Evaluation of two instruction methods to

(1)

Evaluation of two instruction methods to increase employment options

for young adults with autism spectrum disorders

Raymond V. Burke

a,b,

*

, Melissa N. Andersen

b

, Scott L. Bowen

a

,

Monica R. Howard

c

, Keith D. Allen

c

a

The Prevention Group, Omaha, NE, United States b_{University of Nebraska, Lincoln, NE, United States} c

Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, United States

1. Introduction

Among employment-age adults with disabilities, some of the lowest employment rates are for individuals on the autism spectrum. For example, Engstrom, Ekstrom, and Emilsson (2003) found that only 2% of participants with Asperger’s Syndrome or High Functioning Autism were employed. Results from a longitudinal study of social and employment outcomes in 120 individuals with autism indicated that over 90% were unemployed and not living independently (Bellstedt, Gillberg, & Gillberg, 2005).Barnard et al. (2001)analysis of employment age individuals with an Autism Spectrum Disorder (ASD), found that only 6% of adults with ASD were employed full-time and 4% were employed part-time. In contrast,Benz et al. (2000)study of 709 students with disabilities (the majority of whom were diagnosed with learning disabilities) indicated that 35% were employed full-time at 2 years post high school graduation. The gap is even more disparate between

A R T I C L E I N F O

Article history: Received 22 July 2010 Accepted 30 July 2010

Keywords:

Autism Spectrum Disorders Assistive technology Employment outcomes Personal digital assistants

Community-based vocational training

A B S T R A C T

We evaluated the efficacy of a vocational training program including behavioral skills training, and a ‘‘performance cue system’’ (i.e., a proprietary iPhone application adapted for the study) to teach targeted social-vocational skills to six young adults with an Autism Spectrum Disorder. In two separate studies, participants were employed to assist in the delivery of a fire safety education program. Participants were asked to wear an inflatable firefighter WalkAround1 _{mascot costume and to perform 63 scripted behaviors in} coordination with a fire prevention specialist who was the lead program presenter. In Study 1, three participants were initially exposed to established company training procedures comprised of behavioral skills training components to determine whether they met mastery of the skills. If necessary to reach criteria, participants were then exposed to a performance cue system. In Study 2, three additional participants were provided with the performance cue system alone, and then behavioral skills training if required. A single case, multiple-baseline design across subjects was used to evaluate efficacy of each intervention. Results indicate that 5 of 6 participants reached criterion only after introduction of the cue system while the sixth reached criterion with behavioral skills training alone. The program received high satisfaction ratings from participants, their parents, and consumers. Implications and potential use of the PCS in other employment settings are discussed.

Research in Developmental Disabilities

* Corresponding author at: 2320 Paul Street, Omaha, NE 68102, United States. Tel.: +1 402 408 1324; fax: +1 402 331 2729.

E-mail addresses:ray@thepreventiongroup.org(R.V. Burke),Andersen.Melissa@gmail.com(M.N. Andersen),scott@thepreventiongroup.org(S.L. Bowen),

mrhoward@unmc.edu(M.R. Howard),kdallen@unmc.edu(Keith D. Allen).

(2)

employment age individuals with ASD and their working age peers without disabilities, 70% of whom are employed (Bureau of Labor Statistics, 2010).

Individuals with ASD are characterized by marked and sustained impairments in social and communicative functioning that can impact every aspect of adaptive functioning (American Psychiatric Association, 2000). Although some individuals on the autism spectrum have fewer cognitive and language impairments, most still have continuing difﬁculties with interpreting nonverbal cues and engaging in reciprocal social exchanges (Mu¨ller, Schuler, & Yates, 2008). In addition, because individuals with ASD have limited ranges of interest (Neisworth & Wolfe, 2005), many can become preoccupied with nonfunctional routines and patterns of behaviors that may interfere with work completion. It should not be surprising then that a large percentage of employment-age individuals with ASD experience unemployment and underemployment (Nesbitt, 2000).

Due to the social-communicative deﬁcits associated with the disability, traditional job training and coaching methods (e.g., lengthy verbal instruction) are often counterproductive to helping individuals with ASD ﬁnd and keep a job. Fortunately, there are evidence-based practices for individuals with ASD that can be used to improve employment training and support systems.

Behavioral skills training (BST) has been used extensively to teach skills to individuals with and without disabilities but few published studies have examined BST with individuals with ASD in the workplace. BST has been used to teach a parent and child how to teach social skills to a sibling with ASD (Stewart, Carr, & LeBlanc, 2007) and children with autism how to avoid being abducted (Gunby, Carr, & LeBlanc, 2010). BST also has been used to teach adults with mental retardation how to escape from a burning building (Knudson et al., 2009), how to construct shipping boxes (Maciag, Schuster, Collins, & Cooper, 2000), and how to self-monitor and complete tasks in competitive employment (Browder & Minarovic, 2000). In one of the few studies evaluating BST to address vocational skills in individuals with ASD,Hillier et al. (2007)reported increases in time in employment and earnings using an intervention that focused on pre-placement skills, such as completing applications and interviews and post-placement skills, such as completing job tasks and understanding workplace rules.

One of the reasons why there may be so few studies evaluating behavioral skills training with individuals with ASD in the workplace is that the approach can be relatively labor intensive. In the Hillier study, participants spent up to six months engaged in behavioral skills training with job coaches for up to 20 h per week. So, while BST can be highly effective in teaching new and complex skills, it also can be cost-prohibitive for many potential employers.

