Instructional considerations for young children with autism: the rationale for visually cued instruction

The Need for Technology-Aided Instruction and Intervention Policy for Autistic Youth

This paper examines current technology-aided instruction and intervention (TAII) available for autistic transition-age youth (TAY) and existing policies that may support or hinder the delivery of these interventions. Specifically, we focus on policies that might influence the delivery of TAII to autistic TAY. After a careful review of the literature, we observed that postsecondary policy guiding the delivery of TAII designed to support autistic TAY is lacking. TAII have demonstrated effectiveness, usability, sustainability, and cost-effectiveness, particularly with this population. We suggest possibilities for future policies to support the development, implementation, and evaluation of TAII for autistic TAY.

Teaching Children with Autism Spectrum Disorder to Answer Questions Using an iPad-Based Speech-Generating Device

This study investigated whether a systematic instruction package was effective in child acquisition of question answering using an iPad-based speech generating device (SGD). The study was conducted with two children with autism using a multiple probe across behaviors design. Results demonstrated that the systematic instruction package consisting of graduated guidance, discrete trial teaching, time delay, and reinforcement resulted in acquisition of answering all questions. Follow-up data were collected one, three, and five weeks after instruction ended. For all participants, skills maintained during follow-up and generalized to novel settings and skills. Social validity data were also collected and indicated that teachers without experience using SGDs found them to be effective and feasible for teaching communication skills.

Influence of Modified Instructions on Locomotion Subtest Scores Using the Peabody Developmental Motor Scales, Second Edition

PURPOSE

The current study assessed whether changes in verbal and visual cues used to clarify requirements of the task would result in significant score differences on the Locomotion subtest of the Peabody Developmental Motor Scales, Second Edition (PDMS-2), in children aged 2.5 to 5 years.

METHODS

The Locomotion subtest of the PDMS-2 was administered twice, 2 to 10 days apart, to 37 children. Age-matched and gender-matched groups received instructions in both standardized and modified formats, where order depended on group assignment.

RESULTS

Instruction type resulted in a significant change in Locomotion scores with a medium effect size and no significant interactions between instruction type and age or between instruction type and test order.

CONCLUSIONS

Findings suggest instruction modifications using altered verbal and visual cues change PDMS-2 Locomotion subtest scores in children with typical development. These results support previous literature indicating that normative scores should not be reported if modifications were used during testing.

On the Evaluation of Engagement in Immersive Applications When Users Are on the Autism Spectrum

New generation wearable devices allow for the development of interactive environments tailored for Virtual Reality (VR)- and Augmented Reality (AR)-based treatment of Autism Spectrum Disorders (ASD). Experts agree on their potential; however, there is lack of consensus on how to perform trials and the need arises for evaluation frameworks, methods, and techniques appropriate for the ASD population. In this paper, we report on a study conducted with high-functioning ASD people in the 21-23 age range, with the objectives of (1) evaluating the engagement of two headsets offering distinct immersive experiences, (2) reasoning on the interpretation of engagement factors in the case of ASD people, and (3) translating results into general guidelines for the development of VR/AR-based ASD treatment. To this aim, we (1) designed two engagement evaluation frameworks based on behavioral observation measures, (2) set up two packages of reference immersive scenarios, (3) defined the association between metrics and scenarios, and (4) administered the scenarios in distinct sessions for the investigated headsets. Results show that the immersive experiences are engaging and that the apparent lack of success of some evaluation factors can become potential advantages within the framework of VR/AR-based ASD treatment design.

Effects of a Gamified, Behavior Change Technique-Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults With Autism Spectrum Disorder: Feasibility Randomized Controlled Trial

BACKGROUND

Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD.

OBJECTIVE

This study aimed to compare the effectiveness of a gamified and behavior change technique-based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population.

METHODS

A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI.

RESULTS

The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05).

CONCLUSIONS

Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617.

