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Focus on Autism and Other
Developmental Disabilities
2015, Vol. 30(1) 13 –22
© Hammill Institute on Disabilities 2014
Reprints and permissions:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1088357614525663
focus.sagepub.com
Article
Children diagnosed with Pervasive Developmental
Disorders (PDD) often exhibit stereotypic behaviors such
as rocking, spinning, hand flapping, and excessive move-
ments (American Psychiatric Association, 2013).
Professionals have used various procedures to eliminate
these response classes, including differential reinforcement
of alternative behaviors (e.g., Vollmer, Iwata, Zarcone,
Smith, & Mazaleski, 1993), noncontingent reinforcement
(e.g., Lalli, Casey, & Kates, 1997), and response blocking
(e.g., McKerchar, Kahng, Casioppo, & Wilson, 2001).
Sensory Integration Therapy (SIT; e.g., Ayres, 1979) has
been one approach utilized in the treatment of stereotypic
behaviors of children with autism. “Sensory integration is a
clinical frame of reference for the assessment and treatment
of persons who have functional disorders in sensory pro-

cessing” (Parham & Mailloux, 1996, p. 307). These “func-
tional disorders” are believed to be manifested in overt
behavioral challenges, such as problems with sensory dis-
crimination, perception, proprioception, tactile discrimina-
tion, visual perception, and vestibular processing (Parham
& Mailloux, 1996). An unregulated sensory system may
also inhibit the acquisition of positive skills, such as aca-
demics and socialization competencies (e.g., O’Brien &
Pearson, 2004).
Grandin (1992) posited that “deep pressure,” part of SIT,
can provide a “calming effect” for persons with PDD, since
some believe that persons with autism display high levels of
arousal (e.g., Hardy, 1990). Other methods of providing
“sensory input” include adding weight to vests and back-
packs (e.g., VandenBerg, 2001) and brushing parts of the
body (e.g., Stagnitti, Raison, & Ryan, 1999).
Many researchers have attempted to experimentally
examine the effect of sensory integration procedures (see
reviews of this literature by Arendt, MacLean, & Baumeister,
1988; Baranek, 2002; Daems, 1994; Hoehn & Baumeister,
1994; Miller, 2003; Parham et al., 2007). The general opin-
ion of these reviewers is that there is no consistent evidence
demonstrating a causal relationship between SIT and posi-
tive changes across numerous dependent variables (e.g.,
Parham et al. 2007; Shaw, 2002). For example, VandenBerg
(2001) examined the effect of a weighted vest to increase
on-task behavior of children diagnosed with attention-defi-
cit/hyperactivity disorder (ADHD). Four children between
the ages of 5 and 10 years participated in the study. All had
a diagnosis of ADHD and were receiving school-based
occupational therapy services due to a “sensory modulation
problem” (p. 623), described as “excessive movement”

525663 FOAXXX10.1177/1088357614525663Focus on Autism
and Other Developmental DisabilitiesSniezyk and Zane
research-article2014
1Crossroads Center for Children, Schenectady, NY, USA
2Endicott College, Beverly, MA, USA
Corresponding Author:
Carolyn J. Sniezyk, Crossroads Center for Children, 1136 North
Westcott Road, Suite 100, Schenectady, NY 12306, USA.
Email: [email protected]
Investigating the Effects of Sensory
Integration Therapy in Decreasing
Stereotypy
Carolyn J. Sniezyk, MS, BCBA1 and Thomas L. Zane, PhD,
BCBA-D2
Abstract
Sensory Integration Therapy (SIT) is a popular treatment for
Pervasive Developmental Disorders that involves therapists
using various strategies and manipulanda to provide sensory
stimulation to improve behavioral dysfunctions. Although SIT
is popular, the research literature demonstrates little
experimental proof of effectiveness. Many published studies
find little
to no causal relationship between SIT and improvements in
target behaviors. There are numerous internal and external
validity threats that preclude confidence in a functional
relationship for those studies that report positive changes. The
current study attempted to evaluate the impact of different SIT
techniques on the behavioral excesses of children diagnosed
with autism, while using research designs that adhered to
commonly accepted standards for internal and external validity
controls. The results showed that there was no causal
relationship between the sensory procedures and improvements

in
the targeted dependent variables. Thus, SIT remains an
unproven treatment for autism.
Keywords
autism spectrum disorders, sensory integration, stereotypy
at UNIV OF NORTHERN COLORADO on March 19,
2015foa.sagepub.comDownloaded from
mailto:[email protected]
http://foa.sagepub.com/
14 Focus on Autism and Other Developmental Disabilities 30(1)
characterized by constantly moving, touching body parts,
being out of seat without authorization, laying and rolling
on the floor, and demonstrating extreme difficulty in sus-
tained attention and task completion. Experimenters mea-
sured the total time on-task during fine motor activities in
their classrooms. The intervention consisted of the children
wearing a denim vest to which were added weights of up to
5% of the child’s body weight.
VandenBerg used a single-subject “AB” sequence of
phases (Cooper, Heron, & Heward, 2007), with data first
being taken without, and then with, the children wearing the
vests. There were six sessions each of baseline and inter-
vention. Results seemed to show an increase of on-task
behavior for each child, based on comparisons of child per-
formance to a celeration line indicating statistical signifi-
cance, as determined by a standard deviation of two or
greater. VandenBerg thus concluded that the weighted vest
was an effective intervention to decrease sensory-based
problem behaviors in children with ADHD.

However, there were several potential limitations of this
study. First, the use of an AB sequence limits confidence in
any claim of a functional relationship between the interven-
tion and changes in subject behavior (e.g., Cooper et al.,
2007). Second, although observers were trained to take the
on-task data, this training took place prior to the beginning
of the study, and there were no inter-observer reliability
checks done during the baseline and intervention condi-
tions. Thus, there is no confirmation of the accuracy of
observations during the actual implementation of the
weighted vest procedures. In addition, the observers were
not blind to when the experimental condition was used,
raising the possibility of “expectancy bias” as a threat to
interval validity. Finally, the determination of significant
results was based on statistical analysis, rather than a visual
inspection of data for which there is a requirement of stabil-
ity over time.
Fertel-Daly, Bedell, and Hinojosa (2001) examined the
effect of a weighted vest on five young children ages 2 to 4
years, diagnosed with PDD. The researchers measured
attention to task, duration of different stereotypic behaviors,
and the number of distractions exhibited by the children
during a brief activity. Using a reversal design (Cooper et
al., 2007), the experimenters had the children alternate
between wearing and not wearing the vest. Each of the five
participants showed lower rates of attention in baseline,
higher rates during intervention, and reduced rates in the
second baseline phase. Only one subject showed the same
reversal pattern for the duration of stereotypic behaviors;
that is, there was a failure to replicate the higher baseline
phase with four of the five subjects.
Although this study seemed to support the hypothesis
that the weighted vest was functionally related to improve-

ments in these particular behaviors, the possibility of con-
founding variables influencing the results cannot be ruled
out. For example, Fertel-Daly et al. (2001) noted that
increased attention after a weekend could have been due to
the children being in a more calm and structured context
(i.e., school) than over the weekend. Most disconcerting,
however, is the fact that reliability data on the dependent
variables, and procedural fidelity data were not reported,
and the raters were not blind to the conditions being
implemented.
Van Rie and Heflin (2009) conducted a study empirically
investigating the causal relationship between sensory pro-
cedures and positive changes in learning. The rationale for
this study was the possible relationship between sensory
dysfunction and learning. An individual engaging in stereo-
typy and other repetitive behaviors may do so because of
difficulty in processing sensory input as is typically done.
An “optimal level of arousal” is needed for learning, and
stereotypy may interfere with this. Thus, Van Rie and Heflin
focused on using sensory procedures in an attempt to pro-
duce this optimal state of arousal and assess whether the
students then learned better. Four young children (aged 6–7
years) diagnosed with autism participated in the study. All
these children exhibited behaviors that could be interpreted
as being sensory based, such as bounding, looking away
from ongoing tasks, jumping up from the floor or chairs and
running away from instructional activities, walking on tip-
toes, and engaging in verbal stereotypy. Using an alternat-
ing treatments design, Van Rie and Heflin counterbalanced
implementing a control condition of a teacher reading a
story to the child, with sensory activities, of swinging or
bouncing on a ball, during 5-min sessions. The authors
measured the percentage of correct responses the children
made on selected academic tasks (receptive or expressive

