A Survey of ICT Tools for Communication Development in Children

with ASD

Margarida Lucas da Silva

1,2

and Daniel Gonc¸alves

Instituto Superior T

ecnico, Av. Rovisco Pais, 49, 1050-001 Lisboa, Portugal

INESC-ID, Rua Alves Redol, 9, 1000-029 Lisboa, Portugal

Keywords:

Autism Spectrum Disorders, Information and Communication Technologies, Communication Development.

Abstract:

Several studies using Information and Communication Technologies (ICT) have been carried out over the

years, trying to solve problems related with multiple dimensions of the limitations faced by children with

Autism Spectrum Disorders (ASD). It is not yet possible to conclude that the use of ICT is more beneﬁcial

than the use of alternative or traditional educational approaches for children with ASD. In this paper we are

going to look at several studies related with communication development in children with ASD, with the

purpose of understanding the approaches available and some of their possible results.

1 INTRODUCTION

The constant evolution in Information and Communi-

cation Technologies (ICT) brought a wide range of

new possibilities to help people with learning dis-

abilities access new opportunities for learning, enter-

tainment and personal development. Children with

Autism Spectrum Disorders (ASD) are included in

this group, and although many approaches have been

tested but, few have been adopted or successfully in-

tegrated in the daily life of the children, their tutors

or caregivers (Putnam and Chong, 2008). Due to the

difﬁculties faced by children with ASD in terms of

communication skills, a few studies have been devel-

oped throughout the years in order to ﬁnd solutions

to minimize this issue. Several approaches have been

tested since there is no formula nor enough empiri-

cal evidence on how to develop for such a context.

Nowadays, the most commonly used tool with chil-

dren with ASD is the traditional Picture Exchange

Communication System (PECS). PECS is an augmen-

tative communication system, developed to help sub-

jects in quickly acquiring a functional means of com-

munication (Bondy and Frost, 2001). It is versatile

and inexpensive, since tutors can create and print the

pictures that the children needs. It is used with chil-

dren who need to communicate, but have some sort

of impairment that prevents them from using the nor-

mal communication channels, and it is sucessfull in

delivering clear messages. This tool is mostly used

by people with speech limitations, with the need to

communicate and understand actions in an effective

way. Although a simple approach, this is the general

base for most systems and tools aimed at supporting

children in communication.

In this chapter we are going to review some of

the most relevant studies in this area, focused on any

kind of approach for communication development,

and also look at commercially available tools, some of

which are not speciﬁcally designed for patients with

ASD, but are still used in some cases.

2 ICT STUDIES

We are going to describe 15 studies, all focused on

communication, but with some differences on the

targeted communication outcomes. Hailpern et al.

(2009) (Hailpern et al., 2009) and Simpson et al.

(2004) (Simpson et al., 2004) focus their studies in

developing the number of vocalizations, proposing

methodologies that force the use of speech. Bosseler

and Massaro (2003) (Bosseler and Massaro, 2003),

Coleman-Martin et al. (2005) (Coleman-Martin et al.,

2005), Hetzroni and Shalem (2005) (Hetzroni and

Shalem, 2005), Massaro and Bosseler (2006) (Mas-

saro and Bosseler, 2006) and Moore and Calvert

(2000) (Moore and Calvert, 2000) focused on de-

veloping the children vocabulary, proposing a set of

methodologies that tried to teach word to picture

matching. Woodcock and Woolner (2007) (Wood-

285

Lucas da Silva M. and Gonçalves D..

A Survey of ICT Tools for Communication Development in Children with ASD.

