June 15, 2015

As the reported incidents rate of autism increases (the CDC’s current statistics show the prevalence to be 1 in 68 children in the US who have been identified with Autism Spectrum Disorder, or ASD), so too has the urgency to find treatments and strategies for this complex condition. Autism is a developmental disorder that includes impairments in language, communication and social interaction. Someone with autism also often displays rigid, repetitive behaviors and sensory processing issues. The severity of these impairments is a different mix in each individual, and they can range from mild to severe.

In recent years, the tech field has been stepping forward to help relieve some of these impairments. Most notably, Apple’s iPad has become a particularly popular resource for communication tools and therapeutic games. The tactile nature of the touch-screen, combined with the visual appeal of the medium makes it an appealing choice for those with autism.

CC BY-ND by Ant McNeill
CC BY-ND by Ant McNeill

As a parent of a child with autism who is obsessed with the iPad, I can personally attest to its power for learning. Not a day goes by where my son isn’t on his iPad, playing games or looking at videos. It soothes him when he is distraught and teaches him language with closed captioning on videos. Which is why, over the years, I’ve become such a strong advocate for using the iPad as a tool for autistic people – and not just for apps that help nonverbal people speak. (Although those are important, too!) The iPad has become a necessary tool for managing routines, behaviors, and learning for those on the autism spectrum.

I’ve been working with a company called InteractAble to develop uChoose, an iPad-based game that teaches social skills to children with autism. Aimed at children who are roughly between the ages of 7 and 11, the app is intended for those with milder symptoms of autism who are ready to embark on improving their social interactions. Through our initial research, as well as rounds of app testing with our target population, we have found certain elements to be crucial to a successful learning experience for children with autism. What follows are six characteristics critical to building an effective social skills learning experience for children on the autism spectrum.

1. Rich Narrative
A good story appeals to everyone, but it seems like those with autism are especially drawn to narratives that have drama. As Ron Suskind described so eloquently in his book Life, Animated, the stories in Disney movies helped his autistic son understand emotions in our world. Exaggerated facial expressions in animation and stories of outcasts and those “different” from those in society (e.g., Dumbo, Pinocchio, the Little Mermaid, the Hunchback) are what made those Disney movies appealing. We need similar stories with a rich narrative involved in iPad apps intended for children with autism.

2. Visual appeal
Temple Grandin, among others, has always said that the autistic brain is one that “thinks in pictures.” Therefore, any educational tool for those with autism needs to be visually appealing to stimulate thought. To that end, overstimulation needs to be considered; very bright colors, flashing buttons or cluttering details might detract from the learning. A good solution is to go with muted colors, like greens and blues, which evoke a calm feeling. In addition, characters should provide appropriate facial expressions as called for by the social situation. A review of existing literature on using computers to teach children with autism by Konstantinidis and colleagues (2009) showed using Virtual Environments (VE’s) and expressive avatars allowed for an increase in both enjoyment and learning.

3. Repetition
Repetitive behaviors are one of the distinguishing features of a person diagnosed with autism. As Naoki Higashida, a Japanese 13-year-old with autism explains in his book, The Reason I Jump: “…the repetition doesn’t come from our own free will. It’s more like our brains keep sending out the same order, time and time again. Then, while we’re repeating the action, we get to feel really good and incredibly comforted.” So repetition of actions, words or experiences is basically soothing and pleasurable to those with autism. In the past, many autism professionals have advised parents and educators to extinguish repetitive behaviors, as they are not considered “normal.” However, a growing movement is seeing the merit to allowing repetition. There is meaning in allowing something to repeat; it is key to helping an autistic person learn and understand. To that end, a good social skills app will allow for repeat plays, both for pleasure and learning.

4. Promoting flexible thinking
Autistic individuals have a tendency to be rigid in nature. Flexible thinking is considered an executive functioning skill. In 2008, Willcutt and colleagues demonstrated (through a meta-analysis of other research) that individuals with autism were more likely to demonstrate a “cognitive inflexibility” than their typically developing peers; that is, those with ASD find comfort in repeating the same routine; veering off that routine can be traumatizing. Therefore, it is important for those individuals to “practice” flexibility in social situations. To build our app, we included gentle ways that push the user to be flexible in his/ her thinking in the social scenes presented. This includes making characters or situations change every time the scenarios are played. The user is prompted to apply skills learned in previous playthroughs to new situations, and given positive reinforcement for doing so.

5. Rewarding success
Negative outcomes in a game can be hard for any child to handle, but for autistic children, losing or making the wrong choice might lead to prematurely quitting the game. Positive feedback is a powerful tool that builds self-confidence and self-esteem. It is also an important component of Applied Behavior Analysis (ABA), which is a widely used technique to teach children with autism. By reinforcing the individual with rewards and positive feedback, children are encouraged to keep trying. A good social skills app for autistic children should have goals to achieve and offer encouragement throughout the game to keep the user motivated. Rewards should also be aligned with learning objectives. For example, a game that the user gets to play with a friend is a great reward after he has successfully initiated a conversation.

6. FUN
Too often, developers of apps for children with autism seem to focus so much on the learning content that they forget that the people playing are still kids! Fun is not only a good thing to offer to all children, but also acts as motivation for the kids to keep playing. It also serves as a crucial break in the learning. For example, our social skills app incorporates playful mini-games, such as an outer-space asteroids game. Some of the best learning can be accomplished by making something fun and enjoyable. The hard (but most important) part is making sure the fun compliments rather than distracts from learning goals.

As a parent and professional in this field, I believe that this is a good mental list to have in mind when considering apps for autistic children. My experience with InteractAble has taught me that while it can be difficult to design a game that incorporates all these design elements, it is indeed possible. So many benefits can be gained from apps that are both engaging and entertaining for this specific audience.

Reprinted with permission of the author. Original can be located here.

 About Melissa Morgenlander, PhD

Melissa MorgenlandeMelissa Morgenlander, PhD is a researcher and curriculum designer who is passionate about leveraging the power of television, games, video, and mobile technology for learning experiences for children. You can find her blog at www.IQJournals.com

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