Therapeutic Use f Life Simulatin Games fr Peple with Cgnitive Impairments Edmund F. LPresti, PhD University f Pittsburgh
Cgnitive Skills Enhancement Prgram Fifteen week pst-secndary, prevcatinal cgnitive skills training prgram University f Pittsburgh cntract with Pennsylvania Office f Vcatinal Rehabilitatin Based at Hiram G. Andrews Center, Jhnstwn, PA
Cgnitive Skills Enhancement Prgram Variety f cgnitive impairments Learning Disability ASD Traumatic Brain Injury Supprt cgnitive skills Self-awareness Executive functins Scial skills
The Sims Vide game that simulates everyday life Characters maintain a husehld, hld jbs, manage scial relatins Based n Maslw s hierarchy f needs, characters have basic needs and higher aspiratins Nn-immersive virtual reality
Related Wrk Use f virtual reality envirnments t teach functinal skills (Brks et al. 2002, Strickland et al. 2007) and scial skills (Bernard-Opitz & Nakhda-Sapuan 2001, Hetzrni and Tannus 2004, Parsns et al. 2006) The Sims has been used by schl-age children with cgnitive impairments t create narratives f their characters lives (de Craene & Cuthell 2006) and t address issues such as anger management, scializatin, and pattern discvery in lw-incme yuth (Tsikalas 2001). Imprtant f a mediated experience t supprt generalizatin (Kerr et al. 2002, Mitchell et al. 2007)
Clinical Applicatin Used with 191 clients with cgnitive impairments since spring 2007 Clients each create a character that represents him- r herself Physical characteristics Persnality traits Preferences
Sims Persnality Traits: Sims 2 Five Dyads Slppy/Neat Shy/Outging Lazy/Active Serius/Playful Gruchy/Nice
Sims 3 Persnality Traits Absent-Minded Ambitius Artistic Athletic Bkwrm Brave Charismatic Childish Clumsy Cmmitment Issues Cmputer Whiz Cuch Ptat Cward Daredevil Dislikes Children Easily Impressed Excitable Family-Oriented Flirty Friendly Frugal Genius Gd Gd Sense f Humr Green Thumb Grumpy Handy Hates the Outdrs Heavy Sleeper Hpeless Rmantic Ht-Headed Inapprpriate Light Sleeper Lner Lves the Outdrs Mean Spirited Mch Natural Ck Neat Neurtic N Sense f Humr Over-Emtinal Party Animal Perfectinist Schmzer Slb Snb Technphbe Vegetarian Virtus Wrkahlic
Clinical Applicatin Clients play game fr 8-14 weeks, Independently during unstructured time With staff bservatin and feedback nce every 1-2 weeks Staff fllw up with client t supprt generalizatin
Practive, Reactive, and Passive Play Characters in the Sims act under a cmbinatin f cmputer cntrl and player cntrl Character behavir under cmputer cntrl is determined by persnality traits
Gals Self-awareness Planning and prblem slving Vcatinal awareness Scial awareness
Self Awareness See hw selected persnality traits effect the character s behavir Real-life issues reflected in the game due t the character s persnality r the client s playing style Explring strategies Trying t maintain a schedule Experimenting with less rigid behavir
Planning and Prblem Slving budget wants md basic needs
Vcatinal Awareness getting t wrk jb requirements
Scial Awareness Frming friendships Practicing scial engagement Explring ther character s reactins t varius interactins Repairing damaged relatinships
Scial Awareness
Scial Awareness
Evaluatin: Client Surveys Surveys cmpleted by 57 clients D yu have a better understanding f yurself after playing the Sims? 1. Definitely 2. Maybe 3. Prbably nt 4. Definitely nt Did playing the Sims allw yu t practice real-wrld skills r strategies? 1. Definitely 2. Maybe 3. Prbably nt 4. Definitely nt Hw did the Sims resemble real life? Hw might yur experience with the Sims help yu in real life?
Results: Client Surveys D yu have a better understanding f yurself after playing the Sims? 1. Definitely (25/57) 2. Maybe (25/57) 3. Prbably nt (5/57) 4. Definitely nt (2/57) 95% Cnfidence Interval: (1.5,1.9) Did playing the Sims allw yu t practice real-wrld skills r strategies? 1. Definitely (27/57) 2. Maybe (28/57) 3. Prbably nt (1/57) 4. Definitely nt (1/57) 95% Cnfidence Interval: (1.4,1.7)
Evaluatin: Staff Surveys Surveys cmpleted by 10 staff (3 certified rehabilitatin cunselrs and 7 graduate students in rehabilitatin cunseling) based n interactin with 68 clients
Evaluatin: Staff Surveys Has playing the Sims had an impact n yur client(s) real-wrld strategies related t prblem slving, scial skills, r ther cgnitive skills? 1. Definite psitive impact 2. Likely psitive impact 3. N impact 4. Likely negative impact 5. Definite negative impact Has playing the Sims had an impact n yur client(s) self-awareness? 1. Majr imprvement in self-awareness 2. Sme imprvement in self-awareness 3. N impact 4. Sme reductin in self-awareness 5. Majr reductin in self-awareness (e.g. unrealistic expectatins) In what specific ways has playing the Sims helped yur client(s)? In what specific ways has playing the Sims been detrimental fr yur client(s)? What might imprve the prcess f using the Sims in a clinical setting?
