How effective is Therapeutic Design for Autistic

Children in Today’s Community

By Eliot Robert Sleep

BA (Hons) Graphic Design - 2014 ADGP34 Contextualisation

 

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How effective is Therapeutic Design for Autistic Children in

Today’s Community

-

“Submitted by Eliot Sleep to Plymouth College of Art in partnership with the Open

University as a written research project towards the degree of Bachelor of Arts by study

in BA (Hons) Graphic Design on March 14th 2014”.

I certify that all material in this project, which is not my own work, has been identified. Signature……………………………………………………………………………

 

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Abstract:

Autism is a pervasive developmental disorder that affects how a person

interacts with other people. The disorder is becoming more prevalent in

today’s society due to both genetic and environmental factors. Children are

currently the most affected by autism. Therefore there must be a therapeutic

intervention that can be created to help autistic people.

With autism affecting more children that ever before (most of all boys), it

seems that our community needs to start thinking about how to help treat

autistic people.

This writing will investigate whether or not our creative community are making

effective therapeutic design. The investigation will highlight three design

examples, these being a gestural interface technology, an environmental

design index and a humanoid robot technology. After exploring these designs

the results will suggest what people have done, are doing and will be doing to

help autistic people.

The results show that these examples of therapeutic design are in fact

effective. The gestural interface technology proves to be an effective asset for

an autism care centre in the US. The environmental design index has become

an international reference for architects and carers. Furthermore the

therapeutic robot is providing autistic children with a comfortable way to

communicate.

The implication of these results is that effective design is being created and

that there are therapeutic solutions still being developed that can potentially

change autism therapy forever.

 

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Contents: Section Page Number

1

Acknowledgements 5

2 Introduction

6 - 8

3 Gesture-based Technology

9 - 16

4 Therapeutic Environment Design

17 - 22

5 Future Technologies

23 - 27

6 Conclusion 28 – 30

7 Bibliography 31 - 35

 

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Acknowledgements:

I am thankful for the guidance and support of my contextual tutors Maddy

Pethick & Paul Singleton. Maddy’s support during the early stages of my

dissertation research was truly helpful and gave me direction I needed. Paul

was able to guide me at a much later part of the writing, which aided me in

creating my final version of the dissertation.

I would like to thank family and friends that have taken the time to support me.

Whether it was informative conversation or reading through pages of my work,

it was a great aid to me and I am grateful.

Finally I would like to thank Kelly Shorland. Her interview provided me with

valuable information that has helped me with all of my current projects.

 

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1. Introduction:

Pervasive developmental disorders are becoming more common in todays

society (Volkmar, 2005). There are many variations of these disorders; the

most common are autism and Asperger syndrome, both affect the person's

ability to cope with everyday life (Nguyen, 2006). This essay will focus on

autism and analyse therapeutic design available for autistic children. It will

question whether the community is doing enough to assist people with

disorders and if so what the therapy is capable of achieving.

The National Autistic Society (NAS) states that more than 700,000 people

suffer from autism in the UK alone. The society also states that autism

presents itself within the first three years of a person’s life, meaning that

children are currently the most affected by this disorder (National Autistic

Society, 2014). Prevalence studies in the USA have shown that there has

been a 210% rise in the amount of people affected by autism between 1987

and 1998 (Hollander, 2003).

“A mental disorder characterized by severely abnormal development of social interaction and of verbal and nonverbal communication skills.” – Stedman’s Medical Dictionary (2000)

The medical definition proceeds to explain that autism effects social

development in three main areas, interaction, communication and

imagination. This means that being involved in social interaction can cause

autistic people severe anxiety and stress. The disorder is part of a spectrum,

meaning that the effects can vary between people; hence some people are

able to live relatively normal lives, while others need full-time, specialist

support (Stedman, 2000).

This writing will highlight three examples of therapeutic design, those being

gesture-based technology, environmental optimisation and future innovation.

These projects will support this investigation by showing how they are

beneficial towards autism therapy. By analysing three examples of design

 

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there will be trends that appear in multiple studies, thus showing the

limitations and benefits of current therapeutic design.

The importance of this factor is due to the amount of people that are currently

suffering from this condition. Baird et al. studied children in South Thames,

London in 2006. The investigation shows the prevalence rate was 38.9 (per

10,000), which was the highest rate to date. The population targeted was over

56,000, meaning that the results were likely to be exceptionally valid (Amaral

and Dawson et al., 2011).

