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The effectiveness of autism therapy
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Transcript of The effectiveness of autism therapy
How effective is Therapeutic Design for Autistic
Children in Today’s Community
By Eliot Robert Sleep
BA (Hons) Graphic Design - 2014 ADGP34 Contextualisation
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How effective is Therapeutic Design for Autistic Children in
Today’s Community
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“Submitted by Eliot Sleep to Plymouth College of Art in partnership with the Open
University as a written research project towards the degree of Bachelor of Arts by study
in BA (Hons) Graphic Design on March 14th 2014”.
I certify that all material in this project, which is not my own work, has been identified. Signature……………………………………………………………………………
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Abstract:
Autism is a pervasive developmental disorder that affects how a person
interacts with other people. The disorder is becoming more prevalent in
today’s society due to both genetic and environmental factors. Children are
currently the most affected by autism. Therefore there must be a therapeutic
intervention that can be created to help autistic people.
With autism affecting more children that ever before (most of all boys), it
seems that our community needs to start thinking about how to help treat
autistic people.
This writing will investigate whether or not our creative community are making
effective therapeutic design. The investigation will highlight three design
examples, these being a gestural interface technology, an environmental
design index and a humanoid robot technology. After exploring these designs
the results will suggest what people have done, are doing and will be doing to
help autistic people.
The results show that these examples of therapeutic design are in fact
effective. The gestural interface technology proves to be an effective asset for
an autism care centre in the US. The environmental design index has become
an international reference for architects and carers. Furthermore the
therapeutic robot is providing autistic children with a comfortable way to
communicate.
The implication of these results is that effective design is being created and
that there are therapeutic solutions still being developed that can potentially
change autism therapy forever.
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Contents: Section Page Number
1
Acknowledgements 5
2 Introduction
6 - 8
3 Gesture-based Technology
9 - 16
4 Therapeutic Environment Design
17 - 22
5 Future Technologies
23 - 27
6 Conclusion 28 – 30
7 Bibliography 31 - 35
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Acknowledgements:
I am thankful for the guidance and support of my contextual tutors Maddy
Pethick & Paul Singleton. Maddy’s support during the early stages of my
dissertation research was truly helpful and gave me direction I needed. Paul
was able to guide me at a much later part of the writing, which aided me in
creating my final version of the dissertation.
I would like to thank family and friends that have taken the time to support me.
Whether it was informative conversation or reading through pages of my work,
it was a great aid to me and I am grateful.
Finally I would like to thank Kelly Shorland. Her interview provided me with
valuable information that has helped me with all of my current projects.
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1. Introduction:
Pervasive developmental disorders are becoming more common in todays
society (Volkmar, 2005). There are many variations of these disorders; the
most common are autism and Asperger syndrome, both affect the person's
ability to cope with everyday life (Nguyen, 2006). This essay will focus on
autism and analyse therapeutic design available for autistic children. It will
question whether the community is doing enough to assist people with
disorders and if so what the therapy is capable of achieving.
The National Autistic Society (NAS) states that more than 700,000 people
suffer from autism in the UK alone. The society also states that autism
presents itself within the first three years of a person’s life, meaning that
children are currently the most affected by this disorder (National Autistic
Society, 2014). Prevalence studies in the USA have shown that there has
been a 210% rise in the amount of people affected by autism between 1987
and 1998 (Hollander, 2003).
“A mental disorder characterized by severely abnormal development of social interaction and of verbal and nonverbal communication skills.” – Stedman’s Medical Dictionary (2000)
The medical definition proceeds to explain that autism effects social
development in three main areas, interaction, communication and
imagination. This means that being involved in social interaction can cause
autistic people severe anxiety and stress. The disorder is part of a spectrum,
meaning that the effects can vary between people; hence some people are
able to live relatively normal lives, while others need full-time, specialist
support (Stedman, 2000).
This writing will highlight three examples of therapeutic design, those being
gesture-based technology, environmental optimisation and future innovation.
These projects will support this investigation by showing how they are
beneficial towards autism therapy. By analysing three examples of design
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there will be trends that appear in multiple studies, thus showing the
limitations and benefits of current therapeutic design.
The importance of this factor is due to the amount of people that are currently
suffering from this condition. Baird et al. studied children in South Thames,
London in 2006. The investigation shows the prevalence rate was 38.9 (per
10,000), which was the highest rate to date. The population targeted was over
56,000, meaning that the results were likely to be exceptionally valid (Amaral
and Dawson et al., 2011).
The key research used in this investigation will include an interview with
autism specialist Kelly Shorland, creator of the Auty Not Naughty campaign.
Other research will include studies and references from local libraries and the
Internet.
The term therapeutic design relates to all forms of design that can be
beneficial towards the autistic community. This can be in the form of
technology, product design, architecture and other concepts that undergo a
design process. This was the boundary for the studies that are referenced.
The first section will analyse gesture-based technology. This relates to the
different technologies that allow interaction via movement of the users body.
While this type of technology has been available for some time now, only
recently have specialists began customising the experience for autistic
therapy (Felicia, 2012). The Xbox Kinect gaming console will be the main
technology investigated during this part.
This essay will then progress into the examination of therapeutic environment
design. This consists of the architectural design quality in order to create
buildings suitable for autistic people. These environments can come in the
form of schools, classrooms, living quarters and more. Until recently there
wasn’t a specific way of indexing how this kind of work was created, meaning
the quality was far from beneficial (Nguyen, 2006). This section will study the
autism-based design index created by Dr. Magda Mostafa.
