TY - JOUR
AU - Al Mahmud,, Abdullah
AB - Abstract At present, technology is being extensively used among children with autism spectrum disorder (ASD) in affluent countries. However, there is a lack of studies exploring the use of technology for children with ASD in developing countries. This study, therefore, investigates the current role of technology for children with ASD in Sri Lanka where the autism prevalence is 1 in 93 children in the age group of 0–3. This qualitative study utilized semi-structured interviews and focus group sessions with 32 parents and 18 practitioners who work closely with children with ASD. The findings of this study indicate that a wide array of technological applications (n = 37) is used among children with ASD in Sri Lanka at home and therapy settings. This study further identifies different patterns of using technology at home and in therapy settings. For instance, parents mostly use passive learning technologies such as television and YouTube channels on smartphones to educate children with ASD in home settings. On the other hand, practitioners use interactive technologies such as desktop computer programs and tablet applications to develop skills and engage with children with ASD. Though many technological applications are used among Sri Lankan children with ASD, parents and practitioners illustrated that current technological applications need to be further improved and modified to cater for the needs of children with ASD and to make learning more effective. We also found out that having flexible customization can be a powerful tool when designing software applications for children with ASD in Sri Lanka. Finally, we present the implications for designing technologies for children with ASD highlighting the similarities and differences of our findings with those studies conducted in affluent countries. RESEARCH HIGHLIGHTS Digital technology such as TV and desktop computers are widely used among children with ASD in Sri Lanka. Most parents of children with ASD use passive learning technologies (i.e. TV), while practitioners use more interactive technologies such as tablets and computers. The most common use of technology at home is to teach academic skills (i.e. vocabulary and maths), while the most common use of technology at therapy is for sensory integration. Applications supporting Sri Lankan cultural context is one of the popular functionality required by both parents and practitioners of children with ASD. Customization can be a key feature when designing software applications for children with ASD in non-English speaking multilingual countries like Sri Lanka. 1. INTRODUCTION Autism spectrum disorder (ASD) is a pervasive neurodevelopment condition characterized by significant impairments in social communication and social interactions along with stereotype restricted and repetitive behaviours (Balsis et al., 2009). These impairments include limited reciprocal social interactions, dysfunctional communication and language skills, joint attention and lack of functional or pretend play. Prior research shows that some children with ASD might also have impaired cognitive skills such as difficulties in the theory of mind, executive functions (Long et al., 2011) and sensory abnormalities such as attraction for light sources and staring and spinning objects (Posar and Visconti, 2018). There are several types of therapies such as behavioural, speech, educational, psychological and medical therapies including both traditional and technological intervention programs to improve these core deficits of children with ASD. These therapies are individualized to each child and vary depending on their cognitive development level and age (Warren et al., 2011). With the advancement of technology, there have been many digital technology-based autism interventions, which include the use of interactive environments implemented in computers and special input devices (Hayes et al., 2010), virtual environments (Didehbani et al., 2016), robots (Zheng et al., 2016) and tablet games (Murdock et al., 2013). These studies show promising results for the autism communities. Some experimental and explorative studies have demonstrated that technological interventions can improve many core impairments such as social (Mora-Guiard et al., 2016; Winoto and Tang, 2017), communication (Chien et al., 2015) and emotional intelligence (Hopkins et al., 2011) of children with ASD. For instance, Hourcade et al. (2013) found out that collaborative games can be designed to naturally encourage positive social interactions (i.e. verbal initiation and supportive comments) through creative, expressive and collaborative activities. Even though prior research shows that the use of technology can be beneficial for children with ASD (Bailey et al., 2017; Fteiha, 2016), recent reviews on interactive technologies for children with ASD show that most of the technology-based interventions have not been validated beyond proof of concept studies (Boucenna et al., 2014). Hence, it is essential to explore how technological interventions are currently being used in therapy and school settings to understand the practical use of technology among children with ASD. Furthermore, understanding how parents and practitioners use technology and its limitations can help identify design opportunities for future developers. However, only a limited number of studies explore the practical use of technology in children with ASD. As a case in point, Clark et al., (2015) examined the attitudes of parents and professionals towards iPad application use in children with ASD in Australia. This study found that parents are more interested in using iPad applications; however, practitioners were reluctant to use iPads at therapy sessions. This study provides useful insights on complex interactions between anxiety, self-efficacy, attitudes and behaviour towards the use of iPads (Clark et al., 2015). However, data were not collected regarding the types of applications children used or views of the professionals and parents on the purposes of using applications (i.e. to develop skills and for entertainment), which are also vital to assess the role of the technology. Notably, little research on this topic has been contacted in developing countries where resources are limited and have lower rates of computer literacy. More research on this topic among developing countries is warranted to capture nuanced information from different angles (Winter, 2000). Most of the research conducted in developing countries related to autism are limited to designing and evaluating technology-based interventions for children with ASD (Ahmad and Shahid, 2015; Hassan et al., 2011; Sharma et al., 2018). Further, to our knowledge, no study investigates the perspectives of parents and practitioners on the practical use of technology for children with ASD in home and therapy setting in developing countries. Therefore, the main research aims for this study are to investigate (i) the differences and commonalities of parents’ and practitioners’ views and motives on use of technology and (ii) to identify the potential features and design opportunities of software applications for children with ASD in Sri Lanka. This paper contributes to the current body of literature in understanding the use of technology for children with ASD in low-resource countries and potential design opportunities in designing technology for children with ASD in Sri Lanka. Further, we compare these findings with wealthy countries to understand how our findings differ from affluent countries and to what extent these findings apply to both regions. 2. RELATED WORK 2.1. Role of the practitioners and their attitude towards using technology with children In developed countries, special education teachers and therapists used assistive technology to support children with ASD in classroom and therapy settings. Prior studies have found out that practitioners use smart-boards, tablet devices and personal computers when teaching children with ASD (Licona and Loke, 2017; Rising, 2017). For instance, studies conducted in the USA report that use of technology is one of the top five strategies to teach elementary school children with ASD (Hess et al., 2008). Similar to the USA, the use of digital technology is not uncommon in special education classroom for children with ASD in Australia. Studies have also found that one of the most common interactive tools used in the classroom is the iPad (Licona and Loke, 2017). Teachers and therapists use iPad to watch educational programs and to play educational games (`Injini’, `Temple Run’ and `LEGO Juniors Create and Cruise’) that promote fine motor and early literacy skills of children with ASD. In addition to educational activities, iPad has been used in the classroom to engage, reinforce and practise turn-taking and requesting skills of children with ASD (Licona and Loke, 2017). Some studies report that special education teachers use iPad applications to improve handwriting skills of children with ASD. Furthermore, the same study reported that some teachers use music in smartphones to calm down children with ASD when they are distressed (Stokes et al., 2017). Similarly, Dutch practitioners use technology to improve communication, social/interpersonal interactions and relations along with emotional well-being (Huijnen et al., 2016). In addition to skill development, iPad and tablet devices were used as a communication platform for children with ASD using AAC application in classroom and therapy settings (King et al., 2014; Maida, 2015). To understand the practical use of technology among children with ASD, it is important to explore how technological interventions are currently used in therapy and school settings. For instance, some practitioners claim that children with ASD may benefit when using assistive technology in therapy (Attwood, 2003). On the other hand, a few special education teachers reported few concerns when using technology with children with ASD. For instance, teachers reported that a few children preferred reading on printed text compared to reading on the iPad, due to the usability of the iPad. They further explained that it was too easy to change the pages using the iPad and students kept doing it accidentally (Gasparini and Culén, 2012). Therefore, when designing technologies for children with ASD, it is critical to investigate the views of those who work with children with ASD such as special education teachers and therapists, as their years of experience will likely to affect the use of technology among children with ASD (Smith et al., 2000). Although there are several studies that explore how technology is used for children with ASD in affluent countries (Hassan et al., 2011; Stokes et al., 2017), to our knowledge there has been no known literature on the practitioner’s perspective and the practical use of technology in low-resource countries. However, a few studies explore the teacher’s awareness and use of assistive technology for children with special needs. For instances, a survey conducted with 450 Nigerian teachers on awareness and use of assistive technology in teaching with special needs children found out that majority of the teachers (59%) were aware of assistive technology. However, most of the teachers (69%) in this study reported that they are not competent in using assistive technology with children with special needs (Shikden, 2015). Furthermore, this study (Shikden, 2015) highlights that teachers also face many issues in using technology due to lack of training and lack of devices in special needs school settings. Similarly, a study conducted in Pakistan showed that the majority of the special education schools/institutes provide sufficient amount of access to assistive technology for blind students (Saleem and Sajjad, 2016). Though these studies provide useful insights on the awareness of assistive technology in children with special needs, they do not focus on how technology is used among children and future expectations towards technology. 