Review of Twenty-First Century Portable Electronic Devices for Persons with Moderate Intellectual Disabilities and Autism Spectrum Disorders - CEC ...
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Education and Training in Autism and Developmental Disabilities, 2011, 46(4), 479-498
© Division on Autism and Developmental Disabilities
Review of Twenty-First Century Portable Electronic Devices
for Persons with Moderate Intellectual Disabilities and
Autism Spectrum Disorders
Linda C. Mechling
University of North Carolina Wilmington
Abstract: Use of portable electronic devices by persons with moderate intellectual disabilities and autism spectrum
disorders is gaining increased research attention. The purpose of this review was to synthesize twenty-first century
literature (2000-2010) focusing on these technologies. Twenty-one studies were identified which evaluated use
of: (a) media players with audio playback; (b) cellular/smartphones; (c) handheld computers and handheld
video players across various skills and settings to assist persons with disabilities. Guidelines and recommen-
dations for instruction and future research are provided.
Persons with moderate intellectual disabilities mass produced (Carey, Friedman, & Bryen,
(ID) and those with a diagnosis of autism 2005). Their portability and capacity for stor-
spectrum disorder (ASD) have been shown to ing large amounts of data formulate a tool for
have the ability to self-manage their own be- providing multiple uses for persons with mod-
haviors and to independently complete func- erate ID and ASD including: (a) remembering
tional, daily tasks when provided with the and performing steps of a complex task (Riffel
proper tools and technologies (Mechling, et al., 2005); (b) decision making (Davies,
2007; Wehmeyer, Palmer, Smith, Davies, & Stock, & Wehmeyer, 2003); (c) organization
Stock, 2008). With the use of assistive technol- and time management (Gillette & DePompei,
ogies or mainstream technologies, one of the 2008); and (d) self-monitoring and self-man-
goals is to increase independence while de- agement of behaviors (Cihak, Wright, & Ay-
creasing reliance on other persons for assis- res, 2010).
tance. Today’s portable electronic technolo- While these portable electronic devices are
gies, including handheld computers, cellular rapidly increasing in number and advancing
(cell) phones, e-books or electronic readers, in capabilities, research evaluating their ap-
global positioning systems (GPS) and per- plied use with persons with disabilities re-
sonal media or MP3 players, appear to hold mains relatively minute. In their meta-analysis
potential for assisting persons with moderate of single-subject design studies which evalu-
ID and those with a diagnosis of ASD. These ated use of technology by persons with intel-
portable technologies may be adapted or spe- lectual disabilities, Wehmeyer et al. (2008)
cially designed for persons with disabilities recommended more research with a wider
(i.e., Community Integration Suite by range of technology devices and reported that
Ablelink Technologies; Cyrano Communica- only .9% of the 81 studies they evaluated used
tor TM by Kiba Technologies, LLC) or ge- palmtop computers, 2.2% evaluated palmtop
neric, mainstream technologies such as cell computers with audio vibrators, and 4.8%
phones and the iPod by Apple, Inc. that are evaluated electronic and information technol-
ogies (i.e., cell phones).
The purpose of this review was to examine
Correspondence concerning this article should
the most current research which has applied
be addressed to Linda Mechling, University of portable electronic devices to increase the in-
North Carolina Wilmington, Department of Educa- dependent functioning of persons with mod-
tion of Young Children and Special Education, 601 erate ID and those with a diagnosis of ASD. By
S. College Road, Wilmington, NC 28404-5940. examining the present status of a relatively
Twenty-First Century Portable Electronic Devices / 479new line of research, the review holds poten- ate intellectual disability and/or autism
tial for laying the ground work for additional spectrum disorder.
lines and directions for future research.
Results
Method Twenty-one studies (Table 1) were identified
The period of review was limited to those and included in this review. Although not
studies conducted in the twenty-first century. within the scope of this literature review, read-
Although a review of this limited extent risks ers may also wish to review the work being
exclusion of some earlier findings, devices conducted with handheld devices and smart-
such as personal digital assistants, which have phones as memory and organization aids with
been in existence since the beginning of the persons with traumatic brain injury (i.e., De-
eighties, have only become extensively popu- Pompei et al., 2008; Gentry, Wallace, Kvar-
lar in the last few years (Nashville, 2009). Like- fordt, & Lynch, 2008; Gillette & DePopmei,
wise, cellular phones were a rarity fifteen years 2008; Hart, Buchhofer, & Vaccaro, 2004; Hart,
ago (Cell Phones.org, 2008), and the popular O’Neil-Pirozzi, & Morita, 2003; Wade & Troy,
iPod and video iPod by Apple, Inc. were intro- 2001). The review is organized around three
duced in 2000 and 2005 respectively. There- types of portable electronic technologies:
fore, due to the relatively recent introduction handheld computers and handheld video
of these portable electronic technologies into players (17 studies), cellular phones (3 stud-
mainstream society, and the rapidly changing ies), and MP3 players (1 study). Skills ad-
nature of technology, this review extended dressed were: functional, multi-step skills (15
from the years 2000 –2010. Journal articles studies); time management and organization
published between those years were located skills (4 studies), and independent transitions
using an electronic search through a univer- (2 studies). The majority of participants were
sity EBSCOhost database (Academic Search 15 years of age and older (18 studies) while
Premier, Eric, MasterFILE Premier, PsychAR- seven studies included students under the age
TICLES, and PsycINFO). Specific key words of 15 years and two studies included elemen-
used in the search were a combination of the tary age students. The majority of the studies
words disabilities, intellectual disabilities, au- evaluated use of portable electronic devices
tism, autism spectrum disorders, mental retar- with students with moderate ID (17 studies)
dation and the words personal digital assis- and five of the studies included students with
tants, PDAs, handheld computers, palmtop ASD.
