State of the art references

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Literature review

Currently, these are the summaries of the state of the art articles

1. Blessings in Disguise: Idiomatic Expression as a Stimulus in Group Art Therapy with Children.

Group therapy can be used to relax defences and increase participation. Structuring a group psychotherapy sessions can be problematic. Those children often seem to be ego-centric individuals where the give and take needed for a productive group dynamic can be difficult. Some therapist want to achieve a good dynamic in the group. This can become confusing because a serious content becomes masked by fun-oriented formats. Giving idoms as stimulus serves as an open-ended structure within both the session’s verbal and artmaking components. Most outcomes had the effect of camouflaging criticism by infusing an element of levity and playfulness to the work that comes with the group therapy process.

2. Outcome-Based Evaluation of a Social Skills Program Using Art Therapy and Group Therapy for Children on the Autism Spectrum.

Art therapy and cognitive-behavioral techniques in a group therapy format are used to help children with social developmental disorders to improve their social skills. Scores revealed a significant improvement in assertion scores, coupled with decreased internalizing behaviors, hyperactivity scores and problem behavior scores in student.

3. Response in HRI-a case study on evaluation of child with autism spectrum disorder interacting with a humanoid robot Nao.

The result of this research shows that the basic HRI (human robot interaction) carried out by NAO is able to suppress the child’s autistic behavior during the child-robot interaction. Also, more eye contact is observed between the child and robot compared to the child with his teacher during regular class sessions. The IQ of the children participating in this research falls in the moderate catergory.

4.Why Robots? A Survey on the Roles and Benefits of Social Robots in the Therapy of Children with Autism.

An robot can function as a friendly playmate, as a behavior eliciting agent, as a social mediator, as a social actor, as a personal therapist. The main advantages are that robots are less complex than humans. They are more predictable and it is easier for children to follow instructions from a robot than a human. The children will not be overwhelmed by the complexity of verbal and non-verbal communication. Robots also make embodied interactions possible. Due to their physical affordances, interactions involving tactile exploration and physical movements make the robots more engaging and interesting for children. Robots are less intimidating than humans. Robots can be used as small, colorful toys, ensuring that children feel at ease during the interaction.

5. Trends and Considerations in Robot-Assisted Autism Therapy.

Autistic children have problems with several things like self-initiated interactions, turn-taking activities, imitation, emotion recognition, joint attention and triadic interactions.

6. Interactive social robots in special education.

Parents and therapists are enthusiastic to work with robots such as NAO as it encourages children to participate on a social level. Especially for children with ASD as NAO is not impulsive and gives a certain structure. The main problem at this time is related to voice recognition.

7. Long-term LEGO therapy with humanoid robot for children with ASD.

Game-based therapy have positive effects on training social skills, especially with lego. Children in the experiment did not like a slow speaking robot. The repetition of the rules also irritated them. Therapists prefer one on one therapy with a robot and a child, instead of a pair of children as a robot cannot adapt well to situations happening between the two children. One clear outcome is that children (with ASD?) react more strongly to the verbal than non-verbal communication, thus the speech should be improved most. Major challenge is keeping children with ASD focused, especially when the task at hand takes long. However, robots are considered exciting by the children, which makes it easier to keep their focus.

8. Improving collaborative play between children with autism spectrum disorders and their siblings : the effectiveness of a robot-mediated intervention based on lego (R) therapy.

For this study children with ASD were paired with their siblings. The idea was that a robot mediated lego therapy, which is supposed to improve collaborative behaviors. However no significant changes in behavior was found (as opposed to lego therapy without a robot mediator). Even though robot therapy is advised for children with ASD, it comes with limitations. One of the main limitations is that the robot has a limited behavioral repertoire, so no differentiation in prompt levels could be made. The article thus recommends the increasing of the variability in prompt levels to respond to children’s individual needs.

9. Effects of robots’ intonation and bodily appearance on robot-mediated communicative treatment outcomes for children with autism spectrum disorder.

