Self-initiations in young children with autism during Pivotal Response Treatment with and without robot assistance

Pivotal response treatment and applied behavior analysis interventions for autism spectrum disorder delivered by human vs robotic agents: a systematic review of literature

Robotic technology-aided instruction and interventions have been designed to support both Applied Behavior Analysis (ABA) and Pivotal Response Treatment (PRT) interventions for children with ASD. However, to the best of our knowledge, this field has not been systematically reviewed. Thus, we aimed to systematically review the literature to determine whether ABA or PRT methods in a robotic therapeutic context yield better outcomes for individuals with ASD, specifically in terms of approaching and accepting robots. A comprehensive search of electronic databases including PubMed, EMBASE, and Google Scholar was conducted. Randomized control trials (RCT) and pre-post-test design investigations that assessed the impact of ABA vs. PRT approach via robot-mediated technology vs. human trainers on intervention outcomes of children with ASD were selected and included in this systematic review. Finally, 13 papers met the criteria for inclusion in the systematic review. Two independent reviewers extracted the associated data from each selected study according to the standardized data extraction form. Two reviewers also assessed the quality of each study independently using the Cochrane Back Review Scale and JBI tool for quasi-experimental studies. We categorized two general classifications of findings including ABA vs. PRT as well as robotic technology vs. human. In conclusion, the existing investigations on the effect of robotic assistive technology using ABA or PRT approach are promising particularly in therapeutic contexts with a more natural context and social flavor.

Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan

IMPORTANCE

Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations.

OBJECTIVE

These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners.

METHOD

These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process.

RESULTS

A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines.

CONCLUSIONS AND RECOMMENDATIONS

Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.

A Scoping Review of the Use of Robotics Technologies for Supporting Social-Emotional Learning in Children with Autism

This scoping review synthesises the current research into robotics technologies for promoting social-emotional learning in children with autism spectrum disorder. It examines the types of robotics technologies employed, their applications, and the gaps in the existing literature. Our scoping review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines. The systematic search of relevant databases allowed us to identify studies that use robotics technologies for fostering social, emotional, and cognitive skills in young children with autism. Our review has revealed that various robots, such as Nao, Kaspar, and Zeno, have been used to support the development of social and emotional skills through imitation games, turn-taking, joint attention, emotional recognition, and conversation. As most of these studies were conducted in clinical settings, there is a need for further research in classroom and community-based environments. Additionally, the literature calls for more high-quality longitudinal studies to assess the long-term effectiveness and sustainability of robot-assisted therapy and to assess adaptive and personalised interventions tailored to individual needs. More emphasis is recommended on professional development for educators, parents, and health professionals to incorporate robotics technologies as evidence-based interventions as a pathway for creating inclusive learning environments for children with autism.

Clinic-Based Interventions to Support Social Participation for Autistic Children and Adolescents (2013-2021)

Systematic review briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from clinic-based studies to support social participation for autistic1 children and adolescents (birth to 18 yr).

Using the high-probability instructional sequence to improve initiation and completion of low-probability instructions in young autistic children

This study examined the use of the high-probability (high-p) instructional sequence during pre-academic or academic activities for three young children diagnosed with autism spectrum disorder (ASD) served in public elementary schools. Specifically, we examined the effects of the high-p instructional sequence on the children's initiation and completion of low-probability (low-p) instructions, implemented by their classroom teachers. A nonconcurrent multiple-baseline design across participants was used to evaluate the intervention outcomes. The results indicated that the high-p instructional sequence may be an effective antecedent-based intervention for autistic children who typically initiate the low-p instructions but have difficulty completing the instructions. A strong magnitude of effect was shown for initiation across children. For one child, initiation and completion increased during high-p, and the improvement was maintained above criterion levels when high-p instructions in sequence were faded. For two children, we found high levels of initiation but variable performance in completion during high-p. The use of programmed reinforcement for one child suggests that for autistic children who do not often initiate the low-p instructions, the addition of programmed reinforcement may be needed to increase completion of low-probability instructions.

