&

MATO
Health and Technology
https://doi.org/10.1007/s12553-019-00317-4
Karina Cinel 2023

ORIGINAL PAPER

Technology Impact on Reading and writing skills of children

with autism: a systematic literature review
Manal Abdo 1 & Hussein Al Osman 1

Received: 10 April 2018 / Accepted: 26 March 2019

# IUPESM and Springer-Verlag GmbH Germany, part of Springer Nature 2019

Abstract
Due to the recent fast-paced advances in technology and its potential in ameliorating the writing and reading skills of children
with autism, there is a need to update the study published by Knight, McKissick, and Saunders (J Autism Dev Disord
43(11):2628–48) to survey the latest research on the topic. Hence, the objective of this paper is to assess the methodology and
limitations of published literature that investigate the use of technology to teach reading and writing skills to children with Autism
Spectrum Disorder. We conduct a systematic literature review of peer-reviewed studies on the impact of technology on reading
and writing skills of children with autism for the years between 2013 and December 2017. We apply the criteria developed by
Horner et al. (Except Child 71:165–178, 2005) and Gersten et al. (Except Child 71:149–164, 2005) to determine the quality of
single-subject and group experimental research studies. We present seventeen studies that met the inclusion criteria. The studies
examine 101 participants including 77 diagnosed with autism with the mean age of 8.7 years. None of the seven-reviewed single-
subject studies meet the criteria for high or acceptable quality. The group-subject study does not meet the quality criteria. We
conclude that the level of the impact technology has on helping children with autism improve their reading and writing skills is
hard to quantify due to the high variability in the results presented in the surveyed papers. Overall, all studies report positive
outcomes despite the lack of software applications adapted for children with autism.

Keywords Autism . Technology . Reading . Writing

1 Introduction education services and parental productivity loss. Adults with

In many ways, autism remains a mystery. There is no perma-
nent cure for autism and the causes for this developmental
disorder are unknown. Children with autism require special
health, education, and social services [1]. Autism is a severe
developmental disorder that appears within the first three
years of life. This disorder involves impairments in social
interaction, verbal and non-verbal communication. People
with autism may have limited interests, unusual eating or
sleeping behaviors or a tendency to engage in activities to hurt
themselves [2]. The cost of supporting an individual with au-
tism, during his/her lifespan is 2.4 million US dollars in the
United States and £1.5 million in the United Kingdom [3].
The largest contributing factors to the cost come from special
* Hussein Al Osman
halosman@uottawa.ca
1
University of Ottawa, Ottawa, Ontario, Canada
autism require high-cost residential care or supportive living
accommodations [3]. The criticality of this disorder empha-
sizes the need to continue to search for effective interventions
[3]. Individuals with Autism Spectrum Disorder (ASD) can
benefit beyond childhood from intensive interventions. In
fact, researchers have observed favorable results in terms of
intelligence, language, daily living skills, and positive social
behavior improvements as a result of intensive intervention
for children with autism [4].
Parents and clinicians report that technological devices
are attractive and fascinating to children with autism.
Also, the use of technology to teach children with autism
is gaining acceptance among scholars as evidenced by the
development of new journal publications on the topic
(Journal of Special Education Technology, the Journal of
Educational Multimedia and Hypermedia, the Journal of
Computer Assisted Learning, etc.) [5]. Many forms of
technology have an impact on academics, behavior, com-
munication, social, and vocational skills. Desai et al. sup-
port the classroom implementation of high-tech devices