Using Self-Management and Visual Cues to Improve Responses to Nonverbal Social Cues in Adults With Autism Spectrum Disorder

Many individuals with Autism Spectrum Disorder (ASD) experience challenges with social communication, including recognizing and responding to non-verbal cues. The purpose of this study was to assess the efficacy of self-management combined with textual cues to teach adults with ASD to recognize and respond to nonverbal expressions of boredom and confusion during social conversation. A multiple baseline across participants design was used to assess the efficacy of this intervention for three participants. Results showed substantial gains across all participants in their recognition and responsiveness to the targeted nonverbal cues. Moreover, this skill maintained after the completion of intervention and generalized to novel conversation partners and settings with large effect sizes. The findings add to the literature base on interventions for adults with ASD, and further support the use of self-management and textual cues as effective intervention strategies for improving nonverbal communication.

Combined Effects of Virtual Reality and Computer Game-Based Cognitive Therapy on the Development of Visual-Motor Integration in Children with Intellectual Disabilities: A Pilot Study

PURPOSE

Visual-motor integration is a good indicator of a child's overall developmental and functional level. This study investigated the combined effects of virtual reality (VR) and computer game-based cognitive therapy on the development of visual-motor integration in children with intellectual disabilities.

METHODS

The study used a single-group pre-post study design and 13 children with intellectual disabilities who were recruited from a community rehabilitation center participated in the study. We used the Wii VR video game and the CoTras computer game to deliver cognitive therapy over 12 sessions. The Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) was used to evaluate motor function related to visual-motor integration to identify changes in function, and the Developmental Test of Visual Perception-2 (DTVP-2) was used to assess changes in visual perception function associated with visual-motor integration.

RESULTS

The VR and computer game-based cognitive therapy has shown significant difference in total standard score of BOT-2 associated with visual-motor integration representing improved motor function (p < 0.01). Comparison of the DTVP-2 scores showed the significant difference in visual-motor integration of spatial relation and visual-motor speed (p < 0.05), motor-reduced visual perception (p < 0.01), and general visual perception (p < 0.01).

CONCLUSIONS

Results of this study provide useful evidence supporting the possibility of combined VR and computer game-based cognitive therapy for children with intellectual disabilities.

Beyond the Motor Domain: Exploring the Secondary Effects of a Fundamental Motor Skill Intervention for Children With Autism Spectrum Disorder

Early motor skill interventions have been shown to improve the motor skill proficiency of children with autism spectrum disorder; however, little is known about the secondary effects associated with these types of interventions (e.g., influence on behavior, social skills, family dynamics). The purpose of this qualitative study was to (a) investigate parents' perceptions of the child-level benefits associated with a fundamental motor skill intervention for their 4-year-olds with autism spectrum disorder and (b) explore how child-level benefits influenced the family unit. Eight parents (N = 8) were interviewed (semistructured) about their experiences with the intervention for their child(ren); the study was grounded in phenomenology. Five main child-level benefits emerged, including improvements with (a) motor skills, (b) social skills, (c) listening skills, (d) turn-taking skills, and (e) transition skills. The child-level benefits then extended to family members in a number of ways (e.g., more positive sibling interactions). These findings highlight several important secondary effects that should be investigated in future research.

Using a kinect-based game to teach oral hygiene in four elementary students with intellectual disabilities

BACKGROUND

Individuals with intellectual disabilities (ID) may have difficulties in performing daily living tasks. Among other daily living tasks, independent oral hygiene is an essential life skill for people with ID.

MATERIALS AND METHODS

Four children with intellectual disabilities (two males and two females, ages 7-11) participated in the experiment. We employed the Kinect^TM V2 sensor to gamify oral hygiene skill training. Specifically, a non-concurrent multiple baseline design was adopted to demonstrate the relation between game-based intervention and independent oral hygiene skills.

RESULTS

All students learned how to brush their teeth independently and maintained the skill 4 weeks later with the introduction of the game-based training. Social validity results showed the teachers and parents considered the video game was useful.

CONCLUSIONS

The proposed Kinect-based video game might be used for effective training of elementary students with ID to improve oral hygiene independently.

Usability inquiry of a gamified behavior change app for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder

The purpose of this study was to conduct the first usability inquiry of a gamified, behavior change theory-guided mobile app PuzzleWalk for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder (ASD). Eighteen adults with and without ASD participated in a mixed-methods study that consisted of cognitive walkthrough, system usability assessment, and qualitative interviews. The results of the system usability testing indicated satisfactory quality of the PuzzleWalk system that can be readily applicable to both adults with and without ASD. Several notable issues were identified from the qualitative interviews that address critical insights into unique health and social needs in adults with ASD. Future work is warranted to examine the long-term effects of the PuzzleWalk system on increasing physical activity and reducing sedentary behavior in adults with and without ASD in real-world settings.

