=Paper=
{{Paper
|id=Vol-2747/paper24
|storemode=property
|title=Mr. Pizza: An Educational Game for Inclusion of Children with Autism Spectrum Disorder
|pdfUrl=https://ceur-ws.org/Vol-2747/paper24.pdf
|volume=Vol-2747
|authors=Lucas Gomes Pereira,Matheus Santiago França,Victor Helfstein Piccoli,Willi Takeshi Rodriguez,Maria Amelia Eliseo
}}
==Mr. Pizza: An Educational Game for Inclusion of Children with Autism Spectrum Disorder==
https://ceur-ws.org/Vol-2747/paper24.pdf
Mr. Pizza: An Educational Game for Inclusion of
Children with Autism Spectrum Disorder
Lucas Gomes Pereira1, Matheus Santiago França1, Victor Helfstein Piccoli1, Willi
Takeshi Rodriguez1, Maria Amelia Eliseo1
1
Mackenzie Presbyterian University
{lucasgomesp22, francamatheus97, victorhelfstein178, willitakeshi}@gmail.com
mariaamelia.eliseo@mackenzie.br
Abstract. Digital games have been widely explored in our daily lives, not only
as recreational use, but also as learning resources, thus shaping education using
technology, far beyond just entertainment. The present work aimed to study and
analyze accessibility guidelines to create a digital and educational game to help
developing the social and cognitive skills of children between 6 and 9 years old
with Autism Spectrum Disorder. In this context, a game called Mr. Pizza was
developed, based on ABA (Applied Behavior Analysis) therapy with health
professionals, who gave suggestions for improvements.
Keywords: Autism, Games, Education
1 Introduction
Play is fundamental to child development. In addition to being something geared
towards entertainment and leisure, it provides children with unique moments, where
they encounter challenges of interaction with the world, granting clarity that it is full
of opportunities and challenges, aiding learning and improving cognitive abilities.
Digital games, which in the past were considered only hobbies, today can be used as
educational objectives, enabling the development of cognitive skills [1]. Regarding
the cybernetic interaction provided by technologies for children with Autism
Spectrum Disorder (ASD), they point out significant transformations in the areas:
cognitive, affective, emotional and in communication.
Autism Spectrum Disorder (ASD) encompasses different categories for
classification, according to the individual's need for help or degree of independence.
ASD is divided into five categories: Asperger's Syndrome, Invasive Development
Disorder, Autistic Disorder, Rett Syndrome and Childhood Disintegrative Disorder,
each category has its peculiarity, but the symptoms related to the difficulty of
communication due to language deficiency and in the use of imagination to deal with
symbolic games, difficulty in socializing and a pattern of restrictive behavior are very
Copyright c 2020 for this paper by its authors. Use permitted under Creative Commons
License Attribution 4.0 International (CC BY 4.0).
1
similar, varying only in the degree: mild (level 1), moderate (level 2) and severe
(level 3) [2].
Very little is thought about the concepts of accessibility during the development of
digital games in the educational setting, which impairs the accessibility of people who
have special needs diagnosed with ASD, thus creating a negative experience and
compromising learning. This paper aims to study and analyze accessibility in games
aimed at learning, in order to provide guidelines for the construction of educational
games for children with ASD. To validate the studied guidelines, the game “Mr.
Pizza” was implemented. Mr. Pizza's purpose is to help developing the cognitive and
communicative skills of children with ASD, through simple activities such as
choosing the ingredients they like and organizing the ingredients in the order of
making a pizza.
People with this diagnosis are sometimes rejected, according to the United Nations
secretary-general, Ban Ki-moon [3]. This rejection is a huge waste of potential, as
many of these people have many talents, whether visual, artistic or academic, showing
that the inclusion of these children is something that should start to be done by
institutions, helping them to use their talents during life.
Institutions and developers of digital educational games, be it web, mobile,
videogame, among others, create their applications without thinking about all possible
users and without giving much attention to children with autism. Thus, this paper
aims to show the possibility of creating accessible and educational games for children
diagnosed with ASD.
