Social communication between virtual characters and children with autism

Children with ASD have difficulty with social communication, particularly joint attention. Interaction in a virtual environment (VE) may be a means for both understanding these difficulties and addressing them. It is first necessary to discover how this population interacts with virtual characters, and whether they can follow joint attention cues in a VE. This paper describes a study in which 32 children with ASD used the ECHOES VE to assist a virtual character in selecting objects by following the character’s gaze and/or pointing. Both accuracy and reaction time data suggest that children were able to successfully complete the task, and qualitative data further suggests that most children perceived the character as an intentional being with relevant, mutually directed behaviour

Co-Design of a Virtual Reality Multiplayer Adventure Game for Adolescents With Autism Spectrum Disorder: Mixed Methods Study

Background: Virtual reality (VR) adventure games can offer ideal technological solutions for training social skills in adolescents with autism spectrum disorder (ASD), leveraging their support for multisensory and multiplayer interactions over distance, which may lower barriers to training access and increase user motivation. However, the design of VR-based game environments for social skills training is still understudied and deserves the deployment of an inclusive design approach to ensure its acceptability by target users. Objective: We aimed to present the inclusive design process that we had followed to develop the Zentastic VR adventure game to foster social skills training in adolescents with ASD and to investigate its feasibility as a training environment for adolescents. Methods: The VR game supports multiplayer training sessions involving small groups of adolescents and their therapists, who act as facilitators. Adolescents with ASD and their therapists were involved in the design and in an explorative acceptability study of an initial prototype of the gaming environment, as well as in a later feasibility multisession evaluation of the VR game final release. Results: The feasibility study demonstrated good acceptability of the VR game by adolescents and an enhancement of their social skills from baseline to posttraining. Conclusions: The findings provide preliminary evidence of the benefits that VR-based games can bring to the training of adolescents with ASD and, potentially, other neurodevelopmental disorders

Factors Influencing the Adoption of Immersive Virtual Reality for Individuals with Autism Spectrum Disorder: Parents Perceptions

The purpose of this qualitative study was to identify factors that affect the adoption of a spherical video virtual reality (SVVR) mobile application among parents of adults with Autism Spectrum Disorder (ASD). The study used the diffusion of innovation theory by Rogers (2003) as a framework to explore parents’ perceptions of an SVVR transportation model designed to improve the quality of life of adults with ASD. In addition, the study sought to learn what might increase adoption of VR technology among other parents of individuals with ASD and what life skills that might be addressed using VR technology in the future. The study employed interviews, focus groups, and observation to collect data. The factors that negatively affected the perception of VR technology among parents were categorized into themes: awareness of VR learning applications, availability, disadvantages of SVVR, and technical issues related to the SVVR transportation model. Factors that positively affected the parents’ decision to adopt VR were immersion, realism, ease-of-use, enjoyment and motivation. To increase the adoption of VR by other parents of individuals with ASD, parents suggested that understanding of VR learning applications needs to increase, more teachers should be trained to use VR, the SVVR model should be improved, and there should be greater exposure to VR in schools and at home. Potential future life skills that need to be addressed through the VR technology were also identified. The findings of this study may help eliminate concerns about using VR technology as a therapy for ASD individuals and encourage more parents, teachers, and other stakeholders to adopt it

