Robots as New Tools in Therapy and Education for Children with Autism
Claire AGJ Huijnen1,2*, Monique AS Lexis1 and Luc P de Witte3
1Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
2CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
3CATCH Centre for Assistive Technology and Connected Healthcare, University of Sheffield, UK
- Corresponding Author:
- Claire AGJ Huijnen
Research Centre Technology in
Zuyd University of Applied Sciences
Henri Dunantstraat 2, Heerlen, 6419
PB, The Netherlands
E-mail: [email protected];
Received date: July 10, 2017; Accepted date: June 28, 2017; Published date: August 04, 2017
Citation: Huijnen CAGJ, Lexis MAS, de Witte LP (2017) Robots as New Tools in
Therapy and Education for Children with Autism. Int J Neurorehabilitation 4:278.
Copyright: © 2017 Huijnen CAGJ, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
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Robots are increasingly considered as a promising tool in therapeutic and educational interventions for children with autism spectrum disorder (ASD). International literature indicates that robots can potentially be applied to a wide range of objectives. The aim of this article is to present an overview of robots that are currently used in therapy and educational for children with ASD and to indicate what objectives they address. Focus group sessions (N=9) with ASD professionals (N=53) from nine organisations were conducted which identified potential objectives for children with ASD. A systematic literature study delivered an overview of the state of the art of robots under study. Professionals reported to work on 74 ASD objectives in 9 different domains (based on the International Classification of Functioning - Child and Youth, ICF-CY). The robots (N=14) found in the literature addressed 24 of these objectives in 8 of the 9 domains, indicating the potential contribution of these robots to therapy and education of children with ASD. Domains that are targeted most often by robots currently are ‘social or interpersonal interactions and relations’, ‘play’ and ‘communication’. Results indicate that robot mediated interventions are considered to be a possible valuable tool in the education or therapy for children with autism. In order to unlock the potential of robots, it is advised that technical developers use knowledge from ASD practice so that meaningful applications can be developed.
Autism spectrum disorder (ASD); Children; Therapy and
education objectives; Robots
More and more children, about 0.66% or 1 child in 152 children,
have the diagnosis of Autism Spectrum Disorder (ASD) [1-5]. Autism
spectrum disorder is characterised by persistent deficits in social communication and social interaction across multiple contexts, as well
as restricted, repetitive patterns of behaviour, interests, or activities .
It is a disorder which affects multiple areas of daily living throughout
a person’s life. People (children) benefit from early and on-going
intervention that is tailored to their specific individual needs .
Technology is an accepted and efficient support tool in the therapy and education of individuals with ASD and their (informal) carers [7-10].
More, specifically, robot-assisted therapy (RAT) or robot-mediated
intervention (RMI) is considered promising for children with ASD
[11-16]. Although it might sound contradictory to use a robot to teach
children skills in areas such as communication and social interaction,
the use of robots has a number of advantages for these children.
Interacting with a robot can be easier for them than interacting with
a person, but also less complex, more predictable, simpler and more
appealing; robots can be applied in a controlled manner which decreases
the risk of stressful situations; robots are better in endless repetitions
and variations can be made in a conscious and controlled way [8,17].
The aim of this short commentary is to provide a short overview of
robots for use in ASD interventions as presented in the literature.
A mixed method approach, including focus groups and a systematic
literature study was used to create this overview. This short commentary
is based on previous research . Professionals (N=53) working in
care organisations or special needs schools for children with ASD
participated in 9 focus group sessions to provide insight into the
objectives that are important for these children . This resulted in an
overview of 9 domains including 74 objectives, as presented in Figure
1. These domains, based on the ICF-CY, were: communication, social/
interpersonal interactions and relations, self-care/independent living,
play, emotional wellbeing, sensory experiences and coping, motor
experiences and skills, preschool skills and functioning in daily reality.
Figure 1: Overview of therapy and education objectives for children with autism spectrum disorder.
Each of these domains includes a number of specific objectives (Figure
1). A systematic literature study was conducted based on principles of
the Cochrane Handbook  to learn more about the state of the art of
robotics for this target group. The consulted databases were PubMed,
CINAHL, EMBASE, ERIC, IEEE Xplore digital library, Science Direct,
Springer Link and Taylor & Francis. Furthermore, a Google Scholar
search was carried out.
