Received: 23 March 2016 Revised: 30 November 2016 Accepted: 12 January 2017

DOI: 10.1002/bin.1471

RESEARCH ARTICLE

A comparison of computerassisted and therapist

led instruction for children with autism spectrum
disorder
Brittany A. LeBlanc1 | Tiffany Kodak1 | Tom Cariveau2 |

Vincent Campbell2

1
Department of Psychology, University of
WisconsinMilwaukee, Milwaukee, WI, USA The current investigation applied a model of assessmentbased
2
Department of Special Education and Clinical instruction to an evaluation of the efficacy and efficiency of
Sciences, University of Oregon, Eugene, OR, computerassisted and therapistled instruction on skill acquisition
USA
for 3 participants with autism spectrum disorder. We also evaluated
Correspondence
the participant's attending during instruction and the social validity
Dr. Tiffany Kodak, Department of Psychology,
University of WisconsinMilwaukee, 2441 E. of each format of instruction. The results showed that computer
Hartford Avenue, Garland 238E, Milwaukee, assisted instruction was most efficient for 2 of the 3 participants,
WI 53211, USA. although attending varied across instructional formats. In addition,
Email: kodak@uwm.edu
the social validity of instructional formats varied across participants.

1 | I N T RO DU CT I O N

Computerized instruction is growing in popularity in school settings, particularly for students receiving special educa-
tion services who have access to computers or tablets throughout the school day (Neely, Rispoli, Camargo, Davis, &
Boles, 2013). Technology may provide benefits to the classroom. For example, computerassisted instruction (CAI)
may lead to higher treatment integrity for instructional staff with limited training (Kodak, Fisher, Clements, &
Bouxsein, 2011), because it reduces the potential for human error during instruction and does not require extensive
staff training to conduct. Nevertheless, there also may be disadvantages to CAI. For example, CAI requires technology
and specific programs to teach a particular skill. In addition, some learner prerequisite skills such as attending to
relevant stimuli presented on computers may influence the efficacy of instruction. Therefore, it is important to eval-
uate whether CAI produces beneficial outcomes for learners.
Assessmentbased instruction provides a method for examining the efficacy of interventions prior to
implementing them in practice. Assessments are used to determine which types of prompts to provide during
instruction (e.g., Seaver & Bourret, 2014), the efficacy and efficiency of promptfading strategies (e.g., Libby,
Weiss, Bancroft, & Ahearn, 2008; Seaver & Bourret, 2014), efficient errorcorrection strategies (e.g., Carroll,
Joachim, St. Peter, & Robinson, 2015; McGhan & Lerman, 2013), and how to arrange consequences for indepen-
dent and prompted correct responses (e.g., Boudreau, Vladescu, Kodak, Argott, & Kisamore, 2015). These assess-
ments are needed to identify how to arrange instruction because the most efficacious and efficient instructional
strategies often differ across individuals. Rather than selecting an intervention at random, which could lead to

We thank Annie Bailey and Sienna Schultz for their assistance with data collection.

Behavioral Interventions. 2017;32:133143. wileyonlinelibrary.com/journal/bin Copyright 2017 John Wiley & Sons, Ltd. 133
134 LEBLANC ET AL.

