Technologies as support tools for persons with autistic spectrum disorder: a systematic review

Seeing through a robot's eyes: A cross-sectional exploratory study in developing a robotic screening technology for autism

The present exploratory cross-sectional case-control study sought to develop a reliable and scalable screening tool for autism using a social robot. The robot HUMANE, installed with computer vision and linked with recognition technology, detected the direction of eye gaze of children. Children aged 3-8 (M = 5.52; N = 199) participated, 87 of whom had been confirmed with autism, 55 of whom were suspected to have autism, and 57 of whom were not considered to cause any concern for having autism. Before a session, a human experimenter instructed HUMANE to narrate a story to a child. HUMANE prompted the child to return his/her eye gaze to the robot if the child looked away, and praised the child when it re-established its eye gaze quickly after a prompt. The reliability of eye gaze detection was checked across all pairs of human raters and HUMANE and reached 0.90, indicating excellent interrater agreement. Using the pre-specified reference standard (Autism Spectrum Quotient), the sensitivity and specificity of the index tests (i.e., the number of robot prompts and duration of inattentiveness) reached 0.88 or above and the Diagnostic Odds Ratios were beyond 190. These results show that social robots may detect atypical eye patterns, suggesting a potential future for screening autism using social robots.

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.

Learning Experience Design and Unpacking Sociocultural, Technological, and Pedagogical Design Considerations of Spherical Video-Based Virtual Reality Systems for Autistic Learners: A Systematic Literature Review

This systematic literature review discusses the use of spherical video-based virtual reality (SVVR) as a training and therapy intervention for autistic individuals. The authors emphasize the need for an evidence-based framework with guidelines and design considerations to help developers and educators tailor SVVR to the diverse needs of autistic learners. The paper highlights the unique benefits of SVVR, such as being relatively easier to develop compared to other VR technologies and high compatibility with various devices, making it more affordable for educational settings. The authors also discuss the importance of the STP (Sociotechnical-Pedagogical) framework for evaluating and designing social aspects of SVVR interventions for autistic individuals.

A social robot connected with chatGPT to improve cognitive functioning in ASD subjects

Neurodevelopmental Disorders (NDDs) represent a significant healthcare and economic burden for families and society. Technology, including AI and digital technologies, offers potential solutions for the assessment, monitoring, and treatment of NDDs. However, further research is needed to determine the effectiveness, feasibility, and acceptability of these technologies in NDDs, and to address the challenges associated with their implementation. In this work, we present the application of social robotics using a Pepper robot connected to the OpenAI system (Chat-GPT) for real-time dialogue initiation with the robot. After describing the general architecture of the system, we present two possible simulated interaction scenarios of a subject with Autism Spectrum Disorder in two different situations. Limitations and future implementations are also provided to provide an overview of the potential developments of interconnected systems that could greatly contribute to technological advancements for Neurodevelopmental Disorders (NDD).

SPAN Website for Remote Intervention with Autistic Adolescents and Young Adults: Feasibility and Usability

Adolescents and young adults (AYA) with autism spectrum disorders (ASD) report less functional independence and social participation than their neurotypical peers. Remotely delivered interventions may allow autistic AYA to promote their independence, social participation, and wellbeing as they transition to adulthood. Social Participation and Navigation (SPAN) is a technology-based remotely delivered intervention initially developed for AYA with acquired brain injuries. The SPAN (website, application, and intervention manual) was modified to address the needs of AYA with autism (SPAN-ASD). This study examined the SPAN-ASD website and web application's feasibility and usability. Participants comprised 12 autistic AYA and 18 practitioners (all occupational therapists) with more than 1 year of experience in working with autistic AYA. All navigated the SPAN-ASD website and goal-management application. Practitioners completed the SPAN-ASD components and the Usefulness, Satisfaction, and Ease of Use questionnaires; AYA completed the System Usability Scale. The practitioners' average feasibility scores ranged from 4.30 to 4.68 (high); the overall usability score was 5.77 (good). The autistic AYA rated SPAN-ASD as a good, acceptable, and useful tool. Content analysis and item-level ratings indicated some needed improvements. Practitioners and autistic AYA perceived the SPAN-ASD website and application as highly feasible and usable, with excellent potential for technology-supported interventions.

Comparing the effectiveness of robot-based to human-based intervention in improving joint attention in autistic children

Background

Children with autism have impairments in initiation of joint attention (IJA) and response to joint attention (RJA).

Aims

The present study compared the learning effectiveness of robot-based intervention (RBI) with that of content-matched human-based intervention (HBI) in improving joint attention (JA). We examined whether RBI would enhance RJA, in comparison to HBI. We also examined whether RBI would increase IJA, in comparison to HBI.

Methods and procedures

Thirty-eight Chinese-speaking children with autism aged 6 to 9 years were randomly assigned to RBI and HBI groups. Before intervention, their autism severity, cognitive abilities, and language skills were assessed. Each child received six 30-min training sessions over 3 weeks. During training, he/she watched one or two robot/human dramas twice where two robot/human actors demonstrated eye contact and RJA.

Outcomes and results

Children in the RBI (but not HBI) group produced more RJA and IJA behaviors in the delayed post-test than in the pre-test. Parents of the RBI children rated the program more positively than those of the HBI children.

Conclusions and implications

RBI may be more effective than HBI in promoting JA in autistic children with high support needs. Our findings shed light on the application of robot dramas in enhancing social communication skills.

