=Paper=
{{Paper
|id=Vol-2730/paper10
|storemode=property
|title=Brief review of robotics in low-functioning autism therapy
|pdfUrl=https://ceur-ws.org/Vol-2730/paper10.pdf
|volume=Vol-2730
|authors=Daniela Conti,Grazia Trubia,Serafino Buono,Alessandro Di Nuovo,Santo Di Nuovo
|dblpUrl=https://dblp.org/rec/conf/psychobit/ContiTBNN20
}}
==Brief review of robotics in low-functioning autism therapy==
https://ceur-ws.org/Vol-2730/paper10.pdf
Brief Review of Robotics in Low-Functioning Autism
Therapy
Daniela Conti 1[0000-0001-5308-7961], Grazia Trubia 2[0000-0003-4124-0839],
Serafino Buono 3[0000-0002-3786-3323], Alessandro Di Nuovo 4[0000-0003-2677-2650], and
Santo Di Nuovo 5[0000-0002-3786-3323]
1,4
Sheffield Robotics, Sheffield Hallam University, Sheffield, S1 1WB, UK1
{d.conti,a.dinuovo}@shu.ac.uk
2,3
Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina (EN), Italy
{gtrubia,fbuono}@oasi.en.it
5
University of Catania, Via Teatro Greco 84, 95124 Catania, Italy
s.dinuovo@unict.it
Abstract. In the last decade, numerous research studies showed that robots can
be suitable assistants in the care and treatment of children with Autism Spectrum
Disorder (ASD). Still, more investigation is required to fully assess the introduc-
tion of robotics assistants, as the majority of the studies was limited in numbers
of participants and scope, e.g. by considering stand-alone interventions, High
Functioning Autism (HFA) individuals only, and provided limited objective re-
sults, i.e. usually the success is evaluated via qualitative analysis of videos rec-
orded during the interaction.
In this paper, we present a brief review of the experience on integrating robot-
assisted therapy also in the treatment of children with Low-Functioning Autism
(LFA) which is the most common case (>70%). Studies described here investi-
gated the integration of a robot-assisted intervention in the training, and the re-
sults encourage the use of a robotic assistant also in LFA. Based on this experi-
ence, we suggest that current robotic technology is still at an experimental stage
and require to actively involve all stakeholders in design of new robotic systems
that can successfully account for the peculiar characteristics of ASD individuals.
Keywords: Socially Assistive Robotics, Low-Functioning Autism, Intellectual
disability, Autism therapy.
1 Introduction
Intellectual Disability (ID) and Autism Spectrum Disorders (ASD) are main neuro-
developmental disorders with a frequency of 2-3% in western countries [1]. ASD is a
Copyright © 2020 for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC
BY 4.0).
2
general term for a “spectrum” of behavioural phenotypes including deficits in commu-
nication and social interaction, and restricted and repetitive behaviours, interests and
activities [2, 3], and it usually manifests in the first three years of the developmental
period. ASD can often comorbid with some level of ID [4], in fact it has been reported
that 70% of children with ASD have an Intellectual Quotient (IQ) below 70 [5], which
encompasses four ID levels: “mild”, “moderate”, “severe” and “profound”, character-
ized by significant limitations in both intellectual function and in adaptive behavior
before the age of 18 [5]. This condition is often referred to as Low-Functioning Autism
(LFA - IQ lower than 70), in contrast to High Functioning Autism (HFA - IQ higher
than 70) [6]. Specifically, LFA individuals are characterised by significant limitations
in both intellectual functions and adaptive behaviour i.e. in problems with reasoning,
learning or problem-solving as well as communication and social skills difficulties [7].
This mixture of conditions requires therapeutic interventions more challenging and,
therefore, technological aids could be useful to help therapeutic work aiming at obtain-
ing an adequate quality of life [8].
2 Socially Assistive Robotics and Low-Functioning Autism
Considering the complexity of LFA it is appropriate to use a multi-modal therapeutic
intervention that can be adapted to the individual’s needs to obtain the best benefits
from the treatment [9]. Researchers have shown that some individuals with ASD prefer
robots to humans and that robots generate a high degree of motivation and engagement
in individuals who are unlikely or unwilling to interact socially with human therapists
[10].
