=Paper=
{{Paper
|id=Vol-2524/paper28
|storemode=property
|title=A classification model for psychological apps: a first categorization of apps for children with autism spectrum disorder
|pdfUrl=https://ceur-ws.org/Vol-2524/paper28.pdf
|volume=Vol-2524
|authors=Andrea Mennitto,Lucia D'Angelo,Michele Iorio,Federica Somma
|dblpUrl=https://dblp.org/rec/conf/psychobit/MennittoDIS19
}}
==A classification model for psychological apps: a first categorization of apps for children with autism spectrum disorder ==
https://ceur-ws.org/Vol-2524/paper28.pdf
A classification model for psychological apps: a first
categorization of apps for children with Autism Spectrum
Disorder
Andrea Mennitto1, Lucia D’Angelo2, Michele Iorio3 and Federica Somma2
1 Neapolisanit S.R.L. Rehabilitation Center, Ottaviano, NA 80044, Italy
2 Università degli Studi di Napoli Federico II, Napoli NA 80138, Italy
3 IRFID s.r.l., Ottaviano, NA 80044, Italy
a.mennitto@neapolisanit.net
Abstract. Technology is increasingly used in the context of existing rehabilita-
tion therapies for neurodevelopmental disorders as Autism Spectrum Disorder
(ASD). The use of mobile devices appears extremely functional for people with
autism spectrum disorder (ASD) primarily due to how easy it is to use mobile
phones, now within everyone's reach. Technology can be transported, used, and
also for the possibility that these devices offer to overcome problems in the man-
agement of face-to-face interactions or problems associated with treatment out-
side the therapy room. The recurrent use of technologies in rehabilitation has
generated, in recent years, a proliferation of software for autism in different areas
and categories and, in addition, confusion and disorientation due to the absence
of a guideline that helps parents, teachers, and therapists in selecting the applica-
tion closest to the individuals with ASD critical issues. Thus, our work aims to
propose a categorization model of existing applications for children with ASD
starting from a functional diagnosis approach. Applications are described and
categorized according to the areas on which training and rehabilitation are fo-
cused. Our intent is to create a guide for caregivers, with the hope that it could
become a really effective tool to deal with the difficulties that ASD disorder in-
volves.
Keywords: autism, app, technology.
1 Introduction
1.1 Autism Spectrum Disorders: an overview
Autism Spectrum Disorder is a particular condition of neurological development [1]
that leads to atypical cognitive development and behavior. Despite the fact that indi-
viduals with ASD all belong to the same diagnostic label, the term ‘spectrum’, express
the variability of cases. The disorder’s manifestations vary in relation to the severity
level of ASD condition [2] and it is also related to the chronological age and the level
of development of the individual.
2
However, some common behavioral aspects of the autism condition have been iden-
tified. Diagnostic classification systems [3] have defined the ASD as a condition char-
acterized by communicative and social difficulties and a restricted repertoire of inter-
ests and activities. There is an ASD prevalence in male children rather than females
with a 4:1 ratio. DSM-5 outlines the different diagnostic criteria of the Autism Spec-
trum including atypical behaviors in socio-emotional reciprocity, in orientation and at-
tention towards social stimuli, difficulty to adapt behavior to different social situations,
and lacking integration of verbal and non-verbal communication. Movements and
speech are often stereotyped, behavior rituals and everyday routine are rigid.
Moreover, impairment of the function of people with ASD compromises and has
consequences in various contexts such as school [3]. A good evaluation of the child
with ASD should be global, therefore including every aspect of its functioning, and
performed by a professional team in collaboration with caregivers in order to implement
personalized interventions aimed at improving both children and caregivers quality of
life.
1.2 ASD and mobile technology
Interventions for people with ASD are different and programmed according to the spe-
cific characteristics of the individual. Some intervention programs include the use of
mobile technology, like tablets. Mobile technology generally stimulates motivation and
the interest of children with ASD is more easily captured with the use of tablets: the
child with ASD, therefore, appears more inclined to focus on the task. Another ad-
vantage is represented by the fact that the use of a tool like a tablet, could reduce the
anxiety of some children with ASD and could be perceived as safer: the anxiety derives
from the discomfort of relating to other people and from weak communication skills.
Technology can also enhance the work of those who evaluate and diagnose, as a real-
time data acquisition combined with rapid information processing can guide in the
choice of tests for an in-depth evaluation, useful to provide a picture as complete and
detailed as possible of the difficulties experienced by the person.
Mobile technology is easy to transport, is supplied by flexible multimedia content
and big storage capacity, provides accuracy of data recording and collection[4]. These
advantages make mobile technology so useful and concretely profitable [5].
