Chapter 4
Rapid Literature Review on AT in Education
Disabilities manifest themselves in many different forms and severities. To discern where, when, how, and for whom AT works we need to understand both the depth of research within specific disability categories as well as the breadth of technologies that support core functioning. Previous research has demonstrated that some disabilities are under-represented in the special education technology research literature (i.e., blindness, specific learning disabilities) while some disabilities like intellectual disabilities and speech, language, and communication disorders have a robust research base.
The essence of assistive technology involves finding appropriate tools that enhance the functional performance of a person with a disability to complete routine tasks that are difficult or impossible. The magnitude of this task is not insignificant as there are over 25,000 assistive technology devices (Abledata, 2020). When a person finds the appropriate AT, they are able to complete tasks that they previously could not complete, did slowly, or did poorly. The right AT augments, bypasses, or compensates for a disability. This chapter will highlight the findings of the rapid literature review relative to what is presently known about AT use in educational settings.
A common characteristic of pediatric health care involves universal vision and hearing screenings to detect issues (a) that may impair learning and development, and (b) that are easily corrected with appropriate interventions. Similarly, school districts often develop outreach activities to families to identify young children who may be eligible for early intervention special education preschool services.
Yet, despite global support advocating for the equitable use of AT, there is no evidence of any policy that promotes universal screening of children who may be able to benefit from AT. This means that pupils and students who use AT do so because someone championed their special needs by navigating the educational, service delivery, and funding systems in order to secure access to appropriate AT devices and services. If educational systems are truly committed to ensuring that students have access to appropriate AT devices and services, significant attention must be focused on policies and procedures associated with universal AT screening to find all children and students who are experiencing unnecessary frustration and failure in core life functions (i.e., communication, independence, learning, mobility) who could benefit from AT.
Little is known about the prevalence of AT users within educational systems because most studies focus only on a small geographic sample (i.e., one school jurisdiction, one special school) that is not necessarily representative of the larger population. Only two large-scale studies focused on AT use in schools were identified in this review but methodological shortcomings limit their value for understanding, at the population level, how many pupils and students use AT (Bausch, Ault, Hasselbring, 2015; Fennema-Jansen et al., 2007; Quinn, et al., 2009). Despite the general advocacy for AT by policymakers, educators, parents, and developers, there is no credible evidence to suggest that everyone who could benefit from AT has access to appropriate AT devices and services. As a result, there is a huge gap between the potential of AT and the reality of learners with special educational needs and disabilities who needlessly struggle on a daily basis to complete routine tasks because they do not have ready access to appropriate AT devices and services.
To address this void, AT policy researcher Diane Golden (1999) created a series of estimates to help school administrators understand the number of potential AT users they might expect to see within different disability groups within their jurisdiction (see Table 10) and to take action if their local numbers were significantly below these expectancy figures.
Table 11 Golden’s AT Expectancy Figures
Golden’s work should be subjected to empirical testing through new AT policy research. First, research is needed to validate the expectancy figures through surveys of AT consumers and experts to determine if indeed the ranges are accurate and reasonable concerning the need for AT. Second, research is needed to determine the prevalence of AT use within each disability category of the school-aged population. Empirically validating the difference between expectancy and prevalence figures will help policymakers, educators, and practitioners establish priorities for AT service delivery systems.
One method for understanding the application of AT is to examine functional domains. The International Classification of Functioning Disability and Health (ICF, WHO, 2001) is a recognised taxonomy for coding factors that reflect a person’s health rather than focusing on one's disease, illness, or disability. The strength of the ICF is that it standardises the vocabulary and classification of human functioning. However, one criticism of the ICF is that it promotes a medical model of disability and therefore is insufficiently sensitive for informing the design, delivery, and evaluation of pedagogical interventions focused on learning and development (e.g., cognition, executive functioning, memory, problem solving). A children and youth version of the ICF (ICF-CY) was released in 2007. In the current study, 26 documents made reference to the ICF. However, researchers have noted fundamental limitations of the ICF model for measuring AT interventions and outcomes (Smith, et al., n.d.).
For the purpose of this study, seven domains were used to code the application of AT found in the rapid literature review: access, behavioral/social, communication, employment, independence, learning/cognition, and mobility. Table 11 summarises the number of found documents within each of the domains. Low numbers in the area of behavioral/social are not surprising given the limited work in this area. Similarly, the low numbers found in employment and mobility were expected as an artifact of the inclusion/exclusion criteria.