Real-time facial emotion recognition system among children with autism based on deep learning and IoT

Diagnosis of autism considers a challenging task for medical experts since the medical diagnosis mainly depends on the abnormalities in the brain functions that may not appear in the early stages of early onset of autism disorder. Facial expression can be an alternative and efficient solution for the early diagnosis of Autism. This is due to Autistic children usually having distinctive patterns which facilitate distinguishing them from normal children. Assistive technology has proven to be one of the most important innovations in helping people with autism improve their quality of life. A real-time emotion identification system for autistic youngsters was developed in this study. Face identification, facial feature extraction, and feature categorization are the three stages of emotion recognition. A total of six facial emotions are detected by the propound system: anger, fear, joy, natural, sadness, and surprise. This section proposes an enhanced deep learning (EDL) technique to classify the emotions using convolutional neural network. The proposed emotion detection framework takes the benefit from using fog and IoT to reduce the latency for real-time detection with fast response and to be a location awareness. From the results, EDL outperforms other techniques as it achieved 99.99% accuracy. EDL used GA to select the optimal hyperparameters for the CNN.

On the Evaluation of Engagement in Immersive Applications When Users Are on the Autism Spectrum

New generation wearable devices allow for the development of interactive environments tailored for Virtual Reality (VR)- and Augmented Reality (AR)-based treatment of Autism Spectrum Disorders (ASD). Experts agree on their potential; however, there is lack of consensus on how to perform trials and the need arises for evaluation frameworks, methods, and techniques appropriate for the ASD population. In this paper, we report on a study conducted with high-functioning ASD people in the 21-23 age range, with the objectives of (1) evaluating the engagement of two headsets offering distinct immersive experiences, (2) reasoning on the interpretation of engagement factors in the case of ASD people, and (3) translating results into general guidelines for the development of VR/AR-based ASD treatment. To this aim, we (1) designed two engagement evaluation frameworks based on behavioral observation measures, (2) set up two packages of reference immersive scenarios, (3) defined the association between metrics and scenarios, and (4) administered the scenarios in distinct sessions for the investigated headsets. Results show that the immersive experiences are engaging and that the apparent lack of success of some evaluation factors can become potential advantages within the framework of VR/AR-based ASD treatment design.

Virtual reality in the diagnostic and therapy for mental disorders: A systematic review

BACKGROUND

Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.

OBJECTIVE

To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.

DATA SOURCE

Systematic literature searches via PubMed (last literature update: 9^th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.

ELIGIBILITY CRITERIA

To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.

STUDY EVALUATION

For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.

RESULTS

Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.

CONCLUSION

While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.

REVIEW REGISTRATION

PROSPERO register CRD42020188436.

FUNDING

The review was funded by budgets from the University of Bonn. No third party funding was involved.

A systematic review of the use of telehealth to facilitate a diagnosis for children with developmental concerns

BACKGROUND

Telehealth can reduce the gap between developmental concern and diagnosis. Evaluation of telehealth methods is needed for providers to make decisions about using telediagnostic assessments.

AIM

This systematic review examined telehealth in facilitating a diagnosis for children with developmental concerns and assessed 1) study characteristics and type of diagnostic evaluation; 2) comparison of telehealth technologies to in-person diagnostic methods; 3) feasibility and acceptability of telehealth technologies; and 4) methodological quality.

METHOD AND PROCEDURES

Peer-reviewed studies from PsycINFO, CINAHL, Web of Science, PubMed, Embase, and Cochrane published January 2000-July 2021 were searched using "telehealth" AND "developmental concern" AND "diagnosis". Data extraction included study characteristics, diagnostic evaluation, technology, diagnostic accuracy, feasibility, and acceptability. Methodological quality was assessed using NHLBI tools.

OUTCOMES AND RESULTS

Nine studies met inclusion. Children with suspected FAS, social-emotional concerns, suspected genetic conditions, and failed hearing screenings received a telediagnosis. Evaluations included dysmorphology, feeding, neurological, developmental, audiological, and psychiatric. Seven studies used videoconferencing in real-time and two used Store-and-Forward methods. High diagnostic agreement occurred between face-to-face and remote methods. Stakeholders reported high satisfaction and feasibility. Many of the studies were rated as fair quality.

CONCLUSIONS AND IMPLICATIONS

Findings underscore partnership models between local providers and remote specialists. Rigorous study designs with larger samples covering a wider range of developmental domains are needed to provide a stronger empirical base for providers.

Extended Reality (XR) and telehealth interventions for children or adolescents with autism spectrum disorder: Systematic review of qualitative and quantitative studies

World Health Organization reported that almost one in 100 children is diagnosed with autism spectrum disorder (ASD) worldwide. Extended Reality (XR) and Telehealth interventions are evident to be effective for ASD treatments. While there is no comprehensive systematic review to summarize and evaluate the evidence for promoting the accessibility of different technology-based treatment regiments. This paper aims to verify the efficacy and validity of XR and Telehealth interventions for children and adolescents with ASD. We reviewed 112 studies from databases of PubMed, Web of Science and Cochrane Library, published in English between January 2010 to April 1st, 2022. We found that after interventions, positive improvements for ASD participants were observed in social interaction, acceptance, and engagement, communication and speech, emotion recognition and control, daily living skill, problem behavior reduction, attention, cost reduction, anxiety symptom reduction, pretend play, contextual processing, match to sample skill, and insomnia control. Our findings provide a solid and positive evidence of XR and Telehealth interventions in improving the treatment outcomes for children and adolescents with ASD. In the future, more research with RCTs and standardized outcome measurements are required to establish the therapeutic efficiency of the two interventions independently or combined.

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).

Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review

BACKGROUND

The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions.

OBJECTIVE

To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions.

METHODS

We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care.

RESULTS

Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence.

CONCLUSIONS

Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.

