'Emotiplay': a serious game for learning about emotions in children with autism: results of a cross-cultural evaluation

Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies

Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.

Gamified Environments and Serious Games for Students With Autistic Spectrum Disorder: Review of Research

The aim of this study is to review the available research (N = 70) derived from the use of Gamified Environments and Serious Games with people with Autistic Spectrum Disorder (ASD), identifying: authorship, nationality, publication period, topic, and design of the investigation. After that, the advantages and limitations observed are identified. Results indicate that most of them are focused on the design and testing of prototypes, (mostly) linked to the increase of social and emotional skills. The revision highlights that the game's mechanics and dynamics (feedback, rewards, missions, etc.) involve students from motivation. There is unanimous agreement to emphasize the positive impact of these resources to increment self-control, self-conscience, autonomy, and empathy.

Technology for supporting emotion regulation of individuals with developmental disabilities: A scoping review

BACKGROUND

Emotional competencies are skills necessary to adequately understand, express, and regulate emotional phenomena. Among the emotional competencies is emotion regulation. Not having adequate development of this emotional competence is related to psychological problems such as depression. One of the characteristics of individuals with developmental disabilities is the presence of difficulties with emotion regulation. These difficulties can affect an individual's autonomy, social competence, and the development of independent life.

AIMS

This paper presents a scoping review to identify the technology designed and developed to support the emotion regulation of individuals with developmental disabilities.

METHODS AND PROCEDURES

We combined the guidelines for a systematic literature review in computer science and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The process resulted in twelve stages through which we conducted this scoping review. First, a search query was defined and executed in computer science's five most representative search engines. We used different inclusion, exclusion, and quality criteria for selecting the works included in this review.

OUTCOMES AND RESULTS

Thirty-nine papers aimed at supporting the emotional competencies of individuals with developmental disabilities were included, of which nine support emotion regulation. As a result, different areas of opportunity in developing technology to support the emotion regulation of individuals with developmental disabilities are discussed.

CONCLUSIONS AND IMPLICATIONS

Technology supporting emotion regulation in individuals with developmental disabilities is a growing but little-explored field. For the literature supporting emotion regulation, we detected opportunities for study. Some of them aimed at investigating whether we could use technologies developed for other emotional competencies to support emotion regulation and how the characteristics of this technology can support individuals with developmental disabilities.

Serious Games in the new era of digital-health interventions: A narrative review of their therapeutic applications to manage neurobehavior in neurodevelopmental disorders

Children and adolescents with neurodevelopmental disorders generally show adaptive, cognitive and motor skills impairments associated with behavioral problems, i.e., alterations in attention, anxiety and stress regulation, emotional and social relationships, which strongly limit their quality of life. This narrative review aims at providing a critical overview of the current knowledge in the field of serious games (SGs), known as digital instructional interactive videogames, applied to neurodevelopmental disorders. Indeed, a growing number of studies is drawing attention to SGs as innovative and promising interventions in managing neurobehavioral and cognitive disturbs in children with neurodevelopmental disorders. Accordingly, we provide a literature overview of the current evidence regarding the actions and the effects of SGs. In addition, we describe neurobehavioral alterations occurring in some specific neurodevelopmental disorders for which a possible therapeutic use of SGs has been suggested. Finally, we discuss findings obtained in clinical trials using SGs as digital therapeutics in neurodevelopment disorders and suggest new directions and hypotheses for future studies to bridge the gaps between clinical research and clinical practice.

Evaluation of the Effect of a Serious Game on the Performance of Daily Routines by Autistic and ADHD Children

Objectives

Learning and performing new routines are difficult for children with neurodevelopmental disorders. Studies have shown that consistency in child reinforcement and parental support are effective. For example, digital solutions such as serious games can be used to support parents and children in developing these life skills. The objective of this study was to evaluate the effect of a serious game on the performance of daily routines by autistic and ADHD children.

Methods

A total of 201 families (parents and children) participated in the study. The study used a combined 3 (intervention) × 3 (diagnosis) × 3 (time) research design with repeated measures. Participants were randomly assigned to three intervention groups (serious game, parental support, and a combination of serious game and parental support) based on their diagnosis (ASD, ADHD, neurotypical). Latent growth modeling and repeated ANOVAS were performed to analyze routine scores collected at three moments (baseline, midpoint, persistence) over an 8-week period.

