Jan. 15, 2008 -- Texas researchers believe that people suffering from Asperger's syndrome -- a cognitive disorder often referred to as high-functioning autism -- may have found a new therapy in an unlikely place: the online virtual world Second Life.
Researchers at the University of Texas at Dallas Center for Brain Health started using the online therapy, which pairs clinicians' avatars with those of Asperger's patients, in a conversation, according to Sandra Chapman, the center's chief director.
"Asperger's usually affects people who have high-functioning learning skills but have a deficit interacting with people," Chapman said. "[They say], 'How do you ask people for a date? How do you inject yourself into a conversation when you want to talk?' This provides a forum for that."
Asperger's syndrome is just one disorder in the autism family, resulting in extreme social awkwardness. But unlike many autistic people, those with the disorder can maintain relationships with people, including marriage, and hold down jobs, according to Chapman. Despite this, patients often have a hard time detecting emotional subtleties and social cues that the average person takes for granted.
As a treatment, professionals that include occupational therapists and psychiatrists take patients through a series of exercises, in groups and individually, designed to help them learn social skills. In the center's new therapy, patients may have a job interview with a "boss" character or learn to ask another avatar out on a date.
Chapman believes that the Second Life therapy could be superior in that it makes situations seem more real because they're connected to a character, not a therapist you see every week.
"You're going to have to introduce someone to your boss and you're going to have to ask for a raise," Chapman said. "Within the virtual world, they say they feel the emotion as they would in the real world, which role-play doesn't do. It's too artificial. ... Once they begin to gain confidence in the virtual world, they can interact in the real world."
Asperger's patients and their caregivers have already taken to Second Life on the island of Brigadoon, a space started by John Lester, who was a Harvard research associate at the time, in 2005.
Experts in the field, however, are unsure about the potential effectiveness of such a program, saying that using virtual interaction could become so comfortable to patients who are already socially awkward, they might never move beyond it.
"I think it's a very creative and interesting idea," said Wendy Stone, a pediatrics professor at Vanderbilt Children's Hospital. "Psychologists in supervised treatments have used different types of methods. We use puppets to express feelings, we use books, we use role-playing. There are a lot of precedents for using different kinds of techniques. ... This sounds like a very clever way of helping people who have difficulty negotiating social duress to make them perhaps feel safer and respond to feedback better."
Stone, however, questions how well interacting online will translate to real life.
"Any treatment, no matter where we do it, no matter how we do it, needs to incorporate strategies for other settings, and if it doesn't do that then it's not useful," she said. "What we would hope to see is that what these individuals are learning will help them understand social situations, feelings of others, their own motivation and will help them negotiate real life social situations. You don't want them to just be able to interact via a computer."
Dr. Patricia Manning-Courtney, the director of the Kelly O'Leary Center for Autism Spectrum Disorders at the Cincinnati Children's Hospital Medical Center, agreed.
"The good thing about this model is that it's probably a highly motivating model," Manning said. "Online things in general are much easier formats for a lot of patients. They don't have to incorporate facial expressions or gestures but just have to type."
The flip side, according to Manning-Courtney, would be if patients had trouble moving beyond that online environment into a real one. Asperger's patients are notoriously inflexible. They can learn what sarcasm is, for example, but if someone uses it in a slightly different context than what they were taught, they might not be able to recognize it.
That inflexibility and tendency toward obsession makes Dr. Susan M. Anderson, the director of the autism program at the University of Virginia Children's Medical Center, wonder if the online nature of the game might be problematic.
"Asperger's kids love computers anyway. They play video games a lot, and it's tough to separate in a way," Anderson said. "I wonder whether you would be able to do it in other ways with a therapist."
But Chapman is undeterred and hopes that the Second Life isn't the end of the road for virtual socialization for Asperger's patients. The center is developing another program like Second Life but that will allow avatars to express -- and help Asperger's patients ability to detect -- a broader range of emotional depth.
"Second Life can't see emotions," she said. "We're moving to a new platform where we can teach the basic fundamental emotions, teach what happy is."