identification of community helper and safety signs flash-
cards) during instructional sessions immediately following
the implementation of the independent variables.
The authors reported mixed results. A functional rela-
tionship between a sensory procedure and positive learning
was demonstrated for two of the four children. One student
showed better learning after the swinging intervention, and
the other student improved after bouncing on the ball. For
the other two children, no clear functional relationship
could be shown. In addition to showing some positive
results, Van Rie and Heflin provided an excellent model of
state-of-the-art experimental methodology by building into
their design commonly accepted research standards, such as
the measurement of both dependent measure and proce-
dural fidelity reliability, social validity assessments, a
strong experimental design, random assignment of partici-
pants to conditions, and rigorous data collection and
interpretation.
Schaaf et al. (2013) conducted a recent test of sensory
integration procedures with 32 children diagnosed with
autism spectrum disorder ranging in ages between 4 and 8
years. Using a manualized sensory integration intervention,
Sniezyk and Zane 15
the researchers implemented the treatment 3 times per week
during hour-long sessions, for 10 weeks. Dependent mea-
sures included standardized assessments in the sensory and

cognitive areas, and a general goal attainment assessment.
The researchers reported significantly higher scores on the
outcome variables after treatment, providing support for the
sensory procedures used. A strength of this study involved
the measurement of fidelity of implementation of the proce-
dures. A potential limitation involved assessing progress
through the use of standardized assessments instead of
direct measurement of target behaviors hypothesized to be
affected by the sensory procedures.
In summary, although sensory procedures are widely
used clinically (e.g., Olson & Moulton, 2004), there is a
lack of experimental literature using well-designed research
protocols supporting the effectiveness of sensory integra-
tion procedures on challenging behaviors exhibited by chil-
dren with autism (see Smith, Mruzek, & Mozingo, 2005, for
a review of this field). Dubouloz, Egan, Vallerand, and von
Zweck (1999) noted that, in the past, some members of the
occupational therapy field felt threatened by a focus on
making treatment decisions based on sound research.
Currently, there seems to be a clear trend in occupational
therapy, at least in the number of articles published about
“evidenced-based practice” (EBP), that this conceptual
framework is becoming the guiding principle in practice
(Ottenbacher, Tickle-Degnen, & Hasselkus, 2002).
Professionals must demonstrate a cause-and-effect relation-
ship between their techniques and improvements in their
clientele (Goldstein, 2000). Ottenbacher et al. (2002) advo-
cated for occupational therapists to pursue EBP more vigor-
ously in an attempt to empirically verify the effectiveness of
procedures in this field. They called occupational therapists
to “develop and use the skills necessary to plan treatment
strategies for individual clients based on what is supported
by evidence” (p. 247).
The purpose of the current study was to experimentally

evaluate the effect of various sensory techniques on the ste-
reotypy of three children diagnosed with autism. Several
specific questions were to be addressed. Will students
engage in less stereotypy after being exposed to slow ves-
tibular movements via the swing? Will students engage in
less stereotypy after being provided deep pressure? Will the
use of a sensory diet decrease rates of stereotypic
behavior?
Method
Participants
Three children (two males and one female) attending a pre-
school program for children with developmental disabilities
served as participants. All students participated in speech
and language testing using the Preschool Language
Scale–Fourth Edition (Zimmerman, Steiner, & Pond, 2002)
and cognitive testing using the Battelle Developmental
Inventory–Second Edition (Newborg, 2005). Tristan was 3
years, 5 months of age with receptive and expressive lan-
guage standard scores (SS) of 59 and 58, respectively, and
received an SS of 60 on measures of cognitive ability. He
was non-verbal, used a Picture Exchange Communication
System (PECS) to communicate, and engaged in stereo-
typic behaviors and active non-compliance to the extent
that performance of academic and social tasks were
interrupted.
CJ was also non-verbal and was learning to utilize PECS
for communication. He was 2 years, 10 months of age and
earned SS of 50 and 58 for receptive and expressive lan-
guage skills, respectively, and functioned in the Mild
Developmental Delay range (SS of 71) of cognitive ability.
CJ engaged in self-injury, active non-compliance, and ste-

reotypic behaviors that interfered with attention to task and
disrupted group activities.
Rosie was 2 years, 9 months of age at the onset of the
study. Testing revealed that her cognitive ability fell within
the Mild Developmental Delay range (SS of 73) with recep-
tive and expressive language scores being 3 standard devia-
tions below the mean (SS of 50 on both measures). She
engaged in stereotypy and tantrums that disrupted perfor-
mance on tasks and interrupted social exchanges, had no
functional language, and was working on verbal imitation
skills at the onset of the project. All children were diag-
nosed with autistic disorder by a developmental pediatri-
cian prior to participating in the study.
Program Description
All participants attended a preschool program that utilized a
treatment philosophy based on applied behavior analysis.
The program operated 5 days per week for 5½ hr each day.
The classrooms were organized by level of student func-
tioning rather than age range. Children placed in this pro-
gram received from 0 to 2½ hr of discrete trial training per
day depending on their level of cognitive functioning,
speech and language skills, socialization skills, and behav-
ioral excesses. They also received speech therapy, occupa-
tional therapy, and physical therapy as needed based on
their initial evaluation.
Target Behavior and Response Measurement
Stereotypy was chosen as the target behavior for measure-
ment for all three participants. Staff believed that this
response class negatively affected classroom performance
and learning, and was an important intervention target.
Stereotypy was defined as a rhythmic, repetitive, exagger-

ated or unusual tightening of the muscles of either a particu-
lar body part or entire body, in the absence of an appropriate
environmental context. Functional assessments of behavior
were conducted for all three participants. In each case sen-
sory/automatic reinforcement was identified as the primary
function. The data collection system chosen for the study
was 10-s partial interval recording.
Research Design
A within-subjects reversal design (Cooper et al., 2007) was
chosen. First steady state responding during an initial base-
line period was established, and then SIT (in whatever form
it was prescribed by the occupational therapist for each
child) was implemented. A return to baseline phase would
have been conducted if, during the treatment phase, there
was a visually clear pattern of the target behaviors changing
in a positive way from the trend in the initial baseline phase.
If, during the second baseline phase, it was determined that
the behavioral trend matched the trend in the initial baseline
phase, the treatment would have been implemented again.
Settings and Procedures
The investigators met with the occupational and physical
therapy (OT/PT) staff to discuss the target behaviors and
possible interventions. In all cases, the OT/PT staff hypoth-

esized that the participants were over-stimulated and
engaged in the behavior as a means to “calm their sensory
systems.” Three different treatment plans were proposed by
the OT/PT department to reduce stereotypy. All plans were
chosen based on their hypothesized calming effects.
Tristan. Snack time was chosen as the target setting for
Tristan. A net swing was used to treat his stereotypy. This
technique was chosen based on the observation by the OT/
PT staff that the net swing seemed to produce a calming
effect for Tristan. During baseline, on a daily basis, a staff
member brought Tristan to the OT/PT room prior to partici-
pating in snack time; however, he was not placed on the net
swing. The staff simply sat on the floor with him and sang
to him.
During treatment, a staff member brought him to the OT/
PT room at which time he was placed in the net swing and
gently pushed back and forth by the staff. The staff placed
him in the net swing on a pillow and slowly and rhythmi-
cally swung him from side to side for 3 to 5 min while sing-
ing to him. He was then removed from the swing and
brought back to the classroom to participate in snack. This
procedure was conducted once per day.
CJ. Circle time was chosen as the target setting for CJ. He
was provided with “deep pressure” in an effort to reduce ste-
reotypy during the activity immediately following the sen-
sory technique. The baseline condition involved observing
CJ during circle using a 10-s partial interval recording sys-
tem. For the intervention, prior to the daily onset of circle
time, a staff member provided CJ with “deep pressure” by
prompting CJ to sit down in a chair, sitting behind CJ, placing
her hands on CJ’s shoulders (left hand on his left shoulder
and right hand on his right shoulder), pushing down for 2 s

and releasing for 2 s. The staff member repeated this 5 times
before moving to the next body part (e.g., bicep). The staff
member applied pressure to each bicep for 2 s and released
for 2 s, moving down the arm 2 to 3 in. at a time. The staff
member repeated the same procedure starting at CJ’s thighs
and moving down to his ankles (left hand on left thigh and
right hand on right thigh). Finally, the staff member provided
“deep pressure” to CJ’s trunk (left hand on left side of trunk
and right hand on right side of trunk) and moved down to his
waist. This procedure took approximately 2 min to complete
and was conducted once per day.
Rosie. Circle time was the target setting chosen for mea-
surement; however, Rosie was exposed to the sensory diet
throughout the entire day. To establish baseline levels of the
target behavior, Rosie was observed during circle time
using a 10-s partial interval recording system. Four activi-
ties comprised the sensory diet and staff exposed her to one
of the four activities on a half-hour rotating schedule. The
four activities were “deep pressure” via heavy work activi-
ties, “deep compression” via the therapy ball, joint com-
pressions, and the “meatball squeeze.” It was hypothesized
that this type of schedule would reduce stereotypy during
the entire day.
“Deep pressure” via heavy work activities involved the
therapist placing three gallon-sized laundry detergent bot-
tles filled with water on small utility cart/stroller. The thera-
pist prompted Rosie to push the cart with both hands up and
back the entire length of the hall in the school. This proce-
dure took approximately 3 to 5 min to complete.
Staff provided Rosie with “deep compression” via the
therapy ball by prompting Rosie to lie down on her stom-
ach, placing the therapy ball on Rosie’s back and applying
gentle pressure down onto the ball. The therapist rolled the

