ProcessingAutism

Autism and Computer Assisted Instruction

Article translated by Chris Lareau; content source: Connexions

by Jonathan Emmons.

Children in the autistic spectrum disorder experience qualitative impairments in social interaction and communication. Characteristically they develop repetitive and stereotyped patterns of behavior, interests, and activities. They often show a significant delay in the acquisition of spoken language and do not appear to reciprocate on a social or emotional level, and are often seen as inflexible and compulsive when it comes to schedules and routines (DSM-IV).

Consequently, teaching autistic children can be a frustrating undertaking. In order to be effective, instructors have to overcome communication barriers, engage a learner, and work in a world where the unexpected, no matter how inconsequential it may seem, can completely overwhelm the teacher and child. Intensive one-on-one instruction becomes a necessary requirement for a successful educational program (Silver & Oakes, 2001).

Recent studies have shown that autistic populations respond well to computer assisted instruction (CAI) programs. These programs offer predictable, stable results and never suffer from fatigue, unlike caregivers (Silver & Oakes, 2001). Autistic children may pay more attention to computer programs than to instructors in a traditional learning environment, and as a result their learning potential increases when using CAI programs (Moore & Culvert, 2000). 

Characteristics of Autism

There are three major characteristics of autism. The first involves impaired social interaction skills. This means difficulty in understanding facial expressions, a lack of emotional reciprocity, and delay in developing peer relationships, among other common problems (DSM-IV).

A second difficulty involves verbal communication. It is common for autistic children to have severely delayed speech or mutism (Bonvillian & Nelson, 1976; DSM-IV).

The third difference deals with repetitive and stereotype patterns of behavior, such as a strict adherence to a specific, frequently nonfunctional or ritual routine (DSM-IV).

In addition, it is commonly believed that autistic individuals have difficulty screening out sensory information that is not task-specific, causing them to be situationally overwhelmed in social settings.

The severity of these symptoms can fall into a very wide range. Individuals with Asperger’s syndrome, a “mild” form of Autistic Spectrum Disorder, might appear to be very capable in their daily lives but have difficulty reading and interpreting the facial expressions of others (Silver & Oakes, 2001). An example of a more extreme case of autism involves a child who reaches his ninth birthday having failed to produce words or even to imitate sounds (Bonvillian & Nelson, 1976).

It is thought that autistic children have difficulties making visual-to-auditory cross-modal association (Fulwiler & Fouts, 1975) and do not react well to simultaneous, multiple sources of sensory input, a situation that can create an overpowering stimulation for any child (Strickland et al., 1996).

Computer Assisted Instruction with Autistic Children  

In recent years efforts have been made to introduce computer assisted instruction with autistic children while creating a more efficient medium for intensive instruction. Studies have found that autistic children often find computer-based instruction as more useful than teacher-based instruction. The children spend more time focusing and often continue working longer when they are working with computers (Moore & Culvert, 2000). The development of computer assisted instruction for children with autism could lead to breakthroughs in overcoming the usual social, emotional, and communication difficulties.

In addition to the many established benefits of computers in instructional technology, there are several additional reasons that computer intervention programs are an appropriate choice for autistic populations (Silver & Oakes, 2001). As mentioned above, one of the more common difficulties autistic children face is sensory-overload. This is the inability to filter out interesting, but unneeded and irrelevant sensory input. Placing the child at a computer terminal and having him focus on the screen can help to avoid that problem because only relevant information is presented. The computer also provides an unchanging and consistent environment. The computer makes predictable and immediate feedback to any input the child provides for as long as the child wants. The goals and expectations are transparent to the child and the program moves at his own pace, not one set by an instructor or peers.

Skill sets can be customized to fit the student’s needs, and the structure of the program can be designed to increase in scope and difficulty as the child desires it (Silver & Oakes, 2001). In addition, computer intervention programs can be enhanced with multimedia (such as sound effects, graphics, and animation) designed to attract the attention of the children. These additions can make instructional sessions more interesting, and therefore more successful.

Not surprisingly, programs designed in such a fashion have been very successful among autistic children. Autistic students participating in a study by Moore and Culvert (2000) spent more time at the computer assisted instruction than they did with the teacher-based instruction and more than half wanted to continue with the computer. In contrast, no subjects in the control group, who received only teacher-based instruction, were interested in continuing. The program, designed to teach autistic children new vocabulary words, produced a strong correlation between time spent paying attention and post-test scores. This meant that students who participated in the computer assisted instruction were able to learn more, and the more time they spent at the computer the more words they were able to learn.

Blischak and Schlosser (2003) investigated the use of speech generating devices (SGDs), such as talking word processors, as a tool for improving spelling among non-speaking autistic children. When a word was produced, students received simultaneous feedback in the form of synthetic speech (the word spoken through the machine) and text (the word displayed on a screen). This dual feedback reinforced proper spelling with both aural and visual stimuli, increasing the rate at which the children were able to master the tasks given to them. The authors point out that the students were able to continue practicing their spelling without an instructor. Autistic children in this study enjoyed using the SGDs and improved in other areas besides spelling. One surprising finding from this study is that, given feedback including print only, speech only, or print with speech, autistic subjects were split evenly: Half of the students did equally well on speech and speech with text and poorly on text only, while the other half did poorly on speech only and equally well in the other two categories. This is contrary to conventional wisdom that suggests that autistic individuals are overwhelmingly visual learners (Layton, 1988) and strongly suggests that multiple-feedback approaches (involving both audio and video feedback) will be more successful overall then any single approach.

