A Randomized Clinical Trial on Promoting Face Recognition Skills in Children with ASD Using the Facestation Video Game Curriculum

Background: While individuals with autism spectrum disorders (ASD) have many complex social skill impairments, this randomized controlled trial (RCT) focused on face perception skills, a central ability for successful social interactions. The impairments of a majority of children with ASD in their ability to recognize a person’s identity and facial expressions are well-documented. However, there is a dearth of intervention studies targeting face perception skills in children and adolescents with ASD. Computerized video games are an especially promising intervention tool, because they capitalize on powerful “reward” circuits in the brain that co-opt the natural tendency to play in the pursuit of learning. For this RCT, we developed a novel therapeutic video game platform, FaceStation, to improve face recognition skills among children and adolescents with ASD.     

Objectives: The purpose of the RCT was to determine whether systematic gaming with FaceStation can improve basic face perceptual skills in children and adolescents with ASD compared to age and IQ matched individuals with ASD not playing these games (waitlist controls). We also explored the extent to which individual differences in responsivity of reward circuitry measured with fMRI at baseline predicted treatment effort (i.e., amount of game play) in the game-playing ASD participants. 

Methods: Sixty participants were included in the final data analyses (24 TDC, 19 ASD active treatment, and 17 waitlist control). TDC served as normative comparison group for basic face perception skills. Only participants with ASD, who were significantly impaired in their face recognition abilities, were assigned to either a treatment or a waitlist group. Children in the active treatment group were asked to play at least 20 hours – and up to 50 hours – of FaceStation video games over 3 months. The FaceStation platform is a systematic curriculum for enhancing face recognition skills. It consists of seven different, stand-alone computer games, modeled after perceptual expertise training. Pre- and post-intervention performance for the two ASD treatment groups was assessed with the Benton Test of Facial Recognition. In addition, at baseline participants were asked to take part in a 3T functional imaging experiment to study reward circuitry activation with an incentive delay task from the normative literature (Kohls et al. 2013, Neuropsychologia).      

Results: The main finding was that, relative to the waitlist control group, the active treatment group demonstrated improvements in face recognition skills through ~29 hours of game play on the FaceStation platform (Benton Test: group by time interaction effect p=0.026). While both ASD groups had diminished face recognition skills at baseline relative to TDC, the active treatment group did not differ from healthy controls after the intervention (whereas the waitlist group still did). In addition, basic reward circuitry activation in the ventral striatum predicted gaming effort in the active treatment group (r=0.47, p=0.05).     

Conclusions: These results suggest that a relatively short-term video game curriculum can produce measurable ameliorations in face recognition skills of children with ASD. Moreover, basic reward circuit responsivity may serve as a potential „biomarker“ for therapy engagement (and success?) in ASD.