Individual PBS Module 3:

Instructional Issues and Strategies

2

Positive Behavior Support (PBS) Training Modules

This is the third of four PBS training modules.3. Instructional Issues and Strategies

The other modules should be taken in the following order:1. Collaborative Teaming and Person-Centered Planning2. Functional Behavior Assessment3. Instructional Issues and Strategies4. Developing, Implementing, and Evaluating Positive Behavior

Support Plans

These modules are designed to support a team as they go through a Positive Behavior Support process with a child or adult with problem behaviors. Let's begin with the first module by reviewing the goal of Florida's PBS Project and the definition of Positive Behavior Support.

3

Link Between Curriculum & Instruction & Behavior?

Is there a link between curriculum and instruction and behavior?

4

Learning & Challenging Behavior

Learning and behavior problems result frominteraction between the individual and his

or her environment.

5

Rationale for an Educational Approach to

Behavior Support Because behavior problems are often a reflection of skill deficits teaching is often the best intervention. Instructional and curricular variables have been found to influence student behavior. Modifications to curriculum and instructioncan result in improved behavior and increasedopportunity for learning.

6

Effective Practices

7

Good Teaching Practices

Researchers have found a number of teachingstrategies that have proven to be effective. Use of good teaching strategies benefits ALL students; both typically developing and students with disabilities. Using proven effective strategies results in more effective teaching and learning.

8

Effective Instructional Practices

Westling & Fox (2000) identified the following effective instructional practices: • Carefully plan instruction• Manage instructional time efficiently• Manage behavior effectively• Design instructional groups that meet learning needs• Carefully present instructional materials and procedures• Establish smooth, efficient classroom routines• Provide frequent feedback• Monitor performance• Review and re-teach material as necessary• Integrate skills needed for adulthood into instruction (e.g. problem solving

skills)• Have appropriate high expectations• Interact in a positive, caring manner In general, these practices should be reflected in all instructional practices

impacting all students.

Beyond Good Practice Using proven effective teaching strategies is not always enough to engage students in learning. Researchers have also identified promising instructional practices for teaching students with disabilities.

The problem behavior of students can signal a need to further address teaching strategies and the content of curriculum.

10

Address Curriculum and

Instruction

11

When to Address Curriculum & Instruction in Dealing with Behavior

ProblemsConsider curriculum and instruction as potential areas to

intervene when: • Hypotheses generated during the Functional Behavior

Assessment (FBA) include avoidance of academic tasks/activities

• Problem behaviors occur upon receiving instruction and/or direction that may include:• Off-task• Out-of-area• Misuse of materials• Non-compliance

  

12

Steps for Making Individualized Adaptations 

Making individualized adaptations can occur outside of a functional assessment process. The steps for making adaptations for individuals follow the same series of steps whether they are imbedded in a traditional functional assessment process or not. Step 1. Identify problem behavior(s)Step 2. Gather information about the student & the

task/settingStep 3. Develop a hypothesis about the behaviorStep 4. Develop adaptationsStep 5. Monitor and evaluate adaptations

13

Step 1. Identifying Problems

Review the information gathered during the FBA process related

to the context of problem behaviors. Look for anything that indicates that problem behaviors may be related to learning activities or tasks. • What were the problem behaviors? • Did problem behaviors occur during learning activities or

tasks? • Did any hypothesis statement refer to a learning activity or

task?

14

Step 2. Gathering Information about the Student & Task/Setting

Review information gathered during the FBA process related to student characteristics. Look for details related to functioning level,

preferences, strengths, areas of need, learning style, preferred response, etc?

Investigate the curriculum, instructional methods, and ecological elements of the task and situation during which problem behaviors occur. 

Consider the following factors:

Curricular: • Scope and sequence objectives• Presentation modes• Content• Topics 

 

15

Step 2. Gathering Information about the Student & Task/Setting

Instructional • Teaching methods• Response opportunities for students• Activities for acquisition & mastery• Teacher responses  Ecological • Physical arrangement• Predictability of environment• Equipment & materials available

Download the Classroom Assessment Tool from our the classroom section on our website.

Step 3. Developing Hypotheses

Review the hypotheses developed during the FBA process. Remember that the more precise the hypothesis is, the more likely that the intervention developed

will adequately remedy the problem.  

