The Spectrum Through a Screen — How Virtual Reality Based Training Helps People with Autism
Visit www.cognalityvr.com to learn more.
Communication is a vital life skill. It bridges the gap between an individual and others and brings people closer to each other. We learn how to communicate by mimicking those around us as toddlers and such learning comes naturally for people who are neurotypical. Autism Spectrum Disorder (ASD) is a neurological condition that impairs communication and behavioral skills. There is no cure for this condition, but behavioral therapy can help mitigate its negative effects. However, therapy is expensive, takes a lot of time and effort, and is not accessible to everyone. Virtual reality is an immersive alternative to traditional therapy methods such as behavioral, exposure, or in vivo therapy, each of which have many limitations. While virtual reality has its own drawbacks, it has immense potential to change the lives of those affected by autism. If we wish to help make therapeutic learning more accessible to people with autism, virtual reality is the most favorable option.
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Autism and its Effects on the Brain. While communication and social skills are often taken for granted, people with autism struggle with these skills everyday. According to Patricia Mesa-Gresa, a professor of Psychobiology at the University of Valencia, “Autism Spectrum Disorder (ASD) is an atypical neurodevelopmental disease characterized by impairments in social communication, interaction, competences, and language, as well as the maintenance of restricted and repetitive behaviors, interests, and activities” (Mesa-Gresa et al. 1).
Children and teenagers struggle to make friends and communicate what they are feeling, which strips them from the essential process of growing up (Smith et al. 3364). Similarly, autistic adolescents battle with the job interview process which is the first step when looking for work. Many adults with autism struggle to pursue independent living or gain work experience, which in return leaves them feeling socially isolated. This further causes them to block themselves from the world (Smith et al. 3365). In the past few years, autism diagnoses have increased (Chung 1:26–2:38). Generally, this is thought to be due to rising awareness about this condition (Chung 1:26–2:38).
Currently there is no cure for autism, but this does not mean that there aren’t treatments that can help reduce its effects (“What are the causes…”). Many experts believe that autism can be caused by myriad factors, most being genetics. In current estimates, about 200 to 400 genes are believed to cause autism (Chung 10:26). Other factors might include advanced paternal age or exposure to certain agents that can affect a fetus’s developmental period while in the womb (Chung 4:03–5:32). Furthermore, the findings of Watanabe et al. state that the brains of people with autism process and hold onto sensory input for less time than neurotypicals. Surprisingly, this seems to be because of differences in the structure and activity of individual brain regions (Watanabe et al.).
People try to treat the condition through medication or therapy. A range of therapies have proven effective in mitigating autism’s negative effects. These therapies include behavioral, exposure, or in vivo therapy (Mesa-Grasa 5–7). “1 in 68 children in this world are suffering from Autism Spectrum Disorder (ASD)” (Labs 1). This is an outstanding amount and there are no signs that this number will be decreasing any time soon. We don’t know who around us might be in the spectrum and not getting the help they deserve, therefore, it is necessary for us to be involved in raising awareness about the condition and the ways they can receive aid.
Types of Therapies Currently Recommended. Writing in the Journal of e-Learning, Chandra Ramachandiran and various other authors state that, “[…]to educate autistic children on social skills a flexible and interactive teaching method or technique should be established […] However, the majority of the prevalent methods of teaching aids available to autistic children have certain drawbacks in terms of enhancing social skills.” (Ramachandiran 358 ) Ramachandiran suggests that the majority of therapies currently in use are limited in terms of flexibility or opportunity for interaction, or both (Ramachandiran 358).
The most common methods used to support autistic people are social skills based and group-based therapy. These offer people who are autistic a chance to share their experiences and develop social skills within the autism family, but limit the amount of practice time spent interacting with others outside the autism spectrum (Kandalaft et al. 35). Other therapy methods include Priming (also known as Social Story), where an adult previews activities for a child with autism in order to decrease the stress of going into a new situation (Ramachandiran 359). Although this method is effective, it is limited by the imaginative potential of those with autism and it’s success depends upon the skill of the therapist. In-Vivo Exposure Therapy (Mesa-Grasa 7) is a scenario where people with autism are physically exposed to a specific stressor in a controlled environment. While it is sometimes effective, exposure therapy can have re-traumatizing effects. Applied Behavioral Therapy (ABT) is a range of systematic, evidence based methods aimed at improving desired behaviors and skills. Despite the positive results this therapy has been shown to have, it is not practical for all patients. It requires parents to participate outside the therapy room and is very expensive, costing about $150 per hour session (“The Financial Impact . . .” par. 7). Many caregivers do not have the financial means to afford ABT, others do not have the option to dedicate the time it takes to implement such therapies outside the clinical setting.
