iPad Apps in Teaching Programs for Kids with Autism Spectrum
Instituto Superior Tecnico, Lisboa, Portugal
From day to day, the use of technology as a teaching tool has grown. The presentation of educationalexercises through electronic devices reveals itself as more attractive and captivating to the user whencompared with traditional methods. The objective of this thesis was to develop an attractive mobileapplication that would make the development and acquisition of learning skills easier to childrendiagnosed with autism spectrum disorders. With that in mind, we researched about autism, its impacton children and traditional teaching methods available and used. Also, we researched how technologyis used as a teaching tool in order to understand what are the methods and techniques most successfulin an application of this kind. After the research was done, and after we concluded that the possibilityof customization was one of the keys to success, we designed and architect one first version of thisapplication. This version was then tested and submitted to several changes based on the feedback ofa professional specialized in Special Education and Rehabilitation. The last implementation stages ofthis application were submitted to tests with a user diagnosed with an autism spectrum disorder, inorder to test and enhance its efficiency. The results of the evaluation met our objectives given thatthey show that there is in fact a improvement in reading skills.Keywords: educational exercises, electronic devices, mobile applications, children, autism spectrumdisorder
According to statistics in the United States ofAmerica (USA), 1 in every 68 children (from birthto age 8 years) have been diagnosed with an AutismSpectrum Disorder (ASD), and boys are four to fivetimes more likely than girls to have it. 
Although there is no statistics for Portugal, if wetake this numbers into account and consider that inthe last population census (2012) there were 994835children aged from 0 to 9 years  we can make anestimation of 113.600 children being identified withASD.
ASD refers to a group of development brain dis-orders. It is called a spectrum due to its wide rangeof symptoms and levels of impairment or disabil-ity. Most certainly a child suffering from ASD willhave difficulties in social interactions and commu-nication, and will engage in repetitive behaviours.
Recent studies   show that the use of iPadsand other related devices in educational and reha-bilitation problems can help individuals with ASD,from mildly impaired to severely disabled.  Its in-tuitive and uncomplicated way of use are some ofthe aspects that make it so helpful and a good tool
to approach individuals with such characteristics asthe ones with ASD.
2. Background2.1. Autism
The term autism, as it is known today, was firstused in a paper  in 1943, written by Dr. LeoKanner, a child psychiatrist and physician at JohnsHopkins University in Baltimore, USA. He observeda group of eleven children (eight boys and threegirls) with ages below 11, who were considered byothers schizophrenic and feeble-minded, and con-cluded that all of them had difficulties in relatingwith other people, communicating and engaged inrepetitive rituals, but were all unquestionably en-dowed with good cognitive potentialities and thatalthough there are many similarities with childhoodschizophrenia this condition had different particu-larities. 
Today this disorder still continues to be describedby similar symptoms, namely difficulties in socialrelations and interactions, problems with commu-nication and repetitive behaviours and actions.
Since May 2013, with the publication of Diagnos-tic and Statistical Manual, fifth edition, (DSM-V)
all autism disorders were merged into one spectrumdiagnosis of ASD, no longer being divided into dif-ferent subtypes. For example, a children that wouldpreviously be diagnosed with Aspergers syndromewould now be diagnosed with ASD without lan-guage or intellectual impairment. 
ASD is diagnosed by physicians and psycholo-gists, based on behavioural evaluations, but theparents are the ones who usually notice the firstsigns. 
2.1.1 ABA - Applied Behaviour Analysis
This therapy combines decades of research in be-haviour modification. In fact, it goes back to 1900swhen Ivan P. Pavlov found what he called condi-tional reflex and Edward L. Thorndike describedthe law of effect. This law states that when a be-haviour produces a pleasing effect on the surround-ing environment, there is a higher probability of itoccurring again in the future, under similar circum-stances.
This is the main principle behind ABA, whichis called positive reinforcement. For example, if achildren receives a candy for each time she eats thewhole soup, she is more likely to eat the whole soupin the future. To be effective a reinforcement shouldimmediately follow the behaviour.
