A Systematic Review of Technology-Supported Interventions for Children with Autism
Stephanie Miodus, M.A., M.Ed.
Telehealth has risen in popularity and is expected to continue growing to increase access to mental health services. General guidelines for telehealth and technology in interventions exist, but special considerations are needed when working with children with autism. This poster session will present findings from a systematic review and support practitioners in increasing their knowledge of technology-supported interventions for children with autism that can be adapted for use in schools and in collaboration with families.
Technology-supported interventions present both benefits and challenges, as well as an opportunity for supporting children with autism.
Telehealth has risen in popularity and is expected to continue growing to increase access to mental health services (Thomas et al., 2020). Beyond telehealth, technology more generally can also be beneficial in academic, social, and emotional interventions, such as the use of mobile technology (e.g., Mintz, 2013) or robots (Robins et al., 2005). General guidelines for telehealth and technology in interventions exist (e.g., Reed et al., 2000), but special considerations are needed when working with children with autism and this information is limited (Ferguson, 2019). When tailored to meet their specific needs, technology has been shown to be effective for children with autism in classrooms (e.g., Xin & Sutman, 2011; Cramer et al., 2011). Use of technology and telehealth has also been shown to be socially valid among children with autism and their families (Baweja et al., 2021). Yet, there is no review that examines the current existing literature on technology-supported interventions for students with autism broadly, beyond applied behavior analysis specifically (Ferguson, 2019). Thus, this poster session seeks to explore best practices for implementing technology-supported interventions for children with autism by presenting findings from a systematic review to support practitioners in increasing their knowledge of such interventions that can be adapted for use in schools and in collaboration with families. Specifically, the review addresses three main areas related to technology-supported interventions for children with autism that can be used in schools and with families: 1) benefits; 2) challenges; and 3) identified best practices and strategies.
The search for relevant studies focused on terms related to autism and technology-supported interventions. The search was limited to research that focused on school-aged populations, to be applicable to school psychologists. It was also limited specifically to interventions, rather than incorporation of technology in autism assessment or research. Autism-related terms in the search included “autism,” “ASD,” “autistic,” and “autism spectrum disorder.” Technology-related terms included “technology,” “iPad,” “telehealth,” “telepsychology,” “mHealth,” “telecommunication,” “tech,” “computer,” “robot,” and “automation.” Age-related search terms, specifically “youth,” “children,” “adolescent,” “teenager,” “classroom,” and “school-age” were also included in the search. For studies that lacked these age terms, searches were narrowed by age group when possible. These terms were used to search fourteen databases. These included Academic Search Complete, Google Scholar, ERIC, JSTOR, Academic OneFile, APA PsycInfo, EBSCOhost Research Databases, Social Service Abstracts, PubMed, ProQuest, Scopus, Psychology and Behavioral Sciences Collection, Open Access Theses and Dissertations, and ProQuest Dissertations. Citations of articles identified as relevant based on the initial search criteria were scanned for additional studies that met inclusion criteria as described below. Articles that cited the relevant articles found in the initial search were also screened to see if they met inclusion criteria.
For this review, the focus was on the use of technology-supported interventions to support school-aged children and adolescents with autism. Research examined in this review includes articles published in peer-reviewed journals, as well as unpublished theses and dissertations. Abstracts of each study were reviewed to screen for these criteria for inclusion in the systematic review.