Psychophysiological analysis of a pedagogical agent and robotic peer for individuals with autism spectrum disorders.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by ongoing problems in social interaction and communication, and engagement in repetitive behaviors. According to Centers for Disease Control and Prevention, an estimated 1 in 68 children in the United States has ASD. Mounting evidence shows that many of these individuals display an interest in social interaction with computers and robots and, in general, feel comfortable spending time in such environments. It is known that the subtlety and unpredictability of people’s social behavior are intimidating and confusing for many individuals with ASD. Computerized learning environments and robots, however, prepare a predictable, dependable, and less complicated environment, where the interaction complexity can be adjusted so as to account for these individuals’ needs. The first phase of this dissertation presents an artificial-intelligence-based tutoring system which uses an interactive computer character as a pedagogical agent (PA) that simulates a human tutor teaching sight word reading to individuals with ASD. This phase examines the efficacy of an instructional package comprised of an autonomous pedagogical agent, automatic speech recognition, and an evidence-based instructional procedure referred to as constant time delay (CTD). A concurrent multiple-baseline across-participants design is used to evaluate the efficacy of intervention. Additionally, post-treatment probes are conducted to assess maintenance and generalization. The results suggest that all three participants acquired and maintained new sight words and demonstrated generalized responding. The second phase of this dissertation describes the augmentation of the tutoring system developed in the first phase with an autonomous humanoid robot which serves the instructional role of a peer for the student. In this tutoring paradigm, the robot adopts a peer metaphor, where its function is to act as a peer. With the introduction of the robotic peer (RP), the traditional dyadic interaction in tutoring systems is augmented to a novel triadic interaction in order to enhance the social richness of the tutoring system, and to facilitate learning through peer observation. This phase evaluates the feasibility and effects of using PA-delivered sight word instruction, based on a CTD procedure, within a small-group arrangement including a student with ASD and the robotic peer. A multiple-probe design across word sets, replicated across three participants, is used to evaluate the efficacy of intervention. The findings illustrate that all three participants acquired, maintained, and generalized all the words targeted for instruction. Furthermore, they learned a high percentage (94.44% on average) of the non-target words exclusively instructed to the RP. The data show that not only did the participants learn nontargeted words by observing the instruction to the RP but they also acquired their target words more efficiently and with less errors by the addition of an observational component to the direct instruction. The third and fourth phases of this dissertation focus on physiology-based modeling of the participants’ affective experiences during naturalistic interaction with the developed tutoring system. While computers and robots have begun to co-exist with humans and cooperatively share various tasks; they are still deficient in interpreting and responding to humans as emotional beings. Wearable biosensors that can be used for computerized emotion recognition offer great potential for addressing this issue. The third phase presents a Bluetooth-enabled eyewear – EmotiGO – for unobtrusive acquisition of a set of physiological signals, i.e., skin conductivity, photoplethysmography, and skin temperature, which can be used as autonomic readouts of emotions. EmotiGO is unobtrusive and sufficiently lightweight to be worn comfortably without interfering with the users’ usual activities. This phase presents the architecture of the device and results from testing that verify its effectiveness against an FDA-approved system for physiological measurement. The fourth and final phase attempts to model the students’ engagement levels using their physiological signals collected with EmotiGO during naturalistic interaction with the tutoring system developed in the second phase. Several physiological indices are extracted from each of the signals. The students’ engagement levels during the interaction with the tutoring system are rated by two trained coders using the video recordings of the instructional sessions. Supervised pattern recognition algorithms are subsequently used to map the physiological indices to the engagement scores. The results indicate that the trained models are successful at classifying participants’ engagement levels with the mean classification accuracy of 86.50%. These models are an important step toward an intelligent tutoring system that can dynamically adapt its pedagogical strategies to the affective needs of learners with ASD

Tangible user interfaces and social interaction in children with autism

Tangible User Interfaces (TUIs) offer the potential for new modes of social interaction for children with Autism Spectrum Conditions (ASC). Familiar objects that are embedded with digital technology may help children with autism understand the actions of others by providing feedback that is logical and predictable. Objects that move, playback sound or create sound – thus repeating programmed effects – offer an exciting way for children to investigate objects and their effects. This thesis presents three studies of children with autism interacting with objects augmented with digital technology. Study one looked at Topobo, a construction toy augmented with kinetic memory. Children played with Topobo in groups of three of either Typically Developing (TD) or ASC children. The children were given a construction task, and were also allowed to play with the construction sets with no task. Topobo in the task condition showed an overall significant effect for more onlooker, cooperative, parallel, and less solitary behaviour. For ASC children significantly less solitary and more parallel behaviour was recorded than other play states. In study two, an Augmented Knights Castle (AKC) playset was presented to children with ASC. The task condition was extended to allow children to configure the playset with sound. A significant effect in a small sample was found for configuration of the AKC, leading to less solitary behaviour, and more cooperative behaviour. Compared to non-digital play, the AKC showed reduction of solitary behaviour because of augmentation. Qualitative analysis showed further differences in learning phase, user content, behaviour oriented to other children, and system responsiveness. Tangible musical blocks (‘d-touch’) in study three focused on the task. TD and ASC children were presented with a guided/non-guided task in pairs, to isolate effects of augmentation. Significant effects were found for an increase in cooperative symbolic play in the guided condition, and more solitary functional play was found in the unguided condition. Qualitative analysis highlighted differences in understanding blocks and block representation, exploratory and expressive play, understanding of shared space and understanding of the system. These studies suggest that the structure of the task conducted with TUIs may be an important factor for children’s use. When the task is undefined, play tends to lose structure and the benefits of TUIs decline. Tangible technology needs to be used in an appropriately structured manner with close coupling (the distance between digital housing and digital effect), and works best when objects are presented in familiar form