A cost effective alternative to behavioral skills training is to use prompts or cues that signal an individual both what to do and when to do it. Numerous studies have used video, picture, text, or verbal cuing to teach clients with developmental disabilities (DD) daily living skills such as how to set a table (Goodson, Sigafoos, O’Reilly, Cannella, & Lancioni, 2007), attend to personal hygiene (Garff & Storey, 1998), make peanut butter and jelly sandwiches (Rehfeldt, Dahman, Young, Cherry, & Davis, 2003), make microwave popcorn (Sigafoos et al., 2005), and unpack groceries (Cannella-Malone et al., 2006). There also is a long history of using cuing to teach individuals with DD basic computer skills (Frank, Wacker, Berg, & McMahon, 1985) and how to access preferred Internet sites (Jerome, Frantino, & Sturmey, 2007). Minarovic and Bambara (2007)

successfully used sight-word checklists as cues to teach non-reading adults with moderate intellectual disabilities to complete a variety of job tasks. Prompting and cuing also have been used individually and in combination with other strategies to help children with autism initiate and respond to interactions with peers (Licciardello, Harchik, & Luiselli, 2008), imitate peers’ play activities (Ganz, Bourgeois, Flores, & Campos, 2008), and be more empathetic to peers (Schrandt, Townsend, & Poulson, 2009). A review of related research literature found only one published study that used cuing to teach young adults with ASD job skills.Hume and Odom (2007)effectively used cuing to help a 20-year-old male increase his time on task, increase task completion (i.e., scanning document pages), and decrease the number of prompts needed to complete tasks over time.

There is a small but expanding body of research examining the use of personal digital assistants (PDAs) to prompt students and adults as a means of increasing completion of daily living tasks and academic tasks in school, and developing social, emotional, and behavioral skills. For example,Gentry et al. (2010)trained transition-age high school students with autism to use PDAs as task management tools. Results indicated that the majority of participants used PDAs as trained and reported an increase in daily living task completion. In a study examining the use of PDAs with audio, video, picture, and voice-over capabilities, teen students with autism were found to increase completion of lesson tasks and their ability to adjust prompting levels to meet their needs (Mechling, Gast, & Seid, 2009). Published studies of PDA use as a prompting aid for completing job tasks are far less available. One promising study examined the use of a PDA to improve decision making and task completion of individuals with cognitive disabilities when completing two, 11- and 12-step packing tasks, e.g., putting product and materials in a container for shipment. Results indicated higher accuracy of decisions and task completion and fewer requests for assistance when participants used the PDA than when not using the prompting device (Davies, Stock, & Wehmeyer, 2003).

Although both behavioral skills training and cuing procedures offer potentially effective and complimentary approaches to teaching vocational skills, there are few studies that have assessed the effectiveness of these approaches with adults with ASD in the workplace. Additionally, PDAs hold promise as an effective means of providing cues in a wide variety of job settings, thereby increasing the possibility of employment for individuals on the autism spectrum. As a result, the two current studies were designed to evaluate the efﬁcacy of behavioral skills training and a novel PDA-based performance cue system on the ability of individuals with ASD to perform a complex chain of workplace behaviors.

(3)

2. Study 1

2.1. Method

2.1.1. Participants

Participants were three young adults diagnosed with ASD. To obtain a measure of the participants’ cognitive and adaptive functioning at the time of the study, the participants were administered the Kaufman Brief Intelligence Test-Second Edition (KBIT-2;Kaufman & Kaufman, 2004), and the participants’ parents completed the Adaptive Behavior Assessment System-Second Edition (ABAS-II;Harrison & Oakland, 2003).

Zane was a 20-year-old Asian American male with a diagnosis of Asperger’s Syndrome. His overall cognitive functioning was found to be within the borderline range (Composite = 70) while his adaptive skills ranged from typical (Conceptual = 85) to signiﬁcantly delayed (Social = 68). Gary was a 20-year-old European American male with a diagnosis of PDD-NOS. His overall cognitive functioning adaptive skills ranged from typical (Conceptual = 97, Social = 106) to borderline (Practical = 79). Finally, Danny was a 27-year-old European American male with a diagnosis of Asperger’s Syndrome. His overall cognitive functioning was found to be within the typical range (Composite = 85) however his adaptive skills ranged from borderline (Conceptual = 77, Practical = 75) to signiﬁcantly delayed (Social = 64).

2.1.2. Materials and setting

2.1.2.1. Costume. WalkAround1 _{mascots, manufactured by Signs & Shapes, International (Omaha, NE), are air-inﬂated}

costumes used by professional sports teams for on-court entertainment, by educational programs, and by corporations for in-store or event marketing. The inflatable WalkAround mascot used in this project, ‘‘FirePal’’, was a male firefighter that stood about 10 feet tall, and could accommodate individuals ranging in height from 5 to 6.5 ft tall. To wear the WalkAround FirePal costume, participants were required to strap on a belt which supported a battery pack and mechanical blower that weighed about 14 lbs. Then they stepped inside the uninflated costume. Participants used Velcro to strap their feet into the feet of the costume and zipped up the back of the costume. Once the blower was engaged, the costume inflated to full size in about 20 s. The material in the front midsection of the costume was transparent at the participant’s eye level, enabling the participant to see the surrounding environment. The costume was equipped with arms and hands that could be moved when the participant inserted their arms and hands into the arms and hands of the costume. The mascot’s head could be moved to indicate ‘‘Yes’’ and ‘‘No’’ responses to questions and the mustache could be moved to simulate talking by the mascot, however, participants were asked to not speak while in the FirePal mascot before, during, or after the school assembly.

