#JHFA Intern Research

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Article Summary: Hyperacusis in Autism Spectrum Disorders

Written by Kevin Bandel

Hyperacusis is the condition in which sounds which are not considered threatening or uncomfortable to most are perceived as intolerable. These reactions are to sound in general rather than a dislike of particular sounds. This report explores the prevalence of hyperacusis in the autistic population, the etiology (study of a condition’s causes) of hyperacusis in autism, and possible symptom management.

The exact cause of hyperacusis is unknown, but there are theories about what may increase its likelihood. One theory is that there is an increased synchronization between the auditory cortex and neurons that typically respond to loud sounds, which means the neurons would activate from lower intensity sounds. Another theory is an alteration between the limbic system (part of the brain responsible for emotional responses) or the auditory pathway. In observing those with hyperacusis, scientists have used Magnetic Resonance Imaging (MRI) on these subjects and detected elevated auditory activity in the midbrain, thalamus, and cortex.

While it is suspected that a significant portion of the autistic population experiences hyperacusis, studies have been inconsistent on how widespread it is. In 1999, one study reported an 18% prevalence for hyperacusis in children and adolescents with autism. Another study conducted in 2016 reported an increased sound sensitivity in 37% of the autistic children and adolescents it observed. The highest rate of hyperacusis was from a study in 2015, which tested autistic individuals ages 4 to 42, found that 69% of the participants were in the reported hyperacusis range.

Despite how large and inconsistent the estimated of range of hyperacusis in autistic individuals, a range of 18%-69% is a noticeable difference from the general population that possibly has hyperacusis, which is 3.2% to 17.1% The other important factor was of a study of 61 children with hyperacusis, 46% of them had a concurrent neurodevelopmental condition, with the most common being autism. The prevalence of concurrent autism and hyperacusis was likely influenced by autism influencing differences in sensory processing.

The article recommended three approaches to managing hyperacusis. One was habituation training, which involves playing a list of sounds the patient finds bothersome at a low level, with a gradual increase to the volume each week. Another was Cognitive Behavioral Therapy (CBT), which attempts to reframe a patient’s negative thoughts and behaviors. The last one was Auditory Integration Training (AIT), which plays an audio recording that filters out the sounds that the subject finds most intolerable, adding them back into the recording at a slow increase in volume. Of the three approaches, the article provided studies that Auditory Integration Training was the least supported in its effectiveness of dealing with hyperacusis.

An issue in assessing and coping with hyperacusis is the difficulty to measure and define it. Since it is a combination of both sound sensitivity and personal experience, studies would need to account for both dimensions of the condition. Subjective emotions are very challenging to measure precisely, but are a crucial part of hyperacusis since one’s perspective of sounds affects how much one can tolerate them.

While much is undetermined about hyperacusis, it appears to explain and conceptualize struggles that many autistic people face, especially since pursuing music involves a high exposure to sound.

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Article Summary: Sweet spot in music—Is predictability preferred among persons with psychotic-like experiences or autistic traits?

 Written by Kevin Bandel

(Note: Just because “psychotic-like experiences” and autism are used in the same sentence, it does not mean they are similar. For example, the sentence, “Dangerous psychopaths and morally upstanding people need water to survive,” does not mean that dangerous psychopaths and morally upstanding people are comparable in most ways.  Furthermore, having a psychosis does not make a person “bad.”)

It is often assumed that music listeners prefer a balance of predictability. The ideal is that music is not so predictable that it becomes uninteresting, but not so unpredictable that it is jarring and incomprehensible. Individuals can vary in how they perceive a specific level of predictability. Some may find a piece of music monotonous; some may find the same piece chaotic, and others may have an opinion in between.

The authors of this article wondered if psychosis or autism would influence the amount of preferred predictability in their musical taste. Some symptoms of psychosis include paranoid ideas and difficulty telling reality from fantasy, which often leads to increased distress in unpredictable situations and an increased comfort with the familiar. Autistic people tend to experience heightened emotional arousal from the less known and may specialize in areas they are most focused on, which may also lead to an inclination toward a more consistent and regular lifestyle. The authors of this article were curious to see if these general behaviors applied to musical taste.

However, there are factors that can influence preferences to predictability in music outside of psychosis or autism. Individuals may be exposed to certain types of music most frequently, which may establish the baseline of predictability in music a person uses. Pieces often have conventions that can be observed across other pieces of the same genre, which would increase the level of perceived predictability for those familiar with a specific genre.

321 participants with either autism or psychosis were recruited from Prolific.co (a website designed to connect researchers and participants) and the Arctic University of Norway. The average years of music training (either formal or self-taught) was 5.69 with a standard deviation of 7.6. Participants rated various music excerpts on a scale of 0 (disliked very much) to 100 (liked very much). A panel of 8 music experts measured predictability of each excerpt and gave them a 1-10 rating, with 1 being the most predictable/least complex and 10 being the most difficult to anticipate/most complex. The average of the participants’ enjoyment of the excerpts was compared to the complexity score that the panel of experts gave the music.

A limitation of the study is that it did not measure the perceived predictability of the participants, only their enjoyment. Perceived predictability and enjoyment could be linked. Furthermore, age was not linked to participant responses to preserve anonymity. Age could impact both perceived predictability and enjoyment. With all aspects of the study considered, the authors concluded while research in the area is incomplete, there was insufficient evidence to suggest autism or psychosis affected the “sweet spot” for preferred predictability in music.

