Developing an ipad app for young children with autism

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1 Developing an ipad app for young children with autism a case study of stakeholder informed design, business partnership, rigorous evaluation and commercial dissemination Sue Fletcher-Watson Digital Bubbles, Bath July 2015

2 Conflict of Interest ipad apps available on the app store Licensing includes royalty payment for paid downloads

3 Outline The role of chance Foundations in psychological theory User-informed design, expert consultation Rigorous evaluation Commercial partnership & broad dissemination Conclusions

4 The role of chance

Goals Create a functioning technology-based top-up intervention for very young children with autism Have an impact on real-world socio-communicative skills

5 Goals Create a functioning technology-based top-up intervention for very young children with autism Have an impact on real-world socio-communicative skills Provide value for money in intervention delivery; assess feasibility Enhance well being for the whole family Make the intervention immediately and widely available

6 Foundation in theory Development of social attention Attention to people Following gaze and pointing Foundation of social and communication skills

7 App design: level 1 [VIDEO OF CHILD WITH AUTISM ILLUSTRATING LACK OF ATTENTION TO PEOPLE]

8 App design: level 1

9 Interdisciplinary working: Level 2

11 User designs

Design and Pilot Process Classroom-based user design Pilot tests: playgroups, nurseries, homes Best motivation techniques Accessible to non-verbal / very young children Familiarity / repetition

12 Design and Pilot Process Classroom-based user design Pilot tests: playgroups, nurseries, homes Best motivation techniques Accessible to non-verbal / very young children Familiarity / repetition Advisors: teachers, parents, therapists, adults on the spectrum Use-ability, family-friendly, trial design Expert input Interface, structure, data recording Student contributions Fletcher-Watson, Hammond, Humphry, Pain & McConachie, in sub, IJCCI

13 Resulting changes

14 Resulting changes Minutes played Touches to background

15 Outline The role of chance Foundations in psychological theory User-informed design, expert consultation Rigorous evaluation Commercial partnership & broad dissemination Conclusions

background including gaming experience & TAU Communication & Symbolic Behaviour Scales Random assignment

16 The Trial: design Baseline Autism Diagnostic Observation Schedule (module 1 or 2) Parent-child play scored with Macarthur Communicative Development Inventory (vocab) Mullen visual reception and fine motor Family background including gaming experience & TAU Communication & Symbolic Behaviour Scales Random assignment (opaque envelope procedure) 2 months: CSBS, MCDI, app evaluation, in-app data 6 months: repeat baseline (without Mullen)

17 Results

18 Conclusions?

19 Individual differences

20 Results: function & cost Face validity appraised by professionals Average play of 6 minutes per day 75% of children completed the app, of which all but one went on to play the whole game again No link between game play and baseline ability levels Minimal faults Competitive pricing when compared with therapist hourly rate 30 over 12 months assuming half rate of play

21 Results: family well being I was very skeptical whether she understands what she's supposed to do but after she figured it out she played the game for the whole hour. She even didn't want to give it back to me :) I'm sure she will have a lot of good time with the ipad. I was very proud of her that she knows what to do. He learnt to say Lewis ipad and played every day He is saying Can you help me? now, instead of just screaming

22 Results: Engagement [VIDEO OF CHILD WITH AUTISM ILLUSTRATING CONTRAST BETWEEN INTERACTIVE STYLE DURING PLAY WITH STANDARD TOYS AND INTERACTIVE STYLE DURING PLAY WITH IPAD]

23 Commercial partnership Set up by Edinburgh Research & Innovation University spin-out company led by former PhD student Licensed based on game description Marketing plan Press release Promo video Lots of discussions about IP

Record your own voice Menus and parent info Further

24 Commercial impact on the app Free versus paid version New content we couldn t afford ourselves Record your own voice Menus and parent info Further apps and an Android version 100,000 downloads in first two years

25 Goals Create a functioning technology-based top-up intervention for very young children with autism Have an impact on real-world socio-communicative skills Provide value for money in intervention delivery; assess feasibility Enhance well being for the whole family Make the intervention immediately and widely available

26 So the app was influenced by Luck Psychological theory User-centred design & expert advice Beta-testing Freebies Commercial considerations But not by the RCT (in fact we released the free app commercially before the RCT was finished)

Rigorous evaluation Getting involved in an emergent research field Data collection

27 What we did well Interdisciplinary working Psychology, paediatrics, SLT, OT, HCI, computer science, animation, art & design Student learning and contributions Rigorous evaluation Getting involved in an emergent research field Data collection within the app (sort of, possibly) A fun game and a positive experience for participants

28 What we did less well Hitting the intervention target Setting the intervention target? Participatory design Engaging end users effectively Understanding learning principles Personalisation Outcome measurement Mechanisms of change Sharing data and code

29 Alex Petrou, Helen McConachie, Anne O Hare, Helen Pain, Sean Hammond, Sue Davidson, Pamela Dicks, Cat Graham, Aly Humphry, LaerLab, recruiters, advisors, families.

30 Discussion questions How do autistic children learn (from technology)? Do high levels of use = good quality use? How can we design for autistic learning preferences? What outcome measures are suited to technology evaluations and meaningful to autistic people? What level of evidence is appropriate? To RCT or not to RCT Autistic involvement in trial design What are the positive and negative impacts of commercial partnerships?

Autism & Technology. Research on the use of technology for children and adolescents with autism. Sue Fletcher-Watson. Tønsbergkonferansen, June 2018

Autism & Technology. Research on the use of technology for children and adolescents with autism. Sue Fletcher-Watson. Tønsbergkonferansen, June 2018 Autism & Technology Research on the use of technology for children and adolescents with autism Sue Fletcher-Watson Tønsbergkonferansen, June 2018 Outline What s autism? What s technology? The state of