Open-access Instruments for augmentative and alternative communication for children with autism spectrum disorder: a systematic review

Abstract

  New technologies designed to improve the communication of autistic children can also help to promote interaction processes and cognitive and social development. The aim of this study was to analyze the instruments used to improve the communication skills of children with autism spectrum disorder. We searched the PubMed and Web of Science databases using the descriptors “autism”, “Asperger”, “education”, “children” and “assistive technology” and selected articles that met the following inclusion criteria: (i) original research; (ii) written in English; (iii) based on participants with a primary diagnosis of autism spectrum disorder; and (iv) tested an instrument designed to promote communication in children with autism spectrum disorder. Our search retrieved 811 articles, of which 34 met the inclusion criteria. Data on 26 instruments were extracted, and the measurement properties of the instruments were combined with information about their outcomes and presentation. The most commonly used interventions were the Treatment and Education of Autistic and Related Communication Handicapped Children program and the Picture Exchange Communication System. The Treatment and Education of Autistic and Related Communication Handicapped Children program was shown to produce improvements in the communication skills, socialization and self-care skills of children with autism spectrum disorder. The Picture Exchange Communication System produced inconsistent results. The results of the identified studies confirm the significant importance of these instruments in improving the communicative process of autistic children.

Autism; Asperger; Education; Children; Assistive Technology


INTRODUCTION

In the natural course of life, children produce verbal meanings from interactions with those around them. The exchange of information is essential to development, and social interaction is the basis of typical development. Lack of communication impairs children’s development and causes problems for the people who love them (1).

Autism spectrum disorder (ASD) causes difficulties in communication and education and is characterized by a set of changes and issues relating to interaction, social communication and repetitive behavior that are usually noticed in children between 12 and 14 months old (2). In children with ASD, the development of communication has several peculiarities and does not follow the same path as in typical children (1). Another important feature of ASD is the atypical pattern of gazing during social interactions and monitoring; gaze is therefore a useful intervention target or tool (3).

The increased number of cases of ASD diagnosed worldwide (2) means that it is extremely important to develop tools to educate children with ASD and develop their communication skills. Many authors have pointed out the need to develop software and hardware that, combined with specific technology, will increase the vocabulary and communication skills of people with ASD (2,4,5).

A systematic review (2) found several tools for ASD and revealed how useful these tools are in therapy. However, these are generic tools, which means that a custom tool that meets the needs of each person is still missing, and this challenge is still very present in the interventions used today. Another study (4) found that using software with a participatory design, developed with the help of special education teachers, was an alternative way to facilitate communication and improve the social skills of children with ASD.

Furthermore, Hourcade et al. (5) found that although early intervention may occur in this population, most adults did not benefit from early intervention. However, since the launch of the iPad, there has been considerable enthusiasm in the autism community about multitouch tablets and their possible use in interventions, and hundreds of applications have been launched that may help children with ASD; however, there is little empirical evidence that any of them have positive effects. In this same study, the researchers found that children spoke more sentences, had more verbal interactions and were more physically involved with the activities when using these applications, and the authors suggested that more similar approaches should be used to increase positive social interactions in children with ASD.

Assistive technology promotes the autonomy of people with physical or cognitive disabilities, contributing to functional improvement and promoting social inclusion (1). Within the concept of assistive technology, there is a category called augmentative and alternative communication (AAC). AAC aims to develop tools that, using high or low technology, help people with orality and literacy deficits during communication and education (6).

Given how important communication is to children’s development and education, it is believed that the AAC instruments used with ASD children contribute to the children’s cognitive and social development and can facilitate interaction processes. Systematic reviews are needed to provide an overview of current tools and practices designed to improve the communication and education of people with ASD. Thus, the objective of this review was to analyze research on instruments for AAC and education used to improve communication skills in children with ASD.

METHOD

This systematic review was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (7). A review of the literature was conducted in January 2018 to identify assistive technology for children with ASD.

Search Strategy

A comprehensive analysis of tools used to promote communication in children with ASD was conducted. This study followed the standardized PICOS (population, intervention, comparison, outcomes and studies) format (Figure 1); the search included publications on “Autism OR Asperger patients” (population) AND “Education” (intervention). The various instruments used for communication or education (comparison) were compared based on quantitative data on the effects of using the instruments with this population (outcomes).

The search for relevant articles was conducted in January 2018 and included the PubMed (http://www.ncbi.nlm.nih.gov/pubmed) and Web of Science (https://webofknowledge.com/) databases (Table 1). Two different searches were carried out in PubMed. The first search used the following search string: Autism OR Asperger AND Education AND Children. The second search used the search string Autism AND Assistive Technology AND Communication. Both searches looked for occurrences of the keywords in the title or abstract fields. The search string used on Web of Science was Autism AND Assistive Technology AND Communication; it was applied to the topic field, and the search was restricted by language (English) and type of document (article).

Selection Process

The first step in the selection process involved reading the titles and abstracts of all the identified articles. After excluding irrelevant articles on this basis, the full text of the remaining articles was read.

Inclusion Criteria

The literature review included original experimental articles that were written in English and based on participants with a primary diagnosis of ASD that investigated the use of a tool to promote communication in this population.

Exclusion Criteria

Review articles, meta-analyses and editorials were excluded, and published clinical trial protocols were excluded as they do not provide data for analysis.

Data Extraction and Quality Study

Data from the included studies were extracted using Microsoft Excel 2010. The form included the following fields, which were filled by a reviewer in the order in which they are listed below: (1) study identification (main author’s name, year, and country); (2) study method (type of study, blinding, and secret allocation); (3) sample characteristics (age and gender); (4) aspects of the intervention (sample size, presence of supervision, frequency, session length, and follow-up); (5) presence of follow-up; (6) loss of follow-up; (7) reported outcomes; and (8) presented results.

RESULTS

The PubMed and Web of Science searches generated a total of 811 articles. After filtering by title and abstract, 262 articles were read in full, of which 34 fulfilled the inclusion criteria for this review (Figure 2). The exclusion criteria included the following: articles on the assessment of adolescents (n=9), adults (n=13), caregivers (n=13), or typical children (n=1); review/discussion articles (n=4); articles duplicated in both databases (n=7); epidemiological studies (n=59); protocol studies (n=1) (n=17); immunization studies (n=6); books (n=2); non-English articles (n=40); articles that did not intervene (n=5); articles that did not use AAC (n=247); neurology studies (n=11); studies on other diseases (n=14); information for health professionals/education presented in symposium (n=11); and informative texts (n=2).

