Playful Tray: Adopting Ubicomp and
Persuasive Techniques into Play-based
Occupational Therapy for Reducing Poor
Eating Behavior in Young Children
UBICOMP 2007
Dori Lin, Hao Chu, Arthur Chen, Jane Hsu, Polly Huang
Graduate Institute of Networking and Multimedia
National Taiwan University
Jin-Ling Lo, His-Chin Chou
National Taiwan University Hospital
1
Child Behavior Training
• Child behavior training as important but
challenging parental responsibility
– Potty training, tooth brushing, self-dressing,
cleaning room, slow eating (focus of this work)
• The most common form of parental
persuasion is verbal persuasion.
– “if you don’t finish your food, you are going to sit
here for the rest of your life”.
• Effective and Why not?
– Verbal persuasion alone lacks proper incentive
to motivate child
2
A Case Study: Child Mealtime
Behavior
• Target child long mealtime problem (over 30 minutes)
– Affect the participation of daily activities
– Negative parent-child interaction
• Dinner time supposed to be valuable family time together
• Common scenario: A child refuses to eat -> Mother upset -> Mother
force feed -> Child upset
3
Play-based Occupational Therapy
• Pediatric occupational therapy (O.T.)
– Leverage the desire of children to play to induce their behavior
change willingly.
• A child may not like to sit & eat dinner, but likes to play.
• Add playfulness (game) into the eating activity
– Effective – full of toys in pediatric O.T. clinic.
4
Play-Based O.T. Limitations
(1) Children treated in clinics during regular office hours (NTU
Hospital)
– Many child behavior problems not observable to therapists
• Eating (dinner time), sleeping (night time), etc.
• Effective treatment is difficult.
(2) Train general performance skill rather than specific
functional skill
– Hand scoping skill vs. eating skill
– Improvement in general performance skills may not translate into
specific functional skills
5
UBICOMP Opportunities
• Embed digital technology into a child naturalistic living
environment
– Sensing to observe child behavior anytime, anywhere
– Game playing to influence child behavior anytime, anywhere
• Occupational therapist perspective:
– From treatment clinic
– To the child actual living environment (functional behaviors)
• UBICOMP perspective:
– From sense and track behaviors
– To engage children to change behaviors
• Also called Persuasive technology (by Fogg and others)
6
Playful Tray Prototype 1: Coloring
Game
• Sensing
– Weight sensors underneath tray
detect child eating actions
– Eating actions are game input
• Playing
– An interactive game of coloring a
cartoon character
– To fully color the cartoon character, a
child is motivated to eat.
• Is this design successful?
7
Why not?
Show prototype #1 to our pediatric O.T. partners, their feedbacks are two
questions:
• Do you think the child would pay attention to playing the
game or eating (enjoying) food?
• What would happen if parents take away the tray after a
while?
– Intervention (Effective) – Post (Ineffective)
Guess their opinions from their questions …
8
Play-based Occupational Therapy
Model
• Treatment program is about designing a play activity
(three elements).
Volition
Bring enough
enjoyment to
attract a child to
participate in the
target activity.
Performance
Ensure a child will
have a successful
experience. Set
appropriate level
of difficulty.
Habituation
Apply reinforcement
to reward good
performance, so
increase change of
repeating desirable
behavior. Enough
times to become a
habit.
9
Design Consideration
• Attention (Child)
– Split between playing and eating
– Game playing (secondary) not overtaking eating (primary, target)
• Enjoyment (Game)
– Bring just enough fun to attract children to eating
• Engagement (Game)
– Simple (Not all young children can learn to operate complex devices)
– Use natural eating actions as game inputs
• Child must eat to continue playing
(eating becomes self-inforced)
10
Prototype 1: Problems
• Disengagement
– Grabbed too much attention & distract children from proper
eating.
• Gobbling
– Impatient children ate too quickly (to color cartoon character).
• Single weight cell is sufficient
– Food is served in one bowl to a young child (at home or school).
11
Prototype 2: Racing Game Tray
Palm-top PC with touch screen
For placing the bowl
Weight sensing surface
12
The Racing Game
13
The Racing Game
• No reward for eating too fast
14
Racing Game Tray: Feedbacks
• Tray was too thick (3 cm)
– Inconvenience for young children with short arms
• Playing the same game boring
– Download new games
• Expensive
• Difficult to wash
15
Prototype 3: Mobile Penguin
Fishing Tray
Bluetooth mobile phone accessory
Placemate skin
Light, foldable, washable,
changeable
Weight sensing module
50% Thinner (1.5 cm)
Mobile Phone
Download new games
Only buy the skin &
weight sensing model
16
Install weight sensing
module
17
Game start
Child selects a penguin to compete in a fishing
game.
18
Game start
Each bite causes one penguin to get a fish
The penguin getting more fish at the end wins
Child is motivate to help in order to help penguin to win.
19
Pilot User Study on Prototype #2
• Conducted by our pediatric O.T. team
• Subjects: four young children with reported
long mealtime problems (30 min to over 1 hr)
Children
Age
Diagnosis
A
7
Asperger’s Syndrome
B
5
High function autism
C
5
Asperger’s Syndrome
D
4
No specific diagnosis
20
User Study Procedure
1.
2.
3.
4.
Child’s Mealtime Behavior Checklist
Interview - to clarify behavioral details
Record eating activities without the tray
Record eating activities with the tray within 1 week
21
Measurement method
• Code behaviors of both children & parents from taped
videos
• Our eating coding behavior table was modified from
Moore.
