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- Title
Effect of Wearable Digital Intervention for Improving Socialization in Children With Autism Spectrum Disorder: A Randomized Clinical Trial.
- Authors
Voss, Catalin; Schwartz, Jessey; Daniels, Jena; Kline, Aaron; Haber, Nick; Washington, Peter; Tariq, Qandeel; Robinson, Thomas N.; Desai, Manisha; Phillips, Jennifer M.; Feinstein, Carl; Winograd, Terry; Wall, Dennis P.
- Abstract
This randomized clinical trial evaluates the efficacy of a wearable behavioral intervention for improving social outcomes of children with autism spectrum disorder. Key Points: Question: Can a wearable artificial intelligence intervention designed for use in the home to reinforce facial engagement and emotion recognition improve socialization in children with autism spectrum disorder? Findings: In this randomized clinical trial of 71 children with autism spectrum disorder, children treated at home with the wearable intervention showed a significant improvement in socialization over children only receiving standard of care behavioral therapy. Meaning: The mobile intervention, which teaches the recognition and relevance of emotion in the child's natural setting, can augment standard of care therapy to achieve higher socialization in children with autism spectrum disorder. Importance: Autism behavioral therapy is effective but expensive and difficult to access. While mobile technology–based therapy can alleviate wait-lists and scale for increasing demand, few clinical trials exist to support its use for autism spectrum disorder (ASD) care. Objective: To evaluate the efficacy of Superpower Glass, an artificial intelligence–driven wearable behavioral intervention for improving social outcomes of children with ASD. Design, Setting, and Participants: A randomized clinical trial in which participants received the Superpower Glass intervention plus standard of care applied behavioral analysis therapy and control participants received only applied behavioral analysis therapy. Assessments were completed at the Stanford University Medical School, and enrolled participants used the Superpower Glass intervention in their homes. Children aged 6 to 12 years with a formal ASD diagnosis who were currently receiving applied behavioral analysis therapy were included. Families were recruited between June 2016 and December 2017. The first participant was enrolled on November 1, 2016, and the last appointment was completed on April 11, 2018. Data analysis was conducted between April and October 2018. Interventions: The Superpower Glass intervention, deployed via Google Glass (worn by the child) and a smartphone app, promotes facial engagement and emotion recognition by detecting facial expressions and providing reinforcing social cues. Families were asked to conduct 20-minute sessions at home 4 times per week for 6 weeks. Main Outcomes and Measures: Four socialization measures were assessed using an intention-to-treat analysis with a Bonferroni test correction. Results: Overall, 71 children (63 boys [89%]; mean [SD] age, 8.38 [2.46] years) diagnosed with ASD were enrolled (40 [56.3%] were randomized to treatment, and 31 (43.7%) were randomized to control). Children receiving the intervention showed significant improvements on the Vineland Adaptive Behaviors Scale socialization subscale compared with treatment as usual controls (mean [SD] treatment impact, 4.58 [1.62]; P =.005). Positive mean treatment effects were also found for the other 3 primary measures but not to a significance threshold of P =.0125. Conclusions and Relevance: The observed 4.58-point average gain on the Vineland Adaptive Behaviors Scale socialization subscale is comparable with gains observed with standard of care therapy. To our knowledge, this is the first randomized clinical trial to demonstrate efficacy of a wearable digital intervention to improve social behavior of children with ASD. The intervention reinforces facial engagement and emotion recognition, suggesting either or both could be a mechanism of action driving the observed improvement. This study underscores the potential of digital home therapy to augment the standard of care. Trial Registration: ClinicalTrials.gov identifier: NCT03569176
- Subjects
DIAGNOSIS of autism; TREATMENT of autism; ARTIFICIAL intelligence; BEHAVIOR therapy; BIOMETRY; CHILD care; EMOTIONS; FACIAL expression; MEDICAL quality control; MEDICAL schools; PSYCHOLOGY of children with disabilities; SOCIAL skills; SOCIALIZATION; TELEMEDICINE; RANDOMIZED controlled trials; HEALTH literacy; MOBILE apps; DESCRIPTIVE statistics; CHILDREN
- Publication
JAMA Pediatrics, 2019, Vol 173, Issue 5, p446
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2019.0285