Mobile Technology as a Prosthesis: Using Mobile Technology to Support Community Engagement and Independence




© Springer International Publishing Switzerland 2016
Teresa A. Cardon (ed.)Technology and the Treatment of Children with Autism Spectrum DisorderAutism and Child Psychopathology Series10.1007/978-3-319-20872-5_11


11. Mobile Technology as a Prosthesis: Using Mobile Technology to Support Community Engagement and Independence



Kevin M. Ayres , Sally B. Shepley1, Karen H. Douglas2, Collin Shepley3 and Justin D. Lane4


(1)
The University of Georgia, Athens, GA, USA

(2)
Illinois State University, Normal, IL, USA

(3)
Oconee County Schools, Watkinsville, GA, USA

(4)
The University of Kentucky, Lexington, KY, USA

 



 

Kevin M. Ayres



Keywords
Instructional technologyAssistive technologyMobileSupportsIndependenceCommunication


Portable computer technology has existed since the late 1960s and early 1970s but was largely restricted to research and development centers (e.g., PARC). In 1989, Apple introduced a portable computer that weighed in at 16 lbs and cost over $6,000. In the late 1990s, researchers began using other mobile technologies such as portable DVD players (Mechling and Stephens 2009) and handheld computers (Davies et al. 2002) as instructional supports for children and adults with ASD and intellectual disability (ID). Broadly speaking, as technology became more mobile and less expensive, researchers found new ways to use these tools for instruction.

To facilitate a quality discussion of mobile technology, however, we must first define what “mobile technology” will encompass for this chapter. Historically speaking, one might argue that books are a mobile technology far more advanced than stone tablets and they are certainly much more portable. The focus of this chapter though will try to move closer to the edges of technological advancement and beyond the technology of a paperback book. Not to oversimplify, but the technology this chapter addresses incorporates some form of computer technology (electronic device designed to store, display, and process data; American Heritage Dictionary 2000) and can in general be carried in one hand or worn on the body.

The ubiquity of mobile technology establishes it as a socially valid tool for teaching and support. Two main principles will moderate this discussion. First and foremost, technology (whether a book or a laptop) is only a tool. Alone, technology cannot truly teach (even with self-instruction, one must learn to self-instruct first); someone (like a teacher) has to plan for how learning will occur with the technology. Second, computer technology changes very rapidly. Therefore, most of the discussion in this chapter will hinge on the application of the technology for teaching rather than on the specifications of the technology. Discussing the latest mobile phone from Apple (iPhone® 6 at the time of this writing) would only waste space and render large portions of the chapter obsolete less than a year after publication. Instead, if we attend to ways of using technology in general and the evidence base behind it, we can provide educators with a more practical reference.

The final consideration to address before moving forward is a conceptual distinction between instructional technology and assistive technology. This is not a perfect taxonomy as much as a means to help organize the discussion and narrow our focus. As suggested by Ayres et al. (2014), we consider instructional technology a tool (e.g., software) designed to help a learner acquire a set of responses (e.g., multiplication facts), typically used for a short period of time during the acquisition or fluency phase of learning (i.e., the technology will no longer be used once the learner can perform the target behavior independently). In contrast, assistive technology (or supporting technology) refers to tools a user might rely on indefinitely (e.g., an augmentative communication device, a calculator, or text/screen reader). Our focus will remain on the latter, assistive technology, and how this can help support greater independence and integration into the community, but more specifically how the technology can support self-management (SM). In this way, mobile technology can serve as a prosthesis: essentially an external support designed to compensate for something that is missing. Linsley (1964) wrote a pioneering paper in which he stated, “Children are not retarded [sic]. Only their behavior in average environments is sometimes retarded. In fact, it is modern science’s ability to design suitable environments for these children that is retarded” (p. 62). He goes on to discuss the idea of learning prosthesis. It seems that modern science may currently be providing quality portable prosthesis that can help individuals better access their environments.


Technology as a Teaching Tool


Though we will not discuss technology as a teacher-directed instructional tool, we want to highlight some brief uses of technology as an aide for instruction. This will help provide some context for later discussion around self-instruction. Examples of technology as an aide for instruction include using (a) an MP3 player and headphones as a prompting device for teaching daily living skills (Taber-Doughty 2005), (b) a portable DVD player to teach cooking tasks (Mechling and Stephens 2009), and (c) handheld computers (early HP windows based and older, now defunct Palm OS) to teach a range of academic and vocational skills (Davies et al. 2002; Mechling and Savidge 2011). What these examples have in common is that a teacher used technology-delivered prompting rather than more traditional teacher-delivered prompting for the learners to acquire the target skills. This advancement in technology-based instruction with mobile devices is laudable as it created opportunities for further development and advancement. This work served as evidence that these tools have value to educators as well as students. In addition, often these materials had practical utility for educators beyond their initial use because they could easily be reused with other learners and provided consistency across instructors (i.e., a teacher and paraprofessional use the same prompt).

