Touro Scholar Touro Scholar

Department of Behavioral Science Publications

and Research

The School of Health Sciences

2017

The Effects of Visual Cues, Prompting, and Feedback within The Effects of Visual Cues, Prompting, and Feedback within

Activity Schedules on Increasing Cooperation Between Pairs of Activity Schedules on Increasing Cooperation Between Pairs of

Children with Autism Spectrum Disorder Children with Autism Spectrum Disorder

Karrie Lindeman

Part of the Special Education and Teaching Commons

Recommended Citation Recommended Citation

Lindeman, K., McDonald, M. E., Lee, R., Gehshan, S., & Hoch, H. (2017). The Effects of Visual Cues,

Prompting, and Feedback within Activity Schedules on Increasing Cooperation Between Pairs of Children

with Autism Spectrum Disorder.

Special Education Research, Policy & Practice, 1

(1), 5-27. Retrieved from

https://touroscholar.touro.edu/dbs_pubs/56

This Article is brought to you for free and open access by the The School of Health Sciences at Touro Scholar. It

has been accepted for inclusion in Department of Behavioral Science Publications and Research by an authorized

administrator of Touro Scholar. For more information, please contact [email protected].

Activity schedules are visual support strategies that use visual cues, such as photographs and/or

written words, to teach a learner to engage in a sequence of tasks or activities independently.

Until recently, research on activity schedules has involved one schedule being followed by one

individual. In order to facilitate cooperation between two individuals to complete one task, and

to increase engagement between peers, cooperative activity schedules are being introduced as

interventions in educating students with autism. A multiple baseline design across three activities

was used to assess the effects of including an instructional package consisting of visual cues,

prompting, and feedback to increase cooperation within an activity schedule between two

students with autism spectrum disorder (ASD). This design was replicated across two pairs of

Cooperative Activity Schedules in Children with Autism Spectrum Disorder

Children diagnosed with autism spectrum disorder (ASD) often present with a range of social

impairments that make it difficult to engage in cooperative behavior with others (Liebal,

Colombi, Rogers, Tomasello, & Wareken, 2008). These include deficits in imitation skills

(Rogers & Pennington, 1991; Griffith Pennington, Whener, & Rogers,1999; Sigman & Ungerer,

1984; Bryson & Smith, 1998), the use of joint attention (Jones & Carr, 2004; Bono, Daley, &

Sigman, 2004; Kasari, Sigman, Yirmiya, 1990; Sigman & Mundy, 1989), and initiating bids for

joint attention (Baron-Cohen, 1987). Imitation plays a fundamental role in the development of

coordinated acts (Liebal et al., 2009). Imitation skills provide children with visual or verbal cues

others (Tomasello, Carpenter, Behne, & Moll, 2005).

Similar to joint attention, cooperation involves activities with shared goals and intentions (Liebal

et al. 2008). Shared cooperative activities have three main features that consist of cooperating

partners who are 1) mutually responsive to each other, 2) hold a shared goal, and 3) mutually

support each other in their roles in order to achieve that shared goal (Bratman, 1992).

Individuals with ASD tend to demonstrate difficulty engaging in cooperative behavior, either in

play or during social activities, thus leading to difficulties within group teaching contexts

(Spriggs Gast, & Ayres, 2007). Cooperation skills are defined as two students working together

to complete a task. This may involve turn taking and sharing responsibilities of task completion

Deficits in cooperative skills in individuals with ASD can contribute to dependence on

caregivers, teachers, and supervising adults to initiate a task or activity (Copeland & Hughes,

2000). Many intervention packages rely heavily on verbal instructions, modeling, and gestures.

These stimulus prompts are often associated with reinforcement during teaching, and might,

thereby, acquire stimulus control over the target responses (MacDuff, Krantz, &, McClannahan,

1993). Consequently, learners with ASD may become prompt dependent. That is, they fail to

perform target responses independently and rely on interaction with the instructor to complete

the skill and the presence of the stimulus prompts. For example, an individual with autism might

learn a complex behavior chain, such as playing with toys, completing vocational tasks, or

1999).

An activity schedule is a visual support strategy that uses visual cues, such as photographs and/or

written words, to facilitate following a sequence of tasks or activities independently

(McClannahan & Krantz, 1999). Visual stimuli can be presented in a variety of forms.

