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Self-controlled technologies to support skill attainment in persons with an

autism spectrum disorder and/or an intellectual disability: A systematic
literature review

Article in Disability and rehabilitation. Assistive technology · May 2014

DOI: 10.3109/17483107.2014.921248

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ISSN 1748-3107 print/ISSN 1748-3115 online

Disabil Rehabil Assist Technol, Early Online: 1–10

! 2014 Informa UK Ltd. DOI: 10.3109/17483107.2014.921248

REVIEW PAPER

Self-controlled technologies to support skill attainment in persons

with an autism spectrum disorder and/or an intellectual disability:
a systematic literature review
W. L. J. E. den Brok1 and P. S. Sterkenburg1,2
Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by 145.108.209.254 on 05/22/14

1
VU University Amsterdam, FPP, Clinical Child and Family Studies and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands,
and 2Bartiméus, Department of Psychotherapy, Doorn, The Netherlands

Abstract Keywords
Persons with an autism spectrum disorder and/or intellectual disability have difficulties in Autism spectrum disorder, difficulties
processing information, which impedes the learning of daily living skills and cognitive concepts. processing information, intellectual
Technological aids support learning, and if used temporarily and in a self-controlled manner, disability, self-controlled technologies
they may contribute to independent societal participation. This systematic review examines
the studies that applied self-controlled technologies. The 28 relevant studies showed that skills History
and concepts are learned through prompting, interaction with devices, and practicing in
(realistic) virtual environments. For attaining cognitive concepts, advanced technologies such Received 19 November 2013
For personal use only.

as virtual reality are effective. Five studies focussed on cognitive concepts and two on emotion Revised 8 April 2014
concepts. More research is necessary to examine the generalization of results and effect Accepted 1 May 2014
of using technology for learning cognitive and emotional concepts. Published online 22 May 2014

ä Implications for Rehabilitation

 Persons with a moderate to mild intellectual disability and/or with autism can use self-
controlled technology to learn new activities of daily living and cognitive concepts (e.g. time
perception and imagination).
 Specific kinds of technologies can be used to learn specific kinds of skills (e.g. videos on
computers or handheld devices for daily living skills; Virtual Reality for time perception
and emotions of others).
 For learning new cognitive concepts it is advisable to use more advanced technologies as
they have the potential to offer more features to support learning.

