Autism Spectrum Disorder

Several ingenious people from the history such as Galileo, Einstein, and Edison, are believed to perform some behaviors indicates that they have autism (Armstrong, 2010; Diener, Wright, Smith, & Wright, 2014; Fitzgerald, 2004; Webb, Amend, Webb, Goerss, Beljan, & Olenchak, 2005). Autism spectrum disorder is not an entirely well-studied topic, so it is hard to define it with whole its characteristics. It includes an extensive variety of inability and conditions. First, in 1911, the psychiatrist Bleuler used the term autism to describe a type of childhood schizophrenia. Then in 1940s two psychiatrists Asperger and Kanner found out that some kids have different symptoms than the others in childhood schizophrenia. In that way, the foundation of autism which we know today has established and related studies have started (Milton, 2012). Since then, the behavior patterns of people on the autism spectrum is still being experimented. But in general, when some behavior patterns are present in a person, then that person called as autistic (Osgood, 2012). According to Lord and Jones (2012), ASD can be characterized as a short-term for some social interaction deficits including repetitive and limited behaviors and interests.

According to Wing and Gould (1979) that every autistic people is not detached and introverted. It is because autism is a spectrum disorder, which means it has types with different strengths or weaknesses. About 1 percent of the world population has autism spectrum disorder (URL-2). It is a lifelong condition found across the age range from children around the age of three to older adults. While people on the autism spectrum have some common disabilities, each autistic people has unique difficulties in their daily life. Thus, assistive applications should offer customization options to every user. Williams (2004) states that if the autistic kids battle to comprehend their general surroundings, at that point there should be something to support them managing their environment by helping with everyday challenges. Introducing an open door for expanded worlds may well offer new roads to autistic people through an extended feeling of control.

Most of the studies imply that people on the autism spectrum have better visio-spatial skills compared to neurotypicals (Shah and Frith, 1983, 1993; Mitchell and Ropar, 2004; Jung, Lee, Lee et al., 2006). It is because they scored mostly high on Block Design Test which is a test to measure spatial ability and spatial visualization ability. Block Design Test is developed by Kohs in 1923 and still has accepted as the leading non-verbal intelligence test (Clinciu, 2016). Since Kohs, there have been many different versions of the test, but the underlying logic stays the same. During the test, the test-taker needs to rearrange blocks with different colors to match a specific pattern (Figure.2.1).

Figure 2.1: Block Design Test Task Example (Shah, & Frith, 1993).

Even though there are some researchers arguing that spatial visualization ability is a not superior for autistic people (Muth, Hönekopp, & Falter, 2014), the fact that most of them showing high-performance on Block Design Test, cannot be ignored. Frith (1991) posits that the success of autistic people on the test can be explained by their detachment. Their social disabilities based on the missing coherence in their cognitive system. In that way, they may also be incapable of recognizing the whole body. Instead, they can detect the details and embedded figures that are generating the complete form. And that may lead to the excellence on Block Design Test.

Considering people on the autism spectrum are having many difficulties during their lifetime, the assistive studies should be focused on their strengths to support them adequately. Since people who have spatial visualization ability or visual-spatial ability can manipulate 2-dimensional (2D) and 3D figures mentally, this ability of autistic people can be considered as a way to improve the current three-dimensional interfaces used in mixed reality environments. Thus, based on those studies, we considered that there is a lack of spatial interfaces to assist autistic people.

The technology based interventions have been found effective for autistic people in most cases (Diener, Wright, Dunn, et.al., 2016; Lynch, 2016; Bresnahan, Burke, Partin, Ahlness, & Trimmer, 2016; Ramachandiran, Jomhari, Thiyagaraja, & Maria, 2015; Ayres, & Langone, 2005; Goldsmith, & LeBlanc, 2004; Charlop-Christy, Le, & Freeman, 2000; Higgins, & Boone, 1996; Heimann, Nelson, Tjus, & Gillberg, 1995). Therefore, there have been numerous studies about the use of technology for autistic people.

