Running head: TECHNOLOGY-BASED COMMUNICATION

Technology-Based Strategies to Teach Communication Skills to Individuals with Intellectual
and/or Developmental Disabilities: A Review of the Literature
Submitted by: Sara Sayam
Capilano University

TECHNOLOGY-BASED COMMUNICATION
Abstract
Handheld electronic devices in the form of speech generating devices (SGD), have become
increasingly prevalent in today’s society for individuals with intellectual and/or developmental
disabilities (I/DD). These tools have been demonstrated to be effective through various research
studies, promoting its development of attaining its status as an evidence based practice. This
literature review encompasses ten research studies evaluating the effects of handheld mobile
technological devices (e.g., iPad, iPad Mini, iPod), as SGDs by means of fostering functional
communication skills such as madding, responding, commenting and discriminating between
stimuli in individuals with I/DD. The research question imposed for this literature review
involves the effectiveness of technological devices as a form of teaching communication skills to
individuals with I/DD who have little to no speech abilities. Through the findings in this review,
the results suggest an overall increase in communication through various forms for all
participants involved. This suggests continued support for the use of handheld computing
devices as SGDs for individuals with I/DD. Future directions in research can include
advancements in teaching of more complex forms of communication such as requesting using
full sentences, independently asking questions, in addition to inclusion of social factors for
communication such as eye contact, smiling, and body posture.

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Technology-Based Communication Strategies: A Review of the Literature
With recent advances in technology over the decades, the use of handheld electronic
devices have become more and more apparent in today’s society. Many individuals with
intellectual disabilities (ID) and/or developmental disabilities (DD), are utilizing the power of
technology as a means to increasing their independence while decreasing their dependence on
others for assistance (Van Laarhoven, Carreon, Bonneau, & Lagerhausen, 2018). Many
individuals with I/DD fall under the category of autism spectrum disorder (ASD) as well, being
those who present little to no use of functional speech (Xin & Leonard, 2015). They rely on
gestural behaviors such as pointing, reaching, and facial expressions to communicate their wants
and needs. However, through the use of technological devices, we can instead teach these
individuals to learn functional communication skills and therefore empower them to speak their
desires through an output produced by a speech generating device (SGD). Lorah (2018) stated
these devices use pictures, words, or other symbols that represent aspects of speech including
nouns, verbs, adjectives, and adverbs. When the respective symbol is selected on the screen of
the device, an audible output is projected, which is the form of communication that is used to
display the message. These devices have become more and more apparent in today’s society with
the recent developments in technology and handheld computing devices (i.e., the iPad and iPad
Mini) and portable multimedia players (i.e., the iPod), which can thus be formed to function as a
SGD through use of relevant tools and applications.
In a review of the literature, 10 studies examining the use of technological devices as a
method of communication strategies for individuals with I/DD have been selected and identified
as published within between 2014 and 2018. The parameters around the methods in obtaining
relevant studies were primarily attained through search engines such as Google Scholars and

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Capilano University’s library database known as Academic Search Complete. The focal point of
this literature review was to gather evidence for technology-based communication strategies for
individuals with I/DD. The 10 studies found highlight the significance of teaching functional
communication strategies to individuals who possess little to no forms of communication. Thus,
this paper will review various forms of mobile technological procedures for teaching individuals
with I/DD relevant communication skills.
Dependent Variables
A total of ten studies were included in this literature review which addressed technologybased communication as a method to teach functional communication skills to individuals with
intellectual and/or developmental disabilities. These studies included a total of 32 participants
with an age range of 1.8-18 years of age for nine of the ten studies. These studies involved
children and adolescents with ASD, ID, DD, Asperger’s Syndrome, attention deficit disorder
(ADD), bipolar disorder, obsessive compulsive disorder (OCD), and/or seizure disorder. The
remaining study included 3 individuals within the age range of 31-44 years old who had
diagnoses of ASD, OCD, ID, attention deficit hyperactivity disorder (ADHD), and
schizoaffective disorder. The dependent variables in these studies incorporated the use of several
technology based SGDs consisting of iPad, iPad Mini, iPod, and HP slate devices. Independent
manding behaviors were targeted in (Copple, Koul, Banda, & Frye, 2015; Gervarter et al., 2014;
Hill & Flores, 2014; Lorah, 2018, Nepo, Tincani, Axelrod, & Meszaros, 2017; Strasberger &
Ferreri, 2014; Xin & Leonard, 2015) using SGD’s to teach communication. Responding to
questions was also targeted using an iPod, iPad, and HP slate device in research conducted by
(Strasberger & Ferreri, 2014; Van Laarhoven et al., 2018; Xin & Leonard, 2015). Independent
comments made by participants using an iPad were measured also measured in Xin and Leonard

