Pivotal Response Treatment with and without robot-assistance for children with autism: a randomized controlled trial

Pivotal response treatment and applied behavior analysis interventions for autism spectrum disorder delivered by human vs robotic agents: a systematic review of literature

Robotic technology-aided instruction and interventions have been designed to support both Applied Behavior Analysis (ABA) and Pivotal Response Treatment (PRT) interventions for children with ASD. However, to the best of our knowledge, this field has not been systematically reviewed. Thus, we aimed to systematically review the literature to determine whether ABA or PRT methods in a robotic therapeutic context yield better outcomes for individuals with ASD, specifically in terms of approaching and accepting robots. A comprehensive search of electronic databases including PubMed, EMBASE, and Google Scholar was conducted. Randomized control trials (RCT) and pre-post-test design investigations that assessed the impact of ABA vs. PRT approach via robot-mediated technology vs. human trainers on intervention outcomes of children with ASD were selected and included in this systematic review. Finally, 13 papers met the criteria for inclusion in the systematic review. Two independent reviewers extracted the associated data from each selected study according to the standardized data extraction form. Two reviewers also assessed the quality of each study independently using the Cochrane Back Review Scale and JBI tool for quasi-experimental studies. We categorized two general classifications of findings including ABA vs. PRT as well as robotic technology vs. human. In conclusion, the existing investigations on the effect of robotic assistive technology using ABA or PRT approach are promising particularly in therapeutic contexts with a more natural context and social flavor.

Psychometric Properties of the Standardised Instruments that are Used to Measure (Pragmatic) Intervention Effects in Autistic Children: A Systematic Review

Background and aims

Pragmatic language difficulties can negatively influence the learning, socialization, and mental health of children diagnosed with autism spectrum disorder (ASD). Several studies have sought to determine the effects of interventions, including competencies to help these children use language for social purposes. However, are the instruments used to measure the results of the interventions appropriate and psychometrically adequate? This systematic review aims to analyze the psychometric properties of the standardized instruments that are used to measure the effects of interventions addressing (not exclusively, but also) pragmatic language competencies for autistic children.

Method

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematic literature research was carried out in four electronic indexing databases: CENTRAL, PubMed, Web of Science, and Scopus.

Results

A total of 49 studies from 2005 to 2023 were included and 19 standardized instruments were identified.

Conclusions

After analyzing the instruments psychometric properties, the results indicated that all present some evidence of validity and reliability, but none report responsiveness. Implications: Given the impact that an instrument can have on analyzing the effects of an intervention, this study highlights the importance of considering not only the validity and reliability of an instrument but also responsiveness as a psychometric property, and the need to better describe the rationale for the outcome measures and specify what abilities are being targeted and measured. This will accurately guide future research and improve clinical decision-making around ASD.

Systematic bibliometric and visualized analysis of research hotspots and trends in artificial intelligence in autism spectrum disorder

Background

Artificial intelligence (AI) has been the subject of studies in autism spectrum disorder (ASD) and may affect its identification, diagnosis, intervention, and other medical practices in the future. Although previous studies have used bibliometric techniques to analyze and investigate AI, there has been little research on the adoption of AI in ASD. This study aimed to explore the broad applications and research frontiers of AI used in ASD.

Methods

Citation data were retrieved from the Web of Science Core Collection (WoSCC) database to assess the extent to which AI is used in ASD. CiteSpace.5.8. R3 and VOSviewer, two online tools for literature metrology analysis, were used to analyze the data.

Results

A total of 776 publications from 291 countries and regions were analyzed; of these, 256 publications were from the United States and 173 publications were from China, and England had the largest centrality of 0.33; Stanford University had the highest H-index of 17; and the largest cluster label of co-cited references was machine learning. In addition, keywords with a high number of occurrences in this field were autism spectrum disorder (295), children (255), classification (156) and diagnosis (77). The burst keywords from 2021 to 2023 were infants and feature selection, and from 2022 to 2023, the burst keyword was corpus callosum.

