Technology to support psychosocial development and self-management in persons with autism- spectrum disorder Henry Kautz Machines of Loving Grace Spring 2008
Dec 18, 2015
Technology to support psychosocial development and self-management in
persons with autism-spectrum disorder
Henry KautzMachines of Loving Grace
Spring 2008
Psychosocial Disorders
• So far in the course, we have considered technology to support– Memory– Executive function
• Now, we turn to technology to assist with– Behavioral dyscontrol– Limitations in social interaction
in the context of autism• Next class: Mood disorders
Potential advantages of ATC
• Less intrusive than teachers or coaches• Context aware• Demand aware• Record data and deliver interventions using
same system• User control of interventions• Potentially more acceptable to recipient
Example: Behavioral Dyscontrol
• Notice personal factors preceding behavioral dyscontrol?– Autonomic– Physical behavior (rocking, shifting position)
• Notice social environmental factors– Proximity of voices– Ambient noise– Activity of others
• Context sensitive AI intervention via cell phone/PDA
Example: Promoting social interaction
• Notice proximity of people• Social networking – understanding availability
of known communication partners• Monitoring initiation and maintenance of
communication• Too short? Too long?• Context sensitive intervention via cell
phone/PDA
AUTISM SPECTRUM DISORDER
Core symptoms
Major impairments:•Social Skills/Relationships•Communication•Stereotypical Behaviors•Desire for Sameness
Autism is a spectrum disorder:
Autism / PDD-NOS/ Asperger Syndrome – key impairment in social skills is common to all
WHAT IS SOCIAL INTERACTION?
Social interaction is a reciprocal process in which children effectively initiate and respond to social stimuli presented by their peers.
(Bauminger, Shulman, & Agam 2003)
WHAT ARE THE SOCIAL INTERACTION CHARACTERISTICS OF TYPICALLY DEVELOPING
CHILDREN?
Characteristics Include:
• Emotional Impulse Control• Conforming and Friendly Behaviors• Cooperative Play (Playing well with others)• Assertive Leadership Skills• Helping• Sharing• Comforting Behavior
(Hart, Fujiki, Brinton, & Hart, 2004)
WHAT ARE THE SOCIAL INTERACTION CHARACTERISTICS OF HIGH-FUNCTIONING
AUTISTIC CHILDREN?
Deficit in “Theory of Mind”
• - from The Curious Incident of the Dog in the Night, by Mark Haddon
e) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
1. social interaction2. language as used in social communication3. symbolic or imaginative play
D. The disturbance is not better accounted for by Rett's Disorder
How do they diagnose full-syndrome?
How do they diagnose Asperger Syndrome?
• (IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)
How do they diagnose Asperger Syndrome?
• (V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.
Genetic or environmental cause?• Studies of identical twins reveal:
– Co-occurrence is 40-80%; if 100%, then only due to genes; so genes are important, but so are unknown environmental factors
– 5-10% chance siblings of ASD children will have autism
– 25% chance of major speech delay
… so carefully monitor siblings
Which Genes?
• Many genetic studies of autism, but they generally disagree: too few subjects and too many genes
• Probably 10-20 genes involved in complex manner
• Translational Genomics (TGen) plans largest study ever (1000 subjects)
• In two similar conditions, Fragile X and Rett’s Syndrome, a single gene has been identified for each
Which Environmental Causes?• No general agreement
• Possible causes with limited scientific data include:– High levels of heavy metals (e.g., mercury, lead, aluminum) due
to limited excretion because of low glutathione– Excessive oral antibiotic usage (gut damage = poor health and
neurodevelopment due to poor digestion of nutrients)– Vaccine damage (especially MMR)– Exposure to pesticides– Lack of essential minerals (iodine, lithium)– Other unknown factors
Rapid increase in incidence
• 1970’s: 2-3 per 10,000• 2007: 1 per 150 (U.S.); 1 per 58 (U.K.) • In the U.S., affects 1 in 80 boys, since 4:1
boy:girl ratio• In California (which has best statistics),
autism now accounts for 45% of all new developmental disabilities
Prognosis?
Two major lifetime studies:
Autism: 90% of adults unable to work, unable to live independently, < 1 social interaction/month
Asperger (50% with college degrees):Similar prognosis – social skills, limited use of intellectual abilities
Grim prognosis if untreated, but many treatments now available, and there is MUCH more hope
Autism is TREATABLE!
