Appropriateness of the TOBY Application, an iPad Intervention for Children with Autism Spectrum Disorder: A Thematic Approach

Abstract

This study aimed to explore the appropriateness of an ICT intervention, the Therapeutic Outcomes by You application (TOBY app), from the perspectives of the parents. Parental experiences of twenty-four parents of a child with ASD who had participated in a three-month trial using the TOBY app were collected using semi-structured interviews. Thematic analysis was conducted and themes were mapped against an appropriateness framework. Collectively, parents felt the TOBY app was relevant and important to them and their children’s needs, while expressing partial support of the TOBY app as: a positive experience for them and their children, beneficial for them and their children, a socially and ecological valid intervention, and an intervention that supported change and continuation in the skills learnt.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Allan, N., Wilkes-Gillan, S., Bundy, A., Cordier, R., & Volkert, A. (2018). Parents’ perceptions of the long-term appropriateness of a psychosocial intervention for children with attention deficit hyperactivity disorder. Australian Occupational Therapy Journal, 65(4), 259–267.

    Article  PubMed  Google Scholar 

  2. Allen, M. L., Hartley, C., & Cain, K. (2016). iPads and the use of “apps” by children with autism spectrum disorder: Do they promote learning? Frontiers in Psychology, 7 1305.

    PubMed  PubMed Central  Google Scholar 

  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washinton, DC: American Psychiatric Pub.

    Book  Google Scholar 

  4. Anney, V. N. (2014). Ensuring the quality of the findings of qualitative research: Looking at trustworthiness criteria. Journal of Emerging Trends in Educational Research and Policy Studies, 5(2), 272–281.

    Google Scholar 

  5. Antezana, L., Scarpa, A., Valdespino, A., Albright, J., & Richey, J. A. (2017). Rural trends in diagnosis and services for autism spectrum disorder. Frontiers in Psychology, 8, 590.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Australian Bureau of Statistics. (2011). Australian standard geographical classification system (ASGC). Canberra: Commonwealth of Australia.

    Google Scholar 

  7. Baranowski, T., Buday, R., Thompson, D. I., & Baranowski, J. (2008). Playing for real: Video games and stories for health-related behavior change. American Journal of Preventive Medicine, 34(1), 74–82.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., et al. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

    Article  Google Scholar 

  10. Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A. L., Sandercock, P., Spiegelhalter, D., et al. (2000). Framework for design and evaluation of complex interventions to improve health. BMJ, 321(7262), 694–696.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Campbell, N. C., Murray, E., Darbyshire, J., Emery, J., Farmer, A., Griffiths, F., et al. (2007). Designing and evaluating complex interventions to improve health care. BMJ, 334(7591), 455.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cordier, R., McAuliffe, T., Wilson, N. J., Totino, R., Dender, A., Smith, C., et al. (2016). The appropriateness and feasibility of an online e-Portfolio for assessment of undergraduate allied health students. Australian Occupational Therapy Journal, 63(3), 154–163.

    Article  PubMed  Google Scholar 

  13. Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ, 337, a1655.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks: Sage.

    Google Scholar 

  15. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics, 125(1), e17–e23.

    Article  PubMed  Google Scholar 

  16. Evans, D. (2003). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing, 12(1), 77–84.

    Article  PubMed  Google Scholar 

  17. Fageera, W., Traicu, A., Sengupta, S. M., Fortier, M. E., Choudhry, Z., Labbe, A., et al. (2018). Placebo response and its determinants in children with ADHD across multiple observers and settings: A randomized clinical trial. International Journal of Methods in Psychiatric Research, 27(1), e1572.

    Article  Google Scholar 

  18. Foster, L., Dunn, W., & Lawson, L. M. (2013). Coaching mothers of children with autism: A qualitative study for occupational therapy practice. Physical and Occupational Therapy in Pediatrics, 33(2), 253–263.

    Article  PubMed  Google Scholar 

  19. Gray, D. E. (1994). Coping with autism: Stresses and strategies. Sociology of Health and Illness, 16(3), 275–300.

    Article  Google Scholar 

  20. Hammell, K. W. (2001). Using qualitative research to inform the client-centred evidence-based practice of occupational therapy. The British Journal of Occupational Therapy, 64(5), 228–234.

