A Serious Game for Children with Autism Spectrum
Disorder as a Tool for Play Therapy
Alejandra Ornelas Barajas, Hussein Al Osman, and Shervin Shirmohammadi
Distributed and Collaborative Virtual Environment Research laboratory (DISCOVER Lab)
University of Ottawa, Ottawa, Canada
{aorne025 | halosman}@uottawa.ca, [email protected]
Abstract—We propose a Serious Game (SG) for children on the
Autism Spectrum Disorder (ASD) composed of a Tangible User
Interface (TUI) and a Graphical User Interface (GUI). The TUI is
built from physical Lego-like building blocks augmented with
electronic modules. The proposed SG is envisaged as a play
therapy tool aimed at improving autistic children’s social and
cognitive skills. We investigate the effects of using our SG in a play
therapy exercise, by running an empirical study that compares
conventional clinical non-computer block-games with the
proposed SG. In our preliminary experimental study, the
proposed system showed an improvement in social interaction,
collaborative play and exercise performance, and a decrease in
solitary play. Our results suggest that the proposed system can be
a useful tool for play therapy aimed for young children with ASD.
TUIs, when used as a gaming interaction style, have proven
to be useful for the education of children with special needs [13].
TUIs take advantage of the human ability to manipulate physical
objects and allow users to create a connection between the
physical and virtual worlds. Hence, children tend to find it easier
to interact with a TUI compared to a GUI [13].
In this paper, we propose a SG targeting three basic skills:
conceptual, practical, and social. We use MEGA BLOKS® as a
TUI integrated electrically with a 3D graphics application
running on a computer to create a cognitively stimulating and
interactive game. We probe the following research questions:
1.
Does the combination of a tangible and a graphical
interface lead to an effective educational tool that
enhances the basic skills of children with ASD (i.e.
conceptual, practical and social)?
2.
Is the SG more appealing to children with ASD
compared to the non-computer games used for play
therapy?
3.
Does the SG increase the level of social interaction
between children with ASD compared to the
conventional non-computer approaches?
Keywords: Autism Spectrum Disorder; Tangible User Interface;
Play Therapy; Special Education; Serious Game.
I. INTRODUCTION
Autism Spectrum Disorder (ASD) is defined as a
developmental condition characterized by a marked impairment
in social interaction and communication skills [1]. Findings of
the CDC’s (Centers for Disease Control and Prevention) Autism
and Developmental Disabilities Monitoring Network, show that
about 1 in 68 children in the United States were identified with
ASD [2]. Some of the most common signs of ASD include
differences in the way a person communicates, learns, interacts,
and behaves [1]. These signs usually appear during early
childhood. The sooner the individual receives an intervention,
the more likely he/she can live an independent life as an adult
[3].
People with ASD typically present limitations in adaptive
behaviour that engender Special Education Needs (SEN) [4].
During the past few years, researchers have reported positive
results for the use of technology in special education [5][6][7].
With the growing popularity of mobile devices such as
smartphones and tablets, video games are becoming even more
prominent tools for education [8][9]. The term SG was first
introduced by Abt in 1970 [10]. He devised games to improve
education inside and outside the classroom. Ever since then,
serious gaming has been redefined to encompass any game that
presents a utilitarian purpose in education, health care, work
training, military, among many others. More recent definitions
of serious gaming refer exclusively to computer games (i.e.
video games) that exhibit another goal beyond mere
entertainment [12]. For this work, we adopt the latter definition,
since we are solely interested in computer games.
In this paper, we do not aim to conclusively answer the
above questions through our preliminary and short-term
experiment; however, we intend to shed some light on these
queries. Hence, this paper serves as a preface for a deeper study
of these questions.
The rest of this paper is organized as follows. Section II
presents a review of related work on serious games and play
therapy for children with special needs. Section III describes the
characteristics of the proposed system along with the technical
details of the implementation. Section I details the method used
to evaluate the proposed SG. Section V presents and discusses
the results obtained. Finally, section VI summarizes the
conclusions of this work.
