Innovation
Pick
Conducting Preference
Assessments With Students
With Significant Disabilities
Helen I. Cannella-Malone, Linsey M. Sabielny,
Elseo D. Jimenez, and Megan M. Miller
Mr. Woods teaches eight middle-school-
age students who all have significant
intellectual and developmental disabili-
ties and limited communication skills.
Six of Mr. Woods's students make
choices by physically reaching out and
selecting an item or picture. His other
two students have significant physical
disabilities and are unable to physically
select an item or picture if it is present-
ed to them. Although Mr. Woods tries to
build in choice-making opportunities
throughout the school day, he struggles
with developing systematic reinforcers
for his students' behavior. He has often
wondered if there were a way he could
identify age-appropriate reinforcers for
each of his students given that they
have a wide range of strengths and
challenges.
It is essential to identify the prefer-
ences of students with significant intel-
lectual, developmental, and physical
disabilities (SIDPD) so that teachers
can use those preferences to reinforce
new behaviors. Students with SIDPD
have demonstrated that they can indi-
cate clear preferences when teachers
conduct methodologically rigorous
preference assessments. Moreover,
teachers can use the items as rein-
16 COUNCIL FOR EXCEPTIONAL CHILDREN
forcers once students have identified
them as preferred using these assess-
ments. Many teachers have found the
items useful as reinforcers to teach
new behaviors and maintain learned
behaviors (Cannella, O'Reilly, &
Lancioni, 2005). By relying on prefer-
ence assessments to assist in the
identification of potential reinforcers,
teachers can not only consider stu-
dents' individual preferences, but
teachers can also provide more effec-
tive instruction for each student.
Teachers often ask why they
couldn't simply ask others what the
student likes, including parents, spe-
cialists, and other caregivers. First,
most people select common items for
students to choose fromincluding
many items that teachers have offered
for student choices for many years,
without variety. Second, in only offer-
ing common items for choice, teachers
may overlook idiosyncratic items. For
example, we have worked with stu-
dents whose most preferred activities
included watching another person
sneeze or watching someone trip,
which we did not suggest as possible
preferences in initial questionnaires.
Instead, students identified these activ-
ities as possible reinforcers during a
structured preference assessment when
the student responded positively (e.g.,
laughed, looked toward the researchers
and smiled) when the researcher just
happened to sneeze or trip. Finally,
researchers have suggested that many
educators identify the wrong rein-
forcers nearly 50 % of the time (Can-
nella et al., 2005). Therefore, it is pure
chance if items identified by people
close to the student actually act as
reinforcers. Bearing this in mind, how-
ever, it is always worth communicating
with parents and care providers as a
starting point in identifying items that
could be included in a systematic pref-
erence assessment.
Given the evidence that conducting
direct preference assessments can suc-
cessfully identify reinforcers for stu-
dents with SIDPD, researchers need to
provide teachers guidelines for con-
ducting these assessments. In this arti-
cle, we describe methods for choosing
the most appropriate assessment for a
particular student, describe four com-
monly used preference assessment pro-
cedures, offer troubleshooting solu-
tions, and discuss how teachers can
use results to enhance educational pro-
gramming for students with SIDPD
TEACHING EXCEPTIONAL CHILDREN | JULY/AUG 2013 17

