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VIRTUAL REALITY THERAPY FOR HIGH FUNCTIONAL AUTISM SPECTRUM DISORDER IN IMPROVING SOCIAL, COGNITIVE AND SELF-CARE SKILLS USING AUTICARE
Abstract
Background: Advances in Virtual Reality (VR) technologies provide new opportunities for developing
treatments for key behaviors associated with autism spectrum disorder (ASD) that promote advancement
towards optimum results. Progress in Virtual Reality technologies provides better and effective opportunities
for developing treatments for core behaviours associated with High Functional Autism. Auticare is an XR-AI
based Assistive Technology Platform that aids the user to improve socio-cognitive, self-care skills and facilitates
special education through virtual reality therapy under the supervision of the clinical therapists.
Objective: The primary object of the present pilot study was to explore the feasibility of using the product
Auticare among school-aged children with high functioning autism in hospitals and special education settings.
The second objective of the study was to explore cognitive, social and self-care aspects designed to use among
the autistic population and to observe whether there was any change in score levels from initial sessions to the
final session in self-care and socio-cognitive skills.
Method: A total of 5 participants (ages range from 8 to 10 years) were chosen for the present pilot study from
National Intitute of Physical Medicine and Rehabilitation, Thrissur. The participants chosen were given training
sessions using Auticare in different cognitive, social and self-care scenarios through virtual reality environment
along with other therapies under the supervision of the occupational therapists over a period of 6 months.
Results: All five participants were much eager to attend virtual reality training and therapy sessions than other
modes of therapy. The participants were much enthusiastic to attend the training sessions in virtual reality and
also no participants in the present study dropped out until the end of the study.
Based on the data obtained, all five participants allowed the headset to be placed over the participant’s head
and participants showed considerable improvement in virtual reality therapy sessions. Additionally, comparing
the response of the participants’ pre and post sessions suggested positive changes in participant skills related
to prolonged cognitive skills, social and self-care skills. Also, the participants were observed to be less anxious
when in closed spaces as they were trained in a virtual reality environment.
Conclusions: The present study suggests that the virtual reality scenarios in Auticare have no harmful effects
on children and is well accepted by children with high functioning autism. Also, the preliminary finding
suggests that the training in virtual reality scenarios using Auticare improves the user’s social, cognitive and
self-care skills.
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Children and adolescents diagnosed with autism spectrum disorder (ASD) have significant difficulties with communication and social skills. Consequently, children diagnosed with ASD are often victims of social rejection and targets of bullying, which have an adverse impact on their emotional and mental wellbeing. Social anxiety, depression, and poor academic achievement are some of the consequences that can harm their whole lives. This chapter will begin with an elaboration of the challenges facing children and adolescents diagnosed with ASD. This will be followed by an introduction to virtual reality (VR) and its advantages for extending the capabilities of some of the traditional interventions developed to teach social and everyday living skills to children and adolescents diagnosed with ASD.
Previous research studies have shown that Virtual Reality (VR) learning is effective for various topics of learning (e.g., social adaptation and skills, job interview, empathy, etc.) on the Autism Spectrum Disorder (ASD) population. VR learning is always delivered using VR devices or installations. Compared to VR installations such as Cave Automatic Virtual Environment (CAVE), with the careful design of VR software, VR headsets are able to achieve a similar degree of immersion and interactivity at a fraction of the cost, while keeping minimum requirements on the venue and the whole setup highly portable. However, there is a lack of research on delivering VR learning for the ASD population using VR headsets. In this paper, we report a case study involving four children with ASD, who were recruited to experience the prototype software for VR learning in our laboratory environment. Our observation reveals that the design allows children with ASD comprehend the three-dimensional world and smoothly interact with virtual objects and avatars while using the VR headsets.
The rapid development of computer and robotic technologies in the last decade is giving hope to perform earlier and more accurate diagnoses of the Autism Spectrum Disorder (ASD), and more effective, consistent, and cost-conscious treatment. Besides the reduced cost, the main benefit of using technology to facilitate treatment is that stimuli produced during each session of the treatment can be controlled, which not only guarantees consistency across different sessions, but also makes it possible to focus on a single phenomenon, which is difficult even for a trained professional to perform, and deliver the stimuli according to the treatment plan. In this article, we provide a comprehensive review of research on recent technology-facilitated diagnosis and treat of children and adults with ASD. Different from existing reviews on this topic, which predominantly concern clinical issues, we focus on the engineering perspective of autism studies. All technology facilitated systems used for autism studies can be modeled as human machine interactive systems where one or more participants would constitute as the human component, and a computer-based or a robotic-based system would be the machine component. Based on this model, we organize our review with the following questions: (1) What are presented to the participants in the studies and how are the content and delivery methods enabled by technologies? (2) How are the reactions/inputs collected from the participants in response to the stimuli in the studies? (3) Are the experimental procedure and programs presented to participants dynamically adjustable based on the responses from the participants, and if so, how? and (4) How are the programs assessed?.
