Pediatric Media Guidance for Parents of Children on the Autism Spectrum: A Thematic Analysis.

Very little is known about pediatric media guidance, or the one-on-onse advice that medical and clinical professionals (MCPs) communicate to parents about their children's recreational media and technology (RMT) use. One population that stands to benefit from a closer examination is children on the autism spectrum due to their behavior and communication challenges. We surveyed one group of pediatric autism MCPs, applied behavioral analysis (ABA) providers (N = 234), due to their proximity to families and conducted an applied thematic analysis of RMT advice they deliver. Providers reported primarily suggesting that caregivers employ restrictive parental mediation with their autistic child, that RMT should primarily be limited to use as a reward or reinforcement, and that parents should set time limits. Our findings offer new insights into the intersections of health communication theory and practice, while highlighting the need for greater research into RMT guidance for children with and without disabilities.

The effect of cue type on directive-following in children with moderate to severe autism spectrum disorder.

For this study, 11 children with moderate to severe autism spectrum disorder (ASD) were given directives containing prepositions in three cue conditions: (a) spoken alone, (b) a short video clip along with spoken cues, and (c) a sequence of three graphic symbols accompanied by spoken cues. Participants followed directives significantly more accurately with the video clip than with spoken cues only, and significantly more accurately with spoken cues only relative to the sequence of graphic symbols. Results suggest that the short video clip along with spoken cues may be an optimal mode for enhancing learners' ability to follow directives containing prepositions. In addition, results reveal three statistically significant correlations between participants' preexisting skills and directive-following accuracy: a positive correlation between spoken preposition preassessment total score and accuracy in the spoken-alone condition; a positive correlation between spoken noun preassessment total score and accuracy in the video-clip condition; and a positive correlation between ASD severity and the need for repetition in the video-clip condition. Results also suggested that, for children with more severe ASD symptoms, the video clips require repetitions so that the relationships illustrated within it can gain more semantic salience. Implications for clinical practice and future research are discussed.

Physician Mediation Theory and Pediatric Media Guidance in the Digital Age: A Survey of Autism Medical and Clinical Professionals.

Research on physician mediation suggests that physicians actively discuss media use (e.g., seeking online health information) with their patients. This theory has been limited though with respect to incorporating key behavioral determinants, varied forms of mediation, and samples beyond primary care physicians (MDs). A survey of 335 U.S.-based medical and clinical professionals (MCPs) treating pediatric clients on the autism spectrum (e.g., pediatricians, speech-language pathologists) examined how they advise caregivers about managing their child's recreational media and technology use, also known as media guidance. Results indicate the frequency of these discussions varies by MCP type. Hierarchical regression analyses show, as hypothesized, that additional behavioral and contextual determinants not previously considered (i.e., perceived norms, self-efficacy, information sources and child factors) are significantly associated with positive, negative and redirective mediation practices. Results expand existing theory and justify extending physician mediation research beyond MDs. Implications for clinical practice and health communication research are discussed.

Providing visual directives via a smart watch to a student with Autism Spectrum Disorder: an intervention note.

Smart watches are discreet and wearable tools that may be repurposed to improve directive-following for individuals with autism spectrum disorder (ASD). Specifically, a mentor can transmit just-in-time (JIT) visual supports (e.g., video clips, photographs, text) that depict an upcoming directive to a learner's smart watch to prompt the learner as needed from a distance. Using a single-case multiple probe design across settings, this investigation evaluated the effectiveness of providing text-based prompts on an Apple Watch 1 to a child with ASD within a school setting. A mentor transmitted 2-step written directives via text message to the participant's Apple Watch. The participant was instructed to attend to, read, and follow directives received on the watch. Results demonstrated that the intervention improved directive-following as well as increased the instructor's distance from the learner. It is proposed that JIT supports sent to a learner's smart watch may reduce the obtrusiveness of traditional prompting while also maintaining the naturalness of ongoing social or academic interactions. Clinical limitations and implications are discussed.

The effectiveness of aided augmented input techniques for persons with developmental disabilities: a systematic review.

When working with individuals with little or no functional speech, clinicians often recommend that communication partners use the client's augmentative and alternative communication (AAC) device when speaking to the client. This is broadly known as "augmented input" and is thought to enhance the client's learning of language form and content. The purpose of this systematic review was to determine the effects of augmented input on communication outcomes in persons with developmental disabilities and persons with childhood apraxia of speech who use aided AAC. Nineteen studies met the inclusion criteria. Each included study was reviewed in terms of participant characteristics, terminology used, symbol format, augmented input characteristics, outcomes measured, effectiveness, and study quality. Results indicate that augmented input can improve single-word vocabulary skills and expression of multi-symbol utterances; however, comprehension beyond the single word level has not been explored. Additionally, it is difficult to form conclusions about the effect of augmented input on specific diagnostic populations. Directions for future research are posited.

Brief Report: Just-in-Time Visual Supports to Children with Autism via the Apple Watch:® A Pilot Feasibility Study.

Using augmented input might be an effective means for supplementing spoken language for children with autism who have difficulties following spoken directives. This study aimed to (a) explore whether JIT-delivered scene cues (photos, video clips) via the Apple Watch® enable children with autism to carry out directives they were unable to implement with speech alone, and (b) test the feasibility of the Apple Watch® (with a focus on display size). Results indicated that the hierarchical JIT supports enabled five children with autism to carry out the majority of directives. Hence, the relatively small display size of the Apple Watch does not seem to hinder children with autism to glean critical information from visual supports.

Autism spectrum disorders in the era of mobile technologies: impact on caregivers.

OBJECTIVE: This paper explores possible connections among existing literature on parental stress, augmentative and alternative communication (AAC), and use of mobile technology for persons with autism spectrum disorder (ASD). METHODS: A narrative review of the literature. RESULTS: Parental support contributes to positive outcomes for children who use AAC. Parents identify communication as a high priority, but describe the process as challenging. AAC is often used with children with ASD, a population in which parental stress is especially high. Though there is research evidence that mobile technology is a promising tool for individuals with ASD, potentially misleading media anecdotes exist, and the effects on parental expectations and stress remain unstudied questions. CONCLUSION: Increased understanding of the connections in these research areas should help clarify the potential impact of mobile technologies on parental stress level, help to define appropriate future research directions, and contribute to development of appropriate caregiver training.