**6. Development and preliminary results**

teachers as mediators of educative practices and count on the intense participation of family to use and adapt those strategies and resources [32, 34, 59, 60]. On the other hand, research trajectory involves several investigation projects developed by the research group in different spaces and moments, with points of intersection and team consolidation through regular meetings to keep investigation on track. Spiral development starts from a deep analysis of existing systems9 adding to the results of the multi-case researches, which gradually informs

From a technological standpoint SCALA has as its main features, a module for building communication boards, a module for the construction of stories, and a module for free communication. It also encompasses common application features such as the ability to import files, edit sounds, save, export, and manage the various files generated by the system (Figure 2). The menu on the left to the user presents the categories of images that can be used with all

From a predefined layout one can fill each card by clicking on the categories of images. Each image has a caption pattern which can be edited. For each card it is possible to record sounds and hear them. If the user does not want to record a sound, a speech synthesizer will read the

In addition to the existing images in the system, it is possible to add personal images allowing customization and adaptation to the sociohistorical context of the user. Finally, the last feature designed was the animation of actions. This feature was introduced as empirical studies have shown evidence that animated actions may be more suitable to forge understanding of

SCALA is currently available for two platforms (web e android), which allows its use with

(a) board module (b) story module (c) story module (editing)

9 The main softwares available in the market have been explored, for example, Amplisoft, Boardmaker,and other free systems whose traits concerning interaction and narrative building were relevant to think about the system's require‐

ments. A complete synthesis of such assessment was developed by [35] as part of her masters research.

the construction of requirements for the system and is constantly adjusted.

668 Recent Advances in Autism Spectrum Disorders - Volume I

the three modules and the horizontal menu bar displays the features.

caption (otherwise, the sound recorded by the user will be supplied).

mobile devices. In the next session, some preliminary results are presented.

metaphorical and symbolic elements with autism [46, 61, 62].

**Figure 2.** Board and Story modules in the version for Android for tablets

In the session, an extract of some preliminary results of our research is presented. It comprises the period of time raging from August 2011 to May 2012. The subjects are three non-verbal children diagnosed with autism aged 4 years old. Three contexts have been taken into account: family, school and laboratory, but, in this report, we mainly focus on the interactions in the context of the laboratory, so, just a few considerations about other contexts are referred.

Interactions have been planned upon the methodology of mediating actions, with particular focus on the promotion of scenes of joint attention in order to accomplish communication and social interaction of the subjects involved. Those interactions happened simultaneously with the three subjects once a week in the laboratory. Interactions in the laboratory took place weekly and duration was flexible in the beginning10 to adapt to the needs of individuals. In addition, there were visits to each subject's home and school followed by observation and initial guidance to mothers and school personnel. This way, the subjects' contexts encompass‐ ing greater social experiences and participation were accessed. The first contact was with the mothers, school and teachers with the distribution of some instruments for data collection11 to help set up an initial profile of the subjects.

The interventions of the researcher in the three contexts do not follow a linear fashion. Visits are scheduled according to opportunity and the needs identified in the course of the research. Interventions are filmed for later analysis and to subsidize reconstruction and development of new possibilities of interactional arrangements so as to contribute to subjects' development across contexts.

Besides the scenes of joint attention, which have been promoted as part of the methodol‐ ogy of intervention, subjects had the opportunity to interact with physical AC materials as instruments of mediation of those scenes. Then, during the first weeks, AC material employing both low and high technology was used along with other resources, as Pre‐ sented in the figure 3.

Mediating actions had a focus on the triadic interactions of the mediator with subjects and objects acting as instruments of mediation to further expand the interactions with the other subjects. With the first interventions in the lab, it was possible to establish bonds with the children and get to know their needs and potential. Furthermore, with the help of their mothers and school teachers, it was possible to outline a descriptive profile of their forms of commu‐ nication, social interaction and initial potentialities.

In spite of the same diagnosis, the three children have very distinctive characteristics within the symptoms of the syndrome and are accompanied by diverse professionals in therapeutic interventions. They are referred to as Case 1, 2 and 3 in the table 1.

<sup>10</sup> In the beginning, meetings were shorter and gradually increased in time.