Introduction will optimize the learning process [10,11]. Second, because

paying attention or focussing on the situation is an important
As technology has advanced rapidly over the last decade, interest
prerequisite of learning, interactive technology can stimulate and
has grown in using technology as an aid in teaching people with
retain attention [12]. Third, technology can be used to create or
cognitive disabilities new skills. Children without an intellectual
control a learning environment that is too complicated or too risky
disability (ID) learn cognitive concepts such as time perception,
to simulate. For example, in a virtual environment, Self et al. [13]
imaginative play, and theory of mind from cues given by persons
taught children with ASD how to react in an emergency situation
in the child’s environment. However, for persons with an autism
such as a fire. Practicing real-life scenarios may be important
spectrum disorder (ASD) or with ID, learning these cognitive
for persons with ASD and/or ID, who can have difficulties
concepts can be a challenge [1–5]. Technology may assist in the
recalling information and generalizing it to new experiences [14].
learning process for persons with ASD or ID [6,7]. Previous
Therefore, technology-based interventions and educational pro-
studies have shown a positive effect of using technology to
grams are effective in supporting persons with ASD and/or ID in
stimulate learning of academic, communication, employment,
attaining new skills [6,7,15,16]. Teaching people with ASD and/or
and leisure skills for persons with ASD or ID [8]. In fact, the use
ID new skills may contribute to independence and improve their
of technology has several benefits. First, it can be adjusted to meet
overall well-being [11,17].
the individual level of understanding of the person with ASD
Technology can be a permanent support or used as a temporary
and/or ID [9] so that the provided information matches needs and
aid. However, costly and time-consuming barriers such as the
continuous training of staff due to high staff turnover and
Address for correspondence: P. S. Sterkenburg, VU University
continuous support to solve and overcome equipment malfunc-
Amsterdam, FPP, Clinical Child and Family Studies and EMGO+ tions make it difficult to use technology on a permanent basis
Institute for Health and Care Research, Van der Boechorststraat 1, 1081 [18]. Thus, the focus of this paper is on technology used
BT Amsterdam, The Netherlands. E-mail: p.s.sterkenburg@vu.nl temporarily to stimulate learning.
 2 W. L. J. E. den Brok & P. S. Sterkenburg
Technology can be administered by the caregiver or by the
person with ASD or ID themselves (self-controlled). Sometimes,
the preference is given for administration by the caregiver because
of the significant amount of time needed to teach persons
with ASD and/or ID how to use technology-based equipment [19].
Yet, over time, the caregiving investment might be reduced when
the persons with ASD and/or ID themselves control the technol-
ogy. As technology advances, more self-controlled formats are
available as aids in teaching persons with ASD and/or ID new
skills without significant support needed from caregivers.
Thus, technology used as a self-controlled and temporary aid
contributes to learning new skills and greater independence for
persons with ASD and/or ID. Although many review articles on
the use of technology are available, no review could be identified
covering the kinds of self-controlled technologies that stimulate
learning and enhance independence. Thus, the aim of this
study was to analyze the literature regarding (1) mobile devices
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(e.g. PDA, iPod, and iPad), (2) robots, and (3) virtual reality (VR)
technologies in relation to learning and independence for people
with ASD and/or ID.
Method
For this systematic review, we performed a comprehensive
literature search. To include recently developed technologies,
this systematic search was conducted for articles published
between 1996 and September 2011. Because few studies have
focussed on the use of technology in the education or intervention
for persons with ASD and/or ID prior to 1996, we used that
year as our starting point. The following databases were used:
For personal use only.
Psychinfo, PubMED, and ERIC. Articles, technical reports,
literature review studies, and articles summarizing the current
theme were included. Only English language papers were
included.
The specific key words used in the search were mental
retardation, intellectual disability(ies), autism, autistic, multiple
disabilities, and developmental disability(ies) paired with key
terms for each of the potential technologies: personal digital
assistant (PDA), handheld, palmheld, palmtop, video(s), robot(s),
robotics, VR, 3D, smartphone, short message service, tele-
phone(s), phone(s), tablet(s) iPod(s), and iPad(s).
Inclusion criteria were moderate to mild ID and/or ASD,
technology used as intervention, and technology suitable for
use during daily activities. Because this paper focuses on self-
controlled and temporary use of technology research studies, the
IQ criteria were set at moderate to mild ID because members
of this population can use technology independently without
continuous support by others. The literature review articles
matching the above-mentioned keywords were also selected. The
exclusion criteria were severe or profound ID or multiple
disabilities (e.g. deaf-blindness); technology used as a medical
assessment tool; technology used in the research procedure but
not as an intervention (e.g. as a guidebook); technology used to
support speech/writing; technology used in an irrelevant context
(e.g. computer games); and articles with no clear description
of independent use of the technology. The characteristics of the
technology were examined by first labeling the reasons mentioned
in the articles for using technology. These labels were categorized
and themes were assigned to each category. The first and second
authors performed this task separately. When there was a
difference in scoring, consensus was reached.
Results
The selection process was as follows (see Figure 1): at first, titles
identified by the search strategy (N ¼ 911) were matched with
the criteria, followed by matching abstracts with our criteria
Disabil Rehabil Assist Technol, Early Online: 1–10
(n ¼ 388). Second, full copies of all 104 identified articles were
examined. From this search, 38 articles were identified of which
14 were literature review articles. From the review articles, four
relevant studies were hand selected. In total, 28 studies were
identified and included in the review. The screening and selection
of articles was done by the first author; reliability tests were
performed by the second author. The inter-rater agreement for the
selection of titles was 91% (Cohen’s kappa ¼ 0.81). The inter-rater
agreement for the abstracts was 84% (Cohen’s kappa ¼ 0.66), and
for the full-text articles, the inter-rater agreement was 94%
(Cohen’s kappa ¼ 0.80). All studies that met the inclusion criteria
were coded in terms of author(s) and year of publication, sample,
experimental design, target skill being taught, type of technology,
features of the technology, effect of the intervention, and
generalization. These studies recruited participants mainly from
the USA and Europe.
Most articles were (68%) published in the past 5 years. The
studies had a single case design with N ¼ 1–11, with the exception
of a between-subjects design study with N ¼ 87 done by Passig
[5]. Table 1 summarizes the results for the learning strategies,
skills and concepts, and features of technologies. Technology was
used to support three different learning strategies: (a) learning
by prompting, mentioned in 13 articles and resulting in a total of
13 newly acquired skills (in one article, three different skills were
taught); (b) learning through interaction with robots, mentioned in
six articles; and (c) learning by practicing in the present, in a real
life or virtual daily living situation, which was mentioned in eight
articles. The used technologies were videos on computers, videos
on handheld devices, pictures on handheld devices, robots,
and VR. No articles using mobile phones or iPads matched the
inclusion criteria; therefore, mobile phones and iPads are not
included in this review. The identified articles on mobile phones
and iPads focussed on the use of the device instead of the device
as supporting learning. We divided skills into nine types, which
were then categorized into activities of daily living or cognitive
concepts. We found the following activities of daily living: daily
living skills (e.g. preparing a hotdog in a microwave), vocational
skills (e.g. folding a pizza box), transitioning within tasks,
transitioning between tasks, engagement (e.g. following eye
gazing), and safety (e.g. street crossing). The cognitive concepts
mentioned were social convention skills (e.g. reasoning about
where to sit), time perception (e.g. putting sequential actions in
the right order), and imagination (e.g. using objects in an irregular
way). Some of the cognitive concepts were emotionally oriented,
such as concepts about understanding the emotions of others by
asking users to empathize with the emotion of an avatar in a
particular situation [20,21]. The themes on features
of technologies were the representation modes (e.g. using a
combination of modalities such as visual and auditory senses,
visual-based information or action-based information), interactiv-
ity, individualization of treatment, and ecological validity.
The studies were conducted with participants between the ages
of 1 and 23.
Features of technologies
The reasons mentioned in the 28 articles for using the technology
resulted in main themes and sub-themes (Tables 2–4). The four
main themes were the representation modes used (found in 15
articles), interactivity (found in 9 articles), individualization of
treatment (found in 19 articles), and ecological validity (found
in 16 articles). Choosing a particular technology because previous
research used it was mentioned in six articles and was the only
reason given in two of the six articles.
Regarding the first theme – ‘‘representation modes used’’ –
researchers often mentioned that their technology enriched the
 DOI: 10.3109/17483107.2014.921248
Figure 1. Diagram of the process of selection
of the literature for the systematic review.
Self-controlled technologies and skill attainment 3
Articles screened on relevance of Articles excluded: n=491
title: 911 Reasons: no technology as intervention,
focussing on medical assessment, no
participants with ASD/ID, not focussing on
support in acquiring a new skill,
participants with severe intellectual or
multiple disabilities, focussing on
changing the medium of therapist
communication (e.g., webcam, email, or
switches), no evaluation of the effect of the
intervention.

Articles screened on relevance of

abstract: 388

Articles excluded: n=284

Reasons: In addition to earlier used
criteria: not focussing on a relevant context
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for daily living (e.g., computer games).

focussing on teaching language skills
(write/read/speech), focussing on
hypnoses.

Full-text articles screened for

relevance: 104
Articles excluded: n=66
Reasons: Not controlled by the participant
and not focussing on supporting the
attainment of new skills. Technologies
used as a supporting technology instead of
a supporting technology in learning.
If different studies were performed with
For personal use only.

the same device, the most valid study was

Final number of articles included in
systematic review: 28 (24 studies +
4 hand-selected studies)
included.
From the 14 relevant review articles and
the literature lists of the 26 articles, the
studies that were not yet included in the
dataset were hand selected and added if not
yet included: n=2.

Table 1. A summary of the results on the learning strategies, skills and concepts, technology and features.

Technology features and skills

Learning style
Technologies Video on computer Video on handheld Picture on handheld Robots Virtual Reality

Features
(1) Representation modes used (1) (1) (1)
(2) Interactivity (3) (2) (2)
(3) Individualization of treatment (4) (3) (3)
(4) Ecological validity (4)
Prompting Skills
Daily living 3 2
Vocational 2, 1* 3
Transitioning within tasks 1 1*
Transitioning between tasks 1, 1*
Robots Engagement 6
Virtual environment Daily living 1
Safety 3
Social reasoning 1**
Understanding emotions of other 2**
Time perception 1**
Imagination 1**

*Three skills one study.

**Cognitive skill.

training environment because it added visual or auditory infor- modes facilitates learning when compared with using only
mation. Although persons with ASD typically respond to a single representation mode [23–25]. Thus, adding more
visual input as their primary source of information [22], the modes of representation to the instruction materials improves
general consensus is that a combination of different representation learning [26–28].
 Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by 145.108.209.254 on 05/22/14
For personal use only.
4

Table 2. Summary of articles on video/computer/PDA, indicating sample, design, skill, technology and features, and outcomes (N ¼ 11).

