Tablet-Based Activity Schedule in Mainstream Environment for Children with Autism and Children with ID

Person-Oriented Research Ethics to Address the Needs of Participants on the Autism Spectrum

Research ethics scholarship often attends to vulnerability. People with autism may be vulnerable in research, but are also vulnerable to unjust exclusion from participation. Addressing the needs of participants with autism can facilitate inclusion and honor the bioethics principle of respect for persons while accounting for risk and vulnerability. Drawing from a review of the literature and informed by a moral deliberation process involving a task force of stakeholders (including autistic people and parents of autistic people), we use the model of person-oriented research ethics to identify several practical strategies researchers can use to address these needs and foster inclusion. Strategies include using multiple means of communication, addressing the sensory environment, preparing participants in advance, and accounting for social context. These practical strategies are not just methodological or design choices; they are inherently related to ethical issues. Method and design choices fulfill ethical aspirations by facilitating inclusion, reducing discomfort, and focusing on individuals.

Behavioral and Cognitive Interventions With Digital Devices in Subjects With Intellectual Disability: A Systematic Review

In recent years, digital devices have been progressively introduced in rehabilitation programs and have affected skills training methods used with children and adolescents with intellectual disabilities (ID). The objective of this review is to assess the effects of the use of digital devices on the cognitive functions and behavioral skills in this population, and to acknowledge their potential as a therapeutic tool. Electronic databases were analyzed until February 2020 using search formulas with free terms related to ID and the use of digital systems with children or adolescents. The risk of bias in randomized controlled trials was assessed by means of the modified Cochrane Collaboration tool and the quality level of the non-randomized studies was assessed using the Newcastle-Ottawa Scale. Forty-four studies were analyzed, most of which were categorized as low quality. Of the executive function studies analyzed, 60% reported significant improvements, most commonly related to working memory. Within the cognitive skills, 47% of the studies analyzed reported significant improvements, 30% of them in language. Significant improvements in the social (50%) and behavioral domains (30%) were also reported. These results suggest that digital interventions are effective in improving working memory and academic skills, and positively affect both the social and behavioral domains. Little information has been published regarding the duration of the effects, which could be limited in time. Further research is necessary to assess long-term effectiveness, the influence of comorbidities, and the effects on subjects with severe ID. The inclusion of smartphones and special education centers is also necessary.

Designing ApplTree: usable scheduling software for people with cognitive impairments

BACKGROUND

Smartphone reminding applications can help overcome memory difficulties experienced by people with acquired brain injury (ABI). Cognitive difficulties with memory and attention make entering reminders into a device, and remembering to set reminders, challenging for this group. ApplTree is a reminding app with features that aim to address challenges. One app feature was push notifications (asking "Do you need to set any reminders?") to support people to initiate use of the app to set reminders. Another app feature was a customisable user interface design to support attention and short term memory during reminder setting.

METHODS

In a mixed-methods user study, five people with self or other reported memory impairment following ABI used ApplTree for at least 4 months. They received push notifications for at least 2 months and no push notifications for at least 2 months. Monthly participant interviews provided insight into user interface preference, app use, and push notification acceptability.

RESULTS

Receiving four Push notifications per day doubled number of daily reminders set and four of the five participants found receiving them to be acceptable. This long-term field study uncovered issues relevant for clinicians and designers, including insights into the potential benefits of different user interface designs, the impact of family members on app use, and the importance of perceived need influencing use and acceptance.

CONCLUSIONS

Feedback provided insight into future considerations when designing reminding apps and using them in neuropsychological rehabilitation. This work highlights the benefit of user-led research into accessible design and use of assistive technologies.IMPLICATIONS FOR REHABILITATION"Unsolicited" push prompts are an easy to implement feature of reminding technology that is useful and acceptable for people with ABI in community rehabilitation.Observations provide insights about how people with ABI make use of reminding apps over time. This can inform those designing apps or providing reminding technology as part of neuropsychological rehabilitation.Participants differed on their preference of the two user-interface designs available in ApplTree. This highlights an area for future research because currently available reminding apps have a broad-shallow design which may not always be appropriate for people with ABI.

