J Autism Dev Disord (2013) 43:26282648
DOI 10.1007/s10803-013-1814-y
ORIGINAL PAPER
A Review of Technology-Based Interventions to Teach Academic
Skills to Students with Autism Spectrum Disorder
Victoria Knight Bethany R. McKissick
Alicia Saunders
Published online: 31 March 2013
Springer Science+Business Media New York 2013
Abstract A comprehensive review of the literature was
conducted for articles published between 1993 and 2012 to
determine the degree to which technology-based interven-
tions can be considered an evidence-based practice to teach
academic skills to individuals with Autism Spectrum Dis-
order (ASD). Criteria developed by Horner et al. (Except
Child 71:165178, 2005) and Gersten et al. (Except Child
71:149164, 2005) were used to determine the quality of
single-subject research studies and group experimental
research studies respectively. A total of 25 studies met
inclusion criteria. Of these studies, only three single-sub-
ject studies and no group studies met criteria for quality or
acceptable studies. Taken together, the results suggest that
practitioners should use caution when teaching academic
skills to individuals with ASD using technology-based
interventions. Limitations and directions for future research
are discussed.
Keywords Technology
Evidence-based practices

Individuals with autism spectrum disorder
V. Knight
Peabody College, Vanderbilt University, Nashville, TN, USA
B. R. McKissick (&)
Mississippi State University, 310 Allen Hall, Box 9705,
Starkville, MS 39762, USA
e-mail: bmckissick@colled.msstate.edu
A. Saunders
University North Carolina at Charlotte, Charlotte, NC, USA
123
Introduction
Undeniably, technology has revolutionized the way that we
live, work, and play. Educators must now consider technol-
ogy when preparing students for situations in which infor-
mation is no longer predominately presented in printed
books, but more often over the Internet and other online
resources (Leu 2002). Todays children also need to be
trained in the use of technology in order to become successful
workers in the future (Lefever-Davis and Pearman 2005).
According to the National Center on Educational Statistics
(NCES 2001), approximately 90 % of children ages five
through seven use computers. In contrast, students with
disabilities are significantly less likely to use computers than
their typical peers (NCES 2001; Wehmeyer et al. 2004).
In the past, when the term technology was used in
conjunction with the term disability, it was usually asso-
ciated with assistive technology (AT, e.g., augmentative
and alternative communication, switches to activate the
computer; Braddock et al. 2004). AT has been used to
increase communication and academic skills for students
with a range of disabilities (Edyburn 2000, 2001, 2002,
2007). While research on the benefits of AT for individuals
with disabilities is robust, there is an increased interest in
research and development of other instructional technolo-
gies which may have the potential to increase autonomy
and quality of life for individuals with disabilities by
learning academic content (Braddock et al. 2004).
Recently, the media has promoted the idea that the use of
the latest and greatest technologies (e.g., iPads, iPods,
Netbooks) can transform academic instruction for students
with autism spectrum disorder (ASD). One online author
stated, The iPad wasnt designed with autistic children in
mind, but anecdotally, the results are seemingly miracu-
lous (Zemla 2012, p. 1).
J Autism Dev Disord (2013) 43:26282648
The use of technology to teach students with ASD is not
a new concept. In fact, technology has been used to teach
students with ASD for over 35 years (Colby 1973). Colby
(1973) conducted one of the first studies examining the use
of computers to teach students with ASD. Colby used a
computer program consisting of various computer games
organized at various levels of complexity with 17 non-
verbal students with ASD. For example, in one game, the
child pressed a letter on the computer and simultaneously
heard the computer say the letter; in another game, the
child pressed a letter (e.g., H) and then saw a horse moving
across the screen and heard the sound of horses hooves.
The purpose of the study was to increase students under-
standing of how letters and sounds form words, and how
words can form expressions. Results claim that 13 of the 17
children showed an increase in involuntary speech,
enjoyment, and motivation. Despite these promising
results, several limitations of the study warrant discussion.
For example, the experimental design was not mentioned;
information regarding the participants ages and method of
diagnosis was not given; and details on the length of ses-
sions used or how long intervention lasted were not
presented.
More than a decade after this study, Panyan (1984)
published a review on the use of computer technology for
children with autism. Although few systematic studies had
been reported, Panyan reported the use of technology to
promote responsiveness, attention, performance, verbal
interactions, social skills, and interactions with peers.
Further, Panyan offered that technology could be used to
capitalize on the learning characteristics of students with
ASD. Specifically, the nature of technology can (a) benefit
students with ASD due to their differences in attention and
motivation from typically developing peers, (b) decrease
stereotypic behaviors, (c) provide students with consistent
feedback, and (d) increase language. Finally, the author
advocated for the use of technology as it can increase
active student responses, by allow[ing] the student to be
in control of the learning situation, rather than [being] a
passive participant (p. 381).
Speech generating devices may also encourage students
with ASD to be more active participants in their learning.
Blischak and Schlosser (2003) examined the evidence of
speech generating devices and talking word software in
supporting spelling for students with ASD. Authors con-
clude that while there were emerging data to suggest that
technology can support independent spelling, design limi-
tations in the studies (e.g., pre-experimental designs) pre-
vent authors from reaching definitive conclusions.
Little has changed in the past 25 years since the initial
review of the literature; well-controlled studies on the
effect of technology (e.g., computers, interactive white
boards) on academic learning for students with ASD are
2629
still lacking. Computer-assisted instruction (CAI) is one
type of instructional technology commonly used to teach
various skills to students with ASD. Even with this fre-
quently used technological approach, quality studies are
scant. For example, according to a recent review conducted
by Pennington (2010) on the effects of CAI to teach aca-
demic skills to students with ASD from 1998 to 2008, there
was a notable lack of experimental control in the CAI
efficacy studies. Further, the author noted that the majority
of studies evaluated the effects of CAI specifically on lit-
eracy related skills, and suggested the need for additional
studies in other content areas.
The lack of research-based literature combined with the
zeal of an appealing practice has led researchers to con-
tinue to debate the promises and limitations of technology
for this population (Mineo et al. 2009). Some researchers
caution that although there is some preliminary evidence
supporting technologies for skill development, one pitfall
in the field of ASD is the use of mythical practices that are
not empirically based (Mineo et al. 2009). Miraculous
claims, such as the one presented by Zemla (2012) about
the use of iPads for children with ASD, should be viewed
with extreme caution, especially when the available evi-
dence was anecdotal. At best, these claims support the need
for repeated empirical study of technological interventions
to determine if the data support the proclamations of
miraculous interventions.
Tincani and Boutot (2005) suggested that researchers
and practitioners in the field of ASD determine the efficacy
of technology for children with ASD and their families
before embracing the practice with intensity. In the era of
evidence-based practices (EBP), it seems especially pru-
dent to examine whether or not technology can increase
academic learning for students with ASD. Horner et al.
(2005) and Gersten et al. (2005) developed criteria to
evaluate individual studies as well as the overall quality of
a practice as evidence-based in both single-subject and
group research designs, respectively.
One argument against technology may be that the effects
on skill development seem to be the same whether deliv-
ered by a computer or a teacher; however, the benefits for
using technology include an increase in autonomy for the
student as well as an additional tool for teachers to provide
one-to-one instruction (Higgins and Boone 1996). Tincani
and Boutot (2005) suggested that while there is mixed
evidence on the effectiveness of CAI for students with
ASD, the following tentative conclusions can be made:
(a) for students who have limited speaking and writing
skills, CAI may be a beneficial alternative for the expres-
sion of literacy skills; (b) children with ASD may prefer
CAI, as it may seem like a game; and (c) CAI may be more
cost and time effective, because the teacher can work with
a greater number of students in the same amount of time.
123
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Tincani and Boutot recommended that current research is
warranted to investigate the use of CAI for children with
ASD in all content areas. Further, they offered that future
studies should explore the use of CAI to teach various
academic skills; student preference of CAI versus tradi-
tional instruction; and the generalization of skills from the
computer-assisted instruction to other skills and settings
(Tincani and Boutot 2005).
Clearly, a comprehensive review of studies examining
the effects of instructional technologies on academic skills
for students with ASD is needed. Prior reviews were lim-
ited in a number of ways. First, prior reviews did not
evaluate both group experimental and single-subject
research studies together to determine the level of evidence
for the practice. Second, the reviews did not use Horner
et al. (2005) and Gersten et al. (2005) criteria to evaluate
the quality of the literature on teaching using technology
for students with ASD. Third, recent reviews evaluated
specific technological interventions (e.g., CAI, speech-
generated devices), rather than evaluating studies of the
broad range of technologies available (e.g., interactive
white boards, Personal Data Assistants; PDAs). Finally, the
current review expanded the search beyond prior search
results and includes more recent studies. The purpose of the
current comprehensive review is to evaluate the evidence-
base for using instructional technology to teach academic
skills to students with autism from the years 19932012.
Method
Literature Search Procedures
First, authors developed a list of search terms to seek
published single-subject and group design research studies
that included technology-based interventions, such as CAI
and computer-based video interventions, which were used
specifically to teach (and not just deliver) academic skills
(e.g., object identification, word identification, and com-
pletion of math problems) across English Language Arts
(ELA), mathematics, social studies, and science content
areas for students with ASD. The list of search terms
included 17 total terms. The authors searched combinations
of the 17 terms using both whole and truncated versions of
each term (e.g., autism, ASD, computer, iPod, computer-
based video instruction, computer assisted instruction,
academic) using Education Full Text, ERIC, Academic
Search Premier, PyschINFO, and PubMed databases. This
initial search yielded more than 400 potential studies. Next,
the authors compared their search results with recent
reviews of literature (Blischak and Schlosser 2003; Pen-
nington 2010) related to using technology to teach aca-
demic skills to students with ASD to ensure the studies
123
J Autism Dev Disord (2013) 43:26282648
found represented the comprehensive range of all pub-
lished research. Once it was determined that all of the
studies included in previous literature reviews were inclu-
ded within their search, the authors read the titles and
abstracts of each study screening for empirical studies that
taught academics to students with ASD. Once this initial
screening was complete, approximately 65 empirical
studies remained and the authors determined whether or
not the remaining studies for analysis based on the inclu-
sion criteria described below.
Inclusion Criteria
Based on the inclusion criteria of (a) publishing in a peer
reviewed within the years of 19732012 having at least one
participant with a diagnosis of ASD, (b) teaching an aca-
demic skill, and (c) including technology as the interven-
tion or part of an intervention package, a comprehensive
list of 29 single-subject and group design research studies
were retained for analysis. Authors agreement for inclu-
sion and exclusion of articles was 100 % following dis-
cussion in which individual articles were evaluated against
inclusion criteria. These studies, including information on
each studys number of participants, dependent variables,
independent variables, results, implications, and limitations
are found in Table 1. Studies were excluded if the tech-
nological interventions pertained to (a) alternative assistive
communication instruction, (b) unspecified assistive tech-
nology, (c) task completion interventions, (d) video-mod-
eling interventions, and (e) video teleconferencing
interventions. Authors excluded these studies due to the
prior reviews demonstrating these interventions (e.g., video
modeling) to be effective (i.e., Colby 1973; Dyches 1998)
in teaching academic skills to students with ASD.
Application of the Horner et al. (2005) Quality
Indicators for Single-Case
Following the establishment of a comprehensive list of
studies for review, authors coded each article based on the
(a) number of participants identified with autism or ASD,
(b) type of research design used, (c) content area for the
targeted skill, (d) intervention, (e) dependent variables,
(f) results, and (g) limitations noted by each study as shown
in Table 1.
Next, authors coded studies in accordance with estab-
lished criteria for single-subject and group experimental
research established respectively by Horner et al. (2005)
and Gersten et al. (2005) to determine if the retained arti-
cles met criteria for quality. For single-subject studies, the
authors used 20 quality indicators developed by National
Secondary Transition Technical Assistance Centers
(NSTTAC 2010; Test et al. 2009) decision rules (See
 Table 1 Characteristics of technology articles
Reference Participants (total Design Content IV (include technology Instructional Components of DV Results Limitations
number of area used) IV (e.g., systematic
participants, (e.g., instruction, principles of
number of ELA, applied behavior analysis)
participants with math,
ASD, ages) science)