2.2. Role of the parents and their attitude towards using technology with children Parents too have a vital influence on the use of technology among children since parents are the entry point to expose computer technology at home and especially in childhood learning situations. For instance, 93% of the parents in the United States believe it is important that their children have access to computers at home as they believe the use of technology is vital to academic achievements (Ortiz et al., 2011). Therefore, it is expected that the attitude of parents towards technology will have an impact on the use of technology by their children with ASD. However, only a limited number of studies explore the practical use of technology in children with ASD. Clark et al., (2015) explored the attitudes of parents towards iPad application use in children with ASD in Australia. This study found that parents are more interested in using iPad applications with their children with ASD Clark et al., (2015). However, data were not collected regarding the types of applications children used with their parents and the purposes of using applications, which are also required to assess the role of the technology. In addition to the study by Clark et al. (2015), another study investigated the parents’ attitude towards the use of technology and portable devices among children with ASD in Saudi Arabia (Athbah, 2015). This study reports that parents have a positive attitude towards using technology by children with ASD. Further, this study shows that children need to be guided by adults when using technology and portable devices. However, this study too does not address what technological tools are most useful when parents are working with their children, and it does not address how technological interventions can be improved to better suit children with ASD. Therefore, it is important to investigate both issues (i.e. types of technological interventions that are most useful and how those tools can be improved), as it will help parents and practitioners to apply the relevant technologies for their children with ASD. Similar to practitioners, parents of children with ASD use technology with their children with ASD. Studies have found that most Australian children with ASD use iPad to watch videos or movies at home settings (Licona and Loke, 2017). Similarly, studies conducted in Saudi Arabia also show that tablet devices are the most common technology used among children with ASD and they are used to watch videos on YouTube application (Athbah, 2015). Similar behaviour can be seen in children with ASD in the UK, Belgium and Spain. An international survey with parents of children with ASD in the UK, Belgium and Spain shows that 50.75% of preschool children with ASD and 61.25% of the school-aged children with ASD use iPad devices. However, the current practice of technology use at home is mostly limited to playing games and watching YouTube videos, and technology is not used to accomplish therapeutic goals of children with ASD by using autism-specific applications (Laurie et al., 2018). To our knowledge, there are no studies conducted in developing countries that examined the parents’ perspective on the use of technology specifically for children with ASD. However, a few studies examine awareness of assistive technologies for children with developmental disabilities (i.e. cerebral palsy) in developing countries. For instances, Jindal (2017) reports that Indian parents are unaware and reluctant to use assistive technology to enable any other function than walking for children with cerebral palsy. However, to our knowledge, none of the literature focuses on the parents’ perspective on the use of technology and future expectations towards technology for children with ASD in developing countries. 2.3. Autism and use of technology in developing countries Even though there is a positive impact on the use of technology for children with ASD, there are only a few studies on technological interventions for children with ASD in the developing world (Nuria and Begonya, 2014; Sharma et al., 2016). Winter (2000) has highlighted that due to limited research and literature on the latest technology and current educational innovation in developing countries, developing countries are trailing behind developed countries (Winter, 2000). In the recent past, there have been a few pieces of researches that focused on designing technology interventions (such as digital media) to support children with ASD in the developing regions such as Ecuador, Africa, Indonesia, Bangladesh and India (Galán-Mena et al., 2016; Hassan et al., 2011; Mensah and Hayfron-Acquah, 2018; Pradibta and Wijaya, 2017; Sharma et al., 2018; Vellanki et al., 2016). Furthermore, a study conducted in underserved developing countries like Georgia-Sakartvelo showed that inexpensive technology can be used for intercontinental telehealth consultations such as Applied Behaviour Analysis (ABA) therapy (Barkaia et al., 2017). Furthermore, such studies demonstrated that inexpensive technology can be the effective solution for telehealth coaching for underserved communities where autism therapies and service deliveries (i.e. ABA services) are limited or unavailable (Barkaia et al., 2017). Similarly, several HCI researchers have claimed the use of technology-based interventions can be effective for children with ASD in low-resource countries like Bangladesh, both socially and economically (Mohan et al., 2017). Furthermore, researchers have shown that information and communication technology can be used in autism communities in low-resource regions as it can be used to develop lower-cost technologies (such as mobile applications) that are culturally adaptable for both caregivers and children with ASD (Ahmed et al., 2018). Even though there have been preliminary studies that explore different technological interventions for children with ASD in developing countries, to our knowledge, none of the studies focuses on the current practical use of technology for children with ASD in developing countries. However, there is a high demand to explore the use of technology in low-resource countries as ASD occurs all over the world (Elsabbagh et al., 2012). The South Asian region accounts for 20% of the global population. However, in most of the (62.5%) South Asian countries (Pakistan, Nepal, Bhutan, Maldives and Afghanistan), the prevalence of ASD is unknown due to lack of research infrastructure and availability of well-trained and experienced professionals (Hossain et al., 2017; Rahbar et al., 2011). From the three countries (Sri Lanka, Bangladesh and India) that have known autism prevalence, Sri Lanka reports the highest prevalence (1.07% or 1 in 93) (Hossain et al., 2017; Perera, 2008). Although this prevalence rate is further consistent with the western regions, we are not aware of any study that focuses on the role of technology for children with ASD in Sri Lanka. A limited number of studies in India have assessed the use of technology for children with ASD, such as the AAC application TORBY Playpad (Vellanki et al., 2016) and the gesture-based applications Kirana, Balloon and Hope (Sharma et al., 2018). These applications focus on improving communication, motor skills, joint attention and life skills of children with ASD. The work of Sharma et al. (2018) further illustrates how technology acceptance within developing countries like India can be improved by involving different stakeholders (i.e. parents, therapists and special education teachers) in the design process. Though these studies (Sharma et al., 2018; Vellanki et al., 2016) bring insightful guidelines for designing technologies for children with ASD in developing countries, there is no evidence as to what extent technology has been used for children with ASD in their daily life and the impact of using technology for their therapeutic goals. There are several challenges of using technology for children with ASD in developing countries like Sri Lanka such as limited access to resources, equipment and knowledge may hinder parents and practitioners using technology at home and school setting (Ahmad, 2015). For instances, prior studies have found that in Sri Lanka, several vital factors hinder families from seeking support for their child with ASD including limited access to services, low income, lack of knowledge, cultural and religious beliefs and limited services in their native languages (Eng and Foster, 2018). In the face of the challenges mentioned above and lack of research evidence on using technology for Sri Lankan children with ASD, we assume that the use of technology among parents and practitioners of children with ASD in Sri Lanka would be minimal. We also expect that the existing software applications would not meet the needs of Sri Lankan parents and practitioners. In the current study, we explore through semi-structured interviews and focus groups with Sri Lankan parents and practitioners of children with ASD on the use of technology and its limitations among children with ASD in home and therapy settings. 3. METHODS 3.1. Participants A total of 50 participants took part in this study across 38 semi-structured interviews and 3 focus group sessions. There were 3 types of participants, namely (i) paediatric psychiatrists (N = 3) who are specialized in diagnosing autism, (ii) practitioners (N = 15) who work closely with children with ASD and (iii) parents (N = 32) who have children diagnosed with ASD. The following inclusion criteria were used when recruiting different categories of participants: Paediatric psychiatrists—minimum 5 years of experience in diagnosing children with ASD in Sri Lanka and employed by the government hospitals and hold Bachelor of Medicine, Bachelor of Surgery (M.B.B.S) with a doctor of medicine (MD) in psychiatry. Practitioners—minimum 4 years of experience in one-to-one teaching or providing therapy for children with ASD under institutes in Sri Lanka and have experience using technology with children with ASD and is a certified child psychologist. Parents—parents who have at least one child with autism and their child’s diagnosis should have been made not less than 6 months before interview/focus group sessions. Paediatric psychiatrists were recruited via email invitations, whereas both practitioners and parents were recruited via the Sumaga Autism Centre in Kelaniya and the Department of Disability Studies in Ragama, Sri Lanka. Practitioners were briefed face to face and invited directly at therapy centres and parents were invited via distributing leaflets within the therapy centre premises. When selecting parents for this study, we made sure that parents from different ethnicities (Sinhalese, Tamil and Muslim) and geographical regions of Sri Lanka (i.e. Colombo, Kandy and Jaffna) were recruited to increase the degree of diversity among the participants. Since most autism intervention centres were located in Colombo district in Sri Lanka, a high percentage of practitioners were recruited from Colombo district. We further gathered information from parents on their child’s severity of autism via the official clinical diagnosis given to the parents by the paediatric psychiatrists. Participants’ characteristics are shown in Tables 1 and 2. TABLE 1. Demographic characteristics of parents who have children with ASD. Number of parents 32 Parent’s age range 27–37 (M: 35) Children’s age range 2.5–13.1 (M: 5.6) Parent’s gender ratio (female: male) 3:1 Children’s gender ratio (female: male) 5:27 Children’s severity Severe, 2; Moderate, 12; Mild, 18 Ethnicity Sinhalese, 28; Tamil, 2; Muslim, 2 Geographical region Colombo district, 23; Kandy district, 6; Kegalle district, 2; Jaffna district, 1 The average amount of money