Figure 1
PICOS.
Figure 2
Flowchart of the Search Strategy and Selection of Articles.

Study Characteristics

The 34 studies included in this review are summarized in Table 2, which provides sample data, intervention time and the instruments used to communicate with children with ASD.

Table 1
Search Syntax.

The included studies were experimental, and most had samples consisting exclusively of children with autism, although some (n=5) used a control group of healthy children (8-12), and others used mixed samples including people with other health conditions, such as attention deficit hyperactivity disorder (ADHD) (10), severe mental retardation (13), invasive developmental disorder not otherwise specified (PDD-NOS) (14-18), Turner syndrome and intellectual disabilities (19), oral motor/dyspraxia, cerebral palsy, Down’s syndrome, developmental delay and prematurity (20). The duration of the intervention was variable. Most of the studies used interventions consisting of multiple sessions (range: 21 to 72 sessions) at varying time intervals.

The Treatment and Education of Autistic and Related Communication Handicapped (TEACCH) program (13,14,17,21-25) and the Picture Exchange Communication System (PECS) (14-16,18,20,26,27) were the most used interventions. Two studies (8,28) developed and tested new tools: an interactive therapy system and the iCan application. Seok et al. (19) developed image cards that resembled images that appeared on another instrument (Korean language application) used by the authors.

Participant Characteristics

The reviewed studies involved a total of 761 participants with ASD. The same sample was used in three studies (15,16,18), and was therefore counted only once. Other participants included healthy children (8-12) and individuals with ADHD (10), severe mental retardation (13), PDD-NOS (14-18), Turner syndrome and intellectual disabilities (19), oral motor/dyspraxia, cerebral palsy, Down’s syndrome, and developmental delay, and one study included premature children (20).

Methodological Features of the Studies

All the studies were empirical (29). The main limitations found in the selected studies were the use of an eclectic intervention and nonblinding of examiners and encoders.

Technology

The studies predominantly used instruments for visual and auditory communication. High-tech devices, such as tablets, were used in four studies (19,28,30,31). One intervention was based on virtual reality (VR) (8). Others used the exchange of objects or the exchange of picture cards (14-16,18,20,26,27) that provided voice output (30,32-34) or instruments chosen by the participants (35). Several studies recorded the eye movements of children using videos (11,12,36). This information is summarized in Table 3.

Table 2
Summary of selected studies that tested tools designed to promote communication in autistic children in reverse order of publication.
Table 3
Objectives and characteristics of the instruments used, ordered by frequency of use.

DISCUSSION

This review aimed to analyze instruments that are being used to improve the communication skills of children with ASD.

Protocol Characteristics

Nine studies were randomized (15,16,18,23,24,26,27,31,37), and six were longitudinal (11,12,17,25,33,36). A total of 768 people with ASD participated in the studies. The limitations of the studies are discussed individually, but it is anticipated that sample size was a problem. The samples ranged from a single participant (case study) to a maximum of 198 participants, but several studies used small samples, and their results may not be reliable. Studies based on mixed samples including participants with other diseases or conditions as well as participants with ASD may produce different results, and these results cannot be generalized to the ASD population. Some studies randomly allocated participants to groups but did not blind the examiner to group status. The quality of the studies included in this review was therefore considered low, and there was little evidence of the use of validated instruments to detect changes following the interventions tested.

Primary and Secondary Outcomes

Research has shown that the main characteristic of autism is difficulty in communicating, so it is essential to develop methods of stimulating communication and social interaction to help this population.

For the sake of convenience, our discussion was split into sections based on the techniques and devices used in the selected studies.

1: Techniques used for ASD

Considering the techniques found, the TEACCH intervention was used in eight articles, but six of those articles, in which these techniques were used individually, showed similar results and were able to prove the effectiveness of the program based on progress in the areas of communication, socialization, self-care, social reciprocity, decreased parental stress, and improved interaction between parents and children and a reduction in autistic symptoms and maladaptive behaviors (13,17,21-23,25). The study by Howard et al. (14) was the only study that used the same group for TEACCH intervention plans and other image-based cards, but this group did not achieve the best results.

A meta-analysis of studies using the TEACCH intervention (38) concluded that it produces small improvements in perceptual, motor, verbal and cognitive skills but has very small or negligible effects on communication skills and daily living activities.

D’Elia et al. (17) compared TEACCH with psychomotor therapy and observed similar positive changes in language and adaptive functioning in both groups. The authors suggested that this result may have been due to the low intensity of the TEEACH intervention (four hours per week). Reviews of speech models (39) and the working management of children with ASD (40) suggested that in order to be effective, treatments must be delivered for at least 20 hours per week over at least 2 years.

Howard et al. (14) used the TEACCH program but did not obtain the best results, although the intervention was applied intensively (25-30 hours per week). In addition to the TEACCH program, the participants engaged in other activities that were incorporated into their daily routines; therefore, the children did not receive an adequate intervention due to changes in their routine.

In the study by Boyd et al. (24), the TEACCH program was compared to another technique called LEAP (Learning Experiences and Alternative Program for Preschoolers and their Parents), and there were observable gains over time, regardless of the intervention used. Regarding cognition, however, TEACCH seems to have performed better than LEAP.

Seven studies used the PECS (14-16,18,20,26,27), but three of them compared it with another technique, Responsive Education and Prelinguistic Milieu Teaching (RPMT).

One comparison of the PECS and RPMT (15) found that the PECS increased nonimitative spoken communication and increased the number of different words used. Howlin et al. (26) demonstrated that the PECS improved the initiation of communication and increased the use of speech, but no effect persisted after the end of the intervention.

Lerna et al. (41) reported different results: they observed that the PECS produced improvements in joint attention, initiation and verbal requests and that these improvements were still detectable one year after the intervention, thus demonstrating that training with the PECS can promote long-term improvement.

A review of the effectiveness of the use of the PECS (42) suggested that individuals with PDD-NOS or autistic traits made better progress under the PECS than children with typical autism. The authors argued that without the quantification of autistic symptoms, the effectiveness of the PECS intervention cannot be reliably evaluated.

