Natural interfaces and virtual environments for the acquisition of street crossing and path following skills in adults with Autism Spectrum Disorders: a feasibility study.

BACKGROUND: Lack of social skills and/or a reduced ability to determine when to use them are common symptoms of Autism Spectrum Disorder (ASD). Here we examine whether an integrated approach based on virtual environments and natural interfaces is effective in teaching safety skills in adults with ASD. We specifically focus on pedestrian skills, namely street crossing with or without traffic lights, and following road signs. METHODS: Seven adults with ASD explored a virtual environment (VE) representing a city (buildings, sidewalks, streets, squares), which was continuously displayed on a wide screen. A markerless motion capture device recorded the subjects' movements, which were translated into control commands for the VE according to a predefined vocabulary of gestures. The treatment protocol consisted of ten 45-minutes sessions (1 session/week). During a familiarization phase, the participants practiced the vocabulary of gestures. In a subsequent training phase, participants had to follow road signs (to either a police station or a pharmacy) and to cross streets with and without traffic lights. We assessed the performance in both street crossing (number and type of errors) and navigation (walking speed, path length and ability to turn without stopping). To assess their understanding of the practiced skill, before and after treatment subjects had to answer a test questionnaire. To assess transfer of the learned skill to real-life situations, another specific questionnaire was separately administered to both parents/legal guardians and the subjects' personal caregivers. RESULTS: One subject did not complete the familiarization phase because of problems with depth perception. The six subjects who completed the protocol easily learned the simple body gestures required to interact with the VE. Over sessions they significantly improved their navigation performance, but did not significantly reduce the errors made in street crossing. In the test questionnaire they exhibited no significant reduction in the number of errors. However, both parents and caregivers reported a significant improvement in the subjects' street crossing performance. Their answers were also highly consistent, thus pointing at a significant transfer to real-life behaviors. CONCLUSIONS: Rehabilitation of adults with ASD mainly focuses on educational interventions that have an impact in their quality of life, which includes safety skills. Our results confirm that interaction with VEs may be effective in facilitating the acquisition of these skills.

A double-blind, parallel, multicenter comparison of L-acetylcarnitine with placebo on the attention deficit hyperactivity disorder in fragile X syndrome boys.

Attention deficit hyperactivity disorder (ADHD) is a frequent behavioral problem in young boys with fragile X syndrome (FXS), and its treatment is critical for improving social ability. The short-term efficacy of stimulant medications like methylphenidate (MPH) is well established in children with ADHD. FXS boys treated with MPH have improved attention span and socialization skills; however their mood becomes unstable at higher doses. Therefore, alternative pharmacological treatment of ADHD symptoms is desirable. A recent study showed that carnitine has a beneficial effect on the hyperactive-impulsive behavior in boys with ADHD without side effects. Our previous placebo-controlled trial indicated that L-acetylcarnitine (LAC) reduces hyperactivity in FXS boys. The objective of this study was to determine the efficacy of LAC in a larger sample of FXS boys with ADHD. The study design was randomized, double blind placebo controlled, parallel, and multicenter (with eight centers involved in Italy, France, and Spain). Sixty-three FXS males with ADHD (aged 6-13 years) were enrolled; 7 patients dropped out, 56 completed the one-year treatment, and 51 were included in the statistical analysis. Both groups improved their behavior, showing that psychosocial intervention has a significant therapeutic effect. However, we observed a stronger reduction of hyperactivity and improvement of social behavior in patients treated with LAC, compared with the placebo group, as determined by the Conners' Global Index Parents and the Vineland Adaptive Behavior Scale. Our results show that LAC (20-50 mg/kg/day) represents a safe alternative to the use of stimulant drugs for the treatment of ADHD in FXS children.

Effect of interface type in the VR-based acquisition of pedestrian skills in persons with ASD.

Possession of `social' skills is crucial for persons with autism spectrum disorders (ASD) to maintain a certain independence and a better quality of life, and interaction with virtual environments seems an effective learning aid. In a previous study, we reported that in adults with ASD interaction with a virtual environment (a virtual city) is beneficial to the acquisition of pedestrian skills (street crossing and street navigation). Interaction was based on a gesture-based interface (Microsoft Kinect). Here we compare the learning performance when the same virtual environment is operated by a gamepad interface. We used exactly the same training protocol and data analysis than the original study. We found that both interface types are effective in the acquisition of street crossing and city navigation skills. The gamepad interface seems easier to use (thus leading to faster interaction), but gesture-based interfaces are superior in terms of transfer of the learned skills to real road environments (as reported by parents and caregivers).