Electronic Gaming and ASD with Annotated Bibliography

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John Hobbs
Dr. Chiara Cillerai
English Composition
10/27/15
Autism Spectrum Disorder and Electronic Gaming
Autism Spectrum Disorder (furthermore with be referred to as ASD) is a developmental
disorder that impairs an individual’s ability to communicate, interact, and comprehend. Even
though mental health awareness is increasing in the international community, it is still not where
it should be. A way to combat the effects of ASD in children is socialization, and recent studies
have shown modern technology may be an available tool in doing so. This paper will discuss the
possible use of electronic games as a means of treatment for children with Autism Spectrum
Disorder. I will bring into question whether or not engagement with video or computer games in
a controlled environment can help a child with ASD with their anxiety, behavior, socialization,
and education.
Education in the life of a child with ASD is crucial in relieving some of the social, and
mechanical ailments that might halter the child. Most children with ASD suffer from anxiety,
speech impediments, and coherency. While with adults who suffer from the disorder, I have
learned that their perception of quantity, time, sequences, and numbers in general can be very
different from a normal functioning individual’s. What this all means is that a child with ASD
may not be able perceive the quantity of the number one, or the sequence that one plus one
equals two. Even though the idea of “one” may seem like immediate knowledge to a non-
affected child, a child with ASD may need some outside intervention for them to be able to fully
comprehend the concept.
In the study “Autism and tablet computers in Turkey: Teaching picture sequencing skills
via a web-based iPad application” researchers attempt to implement electronic gaming into the

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afterschool curriculum of autistic children. Even though such attempts have been made with non-
technological means the researchers in Turkey hold that, “Children with autism were more
attentive, more motivated, and learned more vocabulary with educational software programs of a
computer” (Doeynas 61). Their hopes are to augment the ASD lesson plan in order to better
teach children sequencing. The Turkish researchers developed the iPad app with the specific
purpose of teaching sequencing to students with ASD. The app was meant to act as supplement
to the children’s school curriculum, and the research took place after school. Even though the
test took place in Turkey, and their education system differs from the United States, researcher
say, “Individuals with autism show similar behavioral impairments and share similar learning
characteristics all around the world” (Doeynas 60).
The idea of sequencing in this case has more of a social aspect to it. Most students with
ASD are extremely dependent on others for simple tasks. Daily chores such as getting dressed,
brushing their teeth, and sometimes eating does not come easy to them. The developed app seeks
to educate these children on the appropriate sequencing for such events. The application was
tested on three boys and was broken up into two tests. The first test offered no prompts or
rewards for successful play, while the second offered rewards, prompts and demonstrations of
correct responses. A baseline of the students sequencing skills was taken followed by a teaching
session, and then another testing session. The 11-year-old boy’s sequencing improved without
external help, the 4 year old needed external help, and the 14 year old found the app’s task too
simple (Doeynas 69).
The research in Turkey showed the iPad applications, when used in the right setting, and
aimed at the right age, can have some use in educating children with ASD. I would like to bring
up how the game was found to be less effective for the 11-year-old participant and the 4-year-old

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participant. This shows that games used in ASD intervention should be age appropriate, and
should cater to the needs of the child player. If the game proves to be too advance it will have
little effect on the child, and the same goes if the game is too simple. Electronic gaming as a
means to supplement socialization and education in adolescent ASD needs to monitored, and
should not be generalized to cover all demographics within the ASD community.
With the idea of structured game play in mind, research through Cladwell College seeks
to strengthen this claim. In the study “Teaching Children with Autism to Play Video Games
Using Activity Schedules and Game-Embedded Simultaneous Video Modeling” researchers seek
to discover whether or not structured game play can be used as a learning tool in the adolescent
ASD community. Along with educational purposes, this study hopes to have a social impact on
the youngsters lives, “Children with autism or other disabilities who can play games with their
peers have increased opportunities to learn social skills from their peer interactions and may also
improve their motor skills” (Blum-Dimaya 351). The idea of an activity schedule also brings into
play the creation of stability and independence in the child’s life. The idea being that the
schedules would reduce the player’s dependency on the instructor’s direction to complete the
task. The video modeling will provide visual direction for the child to follow in completing the
game (Blum-Dimaya 352).
The participants of the study were 3 boys and 1 girl; all of them had the motor skills
necessary to distinguish colors, manipulate the controller for the video game Guitar Hero, and
had previously used activity schedules for other learning tasks (Blum-Dimaya 352). The study
followed an ABA style guide, which first established a baseline of their skills at Guitar Hero, and
then implemented supplemental direction through the video game modeling. Each student stuck
to his or her gaming schedule, and this yielded results that surpassed the expectations of the

