Click-East: Using Data Collected within a Therapeutic Ipad App to Elucidate Results of a Randomised Controlled Trial

Background: Young children with diagnoses of ‘core’ autism regularly pay little attention to other people and often struggle to follow social cues. On the other hand, children with autism often have good technological skills and a preference for using technology in leisure and education.  We also know that early intervention is crucial to have the maximum beneficial effect on outcome. These three issues come together in the application of novel technologies to social difficulties of very young children.

Objectives:   The Click-East research project designed and then evaluated an iPad app to teach the fundamentals of social attention to pre-schoolers with autism.  In this report we explore how data collected by the app can elucidate the mixed results of an randomised controlled trial.

Methods: The app was developed using a multi-faceted participatory design, expert consultation and pilot testing process with children with ASD, parents, teachers, and other professionals. The completed app was evaluated in a rigorous randomised controlled trial (n=54) with intervention and waitlist control groups, membership stratified by autism severity using the Autism Diagnostic Observation Schedule.  The primary outcome was based on a rating of child social and communication behaviours during parent-child play at 6 month follow-up. Other measures included the MacArthur Communicative Development Inventory (vocabulary and gesture), and the Communication and Symbolic Behaviour Scales Caregiver Questionnaire.

Results:   There were no main effects of intervention at a group level on the primary outcome measure nor on other outcome measures of vocabulary, gesture, and communication and social behaviour.  This was the case both immediately after intervention and at follow-up. However there was statistically-defined reliable individual change in 5/27 of the intervention group compared to 1/27 of the waitlist control group. An exploration of the demographic characteristics and baseline scores of intervention responders and non-responders revealed no systematic group differences. However, one strength of this technology-based intervention is the opportunity to use detailed data collected within the app to explore the patterns of game play across individuals.

Conclusions:   We will consider our findings in the light of pragmatic approaches to education and support.  The RCT evidence suggests that the intervention is at worst benign and at best may benefit a sub-set of children in social attention.  The app has now been downloaded by 85,000 users meaning that the impact of even a small and minority beneficial effect could already have reached thousands. We also consider spin-off benefits for families (e.g. peer respect, increased on-task behaviour) and review the future of technology-based early intervention for autism.