Research in Developmental Disabilities 45–46 (2015) 1–13
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Research in Developmental Disabilities
Computer and microswitch-based programs to improve academic activities by six children with cerebral palsy Fabrizio Stasolla a,*, Rita Damiani b, Viviana Perilli c, Fiora D’Amico a, Alessandro O. Caffo` b, Anna Stella b, Vincenza Albano b, Concetta Damato b, Antonia Di Leone b a b c
Lega del Filo d’Oro Research Center, Molfetta, Italy Department of Educational Sciences, Psychology, Communication, University of Bari, Bari, Italy Lega del Filo d’Oro Research Center, Lesmo, Italy
A R T I C L E I N F O
A B S T R A C T
Article history: Received 16 December 2014 Received in revised form 12 June 2015 Accepted 8 July 2015 Available online
This study was aimed at extending the use of assistive technology (i.e. microswitch such as a pressure sensor, interface and laptop) with a new setup, allowing six children with cerebral palsy and extensive motor disabilities to improve their academic activities during classroom. A second objective of the study was to assess a maintenance/generalization phase, occurring three months after the end of the intervention, at participants’ homes, involving their parents. A third purpose of the study was to monitor the effects of the intervention program on the indices of positive participations (i.e. constructive engagement) of participants involved. Finally, a social validation procedure involving 36 support teachers as raters was conducted. The study was carried out according to a multiple probe design across behaviours followed by maintenance/generalization phase for each participant. That is, the two behaviours (i.e. choice among academic disciplines and literacy) were learned first singly, then combined together. Results showed an increasing of the performances for all participants involved during intervention phases. Furthermore, during maintenance phase participants consolidated their results. Moreover, positive participation augmented as well. Support teachers, involved in the social validation assessment, considered the combined intervention as more favourable with respect to those singly learned. Clinical, educational and practical implications of the findings are discussed. ß 2015 Elsevier Ltd. All rights reserved.
Keywords: Assistive technology Cerebral palsy Quality of life Choice Positive participation Social validation Developmental disabilities
1. Introduction Cerebral palsy (CP) refers to a group of non progressive disorders concerning the posture and/or the movement, caused by a defect in the fetus or a lesion in the immature brain (Bax et al., 2005; Rosenbaum, Paneth, Leviton, Goldstein, & Bax, 2007) and constitutes a frequent cause of long-term physical disability during childhood, added to speech and cognitive impairments (Huang, Tseng, Chen, Shieh, & Lu, 2013). Consequently, children with CP may have serious limitations in different functional activities. For example, some of them will exhibit ambulation difficulties, some may encounter intellectual disabilities (Palisano, Rosenbaum, Bartlett, & Livingston, 2008), some other may present literacy incapacities
* Corresponding author. Tel.: +39 3496635397; fax: +39 069384564. E-mail addresses:
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[email protected] (F. Stasolla). http://dx.doi.org/10.1016/j.ridd.2015.07.005 0891-4222/ß 2015 Elsevier Ltd. All rights reserved.
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dues to movement deficits (Peeters, de Moor, & Verhoeven, 2011). Thus, the aforementioned clinical conditions may seriously hamper the social image, desirability and status of children with CP, aggravating their passivity and reducing their participation and/or active role in daily life (Spittle & Orton, 2014). Undoubtedly, school is one of the basic contexts where children acquire academic competences and expand social network (Shenker, Coster, & Parush, 2005). According to Jenks, de Moor, van Lieshout, and Withagen (2010) children with CP do not receive adequate instruction time concerning arithmetic in school settings, while Peeters, Verhoeven, de Moor, and van Balkom (2009) point out that children with CP may pose various problems of words decoding, in light of low levels of speech intelligibility. To overcome these issues, one may envisage the use of assistive technology (AT) (Lancioni & Singh, 2014). AT includes tools and/or devices designed to ensure to a child presenting self-determination and independence despite the developmental disabilities, to improve his/her quality of life (Felce & Perry, 1995; Lancioni et al., 2006b; Livingstone & Paleg, 2014). That is, by using an AT device or system, a child with CP may interact autonomously with the outside world, eventually acquiring mastery and reaching satisfactory levels of self-concept (Shields, Loy, Murdoch, Taylor, & Dodd, 2007; von der Luft, Harman, Koenig, Nixon-Cave, & Gaughan, 2008). Literature concerning the use of AT for children with developmental disabilities and CP is robust (Dhas, Samuel, & Manigandan, 2014; Lancioni, Sigafoos, O’Reilly, & Singh, 2012; Pousada, Pareira, Groba, Nieto, & Pazos, 2014; Shih, 2014), although its implementation in school settings has been few investigated (Huang, Sugden, & Beveridge, 2009; Salminen, Petrie, & Ryan, 2004). Within this topic, Stasolla, Caffo`, Picucci, and Bosco (2013) exposed three children with cerebral palsy and severe communication impairments to a computer-aided program, enabling participants to ask for their personal needs (e.g. leisure option), with the mediation of a caregiver, in their home setting. A similar setup was assessed by Stasolla and De Pace (2014) for two boys emerged from a minimally conscious state, and subsequently by Stasolla, Caffo`, et al. (2015) who proposed to three children, emerged from a minimally conscious state and extensive motor disabilities, an update of the aforementioned program, allowing the participants to access to literacy process. Moreover, indices of positive participation were recorded as sign of constructive engagement of participants involved (Stasolla, Damiani, & Caffo`, 2014a). Those indices have been already detected in Alzheimer’s patients (Caffo` et al., 2014; Lancioni et al., 2013, 2014). 