Evaluation of a Personal Digital Assistant as a Self-Prompting Device for Increasing Multi-Step Task Completion by Students with Moderate ...

Education and Training in Autism and Developmental Disabilities, 2010, 45(3), 422– 439
© Division on Autism and Developmental Disabilities

Evaluation of a Personal Digital Assistant as a Self-Prompting
    Device for Increasing Multi-Step Task Completion by
      Students with Moderate Intellectual Disabilities
              Linda C. Mechling                                            David L. Gast
   University of North Carolina Wilmington                               University of Georgia

                                              Nicole H. Seid
                                University of North Carolina Wilmington

Abstract: The purpose of this study was to evaluate whether the use of a personal digital assistant (PDA), with
picture, auditory, and video prompts, would serve as a portable self-prompting device to facilitate independent
task performance by high school age students with moderate intellectual disabilities. A multiple probe design was
used across three cooking recipes and replicated across three students to evaluate the effectiveness of the
self-prompting program. Results indicate that students were able to independently use a PDA to self-prompt
completion of the three cooking recipes without the need for external adult prompting, to maintain use of the
device over time, and to self-adjust the levels of prompts used within and across recipes.

Researchers continue to investigate use of self-            preparation (Singh, Oswald, Ellis, & Singh,
operated prompting systems, operated by per-                1995); assembly tasks (Martin, Mithang, & Fra-
sons with intellectual disabilities, as tools for           zier, 1992); dusting, setting tables, and vacu-
increasing independence and decreasing reli-                uming (Steed & Lutzker, 1997); packaging
ance on external prompts delivered by adults                (Johnson & Miltenberger, 1996); taking cus-
or peers. Self-operated prompting systems                   tomer orders and preparing sack lunches (Ag-
may be used to prompt: completion of tasks                  ran, Fodor-Davis, Moore, & Martella 1992),
with multiple steps (i.e., washing dishes); a               and daily living skills (i.e., setting a table, mak-
sequence of tasks such as following a daily                 ing a bed) (Pierce & Schriebhan, 1994). Au-
schedule; or transitioning independently be-                ditory-based systems have also been used as
tween activities (MacDuff, Krantz, & McClan-                self-prompting devices whereby students oper-
nahan, 1993). Traditionally self-prompting                  ate a portable cassette player (Davis, Brady,
systems for completion of multi-step tasks                  Williams, & Burta, 1992; Grossi, 1998; Taber,
have been in the form of picture-based mate-                Seltzer, Heflin, & Alberto, 1999; Hughes, Al-
rials (Lancioni, O’Reilly, & Oliva, 2001; Mech-             berto, & Fredrick, 2006) or MP3 player
ling, 2007) whereby students look at a static               (Taber-Doughty, 2005) by listening to a de-
picture depicting a step of a task analysis, com-           scription of how to complete a step, or cluster
plete the step, return to the system, mark off              of steps, of a task analysis, complete the step,
the picture corresponding to the completed                  and advance the system to the next step.
step or turn a page in a book, proceed to the                  Researchers have further evaluated use of
next picture and so forth. Static picture                   video based prompting systems to support in-
prompting has been used to prompt: food                     dependent task completion by persons with
                                                            intellectual disabilities. Similar to picture or
                                                            auditory based systems, students watch a video
  Correspondence concerning this article should
                                                            segment of a step of the task being completed,
be addressed to Linda Mechling, University of               pause the video tape, complete the step, and
North Carolina Wilmington, Department of Early              return to the prompting device to watch the
Childhood and Special Education, 601 S. College             next step. Video prompting has been used
Road, Wilmington, NC 28403-5940.                            effectively to teach a range of multi-step tasks