Results

Results show a moderating effect of diagnosis on child routine trajectory. For ADHD participants, we observed a very important significant clinical effect for two interventions (parental support alone and combination of serious game and parental support) where for ASD children, this effect is observed for only one treatment (combination of serious game and parental support). For neurotypical children, results indicate a very important and significant clinical effect when they use the serious game alone.

Conclusions

Results show that the serious game can improve children's routines. However, for some neurodevelopmental profiles (ASD or ADHD), the addition of parental support produces greater clinical improvements.

Features and effects of computer-based games on cognitive impairments in children with autism spectrum disorder: an evidence-based systematic literature review

INTRODUCTION

Children with Autism Spectrum Disorder (ASD) have different cognitive and intelligence profiles than typical developing individuals. Some of these children need cognitive rehabilitation. This study's main purpose is to provide a systematic review about applying computerized cognitive games for autistic children and to determine the effectiveness of such interventions.

MATERIAL AND METHODS

A thorough search of the ISI Web of Science, Medline (through PubMed), Scopus, IEEE Xplore, and APA PsycInfo databases was performed for articles published from inception to May 17, 2022.

RESULTS

Of 1746 papers, 28 studies were found to be eligible in this systematic review. Fifteen studies (53.57%) compared a Control Group (CG) with Experimental Groups (EGs), while 13 papers (46.42%) evaluated only the impact of the applied intervention in an experimental group. Major domains of cognitive functions are divided into five main categories: 1. Executive functions, 2. Social cognition/emotions, 3. Attention/concentration, 4. Learning and memory, and 5. Language. In 42.85% (12 studies) of the screened papers, social cognition and emotions were assessed after cognitive rehabilitation. The highest rate of effects reported by studies were related to social cognition enhancement. Of the total number of included studies, 17 studies reported a positive effect at all scales, of which nine were quasi-experimental, and seven were fully experimental.

CONCLUSION

Using suitable computerized game-based solutions could enhance cognition indexes in autistic children. Hence, further investigation is needed to determine the real effectiveness of these novel technologies.

Emo-mirror: a proposal to support emotion recognition in children with autism spectrum disorders

Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined as persistent difficulty in maturing the socialization process. Health professionals have used traditional methods in the therapies performed on patients with the aim of improving the expression of emotions by patients. However, they have not been sufficient to detect the different emotions expressed in the face of people according to different sensations. Therefore, different artificial intelligence techniques have been applied to improve the results obtained in these therapies. In this article, we propose the construction of an intelligent mirror to recognize five basic emotions: angry, scared, sad, happy and neutral. This mirror uses convolutional neural networks to analyze the images that are captured by a camera and compare it with the one that the patient should perform, thus supporting the therapies performed by health professionals in children with ASD. The proposal presents the platform and computer architecture, as well as the evaluation by specialists under the technology acceptance model.

Fully robotic social environment for teaching and practicing affective interaction: Case of teaching emotion recognition skills to children with autism spectrum disorder, a pilot study

21st century brought along a considerable decrease in social interactions, due to the newly emerged lifestyle around the world, which became more noticeable recently of the COVID-19 pandemic. On the other hand, children with autism spectrum disorder have further complications regarding their social interactions with other humans. In this paper, a fully Robotic Social Environment (RSE), designed to simulate the needed social environment for children, especially those with autism is described. An RSE can be used to simulate many social situations, such as affective interpersonal interactions, in which observational learning can take place. In order to investigate the effectiveness of the proposed RSE, it has been tested on a group of children with autism, who had difficulties in emotion recognition, which in turn, can influence social interaction. An A-B-A single case study was designed to show how RSE can help children with autism recognize four basic facial expressions, i.e., happiness, sadness, anger, and fear, through observing the social interactions of two robots speaking about these facial expressions. The results showed that the emotion recognition skills of the participating children were improved. Furthermore, the results showed that the children could maintain and generalize their emotion recognition skills after the intervention period. In conclusion, the study shows that the proposed RSE, along with other rehabilitation methods, can be effective in improving the emotion recognition skills of children with autism and preparing them to enter human social environments.