Photographs (MacDuff et al. 1993; Jolly, Test, & Spooner, 1993), pictures and line drawings

(Frank, Wacker, Berg, & McMahon, 1985; Pierce & Schriebman, 1994), and symbols and words

(Stromer, Mackay, McVay, & Fowler, 1998) are examples of visual stimuli that can be used

within a schedule to prompt a correct response. The visual component of the activity schedule is

likely a critical component contributing to its effectiveness across situations. The visual

acquisition in students with ASD has been noted (Shopler et al., 1995).

Additionally, individuals with ASD often have difficulty initiating the next step in a complex

chain of behavior. As an individual learns to brush his teeth, he may not be able to complete the

steps consecutively without a prompt to initiate each specific skill within the chain (MacDuff, et

al. 1993). For example, the individual may not put the toothbrush in his mouth after putting the

toothpaste on the brush. Activity schedules mediate transitions between activities by using

visual prompts to occasion specific behavior chains. As a result, an activity schedule can

promote independence in a sequence of multiple activities, such as a self-care morning routine.

ASD continue to rise as the cost of living increases yearly, the need for cost-effective

interventions that require less direct staff intervention to service larger numbers of clients is an

immediate priority (White, E., Hoffman, B., Hoch, H., & Taylor, B., 2011). Students with ASD

have difficulty functioning within group settings due to a myriad of reasons, including behavioral

concerns when in larger settings (White, et al. 2011) and, therefore, only participate in programs

with 1:1 student-teacher ratios (Harris & Handleman, 2006). In order to make group instruction

more efficient and worthwhile, individuals with ASD would require more independence in

schedule following and transitioning between activities (White et al. 2011).

When using activity schedules, students with ASD typically follow individualized schedules that

time.

Because students with ASD have marked impairments in social skills, a cooperative activity

schedule provides the context to teach social skills, such as social interactions, in addition to the

task being targeted for completion. A cooperative activity schedule has been shown to

incorporate the addition of prompting peer engagement in activities, turn taking, and cooperative

play (Betz, et al. 2008). These activities are pertinent to social skill development and are often

neglected in classrooms due to the emphasis of academic programs within a student’s

curriculum. Cooperation within activity schedules may lead to a decrease in reliance on adult

prompts for both activity completion and social interaction, as well as a decrease in the total

Research on cooperation in activity schedules has focused on teaching pairs of students to work

towards one terminal end goal through cooperative schedules, but has highlighted different

aspects of peer interactions. Cooperative schedules have successfully demonstrated an increase

in peer engagement for students with ASD (Betz, et al. 2008) and more recently, increased

collaborative work in completing vocational tasks (White, et al. 2011).

Betz, Higbee, & Reagon (2008) focused on teaching preschool students with ASD to follow joint

activity schedules that cued both individuals to engage in interactive games with each other.

During baseline, the two children were asked to go play. Specific board games were already

The second study by White et al. (2011) that specifically looked at joint activity schedules also

demonstrated success. The tasks selected for this study included teaching three different adapted

living skills. Baseline included completing the task without prompts, reinforcers, or error

corrections. The session ended when the task was completed or when three 1-minute intervals of

non-engagement occurred. Intervention consisted of teaching and probe sessions. Teaching

sessions incorporated prompting the participants to complete only their designated portion of the

behavior chain. During probe sessions, participants were asked to complete the tasks. The results

indicated that all three groups were able to meet criterion to complete a single activity schedule

together. Overall, participants cooperatively worked together on one activity schedule to

complete tasks. The key factor in both of these studies is that selected participants were able to

research to be explored. As the results indicate, following independent schedules may facilitate

the mastery of two individuals jointly following a schedule (White, et al. 2011). It should also be

noted that following an activity schedule cooperatively is a distinct skill compare with following

one independently (Betz, et al. 2008; White, et al. 2011). Currently, there is a need to replicate

these studies in order to support and build on these findings. The research question that was

investigated in this study was: Do activity schedules with embedded cues for cooperation

increase cooperative behavior in students with ASD? This study examined the effects of visual

cues, prompting, and feedback within activity schedules on increasing cooperation between pairs

of children with autism.

