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Assistive Technology for Learning and Communication Challenges in Children with ASD

Autistic Spectrum Disorder (ASD) is a type of developmental disorder that results in social, communication and behavioral challenges in children. It is associated with social communication and interaction problem such as poor eye contact, failure to respond, resistance to holding, repeating phrases, speaking in abnormal tone and inability to express emotions. People affected by ASD tend to show repetitive movements and experience problem with coordination of activities (Aresti-Bartolome & Garcia-Zapirain, 2014). According to the World Health Organization, about one in every 100 children suffers from autism and it is most commonly detected in early childhood (World Health Organization, 2022). The abilities and needs of people with ASD may vary with time. In Australia, the prevalence rate is found to be around 1 in every 150 people. Around 83% of the people with autism are under age 25 years and above. The prevalence of autism was found to increase gradually for school age children (Australian Institute of Health and Welfare, 2017).

One of the problems for children with ASD is that they face problem in learning, education and communication process. To address the learning and other behavioral challenges for patients, many information and communication technology (ICT) tool have been developed to support education for students with special needs. Both software and hardware technologies have been developed since many decades to increase the vocabulary and communication skills of staff. ICT tools can support students in addressing special needs too. It helps in creating controllable environment for patients and increase the possibility of independent work and self-control for the target group (Khan et al., 2019, June). There has been a wide range of research on the role of technology in children with ASD. However, the role of assistive technology in enhancing the quality of life (QoL) of children with ASD is less explored. The aim of the literature review is to evaluate the impact of assistive technologies on the QoL of persons with ASD.

The literature search was completed in suitable databases such as CINAHL, PubMed and Google scholar. The key words used during literature searching included ‘Assistive technology’, ‘autism spectrum disorder’ and ‘quality of life’. In addition, Boolean operators were applied to narrow down the search process. Based on the comprehensive search for literature, total five articles were identified relevant to the research question. To address the research question, a critical review of all the selected articles will be provided. The review will consider aspects such as quality and reliability of the research findings.

Past studies have explored the role of different assistive technology in improving the QoL of people with ASD. The improvement in quality of life has been explored by different positive outcomes such as improvement in communication process, learning experiences or cognitive abilities. A systematic review by Valencia et al. (2019) investigated about the impact of technology on people with ASD. As most of the students enjoy playing games, the influence or the relationship between technology, games, user experience and accessibility for children with autism was explored. As the study had many aspects to consider, total three research questions were framed for the research. The findings of the study were also systematically arranged as per the inclusion and exclusion criteria. New technological approaches such as virtual reality, augmented reality, use of sensors and virtual agents were explored in the review.  For instance, it referred to studies where Estimote Beacon sensors supported children with ASD in pronouncing news words and their meanings. Such form of interpretation could promote learning and improve the QoL of ASD children.

The Role of Technology in Enhancing Communication and Social Skills in Children with ASD

In addition to the use of different technologies, the review reported about positive influence of technology on social communication in children. Social skills was covered in 36.17% of the total resulting studies. One of the studies reported about the use of autonomous virtual humans in facilitating building of social skills in people with ASD. The results of the study revealed that positive outcome for users such as increase in the development of social skills.  In addition, game element was considered as a good source to engage users in learning and promote the efficacy of teaching process. The outcome in the study is consistent with the research by Dechsling et al. (2021) which reported that people with autism experience difficulty in social interactions and they may have impaired expressive language. The study argued for improving social skills in individuals with autism. Through VR training programs, clients can get access to social skills.

There are many strength and weakness of the systematic review paper. The strength of the article is that it considers relation between various elements while estimating the effect of technology on ASD. User experience, accessibility elements and game elements were considered. However, the gap in the research paper is that there was less detail on the use of different research instrument measuring outcomes. Hence, instead of secondary results, there is a need for primary data to get insight about the benefits of virtual reality and other assistive device for people with ASD.

The significance of the study by Kumazaki et al. (2021) is that it reported about a communication training system that can be used to teach communication skills to ASD people during the pandemic. In the study, a PC and a robot was developed for each study. The aim of the article was to investigate if the robot system can be effective in increasing motivation for training in individuals with ASD. To ensure providing communication education to the sample group while maintaining social distancing, a communication exercise was developed using the tele-operated robots. The participants were randomly assigned to robot-mediated communication exercise (RMC) group and taking a class by teachers alone (TCT). Thus, from the research method and the question designed, it can be seen that the study is targeting improvement in QoL by targeting communication skills. The exploration of ICT tools for improving communication in the target group is significant as communication difficulties with autism persist into the adulthood. It can impair day-to-function and increase the risk of social challenges. Thus, it is evident that the extent of social challenges may have worsened during the pandemic and exploring the use of assistive technology in this aspect is considered appropriate (Cummins, Pellicano & Crane, 2020).