Visual and verbal semantic productions in children with ASD, DLD, and typical language

PURPOSE

Associations between visual and verbal input allow children to form, augment, and refine their semantic representations within their mental lexicons. However, children with autism spectrum disorder (ASD) and with developmental language disorder (DLD; also known as specific language impairment) process visual and verbal information differently than their typically developing peers, which may impact how they incorporate visual and verbal features into their semantic representations. The purpose of this exploratory study was to investigate how children with ASD and DLD use visually and verbally presented input to produce semantic representations of newly learned words.

METHOD

Semantic features produced by 36 school-aged children (12 with ASD, 12 with DLD, and 12 with typical language development) were extracted from previously collected novel word definitions and coded based on their initial presentation modality (either visual, verbal, or both in combination) during an extended novel word learning paradigm. These features were then analyzed to explore group differences in the use of visual and verbal input.

RESULTS

The children with ASD and DLD produced significantly more visually-presented semantic features than their typical peers in their novel word definitions. There were no differences between groups in the proportion of semantic features presented verbally or via both modalities in combination. Also, the children increased their production of semantic features presented via both modalities combined across the sessions; this same increase in production was not observed for the semantic features taught in either the visual or verbal modality alone.

CONCLUSION

Children with ASD and DLD benefit from visually presented semantic information, either in isolation or combined with verbal input, during tasks of word learning. Also, the reinforcement of combined visual-verbal input appears to enhance semantic learning over time.

Positive Effect of Visual Cuing in Episodic Memory and Episodic Future Thinking in Adolescents With Autism Spectrum Disorder

Cognitive studies generally report impaired autobiographical memory in individuals with autism spectrum disorder (ASD), but mostly using verbal paradigms. In the present study, we therefore investigated the properties of both past and future autobiographical productions using visual cues in 16 boys with ASD and 16 typically developing (TD) participants aged between 10 and 18 years. We focused on sensory properties, emotional properties, and recollection, probing past and future productions for both near and distant time periods. Results showed that the ASD group performed more poorly than controls on free recall for recent periods, but performed like them when provided with visual cues. In addition, the ASD group reported fewer sensory details than controls and exhibited difficulties in the experience of recollection for the most remote events. These data suggest a combination of consolidation and binding deficits. Finally, our findings reveal the relevance of using visual cues to probe autobiographical memory, with possible perspectives for memory rehabilitation.

Using game technology to teach six elementary school children with autism to take a shower independently

OBJECTIVE

This paper contributes to research investigating the effectiveness of video game intervention in shower training of children with autism spectrum disorders. Previous studies have supported the use of video games in special education.

METHODS

We employed the Kinect sensor to gamify shower training. Specifically, a non-concurrent multiple baseline design was adopted to demonstrate the relation between game-based intervention and taking a shower independently. Six children in a special education class at a regular elementary school participated in the experiment.

RESULTS

Data showed that the percentage of correct task steps significantly increased among all six participants; motivation to engage in training was enhanced as well, thus improving task performance during the intervention and maintenance phases.

CONCLUSIONS

Although the game is a promising and highly accepted training tool for school-use, it currently remains error-prone, and the requested demand exceeds the support that can be provided by special education teachers. A more technically robust system, combined with additional attractive games, will likely result in higher participant motivation and superior task performance.

Moving Along and Beyond the Spectrum: Creative Group Therapy for Children With Autism

Group therapy for autism confronts the core of the syndrome. Non-directed dynamic approaches, in which moment-to-moment spontaneous expressions drive the content of group sessions, are even more intricate. The implementation of nonverbal creative techniques holds the key to self-expression and self-other exploration, promoting communication and play. This manuscript offers an integrative conceptual model and a case report regarding such mind-body therapeutic perspective. The creative arts intervention is presented via a small group of young minimally verbal children with autism, deprived of communicative language, offering an interdisciplinary perspective to delineate group challenges and rationale, process, and outcomes. Vignettes are provided to illustrate the group development. A thorough discussion follows, addressing three intertwining axes: firstly, the implications of nonverbal creative means are considered; secondly, the psychophysiological processes set in motion through sensory-motor experiences are deliberated; and thirdly, the emergence of "moments of meeting" and spontaneously generated playful group activities are enlightened.

