ipad Apps in Teaching Programs for Kids with Autism Spectrum Disorder Engenharia Informática e de Computadores - PDF

ipad Apps in Teaching Programs for Kids with Autism Spectrum Disorder Cátia Vanessa Alves Braz de Matos Rosa Thesis to obtain the Master of Science Degree in Engenharia Informática e de Computadores Supervisor(s):

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ipad Apps in Teaching Programs for Kids with Autism Spectrum Disorder Cátia Vanessa Alves Braz de Matos Rosa Thesis to obtain the Master of Science Degree in Engenharia Informática e de Computadores Supervisor(s): Professor José Alberto Rodrigues Pereira Sardinha Examination Committee Chairperson: Supervisor: Member of the Committee: Professor Mário Jorge Costa Gaspar da Silva Professor José Alberto Rodrigues Pereira Sardinha Professora Maria Luísa Torres Ribeiro Marques da Silva Coheur Maio 2015 ii We must believe that we are gifted for something, and that this thing, at whatever cost, must be attained. - Marie Curie iii iv Acknowledgments First of all, I would like thank my grandmother, Vó Nana. The one that encouraged me to pursue what I wanted. To my parents, Fátima Rosa and Paulo Rosa, for all the education and support and for putting up with my me, specially in the morning! To all my family, specially my sister, Raquel Rosa, for caring. To professor José Alberto Sardinha, for the guidance and knowledge transmitted. To therapist Célia Cunha, for the willingness to help. To my good friends, my second family, the ones that seduce me to go home late when I shouldn t and with whom it is possible to forget all worries and enjoy life. Last, but definitely not least, to the one and only, Luís Santos. The one who always helped me surpass the obstacles and encouraged me to continue. The one that is always there. This work was partially supported by Fundação para a Ciência e a Tecnologia (FCT) through the Carnegie Mellon Portugal Program and its Information and Communications Technologies Institute, under Project CMUP-ERI/HCI/0051/2013. v vi Resumo De dia para dia o uso de tecnologia como ferramenta de ensino tem vindo a aumentar. A apresentação de exercícios educacionais através de dispositivos electrónicos revela-se mais atractiva e mais cativante para o utilizador quando comparada com métodos tradicionais. O objectivo desta dissertação foi desenvolver uma aplicação móvel atraente que facilitasse a aprendizagem e aquisição de competências de leitura a crianças diagnosticadas com desordens do espectro autista. Para tal foi efectuado um estudo sobre o autismo e o impacto que tem nas crianças, assim como os métodos tradicionais de ensino utilizados com as mesmas. Também um estudo sobre a utilização da tecnologia como veículo de ensino foi efectuado, de forma a perceber quais os métodos e técnicas com mais sucesso numa aplicação deste foro. Depois de efectuada a pesquisa, e de concluirmos que a possibilidade de customização era um ponto-chave, foi então desenhada e arquitectada uma primeira versão desta aplicação. Esta aplicação foi depois testada e sujeita a várias evoluções com base em conselhos de uma profissional especializada em Educação Especial e Reabilitação. As últimas fases de implementação desta aplicação foram sujeitas a testes com um utilizador, diagnosticado com uma desordem do espectro autista, de forma a averiguar e aumentar a eficiência da mesma. Os resultados da avaliação realizada foram de encontro aos nossos objectivos uma vez que demonstram uma maior facilidade de aquisição de competências de leitura. Palavras-chave: exercícios educacionais, dispositivos electrónicos, aplicações móveis, crianças, desordens do espectro autista vii viii Abstract From day to day, the use of technology as a teaching tool has grown. The presentation of educational exercises through electronic devices reveals itself as more attractive and captivating to the user when compared with traditional methods. The objective of this thesis was to develop an attractive mobile application that would make the development and acquisition of learning skills easier to children diagnosed with autism spectrum disorders. With that in mind, we researched about autism, its impact on children and traditional teaching methods available and used. Also, we researched how technology is used as a teaching tool in order to understand what are the methods and techniques most successful in an application of this kind. After the research was done, and after we concluded that the possibility of customization was one of the keys to success, we designed and architect one first version of this application. This version was then tested and submitted to several changes based on the feedback of a professional specialized in Special Education and Rehabilitation. The last implementation stages of this application were submitted to tests with a user diagnosed with an autism spectrum disorder, in order to test and enhance its efficiency. The