The use of Virtual Reality in children with Autism

Title:Development of symbolic play through the use of virtual reality tools in children with autistic spectrum disorders
Source:Herrera, G., Alcantud, F., Jordan, R., Blanquer, A., Labajo, G., De Pablo, C. (2008). Development of symbolic play through the use of virtual reality tools in children with autistic spectrum disorders: Two case studies. Autism, 12(2), 143-157. DOI: 10.1177/1362361307086657

In general, I tend to stay away from case reports (studies using one or just a couple of participants). Usually I don’t even read them, since most of the time I feel that, given what we know about methodology today, case reports should not even be published. I say ‘most of the time’ because once in a while a case report is published that reminds me why case reports are important: to provide us with insight as to where future research could focus. So I want to briefly review a case report published in the last issue of Autism as simply food for thought.

Clinically, the absence of pretend play in early childhood is one of the most common features of ADSs. Parents report that their children do not engage in imaginary or pretend play and do not use toys as expected when play requires symbolic understanding. For example, when provided with a box of Star Wars figurines, a child may simply line up the figures making patterns on the floor and may not use the figures to recreate situations or scenes as expected. The assumption is that the child does not view the figures as symbolic representations of people. The authors of this paper wanted to use Virtual Reality as a tool to teach children with autism to use symbolic play. There is some evidence that suggest that symbolic play is of significant importance for the development of several cognitive skills including language, spontaneity, intention, etc. Thus, the authors argued that interventions that teach children to use symbolic play could be of benefit to children with ADSs.

The authors used a computer virtual reality game “the Virtual Supermarket” to teach children to move from physically manipulating the objects (picking up items from the shelves), to engaging in functional play (dressing a doll with miniature clothing), to finally engaging in symbolic play (using a pair of trousers as an imaginary road). The authors used this game with two children, age 8 and 15, who had been diagnosed with Autism based on DSM-IV criteria. The two individuals received 28 sessions of this type of games during 2 ½ months. They were tested on a variety of measures before and after the intervention period. The authors stated that after the intervention period the children demonstrated improvement in functional use of objects, functional play (measured via the Test of Pretend Play – ToPP), symbolic play (ToPP), imagination understanding, and magic understanding.

Although this study suffers from the common limitations of case studies, it is extremely interesting, and it should encourage future research in the use of virtual reality as an intervention tool for the teaching of symbolic understanding.

Adults more tolerant when informed about Autism diagnosis?

Title: Adult Attitudes Toward Behaviors of a Six-year-old Boy with Autism
Source: Chambres, P., Auxiette, C., Vansingle, C., Gil, S. (2008). Adult Attitudes Toward Behaviors of a Six-year-old Boy with Autism. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-007-0519-5

A common experience reported by parents of children with autism is the perception of being ‘judged’ by other adults about their parenting skills or the appropriateness of behaviors displayed by their children. In order to understand this phenomenon, at team of French researchers conducted a very clever study using a methodology popular in social psychology research. The team showed clips of a video of a six year old boy with high functioning autism to 88 French adults. The clips showed the boy engaging in 4 different behaviors, namely: leaning back on a chair and moaning, having a temper tantrum without clear reasons, using a computer, and sitting at a table talking in front of a camera. One half of the adult participants were told that the child had Autism while the other half was not informed of the diagnosis. After showing the clips of each behavior, the adult participants were instructed to rate the child on 10 continuous dimensions (unruly, nice, alert, anxiety-ridden, etc). The authors found that when participants knew the clinical diagnosis of the child, they were more tolerant of the “negative” behaviors shown in the clips. Likewise, these informed adults were also more likely to rate the child positively in cognitive dimensions (intelligent, quick-minded, alert). The authors also found a gender effect. When the adults were informed, there was no difference between male and female participants. However, when the participants were uninformed, males were more harshly in the evaluation of the child than females. The authors commented that one possible reason that adults tend to show judgment towards parents of children with autism is that these children “look” like any typically developing child, so most people unfamiliar with the child would not know that the child had autism. The results are consistent with that idea indicating that when adults know that the child has autism they are more tolerant of behaviors that "do not conform to social norms" and see the child more positively in many dimensions. The results of this study could provide needed empirical support for the need of educational campaigns about ASDs targeted to the general population.

Autism and Spontaneous Communication

Title: Communicative spontaneity of children with autism: A preliminary analysis
Source:Chiang, H. (2008). Communicative spontaneity of children with autism: A preliminary analysis. Autism, 12(1), 9-21. DOI: 10.1177/1362361307085264

The author of this preliminary study wanted to explore the factors that are associated with communicative spontaneity in children with autism. Communicative spontaneity usually refers to “uncued communication”, or communication that is child-initiated and not elicited by direct prompts (questions, requests, etc). The author commented that although current treatments interventions have been effective in teaching communication skills in some non-verbal children, teaching spontaneity has been much more difficult. The participants included 32 children and pre-adolescents with a previous autism diagnosis (unclear how this was determined) but the diagnosis was confirmed via the Childhood Autism Rating Scale (Mean 38.9 with a range of 30-48.5). The children were observed in various naturalistic settings at school, including class time, lunch time, free play, circle time, etc. The video tapes of these kids were then analyzed to determine the type of communication interactions observed. The author divided communication spontaneity into 4 levels representing degrees of spontaneity as a function of the antecedents of the communication. Level 1 represented the most spontaneous communication, that is communication that was merely preceded by natural cues, such as the simple presence of an object or person. Level 4 represented the least spontaneous communication, such as communication preceded by a direct prompt (instruction, physical prompt, etc). The authors found that “surprisingly” most acts of communication coded were at the highest level of spontaneity (unprompted). This may reflect the frequency of antecedents available. For example, a child may have many more opportunities to make spontaneous comments about an object (high level of spontaneity) than in response to a teacher instruction (low level of spontaneity). But the results clearly show some level of spontaneous communication in this sample of children. The authors also found that most spontaneous communicative actions were in the “rejecting” or “requesting” domains as opposed to other domains such as greeting, farewell, or comments. From a behavioral perspective, the rejecting and requesting communicative actions have a more clear reward contingency (immediate result), which may help increase the rate of these behaviors. On the other hand, the contingency for "greetings" and "farewell" actions seem less clear, and arguably more social, which may explain the low rates of these behaviors. This is an interesting (I know, albeit a bit predictable) finding that could inform the design of communication interventions in children with autism.