Designing computer-based rewards with and for children with Autism Spectrum Disorder and/or Intellectual Disability

Self-Guided DMT: Exploring a Novel Paradigm of Dance Movement Therapy in Mixed Reality for Children with ASD

Children diagnosed with Autism Spectrum Disorder (ASD) often exhibit motor disorders. Dance Movement Therapy (DMT) has shown great potential for improving the motor control ability of children with ASD. However, traditional DMT methods often lack vividness and are difficult to implement effectively. To address this issue, we propose a Mixed Reality DMT approach, utilizing interactive virtual agents. This approach offers immersive training content and multi-sensory feedback. To improve the training performance of children with ASD, we introduce a novel training paradigm featuring a self-guided mode. This paradigm enables the rapid creation of a virtual twin agent of the child with ASD using a single photo to embody oneself, which can then guide oneself during training. We conducted an experiment with the participation of 24 children diagnosed with ASD (or ASD propensity), recording their training performance under various experimental conditions. Through expert rating, behavior coding of training sessions, and statistical analysis, our findings revealed that the use of the twin agent for self-guidance resulted in noticeable improvements in the training performance of children with ASD. These improvements were particularly evident in terms of enhancing movement quality and refining overall target-related responses. Our study holds clinical potential in the field of medical treatment and rehabilitation for children with ASD.

Development of oral health resources and a mobile app for caregivers and autistic children through consensus building

LAY ABSTRACT

Caregivers of autistic children often lack knowledge regarding oral homecare and when and where to see the dentist. To address this need, we developed a series of information on oral health. An autistic child assisted in developing two social stories to showcase a dental visit. A mobile app was developed to deliver the above mentioned. Other features include creation of customised social stories and visual schedule and an inbox to allow dentists to send messages to parents. The developed information and social stories were reviewed by experts and parents. The app also underwent anonymous and independent testing by parents. Overall the information and app were well received by the experts and parents.

Effective digital support for autism: digital social stories

Social Stories™ is one of the most popular interventions for autistic children and has been researched extensively. However, effectiveness data has been gathered mainly through single-participant designs which generate outcomes which can lack generalizability and social validity. Stories Online For Autism (SOFA) is a digital application which supports the development and delivery of Social Stories in a real-world setting and has the potential to contribute toward furthering (1) Social Stories research and (2) research on digital applications for autism by gathering large data sets from multiple participants. Three data sets (N = 856) were gathered through the SOFA app and were analyzed to investigate three key variables: What predicted closeness-to-goal of the Social Stories (as rated by an adult/parent/guardian, n = 568); the child's comprehension of the Social Stories (assessed by story comprehension questions, n = 127); and the child's rating of the enjoyability of the Social Stories (n = 161). A merged data set then investigated correlations between these three key variables. Age range (≤15), gender, autism diagnosis, and the child's level of language understanding were the potential predictors for these three key variables. Regression analysis indicated that parental closeness-to-goal ratings for their children were highest for children who were younger and more verbal. Regression analysis also indicated that older children scored higher in comprehension assessment, and autistic children rated the Social Stories as more enjoyable. Closeness-to-goal, comprehension scores and enjoyment ratings did not significantly correlate with each other. This is the largest study of Social Stories effectiveness, which was enabled through the collection of data through a digital app from multiple participants. The results indicate that digital social stories are particularly effective for younger verbal children. While this was the case for all children, it was particularly true for autistic children and female (and gender-diverse) children. For the first time, the gathering of large digital data sets has highlighted that while digital Social Stories can be effective for autistic males, they can be more effective for autistic females and gender-diverse autistic individuals. Thus, the SOFA app can support the investigation of the factors which influence Social Stories outcomes that are generalizable and with high social validity.

The effects of reward and frustration on the task performance of autistic children and adolescents

BACKGROUND

Autistic individuals often exhibit social communication and socio-emotional styles that may interfere with achieving social and academic outcomes. At a more specific level, they may perform differently in various social and academic tasks due to different modes of processing rewards or unpleasant experiences (e.g., frustrating events).

