1007561

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RPSXXX10.1177/15407969211007561Research and Practice for Persons with Severe DisabilitiesClausen et al.

Article
Research and Practice for Persons

A Systematic Review of Modified

with Severe Disabilities
1­–14
© The Author(s) 2021
Schema-Based Instruction for Teaching Article reuse guidelines:
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Students with Moderate and Severe DOI: 10.1177/15407969211007561
https://doi.org/10.1177/15407969211007561
rpsd.sagepub.com
Disabilities to Solve Mathematical
Word Problems

Amy M. Clausen1 , Melissa C. Tapp1 , Robert C. Pennington1,

Fred Spooner1, and Annette Teasdell1

Abstract
Modified schema-based instruction (MSBI) is a strategy to teach mathematical word problem solving to
students with moderate and severe disabilities (MSD). In this comprehensive review, we explore the
current state of research on MSBI to determine whether MSBI is an evidence-based practice (EBP) for
students with MSD. We reviewed 12 studies, of which 11 met quality standards. Thirty-nine participants,
all of whom participated in statewide alternate assessments, were included in these studies, the majority
of whom were middle school students with intellectual disability. Four research teams explicitly targeted
state content standards. The researcher served as interventionist in 82% of the studies. Although the
overall effect size was very large (1.0 Tau), our findings suggest that MSBI is not yet an EBP for students
with MSD. We provide an overview of current contextual factors and suggestions for future researchers
to continue the investigation of MSBI.

Keywords
evidence-based practices, moderate and severe disabilities, mathematical problem solving, modified
schema-based instruction

Evidence-based practices (EBPs) are interventions, procedures, or programs that have been evaluated by
multiple research teams and found to be effective for a specific population (Horner & Kratochwill, 2012).
The identification of EBPs is crucial for students with moderate and severe disabilities (MSD), as these
students require more intense intervention and additional time to learn skills compared with their peers
without disabilities (Browder et al., 2020). When EBPs are not used, time and money is wasted on the
implementation of ineffective practices, leading to caregiver, instructor, and student frustration (Agran
et al., 2017). In addition, some non-evidence-based practices may put students at risk for harm, injury, or
death (e.g., facilitated communication, restraint; Jacobson et al., 2005; Rakhmatullina et al., 2013).
Although it is clear that EBPs for students with MSD are needed, there is some debate among research-
ers about the best method for identifying these practices. For example, in 2005, Horner et al. proposed

1
University of North Carolina at Charlotte, USA

Corresponding Author:
Amy M. Clausen, Department of Special Education and Child Development, University of North Carolina at Charlotte, Cato
College of Education, 8838 Craver Rd. Office 307, Charlotte, NC, 28223, USA.
Email: aclause1@uncc.edu
2 Research and Practice for Persons with Severe Disabilities 00(0)

standards for single-case studies and Gersten et al. for group experimental studies. Subsequently, the What
Works Clearinghouse (WWC, 2020) and the Council for Exceptional Children (CEC; Cook et al., 2014)
developed similar, yet unique, sets of standards for the identification of EBPs based on these seminal arti-
cles. For the purpose of this review, we will use the standards set by Horner et al. (2005) for two reasons.
First, the Horner et al. standards are more stringent than WWC and CEC when considering both the number
of studies required as well as the necessity for those studies to be conducted by multiple research teams
from multiple geographic locations. This higher standard is especially relevant given the criticism that
single-case research often involves too few participants to demonstrate widespread generality and strong
external validity (Horner & Kratochwill, 2012; Ledford & Gast, 2018). Secondly, as the purpose of this
review is to potentially identify additional EBPs for students with MSD, it is important to use the same set
of standards used in previous EBP reviews for this population of students (e.g., Apanasionok et al., 2018;
Browder et al., 2008; Hudson & Test, 2011; Spooner et al., 2019).
One particular area that is lacking a comprehensive set of EBPs is teaching mathematics to students with
MSD. In 2008, Browder et al. identified in vivo instruction, systematic instruction, and opportunities to
respond as EBPs for teaching mathematics to students with MSD. Spooner et al. (2019) extended this initial
examination, reviewing 36 studies published between 2005 and 2016. Although they identified four addi-
tional EBPs (technology-aided instruction, graphic organizers or heuristics, manipulatives, and explicit
instruction), the investigation was broad and did not focus on any particular component of mathematics
instruction. For example, only five studies addressed mathematical problem solving. Competence in math-
ematical problem solving is necessary for individuals with MSD to become independent adults as problem
solving is required across domains, including in the workplace, when making financial decisions, in leisure
activities, and more (Spooner, Saunders, et al., 2017).
To extend the identification of EBPs in teaching mathematical skills to students with MSD, Spooner
et al. (2019) recommended researchers investigate EBPs that have been identified for students with high-
incidence disabilities, such as learning disabilities, and consider possible modifications to make them
appropriate for students with MSD. One mathematical problem solving EBP for students with high-inci-
dence disabilities is schema-based instruction (SBI; Jitendra et al., 2015). SBI is a cognitive-based strategy
for solving word problems which incorporates heuristics, explicit instruction, and self-monitoring and helps
students identify the type of schema represented by a word problem so they may select the appropriate
problem solving strategy to solve it. The two main types of mathematical schemas are additive and multi-
plicative. Within the additive schema, there are change (i.e., increasing or decreasing the quantity of same
items), combine (i.e., putting two groups of objects together; part-part-whole), and compare (i.e., determin-
ing the difference between two sets of objects) problem types. Within the multiplicative schema, there are
equal groups (i.e., rate), comparison (i.e., multiplying a set by a number), and proportion (e.g., ratio, per-
centages) problem types (Powell & Fuchs, 2018).
Although SBI is a promising method to teach mathematical problem solving to students with high-inci-
dence disabilities, students with MSD may require modifications when using this approach, due to charac-
teristics such as limited communication and literacy repertoires, poor working memory, and overall
difficulties with mathematics (Browder et al., 2013; Spooner, Saunders, et al., 2017). These barriers led
Spooner and colleagues (2019) to modify the four essential components of SBI (i.e., schemas, heuristics,
explicit instruction, and metacognitive strategy instruction) to increase the accessibility to students with
MSD. In modified schema-based instruction (MSBI), color-coded graphic organizers are used to supple-
ment schemas and task analyses replace heuristics to better support the students’ procedural understanding
of the problem. In addition, systematic instruction (e.g., system-of-least prompts) is added to explicit
instruction (i.e., “model-lead-test”) to support student responding, and self-monitoring, the use of chants
and hand motions, and modeling think-alouds are used to enhance metacognitive strategy instruction.
While MSBI incorporates multiple strategies identified by Spooner et al. (2019) as EBPs for students
with MSD (e.g., systematic instruction, graphic organizers, explicit instruction), researchers have yet to
investigate whether MSBI is an EBP for students with MSD. At the time of the 2019 review, there had been
only one published study investigating MSBI (i.e., Root, Browder, et al., 2017). The purpose of this review
was to answer the following research questions:
Clausen et al. 3