Basil and N=6 Quasi- ELA Self-directed CAI Differential reinforcement of Literacy acquisition Participants had gains in Major design flaws in
Reyes N(ASD) = 2 experimental including Delta reading sentence created including sentence writing, terms of failing to
(2003) (pre/post with messages and animations; stimulus Reading letters phonological synthesis demonstrate a
Ages: 8, 14 no control prompting skills, and writing skills functional relationship
group) Reading syllables
Reading words
Reading a text
J Autism Dev Disord (2013) 43:26282648

Reading and comprehension

Copy
Dictation
Free writing composition
Bosseler and N(ASD) = 8 Quasi- ELA CAI (Baldi, Feedback for correct and Acquisition of new Students identified Students knew some
Massaro Ages: 712 experimental language wizard/ incorrect responses (i.e., vocabulary (labeling significantly more words prior to training;
(2003) (pre/post with player) smiley or frowning faces); pictures and reading new vocabulary and acquisition potential threats to
Study I no control stimulus prompting; words) and grammatical maintained over time internal validity:
group) reinforcement for correct usage history (may have
behaviors learned words from
SLP or other means),
testing effects (learning
from the pre-test)
Bosseler and N(ASD) = 6 Multiple- ELA CAI (Baldi, Feedback for correct and Generalization of the newly High rate of generalization Utilized tangible
Massaro Ages: 711 baseline language wizard/ incorrect responses (i.e., acquired vocabulary words of words to novel pictures reinforcers to increase
(2003) design across player) smiley or frowning faces); to novel pictures (M = 91 %); however, the compliance during
Study II word sets stimulus prompting; number of training pretesting; testing
replicated reinforcement for correct sessions varied per student effects; odd responses
across behaviors, generalization from some students
students (i.e., use of novel pictures (perseverating and
in new positions on overselectivity)
computer screen)
Chen et al. N=6 Alternating ELA CAI using text, None described Reading comprehension For the 3 participants with No measurement of if
(2009) N(ASD) = 3 treatment pictures, and speech autism, the picture to text picture or speech
output mode was most successful condition was
Ages: 1618 dependent on passage
comprehension
Chen and N(ASD) = 4 Adapted ELA CAI and one to one Changes in proximity to Learning rate of tasks Only one students learning Learning rate was
Bernard- Ages: 47 alternating Math personal instruction trained stimulus; massed ELA: rate was higher in the CAI measured in terms of
Opitz treatment practice; within-stimulus condition than in the average percentage in
(1993) prompts Labeling of pictures personal assistance both conditions, some
Math: condition; motivation and students had difficulty
Addition appropriate behavior were in operating the
higher in the CAI computer
Recall of object position
condition
More and less
2631

