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Assignment 3: Instructional Program


Literature Review
According to research, acquiring adaptive skills is a key to independence for individuals with autism
spectrum disorder. These skills are crucial for daily living, for better quality of life and for greater personal
independence. Experts further stated that individuals on the autism spectrum need to be explicitly taught
adaptive skills which include toileting, washing and drying of hands, and dressing as these are imperative to
adulthood (Sarris, 2014).

Bennett and Dukes (2014), stated that many experts in special education

recognized the importance of teaching functional skills to individuals with disabilities, in order that they be
as independent as possible and successful in their current and future environments; in employment and
community settings. Storey and Miner (2011) similarly wrote that learning functional skills allow maximum
performance in employment, community and independent living skills related to the criterion of ultimate
functioning.
Toileting, washing and drying of hands, dressing are complex self-care skills for children particularly for
those with autism spectrum disorder and other disabilities. Children with ASD are observed to display a
delay in adaptive skills such as basic self-care and hygiene practices and behaviours. Hence toileting, hand
washing and drying, and dressing can be difficult for these children due to a sensitivity in their sensory
system or incidental learning of these skills do not happen easily. It is fundamental to teach and support
young children with ASD in their development of adaptive skills and behaviours to encourage independence
and self-confidence (Texas Statewide Leadership for Autism Training, 2012).

Achieving personal

independence in these skills allows individuals with disabilities to participate in community activities and to
develop a sense of self-confidence and responsibility (Cicero & Pfadt, 2002). In other words, opportunities
for social interaction with others and participation in a wider range of activities are created (Cicero & Pfadt,
2002). It is also important to note that children with ASD have core deficits due to autism spectrum disorder
and they are unable to learn or refine daily self-care skills easily through participation in their environment.
In addition, their difficulties with generalizing skills and behaviours makes it important to encourage them to
make use of these skills across environments (Texas Statewide Leadership for Autism Training, 2012).
According to Ardic and Cavkaytar (2014), relevant literature have cited the success of adaptive skills
training programs using a behaviourist approach, which included positive reinforcement and operant
conditioning principles with consequences. On the hand, Van Wagenen, Meyerson, Kerr and Mahoney (n.d.,
cited in Ardic & Cavkaytar, 2014) developed the teaching of independent toileting abilities to children using
positive reinforcement and forward chaining procedures which results have proven to be effective.
Additionally, many researchers have identified core elements of effective interventions for children with
ASD. Individualized educational plan to support and meet the needs of the individual child with ASD.
Schools have the responsibility to match intervention strategies, services and support to the childs and his or
her familys characteristics. This takes into careful consideration of the childs environment, instructional

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activities and materials, the intensity of instruction and learning opportunities. Systematic Instruction (SI) is
another core element. SI is based on the principles of Applied Behaviour Analysis (ABA) and is an
effective, evidenced-based teaching method (The Chalkboard Project, 2008). According to Iovannone,
Dunlap, Huber and Kincaid (2003, cited in The Chalkboard Project, 2008), SI includes the identification of
authentic educational goals for instruction, instructional procedures for teaching, implementation, evaluation
and the adjustment of instructional procedures based on data. Iovannone et. al (2003, cited in The
Chalkboard Project, 2008) also reiterated that SI ensures that skills taught will be generalized and
maintained, and involved high levels of student engagement (Browder & Spooner, 2011 cited in Brij, 2015
lecture notes). The systematic implementation of ABA principles is to change the students behaviours. The
student will learn both adaptive and maladaptive behaviours and learning takes place due to the
consequences of the behaviours. In addition, a predetermined prompting method, such as the least-to-most
prompting system, most-to-least prompting system, graduated guidance, simultaneous prompting and time
delay, is systematically implemented to increase the students response to intervention (Brij, 2015, lecture
notes).
Researchers also emphasized the importance of specific curriculum content.

This would include the

inclusion of teaching the child basic daily living skills that will increase independence, control of the
environment and better functional performance in future. The next core element of effective intervention is
family involvement. Parents involvement are crucial as they help to provide structure and stability, in goals
setting, selection of instructional strategies, and providing consistency in the implementation of strategies at
home and in community settings. This will enable the child with ASD to generalize skills learned, across
settings (The Chalkboard Project, 2008).
Instructional Program
Student Description
Student L is a 4-year-old boy and the only child of his parents. He was diagnosed with Autism Spectrum
Disorder (ASD) and attends the Early Intervention Programme at Rainbow Centre since January 2014.
Student L is a happy and active child. His grandparents care him for after he returns home from the Centre
while his parents are at work. He spends most of his time at home playing with toy cars, a soft ball,
doodling on the doodle board, running about the apartment, watching advertisements and Chinese news
telecasts on television with his grandmother. Student L has difficulty with speech. He is unable to produce
speech sound to effectively communicate with his parents. He often babbles with word-like sounds, which
often poses a challenge for his parents and paternal grandparents to understand his needs and requests.
When he wants his parents attention, he has learned to grasp their hand and lead them to either play with
him or to retrieve something for him. Student L displays stereotyped body movements such as jumping with
hand flapping movements. According to his parents, the frequency of his jumping and hand flapping
movements have decreased as they have been reminding him to only clap when he is happy or feels excited.