What Does the Research Say
About Preference Assessments?
Research clearly identifies prefer-
ence assessments as a valid and
effective way of identifying preferred
stimuli for students with disabilities
(Tullis, Cannella-Malone, Basbigill,
Yeager, Fleming, Payne, & Wu,
2011). The variety of assessments
allow for individualization of the
preference assessment based on the
student's needs. Teachers can
choose from single-stimulus (Pace,
Ivancic, Edwards, Iwata, & Page,
1985), paired-choice (Fisher, Piazza,
Bowman, Hagopian, Owens, &
Slevin, 1992), multiple stimulus
without replacement (DeLeon &
Iwata, 1996), and eye-gaze
(Fleming, Wheeler, Cannella-
Malone, Basbagill, Chung, &
Graham Day, 2010) assessments.
Within each of these types of
assessments, teachers may make
modifications for the student to
make the assessment more effective.
Additional research is needed
regarding these modifications, espe-
cially given the advancements
occurring with technology. More
research is also needed regarding
the effective use of these assess-
ments in the school and home envi-
ronments by teachers and parents
(Tullis et al., 2011).
(see box, "What Does the Research Say
About Preference Assessments?").
Choosing Ihe Right
Assessment
To select the appropriate assessment
for each student, teachers can refer to
Figure 1, which shows a preference
assessment decision tree.
Assessment Procedures
and Descriptions
Each of the following assessments is
best suited to a particular type of stu-
dent. Instructions include how many
items can be assessed, approximately
how long the assessment will take,
how easy the assessment is to set up
and conduct, what preparation is nee-
18 COUNCIL FOR EXCEPTIONAL CHILDREN
Figure 1 . Decision Tree for Ciioosing tiie Appropriate Preference
Assessment for Students With Significant intellectuai, Developmentai,
and Physical Disabiiities
Can the student
physically select an item?
YES
i
Can the student choose
between two items?
YES
i
Can the student choose
between three or more items?
YES
i
Multiple Stimulus Without
Replacement Assessment
essary, directions for conducting the
assessment, and directions for deter-
mining the preference hierarchy. The
procedures described are based on the
original assessment research, as well as
our experiences conducting the assess-
ments with students who have SIDPD.
Single-Stimulus Preference
Assessment
The single-stimulus preference assess-
ment was one of the first preference
assessments developed for students
with significant disabilities (Pace,
Ivancic, Edwards, Iwata, & Page,
1985). It was designed particularly for
students who do not choose from mul-
tiple items, but do attend to a single
item when it is presented. Up to 16
items can be assessed before the
assessment becomes too cumbersome.
As more items are added, the time to
conduct the assessment increases. If
Eye Gaze
Assessment
Single Stimulus
Assessment
Paired Stimulus
Assessment
six items are included and each is
presented five times, this will take at
least 1 hour to complete. Although it is
time consuming, benefits of this
assessment are that the procedures are
simple to implement, and choice mak-
ing is not a prerequisite.
To conduct this assessment, the
teacher should first prepare the data
sheet (see Figure 2) by listing the items
that will be assessed and defining
"engagement" for the student. This
assessment is based on examining stu-
dent engagement with possible rein-
forcers as a way to determine potential
reinforcing strength. Engagement might
include looking at the item, leaning
toward the item, taking the item and
playing with it, or a calming response
(e.g., a student who engages in Stereo-
typie behavior may stop engaging in
the behavior when a particular item is
presented). When defining engage-
ment, the teacher should be sure to Figure 2. Singie-Stimuius Preference Assessment Data Siieet
use a description that is both observ-
able and measurable, meaning that
anyone observing the student would Items THal 1 THalZ Trial 3 TVia!4 Trials Total
clearly be able to say that engagement
occurred without additional input.
Next, the teacher should make sure
that each item on the list is available
and the student is comfortable [e.g.,
sitting at a table, on the floor, in a
wheelchair, or in a Stander). Then, the
teacher should present each item indi-
vidually for 30 seconds. If the item is a
power toy, it should be given to the
student turned on; if the student is Rank items from the highest total to the lowest total to obtain a preference
placed in a swing, it should be lightly hierarchy, where the higher number indicates a higher preference.
pushed to move the swing, and so 1.
forth. If the student engages with the 2. _
item, the teacher should score the first 3. _
trial for that item with the number 1. If 4. _
the student does not engage with the
5. _
item, the teacher should score the first
trial for that item with a zero. Once
each item has been presented once, the Notes:
teacher should present them all again
for 30 seconds each in a different
order. Each item should be presented a
total of five times.
Although it is possible to conduct
this assessment in one sitting, the stu-
dent may get fatigued and stop engag-
ing. If the assessment will be broken
up across time periods, it is best to
complete at least one presentation of
each item in each session. During the Note. Sample data sheet for a single-stimulus preference assessment that includes
next session, the teacher should follow five items to be assessed. Add rows to the trials table and rank-order list as you
the same procedures, changing the add items to be assessed.
presentation order from the previous
session. If 10 or more items are being Paired-Stimulus Preference items, 121 pairs will be presented. A
assessed and breaks will be required, it Assessment teacher can expect to spend 45 minutes
is best to split the items into groups A paired-stimulus preference assess- assessing six items and at least 2 hours
with like numbers of items. Using ment is appropriate for students who assessing 16 items. Although the
these general guidelines, decisions can choose between two items but do preparation is slightly complicated, the
about how to break up the assessment not reliably select items from a larger assessment procedures are easy to
should be based on the individual array [Fisher et al., 1992). A teacher implement. A benefit of this assess-
needs of the student. To determine the can assess up to 16 items in a paired- ment [and all subsequent assessments)
preference hierarchy once the assess- stimulus assessment, though the num- is that it provides information on dif-
ment is complete, the teacher should ber of items assessed is generally clos- ferential responding, which allows a
er to five. As this number increases, teacher to compare preference in rela-
sum the number of times the student
the complexity and duration of the tion to other items included in the
engaged with each item, and then rank
assessment also increases, because assessment, something that is impossi-
the items from the highest to lowest
each item has to be paired with every ble with the single-stimulus assess-
total. Items with higher totals are con- other item included in the assessment. ment.
sidered more highly preferred than For example, to assess six items, 15 To conduct this assessment, the
those items with lower totals. pairs will be presented; to assess 16 teacher should first prepare the data

