Over the past few years, a town that features a school, a bookstore, a movie theater and an apartment building has sprung up in central Dallas, not far from Love Field. Despite its attractive amenities, and the fact that it has drawn visitors from as far away as Connecticut, this major development has been largely invisible to the general public.
That’s because the town, Brainville, is made of code and pixels instead of bricks and mortar. The virtual world was created by researchers at the Center for BrainHealth, an outpost of the University of Texas at Dallas housed in the Southwestern Medical District. While in Brainville, children and adults with autism spectrum disorders or traumatic brain injuries can practice social interaction in a safe, controlled environment. In theory, they can apply lessons learned in the virtual world to real-world conversations with relatives, co-workers and, hopefully, friends.
“If you think about the idea of somebody who all they want is just to have a friend, and this program can give that to them, it makes it incredibly powerful,” says Carl Lutz, the Center for BrainHealth’s creative director and one of the architects of Brainville.
A number of similar efforts are underway at the University of North Texas, where researchers in various departments are independently using virtual reality to help people on the autism spectrum develop empathy for others, to better understand how humans process social information and to study balance and movement impairments.
UNT’s Kristin Farmer Autism Center uses virtual reality to focus on “theory of mind” applications for higher-functioning individuals on the spectrum. “Theory of mind [deficit] is simply not being able to understand what others are thinking or feeling, and it’s almost universal among higher-functioning individuals with autism,” explains Kevin Callahan, Ph.D., the Kristin Farmer Autism Center’s executive director. “We’re looking at things like emotion recognition and awareness of what the perspectives of other individuals are.”
Meanwhile, the Computational Neuropsychology and Simulation Lab, a component of UNT’s Department of Psychology, researches how virtual reality, video games and human-computer interfaces can affect the way we take in and use information about ourselves and others. And the Human Movement Performance Laboratory at UNT’s Health Science Center in Fort Worth uses virtual reality as a form of physical therapy. Subjects are placed on a moving platform in front of a 180-degree screen and shown virtual scenarios. How they react provides data on the underlying mechanisms that control motor function.
Such innovations are not limited to the Dallas-Fort Worth area, of course. University of Missouri researchers have developed an educational program called iSocial, which allows four to six students on the autism spectrum to interact with each other. Each student has an avatar, as does the teacher. Lessons progress from a didactic discussion of the topic at hand, to a structured practice between the teacher and the students, to a “natural” practice in which students work with each other, developing skills via games or activities like scavenger hunts. More often than not, these students are not in the same city.
“We designed it to meet the needs of families and schools and programs all over the world,” says Janine Stichter, Ph.D., a professor of education at Missouri. “If folks have to come to the university, then that reduces significantly how many people’s needs we can meet with this.”
The majority of the people who have virtually visited Brainville have also physically visited the Center for BrainHealth. But through a partnership with the Dallas Independent School District, students at four middle schools have participated via laptops on their individual campuses. And joint research conducted with Yale University saw subjects exploring Brainville from more than 1,500 miles away.
“The scalability is one of the great advantages to doing this in a virtual reality, as opposed to setting up plywood and drywall in some real-world location,” asserts Erik Rapert, a Brainville programmer. “Virtual reality allows us to reach anyone across the entire globe as long as they have an Internet connection and a computer capable of running the software. We’re not quite to that point yet, but that is the direction we’re going.”
But is virtual reality the direction that autism treatment is going? Demetria Ellis-Cole, Ph.D., director of the Technology and Applied Research in Autism Laboratory at UNT, isn’t so sure. She works with parents each semester to design curricula that will build foundational skills in grade-schoolers on the autism spectrum.
“I’ve got several parents who are wanting to move away from so much tech and do a little bit more hands-on table work,” Ellis-Cole reveals, “so the kids get that opportunity to hone their fine and gross motor skills, or an opportunity to read and comprehend and focus on inferring challenges, and other things that are more academic.”
As the mother of a 15-year-old with autism, Ellis-Cole has personal experience with the perils of too much technology. She says her son is handy with gadgets, and might focus on nothing else if it were up to him.
“He does really good at imitation, and that’s how he learns,” Ellis-Cole says. “So we’re trying to make sure he doesn’t just attend to those things. He will zero in on the smallest details, and then carry those over into real life. And we don’t want that. Video worlds and virtual worlds are wonderful, but I always advocate a moderate approach to the use of technology, under supervision.”
Even Callahan, who is using virtual reality at the Kristin Farmer Autism Center, still questions whether the technology can be an effective tool in the long run. “The long-term goal is to really be able to get them to function with real people,” he says. “It’s one thing if they can do great things and make great progress in a virtual reality environment, but we don’t want that to generalize to their interactions with parents, siblings, classmates or colleagues in work settings.”
A TRIP TO BRAINVILLE
When a participant enters Brainville, he dons a set of headphones equipped with a microphone and sits in front of a computer screen that shows images similar to those in a first-person video game — in other words, through the eyes of a character. As the participant navigates the virtual town, he interacts face-to-face with a handful of other characters portrayed by a clinician. Thanks to facial recognition software that was originally developed to detect drowsiness in long-haul truckers, the expressions on a clinician’s face can be reproduced by each character in real time. Typically, the participant and the clinician are separated by a wall with a one-way mirror.
One of Brainville’s first participants was Josh McCombs, who was diagnosed at age 6 with PDD-NOS (pervasive developmental disorder, not otherwise specified).