ball from Rosie’s shoulders, down her back, over her but-
tocks, and down to her calves. They then reversed the
motion of the ball to return back to her shoulders. This pro-
cedure was repeated 15 times and took approximately 2 min
to complete.
The therapist provided Rosie with joint compressions on
the following joints: elbow, wrist, fingers, hip, knee, and
ankle (both left and right sides of the body). The therapist
placed one hand just below the joint and one hand above the
joint on Rosie, gently compressed the joint together, and
then released compression. The compression was repeated
at all joints 10 times at a rate of 1 compression per second.
Joint compressions could be applied to all the above men-
tioned joints in approximately 2 min.
To implement the “meatball squeeze,” the therapist sat
Rosie in front of her (therapist and Rosie facing the same
direction), bent Rosie’s knees up and crossed her arms in
Sniezyk and Zane 17
front of her chest and knees (fetal position). The therapist
wrapped her arms around Rosie with the therapist’s hands at
Rosie’s shins while she was in this position and gently
squeezed Rosie for 10 s and then released. The therapist
repeated the squeeze 10 times. The “meatball squeeze” took
approximately 3 min to complete.
Inter-Observer Agreement (IOA) and

Procedural Fidelity
We obtained dependent measure and procedural reliability
checks on a minimum of 25% of all sessions across the par-
ticipants. A second independent observer viewed the ses-
sion and collected data on the occurrence of the target
behaviors. IOA was calculated by dividing the number of
10-s intervals with agreements by the number of 10-s inter-
vals with agreements plus disagreements and multiplying
by 100. The mean IOA was 97.3% (range, 96.5%–97.8%).
To determine procedural fidelity, the OT who designed
the intervention trained all staff to implement the proce-
dures and signed off on their competence. She then viewed
a minimum of 25% sessions for Tristan and CJ via video-
tape and observed 98.8% (range, 97.5%–100%) accuracy in
implementing the procedures, using the attached procedural
fidelity checklist (see appendix). Due to the high frequency
with which techniques were implemented with Rosie (rotat-
ing through 11 opportunities throughout each day for sev-
eral months), it was not feasible for the OT to observe 25%
of sessions. However, she viewed each intervention twice.
The fidelity of implementing the sensory procedures ranged
from 83% to 100% (M = 92.5%).
Results
Tristan engaged in the target behavior during an average of
29% (range, 26%–31%) of intervals during baseline (see
Figure 1). The average number of intervals during which he
engaged in the target behavior during intervention was 40%
(range, 31%–62%). A return to baseline condition was not
conducted because the levels of the behavior increased
rather than decreased.
Data for CJ are displayed in Figure 2. CJ engaged in the

target behavior during an average of 36% of intervals dur-
ing baseline (range, 22%–58%). The average number of
intervals during which he engaged in the target behavior
during intervention reduced to 28% (range, 24%–25%). We
then returned to baseline conditions and the occurrence of
the target behavior continued to trend downward (M = 9%;
range, 4%–10%).
Figure 3 depicts the percentage of intervals in which
Rosie engaged in the target behavior over four phases.
Phase 1 was the baseline condition during which Rosie
engaged in the target behavior on an average of 23.9% of
intervals (range, 8%–54%). Phase 2 was the intervention
condition consisting of 3 data points, these being the last 3
days of school prior to summer recess. She engaged in the
target behavior during an average of 15.3% of intervals
(range, 9%–23%). After the summer recess, Rosie began
program in a new classroom with new staff members. All
staff members were trained as described previously. Phase 3
depicts data collected during circle time with the interven-
tion in place in the new classroom. Rosie engaged in stereo-
typy between 8% and 14% of intervals (M = 13.3%) during
this condition. We returned to baseline in Phase 4. There
0
20
40
60
80
100

1 5 10
%
o
f i
nt
er
va
ls
Sessions
Baseline Swing Intervention
Figure 1. Percentage of intervals of stereotypy for Tristan.
was a further reduction in the percentage of intervals with
which Rosie engaged in the target behavior (M = 3.7%,
range 0%–8%).
Discussion
The purpose of this investigation was to use well-designed
experimental procedures to investigate several questions
pertaining to the effectiveness of different sensory proce-

dures on reducing various self-stimulatory behaviors of
children diagnosed with autism. We wanted to explore
whether students engaged in less stereotypy after being
exposed to slow vestibular movements via the swing. In
addition, would students engage in less stereotypy after
being provided with “deep pressure,” and would the use of
a “sensory diet” decrease rates of stereotypic behavior?
Based on recommendations by the participants’ occupa-
tional therapists, sensory procedures were implemented
according to the protocols established by the OTs.
Dependent measure and procedural fidelity were assessed
and found to be at acceptable levels. The results showed
that with no participant was there a clear functional rela-
tionship between positive changes in dependent measures
and the implementation of sensory procedures. In the cases
where there was reduced behavior during the SIT phase, the
behavior continued to decrease when SIT was removed,
suggesting that the initial reduction was not causally related
to the SIT procedures.
These results correspond with much of the literature
about the effectiveness of sensory integration procedures on
problem behaviors of persons with autism spectrum
disorders (e.g., Parham et al., 2007; Smith et al., 2005).
Reviewers of the literature report inconsistent results at
best. Often, when results seem promising, there are obvious
research design flaws, such as no reliability of measurement
or uncontrolled threats to internal validity. However, Van
Rie and Heflin (2009) conducted a study that met rigorous
research standards, and found some positive results, as did
Schaaf et al. (2013). More research, with the same level of
care when designing methodological controls approximat-
ing Van Rie and Heflin, is sorely needed. Strengths of the
current study include the use of a tightly designed investiga-
tion of sensory integration procedures and utilization of

common research methodologies to enhance both the inter-
nal and external validity of the outcomes.
With Tristan, the swing had no decelerative effect;
indeed, the target behavior actually increased slightly in
rate during intervention. Prior to the study, Tristan’s OT
noted that based on observation, Tristan seemed to be calm
during swinging. Post results, the OT could not explain why
the intervention had an excitatory effect; she noted that lin-
ear movement is typically calming and organizing; a rotary
movement would be considered to produce an excitatory
reaction, and could not speculate why swinging had such an
opposite effect on Tristan. In this case, there are at least two
possible explanations. First, perhaps the OT’s initial obser-
vations of Tristan—that he seemed to calm during swing-
ing—were simply in error or biased. Without objective
assessment based on data, the true nature of what transpires
may be lost. Second, it is highly likely that there are signifi-
cant differences across individuals with regard to respon-
siveness to sensory stimulation. That is, individuals are
0
20
40
60
80
100
1 5 10 15
%

o
f i
nt
er
va
ls
Sessions
Baseline Deep Pressure Baseline
Figure 2. Percentage of intervals of stereotypy for CJ.
Sniezyk and Zane 19
likely to respond to sensory stimuli as differently as they do
to other environmental stimuli. A sensory theory predicting
similar outcomes across different individuals seems
unlikely.
The data collected for CJ do not reveal a functional rela-
tionship between “deep pressure” and stereotypy. While the
target behavior did decrease in occurrence, it is important to
note that the intervention data were within the same range
as baseline; however, levels were more stable. The contin-
ued decrease in the occurrence of the target behavior during
the return to baseline condition does not allow a confident

assumption of a functional relationship between the inter-
vention and the target behavior. Some potential explana-
tions for this post-intervention reduction include maturation
or a cumulative effect of the intervention. A cumulative
effect is unlikely based on the large lapse in time in between
intervention and return to baseline. Any residual effects of
the treatment would most likely have worn off during this
time. It should be noted that the intervention phase was ter-
minated on the completion of the extended school year pro-
gram in August. CJ changed classrooms when school
commenced in September. Although the change in class-
rooms may be a confounding variable, it was considered to
be a natural opportunity to terminate the intervention phase.
Moreover, it is unlikely that the change in environment pro-
duced a decrease in the target behavior because CJ’s alleged
internal sensory issues would still be present in the new
classroom. CJ did experience some difficulty with the tran-
sition to the new classroom. He frequently engaged in tan-
trum behavior that resulted in staff prompting. Data were
not collected on days that CJ engaged in tantrum behavior
because his tantrum behavior was incompatible and inter-
fered with the observation of the target behavior.
Rosie is another child for whom a functional relationship
between improved behavior and the implementation of sen-
sory procedures cannot be established. Possible explana-
tions for the observed decreased occurrence of the target
included are the same as for CJ. In terms of maturation, it
should be noted that Rosie began imitating words and inde-
pendently initiating verbalizations after the break in
November. In addition, one would not expect the level of
behavior to continue to decrease after the intervention was
removed. The argument is the same for whether or not a
cumulative effect was observed. One would not expect con-
tinued improvements over intervention levels. It would seem