ABBREVIATED LIST OF INCLUDED LITERATURE
*contact author for full list of articles included in the review
Kalvin, C. B., Jordan, R. P., Rowley, S. N., Weis, A., Wood, K. S., Wood, J. J., Ibrahim, K., & Sukhodolsky, D. G. (2021). Conducting CBT for anxiety in children with autism spectrum disorder during COVID-19 pandemic. Journal of Autism & Developmental Disorders, 51(11), 4239–4247. https://doi.org/10.1007/s10803-020-04845-1
Commentary on adapting CBT for anxiety for children with autism to a telehealth format
Rashedi, R. N., Bonnet, K., Schulte, R. J., Schlundt, D. G., Swanson, A. R., Kinsman, A., Bardett, N., Juárez, P., Warren, Z. E., Biswas, G., & Kunda, M. (2021). Opportunities and challenges in developing technology-based social skills interventions for adolescents with autism spectrum disorder: A qualitative analysis of parent perspectives. Journal of Autism & Developmental Disorders, 52, 4321–4336. https://doi.org/10.1007/s10803-021-05315-y
18 interviews with parents
Explore preferences for devices, as well as both the positive and negative effects on children's moods and behaviors
Dai, Y. G., Thomas, R. P., Brennan, L., Helt, M. S., Barton, M. L., Dumont-Mathieu, T., & Fein, D. A. (2021). Development and acceptability of a new program for caregivers of children with autism spectrum disorder: Online parent training in early behavioral intervention. Journal of Autism & Developmental Disorders, 51(11), 4166–4185. https://doi.org/10.1007/s10803-020-04863-z
Describes the development and acceptability of a self-directed online program for caregivers of children with ASD focused on skill development for a naturalistic lens
Treszl, A., Koudys, J., & O’Neill, P. (2021). Evaluating the effects of Picture Exchange Communication System® mediator training via telehealth using behavioral skills training and general case training. Behavioral Interventions, 37(2), 290-305. https://doi.org/10.1002/bin.1835
One child with ASD and both parents
Multiple baseline design across skills to monitor the primary parent trainee's fidelity during training sessions
Multiple probe design to monitor both parents' treatment fidelity in the natural environment with their child
After PECS via telehealth, parent was effective with implementation within training setting but the parent could not reliably implement PECS skills in another environment in the generalization phase
Turgeon, S., Lanovaz, M. J., & Dufour, M.-M. (2021). Effects of an interactive web training to support parents in reducing challenging behaviors in children with autism. Behavior Modification, 45(5), 769–796. https://doi.org/10.1177/0145445520915671
47 parent-child dyads but only 21 complete the training
Self-guided web training completed by parents showed promising results for reducing challenging behaviors for children with ASD
Barriers to completing the training so while intervention may be effective, there is a need to investigate how to support parents in their engagement
Werner Juarez, S. (2021). Using behavioral skills training to support caregivers through educational telehealth. Teaching Exceptional Children, 1. https://doi.org/10.1177/00400599211051007
Case study highlights strategies on providing behavioral skills training for antecedent- and consequence-based interventions to parents of a child with ASD via telehealth
Daily Living Skills:
Robertson, C. E., Spooner, F., Wood, C. L., & Pennington, R. C. (2021). Color-coding print versus digital technology to teach functional community knowledge to rural students with autism and complex communication needs. Rural Special Education Quarterly, 40(4), 180–190. https://doi.org/10.1177/87568705211032378
Four high school–age students with moderate to severe intellectual disabilities and autism
Single case alternating treatments design
Compared print versus digital technology instruction on students' abilities to accurately respond to Wh- (e.g., who, what) functional community knowledge questions
All participants showed increased knowledge across conditions
Family Support Interventions:
Kremkow, J. M. D., & Finke, E. H. (2022). Peer experiences of military spouses with children with autism in a distance peer mentoring program: A pilot study. Journal of Autism & Developmental Disorders, 52(1), 189–202. https://doi.org/10.1007/s10803-021-04937-6
12 peer participants who were military spouses with a child with ASD
Pilot study showed that distance peer-to-peer mentoring is feasible for this population and may be a helpful support prior to relocations
Vallefuoco, E., Purpura, G., Gison, G., Bonifacio, A., Tagliabue, L., Broggi, F., Scuccimarra, G., Pepino, A., & Nacinovich, R. (2021). A multidisciplinary telerehabilitation approach for supporting social interaction in autism spectrum disorder families: An Italian digital platform in response to COVID-19. Brain Sciences (2076-3425), 11(11), 1404. https://doi.org/10.3390/brainsci11111404
30 participants (18 therapists and 12 parents of children with ASD)
Promising results for a digital platform (SUPER) promoting collaboration and sharing information among families, clinical providers, and schools through enhancing knowledge of ASD and promoting personalized programs for children with ASD
Motor Skills Interventions:
Hocking, D. R., Ardalan, A., Abu-Rayya, H. M., Farhat, H., Andoni, A., Lenroot, R., & Kachnowski, S. (2022). Feasibility of a virtual reality-based exercise intervention and low-cost motion tracking method for estimation of motor proficiency in youth with autism spectrum disorder. Journal of NeuroEngineering & Rehabilitation (JNER), 19(1), 1–13. https://doi.org/10.1186/s12984-021-00978-1
