CONCEPT PROPOSAL (AUTISM SPECTRUM DISORDER)

ARTIFICIAL INTELLIGENCE(AI) IN AUTISM SPECTRUM DISORDER

Introduction

Autistic spectrum disorders are pervasive neurobehavioral disorders characterized by

qualitative impairment in social interaction, communication and repetitive and stereotypic
patterns of interests and activities. The prevalence of ASD as per 2018 CDC report is 1 in 59.
The Indian data as per INCLEN study showed prevalence of ASD as 1 in 89. It was 1% in 2-6
years and 1.4% in 6-9 years. No medical treatment has been effective in ameliorating core
autistic symptoms. In our past research work (2014, PNAS), we have hypothesized that
predictive skill is impaired in individuals suffering with autism spectrum disorder. There are
no targeted therapies available until now. Hence, we are proposing reinforcement based AI
model that will help in developing the predictive skills in subjects with ASD. A rich collection
of empirical findings accumulated over the past three decades attests to the diversity of traits
that constitute the autism phenotypes. It is unclear whether subsets of these traits share any
underlying causality. This lack of a cohesive conceptualization of the disorder has complicated
the search for broadly effective therapies, diagnostic markers and neural/genetic correlates. In
our past work, we have highlighted some salient aspects of the autism phenotype may be
manifestations of an underlying impairment in predictive abilities. With compromised
prediction skills, an individual with autism inhabits a seemingly 'magical' world wherein events
occur unexpectedly and without cause. Immersion in such a capricious environment can prove
overwhelming and compromise one’s ability to effectively interact with it. If the proposed AI
based learning model is validated, then this hypothesis will not only provide unifying insights
into multiple aspects of autism, with attendant benefits for improving diagnosis and therapy
but also help in bringing this special kind of children/adults to mainstream society.

Review of literature

Autistic spectrum disorders are pervasive neurobehavioral disorders characterized by

qualitative impairment in social interaction, communication and repetitive and stereotypic
patterns of interests and activities.

Autism was first described in 1943 among children born in 1930s and prevalence of autism is
on the rise as reported from all over the world. Early intervention can ameliorate the morbidity
significantly. The etiology of autism is not well defined. Both environmental factors and
genetic susceptibility are believed to act in concert in pathogenesis. A number of environmental
agents like heavy metals have been shown to demonstrate neurotoxic effects ranging from
severe intellectual disability to more subtle changes in function in both human and laboratory
animal studies. The role of heavy metals is biologically plausible because they are known to
disrupt enzyme functions, alter cellular signaling processes, and generate oxidative stress
leading to apoptosis. One of the most important therapies to offer the child with ASD addresses
social skill competency, pivotal to help those with ASD overcome social/communication
challenges, a core deficit in this disorder(3-9)

The prevalence of ASD as per 2018 CDC report is 1 in 59. The Indian data as per INCLEN
study showed prevalence of ASD as 1 in 89. It was 1% in 2-6 years and 1.4% in 6-9 years(1).

Screening:

All children should receive autism specific Screening at 18 and 24 months of age. A number
of screening tool designed to identify Children with ASD, Modified Checklist for Autism in
Toddlers (M-CHAT) is a free online 23 item autism screening tool designed to identify children
16-30 months of age who should receive a more thorough assessment for possible early signs
of ASD or developmental delay.

If screening indicates ASD symptoms, thorough diagnostic assessment should be performed to

determine whether full criteria are met. Evaluation from various professionals including
Developmental Pediatrician or Pediatric Neurologist, Medical Geneticist, Child and
Adolescent Psychiatrist, Speech and language Pathologist, Occupational Therapist or Medical
Social Worker may be indicated.

Evaluation:

Whenever suspected case of autism presents first we apply DSM V criteria to establish
diagnosis of autism. In a case of autism we apply Childhood Autism Rating Scale (CARS) is
applied to determine the severity of autism. AIIMS modified INDT- ASD tool also will be used
to assess the severity, which was developed under this division based on DSM 5(2) Childhood
Behavioural Checklist (CBCL) and Sensory Profile -2 are applied to determine behavioural
comorbities and sensory issues. Developmental quotient (DQ) and Intelligance Quotient (IQ)
are determined by MISIC (Malin’s Intelligence scale for Indian children), VSMS (Vineland
Social maturity Scale) or BKT (Binet Kamat Test of Intelligence) as applicable and feasible.