Sample, age, sample

Reference size, origin Design Skill Technology Features noteda Outcome of study Outcome of generalization
Burke et al. [46] ASD, age: 18–27, ABC, A: no intervention, B: Prompting: vocational task Picture on PDA 3a, 4d Task performance was Some decrease in task per-
N ¼ 3, USA training nearly fully achieved for formance for one out of
two out of three one
Cihak et al. [43] ASD, age: 6–8, ABAB, A: no intervention Prompting: transitioning Video on PDA 1b, 4b Task performance was Some decrease in task
N ¼ 4, USA between tasks nearly fully achieved performance
Cihak et al. [45] ASD, age: 11–13, ABAB multiple baseline, Prompting: vocational task Picture on PDA 1b, 3a, 4b, 4d Task performance was fully Task performance barely
N ¼ 3, USA A: no intervention achieved maintained
Dauphin et al. [35] ASD, age: 3, N ¼ 1, BA, A: notebook schedule Prompting: transitioning Video on computer 5 Task performance was First improvement over
USA within task nearly fully achieved time then decline in task
W. L. J. E. den Brok & P. S. Sterkenburg

performance
Davies et al. [44] ID, age: 18–70, Two group within-subjects Prompting: vocational task Picture on PDA 3a, 4b, 4d Significantly fewer errors n.a.
N ¼ 10, USA and prompts needed
Mechling et al. [39] ASD, age: 16–17, ABABAB multiple base, A: Prompting: daily living Video on PDA 1b, 3a, 4b, 4d Task performance was fully No decline in task
N ¼ 3, USA recipe on paper achieved performance
Mechling [33] ID, age: 15–17, ABAB, A: recipe on paper Prompting: daily living Video on PDA 1a, 3a, 4b, 4d Task performance was No decline in task
N ¼ 3, USA nearly fully achieved performance
Mechling and ASD, age: 14, N ¼ 3, ABABA multiple base, A: Prompting: vocational, Video on PDA 1b, 3a, 4d, 5 Task performance on voca- No decline in task
Savidge [40] USA picture-based task strip transitioning between tional task and within performance
tasks and within task task transitions were
nearly fully achieved.
Task performance
between task transitions
was not achieved
Taber-Doughty et al. ID, age: 13–15, ABABA, A: cards with Prompting: vocational task Video on PDA 3a, 5 Task performance was Some decline in task per-
[41] N ¼ 3, USA numbers nearly fully achieved formance for two of the
three participants
Van Laarhoven et al. ASD + ID, age: 13– ABA, A: no intervention Prompting: daily living Video on computer 1b, 5 Task performance was No decline in task
[36] 14, N ¼ 2, USA nearly fully achieved performance
Van Laarhoven and ID, age: 17–19, Three group within-sub- Prompting: daily living Video on computer 1a, 3a, 4a, 4d Task performance was Some decrease in task per-
Van Laarhoven- N ¼ 3, USA jects, ABA, A: no nearly fully achieved formance over time
Myers [37] intervention
Van Laarhoven ID, age: 12–17, Pre-test, 3 participants Prompting: daily living Video on computer 5 Task performance was No decline in task
et al. [38] N ¼ 2 USA within-subjects, general- nearly fully achieved performance
ization test, pre-test: no
intervention generaliza-
tion test
Van Laarhoven ID, age: 17, N ¼ 1, AB, A: no intervention Prompting: vocational task Video on PDA 3a, 4c, 4d Task performance was n.a.
et al. [38] USA nearly fully achieved
a
1: representation modes used (1a: combination of modalities, 1b: visual-based information, 1c: action-based information); 2: interactivity (2a: appealing); 3: individualization of treatment (3a: repeatability,
3b: adjustability, 3c: simplicity); 4: ecological validity (4a: offering a learning opportunity, 4b: portability, 4c: social acceptability, 4d: self-manageability); 5: previous research.
Disabil Rehabil Assist Technol, Early Online: 1–10
 DOI: 10.3109/17483107.2014.921248 Self-controlled technologies and skill attainment 5

1: representation modes used (1a: combination of modalities, 1b: visual-based information, 1c: action-based information); 2: interactivity (2a: appealing); 3: individualization of treatment (3a: repeatability, 3b:
generalization
Outcome of
Interactivity was often reported as the reason for using that
specific kind of technology. Riva [12] mentioned that interactive

n.a.

n.a.

n.a.

n.a.

n.a.

n.a.
interventions stimulate persons to focus on a task. In other words,
the interactivity of the technology supports learning a task.
One way to be interactive is to offer some control over the
is environment and, because of the ‘‘simulation technology’’,

is

is

is

Explorative, engagement is

Explorative, engagement is
provide the opportunity to be actively involved, e.g. in treatment
Explorative, engagement

Explorative, engagement

Explorative, engagement

Explorative, engagement
of stress management or anxiety [29]. Interactivity can be
Outcome of study

stimulated by appealing technology or technology with interesting

features such as moving parts or remarkable colors [30].
Individualization of the intervention by using technology
stimulated

stimulated

stimulated

stimulated

stimulated

stimulated

adjustability, 3c: simplicity); 4: ecological validity (4a: offering a learning opportunity, 4b: portability, 4c: social acceptability, 4d: self-manageability); 5: previous research.
was an important theme. Some kinds of technology can adjust
the information so that it meets the needs of the individual.
Technology offers some form of control and allows participants to
repeat the learning material as often as necessary, depending on
their own needs. Meeting the needs of the participant facilitates
the learning process [6].
1b, 2a, 2, 3b, 3c
Features noteda
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Many researchers stressed the importance of ecologically

1c, 2

2a, 5
2, 3c

2, 3c

valid technology. Technology that closely resembles real-world

3c

situations can facilitate learning because cues from the natural

environment help to trigger the implementation of previously
learned skills. The ecological validity of the technology was
mentioned in studies in which the learning opportunity would
Technology

otherwise be too difficult or unsafe to realize, such as learning

Robot

Robot

Robot

Robot

Robot

Robot

how to cross the road [31]. Technology that is suitable for use
in day-to-day life – because of portability, self-manageability,
or greater social acceptance – contributes to using the technology,
which in turn facilitates learning.
Table 3. Summary of articles on robots, indicating sample, design, skill, technology and features, and outcomes (N ¼ 6).

