Stories at the Dentist

Details of a current research project relating to dental healthcare is  being carried out by the University of Dundee AAC Research Group. The “Stories at the Dentist” project isn’t specifically about autism but would seem to be relevant. Dental treatment for people on the autistic spectrum can be problematic due to the high degree of communication needed between the dentist and the patient e.g. seeking consent from patients during consultations. For those with sensory issues touch/sounds/taste/sight lights etc.  involved in treatment can be overwhelming and distressing.

“The main objective is to create an effective and efficient means of generating personalised social stories for individual patients within the dental context. This study aims to develop a computer based communication system to support people with intellectual disabilities to understand dental procedures with the aim of reducing anxiety for both patients and clinicians, and to enable patients to be more involved in the decision making process.”

Visit the Stories at the Dentist project website for full details of this research and to see the prototype of an app used to support the work of this project. They are experimenting with social stories to explain processes involved in treatment and e.g. pictures of dental practice staff to introduce the environment.

Autism research journals and papers

Research Journals

Some journals with an electronic presence.
Tip: Some journals have “Open Access” articles for papers that don’t require a subscription to read, look for icons of unlocked padlocks.


Some papers involving hand held devices

UK autism electronic research networks – divided by a common language

I was looking electronic discussion forums for where you might find UK autism professionals or academics discussing topics of relevance. It seems the two main ones are

and particularly in Scotland

I’m an IT person what immediately strikes me is that both of these discussion forums are “closed” i.e. you have to go through a registration procedure even to just read the messages.

This is a personal opinion – I’m delighted to find these forums and have already found some valuable contacts and projects but wearing my “what about the punters” hat, I feel that having these closed to reading by ‘anonymous’ users is a pity. As a technical administrator of various forums on Scottish websites over the years I usually find from the usage statistics that the ratio of people who read messages on open systems (no registration for reading) to those who actually post a message is about 100 to 1 i.e. about 100 times more people will read a message than will ever contribute.

If web-based electronic research communities require registration to view they are also immediately cutting themselves off from the possibility of their topics and current research discussions ever being found by people using search engines on the web like Google. Thus the general public is effectively blocked from easily ‘stumbling’ on relevant topical material. There’s so little research on autism  available to the general public, most is currently locked up in subscription-only academic journals, every scrap is valuable.

I can understand the need for some locked forums relating to specific individuals/courses/individual privacy notions but for general research and debate?  I find it difficult to understand. One of the features of autism is considered to be “…impaired social interaction…”. Indeed. See irony?

Review of Using iPads in AAC – Augmentative Communication in Practice: Scotland

“Established in 1991, Augmentative Communication in Practice: Scotland (ACiP:S) is a national network that links together specialist AAC services and professionals; children and adults who use AAC (and their families); statutory services and voluntary agencies; and that provides resources, information and support.”

In 2012 ACiP:S had a study day, “Using iPads in AAC” and the papers from that day can be downloaded. What’s useful is that they have many case examples of using particular apps with different people and seeing pros and cons for each individual.

A common finding was that tablet devices (compared to smaller iPod devices) were preferred for children just starting to learn language skills and those with poor dexterity as iPads have larger screens making them easier to use and read but at added expense and they are heavier to hold if no surface is available to rest the tablet on. Accessories used for making devices easier to hold for children and to provide stands for working at a desk included the Big Grips cases.

App reviews

Sally Millar of CALL Scotland has a good review of a selection of apps in her paper

Simple Photo and Video Apps to Support Communication [PDF]

List of apps used in paper case studies

Here’s a list of some of the apps that this group has documented in case studies.

Scottish Government Guidance: A Right to Speak Supporting Individuals who use Alternative and Augmentative Communication

“Guidance to be used by people who use Alternative and Augmentative Communication (AAC), their families, strategic and operational heads within health boards, local authority social work and education departments and the voluntary sector”

A Right to Speak Supporting Individuals who use Alternative and Augmentative Communication [Scottish Government]

Enabling technology – making technology work better for disabled people

“..Digital technology can be incredibly enabling for many disabled people. But for others, obtaining affordable devices that meet their needs and accessing essential digital services can be difficult or impossible…

This report is an output of a 15 month design research project carried out by the Helen Hamlyn Centre for Design at the Royal College of Art, in partnership with BT and Scope as part of the BT Better Future Program. It looks at steps that can be taken by commissioners and producers of enabling technology, as well as providers of key digital services, to maximise the enabling potential of digital technology for the 11 million disabled people in the UK. It emphasises the importance of flexibility in the creation of technology used by disabled people, whether hardware, devices or digital services…”

Enabling technology – making technology work better for disabled people [PDF]



Review: The Apple iPod Touch as a vocational support aid for adults with autism: Three case studies

The Apple iPod Touch as a vocational support aid for adults with autism: Three case studies [PDF]

“Abstract. Personal digital assistants (PDAs) offer task management and organisational features that may be utilised to help people with autism spectrum disorder (ASD) function more successfully in the workplace. Additionally, onboard video cameras and addon software applications provide rich opportunities for the implementation of personalised vocational supports for individual workers. This article reports on three cases of workers with ASD who have been trained to use Apple iPod Touch PDAs as vocational supports in the workplace, resulting in improved functional performance and reduced behavioural challenges.

