When the screams become overwhelming I hurry to the far end of the playground to hide. My vision seems to melt, and the ringing in my ears is so sharp that it hurts. All I can do is press my face against the fence and wait for it all to subside.
I haven’t been attacked by any kind of enemy. Behind me is a simple playground, children innocently playing together on a roundabout and swing-set. My senses have become my adversary. They have forced me into isolation.
This is my first experience of Auti-sim, a free game that aims to show how it can feel to live as an autistic child in even the most innocuous settings. Simple pleasures, familiar to all of us, can be transformed into terrifying ordeals.
“That’s exactly what we were trying to communicate,” says Taylan Kadayifcioglu, programmer and game designer on the Auti-sim project. “How social isolation can be a natural coping mechanism for people with this affliction.”
That he chose a video game to communicate this is particularly telling. It has long been observed that many autistic children, and often adults, form a strong relationship with screen-based media such as television and video games. It’s only recently that research into the impact of this has been conducted, and the question asked of whether video games are harmful or beneficial to children with autistic spectrum disorder (ASD). I decided to explore further.
Autism is difficult to summarise, and even harder to treat. It manifests itself in many different ways, with varying levels of severity from person to person. Someone with ASD may experience symptoms very different to those of somebody else. It can be a relatively minor affliction that allows for a mostly normal life, or it can be completely disabling.
Symptoms of autism in children can include difficulty with verbal communication; difficulty with nonverbal communication such as facial expressions and gestures; difficulty with social interaction; and the inability to make friends. Statistics show that around 1 in 50 American kids has autism.
The range of symptoms and severity makes treatment difficult. “Individuals vary quite a bit in terms of their unique strengths and challenges,” says Micah Mazurek, Assistant Professor in the Department of Health Psychology at the University of Missouri.
Simple pleasures, familiar to all of us, can be transformed into terrifying ordeals.
The most widely used treatments are behavioural interventions, based on the principles of applied behavioural analysis (ABA), which aims to modify behaviour through long-term intensive therapy. There are also nutritional systems, and shorter treatments designed to stimulate the brain, such as that practiced by Zelda Landau, Director of the National Light & Sound Therapy Centre in London.
“There are no easy solutions,” she tells me. “The biggest challenge in dealing with children with autism is that they are unable to express themselves.”
This inability to communicate is what leads many autistic children to turn to video games. Here they can control a character in a world with fewer sensory stimuli and without the stresses of social interaction.
“Many individuals with ASD are particularly drawn to screen-based technology,” says Mazurek. “I am certainly not the first to observe this – parents, educators, clinicians, and individuals with ASD have been discussing this anecdotally for many years.”
Most of Mazurek’s clinical work and research focuses on improving outcomes for individuals with autism spectrum disorders. She spends a lot of time with those afflicted and their families, and this piqued her interest in the relationships between ASD and screen-based media, particularly video games. She has recently published several studies on the issue.
One study used “parent-report questionnaires to assess screen-based media use among children with ASD as compared to their typically developing siblings.” Parents reported on their children’s extracurricular activities and behaviours, and were asked to report specifically on their use of video games. The questions assessed information such as amount of time spent playing video games, the types of devices used, and preferred game types. In many ways, the results were not surprising.
“Essentially, we found that children with ASD spend much more time on screen-based media, including video games, than on other activities,” says Mazurek. “We also found that they spent much more time playing video games than their typically developing siblings. This finding supported the idea that these technologies may be especially reinforcing for children with ASD.”
This may seem like stating the obvious, but formal studies had never been conducted. “I have had no experience in the use of video games for children with autism,” admits Landau, a treatment veteran of over 20 years, though she is open to the idea of further exploration.
Firmly establishing a link between ASD and video games potentially opens the door for the practical application of video games and other screen-based media in ASD therapy. It might be as simple as using a gamepad to teach sharing, or using online games to teach autistic children social skills in a safe, virtual environment.
But there is more to consider.
Taylan Kadayifcioglu doesn’t personally know anybody with ASD. This didn’t stop him from creating a game about it. “I am married to a very kind and compassionate woman who works with kids with special needs,” he tells me. “Her experiences, insights, and awareness on issues around accessibility are what made me interested in making a game that dealt with issues of accessibility and inclusion.”
Auti-sim is a simple game that was created in a weekend as part of Hacking Health, a hackathon focused on the health industry. The game takes place in a small playground environment populated by groups of children enjoying the play equipment. It should be a happy setting. But as soon as you take control of the game you realise that something isn’t quite right. You play from a first-person perspective. As you approach the other children the sound of their laughter spikes to an unbearable volume. You realise that they have no faces. The visuals suddenly blur and degrade until they’re almost painful to look at. The only reprieve comes when you retreat to an empty corner of the playground. What should be a joyful environment is quickly reduced to one of isolation and fear.
