How robots are helping children with autism

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autism, body movements, chest monitor, Children, classroom, communication, early diagnosis, emotion, facial expressions, family, feedback, interaction, modes, motions, non-threatening, non-verbal communication, reactions, research, robot, social interaction, social skills, teacher, therapist, treatment, withdrawal

How robots are helping children with autism

Anthony Arceri is seven and has autism. His clothes are covered in sensors, and he is standing in front of Zeno, a smiling, 2ft-tall robot. “What is your favourite food?” Zeno asks Anthony. “Chocolate milk and french fries.” “I love chocolate milk,” Zeno replies. The robot raises its arm, and Anthony copies. Zeno rubs his stomach, and so does Anthony.

It looks like fun – and for Anthony, it is. But researchers believe the interaction between Anthony and the robot also holds the key to early diagnosis and treatment of autism. Zeno is the result of a collaboration between Dr Dan Popa at the University of Texas at Arlington, Hanson RoboKind, Dallas Autism Treatment Centre, Texas Instruments and National Instruments – and is the brainchild of Hanson Robot owner and former Disney imagineer David Hanson.

Diagnosis of child autism has traditionally taken place through social interaction and speech exercises. This means that, until a child can speak, diagnosis is either a lengthy process, or can’t happen. But Zeno can interact with children through nonverbal communication such as body movements and facial expressions, speeding up diagnosis and perhaps even enabling it to be carried out before a child can talk.

Zeno isn’t just used for diagnosis. Children with autism can sometimes find social interaction threatening – making them withdraw, even from family members. Robots such as Zeno have features that look slightly human, but are obviously not human. This makes communication, with all its complex and frightening subtleties and nuances, less complicated and more comfortable for the child.

Anthony’s mother, Pamela Rainville, found out about Zeno from the Dallas Autism Treatment Centre, and thought the project might benefit Anthony. “It’s always good for him to be put in different situations, things outside his normal routine. Anytime he can be around other people, it’s a good learning and growing experience for him.”

So far, Anthony has had two therapy sessions with Zeno. Rainville believes he got more out of the second meeting than the first, and she expects he will get even more out of subsequent interactions with the robot. “This second time, Anthony fist-bumped Zeno, which was great. It shows he was a little more relaxed.”

Popa believes that Zeno is a good motivator for children as he is engaging and non-threatening: the children listen to the robot. “The idea is for the robot to instruct kids, give them some useful social skills and at the same time observe their reactions and calculate their reaction times. That calculation could form some kind of an autism scale.”

He says there are three ways in which therapists can use Zeno. “The first mode is called a scripted mode of interaction, where you pre-programme a certain sequence of motions. For the second mode, we have added a control system so we can have an operator or therapist control the robot by tele-operations. In this mode, it mirrors the motions of the instructor.”

In the third mode, the child can take control of the robot. “This can be unsafe as the child can do things – such as slap himself – that the robot will copy and possibly break. So we tend to use this third mode as entertainment only.”

Zeno now has a brother, Milo, as well as an international family. Zeno came first, and is used in research and classroom settings. Milo was created specifically to work directly with children. According to Richard Margolin, director of engineering at Hanson RoboKind and part of the team who developed both robots, some children with autism who had never spoken directly to an adult teacher spoke to Milo.

Milo looks very similar to Zeno. His expressive face is an important feature, because a characteristic of autism is the inability to read and connect with the emotions of others. Children are asked to identify the emotion shown by Milo from multiple choices on an iPad. Milo’s eyes are cameras, recording feedback. The child wears a chest monitor that records changes in heart rate and therefore emotion. A typical lesson would involve Milo and a child interacting one-to-one; the child responding to the robot with an iPad, and a therapist or teacher present to help if needed and record difficulties and progress.

One of Zeno and Milo’s international relatives is Kaspar, designed in the UK by the University of Hertfordshire’s Adaptive Systems Research Group. The size of a small child, unlike Zeno and Milo, Kaspar has a neutral expression so that children can interpret him how they wish. Research is under way to see how Kaspar’s use could support children with other developmental conditions, such as Down’s syndrome or attention deficit hyperactivity disorder, known as ADHD.

