586190 research-article2015

RPSXXX10.1177/1540796915586190Research and Practice for Persons with Severe DisabilitiesSpooner et al.

Article

Generalization of Literacy Skills Through Portable Technology for Students With Severe Disabilities

Research and Practice for Persons with Severe Disabilities 2015, Vol. 40(1) 52­–70 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1540796915586190 rps.sagepub.com

Fred Spooner1, Amy Kemp-Inman1, Lynn Ahlgrim-Delzell1, Leah Wood2, and Luann Ley Davis1

Abstract Literacy is an important skill for accessing all academic content areas, and there has been an increased focus on using a variety of assistive technology (AT) to support the acquisition of literacy skills for students with severe disabilities. Literacy also provides these students with skills to increase community participation, with independence, with skills to make individual choices, and with opportunities for potential employment. Portable technology such as an iPad2® can be used to enhance literacy skills for students with severe disabilities in elementary school. A typical way to teach literacy to this population is through the use of a shared story. Although systematic instruction has proven to be an effective teaching strategy, the generality of the literacy skills usually has not been the focus of the training. In this study, five students with severe disabilities (IQ below 55, range in age 7-11 years, grade range 2nd-6th grades) were taught to generalize literacy skills via multiple exemplar training. A multiple probe design across participants demonstrated a functional relation between student responding and the intervention. Extension of what we currently know, limitations, and future research are discussed. Keywords literacy instruction, severe disabilities, generalization training, shared stories, systematic instruction Technology has become ubiquitous as a tool in education, and for students with intellectual disability or autism spectrum disorders (ASD), it can be enjoyable, appealing, help students attend to tasks at school, and be used in an assistive capacity to increase student access to instruction (Douglas, Wojcik, &Thompson, 2012; Fernández-López, Rodríguez-Fórtiz, Rodríguez-Almendros, & Martínez-Segura, 2012; Kagohara et al., 2013; Knight, McKissick, & Saunders, 2013; Mechling, 2011). Assistive technology (AT) is constantly evolving to deliver multiple forms of practical supports, which provide behavioral, social, and academic enrichment within a single device. Interactive and portable devices such as the iPad2® and other tablets have increased accessibility and could be instrumental in augmenting the acquisition of new academic skills for students with severe disabilities (Kagohara et al., 2013; Mechling, 2011). However, there are challenges in using iPad2® technology for students with more complex motor, cognitive, and sensory perceptual impairments. For example, many of these applications require significant motor, cognitive, and sensory perceptual skills (Kagohara et al., 2010). In addition, there have been few if any efforts to truly

1University 2California

of North Carolina at Charlotte, USA Polytechnic State University, San Luis Obispo, USA

Corresponding Author: Fred Spooner, Department of Special Education and Child Development, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223-0001, USA. Email: [email protected]

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integrate communication access for individuals who require augmentative and assistive communication (AAC) so that they can more effectively utilize the various functions across applications (McNaughton & Light, 2013). Preliminary evidence indicates the use of digital text via computers and tablets may provide students with severe disabilities increased access to the content and skills of their same-aged peers through the use of features such as text-to-speech, touchscreen, multiple applications, and the ability to embed pictures and videos (Coyne, Pisha, Dalton, Zeph, & Smith, 2012; Mechling, 2011; Spooner, Ahlgrim-Delzell, KempInman, & Wood, 2014). The use of digital text to support communication and instruction for students with severe disabilities is emerging in current research literature, specifically in the area of literacy (e.g., AhlgrimDelzell, Browder, & Wood, in press; Coleman, Hurley, & Cihak, 2012; Coyne et al., 2012; Wood, Mustian, & Cooke, 2012), which is consistent with the emphasis of improving literacy for all students (National Governors Association Center for Best Practices & Council of Chief State School Officers [NGA & CCSSO], 2010; National Institute for Literacy, 2001). Emergent literacy skills have been described as behaviors that form a foundation for the development of formal literacy skills such as decoding, oral reading fluency, and reading comprehension (Lanter, Watson, Erickson, & Freeman, 2012; National Early Literacy Panel, 2008). These skills include letter awareness and looking to print for information, essentially pointing the child toward an understanding of the purpose of reading (McDonnell et al., 2014; Pullen & Justice, 2003; Whitehurst & Lonigan, 1998). Although emergent literacy skills usually develop as a result of interactions with adults (e.g., teachers and parents) and a literacy-rich environment, students with severe disabilities may not naturally develop these skills (Lanter et al., 2012; McDonnell et al., 2014). Frequently, students with severe disabilities are not successful in acquiring reading skills when typical instructional procedures are applied (i.e., Tier 1 supports: screening and benchmark testing of students to determine instructional needs, core curriculum based on scientifically validated research, and continuing professional development to ensure every student receives quality instruction, for example, Al Otaiba, Kosanovich-Grek, Torgesen, Hassler, & Wahl, 2005; Vaughn, Wanzek, Woodruff, & Linan-Thompson, 2007). However, practitioners can promote access to grade-aligned literature and the development of emergent literacy skills through the use of shared stories, an evidence-based practice for teaching literacy to this population of students (Hudson & Test, 2011). Originally a strategy used for very young children without disabilities (Justice, 2002; Pullen & Justice, 2003), emergent readers can engage in the shared story format to increase their knowledge of the subject matter as well as to gain these important early literacy skills (National Early Literacy Panel, 2008). Adapted versions of the text can be used to assist students in comprehending the story while maintaining their interest (Browder, Mims, Spooner, Ahlgrim-Delzell, & Lee, 2008; Browder, Trela, & Jimenez, 2007; Mims, Browder, Baker, Lee, & Spooner, 2009; Mims, Hudson, & Browder, 2012). To facilitate success for students with severe disabilities, explicit, systematic instruction can be used to teach the components of a shared story (Browder et al., 2008; Mims et al., 2012; Spooner et al., 2014). Based on behavioral principles of learning, systematic instruction is an evidence-based practice for teaching students with severe disabilities (Spooner, Knight, Browder, & Smith, 2012). For shared stories, these methods include the use of task analytic instruction (Gold, 1976; R. D. Horner & Keilitz, 1975; Test, Spooner, Keul, & Grossi, 1990), time delay (Snell & Gast, 1981; Touchette, 1971), and least to most prompting (Mims et al., 2012). Several studies involving shared stories have incorporated AT into one or more steps of the task analysis to further enhance access to literacy for non-readers. For example, AAC devices have been used to facilitate completion of a repeated storyline and to provide response options for students with little to no verbal ability (Browder et al., 2008), and Coyne et al. (2012) used electronically formatted books (e-books) to teach literacy to this population of students. In a study more closely related to the present investigation, Spooner et al. (2014) examined the effects of systematic instruction, including constant time delay and a modified system of least prompts using an iPad2® and a GoTalkNow© communication application (Attainment Company, 2011) to teach gradeappropriate literature in a shared story format for students with ASD and limited verbal ability. Using a task analysis to direct the shared story process, participants were able to increase the number of independent

