A Bayesian Model of the Uncanny Valley Effect for Explaining the Effects of Therapeutic Robots in Autism Spectrum Disorder

Exploring the impact of socially assistive robots on health and wellbeing across the lifespan: An umbrella review and meta-analysis

BACKGROUND

Socially assistive robots offer an alternate source of connection for interventions within health and social care amidst a landscape of technological advancement and reduced staff capacity. There is a need to summarise the available systematic reviews on the health and wellbeing impacts to evaluate effectiveness, explore potential moderators and mediators, and identify recommendations for future research and practice.

OBJECTIVE

To explore the effect of socially assistive robots within health and social care on psychosocial, behavioural, and physiological health and wellbeing outcomes across the lifespan (PROSPERO registration number: CRD42023423862).

DESIGN

An umbrella review utilising meta-analysis, narrative synthesis, and vote counting by direction of effect.

METHODS

14 databases were searched (ProQuest Health Research Premium collection, Scopus, PubMed, Web of Science, ASM Digital Library, IEEE Xplore, Cochrane Reviews, and EPISTEMONIKOS) from 2005 to May 4, 2023. Systematic reviews including the effects of socially assistive robots on health outcomes were included and a pooled meta-analysis, vote counting by direction of effect, and narrative synthesis were applied. The second version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) was applied to assess quality of included reviews.

RESULTS

35 reviews were identified, most focusing on older adults with or without dementia (n = 24). Pooled meta-analysis indicated no effect of socially assistive robots on quality of life (standard mean difference (SMD) = 0.43), anxiety (SMD = -0.02), or depression (SMD = 0.21), although vote counting identified significant improvements in social interaction, mood, positive affect, loneliness, stress, and pain across the lifespan, and narrative synthesis identified an improvement in anxiety in children. However, some reviews reported no significant difference between the effects of socially assistive robots and a plush toy, and there was no effect of socially assistive robots on psychiatric outcomes including agitation, neuropsychiatric symptoms, and medication use.

DISCUSSION

Socially assistive robots show promise for improving non-psychiatric outcomes such as loneliness, positive affect, stress, and pain, but exert no effect on psychiatric outcomes such as depression and agitation. The main mechanism of effect within group settings appeared to be the stimulation of social interaction with other humans. Limitations include the low quality and high amount of overlap between included reviews.

CONCLUSION

Socially assistive robots may help to improve loneliness, social interaction, and positive affect in older adults, decrease anxiety and distress in children, and improve mood, stress, and reduce pain across the lifespan. However, before recommendations for socially assistive robots can be made, a cost-effectiveness analysis of socially assistive robots to improve mood across the lifespan, and a quantitative analysis of the effects on pain, anxiety, and distress in children are required.

People with Autism Spectrum Disorder Could Interact More Easily with a Robot than with a Human: Reasons and Limits

Individuals with Autism Spectrum Disorder show deficits in communication and social interaction, as well as repetitive behaviors and restricted interests. Interacting with robots could bring benefits to this population, notably by fostering communication and social interaction. Studies even suggest that people with Autism Spectrum Disorder could interact more easily with a robot partner rather than a human partner. We will be looking at the benefits of robots and the reasons put forward to explain these results. The interest regarding robots would mainly be due to three of their characteristics: they can act as motivational tools, and they are simplified agents whose behavior is more predictable than that of a human. Nevertheless, there are still many challenges to be met in specifying the optimum conditions for using robots with individuals with Autism Spectrum Disorder.

Social robots in the instruction of social skills in autism: a comprehensive descriptive analysis of single-case experimental designs

PURPOSE

The rapid technological advances, the traits of individuals with ASD and their interest in technology are promising for the instruction of social skills to individuals with autism spectrum disorder (ASD) using various technological interventions. Robotic interventions are among these. However, although robotics is frequently used with individuals with ASD, there is a limited number of reviews on social skills instruction and methods. The present study aimed to conduct a comprehensive descriptive analysis on single-case experimental designs where social skills were instructed to individuals with ASD and social robots were included as independent variables.

