Background. Children with intellectual disability (ID) and low vision have a deficit in intellectual and visual impairment. As a result, they have limitations in their ability to function adaptively, such as dressing. Meanwhile, mastery of dressing skills is important for them because these skills promote independence in daily living. Dressing skills include several skills, one of them is the buttoning skills. Children need help to master the buttoning skills according to their level of intelligence and vision limitation they had. The buttoning skills is a complex behavior chain that consists of sequences. Therefore, the buttoning skills can be trained by using backward chaining technique. This technique taught the child to master the skills from the last step, which was the most easy and simple step. The last step is taught first, then the next-to-last step is taught and linked to the last step, then the third-from-last step is taught and linked to the last two steps, and so on. At the end, the child is trained to perform sequence of buttoning skills completely. Thus, the purpose of this study is to evaluate the effectiveness of backward chaining to improve buttoning skills of a child with ID and low vision.

Method. This research used a single-subject ABA design with a child who had ID and low vision. The child was taught 3 steps of buttoning sequence, (1) hold the button and the buttonhole with each hand; (2) insert the button into the hole; and (3) releasing the button from the hole. The child trained with a button on a cloth that placed in front of him, so that he was easier to see the button and the buttenhole. A baseline measure was followed by an 8-sessions backward chaining program for 8 days, and a removal of intervention program. One session consisted of 6 trials with 5 minute inter-trial spacing. In addition to teaching the skills, the intervention program also involved verbal and physical prompts. Each session has a different prompt reduction and step mastery improvement. One trial considered successful if the child was able to buttoning according to the prompt demands of the session. At session 1 to 4, the child trained to buttoning by using a 12 cm diamater button. Then, he trained to buttoning by using 3,5 cm diameter button at session 5 to 8. The 3,5 cm diameter button was also used during baseline and follow-up.

Results. The child mastered the buttoning skills independently within 8 days. The comparison of baseline and follow-up results shows that, the child only mastered 1 of  3 steps in the sequence of buttoning before the intervention was given. After the intervention, he mastered the sequence of buttoning skills completely. Moreover, the duration that he needed to buttoning decreased. During baseline, the child was not able to buttoning until the time limit; 5 minutes. During the intervention session, the duration of the child’s buttoning skills was fluctuating. At the final session of intervention and follow-up, the child was able to perform the chain of buttoning skills for less than 1 minute. Futhermore, the prompt given when the child was buttoning decreased, and no prompt he needed during follow up.

Conclusion. At the end of the intervention, the backward chaining technique was found to be effective in improving the child’s buttoning skills independently. This skills lasts up to 1 month after the session ends

Added-Values. It is very important to consider the size of the button that used during the intervention. For children with same condition, the buttoning skills are better taught by using clothes that placed in front of the child, than using clothes that he wear.

Keywords: intellectual disability, low vision, buttoning skills, backward chaining