Multipurpose Handheld Devices and Communication in Individuals with Autism Spectrum Disorder: A Meta-Analysis

Background: The development in technology has permitted the use of tablets for communication and social interactions. Tablet-based speech-generating devices (SGDs) have specific features that led to the frequent use of these devices in the AAC field, such as flexibility, availability, social acceptability, cost-efficiency, portability, and high quality. Recent systematic reviews show some common patterns about the effectiveness of utilizing tablet-based SGDs to enhance social-communication skills in individuals with autism spectrum disorder (ASD). However, the majority of systematic reviews used behavior-change indices (e.g., percentage of nonoverlap data–PND), that may provide unreliable results. Further, most meta-analyses did not mention whether tablet-based SGDs are considered an evidence-based practice (EBP).

Objectives: We aim to answer the following research questions: What is the magnitude of effectiveness of tablet-based SGDs by using rigorous nonoverlap method (i.e., nonoverlap all pairs-NAP) combined with with confidence interval (CI)? What is the level of evidence of utilizing tablets as SGDs by individuals with ASD?

Methods: Electronic databases, ancestral, and hand search were conducted to located relative studies. The studies were included based on the following criteria: (a) the study must utilize single-case experimental design (SCED) that demonstrate functional relation; (b) at least one participant with a diagnosis of ASD must be included in the study; (c) the independent variable had to be handheld multipurpose devices with AAC apps; (d) social-communication skills (e.g., requesting, labeling, answering and asking questions) had to be the main dependent variable; and (e) the study had to be published in English in a peer-reviewed journal. The studies were coded based on participants' characteristics, experimental design, setting, intervention, teaching methods, target behavioral outcome(s), quality of the single-subject research based on the quality indicators suggested by Horner et al. (2005), and effect size of treatment(s).

Results: The systematic review identified a total of 29 studies that applied tablet-based SGDs as a single treatment or as a treatment package in 81 individuals with ASD. The average NAP value for the tablet-based SGD was higher (M = 0. 90) with narrow estimated intervals (CI95% = 0.84, 0.94) compared to picture communication system (PCS) and manual sign (MS), which indicated more reliable and trustworthy effect size. Based on evaluating the quality of each study, all 29 were considered acceptable quality by the quality indicators established by Horner et al. (2005).

Conclusions: Overall, this review shows that using tablets as dedicated SGDs to teach social-communication skills met all the standards, suggested by Horner et al. (2005), to be considered EBP. Further, tablet-based SGDs display medium effects in improving different social-communication skills in individuals with ASD. The results of the review help guide future research in several directions to close the gap in the literature. Future studies should investigate whether tablet-based SGDs are best suited for infants, toddlers, and adults with ASD with a wide range of autism severity. Finally, future research is recommended to examine the stakeholders' perspectives about the effectiveness and the acceptability of tablet-based SGDs.