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FACILITATING CONVERSATION USING SMART PHONE PHOTO
ALBUMS FOR A YOUNG ADULT WITH INTELLECTUAL DISABILITIES
A thesis submitted to the faculty of San Francisco State University
In partial fulfillment of the requirements for
the Degree
3(^
2 0 1£
' X33Master of Arts
In
Special Education
by
Jennifer Forbes Kabbabe
San Francisco, California
May 2015
CERTIFICATION OF APPROVAL
I certify that I have read Facilitating Conversation Using Smart Phone Photo Albums for
a Young Adult With Intellectual Disabilities by Jennifer Forbes Kabbabe, and that in my
opinion this work meets the criteria for approving a thesis submitted in partial fulfillment
of the requirement for the degree Master of Arts in Special Education at San Francisco
State University.
LLa»~1~Pamela Hunt, Ph.D. Professor
Yvonne Bui, Ph.D. Department Chair
FACILITATING CONVERSATION USING SMART PHONE PHOTO ALBUMS FORA YOUNG ADULT WITH INTELLECTUAL DISABILITIES
Jennifer Forbes Kabbabe San Francisco, California
2015
This paper reviewed recent literature on hand-held technology and communication book
use to facilitate conversation for students with moderate to severe intellectual disabilities.
The study sought to investigate whether a young adult student with a moderate to severe
intellectual disability could use pictures on his smart phone to increase the number of
social initiations he made to familiar peers and staff across three different settings in his
community-based transition program. The study expands on the work of previous
researchers by working with a young adult student and using a smart phone to store and
deliver the intervention. The results of the study indicate that the smart phone
conversation photo album enabled the student to increase his social initiations. Results of
a survey administered reveal the intervention was perceived as effective, easy to use, and
enhanced the subject’s relationships with his peers.
I certify that the abstract is a correct representation of the content of this thesis
s ~ l t ( h rChair, Thesis Committee Date
TABLE OF CONTENTS
List of Tables.............................................................................................................................v
List of Figures...........................................................................................................................vi
Introduction............................................................................................................................... 1
Method......................................................................................................................................10
Participants...................................................................................................................10
Setting.......................................................................................................................... 13
Independent Variable..................................................................................................15
Dependent Variables and Measures.......................................................................... 17
Interobserver Agreement........................................................................................... 19
Social Validity............................................................................................................22
Procedures................................................................................................................... 23
Results...................................................................................................................................... 27
Social Initiations.........................................................................................................27
Social Validity Results............................................................................................... 30
Discussion................................................................................................................................ 33
Reference................................................................................................................................. 36
Table Page
1. Social validity survey results........................................................................... 33
LIST OF TABLES
v
LIST OF FIGURES
Figures Page
1. Smart phone make and model............................................................................. 16
2. Example data sheet............................................................................................... 18
3. Example of independent observer data sheet......................................................20
4. Social validity questionnaire............................................................................... 24
5. Results graph........................................................................................................ 28
1
Chapter 1
Introduction
The ability to interact, communicate, and converse with others is an important
component of independence, a crucial skill for building meaningful relationships, and an
important quality of life factor for individuals with intellectual disabilities (Schalock et
al., 2002). Intellectual disability, by definition, affects adaptive functioning in the realms
of language, interpersonal communication, and the ability to make and maintain
friendships (American Psychiatric Association, 2013). In addition to the physical and
cognitive mechanics that may make language and communication difficult for these
individuals, the social acuity required to understand and navigate interpersonal exchanges
and decipher relevant social cues may also be a challenge. Deficiencies in social
communication can make creating and maintaining relationships difficult for individuals
with intellectual disabilities. These deficits only become more impacted as individuals
age, as the social world becomes far more complex and nuanced into adulthood (Carter &
Hughes, 2005).
Research has demonstrated that adolescents and adults with intellectual
disabilities are, in fact, dramatically lacking in meaningful relationships and friendships.
In a survey of 235 adolescents and adults with autism, only 8.1% of them reportedly had
at least one same-aged friend outside of organized settings, and almost half (46.4%) of
this sample were reported to have no same-aged friends, either in natural or prearranged
settings (Orsmond, Krauss, & Seltzer, 2004). Even adults with intellectual disabilities
2
who are highly active in their communities have significantly restricted support networks
and develop and maintain few relationships outside of their support staff, despite a desire
to see and interact with friends more often (Lippold & Bums, 2009; McVilly, Stancliffe,
Parmenter, & Burton-Smith, 2006). There is a need for this population to increase
interaction and social communication in order to improve the likelihood that they may
develop reciprocal friendships throughout their lifetime. Helping individuals with
disabilities form and maintain meaningful social relationships would require, then, some
training in the area of navigating interpersonal communication and exchanges.
Of the numerous interventions available to support social communication, many
have focused specifically on increasing interactions between school-aged students with
disabilities and their peers. One such intervention is the use of communication books, or
picture prompt booklets, to facilitate conversation. These interventions provide visual
supports, along with training, to increase initiations, responses, and conversation topics
discussed during social exchanges (Carter & Hughes, 2005). These interventions seek to
support students with disabilities to have more social communication with their peers,
and in turn, foster friendships and relationships.
