Play and Heal:
Video Games As Autism Therapy
A young autistic child sits alone in his room, glued to the television screen and playing a video game. Our assumptions may lead us to believe that he is doing this as a result of a symptom of autism: social isolation. Or, perhaps he just really likes video games. Surprisingly, this child is actually alleviating the symptoms of his disorder, whether he knows it or not. A plethora of research within the last decade has lead to the development of video games and apps aimed at treating autism. Although not yet legally considered a prescription medication, these neuroscience-backed games will likely be prescribed by the family pediatrician before long. The days of instructing autistic children to swallow pills that induce various side effects will end, soon to be replaced by fun and interactive games.
Game developers at the Center for Brain Health at the University of Texas, working alongside neuroscientists, pioneered the wave of autistic treatment games upon creating BrainVille. While familiar psychological treatment involves a patient sprawled on a couch and verbally deciphering social situations with a clinician, this new innovation is more realistic and hands-on. A socially-stunted child may have reservations about traveling to some unknown psychologist’s office to talk about problems. Yet the majority of the current generation of children have much experience with gaming. BrainVille presents players with real-life scenarios to navigate, including job interviews, going on dates, and dealing with neighbors, all from the comfort of home. Admittedly, children do not have a lot of experience in these realms, but they are sure to face them in coming years. Beginning to practice while young in a stress-free, virtual environment allows for those on the autism spectrum to overcome the obstacles of this disorder and become socially knowledgeable for future encounters.
High-tech graphics and face tracking are included to provide a realistic experience. The child can observe the life-like facial expressions of the virtual characters, who respond accordingly to actions they choose. If the player commits a social faux pas, the characters are designed to make unsatisfied faces, like scrunching or a furrowing of the eyebrows. These actions mimic our facial motions, allowing for the children to begin to read faces and understand what others are thinking.
The lead clinician of the project, Sandra Allen, noted remarkable progress in the game’s early users. Scores rose on tests of emotional recognition and “theory of mind,” the ability to attribute mental states to oneself and others. During interviews several weeks after experiencing the game, most participants stated that conversation skills had improved and that they had developed several new friendships.
Playing the game did not make these kids mind readers, but it allowed for them to develop a deeper understanding of what causes certain emotions, and how these emotions look on the surface. This may all sound inconsequential to those of us who are socially savvy, but the ability to read faces and develop a better understanding of what to say and when is a large step in the life of a child suffering from autism.
College campuses appear to be the breeding grounds for these therapeutic games, as students at the University of Southern California released an app that is similar to BrainVille, yet goes one step further. The foundations of effective autism treatment, referred to as evidence-based practices, are consciously weaved into every aspect of Social Clues.
Say goodbye to the days of going to the pharmacy and picking up autism medication. Now, we can just download an app, hand a child the iPad, and begin treatment. The Social Clues app incorporates four key evidence-based practices that raise it into the realm of a treatment: ABA (Applied Behavioral Analysis), errorless learning, social narrative, and discrete trial training. These fancy phrases mean nothing to children, but that’s fine. The treatment they undergo is subtle, and they do not have to be aware of the science behind the game that they are enjoying.
Children are exposed to ABA through colorful in-game characters. No virtual scientist in a harsh white lab coat appears, detailing how behavior will be observed and measured during play. Instead, aptly named characters like particiPETE and communiKATE are available to control, and it is through either of these avatars that ABA is experienced. Various scenarios are presented, and the player’s job is to follow the most fitting course for the situation at-hand. For instance, a toy is lost and must be found with the help of classmates. The player is prompted to engage in social necessities such as eye contact and maintaining conversations for an allocated amount of time. The NPCs (non-player characters) react accordingly, either pleased or unresponsive to the social conduct that took place. Through these decisions and subsequent reactions, children learn what type of behavior is suitable for common social situations. Social Clues modifies behavior from the child’s home, a relaxed environment that is quite different from the normal, fluorescent hell that a doctor’s office tends to be. ABA subtly changes behavioral problems overtime, rather than attempting to force change upon the socially-anxious player.
