The following literature review ties closely with my experience and research interests for my doctoral degree in Learning Design and Leadership at the University of Illinois. Currently, I am a fourth year special education teacher for early childhood. I have an innate passion for exploring new and innovative tools that can be utilized in the classroom as individualized supports for children. Through my years of teaching, the diagnosis of Autism Spectrum Disorder (ASD) has increased significantly. Recently, of my four years of teaching, each of my classes have an average of at least, 1 child per every 10 students who has acquired and/or will receive a diagnosis of for a child on the autism spectrum. My goal is to find patterns, correlations, limitations and strategies in current research that will enhance my educational practice to increase dialogue and advocacy within the realm of special education to meet the needs of my students and their families.

As defined, "it is well documented that the population of individuals with ASD is heterogeneous (Ennis-Cole, Smith 2011). According to these authors, individuals on the spectrum vary in their intellect, functional ability, preferences, language ability, motor skills, and cognitive ability. The degree of severity also varies from person to person. Some individuals are nonverbal with severe cognitive deficits while others have normal or average intelligence. Ennis-Cole and Smith (2011) described some individuals in the spectrum as possessing skills that make them a genius in a narrowly defined area, which relies on memorization, pattern recognition, computation, musical, or artistic talent. Autism is characterized by impaired language function, idiosyncratic speech, and an inability to maintain conversations coupled with cognitive and motor difficulties (Holstein, 2013) (Nkabinde, 2016)"

I have compiled and studied a series of credible sources, found directly through the University of Illinois online library. Each article is dated within the last decade, many as early as within the last five years. With the rapid adaption of technology in educational settings, I will be focusing on the assistive technology tools available to support children with ASD in a childhood setting. The three characteristics in children that I will expand upon are language and communication skills, functional skills, and social skills.

                                                     Figure 2. Introduction to autism

The general themes and concepts of this research are collected to address the importance of children with ASD having the opportunity to assimilate in general education environments with typically developing peers. Depending on the severity of the child, it is most often than not that students on the spectrum are restricted in self-contained classroom settings. This style of classroom is equipped with greater number of adults (i.e. teaching assistants, specialists, teachers), instruction is intervention focused, and social interactions and learning opportunities with typical children are limited. This style of classroom may pose harmful effects, such as less opportunities for social interactions, no typical peer models, limited instructional challenges, and/or too much adult support. Instructional classrooms also receive a push-back from parents, as they fear their child will be limited in restricted placements. As reported by literature, common themes seen are children with technological supports often are noted with increased language, social and functional skills. The themes within the literature include various apps, software and high-picture supports that children learn to utilize independently to communicate. These tools may often be carried into general education settings to emphasize their learning in typical environments. 

A synthesis of key concepts and theoretical framework in the collection of literature, all carry the same theme of focusing on the significance of assessing the child prior to providing assistive technology. Especially in the early childhood setting, children are evaluated prior to starting the program. This ensures that children are diagnosed, identified and provided an Individual Education Plan (IEP) that binds the child to legal services. This includes, "...more than just a written legal document (or “plan”). It’s a map that lays out the program of special education instruction, supports and services kids need to make progress and succeed in school. Each program is designed to meet a child’s exact needs. The term IEP is also used to refer to the written plan that spells out the specific types of help the child will get. Both the program and the plan are covered by special education law, or the Individuals with Disabilities Education Act (IDEA) (Understood, 2019)."

With a formal IEP, a child has the opportunity to utilize assistive technology in the classroom, regardless of setting. Assistive technology is used to assist the child to meet their benchmarks, learning targets, and goals. Key concepts that are considered throughout the texts include the process in identifying if assistive technology will help a child succeed. As stated, "Technology is rapidly changing, and products come and go; however, many features remain relatively stable over time with additional features being added to products. Therefore, it is important is to gain an understanding of the features and how they match student needs rather than the product examples provided, which are merely a few of the many possibilities. Further, it is likely that a student would need a combination of features to meet her needs, and it is this combination of features that ultimately drives the final product selection. Finally, it is important to conduct product trials before purchase to ensure an effective match (Myles, B. S., & Rogers, J. p. 24, 2014)."

