Game-Based Mobile App for Autism

Overseen By Daehyoung Lee, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Delaware

Disqualifiers: Moderate-to-profound ID, Orthopedic conditions

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a fun mobile app called PuzzleWalk, designed to help autistic adults become more active and reduce sitting time. The app converts daily steps into game time, encouraging regular movement by making it enjoyable. It aims to improve health and well-being in autistic adults at risk for health issues due to low activity levels. Ideal participants are autistic adults who have a smartphone with an iOS 13+ operating system and can walk independently. As an unphased trial, this study offers a unique opportunity to contribute to innovative research focused on enhancing the quality of life for autistic adults.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this app is safe for autistic adults?

Research has shown that the PuzzleWalk app has been tested with both autistic and non-autistic adults. Findings indicate that users generally experience positive outcomes with the app. No reports of negative effects have emerged from using PuzzleWalk. The app encourages physical activity by converting steps into time for playing a puzzle game. This feature helps people stay active without requiring in-person interaction, which some might prefer to avoid. Overall, the app appears safe and aims to improve health in a fun and engaging way. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike traditional therapies for autism that often rely on face-to-face interactions or medication, PuzzleWalk is a gamified mobile app designed specifically for autistic adults. It stands out by integrating gamification strategies to encourage walking and physical activity, translating step counts into playtime for engaging "spot the difference" puzzles. This approach leverages the strengths of visual learning and reduces the pressure of social interactions. Researchers are excited because PuzzleWalk taps into the psychological satisfaction of autonomy, relatedness, and competence, offering a unique and personalized way to support behavioral changes in autistic individuals.

What evidence suggests that the PuzzleWalk app is effective for promoting physical activity in autistic adults?

Research shows that the PuzzleWalk app, used by participants in this trial, helps autistic adults become more active and reduce sitting time. Studies have found that apps with fun, game-like features can encourage increased movement. PuzzleWalk turns daily steps into a game, making walking enjoyable and appealing to many autistic adults. Previous research suggests that combining step tracking with games can promote activity, which is important for better health. The app has also undergone testing to ensure ease of use and safety for both autistic and non-autistic adults. ^{1 2 6 7 8}

Who Is on the Research Team?

Daehyoung Lee, PhD

Principal Investigator

University of Delaware

Are You a Good Fit for This Trial?

This trial is for autistic adults, including those with mild intellectual disabilities. It's designed to help participants who are at risk of health issues due to low physical activity and high sedentary behavior. The study seeks individuals willing to use a gamified mobile app aimed at increasing their daily movement.

Inclusion Criteria

Individuals who have regular access to a supported smartphone (iOS 13+ operating system)

Individuals diagnosed with an autism spectrum disorder by a medical professional or self-identify as neurodivergent

Exclusion Criteria

Individuals with a moderate-to-profound intellectual disability

I use a wheelchair or crutches due to a significant orthopedic condition.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-3 days

1 visit (in-person or virtual)

Baseline Data Collection

Participants undergo baseline data collection including demographics, technology and medication use, and accelerometer-derived PA and sedentary time

1 week

1 visit (in-person or virtual)

Intervention

Participants use the upgraded PuzzleWalk app to increase physical activity and reduce sedentary behavior, supported by periodic reminders and reinforcement messages

6 weeks

Ongoing app usage with periodic virtual check-ins

Follow-up

Participants are monitored for changes in physical activity and sedentary behavior after the intervention

1 week

1 visit (in-person or virtual)

What Are the Treatments Tested in This Trial?

Interventions

• PuzzleWalk

Trial Overview The clinical trial is testing PuzzleWalk (PW), a game-based mobile app developed to promote physical activity and reduce time spent inactive in autistic adults. The app uses gaming elements like turning steps into puzzle playtime as motivation.

How Is the Trial Designed?

Group I: PuzzleWalk (Gamified mHealth) Experimental Treatment 1 Intervention

PuzzleWalk integrates gamification strategies and incentivization of walking behaviors to induce target behavior changes. Capitalizing on the distinctive attributes and preferences of autistic adults, PW emphasizes the advantages of visual learning while minimizing the need for undesired face-to-face social interactions. A novel feature is its conversion algorithm that translates daily step counts into playtime for "spot the difference" puzzle games, which leverages the psychological satisfactions of autonomy, relatedness, and competence.

