The Impact of Technology Based Interventions on Autism

The autistic disorder is defined by specific diagnostic criteria as determined in DSM-V (APA, 2013). Although individuals with autism demonstrate a broad spectrum of difficulties and abilities, and overall intellectual functioning levels vary among them, all individuals diagnosed with autism show qualitative impairment in social communication, interaction and restricted repetitive patterns of behavior, interests or activities. The Center of Disease Control (CDC, 2018) statistics related to diagnosis of autism indicated that 1 out of 68 children in the United States will be diagnosed with autism spectrum disorder. In addition, when those individuals had speech and language disabilities, children require to have alternative communication strategies to express themselves. Impairments in communication had significant influence on their quality of life, and development of social relationships. Therefore, children’s life are negatively affected. 

Several theories focused on explaining and understanding major cause of autism at the psychological and cognitive level. It is a neuropsychiatric disorder derived from a Greek word autos which means isolated self where an individual keeps himself/herself isolated from the surrounding interactions. Clinical symptoms of autism arose due to irregularity in the computational and physical connectivity of neurons. Its manifestations are appeared as disturbed sleep and other sleep problems, depression, anxiety (Belmonte et al., 2004).

Several studies have investigated the impact of technology-based interventions on children with autism. In this report, it was aimed to provide empirical support for the efficacy of technology-based interventions in children with autism. It is important to note that during this paper is written a previous review was considered (Goldsmith & LeBlanc, 2004) but papers cited here was deeply investigated in relate to a impact of technology in children with autism.

Technology Advances for Children with Autism

Children with autism needed external stimulus prompts for initiation, maintenance and termination of their behaviors. Advances in technology created automated prompting devices in which human effort to deliver prompts remained less. Auditory and tactile prompts are the most commonly used one which has been shown to have significant effects in children behavior.

For instance, the use of auditory prompts decreased off-task behavior for a student with autism and moderate mental retardation (Taber, Seltzer, Juane Heflin, & Alberto, 1999). The male student at the age of twelve with autism was given to use a self-operated auditory prompting system in which this system consisted of prompts with recorded music such as “keep working, pay attention”. By the help of this technology, there has been shown reduction in inappropriate and off-task behavior both at school and home. This study is important because children with autism are appeared as heterogeneous learners (i.e several prompting approaches could be utilized at the same time and children may prefer one prompting strategy into other) and therefore the efficacy of auditory learning has been proven through this study in which difficulties using auditory strategy are eliminated. The main reason showing success of auditory prompting proposed in the paper is explained as relevant auditory stimuli is isolated but irrelevant stimuli is filtered out. In addition, frequency of prompt delivery was increased which resulted in meaningful reduction from baseline teacher prompts. Therefore, increase in frequency during prompt delivery enhanced task fluency and reduction in inappropriate behavior might be observed (Taber et al., 1999). Since auditory prompting devices require less human power, they can be used to get benefit to maintain behaviors of children with autism. For instance, auditory prompts such as mp3 players, portable compact disks can be used to decreasing off-task behaviors of children with autism.

Tactile prompting has also successfully used in children with autism. For instance, “Gentle Reminder” was the device with vibrating function in which child is prompted to initiate during play sessions. Taylor and Levin’s study (1998) investigated conditions with no prompt, verbal prompt (prompt verbally done by adult) and tactile prompt (i.e vibratory prompt). Tactile prompt conditions lead to significant increases in verbal initiations in none-prompt and verbal prompt conditions. The most profound finding of this study is that tactile prompting resulted in more verbal initiations even when the Gentle Reminder device was not active. However, spontaneous initiations did not observe since prompt fading approach were not effective in the subject. The main limitation of this study was only one child with autism is used. In addition, in the follow-up study, subject were not aware that Gentle Reminder device signaled him to speak (Taylor & Levin, 1998).  Tactile prompting applications should also be applied to several skills. For instance, tactile prompting should be used to prompt children to look before crossing street, to increase eye contact and to take their medication. In addition, future research should allow effective prompt fading which is gradually reducing the prompt. Therefore, by the help of prompt fading, children’s performance should be carefully monitored and prompt dependence of children should be prevented. Collaboration of researchers with technology developers will allow new products as well as the use of auditory and tactile prompting will become more important intervention approach for children with autism.

On the other hand, video technology is economically applicable and portable and several people can utilize this technology without needing an instruction. In addition, video technology is a great tool for modeling a behavior, and appearing as a medium for presenting fundemental instructions for children (Sturmey, 2003). Therefore, use of video may increase skills in children with autism. Indeed, many studies supported this claim in which video modeling effectively used to teach conversational speech, increase task fluency, improve social communication and improve perception of emotion and encourage social initiations (Better, 2001; Corbett, 2003; Lasater & Brady, 1995; Nikopoulos & Keenan, 2004; Sturmey, 2003). Charlop and Milstein (1989) compared effectiveness of video interventions to in vivo modeling for teaching development skills in children with autism. Results suggested that video modeling result in faster acquisition of play, improvement in language and self-help skills in comparison to in vivo condition (Charlop & Milstein, 1989). The most notable finding of this study is that video intervention resulted in extremely good outcome in children’s speech and language deficits.   In sum, video technology is popular, low-cost and user-friendly technology in which its effectiveness was proven in children with autism. As a future recommendation, researchers and clinicians should design video models with clear and detailed behaviors which minimizes irrelevant stimuli and should combine video modeling with intervention approaches such as reinforcement to increase effective learning.