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Chua Anne May 210054
At the Rainbow Centre, the Assessment Evaluation Programming System (AEPS) Child Observation Data
Recording Form (CODRF) from birth to three years is the main assessment tool used to target goals for
Student L every year. According to the AEPS, in the fine and gross motor domain, Student Ls score was
80%, which is equivalent to the developmental age of a 3 years child. In the adaptive domain, he is able to
swallow liquids, brings food to mouth using utensil and also picks food with fingers. He showed emerging
skills in this domain such as washing and drying hands, transferring food and liquid between containers,
biting and chewing hard on chewy and crisp foods and to put on shirt and pants. In the cognitive domain, he
is able to locate objects in more than two hiding places and is able to activate mechanical toys. He
demonstrated emerging skills such as retaining objects with new objects are obtained, solving common
problems (eg. taking a chair to stand on when reaching an object that is too high for him), matching of
pictures and/or objects and using functionally appropriate actions with objects (eg. using a spoon for
feeding, using a chair for sitting, using a marker for writing). Student L is currently using the Picture
Exchange System (PECS) during snack time, free play and work time that would target his social
communication domain. In the social domain, he displayed emerging skills in responding appropriately to
adults (eg. responding with hi-five when parents initiate), initiates communication with adults (eg. grasp
hand leading to what he wants), uses appropriate strategies to self-soothe (eg. going to a corner or confined
space when upset) and participates in established social routines with transitional prompt (eg. giving visual
card for work time after free play).
Current Living Environment and Educational Setting
Student L live with his parents and paternal grandparents in a three room apartment. The apartment has a
living room, two bedrooms, a kitchen and two toilets. Upon entering the apartment, is the dining table. A
walking space separates the table from the couch and the coffee table. A television is placed in front of the
coffee table and is near the window. The bedrooms are situated to the left of the living room, one of which is
the master bedroom has an attached toilet. The other toilet is located in the kitchen area. The master
bedroom is occupied by student L and his parents. His paternal grandparents occupy the other bedroom.
The bedrooms are furnished with a queen sized bed, wardrobe and dressing table with the exception of an
extra mattress on the floor near the window in the master bedroom. According, to student Ls parents, he
sleeps on this mattress. The kitchen is also located to the left of the dining area and it is furnished with a
stove, cabinets, a refrigerator and a sink.
Student L is engaged in a learning centre where the space is shared with two other classes. There are three
classrooms in the learning centre and student L participates in one of them. His classroom includes
designated spaces for his work station, circle time and group activities. Outside of his classroom includes a
free play area and a snack area. The snack area includes a sink, tables and chairs. Overall, there are different
areas to different activities that Student L participates in.

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Chua Anne May 210054
Students Characteristics
Wash and Dry Hands. At home, Ls parents have said that he is able to understand the verbal instruction of
washing hands when told to do so. However, when at the sink, L is not able to switch on the tap as the tap
switches on and off with a upward and downward motion. Parent needs to switch on the tap before he puts
his hands under the water. Parent also needs to instruct him on the next step to use liquid soap in a pump
bottle. L is able to put soap on his hand with hand over hand assistance. He then washes his hands under
running water independently. He will then be instructed to off the tap with assistance and dries his hands
using the towel hung on the rack independently. Similar behaviour is displayed at school as well.
Toileting. In school, L has his diapers on. He receives some assistance from his teacher in school when he
needed a change of diapers during toileting. Ls parents have expressed their desire for him to be toilet
trained in school. At home, as Ls parents are both working, Ls toileting needs are supervised by his paternal
grandmother after his school hours on weekdays by changing of his diapers when needed. In the evenings
on weekdays and all day on weekends, Ls parents would follow a two-hour toilet routine (bringing him to
the toilet every two hours). L will be lead to the master bedroom toilet by his parents and they would get
him orientated with the child sized potty such as sitting on it for a at least 20 seconds before getting up and
wearing his pants again.
Dressing.Student L is able to undress independently. He is able to take off his pants by pulling them down
and also taking off his shirt as. However, to put on t-shirt and pants, L will be assisted by an adult at home.
The adult would hold up the round-neck t-shirt over his head and pulls it over his head. L will then be
prompted to lift his arms and prompted to put his arms into the shirt sleeves accordingly. The adult will then
assist him to adjust his t-shirt over his torso. When wearing pants, the adult will provide full assistance by
holding his pants and indicating to L the foot to put into the pant leg. Adult will pull up the waistband of the
pants over his hip up to his waist to complete the dressing.
A. Objectives and Task Analysis
Listed below is the objective for the cluster of three skills that we will target for Student Ls instructional
program.
At home and in the school toilets, Student L will independently perform his toileting routine, wash and dry
his hands in 3 out of 5 times a week. When given his pull up pants, he will independently dress in 3 out of 5
times in a week.
Listed below is the task analysis for the cluster skills selected:
Toileting (Applied from Bowell & Grey, n.d.)
1. Enters the bathroom
2. Pulls pants down below knee level