Some studies using conversation books have looked specifically at the number of
conversational turns occurring between students with disabilities and their conversation
partners, specifically for students with significant support needs and limited verbal
communication (Hunt, Alwell, Goetz, & Sailor, 1990; Hunt, Alwell, & Goetz, 1991a;
3
Hunt, Alwell, & Goetz, 1991b). In these studies, students used high-interest images in
photo albums to augment communication with their peers and family members. The
pictures in the communication books were used to guide conversation topics, as both the
student and conversation partner could refer to the images in order to generate questions,
comments, and responses during conversation. With training, the communication books
proved to increase balanced turn taking between multiple conversation partners across
various settings. In addition, these skills were found to generalize to new settings once
new communication partners received basic training on how to use the books to prompt
and facilitate conversation. The participants with disabilities also showed increases in
conversation skills such as greeting and commenting, and decreases in inappropriate
social behaviors (Hunt et al., 1990).
More recently, a number of similar studies were conducted with students of
varying communication levels and verbal abilities that sought to increase the percentage
of time intervals students with disabilities spent conversing with their peers. A study by
Hughes, Rung, and Wehmeyer (2000) looked specifically at increasing social initiations
made by students with disabilities while interacting with peer partners during 5-minute
observation periods. The students learned to use conversation books with black and white
drawings printed on index cards to visually support the initiation of comments and
questions. Non-disabled peers trained the participants to use the books to start and
maintain conversation. After the intervention was introduced, all participants showed a
rapid increase in appropriate social initiations to both familiar and unfamiliar peers, as
4
well as an increase in conversational topics discussed, and a decrease in inappropriate
social initiations. All participants reported they had made more friends at school as a
result of the intervention.
A following study by Hughes et al. (2011) implemented the conversation turn-
taking intervention with high school students with autism and intellectual disabilities,
who ranged in their verbal abilities from non-verbal to use of perseverative verbal speech.
The conversation books included laminated cards with picture communication symbols
and typed communication openers that the student either read or pointed to, depending on
their verbal skills. Students and their peer partners were trained in how to effectively use
the books and were paired for conversation during 5-minute observation sessions. During
baseline, participants rarely interacted with their peers. After participants were trained to
use their communication books, they increased their level of conversational initiations to
within the range of expected behavior of typical high school students. All participants
reported they had more friends at school after the intervention, and peers reported
enjoying talking with the participants while using the communication books.
A few years later, Hughes et al. (2013) used a similar design for students with
strong verbal and literacy skills. The communication books had 10-20 pages with a
variety of conversation topics that used text, text with a supporting picture, or text with
corresponding Braille to support students in self-prompting conversational initiations.
During baseline sessions, participants initiated in only 2% of timed intervals, with few
5
partner responses. After introducing communication books, the percentage of intervals
with participant initiations jumped to the expected range of a student without disabilities.
Likewise, conversational partner responses also increased. During follow up sessions six
to eight months later, participant performance maintained this high percentage of
interaction between students with disabilities and their non-disabled peers. As in the
previous studies, participants reported that they had more friends at school as a result of
the intervention and that the books helped them talk to their peers. Feedback from the
conversation partners provided additional support for the effectiveness and acceptability
of the intervention.
With such promising results from studies incorporating communication book use,
an important next step would be to expand similar interventions to new formats and
settings. Traditionally, communication book interventions have used printed photo
albums or bound paper index cards containing pictures or scripts to prompt
communication (Hughes et al., 2013; Hunt et al., 1991). However, many recent studies
have shown the effective use of portable technology devices, such as iPods, iPads, cell
phones, and related devices to support learning, communication, and behavior for
individuals with disabilities (Ayres, Mechling, & Sansosti, 2013). Using portable
electronic devices in the classroom has shown to increase academic engagement,
motivation, independence, on-task behavior, learning, and work performance for students
with a range of disabilities (Bedesem, 2012; Cumming & Draper Rodriguez, 2013;
Cumming, Strnadova, & Singh, 2014; Flores et al., 2012). Students have also
6
demonstrated more confidence and communication when using electronic devices in the
classroom, interacting more with their peers, utilizing peer-assisted learning to solve
problems, and communicating more in the classroom through the use of text-to-speech
applications, as well as using a device’s camera to take pictures and share personal
experiences (Campigotto, McEwen, & Demmans Epp, 2013; Cumming et al., 2014).
In addition, many students have shown a preference for using electronic devices
over visual/manual or other traditional communication modes, and students learn faster,
perform better, and maintain skills better when learning and communicating in their
preferred mode (Shane & Douglass, 2002; van der Meer, Sutherland, O’Reilly, Lancioni,
& Sigafoos, 2012; van der Meer, Didden, et al., 2012). For students with autism spectrum
disorder [ASD] in particular, interacting with electronic screen media seems to be
naturally motivating. A study that surveyed 90 parents of children with ASD indicated
that when given long amounts of leisure time, children tended to engage with electronic
media (television, video, and computer use) more than other play activities (Shane &
Albert, 2008). This natural motivation, along with the observed behaviors exhibited by
the children while interacting with media, suggested that the students’ preferred media
activities may be effective for providing educational instruction. Students with ASD also
seem to respond better to electronic media in educational settings. Moore and Calvert
(2000) found that when students with ASD were given a vocabulary acquisition task, the
students learned more words and were more motivated when words were presented by a
computer, rather than a teacher. The students were attentive to the computer condition
7
97% of the time, but only attentive 62% of the time with only a teacher present. This
evidence suggests that electronic screen media could be an effective tool for instructing
language and communication skills.