Results: Staff Surveys Has playing the Sims had an impact n yur client(s) real-wrld strategies related t prblem slving, scial skills, r ther cgnitive skills? 1. Definite psitive impact (9/68) 2. Likely psitive impact (48/68) 3. N impact (11/68) 4. Likely negative impact (0/68) 5. Definite negative impact (0/68) Cnfidence Interval: (1/9,2.1) Has playing the Sims had an impact n yur client(s) self-awareness? 1. Majr imprvement in self-awareness (6/68) 2. Sme imprvement in self-awareness (53/68) 3. N impact (9/68) 4. Sme reductin in self-awareness (0/68) 5. Majr reductin in self-awareness (0/68) Cnfidence Interval: (1.9,2.1)
Evaluatin: Crss-ver Design Cntrl Sims Week 1 Functinal Ratings (Pre) Weeks 2-7 Grup B Grup A Week 8 Functinal Ratings (Mid) Weeks 9-14 Grup A Grup B Week 15 Functinal Ratings (Pst)
Evaluatin: Crss-ver Design Grup A 3 clients 1 male, 2 female mean age 21.6 years, SdDev 1.1 years multiple diagnses: 2 with ASD, 2 with learning disabilities, 2 with ADHD, and 1 with anxiety disrders Grup B 6 clients 5 male, 1 female mean age 20.4 years, SdDev 1.8 years multiple diagnses: 3 with ASD, 1 with BIF, 2 with learning disabilities, and 2 with ADHD
Evaluatin: Crss-ver Design Functinal Ratings During weeks 1, 8, and 15, clinicians rated each client using a 7- pint Likert scale n 14 areas self-awareness, judgment and prblem slving, cmmunicatin, attendance/punctuality, md, behavir, scial skills, rganizatin, participatin, and strategy and assistive technlgy use. 7 indicates that the client is effective at the given skill 90-100% f the time, and 1 indicates that the client is effective at the given skill 0-15% f the time.
Results: Crss-Over Design Greater imprvement in functinal ratings during Sims half-term fr 11 f 14 measures Intellectual self-awareness, emergent self-awareness, judgement/prblem slving, cmmunicatin, md, behavir, scial skills, rganizing things, rganizing thughts, rganizing time, participatin Only significant fr Md and Scial Skills
Anecdtal Results Players wh identified themselves as slppy and/r lazy in real life, and created characters accrdingly, have bserved hw their characters refuse t clean their hmes r g t wrk n time, resulting in negative cnsequences. One client expressed interest in using the game t recreate past prblems and explring what culd be dne differently. Clients expressed bservatins such as the character needing a regular rutine like the client has, r alternatively wanting the character t be less anxius and dependent n rutine than the client is in real life.
Anecdtal Results In pen-ended survey respnses, sme clients made statements such as The Sims resemble real life because I d the same things, it acts like me, and des what I d, It wuld d the same things I wuld d in real life ; smetimes giving specific examples that they bserved such as emtinal utbursts, being shy arund thers, r being easily distracted.
Anecdtal Results Sme clients stated in pen-ended survey questins that they believed that The Sims had helped shw t expect unexpected events, understanding priritizing time t I can have time t myself, being practive, better time management skills.
Anecdtal Results Staff have reprted bserving situatins in the game that match the srts f situatins that clients face in real life
Future Wrk Better supprt generalizatin t real life Better measure generalizatin t real life
References Bernard-Opitz, V., Sriram, N., & Nakhda-Sapuan, S. (2001). Enhancing scial prblem slving in children with autism and nrmal children thrugh cmputer-assisted instructin. Jurnal f Autism and Develpmental Disrders, 31, 377 384. Brks BM, Rse FD, Attree EA Ellit-Square A. (2002). An evaluatin f the efficacy f training peple with learning disabilities in a virtual envirnment. Disability & Rehabilitatin. 24(11-12):622-626. De Craene, M. & Cuthell, J. (2006). Re-prgramming Piaget: A Develpmental Lk at ICT and 21st Century Learning. In C. Crawfrd et al. (Eds.), Prceedings f Sciety fr Infrmatin Technlgy and Teacher Educatin Internatinal Cnference 2006 (pp. 2191-2195). Chesapeake, VA: AACE. Hetzrni, O. E., & Tannus, J.(2004). Effects f a cmputer-based interventin prgram n the cmmunicative functins f children with autism. Jurnal f Autism and Develpmental Disrders, 34, 95 113. Kerr SJ, Neale HR, Cbb SVG. (2002). Virtual envirnments fr scial skills training: the imprtance f scafflding in practice. Prceedings f the fifth internatinal ACM cnference n Assistive technlgies. p. 104-110. Mitchell P, Parsns S, Lenard A. (2007). Using Virtual Envirnments fr Teaching Scial Understanding t 6 Adlescents with Autistic Spectrum Disrders. Jurnal f Autism and Develpmental Disrders. 37(3):589-600. Parsns, S., Lenard, A., & Mitchell, P. (2006). Virtual envirnments fr scial skills training: Cmments frm tw adlescents with autistic spectrum disrder. Cmputers and Educatin, 47 (2), 186-206. Strickland, Drthy C., McAllister, David, Cles, Claire, Osbrne, Susan (2007). An evlutin f virtual reality training designs fr children with autism and fetal alchl spectrum disrders. Tpics in Language Disrders. Virtual Reality: Explring New Dimensins fr Cnversatin, Language, and Learning. 27(3):226-241, July/September. Tsikalas, K.E. (2001). When the SIMS get real: an analysis f hw digital play spaces prmte learning in lwincme, diverse cmmunities. Center fr Yuth and Technlgy, NYC and CILT Playspace prject. In http://cncepts.cncrd.rg/playspace.