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How Digital Learning Can Prepare Neurodivergent Learners For the Job Market

Written by Alan Berkeley

Technological literacy is a skill we are all expected to have in this modern age. Still, the rapid transition to fully digital learning environments over the past few years has come with a learning curve and has often left educators scrambling to adjust. Many people continue to find themselves wrestling with a new mode of learning that involves adopting an unfamiliar set of skills. This abrupt change to online learning, brought on by the pandemic, has been an unprecedented shift for education systems worldwide that has yielded drastically increased workloads for teachers and varied effects on students’ engagement, concentration, and motivation (Allen et al., 2020). However, an important question remains: are online learning methods simply a drain on mental resources for students and educators alike, or can they provide opportunities for developing novel skills technologically and developmentally? 

For neurodivergent individuals like the aspiring musicians at Jazz Hands For Autism’s Musicians Academy, learning technology can provide an excellent medium to develop a wide range of transferable skills, whether they are taking courses in person, online, or in a hybrid format. Assistive technologies such as touch-based interfaces and interactive digital environments, explicitly designed to help neurodivergent students, have positively impacted students with autism, and digital learning environments seem to mirror these impacts (Wilson et al., 2017).  For example, although many of us felt hindered socially by working and studying digitally, studies like that of Passerino and Santarosa (2008) have indicated that digital learning environments can promote interaction skills among users with autism regardless of their support needs. The additional predictability and control within these spaces lead to an increased feeling of safety, so students are less likely to feel uncomfortable interacting with others. Furthermore, digital environments minimize distractions (such as outside noise and irrelevant visual stimuli), which are present in the outside world; meaning students can feel less anxious or overwhelmed, thus helping break down communication barriers and foster communicational development (Bartoli et al., 2014). 

Autonomy is another area where digital learning can significantly aid our neurodivergent demographic. Research on the effects of digital environments on autonomy goes back decades (see Panyan, 1984), with many of these studies yielding promising results (Knight et al., 2013).  Digital environments can provide flexibility, a more customizable experience, and a consistent mechanism for positive reinforcement. These aspects of digital learning are essential for the curriculum and instructional designers at Jazz Hands For Autism. Common questions considered by Jazz Hands For Autism’s lead instructional designer Dante Treggs include “What support structures are there? Are they [students] going to need multiple modes of accessibility?”  Instruction through these programs is well-equipped to adapt to the individualized and unique skill sets, academic levels, and support needs of each student (or aspiring musician). 

The predictability of digital environments also seems to influence their benefits yet again regarding autonomy, with the repetitive nature of many digital interfaces synergizing with the tendencies toward patterns that many neurodivergent children and young adults are drawn to (Glumbić et al., 2022). This element of digital learning may also play a role in improving student organization, a skill that is undoubtedly key in the classroom and the workplace. Organization was cited by one student at Jazz Hands For Autism, who is taking his classes entirely online and had previous experience with online instruction, as the most significant advantage digital learning can offer. Some online learning platforms organize their assignments in tabs, making it simple to find required assignments, while virtual calendars allow students to easily track work that is coming up and even set reminders so they are not surprised by a sudden deadline. Moodle, the learning management system that Jazz Hands For Autism uses to deliver its online and hybrid courses, even offers additional plugins that enhance organization and customization further. Additionally, in many cases, students can view course content in a wider scope than may be possible by reading a syllabus, allowing them to prepare more effectively for upcoming content. However, perhaps the most important advantage in this area for arts-based vocational and educational organizations like Jazz Hands For Autism is that digital environments have the potential to promote self-expression (Wilson et al., 2017). Although this is essential for creativity within artistic mediums, improved self-expression also leads to inventive thinking and enhanced well-being in the workplace (Wilson et al., 2017). 

The benefits of digital learning environments have been made evident through research, but there are certainly some shortcomings that may reveal the benefits of in-person instruction. “I learn a lot more in person,” said David, an aspiring musician who is taking his courses in person at the Jazz Hands For Autism Musicians Academy and aims to work in a studio upon his completion of the program. David also reported that interaction with his peers and instructors became more challenging in the digital realm, as he found that they often spoke over each other. Upon asking him if he found any benefits in learning digitally, David could not find anything that he felt was superior to learning in person, which he found both more effective and more enjoyable. On a more general level, some digital spaces may overwhelm the senses of some neurodivergent people. Hindrances in communication development could also be a drawback, mainly if the environment is not geared towards messaging and interacting with others. Furthermore, the pattern aspect of digital learning mentioned earlier may even be a double-edged sword. Students may develop behavioral patterns that are limited in their scope, as their learning environment may not provide them with enough variation to cultivate robust responses to complex stimuli (Bradley & Newbutt, 2018). 

Overall, though there are drawbacks for some, digital learning appears to be an effective way for many neurodivergent students to develop essential skills for the job market. While technological proficiency improves through the frequent utilization of digital spaces, the soft skills that can evolve in tandem with this technical proficiency are just as essential. Autonomy and social interaction are key facets of advancement for people with autism both in the classroom and the workplace, so for digital learning to nurture these attributes means that it can effectively prepare students for life beyond school. Still, we must note that neurodivergence exists on a spectrum, and with this comes a plethora of learning styles. No learning strategy can work for everybody, neurodivergent or not, so the positives of digital learning may only be beneficial in the eyes of particular learners. Therefore, a learning environment that provides flexibility through offering courses online, in-person, or a hybrid of the two like Jazz Hands For Autism Musicians Academy provides, means that students can foster the essential skills they need for their careers through a diverse array of methods and mediums. While many students may see the transition to digital learning as an obstacle and find they are more successful with in-person instruction, neurodivergent learners who may prefer to learn online can leverage the transition to digital learning to gain skills that make them indispensable in the working world.