Likewise, many instructors have reported their preference for electronic
communication tools due to their ease of use, reduction of time spent preparing materials,
fewer materials required for implementation, and increased speed in students’ ability to
communicate (Flores et al., 2012). One study that increased noun and verb usage by
students with ASD by delivering scripts on an iPad showed that the iPad was preferred by
instructors over paper-based methods because the iPad stores all information in one
place, is easily transportable, may be less conspicuous than a notebook or binder, and
does not stigmatize the user due to its common use in everyday society (Ganz, Boles,
Goodwyn, & Flores, 2014).
With the advances of current technology, research should not only be limited to
iPads and iPods, as there are many devices on the market with communication software
applications and other internal tools that can be used to augment and support
communication. The widespread availability of handheld electronics and smartphones has
made the use of visual supports for individuals with disabilities more of a reality. As
Shane et al. (2012) reports, these small, portable devices can organize, store, and display
large numbers of images and videos, making cumbersome, low tech materials obsolete.
These devices allow users to access images quickly and take full advantage of
8
communication opportunities. In addition, many of these devices have internal cameras
that can capture images for on-the-spot creation of communication materials. Smart
phones allow individuals with disabilities and their caregivers to use and access both
images and videos across multiple settings for multiple communication purposes. To
date, studies that have used these devices to teach communication have focused mostly
on training students to request preferred items or activities. There is a need, however, for
future research on the use of these and similar devices for other communication purposes
such as greeting, commenting, and conversation (Kagohara et al., 2013).
The purpose of the current study is to examine whether hand-held technology
(i.e., a smart phone) can serve as an effective method of delivering a communication
book intervention to a student with an intellectual disability. The ubiquitous nature of
these devices, coupled with their ease of use and portability, makes them an ideal
candidate for providing socially acceptable and age appropriate communication support,
especially for older students and adults.
In addition to altering the format of these communication books, this study also
seeks to expand the population of participants to young adult transition students, between
the ages of 18-22, who are being educated outside of a traditional school environment.
Older students are not well represented in the current communication book literature, as
many interventions seeking to increase peer interactions have targeted younger students.
In addition, all the studies conducted with older students (high school) have been
9
completed in inclusive school settings (Carter, Sisco, Chung, & Stanton-Chapman, 2010)
It seems important, then, to consider conversation interventions for young adult students
attending education programs in community settings. The need for structured
communication and social supports for individuals with disabilities is not limited to
school-aged students in the classroom, but is relevant for individuals with disabilities of
all ages and across various settings.
To investigate this, this study will explore whether using photos on a smart phone
to support social interaction will increase the number of social initiations made by a
young adult with moderate to severe intellectual disabilities in a community-based
learning environment. This study will extend the scope of previous research on
communication book interventions to include transition-aged students, aged 18-22, and
the use of smart phones as the basis for conversational exchanges. This study will also
examine whether the communication tool is socially acceptable, easy to use, and whether
the participant feels he/she has better social relationships at as a result.
10
Chapter 2
Method
Participants
The subject of this study was Arvin, a 19-year-old, Filipino/Caucasian mixed-race
male with an intellectual disability. Arvin’s medical history states that his parents first
became concerned with his development as young as 27 months, when, despite normal
hearing and vision, he had not developed appropriate language skills for his age. Arvin
was quickly referred to special education services and began receiving early intervention
at 28 months with the initial eligibility of speech and language impaired. When Arvin
reached the 5th grade, his primary eligibility was changed to autism, and a year later, as
the result of a speech/language and psycho-educational assessment, his primary eligibility
was changed to intellectual disability, with a secondary eligibility of autism, and a third
eligibility of speech and language impaired. Arvin received speech and language services
• • th •until the end of his 12 grade year, after which this service was discontinued. Throughout
the history of his schooling, Arvin received a mix of speech and language services,
physical therapy, occupational therapy, mental health services, and specialized academic
instruction.
Arvin received his last speech/language and psycho-educational assessment at age
18. The assessment results placed him below the first percentile in both expressive and
11
receptive language, with far be low-average cognitive abilities. Arvin’s primary mode of
communication was speech, and while his articulation, fluency, and voice were within
age-level expectancy, he generally showed weaknesses in his communication skills. He
demonstrated an understanding of conversational turn taking and was able to provide
accurate answers to questions; however, he struggled to elaborate on his thoughts and
feelings or provide details on a given conversation topic. His cognitive assessment placed
him within the intellectual disability range, with weaknesses identified in leisure and
social domains and strengths identified in the areas of community use, school living, and
self-care skills.