Procedural-Reasoning Architecture for Applied Behavior Analysis-based Instructions

Autism Spectrum Disorder (ASD) is a complex developmental disability affecting as many as 1 in every 88 children. While there is no known cure for ASD, there are known behavioral and developmental interventions, based on demonstrated efficacy, that have become the predominant treatments for improving social, adaptive, and behavioral functions in children. Applied Behavioral Analysis (ABA)-based early childhood interventions are evidence based, efficacious therapies for autism that are widely recognized as effective approaches to remediation of the symptoms of ASD. They are, however, labor intensive and consequently often inaccessible at the recommended levels. Recent advancements in socially assistive robotics and applications of virtual intelligent agents have shown that children with ASD accept intelligent agents as effective and often preferred substitutes for human therapists. This research is nascent and highly experimental with no unifying, interdisciplinary, and integral approach to development of intelligent agents based therapies, especially not in the area of behavioral interventions. Motivated by the absence of the unifying framework, we developed a conceptual procedural-reasoning agent architecture (PRA-ABA) that, we propose, could serve as a foundation for ABA-based assistive technologies involving virtual, mixed or embodied agents, including robots. This architecture and related research presented in this disser- tation encompass two main areas: (a) knowledge representation and computational model of the behavioral aspects of ABA as applicable to autism intervention practices, and (b) abstract architecture for multi-modal, agent-mediated implementation of these practices

New Research in Children with Neurodevelopmental Disorders

This book collects recent research in the field of care for neurodevelopmental disorders, emphasizing transdisciplinary work in clinical, educational and family contexts. It presents an opportunity to learn about the impact of participation on children and adolescents with neurodevelopmental disorders. Mainly, new therapeutic approaches are presented in children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, or motor coordination disorders

The integration of children with Autism in the Egyptian society by the use of ICT tools

Autism has been discussed through the fields of medicine, sociology or psychology all over the past decades. Today, however it is being discussed through a different lens: „Communication‟. Being privileged by so many virtues, the Mass communication field not only spreads information, news and discusses views but also bonds people together. In that sense, Children with Autism should be part of this dynamic sphere, with the use of Information and Communication Technologies (ICT) tools, integrating those suffering from autism within the Egyptian society. A Descriptive Survey research clarifies the actual use of children with autism to ICT tools through the perspectives of their parents and their caregivers. A comparison between both views interweaving with various demographic criteria clarifies a larger outlook of the issue. The topic was explored through the Uses & Gratification and Digital Divide theories and further added the Laswell Model to elucidate possible clarifications to realize the integration of children with autism in the Egyptian society through the use of ICT tools. „Who, says what to whom‟ principle is scrutinized to identify the best mode to address the information to the children with Autism and make it reach them, based on research and experience. Although the innate limitations of children with Autism can impede integration willingness, the role of ICT can be shaped to serve the parents and caregivers with valid ideas, information and handling mechanisms with the aim of supporting the children with Autism to develop improved behavioral patterns. These techniques will help people affected with autism to be more accepted within the society‟s social code of conduct, and consequently more integrated. High importance is given to early intervention that avoids the hassle of unlearning negative traits. iii The research proved that neither the standard of education nor the financial capabilities of the parents, directly affects the child with Autism‟s acquisition of ICT tools thus the integration within the society. Computer tablets in particular and various ICT tools in general are provided, but the main issue is the awareness and training of the parents and caregivers to know that the child‟s use should be accompanied and tutored for best outcomes. A further step in the research focuses on the correct choice and use of the applications installed on the computer tablets and assistive ICT tools to be tailored to help each child‟s personalized need

Enhancing Skills in Individuals with Autism Spectrum Disorder through Technology-Mediated Interventions