2.1.2.2. DVD. A training DVD was used that had been created by the employer to train fire department personnel responsible for fire safety education. It depicted a fire prevention specialist accompanied by a FirePal mascot presenting a fire safety lesson to school children during an elementary school assembly. Two versions of the lesson, both approximately 45 min in duration, were included on the DVD. One version provided a start-to-finish example of the assembly and a second version included the entire assembly coupled with a voice-over narrative emphasizing key points for the presenter and mascot, such as, ‘‘Notice that during the presentation, the mascot is never just standing there but is always moving around and interacting with the presenter.’’

2.1.2.3. Script. In addition to a training DVD, participants were given a training script that included detailed text narrative for the presenter and a description of the tasks the mascot was expected to complete during the assembly. Mascot tasks were coded within one of three response categories, which included responding to cues from the ﬁre safety specialist, audience, and script (Table 1). Although there were 63 total task responses, many were scripted to occur on more than one occasion (e.g., the mascot was expected to nod ‘‘yes’’ or point to the ‘‘Have 2 ways out’’ poster on multiple occasions, when appropriate).

2.1.2.4. Cue system. A ‘‘performance cue system’’ (PCS) was adapted as a proprietary iPhone application for the study. It was programmed to display 63 text cues, i.e., one cue per task, for the mascot (e.g., ‘‘Give high ﬁve’’, ‘‘Wiggle mustache’’, ‘‘Get three students’’). The cues were displayed on an iPod screen mounted with Velcro at eye level inside the mascot. The application was programmed so that an assistant, off stage, would touch a text cue on the iPhone which would then display that cue on the iPod inside the mascot.

2.1.2.5. Home practice logs. Home practice logs were provided for participants to document the day, date, start and end time, and practice activity in which they engaged between training sessions (e.g., viewed DVD, read script, practiced responses with parent).

(4)

2.1.2.7. Setting.Training sessions were conducted in a large, open area of a 20,000 square foot building where the WalkAround mascots are produced.

2.1.3. Target behaviors and data collection

Target behaviors consisted of the 63 scripted responses that the mascot was to perform in a specific sequence in relation to the fire prevention specialist’s presentation during an analog fire safety assembly. During each trial, an observer scored each scripted response as occurring or not occurring. A response was scored as occurring if the participant executed the correct movement within 5 s of the corresponding scripted prompt. The percent of steps implemented correctly was calculated by dividing the number of correct responses by the total number of responses in which the participant had the opportunity to engage and multiplying by 100.

2.1.4. Experimental design

2.1.4.1. Design. A multiple baseline design was used to evaluate the efﬁcacy of behavioral skills training (BST) and the performance cue system (PCS) on participants’ ability to perform ﬁre safety assembly tasks to an 80% criterion level. Baseline and treatment conditions were conducted with Zane prior to the implementation of baseline (nonconcurrent baseline) and treatment conditions with Gary and Danny (concurrent baselines). After varying amounts of time in baseline, the BST training component was introduced to each participant, followed by the PCS if necessary to reach job performance criterion. In addition, a reversal design was implemented with Gary in which the PCS was introduced, removed, and then reintroduced to demonstrate additional experimental control.

2.1.4.2. Training criterion.Participants were expected to be able to perform a minimum of 80% of the ﬁre safety assembly tasks/skills in sequence. If the participants had not acquired at least 50% of the required skills by their second visit using BST or reached the 80% success criterion by their 5th_{training visit, then the PCS system was introduced. This ‘‘efﬁciency’’ criterion}

was included because we recognized that we did not have an unlimited amount of time to invest in training. To set this criterion, we consulted with the owners of the company that manufactures the WalkAround mascots (Signs and Shapes, International) and conducts the job-related training. The resulting criterion represents a balance between testing the BST system long enough to evaluate whether it could work, and limiting the training to an amount the employer would be willing to invest to train an employee.

2.1.5. Procedure

2.1.5.1. Baseline. Participants and their caregivers were invited to the company factory where the purpose of the

investigation was described and they were introduced to the WalkAround costume named FirePal. Participants and their caregivers were consented and then participants had the opportunity to become familiar with the costume. The investigators showed participants the component parts of the costume, explained how the costume is operated, and assisted participants with becoming acclimated to wearing and moving around in the costume. Participants were also shown how to perform basic actions such as walking, waving, pointing, nodding, and talking (i.e., wiggling the moustache on the FirePal).

Participants wore the FirePal costume and participated in a mock assembly with a fire safety specialist (first author) and audience (family members and research associates). The safety specialist followed the detailed fire safety assembly script. Participants were instructed that during the fire safety assembly they could assist the fire safety specialist by engaging in behaviors to (a) entertain the audience, (b) reinforce what the presenter was saying, and (c) follow directions given by the specialist to FirePal during the mock assembly.

Mascot responds within 5 sec of facilitator prompts, instructions, or requests.

Responds to facilitator questions

Mascot shakes head ‘‘Yes’’ or ‘‘No’’ in response to facilitator’s questions.

Reinforces key points Mascot points to poster, holds up hands, gestures, claps arms against stomach, jumps up and down, or shakes head or torso in response to facilitator’s narration.