Arvin was a student in a community-based transition program at the time of this
study. He was a positive and engaged member of his school program and was very
responsible at school. Arvin listened in class, was always polite, cooperated well with
staff, always completed tasks assigned to him, and took great pride in his work.
Socially, Arvin was well liked by staff and peers, but was often described as shy.
He was soft-spoken, seldom shared during class discussions, and rarely spoke to fellow
students unless a peer first initiated an interaction. When asked a question, Arvin would
typically answer with one or two word responses and would only provide details about a
subject if probed for specific answers. Arvin reported that he had friends in his program,
and many of his fellow students considered Arvin to be a friend; however, he rarely
interacted with these students socially. Arvin would walk past students and staff members
12
without greeting them and would spend his lunchtime sitting near peers and staff, but he
would not independently engage with them. Arvin was often overlooked in group settings
due to the fact that he rarely voiced his thoughts or opinions.
Arvin gave his full consent to participate in this research after receiving thorough
information about what to expect from the project. He had the option to remove himself
from the research at any time, without consequences, but remained an active participant
for the entire course of the study. Because Arvin was an adult student, parental consent
was not required for his participation. However, due to the nature of Arvin’s disability, a
parental permission letter was sent home and signed by Arvin’s mother, who agreed to
his participation. Both the school administration and Arvin’s teacher (the primary
researcher), agreed to and supported Arvin’s participation in this research.
In addition to Arvin, nine conversation partners participated in this study: five school
staff members, three peers with disabilities, and one nondisabled peer. The peers with
disabilities who participated in the study demonstrated average to strong conversation
skills in order to be a positive model for Arvin as well as an engaging conversation
partner. All conversation partners gave consent to participate in the study, and were
informed of the research being performed as well as their expectations as participants.
Conversation partners had the option to remove themselves from the study at any point
without consequences, but no participants dropped out during the course of the research.
13
Setting
During this study, Arvin attended a community-based transition program for
students 18-22 years old with moderate-severe disabilities. The program was located in
an urban neighborhood in the San Francisco Bay Area. It had 22 students total, two
credentialed teachers, one of whom was the primary researcher in this study, and eight
support staff. This program, although run by the school district, was not located on a
public school campus, but it still provided students with all public school services. The
program’s student population was 36% Asian, 23% mixed race, 18% African American,
14% Hispanic, and 9% White. One hundred percent of the students received free or
reduced lunch because all students were over 18 and qualified for Supplemental Security
Income (SSI) benefits. In this program, Arvin received instruction in functional
academics such as math, reading, job-readiness, and social skills. He also participated in
multiple volunteer and internship placements located in the neighboring community.
During this study, Arvin’s community work sites were in a small local grocery market, a
food bank, and a local farmers market.
The research occurred across three settings during Arvin’s regularly scheduled
program activities. The first setting took place before school at the program site between
7:45-8:00 a.m. while students and staff were first arriving to school. This time of the
morning was unstructured, allowing for students to settle in, socialize, and prepare for
their daily activities. Most students would spend this time greeting staff and peers,
14
socializing, and getting class materials out. Arvin would often spend this time standing
alone outside the program entrance, watching quietly as the buses, students, and staff
would arrive.
The second setting was at a lunch location in the community between the hours of
12:00-1:00 p.m. After students finished at their community work sites, the student group
would choose a community location to have lunch. This was a natural social time, during
which students would eat and have conversations with peers and staff. Arvin’s group
would typically have lunch at a large public park near their community work site.
The third setting was during a morning transition time between 9:00-9:15 a.m.
when students were finishing their morning functional academics and were preparing to
leave for their community work sites. During this time, students gathered the materials
they needed for their time in the community and would wait near the program lobby until
all of their group members were ready. Arvin’s group was often the last to leave because
their community work site was located close to the main program site and required
minimal travel time to get there. This resulted in Arvin and his group having 10-15
minutes of down time at the program site during which students and staff socialized and
discussed the day’s plans.
15
Independent Variable
For this study, Arvin was trained to use a “conversation photo album” on his
smart phone in order to facilitate social initiations with the peers and staff serving as
conversation partners. The model of Arvin’s phone was a T-Mobile myTouch 3G Slide,
which he owned and used regularly prior to this study. The phone had a built in camera,
as well as a photo album feature that allowed Arvin to view photos at any time (see
Figure 1). Arvin had the skills to independently use both the camera and photo album
features prior to starting this intervention but had never previously used either feature to
facilitate social interactions.
The smart-phone conversation photo album used for this intervention had a
minimum of 10 high interest photos at all times. Arvin took the photos, updated, and
maintained the pictures in his conversation photo album independently, with occasional
reminders and encouragement from staff and researchers to add or update photos. Arvin
had the freedom to add or delete photos as often as he liked and had full control of the
content of the photos. With Arvin’s consent, staff could also use Arvin’s phone to take a
picture of Arvin engaged in an activity he enjoyed. Arvin’s conversation photo album
included images of locations he visited within the program schedule, objects from school
or around the community that interested him, his peers and friends, and him doing tasks
at his work or volunteer sites. Arvin was taught to use the content of the images on his
phone to initiate social interactions or comments to others. The intervention occurred in
■
Figure 1. T-Mobile myTouch 3G Slide smart phone used store photographs for the conversation phone album.
