An iPad™-based picture and video activity schedule increases community shopping skills of a young adult with autism spectrum disorder and intellectual disability

Adaptive interviewing for the inclusion of people with intellectual disability in qualitative research

BACKGROUND

Historically the voices of people with intellectual disability have been occluded by barriers imposed by research practice. More recently, adaptive research approaches have been proposed to enhance the inclusion of people with intellectual disability in qualitative research.

METHOD

This article presents an adaptive interviewing approach employed with five people ageing with intellectual disabilities in rural South Australia. The interviews were conducted within a broader participatory action research project in which tools and resources were co-designed for post-parental care planning.

RESULTS

We describe our adaptive interviewing approach incorporating multiple methods: (i) responsive communication techniques; (ii) the inclusion and support of family carers; (iii) visual tools; (iv) walking interviews.

CONCLUSION

Findings contribute knowledge about how an adaptive interview approach supports the participation of people with an intellectual disability in qualitative research.

When you are not here, I cannot do what I want on the tablet - The use of ICT to promote social participation of young people with intellectual disabilities

Most youths use Information and Communication Technology (ICT) for socialising, but there is a discussion about whether using ICT promotes social participation for youths with intellectual disabilities (IDs). Employing the concepts of social participation and self-determination together with the youths' perspectives, as conveyed by staff, we examine how social participation might be promoted for youths with intellectual disabilities in institutional settings in Sweden. The findings revealed three overarching themes. The first theme, Developing skills, self-determination and becoming less reliant, illustrates the basic use of ICT. The second theme, Sharing events, socialising and participating with others, draws attention to how youths take technology a step further to interact with others. The third theme, Resources and attitudes, concerns the youths' need and desires for adequate support and equipment and the mindset of surrounding communities concerning ICT. Our conclusion is that ICT has the potential to promote social participation if the youths have access to personalised equipment and supportive staff.

Systematic review: Need for high-quality research on occupational therapy for children with intellectual disability

BACKGROUND

Enabling participation in everyday life and supporting development are essential goals in occupational therapy of children and young people with intellectual disabilities (ID).

OBJECTIVE

To gather and evaluate evidence of the effectiveness of occupational therapy interventions for children with ID in terms of participation in everyday life.

MATERIAL AND METHODS

A literature search conducted using electronic databases (CINAHL, Cochrane Library, PubMed and EMBASE) from January 2000 to May 2020. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Quality of evidence was critically appraised with the GRADE.

RESULTS

The search yielded 4741 records, of which 15 studies met the inclusion criteria: 3 randomized controlled trials, 3 case-control studies, 2 case series and 7 case reports. The studies were diverse in quality. The evidence is inconclusive because of the limited amount of methodologically robust studies.

CONCLUSIONS AND SIGNIFICANCE

Results support the notion that occupational therapy in daily environments for children with ID may enhances participation in everyday activities. Further research with appropriate study designs and outcome measurements is needed. Although the research evidence was limited, the results encourage focussing on occupational therapy for children with ID to enhance participation in school and home environments.

Interventions for Social Participation for Autistic Adults (2013-2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings on social participation interventions and participation outcomes for autistic1 adults.

Assistive technology for adults on the autism spectrum: A systematic survey

While the needs and care for children on the autism spectrum have been widely investigated, the intervention and services available to autistic adults have been overlooked for a long time. This survey paper reviewed 32 articles that described and evaluated assistive technologies that have been developed and evaluated through a complete circle of interactive product design from ideation, prototype, and user evaluation. These assistive technologies aim to improve independence and living quality in autistic adults. We extracted information from the perspective of requirement gathering, technology designing, and effectiveness of evaluation in the design cycle. We found a general lack of requirements-driven design, and the evaluation process was not standardized either. The lack of requirement gathering results in designs purely based on existing literature without targeting actual user needs. Our synthesis of included paper contributes to developing iterative design considerations in assistive technologies for autistic adults. We also suggest that assistive technologies for autistic adults shift some attention from assisting only autistic adults who require at least substantial support to embracing also those who have been living independently but rather have difficulties in social interaction. Assistive technologies for them have the potentials to help them consolidate and enhance their experiences in independent living.

Daily living skills of autistic adolescents and young adults: A scoping review

Introduction

Daily living skills (DLS) are essential for an increased quality of life and autonomous living. DLS are a focus of occupational therapy practice; however, there has been no identified review of DLS acquisition in autistic adolescents or adults. A scoping review was undertaken of which the objective was to evaluate and synthesise the extent, range, and nature of research activity, and to identify research gaps in the existing literature as they relate to DLS acquisition and autistic adolescents and adults.

