Increasing Comprehension for Middle School Students with Moderate ...

Education and Training in Autism and Developmental Disabilities, 2012, 47(3), 359 –372 © Division on Autism and Developmental Disabilities

Increasing Comprehension for Middle School Students with Moderate Intellectual Disability on Age-Appropriate Texts Jordan Shurr

Teresa Taber-Doughty

Central Michigan University

Purdue University

Abstract: Students with moderate intellectual disability experience a lack of comparable access to literature as compared to their nondisabled peers (Browder et al., 2009; Kliewer, 1998). Problems in access for many of these students may be attributed to low expectations and inadequate support on behalf of students as well as a lack of sufficient literacy skills instruction. Given these issues, the literature students are able to access often is not representative of their chronological age. Literacy interventions such as read-alouds have been successfully used in special and general education alike to provide students access to literature beyond their present skill level. Using a multiple-probe design, investigators read typical age-appropriate texts and examined the effectiveness of pairing texts with the picture symbols and discussion in improving student comprehension. Discussion and implications of the findings within this study are included. Literacy is traditionally described as the act of reading, decoding, and comprehending language (Hoover & Gough, 1990). Literacy affords several social and personal benefits which impact an individuals overall quality of life including perceived competence, control over life choices, personal independence, tools for organization, as well as access to content for learning, information, and leisure (Downing, 2005), and has a profound impact on the day-to-day activities of individuals throughout the life span (Downing, 2005). Literacy can also serve as a primary means to access and participate in one’s own culture through activities such as reading a newspaper to understanding the issues of importance to a particular community or reading a popular novel series (e.g. Harry Potter) to recognize references and commentary made by others who have read it (Browder et al., 2009; Janks, 2010). Students with moderate intellectual disability experience limited access to literature (Downing, 2005; Erickson & Koppenhaver,

Correspondence concerning this article should be addressed to Jordan Shurr, Department of Counseling and Special Education, 321 Education and Human Services Building, Central Michigan University, Mt. Pleasant, MI 48859. Email: shurr.jordan@ gmail.com

1995; Kliewer, Biklen, & Kasa-Hendrickson, 2006). Major obstacles for accessing literature include inadequate literacy instruction and materials, low expectations for success, and negative social attitudes toward disability (Browder et al., 2009; Downing, 2005; Kliewer, 1998; Kliewer et al., 2006). Insufficient access to literacy supports, such as assistive technology or reading instruction, and inadequate instructional time have also been cited as access hindrances. A lack of adequate supports and attention to reading instruction result in a limited personal interaction with literature for these students (Downing, 2005). In addition, persons with intellectual disability often experience difficulties with memory, generalization, motivation, and adaptive behavior frequently make literacy challenging (Browder, Trela, & Jimenez, 2007; Browder et al., 2009; Downing, 2005; Kliewer, 1998; Kliewer & Landis, 1999; Turnbull, Turnbull, & Wehmeyer, 2010). For older students, difficulty accessing literature may occur due to the discrepancy between an individual’s needed supports and his or her age. Older students with intellectual disability, for example, often have support needs (e.g., representative pictures accompanying text, simplified text, text repetition) more similar to young early readers without intellectual disability than the support needs of their same aged peers without disabilities.

Comprehension of Typical Texts

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This needs-age discrepancy may limit the availability of such supports and therefore access to literature (Browder et al., 2009; Downing, 2005). Due to the importance of literacy as it relates to quality of life (e.g. perceived competence, independence) in general and on a day-to-day basis, students with moderate intellectual disability should have increased opportunities for access to literature. Literacy access for students with moderate intellectual disability can be described simply in two parts: (a) access to literature through reading and (b) access to literature through methods other than reading (Browder et al., 2009). A substantial and growing body of special education research focuses on helping students with moderate intellectual disability improve their access to literature through increased attention on reading skills. This includes research on using phonics to increase abilities in word decoding and fluency (Joseph & McCachran, 2003; Waugh, Fredrick, & Alberto, 2009), a meta-analysis of research on the effectiveness of sight word instruction (Browder & Xin, 1998), as well as use of a mixed approach to reading instruction (Allor, Mathes, Roberts, Jones, & Champlin, 2010; Otaiba & Hosp, 2004). Overall, research indicates that students with moderate intellectual disability are able to learn reading skills, which in turn increases their access to literature. However, especially for middle and high school students with moderate intellectual disability, reading skills alone often are not sufficient to access age or grade-level texts. As students with moderate intellectual disability age and the literature appropriate for their age increases in complexity and content, access to this literature via reading skills often declines (Browder et al., 2009). Access to typical age-appropriate texts, the type of literature accessed by same-aged peers without disabilities, is important for students with moderate intellectual disability. In their work on general education content, including typical age-appropriate literature and students with significant intellectual disability, Browder et al. (2007) detailed four reasons for promoting access. These include (a) to foster competence and improve the quality of life, (b) promote high expectations for students, (c) provide equitable access to instructional materials, and (d) to increase opportunities to