for children with complex communication needs [6].
Knight, McKissick, and Saunders show that most of the
studies between 1993 and 2012 indicate that there is a positive
effect of using technology for teaching children with autism
[7]. Since the publication of Knight, McKissick, and Saunders
[7], the technology that can be used to teach children with
ASD has drastically evolved in terms of both hardware and
software. For instance, we have seen the popularization of
tablets for pedagogical and serious gaming applications.
Moreover, we have witnessed the development of novel edu-
cational software and early learning applications such as
Headsprout, Evantuars and Go Talk Now.
The current study is based on a previous review by Knight,
McKissick, and Saunders titled BA Review of Technology-
Based Interventions to Teach Academic Skills to Students
with Autism Spectrum Disorder^ [7]. The previous review
covered the period between 1993 and 2012. Due to the recent
fast-paced advancements in technology and its potential in
ameliorating the writing and reading skills of children with
autism, there is a need to update the latter study to survey
the latest research on the topic (between 2013 and 2017).
The objective of the study is to examine the technology
influence on reading and writing skills of children with
autism. The Knight, McKissick, and Saunders [7] study
did not examine new technology platforms such as hand-
held and portable devices. We assessed the influence of
those devices in the latest research and studied technol-
ogy limitations in terms of hardware and software.
Additionally, Knight, McKissick, and Saunders [7] ad-
vised researchers to address quality issues in future stud-
ies according to the Horner et al. [8] and Gersten et al.
[9] guidelines. We assessed the reviewed studies against
these standards to evaluate their compliance with the
quality indicators.
The purpose of this study is to answer the following
questions:
a. What is the influence of the latest technologies that have
proposed for teaching on the reading and writing skills of
children with autism?
b. When technology is used for teaching, what are the fac-
tors that still affect the reading and writing skills of chil-
dren with autism and how do they compare to the ones
identified in [7]?
c. What is the quality level of the reviewed single and group-
subject studies that assess the effectiveness of teaching
children with autism using technology?
The rest of the paper is organized as follows: Section II
describes the search filtering methodology; Section III pre-
sents the results; Section IV discusses the obtained results;
Section V reports the study limitations and Section VI con-
cludes the paper.
Health Technol.
2 Methods
2.1 Procedure
We conducted a systematic literature review of peer-reviewed
published articles between 2013 and December 2017. We
reviewed the studies that described the impact of technology
on reading and writing skills for children with autism. The first
author performed the processes of identification, screening,
and eligibility including reading the full-texts of the examined
studies.
2.2 Search Strategy
2.2.1 Identification Process
We searched nine databases including Scopus, ACM, Web of
Science, IEEE Xplore, PubMed, Google Scholar, ERIC,
PsychINFO and SpringerLink. The results are summarized
in Fig. 1. Searches returned articles between 2013 and 2017
when the title, abstract, or keywords contained the following
combination: (iPad or iPod or Tablet or computer or
smartphone) and (reading or writing or education) and
(Bautistic child^ or Bautistic children^ or Bautism spectrum^
or autism), and filtered the results by education, computer
science, psychology, child and school psychology, or social
science. Studies were excluded when they were in the fields of
biomedical, neurodevelopment, or genetics. We documented
the search strategy based on the PRISMA flowchart [10]
which illustrates the different stages of a systematic literature
review search process (Fig. 1).
2.2.2 Screening Process
The initial search returned articles across nine databases [N =
354]. We screened the articles based on title, abstract, and
keywords. The inclusion criteria were: a) year of study is
between January 2013 and December 2017, b) technology is
used for teaching, c) technology targets reading and writing
skills, and d) at least one subject is a child with autism (0–
14 years). Articles were excluded if: a) an alternative (non-
technological) method is used as intervention (such as the
conventional implementation of autism intervention curricu-
la), b) the study was not applied to children with autism, or the
participants are youth and/or, and/or c) the technology was
used but its effect was not investigated. After screening, the
number of papers was reduced to [N = 23].
2.2.3 Eligibility Process ↳ incluir
noRS
After a full-text review of the 23 articles for eligibility, six
articles were excluded for the following reasons: a) the results
are based on interviews instead of direct interaction with
Health Technol.
Fig. 1 PRISMA flowchart
technology, and b) there is a focus on reading for communi-
cation only. Seventeen articles met both inclusion and eligi-
bility criteria. (N = 17).
2.3 Data Extraction
Based on [7], we extracted data on a) number of participants
including children with ASD and their ages b) study design (c)
content for targeted skill (d) technology used, i.e.,
Independent Variable (IV) (e) Applied Behavior Analysis
(ABA) principles applied (f) developed skills, i.e.,
Dependent Variables (DVs) (g) study results, and (h) study
limitations. The data is summarized in Table 1. The purpose
of extracting the data of Table 1 is to decompose the studies’
elements so that we can assess them according to the quality
indicators developed by Horner et al. [8] and Gersten et al. [9].
Additionally, we looked at important methodology compo-
nents, such as participants, settings, and examined reading
and writing skills, to find factors that affected the studies’
results. Additionally, we coded data based on a) hardware
used b) software used, and c) technology limitations according
to the reviewed studies’ authors. The data is summarized in
Table 2. ABA is the scientific study of human behavior. Its
techniques are intended to help individuals positively change
their behavior. Behavior is not a static characteristic and refers
to what a person does and says [28]. All reviewed studies
involved instructors or therapists using the ABA principles
to help guide the participants during the experiment on the
use of the technology. Examples of the ABA methods used
were reinforcement and prompting. We extracted ABA related
information to describe the human intervention role in each
study, and to point to the technology limitations that necessi-
tated the application of the ABA principles.
3 Results
3.1 Description of Studies Included
Seventeen studies’ objectives were to evaluate the impact of
using technology on reading and writing skills of children
with autism. Fig. 2 shows the spread of studies over this peri-
od. A total of 101 participants including 77 diagnosed with
autism participated in all reviewed studies. The mean age of
ASD participants was 8.7 years old with an age range of 4.8 to
14.4 years. ASD participants were 67 males and ten females
with a ratio of 6:1.
All studies are summarized in Table 1. Five of the 17 stud-
ies evaluated participants with autism and other intellectual
disabilities. [11, 15, 19, 24, 25]. All participants in the remain-
ing 12 studies had an autism diagnosis. The experiments of 16
studies took place in a school classroom setting. One experi-
ment took place at home [26].
Table 1 Summary of Data Extraction

Reference # of ASD Research Content ABA Principles DVs Results Limitations excluding technology
participants Design
and ages

Ahlgrim-Delzell et al. N = 17 Pre-Test, Reading Early Reading Skills Phonics skills: Segmenting, Students who received the iPad One of the three measures, blending
[11] N(ASD) = 8 Post-Test Builder (ERSB) and decoding, sight, words and curriculum outperformed the sounds to identify words, did not
7 yrs Instructional Procedure comprehension control students produce a significant effect compared
to the other two with high effect.
Alison et al. [12] N=3 Multiple Reading Modified System of Least Number of correct pairings of Sharing stories using technology Choice of children’s literature may not be
N(ASD) = 3 Probe Prompts WH words (who, what, was effective for teaching relevant to their culture. Also, children
8–10 yrs when, why, where and comprehension and may not have generalized their skills to
which) and number of identification of WH words non-adapted or traditional book for-
correct responses to mats.
comprehension questions
Bailey et al. [13] N(ASD) = 20 Pre-Test, Reading Literacy instruction on 1–1 Reading accuracy and ASD may benefit from Unclear if regular class room instruction
5–11 yrs Post-Test basis comprehension skills ABRACADABRA literacy has contributed to the results.
instruction Also, external measures of fidelity were
not collected
El Zein et al. [14] N(ASD) = 3 Alternating Reading Token board as Reading Comprehension and Intervention was associated with Lack of component analysis
9–12 yrs Treatment reinforcement and Frequency of Task Refusal improved performance during
behavior management Teacher-directed instruction
(TDI) and iPad-assisted in-
struction (IAI)
Evmenova et al. [15] N = 10 Multiple Writing Persuasive essay writing Increased writing quality
N(ASD) = 4 Baseline
13 yrs
Ganz et al. [16] N(ASD) = 3 Alternating Reading Verbal prompting Verbs and nouns All participants showed increased Subjects need to view the video multiple
8–14 yrs Treatment use of verbs and nouns times.
spontaneously Booster sessions were added. No
comparison between iPad and
traditional methods. Prior abilities of
subjects were unknown.
Grindle et al. [17] N(ASD) = 4 Pre-Test, Reading Prompts, reminders, Word recognition skills Successfully used with children Advanced reading skills such as oral
4–6 yrs Post-Test encouragement, with autism and can improve reading fluency and comprehension
avoidance behaviors their early reading skills were not assessed
Leytham et al. [18] N(ASD) = 2 Multiple Reading Nonverbal Reading Word identification NRA technology-aided and Not clear if students learned words by
12–13 yrs Probe Approach teacher-led techniques were ef- seeing, hearing or decoding.
fective.
Coleman et al. [19] N=3 Alternating Reading Teacher-directed Sight words Computer-assisted prompting was It should not be used to supplant quality
N(ASD) = 3 Treatment simultaneous 630 words on the Rebecca more efficient teacher-led instruction as the teacher
10-11 yrs prompting vs. Sutton’s List of 1200 High can hear and respond to the student oral
computer-assisted si- Frequency Vocabulary List responses while the software cannot.
multaneous prompting Therefore, student responses were dif-
ferent between teacher-led instruction
and software instruction.
McGonigle-Chalmers N(ASD) = 9 Learning Reading and Motor skills challenge Game Success: Non-speech domain was superior Previous word awareness not confirmed.
et al. [20] 5-17 yrs Game Expressive Spontaneous Syntactic to their spoken language Participant size and scope of study is
Language Production limited.
Latent learning
Health Technol.
Table 1 (continued)