123
 Table 1 continued
2632

Reference Participants (total Design Content IV (include technology Instructional Components of DV Results Limitations
number of area used) IV (e.g., systematic

123
participants, (e.g., instruction, principles of
number of ELA, applied behavior analysis)
participants with math,
ASD, ages) science)

Clark and N(ASD) = 2 Alternating ELA CAI using exclusion Reinforcement for correct Symbol identification Both participants acquired Limitations include the
Green Ages: 9, 11 treatment and delayed cue responses (food); use of a symbol identification of use of arbitrary
(2004) training delayed prompt procedure; targeted symbols more symbols, inconsistent
stimulus prompting rapidly using a delayed cue amount of exposure
between the two
interventions, and a
laboratory setting
Coleman N=3 Alternating ELA CAI with CTD CTD Cooking words Both conditions were Only one generalization
et al. (2012) N(ASD)* = 1 treatments compared to teacher- Stimulus fading (pictures effective for all students, probe, students
design directed CTD and words to words only) but 2/3 students learned distracted while on the
Age: 12 words more efficiently computer, time
* Multiple Reinforcement for correct during teacher-directed requirement to make
disabilities, behaviors condition the PowerPoint
including ASD presentations, student
absences
Coleman- N=3 Multitreatment ELA Teacher instruction Stimulus fading and response Sight word identification Students made acquired Technology was slow and
Martin et al. N(ASD) = 1 only, teacher and CAI prompting (verbal) of target words in all unreliable
(2005) (using the nonverbal phonemes; guided practice conditions
Age: 12 reading approach, (i.e., provided directions,
Power Point TM encouragement, and
software, auditory metacognitive strategy);
component), and CAI error correction, praise for
only correct answers
Heimann N = 30 Quasi- ELA CAI Very little description of Reading, sentence imitation, All students made gains in Loss of data and subjects,
et al. (1995) N(ASD) = 11 experimental Multi-media Alpha program, but article phonological awareness, all measures except small sample size,
(pre/post with environment (voice, suggests use of model verbal behavior/motivation sentence imitation based length of intervention
Ages: control prompts and feedback on t tests was different between
M = 9.4 years, animation, and
group) videos) groups
range 613
Hetzroni and N(ASD) = 6 Multiple probe ELA CAI (including a 7 step Stimulus fading; match to Matching sight words to All children acquired, Evaluated preferred food
Shalem Ages: 1013 across fading process) sample; reinforcer (smiley sample maintained and most items, not all students
(2005) participants face); error correction generalized to actual food generalized skills
resulting in a natural items
consequence (i.e., display
remains unchanged when
the student selects
incorrect answer)
Hetzroni et al. N(ASD) = 3 Multiple probe ELA CAI Reinforcement for correct Symbol identification CAI was effective in Many characteristics of
(2002) **Rett Syndrome across responses; error correction; teaching symbol Rett impacted
participants use of a delayed prompt identification assessment measures
Ages: 810 procedure (e.g., absences,
tremors)
J Autism Dev Disord (2013) 43:26282648
 Table 1 continued
Reference Participants (total Design Content IV (include technology Instructional Components of DV Results Limitations
number of area used) IV (e.g., systematic
participants, (e.g., instruction, principles of
number of ELA, applied behavior analysis)
participants with math,
ASD, ages) science)

Kelly et al. N(ASD) = 1 Quasi- ELA CAI Stimulus prompting; Letter, number, and picture Poor performance during Authors provided no
(1998) Age: 5 experimental Math differential reinforcement; identification visualvisual matching, explanations for study
(pre/post with use of a delayed prompt participant scored much results directly conflict
no control procedure higher on auditory-visual with the requirements
group) matching of visual discrimination
Kinney et al. N(ASD) = 1 Quasi- ELA CAI (video) Differential reinforcement; Spelling Student acquired and No repeated baseline
(2003) Age: 8 experimental use of delayed prompt maintained knowledge measure, no procedural
J Autism Dev Disord (2013) 43:26282648

(pre/post with procedure; stimulus fidelity measure

no control prompts; model prompts
group)
Massaro and N=5 Adapted ELA CAI Stimulus prompting and Receptive identification of According to the authors, the Design flaws, including
Bosseler N (ASD) = 5 alternating Animated tutor with response prompting; error pictures and verbal retention was better and inappropriate use of the
(2006) treatment and without a face correction; praise for production of vocabulary more effective with the AATD (i.e., lack of
Ages: 813 (applied to a correct answers words face condition versus the individual graphs) and
group no face condition inappropriate
average) application of statistics
Mechling N=4 Multiple-probe ELA CBVI (digital Setting/situation Vocabulary acquisition of Students were able to read Potential threat to
et al. (2002) N(ASD) = 1 design across photographs and generalization; system of words found on grocery aisle signs (range interval validity-
three set of videotapes imported least prompts; differential store aisle signs and 91100 % accuracy) and testing effects from
Age: 9 words and into Hyperstudio 3.1) reinforcement; error location of grocery items locate items on list either repeated testing; ceiling
replicated and system of least correction and feedback within the corresponding in picture or written format effect-only 12 words
across prompts aisles across 3 stores were assessed
students
Moore and N(ASD) = 14 Quasi- ELA CAI w/sensory Perceptionally salient Vocabulary acquisition Children were more Small sample size, lack
Calvert Ages: 36 experimental reinforcement (sound features (i.e., animation, (noun recall), attention, attentive, recalled more of maintenance data
(2000) (pre/post with effects, graphics, etc.) sound effects and action); and motivation during CAI nouns, and were more collected over time,
control versus teacher verbal or tangible and teacher instruction motivated to continue potential novelty of
group) instruction reinforcers; response during CAI than teacher CAI
prompting instruction
Pennington N(ASD) = 1 Multiple probe ELA CAI w/selection-based Simultaneous Prompting, Constructing sentences Participant made gains in Only one participant, lag
et al. (2012) Age 7 across writing auditory feedback constructing sentences of effects following
behaviors including two nouns and introduction to the
one verb about 3 different intervention,
topics and maintained intervention was a
skills package so it is unclear
of which components
are responsible for the
behavior change
Reagon et al. N(ASD) = 3 Alternating ELA CAI (video prompts) Stimulus prompts; use of a Object identification Students acquired some Participants initial lack of
(2007) Ages: 34 Treatment delayed prompt procedure; object identification how to response using
error correction and knowledge, no clear data novel technology, no
feedback; differential as to which treatment (with clear indication of
reinforcement text or without text) was which treatment was
most effective more effective
2633

