The Use of Technologies Among Individuals With Autism Spectrum Disorders: Barriers and Challenges

Abstract

Despite the rapid growth in development of technology, such as software or hardware devices, its implementation among stakeholders working with individuals with autism spectrum disorder (ASD) is slow. This suggests that there might be a number of challenges that hinder technology adoption or its continued usage. The current project aimed to investigate stakeholders’ perceptions on potential barriers in adopting technology. We involved 17 stakeholders, including parents of children with ASD, service providers, and administrators of ASD organizations, in interviews. Thematic analysis yielded three themes: (a) making the right choice, (b) apprehension and concern about uptake, and (c) external obstacles to implementation. This project was the first study to involve key stakeholders to determine components that take place in utilization and adoption of technologies in the field of ASD.

Keywords

ASD stakeholders technology adoption barriers qualitative study

Autism spectrum disorder (ASD) is a neurodevelopmental disability characterized by impairments in social communication and atypical motor behaviors (American Psychiatric Association, 2013). The prevalence of this disorder is on the rise, currently affecting about 1 in every 59 children (Baio et al. 2018). Individuals with ASD may have difficulties understanding social cues, identifying emotions, and showing appropriate responses (American Psychiatric Association, 2013). They often consider concrete and literal meanings of words rather than interpreting contextual meanings of conversations (American Psychiatric Association, 2013). These characteristics affect their ability to develop or maintain peer relationships and engage in social groups.

Educational and behavioral interventions have been usually used to manage symptoms observed in individuals with ASD (De Boer-Ott et al., 2004). These interventions are often geared toward addressing social and communication problems in populations with ASD. Implementation of these programs may require family’s motivation and monetary support, which sometimes makes it difficult to continue for those with limited resources (Croen, Najjar, Ray, Lotspeich, & Bernal, 2006; Jacobson & Mulick, 2000). Taking advantage of technologies can help support the delivery of services.

Many individuals with ASD show a special interest in using computer-based programs (Cobb et al., 2002; Moore, Cheng, McGrath, & Powell, 2005). These programs provide a virtual environment in which children with ASD can explore and learn new skills. In addition to easy access to these programs in order to reduce the cost of therapy, they can offer advantages with respect to the core deficits of ASD. These virtual environments are usually devoid of cognitive demands that are evident in real world and can provide consistent and predictable stimuli to teach social skills (Grynszpan, Weiss, Perez-Diaz, & Gal, 2014). Reducing distractors and displaying visual or auditory cues to direct attention on a specific task can help individuals with ASD build skills at their own pace (Golan & Baron-Cohen, 2006; Moore, McGrath, & Thorpe, 2000). These programs allow individuals with ASD to bypass the complexity of real social contexts and gradually learn skills in a controlled environment.

Previous studies have shown that technology-based programs can address diverse needs of individuals with ASD, including academic skills, functional behaviors, initiating conversations, emotion recognition, and daily tasks (Bölte, Golan, Goodwin, & Zwaigenbaum, 2010; Grynszpan et al., 2014). For example, speech-generating devices allow individuals with little or no communication abilities to communicate independently and to scaffold their skills. Tablet, smartphone, or iPad programs can provide the opportunity of learning functional or academic skills. In addition to a platform for building skills, these technologies can offer potential to those individuals with ASD who require augmentative and alternative communication (McNaughton & Light, 2013). While the acceptance of technologies has increased among practitioners and families, these technologies have not been fully adopted by practitioners working with individuals with ASD (National Autism Center, 2009). This raises the importance of identifying the barriers that are inherent in adoption or continuation of using technologies.