Reference # of ASD Research Content ABA Principles DVs Results Limitations excluding technology
participants Design
Health Technol.

and ages

McKissick et al. [21] N(ASD) = 3 Multiple Reading Written cues, verbal and Map Reading All students showed change in Noise from other students in classroom.
Elementary Probe animated prompts level and two students showed Missing adapted software for the
School change in trend participants.
Plavnick et al. [22] N(ASD) = 3 Multiple Reading Contingent reinforcement Online reading All participants showed an
6–7 yrs Probe and match-to-sample increase in correct interactions
training per minute
Plavnick et al. [23] N(ASD) = 4 Multiple Reading Token system Reading instruction Increased engagement and correct Early termination of study limited the
6–10 yrs Baseline interfering behavior was interaction per minute number of participants.
defined as aggression. The 3-min observation period did not ac-
count for behavior correction.
ABA package (blocking, redirection,
contingent reinforcement, extinction,
visual stimuli signaling rules and
consequences) has limited the
conclusion because it is often difficult
for practitioners to implement if they
do not receive the same level of
coaching.
Participants did not say words out loud.
Regan et al. [24] N=4 Multiple Reading Basic word reading skills Word recognition skills Some students were able to master
N(ASD) = 1 Probe and direct instruction word recognition skills while
11 yrs others needed additional direct
instruction
Seok et al. [25] N=3 Multiple Writing Unclear Spelling Improved spelling and acquired
N(ASD) = 1 Baseline vocabulary independently
6 yrs
Sula et al. [26] N(ASD) = 1 Unknown Reading, Assistive instruction Words, drawings, vocabulary, Teaches new skills and increases Only one participant. The system needs
Writing and math concentration further enhancements.
Math
Xin [27] N(ASD) = 4 Multiple Writing Prompting if needed Develop six compositions Students increased their number Small sample size and one teacher. Also,
13–14 yrs Baseline following the four stages of written words and complete
of writing sentences
 Table 2 Technology Matrix

Study Hardware Used Software Used Technology Limitation according to author(s)

