adfa, p. 1, 2011.

© Springer-Verlag Berlin Heidelberg 2011

dmTEA: Mobile learning to aid in the diagnosis of autism

spectrum disorders

David Cabielles-Hernández1, Juan Ramón Pérez-Pérez1, MPuerto Paule-Ruiz1, Víctor

M. Álvarez-García2, Samuel Fernández-Fernández3

1Departament of Computer Science, University of Oviedo, Spain

{UO209910,jrpp,paule}@uniovi.es 2 Katholieke Universiteit Leuven, Belgium

victor.alvarez@cs.kuleuven.be 3Departament of Education Science, University of Oviedo, Spain

samuel@uniovi.es

Abstract. Mobile Learning is a teaching-learning methodology which has been

developed successfully both inside and outside the classroom. Thanks to the

several possibilities of mobile devices, it has been possible to use them with

students with special educational needs thus giving rise to software applications

focussed on competence acquisition on the students’ part and offering such a

high level of interaction that it could not be possible by using a PC. Advances

in the development of mobile devices have made it feasible to go a step forward

and help the teacher with the modelling and evaluation of this type of students.

dmTEA is a mobile technology which allows both behaviour evaluation and

modelling of students on the autism spectrum. It implements 12 activities – du-

ly verified by experts – which are adapted to interaction with the mobile device

within a specific context, the aim of which is to deal with student’s disorders by

observing learning processes and modelling his or her behaviour during task

performance. dmTEA implementation in two studies, i.e. a student with severe

autism and another student with moderate autism, has helped the teacher at the

time of evaluating by offering him or her the necessary information to carry out

any possible intervention.

Keywords: mobile learning; users with special needs; autism

1 Introduction

During the last years, smartphones have undergone a great development both regard-

ing hardware –thanks to their built-in sensors which allow context aware applications

[1] – as well as software, which offers the possibility to explore these devices to their

highest level to develop such applications. Besides, interest has been greater due to

reduction of cost as well as to the support offered to users in different fields such as

education [2–4].

Within the educational field, applications for Android and iOS mobile devices have

given rise to innovative educational scenarios from pre-school education to high

school education, based on access from everywhere and at any time. Context infor-

mation, obtained from sensors available in the device, has given rise to the implemen-

tation of mobile learning [5, 6] in educational projects involving exhibitions, muse-

ums and topic parks. Besides, mobile learning is having a key role as a very useful

tool for being used in the classroom.

"Educational Integration" is a process by means of which ordinary schools are

looking for and producing the supports required by students with learning difficulties,

special educational needs or with any type of disability. The expression “special edu-

cational needs” was first used in the 70s, but it was widely spread in the 80s by the

Warnock Report, prepared by the Secretary of Education of the United Kingdom in

1978. In the specific case of Spain, the law on Education which is now in force, the

LOE 2/2006 passed on the 3rd. of May, in its Title II, mentions the term ACNEAE

(students with specific needs of educational support), as it refers to “any student who

requires, during his or her complete schooling, or any part thereof, certain specific

educational support and care as a consequence of disability or severe behaviour disor-

ders” (section 73).

Among the students with special educational needs we may mention, among oth-

ers, those belonging to the autist spectrum [7]. For autism diagnosis, teachers rely on

specialists’ report and among other questionnaires, on the IDEA inventory (Inventory

of the Autist Spectrum) [8], the main purpose of which is to assess the severity of

autist features and how deep they are in a person who is older than 5-6 years old.

IDEA has been chosen – out of other similar tests – because the other tests involve

rating scales with a few items giving marks which are not highly relevant for the

teacher. Besides, IDEA is a test with a wide theoretical and technical basis; it is more

qualitative than others and thus, the teacher may analyze, in detail, the person’s poten-

tial and he or she may evaluate twelve characteristic dimensions of students with au-

tist spectrum and/or serious development disorders. At the same time, dimensions are

divided into four characteristic levels. The main aims of the IDEA inventory are to

establish, during the diagnosis procedure, the severeness of the user’s autist features,

to help the teacher to prepare learning strategies and to evaluate medium and long-

term changes taking place in the student’s behaviour.