A Virtual Reality Based System for the Screening and Classification of Autism

Autism - also known as Autism Spectrum Disorders or Autism Spectrum Conditions - is a neurodevelopmental condition characterized by repetitive behaviours and differences in communication and social interaction. As a consequence, many autistic individuals may struggle in everyday life, which sometimes manifests in depression, unemployment, or addiction. One crucial problem in patient support and treatment is the long waiting time to diagnosis, which was approximated to thirteen months on average. Yet, the earlier an intervention can take place the better the patient can be supported, which was identified as a crucial factor. We propose a system to support the screening of Autism Spectrum Disorders based on a virtual reality social interaction, namely a shopping experience, with an embodied agent. During this everyday interaction, behavioral responses are tracked and recorded. We analyze this behavior with machine learning approaches to classify participants from an autistic participant sample in comparison to a typically developed individuals control sample with high accuracy, demonstrating the feasibility of the approach. We believe that such tools can strongly impact the way mental disorders are assessed and may help to further find objective criteria and categorization.

Interventions with Serious Games and Entertainment Games in Autism Spectrum Disorder: A Systematic Review

The use of serious games and entertainment games was compared as adjuvant tools for intervention in Autism Spectrum Disorder (ASD). A comprehensive search was performed in the MEDLINE, PsycINFO, Scopus, and Web of Science databases. From 295 studies, 53 studies were selected and included in this review. Overall, studies showed improvement after intervention, regardless of the type of video games, mostly for social skills and behavior. However, these changes should be regarded with caution, as they are limited to the tests applied. Furthermore, neither the entertainment nor the serious approach had a therapeutic impact on emotional resilience, representing the current gap in the field. Thus, even considering the limitations, our study is important because it shows that both categories have strengths.

Video Games for the Treatment of Autism Spectrum Disorder: A Systematic Review

Video games are a promising area of intervention for children diagnosed with Autism Spectrum Disorders (ASD). However, reviews on this topic are scarce. This review on studies exploring video games for the treatment of ASD followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and its protocol was registered in PROSPERO. PubMed, PsycInfo, Embase, WebOfScience and clinicaltrials.gov databases were searched. Twenty-four articles were included in the review. Video game-based interventions were effective for alleviating ASD symptoms, albeit with small effect sizes. High rates of acceptability and adherence to treatment were obtained. Conclusion: Video games are a promising area for improving the treatment of children with ASD. Exploring commercial video games is one of the lines for future research.

Adverse event reporting in intervention research for young autistic children

LAY ABSTRACT

In this study, we looked at published research on interventions for young autistic children that did not involve administering medication. We were interested in determining how often studies reported on whether adverse events (i.e. physical or psychological distress to the participants) or adverse effects (i.e. adverse events that are thought to be caused by the intervention) had occurred. We found that of the 150 reports we examined, only 11 mentioned adverse events. One of these studies reported adverse events occurred, and three reported that adverse effects occurred. We also reviewed the studies to examine the reasons that were given to explain why any participants dropped out of the intervention (termed "withdrawal"), to determine if any of these reasons could be considered adverse events or adverse effects. Fifty-four studies described reasons for withdrawal, and 10 of these studies had reasons that could be categorized as an adverse event, 8 studies had reasons that could be categorized as an adverse effect, and an additional 12 studies had reasons that were too vaguely described to determine whether they were adverse events or not. We recommend that autism intervention researchers develop more systematic methods of looking for and reporting adverse events and effects, so that professionals and families can be better informed when choosing to enroll their autistic children in interventions.

Digital Gaming Interventions in Psychiatry: Evidence, Applications and Challenges

Human evolution has regularly intersected with technology. Digitalization of various services has brought a paradigm shift in consumerism. Treading this path, mental health practice has gradually moved to Digital Mental Health Interventions (DMHI), to improve service access and delivery. Applied games are one such innovation that has gained recent popularity in psychiatry. Based on the principles of gamification, they target psychosocial and cognitive domains, according to the deficits in various psychiatric disorders. They have been used to deliver cognitive behaviour therapy, cognitive training and rehabilitation, behavioural modification, social motivation, attention enhancement, and biofeedback. Research shows their utility in ADHD, autistic spectrum disorders, eating disorders, post-traumatic stress, impulse control disorders, depression, schizophrenia, dementia, and even healthy aging. Virtual reality and artificial intelligence have been used in conjunction with gaming interventions to improvise their scope. Even though these interventions hold promise in engagement, ease of use, reduction of stigma, and bridging the mental-health gap, there are pragmatic challenges, especially in developing countries. These include network quality, infrastructure, feasibility, socio-cultural adaptability, and potential for abuse. Keeping this in the background, this review summarizes the scope, promise, and evidence of digital gaming in psychiatric practice, and highlights the potential caveats in their implementation.

