Abstract
BackgroundTo meet the required hours of intensive intervention for treating children with autism spectrum disorder (ASD), we developed an automated serious gaming platform (11 games) to deliver intervention at home (GOLIAH) by mapping the imitation and joint attention (JA) subset of age-adapted stimuli from the Early Start Denver Model (ESDM) intervention. Here, we report the results of a 6-month matched controlled exploratory study.MethodsFrom two specialized clinics, we included 14 children (age range 5–8 years) with ASD and 10 controls matched for gender, age, sites, and treatment as usual (TAU). Participants from the experimental group received in addition to TAU four 30-min sessions with GOLIAH per week at home and one at hospital for 6 months. Statistics were performed using Linear Mixed Models.ResultsChildren and parents participated in 40% of the planned sessions. They were able to use the 11 games, and participants trained with GOLIAH improved time to perform the task in most JA games and imitation scores in most imitation games. GOLIAH intervention did not affect Parental Stress Index scores. At end-point, we found in both groups a significant improvement for Autism Diagnostic Observation Schedule scores, Vineland socialization score, Parental Stress Index total score, and Child Behavior Checklist internalizing, externalizing and total problems. However, we found no significant change for by time × group interaction.ConclusionsDespite the lack of superiority of TAU + GOLIAH versus TAU, the results are interesting both in terms of changes by using the gaming platform and lack of parental stress increase. A large randomized controlled trial with younger participants (who are the core target of ESDM model) is now discussed. This should be facilitated by computing GOLIAH for a web platform.Trial registration Clinicaltrials.gov NCT02560415
Highlights
To meet the required hours of intensive intervention for treating children with autism spectrum disor‐ der (ASD), we developed an automated serious gaming platform (11 games) to deliver intervention at home (GOLIAH) by mapping the imitation and joint attention (JA) subset of age-adapted stimuli from the Early Start Denver Model (ESDM) intervention
Since computer based approaches may be effective in improving learning cognitive and social skills in children with ASD [13] and that ESDM received good evidence of its efficacy in young individuals with ASD [1], we settled a multidisciplinary group in the context of the MICHELANGELO European project to fulfil these recommendations, and we recently developed a computerised gaming library (GOLIAH—Gaming Open Library for Intervention for Autism at Home) which consists of a set of computer games created by mapping the imitation and joint attention (JA) subset of stimuli from the ESDM [15]
Children and parents participated in 30.5% of the planned sessions at home and in 48.6% of the hospital sessions, which led to a total participation of 39.9%
Summary
To meet the required hours of intensive intervention for treating children with autism spectrum disor‐ der (ASD), we developed an automated serious gaming platform (11 games) to deliver intervention at home (GOLIAH) by mapping the imitation and joint attention (JA) subset of age-adapted stimuli from the Early Start Denver Model (ESDM) intervention. Given the broad spectrum of ASD with significant inter-child variability, there is a need to design a person specific intervention protocol, accounting for both the actual difficulties/strengths of a child and his/her developmental age, to achieve maximal effects. One way of reducing these problems is to involve parents in the intervention protocol and thereby carry out a significant part of the intervention in home settings. This requires parent training and regular monitoring to check whether the parents properly implement the intervention protocol adhering to that outlined by the therapist
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