Lack of usage or discontinuation of a technology can be due to inefficiency of the program (Riemer-Reiss & Wacker, 2000; Rogers, 1995) or concerns on the degree of transferability of learned skills in virtual environments to real-life settings and dependency of children with ASD in using these technologies (Bölte et al., 2010; Pennington, 2010). Although research in the field of ASD is rapidly expanding, we should acknowledge that due to the multifaceted nature of the disorder, there is still a lack of understanding on cost-effective analysis of interventions for each ASD phenotype (Amendah, Grosse, Peacock, & Mandell, 2011; Moldin & Rubenstein, 2006). In addition, due to varieties of information sharing platforms, distinguishing legitimate information might be challenging (Dobbins, DeCorby, & Twiddy, 2004; Dunn & Laing, 2017). While some technologies have shown effectiveness in skill acquisition among children with ASD (Moore et al., 2000; Pennington, 2010), what is not clear yet is what elements play pivotal roles in making decisions for the uptake of a technology-based intervention in children with ASD (Moore et al., 2000; Ploog, Scharf, Nelson, & Brooks, 2013; Riemer-Reiss & Wacker, 2000). As there is a plethora of research utilizing technology, understanding the elements that govern the uptake and implementation of novel devices or developed software among stakeholders in the field of ASD is warranted.

In our review of the literature, we found no study that investigated barriers in adopting technologies among individuals with disabilities or ASD from multiple viewpoints. Given that there is a dearth of information on challenges faced by stakeholders in using technologies, shedding light on the factors that prevent stakeholders from adopting technology is warranted. This study aimed to uncover attitudes and perspectives in adopting technology-based interventions among stakeholders in the field of ASD. Such information can help researchers and professionals to gain a better understanding of barriers and how they can address them to support individuals with ASD. Our research question was: “What are the barriers in using technology among stakeholders working with individuals with ASD?”

Method

Research Design

This project was a qualitative study using interviews with stakeholders in the field of ASD, including administrators of ASD associations, parents of individuals with ASD, educators, and clinicians working with people with ASD in order to uncover factors contributing to technology adoption in the field of ASD. This study adopted interpretive description approach informed by constructivism to collect and interpret data (Thorne, 2016).

Participants

We involved 17 stakeholders, including parents of children with ASD, service providers, and administrators of ASD organizations, in individual or paired interviews to understand their perspectives on factors that impede uptake of the technologies in clinical settings. All participants had to be able to understand written and spoken English. Inclusion criterion for parents was having a child diagnosed with ASD under 16 years old. Inclusion criteria for service providers were (a) having worked at least 1 year with children with ASD and (b) belonging to a licensed/recognized profession working with children with ASD, such as occupational therapy, special education, speech language pathology, or behavioral consultant. Inclusion criterion for administrators was having worked at least 1 year in managing an ASD organization or being involved in decision-making process. We wanted to have broad perspectives and collect input from various stakeholders with diverse backgrounds. Therefore, we did not limit the inclusion criteria to specific age, particular profession, or time spent using technology. Participants were selected through convenience sampling via e-mail and printed posters sent by public or private community-based organizations, health organizations, and networks supporting families of children with ASD across British Columbia, Canada. They were also recruited via snowballing recruitment (i.e., asking participants to pass along information to other potential participants).

Participants included 17 key stakeholders, who self-identified themselves as 4 parents of individuals with ASD, 10 service providers (7 clinicians and 3 special educators), and three managers of ASD organizations. Among clinicians, there were five speech language pathologists, one occupational therapist, and one psychologist. One of the self-identified parents worked as a clinician and one of the self-identified managers had a son with ASD. Most of the participants were Caucasian, and two speech language pathologists self-identified as being Asian. The majority of participants reported that they lived and worked in urban areas, whereas two speech language pathologists and one especial educator stated that they worked in rural areas (see Table 1 for participants’ demographic information).

Table 1.

Demographic Information of Participants.

