The need for and barriers to using assistive technologies among individuals with Autism Spectrum Disorders in China

Therapists' perspective on acceptance of robot-assisted physical rehabilitation in a middle-income country: a study from Vietnam

Robot-assisted physical rehabilitation offers promising benefits for patients, yet its adoption among therapists remains a complex challenge. This study investigates the acceptance of robot-assisted physical rehabilitation technology among therapists in Vietnam, a middle-income country with a growing demand for rehabilitation services. Drawing on the Technology Acceptance Model 2 (TAM2) and the Theory of Planned Behaviour (TPB), an online survey and semi-structured interviews were conducted to explore therapists' attitudes and intentions towards using this technology. The results show that Vietnamese therapists recognised its potential benefits and expressed a willingness to use it. Although having similar acceptance patterns compared to developed regions, they demonstrated significantly higher levels of agreement across acceptance constructs. This may be attributed to factors such as the novelty effect, cultural perceptions of robots, and the high workload of therapists in Vietnam. Gender and location were found to influence two acceptance constructs-subjective norms and image, respectively-highlighting the need for tailored strategies in technology implementation. The study underscores the importance of considering socio-cultural factors in the adoption of technology and provides insights for enhancing the acceptance and effectiveness of robot-assisted physical rehabilitation in Vietnam. This contributes to the global understanding of therapist acceptance of technology in this field.

Developmental Language Differences in Children with Autism Spectrum Disorders and Possible Sex Difference

Developmental difference is a common characteristic of autism spectrum disorder (ASD) with unclear sex differences. The current study included 610 children with ASD, aged between 2 and 7 years, with completed language profiles. We used a nonparametric item response theory model called Mokken scale analysis to examine the order of acquisition of developmental language milestones in children with ASD. Our results demonstrated the developmental language differences in the expressive and receptive language dimensions in children with ASD compared with typical developmental sequences. Furthermore, The acquisition of gestures and pragmatics was more impaired in the female subgroup than in the male subgroup. The identified developmental language sequence could help provide a more comprehensive ASD developmental profile.

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.

A Scoping Review of Studies on Assistive Technology Interventions and Their Impact on Individuals with Autism Spectrum Disorder in Arab Countries

The rising prevalence of autism spectrum disorder (ASD) in Arab countries necessitates evidence-based interventions. Assistive technology (AT) presents a promising approach. However, data on the pervasiveness of AT use and its effectiveness for individuals with ASD, specifically within Arab countries, remain scarce.

OBJECTIVE

To review the current literature on the AT interventions and outcomes reported for individuals with ASD in Arab countries.

METHODS

A scoping review adhering to PRISMA guidelines was undertaken to explore the utilization of AT, segmented into three categories: low-technology (low-tech), mid-technology (mid-tech), and high-technology (high-tech) devices.

RESULTS

Twelve studies had a pooled sample of 1547 participants, primarily male school-aged children with ASD. The AT applications evaluated ranged from low-tech visual schedules and support to high-tech virtual reality systems. Studies have reported the potential benefits of AT in improving communication, social, academic, adaptive, and functional abilities; however, comparative evidence between AT interventions is limited. The identified barriers to the adoption of AT included caregiver uncertainty about the use of AT and a lack of awareness of AT among professionals and the Arab community in general.

CONCLUSION

Available studies suggest that the adoption of AT can enhance the skills of individuals with ASD in Arab countries. However, more rigorous studies across diverse demographic groups and Arab national regions are needed to strengthen the evidence base and provide appropriate recommendations.

Effects of a Nonwearable Digital Therapeutic Intervention on Preschoolers With Autism Spectrum Disorder in China: Open-Label Randomized Controlled Trial

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause difficulty with communication and social interactions as well as complicated family dynamics. Digital health interventions can reduce treatment costs and promote healthy lifestyle changes. These therapies can be adjunctive or replace traditional treatments. However, issues with cooperation and compliance prevent preschool patients with ASD from applying these tools. In this open-label, randomized controlled trial, we developed a nonwearable digital therapy called virtual reality-incorporated cognitive behavioral therapy (VR-CBT).

OBJECTIVE

The aim of this study was to assess the adjunctive function of VR-CBT by comparing the effects of VR-CBT plus learning style profile (LSP) intervention with those of LSP-only intervention in preschool children with ASD.

METHODS

This trial was performed in China on 78 preschool children (age 3-6 years, IQ>70) diagnosed with ASD who were randomized to receive a 20-week VR-CBT plus LSP intervention (intervention group, 39/78, 50%) or LSP intervention only (control group, 39/78, 50%). The primary outcome was the change of scores from baseline to week 20, assessed by using the parent-rated Autism Behavior Checklist (ABC). Secondary outcomes included the Childhood Autism Rating Scale (CARS), Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV), and behavioral performance data (accuracy and reaction time) in go/no-go tasks. All primary and secondary outcomes were analyzed in the intention-to-treat population.

RESULTS

After the intervention, there was an intervention effect on total ABC (β=-5.528; P<.001) and CARS scores (β=-1.365; P=.02). A similar trend was observed in the ABC subscales: sensory (β=-1.133; P=.047), relating (β=-1.512; P=.03), body and object use (β=-1.211; P=.03), and social and self-help (β=-1.593; P=.03). The intervention also showed statistically significant effects in improving behavioral performance (go/no-go task, accuracy, β=2.923; P=.04). Moreover, a significant improvement of ADHD hyperactivity-impulsivity symptoms was observed in 53 children with comorbid ADHD based on ADHD-RS-IV (β=-1.269; P=.02). No statistically significant intervention effect was detected in the language subscale of ABC (β=-.080; P=.83). Intervention group girls had larger improvements in ABC subscales, that is, sensory and body and object use and in the CARS score and accuracy of go/no-go task (all P<.05) than the control group girls. Statistically significant intervention effects could be observed in hyperactivity-impulsivity symptoms in the intervention group boys with comorbid ADHD compared with those in the control group boys (β=-1.333; P=.03).

CONCLUSIONS

We found potentially positive effects of nonwearable digital therapy plus LSP on core symptoms associated with ASD, leading to a modest improvement in the function of sensory, motor, and response inhibition, while reducing impulsivity and hyperactivity in preschoolers with both ASD and ADHD. VR-CBT was found to be an effective and feasible adjunctive digital tool.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100053165; http://www.chictr.org.cn/showproj.aspx?proj=137016.

A Sensor and Machine Learning-Based Sensory Management Recommendation System for Children with Autism Spectrum Disorders

Sensory processing issues are one of the most common issues observed in autism spectrum disorders (ASD). Technologies that could address the issue serve a more and more important role in interventions for ASD individuals nowadays. In this study, a sensory management recommendation system was developed and tested to help ASD children deal with atypical sensory responses in class. The system employed sensor fusion and machine learning techniques to identify distractions, anxious situations, and the potential causes of these in the surroundings. Another novelty of the system included a sensory management strategy making a module based on fuzzy logic, which generated alerts to inform teachers and caregivers about children’s states and risky environmental factors. Sensory management strategies were recommended to help improve children’s attention or calm children down. The evaluation results suggested that the use of the system had a positive impact on children’s performance and its design was user-friendly. The sensory management recommendation system could work as an intelligent companion for ASD children that helps with their in-class performance by recommending management strategies in relation to the real-time information about the children’s environment.