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The present article describes the results of a pilot study, framed within a wider research design, activated in 2019 by the joint effort of the University of Macerata (Italy) and the RobotiCSS Lab of the University of Milan Bicocca (Italy). The study involved a child with High-Functioning Autism in a work session of growing complexity that was designed to foster the development of abilities of emotional and mental states by using the NAO robot. Beside the design process and the sequence of activities the article will illustrate the socio-emotional profile of the child as resulted by the TEC test and the analysis of the indicators related to: ocular contact, attention and imitation and the set of prompts offered during the interactions with the robot. Finally, authors will discuss the opportunity to widen the pilot with a second step of work sessions by integrating the social immersive 3D virtual world edMondo.

This paper reports the design and assessment of a neuro-fuzzy model to support clinicians during virtual reality therapy. The implemented model is able to automatically recognize the perceived stress levels of the patients by analyzing physiological and behavioral data during treatment. The model, consisting of a self-organizingmap and a fuzzy-rule-basedmodule, was trained unobtrusively recording electrocardiogram, breath rate and activity during stress inoculation provided by the exposure to virtual environments. Twenty nurses were exposed to sessions simulating typical stressful situations experienced at their workplace. Four levels of stress severity were evaluated for each subject by gold standard clinical scales administered by trained personnel. The model's performances were discussed and compared with the main machine learning algorithms. The neurofuzzy model shows better performances in terms of stress level classification with 83% of mean recognition rate.

Joint attention (JA), whose deficit is an early risk marker for autism spectrum disorder (ASD), has two dimensions: (1) responding to JA and (2) initiating JA. Eye-tracking technology has largely been used to investigate responding JA, but rarely to study initiating JA especially in young children with ASD. The aim of this study was to describe the differences in the visual patterns of toddlers with ASD and those with typical development (TD) during both responding JA and initiating JA tasks. Eye-tracking technology was used to monitor the gaze of 17 children with ASD and 15 age-matched children with TD during the presentation of short video sequences involving one responding JA and two initiating JA tasks (initiating JA-1 and initiating JA-2). Gaze accuracy, transitions and fixations were analyzed. No differences were found in the responding JA task between children with ASD and those with TD, whereas, in the initiating JA tasks, different patterns of fixation and transitions were shown between the groups. These results suggest that children with ASD and those with TD show different visual patterns when they are expected to initiate joint attention but not when they respond to joint attention. We hypothesized that differences in transitions and fixations are linked to ASD impairments in visual disengagement from face, in global scanning of the scene and in the ability to anticipate object’s action.

Assistive technology is a generic system that is used to increase, help or improve the functional capabilities of people with disability. Recently, its employment has generated innovative solutions also in the field of Autism Spectrum Disorder (ASD), where it is extremely challenging to obtain feedback or to extract meaningful data. In this work, a study about the possibility to understand the visual exploration in children with ASD is presented. In order to obtain an automatic evaluation, an algorithm for free gaze estimation is employed. The proposed gaze estimation method can work without constrains nor using additional hardware, IR light sources or other intrusive methods. Furthermore, no initial calibration is required. These relaxations of the constraints makes the technique particularly suitable to be used in the critical context of autism, where the child is certainly not inclined to employ invasive devices. In particular, the technique is used in a scenario where a closet containing specific toys, that are neatly disposed from the therapist, is opened to the child. After a brief environment exploration, the child will freely choose the desired toy that will be subsequently used during therapy. The video acquisition have been accomplished by a Microsoft Kinect sensor hidden into the closet in order to obtain both RGB and depth images, that can be processed by the estimation algorithm, therefore computing gaze tracking by intersection with data coming from the well-known initial disposition of toys. The system has been tested with children with ASD, allowing to understand their choices and preferences, letting to optimize the toy disposition for cognitive-behavioural therapy.

BackgroundThe recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. ObjectiveOur goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones). MethodsThe study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations—teachers and nurses—that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation. ResultsAlthough both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs CG=0.5%) in chronic “trait” anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill. ConclusionsOur findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management. Trial RegistrationClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h).