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researchers. The children showed a level of mastery over the game that was not expected of
them, seeing how the premise of the study focused on socialization, minimal motor skills, and
leisure skills (Blum-Dimaya 3677).
The results of the Caldwell study shows that proper scheduling of video game use can, in
certain cases, lead to improvement in leisure skills, motor skills, and overall socialization. I
would like to stress that these results were obtained because the students closely followed their
gaming schedules. One thing that a child with ASD needs in their lives is consistency. With
video game modeling the children were able to reap the benefits of video game use. The children
that participated in this study were able to gain a sense of control and independence in their lives:
something that is vital in their socialization process.
The studies presented so far have shown the positive results electronic gaming can have
on the lifestyle of a child with ASD. However the results were gathered under carefully
controlled environments. That means the setting in which the children played the video games
were organized and structured. The children performed systematic tasks on rigid schedule, with
limited game play. What would the results show if the gaming time presented to the kids went
uncontrolled? Studies have shown gaming can lead to deviant behavior in normal functioning
adolescents, but there has been little research done on how it can affect the development of
children with ASD. We know that child with this condition have a tendency to be attracted to
electronic technology, and we also know they have a predisposition to non-responsive behavior;
the following study seeks to discover a connection between the two.
In the year 2012 the academic journal Research in Autism Spectrum Disorders released
an article titled “Video Game Use and Problem Behaviors in Boys with Autism Spectrum
Disorders”. The research provides insight as to how uncensored video game use can negatively

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affect the development and socialization of young boys with ASD. The term “Problem Behavior”
is used to describe inattention, hyperactivity, and oppositional behavior displayed in kids
participating in the study (Mazurek 317). The study examined 169 boy’s ranging from eight to
eighteen, and monitored the number of hours they played a day, the genre of video games they
played, and the type of behavior they displayed after playing the game.
The data for the research was collected through a detailed survey. The survey asked the
parents of the child to disclose how many hours a day their child played video games, the
severity of their child’s disorder, how often they child displayed problematic behavior, and the
genre of game the child was playing. The results showed that the average amount gameplay per
day was 2.4 hours, and the most common genre what action oriented. Interesting enough the
results showed that there was no correlation between the amounts of time the children played
their game and the problematic behaviors (inattention, hyperactivity, and oppositional behavior).
However, the results did show a correlation between the oppositional behavior and role-playing
and first person shooter games (Mazurek 320).
The results from this study show that the content of the game is more influential in
arousing oppositional behavior in boy with ASD. Role playing games encourage the child to take
on the life of the video game character, an action that can distort the child’s perception of reality.
These games are usually designed to provide extensive hours of gameplay, an in depth story, and
a plethora rewards to be found throughout the game’s world. In this scenario it is possible for the
child to form an unauthentic connection to the digital world presented by the game, and when it
is time to be separated from this world the child may display antisocial attitudes towards actual
people, seeing how interacting with the digital games may be easier for them. It’s a catch 22,

