Clare Hudson examines a number of devices and applications designed to assist and develop technology skills for people with disabilities.
For many people, devices such as iPods and iPads have become an extension of their arm. They give us so much at the touch of a screen. They keep us up-to-date on the everyday movements and special events of those who may not be in close proximity (or, in some cases, may be!), and on news from around the world. They provide all sorts of on-the-spot entertainment from music to DVD, games to virtual worlds. And no matter what the issue or problem someone always knows of ‘an app for that!’ This development in the technological world has brought with it fantastic opportunities, particularly in the area of support and development of communication skills.
There are so many options that it’s hard not to feel like the proverbial ‘kid in a candy store’ when we browse our ‘local’ app store (without even having to leave the house!) But the sheer volume of options can quickly become overwhelming and it can often be daunting to know where to start; how to know what you or your child would benefit most from, what type of devices and apps would be appropriate and how to begin using the app. This article aims to point you in a helpful direction with these decisions and dilemmas, discusses how technology can be used for social connection, and finishes with an example of how technology in the form of Skype has been used in an innovative way to connect and provide support for teenagers who stammer.
Techie Words: What the words mean
Advances in technology have brought us a new vocabulary. I for one am guilty of using ‘techie words’ without really understanding what I’m saying, always to be caught out in the mobile phone shop when I realise I am unable to fully participate in the conversation I have started. So, I am going to provide a quick reminder of what I think I mean by a few ‘techie’ words that will be used in this article.
‘App’ is short for “application”, which refers to a software application or a software programme used on a smartphone or mobile device such as the Android, iPhone, iPad or iTouch.
‘Android’ is an operating system for mobile phones and tablets, in much the same way that PCs run Microsoft Windows as their operating system. It is maintained by Google.
‘Tablet’ refers to a tablet computer; a mobile computer with a touch screen display, circuitry and battery in a single device. iPad by Apple is a type of tablet device.
Choosing technology: Where to start?
- Decide on the purpose of the device or app
Devices and apps are available to support education, leisure skills, communication, independent living, social skills and employment. Determine whether the focus is to support the individual’s language and communication skills, or to teach numeracy or literacy, or indeed to provide an activity in which the individual can engage independently for a period of time (e.g. a game or a film).
Figure 1 outlines some of the areas of communication that can be supported and developed through the use of technology.
Figure 1: Elements of Communication which can be supported through use of technology
*AAC: Alternative and Augmentative Communication includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. Voice Output Communication Aid (VOCA) is an aided AAC system as it is a device in addition to the users’ body.
- Match the capabilities and needs of the user/individual to the features of the device/app
Factors to consider when choosing a device/ tablet include
- screen size,
- screen glare,
Factors to consider when choosing an app to use include
- the picture or symbol system used and whether and how easily the system can be personalised with photographs,
- the ability to change the grid size (number of symbols/pictures on a page),
- the presence or absence of a voice output,
- the layout of the folders,
- the capacity for language development.
- Identify and include an appropriate instructional approach as part of the intervention package, as this is required to enhance communication
AAC users and communication partners (the person(s) with whom we communicate) benefit from support and training to use specific techniques and strategies to maximise the benefits and effectiveness of AAC. Likewise it is important to think about what the communication partner can do to support the user to use an app or technology to transition or complete a task more independently.
Wading Through the Apps
There are thousands of apps available to support and develop communication skills, so that the search for the right app can seem overwhelming. I have found some of the following websites and resources useful in my work and others have been recommended to me:
On this website, apps are organised in sections relating to their general purpose (e.g. communication, education, fun, life skills) in an interactive ‘app wheel’ (last updated in April 2015, see Figure 2). The website allows the user to click on each app icon to find out more about the app. This website also publishes regular app reviews which aim to provide an evidence-based perspective on apps for autism.
Figure 2: Interactive app wheel compiled by Sue Fletcher-Watson.
Mark Coppin has also developed an ‘Apps for ASD’ wheel identifying the features that are important when choosing a suitable app. This can be viewed at https://itunesu.itunes.apple.com/audit/COH3CQR8H2
For AAC, http://aactechconnect.com/wp-content/uploads/2011/07/Apps-SummarySummer-6.10-14..pdf provides a list of AAC apps, including information about key features of each app, which will help in discussions with the speech and language therapist as to an app that might best meet your AAC needs.