Participants Group	Number	Sex: Male/Female	Age: Mean (SD)	Work Experience: Mean (SD)
Service providers	N = 10 (7 clinicians and 3 special educators)	2/8	47.44 (15) years	20.3 (14.4) years
Administrators	N = 3	1/2	51 (11.5) years	10.5 (13.4) years
Parents	N = 4	0/4	45 (7) years	—

Of all 17 participants, 12 reported to use technology for children with ASD about 0–4 hr per week and 2 participants (i.e., 1 parent and 1 clinician) spent about 5–9 hr per week. The remaining three participants (i.e., one parent and two clinicians) reported to use the technology for 10–14 hr, 15–19 hr, or above 20 hr per week. This demonstrates the various level of technology usage among participants of the study, indicating the heterogenous sample.

Procedure

We conducted meetings face-to-face, over phone, or Skype, at the time and place agreed by participants. Overall, 13 individual interviews and 2 paired interviews (interview with two people in one session) were conducted. Paired interviews allowed participants to generate ideas and exchange information through discussion, but scheduling was challenging due to participants’ time conflicts. Of all the meetings, six were conducted face-to-face, eight over phone, and three via Skype.

As the term “technology” is broad, and people may have different ways of understanding it, in this study, we shared with the participants our definition of the term prior to the interview. We defined technology as the products that may be used in therapy or education to support children with ASD. This includes, but is not limited to, any types of programs that are being offered on platforms, such as tablets, iPads, smartphones, computers, virtual realities, robots, and augmented realities. We used a semistructured interview guide, including open-ended questions and related probes to facilitate discussion. Our interview questions were as follows: (1) What are the barriers in adopting novel technologies in the field of ASD?, (2) What factors can determine application of new technologies among individuals with ASD?, and (3) What do you think or perceive about tensions that exist in adopting assistive technologies among stakeholders with ASD?

Each interview lasted 1–1.5 hr. The interviews were audio-recorded, with additional field notes taken by the interviewer. We replaced all participants’ names with pseudonyms to maintain confidentiality.

This study was approved by the University Behavioral Research Ethics Board. Informed consents were obtained prior to participation in the study.

Data Analysis

Interview audio-recordings were transcribed verbatim. One researcher listened to all the recorded files and double-checked transcripts to ensure accuracy. To analyze data, we used thematic analysis and the constant comparative method to identify similarities and differences in concepts (Boeije, 2002). Two trained research assistants independently coded the findings. Then, they grouped similar concepts in categories and developed themes in consultation with the first author. Any disagreements were resolved during several meetings and the discussion continued until the consensus was reached.

We used two main trustworthiness strategies: reflexivity and triangulation (Creswell & Miller, 2000). Prior to data collection and analysis, we wrote down our assumptions about potential responses to the interview questions, with the intention of having insight into our unconscious biases. During the data analysis process, we used triangulation by involving three members of our team (P.G., T.J., and J.Z.) and having multiple viewpoints in interpreting findings for confirmatory purposes. We asked these members to review findings and ensure that all data were captured by our themes (Hammell, 2002).

Results

Information gathered from the interviews with families of individuals with ASD, clinicians working in the field, and managers of ASD organizations yielded three themes with regard to factors contributing to technology adoption: (a) making the right choice, (b) apprehension and concern about uptake, and (c) external obstacles to implementation.

Making the Right Choice

Participants reflected on the challenges in selecting an appropriate technology, including being evidence based, being effective in meeting the treatment goals, and having reliable and easily accessible information about the technology.

The majority of stakeholders stated that one of the main barriers in selecting a product is finding the relevant information to prove that the product is evidence based, with research supporting the benefits among the population with ASD. For example, Gina, a clinician, stated, “I think first of all, the foundation of it [technology] has to be research-based, has to be evidence-based with reliable research.” However, the technology is not always supported by evidence, and the problem is that research process is slow and quite behind the current needs. This can be illustrated in Shandra’s quote, as a parent, when she stated, “I think that as a parent you see the time running out, you see? Okay we don’t have all the time in the world to wait for this research, we need to start doing [things], so the research is going to have to catch up.” This aspect may result in trying out some technology devices that are still in research and testing stages. Brook (clinician) said, “I know of a number of private clinics and clinicians that don’t, that they’ll use various assistive technologies, I guess, that aren’t evidence-based.”