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while such games can help with the child’s response time, due to battle or action situations,
motor skills, and sequencing, it can also act as a detriment to their social skills.
How do video games actually affect children with ASD? We have explored how
electronic games can positively enforce the educational and social skills needed in the
development of an autistic child, and we have also seen how they can act as a detriment to their
social interaction, but how do these children perceive them? In a study done by the University of
Strathclyde, researcher Kevin Durkin attempts to examine the effect videogames have on
children with developmental impairments. In his study, “Videogames and Young People with
Developmental Disorders” Durkin observed ASD, Attention Deficit Disorder, and Speech
Impediments. For the sake of this paper I will only focus on the study as it pertains to ASD.
Durkin begins his paper by saying that there are three reasons why children with ASD are
attracted to computers and computer related entertainment: 1) The computer involved no real-life
social factors, 2) The “behavior” of the computer is predictable and consistent, 3) The child can
determine the pace of the activity (Durkin 125). As discussed before children with ASD can
severely struggle with social interaction, and electronic games can give them the benefit of such
interactions without the need to actually do it. Computers, and other forms electronic
entertainment, also do not emote emotions, or complex social cues that need to be picked up on,
which allows for comfortable interaction between it and the user (Durkin 129). Gaming, via
console or computer, can also give the youngster a sense of independence he or she may not have
on a regular basis.
The study dives deep into the neurological responses experienced by a child with ASD as
he or she is playing a game. The study focuses on the Executive function, the Visual Perspective,
and Social implication of gameplay. The Executive Function “is generally understood to

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encompass the cognitive processes that controls the use of other skills and behaviors” (Durkin
123). The Executive function is necessary for goal setting functions; it enables individuals to
plan out actions, initiate those actions, and adjust those actions to changing circumstances
(Durkin 123). The study believes that the goal-oriented gameplay can educate a player on
planning out steps, reacting to their environment, and applying directions to action. Visual
Perspective tags along with this idea; the player needs to remain aware of his or her environment
during gameplay in order to seek out possible rewards or avoid oncoming danger. Seeing how
visual perspective is usually delayed in child ASD developement, the correct use of electronic
gaming can be used as a supplemental device. Lastly, preliminary evidence shows that video
games can be used to direct the social progression of children with ASD. Even though the social
interaction found in games is not real, such interactions game is used as a guiding tool on how to
respond in the normal situations.
Autism Spectrum Disorder can have several symptoms that further halter the
development of a child. A prominent symptom is clinical anxiety. Within the subclinical disorder
of anxiety, children with ASD can suffer from depression, rigid behavior, further problems with
social interaction, and a lack of adaptive functions (Wijnhoven 2). Research has show that 21%
children with ASD are classified with subclinical anxiety, and 40% of the remaining children
display the symptoms of at least one anxiety disorder (Wijnhoven 2). Anxiety plays a large role
in the adolescent autistic community, and yet it has received little research in ways of alleviating
its symptoms. The last study that will be looked at is a proposal that aims to investigate the
possibility of using electronic gaming to reduce the anxiety symptoms expressed by children
with ASD.

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A study proposal released by BMC Psychiatry called “The Effect of the Video Game
Mindlight on Anxiety Symptoms in Children with Autism Spectrum Disorder” claims the
possible connection between their educationally developed game Mindlight and the anxiety
symptoms expressed in children with autism. The game Mindlight has already been used to
research anxiety in normal functioning students, and the results showed a significant decreased in
their anxiety levels (Wijnhoven 1). The game utilizes exposure therapies. Throughout the game
the player is gradually exposed to threatening situations, and as the game progress the player
becomes more relaxed when faced with such situations (Wijnhoven 2). The game uses
neurofeedback mechanisms which balances the arousal and anxiety levels of the player, and bias
modification mechanisms which encourages the player to shift away from the threatening cues,
and focus on the positive aspects of the game (Wijnhoven 3). The researchers believe that such
mechanisms will be impactful of the anxiety levels of the children due to their sensitive reception
of such mechanisms, and because of their close bond with technology (Wijnhoven 3).
The study will observe 120 children between the ages of eight and sixteen. The
participants will play Mindlight one hour a day for six weeks. A control group will be used to
compare the results of study; they will play the puzzle game Triple Town for the same amount of
time. The premise of the game is for the main character, Arthur, to overcome his fear of the
shadows using his “inner strength” which is measured by the Mindlight. During game play
participants will wear headset that acts as an electroencephalogram (EEG). The EEG will
monitor the Alpha and Beta waves of the participants: Alpha measuring the relaxation and
enjoyment of the player and Beta measuring his or her concentration (Wijnhoven 5). After the
game a qualified therapist who will question the child about his or her experience during the

