Teaching complex social skills to children with autism; advances of video modeling

Although there has been a corresponding explosion of literature regarding the treatment of the social deficits in autism, the establishment of more complex social behaviors still remains a challenge. Video modeling appears as one approach to have the potential to successfully address this challenge. Following an introduction to modeling that constitutes the basis of this procedure, the current paper explores those video modeling studies that have targeted the promotion of complex social skills. It is suggested that this approach could be an effective addition to peer-mediated treatment procedures, especially for children with autism who cannot always be in environments where peers are present. Further, the likely success of video modeling seems to be dependent upon the prior elimination of behaviors that interfere with the development of imitation skills

Human-centred design methods : developing scenarios for robot assisted play informed by user panels and field trials

Original article can be found at: http://www.sciencedirect.com/ Copyright ElsevierThis article describes the user-centred development of play scenarios for robot assisted play, as part of the multidisciplinary IROMEC1 project that develops a novel robotic toy for children with special needs. The project investigates how robotic toys can become social mediators, encouraging children with special needs to discover a range of play styles, from solitary to collaborative play (with peers, carers/teachers, parents, etc.). This article explains the developmental process of constructing relevant play scenarios for children with different special needs. Results are presented from consultation with panel of experts (therapists, teachers, parents) who advised on the play needs for the various target user groups and who helped investigate how robotic toys could be used as a play tool to assist in the children’s development. Examples from experimental investigations are provided which have informed the development of scenarios throughout the design process. We conclude by pointing out the potential benefit of this work to a variety of research projects and applications involving human–robot interactions.Peer reviewe

A Virtual Conversational Agent for Teens with Autism: Experimental Results and Design Lessons

We present the design of an online social skills development interface for teenagers with autism spectrum disorder (ASD). The interface is intended to enable private conversation practice anywhere, anytime using a web-browser. Users converse informally with a virtual agent, receiving feedback on nonverbal cues in real-time, and summary feedback. The prototype was developed in consultation with an expert UX designer, two psychologists, and a pediatrician. Using the data from 47 individuals, feedback and dialogue generation were automated using a hidden Markov model and a schema-driven dialogue manager capable of handling multi-topic conversations. We conducted a study with nine high-functioning ASD teenagers. Through a thematic analysis of post-experiment interviews, identified several key design considerations, notably: 1) Users should be fully briefed at the outset about the purpose and limitations of the system, to avoid unrealistic expectations. 2) An interface should incorporate positive acknowledgment of behavior change. 3) Realistic appearance of a virtual agent and responsiveness are important in engaging users. 4) Conversation personalization, for instance in prompting laconic users for more input and reciprocal questions, would help the teenagers engage for longer terms and increase the system's utility

A Biosymtic (Biosymbiotic Robotic) Approach to Human Development and Evolution. The Echo of the Universe.

In the present work we demonstrate that the current Child-Computer Interaction paradigm is not potentiating human development to its fullest – it is associated with several physical and mental health problems and appears not to be maximizing children’s cognitive performance and cognitive development. In order to potentiate children’s physical and mental health (including cognitive performance and cognitive development) we have developed a new approach to human development and evolution. This approach proposes a particular synergy between the developing human body, computing machines and natural environments. It emphasizes that children should be encouraged to interact with challenging physical environments offering multiple possibilities for sensory stimulation and increasing physical and mental stress to the organism. We created and tested a new set of computing devices in order to operationalize our approach – Biosymtic (Biosymbiotic Robotic) devices: “Albert” and “Cratus”. In two initial studies we were able to observe that the main goal of our approach is being achieved. We observed that, interaction with the Biosymtic device “Albert”, in a natural environment, managed to trigger a different neurophysiological response (increases in sustained attention levels) and tended to optimize episodic memory performance in children, compared to interaction with a sedentary screen-based computing device, in an artificially controlled environment (indoors) - thus a promising solution to promote cognitive performance/development; and that interaction with the Biosymtic device “Cratus”, in a natural environment, instilled vigorous physical activity levels in children - thus a promising solution to promote physical and mental health