Participants indicated that another challenge is delineating how the technology can meet therapeutic goals and how the outcome is aligned with what they hope to achieve. Tiffany, a clinician, described, “I have to see that it [technology] actually is targeting what I need to target with the student, so I don’t give technology for the sake of giving technology, or I don’t recommend technology just because it’s technology.” Similarly, Gordon, an administrator of an autism organization, claimed that the efficiency of a technology is the critical point in making the decision to use and purchase it. This implies that one of the challenges is lack of information on the efficacy of using a particular technology. He shared, “If someone’s going to buy something, it has to be useful, or they’re not going to buy it. So, if you want to translate knowledge [share information about technology], you’re going to have to give me something that I can use.” One participant highlighted values in effectiveness of a product compared with its innovative aspects. She stated that effectiveness is the primary element that sometimes is overshadowed by innovation, affordability, and accessibility of technology. Rachelle, a clinician, stated, “It’s like going to a doctor’s office and getting a medicine that’s not really going to work, only because it’s the new medicine and everyone thinks it’s great, it’s super affordable, but if it doesn’t work, then why are you taking it?”

Another main factor in selecting a suitable technology among stakeholders is access to reliable information about the products or options that are available to inform their decision. Sophia, a clinician, stated, “The biggest thing is they [stakeholders] would need to find the app. Do they hear about it and try it?” Similarly, Tiffany, a clinician, reflected on her role in informing families. She said, “I know where to go to get the information I need, but maybe helping parents and people outside institutional settings, how do you help them understand what the assistive technology can do.” This demonstrates that information sharing about the potential applications of technology among individuals with ASD would facilitate the selection process. Rachelle, a clinician, identified some selection biases related to high-tech versus low-tech devices due to advertisement. She stated:

Stakeholders, administrators, or parents don’t often understand what a low-tech device is, because it’s not marketable, it’s not in the media, it’s not covered, it’s not mainstream.…Because of that, people will probably gravitate towards the high-tech device.

This illustrates that increasing awareness and knowledge of alternatives would mediate the selection process. Sharing reliable and valid information about novel technologies and their effects among families and clinicians can facilitate the uptake of a suitable product.

Apprehension and Concern About Uptake

Participants indicated that some of the challenges are due to their feeling of being concerned and uncertain about using a technology. These concerns include potential fear, getting the child dependent on the device, and concern about the generalization of skills.

Lack of interest in using technologies can be due to existing fears among stakeholders on whether using these devices is safe. Given that the cause of autism is unclear and existing assumption about the screen time exposure and autistic symptoms, there are concerns to try new products. This can be illustrated in Zoha’s quote, a clinician, who compared technologies to vaccination and fears associated with it:

I think that some of the people who are afraid of technology would want to avoid that further exposure in their children. So, there’s that side of things, just how some people are not immunizing their children because they read a research study once upon a time that links the MMR vaccine and autism. So, because the cause of autism is unknown there’s still so much fear around the cause of it, and so families are having the belief and then potentially avoiding technology because of that.

Likewise, Barbara, a clinician, who is also a parent of a child with ASD, underscored the lack of knowledge and how it affects the decision. She stated that the lack of information or presence of false beliefs among some of the stakeholders can prevent them from approaching the technology, even those products that have been shown to be safe: “It is just not even knowing how, come on people! It’s science (laughs), we have some people who are afraid of the radio waves, I’m like, really? How did you get that Bachelor’s degree?”

She later pointed out that the existing fear might be because stakeholders try to manage the child, rather than letting technology do this. She mentioned that sometimes technologies as nonhuman devices get out of control, which induces concerns among stakeholders. She said, “I guess, the fear of not being in control. The fear of somebody else controlling your child, especially some non-human…. Yeah, fear of not being in control, and its illusion anyway.” Similarly, Gerald, a special educator, mentioned that nonhuman devices are not easily accepted as illustrated below:

I think they [stakeholders] feel threatened, they’re human. We feel threatened by the fact that you [technology] know more than I do, and there I’m going to look like a dummy, so I’d rather not have you in my class. It’s human nature. We need to suspend our egos, that silly ego of ours really does get in the way, doesn’t it?