Figure 1. PRISMA flowchart.

Note. Flowchart adapted from PRISMA 2009 diagram (Moher et al., 2009).

1. Is MSBI an EBP to teach mathematical problem solving to students with MSD?

2. What are the characteristics of students for whom MSBI has been effective?
3. To what extent has MSBI been used to address standards-based, grade-aligned skills?

Method
Search Procedures
We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA; Moher
et al., 2009) guidelines and identified articles and dissertations through database searching and from addi-
tional sources (see Figure 1). We searched four databases: Academic Search Complete, ERIC, PsycINFO,
and Proquest Dissertations and Theses Global. Search terms were “modified schema based instruction”;
“schema based instruction” AND (severe disabilit* OR autis* OR intellectual disabilit* OR moderate dis-
abilit* OR cognitive disabilit* OR extensive support needs); and (“problem solving” AND math) AND
4 Research and Practice for Persons with Severe Disabilities 00(0)

(severe disability* OR autis* OR intellectual disabilit* OR moderate disabilit* OR cognitive disabilit* OR

extensive support needs). We chose the listed disability-related search terms based on Browder et al.’s
(2020) recommended terminology for students with severe disabilities. Next, we consulted with an expert
in the field and received additional articles currently under review (Root, personal communication, April 7,
2020). Finally, we reviewed the reference lists of all included articles to ensure that no relevant manuscripts
were omitted.

Inclusion Criteria
Initial screening involved evaluating titles and abstracts to determine whether the research was experimen-
tal, included participants with MSD, and targeted mathematical skills as dependent variables. Next, we
conducted an in-depth review of each article that met abstract review criteria and narrowed our inclusion
criteria to articles which investigated the implementation of MSBI with students with MSD. As MSBI is a
relatively new concept, an in-depth review of interventions was necessary to ensure that no relevant studies
were excluded. Studies were included if the independent variable was MSBI, SBI, or included all four com-
ponents (i.e., graphic organizers representing word problem schemas; task analysis; use of explicit and
systematic instruction; and use of metacognitive instruction including a self-monitoring checklist, problem
solving rules, and scripted think-aloud).
We evaluated each study to ensure at least one participant met our criteria of “MSD” by using the fol-
lowing definitions: (a) reported IQ less than 55 and adaptive scores 3 or more standard deviations below the
mean, (b) participation in alternate assessment, or (c) reported exceptionality of moderate or severe intel-
lectual disability (ID). Students with the primary exceptionality of autism were included only if they met
one of the criteria listed. Studies which included only participants with mild ID were excluded. In the case
where some, but not all participants met the criteria for MSD, we still included the study in this review, but
only considered the relevant participants in our analysis.

Coding Procedures
We coded articles using the quality indicator (QI) guidelines set forth by Horner et al. (2005). The first two
authors coded all articles for the 21 QIs across seven variables: (a) participants and setting, (b) dependent
variable, (c) independent variable, (d) baseline procedures, (e) experimental control/internal validity, (f)
external validity, and (g) social validity. We followed visual analysis guidelines set forth by Ledford and
Gast (2018) to identify whether a functional relation was present between MSBI and students’ problem
solving skills. Keeping consistent with similar EBP reviews (e.g., Hudson & Test, 2011; Root, Stevenson,
et al., 2017; Spooner et al., 2019), we evaluated the quality of individual studies using National Technical
Assistance Center on Transition (NTACT, 2016) guidelines. We rated a study as high quality if it met all 21
indicators, acceptable quality if it met the first 17 QIs plus at least one social validity indicator, or not qual-
ity if the study did not meet the first 17 QIs.
In addition, we coded all studies that met the inclusion criteria for instructional variables by study char-
acteristics, participant, and context. We examined each study’s design, dependent variables, generalization
measures, change agents, setting, and mathematical problem type. Variables specific to each participant and
context included age, grade, disability, gender, race, school type, setting, and mathematical standards tar-
geted. After coding these variables, we evaluated the results to identify patterns. The coding spreadsheet is
available upon request from the first author.