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Chua Anne May 210054
3. Turns around, back to the toilet
4. Sit on toilet
5. Urinate and remain seated until urine stops completely
6. Stand up
7. Get toilet paper
8. Wipe off urine with toilet paper
9. Throw toilet paper in the toilet
10. Pull up pants with both hands
11. Flush toilet
Wash and dry his hands (Applied from Brij, 2015)
12. Go to sink
12. Extend the palm of one hand in front of soap pump
12. Use other hand to pump out one squirt of soap into extended hand
12. Rub hands together
12. Turn on tap
12. Put both hands together and rub hands under the water
12. Rub hands until all soap has rinsed off
12. Turn off tap
12. Walk to towel rack
12. Rub hands together with the towel
Dressing (Applied from Brij, 2015)
22. Pick up pants with both hands, holding pants by the waistband
22. Sit down on child sized chair or on the floor
22. Turn pants so that the back side of the waistband with the label is close to their belly
22. Hold the waistband with arms extended outwards
22. Bend and put foot into pant leg for same side of the leg
22. Continue to hold waistband while other foot goes into the other pant leg for the same side
22. Extend legs to the end of both pant legs while holding the waistband
22. Stand up
22. Pull waistband of pants up to waist

B. Location of Instruction

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The environment when L will be instructed in will be his home toilet and the school toilet.
C. Baseline / Probe Procedures
Listed below is the assessment checklist where parents and teachers will use to probe student L during his
morning and night routine. When student L has entered the toilet, teacher / parent will provide a verbal
instruction once, wait 2 seconds and observe student Ls behaviour. Each step will be verbalized and told to
L. If student L is able to perform the step, teacher / parent will mark a + sign. If student L is unable to
perform the step, teacher / parent will mark a -, provide physical assistance to L before moving on to the
next step.

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Chua Anne May 210054
LEARNING OBJECTIVE/GOAL

HE WILL BE ABLE TO

At home and in the school toilets, when given his pull up diapers, round neck shirt and pants
with elastic waistband, Student L will independently perform his toileting routine, wash and
dry his hands, and put on his pants and shirt respectively 3 out of 5 times a week.
#1 Home Toilet
Trial #1

1. Enters the bathroom


2. Pulls pants down below knee level

1
2
1
2

3. Turns around, back facing the toilet

1
2

4. Sit on toilet

1
2

5. Urinate and remain seated until urine stops


completely

6. Stand up

2
1

7. Get toilet paper

2
1
2

8. Wipe off urine with toilet paper

1
2

9. Throw toilet paper in the toilet

1
2

10. Pull up pants with both hands


11. Flush toilet
12. Go to sink
13. Extend palm of one hand in front of soap
pump
14. Use other hand to pump out one squirt of
soap into extended hand
15. Rub hands together
16. Turn on tap
17. Put both ands together and rub hands under
the water
18. Rub hands until all soap has rinsed off
19. Turn off tap
20. Walk to towel rack
21. Rub hands together with the towel
22. Pick up pants with both hands, holding pants
by the waistband
23. Sit down on child sized chair or on the floor

1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1

Trial #2

#2 School Toilet
Trial #1

Trial #2

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Chua Anne May 210054
25. Hold the waistband with arms extended
outwards
26. Bend and put foot into pant leg for the same
side of the leg
27. Continue to hold waistband while other foot
goes into the other pant leg for the same side
28. Extend legs to the end of both pant legs
while holding the waistband
29. Stand up
30. Pull waistband of pants up to waist

2
1
2
1
2
1
2
1
2
1
2
1
2

REMARKS

Legend
+ - student is able to perform the skill
- - student is unable to perform the skill