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correct responses on the task analysis from baseline to intervention, indicating a functional relation between the intervention and student performance. Although research has demonstrated that students with severe disabilities can use AT to successfully access and comprehend text, it is equally important that students learn to generalize these skills across content (Stokes & Baer, 1977; Stokes, Baer, & Jackson, 1974). Students with severe disabilities typically have difficulty with skill generalization (Heward, 2009; Richards, Brady, & Taylor, 2015; Stokes & Baer, 1977; Taylor, Smiley, & Richards, 2015), thus necessitating explicit and purposeful training of generalization for this population. In the seminal piece, Stokes and Baer (1977) suggested several approaches, including training sufficient exemplars. This method has been used in instruction for students with severe disabilities in the form of teaching multiple exemplars (Hicks, Bethune, Wood, Cooke, & Mims, 2011; R. H. Horner, Eberhard, & Sheehan, 1986; Knight, Spooner, Browder, Smith, & Wood, 2013). The purpose of this study was to extend the research on shared stories by examining the use of systematic instruction and training multiple exemplars of emergent literacy skills through a shared story format on the iPad2® to increase acquisition and generalization of emergent literacy skills for elementary-aged students with severe disabilities. There were three primary research questions for this investigation. Research Question 1: What are the effects of grade-aligned, adapted shared stories formatted on an iPad2® and paired with systematic instruction and presentation of multiple exemplars on the acquisition of emergent literacy skills for students with severe disabilities? Research Question 2: What are the effects of the intervention on listening comprehension of students with severe disabilities? Research Question 3: What are the effects of the intervention on generalization of emergent literacy skills for students with severe disabilities?

Method Participants Five elementary-aged students were selected to participate in this study. The selected students met the following inclusion criteria: (a) have an IQ of 55 or below and satisfy the federal criteria for intellectual disability, (b) have the physical ability to touch picture symbols and the iPad2® to indicate a response to a question (participants were screened by being given six questions and provided with four response options on the iPad2® and must have responded by pointing to all six questions to meet this criteria), (c) have limited verbal communication (i.e., must use some form of augmentative communication), and (d) must have returned both the signed parental and student consent forms. All students involved with the investigation used the Unique Learning System curriculum (N2y, 2014) for literacy training. In general, the classroom lessons focused on differentiated literacy (e.g., stories, poems), and students were asked to repeat a line from the story through an active participation response (e.g., voice output device, eye gaze choice, verbally) to demonstrate comprehension. Sebrina.  Sebrina was a 7-year-old African American female in the second grade. She was diagnosed with ASD and had very limited verbal skills such as one word utterances for her wants and needs or gestural communication. Sebrina was evaluated as a pre-school student using the Transdisciplinary Play-Based Assessment (TPBA, Linder, 1993), which is a customary assessment tool utilized to evaluate cognitive functioning for students in the pre-school age range. Her cognitive skills ranged from a 24-month level to a 36-month level with most skills clustered at the 30-month level of development and was identified as significantly below average. Sebrina had Individual Education Program (IEP) goals pertaining directly to early literacy skills, and her literacy skills according to her IEP were at the emerging or pre-primer level. Miranda.  Miranda was an 8-year-old Hispanic female in the third grade. She was evaluated as a pre-school student with the TPBA (Linder, 1993) that reported her cognitive skills ranged from a 24-month level to a 36-month level with most skills clustered at the 30-month level of development and was identified as

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significantly below average. She was diagnosed with ASD at that time and had unintelligible expressive communication. Miranda was identified as an English as a Second Language (ESL) student. Miranda qualified for the North Carolina (NC) Extend 1 (State Alternate Assessment) for both English and mathematics. Miranda had IEP goals pertaining directly to early literacy skills, and her literacy skills according to her IEP were at the emerging or pre-primer level. Jesse.  Jesse was a 9-year-old Hispanic male in the fourth grade. He had been diagnosed with multiple disabilities that include intellectual disability, limited receptive and expressive speech, and limited motor coordination and muscle tone. Jesse had vision and hearing only on his right side, due to significant physical impairments (i.e., oral/palate) that impeded his communicative abilities. Because of his low cognitive functioning, Jesse was administered the Differential Ability Scale II (DAS; Elliott, 2007) and received a full scale score of 50. He was given the Brigance Diagnostic Inventory of Early Development (Brigance, 1991), which indicated his overall functioning as significantly below average in all areas. Jesse qualified for the NC Extend 1 (State Alternate Assessment) for all three areas of English, mathematics, and science. Jesse had IEP goals directly related to early literacy skills, and his literacy skills according to his IEP were at the emerging or pre-primer level. Madison.  Madison was a 9-year-old White female in the fourth grade. She was diagnosed with multiple disabilities that included moderate intellectual disability, limited receptive and expressive speech, limited motor coordination, and attention deficit hyperactivity disorder. Madison’s full scale IQ score was 47 using the Leiter-R (Roid & Miller, 2002). The Brigance Inventory of Early Development (Brigance, 1991) indicated that Madison was functioning significantly below average in all areas. Madison qualified for the NC Extend 1 (State Alternate Assessment) for both English and mathematics. Madison had IEP goals directly related to early literacy skills, and her literacy skills according to her IEP were at the emerging or pre-primer level. Gabriel.  Gabriel was an 11-year-old African American male in the sixth grade. He was diagnosed with Down syndrome and had a full scale IQ score of 50 using the Leiter-R (Roid & Miller, 2002). Gabriel demonstrated selective mutism that impeded his expressive communication. Gabriel qualified for the NC Extend 1 (State Alternate Assessment) for all three areas of English, mathematics, and science. Gabriel had IEP goals directly related to early literacy skills, and his literacy skills according to his IEP were at the emerging or pre-primer level. Although the students in the study ranged in grade level from second to sixth grades, the pre-school assessment data were the information that was used to determine placement. More current assessment information was not available.