Response to cues from audience

Encourages participants Mascot claps arms against stomach, jumps up and down, shakes head, or gives participant high-ﬁve in response to participant’s correct answer or participation in assembly activity.

Response to cues from script

Initiates communication with facilitator

Mascot initiates interaction with facilitator by tapping facilitator on shoulder or leaning toward facilitator and wiggling mascot’s mustache.

Initiates actions per script Mascot acts as prompted by cue specified in script but not (a) communication with firefighter, (b) facilitator instruction, key point, or question, and (c) participant success or response.

(5)

2.1.5.2. Behavioral Skills Training (BST). During BST conditions, participants were provided with the training script (instruction), and the training DVD (modeling) and were told that they could review the script and/or watch the video to practice as many times as they desired in their homes for at least 48 hours prior to their scheduled practice time. They also were provided with a practice log and were instructed to record the day, date, start and end time, and a description of their practice activity at home, and then return the practice log to each session. During scheduled sessions, the participants performed and practiced during a mock assembly (rehearsal) and were provided with praise for scripted actions implemented correctly and delivered at the correct time as well as corrective teaching for missed, incomplete, or poorly timed steps (feedback). The BST included additional live modeling of correct implementation of the required steps as well as additional rehearsal by the participants of steps they had previously missed or done incorrectly.

2.1.5.3. Performance Cue System (PCS). If the PCS was required, the investigators introduced the participants to the PCS, showed them how it worked, and gave them an opportunity to respond to several cues that appeared on the screen. Then the PCS was secured inside the mascot at the participants’ eye level, and the participants were instructed to follow the instructions on the screen as soon as they appeared.

2.1.5.4. Follow-up observations. Approximately 1 month after the conclusion of treatment, two of the participants returned to the site to participate in another mock assembly to assess the maintenance of the acquired skills. Gary continued with the PCS in place and Danny had no PCS because he reached criterion with BST. Participants’ performances were observed and scored in the same manner as described in Section2.1.3.

2.1.6. Generalization

Following completion of the analog trials, two of the participants performed the ﬁre safety assembly in front of an audience of local elementary students. The assembly was conducted in the same location in which the analog trials were conducted, and the ﬁrst author served as the presenter. Participants’ performances were observed and scored in the same manner as described in Section2.1.3.

2.1.7. Interobserver agreement

During 26% of the sessions, an independent observer simultaneously recorded the occurrence and nonoccurrence of participants’ correct implementation of the steps in the script. Interobserver agreement was calculated using the point-by-point agreement ratio method (Kazdin, 1982), which determines the percent agreement by dividing the number of agreements by agreements plus disagreements and multiplying by 100. Mean interobserver agreement was 96% (range, 94– 98%).

2.1.8. Satisfaction surveys

At the completion of the research, the participants and their parents completed treatment satisfaction surveys that asked them to evaluate the training and job program. Parents and participants were asked to rate on a 5 point Likert Scale (1: strongly disagree, 5: strongly agree) with statements about whether they liked the training program, whether they thought it was a valuable experience and whether they would recommend it to others with ASD. After the two school assemblies (see Section2.1.7), adult members of the audience (i.e., teachers and employer) completed a brief survey in which they rated on a 5 point Likert Scale their perceptions of the ability of the participant to successfully complete job tasks (i.e., follow instructions, engage the audience, etc.).

2.2. Results and discussion

Results showed that during baseline, none of the participants were able to perform the scripted skills in sequence without (not surprisingly) some type of focused training. With the introduction of BST, all three subjects showed only small improvements in performance. However, Zane and Danny quickly improved performance and continued to show improvements, although with diminishing returns. Danny ﬁnally reached criterion on the 5th session with BST alone. Zane was unable to reach criterion by the 5th training session, but immediately reached criterion with the introduction of the PCS. Finally, Gary was not showing adequate progress and was introduced to the PCS after only the 2nd BST session. He too showed immediate and dramatic improvement with the PCS and reached criterion after 3 sessions. Upon removal of the PCS, his performance deteriorated, even with continued BST, and remained well below criterion until the PCS was reinstituted. Both Gary and Danny maintained performance at follow-up and performed at or near criterion during the actual generalization assembly (Fig. 1).

(6)

Finally, results from the Satisfaction Surveys show that the parents liked the training program (Mean= 5.0), thought it was a valuable employment experience (Mean= 5.0) and would recommend it to others with ASD (Mean= 5.0). Parents of Gary wrote that ‘‘He enjoyed the experience very much,’’ while parents of Danny wrote that ‘‘he had a lot of fun doing the mascot

. . .it helped him with his self-conﬁdence.’’ Gary and Danny both agreed that they liked the program (Mean= 5.0) and had fun in the program (Mean= 5.0), but Danny did not want to tell friends about it because his friends ‘‘wouldn’t have jobs like this because they have other jobs.’’ Teachers agreed that both participants engaged the audience (Mean= 5.0) and were effective at doing the mascot job (Mean= 5.0).

The results of this investigation demonstrate that BST can successfully teach an extensive and complex skill sequence, but not without a cost. Only Danny reached criterion without the PCS, and even Danny required ﬁve 1-h training sessions and more than 7 h of practice at home to do so. The PCS, on the other hand, produced rapid improvements in both Zane and Gary, who struggled to learn with BST alone. Although the independent effects of the PCS cannot be determined because each participant had already been exposed to BST, the removal and reintroduction of the PCS with Gary suggest that the PCS may be a viable training tool even without the more labor-intensive BST. Study 2 was designed to evaluate the independent effects of the PCS.