Reinforcements can be scheduled to be contin-uous or intermittent, on the first option, the be-haviour is reinforced every time it occurs. If theschedule is defined as intermittent, the person willreceive reinforcement while learning or engaging ina new behaviour, which is called acquisition, andonce the new behaviour is acquired, the reinforce-ment will be delivered intermittently, which is calledmaintenance.
There are four more principles in ABA, namelyextinction, punishment, stimulus control and re-spondent conditioning. Extinction, in oppositionto reinforcement, has the objective of weaken a be-haviour, if an action is no longer reinforced it is ex-pected to extinguish. For example, everyday Johngoes to the vending machine at his work and spendsa one Euro coin on a beverage. For two days in arow John spent the coin but the machine did notgive him his beverage. Since the behaviour stopped,it is not being reinforced, he stopped going to themachine and bought his beverage at the coffee store.
Punishment, such as extinction, is supposed to beused to weaken a behaviour. For instance, imaginethat Mary was cooking and whatever she had on theiron pan started burning. Her immediate reflex wasto grab the pan, with bare hands, and to take it outof the heat. However, as soon as she felt the painshe dropped it. After this happened Mary alwaysuses something to grab things that are hot. Herbehaviour had an immediate outcome that was not
desirable and because of that it is less likely thatshe will repeat it in similar conditions.
All these principles are based on behaviour mod-ification and that a behaviour is controlled by itsconsequences. Stimulus control is used by analystswho try to understand what outcome a behaviourhas and how they can manipulate it in order to mod-ify the behaviour. Reinforcement, extinction andpunishment are related to a certain situation, wheresome behaviours can be reinforced under some con-ditions and punished under another. For example,Michael always asked his grandparents for candybut only his grandmother would give it to him. Astime passed, Michael only asked his grandmotherbecause he knew his grandfather would not give himcandy. Basically, his grandmother reinforced his be-haviour, while his grandparent extinguished it. Wecan say this behaviour is under stimulus control be-cause it only happens under a specific stimulus hisgrandmother.
The last of the basic principles of ABA is respon-dent conditioning. This can be exemplified as fol-lows: imagine that Anna takes the same way homeevery night, and in some days, at a certain place,she hears a scary sound that makes her heart beatfaster. Now every night, with or without the scarysound, when Anna gets to that specific place herheart starts racing. What first is a normal reactionof the body (reacting to the sound) becomes a con-ditioned response (reacting to the place where thesound occurs). In other words a form of learn-ing in which a response is elicited by a neutralstimulus which previously had been repeatedly pre-sented in conjunction with the stimulus that origi-nally elicited the response. 
2.1.2 ABA and AutismThere are several approaches to ABA therapy butall of them use similar methods. A typically ABAtherapy is applied twenty-five to forty hours perweek and each session lasts two to three hours, ac-cording to the childs needs and skills. There istime devoted to learn specific tasks (usually be-tween three and five minutes) and at the end ofeach hour, ten to fifteen minutes breaks are taken.These breaks are also used for incidental teaching orpractising skills in new environments. Every ABAmethod uses a three step process that is intendedto help determine why a behaviour occurs. Thisprocess is known as the ABC:
Antecedent A verbal or physical stimulus, likea request or command;
Behaviour A resulting behaviour, response orlack of response to the stimulus;
Consequence Positive reinforcement, for thedesired behaviour or no reaction otherwise.
All of the approaches use a reinforcement whena desired behaviour occurs. This reinforcement hasto be seen by the child as a reward, and becauseof that, it should be continually evaluated if thechild still feels like it is worth to work for it. Thereinforcement should only be available to the childas a reward or else she can lose interest and it willlose its power.
A variety of reinforcements should be used, notonly to keep the child interested but also as a differ-entiating element. If the child has several reinforce-ments, the ones that are their favourite should beused as a reward for the most desired behaviours.The reinforcement should be appropriated to thechilds age and, whenever possible, it should be pre-sented in different ways. Surprises are very well ac-cepted and highly motivational.