Effects of Modified Instructions on Peabody Developmental Motor Scales, Second Edition, Gross Motor Scores in Children with Typical Development

Aims: The current study assessed whether modifying instructions on the Peabody Developmental Motor Scales, Second Edition (PDMS-2) affected scores in children with typical development. Methods: The gross motor portion of the PDMS-2 was administered twice, 2-10 days apart, to 38 children. Age- and gender-matched groups received instructions in both standard and modified formats, with order depending on group assignment. Results: Gross Motor Quotient results showed an effect for instruction type (p = .03) and an interaction between instruction type and order (p = .02). Improved scores for those given modified instructions during the second session indicated the interaction favored modifications. Stationary scores showed an effect for instruction type (p = .01) and an interaction between instruction type and age (p = .02). Object Manipulation scores showed an interaction between instruction type and order only (p =.002); Locomotion scores showed no significant changes (p = .25). Percentile rank changes ranged from 9% to 22% across subtests. Conclusions: Findings suggested instruction modifications may change PDMS-2 gross motor scores, even in children with typical development. Findings also suggested normative scores should not be reported if modifications were used during testing. Research is needed to determine optimal cues for the best representation of true motor ability during standardized assessment.

Promoting Peer Interaction for Preschool Children With Complex Communication Needs and Autism Spectrum Disorder

PURPOSE

This study investigates the impact of a multicomponent intervention on the social communication and engagement of preschool children with complex communication needs (CCN) and autism spectrum disorder (ASD) and peers without disabilities.

METHOD

Five dyads of children participated in this research. A multiple probe design across dyads was used to evaluate the effects of intervention on the frequency of communicative turns expressed by children with CCN and ASD in interactions with peers. Frequency of peer turns, percentage of turns taken by peers, and joint engagement were investigated to assess the quality of the interaction. The intervention included (a) provision of a communication app on an Apple iPad Air 2 and (b) dyadic turn-taking training.

RESULTS

Four of the 5 participants with CCN completed training and increased independent communicative turn-taking with peers. The 5th participant showed increased turn-taking during training but little change in independent turn-taking. All peers took more turns in intervention than in baseline, with no negative impact on the turn balance between participants. Average joint engagement increased for all dyads, although session-to-session variability was high.

CONCLUSION

The results from this study provide support for the use of this intervention to promote peer interaction for children with CCN and ASD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.5829678.

Comparing the effectiveness of two app-based number lines to teach price comparison to students with autism spectrum disorders

PURPOSE

A number line consisting of Arabic numerals is a commonly used instructional tool for teaching price comparison. However, typical number lines lack concrete visual cues, which may benefit students with autism spectrum disorders (ASD) who have not yet mastered the representation of Arabic numerals.

METHOD

This study investigated the effects of additional visual cues (i.e., dots) by comparing two types of app-based number line conditions: number lines with and without dots. A single-subject, alternating treatment design study was employed across five secondary students with ASD.

RESULTS

Both number line conditions were effective for four of the students in assisting them to select cheaper items and complete task analysis steps. The number line with dots was effective or slightly more effective in selecting smaller numbers for three of the students.

CONCLUSIONS

The findings of this study support the literature on the use of number lines as an effective tool to assist students in price comparison. The benefits of adding concrete visual cues and other teaching strategies (e.g., the holistic and decomposition models) were discussed. Implications for Rehabilitation This study investigated the effectiveness of concrete visual cues, such as dots, on a number line app for teaching students with ASD who had not yet developed the association of quantities with the numerals. We found that incorporation of a hybrid number comparison model - first holistic (for whole numbers) and then decomposition (for numbers after the decimal point) - is effective when teaching students how to compare prices with an uneven number of digits. This study provides an alternative for special education teachers to schedule practice, such as the use of simulated settings to achieve mastery, then transitioning to community-based settings to test skill generalization.