<sup>11</sup> Open interviews, anamnesis and consent forms

**Case 1** Boy, 3.10 y.o., living with his parents and two older sisters; attends nursery (level 3) school in

Building an Alternative Communication System for Literacy of Children with Autism (SCALA) with Context-Centered

**Case 2** Boy, 4.2 y.o. lives with parents and a brother. Some abnormality in his development was

and psychologist. Attends nursery school in the afternoon. **Communication** Presents some language delay. It is difficult to understand what he says. Uses a proper language. Understands speech but does not engage in turn taking.

legs. Moves his hands and fingers in a strange way.

Has difficulty in sitting still or remaining in an activity. Likes to scribbles, but with no apparent meaning. Does not use any form of alternative communication.

Resists to be touched. Contact is accepted only by family members. Limited understanding of the meanings of objects or people.

Appreciates music, fascination for lights, mirrors and bright eyes.

Depends on other people to dress, undress and for hygiene. **Case 3** Boy, 3.5 y.o. lives with parents. Some abnormality in his development was noticed at the

convulsive medication. Attends nursery school in the afternoon..

wants, uses other people's arm or hand. Does not point at objects.

Shows great difficulty in demonstrating what he wants to communicate.

Does not use any form of alternative communication.

Does not get attached to his environment or shows a sense of belonging.

Hyposensitive in relation to senses, laughs for no apparent reason, shows good

age of 1.3 y.o.., neurologist attested ASD. Uses anti-psychotic (Resperidal) and anti-

Communicates through gestures with people who are familiar to him. To get what he

contrariety. Frustration is expressed through aggression (beating himself and others, pulling

Facial expressions are observed when he is displeased, cries and grumbles to show

Some abnormality in his development was noticed at the age of 1.3 y. o. as he did not show any vocabulary. ASD was diagnosed at the age of 1.9 by a team of professionals (pediatrician,

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Is in the process of toilet training and learning to dress and undress with independence.

noticed at the age of 2.3 y.o.. ASD was diagnosed at the age of 2.3 by a neuropediatrician

Facial expressions are observed when he is upset, cries and grumbles to show contrariety. Does not sustain visual contact. Knocks his head to call attention or squeezes his arms and

To get what he wants, uses other people's arm or hand. Pointing is not part of his routine.

Interaction is restricted to objects when they are interesting to him and gets attached to

the afternoon.

**Social interaction and understanding**

**Potencialities – preferences**

them.

coordination.

Likes to jump, lie on the floor and run. Food compulsiveness needs to be managed.

**Communication** Oral communication is expressed through few grumbles.

one's hair, bites).

neuropsychologist and a psychiatrist).

**Figure 3.** Example of AC material of low and high technology


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**Figure 3.** Example of AC material of low and high technology

670 Recent Advances in Autism Spectrum Disorders - Volume I

the afternoon.

Accepts touch.

**Social interaction and understanding**

**Potencialities – preferences**

neuropsychologist and a psychiatrist).

Is starting AC with speech therapist.

Can deal with changes in routine.

Does not present stereotyped behavior.

**Case 1** Boy, 3.10 y.o., living with his parents and two older sisters; attends nursery (level 3) school in

**Communication** Makes some sounds, makes meaningful facial expressions (looks) to pay attention, when he

Understands the meaning of the objects and his own existence.

Interacts when is requested to by sitting at a table.

Can hold a pencil, paints with some limitation, scribbles. Uses his index finger to point at things he wants.

Some abnormality in his development was noticed at the age of 1.3 y. o. as he did not show any vocabulary. ASD was diagnosed at the age of 1.9 by a team of professionals (pediatrician,

is called, to get to know the environment and closes his eyes in protest. He smiles to demonstrate satisfaction and joy and cries, grumbles and mumbles to show contrariety. Body expressions involve pointing and touching what he wants with his finger and waving.

Communicates spontaneously through gestures in order to have his wishes realized.

Demonstrates understanding of other people without engaging in turn taking.

Can interact with objects and other people for short or medium periods of time.

Does not react contradictorily in the presence of people who are strange to him.