Interaction/

Interaction/

Interaction/

Interaction/

Interaction with robot: Interaction/

Interaction with robot: Interaction/

For personal use only.

Prompting by computers and personal digital assistants

Prompts are cues presented to the learner to display a desired
response in specific situations; these include vocal, physical,
Interaction with robot:

Interaction with robot:

Interaction with robot:

Interaction with robot:

Skill

play/engagement

play/engagement

play/engagement

play/engagement

play/engagement

play/engagement

gestural, written/pictorial, and signed prompts [32]. Prompts are

useful when participants have difficulty in connecting an appro-
priate response to naturally occurring cues. For many persons
with ASD and/or ID, it is rarely sufficient after prompting a few
times to discontinue the prompting because extra training is
needed to fade out the prompts so that the individuals can perform
the skills without assistance. Prompt fading involves withdrawing
prompts gradually in small steps over a series of learning
opportunities. This process is necessary because stimulus control
must be transferred from the prompt to the natural stimulus.
engagement (CARS)
Pre-test, intervention,
pre-test: rating on

Technological advancements in the functionality of personal

digital assistants or iPods (small mobile handheld devices
commonly used for organization and tracking of daily tasks; in
short, handheld devices) and other devices (such as laptops) have
Sessions

Sessions

Sessions

Sessions

Sessions

created the potential to deliver the same level of prompting with

Design

less human interaction and obtrusiveness and often less human

effort in managing prompt delivery. This technology increases
participant independence while also decreasing teaching time. In
other words, self-prompting removes the need for external
ID, age: 5–10, N ¼ 3,
Sample, age, sample

ASD + ID, age: 1–3,

prompting to tell participants what to do and when to do it [33].

N ¼ 4, Canada

ASD, age: 7–20,

N ¼ 4, France

N ¼ 11, USA
size, origin

ASD, age: 5–8,

ASD, age: 4–5,

ASD, age: 7–9,

N ¼ 3, Japan

Several technological tools can be used to deliver a prompt.

N ¼ 4, Italy

These include videocassette recorders, computers, and handheld

devices (PDAs/iPods). Most of the video-modeling research
UK

studies incorporated the use of a television with a videotape

recorder [34], which often was not used as a self-prompting
device and were not self-controlled. Computers and PDAs are
often self-manageable and can be used independently.
Duquette et al. [48]

Kozima et al. [50]

Pioggia et al. [51]

Stanton et al. [53]

Computers or handheld devices were used for several

Robins et al. [52]
Giannopulu and

reasons (Table 2): They can simulate one or more representation

Pradel [49]

modes (7 of the 11 articles, e.g. the presentation of information

References

is visual), and they can support ecological validity (9 of the

13 articles, e.g. portability or self-manageability). Another
feature named by researchers was the individualization of
a
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For personal use only.
6

Table 4. Summary of articles on virtual reality, indicating sample, design, skill, technology and features, and outcomes (N ¼ 9).

Sample, age, sample Outcome of

References size, origin Design Skill Technology Features noteda Outcome of study generalization
Cheng et al. [21] ASD, age: 8–10, N ¼ 3, AB, A: no intervention Practice in the present: Virtual reality 3b, 4a Score on test improved n.a.
Taiwan emotion of other
Cheng and Ye [20] ASD, age: 8–9, N ¼ 3, AB, A: no intervention Practice in the present: Virtual reality 3, 4a, 4f, Score on test improved n.a.
Taiwan emotion of other
W. L. J. E. den Brok & P. S. Sterkenburg