The goal of this study was to see whether children with ASD performed better when NAO is more humanlike and when his intonation differs. It looked also for a difference in likeability. There was no evidence that intonation has significant effect on performance. However, as the children in the study where already familiar with NAO and it’s voice Jasmijn, the children may not have experienced possible positive influences of a different intonation as individuals with ASD like things to be the same (thus preferring Jasmijn). Bodily appearance does also not influence the performance. It does however has a large effect on the affective state of an individual. It also helps when the bodily appearance matches the intonation. So mechanical + monotonous or human-like + normal. For these congruent combinations, the happiness also increases.

10. The Clinical Use of Robots for Individuals with Autism Spectrum Disorders: A Critical Review.

The article mentions that there are cases where individuals with ASD react better to robots and prefer interaction with robots over humans. However it also says that studies that come to these findings have very inconsistent results. A lot of studies are too exploratory or theoretical. It concludes that the robots have great potential in a clinical setting, with advantages like the appeal of technology to children with ASD, the ability of a robot to have a simple social behavior (that is easier to understand and focus on) and a robot can be easily adapted for each individual. However further research should be done to determine the validity. Work should be evaluated by experts with clinical expertise as most studies are now focused on the technology development and not necessarily clinical application.

11. Promoting question-asking in school-aged children with autism spectrum disorders: Effectiveness of a robot intervention compared to a human-trainer intervention.

This research aimed at investigating applied behavior analysis (ABA)-based interventions either done by a human trainer or by a robot to promote self-initiated question asking in children with autism spectrum disorder (ASD). In an ABA analysis it is studied how behaviour works in real life situations, with the goal to increase behaviour considered “good” and decrease behaviour that are harmful or affect learning. This research focused mainly on two research questions: (a) are an intervention conducted by a robot and an intervention conducted by a human trainer effective in promoting question-asking in children with ASD? and (b) which of these two interventions is more effective in promoting question-asking in children with ASD? The research in this article was done with the help of six children participants which were between 8-14 years old, had a ASD diagnosis, an IQ of above 80 on a standardized test and where not able to initiate a question after a statement of a trainer. A NAO robot was used and each child had two interventions by both a robot and a human trainer while being under video surveillance. The results of this article state that both robot and human-trainer ABA-based intervention is an effective tool that increased self-initiated question asking in children with ASD between baseline and the first intervention and was maintained during the follow up. The article states that no conclusions could be drawn with regard to the differential effectiveness of the robot or human-trainer interventions.

12. Improving therapeutic outcomes in autism spectrum disorders: Enhancing social communication and sensory processing through the use of interactive robots.

This research focuses at examining a range of socially interactive robots which are currently the most used for therapeutic purposes and their therapeutic effects. The researchers discussed how enhanced sensory processing and integration of social cues into these robots may underlie the benefits that these robots bring about. They state these robots and their interactions might provide therapeutic benefits by allowing the audiovisual cues in social interactions to be experienced in a simplified version of human interaction. The research focusses mainly on two parts: The deficits in autism spectrum disorder (ASD), consisting of a sensory perception and neurobiology part, and the spectrum of socially-assistive robots, where multiple types of robots are examined. They conclude that ASD comes with perception impairments related to multisensory integration of more complex stimuli. Furthermore they state that ASD comes with several neurobiological overarching impairments such as one involving the mirror neuron system which facilitates imitation and social communication, or deficits in the amygdala which might underlie social cognition deficits. After examining the impairments that come with ASD the research focusses on the spectrum of available socially-assistive robots, where they investigate 4 types of robots: humanoid robots, cartoonish robots, animal robots and robots in robotic form. They conclude that humanoid robots were found to elicit enhanced generalization of social skills taught during therapy, however non humanoid robots attract the most attentional engagement and robots with a simple appearance increase levels of interaction and are more easily accepted by children with ASD. Next the research examined the application of neuroscience tools to improve the therapeutic value of the robots and concluded that the underlying mechanism behind the benefits of these robot interactions remains largely unknown and state that recent studies in their lab have begun to address this question. The research does not end with a general conclusion but with a written part about the access to social robot therapies and state that there is a lack of affordable, commercially available robots for in home use and that there is also a lack of longitudinal studies addressing following children’s process as they go through childhood.