Marco teórico Las personas con Trastorno del Espectro Autista (TEA) presentan dificultades en el desarrollo de habilidades de comunicación e interacción social (American Psychiatric Association, 2013) que son fundamentales para los procesos de aprendizaje y aparición del lenguaje verbal. Una de estas habilidades es la atención conjunta (AC), que consiste en la habilidad de una persona para captar la atención de otra hacia un objeto o evento mediante el seguimiento de la mirada, señalar u otro tipo de indicación verbal o no verbal (Mundy, 2016). Por otro lado, el número de estudios sobre intervenciones mediadas por el uso de nuevas Tecnologías de la Información y la Comunicación (TIC) se ha incrementado exponencialmente (Kientz, Goodwin, Hayes y Abowd, 2014) especialmente debido al hecho de que las personas con TEA sienten una afinidad especial por éstas. Sin embargo, la rápida evolución de las TIC y el tiempo que es necesario para llevar a cabo un estudio de intervención y publicarlo en un foro científico (Herrera, 2015), podrían representar una barrera para el establecimiento de Prácticas Basadas en la Evidencia (EBP; Anderson, 2006) en este campo científico. Objetivo Los objetivos específicos fueron los siguientes: Describir las tendencias actuales de intervenciones basadas en el uso de TIC para personas con TEA. Describir las intervenciones basadas en el uso de TIC para la mejora de habilidades de AC en personas con TEA así como determinar su calidad metodológica y el nivel de evidencia alcanzado por esta práctica. Explorar el impacto de una intervención basada en el uso de una TIC de realidad aumentada denominada Pictogram Room sobre la mejora de las habilidades de AC de seguir la mirada y señalar en niños con TEA. Método Esta tesis se articuló en tres estudios diferentes e interconectados que buscaron dar respuesta a cada uno de los objetivos planteados. En el primer estudio se llevó a cabo una revisión sistemática que incluyó todos los estudios (a) recogidos en las bases de datos PsycINFO, PubMed, ERIC y Web of Science, (b) que incluyeron palabras clave relacionadas con TEA y las TIC, y (c) fueron publicados en inglés, en revistas de revisión por pares entre 2000 y 2015. En el segundo estudio se llevó a cabo una revisión sistemática que, siguiendo el mismo método que en el primer estudio, recogió estudios dirigidos específicamente a la mejora de las habilidades de AC. Asimismo, se aplicó el método de evaluación de Reichow, Volkmar y Ciccetti (2008) para analizar la calidad del informe de investigación y evaluar el nivel de EBP alcanzado. En el tercer estudio, se aplicó un diseño de caso único con línea base múltiple para evaluar el efecto de Pictogram Room sobre las habilidades de seguir la mirada y señalar en siete niños con TEA en su centro escolar. Además, se utilizó el método de evaluación de Reichow et al. (2008) para garantizar la calidad del informe de investigación del estudio. Resultados En el primer estudio fueron identificados un total de 178 artículos, 76% de los cuales se publicaron entre 2010 y 2015. Los participantes fueron, en su mayoría, varones de entre 5 y 17 años de edad con los que se utilizó, sobre todo, ordenadores personales para presentar secuencias interactivas en centros escolares. Los diseños de caso único fueron más utilizados que los diseños de grupo y, en general, los estudios presentaron limitaciones metodológicas tales como falta de información descriptiva (e.g., características de los participantes). De estos 178 artículos, cinco fueron incluidos en el segundo estudio. La mayoría de ellos utilizó robots con programas especialmente desarrollados para la mejora de habilidades de AC (e.g., seguir la mirada, señalar) y aplicaron diseños de investigación con ciertas limitaciones metodológicas (e.g., diseños de grupo con menos de 10 participantes y sin grupo control) que les llevó a ser calificados de débiles de acuerdo al método de Reichow et al. (2008). Por tanto, aunque los estudios de intervención revisados fueron efectivos en 21 de los 23 participantes que incluyeron, el uso de TIC para la mejora de las habilidades de AC en personas con TEA no pudo establecerse como una EBP. Finalmente, el tercer estudio mostró que el uso de Pictogram Room fue eficaz para mejorar las habilidades de seguir la mirada y señalar de 6 niños con TEA tras seis sesiones de intervención (PAND > .90; Pearson Phi > .70; p < .01), y que dicha mejora fue generalizada a otras situaciones sociales. Por último, la utilización del método de Reichow et al. (2008) a lo largo del estudio garantizó su calidad, convirtiéndolo en un estudio riguroso susceptible de ser incluido en futuros estudios de replicación y revisiones meta-analíticas. Conclusión Los estudios de intervención mediada por TIC para personas con TEA se han incrementado, especialmente en los últimos años, y todo parece indicar que su número continuará en aumento. Sin embargo, se han hallado múltiples limitaciones metodológicas en la implementación de numerosos estudios que dificultan el establecimiento de EBP. En este trabajo de tesis, se ha demostrado cómo identificando las necesidades de las personas con TEA, utilizando indicadores de calidad disponibles y teniendo en cuenta los estándares de las EBP se puede llevar a cabo un estudio de intervención de una forma rigurosa y obteniendo resultados positivos que pueden contribuir al establecimiento de EBP en el campo de investigación de las TIC para personas con TEA. Referencias bibliográficas American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) Arlington, VA: American Psychiatric Publishing. Anderson, N. B. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271-285. Herrera, G. (2015). App móviles para personas con trastorno del espectro del autismo. Smart Health, 2, 24-26. Kientz, J. A., Goodwin, M. S., Hayes, G. R., & Abowd, G. D. (2014). Interactive technologies for autism. Synthesis lectures on assistive, rehabilitative, and health-preserving technologies. San Rafael, CA: Morgan & Claypool Publishers. Mundy, P. C. (2016). Autism and joint attention: Development, neuroscience, and clinical fundamentals. New York, NY: Guilford Press. Reichow, B., Volkmar, F. R., & Cicchetti, D. V. (2008). Development of the evaluative method for evaluating and determining evidence-based practices in autism. Journal of Autism and Developmental Disorders, 38(7), 1311-1319