II. RELATED WORK
SGs are not necessarily video games. Hence, in this section,
we will first describe relevant non-technological SGs intended
for children with special needs. In particular, we will describe
the concept of play therapy which forms the basis of this work.
Second, since this paper presents a Computer-based SG for
children with special needs, we will survey the latter type of
applications. Third, we will describe the use of TUIs as a
mechanism for interacting with such applications. Finally, we
will present an analysis that highlights the gap in existing work.
A. Non-technological Serious Games for Special Needs
As mentioned previously, SGs are not necessarily video
games. In this section, we will present some of the nontechnological SGs designed for children with special needs.
More specifically, we will discuss the use of SGs during play
therapy. Play therapy is a type of occupational therapy
commonly used for children with developmental conditions
such as ASD and other SEN. This technique allows children to
improve their social and communication skills while playing in
their own way [14].
Building blocks such as LEGO® are a popular tool used for
play therapy. Several studies have shown the advantages of
these toys in improving social skills. For example, LeGoff used
LEGO® play, in both group and individual therapy, to improve
the social competences of children with ASD [15]. He also
demonstrated the long term benefits of this technique through a
3-year study that showed that “the LEGO® groups made twice
the gains demonstrated by the control group on the VABS–SD
(Vineland Adaptive Behavior Scales–Socialization Domain)”
[16]. And more recently, LeGoff et al. released a book on
LEGO®-Based Therapy where they provide an evidence-based
manual for professionals working with children with autism and
related conditions [17].
B. Serious Videogames for Special Needs
Previous work has shown positive results in the use of
technology for children with SEN [6][9][18]. Particularly,
researchers have developed numerous SGs that aim to improve
the social and communication skills of children with ASD [3]
[5][19][20][21]. ComFiM [5] and Open Autism Software apps
[3] are examples of collaborative games dedicated to encourage
positive social interaction among children with ASD using a
tablet with a touch screen. Similarly, GameBook [19] is an
interactive storyteller mobile application that aims to improve
social and cognitive skills while promoting motivation and
imagination.
It has also been proven that it is possible to develop a SG
using a participatory approach [18][22]. Bossavit and Parsons
presented a work where high functioning autistic teens codesigned a SG to improve their academic skills in Geography
[18]. Fletcher-Watson et al. worked closely with pre-school
children with ASD to develop an iPad application where the
children collaborated in the design process [22].
Other studies have shown the influence of avatars and virtual
characters on children with ASD [20][23][24][25].
LIFEisGAME [20] and emot-iCan [23] are SGs aimed to help
children recognize and express emotion through facial
expressions. Furthermore, Carter et al. documented the
interaction between these children and avatars [25]. Their results
show an improvement in nonverbal social behaviors when
avatars with exaggerated facial motions are used.
C. Tangible User Interfaces for Children with Special Needs
While most videogames are digital, TUIs offer an interesting
way of coupling the physical and virtual worlds. Sitdhisanguan
et al. demonstrated through their experiments that a TUI-based
system offers improved ease of use compared to mouse-based
systems. In terms of learning efficacy, TUI-based systems show
better results over touch-based systems [26]. Moreover, a TUI
with an embedded digital system has shown social benefits that
are promising in special education [27].
Block-based toys have been used as educational tools
targeting different types of skills. Zuckerman et al. introduced
the Flow Blocks, a set of components that typically developing
children use to build causal systems [28]. Farr et al. introduced
Topobo, a construction toy with programmable movement of
plastic blocks [27]. The game was used with autistic children to
improve their social skills; their findings suggest that toys with
embedded digital technology may lead to an increase in social
interaction. Humanoid robots are another example of TUIs used
during therapy and special education for children with ASD
[29][30][31]. The ROBOSKIN project based on tactile feedback
is an example of the latter [29].
D. Gap Analysis
There is no doubt that serious gaming has proven to be a
motivating educational method [8][7][32]. But, purely GUI
based videogames lack the interaction with physical objects,
while TUIs have shown to be engaging and have improved
collaborative play in previous cases [13][27].