Method for the Development of Accessible Mobile Serious Games for Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) covers a range of neurodevelopmental disorders that begin in early childhood and affects developmental activities. This condition can negatively influence the gaining of knowledge, skills, and abilities, such as communication. Over time, different techniques and methods have been put into practice to teach and communicate with children with ASD. With the rapid advancement in the field of technology, specifically in smartphones, researchers have generated creative applications, such as mobile serious games, to help children with ASD. However, usability and accessibility have not been often taken into account in the development of this type of applications. For that reason, in this work we considered that both, usability and especially accessibility are a very important differentiators for the quality and efficiency of mobile serious games. Our approach has two important contributions, the incorporation of accessibility as a fundamental requirement in the development of a mobile serious game and the proposal of a method for the development of this type of applications for children with ASD, a method that can be used by other developers.

Visual and Hearing Sensitivity Affect Robot-Based Training for Children Diagnosed With Autism Spectrum Disorder

In this paper, we investigate the impact of sensory sensitivity during robot-assisted training for children diagnosed with Autism Spectrum Disorder (ASD). Indeed, user-adaptation for robot-based therapies could help users to focus on the training, and thus improve the benefits of the interactions. Children diagnosed with ASD often suffer from sensory sensitivity, and can show hyper or hypo-reactivity to sensory events, such as reacting strongly or not at all to sounds, movements, or touch. Considering it during robot therapies may improve the overall interaction. In the present study, thirty-four children diagnosed with ASD underwent a joint attention training with the robot Cozmo. The eight session training was embedded in the standard therapy. The children were screened for their sensory sensitivity with the Sensory Profile Checklist Revised. Their social skills were screened before and after the training with the Early Social Communication Scale. We recorded their performance and the amount of feedback they were receiving from the therapist through animations of happy and sad emotions played on the robot. Our results showed that visual and hearing sensitivity influenced the improvements of the skill to initiate joint attention. Also, the therapists of individuals with a high sensitivity to hearing chose to play fewer animations of the robot during the training phase of the robot activity. The animations did not include sounds, but the robot was producing motor noise. These results are supporting the idea that sensory sensitivity of children diagnosed with ASD should be screened prior to engaging the children in robot-assisted therapy.

E-technology social support programs for autistic children: Can they work?

Autism is a neurodevelopmental condition with associated difficulties that present differently across individuals. One such difficulty is recognizing basic and complex facial expressions. Research has previously found that there are many evidence-based support programs available for building non-verbal communication skills. These programs are frequently administered with a therapist or in a group setting, making them inflexible in nature. Programs hosted on e-technology are becoming increasingly popular, with many parents supportive of them. Applications (apps) that are hosted on technology such as iPads or mobile phones allow users to engage in building skills in real-time social settings and own what they are learning. These technologies are frequently used by autistic children, with apps typically focusing on identifying facial features. Yet at this current time, there are mixed reviews of how to design such programs and what their theoretical backing is, with many studies using a mix of observation and psychological assessments as outcome measures. Eye-tracking and electroencephalography are established methodologies that measure neural processing and gaze behaviors while viewing faces. To better support the field moving forward, objective measures such as these are a way to measure outcomes of apps that are designed for helping children on the spectrum build skills in understanding facial expressions.

Development of a Mobile App to Improve Numeracy Skills of Children With Autism Spectrum Disorder: Participatory Design and Usability Study

BACKGROUND

The use of information and communication technologies is transforming the lives of millions of people including children with autism spectrum disorder (ASD). However, the process of developing a user-friendly and effective mobile app needs to follow a complex standard protocol and culture-sensitive customization, and involves multiple sectors. This complex work becomes even more challenging when considering children with ASD in low- and middle-income countries as the users.

OBJECTIVE

This study aimed to design and develop a more intuitive mobile app to improve numeracy skills of children with ASD in Rwanda and evaluate the usability of the app.

METHODS

A participatory design approach was utilized in this study in which 40 children with ASD, 5 teachers, and 10 parents of children with ASD participated in focus group discussions (FGDs) and usability testing. A narrative literature review was performed to explore existing mobile apps and compare previous studies to design the questions for FGD and facilitate a framework for designing the app. The agile methodology was used to develop the mobile app, and the heuristics evaluation method was used to test and evaluate the usability of the initial version of the app to improve its functionalities. The interviews were recorded, transcribed, and analyzed following the guidelines of the qualitative narrative analysis (QNA) method.

RESULTS

During the FGDs the respondents shared their need for a mobile app in teaching and learning numeracy for children with ASD and pointed to possibilities of integrating the mobile app into existing curriculum. Ten themes emerged from the FGDs and exercise of developing the mobile app. The themes were related to (1) teaching and learning numeracy for children with ASD, (2) planning and development of a mobile app for a person with ASD, (3) testing a mobile app, (4) strength of the developed app against the existing ones, (5) behavioral maintenance and relapse prevention, (6) possibilities to integrate the mobile app into the existing curriculum, (7) data protection for users, (8) social implications, (9) challenges in Rwanda, and (10) focus on future.

CONCLUSIONS

The community plays an important role in the planning, development, and evaluation of a mobile app for children with ASD. In this study, inputs from teachers and parents resulted in an optimally designed mobile app that can improve numeracy skills in children diagnosed with ASD to support the implementation of competency-based curriculum in Rwanda.

Augmented Reality for Autistic Children to Enhance Their Understanding of Facial Expressions

Difficulty in understanding the feelings and behavior of other people is considered one of the main symptoms of autism. Computer technology has increasingly been used in interventions with Autism Spectrum Disorder (ASD), especially augmented reality, to either treat or alleviate ASD symptomatology. Augmented reality is an engaging type of technology that helps children interact easily and understand and remember information, and it is not limited to one age group or level of education. This study utilized AR to display faces with six different basic facial expressions—happiness, sadness, surprise, fear, disgust, and anger—to help children to recognize facial features and associate facial expressions with a simultaneous human condition. The most important point of this system is that children can interact with the system in a friendly and safe way. Additionally, our results showed the system enhanced social interactions, talking, and facial expressions for both autistic and typical children. Therefore, AR might have a significant upcoming role in talking about the therapeutic necessities of children with ASD. This paper presents evidence for the feasibility of one of the specialized AR systems.