Another distant cousin is Nao, who was created in 2006 by Aldebaran Robotics and is being developed as a “house robot”. Along the way, Nao has been used as an educational tool, and the University of Birmingham’s Autism Centre for Education and Research worked with Aldebaran Robotics on a version of Nao to help children with autism. But like Kaspar, Nao has an expressionless face.

What seems to be unique about Zeno and Milo is the way that their expressiveness defies long-held robotic conventions. Designed to be the first advanced social robots in the world, they could eventually have an impact far beyond the diagnosis and treatment of autism. RoboKind envisages a broader role for its robots in educating young children. In the words of his creators, Zeno represents the future of robotics and could be “a wonderful addition to every household”.

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Doctors’ new prescription: ‘Don’t just exercise, do it outside’

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'park prescriptions', activities, environment, Exercise, exercise regime, health, health initiative, nature, obesity, outdoors, park, physically active, prescriptions, scenery, sedentary, stress, trail, wellness

Doctors’ new prescription: ‘Don’t just exercise, do it outside’

It’s become commonplace for San Francisco physician Daphne Miller to write prescriptions that look like this:

Drug: Exercise in Glen Canyon Park
Dose: 45 minutes of walking or running
Directions: Monday, Wednesday, Friday and Saturday at 7am
Refills: Unlimited

She estimates she has now written hundreds of prescriptions for outdoor activity. “For some reason, it is much easier to keep up a movement or exercise regimen when it’s outdoors,” Miller says.

Perhaps it’s because of the varying scenery, the fact that monthly dues and expensive Spandex outfits aren’t required, or even because of what she calls “the camaraderie of the trail”.

Miller’s not alone. Faced with mounting obesity rates and a stubbornly sedentary population, physicians – especially pediatricians – are refining their exhortations that patients need to get more exercise.

Nationwide, they are dispensing thousands of prescriptions with specific instructions – not just going to a gym, but exercising in nature, at a park, along a trail. They’re literally telling their patients to take a hike.

“This is a lot more than getting people physically active. This is about getting them outdoors,” says Zarnaaz Bashir, director of health initiatives for the National Recreation and Park Association, a group that melds parks, recreation, the environment and now, health.

When terms like “park prescriptions” began popping up in 2008 or so, many experts viewed it as a niche idea.

“It was a quirky, fun play on words. I don’t think a lot of people thought there was going to be much substance,” says Kristin Wheeler, program director at the nonprofit parks advocacy group, Institute at the Golden Gate, in San Francisco. “Now, it’s been validated.”

The number of programs has risen steadily. Officials have identified at least 50 specific programs in the US, Wheeler says, but smaller ones may be under their radar, and new programs are popping up all the time.

The trend is spreading to other countries as well – including Australia, where a conference was recently held to discuss the health and medical benefits the country’s natural parks can offer.

In the UK, doctors are prescribing visits to Green Gyms, outdoor sessions run by a conservation group. The idea is to not only improve health and stamina through exercise and activities, such as planting trees, but also to benefit local green spaces.

A result of the green-prescriptions movement has been the unlikely teaming up of otherwise unrelated groups. The Appalachian Mountain Club, for example, forged a partnership in 2013 with MassGeneral Hospital for Children to prescribe regular outdoor physical activity for children.

“With so many proven benefits to getting active outdoors, AMC can help families take the first step in trying out new activities, finding places to explore, and making these outings fun for kids,” club CEO John Judge says.

An early proponent was Robert Zarr, a physician with Unity Health Care in Washington DC who quizzes patients about their interests, checks a searchable database for information on parks in or near their zip code, and then writes a script for specific activities. He told one obese teen to skip one of the two buses she takes to school and walk through a park instead. She ended up losing weight and feeling happier.

“We’ve really got this down,” he told attendees at a conference last year in Philadelphia. “I see this as no different from prescribing medicine for asthma or an ear infection.”

Across the continent in San Francisco, Miller says she has learned that formalizing her recommendation to get out in nature by writing it as a prescription is highly effective. “Well over 80% of patients try it, and many stick to it,” she says.