MATERIALS AND METHODS

Thirteen single-case experimental designs published in peer-reviewed journals in which social skills were taught to individuals with ASD using social robots were reviewed with a comprehensive descriptive analysis based on five categories: (a) key characteristics, (b) methodological characteristics, (c) findings, (d) data analysis, and (e) key parameters in single-case experimental designs.

RESULTS

Social robots are generally effective in the instruction of social skills. Several social skills (e.g., making eye contact, social interaction, simple greetings) were instructed in the studies. Humanoid robots and NAO were used generally. The study data were predominantly analyzed statistically. There were several problems in research based on the basic parameters in single-case experimental designs.

CONCLUSIONS

The researches in this study differ in several respects (e.g., results, data analysis, and dependent variable). Thus, there is still a need for several robotics studies in the instruction of social skills. IMPLICATIONS FOR REHABILITATIONThis study will be a guide for teachers who currently use robots in their classrooms but do not know which skills to use in teaching and how to use them functionally, as it shows applied research with robots.The findings of this research will show implementers working with children with ASD that technological tools can be used in rehabilitation environments, and that teachers can take a place in their robots in interventions for children with ASD, giving them a different perspective.It will be seen that the education of children with ASD is not only 1:1 and with humans, but robots can also provide education. In this way, the power of technology in teaching will become clearer. Especially in rehabilitation.Finally, this research will offer new options in teaching especially for teachers who aim at teaching social skills and will give them the opportunity to comprehensively examine the processes of different studies on these subjects.

Artificial scaffolding: Augmenting social cognition by means of robot technology

The concept of scaffolding refers to the support that the environment provides in the acquisition and consolidation of new abilities. Technological advancements allow for support in the acquisition of cognitive capabilities, such as second language acquisition using simple smartphone applications There is, however, one domain of cognition that has been scarcely addressed in the context of technologically assisted scaffolding: social cognition. We explored the possibility of supporting the acquisition of social competencies of a group of children with autism spectrum disorder engaged in a rehabilitation program (age = 5.8 ± 1.14, 10 females, 33 males) by designing two robot-assisted training protocols tailored to Theory of Mind competencies. One protocol was performed with a humanoid robot and the other (control) with a non-anthropomorphic robot. We analyzed changes in NEPSY-II scores before and after the training using mixed effects models. Our results showed that activities with the humanoid significantly improved NEPSY-II scores on the ToM scale. We claim that the motor repertoire of humanoids makes them ideal platforms for artificial scaffolding of social skills in individuals with autism, as they can evoke similar social mechanisms to those elicited in human-human interaction, without providing the same social pressure that another human might exert.

A Systematic Review of Research on Robot-Assisted Therapy for Children with Autism

Recent studies have shown that children with autism may be interested in playing with an interactive robot. Moreover, the robot can engage these children in ways that demonstrate essential aspects of human interaction, guiding them in therapeutic sessions to practice more complex forms of interaction found in social human-to-human interactions. We review published articles on robot-assisted autism therapy (RAAT) to understand the trends in research on this type of therapy for children with autism and to provide practitioners and researchers with insights and possible future directions in the field. Specifically, we analyze 38 articles, all of which are refereed journal articles, that were indexed on Web of Science from 2009 onward, and discuss the distribution of the articles by publication year, article type, database and journal, research field, robot type, participant age range, and target behaviors. Overall, the results show considerable growth in the number of journal publications on RAAT, reflecting increased interest in the use of robot technology in autism therapy as a salient and legitimate research area. Factors, such as new advances in artificial intelligence techniques and machine learning, have spurred this growth.

Differences in the Optimal Motion of Android Robots for the Ease of Communications Among Individuals With Autism Spectrum Disorders

