can a virtual tour reduce anxiety in young optometry patients with asd?
TRANSCRIPT
Dr Greg Carey ([email protected])
Disability and Community Inclusion UnitSchool of Health Science
Faculty of Medicine, Nursing and Health Science
Can a virtual Tour reduce anxiety in young Optometry patients with ASD?
Can a virtual Tour reduce anxiety in young Optometry patients with ASD?
This study looks at the effect of an online preview of visiting the optometrist on the levels of anxiety in children and adolescence with Autism Spectrum Disorder (ASD). It is hypothesised that those who use the online preview will experience less anxiety before and during the visit resulting in more reliable assessments and improved service for this group. The level of anxiety of those using the online preview is compared to those who had no intervention before the appointment. Before the visit half of those given appointments were given access to an online interactive walkthrough of the examination environment. Others received no contact before the visit. On arrival both groups used a simple visual method to describe their level of anxiety and the self-reporting used to determine any effect of the online preview on the reported level of anxiety. A reduction in the level of anxiety during the visit will bring more accurate and confident results in the testing. This research will have extensive implications for future testing and assessment of health issues for children and adolescents with ASD.
Abstract for this presentationCarey, Constable, Sprick & Parker
Can a virtual Tour reduce anxiety in young Optometry patients with ASD?
We looked at:
......... the effect of an online preview of visiting the optometrist on the levels of anxiety in children and adolescence with Autism Spectrum Disorder (ASD) …….
We hypothesised that:
…….. those who use the online preview will experience less anxiety before and during the visit resulting in more reliable assessments and improved service …….
Our methodology examined:
……… The level of anxiety of those using the online preview is compared to those who had no intervention before the appointment ……….
The result was:
……… A reduction in the level of anxiety during the visit ………...
Who are we?
Dr Greg CareySchool of Health ScienceDisability and Community Inclusion Unit
Dr Paul ConstableSchool of Health ScienceOptometry Unit
Dr Cyle SprickSchool of MedicineClinical Skills and Simulation Unit
Dr Steve ParkerSchool of Nursing & Midwifery
Faculty of Medicine, Nursing and Health Sciences
A new dedicated Autism friendly Optometry Centre
The motivation
What do we know about anxiety and autism
DENTAL VisitsAutism Spectrum Disorder (ASD) can greatly inhibit a child's communication and social interaction skills, impacting their comfort during dental hygiene treatment and services. Children with ASD may exhibit sensory sensitivities, fear of the unfamiliar and lack of socio-cognitive understanding, leading to anxiety and corresponding behavioral deficits.
(Elmore, Bruhn, & Bobzien, 2016 p 111)
Outpatient VisitsSpecial considerations in the outpatient visit and peri-operative setting in the management of ASD patients can enhance the patient-provider relationship and improve the quality of care delivered
(Biyani, Morgan, Hotchkiss, Cecchini & Derkay 2015 p 798)
Medical VisitsMedical visits can be difficult for a child with autism, his/her parents, as well as providers. Medical visits can be particularly challenging because they are not in the child's normal routine, and may entail encounters with many unfamiliar people and expectations
(Chebuhar, McCarthy, Bosch & Baker, 2013 p126)
What do we know about VR and anxiety?
One of the most effective treatments of anxiety is exposure therapy….. This exposure process may be done through actual exposure, with visualization, by imagination or using virtual reality (VR)
(Gorini & Riva, 2008 p 215 ).
Virtual reality exposure (VRE) is potentially an efficient and cost-effective treatment of anxiety disorders
(Rothbaum, & Hodges 1999, p507)
Virtual reality exposure therapy (VRET) is a promising intervention for the treatment of the anxiety disorders
(Opris, Pintea, Garcia-Palacios, Botella, Szamoskozi & David, 2012 p 85).
… exposure to virtual environments bridges the gap between an imagined situation and a real one; it allows the patient to be exposed to anxiety-generating stimuli as if he or she were in a real situation
(Gebara, Barros-Neto, Gertsenchtein, & Lotufo-Neto, 2016 p24).
What did we decide to do?
Since opening all clients of the Clinic are given a visual time table
We wondered if an interactive online virtual tour would further reduce anxiety.
Methodology:
Clients aged between 5 and 18 with initial appointments at the Flinders Vision Autism Centre were divided randomly (coin toss) into two groups
Control Group*: Received no extra support before the visit. Experimental Group*:
Were given access to an online interactive walkthrough of the examination environment.
*Both groups had access to the visual time table
On arrival, a simple 5 point “How do you feel scale?” was used
Adapted from Buron, K. D., & Curtis, M. (2003). The incredible 5-point scale.Shawnee Mission
Participants from the Flinders Vision Autism center – either self referral, OT or Autism SA.
N = 34 included with a Diagnosis of ASD.
Control Group ExperimentalMale 15 12Female 2 5 total 17 total 17
*Clients must have a recognised diagnosis of Autism Spectrum Disorder to be eligible to attend this clinic.