inadequate learning and lack of goal attainment, rapid comparisons of interventions allow for a functional
approach to the selection of instructional strategies for learners (Kodak, Fisher, Clements, Paden, & Dickes,
2011). However, the literature on assessmentbased instruction has yet to be extended to an examination of
the efficacy and social validity of CAI.
It is possible that variations in the format and administration of CAI may be responsible for a paucity of research
comparing its efficacy to instruction delivered by staff. For example, some CAI programs are presented in a manner
that requires participants to independently interact with the computer (e.g., Ciullo, Falcomata, Pfannenstiel, &
Billingsley, 2014; Massaro & Bosseler, 2006). Other programs may require the support of adults to perform aspects
of instruction delivered on computers. For example, Grindle, Hughes, Saville, Huxley, and Hastings (2013) found that,
when teaching early literacy skills to children with autism spectrum disorder (ASD), it was necessary to have a tutor sit
with the participant to provide prompts to attend to the computer or speak aloud as instructed by the computer.
Intermittent reinforcers delivered by adults also were necessary for learning.
The combination of adult and computerized instruction, which we will refer to as CAI, requires further investiga-
tion to determine its efficacy and efficiency in comparison to therapistled (TL) instruction. In addition, the social
validity of CAI for individuals with ASD remains unknown. Although technological advances in instruction allow
children with ASD to receive CAI in their classrooms, it is the assumption of practitioners and treatment teams that
the child with ASD may prefer CAI to TL instruction. Rather than basing treatment decisions on assumptions of inter-
vention preference and efficacy, assessmentbased instruction provides a databased model for selecting socially valid
intervention. The present investigation used a model of assessmentbased instruction to compare the efficacy and
efficiency of CAI and TL. In addition, we evaluated participant's attending during instruction and measured the social
validity of each format of instruction for all three participants.

2 | METHOD

2.1 | Participants, setting, and materials

Three schoolaged children with ASD participated. All three children used a computer for at least some portion of
their instruction at school. Brenna was a 9yearold female who previously acquired at least 600 tacts and 25
mands, could answer approximately 10 fillintheblank questions, and consistently echoed vocal prompts. She
engaged in stereotypic behavior (e.g., body rocking and vocal stereotypy) that interfered with mastery of prior
academic goals and resulted in frequent prompts to look at instructional materials. Brenna's exposure to computer-
ized instruction in her classroom included training on typing, letter identification, and matching sight words to
corresponding pictures.
Eric was a 7yearold male who previously acquired at least 400 tacts, used partial or full sentences to mand for at
least 50 preferred items, and consistently echoed vocal prompts. Eric did not engage in any problem behavior during
academic tasks, and he frequently looked at instructional materials presented by adults. Eric's exposure to computer-
ized instruction in his classroom included typing, shape identification, and tracing numbers.
Dan was an 8yearold male who received instruction in general and special education classrooms. Although Dan
had a diagnosis of ASD, he did not have impairments in language. However, he received specialized instruction
through a Title 1 reading program (i.e., a federally funded general education reading program to provide extra support
to struggling readers) at school due to delays in reading. He did not engage in problem behavior during instruction, and
he consistently looked at academic materials presented by adults. Dan's exposure to computerized instruction at
school included typing, although it is possible that he received additional computerized instruction in previous
academic years.
All sessions were conducted in a private room at a universitybased early intervention laboratory that contained a
desk, chairs, instructional materials, food and toys, and 22 cm by 28 cm pictures that corresponded with each
LEBLANC ET AL. 135

condition (i.e., pictures of the experimenter sitting next to a laptop computer, CAI or holding instructional stimuli, and
TL). During CAI, the room also contained a laptop computer and wireless keyboard.

