Improving therapeutic outcomes in autism spectrum disorders: Enhancing social communication and sensory processing through the use of interactive robots
Introduction
Autism spectrum disorders (ASD) include a continuum of deficits characterized to varying extents by difficulties with communication and social interactions, repetitive behaviors, and restricted interests (American Psychiatric Association, 2013; Kanner, 1943, Lord et al., 2000). Social deficits may include a variety of impairments during interactions, including difficulty initiating joint attention behaviors and responding to joint attention tasks (Charman et al., 1997, Leekam et al., 1997, Mundy and Sigman, 1989). Children with ASD often exhibit a diminished ability to imitate others (Ingersoll, 2008, Rogers and Pennington, 1991, Williams et al., 2004), which is critical due to the key role that imitation is thought to play in the development of social cognition (Meltzoff and Decety, 2003). In addition, individuals with ASD frequently exhibit reduced gaze fixation (Baron-Cohen et al., 2000, Dalton et al., 2005, Lord et al., 2000) and a reduced ability to recognize and respond appropriately to emotional expressions (Celani et al., 1999), making social interactions frustrating, confusing, and potentially aversive. The prevalence of ASD appears to be increasing, with recent estimates as high as 1 in 68 (Baio, 2014). Since few treatment options currently exist, there is a critical need for establishing novel, effective support tools and therapeutic intervention strategies.
Social robots were recently discovered to be promising tools in the diagnosis and treatment of ASD, particularly due to the fact that individuals with ASD often show an interest in technology (Dautenhahn and Werry, 2004, Diehl et al., 2012, Diehl et al., 2014b, Feil-Seifer and Mataric, 2009, Scassellati, 2007). Robots appear to be more effective than interactive software or computer-mediated therapy based on their flexible capacity for interactive play and engaging multisensory design features, including realistic 3-dimensional body movements (Cabibihan et al., 2013, Kim et al., 2013). Both adults and children (typically developing or otherwise) have a natural inclination to anthropomorphize life-like robots, attributing human-like motivations and intentions to robots and relying on human social rules when interacting with them (Hinds et al., 2004, Reeves and Nass, 1996). In fact, typically developing toddlers have been shown to treat robots as peers rather than as toys following repeated exposures to, and interactions with, the robots (Tanaka et al., 2007). If our human social rules and interactions can be generalized to interactions with robots, social robots may represent an ideal tool for facilitating the development of social skills and for delivering interventions that alleviate social difficulties for individuals with ASD. Robotic interactions are inherently more controlled, predictable, and simplistic, thereby generating less frustration for individuals with ASD who may have difficulty interpreting and responding to human social interactions. Children with ASD are proactive in initiating interactions with social robots (Dautenhahn, 2007); produce more speech overall in the presence of a social robot (Kim et al., 2013); and direct more speech (social interaction) toward adults in the same room when also in the presence of a social robot (Kim et al., 2013). In addition, robots are effective at attracting gaze (Werry et al., 2001), and interactions with robots have been shown to significantly decrease social anxiety in children with ASD (Kaboski et al., 2015). Developing early social and communication intervention strategies targeted towards children with ASD is of particular interest because children are especially vulnerable to increasingly complex social demands as they transition to adulthood (Webb et al., 2004). Delays in the development of age-appropriate social communication can be highly detrimental to individuals with ASD, leading to increased social anxiety and depression as well as diminished occupational/professional success as adults (Gillott et al., 2001, Sterling et al., 2008).
Section snippets
Sensory perception & integration: deficits & therapeutic targets in ASD
The development of social robots as a therapeutic tool for individuals with ASD has benefited extensively from advances in engineering and adoption by clinical psychologists. Despite the fact that social interactions inherently rely on audiovisual communication, systems neuroscience approaches addressing the mechanism and efficacy of the therapeutic utility of social robots remain largely unexplored. Systems neuroscience analyses offer the opportunity to elucidate critical components of the
The neurobiology of social interaction & communication deficits in ASD
The inherent heterogeneity of autism spectrum disorders leads to difficulty in pinpointing common neural substrates that may cause core deficits. However, certain neurobiological irregularities do appear to be overarchingly characteristic of ASD. Several neural mechanisms have been proposed to underlie the core social and communication deficits observed in ASD. One such network involves the mirror neuron system, which facilitates imitation and social communication. In a fMRI experiment studying
A spectrum of socially-assistive robots
The use of robots for individuals with ASD is a relatively novel therapeutic tool gaining traction over the last decade (Aresti-Bartolome and Garcia-Zapirain, 2014, Coeckelbergh et al., 2016). During that time, researchers and clinicians have developed robotic models with a wide range of appearances, features, and functional capabilities that draw from expertise in fields such as engineering and clinical psychology (Scassellati et al., 2012). Robotic interactive features include various degrees
Towards an optimal robotic model for use in ASD therapies
There are a variety of outcome measures of robot-assisted therapy such as 1) generalization to human interactions; 2) increased cooperation/collaboration; 3) reduction of repetitive behaviors and restricted interests; 4) increased sharing and turn-taking behaviors; 5) enhanced imitation or joint attention capabilities; and 6) increased motivation and attentional engagement. These outcomes vary according to the traits of the robot being used as well as the severity of symptoms for individuals
Applying systems neuroscience tools to strengthen and extend social robot therapeutic value
Although social robots appear to be effective therapy tools, the perceptual mechanisms underlying these benefits remain largely unknown. Given that social interactions rely on audiovisual communication, it seems likely that social robot stimuli confer added multisensory processing benefits that are lacking in human interactions. These benefits may rely on social robots acting as simplified versions of people, allowing more effective filtering of meaningful perceptual stimuli. Recent studies in
Access to social robot therapies and methodological considerations
Although early intervention strategies using social robot therapies appear to be effective, this efficacy is somewhat hindered by a lack of affordable, commercially available robots for in-home use accessible to families of children with ASD. For practical reasons, it is also beneficial for the robot to be portable, easy to operate to ensure its utility for children with ASD and their families, and durable enough to withstand occasional rough play from children. In an effort to address these
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