to select a preferred snack at the conclusion of each session.

Dependent Variable

The dependent measure was the percentage of tasks completed independently in the order verbally expressed by the teacher. During each session, the teacher verbally directed the student to complete a sequence of three (Katie and Hillary) or five (Donovan and Tristin) tasks. The decision of how many tasks to assign was based on participants’ ability and cognitive functioning. Participants’ responses on the following sequence of behaviors were scored by the teacher as independent or prompted: (a) Participant listens and moves the relevant pictures to the “to do” side of the PAS, while the teacher tells him or her three or five tasks to complete; (b) participant completes Task 1; (c) participant completes Task 2; (d) participant completes Task 3; (e) participant completes Task 4 (when applicable); (f) participant completes Task 5 (when applicable); and (g) participant obtains teacher’s attention to let her know the series of tasks was complete. A response was independent if it was initiated within 3 s of the teacher’s directions or completion of the previous step and completed within 10 s or within a reasonable duration for the task (some tasks such as brushing teeth and washing hands took longer to complete).

Reliability and Fidelity

Interobserver agreement (IOA) and procedural reliability data were collected at least once per condition per participant for a minimum of 29% of sessions per participant. The fourth author was trained as a second observer in data collection procedures and was situated to independently observe sessions. A point-by-point method agreement calculation was used to provide a measure of IOA. Mean IOA for the dependent measure across all conditions and participants was 96%.

For procedural fidelity, the second observer divided the number of procedural sttif correctly completed by the number of planned sttif and multiplied this by 100% to provide a percentage of procedural fidelity. The following sttif were used to evaluate procedural fidelity: (a) teacher states participant’s name; (b) teacher waits for eye contact; (c) teacher delivers verbal direction, “I want you to do a few things. Please ____ (assigns Task 1); (d) teacher waits 3 s; (e) teacher assigns Task 2; (f) teacher waits 3 s; (g) teacher assigns Task 3; (h) teacher waits 3 s; (i) if applicable, teacher assigns Task 4; (j) teacher waits 3 s; (k) if applicable, teacher assigns Task 5; (l) teacher is at location where task assignment was made so that the participant can check in and indicate series completion; (m) teacher provides two noncontingent verbal praise statement at varying times during the session; and (n) teacher provides an edible reinforcer at the conclusion of the session. Mean procedural reliability across all phases was 99% with a range of 86% to 100%. The single lower score of 86% was caused by the researcher providing one rather than two verbal praise statements.

General Procedures

Tasks

Prior to intervention, the teacher identified tasks each participant completed independently in school and community settings. Identifying independently performed tasks was important to this study to eliminate the effect that task instruction and acquisition would have on student independence. The teacher verified participants’ ability to independently read picture symbols associated with the target tasks and subsequently complete that depicted task. During this observational screening process, if task completion was scored as independent, but the participant could not make the correlation between picture symbol and task after a 3-s wait period, the teacher used the system of least prompts until the participant demonstrated independence with first reading the picture symbol and then completing its corresponding task. Participants choose a small edible reinforcer following each screening observation. The tasks that were used to create a task sequence each session appear in Table 2. This table also includes specific information regarding the locations in which the behavior occurred, and required materials.

Table 2.

Tasks Assigned During PAS Instruction, PAS, and No-PAS Conditions.

Tasks	Location	Materials
Giving a note from the teacher to another teacher on the hall	Classroom, hallway, adjacent classroom	Note
Washing hands	Classroom, hallway, bathroom	Water, hand soap
Putting a book on a book shelf	Classroom	Book
Sharpening a pencil	Classroom	Pencil, electric pencil, sharpener
Erasing words on a dry-erase board	Classroom	Wall-mounted dry-erase board, eraser
Pouring a drink from a container into a cup	Classroom	Cup, container with drink
Collecting papers from three desktops	Classroom	Paper
Getting a snack from a refrigerator or cabinet	Classroom	Student snack
Counting out US$5 using 1-dollar bills	Classroom	Instructional money
Writing name and date at the top of notebook paper	Classroom	Paper, pencil
Getting a tissue	Classroom	Facial tissue
Getting a free-time activity from cabinet	Classroom, hallway	Activity of choice (e.g., puzzle, cards)
Washing face	Classroom, hallway, bathroom	Water, soap, paper towels
Brushing teeth	Classroom, hallway, bathroom	Toothbrush, toothpaste, paper towels
Applying chap stick or lip gloss	Classroom, hallway (possibly)	Chap stick or lip gloss
Getting student agenda from book bag and handing it to teacher	Classroom, hallway	Agenda
Using a Clorox wipe to clean a table top	Classroom	Clorox wipe
Putting on deodorant	Classroom, hallway, bathroom	Deodorant
Changing the trash bag in a garbage pail	Classroom	Trash bag, garbage pail with full trash bag
Brushing or combing hair	Classroom, hallway, bathroom	Hair brush or comb

