This article provides the reader with a literature overview of the newest empirical evidences available on the use of assistive technology-based programs for teaching and improving adaptive responding of children with severe to profound developmental disabilities. Four main categories of studies were selected, regarding (a) the technology for promoting independent access to positive stimulation, (b) the combination between microswitch and VOCA aimed at asking for social contact with a caregiver, (c) the cluster technology for increasing an adaptive response, and simultaneously reducing a challenging behavior, (d) the technology for requesting and choosing desired item or the access to the literacy. Overall, 26 studies were reviewed, and 75 participants were involved. The outcomes were largely positive, although few failures occurred. Psychological and Rehabilitative implications of the findings for both research and clinical practices were critically discussed

This chapter provides a literature overview (i.e., range period 2000-2015) concerning the use assistive technology (AT) for children with severe to profound developmental disabilities. Specifically, the chapter presents a general picture concerning the use of electronic tools such as microswitches enabling individuals with multiple disabilities to access independently to preferred stimuli. The chapter focused on the opportunities of choice, literacy process, communication of their own needs, promoting adaptive responses and reducing challenge behaviors, fostering ambulation and/or locomotion fluency, cognitive-behavioral interventions for people estimated within the normal range of intellectual functioning who present pervasive motor impairments. Moreover, the effects of such programs on indices of happiness as outcome measure of participants involved are outlined as well as social validation assessments. Results and implications of the findings are discussed.

Objectives: To extend the use of assistive technology for promoting adaptive skills of children with cerebral palsy. To assess its effects on positive participation of ten participants involved. To carry out a social validation recruiting parents, physiotherapists and support teachers as external raters. Method: A multiple probe design was implemented for Studies I and II. Study I involved five participants exposed to a combined program aimed at enhancing choice process of preferred items and locomotion fluency. Study II involved five further children for a combined intervention finalized at ensuring them with literacy access and ambulation responses. Study III recruited 60 external raters for a social validation assessment. Results: All participants improved their performance, although differences among children occurred. Indices of positive participation increased as well. Social raters favorably scored the use of both technology and programs. Conclusion: Assistive technology-based programs were effective for promoting independence of children with cerebral palsy. Implications for Rehabilitation A basic form of assistive technology such as a microswitch-based program may be useful and helpful for supporting adaptive skills of children with cerebral palsy and different levels of functioning. The same program may improve the participants' indices of positive participation and constructive engagement with beneficial effects on their quality of life. The positive social rating provided by external experts sensitive to the matter may recommend a favorable acceptance and implementation of the program in daily settings.

We further extended the use of a microswitch-based program for assessing contingency awareness and promoting locomotion fluency of five adolescents with Rett syndrome. A second goal was to evaluate the effectiveness and the suitability of the rehabilitative intervention on participants’ indices of happiness as outcome measure of their quality of life and on the reduction of their stereotypic behaviors. Finally, a social validation procedure involving 40 parents of children with severe developmental disabilities and 40 caregivers was carried out. The study was conducted according to an ABABCBCB experimental sequence for each participant, with A representing baselines, B indicating the contingent intervention closely linked to the adaptive responding, and C reporting a non-contingent control phase with positive stimulation occurring throughout the session, irrespective of the adaptive behavior. Results showed an improved performance for all the participants during contingent intervention phases. The control phases revealed that all participants acquired the contingency awareness. The indices of happiness increased as sign of an enhanced quality of life. Both groups of raters favorably scored the use of such technology. Clinical, practical, and psychological implications of the findings were discussed.

Efforts to promote communication in persons with multiple disabilities have largely focused on enabling them to make requests to their immediate caregivers and to exchange text messages or phone calls with distant partners. These two single-case studies extended the research in the latter area. Specifically, Study I targeted text messaging for a woman with visual and motor impairment and mild intellectual disability, teaching her to write her messages via microswitch, virtual keyboard, and word predictor. Study II targeted the use of phone calls for a post-coma adult male with motor impairment and mild to moderate intellectual disabilities, using a technology system that provided him with wide assistance through the process. The results of both studies were quite encouraging, showing an appropriate use of text messaging, including the writing of messages (Study I), and a successful performance of phone calls (Study II). The results were discussed in terms of their general relevance and implications for care and rehabilitation contexts.

