Using ipads to Teach Communication Skills of Students with Autism. Many students with autism spectrum disorders (ASD) present little or no functional

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1 Using ipads to Teach Communication Skills of Students with Autism Many students with autism spectrum disorders (ASD) present little or no functional speech (National Research Council, 2001). They rely on behaviors such as pointing, reaching, eye gazing, and various facial expressions to present their needs. Sometimes, these students present inappropriate behaviors such as aggression, tantrums, and self-injury to express themselves and indicate their wants (Durand, 2001; Frea, Arnold, & Wittinberga, 2001; Reichle & Drager, 2010; Sigafoos, Drasgow, & Halle, 2004). In order to help these students learn communicative skills and reduce their inappropriate behaviors for communication purposes, Augmentative and Alternative Communication (AAC) approaches are recommended for their language and communication development (Bondy & Frost, 2002). The most significant advance in AAC for students with ASD is the emergence of communication designed to help those who are cognitively incapable to express themselves (Mirenda, 2001; Schlosser & Blischak, 2001). AAC devices offer these students a symbol and image, or set of symbols and images, which they can use to express appropriately their needs, wants, and ideas after being taught (Shane & Albert, 2008). When selecting AAC to support communication efforts of students with ASD, their learning characteristics should be considered (Mirenda, 2001). These characteristics include strong visual perception, unusual interest in inanimate objects, having difficulty in processing complex cues and making changes, poor motor planning and small muscle movements, learning anxiety, and behavioral problems (Mirenda, 2001). It was found that there appears to be a strong correspondence between the learning characteristics of students with ASD and the features of AAC, which may make AAC a good fit when trying to meet their communication needs (Cafiero, 2008). For example, AAC relies on visual presentations such as symbols, pictures, photos, and written words to communicate

2 thoughts and ideas. These visual presentations are inanimate, predictable, and more static than speech (Mineo, Peischl, & Pennington, 2008). These features typically motivate students with ASD who often dislike changes and prefer consistency. Because these students often insist on sameness, they may prefer the static and predictable grouping of symbols on a communication board. New concepts and associated vocabulary can be added to the board within the familiar framework of the existing symbols, which makes the learning process consistent and stable with minimal disruptions to a familiar routine. In addition, this creates reduced learning anxiety by creating a gradual introduction of new language as well as an easier way to accurately communicate a student s needs by simply touching or pointing to a symbol or image (Mineo, et al., 2008). Thus, visual language on AAC devices is easier for non-verbal students to understand than speech and manual signs, thus maximizing the comparatively strong visual processing skills of those with ASD (Shane, Laubscher, Schlosser, Flynn, Sorce & Abramson, 2012). Motor planning refers to a student s ability to coordinate and sequence movements to accomplish a particular task, such as the oral-motor movements necessary for speech (Bondy & Frost, 2002). Students with ASD often have challenges with motor planning that make them difficult to generate speech (Bondy & Frost, 2002). Using an AAC device requires a simpler motor act, such as pointing to a symbol on a communication board or touching a button on a device. The touch screen of a computer seems helpful for them, because using a simple action of touching to express their needs requires less complex motor planning than natural speech (Caferio, 2008). Understanding and following the complex cues involved in speech are difficult for students with ASD (Mirenda, 2003). To assist these students, AAC devices can be programmed with simple cues using one symbol, increasing cues with many symbols as the students gradually

3 learn to understand and express themselves with more complex words. An option of AAC is a speech-generating device (SGD). A SGD provides speech that is generated by touching/pressing an icon, which may be a symbol or image on a communication device, resulting in the audible expression of the icon selected. It was found that children who were taught to use individual SGDs with line drawing symbols to represent messages such as I want a snack, please, more, and I need help. with a naturalistic teaching procedure such as child-preferred stimuli, natural cues (e.g. expectant delays and questioning looks to elicit communication), and non-intrusive prompting techniques increased their interactions with classroom staff (Schepis, Reid, Behrmann, & Sutton 1998; Shane, et.al, 2012). Similar findings were indicated in Mirenda, Wilk, and Carson s study (2000) to provide SGDs for students with ASD presenting limited speech. Their SGDs included dedicated speech output devices (e.g. IntroTalkers) and laptop computers with communication software packages (e.g., Macintosh computers with Speaking Dynamically software). Results showed that all participants benefitted from the use of SGDs as communication tools to support their social interactions with teachers and peers (Mirenda, et, al. 2000). Therefore, students with ASD presenting little or no speech are the candidates for AAC approaches to replace or supplement natural speech (Shane, et.al, 2012). Current new technology such as the Apple ipad, using specialized AAC applications (apps), provides additional opportunities for students with ASD to meet their communication needs (Shane, et. al., 2012). For example, some apps (e.g. Proloquo2go, MyTalk, SonoFlex) designed for these devices can serve as a full high-tech AAC system (Shane et al., 2012). The adoption of the new portable hardware and software provides a significant paradigm shift in AAC that is readily available to consumers in a small sized device, easy to transport, and at a relatively low cost (Shane, et. al., 2012). In addition, it avoids some of the barriers that