Effect Size
Instituting a process for calculating effect size estimates for single-case designs is essential to the develop-
ment of meta-analysis, systematic reviews, and the documentation of EBPs (Horner & Kratochwill, 2012).
We calculated effect size for each participant using the Tau-U calculator, available on singlecaseresearch.
org (Vannest et al., 2016). While there is substantial debate as to the appropriateness of effect size measures
for single-case studies and which to use (Horner & Kratochwill, 2012), we chose to remain consistent with
Clausen et al. 5

previous EBP reviews which investigated mathematics interventions for students with MSD (e.g., Spooner
et al., 2019) and used the Tau-U method.
The first author extracted raw baseline and intervention data from the studies that were rated high or
acceptable quality and calculated effect size for each participant. Five studies (Browder et al., 2018; Ley
Davis, 2016; Root et al., 2019; Root, Saunders, et al. 2017; Saunders, 2014) investigated the impact of
MSBI on multiple schemas (e.g., change, combine, group) or across multiple operations (e.g., addition,
subtraction). Based on the nature of these multiphased interventions, we consulted an expert on the approri-
ate way to calculate these effect sizes (K. Vannest, personal communication, September 23, 2020). Supported
by that conversation, we calculated the effect size for each schema (e.g., change schema data in baseline
compared with change schema data in the intervention phase) and then combined all the effect sizes for each
data path to calculate one overall effect size for each participant. We followed established guidelines for
interpreting effect size, with .2 representing a small effect, .2 to .6 representing a moderate effect, .6 to .8 a
large effect, and larger than .8 a large to very large effect (Vannest & Ninci, 2015).

Criteria for Identifying Evidence-Based Practices

After coding the studies for adherence to quality indicators (QIs), we evaluated our findings to determine
whether MSBI is an EBP to teach mathematical problem solving to students with MSD. We matched the
variables coded to determine whether each study met Horner et al.’s (2005) original requirements that (a)
the practice is operationally defined, (b) the context and outcomes associated with a practice are clearly
defined, (c) the practice is implemented with documented fidelity, and (d) the practice is functionally related
to a change in valued outcomes. We then evaluated the practice against Horner et al.’s quantity and disper-
sion guidelines that the practice is implemented (a) in five high or acceptable quality studies, (b) with three
different research teams, (c) in three geographical regions, and (d) with at least 20 participants.

Interrater Reliability
The second author independently coded abstracts of 33% (n =128) of the articles found in the database
search to check for agreement for initial inclusion criteria. Next, she coded 33% (n = 15) of articles included
in the initial review to check for agreement for inclusion in the analysis. Finally, she coded 50% (n = 6) of
the included articles using single-case QIs (Horner et al., 2005) and determined the presence of a functional
relation (i.e., QI #16) using the visual analysis standards set forth by Ledford and Gast (2018). We calcu-
agreements
×100
lated interrater reliability using the point-by-point agreement formula: agreements + disagreements
(Ledford and Gast, 2018). Interrater reliability was 98.4% for initial inclusion criteria, 93.3% for analysis
inclusion, 99.2% for QIs, and 100% for visual analysis.

Results
Outcomes of Literature Review
We found 1,356 results in the initial search of the identified databases. An expert in the field provided a list
of 23 additional records (J. Root, personal communication, April 7, 2020). We reviewed the included cita-
tions and removed duplicates which resulted in 384 unique results. The first author screened titles and
abstracts using the eligibility criteria listed in the methods section and excluded 338 studies. Next, the first
author reviewed the remaining 46 studies and assessed the full text for eligibility. Twelve studies were
included for analysis (see Figure 1).

Determining Quality of Included Studies

All 12 studies used single-case methods, and a functional relation was present in each (see Supplemental
Table 1). Of these 12, all but one (Brosh et al., 2018) study met the criteria set forth by NTACT (2016) for
6 Research and Practice for Persons with Severe Disabilities 00(0)

acceptable quality (see Supplemental Table 2). While Brosh et al. (2018) did meet quality criteria when
reviewed as a complete manuscript, only one participant in their multiple-baseline study had moderate ID.
We followed guidance set by the National Autism Center (NAC, 2009) and reviewed the study looking at
only the eligible participant, which was interpreted as an AB design; thus, experimental control was not
demonstrated and consequently the study was excluded from this review. The remaining 11 acceptable qual-
ity studies met between 17 and 20 QIs (out of 21), with all studies missing one to three social validity
indicators.
Next, we looked for patterns in absent QIs. None of the studies included information about whether the
independent variable was practical or cost effective. In only three studies was social validity enhanced
through the implementation of MSBI by typical intervention agents or in typical physical contexts (Brosh,
2018; Browder et al., 2018; Ley Davis, 2016). Finally, only one research team (Root et al., 2019) did not
report whether the magnitude of change in student problem solving as a result of the MSBI intervention was
socially important.

Participant Characteristics in Quality Studies

A total of 39 students were included in the 11 reviewed studies. Students ranged in age from 7 to 21 years
(M = 12.77). Thirteen students were in elementary school (i.e., Grades 1–5), and 22 were in middle school
(i.e., Grades 6–8). One student was in high school (i.e., Grades 9–12), and three were enrolled in a special-
ized transition program for students aged 18 to 22.
Twenty-five students (64.1%) were identified as having a moderate ID. Intellectual disability severity
was not reported for the remaining 14 students. Seventeen students (43.59%) received services under the
Individuals with Disabilities Education Act (IDEA) category of autism. Twenty-one students (53.85%)
were male and 18 (46.15%) were female. Twenty-two students (56.41%) were White, 10 (25.64%) were
Black, six (15.38%) were Hispanic/Latinx, and one (2.56%) was Middle Eastern. No students were of Asian
and Pacific Islander descent. Participant characteristics are summarized in Table 1.

Context of MSBI in Quality Studies

All 11 studies were conducted in public schools. One study (Gilley et al., 2020) took place in a specialized
setting on a community college campus for students aged 18 to 22 which was an extension of the local
public school district. All students received the majority of their academic instruction (i.e., more than 80%
of the day) in a self-contained special education classroom.
The intervention took place in the special education classroom in 27% (n = 3; Brosh, 2018; Browder
et al., 2018; Saunders, 2014) of studies. The remaining seven studies took place in alternate separate set-
tings (e.g., hallway, empty classroom; Gilley et al., 2020; Ley Davis, 2016; Root & Browder, 2019; Root
et al., 2018, 2019, 2020; Root, Browder, et al., 2017; Root, Saunders, et al., 2017). No studies took place in
the general education classroom or community. All sessions were conducted in a one-on-one format.
The researcher was the change agent in 82% of studies (n = 9; Brosh, 2018; Gilley et al., 2020; Root &
Browder, 2019; Root et al., 2018, 2019, 2020; Root, Browder, et al., 2017; Root, Saunders, et al., 2017;
Saunders, 2014). A classroom teacher implemented the intervention in only one study (Browder et al.,
2018). In addition, Ley Davis (2016) taught peer tutors to implement the intervention. The contextual fac-
tors are summarized in Table 2.