spent on autism therapy (annually) reported by parents 2500 USD–3600 USD Number of parents 32 Parent’s age range 27–37 (M: 35) Children’s age range 2.5–13.1 (M: 5.6) Parent’s gender ratio (female: male) 3:1 Children’s gender ratio (female: male) 5:27 Children’s severity Severe, 2; Moderate, 12; Mild, 18 Ethnicity Sinhalese, 28; Tamil, 2; Muslim, 2 Geographical region Colombo district, 23; Kandy district, 6; Kegalle district, 2; Jaffna district, 1 The average amount of money spent on autism therapy (annually) reported by parents 2500 USD–3600 USD Open in new tab TABLE 1. Demographic characteristics of parents who have children with ASD. Number of parents 32 Parent’s age range 27–37 (M: 35) Children’s age range 2.5–13.1 (M: 5.6) Parent’s gender ratio (female: male) 3:1 Children’s gender ratio (female: male) 5:27 Children’s severity Severe, 2; Moderate, 12; Mild, 18 Ethnicity Sinhalese, 28; Tamil, 2; Muslim, 2 Geographical region Colombo district, 23; Kandy district, 6; Kegalle district, 2; Jaffna district, 1 The average amount of money spent on autism therapy (annually) reported by parents 2500 USD–3600 USD Number of parents 32 Parent’s age range 27–37 (M: 35) Children’s age range 2.5–13.1 (M: 5.6) Parent’s gender ratio (female: male) 3:1 Children’s gender ratio (female: male) 5:27 Children’s severity Severe, 2; Moderate, 12; Mild, 18 Ethnicity Sinhalese, 28; Tamil, 2; Muslim, 2 Geographical region Colombo district, 23; Kandy district, 6; Kegalle district, 2; Jaffna district, 1 The average amount of money spent on autism therapy (annually) reported by parents 2500 USD–3600 USD Open in new tab TABLE 2. Practitioners’ characteristics. Participants Number of participants Years of experience with ASD children in average Children's age range (worked with) Special education teachers 10 5 2–15 Therapists (3, speech; ABAa; educational) 5 6.5 2–17 Paediatric psychiatrists 3 10 1–13 Participants Number of participants Years of experience with ASD children in average Children's age range (worked with) Special education teachers 10 5 2–15 Therapists (3, speech; ABAa; educational) 5 6.5 2–17 Paediatric psychiatrists 3 10 1–13 a ABA means Applied Behaviour Analysis therapy. Open in new tab TABLE 2. Practitioners’ characteristics. Participants Number of participants Years of experience with ASD children in average Children's age range (worked with) Special education teachers 10 5 2–15 Therapists (3, speech; ABAa; educational) 5 6.5 2–17 Paediatric psychiatrists 3 10 1–13 Participants Number of participants Years of experience with ASD children in average Children's age range (worked with) Special education teachers 10 5 2–15 Therapists (3, speech; ABAa; educational) 5 6.5 2–17 Paediatric psychiatrists 3 10 1–13 a ABA means Applied Behaviour Analysis therapy. Open in new tab 3.2. Procedure Before we conducted this study, we obtained ethical approval from our institute’s ethical committee. We conducted semi-structured interviews and focus group sessions with participants. Semi-structured interviews were conducted with paediatric psychiatrists and therapists as they have unique expertise in different aspects of ASD (i.e. speech, occupational, education and diagnosis). Two focus group sessions were carried out with special education teachers with five participants for each group. Since the majority of the parents who had taken part in the study were reluctant to discuss their opinion in group environments, we only had one focus group session with parents (with four participants), and the rest of the sessions were conducted as semi-structured individual interviews. For each group, one topic guide was created around current use of technology among children with ASD, what are the frustrations when using existing technology with children with ASD, how can we improve existing technological applications and future expectations towards technology. However, when conducting sessions, question discussion points were changed according to the participant’s background (for example, for parents, we asked what are the current technologies used at home by their children, while for practitioners, we changed the questions to what are the existing technologies used at therapy centre by children with ASD). All interview questions were translated into Sinhalese before the interview sessions. Interviews were carried out face to face either in Sinhalese (for 95% of the participants) or English language as per their preference. Focus group sessions and individual interviews lasted for 1.5–2 hours and 20–45 minutes, respectively. All sessions were audio recorded. All participants were given a research information statement and consent form to fill out before participation in both English and Sinhalese languages. FIGURE 1 Open in new tabDownload slide Types of technological applications used in home and therapy with children with ASD in Sri Lanka. FIGURE 1 Open in new tabDownload slide Types of technological applications used in home and therapy with children with ASD in Sri Lanka. 3.3. Data analysis Interviews conducted in Sinhalese were translated into English after they were first transcribed in Sinhalese. The first author who is a native Sinhalese speaker and another graduate student whose first language is Sinhalese verified the translations to strengthen the validity of the translations. All transcribed data were saved in Microsoft Word documents for further analysis. The transcribed data were analysed using thematic analysis methodology defined by Braun and Clarke (Braun and Clarke, 2006). Firstly, both authors read all the transcripts multiple times to be familiarized with the data. Then we generated initial codes by labelling the essence or key attributes of the data. Thirdly, we identified themes by collating codes as per their relevance. Once the themes were identified, those were further analysed along with their relationships out of which a thematic map was generated. NVivo software (Castleberry, 2014) was used for coding and thematic map generation. Appendix 2 illustrates the coding schema generated from thematic data analysis. Both researchers coded 20% of the data and compared their codes and themes according to Cohen’s Kappa calculations (Byrt et al., 1993). The rest of the data were analysed by the first author. The inter-rater agreement was 0.82, which is considered a near-perfect agreement. Once the findings were finalized, we summarized the findings and translated them into the Sinhalese language. These summarized copies were sent to 50% of the participants, which included both professionals and parents, for their perusal. Participants were requested to comment on the accuracy of the findings per their experience. Each participant who received the summary verified the accuracy of the results. 4. FINDINGS We present our findings under three main categories: (i) different types of technologies and tools used by parents and practitioners, (ii) how technology is being used and the main purposes of using technology and (iii) future expectations in using technology for children with ASD (see Appendix 1). 4.1. Types of technology used by parents and practitioners We identified 37 different types of applications used by parents and practitioners for children with ASD (see Fig. 1). Out of these 37 applications, 29 applications were mobile apps such as `Fruit Ninja’ and `Talking Tom’ and three were standalone software applications, namely `Word Processor’, `MS Paint’ and `ABC Kids’ (ABC letters and phonics for kids). Some (n = 16; 50%) of the parents said that their children with ASD spend most of their time at home watching educational television (TV) programs (see Fig. 2), such as Baby TV, Nickelodeon and Disney Junior or watching YouTube Programs. Parents believe these applications can improve cognitive skills such as counting, colour/shape matching and English vocabulary skills of children with ASD. We also found that only a few parents (n = 8; 25%) give tablets for their children with ASD and these parents claim most of the time children use tablet devices to watch videos. However, some parents (n = 21; 65.625%) reported that they give their smartphones to their children to play interactive educational games. FIGURE 2 Open in new tabDownload slide Types of devices used at home and therapy with children with ASD in Sri Lanka. FIGURE 2 Open in new tabDownload slide Types of devices used at home and therapy with children with ASD in Sri Lanka. `My son loves watching YouTube, which is mostly educational programs. We only give him educational programs. He learns a lot of English words by watching them. So, we allow it.’—(parent; child’s age, 3.8 years) In contrast to parents, practitioners mostly use desktop computers (e.g. educational-/sensory- related interactive software) and tablets (interactive applications) with children with ASD in therapy and school settings (see Fig. 2). Though most practitioners claim that they use desktop computers more frequently, some practitioners (n = 4; 22%) reported that most children they engaged in has limited fine-motor skills to operate mouse and keyboard effectively. `For some kids, it's really hard to get used to the mouse and the keyboard because of their limited motor skills and hand-eye coordination. They take a long time to learn mouse and keyboard before actually doing the activities. So, we sometimes move into tablets, but we do not have proper applications in the tablets.’—(Speech Education Teacher_4) 4.2. Purpose of using technology by parents and practitioners Parents and practitioners reported that technology is used in many ways with children with ASD in Sri Lanka. The most common use of technology is to develop lacking core skills of children with ASD such as communication, fine-motor skills, academic, sensory and social skills. Table 3 illustrates how technology is used to improve different skills of children with ASD in home and therapy settings. In addition to developing skills, both parents and practitioners use technology for many other purposes, namely (i) to engage with the child when the child is not focused (n = 12; 24%), (ii) to motivate and to reinforce the child (n = 9; 18%), (iii) as a babysitter (n = 5; 10%) when parents are too busy, (iv) to distract the child from the surroundings (n = 10; 20%), (v) to avoid tantrums (n = 5; 10%), (vi) to organize activities (n = 1; 2%) and (vii) to keep the child focused and seated (n = 9; 18%). Table 4 shows how technology is used for different purposes by parents and practitioners. TABLE 3. How technology is used to improve different skills of children with ASD. Skills Software/hardware used The most frequently used application Communication Talking Tom gamea, Jabtalka (AAC), GoTalka (AAC)—iPhone Talking Tom SoundingBoarda (AAC), Verballya (AAC), BitsBoarda—iPad, Cbeebies—laptop MS Paint—desktop computer Balloon Pop Kids Learning Gamea—tablet Fruit Ninjaa: Tablet, iPad, iPhone Reported by practitioners, 3; parents, 1 Fine motor Cbeebies—laptop MS Paint Balloon Pop Kids Learning Game*, Animals Puzzle for Kidsa—tablet MS Paint—desktop computer Fruit Ninjaa—tablet, iPad, iPhone Reported by practitioners, 6; parents, 0 Education Cbeebies, ABC Kid Genius, Starfall.com—laptop YouTube, Word Processor ABC Kidsa, Monkey Jumpa—tablet Balloon Pop Kids Learning Gamea, Alphabet Puzzles for Toddlersa, ABC Appa, Numbers Litea, 123 Numbersa, Puzzingoa, Spelling Games Litea, ABC SPELLING MAGICa—smart phone Starfall.com—laptop Word Processor—desktop computer Sinhala Letter Videos—desktop computer, laptop Phonic songs—desktop computer, tablet, laptop Reported by practitioners, 4; parents, 16 Sensory Panda Popa, Fruit Ninja, Bubblesa—smart phone Fruit Ninja YouTube Slow Motion Videos—tablet Garage Banda—iPad Reported by practitioners, 7; parents, 11 Social Story Makera—iPad Story Maker Reported by practitioners, 1; parents, 0 Skills Software/hardware used The most frequently used application Communication