Three participants, two males and one female ASD children aged between 14 and 18 years took part in this study. The Childhood Autism Rating Scale (CARS) is a behavior rating scale developed by Schopler et al. [27], used to diagnose autism in children. The main purpose of the scale was to differentiate the autistic children from those with other developmental disabilities. All the participants were recruited from a non-profit organization for children with special disabilities. The main aims are to provide them with free public education as well as to teach them life skills (e.g., positive social skills and etiquette, verbal/nonverbal communication, self-confidence, overcome stage fear, work ethics, and so on). All participants had their vision within normal range and due to this reason, they were considered good candidates for learning from video modeling. Moreover, not a single child had previously received video-based instructions for learning. It was seen by informal observations that all participants had imitation skills but no official assessment was conducted.
The proposed study was concisely assessed and ethically accepted by the university ethical committee. Before the study conducted, an informed consent form was filled in and received by the caregivers of autistic individuals. As the participants are unable to read and understand the consent form, therefore, approval was received by their caregivers. Demographic information is provided in Table 1 for each participant. It includes the name, age, gender, and diagnoses. Selection criteria of participants included a few things i.e., the participant should have some knowledge of using smartphone, satisfactory vision and hearing as revealed by the school system’s hearing and vision test, IEP goals connected to self-help and vocational skills, the capability to attend a short video segment and generalized motor imitation.
Table 1
Participants characteristics
Participant
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Name
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Age
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Gender
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CARS Scale
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A
|
Annus Sajid
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16
|
Male
|
MILD
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B
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Sumama Shafiq
|
14
|
Male
|
Moderate
|
C
|
Muskan Ahmed
|
18
|
Female
|
Moderate
|
4.1 Safety Skill Task and Equipment
The focus of the intervention was mainly on instructing the participants to finish safety skill tasks related to both (a) fire and (b) rain (see Table 2). These tasks were considered important for each participant to enhance safety skills. The participants’ teacher also identified these tasks as vital and described that they had not taken any instruction on fire and rain safety skills before. Participants have to perform the task with help of our proposed application. A few user interfaces are shown in Fig. 2.
Video modeling: Rain and fire safety skills were taught using video modeling shown on a mobile phone. Two videos were recorded with the help of an adult model and shot from the performer’s perspective [28] to teach target behaviors about safety skills (e.g., Fire and Rain) for ASD children. Each video consists of eight sequential steps depicting target behaviors for fire and rain safety skills. The digital video camera was used for recording videos and those videos were uploaded onto a computer for editing. Before starting a step, a number of that step was displayed on the screen. After that, a video clip of that particular step was played (e.g., video of a hand touching the Fire Picture Thumbnail to send current location”). The duration of both videos was almost 2 min long. Participants watched a video and learned how to perform the task by looking at the performer going through the sequential steps to achieve target behaviors linked with fire and rain safety skills.
Setting: All the participants were presented in the classroom devoted to children with moderate ASD equipped with a table and chairs. Two mobile phones. a Motorola G4 plus (running Android 7.0) and a Huawei Y6 (running Android 5.0) were used. All the participants used the first phone i.e., Motorola G4 plus to perform the tasks. The other device, Huawei Y6 was used by the caregiver for receiving the current state and location of the autistic children. Moreover, the participants were taught to touch the thumbnail of fire or rain to alert the caregivers with their current situation.
Table 2
Task Analysis for Target Behaviors
Fire Safety Skills
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Rain Safety Skills
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1. The child remains calm on fire alarm sounds
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1. The child remains calm on thunder sound
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2. The child walks to exiting the door
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2. The child locates the nearest shelter
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3. The child exits through the door and walks to the playground area
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3. The child walks to the shelter
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4. The child opens the smartphone
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4. The child opens the smartphone
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5. The child touches the application thumbnail
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5. The child touches the application thumbnail
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6. The child touches the " Fire Picture" Thumbnail
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6. The child touches the " Rain Picture" Thumbnail
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7. The child waits for the confirmation dialog
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7. The child waits for the confirmation dialog
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8. The child remains there until the caregiver approach
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8. The child remains there until the caregiver approach
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4.2 Outcome Measures and Data Collection
The main dependent measure was the percentage of correct responses for both tasks performed by the participant every time he/she heard the fire alarm sound (to perform the fire safety task) or thunder sound (to perform the rain safety task). The first author of this manuscript and a female educator from acted as observers during the sessions. The role of observers was to maintain the checklist and evaluate the target behaviors of all the participants. Every participant was evaluated on each target behavior (e.g., fire and rain) after the sound of a fire alarm/thunderstorm. If the target behavior was correct then it was marked with a check [✓] sign. Similarly, if the target behavior was wrong then it was marked with an [x] sign. Each target behavior was counted as a chance for a child to make a free-response. A behavior is regarded as correct if the next step is initiated within 10 seconds and completed within 20 seconds. Incorrect behavior was defined in different ways: if the student could not finish the step within 10 seconds, if the student did not initiate a target behavior within 10 seconds, or if the student completed a step out of order according to the task sequence. To get the percentage of right answers, a total number of right answers were divided by the total number of steps in the given task analysis. Training sessions happened twice or three times a week and during these one-to-one training sessions, data was collected. Every session was almost 15 minutes long and after each session, the participants were appreciated for participating using verbal praises.