The key research used in this investigation will include an interview with

autism specialist Kelly Shorland, creator of the Auty Not Naughty campaign.

Other research will include studies and references from local libraries and the

Internet.

The term therapeutic design relates to all forms of design that can be

beneficial towards the autistic community. This can be in the form of

technology, product design, architecture and other concepts that undergo a

design process. This was the boundary for the studies that are referenced.

The first section will analyse gesture-based technology. This relates to the

different technologies that allow interaction via movement of the users body.

While this type of technology has been available for some time now, only

recently have specialists began customising the experience for autistic

therapy (Felicia, 2012). The Xbox Kinect gaming console will be the main

technology investigated during this part.

This essay will then progress into the examination of therapeutic environment

design. This consists of the architectural design quality in order to create

buildings suitable for autistic people. These environments can come in the

form of schools, classrooms, living quarters and more. Until recently there

wasn’t a specific way of indexing how this kind of work was created, meaning

the quality was far from beneficial (Nguyen, 2006). This section will study the

autism-based design index created by Dr. Magda Mostafa.

 

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The final part of this investigation will analyse future technologies. This relates

to any design concepts for autistic people that are enduring development. The

technology examined in this section is the ASK NAO. The NAO is a robot that

can encourage autistic children to take part in social interaction (Joubert,

2012).

 

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2. Gesture-based Technology:

Autistic children who suffer from these mental disorders are now able to

practice social interaction and stimulate their brain using something they love,

technology (Craddock, 2003).

"We have heard from many parents about how much their children enjoy mobile devices like the iPad, and how it is helping with learning and communication." – Andy Shih, senior vice president of scientific affairs at Autism Speaks in New York City (2013)

Shih proceeds to explain how these devices are being researched currently

so specialists can understand the impact they are having on autistic children

and their families. These hands-on devices range from the small iPod Touch

to larger games consoles that can recognise the movement of the whole

body. With new technology becoming available to schools and autism

specialist centres, there are new ways to encourage children to interact with

each other and stimulate brain activity (Mintz and Gyori et al., 2012).

The Xbox Kinect is one of the consoles that allow physical gestures to be

used to interact with a gaming experience. Microsoft created the Kinect, which

is a camera and sensor combination that allows the technology to recognise

physical movement (Park, 2012).

Despite Nintendo’s Wii being a huge success in 2006, the Kinect service

allows a much more refined experience without the need for any controller.

This is labelled a limitation for autistic children due to the combination of

buttons and movement. The Kinect technology allows players to use purely

physical movement to control the whole Xbox interface. Whether it navigating

the main menu or actually playing a game, the users interact using only their

body (Park, 2012).

 

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“What surprises me most is the stories I have heard from people…” - Alex Kipman, general manager of incubation for Microsoft's interactive entertainment business (2011)

Kipman proceeds to explain that a mother of an autistic child told him of the

delight she experienced because of this Kinect system. He says that the

technology was bought for an older sibling of the autistic child, who because

of autism had never interacted with technology or relatives unless it was

important. However when confronted with the Kinect system, the autistic child

began playing with others. Kipman used this story during a news interview to

emphasise the Kinect’s effectiveness (Tu, 2014).

An autistic care centre in the USA has started to utilise this technology in their

struggle to help treat autistic children. Lakeside Centre for Autism has

implemented the Xbox Kinect feature into their learning schedule and has

received surprising results because of it (Kagarise, 2012).

The Centre has become internationally recognised for the way it deals with

stimulation tasks for Autistic children. The story of the success with Kinect has

been covered on CNN news and has been included in multiple newspapers,

as well at being featuring on Microsoft’s Kinect website (Kagarise, 2012).

The Lakeside Centre for Autism was founded in 2002 and has helped over

800 families by treating the autistic tendencies of their children. The centre

holds 1700 appointments a month in hope to consult as many people affected

by autism as possible (Kagarise, 2012). The CEO, president and founder of

the centre - Dan Stachelski - explains his own interpretation of autism and the

perks of using technology like this in a video publication created by Microsoft.

“If you could imagine having your hands tied, having a blindfold over you and having tape over your mouth, that’s what these kids feel…” – Dan Stachelski, CEO, president and founder of the Lakeside Centre for Autism (2011)

The interview with Stachelski helps to suggest what the benefits of using the

Xbox Kinect can be. He begins to explain some of the learning outcomes and

 

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treated characteristics that he was beginning to see when they implemented

the Kinect. During the interview he mentions that the gesture-based learning

stimulates problem solving skills, coordination, enthusiasm, participation, peer

interaction, eye contact, turn taking and increased general social activity (The

Kinect at Lakeside Centre for Autism, 2011).

