transport – Autism Card

Commuting Under Pressure

Navigating the sensory landscapes of work based travel

“…David (who has a diagnosis of Asperger Syndrome) retraces his journey from Southampton to Leeds (via London) in order to illustrate the use of mobile technology to assist with travel…”

David makes a very good job of illustrating the kind of sensory overload issues that can be a risk for those using public transport. Clear signage in public areas can be helpful. He makes good use of a smartphone to

Check travel schedules and see whether there are any unscheduled changes to timetables.
Play music and use over-the-ear headphones with his device to block out the sound of the underground and construction work at a train station and other loud or unwanted noise.
Navigation – uses mapping facilities and the GPS of the phone to find out where he is and which direction he’s facing.

He says he’s found using this kind of technology good for reducing the stress associated with travel and helping avert potential panic attacks.

How to…show a banner of text or speak short phrases using Android (bus journey example)

This is a worked example to try and find an example of an approach that might help with existing problems giving a destination on Glasgow buses for those with travel cards (see Pros and cons of autism alert cards and travel cards for details).

In computing we normally call text that’s to be displayed in large lettering a ‘banner’.

So I did a search on the word ‘banner’ on the Google Play App store. And though not all match our intended use there are some that would seem to do what we want. Now if you’ve never downloaded an app from an App store what you very commonly find is that apps for free may have some advertising within them that may or may not be a barrier in what you want to do, mostly but not always paid apps don’t usually have adverts and will often have a larger range of things the app can do – we call these ‘features’.
N.B. If you have photo-sensitive epilepsy be very careful if you try these banner apps out. Most of them will, as a demo, scroll text quickly, some will flash or blink.

I was specifically looking for an app that might provide a banner of large text in clear type that could be read from a distance and in low-light conditions. This could mean that your phone/tablet could be held up to e.g. the bus driver to show what destination you want. Because place names can be long and won’t always all fit on the screen the text needs to be able to animate or scroll so the entire name can be shown. To get the maximum amount of width for text it helps if you turn the device on it’s side with the longer edge at the bottom, shorter on the sides i.e. ‘landscape mode’.

The following sample can display text or can speak short phrases. N.B. There are literally thousands of apps in the app store, I’m only using this as a worked example.

Scroller – LED & Voice

This particular app is free but be aware there is a little bit of advertising. This app allows for up to 15 phrases to be stored and reused though you can change them at any time. You very simply tap on one of the rows of text and type in what text phrase you want to use. In the settings for the app you can change the size of the text, scroll speed and background and foreground text colours, I’ve chosen a blue background and white text in my demo.

Banner text

You tap on the letters ABC in the middle of the screen to indicate you want to display a banner in solid lettering.

To display a banner, tap on the letters ABC in the square to the left of the text phrase you want. Screenshot shows a part near the beginning of “Sauchiehall Street”. The text fills the entire width of the screen and then scrolls the phrase continuously until you tap the screen again.

Voice

You tap on the picture of the loudspeaker to indicate that you want to use text to speech. Then you tap on one of the rows of text and type in what you want spoken. When you are ready to have the device speak on your behalf just press the loudspeaker next to whatever phrase you want to speak.

If you were using the same destinations repeatedly then using the app would be quicker as the text would already be entered so you would only have to tap the square ABC. This app will use the voice you have selected in your accessibility settings (see How to…Scottish voices for text to speech on Android for more details)

Voice Demo

I’ve recorded sound output via the Scroller – LED & Voice using CereProc Scottish voice ‘Heather’. I’ve just tapped through a list of names:

Trongate
Dumbarton Road
Sauchiehall Street
Saint Georges Cross
Wilson Street

Download the CereProc Scottish placenames [MP3]

Pros and cons of autism alert cards and travel cards

Meeting Date: Monday 16 September 2013
Location: Glasgow office of the Adult Autism Team

The Adult Autism Team kindly arranged for me to meet a woman with extensive experience of working in peer support in autism.

Even in the short time since starting this project what has become painfully evident is the current relative lack of research/support techniques for adults on the autistic spectrum, most projects focus on children.

“Do we disappear when we hit 18?”

But we do get some incredibly useful insights via anecdotal reports.

Autism Alert Cards

Here’s an example of the Strathclyde Autism Alert Card.

Pros

They provide a certain amount of gravitas as they are ‘official’ cards only issued to those with a formal ASD diagnosis. This helps with things like applying for benefits or dealing with officialdom
Convenient size, printed on robust plastic similar to credit cards, easily carried by men or women
Although the cards were originally intended to be used in exceptional circumstances some people have found them useful in everyday life e.g. present them to shop assistants, on public transport etc., people usually find the person will then ask them if there’s anything else they can do to help.

Cons

Some have found that the stamped police logo on the front of the card is problematic – on occasion presenting it the other person mistakenly thought the autistic person was an official from the police. Because of this some people have opted to use other plainer cards but those carry no official weight
Some cardholders haven’t understood that it’s not good enough to simply have the card on them…they need to remember to try and present the card to others.
There’s space on the back for a personal contact. Some people have nobody they can think of to put in that box, they’ve thought that the card wont be useful unless that was filled in so haven’t used the card.
No space for personal details

All these kind of details are very useful to me as I look for ways of supplementing these kind of cards. If you know of more pros or cons of these existing cards please leave a reply in the comments or contact me.

Travel cards – Glasgow buses

Some people qualify for free travel due to their disability. In Glasgow there’s one issue on buses where the recent introduction of technology is currently having a negative effect on some autistic people.
Free bus travel for people aged 60+ or those with a disability

In the past what would happen is you would just hold the card up to the driver and board the vehicle. Now that there’s electronic versions of these cards the user has to

Physically place their card on top of a card reader device
Say to the driver their destination stop
Board the vehicle

Some autistic people find bus travel difficult in general,

finding the right stop
waiting
getting into queues and especially in Glasgow the expected social chit chat
getting on the right number of bus

So for people with these kind of difficulties they can already be pretty stressed even before they step onto the bus. It’s “say to the driver their destination stop” that is causing a problem. For those with difficulty with verbal communication they may be unable or too stressed and unwilling to speak which means they run into problems simply trying to board a bus successfully. Some have stopped even trying to travel this way which leads to mobility problems reaching appointments elsewhere.

What would be useful is a way for a person to present the destination to the driver without needing to speak, possible approaches may be

Showing text with the name of the desired destination
Using text-to-speech technology to verbalise the destination on behalf of the person.

With synthetic speech it’s important that the ‘voice’ shouldn’t lead to the person being ridiculed in public.

Gender is also important, most people would probably prefer that their synthetic voice was male or female as appropriate.

Ideally it would be good if any synthetic voice had a Scottish or local accent, some people who have already tried assistive devices refuse to use devices with American or English (e.g. London RP) accents as they don’t like the sound of the voice.

In some cases people may be able to prerecord audio of themselves or others pronouncing destinations so look for tools that can support this.

Post updated 19th September 2013, see the following How tos for examples of apps that might help with this.

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…”