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USING THE STIMULUS EQUIVALENCE PARADIGM TOTEACH COURSE MATERIAL IN AN UNDERGRADUATE

REHABILITATION COURSE

BROOKE D. WALKER AND RUTH ANNE REHFELDT

SOUTHERN ILLINOIS UNIVERSITY

AND

CHRIS NINNESS

STEPHEN F. AUSTIN STATE UNIVERSITY

In 2 experiments, we examined whether the stimulus equivalence instructional paradigm couldbe used to teach relations among names, definitions, causes, and common treatments fordisabilities using a selection-based intraverbal training format. Participants were pre- andposttested on vocal intraverbal relations and were trained using multiple-choice worksheets inwhich selection-based intraverbal relations were taught and feedback was delivered until mastery.Most participants in Experiment 1 showed the emergence of vocal intraverbal relations, butresponding did not generalize to final written intraverbal tests. Participants in Experiment 2showed the emergence of not only vocal intraverbal relations but also written intraverbalrelations on final tests. Results suggest that the stimulus equivalence paradigm can be effectivelyimplemented using a selection-based intraverbal training format, the protocol may be an effectivemeans of emphasizing important concepts in a college course, and emergent skills may generalizeto novel response topographies.

Key words: derived stimulus relations, generalization, higher education, stimulus equivalence,verbal behavior

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Instructional procedures that facilitate theemergence of derived stimulus relations havebeen shown to be effective and efficient inestablishing a variety of preacademic andacademic skills in a variety of learners. Basedon the stimulus equivalence paradigm originallyestablished by Sidman (e.g., 1971; Sidman &Cresson, 1973), the general protocol involvesexplicit reinforcement for a series of conditionaldiscriminations, after which time any numberof untrained stimulus relations is likely toemerge in participants with some degree ofverbal proficiency. Among the body of researchon this topic is a study by Cowley, Green, and

Braunling-McMorrow (1992), which used theprotocol to teach adults with acquired braininjuries to vocally name their therapists.Participants were initially taught conditionaldiscriminations between dictated names andphotographs of their therapists and dictatednames and the written therapist names. Partic-ipants then showed the emergence of untrainedrelations between the photographs and thewritten names, and two participants namedthe therapists when presented with their photos.One participant then located and named allthree therapists in their offices (Cowley et al.), aparticularly worthwhile and socially valid dem-onstration of the transfer of skills to an everydaysetting outside the experimental context.

De Rose, de Souza, and Hanna (1996)established a reading curriculum based onstimulus equivalence procedures for childrenwho did not read. Children were taught tomatch dictated names to their correspondingprinted words and to construct or copy printed

Address correspondence to Ruth Anne Rehfeldt,Behavior Analysis and Therapy Program, RehabilitationInstitute, Southern Illinois University, Carbondale, Illinois62901 (e-mail: [email protected]).

doi: 10.1901/jaba.2010.43-615

This project constituted the master’s thesis completedby the first author under supervision of the second authorin the Behavior Analysis and Therapy program atSouthern Illinois University.

JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2010, 43, 615–633 NUMBER 4 (WINTER 2010)

615

words with movable letters. Following thisinstruction, the children read 51 words andshowed improvement in spelling, and somechildren read novel words that were recombi-nations of the within-syllable units of thetraining words (de Rose et al.). Rosales andRehfeldt (2007) established derived mands inadults with severe intellectual disabilities by firstteaching individuals to mand for items neededto complete chained tasks by exchangingpictures. Participants were then taught to relateconditionally the pictures to their dictatednames and the dictated names to the corre-sponding printed words. As a result, partici-pants exchanged text for the items needed tocomplete the chained task in the absence ofexplicit instruction. One month later, some ofthe participants even vocally requested theneeded items.

This body of work underscores the role that acurricular approach based on derived stimulusrelations might have in a variety of educationaland habilitative settings. In many studies onderived stimulus relations, the ultimate perfor-mance inferred to indicate the emergence ofnew stimulus relations is match to sample,which involves selection-based responding orthe selection of stimuli from an array (seeMichael, 1985). However, these studies alsodemonstrated the emergence of untrained skillsof relevance to participants’ everyday lives (i.e.,naming therapists, spelling, manding; see Cow-ley et al., 1992). Moreover, in the case ofCowley et al. and de Rose et al. (1996), theuntrained skills were also topography based orhad topographies that were unique from oneanother and differed from the response topog-raphy established during training (Michael).Topography-based responding has been arguedto better reflect verbal behavior according to theSkinner (1957) conceptualization (see C. T.Sundberg & Sundberg, 1990), as well as tooccur more frequently in everyday life thanselection-based responding (e.g., Perez-Gonza-lez, Herszlikowicz, & Williams, 2008).

Recently, pioneering efforts by several re-searchers have highlighted a possible role for thederived stimulus relations paradigm in teachingcourse material in the college classroom (e.g.,Fields et al., 2009; Fienup, Covey, & Critch-field, 2010; Ninness et al., 2005, 2006, 2009).Studies by Ninness et al. served as the impetusfor this line of research; Ninness et al. (2005)used a computer-based procedure to enhanceknowledge of algebraic and trigonometrictransformations in participants who lackedtraining in advanced mathematical functions.Specifically, participants were taught to relatestandard to factored formulas and factoredformulas to graphs. Most participants demon-strated the emergence of untrained relationsamong the stimuli, and responding generalizedto include 40 different and complex variationsof the original training formulas and graphs(Ninness et al., 2005; see also Ninness et al.,2006, 2009). Another study in this vein is thatof Fields et al., who applied the derivedstimulus relations protocol to the concept ofstatistical interaction effects in two-way analysesof variance. Participants in this study wereundergraduate introductory psychology stu-dents, and stimuli included graphical represen-tations of the types of interactions (e.g.,crossover, synergistic, divergent, and no inter-action; the A stimuli), written descriptions ofthe types of interactions (the B stimuli), thenames of the interactions (the C stimuli), anddefinitions of the interactions (the D stimuli).After participants completed a computerizedmatch-to-sample procedure that consisted ofmatching the A and B stimuli, followed by theB and C stimuli, followed by the C and Dstimuli, participants not only showed theemergence of four four-member equivalenceclasses among the stimuli but also respondedrelationally with novel examples of originaltraining stimuli. Participants also showedimproved scores on a multiple-choice paper-and-pencil test relative to their pretest scoresand scores for a control group of participants

616 BROOKE D. WALKER et al.

who did not participate in the experiment. Thestudy by Fienup et al. (2010) also usedequivalence-based instruction to establish rela-tions between the anatomical location of variousbrain functions and the actual functions ofthose locations with introductory psychologystudents. These authors administered the in-structional protocols as a series of computerizedlessons, ultimately showing that the applicationof instructional protocols based on derivedstimulus relations can be applied to collegeinstruction as a form of programmed instruc-tion, with numerous opportunities for studentsto respond and receive feedback. Thus, contin-ued investigation of the efficacy of derivedrelations instructional protocols in the collegeclassroom seems warranted, particularly proto-cols that arrange for the emergence of skills inresponse topographies such as speaking andwriting, which have relevance for studentsbeyond their completion of the experiment. Itmay also be worthwhile to explore otherdelivery modes for situations in which the useof computerized protocols is infeasible. Forexample, the procedure developed by Fienup etal. may well lend itself to completion in a largelaboratory in an undergraduate psychologycourse in which students complete manycomputerized exercises over the course of asemester. Unfortunately, this arrangement,although ideal, may not be feasible or evenavailable for other courses.

