Can virtual reality help autistic children navigate the real world?

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This article is part of Upstart, a series about early stage companies leveraging new science and technology.

Vijay Ravindran has always been fascinated by technology. At Amazon, he led the team that built and launched Amazon Prime. He later joined The Washington Post as chief digital officer, where he advised Donald E. Graham on the sale of the newspaper to his former boss Jeff Bezos in 2013.

In late 2015, Mr. Ravindran retired from the rebranded Graham Holdings Company. But his main focus was his son, who was 6 at the time and was undergoing autism therapy.

“Then something amazing happened,” said Mr. Ravindran.

Mr. Ravindran was playing around with a virtual reality headset when his son asked to try it. After using the headset in Google Street View for 30 minutes, the child went to their playroom and began to act out what they had done in virtual reality.

“It was one of the first times I saw him pretend to play,” said Mr. Ravindran. “It was an aha moment at the end.”

Like many autistic children, Mr. Ravindran’s son struggled with role-playing and other social skills. His son’s ability to translate his virtual reality experience into the real world sparked an idea. A year later, Mr. Ravindran founded a company called Floredeveloped the virtual reality classroom to help behavioral therapists, speech and language therapists, special education teachers and parents working with autistic children.

The idea of ​​using virtual reality to help people with autism has been around for some time, but Mr Ravindran said the widespread availability of commercial virtual reality headsets since 2015 has prompted research and commercial use on a much larger scale allows. Floreo has developed nearly 200 virtual reality lessons designed to help children build social skills and train for real-world experiences like crossing the street or choosing a seat in the school cafeteria.

Last year, as the pandemic exploded demand for telemedicine and distance learning services, the company delivered 17,000 hours of classes to clients across the United States. Autism experts believe the company’s flexible platform could be rolled out globally in the near future.

That’s because the demand for behavioral and speech therapy and other forms of intervention to treat autism is so great. Getting a diagnosis of autism can take months—a crucial time in a child’s development when therapeutic intervention can be vital. And such therapy can be costly, requiring a huge investment of time and resources from parents.

The Floreo system requires an iPhone (version 7 or later) and VR headset (a low-end model is only $15-$30) and an iPad for use by a parent, teacher, or trainer. person or remotely. The cost of the program is approximately $50 per month. (Floreo is currently working to enable insurance reimbursement and has received Medicaid approval in four states.)

A child puts on the headset and navigates the virtual reality lesson, while the trainer—who can be a parent, teacher, therapist, counselor, or personal helper—monitors and interacts with the child via the iPad.

The lessons cover a variety of situations, such as: B. visiting the aquarium or going to the grocery store. Many of the lessons involve teaching autistic children who may have difficulty interpreting nonverbal cues to interpret body language.

Autistic self-advocates note that behavioral therapy to treat autism is controversial among people with autism, arguing that it is not a disease that needs to be cured and that therapy for autistic children is often administered by their non-autistic parents or imposed on legal guardians. Behavior therapy, they say, can harm or punish children for behaviors like fidgeting. They argue that society should be more hospitable to them and their different ways of experiencing the world, rather than conditioning autistic people to behave like neurotypical individuals.

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

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

“The Floreo system is designed to be positive and fun while creating positive reinforcement to build skills that help acclimate to the real world,” said Mr. Ravindran.

In 2017, Floreo secured a $2 million Fast Track grant from the National Institutes of Health. The company first tests whether autistic children can tolerate headsets and then conducts a randomized control study to test the method’s usefulness in autistic people’s interactions with the police.

The first results were promising: Loud a study published in the journal Autism Research (Mr. Ravindran was one of the authors), 98 percent of the children completed their classes, easing concerns about autistic children with sensory sensitivities resistant to the headsets.

Ms Gross said she sees potential in virtual reality lessons that help people rehearse unfamiliar situations, like Floreo’s street crossing lesson. “There are parts of Floreo that you can really look forward to: the airport tour or trick or treating – a social story for something that doesn’t happen that often in a person’s life,” she said, adding that they like to see you would lesson on medical procedures.

However, she questioned a general emphasis by the behavioral therapy industry on using new technology to teach people with autism social skills.

A second randomized control study using telemedicine, conducted by Floreo with another NIH grant, is underway, hoping to show Floreo’s approach is as effective as in-person coaching.

But it was these early successes that convinced Mr. Ravindran to dedicate himself fully to the project.

“There were just a lot of really excited people,” he said. “When I started showing families what we had developed, people just gave me a big hug. They would cry that someone is working on such a high-tech solution for their children.”

Clinicians who have used the Floreo system say the virtual reality environment makes it easier for children to focus on skills being taught in class, unlike in the real world where they might be overwhelmed by sensory stimuli.

Celebrate the Children, a non-profit private school in Denville, NJ, for children with autism and related challenges, hosted one of the first pilots for Floreo; Monica Osgood, co-founder and chief executive officer of the school, said the school has continued to use the system.

She said putting on the virtual headset can be very empowering for students as they can control their surroundings with slight movements of their heads. “Virtual reality is certainly a real gift for our students that we will continue to use,” she said.

Kelly Rainey, special education manager at the Cuyahoga County Board of Developmental Disabilities in Ohio, said her organization has used Floreo for the past year to help students with life and social skills. Her colleague Holly Winterstein, an early childhood intervention specialist, said the tools are more effective than the talking cards typically used by therapists. The office started with two headsets but quickly purchased devices for each of its eight employees.

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

“Floreo’s social skills remain,” said Michea Rahman, a speech-language pathologist who focuses on underserved populations in Houston (and a Floreo client). The system “is probably one of the best or best social skills tools I’ve ever worked with.” (She added that 85 percent of her patients are Medicaid-based.)

To date, the company has raised around $6 million. Investors include LifeForce Capital, a venture capital firm focused on healthcare software, and Autism Impact Fund, an early-stage venture capital fund that invests in companies focused on neurological disorders. (Mr Ravindran declined to indicate whether the company was profitable.)

For Mr. Ravindran, the company has become a mission. “When I first 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 would invest some money in, hire a few people, and then go do something else,” he said. “Eventually I got to this place where if I felt like nobody would do it if I didn’t build it.”



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