This exploratory randomised controlled trial tested the effectiveness of a tablet-based information communication technology early intervention application to augment existing therapy with the aim of improving visual motor, imitation, language and social skills in young children with ASD who reside in regional areas. Fifty-nine participants were recruited and randomised to either a therapy-as-usual group or intervention group. With the exception of the expressive language subscale on the Mullen Scales of Early Learning, no significant between-group differences were recorded for visual motor, imitation, receptive language and social skills of participants between baseline and post-intervention. When all participants were pooled and measured over time, improvements were shown in receptive and pragmatic language and social skills; these gains were maintained, thus suggesting skill acquisition.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Akshoomoff, N. (2006). Use of the Mullen Scales of Early Learning for the assessment of young children with Autism Spectrum Disorders. Child Neuropsychology, 12(4–5), 269–277.
Allen, K. D., & Warzak, W. J. (2000). The problem of parental nonadherence in clinical behavior analysis: Effective treatment is not enough. Journal of Applied Behavior Analysis, 33(3), 373–391.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Retrieved from http://dsm.psychiatryonline.org/book.aspx?bookid=556.
Armstrong, R. A. (2014). When to use the Bonferroni correction. Ophthalmic and Physiological Optics, 34(5), 502–508.
Australian Bureau of Statistics. (2011a). Australian standard geographical classification system (ASGC). Canberra: Commonwealth of Australia.
Australian Bureau of Statistics. (2011b). Census of population and housing: Socio-economic indexes for areas (SEIFA), Australia. Canberra, Australia: Commonwealth of Australia. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001.
Australian Bureau of Statistics. (2017). Western Australia: Region data summary. Canberra, Australia: Commonwealth of Australia. Retrieved from http://stat.abs.gov.au/itt/r.jsp?RegionSummary®ion=5&dataset=ABS_REGIONAL_ASGS&geoconcept=REGION&measure=MEASURE&datasetASGS=ABS_REGIONAL_ASGS&datasetLGA=ABS_NRP9_LGA®ionLGA=REGION®ionASGS=REGION.
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis 1. Journal of Applied Behavior Analysis, 1(1), 91–97.
Boucenna, S., Narzisi, A., Tilmont, E., Muratori, F., Pioggia, G., Cohen, D., & Chetouani, M. (2014). Interactive technologies for autistic children: A review. Cognitive Computation, 6, 722–740
Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., … Fabrizio, C. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457.
Bundy, A. (2004). Test of playfulness (TOP) version 4.0. Sydney, Australia: The University of Sydney.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155.
Cordier, R., Munro, N., Wilkes-Gillan, S., Speyer, R., & Pearce, W. M. (2014). Reliability and validity of the Pragmatics Observational Measure (POM): A new observational measure of pragmatic language for children. Research in Developmental Disabilities, 35(7), 1588–1598.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., … Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23.
Dew, A., Veitch, C., Lincoln, M., Brentnall, J., Bulkeley, K., Gallego, G., … Griffiths, S. (2012). The need for new models for delivery of therapy intervention to people with a disability in rural and remote areas of Australia. Journal of Intellectual and Developmental Disability, 37(1), 50–53.
Doenyas, C., Şimdi, E., Özcan, E., Çataltepe, Z., & Birkan, B. (2014). Autism and tablet computers in Turkey: Teaching picture sequencing skills via a web-based iPad application. International Journal of Child-Computer Interaction. https://doi.org/10.1016/j.ijcci.2014.04.002.
Falloon, G., & Khoo, E. (2014). Exploring young students’ talk in iPad-supported collaborative learning environments. Computers & Education, 77, 13–28. https://doi.org/10.1016/j.compedu.2014.04.008.
Fletcher-Watson, S., Petrou, A., Scott-Barrett, J., Dicks, P., Graham, C., O’Hare, A., … McConachie, H. (2016). A trial of an iPad™ intervention targeting social communication skills in children with autism. Autism, 20(7), 771–782.
Golan, O., & Baron-Cohen, S. (2006). Systemizing empathy: Teaching adults with Asperger syndrome or high-functioning autism to recognize complex emotions using interactive multimedia. Development and Psychopathology, 18(02), 591–617.
Heitzman-Powell, L. S., Buzhardt, J., Rusinko, L. C., & Miller, T. M. (2014). Formative Evaluation of an ABA Outreach Training Program for parents of children with autism in remote areas. Focus on Autism & Other Developmental Disabilities, 29(1), 23–38. https://doi.org/10.1177/1088357613504992.
Hoogsteen, L., & Woodgate, R. L. (2013). The lived experience of parenting a child with autism in a rural area: Making the invisible, visible. Pediatric Nursing, 39(5), 233–237.