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exercise self-determination. When age-appropriate literature is available for these students, the benefits include access to the cultural icons and ideas relevant to their age group (e.g. superhero’s, movie stars), appropriately mature content, (Browder et al., 2009) rich vocabulary, and exposure to advanced literacy skills (Kluth & Darmondy-Latham, 2003). Access to literature through methods other than reading includes listening to stories read aloud either by way of technology (e.g. book on tape, computer screen reader) or by an adult or peer, also called a read-aloud. Hearing text read aloud allows students with moderate intellectual disability to access the content of literature irrespective of their reading skills. This allows students to access general ageappropriate texts that are otherwise out of reach. Wehmeyer (2006) describes the successful use of technology to provide access to the novel Moby Dick to an adult with a significant intellectual disability and limited reading skills. The participant in Wehmeyer’s research indicated that this application allowed him to enjoy previously inaccessible literature for leisure. Several studies successfully used readalouds to increase access to literature for students with moderate and severe intellectual disability (Bellon, Ogletree, & Harn, 2000; Browder, Trela, & Jimenez, 2007; Lawhon & Cobb, 2002; Skotko, Koppenhaver, & Erickson, 2004). Browder et al. (2007) found when teachers read age-appropriate adapted stories out loud, they were able to cultivate a leisure interest in literature, improve communication skills, and increase the comprehension abilities of older students with intellectual disability. In a study of the read-aloud behaviors of mothers to their daughters with Rett Syndrome, researchers found an effective and appropriate context was created to practice communication skills as well as comprehension and interaction skills (Skotko et al., 2004). Similarly, Bellon et al. (2000) found readalouds increased the spontaneous communication of a young child with autism. In addition to creating a context for communication skills, read-alouds were also found to provide opportunities for children to observe and interact with an effective model of literate behavior. Modeling literate behaviors such as this was found to be a powerful approach to teaching reading to young children (Lawhon

Education and Training in Autism and Developmental Disabilities-September 2012

& Cobb, 2002). Generalization, the ability to make sense of or complete a task under unfamiliar conditions, was also associated with read-alouds as text and concepts can be presented in multiple and unique ways (Browder et al., 2007; Bellon et al., 2000). In these studies, additional supports (e.g. picture symbols and discussion) were provided to increase student comprehension and engagement with the text. Visual supports such as picture symbols or photographs accompanying text proved to be beneficial in increasing access to the content of literature for students with intellectual disability (Browder, Mims, Spooner, AhlgrimDelzell, & Lee, 2008; Browder et al., 2009; Light, Roberts, Dimarco, & Greiner, 1998; Sevcik, Romski, & Wilkinson, 1991). Slater (2002) reported the advantages of using picture symbols added to texts for both comprehension and word identification. Light, Roberts, Dimarco, Greiner (1998) also reported positive effects of visual supports for increasing the receptive communication of students with autism. In a study on low achieving English language learners, Liu (2004) found cartoon images added to high-level texts to be a successful in increasing comprehension. The positive relationship between using images to increase literacy comprehension is echoed in the general education literature (Hibbing & Rankin-Erickson, 2003). A preliminary study on students with moderate intellectual disability suggested that visual symbols alone are not sufficient to support student comprehension of high-level texts read aloud. An additional intervention, text discussion, which involves a dialogue about certain key elements of a text, was found to successfully increase comprehension (Kucan & Beck, 1997; Moats, 2002). This may include clarifying questions, summary of main events and ideas, and situation of the text to familiar concepts for the student. This present study looks to combine visual supports and discussion to read-alouds, as an intervention to enhance the comprehension abilities of students with moderate intellectual disability on typical age-appropriate texts. This research inquiry attempts to increase the research base in non-reading access supports for this population to typical age-appropriate texts.