13. A robot-assisted behavioral intervention system for children with autism spectrum disorders.

This research aims at examining the feasibility of a robot-assisted intervention system for the training of children with autism spectrum disorder (ASD) via human robot interaction (HRI) based on the discrete trial teaching (DTT) protocol. Their proposed robot architecture configures 4 modules: human perception, user input, the interaction manager and the robot effect, with which the robot can generate different training stimuli and can automatically cope with the child’s responses by using human recognition and interaction techniques. The article consists of 3 main parts: Robot system for autism treatment, experimental setup and results and discussion. In the robot system for autism treatment part they discussed their interaction architecture and its treatment protocols which focusses mainly on the social interaction skill of eye contact and reading emotion. Furthermore they discussed their robot automatic interaction system which involved sound, physical movement made by the robot, displayable content and even material reward. The experimental setup part goes into great detail about the setup used in the research, stating they used two different robots for their tests and a monitoring setup. Their results verify the effectiveness of behavioral intervention in autism treatment using a robot and they claim to be confident that the proposed system they used can be attributed to the positive effect of social skill training in children with ASD.

14. Social engagement of children with autism spectrum disorder in interaction with a parrot-inspired therapeutic robot.

This paper discusses a series of pilot studies in which ten participants (children with ASD) were to engage with a parrot inspired therapeutic robot. Hereby it was evaluated if these children with autism spectrum disorder (ASD) exhibited more social interaction when engaging with the robot compared to another human. The article states that parrots already have a widespread use in therapeutic sessions for example patients with post-traumatic stress disorder, the researches give this as a reason to design a parrot inspired therapeutic robot. The participants were gathered in a study room and three sets of outcomes were collected; one at baseline, one without human and robot interaction and one with robot or human interaction. Data was collected on 12 defined behaviours such as: looking at the person, going close to the person or touching the person. The study’s results indicate a significant improvement in children’s interaction abilities as opposed to sessions with human involvement and the 12 types of social interaction abilities monitored reported that the robot has the potential to act as a social robot to improve social interactions in children with ASD. The article ends with the notion that the sample group was small and the study was not conducted long-term and there were no follow ups, hereby stating they aim to address these limitations by increasing the scale and duration of their research.

15. Who is a better teacher for children with autism? Comparison of learning outcomes between robot-based and human-based interventions in gestural production and recognition.

This study aims to compare the learning outcomes in children with autism spectrum disorder (ASD) and intellectual disabilities from robot based interventions on gestural use versus the human based interventions. A intervention protocol was designed, implemented and tested on a test group of 23 children aged six to 12 divided randomly in two groups; one for human-based intervention and one for robot-based interaction. Two NAO (Aldebaran Robotics Company) robots were used and programmed to speak and/or produce 14 gestures. The treatments consisted of pretests, four training sessions (twice per week), an immediate posttest and a follow up posttests after two weeks. The learning outcomes in gestural production and recognition did not differ between the robot- and human-based intervention groups. The research however suggested that the children in the robot-based intervention group were more likely to establish eye contact with the teachers than those in the human-based intervention groups. To conclude the researchers state that there does not seem to be a difference between the likeliness of children with ASD who received human-based gestural training to recognize gestures and children who received robot-based gestural training.

16. Robots as New Tools in Therapy and Education for Children with Autism.

This article presents an overview of robots that are currently used in therapy and education for children with ASD and to indicate what objectives they address.

17.Therapy Robot Teaches Social Skills to Children With Autism.

This article shows research done about the attention span of children when interacting with a robot compared to therapists.

18. Robotic Social Therapy on Children with Autism: Preliminary Evaluation through Multi-parametric Analysis.

In this work a preliminary evaluation of an innovative social robot-based treatment for subjects with ASD is described.

19. Robot Enhanced Therapy for Children with Autism (DREAM): A Social Model of Autism.

This article reviews studies in robots and autism as a neurodevelopmental disorder that impacts social communication development, and the ways social robots could help children with autism develop social skills.

20. Group Therapy Can Aid Social Skills in Kids with High-Functioning Autism.

This article is about how group-based behavioral therapy may help children and teens with high-functioning autism spectrum disorder (ASD) develop stronger and longer-lasting social skills, according to a new trial of group classes for children with ASD developed at Goethe University Frankfurt in Germany.

