Technology-Based Autism Intervention Options

PECS VS. iPAD FOR AUTISM

Autism spectrum disorder (ASD) has come to be known as one of the more afflicting and damaging mental disorders that affect people around the world, particularly when it comes to the youth. As the understanding of the disorder increases, so do the types and forms of therapies and tools that can be used to combat and treat the disorder. While more traditional interventions like pharmacological and traditional therapy methods are still quite common and pervasive when it comes to the normal treatment courses, there has been the emergence of solutions in particular as a means to assist or create a therapeutic environment for children with autism. A technology-based solution for autism treatment and assistance is the iPad, a product of Apple Corporation. A non-technology solution that is prolifically and commonly used is known as the Picture Exchange Communication System (PECS). What follows in this report is a literature review that speaks about those two methods as it pertains to treatment of patients with Autism Spectrum Disorder.

PECS vs. iPad for Autism

As noted in the abstract, the use of iPads and the Picture Exchange Communication System (PECS) have both emerged as treatment vehicles to assist both treatment facilitators as well as the autism spectrum disorder patients themselves when it comes to treatment of and coping with autism. This document will include a literature review of ten scholarly sources that cover PECS, iPads or both as it relates to the treatment and assistance for patients with Autism Spectrum Disorder (ASD). There will be a discussion of key terms as well as the literature review itself which shall be divided by the key themes and topics involved. A conclusion and summary will end this document along with a recitation of the scholarly sources used for this report. While technology is a not a fix-all and while both the iPad and PECS have their upsides and downsides when it comes to providing effective treatment for Autism Spectrum Disorder, the two technologies can certainly be tools that can make treatment much more effective and much more quickly when it is wielded effectively and properly.

Definition of Terms

Autism Spectrum Disorder: As defined and discussed by the National Institute of Health, Autism Spectrum Disorder (ASD) is characterized by four major categories of symptoms and problems, and they are as follows:

Persistent deficits when it comes to social communication and social interaction across multiple social situations and contexts

A restriction and repetition of certain patterns of behavior, activities and interests.

A certain subset of symptoms that must be present in the early developmental period, usually seen clearly within the first two years of a child's life.

Symptoms that cause a significant amount of impairment in social, occupational, or other important areas of functioning during the developmental stages of life (NIH, 2015).

Technology: The blanket term used for modern electronics and similar objects. For a common person, it would include things such as smartphones, laptop computers, tablet computers, televisions and other similar consumer electronics.

iPad: This is the Apple Corporation offering when it comes to tablet-based computers. Rather than having a conventional keyboard and mouse like a laptop or desktop computer, an iPad (or other tablet) is usually a thin and rectangular shaped device whereby all the interactions with the device occur on the screen of the device. Examples of interacting with the device would include typing on a virtual keyboard, clicking on buttons, scrolling through documents and so forth.

Communication: This is the process, whether verbal or written, whereby people speak with and converse with each other. The prior mentioned technology (including the iPad) as well as the Internet has greatly increased the ease and forms of communication between people in the same general area as well as around the world

Teacher Knowledge: This term speaks to the knowledge and know-how that is possessed by a teacher when it comes to certain topics. As an example, a teacher that makes use of PECS for students with ASD would need to have a good understanding of how the system works and how it should be used. This knowledge and mastery level would need to be measured to ensure that the teacher is qualified to use the method and that they are using it in a way that is sufficiently beneficial for the patients involved.

Evaluation: When it comes to ASD, this relates to the concept of how well a student with ASD is responding to treatment including the type of intervention used, the tools used for said intervention, how often the interventions are occurring and how well the patient is progressing in general. Of course, there is also an initial evaluation period where the initial state and benchmarks for the patient are measured and recorded.

Intervention: This is another way of referring to the manner in which a patient is treated. For example, if a patient has a mental illness and there is the use of cognitive behavioral therapy (CBT) for that patient, then CBT would be the intervention in use for that patient, or at least one of them. Multiple and simultaneous interventions may be needed for a single patient and even for a single disorder.

Computer-Assisted Learning: This is the practice of using computers as a tool to facilitate or create learning environments. In the earlier dates of computing, such computer-assisted learning would often be limited to desktop computers. However, it has since expanded greatly to include laptop computers and tablets like the Galaxy Tabs (made by Samsung) or the Apple iPads, the latter of which is covered in this report.

Picture Exchange Communication System (PECS): As explained by the PECS website, PECS is referred to on its website as being both augmentative as well as an alternative solution when it comes to communication interventions with autism patients. It has applications with Autism Spectrum Disorder as well as other developmental disabilities. The technique makes use of pictures and objects as opposed to a technology-based solution like the iPad (PECS, 2015).