Methods

A structured search of the literature was conducted. Studies published in English between 2011 and 2021 that included a focus on the acquisition of DLS in autistic adolescents and young adults were included. The titles and abstracts of 103 records were screened, and the full text of 53 records was reviewed. These reference lists were hand searched. Following this process, 25 papers were found to meet the inclusion criteria.

Results

Findings indicate inconsistencies throughout the literature, with a lack of consensus on best practice methods, mediums, and/or tools to support optimal outcomes in terms of DLS acquisition for the autistic population. Themes related to (1) Generalisation of Skills Across Contexts, (2) Skill Maintenance, (3) Technology as a Teaching Method, (4) Participant and Family Perspectives, and (5) The Balance of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) focus in research were extracted from the reviewed literature. There is a strong consensus in the findings of the identified papers that autistic adolescents and young adults experience poorer outcomes in terms of DLS acquisition than non‐autistic peers, and peers with other developmental or intellectual disabilities.

Conclusion

Future research is needed to fill these identified gaps and provide a clearer understanding on interventions to support optimal outcomes for autistic individuals.

Community participation in adults with autism: A systematic review

BACKGROUND

This systematic review aimed to explore how adults with autism participate in the community, the impact of community participation on quality of life and mental health, and factors that support and hinder participation.

METHOD

A systematic review was conducted including studies published from inception to 17 January 2021.

RESULTS

Sixty-three reports were included, reporting on 58 studies. Solitary activities, organised group activities, community activities, religious groups and online social participation were identified. The relationship between community participation and quality of life was examined. Barriers and facilitators to increased community participation were identified. Most studies had a moderate to high risk of bias.

CONCLUSION

Adults with autism participate in a range of independent and community activities. The impact of community participation on quality of life and mental health warrants further exploration. Future studies should find effective ways of supporting adults with autism to participate in the community.

Enhanced participation or just another activity? The social shaping of iPad use for youths with intellectual disabilities

The use of smartphones and tablet devices in activities is believed to have great potential for enhancing the participation of people with intellectual disabilities. However, these technologies, in themselves, do not contribute to participation. What matters is how they are used. Employing the concept of domestication and insights gained from interviews with staff, this article examines conditions for the enhanced participation of youths with intellectual disability and how tablet devices are being integrated into social care settings, in particular.The findings reveal two approaches to tablet integration. In one approach, tablet use is an organized practice focused on technology acquisition, skills improvement and entertainment. In the other, it is integrated into existing practices as an aid to interpersonal communication. The organized digital activities create conditions for the youths to participate like non-disabled peers. The greatest potential for enabling participation with each other is when the youths themselves initiate the use of tablets.

Effectiveness of Virtual/Augmented Reality-Based Therapeutic Interventions on Individuals With Autism Spectrum Disorder: A Comprehensive Meta-Analysis

In recent years, the application of virtual reality (VR) for therapeutic purposes has escalated dramatically. Favorable properties of VR for engaging patients with autism, in particular, have motivated an enormous body of investigations targeting autism-related disabilities with this technology. This study aims to provide a comprehensive meta-analysis for evaluating the effectiveness of VR on the rehabilitation and training of individuals diagnosed with an autism spectrum disorder. Accordingly, we conducted a systematic search of related databases and, after screening for inclusion criteria, reviewed 33 studies for more detailed analysis. Results revealed that individuals undergoing VR training have remarkable improvements with a relatively large effect size with Hedges g of 0.74. Furthermore, the results of the analysis of different skills indicated diverse effectiveness. The strongest effect was observed for daily living skills (g = 1.15). This effect was moderate for other skills: g = 0.45 for cognitive skills, g = 0.46 for emotion regulation and recognition skills, and g = 0.69 for social and communication skills. Moreover, five studies that had used augmented reality also showed promising efficacy (g = 0.92) that calls for more research on this tool. In conclusion, the application of VR-based settings in clinical practice is highly encouraged, although their standardization and customization need more research.

Effects of a Community-Based Familiarization Intervention on Independent Performance of Resistance-Training Exercise Tasks by Adults With Intellectual Disability

Adults with intellectual disability (ID) have significantly lower levels of fitness compared to the general population. The study examined the effects of a multicomponent familiarization intervention, consisting of a visual activity schedule and a video-enhanced system of least-to-most prompting, both displayed via an iPad, on the acquisition of resistance-training exercise tasks by adults with ID, aged 18-44 years, in a community fitness center. Twelve participants were randomly allocated to an experimental group (EG) and 12 to an active control group (CG). ANOVA revealed EG correctly and independently performed a significantly greater number of steps of four resistance-training exercise tasks compared with CG, relative to preintervention levels (p < .01). The intervention was effective in promoting functional performance of resistance-training exercise tasks among adults with ID.