In the study, many specific tools were used to evaluate ASD specific behaviours and symptoms. The first tool was the Autism Spectrum Quotient-Japanese Version (ASQ) that has five sub-scales for measurement of social skills, communication, attention switching, imagination. The authors reported about the validity of the tool by reporting about the use of the tool in different cultures and ages. Lundqvist and Lindner (2017) supports that ASQ is the most widely used tools for assessment of autistic traits in the general population. In addition, the severity of social anxiety symptoms was assessed using the Liebowitz Social Anxiety Scale (LSAS). Moreover, the CARS-TV, a Japanese version of the CARs was used to evaluate the degree and profiles of autism in children. The communication performance of participants was rated two weeks before and after the experiment. Emotions linked to communication were explored in the study. The finding revealed that the autistic trait was mild in seven participants as per the CARS score and severe in two participants. Another favourable outcome was that all participants in the RMC group completed the trial process without any challenges. The strength of the finding is preciseness of the intervention was paid attention and one-way ANOVA analysis was done to capture feelings and emotions. There was a statistically significant in description about feelings. For each outcome, scores and p-value were recorded too. Statistical evaluations give true measurement about the preciseness of the treatment effect.

Impact of Different Assistive Technologies on the Quality of Life of Persons with ASD

The study provides many important practical implications in relation to improving QoL of people with autism. Although QoL indicator was not directly measurement, but improvement in this area was suggested by improving in the communication process. The significance of the study is that it reported about the feasibility of a training on tele-operated robots on improving communication while maintaining social distancing. People with ASD are not expressive and they generally tend to isolate themselves from social gathering (Davis & Crompton, 2021). However, in the study, the participants in the intervention or RMT group reported describing their feelings as a fun activity compared to the TCT group. The completeness in reporting of results was seen as the findings were compared with previous research studies. For instance, people with ASD were found to have fewer and shorter emotional states. This study revealed the potential of robots for supporting people with ASD and the study by Lee and Obinata (2013, March) also indicated about the use of robots for help. Thus, the article is a useful source of evidence to enhance to evaluate the utility of technologies such as robots in improving communication skills. Despite the above strength, certain methodological limitations in the study cannot be ignored. Small sample size was one of the draw back of the study and it could affect the generalizability of results (Andrade, 2020)

Many clinical reports have acknowledged poor quality of life in autistic people because of social isolation and diminished ability to accomplish many tasks. The operationalization of QoL is summarized under four domains such as physical, psychological, social and environmental factors. Investigation into the cause behind any of the above factor is an indicator of QoL (Mason et al., 2018). The significance of the third article by Yuan and Ip (2018) is that it explored the impact of assistive technology on the QoL factor of emotional and social skills in autistic children. Virtual Reality Environment (VRE) is a promising training tool that is developed to simulate real-life situations. The aim of the study was to explore the effect of VRE on developing emotional and social skills in children with ASD. The study was done at the City University of Hong Kong and groups of 3-4 children were given briefing sessions to take part in the training process. After the training, the children navigated in the VRE for one hours and this was followed by a debriefing session to discuss about their experience. The advantage of the VRE session was that it simulated real life scenarios such as relaxation, training and consolidation scenario. The research design is promising and it is an emerging technology that is gaining popularity in the treatment of autism (Ip et al., 2018).

After the implementation of the educational session, the psycho-educational profile of children was recorded. Based on the paired sample t-test, it was found that children from training group had high scores in emotional expression and regulation. They also scored high in social interaction after training compared to before training. The effect identified was statistically significant. The strength of the finding is that it used mixed method to evaluate the significance of the interaction. Apart from quantitative data collection, qualitative feedbacks were also collected. Based on collection of feedback from parents, it was found that children were more proactive in interaction with neighbours. Some of the narratives are reflective of positive impact. For instance, children started making preferences for seat and they started making more friends. The positive outcome in the study can also be attributed to measures taken in the study. For instance, briefing and debriefing sessions made children more aware about applying learning skills from VR to reality. Ryoo and  Ha (2015) argues that debriefing is an important part of simulation based learning and it is one of the key to consolidation of knowledge and skills.

Strengths and Weaknesses of the Systematic Review Paper

On reflecting on the strengths and weakness of the paper, it can be said the intervention is not a strategy that can be practically implemented in all settings. The primary reason behind this is that CAVE is an expensive VR-enabling technology and it cannot be locally applied in all settings due to cost related constraints. Despite the gap, the article convincing demonstrates the scope of VR in promoting social skills. Future researchers could designing cheaper VR products that would be suitable for use by all (Wedyan, Al-Jumaily & Dorgham, 2020).

