Virtual Reality as Therapy for Autism

Researchers estimate approximately one fourth of children who have autism struggle with phobias that can negatively impact their daily lives. Thanks to modern technology, researchers have discovered a promising new method of treating these extreme fears. Using virtual reality therapy, researchers at Newcastle University in England in conjunction with Third Eye NeuroTech have created interactive computer-generated scenarios to help children with autism deal with their fears.

Last week, Science Daily published an online article regarding this research that was also published on February 14, 2019, in the Journal of Autism and Developmental Disorders and Autism in Adulthood. [To read “Immersive virtual reality therapy shows lasting effect in treatment of phobias in children with autism,” please click here.]

For this therapy, known as the Blue Room treatment, children and adults with autism were exposed to a 360-degree virtual environment related to their specific fears. In real life, the people with autism would have difficulty coping with these frightening scenes. As researcher Dr. Morag Maskey notes, people with autism may have trouble imagining scenes, but the virtual reality allows them to visualize these scenarios while they are provided support to deal with their fears. Accompanied by a psychologist, the children used an iPad to navigate and control completely the situations they were shown. In addition, they did not have to wear goggles, unlike some forms of virtual reality.

Some of the phobias addressed in this treatment included fears of the dark, walking into rooms, school, public transportation, elevators, dolls, balloons, dogs, and wasps and bees. For the first study, 32 children with autism who were between 8 and 14 years old were divided equally into two groups. The first group began treatment in the Blue Room immediately, whereas the second group, acting as the control group, waited six months to begin the Blue Room treatment. The children spent four sessions per week in the Blue Room with a psychologist observing personalized scenarios related to their individual phobias. Their parents could also observe these sessions through a video link. After these treatments, the parents provided opportunities for their children to face their fears in the real world.

Two weeks after the virtual reality treatment, 25% of the children in the first group were able to cope with their specific phobias. Six months later, the positive effects of the therapy remained, as 38% showed improvement, and only one child displayed an increase in the intensity of the phobia. In the second group, 40% showed improvement two weeks after completing the treatment, and 45% retained the benefits of the therapy six months later.

In a similar but smaller study, eight adults with autism ranging in age from 18 to 57 participated in four twenty-minute sessions in the Blue Room interacting with scenarios personalized for their specific phobias. Six months later, five of the adults retained the benefits of this therapy.

While the research team plans further studies to see how long lasting the effects of this therapy are and to discover why some children and adults do not respond to this treatment, the positive results are encouraging. As Dr. Maskey states, “It is incredibly rewarding to see the effect it [the Blue Room treatment method] can have for some, overcoming a situation which just a week previously would have been so distressing.”

Moreover, the leader of the study, Professor Jeremy Parr from the Institute of Neuroscience at Newcastle University, emphasizes how life changing the effects of this therapy could be. He states, “For many children and their families, anxiety can rule their lives as they try to avoid the situations which can trigger their child’s fears or phobia.” Furthermore, he adds that this treatment “offers hope to families who have very few treatment options for anxiety available to them.”

Since extreme fears can produce debilitating anxiety in people with autism, potentially triggering aggressive panic attacks or causing them to avoid situations they fear, addressing phobias in a supportive way could have lifelong benefits. Fortunately, the researchers at Newcastle University and the technology experts from Third Eye NeuroTech have discovered that virtual reality may help children and adults with autism successfully overcome phobias so that they may face everyday reality fearlessly.

“I prayed to the Lord, and He answered me. He freed me from all my fears.” Psalm 34:4

Fear Not

 

As mothers, our most important task is to raise our children to be happy, healthy, and independent. Consequently, one of our greatest fears is dying before we accomplish that goal. When our children have disabilities that make them rely upon us more, we worry about who might care for our children––even when they are adults––if we were not there to do it ourselves. However, our faith tells us not to fear because God already has everything figured out.

