Gamified Therapy PDT offers high support for children with neurodevelopmental disorders

A digital pet app used as Prescription Digital Therapy (PDT) to encourage children to follow prescribed therapies has received high engagement and function scores from children living with neurodevelopmental disorders.

According to a study published in JMIR Pediatrics and parenthood reported.

The mobile health (mHealth) application, Zingo, was designed to promote therapeutic activities for children aged 6 to 12 living with neurodevelopmental disorders. Although the study authors found it suitable for children with a wide range of neurodevelopmental disabilities, including cerebral palsy and autism spectrum disorders, they noted that some children living with more disabilities serious may need additional assistance while using the app.

At the same time, the authors said children might still find the bright colors, pictures of pets, and activity videos more appealing than paper-based therapy programs.

The iterative, user-centered application development model incorporated the first 3 stages of IM: needs assessment, specification of change goal and objectives, theoretical methods and practical applications.

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

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

The fun aspect of the Zingo app revolved around keeping a digital pet and incorporated incentives earned by completing prescribed therapeutic activities. The parents in the study showed their support for the model.

“I think the idea of ​​a pet would be the most exciting…then the idea of ​​caring for a pet, because [children with disabilities] tend to be more affectionate, the ones I’ve met,” one parent said.

“I would also go with pets,” said another parent. “So I have two daughters and they play a lot of games involving pets, so ‘Animal Jam’ is one of them…my only daughter, she’s 12, she has a disability, but she loves it. game… I think she likes the characters and she likes the fact that you can change them, they can change over time.

Parents also hinted that a digital pet was a better choice over an animated child avatar due to potential challenges with the child’s self-perception. According to parents, some children may not be able to identify with an avatar that presents itself 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 slight handicap or one that cannot be seen. One parent noted that their child doesn’t like looking at themselves in the mirror, which reinforces their support for the digital pet model.

Parents also suggested the idea of ​​app updates to parents on their child’s progress in completing activities at school.

In the prototype test group, the children showed enthusiasm for applying and using the therapies prescribed to them.

App quality testing was measured by the user version of the Mobile App Rating Scale, completed by children using the app. Out of the highest possible score of 5, the assessments 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-centered design process, as shown here, with multi-stage testing and feedback, was important in tailoring the app’s outcome to best meet user needs and be able to be used effectively in future mHealth application development projects,” the authors said. wrote. “We recommend that other methods of user testing with young 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 application for children with disabilities: user-centered design approach. JMIR Pediatrician Parent. 2022;5(3):e34588. doi:10.2196/34588

Lance B. Holton