Serious Games in Autism Spectrum Disorder

An Example of Personalised Design

Ersilia Vallefuoco

, Carmela Bravaccio

and Alessandro Pepino

Department of Information Technology and Electrical Engineering, University of Naples Federico II,

Via Claudio 21, 80125, Naples, Italy

Department of Translational Medical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy

Keywords: Serious Games, Autism Spectrum Disorder, Simulation, Personalised Design.

Abstract: Over the last decade, several studies evaluated the use of Serious Games as tools to encourage the

development of communication, the process of learning, and social behaviour in people with Autism Spectrum

Disorder (ASD) alongside traditional therapeutic approaches. The proposed study intends to employ and rate

the use of Serious Games to create personalised interactive environments aimed to improve the learning of

educational content in children with ASD. In particular, a multidisciplinary team supported the design and

development of the serious game to allow a personalised approach.

1 INTRODUCTION

A Serious Game (SG) is a simulation with a

videogame structure whose purpose is to promote the

development of important skills and strategies in

order to increase the cognitive and intellectual

abilities of the users (Botte, Matera, Sponsiello,

2009).

Today, Serious Games, also called learning

games, educational games, immersive learning

simulations and game-based learning, are very

popular and they get significant market share in the

gaming industry (Alvarez et al., 2010).

Several studies evaluated the Serious Games use

as a tool to support traditional therapy for people with

Autism Spectrum Disorder (ASD) in order to improve

communication, learning, social behaviour and, in

different ways, motor abilities (Zakari, Ma, Simmons,

2014).

The purpose of our research is to investigate

Serious Games use in the Autism Spectrum Disorder

field. In particular, a first Serious Game prototype

was developed to improve the learning of

mathematical basics in children with ASD, promoting

a personalised design.

1.1 Serious Games and Autism

Spectrum Disorder

Autism Spectrum Disorders are a variety of disorders

that affect social and communication skills and, in a

different way, motor and language skills (American

Psychiatric Association, 2013).

The majority of Serious Games aimed at people with

ASD have been developed for therapy, education

(learning and training), and to improve social

communication skills (Noor, Shabodin, Pee, 2012).

Serious Games, which are developed to improve the

learning process, have the goal of helping children or

teachers during the learning process. Bernardini et al.

(2014) have developed ECHOES, a SG that improves

learning and communication in children with ASD

using an avatar. Laertius et al. (2015) have

implemented a digital game, TEO (Tratar, Estimular

and Orientar), to help children with ASD with

learning, communication and problem solving.

Developed by Van Veen et al. (2009), Racketeer is a

learning Serious Game for Autistic children with the

purpose of improving their mathematical skills and

helping them cooperating with others.

Wijnhoven et al. (2015) have been studying the

efficacy of Serious Game MindLight in decreasing

anxiety in children with ASD.

People with ASD often have difficulties in

communicating with others through both verbal and

non-verbal language. For these reasons, several

Vallefuoco, E., Bravaccio, C. and Pepino, A.

Serious Games in Autism Spectrum Disorder - An Example of Personalised Design.

DOI: 10.5220/0006384905670572

In Proceedings of the 9th International Conference on Computer Supported Education (CSEDU 2017) - Volume 1, pages 567-572

ISBN: 978-989-758-239-4

567

Serious Games have been developed to reduce these

difficulties (Anwar et al., 2010).

People with ASD often have difficulties in

recognizing, understanding and expressing their

emotions, therefore several studies investigated the

development and the improvement of affective skills

in children with ASD through Serious Games (Alves

et al., 2013; Serret et al., 2014; Parsons, Mitchell

2002).

Bernardes et al. (2015) have published a study

about a SG for training people with ASD to use the

bus. De Urturi et al. (2012) have implemented a

Serious Game for Android that educates people with

ASD about first aid. Another important Serious Game

developed in the field of training is iSpectrum; it was

developed to improve the working abilities and skills

(Amoroso, 2012).

A few studies also evaluated the impact of

commercial videogames on people with ASD.

FaceSay (Hopkins et al., 2011) and Segret Agent

Society (Beaumont, Sofronoff, 2008), for example,

can help children with ASD to develop social abilities

and understand emotions.