TEACHINC EXCEPTIONAL CHILDREN | JULY/AUG 2013 19

Figure 3 . Paired-Stimulus and Eye Gaze Preference Assessment Data sheet (see Figure 3 ; also see Figure 4
Sheet for a data sheet involving multiple
stimuli) by listing the items that will be
assessed with a corresponding number.
Items Number of Times Chosen
If assessing more than five items, the
1. teacher will need to add pairs to the
data sheet before beginning the assess-
2. ment. The assigned number will help
3. the teacher determine which items are
to be presented and on which side to
4. present each item during a given trial.
5.
The teacher should also determine the
duration of access (with consumable
items given shorter access and activi-
Items (circle selection) ties longer access). This duration
Right should remain constant.
Left
Next, the teacher should gather all
Trial 1 2 1 None
items to be included in the assessment
Trial 2 3 2 None and make sure the student is comfort-
able. Before the first trial, the student
Trial 3 5 3 None
should be allowed to individually sam-
Trial 4 1 3 None ple each item. The teacher should
begin each trial by presenting two
Trial 5 4 2 None
items, within reach of the student,
Trial 6 5 4 None approximately 1 foot apart and saying,
"Pick one." Placement can be adjusted
Trial 7 1 5 None
during the assessment if the student is
Trial 8 1 4 None having difficulty accessing the items
(see Table 1 for troubleshooting sug-
Trial 9 2 5 None
gestions) . If the student selects an item
Trial 10 3 4 None (i.e., physically takes, points to, or ver-
bally labels one item), the teacher
should provide 5-30 seconds of access
Rank items from the highest total to the lowest total to obtain a preference while removing the second item and
hierarchy, where the higher number indicates a higher preference. circling the corresponding number for
1. the selected item for that trial. If the
2. student does not select either item
within 5 seconds, the teacher should
3. remove both items and score the trial
4. as "none." The assessment is complete
5. once all pairs have been presented.
Although it is possible to conduct
Notes: this assessment in one sitting, the stu-
dent may get fatigued and stop engag-
ing with the items. The teacher should
use the procedures described previ-
ously to make decisions about how to
break up this assessment. To determine
the preference hierarchy once the
assessment is complete, the teacher
should sum the number of times each
item was chosen, then rank the items
from the highest to lowest total. Items
Noie. Sample data sheet for the paired-stimulus and eye gaze preference with higher totals are considered more
assessments that include five items to be assessed. Add rows to the items highly preferred than items with lower
table, additional pairings to the trials table, and to the rank-order list as you totals. If a student selected several
add items to the assessment. items an equal number of times, the

20 COUNCIL FOR EXCEPTIONAL CHILDREN

teacher can refer to the trial in which Figure 4 . Multiple Stimulus Without Replacement (MSWO) Preference
those items were paired together to Assessment Data Sheet
determine which item should be
ranked higher. If this assessment iden- Items Session 1 Session 2 Session 3 Session 4 Session 5 Total
tifies multiple low-preference items,
those items should be documented and
replaced with new items in subsequent
assessments.