Two years later, the diagnosis was narrowed to Asperger’s, and Josh (not his real name) began six weeks of Brainville sessions, even though the research was still in the trial stage. His mother, Jessica, says she was not shy about trying out experimental forms of therapy and training, and Brainville stood out from the pack.
“It could present real-life play-by-play scenarios, where the examples could be programmed and the reactions could be programmed,” Jessica says. “So you could talk about deeper things, like if somebody is aloof or if somebody is frustrated. These are very nuanced kinds of social experiences that are hard to talk about without actually experiencing. Brainville allows them to do that in a real safe, controlled environment with someone coaching them as it’s happening — because you can’t be there to coach if it’s happening on the playground.”
Josh’s coach was Tandra Allen, head of the Center for BrainHealth’s virtual training programs. After each of Josh’s sessions, Allen would ask him why his Brainville interactions played out the way they did. She encourages all her participants to work through the factors driving their virtual encounters. This kind of coaching, she says, is the program’s ultimate benefit. “When you tap into the frontal lobe — and the reasoning — it sticks.”
And sometimes it sticks for good. Earlier this year, when Josh was getting ready to enroll in high school, his mother sought advice from Allen in preparation for the major milestone. Jessica mentioned that the Brainville sessions had been the most impactful of all his therapies. “There were some scenarios that occurred there that we still talk about,” Jessica reports. “I don’t know if Josh recognizes that those experiences or those lessons he learned happened at the Center for BrainHealth, but I remember that.”
So Allen suggested he come back for more.
During Josh’s second Brainville session of 2015, Allen portrayed the coach character, who is designed to look like Allen and speaks in her normal voice, as well as three teenage characters who were working on a school project with Josh. A la the three beds in “Goldilocks and the Three Bears,” the three characters represented a spectrum. The first character, Tyler, was reluctant to contribute at all, while the third one, Elizabeth, was dominant, bulldozing her way over Josh’s idea. The second character, Michael, was somewhere in the middle.
After interacting with Tyler in a classroom, Josh told Allen that Tyler’s opinions about the project were “downcast” because he knew one of the other characters would torpedo them. But Josh also recognized that Tyler wanted to contribute his skills.
Allen asked Josh to expand on that second observation. Josh responded that Tyler has aspirations to do great things, but “this virtual obstacle is blocking him.” Allen asked, “What does that mean for you as a friend?” and Josh said, “I want to make sure he has the ability to contribute without being shot down.”
According to Allen, Josh took Tyler’s poor attitude about the project and “moved it forward,” an exciting achievement for the soon-to-be high schooler.
The interaction with Michael happened next, in a bookstore. Before it began, Allen told Josh that Michael was a big Texas Rangers fan who may have been distracted by a playoff game taking place in the real world. Not forgetting that detail, Josh concluded the interaction with “Go Rangers!”
“I liked my ending,” he then volunteered to the coach character.
When Josh spoke to Elizabeth in a coffee shop, he ran into a buzzsaw. She said she had the whole project figured out and had unilaterally taken steps toward completing it, without involving the other members of the team. After Josh expressed that he wanted to make sure Tyler and Michael were part of the group so they could “contribute their talents to the project,” Elizabeth came up with some menial tasks for them.
When Allen resumed the coach character, she didn’t have to ask Josh to assess the final interaction. He immediately said, “That conversation was a little weird. I think this was the biggest challenge.”
During an overall assessment of the session, Allen advised Josh to be careful about stifling his own opinion. “Think about this,” she told him. “How much do you give yourself an opportunity to share your ideas, or are you just trying to make everybody else happy?”
VIRTUAL REALITY = REAL DOLLARS?
All the people who have visited Brainville so far have been participants in Center for BrainHealth studies. But in early 2016, its virtual doors will swing open to a wider audience of visitors — if they are willing to pay a to-be-determined fee. Meanwhile, the University of Missouri has licensed the iSocial technology to a Georgia company, LifeSpan Behavioral Technologies, which is working on a commercial version.
“We’ve seen so many people that we know it works,” Lutz says of Brainville. “Now we want to get it to as many people as possible, and that’s what this commercialization is going to help us do.”
Lutz and his team would like to finish outfitting a clothing store so they can teach participants about the nuances of going shopping with friends, and they plan to complete the interiors of their virtual movie theater and a nearby bar/restaurant so those locales can be used to role-play dating scenarios and job interviews.
While adding more buildings will certainly broaden Brainville’s uses, adding more clinicians is the highest item the wishlist. Allen is one of only three on staff, and their salaries are funded through grants.
“With three clinicians, it limits how many people we can provide this service to,” Lutz explains. “With a pay-for service, if everything goes according to plan, which we believe it will, we can add lots of clinicians, which means being able to help a lot more people.”
Gaining entrance to Brainville will not be a matter of simply registering a credit card number. Allen will screen applicants to determine whether they would benefit from the experience. For example, she says Brainville would not be appropriate for a person seeking treatment for depression. However, participation will not be limited to people with an official diagnosis. The DISD middle school students used the program to work through that universal social awkwardness of the teenage years. The same type of sessions will happen when the program is commercialized.
“There’s never a ceiling on how high you can go with your social connectivity,” Allen says.
Published in the November 2015 issue of Thrive Magazine. ©ISTOCK