Use communicative gestures through meaningful facial and bodily expressions.

Can eat with independence and can put on shoes without shoelaces.

Is fascinated by lights, fans, drains and objects that spin. Appreciates looking at the mirror.


**Figure 4.** Using different *tablet* applications

**Figure 5.** Using *tablets* with subjects with autism

in scenes of joint attention in the mediations with other subjects.

With the use of tablets, we could notice attention spans increased for all the subjects. Speech was also prompted in all mediations. So, subjects' range of vocabulary has increased. Subject 1 showed easiness with the technology and the participation as an intentional agent in mediated actions. He is currently producing more words with two syllables and participating

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**Table 1.** Initial profile of communication, social interaction and potentialities of subjects.

As can be noticed, only one of the subjects used the pointing function. Due to that, initial sessions focused on actions to make that gesture meaningful. SCALA software was used in two versions with symbols and boards with tablets. In the beginning, there was a great need to associate concrete material with the symbols in the boards and, afterwards, the gesture of pointing emerged with the fascination for the tablet technology.

The subject from case 2 accepts to be touched and soon learns to point. He also increases lateral visual contact. Although we accomplished only a few instances of mediation, he started interacting with the technological tool and increased attention span through the observation of details. On its turn, subject 1 improves pointing and eye contact and starts participating in scenes of joint attention in response to the employed mediating actions (mediator-subject-object). He soon shows great autonomy in dealing with the tablet. At last, subject 3 required more time to accept some physical contact and to fix his eyes on the activities proposed. Pointing was initially motivated by the sound produced by this touch on the screen.

Together with SCALA, several free applications have been tried with the children (Figure 4). Applications were picked according to the profile of each of the subjects and that was important to promote the appropriation and understanding of the technology, as seen in Figure 5, along with the use of AC boards (Figure 6).

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**Figure 4.** Using different *tablet* applications

**Case 1** Boy, 3.10 y.o., living with his parents and two older sisters; attends nursery (level 3) school in

Does not accept physical contact and does not make eye contact.

Keeps a fixed and strange look at his fingers and hands.

Faces difficulty to run, jump, climb and go down the stairs.

passive. Is afraid of wide spaces and symmetric floor.

As can be noticed, only one of the subjects used the pointing function. Due to that, initial sessions focused on actions to make that gesture meaningful. SCALA software was used in two versions with symbols and boards with tablets. In the beginning, there was a great need to associate concrete material with the symbols in the boards and, afterwards, the gesture of

The subject from case 2 accepts to be touched and soon learns to point. He also increases lateral visual contact. Although we accomplished only a few instances of mediation, he started interacting with the technological tool and increased attention span through the observation of details. On its turn, subject 1 improves pointing and eye contact and starts participating in scenes of joint attention in response to the employed mediating actions (mediator-subject-object). He soon shows great autonomy in dealing with the tablet. At last, subject 3 required more time to accept some physical contact and to fix his eyes on the activities proposed. Pointing was initially motivated by the sound produced by this

Together with SCALA, several free applications have been tried with the children (Figure 4). Applications were picked according to the profile of each of the subjects and that was important to promote the appropriation and understanding of the technology, as seen in Figure 5, along

Some abnormality in his development was noticed at the age of 1.3 y. o. as he did not show any vocabulary. ASD was diagnosed at the age of 1.9 by a team of professionals (pediatrician,

In some moments, he seems to "unplug" and becomes apathetic to everything and

Does not accept the mediation of the researcher and in rare moments, it happens with

Loud noises call his attention, shows fascination for lights, interest in small details of

Exaggerated attachment and attraction to certain objects, likes to spin them and does not

Changes in routine are not well accepted. Sometimes he is too active and other times too

the afternoon.

672 Recent Advances in Autism Spectrum Disorders - Volume I

everyone

objects.

**Social interaction and understanding**

**Potencialities – preferences**

touch on the screen.

with the use of AC boards (Figure 6).

neuropsychologist and a psychiatrist).

Elects small spaces to stay.

some object he is interested in.

Often puts objects in his mouth.