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Chua Anne May 210054
D. Behaviour Change Procedures
The most-to-least (MTL) prompting hierarchy strategy is chosen for behaviour change procedures. A twosecond time delay will be given at the partial physical prompt level right up to indirect verbal prompt level.
This means that the teacher will give two seconds time delay prior to giving the prompt to allow the student
to engage in the targeted step. The full model prompt level is omitted as it is not practical during the training
of toileting and dressing. The behaviour change procedures are as follows:Order of

Prompting

Prompts
1

Level
Full physical

Description

Criterion for Moving to

Teacher places hand over students shoulders and

Less Intrusive Prompt


Over three days, with

physically guides learner during

two consecutive correct

toileting
hand washing and drying
change of pants

responses to full
physical prompts

In the bathroom, the student will perform

toileting with full physical prompts over

three days
hand washing and drying with full

physical prompts over three days.


putting on pants with full physical

Partial

prompts.
Teacher will give 2 seconds delay before tapping

Over three days with two

physical

students right elbow to indicate the start of

correct responses to

toileting
hand washing and drying
change of pants

partial physical prompts

In the bathroom, the student will perform

Partial Model

toileting with partial physical prompts

over three days


hand washing and drying with partial

physical prompts over three days.


putting on pants with partial physical

prompts.
Teacher will give two seconds delay before

Over three days with two

walking in the direction of the :

correct responses to

toilet to indicate toileting


sink for hand washing
paper towel holder for drying of hands
to where the pants is placed

In the bathroom, the student will perform

partial model prompts

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Chua Anne May 210054

Gesture

toileting with partial model prompt over

three days
hand washing and drying with partial

model prompt over three days.


putting on pants with partial model

prompts
Teacher will give two seconds time delay prior to

Over three days with two

gesturing steps to student by :-

correct responding using

pointing to significant stimuli during

toileting
hand washing and drying
change of pants

gestures

In the bathroom, the student will perform


-

Direct Verbal

toileting gesture prompts over three days


hand washing and drying with gesture

prompts over three days.


- putting on pants with gesture prompts.
Teacher will give two seconds time delay prior to

Over 3 days with two

verbally prompting the student to perform the

correct responses to

following:

direct verbal prompts

steps to toileting
steps to washing and drying of hands
steps to putting on pants

In the bathroom, the student will perform

toileting with direct verbal prompts over

three days
hand washing and drying with direct

verbal prompts over three days.


putting on pants with direct verbal

Indirect

prompts
Teacher will give two seconds time delay prior to

Over three days with two

Verbal

indirect verbal prompt. The teacher will say to the

correct responses to

student

indirect verbal prompts

it time for toileting


wash your hands and then dry them
put on your pants

In the bathroom, the student will perform


-

toileting with indirect verbal prompts over

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Chua Anne May 210054

Independent

three days
hand washing and drying with indirect

verbal prompts over three days.


putting on pants with indirect verbal

prompts
Teacher brings learner to the bathroom

No prompts.

E. Reinforcement
Teacher has identified reinforcers that will be used during the instructional programme. Toy cars of various
types, soft balls, a small pillow, and doddle board. Reinforcement acts as a motivator for the student to
learn. During the instructional programme, the teacher will vary the use of the identified reinforcers. The
student will be given a reinforcer when he has correctly completed the trained step.
When the student has correctly performed each target behaviour correctly during full and partial physical
prompt, reinforcement (small cars) will be given to him to play with it for a specified time. At the partial
model and gesture prompt levels, for each correct response the reinforcement (soft balls) will be used as a
motivator. At verbal prompts stage, the reinforcement (his favourite pillow) will be used as his motivator for
each behaviour performed correctly. When the student is able to independently perform the target skill
behaviours the reinforcement will be the doodle board.

Natasha Khoo Yi Ying 2139664


Chua Anne May 210054
F. Data Collection and Documentation
This section includes the documentation forms that parents and teachers will fill up daily. Prompts used will be filled up in the squares according to the legend
needed to help student L achieve the skill. Steps are arranged from the bottom up so that at the end of the term, a graph can be drawn (home and school) to
determine if student L has improved in the level of prompts and level of independence for each of the skills.
LEARNING GOAL & OBJECTIVE/s

At home and in the school toilets, when given his pull up diapers, round neck shirt and pants with elastic waistband, Student L will
independently perform his toileting routine, wash and dry his hands, and put on his pants and shirt respectively 3 out of 5 times a week.