Complementing the results of Howard et al. (14), the group that used the PECS was unsuccessful probably because the eclectic intervention involved multiple transitions per day. Children with ASD often have difficulty adjusting to changes in their routine and with sustaining attention, so they learn better when instruction is consistent. It is also not clear that children with autism benefit from combinations of various therapies or methods for which there is limited scientific evidence of efficacy. Eldevik et al. (43) reported that children who received eclectic treatment (mixed techniques) did not perform better after one year of intervention than a group that received a behavioral intervention.

Two studies reported that when compared to the PECS, RPMT facilitated the development of communication and language skills, the exchange of objects and the initiation of joint attention (16,18). Siller and Sigman (44,45) explained the importance of joint attention for ASD, and Kasari et al. (46) emphasized that joint attention is important for social and communication skills and facilitates the development of skills such as speech. McDuffie and Yoder (47) presented an example of joint attention: during periods of development and at times when children are not communicating, parents can interact verbally with them as a language facilitation strategy. Parents can follow the example of the child in a game and describe what he or she is doing or who is playing. Sometimes, when the child does not communicate verbally, parents can use expansions as language facilitation strategies (47).

Tomas-Stonell et al. (20) used the PECS in conjunction with other devices and techniques (assistive technology devices and sign language). The authors did not specify how each of the devices and techniques was used but emphasized that there was observable improvement in communicative skills.

In the study by Fteiha (27), the PECS was compared with two other electronic devices (Language Master and the CompuThera program), and the results indicated that these devices produced higher scores for language skills than the PECS.

Another technique used with children with ASD is the ecological referential communication paradigm, which was designed to promote specific communication skills (9). This system includes the guidance of an adult as part of communicative exchange between a speaker and a receiver (48). The task was to build two identical images based on the exchange of information between the two participants, an autistic individual (speaker) and a child with typical development (receiver). The autistic individual described an image, and the child with typical development tried to build the same image based on the description (9).

Individuals with ASD have difficulty selecting and organizing information for speech and hence have problems with referential communication. Sometimes a speaker with ASD sends messages lacking information or with repetitive, ambiguous or disorganized content (49). This practice can be more effective when working with trained speakers who have the help of other support expressions, such as the specific locations of objects (50). Boada and Forns (51) also noted the importance of considering the specific location of objects, although there is no guarantee of accuracy in completing the task.

Board games, art projects and trivia games: Games are used to promote the socialization of all children. A study that used a social intervention that involved pairing children with ASD with developmentally typical children showed that even socially isolated ASD children could participate in activities with their partner if they were interested (35). Other studies converge with the above data and have shown that subjects with ASD increased their level of involvement and initiatives. Additionally, subjects with ASD could socialize in pairs with developmentally typical individuals since the activities were designed around their preferences (52,53). The advantage of using “natural devices” is that children with ASD can choose the task and therapists can adapt any game to make it easy and attractive to the children involved.

Other techniques (PCS and target words) are nontechnological instruments using figures, words and symbols to improve the orthographic performance of children; these instruments were used in conjunction with a speech-generating device (SGD) (34).

2: Devices used to help children with ASD

In addition to techniques for improving communication skills, various devices have also been used for AAC and education in children with ASD. The most commonly used devices are presented below.

Tablet and picture cards: Seok et al. (19) used a tablet and picture cards in their study. Chien et al. (28) also used a tablet with an application (iCAN) based on the PECS. Waddington et al. (30) used an iPad® with Proloquo2Go™, a voice application generator. One of the studies (31) used an iPad with the application Zody, a collaborative game designed to facilitate the social relationships of children. Tablets are high-technology devices that can play an important role in improving communication skills (54).

Two studies suggested that iPad® applications can be used to teach communication skills and improve language (55,56). A previous study also compared the exchange of images with high-technology device cards such as an iPad™ showed that communication acquisition varies among children with autism and on their preference for the instrument (57).

Speech-generating devices (SGDs): Schlosser et al. (32) and Schlosser and Blischak (34) used a LightWRITER SL35, and Schlosser et al (33) used VantageTM. Both studies provided synthetic voice output and spelling feedback. Other studies in children with ASD have shown that this type of device can increase communicative interactions (58) and help adults with ASD to make requests (59).

Nintendo Wii: This alternative was a game pack used in physical education classes in which the child was stimulated to play accompanied by other children, contributing to the improvement of social engagement, which was more visible in boys (37). Corroborating these findings, Hartmann and Klimmt (60) reported that girls and young women were less interested in digital games, had less knowledge about them and played less often and for shorter durations than boys.

Microsoft Word: In the study by Mohan et al. (61), a portable computer was used to teach communicative functions through simple copy in Microsoft Word. There was an observable increase in the quantity and quality of communication. The children came to express their needs with ease and less distraction than without the intervention. A study using computer technology to facilitate communication in children with Down’s syndrome revealed that performance varied substantially. Some of the children acquired the skills needed to enter text at a productive speed, while others were very slow, and the text generated contained a substantial number of errors (62).

Language Master: Language Master was an electronic device used by Fteiha (27); it used cards to record a brief verbal message, which could be accompanied by audiovisual cues such as photos, words or PCS. In the same study, the CompuThera program, which consists of software used to develop reading skills in autistic children was evaluated. These two instruments were compared to a control group that used the PECS, and the study found that Language Master and CompuThera produced higher scores for language skills than the PECS.

vSked: vSked is an interactive visual scheduling system designed for elementary school classrooms that uses a custom design to understand, structure and predict daily life activities and strengthen memory and language comprehension while reducing anxiety in children with autism (63). The use of these visual artifacts in individuals with ASD contributes to reducing the symptoms associated with cognitive, communication and social deficiencies (64,65).

Assistive technology devices and sign language: Thomas-Stonell et al. (20) used these instruments in conjunction with the PECS. However, the authors did not specify what the instruments were or how they were used; the authors emphasized only that there was observable improvement in communication skills. A study with children with Down’s syndrome who also used sign language showed positive results, corroborating the findings above (66).

Frequency modulated (FM) system: Schafer et al. (10) showed that an FM system has the potential to improve speech recognition and classroom behavior. Other studies demonstrated that the FM system helps speech perception and that the benefits are seen in several contexts, both outdoors and in the classroom (67-69). A study involving children with dyslexia also found that those who used the FM system showed greater improvement in reading skills and phonological awareness than a control group, which suggests that this instrument can be used in various situations (70).