that this would be an adequate amount of time for any effects
of the treatment to “wear off” and therefore, one would
observe an increase in the occurrence of the target behavior.
In addition, there could be some unidentified confounding
variable, since Rosie developed a new behavior involving
manipulation of the seams in her clothes. This behavior was
not noted during baseline and the beginning stages of inter-
vention but became more prevalent as time went on. This
behavior is topographically incompatible with the target
behavior and may have interfered with its occurrence.
Several potential limitations should be addressed. There
was no placebo control condition, which could have served
as a test of the potential reactivity to having more attention
by an adult. We chose not to perform such a placebo condi-
tion because we were primarily interested in noting whether
0
20
40
60
80
100
%
o
f i
nt
er

va
ls
Sessions
Baseline Sensory Diet -New Classroom BaselineSensory Diet
1 5 10 15 20 25 30 35 40
Figure 3. Percentage of intervals of stereotypy for Rosie.
or not there was any positive effect of sensory integration
procedures. A second potential limitation is that all aspects
of a reversal design were not implemented with Tristan.
With him, because the behavior did not change in a positive
way from the baseline to intervention phase, it was assumed
that going back to baseline would have again shown no sig-
nificant change and thus the intervention ended. If a return
to baseline had been implemented, there would have been
one of three outcomes—a decrease in rate, an increase in
rate, or no change in trend. None of these possibilities
would have changed the conclusion that the sensory proce-
dures had no positive impact. However, failure to return to
baseline is a potential limitation to the study’s design and
thus could affect the interpretation of the results.
Another potential limitation was the lack of blinded data

collection. We established the validity of the data through
frequent and carefully arranged reliability observations by
observers naïve to the purpose of the study. An additional
design issue concerns the break of the sessions between the
end of the school year and the beginning of the summer ses-
sion for Rosie. There was approximately a 2-week vacation
between the end of phase 2 and the beginning of phase 3. It
is doubtful that this recess influenced the effect of the sen-
sory procedures, since the behavior seemed to be minimally
affected prior to the vacation period. A final limitation con-
cerns the fact that different sensory procedures were used
across the three participants. The variability and implemen-
tation duration of these procedures could have had a con-
founding effect on the results. Although the sensory
procedures differed across the three participants, we believe
that this is not a weakness in our design. The procedures
varied across the participants because the occupational ther-
apist planned the procedures based on the unique needs and
characteristics of each child. We believe this treatment
validity overrides any methodological or experimental con-
cerns. It was important that each child received the therapy
best suited for that child, in the professional opinion of the
Occupational Therapist. To artificially implement treat-
ments for a child that were not identified to be best suited
for his or her unique needs, for the sake of experimental
rigor, may have detracted from the clinical significance of
the study. In addition, we used within-subject designs, using
each participant as his or her own control. Regardless of the
independent variable, the behavior measured during the
independent variable phase was compared with the same
behavior of the same participant during the baseline phases.
Thus, we did not need to worry about similarity of indepen-
dent variable across the three participants. We believe that
for sensory integration, we need to first determine if the
procedures—whatever they are—have any positive effect.

In our study, we provided three tests of three different
procedures.
This study contributes to the investigation of sensory
integration in several ways. First, the OTs—the profession-
als most often using sensory procedures—were given free
rein to determine what they thought were the behaviors to
be influenced by sensory procedures, and exactly what
those procedures would entail, including the exact steps of
the procedure, the duration of each application, the fre-
quency of applications daily, and how long-term the proce-
dures were used. Second, we implemented well-crafted
experimental designs that would allow an investigation of a
causal relationship, should the behavior seem to be sensi-
tive to the independent variables. Third, we rigorously
applied IOA procedures for all dependent variables, and
similarly checked procedural fidelity.
The clinical implication of this study is that service
providers must use sensory procedures with caution. The
current study adds more data from three participants to the
emerging conclusion that we cannot assume sensory pro-
cedures are evidenced-based. That is, the research that
exists on testing the effectiveness of SIT is at best incon-
clusive, at worst showing thus far that it is not an effective
treatment strategy. There does exist proven treatments that
can affect behaviors typically addressed by sensory proce-
dures, such as noncontingent reinforcement (e.g., Cox,
Gast, Luscre, & Ayres, 2009) and response interruption
and redirection (e.g., Ahrens, Lerman, Kodak, Worsdell,
& Keegan, 2011).
Future researchers should focus on developing clear pro-
tocols for testing sensory procedures. The sensory integration
professionals should drive these protocols; but the research-
ers need to develop research design methodologies to control

for threats to internal and external validity, and both depen-
dent measure and procedural reliability. The structure of the
experimental design is important to enhance, since if positive
results were ever discovered, there would be some confi-
dence that positive changes were due to the independent
variable(s) used. Only through a tightening of the experimen-
tal protocols to test sensory integration procedures could we
build a research foundation that provided any empirical sup-
port for this unsubstantiated treatment.
Sniezyk and Zane 21
Appendix
Treatment Fidelity Checklist
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.
“Deep pressure” via
heavy work activities Date Date Date
Holds cart with both
hands
Pushes cart to end

of hall
Pushes cart back to
class
Note. X = step implemented correctly; O = step implemented
incorrectly.
“Meatball squeeze” Date Date Date
Staff and Rosie sit on floor facing
the same direction
Rosie sits on staff’s lap
Bends Rosie’s knees to her chest
Wraps her arms around her
knees
Staff wraps arms around Rosie
Staff squeezes for 10 s and
releases
Repeats 10 s squeeze a total of
10 times
incorrectly.

Joint compressions Date Date Date
Staff grasps one hand above Rosie’s joint
and one hand below the same joint
Squeezes joint and release
Ten squeezes per joint
Left elbow
Left wrist
Left five fingers
Right elbow
Right wrist
Right five fingers
Left hip
Left knee
Left ankle
Right hip
Right knee
Right ankle
incorrectly.
Swing Date Date Date
Student sits on pillow in net swing
Staff moves slowly move swing from
side to side
Student is in moving swing for 3 to
5 min

Staff sings to student
incorrectly.
Joint compressions Date Date Date
Student sits in a chair
Staff sits in chair either in front or
behind student
Staff places left and right hand on
student’s left and right shoulder
Staff applies pressure by squeezing for
2 s and releasing
Staff moves hands down student’s arms
to the wrist, applying 2 s of pressure
every 2 to 3 in.
Staff place left and right hand on
student’s left and right thighs
2 s and releasing
Staff moves hands down student’s legs
to the ankle, applying 2 s of pressure

every 2 to 3 in.
Staff places left and right hand on
student’s trunk under his or her left
and right arm
2 s and releasing
Staff moves hands down student’s
trunk to his or her waist applying 2 s
of pressure every 2 to 3 in.
incorrectly.
CJ “Deep Pressure.”
Rosie Sensory Diet.
“Deep compression” via therapy ball Date Date Date
Rosie on stomach
Staff places ball on her back
Rolls to her ankles and back
Repeats 15 times
incorrectly.
Tristan Swing.

Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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Running head: PARENT GUIDE COMMUNITY INCLUSION
1

Guide to Including Children with Disabilities in
Community Settings in the Arab Gulf Region
Effat Shugdar
University of Northern Colorado
PARENT GUIDE COMMUNITY INCLUSION
2
Abstract

Many parents in the Arab Gulf Region avoid integrating their
children with disabilities into their
local community due to negative cultural beliefs about
disabilities and general unfamiliarity with
disabilities. Using information from research conducted in the
United States, successful
strategies for inclusion in community settings have been
identified that may be useful to parents
of children with disabilities in this region of the world.
Strategies which can be successful
include locating accessible activities when they exist,
increasing familiarity with specific
community settings and activities, finding opportunities for
children to communicate, managing
child behavior in public, and creating parent-to-parent
networks. The goal of the application of
successful strategies for community inclusion is to enable Arab
Gulf parents to understand, plan,
and develop ways to include their children with disabilities in
real activities taking place in their
own communities.
Keywords: inclusion, children with disabilities, community
settings, Arab Gulf Region