computers, pocket PCs, cellular phones, cell
phones, mobile phones, smartphones, mobile Media Players with Audio Playback
technologies, portable electronic devices,
iPhone, iPod, video iPod, MP3 players, and In 2007, Millard reported that “every month a
portable media players. In addition to the new portable MP3 player is on the market”
electronic search, a cross-reference, manual with capabilities and functions extending be-
search was made of previously identified arti- yond music players. She further sites the in-
cles. creased use of these players as a creative
In order to be included in the review, arti- means for providing alternative methods for
cles had to meet the following criteria: students with disabilities to learn. Simply ap-
plied, MP3 players can deliver auditory infor-
1. Use of a quasi-experimental or single-sub- mation to students in a step-by-step format for
ject research design. completing multiple step tasks or they can be
2. Publication in peer-reviewed journal pub- used to prompt on-task behaviors. Media play-
lished in the English language. ers such as the iPod provide auditory prompts
3. Primary intervention was the evaluation of and information in much the same way that
a form of portable electronic technology: earlier studies used portable cassette players
handheld computer, cellular phone, MP3 (Post & Storey, 2003; Taber, Alberto, &
player. Fredrick, 1998), but provide more sophisti-
4. Participants were diagnosed with a moder- cated means for navigating through recorded
480 / Education and Training in Autism and Developmental Disabilities-December 2011TABLE 1
Overview of Handheld Technology
Author(s) Participants Target Skill Research Design Setting Results
(Dependent Variable)
Media Players with Audio
Playback
Taber-Doughty, (2005) n ⫽ 3 CA ⫽ 15-21yrs Operate debit & copy Alternating treatment Domestic living area Picture prompting system,
Moderate ID machine of high school SLP, & MP 3 Player
effective & efficient
procedures.
Performance superior
when students used
their preferred system.
Cellular/Smartphone
Stock, Davies, Wehmeyer, n ⫽ 22 CA ⫽ 18- Operate adapted Within- Subjects Center-based Compared to a
& Palmer (2008) 21yrs Full scale IQ phone functions & paired samples mainstream cell phone,
range 47–69 mainstream phone participants required
functions fewer prompts & made
fewer errors with the
adapted phone.
Taber, Alberto, Hughes, n ⫽ 14 CA ⫽ 11- Dial phone # from Multiple probe across School-based. Participants effectively
& Seltzer (2002) 14yrs Moderate ID printed card when groups Generalization to dialed phone numbers.
lost. Describe community. Difficulty describing
location location.
Taber, Alberto, Seltzer, & n ⫽ 6 CA ⫽ 14-18yrs Operate speed dial, Multiple probe across School-based Participants effectively
Hughes (2003) Moderate ID answer phone students Generalization to used speed dial
when lost. Describe community. function to place
location phone call & to answer
phone when lost in
school or community.
Twenty-First Century Portable Electronic Devices
Difficulty describing
/
location.
481
(Continued)482
/
TABLE 1—(Continued)
Overview of Handheld Technology
Author(s) Participants Target Skill Research Design Setting Results
(Dependent Variable)
PDA with Text, Sound,
and Light Cues
Davies, Stock, Wehmeyer n ⫽ 12 CA ⫽ 19- Compared Two-group within- Community PDA with specially
(2002a) 46yrs Full scale IQ performance of subjects design vocational site designed prompting
range 45–90 tasks on schedule software more effective
using a written than written schedule
schedule or PDA for prompting initiation
of tasks.
Gentry, Wallace, n ⫽ 22 CA ⫽ 14- Independent Quasi-experimental School setting Students were able to use
Kvarfordt, & Lynch 18yrs Autism operation of PDA pre- & post- the PDA as a task
(2010) (enter assessment management tool.
appointments, Maintenance of skill up
schedules, to 8 weeks.
assignments) &
frequency of use of
PDA
Gillette & Depompei n ⫽ 20 CA ⫽ 6-20yrs On-time behavior Comparison of School-based Highest rate of on-time
(2008) Mild - moderate using: written time incidence rate ratios settings behavior using the
ID & task list; paper across conditions & PDA.
planner, & PDA periods using a
Poisson regression
PDA with Picture Cues
Education and Training in Autism and Developmental Disabilities-December 2011
Cihak, Kessler, & Alberto n ⫽ 4 CA ⫽ 16-17yrs Transition between Multiple probe across Community settings Increased independent
(2008) Moderate to vocational tasks students transitions between
Severe ID tasks. Maintenance up
to 9 weeks.TABLE 1—(Continued)
Overview of Handheld Technology
Author(s) Participants Target Skill Research Design Setting Results
(Dependent Variable)
Cihak, Kessler, & Alberto n ⫽ 4 CA ⫽ 18-19yrs Independent task Multiple probe across Community settings Independent task
(2007) Moderate ID completion of tasks completion using the
progressively more PDA. Maintenance up to
difficult tasks 9 weeks.
Cihak, Wright, & Ayres n ⫽ 3 CA ⫽ 11-13yrs Self-monitoring of ABAB Middle school Self-model pictures on the
(2010) High functioning task engagement general education PDA resulted in increased
autism classrooms task engagement &
decreased teacher
prompts.
Davis, Stock, & n ⫽ 40 CA ⫽ 18- Software & Pocket PC Two-group within- Community Use of PDA with specially
Wehmeyer (2003) 54yrs Full scale IQ assembly subjects design vocational setting designed software
range 24–76 incorporating decision
points resulted in
increased independence
& accuracy assembling
both tasks.
Davies, Stock, & n ⫽ 10 CA ⫽ 18- Assemble pizza boxes Two-group within- Community PDA with specially designed
Wehneyer (2002b) 70yrs Full scale IQ & package software subjects design vocational setting software produced
range 39–72 improved task accuracy &
decreased reliance on
adult prompts.
Lancioni, O’Reilly, n ⫽ 6 CA ⫽ 23-47yrs Cleaning, table Alternating treatment Day activity center Students completed more
Seedhouse, Furniss, & IQ unavailable setting, food steps independently when
Cunha (2000) Adaptive Behavior preparation using the PDA compared
Scale, age to a picture based system.
equivalents 2-6.5 Steps were also clustered
Twenty-First Century Portable Electronic Devices
years for daily into fewer pictures on the
/
living PDA.