4 historically have interfered with successful implementation of AAC in schools, such as the lack of technology skills in teachers, and abandonment of technology tools by students (Marino, Sameshima, & Beecher, 2009). Traditional AAC devices often have been intimidating to teachers, leading to their reluctance to apply in the classroom. Technology training is time consuming and many school districts lack funding to provide adequate training or technical support to teachers to become skilled users (Marino et al., 2009). Comparatively, the new mobile devices are easy to use and many teachers are already familiar and comfortable with these devices outside of school. This technology experience in their own lives may motivate teachers to use these mobile devices in their classrooms. Integrating technology is known to contribute to the educational success of students with and without disabilities (Martin, Forsbach-Rothman, & Crawford, 2004). The mobile devices, such as ipads are being used in general education classrooms to engage students in learning that enhances higher-level thinking skills and problem solving (Pilgrim, Bledsoe, & Reily, 2012). They are also resources to support special education services for teachers and students to access content and skill specific applications (Blood, Johnson, Ridenour, Simmons, & Crouch, 2011). For example, teachers can control settings to specific skills or ability levels and monitor student progress. Engaging apps make drills and practice more interesting for students, and the immediate and consistent feedback is beneficial for their learning (Pilgrim, et.al, 2012). According to Price (2011), the ipad and communication apps are superior to traditional AAC in the areas of durability, cost, and appearance. Students with ASD and cognitive disabilities who lack functional speech are able to communicate through the use of ipad- based AAC devices (O Reilly, Lancioni, Lang, & Rispoli, 2011).

5 To date, there are many communication applications available for the ipad and similar mobile devices, allowing them to function as an AAC device. Research on the ipad / ipod as an AAC has studied only the application of Proloquo2Go, except one study that used Pick a Word (Van der Meer, et al., 2011), though there are many anecdotal reports about students with ASD learning to communicate using these software apps (Sennott & Bowker, 2009). More empirical studies on students with ASD being taught to use an ipad as a SGD are needed to evaluate the technology and software, and to find another avenue for meeting the communication needs of students who have limited speech and language. This opportunity would also enable teachers and speech-language pathologists to make evidence-based decisions when choosing an appropriate AAC device and software application for their students, as well as make an argument for funding to purchase the technology. Functional spontaneous communication during daily tasks should be the measure of a successful AAC intervention (Shane, et.al, 2012). To that end, additional studies on expressive language skill acquisition using an ipad and its applications are needed to verify previous findings and add information to the learning outcomes of students with ASD, as an effective communication aid. Our study attempted to expand previous research on mobile technology by using an ipad with an AAC application for communication purposes in natural school settings. Instead of Proloquo2Go, another program with much less cost, called SonoFlex that the speech pathologist recommended for teaching communication skills was used. The purpose of our study is to determine the effect of ipads as AAC devices on spontaneous functional communication responses in school settings, such as classroom and recess. Specifically, the research questions are presented as follows. 1). Will the students with ASD increase their expressive communication, e.g. initiating requests, responding to questions, and making social comments when using an ipad? 2). With a least-to-most prompting hierarchy, will

6 these students increase spontaneous (e.g. unprompted) communication with their teacher and peers when an ipad is applied? Methods Participants Three 10-year-old students, one female and two males, diagnosed with ASD and a moderate cognitive disability, attending a public school, participated in this study. All students were diagnosed with limited speech and language abilities at age of 4. Further, the Vineland Adaptive Behavior Scales (2nd Edition, 2005) and Wechsler Intelligence Scale for Children (4th Edition, 2003) were administered by the school psychologist for all three participants before the study. Table 1 presents the general information of participating students. Student 1, Eric, attempted to communicate by leading an adult towards what he wanted. Through the teacher s observations, it was found that he did not speak any words, but yelled and bit the palm of his hand when tasks or assignments were presented. Student 2, Christian, was usually very quiet and compliant. Based on teacher observations, it was hypothesized that he engaged in hand flapping with a single loud scream because of his uncertainty of expectations or stress to communicate. He seemed to try to speak occasionally by opening his mouth with intention, but no words were uttered. Student 3, Samantha, scripted a few spoken words in a frantic sounding fashion (e.g., swing, good girl, break please, No, thank-you ) when she was asked to do something, but rarely spoke unless prompted to do so by an adult. She was able to repeat a word that was modeled for her in response to a question. Verbal prompts were provided to her constantly, but her words uttered were always isolated and hard to understand. Each of the students had an individual education plan (IEP) in which the goals of learning to use