17
three phases. During the first phase, baseline data were collected on how often Arvin
initiated social comments without any support, prompting, or intervention. In the training
phase, the intervention was introduced, and Arvin received instruction on how to use the
photos on his phone to initiate and maintain conversation. In the third and final phase,
Arvin was observed using the intervention independently.
Dependent Variables and Measures
This study examined whether using the conversation photo album on his smart
phone would increase the amount of social initiations Arvin made to his conversation
partners. The dependent variable of social initiations was defined as the student
producing a verbal or nonverbal behavior toward a conversation partner that introduced a
new topic or expanded on a previous topic (Hughes et al., 2011). This could have
included Arvin showing an image on his phone to a conversation partner, pointing to an
image on his phone while engaged with a conversation partner, making a comment or
asking a question to a conversation partner that may or may not be related to an image on
his smart phone, or any combination of these behaviors. Because of this definition, direct
responses to questions that did not provide new or additional information to the topic
were not counted as social initiations.
Data were collected on the percentage of intervals in which Arvin produced a
social initiation during observation sessions. Data were recorded in 15-sec intervals for a
total of 5 minutes, resulting in 20 total intervals for each observation (see Figure 2). The
18
Setting 1: Before SchoolMark a in the interval if the student makes a social initiation. Mark a i f no initiation.
Int#Date/ Phase/Prompt
Phase B B BPrompt None None None1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total
%
Figure 2. Example data sheet used to record observation data in 15-sec intervals for a total of 5 minutes. Interventionist recorded the date, intervention phase, and prompt level at the top. At the bottom of the sheet, intervals in which the subject produced a social initiation were totaled, and a percentage of the number of intervals in which the subject produced a social initiation calculated.
19
interventionist and independent observer listened to an interval time recording on tape
while collecting session data, which allowed the interventionist and independent observer
to record data in the appropriate time interval. The score for each session was calculated
as a percentage of intervals in which Arvin made a social initiation out of the total
possible intervals (number of intervals with initiation/total intervals x 100 = % correct).
Data were collected using direct observation of student’s performance during each phase
of baseline and intervention. Data were collected twice a week in each of the three
settings, for 5 minutes each session.
Interobserver Agreement
Measures of social initiations. During baseline and intervention conditions, an
independent observer joined the interventionist on 34% of sessions to check for accuracy
of data scoring. During these sessions, both the interventionist and independent observer
separately recorded data on the number of social initiations made by the subject (see
Figure 3). The level of agreement between the interventionist and the independent
observer was calculated by dividing the number of agreements on the occurrence of
social initiations during each observational interval by the total number of agreements
plus disagreements, times 100 (number of agreements/total agreements plus
disagreements x 100 = % of agreement). In the before school setting, the independent
observer joined the interventionist during 33% of baseline sessions and 33% of
For each interval, mark a on the left if an initiation occurs and a on the right if prompts given at the correct level, A "+/+" indicates an initiation occurred and correct prompts given. If no initiation, or an incorrect prompt given, mark a where appropriate
Jnt#D ate/P h ase/P rom p t
Phase B B BPrompt None None None1 i / / / / / ! / / / / /2 / / / / / / / / / I I /3 i / / / / / / / / / / /4 / / / / / / / / / / / /5 / / / i / / / / / / / /6 / i / i / / / / / / / /7 / / / / / / / / / / i /S / / i / i / / / / / / /9 / i / / / / / i / / I /10 i / / t / / / / / / /11 i / / / / / / / 1 / / /12 / ; / / / / / / / / / / /13 / / / / / / / / / / / /14 / / t i / / / / / / / /15 i / / / / / / / / / / /16 / / i i / / / / / / / /17 / / / / / / / / / / i /IS / / t / / / / / / / / /19 / / t / / / / / / / / /20
/ / i / / / / / / / / /fatalCorrect; / / / i / / / / i / / /
% / / / / / / / / / i / /
Figure 3. Example of independent observer data sheet. Independent observer recorded social initiation data on the left of each column, and appropriate prompt level data on the right of each column. At the top, the date, intervention phase, and prompt level were recorded. At the bottom, initiations and correct prompts were totaled, and percentages of intervals with social initiations and correct prompts were calculated.
21
intervention sessions, with 100% agreement in all sessions. In the lunchtime setting, the
independent observer joined the interventionist during 16% of baseline sessions and 50%
of intervention sessions, with a range of agreement from 94% to 100% agreement and an
average of 96.3% agreement. In the morning transition setting, the independent observer
joined the interventionist during 22% of baseline sessions and 66% of intervention
sessions, with a range of agreement from 93% to 100% and an average of 97.6%
agreement. To ensure reliable data, the interventionist and independent observer reviewed
the definition of social initiation prior to each observation session.
