01/10 review

Analysis of Art Therapy for Children with Autism by Using the Implemented Arti ̄cial Intelligence System - review

abstract 자폐증은 사회적 의사소통 장애와 반복적인 감각 운동으로 나타나는 질병입니다. 현재 자폐증 발병률은 전 세계적으로 계속 증가하고 있으며, 자폐증 아동의 수도 증가하고 있습니다. 중국의 자폐아 치료는 중재 중심의 치료가 주를 이루고 있으나 경험이 풍부한 자폐아동 강사가 부족하다. 여기서는 머신러닝과 인공지능(AI) 알고리즘을 기술적 기반으로 채택해 실제 적용 시나리오를 기반으로 교실 내 자폐학생의 정서적 수행능력을 측정하는 시스템을 구축한다. 자폐아동의 교실 학습 데이터를 분석함으로써 학생의 감정을 효과적으로 판단하여 교사가 수업 성과를 평가 및 추적하고 교사의 부담을 줄일 수 있습니다. 결과는 프레임 시퀀스와 키 포인트 좌표로 구성된 행렬을 입력으로 사용할 때 시공간 그래프 컨벌루션 네트워크가 90%의 정확도로 동작 인식의 주요 모델로 결정되고 참여 점수가 다음과 같이 결정됨을 보여줍니다. 동작 응답 시간을 계산하여 얻습니다. 얼굴 표정 인식의 실험 과정에서 랜덤 포레스트의 이미지 기반 특징점 시퀀스 분류 정확도는 99%에 달할 수 있습니다. 따라서 랜덤 포레스트를 얼굴 표정 인식의 주요 분류자로 결정한다. 표현강도, 즐거움, 표현범주 간의 관계를 분석한 후 채점방법을 설계한다. 이 실험은 또한 그림이 자폐증 아동의 재활 치료가 될 수 있다는 사실을 발견했습니다. 이상의 결과는 자폐아 치료에 대한 이론적 기초를 제공할 수 있다.

• Art therapy as a therapeutic tool in mental health

abstract

Digital technology has gradually infiltrated all areas of our daily lives. Health has not escaped the arrival of new technologies and has seen the emergence of a number of new care devices, using connected objects, applications, or artificial intelligence. Addressing the issue of digital technology, however, remains a delicate subject as it is obvious that this field is broad and constantly evolving. However, under the cover of this complexity, avoiding asking this question also leads to a major pitfall. Indeed, new generations have grown up with these technologies, and the arrival of these generations in healthcare structures requires us to take into account the responses to be made to the mutations induced by digital technology. In psychiatry, this question is emerging, particularly through art therapy activities, especially since art has seen the emergence in recent years of 'a digital art. In this article, we propose to develop the issues surrounding digital technology in the field of mental health, to describe the digital revolution in art in order to discuss the possible meeting points between art- therapy and digital tools in mental health.

1. introduction

The digital revolution has left its mark over the years in a growing number of areas, including health, which has seen digital technology gradually offer new approaches to prevention. , support and research. Mental health also benefits from these advances with technological innovations that make it possible to expand the possibilities of care. At the same time, the field of art has been experiencing the same developments in recent decades, with the development of digital art. These elements lead us to question more precisely the impact of this digital revolution on the point of junction between art and mental health that constitutes art therapy. In order to provide food for thought on the possible meeting points between digital tools in mental health and art therapy, we first propose to present the current digital landscape in psychiatry and in art. Then discuss possible interactions between these fields.

2. Digital in the field of mental health

Digital tools in the field of mental health have developed rapidly in recent years, to the point that their number is currently very significant. One of the challenges is, in the face of this exponential multiplication, to be able to control the quality of these tools. We propose to describe through a non-exhaustive presentation some areas of reflection opened up by these tools by presenting them through three main groups.