This is representative of one of the most unpleasant symptoms of autism. The afflicted may not possess natural sensory filters. This means that the sights, sounds, and smells of an everyday environment, such as a playground, can become insurmountable obstacles.
It might be as simple as using a gamepad to teach sharing, or using online games to teach autistic children social skills in a safe, virtual environment.
“I was interested in seeing if one could build a game level where sensory input would become the obstacle course, rather than walls or corridors or whatnot,” says Kadayifcioglu. “Players naturally find themselves preferring solitude by the swings at the far end of the playground, to escape the unwelcome sensory input.”
Some of the most effective ways in which the familiar setting is turned into a hostile space came about as a result of the three-strong team’s limitations. “We didn’t have 3D artists to create game assets from scratch, so our game world had to be constructed with what was readily and cheaply available on the internet.” Kadayifcioglu’s team had access to a trial version of Unity Pro, and they quickly found the playground package on the asset store.
“The fact that the children are all faceless was not really intentional,” admits Kadayifcioglu. “Many people thought it was alluding to the challenges of people with autism around reading people’s expressions and social clues. It was the only free 3D child model I could find at the time.
“Luckily it all came together nicely enough to create that rather eerie playground in the game.”
Auti-sim, despite the title, was never intended to simulate hyper-sensitivity. “The game itself was intended to elicit a response from the player that is similar in quality to the kind of response an autistic person would give to sensory over-stimulation.” He is very aware that, due to varying symptoms and subjectivity of experience, it could never be possible to simulate the experience with perfect fidelity.
“You can make a game where players storm the hyper-realistic beaches of Normandy with every grain of sand individually rendered, but you cannot truly give people the experience of actually being there,” says Kadayifcioglu. “What you can do, however, is approximate the experience. I think we succeeded in that.”
The game has met with a largely positive response. It has resonated with the personal experiences of many with ASD, and some have used the game to communicate their sensory issues to their neurotypical friends and family members. “Similarly we received many comments from neurotypicals saying that playing the game was an eye-opening experience for them because they found themselves displaying behaviours that they had seen autistic people do,” says Kadayifcioglu.
So, in a number of ways, video games prove themselves important within the field of autism therapy. Yet there were some who were not so positive about Auti-sim, and who are wary of the impact that the medium could have on those with ASD.
The results of Mazurek’s studies also raised a number of concerns about the relationship between ASD and screen-based media. “We found that children with ASD demonstrated much higher rates of problematic, or addictive, game use as compared to typically developing children,” she says.
If video games provide a desirable ‘safe’ environment for autistic children away from the real world, they may prefer to spend an unhealthy amount of time within them. Therefore some commentators have used the research to denounce autistic children being allowed to play video games. “Very often the parents are criticised for mismanaging their children,” says Landau. “In actual fact they’re dealing with problems that have no easy solutions.”
They’re dealing with problems that have no easy solutions
“The challenge is to recognise when [ video games are helping ], instead of panicking about video game addiction,” says Kadayifcioglu. “It can be a valid concern. But you also see a familiar pattern in that kind of conversation: a failure to make a distinction between the problem and the coping mechanisms. Games can be amazing tools in coping with the outside world for the sense of control it gives an autistic child, who otherwise may not feel in control of his or her surroundings and life in general. Or they can be therapeutic and reinforcing of certain skills.”
Concern about the harmful impact of games on children with ASD triggered some negative responses to Auti-sim. “Some people were just wary of video games and thought calling it a game trivialised the subject,” Kadayifcioglu says. “Some other people were upset that our game did not reflect their personal experiences with the condition. There were also some misunderstandings, I think, where people did not initially get that this was not a for-profit project.”
Mazurek is less certain, for now, of the potential positive impact of video games for autistic children, but she remains open to the possibilities, particularly when it comes to teaching social and communication skills. “Teaching these skills in ‘real world’ social situations can be stressful and overwhelming for some children with ASD. As such, game-based or virtual reality environments might be more comfortable for initially learning and practicing these skills.
“What we don’t yet know is whether children are able to demonstrate the skills they learned online or in virtual environments in actual face-to-face social interactions.”
So, as ever, there is a great deal more research to be done. Mazurek’s results are preliminary. The next step is a longitudinal study that looks at the effects of video game use over time. There is also a need to study the effects of different types of games. And if these were to have positive outcomes, there is still the need for controlled clinical studies to determine if these extend to real world situations.
If this research can further establish the positive impact of video games on children with ASD, it could allow video games to play an important role in the treatment of autism. This would not only be good news for the afflicted and to the medium, which is still considered by many as harmful to young people. Helping autistic children to integrate into society would benefit us all.
“Having a section of the population excluded from public life is a loss for all of us,” says Kadayifcioglu, “especially if it can be avoided simply with more empathy and understanding. Without such understanding, it is easy to contribute to the problem instead of helping.”