Virtual Reality Exposure Therapy for Adolescents with Public Speaking Anxiety

Bakgrunn: Presentasjonsangst er en av de vanligste fryktene blant ungdom. Angsten innebærer en redsel for å bli negativt evaluert, etterfulgt av en følelse av å bli flau eller ydmyket når man snakker foran andre. Eksponeringsterapi for presentasjonsangst er utfordrende å gjennomføre, da en trenger et reelt publikum som kan fungere som det fryktede stimuli. Virtual Reality (VR) kan være løsningen, da teknologien er i stand til å skape et virtuelt publikum, som kan oppleves som ekte. For voksne med presentasjonsangt finnes det flere randomiserte kontrollerte VR-studier som viser gode kliniske effekter, men en vet lite om effekten relatert til ungdom. Ingen studier har tidligere evaluert effekten av selvveiledet, automatiserte og spillbaserte VR-intervensjoner for ungdom med presentasjonsangst. Mål: Denne oppgaven adresserte aktuelle kunnskapshull ved å kartlegge den kliniske effekten og gjennomførbarheten av to VR-intervensjoner for ungdom med presentasjonsangst: en terapeutveiledet og en selvveiledet, automatisert og spillbasert intervensjon. Målet med Artikkel I var å undersøke gjennomførbarheten og den kliniske effekten av en terapeutveiledet, enkelt-sesjons VR-intervensjon for ungdom med presentasjonsangst. Hovedmålet med Artikkel II var å undersøke den kliniske effekten av en selvveiledet, automatisert og spillbasert VR-intervensjon sammenlignet med venteliste og en selvveiledet nettbasert intervensjon. Et sekundært mål var å undersøke om VR-intervensjonen førte til en økning i påfølgende eksponeringsøvelser under det nettbaserte eksponeringsprogrammet, sammenlignet med de som mottok nettbasert psykoedukasjons- og eksponeringsprogram. Målet med Artikkel III var å undersøke om intervensjonene rettet mot presentasjonsangst også førte til en reduksjon i symptomer på perfeksjonisme og om symptomer på perfeksjonisme modererte den kliniske effekten av intervensjonene for presentasjonsangst. Metode: To kliniske studier ga data for tre studier: en ikke-randomisert gjennomførbarhet- og pilotstudie (papir I) og en to-faset, firearmet randomisert kontrollert studie (papir II og III). Begge studiene undersøkte effekter og moderatorer av behandling: symptomer på generalisert sosial angst ved baseline og tilstedeværelse i det virtuelle miljøet (artikkel I) og om perfeksjonisme modererte behandlingsresultatet (artikkel III). Selvrapporterte symptomer på presentasjonsangst ble innhentet under intervensjons- og oppfølgingsperioden i begge studiene, i tillegg til hjertefrekvensmålinger under VR-eksponeringen i Artikkel I, selvrapporterte symptomer på generalisert sosial angst i Artikkel II og III, og perfeksjonisme i Artikkel III. Gjennomførbarhets- og pilotstudien i Artikkel I inkluderte N=27 ungdommer som deltok i en terapeutveiledet, 90-minutters VR-intervensjon på én sesjon ved klinikken. To-faset, firearmede randomiserte kontrollerte studien i Artikkel II og III inkluderte N=100 ungdommer som deltok i et seks ukers digitalt selvveiledet intervensjonsprogram. Ungdommene ble randomisert i fire grupper, med følgende fase én + fase to intervensjon; 1) Kun VR, 2) VR + nettbasert eksponeringsprogram, 3) Nettbasert psykoedukasjon + eksponeringsprogram, 4) Venteliste + nettbasert psykoedukasjonsprogram. Resultater: Resultater fra Artikkel I viste en signifikant reduksjon i presentasjonsangstsymptomer fra pre til post, og symptomene holdt seg stabile ved en og tre måneders oppfølging. Basert på tilbakemeldinger fra ungdommene, ble gjennomførbarheten av intervensjonen økt i løpet av studien, noe som resulterte i ingen manglende besvarelser ved oppfølging. Symptomer på generalisert sosial angst ved baseline og tilstedeværelse modererte ikke de kliniske effektene. Det var en liten økning i hjertefrekvensen under VR-eksponeringsoppgavene. Resultater fra Artikkel II viste en signifikant større reduksjon i presentasjonsangstsymptomer blant ungdommene som mottok VR-intervensjonen sammenlignet med ventelistegruppen. Resultatene viste også at VR + nettbasert eksponeringsprogram var like effektivt sammenlignet med kun VR og nettbasert psykoedukasjon + eksponeringsprogram. I tillegg hadde alle fire grupper en signifikant reduksjon i presentasjonsangstsymptomer. I motsetning til hypotesen fullførte ikke ungdommer som mottok VR-intervensjon et høyere antall in-vivo-eksponeringsoppgaver i løpet av nettbasert eksponeringsprogram sammenlignet med de som mottok nettbasert psykoedukasjon og eksponeringsprogram. De kliniske effektene holdt seg stabile ved tre måneders oppfølging. Resultater fra Artikkel III viste at intervensjonene ikke reduserte perfeksjonisme på gruppenivå, men det var signifikante individuelle forskjeller i endringer over tid. En nedgang i perfeksjonisme var assosiert med en større reduksjon på alle utfallsmål fra post til oppfølging. Det var ingen signifikante interaksjonseffekter mellom presentasjonsangstsymptomer og nivået av perfeksjonisme før behandling. Høye nivåer av perfeksjonisme før behandling var assosiert med dårligere langsiktige resultater for begge gruppene som mottok det nettbaserte eksponeringsprogrammet. Konklusjon: Denne oppgaven bidrar til det voksende evidensgrunnlaget for VR-eksponeringsterapi, og den første som demonstrerer potensialet til både terapeutveiledet og selvveiledet VR-behandling for ungdom generelt, og spesielt for de med presentasjonsangst. Resultatene indikerer at VR-behandling kan fungere som et indisert forebyggingsprogram for ungdom med PSA. Studiene som inngår i oppgaven er gjennomført ved hjelp av et solid design. Gjennomførbarhet og pilotering var første trinn, før man for første gang med denne målgruppen evaluerte de kliniske effektene i en randomisert kontrollert studie. I tillegg har oppgaven undersøkt relevante moderatorer av behandlinger; rollen til perfeksjonisme og hvordan den kan hindre bedring. Disse resultatene kan være veiledende for hvordan optimalisere fremtidige intervensjoner for ungdom med presentasjonsangst. Fremtidige studier bør undersøke om VR-terapi har en langsiktig forebyggende effekt