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(2015). Unprompted use of nouns and verbs following a question on an iPad as a SGD was
measured through (Ganz, Boles, Goodwyn, & Flores, 2014). Finally, identifying and
discriminating between photos using an iPad is a necessary component to any intervention
related to the use of technological devices as SGDs. The individual must be able to correctly
identify their wants and needs onto the represented picture accurately, as targeted through (Ganz,
Hong, Goodwyn, Kite, & Gilliland, 2015).
Independent Variables
The independent variables used throughout these studies incorporated various instances
of differential reinforcement through the participants individual preferences. These preferences
were determined by Preference Assessments which established which specific object, food,
and/or drinks the participants preferred. Three studies, (Lorah, 2018; Nepo et al., 2017;
Strasberger & Ferreri, 2014), integrated two part preference assessment, starting with a
structured format by using the Reinforcer Assessment for Individuals with Severe Disabilities
(RAISD). This consisted of an interview with the participants’ parents, staff members and/or
caregivers who were familiar with the participants. During the interview, these individuals were
asked questions regarding the items the participant’s seemed to enjoy in order of preferences.
Once there were a few items selected in the RAISD, they were then evaluated in a multiple
stimulus without replacement preference assessment (MSWO) for the studies conducted by
Lorah (2018), and Nepo et al. (2017), and through use of a paired choice assessment for
Strasberger and Ferreri (2014). A similar procedure was conducted for Gervarter et al. (2014)
where parents were asked about their child’s individual preferences which were then ranked and
selected as reinforcers for the study. In another study, (Copple et al., 2015), conducted a
preference probe assessment by administering a Likes and Dislikes Checklist the results of which

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were then used to determine the qualifications of the participants preferred items. Van Laarhoven
et al. (2018) also used differential reinforcement however, in the form of verbal praise (e.g.,
“good job,” and “nice work”). These methods used aided in the correct implementation of the
dependent variables but also helped determine experimental effectiveness for the studies.
Reliability
Interobserver agreement (IOA) data was collected for 9 of the 10 studies included in this
review. This was done by having two or more trained and qualified observers review and record
the same data independently and subsequently report their findings afterwards. IOA data are
measures used to ensure the reliability of the treatment procedures that are in place. This is
calculated by taking the number of agreements and dividing that number by the number of
agreements and disagreements and then multiplying it by 100. Thus, this gives us an overall
percentage of agreement within the data that collected for each study. In order for a procedure to
be deemed reliable, it must achieve an IOA of 80% or higher. For 9 out of the 10 10 studies in
this review, IOA data was collected for a mean of 48% of sessions, with a range of 23-100%. Of
this sample, the mean percentage of IOA was 98% with a range of 95-100%. These suggests
highly reliable and trustworthy results from these studies. However, for one study, (Xin &
Leonard, 2015) there was no form or measure of IOA data stated. This represents a limitation in
this study’s quality of observational data. Without IOA data, we cannot confidently analyze the
results of the data thus, suggesting a question of potential data subjectivity.

