Title: Feasibility study of an RCT to investigate the effectiveness of a humanoid robot to support social skills development in children with an Autism Spectrum Disorder.
Funder: Department of Health and Social Care

Abstract: Autism Spectrum Disorder (ASD) is a lifelong, neurodevelopmental disorder that affects approximately 1 in 100 individuals in the UK1. Individuals with ASD have difficulties in social communication/ interaction and restricted, repetitive patterns of behaviour, interests or activities2. Furthermore, ASD doesn t just impact the health of the individual: mothers of children with ASD are at greater risk for high stress levels and poor mental health than those of typically developing children3,4,5. Although ASD is a lifelong disorder, many researchers feel that it is not necessarily a lifelong disabling condition6. Early intervention increases the likelihood of improved long-term outcomes and is crucial to help children and families achieve the best6,7. However, families report waiting a long time for a diagnosis and express dissatisfaction with the lack of professional support in helping to address child social and emotional development8,9. For intervention to advance the most benefit, it needs to be accessible at the point of diagnosis. To date, there have been a number of interventions that have been advanced. One specific avenue of research has explored the use of Socially Assisted Robots (SAR) in supporting the social and emotional development of children with ASD. SAR have been shown to be effective social mediators, encouraging and facilitating social behaviour between children and developing their social skills10,11. Aresti-Bartalome & Garcia-Zapairain (2014) claimed that SAR may become very useful tools in therapy with children with ASD12. There have been promising results with a humanoid SAR, KASPAR, in studies to improve the development of communication and social skills in children with an ASD. Teachers, parents and carers have reported improvements in children s behaviour13,14,15. NICE guidelines say that psychosocial interventions for autism should include play-based strategies to increase joint attention, engagement and reciprocal communication16. The games, or scenarios, that children can play with KASPAR have been designed so that they each contain elements of joint attention, imitation, turn-taking, cause and effect and collaboration &ndash; important skills for the development of social competence. The aim of the present study is to conduct a feasibility of a Random Control Trial (RCT) comparing the social skills of children who interact with (i) KASPAR to those of (ii) a group who have the same interaction with a therapist only (TOG) and (iii) treatment as usual (TAU). Participants will be recruited from a clinic that assesses communication disorders. Sixty children newly diagnosed with ASD will be randomly allocated to one of the three groups. Outcomes will be assessed at baseline, post-intervention and 3 months after the intervention. The research questions to be addressed concern the feasibility of running a full-scale RCT to evaluate the effectiveness of using KASPAR to improve the social skills of children newly diagnosed with an ASD. The feasibility study will assess recruitment rates, participant attrition, acceptability of the intervention to parents coupled with child enjoyment, the ease of completing outcome measures, the practicality of having three groups and scheduling clinics. A qualitative semi-structured interview will inform us about the patients families' views of the acceptability and use of the intervention.

Lay abstract: Autism Spectrum Disorder (ASD) is a lifelong condition that affects approximately 1 in 100 individuals in the UK. It is associated with difficulties in social communication/ interaction and restricted, repetitive patterns of behaviour, interests or activities. ASD is a disabling condition, but early intervention increases the likelihood of improved long-term outcomes. However, parents frequently report waiting a long time for a diagnosis for their child and express feelings of dissatisfaction with the availability of interventions. One avenue of research has explored the use of Socially Assisted Robots (SAR) in supporting the social and emotional development of children with ASD. There have been promising results with the SAR, KASPAR, in studies to improve the development of communication and social skills in children with ASD, particularly those of young age. Children play games with KASPAR, which contain important skills for the development of social competence. Over a number of case studies, teachers, parents and carers have reported improvements in children s behaviour, suggesting some benefits of robot mediated interventions. The aim of the present research is to conduct a feasibility of a full-scale trial which will compare the social skills of children who interact with (i) KASPAR (ii) a researcher only, and those who receive (iii) usual care. Sixty children newly diagnosed with ASD will be randomly allocated to one of the three groups. The feasibility study will examine how many families can be recruited to the study (and how many drop out), whether the intervention is acceptable to them, how easy it is to complete the outcome measures of interest, and to glean parent perspectives on their experience in the two different intervention groups. The latter will be achieved via qualitative interviews. The feasibility study is the first step towards trialling an intervention that may have benefits for child and parent well-being.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH