The Use of Technology in Treatment of Autism Spectrum Disorders
Statistics released from the Center of Disease Control (CDC) indicate that 1 out of 68 children in the United States will be diagnosed with an Autism Spectrum Disorder (ASD). Studies indicate that 20-30% of these children will be unable to communicate their wants, needs, and thoughts verbally. According to the statistics reported by the CDC, that means over 20,000 children are born each year who will be diagnosed with ASD and remain functionally non-verbal. When individuals have severe speech and language disabilities, augmentative and alternative communication strategies (AAC) can provide them with an opportunity to express themselves and have a voice. The inability to communicate has a significant impact on quality of life, educational access, and development of social skills and relationships. The frustration of not being able to communicate can lead to negative behavior challenges as well.
AAC services developed from the most basic desire to help individuals who were unable to speak or express themselves. In the earliest form, eye gaze, letter, and picture displays were included as AAC. In order to utilize these early forms, face-to-face interaction was required, and the interaction was usually slow. As microprocessor technology was developed, dedicated AAC systems were custom built by small, AAC companies using synthesized speech. These systems were often heavy, cumbersome, and expensive. Personal computers (PC) and standard operating systems became another option for AAC and opened up a new world for developers. Not only could consumers use the technology for face-to-face interactions, but they could also use the technology to write, create and give presentations, and more readily participate in their home, school, work, and community environments. The PC devices were more portable and a little less expensive than the previous dedicated AAC devices. Then along came mobile, multiple use technologies that offered opportunities to the AAC consumer and/or learner that extended far beyond the capacity of current AAC devices and at significantly lower costs. Digital computer technology has become a prevalent feature of everyday life and is an increasingly popular means of communication in today’s society.
The proliferation of inexpensive mobile technology has dramatically changed how service providers deliver educational and behavioral services to individuals with ASD. From touch screen phones to tablet devices, mobile computing devices have never been more user friendly, cheaper, or universally available.
Research findings indicate that as the development of new communication technology progresses at an increasing rate each year, children’s competency and awareness of such technology also inevitably increases—often times overtaking that of their parents’ competence. Children’s increasing use of technology has implication for both educational and communicational practices, because it is now a prevalent environment factor in their lives (Watt, 2010). Children today are often referred to as “native speakers” of technology. This is often true for our students with ASD. Many individuals on the spectrum are more comfortable interacting with inanimate objects such as a computer or iPad. In addition, many individuals are visual learners and have strong technological skills.
In the past two years, there have been many “made-for-TV” flash bites highlighting the use of technology with individuals with autism. Usually, these bites have focused upon a child who could not communicate and often had behavioral issues due to the frustration of not being able to communicate. Once introduced to a communication app on the iPad, the child was able to communicate eloquent thoughts and behaviors disappeared. Therefore, due to the media hype, many consumers began to purchase an iDevice and a certain communication app at an alarming rate, because they were sure that an iPad was a panacea for every individual with ASD. Like all technologies and techniques, certain things work for certain people. Not all individuals with ASD need the iPad for a communication system, but they could have used the technology to increase another skill. However, the consumer who purchased the iPad did not know how to evaluate what app to purchase, what app was appropriate, etc. Therefore, the majority of the iPads were used for entertainment and game playing. We now know that mobile technology can be used effectively for not only entertainment and as an AAC device, but to also assist in teaching academic areas, social skills, video modeling, reinforcement, ABA, speech/language therapy, fine motor skills, visual supports , functional life skills, organizational skills, and increasing independence.
People with ASD have a need for, and a right to, the same range of communication options available to everyone else. Today, most people use multiple devices to address their communication needs. The idea that only ONE communication device can meet all the needs no longer makes sense. Some needs may be met by the mainstream device, while others may require accessories and techniques specifically designed for them (e.g., eye gaze, scanning, adapted keyboards, etc.). Multiple use technology extends past our current AAC technology and at a significant lower cost.
A growing concern for all individuals with ASD is employment and having skills to live independently. National data indicates that the majority of adults with autism are unemployed or underemployed (Institute for Community Inclusion, 2012). Employment is a critical component for having a productive adult life. Individuals living with autism deserve the opportunity to contribute as productive workers in appropriate employment settings; paying taxes and improving their quality of life. Barriers to successful employment for individuals with autism can be poor communication skills; lack of social “soft skills” such as small-talk, office politics, and unspoken requirements; the ability to complete the job independently without a job coach; or sensory issues within the work environment. The use of mobile technology can address some of these barriers.
So why is technology helpful in treating individuals with ASD?
Using devices like tablets and other hand-held devices are useful tools, because they are flexible and portable unlike other dedicated AAC devices that often can be heavy and cumbersome. A hand-held device is easily carried and can promote peer acceptance. The touch screen and layout are more accessible for individuals with coordination or learning difficulties—sliding and tapping are easier than typing. Technology can improve communication with others by the timely use of email or texting, which has a cost and time savings. Technology allows for adaptability and motivation.
Many people with ASD are visual thinkers. According to Temple Grandin, author, speaker, and an individual with ASD, pictures are their first language, and words are their second language. As concrete, literal, visual thinkers, individuals with autism can process information better when they are looking at pictures or words to help them visualize information. Technology just makes visual images more accessible to the individual with ASD. Computer graphics capture and maintain their attention.
Some individuals may have auditory sensitivity and are better able to respond to lower sounds. Using computers we can easily download appropriate voice levels and adjust sound according to the individual’s needs. An individual with ASD or their family may use an app like Noise Down, which will automatically sound an alarm when the decibel level gets too high, or Too Noisy Pro to indicate to the individual that they are being too loud.
Some individuals with autism are unable to sequence. Technology can reduce the number of steps required for the completion of a task or give a visual representation of the task steps in sequence. An example of a use app for sequencing tasks is Sequencing Tasks: Life Skills. Sequencing options are lists of printed words, words and pictures, just pictures, voice/no voice, etc.
Often individuals with ASD have difficulty with fine motor skills making handwriting difficult. Technology helps reduce the frustration with handwriting or drawing. Using a keyboard, touch screen, or speech-to-text app can reduce the difficulty and frustration, thus increasing the individual’s enjoyment for learning. Considering the national data on employment for individuals with autism, teaching technology for skills such as writing needs to be employed as early as possible. Yes, knowing how to write your signature and other information is important, especially when technology is not available; however, when looking at what handwriting skills are currently being utilized today versus keyboarding, dictation, or writing on a screen with a stylus or your finger, we clearly see the current skills needed. In addition, there are many apps that allow individuals to practice fine motor skills in other areas besides handwriting or keyboarding.
Some individuals do not use speech for communication. In times of high stress, they may need additional augmentation to produce verbal thoughts and words. They can use technology as a voice output device to speak for them and help them express themselves more fluently. Nonverbal children with autism find it easier to associate words with pictures if they see the printed words and a picture together. The web can give unlimited access to pictures and words! There are numerous AAC apps, from low- to high-tech, that can be used by individuals living with autism.
It is thought that some individuals with autism cannot look and listen at the same time. Their immature sensory system cannot process simultaneous visual and auditory input. Using technology, they can gradually increase their ability to use both, or alternate between visual and auditory input.
Some children with autism will learn to read phonetically, and others will learn visually with whole words. Voice output helps with the auditory reinforcement, and computer graphics can help the students visualize the words and, therefore, increase their reading skills.
Many individuals with autism have difficulty with executive functioning and struggle with organizational and self-management skills. Again, there are several apps that will assist with organization and self-management with calendars, schedules, work systems, etc. Apps such as Visual Schedule Planner, Pocket Schedule, or Functional Planning System are just a few that assist with organization and self-management.
Today, there are over one million apps available, and the number continues to grow daily. The apps range in price from free to several hundred dollars. There is an app for anything and everything. However, caution must be used. Like all strategies used for the treatment of ASD, the selection of the technology and/or the apps must be personalized to meet the individual needs of the learner. Assessment and data are necessary before making a decision about any technology used. What is the population/individual you will be working with? What skills do you want to target? In what context will the technology/app be used? How do these skills compare with their peers? What will be the outcomes you are expecting?
Two good search engines for finding appropriate apps are Autism Apps and i.AM Search. Autism Apps will allow you to search by category, price, and device rating for the skill/s you want to target. Autism Apps links to reviews by parents, specialists, and other users, usually from first-hand experience; it also has links to video demonstrations or video reviews of the app when available. i.AM Search allows you to create a profile for an individual by supplying the age, gender, and level of dependence of the individual on others to level of independent use of technology. Once the information is entered, it will do a quick search for appropriate apps fitting that profile for review.
Some websites for looking for apps include:
Smart apps for Special Needs
Apps and Autism
Apps for Children with Special Needs
Mobile Learning 4 Special Needs
The decision-making process of how and when to use technology with an individual with ASD, should be a thoughtful and well planned. A decision made by a team of professionals, family members, and the individual wherein the strengths, communication needs, personal characteristics and goals of the individual match the features of the technology is the best strategy. When assessing an individual for a mobile device or communication app, issues such as usability, integration, discontinuance, technology compatibility, context, and sensory and cognitive demands need to be considered. In particular, the goal of AAC has always been about communication and not about the device. The pace of technology is changing more rapidly than ever before and will continue next year, and the next, and the next. This kind of readily-accessible technology is exciting and holds promises for individuals with ASD and other disabilities. There is research to be done, consumer input to be gathered, and commitments to be made. Our work in the world of ASD is always evolving!
Dawson, G. and Watling,R. (2000). Interventions to facilitate auditory, visual, and motor integration in autism: A review of the evidence. Journal of Autism and Developmental Disorders, 30, 415-421.
Bouck, E., Savage, M., et al. (2014). High-tech or low-tech? Comparing self-monitoring systems to increase task independence for students with autism. Focus On Autism and Other Developmental Disabilities, 29, 156-167.
McKinney,T. and Vasquez, E. (2014). There’s a bug in your ear!: Using technology to increase the accuracy of DTT implementation. Education and Training in Autism and Developmental Disabilities, 49, 594-600.