One of the biggest challenges when developing a SG for
children with ASD is to address social interaction and
communication problems. There are different known strategies
used to improve communication skills during therapy exercises
for children with ASD. Some children with ASD respond better
to visual instructions, rather than verbal ones. Also, one of the
most successful strategies to improve social interaction during
exercises is to use visual feedback [11].
Hence, we identify two gaps in existing systems:
•
Purely GUI based videogames for autistic children lack
the interactive quality that TUIs provide
•
Conventional therapy techniques that use tangible
objects (e.g. LEGO® Therapy) lack the visual feedback
that autistic children often respond to
We propose to add a GUI to the conventional non-computer
LEGO®-Based Therapy as a form of visual feedback; we will
examine whether the resulting game becomes more appealing
and engaging. We will also evaluate whether the proposed game
encourages more social interaction during group play.
III. PROPOSED METHOD
We adopt an approach in serious gaming that combines a
TUI and a GUI. Our choice of TUI is building blocks due to the
proven social benefits and popularity of the toy. Specifically, we
use MEGA BLOKS® maxi, with the dimensions of 3 × 3 × 6
cm3. With this interactive game, we intend to create a tool to
stimulate the basic skills of children with ASD and improve their
adaptive behaviour. The goal of the proposed game is to
replicate a model shown on a computer screen with the actual
blocks (i.e. TUI). During game execution, the computer will
provide real-time feedback as guidance to complete each level.
reference point for the child to more easily compare the model
shown on the screen to the physical one being built. The game
itself uses red, green, blue, and yellow blocks. Inside the board
there are four microcontrollers, one master and three slaves
communicating though an Inter-Integrated Circuit (I2C). Each
stud (head of the block) on the board has two concentric
terminals, resembling the ones from the circuit board inside the
blocks (see Fig. 1). All interior terminals are connected to the
VCC power supply and each external terminal is connected to an
ADC channel on one of the microcontrollers. The
microcontrollers map the ADC channels to a position on the
board. The position is indicated by a different character assigned
to each stud (i.e. A-Z, 0-9).
Fig. 1. Tangible User Interface Diagram
A. The TUI
As mentioned previously, the proposed SG uses building
blocks as a TUI. We use big blocks to accommodate ASD
children with fine motor skills difficulties. Also, the big blocks
offer more space for the integration of electrical elements.
1) The blocks
Internally, each one of the blocks has a spring with one end
attached to the top and the other to a circuit; the spring allows
the circuit board to move inside the block (see Fig. 1). The
circuit board consists of a resistor connected to two terminals.
The terminals are concentric circles. The value of the resistance
determines the ID of the block (see TABLE I).
TABLE I.
Fig. 3. Microcontroller UML State Machine
RESISTANCE VALUES FOR THE BLOCK ID
Block ID colour
Resistance (Ω)
Red
Blue
Green
Yellow
0
2.2k
3.3k
4.7k
Fig. 2. System communication
2) The board
As shown in Fig. 1, the board is a square constructed using
36 individual blocks (6 by 6 matrix). It consists of all red blocks,
except the 4 middle blocks which are yellow, to serve as a
Fig. 4. Example of Mini-games
3) Functionality
When a block is placed on the board, the resistor gets
connected to the ADC port of one of the microcontrollers (see
Fig. 1). Then, the microcontroller receives the block ID, given
by the resistance. The slaves map the ADC channel to a position
on the board and then send the information to the master through
I2C (see Fig. 2). The TUI reads the position and the ID of the
block, and this information gets coded into a three character
command (See TABLE II). The master finally sends that
command to the computer via serial communication (i.e.
UART). Similarly, when a block gets removed from the board,
the command gets passed to the computer. When the computer
receives the latter information from the TUI, it maps the real
blocks to its graphical representation. Fig. 3 shows the details of
the process running on the microcontrollers using a UML state
machine. The SG software records the performance of the user
comparing the information sent by the TUI to the graphical
model display on the GUI.
TABLE II.