It has been shown that the persons with ASD are attracted to mechanical and elec-
tronic devices [11]. Consequently, it would seem that a robotic device could be a useful
tool when a therapist is trying to help, teach, communicate, or interact with persons
with this neurodevelopmental disorder. Also, in children with ASD, the complexity of
emotions expressed by persons may be the reason why they experience difficulty un-
derstanding gestures or facial expressions, resulting with them shying away from
friends and the world around them [12]. The robotics, especially humanoid robots, in
children with ASD can be used to invoke interest and engagement [13] or as a diagnos-
tic tool [14], that should always be included in the therapeutic plans [15]. Duquette et
al. [16] showed improvements in affective behavior and attention-sharing with co-par-
ticipating human partners during an imitation task solicited by a robotic doll. Further-
more, the simplified social behaviour of robots may be especially beneficial for indi-
viduals with ASD who face difficulty in perceiving and expressing emotions, under-
standing gestures or facial expressions, because practicing communication can be less
intimidating with a robot than with a human [17, 18].
2.1 Applications of robotics in the treatment of children with LFA
Current social projects increasingly show robots as an instrument for the enhance-
ment of the care already in place, rather than a replacement of the human caregiver,
showing numerous benefits of robot assistants in the treatment of children with LFA
3
[19–21]. The aim of using robots in clinical practice is to reduce the therapists’ work-
load by allowing the robot to take care of some parts of the intervention. This includes
monitoring and recording the behaviour of the children, engaging them when they are
disinterested, and adapting the appropriate levels of treatment [21] while allowing the
therapist to plan the required intervention for every child [22].
However, as most of the studies focused on ASD individuals without ID ignored to
analyse comorbidities, using this approach we could possibly address one of the current
gaps between scientific research and clinical application [23]. While qualitative analy-
sis is frequently considered in previous research (e.g. via analysis of video-recorded
human-robot interaction), the quantitative analysis that can be made through the use of
standardized psycho-diagnostic tools is often missing [23, 24].
In a recent study with five children with LFA the NAO robot was able to attract the
children’s attention, keep each child engaged during interaction and hence give positive
impact to the children’s communication behavior. Specifically, children with ASD and
moderately impaired IQ (from 40 to 54) are receptive to robot-based intervention [12].
A study with three children with ASD and ID suggests that the robot can be effec-
tively integrated in the ASD therapies currently used in the treatment. The results en-
courages the development of effective protocols in which the robot acts as a mediator
between the child with ASD and humans and suggests some research avenues for focus
in the future [25].
In a recent study with six male children with LFA (Fig.1), the robot-assisted therapy
was included in the TEACCH (Treatment and Education of Autistic and related Com-
munication handicapped CHildren) method among the standard activities, which are
identified via a specific visual schedule [15]. The TEACCH approach is based upon
cognitive-behavioral and social learning principles and aims to design environments
that meet the unique learning style needs and preferences of the ASD population [26].
Fig. 1. Example of session with the NAO robot in LFA.
Research suggests that children with LFA and moderately impaired intelligence
show good response to robot-based intervention [12]. However, while other studies
with children with LFA “mild”, “moderate”, and “severe” levels confirm an signifi-
cantly increased imitative level of the children while acquired the capability to perform
new tasks, this does not happen with “profound” level of ID in LFA. In this level, alt-
hough the participants did not learn any tasks and show a modest (5%) increase in the
gross motor imitation of the robot. In this regard, their behavior with the robot was
comparable to that performed with other human beings [15].
4
3 Conclusion
Clinical studies show that the robotic-assisted therapy can be successfully integrated
into the standard treatment of children with LFA when the interaction is adapted to the
specific individual level. Results confirm that the robotic-assisted therapy can be suc-
cessfully integrated into the standard treatment of children with LFA.
Indeed, various studies suggest that care and treatment should be tailored to the
needs of the patient. It is well known that, with the same diagnosis, each condition is
unique and therefore should be treated in a personalized way. The principles of reha-
bilitation indicate how important it is for the therapists to consider the patient's strengths
and weaknesses to achieve the best results in therapy [9]. Experimental results indicate
that the personalization of intervention can significantly improve the utility of an edu-
cational or assistive human-robot interaction [27].
In conclusion, children with LFA are often difficult to treat because they need con-
stant support to carry out usual activities [28], and current robotic technology is still at
an experimental stage and may require complex systems to be deployed [29]. Therefore,
explorative studies of new therapeutic approaches involving robotics are generally fo-
cusing on a small number of cases easier to manage, e.g. without comorbidities (see
[30] for a survey). These limitations have generated doubts and scepticism among the
practitioners about the actual applicability of the robotic-assisted therapy in the stand-
ard treatment [19, 31]. The research findings based on quantitative assessment and
monitoring are crucial to establish a solid ground for the utilization of the humanoid
robot as a mediator with the caregiver, also in the treatment of children with LFA.
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