Social Validity

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Social validity is a meaningful part of any research study as it highlights the significance
of the effects on the dependent variable(s) based on its implications with the independent
variable(s) used. The significance of social validity lies on its dependence of social acceptance,
value, and importance to the client and their families lives. With this description, social validity
can be a potentially ambiguous or subjective factor to measure, however, using Wolf’s (1978)
study this concept is broken down into levels, making this notion much more structured,
objective, detailed, and measurable. Through this, Wolf quantifies social validation at 3 levels,
which include and describe social significance of the goal, social appropriateness of the
procedures, and finally the social importance of the effects it produces. The first level, social
significance of the goals, defines whether or not the behavioral goals in question are truly those
that society wants. The second level, social appropriateness of the procedures, describes the
acceptability of the treatment procedures based on the individuals participating, caregivers,
and/or other associated consumers. Finally, the third level, social importance of the effects
represents whether or not the consumers involved are truly satisfied with the overall results of
the study. Through these three levels, we can ensure objective and reliable measurement of social
validity while avoiding the potential for subjective information.
Two studies (Copple et al., 2015; Van Laarhoven et al., 2018), included direct measures
for social validity through use of five question surveys and social validation surveys,
respectively. These surveys were given to participants, parents and/or teaching staff and included
questions such as the value of the research being conducted as well as the importance of the
skills being taught to the participants in (Copple et al., 2015). Furthermore, (Van Laarhoven et
al., 2018) indicated if the participants liked using the SGDs, if it helped them perform their job
and whether or not they would continue using them in the future. These surveys will give us a

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clear representation of whether or not social validity was established in these two studies.
However, for the remaining eight studies who did not include direct social validation measures,
we can implement Wolf’s (1978) article and analyze the findings using the three levels. The
goals presented within all of these studies are concurrent with the goals society wants for the best
outcomes of the students and their families which was clearly outlined in each study. Next, the
procedures used were scientifically sound and used evidence based practices which promotes the
most reliable and trustworthy research. Finally, the outcomes were also socially valid in which
all of the studies resulted in an increase of communication and mobile technology use in
comparison to their levels at baseline. These outcomes are definitely socially significant as they
promote overall independence for the participants and allows them to have an overall better
quality of life.
Including sufficient measures for social validity is a shortcoming within this literature
review. Majority of the studies included did not demonstrate direct measures of social validity
within their findings. However, through Wolf’s (1978) measures and understanding that
communication is such an important factor of any individual’s life, we can positively conclude
that social validity was established within this review.
Evidence Based Practice Status
A research paper is confidently deemed to be an evidence based practice based on its
demonstration of experimental control across an adequate range of studies, researchers, and
participants, based on Homer et al. (2005). In order to qualify for an evidence based practice,
there should be documentation of multiple instances of single-subject studies. Thus, the
researchers proposed three standards in order to consider a practice as evidence based. Firstly,
there must be a minimum of five single-subject studies that meet acceptable criteria while

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documenting experimental control through publications in peer reviewed journals. Next, the
studies must be conducted by a minimum of three separate researchers across a minimum of
three different geographical locations. Finally, the third aspect being that the studies must
include a total of 20 participants or more. By utilizing this standard of 5-20-3, we have an
objective way to measure the status of evidence based practices confidently and accurately.
The current literature review meets the guidelines to be deemed an evidence based
practice using Homer et al. (2005) evidence based practice standards. This review includes a
total of ten single-subject research studies that have documented experimental control and been
published in trustworthy, prestigious and most importantly, peer-reviewed journals. In these ten
studies, there have been a total of 33 different researcher that have been involved in conducting
the studies over 3 different geographical locations. Finally, these studies combined include 32
participants with a wide age range demonstrating a comprehensive representation of different
populations.
For these reasons stated above, the status of this literature review is in fact an evidence
based practice. This status of an evidence based practice holds value in allowing practitioners to
make informed and confident decisions in apply the findings of this literature review to the
individuals they work with.
Conclusions / Futures Directions / Implications for BCaBAs
The purpose of this literature review was to examine the effects of teaching individuals
with intellectual and/or developmental disabilities, methods of communication strategies through
use of handheld mobile technology devices. The findings suggest handheld devices such as
iPads, iPad Mini’s, iPods and other SGDs are effective ways to promote functional
communication learning in individuals with intellectual and developmental disabilities. The

