Stimulus over-selectivity is a type of “tunnel vision” common in children with autism spectrum disorders (ASD). It can be described as the inclination to zero in on a particular feature of a stimulus, rather than considering the stimulus as a whole (Lovaas, Schreibman, Koegel, & Rehm, 1971). Children who exhibit stimulus over-selectivity will fail to notice obvious features of the world around him, notice them but fail to communicate them to others, or notice them but fail to pull out the features that are most relevant (Interview with Dr. Kari Berquist, 2012).
The consequences of attempting to navigate the world with such a perspective are profound. For example, a child might recognize his mother only by her long hair, and fail to know who she is when she cuts her hair.
Our goal is to support children with ASD in learning to notice and attend to multiple features of the objects they encounter – a skill known as “multiple-cue selectivity” – in the hopes of laying the groundwork for a host of secondary learning benefits.
Existing Solution: Pivotal Response Therapy
Though the problem of stimulus over-selectivity was first documented in children with ASD in 1971, there is no known cure and parents of children with ASD have limited options for addressing this behavior (Lovaas, Schreibman, Koegel, & Rehm).
Pivotal Response Therapy (PRT) is a relatively recent therapy that is built on behavioral principles but designed to teach generalizable skills, including multiple-cue selectivity. According to Pivotal Response Theory, teaching certain “pivotal” behaviors will result in incidental improvements in many other “collateral” behaviors. The success of PRT has shown that behavioral techniques can go beyond simple conditioning to teach general learning strategies to children on the autism spectrum.
In learning the pivotal skill of attending to multiple cues, children also acquire the collateral skills of correctly responding to complex social and learning stimuli (Burke & Cerniglia, 1990).
Filling a gap
It is typically recommended that children with ASD receive somewhere between 25 and 40 hours of therapy per week – a standard that is impossible to meet for many families (Smith, Eikeseth, Klevstrang, & Lovaas, 1997). At the same time, a new study reports that 41% of children with Autism spend “most of their free time” playing video games (Mazurek, Shattuck, Wagner, & Cooper, 2011), dramatically more than the 18% of children nationwide who fall into this same high-user category (Marshall, Gorely, & Biddle, 2006).
It is our hope that an iPad-based intervention that incorporates core elements of ABA therapies could help bridge this gap and introduce additional therapy time in a fun, naturalistic setting.
Our approach is grounded in several key theories of learning:
- Behavioral theory underlies many of the most effective treatments for children with autism developed thus far (Roberts & Prior, 2006).
- Maria Montessori’s philosophy of creating a “prepared environment” where children are free to explore materials that facilitate their development aligns well with the principles of educational video game design, as well as with the principles of PRT (Montessori, 1912).
- James Gee puts forward several design principles which foster both successful video game play and effective learning (Gee, 2003). Per Gee’s suggestions, we attempt to do away with explicit instructions, embed instructions into the game environment to be used only when they are needed, and to keep the game “pleasantly frustrating” for the user – difficult enough to be interesting but easy enough to be approachable (Gee, 2003, p. 2).
- We also encourage joint media engagement (JME) through shared interactions between children and their parents, caregivers, and/or therapists who can help guide them through this highly customized gaming experience. These JME partners provide a resource for “making sense and making meaning in a particular situation” (Takeuchi & Stevens, 2012, p. 10).
We seek to take advantage of children with autism’s documented heavy gaming as a means of shrinking the known gap between the amount of therapy recommended and the amount of therapy received. For this reason, we developed a casual video game, designed with both behaviorally-based therapeutic techniques and popular game mechanics in mind.
We chose to develop specifically on a tablet for several reasons:
- To encourage extensive use and enable anytime/anyplace game play.
- A touchscreen is necessary for enabling the interaction in a way that is intuitive and does not require instruction.
- A touchscreen also broadens the reach of the application, as some children with ASD are able to navigate with touch but have more trouble using a mouse and keyboard (Davis, Dautenhahn, Powell, & Nehaniv, 2010).