A (position)
r (colour)
n (state)
COMMAND EXAMPLES
Command
A r n
character associated with stud on the board
r = red, b = blue, g = green, y = yellow
n = new block, r = block removed
B. The GUI
The game features a 3D GUI to represent a virtual view of
the board and the blocks. From the main menu of the game, the
player can choose between different available mini-games. Each
mini-game consists of a different model representing a number,
letter, or pattern. 0 shows few examples of these mini-games.
The player is assigned the task of replicating the model given by
the computer onto the real board (i.e. TUI). Each time a block is
placed on the board, the TUI reads the position of the block and
relays the information to the GUI. Fig. 4.1 and 4.2 show a
transparent white model. This means that the user(s) only needs
to match the pattern (i.e. the number 2 and letter A). Fig. 4.3 and
4.4 depict colored models and hence the user(s) has to match
both colour and pattern.
Fig. 5 shows a sequence of moves to complete a mini-game.
If a block is placed on the correct position (Fig. 5.2), the GUI
presents a positive visual effect (e.g. glowing particles) and the
transparent block becomes opaque. If the block is placed on the
wrong position, the GUI outputs instructive feedback to remedy
the problem (Fig. 5.4). We minimized the negative feedback to
avoid any possible frustration by the users and to encourage
them to try again. Once the user(s) completes building the
model, the game displays a success message (Fig. 5.6) and asks
the user(s) to remove all the blocks to proceed to the next minigame.
Fig. 5. A mini-game in action. Transparent blocks are the white ones on the monitor
IV. EVALUATION
We conducted an experiment that compares the proposed SG
with a non-computer block game, similar to the one described in
[17] during a LEGO® Therapy session. Our experiment was
approved by the Office of Research Ethics and Integrity at
University of Ottawa (File Number: H06-16-09). The
participants were recruited from Children at Risk, a community
organization in Ottawa that provides services to families of
children diagnosed with ASD. Due to the nature of this research
on a special population, the number of participants was limited.
Nine children between the age of 6 and 15 years old (M=10, SD
= 3.20) volunteered to participate. All participants were
diagnosed with ASD according to clinical opinion, and all of
them were boys. Given that ASD is significantly more common
among boys than girls [2], it was not surprising that all
volunteers that came forward were male.
The experiment was conducted during two consecutive days;
five children were tested on the first day and four children on the
second day. The total duration of the study was approximately
one hour each day. Parents of the participants were present at all
times.
A. Procedure
On Day 1, at the beginning of the experiment, the parents of
the participants signed a consent form and answered a
questionnaire about their children. The questionnaire, shown in
the Appendix, included questions about their children’s
experience working with mobile applications and educational
games. After that, the children were divided into two teams
(Team A and Team B) according to their age. Each team had
between two and three members. For the first phase of the
experiment, Team A was assigned to play with a non-computer
game (conventional method) and Team B was assigned to play
with the computer game (i.e. proposed SG). Both teams received
the instructions for their assigned game. They were given 15
minutes to play. The difficulty level of the game was adjusted
when necessary (i.e. if the teams found it too easy or too hard to
complete).
For the non-computer game, participants were asked to play
with blocks without the graphical interface. Instead, they
received a card depicting an image of the model they need to
replicate with the blocks; a similar approach used on LEGO®
Therapy [17]. For the computer game, participants were asked
to play with the proposed SG. Both teams were instructed to
build the same models.
For the second phase of the experiment, the teams switched
games and they were given the same time (15 minutes) to play.
Finally, at the end of the experiment, participants were asked to
choose their preferred game. On Day 2, the same procedure was
repeated for Team C and Team D.
B. Measurements
We focused on two aspects in our evaluation of the two
games: social interaction and performance. We used an
observational grid to record the following five variables:
•
Social interaction: Number of initiated social
interactions between the participants.
•
Solitary play: Time the participant spent playing alone.
•
Collaborative play: Time the participant spent playing
with other participants.
•
Engagement in other activities: Time the participant
was not engaged in the game.
•
Performance: Number of mini levels (i.e. models) they
successfully completed.
V. RESULTS AND DISCUSSION
For the statistical analysis of the results, a paired-samples ttest was used to compare both games for each of the previously
described five variables.
