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

https://doi.org/10.1016/j.jpsychires.2017.02.004Get rights and content

Abstract

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.

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

References (148)

  • S. Kuriki et al.

    Similar impressions of humanness for human and artificial singing voices in autism spectrum disorders

    Cognition

    (2016)
  • J. Lee et al.

    Which robot features can stimulate better responses from children with autism in robot-assisted therapy?

    Int. J. Adv. Robotic Syst.

    (2012)
  • C. Lord et al.

    Autism spectrum disorders

    Neuron

    (2000)
  • K.F. MacDorman et al.

    Too real for comfort? Uncanny responses to computer generated faces

    Comput. Hum. Behav.

    (2009)
  • J. Navarra et al.

    Exposure to asynchronous audiovisual speech extends the temporal window for audiovisual integration

    Brain Res. Cogn. Brain Res.

    (2005)
  • F. Abell et al.

    The neuroanatomy of autism: a voxel-based whole brain analysis of structural scans

    Neuroreport

    (1999)
  • R. Adolphs et al.

    Abnormal processing of social information from faces in autism

    J. Cogn. Neurosci.

    (2001)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • N. Aresti-Bartolome et al.

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

    Int. J. Environ. Res. Public Health

    (2014)
  • E.H. Aylward et al.

    MRI volumes of amygdala and hippocampus in non-mentally retarded autistic adolescents and adults

    Neurology

    (1999)
  • J. Baio

    Prevalence of autism spectrum disorder among children aged 8 Years — autism and developmental disabilities monitoring network, 11 sites, United States, 2010

    Surveill. Summ.

    (2014)
  • G.T. Baranek et al.

    Sensory Experiences Questionnaire: discriminating sensory features in young children with autism, developmental delays, and typical development

    J. Child. Psychol. Psychiatry

    (2006)
  • S. Baron-Cohen et al.

    Social intelligence in the normal and autistic brain: an fMRI study

    Eur. J. Neurosci.

    (1999)
  • S. Baron-Cohen et al.

    Understanding Other Minds: Perspectives from Developmental Cognitive Neuroscience

    (2000)
  • M. Bauman et al.

    Histoanatomic observations of the brain in early infantile autism

    Neurology

    (1985)
  • G. Bedard et al.

    Impaired timing of audiovisual events in the elderly

    Exp. Brain Res.

    (2016)
  • E.T. Bekele et al.

    A step towards developing adaptive robot-mediated intervention architecture (ARIA) for children with autism

    IEEE Trans. Neural Syst. Rehabil. Eng.

    (2013)
  • A. Bertone et al.

    Motion perception in autism: a “complex” issue

    J. Cogn. Neurosci.

    (2003)
  • A. Bertone et al.

    Enhanced and diminished visuo-spatial information processing in autism depends on stimulus complexity

    Brain

    (2005)
  • A. Billard et al.

    Building Robota, a mini-humanoid robot for the rehabilitation of children with autism

    Assist. Technol.

    (2007)
  • R. Blake et al.

    Visual recognition of biological motion is impaired in children with autism

    Psychol. Sci.

    (2003)
  • N. Boddaert et al.

    Perception of complex sounds in autism: abnormal auditory cortical processing in children

    Am. J. Psychiatry

    (2004)
  • A. Bonnel et al.

    Enhanced pitch sensitivity in individuals with autism: a signal detection analysis

    J. Cogn. Neurosci.

    (2003)
  • J.-J. Cabibihan et al.

    Why robots? A survey on the roles and benefits of social robots in the therapy of children with autism

    Int. J. Soc. Robotics

    (2013)
  • C. Cascio et al.

    Tactile perception in adults with autism: a multidimensional psychophysical study

    J. Autism Dev. Disord.

    (2008)
  • C.J. Cascio et al.

    Somatosensory event-related potentials and association with tactile behavioral responsiveness patterns in children with ASD

    Brain Topogr.

    (2015)
  • G. Celani et al.

    The understanding of the emotional meaning of facial expressions in people with autism

    J. Autism Dev. Disord.

    (1999)
  • Chaminade, T., Da Fonseca, D., Rosset, D., Lutcher, E., Cheng, G., Deruelle, C., 2012. fMRI study of young adults with...
  • T. Charman et al.

    Infants with autism: an investigation of empathy, pretend play, joint attention, and imitation

    Dev. Psychol.

    (1997)
  • M. Coeckelbergh et al.

    A survey of expectations about the role of robots in robot-assisted therapy for children with ASD: ethical acceptability, trust, sociability, appearance, and attachment

    Sci. Eng. Ethics

    (2016)
  • S. Costa et al.

    Promoting interaction amongst autistic adolescents using robots

    Conf. Proc. IEEE Eng. Med. Biol. Soc.

    (2010)
  • C.A. Costescu et al.

    Reversal learning task in children with autism spectrum disorder: a robot-based approach

    J. Autism Dev. Disord.

    (2015)
  • K.M. Dalton et al.

    Gaze fixation and the neural circuitry of face processing in autism

    Nat. Neurosci.

    (2005)
  • M. Dapretto et al.

    Understanding emotions in others: mirror neuron dysfunction in children with autism spectrum disorders

    Nat. Neurosci.

    (2006)
  • K. Dautenhahn

    Robots as social actors: aurora and the case of autism

    Proc. Third Cogn. Technol. Conf.

    (1999)
  • K. Dautenhahn

    Socially intelligent robots: dimensions of human-robot interaction

    Philos. Trans. R. Soc. Lond B Biol. Sci.

    (2007)
  • K. Dautenhahn et al.

    Games children with autism can play with Robota, a humanoid robotic doll

  • K. Dautenhahn et al.

    Towards interactive robots in autism therapy: background, motivation and challenges

    Pragmat. Cognition

    (2004)
  • K. Dautenhahn et al.

    KASPAR - a minimally expressive humanoid robot for human-robot interaction research

    Appl. Bionics Biomechanics

    (2009)
  • L. Dickstein-Fischer et al.

    Combining psychological and engineering approaches to utilizing social robots with children with autism

    Conf. Proc. IEEE Eng. Med. Biol. Soc.

    (2014)
  • Cited by (69)

    View all citing articles on Scopus
    View full text