483TABLE 1—(Continued)
484
/
Overview of Handheld Technology
Author(s) Participants Target Skill Research Design Setting Results
(Dependent Variable)
Riffel et al. (2005) n ⫽ 4 CA ⫽ 16-21yrs Table setting, rolling Multiple probe across School, group Use of PDA with specially
Mild to moderate silverware, laundry participants home, retirement designed software increased
ID, Autism home, restaurant number of steps performed
without adult prompting.
Decrease in duration time
to complete tasks.
PDA with Video Cues &
Handheld Video
Players
Cihak, Fahrenkrog, n ⫽ 4 CA ⫽ 6-8yrs Transitions between ABAB Elementary school Increased independent
Ayres, & Smith (2010) Autism school locations & transitioning with video
activities models presented on
video iPod. Performance
decreased with withdrawal
of video models.
Mechling, Gast, & Seid n ⫽ 3 CA ⫽ 15-17yrs Food preparation Multiple probe across Home living area of Use of PDA with multiple
(2010) Moderate ID tasks high school prompt levels (audio,
picture, video) resulted in
immediate increase in
independent completion of
cooking recipes. Students
prompts used. Performance
maintained over time.
Education and Training in Autism and Developmental Disabilities-December 2011
Mechling, Gast, & Seid n ⫽ 3 CA ⫽ 16-17yrs Food preparation Multiple probe across Home living area of Use of PDA with multiple
(2009) Autism tasks high school prompt levels (audio,
picture, video) replicated
results of Mechling et al.
(2010) although use &
self-adjustment of prompt
levels differed from
previous findings.TABLE 1—(Continued)
Overview of Handheld Technology
Author(s) Participants Target Skill Research Design Setting Results
(Dependent Variable)
Mechling & Seid (2011) n ⫽ 3 CA ⫽ 21-22yrs Pedestrian travel Multiple probe across University campus Use of PDA with multiple
Moderate ID (walking) locating tasks prompt levels (audio,
landmarks & picture, video) resulted in
destinations students independently
locating three different
destinations. Students self-
adjusted prompt levels
used. Maintenance of
skills over time.
Taber-Doughty, Patton, & n ⫽ 3 CA ⫽ 13-15yrs Locating books & Alternating treatments Community library Both simultaneous &
Brennan (2008) Moderate ID DVDs. Use of delayed video modelling
computer to locate effective. Preferred
call numbers modeling system more
effective for 2 students.
Generalization of
performance across
libraries.
Van Laarhoven, Van n ⫽ 1 CA ⫽ 17yrs Emptying trash, Multiple probe across No-kill animal Video prompting & feed-
Laarhoven-Myers, Moderate ID mopping, cleaning tasks shelter back, using a Video iPod,
Grider, & Grider bathroom, cleaning resulted in an increase in
(2009) kennels correct responding across
tasks & decrease in adult
prompting for error
correction & use of the
device.
Van Laarhoven, Van n ⫽ 2 CA ⫽ 18yrs Sorting & sanitizing Multiple probe across Red Robin & Video modeling & feed
Laarhoven-Myers, & Mild to moderate silverware, tasks Applebee’s back & least to most
Zurita (2007) ID portioning recipes, restaurants prompting resulted in
cleaning & increased independent
sanitizing work responding & decrease in
area, clocking in & adult prompting
Twenty-First Century Portable Electronic Devices
out, rolling
silverware
/
485pants were able to complete tasks when two
auditory steps from the original instructions
were clustered together.
Cellular/Smartphones
In addition to meeting basic communication
needs, it is suggested that use of cell phones by
persons with disabilities can address safety is-
sues (i.e., being lost, being stranded if a wheel-
chair breaks down) or be used as a memory
aid (alarms and reminder features) (Bryen,
Carey, & Friedman, 2007). In their survey of
cell phone use by 83 persons with intellectual
disabilities, Bryen et al. found that in addition
Figure 1. MP3 Player (Model: SM-320V). Pine
Technology, Ltd. to day-to-day communication, cell phones
were most often used for emergencies, storing
phone numbers, and storing calendar infor-
segments on the device. In addition, media mation. In the current review, two of the three
players such as video iPods now feature video studies which evaluated use of cell phones by
playback (see section titled Handheld Com- persons with moderate intellectual disabilities,
puters and Handheld Video Players). used a cell phone as an intervention for the
In the only identified study evaluating use emergency situation of being lost in the com-
of a media player with audio playback, Taber- munity. In the first study, Taber, Alberto,
Doughty (2005) used a D’music MP3 Player Hughes, and Seltzer (2002) found that 14
(Pine Technology, Ltd) (Figure 1) to deliver middle school students were able to use a cell
auditory prompts while comparing the effects phone to dial a number by copying a phone
and efficiency of student choice and task per- number from a printed card and to describe
formance between prompting methods (MP3 their physical location. Sessions were first con-
player, system of least prompts, and picture ducted at school and then generalized to a
prompts). Data were collected for the percent community setting. In a final phase, students
of task steps completed independently and also dialed a different phone number than the
the duration of task completion for the tasks one used during training.
of operating a copying machine and making Because some students had difficulty dial-
purchases using a debit card machine. Results ing the phone number in the first study, speed
demonstrated that each system was effective dialing was used in a second study by Taber,
and efficient for five high school age students Alberto, Seltzer, and Hughes (2003). In addi-
with moderate ID and that students’ perfor- tion to the change in dialing, they also evalu-
mances were superior when using their system ated six secondary age students’ abilities to
of choice. answer a cell phone and describe their loca-
Although the experimental design did not tion to the caller for those students who were
meet the criteria for inclusion in the current not able to recognize that they were lost. Once
literature review, one additional study was again, training took place in the school setting
identified which used a portable cassette and then generalization sessions occurred in
player to prompt students with moderate in- two community settings. Results were again
tellectual and visual disabilities (Lancioni, supportive of cell phone use by students with
O’Reilly & Oliva, 2001). The study demon- moderate intellectual disabilities when lost in
strated that although more sophisticated de- the community. One interesting result of each
vices may be available, researchers and practi- of these studies was that in addition to some
tioners are still finding value in lighter tech issues with operation of the cell phone itself,
systems. An interesting finding and focus of students had the greatest amount of difficulty
the study was that following task mastery using describing their physical location.
step-by-step auditory instructions, the partici- In spite of their potential benefits, Bryen et
486 / Education and Training in Autism and Developmental Disabilities-December 2011al. (2007) still found a gap between the use of
cell phones by people with intellectual disabil-
ities compared to persons without disabilities.