422   /   Education and Training in Autism and Developmental Disabilities-September 2010
(Mechling, 2005) including: self-help skills       bile technologies, have incorporated text
(Norman, Collins, & Schuster, 2001); cooking       (Ferguson, Smith-Myles, & Hagiwara, 2005)
(Graves, Collins, Schuster, & Kleinert, 2005;      and text and auditory prompts (Davies, Stock,
Mechling, Gast, & Fields, 2008); microwave         & Wehmeyer, 2002a) to teach time manage-
oven use (Sigafoos et al., 2005); putting away     ment and task completion. Pictures and audi-
groceries (Cannella-Malone et al., 2006); and      tory prompts, presented on a small hand held
setting a table (Cannella-Malone et al.; Good-     digital display, have also been used to teach
son, Sigafoos, O’Reilly, Cannella, & Lancioni,     completion of vocational and independent liv-
2007). Unlike picture or auditory based sys-       ing tasks (Cihak, Kessler, & Alberto, 2007;
tems, video prompting devices hold the advan-      Riffel et al., 2005); transitioning between vo-
tage of offering the student both visual and       cational tasks (Cihak, Kessler, & Alberto,
auditory cuing. In addition, video can provide     2008); and packaging and assembly tasks (Da-
animated, real-life simulations of the task        vies, Stock, & Wehmeyer, 2002b; 2003; Furniss
(Mechling). Although Cihak, Alberto, Taber-        et al., 1999).
Doughty, and Gama (2006) found no signifi-            Presentation of video-based instruction
cant differences between static picture            within the realm of portable systems is also
prompting and video prompting when teach-          beginning to receive research attention.
ing use of an ATM and debit card machine to        Mechling et al. (2008) used a portable DVD
six students with moderate intellectual disabil-   player to deliver video prompts to three young
ities, Mechling and Gustafson (2009) found         adults with moderate intellectual disabilities
that six young adults with moderate intellec-      when the system was placed on a kitchen
tual disabilities independently completed a        counter. Video displayed on portable PDA sys-
greater number of tasks when using video           tems was also explored in two recent studies
prompting compared to static pictures. Mech-       (Taber-Doughty, Patton, & Brennan, 2008;
ling and Gustafson (2008) report similar find-     Van Laarhoven, Van Larrhoven-Myers, &
ings in favor of video prompting in their study    Zurita, 2007). Both Taber et al. and Van Laar-
with six young men with a diagnosis of autism.     hoven et al. used video modeling procedures
Tasks evaluated in each study were compo-          to present information to students on hand
nent steps of recipes (i.e., opening crescent      held systems. Video modeling differs from
rolls), whereby Mechling and Stephens              video prompting by requiring the individual
(2009) included multiple step cooking recipes      to watch an entire video recording followed by
in their study. Results of the study support       immediate performance of the entire task or
video prompting over static picture prompt-        performance of the skill at a later time. Lim-
ing for increasing independent performance         ited research exists comparing the two proce-
of tasks for four students with moderate intel-    dures, however Cannella-Malone et al. (2006)
lectual disabilities.                              found video prompting more effective than
   In addition to investigating differences in     video modeling in promoting acquisition of
skill acquisition using different self-prompting   table setting skills and putting away groceries
devices (picture, audio, video), an area of in-    by six adults with developmental disabilities.
terest concerning self-prompting systems is        Although video prompting has been shown to
portability. Although a paper-based picture        be an effective tool for presenting information
system can be portable (i.e., small notebooks      and instruction to students with moderate in-
or flip cards) some researchers have found         tellectual disabilities (Cannella-Malone et al.;
that students loose their place with such sys-     Graves et al., 2005; Mechling et al.; Mechling
tems (Lancioni, O’Reilly, Seedhouse, Furniss,      & Stephens, 2009; Norman et al., 2001; Si-
& Cunha, 2000; Mechling & Stephens, 2009)          gafoos et al., 2005), to date no research has
and they do not provide auditory feedback. To      been reported in the literature evaluating the
address these concerns and keeping abreast         effects of video prompting on a PDA system.
with developing technologies, research is be-         The purpose of the current study was to
ing conducted on the use of personal digital       evaluate the effectiveness of a PDA self-
assistants (PDAs) by persons with disabilities.    prompting system which combined the use of
These hand held systems, referred to by To-        video, picture, and auditory prompts. While
masino, Doubek, and Ormiston (2007) as mo-         previous research has shown these individual

                                                                   Personal Digital Assistant   /   423
components to be effective prompting sys-               adaptable to varying abilities across students
tems, no study has evaluated a system using a           (Mechling et al., 2008). The current study
combination of these three components nor               sought to answer the following research ques-
has research addressed presentation of a com-           tions: a) Would a hand-held self-prompting
bination system on a portable hand-held de-             system, using video, picture, and auditory
vice. Advantages for combining the systems              prompt levels, increase the percentage of
have been noted by researchers. Van Laar-               cooking steps completed independently by
hoven and Van Laarhoven-Myers (2006)                    students with moderate intellectual disabili-
found that combination systems (video mod-              ties?; and b) Would students with moderate
eling paired with photographs and video mod-            intellectual disabilities self-adjust their use of
eling paired with video prompting) resulted             prompt levels when using the PDA?
in more independent correct responses and
were more efficient in terms of sessions to
criterion than video modeling alone when
teaching community daily livings skills to
young adults with developmental disabilities.
Mechling and Stephens (2009) report that                Three young adults (2 females and 1 male)
some students may by be able to perform                 with moderate intellectual disabilities partici-
some steps of a task using pictures while need-         pated in the study. Each had experience in
ing video descriptions for more difficult steps.        food preparation, computer-based instruc-
Van Laarhoven and Van Laarhoven-Myers                   tion, and use of picture-based prompting al-
found that students, although not permitted             though none had used video based prompting
to do so in the study, tried to self-fade and rely      or a handheld system. Students were screened
on picture prompts rather than use of video             for the following prerequisite skills prior to
prompts as they learned tasks. Similarly,               the start of the study: (a) visual ability to see
Taber-Doughty et al. (2008) found that stu-             video and pictures on a small 2 inch ⫻ 3 inch
dents began to rely only on auditory prompts            digital display; (b) ability to hear auditory
and self-faded looking at video models on a             prompts delivered by the system; (c) fine mo-
PDA system that provided both video models              tor ability to touch the PDA screen or use a
and auditory cues. Based on their findings,             small 1/8 inch diameter stylus; (d) cognitive
Van Laarhoven and Van Laarhoven-Myers                   ability to recognize pictures and icons; (e)
suggest a “scaffolding approach” whereby stu-           ability to attend to video stimuli; and (f) imi-
dents use more intrusive prompts of a system            tation skills. Because the purpose of the study
during initial trials and progress to a less in-        was to evaluate the PDA system as a self-
trusive level of prompting as they become fa-           prompting tool, students were also evaluated
miliar with a task.                                     on their ability to perform individual compo-
   In the current study students could: look at         nents of each task analysis. These included:
a still photograph on a hand held device,               (a) operation of a digital kitchen timer; (b)
touch the photograph and hear an auditory               operation of dials on an electric stove and
prompt, or watch a video segment with audi-             toaster oven; (c) use of a microwave oven; (d)
tory prompting, depending on how much in-               ability to lift off plastic lids; (e) ability to twist
formation was needed. In addition, as they              lids on and off of jars; (f) use of a bread clip;
learned steps of the task analysis, and did not         (g) cutting with scissors; (h) ability to open
need additional information, students could             cheese slices; (i) removing and putting on a
progress the system to the next photograph              cooking spray lid; and (j) operating cooking
without receiving further prompts. The inten-           spray. In addition, the following skills were
tion of the combination prompting system in             adapted to ensure students’ abilities to com-
this study was to allow for adaptations as stu-         plete the component steps of the task analysis:
dents’ needs for prompts changed (Van Laar-             (a) using a bread clip rather than a twist tie;
hoven & Van Laarhoven-Myers, 2006), to pro-             (b) placing food items into plastic storage
vide different prompt levels depending on the           containers rather than zip lock bags in which
complexity of the step (Mechling & Stephens,            they were purchased; (c) cutting open bags
2009), and to provide a system that could be            with scissors rather than tearing or pulling