123
 Table 1 continued
2634

Reference Participants (total Design Content IV (include technology Instructional Components of DV Results Limitations
number of area used) IV (e.g., systematic

123
participants, (e.g., instruction, principles of
number of ELA, applied behavior analysis)
participants with math,
ASD, ages) science)

Schlosser and N(ASD) = 4 Adapted ELA LightWRITER- Intermittent non-contingent Spelling: Percentage of Three students met criterion Study ended due to end of
Blischak Ages: 812 alternating SL35TM(SGD) praise; article suggests use correctly spelled words; for words spelled correctly school year; did not
(2004) treatments featuring text-to- of constant time delay with percentage of correct letter in the print only, speech- focus on use of words
* Replication design speech via model prompt as feedback; sequences, and number of to-print, and speech only for communication
of 1998 (alternating DECtalkTM verbal praise for correct sessions to reach criterion conditions respectively. purposes
study between synthetic speech and answers (spell all 4 words in a set Two students did not
speech only, dual liquid crystal correctly over 2 generalize to novel words,
speech-to- displays (LCDs), and consecutive sessions); and 2 students showed
print, and an instructor using generalization to novel moderate generalization to
print only the copy-cover- words novel words
conditions) compare method with
an error correction
procedure
Schlosser N(ASD) = 1 Adapted ELA LightWRITER- Intermittent non-contingent Percentage of correctly Percentage of words spelled Only1 participant, did not
et al. (1998) Age: 10 alternating SL35TM(SGD) praise; article suggests use spelled words; percentage correctly met criterion in examine phonological
treatments featuring text-to- of constant time delay with of correct letter sequences, 21 sessions for Auditory awareness (feedback
speech via model prompt as feedback; and number of sessions to condition, 26 for Auditory- was given for each
DECtalkTM verbal praise for correct reach criterion (spell all 4 Visual condition, and 31 letter of each word); no
synthetic speech and answers words in a set correctly for Visual condition; measure of
dual liquid crystal over 2 consecutive percentage of correct letter generalization
displays (LCDs), and sessions) sequences increased across
an instructor using conditions. Results
the copy-cover- maintained over time
compare method,
finger spelling, and
an error correction
procedure
Simpson and N(ASD) = 3 Multiple ELA CAI (Interactive songs Similar procedures as used in Picture identification of All students were able to Lack of a baseline probe
Keen Ages: 34 baseline using power point TM PECS (i.e., learning of animals receptively label the before intervention on
(2009) across and an interactive individual symbols are animal pictures from the the second tier of the
participants white board) taught prior to songs multiple baseline;
discrimination tasks); error students were not able
correcting using least to to generalize to other
most prompting system; settings
error correction from the
computer resulting in a
natural consequence (i.e.,
display remains unchanged
when the student selects
incorrect answer)
J Autism Dev Disord (2013) 43:26282648
 Table 1 continued
Reference Participants (total Design Content IV (include technology Instructional Components of DV Results Limitations
number of area used) IV (e.g., systematic
participants, (e.g., instruction, principles of
number of ELA, applied behavior analysis)
participants with math,
ASD, ages) science)

Soares et al. N(ASD) = 1 Reversal ELA CAI and self- DRA; token economy on the Academic tasks (e.g., Student increased academic No measure of
(2009) Age: 13 monitoring computer; self-monitoring answering 5 tasks and decreased generalization across
using a token economy on comprehension questions) tantrums and self-injurious settings, academic
the computer behavior accuracy, no inter-rater
reliability on the
tantrum behavior
Sugasawara N=2 Quasi- ELA CAI (using a Differential outcome (DO) Reading 46 Hiragana Student 1 needed additional Additional prompts and/
J Autism Dev Disord (2013) 43:26282648

and N(ASD) = 1 experimental constructional procedure (i.e., provides characters (Japanese) instruction for or differential
Yamamoto (pre/post with matching-to-sample specific reinforcing maintenance; whereas, reinforcement were not
(2007) ** PDD-NOS no control [MTS] task with a stimulus after a particular student 2 met criterion recorded. Training was
Age: 4 group) differential outcome response); DO stimulus (read 100 % of characters done by students
[DI] procedure) (i.e., word repeated) and for 2 consecutive sessions) parents in the home
reinforcement (i.e., fanfare
animation) provided for all
correct answers; response
prompting; auditory
feedback for error
correction (i.e., beep) and a
natural consequence (i.e.,
display remains unchanged
when the student selects
incorrect answer)
Tanji and N(ASD) = 2 Quasi- ELA CAI (Constructed- Matrix training using a Generative spelling of Both students showed One student required an
Noro (2011) experimental Response Matching visual stimulus (speaker); dictated trained and generative spelling to additional training
(pre/post with to Sample Task; feedback on correct untrained, novel words, trained and untrained session to yield
no control CRMTS) responses; multiple and writing of novel words words. generative spelling
group) exemplar training for one (Japanese characters)
student
Tjus et al. N = 20 Quasi- ELA CAI; multimedia Alpha Differential reinforcement; Childrens behavior: Verbal expression Data loss of 2 students
(2001) N(ASD) = 11 experimental program (Nelson and feedback; stimulus complies, ignores, off-task, significantly increased in with mixed intellectual
(pre/post with Prinz 1991) with prompting seeks help, verbal all children; and for disabilities. Sample
Ages: M = 6.9, control different modes of expressions, protests, students with autism in the size too small for
range 615 group) feedback (voice, enjoyment; Teacher categories of verbal within group
animation, video and behavior: procedure expression, seeks help, and comparisons.
sign language) along comments, content enjoyment. Off-task Nonverbal interaction
with supportive comments, verbal behavior was significantly was not measured
teacher recasts directives, physical higher for students with
directives, adjustment, autism
recasts, praises, enjoyment
2635

123
 Table 1 continued
2636

Reference Participants (total Design Content IV (include technology Instructional Components of DV Results Limitations
number of area used) IV (e.g., systematic

123
participants, (e.g., instruction, principles of
number of ELA, applied behavior analysis)
participants with math,
ASD, ages) science)