Yesterday, I read an emotional article about a young mother who passed away last week, leaving behind a husband and young daughter along with a letter she left for friends and family. When her husband posted this letter on Facebook a few days ago, her words went viral, shared thousands of times and capturing the attention of the mainstream media as well as social media. NBC Chicago entitled the story “Wisconsin Mom Who Died of Cancer Writes Heartbreaking, Hilarious Letter.” [To read this article, which includes a link to her letter, please click here.]

Certainly Heather McManamy’s courage in facing her death is admirable, but I failed to see what the media described as hilarity. Yes, she had some humorous comments in her letter, but I was more struck by the heartbreaking nature of her words. Even more than the sorrow of leaving behind her little girl, Brianna, I felt heartbroken that she did not seem to have faith in God when dealing with this greatest fear mothers face.

She states: “Whatever religion brings you comfort, I am happy that you have that. However, respect that we are not religious.” While I respect her candor that she was not religious, I wish for her sake and her family’s sake that she had had faith, which her letter seems to indicate that she does not. I think perhaps faith could have brought her comfort as she dealt with cancer and facing death and leaving her loved ones behind. Because I have not walked in her shoes, however, I don’t know that for certain.

What was especially heartbreaking from my perspective was that she does not want anyone to tell her daughter that she went to heaven. In her letter, she requests, “Please, please, please do not tell Brianna that I am in heaven. In her mind, that means that I chose to be somewhere else and left her.” She goes on to say, “Because, I am not in heaven.” I must respectfully disagree with her decision because I believe that knowing that our loved ones are in heaven provides comfort rather than confusion, even for children.

While Alex has been mostly spared of having to deal with the loss of loved ones in his life, he does talk about heaven and people whom he knows are there, including his beloved childhood doctor, his grandfather whom he barely remembers, and his most-admired U.S. President, Ronald Reagan. Moreover, he looks forward to going to heaven someday with anticipation because he indicates that he has a lot of questions he wants to ask God that he can’t find in books or on Google. Somehow I think he and God will have some fascinating conversations one day.

Alex’s complete and confident trust in God allows him to face the future mostly fearlessly, which comforts me as his mother. Last week, he awoke in the wee hours of the morning in a full-blown panic attack, something that has not happened in years. (The next day, Ed and I decided that the combination of dairy-free and gluten-free birthday cake and ice cream along with soy egg nog was not a good snack ahead of bedtime, and we decided to limit his evening sugar consumption to prevent further nighttime meltdowns.) Even in the midst of his adrenaline surge in which he shook and muttered about not being able to count to infinity, Alex knew to seek God’s help along with ours.

With his overly quiet voice, Alex rarely yells, but in the midst of his panic, he kept crying out, “Need to talk to God! Need to talk to God!” As Ed and I tried to calm and reassure him, we reminded him that God is always listening and that he can pray anytime to talk to God. While this isolated incident was upsetting because we hate to see Alex so distraught, we felt comforted that he knew what he needed to become calm: he just needed to talk to God. His faith was rewarded, and God calmed the storm within Alex so that his anxiety disappeared, and he could resume a peaceful sleep.

As Alex turned twenty-four last week, I assessed my work as his mother over the past two dozen years. Yes, he is happy and basically healthy, with the notable exception of autism, but he still has a way to go to be independent. However, as I began thinking about the tremendous strength his faith in God gives him, I felt a sense of accomplishment for teaching him what is most important in life. If something were to happen to me, he would have his faith to carry him, and he would know that he would see me again in heaven. Maybe it’s not as important that we teach our children to be independent as to teach them to depend upon God always, especially when life becomes overwhelming.

With the imminent arrival of Christmas this week, Alex and I have faithfully been counting down the days on our Advent calendar. More than most, he knows the true significance of the holiday, reminding us it’s Jesus’ birthday and looking forward to going to church on Christmas Eve to celebrate. Despite autism, Alex can fathom the significance of Christ’s birth, knowing that his Savior guarantees the ultimate reward in heaven. Consequently, we need not fear troubles in this earthly life, knowing that because God’s plans are good, indeed, we can celebrate with great joy.