Person-oriented ethics for autism research: Creating best practices through engagement with autism and autistic communities

Research ethics is an important part of any study. Ethics goes beyond ethics committee approval and consent documents. It addresses broader issues of respect, inclusion, and empowerment in the everyday context of research. This article focuses on everyday aspects of research ethics for studies involving autistic participants. It draws on a review of the literature and a process of ethical deliberation involving a task force of researchers, professionals, autistic self-advocates, and parents. These methods led to the creation of suggestions for researchers. This article describes the community engagement process, briefly presents the task force suggestions, and provides more detailed discussion of select items for illustration. Suggestions are organized around five “person-oriented research ethics” guideposts: (1) individualization (e.g. providing individualized support for participants), (2) acknowledgment of lived world (e.g. acknowledging barriers to care that impact research ethics), (3) empowerment in decision-making (e.g. creating accessible consent processes that address specific communication needs), (4) respect for holistic personhood (e.g. addressing sensory and processing needs and strengths), and (5) focus on researcher–participant relationships (e.g. involving autistic people in ways other than research participants, including but not limited to via participatory research). This project highlights the value of researcher–community partnerships in discussions about research ethics.

Lay abstract

Research ethics means issues that concern the welfare and wellbeing of people who take part in research. It is important in all scientific studies. Ethics helps people who do research treat people who take part in research fairly and with respect. This article is about day-to-day ethics when autistic people take part in research. We present tips for researchers who want to do this type of study. We used two methods to create these tips. First, we wanted to know what other people said about this topic. We used a literature review to find out. Second, we wanted to know what autistic people, parents, and professionals thought, and had a working group meet to discuss it. The working group provided advice that researchers could consider around day-to-day ethics in research. This article talks about these methods and advice. The advice fits into five big groups: Tailor the research process for the unique needs of each person. Think about the world in which people who take part in research live. Make it easier for people to make their own choices. Value what people who take part in research have to share and consider their needs and strengths. Think about how researchers and people who take part in research work together. This project shows why it is useful for researchers and communities to talk about research ethics together.

Tablet Apps to Support First School Inclusion of Children With Autism Spectrum Disorders (ASD) in Mainstream Classrooms: A Pilot Study

The inclusion of children with autism spectrum disorders (ASD) in mainstream classrooms is dramatically impeded by their difficulties in socio-adaptive behaviors. This paper presents a package of mobile applications consisting of both assistive and cognitive rehabilitation applications to support first school inclusion of children with ASD. These applications have been tested in a 3-month intervention in mainstream schools and at home, involving 50 participants (30 children with ASD, half of which was equipped and 20 equipped children with intellectual deficiencies). Benefits on socio-adaptive behaviors and social response in school settings, and socio-cognitive functioning have been assessed. The main results showed that equipped children with ASD improved their socio-adaptive behaviors and their social-response in school settings. Both equipped groups increased their socio-cognitive functioning.

Process Measures of Dyadic Collaborative Interaction for Social Skills Intervention in Individuals with Autism Spectrum Disorders

Technology-based social skills interventions have shown promise for people with Autism Spectrum Disorder (ASD), a neurodevelopmental disorder characterized by impairments in social interaction and communication. Primary advantages of a technology-based approach to intervention relate to consistency of service delivery as well as an ability to quantitatively measure process and outcomes. Despite these strengths, however, many current computer-supported systems rely on survey data or data collected post-interaction. In response, we have developed and pilot-tested DOSE (Dyad-Operated Social Encouragement), a novel game and data acquisition platform for collaborative skills intervention that leverages the ability of software to collect time-series, speech audio, and event information for the purposes of finer-grained analyses of dyadic interactions. A pilot study involving 12 participant dyads—comprised of children with ASD and typically developing (TD) peers (6 ASD-TD dyads and 6 TD-TD dyads)—was conducted and several metrics were computed during interactions. Preliminary results suggest that the DOSE system is engaging to users, is capable of collecting a wide range of quantitative process measures, and that post-training measures show preliminary evidence of increased communication and activity coordination. Furthermore, DOSE has been made open-source, allowing other investigators to use and extend DOSE for a variety of applications.