Can Virtual Reality Help Autistic Children Navigate the Real World?

This article is part of Upstart, a series on young companies using new science and technology.

Vijay Ravindran has always been fascinated with technology. On Amazon, he oversaw the team that created and launched Amazon Prime. Later, he joined the Washington Post as Chief Digital Officer, where he met Donald E. Graham advised his former boss, Jeff Bezos, about selling the newspaper in 2013.

By the end of 2015, Mr. Ravindran was ending his time at Graham Holdings Company by changing his name. But his primary focus was his son, who was 6 years old at the time and under treatment for autism.

“Then it became a wonderful thing,” said Mr. Said Ravindra.

Mr. Ravindran was walking around with a virtual reality headset when his son asked him to give it a try. After spending 30 minutes using the headset in Google Street View, the kid went to his playroom and began to show what he had done in virtual reality.

Mr. Said Ravindra. “It ended as a light bulb moment.”

Like many autistic children, Mr. Rabindran’s son was struggling with the game of hypocrisy and other social skills. Her son’s ability to translate his experience of virtual reality into the real world sparked an idea. A year later, Mr. Ravindra started a company called Floreo, which is developing virtual reality lessons designed to help behavioral therapists, speech therapists, special educators and parents working with autistic children.

The idea of ​​using virtual reality to help autistic people has been around for some time, but Mr. Ravindran said the widespread availability of commercial virtual reality headsets since 2015 has enabled research and business deployments on a larger scale. Floreo has developed nearly 200 virtual reality lessons designed to help children build social skills and train them to choose real world experiences such as crossing the street or sitting in a school cafeteria.

Last year, as the epidemic increased demand for telehealth and remote learning services, the company delivered 17,000 lessons to customers in the United States. Autism experts believe that the company’s flexible platform could go global in the near future.

This is because the demand for behavioral and speech therapy as well as other types of interventions to address autism is huge. Getting diagnosed with autism can take months – a crucial time in a child’s development when therapeutic interventions can be important. And such treatments can be costly and require enormous investment of time and resources by parents.

The Floreo system requires an iPhone (version 7 or later) and a VR headset (low-end models cost as little as 15 to $ 30), as well as an iPad, which can be used by parents, teachers or coaches. Person or remote. The cost of the program is about $ 50 per month. (Florio is currently working to enable insurance reimbursement, and has received Medicaid approval in four states.)

The child donates the headset and navigates the virtual reality lesson, while the coach – who may be a parent, teacher, therapist, counselor or personal assistant – observes and interacts with the child through the iPad.

The lesson covers a wide range of situations, such as visiting an aquarium or going to the grocery store. Many lessons include teaching autistic children who may struggle to interpret nonverbal cues, body language.

Autistic self-advocates note that behavioral therapy for the treatment of autism is controversial among people with autism, often arguing that it is not a treatable disease and that treatment is imposed on autistic children by their non-autistic parents or guardians. Behavioral therapy, they say, can harm children or punish them for behavior such as fidgeting. They argue that instead of conditioning autistic people to act like neurotypical individuals, society should more welcome them and their different way of experiencing the world.

“A lot of inconsistency between autistic people and society is not the fault of autistic people, but the fault of society,” said Zoe Gross, director of advocacy for the Autistic Self Advocacy Network. “People should be taught to communicate with people with different types of disabilities.”

Mr. Ravindran said Florio respects all the voices of the autistic community, where needs are diverse. He noted that while Florio was used by many behavioral health providers, it was deployed in a variety of contexts, including schools and home.

“The Florio system is designed to be positive and entertaining, while creating positive reinforcement to help build skills that help you adapt to the real world,” he said. Said Ravindra.

In 2017, Florio received a ટ્રે 2 million fast track grant from the National Institutes of Health. The company is first testing whether autistic children will tolerate the headset, then conducting a randomized controlled trial to test the usefulness of the method to help autistic people interact with the police.

Preliminary results have been promising: According to a study published in the Autism Research Journal (Mr. Ravindran was one of the authors), 98% of children completed their lessons, allaying concerns about autistic children with a headset-sensitive sensitivity.

Ms. Gross said she saw potential in virtual reality lessons that helped people rehearse in unfamiliar situations, such as Florio lessons on crossing the street. “There are some parts of Florio that get really excited about: a walk at the airport, or a trick or treat – a social story for something that doesn’t happen often in one’s life,” she said, adding that she would love to see it. Lessons for medical procedures.

However, she questioned the general emphasis by the Behavioral Therapy industry on the use of emerging techniques to teach social skills to autistic people.

Florio is conducting another randomized controlled trial using telehealth using another NIH grant, in hopes of showing that Florio’s approach is as effective as individual coaching.

But it was the early successes that Mr. Ravindran is fully committed to the project.

“There were really a lot of excited people.” He said. “When I start showing families what we have developed, people will just give me a hug. They will start crying that someone is working on such a high-tech solution for their children.

Physicians who use the Florio system say that virtual reality environments make it easier for children to focus on the skills taught in lessons, unlike in the real world where they may be affected by sensory stimuli.

Celebrate the Children, a nonprofit private school in Danville, NJ, hosts one of the early pilots for Florio, for children with autism and related challenges; Monica Osgood, the school’s co-founder and executive director, said the school continued to use the system.

She said putting on a virtual headset can be very empowering for students, as they were able to control their environment with the slightest movement of their head. “Virtual reality is definitely something that is a real gift for our students that we will continue to use,” she said.

Kelly Renee, special instruction manager for the Cuyahoga County Board of Developmental Disabilities in Ohio, said her organization used Florio last year to help students with life and social skills. Her colleague Holly Winterstein, an early childhood intervention specialist, said the tools were more effective than the communication cards commonly used by physicians. The office started with two headsets but quickly purchased equipment for each of its eight staff members.

“I see endless possibilities,” Ms. Said Winterstein.

“Social skills stick out of Florio,” said Michea Rahman, a speech language pathologist who focuses on the under-served population in Houston (and the Florio clientele). The system is “probably one of the best or best social skills tools I’ve ever worked with.” (She added that 85% of her patients are Medicaid dependent.)

To date, the company has raised approximately $ 6 million. Investors include venture capital firms focusing on health care software, Lifeforce Capital and Autism Impact Fund, early-stage venture capital funds that invest in companies addressing neurological conditions. (Mr. Ravindra declined to clarify whether the company was profitable.)

For Mr. Ravindran, the company has become a mission. “When I started exploring virtual reality as a therapy, I didn’t know if it was a hobby project, or if it was going to be a business that I invested a little money in, hired a few people, then left. To do something else, “he said.” At some point, I got to the point where I felt like, if I don’t make it, nobody. “

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