A hypothesis may have been developed that specifically addresses a curricular or instructional issue. Consider whether the hypothesis can be improved to more clearly establish a link between instructional and curricular elements and the student’s behavior.

If there were no original hypotheses that addressed a task or activity specifically, and your additional reviews indicated that problem behavior is occurring during certain tasks or activities, you will need to develop an additional hypothesis. As always, this hypothesis should be based on data collected and logically relate the behavior to the situation.

17

Step 4. Developing Adaptations

Using the existing or newly created hypotheses

and that information collected about the individual student, create modifications to

thecurriculum, instruction or ecology.

18

Step 5. Monitoring & Evaluating

As with any intervention, it is important that the team monitors and evaluates the outcomes of the plan.

Monitor student behavior problems as well as academic participation. Determine if adaptations are having a positive effect; are problem behaviors less frequent??, is the student more engaged in learning activities??.

If outcomes are not positive, consider additional or different adaptations and continue to monitor.

19

Adaptations

20

Adaptations

If we understand that a student’s behaviorproblems are a result of curricular and instructional issues, what do we do to assist

the student? Often we can start by making adaptations tothe curriculum, to the instruction, or the ecology in which instruction occurs.

21

What are Adaptations?

Adaptations are changes to learning task requirements, such as changes to the instructional content, teaching methods, materials or physical environment. These changes are temporary or reduced in intensity over time.

Example: Use of a calculator instead of paper and pencil

22

Types of Adaptations

There are three (3) general types of adaptations related to the learning environment: • Curricular Adaptations • Instructional Adaptations • Ecological Adaptations

23

Curricular Adaptations

24

The first of the three categories of adaptations is

Curricular.

25

Curricular Adaptations 

Curricular adaptations require an evaluation of student learning goals. There may be occasions when instructional objectives are modified in the adaptation process, but typically, instructional objectives can remain constant in the midst of adaptation.  Curricular adaptations involve changes to any part of the teaching-learning process including: • Teacher instructional methods and strategies• Instructional materials and learning activities• Performance requirements• Testing procedures

26

Three Types Curricular Adaptations

There are three types of curricular adaptations.

Task Difficulty For some students, facing a task that is challenging, or that the student “perceives” to be challenging, may lead to problem behaviors. There are a variety of ways to address tasks which are perceived to be

difficult, including: • Incorporating or alternating mastered skills/activities with novel

 skills/activities (i.e. addition with subtraction)•  Adjusting difficulty level (i.e. reading the same novel at a lower  reading

level)• Providing errorless learning opportunities (increases confidence)• Shorten difficult assignments• Completing task steps at a lower difficulty level (i.e. science  project with a

less complex topic)   The intentions of these modifications are to keep the student engaged through

careful adjustments that still allow for academic progress.

Student Snapshot Task Difficulty

Read the following Student Snapshot relevant to task difficulty.   Note: Student Snapshots will be provided throughout this module. Each Snapshot provides some basic background information and a hypothesis about the function of the behavior. For this first Snapshot, an adaptation is provided for you. As you progress through this module, you will be asked to generate appropriate adaptations. Sam is a highly articulate 14-yr. old high school student with characteristics of pervasive developmental disorder. He has a wide range of academic skills; his vocabulary skills, reading comprehension, and general knowledge are his strengths, whereas he finds math and other skill areas that require close decision making more challenging. Hypothesis: When Sam is presented with tasks that require high order thinking skills, he engages in self-injurious behavior to avoid completing the assigned task. Curricular Adaptations: The content was simplified by eliminating technical, conceptually difficult or confusing material. Sam completed the new tasks appropriately.

29

Preference/Interest

A student who has difficulty remaining engaged in a task will certainly miss opportunities for making achievement gains, and may become disruptive to the learning environment. Incorporating student preferences and interests can increase students engagement in tasks. Student preferences are those things that the student prefers including tasks, activities, modes of response, order of

activities, Etc.. Preference can be identified by quick and/or successful completion of tasks, good quality of work, evidence that a student is proud of his or her work, positive attitude regarding a

particular task/activity, etc.

