Video game app enhanced self-care skills in children with intellectual disabilities and autism spectrum disorder

The broken mirrors hypothesis states that children with autism spectrum disorders (ASD) have mirror neuron systems that have either been damaged by genetic deficiencies or exposed to environmental risk factors, causing a lack of observational learning skills. Children diagnosed with intellectual development disorders (IDD) comorbid ASD encounter extreme challenges in self-care activities due to cognitive impairment. However, helping them in these tasks could amount to intrusion and reduction of their independence. Although, social stories, which are a set of static pictures teaching specific skills and appropriate behavior, are helpful due to the visual superiority effect, they may not be as effective in the case of children with IDD comorbid ASD due to their impaired ability to recall or perform the learned skills. Recently, video social stories have been developed, but only a few learning resources include games to facilitate frequent practice of skills. Hence, this study aimed to investigate whether a video social story game app intensifies the visual superiority effect and enhances the self-care ability in children with IDD comorbid ASD.  

A case study–mixed methods design was used. Participants were selected from a special school; all had deficits in self-care ability. Primary school students (N = 12, M = 80%), aged 10 to 12 years, diagnosed with moderate IDD comorbid ASD were chosen. They received a five-day training in which they brushed their teeth while interacting with a video story on tooth brushing presented as a game. Next, they were asked to practice tooth brushing using the same game app at home for the next two weeks. Both parents and teachers filled in the pre-test and post-test self-care ability assessment form. On-site observations and semi-structured interviews were also conducted. The resulting data were primarily qualitative but included a small quantitative component for tracking the intervention effect. All participants provided prior written informed consent. 

The results confirmed that video social stories embedded in a game app enhanced self-care ability and strengthened memory. Parents and teachers agreed that the educational game app enhanced cognitive skills and motivated students to demonstrate self-care skills independently. The findings of this study could contribute to clinical suggestions and guide the development of video social story game apps to teach various essential skills to children with IDD comorbid ASD.