Using Peer-Mediated Literacy-Based Behavioral Interventions to Increase First Aid Safety Skills in Students With Developmental Disabilities

Many adolescents with developmental disabilities do not learn the safety skills needed to maintain physical well-being in domestic and community environments. Literacy-based behavioral interventions (LBBIs) that combine print, pictures, and behavioral rehearsal are effective for promoting acquisition and maintenance of self-care skills, but have not been investigated as safety skill intervention. Also, LBBIs have primarily been implemented by teachers and other professionals. In this study, a peer partner was taught to deliver an LBBI story to students so they would learn to perform a basic first aid routine: cleaning and dressing a wound. Results showed that students' accuracy with the first aid routine increased after a peer delivered the LBBI instructional package, and maintained after the peer stopped delivering it. This study demonstrates the effectiveness of the LBBI instructional package for teaching first aid safety skills, and extends previous research showing the efficacy of peers in delivering this intervention.

Effects of point-of-view video modeling for Korean adolescents with autism to improve their on-task behavior and independent task performance during vegetable gardening

Objectives: The present study examined the effects of a point-of-view video modeling (POV) during vegetable gardening for Korean adolescents with autism spectrum disorder (ASD) to improve their on-task behavior and independent task performance. Methods: Three male Korean adolescents, in the range of mild and moderate level on the Childhood Autism Rating Scale (CARS), participated in the study. A multiple probe across participants design was used to evaluate the effectiveness of the intervention. The intervention consisted of (a) point-of view video modeling of weeding and watering skills in gardening and (b) attending a vegetable gardening class right after watching the video modeling. Results: The results showed that all the participants showed an improvement in their on-task behavior and independent task performance. The improved outcomes of the intervention were maintained when the intervention was completed and was applied to other environments. Conclusions: The results suggest that using a POV approach during vegetable gardening could be a desirable intervention for adolescents with ASD to teach them vocational skills in their daily environments.

A virtual tutor for children with autism

Purpose

The picture exchange communication system (PECS) is an established communication intervention for non-verbal children with autism. The purpose of this paper is to present an evaluation of a computer-based PECS approach, in which young non-verbal children with autism respond to an on-screen “virtual tutor” through the manipulation of picture/symbol cards. The paper presents research to investigate how the virtual tutor’s voice influences the children’s participation and performance.

Design/methodology/approach

Eight non-verbal children between six and nine years old and with a diagnosis of autism were presented with a series of computer-based activities, using a virtual tutor with either a natural or synthetic voice, in two separate sessions. Data were gathered using a within-participants counterbalanced design to control against variations between individuals and effects of presentation order.

Findings

Analysis of the children’s responses suggest that they were able to use the system more effectively when the virtual tutor had a synthetic voice, rather than a human voice. The findings demonstrate that a computer-based virtual tutor can provide an engaging method of supporting symbol-based communication for non-verbal children with autism, and that a synthetic voice type was preferable for the sessions undertaken.

Originality/value

Investigations of voice type and its influence on non-verbal children’s participation and performance have so far provided inconclusive results (Ramdoss, 2013). This research suggests that the voice type is an important feature of the learning experience of non-verbal children with autism, and can have a significant influence on their participation and performance in virtual tutor-led learning.

Enhancing conflict negotiation strategies of adolescents with autism spectrum disorder using video modeling

Adolescents with autism spectrum disorder (ASD) have particular difficulty in negotiating conflict. A randomized control trial (RCT) was carried out to determine whether the negotiation strategies of adolescents with ASD would be enhanced via a 6-week intervention based on a video modeling application. Adolescents with ASD, aged 12-18 years, were randomly divided into an intervention group (n = 36) and a non-treatment control group (n = 25). Participants' negotiating strategies prior to and following the intervention were measured using the Five Factor Negotiation Scale (FFNS; Nakkula & Nikitopoulos, 1999) and the ConflicTalk questionnaire (Kimsey & Fuller, 2003). The results suggest that video modeling is an effective intervention for improving and maintaining conflict negotiation strategies of adolescents with ASD.

