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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 52  |  Issue : 1  |  Page : 8-11

AVAZ application (trial version) - A voice for the nonverbal children with autism spectrum disorder: A pilot study


Department of Occupational Therapy, JKKMMRF College of OT, Namakkal, Tamil Nadu, India

Date of Submission07-Feb-2020
Date of Decision25-Feb-2020
Date of Acceptance28-Feb-2020
Date of Web Publication30-Mar-2020

Correspondence Address:
Prof. Jay Vijay Sonawane
JKKMMRF College of OT, Ethirmedu, Komarapalayam, Namakkal - 638 183, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_2_20

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  Abstract 


Background: Children with autism spectrum disorder (ASD) who are nonverbal lack communication skills. These children with ASD are unable to express their needs verbally even if they want to. The introduction of indigenous augmentative and alternative communication system (AAC) can be helpful in improving the social interaction. By using AAC, these children with ASD can easily communicate their needs with parents, teachers, or caregivers. Objective: The objective of this study is to evaluate the importance and need of AVAZ application in special school-going children with ASD. Study Design: A pilot study for short term on small sample was conducted. Methods: A sample of eight special school-going children with ASD was selected. Each child had downloaded AVAZ application trial version on their smartphone from the Google Play Store. The number of sentences formed by the children over a period of 21 days was analyzed. The responses were recorded in the AVAZ application. Results: Percentage improvement was noted in forming relevant sentences through the application of each child from the 1st to 21st session ranging from 28.5% to 40%; five children showed the improvement but three children did not form any sentence neither relevant nor nonrelevant. Conclusion: Our study showed that the use of AVAZ application can be helpful in improving social interaction and can be utilized as a supporting tool for functional communication with others and for the better learning process in children with ASD.

Keywords: Augmentative and Alternative Communication System, Autism Spectrum Disorder, Communication, Occupational Therapy, Social Interaction


How to cite this article:
Sonawane JV, Varshneya H. AVAZ application (trial version) - A voice for the nonverbal children with autism spectrum disorder: A pilot study. Indian J Occup Ther 2020;52:8-11

How to cite this URL:
Sonawane JV, Varshneya H. AVAZ application (trial version) - A voice for the nonverbal children with autism spectrum disorder: A pilot study. Indian J Occup Ther [serial online] 2020 [cited 2020 May 25];52:8-11. Available from: http://www.ijotonweb.org/text.asp?2020/52/1/8/281635




  Introduction Top


Autism spectrum disorder (ASD) is a neural developmental disorder that mainly affects communication and behavior. The essential features are impairment of social interaction, communication and imagination, restricted interests, and repetitive behavior.

Communication deficits affecting both expressive and receptive language are one of the hallmark features of autism. About 50% autism children fail to develop useful, spoken language. Gestural communication, including the ability to learn sign language, may also be affected. Those children who do learn to talk tend to use language in rote, stereotyped patterns rather than using functional communication.[1]

Often, they repeat phrases or songs in a repetitive, sing-song fashion. Speech patterns may be entirely normal when the child is echoing something he or she has just heard, but highly deviant when the child is attempting to speak with communicative intent.[1]

Augmentative and Alternative Communication (AAC) system offers multilingual support for individuals with limited functional speech. There has been much discussion in the AAC community about best practices in AAC system design and intervention strategies, but limited resources exist to help us provide robust, flexible systems for users who speak language other than mother tongue. Services must be provided that take into consideration the unique needs of diverse users of AAC and help them to reach their full communication potential. It is possible to allow people with speech and language disorders to interact with others and eliminate the relational barrier.[2]

AVAZ application is an augmentative and alternative communication tool. It is an electronic version of picture exchange, cards used primarily for children with ASD, cerebral palsy, Down's syndrome, and other nonverbal disabilities. It contains most frequent activities of daily living. It tracks their communication development and helps as to visualize it through easy to understand the graphs and charts. It is a bridge to their literacy because reading and writing are the keys to inclusion in schools.

Thus, the present study was designed to assess the AVAZ application as a mode of communication by special school-going children with ASD, in order to cater the demand of communicating with others. The aim of the study was to introduce the AVAZ application as an alternative nonverbal communication device for special school-going children with ASD. The objective of the study was to evaluate the importance and need of AVAZ application in special school-going children with ASD.