Technology and Communication Considerations for Engaging Youth Receiving Supplemental Security Income (SSI) Benefits: Vocational Rehabilitation Counselor Perspectives

Technology has been shown to enhance daily activities, increase participation in individualized planning and supports, and accommodate the transition needs of students with disabilities. This study examined the benefits and challenges regarding technology use when providing transition services for youth and families receiving Supplemental Security Income (SSI) benefits. Specifically, it explored the nuances of employing technology to encourage engagement in Wisconsin Promoting the Readiness of Minors in Supplemental Security Income (WI PROMISE) services and foster communication between counselors and participants. This qualitative study used a constant comparative method for analyzing data collected through two focus groups of WI PROMISE counselors. Counselors identified technology as essential to maintaining contact with WI PROMISE participants as well as extant barriers including inconsistent access to the internet, financial expense, and insufficient training and support. Recommendations for using technology to communicate with transition-age youth and their families will be discussed.

Der Einsatz der RehaGoal App durch Menschen mit einer intellektuellen Beeinträchtigung bei der Arbeit zu Hause während der Corona-Pandemie

Zusammenfassung. Infolge der Corona-Pandemie 2019 und den damit einhergehenden Restriktionen verloren Menschen mit einer intellektuellen Beeinträchtigung – wie andere auch – ihre Praktikumsplätze oder wurden in das Szenario „Arbeit zu Hause“ geschickt. In einer für den ersten Lockdown konzipierten 3-wöchigen Pilotstudie zur Untersuchung einer mobilen Applikation zur Handlungsplanung kochten drei Teilnehmer*innen mit exekutiver Dysfunktion – und daraus resultierenden Schwierigkeiten in der Handlungsplanung – begleitet von Jobcoaches mithilfe der RehaGoal App. Zur Erfassung der Usability dieser App wurde ein teilstandardisierter Fragebogen von den Teilnehmer*innen und ihren Angehörigen beantwortet. Es zeigte sich, dass die Teilnehmer*innen die RehaGoal App gut einsetzen konnten und sich sicher in der Benutzung fühlten. Zudem gaben die Angehörigen an, sich vorstellen zu können, die App für weitere häusliche Aufgaben zu nutzen.

Do we need to go beyond a purely behavioral approach? A response to Woodcock and Blackwell

: In their recent review, 'Psychological treatment strategies for challenging behaviours in neurodevelopmental disorders: what lies beyond a purely behavioural approach?' Woodcock and Blackwell discuss supposed deficiencies in applied behavior analysis (ABA) and positive behavior support (PBS) to address challenging behavior. This commentary highlights problems with Woodcock and Blackwell's critique based on substantial evidence that behavioral approaches including ABA and PBS are often the best available solution for individuals with neurodevelopmental disorders who display challenging behavior.

eHealth in the support of people with mild intellectual disability in daily life: A systematic review

BACKGROUND

eHealth has recently made rapid progress in care, support and treatment. However, studies on the use of eHealth to support people with a mild intellectual disability in daily life are limited. A systematic review was conducted to provide an overview of this use of eHealth.

METHODS

Seven databases were searched for relevant studies and assessed according to the PRISMA guidelines. Descriptive analyses were deployed using the Matching Person to Technology model to evaluate the key areas contributing to successful eHealth use.

RESULTS

Most of the 46 studies included were small-scale case studies and focused on using eHealth to acquire daily living skills and vocational skills. In addition, several studies focused on eHealth use for self-support in daily living, and three studies focused on remote professional support.

CONCLUSIONS

eHealth offers opportunities to support people with mild intellectual disability in various different contexts of daily life. Scientific research on this topic is in its early stage, and further high-quality research is needed.

Teaching Young Adults with Intellectual Disability Grocery Shopping Skills in a Community Setting Using Least-to-Most Prompting

Using a multiple probe design, we examined the effects of least-to-most prompting to teach young adults with intellectual disability (ID) to locate and select items using a grocery list presented on an iPad. Sessions were conducted entirely in a community grocery store. The results indicated that participants learned to use an initial grocery list, with one participant demonstrating the ability to use a re-sequenced grocery list and a list with novel items. These results are discussed along with implications for practice.

Services for Adults With Autism Spectrum Disorder: a Systems Perspective

PURPOSE OF REVIEW

We review original research about services for adults on the autism spectrum published from January 2013 through December 2018. The main aim is to characterize the topical and methodological aspects of research about services. We review research on services related to employment, living in the community, and social participation. We compare our results with those from a similar review published in 2012 to assess progress and identify where new directions in research about services for adults with autism are needed.