Talking Tom gamea, Jabtalka (AAC), GoTalka (AAC)—iPhone Talking Tom SoundingBoarda (AAC), Verballya (AAC), BitsBoarda—iPad, Cbeebies—laptop MS Paint—desktop computer Balloon Pop Kids Learning Gamea—tablet Fruit Ninjaa: Tablet, iPad, iPhone Reported by practitioners, 3; parents, 1 Fine motor Cbeebies—laptop MS Paint Balloon Pop Kids Learning Game*, Animals Puzzle for Kidsa—tablet MS Paint—desktop computer Fruit Ninjaa—tablet, iPad, iPhone Reported by practitioners, 6; parents, 0 Education Cbeebies, ABC Kid Genius, Starfall.com—laptop YouTube, Word Processor ABC Kidsa, Monkey Jumpa—tablet Balloon Pop Kids Learning Gamea, Alphabet Puzzles for Toddlersa, ABC Appa, Numbers Litea, 123 Numbersa, Puzzingoa, Spelling Games Litea, ABC SPELLING MAGICa—smart phone Starfall.com—laptop Word Processor—desktop computer Sinhala Letter Videos—desktop computer, laptop Phonic songs—desktop computer, tablet, laptop Reported by practitioners, 4; parents, 16 Sensory Panda Popa, Fruit Ninja, Bubblesa—smart phone Fruit Ninja YouTube Slow Motion Videos—tablet Garage Banda—iPad Reported by practitioners, 7; parents, 11 Social Story Makera—iPad Story Maker Reported by practitioners, 1; parents, 0 a Applications that are available on Apple App Store and Google Play Store. Open in new tab TABLE 3. How technology is used to improve different skills of children with ASD. Skills Software/hardware used The most frequently used application Communication Talking Tom gamea, Jabtalka (AAC), GoTalka (AAC)—iPhone Talking Tom SoundingBoarda (AAC), Verballya (AAC), BitsBoarda—iPad, Cbeebies—laptop MS Paint—desktop computer Balloon Pop Kids Learning Gamea—tablet Fruit Ninjaa: Tablet, iPad, iPhone Reported by practitioners, 3; parents, 1 Fine motor Cbeebies—laptop MS Paint Balloon Pop Kids Learning Game*, Animals Puzzle for Kidsa—tablet MS Paint—desktop computer Fruit Ninjaa—tablet, iPad, iPhone Reported by practitioners, 6; parents, 0 Education Cbeebies, ABC Kid Genius, Starfall.com—laptop YouTube, Word Processor ABC Kidsa, Monkey Jumpa—tablet Balloon Pop Kids Learning Gamea, Alphabet Puzzles for Toddlersa, ABC Appa, Numbers Litea, 123 Numbersa, Puzzingoa, Spelling Games Litea, ABC SPELLING MAGICa—smart phone Starfall.com—laptop Word Processor—desktop computer Sinhala Letter Videos—desktop computer, laptop Phonic songs—desktop computer, tablet, laptop Reported by practitioners, 4; parents, 16 Sensory Panda Popa, Fruit Ninja, Bubblesa—smart phone Fruit Ninja YouTube Slow Motion Videos—tablet Garage Banda—iPad Reported by practitioners, 7; parents, 11 Social Story Makera—iPad Story Maker Reported by practitioners, 1; parents, 0 Skills Software/hardware used The most frequently used application Communication Talking Tom gamea, Jabtalka (AAC), GoTalka (AAC)—iPhone Talking Tom SoundingBoarda (AAC), Verballya (AAC), BitsBoarda—iPad, Cbeebies—laptop MS Paint—desktop computer Balloon Pop Kids Learning Gamea—tablet Fruit Ninjaa: Tablet, iPad, iPhone Reported by practitioners, 3; parents, 1 Fine motor Cbeebies—laptop MS Paint Balloon Pop Kids Learning Game*, Animals Puzzle for Kidsa—tablet MS Paint—desktop computer Fruit Ninjaa—tablet, iPad, iPhone Reported by practitioners, 6; parents, 0 Education Cbeebies, ABC Kid Genius, Starfall.com—laptop YouTube, Word Processor ABC Kidsa, Monkey Jumpa—tablet Balloon Pop Kids Learning Gamea, Alphabet Puzzles for Toddlersa, ABC Appa, Numbers Litea, 123 Numbersa, Puzzingoa, Spelling Games Litea, ABC SPELLING MAGICa—smart phone Starfall.com—laptop Word Processor—desktop computer Sinhala Letter Videos—desktop computer, laptop Phonic songs—desktop computer, tablet, laptop Reported by practitioners, 4; parents, 16 Sensory Panda Popa, Fruit Ninja, Bubblesa—smart phone Fruit Ninja YouTube Slow Motion Videos—tablet Garage Banda—iPad Reported by practitioners, 7; parents, 11 Social Story Makera—iPad Story Maker Reported by practitioners, 1; parents, 0 a Applications that are available on Apple App Store and Google Play Store. Open in new tab TABLE 4. How technology is used for different purposes of parents and practitioners. Usage/purpose Software/hardware used The most frequently used application Engage with children YouTube songs—laptop, smart phone YouTube Nursery rhymes—laptop, smart phones Reported by practitioners, 12; parents, 0 Motivate and reinforce YouTube songs, Fruit Ninja gamea, MARVEL Spider-Man Unlimited gamea—smart phone YouTube Reported by practitioners, 5; parents, 4 Baby sitter Nickelodeon, Baby TV, Disney Junior, Sinhalese cartoon, Ben Ten cartoon—TV YouTube/Baby TV YouTube songs, cartoons—smart phone, laptop Reported by practitioners, 0; parents, 5 Distract the child (i.e. feed the child and waiting in line in the hospital) YouTube songs (nursery rhymes, phonic songs, Barney songs)—smart phone YouTube Baby TV, animated movies—TV Animated movies—Laptop MARVEL Spider-Man Unlimited gamea, Temple Run gamea—smart phone Reported by practitioners, 0; parents, 10 Avoid tantrums LumiKids educational gamea, YouTube kid’s songs—smart phone YouTube Animated cartoon (Ice Age)—TV Reported by practitioners, 0; parents, 5 Organize activities—visual schedules ChoiceWorksa—iPad ChoiceWorks Reported by practitioners, 1; parents, 0 Settle down the child YouTube songs—smart phones YouTube Reported by practitioners, 6; parents, 2 Keep the child seated and focused 123s ABC Kids Handwriting Gamea—Tablet 123s ABC Kids Handwriting Game Reported by practitioners, 0; parents, 2 Usage/purpose Software/hardware used The most frequently used application Engage with children YouTube songs—laptop, smart phone YouTube Nursery rhymes—laptop, smart phones Reported by practitioners, 12; parents, 0 Motivate and reinforce YouTube songs, Fruit Ninja gamea, MARVEL Spider-Man Unlimited gamea—smart phone YouTube Reported by practitioners, 5; parents, 4 Baby sitter Nickelodeon, Baby TV, Disney Junior, Sinhalese cartoon, Ben Ten cartoon—TV YouTube/Baby TV YouTube songs, cartoons—smart phone, laptop Reported by practitioners, 0; parents, 5 Distract the child (i.e. feed the child and waiting in line in the hospital) YouTube songs (nursery rhymes, phonic songs, Barney songs)—smart phone YouTube Baby TV, animated movies—TV Animated movies—Laptop MARVEL Spider-Man Unlimited gamea, Temple Run gamea—smart phone Reported by practitioners, 0; parents, 10 Avoid tantrums LumiKids educational gamea, YouTube kid’s songs—smart phone YouTube Animated cartoon (Ice Age)—TV Reported by practitioners, 0; parents, 5 Organize activities—visual schedules ChoiceWorksa—iPad ChoiceWorks Reported by practitioners, 1; parents, 0 Settle down the child YouTube songs—smart phones YouTube Reported by practitioners, 6; parents, 2 Keep the child seated and focused 123s ABC Kids Handwriting Gamea—Tablet 123s ABC Kids Handwriting Game Reported by practitioners, 0; parents, 2 a Applications that are available on Apple App store and Google Play store. Open in new tab TABLE 4. How technology is used for different purposes of parents and practitioners. Usage/purpose Software/hardware used The most frequently used application Engage with children YouTube songs—laptop, smart phone YouTube Nursery rhymes—laptop, smart phones Reported by practitioners, 12; parents, 0 Motivate and reinforce YouTube songs, Fruit Ninja gamea, MARVEL Spider-Man Unlimited gamea—smart phone YouTube Reported by practitioners, 5; parents, 4 Baby sitter Nickelodeon, Baby TV, Disney Junior, Sinhalese cartoon, Ben Ten cartoon—TV YouTube/Baby TV YouTube songs, cartoons—smart phone, laptop Reported by practitioners, 0; parents, 5 Distract the child (i.e. feed the child and waiting in line in the hospital) YouTube songs (nursery rhymes, phonic songs, Barney songs)—smart phone YouTube Baby TV, animated movies—TV Animated movies—Laptop MARVEL Spider-Man Unlimited gamea, Temple Run gamea—smart phone Reported by practitioners, 0; parents, 10 Avoid tantrums LumiKids educational gamea, YouTube kid’s songs—smart phone YouTube Animated cartoon (Ice Age)—TV Reported by practitioners, 0; parents, 5 Organize activities—visual schedules ChoiceWorksa—iPad ChoiceWorks Reported by practitioners, 1; parents, 0 Settle down the child YouTube songs—smart phones YouTube Reported by practitioners, 6; parents, 2 Keep the child seated and focused 123s ABC Kids Handwriting Gamea—Tablet 123s ABC Kids Handwriting Game Reported by practitioners, 0; parents, 2 Usage/purpose Software/hardware used The most frequently used application Engage with children YouTube songs—laptop, smart phone YouTube Nursery rhymes—laptop, smart phones Reported by practitioners, 12; parents, 0 Motivate and reinforce YouTube songs, Fruit Ninja gamea, MARVEL Spider-Man Unlimited gamea—smart phone YouTube Reported by practitioners, 5; parents, 4 Baby sitter Nickelodeon, Baby TV, Disney Junior, Sinhalese cartoon, Ben Ten cartoon—TV YouTube/Baby TV YouTube songs, cartoons—smart phone, laptop Reported by practitioners, 0; parents, 5 Distract the child (i.e. feed the child and waiting in line in the hospital) YouTube songs (nursery rhymes, phonic songs, Barney songs)—smart phone YouTube Baby TV, animated movies—TV Animated movies—Laptop MARVEL Spider-Man Unlimited gamea, Temple Run gamea—smart phone Reported by practitioners, 0; parents, 10 Avoid tantrums LumiKids educational gamea, YouTube kid’s songs—smart phone YouTube Animated cartoon (Ice Age)—TV Reported by practitioners, 0; parents, 5 Organize activities—visual schedules ChoiceWorksa—iPad ChoiceWorks Reported by practitioners, 1; parents, 0 Settle down the child YouTube songs—smart phones YouTube Reported by practitioners, 6; parents, 2 Keep the child seated and focused 123s ABC Kids Handwriting Gamea—Tablet 123s ABC Kids Handwriting Game Reported by practitioners, 0; parents, 2 a Applications that are available on Apple App store and Google Play store. Open in new tab The majority of the parents (n = 18; 68.3%) claimed that their children only use technology to watch academic videos, which takes the form of passive learning. Most parents are keener on using technology for academic purposes, rather than for games or entertainment purposes. `He uses the tablet mostly to watch videos like ABC Songs, and animals and doesn’t use any app other than YouTube. He loves watching realistic videos like live animals shows. He learns about animals and their names by watching these videos.’—(parent; child’s age, 4.5 years) However, some parents (n = 11; 34.37%) commented that their children actively engaged with interactive technology during learning activities such as puzzles and writing, which then showed significant improvements in their knowledge and skills. The parents who claimed that technology could benefit their children also showed some understanding of using technology interactively, not just for passive learning. `I used iPad to keep the child seated for a little bit. He usually is very lazy to write using a normal pen and paper. But he writes letters on iPad willingly. He also plays games like ``123s ABC Kids Handwriting Game”, matching applications like ‘KIDS match'em, and colouring applications. He also does a lot of puzzles on my iPad. He goes to very higher levels in the puzzle game.’—(parent; child’s age, 6.1 years) Some parents (n = 10; 31.25%) reported that one of the important usages of technology is to distract the child when the child is in unpleasant situations such as waiting in line at the hospital or being at a crowded restaurant. `My daughter hates to go to the doctor because the hospital is very noisy for her and she is very impatient. Whenever I go to the hospital or any noisy place she doesn’t like, I take the tablet with me. When she is using the tablet, she forgets everything. Tablet is a good way of distracting children with ASD in situations like this.’