30

Incorporating Student Preferences 

To incorporate student preferences, modify the assignment to include some preferential aspect:  Jack prefers manipulative activities over fine-motor activities• Activity is to count and color on a worksheet• Incorporate preference - provide manipulatives in counting lesson• Count specified number of milk cartons and sort them into groups  Another way to incorporate student preference is to alternate preferred

activities with non-preferred activities:• Jack prefers manipulative activities over fine-motor activities• Activity is to count and color on a worksheet• Incorporate preference - alternate manipulatives with paper/pencil tasks in

counting lesson• Count specified number of milk cartons and sort them into groups, then

record and color on worksheet 

31

Interests

When student interests or preferences are incorporated into an activity, the activity becomes more reinforcing to the student, increasing the likelihood of task engagement and reducing the likelihood of problem behavior.  Student interests can be determined through observation or simple questioning. The interests may be curriculum content related (civil war, outer space), or recreational in nature (playing basketball, drawing).

32

Incorporating Student Interest

Student interests can be incorporated into tasks by modifying the

content topic or by providing choices. When modifications are made to incorporate student interest, instructional objectives should remain constant. Examples:• Number concepts using items of interest as manipulatives

(i.e. dogs, cars, dolls, coins)• Provide a menu of choices (choice as a means of expressing

interest)• Tracing objects of interest

33

Adaptation Exercise

Read the following Student Snapshot related to: • Preference/Interest and generate an appropriate adaptation:

• Juan is a student of average intellectual ability in a classroom for children with severe emotional disturbance. He rarely completes the daily handwriting activity and often engages in disruptive behavior.

• Hypothesis: • When presented with typical handwriting sheets to copy, Juan engages

in off-task and disruptive behavior, to avoid completing the assignement. Now take a few moments and create an appropriate adaptation.

34

Sample Adaptation

Did you come up with an adaptation? Read the actual adaptation that was made for Juan.

 Curricular Adaptation: Juan’s teacher noted his interest in

Nintendo games. She created new handwriting copy sheets that detailed hints for playing his favorite Nintendo game. Juan completed the new handwriting assignments in a timely manner without disruptive behavior.

 Was your adaptation similar? Maybe not. There are many

ways of incorporating student interest, let your imagination run wild!

Student Snapshot Examples

Before After

36

Task Meaningfulness

If a task is meaningful to a student, the student will be more likely to be engaged in the task. A task which is meaningful is one that the student finds relevant to their life and/or has a functional outcome. It emphasizes the skills needed to participate in priority activities in the community. Traditional tasks can be made more meaningful by developing “functional” or “purposeful” activities that meet overall learning objectives.

37

Meaningful/Functional Example

Student: Jill Objective: Correctly form letters using manuscript Traditional Activity: Copy words from handwriting book onto a blank sheet of lined paper for duration of 15 minutes. Traditional Mastery: Time Limit. Upon completion, Jill raises her

hand to inform the teacher that she is finished, turns in paper, and goes on to next activity.  ******************************************************* Functional Activity: Develop and write captions related to photos

taken earlier in the week onto a blank sheet of lined paper for duration of 15 minutes. Functional Mastery; Time Limit. After completion, Jill adds

completed captions to photo album being created as a product.

38

Meaningful/Functional Example

 Student: Jerry Objective: Complete a multi-step assembly task 

Traditional Activity: Six parts of a pen are presented in individual pieces; Jerry assembles each pen by placing parts of the pen together and then placing the completed object in a bin.

 Traditional Mastery: Completion. Place completed pen in designated area, indicate completion by checking off activity on the board, move on the next activity. 

**************************************************** 

Functional Activity: Five-step task to make peanut butter and jelly sandwiches; pieces of the task are laid out sequentially; Jerry is required to complete the steps and put the finished sandwich on a plate.

 Functional Mastery: Completion. Student places plate of sandwiches aside to be given to class for snack later. Check off activity on board and continue with next activity.

39

Instructional Adaptations

Instructional Adaptations

The second category of adaptations is Instructional.