Vibrating pager: Vibrating pagers were used in three studies (71-73) as a discrete method of warning children. Anson et al. (71) demonstrated that a “tactile prompt” (a kind of vibrating pager) improved children’s behavior and engagement in independent activities in the classroom. Two other studies (72,73) found that vibrating pagers were effective in increasing verbal initiations and may promote social interaction between children with ASD and their developmentally typical peers. Tzanakaki et al. (74) corroborated the earlier findings, reporting that the use of a vibrating pager increased the number of occasions that participants initiated verbal communication with their peers.

Looking-while-listening (LWL) and intermodal preferential looking (IPL): The LWL paradigm was used by one study (36), while two studies (11,12) used the IPL paradigm.

Venker et al. (36) used the LWL paradigm to analyze the understanding of language of children with autism; they found that children with greater accuracy when looking at figures presented on an LCD screen processed familiar nouns faster. Considering the LWL, one study (75) found that the speed and accuracy of real-time processing of spoken language at 18 months predicted the subsequent development of vocabulary in both typically developing children and those with a limited vocabulary. Fernald et al. (76) showed that speed and accuracy in children’s recognition significantly increased spoken words and were correlated with lexical and grammatical development measures.

The IPL paradigm (11,12) involved videoing children’s faces as they watched videos and using a custom program to code the children’s eye movements. The children were shown two videos side by side, but they heard the soundtrack for only one of the videos. The direction and duration of a child’s gaze was recorded and used as indicators of his or her understanding (77). According to results for the IPL, in the language acquisition process, the understanding of real-time issues appears to be processed the same way in children with autism and their peers with typical development, but this occurs at a later age in children with autism (11). Many autistic children are able to generalize grammatical patterns, and this capacity can be derived from previous lexical and grammatical knowledge (12).

Interactive therapy system: Choi et al. (8) developed an interactive therapy system that can be used in both home and hospital environments. The system is based on behavioral and cognitive therapeutic techniques and enables children to practice skills in realistic scenarios in various different contexts. The system has three components: (a) measurement of coordination skills; (b) social skills training and sensorial integration therapy; and (c) VR technology with interactive virtual scenarios. The platform was designed to allow children to interact with tangible devices in front of the screen. The therapist can control the process in real time.

VR also seemed to influence performance related to total reaction time task (the basis for many cognitive, skills and processes tasks) in children and adolescents with ASD, although these children and adolescents were slower and exhibited more anticipation than their healthy peers (78). In a study of adolescents with ASD, the use of a VR system improved social communication, performance on complex social tasks and capacity for socially appropriate conversation (79).

The tools described in this review play an important role in improving the communication skills of autistic children. However, before using the tools, an organized protocol to provide effective interventions is needed. Research has shown the importance of quantifying the severity of ASD. A method that is effective in subjects with milder symptoms, such as high-functioning ASD (Asperger syndrome), may be less effective in cases of severe ASD.

Furthermore, interventions should focus on one method at a time, without modifications to a published protocol, as children with ASD may not be able to focus on several activities at the same time. VR appears as to be a valuable tool, as children’s interest is aroused by such devices, and they find them attractive and motivating.

Limitations of the Individual Studies

The main limitation of a number of the studies was the small sample size (12,13,17,19,20,23,25,28,30). One of the limitations in the study by Schafer et al. (10) was the short period of time in which the children used the FM system, as this system is known to have greater effects when used for several hours a day.

In one study (36), the limitation was associated with different interaction devices. The authors considered that using a 58″ LCD screen was much better than using automatic screens for eye tracking, which led to data loss. Olivar-Parra et al. (9) identified the limited number of sessions and small groups as a limitation of their study. Choi et al. (8) stated that their main limitation was the impossibility of individualized therapy and the variety of content that should have been applied individually. The sample used by Panerai et al. (13) included children with severe mental retardation and autism, so their results cannot be generalized to other ASD groups.

D’Elia et al. (17) failed to compare the intervention program with other treatment models. The authors’ study was not randomized, and they evaluated the participants’ cognition only at baseline. Goodwin et al. (11) noted that their samples of spontaneous speech were extracted from 30-minute recordings of mother-child interactions made during six visits, and pointed out that data outside the recorded sessions were lost. Howlin et al. (26) noted that restrictions on financial and personal resources were a limitation and mentioned that the presence of the evaluators may have affected the participants’ behavior.

Anson et al. (71) described a limitation of their data collection procedure, noting that it was based on a recording procedure that might underestimate the behavior of interest. Howard et al. (14) stated that their data were not collected blindly and that allocation to treatment groups was not random but determined by the children’s parents. Nonrandomization of subjects (25) and the fact that the evaluators were not blinded completely was reported in some studies (24,25). Some of the studies did not explicitly report limitations (15,16,18,21,22,27,31-35,37,61,63,72,73).

The tools identified in this review ranged from high-tech devices to exchange picture cards, SGDs, instruments chosen by the subjects themselves and VR systems. All the tools were effective in promoting communication and social skills, increasing the frequency of initiation of communication and joint attention, and improving the behavior of children in the classroom.

ACKNOWLEDGMENTS

The authors would like to thank CAPES (Higher Education Personnel Training Coordination). Call Notice No. 59/2014 - PGPTA and the UNIEDU-SC postgraduate program.

