Symbol labelling improves advantageous decision-making on the Iowa Gambling Task in people with intellectual disabilities.
A two-sticker prompt turns risky card choices into smart ones for adults with intellectual disabilities.
01Research in Context
What this study did
Adults with intellectual disabilities played the Iowa Gambling Task. The task has four card decks. Some decks give big wins but bigger losses. Other decks give small wins and smaller losses.
While they played, the researcher added simple labels. Green smiley stickers went on the good decks. Red frown stickers went on the bad decks. The team then counted how often each person picked the good decks.
What they found
With the stickers in place, players chose the good decks far more often. Their scores almost matched those of adults without disabilities. Without labels, the same adults picked mostly bad decks.
The labels acted like a quick roadmap. They showed which decks hurt and which helped, even when the players could not explain why.
How this fits with other research
The result lines up with Carr et al. (1978). That team used prompting and fading to teach sign labels to autistic children. Both studies show that a short verbal or visual cue can lock in the right choice.
Finney et al. (1995) also fit. They paired speech output with lexigram symbols for adults with severe ID. Adding an extra signal—sound or sticker—cut errors and sped learning, just like the smiley faces did here.
Sönmez et al. (2025) used simultaneous prompting to teach math facts to high-school students with mild ID. Again, a clear prompt delivered right away pushed the correct response and wiped out finger counting.
Giallo et al. (2006) looked almost opposite at first glance. They found that pathological gamblers kept making risky choices even when the odds were clear. The difference is population: the gamblers had average IQ and a long history of reinforcement for risk. The ID group had no such history, so a simple label was enough to flip their choice.
Why it matters
You can borrow the sticker trick any time a client faces a repeated choice with hidden odds. Job training sites, vending machines, or social media tasks are all real-world Iowa decks. A quick green-red cue gives the learner an edge while you fade it later. Try it next session: mark the safe choice and watch the data climb.
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02At a glance
03Original abstract
Individuals with intellectual and developmental disabilities often have difficulties foregoing short-term loss for long-term gain. The Iowa Gambling Task (IGT) has been extensively adopted as a laboratory measure of this ability. In the present study, we undertook the first investigation with people with intellectual disabilities using a two-choice child version of the IGT, with measures of intellectual and executive functioning. Compared to a group of matched controls, people with intellectual disabilities performed advantageously and showed high levels of subjective awareness about the relative goodness and badness of the decks. A symbol labelling intervention, in which participants were taught to label the good and bad decks at regular intervals significantly improved advantageous decision-making to levels approximating that of controls. Factor analysis of executive functioning scores identified working memory and mental flexibility (response initiation and set shifting), with a near-significant inverse correlation between the extent to which the intervention was required and mental flexibility. These findings show, for the first time, that people with intellectual disabilities are capable of performing advantageously on the IGT and add to the growing clinical literature on decision-making.
Research in developmental disabilities, 2010 · doi:10.1016/j.ridd.2009.12.003