Thursday, October 1, 2015

Assistive Technology for Children with Autism

by Susan Stokes Autism Consultant

For years, different modes of technology have been used to improve the quality of life of people who have various developmental disabilities. However, 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.

This article will discuss how various modes of technology (including technology designed as augmentative communication systems), 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 means 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 in order to improve the functional capabilities of children with autism.

Visual Representation Systems

It is important to determine which visual representation system is best understood by the child, and in what contexts. Various visual systems, such as objects, photographs, realistic drawings, line drawings, and written words, can be used with assorted modes of technology, as long as the child can readily comprehend the visual representation. 

Some children may need different visual representation systems in different situations. This may be dependent upon numerous factors, such as the skill being taught, as well as the unique characteristics of autism: attending, organization, distractibility, etc. 

Example: A child may use real objects for his visual schedule, as the objects appear to give him more information as to where he's going and what's coming up next, as well as to help him remain more focused during the transition. However, this same child may use photographs or line drawings in a picture exchange in order to communicate expressively.
Some researchers suggest that, for most children, it is best to start with a visual representation system of line drawings, and move to a more concrete representation system of photographs or objects needed (18). See the line drawings in Mayer-Johnson "Picture Communication Symbols". 

The Mayer-Johnson software program, Boardmaker, is a user-friendly program for both adults and children (18). The program offers a 3,000 Picture Communication Symbol (PCS) library in either black/white or color, and can be accompanied by any written word/message. The symbols can be made in any size, and tend to be universally understood. They present a relatively clear, 'uncluttered' representation and remove any ambiguity, which can sometimes arise when using photographs, especially personally-made photographs, as in the following example.

Example: A teacher took photographs of the various teachers that a child with autism encountered at school, in order to help him learn the names of his teachers. When reviewing the names of the teachers in the photographs, the child referred to the photograph of a particular teacher as "Mexico". Upon further review of this photo, the teacher realized that in the background, barely visible, was the corner of a map of Mexico. Although the teacher's face was the prominent feature in the photo, the child processed the minimally visible map as the most prominent feature and thus labeled the photograph according to this feature.

When using line drawings such as Boardmaker, caution should also be taken in determining whether to use black/white or color picture communication symbols, as some children with autism may prefer or dislike specific colors. They may focus only on the color instead of processing the entire picture. This will render the Picture Communication Symbol (PCS) virtually meaningless to the children as they are not processing the entire picture. Black and white picture communication symbols tend to remove any ambiguity which might arise. 

Example: If a child prefers the color red, and the Picture Communication Symbol (PCS) for "lunch" has a red apple as well as a brown sandwich and orange juice, the child may only process the apple, as it contains his preferred color. The child may not even process the image, but attend only to the color red. Therefore, the PCS becomes non-meaningful to the child.

If the child has difficulty understanding the Picture Communication Symbol (PCS) line drawings and needs a more concrete representation, a good software program to use is Picture This (20). This program allows for the presentation of real photos, without risking ambiguous background clutter, which can be a part of personal photographs. Picture This contains over 2,700 photos from numerous categories which are ideal for:
  •    Creating schedules;
  •    Augmentative communication systems;
  •    Games;
  •    Reading activities;
  •    Sequence activities for following directions;
  •    Various academic activities.
Strategy: To teach a child, who is using photographs or objects as his visual representation system, to understand black/white line drawings, place a small black/white picture communication symbol in the corner of the various objects/photographs currently used by the child. Gradually increase the size of the picture communication symbol until it eventually covers up the entire photograph/object.

For children who have difficulty understanding two dimensional visual representation systems (e.g., photo, drawings, line drawings), and require objects as their visual representation systems, the use of True Object Based Icons (TOBIs) is suggested (3). These TOBIs can be any line drawing, picture, etc., which are cut out in the actual shape or outline of the item they represents. The child can both see and feel the symbol and shape, thus assisting him to more readily understand the two-dimensional representation system. TOBIs tend to be somewhat larger than the typical two-dimensional visual representation system. When first introduced, they may be 3 inches in size or larger (3). The printed word label should always accompany the picture, and should be placed strategically so as not to alter the symbol shape. 

Strategy: When any visual representation system is used, it is important to combine it with a written word, as many children with autism exhibit a high interest in letters and words, and some even become early readers. Therefore we should continually enhance the child's literacy skills by also providing the written word with any type of visual representation system.

The rest of this article will outline the various skill areas commonly associated with children with autism, with supporting technology strategies defined as follows: 

"Low" Technology: Visual support strategies which do not involve any type of electronic or battery operated device - typically low cost, and easy to use equipment. Example: dry erase boards, clipboards, 3-ring binders, manila file folders, photo albums, laminated PCS/photographs, highlight tape, etc.

"Mid" Technology: Battery operated devices or "simple" electronic devices requiring limited advancements in technology. Example: tape recorder, Language Master, overhead projector, timers, calculators, and simple voice output devices.

"High" Technology: Complex technological support strategies - typically "high" cost equipment. Example: video cameras, computers and adaptive hardware, complex voice output devices. 

 If you reprint or use this article, or parts of it, please include the following citation:"Written by Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction. "


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