3
Guide to Including Children with Disabilities in
Community Settings in the Arab Gulf Region
Families who have children with disabilities face numerous
obstacles for successful
inclusion of their children into different community settings.
Some of the consequences of
not participating in society include children with disabilities
being denied the right to live
their lives as others do, such as segregation of these children
from others and prohibitions
or limitations for these children to go outside and see different
places and people. This
exclusion from normal community life can lead to increased
behavioral and emotional
problems for these children. Such unfairness seriously hinders

children with disabilities’
awareness and experience to engage with others and to explore
the environment around
them.
The social and emotional development of children with
disabilities is affected by the
number of different settings and various kinds of interactions,
such as with peers without
disabilities, and people outside of school settings. Including
these students with significant
needs in the community will help the child engage in
interactions with other people more easily
(Bronfenbrenner, 1979). Children with disabilities feel more
comfortable when they are familiar
with a variety of community settings (Souza & Kennedy, 2003).
Families within societies where disability awareness and
disability rights are still
emerging as publicized and discussed issues are often hesitant
about including their children with
severe disabilities in the social milieu and activities of their
culture. Their hesitation may involve
fear of disapproval or embarrassment. Yet, this hesitation may
also have origins in uncertainty as

to how to make such an experience successful for themselves
and their children. As professionals
in the field of special education, we have a responsibility to
guide families in finding ways to
4
include their children with severe disabilities in the larger
community around them. This
involves identifying and communicating to them strategies for
successful community inclusion.
This paper will explore first the experience of being a parent of
a child with a severe disability in
the Arab Gulf Region. Next, it will describe what is meant by
an effective strategy for
community inclusion. Lastly, it will examine specific strategies
that can help parents provide
opportunities for their children with severe disabilities to
experience life in the community.
An Arab Gulf Region Perspective on Having a Child with a
Disability
From previous experiences working with parents who have
children with severe

disabilities in the Arab Gulf Region, I have found that there is
only a small minority of parents
who are willing to include their children with disabilities in
community settings. On the one
hand, Arab Gulf society is more understanding and accepting of
children with hearing or vision
disabilities. The parents of these children often do not feel
devalued by including their children
in the community. On the other hand, parents of children
having disabilities with very evident
effects on their intellectual, physical, communication, or
emotional expression often avoid
engaging their child in different community settings, such as
going to restaurants, shopping,
traveling, or parties because the stigma and lack of knowledge
about these disabilities creates
more discrimination, guilt, and rejection.
There are three major reasons that reinforce Arab Gulf parents’
decisions to avoid
including their children with disabilities in a variety of
community settings. The first reason is
that parents who have children with disabilities may feel
ashamed to be accompanied by their
children with disabilities in the community or public areas

because of negative cultural
judgments about what can be expressed in public versus what is
private; i.e., what should be
permitted versus what should not be disclosed in the
relationship between family and the wider
5
society. Further complicating the picture are feelings that some
Arab parents may have that they
are being viewed by their neighbors and others as having done
something corrupt, and are
therefore being punished by having a child with disabilities.
These parents then feel even more
ashamed and guilty to walk with their children with disabilities
in public view (Arab Gulf
Network for People with Disabilities, 2009). Yet, at the same
time, many of these parents are
also attempting to cope with perceptions that their children
should have the right to live life as
other individuals in Arab society. This mixture of emotions
regarding keeping what is in the
family in the family, shame over how others may view them,

and yet knowing that their children
deserve more than the sheltered life that they are providing
impacts not just the opportunities
their child with a severe disability will have over his/her
lifetime but also the interactions of
these parents with each other and with other members of the
community.
In Arab Gulf society, it is the mother who is primarily involved
with her child and who
plans and carries out activities for her children. This puts
increased pressure on mothers who
have a child with a disability, particularly when the child has
severe disabilities. Even in
countries where disability is more widely understood and
accepted, a mother’s anxiety of stigma
regarding her child may have a negative effect on her
relationship with her child, which further
encourages the mother to isolate her child from the community
(Groce, 1985). Mothers of
children with disabilities often feel devalued and discriminated
against from others who do not
have children with disabilities in the community. Since
communities tend to respond to these
mothers differently when contrasted with their responses to

children who have typically
developing children; this encourages the mother of child with a
disability to sometime feel
jealousy and anger toward the mother of a child without
disability (Geenen, Powers, & Lopez-
Vasquez, 2001). Because of longstanding cultural patterns,
these effects are even more
6
pronounced in the Arab Gulf Region than in the United States
and other countries where
disability issues are more out in the open.
A second reason Arab Gulf parents may avoid including their
children with disabilities in
community settings is because of limitations in community
activities that are actually accessible
to children with disabilities in the Arab Gulf Region. There is a
lack of available and
accommodated facilities for these children to go to and enjoy,
such as public libraries, family
clubs, restaurants, and commercial shops. Al-Turaiki and
Joseph (2004) recommended that more

physical adaptations be constructed in public places to enhance
their accessibility for people with
disabilities, thereby helping encourage them to go places more
easily and spend enjoyable times
with their families.
The third and final reason for limited participation in
community settings, and the one to
be examined in detail here, is that parents are not educated
about how they can include their
children with disabilities in community settings. Ehrmann,
Aeschleman, and Svanum (1995)
reported that parents who have children with disabilities need
support in including their children
in community settings. Thus, parents who have children with
disabilities need instruction and
coaching which is vital to improve their knowledge about how
to integrate their children with
disabilities in different community settings (Day, 2000).
Strategies for Successful Community Inclusion
Strategies for successful community inclusion are steps and
procedures that can help
Arab parents with children who have severe disabilities provide
opportunities for these children

to do as their peers do and to engage in community life. Such
strategies should give direction
and guidance to these parents by providing explicit steps for
them that can result in more
inclusion of their children in community life and with fewer
cultural barriers. As a result,
7
parents’ inclusion of their children with disabilities in the
community can become both more
successful for the children and enjoyable for all family
members. Five specific strategies will be
examined here: (a) locating accessible activities, (b) increasing
familiarity with specific
community settings and activities; (c) providing opportunities
for children to communicate; (d)
managing children’s behavior in public; and (e) creating parent-
to-parent networks.
Locating Accessible Activities
Especially when children have disabilities that impact their
movement and awareness of

space, universal design in buildings can help them experience
full inclusion in their communities
(Turnbull, Turnbull, & Wehmeyer, 2007). The concept of
universal design was created to make
buildings accessible to all people. Examples of universal
design include buildings provided with
curb cuts, electronic and wide doors, and clear aisles. All of
these accessibilities allow children
with disabilities to move more easily and safely in the physical
environment.
Parents who have children with physical disabilities need to
consider locating and
selecting places that are designed to be accessible for their
children so that all can fully enjoy the
opportunities offered by particular community settings. In the
Arab Gulf Region, new
constructions are more likely to include features of universal
design, such as some contemporary
shopping malls, large grocery store chains, modern restaurants
located in malls, and newly-
designed mosques. Special education professionals can help
parents be aware that such places
exist, and assist them in locating such settings that are near
their home.

Increasing Familiarity With Specific Community Settings And
Activities
Many community settings in Arab society are not presently
accessible through universal
design applications. Nor is universal design accessibility always
a concern when a family has a
child with a severe disability. Sometimes, fear may be
associated with simply how best to
8
navigate an area of the community most efficiently, concerns
for pedestrian safety, or concerns
with how to ensure partial participation of a child in an activity.
A family can overcome some of
their concerns by analyzing the environment to determine its
expectations, the skills that could be
useful, the assistance that the family members will need to give
the child to make the experience
enjoyable and successful, and what parts of an activity a child
can do with and without
assistance.
Referred to in the United States as ecological analysis (Falvey,

1989), this process offers
a way to begin being in the community safely and enjoyably.
For example, the parents may want
to take the family, including the child with a severe intellectual
disability, to a local shopping
mall for a day excursion. An advance trip to the mall by the
parents can identify best entrances;
family-friendly restaurants; places for resting and watching; and
a specific store or stores that can
offer particular activities that the child may enjoy for short
times. The trip is then planned by the
family from start to finish, including the roles played by the
various family members in different
locations and activities.
During an activity, the parents can also bring along a familiar
item that the child enjoys,
such as a toy or candy. A familiar item can help the child feel
comfortable in new situations.
Also, parents can do a “trial run” by going to the location of a
special event with the child at a
time when it is less crowded. The next time they all go to this
place, it will be a familiar to the
child. Such strategies can help children with disabilities to be
more familiar with people and

places and to interact positively in the larger community.
Providing Opportunities For Children To Communicate
Communication is a natural skill that all children need to
develop and learn from their
daily activities (Turnbull et al., 2007). Children with
communication difficulties are often unable
9
to let others know their physical needs, to interact with others
in a sustained and satisfactory
ways; or let others know what they are feeling and thinking. To
help, parents can structure
opportunities for their children to interact and communicate
with others by encouraging their
children to introduce themselves, talk about incidents that
happened, and discuss achievements at
their school or events with their family members. Many children
who have difficulty expressing
themselves with words are responsive to questions, which can
be strategically asked to offer
opportunities for children to construct a story or describe an