Ahlgrim-Delzell et al. iPad Early Reading Skills Builder (ERSB) curriculum by iPad-based As students progress in their decoding skills, connected text should be
[11] technological speech support using Go Talk Now (GTN) provided and linked to meaning.
Alison et al. [12] iPad Create a screen in GoTalk Now for each WH word that includes all It is unclear the extent of technology platform with a consistent voice
six WH words. One matching and the others are distractors. recording may have been critical to student success.
Bailey et al. [13] Computer ABRACADABRA. A free literacy program designed to improve The authors did not report technology related limitations.
reading and writing skills of all children, including those of low
literacy abilities.
El Zein et al. [14] iPad A careful assessment of different applications should be conducted to
determine what additional elements derived from more traditional
teacher-directed instruction (TDI) methods may need to be added where
iPad applications are lacking.
Evmenova et al. [15] Computer Using Microsoft Word as a Computer-Based Graphic Organizer The computer-based graphic organizer did not include an opportunity for
(CBGO) to support writing of a persuasive essay. students to benefit from teacher/peer feedback on the essay.
Ganz et al. [16] iPad and Laptop iCommunicate application. Color line drawings and labels for the There was no comparison between the effects of the iPad visuals and
two different actions/nouns were presented using this software. paper-based visuals.
Video clips (Dora the Explorer and The Little Mermaid). Price Is
Right video.
Grindle et al. [17] Computer MimioSprout Early Reading (MER). MimioSprout printable stories It would be interesting to assess whether MER could be used in standard
(including MimioSprout Readers, Read with Me Stories and special educational settings that are not ABA-specific and may not have
Companion Stories) the kind of staff student ratios or the expertise in behavioral methodol-
ogies.
Leytham et al. [18] Computer PowerPoint slides in the same format as a spiral-bound word booklet. Analysis of the auditory and visual presentation of the words will need to
Each PowerPoint slide contained audio component similar to be conducted to determine if the auditory component is more important
teacher instruction to perform a comparison between the than the visual.
computer-based and teacher-based activity.
Coleman et al. [19] Laptop with headphones Intellitools Classroom Suite. A list of sight words from Rebecca A more direct comparison could have been made if an advanced software
Sitton’s List of 1200 High Frequency Words. application that can recognize speech and mimic a teacher in its
responses was employed. However, the software application used is
more representative of a software package actually available for
classroom usage.
McGonigle-Chalmers Tablet – Touch Screen Custom-made learning game named Eventaurs. (a touchscreen-based Eventaurs game has visual properties (icons) that students use to distin-
et al. [20] sequencing that if screen icons were touched in a correct order, the guish words (nouns and verbs). However, some of these icons were
resulting event will occur in a form of an animation) confusing for the students such as showing a wizard as a wand icon, or
showing a kiss as lips icon.
McKissick et al. [21] Laptop with Removable 24-slide PowerPoint presentation with written cues, verbal and Future research could evaluate commercially available CAI to teach
Storage animated prompts and a hyperlink. students with Autism
Plavnick et al. [22] Tablet at Headsprout Center Headsprout Early Reading (HER) session Understand how HER compares to teacher-led early reading instruction
with children with ASD.
Plavnick et al. [23] IPad Headsprout Early Reading (HER) session called BMousing Around^ The authors did not mention technology-side limitations in this study.
Regan et al. [24] Laptop with headphones and a Lexia SOS software. Contains game based activities such as Lexia Quick Reading Test used to identify student’s skills for instruction,

·
mouse matching words to pictures, word sorts, mazes and cloze exercises. may have been an unreliable source.

-888
Seok et al. [25] Samsung Galaxy Note Tablet
Health Technol.
Health Technol.

Research on software and apps to address the needs of these students with

There are many different computer programs available to develop digital

The content areas were reading and writing. Three studies

regard to literacy skills should be further developed and emphasized.

stories, but this study only used Microsoft Photo Story, a free online
This study was the first to use the Galaxy Note, so the data should be
focused on writing skills [15, 25, 27], one study involved both
reading and writing [26], and thirteen studies focused on read-
ing skills. Two studies used Experimental Design [20, 26].

The authors did not report technology related limitations.

Two studies used PostTest/PreTest Control Group Design
[11, 13]. Three studies used Alternating Treatment Research
Design [14, 16, 19], and ten studies used Single Subject
Design (Multiple Probe and Multiple Baseline) with two
Technology Limitation according to author(s)

Group Experimental Design. Two studies used mixed designs

(PreTest/PostTest, Single Subject) [13, 17].
generalized with caution.

3.1.1 Dependent Variables

The studies examined various reading and writing skills.