Table 11 Number of Documents by Domain |
||
|---|---|---|
| Domain | Number of Found Documents | Percentage fof the Total Corpus |
| access | 396 |
29.3% |
| behavioral/social | 9 |
0.0% |
| communication | 250 |
18.5% |
| employment | 12 |
0.1% |
| independence | 97 |
7.2% |
| learning/cognition | 544 |
40.4% |
| mobility | 40 |
3.0% |
| Total (exceeds 968 articles) | 1,348 |
99.4% |
Whereas the impact of a disability can be manifest in many ways for any given individual, there are general domains impacted within a disability category. Table 12 summarises the relevance of the six domains for each disability category. Readers interested in a specific disability category are encouraged to focus on a particular row to understand the relevant applications of AT. Readers interested in a specific domain of AT are encouraged to explore the table columns to understand the various groups that may benefit.
Table 12 Relevant Domains of Potential AT Application by Disability |
||||||
|---|---|---|---|---|---|---|
| Disability | Domains | |||||
access |
behavior/social |
communication |
independence |
learning |
mobility |
|
| autism spectrum disorder | • |
• |
• |
• |
• |
|
| deafness | • |
• |
• |
• |
• |
|
| deaf-blindness | • |
• |
• |
• |
• |
|
| emotional and behavioral disorders | • |
• |
||||
| hearing impairment | • |
• |
• |
|||
| intellectual disabilities | • |
• |
• |
• |
• |
• |
| physical disabilities | • |
• |
• |
• |
||
| specific learning disabilities | • |
• |
• |
|||
| speech language or communication | • |
• |
• |
• |
• |
• |
| traumatic brain injury | • |
• |
• |
• |
• |
|
| visual impairments | • |
• |
• |
• |
• |
|
Readers interested in detailed listings of types of AT by domain and disability are encouraged to consult the online technical report (http://www.knowledge-by-design.com/ukat/).
Autism Spectrum Disorder (ASD) is a developmental disability that affects an individual’s ability to communicate and engage in social interaction. For reasons unknown, the incidence of autism is increasing and is estimated to affect 1 in 54 children. 31% of children with autism also have an intellectual disability (i.e., IQ < 70). Access, behavior/social, communication, independence, and learning, are relevant domains for assistive technology applications. Relevant types of AT for this population include picture-supported text, visual schedules, social skills training, video modeling and prompting, communication boards, and augmentative and alternative communication (AAC). In this review, 77 documents were identified pertaining to AT use by pupils and students with autism and the evidence levels were as follows: 42 demonstrates a rationale, 28 emerging, and 11 moderate-strong.
The comorbid impact of blindness and deafness makes this one of the most isolating and challenging disabilities. Deaf-blindness is a low incidence disability impacting less than 1% of the population. Access, communication, learning, mobility, and independence are critical domains for assistive technology applications. Relevant types of AT for this population include braille, sign language, tactile graphics, wayfinding, mobile technologies, accessible computer workstations, and alternative access devices. In this review, 10 documents were identified pertaining to AT use by pupils and students with deaf-blindness and the evidence levels were as follows: 5 demonstrates a rationale, and 5 emerging. Additional research and development in this area is sorely needed.
Hearing loss is a sensory disability that impacts an individual’s ability to process oral information. Hearing impairments are classified as slight, mild, moderate, severe, or profound and generally affect everyone as a function of aging. Access, independence, and learning, are relevant domains for assistive technology applications. Relevant types of AT for this population include assistive listening devices, personal amplification systems, hearing aids, speech to text, signaling devices, and sign language. Cochlear implants are also a potential medical technology intervention but was considered out of scope for this review. In this review, 27 documents were identified pertaining to AT use by pupils and students with hearing impairments and the evidence levels were as follows:11 demonstrates a rationale, and 16 emerging.
Pupils and students with emotional/behavioral challenges may exhibit aggression towards others, refuse to co-operate, distractibility and impulsiveness, impaired social interactions, and other mental heath issues such as anxiety, low self-esteem, negative self-concept, or withdrawal. Behavior/social and learning are relevant domains for assistive technology applications for this population. Relevant types of AT for this population include video modeling and prompting, social skills training, self-monitoring data systems, and augmentative and virtual reality. In this review, 9 documents were identified pertaining to AT use by pupils and students with emotional/behavioral challenges and the evidence levels were as follows: 6 demonstrates a rationale, and 3 emerging.