incident that happened at some point
in the day or week. Parents can model these strategies when
they are in social events at home,
visiting with neighbors, or in community settings, so that other
people can become more
comfortable interacting with the child who has difficulty
communicating.
Children in the United States are often provided with
sophisticated communication
devices that allow them to construct with pictures, words, or
symbols messages that others can
see or hear. These devices often may not be available to
families in the Arab Gulf Region, but
simple graphic representations can be provided the child to
identify important tools, activities, or
people in a child’s life. Note cards, for example, may include
words and pictures to present the
most commonly used expressions in communication (Downing,
2000; Turnbull et al., 2007).
When children have pictorial or written word representations
that they can use to communicate,
it is important that parents keep these accessible, encourage
their use when appropriate, and to
use the pictures and words themselves when they are

communicating with the child.
Simply because a child does not speak does not mean that he or
she has nothing to say
(Fisher & Fisher, 1996). It is important to honor all of a child’s
efforts to let others know what
he/she wants and needs and to include them in ongoing
discussions and activities among family
members whether or not they add to a discussion with spoken
words. We can, of course explain
10
something, or say something in a different way, when a child
needs help understanding what is
being said. However, it is best to believe that a child can
comprehend much that occurs and is
said in his/her environment rather than to assume that little or
nothing is comprehended by the
child. Often, when we assume understanding, we learn that more
is actually comprehended than
we might have at first guessed, and greater understanding will
emerge when the child feels that
the adults believe in him or her.

Managing Children’s Behavior in Public
For better or for worse, people form impressions of others based
on what they see them
do in public places. If they see a child behave in a manner that
matches expectations of a setting,
than onlookers either don’t notice at all or they notice the child
in a favorable way. If a child’s
behavior is unexpected or disorderly, then disapproval may be
felt or expressed, and the
impression formed may be long lasting.
Parents of children who have behavior problems can encourage
their children to do tasks
in the community. For example, they can ask the children to
select their food from the menu in
the restaurant, let them push the grocery cart, give them the
opportunity to pay the money to the
cashier, or think through and make alternative choices when
what is wanted is not available, such
as a restaurant not having a desired menu item.
Another approach to addressing discipline concerns is to
develop a system of nonverbal
signals to be used by the parent with the child, which mean
when they are delivered that the child

is to observe what certain others are doing (parent, particular
sibling) and to do the same. Such
signals could be gestures or facial expressions. The parent can
then focus on the way home on
what the child did that was right, reviewing the positive
accomplishments and the moments when
the child was paying attention to the parent’s signals.
11
Sometimes it is helpful to review in advance with the child two
or three things for the
child to remember. For example, one might include: (a) stay
with the family; (b) keep your voice
down; and (c) keep your hands by your side unless given
permission to touch something. The
reminders could be reviewed at home or in the car, right before
entering a community context.
Other more complicated systems for assisting with discipline
include preparing and
reading a social story (Sutton, 2011); using pictures to prepare a
child in advance for an

upcoming event; or providing a visual schedule to indicate the
structure of the day and event, and
to identify the place and activities (Souza & Kennedy, 2003).
Special educators need to develop
the skills to do these more advanced procedures, and to be ready
to assist families in
implementing these strategies so that their children can access
community environments safely
and without worrisome incidences.
Creating Parent-To-Parent Networks
As a Saudi Arabian writer and citizen, and from my experience,
people in our region
develop their beliefs regarding disabilities from their cultures,
traditional background, and also
from misinterpretation of religious beliefs. They may believe
having children with disabilities
means God is punishing them for something evil they did in
their lives. Or they may believe that
children with disabilities are something caused by mysticism or
demons. They may not see that
disability might be the result of health or medical outcomes, or
an event of birth that should be
treated as a possible and natural outcome of life. Therefore,
they avoid including their children

with disabilities in the community because of the stigma.
Arab Gulf parents can include their children with disabilities in
spite of cultural belief
barriers and can face society with a greater sense of their own
personal power. However,
initially, parents may want to begin by working together,
creating networks within communities
12
for parents of children with disabilities to meet and talk with
each other. In this network, the
parents can work collaboratively together in taking their
children with disabilities out in the
community. The parents can discuss their concerns regarding
their children; for example, the
places they can go with their children, activities they can do
with their children, and appropriate
strategies that works with each child of each family. Most
importantly, they can provide each
other with increased support for initiating more inclusion.
These parents may want to have weekly meetings or plan parties

that have activities and
exercises for their children in their homes. When these parents
become familiar with each other,
they can go into the community as a group, and thereby, be
stronger and more confident in
facing society.
Conclusion
I have presented a number of strategies for successful
community inclusion that I believe
can be useful for Arab Gulf Region parents to include their
children with disabilities in a variety
of community settings. These strategies are based on research
and practices I have observed or
have read about in the United States, and they are adapted here
to be a guide to Arab Gulf
parents. The strategies for successful community inclusion are
particularly discussed in
conjunction with the impact of cultural issues on including the
children with disabilities in the
community, such as stigma, guilt, discrimination and fear.
Special educators, including myself, have an obligation to assist
families in becoming
part of our culture and the communities of our region. It is not

enough just to train children with
severe disabilities in schools to perform the adaptive skills
required to survive and be functional
in the community. If we are to make a difference, we must
directly work with families, assisting
them to open doors for their children, so that community life
becomes a real possibility for them.
13
References
Al-Turaiki, M. & Joseph, G. (2004). Ambalavavanan:
Environmental and vehicle adaptations
for handicapped- JCRPO experience. Proceedings from the 32nd
Annual National
Conference of Indian Association of Physical Medicine and
Rehabilitation, Calcutta,
India.
Arab Gulf Network for People with Disabilities. (2009). Our
disabled children. Retrieved from
http://m3aq.net/inf/articles-action-show-id-37.htm.
Bronfenbrenner, U. (1979). The ecology of human development:

Experiments by nature and
human design. Cambridge, MA: Harvard University Press.
Day, M. (2000). Supporting inclusion of young children with
disabilities in community settings.
(Order No. 9967889, University of Maryland College Park).
ProQuest Dissertations and
Theses, 237. Retrieved from http://0-
search.proquest.com.source.unco.edu/docview/
304605427?accountid=12832. (304605427).
Downing, J. (2000). Augmentative communication devices: A
critical aspect of assistive
technology. Journal of Special Education Technology. 15, 3-11.
Ehrmann, L., Aeschleman, S., & Svanum, S. (1995). Parental
reports of community activity
patterns: A comparison between young children with disabilities
and their nondisabled
peers. Research in Developmental Disabilities. 16(4), 331-343.
Falvey, M. A. (1989). Community-based curriculum:
Instructional strategies for students with
severe handicaps (2nd ed.). Baltimore: Brookes.
Fisher, D. (Producer), & Fisher, J. (Director) (1996).
Unforgotten: Twenty-five years after

Willowbrook. United States of America: City Lights
Productions
Geenen, S., Powers, L. E., & Lopez-Vasquez, A. (2001).
Multicultural aspects of parent
14
involvement in transition planning. Exceptional Children. 67,
265-282.
Groce, N. E. (1985). Everyone here spoke sign language:
Hereditary deafness on Martha’s
Vineyard. Cambridge (MA): Harvard University Press.
Souza, G., & Kennedy, C. H. (2003). Facilitating social
interactions in the community for a
transition-age student with severe disabilities. Journal of
Positive Behavior Interventions,
5(3), 179-179. Retrieved from http://0-
search.proquest.com.source.unco.edu /docview
/218792784?accountid=12832.
Sutton, B. (2011). Social stories. Educating young children:
Learning & teaching in the early
childhood years, 17(1), 35-36.