2. What this paper adds The present study would represent a further extension of the aforementioned empirical evidences (in terms of participants involved and adaptive behaviours considered), providing a new setup for six children with cerebral palsy and extensive motor disabilities in a school setting. Specifically, the study pursues the following objectives: (a) updating the technology with new options available for each participant involved, (b) introducing a maintenance/generalization phase, three months after the end of the intervention at participants’ homes, involving their parents, (c) monitoring its effects on positive participation, and (d) carrying out a social validation assessment with 36 support teachers as raters (Lancioni et al., 2006a; Stasolla, Perilli, & Damiani, 2014d). 3. Method 3.1. Participants and settings The participants (Alan, Carey, David, Gary, Sharon and Tom) were 10.4, 9.3, 9.5, 11.6, 11.2 and 12.2, respectively (mean age 10.7) at the beginning of the study. They were all diagnosed with cerebral palsy by their neurologists, who recruited and reported them to the research team. Although no formal IQ score was available, since no test was feasible due to their general conditions, they were estimated as borderline between the normal and the mild level of intellectual disabilities, from clinical observations. They presented lack of speech, communication and developmental impairments, low awareness of sphincter needs, dystonic movements, although they were capable of few ambulation responses, if adequately supported by a caregiver. Moreover, they were all equipped with a wheelchair and were capable of ‘‘yes’’ and ‘‘no’’ responses, by using head movements. They were unable to interact positively with surrounding objects due to extensive motor disabilities. They attended regular class with a support teacher and a special educational program and had, three days per week, physiotherapy and speech sessions at home. They were included in this study since they were able to match a picture with an academic activity and they were literate, although they were unable to access to the literacy process, due to extensive motor impairments. The study was carried out within school context, with the cooperation of their support teacher (i.e. baseline and intervention phases, see Section 3.5). The subsequent maintenance/generalization phase was conducted at participants’ homes, with the cooperation of their parents. The academic activities (see below) were selected upon concordance between parents, support teachers and participants. The families and the schools staff considered the rehabilitative program high desirable. In fact, they signed a formal consent for the participation to it, which was approved by a local scientific-ethic committee. 3.2. Selection of stimuli and academic activities Matched to an informal interview with their parents and support teachers, a preliminary formal screening of preference, concerning the academic activities and positive stimulation to be used as primary reinforcement, was assessed, according to
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Crawford and Schuster (1993). That is, within 4 to 6 10 min sessions for each participant, a combined verbal and pictorial instruction was presented (i.e. 8–10 s) for each selected item, with a 15–20 s rest interval before the subsequent environmental event. Added to the traditional criteria (i.e. alert, orientation and/or smile), yes and no responses exhibited through head movements by participants were recorded. Items preferred at least for the 70% of the presentations were retained. 3.3. Technology and response The technology included a laptop equipped with clicker 5 software package (Crick House, Moulton Park, Northampton, UK), a pressure microswitch and an interface connecting the microswitch to the laptop. The homepage of the computer screen presented two pictures (i.e. options and literacy boxes) automatically scanned (each 2 s) through a yellow coloured encirclement (according to the combined intervention and maintenance/generalization phases, see Section 3.5). Conversely, when the baselines and the two single interventions occurred, the three categories option, on one side, and the keyboard emulator, on the other, were directly available (see Section 3.5). Once the options box was selected (i.e. through microswitch activation), three new pictures were available. That is, a little boy who was looking for/listen to a story (Italian literature option), a little boy who was looking for/listen to arithmetic operations (mathematics option), a little boy who was looking for/listen to a landscape (geography option). Selecting the arithmetic box (i.e. activating the microswitch once the box was encircled) the system allows the opening of a second page with the four basic arithmetic operations available (i.e. sum, subtraction, multiplication and division). Selecting the sum box (i.e. once again through microswitch activation contingently to its encirclement) the system allows the opening of a third page with four opportunities of sum (i.e. systematically varied among participants, customer tailored, depending on their characteristics/skills, in accordance with the support teachers). For example, selecting the 3 + 5 option, led the system to ask: ‘‘Do you really want to know how much is 3 + 5?’’