Intellectual disabilities (ID), historically referred to as mental retardation, are a developmental disability that can affect an individual’s intelligence and adaptive behavior and may be classified as mild, moderate, severe, or profound. Intellectual disabilities may be concurrent with other impairments that impact communication or mobility. Access, behavior/social, communication, independence, learning, and mobility are all relevant domains for assistive technology applications. Relevant types of AT for this population include picture-supported text, visual schedules, social skills training, video modeling and prompting, communication boards, and augmentative and alternative communication (AAC), audio books, alternative access, wearable AT, wayfinding, and more. In this review, 71 documents were identified pertaining to AT use by pupils and students with ID and the evidence levels were as follows: 27 demonstrates a rationale, 40 emerging, and 4 moderate-strong.
Physical disabilities, also known as orthopedic impairments, are those that affect an individual’s motor abilities. Examples include cerebral palsy, spinal cord injury, multiple sclerosis, spina bifida, or amputation. These conditions can exist in isolation or comorbid with other disabilities. Access, independence, learning, and mobility are relevant domains for assistive technology applications. Relevant types of AT for this population include alternative methods for accessing the computer keyboard and mouse such as switches and eye-gaze, speech to text, wheelchairs, wearable AT, and writing aids. In this review, 85 documents were identified pertaining to AT use by pupils and students with physical disabilities and the evidence levels were as follows: 37 demonstrates a rationale, 46 emerging, and 2 moderate-strong.
Specific learning disabilities (SLD) are high incidence disabilities that can affect an individual’s ability to read, write, and/or calculate. In the UK, it is estimated that 1.5 million people have a learning disability (Foundation for People with Learning Disabilities, 2020). However, one problem associated with obtaining special educational services and AT for this population is that SLD are considered hidden disabilities. That is, they are not readily discernable. Access, independence, and learning are relevant domains for assistive technology applications. Relevant types of AT for this population include audio books, text to speech, speech to text, talking calculators, text simplification, spelling and grammar checkers, graphic organizers, writing aids, and more. In this review, 81 documents were identified pertaining to AT use by pupils and students with SLD and the evidence levels were as follows: 45 demonstrates a rationale, 33 emerging, and 3 moderate-strong.
The area of speech, language, and communication needs is the most studied area of assistive technology. These types of impairments may affect one or more aspects of communication, such as production of speech sounds, stammering, voice problems, making sense of language, problems using language, or difficulty interacting with others. The prevalence of these issues is considered a high incidence disability. Access, behavioral/social, communication, independence, and learning, are relevant domains for assistive technology applications. Relevant types of AT for this population include picture-supported text, communication boards, augmentative and alternative communication (AAC), instructional software/apps, mobile technologies, and wearable AT. In this review, 125 documents were identified pertaining to AT use by pupils and students with speech, language, and communication needs and the evidence levels were as follows: 72 demonstrates a rationale, 45 emerging, and 8 moderate-strong.
The Need for Technology
The silence of speechlessness is never golden. – Bob Williams, AAC user
A traumatic brain injury (TMI) could be congenital or acquired. Depending on the area of the brain affected it may impact an individual’s communication, mobility, and/or cognition. Access, communication, independence, learning and mobility are relevant domains for assistive technology applications. Relevant types of AT for this population include alternative methods for accessing the computer keyboard and mouse, memory aids, speech to text, audio books, computational tools, and writing aids. In this review, 17 documents were identified pertaining to AT use by pupils and students with TMI and the evidence levels were as follows: 7 demonstrates a rationale, 7 emerging, and 4 moderate-strong.
Visual impairments are a sensory disability that affects an individual’s ability to perceive information and may be classified as mild, moderate, severe, or blind. Whereas everyone loses visual acuity as they age, most mild visual impairments are remedied through the prescription of eyeglasses. Access, communication, independence, learning and mobility, are relevant domains for assistive technology applications. Relevant types of AT for this population include magnification, screen readers, text to speech, tactile graphics, wayfinding, mobile technologies, accessible computer workstations, and alternative access devices. In this review, 93 documents were identified pertaining to AT use by pupils and students with visual impairments and the evidence levels were as follows: 40 demonstrates a rationale, 52 emerging, and 1 strong (i.e. Cochrane Review).
