Adherence and acceptability of a robot-assisted Pivotal Response Treatment protocol for children with autism spectrum disorder

Iris Van Den Berk-Smeekens,Tino Lourens,Martine Van Dongen-Boomsma,Emilia I Barakova,Manon W P De Korte,Nienke C Peters-Scheffer,Jenny C Den Boer,Iris J Oosterling,Jeffrey C Glennon,Wouter G Staal,Jan K Buitelaar

doi:10.1038/s41598-020-65048-3

Abstract

The aim of this study is to present a robot-assisted therapy protocol for children with ASD based on the current state-of-the-art in both ASD intervention research and robotics research, and critically evaluate its adherence and acceptability based on child as well as parent ratings. The robot-assisted therapy was designed based on motivational components of Pivotal Response Treatment (PRT), a highly promising and feasible intervention focused at training “pivotal” (key) areas such as motivation for social interaction and self-initiations, with the goal of establishing collateral gains in untargeted areas of functioning and development, affected by autism spectrum disorders. Overall, children (3–8 y) could adhere to the robot-assisted therapy protocol (Mean percentage of treatment adherence 85.5%), showed positive affect ratings after therapy sessions (positive in 86.6% of sessions) and high robot likability scores (high in 79.4% of sessions). Positive likability ratings were mainly given by school-aged children (H(1) = 7.91, p = .005) and related to the movements, speech and game scenarios of the robot. Parent ratings on the added value of the robot were mainly positive (Mean of 84.8 on 0–100 scale), while lower parent ratings were related to inflexibility of robot behaviour.

Highlights

Digital technology can support interventions and care for children with psychiatric disorders[1] and the development and use of new technologies within mental health care interventions is placed high on the international agenda[2]
We aim to explore whether child and parent ratings of using a robot within Pivotal Response Treatment (PRT) differ by individual characteristics of age, IQ, severity of autism spectrum disorder (ASD) symptoms and psychiatric comorbidity
To explore whether child and parent ratings of using a robot within PRT differ by individual characteristics, subgroups of participants were made based on age, gender, total intelligence quotient (TIQ), severity of ASD symptoms and psychiatric comorbidity (co-morbid diagnosis of attention-deficit hyperactivity disorder (ADHD) versus other co-morbid psychiatric disorder(s), versus no co-morbidity)

Summary

Introduction

Digital technology can support interventions and care for children with psychiatric disorders[1] and the development and use of new technologies within mental health care interventions is placed high on the international agenda[2]. Other studies found no significant changes in verbal initiations, responses and play behaviour during a 5-week intervention with a robot based on Lego© therapy[15] or a similar increase in self-initiated question asking during a 4-session ABA-based intervention with a robot compared to a human trainer condition in children with ASD16 Results of these studies differ highly, which may reflect the use of different sample sizes and research methodology[17]. While treatment adherence is regarded as a core underlying assumption for evidence-ba sed interventions[18] it is remarkable that earlier studies to newly developed protocols for robot assistance within established interventions for ASD do not report on this It is unclear how the design of the robot-assisted intervention relates to treatment adherence and acceptability of both children with ASD and their parents.

Objectives

Methods

Results

Conclusion