October 05, 2017

Teaching Children with Learning Disabilities to Write

This blog, written by Emily Wormald is the second in our series in which students who were awarded masters studentships by the SF-DDARIN discuss their experiences of practice based research.

This blog is the work of the author and does not necessarily reflect the views of the SF-DDARIN or its management team.

For my Masters thesis project I was lucky enough to work alongside an established behaviour support team in a special needs school, overseeing an intervention to teach handwriting to three children with Learning Disabilities (LDs). I was supervised by Dr Corinna Grindle and Professor Carl Hughes (Bangor University), and received a grant from SF-DDARIN to conduct the research.

Handwriting is an important life skill that is often overlooked in children with learning disabilities (LDs). Children with a diagnosis of LD are particularly at-risk for delays in handwriting development –up to 90% of those with a LD have handwriting and/or fine motor difficulties (Tarnopol & Tarnopol, 1977).

Many professionals recommend keyboarding as an alternative writing strategy for children with handwriting difficulties; however, there are several benefits associated with handwriting that aren’t seen with typing. Children who practise spelling using handwriting may acquire spellings faster than those using typing (Cunningham & Stanovich, 1990). Also, teaching children to spell through handwriting may support letter recognition and subsequent reading skills; this has not been seen in those taught through typing (Longcamp, Zerbato-Poudou, & Velay, 2005). Furthermore, children may improve in word reading (Berninger et al., 2006), writing fluency (Berninger et al., 1997), and general self-confidence (Erhardt & Meade, 2005) after specific instruction on letter formation. So, despite the increasing prevalence of typing and technology, handwriting is still an important skill to teach children with LDs.

Handwriting Without Tears® (HWT) is a comprehensive handwriting curriculum, designed by an occupational therapist, that covers foundation level to Year 6. Stages of the curriculum follow a developmental sequence of fine motor skills, beginning with scribbling and colouring, then simple lines and shapes, followed by capital then lower-case letters. Capital letters are introduced first since these are easier to write – they are all the same size, all sit above the line, and are mainly formed of straight lines and curves. Also, letters are grouped by their formation, so ‘F’ ‘E’ and ‘D’ are taught first as they all start with a “big line down, frog jump up [to the top]” – as children practice this sequence, subsequent letters in the group become easier to learn. Simple, repetitive instructions help children remember how to form their letters.

During my project the intervention followed an adapted HWT manual, initially developed by Grindle et al. (2017). The manual has been tailored to incorporate evidence-based teaching strategies for children with LDs. Many core elements of the original HWT curriculum were still included, such as the instructions for each letter. The adapted manual was more condensed, to promote more rapid learning as children with LDs are likely to be using it as a ‘catch-up’, and recommended prompting and generalisation strategies.

Three children aged 9-11 were selected for the study, who were identified as having specific deficits in their handwriting skills. Initially the children’s regular TA received training in how to deliver lessons following the adapted manual, and how to take data. Next, the children were assessed using a range of measures, including a standardised assessment (the Minnesota Handwriting Assessment) and measures of related skills. For the next 8 weeks the TA delivered four 15-minute lessons per week, which I regularly oversaw to provide training. I also reviewed the children’s handwriting sheets after each lesson to check when a letter was mastered, and set the children new targets (a letter was considered mastered if the child wrote it correctly and independently for two lessons).

The primary aim was to establish the feasibility and acceptability of the intervention, and I carried out interviews with the TA and children’s class teacher to explore this. Overall they were very positive about the intervention:

David’s (pseudonym) doing really well...At the beginning he wouldn’t use his right-hand to secure the paper, but he’s doing that a lot more now”

“They seem a bit more focused, you know after we’ve come back from Handwriting Without Tears and they get on with their work”

“I think the boys have got a lot from it. Um they seem to be really enjoying it, looking forward to it in fact.”

“I think it’s a really good programme. I think it should be rolled out as standard for all [children in] primary”

The secondary aim was to see whether there were any improvements in the boys’ handwriting after an 8-week intervention. Results from all assessments reflected improvements in the boys’ handwriting, for example sizing on the Minnesota Handwriting Assessment:


and better formation of ‘Frog Jump Capitals’ on the Screener of Handwriting Proficiency:


Also, children improved their drawings of people; on the Goodenough Draw-a-Person test, which gives an age-equivalent score for drawings, one boy increased his age score by a full year:

Draw a person test

This was an exciting project for the future development of the adapted HWT manual, as we obtained great results by training regular school staff to deliver the intervention. Using this model, there is great potential for the widespread use of the HWT programme as an evidence-based intervention for teaching handwriting across special needs schools.

Further readings / references

Handwriting Without Tears: https://www.lwtears.com/hwt

Grindle, C., Cianfaglione, R., Corbel, L., Wormald, E., Brown, F. J., Hastings, R. P., & Hughes, C. J. (2017). Teaching handwriting skills to children with learning disabilities using an adapted Handwriting Without Tears® program. Manuscript submitted for publication.

