One company, Floreo, is hoping their tools will lead the way, despite some criticisms from autism self-advocates.This article is part of Upstart, a series on young companies harnessing new science and technology.Vijay Ravindran has always been fascinated with technology. At Amazon, he oversaw the team that built and started Amazon Prime. Later, he joined the Washington Post as chief digital officer, where he advised Donald E. Graham on the sale of the newspaper to his former boss, Jeff Bezos, in 2013.By late 2015, Mr. Ravindran was winding down his time at the renamed Graham Holdings Company. But his primary focus was his son, who was then 6 years old and undergoing therapy for autism.“Then an amazing thing happened,” Mr. Ravindran said.Mr. Ravindran was noodling around with a virtual reality headset when his son asked to try it out. After spending 30 minutes using the headset in Google Street View, the child went to his playroom and started acting out what he had done in virtual reality.“It was one of the first times I’d seen him do pretend play like that,” Mr. Ravindran said. “It ended up being a light bulb moment.”Like many autistic children, Mr. Ravindran’s son struggled with pretend play and other social skills. His son’s ability to translate his virtual reality experience to the real world sparked an idea. A year later, Mr. Ravindran started a company called Floreo, which is developing virtual reality lessons designed to help behavioral therapists, speech therapists, special educators and parents who work with autistic children.Mr. Ravindran adjusts his son’s VR headset between lessons. “It was one of the first times I’d seen him do pretend play like that,” Mr. Ravindran said of the time when his son used Google Street View through a headset, then went into his playroom and acted out what he had experienced in VR. “It ended up being a light bulb moment.”Valerie Plesch for The New York TimesThe idea of using virtual reality to help autistic people has been around for some time, but Mr. Ravindran said the widespread availability of commercial virtual reality headsets since 2015 had enabled research and commercial deployment at much larger scale. Floreo has developed almost 200 virtual reality lessons that are designed to help children build social skills and train for real world experiences like crossing the street or choosing where to sit in the school cafeteria.Last year, as the pandemic exploded demand for telehealth and remote learning services, the company delivered 17,000 lessons to customers in the United States. Experts in autism believe the company’s flexible platform could go global in the near future.That’s because the demand for behavioral and speech therapy as well as other forms of intervention to address autism is so vast. Getting a diagnosis for autism can take months — crucial time in a child’s development when therapeutic intervention can be vital. And such therapy can be costly and require enormous investments of time and resources by parents.The Floreo system requires an iPhone (version 7 or later) and a V.R. headset (a low-end model costs as little as $15 to $30), as well as an iPad, which can be used by a parent, teacher or coach in-person or remotely. The cost of the program is roughly $50 per month. (Floreo is currently working to enable insurance reimbursement, and has received Medicaid approval in four states.)A child dons the headset and navigates the virtual reality lesson, while the coach — who can be a parent, teacher, therapist, counselor or personal aide — monitors and interacts with the child through the iPad.The lessons cover a wide range of situations, such as visiting the aquarium or going to the grocery store. Many of the lessons involve teaching autistic children, who may struggle to interpret nonverbal cues, to interpret body language.Mr. Ravindran’s son raises his hand to answer a question about world geography in a virtual classroom while his father looks on via his iPad. Valerie Plesch for The New York TimesFloreo lessons are designed to help autistic children build social skills and train for real world experiences like going to the grocery store. Valerie Plesch for The New York TimesAutistic self-advocates note that behavioral therapy to treat autism is controversial among those with autism, arguing that it is not a disease to be cured and that therapy is often imposed on autistic children by their non-autistic parents or guardians. Behavioral therapy, they say, can harm or punish children for behaviors such as fidgeting. They argue that rather than conditioning autistic people to act like neurotypical individuals, society should be more welcoming of them and their different manner of experiencing the world.