Digital Interventions for Autism Spectrum Disorder: A Meta-analysis

This study aimed to review digital interventions in the treatment of autism spectrum disorder (ASD). A systematic review and meta-analysis was conducted. Nineteen studies were included. The interventions aimed to improve social skills (n = 11), developmental skills (n = 2) and 6 other different targets. Technology used were computer programs (n = 14), tablet apps (n = 3), a robot (n = 1) and an interactive DVD (n = 1). The meta-analysis resulted in an overall effect size (Cohen's d) of 0.32 [0.12-0.51], indicating a small effect. Heterogeneity between studies was high (I² = 100%), limiting the generalization of results. Therefore, we recommend larger RCT studies, and guidelines for the development of trials evaluating digital interventions for ASD, for making comparison of future studies possible.Registration can be found online at Prospero: https://www.crd.york.ac.uk/prospero/ , registration no. CRD42020146542.

Measuring change in facial emotion recognition in individuals with autism spectrum disorder: A systematic review

LAY ABSTRACT

Children and adults with autism spectrum disorder show difficulty recognizing facial emotions in others, which makes social interaction challenging. While there are many treatments developed to improve facial emotion recognition, there is no agreement on the best way to measure such abilities in individuals with autism spectrum disorder. The purpose of this review is to examine studies that were published between January 1998 and November 2019 and have measured change in facial emotion recognition to evaluate the effectiveness of different treatments. Our search yielded 65 studies, and within these studies, 36 different measures were used to evaluate facial emotion recognition in individuals with autism spectrum disorder. Only six of these measures, however, were used in different studies and by different investigators. In this review, we summarize the different measures and outcomes of the studies, in order to identify promising assessment tools and inform future research.

Data-Driven Diagnostics and the Potential of Mobile Artificial Intelligence for Digital Therapeutic Phenotyping in Computational Psychiatry

Data science and digital technologies have the potential to transform diagnostic classification. Digital technologies enable the collection of big data, and advances in machine learning and artificial intelligence enable scalable, rapid, and automated classification of medical conditions. In this review, we summarize and categorize various data-driven methods for diagnostic classification. In particular, we focus on autism as an example of a challenging disorder due to its highly heterogeneous nature. We begin by describing the frontier of data science methods for the neuropsychiatry of autism. We discuss early signs of autism as defined by existing pen-and-paper-based diagnostic instruments and describe data-driven feature selection techniques for determining the behaviors that are most salient for distinguishing children with autism from neurologically typical children. We then describe data-driven detection techniques, particularly computer vision and eye tracking, that provide a means of quantifying behavioral differences between cases and controls. We also describe methods of preserving the privacy of collected videos and prior efforts of incorporating humans in the diagnostic loop. Finally, we summarize existing digital therapeutic interventions that allow for data capture and longitudinal outcome tracking as the diagnosis moves along a positive trajectory. Digital phenotyping of autism is paving the way for quantitative psychiatry more broadly and will set the stage for more scalable, accessible, and precise diagnostic techniques in the field.

The genetic and environmental origins of emotional and cognitive empathy: Review and meta-analyses of twin studies

Empathy is considered a cornerstone of human social experience, and as such has been widely investigated from psychological and neuroscientific approaches. To better understand the factors influencing individual differences in empathy, we reviewed and meta-analyzed the behavioral genetic literature of emotional empathy- sharing others' emotions (k=13), and cognitive empathy- understanding others' emotions (k = 15), as manifested in twin studies. Results showed that emotional empathy is more heritable, 48.3 % [41.3 %-50.6 %], than cognitive empathy, 26.9 % [18.1 %-35.8 %]. Moreover, cognitive empathy as examined by performance tests was affected by the environment shared by family members, 11.9 % [2.6 %-21.0 %], suggesting that emotional understanding is influenced, to some degree, by environmental factors that have similar effects on family members beyond their genetic relatedness. The effects of participants' age and the method used to asses empathy on the etiology of empathy were also examined. These findings have implications for understanding how individual differences in empathy are formed. After discussing these implications, we suggest theoretical and methodological future research directions that could potentially elucidate the relations between genes, brain, and empathy.