2.1. Applications and conversational agents

One of the strengths of digital technology is being able to offer tools that patients can use in their daily lives, even after they have left the healthcare services. These tools also make it possible to reach a wide audience and therefore to detect subjects outside the care systems in order to get them to seek care. Applications in particular allow everyone to be able to collect, through communicating connected objects, encrypted data on their own body (in particular on “health” and well- being). These data can then be transmitted to health services to monitor the evolution of pathologies during treatment. In psychiatry, such applications already exist for different pathologies such as depression [17], suicide [12,13] or addictions [15]. Beyond monitoring encrypted parameters, certain applications also offer active remote support through conversational agents [11] or standardized psychotherapy modules [4, 19].

2.2. Serious games and virtual reality therapies

The contribution of digital technology also makes it possible to offer new modalities of care. Serious games combine a scientific approach based on clinical knowledge and a fun aspect in order to offer care tools that are better accepted by patients. Aspects of gamification can contribute to better adherence to care by supporting the learning of new strategies through games and positive reinforcement. Finally, virtual reality care approaches provide a more immersive dimension and can be combined with gamification approaches or applied independently of this playful aspect. Exposure therapies in virtual reality thus make it possible to work on phobic situations in adapting exposure to these situations and making certain environments accessible for consultation (flight environment, altitude environment).

3. Massive open online courses (MOOCs), Internet and social networks

Digital tools also allow an exchange of information and knowledge. In the field of health, the provision of MOOCs allows patients to access educational content which allows them to better understand their illness and better manage their treatment and their daily lives. These tools lend themselves to psychoeducation approaches and have been implemented for several pathologies outside the field of mental health, for the treatment of obesity in particular. Beyond MOOCs, the Internet also allows access to information and exchange with other users via forums. A study revealed that patients suffering from schizophrenic disorders found testimonials on forums that reduced the feeling of isolation [8]. Finally, the analysis of information flows on social networks makes it possible to highlight the knowledge of the general public, the preconceived ideas and the stigma associated with mental illnesses. Thus, one study looked at the use of the word schizophrenia on social networks; in this study, 27% of the publications related to politics and in these spaces of political discussion, the usage was 90% foreign to the medical definition and always intended. rewarding [7]. This data makes it possible to develop information campaigns as close as possible to the audiences concerned. Digital tools have therefore largely been able to be integrated into psychiatric care with undeniable contributions to the daily lives of patients and data on their effectiveness in certain indications. However, the extension of their use also raises the question of possible transpositions, these transpositions always having to be the subject of a rigorous methodology regarding the design and evaluation of the envisaged devices. Such an evolution can be discussed for art therapy, especially since digital technology has already established itself in the world of art.