An apparatus that has received little attentionin the research literature, but which may havehigh face validity in the college classroom, is thepaper-and-pencil format used by Eikeseth,Rosales-Ruiz, Duarte, and Baer (1997) toinvestigate the effects of written instructionson equivalence class formation. In this study,sample and comparison stimuli were presentedon training worksheets, and participants wereinstructed to make matches by circling thecomparison stimulus that went with eachsample stimulus, much like a multiple-choiceexam. Although this study used Roman letters

as stimuli in lieu of socially relevant stimuli, theauthors accentuated the advantages of thistraining format by describing match to sampleas an ‘‘elaborate and rigorous training protocol’’(Eikeseth et al., p. 276) that was actuallyoriginally developed for research with pigeons,then later modified for use with persons withmental retardation or young children. Thepaper-and-pencil format used by these authorscan be conceptualized as a protocol for teachingselection-based intraverbal relations or relationsbetween verbal stimuli and verbal responses inwhich the responses share no point-to-pointcorrespondence with the stimuli that evokethem (Skinner, 1957). The response of circlingthe correct comparison stimulus is selectionbased (Michael, 1985), as is a match-to-sampleresponse. This training format may be costeffective in situations in which computers arenot readily available: Numerous participantscan complete a protocol simultaneously usinginexpensive materials (Eikeseth et al.), and thetraining format has high face validity in that it isone that is used in many educational settings.An equivalence worksheet is similar in form tothe many worksheets, homework assignments,and exercises students complete in and out ofclass. To date, the use of a paper-and-penciltraining format in establishing derived stimulusrelations in an educational curriculum has notbeen evaluated (see also Smeets, Dymond, &Barnes-Holmes, 2000).

The purpose of the present investigation wasto extend the use of instructional protocols thatprogram for the emergence of derived stimulusrelations in the college classroom. In this study,three protocols were implemented that corre-sponded with the three units of an undergrad-uate course on disabilities. For each unit’sprotocol, three worksheets were used to estab-lish stimulus equivalence relations that includedthe names of a disability, the definition of adisability, the disability’s primary cause, and aneffective treatment or service for the particulardisability. Training thus established selection-

STIMULUS EQUIVALENCE AND TEACHING 617

based intraverbal relations. Vocal intraverbalposttests evaluated participants’ naming of aparticular disability when presented with a flashcard stating its definition, cause, or an effectiveservice or treatment. Students enrolled in thecourse served as participants for each instruc-tional protocol in Experiment 1. For thesestudents, final tests were administered at theconclusion of the semester. Final tests wereshortanswer and fill-in-the-blank formats andrequired students to supply either the name of adisability when given its definition, cause or aneffective treatment or service or the definition,cause, and an effective treatment or servicewhen given the disability name. Like vocalintraverbal posttests, final tests evaluated theemergence of intraverbal responses, but in thiscase the topography of the target responses waswritten rather than vocal (see also Chase,Johnson, & Sulzer-Azaroff, 1985). Participantsin Experiment 2 were not students in thecourse, and for these students, the final writtenintraverbal tests were administered immediatelyfollowing the completion of vocal intraverbal

posttests. All emergent performances targeted inthis experiment were thus topography based.

EXPERIMENT 1

Method

Participants. A total of 22 undergraduatestudents enrolled in an introductory course ondisabilities at Southern Illinois Universityparticipated in the study during the Fall 2008semester. All students in the course were atdifferent stages of their undergraduate academiccareers and varied in the extent of their priorknowledge of various disabilities. A total of 13students participated in each of the three unitprotocols (Table 1), but the same 13 studentsdid not necessarily participate in each unitprotocol. Students were compensated withcourse credit for participating.

Setting and stimulus materials. Sessions lastedapproximately 30 to 45 min and took place ina small laboratory (2.7 m by 3.3 m) thatcontained two chairs and a desk. Eachparticipant sat in one chair at the desk, and

Table 1

Training Trial Blocks to Criterion for Units 1, 2, and 3 in Experiment 1

Participant

Unit 1 Unit 2 Unit 3

A-B A-C C-D A-B A-C C-D A-B A-C C-D

1 2 1 1 3 3 23 1 1 2 1 2 14 1 2 25 2 2 2 2 2 2 1 2 28 2 2 29 2 1 1 1 2 1 2 2 2

10 2 2 311 2 2 212 3 2 2 1 2 2 1 2 213 1 1 2 1 2 214 1 1 2 1 2 215 2 2 2 1 2 2 1 2 116 1 2 2 2 2 217 1 2 218 2 2 2 1 2 119 2 2 2 1 2 2 1 2 220 1 2 221 2 2 222 2 2 223 1 2 2 2 3 124 1 2 225 2 2 2


the experimenter sat directly across from himor her.

Training materials included multiple-choicequestionnaires or worksheets (three for eachunit), printed on two pieces of white paper(21.6 cm by 27.9 cm) in black Calabri font (Size11). Each worksheet consisted of 12 items. Thequestion presented in each item was conceptual-ized as the sample stimulus, and the four responseoptions were conceptualized as comparisonstimuli. Each question was presented three timeson each worksheet, with the order of questionsrandomly determined before the worksheets wereconstructed. The order of response options for agiven question was also randomly determined.The order in which questions and responseoptions were presented was derived via a randomsequence generator (http://www.random.org/sequences/). Test materials for each unit consistedof three sets of 12 white index cards (10.2 cm by15.2 cm) with definitions, causes, and treatmentsfor disabilities printed in black Calibri font (Size20) on the front of the cards. Disability nameswere printed on the back of each card. The fourquestions that were presented on each of the threeworksheets for Units 1, 2, and 3, respectively, areshown in Appendixes A, B, and C.

Training and testing materials for each unitincluded four sets of four stimuli each. Stimuliwere designated with the following alphanu-meric symbols: names of disabilities (A stimuli),definitions of disabilities (B stimuli), primarycauses of the disabilities (C stimuli), andcommon treatments or services for the disabil-ities (D stimuli). The combination of the A, B,C, and D stimuli constituted a class. Each unit’sprotocol was thus intended to result in some(but not all) of the emergent relations (B-A, C-A, and D-A) indicative of the formation of fourfour-member stimulus classes, with each classpertaining to a particular disability. Theprimary textbook, which was used throughoutall three units of the course and from whichstimulus sets were obtained, was Bowe’s (2000)Physical, Sensory, and Health Disabilities: An

Introduction. Stimulus sets incorporated intoeach unit protocol were as follows (Table 2):The Unit 1 protocol included cerebral palsy,spina bifida, multiple sclerosis, and musculardystrophy (physical and developmental disabil-ities); the Unit 2 protocol included cysticfibrosis, sickle-cell disease, hypertension, anddiabetes (health disabilities); and the Unit 3protocol included apraxia, schizophrenia, Alz-heimer’s disease, and dementia (psychiatric andage-related disabilities).