    Article  Google Scholar 

  21. Happé, F., & Ronald, A. (2008). The ‘fractionable autism triad’: A review of evidence from behavioural, genetic, cognitive and neural research. Neuropsychology Review, 18(4), 287–304.

    Article  PubMed  Google Scholar 

  22. Heitzman-Powell, L. S., Buzhardt, J., Rusinko, L. C., & Miller, T. M. (2013). Formative evaluation of an ABA outreach training program for parents of children with autism in remote areas. Focus on Autism and Other Developmental Disabilities, 29(1), 23–38.

    Article  Google Scholar 

  23. Hoogsteen, L., & Woodgate, R. L. (2013). Embracing autism in Canadian rural communities. Australian Journal of Rural Health, 21(3), 178–182.

    Article  PubMed  Google Scholar 

  24. Horlin, C., Falkmer, M., Parsons, R., Albrecht, M. A., & Falkmer, T. (2014). The cost of autism spectrum disorders. PLoS ONE, 9(9), e106552.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Hudry, K., McConachie, H., Le Couteur, A., Howlin, P., Barrett, B., Slonims, V., et al. (2018). Predictors of reliable symptom change: Secondary analysis of the Preschool Autism Communication Trial. Autism and Developmental Language Impairments, 3, 2396941518764760.

    Article  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. Kourkoulou, A., Leekam, S. R., & Findlay, J. M. (2012). Implicit learning of local context in autism spectrum disorder. Journal of Autism and Developmental Disorders, 42(2), 244–256.

    Article  PubMed  Google Scholar 

  29. Krefting, L. (1991). Rigor in qualitative research: The assessment of trustworthiness. American Journal of Occupational Therapy, 45(3), 214–222.

    Article  PubMed  Google Scholar 

  30. Liamputtong, P. (2013). Qualitative research methods (4th ed.). South Melbourne: Oxford University Press.

    Google Scholar 

  31. Mackintosh, V. H., Goin-Kochel, R. P., & Myers, B. J. (2012). What do you like/dislike about the treatments you’re currently using? A qualitative study of parents of children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 27(1), 51–60.

    Article  Google Scholar 

  32. Masi, A., Lampit, A., Glozier, N., Hickie, I. B., & Guastella, A. J. (2015). Predictors of placebo response in pharmacological and dietary supplement treatment trials in pediatric autism spectrum disorder: A meta-analysis. Translational psychiatry, 5(9), e640.

    Article  PubMed  PubMed Central  Google Scholar 

  33. McAuliffe, T., Cordier, R., Vaz, S., Thomas, Y., & Falkmer, T. (2017). Quality of life, coping styles, stress levels, and time use in mothers of children with autism spectrum disorders: Comparing single versus coupled households. Journal of Autism and Developmental Disorders, 47(10), 3189–3203.

    Article  PubMed  Google Scholar 

  34. McConachie, H., & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: A systematic review. Journal of Evaluation in Clinical Practice, 13(1), 120–129.

    Article  Google Scholar 

  35. Nastasi, B. K., Varjas, K., Schensul, S. L., Silva, K. T., Schensul, J. J., & Ratnayake, P. (2000). The participatory intervention model: A framework for conceptualizing and promoting intervention acceptability. School Psychology Quarterly, 15(2), 207.

    Article  Google Scholar 

  36. Nealy, C. E., O’Hare, L., Powers, J. D., & Swick, D. C. (2012). The impact of autism spectrum disorders on the family: A qualitative study of mothers’ perspectives. Journal of Family Social Work, 15(3), 187–201.

    Article  Google Scholar 

  37. Parsons, D., Cordier, R., Lee, H., Falkmer, T., & Vaz, S. (2018). A randomised controlled trial of an information communication technology delivered intervention for children with autism spectrum disorder living in regional Australia. Journal of Autism and Developmental Disorders, 49(2), 569–581.

    Article  Google Scholar 

  38. Pink, B. (2011). Socio-economic indexes for areas (SEIFA). Canberra: Australian Bureau of Statistics.

    Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. Prior, M., & Roberts, J. (2012). Early intervention for children with austism spectrum disorders: ‘Guidelines for good practice’ 2012. Canberra: FaHCSIA.

    Google Scholar 

  41. Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., et al. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65–76.

    Article  PubMed  Google Scholar 

  42. Ramdoss, S., Lang, R., Mulloy, A., Franco, J., O’Reilly, M., Didden, R., et al. (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.

