iPods as the Next-Generation Autism Aid

How apps designed to make all of our lives easier can be co-opted to help adults with autism thrive in the workplace.


The tasks required of Jeffrey by his minimum wage job at a fast food restaurant were not beyond his physical or mental capacities to complete -- he was responsible each day for emptying garbage cans, wiping down tables, sweeping, stocking condiments, and cleaning the bathrooms. But a case study published in the Journal of Vocational Rehabilitation describes how, as a 21-year-old with autism, he required the near-constant supervision of a job coach to prompt him to rotate between his different duties and to help him remember the steps involved in each task.

As Steve Jobs himself said, by pushing past the initial complexities of a problem "you can oftentimes arrive at some very elegant and simple solutions." In Jeffrey's case, the solution was Apple's iPod Touch, programmed by an occupational therapist to guide him through the day. The iPod contained specific instructions that Jeffrey could reference when he forgot what to do, and would alert him when it was time to switch to a different task. Within a week, the two were synched.

The job coach stepped back, and a year later Jeffrey continues to excel at his job. Having the iPod as an interactive reference allows him to function more or less independently, and to feel more at ease in the workplace. His manager noted that he no longer spins in circles while humming or stamps his feet in the corner -- disruptive behaviors that he used to turn to in order to relieve his anxiety and that had been causing management to second-guess their decision to hire him.

Recommended Reading

The iPod even reminds Jeffrey that it needs to be charged each night.

Despite the advantages they can bring to a workplace, from basic productivity to, in some cases, increased ability to focus on complex and repetitive tasks, the common characteristics of autism spectrum disorder (ASD), like difficulty communicating and functioning in social situations and a reliance on routine, can make even menial labor difficult for people with the disorder, who of all disability groups are least likely to attain and keep employment. Jeffrey's case shows that technology already developed and made accessible can provide part of the solution.

Tony Gentry, director of the Department of Occupational Therapy at Virginia Commonwealth University, has been interested in how handheld computers can provide cognitive aid since the days of the black and white Palm Pilot. Back then, he was ahead of his time. Now, he is four years into a five-year study with VCU's Rehabilitation Research and Training Center of the iPod Touch as a form of vocational support for people with ASD. The case studies discussed here indicate that the results, when they're finally written up next year, will be overwhelmingly encouraging.

The Americans with Disabilities Act mandates that employers make "reasonable accommodations" for adults with autism, specified as minor adjustments to the work environment that won't cause undue hardship to the employer. For Jeffrey, something as reasonable as an iPod, which costs $190 (a job coach in the state of Virginia is paid $50 per hour), turned him into a valuable asset. He didn't even need to download any special apps -- the clock and to-do list functions that come standard with the iPod, after minor adaptations were made by a trained occupational therapist, were all he needed.

Once a job coach has programmed in the basics and helped them learn how to use it, the people presented in the case studies were able to function more independently. People with autism tend to respond well to computers, in part because of their predictability. "Symbiosis between man and machine in that population is an amazing opportunity for more focused and individual support," said Gentry. Such was the case with Lily, another young adult profiled by Gentry:

...[Lily] required direct verbal support to stay on task, to switch tasks, and to know which alternating schedule to follow each day. Because Lily takes pride in her work skills, she often became frustrated when her supervisor or job coach provided these task cues, resorting to behaviors that included throwing soft drinks, stomping, crying and phoning her mother at home. Unforeseen changes in the workday schedule also caused outbursts. These challenges made independent job performance problematic.

Having her task cues delivered by an iPod instead of a supervisor allowed Lily to both feel and be more independent. This was emphasized by a two-week period after she lost her iPod, during which she reverted to old behaviors and required an average of six hours a week of direct prompting from her job coach. Once she got a new device, the job coached logged only two hours per week, most of which only involved indirect monitoring.

Other apps not specific to helping people with autism can also, with a bit of creativity, be repurposed. Storykit, for example, was used to create talking picture books for an illiterate worker that could guide her through her tasks and provide positive reinforcement. Basic things like playing games during long commutes and listening to podcasts as a calming strategy -- as many of us do -- took on a special significance for these individuals. What these case studies show is that while our iPods and iPhones are capable of doing some pretty incredible things, there may still be a lot that we're overlooking. It raises the question of what else is already at our disposal that can be re-imagined as a potential tool for people with disabilities.

Gentry emphasizes that the device itself is not the solution -- it takes skilled interventions to build a specialized suite of apps that will work for the unique circumstances of each individual. Workplaces, too, need to be prepared to welcome employees with ASD. "That population is in real, real need of some kind of intervention or support to help them get into the workforce and succeed," said Gentry, "and at the same time we need to have the employers be a little bit more courageous, and be willing to try someone who maybe seems a little different. And that's the hard part."