Four Randomized, Controlled Studies of FaceSay™ have been completed since 2007. The FaceSay participants, when compared to the control participants, demonstrated statistically significantly improvements in an impressive range of measures:
Playground Interactions With Peers (an unmatched breakthrough)
Standardized Emotion Recognition Tests (Ekman, NEPSY II)
Standardized Face Recognition Tests (Benton)
Theory of Mind Tests (NEPSY II)
Parent Self Reports (SSRS)
While still far from FDA-grade evidence, these results are unmatched by any Social Skills technology intervention for students with an Autism Spectrum Disorder.
As part of her dissertation, Linda Rice, a School Psychologist for a California School District, conducted what is now the fourth Randomized, Placebo Controlled Study of my FaceSay Social Skills Software. The study included 32 high functioning students with an ASD (Kindergarten-5th). Half of the students were randomized to a lower dose FaceSay™ intervention, and the other half to the students' usual weekly computer lab activity, SuccessMaker ®. The participants played these games in the computer lab for 25 minute sessions, once a week for 10 weeks. No touch screens were used. The children did not receive any social skills training in school. In prior studies, the FaceSay dosing was twice per week and included touch screens and participants were in private schools with special support for autistic students. Given the lower dose, and the more challenging environment, the outcomes were surprisingly good. The blinded playground observations, which were a breakthrough in Dr. Hopkins' study, were not significant, as I expected. The blinded Teacher reports (SRS) approached, but were not significant, similar to Dr. Hopkins' study (parent SSRS). As expected, the Emotion Recognition (NEPSY II Affect Recognition subscale) was statistically significant (p < .001). The big surprise for me was that the Theory of Mind measure (NEPSY II ToM subscale) was significant (p < .001). This is something we had not measured before and which was very encouraging, particularly given the combined lower dose and more challenging school environment.
Dr. Maria Hopkins submitted a paper on her 2007 randomized controlled trial of FaceSay to a peer reviewed journal. It is actively under review ("noteworthy contribution" commented one reviewer). The paper is now online (Feb 2011)
Trista Perez, a grad student at UAB, successfully defended her master's thesis, "Social Skills Training in a Head Start Population" this month. The was a randomized controlled trial with 60+ neurotypical preschool children. The group that played FaceSay's "Bandaid Clinic" game showed statistically significant improvements in the Benton Face Recognition test. o
"Children’s ability to recognize faces varied significantly based on group assignment nF(2,73) = 7.62, p < .001, with an effect size of 0.17. (Power=0.98) nChildren playing FaceSay™ showed higher scores in a test of face recognition following the 12 week intervention"
Just as interesting is what was not seen. In this HeadStart study, only two of the FaceSay games, "Amazing Gazing" and "Bandaid Clinic" were used. The old version of the "Follow the Face" game, at the time, was thought to be too difficult for the kids and was omitted. "Follow the Face" is the FaceSay game that teaches not emotions explicitly, but an awareness of the physical antecedents of emotions, the facial movements. Interestingly, none of the children in this study showed the improvement shown by the higher functioning autistic children in the first study on the Emotion Recognition test. The difference is that the children in the first study played all three FaceSay games, including the "Follow the Face" game.
Demonstration and Evaluation of Avatar Assistant:
Encouraging Social Development in Children with Autism Spectrum Disorders
Maria Hopkins, PhD
Fred Biasini, PhD
The University of Alabama at Birmingham
The overall purpose of our third study was to determine if a computer-based social skills intervention for children with autism or Asperger Syndrome is effective in improving specific social skills.
View the PowerPoint presentation given at UA Tuscaloosa
Specific Aims:
- The study investigated the effects of an avatar assistant on children with ASD’s emotional cognition.
- The study examined the social skills effects of the intervention.
Measures:
- Social Skills Rating System
- Social Skills Observation
- Emotional Cognition
- Kaufman Brief Intelligence Test (KBIT)
- Childhood Autism Rating Scale
- Benton Test of Facial Recognition
Participants:
- Children with autism (n=25) or Asperger Syndrome (n=24)
- Diagnosis based on DSM-IV criteria
- Age range 6-15 (M = 10.17)
- 44 boys; 5 girls
- Mitchell’s Place, Glenwood, Shelby County schools
Intervention and Control:
- FaceSay and Tux Paint
- 12 sessions (2 per week for 30 minutes)
- One child per computer
- 1-2 research assistants
- Touch screens
- Attendance rates >83% (10 sessions)
- Rewards
Participant Demographics:
Group: Autism Aspergers
Variable: Training Control Training Control
Age 10.31 10.57 10.05 9.85
(3.31) (3.20) (2.30) (2.87)
IQ 55.09 54.79 91.88 93.04
(20.91) (16.41) (19.54) (25.47)
CARS 36.64 36.92 34.01 35.03
(3.93) (5.79) (5.26) (5.22)
Results 1: Emotion Recognition
Group: Autism Aspergers
Measure Control Training Control Training
Adjusted 5.23 6.53 6.79 8.7
Means of (p < 0.05) (p < 0.05)
Emotion
Recognition
Autism: Total emotional skills, F(1, 21) = 6.40, p < 0.05
Asperger: Total emotional skills, F(1, 20) = 23.04, p < 0.001
Post hoc analysis:
R2 = 0.873, F(3, 21) = 55.96, p < 0.001
Higher KBIT scores and pre-test Emotion Composite scores were related to higher post-test Emotion Composite scores.
Results 2: Facial Recognition
Group: Autism Aspergers
Measure Control Training Control Training
Adjusted 12.84 14.48 15.42 18.41
Means of (p > 0.05) (p < 0.05)
Facial
Recognition
Autism: Benton-Short form F(1, 21) = 0.69, p > 0.05
Asperger: Benton-Short form F(1, 20) = 8.29, p < 0.01
Results 3: Parent Reported Social Skills
Group: Autism Aspergers
Measure Control Training Control Training
Adjusted 58.51 64.99 62.27 67.77
Means of (p < 0.05) (p = 0.05)
Social
Skills
Rating
Autism: SSRS, F(1, 21) = 10.36, p < 0.05
Asperger: SSRS, F(1, 20) = 4.36, p = 0.05
Results 4: Observed Social Skills
Group: Autism Aspergers
Measure Control Training Control Training
Adjusted 11.04 9.6 10.46 7.54
Means of (p < 0.05) (p < 0.05)
Social
Skills
Observation
Autism: F(1, 21) = 5.05, p < 0.05
Asperger: F(1, 20) = 13.61, p < 0.001
Post hoc analysis:
R2 = 0.209, F(3, 21) = 3.12, p < 0.05
Higher CARS scores (e.g. more autism symptoms) were related to higher post-test Social Skills Observation scores (e.g. more inappropriate social interactions)
Acknolwedgements
Autism Lab
Symbionica
Dr. Franklin R. Amthor
Civitan International
Mitchells' Place
Glenwood
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