Whalen et al. N(ASD) = 47 Experimental ELA CAI Differential reinforcement; Math: shapes, numbers, most Students in the intervention Limitations include no
(2010) Ages: 36 (group) Math stimulus prompting; and fewest concepts, group scored statistically data collected on part
multiple exemplars; numeral-quantity significantly higher in post of the intervention
pivotal response training matching, math symbols, test scores in the areas of which required teachers
addition, subtraction, receptive language, social to incorporate 20 min
number lines, fractions; understanding, life skills, of off computer
ELA: matching letters, and cognitive academics activities and issues in
letter ID, phonics, word versus student in the teacher fidelity
matching, upper and lower control group implementing the IV
case, letter matching,
initial and ending sounds
ID, book awareness,
rhyming, sight words,
spelling
Whitcomb N(ASD) = 1 Multiple ELA CAI (Headsprout) Visual cues and auditory Percent reading accuracy Student achieved mastery Increasing baselines;
et al. (2011) Age: 9 baseline cues, verbal praise (words read correctly) in ([80 % in 1 day) in both Lack of enough data in
across word word sets and short stories word sets and short stories tiers 24 to show
sets verification; no
maintenance data
collected
Yamamoto N(ASD) = 3 Quasi- ELA CAI NCR for motivation; Verbally production of a All students were able to No measure of
and Miya Ages: 610 experimental reinforcer for completing sentence and construction generalize trained generalization; no
(1999) (pre/post with session (small prize); of a sentence on the sentences to untrained procedural fidelity
Study I no control differential reinforcement computer sentences, but were not collected
group) and error correction during able to generalize the use
the intervention of particles (i.e., in
Japanese, used to specify
the object and subject of
nouns) in the sentences
Yamamoto N(ASD) = 3 Quasi- ELA CAI Verbal production of All students learned to Mortality of one
and Miya Ages: 610 experimental sentences including verbally produce sentences participant; no
(1999) (pre/post with particles including particles; 2 of procedural fidelity
Study II no control the 3 students learned to collected
group) generalize to written
sentences
J Autism Dev Disord (2013) 43:26282648
 Table 2 QIs identified in group and/or quasi experimental design studies
Basil and Bosseler and Heimann Kelly Kinney Moore Sugasawara Tanji Tjus Whalen Yamamoto Yamamoto
Reyes Massaro et al. et al. et al. and and and et al. et al. and Miya and Miya
(2003) (2003) Study 1 (1995) (1998) (2003) Calvert Yamamoto Noro (2001) (2010) (1999) Study 1 (1999) Study 2
(2000) (2007) (2011)

Essential quality indicators

Participants
Described sufficiently Y Y Y Y Y Y Y Y Y Y Y Y
Comparable across N N Y N N Y N N Y Y N N
conditions
Interventionists described N N N Y Y N N N N Y N N
IV
J Autism Dev Disord (2013) 43:26282648

Clearly described Y Y Y Y Y Y Y Y Y Y Y Y
Fidelity of implementation Y N Y Y Y N N N N N N N
described
Comparison condition Y N Y Y Y Y N N Y N N N
described
DV
Multiple measures used Y Y Y Y Y Y N Y N Y N N
Outcomes measured at N Y Y N Y Y Y Y Y Y Y Y
appropriate times
Results
Appropriate data analysis Y Y N Y Y Y Y Y Y Y N N
techniques chosen
Effect size reported Y N Y Y Y N N N Y Y N N
Desirable quality indicators
Participants
Attrition rate \ 30 % N Y N N N Y Y Y Y Y N N
DV
Evidence of testretest N N Y N N Y Y N Y N N N
reliability, internal
consistency reliability, and
IRR
Adequate IOA score Y N N Y Y Y N N N N Y Y
Data collectors blind to study Y N N N Y N N N N N N N
conditions and unfamiliar
with participants
Outcomes measured beyond N Y Y N N Y N Y Y N N Y
immediate posttest
Criterion and construct Y Y Y N Y N N N N Y N N
validity provided
2637

123
2638 J Autism Dev Disord (2013) 43:26282648

(1999) Study 1 (1999) Study 2

Fig. 1, Table 2). These quality indicators were developed
Yamamoto from Horner et al. criteria based on five aspects, the studys
and Miya
description of (a) participants, (b) setting, (c) dependent

6/20
variable and measures, (d) independent variable/interven-

Y
tion, (e) baseline procedures, (f) results, and (g) social
validity.
Yamamoto

Similar to the criteria established for single-subject

and Miya

research, the Gersten et al. criteria for group design studies

5/20
was also used to determine the level of quality for each
N

Y
study based on the studys description of (a) participants,
Whalen

(b) independent variable, (c) dependent variable, and

(2010)

11/20
et al.

(d) results. To assess each article based on the appropriate

N

Y criteria, the researchers again used dichotomous quality

(2001)

indicators, developed by NSTTAC, based on the criteria

13/20
et al.
Tjus

described in Gersten et al. (NSTTAC 2010; Test et al.

N

2009). Based on these quality indicators, the authors

evaluated each study independently. Sample quality indi-
(2011)

10/20
Tanji

Noro
and

cator coding forms are included as Figs. 1 and 2.

Y

Determination of an Evidence-Based Practice

Sugasawara

Yamamoto

for Teaching Academic Skills

(2007)

8/20
and

After coding each study using the corresponding quality

indicators, the authors determined if studies met criteria
necessary to receive high or moderate levels of an
Calvert
(2000)
Moore

13/20

evidence-based practice in accordance with NSTTAC

and

(2010) decision rules. For example, in order for a single-

Kinney

subject study to be considered high quality, it must

(2003)

15/20
et al.

meet all 20 of the quality indicators on the coding form

Y

(See Fig. 1). A single-subject study meets a moderate

(1998)

level of evidence if the study met all indicators with the

Kelly
et al.

9/20

exception of number 2 (description of how participants

N

were selected), number 11 (overt measurement of proce-

Heimann

dural fidelity), and included at least one of the social

(1995)

14/20
et al.

validity indicators (numbers 1620).

Y

For group design studies to meet high quality, studies

(2003) Study 1

had to address all 20 quality indicators shown in Fig. 2. In

Bosseler and

order to reach a moderate level of quality, group design

Massaro

studies had to address all indicators except number 5

11/20

(fidelity of implementation) and number 7 (multiple mea-

Y

sures associated with both the intervention and general-

Basil and

ization measures).
(2003)
Reyes

10/20

When a sufficient number of studies met the criteria for

N

single subject and group experimental research established

either the single-subject Horner et al. (2005) or group
Audio or videotape excerpts
Fidelity of implementation

design Gersten et al. (2005) criteria, the authors analyzed

Comparison conditions

Results were clear and

each group independently to determine if there was suffi-

Total Indicators Met

cient evidence to establish an EBP for teaching academic

Table 2 continued

skills to student with ASD using technology-based inter-

ventions including CAI. Horner et al. criteria for demon-
described
included

included

coherent

strating an evidence-base consists of (a) at least three

Results

researchers represented in the set of experiments, (b) at

IV

least 20 participants across the set of studies, and (c) at

123
J Autism Dev Disord (2013) 43:26282648 2639

Quality Indicator Checklist: Single-Subject Studies

Design type:
Participants
(1) Participants were described with sufficient detail to allow others to select individuals with
similar characteristics (e.g., age, gender, disability, diagnosis).
(2) The process for selecting participants was described with replicable precision. (not
necessary for moderate)
Setting
(3) Critical features of the physical setting were described with sufficient precision to allow
replication.
Dependent Variable/ Measures
(4) All dependent variables were described with operational precision.
(5) Each dependent variable was measured with a procedure that generates a quantifiable
index.
(6) The measurement process was described with replicable precision.
(7) Dependent variables were measured repeatedly over time.
(8) Data were collected on the reliability or inter-observer agreement (IOA) associated with
each dependent variable, and IOA levels met minimal standards (e.g., IOA = 80%; Kappa =
60%).
Independent Variable/ Intervention
(9) Independent variable was described with replicable precision.
(10) Independent variable was systematically manipulated and under the control of the
experimenter.
(11) Overt measurement of the fidelity of implementation for independent variable (not
necessary for moderate)
Procedures
(12) A baseline phase provided repeated measurement of a dependent variable and
established a pattern of responding that can be used to predict the pattern of future
performance, if introduction or manipulation of the independent variable did not occur.