RECENT FINDINGS

We found the evidence base about services for adults on the autism spectrum remains very small and highly variable in aims and methods. There is wide variability in methods used to define sampling frames and recruit participants. Most studies focus on employment. Almost no studies examine the overall ecosystem of services serving autistic adults. Few studies use a conceptual framework for understanding access to, or improvement of, services. The small size of the extant research coupled with inconsistent quality prevents the accumulation of new knowledge in ways that would significantly inform the improvement of systems of care for the growing population of adults on the autism spectrum.

Supporting Independence at Home of People with Autism Spectrum Disorder: Literature Review

BACKGROUND.

The integration of a life environment enabling people with autism spectrum disorder (ASD) to fully exercise their independence must be well prepared.

PURPOSE.

Review and describe interventions intended to develop the independence at home of people with ASD.

METHOD.

The PRISMA method was used to perform a systematic review based on 19 keywords, grouped under three concepts: (a) population age (adolescents and adults), (b) diagnosis (ASD), and (c) independence.

FINDINGS.

Seven effective interventions were identified in the 20 selected articles: (a) video self-modeling, (b) video modeling, (c) behavioural interventions, (d) video prompting, (e) transition planning program, (f) training in the use of a cognitive aid, and (g) social skills group.

IMPLICATIONS.

The results of this review will help guide practitioners in the implementation of interventions that foster the development of independence at home of people with ASD.

Using an augmented reality game to teach three junior high school students with intellectual disabilities to improve ATM use

BACKGROUND

Individuals with intellectual disabilities (ID) may have difficulties in performing daily living tasks. Among other daily living tasks, independent automated teller machine (ATM) skills are an essential life skill for people with intellectual disabilities.

MATERIALS AND METHODS

Three junior high school students in a special education class participated in the experiment. We employed the augmented reality (AR) technology to gamify ATM skill training. Specifically, a multiple baseline design was adopted to demonstrate the relation between game-based intervention and using an ATM independently.

RESULTS

Data showed that the percentage of correct task steps increased among all three participants. Social validity results showed the teachers considered the AR game was very useful and it had helped their students learn the ATM skills effectively.

CONCLUSIONS

The proposed AR game can be used for effective training of students with intellectual disabilities using an ATM independently.

Tablet-based interventions for individuals with ASD: Evidence of generalization and maintenance effects

BACKGROUND

Despite positive effects of and established empirical evidence for tablet-based interventions for individuals with autism spectrum disorder (ASD), it is not known whether such findings can be applicable to maintenance and generalization effects of those interventions.

AIMS

This systematic review evaluated peer-reviewed single-case experimental design (SCED) studies concerning evidence of generalization and maintenance effects of tablet-based interventions for individuals with ASD.

METHODS

To evaluate the methodological rigor of the literature in terms of generalization and maintenance effects, the authors adopted four of the basic design standards developed by What Works Clearinghouse (WWC; Kratochwill et al., 2010/2014). In addition, the authors used Tau-U effect size measure and attempted to calculate effect sizes differentiated by the type of generalization and maintenance teaching strategies.

RESULTS

A total of 21 studies assessed generalization and/or maintenance effects. In the first evaluation of evidence of generalization and maintenance effects, it was found that more than half of the studies included in this review collected interobserver agreement (IOA) on at least 20% of sessions across all generalization and maintenance conditions and met the minimum quality thresholds of IOA. Meanwhile, less than one third of the studies included more than three data points in each generalization and maintenance condition. With regard to maintenance of effects, about half of the reviewed studies did not report the latency to the maintenance measure, which may hamper the assessment of the clinical and practical significance of the effect of the tablet-based intervention. In the second evaluation, the omnibus Tau-U effect size for baseline to generalization comparisons resulted in a moderate effect. For the contrasts between intervention and generalization comparisons resulted in a small effect. The omnibus Tau-U effect size for baseline and maintenance comparisons resulted in a strong effect. For the contrasts between intervention to maintenance comparisons, the omnibus Tau-U effect size resulted in a small effect.

CONCLUSIONS AND IMPLICATION

Findings in this review suggest that efforts should be made to establish a system for appraising generalization and maintenance procedures in SCED studies. In addition, future studies should investigate if tablet-based interventions are truly effective in creating sustainable behavioral change in individuals with ASD.

