Children with autism were able to improve their social skills by using a smartphone app paired with Google Glass to help them understand the emotions conveyed in people’s facial expressions, according to a pilot study by researchers at the Stanford University School of Medicine.

Prior to participating in the study, Alex, 9, found it overwhelming to look people in the eye. Gentle encouragement from his mother, Donji Cullenbine, hadn’t helped. “I would smile and say things like, ‘You looked at me three times today!’ But it didn’t really move the bar,” she said. Using Google Glass transformed how Alex felt about looking at faces, Cullenbine said. “It was a game environment in which he wanted to win — he wanted to guess right.”

The therapy, described in findings published online Aug. 2 in npj Digital Medicine, uses a Stanford-designed app that provides real-time cues about other people’s facial expressions to a child wearing Google Glass. The device, which was linked with a smartphone through a local wireless network, consists of a glasses-like frame equipped with a camera to record the wearer’s field of view, as well as a small screen and a speaker to give the wearer visual and audio information. As the child interacts with others, the app identifies and names their emotions through the Google Glass speaker or screen. After one to three months of regular use, parents reported that children with autism made more eye contact and related better to others.

The treatment could help fill a major gap in autism care: Right now, because of a shortage of trained therapists, children may wait as long as 18 months after an autism diagnosis to begin receiving treatment.

‘Really important unmet need’

“We have too few autism practitioners,” said the study’s senior author, Dennis Wall, PhD, associate professor of pediatrics and of biomedical data science. Early autism therapy has been shown to be particularly effective, but many children aren’t treated quickly enough to get the maximum benefit, he said. “The only way to break through the problem is to create reliable, home-based treatment systems. It’s a really important unmet need.”

Autism is a developmental disorder that affects 1 in 59 children in the United States, with a higher prevalence in boys. It is characterized by social and communication deficits and repetitive behaviors.

The researchers named the new therapy “Superpower Glass” to help make it appealing to children. The therapy is based on applied behavior analysis, a well-studied autism treatment in which a clinician teaches emotion recognition using structured exercises such as flash cards depicting faces with different emotions. Although traditional applied behavior analysis helps children with autism, it has limitations: It must be delivered one-on-one by trained therapists, flash cards can’t always capture the full range of human emotion and children may struggle to transfer what they learn to their daily lives.

Eight core facial expressions

Wall’s team decided to try using applied behavior analysis principles in a way that would bring parents and everyday situations into the treatment process. They built a smartphone app that uses machine learning to recognize eight core facial expressions: happiness, sadness, anger, disgust, surprise, fear, neutral and contempt. The app was trained with hundreds of thousands of photos of faces showing the eight expressions, and also had a mechanism to allow people involved in the study to calibrate it to their own “neutral” faces if necessary.