BRIEF REPORT

Using iPads to Teach Communication Skills of Studentswith Autism

Joy F. Xin • Deborah A. Leonard

� Springer Science+Business Media New York 2014

Abstract The purpose of this study was to examine the

effects of using an iPad to assist students with autism in

learning communication skills. Three, 10 years old learners

diagnosed with autism who present little or no functional

speech, participated in the study. A multiple baseline

design with AB phases across academic and social settings

was used. During the baseline, students were given access

to an iPad with the SonoFlex speech-generating device

application, while no communicative attempts were

observed. During the intervention, the students were taught

to use the iPad to communicate with their teacher and peers

for 6 weeks. With a least-to-most prompting hierarchy, all

students increased initiating requests, responding to ques-

tions and making social comments in both class and recess

settings.

Keywords Technology � Autism � Communication

Introduction

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. To help these students learn

communicative skills, Augmentative and Alternative

Communication (AAC) approaches are suggested (Bondy

and Frost 2002). AAC devices provide symbols, pictures,

photos, and written words to communicate thoughts and

ideas in visual presentations that are inanimate, predictable,

and more static than speech (Mineo et al. 2008). These

features typically motivate students with ASD who often

dislike changes and prefer consistency. New concepts and

associated vocabulary can be added to the existing sym-

bols, which make the learning process consistent and stable

with minimal disruptions to a familiar routine. This may

reduce learning anxiety by creating a gradual introduction

of new language as well as an easy way to accurately

communicate a student’s needs by simply touching or

pointing to a symbol or image (Mineo et al. 2008). It seems

that visual language on AAC devices is easier for mini-

mally verbal students to understand than speech and

manual signs, thus maximizing the comparatively strong

visual processing skills of those with ASD (Shane et al.

2012).

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 pro-

grammed with simple cues using one symbol, increasing

cues with many symbols as they gradually 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

J. F. Xin (&)

Department of Language, Literacy and Special Education,

Rowan University, 201, Mullica Hill Rd, Glassboro, NJ 08028,

USA

e-mail: xin@rowan.edu

D. A. Leonard

J. Mason Tomlin School, Mantua Township, NJ, USA

e-mail: dleonard@mantuaschools.com

123

J Autism Dev Disord

DOI 10.1007/s10803-014-2266-8

cues (e.g. expectant delays and questioning looks to elicit

communication), and non-intrusive prompting techniques

increased their interactions with classroom staff (Shane

et al. 2012).

Current technology such as the Apple iPad, using spe-

cialized AAC applications (apps), provides an opportunity

for students with ASD to meet their communication needs

(Shane et al. 2012). For example, some apps (e.g. Prolo-

quo2go, 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).

IPads are being used in general education classrooms to

engage students in learning to promote higher-level thinking

and problem solving (Pilgrim et al. 2012). These resources

also support special education teachers and students to

access content and skill specific applications (Blood et al.

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).

To date, there are many communication applications

available for iPads to function as an AAC device. How-

ever, research on iPads as AAC devices was only found in

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

communication skills using these software apps (Sennott

and Bowker 2009). More empirical studies using an iPad as

a SGD are needed to evaluate the technology and software,

and to find another avenue for meeting the communication

needs of those who have limited speech and language. This

opportunity would also enable teachers and speech-lan-

guage pathologists to make evidence-based decisions when

choosing an appropriate AAC device and software appli-

cation for their students, as well as make an argument for

funding to purchase the technology. Functional spontane-

ous communication during daily tasks should be the mea-

sure of a successful AAC intervention (Shane et al. 2012).

Thus, additional studies on expressive language acquisition

using an iPad and its applications are needed to verify

previous findings and add information to the learning

outcomes of students with ASD. Our study attempts to

expand previous research on mobile technology by using

an iPad with an AAC application for communication pur-

poses in natural school settings. Instead of Proloquo2Go,

another program with much less cost, called SonoFlex was

used to teach these students communication skills. The

purpose of our study is to determine the effect of iPads as

an AAC device on spontaneous functional communication

responses in school settings, such as classroom and recess.

Specifically, the research questions are presented as fol-

lows. (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 these students increase spontaneous (e.g.

unprompted) communication with their teacher and peers

when an iPad is applied?

