A Mobile Video Game for Studying Social and Nonsocial Executive Functions in Children with ASD

Background: Deficits in executive functioning skills (EFS) is a characteristic for autism spectrum disorder (ASD). Clinicians often use traditional behavioral assessment (e.g. Wisconsin card sorting task) to test children’s EFS, but these resources are not easily accessible for children living in undeveloped areas. Digitalized games have the potential to be a supplementary tool in increasing the accessibility of EFS assessments.

Objectives: To (1) design a well-controlled mobile technology game that can assess and potentially improve EFS in children with autism,using social and nonsocial conditions that test EFS; (2) To conduct a proof of concept usability test of the game.

Methods: We designed a tablet video game with three tasks: set shifting, working memory, and inhibitory control tasks. The program selects either social and nonsocial stimuli as targets for each session of the task, and each session has two social blocks and two nonsocial blocks (randomly counterbalanced). Similar to the Wisconsin card sorting task, our shifting task shows four images on the screen for each trial, and users have to guess which image is the correct answer.he underlying unspoken rule (happy face, angry face, red fractal, or blue fractal) changes for every ten trials. The working memory task shows objects for 10 seconds for participants to memorize, and then they have 45 seconds to choose all the right answers.The difficulty of the task depends on the participants’ performance. For inhibitory task, users are asked to click as many pictures as possible on the screen, but are required to stop touching the screen when a “stop sign” or “angry face” pop out. The stop signal appears 5 times in each session. The appearance time and appearance length of the “stop (signal)” are pseudo-randomized and counterbalanced. Users’ touches are recorded for post-hoc analysis.

Results: A supervised 6-year-old child with autism played all three tasks in 8.5 minutes. Throughout the experiment, the child touched the targets for a total of 74 times. In the shifting game, the child answered 17 out of 40 questions within the 2 minute time limit. He learned the first hidden rule and gave correct answers for the first 9 questions but failed to learn the new rule afterwards and got half of the questions wrong. In the inhibitory game, the child touched 44 targets in total and four of those occurred during the inhibitory stage. Of the four, three occurred during the social trials. In the memory game, the child spent an average of 1.99 seconds finding the memorized images during the two nonsocial trials. However during the two social trials, the child could not remember the correct target before reaching the time limit of 45 seconds.

Conclusions: This video game could be useful for examining discrepancies between socially-oriented and non-socially oriented executive function ability in children with ASD. In the future, we will collect more data from TD children, children with ASD, and TD adults. We will analyze and compare playing patterns, performance, and verbalization of each participant.