Many children now greatly improve, and some even recover, due to evidence-based behavioral and/or biomedical interventions, primarily:– Behavioral Therapies– Biomedical Therapies
Behavioral therapies• ABA – most widely accepted/implemented –
evidence based – well documented results• Appropriate for full-onset
autism
“Behavior is determined by its consequences.”
B.F. Skinner
Applied Behavior Analysis (ABA)• Pioneered by Dr. Ivar Lovaas at UCLA in the 1960s.• Research study (1987) evaluated 19 young autistic
children ranging from 35 to 41 months of age. Children received over two years of intensive, 40-hour/week behavioral intervention by trained graduate and undergraduate students.
• Nearly half of the children improved so much they were indistinguishable from typical children, and they went on to lead fairly normal lives.
• Of the other half, most had significant improvements, but a few did not improve much.
Social Stories
• Use simple narratives to teach social competencies
Structured Social Settings
• For higher-functioning individuals, teaching social skills in structured social settings can be successful– Social groups: target perspective-taking, listening,
turn-taking, conversation– “Constructive application”: work with peer on e.g.
Lego task, with roles of “engineer” and “builder”– Peer partners
AFFECTIVE COMPUTING Rosalind Picard, MIT
Leveraging Systemizing
• Persons with ASC are often extreme systemizers
• Systematic approaches to teaching empathy can be effective
• Key obstacle: detecting clues to others’ affective/cognitive states
• Affective computing: highlights external indicators of affective/cognitive states
Affect Sensors• Expression glasses
– Discriminate positive from negative expressions• Galvactivator
– Skin conductance level to glowing LED level• StartleCam
– Weable camera records when user aroused• Physiological monitors
– Heart rate, breath rate, blood presure, skin temperature
Affect Recognition & Learning• “Mind reading”: computation model of fusing top-
down (context) and bottom-up (e.g. expression) information
Technologies that Enhance Empathizing
• Leverage interest of ASC people in communicating through computers– More predictable than face to face interactiion
• Affective Social Quotient project– Child sees video of person exhibiting emotion– Child asked to pick up up doll that shows same
emotion– System detects doll movement and responds
appropriately
Self-Monitoring
• Eye-contact sensing glasses• Self-cam
– Project with Groden Center– ASC person & teacher both
wear self-cam, interactive session is recorded
– Wearers review session and interact with expression-detection software at their own pace
Practicing Affect Recognition
• Current theraputic practice: have subject watch video tape of actor displaying emotions
• Improvements:– Video clips integrated into a full-fledged tutoring
system– Use video clips of
user, peers, & teacherscaptured by self-camrather than actors
VIRTUAL PEER TECHNOLOGYJustine Cassell, Northwestern University
Authorable Virtual Peer for Childen with ASD
• PAT: Play and Tell• Key features:
– Peer context, rather than teacher/student context– Personally meaningful story-telling task for
practicing language & imagination– Control & author odes, to allow the child to build
social skills from the ground up
Guidelines for Using Technology in Social Interventions
• Interventions must be highly personalizable• Systems scaffold the child – allow risk taking• Appeal of artifacts (Legos, computers) aids
success• Using roles helps children practice social
interactions• Importance of social context environment• Children with ASD have trouble transferring
social skills to new contexts – evaluation of transfer critical in evaluating a therapy
Virtual Peer
• Life-size, full body computer generated animated character
• Can share real toys and respond to child• SAM tells stories with children, sing castle that
“extends” into Sam’s world• Detects child’s speech (but not speech
recognition)• Detects child touching objects with RFID
WOZ
PAT Modes
• Child interacts with PAT as PAT tells stories• Child controls the virtual peer using WOZ
interface, to practice creating & observing different behaviors of the agent
• Child scripts new behaviors for PAT
Authoring Example
Pilot Studies
• “Tom” uses WOZ system to create a new story• “Mary” makes up a story together with the
system (being controlled by a person)• (Not in paper): Child with ASD interacts with
virtual buddy that is being WOZed by a normally developing child
Collaborative Speech Acts
Results of Pilots
• Mary engaged with virtual peer and practiced collaborative behaviors she also uses in interactions with real peers
• When PAT was controlled by another child, the child with ASD exhibited few signs of social anxiety
• Hypothesis: virtual peer authoring tools will encourage children to practice and experiment with social skills, and that these skills will carry over to the real world.
• PLAY VIDEO