Using Mobile Game Application to Teach Children with Autism ...

2014 3rd International Conference on User Science and Engineering (i-USEr)

Using Mobile Game Application to Teach Children with Autism Spectrum Disorder (ASD) Multiple Cues Responding: A Pilot Study Sara Reisi Dehkordi1 and Riaza Mohd Rias2 Universiti Teknologi MARA 40450 Shah Alam, Selangor, Malaysia 1 [email protected], [email protected] Abstract—The ability to respond to concurrent multiple cues is one of the common challenges faced by children with Autism Spectrum Disorders (ASD). This pilot study observed the efficacy of the application tool “Go-Go-Games” (in the iOS platform), which was designed to teach a skill known as multiple cues responding to children with ASD. This study was conducted upon six children with ASD. This research focused on applying the tool on children with ASD to observe the positive effect of the “Go Go Games” application on the selected participants. An observation with the aim to test the students’ response based on the levels achieved in the game was conducted. The results indicated that this application might be an effective technology for helping children with ASD.

researchers indicate that children with ASD do not respond to simultaneous cues from either a single modality or multiple modalities. Pivotal Response Treatment (PRT) is a naturalistic approach to behavioral intervention that is grounded in applied behavior analysis (ABA) method and developmental psychology [5]. This method is scientifically based on the practices of educating autistic children [6] in order to teach children with ASD. This paper looks at an existing mobile game that is readily available in the iOS platform, and observes ASD children’s response to the game to understand their ability to respond to concurrent multiple cues by using touch screen device in therapy sessions.

Keywords-component; computer game, social skills, children with disability

I.

II.

Children with ASD often have “stimulus over selectivity,” which contains failure to use all of the cues in their environment. Children with this limitation have often learned to respond to just one cue interfering with learning new behaviors and generalizing learned behaviors. The PRT strategy addresses five deficit areas [7] which responsiveness to multiple cues is one of them. Reference [8] used individual orienting cues in facilitating responses of nonverbal children to improve their speech. Because an ability to respond to multiple cues significantly enhances learning and generally has positive effects in a number of areas, we define responsively to multiple cues as a pivotal response [9]. PRT occurs in a child’s natural environment (at school or home) and uses everyday activities to teach the child. Over the past decade, the use of technology-based intervention for children with ASD has increased dramatically [1]. Technology, in particular the use of computer software programs, is playing a large part in creating interventions which may help those with autism to learn how to behave in a more socially acceptable manner towards others [10].

INTRODUCTION

Autism spectrum disorder (ASD) is a neurobiological disorder that significantly impairs reciprocal social relations, verbal and nonverbal communication, and behavior of an individual [1]. Children with ASD are more likely than others to respond to small, irrelevant cues, which significantly limit their ability to recognize and generalize more complex stimuli. The signs of autism can be observed in the early years of a child’s life. However, the causes of Autism Spectrum Disorders (ASDs) cannot be detected at that stage of a person’s life. This neurodevelopment condition has frequency of one in 110 children in the USA and one in 625 children in Malaysia [2]. Nowadays, behavioral therapies are normally the treatments for people who are autistic. The most recent development in the evolution of educational and therapeutic programming for children with ASD was an increased interest in technologies for facilitating access to general education core content. Technological interventions allow the user to work at different speeds and locations [3]. The use of technology devices and multimedia increases the interest of participants with ASD, helping them to learn while playing with technology.

Therapeutic computer games are of special interest in the field of autism study, since their rules-based environments presents a safe, appealing vehicle for interventions to improve a person’s level of socialization [11]. Games have evolved in the last decades, and now devices have also evolved from keyboard and mouse to touch screen and mobile gadgets. Several researchers have worked on therapeutic games for

The current results indicate that nearly half the sample (41.4%) of youths with ASD spent most of their free time playing video games [4]. It seems reasonable and helpful to use technology as the third party in therapy sessions. Previous