Robot-mediated interventions for teaching children with ASD: A new intraverbal skill

Socially assistive robots (SAR) have the potential to impact therapies for Autism Spectrum Disorder (ASD) by supporting clinicians in increasing learning opportunities presented to individuals. Recent research on robot-mediated intervention (RMI) delivery has predominantly addressed social deficits in ASD with positive outcomes. Current literature has minimal focus on teaching children with ASD a skill not known apriori by the individual. Furthermore, it is unclear how to integrate robots in clinical settings because current RMIs do not adhere to Applied Behavior Analysis (ABA) protocols. In this work, we investigated whether an RMI could be utilized to teach children with ASD a completely new language and communication skill they could not exhibit at baseline. We utilized a standard ABA assessment tool to first identify appropriate skills to teach children with ASD. We then developed, implemented, and evaluated an RMI intervention that followed standard clinical operating procedures in ABA and targets participants' unique skill deficits. We examined the effects of the RMI training on teaching wh-question answering. All sessions were conducted with the SAR as the primary therapist using evidenced-based ABA human teaching protocols. All participants acquired the wh-questions answering skill within seven sessions, which is in line with their typical acquisition rates.

The use of social robots with children and young people on the autism spectrum: A systematic review and meta-analysis

BACKGROUND

Robot-mediated interventions show promise in supporting the development of children on the autism spectrum.

OBJECTIVES

In this systematic review and meta-analysis, we summarize key features of available evidence on robot-interventions for children and young people on the autism spectrum aged up to 18 years old, as well as consider their efficacy for specific domains of learning.

DATA SOURCES

PubMed, Scopus, EBSCOhost, Google Scholar, Cochrane Library, ACM Digital Library, and IEEE Xplore. Grey literature was also searched using PsycExtra, OpenGrey, British Library EThOS, and the British Library Catalogue. Databases were searched from inception until April (6th) 2021.

SYNTHESIS METHODS

Searches undertaken across seven databases yielded 2145 articles. Forty studies met our review inclusion criteria of which 17 were randomized control trials. The methodological quality of studies was conducted with the Quality Assessment Tool for Quantitative Studies. A narrative synthesis summarised the findings. A meta-analysis was conducted with 12 RCTs.

RESULTS

Most interventions used humanoid (67%) robotic platforms, were predominantly based in clinics (37%) followed home, schools and laboratory (17% respectively) environments and targeted at improving social and communication skills (77%). Focusing on the most common outcomes, a random effects meta-analysis of RCTs showed that robot-mediated interventions significantly improved social functioning (g = 0.35 [95%CI 0.09 to 0.61; k = 7). By contrast, robots did not improve emotional (g = 0.63 [95%CI -1.43 to 2.69]; k = 2) or motor outcomes (g = -0.10 [95%CI -1.08 to 0.89]; k = 3), but the numbers of trials were very small. Meta-regression revealed that age accounted for almost one-third of the variance in effect sizes, with greater benefits being found in younger children.

CONCLUSIONS

Overall, our findings support the use of robot-mediated interventions for autistic children and youth, and we propose several recommendations for future research to aid learning and enhance implementation in everyday settings.

PROSPERO REGISTRATION

Our methods were preregistered in the PROSPERO database (CRD42019148981).

Pivotal Response Treatment (PRT) parent group training for young children with autism spectrum disorder: a pilot study

Pivotal Response Treatment (PRT) is a promising intervention addressing core symptoms of autism spectrum disorder (ASD), with parent involvement as key component. Parent group-delivered PRT may be an effective treatment model, but currently the evidence is limited. Also, little attention has been paid to therapeutic involvement of multiple important contexts (e.g. home, school, community) of the young child. The current study explores a 14-week protocol of PRT parent group training (PRT-PG), complemented with individual parent–child sessions and involvement of teachers and other childcare providers. Children aged 2–6 years old with ASD and their parents (n = 20) were included. Preliminary results showed a significant increase in spontaneous initiations during a semi-structured therapist-child interaction together with widespread gains in clinical global functioning. No significant improvement on parent-rated general social-communication skills was observed. These findings justify further research on parent group delivered PRT models.