7 a SGD to communicate basic needs/wants, responding to questions and making appropriate social comments were addressed. All students were placed in a special education classroom with a teacher and two teacher assistants (TA). Teacher A special education teacher implemented the lessons. She has been teaching students with disabilities for years. At the time of the study, she was enrolled in graduate level studies designed to fulfill the requirement of a thesis for an advanced degree in the area of special education. Instructional Materials Each student was provided with an Apple ipad, housed in a protective cover with carrying handles and a screen shield. Applications (apps) were downloaded onto the ipad that the students could use for their leisure such as story books, coloring pages, music and games, as well as educational apps and behavior support apps, such as a timer, a calm-down counter, and first-then charts. Sonoflex, a SGD app was downloaded onto each student s ipad. The Sonoflex icon was placed in the lower right-hand corner of the ipad opening screen page for consistent ease of access. By tapping on the icon, the Sonoflex screen page opens and displays category buttons, called contexts, that when touched, open to vocabulary screens that are programmed with appropriate Symbolstix picture icons, or photographs taken with the ipad (see Appendix A for an example). When the student selects an icon by touching a button on the screen, computer generated speech for that icon is produced using a gender/age appropriate (woman, girl, man or boy) voice. A single word or a complete sentence may be programmed on each button. For example, when the numeral 4 is touched, the ipad speaks: four, when the icon with snacks is

8 touched, the sentence: I want a snack, please. is spoken. On the home page of the Sonoflex app, the following context buttons were created by the teacher: Morning Meeting, Math, Reading, Social Studies, I want and Being Friendly (see Appendix B for an example of vocabulary words presented on the context screen). Measurement Material An observation checklist was developed by the teacher to record the types of communication and prompting levels required to make a response using an ipad. Each type of communication was tallied as a request, response, or social comment, and a prompt score was assigned to indicate the level of support required to assist the student in using the ipad to communicate with an individual (see Table 2 for the examples of each type of communication, and Table 3 for prompt scores). At the end of the study, the teacher and TAs were interviewed to respond to three openend questions to ensure that the study was socially valid for their students. Procedures Two weeks prior to this study, the students were presented with their ipads and taught to turn on, access and use some simple leisure-time applications such as story books, music, relaxing sounds/patterns and coloring. The instruction consisted of faded physical prompting and natural reinforcement (e.g., the student using the application). Prompts were provided using a least to most prompting hierarchy (see Table 3) paired with a 5-second pause after each type of communication presented. If a student did not respond within the 5-second pause, a higher level prompt was given with another 5-second pause. This pattern continued until a successful communication exchange was achieved. The prompting score was determined by the final level

9 of prompt required to elicit an appropriate communication from the student. All non-physically prompted student communications were immediately recognized for their communication attempt and rewarded with social praise. If it was a request, access to the requested item was granted. A correct response to a question received additional praise. If the answer was incorrect, the question was restated or rephrased, the correct answer indicated on their ipad, and the student was given another opportunity to respond by touching the correct button. A prompting cue of sufficient strength was given to secure a correct response, and a verbal praise, Good answering! was provided. For an appropriate social comment made by the student, a natural, positive social response was enthusiastically given. For scoring purposes, if the same cue was immediately presented again as an additional practice opportunity, only the initial communication attempt was tallied and scored. The instructional method of fading prompt support to achieve independence required the data to reflect (1) attempts at communication and (2) progress of independent communication (e.g., decreased prompt support). Therefore, the median scores were calculated to present appropriate ordinal data such as prompting levels from 0 to 5 (see Table 3) for each type of communication (i.e., request, response, or social comment) recorded. Research Design A single subject, multiple-baseline design with AB phases across settings was used. During the baseline, data were collected during two, ten-minute sessions two days per week for two weeks. The sessions included one academic lesson (Language Arts) and one recess-time, such as after lunch, to provide opportunities for social comments and requests. During this phase, a session began when an academic lesson started or when the participant was dismissed