In recent years there has been an increase in the production of application for the
treatment of Autism Spectrum Disorder. The market contains a high number of appli-
cations but the iOS and Android platforms do not check whether the apps in their stores
have been scientifically validated; they simply perform a standard check of the program
allowing any developer, even with a non-clinical background, to publish applications
in the mental health category and present them to the market as delegated to the treat-
ment of behavioral and psychological problems, psychoeducation, health care [6].
Despite the massive growth in the number of ‘clinical’ applications, the scientific
studies aimed at explaining their use methods and at demonstrating their effectiveness
failed to keep up with their development. Therefore, there is a high risk that these ap-
plications, from the clinical point of view, are used without any scientific reference.
The lack of a guideline has generated confusion about the choice of these applications.
3
Parents, rehabilitators and educators have opted for self-organization in app selection
as an expedient. An association of mothers, for example, has begun to review and cat-
egorize the educational applications [7] of the market by creating their own web page
“Mamamo” [8]. Educators also worked on developing websites that had the same pur-
pose: to create real communities of users willing to provide reviews of the applications
used. Autism Speaks, which is the world’s largest association for autism, has recog-
nized the need to create a filter, still very generic, of existing applications related to this
area. On the website of “Autism Speaks” [9], a section has been dedicated to a database
that generates a list of applications related to inserted criteria, as the use purpose of
applications, the device used, and the age of the child. However, this is still a generic
selection. In Spain, they have created a similar site also available in English “Appyau-
tism” [10].
The need to categorize existing applications has led to the creation of e-books that
have unfortunately assumed the clear appearance of product catalogs. The assistive
technologies world is divided into categories (category of learning, communication,
everyday life, and so on). However, the model used for the division of technologies
does not conform with a classification of technologies for autism based on needs and
learning domains. Considering this large number of existing applications, it is our in-
tention to present a model for classifying existing apps based on a functional diagnosis
of the child with ASD.
2 Categorization model of applications for children with
ASD
The growth of in demand for mobile applications for people with ASD and the propor-
tional increase of them requires more structured guidelines. We propose a categoriza-
tion model of apps that consists of four macro-categories, each of which is related to a
different and specific treatment area of the child. The applications are described and
categorized with reference to the main functional areas for enabling/rehabilitating the
child. The categorization model that we propose in this paper wants to be as much as
possible related and understandable to psychologists, teachers and parents, for this rea-
son we have chosen to propose a categorization of educational applications for mobile
devices that is as close as possible to the functional diagnosis of the child. The func-
tional diagnosis is the analytical description of the psychological and physical functions
of a child who is experiencing difficulties.
The functional diagnosis (F.D.) , in fact, is an articulated document that outlines the
functioning modalities of the child's abilities and is drawn up after an accurate clinical
examination; the F.D. summarizes all the information within a psychological and func-
tional "framework" that will allow teachers, educators and caregivers to understand all
the problems that the child has shown during a complete psychological assessment.
The functional diagnosis, in fact, often becomes a tool that helps to know the child, in
fact the document of the functional diagnosis describes: the set of the difficulties, the
residual capacities and those that can be compensated, and the development potential
of the child.
4
A complete functional diagnosis describes the cognitive aspects, the child's interper-
sonal skills, linguistic development, motor development, memory, attention and spatial
and temporal organization, as well as autonomy.
We believe that a good model for the categorization of educational applications can and
should be as close as possible to the model of functional diagnosis, since it would be
easily consulted and useful to all the experts.
Currently, there is no such categorization, operators rely on reviews in order to choose
the most congenial application to their needs, we decided to start from this scenario and
make an analysis of the applications present on these databases and then categorize
them in the “App autism” website [11].
At the preliminary stage of our work, we carefully examined existing applications
for children with ASD. First, we underlined some aspects that can contribute to making
the classification even more articulated. In fact, we pointed out that each application
can be closed, leaving the user the opportunity to make changes by inserting, for exam-
ple, additional content, or opened, offering the opportunity to modify certain aspects
such as game items. Another significant distinction is the one relating to the hardware
or software nature of the application. Indeed, it is possible that the same application,
conceived as a software, can subsequently be realized also in the hardware version [12]
and can use tangible interfaces [13]. We also identified applications based on the con-
text of use, since there are apps designed for use at school or at home. The last catego-
rization has been made between applications exclusively dedicated to the processing or
designed to be simply a technological exercise. This information is a label that should
simplify the identification of the most suitable application. It must be considered that
many mobile applications on the market cannot be classified as totally educational or
rehabilitative applications, many of them, in fact, have only entertainment purposes.
