1. Technology to support psychosocial development and self-management in persons with autism-spectrum disorder Henry Kautz Machines of Loving Grace Spring 2008

2. 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

3. 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

4. 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

5. 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

6. AUTISM SPECTRUM DISORDER

7. 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

8. 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)

9. WHAT ARE THE SOCIAL INTERACTION CHARACTERISTICS OF TYPICALLY DEVELOPING CHILDREN?

10. 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)

11. WHAT ARE THE SOCIAL INTERACTION CHARACTERISTICS OF HIGH-FUNCTIONING AUTISTIC CHILDREN?

26. Deficit in “Theory of Mind” - from The Curious Incident of the Dog in the Night, by Mark Haddon

27. e)Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: 1.social interaction 2.language as used in social communication 3.symbolic or imaginative play D. The disturbance is not better accounted for by Rett's Disorder How do they diagnose full- syndrome?

28. 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)

29. 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.

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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.

38. Social Stories Use simple narratives to teach social competencies

39. 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

40. AFFECTIVE COMPUTING Rosalind Picard, MIT

41. 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

42. 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

43. Affect Recognition & Learning “Mind reading”: computation model of fusing top- down (context) and bottom-up (e.g. expression) information

44. 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

45. 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

46. 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, & teachers captured by self-cam rather than actors

47. VIRTUAL PEER TECHNOLOGY Justine Cassell, Northwestern University

48. 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

49. 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

50. 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

51. WOZ

52. 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

53. Authoring Example

54. 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

55. Collaborative Speech Acts

56. 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.

57. PLAY VIDEO