Sessions

Sessions occurred during the class period in which the participants received functional skill instruction. Each session lasted approximately 10 to 15 min and occurred 4 to 5 days per week. The number of total sessions ranged from 23 to 24 per student. No more than 3 sessions took place per day, and they were always separated by at least 10 min.

In all conditions, the teacher provided verbal directions from the list of tasks the participant was known to have mastered. No task sequence was repeated in any condition. The verbal directions in each session were limited to no more than two tasks that took the participant out of the classroom, so that the teacher’s time out of the classroom was minimized.

Experimental Design

A withdrawal design (Gast, 2010) was used to evaluate the relation between the PAS and completion of a series of 3 (Katie and Hillary) or 5 (Donovan and Tristin) tasks assigned verbally. This design evaluated experimental control by comparing the percentage of increase for independent completion of the tasks during the PAS (PAS¹) condition, the percentage of decrease during the No-PAS condition (No-PAS¹), and the percentage of increase again with the reintroduction of the PAS in the second PAS condition (PAS²). The researcher sequenced the conditions in the following order: (a) generalization pre-test, (b) No-PAS¹, (c) PAS instruction, (d) PAS¹, (e) No-PAS², (f) PAS², and (g) generalization post-test. This experimental design controlled for history threats to internal validity by using repeated measures and varying the number of sessions per condition to control cyclic variability. Short time frames for each condition and use of the withdrawal and reintroduction method controlled for maturation. Replication of the effect during the PAS conditions controlled for history and maturation threats to internal validity.

No-PAS baseline

The No-PAS¹ condition assessed independent task completion without the support of the PAS. The same sttif were followed as described in the general procedures to begin sessions. Once data were stable, each participant moved individually to the next condition. Participants were not provided any instructional feedback or prompting during No-PAS¹. If a student did not respond or stalled in responding for 10 s, he or she was asked, “Do the best you can.” If a student stopped responding for more than 10 s after the verbal prompt to do his or her best, the session ended.

PAS instruction procedure

The purpose of the PAS instruction phase was to teach participants how to self-manage the PAS as a support for completing tasks when verbally directed to do so. In front of the student, the teacher and paraprofessional modeled twice the procedures needed to implement use of the PAS, with the paraprofessional assuming the role of the student. The teacher taught the sttif for self-management of the PAS as follows: (a) The teacher stated, “I need you to do a few things. Please ______” and Task 1 is assigned; (b) participant moved the corresponding picture symbol to the “to do” column on the first Velcro dot, while teacher waited 3 s; (c) the teacher then assigned Task 2 and waited 3 s for the participant to move the corresponding picture symbol to the “to do” column; (d) the teacher then assigned Task 3 and waited 3 s as the participant moved the corresponding picture symbol to the “to do” column; (e) when applicable, the teacher assigned Tasks 4 and 5 in a similar manner; and (f) participants took the PAS with them as they completed tasks. The paraprofessional modeling use of the PAS demonstrated these sttif but did not go through completion of the assigned tasks. At the point in time when the tasks were to be initiated by the participant, the teacher stated, “When you are doing this, go on and complete the tasks you were asked to do. Once you are finished, you need to come back and tell me you are done.”

