Towards developing digital interventions supporting empathic ability for children with autism spectrum disorder

Abstract

It is very challenging for children with autism to express their emotions to others as well as to recognise others’ feelings accurately. As social difficulties of autistic people might aggravate their loneliness and social isolation, a holistic development is required from an early age. This study aimed to suggest a digital intervention for supporting autistic children’s empathy development by using design thinking. This study developed a mobile-interface design on the basis of the human-centred design approach, and a prototype was evaluated by stakeholders with respect to acceptability and usability. Usability was measured by twelve statements of a combination of design guidelines and the system usability scale, and subsequently, open-end interview questions were offered to collect data regarding acceptability. The separate interviews were recorded and transcribed verbatim, and thus, meaningful data were selected and clustered by themes. The result of the qualitative data analysis is represented by eighteen themes in five categories. Altogether, this research suggests a phased (bit-by-bit) strategy for teaching empathy of children with ASD through a digital intervention.

Appendix A: Requirements generated by systematic literature review

No	Requirements	Target	Author
1	The general design and the structure should be simple, clear and predictable, secondary content that distracts the user should be avoided	G	Dattolo et al. [21]
2	The content should be predictable and should provide feedbacks	G
3	Pictures should be copiously used together with redundant representation of information	G
4	Pictures can be drawings, photographs, symbolic images, should be easy to understand, should not go in the background, should be in a sharp focus	G
5	Background sounds, moving text, blinking images and horizontal scrolling should be avoided	G
6	The text should go with pictures. It should be clear, simple, and short (at most one sentence on a line); should be in a big font (14), in plain sans serif style (e.g., Verdana), in a mild colour. Headings and titles should be used	G
7	Navigation should be consistent and similar in every page/section	G
8	The website and every applications should have a simple and logical structure, the user should be able to easily navigate inside	G
9	Add navigation information and navigation buttons at the top and the bottom of the page. In case of web pages the navigation inside the site should be limited by three clicks	G
10	Allow customisation	G
11	Try to engage the user	G
12	Make adaptive the interaction with users, considering their interaction history, their preferences, requests, and needs	G
13	The language should be simple and precise	G
14	Acronyms and abbreviations, non-literal text, and jargon should not be used	G
15	If the learners have some information about the subject in this is case must use or received graphic or graphic after the text, but if they don’t have low knowledge in this case must use picture before text	G	Omar and Bidin [71]
16	When pictures and texts were used together with autistic children, the size of the fonts needs to be between 10 and 14	C
17	The font size of 16 is essential when the words comes alone with no accompanying pictures are used the size range of certain fonts between 12 and 14 point	C
18	Being good examples of rounded fonts which have enough space between letters, the appropriate font types can be Arial, Comic Sans, Verdana, Helvetica, Tahoma, or Trebuchet	C
19	Autistics are very sensitive to certain colours they make highly respond such as (blue, dark yellow and green) these colours work as a positive effect have motivated them	G
20	Autism children are more looking to the coloured than the shapes	C
21	Use contrast between font and background	G	Pavlov [73]
22	Use soft, mild colours	G
23	Make sure text box is clearly separated from the rest	G
24	Present text in a single column	G
25	Use simple graphics	G
26	Use clear, sans serif fonts	G
27	Do not use bright colours	G
28	Do not user background images	G
29	Do not overlap transparent images and text	G
30	Do not use pop-up elements and distractions	G
31	No element should stand out too much	G
32	Do not have horizontal scrolling	G
33	Strive for simple, clear navigation	G
34	Indicate on each page clearly where the user is	G
35	Support navigation with mouse or keyboard	G
36	Allow the use of browser’s buttons	G
37	Pages should load fast	G
38	Use visual indicators for time-consuming actions	G
39	Have a Help button	G
40	Do not Use complex menus	G
41	Design for simplicity and few elements on screen	G
42	Try to have one toolbar	G
43	Use clear, large buttons with both icons and text	G
44	Give short instructions of use at every step	G
45	Avoid cluttered interface	G
46	Do not use many-coloured icons	G
47	Avoid buttons with icons only, except for the most popular actions. For example, “back”	G
48	Allow personalisation of: Font type and size	G
49	Allow personalisation of: Line-spacing	G
50	Allow personalisation of: Themes for text background and foreground colours	G
51	Colours should not be the only way to deliver content and the contrast between background and objects in foreground must be appropriate to distinguish items and distinct content or relate similar information	G	Britto and Pizzolato [14]
52	Use a simple visual and textual language, avoid jargons, spelling errors, metaphors, abbreviations and acronyms, using terms, expressions, names and symbols familiar to users’ context	G
53	Be succinct, avoid writing long paragraphs and use mark-ups that facilitate the reading flow such as lists and heading titles	G
54	Icons, images and label of menus and actions should be compatible to real world, representing concrete actions and everyday life activities in order to be easily recognised	G
55	Allow colour, text size and font customisation for interface elements	G
56	Provide options to customise information visualisation with images, sound and text according to individual user’s preferences	G
57	Provide options to customise the amount of element in the interface, their arrangement and enable features personalisation	G
58	Enable a reading or printing mode for activities involving reading and concentration	G
59	Avoid using elements that distract or interfere in focus and attention. In case you use it, provide options to suppress those elements on screen	G
60	Design simple interfaces, with few elements and which present only the features and content need for the current task to be performed by the user	G
61	Use blank spaces between Web page elements to separate different contents or focus the user attention on a specific content	G
62	Provide clear instructions and orientation about tasks to ease the user understanding of the content and the content language, in order to stimulate, motivate and engage the user	G
63	The Website or Web application must not rely only in text to present content. Provide alternative representations through image, audio or video and ensure that they will be close to the corresponding text	G
64	Symbols, pictograms and icons should present a textual equivalent near to facilitate symbol understanding and contribute to enrich user’s vocabulary	G
65	Provide audio instructions and subtitles for texts, but ensure that this is not the only alternate content representation	G
66	Provide information in multiple representation, such as text, video, audio and image for better content and vocabulary understand, also helping users focus on content	G
67	Allow images magnification for better visualisation and ensure they continue to be understandable when enlarged	G
68	Avoid the use of disturbing and explosive sounds, like sirens or fireworks	G
69	Provide feedback confirm correct actions or alerting about potential mistakes and use audio, text and images to represent the message, avoiding icons with emotions or facial expressions	G
70	Similar elements and interaction must produce similar, consistent and predictable results	G
71	Use bigger icons, buttons and form controls that provide appropriate click/tap area and ensure that the elements look clickable	G
72	Provide immediate instructions and feedback over a interaction restriction with the system or a certain interface element	G
73	Provide a simplified and consistent navigation between pages, use location and progress indicators and present global navigation buttons (Exit, Back to home page, help) on every page	G
74	Avoid automatic page redirects or expiration time for tasks. The user is who should control navigation and time to perform a task	G
75	Present appropriate instructions to interact with interface elements, provide clear messages about errors and provide mechanisms to solve the errors	G
76	Allow critical actions to be reverted, cancelled, undone or confirmed	G
77	In interactive lessons and educational activities, it is recommended allow up to five attempts before showing the correct answer	G
78	Touch screen interactions should have the appropriate sensibility and prevent errors in selections and accidental touch in interface elements	G