Setting The study took place in a suburban public elementary school in the Southeast. The school served approximately 800 students in Grades kindergarten through fifth with 54% receiving free and reduced-price lunch. The racial and ethnic diversity of the students in the school was 13% African American, 79% White, 6% Hispanic, and 1% Other. Participants received a majority of their academic instruction in one of two special education self-contained classrooms. All sessions in the study took place in a teaching office adjacent to the participants’ self-contained homeroom classes to minimize distractions. The doors connecting the two classrooms to the office were closed during the study sessions. Students sat at a large desk that faced a wall and limited the distractions from the windows.

Experimenters The interventionist was a doctoral student at a local university with a total of 16 years teaching experience working with students with severe developmental disabilities. A second researcher, also a doctoral student

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and a board-certified music therapist working toward licensure in special education, collected interobserver reliability and procedural fidelity data. The interventionist collaborated with the two special education teachers to create a session schedule that ensures the participants did not miss academic instruction (e.g., mathematics, literacy, science) in their typical classrooms (e.g., during morning circle time when calendar and weather were being reviewed).

Measurement Dependent variables.  The first dependent variable was measured across all sessions and was defined as each student’s independent correct responses for items on the task analysis of the shared story for each adapted chapter of Charlotte’s Web. The task analysis offered nine opportunities for the student to respond and was adapted from a template used in previous research to teach story-based lessons (Browder, Trela, et al., 2007; Spooner et al., 2014), combining early literacy and comprehension elements from the book and the iPad2®. The nine elements in the task analysis included opportunities to (a) identify the book title (as represented by a screenshot of the book’s cover); (b) identify the author’s name (as appears on the book cover); (c) turn pages of the adapted chapter; (d) two opportunities to text point left-to-right to words in the book as the text was being read; (e) select the correct vocabulary word definition, using a four-grid response option format (i.e., pictures and text representing one correct response and three distractors); (f) answer two different comprehension questions, one for each page of text, using a four-grid format of response options (i.e., pictures and text representing one correct response and three distractors); and (g) identify the repeated storyline using a button that would voice the words when pressed (e.g., Wilbur was special). Vocabulary word definitions and listening comprehension questions were validated by a literacy expert. Each chapter consisted of two pages, with two to four adapted story sentences on each page. The text was programmed to be read aloud using the text-to-speech function. One vocabulary word per chapter (e.g., runt, sell, crowd) was selected and pre-taught as part of the generalization training intervention (see generalization training under procedures for a more detailed description). When the student touched the highlighted vocabulary word, the program was formatted to immediately jump to the vocabulary response choice page to assess student knowledge of the vocabulary word, and then returned to the story when the correct definition was selected. Mastery criterion for each student was set at eight independent correct responses, or 89% (8 out of 9), on the steps of the shared story task analysis for three consecutive sessions. A second dependent variable was the total number of listening comprehension questions answered correctly without assistance by the student per session. Student performance on listening comprehension was parsed out to examine the effect of the intervention package on listening comprehension alone. At the midpoint and again at the conclusion of each chapter, the student was presented with a listening comprehension question, which corresponded to the chapter book used in that section, for a total of two listening comprehension questions per adapted chapter. All listening comprehension questions were developed at the literal recall level (e.g., What did Fern do every day when she got home from school? Where did Wilbur go to live?) to allow the focus of the intervention to be on foundational, emergent literacy skills that collectively boost participants’ understanding of the book. Answers were directly derived from the text. Four response options, including picture and text, were presented along with the question. Response options consisted of one correct answer, two distractors, and a question mark that sounded “I don’t know, read it again” when pressed. A modified system of least prompts was used to provide students with re-reads of the text if needed to answer the listening comprehension questions. Once the page was read, the student would touch the iPad2® to activate the reading of the question. If the student chose the question mark, the student was referred to the page of text with a portion (approximately two sentences) highlighted to direct the student to the correct answer. The student then was given a second opportunity to answer the question. If the student still pressed the question mark, the student was referred to the page of text with a smaller portion of text highlighted (approximately half to one sentence) to further direct the student to the correct answer. Data collection.  Student responses on the shared story task analysis were recorded throughout baseline, intervention, and maintenance phases. For each item on the task analysis, if the student responded correctly

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within 4 s, the student scored a plus (+). If the student responded incorrectly or did not respond within 4 s, the student scored a minus (−). No feedback or error correction was provided to participants during baseline, intervention, or maintenance phases for the shared story chapters of Charlotte’s Web; thus, student performance on the shared story chapters served to indicate the extent to which participants could generalize emergent literacy skills from the generalization training to the new information presented daily through the Charlotte’s Web chapters.