—(parent; child’s age, 6.0 years) Although parents are more focused on developing academic skills using technology for their children, practitioners (n = 15; 83.33%) are more focused on utilizing technology to improve other key deficits of children with ASD, such as sensory integration, hand–eye coordination, eye contact and communication (see Table 3). `We use MS Paint to improve hand-eye coordination and eye contact. This is done during educational therapy. We also use other software applications with sounds and bright colours such as Fruit Ninja on our tablet, so that children will improve their sensory integration’—Educational Therapists_1 Practitioners (n = 12; 66.67%) reported that in addition to developing skills, they used portable technologies such as tablets and smartphones to reinforce and engaged with the children during other therapeutic activities. `I use technology as a rewarding mechanism. When a child completes a task, I give a little bit of technology to motivate the child at the end of the session. I use picture-based applications using my tablet and try to engage with the child, where he presses a picture and get words and sounds’—(speech therapist_3) 4.3. Future expectations in technology for children with ASD in Sri Lanka Participants suggested several limitations and possible functionalities to improve the current use of technology-based applications for children with ASD in Sri Lanka. These are categorized under eight main functionalities as explained below. 4.3.1. Software applications to be created in the Sri Lankan context One of the most common suggestions provided by both parents and practitioner groups was to have an application that would support the Sinhalese language (the native language of the target groups) as only a limited number of applications are available for children in Sinhalese. Parents (n = 16; 50%) further reported that because there are no applications created in Sinhalese with Sri Lankan cultural context, it is hard to use technology with their children. They also pointed to some issues with current applications, which were found in the Google Play store and the Apple App store. `I wish there were applications built in Sinhalese because we teach him in Sinhala medium. We found this one application called ``AKURU KARAMU”, which teaches writing Sinhalese letters, but it’s very complicated for my child. Not only the accuracy of letter identification is low, but it also is not guided enough for a child with autism.’—(parent; child’s age, 8 years) Similarly, practitioners (n = 7; 38.88%) too reported that they need applications created in Sinhalese, which target children with ASD in Sri Lanka. Additionally, some practitioners (n = 3; 16.67%) highlighted that they can use some language-independent applications such as Talking Tom or MS Paint to improve some of the critical skills such as joint attention and communication. However, practitioners identified that to enhance skills like emotional intelligence, social skills and Sinhalese vocabulary, it is vital to have applications developed in the native language of the children with Sri Lankan cultural context. In addition to the language, some special education teachers (n = 4; 22.22%) complained that most applications are targeted to support children in Western countries focusing on western culture. Thereby, an educational therapist also highlighted the importance of having traditional cultural activities (such as Vesak festival, Sinhalese and Tamil New Year celebrations) embedded in software applications so that children can easily relate software applications with real-world settings. 4.3.2. Software applications facilitating group work and collaboration Practitioners and parents pointed out that one of the most challenging characteristics of autism is the lack of social interactions between children. Therefore, both parents (n = 5; 15.625%) and practitioners (n = 8; 44.44%) reported that they require applications that can improve group work and collaboration skills of children with ASD. Most parents highlighted that though their children watch social activities from TV, they do not imitate these activities back with their peers. `We show our child a lot of social activities on TV, like kids playing together which each other. But unlike his brother who learns positive social interactions via TV, my son with autism doesn’t seem to learn social interactions from TV. So, it would be good if it’s a group activity, so, he will learn group work. That is what he lacks the most’—(parent; child’s age, 6.5 years) In agreement with parents, practitioners explained that since technology is attractive for most children with ASD, technology can be used as a medium to improve social skills. However, they further highlighted that existing technological applications do not facilitate group work or collaboration skills among children. `Most of the software applications supports computer to child or screen to child interactions. Though they learn a lot from technology, they tend to get isolated using technology, as it does not practically promote social interactions. So, I think it’s a good idea to have some application that facilitates group activities with their peers rather than playing alone. Because these children like technology so much, they might actually engage with their peers if we force it through technology, sometimes children are not paying attention to our traditional group therapies.’—(special education teacher_5) 4.3.3. Functionalities to support for emotional intelligence Designing and developing applications to help teach emotional intelligence is an area that was needed by both parents and practitioners. Some parents (n = 4; 12.5%) reported that to understand facial expressions and social cues, currently they use personalized flashcards. However, they reported that it is a tedious job to create flashcards. `To teach emotions, teachers ask us to make flashcards using photos, and pictures from magazines. But it is very hard to find all the emotions from magazines. Sometimes we have to use the internet and find pictures and then print. With our work, it is a tedious job to do’—(parent; child’s age, 6.2 years) Practitioners like special education teachers emphasized the importance of learning emotional skills for children with ASD. Practitioners believed that most of their children with ASD have issues in recognizing, controlling and understanding their emotions. Furthermore, at current therapy, they use many emotion-based interventions to improve children’s emotional intelligence, which in turn can help them understand different emotions and respond to them more appropriately. Furthermore, most practitioners believed it would be efficient to teach emotions via interactive technology as children can get a more realistic experience via audio and video data with interactive feedback. `At present, we do a lot of activities related to emotional skills. We create different types of flashcards picturing six basic emotions. We also have several books to teach different emotions and how to react to different social situations. But I feel it is better to have this via technology because children seem to learn more when it is more interactive’—(speech therapist_2) 4.3.4. Support for simplicity with natural images, sounds and colours Simplicity is another critical factor both parties highlighted. Some parents (n = 3; 9.375%) pointed out that due to the complexity of some tablet applications such as `Akuru Kiyamu’, they failed to use them with their children. Similarly, practitioners (n = 3; 16.67%) too reported their concerns about having applications that are simple with fewer distractions (for example without unwanted animations and sounds). Some practitioners claimed that even though there are a lot of applications with good content, they still failed to use it effectively due to the complexity of the program. `We tried to use ``Proloquo2go’ application for non-verbal children with ASD; however, it did not work due to the complexity of the program. Many parents complained it is too complicated to use.’—(speech therapist_1) Additionally, some parents (n = 7; 21.875%) claimed that it is also essential to have natural images and sounds so that their children can easily relate to the world around them. `The app should have natural images, not cartoon images. Having realistic sounds are also important. So, it’s important that we show them natural things. Even in speech therapy, we use natural images in our picture binders.’—(parent; child’s age, 3.2 years) Practitioners also highlighted the importance of having realistic images while explaining how bright coloured images would improve eye contact of young children with ASD. `It should have attractive but natural pictures with bright colours without black and brown. It's ok to have contrasting colours. It’s good even to practice eye-contact.’—(special education teacher_8). 4.3.5. Support for customization The customization is another area that was discussed by both groups. Practitioners and parents highlighted the need for visual and audio media to be customizable in applications developed for children with ASD. Some parents (n = 12; 37.5%) stressed that customization and personalization are essential to their children as they have unique interests and needs. They further explained the importance of not being limited by a specific set of materials provided in the application itself and have more flexibility embedding materials be provided per the child’s interests. `I want the application to be simple and customizable. Because my child has unique interests, he learns things in depth. For example, he knows so many animal names; even I don’t know some of them. So, if we can search from internet and put the materials that he needs, then it would be great, his learning won’t be constrained.’—(parent; child’s age, 8 years) Practitioners (n = 6; 33.33%) too had similar concerns. Practitioners demonstrated how important is customization to support the individual needs of each child by showing their binders of small cards. Each of these binders is specific to each child based on individual skill level, goals and interests. Practitioners reported that each child they engaged with is different and have unique interests and needs. Furthermore, they also highlighted that though some children like one type of music/object and the other child might like something else. Therefore, it is critical to have software applications that can support different kinds of children. `Maybe if we can customise the music/songs, like if we can add the music we want, then it would be better I think. Because children have their individual tastes in music. If software applications would let us add our own materials because we know what he likes the most, then I think the child could learn more.’—(special education teacher_8) Additionally, practitioners also pointed out the importance of customizing educational content according to the individual child’s preference to make the child more attentive towards learning. 4.3.6. Support to teach actions, settings and materials in different forms In addition to customization, generalizability is another area that was highlighted by both parents and practitioners. Some parents (n = 10; 31.25%) reported that technology could be an excellent medium to teach actions/objects (i.e. the names of fruits and animals) in different forms in technological platforms, for example, computers, which could provide a vast amount of resources. At present, practitioners and parents use paper-based methods to teach children objects in different forms. Therefore, they highlighted the need to have a software application that supports this requirement. `It would be better if we have an app, which shows a cat, makes its sound and all that. We can show different types of cats as well. Different ways of doing different things, different ways of representing the same object activity, like running, eating, laughing’—(parent; child’s age, 3.5 years) Similar to parents, practitioners also highlighted the importance of generalization for children with ASD and how it is taught in current autism therapy practices. At present, practitioners keep books with different sets of images for the same action, settings and materials for teaching the same content in various forms. `Our children have a hard time understanding things when the environment changes, or when the appearance of it change. So, let’s say if I want to teach my children the use of the cup, I need to show them different colours of cups (black, green, yellow), different shapes of cups and the different ways of using the cup. At present, we keep binders for such activities, but I think it would be more appropriate to have an app for this so we can easily get pictures to it.’