Ten children and adolescents (10-17 years)
No direct causal link between the GaitWayXR VR motor skills intervention in improving gross motor skills
Found that low-cost motion capture of children with ASD is feasible with movement exercises in a VR-based game environment
Need to address improving adherence to VR gaming interventions over longer periods
Saggers, B., Tones, M., Dunne, J., & Aberdein, R. (2021). Tele-classroom consultation: Promoting an inclusive approach to supporting the needs of educators, families and early years learners on the autism spectrum in rural and remote areas in contextually responsive ways. International Journal of Inclusive Education, 25(11), 1305–1326. https://doi.org/10.1080/13603116.2019.1609103
Case study shows promise for tele-consultation with teachers in classrooms to support children in rural and remote areas
Social Skills Interventions:
Anthony, N., & Bobzien, J. (2021). Using two formats of a social story to increase the verbal initiations and on-topic responses of two adolescents with autism spectrum disorders. Journal of Autism & Developmental Disorders, 52, 4138–4149. https://doi.org/10.1007/s10803-021-05298-w
Alternating treatments design
Two adolescents with ASD
Variable results for increasing initiations and responses based on condition (technology-based or paper/book social story)
Both participants indicated a preference for the technology-based social story
Parents reported an increase in communication skills from the social story intervention
Babb, S., McNaughton, D., Light, J., & Caron, J. (2021). “Two friends spending time together”: The impact of video visual scene displays on peer social interaction for adolescents with autism spectrum disorder. Language, Speech & Hearing Services in Schools, 52(4), 1095–1108. https://doi.org/10.1044/2021_LSHSS-21-00016
Across-participant multiple baseline design with 4 adolescents with ASD and complex communication needs
High school setting
Paired with peer partners
Following the video visual scene display intervention, all 4 children showed an increase in communicative turns with their partners and modes of communication used
The 3 children who already used vocal speech prior to the intervention all showed increased speech after the intervention
All participants and peer partners reported wanting to continue using the intervention to support social interactions
Beaumont, R., Walker, H., Weiss, J., & Sofronoff, K. (2021). Randomized controlled trial of a video gaming-based social skills program for children on the autism spectrum. Journal of Autism & Developmental Disorders, 51(10), 3637–3650. https://doi.org/10.1007/s10803-020-04801-z
70 children with ASD, aged seven to 12 years, and their parents
35 participants randomized to computer-based social skills program (Secret Agent Society) and 35 participants randomized to a cognitive skills training game for the control condition
Children in the Secret Agent Society condition showed significantly greater improvement on parent-rated social skills and problem behaviors and teacher-rated social skills, which suggests this program could be valuable for social skills development for children with ASD
Canestaro, V. M., Akers, J. S., & O’Guinn, N. (2021). Promoting reciprocal conversations in children with autism using text‐message prompting. Behavioral Interventions, 36(4), 745–755. https://doi.org/10.1002/bin.1822
3 children with ASD
Text-message prompting via an Apple watch as a script delivery message for script training was effective in increasing both initiations and responses for two participants
Effectiveness was not clear for the third participant, but this participant's initiations and responses did both increase after the intervention
Lee, G. T., Hu, X., & Jin, N. (2021). Brief report: Using computer-assisted multiple exemplar instruction to facilitate the development of bidirectional naming for children with autism spectrum disorder. Journal of Autism & Developmental Disorders, 51(12), 4717–4722. https://doi.org/10.1007/s10803-021-04901-4
Multiple probe across 3 participants design
3 5-year-old Chinese boys with ASD
All 3 children increased their performance on bidirectional naming with computer-assisted multiple exemplar instruction, which shows promise for the use of this intervention in applied settings
Panceri, J. A. C., Freitas, É., de Souza, J. C., da Luz Schreider, S., Caldeira, E., & Bastos, T. F. (2021). A new socially assistive robot with integrated serious games for therapies with children with autism spectrum disorder and Down syndrome: A pilot study. Sensors (14248220), 21(24), 8414. https://doi.org/10.3390/s21248414
8 children (one child with neurotypical development, one with Trisomy 21, and six children with ASD, all from 4 to 9 years of age
Promising preliminary results for integrating a socially assisted robot and serious games to support psychosocial and cognitive therapies for children with ASD
Romney, J. S., & Garcia, M. (2021). TF-CBT informed teletherapy for children with autism and their families. Journal of Child & Adolescent Trauma, 14(3), 415–424. https://doi.org/10.1007/s40653-021-00354-0
Provides adaptions to TF-CBT for children with ASD and for delivering via teletherapy
SYNTHESIS OF THE LITERATURE & DISCUSSION
Technology Interventions Identified include:
Technology adaptations of interventions for children with ASD (e.g., visual schedules, Social Stories)
Caregiver training programs
Telehealth adaptations of mental health therapies
Prompts provided via text, IPad, etc.