Diagnosis and treatment:

Diagnostic assessment of autism spectrum disorders includes use of ICD (International
Classification of Disorders) or DSM diagnostic criteria and standardized methods to assess
core and co morbid symptoms. This multidisciplinary assessment includes a review of
caregiver concerns, descriptions of behavior, medical history, and questionnaires. Although
parents are often aware of developmental problems in their child from age 18 months, a
diagnosis is often not made until 2 years after the initial expression of parental concern.

No medical treatment has been effective in ameliorating core autistic symptoms. Various
modes of behavior modification and structured training have been useful, especially if started
early. Families often use complementary and alternative medical treatments. Their popularity
is in part attributable to the chronicity of symptoms of autism spectrum disorder and the
absence of effective medical treatments.

Infact from simple toys to human-like playmates, robots have captured the interest, curiosity,
and attention of both children with autism and typically developing children [Dautenhahn,
1999; Diehl, Schmitt, Villano, &Crowell, 2012]. In particular, robots provide children with
ASD a predictable and consistent interactional object that helps them isolate social input
[Dautenhahn & Werry, 2004] and meaningful social actions (e.g.,vocal messages, music, color
and visual cues, movement, etc.) and that induce positive attitudes in these children [Duquette,
Michaud, & Mercier, 2008; Michaud & Theberge-Turmel, 2002; Ricks & Colton,2010; Villano
et al., 2011] (10). Accordingly, researchers have suggested that robots can be used effectively
as adjunctive clinical tools for improving social engagement in children with ASD. Studies that
have used robots in treatment interventions for children with autism have revealed additional
advantages of robots, including their effectiveness as mediators that provide less anxious
therapeutic environments and that foster close affinity in social interactions [Kozima &
Nakagawa, 2006; Scassellati, Admoni,& Mataric, 2012].

If the proposed AI based learning model is validated, then this hypothesis will not only provide
unifying insights into multiple aspects of autism, with attendant benefits for improving
diagnosis and therapy but also help in bringing this special kind of children/adults to
mainstream society (11). Our hypothesis will focus on how to measure the change in predictive
skills of subjects with ASD in various sensory domains like visual, auditory and tactile pre and
post intervention.
Research Methodology

Hypothesis

In children with autistic spectrum disorder artificial intelligence based reinforcement

techniques will help in enhancing predictive skills in various sensory domain like visual,
auditory and tactile.

Research question

Does artificial intelligence based reinforcement techniques will help in enhancing predictive
skills in various sensory domain like visual, auditory and tactile in children with autistic
spectrum disorder

Objectives

To develop the reinforcement based learning model for enhancing the predictive skills of ASD.
To design robo toys that will interact with ASD (In repetitive fashion) to develop their visuo-
motor coordination.To measure the change in predictive skills in various sensory domains like
visual, auditory and tactile using neuroimaging/Electrophysiological methods like EEG, GSR
and other behavioral methods following training using the proposed AI model.

Justification for the conduct of the Study

Autistic spectrum disorders are pervasive neurobehavioral disorders characterized by

qualitative impairment in social interaction, communication and repetitive and stereotypic
patterns of interests and activities. The prevalence of ASD as per 2018 CDC report is 1 in 59.
The Indian data as per INCLEN study showed prevalence of ASD as 1 in 89. It was 1% in 2-6
years and 1.4% in 6-9 years. No medical treatment has been effective in ameliorating core
autistic symptoms. Hence, we are proposing reinforcement based AI model that will help in
developing the predictive skills in subjects with ASD. This lack of a cohesive conceptualization
of the disorder has complicated the search for broadly effective therapies, diagnostic markers
and neural/genetic correlates. In our past work, we have highlighted some salient aspects of the
autism phenotype may be manifestations of an underlying impairment in predictive abilities.
With compromised prediction skills, an individual with autism inhabits a seemingly 'magical'
world wherein events occur unexpectedly and without cause. Immersion in such a capricious
environment can prove overwhelming and compromise one’s ability to effectively interact with
it. If the proposed AI based learning model is validated, then this hypothesis will not only
provide unifying insights into multiple aspects of autism, with attendant benefits for improving
diagnosis and therapy but also help in bringing this special kind of children/adults to
mainstream society.

Methodology

Step 1: Model Designing based on Reinforcement learning for ASD predictive skill
enhancement Step 2: To create a mathematical framework, which can provide puzzles in a
coherent way to maximize the learning by individuals with autism. Step 3: Development of
robo toys for ASD interaction. Step 4: Designing of the methods to measure the change in
predictive skills of subjects with ASD in various sensory domains like visual, auditory and
tactile.