Design. A pretest-train/posttest-maintenancetest sequence was used in all three unitprotocols. Participants completed one unitprotocol in its entirety in one session. In eachsession, participants first completed B-A (nam-ing a disability when given its definition), C-A(naming a disability when given its primarycause), and D-A (naming a disability whengiven a common treatment or service) vocalintraverbal pretests and then received worksheettraining on the A-B (name to definition)relations. The B-A vocal intraverbal posttestwas administered immediately following mas-tery of the A-B relations. The A-C (name toprimary cause) relations were then trained usingthe worksheets, and immediately following theirmastery, the C-A vocal intraverbal posttest wasadministered. The C-D (primary cause tocommon treatment or service) relations werethen trained using the worksheets, and imme-diately following their mastery, the D-A vocalintraverbal posttest was administered. Trainingwas thus conceptualized as a variation of thesimple-to-complex protocol (Fields et al.,2009). The session corresponding to each unit’sprotocol was conducted prior to coverage of theparticular unit in the course. Final writtenintraverbal tests were presented 114 days afterthe completion of Unit 1, 87 days after thecompletion of Unit 2, and 52 days after thecompletion of Unit 3.

Dependent measure and interobserver agree-ment. The primary dependent measure was thepercentage of correct responses during vocal


intraverbal pre- and posttest probes for each ofthe three unit protocols. Vocal intraverbals wereinferred to have emerged on posttests if aparticipant performed correctly on 11 of the 12test trials (92% correct) for each particular vocalintraverbal relation, including the B-A (naminga disability when given its definition), C-A(naming a disability when given its primarycause), and D-A relations. A secondary measurewas the number of trial blocks required to attainmastery criterion during worksheet training. Anadditional secondary measure was scores onfinal written intraverbal tests.

Interobserver agreement was recorded by anindependent observer for 33% of all partici-pants’ pre- and posttest probe trials and 100%of all participants’ training worksheets for allthree units. The second observer viewed pre-and posttest probe sessions via video. For test

probes, agreement as to whether a correctresponse occurred was calculated by dividingagreements by agreement plus disagreementsand converting the ratio to a percentage. Meaninterobserver agreement was 94% for testprobes. The same formula was used to evaluatewhether or not participants responded correctlyfor each item on each training and finalworksheet, with resulting interobserver agree-ment equaling 100% for both training andfollow-up worksheets.

General procedure. This study included threeinstructional protocols (Table 2) that corre-sponded to the three units of the class: Unit 1protocol, developmental and physical disabili-ties; Unit 2 protocol, health-related disorders;and Unit 3 protocol, psychiatric and age-relateddisabilities. The Unit 2 protocol was imple-mented 27 days after completion of the Unit 1

Table 2

Unit 1, 2, and 3 Protocol Stimuli

Protocol ClassA B C D

Name Definition Primary cause Treatment

Unit 1 1 Cerebral palsy Incomplete control ofbody’s muscles

Oxygen deprivation inthe brain

Positioning aids,environmental control

2 Spina bifida Failure of the spinal cordto close completely

Folic acid insufficienciesduring pregnancy

Supplementation, prenatalsurgery

3 Multiple sclerosis Condition in which thebody attacks the centralnervous system

Causes unknown Medication, air conditioning

4 Muscular dystrophy Progressive weakness anddeterioration of muscles

Insufficient supply of arequired protein

Experimental research

Unit 2 1 Cystic fibrosis Abnormal secretions leadingto mucus accumulationin lungs

A defective recessive gene Anti-inflammatorytreatments, drugs, diet

2 Sickle-cell disease Disorder of the oxygen-transporting red bloodcells

Genetic inheritance fromthe parents

Vaccinations, penicillin

3 Hypertension Condition in which bloodpressure is constantlyelevated

Narrow arteries/fat build-up Drugs, cardiac rehabilitation,surgery

4 Diabetes Condition in which thebody is unable to makeor use insulin

Destruction of beta cellsin the pancreas

Physical exercise, healthyeating, injections

Unit 3 1 Apraxia Loss of ability to carry outlearned movements

Neurological damage ordiseases

Repetetive motor drills,behavioral therapy

2 Schizophrenia Chronic, severe, anddisabling mental disorder

Genetic predisposition orenvironmental stressors

Antipsychotic medication,psycho-social treatment

3 Alzheimer’s disease A progressive neurologicaldisease of the brain

Build-up of proteins in thebrain

Emotional and medicalsupport

4 Dementia Severe loss of cognitiveability

Diseases in the nervoussystem or blood vessels

Healthy diet, memory aids


protocol, and the Unit 3 protocol was imple-mented 35 days after completion of the Unit 2protocol. Participants were given the followinginstructions before their completion of aparticular unit:

You will be asked to complete a series of pretests,training sessions, and posttests on the definitions,causes, and treatments for various disabilities. Testconditions will be conducted in a flash-card-stylefashion, and no feedback will be delivered. Trainingconditions will be conducted using paper-and-pencilquestionnaires, and feedback will be provided aftercompletion of each. There will be a total of threetraining sessions, each followed by a test condition.In order to move on to the test conditions, you mustfirst answer 11 of 12 questions correctly on theworksheets. If you answer fewer than 11 correct, youwill be asked to retake the previous worksheet.

Vocal intraverbal pretests. Each unit protocolbegan with a pretest. Pretests assessed whetherparticipants could name the correct disabilitywhen presented with its definition (B-Arelations), cause (C-A relations), and treatment(D-A relations) on a flash card. The B-Aintraverbal relations were evaluated first, fol-lowed by the C-A and then D-A relations. Thevocal intraverbal B-A relations consisted of 12consecutive test trials, as did the vocal intra-verbal C-A and D-A relations. Within each 12-trial block of trials, each flashcard was presentedthree times each. Participants were given thefollowing instructions before the vocal intra-verbal pretest: ‘‘At this time, I am going to showyou different definitions, causes, and treatmentsfor various disabilities; do your best to try andtell me the name of the disability for each.’’

The presentation of a flash card on whicheither the B (definitions for disabilities), C(common causes), or D (common treatments orservices) stimuli were printed marked the onsetof each trial. Flash cards were presented by theexperimenter one at a time and were positionedapproximately 72 cm from the participant.Participants were given 5 s to provide the nameof the correct disability (the A stimuli). Theexperimenter scored the trial as incorrect if aresponse did not occur, or if a participant

responded with the name of an incorrectdisability or said ‘‘I don’t know.’’ Correct andincorrect responses did not result in feedbackfrom the experimenter. The experimenterrecorded all responses on a computerized datasheet, which faced away from the participant.

The order of stimulus presentations wasdetermined randomly within each 12-trialblock. Prior to the onset of each 12-trial block,the experimenter shuffled the flash cards textside down. Participants advanced to selection-based intraverbal training for a particular unit ifthey scored below 50% on that unit’s vocalintraverbal pretest.