Android robots are employed in various fields. Many individuals with autism spectrum disorders (ASD) have the motivation and aptitude for using such robots. Interactions with these robots are structured to resemble social situations in which certain social behaviors can occur and to simulate daily life. Considering that individuals with ASD have strong likes and dislikes, ensuring not only the optimal appearance but also the optimal motion of robots is important to achieve smooth interaction and to draw out the potential of robotic interventions. We investigated whether individuals with ASD found it easier to talk to an android robot with little motion (i.e., only opening and closing its mouth during speech) or an android robot with much motion (i.e., in addition to opening and closing its mouth during speech, moving its eyes from side to side and up and down, blinking, deeply breathing, and turning or moving its head or body at random). This was a crossover study in which a total of 25 participants with ASD experienced mock interviews conducted by an android robot with much spontaneous facial and bodily motion and an android robot with little motion. We compared demographic data between participants who answered that the android robot with much motion was easier to talk to than android robot with little motion and those who answered the opposite. In addition, we investigated how each type of demographic data was related to participants' feeling of comfort in an interview setting with an android robot. Fourteen participants indicated that the android robot with little motion was easier to talk to than the robot with much motion, whereas 11 participants answered the opposite. There were significant differences between these two groups in the sensory sensitivity score, which reflects the tendency to show a low neurological threshold. In addition, we found correlations between the sensation seeking score, which reflects the tendency to show a high neurological threshold, and self-report ratings of comfort in each condition. These results provide preliminary support for the importance of setting the motion of an android robot considering the sensory traits of ASD.

Robotic Uses in Pediatric Care: A Comprehensive Review

PROBLEM

Advances in technology have made robotics acceptable in healthcare and medical environments. The aim of this literature review was to examine how the pediatric population can benefit from robotic therapy and assistance that are currently available or being developed in diverse settings.

ELIGIBILITY CRITERIA

English language full-text publications focusing on pediatric robotic therapy studies for infants and children under the age of 17 indexed in PubMed and CINAHL and published from 2008 to 2018.

SAMPLE

A total of 272 articles were identified, 69 full-text articles were retrieved and assessed for eligibility, and 21 studies were finally used in the literature review.

RESULTS

From 21 studies, all studies reviewed showed that children benefited from robotic therapies were 1) responsive to the therapies and 2) favored robot's presence since the robotic systems increased their attention and ability to participate in tasks. Due to small sample size, results were statistically inconclusive.

CONCLUSIONS

We identified positive findings, where utilizing pediatric robots played vital roles in assisting and enhancing current pediatric and NICU treatments. Overall, our findings suggested that more clinical trials would be essential, but the uses of robots may contribute to the future advancement in pediatric and neonatal healthcare.

IMPLICATIONS

These review and analysis can be used to inform healthcare environments where there is a room for applying robotic assistance, although most studies required further testing with larger sample size to validate their results. This suggests the need for further research for robotics in pediatric and neonatal healthcare.

A map of assistive technology educative instruments in neurodevelopmental disorders

PURPOSE

The use of assistive technology in mental health has gained an increased interest over the last decades. A growing number of studies have investigated diverse applications of technological interventions for rehabilitation of children with neurodevelopmental disorders. This article presents a map of the technological devises applied as therapeutic instruments.

METHODS

The research question of this review was which technological applications could be referred as an educational instrument for the management of children with autism spectrum disorders (ASDs), intellectual disability and attention deficit disorder. The articles included in this review were collected after a structured literature search in electronic databases using keywords such as "Assistive Technology", "technology devices", "robots", "Autism Disorder", "Intellectual Disabilities" and "Mental Retardation".

RESULTS

Assistive technology with the most up-to-date devices and applications helps children with intellectual disability and ASDs enhance cognitive skills and improve challenging behaviour, social communication and academic performance. Different technological tools are used to foster attention span and improve time management skills in children with attention deficit syndrome.

CONCLUSION

It is important that therapists choose the instrument that will offer the best approach towards the goal that is set. Future research could provide evidence based data, evaluating each specific methodology and tailoring each therapeutic approach specifically to a case.IMPLICATIONS FOR REHABILITATIONTechnology creates environments in which children could practice and learn in a safer, more predictable and pleasant manner.Assistive Technologies provide the opportunity for better acquisition of selfhelp skills and the power of social interaction for individuals with disabilities.By mapping out the wide array of Assistive Technology that is available today, future applications for rehabilitation of children with neurodevelopmental disorders could help extend therapeutic strategies out of the clinical and school settings and into the home, thereby incorporating the family and emphasizing personalization.Future studies could develop a model for the choice and use of each tool, tailoring each therapeutic approach specifically to each case.