Peer reviewed articles discussed 14 different robot platforms that
focus on 24 different objectives of the 74 ASD objectives identified by
the professionals. Figure 2 provides an overview of these robots and the
objectives that they addressed. Some robots (e.g. NAO, Robota, Probo,
Keepon, Isobot, Tito, GIPY-1, KASPAR, Ifbot, Labo-1) have been
applied for multiple objectives, and other robots have been reported in
the context of one ASD objective only (e.g. cat robot, HOAP 3, Robot
arm and Pleo). Objectives that were studied most often were: ‘imitation
in social interaction’, ‘turn-taking’, ‘imitation in play’, ‘collaboration/joint
attention’, ‘playing together – collaborative play’ and ‘attention’. The most
commonly addressed domains are: ‘Social/Interpersonal interactions
and relations’, ‘Play’ and ‘Communication’. The domain of ‘Self-care,
independent living’ is left unaddressed by all robots. ‘Preschool skills’ is
the domain for which the ASD professionals identified most objectives
(n=14). However, only 1 of these 14 objectives was targeted, by the robot
Nao (‘pose a question/ask for help’).
Figure 2: Overview of robots and objectives they may address.
For the domain of ‘Emotional wellbeing’ also one robot (KASPAR)
could be identified in one article addressing one objective (‘self-image,
ASD awareness, who am I’).
Recent research aimed to study the expectations of professionals of
what contribution robot KASPAR can have for children with autism.
Professionals expect that KASPAR can contribute mostly to working
on objectives in the domains of communication, social interaction,
and play . Examples of objectives in these domains are: ‘imitation
in play’, ‘making contact’, ‘orientation to listen’, ‘imitation in social
interaction and relations’, ‘turn taking’, ‘social routines’, ‘attention’,
‘learn a new form of communication’ and ‘talk – use verbal abilities’.
Professionals also expect KASPAR to contribute to objectives in other
domains such as emotional wellbeing and preschool skills: ‘having fun,
experiencing pleasure’, ‘develop interest in play’ or ‘train or practice
skills’, ‘pose a question or ask for help’ and ‘follow up instructions’ .
These results indicate that robot mediated interventions may
address a larger scope of objectives for these children than they
currently do. Although more and more studies highlight the potential
of robots for this target group, robots have not made their way into
(many) classrooms or therapy sessions yet. Many of the robots found
in the literature are still in a prototype stage and not commercially
available. It is highly recommended that knowledge from ASD practice
reaches technical robot developers to guide robot development so that
studies can be conducted with robot interventions that are carefully
designed to meet the specific needs of this target group and that utilise
the potential power of robots .
- Blaxill MF (2004) What’s going on? The question of time trends in autism. Public Health Rep 119: 536-551.
- Olds J, Rubin P, MacGregor D, Madou M, McLaughlin A, et al. (2013) Implications: Human cognition and communication and the emergence of the cognitive society. In: Convergence of Knowledge, Technology and Society SE - 6, M.C. Roco, W.S. Bainbridge, B. Tonn and G. Whitesides, Eds. Springer International Publishing, pp: 223-253.
- Scasselatti B (2005) Paper presented at the IEEE Workshop on Robots and Human Interactive Communications.
- Wong C, Odom SL, Hume KA, Cox AW, Fettig A, et al. (2015) Evidence-based practices for children, youth and young adults with autism spectrum disorder: A comprehensive review. J Autism Dev Disord 45: 1951-1966.
- Volkmar FR, Paul R, Rogers SJ (2014) Handbook of autism and pervasive developmental disorders: Diagnosis, development and brain mechanisms. John Wiley & Sons 1.
- American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
- Aresti-Bartolome N, Garcia-Zapirain B (2014) Technologies as support tools for persons with autistic spectrum disorder: A systematic review. Int J Environ Res Public Health 11: 7767-7802.
- Boucenna S, Narzisi A, Tilmont E, Muratori F, Pioggia G, et al. (2014) Interactive technologies for autistic children: A review. Cognit Comput 6: 722-740.
- Grynszpan O, Weiss PL, Perez-Diaz F, Gal E (2014) Innovative technology-based interventions for autism spectrum disorders: A meta-analysis. Autism 18: 346-361.
- Lee H, Hyun E (2015) The intelligent robot contents for children with speech-language disorder. Educ Technol Soc 18: 100-113.
