Case Study: Asperger Children Playing Nintendo Wii Games

Case Study: Asperger children playing Nintendo Wii games.

Abstract

The aim of this research programme was to investigate the effects of using the Nintendo Wii ‘exergaming’ console with a group of primary aged Asperger children, who had a focused interest in computers. An embedded mixed methods approach was taken which enabled both qualitative data to be collected. The different types of data were then used to interpret and triangulate any perceived and actual changes in fitness and social skills that had resulted during the 5-month trial.

With a growing population of children with autism and a growing population of overweight and unfit children it is important that research focuses on ways to help children with autism lead active and productive lives. This research gives an over view of Asperger Syndrome and its associated characteristics, the fitness levels of today’s children and the use of video games. The research focuses on the new wave of interactive ‘exergaming’ machines i.e. those games consoles that require the player to participate in physical activity to interact with the game.

Children who have been diagnosed as being on the autistic spectrum often have difficulties in communication, social interaction, rigidity of behaviour and stereotypical behaviour. Researchers (Berkeley et al, 2001, O’Connor, French & Henderson, 2000, Levinson & Reid, 1993, Reid, Collier & Cauchon, 1991) have shown that physical activity can help reduce some of these symptoms; however the physical activity referred to is ‘normal’ physical activity and not that associated with computer games.

This study identified issues around the nature of ASD and exercise and although the research was limited to only 4 primary aged boys the research seems to indicate that fitness levels, social skills and communication can be improved in Asperger diagnosed children through the use of the Nintendo Wii.

Background.

Autistic Spectrum Disorder (ASD) is thought to be a neurobiological condition of the brain, which impacts on the individual’s development. The resultant difficulties they experience produce a cluster of features, which provides the diagnostic criteria for autism (Wing & Gould 1979). Individuals therefore have difficulties with social relationships, communication, imaginative play, imagination and changes in routine.

The researcher specifically chose children who had a ‘focused specialised’ interest in computers because the researcher was interested in finding out if this sedentary focused interest could be adapted and channelled into a more physical activity while maintaining the interest of the child. The hypothesis was that the children would use their computer interest to play the games on the Nintendo Wii console and gain some physical and social benefit at the same time. The Wii sports package was chosen because it features six sports that will test skills, stamina and hand-eye coordination.

ASD and exercise

The focused interest of the boys in computers was used to engage them in physical activity. Some research has indicated that the physical fitness activity levels of autistic children may be lower than that of ‘neuro-typical’ children (Auxter, Pyfer & Huettig, 1997). One reason for this difference in activity levels may be the child’s lack of interest in physical activity or their motivation to participate. By focusing upon their interest in computers they may be motivated to use the Wii and therefore increase their level of physical activity, because the initial opponent is the computer, the level of social interaction is in their control.

O’Connor, French and Henderson (2000) state that an autistic child needs a highly structured environment to help them participate in physical activity. O’Connor’s research was carried out before the event of exergaming consoles. Exergaming activities are highly structured so do fall into the same criteria and any increase in physical activity may increase the individuals fitness levels therefore helping to promote well being and specific health and fitness benefits.

Computer games and health

Computers games have for years received a ‘bad’ press in relation to their negative effects (Video games research November 1998).

Video games are often stereotyped as being of little value to health and well-being. Video games have often been blamed as a contributing factors to an increase in obesity levels, medical conditions such as diabetes and high blood pressure (Carpinteria 2007) but a study carried out by the International Sports Sciences Association (Feb 2007) suggests that with the implementation of new technologies, video games may prove to be just what the fitness experts are looking for to help their clients get more active. The report states that ‘Exergaming’ and ‘exertainment’ are an excellent way for getting kids hooked on physical activity, producing good habits for life.

The International Sports Sciences Association (2007) state that new gaming trends such as the Wii have the potential to change the way fitness professionals think about gaming in general, while Wii is doing its part to get gamers off their couches and into a state of activity, concerns were raised in relation to the physical intensity of playing the Wii as it is lower than necessary to substantially affect gamers fitness levels but others disagree. Most benefits of physical activity occur when progressing from sedentary to moderately active so even though exertainment may not produce high levels of fitness it promotes physical activity and can help people meet the physical activity recommendations.