Experimental Design For this study, the researchers utilized a multiple probe across participants design (Gast & Ledford, 2014; R. D. Horner & Baer, 1978). This design allowed researchers to (a) analyze the effectiveness of the intervention based on the discrepancy between baseline and intervention data across participants, and (b) intermittently collect baseline data, thus minimizing participants’ frustration and familiarity with materials prior to receiving instruction during the intervention. Baseline for all participants continued for at least five sessions and until a change in trend or level was observed. The student with the lowest stable baseline (the student with the most need) entered intervention first. When the first participant began intervention, baseline probes continued to occur for the remaining participants until they entered the intervention phase. When the first participant demonstrated a stable accelerating trend in completion of the steps on the task analysis, the next student demonstrating the lowest stable baseline was brought into intervention. This pattern continued for the remaining participants. Mastery consisted of the participant demonstrating eight of nine (89%) independent correct responses on the task analysis for three sessions. Once mastery was achieved, intermittent probes were conducted to ensure that their skills were maintained and entered the maintenance phase. After all participating students had received at least one maintenance session, the study came to completion. The sessions were held in the morning during the students’ English Language Arts (ELA) lessons (approximately 9:00-10:00 a.m., Monday through Friday), lasting approximately 15 min. All students received the intervention for a total of 44 sessions over a period of 14 weeks (with the exception of days students were on a field trip, sick, spring break, school day off). In total, the study lasted approximately 5 months from baseline through maintenance phases for all participants.

Procedures Baseline.  The interventionist presented each session in a one-to-one shared story format with an adapted chapter from two age-appropriate, grade-aligned books (Charlotte’s Web and Because of Winn Dixie). The adapted chapters were randomized during baseline by writing a chapter number (1-13) on small pieces of paper and drawing them out of a cup to determine which adapted chapter would be used during baseline. The chapters were randomized during baseline to ensure that chapters from each book would have an equal chance of being assigned to each participant, thus controlling for book effects in the event students used both Charlotte’s Web and Winn Dixie to complete the study. All students met the mastery criterion using Charlotte’s Web only, and therefore, Winn Dixie was not used in intervention or maintenance. The interventionist used a shared story task analysis to guide delivery of each component. The steps of the task analysis and the procedure used to deliver the generalization training are shown in Table 1. The steps of the task analysis provided the student with nine opportunities to respond (no generalization training occurred during baseline). The interventionist delivered the initial cue to begin, and the student would then touch the iPad2® to voice the title, author, and vocabulary words, and read the adapted story as directed in the order of steps on the shared story task analysis (see Table 1). Generalization training intervention.  The shared story implementation was identical to baseline, except that the chapters were introduced sequentially (i.e., beginning at Chapter 1 of Charlotte’s Web, then Chapter 2, and so on). As in baseline, the shared story task analysis was presented without providing any prompting or corrective feedback to assess the extent to which students were able to generalize their knowledge of emergent literacy skills to new chapters of the book each day. Participants received the generalization training intervention after the shared story (i.e., Charlotte’s Web adapted chapters with task analysis) each day. The

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Table 1.  Shared Story Task Analysis With Generalization Training Procedures. 1. Touch title –Taught using examples and non-examples 2. Touch author name –Taught using examples and non-examples 3. Turn page (at least 3 times) –Taught using time delay (0-s followed by 4-s delay)  4. Text point (first page of text) –Taught using time delay (0-s followed by 4-s delay) 5. Vocabulary –Taught using examples and non-examples 6. Comprehension Question 1 –Taught using modified system of least prompts 7. Text point (second page of text) –Taught using time delay (0-s followed by 4-s delay) 8. Touch repeated storyline –Taught using time delay (0-s followed by 4-s delay) 9. Comprehension Question 2 –Taught using modified system of least prompts Note. The generalization training procedures, presented here in italics, were only implemented during the intervention phase.

order was presented as such to ensure data represented student learning across time (i.e., overnight) and not just immediately following the generalization training intervention. The generalization training intervention consisted of teaching emergent literacy skills needed to complete the shared story and was presented in a model–lead–test format (see Table 1). Examples and nonexamples were presented to teach students to identify titles and author names from a variety of book covers and in different formats (e.g., varying fonts, colors, and placement of author name and title on each book cover). Screenshots of book covers were presented on the iPad2® page in a grid of nine. Next, vocabulary that related to the Charlotte’s Web chapters was pre-taught using pictorial examples and non-examples of the vocabulary word that would appear in the next day’s shared story. A cumulative review of all vocabulary words also was conducted in the same manner. Following the teaching of the author, title, and vocabulary using examples and non-examples, a brief story was then presented (i.e., three to four sentences maximum) to simulate the shared story format and to practice the remaining skills. The practice stories were not related to content presented in the shared story probes. Constant time delay (i.e., 0-s delay between initial cue and model during first generalization training session, and 4-s delay between initial cue and model during subsequent sessions) was used to teach turning the page and text pointing (following text from left to right). For comprehension questions, students were taught to use the question mark that said “I don’t know, read it again” to listen to the text again if needed to answer the questions correctly. To teach this procedure, following presentation of the brief story text, a new iPad2® page presented a grid of four pictures along with the comprehension question. The four pictures included a picture of the correct answer and pictures of two distractors, as well as a question mark symbol that, when pressed, would lead to a page of the brief story with a portion of the text highlighted that contained the answer. The student was again given the opportunity to answer the question using the previously described grid of four pictures. If the student again pressed the question mark, she or he would see another page of the story on which a more focused amount of text containing the answer was highlighted. The student was told to use the question mark to indicate “I don’t know” rather than guessing. Verbal, model, and then physical prompts were used in order of least intrusive prompt to teach students to use the “I don’t know, read it again” options (e.g., by pressing the button with the question mark) if they answered incorrectly. Students were given specific verbal praise (e.g., “Good job using the iPad2® to answer the question!”), which was provided for independent correct and prompted responses for each step of the generalization training.