Clinical heterogeneity is a well-established characteristic of autism spectrum disorder (ASD). While the comorbidity of ASD and ADHD is well known in clinical practice, relatively little research has examined the neuropsychological profile of children with ASD + ADHD. Our study showed significant differences in the neuropsychological characteristics of children with ASD + ADHD compared to those with ASD only. Children with ASD + ADHD showed higher symptoms of anxiety, worse working memory, and less empathy, as measured by the “Reading the Mind in the Eyes.” This suggests that having ADHD brings further challenges to individuals with ASD and may negatively impact their management and outcome. Our findings may have implications for clinical assessment as well as for intervention.
Although the DSM-5 has recently created a single category of autism spectrum disorder (ASD), delineation of its putative subtypes remains clinically useful. For this process, screening instruments should ideally be brief, simple, and easily available. The aim of this study is to describe the validity of one such instrument. We administered the Michigan Autism Spectrum Questionnaire (MASQ), a 10-item questionnaire, to 42 patients with ASD (age range 6-13 years, mean 9.7 years, SD 2.5, one female) and 18 patients with other psychiatric disorders (age range 6-17 years, mean 11.7 years, SD 3.8, 6 females). Responses to each item were scored from 0 to 4 yielding a total score of 30. Patients with intellectual disability were excluded. As a group, patients with ASD scored higher than those with other psychiatric disorders (Chi-square test with 1 df = 16.019, P < 0.0001). Within the ASD group, a linear discriminant analysis found that the best cut-off points were 22 or above for Asperger syndrome, 14 to 21 for autism/PDDNOS, and less than 14 for those with other psychiatric disorders. We propose that the MASQ can be used as a brief measure to screen high-functioning ASD from other psychiatric disorders and to identify its possible subtypes.
Few evidence-based social interventions exist for young adults with high-functioning autism, many of whom encounter significant challenges during the transition into adulthood. The current study investigated the feasibility of an engaging Virtual Reality Social Cognition Training intervention focused on enhancing social skills, social cognition, and social functioning. Eight young adults diagnosed with high-functioning autism completed 10 sessions across 5 weeks. Significant increases on social cognitive measures of theory of mind and emotion recognition, as well as in real life social and occupational functioning were found post-training. These findings suggest that the virtual reality platform is a promising tool for improving social skills, cognition, and functioning in autism.
Virtual reality (VR), a computer-based simulation of the real world, provides a multisensory, multidimensional medium within which users are able to interact in real time. VR is gaining support as a potentially effective tool in autism treatment because of its ability to engage and motivate children with autism while offering certain therapeutic advantages. VR can merge existing approaches to autism treatment that have been traditionally difficult to integrate and can also provide the essential components of autism treatment that are well established in the field. Overall, the approach to using VR in autism treatment is primarily focused on simulating real work environments and offering opportunities to address specific challenges associated with this disorder. The majority of VR programs have been developed to improve the core, diagnostic impairments in autism, particularly social and communication behaviors; however, there are recent programs that focus on safety behaviors as well as underlying cognitive or sensory impairments. Early research exploring VR in autism treatment has revealed great potential for VR as a therapeutic tool; however, the problem of generalization, or skill transfer to new environments, still remains a major difficulty. Future technological developments and continued research in this area will likely focus on overcoming this barrier.
Virtual Reality (VR) technologies have shown potential for learning and assessment for children, adolescents, and adults with autism. Much of the research in this area has taken a conceptual stance of veridicality; that is, that VR offers promise because it can provide authenticity and levels of realism alongside stimulus or environmental control, or both, which may first facilitate learning and the generalization of skills to the real world, and secondly can provide experimental contexts with strong ecological validity for assessment. This conceptual review raises questions about the assumption of veridicality of VR for autism research by examining research literature that has used VR to support learning and to investigate social responding. In so doing, it provides a framework for examining the assumed relationship between virtual and real contexts in order to highlight particular features of design and interaction, as well as background characteristics of participants, that may help or hinder learning and understanding in virtual environments. The conclusions suggest there is a need for the field to systematically examine the different factors that influence responding in VR in order to understand when, and under what circumstances, the responses of individuals with autism can be considered appropriately authentic. There are also opportunities for thinking more radically about research directions through focusing on the strengths and preferences of people with autism, and promoting more participatory and inclusive approaches to research.