To-date, little is known about differences in assistive technology use across grade levels. To answer this research question, the documents were coded by the level of the AT users targeted for the intervention. Excluded from the following summary are studies that included multiple levels and documents that spoke to pupils and students at all educational levels. The results suggest a slight increase in AT as pupils and students become older (see Table 13). However, the findings are difficult to interpret for two reasons. First, there are no baseline population studies to inform our understanding of the prevalence of AT users across the levels of the educational system, Second, there is no systemic way to assess the bias against providing AT interventions because of the myth that AT will undermine motivation to learn how to perform the target behavior (Murphy, 2010; Redford, 2019).
Table 13 AT Use by Grade Level
early learning
(ages 2-6 or pre-K/ K)elementary
(ages 7-11 or grades 1-6)middle/secondary
(ages 12-17 or grades 7-12)further education
(ages 18+ or grade 13 and beyond)Total
An early observer of the special education technology knowledge base, Hannaford (1993) offered the following cautionary tale:
Much of what is presented as being known about the use of computers with exceptional persons is actually what is believed, felt, or hoped. While there is an increasing amount of research and evaluation support associated with various uses of technology, there is still relatively little empirical support for many statements found in the popular literature (p. 12).
Twenty-seven years later we have (a) far more knowledge about AT devices and services, and (b) evidence about how specific forms of assistive technologies improve outcomes for specific types of students with exceptional needs and disabilities. Yet, there is much more to be learned. As Hattie (2009) argues, the research evidence base, while not definitive in all cases, offers significant guidance for improving educational practice that has yet to be implemented at scale.
As this chapter has demonstrated, AT has important applications for all individuals who struggle with routine tasks. As a result, there is an urgent need to provide professionals with guidance about who might immediately benefit from assistive technology and what could be achieved, given the right conditions. A topic we turn our attention to in the next chapter.
AbleData. (2020). AbleData database. Retrieved from https://abledata.acl.gov/
Bausch, M. E., Ault, M. J., & Hasselbring, T. S. (2015). Assistive technology in schools: Lessons learned from the National Assistive Technology Research Institute. In D.L. Edyburn, (Ed.), Advances in special education technology - Volume 1: Efficacy of assistive technology interventions, (pp. 13-50). Bingley, United Kingdom: Emerald Group Publishing.
Fennema-Jansen, S., Edyburn, D. L., Smith, R. O., Wilson, S., & Binion, M. (2007). Developing a statewide system for providing and assessing outcomes of assistive technology. Journal of Special Education Technology, 22(1), 37-52.
Foundation for People with Learning Disabilities. (2020). Learning disability statistics. Retrieved from https://www.mentalhealth.org.uk/learning-disabilities/help-information/learning-disability-statistics-
Golden, D. (1999). Assistive technology policy and practice. What is the right think to do? What is the reasonable thing to do? What is required and must be done? Special Education Technology Practice, 1(1), 12-14.
Hannaford, A.E. 1993). Computers and exceptional individuals. In J.D. Lindsey (Ed.), Computers and exceptional individuals (pp. 3-26). Austin, TX: Pro-Ed.
Hattie, J. A. (2009). Visible learning: A synthesis of over 800 meta-analyses relating to achievement. New York, NY: Routledge.
International Classification of Functioning, Disability and Health: Children and Youth Version: ICF-CY. https://apps.who.int/iris/handle/10665/43737
Murphy, P. (2010). Common AAC myths-sorting reality from untruth. Closing the Gap, 29(1), 12-14.
Quinn, B.S., Behrmann, M., Mastropieri, M, Bausch, M.E., Ault, J. & Chung, Y. (2009). Who is using assistive technology in schools? Journal of Special Education Technology, 24(1), 1-13.
Redford, K. (2019). Assistive technology: Promises fulfilled: From a teacher’s perspective, assistive technology delivers on its potential to transform learning experiences for students with—and without—learning disabilities. Educational Leadership, 76(5), 70-74.
Smith, R.O., Jansen, C., Seitz, J., & Rust, K.L. (n.d.). ATOMS project technical report: The ICF in the context of assistive technology (AT) interventions and outcomes. Retrieved from http://www.r2d2.uwm.edu/atoms/archive/icf.html
World Health Organization. (2001). International Classification of Functioning, Disability and Health. Geneva, Switzerland: Author. Retrieved from https://www.who.int/classifications/icf/en/
Williams, B. (2000). More than an exception to the rule. In M. Fried-Oken & H. Bersani (Eds.), Speaking up and spelling it out (pp. 245–254). Baltimore, MD: Paul H. Brookes.