“And the angel said unto them, ‘Fear not, for behold I bring you good tidings of great joy which shall be to all people. For unto you is born this day in the City of David, a Savior, which is Christ the Lord.” Luke 2:10-11

Fearless

Recently Ed complimented me in a way that totally surprised me by telling me how brave he thinks I am. At first, I thought he was teasing me, as he often likes to do, but he sincerely assured me that he was completely serious. Because I see myself as quite cowardly, this comment took me off guard. I think of myself as the little kindergarten girl who for a month clutched a map my mom had made of the route between home and school, terrified that I would get lost. Driving on highways makes me terribly nervous, and the thought of driving out of town makes me sick to my stomach. Before any new situation, I repeatedly mentally rehearse what I will say and do, for fear of making a fool of myself. If he thinks I’m brave, I must put on a good façade.

This week, we had to take Alex for a physical examination to gain medical clearance for his upcoming oral surgery to remove his twelve-year molars and wisdom teeth under general anesthesia. Because his regular family doctor is now only available limited hours, I decided to take him to another doctor. After rehearsing this scenario in my mind several times, we took Alex to the new physician on Friday. We were quite impressed with the doctor, her staff, and her office, and we were pleased we didn’t have to wait long. However, Alex decided he was not happy to be there and made his displeasure known. First, he waved “the claw,” his right wrist bent at a ninety-degree angle and waved up and down in a dismissive gesture while making a face as though he’d been sucking lemons. Then he decided to stomp his foot on the step of the examination table to get our attention as the doctor and I went over his medical history. Realizing we were ignoring his hand waving and foot stomping, he escalated to swinging his hands and feet. He would not be ignored.

Thankfully, Ed was there to handle Alex, who was acting more like a two-year-old than a twenty-two-year-old, distracting him and trying to keep him calm so that I could convey information to the doctor. Finally, as Alex became more agitated, I apologized to the kind and understanding doctor and asked her to give us about five minutes alone to settle down Alex. Once she left the room, Ed and I went into teamwork mode, with Ed cajoling and coaxing while I instructed him to use the calm down skills he has learned in therapy. With his requested reward of going to Pet Supplies Plus hanging in the balance and a few minutes of reassurance that we were almost done, Alex pulled himself together and was able to complete the physical exam without further incident. However, we knew that we had another step ahead of us before he could receive medical clearance: tests.

Knowing that Alex is much more pleasant in the evening, we decided to take him for his tests after he’d eaten dinner and had his beloved nightly bath. Fortunately, the lab where we needed to take him has evening hours, so we knew this was probably the best scenario to get the testing done. On Friday evening, we discovered that Alex was the only patient, which was ideal because he didn’t have to wait. As usual, he handled the blood draw beautifully, never even flinching and watching in fascination as his blood was drawn into test tubes. The friendly lab technician even commented that he was “a perfect patient.” After that, he needed to have an EKG and chest x-rays, something he had never done before. Uncertain as to how he would do with having to be very still, we were a little nervous about how long these tests could take. However, the x-ray technician was wonderful with him and able to get him to cooperate fully so that the tests went very smoothly. Moreover, Alex apparently had a great time and found the tests interesting. Not only were we pleased with the outstanding and efficient staff at the lab, but we were also delighted that Alex had been so pleasant and cooperative. After dealing with Mr. Hyde at the doctor’s appointment, we were thankful to take Dr. Jekyll to the lab.

Even though we weren’t happy with Alex’s behavior at the doctor and were a little apprehensive about how he would react to the tests, we weren’t afraid. I think we have been through enough difficult situations with him to know that somehow we pull together and pull through to get things done. Ed and I each know our roles in those circumstances: he handles Alex while I handle the paperwork and medical staff, each of us playing to our strengths. Most of all, we support each other so that we can help Alex be healthy, happy, and safe. Part of this fearlessness comes from the faith we have learned in the tough times; we know that God has always seen us through every situation. In fact, one of the things I like best about the facility where we took Alex for the doctor’s appointment and lab tests is that because of its affiliation with the Catholic church, the abundance of Bibles and religious symbols reminded us of God’s presence.

