­Using Robots to Treat Autism

Teaching autistic children to communicate effectively has long vexed parents and therapists. Now, however, researchers are attempting to take autism therapy into the digital age, by introducing robot "co-therapists" that may provide a less threatening and more effective way to connect with children suffering from autism spectrum disorder (ASD).

"Some research shows that children with autism have a fascination with technology and it is effective in aiding them," explains Nilanjan Sarkar, professor of Mechanical Engineering and Computer Engineering at Vanderbilt University.

Sarkar leads an interdisciplinary team that uses a humanoid robot to provide therapy for autistic children. The two-foot-tall playmate, named Nao (pronounced "now"), is integrated with a network camera, LCD monitors and an array of sensors. It offers verbal and physical cues that help an autistic child better focus on tasks.

Meanwhile, a team at the University of Notre Dame is turning to humanoid robots to test therapeutic methods and provide therapy, while another group at University of Hertfordshire in the UK is building life-like robots to interact with ASD-affected children.

Child's Play

Make no mistake, digital technology represents a new and intriguing opportunity to address autism. According to the Autism Society, about one in 88 children (one in 54 boys) is diagnosed with ASD—and the rate of growth is about 10-17 percent annually. Not only is the condition tough on children, teachers and other providers, it presents major obstacles for healthcare systems. The lifetime cost of treating ASD patients is about U.S. $3.2 million per person—about four to six times greater than the lifetime cost of treating individuals without autism.

At Notre Dame, assistant professor of psychology Joshua Diehl led a research study testing robotic therapy and found that children with ASD performed markedly better when using a robot co-therapist, compared to their progress when directly interacting with a human therapist. Diehl and fellow researchers directly controlled the commercially available Nao robot, built by Aldebaran Robotics in France, and sent speech and commands to it from an adjacent room.

Think of this as a "Wizard of Oz" approach. "Part of what may make the technology effective is that it provides fewer social cues," Diehl explains. "The technology may help bridge the gap between where they are (autistic children) at and where they need to be in order to function in the social world."

Michael Villano, a research assistant professor and a member of Diehl's team, relies on HTTP-based commands to control the robot wirelessly. Therapists can choose from upwards of 100 behavioral expressions for the robot, such as clapping or fist pumps. Because the robot has built-in text-to-speech technology, a therapist can type comments into a text field box on a computer and the robot will instantly say the words. As a result, "It's possible to carry on a reasonable conversation with the child," he says.

At Vanderbilt University, researchers are now focusing on building autonomous co-therapists. "Children with autism have a problem understanding other people’s emotions, as well as expressing their own emotions," says Sarkar, who became interested in the idea of robot therapists after a nephew in India was diagnosed with ASD eight years ago.

Sakar used biosensors to gauge blood pressure, skin response and movements related to "emotions" in the children. The data originally was used to program the computer-robot systems to respond to various cues and behaviors.

The interdisciplinary team at Vanderbilt—which includes psychologists and autism experts—has built a system that operates without direct human control. ARIA (Adaptive Robot-Mediated Intervention Architecture) relies on the same Nao robot as Notre Dame to receive feedback from web cameras mounted around a room. The computer tracks a child's head movements using LED sensors mounted in a baseball cap. A session begins when the robot verbally prompts a child to view an image or video on an LCD screen. If the child does not respond as desired, the robot gradually and adaptively adds cues, such as more verbal prompting and physical gestures, to help the child succeed. When the child responds appropriately, the robot praises the child.

ARIA is a closed-loop system that continually adapts to each child individually, depending on how he or she responds. Since no two autistic children follow the same path, "To be useful, the system must be adaptive," notes Zachary Warren, director of the Treatment & Research Institute for Autism Spectrum Disorders at Vanderbilt Kennedy Center and co-investigator of this research. "This is the first real-world test of whether intelligent adaptive systems can make an impact on autism," he adds. "The idea is for the child to transfer the skills learned with the robot to real-world situations."

A Therapeutic Approach

Some autism experts see robots as the next step forward in therapy. Kristin Wier, clinical director of the Ansari Center for Autism in St. Joseph, MI, and a part of the Notre Dame team, says that humanoid robots can lead to "very positive results for the participants and families involved in the therapy." When she observed sessions at Notre Dame, "The children weren't afraid to participate. Their eye contact was better, their posture was more engaged and their choice of words was improved. Many of the children—who weren't receptive to human therapists—were much more switched on during the sessions," she says.

To be sure, researchers are forging ahead with next-generation robotic systems. The Notre Dame team, for example, is continually adding behavioral commands and learning more about how children respond. A team at the University of Hertfordshire is developing a child-sized, life-like robot named KASPAR (Kinesics and Synchronization in Personal Assistant Robots) that will serve as a "robotic mediator" for autistic children. And the Vanderbilt group is adding gestures and behavioral refinements—as well as improving the underlying algorithm.

Concludes Sarkar: "We are searching for ways to make the robot more robust and effective…This is an extremely promising area of research that could shape the future of treating autism in children."

Samuel Greengard is an author and journalist based in West Linn, OR.