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. Prior to the study, Vineland Adaptive

Behavior Scales (2nd Edition, 2005) and Wechsler Intel-

ligence Scale for Children (4th Edition, 2003) were

administered. Table 1 presents the general information of

the 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 uncer-

tainty of expectations or stress. 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’’,

‘‘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

Table 1 General information of participating students

Student WISC,

IQ

scores

Expressive

language**

Receptive language**

Student 1

(Eric)

\75 Non-verbal No score due to interfering

behaviors during testing

attempts

Student 2

(Christian)

\75 Non-verbal No score. Records indicate

he pointed to all responses

for each question

Student 3

(Samantha)

\75 \2 years

old

55, which is considered

‘‘Low’’ (higher than 1 % of

her peers)

* Wechsler Intelligence Scale for Children (4th Edition), Mean: 100

** Vineland Adaptive Behavior Scales (2nd) Edition

J Autism Dev Disord

123

for her in response to a question. Verbal prompts were

provided but her words uttered were always isolated and

hard to understand. Each of the students had an individual

education program (IEP) in which the goals of learning to

use 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 who taught the lessons, and two

teacher assistants (TA).

Instructional Materials

An iPad with a protective cover and carrying handles was

provided to each student. Sonoflex, a SGD app was

downloaded onto each iPad. The Sonoflex icon was placed

in the lower right-hand corner of the 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 (see Appendix 1). 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 voice. A single word or a com-

plete 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 touched, the sentence:

‘‘I want a snack, please.’’ is spoken. On the home page of

the Sonoflex app, the following context buttons were cre-

ated by the teacher: ‘‘Morning Meeting’’, ‘‘Math’’,

‘‘Reading’’, ‘‘Social Studies’’, ‘‘I want’’ and ‘‘Being

Friendly’’ (see Appendix 2 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 to

make a response using an iPad. Each type of communi-

cation was tallied as a request, response, or social com-

ment, 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 Tables 2, 3). Median

scores were calculated to present appropriate ordinal data

based on prompting levels from 0 to 5 for each type of

communication.

Research Design and Procedure

A single subject, multiple-baseline design with AB phases

across settings was used. During the baseline, data were

collected during two 10-min sessions 2 days per week for

2–3 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 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 without any support. 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 prompts. A minimum

of 5 questions were presented. If the student responded,

Table 2 Examples of communications

Types of communication Examples

Request ‘‘I want cereal.’’

‘‘I want a break.’’

‘‘I want to use the bathroom.’’

Response What is your name? ‘‘Eric’’

What is the weather? ‘‘Sunny’’

Where did we go today? ‘‘Bowling’’

Social comment ‘‘I like it!’’

‘‘I am sorry.’’

‘‘It’s your turn’’

Table 3 Least-to-most prompting hierarchy

Level of prompts Scores Examples

Independent 5 The student initiates a communication

without any help. This is considered a

non-prompted communication

Verbal 4 The student is given verbal directives

such as, ‘‘Choose a button.’’ or, ‘‘Do

you want ‘x’ or ‘y’?’’ or, ‘‘Tell

Samantha it’s your turn’’

Gesture 3 Pointing to the specific area that the

student should be looking at to make a

communication attempt

Model 2 Select the correct button and then give

the students the opportunity to select

the button by themselves

Physical 1 Using a hand-over-hand process, guide

the student to make the correct

communication. Provide an

opportunity for the students to make

the selection by themselves

Not

communicative

0 Student was not attentive to instruction

and/or showed unwillingness to

communicate with the iPad

J Autism Dev Disord

123

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 students 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

recorded.

During the intervention, data collection was continued

in the same sessions 2 days per week for 6 weeks.

Instruction was provided using the least-to-most prompting

hierarchy after a 5-s pause. For example, during a Lan-

guage 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-s. If no

response was given, the TA would verbally direct,

‘‘Answer with your iPad.’’ Again, a 5-s pause was pro-

vided. If there was still no response, the question was asked

again, with the same tone of voice. If no response was

given within 5-s, the TA pointed to the correct iPad button,

providing a gesture prompt. If, after a 5-s 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 within 5 s. If no response occurred, the question was

asked again (still 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)

Data Analysis

A visual analysis of the observation data compared the

baseline and intervention 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 et al. (1987)

was used. 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; 70–90 %, an effective treatment; 50–69 %,

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 stu-

dent’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 respec-

tively. 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

Table 4 Total number, mean

scores and standard deviations

of requests, responses, and

social comments

C Class, R Recess

Student Phase A Phase B

Total Total (C) Mean (C) SD PND (%) Total (R) Mean (R) SD PND (%)

Eric

Requests 0 9 1.67 1.37 75 4 .50 .90 34

Responses 0 50 2.22 .66 100 27 2.01 .98 83

Comments 0 9 1.71 1.17 75 46 2.37 .79 100

Christian

Requests 0 6 1.42 1.78 50 6 1.25 1.71 50

Responses 0 60 3.70 .97 100 21 3.59 1.04 100

Comments 0 10 2.83 1.04 83 58 3.14 .65 100

Samantha

Requests 0 6 1.79 1.90 50 6 1.67 1.72 50

Responses 0 61 3.38 1.23 100 15 3.50 1.61 92

Comments 0 9 2.67 1.67 75 60 3.32 .42 100

J Autism Dev Disord

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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 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

83–100 % 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 interven-

tion, while no comments of any students were found during

the baseline. All students made comments in both aca-

demic and social settings, especially during recess, pre-

senting PND scores of 75–100 %, indicating an effective

treatment (see Table 4).