424   /   Education and Training in Autism and Developmental Disabilities-September 2010
them open; (d) using oven mitts rather than          worked well in a quiet and structured environ-
pot holders; and (e) using color coded mea-          ment with frequent praise and reinforcement.
suring cups.                                         Andy enjoyed choir, community outings, and
   Andy was a 15 year, 11 month old male             working on the computer.
diagnosed with Williams syndrome, mild au-              Monica was a 17 year, 3 month old female
tism traits, and a moderate intellectual disabil-    diagnosed with Down syndrome and a moder-
ity (IQ 55, Kaufman Assessment Battery for Chil-     ate intellectual disability [IQ 51, Wechsler Intel-
dren: Kaufman & Kaufman, 1983; Adaptive              ligence Scale for Children–Third Edition (WISC-
Behavior Composite Score 48, Vineland Adap-          III): Wechsler, 1997; Adaptive Behavior
tive Behavior Scales: Sparrow, Balla, & Cicchetti,   Composite Score 70, Vineland Adaptive Behav-
1984). He read simple sight words and some           ior Scales: Sparrow et al., 1984]. She had a mild
letter sounds and was working on identifying         hearing loss and wore eye glasses. She read on
main ideas and themes in stories as well as          a late kindergarten/early first grade level and
increasing his ability to read and match words       recognized simple sight words. She knew the
to pictures. He was able to write his name,          sounds for all letters and was working on
address, phone number and emergency con-             sounding out and blending sounds to read
tact information. He could also write the days       words. She had difficulty with comprehension
of the week and the months of the year. He           and often answered, “I don’t know” to ques-
was working on completing forms, writing sen-        tions about what she had read. She was able to
tences with assistance and writing a grammat-        write simple sentences in a journal and copied
ically correct simple sentence. He could count       sentences dictated to her teacher. She used
objects, rote count to 100 by 1s, 5s, 10s and        modified spelling and often omitted articles
complete simple addition problems using tally        when writing sentences. Her needs included
marks. He was also able to count sets of nickels     increasing her ability to write simple sentences
and dimes, but not in combination. His short         using periods and to write personal informa-
term objectives included use of a calculator         tion and prepare a written grocery list. Monica
and telling time on the hour and half hour.          used a calculator to solve computation prob-
He used appropriate language to ask for help         lems with addition and subtraction and was
and to interact with others with clear articula-     able to tell time to the hour and half hour.
tion and a strength in pragmatic language. His       She used a digital clock and watch for all other
needs included increasing his vocabulary, use        times. One of her short term objectives was to
of descriptive words in sentences, and answer-       understand which hour is next and what time
ing simple who, what when, and where ques-           of day events happened. She was unable to
tions. He had difficulty processing auditory         recognize coins or state their value and had
information and performed tasks better with          difficulty counting by fives and tens. She was
visual cues. Andy’s needs further included           able to take care of her personal needs, was
demonstration of effective listening skills in       working on folding clothes with a model, and
class when directions were being given. He           was able to hang shirts and pants with some
was able to care for all of his self-care needs      prompts for positioning on the hanger. She
and perform simple home living tasks such as         needed assistance making a bed and cooked
making a bed and washing dishes. He was able         with supervision and assistance. Her needs in-
to operate a microwave oven with visual cues         cluded working on planning meals making a
and a toaster oven, but required supervision         grocery list, shopping for items, and prepar-
for all cooking related tasks. He was described      ing meals. She could operate a microwave and
as being very social, polite, courteous and en-      oven and needed assistance with a stove top.
joyed adult attention. He greeted people ap-         She was described as being very outgoing and
propriately and had a good memory for peo-           well liked by her classmates and teachers.
ple’s names and facts about them. He                 Monica enjoyed free time, working puzzles,
continued to have difficulty with peer relation-     coloring, and computer games. She liked
ships, impulse control, and concentration and        Hanna Montana and enjoyed searching web-
was easily frustrated. He frequently left his        sites pertaining to the topic.
chair and stared out the window and asked for           Wanda was a 17 year, 9 month old female
drinks of water or to use the restroom. He           diagnosed with a moderate intellectual dis-