AIM

The present experiment examines how rewards and frustration affect the task performance of autistic children and adolescents METHODS AND PROCEDURES: An affective Posner task was applied to introduce rewards and induce frustration. Forty-four autistic children and adolescents and forty-four typically developing (TD) peers participated in this study OUTCOMES AND RESULTS: Results showed that presenting social and non-social rewards resulted in shorter reaction times and lower error rates in autistic participants, but not in their TD peers. While frustration increased error rates in both autistic and TD individuals, the effect was more pronounced in the autistic group.

CONCLUSIONS AND IMPLICATIONS

Social and non-social rewards help the performance of autistic children and adolescents, whereas frustration (induced through unpredictable feedback) significantly interferes with their task performance. Therefore, receiving two types of rewards and providing predictable feedback may help to improve interventions designed to optimize task performance for autistic children and adolescents.

A rule-based theoretical account of social stories to address the double empathy problem

Social Stories™ (SS) is one of the most popular and researched interventions for autistic children. To date, research that focuses on outcomes has been prioritized over the investigation of the psychological mechanisms that inform the intervention. In this article we consider theoretical accounts proposed thus far which could underpin SS. We argue that mechanisms that are based on social deficit theories lack validity, and propose a rule-based theoretical account to inform a strengths-based approach toward conceptualizing the mechanisms that underpin SS. We apply this account to the 'double-empathy problem' to propose that SS can be adapted to involve all parties in the development and delivery of SS support by adopting a rule-based perspective. We use the example of systemizing (the drive to analyze and explore systems in terms of 'if-and-then' rules), which is proposed to be a relative autistic strength, as a form of rule-based thinking that can provide a theoretical account of SS and a framework to address the double-empathy problem.

INC-Hg: An Intelligent Collaborative Haptic-Gripper Virtual Reality System

Collaborative Virtual Environments (CVE) have shown potential to be an effective social skill training platform for children with Autism Spectrum Disorders (ASD) to learn and practice collaborative and communication skills through peer interactions. However, most existing CVE systems require that appropriately matched partners be available at the same time to promote interaction, which limits their applicability to some community settings due to scheduling constraints. A second shortcoming of these more naturalistic peer-based designs is the intensive resources required to manually code the unrestricted conversations that occurred during the peer-based interactions. To preserve the benefits of CVE-based platforms and mitigate some of the resource limitations related to peer availability, we developed an Intelligent Collaborative Haptic-Gripper System (INC-Hg). This system provides an intelligent agent partner who can understand, communicate, and haptically interact with the user, without requiring the presence of another human peer. The INC-Hg operates in real time and thus is able to perform collaborative training tasks at any time and at the user's pace. INC-Hg can also record the real-time data regarding spoken language and task performance, thereby greatly reducing the resource burden of communication and interaction performance analysis. A preliminary usability study with 10 participants with ASD (ages 8–12 years) indicated that the system could classify the participant's utterances into five classes with an accuracy of 70.34%, which suggested the potential of INC-Hg to automatically recognize and analyze conversational content. The results also indicated high accuracies of the agent to initiate a conversation (97.56%) and respond to the participants (86.52%), suggesting the capability of the agent to conduct proper conversations with the participants. Compared to the results of human-to-human collaborative tasks, the human-to-agent mode achieved higher average collaborative operation ratio (61% compared to 40%) and comparable average frequencies for Initiations and Responses among the participants with ASD. These results offer preliminary support as well as areas of improvement regarding the agent's ability to respond to participants, work with participants to complete tasks, engage in back-and-forth conversations, and support the potential of the agent to be a useful partner for individuals with ASD completing CVE tasks.