DOI: 10.5220/0004641202850292

In Proceedings of the International Conference on Physiological Computing Systems (PhyCS-2014), pages 285-292

ISBN: 978-989-758-006-2

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

cock and Woolner, 2007), Millen et al. (2011) (Millen

et al., 2011), Ohene-Djan (2010) (Ohene-Djan, 2010),

Hetzroni and Tannous (2004) (Hetzroni and Tannous,

2004), Hirano et al. (2010) (Hirano et al., 2010), De

Leo and Leroy (2008) (De Leo and Leroy, 2008) and

Cihak et al. (2012) (Cihak et al., 2012) proposed

methodologies to develop communication in a social

context, by providing tools to socialize by showing

social situations or means to send messages, or to

encourage spontaneous vocalizations. And ﬁnally,

Rodr

ıguez et al (2004) (Gea-Meg

ıas et al., 2004) used

an approach to teach the children communicating by

showing them casual situations, focusing on the de-

velopment of the cognitive component as a way of

increasing vocabulary and social imagination skills.

In summary, we address research studies and tools

according to the following taxonomy:

1. Number of Vocalizations: Studies targeted at

motivating the number of vocalizations produced

by the children, which is of upmost importance in

children that can’t speak.

2. Vocabulary Expansion: Authors that try to in-

crease the number of words that the children rec-

ognize and use. Communication in children with

ASD can be affected by their cognitive abilities,

which is a severe impairment that is usually found

in children with ASD.

3. Communication in a Social Context: Work that

tries to deliver some examples to children on how

to socialize, or engage them in some computer-

mediated situations, in order for the children to

learn how to react and feel more comfortable

when confronted in real life.

4. General Communication Learning: Authors

that try to develop cognitive abilities in order

to improve several communication impairments.

This can help the children to learn more vocabu-

lary, or to prepare them to face different situations.

5. Commercial Tools: Tools that are available for

purchase or free download for children with ASD

or other types of impairments, without having any

research associated, and having only the purpose

to answers the users’ needs.

2.1 Number of Vocalizations

Several studies are focused on developing the

children vocalization abilities, but each author has

followed a different approach. A simpler approach

came with the work by Trying a more social way to

motivate vocalizations, Simpson et al. (2004) (Simp-

son et al., 2004) studied a way to create spontaneous

verbal greetings to peers with examples and counter

examples of the social skill: sharing, following tutor

directions, and social greetings. The approach com-

bined video and computer based instructions using

HyperStudio 3.2. The software had several screens

that provided written instructions, synthetized speech

and video examples. The child was able to select

which content to watch and had to discriminate the

examples from the counter examples displayed in the

videos. Results showed an increase in targeted social

skills, and this study has an interesting approach since

it tries to develop social skills indirectly, through the

communication development. But it’s still a limited

approach, since it doesn’t give the possibility for

the children to get to know somehow other peers,

and directly exchange messages with them as a

safe method to communicate for them. It has a gap

between learning how to communicate, and how to

physically socialize with peers.

As a more comprehensive approach, which tried

to create a package of tools, was proposed by

Hailpern et al. (2009) (Hailpern et al., 2009) by pre-

senting the Spoken Impact Project Software (SIPS).

In their approach, the authors tried to understand how

the effect of audio and visual feedback can encour-

age vocalizations of children with ASD, with aspects

present in previous approaches and with positive re-

sults. The SIPS generates audio and visual feedback

directly related with the amount of external noise pro-

duced by the children and detected by the system, for

example, a square shape showed in the screen might

change to a round shape according to a sound it cap-

tured. The results give us strong indications that au-

dio and visual feedback does encourage spontaneous

speech-like vocalizations in low-functioning children

with ASD. While using the program, they found that

children also have distinct and speciﬁc preferences for

feedback, stating that in the future they might need in-

dividual customization.

2.2 Vocabulary Expansion

Another line of research has been concerned with the

increase of the vocabulary possessed by children, and

although some aspects are somehow similar to those

found in the previously described studies, there are

different views on how to motivate children, by using

other types of stimuli.

A similar study focused on stimulating children

with visual and auditory stimuli was developed by

Moore and Calvert (2000) (Moore and Calvert,

2000), which analyzed the impact of computers on

the extension of the vocabulary of the child, by devel-

oping a software program that builds upon behavioral

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learning principles to enhance the vocabulary skills

of children with autism. The software provides

animations and interesting sounds as a reinforcement

when correct responses to the given commands are

provided by the child. The results are positive as in

the previous study, showing that children pay more

attention when using the computer than with the tutor,

and that they felt more motivated to continue the

study using the computer. An important conclusion is

that the number of correct words identiﬁed increased.

