The difficulties encountered by people with Autism Spectrum Disorders (ASD) in understanding the concept of time are well documented in the currently accepted descriptions of those disorders, in educational practice, and in personal accounts of people with ASD.
Objectives:
This pilot study evaluated the efficacy of the use of the software tool Tic-Tac (available from www.proyectoazahar.org), designed to make time visual, in three adults with autism and learning difficulties. This research focused on applying the tool in waiting situations where the participants exhibited anxiety-related behaviour.
Methods:
The intervention followed an AB design (baseline and intervention) and a partial interval recording procedure was used to code the presence of stereotypes, nervous utterances, wandering or other examples of nervousness during the selected waiting situations. Data were summarised in terms of the percentage of total intervals during which the anxiety-related behaviours were present. Inter-observer agreement was measured with the Pearson quotient at 0.81 between internal and external observers.
Results:
All three participants (William, John and Mary) demonstrated a reduction in their anxiety-related behaviours when Tic-Tac was introduced, although the level of improvement varied depending on the target behaviours. In the case of William there was a reduction from the 78.16% of intervals with stereotypical behaviours in the baseline to 32.21% when using Tic-Tac. In the case of John the percentage fell from 98.74% of intervals to a 67.36%. For participant 2, Mary, stereotypies were not so high at the baseline and no considerable reduction was found (from 40.20% to 37.27%). In terms of wandering and pacing, all three participants showed a reduction during intervention with Tic-Tac: William reduced his wandering intervals from 32.01% to 4.60%; Mary from 32.17% to 0.96%; and John from 83.14% to 16.67%. The average percentage of nervous utterances also fell for all participants: William demonstrated a decrease in this behaviour from 29.56% of intervals to 8.9%; Mary showed a slight reduction from 22.59% to 19.62; and John from 44.53 to 21.25%.Finally, the other examples of nervousness also reduced during intervention with Tic-Tac, decreasing from 80.04% of intervals to 13.82% in William’s case, from 48.86% to 23.65% for Mary and from 86.02% to 50.76% for John. No difference in the results was observed between longer and shorter waiting periods, meaning that the efficacy of the software was similar regardless of duration of use (from 3 to 10 minutes). In order to confirm that the anxiety-related behaviour was caused by the waiting situation and not by other factors, the Communication Notebooks and the Functional Analysis Record were reviewed in detail.
Conclusions:
The results showed that the use of Tic-Tac resulted in lower levels of anxiety-related behaviour in all 3 participants, compared to the baseline, suggesting that this software may be an effective technology for helping people with autism with organization and predictability during waiting periods. The present study demonstrates the positive impact of Tic-Tac with three participants with autism and justifies further work using bigger sample groups and different levels of abilities.