Method Participants Participants in this study included four middle school students ranging in age from 12–15 who were served in a self-contained classroom (less than 60% of their instructional day) setting in a suburban junior high school in a Midwestern state. Participants were nominated by their teacher based on the following criterion: (a) presence of a moderate intellectual disability, (b) ability to verbalize or physically identify a choice, (c) a lack of success with any one specific reading strategy, and (d) a willingness to participate. Five students were initially identified for participation. Following nomination, students were assessed on their ability to answer five basic three-option multiple-choice questions. Due to the emphasis on multiple-choice questions as a measure of comprehension in this study, 80% accuracy on this assessment was required for inclusion in this study. Four students met the criteria for inclusion and expressed interest in participating. Table 1 provides a summary for each participant. Sarah. Sarah was a 14-year old, 8th grade female identified as having a moderate intellectual disability and a language impairment. Sarah’s IQ score was 54. Her most recent Individual Education Program (IEP) indicated she was able to use a large vocabulary of sight words and complete simple reading activities independently but was typically not able to read new or unfamiliar words. Sarah spent the majority of her school day with the classroom staff and students. Weekly activities included functional academic work in the classroom, prevocational tasks within the school and community, as well as instructional outings to various sites within the community (e.g. grocery store, library, and restaurants). She participated in some general education classes throughout the school week such as choir and home economics classes. In terms of literacy, Sarah was exposed to age-appropriate materials such as magazines and an adapted newspaper (News-2-You®), literacy supports such as books on tape and picture communication symbols, and instructional materials such as simple language-oriented reading and writing worksheets. Upon arrival to the classroom


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TABLE 1 Participant Characteristics Student

Age

Ethnicity

IQ

Primary Disability

Secondary Disability

Sarah Ellen

14 14

Caucasian Caucasian

54a 52b

Moderate ID Moderate ID

William Louis

15 12

Caucasian Caucasian

42c *

Multiple Moderate ID

Language Impairment Language Impairment Deaf, Language Impairment, Moderate ID, Speech Impairment Language Impairment

a

WISC-IV b SB5 c UNIT * IQ score not available

each day, Sarah was observed working independently on academic worksheets or actively participating in group activities. Her personality could be described as bubbly as she spoke freely through her comments and questions. Ellen. Ellen was a 14-year old, 7th grade female identified with a moderate intellectual disability (IQ ⫽ 52) and a language impairment. Ellen’s most recent IEP noted she was able to read some basic elementary level sight words but experienced difficulty identifying words she had not memorized. Most of Ellen’s school day was spent with the classroom staff and students. She engaged in functional activities on a weekly basis including math and reading in the classroom, prevocational tasks within the school and community, as well as instructional outings to various sites within the community (e.g. grocery store, library, and restaurants). Ellen participated weekly in some general education classes such as choir. In terms of literacy, Ellen was exposed to ageappropriate materials such as magazines and an adapted newspaper (News-2-You®), literacy supports such as books on tape and picture communication symbols, and instructional materials such as simple language-oriented reading and writing worksheets. Ellen was a relatively quiet and shy young lady but was observed to be both willing and eager to work when asked. William. William was a 15-year old male in the eighth grade. He received special education services for students with multiple disabilities and was identified as having a moderate intellectual disability (Stanford-Binet IQ ⫽ 42), experienced a hearing disability, and speech and language disabilities. William’s most recent IEP indicated he was able to in-

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dependently read some elementary level sight words. Verbal communication was very limited for William. He used a speech-generating device (Dynavox), as well as gestures and a limited verbal vocabulary (yes/no) to communicate. The majority of William’s day was spent with the classroom staff and students engaged in functional activities such as academics in the classroom, prevocational tasks within the school and community, as well as instructional outings to various sites within the community (e.g. grocery store, library, and restaurants). In terms of literacy, William was exposed to age-appropriate materials such as magazines and an adapted newspaper (News-2-You®), literacy supports such as books on tape and picture communication symbols, and instructional materials such as simple language-oriented reading and writing worksheets. Although not always clear, William was very reliant on and fairly efficient in navigating and using his speech generating device to communicate in single word utterances typically to answer a question or make a comment. Although relatively quiet, William demonstrated a good sense of humor and was willing and eager to participate in school activities when requested. Louis. Louis was a 12-year old 7th grade male diagnosed with Down syndrome. His disability labels included a moderate intellectual disability and language impairment. Louis has recently lived in three different states over the past four years thus his official IQ score and school records were unavailable. His most recent IEP indicated that he was able to read and comprehend basic elementary sight words. Louis spent most of his school day with the classroom staff and students in functional


academic activities in the classroom, prevocational tasks within the school and community, as well as instructional outings to various sites within the community (e.g. grocery store, library, and restaurants). Louis enjoyed participating in general education classes on a weekly basis including choir. In terms of literacy, Louis was exposed to age-appropriate materials such as magazines and an adapted newspaper (News-2-You®), literacy supports such as books on tape and picture communication symbols, and instructional materials such as simple language-oriented reading and writing worksheets. Despite his recent move to this school from out of state, Louis was very outgoing and amiable with the adults and his peers in the school. Although sometimes difficult to understand, he readily spoke with classroom visitors and friends. Overall, Louis was observed to be willing and eager to comply with work requests, he occasionally needed to be reminded or redirected in order to complete tasks. Setting Study activities were conducted at a large table in the students’ self-contained classroom. within the local seventh and eighth grade junior high school. Participants sat across from the first author at a table located in the back of the classroom. The classroom included a small kitchen near the entrance, a bathroom, ten student desks arranged in rows facing an interactive whiteboard, a teacher desk, a small computer lab with three computers on a side wall, and a table surrounded by five chairs in the back of the room. Approximately eight students and three classroom staff members were present in the room and engaged in various group (e.g., calendar, cleaning tasks) and independent activities (e.g., independent worksheets, simple reading tasks) throughout the study. Despite the various activities occurring simultaneously, the classroom was relatively calm and free from major distractions. Independent and Dependent Variables The independent variable was a combined intervention with visual support as well as discussion. The visual support, a picture symbol strip containing five photos representative of key