Herrera et al. [3] ASD, age: 8–15, N ¼ 2, Pre-test, intervention, Practice in the present: Virtual reality 1b, 2, 3a, 3b, 3c Ratings on test improved. Study involved a post-
Spain post-test, post inter- imagination Post interviews indicated test.
views with parents positive results for one
of the two participants
Josman et al. [31] ASD, age: 8–16, N ¼ 6, Pre-test, intervention, Practice in the present: Virtual reality 4a, 4f Ratings on test improved, Study involved a post-
Israel post-test safety but task performance test.
was not fully achieved
Mitchell et al. [57] ASD, age: 14–15, N ¼ 6, Within-subjects design, Practice in the present: Virtual reality 4a Ratings on test improved Study involved a post-
USA post-test: with video social skill test.
of a real coffee shop
and a bus
Passig [5] ID, age: 9–21, N ¼ 87, Pre-test, three group, Practice in the present: time Virtual reality 1a, 2, 3b, 3c, 4a Score on test improved Study involved a post-
Israel between-subjects, perception test.
post-test
Self et al. [13] ASD, age: 6–12, N ¼ 8, AB, A: conventional Prompting: safety Virtual reality 1a, 1b, 2a, 2, 3a, 3b Task performance Study involved a post-
USA training improved, but all stu- test.
dents still needed some
guidance
Strickland et al. [56] ASD, age: 5–9, N ¼ 2, Sessions Prompting: safety Virtual reality 1b, 3c, 3b, 4a Explorative, cars were n.a.
USA identified
Tam et al. [58] ID, age: 18–23, N ¼ 8, Pre-test, intervention, Practice in the present: Virtual reality 2, 4a Ratings on test improved, No decline in task
Hong Kong post-test daily living but task performance performance
was not fully achieved
a
1: representation modes used (1a: combination of modalities, 1b: visual-based information, 1c: action-based information); 2: interactivity (2a: appealing); 3: individualization of treatment (3a: repeatability, 3b:
adjustability, 3c: simplicity); 4: ecological validity (4a: offering a learning opportunity, 4b: portability, 4c: social acceptability, 4d: self-manageability); 5: previous research.
Disabil Rehabil Assist Technol, Early Online: 1–10
 DOI: 10.3109/17483107.2014.921248
treatment (9 of the 13 articles, e.g. the device can be used to
repeat prompts as often as needed). Although self-prompting
often involves the participant in starting and stopping the
prompting material, only starting and stopping is a very restricted
way of interaction.
Prompting videos on computers
Four articles are included in this review that used videos on
a computer (a laptop) as a self-prompting device [35–38].
Videos can be used for ‘‘video modeling’’ or ‘‘video prompting’’.
With video modeling, the entire video was shown to participants
to teach them how to perform a task, which differs from ‘‘video
prompting’’, where video fragments are shown step-by-step.
Two types of skills were taught through ‘‘video modeling’’ and
‘‘video prompting’’ (Table 1): daily living skills [36–38] and
transitioning within tasks [34]. These skills are considered to be
‘‘concrete’’ in nature.
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Van Laarhoven et al. [36–38] and Dauphin et al. [35] broke the
skill sequences into short video segments for each step; for
example, the steps to microwave a hotdog. In the study by
Van Laarhoven et al. [38], participants first had to watch the entire
sequence before engaging in the task (i.e. video modeling).
Van Laarhoven et al. [37] used three conditions: video modeling,
ability to access photos during task engagement, or engaging in
the task after each step shown. This last setup was also used
in the study by Dauphin et al. [35]. The results showed that videos
on a computer can improve task performance in the intervention
phase. Although the study by Dauphin et al. [35] showed that
tasks can be mastered, the studies by Van Laarhoven and
For personal use only.
colleagues showed that most participants still needed some level
of prompting in the naturalistic setting.
In addition, Van Laarhoven et al. [37] mentioned that
participants no longer used the prompting devices as they
became more independent in performing the tasks. However,
although they left the computer to perform the task, participants
still relied on the computer for prompts and could not perform the
task independently. Thus, the participants might have over-
estimated their own skill levels or possibly had difficulties
attending to the instruction materials.
The above studies showed that overall participants performed
reasonably well after the intervention. However, the studies by
Van Laarhoven et al. [36–38] showed that after a few weeks, when
participants performed the tasks without technological support,
the level of task performance had decreased. In contrast, in the
study by Dauphin et al. [35], technology-based prompts were
gradually withdrawn and transferred to self-managed cues from a
paper-based notebook schedule, which further improved perform-
ance on scheduled tasks. Thus, the level of independent task
performance without prompting may decrease over time.
However, prompting, regardless of type, has been shown to
improve performance over time.
Prompting videos on a handheld device
Five articles included in this review used videos on a handheld
device as a self-prompting device. The types of skills taught using
videos on handheld devices were (Table 1) daily living skills
[33,39], vocational skills [40–42], transitioning within tasks [40],
and transitioning between tasks [40,43]. All these skills are
considered to be ‘‘concrete’’ in nature.
Taber-Doughty et al. [41] evaluated video modeling during task
engagement. In studies by Cihak et al. [43] and Van Laarhoven
et al. [42], participants first had to watch the video before
engaging in the task. Mechling et al. [33,39] and Mechling and
Savidge [40] evaluated video prompting prior to task engagement
and used it in combination with auditory and picture prompting.
Self-controlled technologies and skill attainment 7
That is, persons could choose to progress to the next photograph
without receiving further prompts. The combined prompting
system in this study allowed for adaptations as each individual’s
need for prompts changed.
Most of the above studies, except the study done by Van
Laarhoven et al. [42], used some form of additional prompting
besides the technology in the form of either a task strip [40],
recipe on paper [33,39], cards with numbers [41], or a prompt by a
caregiver at the beginning of the task sequence [43]. By using
these extra prompts, overall and after some practice, video on
PDA was effective for achieving the mastery of tasks with or
without help from this technology. However, Mechling and
Savidge [40] did not obtain the same result for between-task
transitions because without the technology, all the participants did
not return from the independent workstation to the starting
location.
Another important contribution of the studies conducted by
Mechling et al. [33,39,40] was that participants were in control of
the level of prompting (picture only, picture and auditory, video)
they needed or preferred. In addition, as shown by Mechling
and Savidge [40], participants used more intrusive prompts
(e.g. looking at the video) during transitions between and within
tasks. Although the results above are promising, all the studies
measured performance without the technology only shortly after
the intervention phase; therefore, information on the effects over
a longer period of time is not available.
Pictorial cues on a handheld device(s)
Another way to use technology for prompting is to use pictures on
a handheld. Davies et al. [44] and Cihak et al. [45] used pictures
on a PDA as a self-prompting device. Burke et al. [46] used
pictorial cues on an iPod as a prompting device.
Pictures or pictorial cues on handheld devices in these studies
were used for learning vocational skills. Davies et al. [44] used
one picture and an audio file for every aspect of learning the new
task. Cihak et al. [45] used a photo slideshow with photos
of themselves engaging in the task. When a photo was shown,
a yes/no question was asked about whether they were engaged
