COMPUTER TECHNOLOGY AND AUTISM
"The computer is just a glorified pencil"
Some technology fascinates certain people to such an extent that they
end up by forgetting its finality. Computers and computer technology can
be counted among this group.
I do not wish to consider the myths of the "electronic brain" or"the fear of Big Brother", but more simply the fascination for computer technology by somebody who has just begun to master it. Thus, an economist, a chemist, a doctor can end up by becoming a computer scientist, entirely forgetting the reasons which had originally pushed him/her to becoming interested in the first place... I shall not be discussing the origins of this fascination in the present paper. This ought, however, to diminish as computers are robbed of their originality and their user-friendliness is improved.
The subject which concerns us here: The use of computer technology with the mentally handicapped and particularly those suffering from autism ought to be tackled by not succumbing to this fascination. This calls for an inversion of the proposition. Instead of asking the following question: "How can I use computer technology at my disposal to help this particular handicapped person?", the problem ought to be tackled in a diametrically opposite manner, with the question being asked as follows: "I have before me a person whose handicap causes some difficulty. In light of what we know about this person and of his/her handicap, is there any way of helping him/her with the use of computer aided technology ?".
This approach, which is based on the person and not on available technology, may lead to direct aids for the handicapped person or indirect aids for those working with the handicapped person. One becomes fairly rapidly aware of the obvious interaction and complementarity between these two ways of assisting the handicapped person. The computer aided technology may involve various fields. Taking autism as an example, the following fields will have to be looked at:
As has already been mentioned in the introduction, good understanding of the person and the difficulties at the root of his/her handicap are vital for any form of intervention. In this respect, diagnosis of autism requires a considerably different approach to the care and attention given to the handicapped person to that involving other developmental problems or learning difficulties. This is a fairly new area which still requires exploration. What would these aids, which certain computer systems could provide to improve the diagnosis, consist in? This may involve helping professionals in their diagnostic approach with the use of Expert Systems or, further upstream, providing better definition of the autistic syndrome, especially in borderline cases, whether this concerns cases which are apparently only minor where autism can be confused with other speech disorders or communication problems or very serious cases in which severe mental deficiency partially obscures the real syndrome.
Although general understanding of autism is vital, knowledge and understanding of the person also involves understanding of his/her skills, abilities and learning difficulties. Assessment of the autistic person's possibilities calls for accurate evaluation of several fields of development. Scales which are suitable for a multi dimensional assessment of the person's abilities within a developmental perspective, such as the PEP-R (Schopler) or the LPAD (Feuerstein), enable skills to be assessed and emerging abilities to be highlighted, with this forming the basis for progress by the autistic person. In the case of autism, assessment of the social skills, in addition to his/her cognitive abilities, informs us of the areas which ought primarily to be developed to promote better social integration. In this respect, computer technology can above all provide indirect assistance with assessment, both from the point of view of data collection and analysis as that of the development of new forms of assessment, made possible by the interactive aspect of computer technology, as well as by the possibilities provided for training/guidance and sound and image combination (Multimedia technology).
The choice of activities and exercises, adapted to the level of acquisition and emerging abilities, will depend on the assessment. It is these exercises which will have to be integrated into a computer programme. A great many exercises, which are well adapted to the specificities of the autist's learning difficulties, already exist.
Computerization of some of these exercises could be quite easily undertaken. One could also look at existing educational computer programmes for exercises, which although not specifically developed for autistic people, could very well be of an appropriate level and which do not, above all, present any disconcerting characteristics for autistic people. It is, moreover, in this category that the highest number of computer experiments may be found. Finally, teachers could also invent new exercises which make specific use of the progressive animation and integration capacities of several of the new tool's sensorial modes.
To this end, writing aids for educational programmes have been developed which may either assist in the creation of new programmes or in enhanced personalization of educational programmes. Consideration and examination of the progress made in understanding autism will be extremely important, ensuring that educational programmes are fully adapted to the specificities of this syndrome.