This chapter provides readers with an overview regarding empirical evidences available in the literature within the last decade (i.e., 2005-2015) concerning the use of assistive technology for children with autism spectrum disorders. According to the including and excluding criteria, 36 studies were retained and grouped in four main categories, namely: (a) communication skills, (b) adaptive and/or social skills, (c) life skills, and (d) challenge behaviors. The first aim of the chapter was to outline strengths and weaknesses of the aforementioned studies. The second objective of the chapter was to emphasize practical applications of assistive technology-based programs. Finally, the third purpose was to discuss the findings pointing out some useful guidelines for future research. Results were fairly positive, although some failures occurred. Clinical, educational, psychological and rehabilitative implications were also discussed.

We extended the use of microswitch-cluster technology to six children with severe to profound developmental disabilities and autism spectrum disorders. The primary aim of the intervention was to improve the adaptive behavior (ie, insert three objects in three different containers within 3 s) and simultaneously decrease the challenging behavior of hand/objects mouthing. The second aim was to assess the effects of the intervention on the indices of happiness. An ABCAC experimental sequence was adopted for each participant. Thus, subsequent to a baseline condition, a first intervention phase was implemented for increasing the adaptive responding irrespective of the challenging behavior, followed by a cluster phase in which positive stimulation was provided contingent on an adaptive response, only if the challenging behavior was absent. A 3 month follow-up occurred. Results showed a performance improvement for all participants involved. Additionally, they all consolidated the adaptive responding during the follow-up. Sixty external raters favorably endorsed the use of such technology. Implications of the findings were discussed.

We assessed the use of a microswitch-based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid.

Objectives: Persons with multiple disabilities may frequently fail to achieve independent leisure engagement and communication with distant partners. The aim of this study was to extend the assessment of a technology-aided program providing support in the aforementioned areas with nine participants with multiple disabilities.Methods: The program involved a computer system presenting leisure and communication options and a microswitch allowing the participants to choose among and access those options. For each participant a specific array of options was available (e.g. songs, comedy videos, and text messages), depending on his or her characteristics and interests. The effects of the program were assessed via an ABAB design. Participants and staff's opinions about the program were determined through preference checks and interviews.Results: During baseline (without the program), the participants failed to activate/access the options available and thus had no independent option-related engagement time. During intervention, all participants succeeded in using the program, thus accessing the options available independently, and remaining engaged with option-related events for generally 80-90% of the session time. Participants and staff were highly positive about the program.Conclusions: A technology-aided program adapted to the participants' conditions can be a crucial resource to support their independent leisure and communication engagement.

We compared two behavioral strategies (i.e., self-monitoring [SM] and differential reinforcement of an alternative behavior [DRA]) to promote on-task behavior by three children with cerebral palsy and developmental disabilities during classroom activities. The first objective of the study was to evaluate the effectiveness and the suitability of each strategy individually within a school setting, and make their systematic comparison. A second aim of the study was to assess the effects of the intervention on participants' mood as an outcome measure concerning the quality of life. The third objective was to assess the preference checks for each participant. Finally, a social validation procedure, involving 24 teachers as raters, was conducted for corroborating the clinical validity and providing the study with a formal endorsement by sensitive and expert professionals. The study was carried out according to an alternating treatment embedded in a non-concurrent multiple baseline reversal design across participants. Furthermore, a maintenance phase, three months after the end of the intervention, was realized. Results showed that both interventions were successful, increasing on-task behavior for all participants involved, as well as improving their mood. All participants preferred self-monitoring during preference checks. Raters involved in the social validation assessment considered SM as more positive than DRA. Clinical, educational, psychological and rehabilitative implications of the findings were discussed.

This study assessed a technology-aided program (monitoring responding, and ensuring preferred stimulation and encouragements) for promoting physical activity with 11 participants with severe/profound intellectual and multiple disabilities. Each participant was provided with an exercise device (e.g. a static bicycle and a stepper) and exposed to the program according to an ABAB design, in which A and B represented baseline and intervention phases, respectively. Data recording concerned (a) the participants’ responses with the exercise device (e.g. pedaling) during baseline and intervention phases and (b) their heart rates during the last intervention phase. The results showed that all participants had significant increases in responding with the exercise devices during the intervention phases. Heart-rate values during the intervention sessions indicated that the participants’ responding during those sessions mostly amounted to moderate-intensity physical activity, with potential benefits for their overall physical condition. Implications of the findings and questions for future research in the area were discussed.