elements within the text (e.g. character, setting) was presented to the student at the beginning of each session. A brief discussion about text content and the pictures contained within the picture strip occurred prior to and immediately following the text read-aloud. The dependent variable was the student’s response to a series of four multiple-choice questions about the text content. Questions were asked individually and students were able to respond verbally, by pointing to the correct answer, or through a combination of the two responses. If a student failed to respond within ten seconds, the question was asked again. Materials Texts. Texts for the read-alouds were selected from the SRA Specific Skills Series: Getting the Main Idea (Boning, 1997), Book G. This SRA instructional series contained short expository and narrative high-interest texts designed by content and readability for seventh grade students (McGraw Hill, n.d). All stories were comparable in difficulty and relative length. The SRA booklet was chosen due to the age targeted in both content interest and ability level. Additionally, this text was used due to the similarity in difficulty and length among texts. Fifteen stories were randomly selected from the booklet. The selected stories ranged in length from 78 –108 words with a mean of 97 and median of 95 words per story. Topics were varied and included a biography of Astrid Lindgren, the author of Pippi Longstocking, to facts about Neptune’s largest moon Triton. Comprehension Questions. Each text was accompanied by five, three-option multiplechoice questions. Each question was literal in nature, based on understanding the facts in the story, and framed as one of six wh- questions (who, what, when, where, why, and how). Table 2 provides a sample of questions and answers used for one of the texts. The questions were created based on Piontek’s (2008) nine criteria for creating valid and reliable multiple-choice questions (see Table 3). To ensure adherence to the criteria, each question was independently checked against the criteria. Suggested adjustments were made to the questions, which were followed by an


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TABLE 2 Sample questions for a story about San Francisco’s cable cars 1) When were the cable cars first installed? A. 1999 B. 1815 C. 1873* 2) How are the cable cars powered? A. by a cable that runs underneath the streets* B. by a diesel gas engine C. by electric power lines above the cars 3) Where were the cable cars first installed? A. near the large beach in Hong Kong B. in the dense forests of New Zealand C. on the steep hills of San Francisco* 4) Who has parties, weddings, and political rallies on the cable cars? A. Canadians B. San Franciscans* C. Soldiers * correct answer

independent review by another rater to assure that the adjustments matched the criterion. To ensure consistency in readability between the stories and the questions in-text or textrelated words and phrases were used for the questions and options. A basic review of the questions was also conducted using the FleschKincaid grade level equivalence in Microsoft Word. Each set of questions registered below a seventh grade reading level. TABLE 3 Criteria for Multiple Choice Questions* 1 Stem is a clearly described question, problem, or task. 2 Stem is concise as possible. 3 Only relevant information included in stem. 4 No negatives used in stem. 5 Only one correct answer. 6 No irrelevant clues with correct response. 7 Distractors are plausible but wrong. 8 No “all of above” option 9 Correct answer letter alternated among questions Note. Stem refers to the question statement. Distractors refers to the incorrect answer choices. * (Piontek, 2008)

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Physical Selection Sheet. An 8½-by-11 inch paper with 100-font printed letter options (A, B, & C) were presented to students allowing them to physically point to their answer following the presentation of a multiple-choice question. Students could answer questions by physically pointing to a letter on this paper, verbally answering the question, or both. If students failed to respond within ten seconds of hearing the question and multiple-choice answers, the researcher repeated the question and answers. None of the students required additional prompting to respond. Picture Symbol Strip. A visual support of five, 4-by-4 inch color photos secured to a 4-by-20 inch strip of poster board accompanied each story. Each picture represented one of the key elements of the text. The key elements and representative photos were selected through a search of Google images by the first author and reviewed by two independent reviewers for correspondence with the story. Each reviewer was asked to match each picture symbol strip with the story it represented while presented randomly. Both reviews resulted in 100% agreement of the representation of the picture supports for each of the individual stories.

Research Design A multi-probe across participants design (Kennedy, 2005) was used to assess the effectiveness of the intervention on student’s listening comprehension. This design was selected because it enabled replications across students while controlling for any possible treatment effect. In addition, this design negated the need for a lengthy consecutive baseline that could be overly frustrating for students due to the comprehension difficulty of the material prior to intervention.