1.2 A Personalised Approach

Personalization can be associated to different aspects

of a videogame (Bakkes, Tan, Pisan, 2012) and,

consequently, of a Serious Game. Kalloo et al. (2010)

investigated the use of personalized games in

supporting students’ learning of mathematical skills.

Moreover, another use of personalization in Serious

Games is content adaption to improve the learning

process (Brisson et al. 2012, Zarraonandía, Diaz,

Aedo, 2015).

A personalised approach is also of pivotal

importance in developing Serious Games for people

with ASD because when we talk about the Autism

Spectrum Disorder we are referring to a large set of

different features, which can evolve over time. In fact,

one of the most famous quotations about autism is: “If

you’ve met one person with autism, you’ve met one

person with autism” (Stephen Shore).

For these reasons, it is necessary to carry out a

suitable customized intervention (Franzoni, Hanau,

Cerati, 2008; Wehman et al., 2016) based on

evolution and changes. Moreover, it is important to

consider the personalization of both accessibility of

technologies (Hassan et al., 2011; Uzuegbunam,

Wong, Cheung, 2015) and content (Morris,

Kirschbaum, Picard, 2010) in the development of a

SG aimed at people with ASD.

In our study, we adopted a personalised approach

in the content learning aspect and game design.

The first step was to create a multidisciplinary

team; in fact, Serious Game development has to

involve videogame specialists like game designers,

programmers or graphic designers, as well as other

professional figures unconnected to technical

development (Diehl et al., 2013). In particular, we

formed a team of biomedical engineers, one

neuropsychiatrist, speech therapists, educators, and

parents of children with ASD.

The project team, knowing the specific needs of

the target group, established the elements of

personalization, the content to be learnt, content

learning, the design and development of our SG.

2 METHODS

We implemented an ADDIE methodology (Kirkley,

Tomblin, Kirkley, 2005) to devise our Serious Game.

In particular, we can summarize the different steps in

six phases:

 analysis,

 design,

 development of a prototype,

 testing,

 implementation,

 final testing- evaluation.

2.1 Analysis

Different elements, such as target groups and project

development, are evaluated during the analysis phase.

In particular, several general considerations were

drawn:

 creating an interesting game environment;

 gaming scenes where water is involved (beach,

swimming pool) are to be preferred;

 creating a system feedback (audio, music);

 helping the player to perform the action.

On the basis of these observations, the project team

established the target groups: 10 children aged

between 5 and 12 years with different cognitive skills.

For each child, personal and health data were

collected, as well as information about their usage of

technological tools.

2.2 Design

The design determinates how desired outcomes are to

be achieved. The team draws up a design document

(Whyte, Smyth, Scherf, 2015) that describes the game

and establishes content, purpose, storyboard, scenery,

player, user interface, and

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feedback.

2.2.1 Purpose

Based on the cognitive skills of the target group,

the project team decided that the game’s purpose was

to improve mathematical skills, namely the concepts

of number and quantity: our SG aimed to be a tool of

help and support to children with ASD learning basic

mathematics.

The Serious Game consists of eleven levels in

which the player has to collect the balls on the scene;

the number of balls increases with each level. The

first level introduces the game, directing the player,

while the final level allows for free exploration of the

scene.

2.2.2 Scenery

In order to create a personalised SG, the project team

decided to implement an environment that was

familiar to the children’s target group as a game

scenery. Specifically, the scenery is a swimming pool

with the same features of a real swimming pool where

the children used to undertake different activities. A

personalization of scenery allows the users to identify

with the game, so that they are more interested to

play.

2.2.3 Feedback

The feedback system is delivered through audio,

writing and images. In particular, when the player

collects a ball they receive a positive feedback

through a sound. Moreover, at the end of each level it

was established that an object was to appear on the

scene with particular graphic effects: a three-

dimensional number of total balls collected.

2.2.4 User Interface and Player

The user interface has to be easy and intuitive,

showing the videogame’s mission and the number of

balls collected. In particular, the game’s mission is

displayed through text and images.

The player is put in a first-person perspective that the

user can move with a keyboard and a mouse.

Table 1: Player Controls.