3. Study 2

3.1. Method

3.1.1. Participants

Participants were again three young adults diagnosed with ASD. Bruce was a 20-year-old European American male with a diagnosis of Asperger’s Syndrome. His overall cognitive functioning was found to be within the typical range (Composite = 106) while his adaptive skills ranged from borderline (Social = 70) to typical (Conceptual = 87). Terrence was a 20-year-old European American male with a diagnosis of autism, OCD, ADHD, and Tourette Syndrome. His overall cognitive functioning was found to be within the above average range (Composite = 121) while his adaptive skills were

[(Fig._1)TD$FIG]

(7)

within the borderline range (i.e., 76–81). Finally, Rusty was an 18-year-old male with a diagnosis of Asperger’s Syndrome. His overall cognitive functioning was found to be in the typical range (Composite = 107) while his adaptive skills were all found to be within the signiﬁcantly delayed range (Conceptual = 65, Social = 64, Practical = 61).

3.1.2. Materials and setting

The materials and setting were identical to those used in Study 1 (see Section2.1.2) with the exception that, because we were testing PCS effects in Study 2, participants did not receive the training DVD (see Section2.1.2.2) or the training script (see Section2.1.2.3). As a result, Study 2 participants did not have materials with which to practice at home and, therefore, did not complete Home Practice Logs.

3.1.3. Target behaviors and data collection

The target behaviors consisted of the same 63 scripted responses that the mascot was to perform in Study 1 and calculations of the percentage of correct responses per trial were computed in the same manner as in Study 1 (see Section

2.1.3).

3.1.4. Experimental design

3.1.4.1. Design. A concurrent multiple baseline design was used to evaluate the efﬁcacy of the performance cue system (PCS) on participants’ ability to perform ﬁre safety assembly tasks to an 80% criterion level. After varying amounts of time in baseline, the PCS training component was introduced to each participant, followed by the BST if necessary to reach job performance criterion. In addition, a reversal design was implemented with each participant in which the successful training component(s) were introduced, removed, and then reintroduced to demonstrate additional experimental control.

3.1.4.2. Training criterion. In contrast to Study 1, if the participants had not reached the 80% criterion by their second PCS visit, then the alternate training program was introduced, in this case, the BST. As with Study 1, we modified the criterion in an effort to find a balance between evaluating the efficacy of the PCS system and also trying to find the most expedient way to train employees for this particular job.

3.1.5. Procedure

3.1.5.1. Baseline. Participants were allowed to become comfortable in the Firepal costume, were taught 17 basic moves (from ‘‘Give a high ﬁve’’ to ‘‘Shake your hand as if you touched something hot’’), and then participated in a mock assembly.

3.1.5.2. Performance Cue System (PCS). After baseline, participants were immediately introduced to the PCS, shown how it worked, and were given an opportunity to respond to several cues that appeared on the screen. Then the PCS was secured inside the costume at the participants’ eye level, and the participants were instructed to follow the instructions on the screen as soon as they appeared.

3.1.5.3. Behavioral Skills Training (BST). If a participant did not meet criteria by the end of the second PCS session, then BST was introduced. The BST included live modeling of correct implementation of the required steps as well as additional rehearsal by the participants of steps they had previously missed or done incorrectly. Participants were provided with praise for scripted actions implemented correctly and delivered at the correct time as well as corrective teaching for missed, incomplete, or poorly timed steps (feedback).

3.1.6. Follow-up observations

Approximately one month after the conclusion of treatment, two of the participants returned to the factory to participate in another mock assembly to assess the maintenance of the acquired skills. Both participants continued with the PCS in place. Participants’ performances were observed and scored in the same manner as described in Section2.1.3.

3.1.7. Generalization

Following completion of the mock assemblies, two of the participants performed the ﬁre safety assembly in front of an audience of local elementary students. The assembly was conducted in the same location in which the mock assemblies were conducted, and the ﬁrst author served as the presenter. Participants’ performances were observed and scored in the same manner as described in Section2.1.3.

3.1.8. Interobserver agreement

(8)

3.1.9. Satisfaction surveys

As described in Section 2.1.8, participants, their parent, and adult members of the audience completed a brief survey after the ﬁre safety assembly.

3.2. Results and discussion

Results indicated that, as in Study 1, during baseline none of the participants were able to perform the scripted skills to criterion. With the introduction of PCS, Bruce and Terence showed immediate improvement to criterion level performance for two sessions. Performance dropped considerably without the PCS in place and returned to criterion levels with the return of the PCS. Rusty also showed immediate but unsustained improvement with the PCS so the BST program was introduced and the two training programs together produced immediate criterion level performance. When the PCS was removed, performance dropped below criterion and returned to criterion when the PCS was reinstated. Both Terence and Rusty maintained performances at follow-up and performed at criterion during the actual generalization assembly (Fig. 2).

Results from the Satisfaction Surveys were similar to Study 1 and show that the parents liked the training program (Mean= 5.0), thought it was a valuable experience (Mean= 5.0) and would recommend it to others with ASD (Mean= 5.0). Parents of Rusty wrote ‘‘Thanks!’’ while parents of Terrance wrote, ‘‘We have appreciated all of the opportunities and the various mascot performance that the study provided!’’ Rusty and Terrance both agreed that they liked the program (Mean= 5.0), had fun doing it (Mean= 5.0), and would recommend the program to their friends (Mean= 4.0). Teachers agreed that both participants engaged the audience (Mean= 4.8) and were effective at doing the mascot job (Mean= 4.8). The results of this second study demonstrate that the PCS can successfully teach an extensive and complex skill sequence in a very short amount of time and without extensive behavioral skill training.