There was a significant difference in four out of five
variables (see TABLE III). The computer game showed an
increase in the number of social interactions over the noncomputer game (p = 0.005) with 3.55 interactions on average,
compared to 1.11. Participants spent 45.6% of their time playing
alone with the non-computer game, but they only spent 25.5%
in solitary play time with the computer game. Which means that
the solitary play time was reduced (p = 0.044) by more than
20%. In the same way, collaborative play time was significantly
increased (p = 0.004) by almost 30%. The level of engagement
seemed to be slightly better when the computer game was
employed, however the results were not statistically different (p
= 0.330). And finally, we observed a better performance during
the computer game (p = 0.009), based on the number of minigames completed going from 2.44 to 6.11.
TABLE III.
Variable
Social interaction a
Solitary play b
Collaborative play a
Engagement in other activities
Performance a
a.
p < 0.005
b.
p<0.05
EXPERIMENT RESULTS
Non-Computer game
Mean
σ
1.11
1.27
45.6%
34.55
26.07%
42.13
28.29%
29.01
2.44
2.35
Computer game
Mean
σ
3.55
1.74
25.5% 20.19
56%
27.68
18.5% 21.37
6.11
4.70
Discussion
As it has been previously shown, serious games involving
building blocks can be used to promote social skills for children
with ASD [16][17][27]. But also, the results from our
experiment suggest that computer games can encourage more
social interaction and collaborative play than similar noncomputer games. Our conclusions are compatible with existing
works on the topic [3][7][9][32]. Having a more interactive
game seems to motivate children to work together on a common
goal. In the same way, TUIs provided additional help to enhance
the social benefits of the game. The children enjoyed
manipulating physical objects and seeing the effects on the
computer screen as a result of their actions. The latter finding
agrees with Farr et al. [27] and Sitdhisanguan et al. [26].
We also noted in our experiment that the children’s
performance was significantly better with the computer game as
opposed to the non-computer game. The visual and interactive
feedback offered by the computer allowed them to complete the
game’s levels faster as they were able to follow instructions
more easily and intuitively. However, there was one subject who
liked the negative feedback presented on the GUI and
consequently committed mistakes on purpose. One possible way
to resolve this issue in future iterations of the SG is to increase
the visual stimulation for success (e.g. display smiley faces,
confetti, and sounds) and reduce it for mistakes. Our results
support the notion that visual support is a very important factor
to consider when working with ASD children.
We found that the time the participants spent engaging in
other activities did not present a significant difference between
the two compared games. We think that the way the experiment
was set up might have affected this result. There were some
distractors in the room that interfered with the dynamics of the
games. For instance, since the parents were present at all times,
some of the children got distracted interacting with them, and
hence had some difficulty following instructions. Also, the
children did not have a prior relationship with the researcher
before the experiment. This might have made it more difficult
for them to trust her and follow her directions. Also, some of the
older and higher functioning participants lost interest in both
games after a few minutes, as the games were too easy for them.
This can be avoided by including more challenging levels and
using smaller blocks. Furthermore, because there were two
teams playing with different games at the same time, some of
the children wanted to play with the computer game while they
were supposed to be playing with the non-computer game.
As previously mentioned, the non-computer game we used
was based on LEGO® therapy [17]. However, we adapted the
game to allow for a comparison with the proposed computer
game. For instance, we did not use LEGO® blocks; instead we
used MEGA BLOKS® (bigger blocks). And even though we
tried to assign the roles of “Engineer and Builder” as proposed
by LeGoff, only one team was able to assume such roles. This
may have happened because the participants were not familiar
with the method and possibly needed more time to process the
rules. One of the parents suggested using hats with different
colours to help children differentiate between roles. We will
adopt this advice in future experiments.
There were some limitations to our experiment. Although we
observed statistically significant differences on several key
metrics between the non-computer and computer game, the
number of subjects employed limits our ability to generalize our
results. However, this is a common limitation among work on
the topic. Also, the experiment did not address long term
behavioral changes achieved with the help of the proposed SG.