Selection-based intraverbal (worksheet) train-ing. The following selection-based intraverbalrelations were trained using a paper-and-pencilprotocol: names of disabilities to their defini-tions (A-B), names of disabilities to theirprimary causes (A-C), and primary causes tocommon treatment or services (C-D) for theparticular disabilities in each unit protocol.Worksheets for the A-B relations (names ofdisabilities to their definitions) were completedto mastery first, after which a posttest for thevocal intraverbal B-A relations (naming adisability when given its definition) was pre-sented, followed by the completion of the A-Crelations (names of disabilities to their primarycause) worksheets to mastery, after whichposttests for the vocal intraverbal C-A relations(naming a disability when given its primarycause) were presented, followed by the comple-tion of the C-D relations (primary cause tocommon treatment or service) worksheets tomastery, after which posttests for the vocalintraverbal D-A relations (naming a disabilitywhen given a common treatment or service)were presented.

For each unit, participants were taught fourselection-based A-B (A1-B1, A2-B2, A3-B3,and A4-B4; disability names to definitions), A-C (A1-C1, A2-C2, A3-C3, and A4-C4; namesto primary causes), and C-D (C1-D1, C2-D2,C3-D3, and C4-D4; primary cause to effective


treatments or services) relations each. Duringtraining of the selection-based A-B and A-Crelations, the A stimuli or disability names wereconceptualized as the sample stimuli (i.e.,cerebral palsy), and the B or C stimuli or thedefinitions or causes were conceptualized as thecomparison stimuli (i.e., incomplete control ofthe body’s muscles). During selection-based C-D training, the C stimuli or causes wereconceptualized as sample stimuli, and the Dstimuli or common treatments or services wereconceptualized as comparison stimuli. Eachitem on the worksheet was conceptualized as atrial. A selection-based response of circling thecorrect response option was required for a trialto be scored as correct. A mastery criterion of 11of 12 questions (92%) was in effect for eachworksheet. If a participant failed to meet thiscriterion, he or she was given written feedback,allowed time to look over the answers, and thenwas asked to repeat an identical worksheet untilmastery criterion was met.

Participants were given the following instruc-tions before training:

Now, I am going to ask you to complete a multiplechoice worksheet. Once you have completed theworksheet, I will score your responses and give yousome time to look over any items that you may havemissed. You must answer at least 11 out of 12 correctbefore moving on to the next phase.

Participants were then given as much time asnecessary to complete the worksheet. Theexperimenter remained present in case partici-pants had questions, although none did. Whenparticipants were finished, the experimenterimmediately scored the worksheets using ananswer key. Incorrect responses were markedwith an X, and the correct answer for that itemwas circled in red pen. Participants were givenas much time as they needed to look over theirgraded worksheets, after which they were givenan identical worksheet to complete if theyscored below mastery on the first one.

Vocal intraverbal posttests. Vocal intraverbalposttests were identical to vocal intraverbalpretests, except that posttest trials for all of the

emergent vocal intraverbal relations were notconducted at one time. Rather, posttests for thevocal intraverbal B-A relations (naming adisability when given its definition) wereconducted following mastery of the selection-based A-B training worksheets, posttests for thevocal intraverbal C-A relations (naming adisability when given its primary cause) wereconducted following mastery of the selection-based A-C training worksheets, and posttests forthe vocal intraverbal D-A relations (naming adisability when given a common treatment orservice) were conducted following mastery ofthe selection-based A-D training worksheets.

Written intraverbal final tests. On the last dayof the course, all students were asked tocomplete two final tests for extra points towardtheir class grade. Final tests were conducted toevaluate the transfer of the intraverbal relationsestablished during selection-based training andshown to have emerged during vocal intraverbalposttests across response repertoires. Specifical-ly, posttests evaluated the emergence of writtenintraverbal relations. Both Final Tests 1 and 2were in a paper-and-pencil format and werepresented to students consecutively. Final Test1 evaluated the maintenance of the emergent B-A (naming a disability when given its defini-tion), C-A (naming a disability when given itsprimary cause), and D-A (naming a disabilitywhen given a common treatment or service)relations. The format for each question on FinalTest 1 (Appendix D) was as follows: Given thecombination of B (definition), C (cause), and D(treatment) shown simultaneously, participantswere asked to provide the name (A) of thedisability. Final Test 1 included 12 items, eachaddressing a different stimulus class among thethree unit protocols. Scores were obtained foreach unit separately. There were four items forUnit 1 (Questions 1 to 4), four for Unit 2(Questions 5 to 8), and four for Unit 3(Questions 9 to 12). Thus, for each unitprotocol, there were a total of four possiblepoints that could have been achieved on Final


Test 1. The number of items correct wasdivided by the number of points possible andconverted to a percentage.

Final Test 2 evaluated the maintenance of thedirectly trained relations for each unit protocol,including names of disabilities to their definitions(A-B), names of disabilities to their primarycauses (A-C), and primary causes to commontreatment or services (C-D) for the particulardisabilities in each respective unit protocol. Asshown in Appendix E, participants were providedwith the name of a disability (A) and were askedto provide the definition (B), primary cause (C),and common treatment or service (D) for thedisability. Final Test 2 included 12 items, eachalso addressing a different stimulus class amongthe three unit protocols. Each item on Final Test2 was worth three points (1 point for definition,1 point for cause, and 1 point for treatment).Scores were obtained for each of the three unitsseparately. Thus, there were 12 points possible forUnit 1, 12 for Unit 2, and 12 for Unit 3. Thenumber of points achieved was divided by thenumber of points possible for each unit andconverted to a percentage.

Results

Vocal intraverbal pretests. Figure 1 shows thatall participants (13 in Unit 1, 13 in Unit 2, and13 in Unit 3) who completed the Unit 1, 2, or 3protocols scored in the range of 0% to 42%correct on pretest probes for all vocal intraverbalrelations.

Selection-based intraverbal training. Table 1indicates the number of training trial blocksrequired for each participant to demonstratemastery criterion during training of names ofdisabilities to their definitions (A-B), names ofdisabilities to their primary causes (A-C), andprimary causes to common treatments or services(C-D) relations for Units 1, 2, and 3. Mostparticipants required only one or two trial blocksto master all relations for all three unit protocols.

