Selecting Apps for Executive Function
Impairments
By: Therese Willkomm, PhD, ATP; Stacy Driscoll, MEd; Linda Beliveau
According to the 2013 Annual Disability Statistics Compendium (2013), in 2012, there
were 8,458,332 individuals ages 18 to 64 with cognitive disabilities. The Center for
Disease Control and Prevention (2013), reports that 11% of US children aged 4-17 were
diagnosed with ADHD in 2011 as reported by parents. Cognitive disabilities, ADHD,
and other neurological disorders can impact a person’s executive function skills.
According to the International Classification of Functioning, Disability and Health (ICF)
of the World Health Organization (Sept. 2003), mental functions include consciousness,
orientation, intellectual functions, energy and drive functions, sleep, attention, memory,
emotional functions, perceptual functions, higher level cognitive functions and language.
The purpose of this paper is to identify iPhone/iPad app features that can benefit
individuals who experience executive dysfunction. It is impossible to list all apps that
can benefit executive function limitations since executive function is so broad.
Therefore, the focus is on feature identification to help in the selection of the most
appropriate apps for reminding and organization. Features discussed in this article
include: input and output features; nag and snooze features, cloud syncing; notifications;
push notification to others and the ability to set the type, frequency and duration of the
output reminders.
Putting information into an app, such as tasks to be completed, appointments, and
reminders, can be very challenging. The various methods to accomplish this include
voice, video, typing text, pictures, drop down menus and the selection of icons.
Receiving and processing information from the app as a way of cuing / prompting include
visual, auditory, and tactile modalities. Visual output of information includes: still
images, video clips as short as one or two seconds, icons, colors, text and video
modeling. Auditory output of information includes: sounds, alarms, music, and voice.
Visual and auditory output features do not always require the person to read and process
text based information. Body worn devices, such as a smart watch or smart phone can
also be extremely effective using vibration output as a means for cuing and prompting.
In addition to the input methods, output methods, and general features that an app
includes, it is important to recognize the cognitive demands associated with the app.
When examining the cognitive load, one can ask how many steps are required to program
or enter reminders into the app. Remember, the more steps it takes to program the app,
the more cognitive demand required. Also consider how many steps are required to
acknowledge the prompt and then execute the task. Consider, what is the stimulus /
response sequence. How many steps are needed to execute the task? What steps are
needed? In what sequence will you need to perform the steps in order to execute the task
the app is prompting you to do? Ponder for a moment the capacity needed to hear or feel
a prompt, take action, find the device, open the device, tap on the app or reminder, put the
device away and then execute the task. This sequence requires concentration and high
cognitive demands. In order to best reduce the cognitive load one should examine apps
that reduce the number of steps needed to process information.
For many other individuals it is important to consider the active engagement with the
app. Within the notification center located in settings, users can customize the alert style
for each app. If you set the style as a banner, the alert will appear at the top of the screen
and disappear automatically. If you set the alert style to alerts, the alert will appear in the
middle of the screen and require an action before you are able use the device further.
This active engagement helps individuals to not ignore the cue to complete a task and
further reduces the cognitive load.
A popular reminder device is the Pebbles Watch. Because text reminders are pushed to
the person’s wrist from their smartphone, they don’t need to have their cell phone with
them. It simply needs to be within 50 feet. When the individual’s wrist vibrates he/she
can look at the watch and take action. Another handy feature of the watch is the ability to
locate one’s cell phone. By simply pushing the middle button on the watch three times
the phone will start to play the assigned music. The user can then just follow the sound
to his/her phone without relying on someone to call the phone. The music will even play
on silent mode.
An app such as Nudge – Reminders by Simple Taylor Software that has an automatic
wake and play feature enables mapping of specific sounds to specific tasks that need to
be performed. One individual who lacks the concept of time, states that it is very easy to
stay at work all night. By programming the Nudge app to play jazz music at 6PM every
evening, when she hears the music automatically playing, she is prompted to go home.
