Smartglasses Help Patients With Comorbid Autism, ADHD

Pauline Anderson

April 05, 2018

UPDATED April 6, 2018 // "Smartglasses" — wearable computers that provide real-time guidance through visual and audio cues — reduce symptoms of attention deficit/hyperactivity disorder (ADHD) in individuals with autistic spectrum disorder (ASD), results of a small study show.

Dr Arshya Vahabzadeh

"This preliminary research demonstrates that the augmented-reality smartglasses technology has promise in addressing social communication and attention challenges of children and adults with autism," lead author Arshya Vahabzadeh, MD, innovation officer, Massachusetts General Hospital Psychiatry Academy, in Boston, told Medscape Medical News.

He said that he was encouraged to see such a positive response to this "exciting and emerging" technology. Vahabzadeh is chief medical officer of Brain Power, the company behind the technology.

The study was published online April 2 in JMIR Mental Health.


About one third of people with ASD have diagnosable ADHD. Research has indicated that for patients who have both of these conditions, there is greater cognitive and emotional processing impairment and rates of hyperactivity and impulsivity are significantly higher compared to patients who have only ADHD.

People with both ASD and ADHD may also be less likely to receive appropriate treatment for their ADHD (typically, psychoactive medication, including stimulants). In addition, they do not respond as well to such treatment.

Vahabzadeh said the investigators have already shown that computerized smartglasses are a "feasible technology that kids can use with no adverse effects." In addition, teachers and parents of these patients have noted improved attention and decreased hyperactivity, he said.

The Empowered Brain system used in the new study includes lightweight smartglasses that feature a camera, a microphone, a touchpad, a blink sensor, a gyroscope, and an accelerometer.

This technology is combined with various apps, such as Face2Face and Emotional Charades, which help users recognize and direct their attention toward socially salient stimuli, such as facial expressions.

The study included eight participants who had both ASD and ADHD. The patients ranged in age from 11 years to 20 years. All but one of the participants were male. In autism, the ratio of males to females is about 4 or 5 to 1, said Vahabzadeh.

Social communication abilities varied among the participants, as shown by their scores on the Social Communication Questionnaire (SCQ), which ranged from 11 to 28 points. The mean score on the SCQ was 18.

The researchers used the caregiver-reported hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), which measures inattention, impulsivity, and hyperactivity, although it is weighted toward hyperactivity, said Vahabzadeh.

On the basis of baseline ABC-H scores, the investigators stratified the participants into those with a high degree of ADHD symptoms (scores of 13 or higher for males and 8 or higher for the female) and those with a low degree of ADHD symptoms.

At the start of the study, four participants were in the high-symptom group (average ABC-H score of 25.75), and four were in the low-symptom group (average ABC-H score of 5.5).

Playing Games

Once oriented to the smartglasses, participants interacted with their facilitator or caregiver using what the authors called "gamified" experiences.

For example, with the Face2Face module, users see a cartoonlike character that is imposed over the face of the person they're interacting with. The character encourages them to pay attention to that person.

As participants gets better at the "game," they earn rewards and advance to the next level.

The Emotion Charade app teaches users to identify and understand emotions that are detected through artificial intelligence. Participants select an emoji they think matches the facial expression on the other person's face, using a spoken command or a subtle head tilt.

The technology "is almost coaching the child to improve their attention in social contexts," explained Vahabzadeh.

All participants were able to use the smartglasses and complete the coaching session.

For each participant, the researchers obtained an ABC-H score at 24 hours and at 48 hours after the session. A change from baseline of 25% or more in the score was deemed to be clinically significant.

ABC-H scores were lower by at least 25% for 75% of participants at 24 hours; they were lower by that much for all participants at 48 hours.

At 24 hours, average ABC-H scores had decreased by 54.9% in the group with high ADHD symptoms and by 20.0% in the group with low ADHD symptoms. At 48 hours, ABC-H scores had decreased by 56.4% in the group with high ADHD symptoms and by 66.3% in the group with low ADHD symptoms.

Although the study supports the group's previously published findings regarding the usability and feasibility of this combination of Google Glass and software, the results were not robust enough to be statistically significant.

"While this preliminary research demonstrates that people can use this technology and that it is decreasing ADHD symptoms, we are conducting further research so that we have enough statistical power to reach more robust conclusions," said Vahabzadeh.

He cautioned that an "expectancy effect" may have affected outcomes.

"With anything that's novel, there could be some type of placebo effect, and that's something we have to be wary of," he said.

Vahabzadeh stressed that children who have both ADHD and ASD struggle to achieve success in various aspects of their life.

"It's a double burden, because they have to overcome the challenges associated with ASD and also overcome the challenges associated with ADHD," he said.

Although the study did not show this, reducing ADHD symptoms may have a positive impact in other areas for patients with ASD, he said.

"One could hypothesize that if you're reducing some of these challenges, or helping children to learn new ways of coping, then you could make it easier for teachers and therapists and other professionals to spend more time targeting the other challenges."

Early Days

Many children and young adults with autism tend to have "an affinity" for digital technology, noted Vahabzadeh.

He stressed that this new technology's gamelike experiences should be appropriate for patients at different ages and developmental stages so that everyone is kept engaged.

It is important, he added, that users who are better adapted to the technology do not become too bored and that those with less ability do not become "so exhausted because the game is too difficult and get tired of losing."

The researchers have completed a range of research papers that are currently under review. These show that the smartglasses "improve social communication in a variety of domains and reduce maladaptive behaviors," said Vahabzadeh.

Longitudinal studies are evaluating the longer-term impact of the technology on social communication, behavior, and employment and academic success. One study is assessing autistic children with and without other disorders who wear the smartglasses in school for 10 minutes twice a day.

The technology could be beneficial for other conditions that involve social impairments or attention difficulties, said Vahabzadeh. He and his colleagues are studying the impact, for example, of the use of the technology in patients who have schizophrenia, mood disorders, anxiety disorders, and traumatic brain injuries.

"Some of the symptoms we're looking at actually occur across a wide transdiagnostic landscape of neuropsychiatric disorders," said Vahabzadeh.

But he stressed that this is still early days. "This is exciting and novel, but cautious research is needed to investigate this further," he said.

More information about the research being conducted at Brain Power is available on their website.

Innovative Approach

Commenting on the findings for Medscape Medical News, Alik Widge, MD, PhD, assistant professor of psychiatry, Harvard Medical School, and director, Translational NeuroEngineering Laboratory, Division of Neurotherapeutics, Massachusetts General Hospital, Boston, said the use of smartglasses technology to treat patients with ASD and ADHD is very interesting.

"For some people with autism, particularly those who already enjoy interacting with video games, it might be a helpful approach," said Widge. He is an engineer and computer scientist whose laboratory is developing medical technologies for the treatment of mental disorders. He was not involved in the current study.

"It's very innovative and is different from anything else that's currently available, and it's great to see it being studied," he said.

Widge said he would have liked more details about how long each patient in the study used the glasses, as well as which apps they used.

He noted that the study's patients and caregivers "signed up via an online form out of the blue" and so were "extremely motivated" and likely to do well with this approach.

Widge also said that it remains unclear why being trained to pay attention to faces reduces hyperactivity.

The research was supported by Brain Power. Brain Power receives funding from US federal and congressional sources. Dr Widge has disclosed no relevant financial relationships.

JMIR Ment Health. Published online April 2, 2018. Full text


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