"In many cases, researches have found, autistic children easily interact with an onscreen avatar that mimics their motions - the game world is more predictable and less threatening than real life." – Dan Stachelski, interview with USA Today (2012)

It is clear that the interactive part of this technology is what makes it so

effective with autistic people (Kientz and Goodwin et al., n.d.). Stachelski’s

claims that the Kinect experience is so natural and fun that it distracts the

children from the factors that normally restrict them socially. He suggests this

is why the console is being so successful with children’s learning, and why it’s

branching out to more schools and therapeutic centres (The Kinect at

Lakeside Centre for Autism, 2011).

The benefit to using the Kinect for autism therapy is how it’s more interesting

to children than other forms of therapy. Therapists from the Lakeside Centre

are getting results from this system that they haven’t been able to achieve

ever (examples provided later). This is all supported by other helpful

characteristics, the cheaper price and easier configuration (Smith, 2013).

“A student playing a Kinect game for a few moments moved his arms up and down in unison for the first time, something our therapist was trying to do for six months." – Stachelski (2012)

While the Xbox Kinect’s success at Lakeside may not allow us to generalise

the fact that all activities on the Kinect are therapeutic for autistic children. The

system encourages more than just social interaction; Kinect can have players

running on the spot, jumping and swinging their bodies in order to complete

game objectives (The Kinect at Lakeside Centre for Autism, 2011).

 

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This moves the investigation onto another of this innovative technology;

Autism has been known to limit the speech, communication and physical

strength as well as general social skills (National Autistic Society, 2014).

Fortunately specialists at Lakeside have been able to notice growth in these

areas as well during tasks on the Xbox Kinect (The Kinect at Lakeside Centre

for Autism, 2011).

The first specialist, Vina Sargent, a speech language pathologist has been

able to use this system to target therapeutic goals in the children’s language

skills (The Kinect at Lakeside Centre for Autism, 2011). Autism’s effect on

language can cause many common deficiencies, these can be:

Difficulty understanding communication: In some cases difficulty can slow the

communication process as well as limit how well the autistic person can

respond. This has a negative impact on communication with peers, hence it

will be reflected in social confidence (Amaral and Dawson et al., 2011).

Difficulty imagining: This is the struggle that autistic people undergo when

trying to picture life from another perspective other than their own. This is

reflective in their lack of care for others both physically and socially (Amaral

and Dawson et al., 2011).

Difficulty understanding behaviour: This is the lack autistic people understand

physical behaviour, such as body language. They are unable to pick up on

physical communication such as eye contact, posture and hand gestures.

This again has a negative impact on how autistic people view social

interaction (Amaral and Dawson et al., 2011).

Difficulty with pronunciation: This is common within the autism spectrum.

There are many different ways saying words can be difficult for autistic

children. This can be speaking through the nose, the lack of tone in the voice

(Robotic Sound), repetition of sounds and sometimes a high-pitch sound

rather than words (Amaral and Dawson et al., 2011).

 

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The Lakeside Centre for Autism’s therapy targets all of these areas in their

curriculum. Language specialist Vina Sargent states that all of these areas of

the disorder are positively influenced when children use the Xbox Kinect, as

well as other traits (The Kinect at Lakeside Centre for Autism, 2011). Vina

explains how using something like the Kinect can have an impact on the

language therapy.

“From the time we decide that’s our idea, to the time we choose our game… everything facilitates language, answering questions, problem solving… it’s so supportive of taking turns, playing with peers and the verbal sharing of ideas.” – Vina Sargent (2012)

Vina elaborates on how fast the therapy progresses when using the Kinect.

She explains how previously therapeutic tasks would create stress for the

children and would often lack positive outcomes. The children are now willing

to communicate with each other and share experiences because they have a

more positive experience (The Kinect at Lakeside Centre for Autism, 2011).

Mari Therrien is Lakeside’s head in physical therapy. She speaks on behalf of

the whole physical unit and states how the Kinect has allowed the children to

achieve goals that haven’t been met until now.

“We tried to figure out how we could adapt our goals to fit the things that can

happen in the game…” – Therrien (2012) Therrien explains how easy it is to

link the children’s therapeutic goals to rewards in the games on the Kinect.