. The fourth page was provided with two main boxes: that is ‘‘yes’’ (green coloured) and ‘‘no’’ (red coloured). Responding yes, the system would provide the result with a new box showing the number and the word ‘‘8’’ with eight little dolls, hearths, flowers or aircrafts, depending on participant’s preferences. The result was animated, coloured matched to preferred music, automatically delivered by the system for 10 s, in order to serve as a positive (primary) reinforcement. Else, selecting the option ‘‘literacy’’ to the first (home) page, a keyboard emulator under a word page processor would be available. That is the screen would be provided with a word page on the upper and with the keyboard emulator below. According to previous system (Chiapparino, Stasolla, De Pace, & Lancioni, 2011) the system would systematically scan the rows each 2 s. To select a row, participants were requested to activate the microswitch once the desired row was encircled. Once selected the row, the system would scan the letters included in the selected row each 2 s. A further microswitch activation would produce the writing of the selected letter (once encircled) in the upper reported word page. Finally, the system would be available for a new selection. Both opportunities (i.e. options and literacy) were provided by a vocal output cue (automatically delivered by the system), ensuring children with the requested option or the written word. All participants were positively reinforced with a token at the end of each understandable word written, according to a token economy procedure (Gilley & Ringdahl, 2014; Matson & Boisjoli, 2009). Consequently, at the end of each day all participants received a primary reinforcement, depending on the number of collected token. Furthermore, four non preferred items (i.e. distorted sounds) were automatically and randomly interspersed by the system, where participants were expected to answer ‘‘no’’ in order to minimize unintentional choices (Figs. 1–8).
[(Fig._1)TD$IG]
Fig. 1. AT home page and apparatus.
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Fig. 2. Keyboard emulator for literacy.
[(Fig._3)TD$IG]
Fig. 3. Academic disciplines options.
[(Fig._4)TD$IG]
Fig. 4. Math options.
[(Fig._5)TD$IG]
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Fig. 5. Sum options.
[(Fig._6)TD$IG]
Fig. 6. Question.
[(Fig._7)TD$IG]
Fig. 7. Response.
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[(Fig._8)TD$IG]
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Fig. 8. Final item.
The adapted microswitches were a circular red coloured button (12 cm of diameter) for Alan, Carey, Gary and Sharon and a rectangular yellow coloured sensor (12 6 cm) for David and Tom, fixed on the desk in front of the participants, beside the laptop and the interface. All participants were requested to press on the microswitch (i.e. behavioural response) to activate it. Alan, David, Gary and Tom activated the microswitch with their right hand, while Carey and Sharon with the left one. Therefore, participants could select an option or write a word by activating the microswitch, otherwise they could ignoring the academic activities or the keyboard emulator by abstaining themselves from any response. The behavioural responses selected and the microswitches adopted for each participant were chosen in accordance with the staff and seemed to be the most suitable solution/combination for all children involved. 3.4. Sessions and data collection Sessions lasted 20 min. Within 5 days per week, 3 to 5 sessions for each participant, depending on their general conditions, were carried out. By the time of the study, which lasted approximately 6 month (including rest interval of three months between the end of the combined intervention and the maintenance/generalization phases), 130 sessions for each participant were collected. Thus, 8 sessions (four on each of the two behaviours) constituted the first baseline carried out singly on the options and literacy opportunities. Subsequently, 30 sessions were included within each of the three intervention phases and the maintenance/generalization phase. Finally, four sessions were collected in the second baseline concerning the literacy process. Data collection concerned: (a) the number of requested completed (i.e. at least three activation of the microswitch within the options opportunity) and the number of understandable words written during the literacy process, and (b) the indices of positive participation (i.e. smiling, alerting, gaze orientation to the monitor) according to a partial 15 s interval recording system, where 10 s of observations were followed by 5 s of dichotomous scoring on the presence/absence of positive participation on the previous 10 s observation interval (Stasolla, Perilli, et al., 2015, 2014a). Two research assistants watched independently and simultaneously a random sample about the 40% of collected sessions in order to carry out a percentage of reliability, by dividing the number of agreement by the number of agreements and disagreements and multiplying it by 100 (Stasolla et al., 2014c). The mean percentage for all participants involved exceeded the 93%. 3.5. Experimental conditions The study was carried out according to a multiple probe across behaviours design for each participant (Barlow, Nock, & Hersen, 2009), where after an initial baseline on the two behaviours singly considered, an intervention phase on the first behaviour (i.e. options opportunities) occurred. Once consolidated, a new baseline on the literacy access was conducted. Subsequently, an intervention phase on the literacy was implemented. Finally, a combined intervention phase where both opportunities (i.e. options and literacy) were available was applied. Physical and verbal prompts were provided by research assistants and/or support teachers every 30 s of non responding. Prompted responses (i.e. request or words) were subsequently subtracted from the total. After a three months rest period, by the end of the combined intervention, a maintenance/generalization phase identical to the combined intervention phase was assessed, at participants’ home, with the participation of their parents.