3.1. Digital in the field of art

The birth of digital art is usually linked to an exhibition which took place in London in 1968, “Cybernetic serendipity”, which presented works created by computers.But it was really at the beginning of the 1980s that the question of digital art gained momentum with the appearance of computer- generated images. This new technology is the subject of criticism on the fact that these images have no author, the only author being the computer [10]. The criticism formerly addressed by Delacroix during the advent of photography has also reappeared, the computer- generated image being thus singled out at the end of the as a “copy of is false by dint of being exact”. In the eighties, the reality that appearance of virtual reality saw the criticism of the perfect image shift towards that of a perfect reality, thus polarizing the debate between the refusal of these virtual interfaces and a proselytizing discourse from certain artists welcoming the disappearance of the body in favor of a virtuality freed from all materiality. However, it is in the world of plastic and visual arts that this criticism mainly manifests itself, with synthesized music and computer-calculated music not raising any malicious comments. Ultimately, the debates that emerge at the birth of new technologies are only the extension of the debates that have always fueled the world of art on the relationship between art and science/technology. The first idea of a cosa-mental art put forward by Leonardo da Vinci and takenup by Marcel Duchamp [5] defining the artist as acting according to his whims and his freedom; and the second idea defended by Clément Greenberg [9] of the autonomy of the medium according to which art must look back on the intrinsic qualities of the medium; agree on the idea of freeing art from various supervisions, including science and technology. And what will ultimately contribute to the acceptance of digital technology in art is the decisive observation that digital technology is not a technique but the horizon in which all beings and their expectations have gradually tilted. Added to this idea of a new digital foundation is the idea that the computer is a neuro feedback machine which feedbacks on the technical imagination of the artist and opens up new possibilities ́. These developments thus allow the emergence of new artistic horizons based on interactivity. In 2001, the artist Michel Jaffrenou created a “minimal” digital character (based on artificial intelligence made up of a single neuron) called Diguiden and who could interact directly with spectators. In the field of dance, digital experiments have allowed musician David Rokeby to develop a system called “a very nervous system” which allows a dancer to produce music with his gestures and its movements. Now, it is also possible to create, paint, sculpt, thanks to virtual reality headsets and their associated applications. Some artists therefore offer to immerse visiting spectators in their works using virtual reality headsets, like the artist Fabio Giampetro during his exhibition “Hyperplanes of Simultaneity”. Finally, digital technology makes it possible to offer new means of disseminating art; some museums offer virtual tours and new types of more immersive exhibitions are emerging. Thus, digital technology has reintroduced into art a technicality of a new order, that of automatic information processing.The computer is a hybrid machine which has its own language and whose specificity is to simulate all existing techniques or at least to aspire to them. It is this ability to hybridize techniques that gives digital technology its power of contamination. It moves digital technology from the purely technical level to the aesthetic level. From this point of view, digital technology is transversal to all the already established arts, the boundaries of which it contributes to erasing. However, it is also specific in the sense that it redefines the relationships between the work, the author and the spectator, by modifying forms of production and distribution through interactions.

3.2. Art therapy and digital

Art plays a role of mediator while being the engine of communication and, from this point of view, it is difficult to date the birth of art therapy as the works of patients have since long interested psychiatrists. However, the first formalization of this interest took place through the creation of the International Society of Psychopathology of Expression in 1959. The term “art therapy” composed of the words “art” and “therapy” is not, however, a simple juxtaposition of these terms. If art strives to get closer to an aesthetic ideal, the result of creation does not have such significance in art therapy. Just as the term therapy which relates to the way of treating an illness does not summarize the objective sought by art therapy. Because ultimately, if the definition of art therapy is not easy to formulate, it is important to emphasize that it is through the psychotherapeutic relationship that the art puts itself at the service of care. In art therapy, the work is not simply the projection of the sick patient, what is important in the work is what happens during its construction, which relates to the movement of transfer allowed by the frame. This is why the definition of the framework is fundamental, the therapist being the guarantor of the existence of this therapeutic space and its continuity. Reflection on the possible contributions of digital technology in art therapy cannot then result from the simple combination of the contributions of digital technology in psychiatry and the contributions of digital technology in art, because in fact the framework of intervention prevails in art therapy. However, not addressing the question of the changes to be made with regard to technological developments also raises the question of the continuity of adherence to the framework for new generations.

3.2.1. The new digital generations

The newgenerations can differ from their predecessors by their early access to digital technologies. “Net generation”, “Digital natives”, “Millennials”, these various names have been given to young people since the 1990s. Under these different names can be grouped different specificities, in particular the ease in handling digital technologies and their effects on cognitive functions with a generation described as multitasking. These developments have required adapting certain areas, starting with that of learning which has seen it evolve from traditional linear learning towards interactive learning. In this context, digital technologies have been used to improve communication between teachers and students, with collaborative approaches and sharing of ideas. These genetic developments also concern people suffering from psychological disorders. Studies have shown that, among people suffering from these disorders, those belonging to this new generation have wide access to smartphones and the Internet. Therefore, it is important to ask the question, as was asked in education, of the adaptation of therapeutic frameworks to changes in the sensitivities of these generations. es with digital.