—(special education teacher_3) 4.3.7. Software program to monitor a child's progress and predict and deliver educational content on the child’s progress Few parents (n = 6; 18.75%) and practitioners (n = 4; 22.22%) reported that there is a need to develop applications that can monitor the progress of a child with ASD and share among teachers and parents. Parents explained that they use manual methods to track the development of their children such as using teacher-given report cards and writing down their child’s milestones in a diary. Few parents (n = 2; 6.25%) reported that they have no way of tracking the child’s progress when the child is at home. `Now we track his progress manually and rely on the report card we get from the teachers. We write new words he says and new milestones he passes on a book. Having software to do this would be good.’—(parent; child’s age, 4.5 years) Practitioners further expressed the importance of computerized progress tracking for children with ASD. They noted that it would be more efficient to have a computerized system to track an individual child’s progress and share it with respective parents. `It would be nice to have a software to record each child’s progress. We usually do it manually on paper, so it’s hard to track the progress. Whenever parents ask for the progress, we have to manually go through a lot of papers’—(special education teacher_10) Aligning with progress monitoring, one parent highlighted the importance of predicting educational content according to the child’s past behaviour in educational applications that are designed for children with ASD. He also pointed out how tedious it is to evaluate the child each day and give educational content to the child depending on his daily progress. He further highlighted that most software applications produce educational materials blindly without looking at a child’s past activities or progress. `I would like to have a software to keep track of what my child should do next. I was thinking about it for a long time. Sometimes I get confused on what I should do today, which activity. If the software can give me recommendations looking at her previous activities rather than me memorising for it, that would be nice’—(parent; child’s age, 3.5 years) 4.3.8. Software applications to create and access slow-motion videos Even though none of the practitioners requested, a few parents (n = 3; 9.375%) suggested that having applications that support slow-motion videos, as they believe it, would keep the child to be calm and focused. At present, these parents use YouTube channels to find appropriate slow-motion videos for their children; however, they highlighted it would be much efficient to use a software application that provides relevant slow-motion videos to their children according to individual child’s need. `The slow-motion videos like Bob the train can help. It tells you things and the cartoon moves slowly, so that children can focus on it. I think that type of an application would help.’—(parent; child’s age, 4.5 years) Similarly, another parent explained the hardships of finding slow-motion videos from the internet. He further elaborated his concerns when creating slow-motion videos with his child with ASD. `My child like to gaze into slow-motion videos with real people. On the internet there are some slow-motion videos with real people in them, so we used them, but it is really hard to find them. We sometimes create slow-motion videos using the iPhone, but it only let us create for a few seconds’—(parent; child’s age, 3.8 years) 5. DISCUSSION AND IMPLICATIONS In this study, we assumed that the use of technology would be minimal among children with ASD in Sri Lanka, due to limited access to resources, equipment and knowledge. Further, prior research on the practical use of technology in children with special needs shows that use of and the awareness of using assistive technology with children is limited in low-resource, developing countries (Jindal, 2017; Saleem and Sajjad, 2016; Shikden, 2015). However, the findings of this study show that digital technology is being used widely among children with ASD in Sri Lanka. We also found out that technology is mostly used in the form of non-interactive ways (i.e. watching TV) at home settings. In contrast, children with ASD were observed using technology in more interactive ways at school/therapy settings. Though parents and practitioners use technology with children with ASD in Sri Lanka, current technological interventions need to be further improved to support Sri Lankan children with ASD. In the following section, we discuss our findings by analysing the differences and commonalities of practitioners’ and parents’ views with regards to the use of technology, potential features of the software application and future expectations. We also compare the similarities and differences in our findings with affluent countries. Furthermore, we provide design implications based on the comparison of practitioners’ and parents’ views. 5.1. Differences and commonalities of practitioners’ and parents’ views on using technology Most parents (n = 29; 90.6%) used TV as an educational platform for their children with ASD as they believed it would help improve vocabulary, English language and mathematical skills in children. This finding is consistent with previous research showing that TV help children acquire foreign language skills for children (Koolstra and Beentjes, 1999). We also found out that only a few parents (n = 8; 25%) give tablets and more parents (n = 21; 65.625%) give smartphones to play educational games and YouTube videos for their children. Unlike other developed countries like Australia (Clark et al., 2015; Dixon et al., 2015) and the United States (King et al., 2017), tablet devices are not common among children with ASD in Sri Lanka at home settings. The reason could be because TV and smartphones have become a commodity among parents. On the other hand, tablet devices like the iPad might not be affordable for Sri Lankan parents. Additionally, we also found out that the parents who give tablets and smartphones to their children use these devices mainly to watch videos on YouTube, which is also consistent with other developed countries like Saudi Arabia (Athbah, 2015) and Australia (Licona and Loke, 2017). Watching videos on TV/tablet devices falls under the category of passive learning (observational learning) (Krugman and Hartley, 1970). Furthermore, prior studies have shown that there can be potential benefits of passive learning for children with ASD (Bross et al., 2018; Kim, 2016; Sadler, 2018). However, unlike passive learning environments, interactive learning environments have the added advantages of providing immediate feedback upon actions, which can be more beneficial for children (Huber et al., 2016). Moreover, devices such as tablets, smartphones and computers have the capabilities to incorporate interactive learning environments for children via software applications (Gangaiamaran and Pasupathi, 2017). Therefore, it can be concluded that tablet devices are underutilized as a medium that promotes interactive learning experience to children with ASD not only in developing regions like Sri Lanka but also in other parts of the world. Considering the above, Sri Lankan parents are encouraged to proactively explore ways to utilize the rich potential of tablet applications to provide an interactive learning experience to children with ASD. Studies conducted in other developing countries show that parents are not keen on using technology with children with developmental disabilities. For instance, Indian parents are unaware and reluctant to use assistive technology to enable any other function than walking, for children with cerebral palsy (Jindal, 2017). However, we identified that most Sri Lankan parents of children with ASD use technology to improve sensory and academic skills. Furthermore, we found out that parents have a high preference for using technology for academic purposes rather than using them for entertainment purposes. One of the reasons for this might be because Sri Lankan parents like any other Asian parents preserve the traditional attitude that parents should play a significant role in their child’s education (Yao, 1985). Although parents perceived possible benefits from educational TV programs, practitioners, on the other hand, believed that watching TV programs may lead to social isolation in children with ASD. Therefore, practitioners use more interactive technologies like desktop computers and tablet devices at therapy and school settings. This finding revealed a need for greater communication between parents and practitioners regarding the use of technology at home/school setting. Further, to this end, one suggestion would be to educate/train parents on how to use technology as an interactive learning tool and advocate new modes of parent–child interactions. Unlike developing countries like Nigeria where teachers have limited competency in using technology with special needs children (Shikden, 2015), Sri Lankan practitioners in our study frequently used interactive technology (i.e. computers and tablets) with children with ASD. Further, practitioners reported that one of the most common desires from technology-based interventions is to improve the social, communication, academic and emotional skills of children with ASD. Similar to our findings, one of the critical objectives of Dutch practitioners is to use technology to improve communication, social/interpersonal interactions and relations along with emotional well-being (Huijnen et al., 2016). However, this is not a surprising result since the main challenges of children with ASD are universal, and these challenges are related to communication, social interaction and emotional regulation (CDC, 2016). However, in addition to the skills as mentioned earlier, practitioners in affluent countries also desired to improve other skills such as play skills, self-care, independent living, preschool skills and sensory experiences and coping (Huijnen et al., 2016). The Sri Lankan practitioners, however, did not discuss these skills though they are equally essential skills for children with ASD. One reason for this might be because technology is not widely used in Sri Lankan therapy settings compared to other wealthy countries, as most technological interventions are designed according to the western cultural context and in the English language. Though there are apparent differences in using technology and the types of technology used by parents and practitioners, there were some similarities. For instances, we found out both parents and practitioners use technology mostly for academic activities such as vocabulary, mathematics and sorting skills. Secondly, both groups use technology to support the sensory needs of children with ASD (i.e. applications that support sensory stimulations). Since education and sensory aspects were the most common purposes of using technology for both groups, device and app developers should consider the sensory aspect and the educational value when designing assistive technologies for the Sri Lankan children with ASD. 5.2. Potential