Neurodiversity, Disability, and Gaming

…gaming is actually an incredibly important tool for a lot of autistic people.

Why Gaming Is Actually Good for Autistic Children

Video games have saved my life.

GAConf 2018: A Fraught Love Letter to the Games Industry

Why gaming is actually GOOD for autistic children

In today’s video, I am going to go through the five biggest benefits of gaming and explain why gaming is actually an incredibly important tool for a lot of autistic people.

Why gaming is actually GOOD for autistic children
  1. Learning social skills
  2. Learning key life skills
  3. Having a community
  4. Sense of achievement
  5. Developing friendships

Why gaming is actually GOOD for autistic children – YouTube

I can actually do it without any help or someone watching over me all the time and giving me constant instruction

  • We asked autistic adolescents about gaming, and they gave insightful commentary on how it increases their well-being.
  • Gaming provides opportunities for emotion regulation and agency for autistic adolescents.
  • Our study emphasizes the importance of considering the first-hand perspectives of autistic young people.

Source: ‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Whilst enjoyment is as good a reason as any to engage in hobbies and leisure activities, the insights provided by the young people here suggest that gaming provides a function that goes beyond sheer enjoyment, providing opportunities for skill development (i.e. decision making) and improving emotional well-being. The data painted a rich picture of the benefits and satisfaction that online gaming can bring to the lives of autistic CYP, and are consistent with previous research exploring the perspectives of autistic young adults in relation to gaming.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Online gaming engagement

Online gaming engagement is one potential area of exploration for understanding factors that contribute towards positive well-being in autistic CYP, who spend significantly more time engaging in online gaming than NT peers (Mazurek & Engelhardt, 2013).

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Several studies have suggested that autistic CYP engage in gaming more frequently than non-autistic CYP (Mazurek & Engelhardt, 2013; Mazurek & Wenstrup, 2012; Shane & Albert, 2008). Kuo et al. (2014) found that autistic CYP mostly played video games alone; however, around one-quarter of their sample played with peers, using messaging and chats to communicate during gaming. The authors also found that CYP who used computers for social purposes reported more positive friendships.

The disagreement between what parents saw as ‘valuable’ activities, and what CYP preferred to do caused stress and conflict. These findings suggest that previous research into gaming behaviour in autistic CYP might reflect parental bias in perceptions of their child’s gaming behaviour. It is unclear whether gaming is actually ‘problematic’, or simply reflects the parents’ desire for the child to engage in alternative activities.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Intervention

A meta-analysis from Grynszpan et al. (2014) suggested that technology-based interventions focused on improving ‘social skills’ had limited efficacy.

There is a lack of evidence as to how beneficial the CYP themselves rate these ‘social skills’ to be, and how they relate to their own personal well-being. In regard to personal well-being outcomes, Zayeni et al. (2020) conducted a systematic review to examine the use of video games as a therapeutic support with autistic CYP. They found that commercially available video games can support young people in developing their emotion regulation skills, and to reduce anxiety. However, there is a lack of longitudinal research to help us understand the long-term outcomes of such gaming.

Mazurek et al. (2015) found that video game play offered relief from stress and anxiety experienced in daily life and provided an opportunity for autistic people to momentarily escape from these emotions. This positive impact of gaming on mood is consistent with research from Villani et al. (2018) who identified emotional regulation (ER) as a positive outcome during gaming. They also found that fun and entertainment were highlighted as a major motivator for video game play, which linked to specific game features contributing to the level of enjoyment, for example, achievement and challenge. Similarly, Finke et al. (2018) found that forming and maintaining friendships, emotional regulation, skill development and escapism were key motivators in the gaming engagement of autistic young (mostly male) adults. The participants described gaming as positively impacting their well-being in multiple ways, and providing a therapeutic way to disengage from the stressors of everyday life.

Gallup et al. (2016) found that online games provide a space for autistic young men to socialize with people who share interests, and work together with others to complete quests. These studies highlight the benefits of gaming in autistic young adults from their own perspective.

Their testimony demonstrated that gaming has a positive impact on the subjective well-being of autistic people, and may provide valuable insights into the ways in which autistic people manage their own mental health needs (Lam et al., 2021).

