«Robotics, CBT and entertainment in the enhancement of children with ASD, mental disorders, dysfunctional emotions and irrational belief»

Areti-Eirini Filiou

​

Psychologist, MSc in Special Education

PhD candidate, Department of Educational and Social Policy, University of Macedonia

• Children and adolescents with Autism Spectrum Disorder (ASD) often experience symptoms of various mental disorders along with the characteristics that determine ASD

​

• Problems with anxiety, depression, emotion regulation, cognitive problems such as deficits in the theory of mind and related behavioral problems occur in children with autism of all ages.

​

• The most common symptoms are those of anxiety and depression

​

• About 40% of people with autism show symptoms of mental disorders

2

Introduction

40%

Mental Disorders and Autism

3

​

• In recent years, the application of robots in therapeutic interventions for children with neurodevelopmental disorders and more specifically in children with ASD, has aroused the interest of the robotic community and experts in the field of autism

​

• Social assistance robots are promising in terms of their ability to promote and support mental health in children with ASD

​

• Growing number of studies exploring the feasibility and effectiveness of robot interventions to support children's mental well-being

​

• Management of stress, depression and socio-emotional problems

4

Introduction

​

​

• Several authors have also suggested Cognitive and Behavioral Therapy (CBT) as a very useful intervention therapy

​

• This form of psychotherapy is based on the thought-emotion-behavior model

​

• It includes a variety of techniques, cognitive and behavioral

​

• Great impact on the management of mental disorders

​

• CBT can be implemented in conjunction with a social support robot

5

Introduction

Combination of robots and CBT

6

​

• Coordinated effort, robots, cbt techniques and collaboration with mental health counselors

​

• Many applications of this combination have shown substantial improvements in the management of mental disorders

​

• Children with ASD can improve their social, emotional and behavioral skills

​

• Management of mental disorders, but also the cultivation of new skills (cognitive, emotional, behavioral, social)

7

Introduction

Numerous researches on this combination

Find more maps at slidescarnival.com/extra-free-resources-icons-and-maps

8

Methodology

• Research cases: comorbidity of mental disorders and ASD, robots and ASD, combination of CBT and robots for ASD intervention
• The selection of the studies for the purpose of this paper was based on criteria
• Papers should refer on robots, mental disorders and ASD, CBT, intervention
• Research papers were found by searching through PubMed, Google Scholar, Research gate

• The robots used in therapeutic interventions for children with autism are called Socially Assistive Robots (SARs)

​

• They are a large field of study in the field of human-robot interaction (HRI)

​

• In the development of the interaction of different categories of individuals

10

Socially Assistive Robots

​

• The role of SARs is to provide help through social interaction to individuals or children with reduced or no social and cognitive skills

​

• The most famous social robots used in the identified studies are Nao, Paro, Huggable, Tega and Pleo

11

Socially Assistive Robots

Socially Assistive Robots and ASD

• Socially Assistive Robots were used to diagnose and treat children with autism
• When robots are used to diagnose autism, they observe children in ways and methods that humans can not do
• Monitoring children's eyes promises early diagnosis of autism
• Children feel more comfortable interacting with robots as opposed to humans

12

Socially Assistive Robots and ASD

• SARs, as we have seen, are used in a wide range of applications, including autism.
• Their use is also being studied as a tool for diagnosing autism and as a means of socializing therapies for children when robots are used to diagnose autism, observing children in ways and methods that humans can not do.
• The use of SARs in the treatment of children with autism, lies in the formulation that these children show a special love for mechanical objects and computers.
• the use of SARs can facilitate the development of social stimuli in children

13

Socially Assistive Robots and ASD

• By observing the specific intervention programs with the use of robots, it becomes apparent the continuous investment in the interactive technologies that include or not fully autonomous robots
• In all therapeutic approaches, the robot does not replace the therapist or special educator who interacts with the child, but supervises and controls his activity and uses it according to the intervention.
• When using robots in interventions, the variety of difficulties faced by children with autism spectrum disorders is taken into account, so that they are precisely adapted to the needs and requirements of each child

14

Cognitive Behavioral Therapy

15

• The most effective therapeutic approach according to several researchers is Cognitive and Behavioral Therapy

​

• This psychotherapy seeks to manage the symptoms using various techniques such as relaxation techniques, focus on the imagination, use of metaphors, cognitive reconstruction, role-playing games, etc.