(13) The procedural characteristics of the baseline conditions were described with replicable
precision.
Results/ Graphs/ Design
(14) The design provides at least three demonstrations of experimental effect at different
points in time.

(15) The design controls for common threats to internal validity (e.g., permits elimination of
rival hypotheses).
(16) Experimental effects were replicated across participants, settings, or materials to
establish external validity.
Social Validity [must of have 1 of these 4 for acceptable quality]
(17) The dependent variable is socially important.
(18) The magnitude of change in the dependent variables resulting from the intervention is
measured as socially important.
(19) Implementation of the independent variable was described by author as practical and
cost effective.
(20) Social validity is enhanced by implementation of the independent variable over extended
time periods, by typical intervention agents, in typical physical and social contexts.

Fig. 1 Coding form for single-subject research. Source NSTTAC (2010)

123
2640 J Autism Dev Disord (2013) 43:26282648

Fig. 2 Coding form for group design research. Source NSTTAC (2010)

123
J Autism Dev Disord (2013) 43:26282648
least three geographic locations represented in the set of
experiments. Gersten et al. criteria for demonstrating an
evidence-based practice consists of two high quality or four
acceptable quality studies thats results support the practice
or intervention. According to Gersten et al. criteria, a
practice can also be determined a promising practice if two
or more high quality or four or more acceptable quality
studies have results that support the practice and the
authors report a 20 % confidence interval for a weighted
effect size greater than zero.
Interrater Reliability on Quality Indicators
and Characteristics of Studies
Of the 29 studies interrater reliability data were collected
across 34 % of studies (n = 10 studies) using the same
coding criteria used to originally code the studies. The 10
studies were chosen randomly by two doctoral students
who served as the second scorers and independently coded
the studies.
Results
Interrater Reliability
Agreement for inclusion of the studies was done by con-
sensus of the three researchers, and no disagreements
occurred. The three researchers coded two articles together,
one single-subject and one group design, to establish
fidelity and ensure consistency before coding articles
independently. Interrater reliability for the coding of the
quality indicators was established for 34 % of the studies
included. Interrater reliability was determined using an
item-by-item method and was calculated by dividing the
number of agreements by the total number of agreements
plus disagreements divided by 100 (Cooper et al. 2007).
Interrater reliability was 99.3 % (range 95100).
Description of the Studies Included
Twenty-nine studies, which met the inclusion criteria, were
included in this literature review with a total of 191 par-
ticipants, and of those, 142 had a diagnosis of Autism
Spectrum Disorder (e.g., autism, PDD-NOS, Rett Syn-
drome). The mean age of participants was 8.4 years (range
318 years). Of the studies that included gender specific
information (n = 100 participants total), 22 were female,
M(age) = 9.5, range 317 years, and 78 were male,
M(age) = 8.1, range 318 years.
All studies are summarized in Table 1. One study used a
true, group experimental design, three studies used a quasi-
experimental group design, eight studies used a quasi-
2641
experimental pretest/posttest design with no control group,
and 17 studies used single-subject designs (i.e., five mul-
tiple probe or multiple baseline designs, seven alternating
treatment designs, one multitreatment design, and one
reversal design). All 29 studies focused on the content area
of English-Language Arts, and three of the 29 studies
included a math component (i.e., Chen and Bernard-Opitz
1993; Kelly et al. 1998, and Whalen et al. 2010). No
studies focused on the content areas of science or social
studies. Training settings included participants homes,
school, and clinical settings.
Components of CAI
The articles were examined to determine the specific
instructional strategies (e.g., principles of Applied Behavior
Analysis, systematic instructional strategies, etc.) that were
included in the computer programs. One study used simul-
taneous prompting (e.g., Pennington et al. 2012). Ten studies
used some type of differential reinforcement (e.g., Basil and
Reyes 2003; Kelly et al. 1998; Kinney et al. 2003; Mechling
et al. 2002). Fifteen studies used an error correction and
feedback procedure (e.g., Bosseler and Massaro 2003;
Coleman-Martin et al. 2005; Heimann et al. 1995; Hetzroni
and Shalem 2005; Pennington et al. 2012). Five studies used
a delayed prompting procedure (Clark and Green 2004;
Hetzroni et al. 2002; Kelly et al. 1998; Kinney et al. 2003;
Reagon et al. 2007). Fifteen studies used stimulus prompting
and/or stimulus fading (e.g., Chen and Bernard-Opitz 1993;
Coleman et al. 2012; Sugasawara and Yamamoto 2007; Tjus
et al. 2001; Whalen et al. 2010; Whitcomb et al. 2011). Four
studies used response prompting procedures (Coleman-
Martin et al. 2005; Massaro and Bosseler 2006; Moore and
Calvert 2000; Sugasawara and Yamamoto 2007). Eleven
studies offered some type of reinforcement for correct
responses (e.g., Bosseler and Massaro 2003; Clark and Green
2004; Coleman et al. 2012; Sugasawara and Yamamoto
2007; Tanji and Noro 2011; Whitcomb et al. 2011;
Yamamoto and Miya 1999). Three studies used specific
methods to train for generalization (Bosseler and Massaro,
study 2, 2003; Mechling et al. 2002; Whalen et al. 2010). One
study did not describe any component of the CAI interven-
tion (Chen et al. 2009).
Quality of the Studies
No group experimental studies (e.g., true, quasi, between,
within, or mixed) were of acceptable or high quality based
on the NSTTAC (2010) criteria. Therefore, there was not
enough evidence to determine technology-based interven-
tions including CAI as an evidence-based practice. See
Table 2 for the Quality Indicator Checklist for all group
experimental studies.
123
 Table 3 QIs identified in single-subject studies
2642

Bosseler Chen Chen Clark Coleman Coleman- Hetzroni Hetzroni Massaro Mechling Pennington Reagon Schlosser Schlosser Simpson Soares Whitcomb
and et al. and and et al. Martin et al. and and et al. et al. (2012) et al. and et al. and Keen et al. et al.