“A lot of the mismatch between autistic people and society is not the fault of autistic people, but the fault of society,” said Zoe Gross, the director of advocacy at the Autistic Self Advocacy Network. “People should be taught to interact with people who have different kinds of disabilities.”Mr. Ravindran said Floreo respected all voices in the autistic community, where needs are diverse. He noted that while Floreo was used by many behavioral health providers, it had been deployed in a variety of contexts, including at schools and in the home.“The Floreo system is designed to be positive and fun, while creating positive reinforcement to help build skills that help acclimate to the real world,” Mr. Ravindran said.In 2017, Floreo secured a $2 million fast track grant from the National Institutes of Health. The company is first testing whether autistic children will tolerate headsets, then conducting a randomized control trial to test the method’s usefulness in helping autistic people interact with the police.Early results have been promising: According to a study published in the Autism Research journal (Mr. Ravindran was one of the authors), 98 percent of the children completed their lessons, quelling concerns about autistic children with sensory sensitivities being resistant to the headsets.Ms. Gross said she saw potential in virtual reality lessons that helped people rehearse unfamiliar situations, such as Floreo’s lesson on crossing the street. “There are parts of Floreo to get really excited about: the airport walk through, or trick or treating — a social story for something that doesn’t happen as frequently in someone’s life,” she said, adding that she would like to see a lesson for medical procedures.However, she questioned a general emphasis by the behavioral therapy industry on using emerging technologies to teach autistic people social skills. A second randomized control trial using telehealth, conducted by Floreo using another N.I.H. grant, is underway, in hopes of showing that Floreo’s approach is as effective as in-person coaching.But it was those early successes that convinced Mr. Ravindran to commit fully to the project.“There were just a lot of really excited people.,” he said. “When I started showing families what we had developed, people would just give me a big hug. They would start crying that there was someone working on such a high-tech solution for their kids.”Clinicians who have used the Floreo system say the virtual reality environment makes it easier for children to focus on the skill being taught in the lessons, unlike in the real world where they might be overwhelmed by sensory stimuli.Celebrate the Children, a nonprofit private school in Denville, N.J., for children with autism and related challenges, hosted one of the early pilots for Floreo; Monica Osgood, the school’s co-founder and executive director, said the school had continued to use the system.“When I started showing families what we had developed, people would just give me a big hug,” said Mr. Ravindran.Valerie Plesch for The New York TimesShe said putting on the virtual headset could be very empowering for students, because they were able to control their environment with slight movements of their head. “Virtual reality is certainly something that is a real gift for our students that we will continue to use,” she said.Kelly Rainey, a special instruction manager with the Cuyahoga County Board of Developmental Disabilities in Ohio, said her organization had used Floreo over the past year to help students with life and social skills. Her colleague Holly Winterstein, an early childhood intervention specialist, said the tools were more effective than the conversation cards typically used by therapists. The office started out with two headsets but quickly purchased equipment for each of its eight staff members.“I do see infinite possibilities,” Ms. Winterstein said.“Social skills from Floreo are sticking,” said Michea Rahman, a speech language pathologist who focuses on underserved populations in Houston (and a Floreo customer). The system “is probably one of the best or the best social skills tool I have ever worked with.” (She added that 85 percent of her patients are Medicaid-based.)To date, the company has raised roughly $6 million. Investors include LifeForce Capital, a venture capital firm focusing on health care software, and the Autism Impact Fund, an early-stage venture capital fund that invests in companies addressing neurological conditions. (Mr. Ravindran declined to specify if the company was profitable.)For Mr. Ravindran, the company has become a mission. “When I started exploring virtual reality as a therapy modality, I didn’t know if it was a hobby project, or if it was going to be a business that I put a little bit of money behind, hired some people, then went off to do something else,” he said. “At some point, I got to this place where if felt, if I don’t build it, no one would.”