Following the two trials modeling the use of the PAS with the teacher and paraprofessional, the participants began to use the PAS. During this phase, the teacher responded to the participants using a system of least prompts (Wolery, Jones, & Doyle, 1992) to correct errors or nonresponses, giving each participant 3 s to respond to each of the sttif required to prepare the PAS for the series of tasks assigned. Participants did not receive prompts for any responses required to complete the actual tasks (as they had previously demonstrated independence on the tasks). Prompts used to set up the PAS or continue with the sequence were verbal or modeling, and each step was scored with the most intrusive prompt required to complete the step. Independent response completion was defined as performing the response without a prompt. A verbal prompt was defined as a verbal direction given to the student. A model was defined as a demonstration by the teacher that showed the participant how to complete the response step. The teacher faded prompts by modeling the PAS usage sequence for the initial two trials only and provided the least intrusive prompt as outlined in the system of least prompts procedure. Criterion to advance out of the training condition was 80% or higher performance across two to three consecutive sessions.

PAS procedure

The purpose of this condition was to evaluate the effect the PAS had on the participants’ ability to complete a sequence of verbal directions within the special education classroom and its immediate surroundings without adult assistance or guidance beyond the initial task instructions. The PAS served as the only support throughout this condition, and no verbal or modeling prompts were provided. Once a participant demonstrated 100% correct responses over three consecutive sessions, the teacher implemented the No-PAS² condition (requiring the student to complete the series of tasks without the PAS support). After three No-PAS² sessions, PAS² was implemented with the same criteria as PAS¹, prior to the generalization post-test.

Generalization Assessment Procedures

The generalization conditions assessed whether the students would generalize the use of the PAS to complete three (all students) tasks in a community setting (Table 3). The food court at the local mall served as the community location. Generalization conditions took place prior to the No-PAS¹ condition and following the PAS² condition. As in other conditions, the teacher gained the participant’s attention and provided the task directions (i.e., sequence of tasks). As the participant began to finish the final task, the teacher waited in the general location where the verbal directions had been given. The participant was taught during the instructional phase to return to the teacher and indicate the tasks were completed. The generalization pre- and posttest conditions took place over three sessions. During the generalization conditions, no prompts were provided. If needed, the teacher redirected any attempts by the participant to obtain information regarding the tasks by stating, “Do the best you can”; no other feedback was provided.

Table 3.

Tasks used in Generalization Pretest and Posttest Conditions: Food Court of Mall.

Tasks	Location	Materials
Getting napkin from a dispenser	Counter area of chosen food court establishment	Napkin dispenser and napkin
Throwing away trash	Chosen trash receptacle located at multiple various locations throughout the food court	Trash items from previously purchased food and or drink items
Washing hands	Bathroom adjacent to the food court	Water, soap, paper towels
Getting a drink refilled	Counter area of chosen food court establishment	Previously purchased drink cup that needs refilled
Getting plastic silverware	Counter area of chosen food court establishment	Plastic silverware
Pushing a chair under the table	Designated table and chair area within the food court	Table and chair

Results

Effectiveness of Procedures

Graphic displays of the percentages of correct responses are presented in Figures 2 and 3. Direct intra- and interparticipant replications were achieved for all four participants. The withdrawal design allowed for evaluation of experimental control for the participants by repeating the effects of the introduction and removal of the PAS.

Figure 2.

Performance Using PAS and No-PAS for (a) Katie and (b) Hilary.

Figure 3.

Performance Using PAS and No-PAS for (a) Donovan and (b) Tristin.

Katie

As shown in Figure 2(a), Kate had low percentages of correct responses in the No-PAS¹ and No-PAS² conditions. After PAS instruction, Katie’s performance showed a definite change in level from No-PAS¹ and PAS¹. Her mean performance during the PAS instruction condition was 85% with a range from 60% to 100%. The absolute level change between PAS¹ and No-PAS² was 40%. Both PAS conditions demonstrated zero-celerating trends.

Hillary

As shown in the bottom panel of Figure 2, Hillary had low percentages of correct responses in both the No-PAS¹ and No-PAS² conditions. Following PAS instruction, Hillary’s data showed a change in level from No-PAS¹ and PAS¹. Her mean performance during the PAS instruction condition was 65% with a range from 20% to 80%. The absolute level change between PAS¹ and No-PAS² was 40%.

Donovan

As shown in Figure 3(a), Donovan had low percentages of correct responses in No-PAS¹ and No-PAS² conditions. After the instruction condition, Donovan’s data showed a clear level change from No-PAS¹ and PAS¹. His mean performance during PAS instruction was 96.25% with a range from 85% to 100%. After instruction, the percentage of correct responses remained higher than the No-PAS¹ condition. The absolute level change between PAS¹ and No-PAS² was 43%.