The fourth article by Aydo?du (2022) explored the effect of augmented-reality based program on the motivation, attention and development of conceptual skills in preschool children. The outcome is linked to cognition and improvement in this area can have an impact of later QoL. The advantage of augmented reality is that it has visualization features that makes learning interesting and increase memorization for students. The application of the technology was found limited in early childhood and so the study explored its effectiveness in teaching practices and learning outcomes for school children. The research was conducted using a pretest-posttest quasi-experimental design. The children were recruited from a preschool institution. The cognitive and psychological aspects of children were measured using different tools. For instance, motivation scale consisting of seven subscales were used to measure motivation level. The self-regulation skills scale is a 5-point likert scale that focused on the measurement of self-regulation skills in children. The reliability and test-retest reliability of the all the instruments were considered and it would enhance the validity of the results.

The main intervention in the article was an augmented reality application and the licensed animal characters were purchased through websites. Children in the intervention group participated in the prepared augmented reality application and the children in the control group practiced traditional teaching method. The intervention group children experienced the visuals in three dimensions whereas the children in the control group experienced it in two dimensions. Appropriate statistical measures such as the Mann Whitney U test was used to identify the difference between pretest and posttest scores in both the groups. The comparison of concept acquisition was completed using the frequency and percentage calculations. In the results section, Table 1 recorded pre-test scores and Table 2 recorded post-test scores. For pre-test scores, no major difference between the motivation and attention test scores were found for children in both the group. For the post-test scores, significant difference in score was found for social persistence and high level of satisfaction level. All the motivation sub-scales and the attentions scale post-test score were higher in the intervention group. Thus, the findings provide a comprehensive overview of the statistically important results and rigorous analysis was present (DeJonckheere & Vaughn, 2019).   

The selected study is unique because of various factors. Firstly, through augmented reality, the authors targeted important element such as attention and motivation level of preschool children. Impairment in these areas seriously influences learning of students. The experiment on use of augmented reality revealed the influence of such technology in increasing attention, increasing motivation for learning and promoting social persistence. The study was found to be consistent with previous research literature as appropriate comparison was made. However, the gap in the study needs to be highlighted too as the study has potential for improvement. For instance, the study was conducted only in one kindergarten centre and it could affect the generalizability of the results (Carminati, 2018).

The Significance of a Communication Training System Using Robotics as a Method to Improve Communication Skills During the Pandemic

Lastly, the fifth article by Lian and Sunar (2021) evaluated the impact of mobile augmented reality (MAR) on people with autism. With the upsurge of mHealth solutions, it has been identified as an interesting application for achievement of children with ASD. In this research, a systematic review was conducted to identify use of MAR for autism related interventions and current trends and future gaps were explored. Based on the search for papers in Web of Science, Science Direct, PubMed, SpringerLink and others, total 36 articles were included in the review. The results of the study indicated that augment reality was linked to improvement in attention and communication. It provided an enhanced educational environment to children and improved their social communication skills and engagement skills. The study discussed about the development of app, their prototype framework and concepts. Studies with both qualitative and quantitative feedback were found. Statistical analysis revealed a reduction in irritability for children. Based on the accumulation of fruitful results, it can be concluded that MAR can be effective in enhancing developmental skills in children. However, one gap found in the systematic review was that quality assessment of the study was not done.

The above study has many implications in the broader context. The first implication is that the study clearly shows the application of the technology in solving real life problems of the ASD population. The potential of assistive technology was found both for children as well as adults with ASD. In children, it was identified as an appropriate tool to enhance their cognitive skills. In contrast, in adults it was found to influence their emotions, social skills and ability to express them. The study discussed about the cost aspects too. Although augmented reality tools are costlier, the study reported about the possibility of other devices such as smartphones and tables to empower the brian system. Such devices are flexible and portable too. The second point of strength is that the study used both survey and qualitative research for improving the findings. The study concluded that application of MAR is successful for autistic people. The positive outcomes relate to improvement of basic life skills and defect repair in the area of education. There were certain methodological limitations that could be addressed in future research. It included small sample size, research design issues, generalizability issues and app design issues.

Based on the literature review of assistive technology to improve QoL of an individual with autism, it has been identified that tools such as VR, augmented reality and robots have the potential to support people with autism. Based on improvement in learning improvement, social skills, emotional and attention skills, it is recommended that school teachers take better training on use of these technologies for teaching and learning. In addition, the review gives implication to policy makers to ensure wider application of cheaper technology to assists autistic people in their daily life. All these changes would translate to a high quality of life in children.