Steps

S
E
T
T
I
N
G

2
30. Pull waistband of pants up to
waist

1
2

29. Stand up

1
2

28. Extend legs to the end of both


pant legs while holding the
waistband

1
2

27. Continue to hold waistband


while other foot goes into the other
pant leg for the same side

1
2

26. Bend and put foot into pant leg


for the same side of the leg

1
2

25. Hold the waistband with arms


extended outwards

1
2

24. Turn pants so that the back side


of the waistband with the label is
close to their belly

1
2

Setting 1: Home
Week 1
M

W F

Setting 2: School
Week 2

Week 3
F

Week 4
F

Week 5
M

Week 6
F

Week 7
F

Week 8
F

W F

Week 9
M

W F

Week 10
M

Week 11
M W

Week 12
M W

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Chua Anne May 210054
23. Sit down on child sized chair or
on the floor

1
2

22. Pick up pants with both hands,


holding pants by the waistband

1
2

21. Rub hands together with the


towel

1
2

20. Walk to towel rack

1
2

19. Turn off tap

1
2

18. Rub hands until all soap has


rinsed off

1
2

17. Put both ands together and rub


hands under the water

1
2

16. Turn on tap

1
2

15. Rub hands together

1
2

14. Use other hand to pump out


one squirt of soap into extended
hand

2
13. Extend palm of one hand in
front of soap pump

1
2

12. Go to sink

1
2

11. Flush toilet

1
2

10. Pull up pants with both hands

1
2

9. Throw toilet paper in the toilet

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Chua Anne May 210054
2
8. Wipe off urine with toilet paper

1
2

7. Get toilet paper

1
2

6. Stand up

1
2

5. Urinate and remain seated until


urine stops completely

1
2

4. Sit on toilet

1
2

3. Turns around, back facing the


toilet

1
2

2. Pulls pants down below knee


level

1
2

1. Enters the bathroom

REMARKS

Systematic Instruction

Graduated Guidance

System of Least Prompts

Most to Least
Prompts :

(I) Independent

Simultaneous Prompting
(V) Verbal

(G) Gestural

(M) Modeling

(PP) Partial Physical :

(H/S) hand at shoulder (H/E) hand at elbow

Constant Time Delay


Progressive Time Delay
(H/W) hand over wrist

(FP) Full Physical : (H/H) hand over hand

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Chua Anne May 210054

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Chua Anne May 210054
G. Maintenance and Generalization
The teacher will have a schedule for delivering the reinforcement during maintenance training. In order to
ensure that the skills learned are maintained, when each skill is performed correctly, a reinforcement will be
delivered. The teacher will present two reinforcement items and the student will be asked to make a choice.
The schedule of reinforcement will be thinned gradually. The teacher will deliverer the reinforcer within the
natural environment; the classroom.
Generalization will occur with at home and in the community with the involvement of the students family.
In the students communication booklet, the parents will be updated on the progress of the skills learned in
school. A copy of the task analysis of the skills will be sent home to parents. Natural reinforcers will be
used in the nontraining settings such as the home and community. Reinforcement will be given for general
improvement in performance of skills at home and in community settings.
Rationale for choice of methods/procedures
According to Eren, Deniz and Dzkantar (2013), teaching skills using most-to-least (MTL) prompting
system is an efficient method in teaching individuals with autistic features. This method is defined as
offering prompts by following a prompt hierarchy from using prompts that require the most control to
prompts, which require the least control. Using MTL is also effective on generalization of concepts and
abilities that students with ASD learn. The use of task analysis and the most-to-least (MTL) with a twosecond delay prior to prompting procedure for this instructional programme are based on the students
characteristics, family preference on type of skills to be taught, and the complexity of skills. Children with
ASD experience challenges in understanding, planning and executing multi-step tasks which involve the
executive functioning. The task analysis helps to break a seemly large task into small specific tasks hence
children with ASD will be able to understand, achieve mastery of these smaller tasks and finally learning a
skill that is important for personal independence and hygiene (Rudy, 2014).
According to research, the learner in the acquisition of skill through the use of MTL prompting strategy, as
compared to least-to-most prompting, made fewer errors but took a slighter longer time. The two seconds
time delay is incorporated in the MTL prompting procedure to give the student an opportunity to respond
independently (Libby, Weiss, Bancroft & Ahearn, 2008). The MTL prompting technique also ensures the
student will acquire the skill gradually and systematically at each prompt level. When any error occurs on
the training step or previous learned step, the student will immediately be corrected. The student may also
be required to be retrained on the current training step and all previous acquired steps if two consecutive
errors occur during training (Libby, Weiss, Bancroft & Ahearn, 2008).

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Chua Anne May 210054
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