This is an exclusive BHB+ story
Robots in autism therapy could play a critical role in supporting patient development. But don’t expect to see too many of these showing up in homes or clinics any time soon.
Accelerating tech advancements, the increasing rate of autism diagnosis in America and structural challenges within the autism therapy industry make looking for new tools an utmost priority. But this uber-specific subcategory of health care technology simply isn’t likely to grab the limelight now or in the future, especially as other forms of technology and care interventions move toward adoption.
“This industry is pretty nascent,” Elliot Lewis, CEO of the robo-assisted instruction company Movia Robotics, told Autism Business News.
Lewis, who took on the CEO role of Movia Robotics in May, said the company will always be committed to having robots; the company offers three different models. However, he intends to evolve Movia’s technology to be much more reliant on to-be-established cloud-based and artificial intelligence systems than the robot itself, eventually making the robots a “peripheral” to these remote technologies. Moving to greater use of cloud-based technology attacks some of the fundamentally limiting aspects of robots in autism therapy.
Greater emphasis on cloud technology lessens the reliance on the robot’s hardware, making it more affordable. Movia Robotics’ consumer robots cost between $2,200 and $14,500, plus an annual content licensing fee, according to the company’s website. That content can be more timely, updated more easily, customized to meet a user’s needs and communicate among devices.
An evolution to more modern systems technology will open up other opportunities for Movia Robotics as well as a slate of challenges. It does so in the face of an industry largely occupied by many other challenges that are much more interested in other tech investments.
But why robots?
Existing arguments for automation generally apply to robots in autism therapy. The most central of all is that robots can do the same thing over and over and over again without fail or flaw. In some cases, these are essential elements of therapy or other interventions for those with autism or any number of disabilities.
Also, robots are interesting. With narrow exceptions, children are fascinated by robots, Kerstin Dautenhahn told ABN. Dautenhahn is an electronics and computer science professor, the Canada 150 research chair in intelligent robotics and director of the Social and Intelligent Robotics Research Laboratory (SIRRL) at the University of Waterloo.
“What makes robots very attractive in this context is that they can add something to therapy with people,” Dautenhahn said. “With the example of speech and language therapy, the therapist has to do a lot of repetition, repeating words and playing the same games. If they have 10 to 15 clients a day, that’s a lot of repetition. Also, they have to adapt to every child — their needs and personality, and so on.
“Robots, on the other hand, are really good at doing repetitive things. … It doesn’t get tired if it should interact during the day with 15 to 20 children and always play exactly the same game or variation of the game suitable for the child. It takes away some of the workload from the therapist so that the therapist can then pay more attention to the actual child and to the behavior of the child.”
These automaton-like functions have been the mainstay function of robots in autism therapy, other therapy settings and special education settings, Dautenhahn said. While a digital version of the mechanical fascinations of old-time automatons, these kinds of robots also help reengage, divert or keep attention.
Research has demonstrated that when a robot is used, children’s attention improves during interventions. In one finding, attentiveness increased during sessions with the robot. Specific to autism, there is growing evidence that those with autism “often achieve a higher degree of task engagement through interactions with robots than through interactions” with people, according to another study.
“In general, the affinity of humans to another person is stronger than that to artificial objects. For individuals with ASD, however, neither preference bias toward humans nor repulsion toward artificial objects (in contrast to real humans) is observed,” the same study said. “In some instances, they show behaviors toward robots that individuals without ASD have toward humans.”
Alleviating clinician burdens and delivering consistent, compelling and quality experiences to patients are core challenges that every autism therapy provider faces. But the reason that these are core challenges, in turn, challenges the arrival of robots in autism therapy.
The autism therapy industry faces a vast mismatch between the supply of clinicians and the demand for clinicians. One study found that unduplicated job postings for board-certified behavioral analysts (BCBA) increased 9.2 times in 2023 compared to 2017 to 65,300. Only 66,300 BCBA credentials have ever been awarded. This demand for clinicians, in turn, is driven by a massive increase in demand for such services and a private equity-driven expansion of the capacity of the industry itself. Private equity investment has accounted for 90% of autism services deals in recent years.