To go on ↑ keyboard

To go back ↓ keyboard

To go right → keyboard

To go left ← keyboard

To jump keyboard space

To move camera Mouse

2.2.5 Platforms

The project team evaluated the systems requirements

best suited for implementation. Unity was chosen for

the game engine both because it had already been

used in the development of small/medium

videogames and because it allows the game to be

exported to different platforms, such as Windows,

Android, Nintendo or Xbox. 3D Studio Max was

employed as a 3D modelling software.

2.3 Prototype Development

The prototype development phase consists in the

implementation of a first game prototype and in the

development of the design plans.

The first step was to create 3D models of the

scene’s different objects, such as beach umbrella,

deck chair and the arch. For these reasons, photos of

the swimming pool were collected so that we could

visualize the scene objects. The majority of the

objects were modelled through a 3D modelling

software, while the rest were downloaded from the

Unity Asset Store.

After the 3D modelling, the game environment

was created and the game dynamics was implemented

through scripts in C#.

Figure 1: Game Scenery.

The prototype evolved into a PC and web application

with six different levels.

2.4 Testing

Testing is an important, if sometimes neglected,

phase of SG development (Olsen, Procci, Bowers,

2011). In this phase, user usability (especially in

prototype development), playability and the efficacy

in the learning process have to be evaluated

(Desurvire, Caplan, Toth, 2004).

The project team decided to realize two testing

phases. The first testing phase evaluated the SG

prototype to obtain an initial feedback and to

consider, if necessary, a possible redesign of game

elements to implement on the complete SG.

Serious Games in Autism Spectrum Disorder - An Example of Personalised Design

569

The final testing is carried out on the SG and it has

to evaluate and measure its effectiveness and

efficiency.

The testing phases consist of two tests: a software

and a user test. In particular, a test plan was created

establishing some aspects of the testing session like

the place, the figures involved and the modality of

execution. A methodology proposed by Moreno-Ger

et al. (2012) was adopted so that an event set to

evaluate the system operation, the usability, the

efficiency of personalised elements and the

achievement of the SG’s goals was considered.

Moreover, each test is a set of game sessions and all

sessions have to recorded, easing the analysis of the

results.

After the testing phase, it became necessary to

analyse the collected data and to discuss the obtained

results.

The prototype game, designed for PC, is currently

undergoing testing with users. From the results of the

first phase of testing, it will be possible to rate the

elements that have to be redesigned for the

development of the Serious Game, while a first

estimate of the learning process and skills acquired

will be made.

3 DISCUSSIONS

This study sets out to explore the possibilities of using

Serious Games to improve and help the learning

process in children with Autism Spectrum Disorder.

Moreover, a multidisciplinary team is necessary to

develop a Serious Game aimed at people with ASD

because it is important to consider their different

needs and requirements. The multidisciplinary team

chose the target group and analysed the different

aspects to develop during the design and the

implementation of the game.

In particular, a personalised design is proposed in

order to adapt the content to the player’s specific

needs and to motivate them to play.

Whether the personalised approach is valuable is

not yet clear because the testing phase is at its initial

stages, although preliminary results show success in

the target group.

The prototype is proving to be attractive and

enjoyable, with a good usability, but the testing phase

is being reviewed because of certain limitations. It is

not easy to organize the different testing sessions

because of the children’s availability. Moreover, not

all participants are testing the prototype at the same

time, but at different times of the day, meaning that

for example a child playing after school or therapy

could be less motivated to play. For these reasons, the

testing sessions have to take into account several

other aspects, from the specific needs of the children

to when the game was played.

After the testing phase, the SG development will be

completed.

4 FUTURE WORK

On the basis of this preliminary study, we want to

investigate the use and efficacy of personalised

design in Serious Games aimed at people with ASD.

Future work should consider the need to incorporate

other personalised elements (like avatars or specific

audio effects) and more than two players at the same

time. Moreover, new methodologies for the testing

and the evaluation of content learning will be

investigated.

ACKNOWLEDGEMENTS

This research was supported by SInAPSi Centre,

University of Naples Federico II. We would like to

thank all those who were involved in this study. A

particular acknowledgement goes to Giuliana Paolillo

for reviewing the language. Thank you all for your

support and contribution.

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