**Table 1.** Initial profile of communication, social interaction and potentialities of subjects.

pointing emerged with the fascination for the tablet technology.

use games properly.

With the use of tablets, we could notice attention spans increased for all the subjects. Speech was also prompted in all mediations. So, subjects' range of vocabulary has increased. Subject 1 showed easiness with the technology and the participation as an intentional agent in mediated actions. He is currently producing more words with two syllables and participating in scenes of joint attention in the mediations with other subjects.

Although subject 2 demonstrates he prefers to interact with the equipment on his own, he also starts participating in scenes of joint attention in the mediated actions. In some few instances, he initiates interactions with the other subjects spontaneously. It is possible to notice the verbalization of some isolated words and that he accepts being touched and demonstrates affection through hugs and kisses.

cognitive development of subjects with autism through the use of digital learning environment as instruments of mediation. Just as the present study, they have also adopted a sociohistorical view where mediating actions widen the level of development through the use of symbols and tools in a way that the zone of proximal development is adjusted until internalization of

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In fact, we can consider the significant improvement in both social interaction and cognitive development of subjects with autism with the introduction of technology from a sociohistorical perspective as it allows more flexible adaptive and abstraction processes with increasing levels

To sum up, it is important to highlight that developing assistive technology for alternative communication as proposed in this chapter, that is with Context-Centered Design, implicates a multidimensional process involving technological innovations, pedagogic mediation, cultural practices and contexts, as well as, specific formations pervaded by critical analysis to favor the creation of new technologies with differentiated theoretical and methodological

The introduction of alternative communication can go far beyond the specialized spaces in the scope of Health and Education, such as the rooms of multifunctional resources12, for instance. For those who need it, alternative communication is a tool to be used in varied social spaces

**•** CAPES (Coordination for higher Education Staff Development), which through PROESP (Special Education Support Program), has funded graduate students involved in this

**•** CNPq (National Counsel of Technological and Scientific Development) for research

**•** FAPERGS (Foundation of Research Support of Rio Grande do Sul) for the financial support through through the Edict Pesquisador Gaúcho 2009 that funded the development of phases

12 Rooms of multifunctional resources are equipped with diverse assistive technologies applications that are distributed by the Ministry of Education to regular public schools that serve students with disabilities or special needs through a

scholarships to undergraduate students and grants to research professors;

concepts is complete.

of complexity.

**7. Conclusion**

proposals.

and systematically in daily life.

II and III of SCALA Project; and

specialized educational support outside school hours.

**Acknowledgements**

We would like to thank

project;

Subject 3, through mediating actions accepts touch and demonstrates affection through kisses and hugs. Aggression is only expressed when he feels some pain. His interactions with the object increase and he starts participating in some mediating actions with the researcher. Only one word was said after great insistence, but the symbols of alternative communication start being understood, which is likely to contribute to his way of communication soon.

**Figure 6.** the use of SCALA with subjects with autism in the tablet and a board with symbols

The first image of Figure 3 shows one of the subjects interacting with AC software – SCALA. The second shows a board constructed with the software and meant to be used in the mediated actions. The third image is a board adopting low-technology with printed material.

Apart from the work in the laboratory, mothers were asked to use alternative communication at home. As needs came up, mothers turned to us and together we constructed boards. A tablet was purchased by two families (subjects 1 and 2), so the children started using it in family contexts too. As for schools, the teachers of subjects 1 and 2 have requested some boards to use in that environment too, but we perceived a lack of understanding about how to integrate AC in the school context. Therefore, we are providing two training courses, for teachers and assistants and for the school team.

The results referred here are preliminary as the project stretches until 2013. However, they are consistent with previous research [27, 33, 50, 63] showing relevant outcomes for the social and cognitive development of subjects with autism through the use of digital learning environment as instruments of mediation. Just as the present study, they have also adopted a sociohistorical view where mediating actions widen the level of development through the use of symbols and tools in a way that the zone of proximal development is adjusted until internalization of concepts is complete.

In fact, we can consider the significant improvement in both social interaction and cognitive development of subjects with autism with the introduction of technology from a sociohistorical perspective as it allows more flexible adaptive and abstraction processes with increasing levels of complexity.