Expected Outcome / Endpoints

If the proposed AI model will improve the predictive skill, then the techniques can be employed
as rehabilitation tool for the individual suffering with spectrum. The intelligent robo toys
developed in this project will be useful for the rehabilitation of other kinds of
Neurodevelopmental disorder subjects like cerebral palsy.

Methods :

Inclusion criteria

1. All cases of mild autism diagnosed as per DSM 5 and Childhood autism rating
scale(CARS)

Exclusion criteria

1. All cases of severe autism and/or with any neurological deficits

Sample size

Sample size for the study has been computed to estimate mean percentage change in each of
the three outcome variables (visual, tactile, auditory) based on the following assumptions:

1. Anticipated mean+- SD change in each of the outcome variables = 20+_7

2. Relative precision = 10%

3. Confidence level = 95%

Calculated sample size will be 47 children, considering few droputs we will be including 60
children in the study

Study details-

Step 1: The proposed project would involve subjects recruitment from AIIMS.

Step:2 All the participants would be screened following DSM V guidelines.

Step: 3 Parents and/or subjects (if not minor) would be briefed regarding the procedures, risks
and benefits associated with the project and would be recruited only after taking their written
informed consent. The methodology would adhere to the recommendations of the ethical
committee at AIIMS.

Step: 4 The recruited subjects will be administered AI based technological rehabilitation

protocol (developed at IITD) twice in a week.

Step 5: The follow up study will be conducted to check the improvement in sensory skills
(impaired due to prediction inability)

The proposed project would involve extensive collaboration between the Neurocomputing Lab
(IIT Delhi) and Dept. of Pediatric Neurology (AIIMS). The team of neurologists would be
responsible for their medical expertise, designing of the experiments, subject recruitment and
ethical clearance. Meanwhile, the team at IIT would be responsible for the technical aspects,
designing of algorithms, robo development, statistical analysis, interpretation and finally
development of the rehabilitation tool.

References

1. American Psychiatric Association (APA) (Ed.) Diagnostic and Statistical Manual of

Mental Disorders, 5th ed.; American Psychiatric Association: Arlington, VA, USA, 2013.

2. Koyama, T.; Tachimori, H.; Osada, H.; Takeda, T.; Kurita, H. Cognitive and symptom
profiles in Asperger’s syndrome and high-functioning autism. Psychiatry Clin. Neurosci. 2007,
67, 99–104.

3. Organization for Autism Research, Inc. (OAR) Life Journey through Autism:
Navigating the Special Education System. 2012.

4. Baltimore City Public Schools. Baltimore City Schools Special Education Compliance
Manual:SY2014-2015.
5. Montgomery County Public Schools. Department of Special Education: Services:
Autism.

6. Weitlauf, A.S.; McPheeters, M.L.; Peters, B.; Sathe, N.; Travis, R.; Aiello, R.;
Williamson, E.; Veenstra-Vander Weele, J.; Krishnaswami, S.; Jerome, R.; et al. Therapies for
children with autism spectrum disorder: Behavioral interventions update. In Comparative
Effectiveness Review No. 137; AHRQ Publication; Agency for Healthcare Research and
Quality: Rockville, MD, USA, 2014; No. 14-EHC036-EF.

7. Autism Ontario. Social Metters: Improving social skills interventions for Ontarians
with Autism Spectrum Disorder. 2011.

8. Autism Speaks, Inc. General Strategies for Intervention Based on the Symptoms of
Autism: What Can Help Improve Social Interaction and Development

9. Fonden, T.J.; Anderson, C. Social Skills Interventions: Getting to the Core of Autism.
2011.

10. Villano, M., Crowell, C.R., Wier, K., Tang, K., Thomas, B.,Shea, N., ... Diehl, J.J.
(2011). DOMER: A wizard of oz inter-face for using interactive robots to scaffold social skills
forchildren with autism spectrum disorders. In: Proc. of the6th international Conference on
Human-Robot Interaction(HRI 2011), 279–280. Lausanne, Switzerland.

11. Reed, F. D. D., Hyman, S. R., & Hirst, J. M. (2011). Applications of technology to
teach social skills to children with autism. Research in Autism Spectrum Disorders, 5(3), 1003–
1010

Single centre study

Costs of the tests- It will be borne by ICMR, DST, DBT Welcome trust

Study design: A prospective study

Dosages of drug : N/A

Duration of treatment: 6 months