This paper is organized into five sections. In addition to this introduction, section
2 presents concepts about ASD and educational games. Section 3 presents the
methodology and guidelines used in the implementation of Mr. Pizza. Section 4
presents the results obtained after implementation. Section 5 presents the limitations
of the study and possible future work.
2 Theoretical background
In this section, subjects about the characteristics of Autism Spectrum Disorder (ASD)
and their severity levels will be addressed. Accessibility concepts will be shown, in
addition to presenting specific correlated works for ASD.
2.1 Autism Spectrum Disorder (ASD)
Autism Spectrum Disorder is a neurodevelopmental disorder that has been present
since childhood, with a deficit in the socio-communicative and behavioral dimensions
[4]. The so-called “spectrum” refers to a series of symptoms that can be identified,
which include difficulties in social interaction, communication, repetitive behaviors
and for showing interests in some restricted subjects, also being able to present a
degree of sensory sensitivity [5].
According to [6], "the current use of the Autism Spectrum Disorder nomenclature
makes it possible to cover different levels of the disorder, classifying them as mild,
moderate and severe". Therefore, we cannot match a patient with ASD, seeing that
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they are different subjects, with different degrees of intellectuality. Deficits
manifestations: Communication and Language - absence or delay in the development
of oral language; Social interaction - lack of reciprocity, difficulty in socializing and
the difficulty of contact with others; Behavioral - establish a routine, repetitive
movements.
Autism Spectrum Disorder is not sequenced, as there is no standard that can be
followed to point out some symptoms related to autism. Identifying a patient with
autism is complicated, since the manifestations of deficits can be clear or not, varying
only in the severity level. Symptoms do not usually appear equally for patients
diagnosed with ASD, that is, each diagnosis is private, no subject is the same.
Autism Spectrum Disorder is categorized into three levels of severity, according to
[2]:
• Level 1 - “Demanding support”: as for social communication, there is a severe
deficit in verbal and non-verbal social skills; great limitation in initiating social
interactions and minimal response to social openings that come from others;
inflexibility of behavior; extreme difficulty in dealing with change and restricted /
repetitive behaviors that interfere with functioning in all spheres; great suffering /
difficulty to change the focus or actions.
• Level 2 - “Demanding substantial support”: in relation to social communication,
it presents a serious deficit in verbal and non-verbal social skills; apparent social
damage even in the presence of support; limitation in initiating social interactions and
reduced or abnormal response to social openings that come from others; inflexibility
of behavior; difficulty dealing with change or other restricted / repetitive behaviors
appear often enough to be obvious to the observer; suffering / difficulty to change
focus or actions.
• Level 3 - “Demanding very substantial support”: in the absence of support,
deficits in the media bring notable losses; difficulty in initiating social interactions
and atypical or unsuccessful responses to the social openings of others; it may appear
to have reduced interest in social interactions; inflexibility of behavior causes
interference with functioning in one or more contexts; difficulty in changing
activities; problems with organization and planning are obstacles to independence.
Some therapies help people with ASD, such us ABA (Applied Behavior Analysis)
therapy used in Brazil to treat children with ASD diagnosis. ABA applies behavioral
principles, to everyday situations, that will, over time, increase or decrease targeted
behaviors to help individuals acquire different skills, such as language skills, self-help
skills, and play skills [7].
2.2 Accessibility
Unlike other technologies, digital games provide a high level of player engagement
with the world, the immersion experience is much more complete and requires a
greater level of interaction. This is not only a result of the evolution of consoles,
hardware resources, image and sound, but also by the increase in connectivity and
form of interaction between geographically distant users, where solo games give way
to those of multiplayer, points out [8].
3
Even so, digital games collaborate with the development of several types of
important skills, although not always planned to serve this purpose. In accordance
with [8], through them it is possible to develop the necessary mental structures so that
it is possible to adapt and use new technologies that accompany an individual's life,
not only forming a sociocultural space, but also allowing socialization between
different ages , ethnicity, gender and economic situation. In the view of [9], the main
challenge is how to design truly inclusive digital games that promote inviting
gameplay experiences, without technological barriers that inhibit or prevent the
interaction and consumption of potential players.