Turnbull, A., Turnbull, R., & Wehmeyer, M. L. (2007).
Exceptional lives: Special education
in today’s schools (5th ed.). Columbus, OH: Pearson Merrill
Prentice Hall.
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Invited Commentary
What Legitimizes Segregation?
The Context of Special Education
Discourse: A Response to Ryndak
et al.
Lewis Jackson1

Abstract
Ryndak and colleagues provide a strong case that progress
toward more and better access to general
education is not occurring for students with intellectual
disabilities. This response to their paper begins by
agreeing with their assessment of our current situation, then it
offers one possible reason for this state of
affairs: the discourse that occurs when special education teams
are planning outcomes and instruction for
these students discourages the use of grade-level curriculum and
general education classrooms. Part of the
problem is that the discourse preserves segregation through a
planning terminology that is inconsistent
with how all other students in a school are assessed and
described. However, it is also argued that a
major property of this discourse is a misguided emphasis on
“functional skills,” and that this emphasis
contributes to our lack of progress in achieving access to
general education curriculum and settings.
A related argument is also made that the educational goal
development process that typically occurs
within special education discourse derives student outcomes
from varied skill sources that, collectively,
do not offer the structure and coherency of a real curriculum.
This process, justified at least in part
by interpretations of individualization, may also be impeding
our movement toward greater alignment
with general education for these students. A case is made for
school districts establishing policies that
require the use of grade-level general education curriculum with
these students. Potential issues and
concerns related to individualization, content standards,
curriculum adaptation, and progress monitoring
are discussed.
Keywords

special education discourse, inclusive education, accessing
general curriculum, individualualized educational
programming, functional skills
In “Policy and the Impact on Placement, Involvement, and
Progress in General Education: Critical Issues
That Require Rectification,” Ryndak and her colleagues (2014)
argue that progress has largely come to a
halt for students with intellectual disabilities in their movement
toward increasingly less restrictive place-
ments and practices. They assert that despite legal and research
imperatives that could have significantly
reduced self-contained placements if their implications had been
enacted over the past decade, school sys-
tems have not changed with respect to how these students are
educated either in terms of placement or in
terms of curriculum. Their article scrutinizes and examines the
policy landscape associated with schools,
districts, and governmental entities in relation to least
restrictive environment, progress in general
curriculum, and assessment. Ryndak et al. conclude that policies
governing educational placement and
1University of Northern Colorado, Greeley, USA
Corresponding Author:
Dr. Lewis Jackson, School of Special Education, University of
Northern Colorado, Greeley, CO, 80639 USA.
545960RPSXXX10.1177/1540796914545960Research and
Practice for Persons with Severe DisabilitiesJackson
research-article2014

Jackson 157
practice should be revised or strengthened if we are to achieve
the kinds of access to general education that
can make a difference for these students.
I will start my discussion with a single caveat: There are
individual teachers who practice educational
inclusion everyday of their lives, often against incredible odds;
and there are some schools and districts
within our country that are making integrated education their
standard, sometimes even given pressure from
higher up to use more pullout and self-contained placements.
Having said this, my assessment of our overall
progress toward educating students with intellectual disabilities
in more inclusive situations yields the same
conclusion reached by these authors. I consider the situation to
be quite bleak, and I assert, based on my
observations in schools, that what students with intellectual
disabilities typically receive does not constitute
an “appropriate education” in any sense of the word.
Most likely, there are multiple and varied moderating and
mediating factors determining what is happening
today with these students. Nevertheless, we must first question
our own practices: Is what we advocate and
implement in our practices today, as evidenced in the planning
and instruction of teachers, administrators, and
related service providers, contributing to our lack of progress
toward inclusion with students who have intel-
lectual disabilities? As a way of responding to this question, I
will consider in this article the content and
implications of special education discourse in schools. More

specifically, I will consider aspects of discourse
that reflect and potentially influence how special educators
make decisions about children’s educational ser-
vices and programs. I will then suggest that a “false logic”
permeates this discourse, and this false logic relates
to our widespread emphasis on functional skills. Finally, I will
recommend that concerns raised by Ryndak et
al. can be partially ameliorated by implementing policies in
school districts that mandate grade-level general
education curriculum, with adaptations when needed, as the
only curriculum source to be used by Individualized
Education Program (IEP) teams developing goals and objectives
for students with intellectual disabilities.
Special Education Discourse in Schools
Conversations and interactions across time in which teachers,
administrators, parents, and related service
providers collaborate, plan, and enact a program of activities
(i.e., IEPs, placement, curriculum, and instruc-
tion) for students with intellectual disabilities can be described
as purposeful discourse. In common with
other forms of interpersonal discourse, it expresses the
following properties: (a) an underlying “common
ground” within the exchange that assures a shared
understanding of the content, (b) an “accumulation pro-
cess” in which participants construct knowledge during their
interactions in ways that match the function of
the exchange, and (c) “unilateral action” in which participants
are encouraged to contribute to the exchange
only in acceptable or “right” ways (Schaefer, 1992, p. 145).
Purposeful discourse also reflects what has been
called the narrative of rhetoric; that is, the use of language
within discourse to “inform and persuade” others
toward common ends and consensual understandings (McGuire,
1990, p. 222).

Special education service providers engaged in purposeful
discourse may sometimes express the stance
that it is all about the child, determining his or her real needs,
and configuring a program that is fully indi-
vidualized, independent of location of services. In my
experience, this is often said in IEP meetings when
parents express a desire for “more inclusion” for their child.
However, the discourse eventually, and inevita-
bly, assumes a character that reflects the true culture and
attitudes of the school with regard to disability, and
it mirrors the patterns of service provision that have a history of
use with all other students with intellectual
disabilities. If we were to examine the language of this
discourse, expressions that we would hear when
adults are referencing any and all individuals within this group
of students include the following: (a) catego-
ries of disability that define special education eligibility (e.g.,
autism, severe disabilities), (b) the terminology
of IEP planning (IEP team, educational program, annual
meeting), (c) identified developmental and func-
tional individualized, educational needs (e.g., communication
goals, self-care goals, “speech”), (d) specific
program placement recommendations (e.g., autism class, life
skills), (e) recommended specialized instruc-
tion (Applied Behavior Analysis or ABA, one-to-one
instruction, a list of adaptations and modifications), and
last (f) general education options that are permissible (lunch,
PE, hallways, Science), accompanied by words
such as “appropriate” or “meaningful” inclusion. When
contrasted with the language used to describe all
other students who are not in special education (e.g., first
grader; reader; in Ms. Smith’s class), it can be seen
that “separateness” and “differentness” are mirrored in this
discourse. Purposeful discourse of this type will,
of course, follow students with intellectual disabilities across

their educational careers.
158 Research and Practice for Persons with Severe Disabilities
39(2)
I would propose that social exchanges associated with
purposeful discourse do not just reflect but actu-
ally promote and sustain the program options that are provided
to these students, by maintaining the team’s
focus on educational options that are familiar and acceptable as
defined by this discourse. The implication
is that the educational decision-making processes used by
schools with these students are neither truly indi-
vidualized nor do they focus on providing these students with
the educational opportunities offered to other
students. Instead, these processes operate in a self-preserving
manner, narrowing educational opportunities
to those in keeping with what has been legitimized by the
discourse; that is, those opportunities that are
consistent with the already established social and ecological
boundaries of the program.
A concept that is operative within the purposeful discourse of
special educators in many of these programs
is the notion of functional skills, typically defined as those self-
care and independent living skills that are
needed for a student to be successful in the home and in the
community, and within adult life in general. When
selected as goals and objectives, these skills are drawn from
outside the offerings of general education curricu-

lum. It has been argued that appropriately and effectively
teaching functional skills requires curriculum and
instruction that run contrary to the academic emphasis of the
general education classroom (Bouck, 2009).
The problem with the foregoing is that general education is, of
itself, a functional educational process, in
which students have both broad and particular opportunities for
socialization, acculturation, and information
acquisition related to their culture and society (Jackson,
Ryndak, & Wehmeyer, 2008-2009). Equally impor-
tant, the maturation and growth associated with these
opportunities cannot be realized using the “intense,”
one-to-one instruction typically favored in special education
classrooms. Rather, authentic maturation and
growth is an evolving process, becoming more complex and
more like the norms of adulthood as a product
of a dynamic relationship between long-term exposure to a
shared curriculum and the context of instruction
represented by elementary, middle, and high school classrooms
at grade level (Jackson et al., 2008-2009).
Hence, the logic behind emphasizing functional skills as the
proper and best outcomes for students with
intellectual disability is a “false logic,” embedded within the
persuasive appeals of special education dis-
course to maintain the dominance of this type of instruction and
to bring others into agreement with it. It, in
fact, projects a false picture of both the outcomes of the general
education academic orientation and the
benefits of the special education functional skills orientation.
The foregoing presents a troubling concern for those of us who
are special educators: We have asserted to
parents for many decades now a rationale that something better
and more appropriate is achieved for students

with intellectual disabilities by focusing on a particular and
delimiting definition of “functional skills,” and
our actions are contributing to the large-scale denial for these
students of the normalizing and functional
experiences provided in general education. To make matters
worse, there is no evidence that a better educa-
tion is realized for these students when the emphasis is on
isolated functional skills as opposed to what could
be realized using general curriculum within K-12 classrooms
(Ryndak, Jackson, & White, 2013).
Where Do We Go From Here?
In my work with special education teachers who educate
students who have intellectual disabilities, I have
noted an odd dilemma that they experience when writing IEP
goals. Unlike, say, a first-grade or high school
teacher, special education teachers must come up with goals and
objectives for students not from a unified
curriculum but rather from multiple curriculum and non-
curriculum sources. These may include specialized
curriculum for basic skills (e.g., reading); special education
“expanded” state standards that sometimes bear
little resemblance to grade-level curriculum; their own
experiences as teachers; parents’ wishes for their
children; social, behavioral, and academic initiatives in their
schools; observed gaps in adaptive skills;
developmental assessments from other professionals (e.g.,
occupational therapy); and even, simply, what
they like teaching as part of their program.
The foregoing can be viewed positively as what makes
“individualization” possible, because it opens up a
wide range of outcome possibilities to choose from. However,
the other side of the coin is that it involves picking
and choosing from something that approaches the character of