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Maintenance.  Maintenance probes were conducted for each student once per week, after the student met the mastery criterion. Maintenance procedures replicated baseline conditions (i.e., no generalization training intervention was provided), with sequential assignment of one chapter per session, and students continued to receive vocabulary pre-training on the upcoming session’s vocabulary word. Students remained in maintenance until all students had received at least one maintenance probe. Interobserver reliability.  All baseline and intervention data collection procedures were implemented by the interventionist. Interobserver reliability was collected by the second author, another doctoral student, who viewed video recordings of the sessions. Interobserver reliability was collected across 20% of the video recorded baseline, intervention, and generalization sessions, with a criterion of 80% or above. Interobserver agreement (IOA) was calculated by dividing the number of agreements between the interventionist and the interobserver by the total of agreements plus disagreements, and then multiplied by 100. There was 93% agreement (range = 75%-100% across participants) across baseline, intervention, and maintenance (Cooper, Heron, & Heward, 2007). On the two occasions that IOA scores fell below 80%, the second author and the interventionist met to discuss the scoring discrepancies. Procedural fidelity.  Procedural fidelity also was collected by the second author by viewing video recordings of the sessions. Fidelity was collected across 20% of the video recorded baseline, intervention, and generalization sessions, with a criterion of 80% or above. Procedural fidelity was calculated by dividing the number of items correctly implemented by the interventionist by the total number possible of items and multiplying by 100. For the shared stories, there was a mean of 94% fidelity across all phases (range = 90 %-100% across all participants). For the generalization training, there was a mean of 93% (range = 87%100% across all participants). Social validity.  Social validity data were collected to assess the social acceptability of the goals, procedures, and outcomes, and were measured through teacher, parent, and student surveys (Cooper et al., 2007; Wolf, 1978). The teacher and parent surveys consisted of six statements set on a 5-point Likert-type scale, concerning the degree to which the intervention was helpful and meaningful. The student survey consisted of five statements with picture cues, with answer choices provided in the format of a happy face and sad face to indicate the extent to which the students perceived the intervention as helpful and meaningful.

Results Results for student correct responses on the nine-step shared story task analysis can be seen in Figure 1, and student progress on the comprehension questions is shown in Figure 2. All five participants demonstrated low and/or stable baseline trends on their ability to independently perform the steps of the task analysis, with an immediacy of effect within the first three intervention sessions when each participant was entered into the intervention phase. Students demonstrated acquisition of emergent literacy skills (e.g., identifying the title, identifying the author, turning the page, text pointing, and identifying vocabulary). Student performance on listening comprehension demonstrated a cumulative change from baseline to intervention for all five students (e.g., touching repeated storyline, answering comprehension questions). All five participants demonstrated low and/or stable baseline trends on their ability to independently respond correctly to the two questions presented during each session with cumulative increases throughout intervention and maintenance. Students also demonstrated skill generalization of identifying the title, identifying the author, identifying correct response to vocabulary, and text pointing throughout the book (see Figures 1 and 2).

Student Performance on Task Analysis Sebrina.  Sebrina’s responses during baseline were stable and consistent, scoring two of nine for five consecutive sessions. Her baseline performance had no variability, consistently only getting two of the nine steps correct with a mean of two correct responses. Sebrina was selected to enter intervention first for two

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Intervenon

Maintenance

9 8 7 6 5 4 3 2 1 0

Sebrina

Number of correct responses on the task analysis

9 8 7 6 5 4 3 2 1 0

Miranda

9 8 7 6 5 4 3 2 1 0

Jesse

9 8 7 6 5 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0

Madison

Gabriel 0

2

4

6

8

10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 Sessions

Figure 1.  Number of correct responses on the task analysis across five participants for baseline, intervention, and maintenance phases. Note. Arrows indicate the point at which mastery was met.

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Independent Correct Responses for Listening Comprehension Questions

36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0

Baseline

Intervention

Maintenance

Sebrina 02468101214161820222426283032343638404244464850

36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0

Miranda

36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0

Jesse

36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0 36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0

Madison

Gabriel 0

2

4

6

8

10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50

Sessions

Figure 2.  Cumulative independent correct responses for listening comprehension questions.

Note. Change line indicates when intervention began. Connected data points are sessions up until mastery criteria were met with arrows indicating the point at which mastery was met. Unconnected data points, which follow, are cumulative data points during the maintenance phase.

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primary reasons: (a) Due to her non-verbal communicative characteristics, she demonstrated the highest need, and (b) her consistent, stable baseline data. Sebrina demonstrated a sharp increase in level, jumping from only two correct responses in baseline to six correct responses during the first session of the intervention. She met mastery criterion of 89% or better for three consecutive sessions on her fifth session. Her independent correct responses ranged between 6 and 9 correct responses with a mean of 7.8 correct responses during intervention. Sebrina’s skills generalized across adapted chapters, with an equal or higher number of independent correct responses each time a new adapted chapter was presented. During maintenance, she completed all steps on the task analysis independently between 8 and 9 correct responses for all remaining sessions with a mean of 8.82 correct responses. Miranda.  Miranda’s responses during baseline were generally stable with some slight variability. Baseline performance for Miranda ranged between 2 and 3 correct responses with a mean of 2.6 correct responses. On entering intervention, Miranda was able to demonstrate a sharp increase in level, jumping from 3 correct responses for her last point in baseline to 8 correct responses during the first session of intervention. Her independent correct responses ranged from 7 to 9 with a mean of 8.12 correct responses during intervention. She met the mastery criterion of 89% for three consecutive sessions by her eighth session. Miranda’s skills generalized across adapted chapters, with an equal or higher number of independent correct responses each time a new adapted chapter was presented. During maintenance, she completed all steps on the task analysis independently with a range between 8 and 9 correct responses for the 10 remaining sessions with a mean of 8.38 correct responses. Jesse.  During baseline, Jesse demonstrated some variability in his correct responses on the task analysis with a range between 1 and 2 correct responses with a mean of 1.22 correct responses. He was selected to enter intervention third as his need was greater than the remaining participants. Although his increase in level and trend was not as sharp as the first two participants, Jesse was able to demonstrate a notable increase during his fifth session of intervention. His independent correct responses during intervention ranged from 5 to 8 correct responses, and he met the mastery criterion by the eighth session with a mean of 6.75 correct responses. During the maintenance phase, Jesse’s skills generalized across adapted chapters with a range between 7 and 9 correct responses with a mean of 8.47 for the remaining nine sessions. It was noted that Jesse underwent reconstructive surgery of his left ear between sessions 28 and 32 resulting in less adapted chapters being completed and less frequent data collected than the other participants due to his intermittent absences. Madison.  Madison demonstrated relatively consistent, stable baseline responses with a range between 1 and 2 for 10 sessions and a mean of 1.7 correct responses. She was brought into intervention fourth as she demonstrated the next greatest need. Her first intervention data point was only 1 point higher than her baseline; however, her subsequent intervention data points demonstrated a sharp increase in level and trend, and she met the mastery criterion of 89% or greater correct responses for three consecutive sessions by her fourth intervention session. Her independent correct responses during intervention ranged between 3 and 8 correct responses with a mean of 6.75 correct responses. Madison’s skills generalized across adapted chapters, with her independent correct responses ranging from 7 to 9 correct responses resulting in a mean of 8.15 correct responses for the remaining 11 maintenance sessions. Gabriel.  Gabriel’s baseline data were relatively stable with very little variability, range between 0 and 2 with a mean of 1.0 correct response. On entering intervention as the final participant, his first data point was only a moderate jump in level; however, his subsequent performance demonstrated a rapid increase in both level and trend, meeting mastery by his eighth session during intervention. His range of correct responses during intervention was 4 to 9 with a mean of 7.50 correct responses. Gabriel’s skills generalized across adapted chapters during maintenance with a range between 8 and 9 correct responses with a mean of 8.48 correct responses for the remaining five maintenance sessions. It was noted that the school year ended so Gabriel received fewer opportunities to practice the skill during maintenance.