Thus, research to promote accessibility points out basic principles and
guidelines for the standardization of accessible content, such as the well-known
structure proposed by [8]. In addition, there are WCAG 2.0 recommendations
(accessibility guidelines for web content) [10], and the current version of the
document, WCAG 2.1 [11].
For the web to be usable by any type of user, it is necessary to comply with four
necessary principles that establish content accessible by anyone [11]:
• Perceivable: users must be able to perceive information presented.
• Operable: the interface must provide full user operation.
• Understandable: both operation and interface information
presented must be understandable.
• Robust: content must be accessible as new technologies emerge.
An accessible browsing experience is not only the responsibility of applying
content based on the accessibility guidelines, as there are also other components
involved in the use of the web that relate in a compatible and joint way, points out
[11]. Therefore, the relationship between:
• Content: information (text, images, sounds) through a presentation (code or
markup)
• User agents: web browsers and media players
• Assistive technologies: screen readers, alternative keyboards, scanning
applications, etc.
• Users: users
• Developers: designers, programmers, etc.
• Authoring tools: website creation tools
• Evaluation tools: HTML, CSS validators, etc.
In fact, insufficient accessibility in one component cannot reasonably be overcome
by other components and the result is inaccessibility, making it impossible for some
people with disabilities to use a website, page or resource [11]. Thus, it is necessary to
establish a specific condition, equal to all available interactions, without restrictions and
ensuring the same opportunities for consumption, socialization and entertainment [9].
In this sense, the initiatives that promote accessibility are costly efforts to
implement and validate the successful integration of the recommendations represented
in the restricted literature on accessibility in games, while new technologies are
emerging. Despite the consideration of the market as a prospect of implementation
feasibility, approaches that include educational initiatives aimed at learning from a
playful approach provided by games are not excluded [9].
4
2.3 Related works
As related work, Doctor Tea stands out, which is a game developed by Fundación
Orange [12] that aims to facilitate medical visits by people with Autism Spectrum
Disorder (ASD), providing information to patients about the most common medical
practices for who can understand and anticipate them, in addition to providing doctors
with information about the characteristics of these patients and practical advice for
families, as well as many other features to assist them in visits. As a result, daily
clinical practice demonstrates that, when there has been prior anticipation, specific
training, systematic desensitization or simple habituation to the procedures, the
patient's anxiety decreases considerably before, during and after medical
consultations.
The Brainy Mouse game, available on Android and iOS platforms, was made
aiming at the literacy of children with ASD and attention deficit [13]. The game
works with reading from left to right; word formation using syllables; interaction with
colors; sounds and other “cognitive devices”, which help the user to work on their
development in a playful way. In a very interactive way, the child can customize his
mouse. In addition to being challenged to get “cheesecoin”, a kind of virtual currency.
Another related work is Happy Geese, a special version of a board game [14]. The
idea and usefulness of this game is to enhance the digital leisure of children with
special needs, helping to improve different skills such as learning the vowels, number,
shapes and colors. For this, it has data without numbers, four adaptable trays and,
above all, an intuitive and easy to use interface. The game was applied to three
children at a specialized ASD clinic in São Paulo, Brazil, who were entertained, as
well as learned colors and vowels, repeating as the game taught.
A literature review that analyzes the relationship between the development of skills
inherent to emotional intelligence, and its usefulness in the improvement of
treatments for ASD, using human computer interaction is shown in [15]. They
highlighted the needs of new alternatives of digital applications that be adequate and
easily adaptable to a variety of characteristics of children with ASD in order to
improve their emotional and social conditions.
Like the three first games presented in this section, Mr. Pizza is a game aimed at
children with ASD in order to help them in communication and organization by
choosing the ingredients they like and organizing them in the order of making a pizza.
Mr. Pizza was developed based on accessibility guidelines to serve children with ASD.
3 Development methodology
For the development of this research, theoretical studies on ASD were carried out to
identify children's needs with this disorder. Accessibility guidelines for the
development of games for children with ASD were studied and then a prototype of
the accessible game was developed for this target audience.
