Computer assisted autism interventions for India Citation of the final article: Vellanki, Pratibha, Greenhill, Stewart, Duong, Thi, Phung, Dinh, Venkatesh, Svetha, Godwin, Jayashree, Achary, Kishna V and Varkey, Blessin 2016, Computer assisted autism interventions for India, in OzCHI 2016: Proceedings of the 28th Australian Conference on the Human-Computer Interaction, Association for Computing Machinery, New York, N.Y., pp. 618-622. This is the peer reviewed accepted manuscript. ©2016, ACM This is the author's version of the work. It is posted here by permission of ACM for your personal use. Not for redistribution. The definitive version was published in OzCHI ’16: http://www.dx.doi.org/10.1145/3010915.3011007 Downloaded from DRO: http://hdl.handle.net/10536/DRO/DU:30093647 DRO Deakin Research Online, Deakin University’s Research Repository Deakin University CRICOS Provider Code: 00113B Computer Assisted Autism Interventions for India Pratibha Vellanki1 , Stewart Greenhill 1 , Thi Duong1 , Dinh Phung1 , [email protected] [email protected] [email protected] [email protected] Svetha Venkatesh1 , Jayashree Godwin2 , Krishna V. Achary2 , Blessin Varkey2 , [email protected] [email protected] [email protected] [email protected] 1Centre for Pattern recognition and Data Analytics, Deakin University, Australia 2Tamana School of Hope, New Delhi, India ABSTRACT expand language skills from receptive to expressive Early intervention is critical for children with autism. To language, and maintain learning environments that sustain provide affordable computer assisted therapies for interest. TOBY already includes these aspects, and thus is developing countries, we construct infrastructures for a state-of-art therapy. translating and adapting early intervention programs such as TOBY to an Indian context. A Hindi prototype is built This work describes the adaptation of TOBY to the and two trials are conducted, showing that the technology language (Hindi), culture and contextual setting (in a was accepted and that the children learnt skills using both school) of India. Early intervention needs precision, so language versions, with the children using the Hindi domain experts are required for translation, and we build prototype achieving slightly better measurable outcomes. systems to facilitate this process. We construct: a) technologies to organise media, maintaining dependency Author Keywords on language and culture, b) collaborative environments to Autism, early intervention, India, Hindi, translation, facilitate a team of experts to create new tasks, c) tools to assistive technology. manage translation of tasks and interface. ACM Classification Keywords Using this framework, a Hindi and an English prototype H5.m. Information interfaces and presentation (e.g., HCI): was developed for India. A 3-person team from India Miscellaneous. adapted a subset of 19 skills and trialled the system. An INTRODUCTION initial trial studied iPad acceptance in an Indian setting Autism touches lives of children, their families and with 32 children. A second trial examined learning with 16 communities. The estimated societal cost is $3.2 million children using the English and Hindi prototypes. Our during the lifespan of an individual with autism spectrum results show that our translational goals are met - the disorder (ASD) (NAC 1990). ASD diagnosis is on the rise, children accept both the technology and the therapists, with 1 in 89 children diagnosed with ASD (Baio 2012). progressing through the syllabus. Such systems are Thus of the 158 million children aged 0-6 living in India significant because they empower therapists in developing (MOSPI 2012), there may be 1.8 million children with countries to deliver early intervention during critical stages ASD. of development. Importantly, they provide an affordable option for the first time. In autism, early intervention is crucial, but support is sparse even in developed countries (FaHCSIA 2016). FRAMEWORK Without assistance children may face lifelong cognitive The TOBY syllabus and social disability. In developing countries problems are TOBY Playpad is an autism therapy app for iPad based on compounded by social and economic handicap, and lack of Applied Behaviour Analysis (ABA). In ABA therapy we support. Urgent solutions are required to deliver timely and present a stimulus to which the child responds. If the child cost effective early interventions. gives the desired response we give reinforcement in the TOBY is a recent technology (Venkatesh et al. 2013) that form of verbal praise, or a favourite toy or activity. uses iPads to deliver therapy to children, in English, and in Otherwise, we prompt the child by demonstrating the Western context. It allows parents and teachers to target correct response. Prompting is faded over time so that daily skill development within the home or school eventually the responses are self-initiated. environment, and allows therapists to monitor progress The TOBY syllabus is divided into four major areas: remotely. It delivers a program spanning a range of early developmental skills - imitation, sensory matching, a) Sensory includes skills related to perception and receptive and expressive language, and social skills. It uses discrimination of sensory cues, such as colour, shape, a mix of activities on and off the iPad, providing rigorous same-ness and difference; b) Imitation includes copying recording of stimuli and responses, adapting the program actions, shapes, or producing pre-speech sounds; c) to the child's progress. Trials show promising learning Language involves recognising and producing the names outcomes (Moore et al. 2013). for objects; d) Social includes interpersonal skills such as making eye contact, and joint-attention. A recent review considers technological applications assisting therapy (Wainer & Ingersoll 2011) and identifies For some therapy tasks such as picture matching, the future program developments. This includes programs that system can present the stimulus, measure the response, extend delivery of exclusively computer assisted programs give reinforcement and prompting. The child performs to include teacher-led and computer-led interactions, these “solo” tasks without assistance. The remaining 1 b) Adaptation to language constraints. Some items need to be changed because of language constraints. For example several words in English map to one word in Hindi. There is only one word for “ankle” and “leg” in Hindi, so one category is removed in the Hindi version. c) Adaptation to differences in function. Some items have different utility in the target country - for example, a bucket can be a toy in Australia, but is a household item in India. Thus the sub-category was reclassified. The following sections describe the implementation of changes in specific parts of the syllabus. Online syllabus manaGement system for text The largest resource that needs translation are instructions to the parent or teacher to do NET activities. The TOBY Figure 1. Syllabus manager, Task edit form syllabus covers 51 skills through a mixture of play and adaptive NET activities. There are 292 NET tasks in total, roughly 6 per skill. Each task contains approximately 260 words, with a total of 77500 words for the entire syllabus. NET tasks include instructional text, formatting, and structure data. The text for each task includes a goal, materials, activity, prompts, and reinforcement. We built a web-based system to manage the translation task. We imported the TOBY English syllabus, and created an initial version of the Hindi syllabus using a machine translation service. While these results were poor, they provided a base to be refined by a human translator. Figure 1 shows the layout of the task view in the syllabus manager. The left panel shows the document attributes and the translated text which can be edited via the form. The Figure 2. Syllabus manager, Preview of NET task right panel shows attributes and text of the original “partner ” tasks involve a parent or a teacher: to measure document. The system verifies that essential items are the child's response, to prompt the child, or to present a specified. When an edit is completed it enters “review” stimulus. Another category of “partner” tasks involving state, and must then be accepted by a different user. routines such as meal time and bathing, is done away form the iPad in a natural setting. This Natural Environment The syllabus manager also offers a preview function (see Training (NET) helps to generalise and transfer skills into Figure 2), which launches TOBY in the web browser using real-world situations. the live syllabus data. This allows the editors to see how their tasks will appear on the iPad screen. This is useful for CustomisinG content and lanGuaGe checking layout and readability. If a task is too wordy to TOBY uses a tree-like category schema to organise fit on a single page, then the editor can see what can be content. The main categories are nouns (food, personal simplified to improve the layout. items, household items, outdoor, clothes, toys, animals and body parts) and Skills (Gross-motor Imitation, Actions Adaptation to cultural context of use - the classroom with Objects, etc). To translate the language and culture we TOBY was originally designed for home settings, and must identify objects or tasks that not in common use in a many adaptive tasks are based on familiar routines such as culture or are constrained by