Once students acquire new skills like those referenced above, they require less assistance from parents, teachers, or peers in accessing their community. Educators desire outcomes like this because they represent the success of their work. Thinking hypothetically for a moment, how many combinations of skills does a person need to learn in order to live independently in their community? Certainly more than 100, probably more than 1000, and that number will differ from student to student and from location to location. Regardless of whether we settle on an exact number, the figure will surpass what any reasonable educator can hope to accomplish in the approximately 18 years of public schooling a student receives. Whereas students without ASD learn innumerable skills that facilitate independence incidentally through experience and observing others, many children with ASD require direct instruction to acquire the same skills (Wolery and Hemmeter 2011). Given that time constraints in a school setting a teacher cannot feasibly provide direct instruction for all of the skills a student needs to maximize their life outcomes. Just like teachers do not teach children to spell every single word they will ever need to learn, they should not teach children with ASD every skill they will need to learn. Rather they should consider teaching them a means to learn any new skill just as we teach children to identify the letter sounds in the words they want to spell. This is the role technology (i.e., assistive technology) can help fulfill.


Technology as Prosthesis


For technology to serve as a daily (or even intermittent) support, an individual has to learn to use the technology for this purpose. Think of how you learned to search for information online. Likely, you required at least a little initial instruction to input commands and then sift through information. Teaching someone to use technology requires not only the instruction on how to manipulate the technology but also on how to respond to prompts and other supports offered by the technology. Mobile technology offers an almost ideal platform for self-instruction because of its portability and usability. Further, no one standing in the middle of a store or on the street corner looks out of place staring at the screen of a smart phone, thus illustrating the social acceptability and validity of the technology.

Moving further into the concept of mobile technology as a self-instructional support, we should consider how many people watch videos on their mobile devices. Whether they stream a video file on YouTube or watch a movie on Netflix, they have the means to have a constant stream of information with them. Constructive use of video delivered through conventional Web sites or via purpose built software applications (apps) may permit users to have self-instructional support available to them in a wide range of environments at the point at which it is needed.

Technology can play multiple roles simultaneously to maximize outcomes for individuals with ASD. Understanding the wide range of options for how an educator or caregiver can use technology to help support an individual and subsequently help the individual support him/herself will create greater opportunities for maximizing life outcomes. However, it is important to recognize technology alone is of minimal benefit. For example, a slate and stylus were once revolutionary educational technologies, but the inert objects themselves were poor teachers. If a student was going to learn to write a sentence on the slate, a teacher had to teach him/her. If a student was going to use the slate to keep a list to help remember tasks, someone had to teach him/her. Technologies such as these are merely mediums. Teachers have to plan and arrange the environment to occasion the use of the technology and then prompt and instruct efficient use of that technology. Through this, students gain independence with the technology just as students previously gained independence with a slate and stylus. Eventually that slate and stylus evolved into notebooks, pencils, and post-it notes. In these later examples, the technology can become a prosthesis; it can provide an individual with opportunities they would not have otherwise had without the technology. As readers move through the rest of the chapter, hopefully they will note that the emphasis is not on the glitz of the technology but on the ways that the technologies are used and the means by which research shows us how to use them. The chapter will discuss mobile technology for communication and then SM more broadly.


Communication


As individuals with ASD experience difficulties with effective and appropriate social communication at varying levels (DSM-5), the use of mobile technology as an augmentative and alternative communication (AAC) device may assist individuals who have substantial support needs in communication (Chung and Douglas 2014; Shane et al. 2012; van der Meer et al. 2011). Mobile technologies now provide smaller, lighter, and cheaper AAC devices in comparison with the traditional AAC systems such as DynaVox, Tango, and GoTalk (McNaughton and Light 2013). They also have the potential to decrease the negative stigmatization often times associated with less commonplace devices which in turn could increase their adoption and usage (McNaughton and Light 2013), and decrease the potential for abandonment (Johnson et al. 2006). While there are many specialized apps to support the communication needs of individuals with ASD (Alliano et al. 2012; Bradshaw 2013; Gosnell et al. 2011), we will focus on two apps in particular—Proloquo2Go® and AutisMate.

Proloquo2Go® is a symbol-based communication app only available on Apple devices. There are over 14,000 symbols available or personalized photographs can be inserted. When a symbol or phrase is tapped, it speaks in a naturally sounding voice. The app can be easily customized to meet the vocabulary and page layout needs of individual users. Emails, texts, Tweets (via Twitter), and Facebook posts can be sent from the app also. Talk Tablet, iCommunicate, Voice4U, and iConverse are other grid-based communication apps similar to Proloquo2Go®. In the literature, elementary-age children with ASD displayed increases in reciprocal peer interactions in inclusive settings when trained to use Proloquo2Go® in conjunction with adult-mediated interaction opportunities and environmental arrangement strategies (Chung and Douglas 2014). A comparison of Proloquo2Go® on an iPad® with PECS produced mixed results (Hill and Flores 2014). The authors concluded that PECS may be the preferred communication method during early intervention and then be generalized to use on mobile devices. Additional research is needed to show the effectiveness and long-term outcomes of Proloquo2Go® and similar apps for individuals with ASD.