In their report they found that non-use by
persons with intellectual disabilities was pri-
marily due to cost, perception of not needing
a cell phone, and lack of accessibility. To ad-
dress the issue of cognitive accessibility, Stock,
Davies, Wehmeyer, and Palmer (2008) evalu-
ated a specially designed multimedia software
prototype, Pocket ACE (AbleLink Technolo-
gies), with 22 participants with intellectual dis-
abilities (range IQ score 47– 69). The program
operated on the Pocket PC 2002 Phone edi-
tion of a mainstream PDA and incorporated a
picture-based address book and simplified sys-
tem for operating phone functions of the
Figure 2. Videophone (Avaya Nortel 1535 IP
PDA. Adapted features allowed participants to
model). Retrieved from http://en.wikipedia.
place phone calls by tapping pictures on the org/wiki/Videophone
PDA screen and to see a picture of the person
calling them when they received a call. When
compared to a mainstream Nokia cell phone, ments for both communication parties to own
participants required fewer prompts and the videophones, prevented them from taking
made fewer errors when placing and receiving off (www.answers.com/topic/videophone-1).
calls. High-speed cable and DSL allowed video-
With the widespread availability and rela- phoning to eventually become popular by us-
tively inexpensive cost of cell phones, it may ing a computer and specialized software. In
be time for the field of special education to 2006 Skype popularized the use of video-
look in-depth into cell phone use beyond phones by offering free worldwide calling
emergency applications. Other features and (www.answers.com/topic/videophone-1).
uses identified by Bryen et al. (2007) were: In addition to computer-based systems, vid-
paging and text messaging, connecting to the eophones are also available in desktop or land
internet, use of voice recognition capabilities, line models which provide video and audio
speed dialing, voice mail options, transmitting transmissions for communication between
computer files, taking digital photographs, people in real-time. These videophones are
and video-calling. Incorporating these fea- currently popular among deaf persons who
tures into a cell phone is now recognized use them with sign language and among per-
within the realm of smartphones. Smart- sons with limited mobility (www.answers.com/
phones are electronic handheld devices that topic/videophone) (Figure 2).
integrate the functionality of a mobile phone, Video calling and downloading multimedia
personal digital assistant (PDA), or other in- content on mobile smartphones are currently
formation appliances to offer features beyond available with models such as the Sony-Erics-
making voice calls (www.en.wiktionary.org/ son K800 (www.en.wikipedia.org/wiki/Video-
wiki/smartphone). Smartphones include de- phone) (Figure 3) and the newly released
vices such as BlackBerry, Razr, iPhone and iPhone 4 which allows video chats using a
Palm Treo (www.sag.org/content/new-media- feature called FaceTime (www.apple.com/
glossary). iphone/features/facetime.html) (Figure 4).
Smartphones may also come equipped with Renblad (1999) reported the positive re-
built-in cameras and screens for visual, real- sults of using early picture telephones and
time communications. In the early 1990s video telephones (videotelephony) to in-
AT&T introduced its VideoPhone, but the crease communication and social interactions
bandwidth limitation of dial-up phone lines, among persons with intellectual disabilities. In
high cost of entry ($1,000 each), and require- his review of the literature of studies con-
Twenty-First Century Portable Electronic Devices / 487ID and ASD. When re-examining the research
of Taber et al. (2002, 2003) in which students
had difficult verbally describing their location
when lost, it appears that incorporating video
on cell phones would allow students to video
record and send visual images of their loca-
tion (to the person trying to locate them)
which would provide an important applica-
tion for this technology.
Handheld Computers and Handheld Video
Players
Figure 3. Sony-Ericsson K800. Retrieved from http:// Handheld computers, often referred to today
www.sonyericsson.com/cws/products/ as PDAs (personal digital assistants), are also
mobilephones/overview/k800i known as palmtop computers and Pocket PCs.
These PDAs have been around since the be-
ginning of the eighties, but have only become
ducted in Europe, these technologies were popular in the last few years due to innovative
reported as beneficial for assisting persons in technologies such as 3G mobile telephony
making contacts outside of their work place and wireless connectivity (Nashville, 2009).
and home which might otherwise be difficult These features provide PDAs with the ability
to make. Yet, at the time of this review, pre- to do many of the things that a PC can do,
senting video in a portable cell phone format, such as connecting to the internet, running
had not been researched as a tool for inde- third party applications, and serving as a mo-
pendence by persons with moderate ID or bile phone (Nashville). In the field of special
ASD. Future research needs to investigate the education, PDAs may provide digital content
application of portable electronic devices with (i.e., pictures and video) in flexible formats
video capability with persons with moderate that can be made meaningful to individual
students with disabilities (Abell, Bauder, Sim-
mons, & Sharon, 2003). In their meta-analysis
of single-subject design studies, Wehmeyer et
al. (2008) reported palmtop computers to be
a simple and effective use of technology for
prompting persons with intellectual disabili-
ties. They suggested that these devices are
highly effective in their use of cognitive access
features such as touch screens as well as their
audio and video output and input capabilities.
Further, their portability, relative affordabil-
ity, customization features, and ability to store
large amounts of data, provide a means to
address the needs of persons with intellectual
disabilities (Stock, Davies, Davies, & Weh-
meyer, 2006).
