Effects of Exergaming on Children with Autism Spectrum Disorders: A Pilot Study

Background:  Although not included in the diagnostic criteria for autism spectrum disorders (ASD), executive dysfunction (Pennington & Ozonoff, 1996), motor impairment (David et al., 2009; Dzuik, et al., 2007; Ghaziuddin and Butler, 1998; Ming et al., 2007) and visual motor integration (Hellinckx, Roeyers & Van Waelvelde, 2013; Sachse et al. 2013) have been frequently observed in individuals diagnosed with ASD. They have immediate limiting effects in childhood and long-term effects into adulthood. Executive function (EF) refers to the higher order control processes that are necessary to guide behavior in a constantly changing environment (Jurado & Rosselli, 2007). Studies of motor skills have generally converged on the notion that 80–90% of children with ASD show some degree of motor impairment. Visual motor integration (VMI) is the ability to perform complex eye-hand coordination tasks in which perceptual, motor, and cognitive processes interact and has been identified as a predictor of academic performance (Klein, 1978;  Kulp, 1999), handwriting quality (Hellinckx, et al., 2013; Kushki, Chau, & Anagnostou, 2011)  and driving problems (Keay et al., 2009; Munro et al., 2010). Motor, EF and VMI deficits in children with ASD also contribute to low rates of physical activity participation (Reid, O’Connor, & Lloyd, 2003) and difficulty participating in activities involving constantly changing environments in which fast responses and adjustment need to occur. The Makoto training device was developed for use in performance sports, schools, and medical rehabilitation with goals of improving reaction time, attention, and physical fitness and is classified in the category of exergames(games that combine play and exercise; Bogost, 2005).

Objectives:  This pilot study investigated the effects of a 30-session Makoto arena training intervention, a light and sound speed-based interactive exergame, on EF, motor skills, and VMI in school age children with ASD.

Methods:  17 children with ASD between 8 and 18 years old participated in this pilot study. A full-scale IQ score of at least 70 and willingness to participate in the Makoto intervention approximately three times per week were required for inclusion in this study. Individuals with lower IQs were excluded to avoid the potential for confusion between impaired intelligence and impaired EF. Participants were evaluated before and after intervention on the Behavior Rating Inventory of Executive Function (BRIEF), the Bruininks-Oseretsky Test of Motor Proficiency- Second Edition (BOT-2),  and the Developmental Test of Visual Perception (DTVP-2 and DTVP-A). Average reaction speed was recorded at each Makoto intervention session. Participants completed two minutes of Makoto intervention a minimum of three times per week until thirty intervention sessions were completed, with a total of approximately 1,800 repetitions for each participant.

Results: Participants showed significant improvement in reaction speed, the executive function area of working memory, the motor area of strength and agility, and visual motor integration.

Conclusions:  It is important to identify interventions that are both effective and motivating for children with ASD. Findings suggest that the Makoto intervention has the potential to serve as a valuable addition to standard intervention for children with ASD who have EF, motor and VMI impairments. Further study is indicated.