– Self-feeding (Positive, Negative)
• Child active feeding or related behaviors
– Interaction (Positive, Negative)
• Actively initiated behaviors and synchronous responsive behaviors
of the feeding partners
– Social
• Toward a feeding partner but unrelated to feeding
– Positive (promote self-feeding); Negative (interrupt self-feeding)
22
(1) Self-feeding: a child place food into his/her own mouth
Mother
Child
Positive: A child attempts self-feeding, such as
Positive: A mother allows or promotes self-feeding,
holding utensils, putting food into mouth,
such as verbal encouragement, praises, etc.
etc.
Negative: A mother discourages, disallows, or
interrupts self-feeding, such as pushing the Negative: A child rejects self-feeding, such as
saying “no” or pushing away given food.
child’s hands away, telling the child that she
will feed the child, etc.
(2) Interaction: Actively initiated behavior and the synchronous responsive behavior of the feeding
partner
Mother as the actor
Child’s responsive behavior
Positive: A mother attempts to arouse a child’s
Positive: A child accepts food when it is offered,
interest, such as talking about food, models,
or self-feeds food.
Negative: A child ignores the mother’s cue,
food games, etc. A mother refocuses the
child’s attention on food when the child is
refuses, or walks away from the mother’s
distracted.
cue.
Negative: A mother intrusively attempts to direct
Positive: A child responds by self-feeding.
feeding, such as force-feeding the child,
Negative: A child ignores the mother’s attempts,
holding a child’s head, body, or hand, and
refuses, or walks away from the mother’s
threatening the child.
attempts.
Mother’s responsive behavior
Child as the actor
Positive: A mother synchronously responds to
promote continuous feeding, such as
Positive: A child initiates an attempt to eat, such
interpreting a child feeding cues, responding
as looking at food, talking about food,
to a child’s needs, etc.
requesting food/drink, or touching food.
Negative: A mother synchronously responds to
interrupt the child’s feeding.
Positive: A mother synchronously responds to
23
promote continuous feeding, such as
Negative: A child shows disinterest,
interpreting the child feeding cues,
Measurements (with vs. without the tray)
•
•
•
•
Mealtime duration
Child on-task / off-task behavior ratio
Parent on-task / off-task behavior ratio
Parent positive / negative behavior ratio
24
Result: Mealtime Duration
• (A:23, B:40, C:41, D:25) -> (23, 25, 29, 9)
• Except for Child A, children B, C, D all had reduced
mealtime from 29% ~ 64%.
Mealtime duration (min)
Mealtime duration
without the tray
with the tray
50
40
30
20
10
0
A
B
C
D
Participants
25
Measurements (with vs. without the tray)
• Mealtime duration
• Child on-task / off-task behavior ratio
– On-task behaviors: positive behaviors
– Off-task behaviors: negative + social behaviors
– High ratio is good.
• Parent on-task / off-task behavior ratio
• Parent positive / negative (P/N) behavior ratio
26
Child On-task/Off-task Behavior Ratio
• Improvement in all children
– Children were more focused on self-feeding with the playful tray
Child behavior
without the tray
On-task/Off-task behavior
7.0
with the tray
6.0
5.0
4.0
0.8~1.6
3.0
2.0
1.0
0.0
A
B
C
Participants
D
2.3~5.9
27
Measurements: with vs. without the tray
• Mealtime duration
• Child on-task / off-task behavior ratio
• Parent on-task / off-task behavior ratio
– On-task behaviors: positive behaviors
– Off-task behaviors: negative + social behaviors
– High ratio means good improvement.
• Parent positive / negative behavior ratio
28
Parent On-task/Off-task Behavior Ratio
• Improvement of all parents
– Parents were also more focused on the feeding task with the
playful tray.
On-task/Off-task behavior
Parent behavior
without the tray
with the tray
2.5
2.0
0.5~1.1
1.5
1.0
0.5
0.0
A
B
C
Participants
D
0.8~2.3
29
Measurements: with vs. without the tray
•
•
•
•
Mealtime duration
Child on-task / off-task behavior ratio
Parent on-task / off-task behavior ratio
Parent positive / negative behavior ratio
30
Result: Parent P/N Ratio
• Less negative & more positive interaction between
parent-child.
– A positive interaction cycle of parent giving encouragement and
children responding with positive self-feeding behaviors
– Mealtime experience can be good.
0.79~4.00
4.30~30.00
31
Limitation
• Pilot user study results were encouraging but not
conclusive
– Lack long-term user studies involving more children
– Lack post-intervention study
• What happened when taking away the tray?
• For O.T., success = improvement from posttest to pretest.
Pre
Intervention
Post
32
Conclusion
• This work demonstrates a case study of adopting
UBICOMP technology in play-based occupational
therapy for children
– Pilot user study results were encouraging
33
Ongoing & Future Work (Children have lots of
behavior problems)
• Playful toothbrush
– Tooth brushing behavior
– Sensing: camera vision to recognize brushing motions
– Playing: an game of cleaning dirty teeth
• Mug-Tree
– Regular water drinking habit
– Sensing: tilt sensor to detect drinking actions.
– Playing: watering a virtual tree
34
Many Thanks
• Reviewers for their insightful comments
• Our shepherd Sunny Consolvo
• Keng-hao Chang on helping to create the first prototype
35
Thanks
Q&A
36
Result: Child P/N Ratio
• Child negative behaviors decreased
0.80~13.33
6.95~19.00
37
different food types (rice/ dumpling→easy to eat → less self-feeding actions) ↑