results of the evaluation met our objectives given that they show that there is in fact an improvement in reading skills. Keywords: educational exercises, electronic devices, mobile applications, children, autism spectrum disorder ix x Contents Acknowledgments v Resumo vii Abstract ix List of Tables xiii List of Figures xvi Nomenclature Glossary Introduction Motivation Document Structure Background Autism Therapies ABA and Autism Related Work Using an ipad-based video modelling package to teach numeracy skills to a child with an autism spectrum disorder Teaching Functional Use of an ipod-based Speech-generating Device To Individuals with Developmental Disabilities Effectiveness of Using ipads to Build Math Fluency Using Tablet Computers as Instructional Tools to Increase Task Completion by Students with Autism The Effect of Instructional Use of an ipad on Challenging Behaviour and Academic Engagement for Two Students with Autism Mobile Learning Technology Based on ios Devices to Support Students with Special Education Needs Multitouch Tablet Applications and Activities to Enhance the Social Skills of Children with Autism Spectrum Disorder Vocabulary Acquisition for Children with Autism Teacher or computer Instruction. 14 xi 3.1 Discussion Development Requirements analysis and definition Functional Requirements Non-Functional Requirements Prototyping Architecture Development Tools Design Pattern Implementation Data Store Leitura Exercise Encaixe Exercise Ligação Exercise Improvements Evaluation and Results Evaluation Metrics Single-Subject Designs Evaluation Procedures and Experimental Design Baseline Intervention Follow-up Tutor Feedback Results Baseline Intervention Follow-up Tutor Feedback Discussion Conclusions Future Work Bibliography 47 A Questionnaire 49 xii List of Tables 3.1 Articles Reviewed xiii xiv List of Figures 3.1 Post-Training Phase Picaa Activities Incremental Development Model Available exercises Settings Model-View-Controller Design Pattern Storyboards Adding word to Core Data Core Data Managed Object Model Add Word Words Added Reading Exercise Syllabic Reading Stardust Visual Reinforcement Settings Writing Exercise Single Reinforcement Writing Prompt Customization Matching Exercise Matching Exercise Settings Sound Reinforcements Settings Model Prompt Word Selection A-B Design A-B-A-B Design Data Collection Results xv A.1 Questionnaire part one A.2 Questionnaire part two A.3 Questionnaire part three xvi Chapter 1 Introduction According to statistics in the United States of America (USA), 1 in every 68 children (from birth to age 8 years) have been diagnosed with an Autism Spectrum Disorder (ASD), and boys are four to five times more likely than girls to have it.[3] Although there is no statistics for Portugal, if we take this numbers into account and consider that in the last population census (2012) there were children aged from 0 to 9 years[10] we can make an estimation of children being identified with ASD. ASD refers to a group of development brain disorders. It is called a spectrum due to its wide range of symptoms and levels of impairment or disability. Most certainly a child suffering from ASD will have difficulties in social interactions and communication, and will engage in repetitive behaviours. What was previously classified as five different disorders: Autistic disorder (classic autism), Asperger s disorder (Asperger s syndrome), Pervasive developmental disorder not otherwise specified (PDD-NOS), Rett s disorder (Rett syndrome) and Childhood disintegrative disorder (CDD), are nowadays denominated as ASD.[2] The exact causes of ASD are not yet known but research suggests that both genes and environment can be related. Even though there is no known cure for ASD, there are several therapies that can help children overcome some difficulties and improve or give them new skills. However, no two children are the same and the best approach for one individual is not necessarily the best for other. Some of these therapies include Floortime, SonRise, Training and Education of Autistic and Related Communication Handicapped Children (TEACCH), among others.[9] One treatment that is commonly used is Applied Behavior Analysis (ABA). ABA is a natural-science approach to understanding the behaviour of individuals [6], whereby the treatment is designed for changing behaviours in a long term, rather than changing a personal characteristic or trait.[17] This naturalscience is based on the assumption that a behaviour is the outcome of the surrounding environment (which can be physical or social) and if a behaviour is followed by some sort of reward it is more likely to be repeated. Recent studies[1][4] show that the use of ipad s and other related devices in educational and rehabilitation problems can help individuals with ASD, from mildly impaired to severely disabled.