Eye-Gaze Preference Assessment

The eye-gaze preference assessment
represents an adaptation of the paired-
stimulus preference assessment and
was the first specifically designed to
identify reinforcers for people with
multiple disabilities, particularly those
Rank items from the lowest total to the highest total to obtain a preference
who may lack the physical capabilities
to reach out and select an item hierarchy, where the lower number indicates a higher preference.
(Fleming et ai., 2010). As with the 1.
paired-stimulus preference assessment, 2. ^
up to 16 items can be assessed, but 3.
the time to conduct the assessment
will increase exponentially. If the 4. _
recommended six items are included, 5. _
it will take several hours per student 6. _
to complete.
Notes:

Because eye gaze will vary

greatly across students, it is
importaut that the definitiou is
student specific, as well as
observahle and measurable.

To conduct this assessment, the

teacher should first prepare the data-
coilection sheet (see Figure 3) as
described in the paired-stimulus assess-
ment and define eye gaze for each stu-
dent. Defining eye gaze for each stu-
dent is the most difficult part of this
assessment. Typically, eye gaze is
defined as a 2-secnd directional gaze,
initiated within 5 seconds of the pair of
items being presented. However, pre-
assessment sessions will likely be nec-
essary to determine where to position
the items and whether the student will
maintain his gaze for 2 seconds. For
example, a student's resting position
might be with his head tilted to the
right with chin to chest. In this case,
the teacher should position the items
farther to the right and near the stu-
Note. Sample data sheet for the multiple stimulus without replacement (MSWO)
preference assessment that includes six items to be assessed. Add rows to the trials
table and rank order list as you add items to be assessed.
dent's lap to ensure that both items are come to a neutral gaze, then present
visible. Tilting the student's wheelchair both items by placing or holding the
up or down, adjusting the headrest, items as identified during the pre-
and using or removing the student's assessment. Next, the teacher should
lap tray may enhance a teacher's abili- remove both items and re-present and
ty to observe eye gaze. Because eye manipulate each item individually for
gaze will vary greatly across students, 5 seconds (i.e., sample the items),
it is important that the definition is stu- then remove and present both items
dent-specific, as well as observable and together and say "Pick one." The
measurable. teacher should watch the student's
Following preparation, the teacher gaze to see which item he is looking
should present each pair of items in at. A choice is defined as looking at an
the order listed. To begin, the teacher item for 2-3 seconds, depending on
should allow the student's eyes to the definition of eye gaze created