Participants included four children diagnosed with ASD between the ages of 9 and 14 years who

were enrolled in a special education school that utilizes the principles of applied behavior

analysis. The first pair included a fifteen-year old male, Landon, and a fourteen- year old

female, Alana. The second pair included a 9 year- old male, Dennis, and 10- year old male,

Joey. Participants were selected based on their abilities to independently and accurately follow

picture activity schedules and their results from the Vineland Adapted Behavior Scale. All

participants were diagnosed with autism as toddlers by medical physicians according to DSM-IV

(2000) criteria. All participants exhibited deficits in language, socialization, adapted living,

vocational, and cooperation skills.

sessions were designed based on participant need. All materials necessary to complete the

designated vocational tasks were located within the work center (e.g., spray bottle, rags).

Activity schedules were created with word descriptions of the activity in list format (e.g., replace

the staples). Each participant was assigned to three different activities per dyad group, which

included cleaning the office, cleaning the kitchen, and putting away laundry. Participants had no

prior experience with the specified vocational tasks prior to the start of the study. All activity

schedules were printed on 8-inch by 5-inch, white laminated paper. Times new roman font was

(VABS-2; Sparrow, Cicchetti, & Balla, 2005) provides a comprehensive assessment of typical

performance of the day-to-day activities required for personal or social sufficiency as perceived

by the individual(s) completing the form. Community-University Partnership evaluated the

reliability and validly of the Vineland-II (CUP, 2011). The overall Vineland is broken down into

five domains. These domains include communication, daily living skills, socialization, motor

skills, and maladaptive behavior domains. The domains focused on in this study include

communication, socialization, and daily living skills.

across schedule-following components throughout all phases. Correct responding was defined as

a participant checking the schedule, crossing off the next step with a dry erase marker prior to

completing the step, completing the first or next consecutive step in the activity schedule as

independently and accurately for the trial to be scored as correct. Participants were directly

observed, and data were collected by scoring a plus or minus on the data sheet during probe

sessions. Probe sessions were conducted every third session throughout the study.

opportunities in which cooperation with a peer occurred throughout all phases. Five

opportunities for cooperation were programmed into the schedule during each session for each

dyad. Cooperation was defined as two students working together to complete one task on one

schedule. These tasks could be completed alone but provided an opportunity for students to

interact with each other. For cooperation to be scored as correct, an interaction between the two

own schedule. Data were scored on whether the second participant returned to his/her original

task (schedule). Throughout schedule following, data were also collected on accuracy of the

participants completing the schedule of tasks. Participants were directly observed and data were

collected during probe sessions by scoring a plus or minus on the data sheet.

throughout the activity schedule for each peer. Data were also collected on spontaneous requests

for help or assistance that occurred throughout sessions in the absence of the picture cue.

Participants were prompted to respond by saying “thank you” following completion of helping to

indicate they were finished and could return to their own schedule. Participants were directly

behavior during tasks between two children with ASD. This design was replicated across two

participant dyads. Inter-observer agreement (IOA) data were obtained for 30% of all sessions

conducted across all conditions by a second trained observer. Agreement was calculated by

dividing the number of agreements by the total number of agreements plus disagreements and

multiplying by 100. An agreement was defined when both observers scored a response as either

correct or incorrect. IOA data averaged 97% agreement for schedule following and ranged

between 94% and 100%, 100% agreement for opportunities when cooperation occurred, and

100% agreement for frequency of spontaneous requests for help across baseline and training.

Procedural integrity was obtained for 30% of sessions as well. Procedural integrity was

the correct schedule, 100% for use of the correct materials, 100% for correct placement of

materials, 97% correct verbal instruction to begin the activity with a range of 93% and 100%,

100% for correct dyad pairing, 94% for proper instruction and prompt fading with a range of

91% to 100%, and 97% for correct distribution of the reinforcer with a range of 94% to 100%

across both baseline and training.

To assess social validity, classroom teachers of the participants were provided an anonymous

questionnaire to complete prior to the start of the study, and following the completion of the

study. The questionnaire included questions to assess: (a) if the overall outcome of the study is

of the same age as the participants (9-14 years of age) to determine how much helping is

standard when completing such tasks.