Meta-Analysis of RCTs of Technology-Assisted Parent-Mediated Interventions for Children with ASD

Technology-assisted parent-mediated interventions improve accessibility and are acceptable but not proven to be effective. We conducted a systematic search of 6 databases. We included and analysed results from studies on social and communication outcomes. Sixteen Randomised-Controlled-Trials (RCTs) with 748 participants were included. Most studies were rated as of good quality. Meta-analysis suggested that interventions were probably effective in improving emotion recognition. No significant differences were found in social communication, social functioning or language outcomes. At present, isolated tech interventions do not fulfil criteria for promising or established evidence-based interventions for ASD. Future research needs to focus on improving the effectiveness of technology-assisted parent-mediated interventions for ASD. Prospero Registration Number: CRD42020162825.

Emotional Expression in Children With ASD: A Pre-Study on a Two-Group Pre-Post-Test Design Comparing Robot-Based and Computer-Based Training

Several studies have found a delay in the development of facial emotion recognition and expression in children with an autism spectrum condition (ASC). Several interventions have been designed to help children to fill this gap. Most of them adopt technological devices (i.e., robots, computers, and avatars) as social mediators and reported evidence of improvement. Few interventions have aimed at promoting emotion recognition and expression abilities and, among these, most have focused on emotion recognition. Moreover, a crucial point is the generalization of the ability acquired during treatment to naturalistic interactions. This study aimed to evaluate the effectiveness of two technological-based interventions focused on the expression of basic emotions comparing a robot-based type of training with a "hybrid" computer-based one. Furthermore, we explored the engagement of the hybrid technological device introduced in the study as an intermediate step to facilitate the generalization of the acquired competencies in naturalistic settings. A two-group pre-post-test design was applied to a sample of 12 children (M = 9.33; ds = 2.19) with autism. The children were included in one of the two groups: group 1 received a robot-based type of training (n = 6); and group 2 received a computer-based type of training (n = 6). Pre- and post-intervention evaluations (i.e., time) of facial expression and production of four basic emotions (happiness, sadness, fear, and anger) were performed. Non-parametric ANOVAs found significant time effects between pre- and post-interventions on the ability to recognize sadness [t ₍₁₎ = 7.35, p = 0.006; pre: M (ds) = 4.58 (0.51); post: M (ds) = 5], and to express happiness [t ₍₁₎ = 5.72, p = 0.016; pre: M (ds) = 3.25 (1.81); post: M (ds) = 4.25 (1.76)], and sadness [t ₍₁₎ = 10.89, p < 0; pre: M (ds) = 1.5 (1.32); post: M (ds) = 3.42 (1.78)]. The group^*time interactions were significant for fear [t ₍₁₎ = 1.019, p = 0.03] and anger expression [t ₍₁₎ = 1.039, p = 0.03]. However, Mann-Whitney comparisons did not show significant differences between robot-based and computer-based training. Finally, no difference was found in the levels of engagement comparing the two groups in terms of the number of voice prompts given during interventions. Albeit the results are preliminary and should be interpreted with caution, this study suggests that two types of technology-based training, one mediated via a humanoid robot and the other via a pre-settled video of a peer, perform similarly in promoting facial recognition and expression of basic emotions in children with an ASC. The findings represent the first step to generalize the abilities acquired in a laboratory-trained situation to naturalistic interactions.

Piloting an adaptive skills virtual reality intervention for adults with autism: findings from user-centered formative design and evaluation

Purpose

The purpose of this paper is to present evaluation findings from a proof-of-concept virtual reality adaptive skills intervention called Virtuoso, designed for adults with autism spectrum disorders.

Design/methodology/approach

A user-centric usage test was conducted to investigate the acceptability, feasibility, ease-of-use and relevance of Virtuoso to the unique needs of participants, as well as the nature of participants’ user experiences. Findings are presented from the perspectives of expert testers and participant testers with autism.

Findings

This paper offers findings that suggest Virtuoso is feasible and relevant to the unique needs of the target population, and that user experience was largely positive. Anecdotal evidence of skills transfer is also discussed.

Research limitations/implications

The research was conducted in limited settings and with a small number of participants. Multiple VR hardware systems were used, and some experienced instability. This could be accounted for in future research by deploying across multiple settings and with a larger number of participants. Some evidence of cybersickness was observed. Future research must carefully consider the trade-offs between VR-based training and cybersickness for this vulnerable population.

Originality/value

This paper reports on cutting-edge design and development in areas that are under-represented and poorly understood in the literature on virtual reality for individuals with autism.

Mobile Augmented Reality Technologies for Autism Spectrum Disorder Interventions: A Systematic Literature Review

Over the past decade, enhanced computing capabilities and mobile technologies have begotten the upsurge of innovative mobile health (mHealth) solutions, and many research efforts have occurred recently in the area of technology-based interventions (TBI) for autism spectrum disorders (ASD). Mobile augmented reality (MAR) refers to AR systems that use the handheld mobile device medium (mobile phones, tablets or smart glasses). This article reports the results of a systematic review undertaken on the use of MAR for ASD-related skills learning from the year 2010. It aims to provide an insight into the current state of research on MAR interventions and to provide guidance to relevant designers and researchers. We searched seven databases and retrieved 625 articles initially. After exclusion and screening, 36 articles were reviewed reporting on using MAR to improve various skills of children and adolescents with ASD, and 10 research questions related to PICO (P: Population, I: Intervention, C: Comparison, O: Outcomes) were addressed. This study identifies challenges that still exist in the research efforts towards the development of applications exploiting the MAR for ASD interventions: technology issues, research design consideration, subjective assessment etc. The studies examined suggest researchers should focus on users and improve the quality of the MAR app. In addition, more effective research methods and evaluation methods could be involved in future studies to facilitate the development of MAR intervention applications.