Extended Reality Guidelines for Supporting Autism Interventions Based on Stakeholders' Needs

While Extended Reality (XR) autism research, ranging from Augmented to Virtual Reality, focuses on socio-emotional abilities and autistic children requiring low support, common interventions address the entire spectrum and focus on other abilities, including perceptual abilities. Based on these observations, this paper first addresses common practitioners' interventions, and then suggests XR use cases and guidelines to better support them. To do so, 34 interviews were conducted with stakeholders, mainly including practitioners, and then analyzed. Emerging XR use cases were compared with the findings from two former systematic literature reviews, and emerging design guidelines were compared with the findings from a literature survey that we conducted. Findings suggest that collaborative XR sensory-based and mediation approaches could benefit the entire spectrum.

The impact of using digitally-mediated social stories on the perceived competence and attitudes of parents and practitioners supporting children with autism

A Social Story (SS) is a highly acceptable and widely used intervention by the autism community. Yet, inconsistent implementation of the intervention is reported to be one of the causes of variability in terms of outcome research, particularly in a naturalistic context. This study aimed to (1) investigate whether digitally-mediated social stories (SSs) can improve competence in developing and delivering a SS and thus contribute towards improved implementation, and (2) investigate the impact of the digitally-mediated SS on attitudes towards the SS intervention. Ninety-three participants took an initial pre-engagement survey. Forty-eight of these participants also complete a post-engagement survey. A pre-post design was utilised with the participants who completed both surveys. These 48 participants were invited to develop a digitally-mediated SS with the aim of exploring how digitally-mediated SSs impacted perceived competence and attitudes. Post-engagement data was collected two weeks after the pre-engagement data. Outcomes of this study indicate that both perceived competence and attitudes improved after engaging with digitally-mediated SSs. It is concluded that digitally-mediated SS not only impacted the integrity of how the intervention was delivered but also the beliefs in the participants’ capabilities to develop and deliver a SS. Digitally-mediated SS, thus, has the potential to effectively support development and delivery whilst also addressing challenges related to intervention implementation in a naturalistic context.

Mothers' and practitioners' insights on the use of digitally-mediated social stories with children on the autism spectrum: A convergent mixed-methods study

BACKGROUND

While end-user interest in digitally-mediated Social Story (SS) intervention for children on the autism spectrum is growing, research on the use of SSs in digital form is currently lacking.

AIMS

This study aimed to investigate how digital-mediation can influence parents' and practitioners' attitudes towards the SS intervention as well as impact their perceived competence in their ability to administer the intervention.

METHODS AND PROCEDURES

This study used a convergent mixed-method design. Nineteen participants (ten practitioners and nine mothers) participated in two focus group sessions. Participants then engaged with a digitally-mediated SS and completed a pre- and post-engagement survey measuring attitude, competence and user experience with the intervention.

OUTCOMES AND RESULTS

The mothers' perceived competence ratings improved after engaging with digitally-mediated SSs. Mothers and practitioners also indicated that digitally-mediated SSs increased their perceived efficiency, while mothers felt it improved their autonomy and further empowered them as end-users.

CONCLUSION AND IMPLICATIONS

Digitally-mediated SS has the potential to effectively address challenges related to intervention implementation whilst also empowering further the end-user.

A Pilot Randomised Control Trial of Digitally-Mediated Social Stories for Children on the Autism Spectrum

Social stories is a widely used intervention for children on the autism spectrum, particularly within an educational context. To date, systematic reviews and meta analyses of the research evaluating social stories has produced mixed results, often due to a lack of methodological rigour and variability in the development and delivery of the social stories. To address the gap in methodological rigour, a pilot Randomised Control Trial (RCT) was conducted, incorporating a social stories intervention group (n = 9 children on the autism spectrum) and an attentional control group who received a poem (n = 6 children on the autism spectrum) using a digital platform to address variability. Digitally-mediated social stories were found to be effective in producing beneficial changes in behaviour outcomes, which were sustained at a six-week follow up.

A preliminary investigation assessing the basic digital capabilities of minimally verbal children on the autism spectrum with intellectual disability

Purpose

Children with Autism Spectrum Disorder (ASD) can demonstrate a preference for using digital technologies which can represent a relative strength within the autism community. Such a strength would have implications for digitally mediated interventions and support for autism. However, research to date has not developed a methodology for assessing the capabilities of minimally verbal children on the autism spectrum with intellectual disability (ID) to use digital technology.