in the task or not. Burke et al. [46] used cues during task
engagement to prompt them to take the next step. Both studies
achieved an increase in independent responding during the
intervention. Cihak et al. [45] and Burke et al. [46] tested for
generalization shortly after the intervention and showed
that task engagement decreased without the handheld. This
result is in correspondence with the results of Van Laarhoven
et al. [37].
Interaction with robots
The second learning strategy involves learning through interaction
with robots. The robot creates a situation that encourages a
process of interaction, thereby stimulating interest in the outside
world. This step in turn leads to developing and increasing
interaction, communication, and social skills [47]. People with
ASD and/or ID can have problems with understanding and
showing interest in the outside world. Therefore, the use of
robots can be a helpful intervention for stimulating interaction,
communication, and social skills for children and adults with
ASD and/or ID.
The studies showed that the most common arguments for using
robots as technology were (Table 3) an individualized treatment
(four of the six articles, e.g. robots can be easier to understand
than humans), the ability to be interactive (five of the six articles,
e.g. robots can react to the user), and the ability to simulate one or
more representation modes, which only two studies mentioned
(e.g. robots can be appealing, robots can be physically interacted
 8 W. L. J. E. den Brok & P. S. Sterkenburg
with). However, the argument that robots can support ecological
value was not mentioned in any study.
Robots are electromechanical machines that can perform
tasks automatically or with guidance, typically by remote control.
The level of complexity of their actions and appearance can be
adjusted to match individual skill level. Robots can consist of
simple elements and at the same time be interactive.
Six studies used robots as an intervention focussed mainly on
teaching engagement [48–53]. Engagement is considered to be
more ‘‘concrete’’ in nature.
In the last decade, different kinds of robots were developed
with all kinds of shapes and abilities. Some appeared as a doll
(e.g. Robota [52]), a dog (e.g. Aibo [53]), something creature-like
(e.g. Keepon [50,]; Tito [48]), something human-like (e.g. face
[51]), or very basic with a neutral smiley drawn on a plastic sheet
(e.g. Gipsy [49]). Some robots were remote-controlled (e.g.
Keepon, Tito, Gipsy), and others could respond to touch, motion,
Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by 145.108.209.254 on 05/22/14
and/or sound (e.g. Robota) or responded to infrared (e.g. Aibo).
Some could even respond to vital signs (e.g. face). Most studies
were exploratory in nature, and the interactions were usually
tested through the analysis of physical and verbal interactions,
avoidance or fleeing, visual pursuit, and/or whether the child
imitated the robot. These studies showed that robots using
different stimulations encouraged interaction in children with
autism. In addition, the studies indicated that robots stimulate the
social development of children because affective touching,
imitation, and expressing emotions towards the robot were
encouraged [50–53]. Furthermore, they were persuaded to
wonder and reason about the emotional state of the robot [50],
which indicates that learning social skills can be stimulated by
For personal use only.
interaction with robots. Although the results above are promising,
the studies did not check for effects in real life without the robots;
therefore, no information about generalization or long-term effect
is available.
Practice in the virtual environment using virtual reality
The third learning strategy involves learning through practice
in the virtual environment. According to Riva [12], the more
a person can enact intentions in a successful action, the more
the person is present, making it easier to focus and use more of
his/her senses, which facilitates learning [54]. Although several
technologies are available – e.g. mobile and wireless communi-
cation systems, speech interfaces, 3D social virtual environments
– that can provide learning by practicing in the present [55],
in this literature study, only VR was found to be used as
technology for practicing in the present.
VR can present 3D information live in real time. It is a
computer simulation using graphics to create an artificial world
where a person can hear, see, touch, and communicate with other
objects and figures by using visual, audio, or haptic devices.
Six out of nine studies showed that the most common
argument for choosing VR was the opportunity to individualize
the treatment to the participant (e.g. the environment can be
simplified). Other frequently mentioned arguments to use VR
were four out of nine articles noted interactivity (e.g. users can
control the environment), seven out of nine articles mentioned
ecological validity (e.g. VR can be as realistic as the real
environment), and four out of nine articles reported the ability to
simulate one or more representation modes (e.g. VR can present
visual and audio information).
Different types of skills were taught (Table 4): safety skills
[13,31,56], social conventions [20,21,57], time perception [5],
and imagination [3]. VR was used in a variety of ways, such as on
a laptop [13,20,21,57], touch screen [3,58], or head-mounted
display [56].
Disabil Rehabil Assist Technol, Early Online: 1–10
Although all the studies offered an environment in which
participants could explore the virtual environments, the advan-
tages of VR were exploited in a variety of ways as well, for
instance by presenting rare situations [13,57], offering a safe
situation [31,56], and emphasizing objects in the environment
to make abstract concepts more concrete [3,5]. The ‘‘time’’
concept, for example, was made more concrete by showing the
sequence of baking a cake [3].
In some of the above-mentioned studies, the effect of
the intervention was measured by observing the participant’s
appropriate behavior in a real-life setting similar to the interven-
tion setting, shortly after the intervention [3,13,31,58]. Cheng and
Ye [20] and Cheng et al. [21] examined the effect of the
intervention by using qualitative observations as it took place.
Performance on tests not similar to the intervention phase
was also analyzed. Mitchel et al. [57] observed the participants
while they were watching a video of a café or bus and then, during
the interview, asked about their reasoning for the choices they
made. Cheng and Ye [20] and Cheng et al. [21] used questions
about the emotions of others to test for performance. Passig [5]
asked the participants to order pictures to measure organizational
skills. The study by Strickland et al. [56] was exploratory in
nature and examined if participants could recognize the VR
setting as a realistic practicing setting, and no quantitative study
was added. The results of these studies indicate that VR can
increase knowledge and skills, some of which can be transferred
and used in new settings. Although the results above are very
promising, only a few participants fully mastered the new skills;
most participants still needed extra support to complete the
tasks [13,31], indicating that the generalization of skills remains
to be examined.
Discussion
The aim of this literature review was to analyse the use of self-
controlled technologies that support learning for persons with
ASD and/or moderate to mild ID. In general, there is scien-
tific evidence that technology supports learning of activities
of daily living (e.g. daily living skills) and cognitive concepts (e.g.
time perception, imagination) in children and adults with ASD
and/or moderate to mild ID. The results of the studies showed that
task performance increased during the intervention phase and that
it can be maintained but might decline during the follow-up.
Looking at which technologies were used to support learning
and in what way they contributed to gaining new skills, the results