 

41

Instructional Adaptations

Instructional Adaptations involve changing the way inwhich material is presented and/or the way the student practices or demonstrates learning. There are two (2) general types of instructionaladaptations: • Instructional Presentation • Student Response or Output 

42

Adapting the Presentation 

Adaptations to the presentation involve changes to:

• The information provided during a lesson • The directions provided for an activity • The manner in which the information is provided (i.e. brief  lectures, cues, prompts)• The materials provided for a student during

practice or evaluation

43

Adapting the Presentation 

Presentation can be adapted through a variety ofmeans including: • Task Alternation • Modality • Print Materials • Task Division • Choices • Student Response

44

Task Alternation

Task alternation is the interspersing of different types of activities usually involving a variety of levels of interest, difficulty, and format. Some suggested ways to intersperse activities are: • Novel activities with familiar activities• Preferred activities with non-preferred activities• Teacher directed with independent work• Lecture with interactive activities• Paper and pencil with manipulatives 

45

Task Alternation Snapshot

Read the following Student Snapshot related to task alternation. Generate an adaptation for Sally. Sally is a 7-year old diagnosed with autism and severe mental retardation. She is non-verbal, has poor attending skills and exhibits repetitive behaviors (e.g. rocking). During attempts to teach Sally simple signs, she becomes decreasingly engaged and increasingly upset to the point of terminating the activity. Hypothesis: When Sally is engaged in frustrating learning activities, she becomes off-task and disruptive, to avoid participating in the task. How can the presentation of the task be adapted for Sally? (Move to the next frame after you have thought of an adaptation).

46

Task Alternation Snapshot

Did you think of an adaptation? Read the actual adaptation created for Sally below: 

Curricular Adaptation: Instruction of new signs was presented intermittently with directions to engage

in previously mastered skills such as hand clapping

and pointing to familiar items upon request

47

Adapting the Presentation: Modality

 Modality has to do with the type of sensory involvement that is important to the learner. Learners respond to various types of sensory input in different ways. Sensory channels include visual, auditory, tactile and kinesthetic. Adaptations to presentation modality involve providing the

instructional “input” in various ways including:  • Reading text aloud to students• Accompanying oral information with overheads, graphic

organizers, visual pictures, maps or outlines• Providing audio or videotapes to accompany or supplement texts• Provide models or physical demonstrations

48

Adapting the Presentation to Print Materials

 Adaptations to print materials are somewhat similar to adaptations to modality except that this type of modification is related solely to the printed materials provided to students. Examples of adaptations to print materials: • Highlight a content area textbook (yellow for vocabulary

words, blue for definitions)• Provide large-print materials• Provide answer boxes or more room to write on tests

and worksheets• Add pictures and/or symbols to text 

49

Print Materials Snapshot

Student Snapshot: Susan is a middle school student diagnosed with severe learning disabilities including dyslexia & ADHD. She is served in regular education classes. During social studies activities involving the use of the textbook, Susan is frequently off-task and disruptive. However, Susan participates during social studies discussion activities. Hypothesis: When Susan is presented with new reading material in a content area textbook, she becomes disruptive to avoid participating in the task. What kind of adaptation could be made to the print materials for Susan? (Move to the next frame after you have thought of an adaptation)

50

Print Materials Snapshot

Did you think of an adaptation? Read the actual adaptation created for Susan. Curricular adaptations: The social studies text was copied in a large font with increased space between the lines. This text was assigned as homework on the day before they were to cover it in class. Susan was able to “save face” by using the same text as others during class, yet she felt more confident with reading the content because she had reviewed it in a format that was more comfortable for her.

51

Adapting the Presentation: Task Division

 Task division is a simple means of adapting an activity. The student will be assigned and complete the entire assignment, but that assignment is divided into smaller increments. Typically, task division involves reducing the amount of task presented

to the student at any given time. Instead of giving a student an entire page of spelling words to review, give the student 3 words at a time

until all the work has been completed. By dividing the task, the student will be less likely to become overwhelmed by the amount of work to be accomplished, they will have greater opportunity to experience successful work completion, and they may have more opportunity for staff recognition and feedback.

Task Division Snapshot

Student Snapshot: Josh is an elementary age student in a classroom for students with mild mental retardation. During math skills practice, he would refuse to do his work and often destroyed his worksheets. In response, the teacher often stopped requiring him to complete the math tasks. Hypothesis: When Josh is presented with a full page of math problems to complete, he refuses to comply and destroys his materials to avoid the task. Develop a possible adaptation for Josh that involves task division.(Move to the next frame after you have thought of an adaptation)

53

Task Division Snapshot 

Did you think of an adaptation? Read the following adaptation that was made for Josh:

 Curricular adaptations: Considering Josh’s

comments such as it’s too much, his teacher cut his worksheet into strips by row. Strips were then presented one at a time with feedback after each completed strip. After adaptations, Josh generally completed all his work with no problems.