Measures of correct prompt delivery (implementation fidelity). An
independent observer joined the interventionist on 34% of total sessions to record the
accuracy of the prompts delivered to the subject during baseline, training, and
independent phases. The prompts used during training were predetermined before each
session based on the student’s ability to use the intervention tool successfully. The
prompt sequence began with the most intensive assistance, a direct verbal prompt. Once
the student was successfully initiating social interactions during observation sessions, an
indirect verbal prompt, providing less assistance, was implemented. Gesture prompts
replaced verbal prompts after consistent success at that previous prompt level. During
baseline, no prompt was given to the subject, and during the independent phase, a prompt
was delivered only as a correction. The independent observer rated the interventionist’s
accuracy in delivering prompts at the correct prompt level during overlapping sessions.
To record data, the independent observer marked a “+” in the data box if correct prompts
22
were given for the entire length of that particular time interval, for all 20 intervals of
observation. If an incorrect prompt was given during any one interval, the observer
marked a in the data box for that interval (see Figure 3). The total level of agreement
was calculated by dividing the number of intervals with correct prompts divided by the
total number of intervals, times 100 (number of intervals with correct prompts/total
intervals x 100 = % of intervals with correct prompts).
In the before school setting, the independent observer joined the interventionist on
33% of baseline sessions, 28.6% of training sessions, and 50% of independent sessions,
with correct prompts being delivered in 98% to 100% of all intervals, and an average of
99.3% of intervals with correct prompts. In the lunch time setting the independent
observer joined the interventionist for 16% of baseline sessions, 50% of training sessions,
and 50% of independent sessions, with correct prompts being delivered in 94%-100% of
all intervals, and an average of 96.3% of intervals with correct prompts. In the morning
transition setting the independent observer joined the interventionist for 22% of baseline
sessions, 100% of training sessions, and 50% of independent sessions, with correct
prompts being delivered in 95% to 100% of all intervals, and an average of 98.3% of
intervals with correct prompts. To ensure accuracy of scoring, the interventionist and
independent observer reviewed the current prompt level before each observation session.
23
Social Validity
In order to determine the perceived appropriateness, ease-of-use, and
effectiveness of the intervention, a questionnaire was given to Arvin, three of his peers,
and four his teachers and support staff at the end of the intervention. Social validity data
were collected in the format of a 3-point likert scale questionnaire with positive, negative,
and neutral response options (see Figure 4). The questionnaire for both Arvin and his
peers focused on how much they enjoyed using the intervention, the ease of use, and the
effect it had on Arvin’s social relationships with his peers. The questionnaire for the
teacher and staff focused on any perceived change in Arvin’s social communication,
friendships, and confidence levels, whether the tool was practical to use, and whether it
could be easily implemented with other students. Results of social validity can be found
in Chapter Three.
Procedures
Design. The study used a multiple baseline design with a single participant across
three settings to investigate the effectiveness of using photographs on a smart phone to
increase the student’s ability to make social initiations. The study had three phases: a
baseline phase, a training phase during which the student received prompt support to
learn to use the smart phone conversation photo album to initiate social interactions, and
an independent phase. At the conclusion of the study, the social validity of the
24
Social Validity Q uestionnaire - For P eers
Name: Date:
1. Do vou like having conversations w ith w hen h e /sh e uses pictures on h is /h e r cell phone?© © ©
Yes A little Not really
2. Is it easv to talk w ith w hen h e /sh e uses pictures on h is /h e r cell phone?© © ©
Yes A little Not really
3. Do vou feel vou and a re b e tte r friends now th a t h e /sh e uses h is /h e r cell phone to have conversations?© © ©
Yes A little Not really
Social V alidity Q uestionn aire - For Student
1. Do you like using the p ictu res on y o u r cell phone to have co nversations?© © ©
Yes A little Not really
2. Is it e a sie r to talk w ith o th e r peop le w hen you can use p ic tu res on y o u r cell phone?© © ©
Yes A little Not really
3. Do you feel y o u r friendsh ips have im proved since you 've been able to use p ic tu res on y o u r cell phone du rin g co nversations?© © ©
Yes A little Not really
Social Validity Q uestionnaire - For Teachers/StafF
1. Have vou noticed an increase in 's communication since he/she s tarted using h is/her cell phone to facilitate conversation?
Yes Somewhat No
2. Do vou feel that has increased h is/her friendships since he/she started using h is/her cell phone to facilitate conversations?
Yes Somewhat No
3. Is using pictures on a sm art phone a practical tool for facilitating conversations?
Yes Somewhat No
4. Do you think this intervention would be difficult to implement with other students?
Yes Somewhat No
5. Do vou see any changes in level of confidence when interacting with peers or staff?
Yes Somewhat No
Figure 4. Social validity questionnaires used for subject, subject’s peers, and subject’s teacher/staff.
25
intervention was examined through questionnaires given to relevant study participants,
including the student himself.
Baseline sessions. During baseline, Arvin’s social interactions were observed in
each of the three settings without prompting or use of the intervention tool. The session
time began, and the student was observed interacting with peers and staff as he would
normally. The interventionist remained close enough to the participant to observe any
social initiations that occurred unprompted.
Intervention sessions. The intervention was introduced progressively in each
setting after a consistent baseline had been established. In setting one, the intervention
was introduced after three baseline observations over the course of eight days. In setting
two, the intervention started after six baseline observations sessions over the course of 15
days. In setting three, the intervention was introduced after eight baseline observation
sessions over the course of 23 days. This ensured that any changes in Arvin’s social
initiations could be attributed to use of the intervention tool and not to other extraneous
factors.