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Student Performance on Listening Comprehension Sebrina.  For listening comprehension, two questions per session were presented. Sebrina answered 0 out of 10 questions, with a mean of 0.0%, independently correct during baseline; she did not use text prompts to answer any baseline questions. She answered 34 out of 36 questions, with a mean of 94.4%, independently correct, throughout the 18 intervention and maintenance sessions. Sebrina’s performance across intervention demonstrated an increase in the rate of independent correct responses on listening comprehension questions from the first adapted chapter to the fourth adapted chapter. Miranda.  For listening comprehension, Miranda answered 0 out of 16 questions, with a mean of 0.0%, independently correct during baseline; he did not use a text prompt to answer any baseline questions. During the first adapted chapter, Miranda answered one out of two questions independently correct. Her performance across intervention peaked during Session 6, and she answered a total of 26 out of 36 questions, with a mean of 72.2%, independently correct during intervention and maintenance sessions, with no text prompting used. Jesse.  For listening comprehension, Jesse answered 3 out of 18 questions independently correct during baseline, with a mean of 1.6%; he did not use text prompts to answer any baseline questions. During the first session, Jesse answered 1 out of 2 questions independently correct and answered 1 out of 2 questions correct during the second session, with no text prompt used. During the fifth session, he answered 2 out of 2 independently correct. His performance across intervention demonstrated an increase in rate of independent correct responses on listening comprehension questions for a total of 26 out of 36, with a mean of 72.2%, independently correct throughout intervention and maintenance sessions. Madison.  Given two listening comprehension questions per session, Madison answered 0 out of 20 questions, with a mean of 0.0%, independently correct during baseline; she did not use a text prompt to answer any baseline questions. She answered 12 out of 22 questions correctly throughout the intervention and maintenance sessions, with a mean of 54.5%, independently correct and did not use a text prompt to answer any questions. Gabriel.  For listening comprehension, two questions per session (adapted chapter) were presented. Gabriel answered 0 out of 22 questions, with a mean of 0.0%, independently correct during baseline; he did not use text prompts to answer any baseline questions. During each of the first and second adapted chapters, Gabriel answered 1 out of 4 questions independently correct. In total, across intervention and maintenance sessions, Gabriel correctly answered 22 of 30 questions, with a mean of 73.3%, independently correct. Gabriel’s performance across intervention demonstrated an increase in the rate of independent correct responses on listening comprehension questions from the adapted chapters presented.

Social Validity Survey Outcomes The teacher and parent survey included a total of six statements regarding the use of the iPad2® and literacy. The statements used a 5-point Likert-type scale that ranged from a score of 5 (strongly agree) to 1 (strongly disagree) and assessed perspectives on the value of the intervention (e.g., teaching listening comprehension to students with severe disabilities, using an iPad2® to facilitate instruction, generality of skills learned to other academic areas). A total of eight stakeholders responded to the survey: two teachers, four para-professionals, and two parents. All respondents marked a 5 (strongly agree) for each of the six statements for an overall mean of 5 across all statements, indicating that the intervention was valuable, useful, and practical, and could be generalized to other settings. The students’ social validity survey was composed of five statements read to them, which also included perspectives on the intervention (e.g., importance of literacy comprehension, level of enjoyment using the iPad to learn reading, generalizing skills to other books). Similar to a 5-point Likert-type scale, the students

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were to circle (or color in) one of five smiley faces. The smiley faces ranged from a very happy face (strongly agree) to a very sad face (strongly disagree). All five students circled or colored in the very happy face (strongly agree) for each of the five statements with four of the five responding they “loved the iPad2®,” and two students (Sabrina and Jesse) indicated they wished they could use the iPad2® all the time at school.

