Robot-Assisted Therapy for Autistic Children: Comparison
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Please note this is a comparison between Version 2 by Alfred Zheng and Version 1 by Abeer Alnafjan.

Children with autism face a range of challenges when it comes to verbal and nonverbal communication. It is essential that children participate in a variety of social, educational, and therapeutic activities to acquire knowledge that is essential for cognitive and social development. The robot can engage these children in ways that demonstrate and train essential aspects of human interaction, guiding them in therapeutic sessions to practice more complex forms of interaction found in social human-to-human interactions.

  • robot
  • autism
  • therapy

1. Introduction

Autism Spectrum Disorders (ASDs) are a group of neurodevelopmental disorders that are characterized by persistent deficits in social communication and interaction, as well as restricted, repetitive patterns of behavior, interests, or activities, according to the Diagnostic and Statistical Manual of Mental Disorders [1]. ASD can manifest in a variety of ways, and symptoms can range from mild to severe. However, one common and significant challenge for children with ASD is social interaction and communication. They may struggle to initiate and maintain conversations, understand nonverbal cues, and engage in reciprocal play with peers. In addition, they may engage in repetitive behaviors or routines, which can interfere with their ability to learn and participate in social situations [2].
There is a strong tendency for traditional intervention approaches to require intensive support under the direct supervision of highly trained professionals. Many autistic individuals do not have access to professional care and amenities due to high intervention costs and/or a shortage of qualified therapists. Several interventions for children with ASD have been developed with the goals of improving cognitive ability and daily living skills, increasing their ability to interact and engage in the community, and trying to reduce symptoms. During therapy sessions, for example, assistive technologies have been used. This intervention is driven by the societal need for technological innovations that can support and improve current therapies for the increasing number of children with autism [3].
Today, a variety of assistive technology applications have been developed to assist in the treatment of autism [4], such as computer-assisted learning, virtual reality, telehealth, and robotics. For instance, Frolli et al. [5] investigated the use of virtual reality (VR) as a tool for improving social skills in individuals with ASD. The study compared emotional training using VR to traditional emotional training with a therapist and found that VR interventions can be effective in enhancing the acquisition of social skills, particularly for the use of primary and secondary emotions. The authors suggest that VR can simulate real-life situations for children to explore safely, and create environments that are difficult to experience in everyday life.
Simeoli et al. [6] propose a new method for diagnosing ASD based on motor abnormalities using a software tool that captures detailed information about children’s motor patterns through a smart tablet device. The study involved comparing the movement trajectories of 30 children with ASD and 30 typically developing children and identified autism with 93% accuracy. The study’s results suggest that this method could provide a new means for assessing young children with ASD and a starting point for rehabilitation treatments. In another example, Regaa et al. [7] examined the effectiveness of a video modeling intervention for social and emotional behavior and skills in children with ASD using a tablet PC. The study showed a marked improvement in emotional skills, highlighting the potential of video modeling as an effective technological tool for intervention and rehabilitation of children with ASD.
Robots have been used in a variety of assistive scenarios, such as meeting various human needs and assisting individuals with ASD to achieve their full potential [8]. The clinical use of social or interactive robots appears to be promising for improving the social skills of children with ASD. Humanoid robot-assisted teaching and intervention programs for children with ASD are rapidly evolving [9].
Socially Assistive Robots (SARs) are a potential strategic technology that could help support interventions for children with ASD, while Robot-Assisted Autism Therapy (RAAT) is an assistive technology application involving robots that are used to support autism therapy [8]. For RAATs to be effectively integrated into real-world treatment for individuals with ASD, they should follow current evidence-based practices used by therapists, such as Applied Behavior Analysis (ABA) [10].

2. Robot-Assisted Therapy for Autistic Children

Four topics are key to this research, namely, Autism Spectrum Disorder (ASD), Applied Behavior Analysis (ABA), Socially Assistive Robotics (SAR), and Robot-Assisted Autism Therapy (RAAT). Each of these will now be discussed in some detail.