[(Fig._2)TD$FIG]

(9)

4. Discussion

Results from these two studies extend the scant literature supporting the combination of BST and a PDA-based cueing device, demonstrating that the PCS can be an effective workplace intervention for individuals with ASD. Furthermore, results establish that, by itself, the PCS can (a) help people with ASD be successful in work environments requiring complex skill sequences, (b) facilitate the learning of complex skill sequences that are more than ﬁve times longer than sequences reported in prior studies with PDA-based cue systems (Davies, Stock, & Wehmeyer, 2003), and (c) facilitate learning of skill sequences at faster rates than BST training alone.

These ﬁndings hold promise for the increasing number of young adults with ASD who are entering the United States vocational rehabilitation (VR) system which had a 121% increase in referrals between 2002 and 2006 (Cimera & Cowan, 2009). Unfortunately, a recent analysis of VR services indicated that between 1995 and 2005 there were declines for individuals with disabilities in rates of competitive employment and earnings, and increases in response time between application for services and employment (Migliore & Butterworth, 2008), all of which suggest that caseloads and needs are increasing.

As demonstrated in Study 2, the PCS substantially reduced the amount of training time required to get participants to criterion levels of performance. This ﬁnding holds promise, not only for individuals with ASD, but also for job coaches who, as part of VR services, work with individuals with ASD who need assistance in supportive and competitive employment. But as one front line vocational rehabilitation employment specialist indicated, ‘‘job coaches are few and far between—and stretched’’ (R. Coleman, personal communication, May 27, 2010). Assistive devices such as the PCS may allow job coaches to provide services to the increasing number of individuals with ASD without adding to costs of services in this time of limited local, state, and federal resources.

While some may consider ‘‘acting’’ in an inflatable FirePal WalkAround to be a job with limitations due to its availability and applicability, there are several unique and beneficial features to the job described in this study. First, fire prevention and fire safety take a dramatic toll on the lives of individuals, their families, and their property. Annually, in the United States there are almost 400,000 home structure fires, close to 3000 civilian deaths, more than 13,000 civilian injuries, and US$ 6.4 billion in property damage due to home fires (Ahrens, 2010). Fire safety education is one of six key national strategies for reducing the loss of life and property due to fire (Crawford & Kehoe, 2008). The FirePal mascot has been used effectively by hundreds of fire departments for the past 14 years in fire safety presentations to hundreds of thousands of elementary and middle school students (L. Bowen, personal communication, July 14, 2010). Fire Prevention Educators are widely employed across the country and there is a wide range of private, community, state, and federal funding for such work.

A second benefit of this specific job is that it directly challenges key aspects of ASD’s characteristics, such as difficulty initiating social interactions, reading social cues, and responding to social cues (Gilotty, Kenworthy, Sirian, Black, & Wagner, 2002). Results indicate that participants using the PCS while working in the WalkAround mascot demonstrated high rates of social responding. Future studies will examine PDA-based assistive technology in other work environments.

Third, while ‘‘mascoting’’ can result in full-time employment for a select few (e.g., theme park mascots, professional sports mascots, etc.), for most it will not. Still, individuals employed as part-time mascots may develop vocational skills (e.g., following directions, being prompt, preparing for work tasks) and establish a work history that can serve as a stepping stone to life-long full- or part-time employment elsewhere.

Note that all of the participants had relatively good receptive and expressive language skills. Additional studies are needed to see if results will generalize to those with fewer communication skills. In contrast, all of these participants had very poor (i.e., borderline) practical adaptive skills and yet were successful using a variety of skills appropriate to social environments that included one-on-one interactions with the ﬁre safety presenter and initiating interactions with and responding to individuals in the audience and the audience, as a group. Additional studies assessing the relationship between the PCS and use of adaptive skills in other work environments will help determine whether it is the PCS or the mascot that set the stage for increased social interactions.

These studies also extend the literature on video modeling (VM). Although previous research has demonstrated that VM can be used successfully to teach a variety of skills to individuals with ASD (Darden-Brunson, Green, & Goldstein, 2008), including vocational skills to young adults with ASD who worked in mascots (Allen, Wallace, Renes, Bowen, & Burke, 2010a,b), the current studies suggest that there may be limits to the range of skills that VM can teach. It will be helpful in future studies to assess whether it is the complexity of the task (e.g., 63 skills in sequence) or the challenges of the work environment (e.g., assisting in a presentation in front of an audience) or some other aspect of the video modeling (e.g., video examples of tasks from point-of-view versus aerial or with peer, self, or adult models;McCoy & Hermansen, 2007) that seemed to reduce VM’s effectiveness in this training program. Finally, the social, cognitive, and behavior topography of ASD is many and varied. The current studies demonstrated effects with six young adult males between the ages of 18 and 27 with ASD. Further study should include a greater variety of individuals, including females, those representing other ethnic and racial groups, and people with ASD with comorbid diagnoses, among others.