Therapeutic and Preventive Use of Video Games in Child and Adolescent Psychiatry: A Systematic Review

BACKGROUND

Over the past decade, the use of commercial video games and serious games has developed in child and adolescent psychiatry. These games may become relevant alternatives or adjuncts to traditional psychotherapy, providing that their effectiveness is properly established. The purpose of this literature review was to evaluate the effectiveness of serious games and commercial video games in the treatment or prevention of psychiatric disorders in children and adolescents.

METHODS

Medline's database was used to search articles published between January 2012 and July 2019. The following keywords were used for this search: "Video games" OR "Active video game" OR "serious gaming" OR "Serious game" OR "Exergame" AND "Child mental disorder" OR "Adolescent" OR "Child" AND "Therapy" OR "Prevention". Only comparative studies which targeted interventions on children and adolescents suffering from psychiatric disorders were included.

RESULTS

Twenty-two studies, focusing on a wide range of psychiatric conditions, met our inclusion criteria's: 14 evaluated serious games and 8 commercial games. All studies were randomized controlled trials but only two studies compared the intervention game to psychotherapeutic gold standard; other studies used a no-intervention control group or an alternative game as the control group. Eighteen studies reported significant improvements on the symptoms and test scores targeted.

CONCLUSION

Serious games and commercially available video games can be an effective trajectory for psychotherapy in child and adolescent psychiatry. However, there is a lack of longitudinal studies which assess the sustained effects of these games, and standards for proper evaluation of their effectiveness are missing.

Serious Game-based Intervention for Children with Developmental Disabilities

BACKGROUND

Children with developmental disabilities may need support with motor skills such as balance improvement, cognitive skills such as vocabulary learning, or social skills such as adequate interpretation of emotional expressions. Digital interactive games could support the standard treatments. We aimed to review clinical studies which investigated the application of serious games in children with developmental disabilities.

METHODS

We searched MEDLINE and Scopus on 05 May 2019 limited to the English language. We included people between two and 24 years of age who were affected by neurodevelopmental disorders and who received digital serious game-based medical interventions such as any computer- based or video-based games. We considered any study design reporting primary data. We used title, abstract, and full-text of journal articles to build diagnostic groups, and we described some selected specific game applications.

RESULTS

The majority of the 145 relevant studies reported on autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), developmental coordination disorder (DCD), and disabilities affecting intellectual abilities (DAIA). 30 of the 145 studies reported a randomized design. We detailed six specific applications aimed at improving abilities in children with ASD, ADHD, cerebral palsy, and Down syndrome. We visualized the diagnostic groups by bibliographic mapping, and limited the text to the title and abstract of journal articles.

CONCLUSION

We identified promising results regarding anxiety reduction, stress regulation, emotion recognition, and rehabilitation. Currently, there appears to be a lack of clinical evidence that children with neurodevelopmental disorders can benefit from the application of serious games.

The Effectiveness of Web-Based Interventions Delivered to Children and Young People With Neurodevelopmental Disorders: Systematic Review and Meta-Analysis

BACKGROUND

The prevalence of certain neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), has been increasing over the last four decades. Nonpharmacological interventions are available that can improve outcomes and reduce associated symptoms such as anxiety, but these are often difficult to access. Children and young people are using the internet and digital technology at higher rates than any other demographic, but although Web-based interventions have the potential to improve health outcomes in those with long-term conditions, no previous reviews have investigated the effectiveness of Web-based interventions delivered to children and young people with neurodevelopmental disorders.

OBJECTIVE

This study aimed to review the effectiveness of randomized controlled trials (RCTs) of Web-based interventions delivered to children and young people with neurodevelopmental disorders.