Vocal intraverbal posttests. The B-A (naming adisability when given its definition), C-A

(naming a disability when given its primarycause), and D-A (naming a disability whengiven a common treatment or service) vocalintraverbal relations were inferred to haveemerged if a participant performed with 92%accuracy on test trials for the particular relation.Figure 1 shows the posttest scores for allparticipants on the B-A, C-A, and D-A vocalintraverbal relations in all three unit protocols.Of the 13 participants who completed Unit 1,nine (Participants 1, 3, 9, 12, 15, 16, 17, 19,and 20) demonstrated the emergence of thedefinition-to-name (B-A) relations, 12 (Partic-ipants 1, 3, 5, 8, 9, 12, 15, 16, 17, 18, 19, and20) demonstrated the emergence of the cause-to-name (C-A) relations, and eight demonstrat-ed the emergence of the treatment-to-name (D-A) relations. Of the 13 participants whocompleted Unit 2, 10 (Participants 3, 5, 9,13, 14, 15, 18, 19, 24, and 25) demonstratedthe emergence of the definition-to-name (B-A)relations, 11 (Participants 3, 5, 9, 12, 13, 14,15, 18, 19, 23, and 25) demonstrated emer-gence of the cause-to-name (C-A) relations, andnine demonstrated the emergence of thetreatment-to-name (D-A) relations. Of the 13participants who completed Unit 3, nine(Participants 3, 4, 5, 9, 11, 14, 15, 16, and23) demonstrated the emergence of the defini-tion-to-name (B-A) relations, nine (Participants1, 4, 5, 9, 13, 14, 15, 16, and 19) demonstratedemergence of the cause-to-name (C-A) rela-tions, and 10 demonstrated the emergence ofthe treatment-to-name (D-A) relations. Meansand standard deviations for accuracy on testtrials assessing the emergence of the B-A, C-A,and D-A relations for each of the three unitswere as follows: Unit 1: B-A (M 5 89%, SD 5

13.3), C-A (M 5 98%, SD 5 5), and D-A (M5 86%, SD 5 18); Unit 2: B-A (M 5 94%,SD 5 14.5), C-A (M 5 94%, SD 5 14.2), andD-A (M 5 93%; SD 5 10.7); Unit 3: B-A (M5 86%; SD 5 22.7), C-A (M 5 91%; SD 5

11), and D-A (M 5 94%, SD 5 14.5). Meansand standard deviations for overall accuracy for


the three protocols were as follows: Unit 1(M 5 91%, SD 5 13.9), Unit 2 (M 5 94%,SD 5 12.9), and Unit 3 (M 5 90%, SD 5 16.7).

Written intraverbal final tests. Scores for FinalTests 1 and 2 are shown for each of the threeunit protocols in Table 3. Only one participantscored 100% accuracy on Final Test 1 for the

Unit 1 protocol (Participant 3), and only oneparticipant scored 100% accuracy for the Unit2 protocol (Participant 3). For Final Test 2,most participants scored no higher than 50%correct. The highest score of 83% correct onFinal Test 2 was displayed by Participant 19 forthe Unit 2 protocol. Means and standard

Figure 1. Percentage of correct responses before and after test probes for Units 1, 2, and 3 in Experiment 1. Thedotted line represents accuracy level of 92%.


deviations for overall accuracy for the threeprotocols were as follows: Unit 1 protocol: FinalTest 1 (M 5 60%, SD 5 24.2) and Final Test2 (M 5 34%, SD 5 12), Unit 2 protocol: FinalTest 1 (M 5 63%, SD 5 23.1) and Final Test2 (M 5 54%, SD 5 19.4), Unit 3 protocol:Final Test 1 (M 5 31%, SD 5 29.1) and FinalTest 2 (M 5 23%, SD 5 15.3).

Summary of Experiment 1

These results indicate that all participantsacquired the directly trained selection-basedintraverbal relations for all three unit protocolsusing the paper-and-pencil format with ease.Most participants required only one or twotraining sessions with the worksheets to attainmastery. In addition, test probes revealed thatnearly all the participants for each protocoldemonstrated the emergence of untrainedtopography-based relations, specifically, vocalintraverbal. These results are encouragingregarding the role that stimulus equivalencetechnology might play in higher educationlearning. Not encouraging, however, wereparticipants’ performances on the writtenintraverbal final tests. A number of studies havesuggested that equivalence relations may beremarkably stable over time, enduring for aslong as 2 to 5 months in participants with

intellectual disabilities (Saunders, Wachter, &Spradlin, 1988). Whether participants’ poorperformances on the written intraverbal finaltests reflect a failure of derived responding togeneralize across novel test formats or a failure ofthe emergent relations to endure over time cannotbe determined from the present results. For thisreason, Experiment 2 was conducted with fourparticipants. These four participants completedthe two written intraverbal final tests immediatelyafter completion of their final test probes.

EXPERIMENT 2

Method

Participants. Four graduate students atSouthern Illinois University, who had littleformal education in types of disabilities,participated. All were compensated with a $20gift card to a local electronics store for theirparticipation.

Interobserver agreement. Interobserver agree-ment was calculated in the same mannerdescribed for Experiment 1 for 0% of pre- andposttest probes, 100% of training worksheets,and 100% of written intraverbal final test scores.Agreement was 100% for the training worksheetsand 100% for the final tests.

General procedure. The same procedure usedin Experiment 1 was used for all participants,with the exception that the written intraverbalfinal tests were completed immediately aftercompletion of Unit 3 protocol test probes. Dueto high pretest scores on Unit 2 probes,Participants 28 and 30 completed only theUnit 1 and 3 protocols. Participants 27 and 29completed all three protocols. As was the case inExperiment 1, participants completed one unitprotocol in its entirety in one session.

Results

Vocal intraverbal pretests. Figure 2 shows thatall participants who completed each of the unitprotocols scored in the range of 0% to 42%correct on pretest probes for all of the vocalintraverbal relations.

Table 3

Written Intraverbal Final Test Scores (%) for Experiment 1

Participant


Test 1 Test 2 Test 1 Test 2 Test 1 Test 2

1 25 25 0 03 100 33 100 758 50 339 25 42 75 58 50 33

10 75 1712 50 42 50 33 50 3313 50 50 25 814 75 58 50 3315 75 50 25 50 0 4217 75 5019 50 17 75 83 75 2520 75 3321 0 822 50 25


Selection-based intraverbal training. Table 4shows the number of training trial blocksrequired for each participant to demonstratemastery criterion during training of names ofdisabilities to their definitions (A-B), names ofdisabilities to their primary causes (A-C), andprimary causes to common treatments orservices (C-D) relations. Most participantsrequired only one or two trial blocks to attainmastery criterion in all relations for the unitprotocols in which they participated.

Vocal intraverbal posttests. The B-A, C-A, andD-A vocal intraverbal relations were inferred tohave emerged if a participant performed with92% accuracy. Figure 2 shows the posttestscores for all participants on the B-A (naminga disability when given its definition), C-A(naming a disability when given its primarycause), and D-A (naming a disability when

given a common treatment or service) vocalintraverbal relations in all three unit protocols.Of the four participants who completed theUnit 1 protocol, four demonstrated the emer-gence of the B-A relations, three demonstratedthe emergence of the C-A relations, and twodemonstrated the emergence of the D-Arelations. Of the two participants who com-pleted the Unit 2 protocol, both demonstratedthe emergence of the B-A and C-A relations,and one participant demonstrated the emer-gence of the D-A relations. Of the fourparticipants who completed the Unit 3 proto-col, four demonstrated the emergence of the B-A relations, two demonstrated emergence of theC-A relations, and four demonstrated theemergence of the D-A relations.

