Nine-year-old Anastacia Marquez pauses for a beat, pondering a question from one of her teachers, Melissa Flavell.
Anastacia, a student at Sunrise Elementary School in Las Cruces, N.M., extends her left index finger and presses the corresponding answer on her iPad.
“Yes.”
It’s a simple exchange between student and teacher—one that was more difficult a few months ago.
Anastacia has lived with multiple brain tumors since she was less than a year old. Those tumors—there are now five—and the seven neurosurgeries she has endured silenced her speech. Through a combination of mouthing and whispering, Anastacia can identify many letters of the alphabet and their corresponding sounds. But her ability to communicate verbally is significantly limited.
Anastacia communicates more precisely and efficiently thanks to a specialized technology application for the touch-screen computer.
Touch-screen devices are being embraced by many educators as potential tools for people with autism and other communication disorders because the devices are very visual. But while they are easy to use,teachers say planning and direction for students are key to getting the most out of the technology.
“Because it’s so intuitive, kids just start flipping through it really fast, and the actual processing of information won’t happen unless somebody directs them,” said Jennifer Sullivan, the executive director of the Morgan Autism Center, a San
Jose, Calif.-based school for children and adults with autism. The school serves about 135 3- to 22-year-olds in addition to adults at the center.
For instance, students using a spelling application may be able to spell words quickly with the app, but that skill may not translate to a pen-and-paper task, she said.
“They don’t necessarily take in the information, and they’re not able to generalize that information and apply it without the [technoogy],” she added.
In addition, many children with autism struggle with social and interpersonal skills, raising concerns among some educators and parents about relying heavily on a technology tool to teach.
Ms. Sullivan has found that teaching students to take turns with the device is one way to turn it into a good social-skill builder. Students, she said, are much more interested in what the other person is doing while they are waiting for their turn with the tablet.
“It’s so motivating for the students because they’re so interested in having access to it,” she said.
Because much of the technology is new, however, very little research exists about the effectiveness of the tools beyond anecdotal information.
“At the moment, there is a great deal of excitement around iPads and touch-screen technologies for autism, but more needs to be done to develop reliable and well-tested apps to run on these platforms,” said Andy Shih, the vice president of scientific affairs for the New York City-based advocacy group Autism Speaks.
“Most reported impacts are anecdotal at this point,” he said. The organization will be conductingrigorous research into the potential value of iPads and other technologies for quality-of-life issues as well as function and outcome.
A recent white paper developed by the Augmentative and Alternative Communication Rehabilitation Engineering Research Center on Communication Enhancement, or AAC-RERC, identified an “urgent, unmet need for quality research and development” on the use of touch-screen mobile devices for helping people with communication disabilities. A growing need exists to evaluate the devices that are available, as well as the applications that are emerging, the paper said.
Communication First
Part of the shift is moving from a dedicated device, deemed as medical equipment, to help students with disabilities communicate to a multipurpose mobile device that is available to all consumers, said Pamela Mathy, a speech language pathologist and the program director for the Baltimore-based Kennedy Krieger Institute’s Center for Autism.
“The mobile devices have the ‘cool’ factor,” she said. “Anyone can buy them, they’re much more consumer-friendly, and they’re considerably less expensive” than the dedicated devices of assistive technology that have been used in the past.
However, it’s important for students, parents, and teachers to make sure that the device actually serves the child well before jumping on board, she said.
“We need to make sure we’re matching the apps that the child needs to the child, rather than just trying to do a one-size-fits-all approach,” Ms. Mathy said. “You have to be honest about what it can do.”
And since touch-screen devices,like the iPad, are often attractive to children because of their recreational qualities, it’s important to introduce the devices as communication tools first, she said.
“If you start off with it being a game-type of device,” Ms. Mathy said, “then it can be hard to make it into something else.”
At Sunrise Elementary, Anastacia is able to take her iPad home so she can better communicate with her family as well.
Now, instead of using simple gestures to her parents and three sisters, Anastacia can point out words on the device to express her feelings or interests.
“She likes drawing, ...usually with pencils,” said her sister Maria, a 10-year-old who also attends Sunrise.
Because most of what Anastacia understands right now is visual—she has mastery-level understanding of the alphabet, but can’t yet read—the icons used in the application are critical.
Phrases such as “I feel sick” and “I feel sad” are on the program’s “I feel” screen, along with an illustration of the emotion.
Teresa Calderon, the special education teacher with primary responsibility for Anastacia, said the teachers now spend more time educating Anastacia, and less time simply trying to communicate.
The device, Ms. Calderon said, can also be specially programmed for Anastacia’s needs.
“Every day we make changes to it,” Ms. Calderon said. “We want her to respond verbally, if she can, but if not, she can use this.”
