From Behavioral and Communication Intervention to Interaction Design: User Perspectives from Clinicians
Yao Du, LouAnne Boyd, Seray Ibrahim · 2018 · Proceedings of the 20th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS 2018) · doi:10.1145/3234695.3241480
Summary
This experience report from three clinicians-turned-researchers (a board certified behavior analyst from the US, and two speech and language therapists from the UK and US) reflects on the gap between clinical practice with neurodiverse children and HCI/assistive technology design. The three authors collectively bring 46 years of clinical experience working with children with disabilities across home, school, clinic, and community settings. Each presents their personal journey from clinical practice to doctoral research in HCI, revealing how their tacit clinical knowledge — skills so deeply embedded they had become invisible to them — was not captured in the technology systems they designed. The paper is motivated by the "unfulfilled promise of technology" and its high abandonment rate in clinical tools for children with disabilities. A key insight from the behavior analyst (first author) is that when designing VR and AR systems for social skills training with autistic children, she assumed technology could replicate her therapeutic mediation. Only during intervention studies did she realize that much of what she did as a therapist — adjusting tone of voice, waiting for the child to look at her before speaking, building rapport at the start of each session — was never programmed into the system.
Key findings
Each clinician's perspective reveals distinct but complementary insights. The behavior analyst discovered that VR environments reduced sensory overload more effectively than AR for children with autism, hypothesizing that transforming sensory information into virtual form created comfort that facilitated social interaction. She concludes that technology should do "what it is good at" — automating and transforming information into accessible forms (like real-time visualizations of social feedback) — rather than attempting to replicate the full therapeutic relationship. The UK-based speech therapist highlights the tension between clinical and design-oriented approaches: clinical interventions focus on a person's impairment level, while her doctoral design work focuses on access — a fundamental philosophical shift. She also warns against making assumptions about children's communicative behaviors, describing a girl who refused to participate in a group activity not due to shyness but for reasons only deep clinical engagement could reveal. The US-based speech therapist emphasizes that AAC use is shaped by context-dependent sociocultural practices across stakeholders — teachers resistant to implementation, parents fearing their child will "never speak," and therapeutic priorities that sometimes conflict with real-world communication needs like social media use. She notes many SLTs have created their own therapy apps due to unmet needs, encountering clinical, technical, and ethical challenges in the process.
Relevance
This paper makes a compelling argument that clinicians hold essential tacit knowledge for assistive technology design that is currently underutilized. For accessibility practitioners, the key takeaway is that including clinicians only as informants or proxies for end users misses their most valuable contribution: deep, situated understanding of how communication and behavior actually work in context, which children often cannot articulate themselves. The paper challenges the HCI community's tendency to position children with disabilities only as "users," "patients," or "learners" — labels that fragment their holistic experience. It also raises important questions about the limits of technology: the behavior analyst's realization that her systems captured only the "bare minimum" of therapeutic interaction, missing the rapport-building, sensory accommodation, and moment-by-moment adaptation that made therapy effective, is a cautionary tale for anyone designing AI-mediated interventions. The call for interdisciplinary collaboration between clinicians, designers, and children is especially urgent as technology increasingly mediates therapeutic and educational experiences.
Tags: AAC · autism · children · behavioral intervention · speech and language therapy · neurodiversity · clinician perspectives · assistive technology design · sensory processing