Moreover, as I watched Ed calmly interacting with Alex, especially when Alex was agitated, I realized that his fearlessness has inspired me to be brave. Whether it’s because he grew up in New York City or because he has a few years of life experience on me or because he just doesn’t naturally fret the way I do, I can attribute any bravery I have to what I’ve learned from living with Ed. Today we celebrate Ed’s birthday, and every day I thank God that he is Alex’s dad. I’m sure our life is not what he imagined when he thought of what fatherhood would be like, but being an autism dad has made him rise to the occasion, to be braver and stronger and more patient and more compassionate. Because of his quiet strength and unconditional love, Alex and I are blessed, and the three of us make quite a team, pressing forward fearlessly, ready for the next adventure.

“So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand.” Isaiah 41:10

Swimming

 

Alex has a healthy fear of water, which is actually a good thing. For some unknown reason, many people with autism who wander away from places of safety often gravitate toward water—ponds, lakes, rivers, and swimming pools—where they can drown if not found in time. [For more information on this issue, please click here for my previous blog entry “Autism and Wandering: A Safety Crisis.”] Despite taking swimming classes in high school, neither Ed nor I can swim well, and we know our limitations in water. Specifically, I would never try to swim in water over my head or would always wear a life jacket on a boat because I don’t trust my ability to swim to safety. I’m sure that I have conveyed this sense of being overly cautious around water to Alex, and he recognizes the potential dangers of deep waters to a non-swimmer.

When he was younger, his sensory issues made him overly sensitive to putting his face in water, and he didn’t like getting water in his eyes. Even though he has always loved baths, he was careful not to splash water in his face, and I had to be careful not to get water in his eyes when I washed his hair. Since water in his face seemed to upset him terribly, I delayed putting him in swimming lessons until he was a little older, and I knew that his special needs would require understanding of his sensory issues and delayed motor skills.

At the age of nine, Alex took swimming lessons through our local YMCA that were supposed to be geared for children with special needs. Although the instructors were kind to him, they were teenagers who really had no idea of how to teach special needs children how to swim. In fact, they seemed more interested in visiting with each other than in actually teaching the kids. Consequently, I worked with Alex myself, teaching him the limited skills I know about swimming, which meant he didn’t learn much that summer. Nonetheless, he enjoyed being in the water, yet still maintained a cautious awareness about not getting in deep water. Like Ed and me, he knows his limitations and keeps himself safe by not getting in over his head, literally.

A few weeks ago, an autism mom friend had shared that the local YMCA offers open swimming time for people of all ages with special needs for a very reasonable fee. Moreover, they offer this session before the facility’s opening hours so that the families have more privacy in the locker rooms and the pool. Because our kids’ behavior can be unusual at times, we don’t have to worry what other people think. Since this seemed to be an ideal situation (added to the convenient location of the Y, which is less than five minutes from our home), I asked Alex if this was something he thought he would like to try. He acted enthusiastic about going swimming and asked me several times about going to the pool the week ahead of the first session. However, I was still unsure how he’d react once we actually went the first time.

Last Sunday was the first session for special needs swimming, and he eagerly anticipated going. One of his concerns was whether they would have clocks because he couldn’t wear his watch; keeping track of time is very important to him. This fear was eased immediately when he saw that they had not one clock but four—one on every wall. I was pleased to see that the pool designated for this activity was not very deep and offered a gradual step down into the water. Also, the water was comfortably warm, which is important to Alex and me because we get cold easily. When we first got there, Alex seemed to have some trepidation about getting in the water, which really didn’t surprise me. He gradually stepped into the water, but didn’t seem to want to get much deeper than his knees as he held on tightly to the railing with one hand and my hand with the other. Knowing that Alex must always do things on his own terms, I just waited until he was ready to move forward. He kept asking me about how deep the water was, and I reassured him by pointing out the markings on the pool walls and by showing him that the water was only up to my waist in the middle part of the pool.