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The final part of this investigation will analyse future technologies. This relates
to any design concepts for autistic people that are enduring development. The
technology examined in this section is the ASK NAO. The NAO is a robot that
can encourage autistic children to take part in social interaction (Joubert,
2012).
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2. Gesture-based Technology:
Autistic children who suffer from these mental disorders are now able to
practice social interaction and stimulate their brain using something they love,
technology (Craddock, 2003).
"We have heard from many parents about how much their children enjoy mobile devices like the iPad, and how it is helping with learning and communication." – Andy Shih, senior vice president of scientific affairs at Autism Speaks in New York City (2013)
Shih proceeds to explain how these devices are being researched currently
so specialists can understand the impact they are having on autistic children
and their families. These hands-on devices range from the small iPod Touch
to larger games consoles that can recognise the movement of the whole
body. With new technology becoming available to schools and autism
specialist centres, there are new ways to encourage children to interact with
each other and stimulate brain activity (Mintz and Gyori et al., 2012).
The Xbox Kinect is one of the consoles that allow physical gestures to be
used to interact with a gaming experience. Microsoft created the Kinect, which
is a camera and sensor combination that allows the technology to recognise
physical movement (Park, 2012).
Despite Nintendo’s Wii being a huge success in 2006, the Kinect service
allows a much more refined experience without the need for any controller.
This is labelled a limitation for autistic children due to the combination of
buttons and movement. The Kinect technology allows players to use purely
physical movement to control the whole Xbox interface. Whether it navigating
the main menu or actually playing a game, the users interact using only their
body (Park, 2012).
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“What surprises me most is the stories I have heard from people…” - Alex Kipman, general manager of incubation for Microsoft's interactive entertainment business (2011)
Kipman proceeds to explain that a mother of an autistic child told him of the
delight she experienced because of this Kinect system. He says that the
technology was bought for an older sibling of the autistic child, who because
of autism had never interacted with technology or relatives unless it was
important. However when confronted with the Kinect system, the autistic child
began playing with others. Kipman used this story during a news interview to
emphasise the Kinect’s effectiveness (Tu, 2014).
An autistic care centre in the USA has started to utilise this technology in their
struggle to help treat autistic children. Lakeside Centre for Autism has
implemented the Xbox Kinect feature into their learning schedule and has
received surprising results because of it (Kagarise, 2012).
The Centre has become internationally recognised for the way it deals with
stimulation tasks for Autistic children. The story of the success with Kinect has
been covered on CNN news and has been included in multiple newspapers,
as well at being featuring on Microsoft’s Kinect website (Kagarise, 2012).
The Lakeside Centre for Autism was founded in 2002 and has helped over
800 families by treating the autistic tendencies of their children. The centre
holds 1700 appointments a month in hope to consult as many people affected
by autism as possible (Kagarise, 2012). The CEO, president and founder of
the centre - Dan Stachelski - explains his own interpretation of autism and the
perks of using technology like this in a video publication created by Microsoft.
“If you could imagine having your hands tied, having a blindfold over you and having tape over your mouth, that’s what these kids feel…” – Dan Stachelski, CEO, president and founder of the Lakeside Centre for Autism (2011)
The interview with Stachelski helps to suggest what the benefits of using the
Xbox Kinect can be. He begins to explain some of the learning outcomes and
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treated characteristics that he was beginning to see when they implemented
the Kinect. During the interview he mentions that the gesture-based learning
stimulates problem solving skills, coordination, enthusiasm, participation, peer
interaction, eye contact, turn taking and increased general social activity (The
Kinect at Lakeside Centre for Autism, 2011).
"In many cases, researches have found, autistic children easily interact with an onscreen avatar that mimics their motions - the game world is more predictable and less threatening than real life." – Dan Stachelski, interview with USA Today (2012)
It is clear that the interactive part of this technology is what makes it so
effective with autistic people (Kientz and Goodwin et al., n.d.). Stachelski’s
claims that the Kinect experience is so natural and fun that it distracts the
children from the factors that normally restrict them socially. He suggests this
is why the console is being so successful with children’s learning, and why it’s
branching out to more schools and therapeutic centres (The Kinect at
Lakeside Centre for Autism, 2011).
The benefit to using the Kinect for autism therapy is how it’s more interesting
to children than other forms of therapy. Therapists from the Lakeside Centre
are getting results from this system that they haven’t been able to achieve
ever (examples provided later). This is all supported by other helpful
characteristics, the cheaper price and easier configuration (Smith, 2013).
“A student playing a Kinect game for a few moments moved his arms up and down in unison for the first time, something our therapist was trying to do for six months." – Stachelski (2012)
While the Xbox Kinect’s success at Lakeside may not allow us to generalise
the fact that all activities on the Kinect are therapeutic for autistic children. The
system encourages more than just social interaction; Kinect can have players
running on the spot, jumping and swinging their bodies in order to complete
game objectives (The Kinect at Lakeside Centre for Autism, 2011).
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This moves the investigation onto another of this innovative technology;
Autism has been known to limit the speech, communication and physical
strength as well as general social skills (National Autistic Society, 2014).
Fortunately specialists at Lakeside have been able to notice growth in these
areas as well during tasks on the Xbox Kinect (The Kinect at Lakeside Centre
for Autism, 2011).