Tarnopol, L., & Tarnopol, M. (1977). Brain function and reading disabilities. Baltimore, Maryland: University Park Press.

Cunningham, A. E., & Stanovich, K. E. (1990). Early spelling acquisition: Writing beats the computer. Journal of Educational Psychology, 82, 159. doi:10.1037/0022-0663.82.1.159

Longcamp, M., Zerbato-Poudou, M. T., & Velay, J. L. (2005). The influence of writing practice on letter recognition in preschool children: A comparison between handwriting and typing. Acta psychologica, 119, 67-79. doi:10.1016/j.actpsy.2004.10.019

Berninger, V. W., Rutberg, J. E., Abbott, R. D., Garcia, N., Anderson-Youngstrom, M., Brooks, A., & Fulton, C. (2006). Tier 1 and tier 2 early intervention for handwriting and composing. Journal of School Psychology, 44, 3-30. doi:10.1016/j.jsp.2005.12.003

Berninger, V. W., Vaughan, K. B., Abbott, R. D., Abbott, S. P., Rogan, L. W., Brooks, A., Reed, E., & Graham, S. (1997). Treatment of handwriting problems in beginning writers: Transfer from handwriting to composition. Journal of Educational Psychology, 89, 652-666. doi:10.1037/0022-0663.89.4.652

Erhardt, R. P., & Meade, V. (2005). Improving handwriting without teaching handwriting: The consultative clinical reasoning process. Australian Occupational Therapy Journal, 52, 199-210. doi:10.1111/j.1440-1630.2005.00505.x

September 21, 2017

The Effects of Behavioural Skills Training on the Application of the Seven Steps of Instructional C

One of the goals of the SF-DDARIN is to facilitate high quality implementation research in which there is collaboration between academic and practice communities. As part of this we established a programme of Masters studentships to enable field/practice based research projects that might not otherwise happen because of a lack of funding. Four studentships were awarded at the end of 2016. Projects have now been completed and this blog by Alexandra Herman is the first in a series in which the recipients of the studentship share their experiences and findings.

This blog is the work of the author and does not necessarily reflect the views of the SF-DDARIN or its management team.

The “Seven Steps of Instructional Control” is a framework developed by Schramm (2017) for teaching successful instruction-following to children whose behaviour might challenge. Schramm is the leading BCBA of the German Knospe-ABA Institute. Knospe-ABA provide consultancy services and training for families and ABA therapists, putting a great emphasis on parental training. The Seven Steps are widely known and used by ABA consultants in workshops and training programmes. I first encountered the Seven Steps of Instructional Control when I started working as an ABA therapist in Hungary 8 years ago. I was lucky enough to start working with one of the first families with an ABA programme in Hungary, under supervision of a consultant from Knospe-ABA. The Seven Steps served as one of the core elements of our training. I was pleased to find out that ABA consultants in the UK also often refer to the Seven Steps of Instructional Control during workshops.

Although the Seven Steps are well known and popular in the field of ABA service delivery, and the content of the steps is based on the basic principles of behaviour analysis, there are currently no treatment fidelity studies or evidence-based training packages available around this framework. As an ABA Masters student at Bangor University, I approached Dr Corinna Grindle with my idea of conducting research on the Seven Steps in a practical setting as a thesis dissertation project. The project evaluated the effects of behavioural skill training on ABA therapists’ application of the procedures described by Schramm (2017). I conducted the study under supervision of Dr Corinna Grindle and Dr Carl Hughes.

We recruited four participants through ABA Tutorship, a company that provide and train ABA Tutors for home and school-based ABA programmes. Recruiting participants through an agency resulted in some technical difficulties, such as not being able to reach participants until they have given consent to their line manager to share their details with me. Even though the manager did everything she could, getting replies from therapists took a long time, and delayed the process. The original plan was to compare the effects of the training in experienced and novice therapists, but the plan had to change as we could only recruit four participants (three novice and one experienced).

We planned to recruit six participants and deliver training across two training days (for novice therapists on the first and for experienced therapists on the second day), but only one participant attended the first training day. The first day was used as a pilot evaluation for the second training day. Difficulties around recruitment were followed by more issues around finding and booking venues and trying to find dates that would suit confederate learners, participants, and second observers.

However, the positive feedback I received from participants during and after implementation of the study definitely outweighed the practical difficulties involved. Therapists found the training useful and effective, and they reported that they felt more successful in using the procedures after implementation of the project.

Procedures employed in the study:
• Initial phase: therapists had to interact with a confederate learner who pretended to be the child, using three toys provided to contrive motivation. They were instructed to place three instructions on the confederate. After baseline assessment, I provided them with instructions and modelled implementation of the Seven Steps. Then they took their turns again which was followed by myself providing them with corrective feedback. This procedure was repeated until they reached 80% correct responding on the fidelity checklist we developed. We also used a video observation test and a quiz before and after the training to see whether participants’ declarative knowledge increased as a result of the training.
• Generalisation probes: within the second part of the study, we investigated whether therapists could implement the procedures correctly in real life, with children with ongoing ABA programmes.
• Social validity interviews: I conducted short interviews with two participants following implementation of the study. Participants were asked questions about the training experience (what parts would they keep in future training, what would they change), and the perceived success in teaching instruction-following to children following the training.