In a more targeted approach to the possibilities provided in the field of educational programmes, one may, in relation with the WHO's classification of handicaps: Deficiency, Disability and Handicap, submitted by Wood in 1980 distinguish three levels of intervention:
In contrast to this, however, several experiments involving computer aided teaching in the second area would appear to show encouraging results. It is very important to remember the autistic person's difficulties with memorization, sensorial integration, attention span and generalization which have been highlighted by recent research into this disorder.
As far as exercises which promote socialization are concerned, fairly good educational programmes are now available. Here again, the "Multimedia" technology ought to enable exercises to be offered which more closely match real (social) situations.
Up to now, computer technology has above all been used as a communications aid in cases of cerebral motory disabilities. Depending on the brain damaged person's motory and intellectual abilities, various communications systems based on a pointing method using pictures, symbols or even words displayed on a screen, enable a level of communication which considerably increases the person's autonomy.
This type of use with non verbal autistic people or those experiencing difficulties in expressing themselves verbally has been experimented with by various specialists. This may involve pointing systems using drawings or symbols, similar to the communication cards already used by a number of autistic people to communicate with their entourage. By combining the principle of card communication with the possibilities provided by computers, new fields of application will be developed. For instance, voice synthesis which enables easier communication with an interlocutor or the system of unfolding pictures.
For some autistic people, who do manage to learn to read and write, communication using a computer keyboard or reception using a visual document, either displayed on a computer screen or printed up, could be easier than verbal communication or reception, especially due to the marked preference shown by a high number of autistic people for visual stimuli but also because of the permanence of visual stimuli compared with the transitory nature of auditory stimuli. However, great care is called for in this area in view of certain overly optimistic views linked to the use of a technique known as "Facilitated Communication".
Information technologies can indeed facilitate communication in a more general manner, in particularly via computer networks. This kind of infrastructure could indeed constitute a potentially very powerful and rapid source of information exchanges, for instance the "INTERNET" network."INTERNET" links up several computer networks worldwide, with these being mainly used by universities.
An Electronic Mailing List particularly devoted to autism has already been set up, in which professionals, parents of autistic people and autistic people capable of using a computer keyboard can take part. Other discussions devoted to autism have emerged in discussion groups of a more general nature, called NEWSGROUPS, which operate within the USENET network. A great number of other subjects concerning psychiatry are dealt with by these networks. Some discussions are open to a wide public: professionals and non professionals alike rub shoulders, which can occasionally be irritating for some but is often a very interesting experience. Other discussions are only open to specialists, with access being controlled by the specialists themselves.
I do not wish to consider the use of computers and computer technology
to be found in most medical research laboratories: this is a tool for
statistical analysis, graphical representation, signal processing, etc...
I am thinking more of computer technology which, by modifying one or
several parameters, is able to describe and analyse certain brain
activity. In some cases, the computer model can even simulate this
activity, thereby providing scientists with an experimental field
previously not available to them for obvious ethical reasons.
Recent developments in symbolic Artificial Intelligence and the
exploration work carried out in the field of so called "neuronal"
computers, sometimes also known as connectionist systems, have provided
neuro psychologists and neuro-biologists with exploration models,
enabling them to test their hypotheses. Indeed, I am of the opinion
that this could be an area of profitable cooperation between scientists
working in the field of autism and those doing research on Artificial
The latter find themselves confronted by the "pathologies" of their artificial systems: learning difficulties, rigid behaviour patterns, the near impossibility of making generalizations based on previous experience and above all the difficulty of integrating several outside stimulus at the same time. There is no doubt that, as already mentioned earlier, this will involve working in an area in which some will be able to rediscover with pleasure their fascination for the world of computer technology.
Although some years ago one of the main obstacles to the implementation of computer aided educational programmes was the price of the equipment, this aspect has now become a secondary consideration. Indeed, first rate computer hardware/software can be bought at very reasonable prices. The difficulties encountered are of two kinds:
But new wine must be put into new bottles. It is, indeed, much easier to quote this saying from the Bible than to put it into actual practice. The use of computer technology may require changes in the care, whether therapeutic or educational, afforded autistic people. Such changes must be prepared. The resistance which this technology may give rise to will have to be considered: "It doesn't work, it's useless. We are going to make our children in robots, they will become prisoners of mechanical behaviour, etc..."