ICT and ASD

ICT by itself does not provide a magic solution for people with autism. However it may help increase their peer acceptance. It may offer a range of very useful tools for a person with autism, but this must be embedded in a wider care and educational system to be effective.

The fact that computers will reliably carry on doing the same thing over and over, means that for a person with autism they have an activity that they can do for very long periods of time. Some parents and carers have found it very difficult to get their child off the computer once a routine of using it for long periods has been established, so it is preferable to offer limited periods from the start. Games on the Wii are quite short in comparison to other video games allowing for shorter time periods and easier breaks.To make informed choices about their ICT use with ASD children you need to know something about their autism, something about ICT, but most importantly you need to know the individual, never the less some advantages of computers for individuals with autism are that computers:

• Are predictable and, therefore, controllable.
• They enable errors to be made safely.
• They offer a highly perfectible medium.
• They give possibilities of non-verbal or verbal expression.
• There is the possibility of increased social interaction and the development of social skills.

Methodology

The purpose of this sequential embedded mixed methods study was to explore participant views with the intent of using the information to develop and test the impact of the Wii Sports package. The first phase was a quantitative fitness base line test, followed by a qualitative exploration of the impact of the Wii by collecting semi structured interview data from the participants and their families. Themes from this qualitative data were then developed into an instrument so that the hypothesis could be tested. Quantitative data was also collected at a mid way point along with qualitative interview data and a final data collection point at the end of the study with both methods being employed. A mixed method approach was chosen to provide triangulation and primarily to provide a baseline of fitness levels and any improvement through the use of quantitative data received from standardised fitness testing.

The ‘case’ under investigation involves four boys aged eight to ten years old who have a diagnosis of Asperger Syndrome. They all attend mainstream schools with a varying degree of SEN support. All boys have an interest in computers but had not used the Wii console before the research began. They all exhibit the triad of impairments associated with their diagnosis. The context for most of the research was in the participant’s home environment, which helped with the cognitive and linguistic demands, encountered by the participants (Porter & Lacy, 2005). The participant’s families agreed to act as co researchers for the duration of the study. The researcher did not visit the participant’s home, but relied on the integrity of the family to carry out the recording. It was deemed not practical to set pre study time limits for length of time on the console. Time spent on the console was controlled by the children’s families this is of particular importance due to the associated problems of rigidity and egocentrism.

By carrying out a battery of standard fitness tests data was readily available across a wide range of general fitness components and helped in the monitoring of any progress gained. Physical fitness tests looked at anatomical and physiological components and covered endurance, aerobic capacity, strength, motor fitness and flexibility.These elements of fitness have been chosen, as they are a standard recommended set of tests carried out to ascertain overall fitness levels in a range of physical components (SafritWood, 1995). Protocols were standardised for all three testing sessions. Set tests are listed and have been chosen in relation to their relevance to the research question (SafritWood, 1995).

Test / Area of measurement
Bleep test / Cardio vascular fitness (aerobic)
Six minute test / Cardio vascular fitness (aerobic)
Sergeant jump / Elastic strength
Sit up test / Strength endurance core body strength
Sit and reach / Flexibility of shoulder girdle and hip joint
Shoulder lift / Flexibility of hip joint
Press up / Strength endurance core body strength

A questionnaire was designed to gain further information from ‘neurotypical’ users of the consoles, which was in turn used to triangulate the results from the ASD section of the research. The research purpose of the questionnaire was to discover the ‘Wow’ factor of the consoles and to see if there was any difference between ‘neurotypical’ and ‘Aspie’ (ASD) subjects. The questionnaires were developed after the semi-structured interviews took place, allowing the interviews to act as a pilot for the questionnaire design.

The interviews were used to provide in-depth information from the ASD children and their families, 2 of the respondents were known to the researcher, this therefore made the respondents and researcher comfortable with each other, (issues such as moving off topic, getting stuck on a specific topic, mis understanding and literalness could all be addressed) therefore giving an added advantage when trying to elicit information.

The questionnaire contained comments, which sought qualitative information from the respondents, and the semi-structured interviews pursued this in-depth. The overlay was necessary to allow standardisations and comparisons across users and those not directly involved in the ASD study element.