How did we do it?
10 Go Pro cameras(pushed along with a broom stick)
https://www.youtube.com/watch?v=DQdlMARA6ck&feature=youtu.be
The interactive tour (2:35)
What did we find?
Total 34 (17 in each group) all diagnosed as being on the Autism Spectrum
No significant difference for age (p>0.4)
Case summaries
Group (N=17) M:F Age Anxiety
Video (N=17) 15:2 8.8 ±3.0 3.1 ± 0.8
No Video (N=17) 12:5 9.7 ± 3.7 2.4 ± 0.9
ANOVA >0.4 .01
Significant difference between groups at p= 0.01
In plain English:
There appears to be a significant difference in
reported levels of anxiety between the interactive
virtual tour group and control group
What does this mean?
The use of an interactive online virtual tour when visiting the optometrist reduced levels of anxiety in children with Autism Spectrum Disorder (ASD)
Preliminary results
The introduction of a short 3D virtual video of an unfamiliar health care setting can reduce the overall anxiety levels of children with ASD
Reported average number of views by parents was 2-3 times and children arrived looking for the doorways/passages to the consulting room on arrival and seemed more at ease with the surroundings.
Recommend the use of 3d virtual interactive videos for places for children who are likely to have anxiety.
What next?
This preliminary study may have extensive implications for future testing and assessment of health issues for children and adolescents with ASD
ImmersiveInteractive3D experience
AU$6:00 AU$120
Big Bucks Mega Bucks
New equipment makes further research much easier
Old (high quality)
10 GoPros @ Au$550 each (Au$5500)
14 hours to stitch togetherVery large fileExpertise required to stitch and uploadPowerful computer system required
New 360FLY (good quality)
1 camera @ Au$650<15 minute to stitch togetherUpload to a Youtube-like web pageCan be seen on a mobile phoneLittle expertise Can be uploaded from the camera
Now A$459
Can a virtual Tour reduce anxiety in young Optometry patients with ASD?
We looked at:......... the effect of an online preview of visiting the optometrist on the levels of anxiety in children and adolescence with Autism Spectrum Disorder (ASD) …….
We hypothesised that:…….. those who use the online preview will experience less anxiety before and during the visit resulting in more reliable assessments and improved service …….
Our methodology examined: ……… The level of anxiety of those using the online preview is compared to those who had no intervention before the appointment ……….
The result was:……… A reduction in the level of anxiety during the visit
ReferencesBiyani, S., Morgan, P. S., Hotchkiss, K., Cecchini, M., & Derkay, C. S. (2015). Autism spectrum
disorder 101: A primer for pediatric otolaryngologists. International journal of pediatric otorhinolaryngology, 79(6), 798-802.
Elmore, J. L., Bruhn, A. M., & Bobzien, J. L. (2016). Interventions for the Reduction of Dental Anxiety and Corresponding Behavioral Deficits in Children with Autism Spectrum Disorder. Journal of dental hygiene: JDH/American Dental Hygienists' Association, 90(2), 111-120.
Chebuhar, A., McCarthy, A. M., Bosch, J., & Baker, S. (2013). Using picture schedules in medical settings for patients with an autism spectrum disorder. Journal of pediatric nursing, 28(2), 125-134.
Gebara, C. M., Barros-Neto, T. P. D., Gertsenchtein, L., & Lotufo-Neto, F. (2016). Virtual reality exposure using three-dimensional images for the treatment of social phobia. Revista Brasileira de Psiquiatria, 38(1), 24-29
Gorini, A., & Riva, G. (2008). Virtual reality in anxiety disorders: the past and the future. Expert Rev Neurother, 8(2), 215-233. doi: 10.1586/14737175.8.2.215
Rothbaum, B. O., & Hodges, L. F. (1999). The Use of Virtual Reality Exposure in the Treatment of Anxiety Disorders. Behavior Modification, 23(4), 507-525. doi: 10.1177/0145445599234001
Opris, D., Pintea, S., Garcia-Palacios, A., Botella, C., Szamoskozi, S., & David, D. (2012). Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Depress Anxiety, 29(2), 85-93. doi: 10.1002/da.20910
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Dr Greg Carey ([email protected])
Disability and Community Inclusion UnitSchool of Health Science
Faculty of Medicine, Nursing and Health Science
Sum of Squares df
Mean Square F Sig
Years Between GroupsWithin GroupsTotal
6.618374.000380.618
13233
6.61811.688
.566 .457
Months Between GroupsWithin GroupsTotal
4.971309.647314.618
13233
4.9719.676
.541 .479
Anxiety scale Between GroupsWithin GroupsTotal
4.97121.64726.618
13233
4.971.676
7.348 .011
ANOVA
Significant difference between control and experimental group at p= 0.011
Significant difference between video and non-video groups (p=0.011)