Dautenhahn, Kerstin

Irvine, Karen

Mengoni, Silvana

Robins, Ben

Sharma, Shivani

Wellsted, David

English

University of Hertfordshire Research Archive

Life and Medical SciencesSchool of Psychology and Sports ScienceStudy to investigate the effectiveness of using a humanoid robot (Kaspar) to improve the social skills of children with an Autism Spectrum Disorder: a randomised controlled feasibility trialIrvine, K a, Mengoni, S a, Thakur, D b, Barton, G c, Dautenhahn, K d, Guldberg, K e, Kouroupa, A a,  Robins, Bd, Wellsted, D a, & Sharma, S*. aa Department of Psychology and Sport Sciences, School of Life and Medical Sciences, University of Hertfordshire, UK, b Hertfordshire Community NHS Trust, UK, c Health Economics Group, Norwich Medical School, University of East Anglia, UK, d School of Engineering and Computer Science,  University of Hertfordshire, UK, e Autism Centre for Education and Research, School of Education, University of Birmingham, UK* Contact: s.3.sharma@herts.ac.ukEarly intervention leads to the best outcomes for children with a diagnosis of ASD.1There is growing interest in using robots in autism– one such robot is Kaspar.2A child plays games with a therapist using Kasparas a mediator. All games contain elements of joint attention, turn-taking and imitation i.e. building blocks for social success.Feasibility AimTo test the practicality of running a definitive RCT within NHS settings on the effectiveness of robot mediated interaction for social skills development.IntroductionDesign/SettingA mixed design, single blind feasibility RCT with two parallel groups. Participants were recruited from one NHS Trust (HCT) over an 11-month period. Children were randomised to receive an intervention with Kaspar and a therapist (KG), or the same intervention but with a therapist only (TOG). Participants42 children recruited from Communication Difficulties Assessment Clinic at HCT in Watford, UK.Eligibility criteriaChildren aged 5-10 years,  diagnosed within the past year. Able to speak and/or understand English. With an IQ>=70. The Parent/carer to be able to understand written English. The child not receiving any social communication intervention not usual NHS care.ProcedureChildren randomly allocated into one of two groups:Kaspar groupTherapist only group (Offered Kaspar sessions once their involvement in the study finished)Intervention2 familiarisation sessions followed by six therapy sessions of 20 minutes each.Outcome measuresCompleted at Baseline, 10 weeks after baseline and 12 weeks later:Social Skills Improvement System.3Social Communication Questionnaire.4Parenting Stress Index – 4.5Child Health Utility 9D.6Child and Adolescent Service Use Schedule (amended version). 7Qualitative AnalysisSemi-structured interview with 50% of families.Method     • Agreed to complete study measures, ** had previously dropped out of intervention   ASD Referrals screened N = 322 Ineligible  (N = 175) ASD not diagnosed                           N = 45 Not between 5 and 10 years old         N =129 Having intervention not NHS UC         N = 1  Declined                 N =   4 No response                 N = 38 Ineligible                  N = 0   Eligible N = 147 Consent to referral to study team N =52  First research visit N = 43 (Consented N =42) Randomised N = 38 Declined    N = 3 Moved out of Herts     N = 1         Declined (child didn’t assent)  N= 1 Not randomised (N=4) Ineligible (unable to do IQ test) N = 3 Unable to arrange to do IQ test N = 1           KASPAR group N = 19 Therapist only group N = 19 Baseline visit N =36 Intervention N =36 10 week FU N =34 22 week FU N = 31 Withdrawal from study N=1 Child didn’t want to miss swimming  Withdrawal from study N=1 Unable to contact  Withdrawal from study N= 1 Child anxious about Kaspar  Withdrawal from study N= 2 Unable to contact Requested no further involvement**  Interview N = 17  Declined                              N = 5 Moved out of area            N = 3 Unable to contact             N = 45 Invited to join study N = 47 Study information sent N= 94 Study team unable to contact    N = 5  Withdrawn (anxiety) N = 1 Withdrawal from study N=1 Child unhappy with group allocation Withdrawal from intervention N=3 Concerns about missing school* Child found it boring* Logistical difficulties*  N=7 N=10 ResultsTable 1. Feasibility resultsFigure 1. CONSORT diagram✓ All feasibility criteria were met.✓ Some issues with the technology – these can be addressed.✓ Possible to make games more complex, so engaging for older and more able children.✓ Effect sizes indicate that the children showed improvements in their behaviour.✓ Possible to run a definitive study to investigate whether using Kaspar in this way will improve children’s social skills.Conclusions1Dawson G. Early intensive behavioral intervention appears beneficial for young children with autism spectrum disorders. Journal of Pediatrics 2013;162(5):1080-81. 2Robins B, Dickerson P, Stribling P, et al. Robot-mediated joint attention in children with autism: A case study in robot-human interaction. Interaction studies 2004;5(2):161-98. 3 Gresham FM, Elliott SN. Social Skills Improvement System—Rating Scales. Minneapolis, MN: Pearson Assessments 2008. 4 Rutter M, Bailey A, Lord C. The Social Communication Questionnaire. Los Angeles: Western Psychological Services 2003. 5Abidin RR. Parenting stress index. 4th ed. Lutz, FL: PAR 2012. 6Stevens K. Valuation of the Child Health Utility 9D Index. Pharmacoeconomics 2012;30:729-47. 7Byford S, Cary M, Barrett B, et al. Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial. BMC psychiatry, 2015;15(316):1.ReferencesThis poster presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0215-36122). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.Table 2: The mean treatment effect (Therapy Only vs Kaspar) of the SSISFeasibility Criteria/data requiredOutcomeMore than 40% recruitment rate.Recruitment target – N=40 .Feasibility criterion met: 45% of those who were sent details of the study were randomized. 40.4% gave consent.Recruitment target met: 42 families were consented.Rate of attrition in each arm of the study less than 35% .Feasibility criterion met: 18% of participants withdrew from intervention (26% in KG and 10% in TOG).Completion of at least 80% of the questionnaires .Feasibility criterion met: 96% of questionnaires completed.Good acceptability of the intervention among clinicians, patients and their families.Clinicians reported it would be a beneficial intervention for children with autism.Parents/carers were happy with the intervention.Both clinicians and families reported the intervention to be less engaging for older, more able children.Older children provided feedback to make the games more suited to them e.g. not nursery rhymes.Positive feedback from clinical staff about scheduling clinics .Interviews with clinicians indicated that it could be delivered in an NHS setting.Interviews with parents supported the provision of this therapy within the NHS.The 80% confidence interval of the effect size between groups excludes zero in one of the possible outcome measures.The 80% CI for SSIS problem behaviours did not include zero at 22 weeks.Estimation of completion rates and identification of big cost drivers.100% response rate for both measures.Any issues with study design can be addressed.The issues that arose were technology-related and can be addressed.

Study to investigate the effectiveness of using a humanoid robot (Kaspar) to improve the social skills of children with an Autism Spectrum Disorder: a randomised controlled feasibility trial 

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Study to investigate the effectiveness of using a humanoid robot (Kaspar) to improve the social skills of children with an Autism Spectrum Disorder: a randomised controlled feasibility trial

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