Are social robots ready yet to be used in care and therapy of autism spectrum disorder: A systematic review of randomized controlled trials

Autism is a neurodevelopmental disorder that affects the everyday life of people who have this lifelong condition. Robots hold great promise for uplifting therapy and care of the affected population. We searched Scopus, Medline, ScienceDirect, Web of Science, and PubMed databases for randomized controlled trials that had evaluated robot use in the therapy of people with autism, to see how effective social robots have been incorporated in autism care. Out of 240 papers initially identified, 19 satisfied the inclusion criteria and were fully evaluated. Overall, 10 different robots were utilized in the trials, out of which, four were non-humanoids. The number of papers with positive results for using robots on the main and secondary parameters was 11 and 5, respectively. Three papers reported that robot groups did not achieve better results than others. Robots in the papers included here were mainly added as the "entertainment agent" to elicit greater engagement from the participants, which is understandable, as robots at this stage might not be ready yet to deliver high-end care.

Attitudes towards Social Robots in Education: Enthusiast, Practical, Troubled, Sceptic, and Mindfully Positive

While social robots bring new opportunities for education, they also come with moral challenges. Therefore, there is a need for moral guidelines for the responsible implementation of these robots. When developing such guidelines, it is important to include different stakeholder perspectives. Existing (qualitative) studies regarding these perspectives however mainly focus on single stakeholders. In this exploratory study, we examine and compare the attitudes of multiple stakeholders on the use of social robots in primary education, using a novel questionnaire that covers various aspects of moral issues mentioned in earlier studies. Furthermore, we also group the stakeholders based on similarities in attitudes and examine which socio-demographic characteristics influence these attitude types. Based on the results, we identify five distinct attitude profiles and show that the probability of belonging to a specific profile is affected by such characteristics as stakeholder type, age, education and income. Our results also indicate that social robots have the potential to be implemented in education in a morally responsible way that takes into account the attitudes of various stakeholders, although there are multiple moral issues that need to be addressed first. Finally, we present seven (practical) implications for a responsible application of social robots in education following from our results. These implications provide valuable insights into how social robots should be implemented.

Implementation of Telehealth Services to Assess, Monitor, and Treat Neurodevelopmental Disorders: Systematic Review

BACKGROUND

In response to COVID-19, there has been increasing momentum in telehealth development and delivery. To assess the anticipated exponential growth in telehealth, it is important to accurately capture how telehealth has been used in specific mental health fields prior to the pandemic.

OBJECTIVE

This systematic review aimed to highlight how telehealth has been used with clinical samples in the neurodevelopmental field, including patients with neurodevelopmental disorders (NDDs), their families, and health care professionals. To identify which technologies show the greatest potential for implementation into health services, we evaluated technologies for effectiveness, economic impact, and readiness for clinical adoption.

METHODS

A systematic search of literature was undertaken in April 2018 and updated until December 2019, by using the Medline, Web of Science, Scopus, CINAHL Plus, EMBASE, and PsycInfo databases. Extracted data included the type of technology, how the technology was used (ie, assessment, treatment, and monitoring), participant characteristics, reported outcomes and authors' views on clinical effectiveness, user impact (ie, feasibility and acceptability), economic impact, and readiness for clinic adoption. A quality review of the research was performed in accordance with the Oxford Centre for Evidence-Based Medicine Levels of Evidence.

RESULTS

A total of 42 studies met the inclusion criteria. These studies included participants and family members with autism spectrum disorders (21/42, 50%), attention deficit hyperactivity disorders (8/42, 19%), attention deficit hyperactivity or autism spectrum disorders (3/42, 7%), communication disorders (7/42, 17%), and tic disorders (2/42, 5%). The focus of most studies (33/42, 79%) was on treatment, rather than assessment (4/42, 10%) or monitoring (5/42, 12%). Telehealth services demonstrated promise for being clinically effective, predominantly in relation to diagnosing and monitoring NDDs. In terms of NDD treatment, telehealth services were usually equivalent to control groups. There was some evidence of positive user and economic impacts, including increased service delivery efficiency (eg, increased treatment availability and decreased waiting times). However, these factors were not widely recorded across the studies. Telehealth was demonstrated to be cost-effective in the few studies that considered cost-effectiveness. Study quality varied, as many studies had small sample sizes and inadequate control groups. Of the 42 studies, only 11 (26%) were randomized controlled trials, 12 (29%) were case studies or case series, 6 (14%) were qualitative studies, and 5 (12%) were noncomparative trials.

CONCLUSIONS

Telehealth has the potential to increase treatment availability, decrease diagnosis waiting times, and aid in NDD monitoring. Further research with more robust and adequately powered study designs that consider cost-effectiveness and increased efficiency is needed. This systematic review highlights the extent of telehealth technology use prior to the COVID-19 pandemic and the movement for investing in remote access to treatments.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42018091156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018091156.

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.

Implementation of a school-based Fitbit program for youth with Autism Spectrum Disorder: A feasibility study

BACKGROUND

School settings may be optimal for physical activity interventions for youth with Autism Spectrum Disorder (ASD). Additionally, consumer-based fitness trackers may encourage youth with ASD to increase their physical activity levels, however, no studies have examined whether a fitness tracker program would be feasible in youth with ASD.