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3.5.1. First baseline During the first baseline, the technology was available, except for the microswitch. Participants were requested to perform their request or write words using a traditional mouse. Four sessions on each behaviour were collected. Thus, within the baseline on the first behaviour, the first page of the laptop presented three options (i.e. literature, mathematics and geography). Participants were requested to select the desired item with the mouse. Else, during the second behaviour (i.e. literacy access) check, the initial screen page provided the keyboard emulator with the word page processor. Participants were invited to write desired words with the same mouse. This phase was completed within three days. At the end of a correct procedure, (i.e. a request completed within the options opportunities or a understandable word written within the literacy process) participants would receive a reinforcement (see above). 3.5.2. First intervention During the first intervention, the first behaviour (i.e. options opportunities) was learned. The technology was available with the aforementioned and adopted microswitches, instead of the traditional mouse. Participants could perform their requests with the microswitch. For each participant, 30 sessions were collected, within two weeks. Once consolidated, a new baseline on the second behaviour (i.e. literacy) occurred. Participant would receive a primary reinforcement at the end of a correct procedure completed, depending on their selected items. 3.5.3. Second baseline A new baseline on the literacy process was carried out. Conditions were identical to the first baseline. Four sessions were collected within 2 days. 3.5.4. Second intervention An intervention phase on the literacy opportunity was subsequently conducted. Thus, the technology was available, and a keyboard emulator was presented on the first (unique) page of the screen. Participants were solicited to write desired words using the microswitch. Thirty sessions were collected for each participant within two weeks. All participants were reinforced with a token for an understandable word written. At the end of the day they had the opportunity to receive a primary reinforcement, depending on the number of collected token. Once consolidated, a combined intervention phase, with both opportunities available (i.e. options and literacy), occurred. 3.5.5. Third intervention A combined intervention phase was finally implemented. That is, on the first screen page the two opportunities (i.e. options and literacy) were automatically scanned. Participants were requested to perform their choices with the microswitch. Within two weeks, 30 sessions were collected for each participant. All participants would receive a reinforcement, depending on their choices. 3.5.6. Maintenance/generalization After three months from the end of the aforementioned combined phase, a maintenance/generalization phase occurred, where conditions were identical (in terms of technology available) to the previous one. However, sessions were collected at participants’ homes, with the cooperation of their parents, instead of the support teachers. The phase lasted two weeks and included 30 sessions for each participant. All participants would receive a reinforcement, depending on their choices. 3.5.7. Social validation Thirty-six support teachers (mean age 37.4 and standard deviation 7.23) were involved as raters in a social validation assessment. Support teachers represented a convenience sample of professionals interested in the field of developmental disabilities (Pedhazur & Schmelkin, 1991). They were equally and randomly divided in six groups: one for each participant rated. Each group was required to watch a standard 2 min session of the first (i.e. academic options), the second (i.e. literacy), and of the third (i.e. combined) intervention phases concerning the participant who was assigned to it. The sequence of the watched videotapes was systematically and randomly varied. That is, two groups watched an A-B-C sequence (i.e. first, second and third intervention), two groups watched a B-C-A sequence, and finally two groups watched a C-B-A sequence, in order to balance conditions. Raters responded to an 8 items questionnaire, providing 1–5 scores, where the opposites indicated the least and the most positive ratings, respectively. 4. Results Data concerning the performance of the six participants involved are summarized over blocks of sessions and plotted in Fig. 9. Alan started his first baseline with a mean frequency concerning the options opportunities about 0 and a mean frequency of understandable word concerning the literacy about 0. His mean percentage of indices with positive participation was about 2.96 (range 1.25–6.25). He switch to the first intervention phase with an increased performance to 20.5 (range 12–26), and with a mean percentage of indices with positive participation up to 83.79 (range 56.25–97.5). The second baseline confirmed the trend of literacy to 0 and the range of indices with positive participation to 14.06 (range 10–18.75). During the
[(Fig._9)TD$IG]
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Fig. 9. The graphs summarize the data for Alan, Carey, David, Gary, Sharon and Tom. The dark and the light bars indicate the mean frequencies of options and words, respectively, over blocks of sessions for the two baseline phases, the three intervention phases and the maintenance phase. The black diamonds refer to the mean percentage of intervals with indices of positive participation, over blocks of the same baseline, intervention and maintenance sessions. The number of sessions included in each block is indicated by the numeral above it.