Overall, the findings of this research were consistent with previous studies showing that gaming provides a positive outlet for autistic people. However, unlike previous studies, we did not focus on how this testimony could be used to encourage normative social skills. Instead, our findings highlight the need to acknowledge and validate the viewpoints and experiences of autistic young people in research about their interests and well-being. The young people in this study demonstrated a complex understanding of their own interests, emotional needs, outsider perceptions (i.e. parental disagreements) and challenges in balancing responsibilities with leisure time. We recommend that instead of focusing on the use of autistic CYP interests as a way to develop skills that we think they may find challenging, we should recognize that autistic CYP may already be developing these skills (e.g. autonomy) in ways that adults may not expect. Helping caregivers and educators to recognize the insights that young people have into their own needs, and supporting young people to ‘invite them in’ can lead to further self-development opportunities for young people to find their own methods for self-regulation and skill development.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Being your own boss: a sense of agency and belonging

One of the key motivations for engagement with online gaming was the sense of autonomy and belonging that it fostered in the young people. It provided them with the opportunity to make decisions and have control over an aspect of their life, as well as providing the opportunity to ‘try out’ different roles that might be ordinarily inaccessible.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

A chance to make the choices

The ability to manipulate game features and exert control over players was a consistent theme for many participants. They explained how having opportunities to successfully influence how the narrative unfolds throughout the game appeared fulfilling and satisfying. Participants noted that games were, ‘more fun than the real world because you are in control’ (Aaron) and ‘you can be the boss’ (Luke). The interactive and creative nature of game design allows for dimensions to be fine-tuned to reflect the players’ thoughts and choices

The level of agency the participant felt they had within a game was often associated with positive feelings of enjoyment, ‘when I get to tell everyone what to do, it’s great,’ and ‘I feel good. No one tells you what to do. I do’ (Toby).

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Having the option to be powerful

The ability to take on different identities and become immersed in a fantasy world where you could be and do anything you liked was something the young people in this study found particularly appealing. Specifically, the opportunity to test multiple new identities and attribute their desired characteristics such as strength, power and social status provided a level of fulfilment and satisfaction as they engage with that character.

The challenge of building up a powerful character, and developing skill during gameplay was something that the young people also found intrinsically motivating, giving them the opportunity to acquire skill and knowledge and be recognized as an expert.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Being part of the group

Whilst not all participants reported social interaction as a motivator, several mentioned how gaming facilitated communication and the development of friendships, ‘Easier to talk to friends online,’ (Alex) and ‘I don’t really like talking face to face but online is ok’ (Aaron). Others indicated how it gave them a shared area of interest to enjoy with friends and a sense of belonging to a larger group:

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Learning how to switch off: regulating emotions through gaming and escapism

The young people cited escape from the stressors of everyday life, and the impact it had on their emotional well-being as a strong motivator to engage in online gaming, ‘It isn’t real life so I can transport my brain there and forget about things’ (Tommy). Gaming provided a safe place, and a distraction from their fears and struggles, ‘I can forget about the things that scare me and buzz around my brain’ (Toby). The need for time away from outside pressures was also a common experience, ‘People around me make me frustrated. If I don’t want to do something they keep going on and on,’ (Luke). Henry specifically mentioned the pressures they faced within the school and how gaming provided the opportunity to switch off from it all while still developing new skills.

In addition to providing somewhere to relax and unwind, some young people reported how gaming also provided a way to deal with negative emotions. Online gaming was sometimes used as a distraction from less appealing activities which participants found frustrating or boring

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

A need for understanding: dispositional diversity and parental conflict

It was also clear that gaming helped the young people to unwind and provided the space they needed to engage with family life, though this wasn’t always clear to caregivers. Freddie described how gaming allowed him to ‘switch off’ in order to make that transition between the demands of school and home: My mum usually knows when I come home from school, I play it straight away. If she asks me about my day, I’ll just get annoyed. I need to switch off first.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Getting into the flow: Balancing monotropic focus with self-care

The young people explained their reluctance to engage in everyday activities associated with self-care or homework when they had not achieved a particular goal in the game (e.g. ‘levelling up’). Some of the young people noted that their immersion within a game could make it difficult to disengage, and that this might lead to staying up late playing instead of going to sleep.

Alex noted it affecting his eating habits, I would probably keep playing because I’m not actually hungry. I just have dinner because I have to.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

The importance of autonomy

Participants highlighted a desire for autonomy and opportunities for agency as a strong motivator for engaging in online video gaming. The pervasive nature of these comments indicated that the young people felt like they had little control over most of their daily lives. This was reinforced by their reflections on the use of gaming to de-stress, where many of the young people spoke of feeling pressured by the demands of others. The young people in this study were also engaging with gaming in a way that promoted their agency and decision-making skills which are instrumental in self-advocacy across the lifespan (Pavlopoulou, 2020). Gaming may be one way that young people are able to ‘try out’ more adult or responsible roles in a safe environment and help them to develop their decision-making skills.