After a while, he decided to venture away from the safety of the very shallow water and railing, and he was willing to walk into the waist-deep water, clutching my hand for security. With time, he even played catch with a ball, which meant that he had to let go of my hand and trust himself in the water. By the end of the session, he had walked back and forth across the pool several times, each time seeming more comfortable and confident in the water. However, I knew that the first session had truly been a success when he asked me if we could come back again the following week. Sometimes things work out even better than we plan.

Even though I hope that Alex someday may learn to swim so that he can be safe in the water, I’m pleased that he knows his limitations and shows good sense about not getting in deep water. Moreover, I’m also glad that he’s willing to try new things, to attempt to overcome his fears and sensory issues, and to learn that these new experiences can bring him enjoyment.

“…and it was a river that I could not cross; for the water was too deep, water in which one must swim, a river that could not be crossed.” Ezekiel 47:5

Recalling Tragedy

As we remember the tragic events of September 11, 2001, on this tenth anniversary, we recall what we were doing when we first heard the news. I was teaching my seventh grade English classes on that morning when my close friend Sharon came to find me between first and second periods to tell me that a plane had crashed into the World Trade Center. Knowing that Ed, a native New Yorker, had family who worked in Manhattan, she was concerned about my in-laws and knew I would want to make certain they were all right with a call home to Ed. Not wanting to tie up the phone lines in case Ed was trying to get ahold of his sister and brother, I decided to wait to call him until the break between my next two classes. During the next class, my principal brought me a written message that he was hand delivering to all staff members. In capital letters at the top of the note read the following statement: “DO NOT SHARE WITH STUDENTS!” Trying not to register any emotion, I quickly scanned the rest of the note detailing the planes crashing into both of the World Trade Towers as well as into the Pentagon. Moreover, the note stated that one of the Twin Towers had collapsed. Saying a silent prayer, I somehow calmly taught my students a lesson on punctuation. After that class, I ran to the library, where I knew I would find the comfort of my friend Sharon and hoped to find more news on what had happened.

A quick phone call home to Ed reassured me that he and Alex were fine, and he had been able to ascertain that his brother and his sister’s husband, both of whom worked in New York City, were thankfully safe. Our next concern was how Alex was going to react to the constant barrage of news reports detailing the horrible series of events. We weren’t sure how much he comprehended in his nine-year-old mind impacted by autism. Despite his deficits in social skills, other people’s tears and sorrow have always moved Alex, and we worried that the outpouring of emotion shown on the news would overwhelm him. In addition, we thought that he might be upset because the news coverage interrupted his regular television viewing schedule. He was likely to be more upset by missing The Price Is Right than he was to be upset by the news of the terrorist attacks. Fortunately, he handled the changes better than we expected and did not seem to be agitated by the news broadcasts we had on the television as we were trying to make sense of what had happened.

Despite my upset and fears, I knew we had to discuss with Alex calmly what had happened that day so that he could process it. At the same time, I didn’t want him to have fears that would haunt him in the future, such as being afraid to fly on an airplane or to go in a skyscraper. I had once read that children with autism live in constant fear, and we have always tried to make Alex feel safe, so that he didn’t live in fear. I really don’t think that fear is a constant in Alex’s life because the only things he seems to fear are lightning (probably because I had once told him that he couldn’t go play outside since there was lightning that could strike and kill him—that warning resonated with him) and getting water in his eyes (I take no blame for that one.). He really doesn’t seem overly afraid of anything else, and I hope that’s because he trusts that Ed and I, with God's help, will keep him safe, as we have always done throughout his life. That evening, I asked him if he knew what had happened in New York, and he told me, “Yes, the big buildings fell down.” He didn’t seem to want to talk about it any more than that, and his matter-of-fact nature made us realize that he wasn’t overwhelmed by fear or by what he had seen on the news, and we were thankful that he handled the news calmly. With his vivid visual memory, I’m sure that Alex carries images of September 11th, as we all do—the day when “the big buildings fell down.” Maybe some day he’ll fully comprehend the magnitude of the day’s events, but until he can, I’m thankful that he feels safe and doesn’t allow fear to take any control in his life.