Mathematical Skills Addressed in Quality Studies

Seven research teams targeted additive schemas (Brosh, 2018; Browder et al., 2018; Ley Davis, 2016;
Root & Browder, 2019; Root, Browder, et al., 2017; Root, Saunders, et al., 2017; Saunders, 2014). The
remaining four teams targeted multiplicative schemas (Gilley et al., 2020; Root et al., 2018, 2019, 2020).
Four research teams (Root & Browder, 2019; Root et al., 2018, 2019; Root, Browder, et al., 2017) reported
alignment of the targeted mathematical skills to state standards. The standards, which come from the
 Table 1. Participant Characteristics in High and Adequate Quality Studies.

Root & Root, Root,

Brosh Browder Gilley et al. Ley Davis Browder Browder, Root et al. Root et al. Root et al. Saunders, Saunders
Characteristic (2018) et al. (2018) (2020) (2016) (2019) et al. (2017) (2018) (2019) (2020) et al. (2017) (2014)
Grade band
Elementary 3 4 0 0 0 3 0 0 0 0 3
Middle 0 4 0 4 3 0 2 3 3 3 0
High 0 0 0 0 0 0 1 0 0 0 0
Transition 0 0 3 0 0 0 0 0 0 0 0
Gender
Female 1 5 2 2 3 0 1 3 1 3 0
Male 2 3 1 2 0 3 2 0 2 0 3
Race
Black 0 3 1 1 0 0 0 2 3 0 0
Hispanic/Latinx 1 1 0 1 0 1 0 0 0 1 1
Middle Eastern 0 1 0 0 0 0 0 0 0 0 0
White 2 3 2 2 3 2 3 1 0 2 3
Exceptionalitya
Moderate ID 1 8 0 4 3 3 0 1 1 3 3
ASD with ID 0 0 1 1 3 3 3 1 1 0 3

Note. Numbers represent number of participants in each study who fit the demographic criteria. ID = intellectual disability; ASD = autism spectrum disorder.
a
A student may be counted both as Moderate ID and ASD with ID.

7
8 Research and Practice for Persons with Severe Disabilities 00(0)

Table 2. Content and Context of MSBI in High and Acceptable Quality Studies.

School Intervention Change Number of Effect size

Article setting setting agent participants (Tau-U)
Brosh (2018) PU SC R 3 1.000
Browder et al. (2018) PU SC T 8 0.996
Gilley et al. (2020) PU, S Alt R 3 1.000
Ley Davis (2016) PU Alt P 4 1.000
Root and Browder (2019) PU Alt R 3 1.000
Root, Browder, et al. (2017) PU Alt R 3 1.000
Root et al. (2018) PU Alt R 3 1.000
Root et al. (2019) PU Alt R 3 1.000
Root et al. (2020) PU Alt R 3 1.000
Root, Saunders, et al. (2017) PU Alt R 3 1.000
Saunders (2014) PU SC R 3 1.000

Note. MSBI = modified schema-based instruction; PU = public; S = specialized setting; SC = self-contained classroom;
Alt = alternate setting (e.g., hallway, empty classroom); R = researcher; T = classroom teacher; P = peer tutors.

Common Core State Standards for Mathematics (CCSSM; National Governors Association Center for
Best Practices, Council of Chief State School Officers, 2010), spanned seven grades (second grade to high
school) and addressed five mathematical domains (number and operations in base ten; operations and
algebraic thinking; expressions and equations; ratios and proportional relationships; algebra: reasoning
with equations and inequalities; see Table 3).
Of the 11 studies reviewed, 10 included participant pre-screening measures to assess participants’
prior mathematics knowledge. In seven studies, researchers assessed participants’ numeracy skills prior
to inclusion (e.g., number identification, making sets of quantities, one-to-one correspondence, and rote
counting; Brosh, 2018; Browder et al., 2018; Ley Davis, 2016; Root & Browder, 2019; Root, Browder,
et al., 2017; Root, Saunders, et al., 2017; Saunders, 2014). The remaining three studies required knowl-
edge of more complex mathematical skills, including identifying prices (e.g., $2.78); identifying and
drawing shapes; transferring numbers to a calculator; solving addition, subtraction, and multiplication
problems on a calculator; and identifying and describing the purpose of receipts and coupons (Root et al.,
2018, 2019, 2020).

Effect Size
Effect sizes were calculated for each participant, aggregated by study, and then for the entire intervention.
Every participant but one (Tom; Browder et al., 2018) had no overlap between baseline and intervention
data. Tau-U for participants ranged from 0.9474 to 1.0. Effect sizes for studies ranged from 0.9962 to 1.0
(see Table 2). Tau for MSBI overall is 1.0, with a confidence interval of 95% between 0.9235 and 1.0 and a
p value less than .0000, representing a very large effect size.

Determination of Evidence-Based Practice

Horner et al. (2005) provided five standards for determining whether a practice is evidence-based. The
first requires the practice to be operationally defined. All articles included in this study implemented
MSBI as defined by Spooner, Saunders, et al. (2017). The second requires that studies report clear con-
textual information (i.e., does MSBI work, for whom, by whom, and under which conditions?). All stud-
ies included relevant contextual information (see Tables 1 and 2). The third standard requires that all
studies report fidelity of implementation. All studies included in this review reported implementation
fidelity across an average of 51.2% of sessions (range = 33%–100%) and with an average of 98.7%
accuracy (range = 75%–100%). The fourth standard requires the intervention to be functionally related
Clausen et al. 9

Table 3. Targeted Standards Reported by Research Teams.