AutisMate is a unique app in that it promotes the development of communication and life skills. As an AAC device, it provides visual scene displays with hot spots so items can be labeled or a phrase related to the item can be spoken. Visual scene displays show images of an entire environment (e.g., a classroom) with hot spots (clickable areas) over portions of the environment that may be linked to communication. There is also a grid-based sentence builder with over 12,000 symbols that can be customized in terms of the page organization and the number and size of the symbols. This feature is similar to Proloquo2Go®. In addition to being a communication app, AutisMate provides or allows users to create video models, visual schedules with audio and videos embedded, and visual stories to support the completion of tasks at home, school, and work. AutisMate also includes a predictive keyboard and built-in GPS capabilities.

Light et al. (2004) found children aged 4–5 able to interpret meaning from both visual scene displays and grid-based displays, whereas Drager et al. (2003) and Olin et al. (2010) found younger children under three years old more successful with the visual scene over the grid screen. While these studies did not include children with ASD, the results suggest that more cognitive processing skills may be needed to interpret isolated symbols in comparison with the visual scenes with items presented in naturally occurring locations Shane (2006). Visual scenes portraying activities and events can help improve the comprehension of spoken messages as the visual picture can provide context clues (Shane 2006). Four criteria for effective visual scenes set forth by Dietz et al. (2006) include the following: (a) environmental setting, (b) interactional depiction, (c) individual relevance, and (d) clarity of scene items and their meaning. Other visual scene display apps include Scene Speak, Scene & Heard, and Touch Chat.

While AAC apps are showing great promise, we would be remiss not to mention potential challenges. First, an AAC system should be selected based on the individual’s needs and skills (Beukelman and Mirenda 2013) and not because it is the latest technology fad (McNaughton and Light 2013). Second, educators and users need to learn how to operate and program the device for optimal functionality. Finally, a benefit and a challenge are devices serving multiple purposes (e.g., AAC device, visual schedule, GPS locator, and leisure games), in which the AAC app may not be able to run simultaneously with another app (King et al. 2013). This can potentially limit the accessibility and functionality of the AAC software as individuals would have to toggle between multiple apps. Even though we have to be cognizant of potential challenges, we cannot dismiss the many benefits and positive outcomes of using mobile technology with AAC apps.


Self-management


Self-management (SM) is an evidence-based practice that teaches individuals with ASD to, overtime, control their behavior (Brock 2013). Although this strategy may require an upfront investment in time and training, as the instructor fades support the learner may generalize instruction to novel environments, as well as display (similar) untrained behaviors that serve the same purpose with minimal reliance on training from staff (Lee et al. 2007). By increasing SM strategies on the job and in the community, individuals with ASD will decrease their reliance on external prompts and staff in order to follow a schedule and complete necessary tasks, thus increasing their independence (Mechling 2007).

Mechling and Savidge (2011) evaluated the use of a handheld device (i.e., PDA), in lieu of the traditional picture schedule used in the TEACCH model (Treatment and Education of Autistic and Communication Handicapped Children; Mesibov et al. 2005), as a mobile schedule for students with ASD to complete a set number of independent tasks. Students used a mobile device to view the first task, in which they could listen to an auditory prompt or watch a video model, complete the task, and then advance to the next screen to view the next task. This process was repeated until all tasks were complete, and the student was prompted (via the device) to access a preferred item. This form of mobile technology not only served as a “to-do” list, a SM tool, but it also taught the students how to complete the novel tasks (i.e., self-instruction).

Similarly, Cihak et al. (2010) taught four elementary students with ASD to navigate a handheld device (i.e., Apple video iPod®) to view video models of upcoming transitions through the school. Prior to transition, researchers provided each student with the device and instructed him or her to turn it on. Students viewed the provided video model and then lined up with their classmates. Video models of transitions presented on a handheld device increased all four students’ independence with transitions while also decreasing target inappropriate behaviors (e.g., aggression, elopement, and dropping).

A traditional, hand-written to-do list does not alert you to specific times in which events must occur. For example, there are days when you must be ready (e.g., showered, dressed) by a certain time, in order to catch transportation (e.g., bus, subway, taxi), also at a specific time, to be at a set place (e.g., job, party, appointment), again at an exact time. Following this type of schedule requires the ability to respond correctly to alarms or reminders, another aspect of SM. Davies et al. (2002) compared the efficiency of a hand-written task with a digital clock to a handheld device (i.e., Windows palmtop computer) running a scheduling program. The program provided audio and visual prompts at set times in the day. The reminders could replay automatically, upon request of the adults, or until confirmation that they completed the activity. The handheld device resulted in less assistance and fewer errors over the hand-written task list and digital clock.

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Jun 14, 2017 | Posted by in NEUROLOGY | Comments Off on Mobile Technology as a Prosthesis: Using Mobile Technology to Support Community Engagement and Independence

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