To assess social validity, six videos were shown to four observers who were naïve to the

experimental conditions. Viewers were teachers at the school the participants attended but were

not the participants’ teachers. Videos consisted of both baseline and intervention clips. Videos

provided an array of clips, showing cooperation, no cooperation, and varying amounts of

cooperation. Viewers that were not involved in the study were asked to score cooperation

throughout the clips using a Likert scale, ranging from one to five, one equaling not cooperative,

two being not very cooperative, three being neither cooperative or not cooperative, four being

number of steps to completion and total duration of time required for task completion; all tasks

were similar in duration. For example, cleaning a table and making the bed are within the same

relative duration for completion and may thus be selected versus cleaning an entire room and

making the bed, which vary widely in the duration of time required to complete the task. The

duration of completion for these tasks was assessed through a competent performer. An example

of a potential schedule for cleaning the kitchen includes 10 steps to completion (see Figure 1 for

example of cleaning the kitchen schedule).

kitchen, organizing the office, or folding laundry.

Graduated guidance with spatial fading was used to manually prompt activity schedule following

responses and task completion. Manual prompts were always delivered from behind the

participant. An unspecified prompt fading procedure was implemented, where upon moment-to-

moment decisions about prompting and fading were made based on the participant’s

demonstration of the skill. Fading started by moving from a full physical prompt to a less

intrusive prompt, until independence was achieved. Initially, hand-over-hand manual guidance

was provided, with the experimenter first guiding the participants’ hands, then elbows, and then

upper arm (White, et al. 2011). Following changing the location of the prompt, the experimenter

participants independently achieved 100% accuracy in responding across two consecutive

sessions with the experimenter three meters away. Tokens were provided contingent on

correctly completing a step of the chain, and were exchanged for other primary or secondary

reinforcers (e.g., candy, computer games) following the completion of the task. The

experimenter approached the participants’ and showed them the actual delivery of the token in

their respective bags. Participants exchanged tokens for their self-selected reinforcers following

completion of the activity schedule. For safety purposes, the occurrence of maladaptive behavior

would have resulted in the termination of the session, however, this did not occur for either dyad

group throughout the study. This procedure was replicated across all three activities selected for

each participant during the skill assessment.

_______ Wipe Stove

instances. Two week and one month follow-up probes depict cooperation maintaining at 100%

throughout the five opportunities when the cue is present, with both the experimenter across the

room and the reinforcement system removed. Throughout intervention, no spontaneous requests

for help were made by either Joey or Dennis.

novel setting, different activity, and a peer with whom they have not engaged before for all 4

participants.

Table 1.

classroom, with a novel activity of cleaning the classroom, 100% of the time. The novel peer did

not always reciprocate engagement in cooperative behavior. For Landon, he received the

assistance of the novel peer 100% of the time. Landon returned back to his schedule 100% of

the time, but the novel peer did not. Alana asked for help for 100% of all opportunities. She

received help from the novel peer on 66% of possible opportunities. She returned back to her

schedule accordingly on 100% of the opportunities. The novel peer did not. Joey and Dennis

also cooperated on 100% of the opportunities presented with the novel peer. Joey had 80%

assistance from the peer once requested, and returned to the schedule 100% of the time. Dennis

had 100% of cooperation from the peer, and also returned to the schedule 100% of the time.

Throughout the probe, the novel peer never asked for help when the cue was present.

demonstrated no cooperation, and two participants working next to each other, but not together.

Video clip 3 showed participants cooperating on 2 out of 5 potential opportunities, demonstrating

minimal cooperation. Results of the video clips indicate that all four novel viewers agreed that

videos 1, 4, and 6 were a score of 5-very cooperative. The video clips for video 1, 4, and 6 all

demonstrated cooperation occurring. The scorers agreed 100% that videos 2 and 5 were a score

1-not cooperative. The video clips for 2 and 5 demonstrated no cooperation, and showed two

participants working parallel to each other. Video 3 was a video clip that showed participants

Overall, the results indicated a high level of agreement that cooperation did occur in the videos

amongst all novel viewers.