Who Is Running the Clinical Trial?

University of Delaware

Lead Sponsor

Trials

167

Recruited

25,700+

Autism Intervention Research Network on Physical Health

Collaborator

Trials

2

Recruited

80+

Published Research Related to This Trial

In a study involving 18 children and adults with autism spectrum disorders (ASD), the Empowered Brain AR smartglasses were found to be safe, with 89% of users able to wear and use the device without reporting negative effects.

Caregivers also reported no negative effects, and the majority of users and caregivers expressed satisfaction with the design, indicating that AR technology could be a beneficial tool for social communication in individuals with ASD, although further research is needed on long-term effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and Lack of Negative Effects of Wearable Augmented-Reality Social Communication Aid for Children and Adults with Autism. Sahin, NT., Keshav, NU., Salisbury, JP., et al.[2023]

A systematic review of 7 randomized controlled trials involving mobile device applications for individuals with autism spectrum disorder (ASD) showed promising effects on visual and fine motor skills, with a standardized mean difference of 0.41, indicating a moderate benefit from the interventions.

While the initial results are encouraging, the authors emphasize the need for more comprehensive and larger studies to better understand the effectiveness of mobile apps in improving behavioral symptoms in individuals with ASD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mobile device applications and treatment of autism spectrum disorder: a systematic review and meta-analysis of effectiveness. Moon, SJ., Hwang, J., Hill, HS., et al.[2020]

Gamification of interventions provides a promising alternative for improving social communication and cognitive skills in autistic individuals, allowing for more natural and engaging learning experiences.

This scoping review highlights the potential of game-based approaches and offers resources for parents and professionals to effectively integrate these methods into their practices for supporting autistic children, adolescents, and adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Use of Analog and Digital Games for Autism Interventions. Atherton, G., Cross, L.[2023]

The My JAKE app was successfully used by 144 caregivers of individuals with autism spectrum disorder (ASD) to log daily symptoms and behaviors over an 8- to 10-week period, showing that real-time reporting can effectively capture behavioral data.

Caregivers reported high satisfaction with the app, with over 50% expressing interest in continuing its use beyond the study, indicating that mHealth tools like My JAKE could enhance the accuracy of symptom tracking and improve the understanding of ASD interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Caregiver Daily Reporting of Symptoms in Autism Spectrum Disorder: Observational Study Using Web and Mobile Apps. Bangerter, A., Manyakov, NV., Lewin, D., et al.[2023]

The systematic review analyzed 12 reviews and 43 studies from 2015 to 2020, focusing on the use of augmented reality (AR), serious games (SG), and the Picture Exchange Communication System (PECS) to engage individuals with Autism Spectrum Disorder (ASD) in behavioral therapies.

The findings highlight the need for attractive and engaging environments to improve participation in treatments for ASD, while also identifying gaps in current research and suggesting future directions for exploring these technological tools.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Augmented Reality, Serious Games and Picture Exchange Communication System for People with ASD: Systematic Literature Review and Future Directions. Almurashi, H., Bouaziz, R., Alharthi, W., et al.[2022]

A new automated gaming platform designed for children with autism focuses on improving key skills like Imitation and Joint Attention through engaging games, showing promise for intensive intervention in home settings.

In a 3-month trial with 10 children, parents reported improvements in their child's concentration (78%), flexibility (89%), and self-esteem (44%), indicating the platform's potential effectiveness in enhancing developmental skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

GOLIAH: A Gaming Platform for Home-Based Intervention in Autism - Principles and Design. Bono, V., Narzisi, A., Jouen, AL., et al.[2020]

The PuzzleWalk mobile app was found to be user-friendly and effective for promoting physical activity among both adults with and without autism spectrum disorder (ASD), based on a study involving 18 participants.

Qualitative interviews revealed important insights into the specific health and social needs of adults with ASD, highlighting areas for improvement in future iterations of the app.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Usability inquiry of a gamified behavior change app for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder. Lee, D., Frey, GC., Min, A., et al.[2021]

The GOLIAH gaming platform, used alongside traditional treatment for children with autism spectrum disorder (ASD), showed improvements in joint attention and imitation skills over a 6-month period, although it did not significantly outperform standard treatment alone.