Keywords: Autism, assistive technology, cognition, occupational therapy, personal digital assistant, vocational rehabilitation”

From the Journal of Vocational Rehabilitation 37 (2012) 75–85

Regarding Apple iPod Touch devices:

“…These devices can be carried in a pocket, on a belt clip or on a necklace lanyard, making them appropriate for workers who must use their hands on the job…”

They used the devices to provide the following support

  • task reminders
  • task lists
  • video-based task-sequencing prompts
  • behavioral self-management adaptations
  • way-finding tools, and other supports

One example from the study was a successful pilot with Jeffrey who was having difficulties in his job in a fast food environment. The iPod was worn in a protective case on a belt clip. An occupational therapist worked with Jeffrey to set reminder alarms for tasks, different tasks were given different sounds with additional audio recordings of task notes that could be listened to for extra reinforcement. They didn’t need to use any additional apps, they just used the built-in apps like “Clock”.

You can find details of how to use the built-in apps by going to Apple’s website and downloading the appropriate iPod manual (these are usually PDF files)

e.g.  iPod touch user guide for iOS 6.1 Software (June 2013) [PDF]

Another trial was Lily, a 20-year old woman with Downs Syndrome and ASD. She was employed in a housekeeping duties role.

“…The Storykit application was downloaded from the Apple iTunes Store in order to build verbal and picture-prompting task lists, replacing Lily’s laminated paper prompts…Storykit allows a user to easily create talking picture books…

…The device led to improved work performance, fewer behavioural challenges, and a marked decrease in telephone calls for help to her job coach or mother during the workday.”

In the report they do acknowledge

…It is important to note that each of the three workers had functional cognition, vision, hearing and manual dexterity sufficient to interact with the iPod Touch without the need of accessibility adaptations. Many people with ASD have cognitive, sensory or motor conditions that would make utilisation of such a device problematic…

Once again this highlights how tailored use of any device needs to be to the particular impairments of the individual.

Interesting emerging new role for Occupational Therapists in supporting setting up electronic devices and installing and using appropriate apps. Particularly encouraging is that in each of the three case studies the use of the iPod device helped people complete work tasks with more autonomy and with less supervision in the workplace – one of the factors affecting employment. Some professionals are nervous about technology because they think it will be used to replace their existing jobs, what you can see from a study like this is just how important and valuable their existing skills are if they adapt to utilise new technologies as tools to enhance their roles and make better outcomes for their clients and reduce the stress on clients’ carers.

“…This is an exciting time for anyone in the fields of education, physical rehabilitation and vocational support, where we are seeing a long-awaited merging of consumer products and assistive technologies for all…”

More details about some of the extra apps used:

App: Storykit

So here’s an example of techniques based on a paper-based system being successfully transferred to a hand-held electronic device. Storykit is an iPhone/iPod app, a project of the International Children’s Digital Library (ICDL) created by the University of Maryland’s Human-Computer Interaction Lab.

App: VoCal

VoCal Voice Reminders By GZero Ltd. “…VoCal fuses a Dictaphone, Calendar and Alarm system into one…”

Autistic Children Communicate with Horses and iPads

From Icatha College USA, a project involving Tina Caswell – Clinical Instructor, Department of Speech-Language Pathology and Audiology

With Horses and iPads, Autistic Children Learn to Communicate [Press release]

Interesting to note that they found that the light weight of an iPad device was an important factor

“…traditional assisted speech-generating devices can be cumbersome and heavy and children tend to abandon them due to lack of interest with their limited communication options. On the contrary, iPads loaded with speech-generating applications only weigh around 1 pound, cost significantly less than traditional assisted speaking devices and are more user friendly. …”

In the project they also utilise Dynavox Alternative and Augmentative Communication (AAC) devices.


Autism – research involving phones

This project was sparked by an observation by a clinician from the Autism Resource Centre. She explained that there is a real difficulty getting ASD people to remember to carry cards and/or documentation to be read and used in difficult situations. However she notices that most people will remember to carry a mobile phone with them. So are there ways of making useful information available on such devices so it will always be available in a time of need? Is there any research on this? As I document my search methods I’m always going to try starting with broad searches then refine them to be more specific.

Starting with the “Autism Data”  collection via The National Autistic Society Information Centre Library which would seem to be a good place to start for any research of specific relevance to autism. Let’s try the KISS principle – Keep It Simple Stupid. 

Simple search on ‘phone’ Yields 24 results, search seems to be on the metadata of their records. Brings up records with the phrase ‘phone call’ which is a set of records mostly relating to phone surveys of parents or using phones for charity fund-raising. Unfortunately there doesn’t appear to be a way for me to link to individual search results directly so from now I will refer to the record numbers

  • Record No: 27858
    “…As a younger child, he would pretend to talk on the phone…” This was in the context of language impairment. So even if an individual has a communication impairment the desire to communicate the way everyone else does can still be there. Is a phone an aspirational device for even young children, something they want to use?
  • Record No: 23901
    Author:De Leo G. et al
    Title:A smart-phone application and a companion website for the improvement of the communication skills of children with autism: clinical rationale, technical development and preliminary results
    Source:Journal of Medical Systems, 2011, Vol. 35(4), pp. 703-11
    This looks more promising, hmn how do I get a copy of the article “Journal of Medical Systems“??? Will document a “How to” using an Athens account
    If it has a “companion website” that sounds as if it will be easier to get hold of quickly. From a quick skim of their article they detail a system working on Windows Mobile phones and the technique seems remarkably similar to “Talking Mats” – using visual images for communication. So should bear in mind the importance of using techniques other than solely text (always a good principle for accessibility anyway) and can symbols be more effective for visual learners.


Autism Data – The National Autistic Society Information Centre Library

Autism Data is the ideal research tool for anyone researching autism and Asperger syndrome. It is, as far as we are aware, the only database of published material on all aspects of autism, open for everyone to access on the web. It lists over 30,000 published research papers, books, articles, videos and other materials.”