Different sounds can be mapped or associated with different meanings. It simply requires
the user to memorize the sounds associated with a task that needs to be performed. This
eliminates the cognitive demands associated with locating a device, opening a device,
reading and processing texted-based information, closing the device and finally storing
the device. Additional reminders apps include: Alarmed ~ Reminders and Timers by
Yoctoville and Any.DO Task & To-Do List by Any.DO. With Alarmed you can pick
which melodies you want to alarm you and the app allows you to set super reminders
which will nag you either every hour or every minute until you turn the snooze off. The
simple interface of Any.DO allows users to enter text via speech recognition. The ability
to sync with other device is quite handy. Additionally, 2Do: Tasks Done in Style by
Guided Ways Technologies Ltd and Calendar Alarm - CalAlarm by DEVART are both
robust apps that provide a variety of custom options. For example, 2Do provides a to-do
list with both voice and picture support. CalAlarm provides color organization of events
as well as one touch setting of alarms prior to events.
Priority Matrix by Appfluence LLC is a popular app for organization. The layout of the
app includes four quadrants and the use of four different colors. Instead of a linear to-do
list, tasks can be sorted into the four categories and easily identified with the specific
color of the quadrant. On an iPad 3 or newer, the built in microphone can speed up the
time needed to input information. This makes it easy to add information in a particular
quadrant without having to type anything. By looking at the quadrants and colors, users
can easily identify the correct list to focus on at a particular time. The ability to email
lists to others and have the list emailed daily to yourself adds essential reinforcement to
complete tasks. Priority Matrix will sync between devices assuring you always have
access to your lists and providing family members access to the lists as needed. Besides
Priority Matrix, there are a multitude of apps available to aid with organization. The
30/30 app by Binary Hammer organizes a to-do list in linear fashion but includes a timer
for each task. This app provides icon support. Kan Plan by Houda Hamdane breaks
tasks down, provides color support and can sync with a teacher or parent. Two calendar
apps to consider are Awesome Calendar by YunaSoft Inc and iSecretary by Ernest LS.
The neat feature of the iSecretary app is that users can view all their voice reminders in
calendar form. In other words, when the date is selected, all the voice reminders for the
day appear. Inspiration Maps by Inspiration Software, Inc. and Popplet by Notion
provide a variety of creative ways to organize information.
It is essential for iPhone and iPad users to understand multiple ways to use the built in
Camera app and Photos app that come standard with every device. Once you have taken
pictures or videos with the Camera app you can organize them within the built-in Photos
app into albums. You can take pictures of anything you need to organize and place it in
its own album within Photos. One individual has a tendency to loose receipts. By taking
pictures of his receipts and creating an album called “receipts” to place the pictures in, he
can easily retrieve the receipts whenever needed. Photos is also useful for organizing and
sequencing the steps needed to complete a task. Pictures or short video clips can be
placed into albums. When the album is opened, users can swipe and tap through the
video clips in order to receive directions for each step to completing a specific task.
Thinking creatively, the possibilities for the Photos app are endless. It is important to
note that you can only rearrange the order of the pictures in an album in Photos and not
the Camera on the iPad. Once pictures are in an album, simply hold and drag pictures or
videos into whatever order you desire. Other apps that can be creatively used for picture
and video cueing are; Pictello by AssistiveWare, Book Creator by Red Jumper Studio,
Picture Scheduler by Peter Jankuj, Forgetful by IBEX and Choiceworks by Bee Visual
LLC.
It is important to note that apps are a tool and not a treatment and can be used as
universally designed support system that benefits everyone. The functional limitations
associated with executive function make it difficult to discuss all the apps available but
with careful consideration in regard to input method, output method and general features
of an app, individuals can choose the best apps to reduce the cognitive load needed to
remember to complete tasks and organize information.
Annual Disability Statistics Compendium. (2013). Retrieved from
http://disabilitycompendium.org/compendium-statistics/employment
Center for Disease Control and Prevention (CDC). (2013). Key Findings: Trends in the
Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD:
United States, 2003—2011. Retrieved from
http://www.cdc.gov/ncbddd/adhd/features/key-findings-adhd72013.html
World Health Organization. (Sept. 2003) ICF Checklist. (p. 15). Retrieved from
http://www.who.int/classifications/icf/icfchecklist.pdf?ua=