title: Facing the challenge of teaching emotions to individuals with low- and high-functioning autism using a new Serious game: a pilot study.
abstract: BACKGROUND
  It is widely accepted that emotion processing difficulties are involved in Autism Spectrum Conditions (ASC). An increasing number of studies have focused on the development of training programs and have shown promising results. However, most of these programs are appropriate for individuals with high-functioning ASC (HFA) but exclude individuals with low-functioning ASC (LFA). We have developed a computer-based game called JeStiMulE based on logical skills to teach emotions to individuals with ASC, independently of their age, intellectual, verbal and academic level. The aim of the present study was to verify the usability of JeStiMulE (which is its adaptability, effectiveness and efficiency) on a heterogeneous ASC group. We hypothesized that after JeStiMulE training, a performance improvement would be found in emotion recognition tasks.
  
  
  METHODS
  A heterogeneous group of thirty-three children and adolescents with ASC received two one-hour JeStiMulE sessions per week over four weeks. In order to verify the usability of JeStiMulE, game data were collected for each participant. Furthermore, all participants were presented before and after training with five emotion recognition tasks, two including pictures of game avatars (faces and gestures) and three including pictures of real-life characters (faces, gestures and social scenes).
  
  
  RESULTS
  Descriptive data showed suitable adaptability, effectiveness and efficiency of JeStiMulE. Results revealed a significant main effect of Session on avatars (ANOVA: F (1,32) = 98.48, P < .001) and on pictures of real-life characters (ANOVA: F (1,32) = 49.09, P < .001). A significant Session × Task × Emotion interaction was also found for avatars (ANOVA: F (6,192) = 2.84, P = .01). This triple interaction was close to significance for pictures of real-life characters (ANOVA: F (12,384) = 1.73, P = .057). Post-hoc analyses revealed that 30 out of 35 conditions found a significant increase after training.
  
  
  CONCLUSIONS
  JeStiMulE appears to be a promising tool to teach emotion recognition not only to individuals with HFA but also those with LFA. JeStiMulE is thus based on ASC-specific skills, offering a model of logical processing of social information to compensate for difficulties with intuitive social processing.
  
  
  BACKGROUND
  Comité de Protection des Personnes Sud Méditerranée V (CPP): reference number 11.046 (https://cpp-sud-mediterranee-v.fr/).
authors.affiliation: Autism Resources Center, Child and Adolescent Psychiatry Department, University Hospital CHU-Lenval, Nice, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Serret
authors.affiliation: Autism Resources Center, Child and Adolescent Psychiatry Department, University Hospital CHU-Lenval, Nice, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hun
authors.affiliation: Anthropology and Cognitive and Social Psychology Research Unit (LAPCOS, EA 7278), University of Nice Sophia Antipolis, Nice, France.
authors.forename: Galina
authors.initials: G
authors.lastname: Iakimova
authors.affiliation: Sensory And Ambient Interfaces Laboratory, CEA LIST/DIASI, Fontenay-aux-Roses, France.
authors.forename: Jose
authors.initials: J
authors.lastname: Lozada
authors.affiliation: Sensory And Ambient Interfaces Laboratory, CEA LIST/DIASI, Fontenay-aux-Roses, France.
authors.forename: Margarita
authors.initials: M
authors.lastname: Anastassova
authors.affiliation: Autism Resources Center, Child and Adolescent Psychiatry Department, University Hospital CHU-Lenval, Nice, France.
authors.forename: Andreia
authors.initials: A
authors.lastname: Santos
authors.affiliation: Autism Resources Center, Child and Adolescent Psychiatry Department, University Hospital CHU-Lenval, Nice, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Vesperini
authors.affiliation: Child and Adolescent Psychiatry Department, University Hospital CHU-Lenval, Nice, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Askenazy
keywords: Computer-based Intervention; Emotion Recognition; High-functioning Autism; Low-functioning Autism; Serious game; Social Skills Training