Data Collection Event recording (Kennedy, 2005) was used to record each response to the comprehension questions. Immediately following a student response, investigators recorded the letter chosen by the student. Event recording was selected due to the quick and easily identifiable nature of the dependent variable.


Procedure

TABLE 4

Baseline. In this multiple probe design, students received from three to six sessions of the baseline treatment. During baseline sessions, one story was read aloud to each student. Students were then presented with four related multiple-choice questions. Students were provided up to ten seconds to respond to the first question without prompting. After ten seconds without a response, the question was repeated with an additional ten-second pause. Student responses included pointing to the letter on the letter choice sheet or saying the letter out loud. Following a response to the first question, the next question was asked and the same procedures were followed. Intervention. During intervention, students were presented with the picture symbol strip corresponding to the text presented during that session. Upon presentation of the picture strip, students were asked to verbally describe each photo. An investigator provided verbal feedback by agreeing with or clarifying student comments depending on each response. Next, the investigator pointed to each picture and described what it specifically represented. For example, when presented with a photo of Jupiter’s moon Triton, the investigator commented, “Here is Jupiter. Do you see how it looks rough? Scientists nicknamed it the cantaloupe moon because it looks rough like a cantaloupe. Do you see that?” After each photo was described, the text was read aloud to the student. Next, each photo was reviewed as it related to the text. The description process was interactive as students often commented or asked questions and received responses. Following the description, students were presented with the first of five comprehension questions followed by a ten-second pause for a response before asking the next question. If a student failed to respond within ten seconds, the question was repeated and an additional ten seconds provided for a response.

Social Validity Questions for Students

Social Validity Prior to the first baseline session and following the final intervention session, each student and the teacher was interviewed by the first author to determine his or her perceived

Pre Pre Pre Pre Pre Pre Post Post Post Post Post Post Post

Is it sometimes hard for you to understand what you hear? Is it sometimes hard for you to understand stories that you hear? Does anything help you understand what you hear? Do picture symbols help you understand things that you hear? Do you like to listen to stories read aloud? What kinds of stories do you like? Did looking at the pictures help you understand the story? Did talking about the pictures help you understand the story better? Did you like looking at and talking about the pictures? Would you like to use this intervention at school? Did you like the stories? Which was your favorite story? Why? Which was your least favorite story? Why?

Note. Pre ⫽ questions asked prior to the study, Post ⫽ questions asked following the study

value of text comprehension, to assess whether or not each liked the intervention, and to gain insight on the practicality for the intervention’s use in the classroom (Horner et al., 2005). Informal interview questions (see Tables 4 and 5) were used to assess the students’ and the teacher’s perspectives regarding the independent and dependent variables. Interobserver Agreement and Treatment Fidelity To ensure data validity, the first author and a trained classroom paraprofessional simultaneously yet independently documented each student’s responses to comprehension questions during baseline and intervention conditions. Interobserver agreement was conducted for 25– 60% of baseline sessions with an average of 38% of sessions covered. For the intervention phase, interobserver agreement was conducted for 33– 44% of sessions with an average of 36% of all baseline intervention sessions covered. Responses were compared to calculate reliability. Matching responses were labeled agreements and those not matching


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TABLE 5

TABLE 6

Social Validity Questions for the Teacher

Procedural Fidelity Checklist

Pre

1 2 3 4 5 6 7

Pre

Pre Pre Pre

Pre Post

Post Post Post Post Post Post Post

Is auditory comprehension difficult for your students? What types of interventions have you used to help your students comprehend what they hear? What seems to work best? Do picture symbols help your students understand things they hear? How often is auditory comprehension important for your students throughout their day? What kind of stories do your students like? Did the picture symbols and discussion seem to help your students understand things that they heard? What do you think of this as an intervention? Is it effective? Is it practical? Would you use it in the classroom? What modifications would you make? Where the stories appropriate for your students? Why? What did you think about the use of multiple choice as a test of comprehension?

8

9 10 11

12 13 14

Note. Pre ⫽ questions asked prior to the study, Post ⫽ questions asked following the study 15 16

were considered disagreements. Reliability was calculated by the sum of agreements divided by the sum of the agreements plus disagreements and multiplied by 100. Interobserver agreement for all students in both the baseline and intervention phase was 100%. Due to the simplicity of observation of the dependent variable no disagreements were recorded. Treatment fidelity was measured during the intervention sessions through the observations of a classroom paraprofessional to confirm the correct use of the intervention procedures. As the researcher conducted intervention sessions, the paraprofessional recorded completion of each step on a procedural checklist (see Table 6). An average of 36% of the intervention sessions with a range of 33– 44% among students were monitored for treatment fidelity. Treatment fidelity was calculated by the sum of completed steps di-