                                                                      Personal Digital Assistant   /   425
ability (IQ 44, Stanford-Binet Intelligence Scales      instructor stood to the right of the student
–Fourth Edition: Thorndike, Hagan, & Sattler,           and when present, the reliability data collec-
1986; Adaptive Behavior Composite Score 58,             tor stood behind and to the left of the student.
Vineland Adaptive Behavior Scales: Sparrow et
al., 1984]. She was able to read 25 sight words
                                                        Materials and Equipment
on a primer level and knew the sounds for all
letters. She was working on blending sounds             A Cannon ZR 830 digital video camcorder was
to read words. Her comprehension skills were            used to make all video recordings and still
stronger when read to than when she read a              photographs. The camera record button was
passage. She copies sentences and was work-             stopped between recordings of each video
ing on writing simple three word sentences.             prompting segment (step of the task analysis)
She used a calculator to complete simple ad-            for each recipe. Video recordings were made
dition and subtraction problems with remind-            using an adult model unfamiliar to the stu-
ers for entering decimal points. She could tell         dents. During recording of each step a voice
time on the hour and half hour and need to              over procedure was used to record directions
tell time on five minute intervals. She could           (verbal prompts) provided by the person op-
count by fives and tens, recognized all coins           erating the camera. Video recordings were
and their values and was working on counting            downloaded through the fire wire port of the
coin and dollar combinations to $5. She was             camera to a Dell Latitude ⫻ 300 laptop. Video
able to care for all of her self-care needs ex-         captions were edited using Windows Movie
cept for difficult fasteners. Wanda could make          Maker, and saved on the hard drive of the
her bed, wash dishes, take out the trash, and           laptop for later importing onto the PDA. Like-
follow simple recipes with pictures using a             wise, photographs were downloaded to the
microwave, stove, and oven with close super-            laptop computer through the USB port, con-
vision. Her needs included planning and                 verted to a JPEG files, saved into picture files,
cooking healthy meals, writing a grocery list,          and later imported onto the PDA. The Per-
and locating items in the grocery store. She            sonal Digital Assistant (PDA) used in the study
liked to socialize in the hallways of the high          was the Cyrano Communicator TM (Hewlett
school and had many friends from her com-               Packard iPAQ Pocket PC with pre-installed
munity. She was working on appropriate ver-             software by One Write Company). The soft-
bal behavior and body language in the hall-             ware pre-installed onto the PDA allowed for
ways. In addition to socializing with friends,          importing of pictures and video links directly
she enjoyed making puzzles, working on the              onto available templates, linking of presenta-
computer, physical education class, and play-           tion slides, and recording of auditory
ing basketball.                                         prompts. The program also allowed use of
                                                        larger photographs on the displays which
                                                        could be more readily seen and touched with
Settings and Arrangements
                                                        a finger rather than a stylus. The template
Probe, intervention, and history training ses-          selected for the current study contained three
sions, took place in the home living room at            blocks (Figure 1). A presentation slide, using
the students’ high school. The kitchen area of          the template, was created for each step of a
the home living room was arranged with all of           task analysis. The top or largest block con-
the appliances (refrigerator, stove, dish-              tained a photograph corresponding to the
washer, and sink) positioned in a single row            step of the task analysis. Photographs were
along the wall with counter space separating            downloaded from the laptop, stored on the
each appliance. The microwave was posi-                 PDA, and attached to each presentation slide.
tioned on a countertop next to the refrigera-           An auditory prompt was recorded directly
tor and the toaster oven was positioned on a            onto the PDA and played when the picture
counter top next to the electric stove. All sil-        block was touched by the student (using a
verware, utensils, skillets etc. were kept in the       finger or the stylus). The bottom left block
cabinets above and below the counters along             contained the label “movie” and linked to the
the wall. The PDA was placed flat on the                video prompt when touched. Movie files were
counter between the sink and the stove. The             downloaded from the laptop, and stored di-

426   /   Education and Training in Autism and Developmental Disabilities-September 2010
boxes, bags, jars, measuring cups, spatula, dig-
                                                     ital timer) and responses (i.e., stirring, turn-
                                                     ing, pouring, holding) (Table 1).

