Keywords

1 Introduction

The use of educational or therapeutic videogames (aka Serious Games) in scientific investigations has grown over the past years but their use for people with intellectual disabilities is still a relatively unexplored field. Even though intellectual disabilities are a very broad and diverse field where each individual has very specific characteristics, it would be beneficial to have general recommendations about how to design videogames adapted to their cognitive features. To pursue this goal, the purpose of this paper is to identify and review the available literature on Serious Games for intellectual disabilities and classify the research found according to the learning outcomes associated to them.

Early research on Serious Games for intellectual disabled people is mostly focused on adapting the interface of existing videogames [1, 2] but we consider that the real challenge is to design learning-games identifying the specific needs of intellectual disabilities users to ensure an effective learning outcome.

2 Serious Games for Intellectual Disabilities

The AAIDD (American Association on Intellectual and Developmental Disabilities) describes ‘Intellectual Disability’ as a disability characterized by significant limitations both intellectual functioning (reasoning, learning or problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills [3]. An individual is considered to have an intellectual disability based on the following three criteria: (a) intellectual level (IQ) is below 70–75, (b) significant limitations exist in two or more adaptive skills areas (like communication, self-care, social skills, home living, leisure, self-direction) and (c) the condition is presented from childhood [4].

Attending to this definition there is a wide range of mental conditions that can be considered intellectual disabilities, depending on its causes, signs and symptoms. Even though the different intellectual disabilities have similarities, it is not possible to standardize the learning mechanisms of all impairments and reflect them in the design of a videogame’s mechanics. The result is that not all Serious Games are suitable as learning tools for all disabled game players [5, 6].

Although the search terms used in this review covers most of the intellectual disabilities in general to ensure that the results are representative enough, we are interested in identifying those articles referred to two concrete disabilities: ASD (Autistic Spectrum Disorder) and DS (Down Syndrome) for three reasons:

  1. 1.

    Down Syndrome is the most common genetic disorder found in newborns and the most common intellectual disability associated with mental impairment. The prevalence of Down syndrome has been reported to occur in about 1 out of every 600 live births [7].

  2. 2.

    ASD comprises a group of conditions within the category of developmental disorders. Due to its heterogeneity of symptoms, ASD is the disorder with the largest number of scientific investigations among the intellectual disabilities [8].

  3. 3.

    There are a large number of associations in Spain and US dedicated to ASD and DS (separately) that can provide us advice about the characteristics, skills, attitudes and behavior of each group and provide users for the actual game testing.

3 Method

We applied the same method used by Connolly et al. [9] to examine the available literature in Serious Games.

3.1 Databases Consulted

The databases consulted are relevant in three different fields according to the topic of this article: Computer Science, Psychology, Medicine and Science in general. All of them were accessed in their electronic format and are listed below: ASSIA, BioMed Central, EBSCO (consisting of Psychology and Behavioural Science, PsycINFO, PubMed, SocINDEX, Library, Information Science and Technology Abstracts, CINAHL, ERIC, IEEE, Medline and Academic Search Premier), IngentaConnect, Science Direct and Web of Science.

3.2 Search Terms

We identified three groups of search terms which combination helps us to perform an accurate search in databases referred to the technology, the subject and our particular interest in game design and development methodologies. The final query used in the databases remains as follows:

(“videogame” OR “game”) AND (“intellectual” OR “cognitive” OR “disability” OR “behavior” OR “down syndrome” OR “autism”) AND (“design” OR “methodology” OR “survey”)Footnote 1

3.3 Selection of Papers for Inclusion in the Review

We applied the following selection criteria to the 498 studies found in the databases searched in order to choose which articles include in our review:

  1. 1.

    The purpose of the study is to test the acquisition of knowledge through videogames designed or adapted considering specific needs of a particular intellectual disability or a common feature in people with intellectual disabilities in general.

  2. 2.

    The purpose of the study is to identify patterns and behaviors in the use of videogames in people with intellectual disabilities.

  3. 3.

    The purpose of the study is to apply a methodology in the design or development of videogames for a particular intellectual disability or intellectual disabilities in general.

In addition, we discarded the studies that do not appear in scientific publications and those published before 2005. Those papers that do not report an empirical evidence of the results has been included only when the results show relevant behaviors of the users or when best practices are identified.

Once the inclusion criterion is applied, 43 studies have been included in our review.

The classification of the Serious Games is a controversial issue since there is not a single taxonomy widely accepted by the scientific community [10, 11, 12, 13, 14]. We chose the taxonomy proposed by Wouters et al. [15] who described a classification consisting of four categories of learning outcomes in Serious Games: cognitive, motor skills, affective and communicative. The studies included in our review are classified as follows: First, we determined the purpose of the investigation in accordance to one of our three inclusion criteria. Second, we applied the taxonomy described by Wouters to those studies which purpose is to learn a skill.

4 Studies and Results Classified by Purpose of the Investigation and Learning Outcomes

See Tables 1, 2, 3, 4 and 5.

Table 1. Acquisition of knowledge through the design or adaptation of videogames. Cognitive skills
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Table 2. Acquisition of knowledge through the design or adaptation of videogames. Motor skills and affective learning
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Table 3. Acquisition of knowledge through the design or adaptation of videogames. Communicative Learning
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Table 4. Patterns and behaviors
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Table 5. Methodology for game design or development
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5 Conclusions and Future Work

We provide an outline of the research available on Serious Games for intellectual disabilities by reviewing and classifying 43 studies according to the purpose of the investigation and the learning outcomes associated to them. This is only a first step to obtain guidelines for creating games for users with intellectual disabilities. We have identified challenges and trends after reviewing the literature.

In general terms, most of the studies are designed for users with a certain disability because of the heterogeneity of the skills that this type of users have. Most of the studies describe methodologies and design guidelines that provide recommendations and best practices for a particular disability, but a large number of them have not tested their effectiveness in an actual development with a relevant cohort of users.

We also observed that the results of the studies seem to be positive. Apparently, disabled users acquire new skills through the use of Serious Games but not many investigations provide qualitative results that prove the efficiency of this type of games in a long-term learning process. The use of learning analytics can fill this gap collecting data about the gameplay and the progress of the user, tracking the selected skills to reinforce the learning process.

As a conclusion we believe that the number of the studies and the results obtained are not enough to ensure general recommendations but is a good start point to identify what is working in this type of games. It would be desirable to identify, compile, implement and test these best practices to systematize the creation of tailored serious games for people with intellectual disabilities into a general methodology to simplify the creation of more effective games.