Digital technologies for social inclusion of individuals with disabilities

Information technology can be an important facilitator of social inclusion for people with disabilities into society. However, the goals specified in this area by organizations such as the European Commission have not yet been achieved in their totality. The aim of this paper is to explore which types of information communication technology-based applications and/or digital services have been suggested to facilitate the social integration of people who suffer from different types of disabilities. We performed a literature review that included studies published during a period of 6 years (2010–2016). The results show that, in the data we have had access to, no concrete patterns can be identified regarding the type of technology or technological trends that can be used to support the social integration of individuals with disabilities. This literature review is of relevance to the identification of further research areas and to the identification of issues which have to be considered in the context of the development and implementation of technological innovations that are aimed at promoting or facilitating social inclusion of individuals with disabilities.

Electronic Screen Media Use in Youth With Autism Spectrum Disorder

Electronic and social media play a prominent role in the lives of children and teenagers. Evidence suggests youth with autism spectrum disorder (ASD) use media differently than typically developing peers, and some of these differences place them at greater risk for negative health outcomes related to unhealthy and improper use of media. Such outcomes include physiologic, cognitive, social, emotional, and legal/safety problems. However, several technology-aided interventions have emerged to help youth with ASD across multiple domains. Parents of youth with ASD may benefit from several recommendations and resources from the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.

Effects of video modeling with video feedback on vocational skills of adults with autism spectrum disorder

OBJECTIVE

To examine the effectiveness of a video modeling (VM) with video feedback (VFB) intervention to teach vocational gardening skills to three adults with autism spectrum disorder (ASD).

METHOD

A multiple probe design across skills was used to assess the effects of the intervention on the three participants' ability to perform skills accurately.

RESULTS

The use of VM with VFB led to improvements across skills for two of the participants. The third participant required video prompting (VP) for successful skill acquisition. Skill performance generalized across personnel and settings for two of the participants, but it was not assessed for the third. Skill performance maintained at follow-up for all three participants. Social validity data gathered from participants, parents, and co-workers were positive.

CONCLUSION

These findings suggest that VM with VFB and VP with VFB were effective and socially acceptable interventions for teaching vocational gardening skills to young adults with ASD.

A meta-analysis of single-case research on the use of tablet-mediated interventions for persons with ASD

BACKGROUND

There is a growing amount of single-case research literature on the benefits of tablet-mediated interventions for individuals with autism spectrum disorder (ASD). With the development of tablet-based computers, tablet-mediated interventions have been widely utilized for education and treatment purposes; however, the overall quality and evidence of this literature-base are unknown.

AIMS

This article aims to present a quality review of the single-case experimental literature and aggregate results across studies involving the use of tablet-mediated interventions for individuals with ASD.

METHODS AND PROCEDURES

Using the Tau nonoverlap effect size measure, the authors extracted data from single-case experimental studies and calculated effect sizes differentiated by moderator variables. The moderator variables included the ages of participants, participants' diagnoses, interventions, outcome measures, settings, and contexts.

OUTCOMES AND RESULTS

Results indicate that tablet-mediated interventions for individuals with ASD have moderate to large effect sizes across the variables evaluated. The majority of research in this review used tablets for video modeling and augmentative and alternative communication.

CONCLUSIONS AND IMPLICATIONS

To promote the usability of tablet-mediated interventions for individuals with ASD, this review indicates that more single-case experimental studies should be conducted with this population in naturalistic home, community, and employment settings.

Supporting Tablet Configuration, Tracking, and Infection Control Practices in Digital Health Interventions: Study Protocol

Background

Tablet-based health care interventions have the potential to encourage patient care in a timelier manner, allow physicians convenient access to patient records, and provide an improved method for patient education. However, along with the continued adoption of tablet technologies, there is a concomitant need to develop protocols focusing on the configuration, management, and maintenance of these devices within the health care setting to support the conduct of clinical research.

Objective

Develop three protocols to support tablet configuration, tablet management, and tablet maintenance.

Methods

The Configurator software, Tile technology, and current infection control recommendations were employed to develop three distinct protocols for tablet-based digital health interventions. Configurator is a mobile device management software specifically for iPhone operating system (iOS) devices. The capabilities and current applications of Configurator were reviewed and used to develop the protocol to support device configuration. Tile is a tracking tag associated with a free mobile app available for iOS and Android devices. The features associated with Tile were evaluated and used to develop the Tile protocol to support tablet management. Furthermore, current recommendations on preventing health care–related infections were reviewed to develop the infection control protocol to support tablet maintenance.

Results

This article provides three protocols: the Configurator protocol, the Tile protocol, and the infection control protocol.

Conclusions

These protocols can help to ensure consistent implementation of tablet-based interventions, enhance fidelity when employing tablets for research purposes, and serve as a guide for tablet deployments within clinical settings.