[4] Its 1 intuitive and uncomplicated way of use are some of the aspects that make it so helpful and a good tool to approach individuals with such characteristics as the ones with ASD. It is already possible to find a great number of applications (APP s), with different purposes, made to be used by children with ASD. There are APP s, like Proloquo2go 1, made to be used by children who can not speak or have language delays. By teaching children to build sentences through images and symbols, and allowing children to use the ipad as a communicating device. There are other APP s that help develop fine-motor skills, like writing and manipulating small objects, for example, Balloonimals 2, a simple touch-and-respond APP that helps teaching about cause and effect. The problem with these APP s is that the majority are made for children whose first language is English. 1.1 Motivation This work was developed with the purpose of giving Portuguese children, identified with ASD, a tool that will help them develop reading skills. With that in mind, we developed an APP with the ambition of assist the progress of acquisition and assimilation of words and its meanings. Hopefully this work will simplify that process, for both children and caregiver, with a fun and substantiate approach. To achieve a capable and suitable model we researched the impact of ASD in individuals, tools that are used everyday to help surpass obstacles created by this condition and studies that use technology to teach various skills. Also, in cooperation with a therapist that gave us professional feedback, we developed a plan of what our APP should consist, as well as what types of exercises and what features should it provide. The implementation of the previous plan went through several iterations. When we thought we reached a stable and solid version we submitted it to tests, with the help of the therapist and a child with ASD, and concluded that this APP was effective and helped in the process of teaching a child to read. 1.2 Document Structure This document is divided in seven chapters. In Chapter Two we present an overview of ASD, its impact on children and some available therapies that help children develop their skills. Chapter Three covers our research in related works, studies that have used technology to teach children with ASD, and what we could conclude from them. The result of the two previous research chapters is used in Chapter Four, where we define what our APP will consist of, what are its requirements and how we intend to implement it. After all investigation was done and the initial development was set, in Chapter Five we describe the implementation of our APP, as well as the decisions and changes we made to our initial version. In Chapter Six we discuss the evaluation and results of our APP and lastly, in Chapter Seven, we conclude all the work developed in this dissertation and what can be done as future work. 3 Chapter 2 Background 2.1 Autism The term autism, as it is known today, was first used in a paper[13] in 1943, written by Dr. Leo Kanner, a child psychiatrist and physician at Johns Hopkins University in Baltimore, USA. He observed a group of eleven children (eight boys and three girls) with ages below 11, who were considered by others schizophrenic and feeble-minded, and concluded that all of them had difficulties in relating with other people, communicating and engaged in repetitive rituals, but were all unquestionably endowed with good cognitive potentialities and that although there are many similarities with childhood schizophrenia this condition had different particularities.[13] Today this disorder still continues to be described by similar symptoms, namely difficulties in social relations and interactions, problems with communication and repetitive behaviours and actions. Since May 2013, with the publication of Diagnostic and Statistical Manual, fifth edition, (DSM-V) all autism disorders were merged into one spectrum diagnosis of ASD, no longer being divided into different subtypes. For example, a children that would previously be diagnosed with Asperger s syndrome would now be diagnosed with ASD without language or intellectual impairment.[2] ASD is diagnosed by physicians and psychologists, based on behavioural evaluations, but the parents are the ones who usually notice the first signs.[9] According to DSM-V, a person diagnosed with ASD has to fit the following criteria : A. Persistent deficits in social communication and social interaction across multiple contexts (...) currently or by history (... ). B. Restricted, repetitive patterns of behaviour, interests, or activities (...) currently or by history (... ). C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. 