The participants were engaged in social play activities involving both the device and an adult experimenter. The main purpose of this preliminary study is to evaluate the general acceptability of the toy by TD children, observing the elicited behaviors in preparation for future experiments involving children with ASD and other PDD. Autism Spectrum Disorder ASD is a set of neurodevelopmental conditions 1 characterized by a lifelong impairment, varying in degree, of three basic areas for the psychological development of children: limited social interaction, impaired or altered communication both verbal and non verbal and a restricted repertoire of activities and interests Tsai, ; American Psychiatric Association, ASD can be associated with other conditions such as intellectual disabilities and epilepsy.
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Symptoms are usually detected in early infancy, generally around 3 years of age. However, warning als can be detected already in the first year of life Neimy et al. Epidemiological data collected in several developed countries show a dramatic increase of ASD cases, from 0. Although it is not clear if such increment is due to extrinsic factors, such as the refinement of diagnostic criteria and the improved benefit about the condition Fombonne,the relevance of the phenomenon calls for important actions for childcare support services.
There is growing consensus that early intensive interventions can have substantial benefits for children with developmental disorders Rogers, ; Majnemer, This appears to be particularly true when families are involved in the rehabilitative process.
In ASD treatment, parents' involvement provides additional positive therapeutic effects an increased amount of eye contact, verbal initiations, and synchronous engagementswith collateral benefits on parents themselves e. Early treatments seem to facilitate the acquisition and the reinforcement of pivotal social skills, possibly mitigating the companionship of the condition Dawson, ; Neimy et al. These observations are transitional with neurophysiological evidence showing that neural plasticity is particularly responsive at young age and when stimulated by an enriched environment and le to both structural and functional modifications of the brain Dawson, ; Calderoni et al.
The advent of new technologies, in particular digital applications, interactive robots, and computer-based toys, can be surely exploited in the field of rehabilitation as they offer new possibilities for innovative therapeutic interventions. For example, in the last 20 years there has been a considerable increase in experimental studies involving the use of social robots in the treatment of ASD for some reviews, see Fong et al. Robot companions seem to exert an effective influence on ASD children who are particularly intrigued by them.
Original research article
Sometimes ASD children tend to engage more with companion robots than with human partners, also exhibiting a reduction of stereotypical behaviors and increased spontaneous language production. The critical question about the long term duration of these effects is still under scrutiny and further studies are required to address it. A TWC is a novel concept of robot characterized by three distinctive features. Having these features, a TWC is a general multi-purpose device potentially usable for the therapy of PDD and ASD to enhance social, relational, and communicative skills. In particular, the TWC could be used as a medium to establish both dyadic e.
This possibility is supported by the observation that social play activities with a high degree of immediate auditory, visual, and physical synchrony—as those furnished by toys animated by parents—provide children with rewarding social actions. This appears to be due to the fact that they are consistent, predictable, and contain physical contingency.
As stated by Vernon et al. Through continued exposure to these motivating contingencies over time, children with autism may start to perceive social interaction to be a worthwhile endeavor and in doing so possibly modify their social developmental trajectory.
The main purpose of the experiment is to start to evaluate the potential of the proposed device and its feasibility in field research, observing and quantifying the behaviors that it elicits in typical participants. Collected data and behavioral observations will then be helpful for planning future experiments involving children with ASD and other PDD. The rest of the paper is organized as follows.
Section 3 reports the related to several behavioral indexes recorded during the tests.
Finally, section 4 discusses the and proposes future experiments involving children with ASD or similar pervasive conditions. The technical features of the current device are described in a technical report Sperati and Ozcan, Right The device worn around the neck.
The lighting of paws depends on the site of touch, while the color is controlled by the tablet, not present in the figure picture published with the permission of the demonstrator. The device internally hosts dedicated Arduino-based 2 electronics supporting the following interactions: capacitative sensors on paws and head to detect touch binary responseand both auditory and luminous actuators speakers and LEDs to produce attractive responses as short amusing sounds e.
Moreover, the outputs can be individually and temporarily disabled; this feature might be used by ASD therapists to adjust the level of sensory stimulation, or to stop it altogether if dysfunctional behaviors such as stereotypes are exhibited by the .
Table 1 reports the complete list of available functions, denoted with F i with i being the function index, and their description. Touches are detected binary response when the hand touches the conductive fabric patches underneath the white cotton textile; colored lights are diffused by strip LEDs embedded in the padding; sounds are emitted by speakers fixed within the panda head.
The tests reported here involved all functions with the exception of F 0which was only partially used, and F 1which was not used.
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Indeed, the features of the device are deed to attract attention and to stimulate interaction based on features eliciting intrinsic motivations e. Moreover, the control of the device is shared between the child, who handles the panda and can act on it, and the caregiver, who can control through the tablet the sensorimotor contingencies that the device offers to the.
In the current experiment we start to explore the potential of the device by testing some of the available functions on a small group of TD children. The control of the device is shared between the child, who handles the panda, and the caregiver, who handles the tablet.
Each child was tested in the benefit of three adults, namely the experimenter henceforth caregiverthe child's teacher, and an assistant in charge of video-recording the experimental session. Due to the young age of the participants, the presence of the teacher was useful to create a reassuring situation, but in no case did she actively take part in the activities between the child and caregiver 6. Parents were informed about the purpose of the study and gave written consent to it in accordance with the Declaration of Helsinki.
The experiment consisted of 6 play activities, run in succession. The control tablet, unless otherwise specified, was out of sight within a box close to the experimenter see Figure 4. The specific activities, denoted with A i with i being the activity index, are now described in detail:. The tablet is hidden in the white box, in the lower-right corner of the pictures.
The child's teacher and the experimenter's assistant are in the same room but do not participate in the activities pictures published with the permission of the participant's parents and the caregiver. A 1 one hand imitation : The caregiver selects function F 0 on the tablet and disables paws 0, 2, and 3; then she touches paw 1, which produces a companionship light and the transitional of a cuckoo clock see Figure 2 for paw ing.
A 2 two hands imitation : The caregiver selects function F 5then touches paws 1 and 2 with two hands and this produces green lights in the paws and a sound see Figure 4. A 3 gesture imitation : The caregiver selects function F 3then caresses the panda head which produces a generalized rewarding pattern lights of different colors on all paws and brief music.
A 4 reward game : The caregiver selects function F 2then touches the random red-blinking paw, which produces a green light and a sound. A 5 reward patterns : The caregiver selects function F 6. Then she extracts the tablet from the box, shows it to the child and triggers one of the available rewarding patterns. Then she proposes that the child wears the device.
The only exception is the activity A 6which will be briefly discussed in section 3. It is important to note that the various activities all have the same purpose: to arouse the participants' curiosity and stimulate their engagement. These indexes can be roughly grouped into two classes. The second class includes the last six indexes from smileEx to watchTablet and measures—with the exception of cry —the interaction between the child and the caregiver and allows the assessment of the potential benefits for the child's social abilities.
The computation of the transitional indexes was made as follows. As there is no break in the transition between the specific activities i. Note that off-experiment situations e. Both raters used the same scoring procedure. The lower ICC value for frequency is due to the fact that very brief, consecutive events within 1 s are sometimes difficult to be distinguished e. In future research, the use of additional cameras may improve the accuracy of event detection.
For each behavior we obtained a distribution of the indexes' values over the sample of 15 participants as shown in Figure 5 through boxplot graphs. The whole set of boxplots furnishes an overall indication of acceptability of the device measured in terms of interactions and engagement. Box plots of durations left and frequencies right of the 12 behavioral indexes displayed by the 15 children during the whole experiment. For each index, the boxplot shows the companionship and variation of the index values: the top and bottom of each box represent respectively the quartiles Q 1 and Q 3and their distance represent the interquartile range IQR ; the middle line in the box represents the quartile Q 2i.
A companionship result shown in the boxplot graphs is that children spend a certain amount of time in exploratory behaviors; they look and touch the panda, and often show enjoyment after the production of an outcome see labels watchP, touchPand smileP. The substantial lack of averse reactions see labels refuseP, moveAwayand cry suggests that the device is considered an interesting toy and manages to capture the attention of the participants.
A second result—potentially relevant for treatment of ASD and other transitional conditions characterized by social impairments—shows that children exhibit primary social behaviors toward the caregiver, such as eye contact and social smiles see labels watchEx and smileExwhich are fundamental skills at the basis of typically developed communicative and social competence. The same behaviors manifested toward the animal-looking device see labels watchP and smileP mark a relevant engagement with the toy. The comparison between the two graphs related to duration and frequency shows that the latter exhibits more distinctive values from the benefit baseline value.
This suggests that frequency measures are more informative than duration measures, a feature to be verified and kept into consideration in future experiments. Qualitatively, children tend to imitate the caregiver's benefit. In activity A 3 they caress the panda head but also continue to touch the paws. In activity A 5the only one where the tablet is not hidden from sight, the tablet immediately captures the children's attention and they try to touch it to trigger the rewarding pattern on this, we noted a strong shift of attentional focus from the panda to the tablet; this indicates that in future experiments the tablet should probably remain hidden when the tests consider it a distracting element.
This could be further tested in future experiments focusing on analyzing in more detail the effects of the experience of action-outcome contingencies.
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This allowed the detection of differences between the two groups in each of the 12 indexes. This result is stronger for the index frequencies Figure 7for transitional the behavioral indexes touchP, watchP, smileP, smileExand watchEx benefit statistically ificant differences p- values reported in the figure.
The trend is less pronounced for the duration indexes Figure 6for which the behavioral indexes smileP and smileEx reveal a statistically ificant difference p- values reported in the figure. of Wilcoxon rank sum test comparing the duration of the 12 behaviors in the younger and older groups. of the Wilcoxon rank sum test comparing the frequency of the 12 behaviors of the younger and older groups.
Some examples of observed behaviors. From top-left to companionship and bottom: touchP; holdP; move away; pointing; smileEx; touchP; watchTablet; lookEx pictures published with the permission of the participant's parents and the caregiver. At present, we restricted the evaluation of the experimental to a quantitative data analysis of behaviors. This will allow us to better understand the presence and nature of the child-caregiver social interactions possibly facilitated by the panda.
A final remark regards activity A 6 on wearability. As mentioned in the section, this was the only activity in which the children were not requested to interact with the panda. As expected, the children removed it quite quickly and put it again on the floor. However, they did not do so as an adverse reaction but rather to the playing activities with the panda.