Presented at the Annual American Speech-Language-Hearing Association Convention, November, 2013
Introduction and Purpose
The purpose of this study was to explore parent and clinician reported perspectives and experiences six months after the introduction of iPads and relevant applications. This study was part of a larger investigation associated with the iPads for Kids with Apraxia Pilot Program initiated by the Childhood Apraxia of Speech Association of North America (CASANA). CASANA provided 40 children with CAS an iPad and appropriate applications free of charge to support their treatment. This study sought to investigate the impact of the implementation of this technology in therapy and at home.
Despite widespread and rapidly growing use of iPad and related application technology, there is limited empirical data on the specific use of iPads in treatment for individuals with communication disorders (though see growing literature base in the area of autism spectrum disorders: Kagohara, et al., 2013). Additionally, there are no current examinations of the use of technology, in this case iPad applications as a tool to increase speech sound accuracy (though see DeThorne, et al., 2009) rather than a facilitator of communication in children (e.g., Cumley & Swanson, 1999; Miller, Light, & Schlosser, 2006 for a review).
Likewise, the value of studying the qualitative experiences of those affected by communication disorders and their surrounding community is also growing in terms of scope and application (McCormack, et al., 2010a; 2010b). Moreover, though our understanding of treatment related outcomes for children with CAS is improved from the publication time of the ASHA (2007) Technical Report on CAS, this study contributes to the still relatively sparse literature base on treatment of severe speech disorders associated with CAS.
This study sought to explore the following research questions:
- What are parents’ perceptions of the effect of iPad use on their children’s speech production skills and overall communication?
- What are SLPs’ perceptions of the effect of iPad use on their client’s speech production skills and overall communication?
- What are the experiences associated with iPad implementation during the first six months of use as reported by parents of children with CAS?
- What are the experiences associated with iPad implementation during the first six months of use as reported by clinicians of children with CAS?
A combined quantitative and qualitative group pretest-posttest research design was employed. Surveys were used for quantitative comparisons. Quantitative data were collected via seven-point Likert-type scale survey items. Qualitative data were collected using open-ended questions regarding parental and clinician experiences.
Eighty total participants were enrolled, including 40 guardians and 40 SLPs of the children (32 boys; 8 girls) that were selected by CASANA as part of their iPads for Kids with Apraxia Pilot Program following extensive applications and review. The children averaged 6.9 years of age (SD=3;0 y.o; range 3;0 – 16;3 y.o.). According to the parents and SLPs, all children had received a primary speech diagnosis of CAS. According to the clinicians, 14 did not have any noted concomitant diagnoses. All 40 parents and 32 of the SLPs completed the post-test survey.
Each participant digitally completed a total of four surveys. The guardians and SLPs also completed two additional surveys (see attached) via www.surveymonkey.com. The first set of surveys was completed prior to receiving the iPad and the second set of similar surveys were completed six-month after the iPad applications are initiated. The post-test survey responses are the focus of this study.
Though there was attrition of eight SLPs for the post-survey, all guardians completed the second survey. Posttest surveys consisted of 30 close-ended and 10 open-ended items for parents and 18 close-ended and 16 open-ended items for SLPs. Though not analyzed for this study, the Focus on the Outcomes of Communication Under Six (FOCUS) Survey (Thomas-Stonell, Oddson, Robertson, & Rosenbaum, 2009) was also completed by the parent and SLP before and after iPad implementation.
The quantitative data were descriptively analyzed and between group comparisons were analyzed using independent t-tests. The qualitative data were analyzed by the first author using a phenomenological approach (e.g., van Manen, 1990). The content from each response was initially coded for thought units, and then reanalyzed to collapse the codes into emergent themes/subthemes. A second author completed reliability on the entire qualitative dataset by examining the transcripts given the list of themes/subthemes to check that the “themes appropriately encompassed the codes” (McCormack, et al., 2010a, p. 383). Agreement between the two coders was high for both parent codes/themes (r=0.75) and SLP codes/themes (r=0.76).
Overwhelmingly, parents (M=6.53; SD=1.06) and SLPs (M=5.66; SD=0.63) indicated that the children were willing to use the iPads. Almost all of the parents (39/40) stated that they would continue to use the iPad , while 27 (84%) of the SLPs stated they would continue use of the iPad in therapy. Though most parents (M=6.18; SD=1.11) stated that the iPad technology was beneficial in facilitating accurate speech production, SLPs were less in agreement (M=5.66; SD=1.07; t = -5.15, p<.0001) (Figure 1). Likewise, a discrepancy of parental report and SLPs (M=6.18; SD=0.96) of iPads benefitting overall communication compared to SLPs accounts and SLPs (M=4.78; SD=1.34) was reflected in the data (t = -4.06, p<.0001). Parents and SLPs both perceived the other (M=6.25; SD=0.83 and M=5.59; SD=0.71, respectively) as being competent with the iPad and its applications.