10 for a break. The students were verbally instructed, Get your ipad and turn on SonoFlex. After accessing the SonoFlex app, they were instructed to select the specific context button. The ipad was positioned lying flat on the right side of their desk (all students were right-handed). No additional support or suggestion to use the ipad was given. If it was an academic session, the teacher presented the scheduled lesson for that day, and data were collected by recording each of the teacher s questions as a response and all student responses were recorded without providing any prompt support. A minimum of 5 questions were presented. If the student responded, initiated a request or made a social comment using the ipad, it was scored 5, as an independent communication. If the ipad was not used to respond, 0 was scored. If it was recess time, the ipad was placed in the area (usually within 5 feet) where they were taking their break. If they left the area, no reminders of taking the ipad were given. Any responses, requests or social comments using the ipad were scored. During the intervention, data collection was continued in the same sessions two days per week for six weeks. Instruction was provided using the least-to-most prompting hierarchy after a 5-second pause. For example, during a Language Arts lesson, the teacher asked, Samantha, which word starts the same as car? The teacher waited for her response, by expectantly looking at her for 5-seconds. If no response was given, the TA verbally directed Samantha, Answer with your ipad. Again, a 5-second pause was provided. If there was still no response, the question was asked again, with the same tone of voice. If no response was given within 5- seconds, the TA pointed to the correct ipad button, providing a gesture prompt. If, after a 5- second pause there was no response, the question was re-asked. The TA then provided a model prompt by touching the correct button and then gave the student the opportunity to select the button by herself within 5 seconds. If no response occurred, the question was asked again (still

11 using the same tone as the first time) and the TA immediately guided the student physically to touch the correct button on the ipad. This was followed by an opportunity to touch the button if the student wanted to, by saying, Good touching the button to answer; now you try. If the student chose to touch the button on his/her own, social praise was given; if not, the lesson continued without further comment on the question or response. The process was repeated for each type of communication. During a recess session, the student was prompted to request the item using the ipad when observed to have a particular need, such as staring at a desired toy (request); a social opportunity was provided by starting a game and then saying, Whose turn is it? (response) or, after doing a puzzle together, prompting the social comment, That was fun. (comment) Reliability For all sessions, the participants and teacher were present, and two TAs in the classroom were trained by the researcher to use the checklist to observe students and record scores. The TAs used the checklist in class prior to the study to ensure that they were familiar with the instrument, followed by further practice in the baseline observations. The recording scores were checked by two observers for accuracy each week together with the teacher if a discrepancy occurred. Subsequently, the teacher met the TAs to review and double check the scores to reach at least 90% of agreement. Data Analysis A visual analysis of the observation data compared baselines to interventions for each participant in both class and recess settings, as well as the total number of responses and means. In addition, the percentage of non-overlapping data (PND) procedure described by Scruggs,

12 Mastropieri, and Casto (1987) was used. This type of analysis is commonly applied in singlesubject research design and has been proven to detect intervention effects (Campbell, 2004). The guideline recommended by Asaro-Saddler and Saddler (2010) was adopted. This guideline generated a PND score of 90%, indicating the intervention points exceeding the extreme baseline value for a very effective treatment; 70% to 90%, an effective treatment; 50% to 69%, indicating some effect, and less than 50%, a questionable treatment (see Table 4). Results Table 4 presents the total number of occurrences in each type of communication, and the means and standard deviations across phases. Figure 1 presents individual student s scores of requests in academic and social settings across the baseline and intervention. Results show that Eric made 13 requests, of those 9 were in the academic and 4 in the social sessions with a mean of 1.67 and.50 respectively. Christian made 12 requests (6 in the academic and 6 in the social sessions with a mean of 1.42 and 1.25); Samantha made 12 requests (6 in the academic and 6 in the social sessions with a mean of 1.79 and 1.72) during the intervention, while no one made any requests during the baseline. Although all students increased their requests using the ipad, Eric only made 4 requests out of 12 sessions in recess, generated a PND score of 34%, indicating a questionable treatment. Both Christian and Samantha made 6 requests in both academic and social settings, generated a PND score of 50%, indicating some effect of the intervention. Figure 2 presents individual student s scores of responses across phases. Eric responded to 77 questions (50 in class and 27 in recess with a mean of 2.22 and 2.01 respectively); Christian responded to 81 questions (60 in class and 21 in recess with a mean of 3.7 and 3.59); and Samantha responded to 76 questions (61 in class and 15 in recess with a mean of 3.38 and

