Book Review:

Technology Speaks: Promising Directions in the Treatment of Autism

Technology Tools for Students with Autism: Innovations that Enhance Independence and Learning (2014); Katherina I. Boser, Matthew S. Goodwin, Sarah C. Wayland (Eds.), Paul H. Brookes Publishing Company, Baltimore, Maryland

Richard Strompf, Psy.D. | Dean John P. Burke School of Public Service | Contributing Editor

The treatment of autism has experienced several game-changing breakthroughs in the past few decades. The application of behavior analysis with children as young as 18 months has provided a developmental head-start for many on the autism spectrum who may have otherwise languished in the shadow of our social and cognitive worlds. The use of new psychotropic medication has opened a window of opportunity in our work with adults on the spectrum. It was only a matter of time for the internet and digital technology to provide yet another breakthrough for working with this challenging but promising population.

In the book, Technology Tools for Students with Autism: Innovations that Enhance Independence and Learning, you will learn about everything from apps for emotional recognition to robots with facial expressions to collaborative virtual environments.

The credentials of the three editors and 45 contributors is not only impressive but rather unique considering the subject matter. One would expect to see the likes of developmental, child and cognitive psychologists; special educators; speech pathologists and behavior analysts in a book on the treatment of autism. But expertise in such areas as human-centered applications of mobile and ubiquitous computing technologies, human-computer interactions, computational linguistics, informatics or the use of digital video and facile recognition systems? Or how about subject matter experts from a School of Interactive Computing or a new doctoral program in personal health informatics? Better yet, when was the last time you had an in depth discussion with a fellow of the Association of Computing Machinery?

Autism Spectrum Disorder (ASD) is a life-long condition characterized by social skill and communication deficits and repetitive patterns of behavior including stereotypy and the performance of odd rituals. These individuals often display an inflexible insistence on routine and sameness of environment and have difficulty adapting to change and transition. Hypersensitivity to sensory input is common. Individuals can display significant anxiety, agitation and/or self-injury when prevented from pursuing preferences or confronting sensory, social or environmental antagonists.

The ability to communicate with others and interact with them in social settings is critical for developing interpersonal relationships, learning, academic achievement, employment and, ultimately, independence. Yet individuals with ASD often experience social situations as confusing, overwhelming and even aversive. People can be unpredictable and inconsistent. The resulting avoidance and isolation from these settings limits exposure to the opportunity to learn and develop the necessary skills needed in these areas. The development of such skills as maintaining eye contact, attention, imitation, social and emotional awareness, collaboration and reciprocal interaction is stunted.

Digital technology has the potential to be transformative in the ways that individuals with ASD interact and communicate with the rest of the world. Two of the more fascinating applications of technology are the use of virtual realities (VR) or virtual environments (VE) and robots. Both of these technologies are ideal for facilitating the scaffolding and acquisition of social skills such that skills are mastered in order of increasing complexity.

  People with ASD tend to be visual learners who learn best in concrete situations. VRs (or VEs) provide visual and audio simulations of real-world social environments under carefully controlled, “safe” conditions. Initially, the virtual environment is programmed to be predictable and consistent, free of most social distractions found in real life settings. The student starts off responding to simple social demands in a consistent and predictable environment. As the student gains comfort and competency in, and mastery over this environment, the VE can be programmed to present greater challenges in more and more complex settings until the VE closely approximates real life situations. The student is permitted to learn at their own pace maximizing success and minimizing anxiety, stress and avoidance. VEs also allow for breaking down complex social skills, learning these skills at a more basic level and then slowly reintroducing complexity and nuance to the skill being learned.

Learning in real life situations can be difficult because displays of emotions and nuanced, non-verbal facial expressions can be fleeting, singular and/or variable. VEs can present the student with a common social situation (e.g., a birthday party), virtual peers or avatars to interact with in real time and appropriate scripts to follow and emulate. Repeated exposure and practice in non-threatening environments where the person interacts with virtual (not real and expensive) mentors and peers is possible to achieve. VEs can also provide repetitive training in areas that are difficult to create in real life such as traffic safety, fire safety and avoiding socio-sexual exploitation.

Similarly, the use of robots can be applied to the development of higher level, more refined social and communication skills. Robots can be programmed to be more predictable and less confusing than human interaction. As with VRs/VEs, the person with ASD masters the simpler level of interaction. It can be programmed to offer more sophisticated forms of interpersonal behaviors. The student moves at his /her own pace and only advances to the more challenging and anxiety provoking social situations when success has been experienced and an adequate level of comfort has been established. Robots can be programmed to emit certain facial expressions, vocal intonations, body posture and other important non-verbal cues. These virtual mentors can simulate emotions, model appropriate social behaviors and engage the student in role play. Research has shown that people with ASD often show more interest in working with robots than they do working with human instructors. Robots can be used in the early stages of skill acquisition, then faded, eventually, and replaced with its human counterpart.

Then there is the ubiquitous mobile device. It is, perhaps, the technology that will have the most immediate impact on instruction and treatment. Apps are now being introduced to a variety of areas with higher functioning individuals with ASD. Since almost everyone in our general, “normal” society uses a mobile device, a host of breakthrough, hand-held interventions can be introduced to the individual with ASD with a minimum of social stigma. The use of bulky adaptive devices such as picture vocabulary boards and picture schedules can be avoided in “regular” social settings. Mobile devices are being used to promote greater degrees of independence in a variety of ways. There are schedule and planning apps to facilitate executive functioning, activity initiation and transitions. There are apps for independent navigation, accessing public transportation and for safety monitoring by family or staff when the individual is out alone in the community. Customizable apps for communication, self-monitoring, prompting in interpersonal settings, hygiene reminders and many others are currently being applied with new apps being added to the list on a seemingly daily basis.

The assessment of skill acquisition and behavior is a critical aspect in special education and applied behavior analysis. The assessment of progress toward IEP goals, the acquisition of functionally and socially appropriate behaviors and the reduction of inappropriate ones are used to evaluate treatment efficacy, skill mastery and can provide valuable information for program revision. Data collection has often been difficult, cumbersome and, at times, impossible in real time situations. The more time and effort spent on data collection the less time available for instructional efforts and behavioral intervention. The application of digital technology, such as iPhone apps, offers an easier, more efficient and more accurate approach to collecting observational data in real time. It can provide an automated approach to data analysis presenting the data graphically as its being collected. Information about the individual can be shared, remotely, across school, work and/or home environments to promote treatment collaboration and consistency. Performance data can be shared through web portals and mobile devices. Hand held video cameras can assist with diagnosis and early intervention by video-taping an infant’s achievement, or lack thereof, of developmental milestones.

In their book, the contributors provide information on the benefits of online classrooms for the student and online, asynchronous training on evidence-based procedures for teachers, staff and parents. Interactive whiteboards that provide multi-media, multi-modal and multi-sensory learning technologies are available for use as well as software that provides text-to- speech and speech-to-text functions.  The book also discusses interactive talking books, mind maps, video-streaming and so on (and on).

Importantly, there is information on the precautions to be taken when using of web-based technology including protection of privacy, avoiding internet exploitation and the costs of accessing technology. In addition, a recurring theme throughout the book is the need for further research to establish evidence-based practices in the use of digital technology especially in the all-important area of demonstrating generalization of skill acquisition from the learning environment to the real world in real time. Having said that, this book provides a foundation for the future use and study of digital technology with individuals on the autism spectrum.

In closing, I recommend, enthusiastically, a careful reading of Boser, Goodwin and Wayland’s transformative book for anyone interested in a promising direction in the treatment of autism as we move further into the 21st century.

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