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forms of communication that was taught includes independent manding for preferred items,
responding to questions, making appropriate comments, as well as discrimination between
various picture symbols. These communication skills taught were also administered in novel,
natural settings promoting generalization between different places and people. There may be
several reasons why the use of SGDs such as iPads as a platform are advantageous. As reported
by (Ganz, Boles, Goodwyn, & Flores, 2014), they can hold a collection of visual scripts that can
be easily carried from one place to another. On the other hand, cards, papers, and other forms of
sentence strips may be much less convenient, visually obtrusive, and can also easily be lost. One
of the most compelling pieces of evidence for SGDs is the fact that they are much less
conspicuous in comparison to a notebook, or binder than contains paper scripts. For the general
population, iPads and other handheld technological devices are used for different purposes
including note taking, accessing online reading materials, and calendar and schedule uses, all of
which are becoming increasingly ubiquitous within today’s society. Therefore, a student carrying
a technological device holding their communication abilities would not stand out from their
peers in the slightest. Furthermore, practitioners and family members have expressed preferences
for portable devices such as the iPad for communication related interventions because they are
easily transported amongst different forms of activities and developing pictures and scripts on
these devices are much less time consuming in comparison to constructing and laminating them
onto physical cards.
Based on the findings of this literature review, future research directions can look to
addressing the need to teach individuals with intellectual and developmental disabilities a greater
expansion of vocabulary using SGDs, (Strasberger & Ferreri, 2014). This expansion can include
manding for more items, discriminating between a cluster of items and finally working on more

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forms of responding to different social variables and questions. Further directions can also look
at including more comprehensive peer training packages. These skills can include measuring
skills such as eye contact, body position, smiling, and giving praise. Future research should also
include more instances of direct measures for social validity data from the participants, parents,
and teachers perspectives to demonstrate the acceptability of SGDs as effective methods for
communication. Social validity measures are crucial components of any research study and
should be prioritized more by researchers in the future. Finally, future directions in research can
look at evaluating the effectiveness of teacher and parent implementation and training of the use
of SGDs. The operation of such technological devices can potentially be difficult to novel users
without extended knowledge and practice with the device and/or its applications. Therefore, this
may make troubleshooting problems such as countering glitches troublesome for inexperienced
users. For this reason, this type of training can potentially lead to an increase in the use of and
effectiveness of SGDs as methods for communication for individuals with intellectual and
developmental disabilities.
Communication skills are fundamental skills that are critically important for every
individual to possess, particularly those with intellectual and/or developmental disabilities who
currently have little to no repertoire for functional speech (Xin & Leonard, 2015). Such
individuals are ideal candidates to utilize the benefits of mobile technology in the form of SGDs
as a means to replace or supplement natural speech. These methods will allow individuals the
incredible opportunity to be able to express themselves and display their wants and needs, in
addition to being able to interact with people in their lives such as their family members, friends,
and teachers. As future BCaBA’s we understand the need to teaching individuals with
intellectual and developmental disabilities functional communication strategies. In this day and

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age, with the advances in technology we should strive to incorporate the tools that are out there
to the best of our ability in order to make positive changes to the lives of the individuals we work
with. Technology will keep advancing and with that, so must our teaching strategies. By being
up to date with recent advances, we are encouraging and promoting the best practice for our
clients and their individual needs.

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References

Copple, K., Koul, R., Banda, D., & Frye, E. (2015). An examination of the effectiveness of video
modelling intervention using a speech-generating device in preschool children at risk for
autism. Developmental Rehabilitation, 18(2), 104-112.
doi:10.3109/17518423.2014.880079
Ganz, J. B., Boles, M. B., Goodwyn, F. D., & Flores, M. M. (2014). Efficacy of handheld
electronic visual supports to enhance vocabulary in children with ASD. Focus on Autism
and Other Developmental Disabilities, 29(1), 3-12. doi:10.1177/1088357613504991
Ganz, J. B., Hong, E., Goodwyn, F., Kite, E., & Gilliland, W. (2015). Impact of PECS tablet
computer app on receptive identification of pictures given a verbal stimulus.
Developmental Neurorehabilitation, 18(2), 82-87.
Gervarter, C., O’Reilly, M. F., Rojeski, L., Sammarco, N., Sigafoos, J., Lancioni, G. E., & Lang,
R. (2014). Comparing acquisition of AAC-based mands in three young children with
autism spectrum disorder using iPad applications with different display and design
elements. Journal of Autism and Developmental Disorders, 44(10), 2464-2474.
doi:10.1007/s10803-014-2115-9
Hill, D. A., & Flores, M. M. (2014). Comparing the Picture Exchange Communication System
and the iPad for communication of students with autism spectrum disorder and
developmental disability. TechTrends: Linking Research and Practice to Improve
Learning, 53(3), 45-53.
Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of
single-subject research to identify evidence-based practice in special education.
Exceptional Children, 71(2), 165-179. doi:10.1177/001440290507100203