A research group evaluated an animated series called The Transporters created for autistic kids to enhance emotion recognition (Golan, Ashwin, Granader, et al., 2010). In the series, there are the eight cars with the faces of actors on them showing emotions to get the attention of autistic children. In this way, they aim to introduce different emotions with facial expressions. Another study on enhancing empathy is about a collaborative virtual learning environment (CVLE) for autistic children (Cheng, Chiang, Ye, & Cheng, 2010). In CVLE, a restaurant simulation is created to practice social situations the empathy needed. A similar study is about a technology-enhanced learning environment called ECHOES to assist autistic children ages between 5-7 for social interaction skills (Porayska-Pomsta, Frauenberger, Pain, et.al., 2012). ECHOES consists of a sensory 3D garden with interactive objects and semi-autonomous virtual characters displayed on a multi-touch LCD display. Children can modify the garden by touching on the screen. The program sets goal for children and provide free exploration of the virtual environment. Other study that intent to assist autistic children for developing social skills has a different approach (Doyle, & Arnedillo-Sánchez, 2011). It suggests a framework for teachers/parents not for the children themselves to design social stories for autistic kids that can help to reveal difficulties the children have during social interactions.

VR is another technological intervention that has been integrated into autism studies with lots of success (Didehbani, Allen, Kandalaft, et.al., 2016). One of the studies in VR is about a VR therapy for social phobia (Brinkman, 2008). Different VR scenarios that can cause anxiety like bus stop, clothing store and reception desk of a restaurant are created and the exposure of them re controlled by a therapist. Other parallel research aims to help young autistic people to beat specific phobias (Maskey, Lowry, Rodgers, et.al., 2014). In the study, the scientists combine the cognitive behaviour therapy with VR environment. They designed unique VR scenes for each phobia the children have and tested them on users. Another research is focused on social cognition training in VR for young adults on ASD (Kandalaft, Didehbani, Krawczyk, et.al., 2013). It aims to enhance social skills by training them in VR for some real-life situations in an office building, a coffee house, a school, a restaurant, etc. The VR environment is formed by Second Life with customizable avatars. Other study is about a driving intervention architecture in VR for people on ASD (Wade, 2015). Its purpose is to design a system that analyzes the behavior of the drivers and provides feedback according to their special needs.

In addition to VR, there have been also studies on AR technologies for people on ASD. Bai, Blackwell, and Coulouris have developed an AR system based on the pretend play behavior (2013). The AR system combines the imaginary object and the real object by overlaying virtual image on the real-world boxes on a display. For example, when the child holds a box tagged as a school, s/ he sees himself holding a school building on the screen. Other research posits that AR can help autistic children stay focused (Escobedo, Tentori, Quintana, et.al., 2014). A mobile object identification system in AR is developed to assist children with object identification in a place with the help of digital content. Another study is about the Brain Power AR system which is developed for Google Glass device (Liu, Salisbury, Vahabzadeh, and Sahin, 2017). It provides customizable coaching experiences by using game like AR applications. The aim of the system is to assist children with social behaviors like emotion recognition.

Also, various studies are conducted to test the spatial ability of the autistic people. In an experiment, the researchers analyzed the brain map of autistic people while they are completing tasks (Samson, Mottron, Soulières, and Zeffiro, 2012). The analysis proved that autistic people show better performance at completing visual tasks. They identify the details of objects faster and manipulate them easily. Following this, there is also some articles mentioning that Google SketchUp is widely used by autistic people, helping them to express their ideas visually in a 3D environment (Wright, Diener, Dunn, et.al., 2011). Even though there are many applications available to autistic users on various platforms, not all the of them provide a convenient user experience. Besides the content of the application, the user interface design should also be considered as an essential element of the application and developed carefully. Therefore, it is concluded that there is a need to design spatial interfaces that enable natural interaction for autistic people. This study aims to develop a spatial interface toolkit that can be implemented into mixed reality application projects for autistic people with SPD.