- Begum M, Serna RW, Yanco HA (2016) Are robots ready to deliver autism interventions? A comprehensive review. Int J Soc Robot 8: 157-181.
- Cabibihan J, Javed H, Ang M, Aljunied S (2013) Why robots? A survey on the roles and benefits of social robots in the therapy of children with autism. Int J Soc Robot 5: 593-618.
- Diehl JJ, Schmitt LM, Villano M, Crowell CR (2012) The clinical use of robots for individuals with autism spectrum disorders: A critical review. Res Autism Spectr Disord 6: 249-262.
- Huijnen CAGJ, Lexis MAS, Jansens R, de Witte LP (2016) Mapping robots to therapy and educational objectives for children with autism spectrum disorder. J Autism Dev Disord 46: 2100-2114.
- Pennisi P, Tonacci A, Tartarisco G, Billeci L, Ruta L, Gangemi S, Pioggia G (2016) Autism and social robotics: A systematic review. Autism Res 9: 165-183.
- Scassellati B, Admoni H, Matarić M (2012) Robots for use in autism research. Annu Rev Biomed Eng 14: 275-294.
- Thill S, Pop CA, Belpaeme T, Ziemke T, Vanderborght B (2012) Robot-assisted therapy for autism spectrum disorders with (partially) autonomous control: Challenges and outlook. Paladyn J Behav Robot 3: 209-217.
- Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions. Wiley Online Library 5.
- Huijnen CAGJ, Lexis MAS, de Witte LP (2016) Matching robot KASPAR to autism spectrum disorder (ASD) therapy and educational goals. Int J Soc Robot 8: 445-455.
- Huijnen CAGJ, Lexis MAS, Jansens R, de Witte LP (2017) How to implement robots in interventions for children with autism? A co-creation study involving people with autism, parents and professionals. J Autism Dev Disord, pp: 1-18.
- Warren Z, Zheng Z, Das S, Young EM, Swanson A, et al. (2015) Brief report: Development of a robotic intervention platform for young children with ASD. J Autism Dev Disord 45: 3870-3876.
- Warren ZE, Zheng Z, Swanson AR, Bekele E, Zhang L, et al. (2015) Can robotic interaction improve joint attention skills? J Autism Dev Disord 45: 3726-3734.
- Tapus A, Peca A, Aly A, Pop C, Jisa L, et al. (2012) Children with autism social engagement in interaction with Nao, an imitative robot – A series of single case experiments. Interact Stud 13: 315-347.
- Anzalone SM, Tilmont E, Boucenna S, Xavier J, Jouen AL, et al. (2014)How children with autism spectrum disorder behave and explore the 4-dimensional (spatial 3D+time) environment during a joint attention induction task with a robot. Res Autism Spectr Disord 8: 814-826.
- Bekele E, Crittendon JA, Swanson A, Sarkar N, Warren ZE (2014) Pilot clinical application of an adaptive robotic system for young children with autism. Autism 18: 598-608.
- Huskens B, Palmen A, Van der Werff M, Lourens T, Barakova E (2014) Improving collaborative play between children with autism spectrum disorders and their siblings: The effectiveness of a robot-mediated intervention based on lego therapy. J Autism Dev Disord 45: 3746-3755.
- Huskens B, Verschuur R, Gillesen J, Didden R, Barakova E (2013) Promoting question-asking in school-aged children with autism spectrum disorders: Effectiveness of a robot intervention compared to a human-trainer intervention. Dev Neurorehabil 16: 345-356.
- Bekele E, Young M, Zheng Z, Zhang L, Swanson A, et al. (2013) A step towards adaptive multimodal virtual social interaction platform for children with autism. LNCS, no. PART 2, C. Stephanidis and M. Antona, Eds. Springer Berlin Heidelberg, pp: 464-473.
- Giannopulu I, Pradel G (2012) From child-robot interaction to child-robot-therapist interaction: A case study in autism. Appl Bionics Biomech 9: 173-179.
- Giannopulu I, Pradel G (2010) Multimodal interactions in free game play of children with autism and a mobile toy robot. Neurorehabilitation 27: 305-311.
- Billard A, Robins B, Nadel J, Dautenhahn K (2007) Building Robota, a mini-humanoid robot for the rehabilitation of children with autism. Assist Technol 19: 37-49.