features of software applications for children with ASD in Sri Lanka From our study, we found out three functionalities (see Table 5), which were not commonly explored among the autistic community: (i) software applications to create and access slow-motion videos, (ii) predict and deliver educational content based on prior progress and (iii) teach actions in different forms. We found out from our study that some parents used slow-motion videos effectively to calm children with ASD; however, they further explained the hardships of obtaining slow-motion videos from a technological medium like YouTube and creating new videos. This concern, however, was not raised by any of the practitioners, and none of the practitioners uses slow-motion videos in therapy settings. From prior research, we found out that slow-motion videos can be beneficial for children with ASD as studies have used slow-motion videos to improve and develop gross motor skills of children with ASD (Robinson et al., 2015). However, Sri Lankan parents do not have easy access to create/download slow-motion videos. As Sri Lankan parents were requesting an application to create/download slow-motion videos for children with ASD and since slow-motion videos have a value for children with ASD, it would be beneficial to explore how to design applications that could cater creating and downloading slow-motion videos in future studies. In addition to creating slow-motion videos, progress monitoring feature and predict educational content based on progress is another feature that was requested by both parents and practitioners. Though there are a few applications that have progress monitoring feature (Kołakowska et al., 2017), predicting educational contents based on progress feature has not yet been explored among children with ASD. One reason for this might be because ASD includes a wide array of characteristics and symptoms, and researchers and designers need to consider the individual characteristics of each child (Tseng and Do, 2010) when predicting the educational content for children with ASD. However, to predict educational content, there has been some research in the domain of e-learning in web-based learning systems, which compute on-line automatic recommendation to learners based on their past behaviour using machine learning algorithms (Aher and Lobo, 2013; Khribi et al., 2008). Therefore, we believe these research (Aher and Lobo, 2013; Khribi et al., 2008) can be further extended to children with ASD to predict learning contents based on their previous activities via machine learning technologies. In addition to the above two features, prior research has not focused on a direct software application that teaches actions, materials, in different forms. However, in the past, researchers have used video modelling techniques to teach generalization aspects for children with ASD (Bellini et al., 2007), which in turns can be used to teach actions, materials in different forms. Therefore, when designing future software applications for children with ASD, it would be beneficial to consider promoting generalizability aspect within the software application. TABLE 5. Categorization of potential features of software applications, reported by parents and practitioners. Functionalities that are not commonly explored among the ASD community • To create and access slow-motion videos • Predict and deliver educational content based on the information gathered in the assessment of the child’s progress and past activities • Functionality to teach actions in different forms (e.g. different ways of eating, laughing etc.) Functionalities that are commonly explored but need to be modified for Sri Lankan children with ASD • Software applications facilitating group work and collaboration. • Simplicity with natural contents • Ability to customize images, voice, educational materials and music Functionalities that are only applicable to the Sri Lankan children with ASD • Software applications to be created in the native Sinhalese language with Sri Lankan contexts • Functionality to teach facial expressions and social cues (e.g. understanding different facial expressions, understanding social cues from video/audio clips) Functionalities that are not commonly explored among the ASD community • To create and access slow-motion videos • Predict and deliver educational content based on the information gathered in the assessment of the child’s progress and past activities • Functionality to teach actions in different forms (e.g. different ways of eating, laughing etc.) Functionalities that are commonly explored but need to be modified for Sri Lankan children with ASD • Software applications facilitating group work and collaboration. • Simplicity with natural contents • Ability to customize images, voice, educational materials and music Functionalities that are only applicable to the Sri Lankan children with ASD • Software applications to be created in the native Sinhalese language with Sri Lankan contexts • Functionality to teach facial expressions and social cues (e.g. understanding different facial expressions, understanding social cues from video/audio clips) Open in new tab TABLE 5. Categorization of potential features of software applications, reported by parents and practitioners. Functionalities that are not commonly explored among the ASD community • To create and access slow-motion videos • Predict and deliver educational content based on the information gathered in the assessment of the child’s progress and past activities • Functionality to teach actions in different forms (e.g. different ways of eating, laughing etc.) Functionalities that are commonly explored but need to be modified for Sri Lankan children with ASD • Software applications facilitating group work and collaboration. • Simplicity with natural contents • Ability to customize images, voice, educational materials and music Functionalities that are only applicable to the Sri Lankan children with ASD • Software applications to be created in the native Sinhalese language with Sri Lankan contexts • Functionality to teach facial expressions and social cues (e.g. understanding different facial expressions, understanding social cues from video/audio clips) Functionalities that are not commonly explored among the ASD community • To create and access slow-motion videos • Predict and deliver educational content based on the information gathered in the assessment of the child’s progress and past activities • Functionality to teach actions in different forms (e.g. different ways of eating, laughing etc.) Functionalities that are commonly explored but need to be modified for Sri Lankan children with ASD • Software applications facilitating group work and collaboration. • Simplicity with natural contents • Ability to customize images, voice, educational materials and music Functionalities that are only applicable to the Sri Lankan children with ASD • Software applications to be created in the native Sinhalese language with Sri Lankan contexts • Functionality to teach facial expressions and social cues (e.g. understanding different facial expressions, understanding social cues from video/audio clips) Open in new tab We also found three functionalities [(i) facilitating group work and collaboration, (ii) simplicity with naturalistic images and (iii) customization] that are commonly explored in prior research in the Western world; nevertheless, these functionalities need to be modified to cater to the needs of children with ASD in Sri Lanka (see Table 5). Facilitating group work activities among children with ASD in Sri Lanka is one of the most crucial functionalities requested by both parents and practitioners. Practitioners and parents emphasized on the need for a software application that allows their children to collaborate with their peers, as practitioners highlighted, children with ASD are reluctant to learn social interaction skills via traditional models of therapy. There are several studies, which focus on collaborative skills of children with ASD using tabletop applications conducted in developed countries, such as Italy and Netherlands (Battocchi et al., 2010; Giusti et al., 2011; Veen et al., 2007). These studies indicated positive results using touch-based technology such as multi-touch tabletops. However, such devices might not be affordable for developing countries like Sri Lanka. Therefore, further research into the possibility of using more economical technology-based solutions is required such as collaborative tablet applications with multiplayer functionalities for the Sri Lankan children with ASD. In addition to group work, realistic contents (i.e. natural photos included in applications) included in applications is another requirement both parents and practitioners needed in software applications. We found that realistic images work better than cartoon images for children with ASD, a finding supported by previous research (Leo and Leroy, 2008). Therefore, when designing applications for children with ASD, it would be more beneficial to use naturalistic content. Another concern expressed by both parents and practitioners was the customizability support, which would allow them to change the audio and visual contents of applications including the educational materials. Prior research has shown that using customization applications can be personalized following the needs of children with ASD (Boyd et al., 2015). For instance, AAC applications, such as `Proloquo2Go’, provide some degree of personalization by letting the user customize the colour, voice and pictures (Sennott and Bowker, 2009). Similarly, there are multilingual AAC applications (i.e. `Dynavox V’, `Alexicom AAC’ and `Voice4u’) that can customize the language (English, Spanish, French and German) to support multiple cultural contexts (Suchato et al., 2011). Additionally, there are visual scheduling applications (i.e. vSked) that allow personalization via providing the ability to customize size and the appearance of the interfaces for children with ASD (Hirano et al., 2010). However, the majority of the high-tech assistive technologies have extremely limited flexibility to customize (Hayes et al., 2010), especially for educational application restricting their use to only specific content and specific language (i.e. English). Most Sri Lankan practitioners explained that it is required to customize academic materials as well apart from images, voice and videos, as it is important to change academic materials according to the child’s interest. Therefore, we believe it is important to design software applications that are not tightly coupled with educational materials and content so that it can be customized according to the child’s interests and needs. Furthermore, we found out two functionalities that are strongly related to Sri Lankan autism community: (i) applications to support labelling and identifying emotional expressions and (ii) applications that support cultural context/languages of Sri Lanka (see Table 5). The application to support labelling and identifying emotional expressions was also suggested by some participants. They further elaborated that images of emotional expressions be demonstrated on real faces and explained in native languages, resembling a native social background. There are several studies, which focus on improving emotional recognition (Grynszpan et al., 2008; Lorenzo et al., 2016) and emotional intelligence (Golan et al., 2010) of children with ASD conducted in developed countries. These studies show promising results in improving the emotional skills of children with ASD. However, the aforementioned applications use facial expressions related to the western cultural context. Research has found that emotions are best understood when expressed in native languages and native cultural context (Pell et al., 2009). Therefore, to support emotional skills for