123
Massaro (2009) Bernard- Green (2012) et al. (2002) Shalem Bosseler (2002) (2007) Blischak (1998) (2009) (2009) (2011)
(2003) Opitz (2004) (2005) (2005) (2006) (2004)
Study 2 (1993)

Participants
Described Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
sufficiently
Selection Y Y N N Y Y Y Y Y Y Y N Y N Y Y N
described
Setting
Setting described N N Y N Y Y Y Y N Y Y Y Y Y Y Y N
DV
Described with Y Y N Y Y Y Y Y Y Y Y Y Y Y Y Y Y
replicable
precision
Quantifiable Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
Measurement Y N N Y Y Y Y Y Y Y Y Y Y Y Y Y Y
described with
replicable
precision
Measurement Y Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y
occurred
repeatedly
IOA data reported N N Y N Y Y Y Y N Y Y Y Y Y N Y Y
IV
Described with Y Y N Y Y Y Y Y Y Y Y Y Y Y Y Y Y
replicable
precision
Systematically Y Y Y Y Y Y Y Y Y Y Y Y N Y Y Y Y
manipulated
PF described N N N N Y Y N Y N Y Y N Y Y N N Y
Baseline procedures
Repeated Y N N Y Y Y Y Y N Y Y N Y Y Y Y Y
measurement
and evidence of
pattern
Described with Y N N Y Y Y Y Y N Y Y N Y Y Y Y Y
replicable
precision
J Autism Dev Disord (2013) 43:26282648
 Table 3 continued
Bosseler Chen Chen Clark Coleman Coleman- Hetzroni Hetzroni Massaro Mechling Pennington Reagon Schlosser Schlosser Simpson Soares Whitcomb
and et al. and and et al. Martin et al. and and et al. et al. (2012) et al. and et al. and Keen et al. et al.
Massaro (2009) Bernard- Green (2012) et al. (2002) Shalem Bosseler (2002) (2007) Blischak (1998) (2009) (2009) (2011)
(2003) Opitz (2004) (2005) (2005) (2006) (2004)
Study 2 (1993)

Results/graphs/design
Three Y N N N N N Y Y N Y Y N N N Y Y N
demonstrations
of effect
Internal validity Y Y Y Y Y N Y Y N Y Y Y Y Y Y Y N
External validity Y N N N Y Y Y Y N Y Y N Y N Y N Y
J Autism Dev Disord (2013) 43:26282648

Social validity
DV socially Y N Y N Y Y Y Y Y Y Y N Y Y Y Y Y
important
Change in DV Y N N N Y Y Y Y N Y N N N N Y N N
measured as
socially
important
IV is cost N N N N N Y N N N N N N N N Y Y N
effective/
practical
Implemented over N N Y N Y Y N Y N Y N N N Y N Y Y
time, in typical
contexts, or with
typical agents
Total indicators 15/20 8/20 9/20 10/20 18/20 18/20 17/20* 19/20 * 8/20 19/20* 17/20 * 10/20 16/20 15/20 17/20 17/20 14/20
met

