BACKGROUND: Traditional gamified interventions and serious games have been widely employed by therapists and researchers working with people with autism spectrum disorder. Recent studies have also indicated a trend towards technology-based gamification for training behavioral and social skills in autistic people. Nevertheless, the effectiveness of these gamified interventions in enhancing social interaction and communication outcomes among autistic people remains unclear.
OBJECTIVE: This systematic review and meta-analysis of existing gamified interventions focused on people with autism spectrum disorder aimed to provide an overview of commonly used gamification elements and features for enhancing their social interaction and communication outcomes.
METHODS: A total of 11 bibliographic databases were systematically searched from inception to April 2024. Experimental studies, including but not limited to randomized controlled trials, quasi-experimental studies (e.g., non-randomized studies, pre-post studies), and pilot studies. Medical Subject Heading terms, keywords, and free words such as 'ASD', 'gamification', and 'social interaction and communication' were used for the search. The extracted data were subjected to a narrative synthesis, and the study outcomes were subjected to a meta-analysis. Gamified elements were classified based on the most widely adopted gamification elements for learning purposes.
RESULTS: Twenty studies involving 349 participants were eligible. Of 297 participants included for descriptive synthesis, 246 (82.8 %) were male, with a mean age at study entry of 11.55 years. Children and adolescents with autism spectrum disorder were the most common target populations (k = 19, 95 %), followed by the general adult population (k = 1, 5 %). Two main themes related to the application of gamification interventions emerged from the included studies: the augmentation of engagement in the intervention and the amplification of the desired interventional outcomes. Commonly used gamification elements included feedback (k = 10, 50 %), rewards (k = 10, 50 %), custom learning (k = 9, 45 %), monitoring (k = 9, 45 %), and personalization (k = 8, 40 %). Four of the included studies applied 5-7 elements in their interventions. Five studies were included in the meta-analysis, showing a positive overall effect of gamified interventions on social interaction and communication (pooled standardized mean difference: 0.46; 95 % CI 0.08, 0.85; I<sup>2</sup> 0%).
CONCLUSION: This study offers a comprehensive review of gamification elements and gamified interventions currently used in social interaction and communication skills among people with autism spectrum disorder. The potential benefits of included studies targeting social interaction and communication skills highlight the need for further in-depth investigation in this group. Future randomized controlled trials with more comprehensive development and trials that apply game-related design are suggested.
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