We assessed a computer-based rehabilitative program (i.e., tablet device with touch screen and adapted software) to improve academic performance and to increase the on-task behavior of three children with autism spectrum disorders and mild intellectual disabilities in a school setting. Furthermore, the study pursued the following objectives: (a) monitor its effects on the generalization process, occurring two months after the end of the intervention, within home context, (b) reduce repetitive (stereotypic) behaviors exhibited by the participants (i.e., hand clapping, washing and voice noises), and (c) carry out a social validation assessment involving 48 support teachers (i.e., professionals who follow children with developmental disabilities with a special and individualized training program within a school context) as external raters. The study was conducted according to a changing criterion design for each participant. Results showed an improvement in performance (i.e., 1 Department of Neurosciences, University of Bari, (Italy). E-mail: f.stasolla@libero.it 2 Lega del Filo d’Oro Research Center, Molfetta (Italy). E-mail: vivianaperilli@gmail.com 3 Lega del Filo d’Oro Research Center, Termini Imerese (Italy). E-mail: adele.boccasini@alice.it 4 Department of Educational Sciences, Psychology, Communication, University of Bari (Italy). E-mail: alessandro.caffo@uniba.it 5 Department of Educational Sciences, Psychology, Communication, University of Bari (Italy). E-mail: ritadamiani@libero.it 6 Department of Educational Sciences, Psychology, Communication, University of Bari (Italy). E-mail: eziaalbano@libero.it Correspondence to: Fabrizio Stasolla: f.stasolla@psico.uniba.it.; f.stasolla@libero.it Received: December 20, 2015; Revised: October 13, 2016; Accepted: November 18, 2016 © 2016 Associazione Oasi Maria SS. IRCCS Life Span and Disability Stasolla F. et al. _________________________________________________________________________________________________ _______________________________ 154 academic activities correctly achieved and percentage of intervals with on-task behavior), for all participants recruited, that they generalized once the program was implemented within their homes. Moreover, all children showed a reduction of repetitive behaviors during intervention phases compared to baseline. Finally, external raters (i.e., support teachers) considered the use of the technology favorably. Educational, practical and psychological implications of the findings were discussed.

Background:Persons with moderate/severe intellectual and multiple disabilities may have difficulties determining (a) the times of the day when to engage in specific activities and (b) the sequence of steps needed for those activities. Assistive technology might help them with both requirements.

Cerebral palsy (CP) refers to a group of non progressive postural and/or movement disturbances dues to defects in the fetus or in the immature brain.It constitutes one of the most frequent cause of developmental disabilities.That is, some of those children are unable to walk, some of them may exhibit postural abnormalities, and some others may present different levels of intellectual disabilities [1-3].In fact, children with CP rely constantly on parents and/or caregivers' assistance and are commonly isolated and passive towards the outside world, with negative consequences on their quality of life [4][5].Thus, they are unable to acquire new adaptive skills by themselves [6].To overcome this issue, one may resort on the use of assistive technology (AT) [7][8].

This study assessed a new Speech Generating Device (SGD) with three adult participants whose multiple disabilities included blindness or minimal residual vision. The side of the device facing the participants measured 35 cm × 20 cm and was divided into 15 sections each containing an optic sensor. Above each optic sensor, there was a small object or tag with a word in Braille referring to an activity. Removing an object/tag activated the underlying optic sensor and caused the device to verbalize a request for the activity that the object/tag indicated. The caregiver responded by ensuring the occurrence of the activity. The study was carried out according to a non-concurrent multiple baseline design across participants. During the baseline, the mean frequencies of communication events per 60-min session were zero or close to zero. During the intervention phase, they increased to between about six and 11. The mean cumulative activity time per session exceeded 45 min for all three participants. Each of them preferred using the device over alternative occupation during the preference checks carried out across the intervention period. Moreover, staff personnel interviewed about the device provided highly positive scores regarding its impact and usability. Implications of the findings were discussed.