                                                     Experimental Design and General Procedures
                                                     A multiple probe design across three cooking
                                                     recipes and replicated with three students was
                                                     used to determine the effectiveness of a hand-
                                                     held self-prompting system, using video, pic-
                                                     ture, and auditory prompt levels, to teach
                                                     food preparation (Gast, 2009). The PDA was
                                                     operated individually by each student and
Figure 1.   Illustration of one page on the Cyrano   used to deliver all prompts for task comple-
            Communicator TM PDA.                     tion. One cooking task was performed during
                                                     each session and only one session was con-
                                                     ducted per day, 3– 4 days per week. Experi-
rectly on the PDA. The video caption played          mental conditions occurred in the following
immediately, using Windows Media Player,             sequence: history training for PDA operation,
(available on the PDA) which was automati-           cooking task probe without the PDA (three
cally opened when the block was touched.             recipes), PDA prompting (first recipe), cook-
After the video caption was complete, the            ing task probe without the PDA (three reci-
movie stopped, the student closed Windows            pes), PDA prompting (second recipe), PDA
Media Player using the stylus, and the pro-          prompting probe (mastered recipe), cooking
gram then returned to the presentation slide.        task probe without the PDA (two recipes) and
The block in the bottom right corner con-            so on. Subsequent probe sessions with the
tained a picture of an arrow pointing to the         PDA following mastery of a recipe were con-
right and an auditory prompt which said,             ducted to evaluate use of the device over time
“Next”. This block was linked to the subse-          (maintenance).
quent presentation slide corresponding to the
next step of the task analysis. When the arrow
                                                     Dependent Measure and Data Collection
block was touched by the student (using a
finger or a stylus) the program automatically        During each condition, data were recorded
advanced to the next slide. A student could          for each step of the recipe task analyses shown
repeatedly touch a picture on a page and hear        in Table 1. Data were calculated and reported
the auditory prompt or touch the video block         for the percentage of steps completed inde-
and replay the video recording as often as           pendently using the PDA regardless of the
needed until the step was completed, how-            prompt level used on the PDA. Although the
ever, the program only advanced forward and          primary dependent variable was the percent-
students could not go back or “rewind” to a          age of steps completed independently correct
step. The last presentation slide for each cook-     for each recipe, the type of prompt level the
ing recipe contained a photograph of the fin-        student used on the PDA in order to complete
ished food item, an auditory prompt “fin-            the step (independent, picture only, pic-
ished”, and a video recording of the finished        ture ⫹ auditory, or video) was also recorded.
food item on a plate with the voice over, “Fin-
ished, you may eat the ____.”
                                                     History Training
   Three cooking recipes were selected which
sampled three modes of food preparation:             Prior to the first probe session, students par-
stove top (grilled ham and cheese sandwich),         ticipated in instructional sessions to teach op-
microwave (Hamburger Helper Microwave                eration of the PDA. A washer and dryer were
Singles), and toaster oven (individual serving       present in the home living area and a self-
size pizza). Recipes ranged from 19 to 25 steps      prompting program with five presentation
and required use of a range of stimuli (i.e.,        slides was developed for operation of the

                                                                        Personal Digital Assistant   /   427

Task Analysis for Cooking Recipes

Hamburger Helper Microwave Singles (19 steps)
Get box of Hamburger Helper from cabinet and put on counter
Get 1 cup measuring cup from drawer and put on counter
Get small spoon from drawer and put on counter
Get 2 oven mitts from on top of the microwave and put on counter
Get white mixing bowl from cabinet and put on counter
Open box and take out one packet
Get scissors from drawer, cut open packet and pour contents into bowl
Fill measuring cup with water from sink and pour water into bowl
Stir mixture 8 times, put spoon on counter
Put bowl in microwave, close door, Press “5” “0” “0” “Start:
Wait 5 min for microwave to “ding”
Take bowl out of microwave using oven mitts, put on counter, close microwave door and stir mixture 8
Close box and put in cabinet
Put oven mitts on top of microwave
Put measuring cup in sink
Put spoon in sink
Throw empty packet in trash can
Put scissors in drawer
Grilled Ham and Cheese Sandwich (24 steps)
Get skillet from cabinet and put on front right stove burner
Get plate from cabinet and put on counter
Get spatula from drawer and put on counter
Get cooking spray from cabinet and put on counter
Get bread from refrigerator and put on counter
Get 2 slices of cheese from refrigerator shelf and put on counter
Get package of ham from refrigerator shelf and put on counter
Take off lid of cooking spray and spray bottom of skillet 6 times
Open bread and place 2 slices of bread in skillet
Unwrap 2 slices of cheese and place one slice on each slice of bread
Open package of ham and place one slice of ham on top of one cheese slice
Turn stove dial to “medium”
Get kitchen timer from kitchen drawer
Press minute button two times and press “start”
Wait 2 minutes for timer to beep
Turn stove dial to “off”
Get spatula and place one slice of bread/cheese/ham on top of other, lift sandwich from skillet with
   spatula and place on plate
Close bread with bread clip and put in refrigerator
Put ham in refrigerator
Place lid on cooking spray and put in cabinet
Put cheese wrappers in trash can
Put spatula in sink
Put timer in drawer
Individual Serving Size Pizza (25 steps)
Get plate from cabinet and put on counter
Get knife from drawer and put on counter
Get pizza dough packet from refrigerator and put on counter
Get pizza sauce bottle from refrigerator and put on counter
Get cheese package from refrigerator and put on counter

428   /   Education and Training in Autism and Developmental Disabilities-September 2010
TABLE 1    (Continued)

Get pepperoni package from refrigerator and put on counter
Get mushroom container from refrigerator and put on counter
Get oven mitts from on top of microwave and put on counter
Open pizza dough packet and put one piece on plate
Open pizza sauce and squirt 3 rotations on dough
Hold knife and spread sauce around on dough
Open cheese package and sprinkle one handful of cheese on dough/sauce
Open pepperoni package and place 5 slices on top of dough/sauce/cheese
Open mushroom container and place 5 pieces of mushrooms on top of dough/sauce/cheese/pepperoni
Open toaster oven door, place pizza on cooking sheet inside oven
Close toaster oven door, turn top dial to “bake” and bottom dial to “5 minutes”
Wait for timer to ding, put on oven mitts, open door, pull out cooking sheet and place on top of stove,
  close toaster oven door
Get spatula from drawer and use to place pizza on plate
Put oven mitts on top of microwave
Put spatula in sink
Put knife in sink
Close mushrooms and put back in refrigerator
Close sauce and put back in refrigerator
Put pepperoni, cheese, and dough back in refrigerator

