Feasibility of an app-based parent-mediated speech production intervention for minimally verbal autistic children: development and pilot testing of a new intervention

Abstract

Background Training speech production skills may be a valid intervention target for minimally verbal autistic children. Intervention studies have explored various approaches albeit on a small scale and with limited experimental control or power. We therefore designed a novel app-based parent-mediated intervention based on insights from the video modelling and cued articulation literature and tested its acceptability and usage. Methods Consultation with the autism community refined the initial design and culminated in a pilot trial (n = 19) lasting 16 weeks. Participants were randomly allocated an intervention duration in an AB phase design and undertook weekly probes during baseline and intervention via the app. We evaluated the acceptability of the intervention via feedback questionnaires and examined the usability variables such as adherence to the testing and intervention schedule, time spent on the app and trials completed during the intervention phase. Results High acceptability scores indicated that families liked the overall goals and features of the app. Ten participants engaged meaningfully with the app, completing 82% of the test trials and uploading data in 61% of intervention weeks; however, of these, only three met the targeted 12.5 min of intervention per week. Conclusion We discuss the possible reasons for variability in usage data and how barriers to participation could be surmounted in the future development of this intervention.

A Randomized Case Series Approach to Testing Efficacy of Interventions for Minimally Verbal Autistic Children

“…We applied this approach to evaluate a parent-mediated app-based speech production intervention for minimally verbal autistic preschoolers (n = 19). We have recently described the methods, analysis, and challenges to implementing this approach in a population of children that is difficult to recruit and has highly variable patterns of language growth (Saul and Norbury, 2020b). To our knowledge, random assignment and between-case effect size analysis have not previously been applied to a Single Case Experimental Design targeting expressive language growth in minimally verbal autistic children.…”

“…The overarching goal of the current study is to illustrate how Single Case Experimental Designs with random-assignment can be used to evaluate interventions, particularly for minimally verbal autistic children, by employing the Randomization Test and the Between Case Effect Size. To do this we use real data gathered as part of the BabbleBooster pilot project, with shared data and code (Saul and Norbury, 2020b). We illustrate how in this intervention parents could gather reliable speech attempt data, facilitating remote dense sampling using the app.…”

“…The BabbleBooster intervention app was designed to deliver predictable and repetitive speech models via video-modeling and cued articulation (Saul and Norbury, 2020b). The appplay is parent-mediated, so parents are required to watch the stimuli with their children, encourage them to make the sound, and then provide feedback on the accuracy of the production attempt in order to trigger the reward videos.…”

“…The families were encouraged to make or upload their own reward videos, based on their understanding of the individual child's interests and reward. Acceptability data and development of the app prototype are discussed in Saul and Norbury (2020b).…”

The Implementation of Application Software to Improve Verbal Communication in Children with Autism Spectrum Disorder: A Review

“…No challenging behaviors were observed upon the introduction of the apps during the intervention. However, the features and contents of the apps, particularly how interesting the tasks were to the children and the novelty of the tasks, influenced children's motivation to communicate verbally [41].…”