​

• Practiced by psychologists, psychotherapists, psychiatrists and other mental health professionals

​

• Many studies have shown that children with autism show more interest in interacting with robots as they are attracted to them and do not cause confusion and intimidation as they do when interacting with a therapist or educator

16

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy and Robots

• Research supports CBT as the best possible therapeutic approach for the treatment of underlying symptoms and comorbidities in children with ASD (Costescu, Vanderborght, & David, 2017)
• CBT can be effectively adapted to treat emotional problems in children with ASD and significantly reduce mood disorders in people with ASD
• Its use is most effective when combined with SAR
• The use of a psychotherapy protocol by a therapist with the help of a robot is called robot therapy

17

Cognitive Behavioral Therapy and Robots

• This treatment is done in an individualized context of psychotherapy and is based on protocols followed by the specific psychotherapy
• The robot can be considered as a technological tool that can help psychotherapists achieve their clinical roles and goals (Costescu, Vanderborght, & David, 2017. Marino, Chilà, Trusso, et al. 2020. Yun, Choi, Park , Bong, & Yoo, 2017)
• Social robots as mediators apply techniques mentioned in the CBT protocols, thus helping children with autism in socio-emotional comprehension, empathy, socialization, to regulate their negative emotions such as stress and anger and to learn to relax

18

Cognitive Behavioral Therapy and Robots

• International studies show that this type of treatment is very effective and helps children with autism a lot (Costescu, Vanderborght, & David, 2017. Marino, Chilà, Trusso, et al. 2020. Yun, Choi, Park, Bong, & Yoo, 2017)
• They themselves benefit from contact with the social robot, learn new skills and through relaxation and management techniques of thoughts, emotions and behaviors are able to control and manage symptoms of mental disorders that may occur
• In addition, they appear to have higher emotional control and self-regulation, smaller and less intense outbursts of anger, and higher emotional comprehension (Costescu, Vanderborght, & David, 2017. Marino, Chilà, Trusso, et al. 2020. Yun, Choi, Park, Bong, & Yoo, 2017)

19

Anxiety

20

A storm of thoughts

Internal worry

Muscle tension, irritability, sweating, sore throat, palpitations, etc.

Cognitive avoidances and avoidances of social situations

Difficulty sleeping and frequent waking

A CBT robot for anxiety

21

• Stress in children with autism is a very common phenomenon

​

• Anxiety about social contacts, school, special phobias

​

• The goal is to relax and reduce physical symptoms through the CBT robot

A CBT robot for anxiety

• Introduction of the robot to the child by the therapist
• Robot-child discussion with questions about child interests
• Simultaneous movements of the robot (hands, body)
• Phrases of support and interest in the child such as very nice, well done, very interesting
• This presentation of the robot

22

Relaxation

10 candles

​

​

• The robot tells the child to imagine 10 lighted candles in a row and then extinguish each candle in an attempt to exhale. The robot applies the exercise on its own by extinguishing the supposed candle, in order to achieve the imitation of the exercise by the child. This intervention combines images and controlled breathing. This can also serve as a kind of game between the robot and the child, which aims to start the session and introduce the child to the relaxation that will follow (Storch et al., 2015)

23

Relaxation

Diaphragmatic Breathing

• In this step the child learns a breathing technique based on his diaphragm. This focused breathing helps a lot in relaxing and eliminating negative emotions. Inhalation alerts our body, while exhalation has a calming effect (Storch et al., 2015)
• The robot gives the child oral instructions on how to perform breathing. E.g. - Put one hand on the chest and the other on the stomach. - Take air from your nose and let your stomach swell. - Gently and calmly, take the air out of your nose. The robot, while saying the instructions for diaphragmatic breathing, at the same time follows them by putting one hand on the chest and the other on the abdomen. This will make it easier for the child to imitate the robot and take diaphragmatic breathing. At the same time, relaxing music is heard and the robot's voice is in low and soft tones. In addition, the robot strengthens the child with verbal rewards, well done, you do it very well, he continued, to encourage the child to continue the process. 3 and 4 breaths can be taken

24

Relaxation

Progressive muscle relaxation

​

• In this step, the robot again instructs the child with a slow tone of voice and music in the background, how to gradually relax the muscles of his body. It starts from the bottom up. First the toes, the whole foot, the waist, the back, the toes, the whole hand, the neck and finally the head. The robot gives instructions to the child such as: - first you will relax the muscles in your toes. - You feel heavy. - Let them go. At the same time the robot tells the child to think of happy pictures to relax more easily (Storch et al., 2015). Simultaneously with the relaxation instructions, the robot's eyes light up in blue, which relaxes the child even more. In addition, the hands are shaken up and down slowly for the best possible relaxation

25

CBT robot

26

03

01

02

​

The results of recent research show that interventions with the help of robots can greatly help children with ASD in learning and improving various skills

​

These skills focus on his social and emotional deficits, such as self-regulation, anxiety-related symptoms, anger, depression, emotion regulation, cognitive problems such as deficits in mind theory, and related behavioral problems.

​

Social robots apply CBT protocols, using a variety of cognitive and behavioral techniques, to help and support children with autism

​

The international literature shows that the application of these techniques by social robots is effective and helps these children (Costescu, Vanderborght, & David, 2017. Marino, Chilà, Trusso, et al. 2020. Yun, Choi, Park, Bong, & Yoo, 2017)

27

Conclusions

Questions;

�You can find me at:

• aretifiliou@uom.edu.gr

28

Thank you!

References

Costescu, C. A., Vanderborght, B., & David, D. O. (2017). Robot Enhanced CBT for Dysfunctional emotions in social situations for children with ASD. Journal of Evidence-Based Psychotherapies, 17, 2, 119-132.

Marino, F., Chilà, P., Trusso Sfrazzetto, S., Carrozza, C., Crimi, I., Failla, C., Busà, M., Bernava, G., Tartarisco, G., Vagni, D., Ruta, L., & Pioggia, G. (2020). Outcomes of a Robot-Assisted Social-Emotional Understanding Intervention for Young Children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 50, 1973–1987. https://doi.org/10.1007/s10803-019-03953-x.

Saadatzi, M. N., Pennington, R. C., Welch, K. C., & Graham, J. H. (2018). Small-group technology-assisted instruction: Virtual teacher and robot peer for individuals with autism spectrum dis- order. Journal of Autism and Developmental Disorders, 48(11), 3816–3830.

Sartorato, F., Przybylowski, L., & Sarko, D. K. (2017). Improving therapeutic outcomes in autism spectrum disorders: Enhancing social communication and sensory processing through the use of interactive robots. Journal of Psychiatric Research, 9, 1–11. https ://doi.org/10.1016/j.jpsychires.2017.02.004.

Sharma, S. R., Gonda, X., & Tarazi, F. I. (2018). Autism spectrum disorder: Classification, diagnosis and therapy. Pharmacology and Therapeutics. https://doi.org/10.1016/j.pharmthera.2018.05.007.

Spain, D., Sin, J., Chalder, T., Murphy, D., & Happe, F. (2015). Cogni- tive behaviour therapy for adults with autism spectrum disorders and psychiatric co-morbidity: A review. Research in Autism Spec- trum Disorders, 9, 151–162. https://doi.org/10.1016/j.rasd.2014.10.019.

Sprung, M., Münch, H. M., Harris, P. L., Ebesutani, C., & Hofmann, S. G. (2015). Children’s emotion understanding: A meta-analysis of training studies. Developmental Review, 37, 41–65. https://doi. org/10.1016/j.dr.2015.05.001.

Yun, S.-S., Choi, J., Park, S.-K., Bong, G.-Y., & Yoo, H. (2017). Social skills training for children with autism spectrum disorder using a robotic behavioral intervention system. Autism Research, 10(7), 1306–1323. https://doi.org/10.1002/aur.1778.

Wood, J. J., Kendall, P. C., Wood, K. S., Kerns, C. M., Seltzer, M., Small, B. J., Lewin, A. B., & Storch, E. A. (2020). Cognitive Behavioral Treatments for Anxiety in Children with Autism Spectrum Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 5, 474-483. https://doi.org/ 10.1001/jamapsychiatry.2019.4160.

29