dryer. The self-prompting program followed              cooking recipes prior to instruction and with-
the same format as those used for the three             out use of the self-prompting system. Initial
cooking tasks. Students were taught individu-           probe sessions were conducted individually
ally how to operate the different functions of          for a minimum of three sessions per recipe or
the PDA using a stylus and their fingers. These         until data stabilized. Subsequent probe condi-
functions included: (a) looking at the picture          tions without the PDA system were conducted
prompt; (b) touching the photograph to hear             for one session per recipe immediately follow-
an auditory prompt; (c) touching the “movie”            ing mastery of a cooking task (Probe 2– 4).
block to watch the video prompt; (d) closing            Each session consisted of one trial for one of
the movie by touching a small box in the                the recipes. Trials began with the instructor
upper right corner of the digital display using         showing the student a photograph of the item
the stylist; and (e) touching the arrow block to        to be prepared and delivering the task direc-
advance to the next presentation slide. Stu-            tion, “It’s time to cook ______,” or “Cook the
dents were also taught to touch the screen if it        ____.” The instructor then waited 3 seconds
went blank during the activity. The PDA was             for the student to respond by initiating the
programmed to shut down after a period of               first step for preparing the recipe. Students
approximately 25 seconds of non-use in order            could perform each step of the task analysis
to conserve the battery. In addition to opera-          correctly, incorrectly, or not respond. Steps
tion of the device, students were taught to             for each task analysis were performed by an
complete a step and return to the PDA before            adult without disabilities prior to the study to
advancing the program to the next slide. His-           determine criterion levels for duration. A cor-
tory training, using a system of least prompts          rect response was recorded if the student ini-
procedure, continued until a student was able           tiated a step within 3 seconds of the previous
to independently operate all functions of the           step and completed the step within 30 seconds
device to complete the clothes drying task.             following initiation of the step. Incorrect re-
                                                        sponse was defined as: (a) initiation within 3
                                                        seconds, but failure to complete a step within
Probe Procedures: Cooking without the PDA
                                                        30 seconds of the previous step (duration);
The first probe condition served to evaluate            (b) initiation within 3 seconds of the last step,
each student’s ability to complete the three            but failure to complete the step correctly (to-

                                                                         Personal Digital Assistant   /   429
pographic); and (c) no response, character-             corresponding presentation slide (indepen-
ized by failure to initiate a step within 3 sec-        dent).
onds of the end of the previous step. Failure to           For each step of the recipe a student could
complete a step or initiate a step was also             perform a step correctly or incorrectly, or not
recorded if a student verbally expressed that           respond. An unprompted correct response
he/she did not know how to complete a step.             was defined as initiating a step within 3s and
If a student performed a critical step incor-           completing a step within 30s following the
rectly or did not respond, the instructor               PDA prompt. Students could also navigate
blocked the student’s view and performed the            their way through the prompt levels. For ex-
critical step. A step was considered critical if        ample, a student could look at the photo-
subsequent steps could not be completed                 graph (picture only) and decide that he/she
without the step’s completion (e.g. putting             needed a more intrusive prompt. He/she
the dough on the plate so that the sauce,               then touched the photograph and listened to
mushrooms etc. could be placed on the                   the verbal prompt (picture ⫹ auditory). He/
dough). Students received verbal praise for             she could attempt to complete the step or
attempting steps and for attending to the ma-           progress to a more intrusive prompt level –
terials on an average of every third step (VR-          video prompt. In order to be considered an
3). Students could also eat the food at the end         unprompted correct response, the student
of the session, offer it to another classmate or        was required to initiate the next prompt level
staff member, or save it for later consumption          within 3s of hearing and/or seeing the less
if they so desired.                                     intrusive prompt. A student could also return
                                                        to the system for further prompting on the
                                                        same level or to receive prompting on a more
Self-Prompting PDA Procedure
                                                        intrusive level after a step was initiated. In this
During each cooking session, using the self-            case, an unprompted correct response was re-
prompting system, the PDA was placed on the             corded if the student did so within 30s of
kitchen counter and was used by the student             initiating the step.
to navigate through each step of the task anal-            An incorrect response was defined as (a)
ysis. Each session began with the instructor            initiation of a step within 3s following the
turning on the PDA and locating the correct             prompts, but incorrect performance of the
recipe. The first presentation slide contained          step (topographic); (b) initiation within 3s
a photograph of the recipe to be prepared               but failure to complete the step within 30s of
and an arrow block at the bottom right side of          the prompt (duration); or (c) no response,
the page. The student was given the task di-            whereby the student failed to initiate a re-
rection, “Touch the arrow and start cooking             sponse within 3s of the PDA prompt. If an
the _____using the iPAQ,” (the PDA was re-              incorrect response occurred, the instructor
ferred to as an iPAQ rather than a Cyrano               prompted the student (i.e., said, “Touch the
Communicator because this was the label                 ______” while pointing to the block) to use
found on the outside of the PDA). The stu-              the PDA to perform the step correctly
dent then touched the arrow block which                 (prompted correct). When the instructor
linked to the next presentation slide contain-          prompted the student back to the PDA, she
ing prompts for the first step of the task anal-        pointed to the next intrusive prompt level. For
ysis. Following the model of the system of least        example, if the student touched the photo-
prompts (SLP) the student could look at the             graph, listened to the verbal prompt (pic-
photograph on the slide and complete the                ture ⫹ auditory) and responded incorrectly,
step (picture only), touch the photograph and           the instructor prompted the student to touch
hear an auditory prompt (i.e., “put the dough           the video block.
on the plate”) (picture ⫹ auditory), and/or                If a student failed to perform a step cor-
touch the video block and watch a video cap-            rectly after being directed through all of the
tion of the step being modeled along with a             prompt levels on the PDA (incorrect
verbal description of the step (video). The             prompted response), the instructor per-
student could also complete steps of the task           formed any critical steps (while blocking the
analysis without advancing the system to the            students view) followed by directing the stu-