Concerns in uptake of a technology, especially those that are unfamiliar to stakeholders, may be due to the fear of moving outside of one’s comfort zone. This is exemplified in Tiffany’s (clinician) comments:

But I think even like a real simple technology for some people who are not that oriented to technology, I think it’s a little scary. I think that there’s a fear thing in there because we’re asking them to step out of their comfort zone and use something that they’re not that comfortable or familiar with. [If] you ask me to walk along the cliff with a river down below, I’m really going to be scared. That [technology usage] could generate the same kind of reaction.

This demonstrates that a personal sense of security might be involved during the decision-making process of using a technology among stakeholders.

Most stakeholders identified some concerns about getting the child with ASD to become too dependent on technology. For example, Zoha, a clinician, said, “Kids with autism love technology, actually too much. They spend a lot of time on screens, yet there are many great tools out there, that it’s a fine line, because some kids are becoming addicted to screens.” Similarly, Tiffany, a clinician, pointed out that “I think for some families, there is also a concern that the child will become dependent on the technology.” Gina, a special educator, while acknowledging the technology, was reluctant to use it with clients to avoid dependency of the child on using such devices:

I personally believe this [technology], and I use technology even for myself, but for my students, I feel like I kind of want to steer away from technology because I feel like we’re too dependent on technology in terms of, I mean I haven’t done a whole lot of research on this, but in terms of knowing what they’re talking about now in terms of social media, and technology addiction and video game addiction, so I can see that that could be a problem especially.

Thus, stakeholders identified the need to verify the right amount of technology usage. Gerald, a special educator, brought up this uncertainty in the discussion when he queried that: “How much technology do I use? How much is enough? How much is too much?” These questions show that uncertainty in the adequate amount of using a technology may affect its adoption.

Another factor in being reluctant to use a technology is attitude toward the technology and whether it can solve all existing problems of individuals with ASD. Denise, an administrator of an ASD organization, stated, “Some things are hyped, you know, this particular technology or medication or special inserts for your shoes will be the answer to all of the problems that one faces in autism.” Setting reasonable expectations during taking up a technology were stated by Lucas, a clinician: “They’re [some stakeholders are] hoping it’s [the technology is] basically a panacea for everything, but they need to know exactly what it can do, and what it can’t do.” He later discussed the diversity among individuals with ASD and various needs that cannot be addressed by only one type of technology. He stated that there is not yet a universal product that can work for everyone:

What product works for everybody? Air [laughs]. Not a product yet. Water’s getting to be a product [laughs]! No, but, so which of the devices are we talking about that’s good for everybody and good under all circumstances? For whatever it is that ails you, right? There isn’t anything.

Stakeholders also mentioned that there are doubts and ambiguity in whether children with ASD can generalize learned skills from the technology to real life, which affects using the technology in practice among stakeholders. Rachelle, a clinician, mentioned, “I know that sometimes with colleagues, they’re not fond of certain programs that districts are using. Even if there is research to support that it works, they don’t like it, they think it doesn’t generalize to natural settings, so they’re almost questioning why we’re doing it at all.” Similarly, Gina (clinician) emphasized the real-life communications to function in the society:

If you’re talking about virtual reality…, it can be really great and it could teach them [children with ASD] something, but at the end of the day, it’s not real life, and if you can only learn that way or you can only generalize your skill in that situation, then that wouldn’t be effective. Because if you’re not able to connect with people in real life versus through virtual reality or versus online gaming or texting or social media, then you’re still not able to function in society the way that we’re trying to teach students to do.