OBJECTIVE

To examine the feasibility of a 12-week school-based Fitbit© program for youth with ASD.

METHODS

Six classroom teachers and their students (n = 45) were provided with Fitbit fitness trackers to wear over 12-weeks. Classroom teachers monitored student tracker use and completed open-ended surveys to describe both their experience and their students' experience with the fitness trackers.

RESULTS

Out of the 45 eligible students, 42 (94%) opted to participate in the study. All six teachers and 32 (76%) of the 42 students wore the fitness tracker daily over 12 weeks. Teachers reported that students were most interested in tracking their daily steps, and the short batter life, and account set-up were the biggest challenges to students. All six teachers felt that this program could have long-term sustainability, especially if tracker use could be incorporated into school curriculum and classroom activities.

CONCLUSIONS

A school-based Fitbit program appears to be both feasible, and well-accepted by students with ASD. Future work should evaluate the preliminary efficacy of this type of program.

Robot applications for autism: a comprehensive review

PURPOSE

Technological advances in robotics have brought about exciting developments in different areas such as education, training, and therapy. Recent research has suggested that the robot can be even more effective in rehabilitation, therapy, and education for individuals with Autism Spectrum Disorder (ASD). In this paper, a comprehensive review of robotic technology for children with ASD is presented wherein a large number of journals and conference proceedings in science and engineering search engines' databases were implicated.

MATERIALS AND METHODS

A search for related literature was conducted in three search engines' databases, Web of Science, Scopus, and IEEE Xplore. Thematic keywords were used to identify articles in the recent ten years in titles, keywords, and abstracts. The retrieved articles were filtered, analysed, and evaluated based on specific inclusion and exclusion criteria.

RESULTS

A total of 208 studies were retrieved, while 166 met the inclusion criteria. The selected studies were reviewed according to the type of robot, the participants, objectives, and methods. 68 robots were used in all studies, NAO robot was used in 30.5% of those studies. The total number of participants in all studies was 1671. The highest percentage of the studies reviewed were dedicated to augmenting the learning skills.

CONCLUSIONS

Robots and the associated schemes were used to determine their feasibility and validity for augmenting the learning skills of autistic children. Most of the studies reviewed were focused on improving the social communication skills of autistic children and measuring the extent of robot mitigation of stereotyped autistic behaviours.Implications for rehabilitationSocial robots are not considered as promising tools to be utilized for rehabilitation of autistic children only, but also has been used for children and young people with severe intellectual disability.Rehabilitation for individuals with ASD using robots can augment their cognitive and social skills, but further studies should be conducted to clarify its effectiveness based on other factors such as sex, age and IQ of the participates.Robotic-based rehabilitation is not limited to the physical robots only, but virtual robots have been used also, whereas each of which can be used individually or simultaneously. However, further study is required to assess the extent of its efficiency and effectiveness for both cases.

Use of telehealth for facilitating the diagnostic assessment of Autism Spectrum Disorder (ASD): A scoping review

There is a significant delay between seeking help and a confirmed diagnosis of Autism Spectrum Disorder (ASD). This delay can lead to poor outcomes for both the families and individuals. Telehealth potentially offers a way of improving the diagnostic pathway for ASD. We conducted a scoping review examining which telehealth approaches are used in the diagnosis and assessment of ASD in children and adults, whether they are feasible and acceptable, and how they compare with face-to-face diagnosis and assessment methods. A search for all peer-reviewed articles, combining the terms of autism and telehealth was conducted from 2000 to 2019. A total of 10 studies were identified for inclusion in the review. This review of the literature found there to be two methods of using telehealth: (a) Real-Time method e.g. video conferencing that enables teams in different areas to consult with the families and to assess the child/adult in real time and (b) A Store-and-Forward method as Naturalistic Observation Diagnostic Assessment (NODA) system to upload videos of child’s behaviors to a webportal that enables the clinicians to make an assessment remotely. The findings were positive, finding there to be high agreement in terms of the diagnosis between remote methods and face to face methods and with high levels of satisfaction among the families and clinicians. This field is in the very early stages and so only studies with small sample size using surveys and interviews were identified but the findings suggest that there is potential for telehealth methods to improve access to assessment and diagnosis of ASD used in conjunction with existing methods, especially for those with clear autism traits and adults with ASD. Larger randomised controlled trials of this technology are warranted.

A synthesis of systematic review research on emerging learning environments and technologies

In this introduction to the special issue on systematic reviews on emerging learning environments and technologies, we introduce best practices for conducting systematic reviews and meta-analysis and discuss the need for a systematic review on emerging learning environments and technologies. We synthesize research on seven primary areas of emerging learning environments and technologies that include: (1) social media, (2) massive open online courses, (3) special education technology, (4) mobile learning, (5) game-based learning and gamification, (6) adaptive learning, and (7) learning analytics and introduce the thirteen articles that were included in this special issue. This article also provides implications for the readers on using and conducting systematic reviews.

Transforming treatments for schizophrenia: Virtual reality, brain stimulation and social cognition

Schizophrenia is characterised by delusions, hallucinations, anhedonia and apathy; while impairments in social cognition are often less recognised. Poor social cognition can lead to difficulties in obtaining and maintaining employment, academic progression, interpersonal relationships, and community functioning. Current interventions are highly intensive, require significant resources and have only modest effects on functional outcomes. Virtual reality (VR) and non-invasive brain stimulation (NIBS) may have a role in addressing these limitations. VR allows treatments that are potentially more accessible, less delivery intensive, and have higher ecological validity. While NIBS is able to directly modulate activity in social brain areas in order to promote neuroplasticity, strengthen neural connections and enhance brain function related to social cognitive behaviours. Therefore, the combination of VR and NIBS may allow for more efficient and transferrable interventions than those currently available. This review will explore the potential role of these technologies in the treatment of social cognitive impairment.

