Wearable Technology for Autism: Extraction of Interaction and Physical Design Principles of Wearable Technology for Individual with Autism First Author\[1\]\*, Second Author2 (Double Blind Review: Please do not type or edit anything here until final-camera ready submissions) *1First affiliation, City and Country (Please do not type or edit anything here, until final camera-ready paper submission)* *2Second affiliation, City and Country (Please do not type or edit anything here, until final camera-ready paper submission)*
ARTICLE INFO ABSTRACT

Article history:

Received

Revised

Accepted

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Published 1 March 2024

 Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by challenges in social interaction, communication, and behavior. The term "spectrum" reflects the diverse symptoms and varying severity levels, with each showcasing unique characteristic. The range of symptoms necessitates a careful consideration of their distinct attributes when providing assistance. Individuals with autism often face difficulties in behavior, communication, and interaction, occasionally leading to stress and tantrums due to their limited verbal expression of emotions. While various interventions such as therapy and medication have been employed, conventional methods have proven insufficient for comprehensive support. In the modern landscape, technology, especially wearable technology capable of monitoring physiological parameters, offers promising opportunities for autism intervention. Integrating sensors into wearable technology facilitates parents in monitoring their autistic children's well-being. Recognizing the unique characteristics of autism, this study emphasizes the importance of addressing both interaction and physical components in the design of wearable technology. The study identifies four key elements for each component along with their respective design principles through an extensive process involving literature reviews, focus group discussions, and expert reviews. The proposed design principles outlined in this paper serve as a valuable guideline for tailoring wearable technology to meet the distinctive needs of individuals with autism effectively.

Keywords:

Autism Spectrum Disorder

ASD

Behaviour problems

Symptoms

Wearable Technology

Intervention strategy

DOI:

10.24191/jcrinn.v9i1
# Introduction Autism, or autism spectrum disorder (ASD), is a neurodevelopmental condition marked by challenges in social interaction, communication, and behavior (Malik et al., 2023; Valencia et al., 2021). It is recognized as a spectrum due to the diverse symptoms and varying severity levels, with each individual exhibiting unique characteristics (K. Sagayaraj et al., 2020; Skjeldal & Isaksen, 2023). Individual diagnosed with ASD encounter challenges in both social interaction and communication. The severity of these symptoms varies across the spectrum, ranging from mild to severe. Consequently, individual with ASD (IASD) frequently experience associated morbidities, such as depression and anxiety, as a result of these challenges. Additionally, difficulties in expressing frustration or stress due to communication impairments contribute to experiences of temper tantrums and aggression, further worsening parental stress (Carlier et al., 2019). Nowadays, various intervention and treatment have been utilized for ASD community. The technology-based interventions have been applied to assist ASD person to minimize their difficulties and help them to improve their daily life (K. Sagayaraj et al., 2020). According to Scarcella et al. (2023), several studies have shown that technology-based interventions, such as serious games, social robots, and ICT tools, can be effective in improving social skills and behavioural abnormalities associated with ASD. Moreover, the utilization of wearable technology (WT) as an intervention for ASD, exhibit significant promise in transitioning towards an empowerment approach for individual with autism (Williams & Gilbert, 2020). Wearable technology can be categorized into three types: 1) head-mounted technology, 2) body-worn technology, and 3) accessories and clothing technologies (Black et al., 2020). In this era, WT exhibits the capacity to continuously measure physiological responses, including heart rate and body temperature, through sets of sensors, this technological advancement facilitates the real-time monitoring of behavior for IASD, thereby enhancing the formulation of more effective intervention strategies (Fioriello et al., 2020; Rong et al., 2021). Furthermore, the implementation of WT as an intervention strategy not only mitigates medical expenses but also grants person diagnosed with ASD more freedom, diverging from reliance only on conventional therapeutic approaches, which are considered by both time-intensive processes and elevated costs (Koo et al., 2018). Consequently, these characteristics provide unique opportunities to enhance the lives of the IASD. However, certain researchers have discerned a gap in the understanding of the design factors and user preferences regarding the design of existing WT especially for individual diagnosed with ASD (Francés-Morcillo et al., 2020; Koo et al., 2018). Valencia et al. (2021), state that existing studies lack of discussions on specific attributes, component, or design factors pertaining to the development of systems tailored for individuals with ASD, particularly in relation to user experience (UX) factors. The issues result in the ineffectiveness of designed WT for IASD and contribute to design challenges and appropriate design. Hence, this study identifies two essential components in designing of WT, specifically to meet the unique requirements of IASD which include the interaction design and physical design which start as follows. # Design Concept Two design components, emphasized by numerous existing studies, serve as the foundation for extracting elements and principles for WT in IASD. The subsequent section delves into a detailed discussion of each design component. ## CONCEPT OF INTERACTION DESIGN According to Hussain et al (2016), interaction design (IxD) is the discipline of designing interactive products to support people in their everyday lives, focusing on three dimension which include the system behaviour, form and content. The table below shows and describes the dimensions as mentioned. ** ** > **Table 1.1** Dimension of Interaction design | Dimension | Description | | ---------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | System Behaviour | The focus in this dimension is on the response of the system to user input and the manner in which the system behaves and interacts with users, with the inclusion of parameters and navigation elements. | | Form | The visual appearance and layout of the system, encompassing elements like user interface, screen size, color, and icons, are defined by form. | | Content | The information and functionality provided by the system, including elements such as audio, language, and user guides, are referred to by this dimension. | IxD also an essential an essential component in designing interactive products that fulfill user requirements, address user experience, and represent the communication between humans and digital artifacts from a behavioural standpoint (Ahmad & Mutalib, 2016). When creating interactive content for individuals with ASD, this design component plays a crucial role in addressing challenges they encounter, notably anxiety, affecting more than half of individuals with ASD, particularly those with higher cognitive skills (Di Salvo & Tamborrini, 2017). Over the past few years, interactive visual displays have been employed to increase the efficacy of interventions for individuals with ASD. The utilization of visual displays aids individuals with ASD in practicing social skills, including communication, resulting in enhanced intervention outcomes (Washington et al., 2017). Hence, it is crucial to reflect on appropriate interaction design tailored to the unique characteristics of ASD users to ensure the end product is not only useful and functional but also effective in assisting them. Although wearable technology, as discussed in the earlier section is a potential technology-based intervention for ASD, there still have the design limitations persist, with the most challenging component being the design of the user interface (Motti & Caine, 2015). Therefore, this study explored the principles for designing an effective User interface (UI) and User Interaction (UX) that fulfill the