Sri Lankan children with ASD it is important to have application related to Sri Lankan cultural context. Finally, software application to be created in the Sri Lankan context is one of the most common functionality requested by both parents and practitioners. At present, none of the commercially available applications supports the cultural context of Sri Lanka. Therefore, the most requested feature of all participants is the ability to support the native languages of children with ASD, which is quite apparent and expected. Prior studies have also shown the importance of contextually and culturally relevant tools for children with ASD in low-resourced countries (Sharma et al., 2018). Hence, there is a clear need for research on software applications targeting the specific ethnic background in Sri Lanka. By analysing the functionalities mentioned above, we believe that customization functionality can be a powerful ingredient when designing software applications for children with ASD in non-English speaking multilingual countries like Sri Lanka. Out of the eight functionalities, five functionalities [(i)functionality to teach actions in different forms, (ii) simplicity with natural content, (iii) customization, (iv) functionality to teach facial expressions and social cues and (v) applications supporting Sri Lankan cultural contexts] can be supported by designing applications with the flexibility for customization. For instance, if software applications are designed to support customization of language, audio, images and educational content, any application designed for western countries can be used to support the cultural context of Sri Lanka. Similarly, if applications are designed to customize the content (images/words), users can add features such as teaching facial expressions and teaching actions in multiple forms. Therefore, we believe that flexibility to customize is instrumental when designing software applications for children with ASD in Sri Lanka. 5.3. Strengths and limitations There are some limitations that need to be taken into consideration when interpreting the findings of this study. In this study, we interviewed 50 participants. Even though it is a sufficient number for a qualitative study with semi-structured interviews, it identifies only a fraction of the overall population of children with ASD in the country. Furthermore, most of the parents were recruited from the Sumaga Autism Centre, Colombo, and this could be viewed as a selection-bias of the study participants. However, we attempted to overcome this limitation by selecting participants from different ethnicities (Sinhala, Tamil and Muslim) who live in different districts of Sri Lanka (Colombo, Kandy and Jaffna). Therefore, our study findings have included representative participants, and hence, the study results show the status of the current practice. Further, to strengthen the quality of our study, practitioners who work at multiple therapy centres and schools (special education teachers and therapists) with technology expertise were invited to participate if they possessed a minimum of four years of experience in one-to-one teaching or providing therapy for children with ASD. 6. CONCLUSION In this study, we found out a wide array of technological applications (n = 37) that are used among children with ASD in Sri Lanka at home and therapy settings. The findings further indicate that there are different patterns of using technology at home and in therapy settings. For instance, parents mostly use passive learning technologies such as TV programs and YouTube channels while practitioners use more interactive forms of technology such as desktop computer software (i.e. MS Word and MS paint) and tablet applications (i.e. Talking Tom). Though we found out that parents and practitioners use different types of technology with their children with ASD, both groups use technology for academic purposes (i.e. improve vocabulary and math skills), medium to facilitate sensory needs and a tool to engage with their children. Practitioners and parents further elaborated that current technological applications need to be further improved and modified to cater to the needs of children with ASD in Sri Lanka to make learning more effective. Based on practitioners’ and parents’ feedback, we identified several features for future technological interventions for children with ASD in Sri Lanka, namely (i) software applications to be created in Sri Lankan context, (ii) software applications facilitating group work and collaboration, (iii) functionality to support emotional intelligence (e.g. understand different facial expressions and understand social cues from video/audio clips), (iv) simplicity with natural images and sounds, (v) customization (ability to customize images, voice and music), (vi) functionality to teach actions/materials in different forms (e.g. different ways of eating, laughing etc.), (vii) software program to monitor child's progress and predict and deliver educational content on the child’s progress and (viii) applications to create and access slow-motion videos. Out of these eight functionalities, five functionalities [i.e. (i) functionality to teach actions in different forms, (ii) simplicity with natural content, (iii) customization, (iv) functionality to teach facial expressions and social cues and (v) applications supporting Sri Lankan cultural contexts] can be supported by designing software applications with the flexibility of customization. Therefore, in future research, having the flexibility to customize contents is an important aspect that needs to be considered when designing new technological interventions for children with ASD in Sri Lanka. ACKNOWLEDGEMENTS We would like to acknowledge the support provided by the founder Mrs. Swarna Jayawardene and her staff at Sumaga Autism Centre, Kelaniya, Sri Lanka for this study. We are also grateful to all the practitioners and parents who so generously gave up their time to take part in this study. Reference Aher , S. B. and Lobo , L. 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IEEE Trans. Neural Syst. Rehabil. Eng. , 24 , 682 – 691 . Google Scholar Crossref Search ADS PubMed WorldCat A. APPENDIX Appendix 1. Practitioners and parents’ feedback on use, purpose and future enhancements to current technology Practitioners Parents Types of technology used by parents and practitioners  TV 0 29  Desktop computers 16 7  Laptop computers 2 3  Smart phones 5 21  iPad/android tablets 12 8 Purpose of using technology by parents and practitioners  Communication 3 1  Academic 4 16  Fine-motor skills 6 -  Sensory 7 11  Social 1 -  Engaged with children 12 -  Motivate and reinforce children 5 4  Baby sitter - 5  Avoid tantrums - 5  Organize activities 1 -  Distract the child (i.e. feed the child and waiting in line in the hospital) - 10  Settle down the child 6 2 Future expectations in technology for children with ASD in Sri Lanka  Application supporting native language and Sri Lankan cultural context 8 16  Application facilitating group work and collaboration 8 5  Functionality to teach facial expressions and social cues (e.g. understand different facial expressions, understand social cues from video/audio clips) 2 4  Simplicity with natural images and sounds 3 7  Customization 6 12  Functionality to teach actions in different forms (e.g. different ways of eating, laughing etc.) 6 10 Software programs to monitor a child’s progress and predict and deliver educational contents on a child’s progress 4 7 Applications with slow-motion videos - 3 Practitioners Parents Types of technology used by parents and practitioners  TV 0 29  Desktop computers 16 7  Laptop computers 2 3  Smart phones 5 21  iPad/android tablets 12 8 Purpose of using technology by parents and practitioners  Communication 3 1  Academic 4 16  Fine-motor skills 6 -  Sensory 7 11  Social 1 -  Engaged with children 12 -  Motivate and reinforce children 5 4  Baby sitter - 5  Avoid tantrums - 5  Organize activities 1 -  Distract the child (i.e. feed the child and waiting in line in the hospital) - 10  Settle down the child 6 2 Future expectations in technology for children with ASD in Sri Lanka  Application supporting native language and Sri Lankan cultural context 8 16  Application facilitating group work and collaboration 8 5  Functionality to teach facial expressions and social cues (e.g. understand different facial expressions, understand social cues from video/audio clips) 2 4  Simplicity with natural images and sounds 3 7  Customization 6 12  Functionality to teach actions in different forms (e.g. different ways of eating, laughing etc.) 6 10 Software programs to monitor a child’s progress and predict and deliver educational contents on a child’s progress 4 7 Applications with slow-motion videos - 3 Practitioners Parents Types of technology used by parents and practitioners  TV 0 29  Desktop computers 16 7  Laptop computers 2 3  Smart phones 5 21  iPad/android tablets 12 8 Purpose of using technology by parents and practitioners  Communication 3 1  Academic 4 16  Fine-motor skills 6 -  Sensory 7 11  Social 1 -  Engaged with children 12 -  Motivate and reinforce children 5 4  Baby sitter - 5  Avoid tantrums - 5  Organize activities 1 -  Distract the child (i.e. feed the child and waiting in line in the hospital) - 10  Settle down the child 6 2 Future expectations in technology for children with ASD in Sri Lanka  Application supporting native language and Sri Lankan cultural context 8 16  Application facilitating group work and collaboration 8 5  Functionality to teach facial expressions and social cues (e.g. understand different facial expressions, understand social cues from video/audio clips) 2 4  Simplicity with natural images and sounds 3 7  Customization 6 12  Functionality to teach actions in different forms (e.g. different ways of eating, laughing etc.) 6 10 Software programs to monitor a child’s progress and predict and deliver educational contents on a child’s progress 4 7 Applications with slow-motion videos - 3 Practitioners Parents Types of technology used by parents and practitioners  TV 0 29  Desktop computers 16 7  Laptop computers 2 3  Smart phones 5 21  iPad/android tablets 12 8 Purpose of using technology by parents and practitioners  Communication 3 1  Academic 4 16  Fine-motor skills 6 -  Sensory 7 11  Social 1 -  Engaged with children 12 -  Motivate and reinforce children 5 4  Baby sitter - 5  Avoid tantrums - 5  Organize activities 1 -  Distract the child (i.e. feed the child and waiting in line in the hospital) - 10  Settle down the child 6 2 Future expectations in technology for children with ASD in Sri Lanka  Application supporting native language and Sri Lankan cultural context 8 16  Application facilitating group work and collaboration 8 5  Functionality to teach facial expressions and social cues (e.g. understand different facial expressions, understand social cues from video/audio clips) 2 4  Simplicity with natural images and sounds 3 7  Customization 6 12  Functionality to teach actions in different forms (e.g. different ways of eating, laughing etc.) 6 10 Software programs to monitor a child’s progress and predict and deliver educational contents on a child’s progress 4 7 Applications with slow-motion videos - 3 Appendix 2. The coding schema generated from thematic data analysis FIGURE A1 Open in new tabDownload slide FIGURE A1 Open in new tabDownload slide © The Author(s) 2019. Published by Oxford University Press on behalf of The British Computer Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Technology for Children With Autism Spectrum Disorder: What Do Sri Lankan Parents and Practitioners Want?
JF - Interacting with Computers
DO - 10.1093/iwc/iwz020
DA - 2019-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/technology-for-children-with-autism-spectrum-disorder-what-do-sri-0xvsmPHcBa
SP - 282
VL - 31
IS - 3
DP - DeepDyve
ER -