SIGNIFIYING AND INDICATING THE EFFECTIVENESS OF USING ACTIVITY SCHEDULES IN TEACHING INDIVIDUALS WITH AUTISM

1. SIGNIFIYING AND INDICATING THE EFFECTIVENESS OF USING ACTIVITY SCHEDULES IN TEACHING INDIVIDUALS WITH AUTISM PS 572 Language and Social Skills for Individuals with Autism June 11, 2008 Christeen Z. Scarpa

2. OVERVIEW • This literature review investigates the effectiveness of using activity schedules to teach individuals with autism. There is an abundance of literature and empirical evidence showing the success of the effectiveness when using activity schedules to help facilitate learning. • Leisure time (tv), self help (brushing teeth), and independent skills (puzzles). • Activity Schedules have also shown to be effective in not only promoting new skills in individuals with autism, but also in decreasing depression and self-injurious behaviors. • Nevertheless, there is a lack of literature and empirical evidence available on the effectiveness of activity schedules in teaching language and social skills.

3. ORGANIZATION • Definition • Types of Activity Schedules • Inclusion of all relevant articles • Discussions • Critique of Literature • Comparison with criteria for EBP • Future Research

4. PSYCINFO • psycINFO served as a useful tool in obtaining several current studies included in this literature review. However, psycINFO only provided current studies that focused mainly on the use of computer based technology activity schedules when teaching learners with autism. Research shows that computer use itself is reinforcing (Kimball et. al. 2003 & Stromer, et. al. 2006) • Included studies were also obtained through Jaba

5. DEFINITION AND TYPES OF ACTIVITY SCHEDULES • “An activity schedule is a set of pictures or words that cues someone to engage in a sequence of activities” (McClannahan & Krantz, 1999) • TYPES • PHOTOGRAPHIC • WRITTEN • AUDIO

6. INCLUSION OF ALL RELEVANT ARTICLES • According to the Journal of Applied Behavior Analysis (JABA) over 400 results of studies have been published. • Showing the effectiveness of encouraging already learned skills and promoting likelihood of new skills.

7. ARTICLES • Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response Chains (MacDuff et al., 1993), • The Effects of Sequential Pictorial Cues, Self-Recording, and Praise on the Job Task Sequencing of Retarded Adults (Connis, Richard T., 1979) • Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules (Krantz et al., 1993) • Focused on skills such as increasing social initiations, disruptive behaviors, independent on-task and on-schedule behaviors • The literature clearly shows significant improvement in the increase of above mentioned target skills and the decrease of non functional behaviors.

8. Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response ChainsGregory S. MacDuff, Patricia J. Krantz, and Lynn E. McClannahan, 1993 • Purpose: To increase on task and on-schedule behavior using a photographic activity schedule • Importance of purpose: Many individuals with autism lack functional skills that increase self-care, work, and leisure activities without use of verbal prompts. “People with autism have difficulty acquiring lengthy response chains” (MacDuff et. al. 1993) • Setting: Their residence: Community based Teaching-Family Model group home • Participants: Mike & Walter age 9, Steve age 11, and Roy age 14 • All: diagnosed with autism • History of disruptive and stereotypic behaviors • Severe language deficits • Dependent on verbal prompts to complete self help or leisure activities

9. Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response ChainsGregory S. MacDuff, Patricia J. Krantz, and Lynn E. McClannahan, 1993 • Measurement of behaviors (DV): Focus on On-Task behavior • Data collected: if learners visually attended to work materials, looked at photographic schedules, engaged in play or work appropriately, change from one activity to another. • On-Schedule: Data scored moment of attending, engagement in activity shown on page of activity schedule

10. Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response ChainsGregory S. MacDuff, Patricia J. Krantz, and Lynn E. McClannahan, 1993 • Intervention: sessions- 60m durations and began upon instructor instructions • Baseline: no prompts • Inappropriate behavior ignored • No instructor present • Teaching use of pictoral schedules: • Teacher gave instructor and waited 10s for a response • If no response, teacher manually guided (always from behind) child to activity schedule • Graduated guidance was used to help complete activity schedule and activities • Prompts were faded, when child engaged in on-task behavior for 80% of sessions (MacDuff et. al. 1993) • Procedures replicable

11. Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response ChainsGregory S. MacDuff, Patricia J. Krantz, and Lynn E. McClannahan, 1993 • A Multiple baseline was used. • A functional relationship was illustrated because • “With each application of teaching pictorial schedules, on-task immediately increased for all youths” (MacDuff et. al. 1993) • Interobserver Agreement:30%, (preferred at 33%) calculated by dividing # of (on-task, nonoccurrence of on-task, and on-schedule) agreements by the # of agreement plus disagreements and × by 100%, • Mean of on-task = 96%, nonoccurrence of on-task = 95, and on-schedule = 99 • Treatment Integrity was not assessed, a section of study could have been conducted to take data on the instructors or therapists, helping avoid any bias or objective conduct, and help insure all teaching procedures are consistent and conducted well

12. Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response ChainsGregory S. MacDuff, Patricia J. Krantz, and Lynn E. McClannahan, 1993 • Social Validity: no mention, other teachers or parents could have been asked to observe and fill out a questionnaire on student performance • Generalization: Teacher absent, 2 novel activities of 6 original replaced • Data scored: if learners visually attended to work materials, looked at photographic schedules, engaged in play or work appropriately, change from one activity to another. • On-Schedule: Data scored moment of attending, engagement in activity shown on page of activity schedule • Mean: 99% for all students • Maintenance: Last 5 sessions, no prompts • Data collection same as generalization • Except for Steve, all participants average at 99%

13. Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response ChainsGregory S. MacDuff, Patricia J. Krantz, and Lynn E. McClannahan, 1993 • Results? • Was their analysis data appropriate? • Were findings in agreement with previous research?

14. Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response ChainsGregory S. MacDuff, Patricia J. Krantz, and Lynn E. McClannahan, 1993 • Results: “Clinical data indicated that the participants learned to do a variety of recreational and home-living tasks” (MacDuff et. al. 1993) • Yes, appropriate • Yes, their findings where in agreement to previous research, having activity schedules increase likelihood of leisure, self-help, and independent skills. • However, perhaps further research can investigate social initiations and language skills in individuals with autism

15. The Effects of Sequential Pictorial Cues, Self-Recording, and Praise on the Job Task Sequencing of Retarded Adults (Connis, Richard T., 1979) • Purpose:Using picture cues on independent task changes of four mentally retarded adults. (Connis, 1979) • Importance of purpose: Little research has been shown on the use of visual cues to instruct the mentally retarded individuals • Participants: Alice 24 yrs old, IQ of 50 on Wechsler Adult Intelligence Scale (WAIS) Bill 22 yrs old, IQ of 35 on Stanford-Binet Intelligence Scale, Chuck, 24 yrs old, WAIS IQ of 43, and Doug, 21 yrs. Old WAIS IQ of 48. • Setting: Vocational training program in University of Washington Campus • Measurement of Behavior (DV): Focus on Independent task change. “…beginning the correct assigned task without directives or instruction (Connis, 1979). Data recorded: correct if when task ended, learner correctly changed tasks

16. The Effects of Sequential Pictorial Cues, Self-Recording, and Praise on the Job Task Sequencing of Retarded Adults (Connis, Richard T., 1979) • Intervention: Direction was given to begin task • Picture-cue training: managing changing tasks with photographs • Photographs represented task in a controlled sequence • Photos taped with a small blank paper underneath them on a visible wall in learner’s work domain • Instructions were given at beginning of work day of photographic use: walk to photos, look at correct photo, mark “X” on blank paper beneath photo, begin task presented in photo within a 40 sec time duration • Verbal feedback given periodically 9 (Connis, 1979) • Procedures replicable