4.3 Data Analysis
A Single Subject Design (SSD) [29], precisely A-B design was used in this study along with maintenance after the intervention. In the design, the “A” corresponds to the baseline phase and “B” corresponds to the intervention phase. At the baseline phase, the participants were not taught by video modeling about fire and rain safety skills and it was supposed that all the participants are weak in displaying safety skills. In the intervention phase, safety skills were taught to participants having ASD with the help of video modeling using a mobile phone. After they had mastered the set of safety skills in the intervention phase, the maintenance phase was conducted in the next two weeks for safety skills. In the maintenance phase, the skills of a child were evaluated by providing the sound of fire alarm and thunder. No video model was shown to the children in the maintenance phase. To find the amount of intervention effect on the performance of those children, the PND (Percentage of Non-Overlapping Data) approach was used. This approach is labeled as a “meaningful index of treatment effectiveness” [30]. The non-overlap calculation provides the percentage of treatment or intervention phase data that surpasses the maximum values in the pre-treatment or baseline phase [31]. Visual analysis has many tasks and one important task is to detect the amount of difference or non-overlap in the data points through successive conditions; that is why visual analysis settles nicely with non-overlap methods and these methods deliver important information about treatment effects [32]. If the non-overlap score is above 90% then it is considered very effective, if it is in the range of 70–90% is considered effective, 50–70% questionable and below 50% suggests that the treatment was not effective. Moreover, the aggregated analysis was conducted for all phases, by finding the average percentage of skill proficiency by subject and overall skill proficiency in general.
4.4 Procedure
Prior to baseline: Two training sessions were held before the baseline phase. Session one included instructions on fire safety skills and session two included instructions on rain safety skills. Training sessions were conducted two times per week and the maximum duration of each session was almost 15 minutes.
Baseline: During the baseline phase, participants had to perform the desired tasks for both safety skills. In the fire safety skill session, the participant was brought to the classroom. He/she sat on a chair and was told to perform required tasks related to fire safety after hearing the sound of a fire alarm. For the rain safety skill session, the participant was brought to the ground and he/she was asked to perform the desired tasks related to rain safety after hearing the sound of thunder. Evaluation of each task was carried out within three sessions or until the stabilization of baseline data. If any participant performs the task inaccurately or cannot give a response, the observer intervened to help the participant and completed the task himself/herself, and then the student was again provided with the opportunity to complete the next step in the list. Throughout these sessions, the observer recorded the amount of correctly performed tasks. The session was finished if the participant could not initiate the first step within 10 seconds or failed to finish the previous task within 20 seconds.
Intervention: During the intervention phase, the participants were provided the smartphone having the installed application with module two already opened, and set to play the video for the targeted task. Video modeling was used for training. They were directed to carry out a task through an instruction like “Watch this.” The participant then touched the screen and watched the video on how to do the task. They were then asked to perform that task after the observer said, “Now you do it” and then the participants tried to copy the relative behavior shown in the video clip about fire and rain safety skills once they hear the sound of fire alarm and thunder. Participants also receive verbal praise, i.e., “Nice job”, on performing the task correctly after every third step. They were given 10 seconds to initiate the task and 2 minutes to finish it. If the participant failed to finish the task within 2 minutes or failed to initiate a task within 10 seconds then the session was dismissed. Unsuccessful tasks were left incomplete because the tasks had to be completed in the specified order of respective task analysis. No other prompts, responses, or instructions were delivered. Throughout the intervention phase, the safety skills of participants were assessed two times a week for a total of nine data points.
Maintenance: In the maintenance phase, participants were not shown any video clip for training through video modeling about fire and rain safety skills. They were brought to the classroom and ground of the school for fire and rain safety skill tasks respectively. In the fire safety skill task, they heard the sound of fire alarm, in the rain safety skill task they heard the sound of thunder and then they were told to perform according to the desired behaviors taught throughout the intervention session. A maximum of two sessions was required for the evaluation of each task. If the performance declined below the accepted level then students were allowed to watch the videos again to see whether their performance recovers.