needs of IASD. Moreover, the physical design of the wearable technology also plays a crucial role, which will be discussed in the following section. ## CONCEPT OF PHYSICAL DESIGN The physical design covers the tangible and visible characteristics of the device, including elements such as its overall size, weight, and specific shape. Alternatively, the “physical” means the incorporation of specific hardware in designing the wearable product. These components contribute to the external appearance and structural features, influencing its usability, comfort, and aesthetic appeal. The physical design should not only exhibit aesthetic appeal but must also prioritize practicality, safety, and durability to adequately address user requirements. Moreover, given the diverse range of symptoms experienced by the majority of individuals with ASD, it is essential to comprehend the common symptoms for the development of wearable products tailored to their specific needs. Symptoms related to the physical appearance of wearable products, including sensory issues like hyper or hypoarousal to auditory and visual stimuli and discomfort with physical sensations like wearing watches, can be triggers for individuals with ASD (Koo et al., 2018). Moreover, individuals with ASD may experience anxiety and stress, leading to a dislike for the product, particularly in uncomfortable situations such as extend wear (Black et al., 2020). In a feasibility study conducted by Daniels et al. (2018) regarding the use of Google Glass for children requiring behavioural therapy for autism, the majority of participants expressed their interest in the hardware, indicating that they found it intriguing. This suggests that the external appearance, particularly the physical design, is crucial to ensure the product is attractive and individuals with ASD are inclined to use the product. Ensuring durability and safety is vital for a wearable product designed for individuals with ASD. The durability elements guarantees the long functionality of the wearable product, effectively providing support and comfort to individuals with ASD (Cookson & Stirk, 2019; Rong et al., 2021). Concerning safety, it is essential to ensure safety in the wearable product to safeguard the well-being and physical safety of individuals with ASD while wearing it. (Vitullo & Benitez, 2019). Hence, a review of the literature has been undertaken to identify principles specifically tailored for individuals with ASD based on the mentioned components. The extraction process will be elaborated upon in the next section. # METHODOLOGY This section covers all the activities involved in extracting the principles related to the interaction design and physical design components of wearable technology for IASD. The extraction process comprises two phases: extraction and validation. In the extraction phase, a thorough exploration of literature from previous works was conducted to identify and propose the most relevant design principles for both components. Additionally, suggestions of design principles also were extracted from a focus group discussion conducted with autism practitioners. In the validation phase, the extracted design principles were reviewed and validated with experts to ensure their relevance to IASD. This validation process involved an expert review survey. Figure 1.1 below summarizes the activities in both phases. ![](65b4ec0d6db70_media/media/image1.emf) Fig. 1.1 Research Methodology # EXTRACTION OF DESIGN PRINCIPLES This section outlines the process of extracting elements related to interaction design and physical design. These elements were derived from chosen studies and recommendations provided by practitioners from the autism center. The design principles extracted are grounded in the design guidelines proposed in the selected studies. Consistent with the extraction process, a comparative analysis was undertaken to select the most suitable elements for both interaction design and physical design components. The elimination of irrelevant elements was carried out, and the identified elements, along with their descriptions, are detailed in Table 1.2 and Table 1.3 below. Table 1.2 Elements of Interaction Design | Component | Element | Description | | ------------------ | ------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Interaction Design | Navigation Tools | Navigation tools are different ways users can move around the interface, like menus, buttons, and links, giving users a clear and consistent way to access different features and functions of the system. | | | Feedback | Feedback gives users information about what is happening in the system and the results of their actions, helping them understand the impact and feel satisfied with their actions. | | | Direct Manipulation | Direct manipulation is an interface interaction where users can easily and visibly interact with tasks and objects by directly using their fingers, hands, or other physical inputs on the device. Direct manipulation interaction styles encompass actions like swiping, clicking, and tapping. | | | Multimedia elements | The visual representation of information on the system often incorporating different hues, shades, or patterns to convey specific information, prompt actions, or create a visually engaging and user-friendly interface for colour. Other type of content whether it be in the form of sounds, images or other animations. | Table 1.3 Elements of Physical Design | Component | Element | Description | | --------------- | -------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Physical Design | Material | The choice of material affects the comfort and durability of the wearable product. | | | Screen display | Relates to how the screen looks on a device, covering aspects like size, shape, resolution, and aspect ratio | | | Safety | Involves steps to make sure the product is safe for its intended users, considering factors like the materials used, device stability during use, and potential harm during operation. | | | Portability | The flexibility of the product to be carried or moved. | The elements listed in both tables are the extracted elements for the interaction design components and physical design component. The principles for each