In the first part of my paper, I dealt with the importance of only considering the computer as a useful aid in caring for autistic people and not as a finality in itself. This at least partly answers some of the fears expressed. As far as the computer aided programmes lack of efficiency is concerned, it is difficult to be convincing by opposing theoretical arguments. It is far better to promote exchanges with teams who have already gained experience in this field.
This leads me to talk about another prerequisite for implementation of computer technology and above all the necessary adjustments to be made during use. It is important that the various teams, who have decided to adopt computer technology, are given the opportunity of frequent and practical communication between themselves. This will then lead up to the second area of difficulties, those which concern the technical aspect. To promote such exchanges, communication tools, like those already mentioned in the first section, will have to be set up. Although communication networks, such as INTERNET, exist more or less worldwide and the equipment required for writing and reading messages has become considerably cheaper, there are not very many access points, at least not outside the USA.
As an illustration, there are more than ten million people linked to INTERNET in the USA and less than 500,000 for all of Europe. Since it is above all universities and scientists who use these networks, the USA's lead over the rest of the field can be appreciated.
To return to the more immediate implementation of computer aided solutions, especially within the field of computer aided teaching, one will have to look and see which existing programmes are most suited to the person's learning abilities. This is not a particularly easy task. There is no general list classifying education or recreational computer programmes on the basis of their cognitive level.
One must not forget to examine non specialized programmes, whether this concerns educational programmes or games. The informed professional may very well find unexpected resources, which will no doubt require some adaptation and/or departure from the programme's original intention. Some games, for instance, can provide an opportunity for learning social skills: learning to play in turns for example. Computer simulation in a known environment can help the person to learn basic rules, frequently impossible in a real situation,...
Programmes known as utilities, such as word processing programmes or computer aided programmes for artistic creation are another source of assistance for the mentally handicapped and autistic people. The mentally handicapped people frequently have difficulty in executing a task such as writing or drawing. This does not involve a lack of artistic ability but rather difficulties linked to disorders accompanying their handicap, motory problems, precise coordination, slowness, etc.
An interesting aspect of computer technology is that it accepts a certain degree of error. Word processing programmes enable typing errors to be corrected, some even correct spelling mistakes. Computer aided graphics programmes allow the "painter" to go back over the drawing if it is not quite right. In both cases, one does not have to start again from scratch. This type of programme can be used to help a person tell a story, either with the use of the text or with the help of drawings or even both at once. This can be done individually or collectively. One may also envisage the same type of possibility with certain programmes specifically designed for musical creation.
Another difficulty resides in the lack of standardization of educational material and programmes. Once the first step involving the choice of programme suited to the needs of a particular person has been reached and even taken, the programme will then have to have been rewritten for the educational team's specific type of equipment. Nonetheless, there are some excellent suppliers of educational programmes which operate with several types of computers. These are unfortunately too few and far between.
A number of programmes are poorly suited to the specific needs of people with learning difficulties, especially autistic people. Some are written by experts in specialized teaching and are thus very good from the didactic point of view but their technical qualities are often not up to scratch: insufficiently reliable, insufficiently flexible, laborious implementation, etc. Other programmes have been written by computer scientists which, despite evident good will and obvious computer skills, have only been able to create programmes with generally fairly limited teaching qualities. There is a crying need for coordination between the two groups. Beyond these two specialties and in light of the complexity of the group of people for whom these programmes are developed, it would be good if multi disciplinary teams, including teachers, psychologists, neurologists, psychiatrists, as well as cognitive specialists and occupational therapists took part in the development of educational programmes. As a step in this direction, the following associations: Autisme France, Autisme Europe, the ARAPI and the UNAPEI have organized, in conjunction with IBM France's computer centre and services to the handicapped, France Telcom, an international conference on the subject of Autism and Computer Technology, which brought together specialists from various fields. This conference was held in Nice (France) at the ACROPOLIS in January 1995.
The five themes, mentioned earlier, have been presented: