Assistive technology for people with developmental disabilities

It has been a real honor for me to serve as Guest Editor for this special issue on Assistive Technology. At a time in which technological resources are largely available within people’s daily life, the emphasis on the use of assistive technology is increasing and a special issue on this topic seems to be quite timely and of great practical relevance. Assistive technology primarily refers to any device or system, whether in its commercial form, or in modified and customized versions, that allows an individual with specific disabilities to reach levels of functioning that he or she would not be able to display without the technology (Fukuda et al. 2016; Lancioni et al. 2013). Assistive technology also covers a range of technological solutions aimed at allowing specialized diagnosis, consultation, and treatment from a distance (i.e. telemedicine or telehealth) as well as remote supervision (i.e. telecare) (Gibson et al. 2010; Lee et al. 2015; Wacker et al. 2016).

Some of the most basic and easily recognized assistive technology devices to improve peoples’ functioning include hearing aids, walkers and wheelchairs, and desktop video magnifiers (Puanhvuan et al. 2017). A second group of highly valued assistive technology tools includes, among others, microswitches, speech generating devices, memory aids, video prompts, and robots (Lancioni and Singh 2014). Microswitches are tools used to allow persons with pervasive motor or multiple disabilities to interact with their context through very simple responses (e.g. small movements of their hands/fingers, lips, or eyelids). Through those simple responses, affected people can (a) access a computer system and choose and activate different program options or (b) activate simple environmental stimulation (i.e. depending on their levels of intellectual functioning and engagement interests). Speech generating devices serve to enable persons without speech abilities to use verbal sentences for making requests and providing answers. Persons can activate those devices by touching visual cues (images) on the devices’ screens or keyboards or by triggering sensors/microswitches connected to the devices. Memory aids can involve various forms of technology (e.g. smartphones and computer devices) and are generally aimed at providing people with memory problems reminders about specific activities/responses to carry out at specific times of the day (Baldwin and Powell 2015).

Video prompts are film clips of different actions (e.g. steps involved in a complex activity) and are used to illustrate those actions to the persons who need to carry them out. The prompts/clips are normally shown on a computer screen and last a few seconds (Wu et al. 2016). Robots can have different shapes and functions depending upon the people for whom they are used. Robots used for assisting persons with multiple disabilities during their ambulation are set up to support the persons physically and guide them to the correct destinations (thus ensuring orientation and mobility) (Lancioni et al. 2017). Robots used for providing supervision to persons with neurodegenerative disease or post-stroke rehabilitation needs may be desk-adapted devices serving to help the persons through a series of functional movements (Masiero et al. 2016). Robots used for promoting social responses in children with autism spectrum disorders may be fitted with anthropomorphic features aimed at simplifying their interaction function (Cabibihan et al. 2013).

In light of the above, one could easily argue that multiple technological solutions are available and they might be selected on the basis of the specific characteristics and needs of the persons included in the intervention process. While this situation may be taken as encouraging and new developments in the area can be expected, one should also stress that the availability of technology aids per se may not be sufficient for promoting the desired outcome. The achievement of such an outcome is much more likely or is only possible when a carefully designed intervention program is set up to (a) teach the participants how to use the technology and/or (b) ensure that the use of the technology can lead to positive consequences thus motivating the participants to be reliably active with it.

The implications of this latter point are that the efforts to develop new technology and extend its use within applied settings will have an increasingly larger impact on the achievement of participants with disabilities only if the technology is combined with effective intervention programs. This link between technology and intervention programs (a) may be considered the single most important variable in determining the usability of the technology solutions and their final success, and (b) may signal the emergence of a new specialty area integrating the work of rehabilitation engineering on the one hand with the work of rehabilitation psychology, behavior analysis and special education on the other (Lancioni et al. 2013; Lancioni and Singh 2014). The consolidation of such an area could ensure the development of technology solutions progressively more suited to the participants’ characteristics and education/rehabilitation requirements and the development of increasingly more effective intervention programs (i.e. fostering the appropriate use of the solutions and increasing the participants’ motivation).

This special issue includes eight articles that represent new efforts to evaluate the potential of assistive technology for persons with neurodevelopmental disabilities (i.e. intellectual disability, autism spectrum disorder, and combinations of intellectual disability with autism spectrum disorders or with sensory or sensory-motor impairments). The first two articles (Goldstein et al. and Singh et al.) are concerned with telehealth technology for diagnosis and intervention, respectively. Goldstein et al. analyzed the usability and effectiveness of telehealth technology with children with autism spectrum disorder who have no access to specialized service centers. The authors’ review of relevant literature and direct experience with a telehealth project led them to remain cautious as to the usability of this approach for diagnostic purposes. Their conclusion was that for a number of children, particularly for those with the most classic symptoms, a reliable diagnosis is possible through the use of telehealth technology. For other children who display more variable characteristics (disorders), however, the possibility of obtaining an accurate diagnosis would require carefully planned, direct evaluation.

