Elsevier

Research in Developmental Disabilities

Volume 28, Issue 4, July–September 2007, Pages 386-396
Research in Developmental Disabilities

Addressing physical inactivity among developmentally disabled students through visual schedules and social stories

https://doi.org/10.1016/j.ridd.2006.03.004Get rights and content

Abstract

Introduction

This project tested visual schedules and social stories in a physical education setting in order to increase the physical activity of developmentally disabled students.

Method

This cohort study design involved 17 physical education teachers in a training course with an initial survey and 7-month post-survey. The initial survey assessed participant experience with developmentally disabled students, visual schedules and social stories. The post-survey assessed usage of, effectiveness of, and satisfaction with visual schedules and social stories in a physical education setting.

Results

On the initial survey, 100% of the participants reported that they work with developmentally disabled students and 24% reported little to no training in working with this population. On the post-survey, 75% of the participants reported using visual schedules in their teaching and 64% found them to be “effective” or “very effective”. Six percent used social stories in their teaching, reporting them as 100% “very effective”.

Conclusion

There is an indication that visual schedules and social stories are effective learning tools in the physical education setting, increasing opportunities for developmentally disabled students to be physically active. However, additional resources and training are needed in order for physical education teachers to implement these tools widely in their classes.

Introduction

Obesity is a serious health consequence that is associated with physical inactivity. This issue is of particular concern to developmentally disabled individuals, for whom rates of obesity are significantly higher than that of the average population (CDC, 2002). Physical activity among developmentally disabled students has been addressed through Public Law 94-142, which mandates that all handicapped children must receive physical education in public school settings. However, only 27.5% of developmentally disabled students receive physical activity instruction from a trained adapted physical education instructor (CDC, 2000). Tools exist that can aid all instructors in increasing physical activity among their handicapped students. The current study tests the effectiveness of two tools, visual schedules and social stories, for addressing physical activity among developmentally disabled students in a public school setting.

Developmentally disabled individuals may have difficulty engaging in a sufficient amount of physical activity to maintain a healthy weight. The Centers for Disease Control and Prevention (CDC) defines developmental disabilities as “a diverse group of severe chronic conditions that are due to mental and/or physical impairments. People with developmental disabilities have problems with major life activities such as language, mobility, learning, self-help and independent living. Developmental disabilities begin anytime during development up to 22 years of age and usually last throughout a person's lifetime” (CDC, 2004). Developmental disabilities are estimated to affect up to 17% of children in the United States (Boyle, Decoufle, & Yeargin-Allsop, 1994); examples include autistic disorder, pervasive developmental disorder, Asperger's disorder, mental retardation and Down syndrome. The CDC reports an obesity prevalence of 16.5% in the non-disabled population and 27.4% among persons with disabilities (CDC, 2002). This is a 60% higher prevalence rate. Because obesity increases an individual's risk for many other health problems, including type 2 diabetes, hypertension and cardiovascular disease (National Heart, Lung, and Blood Institute, 1998) it is important to find ways to engage developmentally disabled populations in meaningful physical activity.

These students may derive additional benefits from physical activity besides those related to maintaining weight. For example, it has been shown that following moderate aerobic activity, children with autism may experience increases in attention span, on-task behavior and level of correct responding (Rosenthal-Malek & Mitchell, 1997). Unfortunately, in the 30 years since the original passage of Public Law 94-142, only 17 states have developed specific requirements for adapted physical education specialists. In the remaining 33 states, virtually all physical educators are considered “qualified” under state law, regardless of an educator's level of training or experience in working with children who have disabilities (Block & Burke, 1999).

Such specialized training and experience is vital since children with developmental disabilities often have a difficult time communicating with those around them (Dooley, Wilczenski, & Torem, 2001). Problems often arise during expressive communication as well as receptive communication. Expressive communication takes place when a child is trying to express his or her needs, while receptive communication is the process by which a child receives and understands a message. As a result of these communication difficulties behavior problems often arise, triggered by the inability to communicate or understand communication efforts (Charlop-Christy, Carpenter, Le, LeBlanc, & Kellet, 2002).

Visual schedules and social stories capitalize on the visual aspect of communication in order to aid comprehension – and therefore teaching – among developmentally disabled populations. The goal of a visual schedule is to present the abstract concept of time in a concrete format, while a social story aims at presenting appropriate social behaviors in the form of a story.

Visual schedules may be presented in the form of pictures, words or objects. The schedule utilizes the presence of these visuals in order to communicate clearly and concretely when events and activities will take place. This strategy allows the developmentally disabled child to better predict and plan within their environment. Many studies have shown the effectiveness of using visual schedules to help developmentally disabled students gain independence and increase on-task behavior in a school setting (Charlop-Christy et al., 2002, Dooley et al., 2001, Kravits et al., 2002; Mesibov, Browder, & Kirkland, 2002; Pierce & Schreibman, 1994; Quill, 1997).