A systematic review evaluating the implementation of technologies to assess, monitor and treat neurodevelopmental disorders: A map of the current evidence

Technology-based interventions provide an attractive option for improving service provision for neurodevelopmental disorders (NDD), for example, widening access to interventions, objective assessment, and monitoring; however, it is unclear whether there is sufficient evidence to support their use in clinical settings. This review provides an evidence map describing how technology is implemented in the assessment/diagnosis and monitoring/ treatment of NDD (Prospero CRD42018091156). Using predefined search terms in six databases, 7982 articles were identified, 808 full-texts were screened, resulting in 47 included papers. These studies were appraised and synthesised according to the following outcomes of interest: effectiveness (clinical effectiveness/ service delivery efficiencies), economic impact, and user impact (acceptability/ feasibility). The findings describe how technology is currently being utilised clinically, highlights gaps in knowledge, and discusses future research needs. Technology has been used to facilitate assessment and treatment across multiple NDD, especially Autism Spectrum (ASD) and attention-deficit/hyperactivity (ADHD) disorders. Technologies include mobile apps/tablets, robots, gaming, computerised tests, videos, and virtual reality. The outcomes presented largely focus on the clinical effectiveness of the technology, with approximately half the papers demonstrating some degree of effectiveness, however, the methodological quality of many studies is limited. Further research should focus on randomised controlled trial designs with longer follow-up periods, incorporating an economic evaluation, as well as qualitative studies including process evaluations and user impact.

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

A large number of people in China have been affected by Autism Spectrum Disorders (ASDs). However, different factors associated with current barriers to accessing external support by ASD individuals in China have been identified. Assistive technologies are believed to help address the barriers. To obtain an in-depth understanding of the need and barriers of Chinese individuals with ASD in using assistive technologies, this study surveyed parents of ASD children, ASD professionals, as well as technology developers in the field. This study found that people in China have lower awareness and utilization of assistive technologies but similar demands for technologies when compared to those in the United Kingdom. Monitoring and informing systems, therapeutic recommendation systems and social skill training applications are major forms of assistive technologies desired by the participants in the interviews. Concerns about affordability, public exposure, confidentiality breaches and possible side-effects are considered as barriers that may prevent ASD individuals in China from using assistive technologies. The paper further discussed potential orientations of assistive technology development in China. Considering Chinese individuals may suffer intense stigma and heavy financial burden on mental disabilities, affordable mobile applications that help reduce the stigma would be more acceptable by Chinese ASD individuals.

Reality-Based Technologies for Children with Autism Spectrum Disorder: A Recommendation for Food Intake Intervention

Food selectivity by children with autism spectrum disorder (ASD) is relatively high as compared to typical children and consequently puts them at risk of nutritional inadequacies. Thus, there is a need to educate children with ASD on food types and their benefits in a simple and interesting manner that will encourage food acceptance and enable a move toward healthy living. The use of technological intervention has proven to be an effective tool for educating children with ASD in maintaining attention and mastering new skills as compared to traditional methods. Some of the popularly used technologies are computer-based intervention and robotics which do not support ecological validity (i.e., mimicking natural scenario). Consideration of natural factors is essential for better learning outcomes and generalized skills which can easily be incorporated into reality-based technologies such as virtual reality, augmented reality, and mixed reality. These technologies provide evidence-based support for ecological validation of intervention and sustaining the attention of children with ASD. The main objective of this study is to review existing reality-based technology intervention for children with ASD and investigate the following: (1) commonly used reality-based technology, (2) types of intervention targeted with reality-based technology, and (3) what subjects' inclusion types are used in the reality-based interventions. These objective statements have guided our recommendation of reality-based technology that can support ecological validity of food intake intervention.

New technologies and future trends

Numerous technologies have been introduced for the diagnosis, treatment, and management of patients with neurologic disorders, offering the promise of early diagnosis, tailored and individualized interventions, improvement in quality of life, and restoration of neurologic function. Many of these technologies have become available commercially without having been evaluated by rigorous clinical trials and regulatory reviews, or at the least by peer review of results submitted for publication. A subset is intended to assess, assist, and monitor cognitive functions, motor skills, and autonomic functions and as such may be applicable to persons with developmental disabilities. Barriers that have previously limited the use of technologies by persons with neurodevelopmental disabilities are disappearing as new technologies that have the potential to substantially augment diagnosis and interventions to enhance the daily lives of persons with these disorders are emerging. While recent and future advances in technology have the potential to transform their lives, cautious and thoughtful evaluation is needed to ensure the technologies provide maximal value. As such, further work is needed to demonstrate feasibility, efficacy, and cost-effectiveness, and technologies should be designed to be optimized for individual use.

Design Elements During Development of Videogame Programs for Children with Autism Spectrum Disorder: Stakeholders' Viewpoints

Introduction: Research has demonstrated that videogame programs can be an effective intervention targeting social challenges among children with autism spectrum disorder (ASD). Despite the rapid growth in developing videogame programs, incorporation of stakeholders' views has been limited. Objective: This project aimed to identify the design elements that should be considered during development of videogame programs for children with ASD, from the perspectives of stakeholders. Materials and Methods: We involved 26 stakeholders, including parents of children with ASD, youth with ASD, and clinicians working with individuals with ASD in focus groups and interviews. Results: Thematic analysis yielded three themes: (1) addressing heterogeneity and diverse needs; (2) mirroring real world; and (3) teaching strategies. Conclusion: Incorporating these elements during development of videogame programs can help enhance the outcomes for children with ASD. By including stakeholders' voices, it is assumed that the developed videogame programs may serve as user-friendly and engaging tools to potentially complement traditional interventions when overcoming social difficulties in individuals with ASD.