430   /   Education and Training in Autism and Developmental Disabilities-September 2010
dent to touch the arrow block to advance to       condition for level of prompt used by the
the next presentation slide. If the step was      student (range ⫽ 94.7%–100%)
not defined as critical (subsequent steps did        Procedural reliability data were recorded
not rely on its completion) the student was       for the following instructor behaviors when
immediately prompted to touch the arrow           implementing the study: (a) prompting use of
block. No other prompts were provided for         the PDA; (b) delivery of reinforcement; (c)
task completion by the instructor. Students       blocking student’s view when completing crit-
received descriptive verbal praise on a VR-3      ical steps; (d) assuring that materials and
schedule of reinforcement for unprompted          equipment were in proper locations and work-
and prompted correct responses. At the end        ing order; and (e) turning on the PDA and
of the session the student could also eat the     delivering task directions. Agreement was cal-
prepared food item, package it to be eaten        culated by dividing the number of each ob-
at a later time, or offer it to another student   served instructor behavior by the number of
or staff member. After criteria was reached       opportunities, multiplied by 100 (Billingsley,
for one recipe (100% unprompted correct           White, & Munson, 1980). Mean procedural
for one session), one probe session was con-      accuracy was 97.9% (range ⫽ 90.9%–100%).
ducted to evaluate the student’s completion       Errors occurred, for example, when a high
of the currently mastered recipe and any          school staff member removed the bowl from
remaining recipes without use of the PDA.         the cabinet, the safety cap was not removed in
In addition, mastered recipes were probed         advance from a new bottle of pizza sauce,
using the PDA during subsequent training          Wanda left to go to the bathroom and the
conditions to measure maintenance.                skillet was removed from the stove to prevent
                                                  burning, student held finger on “next” icon
                                                  too long and the program jumped ahead of
Social Validity
                                                  the target slide, bread clip was not placed on a
On the day that each student finished the last    new loaf of bread, and the handle broke on
probe session, each was shown the PDA, a          the measuring cup.
portable DVD player, and a picture-based
cookbook. The instructor showed each stu-
dent a portion of a recipe and operation of
the portable DVD player (video and voice over     Figures 2, 3, and 4 show the percentage of
prompts). The instructor also explained one       steps performed independently correct by
recipe and how to look at and cross off pic-      each student across the three cooking recipes
tures in the cookbook. The instructor then        during probe sessions without the self-prompt-
showed the student a box of pudding and           ing device and during PDA self-prompting ses-
asked, “If you were going to make the pud-        sions. Visual inspection of the figures reveals
ding, which of these would you like to use?”      an immediate and abrupt increase in steps
                                                  completed independently after introduction
                                                  of the PDA system and that performance was
                                                  maintained over time. Although students
Interobserver agreement and procedural reli-      could perform some steps prior to use of the
ability data were recorded simultaneously on      PDA, performance remained low during
33.3% of all sessions across probe and self-      probe sessions with the exception of Wanda
prompting PDA conditions. Interobserver           for making individual serving size pizza. It is
agreement was calculated using the point-by-      possible that her level of performance in-
point method in which the number of instruc-      creased prior to use of the PDA because she
tor and observer agreements was divided by        saw the final product (pepperoni, cheese etc.
the number of agreements plus disagreements       on the pizza) when her classmates brought the
and multiplied by 100. Mean interobserver         pizza into the classroom to share with class-
agreement for student independent correct         mates. In addition, some steps were repeated
responses was 98.8% across all students and       across recipes and Monica, for example, be-
conditions (range ⫽ 94.7%–100%) and 98.1%         gan to obtain potholders independently be-
across all students during the self-prompting     fore using the PDA on her last recipe.

                                                                  Personal Digital Assistant   /   431
Figure 2.    Percentage of steps performed correctly by Andy across the three cooking recipes.

432   /   Education and Training in Autism and Developmental Disabilities-September 2010
Figure 3.   Percentage of steps performed correctly by Monica across the three cooking recipes.

                                                                   Personal Digital Assistant   /   433
Figure 4.    Percentage of steps performed correctly by Wanda across the three cooking recipes.

434   /   Education and Training in Autism and Developmental Disabilities-September 2010
Figure 5.    Percentage of steps performed using each PDA prompt level across three cooking recipes and
            three students.