Our immediate aim is to demonstrate the potential for such
games in encouraging social interaction and achieving a higher
level of engagement. Further investigation is required to study
long term effects of employing the proposed SG.
VI. CONCLUSIONS
In this paper, we propose a SG for children with ASD using
a combination of TUI hardware and GUI software. During our
experiments, we observed significant differences between the
proposed SG and a conventional non-computer game used for
play therapy. Similar to Farr et al. [27], we found that TUIs can
stimulate social interaction and collaborative play in children
with ASD. We observed that children engaged in less solitary
play and achieved better performance with the computer game.
Furthermore, we detected some short-term benefits for visual
feedback during play therapy. Our results suggest that using a
SG, consisting of a blocks-based TUI and a GUI, offers a
promising method that could be used in play therapy for young
children with ASD.
For future work, we intend to use a bigger sample size to see
if our results stand. And also, we will limit the age of participants
to 9 years old, since the older children did not show interest in
playing with big blocks.
APPENDIX - QUESTIONNAIRE
REFERENCES
[1]
American Psychiatric Association, “Autism Spectrum Disorder,”
Diagnostic and Statistical Manual of Mental Disorders, 5th ed.,
Arlington, VA: American Psychiatric Association, 2013, pp. 50-59.
[2]
Autism and Developmental Disabilities Monitoring Network,
“Community Report on Autism,” Centers for Disease Control and
Prevention, United States, 2016.
[3]
J.P. Hourcade et al., “Evaluation of tablet apps to encourage social
interaction in children with autism spectrum disorders,” Proc. of the
SIGCHI Conf. on Human Factors in Computing Systems. ACM, 2013.
[4]
G. Baird et al., “Prevalence of disorders of the autism spectrum in a
population cohort of children in South Thames: the Special Needs and
Autism Project (SNAP),” The lancet, vol. 368, no. 9531, pp. 210-215,
July 2006.
[5]
P. C. Ribeiro and A. B. Raposo. "ComFiM: a game for multitouch devices
to encourage communication between people with autism." Serious
Games and Applications for Health (SeGAH), 2014 IEEE 3rd Int. Conf.
IEEE, 2014.
[6]
C. Afonseca and S. Bermúdez. "Supporting collective learning
experiences in special education." Serious Games and Applications for
Health (SeGAH), 2013 IEEE 2nd Int. Conf. IEEE, 2013.
[7]
J.L. González et al., “Using videogames in special education,” Int. Conf.
on Computer Aided Systems Theory. Springer Berlin Heidelberg, 2007.
vol. 4739, pp. 360-367.
[26] K, Sitdhisanguan et al., “Using tangible user interfaces in computer-based
training systems for low-functioning autistic children,” Personal and
Ubiquitous Computing, vol. 16, no 2, pp. 143-155, 2012.
[8]
M. Griffiths, “The Educational Benefits of Videogames,” Education and
Health, vol. 20, no. 3, pp. 47-51, 2002.
[9]
K. Durkin et al., “Video Games for Children and Adolescents With
Special Educational Needs,” Zeitschrift für Psychologie, vol. 221, no. 2,
pp. 79-89, 2015.
[27] W. Farr et al., “Social benefits of a tangible user interface for children
with Autistic Spectrum Conditions,” Autism OnlineFirst, vol. 14, no. 3,
pp. 237-252, 2010.
[10] C.C. Abt, “Serious games: The art and science of games that simulate
life,” New Yorks Viking, 1970, p. 6.
[11] L. A. Hodgdon, “Visual Strategies for Improving Communication,”
Practical supports for school and home. Troy, MI: QuirkRoberts
Publishing, 1995.
[12] S. Egenfeldt-Nielsen et al., “Serious Games- When Entertainment is not
Enough,” Understanding video games: The essential introduction, 3th
ed., New York, NY: Routledge, 2009, pp. 205-222.
[13] L. Xie, Lesley et al., “Are tangibles more fun?: comparing children's
enjoyment and engagement using physical, graphical and tangible user
interfaces,” Proc. of the 2nd Int. Conf. on Tangible and Embedded
Interaction. ACM, 2008, pp. 191-198.