2.2 | Response measures, interobserver agreement, and procedural fidelity

Our dependent variables included (a) correct unprompted responses, defined as the child engaging in a predefined tar-
get response prior to a prompt; (b) attending, defined as making eye contact with the stimulus card or the stimulus on
the computer screen at any point during the trial; and (c) the participant's selection of an experimental condition (dur-
ing the social validity evaluation), which was defined as the participant touching the picture of an instructional format.
We also evaluated the efficiency of instruction. We defined the most efficient format of instruction as the condition
that required the fewest number of instructional sessions to reach the mastery criterion.
Two independent observers collected trialbytrial data on all trialbased dependent variables (i.e., correct
unprompted responses and attending) during at least 32% of sessions in all conditions. We calculated trialbytrial
interobserver agreement (IOA) by dividing the number of trials in which both observers agreed on the occurrence
and nonoccurrence of all dependent variables by the total number of trials in the session and converted the ratio
to a percentage. Mean IOA was 99% (range, 67% to 100%) for Brenna, 96% (range, 60% to 100%) for Eric, and
98% (range, 63% to 100%) for Dan. We also calculated exact agreement IOA for at least 52% of sessions in the social
validity evaluation. An agreement was defined as both observers recording the same condition selected by the partic-
ipant. We calculated IOA by dividing the number of agreements of intervention selections by the total number of
selection opportunities and converted the ratio to a percentage. Mean IOA was 100% for all three participants.
We collected data on procedural fidelity during at least 30% of sessions. A trial of the TL condition was scored as
an instance of procedural fidelity if the experimenter (a) secured attending to the target stimulus, (b) waited the allot-
ted time for a correct response based on the prompt delay, (c) provided reinforcement contingent on a correct
response, (d) provided a model prompt contingent on no response or an incorrect response, (e) ignored problem
behavior, and (f) correctly recorded the data on the data sheet. A trial of the CAI condition was scored as an instance
of procedural fidelity if the experimenter (a) activated the computer program, (b) selected the key that corresponded
to the participant's response, (c) provided reinforcement contingent on a correct response, (d) progressed the program
to the next trial at the end of each trial, (e) ignored problem behavior, and (f) correctly recorded the data on the data
sheet. Procedural fidelity was calculated by dividing the total number of trials in which the experimenter performed
the protocol correctly by the total number of trials in the session, and the ratio was converted to a percentage. Mean
procedural fidelity was 99% (TL range, 83% to 100%; CAI range, 83% to 100%) for Brenna, 99% (TL range, 90% to
100%; CAI range, 90% to 100%) for Eric, and 99% (TL range, 87% to 100%; CAI range, 86% to 100%) for Dan.

2.3 | Preference assessment

The experimenter conducted a brief multiplestimulus without replacement preference assessment on the basis of
procedures described by Carr, Nicolson, and Higbee (2000). The experimenter presented a horizontal array of five edi-
ble or tangible items identified as preferred on the basis of participant nomination. The experimenter said, Pick one,
and allowed the participant to consume the selected edible or provided 20s access to the tangible item selected. The
remaining items were placed back in the array for another choice until the participant selected and consumed each
item in the array. None of the participants failed to consume any of the items in the array during any daily assessment.
One of the first three items selected by the participant was provided contingent on correct responding during
sessions.

2.4 | Pretest
We selected target stimuli on the basis of the participant's current IEP goals and the results of a pretest in which the
experimenter presented each stimulus three times and did not provide any feedback for correct or incorrect
136 LEBLANC ET AL.

responses. The target stimuli consisted of tacts of prepositions for Brenna, letter sounds for Eric, and letter blends and
sight words for Dan (Table 1). Each condition (TL and CAI) included a different set of target stimuli. The experimenter
selected a second set of target stimuli for each condition in the social validity evaluation using the same criterion for
selection as those used for the first set.

2.5 | General procedure

Participants completed 3 to 10 sessions per day, 2 to 3 days per week. We conducted an adapted alternating
treatments design (Sindelar, Rosenberg, & Wilson, 1985) for each of the participants. Different sets of target stimuli
were associated with each condition, and a set consisted of four stimuli presented three times (Brenna), two stimuli
presented five times (Eric), or eight stimuli presented once (Dan). We equated targets across conditions by placing
stimuli with similar sounds (e.g., G and P) in different conditions and matching the number of syllables in each set.
We randomly alternated between sessions of CAI and TL conditions until the participant's responding met the
mastery criterion. The mastery criterion was two consecutive sessions with correct unprompted responses at or
above 87% (Brenna and Dan) or three sessions out of four with correct unprompted responses at or above 80% (Eric).
Following masterylevel responding in one condition, sessions of the mastered condition were discontinued and only
sessions of the remaining condition continued.

2.5.1 | Baseline and control

The experimenter presented a target stimulus, asked about the location of an item (Brenna only), waited 5 s for a
response, and did not provide any consequences for correct or incorrect responses. The experimenter interspersed
mastered tasks approximately every two trials to provide an opportunity for the participant to access reinforcement.
Correct responses to mastered tasks produced praise and an edible or toy for 20 s. We conducted the control condi-
tion during the treatment comparison and social validity evaluation phases.