The first specialist, Vina Sargent, a speech language pathologist has been
able to use this system to target therapeutic goals in the children’s language
skills (The Kinect at Lakeside Centre for Autism, 2011). Autism’s effect on
language can cause many common deficiencies, these can be:
Difficulty understanding communication: In some cases difficulty can slow the
communication process as well as limit how well the autistic person can
respond. This has a negative impact on communication with peers, hence it
will be reflected in social confidence (Amaral and Dawson et al., 2011).
Difficulty imagining: This is the struggle that autistic people undergo when
trying to picture life from another perspective other than their own. This is
reflective in their lack of care for others both physically and socially (Amaral
and Dawson et al., 2011).
Difficulty understanding behaviour: This is the lack autistic people understand
physical behaviour, such as body language. They are unable to pick up on
physical communication such as eye contact, posture and hand gestures.
This again has a negative impact on how autistic people view social
interaction (Amaral and Dawson et al., 2011).
Difficulty with pronunciation: This is common within the autism spectrum.
There are many different ways saying words can be difficult for autistic
children. This can be speaking through the nose, the lack of tone in the voice
(Robotic Sound), repetition of sounds and sometimes a high-pitch sound
rather than words (Amaral and Dawson et al., 2011).
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The Lakeside Centre for Autism’s therapy targets all of these areas in their
curriculum. Language specialist Vina Sargent states that all of these areas of
the disorder are positively influenced when children use the Xbox Kinect, as
well as other traits (The Kinect at Lakeside Centre for Autism, 2011). Vina
explains how using something like the Kinect can have an impact on the
language therapy.
“From the time we decide that’s our idea, to the time we choose our game… everything facilitates language, answering questions, problem solving… it’s so supportive of taking turns, playing with peers and the verbal sharing of ideas.” – Vina Sargent (2012)
Vina elaborates on how fast the therapy progresses when using the Kinect.
She explains how previously therapeutic tasks would create stress for the
children and would often lack positive outcomes. The children are now willing
to communicate with each other and share experiences because they have a
more positive experience (The Kinect at Lakeside Centre for Autism, 2011).
Mari Therrien is Lakeside’s head in physical therapy. She speaks on behalf of
the whole physical unit and states how the Kinect has allowed the children to
achieve goals that haven’t been met until now.
“We tried to figure out how we could adapt our goals to fit the things that can
happen in the game…” – Therrien (2012) Therrien explains how easy it is to
link the children’s therapeutic goals to rewards in the games on the Kinect.
She mentions one particular child and describes how autism has affected him
physically. Another common symptom of autism is limited regulation; this
means the child struggles with coordinating different parts of his body
together. This child in particular has exceptional difficulty when trying to use
the left and right side of his body simultaneously, meaning tasks like playing
the Kinect should be impossible. However with the help of Kinect therapy,
Therrien has seen him coordinate his body in ways that he hasn’t ever outside
of this experience (The Kinect at Lakeside Centre for Autism, 2011).
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Therrien explains that his motivation has allowed him to push himself to the
point in which he can use his body naturally, perhaps how he would if he
hadn’t been born with autism. This child has seen exceptional progress during
the Kinect tasks, yet still lacks significant progress within other therapy. The
Kinect system has revolutionised autistic therapy by creating an interactive
gaming experience that is so encouraging it motivates children to get involved
more effectively compared to other forms of therapy (The Kinect at Lakeside
Centre for Autism, 2011).
Autistic people can also be challenged by motor planning, meaning their core
muscles are abnormally weak. Decreased strength in core, stomach, legs,
arms and back means that children will be less likely to cooperate when
asked to participate in physical activities due to the stress and pain they
encounter (Smith, 2013). Therrien explains the general effects the Kinect can
have on the children’s physical health. The children can practice physical
coordination, and the movement they undergo whilst using the Xbox has been
shown to strengthen muscles (The Kinect at Lakeside Centre for Autism,
2011).
Therrien explains that using the Kinect allows children to take part in more
physical activities thanks to the console motivating them to use basic
movement. She explains that before everyday activities proved difficult,
however now children are able to sit up straight, handwrite, and dress
themselves independently (The Kinect at Lakeside Centre for Autism, 2011).
If using technology like the Kinect can have such a positive effect on most
areas of autism its clear why the Lakeside Centre has been so
commercialised by using the console for therapy. The progress Kinect has
had with the therapy for the three main limitations of autism (Language, Social
and Physical) has been an eye-opener to how therapeutic intervention works
for Autistic children.
To conclude this first section of the investigation into whether or not there is
effective therapeutic design for autism, the essay must provide criticism about
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this gesture-based technology. There are not many studies from recognised
specialists into how therapeutic this technology can be, however it is easy to
apply studies analysing other areas of technology to this particular device and
see where there may be issues.
One issue that has been recognised is how these children react when
something doesn’t go smoothly; for example if a level is too hard the child
may become aggressive. If there are games that are too difficult for certain
children there will be the chance of stress and feud, as these children struggle
to restrict their anger at times (Attwood, 2004).
A questionable factor could be how effective were the games that weren’t
design for an autistic audience going to be. However Microsoft has answered
this limitation by releasing a Kinect Software Developing Kit. This kit will allow
programmers to implement therapeutic aspects into the system to make the
experience more beneficial (Felicia, 2012).
"Nobody thought of it as a therapeutic device, but it turns out you don't have to look very far, you don't have to scratch very deep, to go, 'Wait a minute. There's something really cool here.'” – Marc Sirkin, Autism Speaks VP (2012)
Sirkin from Autism Speaks explains how although people overlook the Kinect
as a “Therapeutic device”, it is currently being adapted into teaching
schedules as well. He lists a few examples of what the Kinect is capable of
teaching children, those being math instruction, book criticism, science,
history and geography.
