Everyday my Facebook feed is littered with the latest miracle stories of how an iPad (or similar device) has helped an autistic child to communicate. Some of those stories are shared from the web, but most of them are from my friends sharing their latest successes with their own child.
Does the research actually support this miraculous outcry though, and even if it did, should we be getting our kids to put down that iPad and pick up that PECS box? This post is my first effort to answer that question.
First a brief look at some of the existing research. There is a study specifically looking at PECS (Picture Exchange Communication System) as compared to using the iPad to achieve the same ends. It is useful to compare iPads to the PECS system because PECS is a well established communication system for autistic children, with a good reputation. This 2012 study (Flores et al) was a small study, of only five children, but found that those children either improved or had no comparative improvement when using the iPad versus using PECS (ie, an overall positive outcome for iPad use). Van der Meer, Kagohara, et al. (2012) only looked at four children, and at the iPod versus manual signs, with implications for the use of other assistive technologies. Again, it found positive outcomes for those children involved in the study. A recent systematic review of 15 studies on the use of such devices, also found a largely positive outcome.
A theme that comes through the research is that success using these devices is quite individualised; whether a child responds well to the use of a device is not predetermined by their diagnosis. Nevertheless, it appears to do no harm and potentially much benefit, to give it a go.
But what does “giving it a go” entail? The biggest hurdle for many is simply the cost. We are a two iPad family, but we didn’t pay for either (I won one, my husband got his through work). If we had to purchase an iPad specifically for my autistic son, I don’t know that we could have afforded it (or have chosen to do it). But for those families that can, and those families that have other general reasons to have an iPad in the family, it would seem to be worth a try. I do not think though that it is worth putting pressure on publicly funded services to supply an iPad (or similar device) to a family with an autistic child; the fact is there are still traditional and excellent alternatives available. Similarly (and even more so) I do not think there is strong enough reason to demand a family acquire such a device in order to help their autistic child. Ultimately, any therapists working with a family should be willing and able to adapt to what both the family can afford, and what the child responds best to; that individualism focus is itself what comes through the research.
Where other methods have tried and failed or had limited success, there would be a strong reason to try these new devices, and the sooner the better; early intervention is well documented to make a significant difference in an autistic child’s life.
There are those who seem to rebel against the use of this new technology merely because it is new technology. I have the same leaning; I do not like trying new things as a general rule, and I prefer to stick to what I know best, especially if it already works for me. I think, for people like me, it helps to remember that these technological aides are not about turning known and proven methods on their head, it is about making those known methods more accessible and building on their principles; extending rather than turning away from what works.
My own son had huge communication leaps using PECS. We still have his PECS box, full of laminated pictures, Velcroed backs, sentence strips, and category cards. If we’d had and used an iPad app instead, the primary difference I can imagine for us would have been time and convenience: Access to pictures without having to print them off and get them laminated by his therapist; not sitting on the carpet for hours cutting up and applying Velcro to the back of each picture and sorting them into usable categories; and not having to desperately sort through a box trying to find just the right picture while my son tried to contain his frustration.
Even the process of learning how to properly use PECS, could have been assisted by having an appropriate app; one that step-by-step helps and guides the parent through what to do and when to move onto the next learning level. As was, I had to read manuals and be carefully guided and instructed by a speech therapist when using manual PECS. I don’t think it would be wise or recommended to remove the role of the therapist – you still need someone to guide you to what to use for your child and how best to use it, and to help gauge successes and consider alternatives – but you can’t have a therapist with you all day everyday, whereas an iPad’s app might be able to help fill that gap.
We’ve tried my son on computer programs to assist his learning and communication before, and he struggled hugely with coordinating the mouse to do what he wanted on the screen. The iPad and similar touch devices bypass this common coordination issue, and frankly makes the whole experience more fun for all of those involved (the simple value of “fun” should not be underestimated). Swiping a finger and using a finger to move between and select options, is also highly intuitive.
In a practical sense though, how much sense does it make for a child to carry around an expensive (and sometimes large) device at all times, in order to communicate? The size issue to me is redundant here, because that PECS box and folder under my son’s bed was hardly easy to carry around, and the time required to tidy up and reorganize the pictures as we’d go through the day, was no small thing. As for the price of the device in the hands of a child, I think that’s a fair concern, but outweighed by the value of them having constant access to it, and can be offset by getting older or smaller models of devices that cost less.
Choosing the right apps is no small task, but again that is where having therapists who know the child and are familiar with the options, is always going to be valuable asset. On our iPad we have many apps that have been of no use to my son, and get removed the same day we download them. We also have apps that we’ve used to help our son deal with an issue he’s been facing or to extend his skills in a concerning area. I never just download such apps and leave him to it, I sit beside and help guide him through and discuss arising issues with him, just like I do any traditional forms of intervention (such as using social stories).
An iPad can’t replace all intervention types of course, but that’s not the claim for those who sing the virtues of their use. Occupational therapy, physiotherapy, social skills, as well as communication skills, can all be worked on without an iPad, but an iPad could also be used to enhance and reinforce that learning. It would seem a shame to not use one more option that might be the one that helps that child make a break-through in a skill or in their communication.
When I set out to write this post, I was not strongly in favour of the use of these devices, but the more research I do into their use and successes, it is hard to not become strongly pro their use, for those families that can afford them and are willing to try them. I think there is potential for abuse and misuses of iPads, but the same potential exists in all interventions improperly or ignorantly used (PECS for example has strict guides for what steps to go through and when, it is easy to go wrong and further frustrate and misteach a child using standard PECS without appropriate guidance). Perhaps that is where the danger lies: Perhaps there are too many options and too little guidance when it comes to using the iPad for communication purposes. In that case, it is just an argument for therapists to embrace and acknowledge the role and use of this technology, to help families avoid those pitfalls and to help them get the most out of it: To turn a potential problem, into a very real solution.
I also think therapists should actively encourage families to problem-solve their child’s challenges. In the first few years after an autism diagnosis, it makes sense for the role of therapists to be very heavy-handed, to help parents avoid common errors and to not throw their money away on untested and unproven interventions. But as the years go by the parents must be empowered and encouraged to think-through and find the solutions themselves; the presence and ability to use an iPad does – I believe – extend those options for a family.
My summary then: Research, personal experience, talking to other parents and teachers, and simply thinking through the issues (for what that’s worth), do lead me to see great potential benefits and few dis-benefits in iPad use, particularly as an assistive technology for communication. I can see issues with their use (such as cost, and poor selection and use of apps), but I think the key concerns can be addressed by appropriately supporting a family on how to best use an iPad in their child’s life. I think we need to acknowledge that families are going to try iPads anyway, and be willing to help them make the most of it, and acknowledge further that studies so far are quite positive about the potential benefits. As always, it is essential to take into account the individual child’s strengths and preferences.