5. Conclusions

(10)

individuals with disabilities are well-documented (e.g.,Jahoda et al., 2009; Paul & Moser, 2009). Employment-related activities are recognized in the Developmental Disabilities Assistance and Bill of Rights Act of 2000 as a key area of emphasis in the lives of individuals with developmental disabilities. Not only is employment important for people with ASD, these individuals typically have cognitive abilities and job skills that employers value such as attention to detail, trustworthiness, reliability, punctuality, the ability to follow directions, and dependability (Hillier et al., 2007; Howlin, Alcock, & Burkin, 2005; Smith, Belcher, & Juhrs, 1995). Employment can provide a host of social, emotional, and mental health beneﬁts for us all. The combined BST and PCS intervention or solitary PCS intervention provides hope for increasing job opportunities for individuals with ASD, some of the most underemployed members of our society.

Acknowledgements

This project was made possible in large part by the generous support of the Autism Action Partnership, Omaha, Nebraska. Melissa Andersen, M.A., is now at the Child Development and Rehabilitation Center at Oregon Health & Science University, Portland, OR.

References

Ahrens, M. (2010).Home structure fires. National Fire Protection Association: Quincy, MA. Retrieved July 14, 2010 fromhttp://www.nfpa.org/assets/ﬁles/PDF/

OS.Homes.pdf.

Allen, K. D., Wallace, D. P., Renes, D., Bowen, S. L., & Burke, R. V. (2010a). Community-based vocational instruction using videotaped modeling for young adults with autism spectrum disorders performing in air-inﬂated mascots.Focus on Autism and Other Developmental Disabilities, 25, 186–192.

Allen, K. D., Wallace, D. P., Renes, D., Bowen, S. L., & Burke, R. V. (2010b). Use of video modeling to teach vocational skills to adolescents and young adults with Autism Spectrum Disorders.Education and Treatment of Children, 33, 339–349.

American Psychiatric Association. (2000).Diagnostic and statistical manual of mental disorders(4th ed., text rev.). Washington, DC: American Psychiatric Association.

Barnard, J., Harvey, V., Potter, D., & Prior, A. (2001).Ignored or ineligible: The reality for adults with autism spectrum disorders. London, UK: The National Autistic Society.

Bellstedt, E., Gillberg, C., & Gillberg, C. (2005). Autism after adolescence: Population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood.Journal of Autism and Developmental Disorders, 35, 351–360.

Benz, M. R., Lindstrom, L., & Yovanoff, P. (2000). Improving graduation and employment outcomes of students with disabilities: predictive factors and student perspectives.Exceptional Children, 66, 509–529.

Browder, D., & Minarovic, T. (2000). Utilizing sight words in self-instruction training for employees with moderate mental retardation in competitive jobs. Education & Training in Mental Retardation & Developmental Disabilities, 35, 78–89.

Bureau of Labor Statistics, U. S. Department of Labor. (2010).Household data: Employment status of the civilian population by sex, age, and disability status, not seasonally adjusted. Retrieved February 12, 2010 fromhttp://www.bls.gov/news.release/empsit.t06.htm.

Cannella-Malone, H., Sigafoos, J., O’Reilly, M., de la Cruz, B., Edrisinha, C., & Lancioni, G. (2006). Comparing video prompting to video modeling for teaching daily living skills to six adults with developmental disabilities.Education and Training in Developmental Disabilities, 41, 344–356.

Cimera, R., & Cowan, R. (2009). The costs of services and employment outcomes achieved by adults with autism in the US.Autism: The International Journal of Research & Practice, 13, 285–302.

Crawford, J., & Kehoe, B. (2008).Vision 20/20: National strategies for fire loss prevention. Institute of Fire Engineers: Washington, DC. Retrieved fromhttp://

www.strategicﬁre.org/08report.pdfon February 21, 2009.

Darden-Brunson, F., Green, A., & Goldstein, H. (2008). Video-based instruction for children with autism. In J. Luiselli, D. Russo, W. Christian, & S. Wilczynski (Eds.), Effective practices for children with autism: Educational and behavioral support interventions that work.(pp. 241–268). Oxford: University Press.

Davies, D. K., Stock, S. E., & Wehmeyer, M. L. (2003). A palmtop computer-based intelligent aid for individuals with intellectual disabilities to increase independent decision making.Research & Practice for Persons with Severe Disabilities, 28, 182–193.

Engstrom, I., Ekstrom, L., & Emilsson, B. (2003). Psychological functioning in a group of Swedish adults with Asperger syndrome or high-functioning autism. Autism, 7, 99–110.

Frank, A. R., Wacker, D. P., Berg, W. K., & McMahon, C. M. (1985). Teaching selected microcomputer skills to retarded students via picture prompts.Journal of Applied Behavior Analysis, 18, 179–185.

Ganz, J., Bourgeois, B., Flores, M., & Campos, B. (2008). Implementing visually cued imitation training with children with autism spectrum disorders and developmental delays.Journal of Positive Behavior Interventions, 10, 56–66.

Garff, J., & Storey, K. (1998). The use of self-management strategies for increasing the appropriate hygiene of persons with disabilities in supported employment settings.Education & Training in Mental Retardation & Developmental Disabilities, 33, 179–188.

Gentry, T., Wallace, J., Kvarfordt, C., & Lynch, K. (2010). Personal digital assistants as cognitive aids for high school students with autism: Results of a community-based trial.Journal of Vocational Rehabilitation, 32, 101–107.

