Comedic experience with two robots aided a child with autism spectrum disorder to realize the importance of nonverbal communication

摘要

Children with autism spectrum disorder (ASD) have trouble with nonverbal communication, which is strongly associated with poor social function.1 There are few evidence-based interventions for children with ASD, so tutors find it difficult to teach nonverbal communication skills. This letter documents the case of a child with ASD who received an intervention that used two humanoid robots. A 14-year-old boy with ASD diagnosed according to the DSM-5 criteria had a long past history of school refusal because of being bullied. He was regarded as a ‘party pooper’ partly because his nonverbal communication was poor. His Childhood Autism Rating Scale total score of 37 indicated severe ASD. Despite extensive treatment, including social skills training to improve communication skills, his aversion to communicating with others persisted. However, he liked giving a presentation in front of familiar audience. Considering his interest in robots, we decided to have him work on a comedic sketch using two humanoid robots and present it in the school festival. In this experiment, the patient could remotely control the two robots using one laptop. We used the Actroid-F (Fig. S1; Kokoro, Co. Ltd, Hamura, Japan), which resembles a human being in terms of realism and facial expressions, including eye movement, and the CommU (Fig. S1; Vstone, Co. Ltd, Osaka, Japan), which can demonstrate a range of expressions, but in a less complex way than the Actroid-F. We encouraged the patient to engage in the work for 1 h every day for 1 month. Robot engineers were ready at any time to assist him. He had a habit of avoiding looking at people as he had had many experiences of being scolded for staring. However, he could stare at each robot because he understood that they would not get angry. Getting the two robots to interact was not smooth. Being able to control the robots freely got him motivated to work on his own initiative, which made it possible to selectively focus on their interaction and to understand the situation that each robot occupied. He focused on his work to adjust the gazes and facial expressions of the two robots to have them interact with each other smoothly and came to realize the importance of nonverbal communication. Being able to reproduce nonverbal expression in robots at his own pace may have deepened his understanding of its importance. Before this task, the patient had thought it was difficult to make friends because of his lack of confidence in communicating. However, afterwards he thought that he would be able to make himself understood using nonverbal communication and use it voluntarily. Both at home and at school, his family and teachers recognized that he became more expressive and maintained eye contact during conversations. He began interacting with others positively and recovered his confidence. During the intervention, the patient was able to put himself in each robot's position, which promoted his understanding of nonverbal communication and its importance in interaction. Our findings suggest that this type of intervention might trigger understanding of nonverbal communication and increase its expressivity in ASD. This study was supported by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (18H02746) and the ERATO ISHIGURO Symbiotic Human–Robot Interaction Project, and was partially supported by the Center of Innovation Program from the Japan Science and Technology Agency, JST, Japan. Yuichiro Yoshikawa and Hiroshi Ishiguro serve as consultants for Vstone, Co. Ltd. Hiroshi Ishiguro owns stock in the same company. This involvement does not alter the authors’ adherence to the Psychiatry and Clinical Neuroscience policies regarding sharing data and materials. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the