REFERENCES

  • 1 Avila BG, Passerino LM, Tarouco LM. Usabilidade em tecnologia assistiva: estudo de caso num sistema de comunicação alternativa para crianças com autismo. RELATEC: Revista Latinoamericana de Tecnología Educativa. 2013;12(2):115-29.
  • 2 Aresti-Bartolome N, Garcia-Zapirain B. Technologies as support tools for persons with autistic spectrum disorder: a systematic review. Int J Environ Res Public Health. 2014;11(8):7767-802, http://dx.doi.org/10.3390/ijerph110807767
    » http://dx.doi.org/10.3390/ijerph110807767
  • 3 Lahiri U, Warren Z, Sarkar N. Design of a gaze-sensitive virtual social interactive system for children with autism. IEEE Trans Neural Syst Rehabil Eng. 2011;19(4):443-52, http://dx.doi.org/10.1109/TNSRE.2011.2153874
    » http://dx.doi.org/10.1109/TNSRE.2011.2153874
  • 4 De Leo G, Leroy G. Smartphones to facilitate communication and improve social skills of children with severe autism spectrum disorder: special education teachers as proxies. IDC Proceedings - Workshop on Special Needs. 2008;45-8, http://dx.doi.org/10.1145/1463689.1463715
    » http://dx.doi.org/10.1145/1463689.1463715
  • 5 Hourcade JP, Williams SR, Miller EA, Huebner KE, Liang LJ. Evaluation of tablet apps to encourage social interaction in children with Autism Spectrum Disorders. Conference on Human Factors in Computing Systems - Proceedings. 2013;3197-3206, http://dx.doi.org/10.1145/2470654.2466438
    » http://dx.doi.org/10.1145/2470654.2466438
  • 6 Passerino LM, Avila BG, Bez MR. SCALA: um Sistema de Comunicação Alternativa para o Letramento de Pessoas com Autismo. RENOTE Revista Novas Tecnologias na Educação. 2010;8(2):1-10.
  • 7 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700, http://dx.doi.org/10.1136/bmj.b2700
    » http://dx.doi.org/10.1136/bmj.b2700
  • 8 Choi MY, Lee HJ, Lee JH. Design and Development of Interactive Therapy System for Children with Autism. Korean Journal of The Science of Emotion & Sensibility. 2010;13(4):777-88.
  • 9 Olivar-Parra JS, De-La-Iglesia-Gutierrez M, Forns M. Training referential communicative skills to individuals with autism spectrum disorder: a pilot study. Psychol Rep. 2011;109(3):921-39, http://dx.doi.org/10.2466/10.11.15.28.PR0.109.6.921-939
    » http://dx.doi.org/10.2466/10.11.15.28.PR0.109.6.921-939
  • 10 Schafer EC, Mathews L, Mehta S, Hill M, Munoz A, Bishop R, et al. Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): an initial investigation. J Commun Disord. 2013;46(1):30-52, http://dx.doi.org/10.1016/j.jcomdis.2012.09.002
    » http://dx.doi.org/10.1016/j.jcomdis.2012.09.002
  • 11 Goodwin A, Fein D, Naigles LR. Comprehension of wh-questions precedes their production in typical development and autism spectrum disorders. Autism Res. 2012;5(2):109-23, http://dx.doi.org/10.1002/aur.1220
    » http://dx.doi.org/10.1002/aur.1220
  • 12 Naigles LR, Kelty E, Jaffery R, Fein D. Abstractness and continuity in the syntactic development of young children with autism. Autism Res. 2011;4(6):422-37, http://dx.doi.org/10.1002/aur.223
    » http://dx.doi.org/10.1002/aur.223
  • 13 Panerai S, Zingale M, Trubia G, Finocchiaro M, Zuccarello R, Ferri R, et al. Special education versus inclusive education: the role of the TEACCH program. J Autism Dev Disord. 2009;39(6):874-82, http://dx.doi.org/10.1007/s10803-009-0696-5
    » http://dx.doi.org/10.1007/s10803-009-0696-5
  • 14 Howard JS, Sparkman CR, Cohen HG, Green G, Stanislaw H. A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Res Dev Disabil. 2005;26(4):359-83, http://dx.doi.org/10.1016/j.ridd.2004.09.005
    » http://dx.doi.org/10.1016/j.ridd.2004.09.005
  • 15 Yoder P, Stone WL. Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. J Consult Clin Psychol. 2006;74(3):426-35, http://dx.doi.org/10.1037/0022-006X.74.3.426
    » http://dx.doi.org/10.1037/0022-006X.74.3.426
  • 16 Yoder P, Stone WL. A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. J Speech Lang Hear Res. 2006;49(4):698-711, http://dx.doi.org/10.1044/1092-4388(2006/051)
    » http://dx.doi.org/10.1044/1092-4388(2006/051)
  • 17 D'Elia L, Valeri G, Sonnino F, Fontana I, Mammone A, Vicari S. A longitudinal study of the teacch program in different settings: the potential benefits of low intensity intervention in preschool children with autism spectrum disorder. J Autism Dev Disord. 2014;44(3):615-26, http://dx.doi.org/10.1007/s10803-013-1911-y
    » http://dx.doi.org/10.1007/s10803-013-1911-y
  • 18 McDuffie AS, Lieberman RG, Yoder PJ. Object interest in autism spectrum disorder: a treatment comparison. Autism. 2012;16(4):398-405, http://dx.doi.org/10.1177/1362361309360983
    » http://dx.doi.org/10.1177/1362361309360983
  • 19 Seok S, DaCosta B, Yu BM. Spelling Practice Intervention: A Comparison of Tablet PC and Picture Cards as Spelling Practice Methods for Students with Developmental Disabilities. Education and Training in Autism and Developmental Disabilities. 2015;50(1):84-94.
  • 20 Thomas-Stonell N, Robertson B, Oddson B, Rosenbaum P. Communicative participation changes in pre-school children receiving augmentative and alternative communication intervention. Int J Speech Lang Pathol. 2016;18(1):32-40, http://dx.doi.org/10.3109/17549507.2015.1060530
    » http://dx.doi.org/10.3109/17549507.2015.1060530
  • 21 Panerai S, Ferrante L, Caputo V. The TEACCH strategy in mentally retarded children with autism: a multidimensional assessment. Pilot study. Treatment and Education of Autistic and Communication Handicapped children. J Autism Dev Disord. 1997;27(3):345-7.
  • 22 Panerai S, Ferrante L, Zingale M. Benefits of the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) programme as compared with a non-specific approach. J Intellect Disabil Res. 2002;46(Pt 4):318-27, http://dx.doi.org/10.1046/j.1365-2788.2002.00388.x