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Lorah, E. R. (2018). Evaluating the iPad mini as a speech-generating device in the acquisition of
a discriminative mand repertoire for young children with autism. Focus on Autism and
Other Developmental Disabilities, 33(1), 47-54. doi:10.1177/1088357616673624
Nepo, K., Tincani, M., Axelrod, S., & Meszaros, L. (2017). iPod Touch to increase functional
communication of adults with autism spectrum disorder and significant intellectual
disability. Focus on Autism and Other Developmental Disabilities, 32(3), 209-217.
doi:10.1177/1088357615612752
Strasberger, S. K., & Ferreri, S. J. (2014). The effects of peer assisted communication application
training on the communicative and social behaviors of children with autism. Journal of
Physical Disabilities, 26(5), 513-526. doi:10.1007/s10882-013-9358-9
Van Laarhoven, T., Carreon, A., Bonneau, W., & Lagerhausen, A. (2018). Comparing mobile
technologies for teaching vocational skills to individuals with autism spectrum disorders
and/or intellectual disabilities using universally-designed prompting systems. Journal of
Autism and Developmental Disorders, 48(7), 2516-2529. doi:10.1007/s10803-018-35122
Wolf, M. M. (1978). Social validity: the case for subjective measurement or how applied
behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11(2), 203214. doi:10.1901/jaba.1978.11-203
Xin, J. F., & Leonard, D. A. (2015). Using iPads to teach communication skills of students with
autism. Journal of Autism and Developmental Disorders, 45, 4154-4164.

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Table 1. SUMMARY OF RESEARCH ARTICLES
Study
1: Copple et al., 2015

N
3

DV
Manding using a
SGD

IV
VM + least-tomost prompting

IOA
30% session;
mean >:98%

2: Ganz et al., 2014

3

DRO

33% session;
mean >:96%

3: Ganz et al., 2015

1

DRO

100% session;
mean: 100%

Use of DRO resulted in a slight increase in
identification of photos using an iPad

4: Gervarter et al., 2014

3

DRO

33% session;
mean >:97.5%

Use of DRO resulted in increase of
manding using both devices however,
results were most prominent using the
iPad Scene and Heard application

5: Hill & Flores, 2014

5

DRO

6: Lorah, 2018

3

Unprompted use
of nouns and
verbs using an
iPad
Identification of
photos using an
iPad
Manding using
Scene and Heard
application on
iPad or GoTalk
SGD
Requesting
using PECS and
iPad
Manding using
an iPad Mini

43-83%
sessions;
Mean: 96%
36% sessions;
mean: 99%

7: Nepo et al., 2017

3

8: Strasberger & Ferreri,
2014

4

Use of DRO resulted in an increase of
requesting behaviors through use of PECS
and iPad
Combination of time delay and full
physical prompting procedure resulted in
an increase in manding behaviors using an
iPad Mini
Use of DRO resulted in a 93.5-96.7%
increase in manding using an iPod Touch
Combination of time delay, graduated
guidance, and least-to-most prompting
resulted in an increase in manding and
responding to questions using an iPod

Manding using
an iPod Touch
PACA training
on manding and
responding to
questions using
an iPod

Time delay and
full physical
prompting
DRO
Time delay,
graduated
guidance, and
least-to-most
prompting

67% session;
mean >:99.9%
30% session;
mean >:95%

Results
Combination of VM + least-to-most
prompting strategies resulted in an
increase in manding using a SGD with a
PND of 75-100%
Use of DRO resulted in a 61-100%
increase in unprompted usage of verbs and
nouns using an iPad

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9: Van Laarhoven et al.,
2018

4

10: Xin & Leonard, 2015

3

Correct
responses and
media options
selected using
an iPad and HP
slate device
Requests,
responses and
comments made
using an iPad

14
DRO (verbal
praise)

23% session;
mean >:98%

Use of DRO resulted in an increase in
correct responses using an iPad and HP
slate device with a PND of 100%

DRO

Not represented
in the study

Use of DRO resulted in an increase in
requests, responses and comments using
an iPad