- Robins B, Dautenhahn K, Dubowski J (2006) Does appearance matter in the interaction of children with autism with a humanoid robot? Interact Stud 7: 509-542.
- Robins B, Dautenhahn K, Te Boekhorst R, Billard A (2005) Robotic assistants in therapy and education of children with autism: Can a small humanoid robot help encourage social interaction skills? Univers Access Inf Soc 4: 105-120.
- Fujimoto I, Matsumoto T, de Silva PRS, Kobayashi M, Higashi M (2011) Mimicking and evaluating human motion to improve the imitation skill of children with autism through a robot. Int J Soc Robot 3: 349-357.
- Pop CA, Simut R, Pintea S, Saldien J, Rusu A, et al. (2013) Can the social robot probo help children with autism to identify situation-based emotions? A series of single case experiments. Int J Humanoid Robot 10: 1350025.
- Vanderborght B, Simut R, Saldien J, Pop C, Rusu AS, et al. (2012) Using the social robot probo as a social story telling agent for children with ASD. Interact 13: 348-372.
- Wainer J, Dautenhahn K, Robins B, Amirabdollahian F (2014) A pilot study with a novel setup for collaborative play of the humanoid robot KASPAR with children with autism. Int J Soc Robot 6: 45-65.
- Wainer J, Robins B, Amirabdollahian F, Dautenhahn K (2014) Using the humanoid robot KASPAR to autonomously play triadic games and facilitate collaborative play among children with autism. IEEE Trans Auton Ment Dev 6: 183-199.
- Robins B, Dautenhahn K (2014) Tactile Interactions with a humanoid robot: Novel play scenario implementations with children with autism. Int J Soc Robot 6: 397-415.
- Costa S, Lehmann H, Dautenhahn K, Robins B, Soares F (2015) Using a humanoid robot to elicit body awareness and appropriate physical interaction in children with autism. Int J Soc Robot 7: 265-278.
- Kozima H, Nakagawa C, Yasuda Y (2007) Children-robot interaction: A pilot study in autism therapy. Prog Brain Res 164: 385-400.
- Kozima H, Michalowski MP, Nakagawa C (2009) Keepon: A playful robot for research, therapy and entertainment. Int J Soc Robot 1: 3-18.
- Costescu CA, Vanderborght B, David DO (2014) Reversal learning task in children with autism spectrum disorder: A robot-based approach. J Autism Dev Disord 45: 3715-3725.
- Pierno AC, Mari M, Lusher D, Castiello U (2008) Robotic movement elicits visuomotor priming in children with autism. Neuropsychologia 46: 448-454.
- Mun KH, Kwon JY, Lee BH, Jung JS (2014) Design developing an early model of cat robot for the use of early treatment of children with autism spectrum disorder (ASD). Int J Control Autom 7: 59-74.
- Kim ES, Paul R, Scassellati B, Bernier EP, Leyzberg D, et al. (2013) Social robots as embedded reinforcers of social behavior in children with autism. J Autism Dev Disord 43: 1038-1049.
- Srinivasan SM, Lynch KA, Bubela DJ, Gifford TD, Bhat AN (2013) Effect of interactions between a child and a robot on the imitation and praxis performance of typically devloping children and a child with autism: A preliminary study. Percept Mot Skills 116: 885-904.
- Kaur M, Gifford T, Marsh KL, Bhat A (2013) Effect of robot-child interactions on bilateral coordination skills of typically developing children and a child with autism spectrum disorder: A preliminary study. J Mot Learn Dev 1: 31-37.
- Dautenhahn K (2004) Socially intelligent robots: Dimensions of human-robot interaction. Philos Trans R Soc Lond B Biol Sci 362: 679-704.
- Dautenhahn K, Werry I (2004) Towards interactive robots in autism therapy: Background, motivation and challenges. Pragmat Cogn 12: 1-35.
- Duquette A, Michaud F, Mercier H (2008) Exploring the use of a mobile robot as an imitation agent with children with low-functioning autism. Auton Robots 24: 147-157.
- Lee J, Takehashi H, Nagai C, Obinata G, Stefanov D (2012) Which robot features can stimulate better responses from children with autism in robot-assisted therapy? Int J Adv Robot Syst 9.