Parents reported no increase in stress levels while using GOLIAH, suggesting that the gaming intervention may be a supportive tool without adding to parental burdens, warranting further investigation in larger trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

GOLIAH (Gaming Open Library for Intervention in Autism at Home): a 6-month single blind matched controlled exploratory study. Jouen, AL., Narzisi, A., Xavier, J., et al.[2020]

The smartphone-based game GuessWhat? has shown promise in distinguishing children with autism spectrum disorder (ASD) from neurotypical children, achieving a classification accuracy (AU-ROC) of 0.745 and a recall rate of 0.769 using naturalistic gameplay data.

This approach highlights the feasibility of using digital tools for screening ASD, particularly in underserved communities, suggesting that telemedicine can enhance access to early diagnosis and intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Machine learning models using mobile game play accurately classify children with autism. Deveau, N., Washington, P., Leblanc, E., et al.[2023]

Mobile apps designed for autism care can be categorized into various types, including support, educational, and data collection apps, each targeting different users such as individuals with autism, teachers, and parents.

These apps utilize innovative features like gamification and virtual reality, along with user-centered design principles, to enhance usability and effectiveness in improving autism symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Survey on Autism Care, Diagnosis, and Intervention Based on Mobile Apps Focusing on Usability and Software Design. Liu, X., Zhao, W., Qi, Q., et al.[2023]

In a pilot study involving 11 children with autism spectrum disorder (ASD) and 19 typically developing (TD) children, actual object control skills did not improve after playing sports active video games (AVGs) for 6 sessions of 45 minutes each.

However, children with ASD showed an improvement in their perceived object control skills, suggesting that while AVGs may not enhance physical skills, they could boost confidence and motivation to engage in physical activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does playing a sports active video game improve object control skills of children with autism spectrum disorder? Edwards, J., Jeffrey, S., May, T., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7482920/

PuzzleWalk: A theory-driven iterative design inquiry of a ... In this paper, we describe the iterative design inquiry process of PuzzleWalk, a gamified, physical activity-promoting mobile app designed for adults with ASD.

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06566131

NCT06566131 | Development and Evaluation of A Game- ... The clinical study aims to develop and test a gamified mobile health app called PuzzleWalk (PW) to promote physical activity (PA) and reduce sedentary ...

3. researchprotocols.org researchprotocols.org/2025/1/e71631

A Gamified mHealth App to Promote Physical Activity and ... PuzzleWalk is a gamified, behavior change theory–guided mobile app designed to promote regular PA participation among autistic adults by ...

4. formative.jmir.org formative.jmir.org/2022/7/e35701/PDF

Effects of a Gamified, Behavior Change Technique–Based ... Objective: This study aimed to compare the effectiveness of a gamified and behavior change technique–based mobile app,. PuzzleWalk, versus a ...

5. withpower.com withpower.com/trial/phase-autism-spectrum-disorder-7-2024-23063

Game-Based Mobile App for Autism · Info for Participants The PuzzleWalk app was tested for usability in adults with and without autism, and the results indicated satisfactory quality, suggesting it is safe for use.

6. researchgate.net researchgate.net/publication/326493534_Puzzle_Walk_A_Gamified_Mobile_App_to_Increase_Physical_Activity_in_Adults_with_Autism_Spectrum_Disorder

Puzzle Walk: A Gamified Mobile App to Increase Physical ... A gamified mobile app, Puzzle Walk was developed to elevate physical activity (PA) engagement in the target population following an iterative ...

7. udel.edu udel.edu/udaily/2025/january/daehyoung-lee-gamified-mobile-health-app-puzzlewalk-autism/

Gaming for health | UDaily PuzzleWalk, a gamified mobile health app for adults with autism, developed by Health Behavior and Nutrition Sciences Assistant Professor ...

8. patshih.luddy.indiana.edu patshih.luddy.indiana.edu/publications/Lee-PuzzleWalk-VSGAMES-18.pdf

Puzzle Walk: A Gamified Mobile App to Increase Physical ... To gain insight into how adults with ASD perceive PA and technology device use in their everyday lives, questions focused on demographics, main forms of PA.