Conclusion

This research provides a systematic analysis of the literature concerning AI used in ASD, presenting an overall demonstration in this field. In this area, the United States and China have the largest number of publications, England has the greatest influence, and Stanford University is the most influential. In addition, the research on AI used in ASD mostly focuses on classification and diagnosis, and "infants, feature selection, and corpus callosum are at the forefront, providing directions for future research. However, the use of AI technologies to identify ASD will require further research.

Information and communication technologies-based interventions for children with autism spectrum conditions: a systematic review of randomized control trials from a positive technology perspective

Information and communication technologies (ICTs) have become more widely used in the past years to help people with autism spectrum conditions (ASC). Serious games embedded into computers or tablets, as well as social robots, are the most employed ICT-related tools that are appealing to and appropriate for autistic children. The goal of ICT applications is to enhance behavioral abnormalities associated with ASC while also creating an interactive link between one person and one computer. Comparatively, to human-based therapy, ICT tools aid to inspire autistic children by providing predictability and regularity of tasks. Regaining social skills is the primary behavioral goal for which ICT tools have been designed and implemented. In the past several years, many studies have been created to show how effective it is at improving targeted behaviors. However, only a small number of researchers have used an RCT approach to evaluate its effectiveness. In this systematic review, we only included RCT studies where ICT technologies were used to help children with ASC in improving their social skills. Only 14 RCT studies satisfied the criteria and 12 described significant improvements, showing how the use of technology in educational contexts produced better improvement in developing several social skill facets with respect to the traditional face-to-face approach. Some studies used interventions and outcome measures focused on the core ASC symptoms, but many others addressed neurocognitive functions directly, like social cognition or emotional regulation, while other more general functions such as language or adaptive behaviors. We propose a classification based on processes and outcome measures to foster future research in this specific area of research. The behavioral intervention mediated by technological tools such as computer-based, tablet, and social robotics, undoubtedly provides a comfortable environment that promotes constant learning for people with ASC. Evidence provided in this review highlights the translational potential of this field of study in primary care practice and educational settings.

Ethical Considerations in Child-Robot Interactions

Social robots hold promise in augmenting education, rehabilitative care, and leisure activities for children. Despite findings suggesting various benefits of social robot use in schools, clinics, and homes, stakeholders have voiced concerns about the potential social and emotional effects of children engaging in long-term interactions with robots. Given the challenges of conducting large long-term studies of child-robot interaction (CRI), little is known about the impact of CRI on children's socio-emotional development. Here we summarize the literature on predictions and expectations of teachers, parents, therapists, and children regarding the effects of CRI on children's socio-emotional functioning and skill building. We then highlight the limited body of empirical research examining how CRI affects children's social behavior and emotional expression, and we provide a summary of available questionnaires for measuring socio-emotional constructs relevant to CRI. We conclude with design recommendations for research studies aimed at better understanding the effects of CRI, before social robots become more ubiquitous. This review is relevant to researchers, educators, roboticists, and clinicians interested in designing and using social robots with developmental populations.

Eye Movement Desensitization and Reprocessing in adolescents with autism; Efficacy on ASD symptoms and stress

INTRODUCTION

Eye Movement Desensitization and Reprocessing (EMDR) is a well-established and thoroughly researched treatment method for posttraumatic stress symptoms. When patients with an autism spectrum disorder (ASD) are treated with EMDR for their Posttraumatic Stress Disorder (PTSD), they sometimes report a decrease in the core symptoms of ASD. This explorative pre-post-follow up design study is designed to investigate whether EMDR with a focus on daily experienced stress, is effective in reducing ASD symptoms and stress in adolescents with ASD.

METHODS

Twenty-one adolescents with ASD (age 12 to 19) were treated with ten sessions EMDR, focusing on events of daily experienced stress.