Promising results for effectiveness of identified interventions
Much of the research is growing due to the COVID-19 pandemic so implementation of technology outside of necessity is needed
Many interventions focus on behavioral/social skills needs but there is a greater need for interventions targeting mental health needs of children with ASD
More research on caregiver training than direct intervention
Some difficulty with completion of interventions, particularly when they were self-guided
Best Practices and Strategies:
Overall, it is important to recognize the limited research on providing clinical behavioral services for children with autism directly over telehealth (Ferguson, 2019). There is however more research on the effectiveness of behavioral telehealth consultations with parents of children with autism (e.g., Vismara et al., 2013; Wacker et al., 2013), which shows increased parental learning and improved child behaviors. Other research has shown positive effects for an Internet-based training program for parents of children with autism with increases in the children’s social communication (Pickard et al., 2016). With any of these methods, parents are a key component, and it is essential that practitioners work collaboratively with them to ensure quality delivery of service. School psychologists can play a role in family-school collaboration through such consultations with both caregivers and teachers.
While behavior, communication, and social skills are often the focus of services for children with autism, clinically, it is important to also address other challenges this population may be experiencing, such as anxiety (e.g., White et al., 2009). Specifically related to the use of telehealth, there have been promising preliminary results from a study that delivered a cognitive-behavioral intervention over telehealth to children with co-occurring ASD and anxiety (Hepburn et al., 2016), which suggests that after correcting for technical glitches, this may be an efficacious intervention to treat anxiety in children with ASD.
Beyond the use of telehealth, technology can support other interventions for children with autism (Goldsmith & LeBlanc, 2004), including within classrooms (Hirano et al., 2010) to support social, emotional, behavioral, and academic goals.
CONCLUSIONS & FUTURE DIRECTIONS
Parents are a key component of effective technology-supported interventions, and practitioners must work collaboratively with them to ensure quality delivery of service. Increased research on direct telehealth intervention is also needed.
School psychologists engage in family-school collaboration through consultations with both caregivers and teachers, and further research is needed on how to do this effectively when implementing technology-supported interventions for children with ASD.
Much of the focus in the literature is on interventions targeting behavior, communication, and social skills. There is a need for increased research on technology-supported interventions targeting mental health needs for this population of children.
Technology can be incorporated into classrooms to support social, emotional, behavioral, and academic goals.
Domain 4: Mental and Behavioral Health Services and Interventions
Based on a synthesis of the current literature, many of the technology-supported interventions are focused on behavioral health. There is a need for increased research on incorporating technology into mental health services for children with ASD.
School psychologists can incorporate evidence-based strategies of incorporating technology into interventions with children with autism.
Domain 7: Family, School, and Community Collaboration
The synthesis of the literature suggests that families play a critical role in supporting the effectiveness of these interventions.
School psychologists can work collaboratively with families to include them in the implementation of technology-supported interventions for children with ASD to support fidelity and effectiveness.
RESOURCES FOR PRACTITIONERS
Boom Cards: https://wow.boomlearning.com/
FaceSay Social Skills Software: http://www.facesay.com/
GoVisual (used for video visual scene displays): https://www.attainmentcompany.com/govisual
Headsprout Reading Skills Software: https://www.headsprout.com/
Playing Forward Movement Intervention: https://www.playingforward.com/
Secret Agent Society Computer Game: https://www.sst-institute.net/
vSked (and other interactive visual support technologies): http://www.star-uci.org/2010/06/26/interactive-visual-supports-for-children-with-autism/