  Methods Top


A pilot study on a small sample for a short term of 21 days was conducted as a precursor to a long term large sample study design. The present study was carried out in Yatindra Academy School for Special Children, Salem, Tamil Nadu. An official permission was sought from Yatindra Academy School to recruit children in our study through our institution through proper channel, and a formal written approval was gained from the AVAZ application developer. This study was conducted adhering to the principles of “Declaration of Helsinki”. A convenient sample of eight children with ASD who were nonverbal aged 11-14 years attending special school for more than 1 year was included in the study. Children with ASD those who have initiated communication and children having any developmental disability were excluded from the study. Each child underwent 21 days of therapy sessions and followed by the assessment of the sentences made at the end of each session.

Materials required for our study were android mobile phone (5” screen or above) or apple iPad installed with the AVAZ application downloaded from iStore or Google Play store. AVAZ application was invented and developed in India, collaborating with 25 schools along with 500 children, aiding people with speech difficulties to communicate in the most effective and efficient manner. It has a powerful keyboard, uses picture symbols, and high-quality voice synthesis, to help users communicate and also develop language skills. AVAZ's user interface is designed to make speech therapy more effective, develop a user language, and improve their intent to communicate. AVAZ is available in six regional languages such as Hindi, Tamil, Telugu, Malayalam, Marathi, and Kannada.

The key features of the AVAZ application [Figure 1] are easy backup and restore using dropbox, inbuilt training module for the parents, seamless integrated text and keyboard mode, print AVAZ vocabulary as a low-tech support, instant Bing search and download of copyright-free images, right from within the application, reinforcement of image using zoom, color-coded vocabulary, ready-to-use graded vocabulary (three levels), word prediction with both pictures and text, instant search to explore vocabulary easily, consistent motor planning, grammar-morphology options of a word, for example, verb, noun and adjective, settings wizard-personalize AVAZ, based on the user's unique needs, add/edit multiple messages or categories at once, no active internet connection required, grid size control, prompt support on E-mail and chat, introductory video tutorial, application usage analytics, and easy-to-access help screen on all pages.
Figure 1: AVAZ Application

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Procedure

Written informed consent was obtained from the special school teachers and parents. Trial package of the application was installed on android mobile phone of eight children and one for occupational therapist and one for school principal and as per the needs of the child, the settings were arranged. Since the trial version was free for 15 days period, it was too short for carrying out our study and the technical support team of AVAZ application extended further use for 7 more days.

Each child underwent intervention for 21 days, each session per day was of 15-25 min. The children were carefully placed in front of the mobile phone in a controlled environment. Initially, 15 intervention sessions were given with additional 7 days of practice [Table 1].
Table 1: Therapy for the 1st 15 Sessions

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Data Analysis

The data were collected in terms of the relevant and nonrelevant sentences formed by the children through AVAZ application in the duration of 21 days. Percentage improvement in forming sentences in the category of relevant and nonrelevant with total sentences formed during 21 sessions was calculated, at two different points of interval; one at the end of the 1st session and other at the end of the 2nd to 21st session.


  Results Top


All eight children attended the therapy sessions without any dropouts. The sample constituted of only males (n = 8), with a mean age of 12.8 years.

Percentage improvement was noted in forming relevant sentences through the application of each child from the 1st to 21st session ranging from 28.5% to 40% [Table 2]; five children showed improvement, but three children did not form any sentence neither relevant nor nonrelevant. Although those three children were fascinated by the pictorial representation of the items, they were found distracted by the voice control option.
Table 2: Total Sentences, Relevant, and Nonrelevant Sentences Formed by Each Child During the Therapy Session

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  Discussion Top


Augmentative and alternative communication has been proving to be a boon for children with ASD worldwide. Due to limited availability of the literature on the use of AAC, many countries such as the UK, Portugal, the Netherlands, the USA, and the Middle East countries have put different AAC programs to test.[3],[4],[5]

The introduction of AVAZ application in special school-going children with ASD proved to show improvement in expressing through forming relevant sentences. The advantage of using AVAZ application is it's availability in different languages. The multi-linguistic AVAZ application proved to be very beneficial as there were five children with Tamil mother tongue, two with Kannada, and one with Hindi. Moreover, the application was also altered with the pictorial diagrams of regional recipes making it easy for the children to identify and express. The regional language option proved to be distinguishing factor as AVAZ is available in six regional languages such as Hindi, Tamil, Telugu, Malayalam, and Marathi and Kannada, other applications work only on the default language as English and some on Arabic. [2,5-7]

AVAZ application is used in various countries of the world such as India, USA, Denmark, Italy, and Australia. Another advantage of AVAZ application is the availability on android as well as iPhone Operating System. There are many applications with similar interface, but AVAZ application has the provision of low-cost minimal data usage over the other tested apps such as the Photo-Talk, Techno-Talk, Mobile Technology Program, Picaa, My Choice Board, and Go-Talk-Now.[6]

Due to less further scope of initiation of verbal communication in children with ASD age group of 11-14 years was selected, apart from this, children belonging to this age group express their interest in different fruits and recipes. In addition, these children had tendencies to frequently use the toilet without the permission during the school hours. The frequency for using toilet by children with ASD were observed, and it was checked further whether they have expressed this need through the AVAZ application.