21. The Structure of Group Therapy for Anxiety in Children and Adolescents with Autism Spectrum Disorder in a CAMHS.

The study focused on the main topics including introduction and talking to peers, following a conversation, emotion regulation, entering a group and social skills. In counselling groups, the focus was on main themes which participants contributed to, including talking about feelings, developing friendships and communication skills. Small group discussions, role play exercises and feedbacks on the spot. The most helpful thing in therapy was to make it personal and ask the children about their hobbies and incorporating their interests in therapy.

22. Understanding emotions in others: mirror neuron dysfunction in children with autism spectrum disorders.

Children with autism do not show no mirror neuron activity in the inferior frontal gyrus while they imitate something. People without this disability perform the task equally well but show activity. The activity in this area is inversely related to symptom severity in the social domain. This might suggest that a dysfunctional mirror neuron causes the social deficits observed in autism.


23. The Use of Technology in Treatment of Autism Spectrum Disorders.

20-30% of the children with autism in the United States will be unable to communicate their wants, needs and thoughts verbally. To let the children express themselves augmentative and alternative communication strategies (AAC) can be used. Nowadays often tablets and other hand-held devices are used for this. These technologies are more accessible for these people because there light weighted and the touch screen and layout provide an easy to use device. Sliding and tapping seems to be easier than typing. Most people with ASD are visual thinkers. Technology makes visual images more accessible than the products used before.

24. Billard. Robotic assistants in therapy and education of children with autism: can a small humanoid robot help encourage social interaction skills?

This study had a robot and child interact as a form of therapy, a investigator was present during these sessions, to observe the child’s behaviour and to check on the robot. When the children had gotten used to the robot they started interacting with the investigator. They actively seeked the investigators attention to share their experience with them. This shows that the child has increased its social abilities.

25. Cognitive-Behavioral Group Treatment for Anxiety Symptoms in Children With High-Functioning Autism Spectrum Disorders.

A study that shows group therapy can lead to decrease in anxiety in children with ASD. The extent to which anxiety in children with ASD is related to social deficit is unclear. However the presence of anxiety symptoms can interfere with the child’s ability to participate in home, school or community activities. Anxiety can also influence a child’s future, because it can impact their education, underemployment and other psychiatric problems. The therapy was interactive and activity based in order to keep children motivated and focussed. The result of the study was positive, nearly all children showed improvement.