RESULTS

No significant decrease of ASD symptoms was found on the total score of the Social Responsiveness Scale (SRS) as reported by caregivers from baseline to end measurement. However, there was a significant decrease on total caregivers SRS score comparing the baseline to the follow-up measurement. On two subscales, Social Awareness and Social Communication, a significant decrease was found from baseline to follow-up. On the subscales Social Motivation and Restricted Interests and Repetitive Behavior, no significant effects were found. On pre- and posttest scores of total ASD symptoms measured by the Autism Diagnostic Observation Schedule (ADOS-2), no significant effects were found. On the contrary, scores on self-reported Perceived Stress Scale (PSS) showed a significant decrease from baseline to follow-up. Also, 52% of adolescents showed a significant improvement of global clinical functioning at endpoint measurement on the Clinical Global Impression Improvement, rated by an independent child psychiatrist.

DISCUSSION

In sum, these results of this uncontrolled study suggest a partial effect of EMDR in adolescents with ASD on ASD symptoms, rated by their caregivers. In addition, the results of this study show that EMDR treatment on daily experienced stress significantly reduce perceived stress as reported by the participants, and improves global clinical functioning. The results also suggest a 'sleeper effect', since no significant effects were found between baseline- and post- treatment measurements, but only between baseline- and follow up three months after the treatment. This finding is in line with other studies investigating psychotherapeutic effects in ASD. Implications for clinical practice and suggestions for future research are discussed.

Three Study Cases of Social Robotics in Autism Spectrum Disorder Treatment: Personalization and Usability of CASTOR Robot

Social assistive robotics in autism has been implemented in studies and therapies to improve social skills and encourage children to comply with therapies. However, autism symptoms vary in their spectrum, which generates difficulties in implementing social robotics in a general way. In this study, the CASTOR social robot was implemented in three cases: one case of autism fulfilling the inclusion and exclusion criteria and two cases with comorbidities typically excluded in social robotic studies. A pre and post-test professional evaluations were made, and 12 variables about social skills were measured during the implementation. Four sessions of 30 minutes were performed for each study case, improving focal attention, following instructions, working and procedure memory, identifying emotions, and physical and verbal imitation. Regarding the qualification method used at the Howard Gardner Clinic for each speciality, the most remarkable improvements were P1 increased by 20% in physiotherapy, P2 increased by 23% in psychology and P3 increased by 10% in occupational therapy. The pre and posttest results indicate that the presence of the social robot in therapies improves children's progress independently of their qualities.

Social Humanoid Robots for Children with Autism Spectrum Disorders: A Review of Modalities, Indications, and Pitfalls

Robot-assisted therapy (RAT) is a promising area of translational neuroscience for children with autism spectrum disorders (ASDs). It has been widely demonstrated that this kind of advanced technological tool provides a reliable and efficient intervention for promoting social skills and communication in children with ASD. This type of treatment consists of a human-assisted social robot acting as an intervention mediator to increase competence and skills in children with ASD. Several social robots have been validated in the literature; however, an explicit technical comparison among devices has never been performed. For this reason, in this article, we provide an overview of the main commercial humanoid robots employed for ASD children with an emphasis on indications for use, pitfalls to be avoided, and recent advances. We conclude that, in the near future, a new generation of devices with high levels of mobility, availability, safety, and acceptability should be designed for improving the complex triadic interaction among teachers, children, and robots.

Pivotal Response Treatment (PRT) parent group training for young children with autism spectrum disorder: a pilot study

Pivotal Response Treatment (PRT) is a promising intervention addressing core symptoms of autism spectrum disorder (ASD), with parent involvement as key component. Parent group-delivered PRT may be an effective treatment model, but currently the evidence is limited. Also, little attention has been paid to therapeutic involvement of multiple important contexts (e.g. home, school, community) of the young child. The current study explores a 14-week protocol of PRT parent group training (PRT-PG), complemented with individual parent–child sessions and involvement of teachers and other childcare providers. Children aged 2–6 years old with ASD and their parents (n = 20) were included. Preliminary results showed a significant increase in spontaneous initiations during a semi-structured therapist-child interaction together with widespread gains in clinical global functioning. No significant improvement on parent-rated general social-communication skills was observed. These findings justify further research on parent group delivered PRT models.