It is within this educational context where the dmTEA technology is developed. It

gives the possibility to carry out, inside the classroom, an evaluation of users with

autist spectrum, and it may be adapted to the specific needs by means of different

activities. In this respect, dmTEA offers the teacher a detailled report with marks for

each dimension. With the information obtained, families and experts have the possi-

bility to plan an intervention together, focusing on the dimensions that exhibit a great-

er affectation status and improving them gradually with the most appropriate activities

for each case based on the report data.

For this purpose, this study pursues two main objectives. The first one is to define

and develop context-aware tasks which arise student’s interest and motivation, so that

they may provide the basis for evaluating the disorders defined in IDEA. The second

one is to gradually solve the possible disorders suffered by the student by modelling

his or her behaviour during the performance of the tasks in class.

2 Background

The principles of “The Universal Design for Learning” (UDL) [9] encourage the offer

of universal access to educational curricula for all students, thus ensuring equal op-

portunities. Moreover, in the particular case of education, The Universal Declaration

of Human Rights (1948) (http://www.un.org/en/documents/udhr/) states the right to

education and equal access to education for all on the basis of merit (Art 26).

The scientific community has been conscious of this need. Within this context, stu-

dents with autist spectrum have been the focus of part of the development of educa-

tional systems using the benefits offered by mobile devices. The reason is that they

offer several possibilities both in the expressive as well as in the receptive field,

thanks to the reduction of linguistic contents in favour of graphism, iconicism and the

multi-sensorial supports available. There is a wide range of applications which vary

from more communicative aspects to others which are merely educational. Within the

applications facilitating communication, we may mention some examples such as the

builders of phrases based on pictograms - designed at the beginning of the year 2000

in PDAs [10] - to the most recent ones developed in mobile systems (DiegoSays;

https://play.google.com/store/apps/details?id=com.benitez.DiegoDice). Talking about

present educational applications, an important improvement in quality has been

achieved with the use of mobile devices, specially those allowing the teacher to pre-

pare the activities, in such a way so as to be able to increase the possible options both

regarding activities – thanks to sensors - as well as in the search of acquisition of

specific knowledge, specially focussing on the acquision of skills such as language,

mathematics, awareness of environment, capacities regarding autonomous perfor-

mance of activities or other social skills [11]. We may also have applications which

teach organizational aspects by means of pictographic diaries, which offer simple

exercises adapted to different subjects such as Language or Mathematics, which have

the possibility to be adapted to the use of ordinary computer applications or which

help in order to understand feelings by means of exercises using sensors [12].

From a pedagogical point of view, there are different personal computer applica-

tions which partially cover the dimensions offered by IDEA. For our work, we have

made a selection of them (refer to Table 1), chosing those which give the possibility

to cover the greatest part of said dimensions, focussing on the activities specifically

related with autism patterns. In general, most of the applications have the following

characteristics [13]:

They offer a controllable situation and environment; they are a highly-predictable

partner who offers perfect and understandable contingencies: by pressing the same

key, the same results are always obtained.

They present a multisensorial – mainly visual - stimulation, offering benefis to

people with ASD (Autist Spectrum Disorder).

Their effort and motivation capacity is really high, fostering attention and reducing

frustration as a consequence of mistakes.

They foster or give the possibility to carry out autonomous work and to develop

self-control capacities. The TICs are adapted to personal characteristics, thus al-

lowing different learning rates and a greater level of individualization.

They are an active learning element with versatility, flexibility and adaptation as

the main features.

Table 1. PC applications for autist spectrum disorders

Application Aim Author/Publisher/Web

“Sócrates

102 activi-

ties”

It allows the design of tasks aimed at

distinguishing figures, colours and geo-

metrical shapes which allow the evalua-

tion of mental flexibility and receptive

language features.

EMME Interactive

“Adibú” It has exercises which guide the tasks

towards receptive language disorders,

anticipation and suspension, by means of

exercises focussed on solving problems

and ocular and motor coordination.