She mentions one particular child and describes how autism has affected him

physically. Another common symptom of autism is limited regulation; this

means the child struggles with coordinating different parts of his body

together. This child in particular has exceptional difficulty when trying to use

the left and right side of his body simultaneously, meaning tasks like playing

the Kinect should be impossible. However with the help of Kinect therapy,

Therrien has seen him coordinate his body in ways that he hasn’t ever outside

of this experience (The Kinect at Lakeside Centre for Autism, 2011).

 

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Therrien explains that his motivation has allowed him to push himself to the

point in which he can use his body naturally, perhaps how he would if he

hadn’t been born with autism. This child has seen exceptional progress during

the Kinect tasks, yet still lacks significant progress within other therapy. The

Kinect system has revolutionised autistic therapy by creating an interactive

gaming experience that is so encouraging it motivates children to get involved

more effectively compared to other forms of therapy (The Kinect at Lakeside

Centre for Autism, 2011).

Autistic people can also be challenged by motor planning, meaning their core

muscles are abnormally weak. Decreased strength in core, stomach, legs,

arms and back means that children will be less likely to cooperate when

asked to participate in physical activities due to the stress and pain they

encounter (Smith, 2013). Therrien explains the general effects the Kinect can

have on the children’s physical health. The children can practice physical

coordination, and the movement they undergo whilst using the Xbox has been

shown to strengthen muscles (The Kinect at Lakeside Centre for Autism,

2011).

Therrien explains that using the Kinect allows children to take part in more

physical activities thanks to the console motivating them to use basic

movement. She explains that before everyday activities proved difficult,

however now children are able to sit up straight, handwrite, and dress

themselves independently (The Kinect at Lakeside Centre for Autism, 2011).

If using technology like the Kinect can have such a positive effect on most

areas of autism its clear why the Lakeside Centre has been so

commercialised by using the console for therapy. The progress Kinect has

had with the therapy for the three main limitations of autism (Language, Social

and Physical) has been an eye-opener to how therapeutic intervention works

for Autistic children.

To conclude this first section of the investigation into whether or not there is

effective therapeutic design for autism, the essay must provide criticism about

 

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this gesture-based technology. There are not many studies from recognised

specialists into how therapeutic this technology can be, however it is easy to

apply studies analysing other areas of technology to this particular device and

see where there may be issues.

One issue that has been recognised is how these children react when

something doesn’t go smoothly; for example if a level is too hard the child

may become aggressive. If there are games that are too difficult for certain

children there will be the chance of stress and feud, as these children struggle

to restrict their anger at times (Attwood, 2004).

A questionable factor could be how effective were the games that weren’t

design for an autistic audience going to be. However Microsoft has answered

this limitation by releasing a Kinect Software Developing Kit. This kit will allow

programmers to implement therapeutic aspects into the system to make the

experience more beneficial (Felicia, 2012).

"Nobody thought of it as a therapeutic device, but it turns out you don't have to look very far, you don't have to scratch very deep, to go, 'Wait a minute. There's something really cool here.'” – Marc Sirkin, Autism Speaks VP (2012)

Sirkin from Autism Speaks explains how although people overlook the Kinect

as a “Therapeutic device”, it is currently being adapted into teaching

schedules as well. He lists a few examples of what the Kinect is capable of

teaching children, those being math instruction, book criticism, science,

history and geography.

A new team of specialists are using the Kinect Software Developing Kit to

create educational games especially for children with autism. The group is

made of two members of the Lakeside Centre for Autism and both an Xbox

developer and designer. They have labelled themselves The Kinetix Academy

and they plan to “Kick Autism’s ass!” by creating games that focuses on

particular tasks relative to a child’s therapy. The team are also using the

 

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Kinect to collect data from these institutions to try and understand more about

autism therapy.

This means that while it’s clear the Kinect system may not be the ideal

therapeutic technology for autistic children, it is a huge step forward into

gesture-based learning and has helped start a new company that aim to

create a new type of therapy that children can enjoy.

 

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3. Therapeutic Environment Design:

This section will investigate into how designers provide customised

environments for people with autism and how it can reduce autistic struggle in

everyday life. Creating an autism-friendly environment needs to accommodate

for the social, sensory and physical factors of the disorder, so the experience

in that space can be as smooth as possible.