second intervention, Alan augmented his mean frequency of understandable words to 12.93 (range 6–18.) and his mean percentage of positive participation to 84.7 (range 67.5–96.25). He completed his combined intervention phase with the values of 14.9 (range 11–22) concerning the options opportunities and of 10.63 (range 7–14) about the literacy. His mean percentage of indices with positive participation during the combined phase was about 93.71 (range 90–100). Finally, transferring the intervention program to his home, he performed as follows 13.8 (range 9–18), 11.56 (range 9–17) and 93.75 (range 90–100) concerning the options and literacy and the indices of positive participation, respectively. Carey begun her baseline with a mean frequency of 0 concerning both options opportunities and literacy, respectively, while the mean percentage of intervals with indices of participation was about 5.78 (range 1.25–11.25). Her performance increased during the first intervention to 18.8 (range 12–25) with a mean percentage of indices of indices with positive
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participation about 79.21 (range 65–90). Her second baseline was about 0 and the mean percentage of intervals with indices of positive participation was 16.87 (range 7.5–25). Carey increased her performance during the second intervention phase with a mean frequency of understandable words about 10.66 (range 6–16) and a mean percentage of intervals with indices of positive participation about 90.87 (range 70–95). During the combined intervention phase, she showed a mean frequency of 14.7 and of 11.8 (ranges 10–20, 8–14) concerning the options opportunities and the literacy, respectively, while the mean percentage of intervals with positive participation was about 95.5 (range 91.25–100). During the maintenance/ generalization phase, she consolidated her performance to 14.03 and 12.26 (ranges 9–19, 9–16) concerning the options and literacy, respectively, and to 94.58 (range 90–100) about her mean percentage of intervals with indices of positive participation. David started his first baseline with values about 0 and 0 concerning the options opportunities and literacy, respectively. His mean percentage of intervals with indices of positive participation was about 3.9 (range 1.25–7.5). During the first intervention phase, he increased his performance to 17.96 (range 8–26) and to 76.62 (range 55–90) concerning the mean frequency of requests and mean percentage of intervals with indices of positive participation, respectively. His second baseline showed a mean frequency of 0 for the literacy and a mean percentage of 13.12 (range 7.5–17.5) for the intervals with indices of positive participation. David increased those values during the second intervention to a mean frequency of 12.66 (range 6–16) and a mean percentage of intervals with indices of positive participation of 79.87 (range 70–90). The combined intervention phase revealed mean frequencies of 14.8 and 11.76 (ranges 10–22, 10–15) for the two adaptive behaviours considered, respectively and a mean percentage of intervals with indices of positive participation about 94.12 (range 90– 100). Finally, switching to his home during the maintenance/generalization phase, he consolidated his performance to 12.66 and 11.06 (ranges 9–16, 8–14) concerning options and literacy, respectively, while his mean percentage of intervals with positive participation was about 92.33 (range 90–97.5). Gary’s performance during the first baseline was about 0 concerning the options on one side and the literacy on the other. Furthermore, he completed the first baseline with a mean percentage of intervals with indices of positive participation about 5.94 (range 1.25–11.25). The child increased his scores during the first intervention to 16.7 (range 12–24) and to 78.2 (range 60–90) referring to mean frequency of options opportunities and mean percentage of intervals with indices of positive participation, respectively. During his second baseline, he confirmed a mean frequency of 0 concerning the literacy and a mean percentage of 20.94 (about 10–36.25) regarding the intervals of indices with positive participation. Gary augmented those scores to 11.5 (range 6–15) for the literacy, while the mean percentage of intervals with positive participation was about 83.79 (range 60–93.75), during the second intervention. The combined intervention phase revealed mean frequencies of 13.7 and 11.66 (ranges 10–18, 7–16) regarding the options and the literacy, respectively. His mean percentage of intervals with indices of positive participation augmented to 95.37 (range 