The common framework in identifying a child's needs for technology begins with the assessment. A common theme identified in this process is the following steps, "assessment, acquisition, application and an evaluation." Through the evaluation process, "service delivery should include a detailed, systematic process for examining a student’s abilities and difficulties and the demands of the environments and tasks. When considering AT, the environment and the tasks must be considered before tools are selected (Pirtle, J. M., & West, E. A. p. 94, 2014)."

Other key concepts that were found throughout the literature include, the sociocultural factors when implementing new tools, the lack of training and funding in school districts and within families, as well as the overall dynamic fit of the tool with the child. Either the child may be negatively impacted by a new tool and/or the tool may be negatively impacted by the child as seen through technical difficulties, poor handling, lack of knowledge to use the tool. To expand upon the diagnosis and tools, other concepts that were acknowledged include the way the child will use the tool, the amount of time that will be dedicated to technology use, as well as the functionality of the tool to enhance independence and functional skills. A final commonality is technology should be used to supplement learning, not substitute it.

Contrasts that reside through the literature include the difference in the frameworks and language used to define interventions, such as assistive technology. For instance, some educational institutions have constructed a formal process in determining tools. As seen, "Zabala (2002) has proposed a framework called SETT – an acronym for Student, Environment, Tasks, and Tools. Thus, using the SETT framework, the team discusses the student’s strengths and needs, the environments where the student will be engaging in tasks, the tasks the student will engage in, and finally the tools that might meet the needs of the student given the environments and tasks (Myles, B. S., & Rogers, J. p.24 (2014)." On the other hand, framework make vary upon state. For example, the state of Florida in 2004, implemented a Tier framework. "In this new model, Florida has incorporated technology and the use of Universal Design for Learning to support its problem solving and date-based decision making (Florida MTSS, 2011). It is important to mention that Florida uses the verbiage of "instruction" instead of "interventions," in its MTSS (Multi-Tiered Support System) model, which implies that all students are included in the model, not just students who may need specialized assistance (Epler, Ch. 5 p. 72-74, 2017)."

Aside from the framework discrepancies, each literature piece expanded in detail about specific applications, software and gaming sources that improves learning for children on the spectrum. Some of the applications are also in beta state, currently going through trials and piloting. Essentially, a key takeaway from the text is the ability to implement innovational tools for supporting children with special needs to improve learning and quality of life.

The methodologies of research and application employed to address the issues of assistive technology can be seen through mixed themes. These include, observing students learning with technology, testing new innovative designs through pilot modules, and analyzing strengths and weaknesses of the tools based on interviews with educators, families, specialists, and children themselves. A synthesis of various tools are tests sporadically through the literature to collect data on efficiency, engagement, goal achievement, and overall enhancement of autism deficits, such as language, social and functional skills.

One study in particular shows the effects of robotic, virtual tools used to engage children in increased eye-gaze. One common characteristic that the literature addresses is the lack of eye contact for children on the spectrum. Studies show, "robotic technology has been revealed to be appealing to children with ASD (Esubalew et al., 2013). Robots are easy to interact with than humans, can reiterate games with infinite patience and can also record the information for further study and that is changing the way ASD children learn new skills. The robots could be used to sense different conditions under which some social prompts would need to be shared. These can be programmed accordingly and allow children to interact steadily in a customized environment (Sharma, A., Khosla, A., Khosla, M., & Yogeswara Rao M.,. (2017).".

Figure 3. Example of a robot decoy used to enhance social skills for children with ASD.

In the particular study, a quantitative approach was taken to collect data while testing language functionality and communication skills. Ultimately, the goal of the robot is to see if "enhancements in language functionality may improve educational inclusion, enlarge social circle and ultimately, increase independence (Finn et al., 2005) (Sharma, A., Khosla, A., Khosla, M., & Yogeswara Rao M.,. (2017)." According to the study, there are number of popular robots used to enhance social skills in children, like CosmoBot used for therapy settings or Paro an advanced animal robot disguised as a stuffed baby seal. Overall, the common areas of study include social skills, joint attention, functional skills, imitation and motor skills.

