JCPSLP VOL 15 No 1 March 2013

Computer-assisted assessment and intervention

What’s the evidence? The use of iPods ® or iPads ® to support communication intervention for children with ASD Dean Sutherland

A scenario “You are contacted by parents of a 5-year-old who has autism spectrum disorder (ASD). The parents have recently seen a TV documentary that included footage of several children and young adults with ASD using iPods ® and iPads ® during communication exchanges with adults. The family have already purchased an iPad ® and now want you to provide support to teach their child how to communicate using the device.” A clinical question Up to half of all children diagnosed with ASD may be candidates for some form of augmentative and alternative communication (AAC) system due to the considerable difficulty they experience developing spoken language (Mirenda & Iacono, 2009). An appropriate clinical question to ask is “Which AAC system will result in positive communication outcomes for this particular the child?” The answer to this question requires careful assessment and consideration of the available evidence. This issue is becoming more challenging as parents or family members are exposed to information that includes bold statements about the therapeutic powers of new mainstream technology such as the iPad ® . More specifically, the scenario described above leads to the question: “Are iPads ® or iPods ® effective in supporting the development of Information Center (ERIC), Medline, ProQuest and PsycINFO. The search terms used were: autism; ASD; developmental disabilities; communication; augmentative and alternative communication; SGD; speech-generating device; Proloquo2go; iPad; iPod . The inclusion of both iPods ® and iPads ® was considered appropriate as the functionality of these devices is identical when used as a speech generating device (SGD). Only English-language publications were considered and no date restrictions were applied during the search. Additional manual searches of identified publications’ reference lists were also conducted. Only articles that reported outcomes from research studies involving children or young people with ASD using iPads ® or iPods ® for communication purposes in an intervention setting were included. Forty-seven potential articles were identified, of which 9 met the criteria for inclusion. These included 8 individual studies and one systematic review. The systematic review covered the 8 individual studies (Kagohara et al., 2013). The 8 studies identified reported findings involving between 1 (Kagohara et al., 2010) and 5 (Flores et al., 2012) participants aged 4 (van der Meer, Sutherland, communication skills in children with ASD?” Searching for the evidence In order to answer this question, a systematic search was conducted of 4 electronic databases: Education Resources

O’Reilly, Lancioni, & Sigafoos, 2012) to 23 (van der Meer et al., 2011) years. The studies reported the use of iPods ® only (e.g., van der Meer, Didden et al., 2012), iPads ® only (Flores et al., 2012) or a combination of iPods ® and iPads ® (e.g., Kagohara, van der Meer et al., 2012). The studies also involved either the Pick a Word (Flores et al., 2012) or Proloquo2go™ (all other studies) applications loaded to the iPad ® or iPod ® in order to provide the visual symbols and voice output functionality. The evidence The 8 articles reviewed provided level III-2 evidence (NHMRC, 1998) in support of the use of iPods ® or iPads ® for children with ASD to support new, or increase existing communication skills. Level III-2 evidence is in the mid- range of the NHMRC’s hierarchy for determining the certainty that studies are designed to answer the research questions and reduce the effect of bias. Table 1 contains summary information of the identified articles. The studies identified were limited in scope to naming pictures and requesting preferred items (e.g., toys or snacks). Seven of these articles were based on studies using well-constructed single-case experimental designs (Schlosser, 2003). For example, independent and dependent variables were clearly identified, the studies included clear information on how experimental control within and between participants was achieved, and high levels of inter-observer reliability were reported (Koul & Corwin, 2011). Critical appraisal of an example of the evidence Van der Meer, Kagohara, et al. (2012) was selected for critical appraisal as this article reported findings from a study that investigated children’s preferences for AAC options (manual signs vs iPod ® ) and the influence of any preference on increasing vocabulary skills (i.e., requesting “more”). Aim of the study The aims of the study were to determine: • children’s preference for communication using an iPod ® compared to manual signs; • if the use of a preferred mode of AAC leads to increased production of manual signs or use of an iPod ® to request ‘more’ access to a toy or snack item. Study methodology Four children aged 5 to 10 years with diagnosed ASD (n = 2) or developmental disability with ASD-like behaviours (n = 2) participated in the study. The Vineland-II (Sparrow, Cicchetti, & Balla, 2005) was used to determine participants’ level of expressive language. Age equivalences of between 8 months and 2 years: 1 month were recorded. Sessions took place in a small room immediately adjacent

Dean Sutherland

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JCPSLP Volume 15, Number 1 2013

Journal of Clinical Practice in Speech-Language Pathology