The Effectiveness of Web-Based Interventions Delivered to Children and Young People With Neurodevelopmental Disorders: Systematic Review and Meta-Analysis

BACKGROUND

The prevalence of certain neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), has been increasing over the last four decades. Nonpharmacological interventions are available that can improve outcomes and reduce associated symptoms such as anxiety, but these are often difficult to access. Children and young people are using the internet and digital technology at higher rates than any other demographic, but although Web-based interventions have the potential to improve health outcomes in those with long-term conditions, no previous reviews have investigated the effectiveness of Web-based interventions delivered to children and young people with neurodevelopmental disorders.

OBJECTIVE

This study aimed to review the effectiveness of randomized controlled trials (RCTs) of Web-based interventions delivered to children and young people with neurodevelopmental disorders.

METHODS

Six databases and one trial register were searched in August and September 2018. RCTs were included if they were published in a peer-reviewed journal. Interventions were included if they (1) aimed to improve the diagnostic symptomology of the targeted neurodevelopmental disorder or associated psychological symptoms as measured by a valid and reliable outcome measure; (2) were delivered on the Web; (3) targeted a youth population (aged ≤18 years or reported a mean age of ≤18 years) with a diagnosis or suspected diagnosis of a neurodevelopmental disorder. Methodological quality was rated using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs.

RESULTS

Of 5140 studies retrieved, 10 fulfilled the inclusion criteria. Half of the interventions were delivered to children and young people with ASDs with the other five targeting ADHD, tic disorder, dyscalculia, and specific learning disorder. In total, 6 of the 10 trials found that a Web-based intervention was effective in improving condition-specific outcomes or reducing comorbid psychological symptoms in children and young people. The 4 trials that failed to find an effect were all delivered by apps. The meta-analysis was conducted on five of the trials and did not show a significant effect, with a high level of heterogeneity detected (n=182 [33.4%, 182/545], 5 RCTs; pooled standardized mean difference=-0.39; 95% CI -0.98 to 0.20; Z=-1.29; P=.19 [I²=72%; P=.006]).

CONCLUSIONS

Web-based interventions can be effective in reducing symptoms in children and young people with neurodevelopmental disorders; however, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and small samples of included studies. Overall, the number of studies was small and mainly limited to ASD, thus restricting the generalizability of the findings.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews: CRD42018108824; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108824.

Telepsychiatry in intellectual disability psychiatry: literature review

Aims and MethodThe aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted. RESULTS: Four USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.Clinical implicationsThe innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.Declaration of interestNone.

Virtual Reality in Pharmacy: Opportunities for Clinical, Research, and Educational Applications

Virtual reality (VR) has been widely studied and applied in numerous medical applications.1 In pharmacy, VR can potentially be applied as follows: adjunctively or as a replacement for pharmacotherapy; in drug design and discovery; in pharmacist education; and in patient counseling and behavior modification.1-6 Research applying VR in pharmacy is currently limited; however, interest in these applications is increasing. The majority of studies conducted during the past decade have found VR to be safe and effective, and to promote a high degree of user satisfaction.4 VR technology has become increasingly affordable, flexible, and portable, enabling its use for therapeutic purposes in both inpatient and outpatient environments.4 But despite the compelling features of VR, a number of challenges exist, such as validation of clinical efficacy, cost/accessibility and usability issues, technical capabilities, and acceptance.1-5 This article discusses the potential for the use of VR in pharmacy for clinical, research, and educational applications.

Parental experiences using the Therapy Outcomes by You (TOBY) application to deliver early intervention to their child with autism

PURPOSE

As computer-based interventions become commonplace for parents of children with neurodevelopmental disorders, this study sought to understand the experience of using a parent-delivered supplementary early intervention therapy for children with autism spectrum disorder grounded in a variety of behavioral, sensory, developmental, and relationship-based approaches and delivered via a tablet device.

METHODS

Parental experiences using the 'Therapy Outcomes by You' (TOBY) application were collected through semi-structured interviews with 17 parents.

RESULTS

Parents reported TOBY facilitated parent-child engagement, provided ideas for therapeutic activities, created feelings of empowerment, and positively impacted their child's development. Barriers to use included preparation time, execution of the intervention, and individual strengths and weaknesses of their child.

CONCLUSION

The overall parental experience of TOBY was positive when use of the application aligned with parental proficiency, opportunities for use, and importantly, the needs of the child.

Multi-Scale Coordination of Distinctive Movement Patterns During Embodied Interaction Between Adults With High-Functioning Autism and Neurotypicals

Autism Spectrum Disorder (ASD) can be understood as a social interaction disorder. This requires researchers to take a “second-person” stance and to use experimental setups based on bidirectional interactions. The present work offers a quantitative description of movement patterns exhibited during computer-mediated real-time sensorimotor interaction in 10 dyads of adult participants, each consisting of one control individual (CTRL) and one individual with high-functioning autism (HFA). We applied time-series analyses to their movements and found two main results. First, multi-scale coordination between participants was present. Second, despite this dyadic alignment and our previous finding that individuals with HFA can be equally sensitive to the other’s presence, individuals’ movements differed in style: in contrast to CTRLs, HFA participants appeared less inclined to sustain mutual interaction and instead explored the virtual environment more generally. This finding is consistent with social motivation deficit accounts of ASD, as well as with hypersensitivity-motivated avoidance of overstimulation. Our research demonstrates the utility of time series analyses for the second-person stance and complements previous work focused on non-dynamical and performance-based variables.