2.1. Autism Spectrum Disorder (ASD)

ASD is a neurological and developmental disorder that typically begins in early childhood. Individuals with ASD face challenges that may affect how they communicate, interact, behave, and learn. The development of their learning, cognitive, thinking, and social skills can vary considerably from one individual to another. The National Autistic Society (NAS) categorizes them according to impairments in the following three areas:
  • Social interaction; an inability to handle or recognize their own and others’ emotions or understand social cues.
  • Social communication; difficulty in using and understanding verbal and nonverbal language. This also might cause the absence of speech or facial expressions.
  • Imagination; an inability to generalize the skills learned in a particular environment and apply them to different environments or to imagine new situations, which might cause repetitive behavior [11].
Social behavioral therapy (SBT) for ASD focuses on functional independence and quality of life by targeting the development of emotional regulation, social skills, and communication [12]. During SBT sessions, therapists face challenges in working with children with ASD who have difficulties communicating and interacting with others, display repetitive behaviors, and show little interest in social activities. SBT interventions targeting emotional regulation, social skills, and communication are based on Applied Behavior Analysis (ABA), which employs specific teaching methods to develop language, cognitive and sensorimotor skills, social interactions, everyday living skills, and address specific problem behaviors [13].

2.2. Applied Behavior Analysis (ABA)

Applied Behavior Analysis (ABA) is a type of therapy that uses principles of learning and motivation to improve social, communication, and learning skills for children with autism [2]. ABA uses a behavioral theory approach that focuses on teaching children to communicate actively and effectively, improve their social development, minimize inappropriate behaviors, develop academic abilities, and enhance their independence in ways that are tailored to each child. Research has shown that intensive and long-term ABA therapy can improve outcomes for most children with autism, including gains in intellectual functioning, language development, daily living skills, and social functioning [14].

2.3. Socially Assistive Robotics (SAR)

A robot is a programmable machine capable of carrying out complex actions automatically [15]. Robotics is a rapidly growing field with applications in education, healthcare, environmental work, engineering, and manufacturing, among others [14]. Robots may be pre-programmed, semi-autonomous, or fully autonomous, depending on their degree of autonomy [16]. Socially Assistive Robotics (SAR) is an area within the broader field of Human–Robot Interaction (HRI) that focuses on assisting people in social interactions. SAR aims to develop efficient interactions for therapeutic and educational contexts, including addressing the challenges faced by individuals with autism in social learning, communication, and interaction [14,17][14][17]. Four classes of social robots have been identified: socially evocative, social interface, socially receptive, and sociable robots, each with varying levels of capability for social interaction in complex environments. The higher the robot is on the list, the more capable it is of social interaction in complex environments [18]. Additionally, Choi et al. [19] found that the design of social robots can affect humans’ emotional engagement with the robots. Autonomous robots were perceived as more intelligent, while tele-operated robots were perceived as having greater social presence. The authors also discussed the implications of these findings for the design of social robots to enhance emotional engagement with humans. Despite their potential benefits, social robots face significant challenges related to user acceptance, as well as the robustness and degree of autonomy of the robot [20,21][20][21]. Srinivasan et al. [22] found that children lost interest in interacting with robots after a certain period, but their study did not tightly control and systematically manipulate individual elements of the robot (such as animate, inanimate, humanoid, and mobile) therapies. User acceptance is often related to the appearance and tactile qualities of the robot used. Researchers have identified design recommendations for Socially Assistive Robots in health and social care, emphasizing the need for involvement from all stakeholders, including robot developers, to produce appropriate social assistive robotics [23,24][23][24].

2.4. Robot-Assisted Autism Therapy (RAAT)

Robot-Assisted Autism herapy (RAAT) is an assistive technology application involving robots that are used to support autism therapy. It has been used in various fields, such as health and education, to support the developmental needs of autistic individuals, including sensory development, communication, interaction, cognitive development, social development, emotional development, and motor development [23]. RAAT is an emerging field, and there are concerns as to the efficacy of using robots in autism therapy [25]. There are currently only a limited number of studies on the efficacy of RAAT; however, research has shown that using RAAT in treatment sessions can motivate children with ASD to participate in activities. Different design features and appearances have been suggested and investigated to increase therapeutic efficiency. In studying the potential therapeutic role of robots in autism therapy, some researchers have used humanoid robots, while others have used non-humanoid robots. Giullian et al. [26] proposed a set of requirements that would help engineers design and build robots for use in autism therapy, summarized as follows:
  • Appearance requirements; visual appeal, realism, size, and shape must be taken into consideration when designing a robot. For example, a robot with a neutral-colored torso and a face with distinct features is preferable for creating facial cues. The study found that autistic children are more likely to be engaged by a mechanical or mascot-like appearance rather than something that is overly human in appearance.
  • Functionality requirements; the senses of reward, locomotion, and choice/control must be taken into consideration when designing a robot.
  • Safety requirements; the design of the robot must be safe, as the target user group is children, and this means a robust design, free from sharp edges and exposed wiring.
  • Autonomy; the robot must have a level of autonomy, using AI and machine learning methodologies to control its actions and execute them in sequence. The robot does not have to be fully autonomous, as these are not intended to replace the human therapist.

References

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