Normative data specifically geared to the participants’ ages and genders were collected on two

children, one 12-year-old male and one 13-year-old female. While cleaning the office,

cooperation occurred on 4 out of 5 tasks; during cleaning the kitchen, cooperation occurred for 3

of 5 tasks; and while doing laundry cooperation occurred during 4 of 7 tasks. The results

indicated similar results between the normative data and the participants throughout the

intervention.

cooperation between two students with autism. Cooperative activity schedules offer two students

the opportunity to collaborate on a task, thus increasing opportunities for social engagement and

interactions, while decreasing the duration of the task (Betz, et. al., 2008). It is feasible that long

term effects include achieving levels of independence that are necessary for improving the

quality of life for individuals with ASD.

The results of this study indicate that adding a visual help cue to signal cooperation into an

activity schedule increases cooperation among students with ASD in a classroom setting. The

results of this study aligned with the results of Betz and colleagues (2008) as well as White and

colleagues (2011) in demonstrating that cooperative activities schedules can increase cooperation

classrooms and the push for students to spend more time working in groups, having a treatment

that is maintained once the presence of the instructor and the reinforcer is faded out is important

for the long term.

As White and colleagues (2011) describe, prerequisite skills for following activity schedules

vary from following cooperative activity schedules. Following independent activity schedules

proficiently is definitely an important pre-requisite to following cooperative ones. White and

colleagues (2011) noted the importance of the participant mastering the activities within the

schedule prior to introducing it cooperatively. Within this study, participants were required to

master the complete activity schedule individually prior to having the schedule introduced

start of the activity was, “Let’s work together to clean the kitchen” (or other respective activity),

during these sessions, the participants did not cooperate on tasks, and instead returned to

completing the activities parallel to each other. This occurred for both dyads. Prior to prompting

participants to ask for help in the presence of the cue, the participants did not attempt to help

each other or complete the others respective tasks. With no cue present, cooperation did not

occur across either pair of participants. Additionally, neither pair spontaneously requested for

help throughout the study. A possible explanation for this is the fact that the response of

requesting help was never systematically targeted for reinforcement. Additionally, the picture

cue served as a prompt for the response, and was never faded; therefore, it is highly likely that

the picture cue acquired stimulus control, thus the participants did not request help when the

what increased responding. A component analysis would need to be done to fully determine

which component(s) was responsible for the change in behavior. Specific consideration should

be paid to the effect, if any, token reinforcement had on cooperation due to rapid acquisition but

lack of demonstration of the skill in the absence of the visual cue.

A second limitation is that the results did not generalize for requesting help in the absence of the

visual cue. Additionally, participants did not spontaneously request help from each other for

activities in which the picture was absent. Although following a schedule with built in

opportunities for cooperation is a skill, it is useful to look at how the skill of requesting help can

be broadened to facilitate asking for help spontaneously or in the absence of a picture prompt, or

questions may have been too vague, and did not necessarily represent the specific objectives of

the study directly. Additionally, the questionnaire did not provide the definition of cooperation

as used for this study. Thus, teachers may have defined cooperation differently and felt they had

cooperative students prior to the study. However, it should be noted that in anecdotal

discussions with the teachers following completion of the survey, they did report the students as

being more cooperative in their day-to-day activities with peers following completion of the

study.

To increase the number of spontaneous requests for help and generalization of the response in

absence of the visual cue, future studies should look at establishing contingent reinforcement for

cooperative behavior.

Within this study, all opportunities to request for help were generated to encourage cooperation

between two participants, however help was not actually required to complete the activity (e.g.

moving a heavy table). Future research might look at including opportunities for participants to

ask for assistance throughout the schedule during times when it is actually needed. One of the

ways in which to address this may be to select tasks where help will be required as opposed to

instructed. This would likely increase the student’s motivation to ask for help in the moment.

In this study, the response of requesting for help was not demonstrated in the absence of the

Future research might also consider including the ability to wait as a criterion for participant

selection. White et al., (2011) mention that instructing students to wait may be an important area

to target when tasks in the schedule must be completed in a specific order. For example, if the

steps include washing the dishes and then drying the dishes, the dishes must be washed prior to

being dried. In this study, the participants who were selected all demonstrated the ability to wait

throughout the study, although this was not initially planned during participant selection.

In summary, teaching students with ASD in dyads and groups needs to become a focus of future

research. Settings for children with autism are frequently no longer supporting ratios that sustain

one to one instruction, thus, students are being expected to perform in groups without the proper

References

Ashley, J., & Tomasello, M. (1998). Cooperative problem-solving and teaching in preschoolers.