Tristan

As shown in Figure 3, Tristan had low percentages of correct responses in the No-PAS¹ and No-PAS² conditions. Following instruction with the PAS, Tristan’s data showed a change in level from No-PAS¹ and PAS¹. His mean performance during PAS instruction was 78.5% with a range from 71% to 86%. After instruction, the percentage of correct responses remained higher than the No-PAS¹ condition. The absolute level change between PAS¹ and No-PAS² was 57%. During the final session of the No-PAS² condition, Tristan’s data showed a marked acceleration from 14% to 57% for correct responses. The researcher opted to move into the PAS² condition due to similarity with levels of proficiency in the No-PAS¹ condition and the time constraints of the investigation.

Generalization Data

During the generalization pretest condition, percentages of correct responses resulted in a mean score of 0% for Katie, 0% for Hillary, 11% for Donovan, and 11% for Tristan. During the generalization posttest condition, percentages of correct responses resulted in a mean score of 100% for all students. The interparticipant replications help document the effects of the PAS in an untrained setting, indicating generalization of the intervention.

Social Validity

The teacher collected social validity data by surveying professionals who were directly involved with the participants. The professionals participating in the social validity survey included a special education teacher, two special education paraprofessionals, and a speech-language pathologist. The individuals observed a session during a participant’s No-PAS (baseline) and PAS (intervention) conditions, and scored a questionnaire form using a Likert-type scale. The potential responses could range from 1 (strongly disagree) to 5 (strongly agree). The mean score was calculated for each question. Additional social validity data were collected by surveying the research participants. Each participant scored a questionnaire using a similar Likert-type scale. The potential responses could range from 1 (I do not agree) to 3 (I agree a lot). The mean score was calculated for each question from the social validity survey. Questions and means for both groups are provided in Table 4.

Table 4.

Social Validity Results.

Group and questions	M
Professionals^a
This student learned how to complete three or five task directions using the picture prompts	5
This student became more independent while using the PAS	4.93
Implementing the PAS would be feasible	4.88
Following a three-or-five-task verbal direction, this student can only complete the tasks consecutively with teacher intervention	4.69
The PAS could be used for all students	5
Picture prompts are a useful self-management tool	5
The PAS is responsible for students’ completion of three-or-five-task verbal directions	5
This student seemed be more independent and self-directed when using the PAS to complete three-or-five-task verbal directions	5
My opinions have changed as I have observed this student using the PAS	2.75
Participants^b
I learned how to use picture prompts to follow my teacher’s directions and complete assigned tasks	3
The picture prompts helped me to remember all the tasks I was assigned	3
The picture prompts might help other students to complete three or five tasks after a teacher tells the student the assigned tasks	2.75
I liked not needing anyone’s help to remember the tasks I was asked to complete	3
I think it was easy to use the picture prompts to remind me of my assigned tasks	3

Scale = 1 (strongly disagree) to 5 (strongly agree).

Scale = 1 (I do not agree) to 3 (I agree a lot).

Discussion

We sought to evaluate the relations between the use of a picture-based support created in part by the participant using the support and completion of a series of verbal directions. In addition, we wanted to determine whether these same participants could generalize the use of PAS into a community setting. Based on the data, a functional relation exists between the PAS and independent task completion in classroom and community settings.

Our findings add to those of previous researchers who demonstrated that picture symbols are an effective intervention for promoting improvement in vocational, academic, and daily living skills (Bryan & Gast, 2000; Cihak, Alberto, Taber-Doughty, & Gama, 2006; Copeland & Hughes, 2000; Hall et al., 1995; Krantz et al., 1993; Martin, Elias-Burger, & Mithaug, 1987; Mechling & Gast, 1997; Rivera, Koorland, & Fueyo, 2002; Spriggs et al., 2007; Wacker, Berg, Berrie, & Swatta, 1985). Similar to these researchers, we saw an immediate change for all participants and demonstrated a functional relation between the No-PAS and PAS conditions. It should be noted that participants not only demonstrated an increased ability to complete the assigned sequence of tasks following the verbal direction but also completed those tasks in the order they were assigned. This is essential in instances when one task is a prerequisite for the following task (e.g., sweeping a floor prior to mopping a floor) and is frequently required in employment settings when a supervisor requests the completion of a series of tasks.