This study doesn’t disclose many details about the

software, making it somehow suggestive and difﬁcult

to evaluate in terms of the adopted methodology.

Still focusing on vocabulary development, but

using a different approach, Bosseler and Massaro

(2003) (Bosseler and Massaro, 2003) used a software

called Baldi which is a 3D language tutor, qualiﬁed to

help in learning speech and reading through the asso-

ciation between pictures and spoken words. Accord-

ing to the authors, Baldi has been successful in teach-

ing vocabulary and grammar to children with ASD

and to children with hearing problems also they tried

to understand if using the tutors face helped increas-

ing the success in the learning process, so they per-

formed experimental evaluation with and without the

tutors face. They asked children to take pictures of

objects and surroundings at home, which were then

incorpored in the lessons. In the results, the number

of vocabulary words increased, and the authors con-

cluded that the positive results were due to the lessons

with Baldi. Using an embodied agent might be a pos-

itive reinforcement since can more easily relate with

a non-human character. But with time, based on Put-

nam’s ﬁndings (Putnam and Chong, 2008), children

may get bored with the agent itself, leading to loss of

interest. This could mean that over time the lessons

may be increasingly strained, which ultimately leads

to decreased motivation and possibly to the reduction

of visible results.

Later, Massaro and Bosseler (2006) (Massaro

and Bosseler, 2006) also used Baldi as software to

conduct tests to teach vocabulary and grammar by

identifying pictures. Here the program provided

exercises in every lesson with a unique set of items

appropriate for the children’s vocabulary, knowledge,

and abilities. In each lesson they could use the

Baldi agent or only the spoken word. During the

exercises the child had to choose the correct image

given the word that was said, or to choose certain

areas of the image according to what was asked. In

some exercises they had positive reinforcements with

a happy face, or a sad face for incorrect answers.

At some point, the child was asked to vocalize the

name of the item or its function. Results showed that

there were more correct answers with Baldi, than

with the audio alone and in the overall the correct

answers increased. Although this approach using

Baldi it is different from the Bosseler and Massaro

(2003) (Bosseler and Massaro, 2003) study, the two

show that is possible to test several approaches with

the same tool, but the problems listed above of the

possible decrease in motivation still apply here, and

the results are clear in stating that using the agent is

more beneﬁcial than without it.

A suggestive test using rich slides created in

Power Point was developed by Coleman-Martin

et al. (2005) (Coleman-Martin et al., 2005). In

their work, the authors focused on developing the

capacity to identify vocabulary words, by starting to

show a ﬁrst slide with the target word written and

with the corresponding audio vocalization. Then

the subsequent slides presented words by phonemes,

for the child to repeat, which was then followed

by a positive reinforcement picture, and a sonorous

”Excellent”. The last slide presented the whole word

again. The results showed an increase in vocabulary

words, but they tested under three conditions: a) tutor

only, (b) tutor plus computer-aided protocol, and

Power Point gives the possibility to easily change

all contents and structure, regularly creating and

updating slideshows ﬁn-tuned to the childrens needs

can involve a considerably large and time consuming

effort. Another possibility is that they always use

the same document, but that raises the question

previously highlighted in another study about the

potential loss of interest due to habituation by the

child.

Finally, Hetzroni and Shalem (2005) (Hetzroni

and Shalem, 2005) tried a more simple approach fo-

cused on the vocabulary development, after a study

targeted at the development of communication skills

in social context (we will detail this study in the next

section). The authors developed a tool to implement a

7-step gradual fading protocol, where at ﬁrst it shows

the picture of a food item with the name on it, and

then the pictures fade out until only the name is vis-

ible. They also used emoticons as a reinforcement.

Later, in the classroom setting, children were asked

to point out the food items that were written. Results

show that correct matches between the text and the

food items improved for all participants, but the soft-

ware shows limited resources and lacks any kind of

engaging contents for children.