COKTEL

EDUCATIVE

“Respon-

sive Face”

It allows to create stories and watch ani-

mated films, fostering the recognition of

face expresión and feelings.

http://www.mrl.nyu.ed

u/~perlin/facedemo/

“Clic” It gives the possibility to relate images

and to orally interact by means of ques-

tions and replies or by learning new

nouns and adjectives.

Francesc Busquets

http://www.xtec.es/recu

rsos/clic

3 dmTEA: Mobile tool for the diagnosis evaluation of autism

spectrum disorders (ASD)

The previously-described background is the basis for designing an evaluation-

diagnosis tool for autism which includes a set of learning activities based on the

IDEA inventory using, for this purpose, the technology of mobile devices called

“dmTEA”. Specifically, IDEA estimates autism by means of 12 dimensions which are

the main disorders that define it. These dimensions are gathered creating four blocks

which correspond to the four sections mentioned by Lorna Wing [7]: Socialization,

language and communication, anticipation and flexibility, and symbolization (Table

2).

Table 2. IDEA dimensions regarding the main disorders

Disorders Dimensions

Socialization 1. Social relation-

ship

2. Joint reference 3. Inter-subjective

and mentalist

Communica-

tion and lan-

guage

4. Communicative

functions

5. Expressive lan-

guage

6. Receptive lan-

guage

Anticipation

and flexibility

7. Anticipation 8. Flexibility 9. Meaning of the

activity

Simbolization 10. Fiction 11. Immitation 12. Suspension

The final aim of the activities designed is to work on disorders in order to achieve,

by behaviour modelling, gradual solutions at the same time that students acquire the

necessary knowledge and competentes. From a number of 26 tasks initially suggested,

experts – in this case, the teacher and two professional experts on autist disorders

from our University– have chosen 12. The criterion is based on choosing the most

suitable tasks for interacting with the mobile device for the specific context. The

learning activities designed are (Fig. 1):

1. Interaction between the child and an adult by asking the child to press on a specif-

ic figure, which will be a square or a circle. To choose the figure, press his or her

finger on the touchscreen.

2. On the screen, drag a ball towards a child. For this purpose, the student presses on

the ball with his or her finger and drags it on the screen towards the child’s image.

3. To imitate applauses and greetings seen in a video on the screen. The student will

imitate the gestures of the video and appraisal will be manual by pressing on a

button on the screen.

4. To take objects to their profiles, which are symbolised by pictograms, in such a

way that the student should place them in order and he or she must take them, one

by one, to their corresponding mould. For this purpose, he or she must press his or

her finger on the object and drag it along the touchscreen to its outlined shape.

5. To establish the sequencial steps to go to school by means of several pictograms

following a previously-defined order. There will be some boxes into which the

student must place the pictograms. For this purpose, each pictogram will be cho-

sen by pressing his or her finger on it and dragging it towards the chosen box.

6. To make an agenda with pictograms for one day. In this case, the order may be

the one chosen by the student as the suitable one. As in task 5, the student will

have some boxes for the pictograms to be dragged into them with his or her fin-

ger.

7. To forecast the weather based on a picture on the screen of a man holding an um-

brella. With his or her finger, the student will press on a pictogram which repro-

duces the specific weather situation.

8. To point out the different types of mood requested, which are represented by dif-

ferent icons which simulate feelings. For this purpose, the student will press his or

her finger on the icon corresponding to the feeling requested.

9. To differentiate and learn adjectives choosing the one requested by the task out of

the two options shown on the screen, such as open-closed, big-small, etc. The stu-

dent will press on the touchscreen choosing the picture which represents the ad-

jective requested.

10. To repeat the name of the objects, as the mobile device reproduces the names

when the student presses on their pictures on the screen. Once the student listens

to the name, he or she repeats it. Such repetition is heard thanks to the microphone

and the software of the mobile device interprets it to establish if it is valid or not.

11. To decide when the student may cross the street based on the traffic lights appear-

ing on the screen and which will change from red to green after a short period of

time. For this purpose, the student presses his or her finger on the pedestrian ap-

pearing on the picture and he will move if the traffic lights are green or he says

crossing is forbidden because the traffic lights are red.