Items designated with an * are acceptable studies

2643

123
2644
No single-subject design studies were of high quality;
however, four studies were of acceptable quality in
accordance with the NSTTAC criteria (2010; Hetzroni
et al. 2002; Hetzroni and Shalem 2005; Mechling et al.
2002; Pennington et al. 2012). See Table 3 for the Quality
Indicator Checklist for all single-subject studies.
Of the studies that met the acceptable criteria, two Implications for Practitioners
(Hetzroni and Shalem 2005; Mechling et al. 2002) met 19
out of 20 possible quality indicators (QIs), but neither study
reported if the intervention was practical or cost effective,
and thus, did not meet one of the social validity QIs. Two
studies (Hetzroni et al. 2002; Pennington et al. 2012) met
17 out of 20 QIs but were missing a procedural fidelity
measure and two social validity measures. According to the
NSTTAC criteria (2010; Test et al. 2009), three acceptable
quality single-subject studies that demonstrate a functional
relationship from two different research teams indicate a
moderate level of evidence for considering CAI as an EBP
for teaching academics to students with autism.
Four of the 17 single-subject studies (24 %) met
acceptable quality. Eight studies did not demonstrate a
functional relationship (Chen et al. 2009; Chen and Ber-
nard-Opitz 1993; Clark and Green 2004; Coleman et al.
2012; Coleman-Martin et al. 2005; Massaro and Bosseler
2006; Schlosser and Blischak 2004; Schlosser et al. 1998).
Several studies met 14 or more QIs, but were missing key
indicators necessary to be considered of acceptable quality
(i.e., studies must meet all QIs with the exception of 2
[selection of participants described], 11 [procedural fidelity
described], and one of 1720 [social validity] to be con-
sidered acceptable). Of these studies, two studies did not
report interobserver agreement data (Bosseler and Massaro
2003, study 2; Simpson and Keen 2009), and one did not
show replication of effects across participants, settings, or
materials to establish external validity (Soares et al. 2009).
Discussion
The purpose of this comprehensive literature review was to
determine the evidence-base for using instructional tech-
nology to teach academic skills to students with autism
from the years 1993 to 2012. Results of the current review
indicate only four acceptable quality single-subject technology can be used to teach discrete skills such as
studies that demonstrated a functional relation from three
different research teams. According to the NSTTAC (2010)
criteria for single-subject research studies, these findings
suggest a moderate level of evidence for considering
technology as an EBP to teach academics to students with
autism. In addition, no group experimental studies (e.g.,
true, quasi, between, within, or mixed) were of acceptable
or high quality based on the NSTTAC criteria. Based on
the NSTTAC criteria for group design studies, this
123
J Autism Dev Disord (2013) 43:26282648
indicates a low level of evidence for using technology-
based interventions to teach academics to individuals with
ASD. Overall, these results taken together suggest that
technology-based interventions for teaching academic
skills to students with ASD should be used with caution.
Even though students performance data demonstrated
gains in almost all of the studies, considering the low to
moderate level of evidence, the use of technology to teach
academics should be used with caution until additional
quality research is added to the research base. Media
claims regarding miracle outcomes as a result of using the
latest gadgets should not replace the use of an EBP. This is
not to suggest that all technologies for teaching academics
be abandoned, but rather used in conjunction with practices
that are known to be effective. In most of the studies,
technology was combined with or embedded within other
research-based, systematic instructional procedures (e.g.,
time delay). The four studies that met acceptable criteria
for quality used systematic instructional procedures such as
reinforcement for correct responses, stimulus fading, sys-
tem of least prompts, and error correction. In fact, many of
the studies reviewed used error correction and feedback.
For example, in the Pennington et al. (2012) study, using
simultaneous prompting to teach computer-based writing,
if the student did not select the correct word after the
teacher said, Write a story about ______, then the tea-
cher erased the incorrect word and used a physical prompt
to guide the mouse to the correct word. Practitioners should
combine the use of technologies with systematic instruc-
tion considered to be an EBP for teaching academics to
students with severe disabilities, including ASD (Spooner
et al. 2011).
Despite the overall lack of evidence supporting the use
of technology to teach academics to students with ASD, the
four acceptable studies did have some similarities worth
mentioning that teachers can use to guide practice. First,
because all of the acceptable studies taught skills in the
area of ELA, practitioners should feel more confident
presenting instruction via technology in this content area
versus mathematics, science, and social studies. Second,
words and symbol identification; current evidence of its
effect on teaching more complex or chained skills is ten-
uous. Third, some type of error correction and reinforce-
ment should be built in to the software for maximum
benefit. This recommendation is consistent with other
researchers in the field. Higgins and Boone (1996) suggest
error correction to be considered an essential component
when designing or evaluating existing technology-based
interventions. In some of the studies reviewed, smiley faces
J Autism Dev Disord (2013) 43:26282648
or animations were built into the software as reinforcement
(e.g., Basil and Reyes 2003; Bosseler and Massaro 2003),
and in other cases, food, verbal praise and tangible rewards
were used for reinforcement (e.g., Clark and Green 2004;
Massaro and Bosseler 2006; Moore and Calvert 2000).
In addition to using technology-based interventions
along with empirically sound instructional practices, the
interventions should also be evaluated on an individual
basis for their benefits. If an individual education planning
(IEP) team decides that a technology-based intervention is
the best approach for teaching academics to a particular
student, then progress in the academic area should be
monitored before, during, and after the technology-based
intervention. The IEP team should carefully evaluate the
efficacy and efficiency of the intervention, and modify or
change it if it is ineffective or the student is progressing too
slowly.
Limitations of the Studies
The limitations of the group experimental and single-sub-
ject studies accounted for the minimal degree of evidence
for which to recommend technology-based interventions.
First, three quasi-experimental group designs did not have
enough participants in each group to be considered true
group designs (Heimann et al. 1995; Moore and Calvert
2000; Tjus et al. 2001). Second, several single-subject
studies did not demonstrate functional relations, and thus,
could not be evaluated for the level of evidence needed to
establish an EBP (Chen et al. 2009; Chen and Bernard-
Opitz 1993; Clark and Green 2004; Coleman-Martin et al.
2005; Massaro and Bosseler 2006; Schlosser and Blischak
2004; Schlosser et al. 1998). Third, several single-subject
studies did not meet the essential quality indicators because
they were lacking setting descriptions, procedural fidelity
data, interrater reliability data, and social validity. The
limitations to the studies should be considered in light of
the fact that many studies were published prior to 2005
when the Gersten et al. and Horner et al. criteria for high
quality research in group experimental designs and single-
subject designs, respectively, were published in Excep-
tional Children. The authors of the studies conducted prior
to 2005 did not have published guidelines for conducting
quality research, which may have affected decisions on
whether or not to include information related to procedural
fidelity data, interrater reliability data, and social validity in
the final draft of their manuscripts. As such, studies con-
ducted after the publication in Exceptional Children in
2005 might adhere more closely to the quality guidelines
set forth by the Gersten et al. and Horner et al. Finally,
although the authors sought to determine the effects of the
broad range of technologies available (e.g., interactive
white boards, Personal Data Assistants; PDAs, iOS
2645
applications) on academic skills, most studies found in the
literature review used CAI. Authors did not find studies
that used portable devices, and only one study was found
that used an interactive whiteboard. In contrast to a recent
review conducted by Mechling (2011) supporting the use
of handheld electronic devices (e.g., PDAs, ipods) for
increasing functional multi-step skills, transitioning
between tasks and environments, and time and task man-
agement, the lack of studies using these technologies in the
current review prevents recommendations for or against
such technologies at this time.
Suggestions for Future Research from Findings
There are a number of suggestions for future research that
can be derived based on the moderate degree of evidence
from the single-subject studies and the low degree of evi-
dence from the group experimental studies for using
technology-based interventions to teach academics. In
general, the results of the current review support the find-
ings from other reviews calling for additional studies with
sound research designs that are of high quality (e.g.,
Pennington 2010). The dearth of quality studies makes the
opportunities for research almost unlimited. For example,
researchers should replicate the interventions found in the
current review using the Horner et al. (2005) or Gersten
et al. (2005) criteria as guidelines. Further, although studies
are needed in all content areas, investigations are especially
scarce in content areas other than ELA, such as mathe-
matics, science, and social studies. Quality studies that
teach complex academic skills (e.g., problem solving in
mathematics; sentence creation) are also lacking. Future
research should address the lack of procedural fidelity data
and social validity quality indicators in the studies
reviewed.
Finally, there is a critical need for research on the
technologies lacking in the current review (e.g., iPads,
iPods, cell phones as described in the Mechling 2011
review) for academic skills. The recommendation for
future research across a wide range of technologies,
including newer electronic systems that use the principles
of universal design to determine their efficacy for indi-
viduals with disabilities from Wehmeyer et al. (2008), is
also applicable to the current review. Although there is a
clear need for effective interventions in the field of ASD,
it is also important that emphasis of EBP does not prevent
the use, evaluation, and development of innovative tech-
nological advances. Technological tools have the capacity
to offer a wealth of benefits for individuals with ASD in
learning academic content. For example, Wehmeyer et al.
(2008) reported handheld electronic devices to be a sim-
ple and effective way to prompt individuals with dis-
abilities. The authors suggested that these devices are
123
2646
easy for all individuals to access because of their touch
screens as well as their audio/video output and input
capabilities. Further, their portability, relative affordabil-
ity, and the possibility to customize applications based on
individual need are especially appealing for use by indi-
viduals with disabilities (Wehmeyer et al. 2008). Specif-
ically for individuals with ASD, handheld electronic
devices offer a way to present information visually, in a
predictable and sequential manner. In addition, results of
a literature review conducted by Mechling (2011) suggest
handheld devices are non-stigmatizing since the general
public uses them; students like handheld devices and are
motivated to use them.
Conclusion
IPads, iPods, iPhones, and Smartboards are becoming
standard instructional tools in classrooms across the
county. The rapid emergence of new technologies com-
bined with anecdotal reports of miraculous results may
cause some teachers to jump on the technology band-
wagon. Unfortunately, the field of ASD seems especially
vulnerable to miraculous claims, fantastic fads, and
unproven approaches (Simpson 2005). Since there were
few studies found in the current review that used these
instructional tools and the findings suggest a low to mod-
erate level of empirical support for using technology-based
interventions to teach academic skills, teachers are urged to
weigh the benefits of using such technologies with overall
student outcomes.
Initial decisions to use technology to teach academics to
students with ASD must be made on an individual basis,
monitored carefully, used with systematic instruction, and
changed when students are not making progress. If untes-
ted, novel approaches for teaching academics are used,
then one or more EBP (e.g., time delay) should be used
concurrently. Teachers and parents should be knowledge-
able about the advantages and disadvantages of any inter-
vention they choose to adopt because each intervention has
a cost, even if that cost is simply time. In fact, one of the
most valuable resources we have in the field of ASD is
time. There is only so much time in the instructional school
day, and teachers must make careful, deliberate choices for
which instructional approaches to use and on which target
skills to focus. When teachers choose to replace the
empirically supported practices in favor of the latest fad,
they have given up one of our most precious resources.
They have given up time that could be used to teach stu-
dents to become more independent or to learn to read using
effective and efficient practices, which is time that will
never be regained.
123
J Autism Dev Disord (2013) 43:26282648
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