Article Common core state standard for mathematics

Root, Browder, 2.NBT.B.7: Add and subtract within 1,000, using concrete models or drawings and
et al. (2017) strategies based on place value, properties of operations, and/or the relationship
between addition and subtraction; relate the strategy to a written method. Understand
that in adding or subtracting three-digit numbers, one adds or subtracts hundreds and
hundreds, tens and tens, ones and ones; and sometimes it is necessary to compose or
decompose tens or hundreds.
Root, Browder, 2.OA.A.1: Use addition and subtraction within 100 to solve one- and two-step word
et al. (2017) problems involving situations of adding to, taking from, putting together, taking apart,
and comparing, with unknowns in all positions, e.g., by using drawings and equations
with a symbol for the unknown number to represent the problem.
Root, Browder, 3.OA.D.8: Solve two-step word problems using the four operations. Represent these
et al. (2017) problems using equations with a letter standing for the unknown quantity. Assess the
reasonableness of answers using mental computation and estimation strategies including
rounding.
Root, Browder, 4.OA.A.3: Solve multistep word problems posed with whole numbers and having
et al. (2017) whole-number answers using the four operations, including problems in which
remainders must be interpreted. Represent these problems using equations with a
letter standing for the unknown quantity. Assess the reasonableness of answers using
mental computation and estimation strategies including rounding.
Root and 6.EE.B.6: Use variables to represent numbers and write expressions when solving a
Browder real-world or mathematical problem; understand that a variable can represent an
(2019) unknown number, or, depending on the purpose at hand, any number in a specified set.
Root et al. 6.RP.A.3.C: Find a percent of a quantity as a rate per 100 (e.g., 30% of a quantity means
(2019) 30/100 times the quantity); solve problems involving finding the whole, given a part and
the percent.
Root et al. 7.RP.A.3: Use proportional relationships to solve multistep ratio and percent problems.
(2019) Examples: simple interest, tax, markups and markdowns, gratuities and commissions,
fees, percent increase and decrease, percent error.
Root and 7.EE.B.4: Use variables to represent quantities in a real-world or mathematical problem,
Browder and construct simple equations and inequalities to solve problems by reasoning about
(2019) the quantities.
Root et al. HSA.REI.A.1: Explain each step in solving a simple equation as following from the equality
(2018) of numbers asserted at the previous step, starting from the assumption that the original
equation has a solution. Construct a viable argument to justify a solution method.

Note. Common Core State Standards for Mathematics (National Governors Association Center for Best Practices, Council of
Chief State School Officers, 2010). NBT = Number & Operations in Base Ten; OA = Operations & Algebraic Thinking;
EE = Expressions & Equations; RP = Ratios & Proportional Relationships; HSA.REI = High School Algebra: Reasoning with
Equations & Inequalities.

to the outcomes; a functional relation was reported in each included study (see Supplemental Table 1).
Finally, the fifth standard requires that the intervention has been implemented in five high or acceptable
quality studies, with three different research teams in three geographical regions, with at least 20 partici-
pants (i.e., the 5, 3, 20 rule). In this review, we found that there were 11 studies with 39 participants. All
studies took place in the Southeast region of the United States. In addition, of the 11 studies, one researcher
(i.e., Root) was a member of the research team for eight manuscripts (Browder et al., 2018; Gilley et al.,
2020; Root & Browder, 2019; Root et al., 2018, 2019, 2020; Root, Browder, et al., 2017; Root, Saunders,
et al., 2017). Spooner was a member of the research team for the remaining three studies, all of which
were dissertations, in addition to participating in two of the studies with Root (Brosh, 2018; Browder et
al., 2018; Ley Davis, 2016; Root, Saunders et al., 2017; Saunders, 2014). Based on these criteria, addi-
tional studies conducted by unique research teams are needed prior to fully establishing MSBI as an EBP
for students with MSD.
10 Research and Practice for Persons with Severe Disabilities 00(0)

Discussion
The primary purpose of this comprehensive review was to determine whether MSBI is an EBP for teaching
mathematical problem solving to students with MSD. We located 12 studies in which students with MSD
learned to solve mathematical word problems through the implementation of MSBI. Eleven studies met
quality standards set forth by Horner et al. (2005) and NTACT (2016), with 39 students participating. A
functional relation was present in each study, with all participants making significant gains, as demonstrated
by the visual analysis and strong effect sizes. At this time, all studies investigating MSBI with students with
MSD have been conducted in two states, North Carolina and Florida, by overlapping research teams.
Based on the 5-3-20 criteria set by Horner et al. (2005), we cannot yet establish MSBI as an EBP for this
population of students. However, research to date suggests that MSBI has been effective for students with
MSD and warrants further investigation with additional participants and research teams from geographical
regions outside the southeast United States. As no other strategies have yet been established to teach math-
ematical problem solving for students with MSD, practitioners should feel confident that the available
research evidence indicates MSBI is a promising practice.
We also explored the characteristics of participants for whom MSBI interventions have been successful.
Most participants were enrolled in middle school (56.4%, n = 22) or elementary school (33.3%, n = 13).
MSBI has been investigated with only four high school or transition age students with MSD. In addition,
most participants were identified as having a moderate ID (64.1%, n = 25), with the remaining not specify-
ing ID severity. While this lack of information is not surprising as increasingly researchers have shifted
from using the descriptors “moderate” or “severe” intellectual disability (i.e., based on a student’s intelli-
gence quotient [IQ] or adaptive behavior score) to using terms such as “extensive support needs” or “com-
plex communication needs” to describe their participants in terms of supports required to maximize success
(e.g., Root et al., 2019), it is important to note that we do not yet have evidence that MSBI is effective with
students with more severe intellectual disability. Finally, there were participants from multiple race or eth-
nicity groups included in this review which is in contrast to the findings of West et al. (2016) who found
limited diversity in previous EBP reviews.
The third purpose of this investigation was to determine the extent to which MSBI has been used to
address standards-based, grade-aligned skills. At this time, only four research teams explicitly reported
aligning their interventions to state standards. Although other teams certainly targeted skills that likely
could be linked to state standards, it is crucial that instruction begins with the standard, as opposed to link-
ing after-the-fact (Clayton et al., 2006). Standards-based instruction is not only required by law under
Every Student Succeeds Act (2015) but is an integral part of the educational experience to which students
with MSD are entitled (Courtade et al., 2012). In addition, none of the studies took place in inclusive
classrooms.