Mounting evidence shows benefits of being out and active in green spaces: less tension and stress, lower blood pressure, improved immune system responses, and milder ADHD symptoms in children. Japanese researchers have found that adherents to Shinrin-yoku – “forest bathing” – have lower levels of the stress hormone cortisol than study subjects who walk the same distance in a lab.

Beyond that, simply spending more time outdoors – versus in front of the TV screen or computer monitor – equates to an overall increase in physical activity.

Proponents say the nature prescriptions shift the focus of medicine from illness to wellness, leading to the potential for widespread changes in medical care.

Diana Allen, chief of the US National Park Service’s “Healthy Parks, Healthy People” initiative, is seeing mergers of medical schools and parks programs. “That’s wild,” she said. “I think there are going to be some new fields of practice.”

She acknowledges possible opposition from traditional practitioners and drug companies – “this goes against the money machine.” And patients who simply want to pop pills for whatever ails them also may balk.

Other than the doubtless eye-rolling of some physicians who may view the programs as gimmicky, participants in the Philadelphia conference had more practical concerns. Were the parks they would send children to safe? Would weather be an issue? Would lack of transportation be a barrier?

While early adopters of the philosophy simply leapt in without much of plan – it made intuitive sense, after all – organizers now aim to standardize programs so other communities can basically plug and play.

In Philadelphia, more than two dozen partners, including The Children’s Hospital of Philadelphia, are developing Nature Rx, a comprehensive plan aimed at ensuring that when kids show up at a park to “fill” their prescriptions, the staff is ready to welcome them with specific activities.

Gail Farmer, director of education for the 340-acre Schuylkill Center for Environmental Education and one of the organizers, says park audits will start this spring and physicians will begin writing prescriptions come summer.

Adopting standards also will help researchers who are moving to the data-gathering stage. Is it really working? Do people follow the prescriptions? And does their health improve as a result?

Wheeler has just finished an economic benefits analysis for the parks of San Francisco, which put the figure at $1bn a year.

“A piece of it is what we’ve known for a long time. People prefer liveable, walkable communities,” she says. “The big new piece is health benefits.” Those, they pegged at $50m in avoided health care costs.

Self-harm is not just attention-seeking: it’s time to talk openly about the issue

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attention-seeking, Bullying, causes, emotional distress, emotional pain, emotions, isolation, obsessions, pain, physical pain, professional help, relief, secret, self-harm, stress, teenagers, young people

Self-harm is not just attention-seeking: it’s time to talk openly about the issue

Three years ago, with her parents and sisters out for dinner, then-13-year-old Lucy found herself alone in her family’s Lincolnshire home. Dressed in her pink Tinker Bell pyjamas, she began to make herself a cup of tea. Then she spotted an object on the kitchen counter that immediately diverted her attention. “Shall I do it?” Lucy asked herself. “Will it stop the pain?”

For Lucy, now 17, that evening marked the start of a two-and-a-half year struggle with self-harm. Two weeks before, she had been brutally attacked and raped (which she now describes as “the incident”). At the time, anxious they wouldn’t believe her, Lucy never fully revealed to anyone what had happened. In her mind, she tried to repress the rape. She began shutting herself in her bedroom. She told her parents she was feeling unwell. Physical pain, she decided, was the only way to purge her pent-up emotional pain.

“When you keep all your problems in, it feels like you’re screaming inside,” Lucy says. “But when you cut or burn yourself, the pain is more physical. You feel like you’re releasing that scream. After a few months, self-harming became part of my daily routine.”

Eventually, both at school or at home, Lucy was self-harming four times a day. She wore black jeans, black tops and even black gloves to conceal her scars. “I pushed everyone everyone away” Lucy says. “I stopped caring about school. My grades suffered. Self-harm became a real obsession. It took over my life.”

Today, having made a huge effort to stop, Lucy has not self-harmed for more than six months. But self-harm is still on the rise among the UK’s young population. Data published last year by a collaborate study from England Health Behaviour in School Aged Children (HBSC) revealed that up to one in five 15-year-olds across the country self-harm. During the past decade, according to the same study, there has been a three-fold increase in the total number of UK teenagers self-harming.

