GOLIAH (Gaming Open Library for Intervention in Autism at Home): a 6-month single blind matched controlled exploratory study

BackgroundTo meet the required hours of intensive intervention for treating children with autism spectrum disorder (ASD), we developed an automated serious gaming platform (11 games) to deliver intervention at home (GOLIAH) by mapping the imitation and joint attention (JA) subset of age-adapted stimuli from the Early Start Denver Model (ESDM) intervention. Here, we report the results of a 6-month matched controlled exploratory study.MethodsFrom two specialized clinics, we included 14 children (age range 5–8 years) with ASD and 10 controls matched for gender, age, sites, and treatment as usual (TAU). Participants from the experimental group received in addition to TAU four 30-min sessions with GOLIAH per week at home and one at hospital for 6 months. Statistics were performed using Linear Mixed Models.ResultsChildren and parents participated in 40% of the planned sessions. They were able to use the 11 games, and participants trained with GOLIAH improved time to perform the task in most JA games and imitation scores in most imitation games. GOLIAH intervention did not affect Parental Stress Index scores. At end-point, we found in both groups a significant improvement for Autism Diagnostic Observation Schedule scores, Vineland socialization score, Parental Stress Index total score, and Child Behavior Checklist internalizing, externalizing and total problems. However, we found no significant change for by time × group interaction.ConclusionsDespite the lack of superiority of TAU + GOLIAH versus TAU, the results are interesting both in terms of changes by using the gaming platform and lack of parental stress increase. A large randomized controlled trial with younger participants (who are the core target of ESDM model) is now discussed. This should be facilitated by computing GOLIAH for a web platform.Trial registration Clinicaltrials.gov NCT0256041

EnCity:A serious game for empowering young people with Down's syndrome

Down’s syndrome (also known as trisomy 21) is a genetic disorder caused by the presence of a third copy of chromosome 21 in a baby’s cell. With education and proper care the quality of life of these people can be improved, and with the right support people with Down’s syndrome can have an active role in the community. In this paper we examine how a virtual reality serious game, the EnCity game, could engage and encourage young people with Down’s syndrome to have a more active involvement in the community. Players should complete mini games related to everyday tasks (e.g. preparing a meal, shopping in the supermarket, paying a bill, buying a ticket to visit a museum or gallery), and through these mini-games players will gain the appropriate training and encouragement for leading their lives without requiring help from their families or social services

Assistive Technology to Improve Collaboration in Children with ASD: State-of-the-Art and Future Challenges in the Smart Products Sector

Within the field of products for autism spectrum disorder, one of the main research areas is focused on the development of assistive technology. Mid and high-tech products integrate interactive and smart functions with multisensory reinforcements, making the user experience more intuitive, adaptable, and dynamic. These products have a very significant impact on improving the skills of children with autism, including collaboration and social skills, which are essential for the integration of these children into society and, therefore, their well-being. This work carried out an exhaustive analysis of the scientific literature, as well as market research and trends, and patent analysis to explore the state-of-the-art of assistive technology and smart products for children with ASD, specifically those aimed at improving social and communication skills. The results show a reduced availability of products that act as facilitators of the special needs of children with ASD, which is even more evident for products aimed at improving collaboration skills. Products that allow the participation of several users simultaneously through multi-user interfaces are required. On top of this, the trend toward virtual environments is leading to a loss of material aspects in the design that are essential for the development of these children

GOLIAH: A Gaming Platform for Home-Based Intervention in Autism – Principles and Design