This desire to try out different aspects of identity was also explicitly highlighted by the young people as something they found enjoyable about game-play, particularly the chance to make their own decisions, and to be ‘powerful’. Many autistic young people experience social stigma (Crane et al., 2019), peer victimization (Fisher & Taylor, 2016), social exclusion (Kloosterman et al., 2013) and an increase in personal restrictions in comparisons to non-autistic peers (MacMullin et al., 2016). The opportunity to experience life as a powerful person may provide the opportunity to roleplay a more idealized version of themselves.

Power and autonomy, however, were not the only aspects of identity-switching that participants enjoyed. The young people talked about the creative and fantastical aspects of gaming (such as flying, and character customization) as well as the opportunity to see the world through someone else’s eyes. These statements highlight the creativity and perspective-taking skills of autistic young people, which can often be overlooked.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Self-regulation

Video games provided the young people in this study with an outlet for daily stress, and worked as both a way to distract from, and deal with negative emotions as well as increasing feelings of positive well-being and happiness. This is consistent with previous research showing that gaming can provide opportunities for emotion regulation (Reinecke et al., 2012; Villani et al., 2018) and stress release, a key motivation for gaming highlighted by autistic adults (Finke et al., 2018). The participants in the current study demonstrated insights into their own emotional needs and the strategies they use for managing their emotional well-being. These insights can provide caregivers with an understanding of how to support their young people in managing their own well-being. Additionally, they can help caregivers to see why a young person might appear to be prioritizing gaming over other responsibilities (i.e. doing their homework). This information may provide caregivers with the opportunity to find ways to promote agency, for example, encouraging their young person to manage their own emotions in positive ways but also to seek help when struggling instead of avoiding the problem altogether.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Social opportunities

Some of the young people in this study identified the social opportunities provided by online video gaming as a positive benefit. Interacting with friends online instead of face to face facilitated communication and helped to make the young people feel more at ease by providing a platform to communicate on their own terms. The young people also reflected on how online gaming could foster a sense of belonging, through talking to friends with shared interests. These findings are consistent with research into the benefits of online gaming in autistic adults (Gallup et al., 2016), who have highlighted the importance of gaming spaces to share interests with like-minded others. They are also consistent with research which suggests that the communication styles of autistic people may differ from those of non-autistic people (Crompton et al., 2020; Milton, 2012), and that alternative methods of communication may be beneficial for some (Howard & Sedgewick, 2021). Future research should focus on how engagement in hobbies that include a social aspect can (a) foster a sense of belonging and well-being for autistic young people and (b) might encourage them to recognize and advocate for their own communication needs in adolescence.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Dispositional diversity and parental conflict

Despite online gaming providing a wealth of benefits to the young people in this study, they recognized that their parents were not always understanding of their motivations for their engagement with gaming. Milton (2014) highlighted how the concept of ‘dispositional diversity’ (the variation in disposition across different people) can lead to conflict, when mutual misunderstandings arise from a lack of insight into the other’s perspective. The participants expressed how disagreements over what constitutes ‘too much’ gaming could lead to strained relationships with their parents. The majority of studies examining ‘problematic gaming’ in autistic young people typically rely on parent report (Craig et al., 2021). Our findings suggest that what might be labelled as problematic gaming in autistic young people is not necessarily due to ‘excessive’ gaming, but might be due to a disparity in what is classified as excessive by parents (particularly those who do not see the value in gaming as a pastime) and young people. This disparity is important to address, given that parents who see their autistic children as engaging in what they classify as excessive gaming tend to enforce stricter restrictions than they would for siblings (MacMullin et al., 2016; Mazurek & Wenstrup, 2012). These restrictions could lead to the removal of important self-regulation strategies used by autistic young people to modulate their own mood and well-being. The current study provides valuable knowledge to support a sensitive approach from parents and professionals, which acknowledges the needs, experiences and priorities of autistic young people. It is important that we recognize the positive impact that engagement with hobbies can bring to autistic young people, whilst also stressing the need for balancing this engagement with other aspects of their daily routine and responsibilities.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Monotropism and flow states