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game will interview play the child. After the six-week session, a three-month post trial
observation will occur in order to see if the game had a lasting effect.
The case of Mindlight shows the possibility of intervention games alleviating significant
stress disorders in autistic children. Such alleviation can further help with the child’s
development in a normal social setting. Such gameplay can also be used to encourage
independence, and adjustment to news things that may frighten them at first. The theme of
Mindlight is overcoming your fear by using your inner strength, and even if some children with
ASD will not be able to comprehend this concept, there is the possibility that the game play will
help them understand the important message of the game.
The cases presented throughout the paper have showed both the positive and the negative
effects electronic gaming can have on children with ASD. Children with ASD are prone to have
a strong connection with technology. The connection coupled can be used to help treat the
symptoms of their disorder, or it can act as a detriment to their development. Even though each
case of adolescent ASD is unique, the research shown has establish one fact, if electronic gaming
is to be used as positive intervention it must be done so in a structured, and monitored way. The
cases of the Turkish after school program and the videogame scheduling for Guitar Hero showed
positive results because the kids’ game play times were carefully structure and followed.
Research into the effects gaming has on adolescent ASD is new, but with research presented has
shown encouraging results for the future of such treatment. With proposals like the Mindlight
project, research into this disorder has a promising future.

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Works Cited
Blum-Dimaya, Alyssa, Sharon A. Reeve, Kenneth F. Reeve, and Hannah Hoch. "Teaching Children
with Autism to Play a Video Game Using Activity Schedules and Game-Embedded
Simultaneous Video Modeling." Education and Treatment of Children 33.3 (2010): 351-70.
Academic Search Premier [EBSCO]. Web. 10 Oct. 2015.
Doeynas, Ceymi, Emre Şimdi, Ezgi Çaǧla Özcan, Zehra Çataltepe, and Binyamin Birkan. "Autism and
Tablet Computers in Turkey: Teaching Picture Sequencing Skills via a Web-based IPad
Application." International Journal of Child-Computer Interaction 2.1 (2014): n. pag. Academic
Search Premier [EBSCO]. Web. 10 Oct. 2015.
Durkin, Kevin. "Videogames and Young People with Developmental Disorders." Review of General
Psychology 14.2 (2010): 122-40. Academic Search Premier [EBSCO]. Web. 10 Oct. 2015.
Mazurek, Micah O., and Christopher R. Engelhardt. "Video Game Use and Problem Behaviors in Boys
with Autism Spectrum Disorders." Research in Autism Spectrum Disorders 7.2 (2013): 316-
24.Academic Search Premier [EBSCO]. Web. 10 Oct. 2015.
Wijnhoven, Lieke A. M. W., Daan H. M. Creemers, Rutger C. M. E. Engels, and Isabela Granic. "The
Effect of the Video Game Mindlight on Anxiety Symptoms in Children with an Autism
Spectrum Disorder." BMC Psychiatry 15.1 (2015): n. pag. Academic Search Premier [EBSCO].
Web. 10 Oct. 2015.