Communication skills are not the only target of computer intervention programs. A Bernard-Opitz, Sriram, and Nakhoda-Saquan (2001) study investigated how well students would be able to learn about social problem-solving skills, a weakness for autistic children. The program presented a series of problems and tracked creative responses among autistic children and normal-functioning children. Both groups improved significantly along similar lines, with the number of computer sessions correlating with increased success. Important to note, however, was that while normal children seemed to grow bored with the program after a while, autistic children seemed to enjoy the experience a great deal. This enjoyment translated into additional motivation and the resulting increase in test scores on a topic normally considered prohibitively difficult for autistic children (Bernard-Opitz, Sriram, & Nakhoda-Sapuan, 2001).

Silver and Oakes (2001) investigated computer assisted instruction in teaching about the emotions of others, another common difficulty for autistic children. The program presented short stories and asked the student to identify the emotion the character experienced. For example, the child might be told that Sally won the race, and show a picture of a runner crossing a finish line, and ask if Sally is happy, sad, or angry. Correct answers were rewarded with positive feedback, whereas a wrong answer caused the computer to provide help until the correct answer was chosen. The program, called the Emotion Trainer, provided three separate types of cues asking the child to identify the correct emotion, including trials having to do with predicting emotion based on external stimuli and mental states. The study showed significant improvement among the students in these two areas.

Strickland and her colleagues (1996) take a different approach to using computer assisted instruction for teaching autistic children. Rather than providing an exercise to be repeated over and over again until a fixed outcome is achieved, this study is designed to create an open-ended instructional experience where the child has complete control over the outcomes. Virtual reality, the immersion of the user into a computer-generated environment, is being investigated as a potential tool to teach autistic children. The goal in this study was to investigate the tolerance of autistic children to the virtual reality experience. Ultimately, the researchers hoped to use the system to teach the children how to cross the street safely. While this study was more interested in the viability of using virtual reality than in quantifying the outcomes of its use, it is nonetheless worth studying the reactions of the two children; although one child was clearly trying to understand how it worked by looking around the room for the source of the images, both children were generally accepting of this new world.

Training parents might work better than drugs for autism

"We hope to show that these behavioral problems can be reduced in children without medication"

Press release from Yale University:

Parent training key to improved treatment of behavior problems in children with autism

The serious behavior problems that can occur in children with autism and related conditions can be reduced with a treatment plan that includes medication combined with a structured training program for parents, according to Yale University researchers and their colleagues.

Published in the December 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, the study was conducted by the National Institute of Mental Health (NIMH) Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. The 24-week, three-site trial was conducted at Yale, Ohio State University and Indiana University. Lawrence Scahill, professor at Yale School of Nursing and the Yale Child Study Center, is principal investigator at the Yale site.

Results from a 2002 RUPP report showed that the antipsychotic medication risperidone (Risperdal) reduced such behavioral problems as tantrums, aggression and self-injury in children with autism. However, most children's symptoms returned when the medication was discontinued after six months of effective treatment. Also, risperidone is associated with adverse effects such as weight gain, which can lead to obesity and related health problems.

In this new study, the RUPP group tested the benefits of medication alone compared to medication plus a parent training program that actively involves parents in managing their children's severely disruptive and noncompliant behaviors. In a series of 14 sessions over six months, parents were taught to reduce their children's challenging behavior and to enhance daily living skills.

The study included 124 children ages 4 to 13 with pervasive developmental disorders (PDD) such as autism, Asperger's or related disorders accompanied by tantrums, aggression and self-injury. The children were randomly given a combination of risperidone and parent training, or risperidone only.

Although both groups improved over the six-month trial, the group receiving combination therapy showed greater reduction in disruptive behavior, tantrums and aggression compared to the group receiving medication only. The combination therapy group also ended the trial taking an average dose of 1.98 milligrams (mg) per day of risperidone, compared to 2.26 mg per day in the medication-only group—a 14 percent lower dose. However, children in both groups gained weight, indicating "a need to learn more about the metabolic consequences of medications like risperidone," noted Scahill.

"The results show that the parent training intervention can be delivered in a reliable manner and results were the same across all sites," said Scahill. "This is important because it shows that the intervention is exportable—and ready for dissemination."

The RUPP group is expecting to launch a multi-site parent training study in preschool-age children with pervasive developmental disorders. "We hope to show that these behavioral problems can be reduced in children without medication—if intervention starts early," Scahill said. "Future studies may also look for ways in which the parent training program can be used in schools and community clinics."

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The work was funded, in part, by the Yale Clinical and Translational Science Award (CTSA) grant from the National Center for Research Resources at the National Institutes of Health.

Other principal investigators in this NIMH-funded trial included Michael Aman from Ohio State University and Christopher McDougle, M.D. from Indiana University.

Disclosure of Possible Conflicts of Interest of the Researchers: Dr. Aman has served as a consultant to Bristol-Myers Squibb, Johnson & Johnson, and Forest. He has received research support from Bristol-Myers Squibb, Johnson & Johnson, and Forest. Dr. Arnold has served as a consultant to Abbott, Neuropharm, Novartis, Organon, Shire, and Sigma Tau. He has received research support from Eli Lilly, CureMark, Neuropharm, Novartis, Noven, Shire, Sigma Tau, and Targacept. He has served on the speakers' bureaus of Novartis and Shire. Dr. McDougle has served as a consultant to, received research support from, and served on the speakers' bureau of Bristol-Myers Squibb. Dr. Stigler has received research support from Bristol-Myers Squibb and Janssen. Dr. Scahill has served as a consultant to Supernus, Neuropharm, Janssen, Bristol-Myers Squibb, Boehringer-Ingelheim, and Shire. Dr. Handen has served as a consultant to Forest. He has received research support from Bristol-Myers Squibb and Neuropharm. Dr. Wagner held stock in Johnson & Johnson in an amount deemed by government-wide regulations not to create a conflict of interest and has since divested. The other authors report no conflicts of interest.