4 E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make co-morbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level Therapies Although there is no known cure for this disorder there are several therapies that can help an individual to have a better quality of life and are scientifically proven to improve learning, communication and social skills. Our APP is based on Applied Behaviour Analysis (ABA), a therapy that is widely recognised as the single most effective therapy for children with ASD, and that as been consistently validated through several scientific researches. [22] ABA - Applied Behaviour Analysis This therapy combines decades of research in behaviour modification. In fact, it goes back to 1900 s when Ivan P. Pavlov found what he called conditional reflex and Edward L. Thorndike described the law of effect. This law states that when a behaviour produces a pleasing effect on the surrounding environment, there is a higher probability of it occurring again in the future, under similar circumstances. This is the main principle behind ABA, which is called positive reinforcement. For example, if a children receives a candy for each time she eats the whole soup, she is more likely to eat the whole soup in the future. To be effective a reinforcement should immediately follow the behaviour. Reinforcements can be scheduled to be continuous or intermittent, on the first option, the behaviour is reinforced every time it occurs. If the schedule is defined as intermittent, the person will receive reinforcement while learning or engaging in a new behaviour, which is called acquisition, and once the new behaviour is acquired, the reinforcement will be delivered intermittently, which is called maintenance. There are four more principles in ABA, namely extinction, punishment, stimulus control and respondent conditioning. Extinction, in opposition to reinforcement, has the objective of weaken a behaviour, if an action is no longer reinforced it is expected to extinguish. For example, everyday John goes to the vending machine at his work and spends a one Euro coin on a beverage. For two days in a row John spent the coin but the machine did not give him his beverage. Since the behaviour stopped, it is not being reinforced, he stopped going to the machine and bought his beverage at the coffee store. Punishment, such as extinction, is supposed to be used to weaken a behaviour. For instance, imagine that Mary was cooking and whatever she had on the iron pan started burning. Her immediate reflex was to grab the pan, with bare hands, and to take it out of the heat. However, as soon as she felt the pain she dropped it. After this happened Mary always uses something to grab things that are hot. Her behaviour had an immediate outcome that was not desirable and because of that it is less likely that she will repeat it in similar conditions. All these principles are based on behaviour modification and that a behaviour is controlled by its 5 consequences. Stimulus control is used by analysts who try to understand what outcome a behaviour has and how they can manipulate it in order to modify the behaviour. Reinforcement, extinction and punishment are related to a certain situation, where some behaviours can be reinforced under some conditions and punished under another. For example, Michael always asked his grandparents for candy but only his grandmother would give it to him. As time passed, Michael only asked his grandmother because he knew his grandfather would not give him candy. Basically, his grandmother reinforced his behaviour, while his grandparent extinguished it. We can say this behaviour is under stimulus control because it only happens under a specific stimulus his grandmother. The last of the basic principles of ABA is respondent conditioning. This can be exemplified as follows: imagine that Anna takes the same way home every night, and in some days, at a certain place, she hears a scary sound that makes her heart beat faster. Now every night, with or without the scary sound, when Anna gets to that specific place her heart starts racing. What first is a normal reaction of the body (reacting to the sound) becomes a conditioned response (reacting to the place where the sound occurs). In other words a form of learning in which a response is elicited by a neutral stimulus which previously had been repeatedly presented in conjunction with the stimulus that originally elicited the response.[19] ABA and Autism Dr. O. Ivar Lovaas was a Norwegian born psychologist who dedicated his life to improve the life of children with autism. For forty years he researched and published studies that prove that children who receive ABA treatments were far ahead on cognitive tests and social skills than other children with the same age and condition.[11] This treatments are based in behaviour modification, a field of psychology, and are applied by trained professionals who analyse what can be in the source of a behaviour, identifying the events in the surrounding environment, and develop and implement precisely described procedures in order to change the said behaviour.[17] There are several approaches to ABA therapy but al
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