Data Collection

Data collection consisted of a series of inter related activities aimed at gathering information (Creswell, 2007). Initial information on the child was gathered from their families via a simple ‘passport type’ form. An initial baseline battery of fitness tests, carried out by the researcher, followed this. Recognised fitness tests, were chosen, ensuring ratification and safety. Data was collected from children in mid child hood thereby lessening the impact of these growth spurts on the study. Scores achieved on the tests were analysed using improvement performance from one test administration to another. Physical activity was also monitored via the length of time spent playing on the consoles. Semi structured interviews and subsequent questionnaires were used to gain qualitative data, which was analysed using thematic coding.

Findings

The tests were analysed using improvement in performance criteria due to the lack of national norm referenced figures for the age group or disability criteria.

Figure 7 Strength test data

These results show that there was an increase or improvement in performance in strength and noticeable core body strength as the children moved from half to full press-ups and sit-ups. (The lower second number indicates this change). There was also slight increase in explosive power (Sergeant Jump) and flexibility.

Figure 8 Flexibility test data

However the greatest gains were in aerobic and endurance fitness with a significant increase in Bleep Test levels with an increase in lap speed and length of time ran during the 6-minute test.

Figure 9 Endurance test data

These results indicate that there was an improvement in aerobic endurance capacity by all children with the greatest improvement coming from the children with the lowest initial base line scores. When investigating Child A consideration needs to be given to the increase in speed and his refusal to continue. The greatest increase came from the two least coordinated and least active children, which seems to back up previous research.

Initial interview information came a month into the study and was followed up twice during the research. The information gathered showed no change in opinion and likes and dislikes remained unchanged. Information was summarised across all interviews. Family members indicated that the advantages of their child using the Wii were

• They did more physical activity.
• They were fitter.
• They played with others when using the console, which had previously been unheard of.
• Their social skills had improved and the whole family could join in.

All respondents indicated that they had used the Wii independently and with others (family members and friends). The only noted disadvantage was from the mum of child B when she said ‘she had lost the use of her telly’.

Although this research forms only a small case study fifty percent of family members said that there had been an observable increase in their child’s fitness as weight loss had been evident. This may have been because these children were the most unfit and ‘heaviest’ to begin with. Although all families thought that their child’s fitness had improved.

Family results indicated that a possible positive effect of using the Wii had been to help their child control their aggressiveness and their temper along with their perseverance. This was notated through the use of the boxing activity. One mum thought that her son had enjoyed this activity because he could be ‘aggressive’ without getting into trouble. Another thought that the boxing provided a safe way to release their son’s pent up emotions, particularly after a frustrating day at school.

A definite negative effect had been the age fitness score. This had upset all of the children and resulted in Child A refusing to use the console for part of the study. This we felt was down to the children’s literal interpretation of information as they thought that they were really the age the computer had given them. In hindsight the boys should not have carried out the Wii age fitness test on a regular basis.

Problems related to over usage did not materialise although this had been a pre study concern. Parents were happier in relation to time spent playing on the Wii as opposed to their child’s other computer games consoles because their child was playing an active computer game instead of spending hours on ‘thumb movement’ games.

Conclusions

Parental end of study conclusions stated that their child’s activity levels had increased along with their fitness, they had enjoyed the activities and there social interaction had as a family had improved. There had been a noticeable improvement in their child’s turn taking, interest and behaviour. Their child had let friends join in and as a result friends had purchased consoles, however the ASD child was not invited to go to their friend’s house to play. Members of their extended family had purchased consoles including one grandma.

When asked about the appeal of the Wii, results indicated it was popular due to a number of factors listed below,

• Its fun.
• You can play alone or with friends.
• It’s competitive.
• It keeps you fit.
• It’s a challenge.
• It promotes social interaction.
• It’s easy to learn and anyone can participate.

The initial aims of the study and questions raised focused on the use of the Nintendo Wii to raise fitness levels and improve social interaction for Asperger children. The results have indicated that the Wii along with the child’s focused interest did act as a scaffolding tool to raise both social interaction and fitness levels. The activities also proved to be age, cognitive and skill appropriate to the children. The children did spend enough time on the consoles to meet government targets but as to the question is this the right form of exercise for these children further research is required.