In recent years, the use of robots in the treatment of children with Autism Spectrum Disorder (ASD) has been brought to the table. What benefits does this type of therapy offer?

What is ASD?

The concept of ASD (Autism Spectrum Disorder) emerged in 2013 when the American Psychiatric Association (APA) unified autism and Asperger’s syndrome under a single diagnosis, considering both conditions shared very similar traits. According to this categorization, ASD is a neurodevelopmental disorder that mainly affects communication and social interaction, characterized by the presence of very rigid thought patterns. Some examples include focus on interests, deficits in emotional expression, and problems with nonverbal expression. The first signs can be observed in very early stages of individual development, between the first and third year of life.

Another peculiarity of ASD is the diversity of ways in which it can manifest. This is why the concept of a spectrum is used. Each person expresses difficulties in communication, social interaction, and cognitive rigidity differently.

Robots for children with ASD

In recent years, numerous scientific studies, such as the one conducted by the University of the Balearic Islands, have investigated the use of robots to support the development of the learning process in children with Autism Spectrum Disorder (ASD). The conclusions suggest that the predictable and consistent interactions of robots make them feel comfortable, as individuals with ASD tend to have a strong aversion to unpredictability. Additionally, robots are capable of generating motivation to carry out tasks and activities, while also helping children engage in social interactions that may otherwise be threatening in other contexts.

Experts emphasize the importance of designing robots with highly personalized programming that can address the needs of each child. However, they warn that the robot should not be conceived as a teacher or a social worker, but rather as a support tool. In this sense, it should not be an end in itself, but rather the aim should be for the relationship between the child and the robot to serve as a starting point for reinforcing the child’s sociability.

Benefits of using robots for children with ASD

Some of the benefits of this type of therapy are:

• Improves communication skills and expression of emotions. The robot encourages the child’s participation through interactive communication, with visual aids, voice synthesis, and programmed instructions. This enhances the ability to express emotions and empathize with others. Additionally, it creates a comfortable and non-judgmental space where children can develop their skills.
• Facilitates social interaction. The security provided by a robot, through controlled repetitions, allows for more effective interaction. Imitation, turn-taking, and eye contact simulate real-life interactions that teach appropriate responses and gestures for different situations. They can also be useful as mediators and objects of shared attention with adults and peers. The ultimate goal is for children to use all this knowledge in interactions with humans.
• Provides routine. Predictability and routine establish coherent behavior patterns that provide security and stability for children with ASD. This reduces crises and anxiety.
• Promotes play and learning. Often, children with autism have difficulties playing and learning. Robots are capable of adapting to the child’s specific interests to program educational games. Thus, learning becomes a more fun and effective task.
• Simplifies the learning process. Interaction with the robot is simple and helps simplify the learning process. Similarly, it avoids information overload that could overwhelm the child.

Types of support robots for children with ASD

Currently, there are different types of robots. Although each of them has its specificities and its scope of action, in broad strokes we can distinguish them based on their objective, that is, the way they provide support to children with ASD. Thus, we find three classifications:

• Social robots. Thinking androids to interact with children with ASD, with conversations, signals, or expression of emotions.
• Educational robots. Tools that aid during the children’s learning process, using attractive tools to teach different subjects and skills in an organized manner.
• Assistive robots. Robots that provide support in everyday activities. This way, they can reinforce their confidence and independence. For example, with activities such as dressing, brushing teeth, or organizing themselves.

Some examples of robots for children with ASD

Over the past few years, there has been a significant increase in the use of support robots for children with Autism Spectrum Disorder, accompanied by a rise in research on this practice and its benefits. Below, we outline some significant initiatives in this field:

• AURORA. In the late nineties, Kerstin Dautenhahn (University of Reading, England) carried out a pioneering work in the field of robots and autism. The AURORA project aimed to enable children with autism to use a mobile autonomous robot to take initiatives and engage in various actions. According to Dautenhahn, “repetitive behavior can be interpreted as a way to escape from the overstimulation, visual or auditory, that many people with autism experience.” For this reason, a robot easily programmable to perform repetitive and predictable movements can establish “a link between the child and the surrounding world.

• Aisoy 1. Another example is Aisoy 1, a robot capable of recognizing the person with whom it interacts and simulating emotions. Although initially not designed to help children with autism, a study by the MIT Media Lab used the model for this purpose, with a positive result.

• MILO. The first humanoid robot with facial expressions arrived in Spain in 2022, under the name MILO. It is a model that the Polytechnic University of Cartagena (UPCT) purchased from the American company RoboKind. The academic institution acquired it without configuration in order to be able to program it with its own protocol that addresses the emotions and reactions of the child during interaction with the robot. The main objective is to reduce the stress and pressure of children with ASD during exchanges with other people, while training them with the most predictable and simple interactions of the robot. MILO measures 60 cm, has a human-like toy-shaped face, and is capable of expressing emotions through smiles and grimaces, among others.