Literature Review

Apple iPad/Technological Solutions

When it comes to the Apple iPad, there is certainly a large number of proponents that tout its efficacy and performance when it comes to helping autism-stricken children. Boyd, Hart-Barnett and More (2015) note that the advent and emergence of mobile technology has introduced a new communication medium and opportunity for students that are diagnosed with autism spectrum disorder. There is a significant amount of customization that is allowed for with the iPad and the use of the iPad solution, as opposed to systems like PECS, offers a much less stigmatizing and humiliating means to get treatment but yet still allows for therapeutic treatment and progress to take place. However, Boyd and his colleagues do caution that the research about the efficacy of the iPad and similar solutions is not always keeping up with the emergence of the technologies and software suites being used. With that being said, Boyd notes that the quality and performance of intervention can be measured using several different yardsticks including the ability to customize the solution, the motor skills that are needed to operate the system, the resources and time that are needed for the intervention in question, the research or evidence-based practices that support the intervention in question and the cost of the specific device or application that is being used (Boyd, Hart-Barnett & More, 2015).

Another study that focused on the iPad in particular was offered by Cumming, Strnadova and Singh in 2014. The study related to developmentally disabled students at a private high school in Sydney, Australia. There was a collection of data that stemmed from observations of those developmentally disabled students using iPads as a treatment intervention for their disorders. An inductive content analysis approach was used to assess the outcomes. One thing that was discovered is that the learning subjects that were previously not engaging and enrapturing for students became much more interesting and fun for the kids involved once the iPad was used as a vehicle. However, there were some problems with the iPad use overall as many teachers were not well-versed on the technology and there were concerns about fairness due to the autism-stricken children getting to use the iPads but other students were not (Cumming, Strnadova & Singh, 2014).

Fletcher-Watson (2013) looked at the broader subject of computer-assisted learning for children and people in general with Autism Spectrum Disorder. Fletcher-Watson echoed the prior source when she notes that personalization and customization is a critical factor when it comes to technology-based interventions. Non-technology interventions may not be as flashy and "sexy" as systems like the iPad. However, those non-technology interventions are uniquely and specifically designed to treat autism and thus they should not be eschewed if they are effective. On the other hand, technology allows for much easier customization and user-friendly ability to make changes and this would probably make technology the wiser course to use for treatment so long as the underpinning foundations and frameworks for the iPad software in question is designed and crafted properly (Fletcher-Watson, 2013).

Another important to study to focus on related specifically to iPads as a way to treat and assist students with autism. As published in February 2014, research Amy Price covered a pilot study that occurred at Oakstone Academy. The study aimed to reveal the overall role that was played by the use of interactive books that were rendered on iPad rather than using physical copies of books and other materials. The study was eventually expanded to include all of the schools six hundred students. The upside touted by Price is that while the costs can be daunting to some, the applications and options that exist when it comes to the iPad are far superior to just about anything else when used and approached in the right way. The logistics of paying for such technology and sharing the devices when there are more kids than devices can create some issues. However, the effort to manage those challenges is worth it if the proper choice sand methodologies are used (Price, 2014).

PECS System

Even if the PECS system is not technology-driven like the iPad obviously is, its efficacy and performance over time is touted quite often. However, the verdict of PECS being the best or even a decent intervention for Autism Spectrum Disorder is by no means unanimous or overwhelming. This is made clear in many scholarly articles including the study done by Flippin, Reszka and Watson as published in May of 2010. To prove their point, the researchers used eight single-subject experiments with a total of eighteen participants. In total, there were three group studies. There were just less than one hundred PECS participants and there were sixty-five that were using another intervention or they were in the control group. Per the results, it was found that PECS is "promising" but that it is not quite at the point where it can be called an evidence-based solution that is beyond reproach. The authors of the study did not say this casually or based on fleeting research as the research in question was done with a very specific method and they also did a literature review spanning from 1994 to 2009 (Flippin, Reszka & Watson, 2010).

Another study that focused on PECS in particular was the one done by Tincani and Devis in 2011. Similar to the Flippin treatise, there was a group of single participants and their performance before, during and after the use of the PECS system was assessed. Unlike Flippin, the results for PECS interventions aws found to be positive. The term that Tincani and Devis used was "moderately effective." Further, they found that recorded learning sessions that included the vocalizations of autism spectrum disorder patients seemed to reveal that speech was actively facilitated by the PECS system (Tincani & Devis, 2011).

Technology & Non-Technology Compared

One research study in particular that was covered as part of this literature review specifically compared the efficacy of the iPad as an autism intervention with an picture-based system like PECS. It was found that the Apple iPad was mixed in its efficacy as compared to picture-based system. In some instances, the iPad was superior to the picture-based system. However, in other instances there was a not a discernible difference between the outcomes realized between the technology-based and picture card-based solution (Flores et al., 2012).