Conclusion

To conclude, the literature review on assistive technology to promote QoL in autistic individuals identified different factors that could enhance skills development in the target population. The study discussed about the effectiveness robots, virtual reality and augmented reality applications in enhancing the life outcomes of people with autism. The positive outcomes obtained were in the area of attention, social skills, learning and engagement and motivation level. The study gives the implication to integrate such technology in education environment and daily life context of individual with autism.

References

Andrade, C. (2020). Sample size and its importance in research. Indian journal of psychological medicine, 42(1), 102-103.

Aresti-Bartolome, N., & Garcia-Zapirain, B. (2014). Technologies as support tools for persons with autistic spectrum disorder: a systematic review. International journal of environmental research and public health, 11(8), 7767-7802.

Australian Institute of Health and Welfare (2017). Autism in Australia. Retrieved from: https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism

Aydo?du, F. (2022). Augmented reality for preschool children: An experience with educational contents. British Journal of Educational Technology, 53(2), 326-348.

Carminati, L. (2018). Generalizability in qualitative research: A tale of two traditions. Qualitative health research, 28(13), 2094-2101.

Cummins, C., Pellicano, E., & Crane, L. (2020). Autistic adults’ views of their communication skills and needs. International Journal of Language & Communication Disorders, 55(5), 678-689. 

Davis, R., & Crompton, C. J. (2021). What do new findings about social interaction in autistic adults mean for neurodevelopmental research?. Perspectives on Psychological Science, 16(3), 649-653.

Dechsling, A., Orm, S., Kalandadze, T., Sütterlin, S., Øien, R. A., Shic, F., & Nordahl-Hansen, A. (2021). Virtual and augmented reality in social skills interventions for individuals with autism spectrum disorder: A scoping review. Journal of Autism and Developmental Disorders, 1-16.

DeJonckheere, M., & Vaughn, L. M. (2019). Semistructured interviewing in primary care research: a balance of relationship and rigour. Family medicine and community health, 7(2).

Ip, H. H., Wong, S. W., Chan, D. F., Byrne, J., Li, C., Yuan, V. S., ... & Wong, J. Y. (2018). Enhance emotional and social adaptation skills for children with autism spectrum disorder: A virtual reality enabled approach. Computers & Education, 117, 1-15.

Khan, M. S., Mohamadali, N. A. K., Maher, Z. A., Nisa, S. Q., Shaikh, H., & Shah, A. (2019, June). Information technology (IT) based intervention among individuals with ASD (autism spectrum disorder): A review. In 2019 IEEE International Conference on Innovative Research and Development (ICIRD) (pp. 1-3). IEEE.

Kumazaki, H., Muramatsu, T., Yoshikawa, Y., Haraguchi, H., Sono, T., Matsumoto, Y., ... & Mimura, M. (2021). Enhancing communication skills of individuals with autism spectrum disorders while maintaining social distancing using two tele-operated robots. Frontiers in psychiatry, 1641.

Lee, J., & Obinata, G. (2013, March). Developing therapeutic robot for children with autism: A study on exploring colour feedback. In 2013 8th ACM/IEEE International Conference on Human-Robot Interaction (HRI) (pp. 173-174). IEEE.

Lian, X., & Sunar, M. S. (2021). Mobile augmented reality Technologies for Autism Spectrum Disorder interventions: A systematic literature review. Applied Sciences, 11(10), 4550.

Lundqvist, L. O., & Lindner, H. (2017). Is the autism-spectrum quotient a valid measure of traits associated with the autism spectrum? A Rasch validation in adults with and without autism spectrum disorders. Journal of Autism and Developmental Disorders, 47(7), 2080-2091.

Mason, D., McConachie, H., Garland, D., Petrou, A., Rodgers, J., & Parr, J. R. (2018). Predictors of quality of life for autistic adults. Autism Research, 11(8), 1138-1147.

Ryoo, E. N., & Ha, E. H. (2015). The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing. CIN: Computers, informatics, nursing, 33(12), 538-545.

Valencia, K., Rusu, C., Quiñones, D., & Jamet, E. (2019). The impact of technology on people with autism spectrum disorder: a systematic literature review. Sensors, 19(20), 4485.

Wedyan, M., Al-Jumaily, A., & Dorgham, O. (2020). The use of augmented reality in the diagnosis and treatment of autistic children: a review and a new system. Multimedia Tools and Applications, 79(25), 18245-18291.

World Health Organization (2022). Autism. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders

Yuan, S. N. V., & Ip, H. H. S. (2018). Using virtual reality to train emotional and social skills in children with autism spectrum disorder. London journal of primary care, 10(4), 110-112.    

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