References

Allen, J., Mahamed, F., & Williams, K. (2020). Disparities in Education: E-Learning and COVID-19, Who Matters?. Child & Youth Services, 41(3), 208-210.

  Bartoli, L., Garzotto, F., Gelsomini, M., Oliveto, L., & Valoriani, M. (2014, June). Designing and evaluating touchless playful interaction for ASD children. In Proceedings of the 2014 conference on Interaction design and children (pp. 17-26).

  Bradley, R., & Newbutt, N. (2018). Autism and virtual reality head-mounted displays: a state of the art systematic review. Journal of Enabling Technologies.

  Glumbić, N., Đorđević, M., & Brojčin, B. (2022). Autism and Digital Learning Environment. In Digital Inclusion of Individuals with Autism Spectrum Disorder (pp. 47-74). Springer, Cham. - Overview of ASD and digital learning literature

  Knight, V., McKissick, B. R., & Saunders, A. (2013). A review of technology-based interventions to teach academic skills to students with autism spectrum disorder. Journal of autism and developmental disorders, 43(11), 2628-2648.

  Panyan, M. V. (1984). Computer technology for autistic students. Journal of Autism and Developmental Disorders, 14(4), 375-382.

  Passerino, L. M., & Santarosa, L. M. C. (2008). Autism and digital learning environments: Processes of interaction and mediation. Computers & Education, 51(1), 385-402.

  Wilson, C., Brereton, M., Ploderer, B., Sitbon, L., & Saggers, B. (2017, October). Digital strategies for supporting strengths-and interests-based learning with children with autism. In Proceedings of the 19th International ACM SIGACCESS Conference on Computers and Accessibility (pp. 52-61).

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Experiences of autistic and non-autistic individuals participating in a corporate internship scheme

Since research has suggested that autistic people have had challenges in both obtaining and maintaining employment, this study compares the experiences of autistic and non-autistic interns working for the same organization. Specifically, it observed the autistic interns, the non-autistic interns, and their managers using semi-structured interviews and online questionnaires before and after the internship.

Fifty-two adults were involved in the study. Sixteen were autistic adults, and sixteen were their managers. Fifteen of them were non-autistic, and the remaining five were their managers. A few members were not able to participate in the pre or post internship interviews.

Most of the interns spoke English as their first language and had either completed or were earning a university degree. Among the non-autistic participants, they had had no specific diagnoses except for one with ADHD and one with an anxiety disorder. For the autistic interns, nine (60%) had been diagnosed at an early age, but the remaining six (40%) had received their diagnosis in the last ten years.

While there were similarities between both groups of interns, prior employment experiences, mental health, and communication issues were given greater attention for the autistic interns. Managers of autistic interns expressed concern about providing adequate support, effective communication, and equitable treatment when compared to managers of non-autistic interns. The most effective strategies employed by managers of autistic interns were structured tasks and flexible communication, while clear communication and consistent support were beneficial to both intern groups.

Anxiety was a common feature among both the autistic and non-autistic interns, but the non-autistic ones felt anxiety mostly before the internship started. The autistic participants were far more likely to report experiencing it during and after the internship. This lines up with research that suggests that mental health conditions such as anxiety and depression are much more likely to occur among autistic people than the general population.

Some aspects of the study would need more testing. The organization examined by this study, while imperfect in understanding and working with autistic people, still was more equipped to have autistic interns than many organizations. The problems autistic workers may face could be more prevalent than this study suggests. Also, the non-autistic participants were balanced between male and female interns, while the autistic interns were skewed towards having more males. The sample size was also small, as there would unlikely be enough autistic interns in one organization to provide a large enough sample size.

Nevertheless, the study showed willingness from managers to accommodate their autistic interns, autistic interns showed their capability to perform above expectations, and the presence of autistic people in the organization pushed for clearer communication, which benefited everyone. This suggests understanding and supporting neurodiverse people is desirable for any organization.

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Article Summary: Ameliorating the disadvantage for autistic job seekers: An initial evaluation of adapted employment interview questions

Written by Kevin Bandel

Even though autistic people can possess valuable skills, their differences in social communication compared to most non-autistic people frequently make them disadvantaged in interviews. This study sought to test if altering questions of an interview could help create more balanced results between autistic and non-autistic participants.

Fifty adults, twenty-five autistic and twenty-five non-autistic, participated in two mock interviews. Interview 1 had typical unmodified questions. The interviews were run by a group of employment experts who were not informed which participants were diagnosed with autism spectrum disorder. After Interview 1, the interview panel rated the interviewees based on their answers and gave them suggestions on how their answers could be improved. For the interview questions, the panel provided feedback on how the questions could be altered to receive more favorable results from the interviewees. The interviewees also provided their experience about the experience.

From input provided from the interview panel and the interviewees, Interview 2 was held six months later and had adapted questions. The ratings for the interviewers were higher for all participants, but the most significant increase came from the autistic interviewees. In Interview 1, the employment experts rated the autistic participants less favorably than the non-autistic ones, but in Interview 2, the gap between the two groups of participants decreased.

In Interview 2, there was still a gap between the autistic and non-autistic participants. The most common reasons given by the panel for this difference is that autistic interviewees appeared to have lower social communication skills, confidence, and impression management. Impression management is influenced by knowledge of social cues and knowledge of the implicit structure of a situation, both of which autistic participants may have reduced awareness of compared to a similarly skilled neurotypical person. The autistic interviewees showed less attention toward impression management than the non-autistic ones, as they were less aware of how the panel would respond to their words and were more prone to making negative comments about themselves.