Discussion

Our study attempts to evaluate the expressive communi-

cation of students with ASD using an iPad with the So-

noFlex app in school settings. They were taught to use the

iPad with the communication application in learning initial

requests, response to questions, and making social com-

ments with a decreasing level of prompts. During the

baseline, none of the participants were able to express

themselves, and no attempts were made to use the iPad for

communication, despite the available access. Same obser-

vations were found during the recess, no students used the

iPad to communicate with the adults and peers.

During the intervention, all 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

responses to questions and making social comments, the

number of initial requests is low. 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

(child-preferred stimuli) to increase students’ requests

should be considered during instruction. In addition, con-

tinuous 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

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 partici-

pants (Christian and Samantha) reached the level of inde-

pendence 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 adjust instruction

accordingly to meet all students’ needs. It seems that the

use of an iPad strongly supports non-verbal students with

ASD to participate in class activities and interact with the

teacher.

Encouraging social comments from the students pro-

moted their awareness of others in the environment. All

participants showed improved skills to make appropriate

social comments. The results show that two students reached

the highest score of 5 with independence without prompting

sometimes, and the other 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. 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

school activities so that they can continue to learn commu-

nication 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 pro-

mote their future inclusion in general education classrooms

with typically developing peers.

In accordance with the findings reported in the previous

research (e.g. Kagohara et al. 2012), our study has

J Autism Dev Disord

123

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 oppor-

tunity to communicate with their teachers in class and

interact with peers in recess. This opportunity would

encourage these students to join with typically developing

Fig. 1 Median scores of each student’s use of the iPad to make requests during academic and social settings

J Autism Dev Disord

123

students 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. Making friends with typically

developing peers often is difficult for students with

disabilities, especially for those with limited speech and

language skills (Mazurek and 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

Fig. 2 Median scores of each student’s use of the iPad to make responses during academic and social settings

J Autism Dev Disord

123

and Kasari 2000). Using mobile devices such as iPads will

allow these students to carry to social settings to interact

with peers using this SGD as a communication tool. This

will definitely create an avenue for students with disabili-

ties 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 6 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

Fig. 3 Median scores of each student’s use of the iPad to make comments during academic and social settings

J Autism Dev Disord

123

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 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 devel-

ops proficiency in the use of AAC. Selecting the most

appropriate AAC app for each student based on individual

needs should be considered.

Implications

Communication skills are important for individuals, espe-

cially 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 familiar with its use. Using a

relatively inexpensive iPad app that can be easily down-

loaded for students to access may lead to improved com-

munication between children and parents at home, as well

as interaction with their peers without disabilities in school.

We believe that the iPad for communication purposes for

students with ASD will increase as its popularity in our

daily lives and its potential to serve as a communication

tool in school.

Appendix 1

See Fig. 4.

Fig. 4 Vocabulary Screen for ‘‘Social Studies’’ context button

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Appendix 2

See Table 5.

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Table 5 Examples of context

buttons and associated

vocabulary words

* The words are changed to

match the current lesson being

taught

SonoFlex context buttons

Morning

meeting

Math Reading* Social

studies*

I want Being

friendly

Bowling

Vocabulary

buttons

Monday 0 Emily Circus food My name

is

Shoes,

size

Tuesday 1 Touch Fun drink Hi Ball

Wednesday 2 Taste Juggler bathroom Bye Strike

Thursday 3 Smell Ringmaster break Classmate Spare

Friday 4 See Animals outside Classmate My turn

January 5 Hear Elephant iPad Classmate Your turn

February 6 I Lion home Classmate Thanks!

March 7 Can Tiger Smartboard Staff Bathroom

Gym 8 Birthday Horses O.T. room Staff Drink

Music 9 Red Website book Staff Snack

Library 10 Loud Train Quiet Staff I’m tired

Sign

Language

Add Sweet Ringling

brothers

Help School

Name

That was

fun!

Sunny Subtract Rough January yes My turn Thank

you

Rainy More Good I no Your turn Bus

Snowing Less Ran Like More,

please

Thanks Break

Cold The

same

Man Work Go home? I had fun! I did it!

Hot All

done

Van Yes Stop,

please

Yes

Yes Yes Fan No I’m good No

No No Yes I’m sorry

No Yes

No

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