A publication by the National Autistic Society highlights some of the

considerations for people when creating an autistic-friendly environment. Anh

Nguyen speaks on their behalf:

“Many people with an ASD have sensory sensitivity. This can affect one or more of the five senses – sight, sound, smell, touch and taste.” – Anh Nguyen, Area Development Coordinator for the National Autistic Society (2006)

Nguyen explains that these “over-developed (hypersensitive) or under-

developed (hyposensitive)” senses have an increased impact on how autistic

people experience certain situations. This means that environmental factors

such as background noise or temperature can cause autistic people unnatural

amounts of stress and sometimes pain (Nguyen, 2006).

These factors can be witnessed by carers and dealt with, however it seems

that actually designing a building that can cater for these autistic factors is

much more effective intervention. Until a decade ago there was difficulty in

creating spaces that could accommodate for autistic people specifically, this

was due architects lacking first hand experience of autism.

In 2003 Christopher Beaver published an article in the NAS magazine that

changed the way designers created these environments all over the world.

The article Breaking The Mould provides information that shows an innovative

way of creating an autism-friendly building without an inhumane design.

 

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“Talk to any carer and the ideal house from a management point of view will have easy-to-clean surfaces, robust finishes and everything as unbreakable as possible. It sounds like a brief for a prison!” - Christopher Beaver, Breaking The Mould (NAS article) (2003)

Autism can be linked with aggression, disruption and self-injury (Baer, D et al.

1968), meaning that accommodation and learning environments must

accommodate for these situations, as highlighted by Beaver in his article.

There are many factors that have to be considered when designing a building

for autistic people; hence it is easy to see why this hadn’t been done before.

“The heart of the brief cannot be written down. It has to come from an understanding of the autistic mind; the things that are comforting and give a sense of security, a feeling of space where there are places for being alone and for socialising, an easily understood geography with no threatening or over-stimulating features.” – Christopher Beaver (2003)

Beaver expresses the dedication that needs to go into creating such a

building for disorderly people. He continues by listing aspects of his building

design and saying why they are vital. One example he uses is the skylight

windows in the “steep” ceiling that allow quick ventilation and temperature

control, but don’t offer an “escape route” for stressed children. This shows

how important it would be to have knowledge of autistic behaviour before

considering starting a building design; there are many unusual circumstances

that the design must cater for (Beaver, 2003).

The project Beaver refers to is the residential accommodation for a school in

the West Midlands. Sunfield School was fortunate enough to have him

present during behavioural meetings so he could begin to understand what

the children were capable of. It is clear that unless an architect was able to

witness what the children were capable of first hand, then the design process

was going to lack sufficient support and not be as effective.

“We have spent many hours listening… talking about their children, their behavioural characteristics and generally learning about autistic spectrum disorders.” - Christopher Beaver (2003)

 

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Architects also have to be aware of the SPELL considerations. This is a

framework created to help facilitate the needs of people with autism. SPELL

stands for structure, positive, empathy, low arousal and links. This ensures

that all planning, design and building will accommodate for each section in the

following ways:

Structure: This relates to routine needed in autistic people’s lives to help

reduce anxiety and stress. Buildings must accommodate factors that limit

factors that will force change in routine.

Positive: This refers to having a positive attitude throughout an autistic

experience. Encouraging the autistic person is important so that they can

reach realistic goals; carers need to be patient and willing in order for them to

be helpful to autistic therapy.

Empathy: Being empathetic towards an ASD sufferer is important, as they

interpret the world differently so there after often obstacles where there

wouldn’t be when caring for someone without autism.

Low Arousal: Due to people with ASD being so sensitive to environmental

factors such as smell, light, noise and heat the proposed design needs to

show significant ways of how to reduce these factors.

Links: The final part of the criteria relates to how carers and parents need to

have consistency in communication. This can be in the form of language or

even how tasks are executed. The physical space needs to be able to be

supportive for varied forms of therapy.

Dr. Magda Mostafa created something much more spectacular than a single

building design. Mostafa created The Autism ASPECTSS™ Design Index and

was the first index created for autism-friendly environment design (Quirk,

2013).

 

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In 2002, whilst studying a PhD, she was asked to design Egypt’s first

educational facility for autism. During the project Mostafa realised that there

weren’t any guidelines for architects in place that could help create such a

facility. In an interview with ArchDaily, an architectural news company, she

expresses there was “virtually nothing” for her to be influenced by (Quirk,

2013).

“If you think of the primary problem of autism being understanding, coping with and responding to the sensory environment, you can grasp the power of architecture in their everyday lives.” – Dr. Magda Mostafa (2013)

Mostafa used this opportunity to create her own index that could be used as

guidelines in her exact circumstance at the time: the creation of a therapeutic

environment for autistic people. She began setting up studies that would allow

her to gather primary information into autism.