METHODS

Six databases and one trial register were searched in August and September 2018. RCTs were included if they were published in a peer-reviewed journal. Interventions were included if they (1) aimed to improve the diagnostic symptomology of the targeted neurodevelopmental disorder or associated psychological symptoms as measured by a valid and reliable outcome measure; (2) were delivered on the Web; (3) targeted a youth population (aged ≤18 years or reported a mean age of ≤18 years) with a diagnosis or suspected diagnosis of a neurodevelopmental disorder. Methodological quality was rated using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs.

RESULTS

Of 5140 studies retrieved, 10 fulfilled the inclusion criteria. Half of the interventions were delivered to children and young people with ASDs with the other five targeting ADHD, tic disorder, dyscalculia, and specific learning disorder. In total, 6 of the 10 trials found that a Web-based intervention was effective in improving condition-specific outcomes or reducing comorbid psychological symptoms in children and young people. The 4 trials that failed to find an effect were all delivered by apps. The meta-analysis was conducted on five of the trials and did not show a significant effect, with a high level of heterogeneity detected (n=182 [33.4%, 182/545], 5 RCTs; pooled standardized mean difference=-0.39; 95% CI -0.98 to 0.20; Z=-1.29; P=.19 [I²=72%; P=.006]).

CONCLUSIONS

Web-based interventions can be effective in reducing symptoms in children and young people with neurodevelopmental disorders; however, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and small samples of included studies. Overall, the number of studies was small and mainly limited to ASD, thus restricting the generalizability of the findings.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews: CRD42018108824; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108824.

Social Cognition in Autism and Other Neurodevelopmental Disorders: A Co-twin Control Study

Alterations in social cognition (SC) are hypothesized to underlie social communication and interaction challenges in autism spectrum disorder (ASD). The aetiological underpinnings driving this association remain unclear. We examined SC in 196 twins with ASD, other neurodevelopmental disorders or typical development using the naturalistic Movie for the Assessment of Social Cognition. Autism and its severity were assessed with the Autism Diagnostic Observation Schedule-2, and autistic traits with the Social Responsiveness Scale-2. Using within twin-pair regression models, controlling for age, sex, IQ, and unmeasured familial confounders such as genetic background and shared-environment, SC correlated with ASD diagnosis, autism severity, and autistic traits. Our findings highlight the importance of SC alterations in autism and suggest a non-shared environmental impact on the association.

Designing a Serious Game for Youth with ASD: Perspectives from End-Users and Professionals

Recent years have seen an emergence of social emotional computer games for individuals with Autism Spectrum Disorder (ASD). These games are heterogeneous in design with few underpinned by theoretically informed approaches to computer-based interventions. Guided by the serious game framework outlined by Whyte et al. (Journal of Autism and Developmental Disorders 45(12):1-12, 2014), this study aimed to identify the key motivating and learning features for serious games targeting emotion recognition skills from the perspectives of 11 youth with ASD and 11 experienced professionals. Results demonstrated that youth emphasised the motivating aspects of game design, while the professionals stressed embedding elements facilitating the generalisation of acquired skills. Both complementary and differing views provide suggestions for the application of serious game principles in a potential serious game.

ICT and autism care: state of the art

PURPOSE OF REVIEW

Over the past 10 years, the use of information and communication technologies (ICTs) has increased in regard to the treatment of individuals with autism spectrum disorders (ASDs). ICT support mechanisms (e.g. computers, laptops, robots) are particularly attractive and are adapted to children with ASD. In addition, ICT algorithms can offer new perspectives for clinicians, outside direct apps or gaming proposals. Here, we will focus on the use of serious games and robots because of their attractiveness and their value in working on social skills.

RECENT FINDINGS

The latest knowledge regarding the use of ICT in the forms of serious games and robotics applied to individuals with ASD shows that the field of serious games has already achieved interesting and promising results, although the clinical validations are not always complete. In the field of robotics, there are still many limitations on the use of ICT (e.g. most interaction are similar to the wizard of Oz), and questions remain concerning their eventual effectiveness.

SUMMARY

To describe the implications of the findings for clinical practice or research, we describe two large projects, namely, JEMImE and Michelangelo, as examples of current studies that are aimed at enhancing social skills in children with ASD by including novel algorithms with clinical insights in robots or serious games.