showed that videos on computers or handheld devices (or pictures
on handheld devices) were commonly used to prompt and were
mainly used to teach activities of daily living such as daily living
skills, vocational skills, and transitioning within and between
tasks. In addition, the results of Mechling et al. [33,34,39] showed
that participants may need more intrusive prompts for more
difficult tasks (e.g. videos instead of pictures on a PDA). Learning
through interaction with robots was commonly used to stimulate
play and engagement. VR was mainly used to create an
environment to practice in the present, most commonly to support
learning cognitive concepts such as time perception, imagination,
or the emotions of others. Thus, the results indicate that
specific kinds of technologies were used to learn specific kinds
of skills.
Furthermore, each kind of technology has its own features to
support learning. VR generally has the most features because it
can simulate one or more representation modes, be interactive,
adapt the treatment to the individual needs of the user, and be
described as ecologically valid technology. Video on computers
or PDAs and pictures on PDAs usually do not possess the feature
of interactivity. Robots usually do not have the feature of
 DOI: 10.3109/17483107.2014.921248
supporting ecological validity. Videos on computers or
handheld devices (or pictures on handheld devices) are less
advanced techniques than VR, indicating that more advanced
techniques have the potential to offer more features to support
learning.
Although which features and technologies are most effective
in teaching a target skill has not been investigated, researchers
seem to have a preference for using specific technologies to
teach certain types of skills. That is, activities of daily living
are most often taught using videos on a computer or handheld
device (or pictures on a handheld device), engagement by robots,
and cognitive concepts by VR. The chosen target skills, therefore,
determine the type of technology.
This review demonstrates not only that technology can support
learning for persons with ASD and/or ID but also demonstrates
which technology supports which kind of learning strategy.
Furthermore, this study shows that technology facilitates
Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by 145.108.209.254 on 05/22/14
learning in different ways depending on the features the technol-
ogy possesses. To our knowledge, this review is the first that
categorized these important aspects of technology and should be a
valuable resource for researchers who want to optimize the use of
technology when teaching a skill.
One of the limitations of the reviewed studies is that although
16 studies examined whether specific knowledge and skills were
transferred outside the intervention setting, only 10 studies
checked whether this occurred in the target setting without any
support. Another limitation is that although most results are
promising, extra guidance was often needed to achieve optimal
improvement. Perhaps a longer intervention period would be
more successful in achieving full mastery of new skills.
For personal use only.
Although the current study provides some essential insights,
gaps exist. First, it is not clear whether certain technologies or
features of these technologies are more effective than others.
Second, because of limited or absent follow-up measures over a
longer period of time, to what extent specific knowledge and
skills are transferred and applied in new settings is unclear.
Third, determining whether other kinds of technologies
(e.g. mobile communication systems) can provide the same
features for learning a target skill or can provide practicing in the
present remains inconclusive. Fourth, many studies focus on
learning activities of daily living. However, training purely
on activities of daily living decreases generalization [59]
while training on concepts enhances generalization. In a study
by Steerneman [60], for example, the training of perspective-
taking improved social skills as well as emotional skills
outside the intervention setting. Thus, through training of
emotional and cognitive concepts, specific knowledge and
activities of daily living might be more easily transferred and
used in new settings.
This review has found promising advances in using technology
to support attaining new daily living skills and cognitive concepts
(e.g. time perception, imagination) in persons with ASD and/or
moderate to mild ID. It seems that most studies involved school-
aged participates. Thus, more research involving older persons
with ASD and/or ID will contribute to a better understanding of
the use of technology in relation to learning and independence.
Only a few reports were found on using technology to stimulate
the understanding of emotions. More research on using technol-
ogy to teach skills with an affective component to persons with
ASD and/or ID may support their participation in society and add
to their overall well-being.
Acknowledgements
The authors would also like to acknowledge the valuable
discussions with Prof. Dr. C. Schuengel during the study.
Self-controlled technologies and skill attainment 9
Declaration of interest
This study received funding from ZonMW-InSight, a Dutch
association promoting application-oriented research to support the
needs of people with a visual impairment (Grant no. 2011/18604/
ZONMW).
References
1. Baron-Cohen S. The theory of mind hypothesis of autism: a reply to
Boucher. Br J Dis Commun 1989;24:199–200.
2. Benson G, Abbeduto L, Short K, et al. Development of a theory of
mind in individuals with mental retardation. Am J Ment Retard
1993;98:427–33.
3. Herrera G, Alcantud F, Jordan R, et al. Development of symbolic
play through the use of virtual reality tools in children with autistic
spectrum disorders: two case studies. Autism 2008;12:143–57.
4. Jarrold C, Boucher J, Smith P. Symbolic play in autism: a review.
J Autism Dev Disord 1993;23:281–307.
5. Passig D. Improving the sequential time perception of teenagers
with mild to moderate mental retardation with 3D Immersive Virtual
Reality (IVR). J Educ Comput Res 2009;40:263–80.
6. Huang AX, Wheeler JJ. Effective interventions for individuals
with high-functional autism. Int J Spec Educ 2006;21:165–75.
7. Standen PJ, Brown DJ. Virtual reality in the rehabilitation of people
with intellectual disabilities: review. Cyberpsychol Behav 2005;8:
272–82.
8. Kagohara DM, van der Meer L, Ramdoss S, et al. Using iPodsÕ and
iPadsÕ in teaching programs for individuals with developmental
disabilities: a systematic review. Res Dev Disabil 2013;34:147–56.
9. Schopler E, Mesibov GB, Hearsey K. Structured teaching in the
TEACCH system. Learning and cognition in autism. New York:
Plenum Press; 1995:2243–68.
10. Scherer MJ, Glueckauf R. Assessing the benefits of assistive
technologies for activities and participation. Rehabil Psychol 2005;
50:132–41.
11. Scherer MJ. Assistive technologies and other supports for people
with brain impairment. New York: Springer Publishing Company;
2012.
12. Riva G. From virtual to real body: virtual reality as embodied
technology. J CyberTherapy Rehabil 2008;1:7–22.
13. Self T, Scudder RR, Weheba G, Crumrine D. A virtual approach
to teaching safety skills to children with autism spectrum disorder.
Top Lang Disord 2007;27:242–53.
14. Numminen H, Service E, Ahonen T, et al. Working memory
structure and intellectual disability. J Intellect Disabil Res 2000;44:
579–90.
15. Ayres KM, Langone J. Intervention and instruction with video for
students with autism: a review of the literature. Educ Train Dev
Disabil 2005;40:183–96.
16. Hitchcock CH, Dowrick PW, Prater MA. Video self-modeling
intervention in school-based settings: a review. Rem Spec Educ
2003;24:36–45.
17. Sigafoos J, O’Reilly M, Cannella H, et al. Computer-presented video
prompting for teaching microwave oven use to three adults with
developmental disabilities. J Behav Educ 2005;14:189–201(13).
18. Coupley J, Ziviani J. Barriers to the use of assistive technology for