In each setting, during the intervention phase, Arvin received prompting to teach
him to use the pictures on his phone to initiate social comments. The training phases used
a most-to-least prompt fade hierarchy that started with telling Arvin exactly what to do
(direct verbal prompt), which was then faded to hinting at what Arvin should do (indirect
verbal prompts). The prompt level was then faded to physical gestures to cue him
26
(gesture prompts). An example of a direct verbal prompt for Arvin would be, “Tell
[conversation partner name] who is in that picture.” An indirect verbal prompt might be,
“What else could you tell [conversation partner name] about this picture?” An example of
a gesture prompt would be for the interventionist to point to something in the image
Arvin could mention, or gesture for him to continue or move on by waving a hand or
imitating the “swipe” motion that moves the photo album to the next picture. Once Arvin
achieved at least 85% success at any one prompt level, he was moved to the next prompt
level, until he finally entered the independence phase of the study. An exception was
made in setting three, during with Arvin was moved into independence from an indirect
verbal prompt with only 75% accuracy. This decision was made based on his consistent
success in other settings and his overall ability to use the intervention tool. If at any point
Arvin was not successful with any one prompt level, a more supportive or intensive
prompt could be given as a correction for that particular interval of observation. If a
correction was needed during any interval in the training phase, the data was marked as
for that interval, indicating that Arvin failed to initiate at the correct prompt level.
Once Arvin moved into the independent phase in any one setting, he was
observed using the intervention without prompts or support. If at any point during the
independence phase Arvin failed to make social initiations appropriately, he could
receive a prompt as a correction. If a correction was needed during any interval in the
independent phase, the data was marked as “-” for that interval, indicating that Arvin
failed to initiate independently.
27
Results
This study examined whether systematic prompting could teach a student with a
moderate to severe intellectual disability to use a conversation photo album on his smart
phone to increase the amount of social initiations he made to familiar peers and staff. In
addition, the social validity of the study was examined, based on feedback from the
subject, his peers, and his staff. Below, the results of the study are discussed.
Social Initiations
Baseline phase. In Setting 1 (before school), Arvin had 0 initiations across three
observation sessions. In Setting 2 (lunch), Arvin produced social initiations in 4.2% of
total intervals across six observation sessions. In Setting 3 (morning transition), Arvin
produced social initiations in 2.5% of total intervals across eight observation sessions
(see Figure 4).
Training phase. During each training session, Arvin received systematic
prompting to teach him how to use the conversation photo album on his smart phone to
initiate and maintain interactions with peers and staff. The training phase results are
presented in Figure 5. In Setting 1, Arvin received direct verbal prompting for three
consecutive sessions. By the third session, Arvin reached a 100% success rate by
producing at least one social initiation in each interval of observation. He was then
moved to indirect verbal prompting. With an indirect verbal prompt, Arvin was able to
Perce
ntage
of Inte
rvals
with S
ocial
Initiati
ons
28
Figure 5. The percentage of intervals with social initiations.
29
produce social initiations in 95% of observed intervals. Next, prompts were faded to
gestures. With gesture prompts, Arvin initiated in 95% of observed intervals. After this,
he was moved into the independence phase where he was observed using the intervention
tool without prompted support.
In Setting 2, Arvin was moved into the training phase after six baseline
observations. He performed with a 90% success rate after receiving direct verbal prompts
for one day. He reached 85% success with indirect verbal prompts over two days, and
85% success after one day of gesture prompts. He was then moved into the independence
phase.
In Setting 3, Arvin was moved into the training phase after 8 sessions in baseline.
He received indirect verbal prompts for one session and produced initiations in 75% of
intervals. Due to his success in other settings and his overall ability to use the
intervention tool correctly, he was moved into the independence phase after only one day
of training.
Independent phase. Arvin was observed twice in each setting using the
intervention tool independently (see Figure 4). In Setting 1, Arvin produced social
initiations in 85% of intervals during the first session, and in 100% of intervals during the
second session. In Setting 2, he produced initiations in 90% of intervals during both the
first and second sessions. In Setting 3, he produced initiations in 95% of intervals during
the first session and in 100% of intervals during the second session.
30
It should be noted that during both the training and independent phases, Arvin
consistently needed a cue from the interventionist to identify when it was an appropriate
time to initiate a conversation. Although it was hoped that Arvin would learn this skill
during training sessions, he consistently failed to independently identify opportunities for
social interaction. After Arvin was cued that it was an appropriate time for conversation,
he was able to successfully complete all other steps of the intervention at the correct
prompt level or independently. Because the ability to identify social opportunities was
not a component of this particular intervention tool, it did not seem appropriate to hold
Arvin back from progressing through the study because of it.
Social Validity Results
In order to determine the perceived appropriateness, ease-of-use, and
effectiveness of the intervention, a questionnaire was given to Arvin, three of his peers,
and four his teachers and support staff at the end of the intervention. The questionnaire
was in the format of a 3-point likert-scaled questionnaire with positive, negative, and
neutral response options (see Figure 4). Overall, the results of the social validity surveys
were positive. All of Arvin’s peers reported they liked having conversations with Arvin
while using the conversation photo album, that it was easy to talk with Arvin while using
the intervention, and that they felt their friendship with Arvin had improved as a result.