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RELATED WORK

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2014 3rd International Conference on User Science and Engineering (i-USEr) children with ASD. Using psychological methods in computer games make these games unique and effective for treating autistic children. Reference [12] presented a serious game based on first aid education for individuals with ASD using android mobile devices. The purpose of the game was how to deal with emergency situations in a fun and dynamic way. “cMotion” is another computer game that uses virtual characters to reinforce emotion recognition and logical problem solving to both normally developed children and high-functioning autistic children [13]. “Picaa”, a game proposed by reference [14] in the iOS platform gave positive effects in the development of learning skills for children who have special educational needs. Evaluation results by [14] showed that the basic skills (language, math, environmental awareness, autonomy and social) of these children have improved. Due to the interface and the contents of the activities in “Picaa” which was adapted specifically for individual players, they have the opportunity to perform activities that previously were not accessible to them. Adaptability has been identified as a key design requirement for new technologies in the mental health care field [15]. Learning activities should be challenging, but children should not be penalized for mistakes as they may be using strategies that worked in the past [16]. Using objects, food, and actions as rewards for desired behavior (prompted by a researcher), that this is a way to engage participants to play with technological devices. Using the PRT method to consider the multiple cues responding skill is still new as there are not many published researches in this area [17]. III.

Fig. 1. A picture from “Build-a-train” game

Fig. 2. A picture from “Wheels and Roads” game

ABOUT GO GO GAMES

We consider that the current knowledge about autism acknowledges the development of strategies and tools to consider the multiple cues responding skill, such as the “Go Go Games” software tool analyzed in this study. “Go Go Games” is an application specifically designed to assist the ability to notice and respond to simultaneous multiple cues in early elementary autistic children and/or children with learning difficulties. The goal of this pilot study is to test and evaluate the efficacy of the “Go Go Games” application based on Pivotal Response Treatment in educating children with ASD and participants with autism. A guiding principle of this game was to create games grounded in existing, evidencebased therapies. PRT is a behavioral intervention that targets key, or “pivotal” skills that are known to bring about incidental improvements in other “collateral” areas [18]. IV.

Fig. 3. A picture from “Out Of This World” game

select body parts of a robot to match the other parts of the robot. The movement of the train as a reward between levels can motivate the player to play with the games.

INTERFACE OF THE GAME

V.

There are three different games in “Go Go Games”. In each game, players repeatedly select a correct choice from a pool of options. Fig.1 shows a picture from “Build-a-train” game, a player should match a model train by repeatedly selecting the correct next railroad car from options on the left side of the screen. Fig.2 shows a picture from “Wheels and Roads” game where the player should decide the direction of his vehicles, with each road marked with a sign. Fig.3 shows a picture from “Out Of This World” game where the player should

METHOD

A. Participants and Settings Six children with ASD between the ages 5~8 (5 boys and one girl) participated in this research. Participants were selected from the Hia Ming School for Autism in Selangor, Malaysia, following these criteria: (1) meeting the diagnostic criteria for autism according to the Diagnostic and Statistical Manual of Mental Disorders. Two of them have high-

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2014 3rd International Conference on User Science and Engineering (i-USEr) TABLE I. THE INITIAL RESPONSE OF THE PARTICIPANTS AND STRATEGY WHEN THE CHOICE WAS WRONG

functioning ASD, two with low-functioning ASD and the last two with severe ASD. (2) presenting difficulties in noticing multiple cues simultaneously and an inability to learn basic skills on how to use technological devices. (3) does not have a physical retardation that obstructs the use of educational computer games. The participants’ parents were informed about the procedure of our pilot study, and they signed a consent form. In the following paragraphs, we describe the results of the research and the reaction showed by the participant towards “Go Go Games”.

Child A

Initial response to cue

Child B

B. Materials During the pilot study period in the school 2 iOS devices (with 3.5“ and 10“ screen touch screen sensitive to finger touch) were used. The teacher and the child sat together and the child was given full control of the smart-phone (Fig 4).

Child D

Child C

C. Procedure Before beginning the pilot study, teachers of the participants were given an instruction of the use of the “Go Go Games” application. The teacher had to be given detailed instruction to help the participant adapt to the new soundings. Some of these children feel intimidated with the new things. Therefore, they need their teacher`s support to help them with this new game. In the first phase of this pilot study, we asked the teacher of the participants to complete a questionnaire that included questions about the difficulties faced by participants with ASD. Then, when the study began the teachers took some notes and also wrote the initial reaction to the game from each student. This experiment required us to visit the school a few times in a span of a week (6 sessions in total). Even though a specific time frame was not given, each child played with the game for approximately 15 to 20 minutes on each visit.

Child F

Child E

D. Instruments The measurement instrument used for this study is an evaluation notes from teachers for different levels of the game. The teacher of each student wrote an evaluation note during the use of the mobile game on each session by observing the student.

Fig. 4. One of the participants playing the “Wheels and Roads” game

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Strategy when error occurs

She was interested in the game to see the rewards. She tried only one choice but after 2 or 3 times, she understood the choice is wrong and she tried other options.

