It's not uncommon in my practice to encounter some struggle with technology. This happens in families who don't live with autism or ADHD, but can be especially difficult for kids with hypersensitive or sensory-seeking nervous systems. It's important to know the benefits and limits of the technological tools we have available; the iPad is the most popular, and this lecture at the University of Washington Autism Awareness Month Series focused primarily on how to create a positive experience for parents and children with this tool.
Presenters Kelly Johnson, Ph.D. & Jo Ristow, M.S., CF-SLP started the lecture by stating that while the iPad and other electronic devices can be alluring and entertaining, it’s very important to keep broader social, language, and cognitive goals in mind during use. Speech pathologists, occupational therapists, behavioral therapists, teachers, and other parents can help in developing these goals and finding the best apps with which to achieve them. And sometimes, apps aren’t even needed to improve the life of your child through technology.
You Don’t Need All the ‘Bells and Whistles’ – Built-in Features of the iPad
With all the fancy apps and software add-ons, it’s important to remember the completely free options the iPad has right out of the box. The still and video camera are great resources for creating social stories and video modeling.
The speakers stated that it’s important to build a photo album using the iPad camera; if photos or video are captured on the iPad stock camera – versus within an app – they area available to all apps and projects on the iPad. Some pictures or videos captured within a specific app are not available in other apps, and will be erased if the app is removed from the iPad itself. This can mean the loss of years of irreplaceable and incredibly useful photos and videos.
Other features to take advantage of are reminders, the calendar (which can sync with many other devices if needed), Facetime for face-to-face communication with other Apple devices, iBooks (for more on this feature, find the ‘Useful Apps’ section below), and the basic internet browsing feature to look up helpful instructive videos and educational material. Additional stock features of the iPad that are a bit more in-depth are explained below:
Guided Access is a built-in feature on all iPads except the first generation devices, and is available on any device with the operating system iOS 6 or later. When activated, it causes certain options to become unavailable within an app. An example of a good use for the feature would be in the case of a child who loves a certain part of a language-building app and constantly moves backwards and forwards to that specific part. If your goal for the child is to build vocabulary, then this situation can severely impair progress. With Guided Access, the backward and forward buttons within the app can be made inaccessible temporarily, to encourage the child to discover more of the language-building content. Guided Access doesn’t restrict apps that the child can access on the home screen, but once within an app there are many options for altering accessible content.
To turn on Guided Access in the iPhone and iPad:
- Launch the Settings app from the Home screen of your iPhone or iPad
- Tap on General.
- Scroll down towards the bottom of the screen and tap on Accessibility.
- Under the Learning section, tap on Guided Access.
- If it’s not already, turn the toggle next to Guided Access to the On position.
- On this same page, you can also Set a Passcode for the Guided Access option so that the child cannot make alterations to your settings.
- On this same page, you can also toggle the Enable Screen Sleep to the off position so that the screen will not dim after a period of inactivity. This would be important, for example, if a child tends to spend a good amount of time on one part of the app without touching the screen.
To enter the Guided Access mode within an app:
- To enter Guided Access mode on your iPhone or iPad, just enter the app you’d like to use and triple click the Home button.
- If you have multiple shortcuts set up for triple clicking the Home button, you’ll be given the option to choose between them.
- Just tap on Guided Access. You’ll now be launched into Guided Access mode and you can begin setting it up.
- To disable Guided Access mode, just press the home key three times again and then tap the End button.
The Guided Access feature automatically turns off all hardware buttons, including the home button, volume and power buttons. When in Guided Access mode, you can circle areas of the screen that will become off-limits during play. You also have that option to turn the motion sensor within the iPad off for apps that feature a shaking movement as part of their functionality.
Another helpful feature that is built-in to the iPad is the ability to disable in-app purchases. Many apps have pop-ups that periodically ask the user to purchase a more complete version or a completely different app with the click of a button. Obviously, this can be problematic for any child.
To disable in-app purchases:
- From your home screen, tap on the Settings app.
- Tap on General.
- Scroll about halfway down the page and tap on Restrictions.
- Tap the Enable Restrictions button.
- When you do this, you’ll be asked to Set a Passcode. The passcode is a password that locks certain functions of the iOS device. Enter the passcode twice to set it.
- Once the passcode is set, scroll down to the Allowed Content section. Toggle the In-App Purchases slider to Off. This will prevent anyone who doesn’t know your passcode from making in-app purchases.
Many other apps exist to help parents control access and available options when using the iPad. The speakers mentioned the MamaBear app; you can take a look and/or purchase the app here.
Useful Apps for the iPad for Individuals with ASD
Answers Yes No HD (Video demo): simple app that helps with communication at a beginning level, displaying two option “buttons” for patients to choose to click on
- “Yes” and “No” are the default buttons displayed
- parents can customize text displayed on “buttons”, add images and record their own text voice
- you can also set up a favorites list of options frequently used
Little Reader App: versatile literacy app for a wide variety of ages and functionality levels
- works on phonics-based curriculum with pre-set words
- parents can add additional words to add functional literacy
- fully customizable – can add your own pictures and audio
- can also make tasks easier or harder by turning off/on audio hints, or changing the number of items in lists
- often beneficial to use family members, pets, favorite characters, etc.
- can turn on and off certain lists for different clients, age groups, or functional levels, or task at hand (i.e. grocery story trip, getting the mail, etc.)
TocaBoca: company has created numerous simple yet entertaining apps that can help develop social and other skills for children
- there are many different apps for different scenarios: Toca Tea Party (Video demo), Toca Kitchen, Toca Birthday Party, etc.