Ravindra Gupta, who led the efforts that resulted in the second case of a patient being cured of H.I.V., was drawn into pandemic research.Visionaries is a limited series that looks at figures who are trying to transform the way we live.Ravindra Gupta had studied drug-resistant H.I.V. for more than a decade when he first encountered Adam Castillejo, who would become known as the “London patient,” the second person in the world to be cured of H.I.V. Dr. Gupta, who goes by Ravi, was a professor at University College London straddling the clinical and academic worlds when Mr. Castillejo presented as both H.I.V.-positive and with relapsed lymphoma, after a previous transplant using healthy stem cells from Mr. Castillejo’s own body had failed.Building on work by the German hematologist Gero Hütter and others that went into curing the first person of H.I.V. — Timothy Ray Brown, known as the “Berlin patient” — Dr. Gupta and his colleagues proposed using stem cells from a donor with a rare genetic mutation that prevents certain individuals from being infected with H.I.V. Mr. Castillejo agreed and had his transplant in 2016. Seventeen months later, Dr. Gupta and his team took Mr. Castillejo off the antiretroviral drugs that kept his H.I.V. at bay. In 2019, three years after the transplant, Dr. Gupta published the results in Nature, confirming Mr. Castillejo was cured of H.I.V.The news shook the scientific world and revitalized the search for a cure. Dr. Gupta was hired as a professor of clinical microbiology at Cambridge and established Gupta Lab on the school’s biomedical campus to continue his research.A few months later, the coronavirus pandemic hit — and with nations going into lockdown and medical systems taxed to their breaking point, he found himself drawn into the response.“Respiratory viruses were never anything I would consider getting into. I didn’t think we had the skills or expertise to be useful,” Dr. Gupta said recently. But, he added, “the clinical interface of what I do dragged me into working on SARS. Things got bad here in March, and everything shut down. One of the desperate needs was identified as rapid testing.”Soon his team had completely pivoted and was publishing some of the first research validating rapid and antibody tests for the coronavirus using techniques honed during H.I.V. research. Over the past two and a half years, Gupta Lab has cranked out cutting-edge research, describing how new variants arise and providing some of the first evidence that breakthrough Covid infections were possible in vaccinated individuals.At his lab at Cambridge, he discussed both the remarkable strides made by scientists over the past three years, as well as the consequences of the public’s diminishing trust in scientific knowledge.This interview has been condensed and edited.How has earlier research on AIDS/H.I.V. affected the response to the coronavirus?Dr. Gupta in his office. “Strides have been made in H.I.V. over about 20 years,” he said. “That happened very quickly for Covid. And in the absence of a vaccine and mRNA technology, we would be in a much darker place.”Mary Turner for The New York TimesThe response to SARS-CoV-2 has accelerated largely because of H.I.V. advances. There have been huge advances in how we make drugs, target viruses, and a lot of this technology has been honed on H.I.V.What are the similarities between these two pandemics?Both have created a huge panic, SARS-CoV-2 more than H.I.V. — for good reason, because it is respiratory. Certain people are more vulnerable than others, and socioeconomics certainly matters. Also, in this age of availability of vaccines, the rich versus poor, global north versus global south — all of those inequalities have been coming through.Has this global emergency improved your ability to work with your colleagues across various disciplines?It’s certainly galvanized a load of interactions we otherwise wouldn’t have done. We got interested in immunology, we did some very cutting-edge work with colleagues downstairs and in different parts of the building. We started using stem cells to make artificial lungs to do experiments in. All of these things started happening as a result of the emergency. People who we would have never talked to, ideas we would have never had. So it’s really been exciting scientifically.Does fatigue account for the public’s waning response to Covid?Yeah, I think so. I think the intensity has caused a burnout of emotional energy. Of course strides have been made in H.I.V. over about 20 years. That happened very quickly for Covid. And in the absence of a vaccine and mRNA technology, we would be in a much darker place.Across society we are seeing a decline in trust in institutions, but in your field there are rather severe consequences to people refusing to get a vaccine, for example. Has that affected the way you think scientists and the medical establishment must communicate with the public?I think there’s a general lack of trust between the public and people who provide information. That’s partly driven by sectors of the public spreading misinformation. I think the actual communication was quite good in the beginning — you got clear messages and I think it was quite good. Public health messaging has gotten more complex because no one wants to wear masks.For example, after vaccination, people thought we’d be mask-free. We published a paper in Nature on breakthrough infections and the C.D.C. the next week cited our work as a reason to mask, even with the vaccine. Which sounds normal now, but back then it drove people crazy. But it was the right thing because your responses after a few months could wane, and plenty of people with double-dose vaccinations can end up with re-infections the second time around. So that all contributed to confusion based on lack of education or knowledge of nuance. And one thing we have to deal with now is that communication takes nuance that even scientists can’t grasp. So expecting the public to grasp this is pretty much impossible. So we’re at a crossroads for how we communicate complex messages.Are there long-term implications if we can’t persuade a larger proportion of the population to be vaccinated?Circulation may take off in places like China, where the population has been relatively naïve when it comes to vaccines, and the vaccines aren’t necessarily the best ones. And if people don’t get their boosters on time, we may end up reaching a period when it becomes another major health problem of the magnitude we have already seen. I can foresee in a few years’ time we may be in trouble again. The worrying thing is that we are winding down a lot of things we developed to deal with this.