2.5.2 | Therapistled instruction

A picture of the experimenter holding target stimuli was presented prior to each session, and the experimenter said,
You are going to work with a person. The picture remained visible to the participant during the session. During each
trial, the experimenter presented the target stimulus, required attending to the stimulus, presented an instruction
(Brenna only), and waited the allotted time for a response. If the participant did not engage in a correct unprompted
response, the experimenter delivered an echoic prompt. If the participant engaged in a correct prompted response,
the experimenter provided praise and highly preferred edible or tangible for 20 s. If the participant did not engage
in a correct prompted response, the experimenter presented the next trial.
We used a progressive prompt delay in which the experimenter immediately delivered an echoic prompt at the
onset of the trial during the first treatment session (i.e., 0s delay). Thereafter, the progressive prompt delay increased
by 1 s per session, independent of participant responding, until it reached a terminal value of 10 s or the participant's
responding met the mastery criterion. The experimenter delivered praise and an edible or toy for 20 s for correct

TABLE 1 Target stimulus assigned to each condition across participants

TL CAI Control

Brenna Green block behind Yellow block next to Blue snake between
Green block in front Yellow block under Blue snake around
Blue block behind Blue block next to Orange snake between
Blue block in front Blue block under Orange snake around
Eric G and R P and S F and M
Dan ai, oo, ire, ing, ese, ith, uge, and pre ew, ind, toi, oes, gi, eal, kno, and ite xer, ov, ial, puhay, ief, ly, and uit

Note. CAI = computerassisted instruction; TL = therapistled.

LEBLANC ET AL. 137

unprompted and prompted responses during training until correct unprompted responding reached 50%. Thereafter,
correct prompted responses produced praise only.

2.5.3 | Computerassisted instruction

The experimenter presented a picture of the computer and said, You are going to work on the computer. The picture
remained visible to the participant during the session. The trial sequence and reinforcement contingencies were iden-
tical to those in TL, although the computer presented stimuli on the screen with a white background and played echoic
prompts (prerecorded by the therapist) on the basis of the programmed prompt delay for the session. The experi-
menter started the computer program, advanced the program to each new trial using a wireless keyboard, and deliv-
ered reinforcement.

2.6 | Social validity evaluation

Following the completion of the treatment comparison of TL and CAI, we evaluated the social validity of these inter-
vention procedures using a concurrentchain arrangement (Hanley, Piazza, Fisher, & Maglieri, 2005). The pictures that
corresponded to TL and CAI conditions were displayed in a horizontal array in front of the participant. The experi-
menter conducted one forcedchoice session for each condition at the beginning of each day by physically guiding
the participant to select a condition, stating the condition that was selected (e.g., You picked to work on the com-
puter), and implementing three trials of the intervention with a novel set of stimuli not included in the evaluation.
The order of forcedchoice trials was counterbalanced across days. Thereafter, the experimenter instructed the par-
ticipant to pick one and implemented the condition selected by the participant.
The procedures for TL and CAI were identical to those described previously. Each condition included a new set of
instructional stimuli. We included a control condition as a choice to evaluate whether the participants acquired the
discrimination between pictures that corresponded to conditions (Brenna and Dan). The stimulus for the control con-
dition was a blank white picture (BWP) card. If the participant selected the BWP, the experimenter (a) removed the
stimulus array, turned away from the participant for 10 s, and initiated another choice (Brenna and Dan), or (b) imple-
mented a 5min session in which correct responding to previously mastered sight words did not produce reinforce-
ment (Dan, third phase of the social validity evaluation).