Vocabulary, map reading, word recognition, verbs and
program.

nouns, and sight words are the reading skills that were
measured. Writing skills included spelling, compositions
and persuasive essay writing. The results of the studies
vary between subjects. For example, studies [15, 24, 27]
Play with Korean Language application. Pictures of 20 fish and other

pictures played music from a well-known children son without the

manner to teach ASD students’ new language, math and life skills)
JXTA based system. Complex JXTA supported software (a Java-based set of protocols that enable

Computer-assisted (Microsoft Photo Story) instruction using digital

stories. Six stories were developed with one story in two weeks.

examined four ASD participants each. There were vari-

sea animals with their names shown below each picture. The

(SmartBox) and RFID cards, to collaborate in a Peer-to-Peer

able baseline and intervention results among all partici-

pants. However, all studies reported positive outcomes
any connected devices, that includes computers, sensors

related to improved skill performance. Dependent

Variables are summarized in Table 1.

3.1.2 Technology (Independent Variable) description

Studies were variable regarding the hardware and software

used. Table 2 lists the technology utilized in the studies and
their limitations according to the researchers. Nine studies
used personal computers (desktop and laptop), and nine stud-
ies used Tablets (iPad, Samsung Galaxy Note). One study [26]
Software Used

built an integrated system based on a Java-based set of proto-

cols that enable any connected devices, that includes com-
lyrics.

puters, sensors (SmartBox) and RFID cards, to collaborate

in a Peer-to-Peer manner in order to teach ASD students
new language, math and life skills. Software varied
from PowerPoint slides to full-featured applications like
RFIDs, Computers and

HeadSprout and MimioSprout (online early reading pro-

system with sensors,

grams). One study used a custom-made application

named Eventaurs which encourages the sequencing of
Hardware Used

Networking

words in order to build language understanding without

Computer

using speech [20]. One software application (Go Talk

Now) was specialized for language skills such as learn-
ing Phoneme identification, blending sounds to identify
words and decoding for picture-word matching [11].
Table 2 (continued)

Fifteen studies used early reading and writing applica-

Sula et al. [26]

tions, and no study used software designed specifically

for children with autism. Three studies did not mention
Xin [27]

technology limitations [13, 23, 26], while 14 studies did

Study

(as described in Table 2).

 Health Technol.

Assistance Center on Transition (NTACT 2016) [29] that is

Fig. 2 Study distribution between years 2013–2017
3.2 Quality Indicators
We conducted a methodology review using Single-Quality
Indicator Checklist created by the National Technical
based on the Single-Subject Research by [8].
We established Table 3 to illustrate the Quality Indicators
of a) participants, b) DVs, c) IV, d) procedure, e) design/graph/
results and f) social validity. We analyzed seven studies [15,
16, 18–20, 24, 30] that met the criteria of [8] and NTACT
2016 [29] (Single-Subject for ages between 11 and 26 years).
None of the seven studies were of high or acceptable qual-
ity since the NTACT checklist requires the first 1–16 indica-
tors to be true. [15, 16, 19, 20, 24, 27] did not clearly establish
external validity. [18] did not indicate that inter-observer reli-
ability and social validity data were collected. [27] Internal
validity and experiment setting were not documented.
Similarly, we conducted a methodology review using the
Group-Experimental Quality Indicator Checklist created by
NTACT [31] that is based on Group-Subject Research by [9].
Two studies [11, 13] were Group-Experimental. We ex-
cluded [11] due to NTACT initial criteria of limiting the age

Table 3 Quality Indicators for Single-Subject Studies

Evmenova Ganz Leytham Coleman McGonigle-Chalmers Regan Xin

et al. [15] et al. [16] et al. [18] et al. [19] et al. [20] et al. [24] [27]