    Article  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

  44. Rao, P. A., & Beidel, D. C. (2009). The impact of children with high-functioning autism on parental stress, sibling adjustment, and family functioning. Behavior Modification, 33(4), 437–451.

    Article  Google Scholar 

  45. Rogerson, J., Falkmer, M., Cuomo, B., Falkmer, T., Whitehouse, A. J. O., Granich, J., et al. (2018). Parental experiences using the therapy outcomes by you (TOBY) application to deliver early intervention to their child with autism. Developmental Neurorehabilitation, 22(4), 219–227.

    Article  PubMed  Google Scholar 

  46. Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 63–75.

    Article  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. Sinclair, C., Holloway, K., Riley, G., & Auret, K. (2013). Online mental health resources in rural Australia: Clinician perceptions of acceptability. Journal of Medical Internet Research, 15(9), e193. https://doi.org/10.2196/jmir.2772.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Smith, T., Scahill, L., Dawson, G., Guthrie, D., Lord, C., Odom, S., et al. (2007). Designing research studies on psychosocial interventions in autism. Journal of Autism and Developmental Disorders, 37(2), 354–366.

    Article  PubMed  Google Scholar 

  50. Solish, A., & Perry, A. (2008). Parents’ involvement in their children’s behavioral intervention programs: Parent and therapist perspectives. Research in Autism Spectrum Disorders, 2(4), 728–738.

    Article  Google Scholar 

  51. 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.

  52. 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.

  53. 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 and Developmental Disorders, 43(12), 2953–2969. https://doi.org/10.1007/s10803-013-1841-8.

    Article  PubMed  Google Scholar 

  54. Vivanti, G., Prior, M., Williams, K., & Dissanayake, C. (2014). Predictors of outcomes in autism early intervention: Why don’t we know more? Frontiers in pediatrics, 2, 58.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Wacker, D. P., Lee, J. F., Dalmau, Y. C., Kopelman, T. G., Lindgren, S. D., Kuhle, J., et al. (2013). Conducting functional communication training via telehealth to reduce the problem behavior of young children with autism. Journal of Developmental and Physical Disabilities, 25(1), 35–48. https://doi.org/10.1007/s10882-012-9314-0.

    Article  PubMed  Google Scholar 

  56. Wainer, A. L., & Ingersoll, B. R. (2011). The use of innovative computer technology for teaching social communication to individuals with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 96–107.

    Article  Google Scholar 

  57. 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.

    Article  Google Scholar 

  58. Whitehouse, A. J., Granich, J., Alvares, G., Busacca, M., Cooper, M. N., Dass, A., et al. (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.

    Article  Google Scholar 

  59. Whyte, E. M., Smyth, J. M., & Scherf, K. S. (2015). Designing serious game interventions for individuals with autism. Journal of Autism and Developmental Disorders, 45(12), 3820–3831.

    Article  PubMed  Google Scholar 

  60. Wilkes-Gillan, S., Bundy, A., Cordier, R., Lincoln, M., & Hancock, N. (2015). Parents’ perspectives on the appropriateness of a parent-delivered intervention for improving the social play skills of children with ADHD. British Journal of Occupational Therapy, 78(10), 644–652.

    Article  Google Scholar 

Download references

Funding

The authors would like to acknowledge the support of the Lishman Health Foundation for funding this research project.

Author information

Affiliations

Authors

Contributions

DP conceived of the study, participated in its design and coordination, performed the interviews, performed the data analysis, interpreted the data and drafted the manuscript; NJW participated in the design, assisted with data analysis and interpretation of the data, and helped to draft the manuscript; SV participated in its design and interpretation of the data; HL participated in the design of the study and interpretation of the data; and RC participated in the design, assisted with interpretation of the data, and helped to draft the manuscript.

Corresponding author

Correspondence to Dave Parsons.

Ethics declarations

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. The authors declare no other conflicts of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 28 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Parsons, D., Wilson, N.J., Vaz, S. et al. Appropriateness of the TOBY Application, an iPad Intervention for Children with Autism Spectrum Disorder: A Thematic Approach. J Autism Dev Disord 49, 4053–4066 (2019). https://doi.org/10.1007/s10803-019-04115-9

Download citation

Keywords

  • Appropriateness
  • Information technology
  • Early intervention