på utvikling av generalisert sosial angst da dette fortsatt er uklart for denne aldersgruppen.Background: Public Speaking Anxiety (PSA) is one of the most common fears reported by adolescents. PSA involves the fear of being negatively evaluated, followed by a feeling of being embarrassed or humiliated when speaking in front of others. Providing state-of-the-art in-vivo exposure therapy for PSA is difficult due to the logistics of recruiting an actual audience trained to act as the feared stimuli. An attractive way of resolving this obstacle is through Virtual Reality (VR) technology, which is capable of creating an immersive experience of being in front of a virtual audience, as if it was real. Although there are several randomized controlled trials demonstrating the clinical efficacy of VR exposure therapy for adults with PSA, little is known about its clinical effects on adolescents. Moreover, no past study has evaluated self-guided and automated VR interventions for adolescents with PSA. Aims: This thesis addressed these key knowledge gaps by exploring the clinical effects and feasibility of both therapist-guided and self-guided, and automated VR interventions for adolescents with PSA. The aim of Paper I was to investigate the feasibility and the clinical effects of a therapist-guided, single-session VR-intervention for adolescents with PSA, using low-cost consumer VR hardware. The primary aim of Paper II was to investigate the clinical efficacy of a self-guided, automated, and gamified VR intervention compared with waitlist and self-guided online programs. A secondary aim was to explore whether the VR intervention led to an increase in subsequent exposure tasks during the online exposure program compared to those receiving the online psychoeducation and exposure program. The aim of Paper III was to investigate whether interventions targeting PSA also led to a reduction in symptoms of perfectionism and whether symptoms of perfectionism moderated the clinical efficacy of self-guided interventions for PSA. Methods: Two clinical trials provided data for three studies: one non-randomized feasibility and pilot study (Paper I) and a two-phased, four-armed randomized controlled study (Paper II and III). Both trials investigated effects and moderators of treatment: baseline generalized social anxiety symptoms and presence in the virtual environment (Paper I) and whether perfectionism moderated treatment outcome (Paper III). Self-reported PSA were assessed during the intervention and follow-up period in both studies, in addition to heart rate measurements during the VR exposure in Paper I, self-reported symptoms of generalized SAD in Paper II and III, and perfectionism in Paper III. The non-randomized feasibility and pilot study in Paper I included N=27 adolescents who participated in a therapist-guided, 90-minutes single-session VR intervention at the clinic. The two-phased, four-armed randomized controlled study in Paper II and III included N=100 adolescents who participated in a six weeks digital self-guided interventions program. The adolescents were randomized into four groups, with the following phase one + phase two intervention; 1) VR only, 2) VR + online exposure program, 3) Online psychoeducation + exposure program, 4) Waitlist + online psychoeducation program. Results: Results from Paper I revealed a significant decrease in PSA symptoms from pre to post, and symptoms remained stable at one- and three-month follow-up. Based on feedback from the adolescents, the feasibility of the intervention was increased during the trial, resulting in no missing data. Baseline generalized social anxiety symptoms and presence did not moderate the clinical effects. There was a small increase in heart rate during the VR exposure tasks. Results from Paper II revealed a significantly greater reduction in PSA symptoms among the adolescents who received the VR intervention compared to the the waitlist group. The results also demonstrated that VR + online exposure program was as equally effective as compared to VR only and online psychoeducation + exposure program. Moreover, all groups had a significant reduction in PSA symptoms. Contrary to the hypothesis, adolescents who received VR training did not complete a higher number of in-vivo-exposure tasks during the online exposure program compared to those receiving online psychoeducation and exposure program. The clinical effects remained stable at three-month follow-up. Results from Paper III revealed that the interventions did not reduce perfectionism at a group level, however, there were significant individual differences in changes over time. A decrease in perfectionism was associated with a larger reduction on all outcome measures from post to follow-up. There were no significant interaction effects between PSA symptoms and the pre-treatment level of perfectionism. High pre-treatment levels of perfectionism was associated with poorer long-term outcomes for both groups receiving the online exposure program. Conclusions: In sum, this thesis contributes to the growing evidence base for VR exposure therapy, and is among the first to demonstrate the potential of both therapist-guided and self-guided, VR interventions for adolescents in general and with PSA in particular. The results indicate that VR may serve as an indicated prevention program for adolescents with PSA. The studies included in the thesis is conducted through a strong design with feasibility and piloting as a first step before evaluating, for the first time with this target group, the clinical effects in a randomized controlled trial. Moreover, the thesis has investigated relevant moderators of treatments, specifically the role of perfectionism and how it may hinder treatment improvement. These results can provide guidance on how to optimize future interventions for the large group of adolescents with PSA. Future studies should investigate whether VR interventions have a long-term preventive effect on the development of generalized social anxiety as this remains unclear for this age group.Doktorgradsavhandlin