State of the Art sources

  • [1] David R. Henley PhD, ATR (2000) Blessings in Disguise: Idiomatic Expression as a Stimulus in Group Art Therapy with Children, Art Therapy, 17:4, 270-275, DOI: 10.1080/07421656.2000.10129762
  • [2] Brook, Marie. (2008). Outcome-Based Evaluation of a Social Skills Program Using Art Therapy and Group Therapy for Children on the Autism Spectrum. Children & Schools. 30. 10.1093/cs/30.1.27.
  • [3] S. Shamsuddin, H. Yussof, L.I. Ismail, S.Mohamed, F.A. Hanapiah, N.I. ZahariInitial (2012) response in HRI-a case study on evaluation of child with autism spectrum disorder interacting with a humanoid robot Nao. Procedia Engineering, 41 (2012), pp. 1448-1455
  • [4] Cabibihan, JJ., Javed, H., Ang, M. et al. Int J of Soc Robotics (2013) Why Robots? A Survey on the Roles and Benefits of Social Robots in the Therapy of Children with Autism. 5: 593. https://doi.org/10.1007/s12369-013-0202-2
  • [5] J Ricks, Daniel & Colton, Mark. (2010). Trends and Considerations in Robot-Assisted Autism Therapy. Proceedings - IEEE International Conference on Robotics and Automation. 4354 - 4359. 10.1109/ROBOT.2010.5509327.
  • [6] A. Amanatiadis, V. G. Kaburlasos, C. Dardani, S. Chatzichristofis (2017), Interactive social robots in special education, Proc. IEEE 7th Intl. Conf. on Consumer Electronics (ICCE), 210-213.
  • [7] Barakova, E. I., Bajracharya, P., Willemsen, M. H. J., Lourens, T., & Huskens, B. (2015). Long-term LEGO therapy with humanoid robot for children with ASD. Expert Systems, 32(6), 698-709
  • [8] Huskens, B., Palmen, A., Van der Werff, M., Lourens, T., & Barakova, E. (2015). Improving collaborative play between children with autism spectrum disorders and their siblings : the effectiveness of a robot-mediated intervention based on lego (R) therapy. Journal of Autism and Developmental Disorders, 45(11), 3746-3755.
  • [9] van Straten, C. L. C., Smeekens, I., Barakova, E. I., Glennon, J., Buitelaar, J. K., & Chen, A. (2018). Effects of robots’ intonation and bodily appearance on robot-mediated communicative treatment outcomes for children with autism spectrum disorder. Personal and Ubiquitous Computing, 22(2), 379-390.
  • [10] Diehl, J. J., Schmitt, L. M., Villano, M., & Crowell, C. R. (2012). The Clinical Use of Robots for Individuals with Autism Spectrum Disorders: A Critical Review. Research in autism spectrum disorders, 6(1), 249-262.
  • [11] Bibi Huskens, Rianne Verschuur, Jan Gillesen, Robert Didden & Emilia Barakova (2013) Promoting question-asking in school-aged children with autism spectrum disorders: Effectiveness of a robot intervention compared to a human-trainer intervention, Developmental Neurorehabilitation, 16:5, 345-356
  • [12] F. Sartorato, L. Przybylowski, D. K. Sarko (2017) Improving therapeutic outcomes in autism spectrum disorders: enhancing social communication and sensory processing through the use of interactive robots, Journal of Psychiatric Research,90, 1-11
  • [13] Yun SS, Kim H, Choi J, Park SK (2016) A robot-assisted behavioral intervention system for children with autism spectrum disorders, Robotics and Autonomous Systems 76:58-67.
  • [14] Jaishankar Bharatharaj, Loulin Huang, Christian Krägeloh, Mohan Rajesh Elara, Ahmed Al-Jumaily (2018) Social engagement of children with autism spectrum disorder in interaction with a parrot-inspired therapeutic robot, Procedia Computer Science, 133, 368-376.
  • [15] Wing-Chee So, Miranda Kit-Yi Wong, Wan-Yi Lam, Chun-Ho Cheng, Sin-Ying Ku,Ka-Yee Lam, Ying Huang, Wai-Leung Wong (2019) Who is a better teacher for children with autism? Comparison of learning outcomes between robot-based and human-based interventions in gestural production and recognition, Research in Developmental Disabilities, 86, 62-75.
  • [16] Huijnen CAGJ, Lexis MAS, de Witte LP (2017) Robots as New Tools in Therapy and Education for Children with Autism. Int J Neurorehabilitation 4:278. doi:10.4172/2376-0281.1000278
  • [18] D. Mazzei et al., "Robotic Social Therapy on Children with Autism: Preliminary Evaluation through Multi-parametric Analysis," 2012 International Conference on Privacy, Security, Risk and Trust and 2012 International Confernece on Social Computing, Amsterdam, 2012, pp. 955-960.doi: 10.1109/SocialCom-PASSAT.2012.99
  • [19] Richardson, Kathleen & Coeckelbergh, Mark & Wakunuma, Kutoma & Billing, Erik & Ziemke, Tom & Gomez Esteban, Pablo & Vanderborght, Bram & Belpaeme, Tony. (2018). Robot Enhanced Therapy for Children with Autism (DREAM): A Social Model of Autism. IEEE Technology and Society Magazine. 37. 30-39. 10.1109/MTS.2018.2795096
  • [21] Shakernaeeni H, Chowdhury U.The Structure of Group Therapy for Anxiety in Children and Adolescents with Autism Spectrum Disorder in a CAMHS Setting in the UK. J Child Dev Disord. 2018, 4:1
  • [22] Mirella Dapretto, Mari S Davies, Jennifer H Pfeifer, Ashley A Scott, Marian Sigman, Susan Y Bookheimer and Marco Iacoboni. Understanding emotions in others: mirror neuron dysfunction in children with autism spectrum disorders; doi: 10.1038/nn1611
  • [25] Reaven, J. A., Blakeley-Smith, A., Nichols, S., Dasari, M., Flanigan, E., & Hepburn, S. (2009). Cognitive-Behavioral Group Treatment for Anxiety Symptoms in Children With High-Functioning Autism Spectrum Disorders: A Pilot Study. Focus on Autism and Other Developmental Disabilities, 24(1), 27–37. https://doi.org/10.1177/1088357608327666
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