element will be discussed at the end of this paper. # VALIDATIONS OF THE EXTRACTED DESIGN PRINCIPLES To validate the relevance of the proposed design principles, an expert review survey method was conducted. As outlined in the previous section, the review process initiated with the preparation of instruments encompassing components, elements, and design principles. These instruments were then sent via email to a group of targeted reviewers who agreed to participate in the review, comprising experts in computer sciences, human-computer interaction (HCI), software engineering, and autism practitioners. A two-week timeframe was allocated for the experts to complete the review and submit their feedback. Experts were chosen based on their expertise to gather additional suggestions and confirm the proposed principles, leveraging their experience in each field and familiarity with IASD. By the end of the allocated period, feedback had been received from nine out of the 20 experts approached. Upon analyzing the feedback, a majority of respondents agreed that the elements within the interaction design components are both relevant and vital for constructing the interface and navigation in wearable technology for IASD. These elements play a vital role in shaping the design to meet the distinctive characteristics of IASD which include the selection of color, multimedia content and navigation tools. According to the experts, utilizing a combination of multimedia elements, including videos and audio, may be suitable methods to divert individuals with autism. Some experts proposed incorporating soft vibrations with a low frequency for feedback on each action. There is also a suggestion to provide automatic pop-up visual message notifications as alerts. However, the suggestion was rejected due to concerns about potential distractions for IASD (Carlier et al., 2019). In general, all experts expressed that the user interface (UI) has the potential to divert individuals with autism from stress and alleviate the severity of their behavioural issues. Furthermore, the physical design components received positive feedback from the experts, with many offering comments on the selection of materials which are the critical elements that significantly contribute to the appearance of wearable technology. For the actual design, the use of durable and water-resistant materials to ensure extended longevity is suggested by experts. Additionally, the consideration of wearable or flexible batteries as a power source is also recommended. In terms of safety, an unnoticeable design implies that the physical design should be well placed on the user’s body, causing no disruption to their movement or attention, then could prevent stress and distraction to the IASD when using the WT. The screen display stands out as a crucial element, with certain experts recommending the use of a touchscreen, an AMOLED display, and a high-resolution screen, as these elements received predominantly positive feedback. They recommended clearly specifying the shape of the screen that is deemed appropriate for use. Derived from expert comments and suggestions, this study identified the validated design principles for both interaction design and physical design in wearable technology, specifically tailored to meet the needs of IASD. The following section discussed the outcomes of the validated design principles for both components. # RESULT AND DISCUSSION In this section, the extracted and validated design principles for the interaction and physical design of wearable technology for IASD are outlined. The interconnected elements and principles within each category hold relevance and have the potential to meet the requirements for designing wearable technology for IASD. The subsequent section elaborates on these principles. ## Interaction Design Principles ### Navigation Tools > Implement a button style for selecting actions - Offer users a straightforward and uniform method for accessing different features and functions of the system. Moreover, button promote the ease of use for IASD as most of them may have sensory sensitivities or motor coordination challenges. Considerations for the designed button style encompass aspects such as button size, tactility, and visual characteristics, ensuring comfort for users ASD and effective engagement with the wearable technology. > > Use recognizable graphical icons for buttons *–* Utilizing universally recognizable icons for specific functions reduces user effort in understanding the system and enables them to anticipate the outcomes of their actions. The familiarity of icons not only prevents confusion for users with ASD but also helps lessen potential stress. > > Provide concise and precise instructions *–* Short labels for buttons are also necessary as alternatives to assist in cases of potential confusion. > > Choose soft and contras colour for the button *–* IASD exhibits sensitivity to color choices, with bright colors potentially triggering anxiety and causing distractions to them. Additionally, the selection of colors should consider the contrast between the background color and the button to ensure button visibility. > > Provide consistent and static button *–* Maintaining a consistent design throughout the interface is a fundamental aspect of the navigation style. Promoting a predictable interaction pattern, buttons should remain static, ensuring their position and appearance consistency across interfaces. This design principle is aimed at fostering a reliable and user-friendly experience. ### Feedback > Provide vibration for action taken *-* Incorporating vibration feedback into wearable applications is effective, serving as a distraction for children and offering gentle, discreet reminders to users. > > Use low frequency vibration *–* Low-frequency vibrations are generally milder and less forceful, offering benefits, especially for sensitive ASD users who have specific sensory requirements. This offers a less disruptive feedback method, improving the overall user experience while minimizing the likelihood of discomfort or distraction. ### Direct Manipulation > Use a touch-and-slide approach *–* This method lessens the requirement for users to have advanced motor skills