In the current review, identification of stud-
ies using handheld computers and handheld
video players were categorized as those using:
(a) text, sound, and light; (b) picture cuing
with and without voice recording; and (c)
video recordings. Within those categories, the
Figure 4. iPhone 4. Retrieved from http://www. identified purposes of the devices were to
apple.com/iphone/features/facetime.html function as: (a) reminders and tools for time
488 / Education and Training in Autism and Developmental Disabilities-December 2011management; (b) transition aids; and (c) provided by the PDA since each system was
prompts and models for completing multi- comprised of a similar list of assigned tasks.
step functional skills. In light of these positive results using the
PDA with text, sound, and light cues. PDAs, more basic features of a PDA, future research
which were originally designed to provide may want to include evaluation of alarming or
electronic task organization, can now be pro- auditory signaling features as reminders for
grammed to include complex activity sched- additional types of tasks from those which
ules whereby each task can be linked to a have been evaluated. These may include self-
reminder alarm to prompt students to check management of health and safety issues such
their schedule (Gentry, Wallace, Kvarfordt, & as reminders to brush one’s teeth (O’Hara,
Lynch, 2010). The basic features of text, Seafriff-Curtin, Levitz, Davies, & Stock, 2008),
sound, and flashing lights have been used in checking the lock on the front door of an
this capacity to remind students to complete apartment, or turning off the kitchen stove.
tasks. Gentry et al. used a quasi-experimental, Individuals with moderate ID or ASD may
pre- and post-assessment design to evaluate have the ability to complete these tasks, but
the ability of 22 high school students with ASD may require a reminder to do so. For many,
to enter appointments, schedules, and assign- the inability to remember to complete such
ments onto a Palm Zire 31 PDA with a re- tasks may prohibit them from participating in
minder alarm linked to each entry. Results less restrictive living and work situations or
showed that students were able to use the PDA require external reminders to be delivered by
as an electronic task management tool and to other adults.
maintain their ability to use the cognitive aid PDA with picture cues. Digital content, in
over an eight-week period following a brief the form of pictures, can also be incorporated
training period. onto handheld devices and have primarily
Davies, Stock, and Wehmeyer (2002a) used been used to provide step-by-step instructions
specially designed software, Schedule Assis- for performing multi-step functional skills that
tant (AbleLink Technologies), as a time man- may be new or difficult for the learner (i.e.,
agement tool that operated on a Windows CE operating a washing machine) and tasks
palmtop computer platform. The program which are performed infrequently (i.e., bak-
provided an auditory beep to cue 12 students ing a birthday cake). With these systems, in-
with intellectual disabilities (IQ scores ranged formation is presented on a single picture and
from 45–90) to check their PDA schedule fol- the student performs the step based on the
lowed by a recorded auditory cue telling them information provided in the picture before
what task to perform. When compared to a advancing the system to the next picture
traditional written schedule, results demon- (step) in the task sequence.
strated that the palmtop computer with sched- Lancioni, O’Reily, Seedhouse, Furniss, and
ule prompting software was more effective Cunha (2000) found that six students with
than the written schedule for prompting ini- intellectual disabilities correctly performed a
tiation of tasks. greater number of cleaning, food prepara-
Twenty students with intellectual disabilities tion, and table setting steps when pictures
were included in a comparison study which were presented on an IBM 110 palm-top com-
evaluated use of a written time and task list, puter compared to a card-based picture sys-
paper planner, and PDA with students with tem. The researchers further found that task
mild to moderate ID (Gillette & DePompei, steps could be clustered into fewer pictures as
2008). Students responded with the highest students’ task performances improved. One
rate of on-time behavior using a 1-Dell Axim reason attributed to the differences in perfor-
and a 2-Palm Zire 71 or 72 PDA with an alarm mance was the ease of navigation with the
function compared to a list or planner. The PDA (pushing one button to advance the pro-
alarm function served as an effective reminder gram) compared to physical manipulation of
to prompt students to read the written mes- the card system.
sage on the PDA screen which indicated the Cihak, Wright, and Ayres (2010) used self-
task to be completed. The researchers attrib- modeling static picture prompts via an HP
uted the positive results to the audible “beep” iPAQ Mobile Media Companion handheld
Twenty-First Century Portable Electronic Devices / 489computer with three middle school students diagnosed with high-functioning autism. Dif- ferent photographs showing the individual student modeling task engagement (i.e., writ- ing, reading) were downloaded onto Power- Point slides so that one photograph was dis- played every 30 seconds and the program advanced automatically during the class pe- riod. In addition to use of the PDA, students self-recorded their task engagement on a 3x5 inch index card as each new picture appeared. Results supported prompts delivered by the handheld computer and self-recording by stu- dents for increasing task engagement and de- creasing teacher directed prompts. Students were further able to generalize use of the system across general education classrooms (i.e., math, science, language arts). Picture-based PDA systems can also incorpo- rate voice recordings to provide additional information to that provided by the visual pic- tures. Students typically touch the picture or a button on the PDA to hear a verbal descrip- tion of how to perform the step. Davies, Stock, and Wehmeyer (2002b) provided information to students using picture ⫹ voice recording format. They evaluated the software program, Visual Assistant (AbleLink Technologies), which ran on a Windows CE platform of a handheld computer. Ten adults with intellec- tual disabilities (Mean IQ ⫽ 54.8) viewed step- by-step pictures along with verbal instructions Figure 5. Pocket Compass. AbleLink Technogies. as they completed steps for assembling pizza boxes and packaging software. Students dem- onstrated improved task accuracy and de- the screen and audio instructions which cor- creased reliance on adult prompts across both responded to different options available to the tasks within a vocational setting. Using the student (i.e., different colors of CDs to put same Visual Assistant program and a Cassio- into a box) (Figure 5). When the student peia TFT palmtop computer, Riffel et al. touched one of the decision point pictures, (2005) demonstrated the ability of four tran- the program advanced to the corresponding sition-age students with mild to moderate ID sequence of pictures and auditory cues. Forty and one student with ASD to increase the transition-age students with intellectual dis- number of steps they completed without ex- abilities (mean IQ ⫽ 55.53) participated in ternal adult prompting (i.e., doing laundry, the beta test and increased their indepen- rolling silverware, and setting tables) and to dence and accuracy in completing assembly decrease duration time spent on each task. tasks within a vocational setting as well as their Davies and colleagues (2003) evaluated an ability to navigate decision points. additional software prototype, Pocket Com- Cihak, Kessler, and Alberto (2007; 2008) pass (AbleLink Technologies), which incorpo- conducted two similar studies to evaluate use rated decision points into a picture ⫹ audio of picture and auditory prompts via a PDA to prompting system. The software application, prompt independent task completion and which operated on a Pocket PC palmtop com- transitions by students with moderate intellec- puter platform, provided multiple pictures on tual disabilities. Each study presented the vi- 490 / Education and Training in Autism and Developmental Disabilities-December 2011
sual and auditory cues on an Axim ⫻30 hand- choice or decision made by the user (i.e.,
held computer by Dell. In the first study four which recipe to cook, laundry load size for a
students completed four separate community- washing machine).
based tasks (i.e., stocking milk, making sub- PDA with video cues and handheld video players.
rolls) with each subsequent task increasing in In a recent literature review of assistive tech-
the number of steps required for completion. nology devices (including PDAs) used as self-
The PDA, used in conjunction with a least-to- management tools for prompting students
most prompting system delivered by the in- with ID, no studies were available (through
structor, was an effective tool for delivering 2005) evaluating the use of video presented
prompts to students and task performance was on handhelds (Mechling, 2007). The current
maintained up to 9 weeks. In the second review identified eight studies between the
study, four of the same tasks were used from years 2007 and 2010 addressing use of video
the first study, along with six additional tasks, modeling or prompting presented on porta-
to evaluate independent transitions between ble handheld devices as intervention tools for
tasks by four students with moderate to severe students with moderate ID and ASD.
intellectual disabilities. Similar results indi- Video modeling, watching an entire video
cated that the handheld prompting system recording demonstrating how to perform a
was an effective tool for increasing indepen- task prior to completing the task, was used in
dent task transitions and skills were once three of the eight identified studies utilizing
again maintained for up to 9 weeks. video on handheld devices. Van Laarhoven,
In summary, although similar to picture- Van Laarhoven-Myers, and Zurita (2007)
based booklets, the presentation of pictures worked with two high school aged males with
on electronic PDAs, may provide a more effi- mild and moderate intellectual disabilities in
cient and effective means for delivering two employment settings (Red Robin and
prompts whereby students may find the tradi- Applebee’s) using video modeling presented
tional form of presentation to be more cum- on an HP iPAQ hg2700 series Pocket PC. Each
bersome to manipulate and may lose their student completed three different tasks (i.e.,
place in the sequence (Lancioni et al., 2000). rolling silverware, portioning recipes) using
Electronic picture-based systems with and video modeling and video feedback (re-watch-
without voice recordings were both found to ing the video after errors occurred) in con-
be effective in this review. In light of research junction with a least-to-most prompting system
which indicates that students with ASD may be delivered by the instructor. Both students
stronger visual than auditory learners (Quill, demonstrated an increase in independent re-
1995; West, 2008), what remains unanswered sponding and a decrease in external adult
is whether it is necessary to include voice re- prompting while using the device.
cordings in conjunction with pictures. In ad- Taber-Doughty, Patton, and Brennan
dition to examining the need for voice record- (2008) used a 30GB Apple video iPod (Figure
ings, future research should also continue the 6) to deliver simultaneous prompting in a
line of investigation initiated by Lancioni et al. library whereby students watched an entire
concerning clustering multiple pictures into video task chain, with audio instructions,
fewer pictures (2000) and clustering individ- while simultaneously completing each step.
ual verbal prompts of steps into longer This format was used for locating books and
streams of auditory recordings (2001) as tasks DVDs and using a computer to obtain call
are acquired. Research will need to examine numbers by three middle school students with
not only students’ abilities to use these fea- moderate intellectual disabilities. This study
tures, but the flexibility of systems for making compared simultaneous video modeling and
these adjustments with regards to preparation delayed video modeling in which a student
time. The line of research initiated by Davies watched a video model at least one hour prior
et al. (2003) into the capabilities of PDAs to to traveling to the library and locating the
function in a non-linear format also warrants items. The delayed video modeling was pre-
more attention. With such programming, pic- sented on a VCR/DVD player. Both systems
tures on one screen can be linked to a differ- were found to be effective and students were
ent sequence of pictures depending on the able to generalize the skills to a second library,
Twenty-First Century Portable Electronic Devices / 491Students experienced an increase in indepen-
dent transitions when using the handheld
video device paired with a least-to-most
prompting system delivered by the instructor
and descending trends in performance when
the device was removed.
A third study also used a video iPod, but
compared to the previously reviewed studies,
the researchers used video prompting and
feedback on the device rather than video
modeling (Van Laarhoven, Johnson, Van
Laarhoven-Myers, Grider & Grider, 2009).
Video prompting requires the user to watch
one video segment on the device, complete
the corresponding step, return to the device,
watch the next video segment in the task se-
quence and so forth. Van Laarhoven and oth-
ers used video prompting and feedback to
present steps to a 17-year-old young man for
completing work-related tasks in a no-kill an-
imal shelter. Compared to the Van Laarhoven
et al. (2007) study, the participant referred
back to individual video segments (rather
than the entire video) when an error occurred
on a particular step The program also con-
tained still photographs at the beginning of
each video clip to present critical features of
Figure 6. Video iPod. Apple, Inc. steps and a title screen at the end of each
video clip to prompt the student to stop the
device and complete the step. Voice over nar-
however, when using the video iPod with si- ration was also uploaded to the video iPod.
multaneous prompting, acquisition and gen- Introduction of the video-based materials re-
eralization of skills was slightly greater for two sulted in an increase in correct responding by
students for the computer task and for all the participant across three job-related tasks
three students when locating DVDs and and a decrease in adult prompting for error
books. Of further interest was the preference correction and use of the device.