Our findings may be used to offer students with disabilities an effective tool with which to self-manage tasks assigned in a series of verbal directions. Students not only gained independence by learning how to create their task list, but based on the results of the participant social validity questionnaire and anecdotal comments made to the teacher, they had positive feelings about being able to independently create their task list and, most importantly, complete their series of tasks without adult intervention or guidance. These results can be used to highlight the utility of teaching students to self-operate compensatory strategies often required for gaining maximal independence. Using the PAS as a strategy for following multitask verbal directions has implications in the home, school, and vocational settings. Individuals with intellectual disability can use picture symbols to create a “to do” list even if they have limited or no writing skills. This in turn promotes learning of self-management and independence. When using PAS, there also is greater flexibility in the manner in which teachers and others can assign tasks. The PAS user can select task picture symbols from an entire skill repertoire “list” and then independently create a reminder system for the tasks assigned in a particular session. At the same time, the person assigning the tasks can vary the number and types of tasks, depending on what the needs might be for a particular time interval such as in a workday.

Future researchers could explore the use of the PAS in a vocational setting with job tasks assigned verbally. They might also investigate the use of the PAS in home settings. In this setting, parents or caregivers might give verbal directions for chained activities in which the separate tasks within the chain might vary from time to time. For example, getting ready for bed might not always include a bath; some chores may not need to be completed at the same frequency as others. Another area to investigate is the effect the PAS has on chains of more complex skills in a student’s repertoire, as the tasks assigned in this study were fairly simple, straightforward, and completed in a relatively short period of time. In addition, this study could be replicated with participants who have different disability levels and ages. By replicating the study across participants, conditions, or behaviors, the external validity of the intervention would be strengthened.

One limitation of the study was that research with all participants occurred within the same classroom area or vicinity. This meant that while the teacher was observing and working with one participant, some of the other participants may have observed or overheard portions of the session. This may have inadvertently assisted with their progress. A second limitation was that the researchers did not determine whether participants succeeded because they manipulated the picture symbols while making their list or because participants took the “to do” list with them as they completed their assigned tasks. Awareness of these limitations might be helpful for future research about the PAS or the study of self-managing picture prompts from verbal directions. Finally, while social validity data collected from adults and participants supported use of the intervention, it should be noted that the teacher was responsible for gathering data from her own students and colleagues. It is therefore possible that respondents completed the social validity questionnaires in a way that supported the efforts of the teacher. In the future, researchers might use a nonbiased person familiar to the adults and students but not directly affiliated with the research project to gather these data.

All students benefit from self-determination skills that increase their autonomy and self-regulatory ability (Wehmeyer, Kelchner, & Richards, 1996). As students become more self-determined, their quality of life is enhanced (Wehmeyer & Schalock, 2001). The use of PAS may assist students with intellectual disability in self-managing their daily tasks, which in turn could increase their independence and decrease their reliance on others. Strengthening students’ self-management skills is one step in becoming a more self-determined individual.

Footnotes

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) received no financial support for the research, authorship, and/or publication of this article.

References

Beirne-Smith

Patton

Kim

(2006). Mental retardation: An introduction to intellectual disabilities (7th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Bryan

Gast

D. L.

(2000). Teaching on-task and on-schedule behaviors to high functioning children with autism. Journal of Autism and Developmental Disorders, 30, 553–567.

Carson

Gast

D. L.

Ayres

K. M.

(2008). Effects of a photo activity schedule book on independent task changes by students with intellectual disabilities in community and school job sites. European Journal of Special Needs Education, 23, 269–279.

Cihak

Alberto

P. A.

Taber-Doughty

Gama

R. I.

(2006). A comparison of static picture prompting and video prompting simulation strategies using group instructional procedures. Focus on Autism and Other Developmental Disabilities, 21, 89–99.

Copeland

Hughes

(2000). Acquisition of a picture prompt strategy to increase independent performance. Education and Training in Mental Retardation and Developmental Disabilities, 35, 294–305.