A new team of specialists are using the Kinect Software Developing Kit to
create educational games especially for children with autism. The group is
made of two members of the Lakeside Centre for Autism and both an Xbox
developer and designer. They have labelled themselves The Kinetix Academy
and they plan to “Kick Autism’s ass!” by creating games that focuses on
particular tasks relative to a child’s therapy. The team are also using the
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Kinect to collect data from these institutions to try and understand more about
autism therapy.
This means that while it’s clear the Kinect system may not be the ideal
therapeutic technology for autistic children, it is a huge step forward into
gesture-based learning and has helped start a new company that aim to
create a new type of therapy that children can enjoy.
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3. Therapeutic Environment Design:
This section will investigate into how designers provide customised
environments for people with autism and how it can reduce autistic struggle in
everyday life. Creating an autism-friendly environment needs to accommodate
for the social, sensory and physical factors of the disorder, so the experience
in that space can be as smooth as possible.
A publication by the National Autistic Society highlights some of the
considerations for people when creating an autistic-friendly environment. Anh
Nguyen speaks on their behalf:
“Many people with an ASD have sensory sensitivity. This can affect one or more of the five senses – sight, sound, smell, touch and taste.” – Anh Nguyen, Area Development Coordinator for the National Autistic Society (2006)
Nguyen explains that these “over-developed (hypersensitive) or under-
developed (hyposensitive)” senses have an increased impact on how autistic
people experience certain situations. This means that environmental factors
such as background noise or temperature can cause autistic people unnatural
amounts of stress and sometimes pain (Nguyen, 2006).
These factors can be witnessed by carers and dealt with, however it seems
that actually designing a building that can cater for these autistic factors is
much more effective intervention. Until a decade ago there was difficulty in
creating spaces that could accommodate for autistic people specifically, this
was due architects lacking first hand experience of autism.
In 2003 Christopher Beaver published an article in the NAS magazine that
changed the way designers created these environments all over the world.
The article Breaking The Mould provides information that shows an innovative
way of creating an autism-friendly building without an inhumane design.
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“Talk to any carer and the ideal house from a management point of view will have easy-to-clean surfaces, robust finishes and everything as unbreakable as possible. It sounds like a brief for a prison!” - Christopher Beaver, Breaking The Mould (NAS article) (2003)
Autism can be linked with aggression, disruption and self-injury (Baer, D et al.
1968), meaning that accommodation and learning environments must
accommodate for these situations, as highlighted by Beaver in his article.
There are many factors that have to be considered when designing a building
for autistic people; hence it is easy to see why this hadn’t been done before.
“The heart of the brief cannot be written down. It has to come from an understanding of the autistic mind; the things that are comforting and give a sense of security, a feeling of space where there are places for being alone and for socialising, an easily understood geography with no threatening or over-stimulating features.” – Christopher Beaver (2003)
Beaver expresses the dedication that needs to go into creating such a
building for disorderly people. He continues by listing aspects of his building
design and saying why they are vital. One example he uses is the skylight
windows in the “steep” ceiling that allow quick ventilation and temperature
control, but don’t offer an “escape route” for stressed children. This shows
how important it would be to have knowledge of autistic behaviour before
considering starting a building design; there are many unusual circumstances
that the design must cater for (Beaver, 2003).
The project Beaver refers to is the residential accommodation for a school in
the West Midlands. Sunfield School was fortunate enough to have him
present during behavioural meetings so he could begin to understand what
the children were capable of. It is clear that unless an architect was able to
witness what the children were capable of first hand, then the design process
was going to lack sufficient support and not be as effective.
“We have spent many hours listening… talking about their children, their behavioural characteristics and generally learning about autistic spectrum disorders.” - Christopher Beaver (2003)
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Architects also have to be aware of the SPELL considerations. This is a
framework created to help facilitate the needs of people with autism. SPELL
stands for structure, positive, empathy, low arousal and links. This ensures
that all planning, design and building will accommodate for each section in the
following ways:
Structure: This relates to routine needed in autistic people’s lives to help
reduce anxiety and stress. Buildings must accommodate factors that limit
factors that will force change in routine.
Positive: This refers to having a positive attitude throughout an autistic
experience. Encouraging the autistic person is important so that they can
reach realistic goals; carers need to be patient and willing in order for them to
be helpful to autistic therapy.
Empathy: Being empathetic towards an ASD sufferer is important, as they
interpret the world differently so there after often obstacles where there
wouldn’t be when caring for someone without autism.
Low Arousal: Due to people with ASD being so sensitive to environmental
factors such as smell, light, noise and heat the proposed design needs to
show significant ways of how to reduce these factors.
Links: The final part of the criteria relates to how carers and parents need to
have consistency in communication. This can be in the form of language or
even how tasks are executed. The physical space needs to be able to be
supportive for varied forms of therapy.
Dr. Magda Mostafa created something much more spectacular than a single
building design. Mostafa created The Autism ASPECTSS™ Design Index and
was the first index created for autism-friendly environment design (Quirk,
2013).
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In 2002, whilst studying a PhD, she was asked to design Egypt’s first
educational facility for autism. During the project Mostafa realised that there
weren’t any guidelines for architects in place that could help create such a
facility. In an interview with ArchDaily, an architectural news company, she
expresses there was “virtually nothing” for her to be influenced by (Quirk,
2013).