In conclusion, the use of robots in children with ASD allows for improvement in their social interaction, thanks to the ability to perform repetitive and predictable actions. This possibility, along with the customization of the device, makes the robot an innovative tool that brings new intervention methods to the table in this field.

References

¿Qué es el TEA?, EspacioAutismo. Available in: https://telos.fundaciontelefonica.com/la-cofa/robots-sociales-que-ayudan-a-abrirse-al-mundo-al-nino-autista/ [12/03/24] 

Programación de Robots para mejorar la atención terapéutica de niños con Trastornos Generalizados del Desarrollo (TGD), Diego Paracuellos de los Santos. Universitat Politècnica de València. Available in: https://riunet.upv.es/bitstream/handle/10251/91794/PARACUELLOS%20-%20Programaci%C3%B3n%20de%20Robots%20para%20mejorar%20la%20atenci%C3%B3n%20terapeutica%20de%20ni%C3%B1os%20con%20Trastornos….pdf?sequence=1 [12/03/24] 

Robots sociales que ayudan al niño autista a abrirse al mundo, Pablo Rodríguez Canfranc. Telos (Fundación Telefónica). Available in: https://telos.fundaciontelefonica.com/la-cofa/robots-sociales-que-ayudan-a-abrirse-al-mundo-al-nino-autista/ [12/03/24] 

Robots para autismo: ¿el futuro de una terapia eficaz de ayuda?, Autismo En Vivo. Available in: https://www.autismovivo.org/post/robots-para-autismo-el-futuro-de-una-terapia-eficaz-de-ayuda [12/03/24] 

El robot social de Elche que se cruzó en Kansas con un niño autista, Ana Hernando. SINC. Available in: https://www.agenciasinc.es/Reportajes/El-robot-social-de-Elche-que-se-cruzo-en-Kansas-con-un-nino-autista [12/03/24] 

Así es Milo, el primer robot con emociones que interactúa con el autismo y que ya está en Cartagena, Jorge García Badía. El Español. Available in: https://www.elespanol.com/omicrono/tecnologia/20220713/mylo-primer-robot-emociones-interactua-autismo-cartagena/687431519_0.html [12/03/24] 

Robot como tratamiento para niños con autismo, Jessica Davó García. El mundo del autismo. Available in: https://www.elmundodelautismo.es/el-robot-como-tratamiento-para-ninos-con-autismo/ [12/03/24] 

Use of technology in interventions for Children with Autism, Tina R. Goldsmith, Lina A. LeBlanc. APA PsycNet. Available in: https://psycnet.apa.org/fulltext/2014-52005-004.html [12/03/24] 

Robots sociales como promotores de la comunicación en los Trastornos del Espectro Autista (TEA), Virginia Pinel, Laura Aguiló Rendón, Daniel Adrover-Roig. Letras de Hoje. Available in: https://www.scielo.br/j/lh/a/bgNcrznydKySBCKJPtyW7HG/# [18/03/2024] 

Unwanted loneliness is a problem that has a particularly relevant impact on the elderly population. How should it be addressed? What innovative tools can be promoted from social services to reverse this feeling?

What is unwanted loneliness?

Unwanted loneliness is a subjective and complex phenomenon that occurs when people feel that their relationships are not satisfactory. There is a mismatch between real and desired relationships, either in terms of quantity or quality. Although it is a phenomenon that can occur at any age, it is more commonly present among the elderly. According to the spanish State Observatory of Unwanted Loneliness, this feeling has individual costs (mental and physical health, satisfaction of vital needs, relationship with the environment…) and social costs (impact on health systems and drug consumption).

This article discusses the emerging opportunities that arise from technology and novel approaches in addressing involuntary loneliness, providing innovative tools for professionals in social services and citizen support.

Factors influencing unwanted loneliness in older adults

According to the guide Detecting loneliness during aging, commissioned by the Loneliness Observatory of the organization Friends of the Elderly, it is necessary to pay attention to different areas to understand the risk factors:

• Sociodemographic factors: gender, age, socioeconomic status, place of residence. Being female, having low income levels, and living in an inaccessible environment are factors that increase the risk of experiencing loneliness.

• Health and personal autonomy: self-perceived health, mobility difficulties, deterioration of sensory capacities. Loss of autonomy and the accumulation of diseases are risk indicators.

• Psychological and personality factors: depression, low mental health and self-esteem, unhealthy behaviors…

• Interaction and participation: household composition, social network, quantity and quality of social relationships, level of social participation, social support…

The report Preventing and alleviating loneliness in older adults (Caritas) points out that there are situations of greater vulnerability, such as the death of a partner or other family members, retirement, and moving. On the other hand, the social conception of care for older people, which often focuses on physical needs but overlooks the importance of comprehensive care and psychological aspects, can worsen situations of unwanted loneliness.

How to address situations of unwanted loneliness?

The Barcelona City Council, in the Guide for the prevention, detection, and support of elderly people in situations of loneliness, recommends several points to follow:

• Firstly, it is important to pay attention to indirect verbalizations, as they can be a source of information about the feeling of loneliness.

