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‘Gaming Seriously!’: A Systematic Review and Meta-Analysis of the Influence of Serious Game Elements on the Effectiveness of Social-Emotional Computer Based Interventions in Autism
The utility of Serious Games as a tool to target social emotional skills of individuals on the autism spectrum is increasingly explored in research. Current application of Serious Game features in computer-based interventions (CBI) in autism are heterogeneous, likely attributed to the limited frameworks outlining the most salient autism specific design features. Further understanding is required to examine the potential application of Serious Game design principles in improving the effectiveness of social emotional CBI for individuals on the autism spectrum.
Objectives:
This review aimed to evaluate the potential impact of Serious Game design in enhancing the effectiveness of social emotional CBI in autism. The objectives were to (1) develop an assessment tool to quantitatively evaluate the design of Serious Games based on an existing framework by Whyte et al. (2014), (2) provide a conceptual systematic review of the design quality of social emotional CBI in autism, (3) and to evaluate the potential moderating influence of Serious Game design principles in improving social emotional outcomes for individuals on the autism spectrum.
Methods:
The Serious Game Assessment Tool was developed through reviewing the five Serious Games principles previously outlined by Whyte et al. (2014). The five principles included motivating storyline, goal-directed learning, rewards and feedback, progression in levels of difficulty and individuation. Operational definitions and a grading system for each Serious Game principles were developed and tested for reliability. Five electronic databases were then searched with the main keywords “autism”, “social”, “emotion”, and “computer” to retrieve relevant experimental studies evaluating social emotional CBI for individuals on the autism spectrum. With the developed Serious Game Assessment tool, a conceptual review and summary of the design features of social emotional CBI was conducted. Dependent measures relating to social emotional outcomes; close generalisation, distant generalisation, transferability to other skills, maintenance and engagement were extracted. Effect sizes were calculated and analysed using random effects model. Meta-regressions were conducted to examine the moderating influence of Serious Game design principles on social emotional outcomes.
Results:
A total of 28 experimental designs evaluating 18 existing CBI were retrieved. The application of Serious Game design was heterogeneous between interventions and few consistently incorporated Serious Game design elements (average percentage of Serious Game design application was 47%). Fifteen experimental design studies with a control group were retrieved for meta-analysis. Results indicated significant effects for CBI improving the social emotional skills for individuals on the autism spectrum (close generalisation: g = 0.69, CI =0.49-0.88, p<.001; distant generalisation: g = 0.48, CI =0.11-0.85, p<.001; transferability: g = 0.36, CI =-0.00-0.72, p=.05). Of central interest, a moderating influence of Serious Game design principles enhancing CBI-related distant generalisation outcomes was found (g = 0.33, p =.03).
Conclusions:
The findings demonstrate the importance of considering Serious Game design principles for the development of CBI in autism. The Serious Game Assessment Tool developed as part of this review may provide helpful guidance for the systematic evaluation of existing CBIs and for the prospective development of social emotional interventions.