4. Observation of the place of digital technology in art therapy activities at Toulouse University Hospital

The observation that the activities offered in art therapy could bean obstacle to compliance with care for the younger generations arose for us following several treatments during which these young patients had difficulty adhering to the activities offered. Adherence to care is a broad issue in the field of psychiatry; However, the feedback from these patients mainly concerned the media used within the activities. In order to address this question with greater precision, we requested the help of an expert patient, that is to say in our case a patient with Indian knowledge. deniable regarding his pathology but also benefiting from solid knowledge of digital technologies. This expert patient was able to experience the activities offered in art therapy and was able to observe a lack of use of digital technologies within these activities. His proposals for improving activities focused on the implementation of new tools, serious games, fab lab (with 3D printing possibilities), and the contribution of motion gaming and of virtual reality for working on bodily dimensions. These proposals should be contextualized in the request that was made to him, namely to propose avenues for reflection, without worrying about their implementation. They highlight the demand for the integration of digital technology into activities. However, the setting implementing this digital transformation may come up against numerous limits, the first being the cost of its devices, the second being the need for training of teams which are not always familiar with these technologies.

5. Prospects for implementing digital technology in art therapy

It is therefore noted that there are limits to the implementation of new technologies within a healthcare structure. However, these limits seem to be able to be circumvented and the question of the integration of digital technology within activities seems to be able to find certain points of response.Because beyond the purely technical aspects of digital technology, it is, as we have underlined, the changes in relationships with the environment induced by the digital revolution which are important to take into account. . And in art therapy, the fact that the workshop is conceptualized as a transitional area which allows room for play, that through which the patient expresses and constructs himself, and that of pretending constitutes a door input for digital. Thus, certain accessible tools already seem to be able to be integrated into art therapy. Videos shot via smartphones can constitute bases of expression and then give rise to montages with the idea of digital hybridization with musical supports for example, digital supports created Also during activities or imported royalty-free sound bases. Concerning serious games, if some were specifically created for certain psychiatric indications, the use for therapeutic purposes of games marketed for the general public could be shown. This is particularly the case of the game Tetris1 which could be used to work on visuospatial functions. The use of media derived from motion gaming could be an avenue for imagining digitally inspired bodily activities. Obviously, these proposals have exemplary value and the expertise of art therapists remains essential in order to be able to integrate these digital dimensions into their activities while retaining the value of the therapeutic framework. This point of precision leads to discussion of the modifications induced by the digital revolution on this framework in particular. Indeed, in recent years, companies have had to adapt their working frameworks to integrate these new generations. The demand for more collaborative approaches, more autonomy and the fact that this generation gives more importance to intellectual contribution than to any other criterion have modified their relation to work. Obviously, these arrangements cannot be transposed as they are to mental health care activities as it is important to also take into account the modifications induced by the psychopathology of the different disorders. However, it nevertheless seems essential to take these factors into account when developing a therapeutic framework adapted to these new generations. Finally, the contributions of digital technology can also raise the question of the establishment of new means of communication around art therapy. The establishment of MOOCs or virtual exhibitions could allow a wider dissemination of works. Formatting testimonies from patients and caregivers around the creations can also contribute to better knowledge and understanding of psychological disorders on the part of the general public. And the interactive and collaborative dimensions enabled by digital technology are a new force that can be put to the service of the integration of patients with mental disorders within the city by making it possible to better break down boundaries. traditional res between city and hospital. Finally, the immersive dimension linked to virtual reality and which probably requires more financial resources, but the costs of which are likely to evolve in the years to come, could be put to the service of a better representation of psychological disorders. In this register, one example of an immersive experience is the game “Depression Quest1 ” which places the player in the shoes of a young man suffering from depression; with an immersive soundtrack, the player must make choices that modify the rest of the story, while certain options are not available due to the depression the main character is suffering from. Art therapy treats through the creative process which is established within the therapeutic framework and which allows the return of aform of expression, thereby allowing a return of the relationship with oneself, with one's body and with one's emotions. In line with these elements, digital technology has two additional elements. The first is to participate in the uptake of care for new generations at a time when the digital landscape is essential for digital natives. The second is to promote the diffusion of subjectivity, expressed in art therapy, within the city thanks to new media.