Written intraverbal final tests. Scores for FinalTests 1 and 2 are shown for each of the three

Figure 2. Percentage of correct responses before and after test probes for Units 1, 2, and 3 in Experiment 2. The

dotted line represents accuracy level of 92%.


unit protocols in Table 5. For Unit 1, three ofthe four participants scored 100% accuracy onFinal Test 1, and all participants scored at orabove 67% accuracy on Final Test 2. For Unit2, both participants scored 100% accuracy onFinal Test 1; Participant 29 scored 92%accuracy on Final Test 2, and Participant 27scored 75% accuracy on Final Test 2. For Unit 3,three of the four participants scored 100%accuracy on Final Test 1, and all participantsscored at or above 75% accuracy on Final Test 2.

Summary of Experiment 2

These results replicate the findings ofExperiment 1 in that (a) most participantsacquired the selection-based intraverbal rela-tions for all three unit protocols within one ortwo training sessions using the paper-and-pencilformat, and (b) almost all participants demon-strated the emergence of untrained topography-based vocal intraverbal relations followingmastery of the worksheets. Further, participantsin Experiment 2 derived untrained writtenintraverbal relations for all three unit protocolsimmediately after completion of the Unit 3vocal intraverbal test probes. In Experiment 2,scores on final written intraverbal tests were

much higher than those of Experiment 1,indicating that poor final test performances inExperiment 1 were a retention, not generaliza-tion, failure. The results also indicate thattraining selection-based intraverbal relationsmay facilitate the emergence of both vocal andwritten topography-based intraverbal relations.It should be noted that the participants inExperiment 2 were graduate students, whereasthe participants in Experiment 1 were undergrad-uate students. It is possible that the participants inExperiment 2 had richer histories of relatinginstructional stimuli and were thus better preparedto be successful on posttest probes. However,given similarities in the pre- and posttestperformances of participants in both experiments,time of testing is a plausible explanation for thedifferences in final test performance.

DISCUSSION

The present results contribute to the growingbody of literature that underscores the utility ofthe stimulus equivalence paradigm in highereducation. The protocol seems to be useful inillustrating course concepts, emphasizing rela-tions, and expanding repertoires to a variety ofnovel topographies following just a smallamount of teaching. Although the paradigmhas been valuable in teaching a variety of basiclanguage and academic skills in learners withrudimentary repertoires, the present results jointhose of Ninness et al. (2005, 2006, 2009),Fienup et al. (2010), and Fields et al. (2009) inaccentuating the equivalence protocol as ateaching tool with verbally sophisticated learn-

Table 5

Written Intraverbal Final Test Scores for Experiment 2

Participant


Test 1 Test 2 Test 1 Test 2 Test 1 Test 2

27 100 67 100 75 100 7528 75 75 75 8329 100 100 100 92 100 9230 100 92 100 83

Table 4

Training Trial Blocks to Criterion for Units 1, 2, and 3 in Experiment 2

Participant


A-B A-C C-D A-B A-C C-D A-B A-C C-D

27 2 2 2 1 2 2 2 2 228 3 1 2 1 2 129 1 2 2 1 1 1 1 2 130 2 2 2 1 2 1


ers. The protocols used in this and otherexperiments seem to reflect the best practicesin teaching articulated by Skinner (2003), whoargued for the provision of numerous opportu-nities for student feedback and teaching untilmastery.

Not only do the results support the role ofstimulus equivalence protocols in higher edu-cation, but the paper-and-pencil training formatused in this study is a particularly noteworthyinnovation. Superficially, paper-and-pencil pro-tocols are no different from the myriad ofhomework assignments, worksheets, and evalu-ation tools already present in many classrooms(Eikeseth et al., 1997). Moreover, the protocolwas efficient from both learning and instruc-tional standpoints: Most participants masteredthe selection-based intraverbal relations in fewtraining blocks, and little time or effort wasrequired on the part of the experimenter, whoonly needed to read the instructions toparticipants and grade the worksheets. For thisreason, the protocol might easily be imple-mented in small-group learning arrangementsthat are common in many classroom settings.Finally, given the widespread availability ofmaterials, the effects of the paper-and-pencilprotocol in one classroom could be easilyreplicated in another classroom. Because of thesebenefits, future research should continue toexplore the ease with which this protocol can beimplemented in educational settings of any level.

All of the emergent skills demonstrated byparticipants were topography based rather thanselection based. Untrained skills revealed onvocal intraverbal posttests and written intraver-bal final tests all emerged from the simpleselection-based intraverbal training conductedusing the worksheets. Although successfulperformance on multiple-choice exams, whichrequires selection-based responding (Michael,1985), is emphasized in many college courses,this repertoire is arguably not a good represen-tation of the desirable verbal skills that shouldbe aquired in college. Higher education em-

phasizes the development of skills in bothwritten and oral expression. The present resultssuggest that vocal and written intraverbalbehavior can emerge following the establish-ment of selection-based intraverbal relations(see also Chase et al., 1985; Perez-Gonzalez etal., 2008). In addition to reflecting skills inwritten and oral expression, intraverbal re-sponding may also be said to reflect compre-hension of the material (see M. L. Sundberg,2008). Thus, the most noteworthy findings maywell be the performance of the four participantsin Experiment 2 on the written intraverbal finaltests. Critchfield and Fienup (2008, p. 363)describe a learning experience as generative if it‘‘spawns novel abilities.’’ Both final testsrequired considerably more generative behavioron the part of participants than was requiredduring posttests or training; moreover, respond-ing on final tests required a different responsetopography than that which was required at anyother time during the experiment. These resultssuggest that with the stimulus equivalenceparadigm, relatively inexperienced but verballyskilled students are capable of going wellbeyond basic multiple-choice items to masterintricate and comprehensive relations withimpressive competence. It should be noted thatall participants in this study had sophisticatedrepertoires of textual responding or covert orovert responding under the control of text(Skinner, 1957), so a proficient textual reper-toire is an apparent prerequisite for participantsto demonstrate desired outcomes with similarinstructional protocols.

Several limitations merit mention. First,performances on the written intraverbal finaltests for Experiment 1 were not encouraging.Prior research has suggested that derivedstimulus relations may be considerably stableover time (Rehfeldt & Hayes, 2000; Saunders,Wachter, & Spradlin, 1988), even in partici-pants with limited cognitive abilities. Thatparticipants in Experiment 1 performed sopoorly on the written intraverbal tests is