Mostafa’s studies were labelled “among the first autism design studies to be

prospective not retrospective, have a control group, and measure quantifiable

factors in a systematic way” (International Journal of Architectural

Research. Volume 2 Issue 1, 2008) therefore her supporting studies were

exceptionally valid.

After six years of research and development, the ASPECTSS index was

finished. Mostafa’s index is now used internationally and serves as a guideline

for new builds as well as being referenced by autistic facilities already

created. The benefit of this index doesn’t stop there; architects are able to

reference ASPECTSS to receive other information gathered by Mostafa’s

studies into autistic behaviour.

Mostafa provided an informative example of her study into autistic behaviour

in an interview with Autism Daily Newscast. This was how to avoid “the

greenhouse effect”; the term describes how autistic people can become too

comfortable in these autism-friendly zones. She explains that gradual

 

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exposure to outside environments is beneficial to autistic people, so that they

don’t become too complacent with their sensory-aware environment.

One limitation Mostafa has encountered is how funding sources overlook her

index, meaning her research is limited to a strict budget. Her interview with

ArchDaily portrays how she has struggled with funding since the beginning of

this project.

“The biggest challenge, as with most research is funding. This topic lies – where I believe much of the innovations of our future generations lie – at the intersection of many disciplines” – Dr. Magda Mostafa (2011)

Mostafa says due to there being no previous index like this, financial parties

focus on more physical factors such as staff training, curriculum design and

therapy intervention. This may not be a bad thing, however it does limit what

research can support the growth of Mostafa’s index and therefore affects the

potential of therapeutic environment design (Henry, 2011).

The importance of the index’s development should be more of a concern than

it is currently. Studies show that there are many therapeutic ways to enhance

an autistic person’s environment and that it is highly beneficial towards their

disorder. While it can be easier to fund the physical aspects of therapy, there

is no doubt funding an index that can include all forms of this therapy will be

more beneficial (Joss, 2014).

An example of environmental success is the study into sensory stimulation in

young males by Cynthia Woo and Michael Leon. This study led to the

discovery of how sensory enrichment could lead to significant improvement in

communicate and behaviour. The study involved the autistic children

undergoing various sensory stimuli everyday for six months (Irvine, 2013).

The results show that providing children with such enrichment can lead to

better health and can limit the effects that autism has on their language and

communication. Woo states “this therapy provides a low-cost option for

 

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enhancing their child's progress”; this means that therapy doesn’t necessarily

have to be expensive in order to provide good results (Irvine, 2013).

 

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4. Future Technologies:

The final section of this investigation will focus on innovative design concepts

that have been designed recently and are still being tested and developed for

autistic people. There are revolutionary technologies that, once advanced

enough, will be able to change the way we treat autism forever.

While there are no effective drug-based treatments for autism, there have

been scientific breakthroughs in how brain stimulation can return brain activity

to a “normal” state. Scientists of the EU-AIMS (European Autism Interventions

- A Multicentre Study for Developing New Medications) have been exploring

into a gene called Neuroligin-3 using tests on mice.

These tests have proven that encouraging regular brain activity in these

autistic mice can allow for a natural amount of Neuroligin-3 to be produced.

Meaning these mice are able to begin recovering from the “autism-like”

changes in the brain (Pavilion Publishing Ltd, 2013).

“We have also demonstrated proof of concept that abnormal brain activity in adults with autism can be reversed by modulating brain serotonin. We now want to see if we can translate those findings to the clinic.” - Professor Declan G Murphy, head of the Department of Forensic and Neurodevelopmental Sciences (2011)

Referencing this particular study supports the fact that in the near future,

when we have a better understanding of autism, the treatment for this

disorder will be in the form of brain stimulation rather than a drug or medicine.

Despite there being medication that is helpful for autistic people, treatment

that targets the source of the disorder is much more effective. This can be in

the form of sensory, physical and “psychoeducational” therapies (Tyrer and

Silk, 2008).

Therefore this section will study the ASK NAO, a robot that is able to interact

with autistic children in order to develop social and language skills. The robot

 

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was designed and created by Aldebaran Robotics; a French company that

specialises in manufacturing humanoid robots. In 2008 Aldebaran created

their first NAO (Robot) and due to the robots success, it replaced all previous

robots used for academic purposes.