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2.3 Communication in a Social Context

With a more social approach, Hetzroni and Tannous

(2004) (Hetzroni and Tannous, 2004) investigated the

possibility of enhancing communication functions of

children with autism, using software developed by

them. They focused on delayed echolalia, immediate

echolalia, irrelevant speech, relevant speech, and

communicative initiations. The software showed

animations of daily routines, and in each one an

animation of an adult asking a question related

with the current routine. After the child selects the

response from a given list, an animation is shown

with the results of the selected answer. The results

were positive, evidencing a decrease in delayed

echolalia, in immediate echolalia, and in irrelevant

speech, together with an increase in relevant speech

communication initiations. Also, this study showed

that children were able to transfer the knowledge

from the experimental settings to their real world rou-

tines. Over time, children train all possible situations,

repeating already trained scenarios, which may lead

to a decline in their interest and communication skills.

Woodcock and Woolner (2007) (Woodcock and

Woolner, 2007) describe a low cost and user-tuned

polysensory environment developed for children with

ASD; their work, called inserted in Project Spectrum,

which tries to engage children with ASD in using

digital technologies. This project has several modules

that try to address the whole triad of impairments, by

providing a set of predeﬁned interactive activities that

are considered to be engaging for children with ASD.

It has the concern of including fun and engaging

content, leading children to actively seek the use of

the software. Using interactive activities, the authors

want to provide children with opportunities to com-

municate and encourage spontaneous vocalizations.

One of the drawbacks of this project is the fact that

it requires a demanding experimental setup: video

cameras for motion tracking, a microphone, lights,

a projector, speakers, and a computer. This setup

can be very expensive, it requires tutors to learn an

extensive set of skills to use it, and it doesn’t provides

impliﬁed modules for message exchange between

users.

Devised as a more practical approach, De Leo and

Leroy (2008) (De Leo and Leroy, 2008) use a

smartphone as a mean to enhancing communication

and social skills. They developed a tool called

PixTalk

, which gives the possibility of choosing

from any image placed in the program (that can be

customized according to the user’ interests), write

http://www.communicationautism.com

a message, and send it to another user. This is a

conceptually approach when compared to ours, since

they try to meet the interests and preferences of

the users and let them communicate in the way in

which they feel more comfortable with. This project

evolved to a commercial tool called I Click I Talk

and currently has more features than the one used

in the study. We were not able to have access to the

results of this study, but since a similar approach was

followed, we thought that was important to make a

reference. Despite the message functionality being

similar, it still lacks all the other functionalities and

ease of content access and customization, like videos

or images to help motivate tool usage and sharing

preferences.

Thinking more speciﬁcally in a classroom envi-

ronment and its requirements, often forgotten in these

studies, Hirano et al. (2010) (Hirano et al., 2010)

developed vSked, an interactive and collaborative

visual scheduling system, designed for elementary

school classrooms. They deﬁne a visual schedule

as a set of pictures or words that cues someone to

engage in a sequence of activities. They tested it as a

timetable with all the children’s activities during the

day, and each entry on the timetable had an animation

associated with that activity. Each student received

a notiﬁcation in their personal devices indicating a

location of that activity, or a set of choices for the

child to choose the right location. It also provided

help when the child chose the wrong answer, or just

didn’t answer. When the answers were correct, chil-

dren were rewarded with animations of their liking.

The acceptance in the classroom was good both by

the children and staff, which reported reductions

in the effort required to use visual supports. The

results were also positive, showing that the children

have interest in using the system, and reached an

increase in communication and social interactions

in the classroom. But despite proving to be a useful

tool, it has a different purpose, and doesn’t enable the

children to communicate directly with their peers, or

visualize their favorite content.

Ohene-Djan (2010) (Ohene-Djan, 2010) de-

veloped Winkball, a new Internet-based video

messaging and broadcasting technology, designed to

support the teaching of oral and visual communica-

tion skills in schools. Despite not targetting children

with ASD, the author believes that the technology

can also be beneﬁcial for this population, since

the use of media is usually perceived as interest-

ing and motivating. The author doesn’t show any

http://www.iclickitalk.com

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tests or results related with the tool, and therefore it

is difﬁcult to draw conclusions about its effectiveness.