It has come to the attention of various doctors and scientists that therapy is not as accessible as many might originally believe, thus a need for a more attainable alternative. In addition to the limitations of the therapy methods listed above, there are limited therapists who offer these services, “According to the latest estimates, there are more than 1 million autistic children in the United States but only about 8,300 child psychiatrists, 1,500 child neurologists and 1,000 developmental-behavioral pediatricians. And within those small numbers, autism remains an unpopular choice […]” Furthermore, few health care professionals specialize in autism, though expensive for patients, providing therapies related to autism is less lucrative than the treatment of other conditions (Hsu par. 2). Any person who struggles with autism usually needs more than just one therapist, but often families cannot afford multiple therapies. (Hsu par. 4) Thus, it is evident that there is a need for a more accessible alternative when it comes to aiding those in the autism spectrum with the development of socially appropriate behaviors.
Virtual Reality and How it can be Applied to Autism Therapy. Merriam Webster defines virtual reality as “an artificial environment which is experienced through sensory stimuli (such as sights and sounds) provided by a computer and in which one’s actions partially determine what happens in the environment.” In keeping with the qualities recommended by Ramachandrin, virtual reality simulates a flexible environment that has the potential to positively change the lives of those affected by autism. Like an airplane, virtual reality allows users to leave actual reality and access a different experience. However, instead of taking hours or even days, it can happen instantly, virtually. The flexibility of the virtual environment makes it ideal for implementation as a therapeutic method for people with autism.
Virtual reality has been shown to help people with autism develop social skills and learn professional behaviors through a more personalized approach,
Studies have shown that a Virtual 3D environment can stimulate users’ interactivity and motivation. It affords opportunities for social interaction, especially in the classroom, by making conversations easy, structured and inclusive, through, for example, text-chat systems. Virtual Worlds (VW) can offer users a sense of co-presence and realism and provide an increased sense of control, allowing participants to have more engaging in-world experiences. Moreover, a VW can improve students’ knowledge, their enjoyment and interest in the learning process, if they are structured correctly, just like game-based learning does. (Politis 3)
Given the wide range of benefits listed above, it is clear that virtual reality should be widely implemented as a therapeutic strategy for those with autism.
In addition to helping those on the autism spectrum orient themselves socially, VR can also be used to help raise awareness about the condition, and can help caregivers better understand the world as people with autism experience it (Rogers 4). A company called Don’t Panic created an immersive experience that simulates how someone who is autistic feels when overwhelmed in a shopping mall (Rogers 6). This helped caregivers and the general public have a better understanding of what having autism entails. Using virtual reality in this sense would increase the likelihood of caregivers being more open to allowing someone who is autistic use virtual reality as a means of educational therapy.
Disadvantages of Virtual Reality. Despite such promising possibilities, there are some drawbacks to virtual reality that should be addressed. First off, virtual reality is a new type of technology which has only recently become popular in mainstream society. Virtual reality is usually used as a tool for entertainment purposes, and the headsets, which are usually found in game stores, can cost between $5-$800, depending on the quality of the equipment (Robertson par. 1). This price range can be prohibitive. In addition, the idea that VR can be used for medical or therapeutic purposes is a new idea, and while people feel open to using this technology for the purpose of entertainment, there is scepticism about its therapeutic applications within the health care community (Abernathy). Further disadvantages of using virtual reality as a therapeutic response to autism include “[…]requiring special guidance, skills domination, imagination problems, equipment storage and deterioration of storage medium” (Ramachandiran et al. 357). In addition, it has been suggested that virtual reality might not help children with low functioning autism as much as it might help those with high functioning autism because those who are considered low functioning are more sensitive to stressors and can inflict harm on themselves if uncomfortable (Abernathy). Wearing a headset may stress such individuals, and could be physically dangerous or cause psychological aversion. All in all, despite such drawbacks, researchers still believe virtual reality can be a good, if not better, alternative to everyday therapy for mid to high functioning autistic people.
My own experience with virtual reality leads me to believe that the technology is far more affordable than most people assume. The quality Fresnel lenses are embedded in the headset and thus protected from any potential outside damage. The headset works with any type of phone because the headset comes with flexible velcoro. Additionally, it is easily portable because it is foldable. Although it is not the most comfortable headset out there, it does the job well. Despite the cost, a one time purchase of a $5-$800 headset is less expensive than paying for weekly — sometimes even daily — therapy.
Studies that have Proven Virtual Reality is Effective. Despite the limitations listed above, virtual reality based training for those with autism has proven successful in clinical trials.
For example, the Center for BrainHealth and the Child Study Center at Yale University’s School of Medicine collaborated to help young adults with ASD achieve economic and social independence with the help of VR. Carly McCullar, who has ASD, went to the Center’s social cognition training during her senior year. The training taught her to handle situations such as job interviews, a problem with a neighbor and even dating. (Rogers 3)
Additionally, according to the research of Mesa-Gresa and others, collaborative VR scenarios indicate that the use of technology facilitates training in flexibility, identity, the construction of social norms and emotional recognition (Mesa-Gresa). Floreo, a company which created specialized VR environments to help autistic children manage social interactions, has proved the promising effects of VR treatment (Rogers 3). In addition, since eye contact in infants can help diagnose autism at a very early age, a company named Looxid Labs has created a headset that measures eye movement and brain waves, which can change the way autism is diagnosed in young children (Labs 3).
