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
[email protected] 3Departament of Education Science, University of Oviedo, Spain
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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