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

Abstract

Children with Autism need intensive intervention and this is challenging in terms of manpower, costs, and time. 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 Imitations 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 (Trial ID: NCT02560415, Clinicaltrials.gov). The children and the parents participated in 80% of the sessions both at home (77.5%) and at the hospital (90%). All children went through all the 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.

Keywords: Early Start Denver Model; Imitation; Joint Attention; autism spectrum disorder; intensive intervention; nomadic settings; serious game.

Figures

Figure 1

The conceptual closed-loop intervention system. The games contained in the platform are used for assessing the child, first, and for intervention purposes later. The first aim is to characterize the starting cognitive skills of a child by playing games at different levels of difficulty. After identifying the current level of ability of the child, a series of games and difficulties will be planned by the therapist and employed at home. According to the evaluation, both automated and manual, a new set of games will be planned by the therapist.

Figure 2

Main windows of the therapist/parent during the beginning of the game. The therapist/parent (blue windows) will select the language, the category of the game (whether Joint Attention or Imitation), and the game, according to the category chosen.

Figure 3

Flow of the Joint Attention game 3 – Bake a recipe. The therapist/parent (blue windows), after selecting the recipe, will select each ingredient to be dragged into the bowl. The red arrow on the player’s device (red window) will indicate the ingredient selected by the therapist/parent. After dragging all the ingredients, the player’s will click on the recipe cooked.

Figure 4

Flow of the Imitation game 1 – Free drawing. The therapist/parent’s drawing (blue window) appears on the player’s window (red window) who will then imitate the drawing and send it to the therapist/parent. After the therapist/parent’s feedback, the smiley will appear on the player’s device, while the therapist/parent will evaluate the imitation as Correct/Incomplete/Incorrect.

Figure 5

Evolution of the time (in seconds) to complete the task for the Joint Attention game 3 – Bake a recipe. Evolution of the time occurred to complete the Joint Attention game 3 for each child (each color represents a child) across different sessions. The average across children, in dotted red, shows a decreasing trend across sessions.

Figure 6

Number of errors performed to complete the task for the Joint Attention game 3 during different periods. The figure contains the number of mistakes committed by the 10 children during the Joint Attention game 3. The total number of errors decreases across the different periods, as shown by the variability (from 19 to 5).

Figure 7

Evolution of the time (in seconds) to complete the drawing in Imitation game 1. Evolution of the time occurred to complete the Imitation game 1 for one child across different sessions. Figure shows that the child becomes faster at reproducing the drawing model.

Figure 8

Evolution of the performances of one child during the Imitation game 1. The error bars (A) describes the variations of the scores given by the therapist at hospital for different sessions. The quality of imitation improved throughout the sessions: the average score (av = 1.7) during the third period (T7–T9) is closer to the maximum score (score 2) and higher than the initial scores for the periods T1–T3 (av = 1.2), and T4–T6 (av = 0.9). The average number of trials required to complete the imitation, shown on the right (B), has decreased as well across different sessions from the first period (T1–T3 with av = 2) to the next periods (T4–T6 and T7-T9 with av = 1.4).

Figure 9

Evolution of the imitation skills of a child across three periods. Example of the evolution of the imitation skill for one of the children across different periods.

Figure 10

Results related to the questionnaire proposed to the parents. Answers given by the parents of the children recruited for the study to the questionnaire containing the questions related to the use of the GOLIAH platform.