Hopkins, I. M., Gower, M. W., Perez, T. A., Smith, D. S., Amthor, F. R., Wimsatt, F. C., & Biasini, F. J. (2011). Avatar assistant: Improving social skills in students with an ASD through a computer-based intervention. Journal of Autism and Developmental Disorders, 41(11), 1543–1555.
Horlin, C., Falkmer, M., Parsons, R., Albrecht, M. A., & Falkmer, T. (2014). The cost of Autism Spectrum Disorders. PLoS ONE, 9(9), e106552.
Howlin, P., Magiati, I., Charman, T., & MacLean, J. W. E. (2009). Systematic review of early intensive behavioral interventions for children with Autism. American Journal on Intellectual and Developmental Disabilities, 114(1), 23–41. https://doi.org/10.1352/2009.114:23-41.
Hutton, A. M., & Caron, S. L. (2005). Experiences of families with children with autism in rural New England. Focus on Autism and Other Developmental Disabilities, 20(3), 180–189.
IBM Corporation. (2015). IBM SPSS statistics. Armonk, NY: IBM Corporation.
Ingersoll, B., & Berger, N. I. (2015). Parent engagement with a telehealth-based parent-mediated intervention program for children with Autism Spectrum Disorders: Predictors of program use and parent outcomes. Journal of Medical Internet Research. 17(10).
Keane, S., Smith, T., Lincoln, M., & Fisher, K. (2011). Survey of the rural allied health workforce in New South Wales to inform recruitment and retention. Australian Journal of Rural Health, 19(1), 38–44.
Krueger, C., & Tian, L. (2004). A comparison of the general linear mixed model and repeated measures ANOVA using a dataset with multiple missing data points. Biological Research for Nursing, 6(2), 151–157.
Levy, S., Souders, M., Wray, J., Jawad, A., Gallagher, P., Coplan, J., … Mulberg, A. (2003). Children with autistic spectrum disorders. I: Comparison of placebo and single dose of human synthetic secretin. Archives of Disease in Childhood, 88(8), 731–736.
Lowe, M., & Costello, A. J. (1988). Symbolic play test: Manual (2nd edn.). England: The NFER-NELSON Publishing Company.
Luyster, R. J., Kadlec, M. B., Carter, A., & Tager-Flusberg, H. (2008). Language assessment and development in toddlers with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 38(8), 1426–1438.
McConachie, H., & Oono, I. (2013). Cochrane in context: Parent-mediated early intervention for young children with Autism Spectrum Disorders (ASD). Evidence-Based Child Health, 8(6), 2483–2485. https://doi.org/10.1002/ebch.1954.
Moore, D. W., Venkatesh, S., Anderson, A., Greenhill, S., Phung, D., Duong, T.,.. . Whitehouse, A. J. (2013). TOBY play-pad application to teach children with ASD-A pilot trial. Developmental Neurorehabilitation, 25, 1–5.
Moore, D. W., Venkatesh, S., Anderson, A., Greenhill, S., Phung, D., Duong, T., … Whitehouse, A. J. (2015). TOBY play-pad application to teach children with ASD–A pilot trial. Developmental Neurorehabilitation, 18(4), 213–217.
Mullen, E. M. (1995). Mullen scales of early learning (AGS ed.). Bloomington: Pearson.
Parsons, D., Cordier, R., Vaz, S., & Lee, H. C. (2017). Parent-mediated intervention training delivered remotely for children with Autism Spectrum Disorder living outside of urban areas: Systematic review. Journal of Medical Internet Research, 19(8), e198.
Perneger, T. V. (1998). What’s wrong with Bonferroni adjustments. BMJ: British Medical Journal, 316(7139), 1236.
Ploog, B. O., Scharf, A., Nelson, D., & Brooks, P. J. (2013). Use of computer-assisted technologies (CAT) to enhance social, communicative, and language development in children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 43(2), 301–322.
Prior, M., & Roberts, J. (2012). Early intervention for children with Austism Spectrum Disorders: ‘Guidelines for good practice’ 2012. Canberra: Australian Government.
Rajendran, G. (2013). Virtual environments and autism: A developmental psychopathological approach. Journal of Computer Assisted Learning, 29(4), 334–347.
Ramdoss, S., Lang, R., Mulloy, A., Franco, J., O’Reilly, M., Didden, R., & Lancioni, G. (2011). Use of computer-based interventions to teach communication skills to children with Autism Spectrum Disorders: A systematic review. Journal of Behavioral Education, 20(1), 55–76.