Limitations and Future Directions

We attempted to conduct a comprehensive search of the literature, including a review of dissertations and
manuscripts under review, but there is always the possibility that we missed relevant studies. In addition, it
is possible we excluded relevant studies in which the researchers did not explicitly describe the participants’
disability. For example, Buncher (2019) investigated the effects of MSBI on word problem solving of three
students with autism but did not report whether the students had a comorbid intellectual disability or were
eligible for their state’s alternate assessment. We felt it was important to follow Spooner, McKissick, and
Knight’s (2017) guidance and narrowly define the population of students in this review so that educators
more clearly understand whether their own students match the characteristics of the students for whom
MSBI has been effective.
In addition, while there are currently multiple examples in the literature to calculate effect sizes for sin-
gle-case studies (e.g., Maggin et al., 2011; Parker et al., 2010), most of these are straight-forward compari-
sons with two phases, baseline to intervention. In the current review, several research teams conducted
investigations involving the initial collection of baseline data, followed by the introduction of MSBI to
different stimulus conditions (i.e., types of problems) across separate phases. This presented a challenge in
Clausen et al. 11

calculating effect sizes for phases that were not adjacent to the initial baseline condition. We decided to
combine comparisons as described earlier, but as a result our effect size calculations may not be sensitive to
generalization following exposure to MSBI in a previous phase.
Spooner, Saunders, et al. (2017) posed the following suggestions for future research in their conceptual
article on MSBI: (a) replicating MSBI to other geographical regions and by additional research teams, (b)
increasing student expectations by fading supports, (c) implementing MSBI with students with severe dis-
abilities who may not have the precursor skills and need more time or additional supports, and (d) general-
izing MSBI to real-world mathematical problem-solving situations. Unfortunately, our findings indicate
that little progress has been made in answering these questions. We encourage future researchers to consider
these factors when planning new investigations. Finally, we suggest that future researchers consider the
impact of MSBI not only on the process of problem solving (i.e., following the task analysis) but also on the
product, or the number of problems solved correctly.

Implications for Practice

While we cannot at this time formally characterize MSBI as an EBP, practitioners should not interpret this
review as a barrier to exploring the use of MSBI with their own students who have MSD. Indeed, research-
ers have demonstrated MSBI to be an effective strategy across multiple populations of students. Furthermore,
the available research literature indicates MSBI has been highly effective for students with MSD. Finally,
to date, there are no established alternatives for teaching mathematical problem solving to students with
MSD. We recommend that instead of waiting for MSBI to accumulate additional support, teachers of stu-
dents with MSD should consider using MSBI to teach problem solving to their students while carefully
monitoring its effects on their performance.

Conclusion
We investigated the degree to which MSBI was an EBP for teaching mathematical problem-solving skills
to students with MSD using the Horner et al. (2005) standards. Eleven of the 12 studies reviewed met qual-
ity standards with an omnibus large effect size for the practice. Participants in these investigations were
largely middle school students with moderate intellectual disability who participated in statewide alternate
assessments and received their education in self-contained settings. Additive and multiplicative schemas
aligned to state-targeted mathematics standards were representative of the skills being taught. Based on the
established quantity and dispersion guidelines, the 5-3-20 rule, we cannot document that MSBI is an EBP
as all experiments to date have been relegated to North Carolina and Florida, with overlapping research
teams. Although the practice was conceptualized recently in 2017 (Spooner, Saunders, et al.) and we only
located 12 studies, we wanted to start documenting the effects of MSBI in an effort to aid the practical
implementation of validated practices to teach mathematical problem solving to students with MSD. At this
juncture, MSBI is a promising practice with no negative or contraindicated effects which needs to be inves-
tigated by independent research teams to further build the research base.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of
this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs
Amy M. Clausen https://orcid.org/0000-0002-4109-4133
Melissa C. Tapp https://orcid.org/0000-0001-7805-4146
12 Research and Practice for Persons with Severe Disabilities 00(0)

Supplemental Material
Supplemental material for this article is available online.

References
References marked with an asterisk indicate studies included in EBP review.
Agran, M., Spooner, F., & Singer, G. H. S. (2017). Evidence-based practices: The complexities of implementation.
Research and Practice for Persons with Severe Disabilities, 42(1), 3–7. https://doi.org/10.1177/1540796916685050
Apanasionok, M. M., Hastings, R. P., Grindle, C. F., Watkins, R. C., & Paris, A. (2018). Teaching science skills
and knowledge to students with developmental disabilities: A systematic review. Journal of Research in Science
Teaching, 56(7), 847–880. https://doi.org/10.1002/tea.21531
*Brosh, C. R. (2018). Effects of a multi-component intervention package on academic skills for students with severe
disabilities [Doctoral dissertation, University of North Carolina at Charlotte]. UNC Charlotte Electronic Theses
and Dissertations. https://ninercommons.uncc.edu/islandora/object/etd%3A1282
*Brosh, C. R., Root, J. R., Saunders, A. F., Spooner, F., & Fisher, L. B. (2018). Embedding literacy in mathematics
problem solving instruction for learners with intellectual and developmental disability. Inclusion, 6(2), 81–96.
https://doi.org/10.1352/2326-6988-6.2.81
Browder, D. M., Spooner, F., Ahlgrim-Delzell, L., Harris, A., & Wakeman, S. (2008). A meta-analysis on teaching
mathematics to students with significant cognitive disabilities. Exceptional Children, 74(4), 407–432. https://doi.
org/10.1177/001440290807400401
Browder, D. M., Spooner, F., & Courtade, G. R. (2020). Teaching students with moderate and severe disabilities (2nd
ed.). Guilford Press.
Browder, D. M., Spooner, F., & Lo, Y.-y., (Co-Investigators). (2013-2017). The solutions project: Teaching students
with moderate/severe intellectual disability to solve mathematical problems (Project No. R324A130001) [Grant].
U.S. Department of Education, Institute of Education Sciences. https://access.uncc.edu/solutions-project
*Browder, D. M., Spooner, F., Lo, Y.-y., Saunders, A. F., Root, J. R., Ley Davis, L., & Brosh, C. R. (2018). Teaching
students with moderate intellectual disability to solve word problems. The Journal of Special Education, 51(4),
222–235. https://doi.org/10.1177/0022466917721236
Buncher, A. G. (2019). Effects of modified schema-based instruction on addition and subtraction word problem
solving of students with autism spectrum disorder and intellectual disability [Doctoral dissertation, University
of Cincinnati]. OhioLINK Electronic Theses & Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_
num=ucin1562922776447393
Clayton, J., Burdge, M., Denham, A., Kleinert, H. L., & Kearns, J. (2006). A four-step process for accessing the general
curriculum for students with significant cognitive disabilities. TEACHING Exceptional Children, 38(5), 20–27.
https://doi.org/10.1177/004005990603800503
Cook, B., Buysse, V., Klingner, J., Landrum, T., McWilliam, R., Tankersley, M., & Test, D. (2014). Council for
Exceptional Children: Standards for evidence-based practices in special education. TEACHING Exceptional
Children, 46(6), 206–212. https://doi.org/10.1177/0040059914531389
Courtade, G. R., Spooner, F., Browder, D., & Jimenez, B. (2012). Seven reasons to promote standards-based instruction
for students with severe disabilities: A reply to Ayres, Lowrey, Douglas, & Sievers (2011). Education and Training
in Autism and Developmental Disabilities, 47(1), 3–13.
Every Student Succeeds Act, 20 U.S.C. § 6301. (2015). https://legcounsel.house.gov/Comps/Elementary%20And%20
Secondary%20Education%20Act%20Of%201965.pdf
Gersten, R., Fuchs, L. S., Compton, D., Coyne, M., Greenwood, C., & Innocenti, M. S. (2005). Quality indicators for
group experimental and quasi-experimental research in special education. Exceptional Children, 71(2), 149–164.
https://doi.org/10.1177/001440290507100202
*Gilley, D. P., Root, J. R., & Cox, S. K. (2020). Development of mathematics and self-determination skills for
young adults with extensive support needs. The Journal of Special Education, 54(4), 195–204. https://doi.
org/10.1177/0022466920902768
Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research
to identify evidence-based practice in special education. Exceptional Children, 71(2), 165–179. https://doi.
org/10.1177/001440290507100203
Horner, R. H., & Kratochwill, T. R. (2012). Synthesizing single-case research to identify evidence-based practices:
Some brief reflections. Journal of Behavioral Education, 21(3), 266–272. https://doi.org/10.1007/s10864-012-
9152-2
Clausen et al. 13

Hudson, M. E., & Test, D. W. (2011). Evaluating the evidence base of shared story reading to promote literacy for
students with extensive support needs. Research and Practice for Persons with Severe Disabilities, 36(1-2), 34–45.
https://doi.org/10.2511/rpsd.36.1-2.34
Jacobson, J. W., Foxx, R. M., & Mulick, J. A. (2005). Controversial therapies for developmental disabilities: Fad,
fashion, and science in professional practice. Routledge.
Jitendra, A. K., Peterson-Brown, S., Lein, A. E., Zaslofsky, A. F., Kunkel, A. K., Jung, P.-G., & Egan, A. M. (2015).
Teaching mathematical word problem solving: The quality of evidence for strategy instruction priming the prob-
lem structure. Journal of Learning Disabilities, 48(1), 51–72. https://doi.org/10.1177/0022219413487408
Ledford, J. R., & Gast, D. L. (2018). Single case research methodology: Applications in special education and behav-
ioral sciences (3rd ed.). Routledge.
*Ley Davis, L. (2016). Effects of peer-mediated instruction on mathematical problem solving for students with moder-
ate/severe intellectual disability. [Doctoral dissertation, University of North Carolina at Charlotte]. UNC Charlotte
Electronic Theses and Dissertations. https://ninercommons.uncc.edu/islandora/object/etd%3A661
Maggin, D. M., Swaminathan, H., Rogers, H., O’Keefe, B. V., Sugai, G., & Horner, R. H. (2011). A generalized least
squares regression approach for computing effect sizes in single-case research: Application examples. Journal of
School Psychology, 49(3), 301–321. https://doi.org/10.1016/j.jsp.2011.03.004
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and
meta-analyses: The PRISMA statement. The BMJ, 339(b2535), 1–8. https://doi.org/10.1136/bmj.b2535
National Autism Center. (2009). National standards report. https://www.nationalautismcenter.org/reports/
National Governors Association Center for Best Practices, Council of Chief State School Officers. (2010). Common
Core State Standards Mathematics. http://www.corestandards.org/Math/
National Technical Assistance Center on Transition. (2016, June). Quality indicator checklist: Single case. https://tran-
sitionta.org/system/files/effectivepractices/Quality%20Indicator%20Checklist_Single%20Case_11-04-16%20(1).
pdf?file=1&type=node&id=1132&force=
Parker, R. I., Vannest, K. J., Davis, J. L., & Sauber, S. B. (2010). Combining non-overlap and trend for single case
research: Tau-U. Behavior Therapy, 42(2), 284–299. https://doi.org/10.1016/j.beth.2010.08.006
Powell, S. R., & Fuchs, L. S. (2018). Effective word-problem instruction: Using schemas to facilitate mathematical
reasoning. TEACHING Exceptional Children, 51(1), 31–42. https://doi.org/10.1177/0040059918777250
Rakhmatullina, M., Taub, A., & Jacob, T. (2013). Morbidity and mortality associated with the utilization of restraints.
Psychiatric Quarterly, 84(4), 499–512. https://doi.org/10.1007/s11126-013-9262-6
*Root, J. R., & Browder, D. M. (2019). Algebraic problem solving for middle school students with autism and intel-
lectual disability. Exceptionality, 27(2), 118–132. https://doi.org/10.1080/09362835.2017.1394304
*Root, J. R., Browder, D. M., Saunders, A. F., & Lo, Y-y. (2017). Schema-based instruction with concrete and virtual
manipulatives to teach problem solving to students with autism. Remedial and Special Education, 38(1), 42–52.
https://doi.org/10.1177/0741932516643592
*Root, J. R., Cox, S. K., Davis, K., & Hammons, N. (2020). Contextualizing mathematical problem-solving instruction
for secondary students with extensive support needs: A systematic replication. Research and Practice for Persons
with Severe Disabilities, 45(4), 241–255. https://doi.org/10.1177/1540796920949448
*Root, J. R., Cox, S. K., Hammons, N., Saunders, A. F., & Gilley, D. (2018). Contextualizing mathematics:
Teaching problem solving to secondary students with intellectual and developmental disabilities. Intellectual and
Developmental Disabilities, 56(6), 442–457. https://doi.org/10.1352/1934-9556-56.6.442
*Root, J. R., Cox, S. K., Saunders, A., & Gilley, D. (2019). Applying the universal design for learning framework
to mathematics instruction for learners with extensive support needs. Remedial and Special Education, 41(4),
194–206. https://doi.org/10.1177/0741932519887235
*Root, J. R., Saunders, A., Spooner, F., & Brosh, C. (2017). Teaching personal finance mathematical problem solving to
individuals with moderate intellectual disability. Career Development and Transition for Exceptional Individuals,
40(1), 5–14. https://doi.org/10.1177/2165143416681288
Root, J. R., Stevenson, B. S., Ley Davis, L., Geddes-Hall, J., & Test, D. W. (2017). Establishing computer-assisted
instruction to teach academics to students with autism as an evidence-based practice. Journal of Autism and
Developmental Disorders, 47(2), 275–284. https://doi.org/10.1007/s10803-016-2947-6
*Saunders, A. F. (2014). Effects of schema-based instruction delivered through computer-based video instruction on
mathematical word problem solving of students with autism spectrum disorder and moderate intellectual dis-
ability [Doctoral dissertation, University of North Carolina at Charlotte]. UNC Charlotte Electronic Theses and
Dissertations. https://ninercommons.uncc.edu/islandora/object/etd%3A888
Spooner, F., McKissick, B. R., & Knight, V. F. (2017). Establishing the state of affairs for evidence-based practices in
students with severe disabilities. Research and Practice for Persons with Severe Disabilities, 42(1), 8–18. https://
doi.org/10.1177/1540796916684896
14 Research and Practice for Persons with Severe Disabilities 00(0)

Spooner, F., Root, J. R., Saunders, A. F., & Browder, D. M. (2019). An updated evidence-based practice review
on teaching mathematics to students with moderate and severe developmental disabilities. Remedial and Special
Education, 40(3), 150–165. https://doi.org/10.1177/0741932517751055
Spooner, F., Saunders, A., Root, J. R., & Brosh, C. (2017). Promoting access to common core mathematics for students
with severe disabilities through mathematical problem solving. Research and Practice for Persons with Severe
Disabilities, 42(3), 171–186. https://doi.org/10.1177%2F1540796917697119
Vannest, K. J., & Ninci, J. (2015). Evaluating intervention effects in single-case research designs. Journal of Counseling
& Development, 93(4), 403–411. https://doi.org/10.1002/jcad.12038
Vannest, K. J., Parker, R. I., Gonen, O., & Adiguezel, T. (2016). Single case research: Web based calculators for SCR
analysis(Version 2.0) [Web-based application]. Texas A&M University. singlecaseresearch.org
West, E. A., Travers, J. C., Kemper, T. D., Liberty, L. M., Cote, D. L., McCollow, M. M., & Stansberry Brusnahan,
L. L. (2016). Racial and ethnic diversity of participants in research supporting evidence-based practices for
learners with autism spectrum disorder. The Journal of Special Education, 50(3), 151–163. https://doi.org/10.
1177/0022466916632495
What Works Clearinghouse. (2020). Standards handbook (Version 4.1). Institute of Education Sciences. https://ies.
ed.gov/ncee/wwc/Docs/referenceresources/WWC-Standards-Handbook-v4-1-508.pdf

Author Biographies
Amy M. Clausen is a doctoral student at the University of North Carolina at Charlotte. Her research interests include
general curriculum access and personnel preparation.
Melissa C. Tapp is a doctoral student at the University of North Carolina at Charlotte. She studies practice for improv-
ing outcomes for students with extensive support needs.
Robert C. Pennington is a professor and the Lake and Edward J. Snyder, Jr. distinguished scholar in Special Education
at the University of North Carolina at Charlotte. His current research interests are in the application of behavior analytic
procedures to develop written communication repertoires for students with intellectual and developmental disabilities.
Fred Spooner is a professor of Special Education at the University of North Carolina at Charlotte. His research inter-
ests include access to the general education curriculum for students with severe disabilities and applied behavior
analysis.
Annette Teasdell is a lecturer in Africana studies and women’s and gender studies at the University of North Carolina
at Charlotte. Her research is centered on the fundamental belief that culturally responsive pedagogy combined with a
curriculum that is accurate, relevant, and appropriate, and whose educational processes are humane can yield improved
student outcomes.

Date Received: June 3, 2020

Date of Final Acceptance: February 4, 2021
Editor-in-Charge: Donna H. Lehr