3 | RESULTS

The top panel of Figure 1 shows the percentage of correct unprompted responses during the treatment comparison
for Brenna. She met the mastery criterion in 26 sessions and 28 sessions in CAI and TL, respectively, although she had
higher levels of attending during TL than CAI (Figure 1, middle panel). The bottom panel of Figure 1 shows the cumu-
lative number of sessions selected by the participant for each condition during the social validity evaluation. Brenna
selected both the CAI and TL conditions. CAI was the most socially valid format of instruction for Brenna, which she
selected during 62% of choice sessions. Brenna mastered all targets in both conditions of the social validity
assessment.
Eric mastered targets in the CAI condition in 29 sessions (Figure 2, top panel). He engaged in biased
responding during TL and failed to acquire targets in this condition. However, he had high levels of attending
for TL and CAI (Figure 2, middle panel). The bottom panel of Figure 2 shows that Eric chose the TL condition dur-
ing all eight sessions of the social validity evaluation even though this intervention had failed to produce mastery
responding during the previous comparison of formats of instruction. Similarly, Eric did not master the targets in
the TL condition during the social validity assessment, and we ended this assessment due to a consistent bias in
responding to one stimulus.
138 LEBLANC ET AL.

FIGURE 1 Brenna's percentage of correct responding (top) and attending (middle) during the treatment comparison
and the cumulative number of selections during the social validity evaluation. BL = baseline; BWP = blank white paper;
CAI = computerassisted instruction; TL = therapistled

Dan mastered the target stimuli in the TL condition first following 19 sessions of instruction in comparison to 24
sessions of CAI (Figure 3, top panel). He also had high levels of attending in both conditions (Figure 3, middle panel).
During Dan's first phase of the social validity evaluation (Figure 3, bottom panel), he selected CAI during 70% of
choice session. Although Dan showed a slight preference towards the CAI, we introduced BWP as a choice in the
LEBLANC ET AL. 139

FIGURE 2 Eric's percentage of correct responding (top) and attending (middle) during the treatment comparison and
the cumulative number of selections during the social validity evaluation. BL = baseline; CAI = computerassisted
instruction; TL = therapistled

second phase of the social validity evaluation to ensure that Dan was discriminating between treatment conditions.
During the second phase, Dan selected CAI during 50% of choice sessions and he occasionally selected the BWP,
which produced a brief break from working (30% of choice sessions). We then paired the BWP with a task in the final
phase of Dan's social validity evaluation, and he selected to receive CAI in every session.
140 LEBLANC ET AL.

FIGURE 3 Dan's percentage of correct responding (top) and attending (middle) during the treatment comparison and
the cumulative number of selections during the social validity evaluation. BL = baseline; BWP = blank white paper;
CAI = computerassisted instruction; TL = therapistled

4 | DISCUSSION

The results showed that the most effective and efficient format of instruction varied across participants. All three par-
ticipants acquired targets during CAI; however, only Brenna and Dan mastered the targets taught during TL instruc-
tion. Furthermore, CAI was the most efficient format of instruction for Brenna and Eric, whereas TL was the most
LEBLANC ET AL. 141