A Long-Term Engagement with a Social Robot for Autism Therapy

Social robots are increasingly being used as a mediator between a therapist and a child in autism therapy studies. In this context, most behavioural interventions are typically short-term in nature. This paper describes a long-term study that was conducted with 11 children diagnosed with either Autism Spectrum Disorder (ASD) or ASD in co-occurrence with Attention Deficit Hyperactivity Disorder (ADHD). It uses a quantitative analysis based on behavioural measures, including engagement, valence, and eye gaze duration. Each child interacted with a robot on several occasions in which each therapy session was customized to a child's reaction to robot behaviours. This paper presents a set of robot behaviours that were implemented with the goal to offer a variety of activities to be suitable for diverse forms of autism. Therefore, each child experienced an individualized robot-assisted therapy that was tailored according to the therapist's knowledge and judgement. The statistical analyses showed that the proposed therapy managed to sustain children's engagement. In addition, sessions containing familiar activities kept children more engaged compared to those sessions containing unfamiliar activities. The results of the interviews with parents and therapists are discussed in terms of therapy recommendations. The paper concludes with some reflections on the current study as well as suggestions for future studies.

Robot-Assisted Autism Therapy (RAAT). Criteria and Types of Experiments Using Anthropomorphic and Zoomorphic Robots. Review of the Research

Supporting the development of a child with autism is a multi-profile therapeutic work on disturbed areas, especially understanding and linguistic expression used in social communication and development of social contacts. Previous studies show that it is possible to perform some therapy using a robot. This article is a synthesis review of the literature on research with the use of robots in the therapy of children with the diagnosis of early childhood autism. The review includes scientific journals from 2005-2021. Using descriptors: ASD (Autism Spectrum Disorders), Social robots, and Robot-based interventions, an analysis of available research in PubMed, Scopus and Web of Science was done. The results showed that a robot seems to be a great tool that encourages contact and involvement in joint activities. The review of the literature indicates the potential value of the use of robots in the therapy of people with autism as a facilitator in social contacts. Robot-Assisted Autism Therapy (RAAT) can encourage child to talk or do exercises. In the second aspect (prompting during a conversation), a robot encourages eye contact and suggests possible answers, e.g., during free conversation with a peer. In the third aspect (teaching, entertainment), the robot could play with autistic children in games supporting the development of joint attention. These types of games stimulate the development of motor skills and orientation in the body schema. In future work, a validation test would be desirable to check whether children with ASD are able to do the same with a real person by learning distrust and cheating the robot.

The Effects of Long-Term Child–Robot Interaction on the Attention and the Engagement of Children with Autism

Using a social robot has been proven to have multiple benefits for the training of children with Autism Spectrum Disorder (ASD). However, there is no clarity on the impact of the interaction quality between a child with ASD and a robot on the effectiveness of the therapy. Previous research showed that the use of a robot in Pivotal Response Treatment (PRT) could be an effective treatment component in diminishing ASD-related symptoms. Further analyzing the data from a randomized controlled trial of PRT treatment, we looked at the long-term effects of child–robot game interactions to see whether the interaction quality changes over time. The attention and the engagement of six children were measured through the observation of non-verbal behavior at three different stages in the treatment that took 20 sessions per child. The gaze and arm/hand behavior of the participants towards the robot, the game, and other present humans were observed. The analysis showed no significant decrease in the attention and the engagement of the children towards the robot and the game. However, the attention and engagement toward the parents of the children increased. We conclude that the main result of sustained attention and engagement with the robot is due to the personalization of the games to meet the specific needs of this user group. These specific needs are met through inclusion of variability to the level of development and personal choice of each participating child. We see the additional finding of increased attention towards the parents as especially positive since the children are expected to improve in human–human interaction as a result of this treatment.