Aldebaran donated NAO robots to autistic schools in 2012; these NAO were a

new generation of the robot, featuring better hardware and software. This

meant that the robots were going to be smarter and more robust, which are

the ideal characteristics for use with autistic children. One of the first sets of

NAO donated was used at Topcliffe Primary, a school in the UK that helped

teach autistic children.

"The robots have no emotion, so autistic children find them less threatening than their teachers and easier to engage with." – Ian Lowe, head teacher of Topcliffe Primary School (2012)

Lowe continues to explain that roughly a quarter of the children at the school

are autistic. The school receives specialist support and funding, which is used

to create separate environments for autistic children and allows funding for

the appropriate technology.

"They are really cute looking. Children with autism struggle with communicating with adults and with other children, but for some reason they engage with these robots.” – Ian Lowe (2012)

The NAO robot is a knee-high humanoid robot that is capable of realistic

movement and interaction. The NAO can perform life-like actions such as

dancing, comedy sketches, play football, and affectionate interaction. The

“cute” robot is present in the classroom alongside teachers and encourages

children to complete basic tasks that train memory, phonics and imitation.

Aldebaran also programmes these robots, meaning that they customise the

NAO’s characteristics to be used with autistic children. The aim of this version

of NAO is participation; the children are motivated by the robot to take part in

tasks that enhance their social interaction and language communication skills.

Due to the predictability of the robot, the children are much more comfortable

 

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interacting with the robot than any teacher or carer (Krichmar and

Wagatsuma, 2011).

The children are learning more with this robot, as they feel more comfotable in

the NAO’s presence. The amount of information these children have to take in

is limited and controlled, hence developers and carers can now be disciplined

with how much social information they give to the children. The autistic

children don’t have the stress of dealing with interpreting body language, eye

contact or facial expressions (Krichmar and Wagatsuma, 2011). These are

the main factors that can make social interaction difficult for autistic children

(Schopler and Mesibov, 1986).

"Children who first come into school unable to make eye contact with humans

start to communicate through the robots." – Ian Lowe (2012) While this

technology seems to be very helpful for these autistic children, there are a few

drawbacks that can affect this robot becoming the next step for autistic

therapy. The first and most notable limitation of the NAO is it’s cost - despite

Aldebaran donating robots to autism-specialist schools here in the UK– the

price is currently £15,000 for a single robot and a year’s support (Burns,

2014).

Another consideration is that the NAO needs further development, due to its

accidental discovery of it being a success with autistic children. Dr. Olivier

Joubert explains that Aldebaran stumbled across its spontaneous effect on

autistic children during a conference.

Joubert explains that Aldebaran have donated NAO robots to the USA and

UK due to the developed autistic communities there:

“The autism community is stronger in the UK and USA… French schools are generally not ready to integrate technology like NAO.” – Dr. Olivier Joubert (2012)

Joubert elaborates by saying that while there is no cure for autism; he feels

that the NAO is proving to be a step in the right direction. Joubert continues

 

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by stating that Aldebaran has still labelled the NAO a “prototype”, meaning

that it is still early days for the robot and that there is still a lot of potential for

what it can achieve. The final statement by Joubert highlights that while 70

percent of children are “spontaneously attracted” to the NAO, it is still

unavailable for purchase to the general public and can only be acquired by

legitimate institutions for autism therapy (Quirk, 2013).

Although the NAO have a high cost to manufacture and support, it seems

there is a reason for this. The NAO are proving to be a link for autistic children

by introducing social factors that they are not confident enough to experience

for real. The robots are collecting information constantly and are able to

create a database including results from tasks for each individual child. They

can then link this information to the correct child in the classroom by using

either facial or voice recognition (Krichmar and Wagatsuma, 2011). Therefore

the technology needed to complete these tasks must be the reason for this

high price.

Initial research by Aldebaran into the information gathered by the NAO

suggests that when the NAO is present in a room with an autistic child, the

number of times the child interacts socially is increased by 30 percent. These

results cannot account for the success with all autistic children, due to them

being from just two prototype robots. One of which was from the UK,

Birmingham for autistic children aged 5–10, the other was used in the USA,

Massachusetts with children aged 3–5.

It is clear that Aldebaran aim to continue expanding on this innovative

technology by developing more ways NAO can influence autistic children. The

robot has recently become the most widely used humanoid robot for

academic purposes (Aldebaran, 2013).