Millen et al. (2011) (Millen et al., 2011) tried

to ﬁnd ways of supporting communication and

collaboration skills for children with autism in the

scope of the COSPATIAL project (Communication

and social participation: collaborative technologies

for interaction and learning)

. This project de-

veloped a suite of applications composed by two

Collaborative Virtual Environments (CVE) to support

the enhancement of social skills in children with

autism, and two educational technologies in the

form of Shared Active Surfaces (SAS). This suite

is composed by Block Party CVE (a collaborative

puzzle-style game that requires users to communicate

and collaborate in order to build a speciﬁc tower of

blocks in a given pattern), TalkAbout CVE (an avatar

with which children must train a social conversation),

Join-In Suite SAS (a set of short problematic stories

presented to children, that have different solutions

either given by the program or suggested by the chil-

dren, which the child can experience later in a game),

and No-Problem! (an activity in which children

can explore stages of a social conversation, explore

alternatives solutions or suggest new ones). To date,

only descriptive information about the project and its

goals is available, meaning that there are no results

available. Still, we considered important to make a

reference to such a project.

Finally, Cihak et al. (2012) (Cihak et al., 2012)

tried a simple approach consisting on the evaluation

of PECS used in conjunction with Video Modeling

(VM) as a technique to increase independent commu-

nicative interactions in children with limited to no ver-

bal communication skills. In this study, the authors

use video to teach what would normally be taught

with PECS. Tests show that as a result of using VM in

conjunction with PECS, all students increased inde-

pendent communication interactions, and the students

rate of learning was quicker when using VM. Still,

this technique is very limited in giving the children a

comprehensive set of tools to enable learning of com-

munication skills, and communicating with others.

2.4 General Communication Learning

Rodr

ıguez et al (2004) (Gea-Meg

ıas et al., 2004)

propose the Sc@ut Communicator, an Augmenta-

tive and Alternative Communication (AAC) designed

to help people with communication problems, such

http://cospatial.fbk.eu

as subjects with ASD dysphasia and brain paraly-

sis. The communicator runs in several portable de-

vices (pocket PCs, mobile phones, video game con-

soles and computers), and uses hypermedia templates

with sounds and pictures to improve learning. Sc@ut

shows a structure of templates with images, simi-

lar to PECS. Images can be pictograms, photos or

drawings, which represent objects that the user can

ask for, or actions that can be carried out. When

an image is selected, an associated sound previously

stored is played. This sound, which can be a word

or a sentence, represents a reinforcement for the user

and allows tutors to know what the user wants. It

also provides links between templates, when a spe-

ciﬁc image is selected in it. This interaction allows

the construction of structured sentences, or the clas-

siﬁcation of actions and elements. They also have

a separate tool called Sc@ut Generator (Gea-Meg

ıas

et al., 2004), which allows the Communicator to be

customized “ad-hoc”, while the child is progressing

in his learning activities, thus adapting dynamically

to the progress of the child, unlike other more rigid

AAC systems. This way tutors can change content

and interaction, adapting them to speciﬁc educational

contexts, so that the software can be used as a sup-

port in learning process. This tool tries to adapt to the

children’ needs and give them a way to easily learn

context-speciﬁc situations, but it doesn’t allow them

communicate directly with other people.

2.5 Commercial Tools

There are a few applications in the market that despite

not being the matter of a study for which we can

assess experimental results, are still important to look

and evaluate. Some of them have been speciﬁcally

developed for people with ASD, trying to help with

the cognitive and communication impariments. Other

tools are broad spectrum and aimed at populations

with very distinct needs, although they are also

applicable to people with ASD. As in the previous

section we are going to analyze and describe these

tools.

