A new video game fosters more social initiation for those with ASD

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Narcís Parés, a member of the Cognitive Media Technologies research group of the Department of Information and Communication Technologies (DTIC) at UPF, is working on a research line known as “full-body interaction”.

At his laboratory, he designs different applications based on such interaction in order to study the mediation of experiences.

In conjunction with Hospital Sant Joan de Déu, he created Pico’s Adventure, a videogame based on full-body interaction that encourages social communication among participants.

The videogame seeks to facilitate the social interaction of children with autism by means of a series of fun, collaborative experiences.

As Parés explains, “the first experimental studies proved effective as a complement to conventional therapies”.

“Since then, Pico’s Adventure has become an important benchmark in the search for ICT-based tools to promote social interaction conduct in children with ASD”.

In a recent study, published in the advanced online edition of Research in Autism Spectrum Disorders, a group of 15 four to six-year-olds diagnosed with ASD participated in four sessions in which they played with the Pico’s Adventure video game and with other types of game.

The research was led by Narcís Parés in collaboration with researchers from Hospital de Sant Joan de Déu and Mutua Terrassa, who have studied the participants’ behaviour according to an observational scale.

This is a screen shot of the game

Screenshot of the videogame Pico’s Adventure, level 3 The image is credited to UPF.

This observational research sought to study social initiation conducts using a full-body interaction videogame compared to the number of social interaction conducts occurring during a free-play activity in children with ASD.

“In this case, we refer by free-play to playing with toys (push-chairs, dolls, balls, etc.), alone or with a partner, without any guidance or rules”, Parés explains.

The authors posited that the videogame could elicit a higher number of social conducts and, therefore, this technology could be proposed as a tool to promote social initiation skills.

The videogame has also proved to be more effective at reducing repetitive conducts and improve the children’s gestural expression.

The results have shown that the videogame fosters more social initiation than free-play, in children with ASD when they played alone or in pairs.

Moreover, when the child played with its parents, the videogame proved to be as effective as free-play in promoting social initiation.

The videogame has also proved to be more effective at reducing repetitive conducts and improve the children’s gestural expression.

Videogames could be considered as being a suitable tool to foster social behaviour as well as being useful as a complement to traditional treatments, but “future work is needed in order to obtain further data that support this hypothesis”, the researcher add.


Assessing the existence and severity of ASD symptoms in children is difficult and often requires a lengthy interview with the parents, multiple interactions with the child, and sometimes even a visit to observe the child in the kindergarten.

While clinical assessments can include structured tests such as the autism diagnostic observation schedule (ADOS)1 and the autism diagnostic interview – revised (ADI-R)2, these clinical evaluations are mostly focused on determining whether a diagnosis is warranted or not, and offer relatively limited quantitative information regarding the severity of specific symptoms.

For example, the DSM-5 allows clinicians to define the severity of the condition on a scale of 1–3 according to the support that the child will require3.

Similarly, the ADOS-2 offers comparison scores that estimate the severity of the condition on a scale of 1–104. These scales have a limited range and combine a variety of behaviors and symptoms into a single score.

This means that ASD children with different symptoms and severities can end up with an identical score, thereby undermining the ability of existing clinical tests to quantify specific ASD symptoms and measure how they change over time, and in response to treatment.

Developing objective, quantitative, and sensitive measures for specific ASD symptoms is extremely important for several reasons.

First, ASD is a remarkably heterogeneous condition in terms of its phenotype5, genotype6, and hypothesized underlying mechanisms7.

Quantitative measures of specific ASD symptoms are, therefore, critical for identifying ASD sub-groups with distinct phenotypes. Second, determining the efficacy of existing and novel treatments requires the availability of sensitive quantitative measures that can assess change over time and determine the impact of each treatment on specific symptoms.

Third, quantitative measures of specific symptoms may be useful for early detection (or risk assessment) of specific sub-types of ASD, even before the condition can be diagnosed by conventional means. Note that developing such measures for young children with ASD is likely to have the largest clinical impact given the flexibility of early development8 and the efficacy of early ASD interventions9.

Previous attempts to quantify core social symptoms in children with ASD have mostly used manual coding of live or video-taped observations, or utilized parental questionnaires. For example, studies have used observations of children in their natural habitat (i.e., kindergarten) to manually code the number and duration of social interactions10.

Others have coded the amount of eye contact, tendency to smile, and general social activity11. Such studies often report that children with ASD tend to spend less time engaged in social interactions1214, initiate fewer social encounters12, and exhibit poorer quality of social interaction10 when compared to typically developing children. In parallel, studies have reported that children with ASD exhibit lower scores on a variety of parent or teacher questionnaires that estimate social behaviors and preferences15,16. While such quantification is very useful, manual scoring and questionnaires are subjective and time consuming. This limits their reliability across sites and applicability in large-scale longitudinal studies or clinical routines.

A promising alternative for manual coding is automated coding using motion-tracking technologies, which can track the movements of multiple individuals simultaneously and quantify their interactions.

Such technology has been used extensively in the study of social interactions in animals17, enabling large studies of fruit flies18 and mice19, including mouse models of ASD20. Similar approaches have been used to study human behavior in adults21, and even to identify repetitive movements in older children with ASD22 or typically developing adults mimicking such movements23. However, to the best of our knowledge this technology has not been used so far to study social interactions in children or to assess the severity of social symptoms in ASD children.

In the current study we utilized a marker-free motion-capture system, that integrated information from four synchronized Microsoft Kinect sensors. We analyzed the ADOS assessments of 44 children who were referred to the Negev Autism Center with a suspicion of ASD. Most of the ADOS assessment is conducted with the child and clinician seated next to a table so that the child can focus on completing specific tasks.

However, every ADOS session also includes a 5–10-minute period called “free play” where the child is encouraged to leave their seat and freely explore their surroundings. This segment of the ADOS was used when quantifying the social behavior of each participating child with the motion capture system. We quantified several basic measures of social interaction, which included the distance between the child and the clinician, the relative amount of movement that the child made towards (i.e., approach) or away (i.e., avoid) from the clinician, and the amount of time that the child faced the clinician.

These measures explained ~30% of the variability in ADOS scores across children. It is remarkable that quantification of the children’s movements in relation to the clinician, even from a short 5-minute segment of the ADOS, was indicative of their individual ADOS scores. We, therefore, suggest that these objective and automated measures of social-interaction can add an important quantifiable dimension to the assessment of ASD children.

Furthermore, this technology can be adapted for the home and kindergarten environments, and with additional research into relevant motion tracking measures may enable truly ecological measurements of social difficulties, how they change over time, and in response to treatment.


Source:
UPF Barcelona
Media Contacts:
Núria Pérez – UPF Barcelona
Image Source:
The image is credited to UPF.

Original Research: Closed access
“A full-body interactive videogame used as a tool to foster social initiation conducts in children with Autism Spectrum Disorders”. Narcís Parés et al.
Research in Autism Spectrum Disorders doi:10.1016/j.rasd.2019.101438.

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