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A Review of Evidence for Teaching Young Children to Use Assistive Technology

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A Review of Evidence for Teaching Young Children to. Use ... Evidence-Based Practices Literature Review. Data Sources. AT Use and Prevalence. EI Part C ... – PowerPoint PPT presentation

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Title: A Review of Evidence for Teaching Young Children to Use Assistive Technology


1
A Review of Evidence for Teaching Young Children
to Use Assistive Technology
  • Suzanne A. Milbourne
  • Philippa H. Campbell
  • Lauren M. Dugan
  • NTAC Conference April 27, 2006

This work was completed through the
Tots n Tech Research Institute which is supported
by U.S. Department of Education,
Office of Special Education Grant
H327X010003
2
Tots N Tech Research Institute
  • Is funded by the U.S. Department of Education,
    Office of Special Education Programs.
  • Was established in 2001 as a collaborative effort
    of Arizona State University and Thomas Jefferson
    University.
  • The mission of TnT is to study prevalence, policy
    and resources, individualized decision making,
    training and support and funding related to use
    of assistive technology (AT) devices and services
    in early intervention, Part C.

3

Institute Research Areas
  • AT Use by Infants Toddlers
  • Policy Resources
  • Decision Making
  • Training Support
  • Funding
  • Best Practices
    Implementation

4
Data Sources
  • People
  • Part C Coordinators
  • Tech Act Directors
  • National Parents
  • National EI Practitioners
  • Lending Library Directors
  • Communities of Teams
  • Documents
  • State Document Analysis
  • Evidence-Based Practices Literature Review

5
AT Use and Prevalence
  • EI Part C

6
AT Use and Prevalence
  • 4 of infants/toddlers nationally have AT listed
    on their IFSPs (DOE Report to Congress, 2003)
    this number shown little change over the years.
  • Approximately 4 of infants toddlers in the
    NEILS sample were reported to be receiving AT
    services
  • 18.1 of providers sampled believed that all
    children on their caseloads who needed AT were
    receiving it 44 reported that few or none of
    the children who needed AT were receiving it.

7

AT Use and Prevalence
  • Part C Coordinators
  • Limited availability of devices (communication
    devices switch interfaces) viewed as AT device
    by gt90
  • Off-the-shelf (readily available) such as
    computers, battery toys, not viewed as AT device
    by lt60
  • Providers
  • Limited availability
    devices viewed as
    high-tech
  • Off-the-shelf not mentioned
    within categories of

    high- and low-tech

8
Whats Influencing Use Prevalence?
  • Resources for Decision- Making
  • Beliefs
  • Evidence

9
Percent of States Reporting AT Policies and
Guidelines n 36 states
10
Belief Statements (Myths)
(Agree or Disagree?)
  • Young Children need to have certain skills, like
    using their hands or being able to recognize
    symbols, before they can use AT (Required Skill)
  • AT requires extra effort of a child and it is
    much easier to just do things for the child
    (Extra Effort)
  • Using AT means giving up on doing things the
    natural way and may prevent the child from
    learning certain things (Giving up on natural
    way)
  • AT costs a lot of money and it is a good idea to
    wait until the child is older to decide what will
    work (Cost)

11
Parent and Providers disagree
  • Required Skill Myth
  • Providers 75.7
  • Parents 47
  • Extra Effort Myth
  • Providers 94.7
  • Parents 76
  • Giving up on natural way Myth
  • Providers 97.3
  • Parents 80.4
  • Cost Myth
  • Providers 94
  • Parents 81.8

12
Belief Findings
  • A majority of parents and providers disagreed
    with the three belief statements
  • use of AT requiring extra effort,
  • giving up on the natural way, and
  • expensive.
  • More than half of parents agreed that children
    need certain skills before they can begin to use
    AT but professionals reported disagreement.

13
What Would You Do?
Case 1 What would you do if a child can hold,
but not manipulate, toys? Case 2 What would
you do if a child is not talking and struggling
to vocalize? Case 3 What would you do if a
child cannot eat or drink without assistance?
lt12 months 12 - 24 months gt24 months
Skill development Use low tech Use high tech No
concern
Skill development Use low tech Use high tech No
concern
Skill development Use low tech Use high tech No
concern
14
Provider Decision-Making Case Examples
Case 1 What would you do if a child can hold,
but not manipulate, toys?
15
Provider Decision-Making Case Examples
  • Case 2 What would you do if a child is not
    talking and struggling to vocalize?

16
Provider Decision-Making Case Examples
  • Case 3 What would you do if a child cannot eat
    or drink without assistance?

17
What does the evidence say about teaching young
children to use AT
  • EI Part C

18
Purpose/Rational
  • When devices are selected, strategies or
    interventions are needed to teach infant-toddlers
    and their families to use the device effectively
    and efficiently within the context of routines
    and activities.
  • Published articles were reviewed to identify
    successful strategies for teaching children to
    use AT in their everyday lives.

19
Methods 1
  • Computer and hand searches of journals, published
    between 1980 and 2004, were conducted to identify
    potential articles to be included in this review
  • The searches yielded 115 potential articles

20
Methods 2
  • A total of 88 articles were eliminated
  • Articles regarding persons age 6 and above
  • Articles that reported assistive technology needs
    of children birth through age 5
  • Articles about assistive technology resources
    position papers
  • Articles about technology as related to typically
    developing children
  • Articles that related to assistive technology
    best practice/intervention with children birth
    through age 5 but did not yield empirical evidence

21
Included
  • 27 Articles Included - Critical Literature which
  • addressed AT best practice and intervention,
  • with children birth to three and
  • yielded evidence through an "empirical" study.

