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Gamified Therapy PDT Yields High Support From Children With Neurodevelopmental Disabilities


A digital pet app used as a prescription digital therapeutic (PDT) to encourage children to complete prescribed therapies received high engagement and function scores from children living with neurodevelopmental disabilities.

A gamified therapy prescription app that incorporates intervention mapping (IM) and behavior change techniques (BCTs) yielded high engagement, function, aesthetic, and subjective quality scores from users, a study published in JMIR Pediatrics and Parenting reported.

The mobile health (mHealth) app, Zingo, was designed to promote therapy activities for children aged between 6 and 12 years living with neurodevelopmental disabilities. While the study authors found it suitable for children with a broad range of neurodevelopmental disabilities, including cerebral palsy and autism spectrum disorder, they noted some children living with more severe disabilities may require additional assistance when using the app.

At the same time, the authors said children may still find the bright colors, pet images, and activity videos more engaging than paper-based therapy programs.

The iterative, user-centered app development model incorporated the first 3 steps of IM: needs assessment, specification of the goal and change objectives, and theory-informed methods and practical applications.

The needs assessment was conducted utilizing user feedback from a previous mHealth app study by the authors, a literature review, and a market audit. Then, goals and change objectives were specified in alignment with psychological needs of autonomy, competence, and relatedness, as identified in self-determination theory. BCTs were then selected from these change objectives, and parameters for each BCT’s effectiveness and operationalization were established.

To inform the mHealth app’s development, the study authors also conducted 2 rounds of consultations with 3 parents, 3 teachers, and 4 therapists, as well as 1 round of prototype app testing with 4 children. Based on findings from these consultations and tests, a final iteration of the app was developed for further testing.

The gamified aspect of the Zingo app revolved around looking after a digital pet, and incorporated incentives earned by completing the prescribed therapy activities. The parents in the study showed support of the model.

“I think the pet idea would be the most exciting...so the idea of looking after a pet, ’cause [children with disabilities] tend to be more nurturing, the ones that I’ve met,” said a parent.

“I’d go with pets as well,” said another parent. “So, I’ve got two girls and they play a lot of games involving pets, so ‘Animal Jam’ is one of them...my one daughter she’s 12, who’s got a disability, but she loves this game...I think she likes the characters and she likes the fact that you can change them, they can evolve over time.”

The parents also alluded to a digital pet being a better choice compared with an animated child avatar due to potential challenges surrounding the child’s self-perception. According to the parents, some children may not be able to identify with an avatar who presents as able-bodied if the child has a visible disability, or an avatar with a dramatized visual indicator of a disability if the child has a mild disability or one that cannot be seen. One parent noted her child does not like to look at themself in the mirror, which adds to their support of the digital pet model.

The parents also suggested the idea of updates from the app to the parents on their child’s progress in performing activities at school.

In the prototype testing group, the children showed enthusiasm towards the app and using the therapies prescribed to them.

App quality testing was measured by the user version of the Mobile Application Rating Scale, completed by children using the app. Out of a highest possible score of 5, evaluations yielded mean (SD) scores of 4.5 (0.8) for engagement, 3.3 (1.6) for function, 3.3 (1.7) for aesthetics, and 4.3 (1.1) for subjective quality.

“A strong user-centred design process, as outlined here, with testing and feedback at multiple stages was important for adapting the app outcome to best suit the needs of the users and could be effectively used in future mHealth app development projects,” the authors wrote. “We recommend that other methods for user testing with younger children with disabilities be explored in future studies.”


Johnson RW, White BK, Gucciardi DF, Gibson N, Williams SA. Intervention mapping of a gamified therapy prescription app for children with disabilities: user-centered design approach. JMIR Pediatr Parent. 2022;5(3):e34588. doi:10.2196/34588

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