A vast literature exists related to the incidence and impact of stereotypical behaviors in individuals with Autism Spectrum Disorder (ASD). These behaviors may significantly interfere with the individual’s ability to perform regular tasks, acquire new skills and integrate socially. Being aware of the individual’s external environment as well as physical and physiological characteristics will allow the caregiver to understand causes of stereotypical behaviors. There has also been a significant amount of work done on the recognition of repetitive behaviors and their relation to physiological change. To date, however, there is no technology that enables the stakeholders to derive better inferences about the inducers of repetitive behaviors or to determine if interventions have been successful in reducing their numbers.
Objectives:
To empower caregiver with the ability to infer causes of stereotypical behaviors and determine if interventions are effective in reducing them.
Methods:
We have developed a system called iExpress, to contextualize stereotypical behavior by mapping occurrences, identified by analyzing data from on-body accelerometers, to heart-rate data and audio-visual information obtained from the environment. iExpress tacitly captures important events of interest, stores data over a period of time and provides a visualization tool to perform analysis. A formative study has been conducted with 12 participants involving 4 parents, 3 children with ASD and five caregivers. Children were asked to use wearable wrist mounted accelerometers and a heart rate monitor in order to determine their comfort level. Parents were introduced to the iExpress prototype with synthesized data. After they interacted with the system they filled a short questionnaire. This was followed by a focus group discussion on the feasibility, usefulness and usability of iExpress. In another setting five caregivers of children with ASD were asked to fill out a questionnaire and participate in a focus group. The caregivers included 4 teachers one of whom was also a therapist and one consultant.
Results:
All the participants provided positive feedback on the iExpress prototype. None of the participants including child participants indicated any opposition or signs of discomfort to the on-body sensors. All participants indicated willingness and a desire to share the data with other stakeholders. They suggested integrating iExpress with the child’s schedule so that correlations could be made between what the child was doing at that time, and the events of interest. This would be most useful at school, where the child follows a more structured schedule. The participants also suggested augmenting the system to turn it into a diary of events by allowing note taking. Parents showed a high interest in using iExpress on a daily basis and the caregivers were keen to use it at least once a week.
Conclusions:
Feedback received from study participants indicated that the iExpress system could be very useful to parents and other caregivers in determining causes of stereotypical behaviors. Our initial apprehensions about children having a reaction to the on-body sensors turned out to be unwarranted. We were pleasantly surprised that both parents and caregivers wanted to use iExpress more frequently than our initial expectations.