[14] A.H. Morgenthal, Child-Centered Play Therapy for Children with
Autism: A Case Study, Ph.D. dissertation, Clinical Psychology, Antioch
University New England, Keene, New Hampshire, 2015.
[15] D.B. LeGoff, “Use of LEGO© as a therapeutic medium for improving
social competence,” Journal of Autism and Developmental Disorders,
vol. 34, no. 5, pp. 557-571, 2004.
[16] D.B. LeGoff and M. Sherman, “Long-Term Outcome of Social Skills
Intervention Based on Interactive LEGO ® Play,” SAGE Publications
and The National Autistic Society, vol. 10, no 4, pp. 317-329 , 2006.
[17] D.B. LeGoff et al., LEGO®-Based Therapy: How to build social
competence through LEGO®-based Clubs for children with autism and
related conditions. Jessica Kingsley Publishers, 2014.
[18] B. Bossavit and S. Parsons, “"This is how I want to learn": High
Functioning Autistic Teens Co-Designing a Serious Game,” Proc. of the
2016 CHI Conf. on Human Factors in Computing Systems. ACM, 2016,
pp. 1294-1299.
[19] P. Cunha et al., “Augmented reality for cognitive and social skills
improvement in children with ASD,” 13th Int. Conf. on Remote
Engineering and Virtual Instrumentation (REV), Madrid, 2016, pp. 334335.
[20] B. Abirached et al. "Improving communication skills of children with
ASDs through interaction with virtual characters." Serious Games and
Applications for Health (SeGAH), 2011 IEEE 1st Int. Conf. IEEE, 2011.
[21] L.E. Boyd et al., “Evaluating a collaborative iPad game's impact on social
relationships for children with autism spectrum disorder,” ACM
Transactions on Accessible Computing (TACCESS), vol. 7, no 1, pp. 3,
2015.
[22] S. Fletcher-Watson et al., “Designing for young children with autism
spectrum disorder: A case study of an iPad app,” International Journal of
Child-Computer Interaction, vol. 7, pp. 1-14, 2016.
[23] D. Sturm et al. "eMot-iCan: Design of an assessment game for emotion
recognition in players with Autism." Serious Games and Applications for
Health (SeGAH), 2016 IEEE Int. Conf. IEEE, 2016.
[24] D. Moore et al., “Collaborative virtual environment technology for
people with autism,” Focus on Autism and Other Developmental
Disabilities, vol. 20, no 4, pp. 231-243, 2005.
[25] E.J. Carter et al., “Investigating the Influence of Avatar Facial
Characteristics on the Social Behaviors of Children with Autism,” Proc.
of the 2016 CHI Conf. on Human Factors in Computing Systems. ACM,
2016.
[28] O. Zuckerman et al.. “Flow blocks as a conceptual bridge between
understanding the structure and behavior of a complex causal system,”
Proc. of the 7th Int. Conf. on Learning Sciences. International Society of
the Learning Sciences, pp. 880-886, 2006.
[29] B. Robins and K. Dautenhahn, “Tactile Interactions with a Humanoid
Robot: Novel Play Scenario Implementations with Children with
Autism,” International Journal of Social Robotics, vol. 6, no. 3, pp. 397415, 2014.
[30] B. Robins et al. “Tactile interaction with a humanoid robot for children
with autism: A case study analysis involving user requirements and
results of an initial implementation." 19th Int. Symp. in Robot and Human
Interactive Communication. IEEE, pp. 704-711, 2010.
[31] D.C.M. François, Facilitating play between children with autism and an
autonomous robot, Ph.D. dissertation, School of Computer Science,
Faculty of Engineering and Information Sciences, University of
Hertfordshire, UK, 2008.
[32] A. Hiniker et al., “Go go games: therapeutic video games for children
with autism spectrum disorders,” Proc. of the 12th Int. Conf. on
Interaction Design and Children. ACM, 2013, pp. 463-466.