Participants & Settings

Described with sufficient details Y Y Y Y Y Y Y
Clear selection process Y Y Y Y N Y Y
Setting description allows replication Y Y Y Y N Y N
DV
Described with operational precision Y Y Y Y Y Y Y
Measured quantifiably Y Y N Y Y Y Y
Measurement process described with Y N Y N Y Y Y
replicable precision
Measured repeatedly over time Y N Y Y Y Y N
Reliability (Inter-observer) data collected Y Y N Y N Y Y
IV
Described with replicable precision Y N Y N Y Y Y
Systematically manipulated and controlled Y Y Y Y Y Y Y
by experimenter
Overt measurement of implementation fidelity Y N Y Y N Y N
Procedures
Baseline phase established a pattern Y Y Y Y N Y Y
Baseline conditions described Y Y Y Y N Y Y
Design / Graph / Results
3 or more demonstrations Y Y Y Y Y N Y
Control for common internal validity threats N N Y Y N Y N
Established external validity N N Y N N N N
Social Validity
DV is important Y Y Y Y Y Y Y
Change in DV is important Y Y N Y Y Y Y
IV practical and cost effective Y Y N N Y Y N
Social validity is enhanced by IV Y N N Y N Y N
Score 18/20 13/20 15/20 16/20 11/20 18/20 13/20
Health Technol.

to 11–26 years. We analyzed one study and established and Saunders [7] stated that due to the lack of studies using
Table 4 to illustrate the Quality Indicators of a) participants, handheld devices, the review did not make a recommendation
b) intervention and comparison conditions, c) outcome mea- on their use. In this review, eleven studies used portable de-
sures, and d) data analysis. vices (Laptops, iPad, Galaxy Note Tablet), five studies used
The reviewed study [13] did not meet the high or accept- computers and one study used a complex system with sensors,
able quality criteria due to the missing documentation for RFIDs, computers, and networking devices. All studies re-
interrater reliability (item 12 of the NACT criteria). ported positive results. In the current study, we examined 17
studies that were positive. Ten of the eleven studies that used
portable devices and four of five studies that used computers
reported limitations in software. None of the reviewed studies
4 Discussion used adapted software for children with autism which may
have contributed to the level of influence. We recommend
The objective of this study is to review the impact of technol- the use of adapted software to improve the technology influ-
ogy on reading and writing skills of children with autism. Its ence and ensure continuous learning.
main audience is researchers and practitioners in this field. In McKissick et al. [21] suggested that future research could
the current review, all studies reported a positive impact for evaluate commercial applications to teach children with au-
using technology in the interventions. However, based on the tism. Autism Speaks lists around 200 software applications
current study, it is difficult to determine the level of influence recommended for children with autism that apply to language
of technology since the results were highly variable in both training [32]. Despite this vast number of applications in re-
baseline and intervention. This was due to two factors: limi- cent years, several studies used simple or non-specialized
tation in technology used and the wide differences in diagno- technology methods to prove the impact of technology on
sis levels for the participating subjects. Knight, McKissick, reading and writing skills of children with autism. This high-
lights the need to use technologies adapted or developed spe-
Table 4 Quality Indicators for Group-Experimental Studies
cifically for children with autism in future studies.
One of the reasons for employing technology to teach chil-
Bailey et al. [13] dren with autism is to reduce human intervention in the learn-
ing process [30]. Most studies depended on human interven-
Participants
tion and applied ABA principles such as reinforcement, error
Participants demonstrated disabilities Y
correction, and prompting. Only one study, in the current re-
Increase probability that participants were Y
view, experimented with teaching children writing skills with-
comparable across conditions
Sufficient information about intervention providers Y out the presence of an ABA therapist or a special needs work-
Documented attrition rates N er. We confirm Knight, McKissick, and Saunders [7] recom-
Intervention and Comparison mendation to build reinforcement and error correction into the
Clearly described Y educational tools.
Fidelity of implementation described Y Five studies [11, 15, 19, 24, 25] combined subjects with
Fidelity of Implementation Assessed Y
ASD and other disabilities. We recommend using homoge-
Comparison conditions described and documented Y
neous participant samples when examining the effectiveness
Outcome Measures
of technology on improving reading and writing skills for
children with autism. Autism differs from other intellectual
Multiple measures were used Y
disabilities in screening, diagnosis and caregiver training
Outcomes measured Y
[33, 34]. Horner et al. stated that Bglobal descriptions such
Evidence of reliability (test-retest, internal N
consistency, interrater) as identifying participants as having developmental disabil-
Interrater reliability documented N ities would be insufficient^ [8]. Four of those five studies
Data scorers and collectors are neutral Y mixed ASD subjects with participants with other intellectual
Outcomes measured beyond posttest Y disabilities by relying on IQ as one of the factors in subject
Validity measured (Criterion, Construct) N selection. However, Grynszpan et al. did not find IQ to be a
Data Analysis moderating factor when they assessed the effectiveness of
Appropriate data analysis techniques Y technology-based training for ASD subjects [35].
Enough information provided to calculate the effect Y Knight, McKissick, and Saunders stated that the applica-
Clear results Y tion of technology as opposed to traditional methods and
Audio/Video excerpts provided N teacher-led education may make learning more engaging and
Score 14/19 attractive [7]. This type of learning can be repeated at different
times and settings and with a smaller cost and effort compared