Adapting the Presentation: Present Choices

 Researchers have clearly linked the opportunity to make choices to reductions in problem behaviors. Additionally, the ability to make choices is an important social skill. However, the opportunity to make choices during the school day is generally limited. For students with disabilities, it is usually even more restricted. The opportunity to make choices can be provided in many areas throughout the school day. Opportunities to make choices regarding academic activities can include choice of task, response method, who to work with, where to complete work, and others.

55

Present Choices Snapshot 

Student Snapshot: James is an animated 11-yr. old student with severe mental retardation. When presented with tasks using manipulatives, he often throws them across the room. During free-time, James often chooses those same items to play with. Hypothesis: When the teacher assigned James a learning activity, he becomes disruptive to avoid engaging in the task. Develop an adaptation for James that involves choice.(Move to the next frame after you have thought of an adaptation)

56

Present Choices Snapshot 

Did you come up with a means of providing choice for James? Read the following adaptation that was made for James: Curricular adaptations: James was allowed to choose from a list of 3-4 activities which all met the teacher’s learning objective for the day. James selected the task and remained engaged.

57

Adapting Student Response

 Adapting the student response concerns the way in which students demonstrate their knowledge or skill; their “output.” Student responses include listening to a lecture, reading a resource book, note taking, organizing and writing information, selecting from multiple choice options, verbal response, and others.  Sometimes student behaviors can be improved when the method of response required is changed or modified. Changes to student response may address modality or print material.

58

Adapting Student Response: Modality

 Modality, as discussed in adaptations of presentations, is related to sensory channels (sometimes referred to as learning styles). Adaptations to response modality involve changes in the means by which a student demonstrates knowledge or skill. Examples of response modality adaptations are: • Dictate answers, rather than writing them on paper• Use a computer to demonstrate spelling word knowledge• Make models of entities with labels (i.e. plant cell from Playdoh)

59

Modality Snapshot

Student Snapshot: Rylee, a 6-yr. old kindergarten student in a classroom for students identified with severe emotional disturbance, was frequently off-task and disruptive during math activities involving worksheet to practice counting. Hypothesis: During paper and pencil math activities, Rylee engages

in off-task and disruptive behavior to avoid completing the assigned activity. How can the response modality for Rylee be adapted?(Move to the next frame after you have thought of an adaptation)

60

Modality Snapshot

Did you develop an adaptation for Rylee? Read the actual adaptation below:

Curricular adaptations: After identifying Rylee’s interest in Lego’s, the worksheet counting activity was replaced with counting Lego’s as she constructed objects.

61

Adapting Student Response: Print Material

 Students are often required to respond in print format that usually involves pencil/paper tasks. However, there are a variety of other

ways to demonstrate knowledge and skill. Adapting student response in

print material involves minimizing the use of pencil/paper, limiting the

length of paper/pencil activities, and using alternatives to print. Some samples of adaptations to print material include: • Count, add, or subtract with play money rather than printed

worksheets• Complete a chart, map or outline instead of writing an essay about

a novel or story• Use a computer rather than paper/pencil to record answers

62

Print Material Snapshot

Student Snapshot: Amy is a 10-year old child diagnosed with autism. During her daily letter tracing assignments using a paper and pencil, Amy becomes disruptive; yelling and throwing her materials. Hypothesis: When Amy is presented with paper/pencil tasks;

she becomes disruptive to avoid working on the task. Consider what kind of adaptation could be made to the print materials used with Amy.(Move to the next frame after you have thought of an adaptation)

63

Print Material Snapshot

Did you think of an adaptation for the print materials? Read the actual adaptation below: Curriculum Adaptations: Amy’s teacher noticed that during free time, Amy often chose to use the dry

erase board. She obtained a small dry-erase board for Amy to use in her handwriting practice. (In the future, the dry-erase assignment will be alternated with typical paper/pencil tasks.)

64

Ecological Adaptations

Ecological Adaptations

Ecological Adaptations: Research shows that the most effectiveschools are those with a well-ordered environment and high academic expectations.

66

Ecological Adaptations

Adaptation to the ecology involves modifications to the physical surroundings of the situation; the setting for the task/activity, sights, sounds and arrangements.  The purpose of ecological adaptations is to enable a student with social, behavioral, or emotional needs to cope with the demands of the environment while learning new skills.