13 3.5) during the intervention, while none of them responded during the baseline. All students increased their responses to questions both in class and recess, especially in class, presenting PND scores of % to indicate a very effective treatment (see Table 4). Figure 3 presents each participating student s scores of social comments across phases. Eric made 56 comments (10 in class and 46 in recess with a mean of 1.71 and 2.37 respectively); Christian made 68 social comments (10 in class and 58 in recess with a mean of 2.83 and 3.14); and Samantha made 69 social comments (9 in class and 60 in recess with a mean of 2.67 and 3.32) during the intervention, while no comments of any students were found during the baseline. All students made comments in both academic and social settings, especially during recess, presenting PND scores of %, indicating an effective treatment (see Table 4). Social Validity At the end of the study, the teacher and TAs were interviewed with open-ended questions. These questions asked their opinions about their students overall response to the use of an ipad in school, helpfulness of the ipad as a SGD to the students or teachers, and typically developing peers responding to their students with ASD using an ipad. When asked about their opinions about their students overall response to using the ipad in school, all teacher and TAs observed that the students willingly took their ipad with them and chose to use the ipad during breaks, frequently exploring the SonoFlex app on their own. In response to the question about the helpfulness of an ipad to their students and instruction, they indicated that it was very convenient to have multiple tools at their disposal, especially a visual timer app, and apps specifically selected for each student that he/she could use and enjoy during breaks. The ipad camera allowed quick access for the recording of events, people and objects for

14 future references. When asked about an opportunity for their students to use an ipad to interact with peers without disabilities, all teacher and TAs observed positive reactions of their peers on the students carrying or using their ipad. The teacher stated that it was good to see other students pointing at the ipad and remarking on how lucky it was that these students had their own ipad. Discussion This study attempted to collect data in both academic and social settings in school to measure the expressive communication of students with ASD who were using an ipad, with the SonoFlex app and the level of prompting necessary to increase their requests, responses to questions, and social comments. Students with ASD were taught to use the ipad with the communication application. They were learning to initiate requests, respond to questions, and make social comments in both academic and social settings with a decreasing level of prompts. During the baseline, none of the three participants were able to express themselves, and no attempts were made to use the ipad for communication, despite the available access. Same observations were found during the recess time, no students used the ipad to communicate with the adults and peers. They played as usual, making no attempt for requesting a specific game or toy, or make comments, such as, It s your turn., I won! or I am finished. They did not use it to request a drink or snack either. During the intervention, all three participants were receptive to instruction in both academic and social settings. Results showed an increase of their initial requests indicating their needs by touching the icon on the ipad screen with reduced prompts. However, initiating (expressive language) is comparatively harder than responding to questions for students with ASD (Tiegerman, 1993). Comparing to the number of responses to questions and making social

15 comments, the number of initial requests is low, though some requests were presented in both settings using the ipad. Requests (or mands) are of direct benefit to the speaker, and the motivation to request could be high if the speaker gains access to the requested object or activity preferred (Kagohara, et. al, 2012). Thus, using highly preferred objects and activities (childpreferred stimuli) to increase students requests should be considered during instruction. In addition, continuous instruction with prompts is needed to encourage students to express themselves and initiate their needs which are functional in school. Intensive and frequent interactions (Nind, 1999) between teachers and students in both class and social settings should be provided to affect and improve their initiation for communication. Responding to questions is a vital communication skill in the classroom. It allows teachers to assess student comprehension as well as better understand individual needs. During the intervention, all students were engaged in the academic lessons as they scanned the vocabulary words available and touched the screen to respond to the teacher s questions. Results show that two of the participants (Christian and Samantha) reached the level of independence without prompting (highest score of 5), and the other (Eric) gained scores. These scores not only present the improvement of their communication, but also provide important feedback for the teacher to check for each student s understanding, so that the instruction can be adjusted accordingly to meet all students needs. It seems that the use of an ipad strongly supports nonverbal students with ASD to participate in class activities and interact with teachers. Encouraging social comments from the students promoted their awareness of others in the environment. All three students showed improved skills to make appropriate social comments. For example, Christian and Samantha made increasingly independent comments (highest score of 5) on some occasion but continuing to require either a verbal or gesture prompt.