Post-coma children usually fail to be constructively engaged with their surrounding environment, due to extensive motor disabilities and lack of speech. In fact, they may pose serious challenges to daily life contexts (i.e., home, medical and rehabilitative settings), since they are frequently unable to correctly manage the positive stimulation by their-own and they are inadequate to be involved within conventional and traditional programs [1,2]. Thus, these children may be not capable of: (a) regulate the amount and the type of stimulation available, and (b) positively interact or communicate with their partners (e.g., parents and caregivers), with negative outcomes on their quality of life [3,4]. To overcome this issue one may resort on assistive technology-based interventions (AT) [5]. AT refers to any device, equipment or piece enabling a participant affected by severe to profound developmental disabilities with self-determination towards the outside stimuli [6].

AbstractPersons with multiple (intellectual and sensory-motor) disabilities can have serious difficulties managing their independent engagement in leisure activities and communication, particularly with partners not present in their immediate environment.This study assessed two versions of a technology-aided program (involving a computer system to present leisure and communication options and a microswitch to choose among them) with four participants with multiple disabilities. Two participants used the first version of the program, which allowed them to choose among leisure (music) options. The other two participants used the second version of the program, which allowed them to choose among leisure (music and videos) and communication (telephone calls) options. Each program version was implemented according to a non-concurrent multiple baseline design across participants.Data showed that both program versions were successful in helping the participants achieve the objectives pursued, that is, choose and access leisure or leisure and communication options independently.Technology-aided programs can enable persons with multiple disabilities to manage positive occupational engagement and communication.

This chapter presents an overview of the assistive technology-based solutions available in the recent literature, illustrates their use, and summarizes some options with individuals who have severe to profound developmental disabilities, including multiple disabilities. Specifically, the text describes implementation of (i) one microswitch (i.e., allowing the independent access to preferred stimulation), (ii) two microswitches (i.e., enabling the participant with choice opportunities), (iii) a combination of microswitch and voice output communication aid (i.e., ensuring that the participant has independent access to preferred stimulation or social contact with a caregiver), (iv) microswitch-cluster (i.e., aimed at promoting an adaptive response and reducing a challenge behavior), (v) microswitch and computer (i.e., with the presentation of two or more categories of personal needs such as leisure, communication, literacy process, video, music and so forth), and (vi) microswitch and contingent stimulation (i.e., to foster ambulation responses or locomotion fluency). For each category, we give the empirical evidence, emphasizing the strengths and weaknesses of the selected studies. Furthermore, social validation assessments will be pointed out, as well as practical implications for future research.

This study assessed whether a computer-aided program presenting static pictorial instructions or video prompts according to prearranged time intervals would be suitable for teaching six persons with multiple (i.e., intellectual, sensory, and social) disabilities to perform simple daily activities. The program was applied with each participant according to a multiple probe across activities design. The results showed that all participants (i.e., the five using pictorial instructions and the one using video prompts) had a fairly rapid performance improvement with the introduction of the program. A post-intervention probe carried out to verify whether the participants had eventually become capable of performing the activities independent of the instructions showed clear declines in performance. Such declines underlined the enduring relevance of the instructions. These results (a) extend previous evidence on the use of visual instructions and computer-aided programs for supporting their presentation and (b) have clear practical implications for daily contexts.

These two studies extended the evaluation of technology-aided programs for fostering occupational engagement and mobility in persons with multiple disabilities (i.e., severe to profound intellectual disability and blindness or limited residual vision). In Study I, the program (a) provided auditory cues to guide three adults to various desks, at each of which a simple occupational activity was to be carried out, and (b) ensured preferred stimulation at each of the desks. In Study II, the program (a) provided auditory or visual plus auditory cues to guide two adolescents to gather five objects of a collection at five different desks and put each of them into a container located at a sixth desk, and (b) ensured preferred stimulation at each desk. The results of both studies were largely positive with all participants learning to move from one desk to the next independently to deal with the activities/objects properly. The results were discussed in light of previous evidence in the area and in terms of practical and technical implications for daily intervention with persons with multiple disabilities.