Activity Schedules for Children with Severe Diagnoses: Teaching Independent Play in the Absence of Adult Prompting

Abstract

Children diagnosed with severe intellectual disabilities (ID) and autism spectrum disorders (ASD) often lack independence, relying on adult prompting to engage in play activities. In the absence of adult prompting or access to reinforcers (R+), independent engagement typically does not occur. Activity schedule (AS) interventions have been successfully implemented to develop a wide range of skills in this population, but many AS studies incorporated additional prompts and therefore do not adhere to the original protocol designed by MacDuff et al. (1993), named here as PCDI-AS. While other methods have been successful, it is not clear if adding gestural and/or verbal prompting improves effectiveness. To investigate the effectiveness of PCDI-AS and AS using other methods for individuals diagnosed with severe ID and/or ASD, two studies were completed:

Study One - Systematic Review:

Aims. To a) to systematically assess both effectiveness and quality of all studies using AS with participants with ID or ASD, and compare results of PCDI-AS versus AS using other methods, and b) provide a narrative synthesis of all studies with a focus on interventions designed to develop independent play skills.

Method. A systematic review was conducted, including a narrative synthesis. Each study was assessed for quality using the single case experimental design (SCED) scale (Tate, McDonald, Perdices, Togher, Schultz & Savage, 2008). The percentage of non-overlapping data (PND) method was used to estimate effect size (Scruggs, Mastropieri & Casto, 1997).

Results. Comparison of both quality and effectiveness data indicate that while AS are moderately effective, the PCDI-AS approach is highly effective. PCDI-AS evidenced more generalisation than AS using other methods. While only one study implemented PCDI-AS to develop independent play skills in those with severe diagnoses, results indicate it was effective

Conclusion: Findings are limited to use of PND and SCED as measurement systems, as other measurement systems may have yielded different results, however, data collected via these methods suggest that for developing independent play skills in those with ID and/or ASD diagnoses PDI-AS is more suitable than AS using other methods.

Study Two - Intervention:

Aims. To a) identify if PCDI-AS are suitable for teaching engagement with play materials to individuals with severe ASD or ID, in the absence of adult prompting, and b) to see if skills acquired during training would generalise to other settings under the control of naturally occurring stimuli.

Method. Following pre-requisite skill training, PCDI-AS was introduced, at different time points, to a cohort of 9 pupils presenting with ID and/or ASD within the severe range. To measure the effect of PCDI-AS on independent engagement with play materials in another setting, for each individual, different aspects of play skills were measured during child-initiated play sessions both prior to and during the intervention. Data were compiled to create non-concurrent multiple baseline across participants designs.

Results. PCDI-AS appears to be effective for developing independent play skills in participants with severe diagnoses; six pupils mastered schedule following. Play observations suggested that PCDI-AS impacted upon behaviour in other settings. Following the start of training, for most, levels of engagement increased and variety of play materials widened.

Conclusion: The current study is limited to 9 pupils in one location, therefore, results must be interpreted with caution. However it has significance for pupils with severe diagnoses who are prompt dependent and lack independent play skills, and for those professionals who seek to develop their skills.

Discussion

While AS are effective in general, the systematic review suggests that PCDI-AS are more effective than AS using other methods, and are associated with more generalisation. To develop their independent play skills, pupils with severe diagnoses were introduced to PCDI-AS. The intervention appeared to be successful; independent schedule following occurred under the stimulus control of visual cues alone, in the absence of adult prompting. Furthermore, evidence suggested that skills can be generalised to other settings under the control of naturally occurring stimuli.