Animal Faux Pas: Two Legs Good Four Legs Bad for Theory of Mind, but Not in the Broad Autism Spectrum

Research shows that the general population varies with regard to both autistic traits and theory of mind (ToM) ability. Other work has shown that autistic individuals may not underperform on ToM tests when the agent of evaluation is anthropomorphic rather than typically human. Two studies examined the relation between ToM and autistic trait profiles in over 650 adults using either the standard Faux Pas Recognition Test (FPT) or an anthropomorphized version of the FPT (FPTa). Results showed that autistic trait profiles were related to faux pas detection ability in the FPT but not the FPTa. Furthermore, while those with the broad autism phenotype scored significantly worse than those who were typically developed on the FPT, scores did not significantly differ on the FPTa. These findings add to a growing body of work suggesting that ToM ability is not at a global deficit in those on the autistic spectrum, but may relate to the mindreading of specifically human agents.

Attitude Towards Humanoid Robots and the Uncanny Valley Hypothesis

The main aim of the presented study was to check whether the well-established measures concerning the attitude towards humanoid robots are good predictors for the uncanny valley effect. We present a study in which 12 computer rendered humanoid models were presented to our subjects. Their declared comfort level was cross-referenced with the Belief in Human Nature Uniqueness (BHNU) and the Negative Attitudes toward Robots that Display Human Traits (NARHT) scales. Subsequently, there was no evidence of a statistical significance between these scales and the existence of the uncanny valley phenomenon. However, correlations between expected stress level while human-robot interaction and both BHNU, as well as NARHT scales, were found. The study covered also the evaluation of the perceived robots’ characteristic and the emotional response to them.

Avoidance of Novelty Contributes to the Uncanny Valley

A hypothesis suggests that objects with a high degree of visual similarity to real humans trigger negative impressions (i.e., the uncanny valley). Previous studies have suggested that difficulty in object categorization elicits negative emotional reactions to enable the avoidance of potential threats. The present study further investigated this categorization-difficulty hypothesis. In an experiment, observers categorized morphed images of photographs and human doll faces as "photograph" or "doll" and evaluated the perceived eeriness of the images. Additionally, we asked the observers to answer questionnaires on behavioral inhibition systems (BIS). The results indicated that individual differences in the BIS score were associated with enhanced eeriness in the objects with a specific human likeness. These findings suggest that the tendency to avoid a potentially threatening novel experience contributes to promoting the perceived eeriness of objects with some degree of visual similarity to real humans.

Improving therapeutic outcomes in autism spectrum disorders: Enhancing social communication and sensory processing through the use of interactive robots

For children with autism spectrum disorders (ASDs), social robots are increasingly utilized as therapeutic tools in order to enhance social skills and communication. Robots have been shown to generate a number of social and behavioral benefits in children with ASD including heightened engagement, increased attention, and decreased social anxiety. Although social robots appear to be effective social reinforcement tools in assistive therapies, the perceptual mechanism underlying these benefits remains unknown. To date, social robot studies have primarily relied on expertise in fields such as engineering and clinical psychology, with measures of social robot efficacy principally limited to qualitative observational assessments of children's interactions with robots. In this review, we examine a range of socially interactive robots that currently have the most widespread use as well as the utility of these robots and their therapeutic effects. In addition, given that social interactions rely on audiovisual communication, we discuss how enhanced sensory processing and integration of robotic social cues may underlie the perceptual and behavioral benefits that social robots confer. Although overall multisensory processing (including audiovisual integration) is impaired in individuals with ASD, social robot interactions may provide therapeutic benefits by allowing audiovisual social cues to be experienced through a simplified version of a human interaction. By applying systems neuroscience tools to identify, analyze, and extend the multisensory perceptual substrates that may underlie the therapeutic benefits of social robots, future studies have the potential to strengthen the clinical utility of social robots for individuals with ASD.

Human-likeness assessment for the Uncanny Valley Hypothesis

The Uncanny Valley Hypothesis (UVH, proposed in the 1970s) suggests that looking at or interacting with almost human-like artificial characters would trigger eeriness or discomfort. We studied how well subjects can assess degrees of human likeness for computer-generated characters. We conducted two studies, where subjects were asked to assess human likeness of given computer-generated models (Study 1) and to point the most typical model for a given category (Study 2). The results suggest that evaluation of the way human likeness is assessed should be an internal part of UVH research.