Zac Browser

The Zone for Autistic Children Browser (Zac

Browser)

, is a multimedia software developed for

children with ASD. This tool was inspired in an

autistic child named Zachary, which was unable to

use his computer using regular computer software

tools (e.g. Internet Explorer, Windows Messenger,

etc.). Faced with these difﬁculties, his grandfather

decided to develop the Zac Browser as a software

http://zacbrowser.com

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completely adapted to Zachary’s needs with a more

visual navigation, and safer to use due to parental

control. This software is especially designed for

recreational and entertainment use, and as such, it

does not explore the interpersonal communication

speciﬁcities. Furthermore, tutors are limited in terms

of content adaptation and software conﬁguration,

given that they are bound to the pre-deﬁned contents.

Furthermore, the tool depends on Internet connection

to access most contents, which may not available in

every school.

Boardmaker

is a suite of applications that enables

the adaptation of learning materials to the needs of

each child. The program has a large database of

symbols they call Picture Communication Symbols

(PCS)

, and allows the users to create any kind

of customized material, such as schedules, manual

communication boards, books, teaching materials,

etc. The material can be used in the computer or

printed, making this tool usefull to create materials

for teaching, however, this software is designed

for the tutor and was not conceived to be used by

children.

TeachTown

is a Computer-Assisted Instructional

(CAI) program designed for developmental ages

between 2-6 years, speciﬁcally to meet needs of ASD

population. The program includes a comprehensive

curriculum that aligns to standardized measures,

which integrated the following learning domains: 1)

Language Development; 2) Social and Emotional

Skills; 3) Adaptive Skills; 4) Cognitive Skills; 5)

Language Arts; and 6) Mathematics. The curricu-

lumdepends on the performance and is adjusted for

each student. Tutors can customize the curriculum

to meet Individual Educational Plan (IEP) goals.

TeachTown also collects data from the children usage

and produces reports, to track the student progress.

This tool is one of the most complete applications for

children with ASD currently available, and extensive

research has proven that an ICT tool like TeachTown

has beneﬁcial results. However, this tool is not

completely customizable, and it is not targetting all

the children preferences, which can have poor effects

in their attention and engagement. Furthermore,

this tool was devised for individual use, and lacks

features that can promote communication and social

interaction skills.

http://www.mayer-johnson.com/boardmaker-software

http://web.teachtown.com/

Tablet Applications

With the advent of the iPad, several new applica-

tions have been created for children to use in tablet

devices, motivated by the ease-of-use of the touch-

screen. In fact, touchscreens brought new possibil-

ities, since users with cognitive and motor impair-

ments have an easier way to interact with the com-

puter. Instead of using the usual keyboard and mouse,

which requires a higher coordination or a greater un-

derstanding of its operation that the child sometimes

does not have, tablets enable a more natural interac-

tion.

There are some applications that became a ref-

erence in the autism area such as Proloquo2Go

MyTalk

, Grace

and iCommunicate

. Despite be-

ing different applications, all of them use the PECS

format to communicate; the child can choose the pic-

ture that best translates what he/she is trying to say,

or combine several pictures to write a phrase or story.

Some applications also have voice speech that reads

what the children write. Most of them are paid, which

means that these applications are developed with a

commercial purpose in mind, and they only allow a

local and physical interaction using the tablet with

their peers.

3 CONCLUSIONS

In the overall, existing approaches and methodolo-

gies proposed to date focus on self-development and

don’t show much concern towards enabling children

to communicate with each other, to adapt the tool to

the user, or deliver any kind of courseware. Most of

the work found to data is inspired in PECS, which is

a simple system that children understand, and is sim-

ple to use. After a closer look at the studies focused

on communication, we can understand the different

concerns and tactics used. In vocalizations studies

we see that audio is the most important feature to be

used, as these approaches try to resort to imitation as

a way to increase the user conﬁdence in using speech.