TEACHING EXCEPTIONAL CHILDREN | JULY/AUG 2013 21

Tabie 1 . Treubiesiiooting Tabi< Witb tbe Probiem/Pitfaii and
Suggested Soiutions
Problem/Pitfall
The student grabs all of the
assessment items
The student selects in a certain
order
The student won't select any of the
options
The student satiates on the
assessment items
Several items are ranked equally
The student selects unavailable
items/activities
The student demonstrates a side
bias
The student will not select from an
array of 6 or more items, but will
choose from an array of 3
If a student is not able to sample
the item, the assessment may be
inaccurate
Behavior doesn't increase when
items are presented contingently
during the pre-assessment. Once a
choice has been made, the teacher
should provide access to the chosen
item for 30 seconds and remove the
item not chosen. For each trial, the
teacher should circle the choice made
by the student on the data sheet. If a
directional gaze is not initiated within
S seconds, both items should be
removed and then re-presented without
sampling the items. If a directional
gaze is again not initiated within 5 sec-
onds, the teacher should remove both
22 COUNCIL FOR EXCEPTIONAL CHILDREN
Solution
Arrange items so they're not easily
grabbed (in a cupcake tin) or have
another person assist
Randomize the presentation order or
introduce distractions
Possibly use a different selection
response, a more basic assessment, or
prompt sampling
Provide smaller samples of the items or
break the assessment up over days
Items may be equally preferred, you can
conduct another assessment to confirm
Make an inventory of the available
options
Shift all choices to that side or present
vertically
Decrease the number of items in the
assessment
Allow the student to sample each item
when selected
Increase rate of reinforcement
The reinforcing effects may not be pow-
erful enough if the behavior is particu-
larly challenging. It may be necessary to
conduct another assessment with new
items
In addition to using preferred items to increase behavior,
a teacher can use the identified items to provide his students
with activities for which they have demonstrated preference.
items, indicate "no choice" on the data
sheet, and present the next pair. This
process should be repeated until all
pairs have been presented.
This assessment should be conduct-
ed across days, because the selection
method (i.e., eye gaze) is fatiguing for
the student. Some students can toler-
ate up to five trials per day, but some
students will only complete one trial
per day. To determine the preference
hierarchy once all trials are complete,
use the guidelines presented for the
paired-stimulus preference assessment.
Multiple Stimulus Without
Replacement
DeLeon and Iwata (1996) developed
the multiple stimulus without replace-
ment (MSWO) assessment in an effort
to combine paired-and multiple-stimu-
lus assessments. The MSWO is appro-
priate for students who choose from
an array of three or more items and
can be used to assess up to 16 items.
Although the assessment duration
increases as items are added, the total
duration is much shorter than the
other assessments and will vary based
on the number of items and trials
presented. The average duration is
approximately 20 minutes when six
items are assessed across five sessions.
To conduct this assessment, the
teacher should first list the items to be
assessed on the data sheet (see Figure
4). The duration of access should also
be determined (with consumable items
given shorter access and activities
longer access). This duration should
remain constant.
Next, the teacher should make sure
the student is seated comfortably with
a tray or table in front of him to dis-
play the items. The teacher should
place all items in front of the student
at the same time, generally in a
straight line. The teacher should then
tell the student to "pick one" and wait
S seconds. Once the student selects an
item (as defined in the paired-stimulus
assessment), the array should be
removed and the student should be
allowed to engage with the item for
the predetermined duration. On the
data sheet, the teacher should record a
"1" in the first column next to the
item the student chose. Next, the
teacher should rearrange the remaiti-
ing items and present the array again.
This procedure should be repeated
until all items have been selected or
the student stops selecting items, and
the teacher should record the order of
selection for each item in the array
(e.g., if item 2 is selected third, write
a "3" in the row for item 2 in session
1). This is considered one session, and
five sessions should be conducted
before calculating the preference
hierarchy.
All five sessions of the MSWO need
not be conducted in one sitting.
Although this is a relatively quick
assessment, it is important to only
conduct the assessment while the stu-
dent is engaged, attending, and moti-
vated. The teacher should use the pro-
cedures described previously to make
decisions about how to break up this
assessment. To determine the prefer-
ence hierarchy once five sessions have
been completed, the teacher should
sum the rankings of each item across
the five sessions. In this case, the
items with lower totals are considered
