The EFFECT of A CO-Robot Therapist On Repetitive Behaviors DURING Applied BEHAVIOR ANALYSIS In Individuals with AUTISM Spectrum DISORDERS

Background: The use of an interactive humanoid “co-robot” in therapy to aid a human therapist in teaching communicative skills to children with autism spectrum disorders (ASD)  is a relatively new approach with limited clinical data (Diehl et al. 2011).  It is important to understand both the benefits of this approach and potential undesirable outcomes of this technique.  One potential unwanted outcome is the possibility that the presence of the co-robot would increase repetitive behaviors displayed by participants because of increased arousal.  Current theory on repetitive behaviors suggests their importance in regulating emotional arousal and sensory input from the environment (Leekam et al, 2011). 

Objectives: The purpose of this study was to examine the effect that the introduction of a co-robot had on repetitive behaviors displayed by children with ASD during an Applied Behavior Analysis (ABA) therapy session. 

Methods: Participants were four children with ASD (ages 8-11) taken from a larger study examining the incremental validity of using co-robots in empirically supported treatments.  Diagnoses were confirmed using the Autism Diagnostic Observation Schedule, the Social Communication Questionnaire (Lifetime Form), and clinical judgment.  All participant Full Scale IQs and language standard scores were at least two standard deviations below the mean for their age.  Participants were pair-wised matched on chronological age, gender, Full Scale IQ, and language abilities, and both pairs had the same human therapist.  Participants received 12 sessions of ABA therapy, six of which included communicative interactions with a co-robot (Nao, Aldebaran Robotics) controlled by an experimenter in an adjacent room.  For each child, we examined the frequency of nonverbal repetitive behaviors (e.g., flapping hands) and repetitive verbalizations.  The number of times each behavior was displayed by each participant was recorded within the first 10 minutes of practice during each of the 12 sessions.  Patterns of response were examined across all four participants, and also individually for each participant.

Results:   Preliminary data suggest that the presence of a co-robot in therapy had a differential effect on verbal and nonverbal repetitive behaviors, (Χ²=5.76, p<.05).  Nonverbal repetitive behaviors were more frequent in sessions involving the co-robot, whereas verbal routines were no different whether or not the robot was present in the session.  It should be noted, however, that in addition to this broader pattern there were individual differences between the four participants in the way in which the robot affected specific repetitive behaviors, and individual differences appeared to be related to the purpose of the behavior (increasing or decreasing arousal).

Conclusions: These pilot data suggest that the introduction of a co-robot into therapy might increase the frequency of nonverbal repetitive behaviors in children with ASD.  Therefore, interventions that test the clinical utility of co-robots must consider both potential benefits and potential obstacles to optimal therapeutic outcomes.  It is also possible that the co-robot could be used as a method of eliciting the repetitive behaviors as a means of teaching replacement behaviors using differential reinforcement of an alternative behavior.