“If you think of the primary problem of autism being understanding, coping with and responding to the sensory environment, you can grasp the power of architecture in their everyday lives.” – Dr. Magda Mostafa (2013)
Mostafa used this opportunity to create her own index that could be used as
guidelines in her exact circumstance at the time: the creation of a therapeutic
environment for autistic people. She began setting up studies that would allow
her to gather primary information into autism.
Mostafa’s studies were labelled “among the first autism design studies to be
prospective not retrospective, have a control group, and measure quantifiable
factors in a systematic way” (International Journal of Architectural
Research. Volume 2 Issue 1, 2008) therefore her supporting studies were
exceptionally valid.
After six years of research and development, the ASPECTSS index was
finished. Mostafa’s index is now used internationally and serves as a guideline
for new builds as well as being referenced by autistic facilities already
created. The benefit of this index doesn’t stop there; architects are able to
reference ASPECTSS to receive other information gathered by Mostafa’s
studies into autistic behaviour.
Mostafa provided an informative example of her study into autistic behaviour
in an interview with Autism Daily Newscast. This was how to avoid “the
greenhouse effect”; the term describes how autistic people can become too
comfortable in these autism-friendly zones. She explains that gradual
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exposure to outside environments is beneficial to autistic people, so that they
don’t become too complacent with their sensory-aware environment.
One limitation Mostafa has encountered is how funding sources overlook her
index, meaning her research is limited to a strict budget. Her interview with
ArchDaily portrays how she has struggled with funding since the beginning of
this project.
“The biggest challenge, as with most research is funding. This topic lies – where I believe much of the innovations of our future generations lie – at the intersection of many disciplines” – Dr. Magda Mostafa (2011)
Mostafa says due to there being no previous index like this, financial parties
focus on more physical factors such as staff training, curriculum design and
therapy intervention. This may not be a bad thing, however it does limit what
research can support the growth of Mostafa’s index and therefore affects the
potential of therapeutic environment design (Henry, 2011).
The importance of the index’s development should be more of a concern than
it is currently. Studies show that there are many therapeutic ways to enhance
an autistic person’s environment and that it is highly beneficial towards their
disorder. While it can be easier to fund the physical aspects of therapy, there
is no doubt funding an index that can include all forms of this therapy will be
more beneficial (Joss, 2014).
An example of environmental success is the study into sensory stimulation in
young males by Cynthia Woo and Michael Leon. This study led to the
discovery of how sensory enrichment could lead to significant improvement in
communicate and behaviour. The study involved the autistic children
undergoing various sensory stimuli everyday for six months (Irvine, 2013).
The results show that providing children with such enrichment can lead to
better health and can limit the effects that autism has on their language and
communication. Woo states “this therapy provides a low-cost option for
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enhancing their child's progress”; this means that therapy doesn’t necessarily
have to be expensive in order to provide good results (Irvine, 2013).
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4. Future Technologies:
The final section of this investigation will focus on innovative design concepts
that have been designed recently and are still being tested and developed for
autistic people. There are revolutionary technologies that, once advanced
enough, will be able to change the way we treat autism forever.
While there are no effective drug-based treatments for autism, there have
been scientific breakthroughs in how brain stimulation can return brain activity
to a “normal” state. Scientists of the EU-AIMS (European Autism Interventions
- A Multicentre Study for Developing New Medications) have been exploring
into a gene called Neuroligin-3 using tests on mice.
These tests have proven that encouraging regular brain activity in these
autistic mice can allow for a natural amount of Neuroligin-3 to be produced.
Meaning these mice are able to begin recovering from the “autism-like”
changes in the brain (Pavilion Publishing Ltd, 2013).
“We have also demonstrated proof of concept that abnormal brain activity in adults with autism can be reversed by modulating brain serotonin. We now want to see if we can translate those findings to the clinic.” - Professor Declan G Murphy, head of the Department of Forensic and Neurodevelopmental Sciences (2011)
Referencing this particular study supports the fact that in the near future,
when we have a better understanding of autism, the treatment for this
disorder will be in the form of brain stimulation rather than a drug or medicine.
Despite there being medication that is helpful for autistic people, treatment
that targets the source of the disorder is much more effective. This can be in
the form of sensory, physical and “psychoeducational” therapies (Tyrer and
Silk, 2008).
Therefore this section will study the ASK NAO, a robot that is able to interact
with autistic children in order to develop social and language skills. The robot
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was designed and created by Aldebaran Robotics; a French company that
specialises in manufacturing humanoid robots. In 2008 Aldebaran created
their first NAO (Robot) and due to the robots success, it replaced all previous
robots used for academic purposes.
Aldebaran donated NAO robots to autistic schools in 2012; these NAO were a
new generation of the robot, featuring better hardware and software. This
meant that the robots were going to be smarter and more robust, which are
the ideal characteristics for use with autistic children. One of the first sets of
NAO donated was used at Topcliffe Primary, a school in the UK that helped
teach autistic children.
"The robots have no emotion, so autistic children find them less threatening than their teachers and easier to engage with." – Ian Lowe, head teacher of Topcliffe Primary School (2012)
Lowe continues to explain that roughly a quarter of the children at the school
are autistic. The school receives specialist support and funding, which is used
to create separate environments for autistic children and allows funding for
the appropriate technology.
"They are really cute looking. Children with autism struggle with communicating with adults and with other children, but for some reason they engage with these robots.” – Ian Lowe (2012)
The NAO robot is a knee-high humanoid robot that is capable of realistic
movement and interaction. The NAO can perform life-like actions such as
dancing, comedy sketches, play football, and affectionate interaction. The
“cute” robot is present in the classroom alongside teachers and encourages
children to complete basic tasks that train memory, phonics and imitation.