A schedule's accessibility and consistent use are necessary for its success (Kravits et al., 2002). The materials used to construct a visual schedule can vary widely depending on a child's visual abilities and cognitive thought processes. Presentation options include tactile object schedules, picture schedules or word schedules (National Information Clearinghouse on Children Who are Deaf-Blind, in press).

While relatively few studies have addressed the use of visual schedules, current literature supports their effectiveness. Dooley et al. (2001) found a decrease in the disruptive and aggressive behavior of a developmentally disabled 3-year-old boy after he was taught to use a picture-based schedule board. Similarly, Pierce and Schreibman (1994) taught three boys with autism to follow picture prompts in order to accomplish daily living skills. All three boys exhibited much higher rates of on-task behavior and fewer inappropriate behaviors after the picture prompts were introduced and were more effective self-managers in the absence of supervision. Finally, four autistic students learned to use picture activity schedules in order to decrease their need for supervision in the classroom, and all demonstrated increased on-task behavior as a result (Bryan & Gast, 2000).

Social stories have been found to be another promising tool for behavior improvement among children with developmental disabilities (Barry & Burlew, 2004; Graetz, Mastropieri, Scruggs, & Agosta, 2004; Kuttler, Myles, & Carlson, 1998; Scattone, Wilczynski, Edwards, & Ravian, 2002; Thiemann & Goldstein, 2001). Social stories also use visual communication, presenting appropriate social behaviors in the form of a story. The story breaks down a situation into small steps in order to help a child cope with new situations, understand a social situation, or deal with a particular problem or issue (Gray, 1995). An effective social story is specific and gives clear directions, is written in the first person present tense in order to place the child in the situation, is written at the child's level of vocabulary and understanding, and is continually read to the child to establish and maintain understanding (Gray, 1995). These stories take into account an individual's level of understanding and perception of a situation; they are written to include the who, what, when, where, and why of a social situation. This direction through a story format teaches a child how to interact appropriately with others (Gray Center for Social Learning and Understanding, 2002–2004), which is vital within a teaching environment.

Social stories can be implemented in a number of ways. If the child can read, the child can read the story independently each day after an initial introduction. If the child cannot read, someone must read the story with the child or provide a recording of the story in order for the child to review the story each day (Scattone et al., 2002). Once a child independently initiates the behavior described in the social story, the story can be faded out either by reducing the number of times the child reads the social story or by gradually re-writing the story to include fewer directive sentences.

Previous research supports the use of social stories to improve behaviors among children with developmental disabilities. In one study, three children with autism demonstrated a reduction in their disruptive behaviors with the use of social stories (Scattone et al., 2002). In a similar study, two students given social stories to prompt choice-making during play time demonstrated improvements in the ability to make independent choices and play appropriately (Barry & Burlew, 2004). Kuttler et al. (1998) used social stories to reduce the tantrum behavior of a 12-year-old boy with autism. After the intervention, the child demonstrated no tantrum behaviors, showing the effectiveness of this method for achieving a positive behavior outcome.

The current study drew upon this body of research in order to carry out three aims: (1) determine whether public school physical education teachers feel adequately prepared to instruct children with developmental disabilities, (2) determine whether visual schedules and social stories are useful to public school physical education teachers when working with students with developmental disabilities, and (3) determine whether visual schedules and social stories are effective at increasing on-task behavior in the physical education setting so that physical activity can be maximized.

Section snippets

Participants

Participants included 17 physical education teachers from all grade levels. This sample serves approximately 9,000 students, which represents 20% of the 45,000 students in the Douglas County School District. Douglas County is the fourth largest school district in the state of Colorado, representing 53 elementary, middle and high schools (Douglas County School District, 2005). Participant demographics are summarized in Table 1.

Development of materials

A general training handbook was constructed for teachers in how to

Results

Data from the initial survey and post-survey were analyzed using SPSS Version 13.0 software. All 17 participants responded to the initial survey, while 16 of the 17 of the participants responded to the post-survey. Missing data was excluded from analysis.

Discussion

The current study provides support for the usefulness of visual schedules and social stories as educational tools for developmentally disabled students in the physical education setting. There is a need for this type of creative intervention, as all study participants worked with students with developmental disabilities, but only 70% of the participating teachers felt adequately prepared to work with this population of students and only 25% felt that they had quite a bit of training in regards

Conclusions

This study represents an important beginning in the introduction of specialized teaching methods within the physical education environment for the purposes of increasing physical activity among students with developmental disabilities. The present study provided an empirically based model to improve the way in which physical education is delivered to students with developmental disabilities. Results of this pilot training program indicate that visual schedules and social stories are a useful

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