• It is also relevant to know the family or cohabitation situation and build a relational map of the person. This will allow weaving alliances to reduce this feeling.

• Similarly, it is necessary to know what their interests and preferences are, and thus collectively seek personalized alternatives that adapt to each individual.

• On the other hand, the report highlights the importance of promoting a vision of relationships that contributes to reducing the guilt that family members may feel in the face of loneliness. On many occasions, when the person expresses this feeling, people in their environment feel responsible. It is important to understand that someone can feel lonely even when surrounded by people, as it is a subjective feeling and families cannot always alleviate it.

The Friends of the Elderly association emphasizes that it is key not to promote self-perception of fragility, as it promotes isolation. It is also necessary to avoid using infantilizing and judgmental language. Additionally, it emphasizes the relationship between the social perception of loneliness and the personal experience of the feeling. To break negative stereotypes, it is necessary to create an empowering narrative that reverses discrimination.

The organization suggests five lines of action:

1. Recognize: Professionals’ perspective is crucial to identify situations of loneliness.
2. Understand: It is important to understand the phenomenon and its causes to have common starting points.
3. Consider: The subjective nature of unwanted loneliness, the diversity in each case, and the existing stigma in our sociocultural context should be taken into account. Risk factors should also be known.
4. Discover: Communication is a key tool to detect the feeling of loneliness. The guide proposes paying attention to silences and expression rhythms, establishing active listening, and relying on other trusted agents in the person’s environment.
5. Act: Any solution must be centered on the individual and foster empowerment.

Innovative proposals:

• Digital meeting spaces. Organizing collective activities and events allows building new connections with people who share common interests, which can reverse the feeling of loneliness. Through social media and the internet, individuals can access online meetings, overcoming mobility, transportation, or access issues. It is important to work to overcome the digital gap that exists in a large part of the elderly population. An example is the program Proyectando vidas, uniendo almas, aimed at older adults living in rural towns in Castilla y León. The project aims to alleviate this feeling through telecommuting group activities. Similarly, the British initiative The Silver Line offers a free telephone contact for people over 55, available 24 hours a day. The staff handling the calls provide listening, advice, and referrals to other organizations.

• Robots and voice assistants. Technological advances of the last decade have also been introduced in social services and citizen care. Some organizations have experimented with robots and voice assistants, which complement the work of professionals. An example is the Intelligent Robotic Assistant (ARI), designed by the Saltó Group, which accompanies older adults living in Barcelona.

• Creating support networks from new technologies. Others initiatives like Vincles (iSocial Foundation) use technological systems to collect standardized territorial information to detect loneliness situations in an updated, immediate, and truthful manner. The project is inspired by Auzosare, an innovative program that combines technology, community activation, and socio-educational intervention to prevent and improve the quality of life of people in fragile situations of loneliness.

• Applications to generate intergenerational exchanges. One way to include older adults in the community is to involve younger generations, who can be good allies in contributing to social inclusion. In Bilbao, the association Kuvu connects people of different generations to share housing and mutual company. Another example is the Vollpension Generationencafé. This German initiative operates through cafes staffed voluntarily by retirees, who share time and conversations with the people attending the venue. Unlike traditional intergenerational volunteerism, it’s not the young who volunteer and visit the elderly, but rather the elderly who actively foster their social integration. This way, it promotes feelings of fulfillment, satisfaction, and community service.

• Preventive emotional management tools: To prevent the feeling of loneliness, some initiatives work to offer emotional management tools, helping individuals understand their feelings and avoid potential mental health problems. The Bakardadeak Eskola (School of Solitudes) contributes to demystifying myths and fears about loneliness to change society’s perception of this phenomenon.

References

[1] Detecting loneliness during aging, Observatorio de la Soledad. Available at: https://amigosdelosmayores.org/es/detectar-la-soledad-durante-envejecimiento-una-guia [29/01/24]

[2] Preventing and alleviating loneliness in older people, Cáritas. Available at: https://www.caritas.es/main-files/uploads/2021/02/DOC-TRAB-9-INTERIOR_3.pdf [29/01/24]

[3] Guide for the prevention, detection, and support of older adults in situations of loneliness, Barcelona City Council. Available at: https://bcnroc.ajuntament.barcelona.cat/jspui/bitstream/11703/130451/1/Soledad_GuiaPersonasMayores_ES.pdf [29/01/24]

[4] Unwanted loneliness, Observatorio Estatal de la Soledad No Deseada (SoledadES). Available at: https://www.soledades.es/la-soledad-no-deseada [29/01/24]

[5] Inspiration, Observatorio Estatal de la Soledad No Deseada (SoledadES). Available at: https://www.soledades.es/inspiracion [29/01/24]

[6] Resources, Observatorio Estatal de la Soledad No Deseada (SoledadES). Available at: https://www.soledades.es/recursos [29/01/24]