The research behind Pebble
What Pebble is built on, what we left out, and what nobody knows yet. We would rather you trusted Pebble a little less than believed something that is not true.
In short
Pebble is evidence-informed. Its design uses practices with good research behind them for autistic children, such as visual schedules, hints that fade as a child learns, rewards that are never taken away and grown-ups showing words on a picture board, and it leaves out contested ones. Pebble itself has not been tested in a trial, and it does not treat or diagnose autism.
On this page
We started from UK guidance, including NICE's guideline on supporting autistic children and young people and the Royal College of Speech and Language Therapists' position on communication aids, and from a 2020 review by the US National Clearinghouse on Autism Evidence and Practice (NCAEP). That review found 28 practices with enough research to call them evidence-based [1, 2, 3].
How the research shows up in Pebble
| Practice | What the research says | In Pebble |
|---|---|---|
| Visual supports and schedules | One of the best-studied practices. The NCAEP review counted 65 studies, and a review of visual schedules found them evidence-based, especially alongside other teaching [1, 4]. NICE's guideline includes visual supports [2]. | Now and Next on My day, a picture of what comes next before every change, and a printable picture strip. |
| Hints that fade (prompting and time delay) | Prompting is the most studied practice in the NCAEP review (140 studies). Time delay, which fades help gradually, has 31 [1]. | New things get a hint straight away. After two right answers the hint waits a little longer, and a mistake brings it back. There is no wrong sound. |
| Rewards (reinforcement) | 106 studies in the NCAEP review [1]. | A star board themed on your child's favourite topic. The reward is chosen first, and stars are never taken away. |
| A picture-and-voice board that is always there | Communication aids such as picture boards have 44 studies in the NCAEP review [1]. UK speech and language therapists say there are no pre-requisites for using them [3]. | Talk is on every screen and in every game. It is never locked, counted, timed or earned. |
| Grown-ups showing words on the board | A review of 28 studies found this “highly effective” [5]. | Model mode lets a grown-up tap words as they talk. Those taps are kept apart and never shown as the child's message. |
| Asking for help or a break | Functional communication training, teaching a child a simple way to ask, is one of the 28 practices in the NCAEP review [1]. | Help, stop, break and finished are on every screen and work straight away, in games too. |
| Playing together | In the UK PACT trial of 152 children aged 2 to 4, coaching parents in responsive play made a large difference to how parents and children communicated, but not to autism scores at 13 months [6]. A follow-up about six years later found a modest effect over the whole period [7]. | Ready steady go waits for your child and never says "go" for them. Take turns names each turn. Tips for grown-ups each show their source. |
| Movement | Exercise and movement is one of the practices in the NCAEP review (17 studies) [1]. | Movement cards among the calm tools, and Move my way, which treats stimming as a good way to calm. |
| Stories (social narratives) | 21 studies in the NCAEP review [1], though the evidence for young children is mixed. | Eight picture stories, and a story writer that keeps stories describing and positive rather than bossy. |
| Breaking a task into steps (task analysis) | 13 studies in the NCAEP review [1]. | What comes next: put the steps of an everyday task in order, one step at a time. |
What we left out on purpose
- Tasks that ask for eye contact.
- Anything that tries to stop or reduce stimming.
- Losing stars, tokens or progress.
- “ABA” branding.
- Streaks, lives, leaderboards, surprise rewards, adverts and purchases.
- The phrase “special interests”. Pebble says “favourite topics”.
What is not known yet
Most of the research above is about adults teaching children in person, often in small studies. None of it tested a self-paced app like Pebble. So Pebble's settings, such as how long a hint waits, are starting points that you can change.
App trials also show that children can enjoy an app without it changing much in daily life. In the UK FindMe trial, 54 children under 6 played consistently, but there were no differences in parent-reported outcomes or in observed play with their parents [9]. In another trial, use of a therapy app fell from 19 minutes a day in the first three months to 2 minutes a day in the next three [10]. A large 2023 review of 252 studies found that many positive results for early autism interventions shrank when it looked only at the most reliable measures [8].
That is why Pebble is made to be used with a grown-up and away from the screen too, with a printable plan, an All about me profile and tips for playing together. Pebble has not been tested in a trial.
Not a medical device
Pebble is not a medical device. It does not diagnose, treat or monitor autism, anxiety or any other condition, and it does not replace support from professionals. Our editorial policy explains how we keep our guides separate from the app.
If you use Pebble and something does not work for your child, please tell us at support@rocksmakepebbles.co.uk. The beta is how we find out.
Sources
- Evidence-based practices for children, youth, and young adults with autism National Clearinghouse on Autism Evidence and Practice (NCAEP), 2020
- Autism spectrum disorder in under 19s: support and management (CG170), recommendations NICE
- Augmentative and alternative communication (AAC) position statement Royal College of Speech and Language Therapists, 2024
- Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders Knight, Sartini and Spriggs, Journal of Autism and Developmental Disorders, 2015
- Effects of interventions that include aided AAC input on the communication of individuals with complex communication needs: a meta-analysis O'Neill, Light and Pope, Journal of Speech, Language, and Hearing Research, 2018
- Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial Green and others, The Lancet, 2010
- Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial Pickles and others, The Lancet, 2016
- Autism intervention meta-analysis of early childhood studies (Project AIM): updated systematic review and secondary analysis Sandbank and others, BMJ, 2023
- A trial of an iPad intervention targeting social communication skills in children with autism Fletcher-Watson and others, Autism, 2016
- A randomised controlled trial of an iPad-based application to complement early behavioural intervention in autism spectrum disorder Whitehouse and others, Journal of Child Psychology and Psychiatry, 2017