The main findings of the study:
• The training was effective in increasing levels of performance of each therapist in implementing the procedures described by Schramm (2017).
• Performance on the video observation test remained stable for three participants, and decreased for one.
• The percentage of correct responses in the quiz increased for three participants, but remained stable for one.
• Three therapists maintained their levels of performance in real life with children (one therapist left ABA Tutorship before starting to work with families).
• Therapists found the training useful and felt successful in teaching instruction-following to children after the training.

Results of this study indicate that conducting research on the Seven Steps of Instructional Control is feasible. The checklists and tests used should be developed further for future research and practice. The project contributed to developing an evidence-based training package for therapists for teaching instruction-following to children whose behaviour might challenge. We are planning to develop the training package further, so that it can be used by consultants during therapist and parental training. I am looking forward to using the experiences I have obtained from this study in future projects.

July 18, 2016

ABA, good evidence, and the "nasty party"?

This is the blog page for the Sharland Foundation Developmental Disabilities ABA Research and Impact Network (SF-DDARIN).

The primary objective of SF-DDARIN is to increase the reach and impact of Applied Behaviour Analysis (ABA) based interventions for children and adults with intellectual disabilities and/or autism to support their independence and increased quality of life.
So what does that mean in plain speak? It means that we have a big challenge in the UK. Despite the fact that ABA practices in the support of individuals with developmental disabilities, as well as more broadly (including autism) are becoming nationally recognised, negative attitudes and misinformation about “ABA” are commonplace. As a result, many of those who might otherwise benefit the most from our field are not; and those that are, have often had to fight for services or to pay more than they might otherwise need to.
There are a number of different aspects to this challenge. Here are a few for starters and listed in no particular order.

What is ABA?
Even professionals don’t always seem to agree! And given the misunderstanding and misconceptions of ABA, myths abound. Prof Hastings’ excellent blog has tried to address this in respect of autism
so I am not going to repeat his arguments here. It is clear however that if we cannot clearly articulate the difference between ABA and approaches that are underpinned by behaviour analysis, we will limit our ability to be able to provide appropriate behaviourally based interventions to those who need them. ABA is the practical application of basic scientific knowledge about learning i.e. a branch of the science of behaviour analysis. Approaches such as Early Intensive Behaviour Intervention (EIBI), Positive Behavioural Support (PBS) and Pivotal Response Training (PRT) are varieties of ABA designed for specific populations. They are not alternatives.

What is “good” evidence?
Google “gold standard” of research and you invariably see references to randomised control trials (RCTs). In the developmental disabilities field, there is a significant lack of high quality research recognised by the scientific community as providing strong evidence for ABA interventions. This is mainly due to a lack of RCT evaluations of ABA interventions, and a lack of attention to evidence summary/synthesis methods such as systematic review and meta-analysis.
“Evidence” however can be established in different ways and, critically, can serve different purposes. One of these is implementation although evidence alone will not lead to this. Implementation involves, amongst other factors, decision making. And when it comes to the implementation of behaviourally based approaches there are a number of different groups who may be involved in that decision making process such as parents, teachers, commissioners, learning disability nurses. What constitutes “evidence” for each of these may be different and experiential and anecdotal evidence can be as important, if not more than RCTs or meta-analyses. As a field we need to ensure that research presents a complete range of evidence.

Who do we talk to? What do we say?
I love going to ABA events. I meet friends and colleagues and we generally agree that what we are doing is great and lament the fact that the rest of the world does not take much notice of us. It’s very comforting. What is striking about these (admittedly less so with the recently held “Festival of Behaviour Change” – well done Bangor!) is that we are presenting to the converted. As a community we need to be reaching out to a wider audience, finding ways in which we can attract the attention of that wider audience and adjusting our language accordingly. Theresa May claims the “nasty party” can do it. We can too! And we need to listen. We are not always very good at acknowledging the contributions that other professions make to our field of inquiry and at developing ways of working with them. Some of the work around Positive Behavioural Support illustrates this – whilst we may be clear that this is a framework within which many professionals can work we have not been explicit enough in explaining (for example) the role of psychiatrists or Speech and language therapists within this.

The aim of the SF-DDARIN is to address these and other issues. This blog is one of the ways that we can share how we are going about this as well as inviting others to critique and to outline their experiences of behaviourally based practices. Please contribute your own thoughts, reflect on your experiences as a researcher, let us know about small (and large!) successes. Join the discussion!

Search this blog


Blog archive

Not signed in
Sign in

Powered by BlogBuilder