Human experience in the natural and built environment : implications for research policy and practice

22nd IAPS conference. Edited book of abstracts. 427 pp. University of Strathclyde, Sheffield and West of Scotland Publication. ISBN: 978-0-94-764988-3

Developing a virtual reality environment for educational and therapeutic application to investigate psychological reactivity to bullying

Understanding how bullying victimisation influences cognitive and emotional processes may help to direct early intervention to prevent the development of psychopathology. In a convenience sample of 67 female adolescents, we assessed the potential of a newly developed classroom-set bullying experience in virtual reality (VR) to evoke psychological reactions. Two VR experiences were co-developed with young people, one neutral and one hostile (bullying). Participants were matched and assigned to a condition based on measures of anxiety, depression, paranoia, and previous bullying, before experiencing either the neutral or hostile scenario. Before and after the VR session, participants completed measures of negative affect and levels of distress. All participants remained immersed for the whole duration, which supports the acceptability of using these VR experiences with more vulnerable participants. Those experiencing the hostile version reported greater negative affect post-immersion compared to those experiencing the neutral version (p = .018; d = 0.61). Although non-significant, a similar outcome was found regarding distress (p = .071; d = 0.37). Whilst we did not find a significant relationship between pre-existing internalisation on negative affect and distress, our sample was limited by containing adolescents with relatively low levels of previous bullying experience. Yet we still found evidence that the VR scenario evoked bullying-related psychological reactions. Further testing with a more representative groups of adolescents, especially those with more experience of bullying, would be advised. The VR scenario could potentially be used in educational and therapeutic settings to enhance empathy towards victimised children or enhance resilience following victimisation