Playgrounds are not friendly learning arenas. Although real-world social experience has advantages, those on the autism spectrum know the cruelty and humiliation that lurks around every corner at school. Take a social misstep in front of classmates, and rude remarks and admonition follow. Social Clues intends to remove this negative stimuli, employing errorless learning to do so. “You’ve failed” or “game over” messages do not litter the screen. As in real life, each decision made comes with different results. The player is gently guided to the most fitting choice by a humorous narrator, a parrot who lightens the mood and explains why one decision is generally wiser than another.
Children love stories of all kinds, and this app quenches the narrative thirst. Social narratives are inherent, allowing the gameplay to be relatable to young minds. For instance, a complete day at school is one such arc, covering the day-to-day aspects of taking the bus, talking with classmates, eating lunch, and doing schoolwork. All children who are not home-schooled are familiar with these concepts, and being able to experience them through virtual characters provides a cohesive plot that they can clearly grasp and watch progress thanks to decisions they make.
Discrete trial training (DTT) is the final science-based aspect of Social Clues. Each level is a trial aimed at instilling a certain social skill. Following each one, a report summarizes the player’s progress, detailing the areas that need additional work. Instructors or parents can view these reports and help the child in these specific skills. Since the game is divided up and does not make the player work on multiple areas of socialization at once, playing involves tackling digestible chunks one at a time.
The third in the trio of autism treatment games is Project Evo. Whereas the previous two games involved narrative arcs and entire worlds, this title is fast-paced and short, without multiple levels. Think therapeutic Pacman. The game epitomizes the work neuroscientists and game developers are doing to treat cognitive ailments like autism. Players control a car skidding on ice, simultaneously tapping color-specified fish that appear at the top of the screen. The goal is to employ multitasking, a capability in the same neural networks as attention span and working memory. These areas are bridged together while playing, training the brain to increase its focus and memorization. Tapping fish while driving a virtual car sounds nonsensical, but players in nine completed clinical trials displayed improvements in autism, ADHD, and depression.
The future looks bright for those on the autism spectrum. The child sitting alone in his room playing a video game now has good reason to do so. He is using a method developed by neuroscientists and game developers, one that uses evidence-based practices through fun and entertaining means. Currently, autism medications come with a slew of unfortunate side effects. These include sleep loss, low appetite, and stomach pain, to name a few. The creators behind these games expect a sharp decline in the use of these drugs once therapeutic games inevitably become available over the counter. Sore thumbs and tired eyes are the only potential side effects with this new method, which is much more humane than pills that cause all sorts of physical problems.
As it stands, these games are not available as prescription. The FDA is the sole roadblock. Games typically travel from conception to retail shelves in six months. This simple and quick process is extended to an arduous ordeal that can cost several million dollars and take up to three or four years to complete because of the FDA’s medical device approval process. The small companies who create these miraculous games do not have the money or time required for the FDA stamp of approval. Science, logic, and clinical trials have all been established. Once the approval is given, doctors can write prescriptions for games and insurance companies can begin covering the cost. Even drug companies are awakening to the possibilities. Pfizer, collaborating with the Project Evo team, is attempting to improve the diagnosis of Alzheimer’s using the game.
Health care professionals, neuroscientists, and pharmaceutical companies have all realized the potential of providing children of the 21st century with a treatment method they are bound to love and find accessible: video games. The FDA is the black sheep, the single reason that these medically beneficial games are not yet available as prescriptions. Video games will be legalized as therapy once the FDA is on board, and autistic children can rejoice as they grab the Playstation controller and begin undergoing an exciting new treatment.
Trepidation is inherent with most technological innovations. The counterintuitive nature of instructing children who are not socially adept to enhance this lacking area through a virtual, single-person endeavor can cause raised eyebrows. Yet healing is exactly what is taking place as a result of playing these new games. The evidence-based practices that pervade the gameplay, along with the neuroscience, clinical trials, improved social test scores, and the praise of players themselves, have made the era of therapeutic gaming a feasible reality. We should approach these new platforms of social learning with excitement, for in them await virtual worlds designed to heal suffering children.
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