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Annotated Bibliography
Lieke Wijnhoven, Daan H.M. Creemers, Rutger C.M. Engels, and Isabela. “The effect of the
video game Mindlight on anxiety symptoms in children with an Autism Spectrum
Disorder.” BMC Psychiatry 20 April 2015 
Researchers seek to discover if an educationally developed game, Mindlight, can
reduce the clinical anxiety expressed in children with Autism Spectrum Disorder. The Test
will take place through a randomized controlled trial. Participants will be children 8-16
with ASD with (sub) clinical anxiety. Experimental participants will play one hour of
Mindlight a week for six consecutive weeks. Control will play one hour of tower town a
week for six consecutive weeks. After 3 month follow up students, parents, and teacher will
fill out follow up report on the student’s current condition. This article is a research
proposal, but provide significant background information on how anxiety plays a role in
the child’s life, and the possibilities the video game can have on children with ASD. The
researchers believe that with guided used; Mindlight can reduce the anxiety levels in the
experimental group within three month’s.
Ceymi Doeynas, Emre Simdi, Ezgi Cagla Ozcan, Zehra Catalepe, Binyamin Birkan.
“Autism and tablet computers in Turkey: Teaching picture sequencing skills via a web-
based iPad application.” International Journal of Child- Computer Interaction 6 April 2014
Researchers designed user a specific iPad application for students with ASD. The
application acts as a supplemental game to teach the students sequencing, and was tested
on three boys. The first test offered no prompts or rewards for successful play, while the
second offered rewards, prompts and demonstrations of correct responses. A baseline of
the students sequencing skills was taken followed by a teaching session and then another
testing session. The 11-year-old boy’s sequencing improved without external help, the 4
year old need external help, and the 14 year old found it too simple. This article will
provide information on how electronic game with a reward system can yield positive
results in ASD child education. I will also use this article to reinforce the argument that
video game use in such cases needs to be monitored, and used in a controlled environment.
I will also raise the point on how electronic games might be more suitable for older ASD
students.
Alyssa Blum-Dimya, Sharon A. Reeve, Kenneth F. Reeve, Caldwell College, Hannah Hoch,
and Rethink Autism. “Teaching Children with Autism to Play a Video Game Using Activity
Schedules and Game- Embedded Simultaneous Video Modeling.” West Virginia University
Press: Education and the Treatment of Children Vol. 33, No.3, 2010
The study aimed to help with the socialization of Children with ASD by teaching
them age appropriate leisure skills. The group of kids were taught how to play guitar her
with the use of, “(a) an activity schedule to set up, turn on, and turn off the game and system, (b)
simultaneous video modeling embedded in the game to teach manipulation of the Guitar Hero

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IITM controller to play the game, and (c) the training of multiple exemplars of songs to develop
a generalized repertoire of playing Guitar Hero II.” This article is used to support the argument
of controlled electronic game use. The study shows positive results in socialization for the
children with ASD, and showed to decrease their anxiety. However, it is important to note that
these results came from a controlled environment. The study shows that as the student
consistently followed the scheduling the more their scores in the game would increase.
Micah O. Mazurek and Christopher R. Engelhardt. “Video game use and problem behaviors
in boys with autism spectrum disorders” Research in Autism Spectrum Disorders 21
September 2012
This article sought to discover a correlation between behavior issues in boys with
ASD (ages 8-18), and problematic videogame use; problematic use in this sense meaning
addictive use. The study showed that there was a correlation between problematic
videogame use and oppositional behavior. The study also researches the different effects
that different genres had on the behavior. The results showed that unmonitored video
game use had a direct relationship to oppositional behavior and in the participants. The
surveys showed that participants who played more than two hours of uncontrolled gaming
a day, displayed oppositional behavior. The study showed that Role Play Gaming, and
shooting games had a correlation to such behavior as well. This will used to show how un-
monitored gaming can be detrimental to the socialization and development of children
with ASD.
Kevin Durkin, “Videogames and Young People With Developmental Disorders” Review of
General Psychology Vol. 14, No. 2, 122-140 2010
This study attempts to examine the reaction video games have on children with
developmental impairments. The conditions being observed are ASD, ADHD, and Speech
Impediments. The researcher analyzes how students with various developmental disorders
respond to certain feature and challenge in video games. The study focuses specifically on
the sensory, cognitive, and social dimensions of playing. For the purposes of this paper I
will focus on the aspects relation to ASD. In general the study shows how video game with a
structured sequence, a rewards system, and character interaction can attract kids with
ASD. The study goes on to detail the social dimensions of gaming through the perspective of
a kid with ASD, and analyzes why such kids are attracted to certain game over reality.
Again, all of these analyses were given under a controlled environment, where gameplay
was monitored and limited. I plan to use this paper to analyze the different mental and
social effects gaming can have a kid with ASD.

Electronic Gaming and ASD with Annotated Bibliography

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