 The limitations of the study were that the mock interview did not include a specific job description, as the participants did not all have the same career background. This would decrease the specificity of answers, and the participants reported the trial interview lacked the pressure of a real interview. Another limitation was that the panel observed the interviews through a transcript of the interviewee’s words rather than real time, which means parts of the participants’ communication skill was not observed.

Despite its flaws, the study implies the importance of asking specific, non-open-ended questions to people on the spectrum and that it is not fair to place all of the onus on autistic interviewees changing their behavior when interviewers could ask more accommodating questions.

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Article Summary: Perspective-taking is two-sided: Misunderstandings between people with Asperger’s syndrome and their family members

Written by Kevin Bandel

Despite no longer being an official diagnosis after 2013, this study still uses the description “Asperger’s syndrome.” What was previously assumed to be Asperger’s syndrome is now simply being on the autism spectrum with perceived “mild” or “high functioning” characteristics. The description “Asperger’s syndrome” will not be used in favor of using “autism” and “autistic” in this summary instead.

Misunderstandings are almost always bidirectional rather than the fault of one person. Unfortunately, communication problems involving autistic people are often viewed by focusing on those who have a neurodiverse diagnosis rather than the dynamic of the social interaction. This study went against this tendency by evaluating the misunderstandings between twenty-two pairs, one autistic participant and one of their family members.

Both parts of each pair were asked a series of twelve questions. In answering these questions, they also have ratings about oneself, the other part of the pair, and the predicted score they would receive from the other interviewee. The ratings were about knowledge and proficiency in certain aspects of social communication and self-awareness. All participants were aware of the presence of autism in half of the members.

The findings showed that the autistic subjects were able to predict that the ratings they would receive from their family numbers would be lower than how they rank themselves. The autistic participants were able to make this accurate guess even though they disagreed with their family members’ views. Both based on these results and the autistic participant’s answers, it is implied that the family members overestimated the egocentricity in their autistic relatives’ views.

While these findings suggest that misunderstandings are two-sided, there are some limitations of the study. First, most of the most common pairing observed was an autistic son and his mother. Other kinds of relationships, especially ones that included autistic females, were underrepresented. Second, participants were recruited through charity, which means the autistic participants might have been more willing than average to take part in the survey and have a family member who was able to take part. Third, social misunderstandings were evaluated in retrospect instead of during natural real-time interactions.

Even with some areas that could use more experimentation, the idea of misunderstandings being bidirectional is an important lesson for working with students at JHFA. Furthermore, if a student talks about certain topics often, it is not necessarily out of selfishness. The intent of why that topic is brought up should be considered, so we should avoid overestimating the egocentricity of autistic people.

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Article Summary: Social Competence Intervention Program (SCIP): A pilot study of a creative drama program for youth with social difficulties

Written by Kevin Bandel

Note: For this article, only part of it was available for free, so there will be some specifics that are not included in this summary

Using drama to enhance an intervention to improve social skills and communication, the Social Competence Intervention Program (SCIP) included children with autism spectrum disorder, nonverbal learning disability, and ADHD. A group of eighteen participants were compared with a clinical control group of sixteen. The qualities measured in the participants were social perception, social competence, and naturalistic observed behavior (examining a subject’s behavior in their typical environment without external influence).

Interviews were conducted from both the participants and their parents about how they were performing in the measured areas post-treatment. The treatment group showed significant progress in the measured social skills and behaviors compared to the clinical control group. This change was noted both in the participants and their parents.

The study deemed these findings to be preliminary steps to support the effects of creative drama programs for people with social perception and competence struggles. They are only preliminary steps because of the small sample size, especially when considering the eighteen neurodivergent participants represented three different conditions. The benefits of creative drama may impact various neurotypes in different ways, so a larger sample size would be needed to have more data.

While it requires more experimentation and results to verify its accuracy, the concept of using drama to learn the implicit aspects of social communication could be valuable to autistic people. When talking to others, trying to learn these skills in addition to having thoughtful conversing with others could be overwhelming to those on the autism spectrum. Drama allows participants to study the subtleties of facial expressions and tone of voice in isolation, giving more focus to them without overloading someone with information. In addition to the general development of social communication drama can provide, acting and singing are often overlapping fields. Given the number of singers that are either enrolled in or plan to enroll in JHFA, the benefits of drama should be worth our consideration for certain participants.

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Article Summary: Impairments in cognitive empathy and alexithymia occur independently of executive functioning in college students with autism

Written by Kevin Bandel

Much like how there are several forms of empathy (the two main forms are cognitive and affective), this study tested if there are cognitive and affective forms of alexithymia. Cognitive empathy is the ability to take others’ perspective and understand what they are feeling. Affective empathy is the involuntary feeling of emotions in response to others’ situation, often accompanied by distress if they are in pain and a desire to help them. Alexithymia is the difficulty of understanding, identifying, and expressing emotion.

Both empathy and alexithymia are connected to understanding emotions in others or oneself, so it is reasonable to observe how they manifest in autistic people. Cognitive empathy problems are common among autistic people, as is alexithymia. Another hypothesis this study sought to evaluate is if cognitive empathy and alexithymia impacted executive functioning.

According to many experiments, autism does not impair every form of empathy. While cognitive empathy is often lower in autistic people than neurotypical ones, levels of affective empathy are comparable between the neurotypes. With these findings in mind, the researchers for this study speculated that if there are cognitive and affective forms of alexithymia, cognitive alexithymia would be higher (more emotional blindness) in the autistic population than it would be in the neurotypical population. Similarly, affective alexithymia would be at comparable levels between the groups.

