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
Kath Dickinson M.A. Autism & M.A. Early Years Education - written 2008
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 wellbeing. 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.
Kath Dickinson M.A. Autism & M.A. Early Years Education - written 2008

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 (Safrit & Wood, 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 (Safrit &Wood, 1995).
Test
Bleep test
Six minute test
Sergeant jump
Sit up test
Sit and reach
Shoulder lift
Press up
Area of measurement
Cardio vascular fitness (aerobic)
Cardio vascular fitness (aerobic)
Elastic strength
Strength endurance core body strength
Flexibility of shoulder girdle and hip joint
Flexibility of hip joint
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
Kath Dickinson M.A. Autism & M.A. Early Years Education - written 2008
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.
Strength- Sit ups
35
30
Number of sit ups
25
20
Initial test
Final test
15
10
5
0
Child A sit
ups
Child B sit
ups
Child C sit
ups
Child D sit
ups
Kath Dickinson M.A. Autism & M.A. Early Years Education - written 2008
Strength- Jump
Difference in height
30
25
20
Initial test
15
Final test
10
5
0
Child A
sergeant jump
Child B
sergeant jump
Child C
sergeant jump
Child D
sergeant jump
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.
Kath Dickinson M.A. Autism & M.A. Early Years Education - written 2008
Bleep Test Results
16
14
12
Test levels
10
initial test
8
Final test
6
4
2
0
Child A
Child B
Child C
Child D
bleep test bleep test bleep test bleep 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
Kath Dickinson M.A. Autism & M.A. Early Years Education - written 2008
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.
Recent years have seen an increase in the number of ASD diagnosed children
and physical activity has shown potential in helping children with ASD develop in all
areas. While more research is needed and there are still many unanswered questions,
physical activity through the use of exergaming machines may help the autistic child
to lead a healthier life and aid their social interaction. Although the study was small
research findings suggest that there are benefits in fitness and social skills, which
could result in an improved quality of life for autistic children from using these types
of exercise consoles.
Issues that need further research are,


A control group was not used which means it is not possible to reliably
say that the results can be solely related to the Wii. The results could
be attributed to natural changes related to maturity, although national
statistics are not available.
A long-term study would indicate if fitness improvements were related
to the movement from mainly sedentary to exercise and to the
longevity of the results.
Kath Dickinson M.A. Autism & M.A. Early Years Education - written 2008


Set times were not indicated for length of play so evidence is not
available related to optimal play levels or the best type of activity to
improve fitness.
Only a small study sample was used with restricted gender and age.
Personal note: Let’s remember exergaming is here to stay so let's figure out how to
make this a positive for ASD children.
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