17. The Effects of Sequential Pictorial Cues, Self-Recording, and Praise on the Job Task Sequencing of Retarded Adults (Connis, Richard T., 1979) • Multiple Baseline Design was used. • “The results indicate the effectiveness of pictorial cues and self-recording in increasing and maintaining independent task-change behavior.” (Connis, 1979) • Functional Relationship showed that after intervention, target behaviors increased. • Interobserver Agreement: 20% (not enough) dividing # of task-change agreements by the number of agreements + disagreements × 100% • Mean of 98.9% for Alice, 100% for Bill, 97.8% for Chuck, and 98.5% for Doug • Treatment Integrity: No mention, a section of study could have been conducted to take data on the instructors or therapists, helping avoid any bias or objective conduct, and help insure all teaching procedures are consistent and conducted well

18. The Effects of Sequential Pictorial Cues, Self-Recording, and Praise on the Job Task Sequencing of Retarded Adults (Connis, Richard T., 1979) • Social Validity: not assessed, novel teachers could have been asked to observe and fill out a questionnaire on student performance • Generalization: Learners not required to use photographs and self-recording system • Correct change of tasks without any cues, independent task change was recorded. • Maintenance: High levels of independent task change was measured. • Self-recording mean average of 98% across all students

19. The Effects of Sequential Pictorial Cues, Self-Recording, and Praise on the Job Task Sequencing of Retarded Adults (Connis, Richard T., 1979) • Results? • Was their analysis data appropriate? • Were findings in agreement with previous research?

20. The Effects of Sequential Pictorial Cues, Self-Recording, and Praise on the Job Task Sequencing of Retarded Adults (Connis, Richard T., 1979) • “The results indicate the effectiveness of pictorial cues and self-recording in increasing and maintaining independent task change behavior” (Connis, 1979) • Yes, appropriate • Not much research have been conducted in finding for the use of visual cues to instruct the mentally retarded individuals • However, Learner’s memorized the task sequence and were no longer guided by the photographic cues.

21. Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules Patricia J. Krantz, Michael T. MacDuff, and Lynn E. McClannahan, 1993 • Purpose: Parents helping their children follow a photographic activity schedule showing different home living tasks • Importance of Purpose: “Many parents report that their youngsters with autism do not participate in family life … limiting their opportunities to undertake routine household tasks, to attend to other children, or to pursue community activities” (Krantz et al. 1993) • Participants: Jack, 8 yrs old., Jay, 6 yrs. Old, Miles, 7 yrs. Old • All had autism • All had pre-teaching to photographic activity schedules • Setting: private residence

22. Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules Patricia Patricia J. Krantz, Michael T. MacDuff, and Lynn E. McClannahan, 1993 • Measurement of behaviors (DV): Focus on Engagement • Data collected: if learners visually attended to work materials, looked at photographic schedules, engaged in play or work appropriately, change from one activity to another.

23. Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules Patricia Patricia J. Krantz, Michael T. MacDuff, and Lynn E. McClannahan, 1993 • Intervention: modeling to parents how to use graduated guidance to teach use of photographic activity schedule • Parents used their own strategies to care for the child with autism. (Krantz et al. 1993) • Jack’s parents received 74 hrs of training • Jay’s parents received 90 hrs of training • Mile’s parents received 53 hrs of training • Supervision and feedback given • These procedures are difficult to replicable

24. Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules Patricia Patricia J. Krantz, Michael T. MacDuff, and Lynn E. McClannahan, 1993 • Multiple baseline ABC • Functional Relationship showed that after intervention, target behaviors increased. • Interobserver Agreement: assessed at 60% (enough), unclear on method of calculation. • Mean ranged form 79%-100% • Treatment Integrity: No mention, a section of study could have been conducted to take data on the instructors or therapists, helping avoid any bias or objective conduct, and help insure all teaching procedures are consistent and conducted well. • Social Validity:No mention,Independent observer could have assessed performance of parents

25. Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules Patricia Patricia J. Krantz, Michael T. MacDuff, and Lynn E. McClannahan, 1993 • Generalization:No mention, intervention could have been implemented across novel settings and people. • Maintenance: data was collected, however, not much information regarding maintenance measurment • Observation sessions occurred daily during baseline and weekly during teaching and the first 2 to 3 weeks of maintenance. (Krantz et. al. 1993)

26. Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules Patricia Patricia J. Krantz, Michael T. MacDuff, and Lynn E. McClannahan, 1993 • Results? • Was their analysis data appropriate? • Were findings in agreement with previous research?

27. Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules Patricia Patricia J. Krantz, Michael T. MacDuff, and Lynn E. McClannahan, 1993 • “Literature shows increases in engagement and decreases in disruptive behavior when parents taught their children to follow photographic activity schedules” (Krantz et al. 1993) • Yes, their data was appropriate • Yes • Pre-training may have assisted these children’s rapid behavior change

28. Example of Activity Schedule • Activity Schedule

29. CRITIQUE OF LITERATURE • Teaching Children with Autism to Use Photographic Activity Schedules: Maintenance and Generalization of Complex Response Chains (MacDuff et al., 1993), • No resistance to manual guidance was recorded (could there have been tantrums?) • After intervention, off-task was sometimes scored, • Learner’s were not observed whether engagement in novel activities other than those depicted in activity schedules occurred. • Little manual prompts given, perhaps of previously learned skills

30. CRITIQUE OF LITERATURE Cont’d • The Effects of Sequential Pictorial Cues, Self-Recording, and Praise on the Job Task Sequencing of Retarded Adults (Connis, Richard T., 1979) • Social Validity and Treatment Integrity were not assessed, therefore, any type of bias may be possible and social observations or assessment was not measured • “Future research may suggest that complete withdrawal of the package does not indicate clear response maintenance…and generalization programming” (Connis, 1979)

31. CRITIQUE OF LITERATURE Cont’d • Programming Participation In Family Activities For Children with Autism: Parents Use of Photographic Activity Schedules (Krantz et al., 1993) • Social Validity and Treatment Integrity were not assessed, therefore, any type of bias may be possible and social observations or assessment was not measured. • Generalization not mentioned and weak depiction of maintenance procedures • “Pre-training in the treatment setting may have facilitated these children’s rapid behavior change at home” (Krantz et al. 1993) .

32. Comparison with Criteria for Evidence Based Practice • All literature conducted by a team of experts • All Peer-reviewed • Not all included treatment integrity, social validity, generalization, and no/weak maintenance procedures • All literature have interventions with important supporting evidence • No harm produced • Further research identified

33. ASSESSMENT AND FUTURE RESEARCH • The development of activity schedules began with the use of sequential picture cues to teach independence and on task behavior the mental retardation population. • Autism professionals developed the use of picture cues and implemented them into activity schedules, having activity schedules a vital and efficient teaching tool. • Peer reviewed literature research demonstrates that activity schedules are effective resources to teach various skills. • Nevertheless, published research on activity schedules, particularly on their use for teaching social and language skills, is needed. • Future research should examine different ways of teaching language and social skills through the use of many models of activity schedules.

34. References • Connis, R.T. (1979). The effects of sequential pictorial cues, self-recording, and praise on the job task sequencing of retarded adults. The Journal of Applied Behavior Analysis, 12, 355-361. • Kimball, J.W., Kinney, E.M., Taylor, B.A., & Stromer, R. (2003). Lights, camera, action! Council for Exceptional Children, 36, 40-45. • Krantz, P. J., MacDuff, M. T., & McClannahan, L. E. (1993). Programming participation in family activities for children with autism: Parents' use of photographic activity schedules. Journal of Applied Behavior Analysis, 26(1), 137-138. • MacDuff, G.S., Krantz, P.J., & McClannahan, L.E. (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. The Journal of Applied Behavior Analysis, 26, 89-97. • McClannahan, L.E., & Krantz, P.J. (1999). Activity schedules for children with autism. Bethesda, MD: Woodbine. • Stromer, R., Kimball, J.W., Kinney, E. M., & Taylor, B.A. (2006). Activity schedules, computer technology, and teaching children with autism spectrum disorder. Focus on Autism and Other Developmental Disabilities, 21, 14-24.