Meeting the required intensive intervention hour for treating children with autism is challenging in terms of trained manpower needed and costs. Advances in Information Communication Technology and computer gaming may help in this respect by creating a nomadically deployable closed loop intervention system involving the child and active participation of parents and therapists.An automated serious gaming platform enabling intensive intervention in nomadic settings has been developed by mapping two pivotal skills in autism spectrum disorder: Imitation and Joint Attention (JA). Eleven games – seven Imitation and four JA – were derived from the Early Start Denver Model. The games involved application of visual and audio stimuli with multiple difficulty levels and a wide variety of tasks and actions pertaining to the Imitation and JA. The platform runs on mobile devices and allows the therapist to (1) characterize the child’s initial difficulties/strengths, ensuring tailored and adapted intervention by choosing appropriate games and (2) investigate and track the temporal evolution of the child’s progress through a set of automatically extracted quantitative performance metrics. The platform allows the therapist to change the game or its difficulty levels during the intervention depending on the child’s progress. Performance of the platform was assessed in a 3-month open trial with 10 children with autism. The children and the parents participated in 80% of the sessions both at home (77.5%) and at hospital (90%). All children went through all games but, given the diversity of the games and the heterogeneity of children profiles and abilities, for a given game the number of sessions dedicated to the game varied and could be tailored through automatic scoring. Parents (N = 10) highlighted enhancement in the child’s concentration, flexibility and self-esteem in 78%, 89% and 44% of the cases respectively and 56% observed an enhanced parents-child relationship. This pilot study shows the feasibility of using the developed gaming platform for home-based intensive intervention. However, the overall capability of the platform in delivering intervention needs to be assessed in a bigger open trial

XR, music and neurodiversity: design and application of new mixed reality technologies that facilitate musical intervention for children with autism spectrum conditions

This thesis, accompanied by the practice outputs,investigates sensory integration, social interaction and creativity through a newly developed VR-musical interface designed exclusively for children with a high-functioning autism spectrum condition (ASC).The results aim to contribute to the limited expanse of literature and research surrounding Virtual Reality (VR) musical interventions and Immersive Virtual Environments (IVEs) designed to support individuals with neurodevelopmental conditions. The author has developed bespoke hardware, software and a new methodology to conduct field investigations. These outputs include a Virtual Immersive Musical Reality Intervention (ViMRI) protocol, a Supplemental Personalised, immersive Musical Experience(SPiME) programme, the Assisted Real-time Three-dimensional Immersive Musical Intervention System’ (ARTIMIS) and a bespoke (and fully configurable) ‘Creative immersive interactive Musical Software’ application (CiiMS). The outputs are each implemented within a series of institutional investigations of 18 autistic child participants. Four groups are evaluated using newly developed virtual assessment and scoring mechanisms devised exclusively from long-established rating scales. Key quantitative indicators from the datasets demonstrate consistent findings and significant improvements for individual preferences (likes), fear reduction efficacy, and social interaction. Six individual case studies present positive qualitative results demonstrating improved decision-making and sensorimotor processing. The preliminary research trials further indicate that using this virtual-reality music technology system and newly developed protocols produces notable improvements for participants with an ASC. More significantly, there is evidence that the supplemental technology facilitates a reduction in psychological anxiety and improvements in dexterity. The virtual music composition and improvisation system presented here require further extensive testing in different spheres for proof of concept

Reflections on the role of the ‘users’: challenges in a multi-disciplinary context of learner-centred design for children on the autism spectrum

Technology design in the field of human–computer interaction has developed a continuum of participatory research methods, closely mirroring methodological approaches and epistemological discussions in other fields. This paper positions such approaches as examples of inclusive research (to varying degrees) within education, and illustrates the complexity of navigating and involving different user groups in the context of multi-disciplinary research projects. We illustrate this complexity with examples from our recent work, involving children on the autism spectrum and their teachers. Both groups were involved in learner-centred design processes to develop technologies to support social conversation and collaboration. We conceptualize this complexity as a triple-decker ‘sandwich’ representing Theory, Technologies and Thoughts and argue that all three layers need to be appropriately aligned for a good quality ‘product’ or outcome. However, the challenge lies in navigating and negotiating all three layers at the same time, including the views and experiences of the learners. We question the extent to which it may be possible to combine co-operative, empowering approaches to participatory design with an outcome-focused agenda that seeks to develop a robust learning technology for use in real classrooms

An investigation into the efficacy of a game-based learning tool to assist school children with an autistic spectrum condition to overcome sensory difficulties