The first parameter to take into consideration to check if a mobile application is profes-
sional and suitable for use in schools or during a rehabilitation session, is to check
whether it contains learning assessment tests, if there are any clear references to learn-
ing areas and if it integrates a reporting system of the learning that the child acquires
during the game sessions.
After a preliminary investigation and classification phase, we implemented the clas-
sification model of applications for children with ASD. Our model consists of four
macro-areas: ‘routine and behavior tracking’, ‘social-emotional training’, ‘functional
communication’ and ‘data recording and ABA practices’ (Fig.1).
5
routine and
socio-emotional
behavioral
training
tracking
data recording
functional
and ABA
communication
practices
Fig. 1. Categorization areas
Macro-areas:
Applications that simplify the acquisition and
processing of data on behavior and produce
1. Behavior tracking graphs that allow to check the behavior’s
trend.
Applications designed to work on communi-
cation and social interaction deficits mani-
2. Socio-emotional fested by the subject in contexts in which he
training lives and aimed to improving the capacity for
self-regulation.
Applications created to progressively elimi-
3. Functional com- nate the problem behavior deriving from a
munication communication deficit.
4. Data recording Applications that the behavior analyst uses to
and aba practices facilitate and integrate his own work.
Table 1. Categorization macro-areas
For each of them, there is a description of how the application must be characterized to
be part of it. The app related to ‘behavior and tracking behavior’ area facilitate and
speed up the processes of acquisition and development of data on behavior and generate
automatic graphs that allow to visualize and therefore monitor the trend[14]. An app
6
placed in this area must then satisfy some requirements such as: taking note of the in-
dividual behavior in a predetermined time interval, collecting the data and inserting it
in a graph to allow observing the trend, processing the data so that it is possible to
document the progress of the intervention.
Within the ‘training socio-emotional training’ area we find all those applications that
stimulate self-regulation and empower communication [15, 16] and social interaction
in different contexts. Children with ASD often don’t develop a theory of mind and are
not able to attribute mental states to others, communication exchanges are compromised
and there’s a lack of interest for social contexts to which they belong. The applications
related to this category are aimed at reducing the difficulties in conversation, moderat-
ing non-verbal communication, improving the ability to maintain relationships, stimu-
lating motivation to interact, making the child able to adapt his behavior to the different
contexts.
Cognitive, emotional and social self-regulation concerns the control and modulation of
thoughts and emotions but also behavior monitoring. When an individual develops
good self-regulation he is able to respond adequately to the environment’s demands. In
children with ASD self-regulation is compromised. Applications that support the child
during the creation of social stories are particularly suited to meeting the criteria of the
applications placed within this category.
The macro area of ‘functional communication’ encompasses all those applications that
aim at the progressive extinction of problem behaviors deriving from a communication
deficit. It frequently happens that children with ASD have significant difficulties in
communicating their needs and thus implement problem behaviors. The applications
related to this macro area have been designed to contribute to the reduction of these
communication problems.
‘Data recording and ABA practices’ is the last macro area we have identified. Within
this area are placed all those applications that constitute an integration of the behavioral
analyst’s work. It has been discovered that the ABA method is considered as an effec-
tive intervention strategy for people with ASD, the applications of this category collect
and analyze the treatment data, guaranteeing greater efficiency and quality to the inter-
vention and offer the possibility of integrating and consolidate the work done by the
therapists thanks to the chance to use the app at home, therefore outside the therapy
room.
3 Conclusions
Recognizing then the potential of applications in the contexts of diagnosis, rehabilita-
tion and treatment of people with ASD, the objective is to encourage integration, learn-
ing, socialization, cognitive improvement, personal skills through the development and
the use of software and mobile devices. Therefore, mobile technology and, specifically,
all those applications designed and created exclusively for subjects with ASD, can re-
spond concretely to the needs of the caregivers and therapist community [17]. In order
to disseminate this categorization model for mobile applications that support the reha-
7
bilitation of children with ASD, we have also created a website (http://appautismo.al-
tervista.org/) that collects the applications that have been categorized during our study.
Within the website, every application that was found was tested by a team of expert
psychologists who also produced videos to show how it works. Subsequently, for each
application, the team of psychologists identified the most suitable age group to be used
by a child and, finally, proceeded to describe the possible psychology methodology that
could have inspired the exercises and games proposed.
The choice of the best application is still based on intuition. A model of categoriza-
tion of existing applications is therefore necessary. Inserting in the description a link
that refers to a specific model of categorization of applications for the ASD, like the
one we developed, could help to make a more informed choice of the application. Our
intent was to create a guide, a real useful tool for children caregivers, with the hope that
it could become a real effective tool to deal with the difficulties that ASD disorder
involves.
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