more preferred than those with higher
totals.
What Happens If Something
Goes Wrong?
Ideally, teachers have identified the
correct preference assessments to use
with their students, the assessments
were conducted without any problems,
and the teacher identified several high-
ly preferred items to use with his stu-
dents. Several challenges, however,
could arise throughout the assessment
process. Table 1 depicts common
issues and possible corresponding
solutions.
The Assessments Are
Finished! Now What?
A teacher now has several items that
have been identified as highly pre-
ferred for his students. So what can be
done with them? Highly preferred
items should be used during instruc-
tion to reinforce students' behaviors
that are in acquisition and to maintain
learned behaviors. We know that rein-
forcing behaviors is the key to increas-
ing them and that the reinforcement of
new skills is most powerful when the
reinforcer used is highly preferred. So,
the teacher should use those items
identified as highly preferred during
instruction, by allowing access to the
items contingent on desired behaviors.
In addition to using preferred items
to increase behavior, a teacher can use
the identified items to provide his stu-
dents with activities for which they
have demonstrated preference. Stu-
dents with significant disabilities may
have restricted interests or have few
activities in which they engage inde-
pendently. By conducting preference
assessments and identifying preferred
activities, teachers can broaden the
number and type of activities available
to the student.
Teachers should always remember
the following as they begin to use pref-
erence assessments. First, instruction
will be enhanced with the use of con-
tingently delivered reinforcers (i.e.,
only providing access to the reinforcer
immediately following a behavior to be
increased). Second, the identification
of these reinforcers for students with
SIDPD can most successfully occur
using one of the preference assess-
ments described in this article. Finally,
a preference assessment will only be as
good as the items included, so teachers
should be sure to identify age-appropri-
ate items.
After conducting systematic preference
assessments with each of his students,
Mr. Woods has successfully identified
new reinforcers for all of his students.
He used the MSWO with three of his
students, the paired-stimulus preference
assessment with two students, the
single-stimulus preference assessment
with one student, and the eye-gaze
assessment with two students.
Although he had to use various assess-
ment methods with his students, he is
thrilled that each student has made
improvements since he started using
the highly preferred items as reinforcers
in his instruction.
TEACHING EXCEPTIONAL CHILDREN
References
Cannella, H. 1., O'Reilly, M. F., & Lancioni,
G. (2005). Choice and preference assess-
ment research with people with severe to
profound developmental disabilities: A
review of the literature. Research in
Developmental Disabilities, 26, 1-15.
http://dx.doi.Org/10.1016/j.ridd.2004.01
.006
DeLeon, I. G., & Iwata, B. A. (1996). Evalu-
ation of a multiple-stimulus presentation
format for assessing reinforcer prefer-
encers. Joumal of Applied Behavior
Analysis, 29, 519-533.
Fisher, W., Piazza, C. C , Bowman, L. G.,
Hagopian, L. P., Owens, J. G., & Slevin, I.
(1992). A comparison of two approaches
for identifying reinforcers for persons
with severe and profound disabilities.
Joumal of Applied Behavior Analysis, 25,
491-498. http://dx.doi.org/10.1901
/iaba. 1992.25-491
Fleming, G. V., Wheeler, G. M., Gannella-
Malone, H. I., Basbagill, A. R., Ghung, Y.
G., & Graham Day, K. (2010). An evalua-
tion of the use of eye gaze to measure
preference of individuals with severe
physical and developmental disabilities.
Developmental Neurorehabilitation, 13,
266-275. http://dx.doi.org/10.3109/175
18421003705706
Pace, G. M., Ivancic, M. T., Edwards, G. L.,
Iwata, B. A., & Page, T. J. (1985). Assess-
ment of stimulus preference and rein-
force value with profoundly retarded
individuals. Joumal of Applied Behnvior
Analysis, 18, 249-255. http://dx.doi.org
/10.1901/jaba.l985.18-249
Tlillis, G. A., Gannella-Malone, H. I., Bas-
bigill, A. R., Yeager, A., Fleming, G. V.,
Payne, D., & Wu, P. (2011). Review of the
choice and preference assessment litera-
ture for individuals with severe to pro-
found disabilities. Education and Train-
ing in Autism and Developmental Disa-
bilities, 46, 576-595.
Helen I. Cannella-Malone (Ohio CEC),
Associate Professor; Linsey M. Sabielny
(Ohio CEC), Doctoral Student: Eliseo D.
Jimenez (Ohio CEC), Doctoral Student: and
Megan M. Miller (Ohio CEC), Doctoral
Student, Department of Educational Studies,
The Ohio State University, Columbus.
Address correspondence concerning this
article to Helen I. Cannella-Malone, Depart-
ment of Educational Studies, A324 PAES
Building, 305 W. 17th Avenue, The Ohio
State University, Columbus OH 43210
(e-mail: malone. 175@osu.edu).
TEAGHING Exceptional Ghildren, Vol. 45,
No. 6, pp. 16-23.
Copyright 2013 CEC.
JULY/AUG 2013 23
Copyright of Teaching Exceptional Children is the property of Council for Exceptional
Children and its content may not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.