This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD. However, sustained use of the app over the full 6-month period was a challenge for most families.

BackgroundEvidence for early intensive behavioural interventions (EIBI) by therapists as an effective treatment for children with an Autism Spectrum Disorder (ASD) is growing. High-intensity and sustained delivery of quality EIBI is expensive. The TOBY (Therapy Outcomes by You) Playpad is an App-based platform delivering EIBI to facilitate learning for young children with ASD, while enabling parents to become co-therapists. Intervention targets include increasing joint attention, imitation and communication of children with ASD. The primary aim of the study presented in this protocol is to determine the effectiveness of the TOBY App in reducing ASD symptoms when used as a complement to conventional EIBI. The secondary aim is to examine parental attributes as a result of TOBY App use.Methods and designChildren aged less than 4;3 years diagnosed with ASD and parents will be recruited into this single-blind, randomised controlled trial using a pragmatic approach. Eligible participants will be randomised to the treatment group ‘TOBY therapy + therapy as usual’ or, the control group ‘therapy as usual’ for six months. The treatment will be provided by the TOBY App and parent where a combination of learning environments such as on-iPad child only (solo), partner (with parent) and off-iPad – Natural Environment (with parent) Tasks will be implemented. Parents in the treatment group will participate in a TOBY training workshop. Treatment fidelity will be monitored via an App-based reporting system and parent diaries. The primary outcome measure is the Autism Treatment Evaluation Checklist. The secondary outcome measures involve diagnostics, functional and developmental assessments, including parent questionnaires at baseline (T0), three months (T1) and six months (T2).DiscussionThis trial will determine the effectiveness of the TOBY App as a therapeutic complement to other early interventions children with ASD receive. The trial will also determine the feasibility of a parent delivered early intervention using the iPad as an educational platform, and assess the impact of the TOBY App on parents’ self-efficacy and empowerment in an effort to reduce children’s ASD symptoms. The outcomes of this trial may have EIBI services implications for newly diagnosed children with ASD and parents.Trial registration ACTRN12614000738628 retrospectively registered on 1st of July, 2014. UTN: U1111-1158-6423.

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The results suggest that VM was more effective than VR in facilitating learning. Implications for future research are discussed.

School students are increasingly using apps for health-related purposes, either on their own or when recommended by psychologists or counsellors, as apps offer a way to assist students to change their behaviour. However, there is a growing need for psychologists and counsellors to be able to evaluate the quality and usefulness of such apps to effect behaviour change. This study was therefore undertaken to identify methods by which school psychologists and counsellors could evaluate health-related apps for clinical use or research purposes. After examining 15 studies of apps that met the inclusion criteria, it was clear that researchers used a number of taxonomies to evaluate the apps. There were seven taxonomies identified, of which five were generalisable to all health conditions, with the behaviour change technique (BCT) taxonomy being the most comprehensive, containing 13 key behaviour strategies. Despite the utility of the taxonomies to identify the amount of behaviour change content within the apps, it was difficult to determine how the behaviour change strategies were measured, thus reducing the ability to predict app effectiveness. Approaches to improving methods by which apps can be developed and evaluated are proposed.