children with multiple disabilities. Occup Ther Int 2004;11:229–43.
19. Meijer S, Woittiez IB, Ras M. Verstandelijke handicap: Welke zorg
gebruiken patiënten en wat zijn de kosten? In: Volksgezondheid
Toekomst Verkenning. Bilthoven: RIVM; 2010. Available from:
http://www.nationaalkompas.nl/gezondheid-en-ziekte/ziekten-en-
aandoeningen/psychische-stoornissen/verstandelijke-handicap/
welke-zorg-gebruiken-patienten-en-kosten/ [last accessed 19 May
2014].
20. Cheng Y, Ye J. Exploring the social competence of students with
autism spectrum conditions in a collaborative virtual learning
environment. The pilot study. Comput Educ 2010;54:1068–77.
21. Cheng Y, Chiang HC, Ye J, Cheng LH. Enhancing empathy
instruction using a collaborative virtual learning environment for
children with autistic spectrum conditions. Comput Educ 2010;55:
1449–58.
22. Quill KA. Instructional considerations for young children with
autism: the rationale for visually cued instruction. J Autism Dev
Disord 1997;27:697–714.
 10 W. L. J. E. den Brok & P. S. Sterkenburg
23. Mousavi SY, Low R, Sweller J. Reducing cognitive load by mixing
auditory and visual presentation modes. J Educ Psychol 1995;87:
319–34.
24. Ottaviani BF, Black JB. The effects of multimedia presentation
formats on the spatial recall of a narrative. Paper presented at the
National Convention of the Association for Educational
Communications and Technology, Nashville, TN, 16–20 February
1994.
25. Vasu ES, Howe AC. The effect of visual and verbal modes of
presentation on children’s retention of images and words. J Res Sci
Teach 1989;26:401–7.
26. Bruner J. The growth of representation processes in childhood. In:
Anlin J, ed. Beyond the information given: studies in the psychology
of knowing. New York: Norton; 1973:313–24.
27. Bruner J. Actual minds, possible worlds. Cambridge (MA): Harvard
University Press; 1986.
28. Bruner J. Acts of meaning. Cambridge (MA): Harvard University
Press; 1990.
29. Riva G. Virtual reality: an experiential tool for clinical psychology.
Br J Guid Couns 2009;37:337–45.
Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by 145.108.209.254 on 05/22/14
30. Norman D. Emotional design: why we love (or hate) everyday
things. New York: Basic Books; 2004.
31. Josman N, Ben-Chaim HM, Friedrich S, Weiss PL. Effectiveness of
virtual reality for teaching street-crossing skills to children and
adolescents with autism. Int J Disabil Hum Dev 2008;7:49–56.
32. Macduff GS, Krantz PJ, McClannahan LE. Prompts and
prompt-fading strategies for people with autism. Austin (TX):
Pro-Ed.; 2001.
33. Mechling LC, Gast DL, Seid NH. Evaluation of a personal digital
assistant as a self-prompting device for increasing multi-step task
completion by students with moderate intellectual disabilities. Educ
Train Autism Dev Disabil 2010;45:422–39.
34. Mechling LC, Pridgen LS, Cronin BA. Computer-based video
instruction to teach students with intellectual disabilities to verbally
For personal use only.
respond to questions and make purchases in fast food restaurants.
Educ Train Dev Disabil 2005;40:47–59.
35. Dauphin M, Kinney EM, Stromer R. Using video-enhanced activity
schedules and matrix training to teach sociodramatic play to a child
with autism. J Posit Behav Interv 2004;6:238–50.
36. Van Laarhoven T, Kraus E, Karpman K, et al. A comparison of
picture and video prompts to teach daily living skills to individuals
with autism. Focus Autism Other Dev Disabil 2010;25:195–208.
37. Van Laarhoven T, Van Laarhoven-Myers T. Comparison of three
video-based instructional procedures for teaching daily living skills
to persons with developmental disabilities. Educ Train Dev Disabil
2006;41:365–81.
38. Van Laarhoven T, Zurita LM, Johnson JW, et al. Comparison of self,
other, and subjective video models for teaching daily living skills to
individuals with developmental disabilities. Educ Train Dev Disabil
2009;44:509–22.
39. Mechling LC, Gast DL, Seid NH. Using a personal digital assistant
to increase independent task completion by students with autism
spectrum disorder. J Autism Dev Disord 2009;39:1420–34.
40. Mechling LC, Savidge EJ. Using a personal digital assistant to
increase completion of novel tasks and independent transitioning by
students with autism spectrum disorder. J Autism Dev Disord 2011;
41:687–704.
41. Taber-Doughyt T, Patton SE, Brennan S. Simultaneous and delayed
video modeling: an examination of system effectiveness and student
preferences. J Spec Educ Technol 2008;23:1–18.
42. Van Laarhoven T, Johnson JW, van Laarhoven-Myers T, et al. The
effectiveness of using a video iPod as a prompting device in
employment settings. J Behav Educ 2009;18:119–41.
View publication stats
Disabil Rehabil Assist Technol, Early Online: 1–10
43. Cihak DF, Fahrenkrog C, Ayres KM, Smith C. The use of video
modeling via a video iPod and a system of least prompts to improve
transitional behaviors for students with autism spectrum disorders in
the general education classroom. J Posit Behav Interv 2010;12:
103–15.
44. Davies DK, Stock SE, Wehmeyer ML. Enhancing independent task
performance for individuals with mental retardation through use of a
handheld self-directed visual and audio prompting system. Educ
Train Ment Retard Dev Disabil 2002;37:209–18.
45. Cihak DF, Wright R, Ayres KM. Use of self-modeling static-picture
prompts via a handheld computer to facilitate self-monitoring in the
general education classroom. Educ Train Autism Dev Disabil 2010;
45:136–49.
46. Burke RV, Andersen MN, Bowen SL, et al. Evaluation of two
instruction methods to increase employment options for young
adults with autism spectrum disorders. Res Dev Disabil 2010;31:
1223–33.
47. Groothoff E, Jamin H, Beer-Hoefnagels E de. Spel in psychother-
apie: Theorie, techniek en toepassing. Assen: Koninklijke Van
Gorcum; 2009.
48. Duquette A, Michaud F, Mercier H. Exploring the use of a mobile
robot as an imitation agent with children with low-functioning
autism. Autonomous Robots 2008;24:147–57.
49. Giannopulu I, Pradel G. Multimodal interactions in free game play
of children with autism and a mobile toy robot. NeuroRehabilitation
2010;27:305–11.
50. Kozima H, Nakagawa C, Yasuda Y. Children-robot interaction:
a pilot study in autism therapy. Prog Brain Res 2007;164:385–400.
51. Pioggia G, Igliozzi R, Sica ML, et al. Exploring emotional and
imitational android-based interactions in autistic spectrum disorders.
J CyberTherapy Rehabil 2008;1:49–61.
52. Robins B, Dautenhahn K, Boekhorst T, Billard A. Robotic assistants
in therapy and education of children with autism: can a small
humanoid robot help encourage social interaction skills? Univ
Access Inf Soc 2005;4:105–20.
53. Stanton CM, Kahn PH Jr, Severson RL, et al. Robotic animals might
aid in the social development of children with autism. HRI ‘08
Proceedings of the Third ACM/IEEE International Conference on
Human Robot Interaction; 2008:271–8.
54. Cliburn DC. Virtual reality for small colleges. J Comput Sci Coll
2004;19:28–38.
55. Biocca F, Harms C, Burgoon J. Toward a more robust theory and
measure of social presence. Presence: Teleop Virt Environ 2003;12:
456–80.
56. Strickland D, Marcus LM, Mesibov GB, Hogan K. Brief report: two
case studies using virtual reality as a learning tool for autistic
children. J Autism Dev Disord 1996;26:651–9.
57. Mitchell P, Parsons S, Leonard A. Using virtual environments
for teaching social understanding to 6 adolescents with autistic
spectrum disorders. J Autism Dev Disord 2007;37:589–600.
58. Tam SF, Man DWK, Chan YP, et al. Evaluation of a computer-
assisted, 2-D virtual reality system for training people with
intellectual disabilities on how to shop. Follow Rehabil Psychol
2005;50:285–91.
59. Ferretti RP, Cavalier AR, Murphy MJ, Murphy R. The self-
management of skills by persons with mental retardation. Res Dev
Disabil 1993;14:189–205.
60. Steerneman P. Een sociale cognitietraining voor kinderen met
problemen in sociale situaties. In: Collot d’Escury-Koenings A,
Snaterse T, Mackaay-Cramer E, eds. Sociale vaardigheidstrainingen
voor kinderen. Indicaties, effecten en knelpunten. Lisse: Swets and
Zeitlinger; 1995.