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17

Present Picture strip Ask student what he/she sees Comment/discuss each picture Read story Comment/discuss each picture Ask comprehension question 1 Point to letter choice while naming answer options Allow student 10 seconds to respond; If no response, repeat question and wait 10 more seconds. If still no response, ask if student wants to continue (student may verbally say or point to answer). Ask comprehension question 2 Point to letter choice while naming answer options Allow student 10 seconds to respond; If no response, repeat question and wait 10 more seconds. If still no response, ask if student wants to continue (student may verbally say or point to answer). Ask comprehension question 3 Point to letter choice while naming answer options Allow student 10 seconds to respond; If no response, repeat question and wait 10 more seconds. If still no response, ask if student wants to continue (student may verbally say or point to answer). Ask comprehension question 4 Point to letter choice while naming answer options Allow student 10 seconds to respond; If no response, repeat question and wait 10 more seconds. If still no response, ask if student wants to continue (student may verbally say or point to answer).

vided by the sum of the completed steps plus incomplete steps multiplied by 100. For all sessions documented, treatment fidelity was 100%. Due to the simplicity of the procedure, no disagreements were recorded. Results Figure 1 illustrates the overall effectiveness of the intervention on comprehension of the typical age-appropriate stories. Visual analysis revealed repeated gains in reading comprehension from the baseline to intervention


Figure 1. Comprehension Accuracy across Participants.

condition for each student. With the exception of a few sessions, baseline remained stable or exhibited downward trending. Intervention indicated stability or upward trending across all students.

Louis. Louis’s baseline remained at and below 50% accuracy with a downward trend and an overall average of 42% accuracy on comprehension questions. With the introduction of intervention, this level rapidly in-


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creased to 85% representing a 43% rise over the baseline mean. Visual analysis showed considerable and stable progress during the intervention phase ranging from 50% to 100% accuracy. Sarah. Sarah’s baseline accuracy ranged from 25%–75% with an average and median score of 50% over four baseline sessions. With the introduction of intervention, this level rapidly increased to 89% representing a 39% increase over the baseline mean. Visual analysis showed noteworthy and stable comprehension accuracy during intervention ranging from 75%–100%. Ellen. Ellen’s baseline scores indicated her comprehension accuracy ranged from 25%– 75% with an average of 45%. With the introduction of intervention, this level rapidly increased to 75% representing a 30% increase over the baseline mean. Visual analysis revealed considerable and stable comprehension accuracy during intervention ranging from 50 –100%. William. William participated in six baseline sessions and demonstrated a relatively stable and low accuracy on comprehension questions. His average baseline accuracy was 17% with a median of 0% and a range of 0%–75%. With the introduction of intervention, this level rapidly increased to 75% representing a 58% increase over the baseline mean. Visual analysis indicated considerable and stable comprehension accuracy during intervention ranging from 50 –100%. Social Validity Social validity interviews confirmed the functionality, social acceptance, and the practicality of the intervention used during this study. In the pre-study interview, the teacher indicated the importance of her student’s comprehension abilities on a daily basis. This sentiment was confirmed by two of the four students. When asked about supports used to aid in auditory comprehension, the teacher mentioned that multiple supports including picture symbols, gestures, and object use were necessary. One student, Ellen, also mentioned she would “ask the teacher to help” when she did not understand something. Prior to the study, the teacher and students agreed that pictures or other visual symbols help them

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understand what they heard. Following the intervention, students were asked to identify their favorite stories. Three students chose various favorites (e.g. the stories about dolphins, cable cars, and horse shoes) while William mentioned he liked them all. Two students expressed a specific story they liked the least, one did could not think of a least favorite, and Sarah mentioned that she “just liked them all.” The teacher echoed her satisfaction with the stories used. The use of age appropriate content and new, informative topics for students were cited as reasons. Students all responded they would like to use the picture symbol plus discussion intervention support more at school. The teacher also favored the intervention and saw it as a realistic intervention for the classroom. She added that she would likely use the intervention with groups of students simultaneously rather than in individualized instructional settings so as to maximize classroom support staff, while still providing the intervention. Discussion In light of the multiple access barriers for middle school students with moderate intellectual disability to typical age-appropriate texts, intervention research is essential (Browder et al., 2009; Downing, 2005; Kliewer, 1998; Kliewer et al., 2006). Access to age appropriate literature is essential for these students to experience the vocabulary-rich, sufficiently mature, and socially acceptable texts with increased comprehension (Browder et al., 2009; Kluth & Darmondy-Latham, 2003). Additionally, access to these texts foster an improved quality of life, promote high expectations, provide equitable access to instructional materials, and increase self-determination opportunities (Browder et al., 2007) Unfortunately, the use of effective strategies and appropriate materials are often not available to these students (Browder et al., 2009; Downing, 2005; Kliewer, 1998; Kliewer et al., 2006). This study investigated the effect of a combined visual- and discussion-based intervention on the comprehension abilities of middle school students with moderate intellectual disability when they were read typical age-appropriate texts. The intervention’s positive effect