Autism Spectrum Disorders (ASD) are characterized by deficits in social skills and communications. This paper describes a Collaborative Virtual Environment (CVE) on the Android platform designed to investigate the collaborative behaviors and communication skills of children with ASD. The mobile CVE has the advantages of (1) widespread availability, and (2) allowing flexible communication between people. This presented mobile CVE allows two users in different locations to interact and communicate with each other while playing puzzle games on mobile devices. Multiple puzzle games with different interaction patterns were designed in the environment, including turn-taking, information sharing, and enforced collaboration. Audio and video chat were implemented in the environment in order for the geographically distributed players to talk with and see each other. The usability of the environment has been validated through a user study involving five pairs of subjects. Each pair included one child with ASD and one typically developing (TD) child. The results showed that the presented CVE environment may have the potential to improve players’ collaborative behaviors and communication skills.
Children with Autism spectrum disorders (ASD) often suffer from deficits in communication and social interaction, which lead to various social challenges in interacting with peers in collaborative tasks. The application of Collaborative Virtual Environment (CVE) technology in ASD intervention brings advantages in providing a safe, flexible, and collaborative environment. This paper proposes and describes the development of a novel distributed CVE system for playing a series of collaborative games using hand movement that is tracked in real-time via cameras. These games aim to positively impact the social interaction of users. A usability study indicated potential of this system in fostering collaboration and communication skills among children with and without ASD.
Children with Autism Spectrum Disorder (ASD) are characterized by deficits in socialization, communication and imagination. In recent years several assistive technologies e.g., Virtual Reality (VR) are being investigated to promote social communication skills in these children. However these only report on performance and do not use physiological markers as predictors of one's affective states. In conventional techniques, a therapist adjusts the intervention paradigm by monitoring the affective states of these children. However, these children often demonstrate inability to explicitly express their affective states thereby inducing limitations on conventional techniques. Physiological signals being continuously available and not directly impacted by these communication difficulties can be used as markers of one's affective states. In India, research on technology-assisted intervention for children with ASD is rare. Here, the presented work seeks to address the challenge of maintaining the subtle Indian social aspects which still remains untouched in research, but are valuable contributors to social communication while developing VR based social conversation system. Additionally, we acquired physiological markers and correlated these with the affective state having implication on one's performance. A preliminary usability study indicates the potential of the system to improve social task performance and to induce variations in one's physiological markers.
Innovative computer aided solutions can serve as effective teaching-learning as-well-as assistive aids for children with autism and mild mental retardation. Teaching children with the help of day-to-day real time objects in the environment, by adding parent's voice/narration, associating virtual 3D images and rendering them on mobiles, would enhance the learning process. Augmented Reality (AR) is proving to be a useful technology to achieve this kind of teaching objectives. The implementation presented here, supports creation of teaching content using features of inbuilt camera and speaker of any basic Android device. This application helps in capturing and associating the pictures of surrounding objects like child's photos, videos etc., with AR content and aids in rendering them on to the screens using QR Codes (Quick Response Codes). Using this mobile application, parents/teachers can make paperless, personalized AR lessons on-the-fly. Application supports Functional Reading, Visual Schedulers and Speaking Albums for the children, to learn from real life scenarios.
People with autism experience profound and pervasive difficulties in the social domain. Attempts to teach social behaviours tend to adopt either a behavioural or a 'theory of mind' (ToM) approach. The beneficial aspects and limitations of both paradigms are summarized before an examination of how virtual reality technology may offer a way to combine the strengths from both approaches.
This is not an exhaustive review of the literature; rather, the papers are chosen as representative of the current understanding within each broad topic. Web of Science ISI, EMBASE and PsycInfo were searched for relevant articles.
Behavioural and ToM approaches to social skills training achieve some success in improving specific skills or understanding. However, the failure to generalize learned behaviours to novel environments, and the unwieldy nature of some behavioural methodologies, means that there is a need for a training package that is easy to administer and successful in promoting learning across contexts.
Virtual reality technology may be an ideal tool for allowing participants to practise behaviours in role-play situations, whilst also providing a safe environment for rule learning and repetition of tasks. Role-play within virtual environments could promote the mental simulation of social events, potentially allowing a greater insight into minds. Practice of behaviours, both within and across contexts, could also encourage a more flexible approach to social problem solving. Virtual environments offer a new and exciting perspective on social skills training for people with autistic spectrum disorders.
Neurohab: a platform for virtual training of daily living skills in autism spectrum disorder
- M Simões
- S Mouga
- F Pedrosa
- P Carvalho
- G Oliveira
- M C Branco
Simões, M.; Mouga, S.; Pedrosa, F.; Carvalho, P.; Oliveira, G.; Branco, M.C. Neurohab: a platform for virtual
training of daily living skills in autism spectrum disorder. Procedia Technol. 2014, 16, 1417-1423.