67

Types of Ecological Adaptations

68

Ecological Adaptations: Where

 Change the place in which the student is to work on the task or activity:

 • Provide a “private” place for a student who has difficulty concentrating or staying on task (e.g. study carrel, quiet

room)• Minimize congestion and clear traffic lanes• Groups/stations positioned to minimize distractions• Clear lines of vision to the students• Students see all instructional displays• Clearly post behavioral expectations 

69

“Where” Snapshot 

Student Snapshot: Andy is a 9-yr. old in a classroom for students with varying exceptionalities. He is an intelligent and conscientious boy who experiences a significant amount of frustration in his work. During independent seatwork his frustration at becoming distracted by

things around him lead him to self-injurious behaviors. Hypothesis: When there is movement and noise around him during seatwork; Andy becomes distracted and engages in self-injurious behavior to get himself to attend to the task at hand. How could you adapt the “where” aspect of the ecology for Andy?(Move to the next frame after you have thought of an adaptation)

70

“Where” Snapshot

Did you consider an adaptation to “where” for Andy? Read the actual adaptation made below. Ecological Adaptations: Andy was given the opportunity to work at his regular desk, or in a study carrel. When things around him distracted Andy, he could move to the carrel where he could focus on his work.

71

Ecological Adaptations: When

 Change the time during which the student is expected to work on a particular task. • Adapt the daily schedule to provide additional breaks• Find opportunities for a student to spend extra time with

preferred adults or peers• Post the daily schedule• Develop individualized student schedules when needed• Post procedures for transition and non-transition times• Intersperse preferred with non-preferred tasks• Provide predictable routines• Color code scheduling information

72

“When” Snapshot  

Demetrius is an engaging 8 yr. old boy in a classroom for students with mild to moderate mental retardation. During group activities such as circle time, story time, and calendar, Demetrius is engaged. During independent work activities, especially those that require him to remain seated and quiet, he becomes disruptive. Hypothesis: During independent work activities, Demetrius

becomes disruptive to get attention from others. How can the “when” of the ecology be adapted for Demetrius? (Move to the next frame after you have thought of an adaptation)

73

“When” Snapshot

Did you think of an adaptation for Demetrius? See how your adaptation compares to the actual adaptation described below: Ecological Adaptation: The schedule was adjusted to ensure that independent activities were alternated with interactive activities. A picture schedule was developed to cue Demetrius that a preferred activity is coming.

74

Ecological Adaptation: Who 

Change the people involved in completing a particular task or activity:

 • Use a different teacher for a particular subject or activity• Reduce the adult-to-student ratio• Change the number of peers with whom the student is

grouped for instruction• Promote friendships between students with and without

disabilities• Provide inclusive opportunities for students with disabilities• Put mechanisms in place for regular and effective

communication between student and teacher 

75

“Who” Snapshot

Student Snapshot: Alena is a 15-yr. old student diagnosed with autism, who is mainstreamed in regular classes. In math and science, Alena is frequently non-compliant and occasionally becomes disruptive. In language arts, Alena participates appropriately. It was identified that Alena’s math and science classes contained over 30 students, while

her language arts class had only 20. Hypothesis: When working in a large group of students, Alena is disruptive to get attention from the teacher How can the “who” of the ecology be adapted for Alena?(Move to the next frame after you have thought of an adaptation)

76

“Who” Snapshot

Did you think of an adaptation for Alena? Was it similar to the actual adaptation described below: Ecological Adaptation: Alena was switched to math

and science classes that contained fewer students and was moved to a seat near the teacher to enable the teacher to give her that additional attention that she needed to be successful in class.

Review Problem behaviors in the classroom can often be eliminated orgenerally reduced by making adaptations to the learning environment including curriculum, instruction, and the

ecological environment.

The adaptation of curriculum and instruction can result in improved behaviors and increase the opportunity for learning.

78

Accommodations

Accommodations are modifications that are documented by the eligibility process and specified in a student’s Individualized Education Plan. They are provided to enable the student to gain access to the classroom or the curriculum. Many of the Adaptations described in this module may be identified as accommodations in a student’s IEP or 504 plan. Sample accommodations:• Extra time for a test• Accompany oral directions with written directions• Tape recorded versions of printed materials• Larger bubbles on multiple-choice questions