Design/methodology/approach

Six minimally verbal children with ASD and ID undertook an accessible assessment that identified what capabilities for interacting with a digital tablet device they could and could not demonstrate. Twelve brief assessments were demonstrated, including turning on the device, adjusting the volume, operating the camera, touching, tilting and rotating the screen.

Findings

Participants could be assessed on their digital capabilities. In this study, participants could largely touch and swipe the screen effectively and leave the app, but could not tilt and rotate the screen nor turn on the digital tablet device.

Research limitations/implications

While the numbers were small, the findings indicate that the digital capabilities of this group can usefully be assessed. Future research can use such assessments to highlight how intervention effectiveness and support can be enhanced by matching the digital capacities of minimally verbal children with ASD and ID to technological support. This is a preliminary study and a greater understanding of children’s prior experiences with technology will better inform how and which digital capabilities develop.

Originality/value

This is the first study to assess a range of basic capabilities for using digital tablet devices in minimally verbal children with ASD and ID.

Digitally-Mediated Social Stories Support Children on the Autism Spectrum Adapting to a Change in a 'Real-World' Context

Social Stories™ (SS) is a widely used intervention for children on the autism spectrum. A preliminary survey of 103 practitioners highlighted that SS are often used to support adapting to a change. This study investigated the use of digitally-mediated SS to support ten children on the autism spectrum attending a school summer camp. Teacher perceptions of anxiety, understanding and closeness to the goal of the SS were assessed before and after the intervention (prior to the event). The pre- post-intervention comparisons highlighted significant improvements in child understanding, anxiety, and closeness to goal with medium-large effect sizes. The child’s understanding and closeness to SS goal post-intervention related to their difficulties with the SS goal and their anxiety during the event.

A framework of evidence-based practice for digital support, co-developed with and for the autism community

A wide array of digital supports (such as apps) have been developed for the autism community, many of which have little or no evidence to support their effectiveness. A Delphi study methodology was used to develop a consensus on what constitutes good evidence for digital supports among the broader autism community, including autistic people and their families, as well as autism-related professionals and researchers. A four-phase Delphi study consultation with 27 panel members resulted in agreement on three categories for which evidence is required: reliability, engagement and effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. These were differentially weighted as sources of evidence within these three categories.

Serious Game-based Intervention for Children with Developmental Disabilities

BACKGROUND

Children with developmental disabilities may need support with motor skills such as balance improvement, cognitive skills such as vocabulary learning, or social skills such as adequate interpretation of emotional expressions. Digital interactive games could support the standard treatments. We aimed to review clinical studies which investigated the application of serious games in children with developmental disabilities.

METHODS

We searched MEDLINE and Scopus on 05 May 2019 limited to the English language. We included people between two and 24 years of age who were affected by neurodevelopmental disorders and who received digital serious game-based medical interventions such as any computer- based or video-based games. We considered any study design reporting primary data. We used title, abstract, and full-text of journal articles to build diagnostic groups, and we described some selected specific game applications.

RESULTS

The majority of the 145 relevant studies reported on autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), developmental coordination disorder (DCD), and disabilities affecting intellectual abilities (DAIA). 30 of the 145 studies reported a randomized design. We detailed six specific applications aimed at improving abilities in children with ASD, ADHD, cerebral palsy, and Down syndrome. We visualized the diagnostic groups by bibliographic mapping, and limited the text to the title and abstract of journal articles.

CONCLUSION

We identified promising results regarding anxiety reduction, stress regulation, emotion recognition, and rehabilitation. Currently, there appears to be a lack of clinical evidence that children with neurodevelopmental disorders can benefit from the application of serious games.

The Use of Information Communication Technologies Among Children With Autism Spectrum Disorders: Descriptive Qualitative Study

BACKGROUND

The prevalence of Autism Spectrum Disorder (ASD) appears to be increasing globally due to the complex interaction of multiple biopsychosocial and environmental factors. Mobile phones, tablets, and other electronic gadgets have transformed our means of communication, and have also changed both healthcare and how we learn. These technological enhancements may have a positive impact on the lives of children, but there is currently a global scarcity of information on how information technology influences the education of children with ASD.

