Graduated Guidance Meets Augmented Reality: Comparative Outcomes for Teaching Hand-Washing in Children With Intellectual Disabilities

Teaching self-care skills such as hand-washing to children with intellectual disabilities can be challenging and often requires substantial instructional support. This study compared three approaches for delivering hand-washing instruction within a graduated guidance framework: a photo-based activity schedule, a video model, and an Augmented Reality (AR) application. Fifteen children with intellectual disabilities were randomly assigned to one of the three groups and participated in baseline, intervention, and maintenance phases. In addition, semi-structured interviews were conducted with special education teachers to gather feedback on the interventions. The results showed that all three approaches led to significant improvements in hand-washing performance from baseline to maintenance. However, participants in the AR group reached proficiency in fewer sessions and required fewer training trials than those in the other groups, while also maintaining a 100% success rate during the maintenance phase. Teacher interviews further suggested that the AR application increased student engagement and was perceived as easier to implement during instruction. These findings indicate that AR can be an effective and efficient tool for teaching self-care skills to children with intellectual disabilities. At the same time, the qualitative findings suggest that the choice of instructional technology should consider the individual needs and characteristics of the learner.