A Comparison of Prompting Tactics for Teaching Intraverbals to Young Adults with Autism

Several researchers have compared the effectiveness of tact or textual prompts to echoic prompts for teaching intraverbal behavior to young children with autism. We extended this line of research by comparing the effectiveness of visual (textual or tact) prompts to echoic prompts to teach intraverbal responses to three young adults with autism. An adapted alternating treatments design was used with 2 to 3 comparisons for each participant. The results were mixed and did not reveal a more effective prompting procedure across participants, suggesting that the effectiveness of a prompting tactic may be idiosyncratic. The role of one's learning history and the implications for practitioners teaching intraverbal behavior to individuals with autism are discussed.

Use of video modelling to teach complex and meaningful job skills to an adult with autism spectrum disorder

OBJECTIVE

To examine the effectiveness of a video modelling (VM) intervention to teach job-related telephone skills to an adult with Autism Spectrum Disorder (ASD).

METHODS

A multiple baseline design across four telephone-relevant behaviours was used to assess the effects of the intervention on the participant's ability to respond to telephone calls.

RESULTS

Use of the VM intervention led to immediate improvements in listening and responding to both orders and complaints; more gradual improvements were also observed in the participant's professional speech. All skill increases were maintained at follow-up.

CONCLUSION

VM may be an effective method of teaching complex vocational skills to adults with ASD, although a stronger focus on social skills may be warranted in the future.

Enhancing Vocal Imitations in Children with Autism Using the IBM Speech Viewer

This experiment compared the effect of computerized visual feedback (computer assisted instruction) with traditional play interaction (personal instruction) in promoting vocal imitation in children with autism. Ten non-verbal children with autism participated in ten sessions. Each session was composed of four sections: a parent and a trainer interacted with the child on the computer or using play interactions. The study was conducted as a simultaneous treatment design and the sequence of experimental conditions was randomized across sessions. Participants showed significantly greater vocal imitations in the computer assisted instruction condition, compared with the personal instruction condition. This trend was present in nine out of ten children. Vocal imitations increased across the sessions, with greater increments in the computer assisted instruction condition. These effects were consistent across both parent and trainer.

Video Modeling and Observational Learning to Teach Gaming Access to Students with ASD

The purpose of this study was to evaluate both video modeling and observational learning to teach age-appropriate recreation and leisure skills (i.e., accessing video games) to students with autism spectrum disorder. Effects of video modeling were evaluated via a multiple probe design across participants and criteria for mastery were based on these results. Secondary measures were collected on observational learning across participants and behaviors. Participants included 4 children with autism, ages 8-11, who were served in self-contained special education classrooms. Results indicated a functional relation between video modeling and increased independence in gaming; observational learning occurred for at least some steps across students. Results, implications for practitioners, limitations, and ideas for future research are discussed.

Accurate or assumed: visual learning in children with ASD

Children with autism spectrum disorder (ASD) are often described as visual learners. We tested this assumption in an experiment in which 25 children with ASD, 19 children with global developmental delay (GDD), and 17 typically developing (TD) children were presented a series of videos via an eye tracker in which an actor instructed them to manipulate objects in speech-only and speech + pictures conditions. We found no group differences in visual attention to the stimuli. The GDD and TD groups performed better when pictures were available, whereas the ASD group did not. Performance of children with ASD and GDD was positively correlated with visual attention and receptive language. We found no evidence of a prominent visual learning style in the ASD group.

An examination of the effectiveness of video modelling intervention using a speech-generating device in preschool children at risk for autism

OBJECTIVE

To investigate whether preschool children at risk for autism would learn to request a preferred object using a speech-generating device (SGD) following a video modelling (VM) intervention and generalize requesting behaviours to preferred objects across stimuli and communication partners.

METHOD

A single-subject multiple baseline design across participants (n = 3) was used to assess the effects of VM intervention on requesting behaviour. Intervention consisted of having each participant view a VM of two adults demonstrating the requesting of a preferred object using the SGD. Additionally, a least-to-most-prompting technique was employed to facilitate the production of a correct response.

RESULTS

All three participants demonstrated the ability to request preferred objects following the intervention and were able to generalize the newly acquired requesting behaviour across stimuli and people.

CONCLUSIONS

Study findings indicate that a VM treatment package is effective in facilitating communication in children with little or no functional speech.

Understanding the brain-behaviour relationship in persons with ASD: implications for PECS as a treatment choice

INTRODUCTION

This article presents emerging neurological findings in Autism Spectrum Disorders (ASD) with particular attention to how this information might inform treatment practices addressing communication impairments.

METHODS

The article begins with a general discussion of the brain-behaviour relationship and moves to the presentation of recent research findings related to ASD. There is particular attention to individuals with autism who are either non-verbal or present emergent verbal abilities.

RESULTS/DISCUSSION

A specific communication treatment, the Picture Exchange Communication System (PECS), is presented as an example of an intervention that addresses the learner needs of many individuals with ASD. The success of PECS is discussed within the context of its fit with brain-based learner characteristics.

Eye examination testability in children with autism and in typical peers

PURPOSE

To compare testability of vision and eye tests in an examination protocol of 9- to 17-year-old patients with autism spectrum disorder (ASD) to typically developing (TD) peers.

METHODS

In a prospective pilot study, 61 children and adolescents (34 with ASD and 27 who were TD) aged 9 to 17 years completed an eye examination protocol including tests of visual acuity, refraction, convergence (eye teaming), stereoacuity (depth perception), ocular motility, and ocular health. Patients who required new refractive correction were retested after wearing their updated spectacle prescription for 1 month. The specialized protocol incorporated visual, sensory, and communication supports. A psychologist determined group status/eligibility using DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) criteria by review of previous evaluations and parent responses on the Social Communication Questionnaire. Before the examination, parents provided information regarding patients' sex, race, ethnicity, and, for ASD patients, verbal communication level (nonverbal, uses short words, verbal). Parents indicated whether the patient wore a refractive correction, whether the patient had ever had an eye examination, and the age at the last examination. Chi-square tests compared testability results for TD and ASD groups.

RESULTS

Typically developing and ASD groups did not differ by age (p = 0.54), sex (p = 0.53), or ethnicity (p = 0.22). Testability was high on most tests (TD, 100%; ASD, 88 to 100%), except for intraocular pressure (IOP), which was reduced for both the ASD (71%) and the TD (89%) patients. Among ASD patients, IOP testability varied greatly with verbal communication level (p < 0.001). Although IOP measurements were completed on all verbal patients, only 37.5% of nonverbal and 44.4% of ASD patients who used short words were successful.

CONCLUSIONS

Patients with ASD can complete most vision and eye tests within an examination protocol. Testability of IOPs is reduced, particularly for nonverbal patients and patients who use short words to communicate.

A comparative study of sensory processing in children with and without Autism Spectrum Disorder in the home and classroom environments

Sensory processing and higher integrative functions impairments are highly prevalent in children with ASD. Context should be considered in analyzing the sensory profile and higher integrative functions. The main objective of this study is to compare sensory processing, social participation and praxis in a group of 79 children (65 males and 14 females) from 5 to 8 years of age (M=6.09) divided into two groups: ASD Group (n=41) and Comparison Group (n=38). The Sensory Processing Measure (SPM) was used to evaluate the sensory profile of the children: parents reported information about their children's characteristics in the home environment, and teachers reported information about the same characteristics in the classroom environment. The ASD Group obtained scores that indicate higher levels of dysfunction on all the assessed measures in both environments, with the greatest differences obtained on the social participation and praxis variables. The most affected sensory modalities in the ASD Group were hearing and touch. Only in the ASD Group were significant differences found between the information reported by parents and what was reported by teachers: specifically, the teachers reported greater dysfunction than the parents in social participation (p=.000), touch (p=.003) and praxis (p=.010). These results suggest that the context-specific qualities found in children with ASD point out the need to receive information from both parents and teachers during the sensory profile assessment process, and use context-specific assessments.

The Use of Peer Networks to Increase Communicative Acts of First Grade Students with Autism Spectrum Disorders

Peer networks including social groups using typical peers, scripted instruction, visual text cues, and reinforcement were examined with students with autism spectrum disorders (ASD). A multiple baseline design across four participants was used to measure students’ use of communication acts with peers during free play following instruction. Peer Network groups occurred over a 3-month period for 30 min 3 times per week. Visual inspection of trends and TauU effect size calculations showed significant changes in total communication acts for all four participants during peer network sessions and increased initiations for three of the four participants. Generalization probes during classroom centers indicated increased communications following interventions for three of the four participants.

Efficiency of lexical access in children with autism spectrum disorders: does modality matter?

The provision of visual support to individuals with an autism spectrum disorder (ASD) is widely recommended. We explored one mechanism underlying the use of visual supports: efficiency of language processing. Two groups of children, one with and one without an ASD, participated. The groups had comparable oral and written language skills and nonverbal cognitive abilities. In two semantic priming experiments, prime modality and prime-target relatedness were manipulated. Response time and accuracy of lexical decisions on the spoken word targets were measured. In the first uni-modal experiment, both groups demonstrated significant priming effects. In the second experiment which was cross-modal, no effect for relatedness or group was found. This result is considered in the light of the attentional capacity required for access to the lexicon via written stimuli within the developing semantic system. These preliminary findings are also considered with respect to the use of visual support for children with ASD.

Self-controlled technologies to support skill attainment in persons with an autism spectrum disorder and/or an intellectual disability: a systematic literature review

Persons with an autism spectrum disorder and/or intellectual disability have difficulties in processing information, which impedes the learning of daily living skills and cognitive concepts. Technological aids support learning, and if used temporarily and in a self-controlled manner, they may contribute to independent societal participation. This systematic review examines the studies that applied self-controlled technologies. The 28 relevant studies showed that skills and concepts are learned through prompting, interaction with devices, and practicing in (realistic) virtual environments. For attaining cognitive concepts, advanced technologies such as virtual reality are effective. Five studies focussed on cognitive concepts and two on emotion concepts. More research is necessary to examine the generalization of results and effect of using technology for learning cognitive and emotional concepts. Implications for Rehabilitation Persons with a moderate to mild intellectual disability and/or with autism can use self-controlled technology to learn new activities of daily living and cognitive concepts (e.g. time perception and imagination). Specific kinds of technologies can be used to learn specific kinds of skills (e.g. videos on computers or handheld devices for daily living skills; Virtual Reality for time perception and emotions of others). For learning new cognitive concepts it is advisable to use more advanced technologies as they have the potential to offer more features to support learning.

Exploring the feasibility of the visual language in autism program for children in an early intervention group setting: views of parents, educators, and health professionals

OBJECTIVE

To explore the views of key stakeholders on using visual supports for children with developmental disabilities in early intervention group settings. Specifically, this study aimed to determine stakeholders' views on the barriers to and facilitators for the use of visual supports in these settings to inform the feasibility of implementing an immersive Visual Language in Autism program.

METHODS

This study involved three focus groups of parents, educators, and health professionals at one Australian early intervention group setting.

RESULTS

Lack of time, limited services, negative attitudes in society, and inconsistent use were cited as common barriers to using visual supports. Facilitators included having access to information and evidence on visual supports, increased awareness of visual supports, and the use of mobile technologies.

CONCLUSION

The Visual Language in Autism program is feasible in early intervention group settings, if barriers to and facilitators for its use are addressed to enable an immersive visual language experience.

Prospective Social Entrainment: Imitation Interventions in Children With Autism

Imitation provides the basis for acquiring knowledge, as well as providing a foundation for the development of reciprocal social skills. Children with autism spectrum disorders (ASD) do not naturally imitate others, and it is hypothesized that deficits in imitation may impede their ability to develop both academically and socially. Early imitation intervention studies, using traditional direct teaching (e.g., teacher-directed discrete trial training), focused on the learning function of imitation and were successful in improving skill acquisition but had little impact on the development of socially successful interactions. More recently, imitation interventions have targeted reciprocal or synchronous imitation (e.g., child-directed reciprocal imitation training), focused on the social function of imitation and have resulted in gains in imitation abilities and concomitant improvements in social engagement. This article explores imitation deficits in individuals with ASD, describes basic and applied research focusing on improving imitation skills, discusses implications for clinical intervention, and provides a synthesis of the current literature within the framework of prospective cognition.