Use of Technology to Support Self-Management in Individuals with Autism: Systematic Review

Toward a strengths-based model for designing virtual reality learning experiences for autistic users

LAY ABSTRACT

Virtual reality has been studied for its potential in supporting individuals with autism, but existing research often focuses on deficits and lacks consideration of individual preferences and strengths. This article introduces a framework that emphasizes the strengths and abilities of autistic individuals when designing virtual reality interventions. It builds upon an existing taxonomy of educational technology affordances and extends it to align with the unique needs of autistic individuals. The framework provides guidance for incorporating virtual reality technology that supports and amplifies autistic strengths, such as visual perception and response to positive feedback. The framework has implications for practice, research, and policy. For practitioners, it offers a tool for designing virtual reality experiences that cater to the strengths of autistic individuals, enhancing engagement and educational outcomes. Researchers can utilize the framework to guide the development of user-centered virtual reality interventions and expand our understanding of the potential benefits of virtual reality for autistic populations. Policymakers and educators can consider this framework when incorporating virtual reality into educational settings, ensuring that virtual reality technology is used in a way that aligns with the strengths and needs of autistic learners. Overall, the framework promotes a strengths-based approach in utilizing virtual reality technology for individuals with autism, fostering inclusivity and maximizing the benefits of immersive experiences.

Effectiveness of serious games in social skills training to autistic individuals: A systematic review

Autism Spectrum Disorder (ASD) is a complex neurological condition that significantly impacts individuals' daily lives and social interactions due to challenges in verbal and non-verbal communication. Game-based tools for psychological support and patient education are rapidly gaining traction. Among these tools, teaching social skills via serious games has emerged as a particularly promising educational strategy for addressing specific characteristics associated with autism. Unlike traditional games, serious games are designed with a dual purpose: to entertain and to fulfill a specific educational or therapeutic goal. This systematic review aims to identify and categorize serious computer games that have been used to teach social skills to autistic individuals and to assess their effectiveness. We conducted a comprehensive search across seven databases, resulting in the identification and analysis of 25 games within 26 studies. Out of the 104 criteria assessed across these studies, 57 demonstrated significant improvement in participants. Furthermore, 22 of these studies reported significant enhancements in at least one measured criterion, with 13 studies observing significant improvements in all assessed outcomes. These findings overwhelmingly support the positive impact of computer-based serious game interventions in teaching social skills to autistic individuals.

A Meta-Analysis of Self-Management Interventions in Teaching Daily Living Skills to Autistic Individuals

The current study aimed to conduct a systematic review and meta-analysis of self-management interventions for teaching daily living skills to autistic individuals. This study accessed the corresponding studies by doing a search in six databases. 14 articles and one dissertation met the inclusion criteria. The included studies were first analyzed descriptively and coded according to quality indicators using What Works Clearinghouse (WWC) standards. Second, the effect sizes of the included studies were calculated using two different effect size measures (i.e., Tau-U and performance-criteria-based effect size values [PCES]). Third, these analyses were also conducted for generalization and maintenance data. Of 15 studies included in this review, nine met the WWC standards with and without reservations. Tau-U analyses were conducted for 14 studies, whereas PCES values were calculated for only eight studies with mastery criteria. The findings indicated that the self-management interventions had a .93 CI95 (.80, 1) overall effect size for Tau-U with a very large effect. On the other hand, the overall effect size for the PCES values indicated a moderate effect with .99. The weighted effect sizes in generalization and maintenance phases were very large for Tau-U; however, moderate to high effects for PCES. Although self-management interventions showed diversity, one of the domains of daily living skills (i.e., community living skills) has not been studied in the field. Notably, among the studies in our review, the last ones are from 2019. Detailed findings from descriptive analyses and two different effect size calculations are discussed, and recommendations for future studies are given.

Using off-the-shelf solutions as assistive technology to support the self-management of academic tasks for autistic university students

Having the skills to self-manage the demands of academic life in third-level education is critical to the successful completion of courses taken there. Independent study behavior is an aspect of university life that pervades all topics but one that requires the self-management of time in relation to study goals. Individuals with additional educational needs, such as autism, often have difficulty self-managing independent study. This may result in students failing to meet the standards required for successful course completion. The current study (n = 2) used a range bound changing criterion design to evaluate the effects of a behavioral intervention that included assistive technology in the form of a smartphone and wearable smartwatch. The intervention aimed to increase the duration of independent study behavior among university students with autism. The intervention combined self-management (goal setting, self-monitoring, self-recording) together with assistive tech. to prompt engagement in, and recording of, independent study behavior. Findings showed the intervention to be effective at increasing independent study duration for autistic adults attending third-level education.

