Can virtual reality help autistic children navigate the real world?

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

Vijay Ravindran has always been fascinated by technology. At Amazon, he oversaw the team that built and started Amazon Prime. He later joined the Washington Post as Chief Digital Officer, advising Donald E. Graham on the sale of the newspaper to his former boss, Jeff Bezos, in 2013.

By the end of 2015, Mr Ravindran was winding down his time at the renamed Graham Holdings Company. But his primary focus was his son, who was 6 years old at the time and was undergoing therapy for autism.

“Then an amazing thing happened,” Mr. Ravindran said.

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

“It was one of the first times I’ve seen him play such a game,” Mr. Ravindran said. “It ended up being a lightbulb moment.”

Like many autistic children, Mr. Ravindran’s son struggled with pretend play 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 started a company called Floreothat develops virtual reality classes 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 a while, but Mr Ravindran said the widespread availability of commercial virtual reality headsets since 2015 had enabled research and commercial application on a much larger scale. Floreo has developed nearly 200 virtual reality classes designed to help children build social skills and train for real-world experiences, such as crossing the street or choosing a seat in the school cafeteria.

Last year, as the pandemic increased demand for telehealth and distance education, the company delivered 17,000 classes to customers in the United States. Autism experts believe the company’s flexible platform could go global in the near future.

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

The Floreo system requires an iPhone (version 7 or later) and a VR headset (a low-end model costs just $15 to $30), as well as an iPad, which can be used by a parent, teacher, or coach in-house. person or remotely. The cost of the program is approximately $50 per month. (Floreo is currently working on enabling insurance reimbursement and has received Medicaid approval in four states.)

A child puts on the headset and navigates through the virtual reality lesson, while the coach – who can be a parent, teacher, therapist, counselor or personal assistant – monitors and communicates with the child via the iPad.

Lessons cover a wide variety of situations, such as visiting the aquarium or going to the grocery store. Many of the lessons relate to teaching autistic children, who struggle to interpret non-verbal cues, to interpret body language.

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

“Much of the mismatch between autistic people and society is not the fault of autistic people, but society’s fault,” said Zoe Gross, the director of advocacy at the Autistic Self Advocacy Network. “People need to learn how to interact with people with different kinds of disabilities.”

Mr Ravindran said Floreo respected all voices in the autistic community, where needs are diverse. He noted that although Floreo was used by many behavioral therapists, it had been used in a variety of contexts, including schools and the home.

“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 was awarded a $2 million fast track grant from the National Institutes of Health. The company will first test whether autistic children tolerate headsets and then conduct a randomized control study to test the method’s usefulness in helping autistic people interact with the police.

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

Ms. Gross said she saw potential in virtual reality classes that helped people practice unfamiliar situations, such as Floreo’s lesson on crossing the street. “There are parts of Floreo to get really excited about: the airport you walk through, or trick or treating — a social story for something that doesn’t happen very often in someone’s life,” she said, adding that she’d like a lesson for medical procedures.

However, she questioned the behavioral therapy industry’s general emphasis on using emerging technologies to teach autistic people social skills.

A second randomized control trial using telehealth, conducted by Floreo with another NIH grant, is underway, hoping to demonstrate that Floreo’s approach is as effective as face-to-face coaching.

But it was those early successes that made Mr. Ravindran to devote himself completely to the project.

“There were just a lot of 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 was 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 the skill taught in the lessons, as opposed to the real world where they can be overwhelmed by sensory stimuli .

Celebrate the Kids, a not-for-profit private school in Denville, NJ, for children with autism and related challenges, hosted one of the first pilots for Floreo; Monica Osgood, the school’s co-founder and principal, said the school had continued to use the system.

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

Kelly Rainey, a special instruction manager with the Cuyahoga County Board of Developmental Disabilities in Ohio, said her organization had used Floreo over the past year to help students with life and social skills. Her colleague Holly Winterstein, a specialist in early childhood interventions, said the tools were more effective than the conversation cards typically used by therapists. The office started with two headsets, but soon bought equipment for each of the eight employees.

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

“Floreo’s social skills are stalling,” said Michea Rahman, a speech therapist who focuses on underserved populations in Houston (and a Floreo client). The system “is probably one of the best or the 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 approximately $6 million. Investors include LifeForce Capital, a venture capital firm focused on healthcare software, and the Autism Impact Fund, a venture capital startup fund that invests in companies targeting neurological disorders. (Mr. Ravindran declined to state whether the business was profitable.)

For Mr. Ravindran, the business has become a mission. “When I started exploring virtual reality as a form of therapy, I didn’t know if it was a hobby project or if it was going to be a company that I put a little money behind, hired people and then left to do something else,” she said. he. “At some point I got to this place where if I felt like if I didn’t build it, nobody would.”

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