This thesis discussesan investigation that has explored the efficacy of a game-based learning intervention designed to assist children with an autistic spectrum disorder overcome sensory dysfunctions. The aim of the study is to verify, through examining past research and solutions, that there is an existing need for coping strategies to address sensory dysfunction. The investigation aims to corroborate the background research by creating an intervention generated by participants on the autistic spectrum, their family and education support network that fulfils a need to minimise sensory distress. The overall purpose of the study is to show that a game based intervention catering to sensory dysfunction can be a successful application as a learning tool. The design-based research methodology used reflected the game based and participatory process which drive the intervention‟s development. The data provided by the participants was instrumental in enabling a design to be made that ostensibly met the needs of its users based on the information disclosed. Discussion takes place of the challenges that affected the investigation and how the direction of the study was steered as a result of the data acquired and adjustments that were made. The findings allowed a number of conclusions to be reached and the last chapter reflects on how the background research contributed towards the results and how the design of the development was affected as a result. The final chapter deliberates on the autistic diagnostic process, the place that sensory dysfunction takes within this procedure and how the investigation highlights the need for more consideration to be given to sensory behaviours within this process. The thesis concludes with possible answers to the research question, accompanied by an explanation of the reasons for the outcomes. Finally, contemplation is given to the findingsand how the study could benefit from further research

Increasing physical activity for individuals with intellectual disability through indoor bike cycling and exergaming

Studies reveal that individuals with intellectual disabilities have more sedentary lifestyles than the general population. Regular physical activity is of both medical and social importance, reducing risks of cardiovascular diseases and obesity. Health organizations recommend that everyone should at least engage in 150 minutes of physical activity each week because of the beneficial health effects. There exist several technical solutions that aim to encourage physical activity. Among these solutions are exergames, where the users must move their body to control game-objects. The idea behind exergames is that a user needs to engage in physical activity in order to play the video game. The point is that it should motivate the user to perform physical activity. Exergames comes in several forms and types on the market today. However, most of them are not user-friendly for individuals with intellectual disabilities. The video-game designs do not adapt to the many challenges that are present for this group. In this project we developed hardware and software modules to record the amount of physical activity on an indoor stationary bicycle and an ergometer bike. An app receives the recorded activity data and uses it to display entertainment for the user, which makes the app an exergame. The design and development process uses knowledge about individuals with intellectual disabilities to customize the system for this group. Information about individuals with intellectual disability has been gathered through literature searches, conferring with experts, talking with parents of children with intellectual disability, and staff working at institutions providing services for individuals with intellectual disabilities. The system is tested at an institution where several individuals with an intellectual disability could try it out. Feedback from testing indicates that the users with an intellectual disability enjoyed using the system, and it was a useful tool for the staff to promote physical activity for the users at the institution. Testing also gave valuable information on what should be included in the further development of the system to improve it. This project has shown that with close user interaction during the development, it is possible to create promising technical solutions for individuals with intellectual disability. The results of this project provide valuable information on beneficial technological interventions for individuals with intellectual disabilities to promote regular physical activity

Computers as an environment for facilitating social interaction in children with autistic spectrum disorders

Autism is a developmental condition that affects communication, imagination and social interaction. Of these three impairments, it is the last which has the greatest negative impact on the life of children with autism and their families. Different intervention programs have attempted to address social interaction difficulties but there is clearly a need for a school-based program that helps develop social interaction and promote social skills within educationally 'natural' settings.Teachers, parents and researchers widely believe that children with autism enjoy using computers and in most western countries, most children with autism have access to them at home or at school. Drawing from communication theory, this thesis explores the hypothesis that computers can provide a motivating, real-life environment in which social interaction in children with autism can be facilitated.In a series of staged studies, the ways in which computers might be used to facilitate social interaction are investigated. The first phase established the level of access to computers that children with autism typically now have and how educators currently use computers with this group of children. The experience of those working in non-school based programmes aimed at developing social interaction in children with autism was also explored. It was also necessary to explore any inherent constraints on the development of software specifically aimed at children with autism.Having established available resources and constraints, the thesis then explored the social behaviours of children with autism within a computer-based environment, using play-based activities. In a number of interlinking studies, differences and similarities in social interactions were explored when i) working on a paper-based versus computer-based version of the same two player game, ii) playing the same game at the computer, either against a partner or alone, and iii) working with a partner on a series of graded, computer-based jigsaw puzzles, with the partner acting either as a collaborator or competitor.The findings presented illustrate the potential for eliciting increased social interaction in children with autism when working alongside other with computers, and suggest the possibility that time spent with computers by children with autism may help them to gravitate from a solitary activity towards a social one. The relevance of the findings of these studies to practice are discussed and the need for further studies highlighted