Likewise, Tiffany, a clinician, focused on communication and highlighted the importance of face-to-face interactions to teach communication as opposed to virtual interactions that technology offers:

My job is to teach kids communication, and I really struggle with that concept of technology being part of that process, because communication is face-to-face between two people. So, when it comes to technology, that’s the piece that I really struggle with….You can’t replace the face-to-face contact with the kids, and I’m teaching them the kids face-to-face.

These illustrate that although technology can provide a medium for managing some symptoms in individuals with ASD, its extent in which it can offer benefits is unclear. Implicit concerns and assumptions might play significant roles in making decisions of whether the technology, what types, how, and when it can be used.

External Obstacles to Implementation

Stakeholders identified the external barriers that might impede utilization of a technology. These include financial burden, time to invest, and technical support during implementation process.

Many of the barriers experienced by stakeholders to adopting a technology had external origins. Financial burden incurred by the stakeholders might overshadow other existing hurdles. For example, Tiffany, a clinician, said, “In school systems, everything is about money, everything. Because there’s never enough to go around. If there was lots and lots of money for school systems, we would have all the technology we ever wanted. Truly, money is the first and biggest barrier in public schools.” Shandra, a parent, stated that because the budget might be a barrier, school staff might not be transparent with families. However, families are willing to cover the cost if the program is useful:

I think a lot of it has to do with money, maybe not the funding, and not [school staff] wanting people to ask, because then it’ll have to be funded, and there’s no funding for it, so it’s a lot of funding I would say. Whereas I think many parents would say I’m willing to pay for that, if it costs money, we’ll pay for it, if we need it. For “us,” it’s not money, it’s [that] we just need to have it, we need to do it. That seems to be a barrier, hiding things because it costs money.

Sophia, a clinician, confirmed that the cost is a barrier but reflected on how this cost has decreased in the last few years: “There is the cost, but the cost is actually much lower than what augmentative communication was before, so that’s not a barrier.”

Stakeholders explained that to implement a technology, they need to invest time, which may be another obstacle. Rachelle, a clinician, described that usually clinicians have a lot on their plate: “Educators don’t have a lot of time to reflect on their practices, and what that does is [it] creates kind of a loop where they’re short for time so they’ll do what they can to get their work done or in a clinical perspective to do whatever practice there is that’s been going on.” Zoha (clinician) described how her own practice in which she asks clients to bring their iPads becomes time-consuming:

It is amazing how many times I tell families to bring their iPad to the session so that I can upload an app for them and help them in that way, and they forget, so I have to remind them, I’ll text them, I’ll email them, and they show up to the appointment, “Oh we forgot the iPad!” So, it’ll take me like a month of seeing their kid weekly until I can get a hand on their iPad.

Sophia, a clinician, pointed out that she prefers to use a technology that takes less time for her to figure out how it works in comparison to the ones that are complex. She stated:

I find that, for instance, all the new apps that are out [there] are fairly overwhelming, especially more complex apps that you have to spend time learning how to use them. I find I download a lot of them onto my iPad, and I don’t use them because I don’t have time or motivation to figure them out.

As another factor, participants stated that having the technical support to enable them to use the technology in fixing the system or downloading the programs is critical. Barbara, a parent who is also a clinician, said:

The keeping up with the technology, technology changes so fast, and what do you mean I have to wait 3 months until the technology people can come in and fix it or just download the program to my computer, right?

Similarly, Tiffany, a clinician, stated that a delay in having the technical support to make the system ready to use led them to face challenges during implementation. She mentioned: “This year my boss ordered the SLPs [speech language pathologists] in our district, we each got a brand new iPad, but they sat on her desk for 6 months, we didn’t get them until about 2 weeks ago, because the IT guys couldn’t come to set them up. So, have I been able to use that iPad to work with children? Absolutely not!” Lucas, a special educator, elaborated on the necessity of having the technical support to maintain the functionality of the system for service providers:

I think the understanding of how much or type of support somebody who is using assistive technology might need in order to actually keep it functioning properly is huge. Most of the guys that I work with by themselves can use the technology, but can’t manage the technology, like putting new items into, reorganizing things, and things like this that they would need to have somebody fix it, I mean some of them even when the batteries go out don’t know what to do.