Elliot

C. D.

(2007). Differential abilities scale--Second edition (DAS-2). San Antonio, TX: Psychological Corporation.

Gast

D. L.

(2010). Single subject research methodology in behavioral sciences. New York, NY: Routledge.

Hall

L. J.

McClannahan

L. E.

Krantz

P. J.

(1995). Promoting independence in classrooms by teaching aids to use activity schedules and decreased prompts. Education and Training in Mental Retardation and Developmental Disabilities, 30, 208–217.

Harrison

Oakland

(2003). Adaptive Behavior. Assessment System (2nd ed.; ABAS-II). San Antonio, TX: Pearson.

10.

Henry

Winfield

(2010). Working memory and educational achievement in children with intellectual disabilities. Journal of Intellectual Disability Research, 54, 354–365.

11.

Krantz

P. J.

MacDuff

M. T.

McClannahan

L. E.

(1993). Programming participation in family activities for children with autism: Parent’s use of photographic activity schedules. Journal of Applied Behavior Analysis, 26, 137–138.

12.

Martin

J. E.

Elias-Burger

Mithaug

D. E.

(1987). Acquisition and maintenance of time-based task change sequence. Education and Training in Mental Retardation, 22, 250–255.

13.

Mechling

L. C.

Gast

D. L.

(1997). Combination audio/visual self-prompting system for teaching chained tasks to students with intellectual disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 23, 138–153.

14.

Rivera

M. O.

Koorland

M. A.

Fueyo

(2002). Pupil-made pictorial prompts and fading for teaching sight words to a student with learning disabilities. Education & Treatment of Children, 25, 197–207.

15.

Roid

G.H.

(2003). Stanford-Binet Intelligence Scale–5th Edition . Itasca, IL: Riverside Publishing.

16.

Sparrow

S. S.

Cicchetti

Balla

D. A.

(2005). Vineland Adaptive Behavior Scales–2nd edition manual. Minneapolis, MN: NCS Pearson, Inc.

17.

Spriggs

A. D.

Gast

D. L.

Ayres

K. M.

(2007). Using picture activity schedule books to increase on-schedule and on-task behaviors. Education and Training in Developmental Disabilities, 42, 209–223.

18.

Van der Molen

M. J.

Van Luit

J. E. H.

Van der Molen

M. W.

Jongmans

M. J.

(2010). Everyday memory and working memory in children with mild intellectual disabilities. American Journal on Intellectual Disabilities, 115, 207–217.

19.

Wacker

D. P.

Berg

W. K.

Berrie

Swatta

(1985). Generalization and maintenance of complex skills by severely handicapped adolescents following picture prompt training. Journal of Applied Behavior Analysis, 18, 329–336.

20.

Wechsler

(2001). Wechsler Individual Achievement Test– Second Edition. San Antonio, TX: Psychological Corporation.

21.

Wehmeyer

M. L.

Gragoudas

Shogren

(2006). Self-determination, student involvement, and leadership development. In Wehman

(Ed.), Life beyond the classroom: Transition strategies for young people with disabilities (4th ed., pp. 41–70). Baltimore, MD: Paul H. Brookes.

22.

Wehmeyer

M. L.

Kelchner

Richards

(1996). Essential characteristics of self-determined behavior of individuals with mental retardation. American Journal on Mental Retardation, 100, 632–642.

23.

Wehmeyer

M. L.

Palmer

S. B.

(2003). Adult outcomes for students with cognitive disabilities three-years after high school: The impact of self-determination. Education and Training in Developmental Disabilities, 38, 131–144.

24.

Wehmeyer

M. L.

Schalock

R. L.

(2001). Self-determination and quality of life: Implications for special education services and supports. Focus on Exceptional Children, 33(8), 1–16.

25.

Wilkinson

G. S.

(1993). WRAT: Wide Range Achievement Test Administration Manual. Wilmington, DE: Wide Range, Inc.

26.

Wolery

Jones

M. A.

Doyle

P. M.

(1992). Teaching students with moderate to severe disabilities. White Plains, NY: Longman.

27.

Woodcock

R. W.

McGrew

Mather

(2001). Woodcock Johnson tests of cognitive abilities and tests of achievement. Chicago, IL: Riverside.