The young people in this study did acknowledge that it could be difficult to disengage from gaming when they were immersed in completing a particular task, and that this might cause difficulty in other aspects of their daily routine (i.e. remembering to go to sleep, or eat dinner). This increase in immersion can be explained by the monotropic attentional style theorized to be a core feature of autistic cognition (Murray et al., 2005). Monotropism is characterized by a more singular attentional allocation (as opposed to spreading attention across stimuli, in a polytropic manner) and can lead to increased flow states (McDonnell & Milton, 2014), where complete absorption in an enjoyable task can make it more challenging to track the passing of time (Csikszentmihalyi, 1990) and disengage from one task to move on to another. Finding ways to balance engagement in leisure activities with other responsibilities is something many people (autistic or not) have to learn to develop as they transition into adulthood and as responsibilities increase. Placing strict restrictions on gaming time is unlikely to help young people to develop this balance effectively. Instead, caregivers may want to work with their young person to figure out ways to help them transition more smoothly from one activity to another, and learn about the potential impact of neglecting self-care (i.e. being too tired the next day from staying up too late online gaming). Future research should examine how we can support autistic young people to balance their leisure time with other daily responsibilities, with a focus on personal autonomy that will aid in the development of independence.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Games Before Bed

One of our young Stimpunks wanted to emphasize this quote:

However, a self-report study from Pavlopoulou (2020) examining sleep and well-being in autistic CYP found that engaging in video games prior to bedtime could help young people to unwind as part of their regular nightly routine.

‘I can actually do it without any help or someone watching over me all the time and giving me constant instruction’: Autistic adolescent boys’ perspectives on engagement in online video gaming

Hard Mode is My Norm: Gaming Accessibility and Community

Cherry Thompson (@cherryrae) shares a “deeply personal love letter” to the gaming industry in this talk at the 2018 Gaming Accessibility Conference. Her personal story of gaming accessibility is moving, illuminating, and joyfully filled with love and compassion for gaming and developers.

https://channel9.msdn.com/Shows/Level-Up/GAConf-2018-A-Fraught-Love-Letter-to-the-Games-Industry

Like Thompson, I’m autistic, managing chronic pain, and losing bodily and cognitive function. I relate to much of her story. I cried along in recognition and remembrance. Thank you, @cherryrae.

Video games have saved my life.

Along with books, the ongoing explosion of good scripted television, and online communities of fellow autistic and disabled people, games get this “chronic loaf” through a life now lived mostly in bed, where I am propped and bolstered against gravity and assisted by articulated arms in a creche of shredded foam. Games help many disabled people like me through struggles with the medical model, structural ableism, and structural inaccessibility. They help us exist in our bodies and world, and beyond. They are essential to coping.

Games were a big help to my mental health and personal struggles, they got me through some big scary things as a child and a teenager. And this is where my spark of adoration for the industry began.

Games bolster us when our health, lives, identities, and support networks erode.

…from losing bodily and cognitive function to hospital stays, losing friends, communities, a lot of what made me me.

Game immersion is therapy and pain management.

Games have been my company, my community, my adventure, my therapy. They’ve challenged me in more ways than one. Games have even been pain management.

Games empower us and make us feel wholer.

Games can be more than entertainment, they empower us.

The games I love make me feel wholer than I can in this society we have today, and believe me I’ll remember the ones that leveled the access for us, and made access as effortless as it was for everyone else.

Perhaps most importantly, games provide community. Chronic pain, reduced mobility, sensory overwhelm, and social anxiety limit my excursions beyond my Cavendish bubble.

Living with progressive disability can be really isolating.

I’m different, I don’t fit in society the way other people do, and it’s both physically and mentally isolating.

Through backchannels, written communication, and games, I’ve connected with many, including the #ActuallyAutistic community.

@cherryrae’s talk is a personal story of gaming accessibility that includes autistic auditory processing (I turn on subtitles because I process and remember text better than speech), sensory overwhelm, and the life-changing importance of connecting with your tribe. Love this talk. Thank you @cherryrae.

Games were a big help to my mental health and personal struggles, they got me through some big scary things as a child and a teenager. And this is where my spark of adoration for the industry began.

Video games have saved my life.

…from losing bodily and cognitive function to hospital stays, losing friends, communities, a lot of what made me me.

Living with progressive disability can be really isolating.

I’m different, I don’t fit in society the way other people do, and it’s both physically and mentally isolating.

The games have saved me. By my love of games, I found the accessibility community. I became in advocacy work, and I found purpose.