Singh et al. assessed whether telehealth technology could be applied to teach three teachers in a rural school district to use a simple mindfulness-based procedure, measured the fidelity of the teachers in teaching the procedure to their students, and determined the impact of the students’ use of the procedure on their physical and verbal aggression. The students were three children with a diagnosis of mild intellectual disability. Data showed that the telehealth technology could be applied effectively to enable the teachers to use the procedure and pass it on to their students reliably. The students, in turn, benefited from using the procedure with a reduction of their aggression behavior to zero or near-zero levels.

The third article (Davies et al.) evaluated a computer-aided system that was set up to guide adult participants with intellectual disability through a test situation. The system (a) verbally presented the questions that the participants were to answer, (b) allowed the participants to have the questions repeated, (c) verbalized any answer the participants explored, and (c) allowed the participants to proceed to the next question only after they had provided an answer to the previous one. The study employed a standard two-group within-subjects design in which 40 participants used both conventional (written) and computer-aided versions of the testing. Data indicated that the computer-aided version, which was introduced through a brief familiarization/practice period, allowed the participants to complete the testing with greater accuracy, increased independence, and superior efficiency.

The following three articles (Cannella-Malone et al., Schlosser et al., and Ledbetter-Cho et al.) assessed the impact of technology-aided visual cues on participants’ performance. Specifically, Cannella-Malone et al. assessed the effects of self-directed video prompting via iPod-touch on the acquisition of vocational skills by two adults with moderate intellectual disability. The participants were taught to use the video prompting with one task and a least-to-most prompting strategy with another task. Results indicated that both instructional techniques were effective in teaching the skills, and students generalized their use of the technology to learn a new skill with no additional instruction.

Schlosser et al. assessed the possibility of using an Apple Watch to provide just-in-time (JIT) visual cues (i.e. relevant photos or video clips) to supplement the verbal directives available for five children with a dual diagnosis of intellectual disability and autism. The question was whether the availability of JIT-delivered visual cues increased the children’s ability to follow the directives. Data showed that the children successfully followed 21 of the 50 directives available via verbal input alone. They managed to respond to (a) 20 additional directives when static visual cues were added and (b) three of the remaining nine directives when dynamic cues were introduced.

Ledbetter-Cho et al. assessed the use of an iPod-touch to deliver a video-enhanced presentation of the activities scheduled for two students with intellectual disability and autism spectrum disorder. Specifically, for each visual image of a step of the activities, a video clip of a model performing that specific step was added. Touching the image led the students to see the video clip. This video-enhanced presentation mode was effective in teaching both participants to independently complete a variety of academic tasks. Generalization and maintenance effects were also observed.

The last two articles (Ricci et al. and Sigafoos et al.) focused on the use of speech generating devices (SGDs) but with different emphasis. Sigafoos et al. assessed the effects of a staff-training program on the iPad-based communication of 11 adult participants with developmental disability and severe communication impairment. Data showed that the program was effective and the participants had an increase in functional communication. Yet, the gains were maintained only for some of the participants (i.e. those attending one of the two settings involved). Staff rated the training program positively.

Ricci et al. assessed a new SGD for supporting request responses in five participants with intellectual and sensory or sensory-motor disabilities. The new device included a smartphone and a series of mini objects or chips with pictures fitted with specific codes. When the participants placed one of the mini objects or chips with pictures against the smartphone, this emitted a verbal request concerning the activity indicated by the mini object or chip. All participants learned to make requests with the help of the new device.

In conclusion, it might be argued that the articles included in this special issue touch a range of topics that can be considered relevant for the general debate on assistive technology. Such debate should advance our knowledge and help us develop new, beneficial technology solutions and intervention programs for people with developmental disabilities. As a final statement, I would like to express my gratitude to the journal’s Editors — Brian Salmons and Arturo Langa — for the opportunity they gave me to put together this special issue and to the authors who have contributed their articles to the issue.

Note from the editors

The editors of the International Journal of Developmental Disabilities (IJDD) would like to thank the guest editor, Giulio Lancioni, for his hard work and commitment to conceive and produce this special issue as well as the individual contributors, authors, and reviewers. Assistive technologies are revolutionizing the lives of those with disabilities and this special issue will contribute to this important field. The editors also wish to thank the “Lega del Filo d’Oro” for organising a conference around this special issue. The meeting is the First International Conference on Assistive Technologies and Disabilities, to be held in Rome, Italy 4–6 October 2017. Arturo Langa and Brian Salmons