12. To paint a tree on a screen picture with different colours and thicknesses. On the

right, the student will find two colours, i.e. greean and brown, and two thickness-

es. These elements may be chosen by pressing on them. To paint, it is only neces-

sary to drag his or her finger on the screen after having chosen the colour.

Fig. 1. Screenshots corresponding to the picture agenda tasks (5). Repeat the object names (10)

and paint a tree (12).

In the following step, experts decide the specific aspects of IDEA (Table 3) which

are most suitable for being evaluated with electronic devices. Selection is based on

deciding which aspects could be more related with the tasks chosen in the previous

step, in order to optimize the result of the tests, taking into account a maximum poten-

tial relation between dimension and task, and rejecting the most complicated ones or

those which are impossible to be assessed with a mobile device. This is because IDEA

shows dimensions, such as those of social relationship, which are nearly impossible to

be estimated automatically by using a device because real interaction with another

user must be checked in person.

Table 3. Dimensions assessed in the evaluation

Dimensions Description

Dimension 1 Non-frequent, induced and external relations with peers.

Relations are more a response than the consequence of own

initiative

Dimension 2 Use of joint reference looks in directed but non-open situa-

tions.

Established guidelines of joint action and attention but not

joint worry.

Dimension 5 Language made up of loose words or echolalias. There is no

formal creation of phrases and sentences.

Sentence language. There are some sentences which are not

echolalic, but they do not create speech or conversation.

Dimension 6 Literal and nearly inflexible understanding of the statements,

with some kind of structural analysis. The speech cannot be

understood.

Conversation is understood but the difference between literal

and intentional meaning could hardly be distinguished.

Dimension 7 Simple anticipatory behaviour in daily routines. Frequently,

opposition to changes and worsening in situations which imply

changes.

Dimension 8 Complex rituals. Excesive affection towards objects. Obsesive

questions.

Obsesive and limited contents of thought. Nearly unfunctional

and flexible interests. Strict perfectionism.

Dimension 10 Symbolic game which is generally not really spontaneous and

obsessive. Important difficulties to distinguish between fiction

and real world.

Dimension 11 Simple, recalled and non-spontaneous motor imitations.

Established imitation. Lack of inside patterns.

4 Methodology

With the taks and dimensions chosen, we have designed an assay with which the tests

are going to be carried out with the users (Fig. 2). This assay is a simplified version of

the Delphi Method [14], in which other experts make assessments of tasks and dimen-

sions, filling in a matrix form in which the rows are the dimensions while the columns

represent the tasks. Specialists give a mark from 0 to 10 regarding the relationship

between the taks and the dimension, being 0 an invalid relation and 10 an excellent

result in the task.

Fig. 2. Diagram which represents the use and assessment of dmTEA

Tasks of the assay are carried out with two users, one suffering from severe autism

(Kanner type) and the other one with moderate autism (High-Functioning type) of the

ADANSI centre (Association for the Support of Families with Autistic Members;

http://www.adansi.es/). To perform the tasks, we have been helped by the teacher of

the centre with the co-operation of 3 experts, who observe the performance of the

tasks by each user. Based on this observation, each party will give the mark consid-

ered as the most suitable one based on his or her experience. Assessment is not given

based on the proper performance of the task as the user’s behaviour while performing

the task is the clue for assessing the level of the user’s disorder. Therefore, an exercise

may be left incomplete but it will not necessarily mean that the user has some features

of such disorder.

Fig. 3. Test of a task with the teacher and real users

All the tests are carried out in the institution to avoid the students’ lack of concen-

tration. The teacher will be in charge of giving the main orders, as they are the per-

sons with whom they have a closest contact. In this way, it is avoided to have prob-

lems getting the expert confused when giving marks and that a mistaken assessment

of the test is achieved because it is considered that it is not suitable, when the real

problem is the lack of trust on other persons. All tasks have a feedback, which arrises

the student’s interest and he or she will be congratulated if it is properly performed or

stimulated to do it again if he or she has failed. Besides, all activites may be repeated

modelling the student’s behaviour, thus allowing a better understanding of what it is

requested in the task and being able to perform it properly by following the teacher’s

instructions.