to conventional methods [7]. In the current review, most of the
studies are applied in the vicinity of classrooms with very few
studies applied at home. This does not reflect the real need to
pursue the education in other environments such as the home.
Knight, McKissick, and Saunders [7] used a 2010 version
of single-subject and group-experimental quality indicator
NTACT checklist. The current study used a 2015 version of
the NTACT checklist [17] that included more detailed descrip-
tions. The quality indicators of the single-subject checklist
have not changed; however, the interrater reliability criterion
was added to the group-experimental checklist. Bailey et al.
[13] did not meet the acceptable quality level as it does not
satisfy the interrater reliability criterion. If this study was eval-
uated based on the 2010 version of the group-experimental
quality indicators, it would have met the acceptable quality
criteria. Since none of the studies have met the high or accept-
able quality criteria, we conclude that existing studies have
shortcomings that should be carefully addressed in future
work on the topic.
5 Study Limitations
5.1 Internal Validity
There is a threat to internal validity since all included studies
were retrieved and reviewed by a single researcher and within
a restricted time limit. However, extra care was taken to over-
come this threat such as searching nine databases according to
clear inclusion criteria and methodology. Moreover, the cur-
rent study is revisiting an existing review that was used as a
reference and template. A vast spectrum of disorders falls
under the umbrella of ASD. This makes general conclusions
about the effectiveness of technology to teach ASD children
reading and writing skills difficult to attain. Nonetheless, we
can still draw conclusions regarding the quality of the studies’
design and tools employed. Furthermore, we can render rec-
ommendations on how to improve educational tools to cater
for a large number of ASD children with various levels of
functioning.
6 Conclusion
Overall, the use of technology for teaching academic subjects
in the classroom or at home is well established, whereas, using
technology in teaching children with ASD lags behind. The
review by Knight, McKissick, and Saunders, urges parents
and teachers not to replace proven methods for teaching chil-
dren with ASD with other unproven and untested methods
since they risk wasting time, one of the most precious re-
sources for caregivers and children [7]. Also, it contends that
many of the reviewed studies lacked quality standards
Health Technol.
compliance. Unfortunately, the ASD field is vulnerable to
unproven approaches and miraculous claims [36].
The reviewed studies addressed some aspects of the chil-
dren with autism reading and writing needs using technology-
based instruction. However, there is a gap in most of these
studies as it concerns individual needs and a variety of levels
of autism. The one product fits all does not address the differ-
ent levels of autism as autism is a spectrum. Most of the
existing software applications covered in the studies may be
suitable for high-functioning children with autism but do not
have the adaptability to support children lower functioning
children. Also, the ASD children have a particular need for
generalization. Generalization increases the likelihood that the
behavior change will occur in all relevant situations or circum-
stances in person’s life. In behavior modification, generaliza-
tion is defined as the occurrence of the behavior in the pres-
ence of all relevant stimuli outside the training situation [28].
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Ethical approval This article does not contain any studies with human
participants or animals performed by any of the authors.
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