22
Analysis
  • 27 Articles were analyzed using the American
    Academy of Cerebral Palsy and Developmental
    Medicine (AACPDM) Levels of Evidence
    Classification System

23
AACPDM Classification
  • Level 1 well-controlled experiments including
    random allocation and manipulation of
    intervention.
  • Level 2 studies that do not include
    randomization but are otherwise well controlled
    experiments or comparison studies.
  • Level 3 comparison studies with one (or both) of
    the comparisons being retrospective.
  • Level 4 study designs have no comparison group
    or condition.
  • Level 5 all non-empirical research which can
    merely hint at possible relationships between
    intervention and outcome.

24
Articles were subdivided into 5 intervention
categories
  • 1. Assistive technology device design and
    selection processes in supporting young children
    with various physical disabilities (n 5, 13).
  • 2. Teaching young children with disabilities
    through the use of computers (n 5, 15).
  • Teaching young children with disabilities how to
  • 3. use powered mobility devices (n 2, 5).
  • 4. use Augmentative and Alternative
    Communication Devices (n 1, 3).
  • 5. use switches (n 13, 34).

25
Device Design and Selection (n 5 13)
  • 3 single subject
  • Krebs, et al. 1988
  • Mendez, 1985
  • Meredith, et al., 1993
  • 2 case stories
  • Sauter et al., 1985 Zazula Foulds, 1983
  • Yielded Evidence 3, 4, 5
  • explored use of upper extremity prosthetics with
    high rates of success with practice using the
    device functionally
  • maintenance and glove wear were greatest
    challenge
  • practice during naturally occurring routines and
    activities in the home and community
  • design, fitting and functional use of a mobility
    device specifically designed for an 11m old
  • successful forward use within four months of
    practice in the home
  • precise molding and positioning emphasized
    safety and comfort based on childs developmental
    level and needs

26
Teaching Use of Computers (n 5, 15).
  • Included group research methods, single-subject
    methods, and case stories
  • yielded a range of evidence
  • all studies looked at multiply-disabled children
    birth - five
  • Yielded Evidence 2,3,4,5

27
Teaching Use of Computers (n 5, 15).
  • Compared use of traditional language intervention
    with use of computer-aided language instruction
  • Exposed children to three types of treatment
    conditions and explored educational gains
  • Explored computers vs. toys as social
    facilitators with peers
  • Examination of free-choice preferences when using
    computers was a choice

28
Power Mobility (two single-subject)
  • Butler et al., 1983 Butler et al., 1984
  • teaching two groups of children age 20 - 37
    months to master power mobility in an average of
    three weeks
  • average cognitive abilities varying physical
    disabilities
  • fitted for wc positioned optimally
  • achievement of seven skills i.e..
    Stopping/starting
  • practice at home several hours per day
  • cluster patterns of learning 4-5 skills per day
  • all but one child were successful

29
Power Mobility (one case story)
  • Butler 1986
  • Effects of power mobility on physical interaction
    with objects communications with caregiver
    changes of location in space
  • Tx - self-initiated behaviors with and with out
    the use of power mobility
  • Results - some increase in self-initiated
    behavior in all children but mixed with some
    decreases in behavior.
  • Yielded Evidence 3,4

30
AAC (1 single-subject study)
  • Schepis, et al., 1989 Level 2 Evidence
  • Teaching children with Autism to use AAC using a
    naturalistic instructional strategy
  • Successful in teaching use of Voice Output
    Communication Aid (Cheap Talk) to 4 children, age
    3-5 during snack and play routines
  • Training for staff Trial for child
  • Observation of various communication behaviors
  • Multiple probe across time and across routines
  • All four children demonstrated an increase in
    communicative interactions relative to baseline

31
Teaching use of switches (n 13, 34)
  • Learning cause and effect
  • Increase ability to control environment

32
Teaching use of switches (n 13, 34)
  • Three sub-categories of studies
  • contingent feedback learning (n 11)
  • cognitive/developmental
  • systematic prompting and prompt withdrawal
  • Made up of case story, single-subject, and group
    research designs
  • Yielded Evidence 1 - 5

33
Findings
  • 27 articles between 1980 and 2005 that report
    some level of empirical evidence
  • Majority of articles used small sample sizes
    some form of within- or single-subject design
  • Range of AT covered - and all classified as
    High-Tech
  • None of the articles discussed strategies for
    helping children with readily available or
    Low-Tech items
  • Suggests that practices may be viewed as needed
    only when devices are complicated
  • None of the articles discussed working with
    families so that they can support their
    children's use in everyday life through the use
    of AT

34
What have we learned?
  • Summary

35
We know that...
  • AT is underutilized with infants and toddlers
  • Reasons that have been proposed for under use
    have not been upheld in our database
  • People have differing views about what AT may or
    may not be
  • This does not necessarily matter if the focus is
    on childrens success in participating in family
    routines and activities
  • Adaptation approach
  • Providers tend to be more concerned with
    promoting developmental skill acquisition than
    with childrens successful participation
  • This skill focus is apparent from the national
    surveys as well as initial results from the
    implementation study
  • Limited empirical evidence emphasizes high-tech
    devices indicates a potentially low interest in
    identifying optimal intervention practices and
    suggests that practices may be viewed as needed
    only when devices are complicated.

36
Please visit our website for summaries of
research, resources, and ideas for the selection
and use of AT in early intervention.
http//tnt.asu.edu
Institute Directors Philippa H. Campbell,
Thomas Jefferson University and M. Jeanne Wilcox,
Arizona State University
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