efficient format for Dan. During the social validity evaluation, Brenna and Dan showed a preference for CAI, whereas
Eric showed a consistent preference for TL.
The current study extends the literature on assessmentbased instruction to the selection of formats of
instruction for learners with ASD. Similar to previous studies on assessmentbased instruction, the assessment
produced learning of targeted skills (e.g., McGhan & Lerman, 2013). Thus, the time spent conducting this assess-
ment may be offset by the learner acquiring treatment goals during assessment sessions. This assessment was
beneficial for empirically evaluating the format of instruction that produced the most efficient skill acquisition.
Although Eric's teacher primarily used TL, the outcomes of the assessment indicted that the opposite format of
instruction was more efficacious. As such, there are important considerations for the outcomes of assessment
based instruction. Evaluating the efficacy and efficiency of an intervention allows practitioners and teachers to
make wellinformed, databased decisions regarding the format of instruction to use with a learner. Measures of
social validity also could assist in the selection of an instructional format. As described by Hanley (2010), social
validity may have the greatest impact on the efficacy of intervention provided to the individual, and treatment
choice should be afforded to children with ASD whenever possible. Nevertheless, only one participant selected
the most efficacious intervention during the social validity evaluation. Identifying the component(s) of intervention
that lead to a preference for that procedure is a necessary topic of future research. Once the preferred compo-
nents of intervention are identified, more efficacious but less socially valid interventions could be modified to
include these components and potentially improve the acceptability of or preference for highly efficacious
interventions.
Differences across formats of instruction may have influenced the outcomes of our treatment comparison.
During CAI, the computer presented the instructional materials and prompts. The computer did not require attend-
ing or measure whether the participant attended to the material presented on the screen during each trial. In
comparison, the experimenter required attending before initiating the trial during TL instruction. Because teachers
may be likely to require attending to stimuli when delivering TL instruction, we arranged our procedures for TL to
match our participant's typical instruction. Nevertheless, it is unclear whether attending was artificially inflated
during the TL sessions in comparison to attending during TL in other settings. In addition, the definition of attend-
ing may not have accurately captured the behavior, specifically during the CAI condition. This is demonstrated
during Brenna's initial treatment comparison in which levels of attending were lower during CAI although she
mastered these targets in the fewest number of sessions. Due to Brenna's type of targeted skill (prepositions)
and number of different targets (four), making eye contact with instructional stimuli is necessary to consistently
respond correctly. Yet it is possible that CAI was even more efficient for Brenna than identified by our efficiency
measures because she did not look at the instructional materials on every training trial in a session. Thus, it is
likely that she had fewer overall trials of effective instruction in CAI per session, and this was the most efficient
intervention. Future studies may consider providing reinforcement for attending across conditions or inserting
differential observing responses to ensure that participants are consistently attending to instructional materials
during intervention comparisons.
Another difference between TL and CAI is the amount of social interaction between the experimenter and par-
ticipant. Eric frequently said, hello and attempted to interact with the experimenter during CAI. He also said, No!
Work with a person. prior to some of the CAI sessions. Because children with ASD have deficits in social relationships
and nonverbal behavior (e.g., decreased eye contact and few social initiations), formats of instruction that require chil-
dren to engage socially with an adult and practice appropriate nonverbal behavior may be as important as the specific
skill being targeted during instruction. Prior to selecting CAI, stakeholders could consider whether other formats of
instruction may assist the learner with ASD in acquiring both social communication and the targeted skills. Although
improvements in social behavior were not targeted within this study, additional research could examine differences in
social behavior during TL and CAI.
There are additional limitations of the present investigation that are important to note. First, the social validity
evaluation differed across participant. We did not include the BWP as a choice of treatment for Eric. It is possible
142 LEBLANC ET AL.

that his exclusive selection of TL was the result of a bias, although his response to forcedchoice trials of CAI
suggests that this is unlikely (e.g., he said No! Work with a person. when guided to touch CAI). Furthermore,
the BWP was paired with a task for Dan only. It is possible that Dan's selection of the CAI during the third phase
was a response away from the BWP to avoid the associated task. However, he did consistently select CAI over TL
during this phase, which is similar to his selections in the first phase of the social validity evaluation. Future
studies may consider including a choice associated with a control condition (i.e., a response selection to the
stimulus results in the control condition procedures) as a measure of discrimination during currentchain
arrangements.
We included two mastery criteria for the participants. The specific mastery criterion can impact treatment com-
parisons such as ours, and researchers should carefully consider how their mastery criterion impacts the interpretation
of the results.
The present investigation extended assessmentbased instruction to an evaluation of formats of instruction for
participants with ASD. Although the rapid comparison of interventions identified an efficient intervention for each
learner, the generality of these outcomes across different skills is unknown, and future research is warranted. In
addition, research on the benefits of CAI, prerequisite skills that may impact the efficacy of CAI (e.g., attending to
the computer screen and responding to computerized prompts), and the social validity of this format of instruction
for children and teachers will help identify the specific conditions under which this valuable technology should or
should not be applied to the instruction of individuals with ASD.

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How to cite this article: LeBlanc BA, Kodak T, Cariveau T, Campbell V. A comparison of computerassisted
and therapistled instruction for children with autism spectrum disorder. Behavioral Interventions.
2017;32:133143. https://doi.org/10.1002/bin.1471