All of this can lead to high caseloads and high demands on clinicians, potentially burning them out of these roles. Turnover rates at autism therapy providers are high. An annual rate of turnover of 75% is not usual. One cohort of providers that use the software of the tech company CentralReach had turnover rates as high as 104% for organizations generating more than $30 million in annual charges and 79% for smaller providers generating less than $5 million. However, the top 10% of performers in each group had turnover rates of 48% and 25%, respectively.
Key opportunities and challenges for robots in autism therapy
There are several challenges to the autism robot uprising. At a premise level, there is some degree of reticence on the part of Americans about robots. Survey data from Pew Research indicates that 72% of Americans are somewhat and very worried about robots during human work.
Generally, the United States hasn’t adopted robotics like other countries have, even in manufacturing. For example, the International Trade Administration, a part of the U.S. Department of Commerce, finds that “Japan had 631 robots working in the manufacturing sector for every 10,000 humans in 2021. By comparison, the U.S. had 274 robots for every 10,000 humans.” The trade administration states Japan turns to robots due to “acute workforce shortages.”
Still, autism therapy is not manufacturing.
“In the frame of mind of an ABA provider or a family who’s looking to see their child make more progress toward goals and reach their full potential, there’s generally a willingness to try new solutions if the costs and the logistics of the solutions are feasible,” Vijay Ravindran, CEO of Floreo, told Autism Business News.
That willingness is something Ravindran and Floreo have experienced firsthand. Floreo, a digital therapeutic company that develops virtual reality learning scenarios for those with neurodivergences, was founded in 2016 and has landed several marquee partners, successfully advocated for the addition of new CPT codes for virtual reality as an adjunctive to parent therapy codes and started the FDA-approval process for its system. The FDA has granted the company its Breakthrough Device Designation and accepted it to its Total Advisory Product Lifecycle (TAP) Pilot program.
Virtual reality generally and other software-based solutions don’t have the same kinds of equipment overhead that robots in autism therapy do. VR and other software are often designed to work on and are typically available on consumer-grade devices. What’s more, robotics for autism doesn’t have a clear source of revenue for providers, making the business prospect of such a tech investment dicey at best.
Further complicating the prospect of investing in a robot is the unlikely chance that the company folds, which happened with consumer-target AI and robotics company Emboddied, which made the Moxie AI robot. The company billed Moxie AI as a toy that also could teach those children social skills, including those with autism. Emboddied folded, it said, because it failed to secure venture backing. Now, it’s $1,200 (and then later $800) robots don’t work.
“To buy a multi-thousand-dollar custom robot and you decide you don’t want to use the robot anymore or the service is not available, you have a giant doorstop, essentially,” Ravindran said.
On top of the direct expense, legal liability and privacy concerns compound with the addition of a new technology, especially if that technology can and does collect data on patients.
“I think that vast amounts of unnecessary information are collected on a daily basis in all kinds of contexts,” Thomas Slattery, supervising attorney at Westview Legal Group, told ABN, adding that users of these technologies should limit what data is collected to only the most essential points. “By collecting less data, providers can easily lower the possibility of privacy violations.”
When data is gathered, eliminating personally identifiable information (PII), limiting the exfiltration of that data to other parties, and ensuring security and privacy are taken to their utmost by providers and technology companies alike is essential, Slattery said.
Lewis reflected that sentiment. And it’s a mission that his resume suggests he is set to accomplish. Previously, Lewis was a chief officer or director over technology services, focusing on cybersecurity, for several big-name companies, including Microsoft, Merill Lynch and Cisco Systems.
“Every bit of data that robot is collecting and using is HIPAA data — it’s privacy data — and not only is it privacy data, it is the data of the most vulnerable audience on planet,” Lewis said “One of the functions that Movia must do is protect that client from anything that could hurt them. … One of the reasons I was asked to take over was so that I could bring that kind of focus.”