The Effects of Embodied Rhythm and Robotic Interventions on the Repetitive and Negative Behaviors of Children with Autism Between 5 and 12 Years of Age

Background:   Repetitive behaviors are one of the core diagnostic symptoms of Autism Spectrum Disorders (ASDs). Children with ASDs demonstrate stereotypies such as arm flapping and finger flicking, as well as sensory behaviors with objects such as atypical visual fixation and persistent mouthing (Leekam et al., 2013, Richler, 2007). In addition, children demonstrate negative and maladaptive behaviors including temper tantrums, self-injurious behaviors, and aggression towards others (Dominick et al., 2007, Hartley et al., 2008). Applied Behavior Analysis approaches are typically used to reduce the frequencies of repetitive behaviors in children with ASDs.  Recently, novel interventions capitalizing on the predilections of children with ASDs, for example, robotic and rhythm interventions have been used to facilitate social communication skills. However, their effects on repetitive and negative behaviors have not been reported.

Objectives:   In this study, we evaluated the effects of novel embodied rhythm and robotic interventions on the repetitive and negative behaviors of children with ASDs between 5 and 12 years of age.

Methods:   36 children with ASDs between 5 and 12 years of age were observed for 10 weeks with the pretest and the posttest visits conducted in the first and last weeks of the study respectively. Children were matched on age and level of functioning and were randomly assigned to one of the three intervention groups - rhythm, robotic, or academic. Training was provided for 8 weeks with 2 sessions provided each week. In the rhythm group, children engaged in music and movement-based activities focusing on whole body imitation and synchrony with an expert trainer and an adult model. In the robot group, children engaged in action imitation games with a 23-inch humanoid Nao robot, a trainer, and a model. Lastly, in the academic group, children engaged in standard-of-care tabletop activities that focused on promoting fine motor and academic skills with a trainer and an adult model. We coded an early, a mid, and a late training session for the frequencies of stereotyped, sensory, and negative behaviors over a 45-minute session.

Results: In the early session, the rhythm and robotic groups demonstrated greater frequencies of negative behaviors compared to the academic group, probably due to the novel activities practiced (Mean (SD) –Rhythm: 60.86 (46.81), Robotic: 35.39 (29.81), Academic: 13.39 (16.07)). In contrast, the academic group demonstrated higher levels of repetitive sensory behaviors with the supplies used for the training compared to the other groups (Rhythm: 12.33 (10.51), Robotic: 23.73 (30.94), Academic: 37.60 (27.63)). Across training weeks, the rhythm group demonstrated a significant decrease in negative behaviors (Early: 60.86 (46.81), Late: 27.76 (24.79)). No training-related improvements were observed in the robotic and academic groups.  

Conclusions: Although children with ASDs found music and movement-based gross motor activities challenging to begin with, across training weeks they demonstrated a significant reduction in repetitive behaviors. Sedentary tabletop play seems to afford object-based perseveration and may influence opportunities for social interactions. Our positive findings from the rhythm group add to the literature supporting the inclusion of music and movement interventions in the treatment of autism.