- these apps can help children to develop skills such as turn-taking and encourages pretend play
- can help to prepare kids for various social scenarios that might arise
Enhanced Books: many enhanced books are available on the iPad, with one example being The Cat in the Hat- Dr. Seuss
- can change narrator’s voice or record your own
- “Read to Me” option can be enabled or disabled, as well as sound effects, music, “tap on pictures” feature, and read alerts
- multiple modes to cater to the individual child (see below)
- Read it Myself – tapping on words will result in the word being read out loud (this can help if a child needs help with certain words or wants to confirm correct pronunciation)
- Auto Play – reads and turns pages without interaction from the child or reader
- Read to Me – book is read to the child but each word is highlighted in red to allow reader to track the audio; words can appear when different pictures on screen are touched, characters will pop up on screen
VisTimer: a visual way of demonstrating the abstract construct of time, which can aid in transition between activities, taking turns and self-regulation
- options for sound when timer has ended (calming or alerting)
- early warning sound or visual reminder
- can also customize color displayed
- option for digital numerical display which can be large or small
- ability to disable the sleep mode on iPad within the app so that it doesn’t turn off while the timer is going
- there is also a Free version (maximum time is 5 min)
ChoiceWorks: aids in emotional behavior regulation and task completion
- can add own sound and pictures
- can turn off editing while child is using the app, can turn off audio, can import boards (from library on iTunes), or can transfer from home to school etc.
1) Calendar/Schedule Section
- build visual schedules for your child
- add many different schedule boards
- drag tasks to opposite side of screen when done, easy to see when tasks are completed
- can have reward activity at the end of page
2) Pre-made Template Section
- templates for the activity ‘waiting’, for example, may include the scenario “I am (not interrupting) for (time period)…while I am waiting I can (action or activity) or (action or activity).”
3) Emotions Section
- can build pages for certain situations, with cause and effect relationships and emotions; an example would be pages stating “When I am (emotion) I can (action or activity) or (action or activity), then I can (action or activity) or (action or activity).”
Sōsh – for social skills development; includes voice meter to help with sleep regulation, guided deep breathing exercises, and strategies/audio to help with sensory difficulties
Speech with Milo: series of apps created by Speech Language Pathologist that can help with elements of speech
In Summary: Five Tips for Improving a Child’s Life through Technology
Some of the key points of this talk we thought would be helpful to families are listed below:
1) Apps that are more expensive are not necessarily of higher quality OR value to your child or family.
For example, ModelMeKids and Pictello are both apps that allow families to do video modeling at home. ModelMeKids apps are free, while the price of the Pictello app is about $20. Below is highlighted the difference between the two apps:
- Pictello – aid in vocabulary development, sharing personal stories, task completion by making a family album with younger kids, show steps for multi-step task, commemorate a loss, memory book for trip, dealing with a fear; can make your own social stories, can do text to voice (also in different languages), record your own speech, and change how pages transition
- ModelMeKids - music in the background can be distracting for some children (no option to turn music off), only a little boy modeling (which may or may not be applicable to your family scenarios), can’t modify as much of the program as Pictello (not as adaptable for individuality)
2) If your child is going to use the iPad for essential life skills, it should be 100% dedicated to the child’s use.
If the iPad is key in your child’s communication, then that ability to communicate is taken away when someone else is using the device. The speakers advocated for these children by stating that parents should think of the iPad as their child’s voice.
3) Don’t forget that rule-setting teaching, supervision, and monitoring are still important.
Teach your child about social networking, as he or she may not be able to recognize social cues and/or warning signs of impending harm in an interaction. This, of course, is true not only for children and teens with an autism spectrum disorder, but those who are neurotypical as well.
Set limits on iPad free time. For children of all abilities, technology should not be a substitute for important aspects of development. It’s important to engage your child while using the iPad; try not to let the iPad, or any other electronic device, become a ‘babysitter.’ Be mindful of what goals are associated with using the iPad. The value of the electronic device will be vastly increased if there are goals set for improvements in behavior, social skills, and/or language.
4) Don’t be afraid to ask the professionals.
The ‘best approach’ according to the speakers is to get an Assistive Technology (AT) or Augmentative/Alternative Communication evaluation from a skilled clinician. Apps can seem intuitive to use and navigate, but these professionals can help with goal-setting and developing a child’s language and social skills to their fullest potential.
5) Always use the child as your guide, taking into account their individual challenges, needs, strengths, and interests.
Feature Matching is a way to take a child’s skills and challenges and use them to guide in selecting the most appropriate and effective apps available. One of the documents that can help with this process is called the App Wheel. Many apps that can benefit your child may not be found in the ‘special education’ section of the app store, so be creative in your searches. For example, the Toca Boca apps mentioned above are entertaining for children of all abilities and can help to build valuable social skills.
And the most important aspect of utilizing an iPad in the treatment of autism spectrum disorders is to always use the individual child or teen as your guide. Keeping individualized goals in mind for behavior, sleep, emotional health, and social skills is the best way to use an iPad to enrich – rather than hinder – your child’s life and development.
Dr. Bethany Glynn is currently taking patients in the Seattle and Greater Eastside areas. To make an appointment, or to learn more about her practice, click here. The above blog post is the combination of clinical experience/research by Dr. Bethany Glynn and the summary of a lecture at the University of Washington Autism Awareness Month Series. It was adapted and updated by Dr. Bethany Glynn from a blog post originally co-authored with Dr. Carrie McMillin.