Can virtual reality help autistic children navigate the real world?

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

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

At the end of 2015, Mr. Ravindran was finishing his time at the renowned Graham Holdings Company. But his main focus was his son, who was then 6 years old and in therapy for autism.

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

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

“It was one of the first times I saw him play pretend like that,” said Mr. Ravindran. “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 founded a company called Floreo, which is developing virtual reality lessons designed to help behavior therapists, speech therapists, special educators and parents who work with autistic children.

The idea of ​​using VR to help autistic people has been around for some time, but Ravindran said the widespread availability of commercial VR headsets since 2015 has enabled research and commercial deployment on a much larger scale. Floreo has developed nearly 200 virtual reality lessons that are designed to help children develop social skills and train for real-world experiences, like crossing the street or choosing where to sit in the school cafeteria.

Last year, when the pandemic exploded demand for telehealth and remote learning services, the company delivered 17,000 lessons to clients in the United States. Autism experts believe the company’s flexible platform could go global in the near future.

This is because the demand for speech and behavior therapy, as well as other forms of intervention to address autism, is so vast. Obtaining 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 expensive and require huge investments of time and resources on the part of parents.

The Floreo system requires an iPhone (version 7 or later) and a VR headset (a lower-end model is as little as $15 to $30), as well as an iPad, which can be used by a parent, teacher, or coach in- 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 through the virtual reality lesson, while the coach, who can be a parent, teacher, therapist, counselor, or personal assistant, monitors and interacts with the child via iPad.

The lessons cover a wide range of situations, such as visiting the aquarium or going to the supermarket. Many of the lessons involve teaching autistic children, who may have difficulty interpreting nonverbal cues, to interpret body language.

Autistic self-advocates point out that behavioral therapy to treat autism is controversial among people with autism, arguing that it is not a curable disease and that non-autistic parents or guardians often force therapy on autistic children. Behavioral therapy, they say, can harm or punish children for behaviors like fidgeting. They argue that instead of conditioning autistic people to act 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 of society,” said Zoe Gross, director of advocacy for the Autistic Self Advocacy Network. “People should be taught how to interact with people who have different kinds of disabilities.”

Mr. Ravindran said that Floreo respected all voices in the autistic community, where the needs are diverse. He noted that while Floreo was used by many behavioral health providers, it had been implemented in a variety of settings, including in schools and at home.

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

In 2017, Floreo secured a $2 million accelerated grant from the National Institutes of Health. The company is first testing whether autistic children will tolerate the headphones and then running a randomized control trial to test the usefulness of the method in helping autistic people interact with the police.

Early results have been promising: According to a study published in the journal Autism Research (Mr. Ravindran was one of the authors), 98 percent of children completed their lessons, allaying concerns about autistic children with resistant sensory sensitivities. to the headphones.

Ms. Gross said she saw potential in virtual reality lessons that helped people rehearse unfamiliar situations, like Floreo’s lesson about crossing the street. “There are parts of Floreo to get really excited about: the ride through the airport, or trick-or-treating, a social story of something that doesn’t happen that often in someone’s life,” he said, adding that he would like to see a lesson. for medical procedures.

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

A second randomized control trial with telehealth, conducted by Floreo with another NIH grant, is underway in hopes of showing that Floreo’s approach is as effective as in-person training.

But it was those early successes that convinced Mr. Ravindran to fully commit to the project.

“There were a lot of people really excited,” he said. “When I started showing families what we had developed, people would just give me a big hug. They would start crying because someone was working on a high-tech solution for their children.”

Doctors who have used the Floreo system say the virtual reality environment makes it easier for children to focus on the skill being taught in lessons, unlike in the real world, where sensory inputs can overwhelm them.

Celebrate the Children, a private nonprofit school in Denville, NJ, for children with autism and related issues, hosted one of Floreo’s first pilot programs; Monica Osgood, the school’s co-founder and CEO, said the school had continued to use the system.

He said that putting on virtual headsets could be very enriching for students, because they could control their surroundings with slight head movements. “Virtual reality is certainly something that is a real gift to our students that we will continue to use,” she said.

Kelly Rainey, special instruction manager for Ohio’s Cuyahoga County Board of Developmental Disabilities, said her organization had used Floreo over the past year to help students with social and life skills. Her colleague Holly Winterstein, an early childhood intervention specialist, said the tools were more effective than the talking cards therapists often use. The office started with two headsets, but quickly purchased sets for each of the eight staff members.

“I see endless possibilities,” Winterstein said.

“Floreo’s social skills hold up,” 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 have Medicaid.)

To date, the company has raised approximately $6 million. Investors include LifeForce Capital, a venture capital firm that focuses on health care software, and Autism Impact Fund, an early-stage venture capital fund that invests in companies that address neurological diseases. (Mr. Ravindran declined to specify whether the company was profitable.)

For Mr. Ravindran, the business has become a mission. “When I started exploring virtual reality as a therapy modality, I didn’t know if it was a hobby project or if it was going to be a business where I put a little money, hired a few people, and then left. to do something else,” he said. “At some point, I got to this place where if I don’t feel it, if I don’t build it, no one would.”

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