A Smartphone Application Designed for Teaching Emergency Safety Skills to Children with Autism Spectrum Disorders

Background: Safety in emergency situations is a major concern for parents of children with Autism Spectrum Disorders (ASD). Many children with ASD demonstrate a lack of safety awareness and may be more at risk of injury than typically developing children. Training children to recognize emergencies, dial 911 and communicate to a dispatcher can save lives.

Personal mobile smartphones are rapidly replacing landline phone use and children are reported to be the largest new user group of mobile technology. However, due to the complexity of mobile smartphone devices, compared to landline phones, children may not know how to access the emergency call function, bypass a passcode, access the phone keypad, and/or dial 911 on a mobile device. Further, 911 dispatchers are often unable to verify a location from a mobile phone call and therefore require a caller’s report of their address and/or location, name, and emergency.

Applied Behavior Analysis (ABA) has been shown to be an effective way to teach children with ASD new target skills. The Behavior Skills Training (BST) model (i.e., instruction, modeling, rehearsal and feedback) is an effective way to teach emergency skills. Given the unique needs of children with ASD, and the progression toward widespread use of mobile technology, an emergency skills training program for mobile phones using ABA principles would be a novel and effective way to prepare children with ASD for emergencies. Traditional emergency education programs do not incorporate ABA techniques or address the specific  needs of children with ASD.  

Objectives:   The objective of this study was to design a smartphone mobile training application (app) using ABA principles and simulated practice to teach children with ASD to recognize an emergency and to respond to the emergency by calling 911 on a mobile phone to seek help.

Methods:  Using a sociotechnical approach an inter-disciplinary team of experts from developmental pediatric medicine, behaviour therapy, simulation, biomedical engineering, and mobile app design developed a smartphone app that utilizes the principles of ABA and simulation training techniques, including video modelling, simulated practice (rehearsal), prompting strategies and fading of promtps (for errorless learning opportunities) and  feedback (via positive reinforcement). 

Results:  The app includes a video model, simulated training to recognize emergency situations, and teaching how to dial 911. The app includes both verbal and visual prompts which gradually fade when mastery  is achieved. Feedback is given through gamification, with points for success. The advanced levels also provide practice responding to a simulated 911 dispatcher with voice recognition capabilities, including identifying type of emergency, name, location and description of emeregency event. Accuracy (percentage of steps correct) , frequency of use and level of achievement are collected. 

Conclusions:  Using ABA principles, we developed a fully operational prototype of a smartphone app designed to teach children with ASD to recognize emergencies, to respond to the emergency by dialing 911 and to communicate with a 911 dispatcher on a mobile phone. Studies are planned to evaluate effectiveness and utility of the app for emergency skills training in children with ASD.