Autism researchers explore technology’s use in clinical therapy

Two teams of professors are working on creating augmented reality applications to help participants of the spectrum learn and practice safety and employment skills.

A year ago, Alexandra Ramirez's 2-year-old patient refused to sit at a table and was unable to communicate his wishes and needs to the adults around him.

He would get upset and cry when he needed something, and his family wondered desperately what exactly he wanted. The challenges seemed endless until his family found the University of Miami Intensive Behavioral Intervention Services (IBIS) clinic- -This serves children with developmental delays and those diagnosed with autism spectrum disorder - and began therapy.

These days, toddlers can point or tap on a picture board to communicate whatever they want. They begin to use some form of sign language to say the word "more" when they want extra food or to play a game again. He often hugs Ramirez and grins as she agrees to keep jumping if he says "more". His fleeting facial reaction is a critical step.

“He used to be so frustrated and shake his head, but now he can point to the toy he wants. And he's starting to use a few words, ”Ramirez said.

Although the toddler's progress is slow and he must practice these skills on a daily basis, the boy's therapy team is thrilled that he is capturing these important social cues. He is only one of around 15 to 20 students a year who spend three hours a week in the IBIS Clinic. And now one of the clinic's directors is looking for new ways the technology can expand its services even further to those on the spectrum.

The IBIS Clinic was founded in 2015 and offers applied behavior analysis (ABA) therapy to children in the South Florida region aged 18 months to 3 years. Every child has an individual therapist right from the start, who is also a PhD student in the behavioral analysis master’s program. Each therapist is partnered with a more experienced graduate student as well as a faculty member in the Department of Psychology at the College of Arts and Sciences. Together, the team designs an individual learning plan for each child based on strengths and weaknesses. Then each day during therapy, a faculty member and a sophomore student watch the session on a tablet- -at least during the COVID-19 pandemic- -and provide feedback and guidance to the therapist through a wireless earbud (they usually work together in person).

According to the U.S. Centers for Disease Control, 1 in 54 children is diagnosed on the autism spectrum, and boys are four times more likely to be diagnosed than girls. Research shows that the earlier children on the autism spectrum start therapy, the better they can adapt to social norms that are expected at school. It is for this reason that the IBIS Clinic is working with young children at this crucial time, before they turn 3, said psychology professor Anibal Gutierrez, co-director of the clinic and assistant director of the Southeastern University Center for Autism and University at the University of Miami-Nova Related disabilities (UM-NSU CARD). The clinic is a collaboration between faculties and staff who are experts in ABA therapy. It uses evidence-based practices and high repetition to help young children acquire the skills they need to thrive.

The results are often amazing. By focusing on the building blocks of social communication- -Shared attention, play, imitation and language - the therapists record the children's progress literally every day, said Elaine Espanola-Aguirre, a board-certified behavioral analyst and one of the IBIS clinic's four co-directors and the internship coordinator for the Master in Applied Behavioral Analysis. One of the goals of the clinic is to prepare these children to adjust to a school environment.

“We also want them to find their voice. Because while these children are communicating, it's not always that we can understand, ”she added.

While some children may come in completely non-verbally and not be able to identify their family members in photos, after a year they often leave the clinic to chat or say a few words. Others cannot make eye contact at the beginning of their therapy and later interact with their therapist or another child without being asked.

"Every child has a different outcome, but we always see a difference in all of our children," said Espanola-Aguirre. "We all love to be here every day because we all know we have the opportunity to directly influence a child's life."

While the IBIS Clinic's results are encouraging, Gutierrez also recognizes its limitations. In order to ensure effective therapy, small children in the spectrum need so much one-to-one tuition that there are often not enough therapists or clinics to meet the demand. While kids enrolled in the small IBIS clinic get 12 hours of therapy every week, they could use a lot more, he said. For this reason, Gutierrez works in two interdisciplinary teams on the development of virtual reality and augmented reality applications that could complement a patient's time in the clinic.

A team from the University Laboratory for Integrative Knowledge (U-LINK), which includes Gutierrez, professor of psychology Yanerys Leon, professor of interactive media, Kim Grinfeder and professors of electrical and computer technology Hammam Alsafrjalani and Mohamed Abdel-Mottaleb, is working on the Developing applications for adolescents and teenagers Adults in the spectrum learn skills for independence, such as building a hamburger, washing your hands, doing your own laundry and getting used to an office space. Meanwhile, Gutierrez is also working on other virtual reality applications for toddlers in the Spectrum to learn how to identify shapes, colors, animals, letters, and numbers.

“For most people, learning happens so quickly that we don't even realize it, but for people with autism it can take days or weeks to learn- -They often take a lot more practice, ”said Gutierrez, a board certified behavioral analyst who has worked with those on the spectrum for more than 20 years. "These repetitive tasks lend themselves to the technology that helps."

Once the applications are fully developed, Gutierrez hopes to test some of them at the IBIS clinic, as well as through the UM-NSU CARD network, to find people with ASD of all ages - to see if the technology is useful for therapy . The pandemic has slowed its progress a bit, but Gutierrez is hoping to start this summer.

"Some kids go to therapy for a few hours and that's it, but that could be like homework and the goggles could guide them," he said. "For example, children with autism need a lot of physical exercise. So could the goggles point them in the right direction?"

As artificial intelligence advances, these apps could also learn each child's preferences, as therapists at the IBIS Clinic do to motivate the kids, said Grinfeder, chairman of the interactive media division and director of the Extended Reality (XR) initiative University working with Gutierrez to develop additional applications where the technology could enhance therapy. For example, in the clinic, Ramirez knows that her patient loves Baby Shark. That's why she often gives him breaks between lessons with a Baby Shark book or a puzzle. In the future, the applications could learn that a child likes a particular song or character and offer it every time the child succeeds in a task.

"Children and adults on the autism spectrum often need training, experience, and coaching," Gutierrez said. "So we're thinking about how we can use technology to contribute to greater independence."

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