Two Ways Technology Can Make Treatment for Individuals with Autism More Innovative

By Sarah Kupferschmidt, M.A., BCBA

bSci21 Contributing Writer

More and more people are using technology for different things. Whether it be to communicate with our smartphone and/or tablet, or measure the number of steps we take on a given day with our wearable device, technology is becoming more and more accessible and is innovating how we engage in many of our day to day activities. When it comes to providing treatment to individuals with autism that is based on Applied Behaviour Analysis (ABA), technology has also had a huge impact.  For example, recent advances in technology like the touch screen, and tablet devices, have enabled behaviour analysts to teach functional communication to many individuals who may not otherwise have had a voice to get his/her needs met.  These devices have become much more affordable in recent years and have made it easier for parents to access them (Lorah,E.R., Parnell, A.,  Whitby, P., and Hantula, D.,  2014).  For a review of why I believe it is so important to leverage technology and in doing so, make treatment that is based on ABA more accessible to families who have a child with autism, check out my article in the Huffington Post last year. 

One area with lots of potential for innovating treatment for individuals with autism is in wearable technology. Wearable technology has moved well beyond the step or calorie burning measurement tool (e.g., Fitbit or Nike fuel band).  For example there are now wearable clothing and jewelry options that will record measures such as:  1) heart rate; 2) cadence or number of steps per minute; and 3) galvanic skin response (GSR) just to name a few (e.g., Hexoskin ).   Other wearable devices may be attached to the person in a variety of different ways.  For example, there is a line of jewelry or watches that measure GSR.  These are becoming easier to wear because they may be smaller and are not necessarily packaged in the traditional format of a wristband or watch, which may be difficult for some individuals with autism to wear because of the sensory challenges associated with them (i.e., a ring, or a small clip that attaches to a belt loop).

Here are two ways in which wearable technology may innovate how we develop a treatment program that is based on ABA for individuals with autism:

Teaching Skills

Some wearable devices allow us to provide haptic/tactile prompting to the person wearing the device.  For example the Apple watch allows users to send vibrations to another’s wrist using a pattern of choice (e.g., 3 tactile vibrations vs. 2).  Some remarkable work has already been done using haptic/tactile prompting devices to teach individuals with autism important safety and social skills (Hoch, H., Taylor, B. A., & Rodriguez, A. ,2009).  The devices used in the past were vibrating pagers that may have been controlled remotely.  Newer technology with the same functionality, and in some cases better functionality (e.g., ability to fade tactile prompt by intensity or frequency of prompt) presents a unique opportunity to innovate how we teach safety and social skills.  These devices are unobtrusive and remove the requirement of an adult to deliver a prompt in the natural environment where we would want the behavior we are teaching to occur.  The ability to measure heart rate and GSR may provide behaviour analysts with new ways of teaching individuals with autism to discriminate when he/she is starting to become “stressed” as defined for that unique individual, and to self-monitor and regulate his/her own behaviour based on that ability.  For example, the data collected on heart rate may be used to determine when to prompt someone with his/her wearable technology to engage in relaxation training.  These tools need to be investigated further as to how and if they would be viable.  Given the potential for these to have a positive impact on the quality of life of individuals with autism and the general public it is important that behaviour analysts have a voice in the development of these types of tools, and that we continue to add to the literature on how these devices are best used.

Dealing with Challenging Behavior

Developing a treatment plan for challenging behavior requires the implementation of a functional behavior assessment so that the information gathered from that assessment will inform a function-based intervention.  Recently, some researchers have demonstrated that if we implement the same procedures for precursor behavior, that is behavior that precedes severe problem behavior, we may be able to intervene on the precursor behavior itself as opposed to the problem behavior, and achieve the same results (Najdowski, A.C., Wallace, M.D., Ellsworth, C.L., MacAleese, A.N., Cleveland, J.M., 2008).  This may mean that individuals with severe problem behavior may be less likely to injure themselves or someone else because the intervention and assessment procedures are focused on the precursor behavior.  Contrast this research with the likes of Dr. Francisco Barrera and colleagues in which they measured cardiac function of three adults with developmental disabilities during a functional analysis.  They found that there were reliable and consistent patterns in heart rate (HR) in all conditions, that there was an escalating HR immediately before the self-injurious behavior, and a temporary drop in HR following the self-injurious behavior (Barrera, F.J., Violo, R.A. and Graver, E.E., 2007).   Given these two lines of research and the increased accessibility of tools that are able to measure heart rate and other measures we may not have considered in the past, there appears to be a new frontier for behavior analysts.

These are just a few of the ways that technology can innovate how we are measuring, teaching and treating behavior of individuals with autism.  Remarkable work has been, and continues to be done by the many behavior analysts around the world.  Recent advancements in technology may allow us to innovate some of the work we are currently doing or even think of new ways to do what we are already doing that may be more efficient and more widely accessible.   

Let us know how you think technology can affect behavioral treatments in the comments below, and be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!  

References:

Barrera, F.J., Violo, R.A. and Graver, E.E. (2007).  On the Form and Function of Severe Self- Injurious Behavior. Behavioral Interventions,22: 5-33 (2007)

Hoch, H., Taylor, B. A., & Rodriguez, A. (2009). Teaching teenagers with autism to answer cell phones and seek assistance when lost. Behavior Analysis in Practice, 2, 14–20.

Kelly, K.M., Connor, J. (2015).  Apps for Behavior Analysts.  Article posted in A Special Interest Group of the Association for Behaviour Analysis International.

Lorah, E.R., Parnell, A., Whitby, P.S., and Hantula, D. (2015) A Systematic Review of Tablet Computers and Portable Media Players as Speech Generating Devices for Individuals with Autism Spectrum Disorder.  Journal of Autism and Developmental Disorders, 45 (12), 3792-3804.

Sarah Kupferschmidt, M.A., BCBA, realized that Behavior Analysis was her calling when she first started working with children with autism in 1999. Once she discovered its effectiveness and the impact it had in helping children with autism and their families, it inspired her to pursue a Masters of Arts in Psychology, with a specialization in Behavior Analysis from the University of Nevada, Reno. She is also a Board Certified Behavior Analyst (BCBA).

Not only does Sarah enjoy working directly with children and youth with autism, she’s also very passionate about empowering others with the most effective tools to teach children and youth with autism. She has trained hundreds of staff, clinicians and parents on how to implement strategies that are based on ABA to improve the quality of life for his/her student or child. Currently she is Co-Founder of Special Appucations, is a part-time faculty member at Mohawk College in the certificate in ABA program offered through McMaster University. Sarah is also a consultant and coaches parents and clinicians on how to effectively implement strategies that are based on ABA. She regularly presents workshops on a variety of topics related to teaching or working with individuals with autism and has been named Top Safety Contributor for Autism Parenting Magazine, is a Huffington Post contributor and a TEDx speaker. Ultimately her goal is to help improve the quality of life for children and youth with autism and his/her family by making ABA accessible to all.  You can contact her at [email protected].