“We visit each school every two weeks so we can get a better understanding

of how teachers use NAO in the classroom.” – Olivier Joubert, (2012)

If this commitment to the autistic community continues then the NAO may

become more customisable for autistic audiences of varied levels. This will

 

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allow Aldebaran to endure work with schools and parents to have an even

bigger impact on tackling autism. Until this happens it is difficult to analyse

how effective the NAO will be for autistic children, as there is still potential for

how therapeutic the robot can be.

One final reference that reflects the NAO’s potential future success is from Dr.

Karen Guldberg, director of the university's Autism Centre for Education and

Research. She speaks to BBC about her experience with the NAO and how

she feels about it therapeutic influence.

"We are thinking creatively about how best to programme these robots to help develop the children's social interaction and communication skills." – Dr. Guldberg (2012)

This quote suggests that not only Aldebaran will be working on making these

robots more effective towards the therapy of autistic children. Researchers at

the University of Birmingham have supported the fact that the programming of

this robot is what can make the NAO a beneficial therapeutic device.

Therefore Aldebaran is working with autism specialist companies to plan how

they can continue to progress the NAO (Burns, 2014).

"If you can meet the needs of children with autism you can meet the needs of all children, when people feel safe and are motivated they learn much better." – Dr. Guldberg (2012)

This statement shows how confident Guldberg is in the progression of this

technology. Meaning that the NAO may prove to be a therapeutic learning

asset to children who don’t suffer with autism. This is an interesting concept

and it will be exciting to see what Aldebaran’s ASK NAO is capable of

achieving in the future.

 

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5. Conclusion:

The main aim of this investigation was to found out whether or not designers

are creating effective therapeutic design for autistic children. The three

examples of “design” included in this investigation were: architecture and

environmental design, gesture-based technology and future technology.

This study intended to highlight three studies into different areas of design

and see how they could be beneficial towards the autistic community. In order

to create a significant examination of therapeutic design, finding diverse

examples of autistic therapy was the priority. The results have shown that all

the therapeutic interventions included within this essay are currently having a

positive impact on treating autistic children.

Each example provides solutions for the different symptoms of autism. The

Xbox Kinect system provided to be a new therapeutic technique for The

Lakeside Centre for Autism. The gestural interface not only improves

children’s motor skills, it also helps motivate children to take turns and show

respect for other people. Furthermore this can be achieved for a realistic

price, thus allowing parents to begin therapy at their own natural pace (Smith,

2013).

The Autism ASPECTSS design index has proven to be a suitable reference

for architects and carers to help them create an autism-aware zone. The

index is useful to anyone who intends to help make an environment more

suitable for autistic people. The index can also be used as a reference for

parents; there are small, practical modifications that can be made in any

environment to make it safer and more comfortable for autistic children

(Nguyen, 2006).

The NAO robot had become the next step in social therapy for autistic

children. Aldebaran has created a social intervention that children can relate

to because of its harmless appearance and predictable behaviour. This is

 

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allowing specialists to begin communicating with children that are

unresponsive to human interaction. The robot is still being developed, so the

NAO robot has the potential to completely remove the social barrier that these

autistic children experience. Furthermore the NAO is becoming the perfect

balance between technology and therapy. Autistic children want to undergo

“therapy” because the robot makes it fun (Griffiths, 2014).

The significance of this matter is becoming more serious due to studies

showing that autism is becoming more prevalent. While there are many

sources that suggest this could in fact be because of the better diagnostics

present today, a percentage of our population is affected by autism so there

should be support and funding in place that can be applied to autism therapy.

After investigating into therapeutic design, its clear that the one limitation that

affects current projects the most is finance. Two of the studies have shown

that with an increase in funding more could be done towards designing,

creating and executing innovative therapy. This may be a predictable

limitation, however it seems that investors often overlook these innovative

concepts because they aren’t categorised by any current definition. It seems

that creating design in new avenues intimidates these financial assets.

The main findings were that there is effective therapeutic design and that

there are designers that can potentially change how autism therapy works

forever. The kinect and NAO studies both show potential to affect autism

therapy in the future.

The Kinetix Academy will look to alter the Xbox Kinect so it can work

specifically for autism therapy. The company plan to create their own

educational and therapeutic games for autistic children.

Aldebaran is going to develop the programming of the NAO, which will allow

them to improve how the robot acts with autistic children. The company also

plan to work alongside French Cap Design in the creation of Romeo. Romeo

 

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is a larger version of the NAO robot that can participate in physical tasks like

opening doors and helping people to their feet.

Therefore there is sufficient therapeutic design and more people are getting

involved with helping autistic children.

 

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