Ramdoss, S., Machalicek, W., Rispoli, M., Mulloy, A., Lang, R., & O’Reilly, M. (2012). Computer-based interventions to improve social and emotional skills in individuals with Autism Spectrum Disorders: A systematic review. Developmental Neurorehabilitation, 15(2), 119–135.
Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Annals of Internal Medicine, 152(11), 726–732.
Silver, M., & Oakes, P. (2001). Evaluation of a new computer intervention to teach people with autism or Asperger syndrome to recognize and predict emotions in others. Autism, 5(3), 299–316.
Smith, K. B., Humphreys, J. S., & Wilson, M. G. (2008). Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research? Australian Journal of Rural Health, 16(2), 56–66.
Stanley, G. C., & Konstantareas, M. M. (2007). Symbolic play in children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 37(7), 1215–1223.
Sterne, J. A., White, I. R., Carlin, J. B., Spratt, M., Royston, P., Kenward, M. G., … Carpenter, J. R. (2009). Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls. Bmj, 338, b2393.
Struber, J. (2004). Recruiting and retaining allied health professionals in rural Australia: Why is it so difficult. The Internet Journal of Allied Health Sciences and Practice, 2(2), 1–8.
Tanaka, J. W., Wolf, J. M., Klaiman, C., Koenig, K., Cockburn, J., Herlihy, L., … Schultz, R. T. (2010). Using computerized games to teach face recognition skills to children with Autism Spectrum Disorder: The Let’s Face It! program. Journal of Child Psychology and Psychiatry, 51(8), 944–952.
Thabane, L., Mbuagbaw, L., Zhang, S., Samaan, Z., Marcucci, M., Ye, C., … Kosa, D. (2013). A tutorial on sensitivity analyses in clinical trials: The what, why, when and how. BMC Medical Research Methodology, 13(1), 92.
Tseng, R.-Y., & Do, E. Y.-L. (2010). Facial expression wonderland (FEW): A novel design prototype of information and computer technology (ICT) for children with Autism Spectrum Disorder (ASD). Paper presented at the Proceedings of the 1st ACM International Health Informatics Symposium.
Venkatesh, S., Phung, D., Duong, T., Greenhill, S., & Adams, B. (2013). TOBY: Early intervention in autism through technology. Paper presented at the Proceedings of the SIGCHI Conference on Human Factors in Computing Systems.
Vismara, L. A., McCormick, C., Young, G. S., Nadhan, A., & Monlux, K. (2013). Preliminary findings of a telehealth approach to parent training in Autism. Journal of Autism & Developmental Disorders, 43(12), 2953–2969. https://doi.org/10.1007/s10803-013-1841-8.
Wetherby, A. M., Allen, L., Cleary, J., Kublin, K., & Goldstein, H. (2002). Validity and reliability of the communication and symbolic behavior scales developmental profile with very young children. Journal of Speech, Language, and Hearing Research, 45(6), 1202–1218.
Wetherby, A. M., & Prizant, B. M. (2002). Communication and symbolic behavior scales: Developmental profile. Baltimore: Paul H Brookes Publishing.
Whalen, C., Liden, L., Ingersoll, B., Dallaire, E., & Liden, S. (2006). Behavioral improvements associated with computer-assisted instruction for children with developmental disabilities. The Journal of Speech and Language Pathology-Applied Behavior Analysis, 1(1), 11–26.
Whalen, C., Moss, D., Ilan, A. B., Vaupel, M., Fielding, P., MacDonald, K., … Symon, J. (2010). Efficacy of TeachTown: Basics computer-assisted intervention for the intensive comprehensive autism program in Los Angeles unified school district. Autism, 14(3), 179–197.
Whitehouse, A. J., Granich, J., Alvares, G., Busacca, M., Cooper, M. N., Dass, A., … Richdale, A. (2017). A randomised controlled trial of an iPad-based application to complement early behavioural intervention in Autism Spectrum Disorder. Journal of Child Psychology and Psychiatry, 58(9), 967–1064.
The authors would like to acknowledge the support of the Lishman Health Foundation for funding this research project. The authors would also like to acknowledge the support of the South West Autism Group (SWAN) and the Telethon Kids Institute. The funders had no role in the analysis or drafting of this manuscript.
Conflict of interest
The application described in this paper is available online through the Apple iTunes store. The authors (and funders) have no affiliation with the application or its developers and will not receive, or have previously received, any royalties from sales.
About this article
Cite this article
Parsons, D., Cordier, R., Lee, H. et al. A Randomised Controlled Trial of an Information Communication Technology Delivered Intervention for Children with Autism Spectrum Disorder Living in Regional Australia. J Autism Dev Disord 49, 569–581 (2019). https://doi.org/10.1007/s10803-018-3734-3
- Information technology
- RCT design
- Parent training
- Early intervention