July 31, 2017

ASSISTIVE TECHNOLOGY: A support for children with autism spectrum disorder

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.

Assistive technology supporting children with autism spectrum disorder

The inability to communicate effectively 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.

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.

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. Children’s increasing use of technology implies both educational and communicational practices because it is now a common environmental factor in their lives (Watt, 2010). Children today are often referred to as “native speakers” of technology. This is often true for students with ASD as well. Many individuals on the autistic spectrum are more comfortable interacting with inanimate objects such as a computer or iPad. Also, many individuals are visual learners and have strong technological skills.

Until recently, the majority of the iPads were used for entertainment and game playing. Although the varied use of technology for children with autism continues to receive limited attention, despite the fact that technology tends to be a high-interest area for many of these children, we now know that it 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, speech/ language therapy, fine motor skills, visual supports, functional life skills, organizational skills, and increasing independence.

Various modes of technology can be used for children with autism to increase or improve their:

Overall understanding of their environment;
Expressive communication skills;
Social interaction skills;
Attention skills;
Motivation skills;
Organization skills;
Academic skills;
Self-help skills;
Overall independent daily functioning skills.

What is Assistive Technology?

According to the Technology-Related Assistance for Individuals with Disabilities Act of 1988 (Public Law 100-407), an assistive technology refers to any item, piece of equipment, or product system, whether acquired commercially, off-the-shelf, modified or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. Assistive technology service is any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.

Typically, children with autism process visual information easier than auditory information. Any time we use assistive technology devices with these children, we're giving them information through their strongest processing area (visual). Therefore various types of technology from "low" tech to "high" tech should be incorporated into every aspect of daily living to improve the functional capabilities of children with autism.

How can assistive technology help a child on the spectrum?

The process of determining the most appropriate assistive technology devices and services for your child will begin with an evaluation. The evaluation can be conducted by your child’s school or by an independent agency or consultant and should address both strengths and challenges that your child possesses. Assistive technology can help your child learn the classroom material in a way that he/ she can understand it. It can also help reduce the barriers your child may face that may prevent them from being at the same level as his/ her classmates.

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 the sound according to the individual’s needs. There are apps that an individual with ASD or their family may use which automatically sound an alarm when the decibel level gets too high, or indicate to the individual that they are 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 an app used 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 of learning.

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.

In particular, when used in the classroom, assistive technology allows the children who need support to:

Better understand their environment
Improve communication skills
Increase social interaction
Build better attention skills
Expand motivators
Improve organizational skills
Keep up with the classroom curriculum
Increase independence

Strategies

The strategies used in assistive technology can be divided into three main categories: low-tech strategies, mid-tech strategies, and high-tech strategies.

Low-Tech Strategies
These are low-cost technology strategies. For example, visual support strategies that do not involve any form of technology such as a dry erase board, clipboards, 3-ring binders, manila file folders, photo albums, laminated PCS/photographs, highlight tape, etc.
Regular and consistent use of individualized schedules helps to increase a child’s organizational skills while at the same time fostering independence and discouraging challenging behavior. Examples of individualized schedules include calendars and visual routine checklists that tell a child what is currently happening, what will happen next when they are “all done” with something and any changes that might occur. With each completion of a task, the child can mark off is done. Be careful to select images the child will find helpful. For example, if color tends to confuse or over-stimulate a child, use black and white instead visuals instead.

Mid-Tech Strategies
These strategies involve some type of battery operated device such as a tape-recorder, Language Master, overhead projector, timers, calculators, and simple voice output devices that enhance specific skill areas.

Most devices in this category refer to Voice Output Communication Aids (VOCAs).It is important to understand that these products were created for use as an “augmentative means to expressively communicate.” These devices include “Big Mack,” “Talk Pad,” “Voice in the Box,” “Cheap Talk 4”, “Step by Step Communicator.”
These strategies help to develop skills dealing with language comprehension, expressive communication skills, social and attending socials, organizational skills and academic skills

High-Tech Strategies
These are complex technical support strategies - typically "high" cost equipment, such as video cameras, computers, and adaptive hardware, complex voice output devices.

Some of the skills they are used to develop language and social skills.
Nonverbal social cues such as tone of voice, body language, facial expressions, etc. can be demonstrated and studied through the use of video as well.
The use of computers by children with autism could increase attention and focus while at the same time, increase fine motor skills and decrease agitation. In some cases, the computer may need to be adapted to the child’s particular needs.

Conclusion

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?

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.

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