An Analysis of Graduated Guidance to Teach Spoon-use to Children with Multiple Disablities

Abstract

Children’s ability to use a spoon facilitates increased independence during mealtimes and greater control over the pace and quantity of food intake. Children with multiple disabilities including visual impairment (MDVI) have significant communication, cognitive, and motor delays that put them at risk during mealtimes of choking, aspirating, overeating, or undereating when adults control children’s food intake. Therefore, for this group of learners, independent spoon use has important implications for health and self-determination. For this study, I used graduated guidance (GG) to teach spoon use to three children with MDVI in a pullout setting during afternoon snack at school. Efficacy of GG was tested using a multiple probe design across participants; however, a functional relation was not established. Results were analyzed visually, displayed as percentage of prompted and unprompted correct trials (i.e., bites of food) per session, and unprompted correct responses for each step of spoon use per session. All three students’ data at the step level showed a slow, gradual increase in independent spoon use above baseline levels, beginning 3-5 sessions after introduction of the intervention. Two students’ data at the trial level showed a positive trend change, beginning 9-17 sessions after introduction of the intervention. Student data at the step and trial level were highly variable, and students did not reach mastery criterion. Efficacy of GG and generalization of learning as well as implications for practice and future research are discussed.