somewhat surprising. However, we did notexamine the long-term stability of the directlytrained selection-based relations or the emer-gent vocal intraverbal relations demonstrated onposttests, so it is uncertain whether theseperformances would have been maintained onthe final tests as well. In addition, participantswho did not show the emergence of the vocalintraverbal relations during posttests did com-plete written intraverbal final tests, so there isno reason to expect that those participantswould have showed retention of the relations.Because most instructors hope that students willretain the information learned in a course wellbeyond the completion of the course, futureresearch should examine the long-term stabilityof relations established via the stimulus equiv-alence protocol in classroom settings. A secondlimitation is the fact that participants’ respond-ing during training could have been controlledby the first few words of each response optiononly. In other words, because the configurationof words and letters was different for thedifferent response options, it is possible that aparticipant could have responded correctly byreading only the first part of each responseoption. Similarly, the order of questions on thetraining worksheets did not differ from onetraining worksheet to the next, so respondingcould have also come under the control of thequestion numbers. It is doubtful that partici-pants would have performed with such highaccuracy on vocal intraverbal posttests andwritten intraverbal final tests (Experiment 2)had this been the case, but future studies shouldstrive for structural similarity when employingphrases as stimuli as well as employ differentversions of worksheets targeting the samerelations in which the questions are presentedin different orders. Third, one might argue thatbecause a single-subject design was not used, thepretest-train/posttest sequence used in thisstudy did not control for plausible threats tointernal validity given that participants inExperiment 1 were completing an undergradu-

ate course on disabilities at the time of theirparticipation. However, all of the participantscompleted the unit protocols prior to anylectures or assigned readings on the particulardisabilities in the course. In addition, the factthat pretests, training, and posttests were allcompleted in one session makes threats tointernal validity (e.g., history and maturation)highly implausible. Fourth, we cannot discernfrom the present results whether the protocolsused in this study would be more effective thanmore conventional educational approaches,including the participation in lecture or com-pletion of study questions. Future researchshould compare the performance of studentswho participate in such protocols to those ofstudents who participate in more conventionalclassroom practices (see Fields et al., 2009).

The construction of the final written in-traverbal tests merits mention. On Final Test 1,students were required to supply the name of adisability (A stimulus) when provided with itsdefinition (B stimulus), primary cause (Cstimulus), and a common treatment or service(D stimulus). Given the presence of the B, C,and D stimuli on Final Test 1, it is possible thatthese stimuli controlled participants’ respond-ing on Final Test 2, on which they had tosupply the definition (B stimulus), primarycause (C stimulus), and a common treatment orservice (D stimulus) when provided with thename of a disability (the A stimulus). Thus,performance on Final Test 2 may have beeninfluenced by the stimuli provided to partici-pants on Final Test 1.

Future research should further examine theefficacy of paper-and-pencil methods for im-plementing stimulus equivalence methods inhigher education by continuing to explore thelong-term stability or retention of verbalrelations established during experimental ses-sions. The stability of both emergent anddirectly trained performances should be exam-ined. In addition, future research shouldcontinue to explore the degree to which


instruction in one repertoire facilitates theemergence of skills in another repertoire.Finally, this study focused on the establishmentof relations of equivalence or sameness only.Relational frame theory (i.e., Hayes, Barnes-Holmes, & Roche, 2001) posits that any varietyof contextually controlled relations may emergevia a history of relating multiple exemplars,including relations of sameness, opposition, andcomparison (e.g., greater than and less than; seeBerens & Hayes, 2007; Ninness et al., 2009).Students are often asked to ‘‘compare andcontrast’’ different aspects of course material, acomplex form of relating that likely involves thederivation of comparative relations. Futureresearch should examine the role of morecomplex stimulus networks in college courses.

REFERENCES

Berens, N. M., & Hayes, S. C. (2007). Arbitrarilyapplicable comparative relations: Experimental evi-dence for relational operant. Journal of AppliedBehavior Analysis, 40, 45–71.

Bowe, F. (2000). Physical, sensory, and health disabilities:An introduction. Upper Saddle River, NJ: PrenticeHall.

Chase, P. N., Johnson, K. R., & Sulzer-Azaroff, B. (1985).Verbal relations within instruction: Are there sub-classes of the intraverbal? Journal of the ExperimentalAnalysis of Behavior, 43, 301–313.

Cowley, B. J., Green, G., & Braunling-McMorrow, D.(1992). Using stimulus equivalence procedures toteach name-face matching to adults with braininjuries. Journal of Applied Behavior Analysis, 25,461–475.

Critchfield, T. S., & Fienup, D. M. (2008). Stimulusequivalence. In S. F. Davis & W. F. Buskist (Eds.),21st century psychology (pp. 360–372). ThousandOaks, CA: Sage.

de Rose, J. C., de Souza, D. G., & Hanna, E. S. (1996).Teaching reading and spelling: Exclusion and stim-ulus equivalence. Journal of Applied Behavior Analysis,29, 451–469.

Eikeseth, S., Rosales-Ruiz, J., Duarte, A., & Baer, D. M.(1997). The quick development of equivalence classesin a paper-and-pencil format through written instruc-tions. The Psychological Record, 47, 275–284.

Fields, L., Travis, R., Yadlovker, E. D., Roy, D., Aguiar-Rocha, L., & Sturmey, P. (2009). Equivalence classformation: A method for teaching statistical interac-tions. Journal of Applied Behavior Analysis, 42,575–593.

Fienup, D. M., Covey, D. P., & Critchfield, T. S. (2010).Teaching brain–behavior relations economically withstimulus equivalence technology. Journal of AppliedBehavior Analysis, 43, 19–33.

Hayes, S. D., Barnes-Homes, D., & Roche, B. (2001).Relational frame theory: A post-Skinnerian account ofhuman language and cognition. New York: Kluwer/Academic Plenum.

Melchiori, L. E., de Souza, D. G., & de Rose, J. C.(2000). Reading, equivalence, and recombination ofunits: A replication with students with differentlearning histories. Journal of Applied Behavior Analysis,33, 97–100.

Michael, J. (1985). Two kinds of verbal behavior and apossible third. The Analysis of Verbal Behavior, 3,2–5.

Ninness, C., Barnes-Holmes, D., Rumph, R., McCuller,G., Ford, A. M., Payne, R., et al. (2006).Transformations of mathematical and stimulusfunctions. Journal of Applied Behavior Analysis, 39,299–321.

Ninness, C., Dixon, M., Barnes-Holmes, D., Rehfeldt, R.A., Rumph, R., McCuller, G., et al. (2009).Constructing and deriving reciprocal trigonometricrelations: A functional analytic approach. Journal ofApplied Behavior Analysis, 42, 191–208.

Ninness, C., Rumph, R., McCuller, G., Harrison, C.,Ford, A. M., & Ninness, S. K. (2005). A functionalanalytic approach to computer-interactive mathe-matics. Journal of Applied Behavior Analysis, 38,1–22.

Perez-Gonzalez, L. A., Herszlikowicz, K., & Williams, G.(2008). Stimulus relations analysis and the emergenceof novel intraverbals. The Psychological Record, 58,95–129.

Rehfeldt, R. A., & Hayes, L. J. (2000). The long-termretention of generalized equivalence classes. ThePsychological Record, 50, 405–428.

Rosales, R., & Rehfeldt, R. A. (2007). Contrivingtransitive conditioned establishing operations toestablish derived manding skills in adults with severedevelopmental disabilities. Journal of Applied BehaviorAnalysis, 40, 105–121.

Saunders, R. R., Wachter, J., & Spradlin, J. E. (1988).Establishing auditory stimulus control over an eight-member equivalence class via conditional discrimina-tion procedures. Journal of the Experimental Analysis ofBehavior, 49, 95–115.

