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Friday, March 20, 2009

iPad -- a new tool to help treat autism?

Leo has plenty of toys, including this circular balance
beam, but nothing tops the iPad. (Photo by Kelly Nicolaisen)
iPad is probably the most popular high-tech toy on the market right now. But can it be more than just a toy and be useful in other ways, such as helping treat children with autism? The answer is a definite yes.

You might wonder why I am all of a sudden interested in the subject of treating children with autism. Actually, I have been a member of the TiLAR research group working on using assistive robotics technology to help treat children with autism. TiLAR stands for Therapist-in-the-Loop Assistive Robotics.

Recently, I came across an article named iHelp for Autism from SF Weekly. The article told multiple stories of how an iPad helped improve the behaviors of Leo, a 9-year-old artistic child, the son of Shannon Rosa. Shannon had won the iPad from a school raffle, and in the following months, she was pleasantly surprised again and again by how the iPad changed Leo's life and her own, to a better effect, that's of course.

It is important to note that the word autism could mean a spectrum of psychological conditions, that's why the more formal name Autism Spectrum Disorders (ASD) is frequently used. Despite the wide spectrum, autistic children display common symptoms of deficiency in social interactions and communication and severely restricted interests and highly repetitive behavior.

So what are the benefits of using an iPad? Here I'll list some just off the top of my head:
  • It looks slick and cool (remember it won't be like that forever).
  • It's really a platform, so you can run all kinds of things on it like songs, movies, games, maps, etc.
  • You can select things, move things, draw things with your fingers -- a multitouch interface -- and you have plenty of space to do it (unlike an iPhone). The interface is also relatively simple and intuitive, so it doesn't take a lot of time to learn or explore.
  • It's relatively lightweight and is battery powered, so you can carry it with you everywhere you go.
Of course an iPad also has disadvantages:
  • It's expensive.
  • It's fragile (especially the screen).
  • Battery life is not great.
  • Apps have to be approved by Apple (but there's always iPad like devices running Android).
Now when we give an iPad to an autistic child, what could be good?
  • Because an iPad is a fashionable item (at least for now), it would encourage the child to participate in more social activities while holding an iPad -- confirmed by a study.
  • The intuitive and simple finger-controlled interface is attractive to autistic children because they can easily identify things and things are predictable. The finger touch interface is also great to encourage the autistic children to practice manipulate things with their fingers, improving motor skills that are normally problematic for autistic children.
  • Because an iPad can run many games and apps, autistic children are more prone to play educational games on an iPad, so there's more opportunity to learn while feeling good about it.
  • The portability of iPad allows the child to use it anywhere the child wants, and movie playing capability can let the child watch instructional demonstrations -- termed Video Modeling -- frequently and in various locations.
  • An iPad can also act as a communication tool. For example, an autistic girl used an iPad to tell her mother where she'd like to go shopping.
So what could go wrong when we give iPad to an autistic child?
  • One bad tantrum, there goes the screen, and it's expensive!
  • If the child is over-reliant on the iPad as a communication tool, once the battery is dead, the child might go berserk.
As I mentioned earlier, autistic children tend to behave differently from social norms and have problems communicating with others. It seems that we ought to look at three different dimensions when we think about treatment. The first dimension is deviation from social norms. The child can behave more like social norms after treatment or deviate further away. The second dimension is the ability to communicate. A treatment might help the child to communicate better or make it worse. The third dimension is the ease for caregiver. A treatment can change the child's behavior so it's easier for the caregiver to take care of the child. It might also make the care-giving more demanding/challenging.

Ideally, we'd like the treatment to move the child positively on all three dimensions, but that might not always be true depending on the kind of treatment we provide and the kind of tool we use. Some people might also want to settle at different spots in this three-dimensional space. They'd accept a solution that improves the child's ability to communicate and makes the caregiver's life easier while the child's behavior might deviate further away from social norms. Therefore, one important question to ask is: Where in the 3D chart do you want the autistic child to be? For example, if an autistic child always uses the iPad to tell you what he wants, is that what you want? If the answer is no, then the iPad might actually have done harm instead of good.

Are there other creative ways of using an iPad to help support treating children with autism? The article mentioned that some researchers are actually using iPad to help collect physiological data of the autistic child on-the-go and maybe play a soothing sound/music if they get tense. I'll throw out some ideas of my own just for brainstorming purposes. If you can think of any, feel free to tell me in the comments section.
  • Since we use a robot to assist the therapist in clinic sessions, the iPad can be used by the therapist before the session to program robot behaviors.
  • We can put a virtual character in the iPad to encourage the child to imitate the character's moves. The virtual character can also encourage the child for certain behaviors such as turn taking with the therapist and the robot. The therapist can act as the sensor and use wireless devices to "inform" the virtual character if the child has performed the desired behavior.
  • Maybe let the child use the iPad to choose what games to play with the robot and/or the therapist?
  • The child can also use the iPad to tell the robot what to do (different sequences of moves). Later the child will be required to not only choose buttons on the iPad, but also speak out the request, for the robot to actually perform the moves. Either the robot will try to recognize the speech, or the therapist can be the sensor/processor and issue the approval command instead.
  • The robot might also touch the iPad to do things. We just have to make sure the robot doesn't damage the delicate screen.

Picture of the Day:

TiLAR research group's robot Troy in the middle of a clinical
session with a therapist and a kid.