The memory option of the application provided the opportunity to retrieve the previous attempts of identified objects and formulated sentences, in the storage, hence, helping the occupational therapist and special educators to review the sentences formed by each child, thus making it user-friendly for the occupational therapist and the special educators.

The AVAZ application recorded and stored all sentences and various pictorial items identified by the children, thus a clinical judgment can be made about the each child interest. The voice interface of the application is also an attractive factor to grab the attention of the children. AVAZ embedded with several high-quality voices from IVONA, even recording of own voice is possible. AVAZ takes the hassle out of “programming” a typical AAC aid and keeps the focus on interacting with the user.

Although only five children made relevant and meaningful sentences, the remaining three children did not make even a single relevant or nonrelevant sentence, but during the sessions identified multiple pictorial diagrams by tapping over the phone.

Previous documented researches have mentioned the use of iPad alone for the applications to function, whereas AVAZ can be easily installed on any android smartphone (5” or more) or iPad. [2, 7, 8, 9] The child displayed greater confidence and showed increased communication intention. The concepts of easily capturing and managing photographs using the mobile device have merits for children with ASD. However, the use of this application could not be generalized as the device was employed only during the therapy sessions. If provided with more time and more sessions, in future, this application can be proved as a boon for good performing children and their family members, as this application can be modified according to our native vocabulary and daily need items. One of the negative was children can use the mobile to harm themselves or others by throwing the phone. Furthermore, the use of smartphone at this age can be controversial.

Limitations of our study was that it was conducted only on special school-going children with ASD, with a short duration of intervention, AVAZ application was used only in school, and only relevant and nonrelevant responses were studied.

Future recommendation includes conducting the study in various setup, and follow-up effects of the use of AVAZ application could be studied. Furthermore, customized pictorial depiction (school, home, car, toys, pets, etc.,) can be uploaded on the application and responses can be recorded and studied.


  Conclusion Top


Our study showed that the use of AVAZ application can be helpful in improving social interaction and can be utilized as a supporting tool for functional communication with others and for better learning process in children with ASD. A long term study on a larger sample with more and better assessment and treatment strategies is in process following this pilot study, the results of which will be published on completion of the study.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
  References Top

1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR®. American Psychiatric Association; 2000.  Back to cited text no. 1
    
2.
Gevarter C, O'Reilly MF, Rojeski L, Sammarco N, Sigafoos J, Lancioni GE, et al. Comparing acquisition of AAC-based mands in three young children with autism spectrum disorder using iPad® applications with different display and design elements. J Autism Dev Disord 2014;44:2464-2474.  Back to cited text no. 2
    
3.
Fernández-Lópeza Á, Rodríguez-Fórtiz MJ. Mobile learning technology based on iOS devices to support students with special education needs students with special education have difficulties to develop cognitive abilities and acquire new knowledge. Comput Educ 2012;61:77-79.  Back to cited text no. 3
    
4.
Boster JB, McCarthy JW. Designing augmentative and alternative communication applications: The results of focus groups with speech-language pathologists and parents of children with autism spectrum disorder. Disabil Rehabil Assist Technol 2018;13:353-365.  Back to cited text no. 4
    
5.
Ganz JB. AAC interventions for individuals with autism spectrum disorders: State of the science and future research directions. Augment Altern Commun 2015;31:203-214.  Back to cited text no. 5
    
6.
Angermeier, K, Schlosser RW, Luiselli J K, Harrington C. Effects of iconicity on requesting with the picture exchange communication system in children with autism spectrum disorder. Res Autism Spectr Disord 2008;2:430-446.  Back to cited text no. 6
    
7.
Al-Wakeel L, Al-Ghanim A. A usability evaluation of arabic mobile applications designed for children with special needs-autism. J. Eng 2015;3:3-5.  Back to cited text no. 7
    
8.
Flores M, Musgrove K, Renner S, Hinton V, Strozier S, Franklin S, et al. A comparison of communication using the Apple iPad and a picture-based system. Augment Altern Commun 2012;28:74-84.  Back to cited text no. 8
    
9.
Achmadi D, Kagohara DM, Vander Meer L, O'Reilly MF, Lancioni GE, Sutherland D. Teaching advanced operation of an iPod-based speech-generating device to two students with autism spectrum disorders. Res Autism Spectr Disord 2012;6:1258-1264.  Back to cited text no. 9
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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