Cognitive alexithymia would include challenges identifying, verbalizing, and analyzing emotions. Affective alexithymia would involve difficulties experiencing emotional arousal and imagining emotional situations.

The participants in the study were eighty-two adult college students ages 18-28 from the Netherlands. Fifty-three of them were diagnosed with autism, and the rest were neurotypical. The participants were in the high IQ range, with about three males for every one female.

The results suggested that cognitive empathy was lower in the autistic participants and cognitive alexithymia was higher. Affective empathy and affective alexithymia had no significant difference between the autistic and the neurotypical groups. However, there seemed to be no link between higher alexithymia and executive functioning problems as hypothesized. At JHFA, since alexithymia could be a common condition for students, this implies that we should not overestimate its impact on high IQ students.

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Research Summary of the Article: Impacts of using a social robot to teach music to children with low-functioning autism

Written by: Lawrence Lynn

Keywords:

Autism: a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication

Music education: a field of practice in which educators are trained for careers as elementary or secondary music teachers. It is also a research area in which scholars research on ways of teaching and learning music. It touches on learning domains such as: development of skills, acquisition of knowledge, and learner's willingness to receive, internalise, and share what is learned.

Social Robot: an artificial intelligence system that is designed to interact with humans and other robots

Why are they doing this? What are they trying to find out?

The researchers were exploring the "impact of conducting robot-assisted music-based intervention sessions for children with low-functioning (LF) autism." As a continuation of their previous work, “Teaching music to children with autism: a social robotics challenge,” this particular study takes places focus on low-functioning autistic individuals as the previous work's focal point was, coincidentally, high-functioning (HF) autistic individuals. They in particular wanted to answer 3 research questions:

Does a teacher-assistant humanoid robot have the ability to teach music rhythms and notes to children with LF autism?

Does a robot assisted music-based education have an impact on the social and cognitive skills of children with LF autism?

Can robot-assisted interventions affect the stress levels of the LF participants' parents during music-education classes?

Additionally, they also wanted to do a comparison on the results of this test as to their previous work

What is the hypothesis? How did they do this?

Their hypothesis was that, when applied assisting a human therapist, the social robot could positively impact children with LF autism in the areas of music learning as well as their social and cognitive skills. Additionally, as observed by their previous study, the robot could reduce the stress levels of the LF participants' parents during the music education classes.

What did they do?

4 low functioning autistic children participated in a 22 week program that had several phases including one session of Baseline (Week #1), a Pre-Test (Week #6 before starting the first music intervention session), nine robot-assisted music-based educational sessions (Weeks #6–14), a Post-Test (Week #14 after the last music session), and a Follow-up Test (Week #22, 2 months after the last session). A drum/xylophone playing robot, along with a present and highly engaged human teacher, is used to teach basic concepts of how to play the instruments to four participants with LF autism during nine educational 20-30 minute sessions. Throughout the study, in order to answer their research questions, two kinds of assessments were used. Firstly, developmental assessments which assess imitation, joint attention of the participants as well as musical learning ability. Secondly, four questionnaires were given to the parents of the participants to to see how the sessions affected the children outside of the sessions as well as the parents' stress levels. Cohen's d effect size was used to measure the effects of the sessions on the participants.

What are the results? Did it support or disprove the hypothesis?

The main findings were that the stereotyped behaviours of all the subjects decreased during the course of the program with an approximate large Cohen’s d effect size, meaning quantitatively the sessions had a large effect on the participants. Moreover, the children showed some improvement in imitation, joint attention, and social skills from the Pre-Test to Post-Test, especially in communication. They also answered their research questions: 

"Social robots do have the ability to teach music rhythms to children with LF ASD; however, it has not been proven if robots can teach music notes and phrases to LF subjects"

They "concluded that robot-assisted music education classes could slightly improve the social and cognitive skills of children with LF ASD, but the amount of improvement regarding the music education for the LF subjects are not comparable to the HF participants’ performances previously performed/presented" in their previous work.

They "conclude that robot-assisted music-based interventions could reduce the stress levels of the parents of children with LF ASD (with a large effect size)"

What is the takeaway for everyone to know? What can we do with this information?

As an exploratory endeavour, the study illustrates the potential of integrating a social robot into music education for children in the autistic spectrum disorder. Although not as sole teachers and instructors, they could be useful tools or as teaching aids for human teachers and instructions. The promising results acts as further incentive for further research. 

In your opinion, how is this helpful or not helpful?  What are the issues of the study/article, if any? What other moderators or factors that could have affected the results. etc.

Admittedly, the study has little practicality in present implementation. It's helpfulness pertains towards the future. While the study show promise for the potential positive effect the social robot has on the children and their parents, the small number of participants, lack of a control group, and small number of sessions limit the study as a exploratory one and not conclusive. Additionally, the participants may have also been affected by other education outside the control of the researchers. That said, the study does show the potential promise of combining social robots and music education for children in ASD and further study should be done with an expanded scope.

Bibliography:

Taheri, A., Shariati, A., Heidari, R., Shahab, M., Alemi, M. & Meghdari, A. (2021). Impacts of using a social robot to teach music to children with low-functioning autism. Paladyn, Journal of Behavioral Robotics, 12(1), 256-275. https://doi.org/10.1515/pjbr-2021-0018

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Research Summary of the Article: Impacts of using a social robot to teach music to children with low-functioning autism

Written by: Lawrence Lynn

Keywords:

Autism: a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication

Music education: a field of practice in which educators are trained for careers as elementary or secondary music teachers. It is also a research area in which scholars research on ways of teaching and learning music. It touches on learning domains such as: development of skills, acquisition of knowledge, and learner's willingness to receive, internalise, and share what is learned.