   As reflected in Figures 2– 4 students were         incorrectly and was prompted by the instruc-
able to learn to independently use the PDA            tor to look at the picture (next prompt level).
self-prompting system to complete recipes                Figure 5 presents the percentages for each
without instructor prompts. Andy and Monica           prompt level used by each student across the
required the greatest number of sessions to           three cooking recipes during self-prompting
criteria on their first recipe, however, Wanda        and probe sessions with the PDA. Students
increased her number of sessions to criteria          showed trends toward requiring less intrusive
on the second recipe. Although the ham and            prompt levels (video and picture ⫹ audio)
cheese recipe (Wanda’s first recipe) required         within and across tasks. All three students
24 steps (compared to 19 steps for microwave          used video for the greatest amount of time
hamburger helper), it appears that students           during the first session of the their first recipe
found this recipe less difficult to perform           (Andy 78.9%, Monica 72%, and Wanda 37.5),
when using the PDA. Errors across all recipes         but quickly faded it’s use within the second
were most frequently committed when stu-              session (Andy 0%, Monica 2%, and Wanda
dents initiated completion of a step without          8.3%) and subsequently relied less on video
using the PDA and performed the step incor-           across the first session of the remaining reci-
rectly, thus requiring the instructor to prompt       pes (i.e., use of video on first session of second
them to use the devise. This behavior oc-             recipe: Andy 13.6%, Monica 25%, and Wanda
curred with Wanda when completing her sec-            21.1%). With the exception of Monica on her
ond recipe. She proceeded to perform a step           last recipe, students infrequently used the pic-

                                                                       Personal Digital Assistant   /   435
ture ⫹ audio feature of the PDA, but instead            for more difficult steps (Mechling & Stephens,
they frequently accessed the picture prompt if          2009) or may need to refer back to more
they were unable to perform a step indepen-             intrusive prompt levels when a task is not con-
dently. This behavior continued for each stu-           tinuously performed
dent into maintenance sessions when students               The small number of students participating
were presented with the PDA for use with                in the study calls for future research to repli-
previously mastered recipes.                            cate the findings. Furthermore, additional
                                                        studies are needed to investigate use of self-
                                                        prompting systems with multiple prompt lev-
Social Validity
                                                        els across other disabilities and tasks. Of inter-
When presented with a choice of the PDA,                est, for example, would be how students with
portable DVD player, or picture cookbook to             autism use the system and on which prompt
hypothetically cook pudding, all three stu-             levels they would rely (visual, auditory, video).
dents responded that they would like to use             Further evaluation of different tasks may pro-
the portable DVD player because it had mov-             vide information concerning whether some
ies. Imitating a cable television cooking pro-          activities or steps are better suited for video
gram, Monica further said that she wanted to,           modeling or prompting or whether pictures
“Watch the movies and be an iron chef.”                 or auditory prompts will suffice. Furniss et al.
                                                        (1999) stated that the nature of the task rather
                                                        than students’ abilities likely influenced suc-
                                                        cessful use of a PDA in their study.
As the technology of PDA systems progresses                A limitation of the current study was that
and prices lower (Swan, Swan, Van Hover, &              there was no further clustering of task steps as
Bell, 2002), handheld computers may be a                they were learned or a change in the photo-
low-cost, effective means for students to have          graphs or video segments used. As tasks are
access to information anywhere at anytime               learned it may be beneficial to cluster steps
(van ‘t Hooft & Vahey, 2007). The current               into fewer pictures or combine multiple video
study supports previous research reporting              segments into fewer segments (Furniss et al.,
that students with intellectual disabilities can        1999). Students may initially require video
learn to use an electronic, portable, handheld          prompting and then move to lengthier video
prompting system to independently complete              segments that resemble video modeling (Can-
tasks (Cihak et al., 2008; Davies et al., 2002b,        nella-Malone et al., 2006). It is important to
2003; Riffel et al., 2005; Taber-Doughty et al.,        select methods of instruction that match the
2008; Van Laarhoven et al., 2007). The study            needs of the individual students (Simpson,
extends the research literature evaluating              2005). One critical advantage of a PDA is the
handheld self-prompting systems by using a              ability to individualize the system to meet the
system that provided picture, auditory, and             needs of each student (Furniss et al., 1999).
video prompting within one program.                     Future studies may wish to investigate the
   Students demonstrated the ability to inde-           adaptability of prompts as a student’s perfor-
pendently use a PDA to self-prompt comple-              mance progresses, presentation of cues at the
tion of the three cooking recipes without the           student’s own individual pace (Davies et al.,
need for external adult prompting. An impor-            2003), and other customization features that
tant contribution of the current study was              can be adapted to the individual. For exam-
demonstrating the ability of students to deter-         ple, realistic photographs and video segments
mine what level of prompting they needed or             from the student’s actual environment may
preferred. Students initially used more intru-          assist with acquisition of skills compared to
sive levels of prompts if needed and self-faded         generic stimuli on commercial programs. The
these levels of prompts (i.e., video to photos),        current study used custom-made photographs
later re-instituted use of more intrusive               and video recordings that exemplified each
prompt levels when needed (i.e., during main-           student’s cooking environment. Future re-
tenance sessions), or used no prompts at all.           search may need to compare the benefits of
These results show that students may initially          customized verses commercially available soft-
need video prompts rather than photographs              ware programs for prompting tasks. Although

436   /   Education and Training in Autism and Developmental Disabilities-September 2010
easier to obtain, commercially available prod-     use by the general public (Davies et al.,
ucts may be more costly. The question re-          2002b) and their non-obtrusive format that
mains, are commercial products as effective as     does not make students stand out among
those made specifically for each student? In       peers in school (Myles, Ferguson, & Hagiwara,
addition, auditory recordings pertinent to the     2007).
student such as key words or a student’s name
may be used to gain attention before present-
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