JCPSLP March 2013

Computer-assisted assessment and intervention

JCPSLP

Volume 15, Number 1 2013

Journal of Clinical Practice in Speech-Language Pathology

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

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

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

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

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,

What’s the evidence?

The use of iPods

or iPads

to support communication

intervention for children with ASD

Dean Sutherland

Dean Sutherland