This randomized controlled trial evaluates the effectiveness of a "Gamified Tai Chi" intervention on improving executive functions (such as inhibitory control, working memory, and cognitive flexibility) in children with Autism Spectrum Disorder (ASD). The study aims to determine whether integrating game mechanics (based on the Mechanics, Dynamics, and Aesthetics framework) into Tai Chi training offers superior benefits compared to traditional Tai Chi training or routine care. Approximately 200 children aged 8-15 years will be randomly assigned to one of three groups for a 12 months period: Gamified Tai Chi Group: Participants will attend sessions combining simplified Tai Chi forms with interactive tasks, such as digital chasing games and cooperative challenges, using a point-based reward system to enhance engagement. Traditional Tai Chi Group: Participants will learn the same Tai Chi movements but via standard instruction methods without gamification elements. Control Group: Participants will continue their routine rehabilitation or physical education classes (Waitlist design). Assessors who are blinded to group allocation will evaluate outcomes at baseline and post-intervention using standardized cognitive tasks (e.g., Flanker task, 1-back task) and behavioral questionnaires regarding social functioning and daily living skills.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
100
Participants will receive a 12 months Gamified Tai Chi intervention (3 sessions/week, 45 mins/session). The intervention integrates the MDA (Mechanics, Dynamics, Aesthetics) framework and exergaming elements into traditional Tai Chi movements to target executive functions.
Participants will receive a 12 months standard Traditional Tai Chi training (3 sessions/week, 45 mins/session). This group performs the same physical movements as the experimental group but without any gamification, scoring systems, or interactive game scenarios.
Chaozhou Special Education School
Chaozhou, Gaungdong, China
Change in working memory measured by the 1-back task
Working memory is assessed with a computerized 1-back task. Outcomes are mean accuracy and mean reaction time, together with d' as an index of perceptual sensitivity; the 1-back d' is the principal working-memory index. Higher accuracy and higher d' indicate better working-memory performance.
Time frame: Baseline, week 8, week 16, and week 24 (8 weeks after the end of the 16-week intervention)
Change in inhibitory control measured by the Flanker task
Inhibitory control is assessed with a child-adapted computerized Flanker task. Outcomes are mean accuracy and mean reaction time in each condition and the Flanker conflict effect (the incongruent-minus-congruent difference in reaction time or error rate). Higher accuracy and a smaller conflict effect indicate better inhibitory control.
Time frame: Baseline, week 8, week 16, and week 24 (8 weeks after the end of the 16-week intervention)
Change in cognitive flexibility measured by the Dimensional Change Card Sort (DCCS) task
Cognitive flexibility is assessed with a computerized Dimensional Change Card Sort (DCCS) task in which children first sort cards by color and then by shape after the rule changes. Outcomes are mean accuracy and mean reaction time and the switch cost (the change in performance after the rule switch). Higher accuracy and a smaller switch cost indicate better cognitive flexibility.
Time frame: Baseline, week 8, week 16, and week 24 (8 weeks after the end of the 16-week intervention)
Change in restricted and repetitive behaviors measured by the Repetitive Behavior Scale-Revised (RBS-R)
Description: Restricted and repetitive behaviors are assessed with the caregiver-rated Repetitive Behavior Scale-Revised (RBS-R), covering stereotyped, self-injurious, compulsive, ritualistic, and sameness behavior and restricted interests. Each item is scored 0-3, and subscale scores and a total score are derived; the RBS-R total score is the main outcome. Higher scores indicate more prominent restricted and repetitive behaviors.
Time frame: Time Frame: Baseline, week 8, week 16, and week 24 (8 weeks after the end of the 16-week intervention)
Change in aberrant behaviors measured by the Aberrant Behavior Checklist (ABC)
Autism-related problem behaviors are assessed with the caregiver-rated Aberrant Behavior Checklist (ABC), comprising five subscales: irritability, social withdrawal, stereotyped behavior, hyperactivity and noncompliance, and inappropriate speech. Each item is scored 0-3, and subscale scores and a total score are derived; the ABC total score is the main outcome. Higher scores indicate more severe problem behaviors.
Time frame: Baseline, week 8, week 16, and week 24 (8 weeks after the end of the 16-week intervention)
Change in emotion regulation difficulties measured by the Difficulties in Emotion Regulation Scale (DERS)
Description: Difficulties in emotion recognition, acceptance, and regulation are assessed with the caregiver-rated Difficulties in Emotion Regulation Scale (DERS), with subscales for nonacceptance, goal-directed behavior, impulse control, emotional awareness, access to regulation strategies, and emotional clarity. Subscale scores and a total score are derived; the DERS total score is the main outcome. Higher total scores indicate greater difficulties in emotion regulation.
Time frame: Baseline, week 8, week 16, and week 24 (8 weeks after the end of the 16-week intervention)
Change in overall strengths and difficulties measured by the Strengths and Difficulties Questionnaire (SDQ)
Psychological and behavioral problems are assessed with the caregiver-rated Strengths and Difficulties Questionnaire (SDQ), comprising emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior subscales. The total difficulties score (sum of the emotional symptoms, conduct problems, hyperactivity, and peer problems subscales) is the main outcome. Higher total difficulties scores indicate greater difficulties, whereas higher prosocial behavior scores indicate more positive social behavior.
Time frame: Baseline, week 8, week 16, and week 24 (8 weeks after the end of the 16-week intervention)
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