We can see that only two use images, and only one

uses video, from which we can infer that using this

kind of media to motivate speech imitation might be

intentionally avoided, in order to prevent any stress

caused by the people present or interacting with peo-

ple (even if it is through the computer). In general at

the end of the tasks, all experimental setups present

animations to the user as a positive feedback reward

http://www.assistiveware.com/product/proloquo2go

http://www.mytalktools.com

http://www.graceapp.com

http://www.grembe.com/icommunicate

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for their efforts, motivating them. As previously de-

scribed, in this type of tests, direct human interactions

are not used, and so there are no social components

involved. Furthermore, except for one of the stud-

ies (Simpson et al. (2004) (Simpson et al., 2004)),

none of the proposed approaches gives the possibil-

ity to change any aspect of the tool. It is also im-

portant to highlight that most of the platforms used

in the presented studies are not developed speciﬁcally

for the study; most of the features addressed by our

work are not be present because the researchers sim-

ply were not able to experiment with them or just

haven’t felt the need to use it. In the vocabulary

expansion ﬁeld, where most studies are found, most

of the conclusions stated for vocalizations also ap-

ply. We see that social communication continues to be

missing, also probably to avoid stressing the children.

Media support is found to be very important; most of

the studies support mainly images, audio and anima-

tions, although videos still don’t seem to have much

importance, since most of the studies don’t support

or use them in the tests. The main difference is that

most of the tools enable the possibility to change con-

tent (Heimann et al., 1995; Moore and Calvert, 2000;

Bosseler and Massaro, 2003; Coleman-Martin et al.,

2005; Hetzroni and Shalem, 2005), which might show

that researchers realized the importance of adapting

the tool to the user, in order to achieve better out-

comes. These results also apply to the studies that

focus on developing communication in a social con-

text, and where the only obvious difference is the in-

clusion of message exchange in three of the studies

(De Leo and Leroy, 2008; Ohene-Djan, 2010; Millen

et al., 2011). Other commercial tools include more

functionalities supporting most media formats, mes-

sages and the possibility to change a few aspects of

the content and some functionalities of the tool itself

(a feature not found in any of the other studies). How-

ever, these features are motivated by the need to ad-

dress the requirements of a broader spectrum of tar-

get user groups (e.g. people with motor impairments),

which in most cases does not account for aspects that

are core to the ASD population, such as having en-

gaging and fun contents and interfaces. But they don’t

show much concern about being able to put the chil-

dren to communicate with each other, to adapt the tool

to the user, or deliver any kind of courseware. All

of the studies explore the use of multimedia, which

shows us that this is the most effective way of cap-

turing the attention of the children and help in the de-

velopment of new communication skills. In general,

we see that two of the main lines of research, the en-

hancement of the children’s vocalizations and vocab-

ulary, are using a more mechanic approach supported

by imitation combined with a visual and audio pos-

itive reinforcement. This kind of approach, despite

helping children to talk, doesn’t help them to com-

municate with other people or offers ways to do it in

a comfortable way for them. These tools also have

a high probability of leading to lack of interest over

time, since the contents and interface are always the

same, not giving the possibility for tutors to change

anything in order to stimulate a more constant mo-

tivation. This same reason makes the tool less fun

for the children, which is an important factor that is

pointed out in Putnam’s study (Putnam and Chong,

2008) as one of the main causes of abandonment in

computer-based interventions. These issues arise due

to the fact that little power is given to the tutors, to

change either contents, or the tool interface, easily

becoming outdated. None of the studies focuses on

the tutors’ or parents’ deep knowledge of their child’s

interests and needs, which should be one of the best

ways to get through to the child and prepare user-

tuned contents in a way that is more engaging and

positive for their personal development. New possi-

bilities have emerged with touchscreen technologies

(e.g. smartphones and tablets), bringing new oppor-

tunities to users (usually paid), and mostly designed

to help parents in the interaction with their children.

Typically, most applications arising nowadays show

concerns about enabling the children to compose sto-

ries or phrases to communicate, using custom key-

boards or touchscreen, to facilitate the handling of the

and to enhance self-communication through and mes-

sage composition.

ACKNOWLEDGEMENTS

This work has been partially funded by Fundac¸

ao Por-

tugal Telecom, ASUSTeK Computer Inc., and by the

Fundac¸

ao para a Ci

encia e Tecnologia (FCT) under

project PEst-OE/EEI/LA0021/2013.

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