I found I had community just by talking about games.

Through streaming I found even more community, people like me, but also people not like me at all. Just by being out there both showing how inclusion matters and finding a way to break down the ways people see disability. When we can play the same games as the rest of the community, they unite us despite how different we are. Games can be more than entertainment, they empower us. Inclusion at every level of the industry makes a difference.

Games have been my company, my community, my adventure, my therapy. They’ve challenged me in more ways than one. Games have even been pain management.

When I save games saved my life, I really mean it.

The games you all work so hard to make for us bring me so much. I have such deep connections to the games I love.

The games I love make me feel wholer than I can in this society we have today, and believe me I’ll remember the ones that leveled the access for us, and made access as effortless as it was for everyone else.

Disabilities intersect and fluctuate.

My needs change frequently, even sometimes in the middle of playing a game.

I believe accessibility is really not that much different than accounting for normal human variation. I would even argue that disability is normal human variation.

Having empathy for your audience informs good design. But, I believe it goes two ways, and I want all of you to know and feel that we get it. Many of us disabled gamers know the struggle of accessibility. We live and breathe it. We know how hard you’re working. We see you, and we appreciate you.

Options go a long way to helping empower us to navigate our own impairments, and then the myriad ways the intersect.

Most of my frustrations as a disabled gamer could have been solved had the options been given to me to change things in some way.

Button remaps are a big deal for both physically and cognitively disabled gamers like me, even when disabilities are relatively mild.

Button remaps are important for using third part assistive tech.

Sometimes I have to choose a lack of control in physical pain over constantly pressing the wrong buttons

Accessibility for one group can lead to accessibility for others.

Autistic people like me can also benefit from subtitles? I process information in every form differently to most. I especially struggle when speech is coupled with animated lips that move imperfectly with the words.

Subtitles helped me enormously. I need subtitles. I miss a lot without them.

When subtitles aren’t clear enough, whether that’s due to font choice, text size, or contrast issues, my imperfect sight, dyslexia, and ADHD all collide, and I’m likely to get even less information than if there were no subtitles at all.

I live with something called sensory processing disorder where I process sensory information differently. Too much of anything or everything, and I can get extremely overwhelmed.

I don’t always know at first what I’m finding inaccessible about a game.

Disabled gamers like me want to help you. We are experts. Include us.

It is dangerous to go alone. Take us.

In my experience, the best results of implementing accessibility are when disabled people are included in the process.

You’re not in this alone. We are here.

Disabled people are great overachievers. Even if something is prohibitive or extremely difficult, we strive for a way.

We face barriers in games all the time, but we have some of the most creative solutionists. Again, we often find a way.

Most games I’ve played have been hard mode for me in some way because I’ve been working around barriers.

I want to feel like I matter to the industry I adore so much.

For me, accessibility is about quality of life. A lack of accessibility doesn’t always mean zero access at all. More often than not, it means playing is painful, exhausting, extra frustrating, or just not very fun. Sometimes it’s a reminder of how different I am to the majority of the world. Now, gamers like to makes jokes about things that break their immersion, cliches, bugs, clunky UI. But as a disabled gamer, my immersion could be broken by heightening my sense of being disabled, of being different.

Games unite people. They provide a wonderful sense of community. Thousands or sometimes even million of people getting about a game is an incredible thing to behold. The hype is real. It’s really real, and it’s an absolute thrill. Sadly, when a game isn’t accessible, what unites thousands or millions of people isolate me and others like me. It’s a little bit heartbreaking, just a little, to feel lie you’re on the fringe or the outside of that shared cultural excitement.

When games get it right, when they level the access, when we’re included, whether directly or indirectly, it is magnificent. Suddenly, we’re enveloped into the fold. We can talk with our non-disabled peers about how fun, challenging, exciting, or downright beautiful a game is. We can play alongside them, we can laugh at our failures, and we can share our hard-earned wins. We’re no longer the disabled gamer, we’re just a gamer like everyone else.

Games that provide us the options we need, not only give us great adventure, profound experience, and fun, they include us in a community that otherwise we aren’t a part of. It is a brilliant thing.

I deeply adore this industry and everything it does for me. I’ll be loyal to the grave to accessible games and inclusive studios. I’ll promote them to death and defense their honor everywhere I set wheel.

“Work as if you live in the early days of a better world.”

GAConf 2018: A Fraught Love Letter to the Games Industry | Microsoft Docs
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