Aldebaran also programmes these robots, meaning that they customise the
NAO’s characteristics to be used with autistic children. The aim of this version
of NAO is participation; the children are motivated by the robot to take part in
tasks that enhance their social interaction and language communication skills.
Due to the predictability of the robot, the children are much more comfortable
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interacting with the robot than any teacher or carer (Krichmar and
Wagatsuma, 2011).
The children are learning more with this robot, as they feel more comfotable in
the NAO’s presence. The amount of information these children have to take in
is limited and controlled, hence developers and carers can now be disciplined
with how much social information they give to the children. The autistic
children don’t have the stress of dealing with interpreting body language, eye
contact or facial expressions (Krichmar and Wagatsuma, 2011). These are
the main factors that can make social interaction difficult for autistic children
(Schopler and Mesibov, 1986).
"Children who first come into school unable to make eye contact with humans
start to communicate through the robots." – Ian Lowe (2012) While this
technology seems to be very helpful for these autistic children, there are a few
drawbacks that can affect this robot becoming the next step for autistic
therapy. The first and most notable limitation of the NAO is it’s cost - despite
Aldebaran donating robots to autism-specialist schools here in the UK– the
price is currently £15,000 for a single robot and a year’s support (Burns,
2014).
Another consideration is that the NAO needs further development, due to its
accidental discovery of it being a success with autistic children. Dr. Olivier
Joubert explains that Aldebaran stumbled across its spontaneous effect on
autistic children during a conference.
Joubert explains that Aldebaran have donated NAO robots to the USA and
UK due to the developed autistic communities there:
“The autism community is stronger in the UK and USA… French schools are generally not ready to integrate technology like NAO.” – Dr. Olivier Joubert (2012)
Joubert elaborates by saying that while there is no cure for autism; he feels
that the NAO is proving to be a step in the right direction. Joubert continues
26
by stating that Aldebaran has still labelled the NAO a “prototype”, meaning
that it is still early days for the robot and that there is still a lot of potential for
what it can achieve. The final statement by Joubert highlights that while 70
percent of children are “spontaneously attracted” to the NAO, it is still
unavailable for purchase to the general public and can only be acquired by
legitimate institutions for autism therapy (Quirk, 2013).
Although the NAO have a high cost to manufacture and support, it seems
there is a reason for this. The NAO are proving to be a link for autistic children
by introducing social factors that they are not confident enough to experience
for real. The robots are collecting information constantly and are able to
create a database including results from tasks for each individual child. They
can then link this information to the correct child in the classroom by using
either facial or voice recognition (Krichmar and Wagatsuma, 2011). Therefore
the technology needed to complete these tasks must be the reason for this
high price.
Initial research by Aldebaran into the information gathered by the NAO
suggests that when the NAO is present in a room with an autistic child, the
number of times the child interacts socially is increased by 30 percent. These
results cannot account for the success with all autistic children, due to them
being from just two prototype robots. One of which was from the UK,
Birmingham for autistic children aged 5–10, the other was used in the USA,
Massachusetts with children aged 3–5.
It is clear that Aldebaran aim to continue expanding on this innovative
technology by developing more ways NAO can influence autistic children. The
robot has recently become the most widely used humanoid robot for
academic purposes (Aldebaran, 2013).
“We visit each school every two weeks so we can get a better understanding
of how teachers use NAO in the classroom.” – Olivier Joubert, (2012)
If this commitment to the autistic community continues then the NAO may
become more customisable for autistic audiences of varied levels. This will
27
allow Aldebaran to endure work with schools and parents to have an even
bigger impact on tackling autism. Until this happens it is difficult to analyse
how effective the NAO will be for autistic children, as there is still potential for
how therapeutic the robot can be.
One final reference that reflects the NAO’s potential future success is from Dr.
Karen Guldberg, director of the university's Autism Centre for Education and
Research. She speaks to BBC about her experience with the NAO and how
she feels about it therapeutic influence.
"We are thinking creatively about how best to programme these robots to help develop the children's social interaction and communication skills." – Dr. Guldberg (2012)
This quote suggests that not only Aldebaran will be working on making these
robots more effective towards the therapy of autistic children. Researchers at
the University of Birmingham have supported the fact that the programming of
this robot is what can make the NAO a beneficial therapeutic device.
Therefore Aldebaran is working with autism specialist companies to plan how
they can continue to progress the NAO (Burns, 2014).
"If you can meet the needs of children with autism you can meet the needs of all children, when people feel safe and are motivated they learn much better." – Dr. Guldberg (2012)
This statement shows how confident Guldberg is in the progression of this
technology. Meaning that the NAO may prove to be a therapeutic learning
asset to children who don’t suffer with autism. This is an interesting concept
and it will be exciting to see what Aldebaran’s ASK NAO is capable of
achieving in the future.
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5. Conclusion:
The main aim of this investigation was to found out whether or not designers
are creating effective therapeutic design for autistic children. The three
examples of “design” included in this investigation were: architecture and
environmental design, gesture-based technology and future technology.
This study intended to highlight three studies into different areas of design
and see how they could be beneficial towards the autistic community. In order
to create a significant examination of therapeutic design, finding diverse
examples of autistic therapy was the priority. The results have shown that all
the therapeutic interventions included within this essay are currently having a
positive impact on treating autistic children.
