Thursday, December 6, 2018

Observations on Robot-mediated Behavior Intervention (RMBI) for autism

I need to share at the outset that I am not a medical expert or an expert in autism diagnosis or treatment. I am however an experienced technology executive with over 45 years of real-world experience on focusing emerging and new technologies to address and solve real world problems and challenges. When I entered the robotics field it was not long before I experienced firsthand the engaging and positive impact that robotic technology had upon children with autism.

The history of the utilization of robots as a pathway vehicle to effective autism therapy has been attested to by many leading researchers. Bottom line is that numerous university-based research studies attest to the positive impact robots can have on autistic behavior intervention. The reasons for the positive findings while varied, group around the following observations. Children trust robots. Most children are captivated by robot interactions. Robots do not tire in their interactions. Robots do not inadvertently convey upsetting facial expressions or use nuanced voice inflections that children find distracting or even upsetting. Robots do not get emotionally swayed off the path.

This article is founded upon my observations while working to increase the attention and focus of clinicians, researchers and educators on the as of yet unrealized future positive possibilities and benefits of robot assisted behavior interventions for autism or what I refer to as robot-mediated behavior intervention or RMBI.

The numbers of children being diagnosed with autism continue to increase at an alarming rate. The CDC now has posted that number at 1 in 59 children. This is a staggering number. The impact on individual lives is also staggering. The average cost for a family to care for an autistic child is approximately $60K/year. Autism is a lifelong challenge and it is not just an early childhood issue. Being able to “skill develop” and prepare younger children for their learning and teenage years and then on to self-sufficient adult living can take years of behavior intervention and skills development. The burden on families emotionally and financially can be crushing. Most therapists would agree that 40 hours of therapeutic and skills development interactions and behavior interventions per week is what is needed. Imagine dedicating 40 hours per week to the treatment of a single child? That is a full-time job for anyone.

At the foundation of robot-mediated behavior intervention lies ‘behaviorist’ psychological principles, that behaviors are the result of ‘stimulus-response’ interactions and that resulting behaviors can be observed by the therapist and learned by the child through the repetitive utilization of such interactions. In the case of autism, we are striving to encourage the recognition and learning of acceptable social interactions and create confidence in their adoption and use by the child with autism.

While many states in the U.S. recognize the need especially for early childhood intervention and many now even provide some financial subsidy or medical reimbursement for such therapy, the available resources outstrip the demand. Most of the burden falls upon special education teachers in public or special needs schools and increasingly on the families of children with autism themselves.

Great progress is being made to culturally embrace children and adults with autism. Autism is now more frequently seen less as a disease or a handicap and more as a condition that bespeaks the uniqueness of a person. “Each child is unique” is the mantra of those impacted or those working with those impacted. While I respect these sentiments, it tends to belie the work that needs to be done to treat such a devastating condition. None the less we must always keep in mind that every therapeutic approach must embrace the uniqueness of the child being cared for.

More than a decade of research has established the fact that human-robot interaction possesses a huge potential as an intervention tool for many children with autism. The world-wide prevalence of autism has triggered the need for training professionals and developing new technologies to efficiently deliver autism intervention to a wave of demand that if it has not already, will soon overwhelm providers.  Technology-aided interventions should be seen as emerging tools for autism intervention and robot-mediated behavior intervention (RMBI). More importantly as robot technology advances and costs lower the possibility of having a robot mediated intervention platform that can be used in a “at home” setting is the real target. Leading researchers have documented that 30 days of 30 minute in home use can have very positive results.
Another noted university researcher has recently stated however, that “Despite impressive new developments in robot-mediated behavior intervention (RMBI), there is a huge gap in understanding among robotics researchers, robotics industries and stakeholders (autistic children, parents/caregiver, and clinicians) on the clinical utility of robots in autism intervention, best practice in RMBI, and the robotics technology (hardware and software) required to establish RMBI as an effective evidence-based practice (EBP) in autism”.

We are entering a new era of robotics and for social robots in particular. Advances in artificial intelligence and machine learning when combined with the hardware elements and technologies that comprise today’s robots clearly point to a future where much of the behavior intervention work can be assisted by or transferred to a social interactive style robot. Every day we learn more about robots that can sense emotions and derive diagnostic, personality-based information by ‘reading’ facial expressions. Unfortunately, the momentum in robot-based autism behavior interventions once driven by university-based research programs has lessened as seemingly, in their minds the case for the use of robots has been made. While this is true, we now need to advance, in a unified manner, the software, robotic platform design and the Applied Behavior Analysis (ABA) curricula needed to establish the expanded viability of robot mediated behavior interventions. This needs to be done so that more individuals, family members in particular, and not just professional therapists can with the assistance of a social robot, engage in credible behavior intervention and skills development therapies. Families need access to comprehensive social robot-based platforms that can increase the amount of productive skills development time they can provide to a child’s development.  This is especially powerful as therapy in a home-based environment is a more natural and less threatening environment than a school room or a therapist’s office location. This approach would open the pathway to an increased utilization of robots in autism behavior interventions which in turn expands the number of hours that can be applied to therapies and skills development.

Much is being said and written about the impacts, advantages and threats that the advent of the age of robots has and will have on our society and culture. And, those discussions and debates are important and vital to our perceptions and our thinking. However, I believe that the use of robots in therapeutic sessions for autism and many other conditions will only continue to develop and expand. The major objections to the advancement of robots in the medical arena I encounter are (1) robots remove the human touch (2) robots are to expensive and (3) robots will take my job away. To which I observe that we adopt the use of X-ray machines and MRI machines which improve on our human constraints, and that costs will overtime, be reduced as adoption grows and the need for workers in robot related fields will expand, creating jobs. 

What I rarely hear is that robot mediated behavior does not work. Experience the child with autism in front of a robot and you will see the real joy of engagement. It is that experience that makes for the passion to continuously work to advance robot-mediated behavior intervention.

*Michael D. Radice is Chairman, Technology Advisory Board of ChartaCloud Technologies / Robotteca