was repeated across all participants in the study. Social validity interviews confirmed the importance of a comprehension-related intervention to the students and their teacher. Additionally, the interviews indicated the ease of use and practicality of this intervention for the classroom. Results indicate the intervention was successful in enhancing the comprehension abilities of students when read typical age-appropriate texts. Data also point to the usefulness of this particular intervention for increasing the comprehension abilities of students with moderate intellectual disability when read texts appropriate for their age. While all students performed more accurately during the intervention phase, Sarah displayed the most consistent and stable change in performance from baseline to intervention. During the baseline phase she was generally less than 80% accurate. But during intervention, her responses were consistently between 80% and 100%. She had the highest intervention average scores of the students with the third highest average growth. During all sessions, Sarah appeared interested and was very cooperative. She appeared to enjoy looking at the pictures and discussing the content. Frequently, she made comments about the pictures regarding what she saw, or how they related to the story. Later, Sarah indicated she enjoyed hearing all of the stories read out loud. On most occasions, Sarah answered the questions by stating the corresponding letter. Louis, the student with the most intervention sessions also experienced a rapid and relatively stable increase in comprehension scores between baseline and intervention phases (43% increase). Louis was typically willing to begin the sessions, but preferred, and was allowed, to finish any seatwork (worksheet, reading activity) before coming to the back table to work with the researcher. Louis listened intently as the stories were read and answered the questions quickly and with confidence. He rarely needed to hear the questions or options twice before responding. Louis answered questions by pointing to the corresponding letter on the answer selection sheet. Ellen also performed more accurately during intervention than in the baseline phase (39% increase). Ellen seemed to enjoy the

individual sessions and on occasion spent the first few minutes prior to beginning talking about what she did or was planning to do in the current week. On a few occasions, Ellen did not answer the questions within ten seconds and needed to hear them again. She frequently answered by verbalizing the correct answer by name, often in shorthand, speaking just the key words of the answer choice. For example, in a question about why plants and animals need to adapt to the desert, she correctly responded, “so little water” for the answer choice (c) there is so little water. William exhibited the most growth (58% increase in the mean accuracy from baseline to intervention) of all participants in the study. Four out of his six baseline sessions resulted in 0% accuracy in his comprehension of the texts. He was typically quiet but came willingly and usually paused for a few seconds before answering the comprehension questions. On a few occasions, during the discussion, William responded to the question, “What do you see?” with a one word utterance through his speech generating device. It was sometimes difficult for the researcher to see the connection between his selected word and the content of the photo; however, William’s comprehension accuracy during the intervention phase suggests he did have a good understanding of the stories and was making a connection, which he considered valid and or logical, although unfamiliar to the investigator. William answered the comprehension questions typically by pointing to the letter on the physical selection sheet. Hibbing and Rankin-Erickson (2003) suggest that students benefit from visual representations accompanying unfamiliar texts. In the current investigation, images appeared to help students attend to the key content within the stories. In addition, discussing the pictures with students helped attach contextual meaning from the story to the pictures. These findings are consistent with Kucan and Beck’s (1997) review of articles on the effects of discussion on reading comprehension. These authors found that teacher supported discussion, such as that used in the study, was effective in enhancing the comprehension abilities of students without disabilities. Additionally in regards to discussion, Moats (2002) described the benefits of modeling and prac-


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ticing discussion in relation to texts to increase and support the development of comprehension for older students who struggle with reading. Limitations and Future Research One limitation of this study was the exclusive use of multiple-choice questions as a measure of student comprehension. While the students in this study did prove their ability to accurately respond in a multiple-choice format prior to participation, the complexities involved in using multiple-choice responses to express comprehension could exclude other students with moderate or severe intellectual disability from replicating the effects of the intervention. For instance, one student, who may have benefited from this intervention, was specifically excluded from this study due to her repeated inaccuracy in answering the novel multiple-choice questions. And several other students in the classroom were not recommended for participation by the teacher due to their inconsistency in responding to questions. Future research in this area should focus on an expanded approach for assessing student comprehension of read aloud texts. While two individuals separately reviewed the photo sets to ensure the accuracy of their representative connection to the texts, this evaluation did not sufficiently address the need for consistency in identifying the critical representative concepts of a text or selecting accurate representations from photos. In this study, main ideas and concepts were selected from each story by the first author. These main ideas and concepts were then used as the basis for selecting representative photos. While this process did prove reliably representative among the raters and popular among the students for the short texts used, it may not have the same effect on more elaborate texts (e.g. novels, biographies). Future research should include more precise and formulaic approaches to the process of selecting key themes and representative images for text. The discussion portion of the intervention was loosely based. Sessions began by asking each student to comment on the photos and continued with an unscripted description of each photo followed by a conversation with the student regarding how the photos repre-