    » http://dx.doi.org/10.1046/j.1365-2788.2002.00388.x
  • 23 Ichikawa K, Takahashi Y, Ando M, Anme T, Ishizaki T, Yamaguchi H, et al. TEACCH-based group social skills training for children with high-functioning autism: a pilot randomized controlled trial. Biopsychosoc Med. 2013;7(1):14, http://dx.doi.org/10.1186/1751-0759-7-14
    » http://dx.doi.org/10.1186/1751-0759-7-14
  • 24 Boyd BA, Hume K, McBee MT, Alessandri M, Gutierrez A, Johnson L, et al. Comparative efficacy of LEAP, TEACCH and non-model-specific special education programs for preschoolers with autism spectrum disorders. J Autism Dev Disord. 2014;44(2):366-80, http://dx.doi.org/10.1007/s10803-013-1877-9
    » http://dx.doi.org/10.1007/s10803-013-1877-9
  • 25 Tsang SK, Shek DT, Lam LL, Tang FL, Cheung PM. Brief report: application of the TEACCH program on Chinese pre-school children with autism--Does culture make a difference? J Autism Dev Disord. 2007;37(2):390-6, http://dx.doi.org/10.1007/s10803-006-0199-6
    » http://dx.doi.org/10.1007/s10803-006-0199-6
  • 26 Howlin P, Gordon RK, Pasco G, Wade A, Charman T. The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: a pragmatic, group randomised controlled trial. J Child Psychol Psychiatry. 2007;48(5):473-81, http://dx.doi.org/10.1111/j.1469-7610.2006.01707.x
    » http://dx.doi.org/10.1111/j.1469-7610.2006.01707.x
  • 27 Fteiha MA. Effectiveness of assistive technology in enhancing language skills for children with autism. International Journal of Developmental Disabilities. 2017;63(1):36-44, http://dx.doi.org/10.1080/20473869.2015.1136129
    » http://dx.doi.org/10.1080/20473869.2015.1136129
  • 28 Chien ME, Jheng CM, Lin NM, Tang HH, Taele P, Tseng WS, et al. iCAN: A tablet-based pedagogical system for improving communication skills of children with autism. Int J Human-Computer Studies. 2015;73:79-90, http://dx.doi.org/10.1016/j.ijhcs.2014.06.001
    » http://dx.doi.org/10.1016/j.ijhcs.2014.06.001
  • 29 Strahler Rivero T, Herrera Nuãez LM, Uehara Pires E, Amodeo Bueno OF. ADHD Rehabilitation through Video Gaming: A Systematic Review Using PRISMA Guidelines of the Current Findings and the Associated Risk of Bias. Front Psychiatry. 2015;6:151, http://dx.doi.org/10.3389/fpsyt.2015.00151
    » http://dx.doi.org/10.3389/fpsyt.2015.00151
  • 30 Waddington H, Sigafoos J, Lancioni GE, O’Reilly MF, van der Meer L, Carnett A, et al. Three children with autism spectrum disorder learn to perform a three-step communication sequence using an iPad®-based speech-generating device. Int J Dev Neurosci. 2014;39:59-67, http://dx.doi.org/10.1016/j.ijdevneu.2014.05.001
    » http://dx.doi.org/10.1016/j.ijdevneu.2014.05.001
  • 31 Boyd LE, Ringland KE, Haimson OL, Fernandez H, Bistarkey M, Hayes GR. Evaluating a Collaborative iPad Game's Impact on Social Relationships for Children with Autism Spectrum Disorder. ACM Trans Access Comput. 2015;7(1):1-18, http://dx.doi.org/10.1145/2751564
    » http://dx.doi.org/10.1145/2751564
  • 32 Schlosser RW, Blischak DM, Belfiore PJ, Bartley C, Barnett N. Effects of synthetic speech output and orthographic feedback on spelling in a student with autism: a preliminary study. J Autism Dev Disord. 1998;28(4):309-19, http://dx.doi.org/10.1023/A:1026060619378
    » http://dx.doi.org/10.1023/A:1026060619378
  • 33 Schlosser RW, Sigafoos J, Luiselli JK, Angermeier K, Harasymowyz U, Schooley K, et al. Effects of synthetic speech output on requesting and natural speech production in children with autism: A preliminary study. Research in Autism Spectrum Disorders. 2007;1(2):139-63, http://dx.doi.org/10.1016/j.rasd.2006.10.001
    » http://dx.doi.org/10.1016/j.rasd.2006.10.001
  • 34 Schlosser RW, Blischak DM. Effects of speech and print feedback on spelling by children with autism. J Speech Lang Hear Res. 2004;47(4):848-62, http://dx.doi.org/10.1044/1092-4388(2004/063)
    » http://dx.doi.org/10.1044/1092-4388(2004/063)
  • 35 Koegel LK, Vernon T, Koegel RL, Koegel BL, Paullin AW. Improving Social Engagement and Initiations between Children with Autism Spectrum Disorder and Their Peers in Inclusive Settings. J Posit Behav Interv. 2012;14(4):220-7, http://dx.doi.org/10.1177/1098300712437042
    » http://dx.doi.org/10.1177/1098300712437042
  • 36 Venker CE, Eernisse ER, Saffran JR, Ellis Weismer S. Individual differences in the real-time comprehension of children with ASD. Autism Res. 2013;6(5):417-32, http://dx.doi.org/10.1002/aur.1304
    » http://dx.doi.org/10.1002/aur.1304
  • 37 Dickinson K, Place M. The Impact of a Computer-Based Activity Program on the Social Functioning of Children with Autistic Spectrum Disorder. Games Health J. 2016;5(3):209-15, http://dx.doi.org/10.1089/g4h.2015.0063
    » http://dx.doi.org/10.1089/g4h.2015.0063
  • 38 Virues-Ortega J, Julio FM, Pastor-Barriuso R. The TEACCH program for children and adults with autism: a meta-analysis of intervention studies. Clin Psychol Rev. 2013;33(8):940-53, http://dx.doi.org/10.1016/j.cpr.2013.07.005
    » http://dx.doi.org/10.1016/j.cpr.2013.07.005
  • 39 Prior M, Roberts JM, Rodger S, Williams K. A review of the research to identify the most effective models of practice in early intervention for children with autism spectrum disorders. Australian Government Department of Families, housing, Community Services and Indigenous Affairs, Australia. 2011.
  • 40 Myers SM, Johnson CP; American Academy of Pediatrics Council on Children With Disabilities. Management of children with autism spectrum disorders. Pediatrics. 2007;120(5):1162-82, http://dx.doi.org/10.1542/peds.2007-2362
    » http://dx.doi.org/10.1542/peds.2007-2362
  • 41 Lerna A, Esposito D, Conson M, Massagli A. Long-term effects of PECS on social-communicative skills of children with autism spectrum disorders: a follow-up study. Int J Lang Commun Disord. 2014;49(4):478-85, http://dx.doi.org/10.1111/1460-6984.12079
    » http://dx.doi.org/10.1111/1460-6984.12079
  • 42 Preston D, Carter M. A review of the efficacy of the picture exchange communication system intervention. J Autism Dev Disord. 2009;39(10):1471-86, http://dx.doi.org/10.1007/s10803-009-0763-y
    » http://dx.doi.org/10.1007/s10803-009-0763-y
  • 43 Eldevik S, Jahr E, Eikeseth S, Hastings RP, Hughes CJ. Cognitive and adaptive behavior outcomes of behavioral intervention for young children with intellectual disability. Behav Modif. 2010;34(1):16-34, http://dx.doi.org/10.1177/0145445509351961
    » http://dx.doi.org/10.1177/0145445509351961
  • 44 Siller M, Sigman M. Modeling longitudinal change in the language abilities of children with autism: parent behaviors and child characteristics as predictors of change. Dev Psychol. 2008;44(6):1691-704, http://dx.doi.org/10.1037/a0013771
    » http://dx.doi.org/10.1037/a0013771
  • 45 Siller M, Sigman M. The behaviors of parents of children with autism predict the subsequent development of their children's communication. J Autism Dev Disord. 2002;32(2):77-89, http://dx.doi.org/10.1023/A:1014884404276
    » http://dx.doi.org/10.1023/A:1014884404276
  • 46 Kasari C, Gulsrud A, Freeman S, Paparella T, Hellemann G. Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play. J Am Acad Child Adolesc Psychiatry. 2012;51(5):487-95, http://dx.doi.org/10.1016/j.jaac.2012.02.019
    » http://dx.doi.org/10.1016/j.jaac.2012.02.019
  • 47 McDuffie A, Yoder P. Types of parent verbal responsiveness that predict language in young children with autism spectrum disorder. J Speech Lang Hear Res. 2010;53(4):1026-39, http://dx.doi.org/10.1044/1092-4388(2009/09-0023)
    » http://dx.doi.org/10.1044/1092-4388(2009/09-0023)
  • 48 Boada H, Forns M. Observational guidelines of communicative exchange: An ecological approach to referential communication. Anuario de psicología/The UB Journal of psychology. 1997(75):7-36.
  • 49 Loveland KA, Tunalia B, Mcevoy RE, Kelley ML. Referential communication and response adequacy in autism and Down's syndrome. Applied Psycholinguistics. 1989;10(3):301-13, http://dx.doi.org/10.1017/S014271640000864X
    » http://dx.doi.org/10.1017/S014271640000864X
  • 50 Plumert JM, Ewert K, Spear SJ. The early development of children's communication about nested spatial relations. Child Development. 1995;66(4):959-69, http://dx.doi.org/10.2307/1131791
    » http://dx.doi.org/10.2307/1131791
  • 51 Boada H, Forns M. The cognitive complexity of the referent and self-regulation in children's messages. J Psycholinguist Res. 2004;33(3):237-61, http://dx.doi.org/10.1023/B:JOPR.0000027964.51244.d8
    » http://dx.doi.org/10.1023/B:JOPR.0000027964.51244.d8
  • 52 Baker-Ericzen M, Koegel R, Koegel LK. Increasing the social behavior of young children with autism using their obsessive behaviors. Research and Practice for Persons with Severe Disabilities. 1998;23(4):300-8.
  • 53 Koegel R, Kim S, Koegel L, Schwartzman B. Improving socialization for high school students with ASD by using their preferred interests. J Autism Dev Disord. 2013;43(9):2121-34, http://dx.doi.org/10.1007/s10803-013-1765-3
    » http://dx.doi.org/10.1007/s10803-013-1765-3
  • 54 Still K, Rehfeldt RA, Whelan R, May R, Dymond S. Facilitating requesting skills using high-tech augmentative and alternative communication devices with individuals with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders. 2014;8(9):1184-99, http://dx.doi.org/10.1016/j.rasd.2014.06.003
    » http://dx.doi.org/10.1016/j.rasd.2014.06.003
  • 55 Desai T, Chow K, Mumford L, Hotze F, Chau T. Implementing an iPad-based alternative communication device for a student with cerebral palsy and autism in the classroom via an access technology delivery protocol. Computers & Education. 2014;79:148-58.
  • 56 King ML, Takeguchi K, Barry SE, Rehfeldt RA, Boyer VE, Mathews TL. Evaluation of the iPad in the acquisition of requesting skills for children with autism spectrum disorder. Research in Autism Spectrum Disorders. 2014;8(9):1107-20, http://dx.doi.org/10.1016/j.rasd.2014.05.011
    » http://dx.doi.org/10.1016/j.rasd.2014.05.011
  • 57 Lorah ER, Tincani M, Dodge J, Gilroy S, Hickey A, Hantula D. Evaluating Picture Exchange and the iPad™ as a Speech Generating Device to Teach Communication to Young Children with Autism. J Dev Phys Disabil. 2013;25(6), http://dx.doi.org/10.1007/s10882-013-9337-1
    » http://dx.doi.org/10.1007/s10882-013-9337-1
  • 58 Schepis MM, Reid DH, Behrmann MM, Sutton KA. Increasing communicative interactions of young children with autism using a voice output communication aid and naturalistic teaching. J Appl Behav Anal. 1998;31(4):561-78, http://dx.doi.org/10.1901/jaba.1998.31-561
    » http://dx.doi.org/10.1901/jaba.1998.31-561
  • 59 Sigafoos J, Drasgow E, Halle JW, O'Reilly M, Seely-York S, Edrisinha C, et al. Teaching VOCA use as a communicative repair strategy. J Autism Dev Disord. 2004;34(4):411-22, http://dx.doi.org/10.1023/B:JADD.0000037417.04356.9c
    » http://dx.doi.org/10.1023/B:JADD.0000037417.04356.9c
  • 60 Hartmann T, Klimmt C. Gender and computer games: Exploring females’ dislikes. Journal of Computer-Mediated Communication. 2006;11(4):910-31, http://dx.doi.org/10.1111/j.1083-6101.2006.00301.x
    » http://dx.doi.org/10.1111/j.1083-6101.2006.00301.x
  • 61 Mohan V, Kunnath SK, Philip VS, Mohan LS, Thampi N. Capitalizing on technology for developing communication skills in autism spectrum disorder: a single case study. Disabil Rehabil Assist Technol. 2017;15:1-7, http://dx.doi.org/10.1080/17483107.2017.1413144
    » http://dx.doi.org/10.1080/17483107.2017.1413144
  • 62 Hu R, Feng J, Lazar J, Kumin L. Investigating input technologies for children and young adults with Down syndrome. Univ Access Inf Soc. 2013;12:89-104, http://dx.doi.org/10.1007/s10209-011-0267-3
    » http://dx.doi.org/10.1007/s10209-011-0267-3
  • 63 Hirano SH, Yeganyan MT, Marcu G, Nguyen DH, Boyd LA, Hayes GR. vSked: Evaluation of a System to Support Classroom Activities for Children with Autism. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; Atlanta, Georgia, USA. 1753569: ACM; 2010. p. 1633-42.
  • 64 Yeganyan MT, Cramer M, Boyd LA, Hayes GR. vSked: an interactive visual schedule system for use in classrooms for children with autism. Proceedings of the 9th International Conference on Interaction Design and Children; 2010: ACM.
  • 65 Cohen MJ, Sloan DL. Visual supports for people with autism: a guide for parents and professionals. Journal of Developmental & Behavioral Pediatrics. 2007;29(6):p449.
  • 66 Deckers SRJM, Van Zaalen Y, Van Balkom H, Verhoeven L. Core vocabulary of young children with Down syndrome. Augment Altern Commun. 2017;33(2):77-86, http://dx.doi.org/10.1080/07434618.2017.1293730
    » http://dx.doi.org/10.1080/07434618.2017.1293730
  • 67 Davies M, Yellon L, Purdy SC. Speech-in-noise perception of children using cochlear implants and FM systems. Australian and New Zealand Journal of Audiology. 2001;23(1):52-62, http://dx.doi.org/10.1375/audi.23.1.52.31096
    » http://dx.doi.org/10.1375/audi.23.1.52.31096
  • 68 Jacob RT, Bevilacqua MC, Molina SV, Queiroz M, Hoshii LA, Lauris JR, et al. Sistema de frequência modulada em crianças com deficiência auditiva: avaliação de resultados. Rev Soc Bras Fonoaudiol. 2012;17(4):417-21, http://dx.doi.org/10.1590/S1516-80342012000400009
    » http://dx.doi.org/10.1590/S1516-80342012000400009
  • 69 Schafer EC, Bryant D, Sanders K, Baldus N, Algier K, Lewis A, et al. Fitting and verification of frequency modulation systems on children with normal hearing. J Am Acad Audiol. 2014;25(6):529-40, http://dx.doi.org/10.3766/jaaa.25.6.3
    » http://dx.doi.org/10.3766/jaaa.25.6.3
  • 70 Hornickel J, Zecker SG, Bradlow AR, Kraus N. Assistive listening devices drive neuroplasticity in children with dyslexia. Proc Natl Acad Sci U S A. 2012;109(41):16731-6, http://dx.doi.org/10.1073/pnas.1206628109
    » http://dx.doi.org/10.1073/pnas.1206628109
  • 71 Anson HM, Todd JT, Cassaretto KJ. Replacing overt verbal and gestural prompts with unobtrusive covert tactile prompting for students with autism. Behav Res Methods. 2008;40(4):1106-10, http://dx.doi.org/10.3758/BRM.40.4.1106
    » http://dx.doi.org/10.3758/BRM.40.4.1106
  • 72 Shabani DB, Katz RC, Wilder DA, Beauchamp K, Taylor CR, Fischer KJ. Increasing social initiations in children with autism: effects of a tactile prompt. J Appl Behav Anal. 2002;35(1):79-83, http://dx.doi.org/10.1901/jaba.2002.35-79
    » http://dx.doi.org/10.1901/jaba.2002.35-79
  • 73 Taylor BA, Levin L. Teaching a student with autism to make verbal initiations: effects of a tactile prompt. J Appl Behav Anal. 1998;31(4):651-4, http://dx.doi.org/10.1901/jaba.1998.31-651
    » http://dx.doi.org/10.1901/jaba.1998.31-651
  • 74 Tzanakaki P, Grindle CF, Dungait S, Hulson-Jones A, Saville M, Hughes JC, et al. Use of a tactile prompt to increase social initiations in children with autism. Research in Autism Spectrum Disorders. 2014;8(6):726-36, http://dx.doi.org/10.1016/j.rasd.2014.03.016
    » http://dx.doi.org/10.1016/j.rasd.2014.03.016
  • 75 Fernald A, Marchman VA. Individual differences in lexical processing at 18 months predict vocabulary growth in typically developing and late-talking toddlers. Child Dev. 2012;83(1):203-22, http://dx.doi.org/10.1111/j.1467-8624.2011.01692.x
    » http://dx.doi.org/10.1111/j.1467-8624.2011.01692.x
  • 76 Fernald A, Perfors A, Marchman VA. Picking up speed in understanding: Speech processing efficiency and vocabulary growth across the 2nd year. Dev Psychol. 2006;42(1):98-116, http://dx.doi.org/10.1037/0012-1649.42.1.98
    » http://dx.doi.org/10.1037/0012-1649.42.1.98
  • 77 Golinkoff RM, Hirsh-Pasek K, Cauley KM, Gordon L. The eyes have it: lexical and syntactic comprehension in a new paradigm. J Child Lang. 1987;14(1):23-45, http://dx.doi.org/10.1017/S030500090001271X
    » http://dx.doi.org/10.1017/S030500090001271X
  • 78 Herrero D, Crocetta TB, Massetti T, de Moraes IA, Trevizan IL, Guarnieri R, et al. Total Reaction Time Performance of Individuals with Autism after a Virtual Reality Task. International Journal of Neurorehabilitation. 2015;2(5):1-5, http://dx.doi.org/10.4172/2376-0281.1000189
    » http://dx.doi.org/10.4172/2376-0281.1000189
  • 79 Lahiri U, Bekele E, Dohrmann E, Warren Z, Sarkar N. A physiologically informed virtual reality based social communication system for individuals with autism. J Autism Dev Disord. 2015;45(4):919-31, http://dx.doi.org/10.1007/s10803-014-2240-5
    » http://dx.doi.org/10.1007/s10803-014-2240-5

Publication Dates

  • Publication in this collection
    2018

History

  • Received
    22 Feb 2018
  • Accepted
    22 June 2018
Creative Common - by 4.0
This is an Open Access article distributed under the terms of the Creative Commons License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
location_on
Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br
rss_feed Stay informed of issues for this journal through your RSS reader
Acessibilidade / Reportar erro