These quotes illustrate that external barriers including time, monetary resources, and technical support to use the technology and maintain its functionality play pivotal roles in making decisions in adoption or discontinuation of technology.

Discussion

Technology can serve as a powerful tool, potentially to enhance social skills and function among individuals with ASD. Despite the rapid growth in development of technology-based programs, its implementation in educational and therapeutic settings among individuals with ASD is slow. Slow adoption of technology suggests that there might be a number of significant challenges that hinder technology adoption or its continued usage. This project is the first study to investigate stakeholders’ perceptions on potential barriers and challenges they confront in the uptake of a technology in the field of ASD. Our findings provide new insight into contributing factors and perceived barriers in the usage of technology for individuals with ASD in three main areas, including making the right choice, apprehension and concern about uptake, and external obstacles to implementation. These barriers are intertwined together and affect the decision-making process in adoption, continuation, or discarding of a technology in the field of ASD.

Participants highlighted the importance of selecting the right technology for individuals with ASD. Knowledge of the available resources and accessibility to the information would create an environment where stakeholders can explore, identify, and select the best options that fulfill the clients’ needs (Gamble, Dowler, & Orslene, 2006). With the advancement of technology, it is challenging to keep resources updated and reliable to help stakeholders with the process of decision-making (Dobbins, DeCorby, & Twiddy, 2004; Dunn & Laing, 2017). To be able to select a suitable technology in practice, interpretation of research findings is required. However, not every stakeholder, parent, or clinician is equipped with the skills to critically appraise the literature (Straus, Tetroe, & Graham, 2009). Thus, disseminating information and knowledge through various strategies, such as involving knowledge brokers or researchers, using lay language in communication, and making the information accessible for stakeholders, would facilitate the process of identifying the suitable option (Scott et al., 2012).

In addition to the availability of the information, stakeholders underscored the necessity of research and quality of evidence as a critical step in the uptake of technology. According to the literature, perceived usefulness is considered as a key determinant to implement the technology (Davis, 1985). While there is some evidence demonstrating the positive effects of technology for individuals with ASD, the sample size was relatively small (Golan et al., 2010; McNaughton & Light, 2013). Due to diverse symptoms and a wide range of functionality of individuals with ASD, the extent to which potential benefits can be achieved through using various technology-based interventions is unclear. This uncertainty makes the process of identifying the best option difficult among stakeholders working in the field of ASD. Thus, further research is required to investigate the effectiveness and relative cost-benefit analysis of using various technology-based interventions, compared with other therapeutic approaches for individuals with ASD (Jacobson & Mulick, 2000).

Stakeholders indicated that existing concerns and fear of potential side effects might contribute to the reluctance in the uptake of technology in the field of ASD. According to social learning theory, beliefs and attitudes might be influenced by the society (Rosenstock, Strecher, & Becker, 1988). Some stakeholders identified that technology-based approaches may intensify the social disability of individuals with ASD as they would over-rely on the simulated interaction, which would consequently decrease real-life communication and lead to further isolation. However, it has been shown that taking advantage of using technology that motivates individuals with ASD and offers an active control over the interaction may help increase their confidence and enhance outcomes (Parsons & Cobb, 2011). Individuals with ASD can learn concepts through technology-based programs and can apply the learned skills in real-life situations to the extent that they are similar to the program (Parsons & Cobb, 2011; Parsons & Mitchell, 2002). While technology indeed has its own limitation, these concerns or unwillingness can be in part due to insufficient evidence and/or not feeling the necessity of having technology in place when the common behavioral approach is working.