What drives young people to self-harm? Therapist Jenna Mutlick, who has a personal experience of it, says it is usually some form of “self-punishment”. People believe they have done something wrong – even when they haven’t – and then feel they deserve the pain. “I know a few people who self-harm because they are bullied and eventually come to believe that they then deserve to be bullied,” she says. “When you self-harm, it is so hard to escape from the [mental] space that you are in.”

“It’s a very heterogeneous group of people who self-harm, and there are a variety of reasons why people might start,” says Professor Glyn Lewis, head of psychiatry at University College London. “Clearly, there are people who self-harm because they want to take their own lives, but there are also people who want to self-harm because they are in difficult situations or want to relieve stress.

“As a long-term strategy, of course, self-harm is not very effective,” he adds, “but people do report that they get some form of relief from upsetting thoughts or emotions. Some forms of self-harm are obviously very dangerous, but there’s a continuum. Some people may only scratch themselves very superficially, for example, which won’t do any long-lasting damage.”

The causes of self-harm are likely to be complex, even if the person harming does not see the issues in that way. Kieran, from Glasgow, began self-harming after five years of “constant” physical and verbal bullying at school. His parents split up when he was seven, though he says it was the bullying – which still torments him today – that incited his self-harming. “The bullying made me feel really unbalanced,” says Kieran, now 23. “I started to self-harm when I was aged 11, and it kind of just snowballed from there. I stopped eating. I isolated myself from a lot of my friends and family. I kept it a secret for almost a decade.”

Like Lucy, Kieran says that self-harming became a secret obsession. The bullying made him feel “physically and mentally numb”. Self-harm, by contrast, made Kieran feel more alive, and he would regularly self-harm in his bedroom at night. “It brought me out of my slumber,” he says. “It made me feel normal, and I became addicted to doing it for that reason.” He says that the self-harm was like an “adrenaline shot” that brings everything back into focus.”

Kieran admits that he still has a “daily battle” with self-harm. He is significantly better than he was a few years ago, though, when he would harm himself up to 400 times in one evening. “It’s a high level of emotional distress that causes people to resort to self-harming,” he says. “People sometimes feel like they can’t cope with their emotion. It’s how they cope with life’s daily stresses.”

Chris Leaman, from the UK mental health charity YoungMinds, says it is still very much a taboo subject in British society. “Every year, we work with Childline, YouthNet and selfharmUK to try and combat these sort of stigmas for Self-Harm Awareness Day,” he says. “There is a definite problem around young men not feeling like they can talk about their issues, which can make self-harm quite a common issue among them.”

“Some people do talk about self-harm quite openly, but that’s relatively unusual,” says Professor Glyn Lewis. “A lot of people conceal self-harming behaviour from their friends and family. There are not necessarily signs to look out for; it’s more a case of often asking people how they are feeling, and keeping communication open with them. As a rule, families and friends concerned about someone self-harming always should talk to the person themselves and encourage them to seek professional help.”

Statistically, teenage girls are still more than twice as likely to self-harm than young males, and this has helped create another gender-based stigma: that self-harming girls are simply seeking attention. Fiona Brooks, professor of adolescent and child health at the University of Hertfordshire, who led the investigations for last year’s HBSC report, identifies this as a prevalent problem. “Nowadays, young people are in a much more uncertain world than before,” she says. “Instead of self-harming just being dismissed as attention seeking, it’s something that needs to be taken seriously. Equally, if young girls are self-harming for attention, that’s a different matter that needs to be taken just as seriously.”

Lucy thinks back on that evening she started self-harming, and wishes that she could tell herself to stop – and talk to someone. Talking, like with most former self-harmers, has been a significant part of Lucy’s recovery, but she also credits her own determination as a decisive factor. “If you don’t want to stop, you won’t,” she says. “In the end, a lot of it comes down to how you see yourself. I used to feel people were always judging me, but now I feel I don’t care what they think. Why should I let them control my happiness?”