After 2 or 3 times she tried other options. When she was sure about one choice that is wrong she didn’t try that particular choice again.

His first response was to try the nearest option rather than trying to find the correct choice by paying attention to the cues. He was very good in understanding the rule of the game but tried only one option every time.

He tried only one-option over and over again; he didn’t try to test other choices for 4 sessions. His teacher helped him to pass to the next level and after 4 sessions he became familiar with the cues and options.

For the first session, the rule of the game was difficult for him to understand and follow. In the simple levels, he could play the game easily. However, he became confused in the difficult levels and tried options by chance.

He couldn’t play the game on difficult levels but only on simple levels as he could match the choice with cues after at least 4 times of trials. In simple levels his teacher should show him the cues and direct his attention to the correct cue.

He enjoyed playing the game especially the dragging items part but tried the options by chance to see the rewards. He has no attention to cues and in some cases he tried only one choice that is nearer to him than other choices.

After 3 times on each level that he couldn’t see the reward he tried to drag other items. On each level he tried one option at least 4 times.

He was not interested in mobile or iPad devices at first. After 2 sessions he became interested in the game but only dragged and dropped the options randomly.

After 2 sessions, he became interested in the rewards and tried to pay attention to cues to pass the level and see the rewards, when he couldn’t pass the levels he took his teacher’s finger to help him and show him the cues.

For the first 5 minutes of each session he enjoyed dragging all the choices but after his teacher passed first levels he became interested in the rewards and tried to match the choices.

He didn’t realize when his choice was wrong but he tried other options when he couldn’t see the reward, which was the moving train. He waited for his teacher to show him the correct cue and he continued the game based on the cue.

2014 3rd International Conference on User Science and Engineering (i-USEr) VI.

ANALYSIS

autism as they teach them new skills. In our experiment, we found that the game (Go Go Games) helped the children to match their abilities with the levels in the game. This study is a part of a large study, which consists of several pilot studies. The findings show this study had indicated some positive implications provide multiple cues of improved social skills among ASD children.

The following Table I shows the initial response of the participants to choices and their strategy when their choice was wrong during six sessions. The information in Table I come from notes that teachers wrote during each session. All six participants showed some level of improvement in playing and responses to cues when “Go Go Games” was introduced, although the level of improvement varied depending on the target behaviors.

ACKNOWLEDGMENT The authors would like to thank the Ministry of Education, Universiti Teknologi MARA (UiTM) and the Research Acculturation Collaboration Effort (600-RM/RACE 16/6/2(1/2012)) for sponsoring a part of this research.

VII. DISCUSSION In relation to the behavior displayed by the children while actively being engaged with “Go Go Games”, we focused the analysis on two parameters. The first parameter focuses the moment when the child has to respond to cues and the second moment occurs when the child cannot find the correct answer and he has to try other options. This is to understand their needs and preferences in learning. These findings are presented in Table I together with the result of evaluation of each child. This research suggests that the emerging technology enables children with ASD to take advantage of this development in a safe and secure environment instead of attending psychological treatment sessions. For the first minutes of the sessions, five participants out of six were not interested in the game; their teachers helped them to play the game for a few minutes before they became engaged with the game and understood the rules of each game. They were interested in cars and vehicles and the train in the game as a reward encouraged them to play the game. During the first session, the rules of the game was difficult for our participants to grasp but gradually their teachers helped them to understand the rules and after 3 sessions they made improvement with regards to their responses towards cues even on the difficult levels. After 6 sessions all of the participants could match the choices with cues in simple levels easily, while 3 of them had to try at least 4 times in difficult levels to match the choices, they were confident with the game and were engaged to pass the simple levels and face with more challenges. These results indicate that “Go Go Games” on iOS platform can produce improvements in the multiple cue responding skills of autistic children. As a treatment for responses to concurrent multiple cues, the “Go Go Games” application has advantages for children with ASD and is suitable for home and school use. VIII.

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FUTURE WORK AND CONCLUSION

The initial success of this experiment will help us to design and develop a game for children with ASD by using touch screen devices. We have planned to extend our research further by including suitable components and simple rules to engage with these special children. The concept of rewards will be a focal point in the research. We also plan to experiment with more children and for a longer period of time. Children with autism will have to live with their limitations and problems, as there is no found cure for them. Computer games have been proven to be helpful to help children with

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