Discussion This study investigated the effects of using an iPad2® paired with systematic instruction on student demonstration of generalization and listening comprehension skills with the use of shared stories. Overall, the data indicated there was a functional relation between the use of the iPad2® and systematic instruction to implement a shared story. A functional relation is described as an effect produced in experimentation where the change in the dependent variable can reliably be reproduced by the independent variable, and the change identified in the dependent variable likely is not due to the influence of some other extraneous variable (Cooper et al., 2007; Gast & Ledford, 2014; Johnston & Pennypacker, 1980, 2008; Tawney & Gast, 1984). All five students increased in the number of independent correct responses on listening comprehension questions from baseline to intervention as evidenced by a jump in level and an increase in trend from baseline to intervention with no occurrences of overlapping data, demonstrating a clear effect of intervention. Similar to Spooner et al. (2014), the present study included embedded response opportunities, such as turning pages and reading repeated story lines, on an iPad2® in the delivery of grade-aligned adapted chapters to teach emergent literacy skills to elementary students with developmental disabilities (all of which were eligible to receive an alternate assessment via alternate achievement standards). This current investigation in conjunction with the Spooner et al. study indicates that students with severe disabilities can use technology to meaningfully participate in grade-appropriate literacy experiences and can make responses that demonstrate an ability to generalize literacy skills to a variety of presentations for alternating title, author, and cover pages, and demonstrate an understanding of the storyline, plot, and characters, as well as an understanding of vocabulary associated with the presented story. Increasing opportunities to engage in literacy is important because it provides access to the general curriculum, gives students a more extensive exposure to the world, and provides the opportunity to build a foundation for future appreciation of literature (Browder et al., 2009; Jackson, Ryndak, & Wehmeyer, 2008-2009). The outcomes from this study will contribute to the field in several ways. First, the body of literature on teaching early literacy skills and comprehension with the use of portable technology such as an iPad2® to students with severe disabilities is extremely limited. This study sought to build on the study by Spooner et al. (2014), by utilizing an iPad2® to deliver responding and communication opportunities synchronously with the grade-aligned, age-appropriate shared story. While studies have used AAC devices and AT to support student independence in specific portions of shared stories (e.g., Browder et al., 2007; Trudeau, Cleave, & Woelk, 2003), the iPad2® was used in this study to incorporate all assistive elements of the shared story lesson (e.g., text-to-speech formatting of adapted story and repeated storyline, pictorial representation of response options with auditory cue) with a generalization element. It is important to understand, in this study, as well as others that have used portable technology as a teaching tool with this population (e.g., Coyne et al., 2012), that the full range of communication options has not been explored, as with other AAC devices. There are multiple advantages to using an iPad2® when delivering instruction to this population. The iPad2® is a familiar instrument used within any mainstream environment and is less stigmatizing than other AAC or AT devices (Bortoli, Arthur-Kelly, Mathisen, Foreman, & Balandin, 2010), and is versatile (e.g., portability, multiple software options, text-to-speech options), which allows students to demonstrate concept understanding with more independence. In a review of the 21st century devices, Mechling (2011) found that digital mediums with flexible formats can easily be altered to meet the individual needs across students, and that multimedia capabilities of the iPad2® increase the accessibility for all students. The iPad2® was considered a cost-effective device for delivering the instruction. In this instance, each of the two classrooms already had their own iPad2® tablets, and the teachers could provide the students with

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access to adapted grade-aligned chapter books following this study. In addition, because the iPad2® and the GoTalkNow© application (Attainment Company, 2011) served multiple functions across students in each classroom, the device functioned as a low-cost alternative to multiple instructional programs and AAC devices. All five students had some experience with the iPad2® through teacher-guided and independent activities, and were able to learn to perform the requested tasks with ease, making the iPad2® very usable. A focus on generality is important, as it continues to extend what we know about teaching literacy instruction to this population and moves toward everyday applications that improve the quality of life for individuals with severe disabilities by providing access to printed materials. Students with severe disabilities have demonstrated that they can learn meaningful literacy and comprehension skills (e.g., Coyne et al., 2012; Mims et al., 2012; Spooner et al., 2014); however, we also must find ways to teach these students to generalize these skills to new situations and materials (Stokes & Baer, 1977). Consistent with previous research (Hicks et al., 2011; R. H. Horner et al., 1986; Knight, Spooner et al., 2013), the present study demonstrated that teaching multiple examples and non-examples can be a successful strategy for teaching early literacy skills that generalize to new material. All five students in the present study were able to respond and comprehend a variety of features within the adapted chapters of the book. For example, they could track text from left to right by following along with their finger, as well as generalize the location of the title and author for each book when presented with different book covers where the title and author were presented in multiple places and in a variety of fonts. This generalization was intended to provide similarity to those books being read by their peers without disabilities. Modifications were made to assist the students in accessing the content without requiring them to demonstrate other skills (e.g., memorization of entire adapted chapter material). These modifications included providing the students with the correct response, two incorrect responses, and an icon to allow them to return to the text to find the correct response within the adapted chapter. Students were taught how to locate the information through the use of a prompt on the iPad2® to return to the page where the correct answer for the listening comprehension question could be found. Interestingly, none of the students used the prompt icon to return to the text to locate the correct response during the shared story sessions, although they did use the feature during the generalization training. For some students, this may be a result of the students correctly answering the listening comprehension questions, making the return-to-text prompt unnecessary. It might also imply that some students may not have generalized the skill from the training to the shared story session. The findings from the present study provide additional support to the existing body of research supporting the use of systematic instruction to teach literacy skills to students with disabilities, and a modified system of least prompts to teach comprehension skills to students with moderate intellectual disabilities and autism (e.g., Browder et al., 2007; Browder et al., 2008; Spooner et al., 2014). While prior research has used a modified system of least prompts to promote listening comprehension during read-alouds through an extra prompt consisting of a re-read of the text (e.g., Browder et al., 2007; Browder et al., 2008; Spooner et al., 2014), the present study used the iPad2® text-to-voice feature to deliver the repeated readings of text. Similar to these prior studies, the system of least prompts was used in the present study as a component of the overall intervention package, which included multiple exemplar training. The present study also may contribute to the small body of research in which students with moderate and severe disabilities, and autism, respond to listening comprehension questions. Due to the projected difficulty of both decoding and processing meaning, the present study incorporated some higher-level thinking through the use of vocabulary building and listening comprehension questions. To eliminate decoding and word meaning difficulty, students were introduced to the next session’s vocabulary word and given multiple examples and non-examples to provide meaning to unfamiliar words. Difficulty with comprehension was addressed by providing text-to-speech listening comprehension to read the question and possible responses. The present study adds to the large body of research supporting the use of time delay in conjunction with the presentation of multiple exemplars to teach vocabulary words to students with disabilities. In the present investigation, all 5 students reached mastery of correctly identifying the corresponding picture definition for all 12 vocabulary words presented (e.g., runt, slaughter, help, and friend).