Baron-Cohen, Simon. (2001). Theory of mind in normal development and autism. Prisme, 34,

174-183.

Betz, A., Higbee, T., & Reagon, K. (2008). Use of joint activity schedules to promote peer

engagement in preschoolers with autism. Journal of Applied Behavior

Billingsley, F. F. & Romer, L. T. (1983). Response prompting and the transfer of stimulus

Bratman, M. (1992). Shared cooperative activity. The Philisophical Review , 101 (2), 327-341.

Bryan, L. A., & Gast, D. (2000). Teaching on-task and on-schedule behaviors to high-

Bryson, S. & Smith, I. (1998). Epidemology of autism: Prevalance, associated characteristics,

Developmental Disabilities, 2, 97-103.

Center for Disease Control and Prevention. (2012). Autism statistics, 2012. CDC.gov. Retreived

October 18, 2012 from http://www.cdc.gov.

Copeland, S. R. & Hughes, C. (2000). Acquisiton of a picture prompt strategy to increase

Harris, S. L. & Handleman, J. S. (2006). An introduction to school-age education programs for

Jolly, A., Test, T., & Spooner, A. (1993). Using badges to increase intitiations of children with

severe disabilities in a play setting. Journal of Association for Persons with Severe

Handicapps, 18, 46-51.

Kasari, C., Sigman, M., Mundy, P., & Yirmiya, N. (1990). Affective sharing in the context of

joint attention interactions of normal, autistic, and mentally retarded children. Journal of

Autism and Developmental Disabilities, 20, 87-100.

MacDuff, G., Krantz, P. J. & McClannahan, L. E. (1993). Teaching children with autism to

photographic activity schedules: Maintenance and generalization of complex response

chains. Journal of Applied Behavior Analysis, 26 (1), 89-97.

McClannahan, L. E., & Krantz, P. J. (1999). Activity schedules for children with autism:

Teaching independent behavior. Bethesda, MD: Woodbine House, Inc.

Pierce, K. L. & Schriebman, L. (1994). Teaching daily living skills to children with autism in

unsupervised settings through pictorial self-management. Journal of Applied Behavior

Analysis, 27, 471-481.

Rogers, S. J. & Pennington, B. F. (1991). A theoretical approach to the deficits in infantile

autism. Development and Psychopathology, 3, 137-162.

Sigman, M. & Mundy, P. (1989). Social attachments in autistic children. Journal of the

Sigman, M, & Ungerer, J. (1984). Cognitive and language skills in autistic, mentally retarded,

Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland-II Adaptive Behavior

Spriggs, A., Gast, D., & Ayres, K. (2007). Using picture activity schedule books to increase on-

2, 209-223.

Stromer, R., Mackay, H. A., McVay, A. A., & Fowler, T. (1998). Written lists as mediating

White, E., Hoffman, B., Hoch, H., & Taylor, B. (2011). Teaching teamwork to adolescents with

autism: the cooperative use of activity schedules. Behavior Analysis in Practice, 4, 27-

35.

About the Authors

Certified Behavior Analyst, and licensed behavior analyst in New York. She has been involved

in the field of behavior analysis for over 12 years. Dr. Lindeman is currently an adjunct

in the Department of Specialized Programs in Education at Hofstra University in Hempstead,

NY. She is currently the Program Director for the Advanced Certificate Programs including the

Advanced Certificate in Applied Behavior Analysis Program. She is a Board Certified Behavior

Analyst- doctoral level and a licensed behavior analyst in the state of NY. Dr. McDonald has

worked in the field for over 20 years. Some recent areas of publication include: PECS and

maladaptive behavior, use of a tactile prompt, social reciprocity, inclusion and persistence of

fads in autism intervention.

Applied Behavior Analysis program at William James College located in Newton, MA. A

published or presented on topics such as response variability, conditioned reinforcement,

preference assessments, instructional methods, staff training, and evidence-based practices in

autism intervention.

Analyst who currently serves as a program supervisor in a school in Long Island, New York

servicing children on the autism spectrum. She has been involved in the field for over 10 years.

Her research interests include staff training and increasing social skills in children with autism.

interests include reduction of challenging behavior and increasing language and social skills in

children with autism.