Each example provides solutions for the different symptoms of autism. The
Xbox Kinect system provided to be a new therapeutic technique for The
Lakeside Centre for Autism. The gestural interface not only improves
children’s motor skills, it also helps motivate children to take turns and show
respect for other people. Furthermore this can be achieved for a realistic
price, thus allowing parents to begin therapy at their own natural pace (Smith,
2013).
The Autism ASPECTSS design index has proven to be a suitable reference
for architects and carers to help them create an autism-aware zone. The
index is useful to anyone who intends to help make an environment more
suitable for autistic people. The index can also be used as a reference for
parents; there are small, practical modifications that can be made in any
environment to make it safer and more comfortable for autistic children
(Nguyen, 2006).
The NAO robot had become the next step in social therapy for autistic
children. Aldebaran has created a social intervention that children can relate
to because of its harmless appearance and predictable behaviour. This is
29
allowing specialists to begin communicating with children that are
unresponsive to human interaction. The robot is still being developed, so the
NAO robot has the potential to completely remove the social barrier that these
autistic children experience. Furthermore the NAO is becoming the perfect
balance between technology and therapy. Autistic children want to undergo
“therapy” because the robot makes it fun (Griffiths, 2014).
The significance of this matter is becoming more serious due to studies
showing that autism is becoming more prevalent. While there are many
sources that suggest this could in fact be because of the better diagnostics
present today, a percentage of our population is affected by autism so there
should be support and funding in place that can be applied to autism therapy.
After investigating into therapeutic design, its clear that the one limitation that
affects current projects the most is finance. Two of the studies have shown
that with an increase in funding more could be done towards designing,
creating and executing innovative therapy. This may be a predictable
limitation, however it seems that investors often overlook these innovative
concepts because they aren’t categorised by any current definition. It seems
that creating design in new avenues intimidates these financial assets.
The main findings were that there is effective therapeutic design and that
there are designers that can potentially change how autism therapy works
forever. The kinect and NAO studies both show potential to affect autism
therapy in the future.
The Kinetix Academy will look to alter the Xbox Kinect so it can work
specifically for autism therapy. The company plan to create their own
educational and therapeutic games for autistic children.
Aldebaran is going to develop the programming of the NAO, which will allow
them to improve how the robot acts with autistic children. The company also
plan to work alongside French Cap Design in the creation of Romeo. Romeo
30
is a larger version of the NAO robot that can participate in physical tasks like
opening doors and helping people to their feet.
Therefore there is sufficient therapeutic design and more people are getting
involved with helping autistic children.
31
6. Bibliography:
Aldebaran. 2013. Aldebaran Robotics - Introduction. [Online] Available at:
http://www.aldebaran-robotics.com/en [Accessed: 10 Dec 2013].
Amaral, D., Dawson, G. and Geschwind, D. H. 2011. Autism spectrum
disorders. New York: Oxford University Press.
Attwood, T. 2004. Exploring feelings. Arlington, Tex.: Future Horizons.
BBC News. 2014. Voice analysis 'clue to autism'. [Online] Available at:
http://www.bbc.co.uk/news/health-10686912 [Accessed: 7 Jan 2014].
Beaver, C. 2003. Breaking the mould. [Online] Available at:
http://www.autism.org.uk/working-with/leisure-and-
environments/architects/breaking-the-mould.aspx [Accessed: 12 Dec 2013].
Burns, J. 2014. Robots help teach autistic pupils. [Online] Available at:
http://www.bbc.co.uk/news/education-20252593 [Accessed: 11 Jan 2014].
Craddock, G. M. 2003. Assistive technology. Amsterdam: IOS Press.
Dautenhahn, K. 2012. Design Issues on Interactive Environments for Children
with Autism. [Online] Available at:
http://uhra.herts.ac.uk/bitstream/handle/2299/1944/902099.pdf?sequence=1
[Accessed: 17 Dec 2013].
Dutton, F. 2012. Kinect could help doctors diagnose autism in kids. [Online]
Available at: http://www.eurogamer.net/articles/2012-05-09-kinect-could-help-
doctors-diagnose-autism-in-kids [Accessed: 11 Dec 2013].
Eid, N. 2013.
INNOVATION AND TECHNOLOGY FOR PERSONS WITH DISABILITIES.
[Online] Available at:
http://www.un.org/esa/socdev/egms/docs//2013/ict/innovation-technology-
disability [Accessed: 5 Dec 2013].
32
Felicia, P. 2012. Proceedings of the 6th European Conference on Games
Based Learning, 4-5 October 2012, [College Cork], Ireland. Reading:
Academic Publishing International Limited.
Greenberg, M. 2013. Autistic DC Students Use Xbox Kinect in the Classroom
| InTheCapital. [Online] Available at:
http://inthecapital.streetwise.co/2012/06/01/autistic-dc-students-use-xbox-
kinect-in-the-classroom/ [Accessed: 11 Dec 2013].
Griffiths, A. 2014. The robot teacher connecting with autistic children -
Telegraph. [Online] Available at:
http://www.telegraph.co.uk/technology/news/10632937/The-robot-teacher-
connecting-with-autistic-children.html [Accessed: 11 Jan 2014].
Henry, C. 2011. Designing for Autism: Spatial Considerations. [Online]
Available at: http://www.archdaily.com/179359/designing-for-autism-spatial-
considerations/ [Accessed: 11 Dec 2013].
Hollander, E. 2003. Autism spectrum disorders. New York: Marcel Dekker.