A fact sheet about iPad and Tablet apps has been published by I CAN, the children’s communication charity, at
Apps relating to the various areas of communication including language, speech, emotions, social communication and organisation are outlined in an easy to read table which includes the price and comments about the app.
In my experience, many apps are regularly updated as a result of both user feedback and further advances in technology. An example of this is in visual schedule/organisation/social story apps. Where once these apps were personalised through use of photographs, they can now be personalised through use of video of the individual completing the task, or steps in the task. Planned use of videos is known as ‘Video Modelling’ and ‘Video Self-Modelling’ and have been found to be effective means of skill acquisition, maintenance and generalisation for individuals with ASD (Bellini & Akullian, 2007).
Apps vary in price; some are free with others being relatively expensive. Many apps offer a ‘lite’ version, which is a free taster of the app and others offer a free trial period of the app. Trials and ‘lite’ versions can be a very effective part of the decision-making process to know if the app is the right one for you at the moment. In addition, there are a number of websites, blogs or forums on which parents and app users provide reviews and personal accounts of their use of the apps.
Apps as VOCAs
If technology is being used as a VOCA it is advisable that parents, the device user and the speech and language therapist work in partnership to identify and plan when the device will be used, with what vocabulary and the role of the communication partner (the listener) during interactions. ‘Augmented input’ (Elder & Goosens, 1994 cited in Mirenda, 2001; Cafeiro, 2005) is an approach advocated by many in the field of AAC that involves the communication partner simultaneously touching the corresponding symbols to his/her spoken words as they are spoken. This provides a model to use the VOCA. Alternatively, some apps have specific instructional packages in which the communication partner is less actively involved. Regardless of the instructional approach, integration of the VOCA into an individual’s everyday activities has been shown to lead to the most successful outcomes for functional communication (Beukelman & Mirenda, 2005). In terms of evidence-based practice, various analysis of research into the use of technology such as iPad and iPod to enhance the communication of individuals with developmental difference such as ASD has shown favourable outcomes (e.g., Kagohara et al., 2013; Alzrayer et al., 2014)
Apps for Interaction & Leisure
We know that individuals learn best when they are interested and engaged in an activity. If tablet technology and apps are attractive and engaging for you or a family member, it is important for communication partners and practitioners to use this interest to foster and build communication and interaction skills, even if this is not the advertised purpose of the app. It is worth considering “The 7 Ps of Using Mobile Technology in Therapy” (DeCurtis & Ferrer, 2011) as a guide to help to maximise interaction and communication with the device or app in everyday situations. The 7 Ps are:
- Preparation: What is the rationale behind using an app versus using actual books/toys?
- Participants: Consider characteristics of the child using the device/app
- Parameters: What is the appropriate amount of time for the child to spend using the device? Might the device interfere with naturally occurring communication at times?
- Purpose: What is the advertised purpose of the app? How can this app meet a child’s goals (by means of this purpose or using the app in an alternative way)?
- Positioning: How and where should you position the child and/or yourself to maximise interaction and communication?
- Playtime: How will you and your child experience shared enjoyment with the app?
- Potential: How will you extend and expand the learning gained from using an app to real-life experiences and to support future learning?
For more information on “The 7 Ps”, see http://pampclub.org/site/2011/07/01/maximizing-mobile-technology-with-toddlers-preschoolers .
Managing Time with the Tablet
As with all exciting developments comes caution. Learning and interacting through technology alone may not always provide everything a child needs for development; variety of learning opportunities should be encouraged. Many parents, however, have discussed how it can be difficult to limit time with technology. The National Autistic Society (www.autism.org.uk/technology) suggests ways to manage the amount of time and quality of time a user spends with portable technology. The suggestions include:
– Use the child’s routine to make the technology available at specific times;
– Use the battery life icon;
– Use an online timer;
– Use different coloured cases when using the device for different purposes.