The game was developed for children aged 6 to 9 years with ASD Level 1
Severity, where the diagnosed person has difficulty changing activities, problems
related to organization and planning, difficulty initiating social interactions and
5
reduced interest in social interactions [2]. To play, it is necessary that the child has
verbal communication skills to understand the dialogues and dynamics of the game,
as well as preserved intelligence in relation to visual working memory. Once the
profile of children with ASD was identified, the necessary requirements for the
implementation of an accessible game that meets the needs of this public were
gathered. Table 1 shows the accessibility guidelines used in the development of Mr.
Pizza, based on [8] and [10].
Table 1. Accessibility guidelines for children with ASD based on [8] and [10].
Guidelines Description
Compatible Maximize compatibility with current and future user agents,
including assistive technologies
Alternative texts Provide alternative texts for any non-text content so that it can be
changed in other ways that people need (speech synthesis,
symbols, among others)
Time-based media Provide alternatives to time-based media (pre-recorded audio or
video) such as subtitles, audio description or other alternative
media
Adaptable Create content that can be presented in different ways (simpler
layout, for example) without losing information or structure
Distinguishable Make it easier for users to see and hear content, including
separating foreground from background
Keyboard Make all features available and operable using a keyboard
accessibility
Enough time Provide users with sufficient time to read and use the content
Seizures and Do not design the content in a way that is known to cause epileptic
physical reactions seizures
Navigable Provide ways to help users navigate, find content and determine
where they are
Configurable Allow the player to adjust, simplify and save controls for the game
Input modes Allow users to operate with multiple inputs in addition to the
keyboard
Readable Make content readable and understandable
Predictable Make pages appear and operate in predictable ways
Insert assistance’ Help users avoid and correct mistakes and errors
Documentation Provide accessible documentation in multiple formats
Learning and Provide training modes and manual challenge level adjustment
challenge
For the design of the game, the setting of a pizzeria was chosen, in order to
establish communication with the child using commonly consumed products,
approaching the whole process of creating a pizza. Thus, the main purpose of the
game is to explore and develop some aspects such as the ability to interact, memorize,
the ability to listen, understand and execute a command, as well as stimulate planning
and organization.
Unity, a development platform for the creation of multiplatform games in 2D and
3D and interactive experiences, was used to implement the game. Regarding the
execution of the game, the following minimum requirements are necessary:
• Operating system: Windows 7 SP1+, macOS 10.12+, Ubuntu 16.04+
6
• Graphics card with DX10 features (shader model 4.0).
• CPU: support for SSE2 instruction set.
• WebGL: any recent version of Firefox, Chrome, Edge or Safari.
4 Discussion and Results
Based on the studied accessibility guidelines and ABA therapy, was developed the game
“Mr. Pizza” with the intention to improve social skills, interaction and memorization, as
well as stimulate the planning and organization of children with ASD. On the game's
home screen, users can start the game by clicking on the Play button. They can see the
tutorial and the game’s credits. The user can also enable or disable the game's background
music and the monitoring of game texts via audio by clicking on the respective icon.
Fig. 1. Ingredients Selection Screen.
When starting the game, the Ingredients Selection screen appears (Fig. 1) showing
to users some ingredients options for assembling the pizza. This screen allows to
select the favorite ingredients, respecting the following rule: it is necessary to select at
least 2 ingredients out of 8 possible, except for pasta and sauce, which are essential
and mandatory.
After choosing the ingredients, the user moves to the next screen “Assembly Order”
to check the order of ingredients previously selected in which the pizza will be
assembled and their respective quantities. On this screen, the player must memorize the
sequence for assembling the pizza that will be made on the next screen.
7
Then, users interact with their favorite ingredients and their respective quantities to
assemble the pizza. The assembly must respect the order of the ingredients selected in
the previous screen (Fig. 2). After assembling the pizza respecting the correct order of
ingredients and quantities, the user returns to the previous screen that will show a new
sequence of ingredients and will add another unit of ingredient at random, challenging
the child's memory, who must assemble a new pizza following the new order. The
game ends when the quantity of each ingredient selected by the child is equal to 10 or
when the child forgets the assembly order. At the end, the final screen shows player's
name and his game rating are stored.