an ill-defined list and not from a skill set that has
a defined scope and sequence. The question that can be raised
here is whether individualization, as accomplished
by this process, is any better of a way to define outcomes than
using the unified school curriculum, the latter at
least bearing an apparent relationship with the educational
standards of the area. When one considers how the
Jackson 159
purposeful discourse of the special education team plays out
when choosing educational outcomes, the prediction
would be that individualization is no better served, because
goals and objectives would tend to regress toward the
mean of the program. Moreover, the discourse processes of the
service providers would tend to discourage con-
sideration of goals related to age-level general education
curriculum, because these require language and con-
cepts that are at odds with the language and conceptual
boundaries of the discourse.
The issue of establishing and setting expectations based on a
single curriculum versus multiple curricu-
lum and non-curriculum sources can be framed as a policy
issue. In my opinion, districts need to move
quickly toward viewing grade-level general curriculum as the
curriculum source for all students, and dis-
tricts should begin mandating that other instructional outcomes
(e.g., using a communication device, fol-
lowing an activity schedule, independent mobility) be framed

not as IEP goals but instead as supports and
adaptations that assist students in accessing general education
curriculum. When general education curricu-
lum is the established curriculum for all students, the
fundamental question that must be asked by IEP teams
would change in ways that could enhance inclusive placements:
“How can we better teach and test general
education curriculum knowledge,” instead of, “How do we make
a determination whether grade-level gen-
eral education curriculum is appropriate or not.”
A concern that can be raised with the foregoing is that such a
policy elevates the influence of a single
curriculum and lowers that of IEP teams in the task of choosing
learning expectations for students. However,
one should ask, has giving this kind of authority and power to
IEP teams benefitted students with intellec-
tual disabilities in today’s climate of standards-based testing? I
think not. If anything, the team’s power to
override grade-level curriculum has likely contributed to the
decline of inclusion in schools that is described
by Ryndak et al. (2014). Of course, a related concern is whether
the courts, given what is expected of IEP
teams by the Individuals With Disabilities Act (IDEA), would
overturn a single curriculum policy if legally
challenged. I can only respond to this by noting that IDEA also
favors general education curriculum and
classes, and that a unified curriculum does not prevent
individualization or interdisciplinary teaming. It only
gives direction to both.
A final concern about district policy mandating the use of K-12
curriculum for all children is, “How does
this impact standards-based assessment results, especially
alternate assessment results?” I note first that if
alternate assessments are really assessing the same standards as

the regular tests, then results could improve
for these students because of the increased focus on general
education curriculum and because there could
be a greater reliance on qualified instruction from general
education teachers. At the same time, issues in
the alignment between instruction and alternate testing might
need to be further examined. This concern, of
course, exists for all children who participate in standards-based
testing; that is, concern for the alignment
between what is taught and what is tested. However, in my
view, this research should not simply examine
whether what is taught aligns with what is tested. Rather, it
should examine instead how the results of two
assessments, standards-based/alternate testing and adapted
(modified or accommodated) measurement of
what is being taught, align with each other, and a third source
of information. This third source could
include post-school success indicators (McDonnell, Hunt,
Jackson, & Ryndak, 2013) and self-determina-
tion measures (Hughes, Cosgriff, Agran, & Washington, 2013).
Conclusion
Ryndak and her colleagues have raised valid concerns about
backsliding with respect to less restrictive
placements, access to general curriculum, and alternate
assessment testing. There is obviously no simple
solution, but one approach is for those of us in special
education to reflect more thoughtfully about our
discourse processes when engaged in educational planning with
these students, and consider whether what
we have advocated in the past regarding functional skills
actually benefits students with intellectual dis-
abilities. I have argued that our advocacy on this account is not
only part of the problem but is actually a
questionable practice in and of itself. I note in closing that

evidence-based practice research showing that
functional skills can be effectively taught (Alwell & Cobb,
2009) does not validate these skills as outcomes
for students in the K-12 period of life; it only shows that these
students can learn them.
Ryndak and her colleagues argue that district and state policies
need to be more assertive in assuring access
to general curriculum. I suggest that one way we might achieve
this, and realize more inclusive placements as
160 Research and Practice for Persons with Severe Disabilities
39(2)
well, is through encouraging districts to implement policies that
mandate general education grade-level cur-
riculum as the curriculum to be used with all students. I
emphasize that “grade-level” does not mean that one
cannot use the principles of universal design for learning (UDL)
to creatively adapt content and response
expectations to achieve curriculum access, or to provide
alternative means to measure progress. However, it
does mean avoiding derivatives of standards (“expanded
standards”) that alter both what is taught and what is
expected to the point where neither resemble the content
standards presumably represented.
To accomplish the foregoing, it is evident that we in special
education must relinquish a belief structure
and a set of practices that are cherished by many of us, the

delineation of “functional skills” as primary IEP
goals and objectives for students with intellectual disabilities
during the K-12 period. We must then gener-
ate a very different special education discourse that will be
heard throughout our schools, one that commu-
nicates grade-level general education curriculum as the basis for
educating these and all students. In my
view, this would represent an important, positive step toward
encouraging districts to move away from the
routine segregation of these children and youth for educational
purposes.
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.
References
Alwell, M., & Cobb, B. (2009). Functional life skills curricular
interventions for youth with disabilities: A systematic
review. Career Development and Transition for Exceptional
Individuals, 32, 82-93.
Bouck, E. C. (2009). No Child Left Behind, the Individuals
With Disabilities Act and functional curricula: A conflict
of interest? Education and Training in Developmental
Disabilities, 44(1), 3-13.
Hughes, C., Cosgriff, J. C., Agran, M., & Washington, B. H.

(2013). Student self-determination: A preliminary inves-
tigation of the role of participation in inclusive settings.
Education and Training in Autism and Developmental
Disabilities, 48(1), 3-17.
Jackson, L. B., Ryndak, D. L., & Wehmeyer, M. L. (2008-
2009). The dynamic relationship between context, curricu-
lum, and student learning: A case for inclusive education as a
research-based practice. Research and Practice for
Persons With Severe Disabilities, 33-34, 175-195.
McDonnell, J., Hunt, P., Jackson, L., & Ryndak, D. (2013).
Educational standards for students with significant intel-
lectual disabilities: A response to Lou Brown. Connections,
38(4), 30-34.
McGuire, M. (1990). The rhetoric of narrative: A hermeneutic,
critical theory. In B. K. Britton & A. D. Pellegrini
(Eds.), Narrative thought and narrative language (pp. 219-236).
Hillsdale, NJ: Lawrence Erlbaum.
Ryndak, D. L., Jackson, L. B., & White, J. M. (2013).
Involvement and progress in the general curriculum for students
with extensive support needs: K-12 inclusive education research
and implications for the future. Inclusion, 1, 28-49.
Ryndak, D. L., Taub, D., Jorgensen, C. M., Gonsier-Gerdin, J.,
Arndt, K., Sauer, J., Ruppar, A. L., Morningstar, M. E.
& Allcock, H. (2014). Policy and the impact on placement,
involvement, and progress in general education: Critical
issues that require rectification. Research and Practice for
Persons With Severe Disabilities, 39, 65-74
Schaefer, E. F. (1992). Contributing to discourse. In H. H. Clark
(Ed.), Arenas of language use (pp. 144-175). Chicago,
IL: University of Chicago Press.

Author Biography
Lewis Jackson is a professor of special education at the
University of Northern Colorado. He coordinates the Master
degree program for preparing special education teachers to work
with a wide range of students in today’s schools. Over
his forty years in special education, he has worked in both self-
contained and “inclusive” settings, with the result being
that he has become a strong proponent for inclusive educational
practices. He consults, publishes, and provides advo-
cacy supports at the state, national, and international level.
Received: March 17, 2014
Final Acceptance: May 22, 2014
Editor in Charge: Martin Agran
Including Learners with Low-Incidence Disabilities
Facilitating Supports and Services for Learners with Low-
Incidence Disabilities
Jody Marie Bartz Jennifer Kurth Matthew Wangeman
Article information:
To cite this document: Jody Marie Bartz Jennifer Kurth
Matthew Wangeman .
"Facilitating Supports and Services for Learners with Low-
Incidence Disabilities" In
Including Learners with Low-Incidence Disabilities. Published

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