Social Robot: an artificial intelligence system that is designed to interact with humans and other robots

Why are they doing this? What are they trying to find out?

The researchers were exploring the "impact of conducting robot-assisted music-based intervention sessions for children with low-functioning (LF) autism." As a continuation of their previous work, “Teaching music to children with autism: a social robotics challenge,” this particular study takes places focus on low-functioning autistic individuals as the previous work's focal point was, coincidentally, high-functioning (HF) autistic individuals. They in particular wanted to answer 3 research questions:

Does a teacher-assistant humanoid robot have the ability to teach music rhythms and notes to children with LF autism?

Does a robot assisted music-based education have an impact on the social and cognitive skills of children with LF autism?

Can robot-assisted interventions affect the stress levels of the LF participants' parents during music-education classes?

Additionally, they also wanted to do a comparison on the results of this test as to their previous work

What is the hypothesis? How did they do this?

Their hypothesis was that, when applied assisting a human therapist, the social robot could positively impact children with LF autism in the areas of music learning as well as their social and cognitive skills. Additionally, as observed by their previous study, the robot could reduce the stress levels of the LF participants' parents during the music education classes.

What did they do?

4 low functioning autistic children participated in a 22 week program that had several phases including one session of Baseline (Week #1), a Pre-Test (Week #6 before starting the first music intervention session), nine robot-assisted music-based educational sessions (Weeks #6–14), a Post-Test (Week #14 after the last music session), and a Follow-up Test (Week #22, 2 months after the last session). A drum/xylophone playing robot, along with a present and highly engaged human teacher, is used to teach basic concepts of how to play the instruments to four participants with LF autism during nine educational 20-30 minute sessions. Throughout the study, in order to answer their research questions, two kinds of assessments were used. Firstly, developmental assessments which assess imitation, joint attention of the participants as well as musical learning ability. Secondly, four questionnaires were given to the parents of the participants to to see how the sessions affected the children outside of the sessions as well as the parents' stress levels. Cohen's d effect size was used to measure the effects of the sessions on the participants.

What are the results? Did it support or disprove the hypothesis?

The main findings were that the stereotyped behaviours of all the subjects decreased during the course of the program with an approximate large Cohen’s d effect size, meaning quantitatively the sessions had a large effect on the participants. Moreover, the children showed some improvement in imitation, joint attention, and social skills from the Pre-Test to Post-Test, especially in communication. They also answered their research questions: 

"Social robots do have the ability to teach music rhythms to children with LF ASD; however, it has not been proven if robots can teach music notes and phrases to LF subjects"

They "concluded that robot-assisted music education classes could slightly improve the social and cognitive skills of children with LF ASD, but the amount of improvement regarding the music education for the LF subjects are not comparable to the HF participants’ performances previously performed/presented" in their previous work.

They "conclude that robot-assisted music-based interventions could reduce the stress levels of the parents of children with LF ASD (with a large effect size)"

What is the takeaway for everyone to know? What can we do with this information?

As an exploratory endeavour, the study illustrates the potential of integrating a social robot into music education for children in the autistic spectrum disorder. Although not as sole teachers and instructors, they could be useful tools or as teaching aids for human teachers and instructions. The promising results acts as further incentive for further research. 

In your opinion, how is this helpful or not helpful?  What are the issues of the study/article, if any? What other moderators or factors that could have affected the results. etc.

Admittedly, the study has little practicality in present implementation. It's helpfulness pertains towards the future. While the study show promise for the potential positive effect the social robot has on the children and their parents, the small number of participants, lack of a control group, and small number of sessions limit the study as a exploratory one and not conclusive. Additionally, the participants may have also been affected by other education outside the control of the researchers. That said, the study does show the potential promise of combining social robots and music education for children in ASD and further study should be done with an expanded scope.

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Article Summary: Mental representations of speech and musical pitch contours reveal a diversity of profiles in autism spectrum disorder

Written by Kevin Bandel

Numerous studies have tested the pitch processing of those on the autism spectrum. However, results have been mixed, as findings have suggested either increased, typical, or reduced pitch recognition. The study featured in the article tested the pitch processing of 32 Mandarin-speaking autistic individuals and 32 non-autistic individuals. The conclusions were that the average pitch processing of the autistic and non-autistic groups were similar. The authors believe that pitch representation in speech and music for autistic individuals is domain-general, meaning that pitch may be processed in the same way and area of the brain as many different types of information. This has implications for how the brain develops pitch recognition skills.

While autism has a variety of symptoms and severity of those symptoms across individuals, challenges with language and communication are common among many of those on the spectrum. However, exceptional musical abilities, especially in musical memory and sensitivity to musical pitch, have been reported among autistic people. The disconnect between these skill sets has garnered attention from researchers. They investigate how frequently this characteristic is present among the autistic population and how neurologically connected speech and music are. The debate about the extent that speech and music are separate or linked continues today, and autistic people with impaired speech but enhanced music processing are an illuminating part of this discussion.

For this study, 32 autistic and 32 non-autistic individuals ages 7 to 15 years old participated. All participants were native Mandarin speakers, and the non-autistic subjects had no suspected history of neurological divergences. The average time of musical training was one year with a standard deviation of 1.37 years.

Both groups of participants were assessed in areas of speech (Mandarin is a tonal language), complex tone, and melody. For speech, participants would be provided 400 pairs of words and answered which of the two words best matched a specific meaning. For complex tones, 400 pairs of words were given, which subjects would identify which of the tones best matched a rising tone. For melody, participants would judge which of 300 pairs of randomly manipulated song fragments best resembled the melody of the Chinese nursery rhyme “Two Tigers.”