Fig. 2. Assemble the Pizza screen.
Based on the 16 accessibility guidelines, basic goals for implementing accessibility,
presented in Table 1 of section 3, some were used in the game “Mr. Pizza ”, among
them we have the Alternative Text guideline that aims to provide textual alternatives
for all non-text content (ASCII art that consists of a character pattern), emoticons,
leetspeak (which uses character substitution) and images that represent text) in a way
that can be changed to different forms such as speech or symbols.
Still based on the guidelines, the Time-based media guidelines were applied:
Subtitles (pre-recorded) and Descriptive Subtitles (pre-recorded), these subtitles are
used for spoken content (speech, narration) and for audio content (sound effects,
description of music type in animations), both can be enabled or disabled.
When creating the screen layout, concepts from the Adaptive guideline were used,
which is based on the creation of content and interfaces that can be presented in
different ways without losing essential application information, making the layout
simpler and with just the necessary buttons of action and with the look of the pizzeria
8
organized. Some graphic elements were used to improve the visual structure of the
application, such as pointers and marks (change in the size of the pointer, even if it
impairs the graphic resolution a little), and the reduction of details in order to decrease
some elements and actions that take the focus off the main goal user.
Regarding time, the Sufficient Time guideline assumes to provide players with
enough time to read, understand, use the contents and features that have been
implemented. Thus, due to the characteristics of the game and the target audience, it is
desirable do not use time limitation, as the interpretation and response time of the user
may vary according to the degree of ASD. Related to the game language, the Legible
guideline was implemented to make the information clearer and easier to be
interpreted and understood by the user. Simple language was used, where all textual
content was written in a simple, objective and succinct language (limiting phrases up
to 50 characters). Still related to language, it is worth mentioning the implementation
of a mechanism to explain the meaning of complicated or unusual words, this also
serves for abbreviations and acronyms.
To help users avoid some errors and correct mistakes, the Assistance guideline has
been implemented. Help in the application must be available to be called at any time
to assist the player with instructions, reminders or tips on how to go through a
challenge. Still thinking about the auxiliary part, it is desirable to create a step by step
to configure the game controls, letting the user customize the settings so that it is
appropriate and more comfortable, thus facilitating and increasing the immersion in
the game.
Considering the target audience chosen for the development and implementation of
the game, some difficulties were encountered. Considering that each diagnosis is
different, the guidelines that were implemented in the application had to be thought
out and structured to meet all the needs of the public and ensure an adequate playful
interaction for cases of ASD, as pointed out [15]. In the development process, it is
important to pay attention to the limitations of users and the appropriate accessibility
guidelines to build a game that, in addition to meeting the objectives, can promote the
social inclusion of children with ASD.
5 Final considerations and future work
After a review of the literature on Autism Spectrum Disorder and the guidelines for
accessibility in games, this article resulted in the development of an accessible game
for children with ASD, "Mr. Pizza". The game implemented is intended to support the
development of communication, memorization, the ability to listen, understand and
execute a command, as well as stimulate planning and organization. Educational
games prioritize objectivity, visual appeal, the use of a friendly and safe environment,
which provides security for the user, promoting a more specific and non-generalized
view.
Regarding accessibility, the guidelines for Time-based media, Seizures and
physical reactions, Navigable, Configurable, Readable and Predictable were
implemented to meet the needs of a child diagnosed with ASD. These guidelines
consider the limitations in communicate and expression skills in social environment in
9
which he lives. In addition to making the mechanics of the game clearer and
maintaining the focus on the means of organization and planning.
As future work, we suggest users’ tests to verify the usability of the game “Mr.
Pizza”. In addition, we suggest to improving the mechanics of the game so that the
teaching and learning capacity is expanded by studies more in-depth, enabling
customization of the application, making the game increasingly adaptable and
practical.
This research contributes to studies on accessibility in games, in order to help and
facilitate the understanding and application of these guidelines in the construction of
accessible digital games. It is intended to strengthen the theme of accessibility in
games, understanding that this study and effort stimulate the development of inclusive
games.
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