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sented the texts. While the discussion appeared to have a beneficial effect on the student’s comprehension abilities of the texts read aloud, the lack of structure utilized is deemed a limitation in terms of research replication and application in the classroom. Unstructured discussions have the potential to not only vary in methodology and results, but also to detract from the main purpose of the intervention, which is to help students comprehend text read out loud. Future research in the combined picture symbol plus discussion intervention should examine the use of structure interviewing strategies to provide increased consistency in the discussion portion of this intervention. Fifteen short expository and narrative high interest stories were used as the age-appropriate literature in this study. While the content appeared to hold students’ interest and attention, using longer texts such as age-appropriate novels, magazine articles, or newspapers may provide more credibility to the robustness of the present intervention. Future studies using this intervention should explore its effectiveness with longer, more commonly accessed texts such as popular adolescent novels, academic textbooks, or newspapers. Finally, caution should be used when interpreting the results of this study due to the small number of participants involved. While this study contributes to the literature on access for students with moderate intellectual disability to age-appropriate texts, additional research on this particular intervention and as well as variations of it, should be conducted to promote generalizability of these results. References Al Otaiba, S., & Hosp, M. K. (2004). Providing effective literacy instruction to students with down syndrome. Teaching Exceptional Children, 36(4), 28 –35. Allor, J. H., Mathes, P. G., Roberts, K., Jones, F. G., & Champlin, T. M. (2010). Teaching students with moderate intellectual disabilities to read: An experimental examination of a comprehensive reading intervention. Education and Training in Autism and Developmental Disabilities, 45, 3–22. Bellon, M. L., Ogletree, B. T., & Harn, W. E. (2000). Repeated storybook reading as a language intervention for children with autism. Focus on Autism and Other Developmental Disabilities, 15, 52–58.


Boning, R. A. (1997). SRA Specific Skills Series: Getting the Main Idea. Book G (5th ed.). Columbus, OH: SRA/McGraw Hill. Browder, D. M., Mims, P. J., Spooner, F., AhlgrimDelzell, L., & Lee, A. (2008). Teaching elementary students with multiple disabilities to participate in shared stories. Research and Practice for Persons with Severe Disabilities, 33, 3–12. Browder, D. M., Trela, K., & Jimenez, B. (2007). Training teachers to follow a task analysis to engage middle school students with moderate and severe developmental disabilities in grade-appropriate literature. Focus on Autism and Other Developmental Disabilities, 22, 206 –219. Browder, D. M., Wakeman, S. Y., Flowers, C., Rickelman, R. J., Pugalee, D., & Karvonen, M. (2007). Creating access to the general curriculum with links to grade-level content for students with significant cognitive disabilities. The Journal of Special Education, 41, 2. Browder, D. M., & Xin, Y. P. (1998). A meta-analysis and review of sight word research and its implications for teaching functional reading to individuals with moderate and severe disabilities. The Journal of Special Education, 32, 130 –153. Browder, D., Gibbs, S., Ahlgrim-Delzell, L., Courtade, G. R., Mraz, M., & Flowers, C. (2009). Literacy for students with severe developmental disabilities. Remedial and Special Education, 30, 269 – 282. Downing, J. (2005). Teaching literacy to students with significant disabilities: Strategies for the K-12 inclusive classroom. Thousand Oaks, CA: Corwin. Erickson, K. A., & Koppenhaver, D. A. (1995). Developing a literacy program for children with severe disabilities. The Reading Teacher, 48, 676 – 684. Hibbing, A. N., & Rankin-Erickson, J. L. (2003). A picture is worth a thousand words: Using visual images to improve comprehension for middle school struggling readers. The Reading Teacher, 56, 758 –770. Hoover, W. A., & Gough, P. B. (1990). The simple view of reading. Reading and Writing, 2, 127–160. Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of singlesubject research to identify evidence-based practice in special education. Exceptional Children, 71, 165–179. Janks, H. (2010). Literacy and power. New York, NY: Routledge. Joseph, L. M., & McCachran, M. (2003). Comparison of a word study phonics technique between students with moderate to mild mental retardation and struggling readers without disabilities. Education and Training in Developmental Disabilities, 38, 192–199. Kennedy, C. H. (2005). Single-case designs for educational research. Boston. MA: Pearson Education.

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Received: 23 September 2011 Initial Acceptance: 28 November 2011 Final Acceptance: 6 January 2012