OBJECTIVE

This study was conducted in Rwandan schools and communities, and aimed to understand the perceptions of students with ASD, their parents, and their teachers, on the use of Information and Communication Technology (ICT) in the education of those with ASD.

METHODS

This qualitative descriptive study was conducted from December 2017 to July 2018. Researchers conducted four focus group discussions (FGDs) with 54 participants from different backgrounds: teachers, parents, and students with ASD. Each of the FGDs took approximately two and a half hours. A predefined set of open-ended questions were selected to discover people's perceptions regarding assistive technologies used in ASD, their effectiveness, the scope of using them in their context, and upcoming challenges during implementation. The interviews were recorded, transcribed, and analyzed.

RESULTS

The findings of the study revealed seven key themes: (1) the use of ICT for the education of children with ASD; (2) existing augmentative facilities for learning; (3) current patterns of use of ICT in education; (4) preferred areas of learning for ASD students; (5) integration of ICT into educational programs; (6) areas of interest outside the classroom; and (7) future opportunities and challenges in Rwanda. We found most of the study participants assumed that appropriate technology and related innovations might solve the challenges faced by learners with ASD in classrooms. Moreover, they thought that children with ASD more so enjoyed watching television, playing digital games, and drawing objects using gadgets than interacting with people or playing with other children.

CONCLUSIONS

The use of various low-cost technical devices can aid with teaching and the education of children with autism in Rwanda. However, this area requires further research to discover the impact ICT can have on the education of children with ASD, so this study may become a starting point for further research in the area.

Designing a Serious Game for Youth with ASD: Perspectives from End-Users and Professionals

Recent years have seen an emergence of social emotional computer games for individuals with Autism Spectrum Disorder (ASD). These games are heterogeneous in design with few underpinned by theoretically informed approaches to computer-based interventions. Guided by the serious game framework outlined by Whyte et al. (Journal of Autism and Developmental Disorders 45(12):1-12, 2014), this study aimed to identify the key motivating and learning features for serious games targeting emotion recognition skills from the perspectives of 11 youth with ASD and 11 experienced professionals. Results demonstrated that youth emphasised the motivating aspects of game design, while the professionals stressed embedding elements facilitating the generalisation of acquired skills. Both complementary and differing views provide suggestions for the application of serious game principles in a potential serious game.

Development and evaluation of a 3-D virtual pronunciation tutor for children with autism spectrum disorders

The deficit in speech sound production in some children with autism spectrum disorder (ASD) adds to their communication barriers. The 3-D virtual environments have been implemented to improve their communication abilities. However, there were no previous studies on the use of a 3-D virtual pronunciation tutor designed specifically to train pronunciation for children with ASD. To fill this research gap, the current study developed and evaluated a 3-D virtual tutor which served as a multimodal and real-data-driven speech production tutor to present both places and manners of Mandarin articulation. Using an eye-tracking technique (RED 5 Eye Tracker), Experiment 1 objectively investigated children’s gauged attention distribution online while learning with our computer-assisted 3-D virtual tutor in comparison to a real human face (HF) tutor. Eye-tracking results indicated most participants showed more interests in the visual speech cues of the 3-D tutor, and paid some degree of absolute attention to the additional visual speech information of both articulatory movements and airflow changes. To further compare treatment outcomes, training performance was evaluated in Experiment 2 with the ASD learners divided into two groups, with one group learning from the HF tutor and the other from the 3-D tutor (HF group vs. 3-D group). Both groups showed improvement with the help of computer-based training in the post-intervention test based on the calculation of a 5-point Likert scale. However, the 3-D group showed much higher gains in producing Mandarin stop and affricate consonants, and apical vowels. We conclude that our 3-D virtual imitation intervention system provides an effective approach of audiovisual pronunciation training for children with ASD.