These tests are carried out during two weeks, and two tasks are performed daily in

order not to make the student feel tired. The first week is focus on sessions during

which the students are in contact with the tasks while the second week is focussed on

consolidation in order to understand the tasks in a better way and to perform them

efficiently.

5 Results and Discussion

The aims of this analysis are to determine, by means of observation, the applicability

and compliance of the tasks with the IDEA’s pattern and to check the agreement be-

tween observers at the time of making the assessment in the matrix form.

Table 4. Final averages for moderate autism

T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12

D1 6.0 6.0 5.3 5.6 5.3 5.6 5.6 5.6 5.3 4.6 5.0 4.3

D2 5.3 4.8 5.7 5.2 6.6 6.3 6.5 6.1 4.8 6.0 6.3 6.2

D5 7.0 6.3 3.7 7.1 6.2 7.5 7.8 7.0 6.2 7.0 6.8 4.0

D6 6.3 7.0 5.7 7.5 7.3 6.0 5.0 1.1 5.8 5.2 5.1 5.1

D7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

D8 8.2 6.8 6.5 7.1 6.3 6.5 6.6 6.5 5.8 5.0 6.2 5.3

D10 4.6 3.6 0.0 4.6 0.0 0.0 4.0 0.0 0.0 0.0 0.0 0.0

D11 6.1 4.6 6.3 5.3 6.3 6.3 4.1 1.0 6.2 6.5 5.3 5.6

Berk

index 0.9 0.8 0.9 0.9 0.9 0.9 0.9 1 0.9 0.9 0.9 0.8

Table 5. Final averages for severe autism

T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12

D1 8.3 8.3 6.0 7.3 9.6 6.0 7.3 6.3 6.3 7.0 8.0 6.3

D2 5.3 1.8 5.7 2.0 9.2 5.5 4.5 6.7 5.8 5.5 3.0 5.5

D5 0.0 0.0 6.2 0.0 6.2 0.0 7.0 5.5 6.0 6.0 3.2 7.2

D6 9.0 8.0 5.5 10.0 8.1 2.5 4.3 5.0 3.8 7.2 8.3 8.2

D7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

D8 0.0 0.0 0.0 0.0 0.0 4.5 0.0 0.0 0.0 0.0 0.0 0.0

D10 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

D11 7.8 8.0 8.0 7.7 2.3 6.5 7.2 7.2 5.7 7.0 6.2 0.0

Berk

Index 1 1 0.8 0.9 1 0.9 1 1 0.9 1 1 1

The value of the Berk index (agreement between observers), shows that in both

cases, there is an excellent level of agreement between experts for all the tasks. Based

on the results obtained, the average rates of the marks collected by the observers may

be estimated as well as the average correlation level of task and dimension (Tables 4

and 5).

In the case of severe autism (Table 5), it can be observed that the most saturated

dimensions due to the tasks carried out are 1 (social relationship), 6 (receptive lan-

guage) and 11 (imitation). Thus, it can be declared that the set of tasks gives us the

possibility to establish first estimations of the functional diagnosis about such dimen-

sions. It may also be observed that relationships are not bi-univocal, i.e., tasks are not

related with all the dimensions in the same way. The most consistent relations may be

observed in task 5 (to establish the steps to go to school) with dimensiones 1 (social

relationship) and 2 (capacities of joint reference), in task 4 (to put objects to their

outline shapes) with dimension 6 (receptive language) and in task 2 (to move a ball

towards a child) with dimension 11 (imitation).

Results shown in Table 5 show the student’s communication problems. The teacher

informs that communication relations between the student and himself or herself are

induced by the latter, which means that conversation only takes place when the teach-

er encourages it. Therefore, we may declare that, for this specific case, the infor-

mation shown in the Table supports the aims initially specified in this analysis of

applicability and adjustment of the tasks to the IDEA paradigm. Thanks to such aim

achivement, dmTEA allows the teacher to detect, empirically, the IDEA dimensions

in which the student commits mistakes, supplying information for a possible interven-

tion.