Irvine, C. 2013. Enrichment therapy effective among children with autism.
[Online] Available at: http://news.uci.edu/press-releases/enrichment-therapy-
effective-among-children-with-autism-uci-study-finds/ [Accessed: 13 Jan
2014].
Joss, L. 2014. Architect Creates Autism-Friendly Guidelines for Builders.
[Online] Available at: http://www.autismdailynewscast.com/architect-creates-
autism-friendly-guidelines-for-builders/3517/laurel-joss/ [Accessed: 11 Jan
2014].
Kagarise, W. 2012. Lakeside Center for Autism uses technology as treatment
tool : The Issaquah Press – News, Sports, Classifieds and More in Issaquah,
WA. [Online] Available at:
http://www.issaquahpress.com/2012/03/20/lakeside-center-for-autism-uses-
technology-as-treatment-tool/ [Accessed: 11 Dec 2014].
33
Kientz, J. A., Goodwin, M. S., Hayes, G. R. and Abowd, G. D. n.d. Interactive
technologies for autism.
Krichmar, J. L. and Wagatsuma, H. 2011. Neuromorphic and brain-based
robots. Cambridge, UK: Cambridge University Press.
Medilexicon.com. 2014. Autism -- Medical Definition. [Online] Available at:
http://www.medilexicon.com/medicaldictionary.php?t=8669 [Accessed: 3 Jan
2014].
Microsoft. 2014. The Kinect Effect - Xbox.com. [Online] Available at:
http://www.xbox.com/en-GB/Kinect/Kinect-Effect [Accessed: 11 Dec 2013].
Mintz, J., Gyori, M. and Aagaard, M. 2012. Touching the future technology for
autism?. Amsterdam: IOS Press.
Mitchell, P. 2012. Visuo-spatial abilities in autism: A review. [Online] Available
at:
http://www.psychology.nottingham.ac.uk/staff/peter.mitchell/icd%20article.pdf
[Accessed: 10 Jan 2014].
National Autistic Society, T. 2014. What is autism?. [Online] Available at:
http://www.autism.org.uk/about-autism/autism-and-asperger-syndrome-an-
introduction/what-is-autism.aspx [Accessed: 10 june 2013].
Newscientist.com. 2012. Kinect cameras watch for autism - tech - 08 May
2012 - New Scientist. [Online] Available at:
http://www.newscientist.com/article/mg21428636.400-kinect-cameras-watch-
for-autism.html?DCMP=OTC-rss&nsref=online-news#.Ux7Rjud_uH9
[Accessed: 15 Dec 2014].
Nguyen, A. 2006. Creating an autism friendly environment. London: National
Autistic Society.
Park, J. J. 2012. Future information technology, application, and service.
Dordrecht: Springer.
34
Pavilion Publishing Ltd. 2013. Research hints at a potential future treatment
for autism. [Online] Available at:
http://www.learningdisabilitytoday.co.uk/research_hints_at_a_potential_future
_treatment_for_autism.aspx [Accessed: 2 Dec 2013].
Picard, R. 2009. Future affective technology for autism and emotion
communication. 364 (1535), p. 3575. Available from: doi:
10.1098/rstb.2009.0143.
Porayska-Pomsta, K. 2011. Developing Technology for Autism: an
interdisciplinary approach. [Online] Available at:
http://www.cbcd.bbk.ac.uk/people/sam/PUC%20paper [Accessed: 5 Dec
2013].
Quirk, B. 2013. Ask NAO: Robots Bridge Gap for Children with Autism.
[Online] Available at: http://www.myschoolrocks.com/the-
magazine/features/ask-nao%3A-robots-bridge-gap-for-children-with-autism/
[Accessed: 4 Dec 2013].
Quirk, V. 2013. An Interview with Magda Mostafa: Pioneer in Autism Design.
[Online] Available at: http://www.archdaily.com/435982/an-interview-with-
magda-mostafa-pioneer-in-autism-design/ [Accessed: 19 Dec 2013].
Schopler, E. and Mesibov, G. B. 1986. Social behavior in autism. New York:
Plenum Press.
Shorland, K. 2014. Interview on autism experience. Interviewed by Kelly
Shorland [in person] Southland Park Road (Her House) Devon, 20th January
2014.
Smith, K. 2013. Digital outcasts. Waltham, MA: Morgan Kaufmann.
Stedman, T. L. 2000. Stedman's medical dictionary. Philadelphia: Lippincott
Williams & Wilkins.
Stokes, S. 2010. Assistive Technology for Children with Autism. [Online]
Available at: http://www.specialed.us/autism/assist/asst10.htm [Accessed: 5
Dec 2013].
35
Supraja Seshadri, S. T. C. 2014. iPad gives voice to kids with autism. [Online]
Available at: http://edition.cnn.com/2012/05/14/tech/gaming-gadgets/ipad-
autism/ [Accessed: 28 Jan 2013].
The Kinect at Lakeside Centre for Autism. 2011. [Video] Issaquah, WA:
Tribeca Flashpoint.
Tu, J. 2014. As people experiment, they find Kinect is much more than a
game. [Online] Available at:
http://seattletimes.com/html/businesstechnology/2016644446_kinect31.html
[Accessed: 12 Nov 2013].
Tyrer, P. J. and Silk, K. R. 2008. Cambridge textbook of effective treatments
in psychiatry. Cambridge, UK: Cambridge University Press.
Volkmar, F. R. 2005. Handbook of autism and pervasive developmental
disorders. Hoboken, NJ: John Wiley & Sons.