of two of the students for using the video iPod. In the final three studies identified in this
A video iPod, with video modeling was also review, PDAs were used to present multiple
used by Cihak, Fahrenkrog, Ayres, and Smith media options to the users including: voice
(2010) to increase independent transition be- recordings, digital photographs, and digital
haviors of four elementary students diagnosed video. Unlike the other studies reviewed
with ASD within a general education class- which incorporated video onto handheld de-
room. A combination of video self-modeling vices, each of these studies used a specialized
without audio (video clips of the student as assistive technology device rather than a main-
the model lining up, walking in the hallway, stream, commercially available product. The
and entering the next area of the school) and studies used a Cyrano Communicator TM
person first point-of-view (students’ vantage (Kiba Technologies, LLC.) which was origi-
point as if they were walking to the next area) nally designed as a portable augmentative
were used to create the video models of ten communication device. The device operated
daily transitions. At the beginning of each using specially designed software on a com-
transition the student watched the video mercially available PDA (Hewlett Packard
model on the video iPod followed by a teacher iPAQ Pocket PC or Pidion BM-150R) with
prompt to “line up” and begin the transition. multimedia features that allowed the user to
492 / Education and Training in Autism and Developmental Disabilities-December 2011access pictures, video, text, and audio all on
one screen. In each of the three studies the
PDA was used for prompting step-by-step com-
pletion of multi-step functional skills. Stu-
dents could look at a picture to receive infor-
mation, repeatedly touch a picture on the
screen and hear a voice recording, touch a
video icon and play a video recording, or ad-
vance the program to subsequent screens
(task steps). Using these multiple prompting
features students could choose and self-adjust
the level of prompting delivered by the device
for each step of the task. Unlike the studies
previously reviewed in this section, no exter-
nal adult prompting (i.e., least-to-most
prompting system) was provided for task com-
pletion although the instructors did provide
prompts for use of the device.
The first study evaluated the effects of mul-
tiple prompt levels on the independent prep-
aration of recipes by three high school age
students with moderate intellectual disabilities
(Mechling, Gast, & Seid, 2010). Immediate
and abrupt increases in the percentage of
steps completed independently were demon-
strated by each of the participants following
introduction of the PDA system and perfor-
mance was maintained over time. Results also
indicated that participants initially used more
intrusive levels of prompts and self-faded
these levels of prompts (i.e., video to photos)
Figure 7. Cyrano Communicator TM. Kiba Tech-
and later reinstated use of more intrusive
nologies, LLC.
prompt levels, as needed, during maintenance
sessions.
In response to the Mechling et al. (2010) evaluated the effectiveness of the PDA with
study, a second study was implemented in or- multiple prompt levels to prompt indepen-
der to evaluate the effects of the PDA proce- dent pedestrian travel by three transition age
dure on the same food preparation tasks, but students with moderate intellectual disabili-
with three high school age students with ASD ties. Similar to a global positioning system
(Mechling, Gast, & Seid, 2009). Results repli- (GPS), students who were unable to read
cated those of the previous study in support of maps or text used photographs and video re-
a PDA with video, pictures, and auditory cordings of landmarks along the routes to
prompts as a self-prompting device to assist independently reach three different destina-
students with ASD to perform multi-step tasks. tions on a college campus (Figure 7). Similar
Differences did exist between the two studies to the other studies using multiple prompt
in regards to the levels of prompts used by levels on one screen, the three students self-
students with ASD. Although they also self- adjusted their use of prompt levels as they
adjusted the use of prompt levels, overall their became more familiar with each route.
tendency was to continue to rely on prompts Results of this review on the use of hand-
from the PDA within and across recipes even held computers with students with moderate
though they were able to complete the recipes ID and ASD demonstrate that these small por-
independently when the PDA was removed. table systems provide some definite advan-
In a third study Mechling and Seid (2011) tages for individuals, including portability. For
Twenty-First Century Portable Electronic Devices / 493example, in contrast to previous studies exam- when using picture-based and video-based
ining video and transitions, students in the systems (Rayner, Denholm, & Sigafoos,
Cihak et al. (2010) study did not have to re- 2009).
turn to a “home base” in order to view the ● effects of handheld devices on different
video on a television or computer screen. In- types of task (i.e., fine motor compared to
stead, the portable device moved with the stu- gross motor) (Furniss et al., 1999).
dents across environments. Similarly, in the ● provision of high-tech handheld systems
Mechling and Seid (2011) and Van Laarhoven during acquisition of skills followed by use
et al. (2009) studies, students were able to of light-tech (picture or auditory) systems
walk with the PDA while locating destinations during review or continuous performance
and completing job tasks within an animal of skills.
shelter. ● provision of multiple prompt levels (text,
Although the results have all been positive audio, picture, and video) on one device or
when using PDAs with different presentation one screen of a device.
modes (i.e., picture, video), accessibility issues ● ability of users to self-adjust the prompt lev-
remain with these mainstream devices. Stock els used on devices and development of sys-
et al. (2006) identified and affectively ad- tems that permit this adjustment (Van Laar-
dressed some of these barriers by developing hoven & Van Laarhoven-Myers, 2006).
and evaluating a simplified multimedia soft- ● effects of clustering multiple pictures of
ware system, Pocket Voyager (AbleLink Tech- steps into fewer pictures (Lancioni et al.,
nologies) for use with a PDA. With their pro- 2000), lengthening or shortening verbal re-
totype, they created: (a) oversized icons to cordings (Lancioni et al., 2001), and adjust-
address the issue of physical access with small ing the length of video recordings (Can-
icons; (b) digital pictures for identification of nella-Malone et al., 2006) as tasks are
contacts in the address book for persons who learned and repeated.
had difficulty reading text; (c) audio messages ● use of wide screen or zoom shots with pho-
to assist understanding of what applications tographs and videos when presenting differ-
were represented by each icon; (d) recorded ent components of tasks (Van Laarhoven et
audio files for reading phone numbers in the al., 2007).
address book; and (e) numbers in larger fonts ● comparative effects of screen size and im-
for persons who had difficulty recognizing ages for delivering information through pic-
and dialing numbers. They further identified tures and video (Stock et al., 2008).
the problems persons have with complex PDA
operating systems and provided greater con-
Discussion and Recommendations for Future
sistency across steps for starting different ap-
Research
plications in the system. When compared to
use of a standard Windows CE operating sys- Research into the potential benefits of porta-
tem and Pocket PC, 32 participants with intel- ble electronic technologies for persons with a
lectual disabilities (mean IQ score 56.1) re- diagnosis of moderate intellectual disabilities
quired fewer prompts and committed fewer and autism spectrum disorders is in its initial
errors when using the specially designed soft- stages. Studies to date support the use of these
ware program. technologies across environments including
In addition to access when using handheld work, school, and community settings and
computers, further research and development across skills including functional multi-step
should continue to investigate the following: skills, transitioning between tasks and environ-
ments, and time and task management.
● use of video prompting compared to video In spite of the positive results reported in
modeling on portable handheld devices. the studies reviewed, persons with intellectual
● comparative effects of different systems disabilities have traditionally accessed cutting
(i.e., picture-based and video-based systems; edge technologies far less often than those
self-operated auditory prompting and video without disabilities (Carey et al., 2005). In
prompting) (Taber-Doughty et al., 2008). their survey of 83 adults with intellectual dis-
● importance of verbal/voice over recordings abilities, Carey and colleagues found that only
494 / Education and Training in Autism and Developmental Disabilities-December 201141% used a computer, 25.3% used the Inter- and use by persons with intellectual disabili-
net, 27.7 used cell phones, and 10.8% used ties (Stock et al., 2006; 2008). Researchers
electronic organizers on a regular basis. They may wish to evaluate commercial mainstream
reported that primary barriers to use included products such as the video iPod to determine
lack of access, lack of training and support, if they are as effective as those made specifi-
and expense. They further found that age, cally for persons with disabilities (i.e., Ablelink
employment status, and self-perceived ability Technologies, Kiba Technologies, LLC.) in
to perform fine motor tasks, significantly af- delivering information and providing access.
fected use of these technologies. More specif- Other directions for future research center
ically, younger persons used more technology; around the need to explore the application of
those employed in competitive employment currently available features offered by PDAs
and those unemployed used more technology and smartphones (Gentry et al., 2010) These
than those in sheltered workshops: and per- include:
sons who were manually able to copy informa-
● text to speech features on portable devices
tion (i.e., write/copy an address from a busi-
ness card) used more technology. so that information (i.e., emails, contact in-
To address the issues of availability and ex- formation) can be read to the user. Fonix
pense, some researchers support the use of VoiceCentral 3.1 (Fonix Speech, 2008) has
mainstream, generic devices that are designed built-in text-to-speech software that allows a
for the general population in mass quantities Pocket PC to read information and Voice-
(Cihak et al., 2008). In developing these ge- Central Black Swan, available for iPhones
neric devices, commercial producers are in- (Riverturn, Inc., 2009 –2010), has this capa-
creasingly following the principles of universal bility.
● voice recognition for operating applica-
design which allow accessibility to all users (as
much as possible) without incorporation of tions, making phone calls etc. Features are
special designs or customization (Cihak et now being offered through products such as
al.). Wehmeyer et al. (2008) recommend fu- Dragon Pdsay (Nuance Communications,
ture research and development across a wide Inc., 2010) which provides voice input as
range of technologies, including newer elec- well as text to speech features.
● video telephoning to increase skills and op-
tronic and information systems which employ
aspects of universal design to determine their portunities such as social, communication
applicability to persons with intellectual dis- (Renblad, 1999), and safety skills.
● video playback on smartphones to prompt
abilities. In addition to being readily available
and less expensive, mainstream handheld de- task completion.
vices and phones are reported to be non-stig- In addition to these directions, it appears
matizing means for providing assistance to that special education and related fields
persons with intellectual disabilities because should also explore development of applica-
they are predominantly used by the general tions that will afford the following:
public (Davies et al., 2002b; Gentry et al.,
2010; Gillette & DePompei, 2008; Myles, Fer- ● use of electronic readers on a PDA or smart-
guson, & Hagiwara, 2007). Results of the re- phone which would allow instant photo-
viewed studies further indicate that students graphs to be taken of text which could be
like handheld devices and are motivated to converted to speech to allow ready access to
use them (Cihak et al., 2010; Mechling & Seid, print materials. This feature, which is avail-
2011; Taber et al., 2003; Taber-Doughty et al., able on the Intel Reader (Intel Corpora-
2008; Van Laarhoven et al., 2007). However, tion) would allow persons with moderate ID
the old saying, “one size does not fit all” may or ASD to take a photograph in a commu-
also apply to the use of portable electronic nity setting (i.e., street sign, grocery aisle)
devices. For many users, cognitive and physi- and have the information read to them.
cal accessibility are concerns and there con- ● simple to use GPS systems which provide
tinues to be a need to modify mainstream pictorial, auditory, and video information to
software which operates portable electronic users with moderate intellectual disabilities
devices in order to increase their accessibility who are walking (Mechling & Seid, 2011) or
Twenty-First Century Portable Electronic Devices / 495using public transportation. Devices such as with intellectual disabilities. Mental Retardation,
the Trekker Breeze (HumanWare, 2005– 43, 322–333.
2009) are currently used by persons who are Cell Phones.org (2008). Cell phone history. Re-
blind to provide auditory information about trieved from www.cellphones.org/cell-phone
history.html on June 23, 2010.
locations, directions, routes, and land-
Cihak, D., Fahrenkrog, C., Ayres, K. M., & Smith, C.
marks.
(2010). The use of video modeling via a video
While considering these listed features, it iPod and a system of least prompts to improve
transitional behaviors for students with autism
appears relevant to individually evaluate them
spectrum disorders in the general education
as independent variables as well as to evaluate
classroom. Journal of Positive Behavior Intervention,
them in conjunction with each other such as 12, 103–115.
using a single device for prompting step-by- Cihak, D. F., Kessler, K. B., & Alberto, P. A. (2007).
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ogies that merge functions into one device, Use of a handheld prompting system to transition
mainstream or customized, will be made avail- independently through vocational tasks for stu-
able so that students will have access to multi- dents with moderate and severe intellectual dis-
ple features on one device. abilities. Education and Training in Developmental
Disabilities, 43, 102–110.
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496 / Education and Training in Autism and Developmental Disabilities-December 2011You can also read