The use of social robots with children and young people on the autism spectrum: A systematic review and meta-analysis

Background

Robot-mediated interventions show promise in supporting the development of children on the autism spectrum.

Objectives

In this systematic review and meta-analysis, we summarize key features of available evidence on robot-interventions for children and young people on the autism spectrum aged up to 18 years old, as well as consider their efficacy for specific domains of learning.

Data sources

PubMed, Scopus, EBSCOhost, Google Scholar, Cochrane Library, ACM Digital Library, and IEEE Xplore. Grey literature was also searched using PsycExtra, OpenGrey, British Library EThOS, and the British Library Catalogue. Databases were searched from inception until April (6th) 2021.

Synthesis methods

Searches undertaken across seven databases yielded 2145 articles. Forty studies met our review inclusion criteria of which 17 were randomized control trials. The methodological quality of studies was conducted with the Quality Assessment Tool for Quantitative Studies. A narrative synthesis summarised the findings. A meta-analysis was conducted with 12 RCTs.

Results

Most interventions used humanoid (67%) robotic platforms, were predominantly based in clinics (37%) followed home, schools and laboratory (17% respectively) environments and targeted at improving social and communication skills (77%). Focusing on the most common outcomes, a random effects meta-analysis of RCTs showed that robot-mediated interventions significantly improved social functioning (g = 0.35 [95%CI 0.09 to 0.61; k = 7). By contrast, robots did not improve emotional (g = 0.63 [95%CI -1.43 to 2.69]; k = 2) or motor outcomes (g = -0.10 [95%CI -1.08 to 0.89]; k = 3), but the numbers of trials were very small. Meta-regression revealed that age accounted for almost one-third of the variance in effect sizes, with greater benefits being found in younger children.

Conclusions

Overall, our findings support the use of robot-mediated interventions for autistic children and youth, and we propose several recommendations for future research to aid learning and enhance implementation in everyday settings.

PROSPERO registration

Our methods were preregistered in the PROSPERO database (CRD42019148981).

ASDesign: A User-Centered Method for the Design of Assistive Technology That Helps Children with Autism Spectrum Disorders Be More Independent in Their Daily Routines

COVID-19 has posed new physical and mental challenges for the population worldwide, establishing social and structural changes in the labor market that could be maintained and implemented permanently. This new reality will require new strategies to improve family and work conciliation, which is especially challenging for families with children suffering from psychological pathologies such as autism spectrum disorder (ASD). These changes have led to more frequent and intense behavioral problems, causing stress, anxiety, and confusion for these children and their families. Thus, the need to have tools that help parents reconcile work with the care of these children, who have low autonomy, is reinforced. This work develops a method for the design of assistive technology and smart products to support children with ASD in following a routine and managing tasks autonomously. In this way, the article analyzes the design problem including the needs and preferences of children with ASD and their parents during confinement in terms of dependence and adaptability; develops a design method for interactive and smart products focused on children with ASD in confinement situations; and validates this method in a case study, in which a robot is developed that makes it easier for children with ASD to follow a routine.

Teaching adults with developmental disabilities to problem solve using electronic flowcharts in a simulated vocational setting

Teaching job-related problem-solving skills may increase the likelihood that individuals with developmental disabilities obtain and maintain employment (Kaye et al., 2011; Peck & Kirkbride, 2001; Unger, 2002). In this study, we evaluated the use of electronic-based flowcharts on an iPod Touch as a form of self-instruction to increase problem solving skills with 2 men diagnosed with developmental disabilities. An instructor implemented behavioral skills training (BST) to teach the participants how to use an electronic flowchart to solve one problem and then evaluated the participants' use of electronic flowcharts to solve other types of problems, including those that required more than one solution. Results showed increases in problem solving skills across at least 2 problems that were not associated with BST and increases across all problem exemplars with verbal reminders and feedback. These findings have important implications for increasing independence on the job and decreasing intrusive and costly supports for those with disabilities.

A framework of evidence-based practice for digital support, co-developed with and for the autism community

A wide array of digital supports (such as apps) have been developed for the autism community, many of which have little or no evidence to support their effectiveness. A Delphi study methodology was used to develop a consensus on what constitutes good evidence for digital supports among the broader autism community, including autistic people and their families, as well as autism-related professionals and researchers. A four-phase Delphi study consultation with 27 panel members resulted in agreement on three categories for which evidence is required: reliability, engagement and effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. These were differentially weighted as sources of evidence within these three categories.