Sidman, M. (1971). Reading and auditory-visual equiv-alences. Journal of Speech and Hearing Research, 14,5–13.

Sidman, M., & Cresson, O. (1973). Reading and crossmodal transfer of stimulus equivalences in severeretardation. American Journal of Mental Deficiency,77, 515–523.

Skinner, B. F. (1957). Verbal behavior. Englewood Cliffs,NJ: Prentice Hall.

Skinner, B. F. (2003). The technology of teaching. Acton,MA: Copley.


Smeets, P. M., Dymond, S., & Barnes-Holmes, D.(2000). Instructional stimulus equivalence and stim-ulus sorting effects of sequential testing arrangementsand default option. The Psychological Record, 50,339–350.

Sundberg, C. T., & Sundberg, M. L. (1990). Comparingtopography-based verbal behavior with stimulusselection-based verbal behavior. The Analysis of VerbalBehavior, 8, 31–41.

Sundberg, M. L. (2008). The verbal behavior milestonesassessment and placement program. Concord, CA: AVBPress.

Received July 22, 2009Final acceptance, January 29, 2010Action Editor, Anna Pettursdottir

APPENDIX A

Multiple-Choice Training Worksheet for A-BRelations in the Unit 1 Protocol

Each question was presented three times on aworksheet in a randomly determined order. Theorder of the response options was also randomlydetermined and differed from one question tothe next for a given relation.

1.) Define cerebral palsya. Failure of the spinal cord to close com-

pletelyb. Incomplete control of the body’s musclesc. Progressive weakness and deterioration of

musclesd. Condition in which the body attacks the

central nervous system

2.) Define muscular dystrophya. Incomplete control of the body’s musclesb. Failure of the spinal cord to close com-

pletelyc. Condition in which the body attacks the

central nervous systemd. Progressive weakness and deterioration of

muscles

3.) Define spina bifidaa. Failure of the spinal cord to close com-

pletelyb. Progressive weakness and deterioration of

musclesc. Condition in which the body attacks the

central nervous systemd. Incomplete control of the body’s muscles

4.) Define multiple sclerosisa. Condition in which the body attacks the

central nervous system

b. Incomplete control of the body’s musclesc. Progressive weakness and deterioration of

musclesd. Failure of the spinal cord to close

completely

APPENDIX B

Multiple-Choice Training Worksheet for A-CRelations in the Unit 2 Protocol


1.) What causes muscular dystrophy?a. Oxygen deprivation in the brainb. Insufficient supply of a required proteinc. Causes unknownd. Folic acid insufficiencies during pregnancy

2.) What causes cerebral palsy?a. Causes unknownb. Oxygen deprivation in the brainc. Insufficient supply of a required proteind. Folic acid insufficiencies during pregnancy

3.) What causes spina bifida?a. Insufficient supply of a required proteinb. Causes unknownc. Oxygen deprivation in the braind. Folic acid insufficiencies during pregnancy

4.) What causes multiple sclerosis?a. Folic acid insufficiencies during pregnancyb. Causes unknownc. Oxygen deprivation in the braind. Insufficient supply of a required protein


APPENDIX C

Multiple-Choice Training Worksheet for C-DRelations in the Unit 3 Protocol


1.) How do you treat a disability for whichcauses are unknown?

a. Positioning aids, environmental controlsb. Diet supplementation, prenatal surgeryc. Medication, air conditioningd. Experimental research

2.) How do you treat a disability caused byoxygen deprivation in the brain?

a. Diet supplementation, prenatal surgeryb. Positioning aids, environmental controlsc. Medication, air conditioningd. Experimental research

3.) How do you treat a disability caused byfolic acid insufficiencies during pregnancy?

a. Positioning aids, environmental controlsb. Experimental researchc. Diet supplementation, prenatal surgeryd. Medication, air conditioning

4.) How do you treat a disability caused byinsufficient supply of a required protein?

a. Medication, air conditioningb. Positioning aids, environmental controlsc. Diet supplementation, prenatal surgeryd. Experimental research

APPENDIX D

Final Test 1

1.) Susan has incomplete control of herbody’s muscles, which was caused byoxygen deprivation in her brain and isusing positioning aids and environmen-tal controls to treat her disability. Whatdisorder does she have?

2.) Samantha’s spinal cord is not closedcompletely due to folic acid insufficien-cies. To decrease the chances of herchildren being born with the samedisability, she is taking dietary supple-ments. What disorder does she have?

3.) Thomas has a condition where his bodyattacks his CNS, and professionals areunsure of what causes this condition.However, his doctors recommend med-ication and air conditioning for treat-ment. What disorder does he have?

4.) Samuel has a condition where he experi-ences progressive weakness and deteriora-tion of his muscles caused by an insuffi-cient supply of a required protein. Hismother had considered gene therapyduring pregnancy, however decidedagainst it due to it being highly experi-mental. What disorder does he have?

5.) Nicholas has a condition where his bodyis unable to produce a certain type ofprotein, which was caused by a defectiverecessive gene and is treating his condi-tion through the use of anti-inflamma-tory treatments, drugs, and a specializeddiet. What disorder does he have?

6.) Leah has a disorder of the oxygen-transporting cells, which she geneticallyinherited from her parents and can oftenbe prevented through prenatal screeningand vaccinations. What disorder does shehave?

7.) Bianca’s blood pressure is constantlyelevated due to the narrowing of herarteries and fat build-up. Her doctor hasprescribed her medication and recom-mended she exercise regularly to treat hercondition or else she may need surgery ifher condition worsens. What disorderdoes she have?

8.) Dennis is unable to produce insulin dueto destruction of beta cells in hispancreas. He now uses injections to treathis condition and closely monitors his


blood sugar. Dennis encourages his son toeat a healthy diet and exercise routinely toprevent him from acquiring this condi-tion. What disorder does he have?

9.) Sabrina has lost her ability to carry outlearned movement due to neurologicaldamage. She now practices repetitivemotor drills and receives behavior ther-apy to treat her condition. What disor-der does she have?

10.) Tyler has a chronic, severe, and disablingmental disorder caused by a combina-tion of genetic predisposition and envi-ronmental stressors. To treat this condi-tion, he takes antipsychotic medicationand receives psychosocial treatment.What disorder does he have?

11.) Carson has a progressive neurologicaldisease of the brain caused by build-upof proteins in the brain and now receivesemotional and medical support. Whatdisorder does she have?

12.) Mimi experienced a severe loss of hercognitive ability due to a disease in her

nervous system or blood vessels. Herdoctor now encourages her to eat ahealthy diet and use memory aids. Whatdisorder does she have?

APPENDIX E

Final Test 2List and describe the (a) definition, (b)

primary cause, and (c) treatment for thefollowing disabilities:

1.) Cerebral palsy2.) Spina bifida3.) Multiple sclerosis4.) Muscular dystrophy5.) Cystic fibrosis6.) Sickle-cell disease7.) Hypertension8.) Diabetes9.) Apraxia

10.) Schizophrenia11.) Alzheimer’s disease12.) Dementia


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