The average results of both the autistic and non-autistic participants did not differ significantly in speech, complex tone, or melody. However, the variability in the autistic participants’ results was noticeably higher than the non-autistic group. Of particular note, there was a subset of autistic individuals with exceptional pitch sensitivity, which is perhaps why the perception of the “musically gifted” autistic person exists.

The study did not test adults, participants from non-Chinese language backgrounds, or more complex pitch recognition, so those factors can still be investigated. The authors of the article suggest that the autistic participants showed similar processing between speech and music, which could help the development of social skills of autistic people.

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Article Summary: “Camouflaging” by adolescent autistic girls who attend both mainstream and specialist resource classes: Perspectives of...

Written by Kevin Bandel

An autistic person motivated to navigate mainstream social settings may feel the need to “hide” autistic behaviors to fit in with others. Interviews were held for 8 autistic girls, their parents, and their school staff. The results from the interview revealed that the girls used camouflaging to hide their autism and learning needs. Unfortunately, these attempts were often unsuccessful. Although camouflaging helped these girls meet social expectations, they found doing so to be exhausting, distressing, and negatively impact their relationships, learning and mental health. The purpose of the research is to increase awareness of camouflaging and ways to support autistic girls fully participate and learn in school.

The interviews revealed several different attempts at camouflaging. To appear “normal,” the girls would employ some combination of appearing busy on their phones, planning conversation scripts in advance, hiding their interests, pretending to understand social norms, and researching normative social interactions. Their parents and educators noted that these strategies were not always effective and consistent, especially in more challenging and unexpected social situations.

With these attempts at camouflaging, the girls did not feel they fit in either the mainstream or the resource base classes (Individualized Education Plan students). While they felt less need to camouflage in resource base classes, being a part of these classes would isolate them from their mainstream peers at times. Because the girls were seeking to build friendships with mainstream peers, they felt not fully included in either the mainstream or the resource base classes.

Those interviewed described the exhaustion the girls would reveal when leaving school. The girls would further express anxiety regarding how successful their camouflaging was and fear of failing. Their parents shared their worries that camouflaging would have on their identity along with the difficulty of them being accepted if they do not meet social expectations. Contributing to the exhaustion was that many teachers were unaware of their autistic students’ learning struggles, as they would hide their learning struggles out of fear of looking “stupid.” Attempting to learn without addressing holes in understanding would both reinforce anxieties about appearing unintelligent and the draining experience of attending school.

However, the study includes a small sample size and does not examine how autistic boys or other kinds of students may experience negative effects from camouflaging. While it is a known issue for autistic females, it is not only limited to them. Second, the information of the study is almost entirely qualitative, so some information is not present. Still, the study’s findings are reflected in other research, so it likely has validity. It would be beneficial to investigate how to best support students who experience hardship from camouflaging and apply this knowledge beyond just autistic girls.

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Article Summary: How Well Do We Understand Autistic Savant Artists: A Review of Various Hypotheses and Research Findings to Date

Written by Kevin Bandel

In fictional works, savants are sometimes portrayed as also being on the autism spectrum. This has helped increase the public perception about the capabilities of autistic people. However, it is important to understand that being an individual with autism and being a savant are not synonymous even if they may overlap. The article includes three studies mentioned in the article that had different results about the overlap between savant syndrome and autism. One study estimated around a 50% overlap, another reported 30% of autistic individuals exhibited savant traits, and yet another said 1 in 200 of autistic people were savants. While the last study was criticized for its faulty estimation, the discrepancy can suggest that there may be inconsistencies with definitions of “savant”, methodologies in measuring savant characteristics, or both.

Furthermore, savant traits are most often recognized in memory, science, and mathematics, but they also can exist in fields of art such as drawing, music, and theater. Perhaps the reason for this in certain areas such as memory can be more clearly measured than artistic ability. This places more ambiguity on what qualifies as a savant characteristic. Still, the authors of the article include a set of qualities they believe to be needed for someone to be an autistic savant. Some of those rules are:

A)     Savant skills lie on a spectrum. Some categories include the “talented savant,” whose level of expertise contrasts inordinately with their overall level of disability. Another is the “prodigious savant” whose ability advantages them even over a “non-impaired” individual.

B)     Special skills must be accompanied by prodigious memory.

C)     Savant syndrome can be genetic or acquired.

D)     There is no single explanation for all savants.

Since this article is a review of other studies, it summarizes some of the research findings of some studies. It stated that there were a limited number of assessments for artistic savant traits, and they are still being developed. It also mentions disagreements between different researchers about how much and whether an increase in savant traits in autistic people affects social communication ability.

The authors of the article hypothesize that a significant number of non-savant autistic people still possess latent abilities but disagree that the degree of the latent and/or savant characteristics are related to decreased social communication skills.  They argue that if these underlying skills are in the arts, they can be leveraged to understand emotions and enter a flow state, potentially assisting in transforming autistic individuals’ sociability.

Some of areas the authors suggest need future research are to further develop assessment of artistic ability and do so by autistic standards rather than neurotypical ones. Longitudinal and neurobiological studies will also be essential, as they can help test if savant syndrome is consistent throughout a person’s life. From a broader perspective, the authors believe that understanding what leads to artistic savant characteristics can help illuminate what are the neurobiological triggers that influence humans into perceiving something as artistic and/or beautiful.