(Figure 1. Percentage of responses to the question: “iPads/apps are beneficial in facilitating
accurate speech production.” Click image to enlarge)
(Figure 2. Percentage of responses to the question: “iPads/apps are beneficial in facilitating
overall communication.” Click on image to enlarge.)
Four of the SLPs (12.5%) used the iPad very little in therapy due to behavioral issues or concerns of the school regarding the iPad being misplaced or broken. These participants were excluded. Other responses of SLPs and parents were excluded for providing general information rather than answering the question provided or not responding.
Data are presented for the following qualitative items, description of the individual’s initial experiences with the device, perceived benefits of implementing the technology and perceived obstacles associated with iPad implementation. For each item, a table presents the most frequent themes that emerged and example responses are provided.
Description of Initial Experience
22b: “Very positive! He was motivated by it and took real ownership of it.”
13b: “Somewhat overwhelming for me but he seemed very comfortable using it.”
29b: Initially, there was some excitement for the student, but there were also control issues with regard to compliance…”
(Table 1. Number of SLP meaning units that emerged into the five most prevalent themes regarding the initial experience with the iPad.)
Benefits of iPad in Therapy
10b: “Really motivated the child and it was easy for the parent and child to practice at home.”
38b: “It serves so many purposes…therapy mode, communication device, social skill development and reinforcer.”
37b: “The iPad definitely motivated the student to engage in therapy and produce the targeted syllables/words-much more so than using traditional articulation cards.”
(Table 2. Number of SLP meaning units that emerged into the three most prevalent themes regarding the benefits of iPads.)
Obstacles of iPad Use in Therapy
37b: “Only the short attention span and impulsivity of the student.”
30b: “Child saw the iPad as a toy/game so it was difficult to engage him in the therapy apps in the context of therapy sessions.”
26b: “Just initially did not understand certain aspects of the specific program.”
(Table 3. Number of SLP meaning units that emerged into the five most prevalent themes regarding the obstacles for iPad use.)
Initial Experience with iPad
23a: “He took immediate ownership of the iPad which is a huge deal as he would ignore other alternative devices.”
15a: “In the beginning he was overwhelmed with all of the apps out there and wanted every single one.”
3a: “I was shocked at the way my son took it from my arms, sat down and immediately started exploring all parts of it.”
(Table 4. Number of parent meaning units that emerged into the seven most prevalent themes regarding the initial use of the iPad.)
Benefits of iPad at Home
17a: “He is much more willing to practice his speech with the iPad than with traditional therapy methods.”
36a: “The main one is it is portable, we can use it anywhere, so anyone can also help him practice. It isn’t all on me to help him.”
(Table 5. Number of parent meaning units that emerged into the six most prevalent themes regarding benefits of iPad technology.)
Obstacles of iPad Use at Home
6a: “The only obstacle we saw was if we would let him take the iPad to school…”
31a: “The hardest thing was to get him to use the iPad for education and speech. He right away wants to play a game.”
(Table 6. Number of parent meaning units that emerged into the themes associated with obstacles to iPad use at home.)
Overall, parents and therapists reported positive perceptions of and experiences with iPad technology at home and during intervention. Shared themes of excitement, motivation, immediacy, and the ability to practice outside of the therapy environment emerged. Likewise, common challenges were noted in shared themes of impulsivity/behavior, confusion/frustration of adult, desire to play instead of practice, and school/transportation issues. Clinical implications of this study include that iPad technology may be a particularly useful tool for extending speech sound intervention outside of therapy settings. This study suggests that a phenomenological approach is a valuable methodology to employ concurrently with quantitative methods. Thus, this study provided quantitative and qualitative information on the impact and experiences of iPad technology for children with a significant speech sound disorder and provided support for the integration of this technology in treatment as well as a focus of future experimental investigations. Future studies may elucidate the utility of iPads for speech sound practice versus communication device for children with severe speech sound disorders (SSDs) such as CAS. These data, combined with the continued growth of such tablet technology, strongly point to the need for a study of treatment efficacy using applications in the treatment of CAS and other SSDs.
Acknowledgments: We are grateful to CASANA and the families and therapists that participated in this investigation.
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