“For God has not given us a spirit of fear and timidity, but of power, love, and self-discipline.” 2 Timothy 1:7

Storms

When Alex was younger, he was terrified of storms. Here in Northwest Indiana, spring and summer weather brings many thunderstorms along with frequent tornado watches and warnings, such that most people become accustomed to stormy weather. We never knew whether Alex was afraid of the flashes of lightning, the rumble of thunder, the howling winds, or the annoying beeping of severe weather warnings. With his sensory issues, any of these sights or sounds could have been troublesome for him. In addition, his strong attachment to his primary sources of entertainment in the forms of cable television and computer internet access may have caused him to fret more about the potential loss of electricity, cable, or internet power, due to storms, than most people do. Whatever the reason, Alex would basically melt down during major storms, causing us to dread weather warnings.

The worst circumstances for us were thunderstorms that suddenly appeared in the middle of the night, waking Alex from a sound sleep and sending him into a screaming fit. Despite our best attempts to comfort him and reassure him he was fine, he would continue to yell and pound on his bedroom wall. No matter what we did, he wouldn’t settle down until the storms outside subsided, which meant that all of us endured storms inside the house, as well, and all three of us dealt with sleep deprivation. At some point, perhaps during a tornado warning that sent us to the safety of our finished basement, we realized that the best place for Alex during any storm was the quiet of the basement, where he couldn’t hear the crack of thunder or the whipping winds, nor could he see the flashes of lightning. Unaware of what was going on outside, he would settle down and go to sleep in the spare bed in the basement while Ed and I slept on the pull-out couch in the adjoining basement family room. Once we had arrived at such a simple solution to a major problem, we knew to take him to the basement to sleep any time storms were predicted in the night so that we could completely avoid his having a fit about the weather and ensuring we would all get a good night’s sleep. Alex thought that sleeping in the spare bed was a real treat and willingly headed for the basement as though he were staying at a luxury hotel. About the time we figured out how to deal with his fears of storms, he seemed to overcome this anxiety. We noticed that he seemed less bothered by storms during the day, not fretting when they were announced on television, nor becoming upset when they arrived outside. The true test, however, came when he not only didn’t become agitated during storms in the night, but also slept through them peacefully, completely undisturbed by the unsettled weather.

As we’ve been dealing with some different storms lately in the form of Alex’s somewhat detached behavior, I’m reminded that the storms always eventually pass and that overcoming the fear of those storms makes life easier. While we’re still not certain why Alex isn’t as energetic and happy as he normally is, we are thankful that we know he’s not physically ill, as confirmed by his recent blood tests. Because we see him “happy hop” through the house and smile in amusement every day, we know that our Alex is still in there, even though he isn’t quite his usual enthusiastic self. Looking for gradual improvements, we are pleased that he is spending more time sitting upright instead of lying on the couch, and the angry outbursts we faced a few weeks ago have nearly completely subsided. Moreover, he has been more willing to go places, which he was avoiding for a couple of weeks. However, when he chooses to sit alone in a room for periods of time, not talking or responding to our questions, we worry about why he is acting withdrawn and hope the cause is simply teenage rebellion or his way of dealing with the irritation of high pollen counts in the air. Whatever the reason for the changes, we feel certain he will emerge from this phase soon, just as he has overcome other behavioral issues in the past, and we will be grateful that Alex has again made progress. Until then, we ensconce ourselves safely in a figurative basement, and we keep hoping and praying that this storm will pass so that we can enjoy sunny skies again.

“Do you know how God controls the storm and causes the lightning to flash from His clouds?” Job 37:15