Technology for Social Connection
Social media such as Facebook and Twitter and online communities are increasingly used as a means of staying connected with friends and families, creating new relationships with like-minded individuals and exploring topics and dilemmas in an undisclosed manner. The face-to-face element of social communication can be eliminated in communication via technology. For some individuals for whom initiating and maintaining conversation can be a daunting task, social media can allow a greater sense of control over the conversation, more time to process what has been ‘said’ and what to ‘say’, and avoids the need to process the non-verbal messages that come with face-to-face interactions. Within the literature on the use of technology by individuals with ASD, the themes that emerge relate to the sense of empowerment and social connection experienced by people using technology as a medium for communication as well as the voice given to this community (Byrne, 2013; Davidson, 2008).
“Technology doesn’t mean sitting alone in a darkened room any more, and the line between technology and ‘real life’ is disappearing” (NAS, 2015, www.autism.org.uk/technology).
‘Cyber safety’ is an important element of any online activity. It is critical that internet users are aware of the dangers that exist when talking online and learn to be cyber safe.
Technology and Innovative Practice
Advances in technology also provide a challenge to the teams working with individuals with communication needs and their families. Many practitioners are involved in innovative practice using technology. An example of this can be found in the work of The Irish Stammering Association, which runs an online support group for teenagers who stammer. Callum Wells, Speech and Language Therapist, explains below how the online group works including feedback from participants:
Irish Stammering Association runs a monthly online support group for teenagers who stammer. The group aims to provide a place for teenagers who stammer from all over Ireland to meet, chat and share experiences online. The group uses Skype to connect to a video conversation. The group is facilitated by speech and language therapists but the young people discuss topics of interest to them. The group was established in early 2014 and members hail from various parts of the country. Feedback from members has been positive: “I get to talk to people and I don’t [need to] think about my speech”, “I’m going out of my comfort zone…it’s a good thing and helpful” and “the call reminds me about techniques”. As a group facilitator, I have enjoyed being part of the discussion on stammering and have been impressed by the willingness of people to share experiences and support each other. A variety of topics have been discussed ranging from stammering to X-Factor contenders, which allowed for a more free-flowing and fun conversation. I hope that more young people from different parts of the country will participate in upcoming groups and that they will be empowered from group support.
Callum Wells’ contact details: firstname.lastname@example.org
Final Thoughts …
Advances in technology have brought new opportunities to support, develop and enhance communication skills. This technology may be life-changing for some families but it is rarely the answer to all the communication needs of an individual. Communication is by definition an interactive process where messages are sent between a speaker and a listener. The listener is vital to the further development of communication skills, even with the addition of a device or app.
Alzrayer, N., Banda, D., & Koul, R., (2014) Use of iPad/iPods with Individuals with Autism and other Developmental Disabilities: A Meta-analysis of communication Interventions
Bellini, S., & Akullian, J., (2007) A Meta-Analysis of Video Modelling and Video Self-Modelling Interventions for Children and Young People with Autism Spectrum Disorders, Exceptional Children, 73, 261-284
Beukelman, D.R., & Mirenda, P. (2005) Augmentative and Alternative Communication; Supporting Children & Adults with Complex Communication Needs (3rd Edition) Baltimore: Paul H Brookes Publishing Co.
Byrne, J., (2013) Autism and Social Media: An exploration of the use of computer mediated communications by individuals on the autism spectrum, University of Glasgow Chancellor’s Fund, Student Project Report FINISH THIS REFERENCE WITH WEB PAGE
Cafiero, J. (2005) Meaningful Exchanges for People with Autism; An Introduction to Augmentative and Alternative Communication, (MD: Woodbine Inc
Cafiero, J. (2008) Technology Supports for Individuals with Autism Spectrum Disorders, Technology in Action, 3, 3, 1-12
DeCurtis, L. L., & Ferrer, D. (2011). Integrating mobile technology using a family-focused approach. CSHA Magazine,41, 1, 10–11, 25.
Howard, S.C., Laubscher, E.H., Schlosser, R.W., Flynn, S., Sorce, J.F., Abramson, J., (2012) Applying Technology to Visually Support Language and Communication in Individuals with Autism Spectrum Disorders, Journal of Autism and Developmental Disorders, 42, 1228-1235
Kagohara, D., et al (2013) Using iPods and iPads in teaching programs for individuals with developmental disabilities: A systematic review, 34, 147 – 156
Mirenda, P. (2001) Autism, augmentative communication, and assistive technology: what do we really know? Focus on Autism and Other Developmental Disabilities, 16, 3, 141- 151