Gilotty, L., Kenworthy, L., Sirian, L., Black, D., & Wagner, A. (2002). Adaptive skills and executive function in autism spectrum disorders.Child Neuropsychology, 8, 241.

Goodson, J., Sigafoos, J., O’Reilly, M., Cannella, H., & Lancioni, G. (2007). Evaluation of a video-based error correction procedure for teaching a domestic skill to individuals with developmental disabilities.Research in Developmental Disabilities, 28, 458–467.

Gunby, K., Carr, J., & Lebianc, L. (2010). Teaching abduction-prevention skills to children with autism.Journal of Applied Behavior Analysis, 43, 107–112. Harrison, P. L., & Oakland, T. (2003).Adaptive Behavior Assessment System(2nd ed.). San Antonio, TX: Harcourt Assessment.

Hillier, A., Campbell, H., Mastriani, K., Vreeburg Izzo, M., Kool-Tucker, A., Cherry, L., et al. (2007). Two-year evaluation of a vocational support program for adults on the autism spectrum.Career Development for Exceptional Individuals, 30, 35–47.

Howlin, P., Alcock, J., & Burkin, C. (2005). An 8-year follow-up of a specialist supported employment service for high-ability adults with autism or Asperger syndrome.Autism, 9, 533–549.

Hume, K., & Odom, S. (2007). Effects of an individual work system on the independent functioning of students with Autism.Journal of Autism & Developmental Disorders, 37, 1166–1180.

Jahoda, A., Banks, P., Dagnan, D., Kemp, J., Kerr, W., & Williams, V. (2009). Starting a new job: The social and emotional experience of people with intellectual disabilities.Journal of Applied Research in Intellectual Disabilities, 22, 421–425.

Jerome, J., Frantino, E. P., & Sturmey, P. (2007). The effects of errorless learning and backward chaining on the acquisition of Internet skills in adults with developmental disabilities.Journal of Applied Behavior Analysis, 40, 185–189.

Kaufman, A. S., & Kaufman, N. L. (2004).Kaufman Brief Intelligence Test(2nd ed.). Circle Pines, MN: American Guidance Service. Kazdin, A. E. (1982).Single-case research designs: Methods for clinical and applied settings. New York: Oxford University Press.

(11)

Knudson, P., Miltenberger, R., Bosch, A., Gross, A., Brower-Breitwieser, C., & Tarasenko, M. (2009). Fire safety skills training for individuals with severe and profound mental retardation.Journal of Developmental and Physical Disabilities, 21, 523–535.

Licciardello, C., Harchik, A., & Luiselli, J. (2008). Social skills intervention for children with autism during interactive play at a public elementary school. Education & Treatment of Children, 31, 27–37.

Maciag, K., Schuster, J., Collins, B., & Cooper, J. (2000). Training adults with moderate and severe mental retardation in a vocational skill using a simultaneous prompting procedure.Education & Training in Mental Retardation & Developmental Disabilities, 35, 306–316.

McCoy, K., & Hermansen, E. (2007). Video modeling for individuals with autism: a review of model types and effects.Education and Treatment of Children, 30, 183–213.

Mechling, L., Gast, D., & Seid, N. (2009). Using a personal digital assistant to increase independent task completion by students with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 1420–1434.

Migliore, A., & Butterworth, J. (2008). Trends in outcomes of the Vocational Rehabilitation Program for adults with developmental disabilities: 1995–2005. Rehabilitation Counseling Bulletin, 52, 35–44.

Minarovic, T., & Bambara, L. (2007). Teaching employees with intellectual disabilities to manage changing work routines using varied sight-word checklists. Research & Practice for Persons with Severe Disabilities, 32, 31–42.

Mu¨ller, E., Schuler, A., & Yates, G. B. (2008). Social challenges and supports from the perspective of individuals with Asperger syndrome and other autism spectrum disabilities.Autism, 12, 173–190.

Nesbitt, S. (2000). Why and why not? Factors inﬂuencing employment for individuals with Asperger’s Syndrome.Autism, 4, 357–370.

Neisworth, J. T., & Wolfe, P. S. (2005). Asperger’s syndrome. In J. T. Naismith & P. S. Wolfe (Eds.),The Autism Encyclopedia(pp. 13–14). Baltimore: Paul H Brookes Publication.

Paul, K. I., & Moser, K. (2009). Unemployment impairs mental health: Meta-analyses.Journal of Vocational Behavior, 74, 264–282.

Rehfeldt, R. A., Dahman, D., Young, A., Cherry, H., & Davis, P. (2003). Teaching a simple meal preparation skill to adults with moderate and severe mental retardation using video modeling.Behavioral Interventions, 18, 209–218.

Schrandt, J., Townsend, D., & Poulson, C. (2009). Teaching empathy skills to children with autism.Journal of Applied Behavior Analysis, 42, 17–32.

Sigafoos, J., O’Reilly, M., Cannella, H., Upadhyaya, M., Edrisinha, C., Lancioni, G. E., et al. (2005). Computer-presented video prompting for teaching microwave oven use to three adults with developmental disabilities.Journal of Behavioral Education, 14, 189–201.

Smith, M., Belcher, R., & Juhrs, P. (1995).A guide to successful employment for individuals with autism. Baltimore, MD, USA: Paul H Brookes Publishing. Stewart, K. K., Carr, J. E., & LeBlanc, L. A. (2007). Evaluation of family-implemented behavioral skills training for teaching social skills to a child with Asperger’s