Emotional prosodic change detection in autism Spectrum disorder: an electrophysiological investigation in children and adults

Background

Autism spectrum disorder (ASD) is characterized by atypical behaviors in social environments and in reaction to changing events. While this dyad of symptoms is at the core of the pathology along with atypical sensory behaviors, most studies have investigated only one dimension. A focus on the sameness dimension has shown that intolerance to change is related to an atypical pre-attentional detection of irregularity. In the present study, we addressed the same process in response to emotional change in order to evaluate the interplay between alterations of change detection and socio-emotional processing in children and adults with autism.

Methods

Brain responses to neutral and emotional prosodic deviancies (mismatch negativity (MMN) and P3a, reflecting change detection and orientation of attention toward change, respectively) were recorded in children and adults with autism and in controls. Comparison of neutral and emotional conditions allowed distinguishing between general deviancy and emotional deviancy effects. Moreover, brain responses to the same neutral and emotional stimuli were recorded when they were not deviants to evaluate the sensory processing of these vocal stimuli.

Results

In controls, change detection was modulated by prosody: in children, this was characterized by a lateralization of emotional MMN to the right hemisphere, and in adults, by an earlier MMN for emotional deviancy than for neutral deviancy. In ASD, an overall atypical change detection was observed with an earlier MMN and a larger P3a compared to controls suggesting an unusual pre-attentional orientation toward any changes in the auditory environment. Moreover, in children with autism, deviancy detection depicted reduced MMN amplitude. In addition in children with autism, contrary to adults with autism, no modulation of the MMN by prosody was present and sensory processing of both neutral and emotional vocal stimuli appeared atypical.

Conclusions

Overall, change detection remains altered in people with autism. However, differences between children and adults with ASD evidence a trend toward normalization of vocal processing and of the automatic detection of emotion deviancy with age.

Influence of anxiety and alexithymia on brain activations associated with the perception of others' pain in autism

The circumstances under which empathy is altered in ASD remain unclear, as previous studies did not systematically find differences in brain activation between ASD and controls in empathy-eliciting paradigms, and did not always monitor whether differences were primarily due to ASD "per se", or to conditions overlapping with ASD, such as alexithymia and anxiety. Here, we collected fMRI data from 47 participants (22 ASD) viewing pictures depicting hands and feet of unknown others in painful, disgusting, or neutral situations. We computed brain activity for painful and disgusting stimuli (vs. neutral) in whole brain and in regions of interest among the brain areas typically activated during the perception of nociceptive stimuli. Group differences in brain activation disappeared when either alexithymia or anxiety - both elevated in the ASD group - were controlled for. Regression analyses indicated that the influence of symptoms was mainly shared between autistic symptomatology, alexithymia and anxiety or driven by unique contributions from alexithymia or anxiety. Our results suggest that affective empathy may be affected in ASD, but that this association is complex. The respective contribution of alexithymia and anxiety to decreased affective empathy of people with ASD may be due to the association of those psychiatric conditions with reduced motor resonance/Theory of Mind.

Emotional preferences and goals and emotion dysregulation in children with Asperger's syndrome and typically developing children

OBJECTIVES

Emotion goals lie at the heart of emotion regulation, as people have to first decide what emotions they want to feel before engaging in emotion regulation. Given that children with Asperger's syndrome (AS) are characterized by exhibiting difficulties in emotion regulation, studying whether they display similar or different emotion goals compared to typically developing (TD) children may provide insightful information.

METHODS

Thirty AS and 30 TD children (10-12 years) reported about their general (i.e., how they want to feel in general) and contextualized (i.e., how they want to feel when confronting vs. collaborating with someone) emotion goals, and about their difficulties in emotion regulation through questionnaires.

RESULTS

Results showed that both groups did not differ in their general emotional goals and in their contextualized emotion goals for happiness for collaboration and anger for confrontation. AS children only differed from TD children in a higher preference for sadness for collaboration and happiness for confrontation. These emotion goals predicted their difficulties to engage in goal-directed behaviour.

CONCLUSIONS

The obtained results support the need to further study emotion goals as an aspect of emotion dysregulation, namely the difficulties to engage in goal-directed behaviour when experiencing different emotions.

PRACTITIONER POINTS

AS and TD children did not differ in their general emotion goals. AS and TD children did not vary in their preferences for happiness for collaboration and anger for confrontation. AS children only differed in a higher preference for sadness for collaboration and happiness for confrontation. Understanding emotion goals might help practitioners to develop better interventions.