Computer-based interventions are used to teach numerous skills including how to recognize and predict emotions, increase problem solving abilities, improve vocabulary, enhance vocal imitiation, improve reading and communication  skills (Heimann, Nelson, Tjus, & Gillberg, 1995; Moore & Calvert, 2000; Silver & Oakes, 2001). For example, a computer animated tutor was shown to improve vocabulary and grammar in children with autism (Bosseler & Massaro, 2003). Bosseler and Massaro (2003) demonstrated that children with autism after computer animated tutor (named as Baldi) identified significantly more items and children recall 85% of newly learned items at least a month after training is completed. In addition, more importantly, children with autism were able to identify, use and transfer what they learn in the real world with a person indicating that computer-based intervention occurred might be an effective strategy in the treatment of autism. Moore and Calvert (2000) compared computerized instruction with a lower-tech behavioral program for vocabulary instruction for children with autism. Results demonstrated that children with autism learnt more vocabulary through the computer instruction rather than low-tech behavioral program. As a result, computer-aided interventions lead to enhanced motivation, reduction in inappropriate behavior and enhanced task performance. However, this study used very small sample size and variations in the responses of children with autism were also observed. In conclusion, although limitations, this study clearly demonstrated the efficacy of computer aided programs on children’s attention, motivation and promotion of their vocabulary learning  (Moore & Calvert, 2000).

Apart from computer-based interventions, advances in virtual reality technology created opportunities to experience three-dimensional and computer-generated world which helped behavioral responses of children with autism. Wearing a heavy awkward helmet, two children were asked to walk within the virtual environment. Children responded the virtual task in an excellent manner and had a willingness to interact to virtually created world. Moreover, researchers found that children with autism who engaged in virtual reality tasks have improved attention and performance (Max & Burke, 1997). In addition, the increase in the ability of children to focus on tasks supports potential significance of virtual reality interventions. Although, this mentioned research give preliminary data about the possible applications of virtual reality for children with autism, more empirical research is needed. The most notable feature of virtual reality applications allows researchers to control and arrange the environment which may promote learning and improvement of children with autism. In addition, highly realistic and safe environment may allow to teach skills just like in the natural environment. However, its cost and programming requirements are disadvantages.

Robotics, on the other hand, should be used as therapeutic work in children with autism in which robots as social interaction tools increase children’s skills. The most impressive advance in robotics was the Aurora project (Dautenhahn, 2003; Dautenhahn & Billard, 2002) in which non-humanoid mobile robot with very simple interaction skills become a toy that serve therapeutic purposes for children with autism. In the beginning of the project, truck-style robots were designed since it was believed that non-human appearance of this robots may better maintain interaction (Graham-Rowe, 2002). This truck robot was programmed with several commands that is necessary to play games.

Next, it was modified to consist of a central point of focus resembling eyes in which children are promoted to have sustained eye contact by this way. This robot was further improved with the “Robota” version since truck robot offers very small amount of interaction with children. The main appearance in humanoid Robota provided an excellent interaction tool to child in which mimicking of body parts as well as more complex actions were seen.

Consequently, this humanoid robot demonstrated in the paper of Dautenhahn and Billard (2002) can detect and copy movements such as head turning and arm rising. This was especially important for children with autism indicating robots are safe interaction partners for children.

Using the numerous robotic models, the Aurora project has moved forward into different stages. In the first stage, data gathered from the 5 children indicated that (1) children are able to interact with robots safely, (2) children were not afraid of robots, (3) the motivation of children to interact with the robot is sufficient, (4) children prefers reactive mode in robots rather than rigid, repetitive and non-interactive behavior. In the second stage, data gathered from 18 children and results demonstrated that majority of the children demonstrated more interest in the robot. In the last stage, researchers found that the established interactions with robot and children were not artificial, social interactions among pairs of children were also observed (Dautenhahn, 2003).

According to Chandler (2016), the most recent advance in technology is appeared as conversation simulations. The newly developed system allows autism spectrum people to have realistic conversations such as job interview with a simulated person. This system was developed by Dr. M. Ehsan Hoque of the University of Rochester in which it provided instant feedback on user’s interactions such as maintaining eye contacts and appropriate voice level and tone. The system is constructed on artificial intelligence. Results collected on this system showed significant improvement in those who got personalized feedback training.

Discussion and Future Directions

Recent advances in technology allow children with autism to have improved life style based on the research provided above. For instance, auditory and tactile prompting, computer-based interventions, virtual reality intervention, use of robotics, as well as use of system based on artificial intelligence improves interaction skills for children with autism. However, these systems are not generally reachable for everyone due to their costs. Therefore, families who have children with autism should be supported by governmental funds to reach the most efficient technology-based interventions.

Future research should focus on multidisciplinary collaborations with programmers, psychologists as well as researchers. Since technology is dependent on computers, the more collaboration means more products to help children with autism. In addition, new cheaper innovations are required in this field.

The main limitations occurring in the technology-based interventions targeting children with autism is the small sample size used. In spite of being limited amount of subject, future research should be tested the outcomes of technology based interventions using more children with autism which will be leading to more accurate results in terms of understanding  the efficacy of these methods. Moreover, more effective strategies should be developed when more sample is used.

In conclusion, technology creates excellent opportunity in children with autism. Several research supports the efficacy of these tools, although more research and design are required.

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