The technology Cognality has developed uses virtual reality to help high functioning autistic children learn to deal effectively with triggering situations. These situations, which can lead to negative behavior patterns commonly referred to as meltdowns, can be avoided through the creation of virtual safe spaces. Since autistic meltdowns are generally triggered by sensory overload, those affected by autism are taught to avoid meltdowns by retreating to a quiet place where they feel safe. In actual reality, however, this is not always possible, especially in public places. Cognality makes safe space available anywhere at any time, since the safe environment can be accessed virtually through a portable VR headset.
Currently, Cognality offers four cost-free preprogrammed calming scenes: the top of a hill, a bedroom, and beach and desert scenes. Google sponsored the company by donating 50 free cardboard headsets with which to pilot this technology, and our product is currently being beta tested by therapists and volunteers in California.
One of our beta testers is Jack, a six year old boy who has high functioning autism. One of our biggest concerns in developing Cognality was that the children and parents we believe will benefit from these technologies would not be open to putting on the headsets and using them. This was not the case with Jack, his parents report that Jack was extremely intrigued with the technology and was eager to test all the scenes we had developed. He felt like he was really in the new environment. After a couple of days, Jack himself would ask his parents if he could use the scenes (Larson). We live in a world where technology is prevalent, and we can now predict that most patients will be more than happy to use the headsets to access the calming scenes offered.
Another concern we had was that therapists would not be open to using Cognality with their patients. However, this perception has been proved incorrect. Portia Abernathy, a special needs teacher and disability rights advocate stated, “I love that [Cognality is] working to develop tools and technology to support children with autism and their families! This is a great area of need as rate of diagnosis continue…[this] is a great idea.” This shows that therapists themselves support the development of such technologies and are open to implementing VR in their own therapy sessions.
Where More Work is Needed, and Why. Using virtual reality for therapeutic purposes has the potential to positively change the lives of so many people. Although a wealth of studies prove that VR is effective, there is still much to be done when it comes to developing VR as a therapeutic instrument. It has been suggested that,
A next iteration of the VR training programme should involve having conversations in a more complex group dynamic that would enhance group members’ self-confidence and self-esteem. Ultimately, this VR training would assist young adults with ASD in their pursuit of independent living by giving them the opportunity to gain work experience. This study, as a proof of concept, would open the door to developing training for other communication, life, academic and vocational skills, while this training would not only be useful for people with ASD, but the wider population. (Politis 1)
Thus, while VR has still not been widely accepted by therapists and those affected with autism, the need to make this potential alternative to traditional therapy more widely available is clear. Virtual reality could be implemented at schools in counseling centers or learning support programs, as well as at homes or in traditional therapy centers. It is important to understand that VR does not necessarily have to be an alternative to traditional therapy, but rather can augment therapy, making it an even more effective option for supporting the cognitive and social development of those on the autism spectrum.
Autism is a term used to indicate a wide range of behavioral patterns in those affected. No two people with this condition experience it identically. Thus, when it comes to helping mitigate the effects of autism, there are many ways to help. Despite some forms of therapy being highly effective, they are often not accessible to all. It is clear that virtual reality has the ability to help those in the autistic community learn basic behavioral and social skills, and that this technology is particularly well suited to provide what research suggests are essential components of therapeutic models focused on supporting the learning of people with autism. Research by Rogers, research by Kandalaft, and research by Mesa-Grasa suggest that virtual reality can be used to not only simulate a flexible environment where people who are autistic can feel safe and comfortable learning, but it can also be used to help parents, loved ones, and caregivers understand the experience autistic people go through by simulating their experience. Of equal importance, VR can be used to help diagnose autism. There is still important research to be done, however, with regards to these applications.
People in the autistic community need to be made aware of how VR can effectively help those with autism. If those who provide services to those in the spectrum –like therapists– are more aware of VR’s benefits, those affected by autism will have increased access to this resource. Additionally, for at least 200 million people, a certain amount of therapy sessions for those with autism is covered by health insurance (Health Insurance Coverage for Autism par. 1). This means that health insurance companies can also provide virtual reality headsets for those who cannot afford them if their purpose is to be used therapeutically, thus making the usage of virtual reality for this community even more accessible.
Our goal as a species should be to support each other in any way possible. Autism is a lot more common than many might think and people who you see everyday might be struggling with this condition. We can get involved by donating to research centers or foundations like Autism Speaks, raising awareness, fundraising, advocating for the usage of VR in schools and/or therapy centers, or volunteering at local clinics. As custodians of our planet, we need to take care of each other and immerse ourselves in ideas such as these in order for new and better ones to surge along the way.
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