6. Conclusion

The contributions of digital technology are numerous and difficult to define and understand. All the more so since this universe is constantly changing. The digital revolution has gradually infiltrated all areas, education, care, art, businesses. However, beyond the purely technical aspects enabled by digital technology, it is important to grasp the more structural changes that it has induced and which push us to revisit our working frameworks. This question has been raised several times by our patients through art therapy activities. The need for digital evolution cannot, however, be addressed by juxtaposing technical solutions with older working bases. And the developments to be built require being able to associate technical advances in digital technology with the theoretical bases of the fields on which it hybridizes so as not to sacrifice substance to simple form.

7.

Discussion with the audience Professor H. Scharbach – This beautiful presentation really interested me. What an evolution between the first grapho-pictorial expression workshops and the digital art therapy workshops with the possibility of creating in 3 D, which marks a remarkable progression! Rapporteur's response – This is indeed a very exciting field of investigation. I would say that the Achilles heel of this field, however, remains the lack of evaluation of the tools proposed. In mental health, those who have used these tools do not always know the theoretical bases of psychopathology. Likewise, professionals competent in the management of psychiatric disorders are not always familiar with digital tools. So that the remarkable progress noted by Professor Scharbach can be best expressed, it is therefore important that the people who develop digital tools and the caregivers increase the number of meeting points. Professor A. Charles-Nicolas – I have two questions, which are perhaps linked: Should we fear that patients will take refuge or are they content with the simplistic diagnostic label, neglecting the complexity of mental functioning, with the risk of an erroneous therapeutic approach? Rapporteur's response – Digital technology has brought profound changes to access to information. All one everyone can now find answers to health questions on the Internet and it is not uncommon for patients to come to a consultation with an idea of their diagnosis. From my point of view, it is a good thing to be able to discuss its elements in our consultations. The problem is that this information can also be a barrier to access to care by conveying false ideas about scientific data. Recently, these excesses have largely contributed to distrust in vaccination. The question raised by Professor Nicolas is therefore essential, because all health-related information must be able to be discussed and criticized if we want it to contribute to improved care, including included in psychiatry. Does the considerable dissemination by these digital tools of confidences about one's pathology promote a de-stigmatization of mental illnesses? Response from the Rapporteur – Here again, a fundamental question which ties in with the previous one. If I take the example of vaccines again, I believe that the reduction in distrust in relation to vaccination was possible thanks to strong political will. The dissemination of clear and easily accessible information via the Ministry of Health and appearing first on Internet search pages has helped combat misconceptions. As far as psychiatry is concerned, from my point of view, digital tools will not be sufficient to ensure the de-stigmatization of pathologies, because the information they convey is sometimes contradictory. I believe that this issue must also be supported by a strong political will to relay clear information to the general public. Professor L. Schmitt – Dr Salles expresses the very large number of applications offered on the market to patients. Can we not envisage that learned societies, such as the Medical-Psychological Society, express an opinion or recommendation on these applications? Rapporteur's response – I think that the evaluation of mental health applications is a dimension highly anticipated by users and public authorities. The fact that experts in the discipline, benefiting from broad knowledge and perspective on scientific data, are looking into this question would be a real opportunity. Such a project can also help create rational intergene emulation and promote bi-directional transmission of knowledge. I am therefore very favorable to this proposal. Dr D. Tesu-Rollier – How useful are applications for a patient in suicidal crisis? Will he talk to his app? Rapporteur's response – Some applications that have been evaluated have shown that patients use them in the event of a crisis. The acceptability of these applications therefore seems to be satisfactory. This acceptability is favored by the fact that certain applications have been co-constructed with patients to best respond to their requests. Regarding the usefulness of these applications, from my point of view it is closely linked to their connection to health professionals and emergency control devices.