90–100). Finally, he consolidated his performance to 14.63 and 10.93 (ranges 10–19, 6–14) concerning the options and literacy, respectively, and to 94.37 (range 90–100) concerning the mean percentage of intervals with indices with positive participation during the maintenance/generalization phase, implemented at home. Sharon begun her baseline with 0 and 0 with respect to options opportunities and literacy, while the mean percentage of intervals with positive participation was about 6.56 (range 2.5–10). Her first intervention phase showed a performance of 15.06 (range 11–22) on the option opportunities and a mean percentage about 75.83 (range 65–86.25) on the intervals of indices with positive participation. The participant maintained a mean frequency of understandable words to 0. She showed a mean percentage about 9.25 (range 7.5–15) on the intervals of indices with positive participation. The second intervention was completed with a mean frequency of understandable words of 13.83 (range 8–18) and a mean percentage of intervals with indices of positive participation about 84.54 (range 76.25–90). The combined intervention phase showed mean frequencies of 13 and 11.16 (ranges10–16, 6–16) with options and literacy, respectively, while the mean percentage of intervals with indices of positive participation was about 94.83 (range 90–100). Sharon consolidated her performance at home during the maintenance/generalization with the mean values of 13.03 and 11.27 (ranges 10–16, 8–15) with respect to options and literacy, and with a mean percentage of intervals with indices of positive participation about 94.46 (range 90–100). Tom ended his first baseline with mean frequencies of 0 and 0 concerning the two adaptive behaviours, respectively, and with a mean percentage of 5.94 (range 2.5–10) regarding the intervals with indices of positive participation. He increased his performance to 15.83 (range 11–22) during the first intervention phase, with a mean percentage of intervals with indices of positive participation about 79.37 (range 52.5–93.75). His second baseline revealed a mean frequency of understandable words about 0 and a mean percentage of intervals with indices of positive participation about 15 (range 5–25). He augmented up to 10.9 (range 5–14) during the second intervention, with a mean percentage of intervals of indices with positive participation about 88.54 (range 55–100). During the combined intervention phase, Tom confirmed his performance to 13.4and 10.2 (ranges 11.20, 8–13), while the mean percentage of intervals with indices of positive participation was about 94.87 (range 90–100). Finally, the child completed his maintenance/generalization phase with mean frequencies of 12.43 and 10.9 (ranges 10–15, 7–13) with respect to options opportunities and literacy, respectively. His mean percentage of intervals with indices of positive participation was 94.46 (range 90–100). Since none of the participants answered ‘‘yes’’ to any of the non preferred items (i.e. distorted sounds, see above) the relative computation was not included in the reported data. The overall mean length for the words was 5.77 letters, ranging from 1 to 9 letters, for all participants involved. All differences between the first baseline and the first intervention, the second baseline and the second intervention and between both baseline and the combined intervention phases were statistically significant (p < .01) to the Kolmogorov–Smirnov test (Siegel & Castellan, 1988). A similar difference was recorded between both baselines and the
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10 Table 1 Social validation questionnaire items.
Do you think that the child is positive participating (i.e. constructive engaged with) this condition? Do you think that this condition is suitable for the child? Do you think that this condition has beneficial/rehabilitative consequences for the child? Do you think that this condition promotes self-determination/independence for the child? Do you think that this condition is practical for school setting? Do you think that this condition is practical for home setting? Do you agree with (i.e. support) this condition? Can you rank the three conditions, with 1 and 3 to more and less preferable, respectively?
Table 2 Social Validation Results. Items
M
SD
M
SD
M
SD
F
p
Post hoc
Participation Suitability Rehabilitation Independence School Home Agree
3.75 3.62 3.79 3.69 3.88 3.72 3.66
.61 .54 .68 .74 .59 .51 .78
3.95 3.99 3.88 3.96 3.94 3.92 3.98
.44 .22 .34 .56 .46 .29 .84
4.32 4.51 4.55 4.82 4.88 4.77 4.62
.36 .29 .43 .32 .49 .47 .66
7.35 15.54 22.86 18.97 38.96 32.44 35.55