As the observation began, "Six ASD and six normal children were taken in the experiment. Based on the cues from the child’s head movement, the robot smartly adapts itself in an individualized manner to produce prompts and supports, with potential to promote skills in the ASD deficit area of early social adjusting. It has been observed that children with ASD spent more time looking at the humanoid robot than normal children and spent less time looking at the human instructor. This research was promising and suggested that robotic tools are successfully pushing toward correct orientation to target and improve joint attention (Sharma, A., Khosla, A., Khosla, M., & Yogeswara Rao M.,. (2017)". In retrospect, all the robot prototypes concluded some successful area in which they enhanced skills for children with ASD. However, in the same breath, researchers do acknowledge there are some limitations to robot-child relationships, that may be harmful in the long term. These limits and gaps will be represented further as the analysis continues.

Commonly, the methodologies of piloting new technology are common and often conducted in the same format, utilizing qualitative and quantitative mixed methods to test products and assess children as they use them. Each study serves as a reflection, as researchers, professionals and specialists enlist a variety of strengths and weaknesses to each innovative tool. Some tools are seen efficient for early childhood children, while others may be too advanced. Many literature pieces explained their findings while sharing implications, however some did not share limitations at all. Many texts were written positively, and can be translated to bias. It is apparent that technology has improved the lives of children, however barriers still reside that must be accounted for. The empirical findings of the research organized with benefits and deficits will follow.

As I compile the main empirical findings and practical implications of the assistive technologies presented in the texts, I must share the patterns that were seen intertwined through each piece. Through the literature, it is apparent that assistive technologies have had positive impacts on children, whether they are small or large responses shown. A main pattern in the literature indicates that assistive technology ranges along three levels: low, mid, and high supports (Pirtle, J. M., & West, E. A. (2014)."  

The most common support that is seen successful among all children are visual picture supports. Research states, "children with autism have been found to have strong visual processing skills... one of the general trends identified in children with autism is that they are visual learners and thinkers (Dettmer, Simpson, Myles, & Ganz, 2000; Edelson, 1998; Grandin, 1995a; Mesibov, 1998; Prizant & Rubin, 1999; Quill, 1997; Wheeler & Carter, 1998) (Pirtle, J. M., & West, E. A. (2014)."

Visual picture supports are the most common supports utilized in early childhood classrooms. "The low-technology tools refer to visual support strategies, which typically preclude involvement of any type of electronic or battery operated device. Examples may include calendars, checklists, reward cards, dry erase boards, highlight tape, and Velcro. These forms of nuts-and-bolts technologies are often used both in the classroom and at home and are primarily designed to address skills related to organization (e.g. time management), attention (e.g. sustained attention in class), self-help (e.g. independence in personal hygiene and care), following directions (e.g. listening and responding appropriately to multi-step requests given by a teacher or parent), following rules (e.g. staying seated in class), and modifying behavior (Lequia, Machalicek & Rispoli, 2012). Visual picture supports are considered to be "low technology." In fact, as seen in my early childhood classroom, low-tech visual supports help a variety of students, especially those on the spectrum. Visual supports are best defined as, (Pirtle, J. M., & West, E. A. (2014)."

Figure 3. Example of Visual Schedule used in classroom and home settings to improve following directions and predictability.

A common example of mid-range technology devices include, "battery-operated devices or electronic devices. Examples of these technologies include simple voice output devices, portable word processors, calculators, tape recorders, and timers. The skills areas addressed by these devices often include receptive language comprehension, expressive communication, social interactions, attention, organization, and classroom performance. Depending on the particular technology and the disability severity level, mid-level technology may be effective in both school and home settings." These devices are also utilized in early childhood settings, especially to supplement children that are non-verbal or limited verbally (Pirtle, J. M., & West, E. A. (2014)." A universal finding among the literature reviews included the use of Augmentative and Alternative Communication (AAC) tools for learners. The AAC approach is specifically reiterated to be useful for children with strong visual skills. 