Insights from mechanistic and digital intervention approaches

Eine effektive Förderung des Sozialverhaltens autistischer Kinder erfordert ein tiefgehendes Verständnis der Ursachen maladaptiver Reaktionen und die Bereitstellung eines leicht verfügbaren Förderangebots. Hier haben digitale Angebote ein großes Potential. Ebenso wie bei der Ursachenforschung mangelt es jedoch an Forschungsansätzen, welche eine Vielzahl an kognitiven und emotionalen Prozessen in die digitale Förderung integrieren. Dementsprechend untersuchte die Dissertation zunächst das Zusammenspiel verschiedener Ursachen aggressives Sozialverhaltens anhand eines etablierten Modells der sozial-kognitiven Informationsverarbeitung. Durch die Integration verschiedener Facetten der Empathie und deren zugrundeliegende Kompetenzen in ein digitales Förderangebot sollte im zweiten Schritt eine Verbesserung des Sozialverhaltens autistischer Grundschüler:innen erreicht werden. Es zeigte sich, dass Emotionsdysregulation verschiedene Formen aggressiven Sozialverhaltens und damit assoziierte feindselige Attributionen verstärkt. Letztere stand vor allem mit verbalen und verdeckten Aggressionsformen sowie mit guten Emotionserkennungsfertigkeiten im Zusammenhang. Eine Verbesserung des Sozialverhaltens und der Emotionsregulation konnte mittelfristig durch das sechswöchige, eltern-begleitete eLearningprogramm „Zirkus Empathico“ erreicht werden. Die multizentrische, randomisiert kontrollierte Studie ergab zudem kurzfristige und moderate Interventionseffekte für Empathie und Emotionserkennung als primäre Endpunkte. Insgesamt unterstreicht die Dissertation die Validität etablierter Modelle der sozialen Informationsverarbeitung sowie die Relevanz, diese zukünftigen Forschungs- und Interventionsansätzen zugrunde zu legen. Durch die Integration verschiedener sozio-emotionaler Kompetenzen scheint die digitale Intervention Zirkus Empathico prosoziales Verhalten autistischer Kinder auf effektive und praktikable Weise zu fördern.Effective training of autistic children`s social behavior requires an in-depth understanding of the causes of maladaptive responses and the provision of easily accessible support services. In this context, digital interventions have great potential. However, there is a lack of research approaches that integrate a variety of cognitive and emotional processes into both, explanation and digital support. The present dissertation first examined the interplay of different causes of aggressive social behavior by applying an established model of social-cognitive information processing to a sample of autistic elementary school students. Second, by integrating different facets of empathy and their underlying competencies into a digital program, the social behavior of autistic elementary school children should be improved. First, it was shown that emotion dysregulation strengthens various forms of aggressive social behavior and associated hostile attribution biases. The latter was mainly related to verbal and covert forms of aggression and good emotion recognition skills. Second, the parent-assisted eLearning program "Zirkus Empathico" led to a medium-term improvement in social behavior and emotion regulation after a six-week training. In addition, the multicenter randomized controlled trial showed moderate intervention effects on empathy and emotion recognition as primary outcomes, which were no longer detectable three months later. Overall, the dissertation highlights the validity of established models of social information processing and the relevance of using them as a foundation for future research and intervention. By integrating various socio-emotional competencies, the digital intervention Zirkus Empathico seems to strengthen autistic children’s prosocial behavior effectively and feasibly