In the case of moderate autism (Table 4) we have that the highly-saturated dimen-

sions are 5 (expressive language), 6 (receptive language) and 8 (mental and behav-

ioural flexibility). As in the previous case, this information gives the possibility to

make initial assessments of functional diagnosis with reference to the dimensions

mentioned. In this case, the most consistent relations have taken place in task 8 (spec-

ify moods) with dimension 1 (social relationship), in task 4 (to put objects to their

outline shapes) with dimension 6 (receptive language) and in task 7 (weather forecast)

with dimension 5 (expressive language).

Results of Table 4 (moderate autism) show the problems regarding behaviour and

language the student has, both of expressive and receptive nature. The teacher informs

that at the time of performing the tasks, the student is anxious, which has gradually

been solved with the teacher’s help as he or she is in charge of calming down the

student while explaining orally and modelling the test performance. Therefore, we

may confirm, as in the previous case, that information included in the table supports

the aims initially laid down in this analysis of applicability and adjustment of tasks to

the IDEA paradigm. For this second case, as in the previous one, dmTEA offers the

teacher the necessary information – based on the marks for each dimension – to carry

out a possible intervention apart from being the support for diagnosis evaluation.

Apart from the data obtained regarding the relationship of tasks and dimensions,

observation gives us the possibility to confirm that it is possible to shape the user’s

behaviour. Finally, the student understands the task and performs it properly; it is not

solved by the trial-and-error method and thus, it is possible to solve the most evident

disorders little by little. The teacher and experts also declare that users suffering from

behavioural and emocional disorders receive a clear benefit when interacting with the

tablet, something which would be practically impossible using a mouse or a keyboard.

6 Conclusions

Integration of mobile devices in education has given rise to a teaching and learning

methodology called Mobile Learning. Characteristics such as access from anywhere

and at any time give the possibility to create contextual educational scenarios, produc-

ing educational applications which may be used both inside and outside the classroom

by teachers and students.

In this paper, we are showing a different scenario of mobile learning application

and specifically, its use and applicability regarding the evaluation and modelling of

behaviour, inside the classroom, of special educational needs, and specifically, for

students with problems regarding behaviour and language. Up to now, mobile devices

have been used within the autism disorder field, with the aim of making students ac-

quire certain competences but not as an element which may help and support teachers

for evaluating and modelling students in their classrooms.

dmTEA is a software technology which permits the evaluation of autist spectrum.

Said evaluation is based on the IDEA inventory, which evaluates twelve characteristic

dimensions of students with autist spectrum and /or with deep development disorders.

This technology implements 12 learning activities adapted to interaction with the

mobile device for a specific context and its aim is to work with disorders to solve

them gradually by modelling behaviour and, at the same time, students acquire the

necessary knowledge and competences.

The experimental use of the dmTEA in two cases, makes us declare that it is a tool

which helps at the time of evaluating the educational possibilities of this type of stu-

dents apart from offering the teacher the necessary information – based on the marks

for each dimension – to carry out a possible intervention. The design of the tasks in

dmTEA benefits the modelling of students’ behaviour, which finally results in the

understading of the task and its proper performance by the students.

Results obtained encourage furthering this study. Directions of future research in-

clude both extending the number of users involved in the evaluation as well as includ-

ing the four existing levels of autism (Kanner, Regressive, High-Functioning and

Asperger), in order to be able to generalize the observed behaviour to situations that

were not examined. Other future lines of work are: complete dmTEA with all the

IDEA dimensions and include more tasks; further development the diagnosis system

to facilitate the present management of the experts’ reports and create new activities

which can progressively help with disorders; and complement dmTEA with other

evaluation instruments for girls and boys from 2 years on, such as CARS (Childhood

Autism Rating Scale) or ADOS (Autism Diagnostic Observation Schedule) which,

besides autism diagnosis, open the possibility of using dmTEA for other type of spe-

cial educational needs.

7 Acknowledgments

This work has been funded by the Department of Science and Innovation (Spain)

under the National Program for Research, Development and Innovation: project

TIN2011-25978 entitled “Obtaining Adaptable, Robust and Efficient Software by

including Structural Reflection to Statically Typed Programming Languages”.

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