Figure 4. Dynamic voice-output device called Tobii, considered as mid-level technology.

A high-level technology device that is commonly mentioned in the literature include, "complex technological support strategies, some of which are more costly, thus limiting their use in school and home settings. Examples include video games, virtual reality environments, computer-based learning, robotics, complex voice output devices, and video cameras (Stokes, n.d.). Evidence is abundant that high level technology may be beneficial across a range of diagnoses and ages (Baxter, Enderby, Evans & Judge, 2012) (Pirtle, J. M., & West, E. A. (2014)." The assistive technologies in this category are seen to be the most costly, and slower to be implemented due to need for training, resources, trials and time for the child and implementor to learn the tool. 

Figure 5. A product that is bringing virtual reality to autism therapy.

The three levels of technology are common empirical findings seen throughtout the literature collected for this review. These areas of assistive technology supports are frequently implemented in school settings, as well as at home when applicable. 

Although there are many positive traits about technology supplementing the world of special education, gaps in the literature do remain. Further work is needed to imply the long-term benefits of assistive technology for children on the spectrum. Many of the studies conducted only represents the short-term goals and benchmarks for students, not how to transition them from technology for the future as they mature. In fact, one implication that is not readily mentioned is the lack of social skills children expend when staring at screens. In many early childhood settings, educators are limited on "screen-time" and restrict children to be watching screen-devices. The argument poses itself, will children on the spectrum increase robot-like behavior by interacting with machines to learn? 

Further work is needed to also study the various implications of new-age tools, including technical difficulties, lack of training for staff, friends and family, as well as shortage in funds to endorse tools in school settings. Socioculture factors are also imparative, as children may not be exposed to such tools and require extensive time to explore and discover the value. Also, as the literature unraveled, it was difficult to understand the most effective tool to be utilized in an early childhood setting, as many options appear to be (i.e. computer, tablet, output devices, hand-held, robot, VR). As assistive technology is a case-by-base basis, it will be beneficial to test these tools with various children with a range of needs in the early childhood setting.

As all tools are said to be ubiquitous and transforming, they have severely lacked acknowledgement to the enhancement of applying academics. For instance, some assistive tools effeciently reinforce vocabulary, concepts and generalizations, yet overall many lack assessment in academic skills. "Only a few studies have included a control group necessary for a rigorous assessment of its efficacy. Further, understanding the capacity of these technologies for advancing academic skills is clouded by several issues such as small sample sizes, inconsistencies in how children’s behavior is assessed across studies, and heterogeneity in how ASD has been characterized among research participants. Thus, further research and more rigorous studies are needed to better understand the utility of assistive technology for facilitating the development of academic skills among children with autism (Andersen, K., Levenson, L., & Blumberg, F. C. (2014)."

To conclude, the analysis of all the literature pieces have exemplified the importance of incorporating assistive technology in education fields, especially in classrooms to enhance general education opportunities. It is implied, that with these supports children with ASD can thrive alongside typically developing peers. In fact, these new-age technologies can enhance their language and communication skills, functional skills, social interactions and other cognitive and motor abilities.

As an early childhood special educator, this research has broadened my view on the assistive technologies available to children and their families. The issue stands, after a diagnosis is given, what technologies may be considered to supplement their learning in educational settings. To expand, which technologies may be purchased and/funded and properly utilized by the child through training, education and repetition. Future researchers should consider the long-term effects of assistive technology and if the increased machine time will lead to long-term deficits or perhaps, increase skill-building with rapid technological advances in society.

As researchers and practitioners, it is our duty to continue to assess, test and evaluate children on the spectrum and problem-solve the best possible tools that can be introduced to them in order for them to thrive. The overreaching goal is to graduate students out of special education, to assimilate them into mainstream settings and garnish their independence in the real world. If assistive technology allows children on the spectrum to create meaning relationships, show self-sufficiency and motivation, and engagement with the world around them, it is to conclude that technology has improved the quality of life for our youngest, most impressionable learners.