16 The results show that these two students reached the highest score of 5 with independence without prompting sometimes, and the other student (Eric) gained scores. All participants made more comments during recess than they did in class. It seems that more opportunities are available for students to make comments on the activities (e.g. games) during recess than the structured class session. As indicated by Tiegerman (1993), social situations are very important for autistic students with communication deficits. Thus, the social opportunity should be offered frequently for students with ASD to participate in social activities so that they can continue to learn communication skills and to increase their social interactions with peers and teachers. Further, increasing communication opportunities in social settings will make these students socially recognizable as school members, which will promote their future inclusion in general education classrooms with typically developing students. In accordance with the findings reported in the previous research (e.g. Kagohara et al. 2012), our study has expanded to an application of the SonoFlex as AAC to support non-verbal students with ASD. The ipad serves as a viable technological aid. Using the SonoFlex application as the communication program not only increased their responses to teacher s questions in class, but also promoted skill learning to other settings such as recess. Our results showed that ipads provided students with ASD an opportunity to communicate with their teachers in class and interact with peers in recess time. This opportunity would encourage these students to join with typically developing students without disabilities in social sessions, such as lunch and recess. Using an ipad is potential for these students to initiate, respond to, and make comments, which will lead them to communicate with their peers in school. As indicated in the teacher and TA s interview, typically developing students made positive reactions to those with ASD for their ipad use. This may create an opportunity for these students to interact with their

17 peers without disabilities, as the ipad may serve as a communication medium. Making friends with typically developing peers often is difficult for students with disabilities, especially for those with limited speech and language skills (Mazurek & Kanne, 2010). Individuals with ASD have significantly less frequent contact with friends, fewer friendships, and lower frequency of meeting when compared to typically developing peers (Bauminger & Kasari, 2000). Using mobile devices such as an ipad will allow these students to carry to social settings to interact with other peers with this SGD as a communication tool. This will definitely create an avenue for students with disabilities to communicate with others, learning skills to make friends and build friendship. Despite positive results of the study, there are some limitations. First, only three participating students and a short time period of six weeks instruction may be difficult to generalize the findings to other settings and students. The lack of independent initiation (request) presented by the data may leave the question of whether the use of an ipad and associated software (app) is part of a meaningful functional communication system for students with autism. According to Kagohara, et.al, (2012), systematic instruction consisting of time delay, least-to-most prompting, and reinforcement with a SGD is strongly recommended for students with ASD to learn functional communication skills. Thus, continued intervention with intensive and frequent interactions (Nind, 1999) between teachers and students is needed to determine the potential of using the ipad for functional communication, in order for students to achieve more independent levels. We believe that with continued instruction and reduced prompts, the use of an ipad as a SGD will be meaningful and effective. Second, students requests, responses and comments were only recorded in two settings, class and recess, though they were in natural school environments. It would be stronger if another setting was included

18 where the students could further learn the communication skills with their ipad as well as their skill generalization in other settings to validate the finding. In addition, the SonoFlex app has some limited features, such as a fixed icon size and all related vocabulary visible on the same screen. Some students would be more successful with larger and fewer icons on a screen, which can link to more specific vocabulary as the student develops proficiency in the use of AAC. Selecting the most appropriate AAC app for each student based on individual needs should be considered. For example, in the study, one student might make better progress if a program with larger and fewer icons presented on the ipad screen. Implications Communication skills are important for individuals, especially for those with ASD who have little and no functional speech. They are the candidates for AAC approaches to replace or supplement natural speech. AAC provides these students an opportunity to express themselves, present their needs and wants, and interact with their teachers, peers, friends and family members. Currently, there are many AAC devices on the market for families and schools to select, however, most of them are expensive. An ipad with apps may provide an alternative opportunity for these students. To date, many families may already have an ipad in their homes and are already comfortable and familiar with its use. Using a relatively inexpensive communication ipad app that can be easily downloaded for students to access may lead to improved communication between students and their parents at home, as well as interaction with their peers without disabilities in school. Recommendations and Conclusions

19 Using an ipad as a SGD may become a key to open the door of spontaneous, functional communication for students with ASD. It is the responsibility for caregivers to provide these students with appropriate communication instruction and the opportunities to enter the world of language with a useful tool, such as ipads. Our study showed an avenue in teaching those students communication skills using an ipad in school. Further studies are needed to continue to validate the use of an ipad as a communication device for a longer period of time with a larger group of participants to allow the results to more accurately reflect the potential of such an AAC. It is our suggestion to involve parents in the technology application that would benefit both family members and students to interact each other and to generalize the communication skills at home. We believe that the ipad for communication purposes for students with ASD will increase as its popularity in our daily lives. It is potential for meaningful application of an ipads as a communication tool in school to increase the opportunity for students with ASD to communicate with teachers and peers.

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