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Article Summary: Rhythmic Relating: Bidirectional Support for Social Timing in Autism Therapies

Written by Kevin Bandel

Rhythmic Relating is a system to promote bidirectional social interaction and complement existing therapies. The main parameters used are pulse, quality, and narrative. They are intended to replicate and understand natural predictive flow and emphases on specific sounds, which is as relevant to music as it is to conversation. The four different therapies of Rhythmic Relating are Dance Movement, Improvisational Music, Play, and Musical Interaction.

Some specific guidelines of Rhythmic Relating are to use direct concrete language, short simple chunks of speech, verbalize emotions, clarify goals and minimize non-communicative body language. It uses mirroring exercises, divided into selective mirroring (initial), selective mirroring (modified), and mirroring (vitality). Selective mirroring (initial) means to imitate a certain movement or sound. The movement or sound would be altered one aspect at a time, and the goal is to maintain connection between the client and practitioner with these changes. Lastly, mirroring (vitality) requires using a whole-body, whole-sound-sound replication of the “essence” of the other person.

Rhythmic exercises are also employed. The practitioner keeps a steady pulse to “anchor” the timing of the client’s expressions. The pulse is established by the practitioner inherent to the client's movement or sound. If the client becomes comfortable with that beat, slight variations to rhythms and accents (which sound is emphasized). There are also periods of time called “jazz gaps,” which are extended pauses in the beats. This is to allow for moments of rhythmic freedom into an otherwise rhythmically consistent form and also simulate giving individuals (both oneself and others) time to respond in a typical conversation.

The article states that Rhythmic Relating is largely child-centered and requires more research, especially in the realm of neurobiology and neuromotor psychology. The improvements made by the study’s participants were measured by recorded observations, making them more qualitative than quantitative. Despite these limitations, the article stated Rhythmic Relating is predicted to increase self-regulation, co-regulation (managing emotions with the support of another individual), trust, and decrease anxiety. It could be worthwhile to test the effects of Rhythmic Relating for other age ranges and in other areas.

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Article Summary: Effects of Creative Movement Therapies on Social Communication, Behavioral-Affective, Sensorimotor, Cognitive, and Functional...

Written by Kevin Bandel

There is increasing evidence that whole-body activities can help autistic people develop beneficials skills related to their condition. Creative movement therapies (CMT) address these areas. Some CMTs included music, dance, yoga, theater, and martial arts. Dance is also considered to be a CMT, but has limited research supporting it currently. This systematic review presented in this article examines 72 studies which included 1,939 participants ages 3 to 65.

67 of the 72 studies recruited neurodiverse individuals with only autism, with the remaining 5 included autistic students as well as ADHD, anxiety disorders, learning disabilities, sensory processing disorder, emotional disorders, and behavioral disorders. The article claims that there were significant, non-zero effects of CMT. Specifically, 30-33% suggested medium-to-large improvements in social communication skills, behavioral domain, and motor outcomes. For cognitive skills, there were medium-to-large improvements in cognitive skills from over 65% of the studies.

Though the article seems to suggest promising effects of CMT, the authors claim that their review is a call to conduct additional research about the effects of CMT for autistic people, particularly in affective and sensory functioning after ending the therapy. There was limited evidence to support the positive impact of CMT in these areas. Another limitation was that some of the observed studies used conventional autism support with added CMT rather than only CMT. This may distort how much the true effects of some of the interventions are from the traditional supports and how much is from CMT.

Still, there are positive and significant results from the more purely CMT-focused interventions. It is also important to consider how these therapies can have positive effects in multiple areas.

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Article Summary: Prevalence of Autism Spectrum Disorder in China: A Nationwide Multi-center Population-based Study Among Children Aged 6 to 12 Years

Written by Kevin Bandel

This study was the first national estimate for the presence of autism in Chinese children aged 6 to 12 years old. 142,086 children participated in this study, with 363 considered to be autistic (0.26%). Of those autistic children, 43.3% of them had not been diagnosed with autism previously. The boy-to-girl ratio of children with autism was 4.3:1. The last findings summarized in the abstract was that 90.4% of the autistic children attended standard schools and 68.8% had another neurodiverse condition.

The strengths of the study was that it had the largest sample size of all Chinese autism studies. It also collected subjects from 8 different locations in China and used two different diagnostic tools, the Modified Chinese Autism Spectrum Rating Scale and ADOS/ADI-R. However, the 8 different locations selected by the study were chosen by having prior research experience with autism, which may not represent every region of China equally. A similar issue of representation is that most subjects were urban residents. Future studies in China are recommended to include a ratio of urban participants closer to the true national proportion. Later studies could also expand the age range of those screened as well.

A noteworthy fact of this study is how the estimated Chinese prevalence of autism (0.29%) is significantly less than the estimates of other countries. The international estimates range from 1-2% of the population. Countries such as the United States, United Kingdom, Australia, and South Korea have around a 2% rate of autism. Lower percentages of autism are also believed to be reported in populations with low socioeconomic status, but other factors may also influence these results. For China, public awareness of autism was not considered to not have emerged until 2010, which may affect knowledge and willingness to get diagnosed.

While this study was conducted in China, it has worldwide implications for our understanding of autism. Several characteristics believed to be associated with autism, such as difficulty reading others, hypersensitivity, narrow attention, and repetitive behaviors, are relative. In every culture, the values imposed on its citizens will be varying degrees of similar and different from the standard model of autistic traits. Autistic attributes can be present in anyone, especially if a culture encourages its citizens to exhibit some of these features. If autism is diagnosed based on how different subjects are from “normal” people, then there are contexts in which the same person could be considered autistic in one environment and not the other. This further creates ambiguity if there is a clear dividing line between autistic and not autistic. Since science and psychology are always evolving, we must be open to possibilities that our perception of autism could change.