Arvin’s teachers and staff reported that both his communication and friendships had
increased. They also reported that the intervention tool was practical to use and would be
31
easy to implement with most other students. Finally, they said that they witnessed a
change in Arvin’s level of confidence during communication. Arvin himself reported that
he liked using the intervention, that it somewhat helped him to communicate with others,
and that his friendships had improved as a result. Survey results can be found in Table 1.
32
Research Subject Questions
Do you like using the pictures on your cell phone to have conversations?
Is it easier to talk with other people when you can use pictures on your cel! phone?
Do you feel your friendships have improved since you've been able to use pictures m your cell phone during conversations?
Subject response Yes A little Yes
Peer Questions Do you like having conversations with [Arvin) when he uses pictures on his cell phone?
Is it easy to talk with [Arvin] when he uses pictures on his cell phone?
Do you feel you and (ArvinJ are better friends now that he uses his cell phone to have conversations?
Peer 1 response Yes Yes YesPeer 2 response Yes Yet YetPeer 3 response Yes Yes Yes
Teacher/staff Questions:
Have you noticed an increase in [Arvin's] communication since he/she started using h is/her cell phone to facilitate conversation?
Do you feel that {Arvin] has Increased his/her friendships since he started using his cell phone to facilitate conversations
Is using pictures on a smart phone apractical tool forfacilitatingconversations?
Do you see any changes in [Arvin'sJ level o f confidence wheninteracting with peers or staff?'
Do you think thisintervention would be difficult to implement with other students?
Staff i response Yes Yes Yes Yes MoStaff 2 response Yes Yes Yes Yes mStaff 3 response Somewhat Yes Yes Yes mTeacher response Yes Yes Yes Yes Somewhat
♦Note: depends on studen t Would be m m i successful with many,:
Table 1. Social validity survey results
33
Discussion
This study investigated whether a conversation photo album on a smart phone
could serve as an effective method of delivering social communication support to a
young adult student with moderate to severe intellectual disabilities. The results of this
study reveal that the conversation photo album had a dramatic effect in the number of
social initiations the study participant was able to produce while engaged with familiar
peers and staff. According to social validity surveys, the intervention was perceived as
an effective, appropriate, and easy-to-use tool for supporting social conversation, was
successful in enhancing the student’s friendships, and is likely to work with other
students with similar skills and needs.
The smart phone conversation photo album included a minimum of 10 high
interest images that the study participant, Arvin, was able to refer to in order to facilitate
social comments. He was observed using the conversation photo album across three
different settings for a total of six weeks, and was successful in increasing his social
initiations in both training and independent conditions in each setting. When given social
opportunities during baseline, the student produced little to no social initiations. By the
end of the study, he was able to initiate social comments and questions without external
prompting in nearly all observation intervals. After receiving a cue from a staff member
or researcher, Arvin was able to approach a conversation partner, show him or her a
picture on his smart phone, make comments about the picture, ask questions, answer
34
questions, and move to the next image independently. Arvin reported that he liked using
his phone to help him interact with others and that his friendships improved as a result.
While the results of this study were very positive, the study did have limitations.
First and foremost, this was a single-case study performed with only one subject. It is
necessary that further research be replicated with additional participants across varied
settings in order to generalize these results. It must also be considered that the participant
in this study had access to the technology necessary for the intervention. Many
individuals do not have the financial resources to purchase cell phones or the hand-held
technology required for this type of communication tool. Finally, future studies should
explore whether smart-phone-based photo conversation books are appropriate for
students of all ages, genders, languages, ethnic, and social-economic backgrounds to
determine whether they can be effective at supporting social interactions for the diverse
population of individuals that could benefit from social communication support.
In addition to expanding this research to additional demographics, there are many
other areas for further investigation. This study exclusively examined the number of
social initiations made by the focus student; however, there are many other components
of meaningful social interaction that must also be considered when examining any
conversation support tool. Some examples are the quality of conversation content,
number and types of topics discussed, number of conversational turns, and overall
engagement of both conversation partners. Additional research should be done to
35
determine whether these areas of social communication could also be supported through
the use of this intervention. In addition, future studies should consider the value of
teaching participants how to identify social opportunities in their environment. The
subject of this current study was unable to identify appropriate conversation opportunities
independently; however, after given a cue that it was an appropriate time to have a
conversation, he learned to complete all other steps on his own. Teaching Arvin how to
identify social opportunities and potential conversation partners is an important next step
to support his social communication and should be considered as a component of any
future studies seeking to support social conversation skills.
Smart-phone-based conversation tools are an exciting new frontier in
communication support research. Expanding the existing research to include young adult
students outside of traditional school settings should be considered a high priority area
for future research. The researcher hopes that the positive outcomes of this study will
encourage other teachers in her school district to implement smart phone conversation
interventions with their students and to continue supporting young adults with disabilities
to achieve greater social communication and enhanced relationships.
36
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