As participants expressed, if technology is considered as a novel tool, it should be consistent with the values and needs of end users for being adopted. Based on the diffusion of innovation theory, the relative advantage, complexity of the device, and compatibility with users’ experiences play a pivotal role in using a technology (Kaminski, 2011; Rogers, 2003). Considering the sensitive role and responsibility of stakeholders in the education and therapy of individuals with ASD, technologies should be tested and the results should be available to stakeholders prior to any commitment to use it. This project shows that lack of information about tangible outcomes and personal attitudes would influence the decision whether or not to use technology. However, the changes in end users’ attitudes do not necessarily facilitate the uptake of technology (Scott et al., 2009).

Participants stated that successful implementation of technology is also influenced by external factors. They emphasized the necessity of having the support to help them with technical issues and troubleshooting the systems because they do not necessarily have the required skills and expertise. Consistent with the unified theory of acceptance and use of technology, effort expectancy and perceived ease of use would facilitate technology adoption (Venkatesh, Morris, Davis, & Davis, 2003; Venkatesh & Davis, 2000). Stakeholders outlined a few other obstacles, including monetary resources to purchase the technology and time to use it. When talking about the finances and time, the relative values should be considered (Jacobson & Mulick, 2000). Some countries such as Canada have federal policies and offer funding to support stakeholders who work with individuals with ASD in purchasing technology. However, the time required to learn and implement the technology is still a potential barrier. Thus, access to technical support to install the software, upgrade the system, and configure and solve potential problems can facilitate the process.

Because of profound distribution of technology and its potential effects in various settings, it is important to know how to support parents, service providers, clinicians, and administrators in making the best choice. Researchers can provide clear and accessible information to facilitate the selection process. Administrators and policy makers in the field of ASD should be aware of unconscious and conscious biases, as well as internal and external barriers that might affect the decision-making process during the technology uptake in health-care settings. The identified factors have implications during commercializing effective programs and/or facilitating the uptake of appropriate technologies in the field of ASD.

Limitations and Future Direction

Several limitations should be considered when interpreting the findings. First, the convenience sampling and small sample size from each group of stakeholders should be discussed. Although this project provides preliminary insight, the convenience sampling and sample size might affect transferability of findings and it leaves a question on how it is representative of the broader population. Second, we were limited in our ability to schedule all meeting face-to-face due to far distances and/or participants’ preference in meeting remotely to save time. Face-to-face meeting would help easier communication and can enrich the study. Third, we endeavored to minimize biases associated with the group in which stakeholder belong to by asking stakeholders to self-identify their group. However, there were some overlap among stakeholders’ roles that make distinguishing perspectives difficult. Having in-depth perspectives from each group of stakeholders might highlight the nuances of barriers that are specific to that target population. Exploring these nuances can be considered in future studies. Fourth, majority of our stakeholders were Caucasian, which might overshadow the perspectives from various ethnic backgrounds, including those who belong to minorities or Indigenous groups. Given that barriers may be different in different regions or in different countries, future studies need to be conducted with larger sample sizes, diverse demographic backgrounds for each stakeholder, and from various geographical locations to further identify barriers in using and implementing technology for individuals with ASD. It is also suggested to identify how these barriers interact with each other and what resources and strategies can help address the challenges from perspectives of each group of stakeholders.

Conclusion

The recent revolution of technology and its accelerating development affect everyday life. Despite the proliferation of technology, not all stakeholders gravitated toward using technology-based interventions for individuals with ASD. The gap between the research and practice calls for the necessity of delineating potential factors that contribute to decision-making process. This project was the first study to involve key stakeholders to determine components that take place in utilization and adoption of a technology in the field of ASD.

Footnotes

Acknowledgments

We would like to express our sincere thanks to funding agencies, the Michael Smith Foundation for Health Research and Peter Wall Institute for Advanced Studies for their great support.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This article received funding from Michael Smith Foundation for Health Research and Peter Wall Institute for Advanced Studies.

ORCID iD

Parisa Ghanouni

Jill G. Zwicker

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