Social reinforcements, like smiles and compli-ments, should also be used in association with phys-ical rewards.
Reinforcements should not be used as a bribe,although this works in a short term. In the longterm, it can create serious problems.
ABA is not only used to modify behaviours butalso to teach. The teaching of a new skill is made bybreaking a complex task into smaller steps or com-ponents. This is called task analysis and is used byeveryone on everyday chores, like following a recipe.It is specially useful for children with ASD giventheir learning needs. This can be used for any skilland the number of steps will depend on the childsability.
Prompts are also used when teaching skills. Aprompt is a question or instruction given with theintention of directing the individual to engage a cer-tain response or behaviour. As the child masterseach step, the prompts are gradually eliminated.This process is called fading.
Another thing that is common to the ABA ther-apies is the assessment of the child. Frequently theprofessional responsible for the therapy assesses thechild in order to keep track of the childs learningand efficiency of the treatment plan.
3. Related Work
After analysing works related to this subject, weconcluded that the use of technology has shownsome proof of being more engaging and motivatingthan traditional materials. This leads to childrenpaying more attention to what they are learningand consequentially to better results.
Results obtained by measurements like A-B-A-B design, show that all sort of skills are improved,or at least maintained, when teaching is deliveredthrough this device. These findings are supportedby teachers and therapists observations.
This results are obtained not exclusively because
technology is being used but also because of factorslike personalization of the APPs, so that it adaptsto the child needs. Also, it allows us to concludethat reinforcement can be more effective when usingimages and sounds.
Although we would like to study more researchesthat were related to reading skills we find this re-sults are transverse, independently of the skills thatare taught. Given that iPads are a recent technol-ogy, and given the number of studies made aboutthis subject, there are not enough findings to con-clude if it can be more effective teaching one skillor another.
4. DevelopmentEnsina-me a Ler has the main objective of teach-ing children reading and writing skills, through aneffective and engaging interface. To develop thisAPP we used an agile approach well known in soft-ware development, the Incremental Development.This method is based on the idea of implementinga base version, expose it to users and evolve it basedon their comments.
4.1. Requirements analysis and definitionIn this phase, we defined what were the require-ments of this APP, what should it do and whatservices should it provide to reflect the needs ofits users and serve its purpose.To define them, weworked in collaboration with the therapist and nar-rowed it to the following:
4.1.1 Functional RequirementsFunctional requirements reflect how the systemshould react, behave and what should it providegiven a certain condition.  We set the followinglist as the main functional requirements list:
The user should be able to add words and im-ages.
The user should be able to turn reinforcementson and off.
The user should be able to choose between dif-ferent types of exercises.
The APP should have different types of exer-cises. It should cover reading, writing and as-sociation.
The APP should allow customization of bothexercises and interface.
The APP should allow to change between nor-mal an syllabic reading.
4.1.2 Non-Functional RequirementsNon-functional requirements are requirements thatare not directly connected to the services deliveredto the user but on which such services depend to
better perform their role. Non-functional require-ments relate to system properties, such as reliabilityand response time, and affect the overall architec-ture of a system.  Given that, the following re-quirements should be met:
The APP should have a clean interface.
The APP should have an intuitive interface.
The APP should allow to store data persis-tently.
The APP should easily allow to add and re-move data.
The APP should be scalable, when new data isadded efficiency should not be compromised.
The APP should allow to store severalwords/images without compromising effi-ciency.
The navigation between scenes should be easyand fast.
After establishing the previous requirements, we de-signed a prototype that allowed us to test our con-cept and provide specifications for the next step, forexample, of what should consist each exercise.
As mentioned before, the main purpose of this workwas to develop an APP that could help the acquisi-tion of academic skills, specifically reading and writ-ing skills. As we could conclude from related works,customization is the key to success. Not only it al-lows to engage the user visually but also to adaptthe difficulty of exercises to his level of knowledge.It is important for this APP that the addition andmanipulation of data 1 is easy and efficient. Thearchitec...