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Implications for Practice Students with severe disabilities and communication deficits may benefit from the use of portable technology such as an iPad2® to access general curriculum content and to actively participate in learning through embedded response opportunities and text-to-speech formatting of the text. The adapted version of gradealigned chapter books presented in a shared story format also may be helpful for these students to learn important emergent literacy skills while additionally working on more advanced vocabulary and comprehension skills. Although students did not use the option to return to the text to answer comprehension questions during the shared story sessions, this skill has been shown to be an effective strategy for all students to comprehend more complex material (Jitendra, Burgess, & Gajria, 2011; McCormick & Cooper, 1991; Mims et al., 2012). Teachers should consider providing a re-read or listen again option for students to access and comprehend increasingly complex content. As in the present study, it may be sufficient for some students to learn this skill through discrete and explicit practice outside of the shared story setting and then generalize it to other literacy activities. In practice, teachers should monitor student performance and, if needed, provide even more intensive skill training on strategies to promote generalization of strategies for locating the answer to comprehension questions within the text. Systematic instruction seems to be a critical component of the shared story strategy, as seen in the present study and in other research (e.g., Browder et al., 2008; Browder, et al., 2007; Mims et al., 2012), which did not use portable technology. This explicit instruction was augmented by the use of training multiple examples and non-examples to promote generalization of the skills. When participants were taught using a wide variety of possible representations of each emergent literacy skill, they did not need to re-learn those skills each time new material was presented but instead were able to generalize the skills to new content. Teachers providing instructional practice for students with severe disabilities should consider effective methods for teaching generalization; multiple exemplar training may be one strategy worth using.

Limitations and Future Research As with any research study, there are limitations to the investigation. First, due to the small sample size inherent to the design, single case experimentation lacks generalization to other participants outside of the present study. This issue is addressed through replication of the demonstration of a functional relation between the independent variable and the dependent variable across all five participants. Maintenance conditions were identical to baseline (i.e., no prompting, systematic instruction, and no praise). Maintenance probes remained above the line of minimal performance (i.e., twice the baseline mean) for all participants thus far, suggesting they maintained skills learned in intervention. Another limitation is that the present study occurred in a small teacher office, not in the participants’ classrooms, and the interventionist was the fifth author, not the classroom teacher. Future research can focus on using the limitations cited in this study to extend what we know and need to know about teaching emergent literacy skills. First, there is a need to replicate the findings from this study, adding more investigations, a dispersed group of investigators, and more participants to work toward establishing an evidence-based practice. Second, investigators should examine the effects of implementing this intervention with students in their natural classroom setting and implemented by teachers to extend the ecological validity of the findings as work progresses in more inclusive settings. Third, based on the studies that have been conducted (e.g., Browder et al., 2008; Koppenhaver, Erickson, & Skotko, 2001; Spooner, Rivera, Browder, Baker, & Salas, 2009) and the review by Hudson and Test (2011), validating shared stories as an evidence-based practice with a moderate level of evidence, it seems logical that training for generality (both stimulus and response generalization) should be built into the standard protocol, as an inability to generalize remains one of the characteristics of the population (Heward, 2009; Richards et al., 2015; Taylor et al., 2015). Future research also might consider extending the modified system of least prompts to include other metacognitive instruction such as teaching rules for answering certain types of comprehension questions to further enhance generalization to new content (e.g., Jitendra et al., 2011; Mims et al., 2012). The ability to generalize literacy skills will continue to lead to an expanded and better quality of life.

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Conclusion As a treatment package, the use of grade-aligned adapted text presented on an iPad2®, paired with explicit instruction, would appear to be an effective strategy for teaching acquisition and generalization of emergent literacy skills for students with severe disabilities and communication difficulty. Students made gains across presentations of new, untrained chapters, indicating that they could generalize the skills as a result of the multiple exemplar training. Students also seemed to be engaged during the training and generalization sessions and were able to operate the iPad2® at a more independent level as the sessions progressed. Overall, the intervention may be an effective means for promoting access to grade-aligned literature and for teaching generalization of emergent literacy skills needed to progress in the general curriculum. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Author Biographies Fred Spooner, PhD, is a professor in the Department of Special Education and Child Development at UNC Charlotte. He is currently Co-Principal Investigator on Project Solutions, a U.S. Department of Education, Institute of Education

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Research and Practice for Persons with Severe Disabilities 40(1)

Sciences Project, examining mathematical problem solving for students with severe disabilities. His research interests include evidence-based practices and instructional strategies for students with severe disabilities. Amy Kemp-Inman is a doctoral student in special education at the University of North Carolina at Charlotte. Her research focuses on the use of assistive technology and systematic instruction to maximize learning for students with intellectual disability, autism, and significant support needs. Lynn Ahlgrim-Delzell, PhD, is an associate professor of research at the University of North Carolina at Charlotte. She has numerous journal articles and book chapters on issues pertinent to academic instruction and assessment for students with developmental disabilities. Leah Wood is an assistant professor at California Polytechnic State University at San Luis Obispo. Dr. Wood earned her PhD in special education from UNC Charlotte in 2014, with an emphasis on moderate and severe disabilities. She is a Board Certified Behavior Analyst (BCBA-D) and specializes in the application of systematic instruction to teach academic content and skills to students with intellectual disability and autism spectrum disorder. Luann Ley Davis, MA-SNC, is a third-year doctoral student at the University of North Carolina at Charlotte. Luann will graduate from UNC Charlotte with a PhD in special education with emphasis on moderate and severe disabilities and intends to specialize in the application of systematic instruction and general curriculum access. Received:    12/12/2014 Final Acceptance: 04/13/2015 Editor in Charge:  Susan Copeland