when using the device. It offers a straightforward approach to user interaction, commonly seen in touchscreen devices. In this style, users can easily control and navigate the interface with intuitive touch movements, promoting user engagement and responsiveness. The touch-and-slide approach aligns with the idea of direct manipulation, allowing users to directly interact with on-screen elements for actions or navigation. > > Prevent automatic pop-up alerts *–* Implementing pop-up notifications for alerts is unsuitable for IASD as it can cause distraction. However, if pop-ups are deemed necessary, they should be customized in a way that minimizes disruption and ensures the message appears on the screen in a suitable manner. > > Avoid multiple objects or operation for single button *-* This functionality has the potential to create confusion for users, especially IASD, who may be prone to sensory overload, resulting in heightened stress levels. Therefore, single operation in one button is necessary. ### Multimedia elements > Use soft and pastel colour – Most reviewer recommended soft and pastel colors over bright ones. Pastel colors enhance physical visibility, incorporating at least five different colors for improved clarity. Selecting colors is crucial to address the emotions of individuals IASD, as many of them are sensitive to bright colors. Hence, softer colors are more suitable. > > Use short dynamic visual – The duration of dynamic visual videos should be short or customizable based on the needs of IASD users. Lengthy visuals can induce stress and lead to disliking the product. Visuals for persuasion, like breathing techniques, could be brief, lasting only three to five seconds. > > Use short audio cues – The elements of audio are also essential for verbal instruction. IASD. Using a combination of multimedia elements, such as images and audio, can be an effective method to divert individuals with autism. It not only provides users with feedback but also enhances their overall experience. ## Physical Design Principles ### Material > Use flexible materials *–* Flexible design facilitates the wearable product in conforming to the user's body contours, ensuring a comfortable and unrestricted fit. This design element enhances adaptability to different body shapes and movements, promoting greater flexibility in the wearable technology. > > Use lightweight materials *–* The use of lightweight materials is essential for an improved user experience when wearing the product. Light materials reduce the burden and facilitate easy portability of the product to any location. > > Use durable materials *–* Utilizing strong materials like water-resistant materials guarantees the durability of the wearable product in response to users' conditions. This durability contributes to the prolonged use and longevity of the wearable product. ### Screen display > Use multitouch screen *–* Multitouch touchscreens can engage IASD by enhancing their communication and attention, fostering a seamless interaction between users and devices. Activation can also occur through pen touch in addition to finger touch. > > Use AMOLED screen *–* The screens provide bright colors, strong contrast, and fast response times. This vivid display improves visual clarity, making content more accessible and enjoyable. AMOLED screens use power efficiently, ensuring a longer battery life, without needing to recharge often. ### Safety > Separate heat dissipating components *–* Regulate the heat produced by the wearable device to prevent overheating, ensuring the wearables remain comfortable and safe for users, considering the sensitivity of IASD to temperature changes. > > Provide insulation for electrical current *–* Insulate the hardware that provides electrical current within the wearable device to safeguard users from potential electric shocks, prioritizing safety for IASD. ### Portability > Use flexible battery *–* The flexible characteristic of the battery enables it to fit to the shape of the designed wearable, promoting comfort for the wearer and allowing integration into various designs beyond conventional wearable forms. > > Provide wireless connectivity *–* Establishing a connection between the wearable worn by IASD and their parents is essential for enhanced monitoring and increased parental awareness of their ASD children's condition. Wireless connectivity further ensures the wearable device facilitates smooth communication and data transfer without relying on physical connections. # CONCLUSIONS This study explores the design principles crucial for designing Wearable Technologies (WT) tailored for individuals with autism spectrum disorder (IASD). The study identified two integral components, namely, interaction design and physical design. Through a literature review and focus group discussion, elements and potential principles were extracted to address behavior problems in IASD. Through the extraction process, the study identified four key elements for both components. In interaction design, these include Navigation Tools, Feedback, Direct Manipulation, and Multimedia elements. For physical design, elements encompass Material, Screen display, Safety, and Portability. Nine experts validated these elements and associated principles through an expert review survey. The study aims to serve as a guideline for developing WT that caters to the unique characteristics of IASD and aids in crafting effective intervention strategies to alleviate behavior problems in their daily lives. However, these outcomes need to be extended to explore more components, elements, and principles related to WT that are tailored with IASD. The recommended future work will ensure the proposed design principles are applicable and effective in assisting IASD in their life through the WT. # ACKNOWLEDGEMENTS # REFERENCES Ahmad, S. Z., & Mutalib, A. A. (2016). Proposing the components of conceptual design model of iCAL4LA using comparative analysis method. *Journal of Telecommunication, Electronic and Computer Engineering*, *8*(8), 1–6.Black, M. H., Milbourn, B., Chen, N. T. M., McGarry, S., Wali, F., Ho, A. S. V., Lee, M., Bölte, S., Falkmer, T., & Girdler, S. (2020). 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